I’m very new to this forum so I tried my best to ask an appropriate question so forgive me if this is still too specific
My father w/ staged 4 NSCLC (after undergoing tumor resection, chemotherapy, radiation to mets site) was newly dx with brain mets (3 sites) through MRI. The thing is, his tumors in the lungs and adrenal glands (metastatic site) were considered “well-controlled” for the past 10 cycles of Keytruda he has received.
However, would the newly-found brain mets while being on Keytruda considered as “disease progression” and resistance to the drug? Or is brain mets normally locally treated while patients continue receiving Keytruda?
Is there a place I can find the guideline for some cases similar to him?
*A note is that since he was doing “well” on Keytruda, the oncologist decreased the dosage from 150mg to 100mg for the past 2 times.
Welcome to GRACE. I’m sorry to hear about your father’s brain mets, but it’s great that he’s otherwise getting a great response to Keytruda.
Although new brain mets indicate disease progression, oncologists often distinguish progression in the brain from that in other parts of the body. This is due to the difficulty most drugs have in crossing the blood brain barrier in therapeutic concentrations. Instead, if the systemic therapy is controlling the disease elsewhere and is well-tolerated, those mets will be treated with radiation and the systemic therapy will be continued.
Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa