Keytruda....Working for MSS....Mutation Burden is the Key

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stu
Posts: 1141
Joined: Sat Aug 17, 2013 5:46 pm

Re: Keytruda....Working for MSS....Mutation Burden is the Key

Postby stu » Wed May 15, 2019 1:44 am

Hi ,
They use a similar combination with stage 4 lung tumours and one chemotherapy is platinum based . You might like to check out some of their forums .

My friend has had an amazing response. She had Keytruda along with two chemo agents and one was a platinum based one . She had four cycles with everything then dropped the platinum one for a further two cycles . Now just Keytruda.

It was rough , but she has functioned throughout and still doing things for her three children. One has a learning disability so she has a lot to do .

The results have been incredible . Most tumours have resolved and the rest continue to shrink at an encouraging rate . She said the research for lung cancer is showing a better response if combined with chemo at the start . Not read any of it myself but you might like to have a look .

Take care ,

Stu
supporter to my mum who lives a great life despite a difficult diagnosis
stage4 2009 significant spread to liver
2010 colon /liver resection
chemo following recurrence
73% of liver removed
enjoying life treatment free
2016 lung resection
Oct 2017 nice clear scan . Two lung nodules disappeared
Oct 2018. Another clear scan .

Pyro70
Posts: 118
Joined: Mon Jan 21, 2019 4:25 pm

Re: Keytruda....Working for MSS....Mutation Burden is the Key

Postby Pyro70 » Wed May 15, 2019 8:52 am

I’m aware of combination of chemo immunotherapy in other cancer types, but I don’t think that’s an approved therapy yet for CRC. Who is the doctor that is suggesting this?

Also are you sure he will prescribe FOLFOX again if you’ve already suffered neuropathy? How many rounds of FOLFOX have you completed? It seems more likely he would start you on FOLFIRI.
Dx Jan 2017 stage IVB w/ PC age 35
FOLFOX
SEP 17 HIPEC 1, anastamosis leak
XELODA
MAR 18 HIPEC 2
JUN 18, ileo reversal and 2nd anastamosis leak

tbt4snow
Posts: 21
Joined: Sat Oct 27, 2018 3:16 pm
Facebook Username: Tina tran

Re: Keytruda....Working for MSS....Mutation Burden is the Key

Postby tbt4snow » Wed May 15, 2019 12:52 pm

Hi all,
There is trial for chemo immunotherapy for crc:
http://clinicaltrials.gov/show/NCT02375672
I’m not qualified to participate due to my disease is not measurable. Both onc at MGH and Dana suggested this treatment. I had 12 sessions of Folfox + Avastin last year. This year I have 4 sessions of folfiry before the surgery but folfiry didn’t work well since the cancer still spreading.
My onc just called me today, he said there is trial with vaccines + immunotherapy that he will try to put me in due to my neuropathy but again, the same issue of qualification as my disease is not measurable. I’m hoping mri will show the spread in ileum. I will see my onc this Friday to discuss about this new option.
Foundation One test is scheduled and hopefully the results will come back before my first treatment.
B.t.w: per my onc, MGH will have in house ctDNA in a few weeks.
Thanks, Tina.
DX: CC stage 4/w ovaries & omentum mets in 12/17 49/F
High grade pT3N1bM1b sigmoid Adenocarcinoma colon
MSS-h TMB=16, NRAS-mutant
Lymph nodes: 1/2 left colic; 3/8 regional
12/2017: Exploratory laparotomy & resect of sigmoid & ovaries
Folfox/avastin 12 sessions from 1/8-6/18. 6/18 CEA 2.1
1/19: CT shows peri mets;
CEA: 12/18 5.1, 1/7/19 7.9; 1/15/19 9.1; 1/30/19: 10.6
4/3/2019 CRS/HIPEC after 4 Folfiry sessions...

