I'm sure Deb will answer you but here are some basics that might help regarding melanoma treatments:

BRAF inhibitors (targeted therapy): work very well for folks with melanoma that test positive the the BRAF mutation. If you don't have it, they don't work. For BRAF positive patients, they can expect a 60-70 % response rate. BRAF inhibitors should always be combined with a MEK inhibitor. Obviously with the mutation the response rate is very impressive. However, for many the response lasts only 6-9 months, as tumors develop the ability to work around the treatment. On the other hand, there are those who have been maintained on these drugs for years. They are also valuable in decreasing tumor burden rapidly, and then quickly switching the patient to immunotherapy which can be slow in taking effect, but provides a more durable response.

Immunotherapy: trigger the body's immune system to deal with melanoma. Therefore, side effects can be caused by an over active immune process. BRAF status is not thought to be a factor in response from most studies.

Types of immunotherapy:

IL2 – requires hospitalization, can be very toxic, has a complete response rate of about 5%. An older approach.

Interferon – another older treatment, with minimal significant effect on progression free survivial, and NO effect on overall survival.

Ipi (Yervoy)  – 15% response rate, but responses are proving durable. Immune related side effects can be significant.

Anti-PD1 –  there are two basically equivalent products: nivolumab (opdivo) and pembrolizumab (keytruda). Both have about a 40% response rate…and ratties are proving responses durable here as well, with fewer immune related side effects compared to ipi.

Ipi/nivo combo: provides the best response rate going with rates of 50% or more. Side effect profile much like ipi…due to ipi.

Hope this helps. There is a great deal of information on all of these on my blog. Celeste

Hi Jenine, 

Looking at your husband's treatments in the profile you created it appears that he has had only interferon and surgery. Also it would seem that he is now Stage IV, if I am understanding things properly. So….I think a very reasonable treatment at this time would be either one of the anti-PD1 products on their own…which are FDA approved for Stage IV patients, or the ipi/nivo combo. I, personally, would probably not choose to do ipi alone at this point as it has a lower response rate and more immune related side effects than anti-PD1. Additionally, studies have shown that when patients have ipi BEFORE anti-PD1, their response rates are decreased.

Here is one report demonstrating that (see #3 in this post…as well as the link with in that part):  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/05/asco-2016-three-anti-pd1-reports.html

I also saw that you are followed by Kirkwood. I think you shouod be aware that he is the King of interferon. Before 2010 when no other treatments for melanoma even existed other than IL2, that was acceptable. However, since the FDA approval of ipi and the BRAFi drugs in 2011, and later the anti-PD1 products, he has still really been pushing interferon…though as I noted above – it provides very little benefit in preventing melanoma progression and NONE whatsoever in helping survival. There are some studies in process combining interferon with other products, however, so far they have not demonstrated benefit greater than the product they have been paired with….but perhaps time will show a different tale.

Hope your appointment went well and your husband gains a viable treatmnent plan soon. I wish you well. Celeste

Hi Jenine, 

Looking at your husband's treatments in the profile you created it appears that he has had only interferon and surgery. Also it would seem that he is now Stage IV, if I am understanding things properly. So….I think a very reasonable treatment at this time would be either one of the anti-PD1 products on their own…which are FDA approved for Stage IV patients, or the ipi/nivo combo. I, personally, would probably not choose to do ipi alone at this point as it has a lower response rate and more immune related side effects than anti-PD1. Additionally, studies have shown that when patients have ipi BEFORE anti-PD1, their response rates are decreased.

Here is one report demonstrating that (see #3 in this post…as well as the link with in that part):  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/05/asco-2016-three-anti-pd1-reports.html

I also saw that you are followed by Kirkwood. I think you shouod be aware that he is the King of interferon. Before 2010 when no other treatments for melanoma even existed other than IL2, that was acceptable. However, since the FDA approval of ipi and the BRAFi drugs in 2011, and later the anti-PD1 products, he has still really been pushing interferon…though as I noted above – it provides very little benefit in preventing melanoma progression and NONE whatsoever in helping survival. There are some studies in process combining interferon with other products, however, so far they have not demonstrated benefit greater than the product they have been paired with….but perhaps time will show a different tale.

