› Forums › General Melanoma Community › “Free fall” between treatments
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DZnDef.
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- December 12, 2014 at 10:33 am
Hello all,
There's loads of great posts on this forum about treatments, but I didn't find anything about the period when switching from one treatment to the other.
My wife is Stage IV, diagnosed in June after several weeks of fever & lesions under her skin appearing, and after many blood tests they ultimately discivered metastatic melanoma after a CT scan. All major symptons disappeared within the first weeks of being on the Dabrafenib/Trametinib combo and her tumors started shrinking on the following CT scans and ultimately she become PET negative on October.
However, on the next scan in December tumor growth was observed, not only in the main sites (liver, spleen) but now also in her bones in several places. We're now onto immune therapy.
Since it may takes weeks, if not months, for that therapy to work, we're in a free fall at the moment. Her condition is worsening and we feel new nodes under her skin. The fevers and night sweats are also back.
So I have two questions:
– Is there any data on how fast the immune therapy typically needs before it kicks in? I know averages are not very useful here, but maybe there is % after x weeks, % after x+2 treatments, etc information.
– How did you feel in this period in between treatments? Did you feel worse, did you get additional treatments, were you hospitalized? How did you cope with it mentally.
For my wife it's very tough as we believed we were on a path to some type of recovery, but now not only is the tumor growth back, so are the symptoms, so it's like starting all over again which is something she had blocked out as a possibility.
Thanks for sharing your "free fall" experiences, and we hope that the parachute will open soon!
Thanks, Rick
(PS. I have posted here several times before but wanted this post to be anynymous for personal reasons, hope you understand)
- Replies
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- December 12, 2014 at 2:14 pm
Hi Rick it would be helpful to know what kind of Immune therapy your wife is getting. The new PD-1 drugs tend to start working a little faster than Ipi which usuall take up to 3 months to show up on scans. With Pd-1 people are getting responses a lot faster. I had tumor shrinkage by the first set of scans at 12 weeks. In early studies of PD-1 they were able to see reductions by 8 weeks on scans. If you want to do some research on your own there is a really good series on youtube, filmed at the Angeles clinic. Dr. Omid Hamid speaks about new clinical trials that are being looked today. The title to search on youtube is " Future Therapies for Melanoma Education Symposium 2014. Dr. Hamid talks about all the new combination that are being tried today. There are several other videos from different experts in the same series. I hope this was helpful to you and I wish you the best of luck with the treatments. Ed
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- December 12, 2014 at 2:14 pm
Hi Rick it would be helpful to know what kind of Immune therapy your wife is getting. The new PD-1 drugs tend to start working a little faster than Ipi which usuall take up to 3 months to show up on scans. With Pd-1 people are getting responses a lot faster. I had tumor shrinkage by the first set of scans at 12 weeks. In early studies of PD-1 they were able to see reductions by 8 weeks on scans. If you want to do some research on your own there is a really good series on youtube, filmed at the Angeles clinic. Dr. Omid Hamid speaks about new clinical trials that are being looked today. The title to search on youtube is " Future Therapies for Melanoma Education Symposium 2014. Dr. Hamid talks about all the new combination that are being tried today. There are several other videos from different experts in the same series. I hope this was helpful to you and I wish you the best of luck with the treatments. Ed
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- December 12, 2014 at 2:14 pm
Hi Rick it would be helpful to know what kind of Immune therapy your wife is getting. The new PD-1 drugs tend to start working a little faster than Ipi which usuall take up to 3 months to show up on scans. With Pd-1 people are getting responses a lot faster. I had tumor shrinkage by the first set of scans at 12 weeks. In early studies of PD-1 they were able to see reductions by 8 weeks on scans. If you want to do some research on your own there is a really good series on youtube, filmed at the Angeles clinic. Dr. Omid Hamid speaks about new clinical trials that are being looked today. The title to search on youtube is " Future Therapies for Melanoma Education Symposium 2014. Dr. Hamid talks about all the new combination that are being tried today. There are several other videos from different experts in the same series. I hope this was helpful to you and I wish you the best of luck with the treatments. Ed
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- December 12, 2014 at 5:46 pm
Wow. Sorry to hear that. I'm suprised the fevers and sweats are from her disease but like my doc says everyone is different.
Immunotherapy is slow to work. PD-1 tends to work faster than ipi but it is still at least 9 weeks before good things show up on scans. However she might start feeling better in a couple weeks after the first dose or at least I did. I didn't actually realize it until my parents kept saying how much better I looked.
