I’ve posted before about my father who was diagnosed stage IV in January 2020 and progressed on pembro (April-June 2020) and then ipi/nivo (June-July 2020). He hasn’t been on any treatment since July due to toxicities to the combo that have finally resolved – other than SRS to several brain mets. Recent scans have shown significant progression (increased tumor burden in the lungs and new sites of involvement in the liver, kidneys, pancreas, gallbladder). He is feeling generally OK other than fatigue and recently some shortness of breath (due to the lung tumors). The options presented at this point for additional treatment are oral temozolomide or trying T-VEC + pembro. Any insights or experiences into these options? I understand that only 10-15% of people respond to chemo, and only for a short time. And I also understand that there isn’t really any data showing that T-VEC + pembro is effective in patients who have progressed on pembro, but anecdotally there may be success stories. Options for clinical trials also seem limited due to the brain mets, prior toxicities while on immunotherapy, and a history of prostate cancer. Thanks in advance for any feedback or insight.
- April 8, 2021 at 12:46 pm
ed williamsParticipantHere is some information on t-vec, Dr. Andtbacka is one of the leading experts in this field. The field has expanded to include IL-12 with TAVO, NKTR-214, TLR-9 agonists, etc. Masterkey265 is the clinical trial of t-vec with pembro that has reported findings. https://www.youtube.com/watch?v=rIsJOfW4gLM https://www.youtube.com/watch?v=-gaDB916tVQ https://www.onclive.com/view/intratumoral-electroporation-of-pil-12-ep-plus-pembrolizumab-elicits-durable-responses-in-pd-1-refractory-advanced-melanoma?utm_source=sfmc&utm_medium=email&utm_campaign=11-13-20_OncLiveSS_SITC%20Conference%20Coverage%20eNL_Cabometyx_NON_US_SEND&eKey=bm9rbmVlc3dpbGxpYW1zQGdtYWlsLmNvbQ== https://jitc.bmj.com/content/8/Suppl_3/A261.1
- April 8, 2021 at 4:33 pm
Thanks so much for your helpful reply. It looks like TAVO + pembro may be more promising than T-VEC + pembro because of the demonstrated benefit (in KEYNOTE-695) in patients with anti-PD-1 checkpoint resistance. I wonder if it would be worth looking into the possibility of expanded access for TAVO + pembro? Does anyone on the forum have experience with expanded access?
- April 8, 2021 at 6:31 pm
- April 9, 2021 at 6:56 pm
Am not sure I can really help you, but I am someone who did respond to TVEC+pembro after one year of pembro had “failed” in that my tumour kept growing – but on the plus side there was no metastasis, only local disease. So I think adding TVEC can help make anti-pd1 work.
I watched Ed’s videos – I could relate to the anecdotal evidence and they left me feeling grateful for the discoveries made and for Andtbacka for pushing intralesionals. I am not sure when they were made though and whether there are any more recent results. The intuition that this approach works best when there is not too much spread makes sense to me. Reading the TAVO link I am not sure this shows it is better than TVEC since the result is recent and the sample size looks small. I think it would be up to you and your doctor to try to work out which injectable is best, in combination with pembro, and which you can gain access to.
I hope with your doctor you can be creative and find a successful next approach
good luck Mark
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