Unfortunately, my Zelboraf story is not so successful. After very aggressive mm progression in April this year I started with full dose of Zelboraf. Together with Zelboraf I had radiotherapy for bone mets (at that time I could barely walk). Side effects were manageable and after some time I felt better, LDH level decreased and we hoped it will go like that. However, PET and MRI after 3 months showed very ‘mixed response’. Mets in lungs shrunk, liver mets slightly grew (but MR showed losing or decreasing of solid component), one of them showed very high SUV index. Additionally, some bone mets disappeared, some of them stayed same, and some grew.
My oncologist thinks we should continue with Zelboraf for some more time, he claims that it is not progression as no new mets were detected. It sounds logical as my option list is getting shorter and shorter. Did any of you first had mixed response with Zelboraf and regression afterwards?
My question is related with bone mets. They started to grow again so I will have another radiotherapy session soon. Zoledronic acid is commonly used to manage metastatic bone pain but I am worried about possible interaction with Zelboraf. Did any of you have bisphosphonates while on Zelboraf (I checked literature and no proves for interaction, but it would be easier if I know someone used it without problems).
It sounds like you have a mixed response. Have you lined up another therapy to do should progression happen? Zelboraf can be long or short term and usually short term. Have you looked at immunotherapies or clinical trials with new agents?
I have asked your specific question of our advisory board and will let you know what I find out.
Insurance in Turkey covers Yervoy, so I guess it would be the next step. We will try to buy some time with radiotherapy and maybe chemo. We are also considering clinical trials with anti pd1, in Turkey or abroad. It is very hard to give right decision.
PD1 would be a good direction. There may be some you can get into that don’t require Yervoy failure. I would definitely line it up so you are ready if you need it. there isn’t any chemo that works well for melanoma.
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