case report - scanning shows possible massive progression, surgery finds only necrotic tumor cells

[Olga]

This article was discussed in another forum re. possible abscopal effect caused by surgery in conjunction with the immune checkpoint inhibitors.
Case Series: Abscopal Benefit of Surgery in 3 Immunotherapy-Treated Patients With Unresectable Cancer
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6069027/
Reading the Case 3, I noticed the great description of the problem that was already mentioned by numerous authors re. ICI drugs treatment response evaluation - the scanning findings of the tumor that appears to be progressing under the treatment contradict to the surgical specimens pathology results.
A quote:
"At her first 6-week restaging scan, the patient showed stable disease with an approximately 10% reduction in tumor size. Her second 12-week restaging scan demonstrated significant growth of the paraspinal thoracic mass with apparent encroachment of the spinal canal at the level of T5 even while the rest of her lesions continued to diminish in size (Figure 3). However, most unusually, the patient did not describe any neurological symptoms. In fact, the day before, the patient went for a 3-mile run. Her chief—and only—complaint was back pain for which she took gabapentin (100 mg, PO) and oxycodone (5 mg, PO, PRN). On physical examination, the patient was neurologically intact with normal reflexes, muscle tone, and sphincter functions and negative Babinski signs.
One week later, the patient underwent surgical resection without incident and with postoperative resolution of her back pain. Pathology of the tumor showed the replacement of necrotic tumor cells with collagenous scar. The rest of her lesions continued to diminish in size in the absence of any treatment, possibly due to surgically induced immunogenicity effects."
so basically the scan was showing a massive progression with the back pain but the surgery found only necrotic tissue with the scarring, with the mass effect causing the pain.

[Olga]

Perhaps there was no abscopal effect caused by the surgery, but the tumor specific memory cells were already formed at the time of the surgery and continued to work after the primary tumor was resected. There were cases in melanoma trial when the durable tumor specific response was developed under the ICI treatment as early as the first weeks of treatment, in some people it can happen very quickly and remain in place for a long time without any additional treatment, no surgery or radiation (off any treatment). So once again, it is unclear if lesions continued to diminish in size in the absence of any treatment due to surgically induced immunogenicity effects as they said versus already formed continued strong tumor specific memory cells attack.

[D.ap]

Olga
Good point .

Surgeries - we all heal accordingly to our genetics, born with innate dad and mom predisposition? Then introduced with moms antigens by possible breast milk not to mention make up .
Then adaptive ie environmental exposures and consequently our diets etc .
add to the mix of immune response possibles.
All still NEED to be understood . Especially with sarcomas as we are the minority .


But we need to know and share .👍🏼❤️
Love