› Forums › Cutaneous Melanoma Community › Help with next move….melanoma is on the move
- This topic has 42 replies, 6 voices, and was last updated 9 years, 2 months ago by
FayFighter.
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- February 22, 2015 at 3:31 pm
Recap;
Husband is 45 y.o. Irish, blue eyes…raised on the jersey shore (lots of sun exposure).
July 2010 Melanocytic Nevi removed from left calf.
F/U with Derm exams x1/6 mos
June 2013 Nodules appear under skin on left calf. We thought they were vericose veins.
July 2013 Swollen left lymph node in groin area. Biopsy. Melanoma. BRAF WT.
Slide from 2010 reread by MSKCC as melanoma in situ
August 2013 Lymphadenectomy of left groin. Just uppers Cloquet node negative. 5/19 nodes positive.
October 2013 Start Yervoy
November 2013 Radiation to Lymph node basin of groin
January 2014 Prednisone needed to control colitis from yervoy. Genomic Studies show NRAS positive.
March 2014 End Prednisone
April 2014 PET/CT Scan shows 3.5 cm lesion in fundus of stomach. Confirmed through biopsy.
May 2014 start PD1/KIR trial
July 2014 too much bleeding from stomach tumor. Surgery to remove.
July 2014 Scan shows mets to liver. numerous.
August 2014 Start MEK/CDK4
October 2014 30% Reduction in liver lesions
November 2014 20% more reduction
December 2014 Stable Lesions. Heart EF low…need to lower doses
Today Scans…new Liver lesions. Subcutaneous lesion on back. Maybe on ribs.
past Friday : 2 small liver mets. Uggggh. Possible gastric met. Sub qs popping up
nih wouldn't take him because of colitis.
Options: checking HLA-A2, if positive candidate for IMCgp100 (Monoclonal T Cell Receptor anti-CD3 scFv Fusion Protein) IMMUNOCORE trial at MSKCC.
Options: Speaking with NIH nurse tomorrow about IL2 trial eligibility.
Update: He is hla a2 match for immunocore Plan b is abraxane/avastin and gamma for brain
What would you do????? Thoughts on il2? The immunocore phase 1 showed 13 percent response
Scrambling here in NJ
- Replies
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- February 22, 2015 at 3:44 pm
I meant two small brain mets this past week were detected. In addition to new liver lesions. And sub qs.
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- February 22, 2015 at 3:44 pm
I meant two small brain mets this past week were detected. In addition to new liver lesions. And sub qs.
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- February 22, 2015 at 8:34 pm
From May to July he was on a pd1 anti Kir trial. Just not sure we were able to tell it was working as he started with a 4.5 cm stomach tumor that grew to 8 cm. it had to come out and that knocked him out of that trial. There is talk of using the "other" pd1. Not sure what to do. The Oncologist seems to want to do the Immunocore. But I have never seen the melanoms grow as much as it did over the last 6 weeks. We are very scared.
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- February 22, 2015 at 8:34 pm
From May to July he was on a pd1 anti Kir trial. Just not sure we were able to tell it was working as he started with a 4.5 cm stomach tumor that grew to 8 cm. it had to come out and that knocked him out of that trial. There is talk of using the "other" pd1. Not sure what to do. The Oncologist seems to want to do the Immunocore. But I have never seen the melanoms grow as much as it did over the last 6 weeks. We are very scared.
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- February 23, 2015 at 2:45 am
I am not an expert, but I would explore the already available drug that has been approved and has some pretty great results. Maybe at least ask again about Keytruda. I think those brain mets can't wait and agree with Artie about gamma knife. Some of the drug results work really well in concert with gamma knife. Don't know if Keytruda is one of them. But I do see you are at Sloan which we all know is top notch. Whatever you decide, my prayers are with you.
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- February 23, 2015 at 2:45 am
I am not an expert, but I would explore the already available drug that has been approved and has some pretty great results. Maybe at least ask again about Keytruda. I think those brain mets can't wait and agree with Artie about gamma knife. Some of the drug results work really well in concert with gamma knife. Don't know if Keytruda is one of them. But I do see you are at Sloan which we all know is top notch. Whatever you decide, my prayers are with you.
