Liver mets: resection, ablation, SBRT, Y-90, anything else?
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Yeah...that feels a little long for me. Wish there was something systemic I could do along with it. Wish there were some data on doing immunotherapy with it.
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in general radiation is a great combo with immunotherapies but I was told not to do y90 simultaneously with my treatment. A 3 month break between is what they suggested. It also depends what immunotherapy you have in mind.
Z
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Things are not great, my liver has not bounced back back fro Sirs and we are facing liver failure, weather it be from the procedure or further cancer.
Ihave a CT scan tomorrow to determine weather we begin chemo and an other drug, however each way is not promising.
Or I bite the bullet and live a quality of life and live my short days out with my children and devastated husband
Any good someone can give me from here would be appreciated.
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Emily Louise. When did you have your procedure? Was it a y90 radioembolization? I'm so sad to hear about liver failure. Let us know about CT results.
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Granada 8 weeks ago today
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Emily Louise. Your IR did mapping and one lobe, correct? Rpooole left you a message on liver mets d thread. It might be helpful. I'm so sorry it has gone badly for you. My numbers have stayed normal the whole time.
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Emily-Louise, I don't have any advice but am saddened to hear this and pray that your liver turns around and the next treatment works. Hugs.
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Emily-Louise I am so sorry to hear this, hoping for a turnaround in your liver function soon.
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Emily Louise, thinking of you and wondering how you are. Check in if you can.
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Just checking in here. It has been 2 years since I had the Y90 procedure in December of 2015. I am still stable and have no signs of progression. I will have scans next week. I hope those of you considering this treatment will weigh all your options and if this is right for you then you have the success that I have been lucky enough to have. I am always happy to answer any questions you have.
Emily Louise-I hope you are feeling better. Sending prayers that you are healing.
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BabyRuth, That is just so great to hear!!! How many tumors did you have in you liver before Y90? Did they give you a percentage of how much of the liver was involved. I have been approved for the procedure, but dragging my feet because I'm scared. I know there is a small chance one can have liver failure due to treatment.
Thanks for any help.
Robin
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BabyRuth. Two years? I pray I get that too. I will have PET in January, I hope it still shows no uptake in liver mets, like the August PET did. My y90s were in April and May. So, I will be 8 months out.
But, I am scared that won't. I have a friend who had good results on her first scan and the second one showed 20new mets! Yikes. And she only had two tumors to begin with, I had at least eight.
Do you know if y90 can be done more than once if needed?
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Grannax2- I hope you get many years also. Good scans would start your New Year off in the right direction! You have done so well and continue to inspire me. Sorry to hear about your friend.
My IR said I could do the Y90 again if needed. It was such a hard treatment for me that I hate to think I would have to do it again but I would definitely consider it if needed. Lets hope that is not anything in my near future.
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Congrats BabyRuth! thanks for checking in.
>Z<
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9 month follow-up CT scan after SBRT, “No evidence of metastatic disease.” Much better news then last year at this time! May we all receive this news on our imaging!
Thinking of everyone always!
B
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I am so happy to see your note! Congratulations!
>Z<
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BStein, wonderful words to hear in a report! Congrats!!
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Bstein. That is amazing!!!! Great news. I have my y90 on 2/20 and 3/22. This gives me so much hope!
Babs
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Great news bstein. Not too long to wait Babs I hope they go well and do the job.
My scan is on Jan 23. I had to reschedule because I have the flu. I hope my liver looks as good as it did in August scan. No uptake is what I want. I'd like that for all of us.
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bstein...YES!!!!
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Great news Bstein! I am interested in exploring this, just not sure on timing. My current Ibrance/Faslodex treatment showed tumors shrank 40% in first 3 month scan. At this point I’m waiting for 6 month results before getting 2nd opinion at UCSF. Was plannto ask about it there. My treating oncologist doesn’t recommend for me but that seems to be a common oncologist response from what I’ve heard.
My father had great results from radiation seeding treatment for prostate cancer, has been fine for almost 10 years since. That’s part of what sparks my interest though I realize it’s a totally different situation.
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For those of you who have had Y-90, will you explain how long the process takes (from initial consult, through mapping and procedure)? Would you recommend teeing it up before one needs it (while someone is still on an active treatment that is working)? Also, if you did the procedure at a different hospital/facility, what medical records did they request you bring to the IR consult? I have found an IR and haven't made an appointment yet. Actually, I tried but was left on hold for 15 minutes with an automated system and hung up. I would like to meet with him now but don't want him to say "come back when your treatment fails and I can assess you then". I don't want to waste precious time I do not have. Thanks.
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JFL - I haven't had TACE or Y90, but I have consulted with an IR on TACE. Y-90 is another option. I do plan to get a consult on that as well. I am glad I did have the consult. My IR felt that TACE is not necessarily something that you wait for progression to do. I understand a lot better how I might fit it into treatment. Have the consult, IMO. Even if now is not the time for it. this research is not something you want to be chasing down during progression.
