Votrient to Opdivo after 3 months. Thoughts?

BellaBinksMom

I met with my oncologist yesterday and he wants to take me off of the 800 mg Votrient and start Opdivo.  

I am currently "stable" on Votrient with a small tumor burden - appx. 1.8 x 2.3 cm mediastinal lymph node with mild pet scan activity, 2 nodules both still "indeterminant" due to size.

Given the small tumor burden, my oncologist believes that starting Opdivo now gives me an excellent chance at remission versus continuing stability on Votrient.  If the Opdivo does not work, I can go back to the Votrient.

Just wondering if anyone has a thought, experience, or opinion on this course of treatment?  It certainly makes sense to me that hitting smaller tumors with Opdivo rather than waiting for progression when Votrient stops working would be the right course of action.  Then again, stability is not such a bad thing.  

Thanks for your thoughts.

Debbie

sblairc

Sounds good!

I would do it. And if you were my husband, (he had the cancer, not me) I would push for it.

 Immunotherapy as that possibility for remission. I say GO FOR IT. 

Best of luck to you. 

Footstomper

sblairc said:

Sounds good!

I would do it. And if you were my husband, (he had the cancer, not me) I would push for it.

 Immunotherapy as that possibility for remission. I say GO FOR IT. 

Best of luck to you. 

Drugs

It worked really well for me for about six months. It kicked the tumours for six but ended up unliveable. It works really well for some people.

saintmont

opdivo

Hi, Definetly try opdivo mininal side effects. I have had good results on opdivo.

saintmont 

foxhd

saintmont said:

opdivo

Hi, Definetly try opdivo mininal side effects. I have had good results on opdivo.

saintmont 

I think

that you should cut the votrient to 400mg and see if you remain stable. I believe you have to fail a TKI (tyrosine kinase inhibitor) like votrient, before ins. will cover nivo. Now that cancer is a part of your life, the rules change. We all want to be free of disease but have already lost that game. You may remain growth free for a couple years at 400mg votrient. And with min. side effects. Then, maybe, in time the "cure" will be available. I've just switched from votrient to nivo but I had new growth and I was at my limit of tolerence for SE's. The general thought is to ride out a drug as far as it can go prior to changing.

Also, it sounds like the doc wants the effects of Il-2 using nivo. Consider Il-2 then. After Il-2, you can tolerate anything if it doesn't work.

Footstomper

foxhd said:

I think

that you should cut the votrient to 400mg and see if you remain stable. I believe you have to fail a TKI (tyrosine kinase inhibitor) like votrient, before ins. will cover nivo. Now that cancer is a part of your life, the rules change. We all want to be free of disease but have already lost that game. You may remain growth free for a couple years at 400mg votrient. And with min. side effects. Then, maybe, in time the "cure" will be available. I've just switched from votrient to nivo but I had new growth and I was at my limit of tolerence for SE's. The general thought is to ride out a drug as far as it can go prior to changing.

Also, it sounds like the doc wants the effects of Il-2 using nivo. Consider Il-2 then. After Il-2, you can tolerate anything if it doesn't work.

Nivo/Optivo

Been on Nivo for 3 weeks, no side effects ( so far, touch wood throw salt over left shoulder etc) apart from feeling a bit fluey which could be

a) Impening death

b)the start of side effects

c)the flu

d) Nothing 

If it carries on like this, and gives my lumps a good kicking I will be well satisfied

Fox, what do you mean about combining it with IL2. That sounds like lunacy! Optivo, from what I read seems to be the best out there at killing the cancer without too many side effects. My Oncologist seemed very keen to get me on it ASAP. I get the impression(tho' its too soon to say) that Nivo is both more effective and has less remarkable side effects

 

 

foxhd

Footstomper said:

Nivo/Optivo

Been on Nivo for 3 weeks, no side effects ( so far, touch wood throw salt over left shoulder etc) apart from feeling a bit fluey which could be

a) Impening death

b)the start of side effects

c)the flu

d) Nothing 

If it carries on like this, and gives my lumps a good kicking I will be well satisfied

Fox, what do you mean about combining it with IL2. That sounds like lunacy! Optivo, from what I read seems to be the best out there at killing the cancer without too many side effects. My Oncologist seemed very keen to get me on it ASAP. I get the impression(tho' its too soon to say) that Nivo is both more effective and has less remarkable side effects

 

 

didn't mean as a combo

just throwing out the other side of the coin. She has great options.

