› Forums › General Melanoma Community › Radiation and Immunotherapy
- This topic has 27 replies, 3 voices, and was last updated 7 years, 5 months ago by
Polymath.
- Post
-
- December 1, 2016 at 3:21 pm
Hey everyone,
I have posted once before about my father who is currently stage 3C BRAFV600K positive.
Quick summary about his battle with melanoma- primary mole found in 2003, stage 1. He remained diligent in his cancer screenings and continued to see his derm every 6 months even after he went 10 years without a reoccurrence. Flash forward to March of 2016, swollen palpable lymph node in his collarbone positive for melanoma. End of May neck dissection, one more out of 10 nodes had microscope traces of the cancer. Started Yervoy and completed 4 doses. End of august to early September Sub qs popped up right at the scar incision of the surgery and have grown since. Pet scan showed 3 sub q nodules with an uptake that ranges from 2.9-5 and a bilateral node w an uptake of 2.9, both his melanoma specialist and radiologist believe it's from the immunotherapy. Brain MRI done at the end of October and thankfully that was clear. LDH ranged from 162-185, he's still working and has a physically demanding job.
I was hoping he would be put on the taf/mek combo, the largest tumor around his shoulder has grown and was causing so much pain and the nodule on his neck has grown causing both pain and getting him very down. It's bad enough knowing you have cancer, even worse when it's staring you in the face everyday. I know the targeted therapy works and works quickly, new 3 year data showing patients like my dad had a very high chance of responding for a long period of time- but he was put on keytruda and radiation. My fear is that immunotherapy doesn't work as well on BRAF positive patients and that he really needs therapy that targets the mutation. I know opdivos combo study has a little data that suggested wild type responds much better.
I'm writing today to get some input- my dad means the world to me, since the day he was diagnosed I made it my mission to know as much as I could about this disease and kept myself up to date on the latest treatments, I owe a lot of what I have learned to this community. I respect and value the thoughts and opinion anyone would have on his treatment plan. Has anyone been on radiation plus immunotherapy, esp anyone who has the BRAF mutation? I've read data about how radiation could help trigger a response but if anyone has more information I would love to read it.
Thanks in advance
- Replies
-
-
- December 1, 2016 at 4:22 pm
Hi Jules,
I guess I have several things in common including being BRAF +, having had BRAF inhibitors, and then later immunotherapies, with radiation added. First, your understanding of BRAF seems accurate although I was a very short-term responder. It varies tremendously, just like all treatments. After failing Keytruda, then Yervoy as single agents, I received first dose of high-powered radiation to a lemon sized sub-q tumor on my back which was causing a lot of problems. Later, I started the ipi/nivo combo, and while in early phase of, receiving both drugs simultaneously, I also did radiation again on two more very large, sub-q masses near each other just below my clavicle. It was the combo of three, ipi/nivo/radiation that produced some limited systemic response, shrinking a couple of smaller, internal tumors in my chest and abdomen not treated by radiation. I have recently progressed again after a year, and have decided to surgically remove a huge (think cantaloupe) tumors engulfing my spleen as well as a nearby soft-tissue mass adjacent to kidney. My LDH has been running at 500+ all year, double the high end of range. In closing, radiation can work for some tumors but in both cases for me, there was collateral damage to healthy tissues and organs. I ruled out radiation to spleen for that reason. Bottom line, my story is only mine. As noted, everyone responds differently but attacking tumors via BRAF inhibitors is a good early step in reducing tumor burden although Dad's is well within normal LDH range. This treatment, once it runs its course seems to set the stage for more effective, long-term immunotherapies. Use of radiation may indeed help the immunotherapy drugs work by triggering tumors to release antigens that signal a systemic immune response. But you must be careful with radiation as it is like an arrow, that hits its target, but continues right on through and can effect the good tissues on the way. I hope this helps. Best to Dad in the battle.
