Nivolumab and Dexamethasone simultaneously – which dosage
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Nivolumab and Dexamethasone simultaneously – which dosage

› Forums › General Melanoma Community › Nivolumab and Dexamethasone simultaneously – which dosage

  • Post
    • December 21, 2016 at 11:29 am
    Mikers
    Participant

      Hello.

      Decided to rechallenge PD1 with Nivolumab this time. Meanwhile LMD disease is symptomatic again – frequent vomiting and absolutely not possible to eat (though drinking is normal). 
      Had only one Nivo infusion and thinking of trying low dose dexamethasone to control nasea and vomiting. I wonder is it possible to have it without strong suppression of PD1 effect (if it still will be working taking into account that pembro has already failed).
      I've seen that in clinical trials they usually demand level of dexamethasone not higher than 2mg.

    Viewing 2 reply threads
    • Replies
        • December 22, 2016 at 8:53 pm
        debwray
        Participant

          Hi Mikers,

          Trials usually demand that steroid use at or below 10 mg prednisolone a day.

          This table gives the equivalents

          http://emedicine.medscape.com/article/2172042-overview?pa=8ti4%2BkK7y93llaobqtV6Hbj5zHhmYwGVhGLU58WUGn%2FbhglaYmIwQj8ozSF441mANg3Q%2BtKAutWw4Cc1J33AWHsf1SXToM9t2GZJwKsZeuU%3D  

          so I reckon that 1.5 mg dexamethasone would meet that requirement-  but there is evidence that nivo works even if high dose steroids are needed for side effects- but guess that comes in after the drug is in your system and has taken away the " melanoma Invisiblity cloak ".Think the reasoning is that the steroids do supress the immune system .. and you want it to attack the melanoma .. but there is simply not enough evidence available to say at what level steroids reduce efficacy of the PD 1drugs.

          I've had problems with nausea and vommiting and have been given three different anti emetics so far but can't say that any of them banished it- rather turned down the volume a level or two. Oncologist says it is worth testing to find the one that works best for you…my triggers were to do with liver function – some of it induced by ipi nivo, some liver tumours and probably some contribution from liver toxic antibiotics. Levels reduced when antibiotics stopped- but still a problem- until started on high dose steroids to control spiking liver enzymes after second ipi nivo treatment..

          Hope you find a way to make it all work for you..

          Best wishes

          Deb

            • December 27, 2016 at 9:29 am
            Mikers
            Participant

              Deb, thank you very much. 

              So far none of the emetics working (nor ondacetron nor metoclopramid). Also have tried haloperidol. So thinking of steroids but don't want much contradiction with current nivolumab. 

              • December 27, 2016 at 9:29 am
              Mikers
              Participant

                Deb, thank you very much. 

                So far none of the emetics working (nor ondacetron nor metoclopramid). Also have tried haloperidol. So thinking of steroids but don't want much contradiction with current nivolumab. 

                • December 27, 2016 at 9:29 am
                Mikers
                Participant

                  Deb, thank you very much. 

                  So far none of the emetics working (nor ondacetron nor metoclopramid). Also have tried haloperidol. So thinking of steroids but don't want much contradiction with current nivolumab. 

                • December 22, 2016 at 8:53 pm
                debwray
                Participant

                  Hi Mikers,

                  Trials usually demand that steroid use at or below 10 mg prednisolone a day.

                  This table gives the equivalents

                  http://emedicine.medscape.com/article/2172042-overview?pa=8ti4%2BkK7y93llaobqtV6Hbj5zHhmYwGVhGLU58WUGn%2FbhglaYmIwQj8ozSF441mANg3Q%2BtKAutWw4Cc1J33AWHsf1SXToM9t2GZJwKsZeuU%3D  

                  so I reckon that 1.5 mg dexamethasone would meet that requirement-  but there is evidence that nivo works even if high dose steroids are needed for side effects- but guess that comes in after the drug is in your system and has taken away the " melanoma Invisiblity cloak ".Think the reasoning is that the steroids do supress the immune system .. and you want it to attack the melanoma .. but there is simply not enough evidence available to say at what level steroids reduce efficacy of the PD 1drugs.

                  I've had problems with nausea and vommiting and have been given three different anti emetics so far but can't say that any of them banished it- rather turned down the volume a level or two. Oncologist says it is worth testing to find the one that works best for you…my triggers were to do with liver function – some of it induced by ipi nivo, some liver tumours and probably some contribution from liver toxic antibiotics. Levels reduced when antibiotics stopped- but still a problem- until started on high dose steroids to control spiking liver enzymes after second ipi nivo treatment..

                  Hope you find a way to make it all work for you..

                  Best wishes

                  Deb

                  • December 22, 2016 at 8:53 pm
                  debwray
                  Participant

                    Hi Mikers,

                    Trials usually demand that steroid use at or below 10 mg prednisolone a day.

                    This table gives the equivalents

                    http://emedicine.medscape.com/article/2172042-overview?pa=8ti4%2BkK7y93llaobqtV6Hbj5zHhmYwGVhGLU58WUGn%2FbhglaYmIwQj8ozSF441mANg3Q%2BtKAutWw4Cc1J33AWHsf1SXToM9t2GZJwKsZeuU%3D  

                    so I reckon that 1.5 mg dexamethasone would meet that requirement-  but there is evidence that nivo works even if high dose steroids are needed for side effects- but guess that comes in after the drug is in your system and has taken away the " melanoma Invisiblity cloak ".Think the reasoning is that the steroids do supress the immune system .. and you want it to attack the melanoma .. but there is simply not enough evidence available to say at what level steroids reduce efficacy of the PD 1drugs.

                    I've had problems with nausea and vommiting and have been given three different anti emetics so far but can't say that any of them banished it- rather turned down the volume a level or two. Oncologist says it is worth testing to find the one that works best for you…my triggers were to do with liver function – some of it induced by ipi nivo, some liver tumours and probably some contribution from liver toxic antibiotics. Levels reduced when antibiotics stopped- but still a problem- until started on high dose steroids to control spiking liver enzymes after second ipi nivo treatment..

                    Hope you find a way to make it all work for you..

                    Best wishes

                    Deb

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