Beginning Radiation/Immunotherapy Combination For Lung Mets

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catstaff
Posts: 177
Joined: Wed Mar 03, 2021 11:37 am

Re: Beginning Radiation/Immunotherapy Combination For Lung Mets

Postby catstaff » Mon Nov 15, 2021 8:03 pm

Good luck, keep us informed.
D/H Dx 10/2019 RC age 61
Clinical T4bN2M1a (common iliac and para-aortic lymph nodes)
MSS KRAS G12D
CRT 11/19-1/20 FOLFOX 3/20-7/20
Pelvic exenteration w/LAR 8/20
ypT4bN0Mx G3 0/14 nodes LVI not seen PNI-
CEA 10/19:20, 1/20-11/20:1.6, 4.3, 3.4, 2.7, 2/21:9.0 3/21:18,40 4/21:28,19, 5/21:13.3,8.6
PET 3/21 recurrence in distal nodes, L5 vertebra, pelvis
FOLFIRI+bev 3/21-

roadrunner
Posts: 460
Joined: Sun Jan 12, 2020 8:46 pm

Re: Beginning Radiation/Immunotherapy Combination For Lung Mets

Postby roadrunner » Mon Nov 15, 2021 9:00 pm

Good luck, indeed! I hope you have success with this approach.
7/19: RC: Staged IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.; lung micronodule
8/19-10/19 4 rds.FOLFOX neoadjuvant, 3 w/Oxiplatin (reduced 70-75%)
neoadjuvant chemorad 11/19
4 rounds FOLFOX July-August 2020
ncCR 10/20; biopsies neg
TAE 11/20, tumor cells removed
Chest CT 3/30/21 growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT nodule 1/22
6/20/22 TAE rectal polyp benign)
NED from 3/22 - 3/23
4 cycles FOLFIRI
LUL VATS lobectomy for radio resistant met 7/7/23

Sunnycd
Posts: 88
Joined: Fri Feb 26, 2021 10:36 am

Re: Beginning Radiation/Immunotherapy Combination For Lung Mets

Postby Sunnycd » Mon Nov 15, 2021 11:12 pm

Good luck, and hopefully you will find a few fun things to do in NY. Broadway shows are back and I think it is much easier to get tix too. Keep us posted. We are all rooting for you!
DX Feb. ‘21 CC IIB @ 51
Jan. ‘21 ER surgery, temp. colostomy
Sigmoid, adernocarcinoma
T4aN0MX, G2
0/24 lymph nodes
LVI: indefinite
PNI: not identified
Margins: clear
March ‘21 started 4 rounds of CAPOX
06/17/21 last day of CAPOX
06/25/21 CT scan clear
CEA: @ dx 4, post surgery 1.9, post chemo: 2.9; 09/21: 1.5
07/14/21 colostomy reversal
09/24/21 CT clear
10/12/21 colonoscopy; 1 polyp
12/05/23 colonoscopy clear
MSS, RAS/RAF wild, PIK3CA mutant

Rock_Robster
Posts: 1027
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Beginning Radiation/Immunotherapy Combination For Lung Mets

Postby Rock_Robster » Mon Nov 15, 2021 11:30 pm

Good luck, and great to hear. Is this as part of a trial, or off-label for the I/O drugs?
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev
3/24 VAXINIA (CF33 + hNIS) trial

MadMed
Posts: 216
Joined: Sun May 02, 2021 5:52 pm
Location: Massachusetts

Re: Beginning Radiation/Immunotherapy Combination For Lung Mets

Postby MadMed » Tue Nov 16, 2021 8:29 am

prayingforccr wrote:
I will update if the thread generates interest.


