Tx Plan 7/10/2023

Here is the plan, concurrent with neurosurgery to come, from my 7/10 video call with my oncologist:

Assessment and Plan--

Kyle E Clarke is a 58 y.o. man with metastatic melanoma involving the brain now with a new imaging finding concerning for a new relapse in the brain.

 

I suggest that the patient keeps his appointment with Dr. Theodosopoulos in Neurosurgery to see what his surgical options are. This surgery is not excessively morbid and thought to be likely to have some significant clinical benefit; this could be considered independently. I would like to resume full doses of ipilimumab and nivolumab, namely 3 mg of ipilimumab with 1 mg of nivolumab every 3 weeks for 4 doses. Because the patient has had recent exposure to these agents, I will add a booster dose of 2 mg of ipilimumab as soon as possible and I'll ask my staff to schedule/make arrangements. In 3 weeks after this dose, I will give the patient both drugs in accordance with the standard of care regimen. The patient expressed understanding and would like to proceed on this basis. I will coordinate care with Neurosurgery and Radiation Oncology as appropriate and I do not think that exposure to a regimen of ipilimumab and nivolumab will preclude surgical intervention.

 

I reviewed the patient's medical information and medical history.

 

I have reviewed the past medical, family, and social history sections including the medications and allergies listed in the above medical record.

I discussed my assessment and plan with the patient, who indicates understanding of these issues and agrees with the plan. Our contact information including the call center number (415)353-9900 was reviewed.

 

Complexity: High -- Managing serious malignancy and coordinating multidisciplinary care

 

Acuity: High -- Life-threatening illness

 

I spent a total of 30 minutes on this patient's care on the day of their visit excluding time spent related to any billed procedures. This time includes time spent with the patient as well as time spent documenting in the medical record, reviewing patient's records and tests, obtaining history, placing orders, communicating with other healthcare professionals, counseling the patient, family, or caregiver, and/or care coordination for the diagnoses above.