Immunotherapy for stage 3-yes or no?

Posted By
Anonymous
11/16/2017 9:24am
Activity
Replies: 4

I've just had lymph nodes resection and depending on pathology report the game plan is to continue with immunotherapy /anti-pd alone since latest research it shows it's more effective that the Ipi combo/ as an adjuvant treatment.My understanding is ,once you have used this option you can't go back to it. So my dillema is this : what if I need immunotherapy down the line  and this option is no longer available for me?I would like to keep that option open as long as possible  but I also want to be pro-active  with adjuvant treatment post resection  and leave nothing to the chance.Any thoughts?I am really torn ot treatment decision.

Adjuvant treatment is a very personal decision.  Anti-PD-1 (Nivolumab/nivo/Opdivo or Pembrolizumab/pembro/Keytruda)had been shown to be more effective than the anti-CTLA-4 drug Ipi (ipilimumab/Yervoy).  Studies addressing the ipi/nivo combo have proven much more effective for active disease.  FYI - response rates for melanoma patients with active disease are:  anti-PD-1 = around 40%, ipi = about 15%, ipi/nivo combo = 50+%.  We know that response rates as adjuvant are much better for nivo than ipi.  We also know that whether taken alone or as a combo...ipi is the bad boy of side effects.  So...the ipi/nivo combo will probably prove to be more effective in adjuvant care as well....but we don't have those numbers in absolute form yet...and there is the side effect issue to consider.  Here are two links that may help you learn what you need:

http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2017/08/melanoma-intel-primer-for-current.html  

http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2017/11/review-of-adjuvant-treatment-in-stage.html  

The cool thing about getting effective adjuvant care is that then you never have to seek treatment again!  However, the sad thing about melanoma treatment (despite amazing strides in therapy options over just the past 5-6 years!!) is that there are no sure things.  You have to do what you think is best for you.

I wish you well.  celeste

Anonymous - (11/16/2017 - 2:08pm)

Thanks for the reply,Celeste.I have to agree with you that nothing in the melanoma world is given.I am strongly inclined to do Opdivo/Keytruda alone exactly to avoid the Ipi bad side effects.I already have colitis and other issues so I am pretty sure I won't tolerate Ipi well. However....I have to re-formulate my question :in case the checkpoint inhibitors don't work, can a different combination of dgugs be tried down the line?I hope that  they will come up with immunotherapy that works for every melanoma patients in the next few years ,the perfect scenario.

The simple answer is yes.  If you take anti-PD1 now....like many others have done before you...if you recur....there are other options, drugs and combo's that you could avail yourself of - with hopefully even more becoming available day by day.  c

I recently went through the same delema.  My doc gave me the option of Opdivo, Dabrafenib/Trametinib, or watch and wait (He basically ruled Yervoy out because of side effects).  I asked him what the chance of recurrence was for my situation and it was unacceptable to me.  I finally asked him point blank what he would do and he said Opdivo.  The Checkmate-238 trial showed one year RFS of 82% for anyone with greater than 5% PD-L1 expression (Mine is 20%).  If it returns i also have other options because I am BRAF+, but I suspect there will be plenty of trials in the future involving products to help increase the reponse rate of Opdivo and Keytruda that will be available if I have a recurrence.