Can bone metastasis in a 27-y/o be cleared with immunotherapy?

Question

Hello doctor,

I am writing about my younger brother, who is only 27 years old, and was diagnosed with lung cancer earlier this year. This news was devastating for our entire family, especially given his age.

Staging revealed that he has bone metastasis in his spine, specifically at the L3-L4 region, as well as in three of his ribs. He started Pembrolizumab immunotherapy five months ago, and his latest PET scan showed what the doctor referred to as a significant metabolic response in the lung primary. However, we are confused about what is happening with the lesions in his bones.

Can bone metastasis in a 27-year-old's spine and ribs be cleared after immunotherapy? His orthopedic surgeon is concerned about the spinal lesions and mentioned the possibility of vertebral instability. Last month, his calcium levels were elevated at 11.8 mg/dL but decreased to 9.6 mg/dL after a Zoledronic acid infusion. While the pain in his back and ribs was severe before, it has actually reduced, which gives us hope.

Please guide me.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and understand your concern.

I am really sorry to hear that your family is facing this difficult situation at such a young age. In your brother's case, there are several important points to consider.

First, the response to immunotherapy with Pembrolizumab is encouraging, as a significant metabolic response on the PET (positron emission tomography) scan indicates effective reduction of tumor activity.

While bone metastases can respond to treatment, it is important to note that they often do not completely disappear on imaging; instead, we may observe decreased metabolic activity on PET scans, conversion to sclerotic or healed lesions on CT (computed tomography) scans, and structural stabilization rather than complete clearance.

A reduction in back and rib pain is also a positive sign, suggesting reduced tumor activity in the bone and a good response to both immunotherapy and Zoledronic acid.

However, concerns about vertebral instability are valid, especially in the case of spine metastases, so any new neurological symptoms, such as leg weakness or numbness, should prompt urgent evaluation, potentially including an MRI (magnetic resonance imaging).

The initial high calcium level of 11.8 mg/dL, likely tumor-related, normalizing, is also reassuring and suggests disease control. Overall, while bone metastases can respond well, they often stabilize rather than resolve, and pain reduction indicates a favorable response.

Ongoing monitoring of the spine will be crucial to prevent complications. If you would like, I can help further with interpreting follow-up PET or CT scans for bone lesions, advice on when to consider spine fixation versus radiotherapy, or practical red flags you should watch for at home.

Hope I have addressed all of your queries and concerns.

Do follow up whenever needed.

Thank you.