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Chemoimmunotherapy as first treatment?
Hi all,
My dad recently was diagnosed with stage 3a NSCLC adenocarcinoma mimicking pneumonia. It's a pretty significant part of his top left lung. He tested 2% for PDL1 and had first treatment today -- abaxrane, carboplatin, & keytruda.
I have seen online chemoradiation is typically first go-to treatment in stage 3a, so why would he be starting on chemoimmunotherapy instead? The oncologist seems pretty hopeful this will work, but I am just confused about it. He is my best friend, and I want to make sure he is receiving the most effective treatment.
This oncologist thinks surgery is off table because of underlying lung disease.... so I am confused why not radiation? I also asked if radiation may come later, and she said maybe.
Please let me know your experience\thoughts.
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I understand that you want only the best for your father, it’s truly so frightening and you feel so helpless, it’s always important to ask questions when you’re uncertain about the treatment they choose. I believe that they’re using chemotherapy first in order to shrink the tumour and then follow with radiation, this process is necessary so they can remove what’s left with radiation more easily. There’s a lot of information about these treatments and it’s very helpful for you to learn about them, it helps you to cope with everything because you are more aware, I have read many stories about different treatments and they vary a lot because of factors like the stage of the disease, age and other health issues that the patient has, you will eventually settle in more with time and experience, many people here have a lot of knowledge and information to share with you, best wishes to you and your dad.
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2 Reactions@nfitzs, it's understandable that you have questions about your father's treatment. Keep in mind that the current thinking is that lung cancer is not one disease, but many different diseases that share a name. What type of adenocarcinoma does your father have? Do you know which mutation: EGFR, ROS1, KRAS, ALK, . . .?
And what is the underlying lung disease that your father has? These factors in addition to his age and general health all contribute to your oncologist's choice of treatment.
I'd start by calling your oncologist, or his or her nurse, and asking them your questions as well as asking them why they are making the choice they are.
In general, immunotherapy has not been terribly effective in treating lung cancer, so there is something going on here that we're not understanding. I wish all the best for you and your dad.
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2 ReactionsHi, thank you for your response. He doesn't have a targetable mutation.
He has COPD, and is 78, but is generally healthy and was going to the gym 4 days prior to being hospitalized with COVID-- which is where it all began.
I asked if radiation is on the table and she said maybe in the future. We are getting a second opinion at MSK on the 29th.
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1 Reaction@nfitzs, GO2 for Lung Cancer, go2.org, has a monthly education series that they archive on YouTube. February's was all about immunotherapy, including immunotherapy combined with other modalities: https://www.youtube.com/watch?v=oOC3ZVFb6t8. Dr. Allen brings up several points that may help you understand your father's treatment. The first point I notice is that, for some reason, immunotherapy is more effective for former smokers than for non-smokers. In additon, immunotherapy is much less invasive than radiation.
I'm glad to hear you're getting a second opinion. I believe everyone should get at least a second, if not a third, opinion. Your father is lucky to have such a strong advocate! Let us know about your updates.
All the best.
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