Now I open this new topic to share the treatment of another Chinese patient who has been fighting with ASPS for more than 7 years. Recently, she had PD-1 therapy combined with Cediranib and received really amazing results. I will firstly briefly describe her treatments before using PD-1 treatment because I cannot wait to share the unbelievable results with you!
![Very Happy :D](./images/smilies/icon_biggrin.gif)
She was diagnosed in 2008 (Found diffuse mets in lungs but cannot find the primary tumor). In June 2012, the primary tumor (8*6 cm) was found in her left thigh and removed in August 2012.
Following are the treatments before using PD-1:
In June 2012, the largest nodule in lung was 2.5*1.9 cm
In September 2013, the largest nodule in lung was 3.2*2.6 cm
In May 2014, the largest nodule in lung was 3.8*3.4 cm. And then 3 tumors were treated by using Cryoablation
In June 2014, the largest nodule in lung was 3.4*3.2 cm
In July 2014, 2 mets (1.2*1 cm and 4mm) were found in brain MRI scan and treated by Gamma Knife. Had lung infusion chemotherapy--several mets shrunk by several millimeters after two courses of treatment.
In August 2014, continued lung infusion chemotherapy--result showed disease progression, so stopped therapy.
In November 2014, two nodules under abdominal wall and scalp were removed. A nodule sized 0.9*0.7 cm was found in liver.
In December 2014, started taking Pazopanib . At that time, the largest tumor in lung was 4*3.2 cm
In Jan 2015, the liver tumor shrunk to 0.9*0.5. In Mar 2015, the largest nodule in lung grew to 4*3.6 cm; the liver nodule shrunk to 0.3 cm
In April 2015, new 8 nodules were found in brain Mri scan and all of them were treated by Gamma Knife.
Following is the PD-1 therapy combined with Cediranib:
In June 2015, scan results show:
Brain: the largest tumor was 0.8*0.7cm
Liver: 0.3 cm nodule
Pancreas: a 0.7cm nodule
Lung: the largest tumor was 5.4*4.5 cm (1.4cm growth in 3 months)
In June 2015, started taking Cediranib. After taking 16 days, the largest lung tumor shrunk to 5*3.9 cm
In July 2015, she started PD-1 therapy combined with Cediranib. After 4 times PD-1 therapy, she stopped the treatment due to serious side effects.
In Sep 2015, scan results show:
Brain: the largest was 0.8*0.7 cm and possible new nodules
Lung: the largest was 6*4.8cm (this largest was a fusion of small tumors), the rest tumors grew about 2-3 mm.
Pancreas: several nodules were found, the largest was 2.2*2.5cm
In 25 Sep 2015, she continued Cediranib
In Oct 2015, two new brain mets (6.6*5.2*5.4mm; 5.7*4.9*4.8mm) were treated with Gamma Knife
From Oct 2015, her overall condition has became much better: she had been suffered from cough for more than 2 years, but from that time, she does not cough at all. Appetite and physical strength have been improved a lot; her weight has gained more than 5kg till now; the blood oxygen goes back to 97 (which was stable at 85, even lower than 80).
In Nov 2015, her latest scan results show following:
Lung: the largest tumor shrunk to 2.3*2.7cm, total number of mets reduced .
Pancreas: the largest tumor shrunk to 1.7*1.8
Brain: overall, mets shrunk. can see cavity in tumors.
The main side effects:
Aggravated cough, feel weak and exhausted, diarrhea, sensitivity in mouth. And the patient developed fungal infection by testing phlegm after 4th PD-1 therapy.
It is the unbelievable result! Before PD-1 therapy combined with Cedirinib, she had hundreds of mets in her lung and many of them were larger than 2cm. Recent CT scan shows the largest is 2.3*2.7cm, the number of mets reduced and most tumors are smaller than 1cm. It is noticeable that after 4 courses of PD-1 therapy, it showed a significant disease progression, especially in Pancreas mets. However, 1 month later, the patient felt much better physical condition that better than past 3 years. It seems that from that time, the lung tumors have shrunk significantly so that the patient stopped coughing.
Therefore, this amazing result should be attributed to the combination of PD-1 and Cediranib? Would Cediranib alone can achieve such significant results?
If this is partly because of PD-1, it seems that PD-1 therapy may result in pseudoprogression?
What should this patient do next? She has stopped PD-1 therapy for about 3 months and now taking Cedirinib only. Should she continue using PD-1 therapy or just taking Cedirinib to see the result in next scans?
I attach the pictures that are the comparison of two latest lung CT scan results. the picture on the left is the scan done Nov 2015; and the picture on the right is the scan done Sep 2015. Please feel the incredible changes in her lung!!!