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Stage 4 Cancer

Stage 4, Stage IV metastatic cancer

“Metastases cancer” or stage 4 cancer, is the medical term for describing a condition where a tumor originating in a certain organ, “primary tumor”, is identified in another organ or in a distant location from the original organ, e.g., metastases of breast cancer can be found in the lungs, brain, bones and liver.

It is important to note, metastases are the same type of the original primary tumor, even if its location is in distant organs and so are the treatments regarded as such, for example, a treatment for a metastatic lung cancer that has spread to the liver, is determined by the treatment for metastatic lung cancer and not by the treatment for liver cancer.

Metastases formation

Cancer cells of the primary tumor can be released into the bloodstream and lymphatic system and circulate to distant organs or adjacent organs and tissues to the primary tumor and “settle” in them and grow.

There are different types of cancer which is known where metastases can be formed, for example,

  • Breast cancer can spread to the bones, brain, liver and lungs
  • Lung cancer can spread to the brain, bones, liver and kidney
  • Prostate cancer can spread to the bones
  • Colon cancer, rectal cancer, colorectal cancer can spread to the liver and lungs
Breast cancer can spread to the bones, brain, liver and lungs
Breast cancer can spread to the bones, brain, liver and lungs

Stage IV metastatic cancer and recovery

In the vast majority of the metastatic cases, the treatments do not cure. Treatment goals are slowing tumor growth rate, prolonging life and reducing the symptoms of the disease, improving the quality of life of the patient.

The efficacy of the treatments is affected by many factors, among them are the type of cancer, number of metastases (also called “lesions”) and their location, how much cancer the patient has in his or her body, growth rate of the tumor lesions, medical history of the patient, background diseases, microenvironment between the tumor cells themselves, resistance the tumor has developed to previous treatments and other.

Advanced treatments and clinical trials for stage 4

The National Cancer Institute (NCI) highlights the fact that for a certain group of metastatic cancer patients, the best treatment option is to join one of the many clinical trials existing worldwide aiming to increase their chances of therapeutic success.

This is also recommended by the USA national comprehensive cancer network, NCCN,  (USA national comprehensive cancer network)

“Patients with cancer should be encouraged to participate in clinical trials during all aspects of their diagnosis and treatment”

Currently, every patient will be offered the standard protocols described above. Sometimes the oncologist may suggest integrating these therapies with trials carried out in the Institute.

Advances in cancer therapies may be found in clinical trials prescribing cutting edge, interesting drugs, some of which have already been recognized by the FDA (US Food & Drug Administration) as “breakthrough treatments” and require further information input before being finally and fully approved.

An entire world of clinical trials and compassionate drugs and treatments are open and available worldwide. It is important to know which cutting edge treatments exist which patients can gain far more from them than the standard care offered.

For most patients with stage 4 metastatic cancer, current treatments are insufficiently effective. This gives rise to the need for innovative strategies with greater efficacy in fighting the disease.

Read our publications on innovative treatments for stage 4 metastatic cancer:

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What is “Hyperprogression” in metastatic lung cancer?

Recently, on September 6, 2018, it was published in one of the world’s most prestigious medical journals, the JAMA, a very worrisome article presenting the results of a study conducted at eight leading medical centers in France, including the leading cancer center in Europe, Gustave Roussy.

What is “Hyperprogression”?

Hyperprogression is the accelerated progression of cancerous tumors following treatment the patient receives.

The study examined Hyperprogression in patients with advanced lung cancer and metastatic lung cancer patients, stage 4, who were treated with immunotherapy.

Although immunotherapy has revolutionized the treatment of lung cancer and other cancers, doctors have noticed that immunotherapy is harmful to some patients to the extent that there are more deaths with immunotherapy than chemotherapy!

Doctors believe that immunotherapy can cause accelerated growth of cancer, and this is based on earlier publications.

The study compared 406 metastatic lung cancer and stage 3 and 4 patients, who were treated with immunotherapy to 59 stage 3 and 4 lung cancer patients who received chemotherapy for their disease.

Results showed that 14% of patients treated with immunotherapy experienced Hyperprogression compared with 5% of patients receiving chemotherapy.

Hyperprogression occurred mainly in stage 4 metastatic lung cancer patients with over 2 metastases.

The researchers of this work claim that if they included in their calculations patients who developed new metastases under treatment, patients who had unmeasurable metastases, for example, bone metastasis and very deteriorated patients, the percentages in both immunotherapy and chemotherapy were even higher!

All patients received second treatment for their advanced disease, “second line”. For a lung cancer patient who developed Hyperprogression, life expectancy was only 3.8 months, compared to 6.2 months in a lung cancer patient who did not develop Hyperprogression.

The problem is that there is currently no marker to predict which patients may develop Hyperprogression under immunotherapy and who may not. Therefore, after starting immunotherapy, it is recommended to do CT faster than normally done and if there is Hyperprogression, replace treatment immediately.

In addition, combination of chemotherapy plus immunotherapy in patients with stage 4 lung cancer, seem to prevent the development of Hyperprogressions in the high percentages observed in the study.

On the other hand, if that’s the case, we did not get rid of chemotherapy and that is one of the goals of immunotherapy, as long as it proves to be better.

Read the article:

https://jamanetwork.com/jo…/jamaoncology/fullarticle/2698845

To hear a podcast discussing the results of the study:

https://jamanetwork.com/learning/audio-player/16733676

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Improving therapeutic success, extending life and quality of life are our main business. We extend to metastatic cancer patients and patients with brain tumors, the most advanced treatment options in the world and the best experts in Israel and abroad.

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