Mono vs. Combo

Very similar situation.My stage 1b was on thigh and returned 7 years later to groin (had 10 nodes removed, only the 1 was positive).7 weeks later a pelvic node was positive so just had 28 deep pelvic nodes removed. Should have gone to MDAnderson for the 1st surgery but didn’t know better. Went for 2nd one. Am 2 weeks post op. Because my nodes are considered regional, not distant , they staged me as 3b. Yervoy is my only choice unless stage 4. If you have surgery please go to a melanoma surgeon. I had superb care at MDA.Also make sure your staging is correct . My local onc had me stage 4 but MDA adamantly refuted that. It will make a difference with treatment choices. Am also looking at radiation to lymph node basin because of the condition of this last node when it was removed. Good luck .

Very similar situation.My stage 1b was on thigh and returned 7 years later to groin (had 10 nodes removed, only the 1 was positive).7 weeks later a pelvic node was positive so just had 28 deep pelvic nodes removed. Should have gone to MDAnderson for the 1st surgery but didn’t know better. Went for 2nd one. Am 2 weeks post op. Because my nodes are considered regional, not distant , they staged me as 3b. Yervoy is my only choice unless stage 4. If you have surgery please go to a melanoma surgeon. I had superb care at MDA.Also make sure your staging is correct . My local onc had me stage 4 but MDA adamantly refuted that. It will make a difference with treatment choices. Am also looking at radiation to lymph node basin because of the condition of this last node when it was removed. Good luck .

Very similar situation.My stage 1b was on thigh and returned 7 years later to groin (had 10 nodes removed, only the 1 was positive).7 weeks later a pelvic node was positive so just had 28 deep pelvic nodes removed. Should have gone to MDAnderson for the 1st surgery but didn’t know better. Went for 2nd one. Am 2 weeks post op. Because my nodes are considered regional, not distant , they staged me as 3b. Yervoy is my only choice unless stage 4. If you have surgery please go to a melanoma surgeon. I had superb care at MDA.Also make sure your staging is correct . My local onc had me stage 4 but MDA adamantly refuted that. It will make a difference with treatment choices. Am also looking at radiation to lymph node basin because of the condition of this last node when it was removed. Good luck .

I also had a recent recurrance in a groin lymph node. Nothing in organs. When making the decision on treatment for me it came down to: what is the most effective. The combo is the most effective with response rates around 60% whereas Opdivo alone is around 40%. The possibility of getting some not so fun side effects are a lot higher with the combo, but one combo infusion is better than none, and if something serious comes up then they will stop the Yervoy part and just put you on the single agent Opdivo. I was able to do all 4 of the combo infusions and just had my first single Opdivo maintenance infusion yesterday. I had a scan recently showing the lymph node had almost no uptake on PET and was much smaller on CT, so repsonse is definitely happening! My philosophy on deciding was, why not kill this thing with the biggest gun I can right now while it's small and easy to shoot!

Hoping for good response with whatever treatment path you take!

I also had a recent recurrance in a groin lymph node. Nothing in organs. When making the decision on treatment for me it came down to: what is the most effective. The combo is the most effective with response rates around 60% whereas Opdivo alone is around 40%. The possibility of getting some not so fun side effects are a lot higher with the combo, but one combo infusion is better than none, and if something serious comes up then they will stop the Yervoy part and just put you on the single agent Opdivo. I was able to do all 4 of the combo infusions and just had my first single Opdivo maintenance infusion yesterday. I had a scan recently showing the lymph node had almost no uptake on PET and was much smaller on CT, so repsonse is definitely happening! My philosophy on deciding was, why not kill this thing with the biggest gun I can right now while it's small and easy to shoot!

Hoping for good response with whatever treatment path you take!

I also had a recent recurrance in a groin lymph node. Nothing in organs. When making the decision on treatment for me it came down to: what is the most effective. The combo is the most effective with response rates around 60% whereas Opdivo alone is around 40%. The possibility of getting some not so fun side effects are a lot higher with the combo, but one combo infusion is better than none, and if something serious comes up then they will stop the Yervoy part and just put you on the single agent Opdivo. I was able to do all 4 of the combo infusions and just had my first single Opdivo maintenance infusion yesterday. I had a scan recently showing the lymph node had almost no uptake on PET and was much smaller on CT, so repsonse is definitely happening! My philosophy on deciding was, why not kill this thing with the biggest gun I can right now while it's small and easy to shoot!

Hoping for good response with whatever treatment path you take!

Hi,

No simple anwers to this one.

