Immunotherapy with SRS
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Immunotherapy with SRS

› Forums › General Melanoma Community › Immunotherapy with SRS

  • Post
    • August 26, 2016 at 7:05 pm
    JohnA
    Participant

      Hey folks, 

      My wife has 4 brain mets and is about to get SRS next week for them at a major medical center.

      Ipi+nivo eliminated all body and previous brain mets in 3 cycles, but these 4 new brain mets grew while on therapy. Bummer.

      The question comes to what to do after the SRS.

      I know of the data (thanks Celeste!) on nivo + SRS from the retrospective study from Moffitt released earlier this year. Basically, if you get Nivo within 4 weeks after SRS, outcomes are improved.

      BUT – she's only had 3 cycles on Ipi+Nivo, so technically she could have 1 more Ipi+nivo.

      Clearly, the concerns are that side effects will be enhanced in the brain by combining SRS and Ipi+Nivo, and if the side effects are bad enough then she'd have to come off treatment entirely and maybe miss the chance to have the Nivo maintenance doses.

      Anyone aware of any data (experiences?) on which to pair with SRS (Nivo only or Ipi+Nivo) and how closely they should be paired in time? I imagine you want the brain inflamation to reduce from the SRS before starting anything new?

      Thanks.

       

    Viewing 5 reply threads
    • Replies
        • August 26, 2016 at 8:04 pm
        Bubbles
        Participant

          Hey John,

          Yes, there is the Moffitt study…but there is also this report out of Cancer, June 2016 in the main body of this post:  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/06/brain-mets-in-melanoma-dont-wait-to-add.html

          It's conclusion states:  "The administration of immunotherapy within 4 weeks of SRS results in improved lesional response of melanoma brain mets in comparison with treatment separated by longer than 4 weeks.  Anti-PD1 therapy also results in greater lesional response than anti-CTLA-4 after SRS."

          This link may get you the whole article…but sometimes it doesn't work.  It wouldn't let me link the actually article.  I'll try this….it should get you the abstract and then you can click on the box to the right (it's orange and says 'full online text')…maybe:  http://www.ncbi.nlm.nih.gov/pubmed/27285122

          For what it's worth.  Best, c

           

           

           

          • August 26, 2016 at 8:04 pm
          Bubbles
          Participant

            Hey John,

            Yes, there is the Moffitt study…but there is also this report out of Cancer, June 2016 in the main body of this post:  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/06/brain-mets-in-melanoma-dont-wait-to-add.html

            It's conclusion states:  "The administration of immunotherapy within 4 weeks of SRS results in improved lesional response of melanoma brain mets in comparison with treatment separated by longer than 4 weeks.  Anti-PD1 therapy also results in greater lesional response than anti-CTLA-4 after SRS."

            This link may get you the whole article…but sometimes it doesn't work.  It wouldn't let me link the actually article.  I'll try this….it should get you the abstract and then you can click on the box to the right (it's orange and says 'full online text')…maybe:  http://www.ncbi.nlm.nih.gov/pubmed/27285122

            For what it's worth.  Best, c

             

             

             

            • August 26, 2016 at 8:04 pm
            Bubbles
            Participant

              Hey John,

              Yes, there is the Moffitt study…but there is also this report out of Cancer, June 2016 in the main body of this post:  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/06/brain-mets-in-melanoma-dont-wait-to-add.html

              It's conclusion states:  "The administration of immunotherapy within 4 weeks of SRS results in improved lesional response of melanoma brain mets in comparison with treatment separated by longer than 4 weeks.  Anti-PD1 therapy also results in greater lesional response than anti-CTLA-4 after SRS."

