- September 6, 2022 at 10:35 pm
How detailed are typical pathology reports? Is my experience (below) typical?
I had a recent recurrence in a lymph node near the surface of my chest. Instead of having surgery immediately, I elected to do T-VEC in parallel with Keytruda.
Without going into too much detail, my future treatment options are potentially limited – I’m BRAF negative and had cardiac inflammation the last time I tried some of the more aggressive combo therapies (IPI+Nivo).
While this recurrence could have easily been treated with surgery, future occurrences might not be as easily treatable. My hope in electing this course of treatments was to get some actual measurements around my immune systems response to the cancer. My doctor agreed with the strategy even with the risk of leaving the cancer in me another 2-3 months while I worked through 4-5 rounds of T-VEC.
Unfortunately, the pathology report following surgery was quite lackluster. The original version spoke mostly to the appearance and color. The follow up was slightly more detailed but doesn’t give any insights into the process of his analysis.
Here’s the data…
“No skin is present. The specimen is a fragment of semi-firm, fibrotic fibroadipose tissue. Upon sectioning, the cut surfaces are yellow-white, firm and fibrotic. A discrete mass lesion is not identified.”
“It is somewhat subjective. There is no active tumor necrosis, but I see scattered viable tumor cells (~10-15%) in this tumor bed showing dense fibrosis and lymphoid aggregates.”
- September 7, 2022 at 9:11 pm
I remember you from when you used to post.
Like you I post less these days in part because there is less activity here but also because in the end my treatment started to work, and staying on the board was not helpful – although I wanted to help others. And I just took a four week vacation and I found myself forgetting about this board.
I cannot help you with the pathology reports (surely there is more detail), and I was hoping that you didnt have a recurrence (but seems from the biopsy that you did). I just wanted to write to tell you that I ended up doing what you are doing, and I htink it makes sense. I was on keytruda on and off for a year or so – it cured a tiny tumour but it could not get rid of the larger tumour which kept growing but slowly. We were going to give up and do surgery (that would have been my third surgery in the same area) – so I guess in a way this was the neo-adjuvant approach. But before doing this we decided to add TVEC, based on a second opinion and a last chance to avoid the third surgery (which would have meant a long recovery time and rehab after plastic surgery). In the end the TVEC plus Keytruda worked – the first few weeks the tumour probably grew slightly (you can see it on the ultrasound used to inject the TVEC) but then it stabilized and started to shrink. And one year later (just over) the tumour finally seemed to have disappeared.
So my point is, I think this approach can work. I would definitely favour TVEC plus keytruda vs. Keytruda alone. And if it works well maybe you can avoid surgery. But if not, then I think gambling a little by keeping the tumour in place and using immunotherapy could give a better result than surgery and then keytruda. So I think its an interesting plan, and if your tumour is localized (think it is) then I think it has more chances of working. And if ipi is too risky (as it was for me) then I think adding tvec is a good alternative way of getting the keytruda to work. I hope it works for you as it did for me.
Good luck Mark
ed williamsParticipantHi Azsocal, in the following video from one of the leaders in the field of neo-adjuvant melanoma research, Dr. Long covers her Australian based program in detail starting at 36:50 min mark. Earlier in the video she talks about use of immunohistochemistry ( staining of cancer cells and view with high powered microscope work)They also consider things like CD8+ T-cell and distance from tumor, T-regs(FoxP3 cells) and Pd-L1 staining. Interferon gamma and TMB (tumor mutational burden) are also considered in her research. So yes a lot more can be looked at depending on if your oncology team is into the research side of things. Now, Dr. Long is based out of Australia but seeing that you are So Cal, then I would recommend getting in touch with Dr. Antoni Ribas based at UCLA (see following link). Dr. Ribas is also at the cutting edge of tissue study and is also looking at injectable including TLR-9 targets and has worked with CMP-001 and a couple of other drug candidates. https://www.youtube.com/watch?v=LPhuuC4QnTw https://www.youtube.com/watch?v=JGA84FLyW-E
- September 8, 2022 at 9:49 am
- September 8, 2022 at 7:49 pm
Thank you! Super helpful context. I was with UCLA originally before transitioning to another center. I was not under Dr Ribas’ care but I had heard good things.
Thank you as well, and glad to hear you found success in this treatment path. I’m generally encourage that TVEC probably had some positive effect, and while I’ll never truly know to what amount, I still want to collect as much data as possible. There were slightly more details in the report than I included, but honestly not much and not nearly what I was under the impression would be provided.
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