› Forums › General Melanoma Community › Hope for those facing interferon
- This topic has 63 replies, 8 voices, and was last updated 8 years, 8 months ago by
Bakerman1960.
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- September 16, 2015 at 4:13 pm
As I was approaching the start of my interferon therapy (for stage 3A), I was troubled that there were seemingly few stories out there of people tolerating the treatment well. As I'm pretty deep into my treatment now, I wanted to share my experience to give hope to some of you earlier in your journey.
I have done the month of infusions, and I am now in my 5th week of injections. I'm not going to say that it's been a fun time, but interferon has not been the terrible monster that I had feared it would be.
The treatment is a constant series of peaks and valleys, but I'm surprised that the valleys aren't as low as I expected. Personally, the flu-like symptoms tapered very quickly. I felt horrible the very first night, kind of crappy the second night, but after that, in general, I rarely woke up at night from discomfort. The biggest problem became the burning sensation in my skin and the "pins and needles" feeling, but those have tapered off as well. I received 2 weeks off before my injections, and so the flu-like symptoms returned for the first night, but immediately tapered afterward.
I had 2 days of nausea during my infusions, but none sense. I have frequent stomach "uneasiness" on my injections, but it doesn't progress to bad nausea. It can be hard to get moving in the morning after my injections because my body feels a little "heavy." Sometimes I have some pretty bad joint pain, but Advil is a lifesaver.
I do warn to keep on eye on the mental side effects. I feel like my temper is shorter, and I'm slightly more irritable, and sometimes I feel like my motivation to do things is down. All of these things come in waves though, and I often feel COMPLETELY normal.
Going into interferon, I decided to be extremely proactive about my health. I slept more, decreased my stress levels, renovated my diet (healthy lean meats and veggies…cut out sweets and processed carbs), and I started a nutrition system. Feel free to message me with any questions on the diet or nutrition system, but I truly feel like living as healthy as possible has helped me to thrive through this interferon treatment.
Everyone is different of course, but it is possible to take this beast of a treatment head on and do very well! And, so far so good…I had a PET scan two days ago, and it was all clear!
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- September 16, 2015 at 4:57 pm
Love your perspective "never". (I am in month 9 of 12 months of the same Interferon treatment plan (3A))
A couple of thoughts for you and others:
Before anybody starts starts faulting him for doing Interferon realize that he is a 3A and most of the new stuff coming out is for Stage 4 (and several trials have recently started for 3B and 3C patients). I have yet to see a viable alternative besides Watch and Wait or some clinical vaccines trials which are still early phases of their development. (If somebody has real options for 3A would love to hear about them). ET and SF have done extensive research on their options when they were a 2B but I think unfortunately they moved into a different world when restaged as a 3B)
The other thought….don't be afraid to take an Interferon drug holiday…this is a marathon and you don't want to stop living. I have taken 2 holidays since the beginning of the year and they have been incredibly important in knowing that I will return to "normal". It takes about 7 days for me to return to 95% and then the following week is almost total bliss (and we go to some really nice beach and just hang out eating, drinking, and being married again. ) The only down side to the drug holiday is the reentry which will be tough but you will get back in the interferon "groove" within 2-3 shots.
For those that have progressed to Stage 3B or beyond and have other options available. I will be eternally grateful to watch your successes (as the doctors perfect their craft with these new treatments)…but also know that Interferon allowed me to extend my chance of reoccurence by about 6 months and in today's world…that is a ton of time.
Best wishes.
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- September 16, 2015 at 8:11 pm
Yes! I encourage anyone facing interferon to make the best decision for themself and ignore the people on here who will post anonymously and bash interferon as completely useless.
For those of you facing this, please look over this published paper. It can be a little dense if you're not used to reading scientific manuscripts, but it has good information. (I'm a scientist, so I enjoy this stuff. I'm a scientist in a cancer center, and I got cancer…the irony isn't lost on me
).In short the Gogas paper took 200 high-risk melanoma patients (IIB – IIIC…some unknown in lymph node status) that have had surgery to remove the tumors and gave them high-dose interferon (HDI) treatments. Some had just the infusions, while some did the infusions and the subcutaneous injections.
The patients were divided into 2 groups: those that eventually showed signs of autoimmunity (could be autoantibodies and not necessarily symptomatic disease) and those that did not show signs of autoimmunity. 52 patients had autoimmunity, while 148 patients did not.
In the no autoimmunity group, 108 out of 148 patients relapsed (73%). In the autoimmunity group, only 7 of 52 relapsed (13%)! That's a substantial drop in the % of patients that relapsed. Now this isn't fully accepted (some studies using lower interferon doses found no correlation between autoimmunity and relapse), but this should give you hope that interferon can be extremely effective in preventing a relapse in a subset of people. It is true that in the majority of people it doesn't seem to help, but you never know which group you're going to be in until you give it a shot.
For those confused on what autoimmunity has to do with anything, the thought is that the development of autoimmunity shows that the interferon is strongly activating your immune response. The "pedal is to the metal" so to speak, and your immune system is attacking both any residual cancer cells and your own organs (such as your thyroid).
This isn't to say that people who get no autoimmunity are doomed. But take solace in seeing that interferon can be really effective when you look at stratified subsets, instead of lumping all patients together!
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- September 16, 2015 at 9:17 pm
Great post about the experience. I agree that while it is challenging, it is possible. And for stage 3ers it is still a viable option.
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- September 16, 2015 at 9:17 pm
Great post about the experience. I agree that while it is challenging, it is possible. And for stage 3ers it is still a viable option.
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- September 16, 2015 at 11:23 pm
Why push something that is proven not to work? Other new adjuvant treatments are available. Lose quality of life for a year to get nothing in return? Check this article out from Sloan Kettering, one of the top institutions who never prescribed it (along with Mayo clinic) And how different are the names you use from anon? Janner posted this here recently too.
Articles by Hurley, K. E.
Articles by Chapman, P. B.
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PubMed Citation
Articles by Hurley, K. E.
Articles by Chapman, P. B.
Helping Melanoma Patients Decide Whether to Choose Adjuvant High-Dose Interferon-2b
Karen E. Hurley, Paul B. Chapman
Department of Psychiatry and Behavioral Sciences, and Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
Key Words. Adjuvant treatment • Interferon • Melanoma • Risk–benefit • Survival
Correspondence: Paul B. Chapman, M.D., Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, USA. Telephone: 212-639-5015; Fax: 212-704-4352; e-mail: [email protected]
Received May 31, 2005; accepted for publication August 1, 2005.
LEARNING OBJECTIVES
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Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
After completing this course, the reader will be able to:
Describe the benefits of adjuvant high-dose interferon- therapy to melanoma patients.
List the toxicities most commonly associated with adjuvant high-dose interferon- therapy in melanoma patients.
Assist patients with melanoma to decide whether to choose adjuvant high-dose interferon- therapy.
Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.com
ABSTRACT
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Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
High-dose interferon-2b is a U.S. Food and Drug Administration–approved adjuvant treatment for stage III melanoma, and yet, because of its limited efficacy and well-known toxicity, it is not universally accepted by patients and oncologists. In this paper, we evaluate the benefits and risks of adjuvant high-dose interferon-2b and try to provide a framework to help oncologists guide patients trying to decide whether to undergo adjuvant high-dose interferon therapy.
INTRODUCTION
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Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
The value of a year of high-dose interferon-2b (HD IFN) for the adjuvant treatment of stage III melanoma remains a source of controversy among oncologists and patients. Since it is a U.S. Food and Drug Administration–approved treatment and is administered on an outpatient basis, some oncologists recommend it to all stage III melanoma patients after complete surgical resection. However, a substantial proportion of oncologists feel that the benefits of adjuvant HD IFN treatment do not justify the toxicities. Initially, some of this controversy arose from the lack of mature results from the two randomized phase III trials comparing adjuvant HD IFN with observation [1, 2]. Over the past few years, however, these data have matured, and an updated pooled analysis has recently been published [3]. These data, which are reviewed below, can be considered to represent the final word on the value of HD IFN, and as a result, it seems timely to consider how oncologists can help patients weigh the risks and benefits of adjuvant HD IFN treatment and so come to an informed decision on whether to undergo this treatment.
THE BENEFITS AND RISKS ASSOCIATED WITH ADJUVANT HD IFN
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Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
The two randomized trials, in which a total of 713 patients received either adjuvant HD IFN or observation, both showed similar results [1, 2]. To be eligible for these trials, melanoma patients had to have had either deep primaries (>4 mm) or regional lymph node involvement. They were started on the trials within 70 days after complete surgical excision. With follow-up now complete in the first trial (median of 12.6 years of follow-up of survivors) and a median follow-up of 6.6 years in the second trial, neither showed an overall survival benefit associated with adjuvant HD IFN treatment. This is reflected in the pooled analysis of these two studies, which was recently published [3]. This pooled analysis showed that the survival curves were virtually superimposable (p = .42). Both treatment arms show an approximately 50% survival rate at 5 years, and there was no effect on the "tail of the survival curve," meaning that HD IFN did not increase the chance of cure. On the other hand, HD IFN was associated with longer recurrence-free survival in both trials. However, in the pooled analysis [3], the median time to relapse was longer in the HD IFN group by less than 1 year.
