› Forums › General Melanoma Community › Vemurafenib and MAC inhibitor as
- This topic has 24 replies, 6 voices, and was last updated 8 years, 10 months ago by
Rita and Charles.
- Post
-
- June 29, 2015 at 11:04 pm
Is this better than nivo or ipi ?
- Replies
-
-
- June 29, 2015 at 11:53 pm
Hi Rita, I think you mean Vemurafenib and Mek inhibitor(Dabrafenib). There will be good and bad points for picking either approach. It is nice to have options, is the way I would look at it. A Melanoma specialist would be the best place to get advice on which way to go. Wishing you the best!!! Ed
-
- June 29, 2015 at 11:53 pm
Hi Rita, I think you mean Vemurafenib and Mek inhibitor(Dabrafenib). There will be good and bad points for picking either approach. It is nice to have options, is the way I would look at it. A Melanoma specialist would be the best place to get advice on which way to go. Wishing you the best!!! Ed
-
- June 30, 2015 at 3:25 am
Thanks Ed……..we are struggling with what path to take. We met with our oncologist and his suggested course is surgical removal of the right mid lobe and all the lymph nodes. Following surgery start on the vemurafenib + MEK. Should the drug therapy not be the right fit, we would then move forward with immune therapy.
Charls has been fairly adamant in not going the surgical route, he has a couple of days to come to a final decision as we need to get going on some form of response. If the final decisoin by him is not to do surgery, he would start the medications alone. t's the proverbial fork in the road time…..
-
- July 1, 2015 at 4:25 pm
Rita,
I tend to agree with Charles. Why not see if the drug works on the lobe then decide what to do next if it does not work.
It is highly likely that Charles has other cancer cells in his body and you just cannot keep on cutting out the cancer with surgery. A drug would treat his entire body and hopefully kill any other cancer cells.
Which doctor did you choose as your primary oncologist? Is Charles Braf +? Has he had his brain MRI because the results of his brain MRI will also dictate your next step.
Good Luck
-
- July 1, 2015 at 4:25 pm
Rita,
I tend to agree with Charles. Why not see if the drug works on the lobe then decide what to do next if it does not work.
It is highly likely that Charles has other cancer cells in his body and you just cannot keep on cutting out the cancer with surgery. A drug would treat his entire body and hopefully kill any other cancer cells.
Which doctor did you choose as your primary oncologist? Is Charles Braf +? Has he had his brain MRI because the results of his brain MRI will also dictate your next step.
Good Luck
-
- July 1, 2015 at 4:25 pm
Rita,
I tend to agree with Charles. Why not see if the drug works on the lobe then decide what to do next if it does not work.
It is highly likely that Charles has other cancer cells in his body and you just cannot keep on cutting out the cancer with surgery. A drug would treat his entire body and hopefully kill any other cancer cells.
Which doctor did you choose as your primary oncologist? Is Charles Braf +? Has he had his brain MRI because the results of his brain MRI will also dictate your next step.
Good Luck
-
- July 2, 2015 at 3:38 am
We are with Scripps Green Hospital in La Jolla, Dr. Michael Kosty. The Sub Carinal lymph nodes are also affected "Lit up like Christmas Trees", so the surgeon says to take out the mid lobe and all the lymph nodes of the right lung and then start the drug treatment. Brain MRI is on 7/8…..thoughts??
-
- July 2, 2015 at 3:38 am
We are with Scripps Green Hospital in La Jolla, Dr. Michael Kosty. The Sub Carinal lymph nodes are also affected "Lit up like Christmas Trees", so the surgeon says to take out the mid lobe and all the lymph nodes of the right lung and then start the drug treatment. Brain MRI is on 7/8…..thoughts??
-
- July 2, 2015 at 3:38 am
We are with Scripps Green Hospital in La Jolla, Dr. Michael Kosty. The Sub Carinal lymph nodes are also affected "Lit up like Christmas Trees", so the surgeon says to take out the mid lobe and all the lymph nodes of the right lung and then start the drug treatment. Brain MRI is on 7/8…..thoughts??
