Adrenal gland as a "spreader" site for metastasis

Portal Forums Lung/Thoracic Cancer NSCLC Stage IV NSCLC Adrenal gland as a "spreader" site for metastasis

This topic contains 4 replies, has 4 voices, and was last updated by  Jazz 1 year, 6 months ago.

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March 27, 2013 at 1:42 am  #1255197    

Jazz

I just read a brief article which discusses “sponge” sites versus “spreader” sites for metastasis. It suggests that bone tends to act like a sponge and prevent mets from spreading, whereas the kidneys and adrenal glands foster proliferation of metastases. This is very worrisome, as I have many new bone mets but also a new met on my adrenal gland, and I recall Blue Skies developed one there in the spring…

Here’s the article:

http://www.medicalnewstoday.com/releases/258209.php

Should I consider having the adrenal lesion radiated? Or is that a silly idea?

Thanks,
Jazz


Non-smoker, Dx 6/06 Stage IV Adeno. EGFR+ (exon 19 del), T790m+. Trial: 2cyc Carbo/Doce/Avastin + 2 w/Gem 8 – 12/06; Avastin maint. 1 – 4/07. Alimta + Tarceva 5/07 – 2/09. NED to 8/09. Tarceva 150 9/09-5/11, SBRT/XRS to lung & spine met 2/11. Trial MK2206 (AKT inhibitor) + Tarceva 5 – 12/11. Afatinib+cetuximab trial 2/12 -2/13. LL collapsed. 1/13 PET – new bone & adrenal mets. 4 cyc Carbo-Gem-Tarceva 5/13. Brain MRI 10/13 – clear. Lost Dad to LC 5/13.Anti-PDL1@Angeles Clinic?

March 27, 2013 at 5:07 am  #1255199    

JimC Forum Moderator

Hi Jazz,

Of course it’s not a silly idea, but I’m sure you’re familiar with the “whack-a-mole” problem of radiating mets, and not only does the article present a new, untested theory but it’s also pretty light on details as to why they have come to this model of how tumors metastasize. That process is poorly understood, and at present no one knows why some cancers (even the same type of cancer in different patients) produce mets in some parts of the body, while others go elsewhere. It seems that once the cancer cells enter the bloodstream there are factors we don’t understand which cause them to “stick” in certain places.

For what it’s worth, at diagnosis my wife’s cancer had spread to the pleural (and possibly pericardial) fluid, later spreading to brain, liver and bones throughout her body without ever being detected in her kidney or adrenal gland.

For those unfamiliar with Dr. Pinder’s whack-a-mole analogy, Dr. Weiss provides a link and discussion here: http://cancergrace.org/forums/index.php?topic=7732.msg56960#msg56960

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

March 27, 2013 at 7:27 am  #1255207    

certain spring

Hmmm.
First, these people are mathematicians.
Second, they are relying on autopsy reports from between 1914 and 1943.
Third, it’s worth quoting the journal abstract for the article that resulted from this research:
“The model shows that the combined characteristics of the primary and the first metastatic site to which it spreads largely determine the future pathways and timescales of systemic disease.” [my italics]

http://cancerres.aacrjournals.org/content/early/2013/02/27/0008-5472.CAN-12-4488.abstract


49-year-old non-smoker, dx stage IV NSCLC May 2010 (squamous tumour of the left lung with multiple brain metastases). Radiotherapy to chest and brain; progressed through two cycles carbo/gemcitabine. Repeated lung collapses; pneumonia in collapsed lung, Nov 2010; bronchial stent placed, Dec 2010. Declined second-line Taxotere. Mutation testing Feb 2011, surprise EGFR exon deletion 19. Started Tarceva (150mg), Feb 2011. Progression in liver and elsewhere, May 2013.

March 27, 2013 at 8:57 pm  #1255220    

Dr West

I think certain spring has provided a critical review of the paper. I think it should lead to absolutely no changes in clinical decisions based on this work.

-Dr. West


Howard (Jack) West, MD
Medical Oncologist

Views expressed here represent my opinion, not those of GRACE or Swedish Cancer Institute. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

March 27, 2013 at 11:34 pm  #1255229    

Jazz

Thanks, Jim, CS, and Dr. West. The premise did seem a bit thin, but I try to keep an open mind. There are so many new and intriguing ideas… perhaps I’ve been watching too many “Through the wormhole” shows (listening to all those theoretical physicists and mathematicians). I’m probably searching for control in an out-of-control situation. I imagine my oncologist wouldn’t radiate my adrenal gland anyway, not even for the sake of palliation. Not only am I familiar with whack-a-mole (or whack-a-gopher, right now), I’ve participated in the radiate-oligo-mets game. And that very one (T8) is back, dadgummit!

I worry about those adrenal glands…but I also have a zillion bone mets – many of which are new. I was not on a bisphosphonate for 8 of the months I was on afatinib-cetuximab. Perhaps the bone disease wasn’t as well-controlled as the areas under surveillance (target lymph node and measurable soft tissue tumors), or there was very rapid, aggressive progression as soon as resistance set in.

As an update, 2 cycles of Carbo-Gemzar-Tarceva are done. 3/25 CT scan “stable” as compared to January; bone scan shows mets to skull, ribs, spine… next appointment April 1. Probably will stay the course. Heading to UCLA to consult, get on wait list for CO-1686, around 4/10. One trial participant (at Stanford) had 25% shrinkage at first 6-week scan and is due for 2nd scan soon. He has no side effects. Another participant, on study since December, had dose increase – 900mg to 1200mg and experienced pericarditis; is unsure if related. She’s stable and had some muscle aches. I’m really starting to wonder how long it’s going to take to find MTD!

Thanks again to the GRACE brain trust. Thank goodness for all the critical thinking going on here! It appears my skills in that arena were left at the last bus stop…

Love to all,

Jazz :)


Non-smoker, Dx 6/06 Stage IV Adeno. EGFR+ (exon 19 del), T790m+. Trial: 2cyc Carbo/Doce/Avastin + 2 w/Gem 8 – 12/06; Avastin maint. 1 – 4/07. Alimta + Tarceva 5/07 – 2/09. NED to 8/09. Tarceva 150 9/09-5/11, SBRT/XRS to lung & spine met 2/11. Trial MK2206 (AKT inhibitor) + Tarceva 5 – 12/11. Afatinib+cetuximab trial 2/12 -2/13. LL collapsed. 1/13 PET – new bone & adrenal mets. 4 cyc Carbo-Gem-Tarceva 5/13. Brain MRI 10/13 – clear. Lost Dad to LC 5/13.Anti-PDL1@Angeles Clinic?

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