Keytruda update

[Chugach]

I know I’m super lucky. I was on the ropes and out of options when a genetic test said I was MSI-h and qualify for immunotherapy Keytruda ; it was a Hail Mary. It was a good year. Now over a year later I’m seeing a PSA bump.

I’ve got a lot of genetic diversity in my PC. Wondering if this is “nothing” or the beginning of the end? Advice please.

PSA-History

* July 2019 - start chemo Taxotere

* Aug 2019: PSA 122; Chemo-Taxotere

* Aug 2019: PSA 81; Chemo-Taxotere

* Sept 2019: PSA 71; chemo-Taxotere

* Oct 2019: PSA 74; Chemo- Taxotere

* Oct 2019: PSA 76; Chemo-Taxotere

* Nov 2019: PSA 86; Keytruda #1 (200mg every 3 weeks)

* Dec 19: No PSA labs; Keytruda #2

* Dec 2019: PSA 1.38 PSA; Keytruda #3

* Jan 2020: PSA 0.07; Keytruda #4

* Feb 2020: PSA <0.01; Keytruda #5

* March 2020: PSA <0.01; Keytruda #6

* April 2020: PSA <0.01; Keytruda #7

* April 2020: PSA <0.01; Keytruda #8

* May 2020: PSA <0.01; Keytruda #9

* June 2020: PSA <0.01; Keytruda # 10 (Start 400 mg every 6 weeks)

* Sept 2020: PSA 0.01; Keytruda #11

* Oct 2020: PSA <0.01; Keytruda #12

* Nov 2020: PSA 0.01; Keytruda #13

* Jan 2021: PSA 0.01; Keytruda #14

* Feb 2021: PSA 0.04; Keytruda #15

I’m not trying to complain about 0.04, but damn it, I want it undetectable <0.01

[GP24]

You had a PSA value of 122 ng/ml and now you worry that it got up to 0.04??

[Chugach in reply to GP24]

Hey GP - I’ve been on this road for awhile now. I’ve taken a lot of arrows. The data I shared is only part of the saga. I’m not worried about the value- I’m looking at the trajectory. This is pretty much my last option. It can’t fail

[GP24 in reply to Chugach]

I do not think you can determine the trajectory from a rise of 0.03 ng/ml. Keytruda worked very well and I think it will do so for quite some time.

[Vindog29]

Hi I've written my husband also received keytruda msh2, after running out of options, but only 2 doses bc liver enzymes went high. His psa over 2yrs later still undetectable but with each psa test I too wonder if it will eventually rise so I totally understand how you feel. I often wonder if it does,not a glitch,or scans shows something could keytruda be reintroduced bc it worked once b4..that would give some peace of mind. I have to ask Dr Morris MSKCC next time...stay strong...keep updating if you can

[Chugach in reply to Vindog29]

Thanks for the reply. I hate to complain on this forum, but those on Keytruda are so few and far between- I was hoping to hear from someone who has seen this bump before. My Med Onc said it happens, bump and then decline back to undetectable. I’m not a doctor but I’d expect that if his enzymes have stabilized he could probably get a small booster if needed.

[Vindog29 in reply to Chugach]

Hey complain away altho I hope you stay well and have nothing to complain about...its really not complaining but reaching out for possible answers and those answers may help someone else. I agree a booster might be possible and the hope continues...you and my husband are blessed...I look forward to reading your next update where it went back to undetectable

[treedown]

I may be missing something but unless you had RP and I don't see you did, undetectable is <0.1. Are you getting ultra sensitive PSA tests? If you are anxiety is why they don't recommend it.

[Chugach in reply to treedown]

Thanks TD. I have not had an RP, they just cooked it with radiation. Not ultra-sensitive PSA that I’m aware of - just standard labs. Perhaps the equipment is improving

[MateoBeach]

A general principle of adaptive genetic emergence of resistances is that any treatment of continued on a sustained basis creates the conditions for eventual genetic adaptation and treatment failures. What to do? Change it up. That is the basis for BAT. We do not know what will specifically reverse Keytruda resistance. But you have options to try when that does happen, possibly chemo, BAT, niclosamide etc. you have more arrows in the quiver.

[Chugach in reply to MateoBeach]

Thanks Mateo - I appreciate your reply. My concern was adaptation of the PC, particularly with mine so genetically variable. I earlier did a clinical trial similar to BAT and I’ve previously had all sorts of chemo and other SOC. It’s good to know there are more arrows as I want to slay this dragon