boxhill
Posts: 268
Joined: Fri Apr 06, 2018 11:40 am

Re: Keytruda....Working for MSS....Mutation Burden is the Key

Postby boxhill » Wed May 15, 2019 4:18 pm

May I ask how your disease can be considered "not measurable" if you have peri mets that show on a CT scan?
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemicolectomy
11 of 25 nodes,5 of 5 mesentery nodes
5mm liver met removed
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/4/18 FOLFOX
Neulasta 6/28
7/9/18 CT NED, 2mm indeterminate lung nodule
11/20/18 CT NED, Lung nodule calcified granuloma. Enlarged spleen.
12/20/18 Liver MRI 5mm liver met and 2 lymph nodes in porta hepatis
12/31/18 Keytruda
6/5/19 Triphasic CT LNs shrunk to normal, Liver node stable
6/28/19 Keytruda paused, predisone for joint pain

tbt4snow
Posts: 21
Joined: Sat Oct 27, 2018 3:16 pm
Facebook Username: Tina tran

Re: Keytruda....Working for MSS....Mutation Burden is the Key

Postby tbt4snow » Wed May 15, 2019 7:10 pm

During the surgery, the surgeon saw a lot of black plaques which are .5 to 1mm in size that spreads out in my ileum thus not resectable and pathology proved they are cancerous. The ct scan after surgery did not show these plaques and my current cea is 2.1. It is a matter of time these plagues will grow so Doctor want to treat it aggressively while it’s still early.
DX: CC stage 4/w ovaries & omentum mets in 12/17 49/F
High grade pT3N1bM1b sigmoid Adenocarcinoma colon
MSS-h TMB=16, NRAS-mutant
Lymph nodes: 1/2 left colic; 3/8 regional
12/2017: Exploratory laparotomy & resect of sigmoid & ovaries
Folfox/avastin 12 sessions from 1/8-6/18. 6/18 CEA 2.1
1/19: CT shows peri mets;
CEA: 12/18 5.1, 1/7/19 7.9; 1/15/19 9.1; 1/30/19: 10.6
4/3/2019 CRS/HIPEC after 4 Folfiry sessions...

boswind
Posts: 61
Joined: Fri Apr 11, 2014 12:04 pm

Re: Keytruda....Working for MSS....Mutation Burden is the Key

Postby boswind » Thu May 16, 2019 4:23 pm

Based on the CT report and continuously rising CEA, my oncologist said Keytruda did not work on me. So I have to return to traditional chemos. I am now still in hospital to complete infusion of FOLFOX + Bevacizumab.
01.24.2014 Male, DX @54 Rectosigmoid Cancer, MRI: T3N0M0
03.19.2014 Completed 5-week Radia+Xeloda
05.07.2014 Had surgery
02.25.2015 CT showed liver and L4 Spine involvement.
03.2015 - 08.2015, folfox + Avastin
08.2015 - 07.2017, 5FU + leucovorin + Avastin for Maintenance
07.2017 - 01.2018, Folfuri + Avastin
02.07.2018 - 03.06.2019, Centuximab + Irinotecan
90 rounds of chemos received (as of 12.27.18)
CEA: 9.8 as of 12.27.18
MSS, KRAS wild type, BRAF wild type
TMB = 12 mut/MB
03.14.2019 - Keytruda

Pyro
Posts: 264
Joined: Mon Oct 12, 2015 7:40 pm
Location: Tucson, AZ

Re: Keytruda....Working for MSS....Mutation Burden is the Key

Postby Pyro » Thu May 16, 2019 9:49 pm

boswind wrote:Based on the CT report and continuously rising CEA, my oncologist said Keytruda did not work on me. So I have to return to traditional chemos. I am now still in hospital to complete infusion of FOLFOX + Bevacizumab.


Well fudge.
Aug 2015- Diag Stage 4 CC with liver Mets(38/m)
Sep 2015- Avastin/Folfox/Iron
Dec 2015-Not liver surgery candidate
Jan 2016- Erbitux/Folfiri, 2nd opinion at MDA in TX
Feb 2016 -MDA liver surgery
Mar 2016 -30% of left lobe rem, PVE
May 2016 - 70% of liver rem
Jun 2016-Rad
Jan 2017-perm colost @MDA
Jul 2017-Erb/FOLFURI
Nov 2017 -Lung & Liver ablations@MDA
Jan 2018 -Xeloda & Avastin mx
Jul 2018-Avast/FOLFURI
Sep 2018-Rad
Mar 2019 - Keytruda fail, CEA @36
Jun 2019 - FOLFURI until I can’t stand it

boxhill
Posts: 268
Joined: Fri Apr 06, 2018 11:40 am

Re: Keytruda....Working for MSS....Mutation Burden is the Key

Postby boxhill » Fri May 17, 2019 3:26 pm

tbtsnow, is there any chance they would show up on an MRI?

