› Forums › General Melanoma Community › The Most Important New Drug Of 2014
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DZnDef.
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- January 5, 2015 at 12:34 pm
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- January 6, 2015 at 12:31 am
You know, I really really want to be excited about this. But when I read this section:
"The drugs shrank tumors in 20% to 40% of patients with melanoma who have been failed by all other treatments. And in 5% to 10% of those patients, the tumor shrinkage persists for more than six months."
I just have to scratch my head. Really? If I read this correctly, people that have a response that lasts longer than six months are only 1% to 4%. Really? I read somewhere the unexplained spontaneous remission rate is around 2%. But they're charging $150,000 a year for these drugs with that low of a success rate? Was the article wrong? Because I could have sworn the success rate was higher than that. If these rates are correct then they don't really seem like the miracle drugs they've been hyped up to be. On this board it seems that lots of folks have had good results with these drugs so it's all a bit confusing. If you are one of the folks it works for, that's fantastic, but evidently there aren't that many of you.
OK, wait. I see now that the patient population is only those patients that have failed "all other" treatments so…. maybe it has a better success rate when used as a first line treatement? Would love to see those trial results. Sorry, but this report is just bumming me out. If those rates earn the title "the most important drug of 2014" it seems the bar has been set pretty low. Is the news somehow better than how I'm reading it?
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- January 6, 2015 at 12:31 am
You know, I really really want to be excited about this. But when I read this section:
"The drugs shrank tumors in 20% to 40% of patients with melanoma who have been failed by all other treatments. And in 5% to 10% of those patients, the tumor shrinkage persists for more than six months."
I just have to scratch my head. Really? If I read this correctly, people that have a response that lasts longer than six months are only 1% to 4%. Really? I read somewhere the unexplained spontaneous remission rate is around 2%. But they're charging $150,000 a year for these drugs with that low of a success rate? Was the article wrong? Because I could have sworn the success rate was higher than that. If these rates are correct then they don't really seem like the miracle drugs they've been hyped up to be. On this board it seems that lots of folks have had good results with these drugs so it's all a bit confusing. If you are one of the folks it works for, that's fantastic, but evidently there aren't that many of you.
OK, wait. I see now that the patient population is only those patients that have failed "all other" treatments so…. maybe it has a better success rate when used as a first line treatement? Would love to see those trial results. Sorry, but this report is just bumming me out. If those rates earn the title "the most important drug of 2014" it seems the bar has been set pretty low. Is the news somehow better than how I'm reading it?
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- January 6, 2015 at 12:31 am
You know, I really really want to be excited about this. But when I read this section:
"The drugs shrank tumors in 20% to 40% of patients with melanoma who have been failed by all other treatments. And in 5% to 10% of those patients, the tumor shrinkage persists for more than six months."
I just have to scratch my head. Really? If I read this correctly, people that have a response that lasts longer than six months are only 1% to 4%. Really? I read somewhere the unexplained spontaneous remission rate is around 2%. But they're charging $150,000 a year for these drugs with that low of a success rate? Was the article wrong? Because I could have sworn the success rate was higher than that. If these rates are correct then they don't really seem like the miracle drugs they've been hyped up to be. On this board it seems that lots of folks have had good results with these drugs so it's all a bit confusing. If you are one of the folks it works for, that's fantastic, but evidently there aren't that many of you.
OK, wait. I see now that the patient population is only those patients that have failed "all other" treatments so…. maybe it has a better success rate when used as a first line treatement? Would love to see those trial results. Sorry, but this report is just bumming me out. If those rates earn the title "the most important drug of 2014" it seems the bar has been set pretty low. Is the news somehow better than how I'm reading it?
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- January 6, 2015 at 1:36 am
Yeah that bummed me out too. Makes no sense. Before I started keytruda I remember seeing 90 percent were still alive at one year and 80 percent at two years. So I'm like awesome I can be on this for quite awhile if I'm lucky. Now im just not sure what is going on with the data or me.
Artie
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- January 6, 2015 at 1:36 am
Yeah that bummed me out too. Makes no sense. Before I started keytruda I remember seeing 90 percent were still alive at one year and 80 percent at two years. So I'm like awesome I can be on this for quite awhile if I'm lucky. Now im just not sure what is going on with the data or me.
Artie
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- January 6, 2015 at 1:36 am
Yeah that bummed me out too. Makes no sense. Before I started keytruda I remember seeing 90 percent were still alive at one year and 80 percent at two years. So I'm like awesome I can be on this for quite awhile if I'm lucky. Now im just not sure what is going on with the data or me.
