We are currently moving most of our patients on both adjuvant and maintained Nivolumab to 4 weeks. It is easier on the patient from a time and financial perspective. They don’t have to take time off of work, find childcare, or have to pay Travel expenses as often. We are keeping patients on he 2 week schedule only if they are complicated or may need a little more frequent visits/monitoring.
While less chair time is ideal for patients and staff alike, we have not yet made the move to the 4-week dosing. Two reasons:
– We are a bit hesitant to go that amount of time between visits. When and if we do make the transition, most likely we would do so with the “trusted” patients 1st. The ones we feel confident they WILL contact us to report a new or changing symptom.
– More importantly to our group and worth mentioning here is that data from the Checkmate 038 trial (unpublished data- can be provided if you ask BMS for it) demonstrating a higher incidence of Grade 1 and Grade 2 hypersensitivity/ infusion reaction for both nivo monotherapy, and nivo + ipi combination at the 30 minute infusion rate. No high grade reaction, NO deaths.
So- for now, we will make decisions on case-by-case basis. However, it is nice to have options!!
We have decided to transition some of our reliable, long term patients to every 4 weeks. For complicated patients with multiple issues, we will keep them on every two weeks. New patients are starting on the 2 week schedule and if doing well after 2-3 cycles, we will consider changing to every 4 weeks. We have not yet seen any infusion reactions thus far.
We haven’t switched anyone yet, but our thinking is in line with yours…..we’ll switch the long-term responders who are reliable about reporting changes first and see how that goes before switching the others.