Beginning Radiation/Immunotherapy Combination For Lung Mets

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utahgal7
Posts: 65
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 - 3 cm mass; located 9 cm from AV
03/20 CEA 2.7; 0.9; 1.4; 0.9; 0.9; 1.2; 1.0
04/20 ST Radiation; 04/20 LAR surgery w/ileostomy
04/20 ypT3N1bM0; MSS; moderately differentiated adenocarcinoma
05/20 CAPEOX
08/20 Ileostomy reversal
09/20 CT scan; suspicious areas in liver; 10/20 MRI liver; dx hemangioma
12/20 CT scan; lung nodules (watch and wait); 03/21 CT scan; stable lung nodules (2)
07/21 & 10/21 CT scan; stable lung nodules

utahgal7
Posts: 65
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 - 3 cm mass; located 9 cm from AV
03/20 CEA 2.7; 0.9; 1.4; 0.9; 0.9; 1.2; 1.0
04/20 ST Radiation; 04/20 LAR surgery w/ileostomy
04/20 ypT3N1bM0; MSS; moderately differentiated adenocarcinoma
05/20 CAPEOX
08/20 Ileostomy reversal
09/20 CT scan; suspicious areas in liver; 10/20 MRI liver; dx hemangioma
12/20 CT scan; lung nodules (watch and wait); 03/21 CT scan; stable lung nodules (2)
07/21 & 10/21 CT scan; stable lung nodules

roadrunner
Posts: 204
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: Rectal cancer: Staged as IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.
8/22 -10/14 4 rounds FOLFOX neoadjuvant, 3 w/Oxiplatin (side effects/reduced size est. 70-75%)
neoadjuvant chemorad 11/19
4 rounds of FOLFOX July-August 2020
ncCR found 10/20; biopsies negative
TAE 11/20, small amount of tumor removed, lung nodules orig id’d 6/20 stable Nov 2020
Chest CT 3/30/21 small growth in 2 nodules (3 and 5mm)
VATS 12/8/21 to remove sub-pleural met 7mm. Considering SBRT for remaining nodule.

prayingforccr
Posts: 213
Joined: Sun Jun 28, 2020 4:44 pm

Re: Beginning Radiation/Immunotherapy Combination For Lung Mets

Postby prayingforccr » Wed Nov 17, 2021 4:56 pm

roadrunner wrote: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?


Why not save that for last?

Also, I would prefer death to chemo until death.

I’ve thought long and hard about this.

No interest in 1970s chemo.
11/19: colonoscopy
12/19: diagnosed with stage 3 rectal cancer 6+cm tumor
1-3/20: 20 sessions of radiation, mon-fri capecetibine+clinical trial drug m3814
7/20: 8 treatmentsFOLFOX
11/20: Primary tumor had complete response. Possible tumor deposits on latest mri. Biopsy negative for cancer.
5/21: Multiple lung nodules (3-6mm) on ct scan
10/21: md anderson gives me 1 year without treatment/3 years with folfiri/avastin (refused)
3/22 Will begin immunotherapy/sbrt at weill cornell and nyu/langone in march

MadMed
Posts: 79
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
surgery postponed until after 2/23 sigmoidoscopy

Bpaint
Posts: 27
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?
My husband (age 41 at dx):
8/20 CRC Stage 4. Mets to lungs, liver, distant lymph nodes (25+)
MSS, KRAS wild
CEA 713 at dx
Folfox (12 rounds)
CEA 113
Liver, colon and lymph node resection 4/21
New lung mets, Vectibix monotherapy started 6/21

prayingforccr
Posts: 213
Joined: Sun Jun 28, 2020 4:44 pm

Re: Beginning Radiation/Immunotherapy Combination For Lung Mets

Postby prayingforccr » Tue Nov 30, 2021 6:58 pm

Bpaint wrote: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?


I’m going to weill/cornell monday for ir biopsy of 1cm nodule in peri hepatic space.

If that is a met, that is what Dr Formenti will radiate, while another Dr at nyu/langone will administer the immunotherapy.

If it isn’t a met, I’m not sure how she will want to proceed because the two largest are still sub centimeter.

I’m desperate to get to remission, somehow/some way.