boswind, sorry to hear that. Is your onc sure that 3 months is long enough to tell?
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemicolectomy
11 of 25 nodes,5 of 5 mesentery nodes
5mm liver met removed
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/4/18 FOLFOX
Neulasta 6/28
7/9/18 CT NED, 2mm indeterminate lung nodule
11/20/18 CT NED, Lung nodule calcified granuloma. Enlarged spleen.
12/20/18 Liver MRI 5mm liver met and 2 lymph nodes in porta hepatis
12/31/18 Keytruda
6/5/19 Triphasic CT LNs shrunk to normal, Liver node stable
6/28/19 Keytruda paused, predisone for joint pain

tbt4snow
Posts: 21
Joined: Sat Oct 27, 2018 3:16 pm
Facebook Username: Tina tran

Re: Keytruda....Working for MSS....Mutation Burden is the Key

Postby tbt4snow » Fri May 17, 2019 5:15 pm

Boxhill, I had MRI done today. I will know in couple of days if it pickups those plagues. If it does then there will be biopsy to get tumor tissues for vaccines. If not, I will move forward with Folfox + Ketruda.
Boswind, I hope you get good results with this new regime. I guess we have to keep trying until we find something that works. Good luck.
DX: CC stage 4/w ovaries & omentum mets in 12/17 49/F
High grade pT3N1bM1b sigmoid Adenocarcinoma colon
MSS-h TMB=16, NRAS-mutant
Lymph nodes: 1/2 left colic; 3/8 regional
12/2017: Exploratory laparotomy & resect of sigmoid & ovaries
Folfox/avastin 12 sessions from 1/8-6/18. 6/18 CEA 2.1
1/19: CT shows peri mets;
CEA: 12/18 5.1, 1/7/19 7.9; 1/15/19 9.1; 1/30/19: 10.6
4/3/2019 CRS/HIPEC after 4 Folfiry sessions...

User avatar
meatie
Posts: 397
Joined: Wed Aug 20, 2014 8:13 am
Location: San Jose, CA

Re: Keytruda....Working for MSS....Mutation Burden is the Key

Postby meatie » Mon May 20, 2019 9:58 pm

Anyone know if the number of mutations increases after going through several different drugs? My mom had one mutation (KRAF?) back in 2015 when a biopsy was done.
Mother DX @59 8/14
cln+lvr res 9/14, stage 4
FOLOX+Avs 12-rd 10/14 to 4/15
Reoccurrence, KRAS mutant 11/15
Folfiri 18-rds 11/15-8/16
PET scan no additional shrinkage 8/16
cyberknife on lymph 10/16

Pyro
Posts: 264
Joined: Mon Oct 12, 2015 7:40 pm
Location: Tucson, AZ

Re: Keytruda....Working for MSS....Mutation Burden is the Key

Postby Pyro » Tue May 21, 2019 8:03 am

meatie wrote:Anyone know if the number of mutations increases after going through several different drugs? My mom had one mutation (KRAF?) back in 2015 when a biopsy was done.


It’s not measurable/predictable like that, ask your oncologist to have it tested.
Aug 2015- Diag Stage 4 CC with liver Mets(38/m)
Sep 2015- Avastin/Folfox/Iron
Dec 2015-Not liver surgery candidate
Jan 2016- Erbitux/Folfiri, 2nd opinion at MDA in TX
Feb 2016 -MDA liver surgery
Mar 2016 -30% of left lobe rem, PVE
May 2016 - 70% of liver rem
Jun 2016-Rad
Jan 2017-perm colost @MDA
Jul 2017-Erb/FOLFURI
Nov 2017 -Lung & Liver ablations@MDA
Jan 2018 -Xeloda & Avastin mx
Jul 2018-Avast/FOLFURI
Sep 2018-Rad
Mar 2019 - Keytruda fail, CEA @36
Jun 2019 - FOLFURI until I can’t stand it

Pyro70
Posts: 118
Joined: Mon Jan 21, 2019 4:25 pm

Re: Keytruda....Working for MSS....Mutation Burden is the Key

Postby Pyro70 » Tue May 21, 2019 1:17 pm

meatie wrote:Anyone know if the number of mutations increases after going through several different drugs? My mom had one mutation (KRAF?) back in 2015 when a biopsy was done.



