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ANTIBIOTICS AND IMMUNOTHERAPY- IPI NIVO

Forums General Melanoma Community ANTIBIOTICS AND IMMUNOTHERAPY- IPI NIVO

  • Post
    debwray
    Participant

      Hi ,

      Am due to start ipi nivo on Monday- large number of diffuse liver mets.

      Am still on high dose antibiotics Cipro and rifampicin following a severe infection in a previous surgical scar on the knee- post CLND on that leg. – although infection now seems to have gone .

      Have started BioKult- pro biotic  to try to improve gut microbiome pretherapy.

      My question is- are antibiotics likely to interfere with efficacy of ipi nivo combo ? Anyone been given advice re this from their oncologist ? 

      Very keen to do what it might take to make the combo work…and reduce risk of side effects. Any hints or tips out there ?

      Thanks in advance

       

       

       

    Viewing 14 reply threads
    • Replies
        cancersnewnormal
        Participant

          I can't say that I have experience with any heavy or high dose antibiotics, so I'm not sure how bad the condition of your guts may be. My doc's biggest concern (I went through a 10 day round for a sinus infection) was diarrhea, as that is an issue with both antibiotics and Ipi. It doesn't seem that the way the meds biologically function would interfere with one another. You'll definitely need to have "the #2 talk" with your doc though. Repeatedly as you get infusions. 

          I did stumble across this interesting mouse research though: http://www.cancercenter.com/discussions/blog/probiotics-may-help-immunotherapy-drugs-fight-cancer/

          Those probiotics you are taking to get your guts back "online" may be beneficial! Hmmmm.

          cancersnewnormal
          Participant

            I can't say that I have experience with any heavy or high dose antibiotics, so I'm not sure how bad the condition of your guts may be. My doc's biggest concern (I went through a 10 day round for a sinus infection) was diarrhea, as that is an issue with both antibiotics and Ipi. It doesn't seem that the way the meds biologically function would interfere with one another. You'll definitely need to have "the #2 talk" with your doc though. Repeatedly as you get infusions. 

            I did stumble across this interesting mouse research though: http://www.cancercenter.com/discussions/blog/probiotics-may-help-immunotherapy-drugs-fight-cancer/

            Those probiotics you are taking to get your guts back "online" may be beneficial! Hmmmm.

            cancersnewnormal
            Participant

              I can't say that I have experience with any heavy or high dose antibiotics, so I'm not sure how bad the condition of your guts may be. My doc's biggest concern (I went through a 10 day round for a sinus infection) was diarrhea, as that is an issue with both antibiotics and Ipi. It doesn't seem that the way the meds biologically function would interfere with one another. You'll definitely need to have "the #2 talk" with your doc though. Repeatedly as you get infusions. 

              I did stumble across this interesting mouse research though: http://www.cancercenter.com/discussions/blog/probiotics-may-help-immunotherapy-drugs-fight-cancer/

              Those probiotics you are taking to get your guts back "online" may be beneficial! Hmmmm.

                debwray
                Participant

                  Hi Niki,

                  Thanks for the inforrmation. The No 2 problems look like an odds on bet…..

                  debwray
                  Participant

                    Hi Niki,

                    Thanks for the inforrmation. The No 2 problems look like an odds on bet…..

                    debwray
                    Participant

                      Hi Niki,

                      Thanks for the inforrmation. The No 2 problems look like an odds on bet…..

                    MoiraM
                    Participant

                      I cannot see that antibiotics would interfere with immunotherapy but I never discussed this with my consultant.

                      I think that taking the Bio-Kult is a good idea. It will renew your gut flora, which will may have been killed off by the antibiotic. As you say, having a healthy gut microbiome is a sensible starting point. 

                      How long will you have to be on the antibiotics?

                        debwray
                        Participant

                          Thanks for your replies.

                          They said I should keep taking antibiotics until the wound from the surgical wash out and removal of infected tissue heals- probably another 4 weeks but there is a debate about when or if to continue beyond that due to lymphoedema /cellulitis issues post CLND. The wound is having to heal from the bottom up and is still being packed. Hole is aout the sie of a £1 coin now and about 2cm deep.

                          Crossing my fingers for a response from the ipi nivo combo and don't want to put any barriers in its way. and hope to get the full 4 doses in if possible…….

                          debwray
                          Participant

                            Thanks for your replies.

                            They said I should keep taking antibiotics until the wound from the surgical wash out and removal of infected tissue heals- probably another 4 weeks but there is a debate about when or if to continue beyond that due to lymphoedema /cellulitis issues post CLND. The wound is having to heal from the bottom up and is still being packed. Hole is aout the sie of a £1 coin now and about 2cm deep.

                            Crossing my fingers for a response from the ipi nivo combo and don't want to put any barriers in its way. and hope to get the full 4 doses in if possible…….

                            debwray
                            Participant

                              Thanks for your replies.

                              They said I should keep taking antibiotics until the wound from the surgical wash out and removal of infected tissue heals- probably another 4 weeks but there is a debate about when or if to continue beyond that due to lymphoedema /cellulitis issues post CLND. The wound is having to heal from the bottom up and is still being packed. Hole is aout the sie of a £1 coin now and about 2cm deep.