For quick results it is usually the braf meds which you already did the combo. There is a phase 1 trial for ERK which is further up the gene chain that might give good results but I can only imagine what the side affects would be. Probably severe.
For the bone stuff you might want to check out xgeva. It is supposed to strengthen the bones.
When I switched from the combo which didn't shrink anything for me to Merck's extended access program of pd-1 I was scared. I knew in my gut if it didn't work I wouldn't last long enough for another treatment. That was from April 23 to May 21. I think I was going on sheer will power. I know now my parents were very worried because I didn't have much strength and was rather sickly. In my head though I thought I was in great shape just my body hadn't caught up yet. Also right before April 23 we went to Nashville trying to get into that PD1. That trip really messed up my health. When I got back I had 3 days of major fevers, shakes not able to eat much and stuff. My parents said sometimes I was shaking so hard the heavy recliner was shaking and they had to hold me down. That doc would hardly talk about the pd1 just said it was difficult to get into. Ha. I'm still hear 7 months later thanks to keytruda. One of my former co-workers gave me a book called Jesus Today. The lady who wrote it was going through a lot of medical struggles and it really hit home trying to get me into a good mental state every day I read a couple passages. It's kind of like brainwashing myself into having a positive attitude. When a pain or something hits that's the radiation, or pd1 or xgeva working. Who knows what it really is but that's the attitude I have to have or I would go crazy. I just finished reading it a second time today and will start it again tomorrow. So yeah you just gotta keep fighting and get to that one treatment that works for you. No matter how many meds have failed you. You just gotta keep fighting. My dad says it is hell on earth. But others have beat this for years and years so why not me? Why not you too? Never give up. Never surrender.
Artie
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- December 12, 2014 at 5:46 pm
Wow. Sorry to hear that. I'm suprised the fevers and sweats are from her disease but like my doc says everyone is different.
Immunotherapy is slow to work. PD-1 tends to work faster than ipi but it is still at least 9 weeks before good things show up on scans. However she might start feeling better in a couple weeks after the first dose or at least I did. I didn't actually realize it until my parents kept saying how much better I looked.
For quick results it is usually the braf meds which you already did the combo. There is a phase 1 trial for ERK which is further up the gene chain that might give good results but I can only imagine what the side affects would be. Probably severe.
For the bone stuff you might want to check out xgeva. It is supposed to strengthen the bones.
When I switched from the combo which didn't shrink anything for me to Merck's extended access program of pd-1 I was scared. I knew in my gut if it didn't work I wouldn't last long enough for another treatment. That was from April 23 to May 21. I think I was going on sheer will power. I know now my parents were very worried because I didn't have much strength and was rather sickly. In my head though I thought I was in great shape just my body hadn't caught up yet. Also right before April 23 we went to Nashville trying to get into that PD1. That trip really messed up my health. When I got back I had 3 days of major fevers, shakes not able to eat much and stuff. My parents said sometimes I was shaking so hard the heavy recliner was shaking and they had to hold me down. That doc would hardly talk about the pd1 just said it was difficult to get into. Ha. I'm still hear 7 months later thanks to keytruda. One of my former co-workers gave me a book called Jesus Today. The lady who wrote it was going through a lot of medical struggles and it really hit home trying to get me into a good mental state every day I read a couple passages. It's kind of like brainwashing myself into having a positive attitude. When a pain or something hits that's the radiation, or pd1 or xgeva working. Who knows what it really is but that's the attitude I have to have or I would go crazy. I just finished reading it a second time today and will start it again tomorrow. So yeah you just gotta keep fighting and get to that one treatment that works for you. No matter how many meds have failed you. You just gotta keep fighting. My dad says it is hell on earth. But others have beat this for years and years so why not me? Why not you too? Never give up. Never surrender.
Artie
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- December 12, 2014 at 5:46 pm
Wow. Sorry to hear that. I'm suprised the fevers and sweats are from her disease but like my doc says everyone is different.
Immunotherapy is slow to work. PD-1 tends to work faster than ipi but it is still at least 9 weeks before good things show up on scans. However she might start feeling better in a couple weeks after the first dose or at least I did. I didn't actually realize it until my parents kept saying how much better I looked.
For quick results it is usually the braf meds which you already did the combo. There is a phase 1 trial for ERK which is further up the gene chain that might give good results but I can only imagine what the side affects would be. Probably severe.
For the bone stuff you might want to check out xgeva. It is supposed to strengthen the bones.
