› Forums › General Melanoma Community › IPI or IL-2 or BioChemo??
- This topic has 18 replies, 7 voices, and was last updated 12 years, 10 months ago by
Vermont_Donna.
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- June 6, 2011 at 2:27 pm
Hi all,
So my husband has been on the PLX 4032 (BRAF inhibitor) trial since the end of March and it's already stopped working. We knew there was a good chance of this as he had been on the P13k/MEK trial before this one and the doctors were'nt sure if that would reduce the efficancy of PLX.
So now we're on to next steps….. pretty sure our choices will be Yervoy ( IPI) , IL-2 or Bio chemo. Wondering what you all think and if you had the choice which one would you do?
Hi all,
So my husband has been on the PLX 4032 (BRAF inhibitor) trial since the end of March and it's already stopped working. We knew there was a good chance of this as he had been on the P13k/MEK trial before this one and the doctors were'nt sure if that would reduce the efficancy of PLX.
So now we're on to next steps….. pretty sure our choices will be Yervoy ( IPI) , IL-2 or Bio chemo. Wondering what you all think and if you had the choice which one would you do?
My husband is Stage IV since May 2010 and has multiple bone mets, 2 or 3 soft tissue tumours and 1 lung nodule ( 7mm). He's also 39 yrs old, and still working part time….
Any way , would love to hear your thoughts…
thanks,
Emily
- Replies
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- June 6, 2011 at 4:39 pm
This is a very personalized disease. So I can give you my answers from my own scenario, subtype and sites, and see if they make sense for your husband's situation.
I was given choice of IL2 or Biochemo last year I chose IL-2. Different oncolgists have very different opinions on biochemo. Both my oncs recommended IL-2 as a something to try, whereas only one recommended biochemo, the other advised against. IL2 worked on my small lung mets. IL2 (and IPI) are percentage plays for sure.
My melanoma subtype is sun-damaged, not BRAF. Now that IPI is on the scene, that's something my oncs are considering as something else I should consider trying as a systemtic treatment since it shows some activity in the brain, which is where my current metastatic activity is, whereas IL-2 apparently doesn't do much in the brain.
One of my friends is in the process of getting onto the MDX-1106 trial. Think IPI, it's also an anti-PD1 drug (and it's the same company), but with less toxic side effect profile. Doing IPI first would rule out MDX-1106 trial, but doing MDX-1106 first, it could still be possible to try IPI afterwards since it's approved.
There may be other interesting trials too. He might qualify for some of the TIL/Adoptive Cell Transfer trials, that would be something to look into too at Moffitt and NCI.
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- June 7, 2011 at 2:58 am
I am not a wiz or anything, but I have done two 12 weeks of the Anti PD 1 vaccine trial at Moffitt receiving it along with 6 peptide injections every other week. I now receive a booster of the anti- PD 1 ( formally known as MDX 1106- now known as BMS-936558). Both Yervoy ( Ipi) and BMS-936558 are monoclonal antibodies, but BOTH are not Anti PD-1.
IPI (Yervoy) blocks CTLA-4 ( its long name is cytotoxic T-lymphocyte antigen.CTLA- 4 is thought to turn off or slow down the immune system allowing melanoma to grow instead of fighting it off. Ipi may work by allowing the body’s immune system to recognize, target, and attack cells in melanoma tumors.Anti-PD-1 human monoclonal antibody MDX-1106, can block tumor growth in different ways. It can block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Cancer.gov defines it as "A fully human monoclonal antibody directed against the negative immunoregulatory human cell surface receptor PD-1 (programmed death-1 or programmed cell death-1/PCD-1) with immunopotentiation activity. Anti-PD-1 human monoclonal antibody MDX-1106 binds to and blocks the activation of PD-1, an Ig superfamily transmembrane protein, by its ligands PD-L1 and PD-L2, resulting in the activation of T-cells and cell-mediated immune responses against tumor cells or pathogens. Activated PD-1 negatively regulates T-cell activation and effector function through the suppression of P13k/Akt pathway activation."I am staged 4 melanoma NED for 14 plus months. Diagnosed stage 4 June 18, 2009.NED since March 26, 2010. -
- June 7, 2011 at 6:36 pm
I'm not a wiz or anything 🙂 thanks for correction Lynn. OK, IPI = anti-CTLA4, MDX-1106 = anti-PD1.
What are your impressions of the Moffitt trial you're on — sounds like the adjuvant stage IV treatment trial with MDX-1106 and peptide vaccines? I actually requested the consent form from Moffitt as it's one of the few I might be able to qualify for. Except I got treated for new brain mets last week (surgery) so I need to achieve stability first again.
i'm very interested in your thoughts on the adjuvant MDX-1106 trial, and on what you think of the MDX-1106 part of it vs. the vaccine parts of it.
