Waiting for PET results & HAI pump issue

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mpbser
Posts: 590
Joined: Wed Apr 19, 2017 11:52 am

Re: Waiting for PET results & HAI pump issue

Postby mpbser » Thu Jan 10, 2019 10:16 am

Here's the section pertinent to the liver:

HEPATOBILIARY: Pattern of diffuse mild heterogeneous uptake in the liver probably related to statistical noise. No definite focal increased uptake corresponding to hepatic lesions which are better characterized on MR abdomen December 3, 2018. Note that assessment of metabolic activity may be limited in view of background of diffuse heterogenous hepatic uptake and/or size of these hepatic lesions.

Interesting.... I don't know what to make of all this.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED

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LPL
Posts: 458
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: Waiting for PET results & HAI pump issue

Postby LPL » Thu Jan 10, 2019 1:21 pm

mpbser wrote:
Calling Mass General today to reschedule the biopsy-ablation which is definitely premature at this point. Friday's MRI at MSK will be extremely helpful.

mpbser, Good Luck tomorrow!
I hope you will get more answers and a clear MRI.
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma pt 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a Stage IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED for now :D
:!: Steroid induced hyperglycemia dx after 3chemo .. hospitalized, insulin -> Metformin
Surgeries (open):
3/18 Emergency colostomy 5/23 Primary+gallbl+colostomy reversal (+port) 9/01 Liver mets

mpbser
Posts: 590
Joined: Wed Apr 19, 2017 11:52 am

Re: Waiting for PET results & HAI pump issue

Postby mpbser » Thu Jan 10, 2019 1:50 pm

Thanks! Let us know how your scan this week went!
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED

User avatar
LPL
Posts: 458
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: Waiting for PET results & HAI pump issue

Postby LPL » Thu Jan 10, 2019 2:06 pm

Thanks - Yes I will. The PET is Thursday next week. We see Onc the Monday after. Reading now about different scenarios.. as ‘we’ do ;| trying to be prepared...
Last edited by LPL on Tue Jan 15, 2019 4:29 pm, edited 1 time in total.
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma pt 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a Stage IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED for now :D
:!: Steroid induced hyperglycemia dx after 3chemo .. hospitalized, insulin -> Metformin
Surgeries (open):
3/18 Emergency colostomy 5/23 Primary+gallbl+colostomy reversal (+port) 9/01 Liver mets

mpbser
Posts: 590
Joined: Wed Apr 19, 2017 11:52 am

Re: Waiting for PET results & HAI pump issue

Postby mpbser » Tue Jan 15, 2019 12:18 pm

Damn it. I had gotten my hopes up. MSK's MRI confirmed that segment 6 has a met. Going to meet with surgeon Dr. D'Angelica on Monday.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED

User avatar
LPL
Posts: 458
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: Waiting for PET results & HAI pump issue

Postby LPL » Tue Jan 15, 2019 3:04 pm

Oh :( I did not see that coming.
But you are in good hands ! Thinking about you.
Hoping you will get a good plan on Monday.
Last edited by LPL on Wed Jan 16, 2019 11:12 am, edited 1 time in total.
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma pt 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a Stage IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED for now :D
:!: Steroid induced hyperglycemia dx after 3chemo .. hospitalized, insulin -> Metformin
Surgeries (open):
3/18 Emergency colostomy 5/23 Primary+gallbl+colostomy reversal (+port) 9/01 Liver mets

mpbser
Posts: 590
Joined: Wed Apr 19, 2017 11:52 am

Re: Waiting for PET results & HAI pump issue

Postby mpbser » Tue Jan 15, 2019 3:30 pm

I am pretty shocked. My husband is now set on the pump. He wants to double his chances of recurrence-free survival.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED

User avatar
LPL
Posts: 458
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: Waiting for PET results & HAI pump issue

Postby LPL » Tue Jan 15, 2019 4:06 pm

mpbser wrote:I am pretty shocked. My husband is now set on the pump. He wants to double his chances of recurrence-free survival.