When I switched from the combo which didn't shrink anything for me to Merck's extended access program of pd-1 I was scared. I knew in my gut if it didn't work I wouldn't last long enough for another treatment. That was from April 23 to May 21. I think I was going on sheer will power. I know now my parents were very worried because I didn't have much strength and was rather sickly. In my head though I thought I was in great shape just my body hadn't caught up yet. Also right before April 23 we went to Nashville trying to get into that PD1. That trip really messed up my health. When I got back I had 3 days of major fevers, shakes not able to eat much and stuff. My parents said sometimes I was shaking so hard the heavy recliner was shaking and they had to hold me down. That doc would hardly talk about the pd1 just said it was difficult to get into. Ha. I'm still hear 7 months later thanks to keytruda. One of my former co-workers gave me a book called Jesus Today. The lady who wrote it was going through a lot of medical struggles and it really hit home trying to get me into a good mental state every day I read a couple passages. It's kind of like brainwashing myself into having a positive attitude. When a pain or something hits that's the radiation, or pd1 or xgeva working. Who knows what it really is but that's the attitude I have to have or I would go crazy. I just finished reading it a second time today and will start it again tomorrow. So yeah you just gotta keep fighting and get to that one treatment that works for you. No matter how many meds have failed you. You just gotta keep fighting. My dad says it is hell on earth. But others have beat this for years and years so why not me? Why not you too? Never give up. Never surrender.
Artie
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- December 12, 2014 at 11:21 pm
I finished Yervoy on Aug 13th and had my first scans Sept 20th and the spots in my lungs are gone and the one in my neck is half it's size..My dr said that things could look worse before getting better with Yervoy, some swelling might happen also..My 2nd scan is on the 15th..Good luck..I'm stage 3 C
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- December 12, 2014 at 11:21 pm
I finished Yervoy on Aug 13th and had my first scans Sept 20th and the spots in my lungs are gone and the one in my neck is half it's size..My dr said that things could look worse before getting better with Yervoy, some swelling might happen also..My 2nd scan is on the 15th..Good luck..I'm stage 3 C
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- December 12, 2014 at 11:21 pm
I finished Yervoy on Aug 13th and had my first scans Sept 20th and the spots in my lungs are gone and the one in my neck is half it's size..My dr said that things could look worse before getting better with Yervoy, some swelling might happen also..My 2nd scan is on the 15th..Good luck..I'm stage 3 C
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- December 17, 2014 at 4:21 pm
I won't get the results until after Christmas, they are very busy and couldn't get an earlier appt..Will update as soon as i know..
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- December 17, 2014 at 4:21 pm
I won't get the results until after Christmas, they are very busy and couldn't get an earlier appt..Will update as soon as i know..
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- December 17, 2014 at 4:21 pm
I won't get the results until after Christmas, they are very busy and couldn't get an earlier appt..Will update as soon as i know..
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- December 13, 2014 at 8:11 am
My Mom was diagnosed at stage IV last year. We found out later that she had brain mets too. She had gamma knife radiation for the mets on 12/9/13 and Yervoy on the 12th. She had a lot of subcutaneous tumors and they started changing and shrinking 3 or 4 days after her first infusion. At 3 weeks there was a big difference and it was more apparent at 6 weeks. In August the said that her response was far above anything they hoped for. Today they feel she is in the group of responders (92%) from the trials @ 5 years are still NED or stable. -She had 25 brain mets treated with no known cognitive issues. Kinda amazing when I write all this down.She is the exception to the rule, but the doctors feel that the gamma knife treatment really jump started her immune system, which it has been shown to do. Could your wife be a candidate for this?
I am a firm believer in second opinions all along the way. It really helped her more than once.
Hope any of this helps you.
– I made my Mom tske turmeric and had her take drops of Cibdex CBD drops. Not sure if this helped, but it did not hurt and a recent study showed brain met patients who took CBD’s and had gamma knife radiation did better that thoes who had gamma knife alone.
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- December 13, 2014 at 8:11 am
My Mom was diagnosed at stage IV last year. We found out later that she had brain mets too. She had gamma knife radiation for the mets on 12/9/13 and Yervoy on the 12th. She had a lot of subcutaneous tumors and they started changing and shrinking 3 or 4 days after her first infusion. At 3 weeks there was a big difference and it was more apparent at 6 weeks. In August the said that her response was far above anything they hoped for. Today they feel she is in the group of responders (92%) from the trials @ 5 years are still NED or stable. -She had 25 brain mets treated with no known cognitive issues. Kinda amazing when I write all this down.She is the exception to the rule, but the doctors feel that the gamma knife treatment really jump started her immune system, which it has been shown to do. Could your wife be a candidate for this?