– Kyle
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- June 7, 2011 at 6:36 pm
I'm not a wiz or anything 🙂 thanks for correction Lynn. OK, IPI = anti-CTLA4, MDX-1106 = anti-PD1.
What are your impressions of the Moffitt trial you're on — sounds like the adjuvant stage IV treatment trial with MDX-1106 and peptide vaccines? I actually requested the consent form from Moffitt as it's one of the few I might be able to qualify for. Except I got treated for new brain mets last week (surgery) so I need to achieve stability first again.
i'm very interested in your thoughts on the adjuvant MDX-1106 trial, and on what you think of the MDX-1106 part of it vs. the vaccine parts of it.
– Kyle
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- June 7, 2011 at 2:58 am
I am not a wiz or anything, but I have done two 12 weeks of the Anti PD 1 vaccine trial at Moffitt receiving it along with 6 peptide injections every other week. I now receive a booster of the anti- PD 1 ( formally known as MDX 1106- now known as BMS-936558). Both Yervoy ( Ipi) and BMS-936558 are monoclonal antibodies, but BOTH are not Anti PD-1.
IPI (Yervoy) blocks CTLA-4 ( its long name is cytotoxic T-lymphocyte antigen.CTLA- 4 is thought to turn off or slow down the immune system allowing melanoma to grow instead of fighting it off. Ipi may work by allowing the body’s immune system to recognize, target, and attack cells in melanoma tumors.Anti-PD-1 human monoclonal antibody MDX-1106, can block tumor growth in different ways. It can block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Cancer.gov defines it as "A fully human monoclonal antibody directed against the negative immunoregulatory human cell surface receptor PD-1 (programmed death-1 or programmed cell death-1/PCD-1) with immunopotentiation activity. Anti-PD-1 human monoclonal antibody MDX-1106 binds to and blocks the activation of PD-1, an Ig superfamily transmembrane protein, by its ligands PD-L1 and PD-L2, resulting in the activation of T-cells and cell-mediated immune responses against tumor cells or pathogens. Activated PD-1 negatively regulates T-cell activation and effector function through the suppression of P13k/Akt pathway activation."I am staged 4 melanoma NED for 14 plus months. Diagnosed stage 4 June 18, 2009.NED since March 26, 2010.
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- June 6, 2011 at 4:39 pm
This is a very personalized disease. So I can give you my answers from my own scenario, subtype and sites, and see if they make sense for your husband's situation.
I was given choice of IL2 or Biochemo last year I chose IL-2. Different oncolgists have very different opinions on biochemo. Both my oncs recommended IL-2 as a something to try, whereas only one recommended biochemo, the other advised against. IL2 worked on my small lung mets. IL2 (and IPI) are percentage plays for sure.
My melanoma subtype is sun-damaged, not BRAF. Now that IPI is on the scene, that's something my oncs are considering as something else I should consider trying as a systemtic treatment since it shows some activity in the brain, which is where my current metastatic activity is, whereas IL-2 apparently doesn't do much in the brain.
One of my friends is in the process of getting onto the MDX-1106 trial. Think IPI, it's also an anti-PD1 drug (and it's the same company), but with less toxic side effect profile. Doing IPI first would rule out MDX-1106 trial, but doing MDX-1106 first, it could still be possible to try IPI afterwards since it's approved.
There may be other interesting trials too. He might qualify for some of the TIL/Adoptive Cell Transfer trials, that would be something to look into too at Moffitt and NCI.
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- June 7, 2011 at 12:50 am
Emily, I have some what of a historical take in framing my medical decisions due to the fact that I have watched and experienced the progression of melanoma, both as a patient and lay scientific observer for now 24 years, so with that in mind here is a quote from an editorial in the New England Journal of Medicine by Marc S. Ernstoff about IPI and IL2.on June 4 of this year.
"To put the BRIM-3 study into perspective, interleukin-2 and ipilimumab have been approved by the Food and Drug Administration as immunotherapies for metastatic melanoma. The 2-week administration of high-dose interleukin-2 produces an objective response in 16% of a highly selected group of patients and complete remission in 6% of patients, with a median duration of complete response of more than 10 years. Four doses of ipilimumab produce a median survival of 10 months (a 4-month advantage over a vaccine control group), a median progression-free survival of 11 weeks, and an objective response rate of 7% (with a rate of complete remission of 0.5%)
Though it is a bit esoteric, I would urge you to read the full text of the editorial and try and absorb it in order to aid you in making informed medical decisions, because it does a fine job,,,,,,,,,,,,,,though highly technical ,of sorthing through your exact question .
Here is the full text: http://www.nejm.org/doi/full/10.1056/NEJMe1105792?query=featured_home
Cheers,
Charlie S
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- June 8, 2011 at 2:48 am
Hi Charlie,
Dr Marc Ernstoff is my melanoma oncologist and I think he is fantastic! I couldnt ask for a better oncologist or compassionate person…he is so personable, and friendly; he explains things so well, and is so caring. He works at Dartmouth Hitchcock Medical Center in Lebanon, NH. He certainly appears up to date on everything!!
