treatment for oligometastatic NSLC kras - 1294613

Mon, 06/11/2018 - 07:29


After inital dx with large tumor in lung and mediastinum NED. Adeno/Kras.
After 1 yr brainmet. Since then 5 other brainmets in period of 12 months and 1 in lung. All treated with SRBT.

So far so good. In brain, mets keep coming up time after time. I m afraid that one time SRBT will not be possible anymore.

Using no medication.Waiting with chemo/immuno untill there is no other option because of possible side-effects.

Are there possible (maintenance) treatments to strenghten the immunesystem to try and stop this, what is given in general?


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Hi phyl13,

Welcome to GRACE. I'm sorry to hear about your diagnosis and the steady appearance of brain metastases. Although you did not state it specifically, I assume that the original tumor was surgically removed and that the brain mets and lung met are the only evidence of recurrence and that they have been successfully treated with radiotherapy.

Although a healthy diet and regular exercise can help strengthen the immune system in general, the problem with cancer is that in the normal course the immune system does not attack cancer cells. Immunotherapy is used to "train" the immune system to recognize and eradicate cancer cells.

As far as your brain mets, I assume that at some point your doctor has suggested whole brain radiation, since it appears that even though the visible brain mets have been treated, micrometastatic cancer cells remain, which have eventually formed new brain mets. WBR is intended to clear the brain of all such remaining cells. Of course, there are side effects, some possibly long-term, but it seems likely that new brain mets (and metastases in the lung and other parts of the body) will continue to appear, in the absence of WBR and/or a systemic therapy that crosses the blood-brain barrier in therapeutically sufficient concentrations.

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hi jim, thanks for answering. The initial tumor and met in the mediastinum were treated with oldfashioned chemo (cisplatin/etoposide) and radiation.

The doc has not suggested whole brain radiation as they think it is not neccessary yet. Yes there can be microscopic cells, but there are cases where the cancer does not re appear for years. Therefore WBRT would be to hefty. It also has too much nasty side effects (cognitive decline etc.).

Chemo/immuno is maybe too much at the moment. Is there also medication on can take as maintenance?


Hi phyl13,

I am glad for you that the doctors do not think you need WBRT yet and you have already gone through a significant chemotherapy regime so it is understandable that you wouldn't want a repeat of that any time soon.

There are targeted medications for actionable mutations that are taken as maintenance as well as immunotherapies. Some chemotherapy drugs are also administered as maintenance following intensive chemo. I am not aware of any maintenance treatments outside of these classes that has proven benefit in metastatic lung cancer. This is in many ways the 'Holy Grail' of cancer treatment that would change advanced lung cancer from a fatal disease to a chronic one. I am also not aware of clinical trials for maintenance treatments outside of these classes, although I would be extremely interested if such trials existed.