boxhill wrote:My oncologist presented my two immunotherapy options as keytruda alone, or Opdivo plus Yervoy. We went with keytruda because it is generally somewhat easier on the body.
From what I've read recently, stats show Keytruda clearly beating Opdivo, but Opdivo plus Yervoy works better than Opdivo alone. At least for some cancers, whether or not not Yervoy is added depends on BRAF status. Do you know yours?
I don't understand why a pharmacy would be dictating this choice.
Hi Boxhill, sorry that did not respond to your comments on this thread I started about immunotherapy experiences (specifically Opdivo and Yervoy). The past few months have been crazy and I haven’t been active on the board.
Congratulations on your recent scan! Looks like Keytruda is doing the job for you! That is awesome. I wish you continued success and NED status.
Just before I was going to start immunotherapy, my doctors and I changed course. We decided to do a second resection of my liver. That decision was made because my scans showed only one small tumor (2cm), and it was in an easy spot to resect (not that liver resection is ever “easy”).
The surgery was on May 9. It went well and my recovery has been fairly easy compared to my first resection last November – a much longer and more complex surgery. The plan now is to scan every three months, and start immunotherapy if I have a recurrence. I know I’m incredibly lucky that I was a surgical candidate one time, let alone twice. So I’m hoping for clean scans in August.
To your point about single agent PD1 inhibitors (Keytruda or Opdivo monotherapy) vs. combination PD1 and CTLA4 therapy (Opdivo plus Yervoy), the emerging clinical data seems to demonstrate better PFS and OS for the combo therapy, although as we know, monotherapy has been life-extending and even curative in many MSI-H/ dMMR stage IVs.
Some oncologists favor monotherapy, because of the higher toxicity profile of the combo (around 30 percent will experience a grade 3 or 4 adverse immune event such as colitis or pneumonitis on the currently recommended dosing schedule). Some oncologists recommend the combo therapy in select cases (including mine) because of the clinical data; ongoing success with their patients; and because the adverse immune events are almost always reversible with steroids. The benefits of the combo apparently remain durable even in the patients who don’t complete four cycles. My oncologists think the higher toxicity is worth the “double punch”, especially because I’m relatively young (42) and otherwise very healthy. Also, the latest results of the Checkmate trials could lead to a different dosing schedule for Yervoy, which could lower toxicity. Something to keep an eye on, for sure.
Here are a few links that I’ve kept in my bookmarks. Keep fighting!
Trevorhttps://www.practiceupdate.com/content/ ... ncer/75457http://theoncologypharmacist.com/top-is ... cancer-tophttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6527887/