What does all this mean to the patient? It means that, among patients destined to recur, a year’s worth of HD IFN treatment can delay the time of recurrence in a small subset, although for half of these patients this delay will be less than 1 year. However, the overall chance of recurrence and the overall survival is not improved. This means that, if the patient is destined to relapse and die of melanoma, HD IFN does not affect this nor does it significantly delay the time of death.
HD IFN is associated with toxicities that result in decreased performance status in virtually all patients. In the most recent HD IFN trials, severe toxicities (grade 3–4) were frequently reported for fatigue, myalgias, and hepatotoxicity (Table 1). Although toxicities such as fatigue, fever, and flu-like symptoms are universal, they are under-reported in publications since generally only grade 3 or worse toxicities are reported. Depression appears to be very common, occurring in 40% of patients if patients are assessed carefully [4]. Patients reporting a depressed mood or insomnia before starting HD IFN have been shown to be at a higher risk for worsening of depression during treatment, particularly if they also have low levels of social support [5]. In some patients, serious cardiac, hepatic, and bone marrow toxicities are also seen, and because of the need to screen for and manage these toxicities, frequent follow-up and blood tests are necessary in patients on HD IFN. This represents both a financial cost as well as a further cost in quality of life (QoL).
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Table 1. Benefits and risks of high-dose interferon-2b therapy
Data on QoL during HD IFN therapy can be presented to patients as part of informed decision-making. Trask and colleagues [6] conducted a longitudinal study of QoL in stage III melanoma patients receiving HD IFN after surgical resection. Patients reported increased depression, fatigue, and somatic complaints and decreased physical well-being over the course of 6 months of HD IFN treatment. Similarly, data from the E1684 trial show that up to 70% of patients on HD IFN experienced grade 3 toxicities or higher and that the mean length of time spent experiencing these symptoms was 7.4 months out of the 12 months of treatment [7].
In oncology, we often offer toxic, noncurative treatment to our patients with metastatic cancer. However, in the setting of evaluable metastatic disease, the oncologist and patient can frequently evaluate the risk–benefit ratio by weighing the antitumor effects in the patient against the side effects being experienced. Even if the treatment is not curative, individual patients could elect to continue treatment if the risk–benefit ratio is sufficiently high. For example, in the setting of stable disease and no toxicity, the patient might reasonably choose to continue treatment. Alternatively, some patients may experience tumor regression and, as a result, might tolerate more toxicity. If the risk–benefit ratio becomes too low, treatment would be stopped.
In the adjuvant setting, it is impossible to assess the ongoing benefits in an individual patient because there is no tumor to evaluate. Although the toxicities are evident, the individual patient cannot gauge the benefit in an individual case; this must be inferred from previous phase III trials. For many adjuvant treatments, data are not available regarding the magnitude or likelihood of the potential benefits, and the risk–benefit ratio must be estimated based on scientific rationale. In the case of HD IFN, however, mature data defining the benefit are available (as noted above), and a more precise risk–benefit analysis is possible.
HOW DO WE DETERMINE THE RISK–BENEFIT RATIO FOR HD IFN?
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Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
Now that the benefits and risks of HD IFN have been well defined (Table 1), it is possible to examine how oncologists and patients might weigh the risks against the benefit of longer relapse-free survival to decide on the advisability of adjuvant HD IFN.
In the case of HD IFN, the question is: How much risk is a median improvement in progression-free survival of less than a year worth to the patient, knowing that there is no improvement in overall survival? Each patient has a sense of what risk–benefit ratio is acceptable. In some cases, it may be reasonable to accept a higher risk–benefit ratio (e.g., when potential benefits are greater). No matter what risk–benefit ratio the patient feels comfortable with, the physician can help the patient come to a treat/no-treat decision by discussing both the benefits (longer progression-free survival but no improvement in survival) and the risks (toxicities, frequent injections, office visits, blood tests). As an example, we may consider a stage IIIB patient with a single, palpable regional lymph node involved with melanoma. This patient has an approximately 50% chance of dying from melanoma over 5 years [8], a risk that is not improved by HD IFN according to the published data [3]. This means that if the patient chooses to receive HD IFN, he runs a 50% risk that he will spend at least 20% of his remaining time (presumably the best 20%, because it is the year immediately after surgery) on HD IFN.
PATIENT DECISION-MAKING ABOUT HD IFN
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Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
Psychosocial studies of patient preferences for HDIFN show large standard deviations [7, 9], suggesting that patients may differ in their subjective valuation of the risk–benefit ratio and that factors other than outcome data are influencing patient decisions [10]. Research on decision making among patients with other types of cancer has shown that patients are less likely to experience regret when they feel the decision was their own rather than undergoing the specific treatment because the doctor told them to [11, 12]. In discussing HD IFN, the oncologist can facilitate this process by exploring the meaning of disease-free survival for the patient, as well as expectations about side effects, to reach a decision that addresses both the patient’s physical and mental well-being. This approach can help maintain the doctor–patient relationship in the long run and facilitate patient acceptance of recommendations in case of toxicities or recurrence.
SUBJECTIVE BENEFITS OF HD IFN
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Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
Some patients may be willing to risk the toxicity of HD IFN because they perceive the advent of recurrence as synonymous with death, whereas the disease-free period allows them to cling to hope that they might achieve long-term survival. For other patients, recurrence in the absence of action may trigger thoughts that they missed an opportunity to stave off death [7]. In this instance, taking HD IFN may represent a form of "regret management" in which patients seek to avoid the scenario that would trigger the most regret and self-blame. Feeling that one has done everything possible may make the possibility of recurrence more bearable; if the disease returns despite HD IFN, the patient may interpret this as meaning that it was meant to be and that he or she is blameless. Paradoxically, severe side effects can be construed as concrete evidence that one’s efforts to survive were sincere and that no stone was left unturned.
DECISION RULES FOR DISCUSSING HD IFN
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Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
Kilbridge and colleagues [9] developed a decision rule consisting of two screening questions that allow identification of patients who would clearly benefit from HD IFN. These questions were based on the assumption that adjuvant HD IFN is associated with an improvement in overall survival. However, since subsequent data no longer support the primary assumption that adjuvant HD IFN is associated with improved overall survival (as discussed above), these specific screening questions appear to be no longer valid. However, the findings do suggest that, for most patients, a discussion of expectations about HD IFN can be accomplished in a brief, focused fashion and that the key elements of assessing patient readiness for HD IFN include a realistic understanding of the probability and nature of the side effects, a clear willingness to tolerate side effects for the possibility of modifying the course of one’s disease, and a realistic understanding of the nature and probability of any benefits of HD IFN.
OTHER OPTIONS FOR ADJUVANT THERAPY
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Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
If the patient (or oncologist) is convinced that the risks of HD IFN are not reasonable for the potential benefits, it is rational to explore alternative options. In the past, adjuvant chemotherapy has been explored, but, aside from one trial assessing the role of adjuvant dacarbazine (DTIC-Dome®; BayerPharmaceuticals Corporation, WestHaven, CT, http://www.bayerpharma-na.com/), all the other randomized trials were either significantly underpowered or tested drugs that we no longer believe are active in melanoma. As a result, the question of the role of adjuvant chemotherapy in melanoma remains an open one. Currently, an intercooperative group study is testing the efficacy of biochemotherapy as an adjuvant treatment compared with HD IFN, a trial in which both treatment arms are associated with significant toxicity and a high risk–benefit ratio. The European Organization for Research and Treatment of Cancer is evaluating the role of prolonged (5-year) treatment with low-dose pegylated interferon- as an adjuvant treatment. Other adjuvant strategies focus on vaccine approaches. Although the benefits are not yet defined, the risks are generally minimal, and patients may view these as having lower risk–benefit ratios.
In most situations in melanoma, patients are faced with trying to make a rational decision in the setting of incomplete information. For the issue of adjuvant HD IFN, however, the information is remarkably complete, and oncologists can help patients to quantitate the risks and benefits that will help them come to a decision.
DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST
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Introduction
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Patient decision-making about hd…
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Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
Dr. Chapman has acted as a consultant for Schering-Plough.
ACKNOWLEDGMENT
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Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
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- September 17, 2015 at 1:58 am
Quoting directly from that same study (literally copy and pasted below)…it is all about buying time and staving off reoccurence as long as possible.
"On the other hand, HD IFN was associated with longer recurrence-free survival in both trials. However, in the pooled analysis [3], the median time to relapse was longer in the HD IFN group by less than 1 year.
What does all this mean to the patient? It means that, among patients destined to recur, a year’s worth of HD IFN treatment can delay the time of recurrence in a small subset, although for half of these patients this delay will be less than 1 year."
Every Interferon study that I have seen shows a benefit of delaying reoccurence by 6+ months….the primary benefit is that doctors all over the world will have more experience in working with these new PD-1 drugs. What works and what doesn't will be substantially better understood during the next 12-24 months.
I ask the same question that I have posed before…are there other viable alternatives for Stage 3A patients (other than watch and wait) or completely unproven vaccines? I don't repeat this question to create anxiety but rather ask it to understand if there is something else out there to consider. (does anybody know what Sloan Kettering is actually recommending for 3A patients?)
All the best
Michel
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- September 17, 2015 at 1:58 am
Quoting directly from that same study (literally copy and pasted below)…it is all about buying time and staving off reoccurence as long as possible.
