New scan on Keytruda. Need opinion.

Please feel free to read, share your thoughts, your stories and connect with others!
plastikos
Posts: 254
Joined: Wed Jan 14, 2015 6:09 am

New scan on Keytruda. Need opinion.

Postby plastikos » Sat Sep 09, 2017 7:48 pm

Hi all. Asking for some input. I have been on Keytruda exclusively since early this year and things have been going well. Extrahepatic lesions (supraclavicular, paraaortic) have gone. Liver lesions have shrunk and are PET negative. I have been gaining weight and am asymptomatic save for extreme dry mouth.

Yesterday I received the results of my PET/CT which showed a new small dot light up in segment VIII of my liver on PET. The same area however showed no structural lesion on the CT part of the scan.

Could this be progression or pseudoprogression? If Keytruda isnt working then why are all the other lesions still gone? Seeing my onc this week. I am in the process of planning SIRT so hopefully it can address that but not sure if they can hit something that cant be detected on CT. Should I stop Keytruda or add something like Avastin on top of it?
Diagnosed St. IV Colon CA @ 37, male, Kras wild type, 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 12/2016 -> pseudoprogression (?), biliary obstruction -> biliary stenting
Chemo 4x: most mets inactive and smaller on PET-CT
March 2017 - Back on Pembrolizumab

rp1954
Posts: 1174
Joined: Mon Jun 13, 2011 1:13 am

Re: New scan on Keytruda. Need opinion.

Postby rp1954 » Sat Sep 09, 2017 11:31 pm

plastikos wrote:Hi all. Asking for some input. I have been on Keytruda exclusively since early this year and things have been going well. Extrahepatic lesions (supraclavicular, paraaortic) have gone. Liver lesions have shrunk and are PET negative. I have been gaining weight and am asymptomatic...

That sounds like an impressive, fine result!

Yesterday I received the results of my PET/CT which showed a new small dot light up in segment VIII of my liver on PET. The same area however showed no structural lesion on the CT part of the scan.

Possibly highly active tissue, microscopic cancer cells or not, and too small to image on CT but a quasar with FDG sugar added. We use that property against targetable cancer cells and some kinds of inflammation.

Could this be progression or pseudoprogression?
If Keytruda isnt working then why are all the other lesions still gone?

Biological heterogeneity, a new mutant or primary, perhaps local and transport differences to different sites, inflammation, or other artifact. We never have had a silver bullet that simply knocked out all sites. We have run across molecular indications of cancer heterogeneity several times now. We have had to pick the sites or types off one-by-one, while beating and holding down general activity and metastatic process. The peritoneum by massive provoked immune reaction and surgical clean up; lung thingies on metronomic immunochemo; then para-aortic LNs by intensified immunochemo and surgery, several liver objects on immunochemo intensified with more/different off-label adjuncts in different years; micromets and variable markers by actively modulated maintenance.

Should I stop Keytruda or add something like Avastin on top of it?

If Keyruda is working nicely on most sites, I'd be reluctant to stop that. I try to intensify or broaden the cancer attack with something bad for some kinds of cancer lines, but good or indifferent to the normal cells. This is an area where the extra markers, blood panels and attention to details are so handy. If CEA has gone down to baseline but AFP and/or CA19-9 are doubling, we can add mild or healthful adjuncts that are more likely to drive down cells related to those markers.

I have no knowledge of Keytruda, but what we did to stop a marker rise, was to scour for drug interactions, start at the low side of therapeutic doses for some targeted, nonstandard add-ons and escalate; or start full dose for some milder items, and monitor the expanded blood work. We even upped sample frequency to every 7-10-14 days, until seriously driving down one or more markers. Then our art was to do intensified immunochemo as close to the surgerical Art as possible, as reflected in various literature, not the standard defaults. There are differences between hours, days and weeks with different regimens and situations.
watchful, active caregiver for stage IVb CC since early 2010. immuno"Chemo forever," for mCRC

veckon
Posts: 84
Joined: Thu Jul 27, 2017 7:44 am

Re: New scan on Keytruda. Need opinion.

Postby veckon » Sun Sep 10, 2017 4:23 am

If only one tumor seems to not be responding it is possible it has mutated a defense to pembrolizumab.
27 yo male
Metastatic rectal cancer diagnosed 12/16
Liver metastases and peritoneal carcinomatosis
Lynch syndrome, MSI-H
Failed liver resection 3/17
FOLFOX6 12/16 - 05/17
Keytruda 5/17 - present
@Memorial Sloan Kettering

KElizabeth
Posts: 379
Joined: Sat Oct 31, 2015 12:41 pm
Facebook Username: KElizabeth
Location: Omaha

Re: New scan on Keytruda. Need opinion.

Postby KElizabeth » Sun Sep 10, 2017 6:33 pm

I'm glad you are getting good results and are felling well!
Female age 38- ,two kids, age eleven and fifteen.
Colon Cancer - DX March 2013
Age 34 at DX - Stage III B
Resection surgery -May 2013
FOLFOX - June, 2013 to Sept, 2013
5FU plus leukavorin Sept, 2013 to Dec, 2013
METs liver and lungs discovered Sept, 2015
KRAS - MSS
FOLFURI plus Avastin - Sept, 2015 - current
Art therapy January 2015 to current
CEA at recurrence:10.1/august, 2015
CEA: 1.9 February, 2016
CEA:: 10.2 December, 2016
CEA: 40.3 January, 2017
CEA: 16.4 March 2017
Facebook.com/natureinink


Return to “Colon Talk - Colon cancer (colorectal cancer) support forum”



Who is online

Users browsing this forum: Bing [Bot], Yahoo [Bot] and 52 guests