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Keytruda and lymph node surgery
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Keytruda and lymph node surgery

› Forums › General Melanoma Community › Keytruda and lymph node surgery

  • Post
    • July 2, 2020 at 4:35 pm
    caman
    Participant
      Has anyone here with stage 3 melanoma, started neoadjuvant therapy and had such rapid and great response from the immunotherapy that you decided to skip the surgery and the removal of nodes?
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        • July 2, 2020 at 5:31 pm
        THMoore
        Participant
          I have taken 2 treatments. 6 weeks only of Opdivo. Have 6 nodes in my neck that are active. All in the mm range. I have 1 I can feel. Seems the same to me. Hope mine goes down like yours. Only been a little tired and skin feels a little sunburned on my head and shoulders area.
          • July 2, 2020 at 5:47 pm
          tkoss
          Participant
            3c here.

            i guess my question is: how do they know there are no LN’s involved?

            near as i can tell you can’t figure out a lymph node has melanoma till you biopsy it. Perhaps if it shows no enlargement they conclude it is clear? Or of perhaps based on characteristic of the primary mole?

            Frankly i found the SLNB portion of my treatment the most confusing and was the only time i had to make any decisions.. The surgical onc ran down SLNB vs. CLNB , side effects and recurrence, etc.
            I had to chose one or the other or none, based on very little information and guidance. They removed 4 and found them to be melanotic but didn’t remove 5 with the 5th not being. you know like replacing Xmas tree lights. Or I guess only 4 LN’s looked like they were involved.

            at 6months of nivo i scanned NED with CT scan, which I think only tells you if LN’s are enlarged.

            I did ask my onc if the fact of no new enlarged LN means nivo works ,or i am cured or if further infusions were unnecessary he was non-committal. As regards to doing 6 more months of immo he simply stated that is the standard of care and wouldn’t speculate if more nivo was unnecessary or not.

            • July 2, 2020 at 9:33 pm
            ed williams
            Participant
              The OpACIN trial published some findings last week on Onclive that you might find of interest. https://www.onclive.com/view/neoadjuvant-nivolumab-ipilimumab-improves-rfs-in-stage-iii-macroscopic-melanoma
              • July 3, 2020 at 12:53 am
              Mark_DC
              Participant
                Dear Caman

                I think I can say that this kind of happened to me. In 2016 after my third local recurrence my oncologist recommended against yet another surgery (would have been tricky given skin graft) and put me on pembro. I guess this was neoadjuvant. Unfortunately it didnt work, it slowed progression but the tumour grew to about 2.5 to 3cm over one year. I was then about to have surgery but instead TVEC plus pembro became an option so we tried this instead starting December 2017. After progression the tumour started to shrink around 3 months in so that by March 2019 it could not be found on the MRI. So, in a sense, I skipped the surgery but only after a quite protracted response.

                I think in my case I had had two surgeries in the same local area (lower calf) which had not succeeded and surgery would have been difficult with side effects so they thought pembro was best. I think this was an implicit neoadjuvant approach but I dont think I realised it at the time! Very happy that TVEC was added to the mix.

                Best wishes Mark

                • July 3, 2020 at 5:40 am
                Tsvetochka
                Participant
                  I was Stage 4. They only offered me Keytruda from the start. There was some talk of maybe doing surgery later, but It turned out that Keytruda was enough. My last PET scan showed NED, nothing bad left in those lymph nodes. So, I’m glad there wasn’t any surgery done.
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