"On the other hand, HD IFN was associated with longer recurrence-free survival in both trials. However, in the pooled analysis [3], the median time to relapse was longer in the HD IFN group by less than 1 year.
What does all this mean to the patient? It means that, among patients destined to recur, a year’s worth of HD IFN treatment can delay the time of recurrence in a small subset, although for half of these patients this delay will be less than 1 year."
Every Interferon study that I have seen shows a benefit of delaying reoccurence by 6+ months….the primary benefit is that doctors all over the world will have more experience in working with these new PD-1 drugs. What works and what doesn't will be substantially better understood during the next 12-24 months.
I ask the same question that I have posed before…are there other viable alternatives for Stage 3A patients (other than watch and wait) or completely unproven vaccines? I don't repeat this question to create anxiety but rather ask it to understand if there is something else out there to consider. (does anybody know what Sloan Kettering is actually recommending for 3A patients?)
All the best
Michel
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- September 17, 2015 at 1:58 am
Quoting directly from that same study (literally copy and pasted below)…it is all about buying time and staving off reoccurence as long as possible.
"On the other hand, HD IFN was associated with longer recurrence-free survival in both trials. However, in the pooled analysis [3], the median time to relapse was longer in the HD IFN group by less than 1 year.
What does all this mean to the patient? It means that, among patients destined to recur, a year’s worth of HD IFN treatment can delay the time of recurrence in a small subset, although for half of these patients this delay will be less than 1 year."
Every Interferon study that I have seen shows a benefit of delaying reoccurence by 6+ months….the primary benefit is that doctors all over the world will have more experience in working with these new PD-1 drugs. What works and what doesn't will be substantially better understood during the next 12-24 months.
I ask the same question that I have posed before…are there other viable alternatives for Stage 3A patients (other than watch and wait) or completely unproven vaccines? I don't repeat this question to create anxiety but rather ask it to understand if there is something else out there to consider. (does anybody know what Sloan Kettering is actually recommending for 3A patients?)
All the best
Michel
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- September 17, 2015 at 2:44 am
Choices? What choices? Those new immunotherapy options are great if you’re stage 3b or worse. If you’re stage 3a or lower, it’s interferon or observation, unless you want to give some vaccine a shot. But we have no chance at the CTLA4, PD-1, or PD-L1 inhibitors.I think stating that interferon does nothing at all is irresponsible. Even you’re quoted study cited increased time to relapse. Other studies do show slight survival increases. The autoimmunity study I cited involved Dr. John Kirkwood, a very renowned melanoma expert. No individual study is the end-all, be-all definitive word, Sloan Kettering or otherwise. It will continue to be a controversial topic. But when your choice is do nothing or give interferon a shot, the purpose of my original post was to provide encouragement to those wanting to do what they could, and provide a positive story that shows it isn’t all bad. I think it’s good to counteract the fear-mongering done by some on the board.
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- September 17, 2015 at 2:44 am
Choices? What choices? Those new immunotherapy options are great if you’re stage 3b or worse. If you’re stage 3a or lower, it’s interferon or observation, unless you want to give some vaccine a shot. But we have no chance at the CTLA4, PD-1, or PD-L1 inhibitors.I think stating that interferon does nothing at all is irresponsible. Even you’re quoted study cited increased time to relapse. Other studies do show slight survival increases. The autoimmunity study I cited involved Dr. John Kirkwood, a very renowned melanoma expert. No individual study is the end-all, be-all definitive word, Sloan Kettering or otherwise. It will continue to be a controversial topic. But when your choice is do nothing or give interferon a shot, the purpose of my original post was to provide encouragement to those wanting to do what they could, and provide a positive story that shows it isn’t all bad. I think it’s good to counteract the fear-mongering done by some on the board.
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- September 17, 2015 at 2:44 am
Choices? What choices? Those new immunotherapy options are great if you’re stage 3b or worse. If you’re stage 3a or lower, it’s interferon or observation, unless you want to give some vaccine a shot. But we have no chance at the CTLA4, PD-1, or PD-L1 inhibitors.I think stating that interferon does nothing at all is irresponsible. Even you’re quoted study cited increased time to relapse. Other studies do show slight survival increases. The autoimmunity study I cited involved Dr. John Kirkwood, a very renowned melanoma expert. No individual study is the end-all, be-all definitive word, Sloan Kettering or otherwise. It will continue to be a controversial topic. But when your choice is do nothing or give interferon a shot, the purpose of my original post was to provide encouragement to those wanting to do what they could, and provide a positive story that shows it isn’t all bad. I think it’s good to counteract the fear-mongering done by some on the board.
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- September 17, 2015 at 5:08 pm
Here is a comprehensive meta-analysis done in 2010 looking at 14 separate randomized controlled trials comparing interferon versus a control observation arm or other treatment. It has over 8000 patients in total.
There were 17 comparisons for disease-free survival, and interferon significantly improved disease-free survival in 10 of those comparisons. There were 14 comparisons for overall survival, and interferon improved overall survival in 4 of those comparisons.
No one can accurately say that interferon has NO effect. But it is definitely true that the effect it has is limited to a small percentage of patients. There is a risk vs. reward in every cancer treatment (as anyone familiar with the clinical trial history of Yervoy knows). But I think blanket, uninformed statements that "interferon has no effect" are counterproductive and interfere with those on here seeking guidance making the best decision for their situation. If you're willing to give interferon a shot on the small chance that you will be a "responder," but knowing you may feel miserable (but may not!), then give it a shot.
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- September 17, 2015 at 5:08 pm
Here is a comprehensive meta-analysis done in 2010 looking at 14 separate randomized controlled trials comparing interferon versus a control observation arm or other treatment. It has over 8000 patients in total.
There were 17 comparisons for disease-free survival, and interferon significantly improved disease-free survival in 10 of those comparisons. There were 14 comparisons for overall survival, and interferon improved overall survival in 4 of those comparisons.
No one can accurately say that interferon has NO effect. But it is definitely true that the effect it has is limited to a small percentage of patients. There is a risk vs. reward in every cancer treatment (as anyone familiar with the clinical trial history of Yervoy knows). But I think blanket, uninformed statements that "interferon has no effect" are counterproductive and interfere with those on here seeking guidance making the best decision for their situation. If you're willing to give interferon a shot on the small chance that you will be a "responder," but knowing you may feel miserable (but may not!), then give it a shot.
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- September 17, 2015 at 5:08 pm
Here is a comprehensive meta-analysis done in 2010 looking at 14 separate randomized controlled trials comparing interferon versus a control observation arm or other treatment. It has over 8000 patients in total.
There were 17 comparisons for disease-free survival, and interferon significantly improved disease-free survival in 10 of those comparisons. There were 14 comparisons for overall survival, and interferon improved overall survival in 4 of those comparisons.
No one can accurately say that interferon has NO effect. But it is definitely true that the effect it has is limited to a small percentage of patients. There is a risk vs. reward in every cancer treatment (as anyone familiar with the clinical trial history of Yervoy knows). But I think blanket, uninformed statements that "interferon has no effect" are counterproductive and interfere with those on here seeking guidance making the best decision for their situation. If you're willing to give interferon a shot on the small chance that you will be a "responder," but knowing you may feel miserable (but may not!), then give it a shot.
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- September 16, 2015 at 11:23 pm
Why push something that is proven not to work? Other new adjuvant treatments are available. Lose quality of life for a year to get nothing in return? Check this article out from Sloan Kettering, one of the top institutions who never prescribed it (along with Mayo clinic) And how different are the names you use from anon? Janner posted this here recently too.
Articles by Hurley, K. E.
Articles by Chapman, P. B.
Search for Related Content
PubMed
PubMed Citation
Articles by Hurley, K. E.
Articles by Chapman, P. B.
Helping Melanoma Patients Decide Whether to Choose Adjuvant High-Dose Interferon-2b
Karen E. Hurley, Paul B. Chapman
Department of Psychiatry and Behavioral Sciences, and Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
Key Words. Adjuvant treatment • Interferon • Melanoma • Risk–benefit • Survival
Correspondence: Paul B. Chapman, M.D., Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, USA. Telephone: 212-639-5015; Fax: 212-704-4352; e-mail: [email protected]
Received May 31, 2005; accepted for publication August 1, 2005.
LEARNING OBJECTIVES
Top
Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
After completing this course, the reader will be able to:
Describe the benefits of adjuvant high-dose interferon- therapy to melanoma patients.
List the toxicities most commonly associated with adjuvant high-dose interferon- therapy in melanoma patients.
Assist patients with melanoma to decide whether to choose adjuvant high-dose interferon- therapy.
Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.com
ABSTRACT
Top
Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
High-dose interferon-2b is a U.S. Food and Drug Administration–approved adjuvant treatment for stage III melanoma, and yet, because of its limited efficacy and well-known toxicity, it is not universally accepted by patients and oncologists. In this paper, we evaluate the benefits and risks of adjuvant high-dose interferon-2b and try to provide a framework to help oncologists guide patients trying to decide whether to undergo adjuvant high-dose interferon therapy.
