Thankfully, though melanoma sucks great big stinky green hairy wizard balls, you have two good treatment options – adjuvant vs neoadjuvant therapy.
- March 29, 2020 at 11:09 pm
Here are some posts/articles that address those options:
Hope this helps. celeste
Without a more complete story I cannot tell you what I would absolutely do. If all scans are negative and this was the only lesion I had, here are the things I would consider and discuss in-depth with my doc:
- March 30, 2020 at 2:08 pm
1. I would want to know my BRAF status. Targeted therapy can work rapidly, and there are good reports (many were included in the link I shared with you previously) in the neoadjuvant setting.
2. I would want to know the plan for follow-up if I were to take Keytruda. Meaning, when would re-scanning take place? When, and based on what criteria, would they consider removing the lesion? Do they have any info on how that choice would be impacted by COVID in your area?
3. I would be very interested in a discussion and possible trial of intralesional therapy. Medication that is injected directly into a lesion that is accessible (which yours clearly is) that can get rid of the lesion and have a bystander effect (kills off lesions that are NOT directly injected). Here are many reports: https://chaoticallypreciselifeloveandmelanoma.blogspot.com/search?q=intralesional&max-results=20&by-date=true
4. Given that this lesion is located along the scar of your prior carotid surgery, is it in an area that would make removal complicated?
Things to keep in the back of your mind.
1. Lots of Stage IV patients with active, present lesions throughout their body, for whom surgery is not an option, can have those lesions resolve on either targeted or immunotherapy.
2. Any treatments, whether intralesional, targeted, or immunotherapy, that can shrink the tumor will make removal, should it even be needed, easier.
This is probably not the answer you want to hear. But this IS precisely what I would be asking my doc. Hope that helps. Celeste
ed williamsParticipantHi Caman, I have been a little “mouse” as part of checkmate 067 trial by Bristol Myer Squibb, which started back in 2013 and data is still being studied on long term survivors from the trial. So, my view is that of helping in the development of information that will be of benefit to patients in the future is the best way to go. By getting the drug first then taking out the tumor, you would allow the researcher’s to look at the effect of Pd-1 drug on your tumor early. This will help to develop a model where these kind of findings can determine next step for patients. Tumor sample might show t-cell (CD-8 cells getting into tumor) which would be predictive of a hot tumor and a good chance that the Pd-1 drug would be effect on it’s own. No T-cell in the tumor would inform the team that they need to add to the Pd-1 via another route be it radiation, Ipi, T-vec, bispecifics, TLR-9 agoinst, targeted therapy triplets, etc etc in order turn a cold tumor into a hot tumor. Good luck with your choice!!!Ed
- March 29, 2020 at 11:31 pm
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