Question about pathology reports

Hi AzSoCal

I remember you from when you used to post.
Like you I post less these days in part because there is less activity here but also because in the end my treatment started to work, and staying on the board was not helpful – although I wanted to help others. And I just took a four week vacation and I found myself forgetting about this board.

I cannot help you with the pathology reports (surely there is more detail), and I was hoping that you didnt have a recurrence (but seems from the biopsy that you did). I just wanted to write to tell you that I ended up doing what you are doing, and I htink it makes sense. I was on keytruda on and off for a year or so – it cured a tiny tumour but it could not get rid of the larger tumour which kept growing but slowly. We were going to give up and do surgery (that would have been my third surgery in the same area) – so I guess in a way this was the neo-adjuvant approach. But before doing this we decided to add TVEC, based on a second opinion and a last chance to avoid the third surgery (which would have meant a long recovery time and rehab after plastic surgery). In the end the TVEC plus Keytruda worked – the first few weeks the tumour probably grew slightly (you can see it on the ultrasound used to inject the TVEC) but then it stabilized and started to shrink. And one year later (just over) the tumour finally seemed to have disappeared.

So my point is, I think this approach can work. I would definitely favour TVEC plus keytruda vs. Keytruda alone. And if it works well maybe you can avoid surgery. But if not, then I think gambling a little by keeping the tumour in place and using immunotherapy could give a better result than surgery and then keytruda. So I think its an interesting plan, and if your tumour is localized (think it is) then I think it has more chances of working. And if ipi is too risky (as it was for me) then I think adding tvec is a good alternative way of getting the keytruda to work. I hope it works for you as it did for me.

Good luck Mark

Hi Azsocal, in the following video from one of the leaders in the field of neo-adjuvant melanoma research, Dr. Long covers her Australian based program in detail starting at 36:50 min mark. Earlier in the video she talks about use of immunohistochemistry ( staining of cancer cells and view with high powered microscope work)They also consider things like CD8+ T-cell and distance from tumor, T-regs(FoxP3 cells) and Pd-L1 staining. Interferon gamma and TMB (tumor mutational burden) are also considered in her research. So yes a lot more can be looked at depending on if your oncology team is into the research side of things. Now, Dr. Long is based out of Australia but seeing that you are So Cal, then I would recommend getting in touch with Dr. Antoni Ribas based at UCLA (see following link). Dr. Ribas is also at the cutting edge of tissue study and is also looking at injectable including TLR-9 targets and has worked with CMP-001 and a couple of other drug candidates. https://www.youtube.com/watch?v=LPhuuC4QnTw https://www.youtube.com/watch?v=JGA84FLyW-E