Does local recurrence mean immunotherapy fail?

Posted By
1/9/2019 9:50pm
Replies: 4

Hi all! About 6 months in of monthly Opdivo treatments, my dermatologist found a few new spots of melanoma along the scar line of the original occurence/surgery. 

One of the docs on my team said that this doesn’t mean that it is an Opdivo fail (based on that the local recurrence could have been residual cells too small to detect previously and that the Opdivo may not have been able to eradicate them), while another says that it does indicate that the Opdivo isn’t working. 

Any thoughts on this? I’m definitely continuing the treatments until I reach 13, but the difference in opinion puzzles me.

Anonymous - (1/10/2019 - 11:48am)

It does mean it failed as a single agent and you will need to add something to it. However it does not mean it cant work in combination and long term. Adding any one of radiation, intralesional, ipi and/or more surgery. Could boost the response rate to where you could continue opdivo only in the future. It by itself will not likely stop local disease.

Thank you! Well they did another excision on the new cells, and I continue on the Opdivo. I asked because I am still making what is for me a weighty decision on the radiation. One doc recommends doing it just on my scalp where the original and re-occurrence happened. Another recommends doing it on both sides of my neck as they’d originally had to remove two positive lymph nodes at the time of the first surgery and second doc recommends doing it just on my scalp where the original and re-occurrence happened. 



Diagnosed April 2018; Stage IIIb; 1 excision on head, started immuno (Opdivo) May 2018; new spots Oct. 2018; second surgery; about to start radiation 

Anonymous - (1/11/2019 - 4:59pm)

In my case similar to yours. I had a second wide excision with no radiation because it popped back up weeks after surgery while still healing. Then I had radiation which got rid of 98% of my disease. Satellite or in transit disease tends to only show up as tip of the ice-berg. Then it can pop up rapidly or further. In some cases the second excision may be all that is needed, but I would definitely do radiation if given the chance. It is really tolerable.

Anonymous - (1/13/2019 - 12:11pm)

original poster, if you are still reading this thread... what did the local recurrence look like?