Tumor molecular test

At first it was thought that only those who tested positive for PDL and PD-L1 would respond to anti-PD-1 products. We have learned that is not actually true. Even those who have little to no PDL in their tumor can gain a response. Therefore, it is no longer required in order to start patients on immunotherapy. And from what I can tell, it is also not required for Keytruda specifically. Here is a link – PD-L1 testing for Keytruda

As far as BRAF goes – it makes no difference in being treated with immunotherapy, but in order for targeted therapy to work one must be BRAF positive. As you can see in the articles and reports in the adjuvant link I sent you, targeted therapy has been very helpful as adjuvant treatments, although I am not sure it is approved for use in those who are staged below Stage III. Here is a report I put together on “BRAF” you may find helpful – What does BRAF mean?

So, tumor testing is important. But more about what choices there are in the future should they be needed.

c

Late note – to be clear – my first paragraph above refers to melanoma patients. Keytruda use for other cancers may require testing as the Keytruda site notes. c

Could I ask what specific genetic test you had done? If it is something like foundation one then the information will make no difference in how treatment should be picked as the information is helpful in knowing if you have any other targetable mutations that might respond to other type of cancer approved treatments. For example the foundation one test might come back showing you have a mutation that those with lung cancer have and there are drugs approved in lung cancer that might work on your specific mutation. This would be an option if the standard of care drugs in melanoma didn’t work for you. Usually when starting treatment drug choice is stage related and in the case of stage 4 factors like tumor burden and location of tumors as well as your medical history are considered when picking best place to start. If you are in good health and have tumors in your lung and they are growing slowly then Pd-1 drugs like Pembrolizumab or Nivolumab might be the best starting place or the new combination of LAG-3 plus nivolumab called Opdualag might be a good starting point. If you have a heavy tumor burden with high Ldh values and the brain is involved then Ipi+nivo would be the place to start based on clinical trial results from checkmate 204. I guess the point I am trying to make is there are a lot of factors to take into consideration that your oncologist is trained in evaluating. What stage are you presently dealing with and what kind of treatment history have you had in melanoma. What specific location of tumors are you dealing with at the present moment?