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Exceptional Responders

Posted 8/24/2015

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  By definition, an exceptional responder is someone who has a unique (positive) response to a treatment, usually chemotherapy, that is not effective for others in a similar situation. The NCI has even launched a study to examine these people and their responses, trying to figure out what and why and how. Scientists are fascinated; if they could understand the reasons, they likely could use that information to improve treatments for others. The phrase, exceptional responder, has a very nice ring, but most of us would be just as happy to consider these responses the miracles that everyone hopes for.

  There have always been a few people who have done wildly better than anyone could have predicted. In a rather low-key way, I know a couple of women who were diagnosed with seemingly terrible initial breast cancers (big tumors, more than 20 positive lymph nodes) who were treated with standard therapies and are absolutely fine decades later. Hearing about them and others is hugely cheering for anyone who has received a frightening diagnosis. When I talk about this with new patients, I always encourage them to consider the real possibility that they might be in this select group. Why not?

  This is a really interesting article from ASCO Connection about one such patient:

The Strangeness of Being an Exceptional Responder
James Randolph Hillard, MD

I mentioned in my last post, “Patient Psychiatrist,” I was diagnosed in December 2010 with stage IV, adenocarcinoma of the distal stomach, with a metastasis to the peritoneum. The ominously named “SEER Database,” (Surveillance, Epidemiology and End Results) suggested that I had a less than 5% chance of surviving for five years. Fortunately, for me, trastuzumab had been approved for HER-2 positive stomach cancer just a month before my diagnosis. About 20% of stomach cancers over express that antigen, about the same percentage as for breast cancers. Trastuzumab was approved because it increased the overall survival time for patients with metastatic disease, but only from an average of 11 months to an average of 13 months. So, over 4.5 years later, with no evidence of disease, I definitely qualify as an exceptional responder.

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