Question on IPI-Nivo Combo

Naturally I do not know but we have all heard/read that the combo is supposed to have the best Orr. Also I believe I have read that nivo works better when used with radiation and ipi works better with viral treatment so combos are certainly advantageous to some. I think I have also heard that the argument has been made that some may be respondent to nivo at different stages or times of their life as in just because you were not responsive last time does not necessarily mean you would not be responsive at a later date as the body changes though this has just been argued and not proven. 

Naturally I do not know but we have all heard/read that the combo is supposed to have the best Orr. Also I believe I have read that nivo works better when used with radiation and ipi works better with viral treatment so combos are certainly advantageous to some. I think I have also heard that the argument has been made that some may be respondent to nivo at different stages or times of their life as in just because you were not responsive last time does not necessarily mean you would not be responsive at a later date as the body changes though this has just been argued and not proven. 

Naturally I do not know but we have all heard/read that the combo is supposed to have the best Orr. Also I believe I have read that nivo works better when used with radiation and ipi works better with viral treatment so combos are certainly advantageous to some. I think I have also heard that the argument has been made that some may be respondent to nivo at different stages or times of their life as in just because you were not responsive last time does not necessarily mean you would not be responsive at a later date as the body changes though this has just been argued and not proven. 

Hey Joshie,

Here's what I got (the third report in this study is how folks did taking nivo after ipi):  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/05/asco-2016-three-anti-pd1-reports.html

Basically folks who took nivo then ipi got a 41% response rate.  Folks who took ipi then nivo got a 20% response rate. 

I looked and looked and didn't find data on folks who had taken both separately and then took the combo.  So…I don't have a real answer to your question.  I know there are some here who have done it (esp when they added radiation) and did well.  I think it is too new for hard numbers. 

I also think…that it is a good question to ask your docs.  But, I would probably start thinking beyond those two meds as you have tried them.  I would look toward things like IDO inhibitors, OX40, LAG 3, lirilumab, etc…combined with anti-PD1.  That's what ASCO and researchers generally have tended to be talking about for folks who are refractory to the more common immunotherapy, singly and in combinations.  Or TIL.  Or one of the oncolytic intralesionals combined with immunotherapy.

I know….I've sung this song before.  Keep asking.  Keep looking.  love, c

Hey Joshie,

Here's what I got (the third report in this study is how folks did taking nivo after ipi):  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/05/asco-2016-three-anti-pd1-reports.html

Basically folks who took nivo then ipi got a 41% response rate.  Folks who took ipi then nivo got a 20% response rate. 

I looked and looked and didn't find data on folks who had taken both separately and then took the combo.  So…I don't have a real answer to your question.  I know there are some here who have done it (esp when they added radiation) and did well.  I think it is too new for hard numbers. 

I also think…that it is a good question to ask your docs.  But, I would probably start thinking beyond those two meds as you have tried them.  I would look toward things like IDO inhibitors, OX40, LAG 3, lirilumab, etc…combined with anti-PD1.  That's what ASCO and researchers generally have tended to be talking about for folks who are refractory to the more common immunotherapy, singly and in combinations.  Or TIL.  Or one of the oncolytic intralesionals combined with immunotherapy.

I know….I've sung this song before.  Keep asking.  Keep looking.  love, c

Hey Joshie,

Here's what I got (the third report in this study is how folks did taking nivo after ipi):  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/05/asco-2016-three-anti-pd1-reports.html

Basically folks who took nivo then ipi got a 41% response rate.  Folks who took ipi then nivo got a 20% response rate. 

I looked and looked and didn't find data on folks who had taken both separately and then took the combo.  So…I don't have a real answer to your question.  I know there are some here who have done it (esp when they added radiation) and did well.  I think it is too new for hard numbers. 

I also think…that it is a good question to ask your docs.  But, I would probably start thinking beyond those two meds as you have tried them.  I would look toward things like IDO inhibitors, OX40, LAG 3, lirilumab, etc…combined with anti-PD1.  That's what ASCO and researchers generally have tended to be talking about for folks who are refractory to the more common immunotherapy, singly and in combinations.  Or TIL.  Or one of the oncolytic intralesionals combined with immunotherapy.

