Low dose nivolumab, ipilimumab and IL-2

Dear Rene and Edward,

as you may recall, we have been in touch before regarding my wife (33 years old) who has stage IV EGFR positive NSCLC. On the last scan there are signs of progression in the lung. She is currently on osimertinib (a targeted drug for EGFR mutant lung cancer) and she has also been on low doses of nivolumab, ipilimumab and a personalized vaccine. Despite this, there seems to now be progression.

We are currently considering one treatment option which I wanted your opinion on. The standard treatment that will be offered here in Oslo will depend on a PET scan which was done yesterday, but quite likely we will be offered to do stereotactic radiation of the growing lesion in the lungs. We believe this is a good option and will most likely go ahead with this. The treatment option we would like your opinion is the following:

-Low dose nivolumab (0.5 mg/kg) weekly for 3 weeks
-Low dose ipilimumab (0.3 mg/kg) weekly for 3 weeks
-After the third injection of nivo+ipi, one week of IL-2 treatment which will be tailored to induce a certain level of fever. The IL-2 treatment is, by the way, done under "taurolidine
protection" (based on this paper I believe: https://link.springer.com/article/10.1007/BF03168992).

The treatment is offered by Dr Ralf Kleef in Vienna, Austria. Note that there are also some other details in the treatment which I believe are not so important, but which is anyway seem to be part of the "package". These other things include whole body hyperthermia and some yogurt containing some good gut bacteria. Here is a case report that Dr Kleef has published as an abstract at ASCO 2016: http://ascopubs.org/doi/abs/10.1200/JCO.2016.34.15_suppl.e23111. It gives some more details on the treatment offered.

Can I ask what you would think of the above treatment?

Kind regards,

Lars
(Oslo, Norway)