Here is a Study published November 2020 highlighting the benefits of high dose IV Vitamin C (1g/kg = 50g) twice weekly during radiation. Not to be confused with vitamin C supplements. At high IV levels, C becomes oxidative which cancer cells cannot handle. In this study, high IV-C significantly reduced NLR/systemic inflammation from radiation treatment. Enormous boost to the immune system. I had IV-C twice weekly throughout my cancer treatment, and will gladly continue it through radiation. It takes 1.5 hours while you watch a movie, nap or listen to music. I considered those my "spa days." - Esther

The Effect of High Dose Intravenous Vitamin C During Radiotherapy on Breast Cancer Patients' Neutrophil-Lymphocyte Ratio

Affiliations

• PMID: 32876471
• DOI: 10.1089/acm.2020.0138

Abstract

Background: Breast cancer is very common, and the incidence is growing every year. Most breast cancers are treated with radiation after surgery. As a side effect of radiation therapy, inflammation, as well as the neutrophil-lymphocyte ratio (NLR), level increases. However, high NLR levels act as independent prognostic factors for increased mortality in all cancers. In this study, the authors investigated whether administration of vitamin C, which is effective in suppressing inflammation, may help to reduce high levels of NLR produced by radiation therapy. Methods: This study was performed retrospectively among 424 patients who were diagnosed with breast cancer and were treated with postoperative radiotherapy at Kosin University Gospel Hospital from January 2011 to December 2017. Among them, 354 patients received radiation therapy without vitamin C (the control group), and 70 experimental patients received vitamin C intravenously twice a week for at least 4 weeks during radiation therapy. The experimental group was divided into two groups according to the dose administrated: a low-dose vitamin C group (less than 1 g/kg, 52 patients) and a high-dose vitamin C group (more than 1 g/kg, 18 patients). The authors conducted three NLR measurements: before and after radiation therapy and at 3 months after radiation therapy; the authors then compared the change in NLR over time between the groups using repeated measures analysis of variance. Results: In the control group and the low-dose vitamin C-administered group, NLR was increased at the endpoint compared to before the radiotherapy, whereas NLR values in the high-dose vitamin C group were 8.4 ± 1.7, 5.9 ± 1.3, and 4.3 ± 1.5, showing a continuous decrease and a statistically significant difference (p_interaction = 0.033). These results were similarly observed in models adjusted by the patient's age and American Joint Committee on Cancer stage, with borderline significance (p_interaction = 0.065). Conclusions: Elevated NLR, a measure of systemic inflammation, has been associated with higher mortality cancer patients, including breast cancer patients. In this observational study, NLR was significantly decreased during radiation therapy in patients administered high-dose vitamin C.

Keywords: breast cancer; high-dose vitamin C; neutrophil–lymphocyte ratio; radiotherapy.

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P.S. A G6PD lab test (for G6PD deficiency which is rare) is performed before the first dose of IV Vitamin C and must be in normal in order to receive High Doses of IV Vitamin C.

PS my N/L ratio stayed low during treatment I think it was apx 2 or 2.5 most of the time.

Olma, Dr. Tripathy is at MDA (top right in video). In my experience so far, they’ve focused on oligo de novo. When I was diagnosed in late 2016, I participated in a CTC study of blood samples but I don’t know if there’s an outcome yet. And I’m not sure about the tumor sizing but I know my bone met was 1.3x1 cm.

Olma, Great research and discussion!

And thanks, Santa Barbarian, I had heard about that and will try the hyperbaric oxygen therapy.

Blessings

Esther

olma- I found that video very VERY interesting. Thanks for posting it. Both DRs said systemic first to see if it was truly oligo.This validates my treatment. Even though they seem to have de novo as the focus, I heard some reoccurrence discussion too. Mine came back 5 years after original treatment.

My MDACC surgeon said no until I had a systemic working at least stable disease and preferably some shrinkage. if I had the whole right liver lobe removed, the regenerative and healing process without any systemic could cause the probable micromets to explode and the surgery would have been more harmful than good. The video talked about risk/benefit like this.

HOWEVER, MDACC offered me an in-house random clinical trial on SBRT vs systemic. That did not track with their talk on the video. I declined because I wanted to still go for surgery at that time and I did not want to take the risk of micromets growing with no systemic.

ALSO, I also had 2 blood biopsies while on treatment at MDACC with 0 result and the tumors were growing/ multiplying. That science needs some more time to improve like they said in the video.

They only hinted at using local therapy to slow down progression and give longer lifespan and better quality of life. No one mentioned local therapy on oligo to reduce tumor burden (that’s what I did with y-90)

I hope this area of treating oligo aggressively for curative intent and what that really means, gets more traction.

Both DRs insisted that more research is needed (ie clinical trials) to gather statistics. Meanwhile I’m glad some of our docs agreed to think outside the box and get us some local therapy that seems to be helping us. Anecdotal data here on this site is how I have educated myself and pushed for local treatments

Dee

(xposted to mTNBC thread(

Keynote 355 Phase 3 clinical trial reports: IMPROVED OS with pembrolizumab (Keytruda) for mTNBC w. PD-L1 >10

details re OS to come at a medical meeting so we don't know how big an effect it has but it reached statistical significance & was clinically meaningful.

https://www.merck.com/news/merck-announces-phase-3...