Gary
-
- December 1, 2016 at 4:22 pm
Hi Jules,
I guess I have several things in common including being BRAF +, having had BRAF inhibitors, and then later immunotherapies, with radiation added. First, your understanding of BRAF seems accurate although I was a very short-term responder. It varies tremendously, just like all treatments. After failing Keytruda, then Yervoy as single agents, I received first dose of high-powered radiation to a lemon sized sub-q tumor on my back which was causing a lot of problems. Later, I started the ipi/nivo combo, and while in early phase of, receiving both drugs simultaneously, I also did radiation again on two more very large, sub-q masses near each other just below my clavicle. It was the combo of three, ipi/nivo/radiation that produced some limited systemic response, shrinking a couple of smaller, internal tumors in my chest and abdomen not treated by radiation. I have recently progressed again after a year, and have decided to surgically remove a huge (think cantaloupe) tumors engulfing my spleen as well as a nearby soft-tissue mass adjacent to kidney. My LDH has been running at 500+ all year, double the high end of range. In closing, radiation can work for some tumors but in both cases for me, there was collateral damage to healthy tissues and organs. I ruled out radiation to spleen for that reason. Bottom line, my story is only mine. As noted, everyone responds differently but attacking tumors via BRAF inhibitors is a good early step in reducing tumor burden although Dad's is well within normal LDH range. This treatment, once it runs its course seems to set the stage for more effective, long-term immunotherapies. Use of radiation may indeed help the immunotherapy drugs work by triggering tumors to release antigens that signal a systemic immune response. But you must be careful with radiation as it is like an arrow, that hits its target, but continues right on through and can effect the good tissues on the way. I hope this helps. Best to Dad in the battle.
Gary
-
- December 1, 2016 at 4:22 pm
Hi Jules,
I guess I have several things in common including being BRAF +, having had BRAF inhibitors, and then later immunotherapies, with radiation added. First, your understanding of BRAF seems accurate although I was a very short-term responder. It varies tremendously, just like all treatments. After failing Keytruda, then Yervoy as single agents, I received first dose of high-powered radiation to a lemon sized sub-q tumor on my back which was causing a lot of problems. Later, I started the ipi/nivo combo, and while in early phase of, receiving both drugs simultaneously, I also did radiation again on two more very large, sub-q masses near each other just below my clavicle. It was the combo of three, ipi/nivo/radiation that produced some limited systemic response, shrinking a couple of smaller, internal tumors in my chest and abdomen not treated by radiation. I have recently progressed again after a year, and have decided to surgically remove a huge (think cantaloupe) tumors engulfing my spleen as well as a nearby soft-tissue mass adjacent to kidney. My LDH has been running at 500+ all year, double the high end of range. In closing, radiation can work for some tumors but in both cases for me, there was collateral damage to healthy tissues and organs. I ruled out radiation to spleen for that reason. Bottom line, my story is only mine. As noted, everyone responds differently but attacking tumors via BRAF inhibitors is a good early step in reducing tumor burden although Dad's is well within normal LDH range. This treatment, once it runs its course seems to set the stage for more effective, long-term immunotherapies. Use of radiation may indeed help the immunotherapy drugs work by triggering tumors to release antigens that signal a systemic immune response. But you must be careful with radiation as it is like an arrow, that hits its target, but continues right on through and can effect the good tissues on the way. I hope this helps. Best to Dad in the battle.
Gary
-
- December 1, 2016 at 7:30 pm
Gary,
thank you so much for responding and all of your incredible insights into my dad's treatment course. What I'm hoping is exactly what you described, the radiation causing the tumors to die and give off extra antigens that trigger immune system and in turn giving the keytruda a chance to increase the lymphocytes- I watched a presentation and in it it showed one lymphocyte go after and kill a very large tumor cell, amazing what our own immune system can do with a little help, just wish the response rate to the I/OS were better.
Question for you, when you were responding to the ipi/nivo/radiation did you notice anything different w your CBCs? Specifically absolute lymphocyte count? I know at the moment my dad is in a good place w his LDH and single site of metastases but I know that can change in a minute, trying to have back up plans in my head in place for any senario. He didn't take it well when he failed on yervoy, so failing on keytruda and radiation will be a big blow.
Im so sorry after responding you have started to progress, I hope that the surgery will be a success. Have you ever considered or discussed TIL therapy for a next course? The fact that you responded to the I/o combo has got to be a good sign for future immune response? Thank you for the well wishes and I sincerely thank you for taking the time to share your story and insights with me.
