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
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