I totally understand that. If we lived in the USA and DH had the same results, that would be what I wished he would decide to do. All the best to you going forward.
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma pt 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a Stage IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED for now :D
:!: Steroid induced hyperglycemia dx after 3chemo .. hospitalized, insulin -> Metformin
Surgeries (open):
3/18 Emergency colostomy 5/23 Primary+gallbl+colostomy reversal (+port) 9/01 Liver mets

User avatar
juliej
Posts: 2904
Joined: Thu Aug 05, 2010 12:59 pm

Re: Waiting for PET results & HAI pump issue

Postby juliej » Wed Jan 16, 2019 8:16 pm

mpbser wrote:Damn it. I had gotten my hopes up. MSK's MRI confirmed that segment 6 has a met. Going to meet with surgeon Dr. D'Angelica on Monday.

D'Angelica is brilliant, as I've mentioned before. He is also very handsome. So be prepared. :D
Stage IV, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/11
LAR, liver resec, HAI pump 11/11
Double lung surgery + ileo reversal 2/12
Adjuvant Xeloda 3-9/12
VATS rt. lung 12/21/12 - benign granuloma!
NED 3/17/12 to 9/14/2018, CEA<1

mpbser
Posts: 590
Joined: Wed Apr 19, 2017 11:52 am

Re: Waiting for PET results & HAI pump issue

Postby mpbser » Thu Jan 17, 2019 7:22 am

julie,

I just noticed that you got the HAI pump although you had lung mets. For some reason (in addition to the fact that extrahepatic cancer disqualifies people from the pump trial at MSK) I thought that one cannot get the pump if there are lung mets.

I am curious because a family friend had two lung ablations recently and just yesterday a scan found another tumor on his liver which had been worked on a few months ago. She is at UPenn where Dr. DeMatteo now is and I have heard that he has wanted to start a pump program there. I'm wondering if she might be a candidate.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED

User avatar
juliej
Posts: 2904
Joined: Thu Aug 05, 2010 12:59 pm

Re: Waiting for PET results & HAI pump issue

Postby juliej » Thu Jan 17, 2019 5:12 pm

mpbser wrote:julie,

I just noticed that you got the HAI pump although you had lung mets. For some reason (in addition to the fact that extrahepatic cancer disqualifies people from the pump trial at MSK) I thought that one cannot get the pump if there are lung mets.

I am curious because a family friend had two lung ablations recently and just yesterday a scan found another tumor on his liver which had been worked on a few months ago. She is at UPenn where Dr. DeMatteo now is and I have heard that he has wanted to start a pump program there. I'm wondering if she might be a candidate.

My two lung mets (a giant one in each lung!) didn't disqualify me for the HAI pump. I had a liver resection, removal of my primary tumor, and the pump implanted in a huge triple 7 1/2 hour surgery shortly after my consultation at MSK. I went back on chemo a few weeks after I recovered. Then three months later, I had double lung surgery plus an ileostomy reversal (another triple procedure). After a short recovery I went back on both chemo in the pump and systemic chemo until I finished my adjuvant treatment.

I would definitely bring this up with Dr. DeMatteo (who's a really great doc!) and see if your friend is a candidate for an HAI pump. If his lung mets have been ablated there's no reason he couldn't have it, as far as I know. He could bring me up as an example and DeMatteo could check with Kemeny for my case file. A lot depends on his current state -- is his current chemo regime working to keep things under control? is his CEA getting lower? what is his genetic profile? etc. -- but it's definitely worth a try.

I think lung mets only really disqualify someone from the pump clinical trial (because trials are very rigid in their requirements), and otherwise it's up to the oncologist and her team to decide if it's a good move for a particular patient. Aggressive treatment isn't for everyone, but when it works, it's a freaking miracle!

Juliej
Stage IV, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/11
LAR, liver resec, HAI pump 11/11
Double lung surgery + ileo reversal 2/12
Adjuvant Xeloda 3-9/12
VATS rt. lung 12/21/12 - benign granuloma!
NED 3/17/12 to 9/14/2018, CEA<1

mpbser
Posts: 590
Joined: Wed Apr 19, 2017 11:52 am

Re: Waiting for PET results & HAI pump issue

Postby mpbser » Thu Jan 17, 2019 6:30 pm

I will make the suggestion to my aunt. It's actually my aunt's best friend who is going through this. Someone on one of the colontown groups on facebook told me that Dr. DeMatteo canceled the pump program when the Codman production stopped. I'm not sure if they are doing the Medtronic-Codman adaptation "off label" like some places are currently doing.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED


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