Will antiPD1work?

[MariaS]

My husband was enrolled in the BMS ipi/nivo three arm trial, he showed both progression and new growth and was kicked out. When he was unblinded we found out he was on the ipi only arm. He is not eligible for the EAP Mercks trials since he is Braf positive and he never took any Braf drugs yet. He started two days ago to take Dabrafenib.

The plan right now is to let Dabrafenib to do it’s magic, for as long as it works, 8 months average, and then go for the antiPD1, hopefully available either as EAP or as standard care for people that failed ipi and Braf meds.

But I do have this thing in mind that really stresses me out. As almost all the stats I read are saying that antiPD1, which as of today is everybody’s dream treatment, is only working on 38% of the patients! what if Dave is one of the unlucky ones? Is there a test out there that tells if his melanoma cells are expressing PDL-1 and antiPD1 will work? I’d rather know this sooner rather than after months of unsuccessful treatment, and try to find another line of treatment, like TILs.

I would only hope that my answer lies on one of the tests that BMS performed on his blood and melanoma tissue they biopsied. I understand why BMS would not make this public information, they obviously don’t want people leaving the trials when they find out antiPD1 doesn’t work on them. I am not going to bring up any ethical issues I may have. I just want an answer: is there anywhere in US or Canada, heck, even in Europe a lab that would analyze Dave’s blood or melanoma tissue and tell us if his melanoma would respond to antiPD1 or not?

[Catherine Poole]

Maria,

That is an excellent question. I will check with my SCIENTIFIC Bd to see if they know how close this biomarker research is getting to reality. I did read this: http://www.esmo.org/Conferences/ELCC-2014-Lung-Cancer/News-Videos/PD-L1-and-PD-1-Expression-in-a-Cohort-of-Molecularly-Selected-NSCLC-Patients

But it was for lung cancer. You are on the right track with therapies for your husband and I hope it all goes well. I will report what I find out.

[Catherine Poole]

According to Dr. Keith Flaherty, co-chair of our Scientific Board: “I would say “refinement” not discovery is needed. We’re getting there. When will we have an approved test? That could be quite a long time from now. But one that doctors can put some stock in? Probably 1-2 years.”

[MariaS]

Thanks Catherine. He just started with Dabrafenib ( Tafinlar) last week, so theoretically we have several months ahead of us until we have to decide what’s the next step. I’m just doing my homework but from all the information I got so far it appears anti PD1 is still the one with the best percentage of success. And there is research saying that even for melanoma cells that don’t express PDL-1 , anti PD1 still works in 17% of the cases.

[pd1gal]

Merk has published some preliminary results concerning “Clinical efficacy and correlation with tumor PD-L1 expression”.

In that document they state

MK-3475 induces durable responses and favorable 1-y OS with acceptable safety in MEL. Although tumor PD-L1 positivity was associated with improved ORR and PFS, antitumor activity was also observed in pts with low baseline PD-L1 expression.

So it appears that even if you do not have strong “PD-L1 positivity” you still might respond to MK-3475.

Here is a link to the article.

http://abstracts.asco.org/144/AbstView_144_130007.html

Hope this helps and good luck.

Kat

[kylez]

Saw this news release about Merck and a company named Dako agreeing to develop a diagnostic test to analyze PD-L1 levels. So a kit will be in the works that would presumably be available for lots of labs sometime in the future.

http://www.marketwatch.com/story/dako-an-agilent-technologies-company-and-us-based-merck-co-to-collaborate-on-companion-diagnostic-test-for-analysis-of-tumor-pd-l1-levels-2014-05-30-9184838” class=”bbcode_url”>http://www.marketwatch.com/story/dako-an-agilent-technologies-company-and-us-based-merck-co-to-collaborate-on-companion-diagnostic-test-for-analysis-of-tumor-pd-l1-levels-2014-05-30-9184838

[Catherine Poole]

I think the issue may be that even if you don’t test well, you probably will take PD1 with hope it will work for you. I don’t believe any of this will be exact science It is all too new to have good answers yet.

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