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Dr. Andrew Rynne

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Suggest treatment for brain metastases

Answered by
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Dr. Deepak Sundriyal

Oncologist

Practicing since :2005

Answered : 1445 Questions

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Posted on Mon, 3 Apr 2017 in Cancer
Question: My husband was given 2 weeks of whole head radiation for a recurring brain metastases and we told he has maybe 3 more months to live and I am wondering if we should seek 2nd or 3rd opinion?
Please help. Thank you for your time
doctor
Answered by Dr. Deepak Sundriyal 21 minutes later
Brief Answer:
Hello dear. Survival depends upon many factors

Detailed Answer:
Hello dear. I have gone through the details. It seems to be a case of carcinoma lung.its an advanced stage 4 disease. Survival in such a case depends upon performance status, other comorbid illness and tumor load. Usual survival in such a case is 6 to9 months but patients can survive even more. Please upload the reports of biopsy and ct scans if any so that i can put more light on it.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Remy Koshy
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Follow up: Dr. Deepak Sundriyal 2 hours later
Thank you for getting back to me promptly.

I have no record or biopsy right now but I will try to get something for you on our next appointment.

He was diagnosed September of 2015 and stage first week of October 2015.
At the time of diagnose, middle right lobe had collapsed. Cancer cells in perual fluid and metastasis to right chest and lymph-nodes and small lesion on the cerebellum. The lesion was treated with gamma knife Nov 2015.

However, my husband has never smoked in his life. We are thinking or we know he inhaled some toxins while in combat-zone doing humanitarian jobs. He has gone through 2 times of gamma knife (last time was April of 2016). He had 5 sessions of chemotherapies which the last one was "Opdivo". Opdivo was bad for him started making the tumor bigger instead of shrinking. It was discontinued and gene test was run again and this time he was EGF.Thank you for getting back to me promptly.

I have no record or biopsy right now but I will try to get something for you on our next appointment.

He was diagnosed September of 2015 and stage first week of October 2015.
At the time of diagnose, middle right lobe had collapsed. Cancer cells in perual fluid and metastasis to right chest and lymph-nodes and small lesion on the cerebellum. The lesion was treated with gamma knife Nov 2015.

However, my husband has never smoked in his life. We are thinking or we know he inhaled some toxins while in combat-zone doing humanitarian jobs. He has gone through 2 times of gamma knife (last time was April of 2016). He had 5 sessions of chemotherapies which the last one was "Opdivo". Opdivo was bad for him started making the tumor bigger instead of shrinking. It was discontinued and gene test was run again and this time he was EGFR Exxon 19 positive and was put on Tarcever 100mg five months ago. Tarcever was working because the last two PET-Scan showed original tumor gone, lymph-nodes clear and zoledronic-acid for the right shoulder working. We were so happy.
Then come MRI & PET-Scan of 5 weeks ago and 1 new lesion and older one back active so, 2 lesions on cerebellum. We made appointment for new gamma knife but, he fell, had seizure and fractured left fib by the ankle (Thank God no cancer on the break). While in patient, doctor did spinal tap and blood tests for new medication, Targrisso. There are cancer cells on the spinal fluid and even though he is not EGFR match for Targrisso, he was still prescribed that because Tarceva does not penetrate brain blood barrier. He was giving, I believe 2 weeks palliative whole head radiations. We were discharged 2 weeks ago with medical walker because he is now experiencing lower lumbar paralysis and giving 3 months to live. I don’t know else do to help him. Please any advice? Thank you for your time in advance.
Sincerely, XXXXXXX
doctor
Answered by Dr. Deepak Sundriyal 2 hours later
Brief Answer:
Hello. Targrisso is the right drug

Detailed Answer:
Hello.

Thanks for providing the details. So your doctor is right is prescribing the radiation to brain. And because tarceva is not working now, next line of drug is targrisso. Targrisso is a good drug and it will add quality of life.
Moreover, I think opdivo is still an option as its an immunotherapy. immunotherapy initially causes pseudoprogression of tumor but in long run causes tumor shrinkage.
Please continue targrisso after radiation.

Thanks and regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Deepak Sundriyal 2 days later
Good Morning Doctor. Thank you for replying again.
I have some questions.
Can Targrisso be used the same time as Opdivo treatment?
Should I bring the topic up at my husband next appointment on March 30th?
March 30th will be the end of the first month of his Targrisso use.

Also, can you please tell me if a referral to Neurology and Spinal doctor will be beneficial for the whole head radiation side-effect of lower lumbar paralysis my husband started suffering after the 3rd session of radiation?

Doctor, my husband was very active and in the military until 7 months ago, being bed ridden and non-ambulatory is killing him more than the lung cancer. Please help!
Thank you again for your time and advices.

Sincerely,
XXXXXXX
doctor
Answered by Dr. Deepak Sundriyal 1 hour later
Brief Answer:
Hello. Targrisso should be given alone

Detailed Answer:
Hello dear. So there are no studies which can suggest that targrisso and opdivo can be combined together. In my opinion, targrisso should be given first and when targrisso fails, opdivo can be tried.
A neurology referral can be taken for the weakness and paralysis. You can discuss these issues, but one should not combine opdivo and targrisso.
Thanks and regards
Feel free to ask further
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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