Mixed Results from Initial Treatment

[sch1979]

Has anyone had mixed results from chemo/immunotherapy?  My uncle was diagnosed with stage iv nsclc (exon 20 mutation) in April.  It has spread to the bones, lymph nodes and adrenal glands.  He did 6 rounds of chemo with immunotherapy (alimta/keytruda/carbo) and then continued with keytruda/alimta.  We just received his first PET and brain MRI results since his initial diagnosis and while some of the cancer shrunk, some grew and there are new lesions not seen in April. The oncologist said not to be alarmed and wants to continue immunotherapy and re-test in three months.  Is that a typical response/course of treatment for mixed results from chemo? I'm very concerned about the new growth.  

[Tom Galli]

Sch,

I’ve found there is no typical in lung cancer. I’ve often heard that existing tumors grow after immunotherapy and that growth is explained as inflammation from the immunotherapy assault. I’ve heard less frequently that new mets appear after immunotherapy. So your uncle’s response kind of aligns with “typical”, the new mets being rather unusual.  

Keytruda is good stuff.  Give it a chance and we’ll know a lot more in 3 months.

Stay the course.

Tom

[Steff]

My mom had Keytruda + Alimta/Carbo for 6 sessions and then proceeded with Keytruda only.  She had what looked like progression around her tumor for quite sometime.  The docs suspected inflammation, but watched it closely in regular scans.  As Tom said, seeing initial "growth" is pretty typical in immunotherapy; new lesions, not so much.  But that does not mean that the treatment is not working.  Those lesions could have grown between initial scan and treatment starting. Unless a scan was taken the day treatment started, we just don't know.  

Take Care,

Steff

[BridgetO]

I wonder, and this is just speculation, whether he could  have more than one type or subtype of lung cancer at the same time, and some responding better or differently than others. Has anybody experienced this? A co-worker of mine had 3 kinds of breast cancer at the same time.

[PaulaC]

5 hours ago, BridgetO said:

I wonder, and this is just speculation, whether he could  have more than one type or subtype of lung cancer at the same time, and some responding better or differently than others. Has anybody experienced this? A co-worker of mine had 3 kinds of breast cancer at the same time.

BridgetO, my oncologist is suggesting that I had two types and I’m still not clear on it. The fortunate thing for me is the treatment worked on both. Squamish cell and adenocarcinoma. 🤷‍♀️

[sch1979]

I just wanted to update that after three more mos, the disease is progressing.  The treatment is not working.  I am posting under another topic re: options.  Thanks to all who responded here.