immunotherapy and swelling
i would like to have technichal info ,i have often read that immunotherapy is inducing swelling of the tumours.therefore the doctors doesnt do scan before the swelling is gone .
My question is how can we explain the swelling? why is it seen only in immunotherapy and not in the others types of treatment like radiation or chemo or else?
thanks in advance
The current immunotheraphies seem to act via pro inflammatory mechanisms that may be at the origin of the swelling. This is somehow against the expectation that inflammation is not the right direction in fighting cancer. However, I read some studies indicating that the combination of immunotherapy with angiogenesis inhibitors can suppress the typical growth that is triggered by immunotheraphy alone. I am sure you will find such studies if you are going to search for them. As you know, on this website we discussed various angiogenesis inhibitors that may be used next to immunotheraphies.
To my knowledge, such reactions are seen also following chemo or other effective treatments. My believe is that, if following such inflammation there are no effective treatments used, it may lead to faster growth.
i ve found this interesting summary on how pdt activate the immune system while creating inflammation in tumours area
This article has a good summary, along with images even showing progression over the course of months in some cases, only to be completely eliminated.
"The third pattern is a delayed tumor response to treatment after an initial increase in tumor burden that manifests as an increase in tumor size. This initial increase in tumor size is thought to reflect a continued increase in the size of the tumor while the body mounts a sufficient immune response and/or a transient increase in tumor size that results from immune cell infiltration of the tumor with or without edema. Both explanations were confirmed with results of tumor biopsy."
"The fourth pattern of response is the appearance of new lesions after the completion of treatment that precede a decrease in tumor burden at subsequent follow-up examinations. The appearance of new lesions may represent an interval increase in the size of micrometastases that were initially too small to be visualized at imaging. These micrometastases become larger and are detectable at posttreatment imaging as a result of immune cell infiltration of the tumor."
I think there is a growing number of people who believe that certain aspects of the immune system actually aid in metastasis and growth of tumours. This is just my guess, but the initial growth in the tumour may be from these aspects of the immune system aiding in the growth and sustenance of the tumour, at least in the short term. I'm not entirely sure of the mechanism behind why this would happen but the post in the "Surgery" section of this forum about the use of NSAIDs might be of use here.
My husband is in on immunotherapy drug trial at MPH. He was diagnosed with peritoneal mesothelioma 2.5 years ago. Done HIPEC debulking operation, grew back. Did 6 & 6 Chemo. Grew back. Is in immunotherapy trial using LAG525 & PDR001. Round 7, & in the last 2 weeks his belly started swelling up. Went in to get fluid drained as docs thought it may be that, but ultrasound showed all tumour, not fluid. Shit.
Up until now tumours were stabilizing or shrinking. Now this. We have learned we need to do a lot of our own research as his disease is not researched. Am reading reports U posted here. Since it is all still experimental, especially with his disease, looking for answers why the sudden increase in tumour mass & possible exploration for where to go from here. Like threading eyes of needles through this journey.
I am very sorry to hear about your difficult experience with the treatments. I understand now your husband is on the combo of a anti PD1 drug from Novartis + LAG525 There are many combos of this type in trials involving anti-PD1 or anti-PDL1 + other checkpoint inhibitors and the truth is that in general the treatments directly interfering with the immune cells are not well understood by humanity. So it is challenging to anticipate what could go wrong. That is why I would use mainstream immuno therapy only when there is no other option left. However, what is known is that most of these approaches first lead to inflammatory reactions that may in turn lead first to tumor grow before a possible reduction. To avoid the first stage of growth, what has been suggested in literature is to use at the same time angio-genesis inhibitors such as but not limited to those discussed here https://www.cancertreatmentsresearch.com/category/angiogenesis-inhibitors/ Of these some of the most powerful I discussed are Thalidomide, Taurolidine and TM. Thalidomide and Taurolidine can act faster while TM requires several months until the conditions required for it's actions are met. I checked, and Taurolidine seems to have been suggested to be effective against mesothelioma https://www.cancertreatmentsresearch.com/taurolidine/ The treatment can be accessed at several clinics in Germany. I do know patients who strongly responded to this treatment and others who did not. Beyond this, you can use "mesothelioma" as a keyword to search for other ideas on this website. Even if "mesothelioma" is not mentioned, most of the treatment options discussed here are from angles such that the cancer types matter less. If you have specific questions related to the content shared here please let me know.