In my latest bloodwork, my cea jumped to 3.4 from 2.1 :( , but ca19-9 collapsed from 61 to 19 :D

So, I have no idea what to expect.
11/19: colonoscopy
12/19: diagnosed with stage 3 rectal cancer 6+cm tumor
1-3/20: 20 sessions of radiation, mon-fri capecetibine+clinical trial drug m3814
7/20: 8 treatmentsFOLFOX
11/20: Primary tumor had complete response. Possible tumor deposits on latest mri. Biopsy negative for cancer.
5/21: Multiple lung nodules (3-6mm) on ct scan
10/21: md anderson gives me 1 year without treatment/3 years with folfiri/avastin (refused)
3/22 Will begin immunotherapy/sbrt at weill cornell and nyu/langone in march

Bpaint
Posts: 27
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.
My husband (age 41 at dx):
8/20 CRC Stage 4. Mets to lungs, liver, distant lymph nodes (25+)
MSS, KRAS wild
CEA 713 at dx
Folfox (12 rounds)
CEA 113
Liver, colon and lymph node resection 4/21
New lung mets, Vectibix monotherapy started 6/21

prayingforccr
Posts: 213
Joined: Sun Jun 28, 2020 4:44 pm

Re: Beginning Radiation/Immunotherapy Combination For Lung Mets

Postby prayingforccr » Tue Nov 30, 2021 8:54 pm

Bpaint wrote: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.


That is the reason I am cautiously optimistic about it.

That, and the two Doctors helping me.

Dr Formenti is a pioneer/practitioner of the abscopal effect for many years.

I do believe it’s going to work.

Will continue to update.
11/19: colonoscopy
12/19: diagnosed with stage 3 rectal cancer 6+cm tumor
1-3/20: 20 sessions of radiation, mon-fri capecetibine+clinical trial drug m3814
7/20: 8 treatmentsFOLFOX
11/20: Primary tumor had complete response. Possible tumor deposits on latest mri. Biopsy negative for cancer.
5/21: Multiple lung nodules (3-6mm) on ct scan
10/21: md anderson gives me 1 year without treatment/3 years with folfiri/avastin (refused)
3/22 Will begin immunotherapy/sbrt at weill cornell and nyu/langone in march

prayingforccr
Posts: 213
Joined: Sun Jun 28, 2020 4:44 pm

Re: Beginning Radiation/Immunotherapy Combination For Lung Mets

Postby prayingforccr » Mon Dec 06, 2021 12:17 pm

Interventional radiation went to biopsy peri hepatic nodule, but there was nothing to biopsy. Nodule had resolved (which is great news)

Waiting on yet ANOTHER lung scan to determine treatment.
Last edited by prayingforccr on Mon Dec 06, 2021 12:41 pm, edited 1 time in total.
11/19: colonoscopy
12/19: diagnosed with stage 3 rectal cancer 6+cm tumor
1-3/20: 20 sessions of radiation, mon-fri capecetibine+clinical trial drug m3814
7/20: 8 treatmentsFOLFOX
11/20: Primary tumor had complete response. Possible tumor deposits on latest mri. Biopsy negative for cancer.
5/21: Multiple lung nodules (3-6mm) on ct scan
10/21: md anderson gives me 1 year without treatment/3 years with folfiri/avastin (refused)
3/22 Will begin immunotherapy/sbrt at weill cornell and nyu/langone in march

MadMed
Posts: 79
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
surgery postponed until after 2/23 sigmoidoscopy

prayingforccr
Posts: 213
Joined: Sun Jun 28, 2020 4:44 pm

Re: Beginning Radiation/Immunotherapy Combination For Lung Mets

Postby prayingforccr » Mon Dec 06, 2021 7:40 pm

COMPARISON:
Chest CT 10/16/2021

FINDINGS:
Lungs and airways: Multiple bilateral solid nodules remain in both lungs, consistent with metastases (annotated on series 303), with slight interval increase in many of the nodules since October. For example:

-- 1.9 x 1 cm nodule (or confluence of nodules) in the right middle lobe (series 303, image 89, previously 1.8 x 0.8 cm;

-- 1 x 0.9 cm nodule slightly more inferiorly in the right middle lobe (series 303, image 93), previously 0.9 x 0.8 cm;

-- 1 x 1 cm nodule in the anterior basilar segment of the left lower lobe (series 303, image 96), previously 0.9 x 0.9 cm;

-- 0.9 x 0.8 cm nodule in the anterior basilar segment of the left lower lobe (series 303, image 102), previously 0.8 x 0.6 cm;

-- 0.8 x 0.7 cm nodule in the lateral basilar segment of the left lower lobe (series 303, image 105), previously 0.7 x 0.6 cm and with interval increase in a small 3 mm cavity from 1 mm;

-- 0.8 x 0.6 cm the nodule in the inferior lingular segment (series 303, image 85), previously 0.6 x 0.5 cm.

