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Melanoma progress in Canada

Forums General Melanoma Community Melanoma progress in Canada

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      My mom progress on pembo and she has nras mutation. Her oncologist asked for combination treatment . This is what we got from Ontario drug company.
      This note is to document that we submitted prior approval request
      for switch to ipilimumab and nivolumab for her metastatic melanoma. She is currently on
      pembrolizumab. Unfortunately the request was denied as switching from single agent to combination
      therapy is no longer allowed as of July 2019 per communication from CCO.
      I do not understand how they can deny the access to combination treatment when she has nras mutation and no other choice .
      I am so sad by this and angry at the healthcare system in Ontario in Canada
      . The cost of ipi is 30k for each treatment 🙁

      If you have a solution please let me know.

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          I would not give up. You need a letter from your mother’s oncologist that this is the recommended treatment. I would also get them to issue you evifence that the recommended treatment is available in the U.S. and Europe. Appeal their decision. Simultaneously, I would immediately contact your local member of Parliament. At the same time, I would contact the drug makers and ask for the drugs to be given on compassionate grounds. These are the first few thoughts which come to mind but I am sure there must be more which you can do. At least it is a good start.
          Best of luck.
            You might ask about immunotherapy with ipilimumab alone. After treatment failure with anti-PD-1 immunotherapy, treatment with ipilimumab alone or with ipilimumab and nivolumab (combination group) gave similar results in this study:
            Copy and paste this link.

            From this link:
            “Ipilimumab should be considered an appropriate option for patients who progressed on prior anti-PD-1 therapy.

            In total, 47 patients were treated with ipilimumab (ipi-group) and 37 patients with ipilimumab and nivolumab (combination group) after treatment failure to anti-PD-1 therapy. Overall response rates for the ipi and the combination-group were 16% and 21%, respectively. Disease control rate was 42% for the ipi-group and 33% for the combination-group. One-year overall survival rates for the ipi and the combination-group were 54% and 55%, respectively.”

            ed williams
              Hi Lilara, to help you build a case, some recent findings could support but not prove the opinion that ipi + nivo or ipi + low dose ipi would be the best route to follow. See two following links from this year, second link from ASCO abstract 10005 is retrospective (looking back) at previous patients.
              We live in Canada as well, but the other side in BC. We were able to get the ipi novo combo through Bristol Myers Squibb. My husband was stage 4 with Mets everywhere including his brain in Jan 2018 and today he is progression free, though not without complications. Any good oncologist should be willing to push for this treatment for you. Access to hope was the name of the program we were put on. I hope this helps and I wish you so much luck.
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