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Question about lung met treatment

Question about lung met treatment

Posted By
10/8/2018 1:45pm
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Replies: 4

Had my lung biopsy 3 days ago and waiting for path results. Was looking back at old posts and comments about drug therapy, and several people mentioned they had a lung resection. I asked my doc about this instead of wasting time with CT guided biopsy...he says that's not the way to go. He needs to be able to measure progress/ effectiveness of the drug by measuring the size of the lung met. If the lung met is gone by surgery, he won't know if I'm on the right drug treatment. That makes sense, but why did some of you have yours surgically removed. Is that the better plan? Maybe biopsy first and then have a bigger surgery? Thanks...Jenny

Hi Jenny

Welcome, Yea, melanoma is perverse!

What your doctor outlines is one way to go.  It is the best way to see if immunotherapy is working, though it can be a little nerve wracking knowing you've got some mel still in you.  Of course surgery gets the known mets out now, but requires surgery and leaves you with no way to know if  there are other critters that are just too small to see and that the drugs would take care of.

I started out with keeping a mel met and doing immunotherapy.  It made sense as I didn't know how many micro-mel mets there were.  And for awhile, it worked. I watched my mel melt away!  Unfortunately it came back, so knowing that the immunotherapy had limited results, I had my lung met surgically removed.  Now this is my story, but there are folks here who have only done immunotherapy and have become "No Evidence of Disease".

Figure out what your comfortable with as there are risks with every treatment option and then go for it!



Stage 3c  (TXN2cM0)-- 2008 WLE, SNB, LND, HD-INF, GM-CSF, SubqQ2013 IPI, SubQ 2014 PEMBRO, SubQ  2017 resected; Feb 2019 SubQ T-VEC

Stage 3a 2017 NSC VATs; Carboplatin & Pemextred; radiation

I was in this exact same boat. My radiation oncologist wanted to let it grow but my oncologist thought that was ridiculous with my history and how high my mitotic rate was. She actually took my situation to the board when all the doctors get together to discuss various cases. Basically, the radiation oncologist was the only one that didn't think surgery ASAP was a good idea. All the other doctors said get it out right away. Personally, I felt like I would rather have it removed then have it monitored. If the medicine does not work you could end up with more tumors. Also, if the medicine doesn't work it doesn't matter so much anymore because it's been cut out. Of all my surgeries, the wedge resection of my right lung was the easiest. The chest tube was the most painful part of it for me. Gregg

Hi Jenny, our folks here responded exactly with what needs to be done(and your team as well), first biopsy, "THEN" appropriated treatments can follow, another words, "Know Your Enemy" before you go to War, it seems easy to just cut the sucker out but, unfortunately, and as "backwards" as it seems, its the correct protocol! If you did read of surgerys being done without biopsy, those cases coulda been a life threatening case, ASAP type...(i had biopsy of my lung before my treatments) ..wish you well!

Im Melanoma and my host is Mike..

My lung lobe was removed to take out the largest tumor burden in my body. It was already known to be melanoma, as I'd had plenty of brain metastasis by that point. We knew what we were dealing with. the current anti-PD1 immunotherapy drugs were not FDA approved AT THAT TIME for use in folks with "uncontrolled brain metastasis" ... aaaaaand mine wouldn't quit cropping up. SO... after failing Ipi, my doc was "buying time" (Keytruda approval was juuuuuust about in place) and trying to "calm the shedding and spreading" of mutant cells from that right lower lung lobe. Thankfully, the Keytruda worked... I still had a subcutatneous lesion on my left arm, as well as a 1.2 cm lesion in the left lower lung lobe... so we knew it was being successful. ALLLLLLLLLL of that aside... I'm not sure how I'd react in your shoes. My lobectomy was robotic, so the cutting was minimal, and rib cracking was completely avoided. That said, there was a persistent air leak that left me attached to a chest drain tube for 7 weeks (not fun), and now I have the permanent 10-15% loss of lung capacity.. along with some muscle "issues" where the cutting was done. Nothing is ever perfect and the same again after a major surgery like that. HOWEVER... if the surgery could have made me NED immediately, with the current option of still getting the adjuvent Keytruda or Opdivo..... I'd really have to bounce that thought around, versus counting on the drugs alone. Sure, with hindsight, I know the drug worked for me... but without knowing for certain if it would or not... hmmmmm. I'm pretty aggressive. I think I'd probably still have wanted to go for it... although, after today's run, I sure would like a lesion free lung lobe still in place.  There really is no "right" or "wrong" choice for you, just two near equally not so appealing options. I suppose it depends on your lifestyle, and where you'd prefer to place your risk.