Wednesday will mark my third dose of Ipi-Nivo — a small number that carries an enormous weight. Each infusion is more than medicine; it’s hope flowing through a line, courage disguised as routine, and faith that my body can keep fighting even when I’m tired of being brave. I walk into this treatment room carrying fear, resilience, and a quiet determination to keep going — not just to survive, but to live, to love, and to believe in what might still be possible.
Each of the 4 induction doses of ipi + nivo isn’t just “more of the same.” Biologically, they do different jobs over time in training and shaping your immune system.
Let’s break it down simply.
First: what each drug does
Ipilimumab (CTLA-4 inhibitor)
Think of this as immune boot camp.
It:
• Activates new T-cells
• Broadens the immune response
• Removes early-stage immune brakes
• Helps the immune system learn what cancer looks like
This is powerful — but messy and inflammatory.
Nivolumab (PD-1 inhibitor)
Think of this as frontline battle support.
It:
• Keeps activated T-cells alive
• Stops them being switched off by the tumour
• Allows long-term immune surveillance
• Sustains the attack
This is more targeted and safer long-term.
Now: what each dose is doing
Dose 1: Immune awakening
This is the shock to the system.
Biologically:-
• Naïve T-cells become activated
• Cancer antigens are recognised
• Immune diversity expands
• The immune system starts learning what melanoma is
This is where many early side effects begin — because your immune system is being turned on hard.
Think:
“Something is wrong. Wake up. Attack.”
Dose 2: Expansion & targeting
Now the immune system starts to multiply the right fighters.
Biologically:
• Cancer-specific T-cells rapidly expand
• Memory T-cells start forming
• Tumour microenvironment begins to change
• Immune infiltration into tumours increases
This is where:
• Tumours may swell temporarily
• Inflammation can rise
• Symptoms can flare
Think:
“This is the enemy. Make more soldiers.”
Dose 3: Deep conditioning
This is about depth and durability.
Biologically:
• Immune memory is being locked in
• The immune system refines its target
• Long-lived T-cells develop
• Suppressor signals from the tumour are blocked more effectively
This is often when:
• Autoimmune side effects appear
• Organs like bowel, liver, thyroid can be hit
Why? Because the immune system is now strong enough to attack anything it thinks is foreign.
Think:
“Never forget this enemy.”
Dose 4: Immune imprinting
This is the final training phase.
Biologically:
• Immune memory becomes durable
• Surveillance mode is established
• Long-term recognition is reinforced
• The immune system is “programmed” for long-term control
After this, ipilimumab is stopped because:
❌ It’s done its job
❌ Further doses don’t add benefit
❌ Toxicity risk skyrockets
Think:
“You now know this enemy for life.”
Then: Nivolumab alone (maintenance)
This isn’t weaker — it’s smarter.
Biologically:
• Keeps trained T-cells active
• Prevents immune exhaustion
• Blocks tumour evasion
• Maintains long-term control
It doesn’t retrain — it maintains.
Why this matters for real patients
This is why:
• Some people respond after 1–2 doses
• Some people never make it to dose 4
• Some people have lifelong remissions
• Some people must stop early due to toxicity and still get the benefit because immune memory forms early.
Going through IPI-NIVO is an emotional tightrope — hope on one side, fear on the other. Every infusion carries the weight of possibility: that this powerful treatment might be the one that works, that your immune system will rise up and fight, that you might be one of the lucky ones. But alongside that hope sits uncertainty, the waiting, the scan anxiety, the quiet questions you ask yourself at night. Still, you show up. You trust. You believe. And in that belief, there is strength — a fragile, fierce hope that this chapter could turn toward healing.
