After Keytruda, what's next?

Posted by liz8716 @liz8716, Aug 28, 2019

@merpreb ...Hi, my name is Elizabeth. 31 yrs old.I was diagnosed with stage IV nsclc in April. I saw your story on here and it has given me hope. I'm currently on keytruda. Unfortunately my oncologist at this time says there is no cure and that keytruda can only be administered for 2 years. That she is only helping me live longer at this point because there is no cure. I did have taxol and carboplatin (4 rounds). My tumors have shrunk. But when I ask the dr "what next after 2 years of keytruda she says we'll wait and see. It's sort frustrating. I have to ask. What was your treatment?? Because the 5 year mark almost sounds impossible from what my dr states. Or if anyone else here knows of any new treatments.

Interested in more discussions like this? Go to the Lung Cancer Support Group.

Hi, I am 60 years old and have been on Keytruda for 4 years. I was diagnosed with stage 3A NSLC in 2019. It worked. When they say only two year treatment is because no studies have been concluded after that and it only became available for lung cancer in 2017 when approved by FDA.

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@goodtogo

I don't know if I was deemed that stage due to the spread to my adrenal gland. They did my biopsy and that's what they staged me. My team at Methodist released me in 2022 (5 years) and I haven't had a scan since. Do you think I should have one? If so how often?

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@goodtogo, I think you have a great team that knows your case inside and out! They certainly know best. Congrats on 5 years and hoping for many more for you!

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@lls8000

Hi @goodtogo, Welcome to Mayo Connect. Congrats on your success. Stories like yours provide hope to others!
Were you deemed Stage IV due to the spread to the adrenal? Do you continue to have scans for monitoring?

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I don't know if I was deemed that stage due to the spread to my adrenal gland. They did my biopsy and that's what they staged me. My team at Methodist released me in 2022 (5 years) and I haven't had a scan since. Do you think I should have one? If so how often?

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@goodtogo

Hello fighters! As I'm reading this discussion about keytruda I felt compelled to share my keytruda story. In May of 2017 three months before my husband died of leukemia I was diagnosed with stage 4 lung cancer that had spread to my adrenal gland. I went to Houston Methodist in the medical center. They put me in a trial which involved inserting a fissure into the tumor on my lung. They gave me pinpoint radiation and loaded up the fissure. The fissure destroyed the tumor and then traveled to the tumor on my adrenal gland and embedded itself into that tumor and destroyed it as well. This process on me only took a few months, no side effects. Then they started my keytruda treatments. I got a keytruda rash twice and they had to stop treatment early due to colitis. This is 2024 and I'm alive! There is hope out there for you! I suggest you get ahold of Houston Methodist in the medical center and ask about their trials for lung cancer. I would give you the name of my oncologist but unfortunately he moved to Colorado. I do know you have to have certain markers etc to do this, I don't know all the details. I do know I qualified because I hadn't had any previous treatments. I don't think, just my opinion that just keytruda on its own is going to help you. I hope this information is helpful to just one person out there. If it is please let me know and I will share this information on other websites as well. Keep up the fight my fellow fighters!

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Hi @goodtogo, Welcome to Mayo Connect. Congrats on your success. Stories like yours provide hope to others!
Were you deemed Stage IV due to the spread to the adrenal? Do you continue to have scans for monitoring?

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Hello fighters! As I'm reading this discussion about keytruda I felt compelled to share my keytruda story. In May of 2017 three months before my husband died of leukemia I was diagnosed with stage 4 lung cancer that had spread to my adrenal gland. I went to Houston Methodist in the medical center. They put me in a trial which involved inserting a fissure into the tumor on my lung. They gave me pinpoint radiation and loaded up the fissure. The fissure destroyed the tumor and then traveled to the tumor on my adrenal gland and embedded itself into that tumor and destroyed it as well. This process on me only took a few months, no side effects. Then they started my keytruda treatments. I got a keytruda rash twice and they had to stop treatment early due to colitis. This is 2024 and I'm alive! There is hope out there for you! I suggest you get ahold of Houston Methodist in the medical center and ask about their trials for lung cancer. I would give you the name of my oncologist but unfortunately he moved to Colorado. I do know you have to have certain markers etc to do this, I don't know all the details. I do know I qualified because I hadn't had any previous treatments. I don't think, just my opinion that just keytruda on its own is going to help you. I hope this information is helpful to just one person out there. If it is please let me know and I will share this information on other websites as well. Keep up the fight my fellow fighters!

