Stereotactic Body Radiation Therapy and Immunotherapy

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prayingforccr
Posts: 461
Joined: Sun Jun 28, 2020 4:44 pm

Stereotactic Body Radiation Therapy and Immunotherapy

Postby prayingforccr » Sun Oct 16, 2022 11:22 am

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.
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 No growth in nodules 6 months
8/22 beginning sbrt and immunotherapy
10/22 sbrt and immunotherapy failed
12/22 TIL Therapy

prayingforccr
Posts: 461
Joined: Sun Jun 28, 2020 4:44 pm

Re: Stereotactic Body Radiation Therapy and Immunotherapy

Postby prayingforccr » Sun Oct 16, 2022 11:23 am

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.
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.
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 No growth in nodules 6 months
8/22 beginning sbrt and immunotherapy
10/22 sbrt and immunotherapy failed
12/22 TIL Therapy

stu
Posts: 1590
Joined: Sat Aug 17, 2013 5:46 pm

Re: Stereotactic Body Radiation Therapy and Immunotherapy

Postby stu » Wed Oct 19, 2022 3:44 am

Looking forward to seeing how this works for you .
All the very best . Sounds extremely positive .
Stu
supporter to my mum who lives a great life despite a difficult diagnosis
stage4 2009 significant spread to liver
2010 colon /liver resection
chemo following recurrence
73% of liver removed
enjoying life treatment free
2016 lung resection
Oct 2017 nice clear scan . Two lung nodules disappeared
Oct 2018. Another clear scan .

prayingforccr
Posts: 461
Joined: Sun Jun 28, 2020 4:44 pm

Re: Stereotactic Body Radiation Therapy and Immunotherapy

Postby prayingforccr » Thu Nov 03, 2022 8:58 pm

Fifth immunotherapy infusion followed by scans tomorrow.

If no growth or smaller lesions, we continue.

If not, next and last stop is nih.
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.
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 No growth in nodules 6 months
8/22 beginning sbrt and immunotherapy
10/22 sbrt and immunotherapy failed
12/22 TIL Therapy

Markdale
Posts: 47
Joined: Wed Dec 02, 2020 4:45 pm

Re: Stereotactic Body Radiation Therapy and Immunotherapy

Postby Markdale » Fri Nov 04, 2022 5:51 am

I’m hoping it works
09/20:Diagnosed after colonoscopy for bleeding.
MRI and ct scan confirmed tumor at rectosigmoid junction aswell as lung nodules in RLL (1X1.2cm) and RUL (3X.5cm)
10/20: low anterior resection tumour t3n2m1 4/24 lymph nodes. No ileostomy.
11/20: pet scan showed low to moderate uptake of glucose.
11/20: folfoxiri - 10/6/21. 12 rounds in total
12/20: ct lung biopsy of lung nodule to confirm metastasis. Biopsy unsuccessful
1/1/21 thoracotomy (unsuccessful)
2/2022 sabr to 2 lung nodules

User avatar
beach sunrise
Posts: 724
Joined: Thu Mar 05, 2020 7:14 pm

Re: Stereotactic Body Radiation Therapy and Immunotherapy

Postby beach sunrise » Fri Nov 04, 2022 10:43 am

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.
8/19 RC CEA 82.6 T3N0M0
Neoadj 5FU/rad 6 wk
High dose IVC 1 1/2 wks before surgery. Continue still twice a week
Surg 1/20 APR - margins T4bN1a IIIC G2 MSI- 1/20 LN+ LVI+ PNI-
pre cea 24/post 5.9
FOLFOX
7 rds 6-10 CEA 11.4 No more
7/20 CEA 11.1, 8.8
8/20 CEA 7.8
9/20 CEA 8.8, 9, 8.6
10/20 CEA 8.1
11/20 CEA 8's
12/20 CEA 8's & 9's
ADAPT+++ TM drug
MHL1+
PMS2+
MSH2+
MSH6+
POLD1 , KRAS Q61H
Chem-sens test NCI "Test failed, neo adj CR worked. Not enough ca cells to test"

roadrunner
Posts: 310
Joined: Sun Jan 12, 2020 8:46 pm

Re: Stereotactic Body Radiation Therapy and Immunotherapy

Postby roadrunner » Fri Nov 04, 2022 2:55 pm

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!
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
CT 3/22: Clear
Chest CT 5/19/22 Clear
6/20/22 TAE rectal polyp benign
CT/MRI 9/11 Clear
11/9/22: Rectal exam/scope Clear (2 yrs.)

prayingforccr
Posts: 461
Joined: Sun Jun 28, 2020 4:44 pm

Re: Stereotactic Body Radiation Therapy and Immunotherapy

Postby prayingforccr » Sat Nov 05, 2022 11:00 am

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
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.
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 No growth in nodules 6 months
8/22 beginning sbrt and immunotherapy
10/22 sbrt and immunotherapy failed
12/22 TIL Therapy

prayingforccr
Posts: 461
Joined: Sun Jun 28, 2020 4:44 pm

Re: Stereotactic Body Radiation Therapy and Immunotherapy

Postby prayingforccr » Sat Nov 05, 2022 8:01 pm

dupe
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.
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 No growth in nodules 6 months
8/22 beginning sbrt and immunotherapy
10/22 sbrt and immunotherapy failed
12/22 TIL Therapy

MadMed
Posts: 187
Joined: Sun May 02, 2021 5:52 pm
Location: Massachusetts

Re: Stereotactic Body Radiation Therapy and Immunotherapy

Postby MadMed » Sun Nov 06, 2022 11:11 am

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.
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

roadrunner
Posts: 310
Joined: Sun Jan 12, 2020 8:46 pm

Re: Stereotactic Body Radiation Therapy and Immunotherapy

Postby roadrunner » Sun Nov 06, 2022 2:40 pm

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.
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
CT 3/22: Clear
Chest CT 5/19/22 Clear
6/20/22 TAE rectal polyp benign
CT/MRI 9/11 Clear
11/9/22: Rectal exam/scope Clear (2 yrs.)

prayingforccr
Posts: 461
Joined: Sun Jun 28, 2020 4:44 pm

Re: Stereotactic Body Radiation Therapy and Immunotherapy

Postby prayingforccr » Mon Nov 07, 2022 6:57 am

MadMed wrote: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.
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.
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 No growth in nodules 6 months
8/22 beginning sbrt and immunotherapy
10/22 sbrt and immunotherapy failed
12/22 TIL Therapy

prayingforccr
Posts: 461
Joined: Sun Jun 28, 2020 4:44 pm

Re: Stereotactic Body Radiation Therapy and Immunotherapy

Postby prayingforccr » Mon Nov 07, 2022 10:00 am

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.
Last edited by prayingforccr on Mon Nov 07, 2022 10:45 am, 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.
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 No growth in nodules 6 months
8/22 beginning sbrt and immunotherapy
10/22 sbrt and immunotherapy failed
12/22 TIL Therapy

MadMed
Posts: 187
Joined: Sun May 02, 2021 5:52 pm
Location: Massachusetts

Re: Stereotactic Body Radiation Therapy and Immunotherapy

Postby MadMed » Mon Nov 07, 2022 10:37 am

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

prayingforccr
Posts: 461
Joined: Sun Jun 28, 2020 4:44 pm

Re: Stereotactic Body Radiation Therapy and Immunotherapy

Postby prayingforccr » Mon Nov 07, 2022 10:38 am

MadMed wrote: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.
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.
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 No growth in nodules 6 months
8/22 beginning sbrt and immunotherapy
10/22 sbrt and immunotherapy failed
12/22 TIL Therapy


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