Ipi nivo has higher response rate at the cost of higher toxicities- but managememt of those is improving due to experience and looking in the right places. Most side effects are reversible with steroids with the exception of some of the endocrine ones – which may be permanent but replacement hormones are available.

Mono therapy is just as good as combo where your disease has high PD1 expression but this is hard to measure accurately in clinical practice and is not yet available as a reliable biomarker to predict clinical response. So not much help with decision making here.

Don't know where you are- here in the uk I could go for either combo or mono therapy but could not trade up if monotherapy did not work.

Also do you know BRAF status ? If monotherapy did not work then BRAF drugs could be used to control disease in the short term then maybe switch to combo ?

Side effects are likely to be lower on mono therapy-but not everyone gets all the side effects of either mono or combo.

Have a look at this presentation http://slideplayer.com/slide/10812486/ or check out Celeste's blog http://chaoticallypreciselifeloveandmelanoma.blogspot.co.uk/search?q=ipi+nivo

My oncologist left the choice to me as he said it was finely balanced in my case- Braf negative.

So far three doses in but with liver test probs and have had 6 week treatment holiday and steroid taper before hitting dose three and liver is upset again so probably won't get to dose 4.

Its an awful lot to take on board but in the end you have to go with what feels right for you.

I have so far had rash, fatigue, and itching – all low level problems – sweats that could be drugs cancer or menopause related- and the liver problems requiring steroids.No evidence of a response yet- but treatment response rates vary between individuals so still hoping.

Best wishes whatever you decide 

Deb

 

 

Hi,

No simple anwers to this one.

Ipi nivo has higher response rate at the cost of higher toxicities- but managememt of those is improving due to experience and looking in the right places. Most side effects are reversible with steroids with the exception of some of the endocrine ones – which may be permanent but replacement hormones are available.

Mono therapy is just as good as combo where your disease has high PD1 expression but this is hard to measure accurately in clinical practice and is not yet available as a reliable biomarker to predict clinical response. So not much help with decision making here.

Don't know where you are- here in the uk I could go for either combo or mono therapy but could not trade up if monotherapy did not work.

Also do you know BRAF status ? If monotherapy did not work then BRAF drugs could be used to control disease in the short term then maybe switch to combo ?

Side effects are likely to be lower on mono therapy-but not everyone gets all the side effects of either mono or combo.

Have a look at this presentation http://slideplayer.com/slide/10812486/ or check out Celeste's blog http://chaoticallypreciselifeloveandmelanoma.blogspot.co.uk/search?q=ipi+nivo

My oncologist left the choice to me as he said it was finely balanced in my case- Braf negative.

So far three doses in but with liver test probs and have had 6 week treatment holiday and steroid taper before hitting dose three and liver is upset again so probably won't get to dose 4.

Its an awful lot to take on board but in the end you have to go with what feels right for you.

I have so far had rash, fatigue, and itching – all low level problems – sweats that could be drugs cancer or menopause related- and the liver problems requiring steroids.No evidence of a response yet- but treatment response rates vary between individuals so still hoping.

Best wishes whatever you decide 

Deb

 

 

Hi,

No simple anwers to this one.

Ipi nivo has higher response rate at the cost of higher toxicities- but managememt of those is improving due to experience and looking in the right places. Most side effects are reversible with steroids with the exception of some of the endocrine ones – which may be permanent but replacement hormones are available.

Mono therapy is just as good as combo where your disease has high PD1 expression but this is hard to measure accurately in clinical practice and is not yet available as a reliable biomarker to predict clinical response. So not much help with decision making here.

Don't know where you are- here in the uk I could go for either combo or mono therapy but could not trade up if monotherapy did not work.

Also do you know BRAF status ? If monotherapy did not work then BRAF drugs could be used to control disease in the short term then maybe switch to combo ?

Side effects are likely to be lower on mono therapy-but not everyone gets all the side effects of either mono or combo.

Have a look at this presentation http://slideplayer.com/slide/10812486/ or check out Celeste's blog http://chaoticallypreciselifeloveandmelanoma.blogspot.co.uk/search?q=ipi+nivo

My oncologist left the choice to me as he said it was finely balanced in my case- Braf negative.

So far three doses in but with liver test probs and have had 6 week treatment holiday and steroid taper before hitting dose three and liver is upset again so probably won't get to dose 4.

Its an awful lot to take on board but in the end you have to go with what feels right for you.

I have so far had rash, fatigue, and itching – all low level problems – sweats that could be drugs cancer or menopause related- and the liver problems requiring steroids.No evidence of a response yet- but treatment response rates vary between individuals so still hoping.

Best wishes whatever you decide 

Deb