Lung: Cryoablation

[Tamira47]

Thank you for the history with Josh, Debbie. I'll request the consult with Dr. Auon. I also want the nodules ablated if possible.
The surgeries were VATs and the right was robotic. Yes, it was smaller prior to surgery. I think the biggest of them was about 1cm. Three were removed from right lung and 7 from left (the side which still has visible disease).

[Olga]

As I understand the axitinib was added 3 months ago, why are you saying the treatment is the same? unless I missed something or misunderstood. When is your next C scan with the contrast to monitor the treatment K+A? are you currently on it?
Where are you located?

[D.ap]

Hi Debbie,
No worries. I don't mind the questions at all.
The primary was under 5cm in the right thigh. Was removed in 2017 prior to identification as malignant. It was radiated, tumor bed resected, and again later due to infection. It's been clear ever since.

The radiated tumor is at the very top (around fissure line of lower left lung) of the lower left lung and growing tumor at upper left lobe. I'm not sure how much lung I'll lose if the growingone is removed.

Been on keytruda and axitinib 3 yrs in June. It held rumors stable for a bit, and then some started growing. There doesn't seem to be new tumors, although the growing one seemed to have 'appeared' right after surgery. Then again, that's at the spot where the pathology report post surgery had a potential positive margin.
Liver function tests are all normal.

Olga this was posted in-https://cureasps.org/forum/viewtopic.ph ... 940#p15940




This was posted earlier on this post -

Hello Olga and Debbie,
The scan was done on 3/18/22.
Radiation ended 12/7/21 and a week later, I added axitinib to keytruda, after a 6 month hiatus( had to stop axi for 6 months prior due to lung surgeries). So, it was 3 months after Radiation and the start of axitinib that the scan was taken. There are 2 other nodules, under 5mm that did not change. Is it possible for this initial inflammation effect to o only affect some nodules?
Debbie, if I go on the anlotinib trial, I'll have to do another scan if it's over a month from last scan. I don't know if insurance will cover an earlier one.
Should I wait to see what the next scan will do? Prior to surgery, nodules were increasing, so I'm wondering if there's reason to believe that the same treatment will suddenly start to work. I'm I wasting valuable time by indecision, while this tumor grows?
Currently, the radiated one is reduced (1.9cm to 1.2cm), I hope, dying. Wondering what the best option at this point is for getting rid of the three nodules? Ablating or radiating the biggest will disqualify me for anlotinib as I lose demonstrable tumor growth.
Is Dr. Littrup in the US?
Miranda

[Olga]

Ok, I got it, it was not the start for axitinib but rather restart of it after the break.
I have to say that there is a strategy to restart the response to ICI drugs by irradiating one selected tumor. When it is dying, there is a short period when the sarcoma cells are not completely dead but the immune system cells are already there due to inflammation of the tissue, and they get the taste of them so to speak. Ivan had the soft tissue met irradiated with this goal at the start of his Keytruda treatment.
Perhaps you should rescan in 3 month interval to confirm the growth, but in the meantime make the initial contacts re. possible cryoablation. As you only have one met growing so far, you can save the systemic options for the future is needed. Are you still on K+A or you were taken off due to growth?

[Tamira47]

Hi Olga,
I'm still on K&A.
I did make the unbridled contact with Dr. Hussein Aoyn's office. Yet to discuss this with my oncologist, so we're on the same page regarding this. I'm curious though as to what happened with Dr. Littrop. Heard he's with Ascension in Michigan, but could not get a hold of his office.

Debbie, did Dr. Auon perform the cryoablation for Josh?

Next scan is in mid June. I'm hoping the 1 nodule growth was just pseudo progression. So do you know if this could happen to just some of the nodules? Should this not have happened to the others?

I also have a cough that's lingered for the past month. It becomes sniffling slightly productive after alot of coughing... clear. I got Singulair for it. Not sure if it's helped . I'm okay for the most part, but have about 3 episodes per day of continuous 2 minute coughing. This gets rriggered when I laugh, take a deep breathe or exert myself physically. Oncologist needs me to keep exercising and using spirometer to open up air sacs. Was coughing before 3/18 CT. I take zyrtec too.

[Olga]

Hi again,
I am not sure about Dr. Littrup as we have not been in a contact for a long time now. His page is still listed as
https://healthcare.ascension.org/doctor ... chester-mi
have you tried their (248) 652-5325 number?

[D.ap]

Hi Olga,
I'm still on K&A.
I did make the unbridled contact with Dr. Hussein Aoyn's office. Yet to discuss this with my oncologist, so we're on the same page regarding this. I'm curious though as to what happened with Dr. Littrop. Heard he's with Ascension in Michigan, but could not get a hold of his office.