Several small 2-6 mm nodules in both lungs are new (see for example series 303, images, 48, 54, 57, 77, 107, 111, 114).

No consolidation. Patent central airways.

Pleura: No pleural effusion.

Mediastinum, Hila, Nodes: No lymphadenopathy.

Heart, Pericardium, and Vasculature: Normal cardiac size. No pericardial effusion. Normal caliber thoracic aorta and central pulmonary arteries.

Upper abdomen: Please see separately dictated abdominal CT.

Bones and Soft Tissues: No aggressive osseous lesions. Unchanged mild spinal degenerative changes, mild upper thoracic levocurvature and minimal bilateral gynecomastia.

Lower neck: Unremarkable

Meeting with Dr Formenti tomorrow.

See what we see.

I’m anxious to get started and either sink or swim.

I’m tired of living like this.
11/19: colonoscopy
12/19: diagnosed with stage 3 rectal cancer 6+cm tumor
1-3/20: 20 sessions of radiation, mon-fri capecetibine+clinical trial drug m3814
7/20: 8 treatmentsFOLFOX
11/20: Primary tumor had complete response. Possible tumor deposits on latest mri. Biopsy negative for cancer.
5/21: Multiple lung nodules (3-6mm) on ct scan
10/21: md anderson gives me 1 year without treatment/3 years with folfiri/avastin (refused)
3/22 Will begin immunotherapy/sbrt at weill cornell and nyu/langone in march

boxhill
Posts: 767
Joined: Fri Apr 06, 2018 11:40 am

Re: Beginning Radiation/Immunotherapy Combination For Lung Mets

Postby boxhill » Mon Dec 06, 2021 11:32 pm

When does your treatment begin?
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
5/19 MRI stable/NED
6/20 Stop Key
All MRIs NED

prayingforccr
Posts: 213
Joined: Sun Jun 28, 2020 4:44 pm

Re: Beginning Radiation/Immunotherapy Combination For Lung Mets

Postby prayingforccr » Tue Dec 07, 2021 2:04 am

boxhill wrote:When does your treatment begin?


Guess I’ll find out today/tomorrow.
11/19: colonoscopy
12/19: diagnosed with stage 3 rectal cancer 6+cm tumor
1-3/20: 20 sessions of radiation, mon-fri capecetibine+clinical trial drug m3814
7/20: 8 treatmentsFOLFOX
11/20: Primary tumor had complete response. Possible tumor deposits on latest mri. Biopsy negative for cancer.
5/21: Multiple lung nodules (3-6mm) on ct scan
10/21: md anderson gives me 1 year without treatment/3 years with folfiri/avastin (refused)
3/22 Will begin immunotherapy/sbrt at weill cornell and nyu/langone in march

prayingforccr
Posts: 213
Joined: Sun Jun 28, 2020 4:44 pm

Re: Beginning Radiation/Immunotherapy Combination For Lung Mets

Postby prayingforccr » Tue Dec 07, 2021 6:51 pm

Met with Dr Formenti

She and I agreed that due to the absence of the liver lesion, and tiny to no progression of lung nodules, that we will wait ANOTHER three months time and then rescan.

Dr Formenti is supportive of my protocol in involving artemisinin, ip6, fenben, quercetin, cbd oil, turmeric, turkey tail and encourages me to continue.

Over and out until March.

Wishing a Merry Christmas and the best for all you warriors out there.

I love you, Erin.
11/19: colonoscopy
12/19: diagnosed with stage 3 rectal cancer 6+cm tumor
1-3/20: 20 sessions of radiation, mon-fri capecetibine+clinical trial drug m3814
7/20: 8 treatmentsFOLFOX
11/20: Primary tumor had complete response. Possible tumor deposits on latest mri. Biopsy negative for cancer.
5/21: Multiple lung nodules (3-6mm) on ct scan
10/21: md anderson gives me 1 year without treatment/3 years with folfiri/avastin (refused)
3/22 Will begin immunotherapy/sbrt at weill cornell and nyu/langone in march


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