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Is Yervoy for brain mets? Your help is greatly appreciated
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Is Yervoy for brain mets? Your help is greatly appreciated

› Forums › General Melanoma Community › Is Yervoy for brain mets? Your help is greatly appreciated

  • Post
    • February 5, 2012 at 1:30 pm
    davidfromsingapore
    Participant

      Had some scans last week that came back somewhat inconclusive.  MRI showed a few spots in the thalamus and some areas near the tumors that were removed from my brain that were "enhanced" after the injection of the dye, but PET/CT said "No suspicious hypermetobolic lesions detected".  If it is cancer, I would like to know if any of you out there have used Yervoy (ipi) for brain mets?  Is Yervoy being administered only in clinical trials or can I get it from my oncologist?

      Had some scans last week that came back somewhat inconclusive.  MRI showed a few spots in the thalamus and some areas near the tumors that were removed from my brain that were "enhanced" after the injection of the dye, but PET/CT said "No suspicious hypermetobolic lesions detected".  If it is cancer, I would like to know if any of you out there have used Yervoy (ipi) for brain mets?  Is Yervoy being administered only in clinical trials or can I get it from my oncologist?

      I've read that Yervoy is a large molecule  (and thus won't pass the blood brain barrier), but then again I see that it has been used with some success for some people with brain mets.  Apparently the white blood cells are still able to cross the blood/brain barrier.  

      Your thoughts are greatly appreciated.  Going through some hard times not knowing.  

       

      Thanks, David

    Viewing 14 reply threads
    • Replies
        • February 5, 2012 at 2:22 pm
        FormerCaregiver
        Participant

          David, Yervoy can be used in patients with brain mets. However, I don't know if it would
          be suitable in your situation and you would need to consult an oncologist about it.

          Yervoy works by acting on the immune system and therefore has the ability to treat
          tumours anywhere in the body. See: http://en.wikipedia.org/wiki/Ipilimumab and
          http://www.yervoy.com/patient/about-yervoy.aspx

          An oncologist can prescribe it for you, but that would depend if it is approved and
          available in your location.

          Hope this helps.

          Frank from Australia

          • February 5, 2012 at 2:22 pm
          FormerCaregiver
          Participant

            David, Yervoy can be used in patients with brain mets. However, I don't know if it would
            be suitable in your situation and you would need to consult an oncologist about it.

            Yervoy works by acting on the immune system and therefore has the ability to treat
            tumours anywhere in the body. See: http://en.wikipedia.org/wiki/Ipilimumab and
            http://www.yervoy.com/patient/about-yervoy.aspx

            An oncologist can prescribe it for you, but that would depend if it is approved and
            available in your location.

            Hope this helps.

            Frank from Australia

            • February 5, 2012 at 2:22 pm
            FormerCaregiver
            Participant

              David, Yervoy can be used in patients with brain mets. However, I don't know if it would
              be suitable in your situation and you would need to consult an oncologist about it.

              Yervoy works by acting on the immune system and therefore has the ability to treat
              tumours anywhere in the body. See: http://en.wikipedia.org/wiki/Ipilimumab and
              http://www.yervoy.com/patient/about-yervoy.aspx

              An oncologist can prescribe it for you, but that would depend if it is approved and
              available in your location.

              Hope this helps.

              Frank from Australia

              • February 5, 2012 at 2:25 pm
              nikolaos
              Participant

                Hello David. Ipilimumab does not attack tumors itself. It stimulates immune system so that it recognize melanoma and produces lymphocytes that attack tumors. Those lymphocytes can hopefully cross the brain barrier and do the job. At early trials there have been no study references to agree with that statement- however most of them (i think all of them) did not include in the study patients with brain metastases..

                However i have come across one study which suggests that ipilimumab has the same level (or at least almost the same) of activity in central nervous system like in extracranial sites.. Here is the link to the study. Look at the conclusion.

                http://www.asco.org/ascov2/Meetings/Abstracts?&vmview=abst_detail_view&confID=74&abstractID=50834

                 

                Conclusions: Ipi has a similar level of activity in brain and non-CNS lesions. This is the first study to prospectively evaluate Ipi in advanced melanoma pts with brain mets, and the data support its potential use as a treatment for these pts. The analyses are ongoing and final data will be presented.

