SCLC: Keytruda vs. Hospice - 1288611

Hi,

My father was diagnosed with stage 4 SCLC at the beginning of this year with many brain metastases. Short history:
- Whole brain radiation: Responded very well, cleared up all the brain tumors
- Chemo - Etoposide + Carboplatin: Responded fairly well. Many tumors reduced in size. Handled side effect excellently.
- Radiation to large tumor under arm & portion of right lung: Again, great response.
- After about a month break after 5 sessions of above chemo, brain tumors showed up again, and other tumors started showing activity
- Started regimen of Irinotecan and Avastin: After 1 session (3 weeks of Irinotecan, 2 weeks of Avastin), there seemed to be great response, where smaller brain tumors cleared up, swelling/bleeding in the brain gone, bigger tumors smaller. Body tumors responding as well. Last infusion was a month ago.
- Unfortunately, even though the imaging results looked great, his physical and mental condition have deteriorated quite significantly. In addition, he started having some heart problems (atrial fibrillation and flutter, weak circulation).
- It is not clear what is causing this decline. Opinions are that it may be due to additive side effects of chemo & radiation on top of the cancer burden and the heart issue.
- He was approved for off-label usage of Keytruda (Pembrolizumab), but his oncologist is recommending hospice. Her reasoning is this: Since his condition is declining even though the tumors are responding to Irinotecan+Avastin, it is unlikely to get better even if Keytruda works well on the cancer.

My question is: Does it make sense to go for Keytruda at this point or give up and go to hospice care?

We obviously don't want my father to suffer through a rough treatment if it is going to be in vain and is not going to improve his quality of life. Yet, we are reluctant to give up leaving a treatment option on the table. Is his condition really unlikely to improve if Keytruda works?

Thanks,
Oreke