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- February 23, 2015 at 2:45 am
I am not an expert, but I would explore the already available drug that has been approved and has some pretty great results. Maybe at least ask again about Keytruda. I think those brain mets can't wait and agree with Artie about gamma knife. Some of the drug results work really well in concert with gamma knife. Don't know if Keytruda is one of them. But I do see you are at Sloan which we all know is top notch. Whatever you decide, my prayers are with you.
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- February 22, 2015 at 8:34 pm
From May to July he was on a pd1 anti Kir trial. Just not sure we were able to tell it was working as he started with a 4.5 cm stomach tumor that grew to 8 cm. it had to come out and that knocked him out of that trial. There is talk of using the "other" pd1. Not sure what to do. The Oncologist seems to want to do the Immunocore. But I have never seen the melanoms grow as much as it did over the last 6 weeks. We are very scared.
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- February 22, 2015 at 3:44 pm
I meant two small brain mets this past week were detected. In addition to new liver lesions. And sub qs.
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- February 22, 2015 at 8:29 pm
It sounds like he wasn't on the pd1 anti kir very long. I'm wondering like the anonymous person if pd1 especially keytruda since it is only every 3 weeks instead of opdivo every 2 weeks because of his colitis maybe that is a decent thing to try.
Not sure what the IL2 trial is. That has been fda approved for a long time so must be something more to it.
definitely gamma knife for the brain spots in my opinion the sooner the better so they don't grow.
dunno about the immunocore. 13 percent is low but if it works that is awesome.
not sure what other trial would be good in his case. to my knowledge msk has the most trials listed for melanoma so he is at one of the best places.
sorry I'm not much help. Maybe others will know more.
Artie
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- February 22, 2015 at 8:29 pm
It sounds like he wasn't on the pd1 anti kir very long. I'm wondering like the anonymous person if pd1 especially keytruda since it is only every 3 weeks instead of opdivo every 2 weeks because of his colitis maybe that is a decent thing to try.
Not sure what the IL2 trial is. That has been fda approved for a long time so must be something more to it.
definitely gamma knife for the brain spots in my opinion the sooner the better so they don't grow.
dunno about the immunocore. 13 percent is low but if it works that is awesome.
not sure what other trial would be good in his case. to my knowledge msk has the most trials listed for melanoma so he is at one of the best places.
sorry I'm not much help. Maybe others will know more.
Artie
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- February 22, 2015 at 8:29 pm
It sounds like he wasn't on the pd1 anti kir very long. I'm wondering like the anonymous person if pd1 especially keytruda since it is only every 3 weeks instead of opdivo every 2 weeks because of his colitis maybe that is a decent thing to try.
Not sure what the IL2 trial is. That has been fda approved for a long time so must be something more to it.
definitely gamma knife for the brain spots in my opinion the sooner the better so they don't grow.
dunno about the immunocore. 13 percent is low but if it works that is awesome.
not sure what other trial would be good in his case. to my knowledge msk has the most trials listed for melanoma so he is at one of the best places.
sorry I'm not much help. Maybe others will know more.
Artie
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- February 22, 2015 at 9:07 pm
The pd1 kir was pretty short. I think his colitis was not from yervoy he had oct – dec 2013.
mskcc doesn't have any il2 trials. It's seems they think it's pretty toxic.
they wanted to send him to NIH for il2 and cell transfer I believe at NIH but that didn't work because they wouldn't accept him. Colitis colon.
because we know (gleaned from folks on this board ) that NRAS folks do pretty well on il2 we found a place 1/2 hour a way. But our doctor doesn't seem to psyched about it.
In fact, if Immunocore doesn't work he want the Abraxane/Avastin with gamma.
My husband wants to try il2. I am wondering if il2 will kick up colon and that's why are doctor is not excited.
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- February 22, 2015 at 9:07 pm
The pd1 kir was pretty short. I think his colitis was not from yervoy he had oct – dec 2013.
mskcc doesn't have any il2 trials. It's seems they think it's pretty toxic.
they wanted to send him to NIH for il2 and cell transfer I believe at NIH but that didn't work because they wouldn't accept him. Colitis colon.
because we know (gleaned from folks on this board ) that NRAS folks do pretty well on il2 we found a place 1/2 hour a way. But our doctor doesn't seem to psyched about it.
