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Thread: mets to lungs?

  1. #1
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    mets to lungs?

    Hello all,

    my dad has been coughing since two weeks ago,testing showed that he got some inflamations in his body.
    he started antibiotics and cough syrup , but after 5 days his cough got worse.
    my dad have mets in his lungs, they were inactive since his first scan, so i talked to his onco and i suggested to do a pet scan to check if the cancer is back.
    we did it yesterday, and the pet scan doctor allowed me to enter to the control room, and from what i was able to see on the screen is that there is some faint glowing on his lungs, no glowing on his mets on liver and the primary.
    so i guess it's the mets on his lungs that are back to activity, since yesterday i've been thinking a lot.
    i dunno if you guys know if there's a specific drug for mets in lungs? or its must be the same protocol he had before?
    meanwhile i think i will push his onco to have a biopsy from his lungs to get the molecular profiling.
    btw we stopped folfirinox because my dad was NED, so i think that folfirinox might still work for him.
    any suggestions on dealing with mets on lungs ?
    and i think the resection is not an option because there is more than 12 spots on the both lungs which i guess makes him inoperable.
    24-06-2017 : Father Diagnosed with Stage 4 adenocarcinoma tumor on the tail of pancreas , mets to liver and lungs.
    06-07-2017 : PET/CT FDG of 2.4 mets in lungs , 4.6 x 3 cm mass on pancreas tail SUV max = 4.2 , innumerable mets on liver SUV max = 6.3
    02-07-2017 : started with folfirinox.
    21-09-2017 : CT scan showed stability of the tumor, significant shrinkage of mets on liver, some mets disappeared.
    03-11-2017 : CT scan showed stability of the tumor, dicrease of the size of mets on liver.
    05-12-2017 : Ca 19-9 = 185 U/ml
    19-12-2017 : Ca 19-9 = 186 U/ml
    04-01-2018 : PET/CT no FDG on mets in lungs ( Scar tissue) , 3.3 cm Calcified tumor showing Faint FDG SUV max = 2.2 , Necrotic mets on liver SUV max = 3.7.
    26-04-2018 : Onco decided to stop chemo after 18 cycles of full Ffx,chemo doesnt work on none active cells. Total = 18 full cycles of Folfirinox.
    19-06-2018 : PET scan ==> NED, cancer's ass beated!
    03-09-2018 : MRI Scan ==> still NED.

  2. #2
    Moderator Senior User IndyLou's Avatar
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    Hello, ahmad-

    I'm sorry to hear that your father is not feeling well, and that you have a concern his cancer may have re-emerged. I'm a little confused by your posting--it feels like you are doing a lot of the diagnosis, rather than the doctor. I'm also confused about the mets to the lungs, those mets being "inactive," yet you still described a period where there was no evidence of disease. I would think that mets, even if in remission, are still evidence of disease.

    My understanding of cancer that has metastasized is that the cancer is still considered to be whatever the origin is. So metastasized pancreatic cancer in the lungs is still considered pancreatic cancer, and it would still be treated by the same chemo or targeted therapies.

    Still, PET scans are notorious for revealing "false positive" results, and "a faint glow" on a PET scan may or may not mean that cancer has returned. I would encourage you to discuss your father's health with his oncologist, and allow them to interpret the test results, and choose the best course of treatment.

    Best wishes to you.
    Age 52 Male
    early Feb, 2013 - Noticed almond-sized lump in shaving area, right side of neck. No other "classic" cancer symptoms
    late Feb, 2013 - Visited PCP for check-up, PCP advised as lymphoma. Did blood work, orders for CT-scan, referred to ENT
    3/7/13 - CT-scan inconclusive, endoscopy negative
    3/9/13 - FNA of neck mass
    3/14/13 - Received dx of squamous-cell carcinoma, unknown primary
    3/25/13 - CT-PET scan reveals no other active tumors
    3/26/13 - work/up for IMRT
    4/1/13 - W1, D1 of weekly cetuximab
    4/8/13 - W1, D1 of IMRT
    5/20/13 - complete 8 week regimen of weekly cetuximab
    5/24/13 - Complete 35-day regimen of daily IMRT
    mid-July 2013 - CT-PET scan reveals no active tumors, but shows necrotic tissue at site of original tumor
    early Sept 2013 - partial neck dissection to remove necrotic tissue. Assay shows no cancer present.
    Spring 2014 - No signs of cancer
    Spring 2015 - NED
    Spring 2016 - NED
    Spring 2017 - NED
    Spring 2018 - NED

