Melanoma: Lalit Pallan interview with Simon

After discovering a mole on his back, Simon was diagnosed with melanoma, which was found to have spread to lymph nodes under his armpits. After surgery, another scan revealed the cancer had spread to his liver and brain, indicating Stage 4 cancer. He underwent stereotactic radiosurgery (Cyberknife) to treat the metastases in his brain, Simon was also offered combination checkpoint blockade (Ipilimumab and Nivolumab), although there were concerns about high risk of potential side effects given he'd previously suffered with intermittent ulcerative colitis. After the first dose of immunotherapy, he developed Grade 3 meningitis, which was treated with steroids; after the second dose, he developed Grade 3 colitis, which was treated with steroids and Infliximab (an anti-TNF-alpha antibody) with good success. Simon then switched to single agent checkpoint blockade but developed further immune-related side effects including Grade 3 hypothyroidism and adrenal insufficiency. His colitis also returned aggressively (Grade 4) despite ongoing use of infliximab and it was felt he may need an operation to remove the entire inflamed bowel (colectomy). Thankfully, this was avoided by the subsequent use of a small molecule drug called Tofacitinib. Due to his severe colitis, his immunotherapy was discontinued after 4 doses in total, with scans showing a shrinkage of cancer deposits in brain and liver. Even after his treatment was stopped, he developed a new immune-related adverse effect of Grade 3 arthritis (joint inflammation). Now over a year since stopping treatment, he remains on methotrexate (for arthritis), mesalazine (for colitis), hydrocortisone (adrenal insufficiency) and levothyroxine (hypothyroidism), all related to his past immunotherapy treatment. He is currently cancer free and remains on regular surveillance.

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