INTRODUCTION
Top
Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
The value of a year of high-dose interferon-2b (HD IFN) for the adjuvant treatment of stage III melanoma remains a source of controversy among oncologists and patients. Since it is a U.S. Food and Drug Administration–approved treatment and is administered on an outpatient basis, some oncologists recommend it to all stage III melanoma patients after complete surgical resection. However, a substantial proportion of oncologists feel that the benefits of adjuvant HD IFN treatment do not justify the toxicities. Initially, some of this controversy arose from the lack of mature results from the two randomized phase III trials comparing adjuvant HD IFN with observation [1, 2]. Over the past few years, however, these data have matured, and an updated pooled analysis has recently been published [3]. These data, which are reviewed below, can be considered to represent the final word on the value of HD IFN, and as a result, it seems timely to consider how oncologists can help patients weigh the risks and benefits of adjuvant HD IFN treatment and so come to an informed decision on whether to undergo this treatment.
THE BENEFITS AND RISKS ASSOCIATED WITH ADJUVANT HD IFN
Top
Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
The two randomized trials, in which a total of 713 patients received either adjuvant HD IFN or observation, both showed similar results [1, 2]. To be eligible for these trials, melanoma patients had to have had either deep primaries (>4 mm) or regional lymph node involvement. They were started on the trials within 70 days after complete surgical excision. With follow-up now complete in the first trial (median of 12.6 years of follow-up of survivors) and a median follow-up of 6.6 years in the second trial, neither showed an overall survival benefit associated with adjuvant HD IFN treatment. This is reflected in the pooled analysis of these two studies, which was recently published [3]. This pooled analysis showed that the survival curves were virtually superimposable (p = .42). Both treatment arms show an approximately 50% survival rate at 5 years, and there was no effect on the "tail of the survival curve," meaning that HD IFN did not increase the chance of cure. On the other hand, HD IFN was associated with longer recurrence-free survival in both trials. However, in the pooled analysis [3], the median time to relapse was longer in the HD IFN group by less than 1 year.
What does all this mean to the patient? It means that, among patients destined to recur, a year’s worth of HD IFN treatment can delay the time of recurrence in a small subset, although for half of these patients this delay will be less than 1 year. However, the overall chance of recurrence and the overall survival is not improved. This means that, if the patient is destined to relapse and die of melanoma, HD IFN does not affect this nor does it significantly delay the time of death.
HD IFN is associated with toxicities that result in decreased performance status in virtually all patients. In the most recent HD IFN trials, severe toxicities (grade 3–4) were frequently reported for fatigue, myalgias, and hepatotoxicity (Table 1). Although toxicities such as fatigue, fever, and flu-like symptoms are universal, they are under-reported in publications since generally only grade 3 or worse toxicities are reported. Depression appears to be very common, occurring in 40% of patients if patients are assessed carefully [4]. Patients reporting a depressed mood or insomnia before starting HD IFN have been shown to be at a higher risk for worsening of depression during treatment, particularly if they also have low levels of social support [5]. In some patients, serious cardiac, hepatic, and bone marrow toxicities are also seen, and because of the need to screen for and manage these toxicities, frequent follow-up and blood tests are necessary in patients on HD IFN. This represents both a financial cost as well as a further cost in quality of life (QoL).
View this table:
[in this window]
[in a new window]
Table 1. Benefits and risks of high-dose interferon-2b therapy
Data on QoL during HD IFN therapy can be presented to patients as part of informed decision-making. Trask and colleagues [6] conducted a longitudinal study of QoL in stage III melanoma patients receiving HD IFN after surgical resection. Patients reported increased depression, fatigue, and somatic complaints and decreased physical well-being over the course of 6 months of HD IFN treatment. Similarly, data from the E1684 trial show that up to 70% of patients on HD IFN experienced grade 3 toxicities or higher and that the mean length of time spent experiencing these symptoms was 7.4 months out of the 12 months of treatment [7].
In oncology, we often offer toxic, noncurative treatment to our patients with metastatic cancer. However, in the setting of evaluable metastatic disease, the oncologist and patient can frequently evaluate the risk–benefit ratio by weighing the antitumor effects in the patient against the side effects being experienced. Even if the treatment is not curative, individual patients could elect to continue treatment if the risk–benefit ratio is sufficiently high. For example, in the setting of stable disease and no toxicity, the patient might reasonably choose to continue treatment. Alternatively, some patients may experience tumor regression and, as a result, might tolerate more toxicity. If the risk–benefit ratio becomes too low, treatment would be stopped.
In the adjuvant setting, it is impossible to assess the ongoing benefits in an individual patient because there is no tumor to evaluate. Although the toxicities are evident, the individual patient cannot gauge the benefit in an individual case; this must be inferred from previous phase III trials. For many adjuvant treatments, data are not available regarding the magnitude or likelihood of the potential benefits, and the risk–benefit ratio must be estimated based on scientific rationale. In the case of HD IFN, however, mature data defining the benefit are available (as noted above), and a more precise risk–benefit analysis is possible.
HOW DO WE DETERMINE THE RISK–BENEFIT RATIO FOR HD IFN?
Top
Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
Now that the benefits and risks of HD IFN have been well defined (Table 1), it is possible to examine how oncologists and patients might weigh the risks against the benefit of longer relapse-free survival to decide on the advisability of adjuvant HD IFN.
In the case of HD IFN, the question is: How much risk is a median improvement in progression-free survival of less than a year worth to the patient, knowing that there is no improvement in overall survival? Each patient has a sense of what risk–benefit ratio is acceptable. In some cases, it may be reasonable to accept a higher risk–benefit ratio (e.g., when potential benefits are greater). No matter what risk–benefit ratio the patient feels comfortable with, the physician can help the patient come to a treat/no-treat decision by discussing both the benefits (longer progression-free survival but no improvement in survival) and the risks (toxicities, frequent injections, office visits, blood tests). As an example, we may consider a stage IIIB patient with a single, palpable regional lymph node involved with melanoma. This patient has an approximately 50% chance of dying from melanoma over 5 years [8], a risk that is not improved by HD IFN according to the published data [3]. This means that if the patient chooses to receive HD IFN, he runs a 50% risk that he will spend at least 20% of his remaining time (presumably the best 20%, because it is the year immediately after surgery) on HD IFN.
PATIENT DECISION-MAKING ABOUT HD IFN
Top
Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
Psychosocial studies of patient preferences for HDIFN show large standard deviations [7, 9], suggesting that patients may differ in their subjective valuation of the risk–benefit ratio and that factors other than outcome data are influencing patient decisions [10]. Research on decision making among patients with other types of cancer has shown that patients are less likely to experience regret when they feel the decision was their own rather than undergoing the specific treatment because the doctor told them to [11, 12]. In discussing HD IFN, the oncologist can facilitate this process by exploring the meaning of disease-free survival for the patient, as well as expectations about side effects, to reach a decision that addresses both the patient’s physical and mental well-being. This approach can help maintain the doctor–patient relationship in the long run and facilitate patient acceptance of recommendations in case of toxicities or recurrence.
SUBJECTIVE BENEFITS OF HD IFN
Top
Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
Some patients may be willing to risk the toxicity of HD IFN because they perceive the advent of recurrence as synonymous with death, whereas the disease-free period allows them to cling to hope that they might achieve long-term survival. For other patients, recurrence in the absence of action may trigger thoughts that they missed an opportunity to stave off death [7]. In this instance, taking HD IFN may represent a form of "regret management" in which patients seek to avoid the scenario that would trigger the most regret and self-blame. Feeling that one has done everything possible may make the possibility of recurrence more bearable; if the disease returns despite HD IFN, the patient may interpret this as meaning that it was meant to be and that he or she is blameless. Paradoxically, severe side effects can be construed as concrete evidence that one’s efforts to survive were sincere and that no stone was left unturned.
DECISION RULES FOR DISCUSSING HD IFN
Top
Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
Kilbridge and colleagues [9] developed a decision rule consisting of two screening questions that allow identification of patients who would clearly benefit from HD IFN. These questions were based on the assumption that adjuvant HD IFN is associated with an improvement in overall survival. However, since subsequent data no longer support the primary assumption that adjuvant HD IFN is associated with improved overall survival (as discussed above), these specific screening questions appear to be no longer valid. However, the findings do suggest that, for most patients, a discussion of expectations about HD IFN can be accomplished in a brief, focused fashion and that the key elements of assessing patient readiness for HD IFN include a realistic understanding of the probability and nature of the side effects, a clear willingness to tolerate side effects for the possibility of modifying the course of one’s disease, and a realistic understanding of the nature and probability of any benefits of HD IFN.
OTHER OPTIONS FOR ADJUVANT THERAPY
Top
Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
If the patient (or oncologist) is convinced that the risks of HD IFN are not reasonable for the potential benefits, it is rational to explore alternative options. In the past, adjuvant chemotherapy has been explored, but, aside from one trial assessing the role of adjuvant dacarbazine (DTIC-Dome®; BayerPharmaceuticals Corporation, WestHaven, CT, http://www.bayerpharma-na.com/), all the other randomized trials were either significantly underpowered or tested drugs that we no longer believe are active in melanoma. As a result, the question of the role of adjuvant chemotherapy in melanoma remains an open one. Currently, an intercooperative group study is testing the efficacy of biochemotherapy as an adjuvant treatment compared with HD IFN, a trial in which both treatment arms are associated with significant toxicity and a high risk–benefit ratio. The European Organization for Research and Treatment of Cancer is evaluating the role of prolonged (5-year) treatment with low-dose pegylated interferon- as an adjuvant treatment. Other adjuvant strategies focus on vaccine approaches. Although the benefits are not yet defined, the risks are generally minimal, and patients may view these as having lower risk–benefit ratios.
