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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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Bladder Cancer – Padcev Plus Keytruda in 1st Line

BACKGROUND

Cisplatin-based combination chemotherapy remains the standard of care for locally advanced or metastatic bladder cancer.

However, toxicity is substantial, responses are rarely durable, and many locally advanced or metastatic patients are ineligible.

Padcev and Keytruda have each shown a survival benefit versus chemotherapy in Bladder Cancer, are not restricted by cisplatin eligibility, and warrant investigation as a first-line combination therapy in patients ineligible for cisplatin.

WHAT IS PADCEV?

Padcev, also called Enfortumab Vedotin, is an antibody-drug conjugate used for the treatment of bladder cancer.

The most common side effects include fatigue, peripheral neuropathy, decreased appetite, rash, alopecia (hair loss), nausea, altered taste, diarrhea, dry eye, pruritus (itching) and dry skin.

The U.S. Food and Drug Administration (FDA) considers it to be a first-in-class medication.

WHAT IS KEYTRUDA?

Keytruda, also called Pembrolizumab, is a humanized antibody used in cancer immunotherapy that treats melanoma, lung cancer, head and neck cancer, Hodgkin lymphoma, stomach cancer, cervical cancer, and certain types of breast cancer.

Common side effects include fatigue, musculoskeletal pain, decreased appetite, itchy skin (pruritus), diarrhea, nausea, rash, fever (pyrexia), cough, difficulty breathing (dyspnea), constipation, pain, and abdominal pain.

It is a type of antibody that blocks a protective mechanism of cancer cells and thereby, allows the immune system to destroy them.

It targets the PD-1 receptor of lymphocytes.

Keytruda was approved for medical use in the United States in 2014. In 2017, the US Food and Drug Administration (FDA) approved it for any unresectable or metastatic solid tumor with certain genetic anomalies.

It is on the World Health Organization’s List of Essential Medicines.

METHODS

In this Phase 1b/2 study, first-line cisplatin-ineligible locally advanced or metastatic patients received Padcev 1.25 mg/kg (Days 1 and 8) and Keytruda 200 mg (Day 1) intravenously in 3-week cycles.

RESULTS

Forty-five patients received Padcev plus Keytruda. The most common treatment-related side effects were peripheral sensory neuropathy, fatigue and alopecia.

Twenty-nine patients had difficult side effects. The most common were increased lipase, maculopapular rash and fatigue.

One death was associated with the treatment.

73.3% of patient benefited from the treatment experiencing a decrease in lesions’ size. In these patients the median Survival was 25.6 months.

15.6% of patients had complete remission. In these patients the median Survival was 26.1 months.

CONCLUSIONS

Padcev plus Keytruda showed a manageable safety profile.

Most patients experienced tumor shrinkage.

The median Survival exceeded 2 years in a cisplatin-ineligible patient population make this a promising combination.

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Bladder Cancer - Padcev Plus Keytruda in 1st Line
Bladder Cancer – Padcev Plus Keytruda in 1st Line

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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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