› Forums › General Melanoma Community › Help on treatment decision (Nivo/Ipi/cyberknife)
- This topic has 12 replies, 4 voices, and was last updated 9 years, 2 months ago by
JoshF.
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- September 10, 2016 at 8:28 am
Dear all,I am stage IV with two visible lesions in close to lung and trachea, respectively.
Ipilimimumab was the initial systemic treatment but I was switched to Nivolumab 20 months ago due to lack of response. Nivolumab has worked well and has shrunk or eliminated all dozen-or-so lesions visible initially.
I am now left with two lesions: A stable, smaller lung lesion and a 40 mm lesion close to the trachea which has grown 10 mm over the past 3 months. Doctors believe it does not respond to the Nivolumab treatment.
I have no pain or problems due to current illness.
I am now faced with the following options:
1/ Add in Ipilimumab to current Nivolumab treatment and see what bitjerapht could do
2/ Attack trachea lesion with cyberknife, continue Nivolumab
3/ Attack trachea lesion with cyberknife, continue Nivolumab and asd in four sessions of Ipilimumab
My primary concerns below:
– I have heard that radiotherapy can make illness more aggressive but then again cyberknife technically is something else.
– Will adding in Ipilimumab “confuse” my immune system which has worked so well with Nivolumab alone?
– Will going “all in” with all three treatments (Nivo + Ipi + cyberknife) be too much at this stage, as we can always revert to cyberknife at a later stage?
– If not opting for cyberknife at this stage, do I risk the lesion growing too large for cyberknife treatment further down the line?I hope you are all coping well and thank you for sharing your thoughts.
Magnus
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- September 10, 2016 at 1:56 pm
There is a great deal of data demonstrating the benefit of immunotherapy combined with radiation when treating melanoma….no matter if we are talking about mets to the brain or elsewhere!! Radiation is radiation whether administered via cyber knife or srs. There are a zillion articles noting these results. Here is just the latest post…with links within that lead to even more:
I wish you well. Celeste
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- September 10, 2016 at 1:56 pm
There is a great deal of data demonstrating the benefit of immunotherapy combined with radiation when treating melanoma….no matter if we are talking about mets to the brain or elsewhere!! Radiation is radiation whether administered via cyber knife or srs. There are a zillion articles noting these results. Here is just the latest post…with links within that lead to even more:
I wish you well. Celeste
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- September 10, 2016 at 1:56 pm
There is a great deal of data demonstrating the benefit of immunotherapy combined with radiation when treating melanoma….no matter if we are talking about mets to the brain or elsewhere!! Radiation is radiation whether administered via cyber knife or srs. There are a zillion articles noting these results. Here is just the latest post…with links within that lead to even more:
I wish you well. Celeste
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- September 10, 2016 at 6:44 pm
Hi Magnus,
I'm a fan of the triple-play, ipi/nivo/radiation. After progressing on BRAF inhibitors including TAF/MEK combo, ipi, then pembro, it was not unitil I did the ipi/nivo combo and had radiation simultaneously that I have achieved "partial responder" status (systemic). In my case the smaller tumors, not directly treated with radiation responded although I have a very large tumor that is still stubborn, but may have at least become stable.
That said, the issue with radiation is the collateral damage. In both of the areas treated with large subcutaneous tumors, I now have what is probably permanent damage to nearby organs and tissues. So although I do believe in the triple-play, be sure to consult with one or more radiation oncologists and ask hard questions about possible collateral damage. In some cases, its just not worth the risk. Best to you in the battle.
Gary
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- September 10, 2016 at 6:44 pm
Hi Magnus,
I'm a fan of the triple-play, ipi/nivo/radiation. After progressing on BRAF inhibitors including TAF/MEK combo, ipi, then pembro, it was not unitil I did the ipi/nivo combo and had radiation simultaneously that I have achieved "partial responder" status (systemic). In my case the smaller tumors, not directly treated with radiation responded although I have a very large tumor that is still stubborn, but may have at least become stable.
That said, the issue with radiation is the collateral damage. In both of the areas treated with large subcutaneous tumors, I now have what is probably permanent damage to nearby organs and tissues. So although I do believe in the triple-play, be sure to consult with one or more radiation oncologists and ask hard questions about possible collateral damage. In some cases, its just not worth the risk. Best to you in the battle.
Gary
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- September 10, 2016 at 6:44 pm
Hi Magnus,
I'm a fan of the triple-play, ipi/nivo/radiation. After progressing on BRAF inhibitors including TAF/MEK combo, ipi, then pembro, it was not unitil I did the ipi/nivo combo and had radiation simultaneously that I have achieved "partial responder" status (systemic). In my case the smaller tumors, not directly treated with radiation responded although I have a very large tumor that is still stubborn, but may have at least become stable.
That said, the issue with radiation is the collateral damage. In both of the areas treated with large subcutaneous tumors, I now have what is probably permanent damage to nearby organs and tissues. So although I do believe in the triple-play, be sure to consult with one or more radiation oncologists and ask hard questions about possible collateral damage. In some cases, its just not worth the risk. Best to you in the battle.
Gary
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