Friend has single lung mass what to do? History of stage 3a melanoma

I'm so sorry to hear about your friend.  We are currently at the same crossroads with my husband Dave.  I think if they can surgically remove it, that is your best bet.  Unfortunately they can't for my husband.  If they can't remove it, a systematic treatment will be his best bet – and there are actually alot of options out there.  Choosing one will be difficult, but knowing there is another out there that may work is the first doesn't is somewhat reassuring.

Best wishes for the both of you. 

Maria

I'm so sorry to hear about your friend.  We are currently at the same crossroads with my husband Dave.  I think if they can surgically remove it, that is your best bet.  Unfortunately they can't for my husband.  If they can't remove it, a systematic treatment will be his best bet – and there are actually alot of options out there.  Choosing one will be difficult, but knowing there is another out there that may work is the first doesn't is somewhat reassuring.

Best wishes for the both of you. 

Maria

They may well do another scan before an operation to double check for any more hot spots.  If there is only one spot they may well operate to remove it and look at the inside of his lung visually when they operate.  If a scan shows multiple locations in several lobes in only one lung they might remove one entire lung.  The other option and certainly what will be done if they were to find multiple spots in both lungs (as they did in my lungs over 4 years ago) they will want to start systemic treatment. 

   One thing they need to learn immediately is what type mutations he may have.  Melanoma is not  one disease.  There can be many diferent mutations and only a few and their signaling paths are well enough known to have targeted therapies to attack the specific DNA mutations in ones tumors.  There are targeted drugs that have recently been being tested and used for the BRAF and C-Kit melanoma mutations on a systemic basis.  There are many treatments that work on a few patients and why they work on some and not others are  not currently known..  The two immunological treatments that work (some times fully, sometimes partially and sometiimes not at all) on the largest number of melanoma patients are IL-2 and the newly approved Yervoy.

   Even if the melanoma cannot be eradicated, it does not necessarily mean a death sentence and certainly not always an immediate one..  I ain't quit living YET!

They may well do another scan before an operation to double check for any more hot spots.  If there is only one spot they may well operate to remove it and look at the inside of his lung visually when they operate.  If a scan shows multiple locations in several lobes in only one lung they might remove one entire lung.  The other option and certainly what will be done if they were to find multiple spots in both lungs (as they did in my lungs over 4 years ago) they will want to start systemic treatment. 

   One thing they need to learn immediately is what type mutations he may have.  Melanoma is not  one disease.  There can be many diferent mutations and only a few and their signaling paths are well enough known to have targeted therapies to attack the specific DNA mutations in ones tumors.  There are targeted drugs that have recently been being tested and used for the BRAF and C-Kit melanoma mutations on a systemic basis.  There are many treatments that work on a few patients and why they work on some and not others are  not currently known..  The two immunological treatments that work (some times fully, sometimes partially and sometiimes not at all) on the largest number of melanoma patients are IL-2 and the newly approved Yervoy.

   Even if the melanoma cannot be eradicated, it does not necessarily mean a death sentence and certainly not always an immediate one..  I ain't quit living YET!

Hi Alicia,

My husband was recently diagnosed with a 2.5 met in one lung and a 7.5 met in the other. The thorasic surgeon was not confident he could get the 7.5 met without taking a lobe.  My husband opted for an ablation which was performed on the 7.5 met last Tuesday. This procedure involved "microwaving" the tumor.  It is very similar to the actual biopsy experience.  The 2nd tumor will go through the same procedure next Tuesday.  He was able to come home that afternoon and back at work within a couple of days.

Good luck with the decision.  There seem to be many options. 

Sandy

Hi Alicia,

My husband was recently diagnosed with a 2.5 met in one lung and a 7.5 met in the other. The thorasic surgeon was not confident he could get the 7.5 met without taking a lobe.  My husband opted for an ablation which was performed on the 7.5 met last Tuesday. This procedure involved "microwaving" the tumor.  It is very similar to the actual biopsy experience.  The 2nd tumor will go through the same procedure next Tuesday.  He was able to come home that afternoon and back at work within a couple of days.

Good luck with the decision.  There seem to be many options. 

Sandy

I was diagnosed in 2010 with 8 smaller (than your friend's) lesions in my lungs. This was after having two independent stage I primaries. They were not willing to declare the lung lesions "melanoma" (nor treat for metastatic melanoma) until they positively confirmed that was the case. They did that via a Video Assisted Thorascopic Surgery (VATS) procedure. That confirmed as melanoma, and opened the door (for me) to stage IV treatments.

They didn't try to resect all 8 lesions because they felt it was probably more spread than could be detected via scan (i.e. microscopic). Instead, we went for a systemic treatment. In 2010 my choices were biochemo and IL-2, I chose IL-2 (and responded — in my lungs.) In 2011 there's at least a third systemic choice — ipilimumab/yervoy.

And there are some interesting clinical trials. They could potentially havest tumor infiltrating lymphocytes from your friend's large tumor and do a systemic treatment called adoptive cell transfer (ACT). In particular:

http://clinicaltrials.gov/ct2/show/NCT00338377

http://clinicaltrials.gov/ct2/show/NCT01005745

http://clinicaltrials.gov/ct2/show/NCT00513604

http://clinicaltrials.gov/ct2/show/NCT01236573

And then there's the BRAF inhibitor trials like those for PLX4032. And other non-BRAF-specific trials like MDX-1106 and E7080. And there's a lot more clinical trials than that, the ones I mention are the ones that have caught my eye for my own specific circumstances.

Hopefully your friend has a melanoma-specializing oncologist who can help guide him through the maze of choices to those choices that have the best odds for his specific melanoma traits.

I was diagnosed in 2010 with 8 smaller (than your friend's) lesions in my lungs. This was after having two independent stage I primaries. They were not willing to declare the lung lesions "melanoma" (nor treat for metastatic melanoma) until they positively confirmed that was the case. They did that via a Video Assisted Thorascopic Surgery (VATS) procedure. That confirmed as melanoma, and opened the door (for me) to stage IV treatments.

They didn't try to resect all 8 lesions because they felt it was probably more spread than could be detected via scan (i.e. microscopic). Instead, we went for a systemic treatment. In 2010 my choices were biochemo and IL-2, I chose IL-2 (and responded — in my lungs.) In 2011 there's at least a third systemic choice — ipilimumab/yervoy.

And there are some interesting clinical trials. They could potentially havest tumor infiltrating lymphocytes from your friend's large tumor and do a systemic treatment called adoptive cell transfer (ACT). In particular:

http://clinicaltrials.gov/ct2/show/NCT00338377

http://clinicaltrials.gov/ct2/show/NCT01005745

http://clinicaltrials.gov/ct2/show/NCT00513604

http://clinicaltrials.gov/ct2/show/NCT01236573

And then there's the BRAF inhibitor trials like those for PLX4032. And other non-BRAF-specific trials like MDX-1106 and E7080. And there's a lot more clinical trials than that, the ones I mention are the ones that have caught my eye for my own specific circumstances.

Hopefully your friend has a melanoma-specializing oncologist who can help guide him through the maze of choices to those choices that have the best odds for his specific melanoma traits.