In fact, if Immunocore doesn't work he want the Abraxane/Avastin with gamma.
My husband wants to try il2. I am wondering if il2 will kick up colon and that's why are doctor is not excited.
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- February 22, 2015 at 9:13 pm
I meant colitis "was" caused by yervoy.
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- February 22, 2015 at 9:13 pm
I meant colitis "was" caused by yervoy.
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- February 23, 2015 at 2:51 am
That explains il2 at nih. It was the til trial that I'm not healthy enough to go through. However il2 by itself can be done anywhere except you really need a staff trained in it. It requires a week or two in the hospital and can be rough. Side affects can be severe so the staff has to have the knowledge to treat them quickly like within minutes then you are fine. Otherwise it could get really bad. But with a good staff the side affects are handled and go away rather quickly from what I've read. I believe before yervoy it was the main treatment they did. Some people here have done it. Only about an 8% response rate if I remember right but might be better with that nras I dunno.
Artie
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- February 23, 2015 at 2:51 am
That explains il2 at nih. It was the til trial that I'm not healthy enough to go through. However il2 by itself can be done anywhere except you really need a staff trained in it. It requires a week or two in the hospital and can be rough. Side affects can be severe so the staff has to have the knowledge to treat them quickly like within minutes then you are fine. Otherwise it could get really bad. But with a good staff the side affects are handled and go away rather quickly from what I've read. I believe before yervoy it was the main treatment they did. Some people here have done it. Only about an 8% response rate if I remember right but might be better with that nras I dunno.
Artie
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- February 23, 2015 at 2:51 am
That explains il2 at nih. It was the til trial that I'm not healthy enough to go through. However il2 by itself can be done anywhere except you really need a staff trained in it. It requires a week or two in the hospital and can be rough. Side affects can be severe so the staff has to have the knowledge to treat them quickly like within minutes then you are fine. Otherwise it could get really bad. But with a good staff the side affects are handled and go away rather quickly from what I've read. I believe before yervoy it was the main treatment they did. Some people here have done it. Only about an 8% response rate if I remember right but might be better with that nras I dunno.
Artie
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- February 22, 2015 at 9:13 pm
I meant colitis "was" caused by yervoy.
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- February 22, 2015 at 9:56 pm
I've heard IL2 is pretty rough, toxic, etc. But if I remember correctly that NRAS mutation does respond to IL2 better than other mutations. Worth researching that connection. NIH is difficult to get into their trials.
Good luck,
Shane
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- February 22, 2015 at 9:56 pm
I've heard IL2 is pretty rough, toxic, etc. But if I remember correctly that NRAS mutation does respond to IL2 better than other mutations. Worth researching that connection. NIH is difficult to get into their trials.
Good luck,
Shane
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- February 22, 2015 at 9:56 pm
I've heard IL2 is pretty rough, toxic, etc. But if I remember correctly that NRAS mutation does respond to IL2 better than other mutations. Worth researching that connection. NIH is difficult to get into their trials.
Good luck,
Shane
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- February 23, 2015 at 4:04 am
I'm sorry to hear about your husband's present situation. I hadn't previously heard that NIH would exclude you solely for ipi related colitis. I'm disappointed–as I too had it. My impression from other posts on this forum is that Dr. Hwu at MD Anderson has a "more lenient" TIL trial. You may want to look at that. As for the MSK trial, I believe that is being run by Wolchok, correct? Your husband is obviously in great hands if that's the case.
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- February 23, 2015 at 4:04 am
I'm sorry to hear about your husband's present situation. I hadn't previously heard that NIH would exclude you solely for ipi related colitis. I'm disappointed–as I too had it. My impression from other posts on this forum is that Dr. Hwu at MD Anderson has a "more lenient" TIL trial. You may want to look at that. As for the MSK trial, I believe that is being run by Wolchok, correct? Your husband is obviously in great hands if that's the case.