(edited to correct link, sorry!)

one for early stage high risk TNBC

FDA approves pembrolizumab for pts with high-risk early stage TNBC based on DFS improvement seen in KN-522

https://www.merck.com/news/fda-approves-keytruda-p...

Lilyishere- I saw that one and thought it was quite interesting. I lasted 4 1/2 years on the AI’s just couldn’t take the SEs anymore. Became metastatic a year later

Here is another summary report of er targeting trials

https://www.onclive.com/view/serds-represent-the-next-generation-of-er-targeting-therapy-in-breast-cancer

Dee

Has anyone here with ER PR + stopped taking the drug Arimidex after 7 years? If so what was your node involvement? Two years ago my MO told me about thise study https://www.breastcancer.org/research-news/5-more-years-of-ais-no-better-than-2-more so we agreed to go two more years making it 7 years of medication. December will be 7 years. The conversation we had on Monday at my 6 month appt was that she wanted me to get a bone density scan and that would determine if we kept going on the arimidex. If I had issues, we would stop it was my guess since it eats at your bones.

I get a call today that I have Osteopenia. I talked to the PA and she said my doctor wants me to go another 3 years on the arimidex and take the Prolia shot every 6 months! I've always been told that with grade 1 I had a cancer that was not aggressive and chemo was an "insurance policy". Now the PA is telling me I am at more high risk because I had node involvement and the 7 years is for people who have no node involvement. My MO has never told me this in the conversations we had about stopping the medication. I'm not sure what I want to do to be honest. I'm disappointed because I was ready to stop with the meds that have my hair thinning, the fat is harder to lose and my vajay jayay is a desert!

AlabamaDee, I hope you are not feeling guilty about stopping AI at 4.5 months. AI can reduce the recurrence up to 50% and from this forum, so many women had recurrences while using tamoxifen or AI. These medications are keeping the cancer cells without their fuel to multiply but obviously, in more than 50% of cases are not killing them. In the best case senario, when the time comes to stop AI, cancer cells can be still "sleeping" or can start multiplying. It is a gamble we are all playing with our lives.

Homemom- the latest report is being repeated on cancer social media. Lillyishere listed it above.

“In postmenopausal women with hormone-receptor–positive breast cancer who had received 5 years of adjuvant endocrine therapy, extending hormone therapy by 5 years provided no benefit over a 2-year extension but was associated with a greater risk of bone fracture.“

You and your MO should talk about this article when making the decision. BTW I am osteopenic but cannot take bisphosphonates like prolia. My MO is happy to keep my vitamin D above 60 and increase weight bearing exercise. Bone density again in 2 years.

Lilyishere - quitting my AI at 4.5 years was probably not the issue since my MBC has the esr1 mutation the AI probably quit working.

Dee

just to go further on AlabamaDee's post, Prolia is not a bisphosphonate, it is a monoclonal antibody. Zometa however is a bisphosphonate & it too is often used to boost bone density.

Moth - so no study anywhere shows benefit for extending 5 years rather than 2. As a matter of fact, we have studies that show it increased possibility of bone fractures. I'm guessing that is why she wants me back on prolia. So three more years of Arimidex and Prolia, she thinks it will significantly decrease my chances of recurrence and protect my bones at the same time. I wonder if there is anything dertimental to doing that? I mean none of the studies suggest that anyone took a bone density drug along with the additional AI

Love this message board by the way!

Important info for LOW ER+

from tweet by Dr Paolo Tarantino

"comparable outcomes b/w early TNBC and "ER-low" BC

Coherent with the recent EJC paper by Villegas et al. - showing that nearly 90% of "ER-low" cancers are basal-like tumors, behaving as TNBC"

Paper he's referring to:

"Impact of estrogen receptor levels on outcome in nonmetastatic triple negative breast cancer patients treated with neoadjuvant/adjuvant chemotherapy" https://www.nature.com/articles/s41523-021-00308-7...

"In conclusion, primary BC with ER1–9% shows similar clinical behavior to ER 1% BC. Our results suggest the use of a 10% cut-off, rather than <1%, to define triple-negative BC."

and

"the St. Gallen Consensus 2015 reported that ER expression values between 1 and 9% should be considered equivocal and that endocrine treatment alone, in the absence of chemotherapy, should not be considered a reliable adjuvant treatment for these patients."

I think the Villegas et al article he's referring to might be this one or one based on same research. I can't find an EJC version... https://cancerres.aacrjournals.org/content/79/4_Su...

bottom line seems to be that low ER might act really be much more like TN than we thought

ASCO treatment update for HER2- metastatic breast cancer

"Chemotherapy and Targeted Therapy for Patients With Human Epidermal Growth Factor Receptor 2–Negative Metastatic Breast Cancer That is Either Endocrine-Pretreated or Hormone Receptor–Negative: ASCO Guideline Update"

https://ascopubs.org/doi/full/10.1200/JCO.21.01374...