I am sorry to hear that your husband has experienced d'Italia metastasis to bone. I experienced the same phenomenon after several rounds of FOLFOX chemo therapy. I was able to tolerate 3 infusions ok Keytruda before suffering catastrophic adverse reactions. The clinical plan was to do repeat scans to see if there were any effects on the bone metss and if not to pursue a lesion-targeted radiotherapy regimen. Fortunately, my repeat scans following my limited therapy with Keytruda showed a good clinical response with respect to my bony lesions.

I believe you said your husband was deemed ineligible for immunotherapy. Did his care team rovide an explanation for withholding qthese therapeutic agents? If not, I would ask them to do so. If he is truly clinically ineligible to receive immunotherapies then targeted radiation therapy is a potentially viable option. Not only may it be effective in reducing or eliminating bone metastasis but also may help with reducing related bone pain. I would also suggest that you request a consult with a pain management specialist to help find an effective pain management regimen that might help with his daily pain burden or pain breakthroughs that may occur on his current pain management regimen. There are a number of options that might be considered including several THC cannabanoids which in addition to controlling breakthrough pain also help with controlling nausea and appetite stimulation.

I also note that you are currently on the west coast and your husband is receiving care through a Stanford affiliate. Stanford is an excellent academic medical system and their Oncology programs are among the top rated in the country. That said, it would behoove you and your husband to seek second option re his case and therapeutic options. It seems that you are in the process of doing so at Mayo's Jacksonville facilities. They're an excellent organization with particular expertise in the medical/surgical management of esophageal carcinoma. I wish you both the best in your on- going battles with this dreadful disease. It's critical that you both adopt a warrior's mentality in confronting challenges ahead. A positive mental attitude and recovery to own the disease and not let it own you is, while difficult at times, critical going forward. Both of you should educate about esophageal carcinoma and current available therapies as well as those in development. Knowledge is power!