It's been a while, but I've been "doing things," most recently getting over anemia. Apologies - I feel a lot better.
Catherine posted a while ago about this trial of a drug currently called DEDN6526A by Genentech/Roche – details at clinicaltrials.gov, trial NCT01522664. It uses something called ADC
technology, which is the hottest wrinkle in cancer therapy these days, and this is the first ADC
drug specifically aimed at melanoma. The first ADC
drug to be FDA approved "came out" 2 weeks ago, for Her-2 breast cancer, the most aggressive form. Many more ADC
drugs are "in the trial pipeline" at present, and you'll likely hear about them soon if you haven't already.
I am just back from visiting Sarah Cannon in Nashville, where I met with Dr. Infante and his group about this, and it is very exciting, but very slowly accruing patients (1 every 3 weeks, there, The Angeles Clinic, and Karmanos in Detroit, I believe - this last needs confirmation - also 2 sites in Australia). It’s been going on for over a year, and response rates look extremely good – comparable or better than anti-PD1 rates (though numbers are really small at this stage, so no truly reliable percentage estimates). Genentech is talking about expanding the trial to other centers – a good sign. The ADC
approach is a targeted chemotherapy, not an immunotherapy (so prior use of Ipi, anti-PD1, etc are not exclusions). The nasty killer chemo payload (Auristatin) is linked to an antibody molecule that is specific to a melanoma cell surface target (endothelin-B), so a tiny amount of the chemo is directly delivered to tumors, where it’s taken in and causes tumor cell death - not to normal tissue. Side effects are therefore minimal and responses are clear (or not) by 6 weeks. They have now pretty much ascertained the effective dose, so there’s no worry about getting too little or too much drug, as often is the case in phase 1 trials. It's apparently surprisingly effective for ocular melanoma patients, as well - I was told by an ocular melanoma patient going to Sarah Cannon that both OM patients in the trial had responded well - remarkable if true.
I want to do the trial, especially since I have few other options. It will mean being in Nashville for the first month of the trial (staying gratis at their Hope Lodge), plus weekly visits for the year duration of the trial, assuming I get a response. So that’s a major issue…People who continue to get a response will have access to the drug after the trial.
For more information on ADCs, here are a couple of links – others can be found by googling things like “antibody-drug conjugate cancer review”:
Key research article (Asundi et al. 2011 out of Genentech) - http://clincancerres.aacrjournals.org/c ... /965.short
Visual description of how ADCs work in cancer (put out by Genentech) – http://www.gene.com/stories/understandi ... conjugates