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Finishing Keytruda

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Finishing Keytruda

Posted By
Tsvetochka
2/21/2020 1:03am
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Replies: 7

In May 2019 I was diagnosed with Stage 4 melanoma, no known primary. I started Keytruda in June. It's gone pretty smoothly. Fast forward to now: my doctor ordered a PET CT. When I look at the results, it seems like there's still some cancer. Two tumours are still there, but inactive and smaller than the last CT scan. One lymph node is still active: "1.9SUV," which is supposedly not significant?

I sent the results to my doctor, and she just answered that they're good, we'll stop treatment. I have an appointment with her in a week or so, and I know we'll discuss it then. But I am just wondering what does this mean? I'm not really NED, right? Is it (almost) No Evidence of (active) Disease?

Anonymous - (2/21/2020 - 6:58am)

others at stage 4 have done the combo. I am 3c and am doing nivo only. can you discuss why you were prescribed keytruda only. I assume from your post you are doing keytruda only.

I had 2 different oncs . one prescribed keytruda and one nivo. is it just a case of which pharama rep took em to lunch or is there some medical reason for the one and not the other?

hxcadam - (2/21/2020 - 7:37am)

They both generally do the same thing. My Onc prescribed me Nivo and told me her reasoning was because we could do it monthly and since I live somewhat far it'd be more convenient for me. I believe keytruda is every 3 weeks. I know Nivo can also be taken every 2 weeks with half doses. I'm stage 4 and wasn't given the combo sighting it's toxicity as the culprit and that "it's still an option if you don't respond to nivo alone". My lesions are relatively small so I guess she feels more comfortable taking that chance? I'll be doing SRS Radiation however because I have brain mets as well.

tkoss - (2/21/2020 - 12:46pm)

thanks

Tsvetochka - (2/21/2020 - 10:37am)

I don't think the combo is approved in my country. I apparently didn't need it anyway. Keytruda was enough.

ed williams - (2/21/2020 - 9:25am)

Hi there Tsvetochka, some thing to consider is what was the SuV uptake on previous scans of same tumor? Second thing is there are really no established norms of when to stop since all the early trials had different rules for stopping, case in point I was on checkmate 067 of ipi+nivo or either drug as a monotherapy. I was considered a partial responder since tumors decreased in size in lung but were still visible on ct scans, so based on trial design which was treat until progression I stayed on treatment from Jan 2014 until Oct 2019, where I was forced to stop due to grade 3 colitis. There is some data starting to come out on those who had complete responses and stopped and how long they remain that way, see following link to article from Memorial Sloan Kettering. https://ascopubs.org/doi/full/10.1200/JCO.19.01464

ed williams - (2/21/2020 - 9:35am)

There is also a short video from Weber that gives his personal view of how to manage stopping from 2018. https://www.youtube.com/watch?v=r0lB9uBzC2A

Tsvetochka - (2/21/2020 - 10:36am)

Thanks. This was my first PET scan, so I don't have anything to compare it to.