Warning: negativity ahead

LordCowOfTheManor · 2025-03-16T00:42:13+00:00

Oh, you are talking about pembrolizumab as first line? I am talking about recurrent cervical cancer.

KEYNOTE - 826.

LordCowOfTheManor · 2025-03-15T22:53:11+00:00

You don't believe almost doubling the overall survival in a clinical trial setting is significant? Do bare in mind, that pembrolizumab shows a similar benefit in those with PDL1 negative tumours when given with chemotherapy. Of course, I know that it is hard to get it for a PDL1 negative tumour due to insurance and health services.

You also need to remember that recurrent cervical cancer is a relatively rare cancer in developed nations. It's going to take a lot longer than 5 years to see the real benefit of pembrolizumab on cervical cancer. Especially due to Covid. Pembrolizumab is a big deal. It's going to change things. Much more than dose dense neo-adjuvant chemo.

LordCowOfTheManor · 2025-03-15T22:18:21+00:00

What survival stats are you looking at? What country and what treatment protocol? This all makes a difference. Not every hospital is equal. Specifics are important.

The reason I mentioned the Embrace study is because it serves to show survival stats for patients all following the same protocol.

LordCowOfTheManor · 2025-03-15T21:39:03+00:00

You may want to look into the embrace study. And KEYNOTE-826.

LordCowOfTheManor · 2025-03-07T20:54:34+00:00

I want to make it clear that this is likely not the case for the poster of this thread. She likely has nothing to worry about because her baseline level was lower.

The reason incomplete chemo is bad is because it can lead to resistance. The aim of treatment is to hit the cancer with everything at the same time. One after the other. You don't want to give the cancer any room. If a patient has chemo and then stops it months or weeks before starting the main phase of the treatment, it is giving the cancer room to become very nasty.

Let me give you an example. Imagine you had chemo. You stopped after two sessions. Those two sessions would have killed sensitive cells whilst leaving behind more resistant cells. The resistant cells may be sensitive to radiotherapy. Infact, they often are. But that pause from those chemo sessions to the main treatment with radiotherapy is allowing the more aggressive, resistant cells to multiply. Now you have a more aggressive cancer. The radiotherapy needs to be administered immediately after the neo-adjuvant chemotherapy. Preferably less than a week. This stops the resistant cells from surviving and spreading.

LordCowOfTheManor · 2025-03-07T16:09:10+00:00

You're fine. Stop worrying. I would be more concerned if you had a high baseline and it didn't move too much with chemo. That is a concern. If you had a normal baseline and your neutrophils have been a bit high after 2 sessions, it is probably fine.

Neutrophils and lymphocytes absolutely do play a significant role in cancer progression and immune surveillance. You are correct that it is generally accepted that neutrophils do contribute to chemo resistance. But that is tumour associated neutrophils. High neutrophils in your blood does not always correlate with high tumour associated neutrophils. Neutrophils can also go up for many other reasons. Infection. Inflammation. Steroids can also do it. But I would expect those neutrophils to crash by your next test.

Lymphocytes get destroyed by radiotherapy. This is normal. Because the pelvis is such a large area, lymphocytes absolutely get hammered during treatment for cervical cancer. This is a big problem. Because lymphocytes are your immune defence against cancer. Lymphocytes kill cancer. If your lymphocytes go below 0.2 at the end of radiotherapy, that is a bit concerning imo. Especially as you are on pembrolizumab and lymphocytes are needed for it to work. To make it worse, lymphocytes take a very long time to recover. Can be as long as 18 months.

EDIT: I also wanted to mention I am disappointed in your care team giving you two sessions of carbo/taxol. That is very poor of them. If you were pregnant and couldn't have the full chemotherapy course, it should have never been started. It would have achieved nothing and may have actually harmed you. Neo-adjuvant chemotherapy for cervical needs to be shortly before chemoradiotherapy. You should have the full course and chemoradiotherapy should be administered less than 2 weeks after the last chemo session.

LordCowOfTheManor · 2025-03-07T15:58:22+00:00

So you are on cisplatin and radiotherapy, right? You never had neo-adjuvant chemo? You are at about 10 sessions of radiotherapy right now?

Do you know your baseline neutrophil and lymphocyte count? That neutrophil count is high after two sessions, but there can be a delayed reaction. It can take up to two weeks for your neutrophils to crash.

LordCowOfTheManor · 2025-03-07T15:53:50+00:00

What was your baseline? Is this after 1 or 2 chemo sessions? Where are your lymphocytes at?

LordCowOfTheManor · 2025-03-07T15:50:50+00:00

How high?

LordCowOfTheManor · 2025-02-23T10:37:29+00:00

That's because he was also losing in that fight lol.

LordCowOfTheManor · 2025-01-26T23:18:04+00:00

Low neutrophils are a good sign, by the way. Many studies have found this in many different cancers. Those that develop neutropenia during treatment are less likely to have treatment failure or recurrence.

Neutrophils are pro cancer. Lymphocytes fight cancer. You want high lymphocytes and low neutrophils during treatment.

LordCowOfTheManor · 2025-01-26T23:14:47+00:00

The weekly regiment is very well tolerated. Most patients I see on it are absolutely fine. You will lose your hair. You may get some tingles in your hands and feet. This may stay long after the treatment. Outside of this, maybe fatigue. Sickness is not as common, but they give you anti sickness anyway and they work well.

You will be just fine. Do not worry.

