Immunotherapy - anyone tried Keytruda + Opdivo combination?

Had my surgery in December and my oncologist's pushing the same combo on me, Stage II but they want to be aggressive. Side effects are no joke, man. Fatigue hit me harder than I expected and some inflammation issues, but so far holding steady. You got this.

Yeah I'm peritoneal like Patricia mentioned, not pleural, but my onc talked about this combo too before we went a different route. Main thing I'd ask your doc about is the logistics. Like how many infusions, what's the schedule looking like, and be real clear on what your insurance is actually gonna cover. I learned that lesson the hard way. Side effects wise, William's right about the fatigue being rough. For me it wasn't just tired, it was like my body just shut down some days. But talk to your team about managing it ahead of time, not after you're already wiped out. And honestly? At our stage you gotta weigh the aggressive approach against quality of life. Not saying don't do it, just saying go in with your eyes open about what you're signing up for. Good luck with it.

I'm peritoneal not pleural so our situations are different, but I've been deep in the literature on immunotherapy combos since my diagnosis last month. CheckMate 743 is solid, the median OS was around 18.1 months for the combo versus 14.1 for chemo alone if I'm remembering the numbers right. But the immune-related adverse events are no joke. Grade 3-4 irAEs occurred in like 60% of patients in that trial, which is... a lot.

My oncologist here in Cleveland is actually recommending I pursue HIPEC first since I'm stage II and potentially resectable, then reassess immunotherapy after. But if I end up doing systemic therapy I'm definitely going to ask about the sequencing and timing. Like whether they'd do induction chemo before the nivolumab/ipilimumab or go straight in. The CheckMate data was mostly chemo-naive patients I think?

Have you asked your doc about your specific mutation status? I know for pleural they're looking at BAP1 and other markers now. Also what's your performance status. That matters a lot for how you'll tolerate the dual checkpoint inhibitors. Those irAEs can hit your GI tract, lungs, and endocrine system pretty hard.

Hey David, I'm Sarah, I'm a nurse practitioner and my dad was diagnosed with stage IV pleural back in March, so I've been living in this world pretty intensely. He's not a candidate for the combo anymore given where he's at, but I watched his oncology team discuss this extensively when we were exploring options early on.

The CheckMate 743 data is legitimately good, median OS of about 18 months versus 14 with just pemetrexed/cisplatin, which is real. Still, the immune-related adverse events (irAEs) are what kept us up at night discussing with his team. William's right about fatigue being rough, but it can also be the autoimmune stuff that sneaks up on you, colitis, pneumonitis, hepatitis. With the combo you're looking at higher rates than single-agent immunotherapy because the ipilimumab really ramps up immune activation.

What I'd push you to nail down with your oncologist: have you had baseline bloodwork and imaging to establish what your baseline inflammatory markers look like? And honestly, biphasic cell type doesn't change the immunotherapy approach but epithelioid tends to respond better overall than sarcomatoid if that's what you are. Also ask about their monitoring schedule. My dad's team did labs and scans every 3 weeks during treatment, which was intense but caught things early.

The side effect profile is manageable if you've got the right support structure and you're watching for symptoms. But it requires real vigilance. Don't minimize anything that feels off.

The fatigue William mentioned, yeah, that's real and it hits different than regular tired. My dad's on palliative care now so we're past the immunotherapy window, but watching his oncology team manage side effects taught me that knowing what to expect actually helps you get through it. Your biphasic status shouldn't change the recommendation since CheckMate 743 enrolled across all histologies.

Yeah I get the nerves. My docs wanted to hit me with chemo after my EPP back in Feb and I was same boat as you. Thing is, this combo's gotta be better than the old stuff they used to do, right? My tune-up starts next month so I'll let you know how it goes but sounds like you're in good hands with an onc who knows the latest.

Joe started the Keytruda and Opdivo combo back in November, right after his diagnosis in September, so we're about three months in now. I won't sugarcoat it, the fatigue William mentioned is real, but what nobody's really talking about yet is the mental piece of it all. Like, I spent thirty years teaching kids how to handle setbacks and failure, right, but watching your husband deal with the exhaustion and the uncertainty about whether it's working... that's a different kind of lesson. What helped us was getting really clear expectations from his oncology team at Tampa General about what "normal" side effects look like versus when to call. They gave us a specific sheet with timeline stuff, like when the worst fatigue typically hits and when it might ease up. Joe's had some skin rashes and we're watching his liver numbers, but so far no major hospitalizations. The CheckMate data is encouraging, truly, but I think what matters most is having an oncologist who checks in regularly and doesn't just send you home with a pamphlet. How often is your doctor planning follow-up scans to see if it's actually working for you?