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Should I take Nivolumab for stage 2B nodular melanoma at age 75?
Melanoma & Skin Cancer | Last Active: 1 day ago | Replies (19)Comment receiving replies
@joetex: I'm glad to hear you were able to have your sons listen in to your appointment with the oncologist. I'm curious as to the type of melanoma you have, if you're open to sharing, and the rationale your provider has for stating that there is no evidence of increased survival from immunotherapy.
As far as I have learned, researched and been informed by health care experts, the survival rates as a result of immunotherapy have yielded such excellent results to the extent - even amongst the otherwise healthy older population (those without significant comorbidities or illnesses) while that melanoma had previously been considered a terminal condition it has now become in many cases a highly treatable condition and often curable chronic condition. This may be something worth clarifying at your next visit. Additionally, the most common way to measure response is through Imaging and Response Tracking that typically involves labs and imaging such as CT, MRI and PET scans. Again, this is something to be discussed further with your oncologist along with the afore mentioned risks vs benefits of immunotherapy.
Perhaps it would help to write down these questions to discuss with your sons and care team. When will you be meeting with them next?
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@grammato3 This is from Cancers journal 2023 and supports what my oncologist told me. The article was for IIb-IV .
“Adjuvant therapy options tested over the past three decades include high-dose interferon-α, immune checkpoint inhibitors (pembrolizumab, nivolumab), targeted therapy (dabrafenib-trametinib for BRAF mutant melanoma), radiotherapy and chemotherapy. Most of these therapies have been demonstrated to enhance relapse-free survival (RFS) but with limited to no impact on overall survival (OS), as reported in randomized trials.”
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@grammato3 My tumor is graded IIb or IIc. There was a difference in two pathology reports and my oncologist is going with IIb for now. They did not find a sentinel lymph node after two attempts with injecting tracer. The reason for his saying there is no evidence of higher survival rates is that he is referring to no clinical data or trials with just immunotherapy vs. no treatment for this stage of melanoma. One reason is that using the new drugs is fairly recent so there’s not much long term data. You are right about longer lifespans and even cure but that is not for just immunotherapy alone, it seems. The patients who have recurrence or advanced stage cancer would have additional treatments like T-cell therapy, surgery, radiation etc. depending where the cancer was. Since I’m NED after they removed the tumor my only treatment option right now is immunotherapy and there’s no data showing that by itself that would give me longer life. It would give me more time before recurrence if I had recurrence at all, but if I chose no treatment to start with then I could still get the advanced treatments if it recurred. I was surprised with this and it really makes me think about risks and benefits of starting immunotherapy now. My oncologist is chairman of the Melanoma center at MDAnderson, one of the top cancer centers in the world so I assume he knows his stuff. He has already laid out the details for follow up blood tests, scans, etc for either choosing treatment or not.