Thank you for forgiving my attempt at humor. I’m once again in need of advice from some of the veterans and google researchers around here. :)
A little bit of background...
After 8 months of single-agent Nivo (following surgery and SRS to the brain), I moved to the Ipi/Nivo combo. I tolerated 3 of the 4 treatments before landing myself in the hospital because of my AST (1700) and ALT (2300) numbers. The good news is that at the hospital I learned that my two lung tumors were shrinking as a result of the combo and my oncologist thought we could add in radiation to hopefully move the elimination process along. So, while on steroids to try to get my liver numbers back in the normal range, I started radiation.
Radiation and, hopefully, steroids wrap up next week and the initial plan was for me to go immediately on single-agent Nivo to get the benefits of concurrent radiation/immunotherapy treatment. However, I’m hesitating because I know if my liver acts up on Nivo, I’m done with immunotherapy forever and I’m wondering if giving my liver a bit more time to recover before resuming Nivo might be a better idea. So, here are a few of my many questions...I know there is no perfect answer but am grateful to anyone who takes the time to share their experience/perspective:
- With almost a year of immunotherapy in me, prior to starting radiation, would that be considered concurrent treatment?
- What is the likelihood of a negative reaction to single-agent Nivo the second time, if I tolerated it well the first time?
- Is there good reason to “save” Nivo for later in case I need it or would it be better to just get it in my system again now?
- Is 11 months of immunotherapy treatment long enough? Should I go back on Nivo even if my scans are clear after radiation?
Not sure that it matters but I am BRAF positive so checkpoint inhibitors are still an option if I ever need them. I just like the durability of immunotherapy.
Stage IV — one brain met (resected via craniotomy 3/1/18 and subsequently treated with SRS) and two lung mets. Started Opdivo 4/16/18. Opdivo not eliminating lung mets, so on 12/5/18 started Ipi/Nivo combo.