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Ipi Nivo colitis

Forums General Melanoma Community Ipi Nivo colitis

  • Post
    tim brown
    Participant
      In mid July I had  my first Ipi/Nivo infusion but had to stop due to surgery to remove a rapidly  growing tumour in my axilla at the start of August. (I have the NRAS mutation). I’m restarting in a couple of weeks time and if the first infusion was anything to go by, then  diarrhea/colitis is likely to be my principal adverse event.
      Any advice on diet and lifestyle that has helped others would be  greatly appreciated.
      Tim
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    • Replies
        kathycaribe
        Participant
          Cutaneous
          I would personally remove all dairy and processed foods but I’m sure that’s not very helpful. Walking is good. Drinking lots of water will move things along in the gut. No narcotics will keep peristalsis going. maybe increasing good gut bacteria (probiotics) but I seem to remember a study indicating weird (both positive and negative?) issues with probiotics and immunotherapy…
            ed williams
            Participant
              Kathy and Tim, just wanted to share some MD Anderson stuff from a couple of years ago, where Dr. Michael Davies shared research from their hospital. If you go to the 23:00 min mark he talks about diet and probiotics. https://www.youtube.com/watch?v=wwup6wOizdo
            tim brown
            Participant
              Thanks Kathy and Ed,

              I had a vague memory that probiotics wasn’t recommended but I’ll watch Dr Davies

              Bubbles
              Participant
                Hey Tim,

                I will be keeping my fingers crossed that all things go well when you resume treatment!!!  Here are a few reports that may interest you – more related to response and the microbiome than preventing colitis – but still…

                This has lots of links within:  The gut microbiome AGAIN – as it relates to immunotherapy for melanoma, other cancers, antibiotic use, and fecal transplants! ~  https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2020/08/the-gut-microbiome-again.html

                This article notes that probiotics from the bottle don’t serve us as well as those attained from natural sources like yogurt, kimchi, sauerkraut, etc – and that making sure to include high fiber foods is key to a good response:

                https://journals.lww.com/oncology-times/fulltext/2019/04200/gut_microbiome_affects_response_to_immunotherapy.23.aspx

                And while I am hoping colitis will not be a significant problem for you, there is this:

                Association of Chronic Immune-Mediated Diarrhea and Colitis With Favorable Cancer Response. Zou, Abu-Sbeih, Ma, et al. J Natl Compr Canc Netw. Dec 2020.

                Background: Immune-mediated diarrhea and colitis (IMDC) is a common immune-related adverse effect related to immune checkpoint inhibitors. We aimed to identify risk factors for chronic IMDC and its prognostic value in cancer outcomes.

                Methods: We retrospectively collected data on patients with a diagnosis of IMDC between January 2018 and October 2019 and grouped them based on disease duration into acute (less than or equal to 3 months) and chronic (greater than 3 months) categories. A logistic regression model and the Kaplan-Meier method with log-rank tests were used for biostatistical analysis.

                Results: In our sample of 88 patients, 43 were in the chronic group and 45 were in the acute group. Genitourinary cancer and melanoma accounted for 70% of malignancies. PD-1/L1 monotherapy (52%) was the more frequently used regimen. We showed that chronic IMDC was associated with proton pump inhibitor use, long duration of IMDC symptoms and hospitalization, a histologic feature of chronic active colitis or microscopic colitis, and delayed introduction of selective immunosuppressive therapy (infliximab/vedolizumab). Chronic IMDC also reflected a better cancer response to immune checkpoint inhibitors (30% vs 51%) and was accompanied by improved overall survival. Similarly, higher doses of selective immunosuppressive therapy were associated with better overall survival.

                Conclusions: Chronic IMDC can develop among patients with a more aggressive disease course and chronic features on colon histology. It likely reflects a prolonged immune checkpoint inhibitor effect and is associated with better cancer outcome and overall survival.

                <hr />

                Hang in there!!  Celeste

                 

                  kathycaribe
                  Participant
                    Cutaneous
                    I spent much of yesterday going through the AIM videos. THank you SO MUCH for those!!!!
                  Threefitty
                  Participant
                    I just want to say that when my colitis hits, which it has both times I had ippy in the treatment, there is no amount of dietary or other control to stop or mitigate the diarreah. The first time was 6 weeks in hospital, the second was reduced doseage and we were able to avoid a hospital situation with outpatient fluids. Still, one and done for the ippi. Just a data point, hope yours in more manageable. Sometimes it is just Not.

                    Now on Optivo Maintenence. I am also NRAS+ and am hoping to be part of that profile mentioned in the research by Bubbles.

                    Congratulations on your very aggressive cancer and horrible side effects, looks like things might be looking up!

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