  3. #3
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    Hello Indylou,

    thank you for your reply, you are right , i'm doing diagnosis without referring to the doctor, but since my dad had this disease i've been reading and checking all the scans he had and comparing it myself just to understand more the situation of my dad.
    but i just received the report of the pet scan, and it actually says what i already said, the pancreatic tumour and the liver mets are all calcified, but the lungs mets increased slightly their activity, SUV before was 2 and now 2,7 and their size by 4mm the biggest is 17mm .
    anyway i spoke to the oncologist and he told me that this slight increase in activity is not important and he still considers my dad to be stable and that he doesn't want to ruin the quality of life of my dad. and the most important thing is that the activity is still very slight, and he doesn't want to lose a line of treatement , since we have only two line of treatements for pancreatic cancer.
    24-06-2017 : Father Diagnosed with Stage 4 adenocarcinoma tumor on the tail of pancreas , mets to liver and lungs.
    06-07-2017 : PET/CT FDG of 2.4 mets in lungs , 4.6 x 3 cm mass on pancreas tail SUV max = 4.2 , innumerable mets on liver SUV max = 6.3
    02-07-2017 : started with folfirinox.
    21-09-2017 : CT scan showed stability of the tumor, significant shrinkage of mets on liver, some mets disappeared.
    03-11-2017 : CT scan showed stability of the tumor, dicrease of the size of mets on liver.
    05-12-2017 : Ca 19-9 = 185 U/ml
    19-12-2017 : Ca 19-9 = 186 U/ml
    04-01-2018 : PET/CT no FDG on mets in lungs ( Scar tissue) , 3.3 cm Calcified tumor showing Faint FDG SUV max = 2.2 , Necrotic mets on liver SUV max = 3.7.
    26-04-2018 : Onco decided to stop chemo after 18 cycles of full Ffx,chemo doesnt work on none active cells. Total = 18 full cycles of Folfirinox.
    19-06-2018 : PET scan ==> NED, cancer's ass beated!
    03-09-2018 : MRI Scan ==> still NED.

  4. #4
    Moderator Senior User IndyLou's Avatar
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    Jan 2014
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    Thank you, ahmad, for the clarification. You seem like you're very much in understanding and knowledge of your father's condition. I think cancer can be a great motivator, either as patients or caregivers, for learning as much as we can about the disease.

    I don't know your father's demographics or health outside of the cancer you described, but I like the oncologist's approach and focus on quality of life. I do think that's important. Is you father seeing the oncologist regularly?
    Age 52 Male
    early Feb, 2013 - Noticed almond-sized lump in shaving area, right side of neck. No other "classic" cancer symptoms
    late Feb, 2013 - Visited PCP for check-up, PCP advised as lymphoma. Did blood work, orders for CT-scan, referred to ENT
    3/7/13 - CT-scan inconclusive, endoscopy negative
    3/9/13 - FNA of neck mass
    3/14/13 - Received dx of squamous-cell carcinoma, unknown primary
    3/25/13 - CT-PET scan reveals no other active tumors
    3/26/13 - work/up for IMRT
    4/1/13 - W1, D1 of weekly cetuximab
    4/8/13 - W1, D1 of IMRT
    5/20/13 - complete 8 week regimen of weekly cetuximab
    5/24/13 - Complete 35-day regimen of daily IMRT
    mid-July 2013 - CT-PET scan reveals no active tumors, but shows necrotic tissue at site of original tumor
    early Sept 2013 - partial neck dissection to remove necrotic tissue. Assay shows no cancer present.
    Spring 2014 - No signs of cancer
    Spring 2015 - NED
    Spring 2016 - NED
    Spring 2017 - NED
    Spring 2018 - NED

  5. #5
    Super Moderator Top User ddessert's Avatar
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    Dr. Donaway (Hollywood, FL) said something in a recent Facebook posting that we (Pancreatic Cancer patients) often wait until things are headed drastically downhill before we attempt not-fully-researched intervention methods, such as NanoKnife (of which he is very experienced) or clinical trials. The failure of these interventions may not be totally due to the treatment, but trying to salvage an unsalvageable situation.

