Opdivo

Hi there all,

Anyone have any experience with treatment from Opdivo or Jervoy?

Hi there and thanks so much for your reply.

I'm asking for my dad. He's coming at the end of success with Xtandi and the next talks have been about a combo of Jervoy and Opdivo. I've been reading about the side effects and they seem pretty bad.

He was on Zytiga with success for about 4 months and then on to Xtandi with success for about 6 months. His last appointment showed an increase in his PSA from 19 to 29. Pretty big jump in a month.

So far, checkpoint blockade with CTLA4 blocker (Yervoy - Ipi) or PD-L1 blocker (Opdivo, Keytruda) has not tested well for PC. There's always the possibility that both together may be effective. Immunotherapies, at least so far, don't seem to do all that much as single agents, but there may be a synergy with radiation or chemo. Most men will have minimal side effects, but there's always the possibility of a potentially fatal runaway autoimmune cascade -- it can work too well. I'm hopeful (as always) that the much-awaited clinical trial of CAR T at COH may prove useful.

Hi all,

Thanks everyone for your response. I've been researching myself and with my dad's age, 89 in July, I think that the risk vs the reward may be a little tricky.

The combo is part of a trial and couldn't really find anything in regards to prostate cancer.

While I don't know much about their applications in Pca, I can speak on both quite a bit as my girlfriend was on both for her renal cell carcinoma but unfortunately they didn't work for her but did give her some stability.

Both Opdivo and Pembro (Keytruda) are checkpoint inhibitors and both show much better responses in patients whose tumors express higher amounts of PDL1. While responses are better in patients that are PDL1 positive, for still unknown reasons there are a small percentage of patients who achieve a response and are PDL1 negative (or at least exhibit minimal expression).

Yervoy works on a different pathway known as CTL4. In many cases it doesn't work as well as either Opdivo or Keytruda but a few years ago, they started experimenting with combing them creating a checkpoint blockade. What they found was that by combing them, they achieved higher rates or stability and also objective responses than one would expect using either as a monotherapy - however it is NOT without side effects.

As I've been knee deep in the RCC community for a few years, I'm well aware of the side effects with all the immunotherapies. While the quality of life is generally better on them then targeted chemo drugs, they do have risk of significant immunologic side effects --- and I mean everything from encephalitis, pancreatitis, arthritis, diabetes, pneumonitis, etc. MOST of them can be reversed pretty quickly with high dose steroids. As these drugs gain favor, they've started to see more and more folks experience more of these side effects...they can come on swiftly at anytime and one of the issues is that the ER's aren't particularly good at recognizing all of them yet as many simply don't have experience with the immunotherapies. They want to assume an infection or other cause when it's often not - it's why you've always got to be your own best advocate.

Opdivo + Yervoy was first approved a few years ago for melanoma where it has produced significantly better durable responses than standard of care...the top RCC docs started trying it about two years ago and it's on it's way to getting FDA approved in RCC this year as well as a 1st line treatment. However the side effects of this combo are very rough - there's a much higher percentage of patients who experience grade 3 & 4 SE's on this combo and many never even finish four treatments. They are given together in four doses a few weeks apart.

Immunotherapies are still like the wild wild west...they offer promise of durable responses and hope where there sometimes is none for the percentage of patients lucky enough to respond to them. I think there's definitely a place going forward but that field is still very much in it's infancy as they try to search for biomarkers to determine who would (or would not be) a suitable candidate for a given treatment.