-
- July 5, 2015 at 9:37 pm
I would vote for immunotherapy as a first line of treatment over surgery as others have noted, once it is in your lungs, it is likely systemic. I had a lobe of my lung removed and more mets showed up in my lungs later (though I did not take drugs because I was misdiagnosed at the time). Systemic treatment would treat the cancer wherever it is (if it works for you). If it doesn't work and the lung met continues growing, you can take BRAF inhibitors to shrink it enough for surgery at that time (if they will allow you to follow that sequence).
Good luck
-
- July 5, 2015 at 9:37 pm
I would vote for immunotherapy as a first line of treatment over surgery as others have noted, once it is in your lungs, it is likely systemic. I had a lobe of my lung removed and more mets showed up in my lungs later (though I did not take drugs because I was misdiagnosed at the time). Systemic treatment would treat the cancer wherever it is (if it works for you). If it doesn't work and the lung met continues growing, you can take BRAF inhibitors to shrink it enough for surgery at that time (if they will allow you to follow that sequence).
Good luck
-
- July 5, 2015 at 9:37 pm
I would vote for immunotherapy as a first line of treatment over surgery as others have noted, once it is in your lungs, it is likely systemic. I had a lobe of my lung removed and more mets showed up in my lungs later (though I did not take drugs because I was misdiagnosed at the time). Systemic treatment would treat the cancer wherever it is (if it works for you). If it doesn't work and the lung met continues growing, you can take BRAF inhibitors to shrink it enough for surgery at that time (if they will allow you to follow that sequence).
Good luck
-
- June 30, 2015 at 3:25 am
Thanks Ed……..we are struggling with what path to take. We met with our oncologist and his suggested course is surgical removal of the right mid lobe and all the lymph nodes. Following surgery start on the vemurafenib + MEK. Should the drug therapy not be the right fit, we would then move forward with immune therapy.
Charls has been fairly adamant in not going the surgical route, he has a couple of days to come to a final decision as we need to get going on some form of response. If the final decisoin by him is not to do surgery, he would start the medications alone. t's the proverbial fork in the road time…..
-
- June 30, 2015 at 3:25 am
Thanks Ed……..we are struggling with what path to take. We met with our oncologist and his suggested course is surgical removal of the right mid lobe and all the lymph nodes. Following surgery start on the vemurafenib + MEK. Should the drug therapy not be the right fit, we would then move forward with immune therapy.
Charls has been fairly adamant in not going the surgical route, he has a couple of days to come to a final decision as we need to get going on some form of response. If the final decisoin by him is not to do surgery, he would start the medications alone. t's the proverbial fork in the road time…..
-
- June 30, 2015 at 12:10 pm
Just to be clear, dabrafenib is not a MEK inhibitor. Vemurafenib aka Zelboraf is by Genentech and is usually paired with MEK inhibitor Cobimetinib by Roche. Dabrafenib aka Tafinlar is by GSK and usually paired with MEK inhibitor Trametinib also by GSK.
-
- July 6, 2015 at 11:27 pm
Thanks Peter, it is Vemurafenib + MEK that our oncologist is suggesting we do first. Its a big "what comes first game" :shrink the tumor so less burden for immune therapy? Or hit with immune therapy and then shrink anything that might still be there? This is a huge melanoma chessboard that we don't know what move to make…….bit by bit.
-
- July 6, 2015 at 11:27 pm
Thanks Peter, it is Vemurafenib + MEK that our oncologist is suggesting we do first. Its a big "what comes first game" :shrink the tumor so less burden for immune therapy? Or hit with immune therapy and then shrink anything that might still be there? This is a huge melanoma chessboard that we don't know what move to make…….bit by bit.
-
- July 6, 2015 at 11:27 pm
Thanks Peter, it is Vemurafenib + MEK that our oncologist is suggesting we do first. Its a big "what comes first game" :shrink the tumor so less burden for immune therapy? Or hit with immune therapy and then shrink anything that might still be there? This is a huge melanoma chessboard that we don't know what move to make…….bit by bit.