Artie
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- January 9, 2015 at 10:44 pm
I am surprised that no one has written that my conclusions are wrong (1%-4% six-month effective rate) or that the article itslef might be wrong. Yet I continue to see people (including Tim) posting that these are the most effective drugs currently available. So is 1%-4% considered effective? Or is the article (or me) wrong? Please, someone clarify as I have been banking on these PD-1 drugs as my backup plan in case everything else I try doesn't work. Thanks in advance for any clarification you can offer.
Best
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- January 9, 2015 at 10:44 pm
I am surprised that no one has written that my conclusions are wrong (1%-4% six-month effective rate) or that the article itslef might be wrong. Yet I continue to see people (including Tim) posting that these are the most effective drugs currently available. So is 1%-4% considered effective? Or is the article (or me) wrong? Please, someone clarify as I have been banking on these PD-1 drugs as my backup plan in case everything else I try doesn't work. Thanks in advance for any clarification you can offer.
Best
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- January 11, 2015 at 5:36 am
I'll take a try.
I think there's better articles out there. I didn't find this one to be very illuminating about immunotherapy. The Forbes writer didn't mention survival at all, just responses. But the statistics that have generated all the excitement for both ipilimumab and now anti-PD1 are in the extension of overall survival (OS), rather than response rate.
Some people, while never getting a RECIST-defined tumor response, achieve stable disease on the medicine. That is is part of why OS gets so much attention. Knock on wood, I seem to be in this category of RECIST "stable disease" without it being able to be called a RECIST response (below 20% growth but above 30% tumor shrinkage).
The Forbes article seemed to note that the patients they are writing about had all failed all previous therapies. If that means they had to fail both IPI and (depending on status) BRAF before getting PD1, that would removed some successes that were instead achieved with ipilimab, with which there is some partial overlap of success with PD1. In other words, all of the statistics for treatment-naive patients would be higher — response rates, but most importantly OS.
-Kyle
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- January 11, 2015 at 5:44 am
Thank you, Kyle, yes, that is very helpful. I would have expected them to put in the most favorable statistics in an article like this so those stats spooked me. You are absolutley right, overall survival is the most important aspect. I look forward to some results on any current trials where PD1 is used in treatment-naive patients. My oncologist seems quite excited about the PD-1 drugs and I see him Wednesday so maybe he can remind me why. I appreciate your response. My "scan nerves" might be causing me to over-react these days.
Cheers!
Maggie
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- January 11, 2015 at 5:44 am
Thank you, Kyle, yes, that is very helpful. I would have expected them to put in the most favorable statistics in an article like this so those stats spooked me. You are absolutley right, overall survival is the most important aspect. I look forward to some results on any current trials where PD1 is used in treatment-naive patients. My oncologist seems quite excited about the PD-1 drugs and I see him Wednesday so maybe he can remind me why. I appreciate your response. My "scan nerves" might be causing me to over-react these days.
Cheers!
Maggie
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- January 11, 2015 at 5:44 am
Thank you, Kyle, yes, that is very helpful. I would have expected them to put in the most favorable statistics in an article like this so those stats spooked me. You are absolutley right, overall survival is the most important aspect. I look forward to some results on any current trials where PD1 is used in treatment-naive patients. My oncologist seems quite excited about the PD-1 drugs and I see him Wednesday so maybe he can remind me why. I appreciate your response. My "scan nerves" might be causing me to over-react these days.
Cheers!
Maggie
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- January 11, 2015 at 5:36 am
I'll take a try.
I think there's better articles out there. I didn't find this one to be very illuminating about immunotherapy. The Forbes writer didn't mention survival at all, just responses. But the statistics that have generated all the excitement for both ipilimumab and now anti-PD1 are in the extension of overall survival (OS), rather than response rate.
Some people, while never getting a RECIST-defined tumor response, achieve stable disease on the medicine. That is is part of why OS gets so much attention. Knock on wood, I seem to be in this category of RECIST "stable disease" without it being able to be called a RECIST response (below 20% growth but above 30% tumor shrinkage).
The Forbes article seemed to note that the patients they are writing about had all failed all previous therapies. If that means they had to fail both IPI and (depending on status) BRAF before getting PD1, that would removed some successes that were instead achieved with ipilimab, with which there is some partial overlap of success with PD1. In other words, all of the statistics for treatment-naive patients would be higher — response rates, but most importantly OS.
-Kyle
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- January 11, 2015 at 5:36 am
I'll take a try.
I think there's better articles out there. I didn't find this one to be very illuminating about immunotherapy. The Forbes writer didn't mention survival at all, just responses. But the statistics that have generated all the excitement for both ipilimumab and now anti-PD1 are in the extension of overall survival (OS), rather than response rate.
Some people, while never getting a RECIST-defined tumor response, achieve stable disease on the medicine. That is is part of why OS gets so much attention. Knock on wood, I seem to be in this category of RECIST "stable disease" without it being able to be called a RECIST response (below 20% growth but above 30% tumor shrinkage).
