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	= The Treatment =		= The Treatment =
		+
		+	First - a little background. I started off with an unconventional treatment that I also came up with myself. But it was in part a copy of a phase 1 study that seemed promising. That treatment involved combining 6 drugs and it was somewhat successful for a while. I had always thought that the immune system was the key but wanted to buy time for the technology to develop.
		+
		+	My oncologist was impressed with the results and it stopped growth for a while. But in April of 2017 scans indicated that the tumors were growing again. That was to be expected. At that point I was out of acceptable options as I am someone who puts quality of life ahead of quantity. My oncologist said if I had any ideas to let him know. 2 days later - I had an idea.
		+
		+	My solution was to start with an infusion of immunotherapy drugs followed by radiation. We chose Ipilimumab (Yervoy) being PD-L1 negative. Ipilimumab had been involved in a lot of abscopal cases. It's an older drug which is likely the reason it has the biggest count. I think it is likely many similar drugs would work as good or maybe better.
		+
		+	2 days after the infusion I get the radiation. The treatment was something I designed and was rather unusual. Rather that trying to kill the tumor with radiation the idea was to burn a hole in the middle of the tumor leaving most of the tumor undamaged. My target tumor was 7.6 cm and the radiation target was about 3 cm in the tumor middle. The idea was to burn a region that was like a hocky puck or small can, a cylinder in the core of the tumor. The size was about 1/3 or less of the tumor volume. This was done with a rectangular beam on a rotating head so that all the beams crossed in the center. The Varian xray machine was set to 9mv and I got 9 gy per fraction and 3 fractions 3 days in a row.
		+
		+	The reason behind this geometry is that by only hitting the center of the tumor, the collateral radiation is still mostly inside the tumor. It is very important to have a large ratio of radiation exposure of cancer tissue to normal tissue and this geometry provided this contrast. And because only the center of the tumor is targeted the total radiation exposure and risk to the patient is greatly reduced.
		+
		+	It is important to understand that we are not counting on the radiation itself to kill the tumor. The goal is to turn the immune system against the cancer and let the immune system do the killing. What we are doing is creating a school inside the tumor so that the immune system will learn the cancer. It is important to understand this is a school and not a battlefield and that the radiologist has to go against their instincts to fry the whole tumor.
		+
		+	It is important that dead cancer be in contact with live cancer to trigger the abscopal response. After the tumor is damaged, but not killed, the tumor will attempt to heal itself. The damage needs to be extensive enough to overwhelm the TILs and require lymphocytes from the outside be brought in to the fight. But when the immune system arrives it finds necrotic cancer, what is called "bad death" and this is a signal to the immune system to classify this tissue as enemy, and the dead cancer exposes its antigens and the immune system picks that up.
		+
		+	4 days after the radiation I came down with a fever of 101. I thought - is this the fever I was hoping for? A fever is caused when the immune system is going after something.

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Revision as of 23:35, 28 October 2017

Introduction

My name is Marc Perkel and I am not a doctor. I am a cancer patient with stage 4 aednocarsonoma of the lung (NSCLC). I have however devised a treatment that seems to have worked taking advantage of the Abscopal Effect. I'm a computer programmer, electronics designer, and I have 45 years of electronic repair experience, all self taught. So solving these kinds of unusual probles is not new to me.

Claiming to cure cancer, especially by a non-doctor, is an extraordinary claim and should be treated as such. However, before you judge who I am or if this is possible, I encourage you to actually read and think through what I propose here on its own merits. I think I'm definitely onto something. Even if this ultimately doesn't work for me I think the fundamental concepts are correct and if this method were tried on 100 people who otherwise have no hope at all, that some of those people would walk away cancer free. And that if this method is tuned and perfected I think it has the potential to cure a wide variety of cancers.

My goal in writing this is to give a step by step instructional manual that is detailed enough that any oncologist can understand and implement. If you are an oncologist who has a patient that you no longer have any treatment for and there's nothing to lose, and you think what you read here makes sense, I encourage you to give it a try. The actual procedure uses standard drugs that are alread commonly used in oncology, and the use of radiation in a way that is a bit unusual, but easier to set up and safer than a normal radiation treatment. The process should involve no discomfort to the patient and will at least not make things worse.