great to hear from you prayingforccr, Good luck, i really hope this works. I’m curious, the primary is completely gone and you never had surgery ? That means you don’t have to deal with post surgical complications right ?
52M DX: RC lower rectum, guessing now 2cm from AV 4/27/2021
T3N0M0 adenocarcinoma with signet ring cell features
Tumor size 30mm
Tumor grade: G3
Baseline CEA 1.0
MSI status: MSS pMMR
Started Folfox 5/12/2021
Switched to FOLFIRINOX from session 2. 8 rounds total.
CT+MRI tumor contained shrunk 80%, no spread to other organs.
CRT started xeloda + 28 days Radiation 9/27-11/04
NED as of 4/06 CT/MRI/sigmoidoscopy
On W&W 04/06/2022

claudine
Posts: 809
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: Beginning Radiation/Immunotherapy Combination For Lung Mets

Postby claudine » Tue Nov 16, 2021 9:31 am

That is fantastic news :D :D :D
Kudos for being so proactive and finding someone ready to go after the multiple mets. I’ll be looking for updates as the treatment progresses, hoping for a complete cure for you!
Wife of Dx 04/18 (51 yo). MSS, KRAS G12A, no primary

Tumors: L4 04/18; left adrenal gland & small lung nodules 03/19
rectum 02/22 (pT3 pN0 stage 2A); L3 09/22

Surgeries: intestinal resect. 05/18 (no cancer - Crohn's); adrenalectomy 02/20
L3-L4-L5 fusion and corpectomy 05/20; LAR 04/22; ileo reversal 09/22
L2-L3 fusion and corpectomy 09/22

Treatments: EBRT 04/18; SBRT 02/19; Failed adjuvant Xelox ; Folfiri/Avastin 03/19 - 01/20
adjuvant chemorad (Xeloda) 06/22; SBRT 11/22; Xeloda/Avastin since 01/24

boxhill
Posts: 789
Joined: Fri Apr 06, 2018 11:40 am

Re: Beginning Radiation/Immunotherapy Combination For Lung Mets

Postby boxhill » Tue Nov 16, 2021 1:54 pm

This is fascinating. I hope this approach works for you. (And others. I had vaguely heard of efforts to sensitize non-MSI tumors to immunotherapy using radiation.)

Please, do, keep us informed. Keeping all appendages crossed for you!
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemi
11 of 25 LN,5 mesentery nodes
5mm liver met
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/18 FOLFOX
7/18 and 11/18 CT NED
12/18 MRI 5mm liver mass, 2 LNs in porta hepatis
12/31/18 Keytruda
6/19 Multiphasic CT LNs normal, Liver stable
6/28/19 Pause Key, predisone for joint pain
7/31/19 Restart Key
9/19 CT stable
Pain: all fails but Celebrex
12/23/19 CT stable
5/20 MRI stable/NED
6/20 Stop Key
All MRIs NED

MadMed
Posts: 216
Joined: Sun May 02, 2021 5:52 pm
Location: Massachusetts

Re: Beginning Radiation/Immunotherapy Combination For Lung Mets

Postby MadMed » Wed Nov 17, 2021 9:47 am

Thank you, i will have to make the surgery decision in a few weeks. Good to know that you got great results locally. I can't imagine going through surgery and then having to deal with chemo post surgery for a recurrence!

As you said, mop up and move on. Sounds like a great plan!
52M DX: RC lower rectum, guessing now 2cm from AV 4/27/2021
T3N0M0 adenocarcinoma with signet ring cell features
Tumor size 30mm
Tumor grade: G3
Baseline CEA 1.0
MSI status: MSS pMMR
Started Folfox 5/12/2021
Switched to FOLFIRINOX from session 2. 8 rounds total.
CT+MRI tumor contained shrunk 80%, no spread to other organs.
CRT started xeloda + 28 days Radiation 9/27-11/04
NED as of 4/06 CT/MRI/sigmoidoscopy
On W&W 04/06/2022

utahgal7
Posts: 201
Joined: Fri Sep 11, 2020 12:04 pm

Re: Beginning Radiation/Immunotherapy Combination For Lung Mets

Postby utahgal7 » Wed Nov 17, 2021 11:53 am

prayingforccr:

I was just thinking about you the other day. I had not seen any recent posts from you and I was worried. Sorry to hear about the lung nodules, but it sounds like you have got a good plan of attack in place. I am really sad that the Joe Tippens protocol was ineffective for you. Unfortunately, I have not read about a single rectal cancer patient that has benefited from it.

