What to do next?

[GoNapoli]

My Pop had a Axumin Pet Scan earlier this week, and was supposed to have his second Xofigo injection which was cancelled because of results/progression. Impression shows lung nodules, which demonstrate mild radiotracer uptake which are new and concerning for lung involvement. Interval development of axumin lower cervical, thoracic and pelvic lymphadenopathy as compared prior CT study concerning for nodal metastatic disease. Now with lung involvement where do we even go from here?

[GP24]

A genetic test could show additional treatment options. Also, at the end of this year PSMA-617 therapy will be approved. Maybe you can get into a trial with this drug before that.

[Loves2golf]

I’m watching your replies with great interest. Yesterday, we went to Dana Farber in Boston for what we thought was going to be a consultation on starting Xofigo since everything else we have tried has failed. We were told his last scan showed some spots on his liver, thus making him ineligible for the treatment. He scheduled us to come back in a week to have a biopsy done to see if there are any new gene mutations that could possibly help in future treatments. He has been tested before, and he had none. Looking for any help or suggestions.

[GP24 in reply to Loves2golf]

You have to get two tests, a germline test (blood) and a somatic test (cancer tissue). If one of the tests detects a BRCA1 or BRCA2 mutation, you can take Olaparib. Consult your doctor for treating further mutations. On the other hand, it was found that Olaparib sometimes also works even when there is no mutation. There is a trial you may be eligable for.

[Loves2golf in reply to GP24]

He had a germline test done 2 years ago. There were no BRCA mutations.

[GP24 in reply to Loves2golf]

About 50% of BRCA mutations are detected with a germline test and 50% with a somatic test. So you could send the tissue from the latest biopsy to a lab to get a somatic test done. The tissue is archived by your pathologist.

[Loves2golf in reply to GP24]

Thank you so much for that info. I’ll be sure to ask about it when the biopsy is done.

[GP24 in reply to Loves2golf]

Your husband had a biopsy when he was diagnosed. You can use this tissue still for the somatic test.

[Tall_Allen]

Can one of the lung nodules be biopsied?

[GoNapoli in reply to Tall_Allen]

Hi there we have an appointment with the oncologist on Tuesday I will ask. Thank you for the response.

[GoNapoli]

Hi Nalakrats, he did genetic and DNA testing no mutations. What does the Chromogranin A test consist of and what information does it provide? I am not familiar with it.

[GoNapoli]

Oh ok got it, I will ask on Tuesday. Thank you. With this kind of spread I wonder what his options will be if he wants to continue with treatment.

[Hidden]

How about keytruda?

[GoNapoli in reply to Hidden]

Do you need genetic mutations for Keytruda?