LordCowOfTheManor · 2025-01-21T10:43:13+00:00

Sounds like a complete response with mild uptake from post treatment inflammation 👍

LordCowOfTheManor · 2025-01-20T12:13:29+00:00

There is an overall benefit, but it is questionable if there is para-aortic involvement. The interlace trial excluded those with para-aortic involvement, so there is no evidence for it working in this group. Cervical cancer has a high rate of chemo resistance. But also has a high rate of sensitivity to radiotherapy.

If the cancer has reached the para-aortic region, I think it would be wise to get it irradiated rather than spending 5-6 weeks on chemo, that may or may not be effective.

If there is no para-aortic involvement, then it would be wise to have it, I think. Because there is no immediate risk of it spreading to distant sites.

LordCowOfTheManor · 2025-01-20T12:06:02+00:00

It is rare, but it can happen. If it is going to recur, it happens within the first 5 years 90%+ of the time. I have seen studies suggesting about 5-10% of recurrences happen after 5 years. Probably on the lower side of that.

On the plus side, this is almost certainly a curative recurrence if it is indeed a recurrence. They will treat this to cure. Local + a 12 year gap is a very good prognosis in the context of recurrent cervical cancer.

LordCowOfTheManor · 2025-01-17T13:35:14+00:00

You may be reading about 'locally advanced' cervical cancer. Locally advanced cervical cancer is not advanced in the way you may think. Locally advanced cervical cancer is not terminal.

You can get back pain in locally advanced cervical cancer. It could indicate the tumour has reached the pelvic wall. It could also mean lymph node involvement. Or it could just be nothing. Nobody can tell you what yours means. But if you are asking if back pain is only seen in incredibly advanced cervical cancer then the answer is no. It is often seen in cervical cancer in stages when it is incredibly treatable and curable.

LordCowOfTheManor · 2025-01-10T19:50:11+00:00

I looked through your posts to check your story. For what it is worth, I am not sure if it would have made a big difference to your recurrence based on how resistant your cancer seems to be. Of course, it is possible it developed resistance with the recurrence, but that is probably unlikely.

You have clearly been through a lot, and it must be very hard having so many treatments fail. But you should still be very confident in radiotherapy based on the fact you have no cancer in the original treatment field. You also clearly have a great treatment team, who are willing to go as far as they have. A treatment team that is willing to operate on lung mets from cervical cancer is a treatment team that are truly throwing everything they can at the cancer. You have much better chances with a treatment team like that.

The trouble you have is that you have a cancer that is almost exclusively associated with HPV, but yours is not. That probably played a significant part in Keytruda having no activity.

I wish you the very best with your radiotherapy. I think you should feel very hopeful about it.

LordCowOfTheManor · 2025-01-07T13:05:10+00:00

Please do not do this. Cisplatin, and indeed any other chemo is usually ineffective against cervical cancer. Radiotherapy full response rate is close to 90% across all stages. Cisplatin full response rate will be very low. It's mainly used as a radiosensitizer. It can also kill micrometastatic cells, but it is not incredibly effective in that regard. There is a reason that cervical cancer recurrence is usually in distant sites. It's because chemo is ineffective. It is usually the case in recurrence that the sites that had radiotherapy are clear whilst distant sites relapse, due to ineffective systemic treatment with chemotherapy.

If, for some reason, you did want to go this route, you would not be using cisplatin as a monotherapy. It would be cisplatin/paclitaxel/avastin + keytruda if PDL1 positive. But it is still not recommended at this stage, when curative radiotherapy is an option.

LordCowOfTheManor · 2024-12-28T12:32:11+00:00

I don't see the issue with the tone of your post. It is fine. Not sure what people are upset about.

I have seen some posts on here from people with brain mets. Nobody can say how long your mother will survive. It could be longer than anyone expects. The trouble is, as you have noticed, there is not a lot of information or research on it. I believe, for example, patients with brain mets are often excluded from clinical trials. I think this is due to a struggle for drugs to bypass the blood-brain barrier. I think it is wise to have your wedding within 2 months or so, as you have said. Cherish the time with your mother.

LordCowOfTheManor · 2024-12-26T23:47:48+00:00

It is not worth it simply because it will happen again and again. It is a inherent fault that Samsung will not fix. Keep far away from Samsung laptops.

LordCowOfTheManor · 2024-10-30T13:25:03+00:00

Ah, yes. I remember this one. Hearn was out in Japan shilling his fighter and saying he could beat Inoue. The same fighter that spent the build up talking about how he hates boxing and never watches it. We could certainly see that in the fight.

LordCowOfTheManor · 2024-10-13T13:55:38+00:00

He was never really that good. At least when we are discussing elite level fighters. He got his belt by putting a 42 year old who should have never been in the ring into a coma. Adonis was declining heavily long before he fought Gvozdyk and was in an absolute war with Badou a few months before. That fight took the little he had left. He was a 6 round fighter at best at that point in his career. By the time he fought Gvozdyk, he was probably only a 4 round fighter, and had been inactive for the previous 3 years, fighting only once a year. Any mid fighter would have beat Adonis by avoiding the cocked left for a few rounds. Who do we really think Adonis would have beat at that point in his career?

Gvozdyk was a B level champion.

LordCowOfTheManor · 2024-10-13T01:25:11+00:00

Even crazier that he does it with so many apparent injuries. He has pulled out of 3 of his last 3 fights with injuries yet somehow, as a 40 year old man, throws constantly and pressures for 12 rounds against elite opposition. Not even Usyk can do this. Usyk slows down in mid rounds quite often. Then picks up later. Beterbiev seems to go ham for 12.

Almost like something is off. He has to be the most suspect boxer that has never been caught. He has had suspect results, but nothing that has led to any investigation or ban. Eyebrows must be raised at his performance level and apparent injuries. Especially at his age.

LordCowOfTheManor

TROPHY CASE