Surgery before chemo vs after; Biochemotherapy vs Yervoy

› Forums › General Melanoma Community › Surgery before chemo vs after; Biochemotherapy vs Yervoy

  • Post
    • January 13, 2013 at 11:24 pm
    mlinc
    Participant
      I am 62 year old healthy male. I was diagnosed with melanoma unknown primary late 2012. I had two tumors removed in small intestines in October2012. I still have small tumor remaining in right medial lobe. All CTs and MRIs have been clear of disease in other sites. BRAF and CKIT mutations negative. Dr. at MD Anderson is recommending Biochemotherapy and then mass removal. He has also discussed combo chemo and Yervoy as two other options. Doing any treatment before mass removal. MD at home insists mass one out first and then do Yervoy or another type of chemo.

      Has anyone been in similar situation that could share experience? Anyone had any of treatment options in similar situation… experience?

      trying to make right decision.

    Viewing 11 reply threads
    • Replies
        • January 14, 2013 at 2:27 am
        Erinmay22
        Participant

          Hey – it's never easy to figure out what the best plan is.   I am a patient at Sloan.  Something similiar.  May '12 found met in small intestine (along with some small lymph nodes near it).  Started Zelboraf for the summer.  Showed some improvement but then started growing.  In Oct had surgery to remove tumor in small intestine but they couldn't get that lymph node.  The week before surgery started Yervoy.  Finished last dose of Yervoy Nov 27th and scans Dec 18th showed growth of that lymph node.  Right now trying to get in pd1 trial.  We haven't discussed biochem at all.  

          Will find out this week if I get in to the pd1 trial.  All things go ok I'll start Jan 21st.

          Best of luck.
          Erin

          • January 14, 2013 at 2:27 am
          Erinmay22
          Participant

            Hey – it's never easy to figure out what the best plan is.   I am a patient at Sloan.  Something similiar.  May '12 found met in small intestine (along with some small lymph nodes near it).  Started Zelboraf for the summer.  Showed some improvement but then started growing.  In Oct had surgery to remove tumor in small intestine but they couldn't get that lymph node.  The week before surgery started Yervoy.  Finished last dose of Yervoy Nov 27th and scans Dec 18th showed growth of that lymph node.  Right now trying to get in pd1 trial.  We haven't discussed biochem at all.  

            Will find out this week if I get in to the pd1 trial.  All things go ok I'll start Jan 21st.

            Best of luck.
            Erin

            • January 14, 2013 at 2:27 am
            Erinmay22
            Participant

              Hey – it's never easy to figure out what the best plan is.   I am a patient at Sloan.  Something similiar.  May '12 found met in small intestine (along with some small lymph nodes near it).  Started Zelboraf for the summer.  Showed some improvement but then started growing.  In Oct had surgery to remove tumor in small intestine but they couldn't get that lymph node.  The week before surgery started Yervoy.  Finished last dose of Yervoy Nov 27th and scans Dec 18th showed growth of that lymph node.  Right now trying to get in pd1 trial.  We haven't discussed biochem at all.  

              Will find out this week if I get in to the pd1 trial.  All things go ok I'll start Jan 21st.

              Best of luck.
              Erin

              • January 14, 2013 at 11:08 am
              buffcody
              Participant

                My situation is a bit similar.  I showed up with two mets in my brain when I was in watch and wait mode after lung surgery after unknown primary diagnosis.  My oncologist at the University of Michigan counseled (and second opinion doctor at Sloan Kettering concurred) to put off the SRS on the brain mets till just before my third IPI infusion to intensify the synergistic effect of the IPI.  Won't know much about it till my next set of scans report on January 30 and probably not then as to whether this was a good move or not. 

                • January 14, 2013 at 11:08 am
                buffcody
                Participant

                  My situation is a bit similar.  I showed up with two mets in my brain when I was in watch and wait mode after lung surgery after unknown primary diagnosis.  My oncologist at the University of Michigan counseled (and second opinion doctor at Sloan Kettering concurred) to put off the SRS on the brain mets till just before my third IPI infusion to intensify the synergistic effect of the IPI.  Won't know much about it till my next set of scans report on January 30 and probably not then as to whether this was a good move or not. 

                  • January 14, 2013 at 11:08 am
                  buffcody
                  Participant

                    My situation is a bit similar.  I showed up with two mets in my brain when I was in watch and wait mode after lung surgery after unknown primary diagnosis.  My oncologist at the University of Michigan counseled (and second opinion doctor at Sloan Kettering concurred) to put off the SRS on the brain mets till just before my third IPI infusion to intensify the synergistic effect of the IPI.  Won't know much about it till my next set of scans report on January 30 and probably not then as to whether this was a good move or not. 

                    • January 14, 2013 at 5:57 pm
                    awillett1991
                    Participant
                      Are they talking surgery or SRS and why? How big is it? Do they know how fast its growing and is it in a vital area? Is your MD at home a melanoma specialist? what drugs for biochemo and other Yervoy + ?? Option and when would they evaluate for a response? How much success have they seen with these approaches are what are the toxicities??

                      I did biochemo at MDA – IL2, Vinblastine, cisplatin + dacarbazine, 4 rounds And was NED ( surgically) at the time. Nasty business with permanent side effects – different for everyone. I do think it slowed down my Mel. It’s very common, especially when you seek another opinion, to have to decide these things yourself.