In most situations in melanoma, patients are faced with trying to make a rational decision in the setting of incomplete information. For the issue of adjuvant HD IFN, however, the information is remarkably complete, and oncologists can help patients to quantitate the risks and benefits that will help them come to a decision.
DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST
Top
Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
Dr. Chapman has acted as a consultant for Schering-Plough.
ACKNOWLEDGMENT
Top
Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
-
- September 16, 2015 at 11:23 pm
Why push something that is proven not to work? Other new adjuvant treatments are available. Lose quality of life for a year to get nothing in return? Check this article out from Sloan Kettering, one of the top institutions who never prescribed it (along with Mayo clinic) And how different are the names you use from anon? Janner posted this here recently too.
Articles by Hurley, K. E.
Articles by Chapman, P. B.
Search for Related Content
PubMed
PubMed Citation
Articles by Hurley, K. E.
Articles by Chapman, P. B.
Helping Melanoma Patients Decide Whether to Choose Adjuvant High-Dose Interferon-2b
Karen E. Hurley, Paul B. Chapman
Department of Psychiatry and Behavioral Sciences, and Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
Key Words. Adjuvant treatment • Interferon • Melanoma • Risk–benefit • Survival
Correspondence: Paul B. Chapman, M.D., Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, USA. Telephone: 212-639-5015; Fax: 212-704-4352; e-mail: [email protected]
Received May 31, 2005; accepted for publication August 1, 2005.
LEARNING OBJECTIVES
Top
Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
After completing this course, the reader will be able to:
Describe the benefits of adjuvant high-dose interferon- therapy to melanoma patients.
List the toxicities most commonly associated with adjuvant high-dose interferon- therapy in melanoma patients.
Assist patients with melanoma to decide whether to choose adjuvant high-dose interferon- therapy.
Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.com
ABSTRACT
Top
Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
High-dose interferon-2b is a U.S. Food and Drug Administration–approved adjuvant treatment for stage III melanoma, and yet, because of its limited efficacy and well-known toxicity, it is not universally accepted by patients and oncologists. In this paper, we evaluate the benefits and risks of adjuvant high-dose interferon-2b and try to provide a framework to help oncologists guide patients trying to decide whether to undergo adjuvant high-dose interferon therapy.
INTRODUCTION
Top
Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
The value of a year of high-dose interferon-2b (HD IFN) for the adjuvant treatment of stage III melanoma remains a source of controversy among oncologists and patients. Since it is a U.S. Food and Drug Administration–approved treatment and is administered on an outpatient basis, some oncologists recommend it to all stage III melanoma patients after complete surgical resection. However, a substantial proportion of oncologists feel that the benefits of adjuvant HD IFN treatment do not justify the toxicities. Initially, some of this controversy arose from the lack of mature results from the two randomized phase III trials comparing adjuvant HD IFN with observation [1, 2]. Over the past few years, however, these data have matured, and an updated pooled analysis has recently been published [3]. These data, which are reviewed below, can be considered to represent the final word on the value of HD IFN, and as a result, it seems timely to consider how oncologists can help patients weigh the risks and benefits of adjuvant HD IFN treatment and so come to an informed decision on whether to undergo this treatment.
THE BENEFITS AND RISKS ASSOCIATED WITH ADJUVANT HD IFN
Top
Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
The two randomized trials, in which a total of 713 patients received either adjuvant HD IFN or observation, both showed similar results [1, 2]. To be eligible for these trials, melanoma patients had to have had either deep primaries (>4 mm) or regional lymph node involvement. They were started on the trials within 70 days after complete surgical excision. With follow-up now complete in the first trial (median of 12.6 years of follow-up of survivors) and a median follow-up of 6.6 years in the second trial, neither showed an overall survival benefit associated with adjuvant HD IFN treatment. This is reflected in the pooled analysis of these two studies, which was recently published [3]. This pooled analysis showed that the survival curves were virtually superimposable (p = .42). Both treatment arms show an approximately 50% survival rate at 5 years, and there was no effect on the "tail of the survival curve," meaning that HD IFN did not increase the chance of cure. On the other hand, HD IFN was associated with longer recurrence-free survival in both trials. However, in the pooled analysis [3], the median time to relapse was longer in the HD IFN group by less than 1 year.
What does all this mean to the patient? It means that, among patients destined to recur, a year’s worth of HD IFN treatment can delay the time of recurrence in a small subset, although for half of these patients this delay will be less than 1 year. However, the overall chance of recurrence and the overall survival is not improved. This means that, if the patient is destined to relapse and die of melanoma, HD IFN does not affect this nor does it significantly delay the time of death.
HD IFN is associated with toxicities that result in decreased performance status in virtually all patients. In the most recent HD IFN trials, severe toxicities (grade 3–4) were frequently reported for fatigue, myalgias, and hepatotoxicity (Table 1). Although toxicities such as fatigue, fever, and flu-like symptoms are universal, they are under-reported in publications since generally only grade 3 or worse toxicities are reported. Depression appears to be very common, occurring in 40% of patients if patients are assessed carefully [4]. Patients reporting a depressed mood or insomnia before starting HD IFN have been shown to be at a higher risk for worsening of depression during treatment, particularly if they also have low levels of social support [5]. In some patients, serious cardiac, hepatic, and bone marrow toxicities are also seen, and because of the need to screen for and manage these toxicities, frequent follow-up and blood tests are necessary in patients on HD IFN. This represents both a financial cost as well as a further cost in quality of life (QoL).
View this table:
[in this window]
[in a new window]
Table 1. Benefits and risks of high-dose interferon-2b therapy
Data on QoL during HD IFN therapy can be presented to patients as part of informed decision-making. Trask and colleagues [6] conducted a longitudinal study of QoL in stage III melanoma patients receiving HD IFN after surgical resection. Patients reported increased depression, fatigue, and somatic complaints and decreased physical well-being over the course of 6 months of HD IFN treatment. Similarly, data from the E1684 trial show that up to 70% of patients on HD IFN experienced grade 3 toxicities or higher and that the mean length of time spent experiencing these symptoms was 7.4 months out of the 12 months of treatment [7].
In oncology, we often offer toxic, noncurative treatment to our patients with metastatic cancer. However, in the setting of evaluable metastatic disease, the oncologist and patient can frequently evaluate the risk–benefit ratio by weighing the antitumor effects in the patient against the side effects being experienced. Even if the treatment is not curative, individual patients could elect to continue treatment if the risk–benefit ratio is sufficiently high. For example, in the setting of stable disease and no toxicity, the patient might reasonably choose to continue treatment. Alternatively, some patients may experience tumor regression and, as a result, might tolerate more toxicity. If the risk–benefit ratio becomes too low, treatment would be stopped.
In the adjuvant setting, it is impossible to assess the ongoing benefits in an individual patient because there is no tumor to evaluate. Although the toxicities are evident, the individual patient cannot gauge the benefit in an individual case; this must be inferred from previous phase III trials. For many adjuvant treatments, data are not available regarding the magnitude or likelihood of the potential benefits, and the risk–benefit ratio must be estimated based on scientific rationale. In the case of HD IFN, however, mature data defining the benefit are available (as noted above), and a more precise risk–benefit analysis is possible.
HOW DO WE DETERMINE THE RISK–BENEFIT RATIO FOR HD IFN?
Top
Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
Now that the benefits and risks of HD IFN have been well defined (Table 1), it is possible to examine how oncologists and patients might weigh the risks against the benefit of longer relapse-free survival to decide on the advisability of adjuvant HD IFN.
In the case of HD IFN, the question is: How much risk is a median improvement in progression-free survival of less than a year worth to the patient, knowing that there is no improvement in overall survival? Each patient has a sense of what risk–benefit ratio is acceptable. In some cases, it may be reasonable to accept a higher risk–benefit ratio (e.g., when potential benefits are greater). No matter what risk–benefit ratio the patient feels comfortable with, the physician can help the patient come to a treat/no-treat decision by discussing both the benefits (longer progression-free survival but no improvement in survival) and the risks (toxicities, frequent injections, office visits, blood tests). As an example, we may consider a stage IIIB patient with a single, palpable regional lymph node involved with melanoma. This patient has an approximately 50% chance of dying from melanoma over 5 years [8], a risk that is not improved by HD IFN according to the published data [3]. This means that if the patient chooses to receive HD IFN, he runs a 50% risk that he will spend at least 20% of his remaining time (presumably the best 20%, because it is the year immediately after surgery) on HD IFN.
PATIENT DECISION-MAKING ABOUT HD IFN
Top
Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
Psychosocial studies of patient preferences for HDIFN show large standard deviations [7, 9], suggesting that patients may differ in their subjective valuation of the risk–benefit ratio and that factors other than outcome data are influencing patient decisions [10]. Research on decision making among patients with other types of cancer has shown that patients are less likely to experience regret when they feel the decision was their own rather than undergoing the specific treatment because the doctor told them to [11, 12]. In discussing HD IFN, the oncologist can facilitate this process by exploring the meaning of disease-free survival for the patient, as well as expectations about side effects, to reach a decision that addresses both the patient’s physical and mental well-being. This approach can help maintain the doctor–patient relationship in the long run and facilitate patient acceptance of recommendations in case of toxicities or recurrence.
