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Leo

Chemo/Radiation or Immune Therapy for Locally Recurrent SCLC

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Looking for input on Opdivo/Yervoy treatment for locally recurring SCLC or success in repeating 1st line chemo/radiation. Apologies for message length.

I have been diagnosed with a local recurrence of small cell lung cancer. I was originally diagnosed with Limited Stage SCLC Oct 31 2017, had a full response to treatment (Carboplatin etoposide with concurrent Radiation) which ended January 17 2018. So it’s been about a year. My oncology team is recommending I go straight to immune therapy (Opdivo & Yervoy) 

I’m struggling with do I go forward with immune therapy (Opdivo and Yervoy) or given local recurrence ( ie no distant Mets ) do I push to repeat prior chemo/radiation treatment . Would want to possibly redo radiation (which may be possible) 

Would be interested in anyone opinion on this, experience with treatment with Opdivo/Yervoy. Also if anyone has had success with repeating original chemo/radiation treatment.  

The local recurrence is in right bronchus intermedius. Subcarinal lymph node 1.3 cm, 5.2 FDG update and azygos esophageal recess (1.64 cm with 4.6 FDG uptake) .  Again no Mets elsewhere. Having an MRI (brain) this week.

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Leo,

Wow -- that is a touch choice.  I know Opdivo has FDA approval to treat small lung cell after a recurrence following conventional chemotherapy. I've not been able to find information on what advantages pairing Opdivo and Yervoy offer but I'm sure your medical oncologist will be able to provide that data.

Full disclosure: I've not experienced immunotherapy treatment but have had two repeats of conventional chemotherapy (Taxol and Carboplatin).  My experience with the repeated conventional therapy is it did affect tumors, eliminating 2 of 3 and it did reduce the size of the third, but it did not eliminate my stubborn tumor. My repeat radiation was actually precision radiation (CyberKnife) that fried my stubborn tumor. It looks like you have three small tumors.  I know folks who've had precision radiation to fry multiple tumors with good results.  You might include precision radiation as a potential treatment. I'd get the precision radiation answer from a radiation oncologist.

Stay the course.

Tom

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Thanks Tom ,  I have found 2 people with SC with similar history as me . 1 had recurrence after 18 months, was NED again but back in the same place 7 months later. She’s going on Opdivo and Yervoy starting Monday as she is tapped out on radiation she can do. Another says   Dr took her off Chem + Immune Therapy And is going for lungectomy or Radio Therapy. Her Dr said if it’s limited & local recurrence it’s not time for Immune Therapy yet. Every case is different. I’ll be hearing back from my oncology people today. I know they want Immune Therapy but I’m not there yet in terms of managing as a chronic illness . Good news is they’re going to review with a lung cancer specialist from a local University/Medical Center with solid cancer treatment credentials. I’ve also asked for them to get my radiation oncologist in the loop (she is really good). In the interim they are setting things up and I’m having a Brain MRI. Anymore advice is certainly appreciated. Leo

 

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Leo,

You know about small cell, obviously: huge chemo-resistant downside and very very persistent.  I know some survivors and of those that did, they had precision radiation as a second line treatment.  In my last consultation with my medical oncologist, I asked his view on treating small dispersed tumors with precision radiation. A classmate of mine had just be diagnosed.  He's in favor.  He's even in favor if the area had conventional radiation. He told me radiation oncologist have a slang for multiple tumor treatment -- spot welding!  My advice is to press hard for spot welding.

Stay the course.

Tom

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I’m hoping with only four cycles of Carboplatin and etoposide and a year since treatment that I’m not at high risk of resistant chemo but I know that’s always possible. Radiation was considered my primary therapy at the time. They are reaching out to my Radiation oncologist for input on treatment. Interesting the consultation with the expert seems to have moved away from Only Immune Therapy to Carbo/Etoposide with Tecentriq as Immune Therapy leg. Will then see where I land on Radiation.Info you provided is very helpful. 

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Updating on my Treatment plan for locally recurrent SCLC (No regional or distant Mets and Clean Brain MRI). After further consultation and Oncology team reaching out to highly reputable Lung Cancer Specialist the original  plan calling for Immune Therapy using Opdivo/Yarvoy was scrapped in favor of  a Chemo/Immune Therapy Treatment - 4 Cycles of 3 days at 3 week intervals with day 1 including Carboplatin Etoposide Chemo with Tecentriq Immune Therapy.  Day 2 and 3 will be Etoposide only.  

I will have my first petscan at end of treatment (12 weeks) . If any cancer remains they will then look to do targeted radiation. Because it is a local recurrence they believe trying to shrink everything as much as can be done will allow the radiation to be more targeted. Had my first treatment today. Will keep you posted 

 

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Hi, Leo,

Thanks for the update! We'll be thinking of you. Please continue to check in and let us know how you're doing.

Have a wonderful weekend,

Lauren
--
Digital Community Manager
LUNGevity Foundation

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