› Forums › General Melanoma Community › Keytruda & Opdivo
- This topic has 33 replies, 8 voices, and was last updated 7 years, 11 months ago by
JoshF.
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- May 23, 2016 at 11:01 pm
So just a quick question for some of you. I should go search in Celeste's blog but I'm curious about what others know or have heard. Reading Kerri's post about Jake made me think more about it. If Keytruda failed Jake and maybe others who will see this, does that mean that Nivo most likely wouldn't work? I understand they're same class of drugs but there has to be a slight difference otherwise how would an oncologist chose? Loyalty to a specific pharma company? Just curious as there has to be a slight difference that could make a difference in response for someone?
Ok now I'm going to go dig in Celeste's blog.
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- May 24, 2016 at 2:32 am
Josh, I don't believe that there is a meaningful difference. Given your success with ipi–and given that you haven't done ipi for more than I year–you might look at ipi-nivo either post surgery or keep it in your back pocket if you find a promising trial.
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- May 24, 2016 at 3:19 am
Josh, I am new to posting and a long time follower of this site. In brief I have been fighting Desmoplastic neurotropic melanoma for over six years now. many surgeries and many treatments. My most recent was Ippi/nivo combo that i had to discontinue after 2 doses. went to nivo for 2 doses but had bad liver counts. Had low dose chemo for 4 doses when tumor grew by a third. We were going to try Nivo again He was able to get Keytruda! I have been able to tolerate 7 infusions and tumor has shrunk down to almost nothing. (size of golf ball)So i have had a response to one and not the other. Dr. says very rare though.
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- May 24, 2016 at 3:19 am
Josh, I am new to posting and a long time follower of this site. In brief I have been fighting Desmoplastic neurotropic melanoma for over six years now. many surgeries and many treatments. My most recent was Ippi/nivo combo that i had to discontinue after 2 doses. went to nivo for 2 doses but had bad liver counts. Had low dose chemo for 4 doses when tumor grew by a third. We were going to try Nivo again He was able to get Keytruda! I have been able to tolerate 7 infusions and tumor has shrunk down to almost nothing. (size of golf ball)So i have had a response to one and not the other. Dr. says very rare though.
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- May 24, 2016 at 3:19 am
Josh, I am new to posting and a long time follower of this site. In brief I have been fighting Desmoplastic neurotropic melanoma for over six years now. many surgeries and many treatments. My most recent was Ippi/nivo combo that i had to discontinue after 2 doses. went to nivo for 2 doses but had bad liver counts. Had low dose chemo for 4 doses when tumor grew by a third. We were going to try Nivo again He was able to get Keytruda! I have been able to tolerate 7 infusions and tumor has shrunk down to almost nothing. (size of golf ball)So i have had a response to one and not the other. Dr. says very rare though.
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- May 24, 2016 at 3:37 pm
Josh, this is not exactly your question. However, I wanted to let you know that my tumors grew on both Keytruda and Ipi. I was on them individually and in hindsight, we may have moved on to new treatments too quickly (this was just before they were FDA approved). At any rate, my doc, Steve Hodi at Dana Farber, said I still may get some results from the Ipi/Nivo combo. I'm keeping that one in my back pocket.
Gwen
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- May 24, 2016 at 3:37 pm
Josh, this is not exactly your question. However, I wanted to let you know that my tumors grew on both Keytruda and Ipi. I was on them individually and in hindsight, we may have moved on to new treatments too quickly (this was just before they were FDA approved). At any rate, my doc, Steve Hodi at Dana Farber, said I still may get some results from the Ipi/Nivo combo. I'm keeping that one in my back pocket.
Gwen
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- May 24, 2016 at 3:37 pm
Josh, this is not exactly your question. However, I wanted to let you know that my tumors grew on both Keytruda and Ipi. I was on them individually and in hindsight, we may have moved on to new treatments too quickly (this was just before they were FDA approved). At any rate, my doc, Steve Hodi at Dana Farber, said I still may get some results from the Ipi/Nivo combo. I'm keeping that one in my back pocket.
