It is my week 7 of the MEDI4736 phase1/2 trial.
I had 2 infusion with 20mg/kg dose which is double of the usual.
My side effects are next to nothing but my tests are not so good.
First of all I started having weird episodes of numbness of left side of face and
fingers of the left hand that last about 10 minutes and happen once every other day.
Brain and spine MRI showed nothing but spinal tap found cancer cells in fluid - so I have
LC now. Doctor said I should continue on trial since it may help with LC.
Indeed after 2nd infusion it got better, I only had 2 episodes in 2 weeks so far.
My CT was on week 5th right next day after infusion, and biopsy on week 6th.
CT showed 60% increase in one tumor, slight increase in septal thickening and more
consolidation of nodules on both side of the lungs.
Doctor's calculation was 7% increase in cancer burden and he said that my tests were too early by the
protocol and I should continue on trial.
I am seriously worrying about this. Should I or should I not?
Is 5 weeks into immuno trial too early scan?
Thank you!
Should I continue MEDI4736? - 1269009
tkirzhner
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Reply # - March 25, 2015, 04:40 AM
It can take a while before
It can take a while before scans show response to immunotherapy, and at times even apparent progression is not a reason to discontinue treatment. In part two of his primer on Dr. West wrote:
"Immunotherapies often demonstrate a different pattern of stable disease or even the appearance of enlargement of existing areas of disease, followed by delayed tumor shrinkage that may continue over many subsequent scans. This is sometimes visualized in the form of a “spider plot,” in which the tumor burden of a given patient is plotted over time as a line moving from a horizontal level up or down, going from left to right as treatment continues (Figure 2). The unusual pattern of initial enlargement of measurable areas of disease or sometimes even the appearance of new lesions after the start of immunotherapy followed by delayed response is known as pseudoprogression."
But he also stated:
"While delayed responses and pseudoprogression are important possibilities to consider, to avoid discontinuing a potentially effective therapy too early, it is important to recognize that pseudoprogression occurs only in a minority of cases (perhaps 10%). Many experts recommend that, in the face of what appears to be progression on early scans, it is important to evaluate other factors that can help distinguish pseudoprogression from true progression, such as whether a patient is experiencing increasing pain, losing weight, or generally feeling well. In the absence of other signals of deterioration, it is very appropriate for patients to continue on immunotherapy and monitor their clinical response through scans over time. On the other hand, it is also important not to delay
(continued in the next post)
Reply # - March 25, 2015, 04:42 AM
(continued)
(continued)
"an appropriate change in treatment if a patient is experiencing escalating cancer-related symptoms along with ambiguous scan findings, in which case the patient is far more likely to be experiencing true progression rather than pseudoprogression."
The fact that your symptoms seem to be improving may be reason to believe that the treatment has begun to show results, but of course this is something your medical team will want to monitor closely.
JimC
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