Monday, November 30, 2015

Response to Jenny regarding adjuvant treatment options as StageIIIB:

Since in it's wisdom the Mollom software blocked my response to your post on MPIP, with questions about being a Stage IIIb melanoma patient with two recurrences and adjuvant treatment options from ipi to leukine (GM-CSF), to anti-PD1 - perhaps I can fix it so that you can see it here:

Hi Jenny,

Melanoma treatment decisions are never easy and are particularly murky for folks who are looking for an adjuvant therapy.  There are many posts on ipi as adjuvant here...including several testimonies that folks have in fact received and docs are prescribing ipi at 3mg/kg rather than the FDA approved 10mg/kg as adjuvant.  As both are on the have latitude...though payor coverage is certainly an issue.  Here's a post with an article with data re: NED folks who took ipi:

As far as GM-CSF or leukine:  Here is a post with some data that you may or may not have found:

In this webinar, Weber and Agarwala note that when ipi is COMBINED with GM-CSF "1 year survival = 68% vs 52% in patients given ipi alone."  However, I think that was from a study in patients with disease, rather than NED, but here's the link:

And, yes...there is data out there about anti-PD1 as adjuvant.  I was rendered NED via surgery and SRS to lung and brain mets in 2010 and participated in the NED arm of a Nivo/Opdivo trial.  Despite some heartbreaking losses, my fellow ratties and I are doing much better than our predicted shelf life.  I remain NED today.  Here is a published report of our data:
With the main points being:  As of 2014, my ratties and I had  an average "relapse free survival of 47.1 months" while "prior studies demonstrate 12 months as a reasonable benchmark".  And....we continue to survive.  So....  Hopefully, with its higher response rate and lower rate of side effects...anti-PD1 products (nivo/opivo and pembro/keytruda) will be approved as adjuvant therapy soon.  However, Big Pharma and the FDA move in mysterious ways and finding anti-PD1 NED trials currently is difficult if not impossible.

Pavlick is amazing and well respected.  Were I in your shoes, I would discuss these options with her and certainly give respect to her advice.  Hope this helps.  I wish you my best.  Celeste

No comments:

Post a Comment