Immunotherapy Decision – 23 Dec 2021

After my Oncology meeting, I have lots of new information to review.  I am delighted that I can choose the direction of travel myself and I’m so appreciative of Oncology that they treated me like an adult, able to make rational decisions about my treatment.  Nursing take note! 

I read everything.  I am slightly disappointed that all the documents I took away most of the content seems to be on the side effects.  One huge takeaway is the side effects.  I get it. 

Option A - Phase 1b/2 Immune & targeted combination therapies.  Pembrolizumab/Lenvatinib MK-3475-03A

I really like the 3 drug therapy trial.  But the downside is there is more monitoring.  Whilst I may think nothing of a 25 min drive to Oncology now, I wonder if I would think the same in two years time, or in January after a burst of snow.   Then I’m unsure about what happens at the end of the 2 year trial.  What treatment follows?  I really like the fact that Merck, NJ, USA will pay NHS Lothian for my participation in the trial.  This really amuses me!  I feel it is almost my duty to choose this option because it is the cheapest for the NHS.  The three drugs and higher risk of side effects plays on my mind. 

It’s the most recent to become available – does that mean it’s the best and most informed, most progressive?!  Who doesn’t want to be on the best drug?!  Dr S told me the drugs are just as good as the other options I’ve been given. 

Option B - Ipilimumab / Nivolimumab

I read an article about this drug combination from Leeds Uni.   It was a trial to see if there was any significant change to outcomes with a changed delivery regime.   It’s a popular treatment option with lots of data and options moving on.  It’s definitely the safe option.  There are likely side effects too, of course. 

Nivo became available in around 2015.  I’ve seen it described as the new miracle drug - but I don't take this onboard.  I need my pragmatic hat on. It used to be only a second line treatment, but more recently it’s been offered as a line 1 option.  Dr A told me some people just keep on and on and on with this drug. . . .     

Decision

I choose the ipi/nivo because of the lower risks of the side effects and the less frequent monitoring, and the fact I can have it locally, 5 mins from my house.   Dr A phones 2 days after our oncology meeting, as we agreed.  I deliver my verdict and off-we-go!

I can’t wait to get started.   I mentally prepare myself to start mid Jan.  

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