It's been a while since we updated here, so wanted to provide everyone an update...
The initial immunotherapy treatment of Ipilimumab and Nivolumab was slated for four rounds of infusion, each three weeks apart. The first one was administered as an inpatient at MD Anderson about a week after initial diagnosis (back in April) of Stage IV cancer of lungs, liver, brain, and a couple of other random places. There were ultimately two more rounds of infusion at MD Anderson (for a total of three) before Erica's liver began to shut down. They identified her liver enzymes were way out of whack, so in mid June it was decided the the fourth infusion wouldn't happen. Some people have tolerated all four infusions, but it is more common for complications to occur after two to three infusions than not.
They gave her a very strong steroid to help the liver recover and within a few weeks the liver enzymes returned to normal levels. The second phase of treatment was then able to begin. Nivolumab by itself is infused every other week. In August she began the Nivolumab only infusions. Nivolumab is less strain on the body because it works by making the tumors less able to hide from the immune system. Ipilimumab that was mixed in to start is much harder on the body because it basically makes the immune system uninhibited and can attack otherwise healthy parts of the body.
We set up a relationship with the Center for Cancer and Blood Disorders in Fort Worth so that she can get the every other week infusion of Nivolumab done locally. She typically feels very fatigued for a few days after the Nivolumab infusions, but hasn't experienced any severe side effects to this point. The Nivolumab is approved for up to 2 years of every other week infusions and will continue so long as no complications present that would require stopping and there is no progression of disease.
Scans at about the three month mark continued to show no evidence of new disease and the tumors were continuing to shrink or remain the same. In the beginning it was thought that she would be undergoing a pin point type of radiation to address the initial brain tumors, but the doctor ultimately decided to wait to see how the response went with the infusion treatment. That was a good call because in early August we learned that all of the brain tumors appeared only as the remains of the dead tissue from the tumors and they were all basically gone. At the three month mark the liver that was previously swelled to almost double normal size was also back to normal size and shape.
On October 17th we went to MD Anderson for the 6 month follow up. Scans revealed that the tumors are remaining the same size or still shrinking some. They did identify that a new brain tumor has formed. It was decided that Gamma Knife pin point radiation will be used to treat/destroy the new brain tumor. It is very, very small and the doctor is confident that the radiation will kill it. The first week of November we will be back at MD Anderson for two separate appointments to prepare for the pin point radiation procedure. We expect the procedure itself will be within a week or so following those appointments.
Erica is amazing! She returned to work for the new school year and has spent zero moments dwelling on any of this. She is constantly stuck with needles and has been through so many scanning machines that I lost count a long time ago. We have been to the emergency room three times with scares related to severe pain and she just bounces right back. She recently told me that she "will" be an old lady and that I will probably die before her. That is just fine by me and something I look forward to!
Treatments referred to as immunotherapy are the most advanced and promising cancer treatments to date and they are finding success with different forms of cancer. The latest research is learning how the malignant cells of various forms of cancer are able to evade the bodies immune system and not be attacked like any other foreign virus or bacteria. The most promising potential is that after immunotherapy treatment the body may "learn" the signature (or antigen) of the mutated cells (melanoma) and be able to address/attack them long term on its own. Ipilimumab was first approved by the FDA for treatment of melanoma in March of 2011. Nivolumab was first approved by the FDA for treatment of melanoma in December 2014. So these are very new treatments that are revolutionary, considering that prior to them there was really no effective treatment of late stage malignant melanoma. Erica's original diagnosis with Stage III melanoma was in January 2010, where she had a malignant mole and positive lymph nodes it had spread to. She went 8 years clear/undetected before this internal/distant spreading occurred.
The support she/we have received has been overwhelming and we are very appreciative and feel so blessed. Our little family of four are enjoying our lives and all staying positive while we support Honey/Babe/Mom/Momma. The boys will be 13 and 16 in January. With the obvious stress of cancer we are also living with a learner permit driver regularly behind the wheel! Watch out world!
Well, no news is good news in this case going forward. We will definitely update in future if anything warrants.
Love to all,
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Harvey & Erica Braden
Journal of our journey with a Metastatic Melanoma Diagnosis. Erica was diagnosed Stage 3 in January 2010 and then Stage 4 in April 2018.