“A Hackathon (Molecular Tumor Board) for Advanced Prostate Cancer Patient and Cancer Researcher Dr. Elliot Davis”
Featuring: Molecular Tumor Board
Watch on Cancer Patient Lab YouTube
Ask Navis about this
Molecular Tumor Board
“A Hackathon (Molecular Tumor Board) for Advanced Prostate Cancer Patient and Cancer Researcher Dr. Elliot Davis” [#114] Brad Power and Gabrielle Ruvinsky September 25, 2024 “I'm at the point where chemotherapy is losing effectiveness, although it still works somewhat. The PSA goes down when I get the treatment, then it goes up again.
” – Elliot Davis “You're in a position now that I think you need to go to a cancer center that has a lot of trials, like ours, Sloan Kettering, Mount Sinai, Johns Hopkins, Fred Hutchinson, UCSF, something like that, where you're going to have access, and not only access, you're going to have doctors that are going to think outside.
Because I know what trials we have here, but I have access to those other doctors, so that when I see them next week at one of the conferences, I'm going to be like, ‘Hey, I got this patient. Do you have a trial for him? Here's his lines of treatment.’ That's what you need.
” – Sumit Subudhi, MD, PhD, MD Anderson Meeting Summary Advanced cancer patients often have relatively easy decisions at diagnosis. There is a standard treatment -- maybe surgery, chemotherapy, or radiation, or some combination -- with a high success in getting a complete response. Increasingly the treatment landscape may also include drugs that are targeted to your unique genetic mutations.
If you're lucky, there is an immunotherapy with a high response rate and durable response. But as the options increase, your treatment selection decision gets more difficult. Newer treatments have less of a long-term track record. And the more rounds of treatment you receive, the more complicated the decisions about your next treatment become. Dr. Elliot Davis is in a predicament.
He is a stage 4 (metastatic) prostate cancer patient, who has been battling the disease for over eleven years. He is 79, and was diagnosed when he was 69. He is on his seventh line of treatment in eleven years. His PSA has been in the 0 to 400 range, but is now in the 5 - 15 range. His metastatic lesions are probably mostly in his bones, which are painful and hard to biopsy.
After getting Pluvicto (a new drug that grabs onto prostate cancer cells and delivers a radioactive payload), the cancer spread to his liver. However, the liver tumor was resolved after switching to cabazitaxel (a chemotherapy treatment used to treat advanced prostate cancer that has spread to other parts of the body), and it seems it may be losing effectiveness.
It is awful stuff, with terrible side effects. He also is getting Orgovyx (Relugolix) which lowers testosterone. He probably will soon have to try some less standard therapy. The treatments have sequentially provided relief for less and less time. Why is Elliot’s treatment decision difficult? Prostate cancer has benefited from a continuous stream of available treatment options.
treatments have sequentially provided relief for less and less time. Why is Elliot’s treatment decision difficult? Prostate cancer has benefited from a continuous stream of available treatment options. For example, “radioligands” which bind to unique receptors on prostate cancer cells have become available in the last two years.
But these new therapies add to the complexity of choosing those treatments. Some advanced cancer patients find that they don't get durable responses from any treatments, and their condition continues to deteriorate. They need to identify new treatment options while also dealing with side effects, weakening health, and blows to their resiliency.
How have others made these complex treatment decisions?
“A Hackathon (Molecular Tumor Board) for Advanced Prostate Cancer Patient and Cancer Researcher Dr. Elliot Davis” [#114] Our spiritual founder of the Cancer Patient Lab, Bryce Olson, faced a similarly difficult decision in December 2020.
Bryce told his friend Brad Power that after seven years and eight rounds of therapy for his metastatic prostate cancer, he had hit a wall and feared that he had run out of treatments that had a chance of knocking down his cancer.
As cancer patients like Bryce try more and more lines of therapy, they look less and less like other patients, and they get farther away from treatments that have solid evidence to support them. In January 2021, the urgency for finding a solution increased as Bryce’s prostate-specific antigen (PSA) test (a measure of the activity of the prostate cancer) spiked up.
By mid-January he also presented with radiographic progression as measured by novel (“PSMA-PET”) scans at UCLA along with conventional imaging at UCSD – all indicating that his cancer was being more aggressive. Brad suggested that they could organize a hackathon – a collective effort to find out what was driving Bryce’s cancer and stop it.
By engaging a broad community of experts with diverse experience, they hoped to identify new molecular drivers and biomarkers along with treatment options that could complement ideas from Bryce’s extremely talented oncologist. Their goal: Get Bryce his next treatment in a couple months.
Bryce put his extensive medical data and reports in a cloud repository and permissioned access to anyone who wanted to review it. The collaborative effort achieved its goal to help Bryce and his medical team decide on his best next treatment. The PSMA-targeted radionuclide therapy which was chosen was not on Bryce’s list of treatment options going into the hackathon.
