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Revision as of 17:57, 29 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. In this case it's the immune system attacking the cancer. 2 days later the fever broke and most of my cancer symptoms, but not all of them, were gone.

I don't have any final images yet that indicates success or failure except that I'm still alive and feeling pretty good right now. Bur even if this doesn't end up working for me the process makes so much sense that it should work for some people and if it is perfected, should work for a lot of people.

The important point here is that this process itself isn't that unusual and that any oncologist has access to these drugs and that the radiation is actually easier to configure than a normal treatment. So it is something that can be tried now. And perhaps if you are an oncologist you might have ideas about how to improve it. My goal here is to encourage people to build on these ideas and beat cancer. I might not be out of the woods either so maybe when I need something else there will be something else available.

The Details

The above should be enough information to try it. But I'd like to share more details that might help doctors understand the process on a deeper level and figure out how to improve it. I will aslo share ideas on how it might be modified to be used for other cancers.

The Immune System

Other than the brain there is probably nothing in the body more complex and least understood than the immune system. Many of you who are not doctors reading this might be wondering why I'm so fixated on the immune system. I'm fixated because the immune system is what keeps everyone from getting cancer.

Cancer isn't a foreign disease like getting the flu. Cancer is you. It grows from your normal cells. And because it is you it is harder for your immune system to distinguish it from normal tissue. However the immune system is both very smart and very sensitive and it is generally capable of seeing the difference and it smacks down cancer all the time. So everyone gets cancer. But the immune system gets rid of it, at least until it doesn't.

When you get cancer it is because a cancer formed and your immune system failed to stop it. This could be because your immune system is weak, or the immune system doesn't see the cancer, or the immune system sees the cancer, but has misclassified it as friend. Most people's immune systems are capable of killing the cancer. It just chooses not to for some reason. Thus if one could get the immune system to see the cancer and classify it as enemy, then the immune system can cure the cancer - everywhere - down to the very last cell.

I am in the spam filtering business. I block junk email for thousands of people and with very good accuracy. It's fortunate that I'm in this business because the way my spam filter works and the way the immune system works are very similar. Both have the same tasks. They have to evaluate email messages or cells and make a binary determination as to friend or foe. Since they are doing the same thing then it wouldn't be unusual for then to share some of the same processes even though they are completely different technologies. For example, hydraulics and electronics are completely different but they share the same formulas as do a great many other things. In this case realizing that the immune system is really an information processing engine allows one to see the problem in a different context. We have a programmable weapon and all we need to do is change the programming.

The Adaptive Immune System

The adaptive immune system is the part of the immune system capable of learning. How it learns is beyond my pay grade. It is completely different than computer technology, but it shares some of the capabilities. One doesn't have to understand how it works if you can imitate the processes than make it work. Monkey see, monkey do.

For example, doctors learned that if you recover from many diseases that you never get that disease again. Once your body learns a disease it remembers it so it it shows up a second time the immune system knows what to look for. From this doctor used a weakened form of the infection and injected it into people creating a vaccine. That teaches your immune system what the enemy is so when it come along it is attacked and defeated without you ever knowing it.

The important thing to know about vaccines is that vaccines are not a form of medicine the was antibiotics are. Vaccines don't kill anything. When they are injecting you with a vaccine you are getting data. It's information. It's a database update. It's programming.

If you have a computer and you're running antivirus software, and you download a virus which it doesn't recognize, the virus runs. But then you download an update to your database of virus definitions and not the antivirus programs sees the virus software and eliminates it. What I'm doing is essentially the same thing. The body doesn't see the cancer or has misclassified the cancer as friend. The goal of this process is to update the database and reclassify the cancer as enemy so that the immune system attacks the cancer and eliminates it.

Thus - the problem is - how do we take the identifying information that is in the cancer and extract it in a way so as to expose it to the immune system with a classification signal that tells it this is the enemy. How do we produce an in situ vaccine that will cause the immune system to attack the cancer?

Understanding Autoimmune Disease

What is autoimmune disease? Autoimmune is when your immune system starts attacking normal issue. It's sort of the opposite of cancer in that cancer should be killed and it's not, and autoimmune is killing something that shouldn't be killed.

One of the side effects of radiation treatment - especially when done concurrently with immunotherapy drugs is an autoimmune response against normal tissue. Especially normal tissue damaged by radiation. Often when radiologists burn out a whole tumor they partially irradiate the surrounding normal tissue and the immune system goes after that. Does this sound familiar? It should because that's in part my inspiration for my treatment. I basically took the process that causes autoimmune and applied it against the cancer.