SUBJECTIVE BENEFITS OF HD IFN
Top
Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
Some patients may be willing to risk the toxicity of HD IFN because they perceive the advent of recurrence as synonymous with death, whereas the disease-free period allows them to cling to hope that they might achieve long-term survival. For other patients, recurrence in the absence of action may trigger thoughts that they missed an opportunity to stave off death [7]. In this instance, taking HD IFN may represent a form of "regret management" in which patients seek to avoid the scenario that would trigger the most regret and self-blame. Feeling that one has done everything possible may make the possibility of recurrence more bearable; if the disease returns despite HD IFN, the patient may interpret this as meaning that it was meant to be and that he or she is blameless. Paradoxically, severe side effects can be construed as concrete evidence that one’s efforts to survive were sincere and that no stone was left unturned.
DECISION RULES FOR DISCUSSING HD IFN
Top
Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
Kilbridge and colleagues [9] developed a decision rule consisting of two screening questions that allow identification of patients who would clearly benefit from HD IFN. These questions were based on the assumption that adjuvant HD IFN is associated with an improvement in overall survival. However, since subsequent data no longer support the primary assumption that adjuvant HD IFN is associated with improved overall survival (as discussed above), these specific screening questions appear to be no longer valid. However, the findings do suggest that, for most patients, a discussion of expectations about HD IFN can be accomplished in a brief, focused fashion and that the key elements of assessing patient readiness for HD IFN include a realistic understanding of the probability and nature of the side effects, a clear willingness to tolerate side effects for the possibility of modifying the course of one’s disease, and a realistic understanding of the nature and probability of any benefits of HD IFN.
OTHER OPTIONS FOR ADJUVANT THERAPY
Top
Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
If the patient (or oncologist) is convinced that the risks of HD IFN are not reasonable for the potential benefits, it is rational to explore alternative options. In the past, adjuvant chemotherapy has been explored, but, aside from one trial assessing the role of adjuvant dacarbazine (DTIC-Dome®; BayerPharmaceuticals Corporation, WestHaven, CT, http://www.bayerpharma-na.com/), all the other randomized trials were either significantly underpowered or tested drugs that we no longer believe are active in melanoma. As a result, the question of the role of adjuvant chemotherapy in melanoma remains an open one. Currently, an intercooperative group study is testing the efficacy of biochemotherapy as an adjuvant treatment compared with HD IFN, a trial in which both treatment arms are associated with significant toxicity and a high risk–benefit ratio. The European Organization for Research and Treatment of Cancer is evaluating the role of prolonged (5-year) treatment with low-dose pegylated interferon- as an adjuvant treatment. Other adjuvant strategies focus on vaccine approaches. Although the benefits are not yet defined, the risks are generally minimal, and patients may view these as having lower risk–benefit ratios.
In most situations in melanoma, patients are faced with trying to make a rational decision in the setting of incomplete information. For the issue of adjuvant HD IFN, however, the information is remarkably complete, and oncologists can help patients to quantitate the risks and benefits that will help them come to a decision.
DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST
Top
Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
Dr. Chapman has acted as a consultant for Schering-Plough.
ACKNOWLEDGMENT
Top
Learning objectives
Abstract
Introduction
The benefits and risks…
How do we determine…
Patient decision-making about hd…
Subjective benefits of hd…
Decision rules for discussing…
Other options for adjuvant…
Disclosure of potential…
References
-
- September 16, 2015 at 9:17 pm
Great post about the experience. I agree that while it is challenging, it is possible. And for stage 3ers it is still a viable option.
-
- September 17, 2015 at 5:08 am
Impressive results in that study! Of course the patients with the most durable responses were pretty sick. Is your plan to try the therapy to see if you successfully fall into that autoimmune category and then to quit if you don't?
I admit I'm not too familiar with the research on interferon. My third-hand understanding is that results looked very promising in earlier studies (e.g. the one you cited), but that they have not stood up well to replication.
-
- September 17, 2015 at 2:43 pm
Got your email, and I responded!
Our plan is to monitor my thyroid function and anti-thyroid antibodies over time. Hoping for autoimmunity sounds scary, but I think it's important to point out that there are varying levels of autoimmunity. It can be subcinical, meaning you've developed anti-thyroid antibodies but have no overt signs of thyroid dysfunction. My plan is to continue even if I'm not seeing signs of autoimmunity. I feel fine, and it's fully covered by insurance, so I see no point in stopping. If I wasn't tolerating it well and saw no signs of autoimmunity after 5-6 months, maybe then I'd have a choice to make.
There are some studies trying to replicate the association of autoimmunity with protection from relapse and didn't find an association. To the best of my recollection, none of those studies used the full high-dose interferon regiment. I believe I recall one using 3 million units/square meter, a substantial drop from the 20 million unit/square meter infusions followed by 10 million units/square meter injections. I think it's important to keep in mind that not all studies make "apples to apples" comparisons as interferon treatment regimens vary.
-
- September 17, 2015 at 2:43 pm
Got your email, and I responded!
Our plan is to monitor my thyroid function and anti-thyroid antibodies over time. Hoping for autoimmunity sounds scary, but I think it's important to point out that there are varying levels of autoimmunity. It can be subcinical, meaning you've developed anti-thyroid antibodies but have no overt signs of thyroid dysfunction. My plan is to continue even if I'm not seeing signs of autoimmunity. I feel fine, and it's fully covered by insurance, so I see no point in stopping. If I wasn't tolerating it well and saw no signs of autoimmunity after 5-6 months, maybe then I'd have a choice to make.
There are some studies trying to replicate the association of autoimmunity with protection from relapse and didn't find an association. To the best of my recollection, none of those studies used the full high-dose interferon regiment. I believe I recall one using 3 million units/square meter, a substantial drop from the 20 million unit/square meter infusions followed by 10 million units/square meter injections. I think it's important to keep in mind that not all studies make "apples to apples" comparisons as interferon treatment regimens vary.
-
- September 17, 2015 at 2:43 pm
Got your email, and I responded!
Our plan is to monitor my thyroid function and anti-thyroid antibodies over time. Hoping for autoimmunity sounds scary, but I think it's important to point out that there are varying levels of autoimmunity. It can be subcinical, meaning you've developed anti-thyroid antibodies but have no overt signs of thyroid dysfunction. My plan is to continue even if I'm not seeing signs of autoimmunity. I feel fine, and it's fully covered by insurance, so I see no point in stopping. If I wasn't tolerating it well and saw no signs of autoimmunity after 5-6 months, maybe then I'd have a choice to make.
There are some studies trying to replicate the association of autoimmunity with protection from relapse and didn't find an association. To the best of my recollection, none of those studies used the full high-dose interferon regiment. I believe I recall one using 3 million units/square meter, a substantial drop from the 20 million unit/square meter infusions followed by 10 million units/square meter injections. I think it's important to keep in mind that not all studies make "apples to apples" comparisons as interferon treatment regimens vary.
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- September 17, 2015 at 5:08 am
Impressive results in that study! Of course the patients with the most durable responses were pretty sick. Is your plan to try the therapy to see if you successfully fall into that autoimmune category and then to quit if you don't?
I admit I'm not too familiar with the research on interferon. My third-hand understanding is that results looked very promising in earlier studies (e.g. the one you cited), but that they have not stood up well to replication.
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- September 17, 2015 at 5:08 am
Impressive results in that study! Of course the patients with the most durable responses were pretty sick. Is your plan to try the therapy to see if you successfully fall into that autoimmune category and then to quit if you don't?
I admit I'm not too familiar with the research on interferon. My third-hand understanding is that results looked very promising in earlier studies (e.g. the one you cited), but that they have not stood up well to replication.
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- September 16, 2015 at 8:11 pm
Yes! I encourage anyone facing interferon to make the best decision for themself and ignore the people on here who will post anonymously and bash interferon as completely useless.
For those of you facing this, please look over this published paper. It can be a little dense if you're not used to reading scientific manuscripts, but it has good information. (I'm a scientist, so I enjoy this stuff. I'm a scientist in a cancer center, and I got cancer…the irony isn't lost on me
).In short the Gogas paper took 200 high-risk melanoma patients (IIB – IIIC…some unknown in lymph node status) that have had surgery to remove the tumors and gave them high-dose interferon (HDI) treatments. Some had just the infusions, while some did the infusions and the subcutaneous injections.
The patients were divided into 2 groups: those that eventually showed signs of autoimmunity (could be autoantibodies and not necessarily symptomatic disease) and those that did not show signs of autoimmunity. 52 patients had autoimmunity, while 148 patients did not.
In the no autoimmunity group, 108 out of 148 patients relapsed (73%). In the autoimmunity group, only 7 of 52 relapsed (13%)! That's a substantial drop in the % of patients that relapsed. Now this isn't fully accepted (some studies using lower interferon doses found no correlation between autoimmunity and relapse), but this should give you hope that interferon can be extremely effective in preventing a relapse in a subset of people. It is true that in the majority of people it doesn't seem to help, but you never know which group you're going to be in until you give it a shot.
