Progression to stage 4 with single liver met – second opinion?

I really do understand why you are confounded with your options!!! Still, as I wrote in the post – “Melanoma never makes things easy. If I found myself in this position now, I would probably opt to start systemic therapy. Follow-up fairly quickly with scans to see what is happening. If the tumor is growing, surgically remove it, and complete systemic therapy. If it is shrinking, watch while continuing therapy and remove the lesion surgically if systemic therapy cannot take care of it on its on. ”

But, that’s just me and we all have to do what we think is best for our situation. Do try to give Dr. Weber a call. I think you will feel better after seeking that consult, no matter what you decide. Yours, c

Ablation or radiation to the liver lesion. Followed by ipi/nivo. Now the lesion would have to be discrete and in a certain position for that to be workable. But, I would ask about it. There are many, many studies that show that the combination of radiation AND immunotherapy work better than either alone. Here’s a link to a few zillion – https://chaoticallypreciselifeloveandmelanoma.blogspot.com/search?q=radiation+and+immunotherapy

c

I agree with Celeste and also what your doctors are proposing. The usual approach is to resect the tumour and then apply immunotherapy to prevent recurrence (adjuvant therapy). But then the immunotherapy does not know what to attack so may be less effective (this is my layman’s interpretation). A new alternative is to apply the immunotherapy first so it knows what to attack and then remove with surgery. This way the immunotherapy may be able to attack other micro stuff lying around but which cant be detected ( I think this is the logic). This is neo-adjuvant.

When my stage III kept recurring locally my oncologist gave up on surgery and put me on immunotherapy. Unfortunately it didnt work and one year later they were going to do surgery (which would be the neo adjuvant approach). But then we added TVEC and after a few months it started to work, So one year later surgery actually was not needed. Its a bit of a scary approach as you dont remove the tumour but monitor it. As long as it does not go out of control it could be superior I think, you just need to monitor closely and regularly.

I agree too with a second opinion, but ths approach makes sense
I am British (in London now for a few days) but treated and work in the USA. Is the NHS proposing this (would be great if true) or private medicine in the UK?
Good luck Mark

This is similar to what occurred with my father, a liver met progression to stage IV. He was put on Nivo montherapy first which shrank the met slowly but then the melanoma started showing up as red spots on his left arm (origin was on his left thumb nail). He was immediately put on the combo therapy and had a very strong positive response, was able to have all four doses, but then developed colitis and had to stop immunotherapy while put on heavy steroids. Even though he had to stop after the four doses he was NED months after the last infusion. He was not put back on monotherapy nivo and 10 months after the last combo treatment eventually it came back to his lung. He was older, 74 years old, so I would hope your husband being younger would reduce the chance of bad side effects. The one thing i wish my father had done was push to go back on nivo after getting off of the steroids due to the colitis.

Best wishes and hugs from Virginia,
-Evan