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- February 23, 2015 at 4:04 am
I'm sorry to hear about your husband's present situation. I hadn't previously heard that NIH would exclude you solely for ipi related colitis. I'm disappointed–as I too had it. My impression from other posts on this forum is that Dr. Hwu at MD Anderson has a "more lenient" TIL trial. You may want to look at that. As for the MSK trial, I believe that is being run by Wolchok, correct? Your husband is obviously in great hands if that's the case.
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- February 22, 2015 at 9:07 pm
The pd1 kir was pretty short. I think his colitis was not from yervoy he had oct – dec 2013.
mskcc doesn't have any il2 trials. It's seems they think it's pretty toxic.
they wanted to send him to NIH for il2 and cell transfer I believe at NIH but that didn't work because they wouldn't accept him. Colitis colon.
because we know (gleaned from folks on this board ) that NRAS folks do pretty well on il2 we found a place 1/2 hour a way. But our doctor doesn't seem to psyched about it.
In fact, if Immunocore doesn't work he want the Abraxane/Avastin with gamma.
My husband wants to try il2. I am wondering if il2 will kick up colon and that's why are doctor is not excited.
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- February 24, 2015 at 10:21 am
FAy, I do have questions on your iinfo. Since they have told you that your husband is does not have a BRAF melanoma, why duid they jumo on a MEK targeted chemo? Did they fina a NRAS mutation in his tumors.???
? Is IL-2 Toxic? Yes, any good IL-2 expert can control thiss aand knows what to watch for. Can one get thru IL-2 with less long term negative effects than fro Yervoy the anti-PD-1s? Very likely. i have much worse long term worries about taking Yervoy and the Anti-PD-1 than IL-2. (PS: I took 49 bags of IL-2 over the three courses of IL-2 (six weeks of adimistartion) Bag by bag journey in my profile. I aam a propnent of learning as much as possible about all treatments. Most Oncologist do not have the UIL-2 experience toadminister it, andd so donot consider it validd, even though 5-8% of across the board melanma patients have been cured with it for over 30 years now. Between the cured and helped rate (total of 20-23%) look close at the yervoy helped rate and its negative effects rate.
You do only want to go to a highly experienced IL-2 Oncologist with a specially trained staff, such as, My Specialist – Dr Geoffrey R. Weiss, Deputy Dir Emily Couric Cancer Ctr at UVA or Dr Michael B Atkins, Deputy Director, Lombardi Comprehensisve Cncer Centeer @ Georgetown University. They have been succesful with administering IL-2 to hundreds of melanoma patients.If you do not meet the criteria toreceive IL-22 they will not administer it.
HAaving said that, If I had already had Yervoy, my personal preference would be t go toOpdivo before IL-2. IL-2 would still be available.later. for BIO-MRKERS to hlp make ones choice, If I had an NRAS mutation and a low LDH, I would jump for the IL-2 as soon as possible.
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- February 24, 2015 at 10:21 am
FAy, I do have questions on your iinfo. Since they have told you that your husband is does not have a BRAF melanoma, why duid they jumo on a MEK targeted chemo? Did they fina a NRAS mutation in his tumors.???
? Is IL-2 Toxic? Yes, any good IL-2 expert can control thiss aand knows what to watch for. Can one get thru IL-2 with less long term negative effects than fro Yervoy the anti-PD-1s? Very likely. i have much worse long term worries about taking Yervoy and the Anti-PD-1 than IL-2. (PS: I took 49 bags of IL-2 over the three courses of IL-2 (six weeks of adimistartion) Bag by bag journey in my profile. I aam a propnent of learning as much as possible about all treatments. Most Oncologist do not have the UIL-2 experience toadminister it, andd so donot consider it validd, even though 5-8% of across the board melanma patients have been cured with it for over 30 years now. Between the cured and helped rate (total of 20-23%) look close at the yervoy helped rate and its negative effects rate.
You do only want to go to a highly experienced IL-2 Oncologist with a specially trained staff, such as, My Specialist – Dr Geoffrey R. Weiss, Deputy Dir Emily Couric Cancer Ctr at UVA or Dr Michael B Atkins, Deputy Director, Lombardi Comprehensisve Cncer Centeer @ Georgetown University. They have been succesful with administering IL-2 to hundreds of melanoma patients.If you do not meet the criteria toreceive IL-22 they will not administer it.