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@carebears91

Thank you. He is going to have pinpoint radiation and just had his gallbladder removed, but is still very sick. I worry that if he does not get these stomach issues worked out he will not be strong enough to tolerate anything. Going back for post surgical this week so I may have to push for something else to be done. I guess the reason we don't understand all of this is that he was told it is slow growing?? I would hate to see what aggressive looks like. I just never did understand why they took him off of it for 6 weeks until he started radioisotopes which they say is not working either. After those 6 weeks he had a new tumor, the others had gotten larger and now has spots on his liver.

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First of all, hang in there. Cancer treatment is a frustrating process. We want things to move at warp speed and who can blame us for that! Six months into my Keytruda treatment scans showed a second cancer site totally unrelated to the initial NSCLC site; adenocarcinoma versus sarcoma. As a friend told me I was "hoggin' all the cancers". It ended up being an uncommon form of cancer called gastrointestinal stromal tumor (GIST, for short) that was surgically removed successfully last August. The best news is that he is now in treatment and being (what seems like) constantly monitored and that is a very good thing. You're on top of things so stay on top of things. Amazing things are happening in the treatment of cancer. I know it's hard but there is always a need for optimism.

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@liz8716 Elizabeth - Keytruda would only be prescribed if your cancer is checkpoint inhibitor positive. The short answer is Keytruda eliminates those inhibitors that are prohibiting your immune system from doing its job and ridding your body of cancer cells. The two years is because that was the initial trial length for Keytruda and some insurance companies don't provide for treatment beyond two years because of that. However, there have been a number of patients treated successfully with Keytruda beyond two years. In my opinion I wouldn't want to deal with a doctor with an attitude like yours. I started treatment with Keytruda in late October 2020 and by the end of April 2021 there was no longer any evidence of disease so don't tell me there isn't any hope! We are all different and our results will vary but my oncologist at Mayo told me right from the start that he had every confidence in the world that immunotherapy would work for me and he was absolutely right. That's who I want on my team!

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@ta52

It is my understanding from my oncologist that the two-year timeframe with Keytruda is based on the length of the original trial which was two years. Some insurance companies will not pay for treatment based on the length of the original trial while others continue to pay based on patient response.
Also, Keytruda itself will not "kill" cancer; it eliminates the inhibitors that are preventing the immune system from doing its job and removing the cancer cells. If they are saying Keytruda isn't working they are probably saying the immune system still isn't responding the way it is supposed to. Keytruda will only be effective on those cells that are checkpoint inhibitor positive which, it sounds like, may only be a portion of his whole situation.

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Thank you. He is going to have pinpoint radiation and just had his gallbladder removed, but is still very sick. I worry that if he does not get these stomach issues worked out he will not be strong enough to tolerate anything. Going back for post surgical this week so I may have to push for something else to be done. I guess the reason we don't understand all of this is that he was told it is slow growing?? I would hate to see what aggressive looks like. I just never did understand why they took him off of it for 6 weeks until he started radioisotopes which they say is not working either. After those 6 weeks he had a new tumor, the others had gotten larger and now has spots on his liver.

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@schmeeckle64

Hi. I was on Keytruda for a year and a half. Then stopped treatment for over a year. Had a scan last week and my tonsils, right adrenal gland and lymph node in my groin lit up. Some really weird places. I'm starting on optiva and yoviro. Not sure I spelled that right. My oncologist said it was a better immunotherapy. I guess we will see. I'm a little scared.

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Schmeeckle, I can imagine you're a little scared to start new treatment. Here is a discussion you may wish to join as you prepare to get Opdivo (nivolumab) and Yervoy (ipilimumab) immunotherapies.
- Has anyone had the Opdivo (nivolumab) / Yervoy (ipilimumab) protocol? https://connect.mayoclinic.org/discussion/opdivo-yervoy-combination/

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@colleenyoung

@carebears91, I moved your questions to this existing discussion called:
- After Keytruda, what's next? https://connect.mayoclinic.org/discussion/keytruda-1/

I did this so you can connect with fellow members who have non small-cell lung cancer and had to consider treatment options other thay Keytruda like @lls8000 @richcolleen @jannad @liz8716 @bentrivercarla @schmeeckle64 and @2onlow8

I encourage you to ask your questions to your oncologist and share your thoughts about not changing medications, especially Keytruda. Your oncologist can consider you and your husband's preferences and also explain the mechanisms of action if this is not they way Keytruda works.

You may appreciate reading @merpreb's post about questions to ask the oncologist here: https://connect.mayoclinic.org/comment/273866/

There may be other options for your husband. I always say, keep asking questions until you understand the "why" and are comfortable moving forward.

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Hi. I was on Keytruda for a year and a half. Then stopped treatment for over a year. Had a scan last week and my tonsils, right adrenal gland and lymph node in my groin lit up. Some really weird places. I'm starting on optiva and yoviro. Not sure I spelled that right. My oncologist said it was a better immunotherapy. I guess we will see. I'm a little scared.

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