Stereotactic Body Radiation Therapy and Immunotherapy

[prayingforccr]

https://www.hematologyandoncology.net/a ... notherapy/

[prayingforccr]

I’ll let you guys know my results as I get them.

Will opdivo/yervoy combined with 5 sessions of sbrt work on MSS lung lesions?

I have my doubts.

First post sbrt/immunotherapy scans in three weeks.

[stu]

Looking forward to seeing how this works for you .
All the very best . Sounds extremely positive .
Stu

[prayingforccr]

Fifth immunotherapy infusion followed by scans tomorrow.

If no growth or smaller lesions, we continue.

If not, next and last stop is nih.

[Markdale]

I’m hoping it works

[beach sunrise]

Hey pccr, Thanks for the update. I hope and pray for good results coming your way!
Keep pushing on and its really good plan B is in place for just in case.
I am cheering for you.

[roadrunner]

I also wish you the best. The way I understand it, success on the immunotherapy front would be icing on the cake, no? And if it isn’t there, you just proceed to the promising experimental therapy you sought through enrolling in this trial. That seems like a reasonably good & hopeful place to be. In any event: Good luck, we are all pulling for you!

[prayingforccr]

Haven’t seen the lung results yet or spoken with docs yet, but this can’t be good:

“ ADRENALS: Interval appearance of 2.1 x 1.4 cm left adrenal nodule. Normal right adrenal“

(sigh)

Assuming next and last stop is nih

[prayingforccr]

dupe

[MadMed]

This seems weird to me, spread to adrenals from CRC is rare unless in stage 4 spread everywhere. Seems to me more of a side effect of immunotherapy.
I hope that's the case pccr. The chest scan results are the key now.

[roadrunner]

I think there’s some reason for concern and vigilance here, but also a silver lining, perhaps? First, this would need to be confirmed as a met. The interval growth/appearance is the concern, of course, and though I don’t know the interval, I suspect the growth rate is concerning. Whether immunotherapy or the alternative therapies you pursue could be involved is beyond my knowledge.

The more positive piece here, I think, is that this may well say little about the lungs or other areas in the body. Metastases in the adrenal glands are famously resistant to the effects of immunotherapy. Much research has been done to determine the reason, but I haven’t seen a definitive answer. In any case, that suggests that the therapy might be having positive effects elsewhere, or that your immune system was controlling disease better elsewhere, or both. The lung scans, therefore, may not be bad even if this is a met. The same goes for the overall picture, I believe.

It does raise potential questions for next steps. I have no clue as to whether TIL therapy could affect an adrenal met, and I doubt the folks leading the study will either. Adrenal mets are usually treated via surgery, so the timing of that and how it might interact with TIL therapy (if necessary) and the trial protocol may become important questions. Again, most of the above presumes that this finding does represent disease, which I hope is not the case.

[prayingforccr]

This seems weird to me, spread to adrenals from CRC is rare unless in stage 4 spread everywhere. Seems to me more of a side effect of immunotherapy.
I hope that's the case pccr. The chest scan results are the key now.

I know the immunotherapy very often affects the thyroid which, in turn, affects the adrenals.

Findings:

01. LIVER: Normal.
02. SPLEEN: Normal.
03. PANCREAS: Normal.
04. GALLBLADDER/BILIARY TREE:
05. ADRENALS: Interval appearance of 2.1 x 1.4 cm left adrenal nodule. Normal right adrenal
06. KIDNEYS:
No calculi or hydronephrosis. No soft tissue attenuating renal mass.
07. LYMPHADENOPATHY/RETROPERITONEUM: Lymphadenopathy
08. BOWEL: Stable appearance of the rectum. Stable infiltrate in the resection margin stomach and small bowel are normal
09. PELVIC VISCERA: Normal bladder and 3.3 cm prostate
10. PELVIC LYMPH NODES: No pelvic adenopathy
11. VASCULATURE: Normal caliber aorta
12. PERITONEUM/ABDOMINAL WALL: No ascites or implants
13. SKELETAL: No lytic/blastic lesions
14. LUNG BASES: See accompanying chest CT

NIH Doctor said thats really good given the fact we’re dealing with metastatic disease.

I haven’t gotten chest ct yet, which is of the most interest.

[prayingforccr]

Dr Chachoua and Dr Formenti believe there has been enough progression to warrant discontinuing with immunotherapy and beginning the TIL treatment at nih.

We are looking to begin mid December

Very disappointing, but not surprising.

I never read any indication that opdivo/yervoy would be effective treatment for MSS tumors.

Better have all my affairs in order and price up helium canisters.

[MadMed]

Progression in the lung mets ? Sorry pccr, gut punch.

[prayingforccr]

Progression in the lung mets ? Sorry pccr, gut punch.

New lymph nodes, as well.

Comparison was all the way back to March 3.

FINDINGS:

LUNGS, AIRWAYS: Central airways are patent. Mild diffuse bronchial wall thickening. Status post interval sublobar resection of the middle lobe with mild soft tissue thickening along the surgical chain sutures, with surrounding scarring and architectural distortion, representing postsurgical changes. Numerous bilateral solid lung nodules have enlarged since the immediate prior chest CT, most of which demonstrate lobulated and spiculated margins, measured on series 5. For reference, 1.6 x 1.5 cm nodule in the left upper lobe on image 127 (previously 1.2 x 0.9 cm), 1.9 x 1.7 cm nodule in the lingula on image 286 (previously 1.0 x 1.0 cm) and 2.2 x 2.0 cm right lower lobe nodule on image 315 (previously 1.2 x 0.7 cm).

PLEURA: No pleural effusion or pneumothorax.

MEDIASTINUM, HILA, LYMPH NODES: Multiple enlarged bilateral hilar and mediastinal lymph nodes are new or enlarged since the immediate prior study, some of which are centrally necrotic, including in the sternal notch, para-aortic, AP window, right and left paratracheal, and subcarinal stations, consistent with nodal metastases. For reference, new 3.6 x 3.0 cm lobulated centrally necrotic right paratracheal lymph node on series 3 image 65 and enlarging 3.2 x 2.4 cm necrotic AP window lymph node on series 3 image 60 (previously 1.3 x 1.0 cm).

HEART AND VESSELS: Normal heart size. No pericardial effusion. Normal caliber thoracic aorta and central pulmonary arteries.

UPPER ABDOMEN: See separately dictated report of companion abdomen/pelvis CT for detailed findings.

BONES AND SOFT TISSUES: No significant chest wall abnormalities. No aggressive osseous lesions.

LOWER NECK: No masses identified in the visualized lower neck.