Nivolumab + cortisone for arthritis - 1272529

dorie4
Posts:29

I will have my 6th infusion of Nivo. this week and have been having increasingly severe pain in my knees (probably from overuse), my left in particular. In the past, cortisone shots have been very effective for various joint pains, but I don't know whether it would be contra-indicated with Nivo.

I understand that infusions must be stopped if steroids are needed to treat significant side effects, but I can't find anything here or elsewhere as to whether or not this is the case with a single shot. I'll ask my oncologist when I see her next, but if any of you can answer or point me in the right direction, I thought it might be helpful for other readers to know as well.

Thanks!

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Reply # - January 10, 2016, 03:21 PM

catdander
Posts:

Hi Dorie,

I hope you are doing well on nivo. I don't know the answer to that but will ask our oncology pharmacist.

Best of luck and hopes,
Janine

Reply # - January 11, 2016, 05:58 AM

dr walko
Posts: 102

Dorie,

Your question is a good one and I definitely recommend discussing with your oncologist about the best way to proceed. Since I'm not sure the exact cause of the joint pain, it may be able to be managed with non-steroid options, which may be preferred but the cortisone shot may not be completely contraindicated. Nivolumab works by keeping your immune system turned and helping it recognize the cancer. Steroids do a variety of things, including decreasing inflammation (which is why they work for some pain) but decrease the immune system. This is why we use steroids to help with some of the side effects of drugs like nivolumab, but try to avoid them unless they are really needed. There is some evidence that use of steroids for managing toxicity with drugs similar to nivolumab does not decrease the efficacy of the immunotherapies like nivolumab, but this should be a discussion with your doctor who knows you well so you can weigh risk and benefit.

Best wishes,
Dr. Walko

Reply # - January 11, 2016, 08:07 AM

dorie4
Posts: 29

Thank you Janine and Dr. Walko for your replies. I am so impressed with the quality and thoroughness of information provided on this site by moderators and professionals alike. There isn't anything like it that I've found on the internet. I hope you all know how much you are appreciated.

Just for the record, my oncologist is well aware of my knee problems and has prescribed two different NSAIDs which have had limited effect. So I'm happy to pass along the information you've provided.

It appears that most people here provide a summary of their dx and treatments, so here goes:

Dx with Extensive stage combined small cell and large cell neuroendocrine carcinoma 4/15, age 72.
Treated with 6 infusions carbo/etopisde 5 to 9/15; minimal side effects but only partial response.
Nivolumab 10/15 to date; CT due 1/21/16

Reply # - January 11, 2016, 08:56 AM

catdander
Posts:

Thank you for the nice compliment. I know how important the site has been for me and I'm honored to be a part of it.

I hope the nivo has great efficacy for you and hope you'll let us know what the scans say. FYI, sometimes the immunotherapies look as if they aren't effective in the first scan so don't be too worried if the scan doesn't show shrinkage...especially if you're not feeling worse.

If you'd like you may want to make your summary permanent by pasting it to the "signature" on your profile. Copy your summary
click "dorie4" to the left of your posts
click edit bio and signature
paste it to the signature box
click Save Display Name, Bio & Forum Signature

The "bio" shows up on the profile page and the signature shows on the bottom of all your posts. (both of mine are the same but you don't have to do both)

Best of luck,
Janine

Reply # - January 11, 2016, 04:23 PM

dorie4
Posts: 29

Thanks for the posting tips, Janine. Now we'll find out whether I followed your instructions!

Dorie

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