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Ipi/Nivo, or Nivo/Ipi??? What is the "right" sequence

Ipi/Nivo, or Nivo/Ipi??? What is the "right" sequence

Posted By
NewEra
7/10/2019 6:56pm
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Replies: 7

My first immuno treatment today. I got Nivo (Opdivo/Nivolumab) ( first (30 mins) then Ipi (Yervoy/Ipilimumab)). I recall seeing a study on the efficacy of the sequence of these drugs, with one sequence having better results, but of course it's now lost in the ether and, despite 30 minutes of searching, I can't find it again!

Any thoughts/input?

Hi there Newera, the short answer is the concept of which drug should come first is not related to should you get ipi or nivo first at the chemo ward when getting the combination IV but rather back in the old days of early trials, was it better to start patients on ipi and if they progress or not respond to ipi to then switch to nivo or vice versa. Usually a scan was required to confirm progression before switching. Here is a link to checkmate 064 one of the early trials that looked at this concept, this was before checkmate 067 trial which lead to the the approval of ipi+ nivo together at the same time which most here call the combination and what you are getting as a treatment approach. Best Wishes!!!Ed https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(16)30126-7/fulltext

OK, if I'm understanding you correctly, then a "sequence" is a series of weeks/treatments on one drug, then a series on another. The order of the two had differences in outcome in past studies.

Now both are delivered in the same session for one series of weeks (for checkpoint inhibitors) and the "which one first" in this "combined" approach doesn't really matter.

RiGHT???

So sorry! Total "Newbie" aleart! Where's that link to the lingo when I need it? GRRRR!)

You got it! And no worries! We were all "newbies" once. Old timers like Ed and myself are just glad that "newbies" these days have legit melanoma treatment options. Still, melanoma and its treatments are confusing beasts. Continue to ask questions as you need to. And if you need a glossary of terms, we got that too!

Here is a link to a primer regarding melanoma treatment that I put together: https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2017/08/melan...

A link to a list of abbreviations related to melanoma is included at the bottom of that post, but here it is from my blog with a link to the thread on this forum where it was posted originally: http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/03/melano...

c

Ed is exactly right. You are getting the combo....30 minutes does not a sequence make. c

But....if you'd like to see into the "ether" - here you go: https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2015/09/seque...
So...if 30 minutes DID matter, you're still good. But more importantly....the COMBO, which is what you are getting, has response rates greater than 50%. c

One more link on the topic from 2016 peer panel talking about sequence of immunotherapy back in the day!!! 5:00 min mark Dr. Weber gets into checkmate 064 trial data!!! https://m.youtube.com/watch?v=eeJp_TKiv54

Ha! Now that i try and think about, i cant remember what was given to me first the ipi or nivo! I wanna say i got the Ipi first, then the Nivo bag...i called it my "Shot & a Beer back!"....sorry for the silly chime in...lol

Melanoma Will Not Beat Me or my MRF Family!
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