>Z<
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JFL, I did meet twice with the IR liver guy to make plans for Y90. We canceled at the end of my second appointment because my TM came in on the computer, showing a good response to the Xeloda I had just started. The IR said we should keep Y90 in our pocket. He wants to see regular scans from me so that we can take action when the time is right. He and my onc are in communication (same facility). So I think it would be a good idea for you to get some preliminaries out of the way, get the IR in the loop, and be poised for action. Get established as a patient. The first appointment included a physical exam (i.e. press under my ribs to see if it hurt), a thorough explanation of the procedures with a chance to ask questions, and an order for a baseline liver CT. (Liver MRI was an alternative.)
I mentioned to my onc my idea of taking the immunotherapy drug Keytruda when I do the Y90 (whenever that may be), to take try and make use of the abscopal effect, where radiation is synergistic with certain other treatments. Like Z doing some targeted bone met radiation close in time to her immunotherapy in Japan. However, my onc said she doubted the IR would approve of my taking any immunotherapy drug at the time of Y90 for my liver, because there is a rare but serious Y90 complication that is some kind of autoimmune problem with the liver. (I can't remember the term or more of what she said about it.)
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JFL. The mapping for y90 was only a few days prior to my first y90, then the second y90 was about five weeks after that. So, a total of two months. I would think that I R would request records from your docs, probably most recent PET at least and labs showing liver numbers.
I continued my TX of IF during the procedures. I doubt he will tell you to wait. Just for the consult, especially. I don't see what it could hurt to get his opinion ahead of time. Always best to be prepared.
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Shetland - PDL-1 inhibition is an interesting idea with Y-90. In general, when you are doing radiation to get an abscopal effect, you are going in with a light touch. You want to stress the cancer cells into expressing certain stress signals and neo-antigens, but you don't want to disturb the immune system infrastructure (kill of T-cells that would be the seed of the immune attack you are trying to achieve). I've read that relative to even normal radiation treatment, Y90 is like a bomb. Therefore it is not the obvious go-to radiation treatment for achieving an abscopal effect. I haven't seen any discussion of the abscopal effect with Y90. No trials, no papers. The focus/results are on a light touch of photons or protons.
But I've wondered about this and I feel your thinking may be ahead of the curve. There are certainly areas that the Y90 doesn't fully get to. These may be accessible to the immune system with appropriate immune suppression. A checkpoint inhibitor could potentially trigger a mop up effort after Y90 that would lead to prolonged response to the treatment. I fully support your line of thinking .... and
There is no reason to do radiation treatment and immunotherapy simultaneously. There are many arguments not to; you've gotten a couple. My immunologist felt that radiation before immunotherapy would be excessively immune suppressing and should be avoided. He felt the optimal window for immunotherapy would be 1-3 months AFTER radiation but even 6 months after radiation could be effective. Radiation disturbs the fragile DNA of cancer cells in a way that manifests over several months.
The other reason to do PDL-1 inhibition after radiation is PDL-1 expression on tumors is transient. Tumors that have no PDL-1 will express PDL-1 when they detect an immune attack coming, such as after radiation. The radiologist I am seeing Monday is in fact the lead author on the paper that first reported that radiation has been shown to provoke PDL-1 expression.
Nobody knows the right timing, but it is probably not immediately after radiation. I did delay returning to Japan a couple weeks to give more time between radiation and immunotherapy. There is a delicate balance between braking the immune system and activating the immune system. Timing is one of the parameters you can play with. Immunotherapy responses play out over months and you often combine treatments most effectively in serial rather than parallel.
>Z<
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Yes, I had been thinking about the bomb -- that's how my IR described it -- and that maybe it would be too heavy duty for the abscopal effect. I was going to email him the question. Thank you so much for the info and your thoughts on timing.
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Thanks for the feedback, Z, Shetland and Grannax! I am going to go ahead and schedule the appointment. My MO did say I could do abemaciclib while I do Y90, because I asked about it. A while back, I did find one, lonely, isolated case of abscopal effect in an elderly man who had Y90. Can't recall what kind of cancer he had. Will try to find it.
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My thinking is that Y90 is a bomb where they target it and they target what they can see. But you have cancer they can't see. Probably Y90 has a partial effect in these areas that may be closer to light touch required for the abscopal effect. And the immune system is most effective on micro-tumors you can't see because they can't setup the whole immunosuppressive tumor environment ... which goes way beyond PDL-1 inhibition. So I envision PDL-1 inhibition working in the areas peripheral to the target that got "bombed". My theory requires a better understanding of Y90 and whether these peripheral areas really exist in the way I am imagining.
>Z<
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