My sister is on Nivolumab. After 8 nivolumab infusions, 6 mm RLL no longer seen, mediastinal lymph node no longer seen, azoesophageal lymph node markedly enlarged; multiple brain mets that were found in Dec. 2015 treated w/WBR and Dexamethasone are larger on MRI after 8 Nivolumab treatments(i.e., 6 mm now 12 mm. How safe is it to wait till after 4 more treatments to rescan and Cyberknife? The only current treatment is Nivolumab .
Thank you,
Sloan
Initially dx stage IIIB adenocarcinoma, K-ras positive -Dec. 2014; carbo/alimta; XRT with cisplatin & etoposide; PET then showed 1 mediastinal node; 4 months later PET showed new 6 mm RLL; one month later developed right sided numbness and trip to ER found multiple brain mets and within days had WBR.
Reply # - April 29, 2016, 06:58 AM
Hi Sloan,
Hi Sloan,
I'm sorry your sister is having such difficulties. Since her case is complicated and unique to her it's difficult to say what the typical treatment would be.
Faced with growing nodules in the body and brain a decision needs to be made about which is most in need of treatment. It could be her oncologist believes the growing nodules outside the brain are her most immediate problem. Presumably her brain mets aren't symptomatic or that would be most important. Perhaps the oncologist wants to get as much out of systemic treatment as possible coupled with as much time without being forced to treat the brain.
Of course you'd need to ask the oncologist what the thinking is behind the decision. This is why oncology is often call an art as much as science; there's so much dependent on the individual.
The oncologist should be alerted if your mom begins to have symptoms related to her brain mets for that will become important to treat right away though it isn't unusual to continue with systemic treatment when brain mets aren't causing symptoms.
I hope your sister responds to the immunotherapy.
All best,
Janine
Reply # - April 29, 2016, 07:49 AM
Thank you for your reply. We
Thank you for your reply. We are always told that Opdivo/Nivolmab is new to the lung cancer world and much is not yet known.
Since her Neuro symptoms come and go, the radiation oncologist attributes them to Opdivo and not brain mets. Her symptoms are: nausea, word finding or mispronouncing a word, slight headache relieved with Tylenol or Nasonex or Benadryl or 5 mg Norco and forward gait and some balance problems. All of these are inconsistent and doc said if it were brain tumor related it would not come and go.
Reply # - April 29, 2016, 08:02 AM
Normally that's how symptoms
Normally that's how symptoms are with brain mets they pretty much stay, however I'll ask one of our oncology faculty to weigh in.
Janine
Edited.
Reply # - April 29, 2016, 01:08 PM
Thank you, I would so
Thank you, I would so appreciate that.
Reply # - May 1, 2016, 07:49 PM
Hard to say, since it depends
Hard to say, since it depends very much on where the brain metastases are, but I don't think that would be advisable. I would consider it very unlikely that these metastases will respond later if they're progressing now. More likely she would just be accepting unnecessary risk and be at risk for worse outcomes in needing to be treated for larger brain mets.
Good luck.
-Dr. West
Reply # - May 2, 2016, 03:07 PM
Thank you Dr. West. I am very
Thank you Dr. West. I am very appreciative of your expertise and this site. Wait made an appointment with oncologist for tomorrow.