HAaving said that, If I had already had Yervoy, my personal preference would be t go toOpdivo before IL-2. IL-2 would still be available.later. for BIO-MRKERS to hlp make ones choice, If I had an NRAS mutation and a low LDH, I would jump for the IL-2 as soon as possible.
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- February 24, 2015 at 10:21 am
FAy, I do have questions on your iinfo. Since they have told you that your husband is does not have a BRAF melanoma, why duid they jumo on a MEK targeted chemo? Did they fina a NRAS mutation in his tumors.???
? Is IL-2 Toxic? Yes, any good IL-2 expert can control thiss aand knows what to watch for. Can one get thru IL-2 with less long term negative effects than fro Yervoy the anti-PD-1s? Very likely. i have much worse long term worries about taking Yervoy and the Anti-PD-1 than IL-2. (PS: I took 49 bags of IL-2 over the three courses of IL-2 (six weeks of adimistartion) Bag by bag journey in my profile. I aam a propnent of learning as much as possible about all treatments. Most Oncologist do not have the UIL-2 experience toadminister it, andd so donot consider it validd, even though 5-8% of across the board melanma patients have been cured with it for over 30 years now. Between the cured and helped rate (total of 20-23%) look close at the yervoy helped rate and its negative effects rate.
You do only want to go to a highly experienced IL-2 Oncologist with a specially trained staff, such as, My Specialist – Dr Geoffrey R. Weiss, Deputy Dir Emily Couric Cancer Ctr at UVA or Dr Michael B Atkins, Deputy Director, Lombardi Comprehensisve Cncer Centeer @ Georgetown University. They have been succesful with administering IL-2 to hundreds of melanoma patients.If you do not meet the criteria toreceive IL-22 they will not administer it.
HAaving said that, If I had already had Yervoy, my personal preference would be t go toOpdivo before IL-2. IL-2 would still be available.later. for BIO-MRKERS to hlp make ones choice, If I had an NRAS mutation and a low LDH, I would jump for the IL-2 as soon as possible.
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- February 26, 2015 at 1:54 am
Yes Jerry. My husband does have an NRAS mutation. We have discussed il2 off line (you sent me all the suggested prep for such treatment ). The one thing that has changed from last we spoke is that he has two small brain mets, more in the liver, more sub qs. And small gastric tumor. So. Disease is progressing now that he got kicked off the Mek/cdk4 inhibitor trial. ( we don't regret the inhibitor. It gave us sept oct nov Dec with disease regression. But now it's back on the move. I am wondering how il2 does across the blood brain barrier. We go to NYC tomorrow to sign the immunocore consents. Hoping hbg looks good. I have a feeling the ldh is going to be much higher than its ever been. Bummed. But we need to try this. Plan b is the Abraxane/avastin with radiation to brain. But I want to do something with il2 before he gets too sick.
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- February 28, 2015 at 1:04 pm
Fay, IL-2 is immunjotherapy.It is not aa chemical to cross the BBB. It used to be that if one had a brain tumors they refused to even think about administeering IL-2. A study was released in Aug 2013 that challenged that thought.
August 27, 2013
Interleukin-2 extends life in melanoma brain metastases
Researchers are suggesting that high-dose interleukin-2 (HD IL-2) therapy should be considered as a treatment option in patients with melanoma brain metastases who are otherwise eligible for therapy, based on the encouraging results of a small retrospective review.
Five men and three women (median age 52.2 years; range 26.8–61.1 years) with stable melanoma brain metastases underwent HD IL-2 therapy between January 1999 and June 2011 at Saint Louis University (SLU) in St. Louis, Missouri. The regimen consisted of 14 doses at 720,000 IU/kg per dose intravenously, two cycles per course, for a maximum of two courses. Three patients had radiosurgery, and one patient had whole-brain radiation prior to HD IL-2 therapy. After HD IL-2 therapy, five patients received consolidation whole-brain radiation, and four underwent radiosurgery.
As noted in an SLU statement accompanying the release of the study results in Chemotherapy Research and Practice, median overall survival of patients with melanoma brain metastases is normally approximately 4 months. But the investigative team, led by SLU's John Richart, MD, found that the median overall survival for the entire HD IL-2 cohort was 8.7 months (range 2.1–19 months).
