- September 18, 2022 at 4:16 pm
I am waiting for results from my tumor molecule test before I start Keytruda. My oncologist doesn’t think that the mutations results would indicate whether or not the treatment will work. I thought knowing If I was PDL positive or not we’re important. What about BRAF?
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
- September 19, 2022 at 7:07 am
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.
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?
- September 21, 2022 at 8:44 am
Thanks for the info, Ed. I was diagnosed with stage 2C. It was from a bump on my back that developed and GREW during my pregnancy. I had it checked twice by the derm…. but removed shortly after baby arrived. No lymph node spread yet, but from what I am learning, you never know.
- September 22, 2022 at 1:45 pm
I’ve decided to start pebrolizumab soon as adjuvant treatment. I am just trying to gather as much info as I can.
Regarding specific testing, I had the CASTLE test done, not the absolute worst result but not great one (2A). My onc is doing molecular testing to determine what mutations it has and for PDL. There’s no name to the test that I am aware.
Anyway, thank you for your response.
Standard of care would be to do BRAF testing to see if your tumor is BRAF+ (positive) as that can give you option if down the road the melanoma was to show up again. Pd-L1 test is a staining test of the tumor tissue looking to see % of Pd-L1 in the tumor tissue. It is not really used to guide treatment in melanoma but some hospitals still do the testing as higher levels of Pd-L1 has a slight association with improved outcome if over a specific % in the staining of the tissue. They call this type of testing immunohistochemistry and is done with a lot of the clinical trials as they are always looking to see if there is a biomarker to help predict outcomes. So far no biomarker has been able to guide who should get which specific drug in melanoma other than BRAF+ requirement to get targeted therapy drugs to block BRAF+ mutation. The Castle test is interesting as it is used for early testing by some doctors but they have yet to prove via clinical trial that there is any predictive value as it really doesn’t matter what the result of the Castle test is as it doesn’t tell the medical team what treatment to use. It could be use for early patient to do closer follow up but that usually depends on insurance company policy. Castle has been trying for the last decade to gain traction but still is not standard of care or part of melanoma guidelines as standard follow up test. Here are two links on the trial, keynote 716 that led to Pembrolizumab approval for stage 2B,2C melanoma. https://www.onclive.com/view/dr-long-on-evaluating-adjuvant-pembrolizumab-vs-placebo-in-melanoma https://www.onclive.com/view/adjuvant-pembrolizumab-results-in-significant-dmfs-improvement-over-placebo-in-stage-ii-melanoma
- September 22, 2022 at 4:16 pm
- You must be logged in to reply to this topic.