Blip in Immunitherapy ?

[Holepunch]

wonder if anyone has experience of a blip in immunotherapy treatment?

My husband has stage 4 non small cell lung cancer

He was diagnosed about 10 months ago and has been responding well to immunotherapy and chemotherapy (3 weekly treatments of pemetrexed and pembrolizubmab spelling maybe a bit wrong?)

However last week his consultant said there was a2mm growth and she felt the immunotherapy may have stopped working?? Just in case there had been a blip she decided to give the treatment another couple of goes and monitor it closely by bringing the next CT forward

[Mazemaze]

Hello there,

My dad was also on pemetrexed and pembrolizumab 3 weekly treatments. He had 4 cycles and then a scan which showed that the tumour had shrunk to 50%. He then went onto a lowered maintenance dose and unfortunately the tumour grew back to almost it's original size 5cm.

Dad has now come off immunotherapy and changed chemo drugs. Have had 2 cycles and we are hoping it works. Hope this information is useful. Dad is S3 Non small cell.

I hope it is a 'blip' in your husband's progress but did not happen for my dad. Personally, I would ask for the CT scan to be brought forward even more.

All the best.

[Holepunch in reply to Mazemaze]

Thank you very much.

My husband is stage 4 and the tumour had shrank at beginning and was then stable for a while.

The CT scan is planned after a couple mor attempts ? Interested in time scale you were thinking of and if you know the type of chemotherapy?

Hope your Dad is responding well

All the best

[Mazemaze in reply to Holepunch]

Hello there

Thanks for your reply.

My dad is stage 3 non small cell lung cancer diagnosed after a biopsy on an infammed lymph node. He responded well initially but then just as he was referred for radiotherapy, they realised he was not a good candidate for that as the tumour had increased and was now too large.

He started treatment in September last year - carboplatin, pembrolizumab and pemetrexed. 4 cycles of 3 weeks each. Had a CAT scan in November which revealed that the tumour had shrank by 50% which was great progress. By late Jan, dad was coughing again and scans in February confirmed that the tumour had grown back much to the surprise of our consultant who had just referred by dad for curative radiotherapy. After an NGS test, it was revealed that there was currently no targeted therapy for that gene mutation or clinical trials available, so we are back with chemotherapy only, no immunotherapy.

Last month dad started on 2 chemo drugs - Docetaxel infusion every 3 weeks with Nintedanib tablets for 4 cycles.

I would ask if it is possible to have a scan after one month to check if it is responding to treatment still as in my dad's case the tumour seemed to grow quicker than expected.

In your husband's case it may be that your consultant thinks progress may only be seen after 2 cycles to give time for the chemo to work. Everyone's case is unique. As your husband has been stable for some time previously, this may be a positive sign too. Wishing him all the best x

[Boo_Radley]

Hi Holepunch, sorry to hear about your husband.

I'm also stage 4 NSCLC, diagnosed 5 months ago. I was offered carboplatin and pemexetred (both chemotherapy drugs) and pembrolizumab (immunotherapy) every 3 weeks for 4 cycles. I finished that, and had no evidence of disease on the last scan. 🥳

So I'm now on to maintenance pembrolizumab. Hopefully for 2 years.

They were a bit 'iffy' with continuing treating me with it after my final combined chemo and immunotherapy cycle, and I was devastated. It was because my liver function readings were too high. In my case, the oncologist thought it could be to do with being on antibiotics for an infection, or the end of the chemo drugs, but he wasn't sure. Either of these things can knock your bloods off a steady keel. They do sometimes pause treatment to let your body recover, and were talking about giving me a course of steroids to get me back on track. They didn't seem overly concerned if this happened, but of course I know how you both feel, it's like they are withdrawing your lifeline.

Push to get that CT scan done - it will offer a bit more clarity than second guessing.

I think sometimes you have to be prepared for a curve ball with all this - sometimes they will switch drugs and strategies depending on what they find, and of course everyone's body is different, so they have to be prepared to change plans.

Wishing you both all the best, keep going, and happy to chat privately if you want to know more. 👍🙂