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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

  • Post
    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
        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
          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
              MichelleRHG
              Participant
                Thank you, Mark. Hoping success for you, too.
              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.
                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

                    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

                      MichelleRHG
                      Participant
                        Thank you.
                        MelMel
                        Participant
                          Mark, thank you so much for sharing the interesting re-challenge study.
                          Melanie
                          MichelleRHG
                          Participant
                            Thank you, Celeste.
                            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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