How many ipi/nivo combos have you had

Goodness, Becky.  You are certainly going through it.  Radiation does have its own side effects, often consisting of fatigue, but has NOT been found to cause any worsening of side effects produced by immunotherapy.  Here are tons of reports (many are addressing brain mets, but the data applies no matter the lesion):  https://chaoticallypreciselifeloveandmelanoma.blogspot.com/search?q=radiation+and+immunotherapy  

As to your other question.  I may not be understanding all of your particulars…..but, I'm not sure there are going to be those who can answer your question about proceeding to a fifth dose of the ipi/nivo combo.  Generally, the ipi/nivo combo is prescribed as 4 doses of the combo every three weeks.  That phase is followed by nivo alone every 2 wks or every 4 weeks (depending on the dose used) with no intermittent doses or additional doses of the combo after the initial 4.  Here is a link to the prescriptive info from the drug company:  http://www.opdivohcp.com/metastatic-melanoma-regimen/dosing/dosing-administration  

Now, I do have dear ones who completed the treatment course as I described, but then recurred and had to kinda start over….and maybe that is what you are dealing with.  In that scenario, some folks do have to stop due to side effects, but that is also true the first time around.  Here are lots of reports on nivo or ipi/nivo after progression on those same drugs: 

 https://chaoticallypreciselifeloveandmelanoma.blogspot.com/search?q=response+after+nivolumab  

Not sure it I've helped you much.  But I wish you my best and perhaps others can chime in.  Yours, celeste

Hi Becky

I was in the adjuvant clinical trial taking lower level doses of Ipi/Nivo before they upped me to the full dose. We discussed whether I should have the last dose of Ipi/Nivo that I actually had as the consultants were becoming concerned I had had enough.  With very few side effects (bit tired and dry mouth) I was keen to press on.  Two weeks after my last dose the side effects kicked in and I had an enlarged pituitary gland and liver issues.  

Personally I still feel I made the right choice as shortly after the side effects kicked in I could feel the Met reduce in size (I have a 4cm met in my arm) and the side effects sound a lot worse than they were.  5 months later and I have just had a bout of severe diahorrea that they aren’t quite sure is down to an immune reaction or bacterial infection.  Another dose of steroids has done the job and I am weaning off at a fast pace over the next couple of weeks.

hope this helps

mark