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Melanoma: What are your tips about immunotherapy (Keytruda)?
Melanoma & Skin Cancer | Last Active: 2 days ago | Replies (106)Comment receiving replies
My mother is 96 years old. She was diagnosed with melanoma on the back of her leg just above her ankle in 2024 at the age of 94. Identified as stage 3. When the surgeon went to remove the one spot, she actually identified another and both were melanoma: therefore, declaring stage 3. After surgery Mom began immunotherapy Opdivo. She had two infusions 28 days apart. After the second infusion, she began to break out in a rash. The rash was unbelievable as it eventually covered her entire body. The rash spots began as blisters and progressed into sores scabbing over. If you have ever had a fever blister, it was like fever blisters all over her. It took almost 8 months to get the rash under control. Obviously, she had no more infusions. The manufacturer came back and said the reason for the severe reaction was her age. Here we are now 2 years later and the melanoma is back. Based on my research it appears to be Amelanotic Melanoma as the dermatologist did not suspect it to be melanoma, 3 places biopsied and all 3 melanoma. She will see a surgeon this week for removal, but the oncologist is recommending that she try Keytruda after this surgery. Based on previous reaction with Opdivo, and the major side affect listed for Keytruda, does anyone know if we should expect the same reaction with Keytruda? The rash before was way worse than the surgery and grafting. She was a real trooper, but everyone medically seemed very perplexed at the side affect. For those with Keytruda rash, how bad was it?
Replies to "My mother is 96 years old. She was diagnosed with melanoma on the back of her..."
@rfannin: Thank you for coming to Mayo Clinic Connect to explore your concerns, which are very understandable given the circumstances. I also had amelanotic melanoma that my dermatologist at the time did not suspect to be melanoma. I was subsequently started on Keytruda some years later when I was found to have metastatic melanoma. My first adverse reaction was a small rash which I reported immediately and was readily treated, but it was mild in nature. Individuals react very differently and at different times throughout the treatment cycle to potential adverse events which can occur at any time. While immunotherapy is generally limited to 2 years as no additional benefit has been found beyond that time period, adverse events may continue therefore one must be alert for them.
Rashes can present with varying severity - in your mother's case, it sounded particularly severe so there may be cause to be more cautious when administering and monitoring this PD-1 checkpoint inhibitor. If this is a new medical provider who will be overseeing your mother's care, be sure they're aware of her previous reaction so they're aware of the risk, which may increase the possibilty of it occuring but is not necessarily guaranteed.
Have you discussed this concern directly with her current medical provider?
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@rfannin rash and itcing can be brutal. It is one of the reasons I have declined Keytruda for myself. I do not know if Keytruda would have exactly the same rash effect as Opdivo, but it is one of the more common side effects. It is medically considered "not a serious side effect," b/c it is not usually life threatening, but it sure is life-interrupting. I will be glad to read answers to your Keytruda rash question myself.