If you are a patient or caregiver and you or someone you care for has no other options, then take this plan to your oncologist and ask for this. If your oncologist refuses and doesn't offer anything better then change oncologists till you get a yes. Even if it doesn't work and you die you are no worse off that you were. And this is experimental and there's no guarantees. However, your success, if you are successful, will inspire more development of the process. I am sure there's a lot of room for improvement.

So - if you will .... read on!

Overview

The Abscopal Effect references a process where cancer patients are effectively cured of cancers, even incurable cancers, because their immune system as learned to recognize the cancer and turned against it. It has been observed for decades retrospectively when it happens. However no one has really figured out why it happens, or more importantly, what to do to make it happen. It seems however obvious to me that figuring out how to reliable trigger the abscopal effect would be a holy grail in the treatment of cancers and therefore a worthy goal, and therefore that's what I set out to do.

Typically the abscopal happens to people getting immunotherapy drugs in combination with radiation. A story starts with someone who starts with chemo, then tries immunotherapy, and nothing is working. Then a lung tumor starts bleeding and they try some palliative radiation to stop the bleeding, and instead of dying, the patient starts getting better. Not only does the irradiated tumor die, but all other cancer in the body dies as well. But this is rare and it takes a long time to really figure out that it happened.

I looked at the problem more like an engineer and a troubleshooter. As anyone with my job will tell you, often you can fix things without really knowing anything about the device you are fixing. It's more about patterns and processes and persistence, and that solutions don't always come from the places you would expect. So even though figuring this out was a long shot to the extreme, as Elon would say, "success was at least one of the possible outcomes."

In cases where the abscopal effect was triggered, what was the common conditions. What is the abscopal effect really? And, more importantly, what steps need to happen for it to occur? But before I get deep into the theory, I want to tell you about my treatment, so we all know what we are talking about. Then I'll go into more detail as to why it works.

The Treatment

First - a little background. I started off with an unconventional treatment that I also came up with myself. But it was in part a copy of a phase 1 study that seemed promising. That treatment involved combining 6 drugs and it was somewhat successful for a while. I had always thought that the immune system was the key but wanted to buy time for the technology to develop.

My oncologist was impressed with the results and it stopped growth for a while. But in April of 2017 scans indicated that the tumors were growing again. That was to be expected. At that point I was out of acceptable options as I am someone who puts quality of life ahead of quantity. My oncologist said if I had any ideas to let him know. 2 days later - I had an idea.

My solution was to start with an infusion of immunotherapy drugs followed by radiation. We chose Ipilimumab (Yervoy) being PD-L1 negative. Ipilimumab had been involved in a lot of abscopal cases. It's an older drug which is likely the reason it has the biggest count. I think it is likely many similar drugs would work as good or maybe better.

2 days after the infusion I get the radiation. The treatment was something I designed and was rather unusual. Rather that trying to kill the tumor with radiation the idea was to burn a hole in the middle of the tumor leaving most of the tumor undamaged. My target tumor was 7.6 cm and the radiation target was about 3 cm in the tumor middle. The idea was to burn a region that was like a hocky puck or small can, a cylinder in the core of the tumor. The size was about 1/3 or less of the tumor volume. This was done with a rectangular beam on a rotating head so that all the beams crossed in the center. The Varian xray machine was set to 9mv and I got 9 gy per fraction and 3 fractions 3 days in a row.

The reason behind this geometry is that by only hitting the center of the tumor, the collateral radiation is still mostly inside the tumor. It is very important to have a large ratio of radiation exposure of cancer tissue to normal tissue and this geometry provided this contrast. And because only the center of the tumor is targeted the total radiation exposure and risk to the patient is greatly reduced.

It is important to understand that we are not counting on the radiation itself to kill the tumor. The goal is to turn the immune system against the cancer and let the immune system do the killing. What we are doing is creating a school inside the tumor so that the immune system will learn the cancer. It is important to understand this is a school and not a battlefield and that the radiologist has to go against their instincts to fry the whole tumor.

It is important that dead cancer be in contact with live cancer to trigger the abscopal response. After the tumor is damaged, but not killed, the tumor will attempt to heal itself. The damage needs to be extensive enough to overwhelm the TILs and require lymphocytes from the outside be brought in to the fight. But when the immune system arrives it finds necrotic cancer, what is called "bad death" and this is a signal to the immune system to classify this tissue as enemy, and the dead cancer exposes its antigens and the immune system picks that up.

4 days after the radiation I came down with a fever of 101. I thought - is this the fever I was hoping for? A fever is caused when the immune system is going after something.