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Hlk

Chemo and Immunotherapy (Keytruda) simultaneously stage IV NSCLC

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Hello, this is my first post. My dad was diagnosed with Stage 4 lung cancer, non-small cell, adenocarcinoma the end of July.  They found 10-13 lesions in the brain, one area on the adrenal gland , one on the spine , and possibly a small area on the liver. My dad had 2 weeks of radiation on the brain immediately. Before treatment, he got very unsteady and had a drop foot. After radiation, he got most of his coordination back. He had palliative radiation to the place on his spine for pain.  Last Monday, my dad's oncologist put my dad on 2 chemo drugs (not sure the names at this time) and ketruda (immunotherapy drug). His oncologist said this was recently approved by the FDA to give both at the same time? I really haven't seen any info about this. I am just wondering if this is a new thing, or are they throwing all of this at my dad at once thinking he don't have much time and this is his best option? Thanks. 

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Hlk,

Welcome here and very sorry to learn of your dad's lung cancer.

As I understand your question, you dad is taking two conventional chemo drugs in combination with Keyruda and you are wondering if this is unusual.  Not in my experience.  You can read more details about combination therapy here (select the down arrow Immune Checkpoint Inhibitors).

Almost everything a medical oncologist does in early treatment is dictated by a national standard of care.  Your dad I believe is in first line treatment -- his first curative treatment for his lung cancer.  There is a recipe of drugs that is followed given the type and stage of cancer and this recipe is proved by tests to yield the best result.  It looks like your dad's situation conforms to the National Cancer Center standard of care for Keytruda combination therapy: "As first-line treatment of patients with metastatic non-squamous NSCLC in combination with the chemotherapy drugs pemetrexed and carboplatin, irrespective of PD-L1 expression."  The words non-squamous mean imply adenocarcinoma, your father's subtype of NSCLC.

Hopefully, combination therapy with Keyturda will arrest his cancer.  If not, there will be a second line (second therapy) treatment, again largely a recipe that is a standard of care.  In third line treatments and beyond, the medical oncologist's intuition and knowledge of your dad's specific situation dictate the type and duration of treatment.  But for now, let's hope we solve this cancer problem at first line.

More questions? This is an ideal place.

Stay the course.

Tom

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Hi, Hlk,

Welcome to LCSC. I am sorry that your family has been affected by lung cancer but you have come to a great place for support. The members of this site are survivors (like Tom), caregivers, and advocates who have a considerable amount of experience navigating a lung cancer diagnosis. Please continue to post updates and ask questions in the discussion boards. We're also happy to help connect you with caregiver resources and provide information on a variety of lung cancer topics. Tom has already provided you with some information about combination therapy. If you're comfortable sharing more information about your dad's treatment plan, we can try to answer more of your questions and connect you with another member who may be on the same treatment.

With gratitude,

Lauren
--
Digital Community Manager
LUNGevity Foundation

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Hlk,

I apologize for this untimely post, but wanted to reassure you that through my personal experience in caring for my mom with NSCLC with high PD-L1 expression, your dad's treatment plan is right on with the latest Keytruda research.  At the end of April, findings were released about Keytruda + chemo.  Research has shown that (at least for NSCLC recurrences, it may be different for 1st line treatment) treatment effectiveness is brought to over 50%.  According to my mom's oncologist, Keytruda alone has a 35-50% "success" rate.  My mom is currently receiving Keytruda + 2 types of Chemo for 8 sessions.  She will have a scan after her 4th session to see how things are going - we have heard that it is not uncommon to see tumors grow in the first few sessions  because they are inflamed from being attacked by the immune system.  She will also have a scan after the 8th treatment.  Treatments are 3 weeks apart.  If all goes well with the first 8 treatments, she will just continue with Keytruda after that.  

After being told that radiation was not an option for her cancer recurrence, we were quite upset.  This new(ish) immunotherapy "stuff" did not match our old school thinking and we were really scared when we were told this was her best treatment option.  We too felt that they were just throwing stuff at us because she was too far gone to do anything else.  But that's absolutely NOT true.  If your dad is being referred for Keytruda, know that it's a good thing.  He is lucky enough to have a "type" of cancer that allows for different types of treatment to be thrown at it.  After being told of my mom's treatment plan, I have done a lot of research into it.  Keytruda is accomplishing amazing things.  Unknowingly, I have a former aunt who has been on Keytruda for 2 years for advanced stage melanoma.  She is to the point where there is no evidence of disease and they are looking at taking a possible treatment break.  She continues to work as a 3rd grade teacher and just got back from a 2 week trip in Europe.  Statistics say that Keytruda is not as effective for melanoma as it is for NSCLC with PD-L1 expression.  

So, with all of that being said, it sounds like your dad is in the right place for treatment since they are educated on the most recent Keytruda findings.  I would love to hear how your dad does with his treatment, since it sounds like they are in similar spots in their treatment.  I am keeping a string of updates in the immunotherapy section of this forum if you are interested in hearing what is going on with my mom.  Hope all is well and you are taking care of yourself.  Best wishes.

