No Opdivo today

Amie you know that I share all of your worries. Sometimes during the fight with melanoma, there are some setbacks. Does this mean that Allyn will completely fail his battle? No way. I'm sure plenty of others will share their setbacks and also their wonderful successes. The oncologists at MD Anderson will have some fantastic ideas as well our board members ( hi Les ). Have trust with MD Anderson, your faith and most important keep the hope with you at all times.

Hey Amie,

I totally understand and so sorry that Allyn is having this reaction.  I've been researching and it's clear that the most important thing is that they treat Allyn for pneumonitis after they confirm that is what is with CT scan.  Need to make sure that is treated (will be treated with corticosteroids).   This is a side effect of Opdivo so no reason yet to think this means new mets.  Wait for the CT to see what that says.  Hopefully this is mild case.  Depending on the severity of pneumonitis (if that is conformed), they may rechallenge with Opdivo.  I found this article.  Here is the link (has a very good section on pneumonitis management and how they determine steps forward according to guidelines):  https://academic.oup.com/annonc/article/28/suppl_4/iv119/3958159#122956601

You can click on the left hand side article contents and go to Immune-induced pneumonitis

Here is short blurb:

Text or call me if you need me, I'm here working at home all day.

In grade 1 to 2 pneumonitis, treatment consists of oral steroids with prednisone 1 mg/kg daily or equivalent [IV–V, B]. Patients should be clinically assessed every 2–3 days initially and, ideally, also radiologically in grade 2 pneumonitis. Steroids should be tapered over 4–6 weeks after recovery and reintroduction of the checkpoint inhibitor should be delayed until the daily dose of steroids equals 10 mg of oral prednisone per day or less.

In grade 3 to 4 moderate to severe cases, the patient should be hospitalised and treatment should consist of high-dose i.v. corticosteroids [(methyl)prednisolone 2–4 mg/kg/day or equivalent], and immunotherapy treatment permanently discontinued [IV–V, B]. Where the patient’s condition does not improve or there is no imaging improvement after 2 days, additional immunosuppressive strategies should be implemented [56, 71, 72]. The addition of infliximab, mycophenolate mofetil (MMF) or cyclophosphamide are possible options. Tapering of steroids should be very slow and careful, over 6 weeks or more; relapses of pneumonitis during steroid tapering have been reported, adding considerations about recurrence in patients who rechallenge immunotherapy [67].

Sorry you and your husband are dealing with this, Amie.  Yes…many of us deal with pneumonitis on immunotherapy.  I had wheezing after almost all of my nivo infusions….sometimes showing up as full blown pneumonitis on scans.  Here is a treatment algorithim for pneumonitis:

  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/07/excellent-pdf-on-how-to-deal-with.html  

The good news about pneumonitis (vs other types of adverse immune reactions) is that even though- Yes, you may need to pause treatment.  Yes, you may need systemic (oral) steroids.  You can often manage it (at least after it is under some control) with INHALED corticosteroids (like QVAR, Symbicort, Pulmicort, Flovent).  Meds most often used by asthmatics.  Acute coughing can also be helped by inhaled albuterol.  The beauty of the "inhaled" version is that you get meds where you need it, but avoid the systemic adverse effects.  

Hope this helps.  Wishing you both my best.  Celeste

MPIP is the absolute best forum. There is so much information, companionship and hope on this board. I do know at times people avoid this board because of the pain and loss of life at times. Having said that, I feel there is so much to learn here, so many success stories and so much hope. The positives completely outweigh the negatives here.