Q about pleural thickenings, ipi/nivo a 2nd time, and after nivo alone

This topic has 11 replies, 5 voices, and was last updated 5 years, 7 months ago by Edwin.

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- September 18, 2019 at 7:19 pm
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MichelleRHG
Participant
Hi All,
All of my melanomas have been resected over the past 3 years,but now I have a non-resectable progression in my lung. In 2018 hilar node was found to have mel, thoracotomy (ouch) to remove.
My last 2 scans (March and June) have shown some nodular pleural thickening , stable, and the one this week showed multiple new thickenings. Frightening, of course.
I had the ipi/nivo combo a little over 2 years ago, and have been having Opdivo alone since then . My onc at MD Anderson is sure this is mel and wants me to get back on the combo . If that fails might look at a NRAS targeted trial if there’s one available. The thickenings aren’t large enough to qualify for TIL. They aren’t specific enough for radiation.
Has anyone experienced these pleural thickenings?
Has anyone had the ipi/nivo combo AFTER nivo alone?
Has anyone had the combo twice, 2+ years apart?
Thanks in advance for any insight. We are devastated.

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- - September 18, 2019 at 9:02 pm
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  MarkR
  Participant
  Hi
  Sorry to hear you are going through this
  I had Ipi Nivo last Feb and and stopped due to side effects after 3 months. Had 6 months where things were ok then progression – started Nivo in March this year and have been broadly stable but with a bit of progression. Not sure if I will be adding Ipi or going to clinical trials will have to wait and see but it’s certainly possible and a response can be achieved. Hopefully you can find the right path for you and get some success
  Regards
  Mark
- - September 18, 2019 at 9:02 pm
  - Quote
  MarkR
  Participant
  Hi
  Sorry to hear you are going through this
  I had Ipi Nivo last Feb and and stopped due to side effects after 3 months. Had 6 months where things were ok then progression – started Nivo in March this year and have been broadly stable but with a bit of progression. Not sure if I will be adding Ipi or going to clinical trials will have to wait and see but it’s certainly possible and a response can be achieved. Hopefully you can find the right path for you and get some success
  Regards
  Mark
  - September 19, 2019 at 12:34 pm
    
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    MichelleRHG
    Participant
    
    Thank you, Mark. Hoping success for you, too.
- - September 18, 2019 at 9:37 pm
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  Edwin
  Participant
  I received ipi + nivo combo immunotherapy, after receiving pembro immunotherapy alone. Pembro immunotherapy did not work for me, but ipi + nivo immunotherapy helped. I received an infusion of nivo this morning. I have been receiving nivo alone for 3 years. My 4th and last ipi + nivo combo infusion was in July 2016.
  - September 19, 2019 at 12:35 pm
    
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    MichelleRHG
    Participant
    
    Thank you, Edwin.
- - September 18, 2019 at 11:59 pm
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  Bubbles
  Participant
  Oh, Michelle. Sorry you are facing this. I do not have the answer to the question you are really asking – ie – does the ipi/nivo combo work if you are taking it second time round?
  
  But, I do have these reports that while not addressing repeating the combo – do address taking anti-PD-1 a second time – if you are interested:
  2017: Response to ipi or ipi/nivo after failing anti-PD1 as single agent in Stage IV melanoma – https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2017/02/response-to-ipi-or-ipinivo-after.html
  
  2017: ASCO 2017: Nivo or Ipi/Nivo combo in melanoma after progression on ipi or anti-PD-1 – https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2017/06/asco-2017-nivo-or-ipinivo-combo-in.html
  
  2018: Nivo after nivo? Or nivo after progression? Can melanoma patients still attain a response??? – https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2018/01/nivo-after-nivo-or-nivo-after.html
  
  2018: anti-PD-1 after progression – https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2018/08/anti-pd-1-after-progression.html
  ______________________________________________________________________________________________________________________________________________________
  So, while not really your situation, but if we extrapolate from those studies – YES! Folks who have previously responded to immunotherapy – can respond again with retreatment.
  
  Now….there are still other options! This was out of ASCO this year. While all of these may not be applicable to you, but some of them might be:
  New Stuff!! Treatment options and current trials for melanoma patients! The first installment of this year’s ASCO review. – http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2019/06/new-stuff-treatment-options-and-current.html
  
  For what it’s worth. Hang in there!! Wishing you my very best. Celeste
  - September 19, 2019 at 5:48 am
    
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    MarkR
    Participant
    
    If your interested this study was undertaken by my team in the Uk. It’s a case study of 3 patients Re-challenged with Ipi Nivo
    Regards
    Mark
    
    https://repository.icr.ac.uk/bitstream/handle/internal/503/JL%20-%20CII%202016%20-%20Spain%20et%20al%20-%20rechallenge%20with%20ipi%2Bnivo%20-%20PROOF%20.pdf?sequence=2&isAllowed=y
  - September 19, 2019 at 12:36 pm
    
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    MichelleRHG
    Participant
    
    Thank you.
  - September 20, 2019 at 5:04 am
    
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    MelMel
    Participant
    
    Mark, thank you so much for sharing the interesting re-challenge study.
    Melanie
  - September 19, 2019 at 12:33 pm
    
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    MichelleRHG
    Participant
    
    Thank you, Celeste.
  - September 23, 2019 at 7:45 pm
    
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    Edwin
    Participant
    
    Seeing the success rate of ipi/nivo after failing anti-PD1 as single agent in stage IV melanoma, I realize how fortunate I have been. After pembro failure and ipi/nivo success, I have had 3 years of good health. In March 2016 my oncologist estimated that I had less than 1 year, if ipi/nivo immunotherapy failed.
    
    For treating stage 4 melanoma the 0.21 success rate of ipi/nivo after anti-pd1 failure is about what one would expect from probability calculations. Pembro has a 0.60 probability of failure. If pembro has failed, ipi/nivo has a 0.79 probability of failure. So, pembro with ipi/nivo as a backup has a 0.60 x 0.79 = 0.47 probability of failure or 0.53 probability of success. This is about the same success rate as that of ipi/nivo given as the first treatment.