Melanoma: What are your tips about immunotherapy (Keytruda)?

Amazingly, thanks for asking. After 3 infusions I had a follow up CT that incredibly revealed full resolution of my 11 mm metastatic lung nodule! I still have to continue with immunotherapy for up to 2 years but obviously this is so encouraging.

How are your infusions going? Have you noticed any change in your prognosis?

I'm doing pretty good on the keytruda. I've only had one dose so far, but am going for my second in 2 weeks. I only had stomach ache for 1 day. The tumor has definitely gotton bigger though on my arm...actually appears larger than the first one that was cut out. This second is only an ich away from the incision of the other taken out 1 year ago. The surgery team did a pep smear to see if they could see more than this one and a small satellite one only a centimeter from the larger one. I guess they wanted to schedule the surgery, but wanted to make sure it hadn't spread so I would be a candidate, The more I read about cancer and treatment, the more I realize no one knows what works and what doesn't. Every case is so different where some do all the stuff, chemo, radiation, target therapy, adjuvaunt, neoadjuvant, etc. I hope I made the right decision on keeping this tumor in while the keytruda has something to fight against, but in the back of my mind im thinking, "Cut this bastard out before it spreads"!

@williamfh, any update? How are you doing on Keytruda?

I’m starting keytruda neoadjuvaunt on Tuesday morning. I’ll keep you posted. I’m at the university of Utah

Welcome @williamfh to the club no one wants to be in, however, I have to say I find the support to be tremendous and much needed. Hope we can provide the same to you, although it helps to keep in mind of course every case is individual and what works for some - or how some react - may not be the same for everyone.

As a retired medical professional myself, I also did quite a bit of online research. One thing I learned is advances in melanoma are taking place so rapidly that treatments and prognoses we find by google searches may be outdated. It helps to always check for more recent data and/or for participating in sessions offered by reliable organizations. For example, I've participated in zoom sessions conducted by the Melanoma Research Alliance and will be attending one at a nearby university in a few weeks. This is due to my own diagnosis of Stage 4 metastatic melanoma nearly 5 years status post WLE of a 1A amelatonic skin lesion. I am due for my third Keytruda infusion next week; to date, I've experienced no untoward side effects despite being informed and reading of several potential ones online prior to treatment. The infusion staff has been very reassuring about the low incidence they've observed with this form of immunotherapy.

I'm also a candidate for possible surgical removal of my identified lung nodule once I undergo a CT scan later this month. The rationale for this is based on a SWOG study my oncologist referenced and I found more readilyy explained in an NIH document Immunotherapy before Surgery Appears Effective for Some with Melanoma.

I hope these references provide you with some additional resources.

@williamfh, I noticed that you wished to post a link to an article with your posts. You will be able to add URLs to your posts in a few days. There is a brief period where new members can't post links. We do this to deter spammers and keep the community safe. Allow me to post it for you:
- Neoadjuvant–Adjuvant or Adjuvant-Only Pembrolizumab in Advanced Melanoma https://www.nejm.org/doi/full/10.1056/NEJMoa2211437

In addition to @markymarkfl helpful posts, I'd also like to bring in fellow melanoma members like @jrc3vette @notdefinedbyyou @rblegend50 @yrarbil @grammato3 into the discussion and experiencing with immunotherapy.

Well, my research on "Their" research says with stage 3 melanoma cancer there is a 37% recurrence rate the cancer will come back after getting the Neoadjuvant therapy, compared to 67% chance coming back if you just do the adjuvant. Furthermore, one study states 3 year survival rate for neoadjuvant to be 80% compared to just having adjuvant therapy at 60%. Another study states event free survival at 2 years with neo at 72% compared with just adjuvant at 49%. Thats a big difference. Therefore, it has been hypothesized that neoadjuvant therapy may be able to activate more antitumor T cells and improve clinical outcomes than administration of the same amount of drug delivered postoperatively. I'll have to ask about that signatera test. To answer your 3) question. I assume if the drug is indeed shrinking the tumor it would do the same to all the cancer cells in the body.

Understood. So I would ask:

1) If they can use the Signatera test or something similar to determine if the immunotherapy is working, instead of just leaving the time-bomb in there and hoping to see it shrink

2) What benefit is there to YOU of leaving the tumor in place, other than a "potentially" shorter course of immunotherapy?

3) Even if they watch the main tumor shrink down to nothing, how will they know it didn't spread anywhere else?

Thank you. The previous tumor that was removed showed positive TPS 6-10% and a TMB that is considered high at 52.6. Supposedly these qualities of the tumor make it a good candidate for the keytruda or immunotherapy. Yes the NEO in front of immuno means they start the drug before they take the tumor out. The believe is if the tumor is there, then the drug has something to work against and if it shrinks they know it is working. If they cut it out first, then they would still do the immunotherapy, but would do the full year, but not really know immediately if it was working or not. I guess my fear is it spreads while waiting after 6 weeks or so to see if it’s working. I have a very fast growing nodular melanoma. It came up between visits to the dermatologist, and by the time they got to it, it already spread to my lymph node. My doctor says there is a 50 percent chance it will grow while doing the treatment but still feels it’s the best thing to do.