For those confused on what autoimmunity has to do with anything, the thought is that the development of autoimmunity shows that the interferon is strongly activating your immune response. The "pedal is to the metal" so to speak, and your immune system is attacking both any residual cancer cells and your own organs (such as your thyroid).
This isn't to say that people who get no autoimmunity are doomed. But take solace in seeing that interferon can be really effective when you look at stratified subsets, instead of lumping all patients together!
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- September 16, 2015 at 8:11 pm
Yes! I encourage anyone facing interferon to make the best decision for themself and ignore the people on here who will post anonymously and bash interferon as completely useless.
For those of you facing this, please look over this published paper. It can be a little dense if you're not used to reading scientific manuscripts, but it has good information. (I'm a scientist, so I enjoy this stuff. I'm a scientist in a cancer center, and I got cancer…the irony isn't lost on me
).In short the Gogas paper took 200 high-risk melanoma patients (IIB – IIIC…some unknown in lymph node status) that have had surgery to remove the tumors and gave them high-dose interferon (HDI) treatments. Some had just the infusions, while some did the infusions and the subcutaneous injections.
The patients were divided into 2 groups: those that eventually showed signs of autoimmunity (could be autoantibodies and not necessarily symptomatic disease) and those that did not show signs of autoimmunity. 52 patients had autoimmunity, while 148 patients did not.
In the no autoimmunity group, 108 out of 148 patients relapsed (73%). In the autoimmunity group, only 7 of 52 relapsed (13%)! That's a substantial drop in the % of patients that relapsed. Now this isn't fully accepted (some studies using lower interferon doses found no correlation between autoimmunity and relapse), but this should give you hope that interferon can be extremely effective in preventing a relapse in a subset of people. It is true that in the majority of people it doesn't seem to help, but you never know which group you're going to be in until you give it a shot.
For those confused on what autoimmunity has to do with anything, the thought is that the development of autoimmunity shows that the interferon is strongly activating your immune response. The "pedal is to the metal" so to speak, and your immune system is attacking both any residual cancer cells and your own organs (such as your thyroid).
This isn't to say that people who get no autoimmunity are doomed. But take solace in seeing that interferon can be really effective when you look at stratified subsets, instead of lumping all patients together!
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- September 17, 2015 at 4:41 am
<<ET and SF have done extensive research on their options when they were a 2B but I think unfortunately they moved into a different world when restaged as a 3B)>>
True. There's a huge difference between IIIa and IIIb, at least as far as qualifications for clinical trials. IIIa is not so different from IIb regarding available options — interferon or a vaccine trial. ET is a very active person and couldn't stand the thought of feeling under the weather and having to spend time away from gardening, sailing, etc., hence her decision not to do the interferon.
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- September 17, 2015 at 4:41 am
<<ET and SF have done extensive research on their options when they were a 2B but I think unfortunately they moved into a different world when restaged as a 3B)>>
True. There's a huge difference between IIIa and IIIb, at least as far as qualifications for clinical trials. IIIa is not so different from IIb regarding available options — interferon or a vaccine trial. ET is a very active person and couldn't stand the thought of feeling under the weather and having to spend time away from gardening, sailing, etc., hence her decision not to do the interferon.
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- September 17, 2015 at 4:41 am
<<ET and SF have done extensive research on their options when they were a 2B but I think unfortunately they moved into a different world when restaged as a 3B)>>
True. There's a huge difference between IIIa and IIIb, at least as far as qualifications for clinical trials. IIIa is not so different from IIb regarding available options — interferon or a vaccine trial. ET is a very active person and couldn't stand the thought of feeling under the weather and having to spend time away from gardening, sailing, etc., hence her decision not to do the interferon.
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- September 17, 2015 at 5:57 pm
The study posted by Nevergonna states clearly there is not evidence that interferon increases overalll survival. Isn't that what we're looking for? This drug has been dropped not only in melanoma centers, but for hepatitis. The permanent side effects, infertility, depression etc aren't worth it. Losing a year to gain a few months doesn't work for me. And I don't support the industry pushing it because they need to still make money on it! Life is too short to waste it feeling crummy.
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- September 17, 2015 at 5:57 pm
The study posted by Nevergonna states clearly there is not evidence that interferon increases overalll survival. Isn't that what we're looking for? This drug has been dropped not only in melanoma centers, but for hepatitis. The permanent side effects, infertility, depression etc aren't worth it. Losing a year to gain a few months doesn't work for me. And I don't support the industry pushing it because they need to still make money on it! Life is too short to waste it feeling crummy.
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- September 17, 2015 at 6:13 pm
I have no idea what you're reading, jpb, but both studies I posted showed some level of survival advantage with interferon treatment. In the Gogas study, there was a dramatic difference in survival in the group that developed autoimmunity. In the meta analysis, 4 of the 14 studies showed a statistically significant survival advantage over the control arm. Obviously the reciprocal is 10 of 14 comparisons showed no survival advantage. But that does not change the fact that numerous published studies show a significant improval in overall survival.
Where is it "clearly stated" in anything that I posted that there is no survival advantage? Is the survival advantage small? Absolutely! Is it found in every study? No (but note there is hetergeneity in study design, patient populations, and probably dose reductions versus patient adherence). But there is published evidence of therapeutic effectiveness in some studies. Personally, I was willing to risk some unpleasant side effects for a small increase in my chance of surviving this terrible disease. It was an added bonus for me when I found the side effects to not be so bad in my case.
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- September 17, 2015 at 6:13 pm
I have no idea what you're reading, jpb, but both studies I posted showed some level of survival advantage with interferon treatment. In the Gogas study, there was a dramatic difference in survival in the group that developed autoimmunity. In the meta analysis, 4 of the 14 studies showed a statistically significant survival advantage over the control arm. Obviously the reciprocal is 10 of 14 comparisons showed no survival advantage. But that does not change the fact that numerous published studies show a significant improval in overall survival.
Where is it "clearly stated" in anything that I posted that there is no survival advantage? Is the survival advantage small? Absolutely! Is it found in every study? No (but note there is hetergeneity in study design, patient populations, and probably dose reductions versus patient adherence). But there is published evidence of therapeutic effectiveness in some studies. Personally, I was willing to risk some unpleasant side effects for a small increase in my chance of surviving this terrible disease. It was an added bonus for me when I found the side effects to not be so bad in my case.
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- September 17, 2015 at 6:13 pm
I have no idea what you're reading, jpb, but both studies I posted showed some level of survival advantage with interferon treatment. In the Gogas study, there was a dramatic difference in survival in the group that developed autoimmunity. In the meta analysis, 4 of the 14 studies showed a statistically significant survival advantage over the control arm. Obviously the reciprocal is 10 of 14 comparisons showed no survival advantage. But that does not change the fact that numerous published studies show a significant improval in overall survival.
Where is it "clearly stated" in anything that I posted that there is no survival advantage? Is the survival advantage small? Absolutely! Is it found in every study? No (but note there is hetergeneity in study design, patient populations, and probably dose reductions versus patient adherence). But there is published evidence of therapeutic effectiveness in some studies. Personally, I was willing to risk some unpleasant side effects for a small increase in my chance of surviving this terrible disease. It was an added bonus for me when I found the side effects to not be so bad in my case.
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- September 18, 2015 at 1:07 am
For me, it seems that people's definition of "significant" varies greatly. A gain of 6 months or a year doesn't seem significant to me – especially if you have already lost a year to the side effects of Interferon. I am new to all this, yes, but even my oncologist says a year of Interferon might – MIGHT – only increase my 10 year survival rate by less than 3%.
I don't know. Maybe I am just a wimp and don't what to feel like I have the flu, added depression on top of my clinical depression, and fatigue for an entire year to maybe gain a year down the road. I suppose the argument is that in that year down the road, they could come up with some miracle cure, but If I am already terminal then, it won't work for me anyway.
I'm sorry if I sound cynical. I am not approaching my cancer that way – just Interferon. Please feel free to try to convince me otherwise. I do want to beat this!
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- September 18, 2015 at 1:07 am
For me, it seems that people's definition of "significant" varies greatly. A gain of 6 months or a year doesn't seem significant to me – especially if you have already lost a year to the side effects of Interferon. I am new to all this, yes, but even my oncologist says a year of Interferon might – MIGHT – only increase my 10 year survival rate by less than 3%.
I don't know. Maybe I am just a wimp and don't what to feel like I have the flu, added depression on top of my clinical depression, and fatigue for an entire year to maybe gain a year down the road. I suppose the argument is that in that year down the road, they could come up with some miracle cure, but If I am already terminal then, it won't work for me anyway.
I'm sorry if I sound cynical. I am not approaching my cancer that way – just Interferon. Please feel free to try to convince me otherwise. I do want to beat this!
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- September 18, 2015 at 1:07 am
For me, it seems that people's definition of "significant" varies greatly. A gain of 6 months or a year doesn't seem significant to me – especially if you have already lost a year to the side effects of Interferon. I am new to all this, yes, but even my oncologist says a year of Interferon might – MIGHT – only increase my 10 year survival rate by less than 3%.
I don't know. Maybe I am just a wimp and don't what to feel like I have the flu, added depression on top of my clinical depression, and fatigue for an entire year to maybe gain a year down the road. I suppose the argument is that in that year down the road, they could come up with some miracle cure, but If I am already terminal then, it won't work for me anyway.
