What experience has anyone had with the Signatera blood test?

Yes. I am also using triamcinoline acetonide cream usp 0.1%. The rash is now almost gone from the chest and back but more noticeable on the sides.

Hang in there! Is your oncologist considering deescalating to just pembro after six EVP cycles? That appears likely based on your commentary.

Natera has amazing technology but very poor operations and customer service in my early experience. I almost refused to use them until my new surgeon personally assured me everything would be handled his office. He didn’t let me down. There were no problems.

Thank you and sorry for delayed response. I had switched doctors after by 2023 Turbt and my current Dr strongly advocated for Signatera. The first was before RC using the tumor from the previous surgeons turbt, second immediately after RC before chemo and then every 3 months during chemo and the following surveillance period. My medical oncologist did additional testing on the tumor before I started chemo and the plan was based on that. Sorry I don’t recall what those tests were. He’s the director of the genitourinary oncology & research program at my cancer institute . He did additional testing after Signatera became detectable this spring. I almost qualified for a new clinical trial , but had not been off chemo from last year long enough. I’ve just completed 5 of 6 cycles Evp with another Signatera and pet scan to follow. He’ll propose the revised plan based on results.

I can empathize! My rashes are pretty much everywhere except bottom of my feet and face. My team works closely with a dermatology oncologist. He prescribed triamcinoline ointment zerteck (sic) for the itch. The rash starts to flare up after the 1st treatment of both padcev and keytruda and then again after the second treatment of only padcev in the second week of every cycle. Heavy duty moisturizing with a non scented excema crème plus the prescribe ointment has kept it manageable . Odd thing is that I look like I have a tan and I peel like I have a mild sunburn. Derm has also prescribed prednisone , since 2 rash events have sent me to emergency room to rule out Stephens Johnson reaction, but luckily it has not been needed. Honestly , loss of appetite , taste and fatigue has been a much bigger issue for me. No issue with neuropathy.

Thank you & so sorry for delayed response . I did chemo after RC.

The rash escalated to my sides, chest and back. I received a topical steroid. It is receding. Very uncomfortable. The PA does concur it is encouraging from an efficacy perspective.

The rash is more pronounced and the itch is noticeable. So far I am managing it with Claritin and Benadyrl. Interestingly, the forearm rash is down but the itch elsewhere is up. The good news is that rash is indicative of treatment efficacy. https://academic.oup.com/oncolo/article/28/12/1072/7191799

Interesting that GC is still very common. I have an annoying rash all over my body in a lot of spots but especially the back of my lower arms now. So I finally joined the ICI rash club.

Curious did you do chemo before or after your RC? Mine was before but same chemo cocktail as yours. I've been on Opdivo for 8 months now post surgery (headed for 12). It's easy to why scans are done so frequently. I had a PET scan in June. I wish you all the best!!

@ Holly: excellent!

@ ronzee50: excellent! I still have old tests showing as pending and canceled from 2024-12. Good thing you called.

@ 141emp: It is good that signatera helped early detection and that EVP is working. It is interesting you did not receive adjuvant preventative nivo based on checkmate 274 after adjuvant GC (and that they opted for GC instead of DDMVAC). Did you draw a signatera after RC and before starting GC? Hopefully you can finish a few EVP cycles and then switch to just maintenance pembro for two years. Signatera before RC should become standard of care: sadly it is not yet. You could potentially boost pembro with akkermansia, CBM588, camu camu, Claritin/Zyrtec, morning infusions (chronotherapy), exercise and intermittent fasting.