Patient Introduction

Hello, my name is Ken. I am 60 years old. About 15 years ago, I had a melanoma on my back that was treated with Mohs surgery. Now it seems like it may have returned and spread. I had a biopsy, and now I am ready to talk to my doctor about my latest test results.

Question #1

Ken, how are you feeling? Tell me about your energy level, on a scale from 1 to 10, and your ability to do normal activities.

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Question #2

Are you having any other symptoms? For example, vomiting, diarrhea, blood in stool, difficulty swallowing, weight loss, respiratory issues, chills, fevers, night sweats, or pain?

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Question #3

The liver biopsy told us that your melanoma has spread to the liver. The CT scan also shows that it’s in the lung, liver, and lymph nodes near the stomach, making it stage IV. The brain MRI didn’t show any melanoma.

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Question #4

Surgery isn’t practical because the tumors are in multiple places. But we have treatment options to relieve symptoms and likely prolong your life. Hopefully, with treatment, you will start feeling better soon. Many patients live years after diagnosis.

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Question #5

We usually prefer to start with medicines called immunotherapy that help your immune system fight the tumor. We prefer to use a combination of two drugs, targeting the cancer in different ways for potentially more effective treatment.

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Question #6

I’m sorry to hear about your friend’s experience; immunotherapy does have side effects, but it is different from chemotherapy. Many patients feel very well while on these medicines and we would monitor how you are tolerating treatment.

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Question #7

Immunotherapy heightens the immune response, so organs can get inflamed. Common side effects are fatigue, rashes, and diarrhea, but organs like the liver and kidneys can also be inflamed.

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Question #8

Depending on the severity, we may hold the immunotherapy until that resolves. Sometimes we treat this with steroids.

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Question #9

Approved combination therapies include the drug nivolumab with either ipilimumab or relatlimab. These are given by infusion in the vein here at our facility, which can take as little as 30 minutes.

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Question #10

Taking one immunotherapy drug is an option, but with melanoma that has spread like yours, we prefer to give the combination for the chance at the best outcome. If you have side effects, you can decrease to one drug.

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Question #11

I am happy to hear that you are open to the combination option. We can also explore clinical trial enrollment, such as a trial of new immunotherapy agents, cemiplimab and fianlimab--they’re similar to those I already mentioned.

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This activity is provided by Med Learning Group.
This program is supported by an independent educational grant from Regeneron Pharmaceuticals, Inc.

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