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Combining chemo & immuno in the treatment of metastatic head&neck canc

Posted by Tom JKT @tomjkt, Jun 26, 2017

Have recent been diagnosed with stage 4 metastatic tonsil cancer that has spread bilaterally to the lymph nodes. A pet scan revealed a lesion on my sternum, so radiation was ruled out. I have had consultations with two medical oncologists, both of whom agree that immunotherapy, in particular Keytruda, may give the best chance of longer term control and possible remission with fewer debilitating side effects even though it is not yet common to use as a first line treatment.

One medical oncologist has proposed keytruda together with carboplatin and abraxine, arguing that immuno alone is insufficient, while the other suggests keytruda alone, stating that the toxicitity of combining both may be too high to tolerate and that the benefits of combining both are unproven.

I am relatively symptom free and physically strong (so far) so I am more inclined to go for a more aggressive treatment initially but I would like to hear any comments or advice others here may have.

FYI, my treatment will be in Singapore as I am an American residing in this part of the world and my insurance doesn't cover treatment in the US.

Interested in more discussions like this? Go to the Head and Neck Cancers group.

A difficult question; there is new data in lung cancer that shows combining Keytruda with chemo is better than Keytruda alone. Keytruda alone is unlikely to cure the cancer so if you are otherwise healthy it may make the most sense to consider the combination. if side effects become very problematic, you can always stop the chemo
Best
C

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I may be able to help here. In January 2016 I also was diagnosed with stage 4 tonsil/throat squamous cell cancer. The cancer also metastasized to my liver and a lymph node at my pancreas. I was able to get into an immunization trial with Keytruda only. It took around 5 months for my tumors to decrease. Actually the tumor in my pancreas lymph node disappeared. And the three in my liver decreased substantially, However, there was only a slight decrease in my throat tumors, Then in late April of this year it was found by a CT scan that the throat tumors started to grow again, So I was taken off of the study and Keytruda. I have just gone through 14 days of radiation on the throat, which I am told would kill the cancer tumors, As a follow up I may or may not get Chemo. I will fine out soon.

What I liked about the Keytruda is that the only side effect was fatigue, which was not bad. I believe this was the best route for me to tackle some of the metastasized cancer first. The radiation treatment was another matter which I am now recovering from.

Hope this helps in your decision

JustJim

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