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Ipi or combo
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Ipi or combo

› Forums › Ipi or combo

  • Post
    • November 26, 2020 at 3:37 am
    Lilara
    Participant
      After my mom progress on Pembrolizumab, her doctor suggested ipi. I told her why she does not do the combo. She said too much side effect . But I think ipi has lots of side effects . What do you suggest? Ipi or ipi/nivo or low does of ipi and nivo full does .
      Thank
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    • Replies
        • November 26, 2020 at 2:29 pm
        Edwin
        Participant
          Any of the 3 treatment options would be reasonable. My melanoma got much worse while receiving pembro. After receiving ipi/nivo and then nivo, I am NED. My first ipi/nivo infusion made me very sick. My oncologist reduced my dose of ipi by 50% for my last 3 ipi/nivo infusions and I had less severe side effects. You might ask for a second opinion.
            • November 26, 2020 at 3:11 pm
            Lilara
            Participant
              Thanks Ed for your response . I think low does of ipi and nivo could work better as well. I have requested from another hospital for second opinion but in Canada it takes too long .
              • November 26, 2020 at 3:13 pm
              Lilara
              Participant
                Happy Thanksgiving to you and I am thankful for your answer . I am glad that you are NED .
                • November 26, 2020 at 5:19 pm
                Edwin
                Participant
                  I am glad I received the full dose of ipi in my 1st ipi/nivo infusion. It worked for me.

                  One study of melanoma patients for whom nivo had failed found that ipi alone had about the same response rate as ipi/nivo.

                • November 26, 2020 at 6:19 pm
                ed williams
                Participant
                  Hi Lilara, I have found that dealing with oncologist’s that it is important to support the idea with data and in this space some recent findings could be helpful. At ASCO this year they published an abstract # 10005 with an international group of oncologist’s as co- authors. In the abstract they looked at 300 patients who had progressed via ( innate or acquired) resistance. I will let you read the ASCO article and take away what you will. There are some pretty good stats that support Ipi+nivo in this group of patients as the best approach after Pd-1 (pembro or nivo) progression. Another thing to consider in Canada is what the provincial government funding rules are, some regions don’t have a lot of flexibility it what is offered to patients after progression on immunotherapy. https://meetinglibrary.asco.org/record/185644/abstract
                    • November 27, 2020 at 2:05 am
                    Lilara
                    Participant
                      Thank Ed for this great article . Yes I will use that . But now I think the Ontario government only approve ipi/nivo on native treatment not as a second line . I wish the oncologist would tell us that . She gave keytruda and now we only have ipi as a second line . I have seen articles about low does of ipi and pembonor nivo and we might just get the pembo with low does of ipi and pay for low does ourselves . Do you know about clinical trails in USA that have ipi/nivo for second line treatment ?
                      Thanks
                      Lila
                      • November 27, 2020 at 4:56 pm
                      ed williams
                      Participant
                        Hi Lila, the combination is past the trial phases in the US and has been approved since 2015. The US oncologist can use combination in second line if insurance company gives OK!!! This is my understanding of how there system works, also being explored is low dose ipi with either nivo or pembro. Here is a link from last years ASCO and how some of the leading oncologist treat their patients. There is still a mix of what they would do first vs second line. A lot depends on if their hospitals offer clinical trials of new drug combinations. https://www.onclive.com/view/advances-in-the-treatment-of-malignant-melanoma?seriesVid=11
                      • November 27, 2020 at 4:26 pm
                      Edwin
                      Participant
                        I would be comfortable with receiving ipi alone in your mother’s situation. My oncologist told me that my cancer center oncologists thought that ipi made the difference in my case.

                        After failure of immunotherapy with nivo alone, treatment with ipi alone or with ipi + nivo gave similar results in this study:
                        http://www.ejcancer.com/article/S0959-8049(17)30064-3/fulltext

                        Don’t try to click this link. Copy and past it.

                        From that link:

                        “Ipilimumab should be considered an appropriate option for patients who progressed on prior anti-PD-1 therapy.

                        In total, 47 patients were treated with ipilimumab (ipi-group) and 37 patients with ipilimumab and nivolumab (combination group) after treatment failure to anti-PD-1 therapy. Overall response rates for the ipi and the combination-group were 16% and 21%, respectively. Disease control rate was 42% for the ipi-group and 33% for the combination-group. One-year overall survival rates for the ipi and the combination-group were 54% and 55%, respectively.”

                        • November 27, 2020 at 6:21 pm
                        Bubbles
                        Participant
                          So sorry for what you and your mom are dealing with Lilara. You’ve gotten some great responses, but if you are interested here are some posts based on articles that address what to do with patients who have progressed after immunotherapy.

                          From 2017 – https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2017/06/asco-2017-nivo-or-ipinivo-combo-in.html
                          From 2020 with lots of links within – https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2020/05/how-to-deal-with-recurrence-on-or-after.html
                          From 2020 – https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2020/08/after-progression-on-anti-pd1-anti-pdl1.html

                          Melanoma makes nothing easy. Hang in there. Your mom is lucky to have you in her corner! Wishing you both my best, celeste

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