Joshua on Keytruda /axitinib off label

[D.ap]

Good morning all.
We had our needle biopsy yesterday and Josh did well with very little issues ( no lung collapse ) but a little sore.
The interventional radiologist went in about 6cms between his left rear rib cage into left lower lung.
Apparently there was a nodule they were seeing that was biopsied .

We will know the final diagnosis by Thursday to what is causing inflammation , so we will know how to move forward . Pneumonia was the initial dxd by radiologist . We had talked initially of waiting a month if it is pneumonia and redoing an X-ray to see if it resolves but choose to biopsy to know more definitely to what we are dealing with.


While in the recovery room our IR who is over seeing Joshua’s liver tumor , came in and let us know of last Friday’s MRI results of the 2 prior embolizations ( April and November 2019) had reduced the 6.5cm liver tumor down to 4-5cms of seen active/ viable tumor ,making it a much better candidate for cryoablation.
He will be performing the procedure with 4 probes and using RFA to cauterize and kill residual tumor upon the removal of the probes in about 2 weeks .

Will update when we know more .

[D.ap]

Hey evening all
I wanted to add to my above post , we are trying to shy away from antibiotics, steroids and also the discontinuation of an ici , in our recent inflammation issue .
Will let all know of biopsy findings.
Love to all
Keep the faith ❤️

[Olga]

There is a possibility that the liver tumor reduction is due to Keytruda working...

[D.ap]

Hello Olga
Yes I believe you are correct . But how is that associated with the lung inflammation ?
Or am I missing your point ?
But I guess it is still to be determined with biopsy .
Inflammation verses infection .
Josh is still on combination regiment of Keytruda and axitinib .
Axitinib low dosage .


😏

[Olga]

My point was the reduction in the liver met size might be from K working so Josh might want to wait with the cryo to see if the met is reduced further.
4 cm met with the margins would be 6-7 cm necrotic tissue area after the cryoablation.
When is the lung biopsy going to be ready?

[D.ap]

Hello Olga
Thanks for the clarification .
With this tumors history of increase , we need to use this reduction and eradication ,opportunity we feel .
We are scheduled for Feb 18th.

The biopsy results should be available by this Friday .

[Olga]

Understood. Given that the liver mets are usually not the best respondent to ICI, this plan is good - on a caution side, using the window of opportunity from the embolization effect.

[Bonni Hess]

Dear Debbie, Thank you for all of the updated information, and best wishes that the lung biopsy results that you are scheduled to receive today will provide some helpful information to help guide your treatment decision to address and resolve dear Josh's chest inflammation. With special caring thoughts, healing wishes, and continued Hope, Bonni

[D.ap]

Hello all
Biopsy findings “irritation “the culprit , not tumor induced .
We will find out what is irritating the left lower lung area ,at our Weds oncologist appointment .
My understanding , still considered a degree of pneumonitis .

https://www.mayoclinic.org/diseases-con ... c-20352623

[Olga]

Good to hear that it seems to be not the progressing met but some kind of the inflammation, although I would advise to ask for the copy of the report itself and review it.

[D.ap]

Hello Olga
Thanks for the clarification .
With this tumors history of increase , we need to use this reduction and eradication ,opportunity we feel .
We are scheduled for Feb 18th.

The biopsy results should be available by this Friday .

Biopsy of lung negative for ASPS😊
Prayers requested as well as thanks to all , as we enter into liver cyro tomorrow .
Love ,

[D.ap]

We are home
Josh is doing great .
Love,

[Olga]

Good to hear but tell them to be very careful as this is only when the cryoablated area de-freezes, it is one large damaged area that is inflammed till it healed. Is he going to be scanned tomorrow to check it? Should be smaller at 3 months follow up scan (taking into consideration the initial increase for the margins)

[D.ap]

Thank you Olga 😊

[D.ap]

Hey all with appointment of last week--

Haven't got the scan written report in hand, but a month after the
procedure, my understanding, majority of the 6cm tumor destroyed. Outward perimeter showing activity. My thought and maybe team? that it is healing ?
Will repeat MRI ? in 3 weeks to make assessment to what to do next.
Everyone stay safe.

Love