The jury is still out on this one. Caris just released a study for lung cancer that suggests chemo or radiation does not significantly increase TMB.

Impact of prior chemotherapy or radiation therapy on tumor mutation burden in NSCLC
https://meetinglibrary.asco.org/record/172774/abstract
Dx Jan 2017 stage IVB w/ PC age 35
FOLFOX
SEP 17 HIPEC 1, anastamosis leak
XELODA
MAR 18 HIPEC 2
JUN 18, ileo reversal and 2nd anastamosis leak

Pyro
Posts: 264
Joined: Mon Oct 12, 2015 7:40 pm
Location: Tucson, AZ

Re: Keytruda....Working for MSS....Mutation Burden is the Key

Postby Pyro » Thu May 23, 2019 4:16 pm

Just got an email from the doc, Keytruda didn’t work for me.
Aug 2015- Diag Stage 4 CC with liver Mets(38/m)
Sep 2015- Avastin/Folfox/Iron
Dec 2015-Not liver surgery candidate
Jan 2016- Erbitux/Folfiri, 2nd opinion at MDA in TX
Feb 2016 -MDA liver surgery
Mar 2016 -30% of left lobe rem, PVE
May 2016 - 70% of liver rem
Jun 2016-Rad
Jan 2017-perm colost @MDA
Jul 2017-Erb/FOLFURI
Nov 2017 -Lung & Liver ablations@MDA
Jan 2018 -Xeloda & Avastin mx
Jul 2018-Avast/FOLFURI
Sep 2018-Rad
Mar 2019 - Keytruda fail, CEA @36
Jun 2019 - FOLFURI until I can’t stand it

stu
Posts: 1141
Joined: Sat Aug 17, 2013 5:46 pm

Re: Keytruda....Working for MSS....Mutation Burden is the Key

Postby stu » Fri May 24, 2019 4:35 am

Sorry to hear that .

Stu
supporter to my mum who lives a great life despite a difficult diagnosis
stage4 2009 significant spread to liver
2010 colon /liver resection
chemo following recurrence
73% of liver removed
enjoying life treatment free
2016 lung resection
Oct 2017 nice clear scan . Two lung nodules disappeared
Oct 2018. Another clear scan .

User avatar
Jack&KatiesMommy
Posts: 587
Joined: Wed Dec 21, 2011 1:08 pm
Location: Columbus, OH

Re: Keytruda....Working for MSS....Mutation Burden is the Key

Postby Jack&KatiesMommy » Fri May 24, 2019 9:50 am

I'm so sorry Boswind & Pyro. I always kept going thinking that the longer I stuck around the more new treatments would be available....I have been fighting this disease for 8 years in August and I have seen 3 new breakthroughs and I think there are more just on the horizon.
Cynthia
Cynthia
Mommy to Jack (8) now (16) and Katie (4) now (12)
(My Most Precious Things)
Dx 8/11 Stage IV CRC (liver mets) CEA 2,600+
9/11 Folfiri 2/12: Failed Liver Resection
5/12 HAI pump/removed primary
4/13 Liver Resection
8/13-12/15 (10) RFAs lungs
5/17: Upper Left Lobe of lung resected.
02/18: 3 new mets lymph nodes lung:
05/18: Keytruda (MSS w/Intermediate TMB): CEA: 66.4, 39.2, 23.8, 13, 3.5 1.8, 1.0, 2.8 3.9, 5.0, 5.6, 1.5, .8, .8, 1.1, 1.1, .7
7/18; 9/18; 11/18; 2/19 Clear CT scans


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