    He raises a good point. I know that the thinking on immunotherapy is that trying to save a stage 4 patients with many tumor masses may not be possible. The immune system needs some time to “rev up” and there may not be that much time left.

    There is much to be said for enjoying the calm before the storm. One of my philosophies has to become as strong/healthy as I possibly can to survive well if that time comes. This is one of the few times I think you can actually “strengthen” the immune system. By that, I mean being exposed to germs and sicknesses so that your body develops the antibodies for those illnesses now. Instead of getting those sicknesses while you’re in treatment and having everything grind to a halt. Along these lines, I do not use any-bacterial soaps or anything like that. Often I just wash my hands with water alone.

    I think you’re on the right track to look for lung-specific treatments. At a recent Metastatic Research conference, I found that other cancers treat metastases from different sites with different treatments. I don’t know that PanCan has progressed that far, but we should because who has more experience with metastatic treatment than us?

    I do think that if you’re looking at 12+ Metastatic sites on the lungs, you will need a systemic treatment - one that treats the entire body. Knowing where you are, molecular profiling may be the best bet.

    If it were me, my first choice would likely be going back to FOLFIRINOX because it was working so well with no signs of letting up.

    You may also want to hold off on molecular profiling until after FOLFIRINOX stops working. The treatments are known to change the biology of the tumor and the results may be different if sampled after FOLFIRINOX stops working.

    I’ve also been VERY impressed by the Gemcitabine/Abraxane/Cisplatin phase 2 clinical trial results. Hopefully the phase 3 trial will corroborate, but your dad may not have time to wait for that (years).
    BRCA2 3398del5
    Dec 2010 - back/abd pain
    May 2011 - Unresectable stage III, 2.5cm tumor
    Jun-Aug 2011 - Gem/Cis, 9 rounds
    Oct-Nov 2011 - Radiation+Xeloda, 25 days in 5 weeks
    Oct 2011-Sep 2012 - shrinking tumor
    Feb 2012 - National Familial Pancreatic Study
    Aug 2012 - Downgraded to stage IIA, PGP
    Sep 2012 - Whipple, T3N0M0, 0.5cm tumor, 0/16 lymph nodes
    Dec 2012 - Quebec PanCan Study
    Sep 2012-May 2018 - NED
    Mar 2013-present - NCT01088789
    @pancanology

  6. #6
    Moderator Senior User BrigitteM's Avatar
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    Hi Ahmad,
    I have lung nodules that have been slowly growing for about 12 months. I even had one nodule that was reported in the beginning, almost three years ago, but then it would not be reported, then it would show again on the reports. I also have been in touch with other patients with lung nodules and we are all scratching our heads very hard to figure out a way to get rid of them! And I had opportunities to ask several pancreatic cancer experts their view on the topic.

    The response from our respective doctors is to treat systemically, because 1. There are too many; 2. Some are in difficult areas to reach or cannot be removed without doing too much damages; 3. some are so tiny, they are difficult to find; 4. And finally, micro-metastasis are probably there but not visible.

    The reasoning is that some could be removed but not all; in that case, a systemic approach is definitely more appropriate. So no matter the method, surgery, radiation, radio frequency ablation, photodynamic therapy (a therapy based on light), or hyperthermic intra thoracic chemotherapy, the result is the same: what about the invisible ones.

    Chemotherapy is problematic too in my view because it usually works better on active tumors. Lung cells seem to be of a different kind and are slow grower. So how can chemotherapy be efficient on low level cancer like our lung nodules? I guess there is no better option right now.

