Could you please discuss perhaps a clinical case or a composite of some clinical cases in your practice that illustrates some of the topics that we have just discussed?
I have a patient with metastatic triple-negative breast cancer that has been diagnosed with brain metastases, lung metastases, and lymphonodal disease almost ten years ago. What I did for this patient is this. I gave a combination of chemotherapy and immunotherapy. In the beginning, when we started using immunotherapy in those breast cancer patients, I must confess to you that she completed the treatment in the context of the clinical trial. After three years, she stopped with treatment, and she’s still alive with no progressive disease. This is an example of a patient with an excellent immune response following chemotherapy and immune checkpoint inhibitors. I believe that in this patient, you have a balance within immune surveillance that is very active and with the disease under control because the immune system of the patient is working.
So such patients with oligometastatic diseases, you know, it is statistically an outlier. I’m sure that a lot of people, including yourself, were curious as to what is the molecular nature of active immune surveillance, as you mentioned. What kind of research-based studies do you think could be done on such patients? And I’m sure such excellent responders exist around the world.
You know, what we are doing actually, is we are proposing a trial including NGS and liquid biopsy, exactly in this patient population of outliers. So we are collecting blood samples, tissue samples, and fecal microbiome samples in the stool. Because I am quite sure that in a multi-dimensional analysis, we will also be using artificial intelligence, we may probably identify which are the features from the genomic point of view, from the transcriptomic point of view, from the microbiome point of view that explains why some patients are outliers. Or as I call them heroes. Because those patients are superheroes, they survived metastatic cancer.
Well, the microbiome is a very interesting point. There was a lot of research going on. There are more microbes in the body than there are in human cells. I think we should remember that.