Newly Diagnosed – SLNB?

I should specify that my own preference for anti-PD1 + anti-IDO in the setting to low volume node-only mets is based on the compromise between likely slightly less benefit in exchange for likely slightly less toxicity versus anti-PD1 + anti-CTLA4. It's still very much an experimental approach. The much more important point I meant to make is that if I had disease beyond the primary lesion/mole, I'd want to know it earlier, because unlike with chemotherapy, I do truly believe that immunotherapy is on average more effective with lower volume of disease.

Hi Majahops,

I see you are new to the forum, so welcome!!!  I presume you are aware of the closure of the ECHO 301 trial:

http://chaoticallypreciselifeloveandmelanoma.blogspot.com/search?q=IDO+inhibitor  

I was not aware of a currently recruiting trial administering IDO inhibitors combined with anti-PD-1 for Stage III melanoma patients.  I could find only these listed:  https://clinicaltrials.gov/ct2/results?cond=Melanoma+Stage+III&term=IDO+inhibitor&cntry=&state=&city=&dist=  

In fact, I can find no active/recruiting studies administering an IDO inhibitor with anti-PD-1 for Stage IV melanoma patients.  You are correct that we have learned that immunotherapy works best with the lowest possible tumor burden and I have had high hopes for the anti-IDO inhibitors when combined with immunotherapy.  Please let us know what trial option you are referring to.

Thanks.  Celeste

Celeste, thanks for the warm welcome. Again, I was only stating what would be on my "wish list." However, some of the trials that seem to be still open for Immunotherapy + IDO inhibitors include ECHO-203, ECHO-208, ECHO-202, NLG2107, NCT02073123 (not sure about the status of the last one). Other approaches that seem interesting include targeting TIM-3 and LAG-3. However, again, those are not anywhere near approved approaches. And again, that was just my "stage 3 wishlist." If I had stage IV melanoma, unless my PD-L1 was ETREMELY high, I would not mess around and would want Ipi + Nivo.

Also, I want to tell you that your material is phenomenal and you are an amazing advocate. Very, very inspiring.

Thanks.  And thanks for the info on the IDO studies…however….

ECHO 203 and 208 are for advanced solid tumors…not necessarily for melanoma and certainly not for Stage III.  ECHO 202 is recruiting and gives pembro with an IDO inhibitor to melanoma patients, and while it is a bit unclear, it seems currently available to those who are refractory with confirmed progressive disease.  Cool, NLG2107 is available for non-resectable or metastatic melanoma, though getting Indoximod is not a sure thing.  And the trial NCT02073123 was posted in 2014…but has not posted data, doesn't seem to be recruiting, and it was last updated in 2016. 

I guess we just have to be careful with what we recommend and to whom.  Folks who don't even know if they are Stage III yet already have a lot on their plate.   celeste

Point taken. I'm new to this. Definitely appreciate it.

Just wanted to add to the Pembro + Ido trial part of the conversation, my understanding is the echo 202- keynote -037 trial led to the phase 3 trial called Echo-301/ keynote-252 which just failed to meet progression free survival goal and has been terminated. So, I would think that Merck has probably stopped all pembro+ ido trials, not 100% sure on last point, they do tend to find ways to recycle things.  See link below for update on phase 3 trial, and a second point is Ipi/Nivo is only available to a stage 3 patient via trial at this point or advanced stage 4 so kind of jumping the gun to bring it up to some one who isn't sure of staging yet. It is great that you want to be helpful but it is really important to try and be as acurate as possible. If you don't mind me asking what is your melanoma history since you didn't fill in your bio history section?https://www.onclive.com/web-exclusives/pembrolizumab-combo-fails-in-melanoma