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Stage II looking for your suggestions.

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Stage II looking for your suggestions.

Posted By
Ran
2/12/2020 4:41am
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Ran
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Replies: 3

Hello, I am a Chinese and my aunt have been diagnosed with melanoma. We found it late and missed the best period. The worst thing is that the best cancer hospital in China do not allow patient hospitalization because of the coronavirus. It is still unknown when the situation will be better, so we have to find a hospital which can receive patient. Here is her diagnose:

Beijing Cancer Hospital
Disease diagnosis
Name: Huiqin Qu
Gender: Female
Age: 57
Department: Kidney Cancer Melanoma Medical Ward
Admission date: 2020-01-17
Discharge date: 2020-01-22
Work Place: Gaoyang mining company

Brief condition:
1. Anal downbearing distention.;
2. Bowel habit has changed for 3 months.

Diagnosis:
1. Anal canal melanoma metastasis;
2. Diagnosed as Anal canal melanoma stage Ⅳ (it has spread around the anus, iliac juxtavascular lymph nodes, liver and lungs);
3. Director Jun Guo suggest plan T1 Combined liver interventional chemotherapy. Taking into account the late liver intervention, the drugs for this chemotherapy were injected from platinum intravenously.

2020-01-18
Start T1 Plan chemotherapy:
1. Temozolomide 320mg, d15
2. Cisplatin 40mg, d-3
3. rh-endostatin 15mg, d-14
W4Q
Body reaction: feel sick and vomit

Suggestions of therapy after leaving hospital:
1. continue rh-endostatin until 2020-01-31. Keep monitoring blood routine, liver and kidney function(1-2 times/week). If the patient has symptom like fever, fatigue, nausea, vomiting, etc, improve the test in time and give symptomatic treatment. If leukocyte<2.0*10°/L or Neutrophil<1.0*10°L, patient can be treated as G-CSF. If platelets<50*10°/L, patient can be treated as interleukin-11 or TPO;
2. Return to the hospital on time for liver intervention therapy before improve blood routine, biochemical and coagulation functions;
3. Carry out plan T1 chemotherapy in the second period and make an appointment for hospitalization in advance;
4. Review of chest and abdominal pelvic CT and evaluate the efficacy;
5. Subsequent visit.

Leaving hospital diagnosis:
Diagnosed as Anal canal melanoma stage Ⅳ (it has spread around the anus, iliac juxtavascular lymph nodes, liver and lungs)

If you have any suggestions, please let me know. I and my families will appreciate your help very much.

I am sorry for what you and your aunt are dealing with. From reading your post this is what I understand-
1. She is Stage IV with melanoma spread beyond the anus - which means it is probably (though I can't be sure) is a subcategory of melanoma referred to as "mucosal".
2. She has been on a combination of Temozolimide, cistplantin and rh-endostatin since January of this year.

While there have been some responses in melanoma to the combination you note, we have learned that patients with melanoma do best when they are given either immunotherapy (which includes anti-PD-1 drugs like Opdivo or Keytruda or the combination of Opdivo and another immunotherapy drug Yervoy - sometimes called the ipi/nivo combo) or targeted therapy (which only works if the tumor is positive for something called BRAF which it would need to be tested for). Here is a report on the most usual and up-to-date treatments for melanoma generally: https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2017/08/melan... Administration of any of these treatments does not require hospitalization, rather they are given in clinics or doctors offices - though in your circumstance I do not know if that changes anything.

If these drugs are not routinely accessible for melanoma patients in China, these trials are currently recruiting and include some of the same sorts of therapy:

This one includes an anti-PD-1 product (though not the same as the ones I list above): https://clinicaltrials.gov/ct2/show/NCT03430297?cond=Stage+IV+Melanoma&c... It appears to be recruiting patients in three locations in China. Here is a report on the anti-PD-1 drug it uses: https://www.ncbi.nlm.nih.gov/pubmed/30642373

This trial is recruiting in Beijing and uses the same anti-PD-1 product above with an oncolytic viral agent : https://clinicaltrials.gov/ct2/show/NCT04206358?cond=Stage+IV+Melanoma&c...
Here is a report on the oncolytic viral component: https://ascopubs.org/doi/abs/10.1200/JCO.2017.35.15_suppl.e21013

And this trial looks promising, though it is not yet recruiting: https://clinicaltrials.gov/ct2/show/NCT04072900?cond=Stage+IV+Melanoma&c...
It combines anti-PD-1 with rhGM-CSF and Imiquimod 5% Topical Cream

Here are some research reports on the use of imiquimod in melanoma: https://chaoticallypreciselifeloveandmelanoma.blogspot.com/search?q=Imiq...
It is a topical cream that will not do much for melanoma alone, but when combined with an immunotherapy, it seems to have improved results.

If your aunt were mine, I would certainly see if I could get her a place in any of these trials. I hope that helps. Ask more as you have the need. There are many caring and smart folks on this forum. I wish you my best. Celeste

To clarify - I mean if your aunt were mine and the immunotherapy and/or targeted therapy I cover in the primer are not available to her - I would try to enroll her in one of the trials I noted rather than her current treatment. Yours, celeste

Thank you very much for these suggestions. I will carefully study the tips you give and discuss them with my families. In fact, today we have just got the results of the genetic test and the patient cannot do the therapy you mentioned. We have also heard of the Beijing experiment you mentioned, and we plan to wait until the second chemotherapy effect comes out before deciding whether to join. Because the second chemotherapy was just two days later. Thank you for your help, it really helped us a lot. I don't even know how to express my gratitude in English. Thanks again! Best wishes to you.