The definition of progression on vemurafenib (zelboraf) has a definition in clinical trials but does not necessarily have the same one in clinical practice. The issue of how much disease progression to “tolerate” before discontinuing vemurafenib is a difficult issue as many patients were treated beyond the first evidence of progression even in the clinical trials and some patients fared well thereafter. Much of the decision is influenced by the issue of whether there are other therapies to pursue (in other words, whether the patient has received ipilimumab previously or not). Similarly, the availability of a compelling clinical trial influenced the decision with regard to how quickly one considers discontinuing vemurafenib in the face of disease progression.
Thankyou so much for sharing this with us Dr Flaherty, can the same thing also be said about Ipilimumab? As many people report a mixed response on forums and I often wonder what that really means and some continue and some stop Ipilimumab.
I think we are all pioneers with these new therapies and it will take time to sort it out. I did find out with PD1 that in Pati’s case they seemed to know after a short time definitively whether it was creating a response or not. A judicious doctor is so important in the scheme of things.
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