              This link may get you the whole article…but sometimes it doesn't work.  It wouldn't let me link the actually article.  I'll try this….it should get you the abstract and then you can click on the box to the right (it's orange and says 'full online text')…maybe:  http://www.ncbi.nlm.nih.gov/pubmed/27285122

              For what it's worth.  Best, c

               

               

               

                • August 26, 2016 at 8:11 pm
                Bubbles
                Participant

                  PS…the study noted above is out of Yale…via Veronica Chiang.  c

                  • August 26, 2016 at 8:11 pm
                  Bubbles
                  Participant

                    PS…the study noted above is out of Yale…via Veronica Chiang.  c

                    • August 26, 2016 at 8:11 pm
                    Bubbles
                    Participant

                      PS…the study noted above is out of Yale…via Veronica Chiang.  c

                      • August 26, 2016 at 10:36 pm
                      vickiaa0529
                      Participant

                        Stupid question but is SRS the same as gamma knife?

                        They want to wait to see if anything comes back before starting any treatment 

                        thanks

                        • August 26, 2016 at 10:36 pm
                        vickiaa0529
                        Participant

                          Stupid question but is SRS the same as gamma knife?

                          They want to wait to see if anything comes back before starting any treatment 

                          thanks

                          • August 26, 2016 at 10:36 pm
                          vickiaa0529
                          Participant

                            Stupid question but is SRS the same as gamma knife?

                            They want to wait to see if anything comes back before starting any treatment 

                            thanks

                            • August 27, 2016 at 5:19 am
                            JohnA
                            Participant

                              Gamma knife is a type of srs, yes. Srs is stereotactic radiosurgery.  

                              • August 27, 2016 at 5:19 am
                              JohnA
                              Participant

                                Gamma knife is a type of srs, yes. Srs is stereotactic radiosurgery.  

                                • August 27, 2016 at 5:19 am
                                JohnA
                                Participant

                                  Gamma knife is a type of srs, yes. Srs is stereotactic radiosurgery.  

                                  • August 27, 2016 at 5:23 am
                                  JohnA
                                  Participant

                                    Thanks Celeste – I guess what I am asking is are we to assume that the combo is also inferior to a pd-1 alone?

                                     

                                    • August 27, 2016 at 5:23 am
                                    JohnA
                                    Participant

                                      Thanks Celeste – I guess what I am asking is are we to assume that the combo is also inferior to a pd-1 alone?

                                       

                                      • August 27, 2016 at 5:23 am
                                      JohnA
                                      Participant

                                        Thanks Celeste – I guess what I am asking is are we to assume that the combo is also inferior to a pd-1 alone?

                                         

                                        • August 27, 2016 at 5:23 am
                                        JohnA
                                        Participant

                                          Thanks Celeste – I guess what I am asking is are we to assume that the combo is also inferior to a pd-1 alone?

                                           

                                          • August 27, 2016 at 2:53 pm
                                          Bubbles
                                          Participant

                                            Hey John,

                                            I don't think we know the answer to that yet. I would make the assumption that the combo is best, nivo next then ipi…as to results after SRS as that is the way those drugs perform everywhere else. The combo is too new to be reported out in research like the two articles discussed here from Moffitt and Yale. Of course your wife's case is complicated due to her having already been on the combo when she developed these additional mets. You could argue that they were there already…and just enlarged enough with the influx of bad ass t cells attacking them to then show up on scans….because she is so early in her combo treatment. Or they may actually be new tumors that are not responsive to the combo. I know. Not helping, am I? It would take a biopsy to tell….but that gets super complicated. I think I would want to keep on the combo, personally. There is only one ipi dose left….which is the bad boy in the side effect profile…so skipping it and just staying on nivo might be just as well. Though there are many studies now showing that folks who had a bad reaction to ipi can still take anti-PD1, but I would sure hate for her to have any more problems than she already has. Boy, does melanoma suck. I would talk to the docs about all this and then it will probably boil down to what you and your wife feel is the best for her. Hang in there. Yours, celeste

                                            • August 27, 2016 at 2:53 pm
                                            Bubbles
                                            Participant

