SRS/Gamma Knife then Keytruda…

Hi there! 

My husband has had multiple brain lesions (all treated with SRS) and he's currently on Keytruda, so I hope that I'm able to answer your question effectively!  Our oncologists do not seem concerned at all about combining SRS treatment and Keytruda – only about combining dexamethasone and Keytruda.  My husband has had 3 doses of Keytruda and, following an MRI that was taken shortly after he began treatment, had to treat a new tumor with SRS between dose 2 and 3.  There was no delay for his Keytruda infusion (we were only told to hold off on the one time, high dose dexamethasone that is typically given after SRS).  Everything stayed on schedule. 

Dexamethasone has been the only roadblock for treatment for us (my husband was symptomatic and was required to be on steroids for quite some time to reduce the swelling around each tumor).  So, no wash-out (or waiting) period between SRS and Keytruda for us, just for steroids! 🙂 

I also wanted to share that Dave (my husband) had 4 tumors pop up in a 2 week span and 1 the week after that (obviously not while he was in treatment).  Once he started treatment, there has only been one brain tumor that showed up, and our radiation oncologists, melanoma specialists, and oncologists all think that it was there prior to treatment starting.  Dave had an MRI a week ago which showed no new tumors and that many of his older tumors have been shrinking.  We are very encouraged.  Hoping and praying that your mother will have a positive response as well! 

Best,

Katie 

Hi there! 

My husband has had multiple brain lesions (all treated with SRS) and he's currently on Keytruda, so I hope that I'm able to answer your question effectively!  Our oncologists do not seem concerned at all about combining SRS treatment and Keytruda – only about combining dexamethasone and Keytruda.  My husband has had 3 doses of Keytruda and, following an MRI that was taken shortly after he began treatment, had to treat a new tumor with SRS between dose 2 and 3.  There was no delay for his Keytruda infusion (we were only told to hold off on the one time, high dose dexamethasone that is typically given after SRS).  Everything stayed on schedule. 

Dexamethasone has been the only roadblock for treatment for us (my husband was symptomatic and was required to be on steroids for quite some time to reduce the swelling around each tumor).  So, no wash-out (or waiting) period between SRS and Keytruda for us, just for steroids! 🙂 

I also wanted to share that Dave (my husband) had 4 tumors pop up in a 2 week span and 1 the week after that (obviously not while he was in treatment).  Once he started treatment, there has only been one brain tumor that showed up, and our radiation oncologists, melanoma specialists, and oncologists all think that it was there prior to treatment starting.  Dave had an MRI a week ago which showed no new tumors and that many of his older tumors have been shrinking.  We are very encouraged.  Hoping and praying that your mother will have a positive response as well! 

Best,

Katie 

Hi there! 

My husband has had multiple brain lesions (all treated with SRS) and he's currently on Keytruda, so I hope that I'm able to answer your question effectively!  Our oncologists do not seem concerned at all about combining SRS treatment and Keytruda – only about combining dexamethasone and Keytruda.  My husband has had 3 doses of Keytruda and, following an MRI that was taken shortly after he began treatment, had to treat a new tumor with SRS between dose 2 and 3.  There was no delay for his Keytruda infusion (we were only told to hold off on the one time, high dose dexamethasone that is typically given after SRS).  Everything stayed on schedule. 

Dexamethasone has been the only roadblock for treatment for us (my husband was symptomatic and was required to be on steroids for quite some time to reduce the swelling around each tumor).  So, no wash-out (or waiting) period between SRS and Keytruda for us, just for steroids! 🙂 

I also wanted to share that Dave (my husband) had 4 tumors pop up in a 2 week span and 1 the week after that (obviously not while he was in treatment).  Once he started treatment, there has only been one brain tumor that showed up, and our radiation oncologists, melanoma specialists, and oncologists all think that it was there prior to treatment starting.  Dave had an MRI a week ago which showed no new tumors and that many of his older tumors have been shrinking.  We are very encouraged.  Hoping and praying that your mother will have a positive response as well! 

Best,

Katie 

I had gamma knife for a 2mm brain tumor before starting Keytruda in Feb.  I was not an ipi responder.  I did well on Keytruda from Feb through June.  July scans showed new sinus and adrenal gland tumors (otherwise stable).  I had surgery for the sinus tumor and will have Cyberknife for the remainder of the sinus tumor and one of the adrenal gland tumors.  I will remain on Keytruda having missed one infusion (my 10th).  Good luck.

I had gamma knife for a 2mm brain tumor before starting Keytruda in Feb.  I was not an ipi responder.  I did well on Keytruda from Feb through June.  July scans showed new sinus and adrenal gland tumors (otherwise stable).  I had surgery for the sinus tumor and will have Cyberknife for the remainder of the sinus tumor and one of the adrenal gland tumors.  I will remain on Keytruda having missed one infusion (my 10th).  Good luck.

I had gamma knife for a 2mm brain tumor before starting Keytruda in Feb.  I was not an ipi responder.  I did well on Keytruda from Feb through June.  July scans showed new sinus and adrenal gland tumors (otherwise stable).  I had surgery for the sinus tumor and will have Cyberknife for the remainder of the sinus tumor and one of the adrenal gland tumors.  I will remain on Keytruda having missed one infusion (my 10th).  Good luck.

I've had lots of radiation but none in the brain. Pressing on and displacing the brain yes but not in.

