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CT Result

Forums General Melanoma Community CT Result

  • Post
    hxcadam
    Participant
      I’ve had 3 Opdivo infusions as well as radiation to all the original sites. Clearly they haven’t worked as well as I’d like. Is there any reason I shouldn’t be taking the combo? Trying to get a hold of my doctor today as tomorrow is my next Opdivo infusion and I want to really stress the fact that I want the combo but just looking for other opinions on here as well. BRAF+ – Original site was right chest wall with small amount found in Right axilla lymph nodes.

      CT CH/ABD/PEL W/ CON
      ——
      5/1/2020 CT of chest, abdomen, and pelvis
      CLINICAL STATEMENT: Metastatic melanoma. EOD
      TECHNIQUE: Multislice helical sections were obtained from the thoracic
      inlet to the pubic symphysis after oral and intravenous contrast
      administration.
      RADIATION DOSE (DLP): 1453 mGy-cm
      COMPARISON: January 2017, 2020 CT scan.
      CORRELATION: None.
      FINDINGS:
      LUNGS/AIRWAYS: Small left lower lobe
      metastases are decreased in size and now measure 1.8 x 1.4 cm along the
      inferior hilum previously 2.1 x 1.8 cm and 0.9 x 0.9 cm in the posterior
      costophrenic sulcus previously 1.2 x 1.1 cm
      PLEURA/PERICARDIUM: No effusion.
      MEDIASTINUM/THORACIC NODES: Statuspost right axillary dissection.
      No new adenopathy
      HEPATOBILIARY: No liver mass or biliary ductal dilatation
      SPLEEN: 4.0 x 3.1 cm mass in the medial
      superior pole is increased in size, previously 1.5x 1.3 cm. Several new
      hypodense metastases measure up to 2.7 x 2.4 cm in the inferior pole
      PANCREAS: Unremarkable.
      ADRENAL GLANDS: New 1.6 x 1.2 cm nodule in left adrenal body
      consistent with metastasis.
      KIDNEYS: Unremarkable.
      ABDOMINOPELVIC
      NODES: No adenopathy.
      PELVIC ORGANS: Mild prostatomegaly
      PERITONEUM/
      MESENTERY/BOWEL: No obstructive bowel dilatation, ascites or
      peritoneal masses
      BONES/SOFT TISSUES: New small lytic metastases in T2 vertebral body
      eroding the left anterior cortex, right pubic bone and left iliac wing
      OTHER: None.
      IMPRESSION:
      1. Since January 2020, increased metastatic disease in spleen, left
      adrenal gland and bones.

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    • Replies
        tedtell1
        Participant
          Hey, just wanted to check in. I guess this scan wasn’t the good news you were looking for and that really sucks. I don’t have any experience with the combo, never did that/needed it fortunately. I guess I am kind of surprised at this point it hasn’t been suggested for you given your new scans. Is your Doc a melanoma specialist? Hopefully the smarter, better educated people will chime in on your post with support and suggestions. God Bless and hope that you get some positive results/action soon!
          Ted
            hxcadam
            Participant
              She has a couple specialties Melanoma being one of them. I was under the impression she was sharing my case with Dr. Wolchok but that doesn’t seem to be the case so I’m going to be talking to Dr. Wolchok next week and get his guidance. As the other poster stated I had gotten colitis from ipi alone at first DX but at a much higher dosage 10mg/1kg.
            MelMel
            Participant
              I am sorry about your CT results. Skimming quickly through your profile, I see you had colitis following two opdivo infusions. This is the reason your oncologist stays away from the combo. However, you may want to have that discussion with her now that the CT results show spread and growth.
              I have had a similar issue however I was on the combo and due to hepatitis needed to come off immunotherapy after two infusions. At the time, my melanoma oncologist said that she has no issues going back on the combo at some point however few months later, she changed her tune. Now that I am on opdivo maintenance only, she says before we try combo again, she wants to try tef/mek targeted therapy if need be. I saw a liver specialist and was involved in a drug induced liver injury study. He believes that only 16% of the patients experience reinjury following a repeated drug exposure. My melanoma oncologist disagrees and thinks it’s more like 38% with the combo immunotherapy. One always needs to weigh the risk vs reward. I would definitely push for more clarification from your oncologist. I have come across a number of articles where many melanoma patients get reintroduced to the drugs which caused them serious side effects, yet the second time around they do not cause the same issues as the first time.
              I hope you find the right treatment for you.
              Melanie
                hxcadam
                Participant
                  My doctor is with MSK though not a specific melanoma specialist its just one of her specialties. I assumed she was sharing my case with the gurus in Manhattan because in emails she told me she was discussing with her team. I feel that is not the case now and will be seeing Dr. Wolchok next week. I don’t think my 2017 colitis should have had any weight on not trying the combo this time around was dosage is obviously significantly lower with the combo. 3mg per 1kg vs what I got was 10mg per 1kg.
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