    There may be a new path: TIL immunotherapy. Iím not very sure about the difference with CAR T cell yet, but the idea is similar. That is a new strategy that Iím following. In the meantime, I do as David, I try to keep my immune system in good shape with similar ruses


    As for the timing issue discussed by David, this is an interesting question. When I look at the progression of my nodules: when I had only a few, they were not big enough to biopsy, which I believe they need to confirm the metastatic status. When one of my nodules finally reached the threshold size, I had already about 10 or 12 nodules, and distributed in both lungs. However, these are slow growing lung nodules, with a bit of luck immunotherapy will still have time to ďrev upĒ before itís too late.
    __________________________________________________ ___________________
    1/12/2016 No symptoms except ongoing fatigue; blood test revealed elevated liver enzymes
    1/18/2016 Liver ultrasound, then MRI confirmed enlarged bile duct
    1/21/2016 ERCP and placement of a temporary stent
    1/28/2016 CT-Scan showed a lesion on the head of pancreas
    2/09/2016 2nd ERCP + EUS + FNA
    2/12/2016 DX Borderline resectable pancreas ductal adenocarcinoma - Stage 3 @ 61
    2/24/2016 FOLFIRINOX 3 cycles (6 infusions)
    5/12/2016 CYBER-KNIFE Stereotactic Radiation 3 sessions
    6/16/2016 WHIPPLE + portal vein and right hepatic artery reconstructions - 0/19 nodes pos - no mets. Restaged to 1A
    8/31/2016 FOLFOX for 3 cycles (6 infusions)
    Sept 2016 Know Your Tumor - PANCAN.org
    11/4/2016 CT Scan clear - NED
    May 2017 Liver lesion - DX mild fatty liver disease - NED
    Aug 2017 Several tiny lung nodules - NED
    Feb 2018 Stable lung nodules - NED
    May 2018. Lung nodules are growing; possibly mets, but still considered NED
    Aug 2018 One lung nodule has reached 1.7 cm. Biopsy confirms it is pancreatic metastasis.
    Sept 2018 Starting clinical trial with RX-3117 and Abraxane (NCT03189914)

  7. #7
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    Ahmad, I'm sorry you and your dad have to deal with the lung mets now. How about 1/2 dose chemo - would that help keep them in check? You have had great success in the past with the primary and liver mets, that's a true blessing they are still out of the picture.

  8. #8
    Moderator Senior User BrigitteM's Avatar
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    Another thought regarding the chemotherapy regimen. Itís not uncommon to see the primary tumor shrinking with one chemotherapy regimen, while the metastatic tumors --in lung, liver, or others--respond differently, or even increase. Even from one met site to the other the response may differ. Even though it is still pancreatic cancer, the cancer cells develop different mutations, which may modify the response to a given chemotherapy or treatment. So changing the regimen for treating the metastatic sites could be an option.

    Another reason to change regimen would be having an easier regimen to tolerate with less risk of irreversible side effects. Oncologists try to find a balance between efficacy with an aggressive chemo regimen and ability to stay longer on a chemotherapy that is easier to tolerate.
    __________________________________________________ ___________________
    1/12/2016 No symptoms except ongoing fatigue; blood test revealed elevated liver enzymes
    1/18/2016 Liver ultrasound, then MRI confirmed enlarged bile duct
    1/21/2016 ERCP and placement of a temporary stent
    1/28/2016 CT-Scan showed a lesion on the head of pancreas
    2/09/2016 2nd ERCP + EUS + FNA
    2/12/2016 DX Borderline resectable pancreas ductal adenocarcinoma - Stage 3 @ 61
    2/24/2016 FOLFIRINOX 3 cycles (6 infusions)
    5/12/2016 CYBER-KNIFE Stereotactic Radiation 3 sessions
    6/16/2016 WHIPPLE + portal vein and right hepatic artery reconstructions - 0/19 nodes pos - no mets. Restaged to 1A
    8/31/2016 FOLFOX for 3 cycles (6 infusions)
    Sept 2016 Know Your Tumor - PANCAN.org
    11/4/2016 CT Scan clear - NED
    May 2017 Liver lesion - DX mild fatty liver disease - NED
    Aug 2017 Several tiny lung nodules - NED
    Feb 2018 Stable lung nodules - NED
    May 2018. Lung nodules are growing; possibly mets, but still considered NED
    Aug 2018 One lung nodule has reached 1.7 cm. Biopsy confirms it is pancreatic metastasis.
    Sept 2018 Starting clinical trial with RX-3117 and Abraxane (NCT03189914)

  9. #9
    Regular User
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    thank u Indylu , actually i learned a lot about this disease even the doctors of my dad calls me the doc . yes my dad is seeing his oncologist regularly. As for my dad Health outside the cancer, he's been on a healthy diet since long time, no smoking,no alcohol abuse, only diabetes showed since like 5 years ago, he used to do sport regularly, but after being diagnosed he stopped sport.