I stayed on keytruda while getting the radiation. Once it was actually the same day. Had radiation switched to the morning that day so I could get my keytruda that afternoon. I see no reason to delay keytruda for radiation if those are the only 2 factors. Actually quite the opposite I recommend them at the same time to maybe get that anecdotal benefit that sometimes happens in combo. When they radiated the one in my head I had 2 others that did not get radiated. But first head scan showed those 2 virtually gone and one was almost as big as the radiated one. Was that the keytruda or near by radiation or the combo affect I dunno but probably the combo. Doesn't always happen though. I've had other spots radiated in my spine while on keytruda and the vertebrae right next to the radiated spot got a little worse. Kind of weird this stuff but I recommend no delay in getting on keytruda based on my experience. Also dr wolchoc years ago was having his ipi patients that needed radiation do it after their 3rd ipi dose. So he must have thought at the time there was something to the combo.

Artie

I've had lots of radiation but none in the brain. Pressing on and displacing the brain yes but not in.

I stayed on keytruda while getting the radiation. Once it was actually the same day. Had radiation switched to the morning that day so I could get my keytruda that afternoon. I see no reason to delay keytruda for radiation if those are the only 2 factors. Actually quite the opposite I recommend them at the same time to maybe get that anecdotal benefit that sometimes happens in combo. When they radiated the one in my head I had 2 others that did not get radiated. But first head scan showed those 2 virtually gone and one was almost as big as the radiated one. Was that the keytruda or near by radiation or the combo affect I dunno but probably the combo. Doesn't always happen though. I've had other spots radiated in my spine while on keytruda and the vertebrae right next to the radiated spot got a little worse. Kind of weird this stuff but I recommend no delay in getting on keytruda based on my experience. Also dr wolchoc years ago was having his ipi patients that needed radiation do it after their 3rd ipi dose. So he must have thought at the time there was something to the combo.

Artie

I've had lots of radiation but none in the brain. Pressing on and displacing the brain yes but not in.

I stayed on keytruda while getting the radiation. Once it was actually the same day. Had radiation switched to the morning that day so I could get my keytruda that afternoon. I see no reason to delay keytruda for radiation if those are the only 2 factors. Actually quite the opposite I recommend them at the same time to maybe get that anecdotal benefit that sometimes happens in combo. When they radiated the one in my head I had 2 others that did not get radiated. But first head scan showed those 2 virtually gone and one was almost as big as the radiated one. Was that the keytruda or near by radiation or the combo affect I dunno but probably the combo. Doesn't always happen though. I've had other spots radiated in my spine while on keytruda and the vertebrae right next to the radiated spot got a little worse. Kind of weird this stuff but I recommend no delay in getting on keytruda based on my experience. Also dr wolchoc years ago was having his ipi patients that needed radiation do it after their 3rd ipi dose. So he must have thought at the time there was something to the combo.

Artie

Hi Patina,

Research indicates that there is absolutely no harm in combining immunotherapies (whether they be anti-PD1 or ipi) with radiation.  To the contrary…the combo seems to provide much more benefit than either therapy singly.  The jury is still out in as to a solid answer regarding the best order to administer them (esp with anti-PD1 since it is newer) but some data with ipi shows that, "Patients treated with SRS during or before ipi had better overall survival and less regional recurrence."  Too bad this doesn't come with a guarantee!!!  There is nothing that indicates the results would be different with anti-PD1 combined with radiation.  Here is a link to several articles that address outcomes when radiation is combined with immunotherapy and what researchers have learned about what happens when you do (maybe):  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2015/03/radiation-for-melanomabetter-when.html

In my case, I had SRS to a brain met in April of 2010.  However, I did not start Nivo/Opdivo until December of that same year.  This delay was no plan….it just took that long for me to find and enter the trial I ended up in! Additionally, I entered the trial with a "blip" in my brain that was most likely another brain tumor, though without biopsy we cannot be certain.  It resolved on Nivo.

Wishing you and your mom my best.  Celeste

Hi Patina,

Research indicates that there is absolutely no harm in combining immunotherapies (whether they be anti-PD1 or ipi) with radiation.  To the contrary…the combo seems to provide much more benefit than either therapy singly.  The jury is still out in as to a solid answer regarding the best order to administer them (esp with anti-PD1 since it is newer) but some data with ipi shows that, "Patients treated with SRS during or before ipi had better overall survival and less regional recurrence."  Too bad this doesn't come with a guarantee!!!  There is nothing that indicates the results would be different with anti-PD1 combined with radiation.  Here is a link to several articles that address outcomes when radiation is combined with immunotherapy and what researchers have learned about what happens when you do (maybe):  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2015/03/radiation-for-melanomabetter-when.html

In my case, I had SRS to a brain met in April of 2010.  However, I did not start Nivo/Opdivo until December of that same year.  This delay was no plan….it just took that long for me to find and enter the trial I ended up in! Additionally, I entered the trial with a "blip" in my brain that was most likely another brain tumor, though without biopsy we cannot be certain.  It resolved on Nivo.

Wishing you and your mom my best.  Celeste

Hi Patina,

Research indicates that there is absolutely no harm in combining immunotherapies (whether they be anti-PD1 or ipi) with radiation.  To the contrary…the combo seems to provide much more benefit than either therapy singly.  The jury is still out in as to a solid answer regarding the best order to administer them (esp with anti-PD1 since it is newer) but some data with ipi shows that, "Patients treated with SRS during or before ipi had better overall survival and less regional recurrence."  Too bad this doesn't come with a guarantee!!!  There is nothing that indicates the results would be different with anti-PD1 combined with radiation.  Here is a link to several articles that address outcomes when radiation is combined with immunotherapy and what researchers have learned about what happens when you do (maybe):  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2015/03/radiation-for-melanomabetter-when.html

In my case, I had SRS to a brain met in April of 2010.  However, I did not start Nivo/Opdivo until December of that same year.  This delay was no plan….it just took that long for me to find and enter the trial I ended up in! Additionally, I entered the trial with a "blip" in my brain that was most likely another brain tumor, though without biopsy we cannot be certain.  It resolved on Nivo.

Wishing you and your mom my best.  Celeste