Cooling off period after Gamma knife?????

Hi Jennifer,

Congratulations on getting the Gamma Knife (GK) treatment arranged.  Take a look at thread below "Brain mets on tak/mek, need advice".  Celeste responded with her blog regarding when to add immunotherapy in regard to GK.  Although I did not have brain mets, I received radiation during my ongoing treatment of ipi/nivo and firmly believe that my partial systemic response was due to the "triple-play" of dual-agent immunotherapy combined with radiation.  Frankly this was the first treatment in three years that has even worked at all for me.  No doubt different doctors have different opinions, and perhaps 2-weeks will not make a big difference but consensus seems to be that concurrent (like me) or immediate immunotherapy may increase the chances of the abscopal effect which capitalizes on the release of tumor antigens to illicit a systemic immune response.  Hope the GK goes well.

Gary

Hi Jennifer,

Congratulations on getting the Gamma Knife (GK) treatment arranged.  Take a look at thread below "Brain mets on tak/mek, need advice".  Celeste responded with her blog regarding when to add immunotherapy in regard to GK.  Although I did not have brain mets, I received radiation during my ongoing treatment of ipi/nivo and firmly believe that my partial systemic response was due to the "triple-play" of dual-agent immunotherapy combined with radiation.  Frankly this was the first treatment in three years that has even worked at all for me.  No doubt different doctors have different opinions, and perhaps 2-weeks will not make a big difference but consensus seems to be that concurrent (like me) or immediate immunotherapy may increase the chances of the abscopal effect which capitalizes on the release of tumor antigens to illicit a systemic immune response.  Hope the GK goes well.

Gary

Hi Jennifer,

Congratulations on getting the Gamma Knife (GK) treatment arranged.  Take a look at thread below "Brain mets on tak/mek, need advice".  Celeste responded with her blog regarding when to add immunotherapy in regard to GK.  Although I did not have brain mets, I received radiation during my ongoing treatment of ipi/nivo and firmly believe that my partial systemic response was due to the "triple-play" of dual-agent immunotherapy combined with radiation.  Frankly this was the first treatment in three years that has even worked at all for me.  No doubt different doctors have different opinions, and perhaps 2-weeks will not make a big difference but consensus seems to be that concurrent (like me) or immediate immunotherapy may increase the chances of the abscopal effect which capitalizes on the release of tumor antigens to illicit a systemic immune response.  Hope the GK goes well.

Gary

Adriana returned to BRAF right after GK for about 2 weeks then transitioned to Keytruda. There were initial concerns that some times swelling occurs immediately post GK and wanted to monitor that prior to starting Keytruda which sometimes also causes swelling prior to tumor reduction and did not want to compound the two. MRI performed 1 week post GK alleviated any concern (and then again at 1 month.) 

May be similar concerns on the part of his Dr.s

Best wishes, Rob

Adriana returned to BRAF right after GK for about 2 weeks then transitioned to Keytruda. There were initial concerns that some times swelling occurs immediately post GK and wanted to monitor that prior to starting Keytruda which sometimes also causes swelling prior to tumor reduction and did not want to compound the two. MRI performed 1 week post GK alleviated any concern (and then again at 1 month.) 

May be similar concerns on the part of his Dr.s

Best wishes, Rob

Adriana returned to BRAF right after GK for about 2 weeks then transitioned to Keytruda. There were initial concerns that some times swelling occurs immediately post GK and wanted to monitor that prior to starting Keytruda which sometimes also causes swelling prior to tumor reduction and did not want to compound the two. MRI performed 1 week post GK alleviated any concern (and then again at 1 month.) 

May be similar concerns on the part of his Dr.s

Best wishes, Rob

Jennifer, do you know why they have decided to break the gamma knife into two separate sessions? How many lesions are they treating and are they large? This just seems unusual for me. I've personally been through 10 rounds of gamma, each time blasting every tumor that was currently showing on the MRI. I became a "regular" in the gamma unit in 2014, as I was cropping up new tumors at a rate of 2-4 per month. The most ever treated in ONE gamma session was 9. Granted, they were small… but 9. Initially, my insurance was denied, as the "standard treatment" was not to radiate more than 4 in any given session. 

As for a "cooling off" period….. At the time of having 9 lesions gamma treated in one session, I was recovering from lung surgery and was still sporting the chest drain. Post radiation, I was back on MEK inhibitor within two days.  New data shows that with immunotheraputic meds such as Nivo, Ipi, and Pembro, the lack of taking any kind of break is actually beneficial due to the functioning of the immune system response being "directed" (for lack of a better term) to the target lesions by the radiation.

Does your dad have a history of brain bleeds, blood thinners, or brain edema?

Jennifer, do you know why they have decided to break the gamma knife into two separate sessions? How many lesions are they treating and are they large? This just seems unusual for me. I've personally been through 10 rounds of gamma, each time blasting every tumor that was currently showing on the MRI. I became a "regular" in the gamma unit in 2014, as I was cropping up new tumors at a rate of 2-4 per month. The most ever treated in ONE gamma session was 9. Granted, they were small… but 9. Initially, my insurance was denied, as the "standard treatment" was not to radiate more than 4 in any given session. 

As for a "cooling off" period….. At the time of having 9 lesions gamma treated in one session, I was recovering from lung surgery and was still sporting the chest drain. Post radiation, I was back on MEK inhibitor within two days.  New data shows that with immunotheraputic meds such as Nivo, Ipi, and Pembro, the lack of taking any kind of break is actually beneficial due to the functioning of the immune system response being "directed" (for lack of a better term) to the target lesions by the radiation.

Does your dad have a history of brain bleeds, blood thinners, or brain edema?

Jennifer, do you know why they have decided to break the gamma knife into two separate sessions? How many lesions are they treating and are they large? This just seems unusual for me. I've personally been through 10 rounds of gamma, each time blasting every tumor that was currently showing on the MRI. I became a "regular" in the gamma unit in 2014, as I was cropping up new tumors at a rate of 2-4 per month. The most ever treated in ONE gamma session was 9. Granted, they were small… but 9. Initially, my insurance was denied, as the "standard treatment" was not to radiate more than 4 in any given session. 

As for a "cooling off" period….. At the time of having 9 lesions gamma treated in one session, I was recovering from lung surgery and was still sporting the chest drain. Post radiation, I was back on MEK inhibitor within two days.  New data shows that with immunotheraputic meds such as Nivo, Ipi, and Pembro, the lack of taking any kind of break is actually beneficial due to the functioning of the immune system response being "directed" (for lack of a better term) to the target lesions by the radiation.

Does your dad have a history of brain bleeds, blood thinners, or brain edema?