Hello Grace community,
We just found out today that mom has progression of her cancer mets to the brain with leptomeningeal carcinomatosis as the most recent complication.
Here is my mom's clinical history:
- July 2009 - stage 1B adenocarcinoma NSCLC, LUL lobectomy; remission
- May 2013 - stage 4, mets to bone; started Iressa; stable
- Feb 2015 - increase pain in bones, progression; started CO-1686
- Aug 2015 - progression via brain mets; WBRT 20Gy, resumed CO-1686
- Nov 2015 - stable brain and body
- Dec 2015 - worsening symptoms, increase brain mets in size and number, vasogenic edema, intracerebral hemorraphage, leptomeningeal carcinomatosis
1. brain MRI with contrast - does "enhancement within the cerebellar folia" suggest a definitive diagnosis of leptomeningeal carcinomatosis?
2. Given the new diagnosis of leptomeningeal carcinomatosis, would it make sense to do a repeat WBRT to help stabilize disease in the brain? Keeping in mind, WBRT was just done 4 months ago and now there is new progression in the brain.
3. Would it be wise to pursue Tagrisso or Nivolumab or Keytruda as the next line of treatment? The goal would be to find a new treatment that would better reach the brain to stabilize things. I read somewhere from anecdotal cases that Tagrisso may in fact cross the BBB and help stabilize some patients with brain mets, I'm not too sure about the new immunotherapy drugs in having the same affect the the brain? However, I heard the former VP of US Jimmy Carter has brain mets and currently taking Keytruda and his brain mets have responded very well? Any thoughts to the available options?
So sorry for all the questions but your responses are much appreciated. Looking forward to hearing back.