                • February 5, 2012 at 2:25 pm
                nikolaos
                Participant

                  Hello David. Ipilimumab does not attack tumors itself. It stimulates immune system so that it recognize melanoma and produces lymphocytes that attack tumors. Those lymphocytes can hopefully cross the brain barrier and do the job. At early trials there have been no study references to agree with that statement- however most of them (i think all of them) did not include in the study patients with brain metastases..

                  However i have come across one study which suggests that ipilimumab has the same level (or at least almost the same) of activity in central nervous system like in extracranial sites.. Here is the link to the study. Look at the conclusion.

                  http://www.asco.org/ascov2/Meetings/Abstracts?&vmview=abst_detail_view&confID=74&abstractID=50834

                   

                  Conclusions: Ipi has a similar level of activity in brain and non-CNS lesions. This is the first study to prospectively evaluate Ipi in advanced melanoma pts with brain mets, and the data support its potential use as a treatment for these pts. The analyses are ongoing and final data will be presented.

                  • February 5, 2012 at 2:25 pm
                  nikolaos
                  Participant

                    Hello David. Ipilimumab does not attack tumors itself. It stimulates immune system so that it recognize melanoma and produces lymphocytes that attack tumors. Those lymphocytes can hopefully cross the brain barrier and do the job. At early trials there have been no study references to agree with that statement- however most of them (i think all of them) did not include in the study patients with brain metastases..

                    However i have come across one study which suggests that ipilimumab has the same level (or at least almost the same) of activity in central nervous system like in extracranial sites.. Here is the link to the study. Look at the conclusion.

                    http://www.asco.org/ascov2/Meetings/Abstracts?&vmview=abst_detail_view&confID=74&abstractID=50834

                     

                    Conclusions: Ipi has a similar level of activity in brain and non-CNS lesions. This is the first study to prospectively evaluate Ipi in advanced melanoma pts with brain mets, and the data support its potential use as a treatment for these pts. The analyses are ongoing and final data will be presented.

                    • February 6, 2012 at 3:34 pm
                    fdess056
                    Participant

                      Hi David  Good to hear from you again.  I was scheduled to start IPI in January for lung mets.  Onc ordered a brain MRI just to have an updated base line.  MRI showed leptomeningeal metastasis, which I believe you've had also.  Onc decided to stick with IPI anyway since it does break the brain barrier.  I have my 3rd infusion scheduled for this Thursday.   I also  just had a set of 4 MRIs done on Saturday……brain and complete spine..   Once I get results I'll take CD and report  to a new neuro-oncologist for consultation.  I'll let you know how it al works out  Best of luck to you!

                      frankd  brooklyn NY 

                      • February 6, 2012 at 3:34 pm
                      fdess056
                      Participant

                        Hi David  Good to hear from you again.  I was scheduled to start IPI in January for lung mets.  Onc ordered a brain MRI just to have an updated base line.  MRI showed leptomeningeal metastasis, which I believe you've had also.  Onc decided to stick with IPI anyway since it does break the brain barrier.  I have my 3rd infusion scheduled for this Thursday.   I also  just had a set of 4 MRIs done on Saturday……brain and complete spine..   Once I get results I'll take CD and report  to a new neuro-oncologist for consultation.  I'll let you know how it al works out  Best of luck to you!

                        frankd  brooklyn NY 

                        • February 6, 2012 at 3:34 pm
                        fdess056
                        Participant

                          Hi David  Good to hear from you again.  I was scheduled to start IPI in January for lung mets.  Onc ordered a brain MRI just to have an updated base line.  MRI showed leptomeningeal metastasis, which I believe you've had also.  Onc decided to stick with IPI anyway since it does break the brain barrier.  I have my 3rd infusion scheduled for this Thursday.   I also  just had a set of 4 MRIs done on Saturday……brain and complete spine..   Once I get results I'll take CD and report  to a new neuro-oncologist for consultation.  I'll let you know how it al works out  Best of luck to you!

