CT Scan Results (Anti-LAG-3 trial, end of 3rd cycle)

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12/1/2017 1:37pm
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Replies: 4

Season's Greetings to all!

I wish I had some really good, positive news to share about my scan last Tuesday. Unfortunately the results again are, while not disastrous, not great.

The good news I suppose is that the disease is still confined to my thoracic lymph nodes, with no organ involvement or enlarged abdominal nodes. I am not a medical professional, and my wife happens to be, but not in this field, and to us the radiologist's report seems to indicate that I am getting little if any benefit from the combination of Opdivo (nivolumab) and relatlimab (the investigational anti-LAG-3 medicine).

Here are the pertinent parts of the radiologist's report:

"1.  Increasing metastatic disease.
2.  Enlarging right axillary lymph node .
3.  Enlarging left hilar lymphadenopathy. Remainder of the known hilar and subcarinal lymphadenopathy is essentially unchanged.

Lymph nodes: Hilar and subcarinal lymphadenopathy are redemonstrated. Representative nodes:
Enlarged 4.2 x 3.8 cm left hilar (6:420), previously 3.2 x 3.0 cm remeasured.
Enlarged right axillary node, measuring 2.1 cm (2:31), previously 1.5 cm.
Unchanged 3.1 x 1.9 cm subcarinal node (2:53), now centrally cystic/necrotic.
Unchanged 1.1 cm node along left side of the left main pulmonary artery (6:279),
Subcentimeter left axillary and supraclavicular nodes.
Unchanged 3.9 x 3.5 cm right hilar (6:293).
Unchanged 1.3 cm right interlobar (6:392)."

I see Dr. Sharfman again on Tuesday, and I suspect this time I will be done with this trial. My local oncologist brought up PV-10 as a possibility for treatment, and Dr. Sharfman said after the last scan that if things weren't moving in the right direction we have "other options." I guess we'll soon be finding out what those options are.


Sorry the anti-LAG3  didn't eradicate the disease as hoped.  But, yes!  You do have options!  Hang in there.  Celeste

Dear Bill, am sorry that you did not receive better news, was thinking of you ahead of and during scan day. And thank you for sharing your results. Celeste is right and her blog lists some of the available options, i think in her post summarizing the various treatments.. And my doctor too has mentioned that there are other options, i think trials, if my treatment fails. Maybe best to read ahead of your upcoming doc visit.

i thought for pv-10 you need to have injectable lesions - and not sure whether there is a numerical limit - so hope yours fit the criteria

i am wondering more about ido inhibitors, which celeste has mentioned too

i wish for lots of good ideas next week and will be thinking of you

best wishes Mark

Sorry to hear about the results, but it sounds like you are in good shape to move on to the next therapy if need be.  There are definitely other options out there. the problem may be one of “cold tumors” (not much t-cell infiltration for the checkpoint inhibitors to amp up). PV-10 or an oncolytic virus or T-Vec may be the way to get your immune system to start noticing the melanoma cells. Good luck

And just to add, Celeste has some great posts on intratumorals on her site - some intratumorals are in trial stage, but nevertheless have good supportive data, or work well systemically and intuitively make sense as intratumorals. Please update if you’re able to get injections in the mediastinum, as I’m having some similar issues in the chest and haven’t heard that brought up by my doctor.