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New member. From 2c to 4

Forums Cutaneous Melanoma Community New member. From 2c to 4

  • Post
      Hello everyone,

      Been reading the forum since initial diagnosis but this is my first posting.

      Sex: Male
      Age: 47

      BRAF status: Negative
      Primary location: right upper back shoulder blade
      Primary thickness: 5.5mm
      Ulceration: Yes
      Mitotic rate: Not determined. I asked the doctor about this and he said the pathology determined ki67.
      SLNB: negative
      Skin graft 2.5cms margins. Margins clear. depth of 2cms.
      Initial stage: 2C
      Initial stage treatment: Interferon Beta monthly injections around primary from May 2019 to Feb 2020.
      Recurrence: In-transit recurrence lump felt by myself on Feb 3rd, 2020. The doctor removed it and the pathology result indicated a melanoma tumor of 2 centimetres. The doctor then ordered a CT. The result of this CT came back on February 19 indicating metastasesin the liver and lungs.
      Current treatment: Started combination Opdivo and Yervoy on February 21, 2020 (Opdivo 1mg/kg and Yervoy 3mg/kg). In order to manage possible side effects, the doctor has me taking 5mg Prednisone and 15mg Lansoprazole daily for 8 days. So far, I have experienced no side effects except very mild rash and mild fatigue.
      Bloodwork History: 2018: LDH 193. AST(GOT) 31. ALT (GPT) 35 (before getting melanoma)
      2020: LDH 334. AST(GOT) 56. ALT (GPT) 90 (3 days after starting Opdivo and Yervoy)

      March 8, 2019: Referred to a specialist for suspicious mole.
      March 18, 2020: WLE. and CT scans.
      March 27, 2020: diagnosed with malignant SSM stage 2C. Thickness 5.5mm ulcerated. Clear margins from WLE, but doctor recommended full-thickness skin graft with additional margins of 2.5cms and SLNB.
      April 8, 2020: Full thickness skin graft and SLNB. Clear margins and no lymph node involvement detected.
      May 2019– Jan 2020: Interferon Beta monthly injections around the primary. I was offered Interferon Alpha heavy dose but declined.
      Feb 4, 2020: Recurrence. In transit 2 cm blob of melanoma removed between the primary and armpit.
      Feb 18, 2020: CT scan
      Feb 19, 2020: CT indicated metastasis in liver and lungs.
      Feb 21, 2020: Started combination of Opdivo and Yervoy. Scheluded every 3 weeks for four cycles followed by every two weeks of Opdivo. Blood tests will be done one week before Opdivo/Yervoy.
      March 4: Blood test scheduled
      March 13: Opdivo/Yervoy 2nd fusion scheduled.

      After four infusion of combo, I will go on opdivo every two weeks.

      Any comments or advice is welcome

      Thank you for reading,

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        ed williams
          HI Beany, just one question that I would ask my oncologist would be why prednisone with no Immune related adverse events happening??? From the very early trials of immunotherapy all the experts that have talked about treating side effects, I have never heard of anyone advocating for steroids up front, since they are used to tamp down the immune system, and the purpose of using ipi and nivo is to get the system to not shut down (breaks off). Good luck with the combo!!! Ed
              Thanks Ed,
              In Japan, doctors are very cautious. In fact, the doctor insisted I stay in hospital for four days while getting my first combo infusion in case I reacted badly.
              He asked me if I wanted to stay again for the second infusion but I said no.
                Prednisone can cause problems. While taking prednisone my glucose rose to 405 mg/Dl. It dropped to normal after stopping prednisone. I have never before heard of giving Prednisone to prevent immunotherapy side effects.
                as I understand it you did NOT have any lymph node involvement but you have tumors elsewhere?
                    Yes. However, last scan showed lymph node involvement in armpit.
                    Beta interferon can increase liver enzymes and as such your Dr. is excercising precaution by placing you on a “preventitive” dose of steroids. I think this is wise. I however question your bloodwork one week in advance of your combo infusions and feel this is too long. In the U.S., I have my bloodwork immediately prior to each infusion. Liver enzymes can drastically change in a matter of just few days. I would have my bloodwork done as close to my infusion as possible (at the most the day before). I managed only two combo infusions before my liver enzyme numbers skyrocketed. The important thing to remember is that you do not need to receive all four combo infusions in order to have a favourable outcome. From my own personal experience precaution is the key. If you need to delay the infusion so be it. The combo continues to work for at least 3 months even while taking huge amounts of daily steroids (160 mg of prednisone). Biweekly Opdivo infusions are the best. You get half of the drug and if anything does go wrong it’s easier to stop a freight train going 50 km/hr than 100 km/hr.
                    Best of luck,
                        I will be having blood work on infusion day too in the morning.
                        Thanks for replying,
                          Hello everyone
                          Blood work was fine and I am sitting in the chair right now getting combo number two.

                          Regards to you all,

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