                          frankd  brooklyn NY 

                            • February 8, 2012 at 2:37 pm
                            davidfromsingapore
                            Participant

                               

                              Frank

                               

                              Thanks so much for your reply.  I do have a question about the Yervoy (ipi).  My oncologist has said it is a large molecule drug and thus does not cross the bb barrier.  But he did say that the white blood cells that it creates will cross the BBB.  Are you certain that Yervoy crosses the BBB?  That would be good news for sure.  Do you think that ipi can give you a long term or complete response for the leptomeningeal melanoma?  What is your next step?  I think I'm headed down the ipi trail. 

                              David 

                              • February 8, 2012 at 4:03 pm
                              fdess056
                              Participant

                                David, good timing on your question.  I just got back from seeing a neuro-oncologist at Mt Sinaiin Manhattan.  He confirmed the opinion of my head onc  that Yervoy does penetrate the brain barrier.  However, he did note that it is not approved in the US by the Food & Drug Admin for that purpose, so there is some controversy about this subject.   Since i also have a met on my left lung, they were able to get clearance to  use the yervoy.  My latest brain MRIs show a  small decrease in size of the original brain met….(possibly due to yervoy?) with no further spread to the brain or spinal column.     This is after 2 yervoy infusions. I have my 3rd one on Thursday.  He  wants to try  Gamma Knife surgery in conjunction with the yervoy.  I'm waiting to hear back from radiology on their insight.  I hope this helps and wish you all the best  You'll continue to be in my thoughts.

                                FrankD

                                • February 8, 2012 at 4:03 pm
                                fdess056
                                Participant

                                  David, good timing on your question.  I just got back from seeing a neuro-oncologist at Mt Sinaiin Manhattan.  He confirmed the opinion of my head onc  that Yervoy does penetrate the brain barrier.  However, he did note that it is not approved in the US by the Food & Drug Admin for that purpose, so there is some controversy about this subject.   Since i also have a met on my left lung, they were able to get clearance to  use the yervoy.  My latest brain MRIs show a  small decrease in size of the original brain met….(possibly due to yervoy?) with no further spread to the brain or spinal column.     This is after 2 yervoy infusions. I have my 3rd one on Thursday.  He  wants to try  Gamma Knife surgery in conjunction with the yervoy.  I'm waiting to hear back from radiology on their insight.  I hope this helps and wish you all the best  You'll continue to be in my thoughts.

                                  FrankD

                                  • February 8, 2012 at 4:03 pm
                                  fdess056
                                  Participant

                                    David, good timing on your question.  I just got back from seeing a neuro-oncologist at Mt Sinaiin Manhattan.  He confirmed the opinion of my head onc  that Yervoy does penetrate the brain barrier.  However, he did note that it is not approved in the US by the Food & Drug Admin for that purpose, so there is some controversy about this subject.   Since i also have a met on my left lung, they were able to get clearance to  use the yervoy.  My latest brain MRIs show a  small decrease in size of the original brain met….(possibly due to yervoy?) with no further spread to the brain or spinal column.     This is after 2 yervoy infusions. I have my 3rd one on Thursday.  He  wants to try  Gamma Knife surgery in conjunction with the yervoy.  I'm waiting to hear back from radiology on their insight.  I hope this helps and wish you all the best  You'll continue to be in my thoughts.

                                    FrankD

                                    • February 8, 2012 at 2:37 pm
                                    davidfromsingapore
                                    Participant

                                       

                                      Frank

                                       

                                      Thanks so much for your reply.  I do have a question about the Yervoy (ipi).  My oncologist has said it is a large molecule drug and thus does not cross the bb barrier.  But he did say that the white blood cells that it creates will cross the BBB.  Are you certain that Yervoy crosses the BBB?  That would be good news for sure.  Do you think that ipi can give you a long term or complete response for the leptomeningeal melanoma?  What is your next step?  I think I'm headed down the ipi trail. 

