Immunotherapy Part Three – Ipilimumab

After two surgeries, the oncologist wanted to start me on an immunotherapy drug called ipilimumab (trade name Verloy). Don’t you love these long drug names? No wonder the docs refer to this one as “ipi.” As far as I can figure out, each of these drugs have five syllables and a “mab” or “nab” as a last syllable. I think this one is e-pee-LIM-oo-mahb. In this case, learning to pronounce this drug name was the least of my worries.

photo patient in bed

The drug lulled me into a false sense of security. After the first two infusions, I had no side effects. I’d spent all that worry about it for nothing.

However, just before the nurse set me up for the third infusion, she noticed a rash on my ankle. She scolded me because I hadn’t called her about it. It was the first sign of an allergic reaction. To be honest, I hadn’t carefully read the doctor’s instructions about this. She ended treatment.

Unfortunately, this wasn’t the end of it.  For the next six weeks, I suffered with a horrible rash over my entire body, edema, vomiting, diarrhea, weakness, and brain fog. In retrospect, the brain fog was the worst because I forgot to take the medications the doc provided to combat these symptoms.

When I finally recovered, the doc referred me to a melanoma specialist, who decided I needed another three months of recovery time. Plus, he wanted to see if the ipi was still doing its tumor-shrinking thing. Alas, that was not the case.

Although these drugs have a wonderful track record, the docs can’t predict whether a particular patient will respond to the drug without side effects. My oncologist knew I had the BRAF gene which made treatment potentially effective. In my case, the cure seemed worse than the disease.

The medical field continues to develop more of these drugs, some of which have fewer side effects and better results. I hope medicine will also determine a patient’s response more accurately. I don’t want anyone to suffer what I did.

Increasing the melanoma survival rate from six to nine months to ten to twelve years is a wonderful achievement, but thousands are waiting for complete eradication. Fortunately for me, my current treatment resulted in no tumors visible in the latest CT scan. Pray that the drug will be completely effective and I can beat the survival-rate odds. Thanks.

Immunology, Part 2 – Clinical Study

In August 2016, I entered a clinical study. I wanted to participate in the possible cancer written on beachdevelopment of new drugs for cancer.

In this case, the docs wanted to use three drugs to see if they together would be more effective than any of them alone. I took two of the drugs by pill with a “run-up” period that gradually increased the dose. The third drug was administered by infusion.

The medical tests were intense. Every week, I had blood tests. I regularly had EKG and CT scans. They even threw in a PET scan for good measure. The docs also took biopsies, which required sedation, and a detailed ophthalmology exam.

I did well for a while but then developed problems with liver levels. The docs stopped one drug and reduced the other. Ultimately they had to stop treatment altogether because the drugs also lowered my sodium levels and landed me in the hospital for two days.

The sodium returned to normal after restricting my water intake. The liver problem was tougher and required prednisone. The steroid accelerated cataract development and resulted in two cataract surgeries after a year.

Clinical trials are necessary in the development of new drugs, including the immunology drug I take now. I’m grateful for patients who participated in that study and hope my statistics will help the next generation.

 

 

 

Immunology, Part 1

Immunology is a new class of drugs. The FDA approved the first drugpills an syringe in 2011. Now there are myriads of them.

Keytruda or pembrolizumab, like other drugs in this category, works with the immune system to help detect and fight cancer. Each works with different kinds of melanoma and boosts the immune system in a different way.

In this case, cancer may use the PD-1 pathway to hide from the T cells the immune system sends out. Keytruda blocks this pathway so the T cells can detect and fight cancer cells.

Unfortunately, the immune system can also attack normal cells. This can lead to side effects. The most common are fatigue, cough, nausea, itching, rash, etc. Compared to other kinds of drugs, these side effects are relatively mild.

BTW, Keytruda is the drug I’ve taken for over a year with only fatigue and rash showing themselves. The last CT scan showed NO tumors. Hooray for modern medicine!

In future posts, I’ll describe other drugs and how they work. Stay tuned!