Debbie, did Dr. Auon perform the cryoablation for Josh?

Next scan is in mid June. I'm hoping the 1 nodule growth was just pseudo progression. So do you know if this could happen to just some of the nodules? Should this not have happened to the others?

I also have a cough that's lingered for the past month. It becomes sniffling slightly productive after alot of coughing... clear. I got Singulair for it. Not sure if it's helped . I'm okay for the most part, but have about 3 episodes per day of continuous 2 minute coughing. This gets rriggered when I laugh, take a deep breathe or exert myself physically. Oncologist needs me to keep exercising and using spirometer to open up air sacs. Was coughing before 3/18 CT. I take zyrtec too.

Hi Miranda ,
Was away from my phone for a day.😊
Yes Joshua’s liver ablation was performed by Dr. Auon .
When Josh had his liver lobe removed last year , the attending IR to the surgeon , who was there Incase the left lobe imaged tumor needed ablating ,
remarked about the excellent job performed by Dr. Auon as it had been 4cm when it had been treated in 2015. It was still good and dead .
Question about your cough and also about your O2 values .
Is the singular and Zyrtec helping produce a productive cough ? Ie clearing phlegm ?
What are your O2 percentages running?

[D.ap]

Hey Miranda ,
Was researching antihistamines and immunotherapies and found this -
https://www.mdanderson.org/newsroom/ant ... 65579.html
They can enhance T cell activations.
What have your NLR been ?
Neutrophils
to lymphocytes , ratio .

Are they performing arterial blood gas tests ?

Also singular can have a side affect of a cough .
Maybe talk to your doc again and maybe an oncological pharmacist?
Have you consulted seen a pulmonologist about your lung issues by chance ?

[Tamira47]

Hi Olga,
I did call his number abs all the prompts, irrespective of which I selected cut the call. I'm waiting for Dr. Aoun's office to contact me on consent to pull files.

Hi Debbie,
Thanks for the review in Dr. Aoun's work. I feel better about getting in touch. I'll let you know when I'm contacted. My O2 dips to 90 when I go up the stairs. When I sit and breathe in, it slowly goes back up to 96. At the hospital when I go in for treatment, it even reads 97, so I really wonder about that.
As of 3/17, neutrophils, 65, Lymphocytes, 30, AST was 22, ALT was 28. TSH was 2.950

The cough started before Singulair. I had not been consistent on taking it, but for the past 4 days, I have. Zyrtec in the am, Singulair at night. After about of coughing, some colorless phlegm does come up. I'm not sure if it's the meds pushing it up or the pressure of the cough. I've always been seasonal allergy prone. This year has been especially worse. Read the article on antihistamines possibly improving immunotherapy is mindbliwing. Yeah for Zyrtec!!! I'll keep taking that. Mypp11

[Olga]

Perhaps Dr.Littrup is not working currently? He had some serious health issues few years ago, who knows. Dr.Aoun his best apprentice and a long term assistant and a very experienced dr himself by now. We have met him during the ablations when they worked together as a team, I would not hesitate to use him.

[Tamira47]

That's great. I already signed a release letter for them to pull my records. My oncologist is okay with it too, which makes it less stressful. I hope I'm a candidate for the procedure.

[Tamira47]

Hi Olga,
So, I send scans to Dr. Aoun and although I've not spoken to him, he related recommended that I see Dr. Littrup as he has an ASPS trial going on...Abscopal 5001 its called. Basically, abating about 10% of tumor in say 3 sessions, each time, also injecting acocktail of keytruda, yervoy and a low dose cytotoxin. I'm scheduled going through the registration process with his team. Here's what I'm thinking. Complete ablation vs partial/cocktail injection. What's best for me? As noted, I'm waiting for Dr. Aoun to call me, as I want to know why the referral, why will the trial be better for me as opposed to a complete ablation.
Anyone also familiar with this technique?
Sincerely,
Miranda.

[D.ap]

Hi Miranda,

Is this the study ?
https://clinicaltrials.gov/ct2/show/NCT04713371

Is your breathing improved?

[Tamira47]

Hi Debbie,
Yes, that's the trial, precisely. It scares me.
My cough, no significant unproven bent. My breathing has improved somewhat.
Miranda.

[Olga]

May be I am missing something, but I do not see that you are the right fit for this? its not for ASPS specifically, and to be eligible, you need to have mets that are not lung mets as I understood from the description? The good news is that Dr.Littrup is working:)