Need advice for next step

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plastikos
Posts: 351
Joined: Wed Jan 14, 2015 6:09 am

Need advice for next step

Postby plastikos » Sat Jul 22, 2017 12:38 pm

Hi all. Just wanted some advice.

Update: I have been on Keytruda 200mg every 3 weeks sine March. Since then scans have improved. Extrahepatic (supraclavicular, cardiophrenic, periportal) nodes have regressed. 2 main liver tumors remain, slightly smaller and less enhancing on MRI. No activity on PET. However the fact that they are still there bothers me. I know that in some cases they disappear and in some they merely become stable.

Short of another hepatic resection (I have had 2) I am considering some form of local therapy. Choices are SIRT vs RFA. I have heard that RFA is better in tumors less than 3-5 cm size. Unfortunately the larger of the 2 tumors is 3 x 6 cm. I am considering SIRT to shrink OR completely kill the tumors and if ever follow through with RFA. Has anyone tried this path? Thanks.
Last edited by plastikos on Sat Jul 22, 2017 11:46 pm, edited 1 time in total.
St. IV Colon CA @ 37, male, Kras wild, MSI-high (2014)
11/2014 Right Hemicolectomy + Liver Resection
12/2014 - 6/2015 FOLFOX + Cetuximab
10/2015 - Recurrence liver
Liver resection 10/2015
FOLFIRI 11/2015 - 5/2016
Recurrence liver, nodes 11/2016
Pembrolizumab started 12/2016 -> pseudoprogression(?) -> biliary obstruction -> biliary stenting
Chemo 4x: most mets inactive and smaller on PET-CT
March 2017 - Back on Pembrolizumab again
Sept 2017 - SIRT - > NED
2019 NED

Lee
Posts: 6207
Joined: Sun Apr 16, 2006 4:09 pm

Re: Need advice for next step

Postby Lee » Sat Jul 22, 2017 4:18 pm

I don't have any advice, butt wanted to says sounds like Keytruda might be having some success, CONGRATULATIONS.

Hopefully others can offer advice. good luck with this next step.

Thinking of you,

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 16 years and counting!

plastikos
Posts: 351
Joined: Wed Jan 14, 2015 6:09 am

Re: Need advice for next step

Postby plastikos » Fri Jul 28, 2017 10:02 am

Lee wrote:I don't have any advice, butt wanted to says sounds like Keytruda might be having some success, CONGRATULATIONS.

Hopefully others can offer advice. good luck with this next step.

Thinking of you,

Lee

Thanks Lee. I am happy with the improvement on Keytruda as well. Would just feel better having those f*ckers nuked is all. Hoping that SIRT plus immuno might be a lethal combo for the cancer.
St. IV Colon CA @ 37, male, Kras wild, MSI-high (2014)
11/2014 Right Hemicolectomy + Liver Resection
12/2014 - 6/2015 FOLFOX + Cetuximab
10/2015 - Recurrence liver
Liver resection 10/2015
FOLFIRI 11/2015 - 5/2016
Recurrence liver, nodes 11/2016
Pembrolizumab started 12/2016 -> pseudoprogression(?) -> biliary obstruction -> biliary stenting
Chemo 4x: most mets inactive and smaller on PET-CT
March 2017 - Back on Pembrolizumab again
Sept 2017 - SIRT - > NED
2019 NED

testing765
Posts: 324
Joined: Tue Aug 19, 2014 9:41 am

Re: Need advice for next step

Postby testing765 » Sun Jul 30, 2017 10:11 pm

I am glad to hear that the treatment seems to be working and I hope that you have continued success. I do not have experience with SIRT or RFA so I can't comment on those procedures.
male-age 44 at diagnosis
8/14-clnscopy
8/14-CT scan,no mets
9/14-left colectomy,CEA 2.2 before surgery
pT2pN2bpM0
3 cm tumor in dscnding colon
7/23 pos LNs
low grade MSI stable
10/14-start folfox
1/15-CT & PET scan and sigmdoscopy- no mets
3/15-finish folfox
9/15- clnscopy- 3 polyps removed
10/15- CT scan, NED
10/16- CT scan, NED, CEA 1.6
10/17- clnscopy- 4 polyps removed, CT scan NED, CEA 1.8
10/14 1.9; 4/15 2.8; 5/15 2.4; 9/15 2.8; 12/15 3.1; 1/16 3.0; 4/16 2.5; 7/16 2.5; 10/16 1.6; 1/17 1.9

Lee
Posts: 6207
Joined: Sun Apr 16, 2006 4:09 pm

Re: Need advice for next step

Postby Lee » Tue Aug 01, 2017 5:17 pm

plastikos wrote:Thanks Lee. I am happy with the improvement on Keytruda as well. Would just feel better having those f*ckers nuked is all. Hoping that SIRT plus immuno might be a lethal combo for the cancer.


I understand and hear your frustration.

Can you get some opinion in your area or are you planning to go out of the country? If I remember correctly, you are in the Philippines. Where would you go outside of the Philippines is you chose that route.

All the best,

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 16 years and counting!

plastikos
Posts: 351
Joined: Wed Jan 14, 2015 6:09 am

Re: Need advice for next step

Postby plastikos » Tue Aug 08, 2017 11:50 am

Lee wrote:
plastikos wrote:Thanks Lee. I am happy with the improvement on Keytruda as well. Would just feel better having those f*ckers nuked is all. Hoping that SIRT plus immuno might be a lethal combo for the cancer.


I understand and hear your frustration.

Can you get some opinion in your area or are you planning to go out of the country? If I remember correctly, you are in the Philippines. Where would you go outside of the Philippines is you chose that route.

All the best,

Lee


Hi. Sorry for the late response. Yes I live in the Philippines. The procedure can be done here. So far the plan is to do it after 1-2 more doses of Keytruda.
St. IV Colon CA @ 37, male, Kras wild, MSI-high (2014)
11/2014 Right Hemicolectomy + Liver Resection
12/2014 - 6/2015 FOLFOX + Cetuximab
10/2015 - Recurrence liver
Liver resection 10/2015
FOLFIRI 11/2015 - 5/2016
Recurrence liver, nodes 11/2016
Pembrolizumab started 12/2016 -> pseudoprogression(?) -> biliary obstruction -> biliary stenting
Chemo 4x: most mets inactive and smaller on PET-CT
March 2017 - Back on Pembrolizumab again
Sept 2017 - SIRT - > NED
2019 NED

Lee
Posts: 6207
Joined: Sun Apr 16, 2006 4:09 pm

Re: Need advice for next step

Postby Lee » Tue Aug 08, 2017 5:19 pm

Good luck, let us know how it goes.

thinking of you,

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 16 years and counting!


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