Hope your appointment went well and your husband gains a viable treatmnent plan soon. I wish you well. Celeste

Hi Jenine, 

Looking at your husband's treatments in the profile you created it appears that he has had only interferon and surgery. Also it would seem that he is now Stage IV, if I am understanding things properly. So….I think a very reasonable treatment at this time would be either one of the anti-PD1 products on their own…which are FDA approved for Stage IV patients, or the ipi/nivo combo. I, personally, would probably not choose to do ipi alone at this point as it has a lower response rate and more immune related side effects than anti-PD1. Additionally, studies have shown that when patients have ipi BEFORE anti-PD1, their response rates are decreased.

Here is one report demonstrating that (see #3 in this post…as well as the link with in that part):  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/05/asco-2016-three-anti-pd1-reports.html

I also saw that you are followed by Kirkwood. I think you shouod be aware that he is the King of interferon. Before 2010 when no other treatments for melanoma even existed other than IL2, that was acceptable. However, since the FDA approval of ipi and the BRAFi drugs in 2011, and later the anti-PD1 products, he has still really been pushing interferon…though as I noted above – it provides very little benefit in preventing melanoma progression and NONE whatsoever in helping survival. There are some studies in process combining interferon with other products, however, so far they have not demonstrated benefit greater than the product they have been paired with….but perhaps time will show a different tale.

Hope your appointment went well and your husband gains a viable treatmnent plan soon. I wish you well. Celeste

I'm sure Deb will answer you but here are some basics that might help regarding melanoma treatments:

BRAF inhibitors (targeted therapy): work very well for folks with melanoma that test positive the the BRAF mutation. If you don't have it, they don't work. For BRAF positive patients, they can expect a 60-70 % response rate. BRAF inhibitors should always be combined with a MEK inhibitor. Obviously with the mutation the response rate is very impressive. However, for many the response lasts only 6-9 months, as tumors develop the ability to work around the treatment. On the other hand, there are those who have been maintained on these drugs for years. They are also valuable in decreasing tumor burden rapidly, and then quickly switching the patient to immunotherapy which can be slow in taking effect, but provides a more durable response.

Immunotherapy: trigger the body's immune system to deal with melanoma. Therefore, side effects can be caused by an over active immune process. BRAF status is not thought to be a factor in response from most studies.

Types of immunotherapy:

IL2 – requires hospitalization, can be very toxic, has a complete response rate of about 5%. An older approach.

Interferon – another older treatment, with minimal significant effect on progression free survivial, and NO effect on overall survival.

Ipi (Yervoy)  – 15% response rate, but responses are proving durable. Immune related side effects can be significant.

Anti-PD1 –  there are two basically equivalent products: nivolumab (opdivo) and pembrolizumab (keytruda). Both have about a 40% response rate…and ratties are proving responses durable here as well, with fewer immune related side effects compared to ipi.

Ipi/nivo combo: provides the best response rate going with rates of 50% or more. Side effect profile much like ipi…due to ipi.

Hope this helps. There is a great deal of information on all of these on my blog. Celeste

I'm sure Deb will answer you but here are some basics that might help regarding melanoma treatments:

BRAF inhibitors (targeted therapy): work very well for folks with melanoma that test positive the the BRAF mutation. If you don't have it, they don't work. For BRAF positive patients, they can expect a 60-70 % response rate. BRAF inhibitors should always be combined with a MEK inhibitor. Obviously with the mutation the response rate is very impressive. However, for many the response lasts only 6-9 months, as tumors develop the ability to work around the treatment. On the other hand, there are those who have been maintained on these drugs for years. They are also valuable in decreasing tumor burden rapidly, and then quickly switching the patient to immunotherapy which can be slow in taking effect, but provides a more durable response.

Immunotherapy: trigger the body's immune system to deal with melanoma. Therefore, side effects can be caused by an over active immune process. BRAF status is not thought to be a factor in response from most studies.

Types of immunotherapy:

IL2 – requires hospitalization, can be very toxic, has a complete response rate of about 5%. An older approach.

Interferon – another older treatment, with minimal significant effect on progression free survivial, and NO effect on overall survival.

Ipi (Yervoy)  – 15% response rate, but responses are proving durable. Immune related side effects can be significant.

Anti-PD1 –  there are two basically equivalent products: nivolumab (opdivo) and pembrolizumab (keytruda). Both have about a 40% response rate…and ratties are proving responses durable here as well, with fewer immune related side effects compared to ipi.

Ipi/nivo combo: provides the best response rate going with rates of 50% or more. Side effect profile much like ipi…due to ipi.

Hope this helps. There is a great deal of information on all of these on my blog. Celeste