Sunday, May 8, 2016

Interesting trial options, for Josh..... thinking about melanoma treatment options for with Stage IV melanoma, having had local excision with negative nodes in 2011. Negative scans until 2013...when local recurrence was resected and found to be melanoma...then 2 spots in lungs show up on scans....leads to treatment with 4 doses of ipi followed by high dose IL2.  NED until another recurrence at original scar is melanoma positive in Jan 2015 and nivo was started.  Now with "2 small spots in lower back".  

I like the idea of intralesionals.  I like immunotherapy combo's as well as BRAFi combo's.  IDO inhibitors and CDK inhibitors seem to hold promise.  Radiation, especially combined with other systemic treatments can also be beneficial.  Trials are tricky because they are trials...and because of all their weird inclusion/exclusion requirements....that are printed, then adjusted....they apply and don't apply to various arms/cohorts.

Here are some trials that dear Eric sent to me that look promising....

Study of IDO Inhibitor in Combination With Checkpoint Inhibitors for Adult Patients With Metastatic Melanoma

Now this one gets tricky because different arms have different exclusion criteria....some won't allow participation if you've had prior ipi or IL-2...but other arms are different.  So...I think worth looking into.

INCB039110 Combined With INCB024360 and/or INCB039110 Combined With INCB050465 in Advanced Solid Tumors
Here a JAK inhibitor is being used.  Not too many exclusions except an ill defined wash out period from other treatments and this:  "Active or inactive autoimmune process."

Epacadostat and Vaccine Therapy in Treating Patients With Stage III-IV Melanoma
Prior immunotherapy appears allowed with washout, including if progression occurred while on those therapies. No immunotherapy  induced "significant" autoimmune disease.

So....not trying to sell participation here.  Just things I might look into if I needed treatment. If interested in ANY trial despite thinking an exclusion might!  Call the doc or the trial coordinator (or have your doc do so) cause those things get modified all the time and the clinical trials site is not always kept completely up to date.   love, c


  1. Hi
    I just wanted to Thank you for the blog. It has be wonderful for me. I am Vick Arnold a 54yr old from Seattle. I am going to start adjuvant therapy for Stage 3b melanoma. Yervoy/ipi. I am nervous about side effects. I am recovering from a groin lymph node dissection. I could really use help maintaining a positive attitude.

  2. I'm glad you've found my blog helpful, Vicki!! Not sure what I can tell you about being positive. I guess the way I look at things is.... You could hide your head under the pillow and pretend melanoma doesn't exist....but I don't think that is positive nor helpful. And you're not doing that!!! You are attacking things head on with your planned treatment with that's positive. You could live in dread of every possible side effect occurring or fear that every new odd sensation or pain is due to those side effects or a melanoma recurrence...but that wouldn't be very positive or helpful either. At the same time, ignoring things your body tells you would be back to hiding your head under the pillow. Side effects can be serious, but usually manageable if addressed in a timely manner. So I guess being positive for me is....being real, living in the moment, finding the beauty in small things, doing the best you can, being grateful for the things and people that you love. You got this!!! c