Ipi/Nivo – side effects

I had to stop after my 2nd infusion due to high liver enzymes and I was on 160 mg of prednisone plus 2000 mg of Cellcept (a tissue rejection drug but also a steroid) for almost 3 months (including tapering). I had 50 % tumor reduction at 2 months post starting infusions and 30 % at 4 months post infusions. You will not necessarily get a reversal of immunotherapy but depending on how long one is on steroids, you may get eventual slowing down of tumor shrinkage. Since then, I have resumed biweekly infusions of Opdivo. Hopefully, the steroids work on settling her intestinal issues soon and she can resume her treatment even on Opdivo alone. As you are probably already aware, many patients have great success even if they get only 2 or 3 out of the 4 dual drug infusions. Rash is also very common and many people remain on small doses of prednisone while continuing infusions.
Wishing your grandma a speedy recovery.
Melanie

As far back as 2015 researchers have noted that patients with significant side effects from immunotherapy SHOULD be treated with steroids if necessary and those patients can still gain a positive effect from their treatment. Here is one such article: http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2015/08/immune-related-side-effects-from.html It states specifically: ” Practitioners and patients should be prepared to treat irAEs and should understand that such treatment does not affect OS or TTF.”

More recently there is this: http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2017/03/patients-with-preexisting-immune.html This is a report specifically noting that folks with pre-existing autoimmune disease, who are more at risk for side effects from immunotherapy, can be safely given said immunotherapy and even if they must be maintained on steroids and similar drugs in order to tolerate it they STILL have positive responses to immunotherapy. Noting: ” All flares of preexisting autoimmune disorders or irAE were managed by immunosuppressive and/or symptomatic therapy and did not require termination of PD-1i therapy. tumour responses (32% in group A and 45% in group B) were unrelated to occurrence of autoimmunity.”

Hope that you find this reassuring. Wishing you and your grandmother my best. celeste

Hello naSullivan, bless your Grandmas heart! Shes doing an awesome drug ipi/nivo combo and it will work great for her!! But, no good deed goes unpunished, immunal drugs comes with side effects (which you learned before hand) sounds like so far, hers are mild! Yaaay! (But doesnt seem so mild to her im sure!!) I understand your question and concern of a Steroid while on immunal therapies, both drugs “on paper” work opposite of eachother, Predisone slows down ones immune system, while ipi, nivo or anyother immunal drug tend to “Rev” up our immune system (a contraindiction of sorts) but, as Bubbles and others plus medical data have expressed, theres a happy medium between the 2 drugs, and your grandmas therapy will continue to work for her as long as monitoring & dosage is adjusted overtime with the steroids…..keep us posted!!