I am a firm believer in second opinions all along the way. It really helped her more than once.
Hope any of this helps you.
– I made my Mom tske turmeric and had her take drops of Cibdex CBD drops. Not sure if this helped, but it did not hurt and a recent study showed brain met patients who took CBD’s and had gamma knife radiation did better that thoes who had gamma knife alone.
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- December 16, 2014 at 4:09 pm
Thanks for sharing!
I didn't knew there could be positive interaction between gamma knife and immune system treatents, good to know. "Unfortunately" my wife doesn't have brain mets, only then you use gamma knife right?
She's also taking tumeric (in a mix called Zyflamend or Zyflamax) and THC cannabis oil.
Hope your Mom is doing well !
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- December 16, 2014 at 4:09 pm
Thanks for sharing!
I didn't knew there could be positive interaction between gamma knife and immune system treatents, good to know. "Unfortunately" my wife doesn't have brain mets, only then you use gamma knife right?
She's also taking tumeric (in a mix called Zyflamend or Zyflamax) and THC cannabis oil.
Hope your Mom is doing well !
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- December 16, 2014 at 4:09 pm
Thanks for sharing!
I didn't knew there could be positive interaction between gamma knife and immune system treatents, good to know. "Unfortunately" my wife doesn't have brain mets, only then you use gamma knife right?
She's also taking tumeric (in a mix called Zyflamend or Zyflamax) and THC cannabis oil.
Hope your Mom is doing well !
-
- December 13, 2014 at 8:11 am
My Mom was diagnosed at stage IV last year. We found out later that she had brain mets too. She had gamma knife radiation for the mets on 12/9/13 and Yervoy on the 12th. She had a lot of subcutaneous tumors and they started changing and shrinking 3 or 4 days after her first infusion. At 3 weeks there was a big difference and it was more apparent at 6 weeks. In August the said that her response was far above anything they hoped for. Today they feel she is in the group of responders (92%) from the trials @ 5 years are still NED or stable. -She had 25 brain mets treated with no known cognitive issues. Kinda amazing when I write all this down.She is the exception to the rule, but the doctors feel that the gamma knife treatment really jump started her immune system, which it has been shown to do. Could your wife be a candidate for this?
I am a firm believer in second opinions all along the way. It really helped her more than once.
Hope any of this helps you.
– I made my Mom tske turmeric and had her take drops of Cibdex CBD drops. Not sure if this helped, but it did not hurt and a recent study showed brain met patients who took CBD’s and had gamma knife radiation did better that thoes who had gamma knife alone.
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- December 29, 2014 at 6:00 pm
Hi all,
An update on the original post… My wife has a really tough time since the time her BRAF MEK combo stopped working an new tumors appeared in her bones, the first Pembro treatment (with Xgeva) actually seemed to make it worse up to the point she was fully bedridden and could barely eat or drink. Bone pains were also 10/10 without pain killers.
We then went to hospital on Christmas Eve and got a string of bad news: docter called the situation 'frightening', basic blood values further deteriorated and he mentioned the tumors in her bones (she didn't know yet as the full PET CT results weren't in during our last visit) and also one under her arm pit was visible. We then were told we had to wait for the full blood results before he could give us the second Pembro.
So we had a pretty quiet and worrisome wait for an hour or so. But then there was good news: LDH values had dropped from 1300 to 650 just above the top of the normal bandwidth! So it seems the Pembro is already working after 1 attempt!
She then had an extra doses of iron via IV followed by Pembro and Xgeva.
We had a pretty quiet Christmas Eve as it had been a long day and trip but the next day she felt pretty good, got dressed and enjoyed a great and long Christmas day with family. The next day she felt again a bit better and the past few days we went out and enjoyed the snow! Quite a chance in a week, maybe some divine intervention ๐
she does still have some bone pains though not nearly as bad as before, gets tired quicky and sometimes nauseous. She also feels some light discomfort in her liver (main tumor location).
But overall we feel really lucky and although it's very early it seems that the Pd1 treatment is working !! Feeling blessed and hope it continues!
we are also considering radiation as it may be synergistic but it is many days in a row so it may be tiring due to the travel and the treatment. We'll see.
will keep you posted and thanks for all the support!