All seven patients with brain metastases at first dose showed progressive disease; median overall survival for this group was 6.7 months (range 2.1–18.2 months). The eighth patient, who began HD IL-2 therapy with metastatic disease limited to the lungs after complete radiosurgical response of a solitary brain lesion prior to HD IL-2 treatment, experienced a marked partial response to HD IL-2. After this therapy, the patient underwent resection of residual lung lesions and was deemed to show complete response in this analysis.
One patient with a history of alcohol abuse had symptoms suggestive of neurotoxicity; those symptoms improved upon initiation of alcohol-withdrawal protocol. No treatment-related deaths occurred.
“Traditionally, melanoma patients with brain metastases have not been considered for HD IL-2 because treatment was thought to be futile,” explained Richart in the SLU statement. “Our study shows that having this condition does not exclude a patient from getting this treatment and can in fact improve the length of their life.”
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- February 28, 2015 at 5:05 pm
Thanks Jerry. Interesting piece. We start the immunocore tues. First scans March 11th. We should know something on that day. There is definitely tumor flare with this treatment. The doctors aren't sure if the immunocore will cross bbb. But they say it's a smaller molecule than pd1 and ctl4a. I will post next week about what we see.
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- February 28, 2015 at 5:05 pm
Thanks Jerry. Interesting piece. We start the immunocore tues. First scans March 11th. We should know something on that day. There is definitely tumor flare with this treatment. The doctors aren't sure if the immunocore will cross bbb. But they say it's a smaller molecule than pd1 and ctl4a. I will post next week about what we see.
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- February 28, 2015 at 5:05 pm
Thanks Jerry. Interesting piece. We start the immunocore tues. First scans March 11th. We should know something on that day. There is definitely tumor flare with this treatment. The doctors aren't sure if the immunocore will cross bbb. But they say it's a smaller molecule than pd1 and ctl4a. I will post next week about what we see.
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- February 28, 2015 at 1:04 pm
Fay, IL-2 is immunjotherapy.It is not aa chemical to cross the BBB. It used to be that if one had a brain tumors they refused to even think about administeering IL-2. A study was released in Aug 2013 that challenged that thought.
August 27, 2013
Interleukin-2 extends life in melanoma brain metastases
Researchers are suggesting that high-dose interleukin-2 (HD IL-2) therapy should be considered as a treatment option in patients with melanoma brain metastases who are otherwise eligible for therapy, based on the encouraging results of a small retrospective review.
Five men and three women (median age 52.2 years; range 26.8–61.1 years) with stable melanoma brain metastases underwent HD IL-2 therapy between January 1999 and June 2011 at Saint Louis University (SLU) in St. Louis, Missouri. The regimen consisted of 14 doses at 720,000 IU/kg per dose intravenously, two cycles per course, for a maximum of two courses. Three patients had radiosurgery, and one patient had whole-brain radiation prior to HD IL-2 therapy. After HD IL-2 therapy, five patients received consolidation whole-brain radiation, and four underwent radiosurgery.
As noted in an SLU statement accompanying the release of the study results in Chemotherapy Research and Practice, median overall survival of patients with melanoma brain metastases is normally approximately 4 months. But the investigative team, led by SLU's John Richart, MD, found that the median overall survival for the entire HD IL-2 cohort was 8.7 months (range 2.1–19 months).
All seven patients with brain metastases at first dose showed progressive disease; median overall survival for this group was 6.7 months (range 2.1–18.2 months). The eighth patient, who began HD IL-2 therapy with metastatic disease limited to the lungs after complete radiosurgical response of a solitary brain lesion prior to HD IL-2 treatment, experienced a marked partial response to HD IL-2. After this therapy, the patient underwent resection of residual lung lesions and was deemed to show complete response in this analysis.
One patient with a history of alcohol abuse had symptoms suggestive of neurotoxicity; those symptoms improved upon initiation of alcohol-withdrawal protocol. No treatment-related deaths occurred.