I do hope you can get back to hiking Camelback Mountain. I didn't know you lived in Phoenix.

Again, I am really sorry to hear about this news. You have been through a lot. You've got this! I will pray and light a candle for you.


Sending you hugs!

Paige
02/20 Rectal Cancer dx - 4 cm mass; located 9 cm from AV
03/20 CEA 2.7; 0.9; 1.4; 0.9; 0.9; 1.2; 1.0; 0.8; 1.1; 1.0; 1.1; 1.7; 1.8; 1.8
1.9; 2.4; 2.3; 2.8; 2.2, 2.8, 3.2; 3.0; 1.6; 2.0; 1.2
04/20 ST Radiation; 04/20 LAR surgery w/ileostomy; ypT3N1bM0; MSS, KRAS G12A
05/20 CAPEOX; 08/20 Ileostomy reversal
12/20 CT scan; lung nodules (watch and wait);
11/22 lung nodule biopsy positive for RC met;
1/23 VATS right lower lobe wedge resection
FOLFIRI 10 cycles

utahgal7
Posts: 201
Joined: Fri Sep 11, 2020 12:04 pm

Re: Beginning Radiation/Immunotherapy Combination For Lung Mets

Postby utahgal7 » Wed Nov 17, 2021 12:27 pm

prayingforccr:

One more thing that I forgot to ask....Sorry if this seems like a stupid question...Would FOLFIRI not help shrink the lung nodules? Also, I thought only patients with MSI-H were eligible for Opdivo? I could not find info in your signature about microsatellite status.
02/20 Rectal Cancer dx - 4 cm mass; located 9 cm from AV
03/20 CEA 2.7; 0.9; 1.4; 0.9; 0.9; 1.2; 1.0; 0.8; 1.1; 1.0; 1.1; 1.7; 1.8; 1.8
1.9; 2.4; 2.3; 2.8; 2.2, 2.8, 3.2; 3.0; 1.6; 2.0; 1.2
04/20 ST Radiation; 04/20 LAR surgery w/ileostomy; ypT3N1bM0; MSS, KRAS G12A
05/20 CAPEOX; 08/20 Ileostomy reversal
12/20 CT scan; lung nodules (watch and wait);
11/22 lung nodule biopsy positive for RC met;
1/23 VATS right lower lobe wedge resection
FOLFIRI 10 cycles

roadrunner
Posts: 460
Joined: Sun Jan 12, 2020 8:46 pm

Re: Beginning Radiation/Immunotherapy Combination For Lung Mets

Postby roadrunner » Wed Nov 17, 2021 1:15 pm

Paige makes a good point. FOLFIRI has good control numbers too. I think it’s expected to stop progression of pulmonary metastases for 9-12 months. And I know there’s at least one member who cleared multiple nodules with FOLFIRI. Also, 5-FU based chemo did well with your primary, so perhaps it has a better chance of working here? Wouldn’t it potentially be better to take that step first?
7/19: RC: Staged IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.; lung micronodule
8/19-10/19 4 rds.FOLFOX neoadjuvant, 3 w/Oxiplatin (reduced 70-75%)
neoadjuvant chemorad 11/19
4 rounds FOLFOX July-August 2020
ncCR 10/20; biopsies neg
TAE 11/20, tumor cells removed
Chest CT 3/30/21 growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT nodule 1/22
6/20/22 TAE rectal polyp benign)
NED from 3/22 - 3/23
4 cycles FOLFIRI
LUL VATS lobectomy for radio resistant met 7/7/23

MadMed
Posts: 216
Joined: Sun May 02, 2021 5:52 pm
Location: Massachusetts

Re: Beginning Radiation/Immunotherapy Combination For Lung Mets

Postby MadMed » Wed Nov 17, 2021 6:30 pm

prayingforccr wrote:
MadMed wrote:Thank you, i will have to make the surgery decision in a few weeks. Good to know that you got great results locally. I can't imagine going through surgery and then having to deal with chemo post surgery for a recurrence!