The Forbes article seemed to note that the patients they are writing about had all failed all previous therapies. If that means they had to fail both IPI and (depending on status) BRAF before getting PD1, that would removed some successes that were instead achieved with ipilimab, with which there is some partial overlap of success with PD1. In other words, all of the statistics for treatment-naive patients would be higher — response rates, but most importantly OS.
-Kyle
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- January 9, 2015 at 10:44 pm
I am surprised that no one has written that my conclusions are wrong (1%-4% six-month effective rate) or that the article itslef might be wrong. Yet I continue to see people (including Tim) posting that these are the most effective drugs currently available. So is 1%-4% considered effective? Or is the article (or me) wrong? Please, someone clarify as I have been banking on these PD-1 drugs as my backup plan in case everything else I try doesn't work. Thanks in advance for any clarification you can offer.
Best
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- January 12, 2015 at 9:06 am
Hi all,
I have been confused about some of the numbers too – and there is a similar discussion on a Dutch melanoma board.
I have read in the past about Yervoy that it has a 10-20% response rate and the PD1s (Opdivo, Keytruda) score around 30-40%. If an article than follows with "…. AND (of those) xx% have a response beyond 1 year" I also multiplied the reponse rate with the 1yr+ rate, and yes then you get to really low numbers of durable success.
HOWEVER, having seen some of the videos posted here from Dr Wolchok for example, they often show the survival curves and they show a horizontal line for Yervoy at around 10-20% as well.
It seems like explained here that you can have a long survival despite not officially classifying as a responder (min. 30% reduction), eg. stable disease thanks to the treatment.
So my conclusion is that Overall Survival is more important than PFS or response rate AND that the results are better than calculated in the original post.
What do you think?
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- January 12, 2015 at 9:06 am
Hi all,
I have been confused about some of the numbers too – and there is a similar discussion on a Dutch melanoma board.
I have read in the past about Yervoy that it has a 10-20% response rate and the PD1s (Opdivo, Keytruda) score around 30-40%. If an article than follows with "…. AND (of those) xx% have a response beyond 1 year" I also multiplied the reponse rate with the 1yr+ rate, and yes then you get to really low numbers of durable success.
HOWEVER, having seen some of the videos posted here from Dr Wolchok for example, they often show the survival curves and they show a horizontal line for Yervoy at around 10-20% as well.
It seems like explained here that you can have a long survival despite not officially classifying as a responder (min. 30% reduction), eg. stable disease thanks to the treatment.
So my conclusion is that Overall Survival is more important than PFS or response rate AND that the results are better than calculated in the original post.
What do you think?
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- January 13, 2015 at 8:00 am
Try this article. http://www.onclive.com/web-exclusives/Nivolumab-Extends-Survival-in-Phase-III-Melanoma-Study I think it might have the kind of numbers and analysis you've been looking for. The trial discussed is for frontline treatment, i.e., treatment-naive patients. My sense is that the efficacy for Nivolumab and Keytruda are very similar. I would have gone for either one.
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- January 13, 2015 at 8:00 am
Try this article. http://www.onclive.com/web-exclusives/Nivolumab-Extends-Survival-in-Phase-III-Melanoma-Study I think it might have the kind of numbers and analysis you've been looking for. The trial discussed is for frontline treatment, i.e., treatment-naive patients. My sense is that the efficacy for Nivolumab and Keytruda are very similar. I would have gone for either one.
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- January 13, 2015 at 8:00 am
Try this article. http://www.onclive.com/web-exclusives/Nivolumab-Extends-Survival-in-Phase-III-Melanoma-Study I think it might have the kind of numbers and analysis you've been looking for. The trial discussed is for frontline treatment, i.e., treatment-naive patients. My sense is that the efficacy for Nivolumab and Keytruda are very similar. I would have gone for either one.
-
- January 12, 2015 at 9:06 am
Hi all,
I have been confused about some of the numbers too – and there is a similar discussion on a Dutch melanoma board.
I have read in the past about Yervoy that it has a 10-20% response rate and the PD1s (Opdivo, Keytruda) score around 30-40%. If an article than follows with "…. AND (of those) xx% have a response beyond 1 year" I also multiplied the reponse rate with the 1yr+ rate, and yes then you get to really low numbers of durable success.
HOWEVER, having seen some of the videos posted here from Dr Wolchok for example, they often show the survival curves and they show a horizontal line for Yervoy at around 10-20% as well.
It seems like explained here that you can have a long survival despite not officially classifying as a responder (min. 30% reduction), eg. stable disease thanks to the treatment.
So my conclusion is that Overall Survival is more important than PFS or response rate AND that the results are better than calculated in the original post.
What do you think?
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