Frequency of Onc visits while on Keytruda?

Posted By
MovingOn
11/15/2017 6:51pm
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Replies: 13

Hi All, Today I had an oncology appointment followed by my 3rd Keytruda infusion. My blood work is all fine and I’m not experiencing any significant side effects. My Oncologist said that going forward we will only have appointments and blood work every 6 weeks (continuing the Keytruda infusions every 3 weeks). Does that seem typical? I was sort of expecting to have blood work and an oncology visit before each infusion.

2018 is a new year!

Hi. Glad to hear your not experiencing any big side effects. For every one of my Keytruda infusions I always had bloodwork done and met with my oncologist before the infusion.  I think they do this so they can keep a good eye on you and to make sure your able to proceed with the next infusion. My first couple keytruda treatments i did fine but by the fourth or fifth one I was experiencing severe joint pain. After that my oncologist cancelled my treatment for that day and we took a break. Unfortunately I developed Lupus from the Keytruda (which is very rare I believe) and I was unable to continue.  The good news is that I am currently showing NED. In my opinion, I believe they should be doing bloodwork prior to each infusion to keep an eye on liver counts, inflammation,  kidney funtions, etc. If they only do it every six weeks they may miss catching a problem while it's still early. I would definitely consider asking for a blood test every three weeks before each treatment. This way, if they see something worrisome they can address it right away. 

Some docs/facilities don't do a visit with every infusion, but I would definitely want to do blood work before each one, that's the best way to be on top of something you may not know is going on. The infusion clinic nurses can review the lab results and decide if you are good to go for the infusion based on what the labs show. 

Jenn - stage IV NED - Completed Ipi/Nivo (Yervoy/Opdivo) + surgery

At my wife's med center, they WON'T treat with Keytruda without updated blood work. She sees the doc the day of treatment - every three weeks. Makes sense, no?

My docs did the same thing.... blood labs and a physical "are you really ok" look into my eyes (including pokes and prods of lymph nodes and liver... BP check... weight... temp... the whole run down!) check before each infusion was ordered up from the lab. 

Hi Moving on, my trial of Ipi/Nivo or either as monotherapies did blood work at start of each cycle or treatment #1 then no blood work for second treatment, follow by blood work before treatment 3.  Then they repeat the same method for next cycle. I did have to see Oncologist before treatment #2 to listen to lungs, check lymph nodes, blood pressure and all that other jazz. What is interesting is BMS (Nivo) has requested to change 2 week schedule to a 4 week schedule with the FDA and we should know the answer early next year. Merck ( Pembro) might be doing this change to be proactive and keep there advantage when it comes to how often patients have to see Oncologist!!! It could just be all about the $$$$ and there battle with BMS for control of the Immunotherapy landscape in Oncology, as sad as that may be!!! Best Wishes on treatments!!!Ed

I have a blood test before each infusion. My Onc has to sign off on it before they put the order into the pharmacy. I see my Onc about every third infusion and after each scan.

Hey Moving,

Just to add my schedule to the mix (and I'm only coming up on my third round of Pembro + I'm in a clinical trial with PV-10 so take my schedule with a grain of salt), I see both my surgical and medical oncologist + labs before each round so far. I'm not sure if that changes once I complete the trial and go to Pembro only but from what I've been told so far labs are going to be part of my life as long as I continue with Pembro as will my visits with at least my medical oncologist. Again, I'm a relative newbie to Pembro so I'm sure they are watching things closely as I get used to this drug to make sure things "stay in range". Maybe because you have tolerated it so well thus far they don't feel like its necessary? 

Tex

Bloodwork day before oncologist usally on Fri with Opdivo/Yervoy following Wed.  Until liver panel too high and 4th treatment cancelled.  That's why they check before each treatment.

Bloodwork day before oncologist usally on Fri with Opdivo/Yervoy following Wed.  Until liver panel too high and 4th treatment cancelled.  That's why they check before each treatment.

aybe different with maintenance??

Bloodwork day before oncologist usally on Fri with Opdivo/Yervoy following Wed.  Until liver panel too high and 4th treatment cancelled.  That's why they check before each treatment.

Thank you all for the responses.

If I think back to my Ipi infusions then it was between the 3rd and 4th infusion when hypophysitis knocked me down. So I’m not comfortable with labs being skipped before any immunotherapy infusion (maybe after 6 months of infusions but not after only 3 infusions).

I’ll ask my Oncologist about this some more and will definitely be getting the labs done every time.

2018 is a new year!

I ended up using the ‘not following blood testing protocols prior to Keytruda’ excuse for switching my melanoma care to a research university medical center instead of the health system where i started my care. The new place is on the list of certified comprehensive cancer centers (I believe the list has ~50 in the US). 

2018 is a new year!