-
- December 2, 2016 at 1:12 am
Hi Jules,
Throughout my drug treatments, over the last three years, my blood work has never caused any alarm except that high LDH. Maybe a little below or above the line, on a few things but never any concern of the doc's. Its always been strange to be so well, and so sick at the same time. In many ways, I've wished for more extreme side-effects because I believe that is also an indication of response. Besides my very first drug treatment, BRAF inhibitor Zelboraf, which gave me every side-effect imaginable, with instantaneous response, everything else including the two rounds of ipi my body shrugged off with almost no side-effects. Apparently it's no-pain, no-gain. It seems like you are well informed and making good decisions. Dad needs to just hang in there as no developments are still coming. I was going to enter a new trial that sounds really promising, but the monster on my spleen is at the point where it's dangerous and it has stubbornly resisted all treatments so I'm going for the surgery now and keep the trial in mind if and when I have measurable disease again.
Gary
-
- December 2, 2016 at 1:12 am
Hi Jules,
Throughout my drug treatments, over the last three years, my blood work has never caused any alarm except that high LDH. Maybe a little below or above the line, on a few things but never any concern of the doc's. Its always been strange to be so well, and so sick at the same time. In many ways, I've wished for more extreme side-effects because I believe that is also an indication of response. Besides my very first drug treatment, BRAF inhibitor Zelboraf, which gave me every side-effect imaginable, with instantaneous response, everything else including the two rounds of ipi my body shrugged off with almost no side-effects. Apparently it's no-pain, no-gain. It seems like you are well informed and making good decisions. Dad needs to just hang in there as no developments are still coming. I was going to enter a new trial that sounds really promising, but the monster on my spleen is at the point where it's dangerous and it has stubbornly resisted all treatments so I'm going for the surgery now and keep the trial in mind if and when I have measurable disease again.
Gary
-
- December 2, 2016 at 1:12 am
Hi Jules,
Throughout my drug treatments, over the last three years, my blood work has never caused any alarm except that high LDH. Maybe a little below or above the line, on a few things but never any concern of the doc's. Its always been strange to be so well, and so sick at the same time. In many ways, I've wished for more extreme side-effects because I believe that is also an indication of response. Besides my very first drug treatment, BRAF inhibitor Zelboraf, which gave me every side-effect imaginable, with instantaneous response, everything else including the two rounds of ipi my body shrugged off with almost no side-effects. Apparently it's no-pain, no-gain. It seems like you are well informed and making good decisions. Dad needs to just hang in there as no developments are still coming. I was going to enter a new trial that sounds really promising, but the monster on my spleen is at the point where it's dangerous and it has stubbornly resisted all treatments so I'm going for the surgery now and keep the trial in mind if and when I have measurable disease again.
Gary
-
- December 2, 2016 at 3:11 pm
Gary,
I know what you mean, it's so crazy how this disease could go undected for so long because some have little to no symptoms that would indicate cancer.
when my dad was NED after the dissection he was having his yervoy closer to home w a general oncologist, after his sub qs popped up I asked what his LDH was and he has never had it taken! Well that changed the day I found out and he has it checked, normal range and continues to be- I'm thankful that there is something to monitor more frequently than scans. I'm just aggravated that we didn't have a baseline to what his LDH was before his in transit metastases happened.
Do you have a date for your surgery? I really hope all goes well and that afterwards you are NED and stay that way. I agree with what you said, bigger and better things are around the corner. I believe something curative or preventative could be possible because melanoma is immunogenic- it's just a matter of maximizing current treatment options until we get there.
Thanks again,
jules
-
- December 2, 2016 at 3:11 pm
Gary,
I know what you mean, it's so crazy how this disease could go undected for so long because some have little to no symptoms that would indicate cancer.
when my dad was NED after the dissection he was having his yervoy closer to home w a general oncologist, after his sub qs popped up I asked what his LDH was and he has never had it taken! Well that changed the day I found out and he has it checked, normal range and continues to be- I'm thankful that there is something to monitor more frequently than scans. I'm just aggravated that we didn't have a baseline to what his LDH was before his in transit metastases happened.
Do you have a date for your surgery? I really hope all goes well and that afterwards you are NED and stay that way. I agree with what you said, bigger and better things are around the corner. I believe something curative or preventative could be possible because melanoma is immunogenic- it's just a matter of maximizing current treatment options until we get there.