Gwen
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- May 25, 2016 at 4:28 am
Josh,
The recent thread on T-Cell Infiltration Biopsies caught my eye because it is being done at UCSF, where I am also seen (except not for the last 2 years while I've been on a clinical trial elsewhere).
It sounds like they use it to decide whether to try Nivo alone, or the Nivo/PD1 combo. Depending on the test result, apparently they figure stronger measures are nececessary, i.e., the combo. I know you've done IPI and HD IL2, and separately Nivo. I think you were considering the IPI/Nivo combo recently. I don't know if that test would help in that decision.
– Kyle
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- May 25, 2016 at 4:28 am
Josh,
The recent thread on T-Cell Infiltration Biopsies caught my eye because it is being done at UCSF, where I am also seen (except not for the last 2 years while I've been on a clinical trial elsewhere).
It sounds like they use it to decide whether to try Nivo alone, or the Nivo/PD1 combo. Depending on the test result, apparently they figure stronger measures are nececessary, i.e., the combo. I know you've done IPI and HD IL2, and separately Nivo. I think you were considering the IPI/Nivo combo recently. I don't know if that test would help in that decision.
– Kyle
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- May 25, 2016 at 9:37 am
Kyle take a look at this video by Ribas of UCLA, at the 19min mark he talks about the future and being able to perdict who will repond and how T-cell (Cd8) cells are very important to getting a responds. Best Wishes!!! Ed https://www.youtube.com/watch?v=YfZt5JdJ9_c&index=5&list=PLBeIlaOP6nFBJQlhqQCFM_75iwzT2DRVp
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- May 25, 2016 at 9:37 am
Kyle take a look at this video by Ribas of UCLA, at the 19min mark he talks about the future and being able to perdict who will repond and how T-cell (Cd8) cells are very important to getting a responds. Best Wishes!!! Ed https://www.youtube.com/watch?v=YfZt5JdJ9_c&index=5&list=PLBeIlaOP6nFBJQlhqQCFM_75iwzT2DRVp
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- May 25, 2016 at 9:37 am
Kyle take a look at this video by Ribas of UCLA, at the 19min mark he talks about the future and being able to perdict who will repond and how T-cell (Cd8) cells are very important to getting a responds. Best Wishes!!! Ed https://www.youtube.com/watch?v=YfZt5JdJ9_c&index=5&list=PLBeIlaOP6nFBJQlhqQCFM_75iwzT2DRVp
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- May 25, 2016 at 4:19 pm
Ed, that was a really interesting video. Got me wondering about what the CD8 levels might be in my biopsies.
Josh, with everything else going on, that must be pretty crazy for you right now, if you get the chance, check out this video from the 19-minute mark to the end of Dr. Ribas' presentation. It seems pretty relevant to the decision points you're at right now. He talks about patients with tumors with low CD8 (TCell?) infiltration not responding to anti-PD1, and how combining anti-PD1 with other therapies like IPI can get things moving in many of those patients.
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- May 25, 2016 at 4:19 pm
Ed, that was a really interesting video. Got me wondering about what the CD8 levels might be in my biopsies.
Josh, with everything else going on, that must be pretty crazy for you right now, if you get the chance, check out this video from the 19-minute mark to the end of Dr. Ribas' presentation. It seems pretty relevant to the decision points you're at right now. He talks about patients with tumors with low CD8 (TCell?) infiltration not responding to anti-PD1, and how combining anti-PD1 with other therapies like IPI can get things moving in many of those patients.
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- May 25, 2016 at 4:19 pm
Ed, that was a really interesting video. Got me wondering about what the CD8 levels might be in my biopsies.
Josh, with everything else going on, that must be pretty crazy for you right now, if you get the chance, check out this video from the 19-minute mark to the end of Dr. Ribas' presentation. It seems pretty relevant to the decision points you're at right now. He talks about patients with tumors with low CD8 (TCell?) infiltration not responding to anti-PD1, and how combining anti-PD1 with other therapies like IPI can get things moving in many of those patients.
