Q about pleural thickenings, ipi/nivo a 2nd time, and after nivo alone
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Q about pleural thickenings, ipi/nivo a 2nd time, and after nivo alone

› Forums › Cutaneous Melanoma Community › Q about pleural thickenings, ipi/nivo a 2nd time, and after nivo alone

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    • September 18, 2019 at 7:19 pm
    MichelleRHG
    Participant
    Hi All,
    All of my melanomas have been resected over the past 3 years,but now I have a non-resectable progression in my lung. In 2018 hilar node was found to have mel, thoracotomy (ouch) to remove.
    My last 2 scans (March and June) have shown some nodular pleural thickening , stable, and the one this week showed multiple new thickenings. Frightening, of course.
    I had the ipi/nivo combo a little over 2 years ago, and have been having Opdivo alone since then . My onc at MD Anderson is sure this is mel and wants me to get back on the combo . If that fails might look at a NRAS targeted trial if there’s one available. The thickenings aren’t large enough to qualify for TIL. They aren’t specific enough for radiation.
    Has anyone experienced these pleural thickenings?
    Has anyone had the ipi/nivo combo AFTER nivo alone?
    Has anyone had the combo twice, 2+ years apart?
    Thanks in advance for any insight. We are devastated.
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  • Replies
      • September 18, 2019 at 9:02 pm
      MarkR
      Participant
      Hi
      Sorry to hear you are going through this
      I had Ipi Nivo last Feb and and stopped due to side effects after 3 months. Had 6 months where things were ok then progression – started Nivo in March this year and have been broadly stable but with a bit of progression. Not sure if I will be adding Ipi or going to clinical trials will have to wait and see but it’s certainly possible and a response can be achieved. Hopefully you can find the right path for you and get some success
      Regards
      Mark
      • September 18, 2019 at 9:02 pm
      MarkR
      Participant
      Hi
      Sorry to hear you are going through this
      I had Ipi Nivo last Feb and and stopped due to side effects after 3 months. Had 6 months where things were ok then progression – started Nivo in March this year and have been broadly stable but with a bit of progression. Not sure if I will be adding Ipi or going to clinical trials will have to wait and see but it’s certainly possible and a response can be achieved. Hopefully you can find the right path for you and get some success
      Regards
      Mark
        • September 19, 2019 at 12:34 pm
        MichelleRHG
        Participant
        Thank you, Mark. Hoping success for you, too.
      • September 18, 2019 at 9:37 pm
      Edwin
      Participant
      I received ipi + nivo combo immunotherapy, after receiving pembro immunotherapy alone. Pembro immunotherapy did not work for me, but ipi + nivo immunotherapy helped. I received an infusion of nivo this morning. I have been receiving nivo alone for 3 years. My 4th and last ipi + nivo combo infusion was in July 2016.
      • September 18, 2019 at 11:59 pm
      Bubbles
      Participant
      Oh, Michelle. Sorry you are facing this. I do not have the answer to the question you are really asking – ie – does the ipi/nivo combo work if you are taking it second time round?

      But, I do have these reports that while not addressing repeating the combo – do address taking anti-PD-1 a second time – if you are interested:
      2017: Response to ipi or ipi/nivo after failing anti-PD1 as single agent in Stage IV melanoma – https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2017/02/response-to-ipi-or-ipinivo-after.html

      2017: ASCO 2017: Nivo or Ipi/Nivo combo in melanoma after progression on ipi or anti-PD-1 – https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2017/06/asco-2017-nivo-or-ipinivo-combo-in.html

      2018: Nivo after nivo? Or nivo after progression? Can melanoma patients still attain a response??? – https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2018/01/nivo-after-nivo-or-nivo-after.html

      2018: anti-PD-1 after progression – https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2018/08/anti-pd-1-after-progression.html
      ______________________________________________________________________________________________________________________________________________________
      So, while not really your situation, but if we extrapolate from those studies – YES! Folks who have previously responded to immunotherapy – can respond again with retreatment.

      Now….there are still other options! This was out of ASCO this year. While all of these may not be applicable to you, but some of them might be:
      New Stuff!! Treatment options and current trials for melanoma patients! The first installment of this year’s ASCO review. – http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2019/06/new-stuff-treatment-options-and-current.html

      For what it’s worth. Hang in there!! Wishing you my very best. Celeste

        • September 19, 2019 at 5:48 am
        MarkR
        Participant
        If your interested this study was undertaken by my team in the Uk. It’s a case study of 3 patients Re-challenged with Ipi Nivo
        Regards
        Mark

        https://repository.icr.ac.uk/bitstream/handle/internal/503/JL%20-%20CII%202016%20-%20Spain%20et%20al%20-%20rechallenge%20with%20ipi%2Bnivo%20-%20PROOF%20.pdf?sequence=2&isAllowed=y

        • September 19, 2019 at 12:36 pm
        MichelleRHG
        Participant
        Thank you.
        • September 20, 2019 at 5:04 am
        MelMel
        Participant
        Mark, thank you so much for sharing the interesting re-challenge study.
        Melanie
        • September 19, 2019 at 12:33 pm
        MichelleRHG
        Participant
        Thank you, Celeste.
        • September 23, 2019 at 7:45 pm
        Edwin
        Participant
        Seeing the success rate of ipi/nivo after failing anti-PD1 as single agent in stage IV melanoma, I realize how fortunate I have been. After pembro failure and ipi/nivo success, I have had 3 years of good health. In March 2016 my oncologist estimated that I had less than 1 year, if ipi/nivo immunotherapy failed.

        For treating stage 4 melanoma the 0.21 success rate of ipi/nivo after anti-pd1 failure is about what one would expect from probability calculations. Pembro has a 0.60 probability of failure. If pembro has failed, ipi/nivo has a 0.79 probability of failure. So, pembro with ipi/nivo as a backup has a 0.60 x 0.79 = 0.47 probability of failure or 0.53 probability of success. This is about the same success rate as that of ipi/nivo given as the first treatment.

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