                      I had SRS for 2 mets between Ipi rounds in Nov 2012, will find out tomorrow if its working!

                      Good luck!

                      • January 14, 2013 at 5:57 pm
                      awillett1991
                      Participant
                        Are they talking surgery or SRS and why? How big is it? Do they know how fast its growing and is it in a vital area? Is your MD at home a melanoma specialist? what drugs for biochemo and other Yervoy + ?? Option and when would they evaluate for a response? How much success have they seen with these approaches are what are the toxicities??

                        I did biochemo at MDA – IL2, Vinblastine, cisplatin + dacarbazine, 4 rounds And was NED ( surgically) at the time. Nasty business with permanent side effects – different for everyone. I do think it slowed down my Mel. It’s very common, especially when you seek another opinion, to have to decide these things yourself.

                        I had SRS for 2 mets between Ipi rounds in Nov 2012, will find out tomorrow if its working!

                        Good luck!

                        • January 14, 2013 at 5:57 pm
                        awillett1991
                        Participant
                          Are they talking surgery or SRS and why? How big is it? Do they know how fast its growing and is it in a vital area? Is your MD at home a melanoma specialist? what drugs for biochemo and other Yervoy + ?? Option and when would they evaluate for a response? How much success have they seen with these approaches are what are the toxicities??

                          I did biochemo at MDA – IL2, Vinblastine, cisplatin + dacarbazine, 4 rounds And was NED ( surgically) at the time. Nasty business with permanent side effects – different for everyone. I do think it slowed down my Mel. It’s very common, especially when you seek another opinion, to have to decide these things yourself.

                          I had SRS for 2 mets between Ipi rounds in Nov 2012, will find out tomorrow if its working!

                          Good luck!

                          • January 14, 2013 at 10:41 pm
                          Josh
                          Participant

                            Hey,

                            Without speaking to your exact situation, I just wanted to point out something I've been thinking about lately in the surgery vs drugs/chemo/radiation debate. I've had many surgeries and have undergone many treatments, and while I don't regret any of the decisions we've made regarding my care, I did recently have my knee (and some shin bone and femur) removed, and that surgery sucked. Don't get me wrong, it was supposed to suck. The surgeon was great, it went as expected, but, without exaggerating, I am aware of having a fake knee with every stiff, limping step I take. Again, I don't regret the surgery because I had to have it, but what if I'd started a drug which worked a couple of weeks before the surgery? What if the drug eliminated the need for  surgery? My point is that you can't undue a surgery, and while many surgeries don't leave significant side effects, many do. Thus, part of me wants to say that surgeries should be put off unless 100% necessary. The other part of me, however, wants to point out that I've heard from many oncologists (mine included) that it's often a good idea to get rid of those "big cancer areas" with surgery, as this sometimes helps the body to fight off the smaller ones. Thus, it's not a simple decision.

                            Good luck!

                            Josh   

                            • January 14, 2013 at 10:41 pm
                            Josh
                            Participant

                              Hey,

                              Without speaking to your exact situation, I just wanted to point out something I've been thinking about lately in the surgery vs drugs/chemo/radiation debate. I've had many surgeries and have undergone many treatments, and while I don't regret any of the decisions we've made regarding my care, I did recently have my knee (and some shin bone and femur) removed, and that surgery sucked. Don't get me wrong, it was supposed to suck. The surgeon was great, it went as expected, but, without exaggerating, I am aware of having a fake knee with every stiff, limping step I take. Again, I don't regret the surgery because I had to have it, but what if I'd started a drug which worked a couple of weeks before the surgery? What if the drug eliminated the need for  surgery? My point is that you can't undue a surgery, and while many surgeries don't leave significant side effects, many do. Thus, part of me wants to say that surgeries should be put off unless 100% necessary. The other part of me, however, wants to point out that I've heard from many oncologists (mine included) that it's often a good idea to get rid of those "big cancer areas" with surgery, as this sometimes helps the body to fight off the smaller ones. Thus, it's not a simple decision.

                              Good luck!

                              Josh   

                              • January 14, 2013 at 10:41 pm
                              Josh
                              Participant

                                Hey,

                                Without speaking to your exact situation, I just wanted to point out something I've been thinking about lately in the surgery vs drugs/chemo/radiation debate. I've had many surgeries and have undergone many treatments, and while I don't regret any of the decisions we've made regarding my care, I did recently have my knee (and some shin bone and femur) removed, and that surgery sucked. Don't get me wrong, it was supposed to suck. The surgeon was great, it went as expected, but, without exaggerating, I am aware of having a fake knee with every stiff, limping step I take. Again, I don't regret the surgery because I had to have it, but what if I'd started a drug which worked a couple of weeks before the surgery? What if the drug eliminated the need for  surgery? My point is that you can't undue a surgery, and while many surgeries don't leave significant side effects, many do. Thus, part of me wants to say that surgeries should be put off unless 100% necessary. The other part of me, however, wants to point out that I've heard from many oncologists (mine included) that it's often a good idea to get rid of those "big cancer areas" with surgery, as this sometimes helps the body to fight off the smaller ones. Thus, it's not a simple decision.

                                Good luck!

                                Josh   

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