Best course of action?

[Chinix]

Hello

My father was diagnosed with melanoma stage 3C during summer 2012 at 69 years old. After the first set of treatments he started the watch and see process. In March 2014 he presented severe anaemia and was diagnosed with a stomach met. He had surgery to remove 80% of his stomach and recovered quite well from the surgery. Pet-scan and brain MRI were clear in April 2014.

2 weeks ago he had his thoracic scan and then a gastroscopy and colonoscopy. The scan showed something in the lung but that day the oncologist was more concerned with some neurological symptoms my father started to present a few days before (trouble talking, gait disturbance and double vision). The oncologist prescribed Decadron. A brain MRI was done this morning and the oncologist called to tell that some lesions were seen but that the radiologist needed more time to study the lesions. The oncologist will see my father next week to discuss the nature of the lesions and future options (he metioned radiotherapy). I forgot to mention that my father is BRAF wild type.

I’ve been reading this forum on and off since my father’s diagnosed and l understand that there are several options for treatment (more than in 2012 when he was first diagnosed). I would very much appreciate if you could give me an idea of what would be the best course of action.

My parents  live in Brazil and although my father is Swiss l think he wants to have his treatment at home in Brazil. I live in Switzerland and for me it’s quite difficult to be far away from them.

Thank you for all the suggestions and advices.

Viviane

[Catherine Poole]

I would first look to gamma knife radiation for the potential brain mets. That needs to be taken care of first and then decide on a systemic therapy. Immunotherapies are his best option being BRAF negative, and IPI I believe is available in Brazil. The PD1 immunotherapy has a higher response rate but I’m uncertain as to its availability. I would question the doctor about these options. Sometimes the IPI (Yervoy) is started while undergoing radiation, and there can be synergy between the two therapies. Again, first step is to take care of the brain mets and hopefully with gamma knife. I hope this helps you. We do have a webinar you might want to view on brain radiation here: http://melanomainternational.org/webinar/2012/01/radiation-treatment-in-brain-metastases/#.VG_QX_nF9SQ

[Chinix]

Thank you Catherine for your quick answer. It comforts me on what l was already thinking (radiation and Ipi). I don’t think PD1 is available in Brazil but l will have a look to see if there is any trial. I will also have a look ar the webinar on brain radiation.

Thank you again.

Viviane

[buffcody]

With my facing somewhat the same situation as your father, my oncologist decided to start me on ipi. I had the first two injections of that before my radiosurgery. He believed that there was a positive synergy between the two treatments. I have had no brain cancer metastases and only one other tumor since. So I’m very happy with the results, though it is always impossible to pin down causes. One followed the other does not necessarily mean one caused the other. Nor do I really know if the order of treatments (ipi first then radiosurgery during) played a specific role in its success.

Frank

[Chinix]

Franck thank you for your reply! Your words are encouraging.

As my father was having neurologic symptoms, the doctor prescribed Decadron (Dexamethasone). He started the medication on Wednesday evening and since more and less the same time he’s been having persistent hicupps. He talked with the doctor over the phone yesterday and the doctor prescribed 2 other medicines to help with the hicupps. But it’s not really helping. I was wondering if anyone had the same experience?

Thanks

Viviane

[JBunyan]

I agree with Catherine. I live in UK and had Gamma Knife for 2 brain mets half way through the 4 dose Ipi treatment (BFAF wild). I think this was done not so much for the synergy but because of the booking system here where Gamma Knife and Ipi on our NHS system are only authorised for patients with a reasonable prognosis – regrettably cost is a factor here as cancer is not covered, as a rule, by private insurance and the State system, whilst marvellous, is sometimes a bit strict on costs. I agree that if you can Gamma Knife for the brain mets and Ipi for the melanoma is the way to go as PD1 is difficult to find outside USA.

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