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Question on Ipi for Adjuvant Treatment in Stage III
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Question on Ipi for Adjuvant Treatment in Stage III

› Forums › General Melanoma Community › Question on Ipi for Adjuvant Treatment in Stage III

  • Post
    • June 4, 2017 at 11:12 am
    Newmanbell
    Participant

      Hi all,

      First I want to thank you for all that you do to answer questions (especially Celeste!) from us terrified patients with this terrible cancer.  I am addicted to this site and read everything I can daily.

      My husband is State IIIb, had a primary removed in 2012, a tumor off his chest earlier this year and 22 lymph nodes removed under his right arm with one just having melanoma.  They have him on 10 mg of Ipi as an adjuvant treatment.  He has done 3 treatments so far.  He is having awful headaches and his eyes really are very red.  I noticed fatigue is playing a roll here too.  We expected some type of reaction.

      I realize some of the combos out there are for Stage IV, but everything I am hearing about Keytruda, has anyone had ths for adjuvant treatment or is it only for Stage IV treatment?  I had asked our doctor about the combos but he stated that was more for treating multiple tumors.  I hear so many good things about Keytruda and overall surval, wondered if this was possible for adjuvant.

      Please pipe in the treatment everyone has endured for Stage III (he is Stage IIIb).  Thank ou.

       

      Donna

       

       

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    • Replies
        • June 4, 2017 at 12:10 pm
        HopefulOne
        Participant

          Hi Donna,

          Sorry to hear about your husband. Yet I know he's in good hands with you as you're reading everything you can to make informed decisions. 

          While I don't know the answer to your question, I wanted you to know that your story resonated with me. My husband had had 31 axial lymph nodes removed in Oct. 2012. 11 of them positive for melanoma. At that time, he went on a vaccine clinical trial as he was Stage IIIC and there was only one FDA treatment at that time. And though he progressed on that trial and needed another surgery, he later got Ipi at 3mg. He was able to tolerate Ipi for four infusions (the amount recommended) with a brief delay in the one due to a bowel issue. Ipi helped him go a year without a recurrence. 

          Fast forward from then, two more surgeries later, he was able to go on Keytruda and has been NED for two years.

          So keep up the hope and asking questions. Even if the answer today is no combo therapy for this stage (if that is true), things are changing on this front every day and tomorrow he might be able to.

          Hopefully for now, even if he only tolerates the three treatments, he receives a durable response from it.

          Best wishes!

           

           

            • June 4, 2017 at 12:44 pm
            02gluken
            Participant

              ​at this time, Yervoy is the only FDA treatment other than interferon for adjuvant therapy. And the other I don't understand is the amount is 10mg/kg of body weight where for mestatic it is 3mg/kg. Plan to again discuss this before treatment starts. At present Ketruda is only apprved for mestatic non resectable melanoma, unles you are involved in a clinical trial.

              • June 4, 2017 at 1:50 pm
              Newmanbell
              Participant
                Thank you so much for your response. I am taking all this in, and all these comments are incredibly helpful.
                • June 5, 2017 at 5:53 pm
                AZSoCal
                Participant

                  Keytruda (PD-1) blocker is currently only approved for Stage IV patients.  There are a number of ongoing studies for Stage III patients that I understand are showing promising data.  There is a reasonable chance the drug will be fast-tracked for approval, but impossible to tell exactly when this will occur.

                  There are a number of trails going on that allow patients to (potentially) gain access to Keytruda or another PD1 drug.  However, these all require no previous treatment regement has been undertaken, and even then there you do not get to pick (randomized studies).  

                  His best course of action is to remain on ipi but make sure the doctors are treating the symptoms early. If you go on vacation or aren't being seen by your hematologist-oncologist for these symptoms make sure they know he's going through these treatments before the prescribe anything.  

                  Unfortunately, ipi (Yervoy) is only approved at 10mg doses for Stage III patients.  That's an incredibly high dosage relatvie to Stage IV patients who are given just 3mg doses.  Most doctors will taper the doasage over time as a result of the side effects. 

                  Good luck!!

                • June 4, 2017 at 2:29 pm
                AliCat61
                Participant

                  Roy went from stage 2b to Stage IV and blew right past stage III, so I can't be of much help there. But one thing I am sure of is this. The wonderful people here who do have experience with treatments for stage III will chime in. Like you, I am so very grateful for this forum and for the wonderful people here. Hang in there! We're all hanging with you!

                  • June 4, 2017 at 4:42 pm
                  jennunicorn
                  Participant

                    As of right now Ipi is the only new approved adjuvant treatment. There are trials testing Nivo (opdivo) and Pembro (keytruda) in the adjuvant setting, but no telling how long until they are approved for it. Hopefully Ipi does the trick for your husband. 

                    As far as his headaches go, make sure his oncologist is very aware of his side effects. The faster the oncologist knows about a side effect the quicker it can get treated. Leaving something to get worse can cause permanent damage.

                    All the best,

                    • June 4, 2017 at 6:35 pm
                    Dhva
                    Participant

                      When you say his eyes are really red, do you mean the whites of his eyes? If so, he may have uveitis and he should see an ophthalmologist to see if he needs steroidal eyedrops. 

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