Page 1 of 1
Flare-up: An often unreported phenomenon nevertheless familiar to oncologists prescribing tyrosine kinase inhibitors
Posted: Sun Apr 08, 2018 5:48 am
by D.ap
Flare-up: An often unreported phenomenon nevertheless familiar to oncologists prescribing tyrosine kinase inhibitors
https://www.tandfonline.com/doi/full/10 ... 0802609574
Re: Flare-up: An often unreported phenomenon nevertheless familiar to oncologists prescribing tyrosine kinase inhibitors
Posted: Sun Apr 08, 2018 5:51 am
by D.ap
From the article above
“Our case is interesting for several reasons. First, we can present radiological evidence for the true existence of “flare-up” in a patient treated with a TKI. Additionally, in a retrospective analysis of 63 metastatic RCC patients treated with sunitinib in our clinical centre, we observed “flare-up” leading to schedule modification and continuous dosing of sunitinib in six patients (9.5%). Our clinical observation is in accordance with pre-clinical studies showing rapid vascular re-growth of tumors after reversal of VEGF inhibition [10] Mancuso MR, Davis R, Norberg SM, O'Brien S, Sennino B, Nakahara Yao VJ, et al. Rapid vascular regrowth in tumours after reversal of VEGF inhibition. J Clin Invest 2006; 116: 2610–21
[Crossref], [PubMed], [Google Scholar]
. This implies that it is unlikely that complete eradication of all cancer cells is achievable and that treatment with TKIs should be continued until disease progression and/or intolerance of treatment. Clear criteria for stopping TKIs should be developed, and the recommendation to continue treatment in the event of progression should be evaluated in prospective trials.
Second, our case illustrates that the timing of radiological assessment in patients treated with discontinuous schemes of TKIs is crucial in order to evaluate accurately the quality and quantity of responses.
The case also highlights potential risks when using TKIs in an adjuvant treatment setting, such as completely resected GIST or RCC. It cannot be excluded that stopping TKIs after a predefined period of time in the context of such therapy might lead to “flare-up” of microscopic residual disease, with detrimental treatment outcome.
In conclusion, oncologists should be aware of the possibility of “flare-up” in patients treated with discontinuous dosing of sunitinib and probably other TKIs. Continuous dosing is a possible option in these patients to prevent “pseudo-progression” and early discontinuation of a possibly life-prolonging drug treatment.
Re: Flare-up: An often unreported phenomenon nevertheless familiar to oncologists prescribing tyrosine kinase inhibitors
Posted: Sun Apr 08, 2018 6:07 am
by D.ap
Our son back in October of 2015, embarked on his first use of medicine to treat his ASPS. It was sutent.
Josh had had a brain tumor at the end of 2014 treated in April of 2015 (LITT), then had a liver ablation in June of 2015 AND then started on sutent —October 2015.
By November , his tumors in his lungs had increase by 4mm over a 7 week period . Granted it was around 5cm prior to the first dose of sutent .
Coughing and some bloodish phlegm followed.
Not to mention he lost additional pounds he could not afford to loose .. went from a year ago of 130 to 114 wet November 2015.
Needless to say , the sutent was discontinued .
However this change pushed us into an incredibly successful immune therapy ( 70% reduction of lung tumors and 139Lbs) , 3 years later . We began June 2016.
http://www.cureasps.org/forum/viewtopic.php?f=82&t=1297
My point , ASPS patients are on these meds just trying to stay ahead of the metastatic game . Some with life threatening tumors .
Let’s please contribute with our knowledge of the pros and cons of our experiences while on these meds , so Asps can become manageable at the very least for all concerned.
Debbie
Link to personals
http://www.cureasps.org/forum/viewtopic ... =135#p8987