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Andreia

Pseudoprogression?

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Hy I have NSCLC with metastasis to lynphonodes, inoporable. I found at age 31 in november 2017. I started Keytruda associated with carboplatin and taxol. I had really good response after 5 session (21days interval), tumor shrinked 50%, lynphnodes with no glucose metabolism activity in pet scan.  After starting Keytruda as single treatment, I experienced significant pain and enlargement of the lynphnodes that were very small before less than 1cm. I think doubled in size. I heard about pseudoprogression with Keytruda. Is it possible what happend? Or it really stopped working? In pet ct showed increased size and metabolism in lynphonodes. Sorry for my English. 

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Andreia, 

Here is what I know about Keytruda and pseudoprogression.  

In a small subset of patients (1%-3%), the tumor on a CT scan may seem to get worse at first and then get better, or there may seem to be new areas of tumor. Doctors have coined the term pseudoprogression to describe this situation. One theory of why this happens is that, as the lymphocytes come in to attack a tumor, the tumor gets larger, and then, as they kill cancer cells, the tumor gets smaller again. The current thinking is that the tumors get larger because a large number of the patient’s T cells move into the tumor to clean it up. Therefore, some tumors that look larger on X-rays and scans are larger because the immune system is attacking the cancer, not because the cancer cells are growing.  For the great majority of patients whose scans show worsening of disease after at least a couple of months on immunotherapy, the scans are accurately showing that the immunotherapy is not working. 

You are most welcome to read more about immunotherapy in our Lung Cancer 101 material at the LUNGevity Foundation website.  As a short cut, here is a link to the page where more information about immunotherapy and pseudoprogression can be found.

I'm not a doctor so couldn't begin to conclude your scan is showing pseudoprogression (hopefully) or metastatic behavior.

Welcome here.  Its a great place to ask questions and your English is just fine.

Stay the course.

Tom

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Andreia,

Your enlarged lymphnodes could be what docs call pseudoprogression. My mom's docs don't like to hear that term (because only a small subset experienced it in initial studies), so we use "inflammation". Inflammation is very common in immunotherapy. To me, it was a way to tell that Keytruda was working for my mom. She had something similar happen in that the area around her mass showed a "thickening". It was believed to just be inflammation. Here, inflammation is a good thing. In other areas of the body, it can be problematic, like in the liver and lungs. Be sure to ask your doc if they think your enlarged lymphnodes are a product of inflammation caused by immunotherapy. Although they can't tell you for absolute positive, they will give you their thoughts. 

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