Ampullary Cancer - Keytruda

Pancreatic cancer, no.  My brother who lives near Boston was diagnosed with stage 4 bladder cancer about 2 years ago.  He was afraid of surgery so even he had blood in his urine since 2012; he never visited a doctor for it until June, 2014.  Nothing could shrink his tumor before he had the operation to remove his bladder.  His doctor did not treat him after the operation in August 2014 because they thought it was incurable.  They started chemotherapy on him in last September because his tumors were getting bigger very fast.  After 3 doses of chemotherapy with Alimta, it did not work so his doctor changed to another drug Taxol, he could hardly walk after 2 doses of it.  His doctor stopped the chemotherapy altogether and told him to prepare for the worst in last December. 

He started using keytruda in the middle of January, the cancerous lump on his neck disappeared in about 10 days.  After 4 doses of keytruda, his biggest tumor shrank from 4.7 X 3.2 cm to 3.1 X 2cm (around 60% smaller).  The smaller tumors shrank almost 80%.  Now after 8 doses of keytruda, he has gained back all the weight he had lost, from around 135 pounds back to 165 pounds.  He will have another CT scan soon (after 8 rounds of keytruda) but his is certainly back according to the blood test. his AFP (tumor marker) was over 2000 when he had stage 4 cancer, over 3000 after 5 rounds of chemotherapy but now it is back down to 3.  That drug works on my brother miraculously. 

But now I have another problem, my mother was diagnosed with liver cancer on January 6, her lesion went from 2.7 X 2.5 cm to 5 X 4.1 cm in just 2.5 months.  After her radiofrequency ablation on March 22, she developed 2 new smaller lesions that are less than 1 cm (it should be bigger now since the CT scan was done on May 3).  Her doctors did not offer much help and keytruda has not been approved in Montreal, Canada yet.  Even it is available, I do not know if it is covered by Quebec as it is very expensive.  

My mother’s oncologist suggested my mother to have chemotherapy with trans-arterial chemo-embolisation (TACE) with drug-eluting beads (DC beads).  I worry about that since my mother is 89-year-old.

I asked that oncologist 2 questions.  I asked him how toxic that drug is.  He told me that drug is mild comparing to other chemotherapy drugs but it could also be fatal.  Then I asked him what his suggestion was, he told me his first suggestion is to do it and the second suggestion is not to do it. 

My mother’s liver doctor did not even bother to read my mother’s reports.  The ultrasound on January 6 showed a 2.5 X 2.7 cm lesion, her tumor was “3.5cm” on March 22 (according to the doctor who performed the radiofrequency ablation, but it was in fact 5 X 4.1 cm on the report she wrote on that day).   On April 13, his liver doctor told me that they nip my mother’s tumor at the bud at 2.5cm.  I told him that tumor was 3.5 cm already on March 22 (according to the doctor who performed the radiofrequency ablation but it was in fact 5 X 4.1 cm),

So without any help from her doctors and that miracle drug keytruda, I really don't know what to rely on.