Multiple tiny mets on lungs—-need knowledge.

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Rock_Robster
Posts: 379
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Multiple tiny mets on lungs—-need knowledge.

Postby Rock_Robster » Wed Sep 11, 2019 9:20 pm

Rock_Robster wrote:[quote=“Amarie123”]
Rock_Robster wrote:Hi amarie, it is likely your microsatellite stability status on the report (presume MSS) which precludes you from the currently-approved immunotherapies (PD1 inhibitors), rather than the KRAS mutation. However you may still respond to a PD1 inhibitor if you have a high tumour mutation burden (TMB), or if it’s combined with another drug. There are also lots of immunotherapies beyond PD1 inhibitors presently available through trials. Personally I would be very interested in my TMB status and accessing immuno options for MSS patients, esp. given 5FU-based therapy is off the table.

Also Avastin isn’t usually considered an immunotherapy, rather it’s a targeted therapy known as a monoclonal antibody.

Best of luck,
Rob


Thanks for the clarification, it’s a lot of information that I don’t always get right. One issue with some of the treatments is insurance - I might not even be covered for the Avastin if I take it with Lonsurf. My onc is generally on the lookout for clinical trials in the Boston area that I’d be a candidate for.

That’s a pain about the Avastin - I hadn’t heard that about insurance issues when combining with Lonsurf.

Good that your onc is considering local trials - you might also want to look into NIH trials as they also usually cover travel and accommodation expenses, I believe?

Best of luck
Rob[/quote][/quote]
Male 37; Melbourne, Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+ PNI-
3 LN; 4 liver mets, resectable
pT3pN1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0
11/18 - FOLFOX x 6
3/19 - Liver resection
4-5/19 - 25 x pelvic radiation; complete met. response, TRG 3
07/19 - ULAR (robot), temp ileo, 1/27 LN
08/19 - Missed liver spot
08-11/19 - FOLFOX x 1, FOLFOXIRI x 1, FOLFIRI x 5
12/19 - Planned liver resection #2 & stoma reversal

Rock_Robster
Posts: 379
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Multiple tiny mets on lungs—-need knowledge.

Postby Rock_Robster » Wed Sep 11, 2019 9:21 pm

Rock_Robster wrote:
Rock_Robster wrote:[quote=“Amarie123”]
Rock_Robster wrote:Hi amarie, it is likely your microsatellite stability status on the report (presume MSS) which precludes you from the currently-approved immunotherapies (PD1 inhibitors), rather than the KRAS mutation. However you may still respond to a PD1 inhibitor if you have a high tumour mutation burden (TMB), or if it’s combined with another drug. There are also lots of immunotherapies beyond PD1 inhibitors presently available through trials. Personally I would be very interested in my TMB status and accessing immuno options for MSS patients, esp. given 5FU-based therapy is off the table.

Also Avastin isn’t usually considered an immunotherapy, rather it’s a targeted therapy known as a monoclonal antibody.

Best of luck,
Rob


Thanks for the clarification, it’s a lot of information that I don’t always get right. One issue with some of the treatments is insurance - I might not even be covered for the Avastin if I take it with Lonsurf. My onc is generally on the lookout for clinical trials in the Boston area that I’d be a candidate for.

That’s a pain about the Avastin - I hadn’t heard that about insurance issues when combining with Lonsurf.

Good that your onc is considering local trials - you might also want to look into NIH trials as they also usually cover travel and accommodation expenses, I believe?

Best of luck
Rob
Male 37; Melbourne, Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+ PNI-
3 LN; 4 liver mets, resectable
pT3pN1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0
11/18 - FOLFOX x 6
3/19 - Liver resection
4-5/19 - 25 x pelvic radiation; complete met. response, TRG 3
07/19 - ULAR (robot), temp ileo, 1/27 LN
08/19 - Missed liver spot
08-11/19 - FOLFOX x 1, FOLFOXIRI x 1, FOLFIRI x 5
12/19 - Planned liver resection #2 & stoma reversal

Rock_Robster
Posts: 379
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Multiple tiny mets on lungs—-need knowledge.

Postby Rock_Robster » Wed Sep 11, 2019 9:21 pm

Rock_Robster wrote:[quote=“Amarie123”]
Rock_Robster wrote:Hi amarie, it is likely your microsatellite stability status on the report (presume MSS) which precludes you from the currently-approved immunotherapies (PD1 inhibitors), rather than the KRAS mutation. However you may still respond to a PD1 inhibitor if you have a high tumour mutation burden (TMB), or if it’s combined with another drug. There are also lots of immunotherapies beyond PD1 inhibitors presently available through trials. Personally I would be very interested in my TMB status and accessing immuno options for MSS patients, esp. given 5FU-based therapy is off the table.

Also Avastin isn’t usually considered an immunotherapy, rather it’s a targeted therapy known as a monoclonal antibody.