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- May 25, 2016 at 4:28 am
Josh,
The recent thread on T-Cell Infiltration Biopsies caught my eye because it is being done at UCSF, where I am also seen (except not for the last 2 years while I've been on a clinical trial elsewhere).
It sounds like they use it to decide whether to try Nivo alone, or the Nivo/PD1 combo. Depending on the test result, apparently they figure stronger measures are nececessary, i.e., the combo. I know you've done IPI and HD IL2, and separately Nivo. I think you were considering the IPI/Nivo combo recently. I don't know if that test would help in that decision.
– Kyle
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- May 25, 2016 at 11:00 am
Hey Josh, I think you've gotten some good info here. Yours is the zillion dollar question just now…If I didn't respond to 'x'….will I respond to 'z'?!!!!!!! I don't have a good answer to your specific question re nivo vs pembro….they are pretty similar. However, folks are gaining some responses when restarting meds and or when switching. Some data indicates if you are anti-PDL1 positive you do better with certain immunotherapies…but then other studies seem to show the response rates are not very different. So, a straight answer is not clear yet. I would absolutely be requsting any sort of tumor testing that could possibly be done to the tumor they remove Friday! You never know….you may get some really important information from it! Hang in there. Love, c
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- May 25, 2016 at 11:00 am
Hey Josh, I think you've gotten some good info here. Yours is the zillion dollar question just now…If I didn't respond to 'x'….will I respond to 'z'?!!!!!!! I don't have a good answer to your specific question re nivo vs pembro….they are pretty similar. However, folks are gaining some responses when restarting meds and or when switching. Some data indicates if you are anti-PDL1 positive you do better with certain immunotherapies…but then other studies seem to show the response rates are not very different. So, a straight answer is not clear yet. I would absolutely be requsting any sort of tumor testing that could possibly be done to the tumor they remove Friday! You never know….you may get some really important information from it! Hang in there. Love, c
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- May 25, 2016 at 11:00 am
Hey Josh, I think you've gotten some good info here. Yours is the zillion dollar question just now…If I didn't respond to 'x'….will I respond to 'z'?!!!!!!! I don't have a good answer to your specific question re nivo vs pembro….they are pretty similar. However, folks are gaining some responses when restarting meds and or when switching. Some data indicates if you are anti-PDL1 positive you do better with certain immunotherapies…but then other studies seem to show the response rates are not very different. So, a straight answer is not clear yet. I would absolutely be requsting any sort of tumor testing that could possibly be done to the tumor they remove Friday! You never know….you may get some really important information from it! Hang in there. Love, c
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- May 25, 2016 at 7:26 pm
Hi Josh!
Sending you positive thoughts and prayers for your upcoming surgery.
I recently attended the AIM Symposium here in LA (Weber, Hamid, and others were all there. It was awesome!). Anyways, many of the docs discussed at length why they think some people respond to immuno and some don't. Hamid (my husband's specialist) used the analogy of a breaks on a car. I know we've all heard this in some form or another, that anti-PD1 basically takes the "brakes" off and allows our immune system to do its thing. He was a bit more detailed about it…so, a car is on an declining hill, you take the breaks off, the car moves (ie an anti-PD1 response, either Nivo or Pembro). The car is on a flat surface, take the breaks off, the car needs a little push to get going (most likely ipi or ipi/nivo combo). The car is on a hill, take the breaks off, and you need a hell of a lot of gas to get it going (combo PLUS other drugs…chemo, IDO inhibitors, etc.). I loved the idea that even though one might not respond to a monotherapy, a combo of 2 or more (he mentioned up to 4(!!!)) drugs could work and get the immune system ramped up, even if prior treatment had failed a patient. Some of us need a little more than just the brakes removed…we need some gas or a shove to get going.
I know it would be a trek for you, but if possible, I would recommend seeing Dr. Hamid. He's really, really amazing and looks far past the conventional treatment that is available for patients to treat their individual disease.