The main benefit of the hackathon to Bryce and his medical team was greater confidence in that selection, and the consideration and upgrading or downgrading of other options, which may be useful if a next round of treatment is needed. What was the advice that Elliot received regarding his decision on his next treatment?
hackathon to Bryce and his medical team was greater confidence in that selection, and the consideration and upgrading or downgrading of other options, which may be useful if a next round of treatment is needed. What was the advice that Elliot received regarding his decision on his next treatment?
●Get advice from a specialist on his specific cancer at an academic research medical center ●Try a medical grade probiotic to help with the weight loss caused by chemotherapy (cabazitaxel) ●Find a clinical trial under a solid, knowledgeable genitourinary medical oncologist ●Identify the type of cancer in the body to get the best treatment possible for that type ●Introduce platinum therapies with the cabazitaxel How can you learn more?
●You can reach Elliot Davis at elliot@cancerantibodies.com . ●To learn more about prostate cancer treatment options, please see our discussions with Dr. Oliver Sartor here and Dr. Sumit Subudhi here. ●Elliot also runs a non-profit cancer research institution Cancer Antibodies Inc. (CAI).
Recently they made breakthroughs in breast cancer and prostate cancer targeted immunotherapy which were presented at ASCO and AACR. For prostate cancer, they isolated a variety of antibodies that bound to prostate cancer cells while not binding to normal cells. For breast cancer, they identified a novel biomarker that exists only on the surface of breast cancer cells.
Antibodies against this target were complexed with toxic drugs (ADCs) which then selectively killed the cancer cells. An overview of their research is available here: https://docsend.
“A Hackathon (Molecular Tumor Board) for Advanced Prostate Cancer Patient and Cancer Researcher Dr.
Elliot Davis” [#114] The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Cancer Patient Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action.
You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health.
“A Hackathon (Molecular Tumor Board) for Advanced Prostate Cancer Patient and Cancer Researcher Dr.
ey (12%), Joe Davis (6%), Frank Nothaft (2%), Brad Power (2%) CHAT CONTRIBUTORS Sumit Subudhi, Rick Davis, Brad Power, Robb Owen, Brian McCloskey, Frank Nothaft, David Plunkett, Chad Magnussen SUMMARY Elliot Davis, a stage four metastatic prostate cancer patient, discussed his treatment journey, including seven lines of therapy and the current ineffectiveness of cabazitaxel.
His PSA levels have risen despite treatment, and he seeks alternative treatments or clinical trials. The community suggested maintaining health through probiotics and calorie counting. Genetic testing revealed low-frequency ATM and BRCA1 mutations, which are not actionable. Dr. Subudhi recommended a clinical trial or platinum-based chemotherapy.
Elliot's liver biopsy results showed metastatic prostate adenocarcinoma. The discussion emphasized the need for a knowledgeable oncologist and explored potential treatments like PARP inhibitors and bispecifics. OUTLINE Elliot Davis' Cancer Journey ●Elliot Davis describes his cancer journey, starting with his initial diagnosis 11 years ago and the various treatments he has undergone.
●He mentions the effectiveness of cabazitaxel initially but notes its declining efficacy and the severe side effects. ●He shares a graph showing his PSA levels over time, indicating the rising PSA despite treatment. ●He expresses a desire to find alternative treatments or participate in a clinical trial.
Community Insights and Suggestions ●Brian McCloskey opens the floor for questions and suggestions from the community. ●Dr. Subudhi asks for a list of Elliot's prior therapies, which Elliot provides. ●Dr. Subudhi and other participants discuss the importance of maintaining health during treatment and the potential benefits of medical-grade probiotics. ●Dr.
Subudhi suggests that Elliot consider a clinical trial or alternative treatments, emphasizing the need for a solid genitourinary medical oncologist.
“A Hackathon (Molecular Tumor Board) for Advanced Prostate Cancer Patient and Cancer Researcher Dr. Elliot Davis” [#114] Genetic Testing and Mutations ●Elliot shares his genetic test results from Foundation One, showing ATM and BRCA1 mutations. ●Dr. Subudhi and other participants discuss the significance of these mutations and the potential for PARP inhibitors.
●Frank Nothaft suggests retesting the genetic sample to see if the allelic fractions have changed. ●Dr. Subudhi and Rick Davis discuss the importance of having a knowledgeable oncologist and the potential benefits of PARP inhibitors for certain mutations. Treatment Options and Clinical Trials ●Dr.
Subudhi emphasizes the need for Elliot to see a clinical trialist and discusses the potential benefits of clinical trials. ●Elliot expresses concerns about the effectiveness of cabazotaxel and the need for a break from treatment. ●Dr. Subudhi suggests adding carboplatin to cabazotaxel or considering a clinical trial as a backup plan. ●Rick Davis and Dr.
Want to learn more about your specific case?
Upload your medical records and ask Navis questions tailored to your diagnosis.