Nivo now vs possibility of Clinical Trial in 4 to 8 weeks?

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  • Post
    • August 5, 2017 at 4:18 am
    guynamedbilly
    Participant

      I'm being treated at Vanderbilt and I've had some surprising news this week.  I met with the Medical Oncologist yesterday and discussed my options, which were IPI, Nivo if insurance would cover it or I got it for free, or waiting on a clinical trial where they will be testing Nivo versus Nivo + low dose IPI.  We decided it would be best to be proactive and check if insurance would cover the Nivo treatment, and I got a call today that they have approved it.

      I know the Nivo + IPI combo has seen some buzz about being slightly better, but not knowing if I would even be accepted into the trial for 4 to 8 weeks (which is when my doctor expects it to start), when I could start Nivo right away seemed like a bad gamble to me.  

      I wonder if anyone has any insight into anything I might be missing. 

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        • August 5, 2017 at 9:47 am
        ed williams
        Participant

          Hi Billy, so if I am understanding this correctly based on your two post that you are stage 3a and your oncologist was able to get you access to Nivo and you can start asap or wait and hope to get into a trial for Nivo + low dose ipi. One question I would have is what other drugs are they looking at in the trial, is the choice Nivo vs Ipi + Nivo or is there another arm with high dose Ipi at 10mg/kg. I know that there is some early data on Nivo for stage 3 checkmate 238 trial that has been released showing good things for Recurrency free survival (RFS) see link https://news.bms.com/press-release/corporatefinancial-news/phase-3-study-evaluating%C2%A0-safety-and-efficacy-adjuvant-opdivo  Last question is how did your oncologist get you access to Nivo if you are 3a, others on the forum would probably like to know!!!Best Wishes!!!ED

            • August 5, 2017 at 12:16 pm
            guynamedbilly
            Participant
              Thanks Ed. You are correct that they staged me as 3a. I asked if there was a clinical trial and she mentioned that trial as I described, not mentioning any other drugs. It definitively sounded like there were only two options for the trial.

              As for how insurance approved it, I was very surprised about that. She did not seem to think that was likely and then by the next day they had. My guess is she was able to argue that because of the thickness of my original tumor (15mm), I was looking at a higher risk of recurrance than normal with stage 3a. I’ll definitely ask about it at my next appointment though.

              • August 5, 2017 at 1:35 pm
              ed williams
              Participant

                One thing to think about ,is clinical trials usually( not always) do more scans and follow up than one would normally get from standard insurance. If the choice is Nivo vs Nivo + low dose Ipi then both would be two thumbs up for a stage 3 patient in my opinion. I know it is only early days of check mate 238 but meeting RFS bench mark already is a good sign. Where are you being treated and who is your oncologist, if you don't mind me asking? Best Wishes!!!Ed

                • August 5, 2017 at 2:30 pm
                guynamedbilly
                Participant

                  Vanderbilt in Nashville, TN.  My Surgical Oncologist is Dr. Mark Kelly and my Medical Oncologist is Dr. Elizabeth Davis.  They have so far been very impressive to me and are on top of the latest information.  

                  My surgeon said Vanderbilt had just changed it's treatment plan at the conclusion of a study last month to no longer recommend regional lymph node dissection after a positive node was found because of no change in survival rates.  My Oncologist said that something with Nivo had changed two weeks ago to be accessible to patients as adjuvant treatment in cases like mine; honestly that point I kind of glossed over because I was trying to absorb too much information.  They have a tumor review board, I think my surgeon called it, that reviewed my case and concured with the treatment plan from my doctors.

                  I've been very impressed so far.

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