                              Crossing my fingers for a response from the ipi nivo combo and don't want to put any barriers in its way. and hope to get the full 4 doses in if possible…….

                            MoiraM
                            Participant

                              I cannot see that antibiotics would interfere with immunotherapy but I never discussed this with my consultant.

                              I think that taking the Bio-Kult is a good idea. It will renew your gut flora, which will may have been killed off by the antibiotic. As you say, having a healthy gut microbiome is a sensible starting point. 

                              How long will you have to be on the antibiotics?

                              MoiraM
                              Participant

                                I cannot see that antibiotics would interfere with immunotherapy but I never discussed this with my consultant.

                                I think that taking the Bio-Kult is a good idea. It will renew your gut flora, which will may have been killed off by the antibiotic. As you say, having a healthy gut microbiome is a sensible starting point. 

                                How long will you have to be on the antibiotics?

                                khubes
                                Participant

                                  My husband was on a 30 (!!) day course of Augmentin for a nasty sinus infection while receiving his regularly scheduled Keytruda infusions.  His melanoma specialist and regular onc were not concerned about mixing the two and told us there wouldn't be any adverse reactions or that the antibiotic would/could alter the efficacy of his treatment.  

                                  I would definitely recommend taking a probiotic to deal with any potential gut issues – antibiotics can be rough!!

                                  Best,

                                  Katie  

                                  khubes
                                  Participant

                                    My husband was on a 30 (!!) day course of Augmentin for a nasty sinus infection while receiving his regularly scheduled Keytruda infusions.  His melanoma specialist and regular onc were not concerned about mixing the two and told us there wouldn't be any adverse reactions or that the antibiotic would/could alter the efficacy of his treatment.  

                                    I would definitely recommend taking a probiotic to deal with any potential gut issues – antibiotics can be rough!!

                                    Best,

                                    Katie  

                                    khubes
                                    Participant

                                      My husband was on a 30 (!!) day course of Augmentin for a nasty sinus infection while receiving his regularly scheduled Keytruda infusions.  His melanoma specialist and regular onc were not concerned about mixing the two and told us there wouldn't be any adverse reactions or that the antibiotic would/could alter the efficacy of his treatment.  

                                      I would definitely recommend taking a probiotic to deal with any potential gut issues – antibiotics can be rough!!

                                      Best,

                                      Katie  

                                      Mat
                                      Participant

                                        I started ipi-nivo in January.  Around June (when I was in the nivo-only portion of the treatment), I developed a sinus infection that was treated with Cipro for 4 months.  No effect on my treatment to my knowledge.

                                        Mat
                                        Participant

                                          I started ipi-nivo in January.  Around June (when I was in the nivo-only portion of the treatment), I developed a sinus infection that was treated with Cipro for 4 months.  No effect on my treatment to my knowledge.

                                            khubes
                                            Participant

                                              Holy crap, Mat!  A 4 month course?!  I thought 1 month was tough!  I hope that your sinus infection finally cleared up!  

                                              How is everything else going?  Hopefully all is well.  

                                              Wishing you my best,

                                              Katie 

                                              khubes
                                              Participant

                                                Holy crap, Mat!  A 4 month course?!  I thought 1 month was tough!  I hope that your sinus infection finally cleared up!  

                                                How is everything else going?  Hopefully all is well.  

                                                Wishing you my best,

                                                Katie 

                                                khubes
                                                Participant

                                                  Holy crap, Mat!  A 4 month course?!  I thought 1 month was tough!  I hope that your sinus infection finally cleared up!  

                                                  How is everything else going?  Hopefully all is well.  

                                                  Wishing you my best,

                                                  Katie 

                                                  debwray
                                                  Participant

                                                    Thanks to all for the replies. I've had 3.5 weeks antibiotics IV followed by4 week oral and am expected to take more. Infection was missed for months in spite of crp regularly 150- 170 range, Thought I was on Keytruda and a possible side effect re joints but was placebo when trial unblinded.

                                                    Eventually got to a rheumy- they said anything above 90- infection most likely culprit. not synovitis or tenosynovitis.Have posted a link on Anne Marie's thread re this problem.

                                                    Sadly the trial confused prompt diagnosis along with a negative aspiration of fluid- but infection was backed up in old scar tissue from earlier knee surgeries and a plate removal., not within the joint itself. 

                                                    Just hoping my immune system still has enough gas to mount a defense given that it has struggled to deal with the infection May-September this year. Still on Cipro and rifampcin- turn your wee and tears orange..

                                                    Been reading some other stuff re mice and gut flora – seems if your gut has the right flora then in the mice model this equals better response to immunotherapy..am pumping in the probiotics but am hoping the antibiotics don't knock them out too much.

                                                    Thanks again to all for sharing. It does help to know that others really get what is going on. 

                                                     

                                                     

                                                     

                                                    debwray
                                                    Participant

                                                      Thanks to all for the replies. I've had 3.5 weeks antibiotics IV followed by4 week oral and am expected to take more. Infection was missed for months in spite of crp regularly 150- 170 range, Thought I was on Keytruda and a possible side effect re joints but was placebo when trial unblinded.

