Different doctors, different approaches ? Germany – U.S.

On the Onclive page the #’s at the bottom are actual backwards, where #6 is the oldest videos and # 1 are more current. The adjuvant stuff is located in # 4 and #5 section mainly. I hope that was clear as mud!!!Ed

Hi Chris, one more group of videos, first from fall of 2017 combi-AD trial adjuvant melanoma ESMO peer panel. Second video is from ESMO 2018 with more data and approvals to make comparisons between targeted therapy and immunotherapy Pd-1 drugs in adjuvant setting. https://www.onclive.com/peer-exchange/melanoma-systemic-therapy/combi-ad-dual-targeted-therapy-for-stage-3-melanoma https://www.youtube.com/watch?time_continue=49&v=Kx5etJjDxL8

Here is the raw data from New England Journal, https://www.nejm.org/doi/full/10.1056/NEJMoa1709030 https://www.nejm.org/doi/full/10.1056/NEJMoa1708539

When the experts talk about adjuvant trials there are many different views on the data and how to interpret the data. Here is a pretty good example of leading oncologist talking about 3a patients. https://www.onclive.com/peer-exchange/advanced-melanoma-paradigms/initiating-adjuvant-therapy-in-stage-3-melanoma

I had a CLND with my SLNB in August 2014, when the SLNB found a trace of melanoma in a lymph node. That CLND did not help me. I wish I had not had it. CLNDs are no longer recommended as much as they were.

Chris,

It would seem to me that you are Stage IIIb…though I don’t know that that makes much difference….but for what it’s worth. The report you are looking at is the first one I discussed in the link of many such articles about adjuvant treatments that I gave you. Looking at the Kaplan-Meier curves it is clear that targeted therapy is superior to placebo in all aspects. And while the curves do come closer together over time, I suspect the results from the targeted therapy remains significant. The problem with clinical trials (which I’ve been bitching about for years….even though an adjuvant trial of nivo that I was lucky to gain access to in 2010 after brain and lung mets most certainly saved my life!) are many and varied.
1. We continue to compare things to placebo or treatments that are clearly “lesser” long after it is appropriate to do so.
2. We fail to have the “head-to-head” trials that would provide real info. Like a randomized trial where Stage III patients are given either targeted therapy or immunotherapy so that we can really see what happens.
3. We fail to use consistent outcome measures, so that comparisons are more reasonable. For instance….if you look at the many adjuvant studies I gave you…there is one by Weber using immunotherapy that looks are RFS, but not with the same time frames as the study you are looking at. There are others using immunotherapy with the same time frame, but look at other outcomes.

In the end, I fear you are just going to have to choose what you think is best for you. At this point, it may be best to complete the adjuvant program of targeted therapy that you are on, be vigilant and see what happens…knowing that you can always go on to immunotherapy should you have the need. I know I am not giving you the information you seek, but at this point we just don’t know which tact is better for adjuvant care. – targeted or immunotherapy. Still, I know we will get there one day…and you are helping make that happen.

Yours, celeste

Gene! C’mon Man!!! What are you playing at? Folks here are asking legit questions about therapy. If you want to have a thread about ancillary issues, diet, whatever – go ahead. But, I continually fail to understand why you do not help folks by letting them know that as a Stage IV melanoma patient in 2011 you were blessed to gain a place in a clinical trial with ipi and GMCSF. Not only did you get access to treatment, a rare thing back in those days…but you RESPONDED!!! Becoming and maintaining NED status since 2012! What an amazing turn of events for you and yours. What a gift to those melanoma patients who have gained responses and help from ipi since. Why don’t you roll with that? You have helped melanoma patients in ways that many never will. Let’s continue that!!! Thanks, celeste

My Dear Celeste,

Thank you for reminding me that I am still alive 😉 Just for the record my wife had a male co-worker about my same age, height but was thinner in weight.
He did the same treatment with the same doctor that I did. Unfortunately, he passed away from the treatment. His physical condition on a scale of 1 to 10 (10 being the highest) was about 3. Mine was a 7 or 8. My treatment was very toxic. So to recommend that everybody just go on immunotherapy is perhaps not the real solution if you don’t know the whole story behind it.

When I was first diagnosed with melanoma I went on sick leave to reduce my stress levels. Spent every waking hour researching the cause of my melanoma. And guess what I found? It wasn’t from to much sunshine. It took me years and hundreds of hours of research to determine the cause and I truly believe that I finally know what caused my melanoma. Lack of sunshine was just one element.

On a different note do you honestly believe they are trying to cure cancer? If so you should go on a day trip to Cleveland Ohio and see all the cancer treatment skyscrapers that are being built. Cancer rates are about the same as when President Nixon declared the war on cancer in 1971. Do you know that there are more people working in the cancer industry than have cancer?

Stress is the leading cause of cancer and this gentleman here may have a very stressful life/job.

Two other things to consider:
According to a recent study by Johns Hopkins, more than 250,000 people in the United States die every year because of medical mistakes, making it the third leading cause of death after heart disease and cancer.

Medical Expenses. A recent Harvard University study showed that medical expenses account for approximately 62 percent of personal bankruptcies in the US.

I have read your story and you are quite an amazing woman with an amazing story. But I would like to remind you that there are more than one way to solve a problem. Most stage 3 melanoma’s could be helped just by changing their diet and lifestyle but the oncologist will never tell them that. We are so bombarded with drug ads that most people just think that drugs cure everything. They Don’t.

Best wishes,

Gene

Thanks for the kind words, Gene. However, I do NOT think there is ONE solution to ANY problem (nor one cause) and that applies a million times over for melanoma. I agree that medical care should NEVER bankrupt anyone – ever. Though, unfortunately, this is the state of medical care in this country far too often. For the rest, I fear we are going to have to agree to disagree. In the United States there will be almost 96,500 new cases of melanoma diagnosed this year. In 2018, there were almost 300,000 new cases of melanoma across the globe. This year, 7,230 melanoma peeps will die in the US alone. Yes, current therapies for cancer are often toxic. Trust me, I am well aware!! I’ve managed to be a two cancer kind of girl and a provider who has cared for many many patients with various cancers. Still, we cure many more folks than once we did. And, you and I??? We are lucky that the drugs we took gave us our combined 16 years with NED after Stage IV melanoma. I hope some day there are many, many more folks like us. Yours, celeste