Thanks again,
jules
-
- December 3, 2016 at 4:58 pm
Hi Jules,
My meeting with the knife is in two-weeks. Need to deal with this thing once and for all. As what comes next, I don't know but I have a feeling, based on the tough case I've had so far, that I'll be dealing with Mr. Mel again. Thanks for the encouragement and sending it back in hopes your Dad kicks the bad-boy to the curb.
Gary
-
- December 3, 2016 at 4:58 pm
Hi Jules,
My meeting with the knife is in two-weeks. Need to deal with this thing once and for all. As what comes next, I don't know but I have a feeling, based on the tough case I've had so far, that I'll be dealing with Mr. Mel again. Thanks for the encouragement and sending it back in hopes your Dad kicks the bad-boy to the curb.
Gary
-
- December 3, 2016 at 4:58 pm
Hi Jules,
My meeting with the knife is in two-weeks. Need to deal with this thing once and for all. As what comes next, I don't know but I have a feeling, based on the tough case I've had so far, that I'll be dealing with Mr. Mel again. Thanks for the encouragement and sending it back in hopes your Dad kicks the bad-boy to the curb.
Gary
-
- December 2, 2016 at 3:11 pm
Gary,
I know what you mean, it's so crazy how this disease could go undected for so long because some have little to no symptoms that would indicate cancer.
when my dad was NED after the dissection he was having his yervoy closer to home w a general oncologist, after his sub qs popped up I asked what his LDH was and he has never had it taken! Well that changed the day I found out and he has it checked, normal range and continues to be- I'm thankful that there is something to monitor more frequently than scans. I'm just aggravated that we didn't have a baseline to what his LDH was before his in transit metastases happened.
Do you have a date for your surgery? I really hope all goes well and that afterwards you are NED and stay that way. I agree with what you said, bigger and better things are around the corner. I believe something curative or preventative could be possible because melanoma is immunogenic- it's just a matter of maximizing current treatment options until we get there.
Thanks again,
jules
-
- December 1, 2016 at 7:30 pm
Gary,
thank you so much for responding and all of your incredible insights into my dad's treatment course. What I'm hoping is exactly what you described, the radiation causing the tumors to die and give off extra antigens that trigger immune system and in turn giving the keytruda a chance to increase the lymphocytes- I watched a presentation and in it it showed one lymphocyte go after and kill a very large tumor cell, amazing what our own immune system can do with a little help, just wish the response rate to the I/OS were better.
Question for you, when you were responding to the ipi/nivo/radiation did you notice anything different w your CBCs? Specifically absolute lymphocyte count? I know at the moment my dad is in a good place w his LDH and single site of metastases but I know that can change in a minute, trying to have back up plans in my head in place for any senario. He didn't take it well when he failed on yervoy, so failing on keytruda and radiation will be a big blow.
Im so sorry after responding you have started to progress, I hope that the surgery will be a success. Have you ever considered or discussed TIL therapy for a next course? The fact that you responded to the I/o combo has got to be a good sign for future immune response? Thank you for the well wishes and I sincerely thank you for taking the time to share your story and insights with me.
-
- December 1, 2016 at 7:30 pm
Gary,
thank you so much for responding and all of your incredible insights into my dad's treatment course. What I'm hoping is exactly what you described, the radiation causing the tumors to die and give off extra antigens that trigger immune system and in turn giving the keytruda a chance to increase the lymphocytes- I watched a presentation and in it it showed one lymphocyte go after and kill a very large tumor cell, amazing what our own immune system can do with a little help, just wish the response rate to the I/OS were better.
Question for you, when you were responding to the ipi/nivo/radiation did you notice anything different w your CBCs? Specifically absolute lymphocyte count? I know at the moment my dad is in a good place w his LDH and single site of metastases but I know that can change in a minute, trying to have back up plans in my head in place for any senario. He didn't take it well when he failed on yervoy, so failing on keytruda and radiation will be a big blow.
Im so sorry after responding you have started to progress, I hope that the surgery will be a success. Have you ever considered or discussed TIL therapy for a next course? The fact that you responded to the I/o combo has got to be a good sign for future immune response? Thank you for the well wishes and I sincerely thank you for taking the time to share your story and insights with me.