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- December 29, 2014 at 6:00 pm
Hi all,
An update on the original post… My wife has a really tough time since the time her BRAF MEK combo stopped working an new tumors appeared in her bones, the first Pembro treatment (with Xgeva) actually seemed to make it worse up to the point she was fully bedridden and could barely eat or drink. Bone pains were also 10/10 without pain killers.
We then went to hospital on Christmas Eve and got a string of bad news: docter called the situation 'frightening', basic blood values further deteriorated and he mentioned the tumors in her bones (she didn't know yet as the full PET CT results weren't in during our last visit) and also one under her arm pit was visible. We then were told we had to wait for the full blood results before he could give us the second Pembro.
So we had a pretty quiet and worrisome wait for an hour or so. But then there was good news: LDH values had dropped from 1300 to 650 just above the top of the normal bandwidth! So it seems the Pembro is already working after 1 attempt!
She then had an extra doses of iron via IV followed by Pembro and Xgeva.
We had a pretty quiet Christmas Eve as it had been a long day and trip but the next day she felt pretty good, got dressed and enjoyed a great and long Christmas day with family. The next day she felt again a bit better and the past few days we went out and enjoyed the snow! Quite a chance in a week, maybe some divine intervention ๐
she does still have some bone pains though not nearly as bad as before, gets tired quicky and sometimes nauseous. She also feels some light discomfort in her liver (main tumor location).
But overall we feel really lucky and although it's very early it seems that the Pd1 treatment is working !! Feeling blessed and hope it continues!
we are also considering radiation as it may be synergistic but it is many days in a row so it may be tiring due to the travel and the treatment. We'll see.
will keep you posted and thanks for all the support!
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- January 2, 2015 at 9:52 am
I was so concerned when I started reading your update. I was afraid your story was heading in another direction. What joy to read of your wife's 180! Excellent turnaround! Thank you for sharing the bad that occurred before the good. It is helpful to know that improvement is possible especially when it appears so bleak. What a wonderful event to share,
Happy New Year (with a fresh dose of New Hope)
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- January 2, 2015 at 9:52 am
I was so concerned when I started reading your update. I was afraid your story was heading in another direction. What joy to read of your wife's 180! Excellent turnaround! Thank you for sharing the bad that occurred before the good. It is helpful to know that improvement is possible especially when it appears so bleak. What a wonderful event to share,
Happy New Year (with a fresh dose of New Hope)
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- January 2, 2015 at 9:52 am
I was so concerned when I started reading your update. I was afraid your story was heading in another direction. What joy to read of your wife's 180! Excellent turnaround! Thank you for sharing the bad that occurred before the good. It is helpful to know that improvement is possible especially when it appears so bleak. What a wonderful event to share,
Happy New Year (with a fresh dose of New Hope)
-
- December 29, 2014 at 6:00 pm
Hi all,
An update on the original post… My wife has a really tough time since the time her BRAF MEK combo stopped working an new tumors appeared in her bones, the first Pembro treatment (with Xgeva) actually seemed to make it worse up to the point she was fully bedridden and could barely eat or drink. Bone pains were also 10/10 without pain killers.
We then went to hospital on Christmas Eve and got a string of bad news: docter called the situation 'frightening', basic blood values further deteriorated and he mentioned the tumors in her bones (she didn't know yet as the full PET CT results weren't in during our last visit) and also one under her arm pit was visible. We then were told we had to wait for the full blood results before he could give us the second Pembro.
So we had a pretty quiet and worrisome wait for an hour or so. But then there was good news: LDH values had dropped from 1300 to 650 just above the top of the normal bandwidth! So it seems the Pembro is already working after 1 attempt!
She then had an extra doses of iron via IV followed by Pembro and Xgeva.
We had a pretty quiet Christmas Eve as it had been a long day and trip but the next day she felt pretty good, got dressed and enjoyed a great and long Christmas day with family. The next day she felt again a bit better and the past few days we went out and enjoyed the snow! Quite a chance in a week, maybe some divine intervention ๐
she does still have some bone pains though not nearly as bad as before, gets tired quicky and sometimes nauseous. She also feels some light discomfort in her liver (main tumor location).
But overall we feel really lucky and although it's very early it seems that the Pd1 treatment is working !! Feeling blessed and hope it continues!
we are also considering radiation as it may be synergistic but it is many days in a row so it may be tiring due to the travel and the treatment. We'll see.
will keep you posted and thanks for all the support!
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