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5 april 2019: lees ook dit artikel: 

https://kanker-actueel.nl/vrouw-van-29-jaar-met-triple-negatieve-borstkanker-stadium-iv-komt-in-complete-remissie-door-aanvullend-op-chemo-persoonlijke-voedingsadviezen-kytogeen-dieet-hyperthermie-en-hyperbare-zuurstoftherapie.html

3 april 2019: Bron: International Journal of Hyperthermie

Patiënten met gevorderde niet-kleincellige longkanker (stadium IV) blijken veel baat te kunnen hebben bij aanvullend op chemo (carboplatin / paclitaxel ) een combinatie van hyperthermie, een persoonlijk voedingsprogramma op basis van het kytogene dieet en hyperbare zuurstoftherapie. Maar liefst 61,4 procent van de 44 deelnemende patienten reageerde met een complete remissie of een gedeeltelijke remissie (50 procent of meer). Slechts 22 procent had progressieve ziekte dus bij die patiënten had de aanpak geen succes. 15 patienten overleden voordat de 5-jarige studie eindigde maar 29 patienten waren nog in leven waarvan een aantal met progressievrije ziekte.  

Meadiane overall overleving (OS)  was 42.9 maanden (95% CI: 34.0–51.8) en progressievrije overleving (PFS) 41.0 maanden (95% CI: 31.1–50.9) wat extreem lang is voor deze groep van longkankerpatienten. De studie duurde van maart 2010 tot juni 2015. Het studierapport werd 1 april 2019 gepubliceerd.

Bijwerkingenprofielen per individuele patiënt waren goed te controleren aldus de onderzoekers.

Ik moet wel zeggen dat alle patienten heel intensief werden behandeld want om naast chemo ook hyperthermie te geven is heel gemakkelijk te doen. Maar voor elke patient werd ook een voedingsadvies samengesteld gegeven op basis van haar / zijn persoonlijke lichamelijke gestelheid op basis van het kytogeen dieet. En daarnaast kregen alle patienten ook nog eens sessies met hyperbare zuurstoftherapie. Maar het blijkt dus zeer de moeite waard te zijn gezien de mediane overall overleving van voor een aantal patienten langer dan 5 jaar. Zelfs uitzaaiingen in de hersenen waren geen contra indicatie, in tegendeel sommige patienten leven al langer dan 5 jaar daarmee. Wel was het zo hoe slechter de lichamelijke gestgeldhied hoe minder de resultaten. Zie Figure 3

Deze opmerkelijke studieresultaten (mediane overall overleving was zelfs beter dan voor immuuntherapie met atezolizumab bv.) werden afgelopen week gepresenteerd in het International Journal of Hyperthermie.

Hier de resultaten zoals gepresenteerd in het volledige studierapport: 

Feasibility study of metabolically supported chemotherapy with weekly carboplatin/paclitaxel combined with ketogenic diet, hyperthermia and hyperbaric oxygen therapy in metastatic non-small cell lung cancer dat gratis is in te zien inclusief grafieken van de karakteristieken van de patienten.

Survival estimates

At the end of 8 cycles of treatment, 42 out of 44 patients (95.4%) were alive and had completed 8 cycles of treatment. Two patients died after receiving 3 cycles of treatment. At the termination of follow-up (15 January 2016), 29 patients were alive (65.9%). Mean overall survival (OS) was 42.9 months (95% CI: 34.0–51.8). Corresponding figure for progression-free survival (PFS) was 41.0 months (95% CI: 31.1–50.9).

Table 3 shows mean survival rates (OS and PFS) by patient characteristics. A higher ECOG status (ECOG ≥2) was associated with worse OS (33.0 vs. 63.9 months, p = .009) and PFS (29.4 vs. 63.4 months, p = .009). On the other hand, age, histology, presence of brain metastasis and smoking had no effect on survival outcome. Figure 3 shows Kaplan–Meier curves for OS. In addition, a subgroup analysis of patients with available ALK fusion data (n = 29) showed numerically better overall survival (61.2 vs. 34.9 months) and progression-free survival rates (61.1 vs. 30.1 months) for patients with fusion (n = 5) than patients without fusion (n = 24); however, the difference did not reach statistical significance (p = .103 and .085, respectively).

Figure 3. Kaplan–Meier curves for overall survival: (A) all patients; and patients stratified by ECOG performance status (B), age (C), and presence of brain metastasis (D). p values are calculated with Log-rank test. A higher ECOG status (ECOG ≥2) was associated with worse overall survival (Panel B, p = .009). However, older age (Panel C) and the presence of brain metastasis (Panel D) did not have an effect on overall survival outcome (p > .05 for both).

Hier het abstract van deze studie:

Feasibility study of metabolically supported chemotherapy with weekly carboplatin/paclitaxel combined with ketogenic diet, hyperthermia and hyperbaric oxygen therapy in metastatic non-small cell lung cancer

Received 10 Sep 2018, Accepted 27 Feb 2019, Published online: 01 Apr 2019

Background: Previous evidence suggests that metabolically supported chemotherapy (MSCT), ketogenic diet, hyperthermia and hyperbaric oxygen therapy (HBOT) could all target vulnerabilities of cancer cells. This study aimed to evaluate the efficacy and the tolerability of this combination therapy in the treatment of stage IV non-small cell lung cancer (NSCLC).

Methods: Forty-four NSCLC patients with distant metastasis that received MSCT (administration of chemotherapy regimen following induced hypoglycemia) plus ketogenic diet, hyperthermia and HBOT combination were included in this retrospective study. Survival and treatment response rates as well as toxicities were evaluated.

Results: Overall response rate (ORR, complete response plus partial response) was 61.4%; whereas, 15.9% and 22.7% of patients had stable disease (SD) and progressive disease (PD), respectively. Mean overall survival (OS) and progression-free survival (PFS) was 42.9 months (95% CI: 34.0–51.8) and 41.0 months (95% CI: 31.1–50.9), respectively. A higher Eastern Cooperative Oncology Group (ECOG) performance status (ECOG ≥2) was associated with worse OS and PFS. Patients received chemotherapy cycles with acceptable toxicity and adverse events. No problems were encountered due to fasting, hypoglycemia, ketogenic diet, hyperthermia or hyperbaric oxygen therapy.

Conclusions: Findings of this study suggest that MSCT combined with other modalities targeting multiple pathways and cellular vulnerabilities may bring about remarkable improvements in survival outcomes and treatment response rates in metastatic NSCLC, without additional safety concerns. Large comparative studies are warranted to draw robust conclusions.

Referentielijst:

Disclosure statement

No potential conflict of interest was reported by the authors.

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