Unique treatment paradigms may be suggested by analysis of tumor growth rate

Figure 17 illustrates results for a patient with pancreatic cancer post Whipple procedure who was found on 6/4/10 to have an enlarged peri-aortic mass = 1.8 cm (3.1 cc). Repeat CT on 8/27/10 noted increased size to 2.9 cm (12.8 cc). Therapy with gemcitabine was initiated on 8/27/10. Post therapy reevaluation of the mass on 12/24/10 revealed growth to 3.1 cm (15.6 cc). The patient was discouraged and frightened and thought he had wasted precious

C a n ce r P a 1 Tumor Kinetics Analysts

Patient name arid date...

Date cm or marKer unn

Projected Marker untreated = 14.72 units TDx lo TPreRx = 47 d= 1.6 m

TPrQ'TPDiLRj! 91 d = 3.0 m MSGR acU OOOtr-Mti

Marker Response = -0.00

Cancer Pal Tumor Kinetics A naiyals

Patient name and date,.

Date cm or marker unit

Date cm or marker unit

' TPOSIH* UiiKjfi

MSGR1 - 0.60 %/d MSGR2 - 0.60 <Wd MDT1 =116.1 d = 3.9m MDT2 e 116.1 d ■ 3 9m

Prurit [od Markör untreated M 16.2É3 units TDx to TPreRx » 47 d = 1.6 m

Market Response = -0.00

Figure 16. PSA projection made for a patient with newly diagnosed prostate cancer time and subjected himself to undo toxicity for no gain. However, evaluation revealed that had the tumor never been treated with gemcitabine it would have reached the projected volume of 96.9 cc by 12/24/10. Thus, based on the initial exponential growth rate from 6/4/10 thru 8/27/10, the tumor volume was actually 84% less than what it would have been had no drug been given (15.6 cc vs. 96.9 cc).

This patient experienced substantial tumor suppression by gemcitabine in spite of its growth. Under these circumstances, when there are poor second choices for effective therapy, instead of discarding gemcitabine, perhaps addition of another compound with differing toxicity might be a reasonable option.

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