The immunotherapy rash settled down quickly with the various pharmacy grade products, and I was cleared to have my fourth dose of Pembrolizumab on time. I have been busy telling my body to stick out the red carpets to invite the drug into zones 6 and 8 of my liver (where my secondaries are), whilst ignoring my skin and any organs that correctly use the PD-1/PD-L1 pathway to create an immune privileged zone. I am not sure my body understands this complex request. I guess I am going to be spending the next few weeks inspecting my body for early signs of rash. My neck and upper chest still look a bit sunburnt and my right boob is still a little pink. Unfortunately the right boob is the one where it all started, and surgery and radiotherapy have left it rather worse for wear. It still looks normal in a bra, so I guess I got away lightly in that respect.
I had my liver MRI this morning. 7:45am appointment, asked to be at the department at 7:30. Doors firmly locked, no-one to be seen. Eventually an arriving nurse let a small number of us in. The liver MRI is a 30 minute nerve jangling procedure, which I have described before. This was my 4th experience, so nothing new to report, an identical set of steps to the previous 3. MRI #3 was my baseline before starting my current Pembrolizumab and NAB-Paclitaxel regime, and it identified that the larger tumour had developed satellites. I am hoping I don’t have a whole constellation in there this time round.
Keynote-355 was the clinical trial that led to NICE approval for my treatment protocol. The treatment is offered to people with metastatic TNBC who pass the threshold of having a combined positive score (CPS; the number of PD-L1–staining tumour cells, lymphocytes, and macrophages, divided by the total number of viable tumour cells, multiplied by 100) of 10 or more. 52.7% of the patients with a CPS of 10 or more in the pembro+chemo arm of the trial achieved an objective response to the treatment. That’s the piece of hope I am holding onto. I have a CT scan on the 15th and see the consultant on the 21st.
