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Pseudo progression with SCLC?


Kycindylou

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My husband had an original diagnosis of nsclc in March 2019,, then they realized there was an error and the biopsy needed to be sent to Mayo for a 2nd opinon, it came back both nsclc and sclc.  Fast forward to after 4 different chemotherapies, progression to brain, so they did whole brain radiation and gamma knife on 6 lesions, it has remained stable, they put him on Imfinzi and he progressed to adrenal gland, which they removed, it was all small cell.  He was then put on Opdivo/Yervoy for 4 cycles and made it fine until the 4th.  His immunotherapy attacked his eyes and intestines and currently he is on 120 mg of prednisone to try and stop that.  Just giving you a little history.  My question is this, his scans from last week came back with several small lesions in his lung.  The Dr said maybe pseudo progression?  I understand what that means but have never heard of that with sclc at all.  Have any of you?  Just hoping for your thoughts on this.  His brain and abdomen are still stable on these recent scans.  The lung had remained stable until this go round of scans, they said they won't know for certain until they scan again in 6 weeks.  He can't continue with the Opdivo infusions until his steroids are tapered down to  40 mg a day  so for now here we are just wondering if anyone else with sclc has experienced pseudo progression.

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Kydindylou,

Welcome here.

Your husband has already been through the wringer in treatment and I'm sorry he is having adverse affects from immunotherapy.

Your question--have we heard of pseudo progression with SCLC? First, consider pseudo progression is a term used to characterize growth of a tumor under immunotherapy assault. As it was explained to me, it is an inflammation of the tumor caused by cellular-level attack of the immune system against cancer cells. This attack causes swelling. It is a common occurrence with immunotherapy treatment. In truth, I've never heard about SCLC tumors displaying pseudo progression, but the mechanism of immunotherapy attack is the same for SCLC and NSCLC, so I venture the doctor's suggestion of pseudo progression as an explanation of small lesion swelling makes sense.

I hope his adverse immunotherapy symptoms resolve from steroids and he can return to immunotherapy treatment soon.  I also hope your scans 6-weeks hence show no evidence of disease or NED.

More questions? This is the place.

Stay the course.

Tom

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  • 3 weeks later...

Hi,
I',m new here. Don't know if it helps, but yes,  we've been said that my father has a pseudo progression too in his liver metastasis. He is waiting for his fourth infusion with etoposide/carboplatin/atezolizumab (first line).

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How long does  pseudo progression last? If someone for instance, is experiencing that with an emlarged lymph node, how long before it will begin to shrink?

 

 

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Jack,

I’m not a physician but from what I’ve read, pseudo-progression is normally seen on the first scan after starting immunotherapy. That would be a mid-treatment scan so perhaps 3 to 4 months after start of treatment. By the second or end of treatment scan, pseudo-progression is either progression or scar tissue. End of treatment scan is normally a month after treatment end date.

Stay the course.

Tom

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