Best of luck,
Rob


Thanks for the clarification, it’s a lot of information that I don’t always get right. One issue with some of the treatments is insurance - I might not even be covered for the Avastin if I take it with Lonsurf. My onc is generally on the lookout for clinical trials in the Boston area that I’d be a candidate for.

That’s a pain about the Avastin - I hadn’t heard that about insurance issues when combining with Lonsurf.

Good that your onc is considering local trials - you might also want to look into NIH trials as they also usually cover travel and accommodation expenses, I believe?

Best of luck
Rob[/quote]
Male 37; Melbourne, Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+ PNI-
3 LN; 4 liver mets, resectable
pT3pN1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0
11/18 - FOLFOX x 6
3/19 - Liver resection
4-5/19 - 25 x pelvic radiation; complete met. response, TRG 3
07/19 - ULAR (robot), temp ileo, 1/27 LN
08/19 - Missed liver spot
08-11/19 - FOLFOX x 1, FOLFOXIRI x 1, FOLFIRI x 5
12/19 - Planned liver resection #2 & stoma reversal

Rock_Robster
Posts: 379
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Multiple tiny mets on lungs—-need knowledge.

Postby Rock_Robster » Wed Sep 11, 2019 9:21 pm

[quote=“Amarie123”]
Rock_Robster wrote:Hi amarie, it is likely your microsatellite stability status on the report (presume MSS) which precludes you from the currently-approved immunotherapies (PD1 inhibitors), rather than the KRAS mutation. However you may still respond to a PD1 inhibitor if you have a high tumour mutation burden (TMB), or if it’s combined with another drug. There are also lots of immunotherapies beyond PD1 inhibitors presently available through trials. Personally I would be very interested in my TMB status and accessing immuno options for MSS patients, esp. given 5FU-based therapy is off the table.

Also Avastin isn’t usually considered an immunotherapy, rather it’s a targeted therapy known as a monoclonal antibody.

Best of luck,
Rob


Thanks for the clarification, it’s a lot of information that I don’t always get right. One issue with some of the treatments is insurance - I might not even be covered for the Avastin if I take it with Lonsurf. My onc is generally on the lookout for clinical trials in the Boston area that I’d be a candidate for.[/quote]
That’s a pain about the Avastin - I hadn’t heard that about insurance issues when combining with Lonsurf.

Good that your onc is considering local trials - you might also want to look into NIH trials as they also usually cover travel and accommodation expenses, I believe?

Best of luck
Rob
Male 37; Melbourne, Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+ PNI-
3 LN; 4 liver mets, resectable
pT3pN1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0
11/18 - FOLFOX x 6
3/19 - Liver resection
4-5/19 - 25 x pelvic radiation; complete met. response, TRG 3
07/19 - ULAR (robot), temp ileo, 1/27 LN
08/19 - Missed liver spot
08-11/19 - FOLFOX x 1, FOLFOXIRI x 1, FOLFIRI x 5
12/19 - Planned liver resection #2 & stoma reversal

Rock_Robster
Posts: 379
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Multiple tiny mets on lungs—-need knowledge.

Postby Rock_Robster » Wed Sep 11, 2019 9:22 pm

Rock_Robster wrote:Hi amarie, it is likely your microsatellite stability status on the report (presume MSS) which precludes you from the currently-approved immunotherapies (PD1 inhibitors), rather than the KRAS mutation. However you may still respond to a PD1 inhibitor if you have a high tumour mutation burden (TMB), or if it’s combined with another drug. There are also lots of immunotherapies beyond PD1 inhibitors presently available through trials. Personally I would be very interested in my TMB status and accessing immuno options for MSS patients, esp. given 5FU-based therapy is off the table.

Also Avastin isn’t usually considered an immunotherapy, rather it’s a targeted therapy known as a monoclonal antibody.

Best of luck,
Rob

Thanks for the clarification, it’s a lot of information that I don’t always get right. One issue with some of the treatments is insurance - I might not even be covered for the Avastin if I take it with Lonsurf. My onc is generally on the lookout for clinical trials in the Boston area that I’d be a candidate for.

That’s a pain about the Avastin - I hadn’t heard that about insurance issues when combining with Lonsurf.

Good that your onc is considering local trials - you might also want to look into NIH trials as they also usually cover travel and accommodation expenses, I believe?

Best of luck
Rob
Male 37; Melbourne, Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+ PNI-
3 LN; 4 liver mets, resectable
pT3pN1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0
11/18 - FOLFOX x 6
3/19 - Liver resection
4-5/19 - 25 x pelvic radiation; complete met. response, TRG 3
07/19 - ULAR (robot), temp ileo, 1/27 LN
08/19 - Missed liver spot
08-11/19 - FOLFOX x 1, FOLFOXIRI x 1, FOLFIRI x 5
12/19 - Planned liver resection #2 & stoma reversal


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