Lingering Questions

[Saturn_Bound]

Hi Everyone,

 

So my mom has started her new chemo regimen which is Taxotere + Cyramza. The plan is to go for four cycles and get a new PET scan from there. As a recap, she was diagnosed at a stage 3b/4a in June 2020 (two oncologists considered her diagnosed 3b vs. 4a). She did chemo starting August 2020 (I think it was Cisplatin + Alimta) for four rounds but the tumor in her lung grew a bit, so was was started on Keytruda in November 2020. 

We changed Oncologists in March due to insurance changing, so she had a 2 week break in treatment. She continued the  Keytruda again about a month ago (now at UCI Medical Center), but she had increased S.O.B, and the new PEt scan showed progression to new lymph nodes and some growth in her lung tumor. 

On Monday, 3/29 my mom starter her new regim the Taxotere + Cyramza. I'm not sure if its mental, but she seems to be doing better already. Her oxygen levels are a bit higher and she has a LOT less coughing and trouble breathing. 

A few lingering questions I have:

1) Is it normal for chemo to work so quick on the tumor? 

2) My mom has no current mutations, what are the chances she develops a targetable mutation in the future?

3) If Keytruda stopped working (she has a PDL1 of 80%!), does that mean a different immunotherapy will be inneffective as well?

4) Has anyone had progression after Keytruda? Has anyone had any luck with the taxotere + Cyrmza combo?

The oncologist has a plan to go from chemo, to immunotherapy, to chemo, and so on. She also hopes she can get my mom on a clinical trial for people with progression after Keytruda.

 

Just nervous and circling back here for any input/hope! Oh also she will be getting another MRI soon to make sure she is clear in the brain. So far the cancer has only metastasized to the other lung and lymph nodes, but distant lypmh nodes, one near the liver.

 

[Tom Galli]

Saturn-Bound,

Addressing your lingering questions, can chemo work quickly on tumors? Yes, chemo can work quickly; it can also workday slowly, and sometimes it doesn't work. What are the chances your mom developed targeted mutations in the future? Understand first that only about 15% of NSCLC adenocarcinoma disease displays driver mutations. There have been drugs developed to treat some of these mutations and research is on going to target more drivers. But while treated lung cancer can transform from say adenocarcinoma to squamous cell or small cell, I do not know that one's lung cancer can develop new targetable mutations. Your mom's progression with Keytruda does not mean that a different immunotherapy or even conventional chemotherapy regime will be ineffective. Many on this forum have progressed after immunotherapy including Keytruda and many have found new treatments to control the progressions. 

I do hope her new chemo regime works and the MRI shows know progression to the brain.

Stay the course.

Tom

[Saturn_Bound]

Thank you Tom as usual you are very helpful and make me feel more at ease about this whole process. 
 

I wish someone could just say “everything will be ok and she will beat this” but I know now that this is a marathon. 

[TJM]

Saturn. I may not be able to guarantee it but I can say it.

"Everything will be OK and she will beat this"

I like my odds at being right.

Peace

Tom