-
- December 1, 2016 at 8:19 pm
Here is a post with many additional artcles linked within: http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/11/radiation-and-ipi-better-responses-than.html
There are many more reports blogged as well….just put 'radiation' in the search bubble at the top left of the blog if you are interested. Hope that helps. Celeste
-
- December 1, 2016 at 8:19 pm
Here is a post with many additional artcles linked within: http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/11/radiation-and-ipi-better-responses-than.html
There are many more reports blogged as well….just put 'radiation' in the search bubble at the top left of the blog if you are interested. Hope that helps. Celeste
-
- December 1, 2016 at 8:19 pm
Here is a post with many additional artcles linked within: http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/11/radiation-and-ipi-better-responses-than.html
There are many more reports blogged as well….just put 'radiation' in the search bubble at the top left of the blog if you are interested. Hope that helps. Celeste
-
- December 1, 2016 at 8:44 pm
For the most part…studies show that while BRAF positive status is required for BRAF inhibitors to work on patients….folks have a pretty equal response to immunotherapy no matter their BRAF status. For my part, I am BRAF positive, developed brain and lung mets in 2010…had brain met zapped with SRS and upper lobe of my lung removed. I was then treated with nivo (Opdivo) for 2 1/2 years and have been NED ever since.
That being said…there are some studies that show BRAF positive folks may even have an edge when being treated with immunotherapy (see the article within this post): http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/06/asco-2016-checkmate-067-ipinivo-combo.html
Here is a study noting that there was no difference in response to immunotherapy in regard to BRAF status: http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2015/07/nivoopdivo-effective-no-matter-braf.html
yours, c
-
- December 2, 2016 at 2:59 pm
C,
thank you so much for this info. I must be losing my mind because I could have sworn I read the opposite- BRAF patients having a lower ORR in the nivo ipi arm vs the wild type. I appreciate you sharing your blog with me, you are a wealth of knowledge and I will be following it moving forward. Thank you for sharing your story with me and I wish you NED status indefinitely!
Did you have any blood work come back suggesting a response while you were responding to Nivo? Absolute lymphocytes? I know not everyone who responds has the same side effects or elevated blood work, and some respond without them but I'll still be paying attention to my dad's just incase. I wish there was concrete biomarkers to look for!
Thanks again,
Jules
-
- December 2, 2016 at 2:59 pm
C,
thank you so much for this info. I must be losing my mind because I could have sworn I read the opposite- BRAF patients having a lower ORR in the nivo ipi arm vs the wild type. I appreciate you sharing your blog with me, you are a wealth of knowledge and I will be following it moving forward. Thank you for sharing your story with me and I wish you NED status indefinitely!
Did you have any blood work come back suggesting a response while you were responding to Nivo? Absolute lymphocytes? I know not everyone who responds has the same side effects or elevated blood work, and some respond without them but I'll still be paying attention to my dad's just incase. I wish there was concrete biomarkers to look for!
