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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?
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.
So turns out that this patient ended up having a pure red blood cell aplasia. She is doing better now.
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 !
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.
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.
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.
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.
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.
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.
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.
Update: We just got an email here yesterday that all non-investigational infusion times for nivolumab will be going to the 30 minute infusions.
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 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.
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.