Jussi from Finland - Dx 2008 - 30.3.1991 - 23.8.2019 R.I.P.

[Olga]

It is still a very open question re. what locations are the best for the abscopal effect creation. What about treating some brain met? SBRT to some that is causing the clinical problem might be easier to get approved for.

[arojussi]

As mandibular met just started to cause severe bleeding having it targeted shouldnt be too difficult it also very sensitive and painfull. Problem is even if we can achieve abscopal effect it can be difficult to get more immunotherapy. After 6 moths there is little but almost certain disease progression, so we must first achieve some shrinkage, before it is reasonable to even ask more opdivo.

[D.ap]

Last infusion was on friday a week ago. Scan next thuesday, so if immunotherapy caused swelling it hasnt settled before scan. I have been on immunotherapy little over 6 moths. As there has been similar case where after 6 moths it wasnt clear if there was treatment response, so they re-scanned again after six weeks of drug holiday and saw response. So I would like to keep taking avastin and cediranib for symptoms and re-scan and have cardiac mri to confirm disease progression in like 6 - 8 weeks. And then discuss about continuing immunotherapy based on scan results.

Jussi
I’m confused..did you have a scan this week? Tuesday ?
What scan will you have next week?

[arojussi]

Well had to measure rest and walking heart rates to know if I need to change pazopanib to cabotsantinib. Well at rest lowest heart rate went was 67. During walking it stayed between 78-97. And after it went down to 73 in few minutes, so I guess I dont have to change pazopanib, while waiting for more cediranib. I checked cabotsantinib side-effects and really don't want to try it. Actually these heart rates make the whole heart tumor progression sound weird.

[arojussi]

scan was this week thuesday and infusion was friday before that. No scan is planned for near future.

Of course we are planning for radiation for mandibula lesion for near future.

[Olga]

Your heart rate looks pretty good to me - resting and active both plus the return lower fast. I am not sure about the heart progression either. Have the mandibular met treated soon - SBRT? cryo? are brain mets stable/shrinking?

[arojussi]

In brains few mm growth. Little but it is there.

[arojussi]

In mandibula there was met surgically removed long ago in summer before gamma knife. Surgery was almost certainly with positive margins, so microscopic cancer cells can start growing now or microscopic cancer can swell, because of immunotherapy tumor cells coming visible in the scan.

[arojussi]

When immunotherapy was started smaller brain mets started shrinking and bigger started growing I am relatively optimistic still, that there was response in the brains it just looked different depending about tumor size.


I hope that if we achieve response by immunesystem either by just waiting or radiating some tumor I hope oncologist will reconsider continuing immunotherapy. As pericardial effusion disappeared after subcutaneus met was radiated, there obviously was some weak response by immunesystem during that time.

[arojussi]

Today heart rate dropped to 70 less than 15 minutes after a hour of very slow walking.

[D.ap]

Hi Jussi
I was researching icis and effusions and found this write up on blockages in the lungs causing effusions ( tumor increases) and 2 cases of Nivolumab ,resolving itself.

https://www.frontiersin.org/articles/10 ... 00004/full

[Olga]

No Deb, in both cases from this article there was an increase in pericardial effusion on nivolumab. In Jussi case there was a significant decrease from the very beginning on it.

[D.ap]

Hi Olga
I was just looking back at when the effusion began and thinking it began before Opdivo infusions ?

http://www.cureasps.org/forum/viewtopic ... ial#p11926
Also Jussi , you mentioned back in April you thought it had been there prior ? The pericardial effusion?

So the question would be did it resolve by way of Opdivo , and or cediranib or the combo is my thought.
As it wasn’t going away prior to these meds being used.
I maybe way off base . Just a thought :)

[arojussi]

Pedicardial effusion most likely caused by cardiac tumor, so it has been there long before opdivo was started. When I had radiation for subcutaneous met, cediranib was on the break. And it was during this time effusion disappeared. Now there is little increase in effusion and tumor size. As adding radiation obviously helped last summer best idea I can come up with would be to radiate mandibular lesion to achieve abscopal effect and hope it makes it easier to immunesystem to reconise cancer.

[arojussi]

Well radiation planning starts tomorrow. There has been several case-studies about radiation achieving abscopal effects even after immunotherapy alone failed. This is not as certain success as gamma knife was, but in theory this might work.