    @ Ddesset & Brigitte & Jamiepat, thank u all for your replies ,actually today we sow the oncologist and he was still trying to convince me by not doing any chemo , he used the term i dont want to trigger something inactive.
    anyway he said that if he wants to get him back t chemo he wants to start with another protocol the Gemzar/abraxane , but i had another approach , i told him we have a gun and we are hitting the target directly called folfirinox, the neuropathy went down like 90% , and why should we wait for those nodules to get bigger than that. so why dont we do 4 cycles of modified dose of folfirinox and after 4 cycles we can check them by a scan .
    and Briggitte yes it's weird that the cancer on pancreas and liver is dead /inactive while on lungs it got back to activity again, i reviewed the last pet scan my dad had after stopping the chemo by 1 month, and the mets on the lungs did not have any fdg uptake, they showed up on CT and the biggest was 8mm but never glowed on the pet.
    i was able to convince him, and we are getting back to folfirinox next week, hoping that folfirinox will get them to inactive state again.
    thank u all for the info and for the support.
    24-06-2017 : Father Diagnosed with Stage 4 adenocarcinoma tumor on the tail of pancreas , mets to liver and lungs.
    06-07-2017 : PET/CT FDG of 2.4 mets in lungs , 4.6 x 3 cm mass on pancreas tail SUV max = 4.2 , innumerable mets on liver SUV max = 6.3
    02-07-2017 : started with folfirinox.
    21-09-2017 : CT scan showed stability of the tumor, significant shrinkage of mets on liver, some mets disappeared.
    03-11-2017 : CT scan showed stability of the tumor, dicrease of the size of mets on liver.
    05-12-2017 : Ca 19-9 = 185 U/ml
    19-12-2017 : Ca 19-9 = 186 U/ml
    04-01-2018 : PET/CT no FDG on mets in lungs ( Scar tissue) , 3.3 cm Calcified tumor showing Faint FDG SUV max = 2.2 , Necrotic mets on liver SUV max = 3.7.
    26-04-2018 : Onco decided to stop chemo after 18 cycles of full Ffx,chemo doesnt work on none active cells. Total = 18 full cycles of Folfirinox.
    19-06-2018 : PET scan ==> NED, cancer's ass beated!
    03-09-2018 : MRI Scan ==> still NED.

  10. #10
    Moderator Senior User BrigitteM's Avatar
    Join Date
    Sep 2016
    Posts
    332
    Thanks for the update. Keep us posted.
    __________________________________________________ ___________________
    1/12/2016 No symptoms except ongoing fatigue; blood test revealed elevated liver enzymes
    1/18/2016 Liver ultrasound, then MRI confirmed enlarged bile duct
    1/21/2016 ERCP and placement of a temporary stent
    1/28/2016 CT-Scan showed a lesion on the head of pancreas
    2/09/2016 2nd ERCP + EUS + FNA
    2/12/2016 DX Borderline resectable pancreas ductal adenocarcinoma - Stage 3 @ 61
    2/24/2016 FOLFIRINOX 3 cycles (6 infusions)
    5/12/2016 CYBER-KNIFE Stereotactic Radiation 3 sessions
    6/16/2016 WHIPPLE + portal vein and right hepatic artery reconstructions - 0/19 nodes pos - no mets. Restaged to 1A
    8/31/2016 FOLFOX for 3 cycles (6 infusions)
    Sept 2016 Know Your Tumor - PANCAN.org
    11/4/2016 CT Scan clear - NED
    May 2017 Liver lesion - DX mild fatty liver disease - NED
    Aug 2017 Several tiny lung nodules - NED
    Feb 2018 Stable lung nodules - NED
    May 2018. Lung nodules are growing; possibly mets, but still considered NED
    Aug 2018 One lung nodule has reached 1.7 cm. Biopsy confirms it is pancreatic metastasis.
    Sept 2018 Starting clinical trial with RX-3117 and Abraxane (NCT03189914)

 

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