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Combination low-dose Ipi/Pembro, High Fiber Diet, and Psoriasis Biologics

Forums General Melanoma Community Combination low-dose Ipi/Pembro, High Fiber Diet, and Psoriasis Biologics

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      Hello Folks!

      I’m stopping by with a quick update and question for those interested. See question at bottom regarding mixing immunotherapy with other immunomodulators treating autoimmune disorders (psoriasis).

        Update on treatment – low does ipi combo + high fiber diet

      After 1 year of stage 3A/3B adjuvant Nivo, I progressed to Stage IV with 1 small, slow-growing nodule, in my lung.

      I tested negative twice using a Signatera test that was tailored using a genetic sequence of my primary tumor.

      I recently started on a ipi/pembro combination using the low-dose ipi (1 mg/kg) discussed here:

      A few key suggestions from my onc team at Johns Hopkins and derm team at Inova Schar to compliment the immunotherapy:

      1. Eat a high fiber diet, getting at minimum 30 g/day
      2. No probiotic supplements or antibiotics.
      3. Vitamin D supplement.


      1. I’ve been using monoclonal antibody treatments (i.e. biologics) to successfully treat my severe palmar psoriasis over the past several years, even preceding my initial melanoma diagnosis by about 9 months. Currently I am on Taltz, which is an IL-17 inhibitor (considered immunomodulating, and not necessarily immunosuppressive).

      After consulting with several oncologists, I’ve had mixed responses about whether I should continue using taltz during immunotherapy. However, the consensus has been that I can continue due to (1) the fact that it significantly increases my quality of life by allowing me use of my hands and (2) there is no body of evidence to support contraindication. My dermatologist and one onc opinion strongly believed that I should be able to continue to use the Taltz, as they did not believe there to be a logical basis that inhibiting IL-17 should negatively impact the ipi/pembro efficacy. My onc team at Johns Hopkins supports this, although was initially hesitant.

      I’m hoping that someone has experience consulting and receiving different opinions, or potentially more nuanced information to support one approach versus another. Thank you !!

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          Hi Jeff,

          Here are some reports that you may find interesting.

          Re diet – we have known for some time that eating a high fiber diet and lots of live cultures (from yogurt, kimchi, etc – NOT pills from a bottle), while avoiding antibiotics if at all possible, is very beneficial to melanoma patients – especially those on immunotherapy. Here are a zillion reports: Microbiome

          We also know that vitamin D helps melanoma patients as well – Vitamin D

          Finally, while it is not ideal – many patients with pre-existing conditions or those who have to have infliximab or other immune suppressive therapies in order to tolerate side effects from their immunotherapy treatment or other pre-existing disease process can and do gain benefit from melanoma treatment. Here are some reports: Preexisting conditions and melanoma immunotherapy

          A recent report that takes a deep dive into the subject, with links within: What to do about immunotherapy if you – take steroids or infliximab for side effects? Have a pre-existing autoimmune disease?????

          And one more link, that may cross over with some of the posts shared above, but highlighting a heroine from this forum and with even more links – Jubes

          Hope that helps. Knowledge is power. Hang tough. I wish you my best. Celeste

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