“Traditionally, melanoma patients with brain metastases have not been considered for HD IL-2 because treatment was thought to be futile,” explained Richart in the SLU statement. “Our study shows that having this condition does not exclude a patient from getting this treatment and can in fact improve the length of their life.”
-
- February 28, 2015 at 1:04 pm
Fay, IL-2 is immunjotherapy.It is not aa chemical to cross the BBB. It used to be that if one had a brain tumors they refused to even think about administeering IL-2. A study was released in Aug 2013 that challenged that thought.
August 27, 2013
Interleukin-2 extends life in melanoma brain metastases
Researchers are suggesting that high-dose interleukin-2 (HD IL-2) therapy should be considered as a treatment option in patients with melanoma brain metastases who are otherwise eligible for therapy, based on the encouraging results of a small retrospective review.
Five men and three women (median age 52.2 years; range 26.8–61.1 years) with stable melanoma brain metastases underwent HD IL-2 therapy between January 1999 and June 2011 at Saint Louis University (SLU) in St. Louis, Missouri. The regimen consisted of 14 doses at 720,000 IU/kg per dose intravenously, two cycles per course, for a maximum of two courses. Three patients had radiosurgery, and one patient had whole-brain radiation prior to HD IL-2 therapy. After HD IL-2 therapy, five patients received consolidation whole-brain radiation, and four underwent radiosurgery.
As noted in an SLU statement accompanying the release of the study results in Chemotherapy Research and Practice, median overall survival of patients with melanoma brain metastases is normally approximately 4 months. But the investigative team, led by SLU's John Richart, MD, found that the median overall survival for the entire HD IL-2 cohort was 8.7 months (range 2.1–19 months).
All seven patients with brain metastases at first dose showed progressive disease; median overall survival for this group was 6.7 months (range 2.1–18.2 months). The eighth patient, who began HD IL-2 therapy with metastatic disease limited to the lungs after complete radiosurgical response of a solitary brain lesion prior to HD IL-2 treatment, experienced a marked partial response to HD IL-2. After this therapy, the patient underwent resection of residual lung lesions and was deemed to show complete response in this analysis.
One patient with a history of alcohol abuse had symptoms suggestive of neurotoxicity; those symptoms improved upon initiation of alcohol-withdrawal protocol. No treatment-related deaths occurred.
“Traditionally, melanoma patients with brain metastases have not been considered for HD IL-2 because treatment was thought to be futile,” explained Richart in the SLU statement. “Our study shows that having this condition does not exclude a patient from getting this treatment and can in fact improve the length of their life.”
-
- February 26, 2015 at 1:54 am
Yes Jerry. My husband does have an NRAS mutation. We have discussed il2 off line (you sent me all the suggested prep for such treatment ). The one thing that has changed from last we spoke is that he has two small brain mets, more in the liver, more sub qs. And small gastric tumor. So. Disease is progressing now that he got kicked off the Mek/cdk4 inhibitor trial. ( we don't regret the inhibitor. It gave us sept oct nov Dec with disease regression. But now it's back on the move. I am wondering how il2 does across the blood brain barrier. We go to NYC tomorrow to sign the immunocore consents. Hoping hbg looks good. I have a feeling the ldh is going to be much higher than its ever been. Bummed. But we need to try this. Plan b is the Abraxane/avastin with radiation to brain. But I want to do something with il2 before he gets too sick.
-
- February 26, 2015 at 1:54 am
Yes Jerry. My husband does have an NRAS mutation. We have discussed il2 off line (you sent me all the suggested prep for such treatment ). The one thing that has changed from last we spoke is that he has two small brain mets, more in the liver, more sub qs. And small gastric tumor. So. Disease is progressing now that he got kicked off the Mek/cdk4 inhibitor trial. ( we don't regret the inhibitor. It gave us sept oct nov Dec with disease regression. But now it's back on the move. I am wondering how il2 does across the blood brain barrier. We go to NYC tomorrow to sign the immunocore consents. Hoping hbg looks good. I have a feeling the ldh is going to be much higher than its ever been. Bummed. But we need to try this. Plan b is the Abraxane/avastin with radiation to brain. But I want to do something with il2 before he gets too sick.
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Tagged: cutaneous melanoma
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