I know….I've sung this song before.  Keep asking.  Keep looking.  love, c

Hi Josh, glad to hear you are back in the hunt.  The beast is elusive indeed.  I failed ipi first, then pembro.  We share some similarities, especially the very large tumor problem.  I began the ipi/nivo combo, and at about the 3rd ipi/nivo cycle received radiation treatment for some large subcutaneous tumors and have continued the nivo only for what is now about the 13th nivo only infusion.  Not counting the one's treated with radiation I am finally responding with two smaller (for me) about 5cm tumors now shrinking and are about 50% smaller.  But what remains my main problem is a really big mass, originally 3 tumors, that has fully engulfed my spleen and being described as a single mass (15cm x 9cm x 13cm) and still growing.  I am looking into radiation for this as the combo seems to be able to tackle the small stuff, but these really large ones are stubborn.  Bottom line is I got a partial response to the combo, after failing both drugs as single agents.  I feel the boost from radiation also contributed.  The problem remains that everyone is different, but in my stubborn case what was deemed as the next logical step in my treatment has garnered some results.  I wish there was an easy choice for you, and as always, wishing you the best in the battle.

Gary

Hi Josh, glad to hear you are back in the hunt.  The beast is elusive indeed.  I failed ipi first, then pembro.  We share some similarities, especially the very large tumor problem.  I began the ipi/nivo combo, and at about the 3rd ipi/nivo cycle received radiation treatment for some large subcutaneous tumors and have continued the nivo only for what is now about the 13th nivo only infusion.  Not counting the one's treated with radiation I am finally responding with two smaller (for me) about 5cm tumors now shrinking and are about 50% smaller.  But what remains my main problem is a really big mass, originally 3 tumors, that has fully engulfed my spleen and being described as a single mass (15cm x 9cm x 13cm) and still growing.  I am looking into radiation for this as the combo seems to be able to tackle the small stuff, but these really large ones are stubborn.  Bottom line is I got a partial response to the combo, after failing both drugs as single agents.  I feel the boost from radiation also contributed.  The problem remains that everyone is different, but in my stubborn case what was deemed as the next logical step in my treatment has garnered some results.  I wish there was an easy choice for you, and as always, wishing you the best in the battle.

Gary

Hi Josh, glad to hear you are back in the hunt.  The beast is elusive indeed.  I failed ipi first, then pembro.  We share some similarities, especially the very large tumor problem.  I began the ipi/nivo combo, and at about the 3rd ipi/nivo cycle received radiation treatment for some large subcutaneous tumors and have continued the nivo only for what is now about the 13th nivo only infusion.  Not counting the one's treated with radiation I am finally responding with two smaller (for me) about 5cm tumors now shrinking and are about 50% smaller.  But what remains my main problem is a really big mass, originally 3 tumors, that has fully engulfed my spleen and being described as a single mass (15cm x 9cm x 13cm) and still growing.  I am looking into radiation for this as the combo seems to be able to tackle the small stuff, but these really large ones are stubborn.  Bottom line is I got a partial response to the combo, after failing both drugs as single agents.  I feel the boost from radiation also contributed.  The problem remains that everyone is different, but in my stubborn case what was deemed as the next logical step in my treatment has garnered some results.  I wish there was an easy choice for you, and as always, wishing you the best in the battle.

Gary

Hi Josh, you do come up with good questions. Just to add to what has been given to you by Celeste about considering other new drugs and trials. I have a link to a talk byDr. Jeffrey Weber, Dr. Keith Flaherty, Dr. Jason Luke, and Dr.Rene Gonzalez on how to turn a cold tumor hot!!!! Best Wishes!!! Ed   https://www.youtube.com/watch?v=J4QdRyaM9YE

Hi Josh, you do come up with good questions. Just to add to what has been given to you by Celeste about considering other new drugs and trials. I have a link to a talk byDr. Jeffrey Weber, Dr. Keith Flaherty, Dr. Jason Luke, and Dr.Rene Gonzalez on how to turn a cold tumor hot!!!! Best Wishes!!! Ed   https://www.youtube.com/watch?v=J4QdRyaM9YE

Hi Josh, you do come up with good questions. Just to add to what has been given to you by Celeste about considering other new drugs and trials. I have a link to a talk byDr. Jeffrey Weber, Dr. Keith Flaherty, Dr. Jason Luke, and Dr.Rene Gonzalez on how to turn a cold tumor hot!!!! Best Wishes!!! Ed   https://www.youtube.com/watch?v=J4QdRyaM9YE

Failed ipi, failed Keytruda, now have almost 6 mos of stability or better on ipi/nivo.  One day at a time.

Failed ipi, failed Keytruda, now have almost 6 mos of stability or better on ipi/nivo.  One day at a time.

Failed ipi, failed Keytruda, now have almost 6 mos of stability or better on ipi/nivo.  One day at a time.