I'm fairly certain I did not answer your question, but thought I would share anyways. Good luck, kick this thing's ass!
Best,
Katie
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- May 25, 2016 at 7:26 pm
Hi Josh!
Sending you positive thoughts and prayers for your upcoming surgery.
I recently attended the AIM Symposium here in LA (Weber, Hamid, and others were all there. It was awesome!). Anyways, many of the docs discussed at length why they think some people respond to immuno and some don't. Hamid (my husband's specialist) used the analogy of a breaks on a car. I know we've all heard this in some form or another, that anti-PD1 basically takes the "brakes" off and allows our immune system to do its thing. He was a bit more detailed about it…so, a car is on an declining hill, you take the breaks off, the car moves (ie an anti-PD1 response, either Nivo or Pembro). The car is on a flat surface, take the breaks off, the car needs a little push to get going (most likely ipi or ipi/nivo combo). The car is on a hill, take the breaks off, and you need a hell of a lot of gas to get it going (combo PLUS other drugs…chemo, IDO inhibitors, etc.). I loved the idea that even though one might not respond to a monotherapy, a combo of 2 or more (he mentioned up to 4(!!!)) drugs could work and get the immune system ramped up, even if prior treatment had failed a patient. Some of us need a little more than just the brakes removed…we need some gas or a shove to get going.
I know it would be a trek for you, but if possible, I would recommend seeing Dr. Hamid. He's really, really amazing and looks far past the conventional treatment that is available for patients to treat their individual disease.
I'm fairly certain I did not answer your question, but thought I would share anyways. Good luck, kick this thing's ass!
Best,
Katie
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- May 25, 2016 at 7:40 pm
Katie-
i have a friend who is surgical onc. He is in Ohio now but used to be West Coast and knows him well and said its worth the trek. I was curious about IDO etc… I should get my things together to see him.
Thanks so much for message and your analogy was great….appreciate it.
Josh
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- May 25, 2016 at 7:40 pm
Katie-
i have a friend who is surgical onc. He is in Ohio now but used to be West Coast and knows him well and said its worth the trek. I was curious about IDO etc… I should get my things together to see him.
Thanks so much for message and your analogy was great….appreciate it.
Josh
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- May 25, 2016 at 7:40 pm
Katie-
i have a friend who is surgical onc. He is in Ohio now but used to be West Coast and knows him well and said its worth the trek. I was curious about IDO etc… I should get my things together to see him.
Thanks so much for message and your analogy was great….appreciate it.
Josh
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- May 25, 2016 at 7:26 pm
Hi Josh!
Sending you positive thoughts and prayers for your upcoming surgery.
I recently attended the AIM Symposium here in LA (Weber, Hamid, and others were all there. It was awesome!). Anyways, many of the docs discussed at length why they think some people respond to immuno and some don't. Hamid (my husband's specialist) used the analogy of a breaks on a car. I know we've all heard this in some form or another, that anti-PD1 basically takes the "brakes" off and allows our immune system to do its thing. He was a bit more detailed about it…so, a car is on an declining hill, you take the breaks off, the car moves (ie an anti-PD1 response, either Nivo or Pembro). The car is on a flat surface, take the breaks off, the car needs a little push to get going (most likely ipi or ipi/nivo combo). The car is on a hill, take the breaks off, and you need a hell of a lot of gas to get it going (combo PLUS other drugs…chemo, IDO inhibitors, etc.). I loved the idea that even though one might not respond to a monotherapy, a combo of 2 or more (he mentioned up to 4(!!!)) drugs could work and get the immune system ramped up, even if prior treatment had failed a patient. Some of us need a little more than just the brakes removed…we need some gas or a shove to get going.
I know it would be a trek for you, but if possible, I would recommend seeing Dr. Hamid. He's really, really amazing and looks far past the conventional treatment that is available for patients to treat their individual disease.
I'm fairly certain I did not answer your question, but thought I would share anyways. Good luck, kick this thing's ass!
Best,
Katie
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