Switching from Ketruda to Yervoy

Posted By
Nick C
11/26/2017 3:05pm
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Replies: 13

Hi all...

Question: Has anyone switched their treatment from Keytruda to Yervoy? If so, any major side effects?

Nick


Hi NIck,

I went from Yervoy to Keytruda and there was a little overlap period (10 days or so) where I felt more crummy than normal because both drugs were in my system at the same time.  This didn't last long, though.

Shalom,

Julie

Stage 3c  (TXN2cM0)-- 2008 WLE, SNB, LND, HD-INF, GM-CSF, (intransits) 2013 IPI, (intransits) 2014 PEMBRO, (intransits resected in 2017)

Stage 3a 2017 NSCLunc Cancer VATs; Carboplatin & Pemextred;  radiation

I switched from Ketruda to Yervoy and Opdivo, then to just Opdivo.  My melanoma spread to many more bones in the 4 months that I received Ketruda.   Receiving Yervoy and Opdivo saved my life, but caused very bad diarrhea and too much weight loss.  My oncologist postponed my 2nd Yervopy and Opdivo treatment for 6 weeks until I regained weight.  I received Opdivo in the interval.   I have received Opdivo every 2 weeks for the past 18 months and am reasonably healthy; I can run and bicycle. 

Hi Nick, If you do go onto Yervoy, then definitely get a TSH (Thyroid stimulating hormone) blood test before starting. Mine started out at 3 (with a high end of normal being 4 and a low end of normal being 0.35) then dropped to 2 after first Yervoy, then dropped to 1 after second Yervoy, then dropped to 0.02 after 3rd Yervoy. Then diagnosed as hypophysitis. Retrospectively, I now wish that I’d have stopped Yervoy after the initial drop in TSH. In my opinion that initial drop was indicating I had developed pituitary antibodies from Yervoy. Had I stopped Yervoy after 1 or 2 doses then maybe some of my pituitary would still function.

Hypophysitis seems to occur more frequently in middle-age and older men on Yervoy. I fit that description. 

I’ve also been wondering lately what immunotherapy comes after Pembro if some tumors continue?

2018 is a new year!

To answer your question about what comes after pembro....

I had what I assume would be considered a complete response to pembro. Visible spots on my skin and nodules in my right lung all shrunk and died. But I stopped responding to pembro and even those went away, new cancer soon emerged in my chest lymph nodes, while I was still receiving pembro.

In my case my oncologist wanted to do radiation and then resume pembro. But I went to Dr. Sharfman at Johns Hopkins, who I always went to see for a consult whenever my condition changed. He told me he thought a trial was a better option for me, so since June I have been in the anti-LAG-3 trial at Johns Hopkins. I get nivolumab followed by relatlimab every 2 weeks. Right now I think if you fail on a PD-1 your only immunotherapy option is a trial.

-Bill

Thank you for the heads up.

Thank you. I also fit the "older men" profile.

I have never heard of going from a PD-1 to Yervoy. I got Yervoy in late 2014 early 2015 and at that time you had to do Yervoy first before you could get a PD-1. I know they've changed that and Keytruda and Opdivo are now first line treatments, but I think the response rate has been better for the PD-1s than for Yervoy. So it seems to me almost as if going from Keytruda to Yervoy would be taking a step backwards.

Regarding your question about side effects, my side effects were much worse with Yervoy than with Keytruda. A massive rash that required over 2 months on prednisone, and a great deal of cramping and gastric upset for about a month after the infusions were done.

-Bill

Hi Bill, you might want to take a look at this ONclive from 2016 with Dr. Weber on sequence of check point inhibitors.https://m.youtube.com/watch?v=eeJp_TKiv54

Deinfitely interesting. Since I put ipi in the rearview mirror 2.5 years ago I haven't been as informed about current thinking. I do know Dr. Sharfman told me before Keytruda or Opdivo were approved that they were getting better results with the PD-1s, but at that time, as I said, you had to do ipi first. I assumed incorrectly that starting with a PD-1 meant that you wouldn't go from there to ipi. But as that video relates it sounds like the response rate for ipi is better if you get it second.

Hey Bill..

The reason for the possible switch is that after a great initial response I have two nodes that continue to show progression. My Keytruda treatments were stopped. My options are a clinical trial or Yervoy. The trial would be a combo of Keytruda and a new drug. Doing my research in order to make my best guess.

Thanks for you response.

Nick

Hi Nick,

I'm following you're thoughts with interest, my Ipi/Nivo trial finishes in Feb, I managed 3 out of 4 dual infusions and have been on Nivo maintenance since March, the last scan had me stable for liver/lung, however I have a couple armpit lymph nodes that are progressing. It has been suggested that radiation, followed by Pembro may be my way forward, tough decisions.....

Tony

Tony -  IV - Ipi/Nivo (Yervoy/Opdivo); now on Nivo maintenance

Hey Tony,

After a year of observation of skin lesions, I had a lymph node removed from my left armpit (surprised that it was the size of a golf ball since I could barely feel it). It was then that I decided it was time for treatment. Started In January and continued until a couple of weeks ago. All the original sites ( 9 in all) were "Resolved" or disappeared. New ones showed up in my abdominal region (two lymph nodes), so we watched for progression. After my last scan, we determined that it true progression. Keytruda was stopped and we looked for other options...clinical trial or Ipi. Radiation and removal were not options.

Making up my mind this weekend.

Nick

Hi Nick

my thoughts are with you, the other option I might push for here in BC is the personalized onco-genomics program, basically a full dna of the cancer in the hope that they can identify an existing drug that will target the defect, I'm sure I read a recent post on MRF referring to a similar program being promoted by the FDA. Might be worth a punt as us English would say.

Tony

Tony -  IV - Ipi/Nivo (Yervoy/Opdivo); now on Nivo maintenance