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Melanoma stage 4 non reactive to Immunotherapy and chemotherapy
Hello,
My father, aged 66, was diagnosed with stage 4 melanoma in July 2025.
treatment 1 - Undergone immunotherpy( Nivolumab + ipilumab). completed 4 doses.
It was progressing
Performed gene mutations, didn't find any positive mutations, hence couldn't try targeted therapy.
treatment -2 Then underwent chemotherapy ( carboplatin + paclitaxel).
It was progressing
treatment 3 - Pembrolizumab + lenvatinib (12 mg). three cycles
PET CT scan showed promising results, activity, and size of lesions were reduced in most parts of the body.
Treatment 4 - continue Pembrozulumab + lenvatinib (12 mg). three cycles
Pet ct scan showed progressive disease again, with a couple of new sites. There was 7 mm tumor in the brain as well. Considering sbrt for brain.
What treatment is recommended now in my father’s condition?
Are there any studies if patients show progressive disease both in immunotherapy and chemotherapy ?
Patient is in india, hence TIL therapy would not be feasible.
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@yasiraffan: It's hard to manage or oversee care for a family member from a distance- which I'm not sure is the situation with you assisting for your father but in any case it appears that not all treatment modalities available elsewhere in the world are offered where he is residing. That must be difficult to deal with, although it remains uncertain if he would be a candidate for TIL as there is specific criteria that would have to be met.
Additionally, it is uncertain if there is actual progression of disease vs pseudoprogression, where tumors initially appear to grow on scans due to immune cells infiltrating the tumor but then shrink although given the details you provided this may be unlikely. The staff providing care to your father would be best to address that as we here at Mayo Clinic Connect are not equipped to offer medical advice regarding next steps in recommended treatment care plans as that is a decision based upon an individual's history, lab work, imaging, and response that only medical professionals are qualitifed to determine.
There is an international organization that may be able to provide direction for alternatives in India: https://www.aimatmelanoma.org/ Let me know if this helps.
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1 ReactionI am 74 but in dec i had til. i also have a bovine artificial aortic valve,before my til, they found 39 btain tumors. they were treated with radiosurgery. so far so good. i do not drive right now due to some inflamation around an optic nerve, but that too is getting better. i work outside now and life is becoming almost normal
i recommend til if you can get it. the IL2 Immune booster was rough but they are using less now, I got my TIL and all care at Univ of Birmingham in alabama. i was only the 4th person to get it. Before til, they too tried all combinations of immunotherapy - nothing worked.
in my book, til is revolutionary treatment! i was in hosp for 17 days and my Docs keep checking with the Natera blood test - no cancer in my blood, and with mris for brain , and pet scans for body,
good luck . it is very much working for me right now
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1 Reaction@darmitag: That is so encouraging and wonderful to hear how well TIL worked for you! Was it very debilitating as you were going through the process? It really is quite amazing how far treatments have come in staying a step ahead of this dreaded condition
@yasiraffan: May I ask how your father is doing? From what I understand, there are some facilities that have been approved for clinical trials in TIL at some of the larger medical institutions in India.