                                                      Eventually got to a rheumy- they said anything above 90- infection most likely culprit. not synovitis or tenosynovitis.Have posted a link on Anne Marie's thread re this problem.

                                                      Sadly the trial confused prompt diagnosis along with a negative aspiration of fluid- but infection was backed up in old scar tissue from earlier knee surgeries and a plate removal., not within the joint itself. 

                                                      Just hoping my immune system still has enough gas to mount a defense given that it has struggled to deal with the infection May-September this year. Still on Cipro and rifampcin- turn your wee and tears orange..

                                                      Been reading some other stuff re mice and gut flora – seems if your gut has the right flora then in the mice model this equals better response to immunotherapy..am pumping in the probiotics but am hoping the antibiotics don't knock them out too much.

                                                      Thanks again to all for sharing. It does help to know that others really get what is going on. 

                                                       

                                                       

                                                       

                                                      debwray
                                                      Participant

                                                        Thanks to all for the replies. I've had 3.5 weeks antibiotics IV followed by4 week oral and am expected to take more. Infection was missed for months in spite of crp regularly 150- 170 range, Thought I was on Keytruda and a possible side effect re joints but was placebo when trial unblinded.

                                                        Eventually got to a rheumy- they said anything above 90- infection most likely culprit. not synovitis or tenosynovitis.Have posted a link on Anne Marie's thread re this problem.

                                                        Sadly the trial confused prompt diagnosis along with a negative aspiration of fluid- but infection was backed up in old scar tissue from earlier knee surgeries and a plate removal., not within the joint itself. 

                                                        Just hoping my immune system still has enough gas to mount a defense given that it has struggled to deal with the infection May-September this year. Still on Cipro and rifampcin- turn your wee and tears orange..

                                                        Been reading some other stuff re mice and gut flora – seems if your gut has the right flora then in the mice model this equals better response to immunotherapy..am pumping in the probiotics but am hoping the antibiotics don't knock them out too much.

                                                        Thanks again to all for sharing. It does help to know that others really get what is going on. 

                                                         

                                                         

                                                         

                                                      Mat
                                                      Participant

                                                        I started ipi-nivo in January.  Around June (when I was in the nivo-only portion of the treatment), I developed a sinus infection that was treated with Cipro for 4 months.  No effect on my treatment to my knowledge.

                                                        Clwilcop
                                                        Participant

                                                          Just a reminder…be sure to have at least a 2 hour window between taking an antibiotic and probiotic, if taken together the anti will kill the pro on contact. 

                                                          Some believe prebiotics are as important as probiotics as they assist in creating an environment in which probiotics can flourish. I much prefer acacia as a prebiotic over the more common chicory root/inulin as it can be difficult to tolerate for some. 

                                                          Also adding fermented foods into the diet can assist in maintaining/creating a healthy microbiome; kombucha, miso, apple cider vinegar, yogurt. Unfortunately popular brands of yogurt are packed with sugar. I prefer Bulgarian yogurt or any yogurt that can be used as a starter. They are packed with cfu's (colony forming units) and usually contain only naturally occurring sugar. 

                                                          So much is being discovered about the connection between the gut and immune system…such an exciting and promising time!

                                                           

                                                          Clwilcop
                                                          Participant

                                                            Just a reminder…be sure to have at least a 2 hour window between taking an antibiotic and probiotic, if taken together the anti will kill the pro on contact. 

                                                            Some believe prebiotics are as important as probiotics as they assist in creating an environment in which probiotics can flourish. I much prefer acacia as a prebiotic over the more common chicory root/inulin as it can be difficult to tolerate for some. 

                                                            Also adding fermented foods into the diet can assist in maintaining/creating a healthy microbiome; kombucha, miso, apple cider vinegar, yogurt. Unfortunately popular brands of yogurt are packed with sugar. I prefer Bulgarian yogurt or any yogurt that can be used as a starter. They are packed with cfu's (colony forming units) and usually contain only naturally occurring sugar. 

                                                            So much is being discovered about the connection between the gut and immune system…such an exciting and promising time!

                                                             

                                                            Clwilcop
                                                            Participant

                                                              Just a reminder…be sure to have at least a 2 hour window between taking an antibiotic and probiotic, if taken together the anti will kill the pro on contact. 

                                                              Some believe prebiotics are as important as probiotics as they assist in creating an environment in which probiotics can flourish. I much prefer acacia as a prebiotic over the more common chicory root/inulin as it can be difficult to tolerate for some. 

                                                              Also adding fermented foods into the diet can assist in maintaining/creating a healthy microbiome; kombucha, miso, apple cider vinegar, yogurt. Unfortunately popular brands of yogurt are packed with sugar. I prefer Bulgarian yogurt or any yogurt that can be used as a starter. They are packed with cfu's (colony forming units) and usually contain only naturally occurring sugar. 

                                                              So much is being discovered about the connection between the gut and immune system…such an exciting and promising time!

                                                               

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