                                      David 

                                      • February 8, 2012 at 2:37 pm
                                      davidfromsingapore
                                      Participant

                                         

                                        Frank

                                         

                                        Thanks so much for your reply.  I do have a question about the Yervoy (ipi).  My oncologist has said it is a large molecule drug and thus does not cross the bb barrier.  But he did say that the white blood cells that it creates will cross the BBB.  Are you certain that Yervoy crosses the BBB?  That would be good news for sure.  Do you think that ipi can give you a long term or complete response for the leptomeningeal melanoma?  What is your next step?  I think I'm headed down the ipi trail. 

                                        David 

                                      • February 7, 2012 at 3:40 am
                                      NancyGM
                                      Participant

                                        David, I do know that Temodar (temozolamide) crosses the blood brain barrier. Have your doctors considered this chemo pill? I did 10 rounds in 2007 and have been clear now for 4 years. I didn't have brain mets. I had a pretty good size lung met which could not be surgically removed.

                                        Very best of luck to you.You have a beautiful family. I think life is full of miracles..who is to say you might not just be one?

                                          • February 8, 2012 at 2:49 pm
                                          davidfromsingapore
                                          Participant

                                            Nancy

                                            Thanks for the helpful advice and the kind words.  Temodar is indeed one of my options.  I think it is the drug my oncologist prefer actually.  Hearing your success definitely helps.  

                                             

                                            All the best, David

                                            • February 8, 2012 at 2:49 pm
                                            davidfromsingapore
                                            Participant

                                              Nancy

                                              Thanks for the helpful advice and the kind words.  Temodar is indeed one of my options.  I think it is the drug my oncologist prefer actually.  Hearing your success definitely helps.  

                                               

                                              All the best, David

                                              • February 8, 2012 at 2:49 pm
                                              davidfromsingapore
                                              Participant

                                                Nancy

                                                Thanks for the helpful advice and the kind words.  Temodar is indeed one of my options.  I think it is the drug my oncologist prefer actually.  Hearing your success definitely helps.  

                                                 

                                                All the best, David

                                              • February 7, 2012 at 3:40 am
                                              NancyGM
                                              Participant

                                                David, I do know that Temodar (temozolamide) crosses the blood brain barrier. Have your doctors considered this chemo pill? I did 10 rounds in 2007 and have been clear now for 4 years. I didn't have brain mets. I had a pretty good size lung met which could not be surgically removed.

                                                Very best of luck to you.You have a beautiful family. I think life is full of miracles..who is to say you might not just be one?

                                                • February 7, 2012 at 3:40 am
                                                NancyGM
                                                Participant

                                                  David, I do know that Temodar (temozolamide) crosses the blood brain barrier. Have your doctors considered this chemo pill? I did 10 rounds in 2007 and have been clear now for 4 years. I didn't have brain mets. I had a pretty good size lung met which could not be surgically removed.

                                                  Very best of luck to you.You have a beautiful family. I think life is full of miracles..who is to say you might not just be one?

                                                  • February 7, 2012 at 3:43 am
                                                  NancyGM
                                                  Participant

                                                    David, I do know that Temodar (temozolamide) crosses the blood brain barrier. Have your doctors considered this chemo pill? I did 10 rounds in 2007 and have been clear now for 4 years. I didn't have brain mets. I had a pretty good size lung met which could not be surgically removed.

                                                    Very best of luck to you.You have a beautiful family. I think life is full of miracles..who is to say you might not just be one?

                                                    • February 7, 2012 at 3:43 am
                                                    NancyGM
                                                    Participant

                                                      David, I do know that Temodar (temozolamide) crosses the blood brain barrier. Have your doctors considered this chemo pill? I did 10 rounds in 2007 and have been clear now for 4 years. I didn't have brain mets. I had a pretty good size lung met which could not be surgically removed.

                                                      Very best of luck to you.You have a beautiful family. I think life is full of miracles..who is to say you might not just be one?

                                                      • February 7, 2012 at 3:43 am
                                                      NancyGM
                                                      Participant

                                                        David, I do know that Temodar (temozolamide) crosses the blood brain barrier. Have your doctors considered this chemo pill? I did 10 rounds in 2007 and have been clear now for 4 years. I didn't have brain mets. I had a pretty good size lung met which could not be surgically removed.

                                                        Very best of luck to you.You have a beautiful family. I think life is full of miracles..who is to say you might not just be one?

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