Treatment decisions

Last week Jeff visited three oncologists at different institutions in order to get multiple opinions on treatments. Based on these meetings, two out of three doctors recommend starting immunotherapy due to a 30% risk of recurrence, while the other recommended monitoring with scans and frequent blood/skin checks.

Our decision on whether to use immunotherapy had to be balanced by considering side effects, which have the potential of being significant and, in infrequent cases, permanent. So with immunotherapy instead of a 30% chance of the melanoma returning, he would have a 15% chance of recurrence and a 15% chance of serious side effects – about even. The oncologist at Georgetown recommended monitoring, primarily because he weighed the risk of side effects more heavily than the potential for benefit (I have a 70% chance of being completely cured without any future treatment, however if the cancer returns it will likely be harder to treat at that point and could be a distant metastasis).

After meeting with these three oncologists (Georgetown, Johns Hopkins, and Inova) and dermatologist that specializes in melanoma (Inova) we weighed the potential risks and benefits and decided to move forward with immunotherapy treatment with Dr. Lipson at Johns Hopkins (which partners with Sibley in DC, so we do not have to drive all the way to Baltimore for every appointment). This decision was difficult, but we feel it will give us the best chance of preventing any potential recurrence.

Jeff had a follow up appointment with Dr. Lipson today and expects to start treatment on February 27. He will be taking Opdivo, which is given intravenously every four weeks, and is a PD-1/PD-L1 inhibitors. These types of drugs “supercharge” the immune system, and help the existing T-cells better recognize and attack cancer cells. Jeff plans to tolerate treatment well (fingers crossed!) and will continue for one year or until the treatment becomes too toxic.