                                              Hey John,

                                              I don't think we know the answer to that yet. I would make the assumption that the combo is best, nivo next then ipi…as to results after SRS as that is the way those drugs perform everywhere else. The combo is too new to be reported out in research like the two articles discussed here from Moffitt and Yale. Of course your wife's case is complicated due to her having already been on the combo when she developed these additional mets. You could argue that they were there already…and just enlarged enough with the influx of bad ass t cells attacking them to then show up on scans….because she is so early in her combo treatment. Or they may actually be new tumors that are not responsive to the combo. I know. Not helping, am I? It would take a biopsy to tell….but that gets super complicated. I think I would want to keep on the combo, personally. There is only one ipi dose left….which is the bad boy in the side effect profile…so skipping it and just staying on nivo might be just as well. Though there are many studies now showing that folks who had a bad reaction to ipi can still take anti-PD1, but I would sure hate for her to have any more problems than she already has. Boy, does melanoma suck. I would talk to the docs about all this and then it will probably boil down to what you and your wife feel is the best for her. Hang in there. Yours, celeste

                                              • August 27, 2016 at 2:53 pm
                                              Bubbles
                                              Participant

                                                Hey John,

                                                I don't think we know the answer to that yet. I would make the assumption that the combo is best, nivo next then ipi…as to results after SRS as that is the way those drugs perform everywhere else. The combo is too new to be reported out in research like the two articles discussed here from Moffitt and Yale. Of course your wife's case is complicated due to her having already been on the combo when she developed these additional mets. You could argue that they were there already…and just enlarged enough with the influx of bad ass t cells attacking them to then show up on scans….because she is so early in her combo treatment. Or they may actually be new tumors that are not responsive to the combo. I know. Not helping, am I? It would take a biopsy to tell….but that gets super complicated. I think I would want to keep on the combo, personally. There is only one ipi dose left….which is the bad boy in the side effect profile…so skipping it and just staying on nivo might be just as well. Though there are many studies now showing that folks who had a bad reaction to ipi can still take anti-PD1, but I would sure hate for her to have any more problems than she already has. Boy, does melanoma suck. I would talk to the docs about all this and then it will probably boil down to what you and your wife feel is the best for her. Hang in there. Yours, celeste

                                                • August 27, 2016 at 5:23 am
                                                JohnA
                                                Participant

                                                  Thanks Celeste – I guess what I am asking is are we to assume that the combo is also inferior to a pd-1 alone?

                                                   

                                                  • August 27, 2016 at 5:23 am
                                                  JohnA
                                                  Participant

                                                    Thanks Celeste – I guess what I am asking is are we to assume that the combo is also inferior to a pd-1 alone?

                                                     

                                                  • August 26, 2016 at 11:20 pm
                                                  Polymath
                                                  Participant

                                                    Hi John,

                                                    Although it was not for brain mets, I did radiation therapy concurrently with the ipi/nivo combo.  If I recall It was right around the 3rd infusion of the combo.  I completed ipi and am now in nivo only, in my 8th month.  My case has been tough, very resistant to various therapies.  I am now getting a partial response, and otherwise pretty stable.  I believe the combo of radiation and immunotherapy is powerful.  Best to your wife in the battle.

                                                    Gary

                                                    • August 26, 2016 at 11:20 pm
                                                    Polymath
                                                    Participant

                                                      Hi John,

                                                      Although it was not for brain mets, I did radiation therapy concurrently with the ipi/nivo combo.  If I recall It was right around the 3rd infusion of the combo.  I completed ipi and am now in nivo only, in my 8th month.  My case has been tough, very resistant to various therapies.  I am now getting a partial response, and otherwise pretty stable.  I believe the combo of radiation and immunotherapy is powerful.  Best to your wife in the battle.

                                                      Gary

                                                      • August 26, 2016 at 11:20 pm
                                                      Polymath
                                                      Participant

                                                        Hi John,

                                                        Although it was not for brain mets, I did radiation therapy concurrently with the ipi/nivo combo.  If I recall It was right around the 3rd infusion of the combo.  I completed ipi and am now in nivo only, in my 8th month.  My case has been tough, very resistant to various therapies.  I am now getting a partial response, and otherwise pretty stable.  I believe the combo of radiation and immunotherapy is powerful.  Best to your wife in the battle.

                                                        Gary

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