NewDay

foxhd said:

didn't mean as a combo

just throwing out the other side of the coin. She has great options.

Possible serious side effects

I struggle with whether I want to jump on that bandwagon.  It is my doctor's plan when the Axitinib stops working.  I know that, so far, most of the people posting here and on SP have been saying that they have few side effects, but it is clearly documented, that some can be very serious and cause you to discontinue treatment and end up on high dose steroids. I know that the side of effects of TKI's can badly affect QOL, but some Nivo side effects can be deadly. 

"Study therapy was discontinued for adverse reactions in 16% of OPDIVO patients and 19% of everolimus patients. Forty-four percent (44%) of patients receiving OPDIVO had a drug delay for an adverse reaction. Serious adverse reactions occurred in 47% of patients receiving OPDIVO. "

Since it was only recently FDA approved, maybe it hasn't been long enough for us to start seeing them or maybe we won't seem them and then I can get on the bandwagon.

 

Dutch1

Agree with Fox

From a layman's perspective and using what I've learned about cancer over the last three years, my tendancy would be to stay on the Votrient until the side effects were intolerable or until the cancer figured out how to overcome this drug.  We only have so many options with this disease.  I'm not going to jump from a drug that's doing well for me only to replace it with one that is unknown as to side effects and effectiveness.  My daughter has heard about Opdivo, too.  She's asked about going on that.  Well, that would be fine if Opdivo could cure this lousy disease.  I'd go for it in a minute.  But, because these drugs usually only delay the cancer's progress, I want to hold out my options for as long as I can.  I want to extend the game.

In fact, I'm on Votrient now.  After a few months from starting with it, my liver readings have gone way out of line.  I've been off of it for two weeks now, hoping to be able to get back on.  If my liver still isn't happy with Votrient at next week's blood workup, maybe I have to go to one of the remaining drugs that are out there for me.  If so, the number of my future options will have been reduced sooner than what I had expected.  Sure, one can always go back to previously-used drugs.  Maybe they'll work the second time around. 

My oncologist wouldn't give the advice yours gave to you.  Who knows which one is right?  Do you have another oncologist who you can go to for a second opinion?  That would be a good idea.

Dutch

mrou50

I have done both

Having done Votrient and currently duing Opdivo, I agree with Dutch if isn't broke don't fix it.  If Votrient is working let it work until it stops then go the next level. That is how my oncologist is approaching this with me, he said think of the drugs as antibiotics, just stay with the drug while it works then move on, if you switch back and forth the cancer is not as vulnerable to Votrient, saying you go to Opdiva  and then come back to Vortrient.  Opdiva will be there when it is needed for now in my opinion let Votrient do it's stuff.

 

Mark

sblairc

She used the word "remission." Perhaps there is a "window"

Perhaps there is some sort of "window" for the drug to take a stronger effect on the cancer when the disease is "inactive" like it is now. 

I guess that was what I took from the original post (i.e., that the oncologist believes that this is a good time to try the drug in order to achieve remission) 

I think the other posts make a lot of sense (RIDE THE WAVE OF STABILITY!!) before switching drugs except it seems like Bella's oncologist might be suggesting the switch at this time to achieve a more durable, long lasting remission. 

Not sure if that's the case or not. 

 

MattInVa

sblairc said:

She used the word "remission." Perhaps there is a "window"

Perhaps there is some sort of "window" for the drug to take a stronger effect on the cancer when the disease is "inactive" like it is now. 

I guess that was what I took from the original post (i.e., that the oncologist believes that this is a good time to try the drug in order to achieve remission) 

I think the other posts make a lot of sense (RIDE THE WAVE OF STABILITY!!) before switching drugs except it seems like Bella's oncologist might be suggesting the switch at this time to achieve a more durable, long lasting remission. 

Not sure if that's the case or not. 

 

Im riding the Votrient wave

Im riding the Votrient wave to the end of its usefulless.

 

Eliezer2

an mets and i say go for opdivo

maybe together with yervoy

 

alrho i was able to coast 4 years just on sutent

Pbaxter

Votrient opdivo and yervoy

how soon do you have to stop votrient before taking yervoy and opdivo?