Vermont_Donna, stage 3a, now NED due to Yervoy
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- June 8, 2011 at 2:48 am
Hi Charlie,
Dr Marc Ernstoff is my melanoma oncologist and I think he is fantastic! I couldnt ask for a better oncologist or compassionate person…he is so personable, and friendly; he explains things so well, and is so caring. He works at Dartmouth Hitchcock Medical Center in Lebanon, NH. He certainly appears up to date on everything!!
Vermont_Donna, stage 3a, now NED due to Yervoy
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- June 7, 2011 at 12:50 am
Emily, I have some what of a historical take in framing my medical decisions due to the fact that I have watched and experienced the progression of melanoma, both as a patient and lay scientific observer for now 24 years, so with that in mind here is a quote from an editorial in the New England Journal of Medicine by Marc S. Ernstoff about IPI and IL2.on June 4 of this year.
"To put the BRIM-3 study into perspective, interleukin-2 and ipilimumab have been approved by the Food and Drug Administration as immunotherapies for metastatic melanoma. The 2-week administration of high-dose interleukin-2 produces an objective response in 16% of a highly selected group of patients and complete remission in 6% of patients, with a median duration of complete response of more than 10 years. Four doses of ipilimumab produce a median survival of 10 months (a 4-month advantage over a vaccine control group), a median progression-free survival of 11 weeks, and an objective response rate of 7% (with a rate of complete remission of 0.5%)
Though it is a bit esoteric, I would urge you to read the full text of the editorial and try and absorb it in order to aid you in making informed medical decisions, because it does a fine job,,,,,,,,,,,,,,though highly technical ,of sorthing through your exact question .
Here is the full text: http://www.nejm.org/doi/full/10.1056/NEJMe1105792?query=featured_home
Cheers,
Charlie S
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- June 7, 2011 at 12:56 am
I also assume / hope your husband is working with a melanoma specializing oncologist. Ideally that person will be up on the latest clinical trial happenings (like my friend's doc recommending the MDX-1106 trial in his case), which things are working best for his subtype (BRAF clearly) — And whether any of the other BRAF trials will allow patients with prior treatment with PLEX4032. The good thing about MDX-1106 — in cases like my friend who was also treated with a BRAF drug — is that the prior treatment is not exclusionary since it's anti-PD1 not BRAF.
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- June 7, 2011 at 12:56 am
I also assume / hope your husband is working with a melanoma specializing oncologist. Ideally that person will be up on the latest clinical trial happenings (like my friend's doc recommending the MDX-1106 trial in his case), which things are working best for his subtype (BRAF clearly) — And whether any of the other BRAF trials will allow patients with prior treatment with PLEX4032. The good thing about MDX-1106 — in cases like my friend who was also treated with a BRAF drug — is that the prior treatment is not exclusionary since it's anti-PD1 not BRAF.
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- June 7, 2011 at 1:09 am
im sitting in the California Pacifc Medical Center icu doing biochemotherapy for the week. their latest stats show as much as 38% long term response rate over 5 years. no othertreatment option i qualified for was anywhere near this. where its done is critical. BUT if he is braf + there may be some others. i just don,t know them. wish me luck and i'll let you know how weathered. God Bless. Robert
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- June 7, 2011 at 1:09 am
im sitting in the California Pacifc Medical Center icu doing biochemotherapy for the week. their latest stats show as much as 38% long term response rate over 5 years. no othertreatment option i qualified for was anywhere near this. where its done is critical. BUT if he is braf + there may be some others. i just don,t know them. wish me luck and i'll let you know how weathered. God Bless. Robert
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- June 7, 2011 at 2:28 am
Hi Emily….
After progressing to Stage 4 in 2006 with bilateral lung mets, I opted for IL-2, knowing full well how toxic and the ensuing complications of side effects. I was able to tolerate 57 treatments and continue to have negative scans and MRI's.
I felt very strongly, that I needed to do this harsh treatment before my health and stamina were compromised by disease. But discussions are difficult and options are few.
If I can be of any help, feel free to contact me. Wishing your husband good health.
Debbie Stage 4 NED (2006)
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- June 7, 2011 at 2:28 am
Hi Emily….
After progressing to Stage 4 in 2006 with bilateral lung mets, I opted for IL-2, knowing full well how toxic and the ensuing complications of side effects. I was able to tolerate 57 treatments and continue to have negative scans and MRI's.
I felt very strongly, that I needed to do this harsh treatment before my health and stamina were compromised by disease. But discussions are difficult and options are few.
If I can be of any help, feel free to contact me. Wishing your husband good health.
Debbie Stage 4 NED (2006)
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