I see no reason why monotherapy with either Nivo or Keytruda wouldn’t be an option. While the combo does have a better response rate, as you mentioned, the side effect profile is also higher. Not knowing his full history and what you mean by him having a 4 year response to Ipi, its a little more difficult to ponder what the oncologist might be reasoning. Did Ken have detectable disease on imaging that the Yervoy “cleaned up”? Or did he take it as an adjuvant therapy? I ask, because if he had no detectable disease, but took Ipi in the “preventative” adjuvant setting… then it may not actually have done anything at all for him. He may simply not have recurred until now. If it visibly shrank (or made disappear) lesions that remained in his body, and cleared him for 4 years, then his melanoma may have found a work around, or his body may just need a “booster” of the Yervoy. Additionally… if the surgeon removes the lymph node, leaving him with no other detectable lesions… I’d personally be concerned about taking the combo versus trying Nivo or Keytruda as a solo adjuvant agent. As you mentioned, with progression on a solo anti-pd1, the Yervoy could always be approved as an addition. I’m typically very aggressive in nature when it comes to attacking back, however, I’m also of the belief “Why try to drink from the fire hose, if drinking from the garden hose will quench your thirst?”
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