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Stage 3A, treatment options

Forums General Melanoma Community Stage 3A, treatment options

  • Post
    MNK016890
    Participant

      I was recently diagnosed with stage 3A melanoma, after a SLNB I was found to have “isolated cells” in one of the eleven nodes that were removed. I was given the options for immunotherapy with Opdivo or observation with aPET/CT and MRI Brain in 6 months. My oncologist suggested observation in his opinion but I am struggling with making this decision. I am 27 and want the best possible outcome long term. Are there any other 3A patients with stories they can share regarding their decisions and treatments. Thank you. 

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    • Replies
        ed williams
        Participant

          Hi Anon, can I call you Anon 3A just incase some other anon answer your post it helps me to keep the anon's straight. You are not going to find to many people that are 3a and have had Pd-1 drugs since the trial that led to Nivolumab approval didn't include 3a, they have now allowed all stage 3 to get access so there might be some new patients that have just got started on treatment but no one that has been on treatment for long. On the other hand the trial that just reported on Pembro(Keytruda) for adjuvant patients did include 80, 3a patients out of the 500 or so patients in the pembro arm of the trial. So there is some data from that trial and I will include a link to some of it. I was 3A back in 2012 and progressed about 15 months later to lung and brain mets. I did Interferon back in the day (lovely stuff) and progressed. The interesting part of the data today is pushing off recurrence or recurrence free survival data. My thinking on the topic is buying time and stats. Treatment for adjuvant melanoma show that on average people are buying time accourding to the stats and maybe won't have a recurrence but data is still very young for long term success and the trials are on going and still collecting data. Down side is getting side effects called IRAE's and having maybe for life side effects that require steroids. Up side no progression to major organs or brain and long term survival. My personal thoughts on the old standard of watching and scanning in stage 3 should be replaced by Immunotherapy or for those with Braf+ Mutation targeted therapy for a year then scanning and close follow up. Here are two links, one about the trial results for Pd-1 in adjuvant and a second possible side effects and % of how often people develop them. Best Wishes!!!Ed https://www.nejm.org/doi/full/10.1056/NEJMoa1802357              https://www.uptodate.com/contents/toxicities-associated-with-checkpoint-inhibitor-immunotherapy

           

            ed williams
            Participant
              NSNewf
              Participant

                Hi Ed

                did your progression show up on scans at 15 months or other ways?  

                I am also a 3a, surveillance only with annual CT’s (Canada). Next would be January 

                 

                thanks

                ed williams
                Participant

                  Yes it was picked up on a x-ray in June of 2013, then we did a Ct-scan in July to confirm followed by a lung needle biopsy in early aug. Protocal to get into trial required Mri of brain which found 3 small tumors in late Sept followed by SRS cyberknife treatment early Oct. Nothing happens fast in Ontario back in 2013, I hope things would go faster today but nothing I have seen would suggest the system is any faster. Take Care!!!!Ed

                  NSNewf
                  Participant

                    Thanks Ed

                    I am East if you and it hasn’t gotten any faster out here. In fact when I met with onc she said she had never experienced anyone getting to her as fast as I did. 4 months from initial consultation with derm. 3 surgery’s from 3 different docs in 3 hospitals in a small province. 

                    Take care

                     

                    btw glad to see you contribute again 

                    dessie
                    Participant

                      Hello Annon,

                       

                      I was dx with melanoma Jan 2018, and 3A in Feb 2018 officially. In Dec 2017 Opdivo had been approved for metastatic melanoma from what my oncologist told me.  I was advised Opdivo every 2 weeks for 1 year.  I spoke to him last week and he did not want to change to monthly.  Dr Gordon said for me , a 3A dx every 2 weeks is good as he is looking to "cure" me… and wants me to keep steady doses with so far minimal side effects.  Coming up on treatment  6 i belive.

                      Good luck with your decision

                      Dessie

                      dessie
                      Participant

                        ps i will have PET scans every 6 months and MRI brain yearly with every 3 month for derm plus the opdivo.

                        dessie

                      guynamedbilly
                      Participant

                        I was staged 3a July of 2017 and almost immediately went on Nivolumab.  It was not a trial, but I think it was because of the location, on the back of my scalp, that I was approved so quickly.

                        For me, it was a no brainer, no pun intended.  I read about the side effect possibilities and the statistics on long term survival with the size and location of my tumor, and never thought twice after the insurance had approved it.  I've been fairly lucky with side effects, with only sensitive skin, occasional rash, and gas bloating.

                          guynamedbilly
                          Participant

                            Oh, I also had to get on Synthroid because of the Nivo, but I've never had any noticeable effects from my thyroid problems so I keep forgetting it happened.  That seems like a very common response to the drugs from what I've read.

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