Thanks again,
Jules
-
- December 2, 2016 at 4:19 pm
The search for biomarkers is a hot item in melanoma research right now. They range from finding accurate blood draws that can id DNA of tumor cells, quantify presence of melanoma, determine BRAF type, response or progression to treatment, to simply understanding what already known lab values mean in regard to melanoma. LDH, neutrophils (esp the neutrophil to lymphocyte ratio), eosinophils, myeloid derived suppressor cells levels have all been found somewhat prognositic. But, it is all still a bit nebulus. It is also known that an outward sign, depigmentation of the skin (vitiligo), is prognostic of a good response to therapy. But….if you want to know about biomarkers there is this (with links to more links within!!!): http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/03/biomarkers-blood-components-circulating_26.html
On a personal note – this is a report on eosinophilia from ASCO 2015 and a graph of my labs while on nivo:
Hope that helps. I think one day we will be much further along with lab tests via a simple blood draw that accurately predict response and analyze presence of melanoma that can be used to benefit diagnosis, treatment choice, and progression for many melanoma patients. At least that is my hope. c
-
- December 2, 2016 at 4:19 pm
The search for biomarkers is a hot item in melanoma research right now. They range from finding accurate blood draws that can id DNA of tumor cells, quantify presence of melanoma, determine BRAF type, response or progression to treatment, to simply understanding what already known lab values mean in regard to melanoma. LDH, neutrophils (esp the neutrophil to lymphocyte ratio), eosinophils, myeloid derived suppressor cells levels have all been found somewhat prognositic. But, it is all still a bit nebulus. It is also known that an outward sign, depigmentation of the skin (vitiligo), is prognostic of a good response to therapy. But….if you want to know about biomarkers there is this (with links to more links within!!!): http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/03/biomarkers-blood-components-circulating_26.html
On a personal note – this is a report on eosinophilia from ASCO 2015 and a graph of my labs while on nivo:
Hope that helps. I think one day we will be much further along with lab tests via a simple blood draw that accurately predict response and analyze presence of melanoma that can be used to benefit diagnosis, treatment choice, and progression for many melanoma patients. At least that is my hope. c
-
- December 2, 2016 at 4:19 pm
The search for biomarkers is a hot item in melanoma research right now. They range from finding accurate blood draws that can id DNA of tumor cells, quantify presence of melanoma, determine BRAF type, response or progression to treatment, to simply understanding what already known lab values mean in regard to melanoma. LDH, neutrophils (esp the neutrophil to lymphocyte ratio), eosinophils, myeloid derived suppressor cells levels have all been found somewhat prognositic. But, it is all still a bit nebulus. It is also known that an outward sign, depigmentation of the skin (vitiligo), is prognostic of a good response to therapy. But….if you want to know about biomarkers there is this (with links to more links within!!!): http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/03/biomarkers-blood-components-circulating_26.html
On a personal note – this is a report on eosinophilia from ASCO 2015 and a graph of my labs while on nivo:
Hope that helps. I think one day we will be much further along with lab tests via a simple blood draw that accurately predict response and analyze presence of melanoma that can be used to benefit diagnosis, treatment choice, and progression for many melanoma patients. At least that is my hope. c
-
- December 2, 2016 at 2:59 pm
C,
thank you so much for this info. I must be losing my mind because I could have sworn I read the opposite- BRAF patients having a lower ORR in the nivo ipi arm vs the wild type. I appreciate you sharing your blog with me, you are a wealth of knowledge and I will be following it moving forward. Thank you for sharing your story with me and I wish you NED status indefinitely!
Did you have any blood work come back suggesting a response while you were responding to Nivo? Absolute lymphocytes? I know not everyone who responds has the same side effects or elevated blood work, and some respond without them but I'll still be paying attention to my dad's just incase. I wish there was concrete biomarkers to look for!
Thanks again,
Jules
-
- December 1, 2016 at 8:44 pm
For the most part…studies show that while BRAF positive status is required for BRAF inhibitors to work on patients….folks have a pretty equal response to immunotherapy no matter their BRAF status. For my part, I am BRAF positive, developed brain and lung mets in 2010…had brain met zapped with SRS and upper lobe of my lung removed. I was then treated with nivo (Opdivo) for 2 1/2 years and have been NED ever since.
That being said…there are some studies that show BRAF positive folks may even have an edge when being treated with immunotherapy (see the article within this post): http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/06/asco-2016-checkmate-067-ipinivo-combo.html
Here is a study noting that there was no difference in response to immunotherapy in regard to BRAF status: http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2015/07/nivoopdivo-effective-no-matter-braf.html
yours, c
-
- December 1, 2016 at 8:44 pm
For the most part…studies show that while BRAF positive status is required for BRAF inhibitors to work on patients….folks have a pretty equal response to immunotherapy no matter their BRAF status. For my part, I am BRAF positive, developed brain and lung mets in 2010…had brain met zapped with SRS and upper lobe of my lung removed. I was then treated with nivo (Opdivo) for 2 1/2 years and have been NED ever since.
That being said…there are some studies that show BRAF positive folks may even have an edge when being treated with immunotherapy (see the article within this post): http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/06/asco-2016-checkmate-067-ipinivo-combo.html
Here is a study noting that there was no difference in response to immunotherapy in regard to BRAF status: http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2015/07/nivoopdivo-effective-no-matter-braf.html
yours, c
-
Tagged: cutaneous melanoma
- You must be logged in to reply to this topic.