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Viewing 15 posts - 1 through 15 (of 27 total)
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  • in reply to: Adjuvant Nivolumab at 480 side effect #4875
    Expert Nurse
    Lisa Kottschade

    I have one guy that is having this. He also gets fever and diarrhea. Has been 2 for 2 on the 480 dose. Have you tried pre-medicating anyone?

    in reply to: Nivolumab dosing and Medicare #4866
    Expert Nurse
    Lisa Kottschade

    Just an update! I’m sure most of us got the memo, but 480 mg dosing is now approved for medicare. I do belive there is a 28 day stipulation on there, so may need to be a little more careful with scheduling.
    Best,
    Lisa

    in reply to: Hemolytic anemia #4865
    Expert Nurse
    Lisa Kottschade

    So turns out that this patient ended up having a pure red blood cell aplasia. She is doing better now.

    in reply to: Variants to mutations; fusions and #4854
    Expert Nurse
    Lisa Kottschade

    Agree this has been a tough clinical dilemma for these patients. We’ve just been taking them on an individual basis. We’ve had varying success with insurance companies as well. Great question !

    in reply to: Pembro plus Epacadostat #4819
    Expert Nurse
    Lisa Kottschade

    The results of this trial were quite striking, especially with strong Phase I/II data. There is some thought that the dose of the IDO inhibitor may have been too low. Was very disappointing as this may have been a good alternative to dual ICI therapy in those that tolerability was questionable.

    in reply to: Skin sensitivity #4818
    Expert Nurse
    Lisa Kottschade

    Krista-

    I too wondered the same thing. I talked to him this week and it has improved, but not gone. He didn’t want to start anything as of yet, so will continue to monitor.

    Take care,
    Lisa

    in reply to: Hypercalcemia #4785
    Expert Nurse
    Lisa Kottschade

    Thank you all. Unfortunately despite early intervention with steroids, dialysis, and PLEX, and getting the calcium down the patient passed away a couple of days ago. Very sad. We still really don’t have a cause, paraneoplastic panel was essentially negative.

    in reply to: Survivorship plans #4733
    Expert Nurse
    Lisa Kottschade

    We too are required to have these survivorship care plans in place. Unfortunately the timeline for doing these is a little bit tight and we are definitely missing people. I think long term follow up for patients who have gotten IO therapy both in the adjuvant setting and for those with long term responses in the metastatic setting is going to be crucial. I think we are going to potentially see more long term rheumatologic conditions as well.

    I agree with the comments regarding stage IV patients above. This is a very unique population now in that we are managing more and more patients like a chronic disease, with long term survivors.

    in reply to: Adjuvant Immunotherapy in stage IIIA patients #4721
    Expert Nurse
    Lisa Kottschade

    Hi Virginia,

    We too have not been offering this to our stage IIIA patients either. I have had patients asking though.

    Thanks for your insight-curious what others are doing.
    L

    in reply to: ASCO/NCCN guidlines now out #4706
    Expert Nurse
    Lisa Kottschade

    I had a chance to review these in a bit more detail since this last post. I do think once you get into the guidelines, the “guidance” offered is a bit more specific, however a bit cumbersome to follow. I think the one thing that I would say is maybe “lacking” is I would have liked to have seen a section on how to work up specific complaints. All of the pathways are after you have a diagnosis. For example, fatigue- would have been nice to have a “consider XYZ in the differential”. I’m curious what others thoughts are.
    Thanks,
    Lisa

    in reply to: Reimbursement for infliximab #4692
    Expert Nurse
    Lisa Kottschade

    We have not used vendolizumab a lot, but have been able to get it paid for in a handful of patients. Our GI docs have been very instrumental in this process.

    in reply to: Infusion times #4691
    Expert Nurse
    Lisa Kottschade

    Update: We just got an email here yesterday that all non-investigational infusion times for nivolumab will be going to the 30 minute infusions.

    in reply to: ASCO/NCCN guidlines now out #4690
    Expert Nurse
    Lisa Kottschade

    I have not had a chance to review these in detail, but plan to do so as well very soon. I’m a little bit concerned about the “blanket” statements of treating based on the grade only. I’m not sure that we’ve come much further then what the drug companies provided as overall guidance early on and that concerns me for folks in the community who are not used to treating a great number of patients. I agree our care step pathways offer a more in depth set of guidelines for nurses.

    in reply to: Practice volume #4689
    Expert Nurse
    Lisa Kottschade

    Hi Krista,

    Great question.

    In response to #1- I would say the approval has increased our volume more in terms of new patients coming for second opinions and I’m not quite sure why. I don’t know if it is because the community is uncomfortable recommending this or patients aren’t wanting to get treatment so they come hoping we won’t recommend anything. I would say I’ve noticed a small increase in the volume of returns as we put more patients on adjuvant nivolumab.

    In response to #2- We are currently not recommending adjuvant BRAF/MEK.
    Thanks,
    Lisa

    in reply to: Infusion times #4667
    Expert Nurse
    Lisa Kottschade

    Hi Kathy,

    Currently we are not using flip dose Ipi/Nivo (“ipi lite” as we like to refer to it) off clinical trial. Thank you all for the responses, we are still working on infusion times here and this is very helpful.

Viewing 15 posts - 1 through 15 (of 27 total)