I'm sorry if I sound cynical. I am not approaching my cancer that way – just Interferon. Please feel free to try to convince me otherwise. I do want to beat this!
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- September 18, 2015 at 2:12 pm
I understand your concerns, and I shared a lot of those fears going into my interferon treatment. I agonized over whether giving it a chance was the right thing to do!
My hope in starting this thread was to shine light on the fact that going through interferon therapy is not guaranteed misery! I had some rough nights early on (which I think will be universally true with any patient), but once I settled into treatment, I usually feel pretty great. By no means am I "losing" a year of my life, and I feel great that I'm being proactive and doing what I can. To me, the cost of hoping to be in that 3-4% or so that get the survival benefit is very low…my treatment is fully covered, and I tolerate it well.
Remember, just because you start interferon doesn't mean you have to finish it. You'll never know if you'll tolerate it well unless you try. If you are truly miserable after a couple of weeks and don't feel you can take it anymore, then you can stop the treatment! But to me, I was pleasantly surprised to find that it wasn't the scary monster that I feared.
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- September 18, 2015 at 2:12 pm
I understand your concerns, and I shared a lot of those fears going into my interferon treatment. I agonized over whether giving it a chance was the right thing to do!
My hope in starting this thread was to shine light on the fact that going through interferon therapy is not guaranteed misery! I had some rough nights early on (which I think will be universally true with any patient), but once I settled into treatment, I usually feel pretty great. By no means am I "losing" a year of my life, and I feel great that I'm being proactive and doing what I can. To me, the cost of hoping to be in that 3-4% or so that get the survival benefit is very low…my treatment is fully covered, and I tolerate it well.
Remember, just because you start interferon doesn't mean you have to finish it. You'll never know if you'll tolerate it well unless you try. If you are truly miserable after a couple of weeks and don't feel you can take it anymore, then you can stop the treatment! But to me, I was pleasantly surprised to find that it wasn't the scary monster that I feared.
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- September 18, 2015 at 2:12 pm
I understand your concerns, and I shared a lot of those fears going into my interferon treatment. I agonized over whether giving it a chance was the right thing to do!
My hope in starting this thread was to shine light on the fact that going through interferon therapy is not guaranteed misery! I had some rough nights early on (which I think will be universally true with any patient), but once I settled into treatment, I usually feel pretty great. By no means am I "losing" a year of my life, and I feel great that I'm being proactive and doing what I can. To me, the cost of hoping to be in that 3-4% or so that get the survival benefit is very low…my treatment is fully covered, and I tolerate it well.
Remember, just because you start interferon doesn't mean you have to finish it. You'll never know if you'll tolerate it well unless you try. If you are truly miserable after a couple of weeks and don't feel you can take it anymore, then you can stop the treatment! But to me, I was pleasantly surprised to find that it wasn't the scary monster that I feared.
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- September 18, 2015 at 10:14 pm
You should not be given interferon if you have ANY history of depression. Someone I met ended up in a mental institution because of that! No reputable doc will prescribe it to someone with a depression history!!!!!
I chose to not have it and thankful I did not. Feeling crappy for a year and getting a few months back (still recovering from feeling crappy) isn't worth it.
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- September 18, 2015 at 11:21 pm
It's a shame that interferon treatment is so polarized – I hate to see comments on this board that shame the decision to take it.
My oncologist applauded me for my decision to go on interferon despite all the criticism. I bought myself time. And I didn't "give up a year of my life". I was sick, but I used the time to rest and reflect.
In the meantime there have been several new melanoma drugs that have come out and more results from trials.
It was the best shot I had for 3A and I don't regret it a moment.
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- September 21, 2015 at 1:54 pm
Feel free to provide some quotes from the best melanoma doctors calling it crap
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- September 21, 2015 at 1:54 pm
Feel free to provide some quotes from the best melanoma doctors calling it crap
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- September 21, 2015 at 1:54 pm
Feel free to provide some quotes from the best melanoma doctors calling it crap
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- September 18, 2015 at 11:21 pm
It's a shame that interferon treatment is so polarized – I hate to see comments on this board that shame the decision to take it.
My oncologist applauded me for my decision to go on interferon despite all the criticism. I bought myself time. And I didn't "give up a year of my life". I was sick, but I used the time to rest and reflect.
In the meantime there have been several new melanoma drugs that have come out and more results from trials.
It was the best shot I had for 3A and I don't regret it a moment.
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- September 18, 2015 at 11:21 pm
It's a shame that interferon treatment is so polarized – I hate to see comments on this board that shame the decision to take it.
My oncologist applauded me for my decision to go on interferon despite all the criticism. I bought myself time. And I didn't "give up a year of my life". I was sick, but I used the time to rest and reflect.
In the meantime there have been several new melanoma drugs that have come out and more results from trials.
It was the best shot I had for 3A and I don't regret it a moment.
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- September 18, 2015 at 10:14 pm
You should not be given interferon if you have ANY history of depression. Someone I met ended up in a mental institution because of that! No reputable doc will prescribe it to someone with a depression history!!!!!
I chose to not have it and thankful I did not. Feeling crappy for a year and getting a few months back (still recovering from feeling crappy) isn't worth it.
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- September 18, 2015 at 10:14 pm
You should not be given interferon if you have ANY history of depression. Someone I met ended up in a mental institution because of that! No reputable doc will prescribe it to someone with a depression history!!!!!
I chose to not have it and thankful I did not. Feeling crappy for a year and getting a few months back (still recovering from feeling crappy) isn't worth it.
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- September 17, 2015 at 5:57 pm
The study posted by Nevergonna states clearly there is not evidence that interferon increases overalll survival. Isn't that what we're looking for? This drug has been dropped not only in melanoma centers, but for hepatitis. The permanent side effects, infertility, depression etc aren't worth it. Losing a year to gain a few months doesn't work for me. And I don't support the industry pushing it because they need to still make money on it! Life is too short to waste it feeling crummy.
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- September 16, 2015 at 4:57 pm
Love your perspective "never". (I am in month 9 of 12 months of the same Interferon treatment plan (3A))
A couple of thoughts for you and others:
Before anybody starts starts faulting him for doing Interferon realize that he is a 3A and most of the new stuff coming out is for Stage 4 (and several trials have recently started for 3B and 3C patients). I have yet to see a viable alternative besides Watch and Wait or some clinical vaccines trials which are still early phases of their development. (If somebody has real options for 3A would love to hear about them). ET and SF have done extensive research on their options when they were a 2B but I think unfortunately they moved into a different world when restaged as a 3B)
The other thought….don't be afraid to take an Interferon drug holiday…this is a marathon and you don't want to stop living. I have taken 2 holidays since the beginning of the year and they have been incredibly important in knowing that I will return to "normal". It takes about 7 days for me to return to 95% and then the following week is almost total bliss (and we go to some really nice beach and just hang out eating, drinking, and being married again. ) The only down side to the drug holiday is the reentry which will be tough but you will get back in the interferon "groove" within 2-3 shots.
For those that have progressed to Stage 3B or beyond and have other options available. I will be eternally grateful to watch your successes (as the doctors perfect their craft with these new treatments)…but also know that Interferon allowed me to extend my chance of reoccurence by about 6 months and in today's world…that is a ton of time.
Best wishes.
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- September 16, 2015 at 4:57 pm
Love your perspective "never". (I am in month 9 of 12 months of the same Interferon treatment plan (3A))
A couple of thoughts for you and others:
Before anybody starts starts faulting him for doing Interferon realize that he is a 3A and most of the new stuff coming out is for Stage 4 (and several trials have recently started for 3B and 3C patients). I have yet to see a viable alternative besides Watch and Wait or some clinical vaccines trials which are still early phases of their development. (If somebody has real options for 3A would love to hear about them). ET and SF have done extensive research on their options when they were a 2B but I think unfortunately they moved into a different world when restaged as a 3B)
The other thought….don't be afraid to take an Interferon drug holiday…this is a marathon and you don't want to stop living. I have taken 2 holidays since the beginning of the year and they have been incredibly important in knowing that I will return to "normal". It takes about 7 days for me to return to 95% and then the following week is almost total bliss (and we go to some really nice beach and just hang out eating, drinking, and being married again. ) The only down side to the drug holiday is the reentry which will be tough but you will get back in the interferon "groove" within 2-3 shots.
For those that have progressed to Stage 3B or beyond and have other options available. I will be eternally grateful to watch your successes (as the doctors perfect their craft with these new treatments)…but also know that Interferon allowed me to extend my chance of reoccurence by about 6 months and in today's world…that is a ton of time.
Best wishes.
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- September 23, 2015 at 8:02 pm
My wife was on Interferon for a year. She had some trouble concentrating and her personality was more subdued. For her it was a little like having mild flu for a year. The one good thing was about 4 months after the treatment ended there were no lasting side effects.
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- September 23, 2015 at 8:02 pm
My wife was on Interferon for a year. She had some trouble concentrating and her personality was more subdued. For her it was a little like having mild flu for a year. The one good thing was about 4 months after the treatment ended there were no lasting side effects.
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- September 23, 2015 at 8:02 pm
My wife was on Interferon for a year. She had some trouble concentrating and her personality was more subdued. For her it was a little like having mild flu for a year. The one good thing was about 4 months after the treatment ended there were no lasting side effects.
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