Lymph node relapse on immunotherapy - 1294062

1 post / 0 new
christi206
Lymph node relapse on immunotherapy - 1294062

Hello Dr. West and Grace community,

My husband was diagnosed 10 months ago at stage IV (bone and lymph node mets). He was a previously healthy, never-smoker 33-year old. He was negative for targetable mutations but had 80% PD-L1 expression. He was put on the triplet Carbo-Alimta-Keytruda and he's still on Alimta-Keytruda maintenance. He also gets monthly XGeva shots. He has done remarkably well with essentially no active cancer in his body at this time and his lung tumor dissolving into scar tissue.

There is one exception though. His previous PET/CT scan 3 months ago showed a right superior paratracheal lymph node that had jumped a lot in SUV uptake, from 4.6 to 11.3. His oncologist thought it made sense to wait at that point in case it was inflammation caused by Keytruda. He said if it was cancer, it would likely grow. Fast forward 3 months, his latest scan showed that same lymph node did, in fact, grow from 1.2 to 1.9cm and modestly jumped in SUV uptake from 11.3 to 12.7. Everything else is looking great on scan. His oncologist's approach to the 'rogue' lymph node was again watchful waiting. He thinks a 7mm growth in 3 months isn't that significant and he still thinks there is a chance it might resolve with the current treatment. He thinks it's not likely to grow significantly or cause any trouble, so he still wants to wait. He said if it continues to grow, we will consider a mediastinoscopy with biopsy and possibly some local radiation. Since my husband is otherwise doing well, it makes sense to keep him on Keytruda (no objection there). Alimta will probably be dropped sometime in the coming months.

My question is: can we afford to wait at least another 3 months to remove this lymph node? Could this be anything else other than local relapse at this point? He was sick with a virus recently but had been symptom-free for at least a week prior to the scan. And is there still a chance this can resolve by treatment alone?
Thank you for your time and input!