use of Avastin as a steroid-sparing agent prior to immunotherapy (ipi+nivo)

I am glad you are proceeding with your radiation.  It is important!  However, we have learned that melanoma responds best when radiation is used in COMBINATION with systemic therapy like the ipi/nivo combo.  Here are a zillion reports covering many years:  https://chaoticallypreciselifeloveandmelanoma.blogspot.com/search?q=radiation

Here are a zillion reports broken down by radiation and brain mets (there is some overlap):  https://chaoticallypreciselifeloveandmelanoma.blogspot.com/search?q=radiation+and+brain+mets

So, I would definitely not delay starting immunotherapy.  Yes, there are those who are concerned that immunotherapy can cause complications when it comes to brain tumors and radiation.  However, we have also learned that this is not valid – or certainly not worth the chance of waiting on melanoma to do its thing!!!  Here is a report about that specifically:

http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2017/05/immunotherapy-with-srs-does-not.html

I am not sure how much good the avastin would do.  There may well be those here who have info on that.  However, I can’t see that there would be any harm.  If your docs should start in on waiting to be off or weaned down on steroids before starting immunotherapy – again – DON’T wait!  I recently put this post together regarding immunotherapy and steroids:  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2021/09/what-to-do-about-immunotherapy-if-you.html

I know it is a lot to take in all at once.  For all that melanoma sucks great big stinky hairy green wizard balls – there is hope.  Granted the truly dark ages of melanoma, when there were no FDA approved targeted or immunotherapies, was only pre-2011.  But we have learned a great deal since then and many of us on this forum have outlived out assigned expiration dates.  I was Stage IIIb in 2003.  Stage IV with brain and lung mets in 2010.  However, after lung surgery, SRS to the brain and a phase 1 trial of nivolumab – I am still alive and kicking and NED for melanoma since 2010.

Hang tough.  Ask more questions as you have the need.  There are many smart caring peeps on this forum.  I wish you my best.  Celeste

My response to the report I believe you reference was this:  <b>First and foremost, this study was done by looking at cells in a petri dish and poor little real live mice.  And, it seems as though the limiting effects created by dexamethasone (a steroid) on T cells was present when the cells were treated with anti-PD-1 but not when treated with ipi (Yervoy).</b>

Certainly, it would be best if no one on immunotherapy required the use of steroids, or it we had a better drug to deal with the conditions for which we use them.  But, there is also this (along with many, many additional similar reports on my blog and in the literature):  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2017/03/patients-with-preexisting-immune.html

In this study, folks with melanoma AND pre-existing immune conditions requiring a variety of immune suppressing meds were treated with immunotherapy.  The researchers found –

There are a lot of disagreements about how steroids can be used with immunotherapy. I was on 20 mg of hydrocortisone for most of my immunotherapy. I started after wild fevers after two rounds of immunotherapy. I started steroids, took a break from immunotherapy to have a large brain met resected and then radiated, and then within weeks returned to immunotherapy.

Have you considered getting a third consult with a melanoma specialist?

(FYI brain has been tumor free ever since)