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Adrenal Node Growing

Forums Cutaneous Melanoma Community Adrenal Node Growing

  • Post
    Lori0529
    Participant
      Received scan results yesterday and was informed an Adrenal node is growing and needs to be evaluated by the review board.

      Does anyone have experience with diagnosis and treatment of melanoma that has spread to the Adrenal gland?

      Thanks!

      History below:

      2008 Melanoma in situ Stage 0 (small dark spot lower right leg)

      2015 Melanoma Stage 2B (skin tag upper right thigh
      Had wide excision surgery.  Sentinel node biopsy was negative

      November 2015
      Lab report
      “mature melanoma”,Breslow Thickness – 2.85 mm, Clark’s Level:  Four, Ulceration:  Present

      January 31, 2020
      CT Scans of Chest, Abdomen, and Pelvis showed 19 mm groin lymph node concerning for metastatic disease

      February 11, 2020
      Biopsy – confirmed as Melanoma

      February 17, 2020
      Immunotherapy Round 1 (Opdivo/Yervoy combo)

      March 2, 2020
      Dermatologist removed more superficial melanoma of new lower right leg spot

      March 9, 2020
      Immunotherapy Round 2 (Opdivo/Yervoy combo)

      April 14, 2020
      Received NEO Genomics report – confirmed BRAF+

      March 30, 2020
      Scheduled for Immunotherapy Round 3 (Opdivo/Yervoy combo)
      Infusion did not take place
      Liver numbers high  AST 115, ALT 257
      Steroids prescribed (Prednisone 10 mg taper)

      April 20, 2020
      Immunotherapy (Opdivo only)

      May 4, 2020
      Scheduled for Immunotherapy (Opdivo only)
      Infusion did not take place
      Liver numbers
      AST 217, ALT 482
      Steroids prescribed (Prednisone 10 mg taper)

      May 7, 2020
      MRI and CT scans revealed lymph node was smaller – partial response to immunotherapy

      June 11 2020

      SURGERY
      Complete Superficial Inguinal Dissection

      August 10, 2020
      Brain MRI, CT Scan of Chest/Abdomen/Pelvis  — all good

      November 16, 2020
      CT Scan of Chest/Abdomen/Pelvis   — all good

      February 16, 2021
      CT Scan of Chest/Abdomen/Pelvis  , CT Scan Right lower extremity — all good

      Jun 16, 2021
      Brain MRI, CT Scan of Chest/Abdomen/Pelvis  , CT Scan Right lower extremity

      Informed that an ADRENAL NODE is growing and that it needs to be evaluated by the Tumor Review board

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    • Replies
        Bubbles
        Participant
          <hr />

          Though I have not had any mets to the adrenal gland personally, I would assume that it would be treated as any other met.  With the notation that adrenal function would need to be monitored and supplemental hormone therapy be supplied if needed.  (However, with one gland still unaffected that may not pose any problem.)  So the real questions to me are ~

          1.  Is this melanoma?  Do we need to biopsy?
          2.  If it is melanoma, along with your history of prior immunotherapy and resulting liver issues, what is the treatment option?
            1. Surgery?  Apart from it being one of your adrenals, surgery can still be a good solution.  Here are two reports on just that –  https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2020/08/surgical-removal-of-lesions.html  and https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2019/07/cut-it-out-prolonged-overall-survival.html
            2. Then again, as even the post points out, we have also learned that treatment with the tumor in place – NEOADJUVANT treatment – can be a good option.  Targeted or immunotherapy can be used.  Here are a zillion articles:  https://chaoticallypreciselifeloveandmelanoma.blogspot.com/search?q=neoadjuvant
            3. Given your BRAF positive status, perhaps it is time to use that.  Pertinent articles: https://chaoticallypreciselifeloveandmelanoma.blogspot.com/search?q=braf
            4. Targeted therapy is best when both a MEK inhibitor and BRAF inhibitor are used.  Strangely, when combined response rates are better and side effects are diminished.  Here is the best analysis I could come up with regarding the various combos – https://chaoticallypreciselifeloveandmelanoma.blogspot.com/search?q=Braftovi  
            5. Finally, clinical trials are another option.

          So…  These are the things that I would want to discuss with my onc if I were in your shoes.  I hope this helps and I wish you my best.  Celeste

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          Threefitty
          Participant
            On treatment after first metastases, i discontinued the combo after 2 doses of the combo due to colitis. i had those 3 tumors disappear (NED) . After massive outbreak 6 months later, including both adrenals, I was given modified combo with yervoy reduction. again this triggered much lighter colitis – manageable but also  treatment stopping. However, the result so far has included reduction of adrenal tumor size. i’m now on optivo maintainence.

            obviously we are all different in situtions related to our immuno-aversity, my experience is a return to  the “safe-side” immuno of optivo. I don’t have Braf+ options. That probably would have happened instead if it was an option – given my tumor load being significant when we crossed that bridge. Your tumor load profile will vary.

            hopefully you are not dealing with this on review. FWIW, I have not experienced a unusual fatigue or side effects from having my adrenals full of mel. some lowered libido. If you don’t know the why’s/wherefores of the liver and combo relationship, it might be good to know.

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