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triplet question

Forums General Melanoma Community triplet question

  • Post
    gopher38
    Participant
    Hello,

    Quick question for people doing the triplet therapy (BRAF/MEK inhibitor; PD-L1).  Did you have progression beforehand with PD immunotherapy, or did you go directly to the triplet?  I was under the impression that everyone (or pretty much everyone) did the single agent first, and then eventually (probably after ipi/nivo) moved on to the triplet if they were BRAF positive. I’m asking because my next treatment plan was supposed to be zelboraf/cotellic, followed eventually with tecentriq, but I just got a letter from my insurance company saying that they had denied tecentriq because I progressed on a similar medication (opdivo).  Like I said, I thought (perhaps incorrectly) that that was pretty much the case with everyone doing the triplet, and that the hope was that the combo of the three would have better results than opdivo alone.

    Thanks for your feedback.

    PS: That zelboraf/cotellic combo really kicked my rear.  Was pretty uneventful for the first 8 or 9 days, and then – bam – in the hospital for 5 days, with high fever, rash on every bit of skin from ankles to shoulders, pretty much every secondary effect listed in their brochure.  Doc dialed back both of them a bit and added prednisone, which I’m almost off now.  Still lots of secondary effects, but more manageable.  Was really hoping to get on the tecentriq to see what that would do after the targeted, but now that sounds in jeopardy. :(

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      TimCT
      Participant
      I started on ipi/nivo out of the gate, and after an initial response I started progressing again, so we started the triplet. I did nivo plus braftovi and mektovi. I’m not sure of what the dance was that my doctor had to do with my insurance company, but they’ve covered it all along.

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      hxcadam
      Participant
      Right out of the gate was given single agent Nivo with radiation.  Showed shrinkage in original tumors but others popped up elsewhere so was given the triplet.  Saw shrinkage everywhere for the first 8-10 months and no new sites.  Last scan in April just showed potential new sites in my right lung but everywhere else was still stable.  My insurance has covered it.  You need to have the doctor fight for you and appeal with cause for the appeal and they should cover it.

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      gopher38
      Participant
      I frickin hate my insurance.  My HR person always tells me, “oh, we have a great insurance plan”. Maybe so in theory, but I had my first PET scan rejected for no apparent reason, and it took me literally months to get it reversed.  Then genetic testing was rejected, and it took me months to get it reversed. Now this. This better not take months.

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      ed williams
      Participant
      Dr. Omid Hamid for the first 10min of the following 2021 presentation talks about triplets and what is going on in that space of research. https://www.youtube.com/watch?v=9WTLFznKRmQ

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        gopher38
        Participant
        Thanks.  That whole presentation is interesting.  I don’t get all the details, but it’s clear that there’s a lot of things being worked on, many of which are – if not always around the corner (although it sounds like some are pretty close) – also not decades down the road.

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