Home Forums Melanoma Diagnosis: Stage IV my comments on anti–pd1

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  • #22419
    Jonathan
    Participant

    In a prior post I wrote some things about anti-pd1 that I had misheard or that may have been misleading. I hope the following is more accurate and less misleading.

    Anti-pd1, whether NIVO or KEYTRUDA, has a response rate, judged primarily by “significant” tumor shrinkage levels, in the 30-40% range,which is higher than those for Yervoy.That general figure does not include patients whose tumors were simply stable for 24 weeks or who had some relatively minor shrinkage. One small study reported over 70% of patients showed some tumor shrinkage during the course of the study – not necessarily lasting. BTW, it’s 87% of refractory Hodgkin’s patients that have been reported as responding to anti-PD1, rather astounding.

    There seems to be agreement that the anti-pd1/Yervoy combo is synergistic (if you can get through the heightened side-effects), and therefore the most exciting prospect. Exactly what response rate that will ultimately mean in a big study isn’t clear yet, but it’s got to be at least 50%, I’d expect.

    The special appeal of these immunotherapy drugs is the long survivorship of those who do respond.

    Also,although my oncologist though differently a year ago, it is now apparent that response rates to anti-PD1 are no different for patients with and without the BRAF mutation or Ipi response.

    One hopeful note I hadn’t heard (from my last conversation with him) – it may well be that, for those who fail anti-PD1 as monotherapy, a subsequent round of Ipi/anti-PD1 combo therapy may well make for a response. More on that in a few months…

    Best,

    Jonathan

    P.S. I’m still doing fine after 10 months on anti-PD1- back on after a short “holiday.”

    #66783
    rick1981
    Participant

    One your last note, our oncologist also mentioned he has several patients in this study that didn’t respond to anti-PD1 (Keytruda/Pembro) but subsequently did respond to Ipi/Yervoy. It’s also an option for my wife as for the moment she doesn’t seem to respond to Pembro (5 infusions) but does to the re-challenged of the BRAF/MEK combo. So a quick move to Ipi/Yervoy could be an option for 1-2 infusions..

    Rick

    #66784
    MathewR
    Participant

    Thanks for the info Jonathan. Following our last exchange I spoke with my team (UPenn) and they concurred with the “~70% benefit” figure you mentioned.

    #66785

    We met with my husband’s oncologist this week and the stats below concur with what we have heard re: ipi and anti-pdi…we have been on a journey this week as it appears he had progressed on ipi and one specialist is recommending BRAF/Mek next while the other is telling us he can definitely get the PD1 and reserve the BRAF for potential high tumor burden later down the road…I know this is counter to the FDA “order” and concern that health insurance won’t cover the PD1 unless BRAF is first. We are being told that it can be done. My husband tolerated ipi very well and has a low tumor burden at this point so we really want to stick with the immunotherapy as long as we can. Has anyone heard of the order being reversed when it is medically indicated? (I have not and am curious to see how it works out)…obviously, would never dispute the BRAF drugs at this time if tumor shrinkage was his immediate medical necessity. If he were to do the BRAF drugs now and developed resistance, they would not be at his disposal if he needed them for a higher tumor burden later on.

    #66786
    Catherine Poole
    Keymaster

    As far as I know the PD1 drugs are only available as second (after IPI if Braf negative) or third line treatments (after IPI and BRAF therapy) As for stats it was at Yale that they said (Kruger) that the combination of IPI and PD1 they were getting 80% response rates.

    Combinations and sequences will be playing an important part in our strategies for therapy as you can see. I hope this all comes to great responses for all soon.

    #66787

    Thanks Catherine and this is exactly the order of protocol on the drugs that we had read as per FDA guidelines, concerns over insurance coverage, etc. However, given my husband’s low tumor burden and his tolerance of yervoy, his Dr. is applying to our insurance for what they call an “exception” to skip BRAF at this time and go right to PD1…apparently this is being accomplished at some of the larger melanoma centers as they are looking at each individual patient and trying to use the FDA approved drugs in the order that works best for each patient…I was really surprised that, upon some digging and pressing, that this is being considered…fingers crossed…will let you know how it turns out so others may have this info in hand when they see their Drs…if it is medically prudent for them to switch order of med and this would be very individualistic obviously and up to each Dr/institutional protocol and would require checking with insurance ahead of time. Takes some work. We hope for PD1 response and if not, BRAF after that…

    I’ll let you know.

    #66788
    Catherine Poole
    Keymaster

    That’s wonderful! I hope this happens often and at more centers. I thought it might be but it could help push this drug to first line approval perhaps!

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