Please opinion needed treatment options

I am sorry but I am not an expert, and also I dont want to give you bad advice. You may need to wait for experts like Ed or Celeste to post or others to give their views. But you did seem urgent so I want to try to help.

Celeste has always said that immunotherapy can take time, be patient with the patient. I am guessing these are your first scans after three months. So while you dont give precise measurements or numbers, they dont seem that bad. You say you have lots of bone mets but I dont know how many and I presume these are what you started with. If so, then the results are not so bad.

In my case my tumour burden was really low, w immunotherapy the tumour grew but very slowly so it was kind of working but not that well. I had to have TVEC to give the immunotherapy a push, but that was after one year of slow progression. You seem to have a much higher burden, but the immunotherapy is working better than in my case.

What does your oncologist say? Is s/he a melanoma specialist? Unless the ones that grew slightly larger are a problem then the news seems good, and you will likely want to continue with this. And there are other trials too, not just TIL, in case this doesnt work.

I am assuming you cannot use targeted therapy and that you are not BRAF positive, else this would be an extra option. But even then might be fine to keep w immunotherapy and hold this in reserve.

I hope this helps a little, the scans dont seem so bad to me, well done and I hope you find the right answers

Best wishes Mark

I will reply since the experts are not replying yet (and I am concerned for you!).

Personally, I think I would stick it out. This is your first scan (but you say you have had keytruda and targeted therapy before so I guess you must have had other scans before) and it is showing mainly good results but sadly a few bad. So it seems to be working but not well enough, but also it can take time.

I have never had bone mets, am sorry for this and hope you are not in too much pain.
In my case I was lucky as my disease was always local / regional – I dont think it spread to my lymph nodes even (I think later maybe it did but never tested too late), and my mets were all local / regional. So I never ran into brain mets and only had a brain scan once a year.

My honest advice would be to make sure you are being treated by a melanoma specialist and ask his or her opinion. And also ask what is the backup plan. And at what stage should you change to the backup plan. My current oncologist says he has a backup plan(s) but I have no idea what it is. Fortunately his treatment worked where the other had failed so we didnt need the backup plan- but I guess w melanoma we always need to be thinking of one.

You can of course always ask medical experts – like Dr Weber and others like Hamid in LA – for second opinions and options.

I hope others here more knowledgeable will read too and help out
Best wishes (and happy easter!!)
Mark