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Hlk,

My mother was diagnosed and in similar condition as your dad in your post. They are not going to give her radiation therapy but only keytruda and chemo combination therapy. 

I would like to know what your dad’s experience has been on keytruda?

Thanks.

Regards,

Dennis

 

 

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Hi, Dennis,

I will reach out to some of our other members who have experience with keytruda and chemo combination therapy and ask them to respond to you in this thread.

With gratitude,

Lauren
--
Digital Community Manager
LUNGevity Foundation

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Dennis,

Here is my updates on my mom's journey of  her lung cancer recurrence and the triplet of Keytruda, carbo, alimpta. My mom completed 6 of the 8 recommended infusions of the triplet and then has continued with Keyteuda only. She's been on Keytruda only since December 2017. Although she is having shortness of breath now, it is likely not cancer related and her cancer is stable.

 

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Dennis,

  I was not on Keytruda but was put on Opdivo, after first having Chemo (back in 2015).  I had done quite well on Chemo (Carbo and Alimta) for some time, but then had progression, so I had Radiation and quickly moved on to Opdivo.   At the time the Immunotherapy drugs had just received FDA approval and because I had NOT been tested for PDL1 (at biopsy, as is now done), my Oncolgoist choose Opdivo, so I could start right away.   She did not want me to have to go through a new biospy have to wait for results, because the cancer was quite aggressive.   At that time, to use "Keytruda" you needed to have a high PDL1 expression, but that was not required for Opdivo and that's the major reason she chose it for me.   

 Happily, I had an excellent response to Opdivo and it quickly shrank my tumor/nodes.    I did develop low-grade Pneumonitis (known side effect) and eventually had to stop treatment, but have now been "Stable" ever since (22 months and counting).   Needless to say, I am very thankful and very happy with my results despite the side effects.  I feel Opdivo saved my life.

  Please be very cautious about the side effects (they will most likely provide her with a long list of potential side effects) and advise if/when she should call in, they ALL should be reported as these treatments are still considered "new" and we are still learning a lot about them.  Immunotherapy for some has amazing results, and for others there are side effects and/or results that are not as promising.   I sincerely hope your MOM will be an excellent responder.

Best of luck,

    Lisa   

NOTE:  I am Stage IV NSCLC patient and also started with a Brain Met, Pulmonary Embolism and the tumor/nodes in my Right Middle Lobe.  Today, I am stable with only a tiny "under 12 mm" spot in my right lung.  My Brain MRI is clear and has been ever since I had Cyberknife back in 2015.  I still have "lingering" signs of Pneumonitis (totally asymptomatic) which moves around in both lungs, but causes me no problems.   My PE is also clear and I'll be on blood thinners forever, but am doing well on Xarelto.   

The new "Triplet" (Carbo/Alimta and Keytruda) was also not available when I was diagnosed, but has become very popular and seems to be working great for many.  This combo was FDA approved in May 2017.  

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On ‎6‎/‎29‎/‎2018 at 11:16 AM, ThePurplePlace said:

Dennis,

  I was not on Keytruda but was put on Opdivo, after first having Chemo (back in 2015).  I had done quite well on Chemo (Carbo and Alimta) for some time, but then had progression, so I had Radiation and quickly moved on to Opdivo.   At the time the Immunotherapy drugs had just received FDA approval and because I had NOT been tested for PDL1 (at biopsy, as is now done), my Oncolgoist choose Opdivo, so I could start right away.   She did not want me to have to go through a new biospy have to wait for results, because the cancer was quite aggressive.   At that time, to use "Keytruda" you needed to have a high PDL1 expression, but that was not required for Opdivo and that's the major reason she chose it for me.   

 Happily, I had an excellent response to Opdivo and it quickly shrank my tumor/nodes.    I did develop low-grade Pneumonitis (known side effect) and eventually had to stop treatment, but have now been "Stable" ever since (22 months and counting).   Needless to say, I am very thankful and very happy with my results despite the side effects.  I feel Opdivo saved my life.

  Please be very cautious about the side effects (they will most likely provide her with a long list of potential side effects) and advise if/when she should call in, they ALL should be reported as these treatments are still considered "new" and we are still learning a lot about them.  Immunotherapy for some has amazing results, and for others there are side effects and/or results that are not as promising.   I sincerely hope your MOM will be an excellent responder. 

Best of luck,

    Lisa   

NOTE:  I am Stage IV NSCLC patient and also started with a Brain Met, Pulmonary Embolism and the tumor/nodes in my Right Middle Lobe.  Today, I am stable with only a tiny "under 12 mm" spot in my right lung.  My Brain MRI is clear and has been ever since I had Cyberknife back in 2015.  I still have "lingering" signs of Pneumonitis (totally asymptomatic) which moves around in both lungs, but causes me no problems.   My PE is also clear and I'll be on blood thinners forever, but am doing well on Xarelto.   

The new "Triplet" (Carbo/Alimta and Keytruda) was also not available when I was diagnosed, but has become very popular and seems to be working great for many.  This combo was FDA approved in May 2017.  

GREAT UPDATE! REALLY HAPPY FOR YOU!!!!!! Hope the PD1 treatment could save more life in the future!

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