It turns out that abscopal and autoimmune are the same thing. It's like the difference between weeds and flowers. But instead of trying to avoid autoimmune my process tries to create it. And because the radiation target is small inside the tumor exposure to normal tissue is minimized.

Improvements and Variations of my Treatment

Here are things I haven't tried but might be useful to oncologists who might experiment with this treatment.

Radiation

Because I had a large lung tumor we used Varian's equipment. But there was movement from breathing. Because the tumor was large and I trained myself to do fast shallow breaths I minimized the motion. A better way, in my opinion, would have been to give me pure oxygen. This would have allowed even shallower breathing or very long breath holds which would allow more precision for smaller targets. Oxygen also has advantages in helping heal radiation damage in normal tissue and kill damaged cancer cells at the same time. But if the tumors were smaller, I would go with the cyberknife. Although I wasn't given oxygen, I did increase oxygen to the area using heat to dilate my blood vessels to carry more blood. I have a heated car seat and put it on high for the 1 hour drive there and back.

Freezing

Because I had lung cancer freezing the tumor was not an option. However if there is an accessible tumor I think freezing the tumor might be more effective that radiation. As with radiation you don't want to freeze the whole tumor because if you kill the tumor then it doesn't try to heal and you don't get the abscopal effect. But you can freeze the surface of the tumor to create a nice big patch of dead tumor for the immune system to learn. Freezing reduces damage to normal tissue and should be much easier to do for many cancers. Freezing has also been known to cause an abscopal response.

Poison

I would also think that and injection of the right kind of poison could do the same thing. You would want something that acted very locally and didn't spread around. Again, the idea is to kill only a piece of the tumor so that the tumor tries to heal without damaging normal tissue that could lead to an autoimmune response.

Drugs

I chose Ipilimumab and I have no idea if I made the best choice. It might be that I got lucky. It might be that any immunotherapy drug would have worked. It may be that through trials that we can test and tune for the best drug for each patient. Perhaps using multiple drugs together is even more effective. In fact, if my first attempt didn't work I'm going to try some combination to amp up the immune system even more. And hopefully I won't kill myself in the process. I'm looking at some combination of these drugs.

• Ipilimumab (Yervoy)
• nivolumab (Opdivo)
• Pembrolizumab (Keytruda)
• gm-cfs

And I'm going to have to guess as to the amount and the sequencing of these drugs and then how long to wait afterwards to do something to damage the tumor(s). The idea here is to figure out what you have to do to put the immune system in lean mode. Perhaps the use of vaccine adjuvants would help?

My Status

At this point I do not know if it worked, or rather to what extent it worked. There is a possibility that I have completely beaten the cancer and it's just a matter of time, probably a lot of time, to be declared cancer free.

It is also possible that nothing happened and that I'm delusional and have a very slow growing cancer and would be no worse off if I did nothing. It is, of course, so easy for someone to fool themselves into believing anything when you have a fatal diagnosis. So I can't rely on my own perception to determine my status.

It is also possible that I still have cancer and I got a partial immune response but didn't achieve a sustained response. Perhaps I started an abscopal effect but I ran out of the right kind of t-cells before it finished the job. I might have to repeat the process in order to beat it.

I still might die

There is no guarantees that this process will work for me. I am convinced that I'm on the right track and if this process were applied to a lot of people that it will work for some of them. So if I die it doesn't mean it doesn't work. It only means it didn't work for me. And I'm still facing having to survive complications from the cancer. I'd had pneumonia at least twice, possibly 3 rimes sine I was diagnosed and the pneumonia may get me eventually. And I'm still coughing up some mucus which is not a good sign.

Going public with this treatment early

Some might wonder why I';m going public with this and recommending it before it is proven. The reason I'm doing it is because I'm convinced that I'm on the right track, but I'm also aware that there might not be a happy ending for me. If I wait till I'm sure I've lost valuable time helping others. And if it is a good idea but fails for me then I've wasted a good idea. And even if I'm totally wrong and it ultimately doesn't work at all, the idea is still good enough right now to we worth trying. Often when doing research there are dead ends, and this could be one of them. Someone reading this might try it and die anyway, possibly even sooner. Life isn't always fair. I'm an anti-smoking activist and I have lung cancer. So how unfair is that.

So - my disclaimer is - I'm not a doctor - it's my opinion this is worth trying - if you read this and you think I'm onto something and you try it, I wish you the best of luck.

People who helped me come up with this treatment