As you said, mop up and move on. Sounds like a great plan!


I did a clinical trial at mskcc which involved chemo radiation concurrent with a trial drug (m3814), then 6 cycles of FOLFOX.

It was a brutal year.

Hoping the best for you, MadMed.



Thank you, i'm rooting for a successful treatment for you. It will help everyone to see you better and see a new avenue for treatment.
52M DX: RC lower rectum, guessing now 2cm from AV 4/27/2021
T3N0M0 adenocarcinoma with signet ring cell features
Tumor size 30mm
Tumor grade: G3
Baseline CEA 1.0
MSI status: MSS pMMR
Started Folfox 5/12/2021
Switched to FOLFIRINOX from session 2. 8 rounds total.
CT+MRI tumor contained shrunk 80%, no spread to other organs.
CRT started xeloda + 28 days Radiation 9/27-11/04
NED as of 4/06 CT/MRI/sigmoidoscopy
On W&W 04/06/2022

Bpaint
Posts: 68
Joined: Sun Oct 11, 2020 8:54 pm

Re: Beginning Radiation/Immunotherapy Combination For Lung Mets

Postby Bpaint » Tue Nov 30, 2021 12:45 pm

I'm hoping for the best for you, prayingforccr!

I'm curious, do you know what they will be radiating? Are they going to target only some of the lung spots, or all of them?
husband (age 41 at dx):
8/20 CRC Stage 4. Mets to lungs, liver, distant lymph nodes
MSS, KRAS wild
CEA 713 at dx
Folfox (12 rounds)
Liver, colon and node resection 4/21
New lung mets, Vectibix monotherapy started 6/21
Stop Vectibix lungs stable about 6 months; all other areas stable
Start Folfiri + avastin 1/22
Stop Folfiri (lungs stable 6 mos); start Vectibix 7/22
Stop Vectibix 12/22 (lungs stable 5 mos this time)
SBRT on lung Mets scheduled for 1/22, will restart Folfiri

Bpaint
Posts: 68
Joined: Sun Oct 11, 2020 8:54 pm

Re: Beginning Radiation/Immunotherapy Combination For Lung Mets

Postby Bpaint » Tue Nov 30, 2021 8:28 pm

Got it. I read the article you linked and a bit more about radiation plus immunotherapy. It’s interesting and I really hope it works for you. I’m going to raise it with my husband’s oncologist at the next visit. I know he is running some clinical trials with opdivo and yervoy for MSS patients, but I don’t think he is also using radiation with them.
husband (age 41 at dx):
8/20 CRC Stage 4. Mets to lungs, liver, distant lymph nodes
MSS, KRAS wild
CEA 713 at dx
Folfox (12 rounds)
Liver, colon and node resection 4/21
New lung mets, Vectibix monotherapy started 6/21
Stop Vectibix lungs stable about 6 months; all other areas stable
Start Folfiri + avastin 1/22
Stop Folfiri (lungs stable 6 mos); start Vectibix 7/22
Stop Vectibix 12/22 (lungs stable 5 mos this time)
SBRT on lung Mets scheduled for 1/22, will restart Folfiri

MadMed
Posts: 216
Joined: Sun May 02, 2021 5:52 pm
Location: Massachusetts

Re: Beginning Radiation/Immunotherapy Combination For Lung Mets

Postby MadMed » Mon Dec 06, 2021 12:41 pm

Awesome news on a Monday morning! thanks for sharing, hoping the lung scan brings more good news.
Stay strong prayingforcc!
52M DX: RC lower rectum, guessing now 2cm from AV 4/27/2021
T3N0M0 adenocarcinoma with signet ring cell features
Tumor size 30mm
Tumor grade: G3
Baseline CEA 1.0
MSI status: MSS pMMR
Started Folfox 5/12/2021
Switched to FOLFIRINOX from session 2. 8 rounds total.
CT+MRI tumor contained shrunk 80%, no spread to other organs.
CRT started xeloda + 28 days Radiation 9/27-11/04
NED as of 4/06 CT/MRI/sigmoidoscopy
On W&W 04/06/2022


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