-
- June 30, 2015 at 12:10 pm
Just to be clear, dabrafenib is not a MEK inhibitor. Vemurafenib aka Zelboraf is by Genentech and is usually paired with MEK inhibitor Cobimetinib by Roche. Dabrafenib aka Tafinlar is by GSK and usually paired with MEK inhibitor Trametinib also by GSK.
-
- June 30, 2015 at 12:10 pm
Just to be clear, dabrafenib is not a MEK inhibitor. Vemurafenib aka Zelboraf is by Genentech and is usually paired with MEK inhibitor Cobimetinib by Roche. Dabrafenib aka Tafinlar is by GSK and usually paired with MEK inhibitor Trametinib also by GSK.
-
- June 29, 2015 at 11:53 pm
Hi Rita, I think you mean Vemurafenib and Mek inhibitor(Dabrafenib). There will be good and bad points for picking either approach. It is nice to have options, is the way I would look at it. A Melanoma specialist would be the best place to get advice on which way to go. Wishing you the best!!! Ed
-
- June 30, 2015 at 4:55 pm
Rita and Charles,
This combination will only work for a period of time. In the vast majority of people their tumors will shrink and then at some point the therapy will no longer work and you need to find and start another treatment option.
This combo was an option for my Mom. (BRAF in Dec of 2013 and MEK and BRAF inhibitors in Jan of 2014.) However, we decided against BRAF and then BRAF and MEK because we knew Keytruda would soon be approved and that alone or combined it only worked for a short period of time. We also knew it would likely be just approved after Yervoy failure, which could mean that it worked, but side effects would not allow the continued use of Yervoy. In addition, when my Mom started treatment the evidence that ipi/Yervoy with SRS for patients with brain mets showed very good results for responders.
It is always good to know what is out there, but you need to get the whole picture and options in place before you decide what to do. Please get a second and third opinion, it will help you in understanding pros and cons, other options and more importantly doctors should check for "misdiagnosis", but they need to look at all CDs of CT, PET and MRIs. If someone does not review images they would not be an oncologist I would choose.
Also, the brain MRI needs to be done and you need to know what the long term results for patients with each option is.. i.e. BRAF and MEK, Surgery with BRAF and MEK, Yervoy alone, Yervoy and SRS, Surgery with BRAF and MEK, Surgery with Yervoy and SRS and any other options available… (Surgery for lung, surgery for lung and lymph node removal too.) – When discussing surgery you also need to know the what the effects of removing lymph nodes can be. One friend had this done and she has had a number of problems and wish she had never done it because of the long term problems.
Your husband may decided to go with surgery if there is clear evidence that he could have much better results and the down time was limited. So, I recommend that you write down all the options you know and start asking more questions about pros and cons of each options the results of each procedure or treatment, how close any new options are close to being approved. (I would not wait to start treatment, but the doctor could tell you what is on the horizon to help you understand what is anticipated in the short term for approval.) One page for each option would be good with: Treatment, Results, Why this is recommended over X….
Also, check out http://www.ncbi.nlm.nih.gov/pmc/ to research options and results.
Best of Luck!
-
- June 30, 2015 at 4:55 pm
Rita and Charles,
This combination will only work for a period of time. In the vast majority of people their tumors will shrink and then at some point the therapy will no longer work and you need to find and start another treatment option.
This combo was an option for my Mom. (BRAF in Dec of 2013 and MEK and BRAF inhibitors in Jan of 2014.) However, we decided against BRAF and then BRAF and MEK because we knew Keytruda would soon be approved and that alone or combined it only worked for a short period of time. We also knew it would likely be just approved after Yervoy failure, which could mean that it worked, but side effects would not allow the continued use of Yervoy. In addition, when my Mom started treatment the evidence that ipi/Yervoy with SRS for patients with brain mets showed very good results for responders.
It is always good to know what is out there, but you need to get the whole picture and options in place before you decide what to do. Please get a second and third opinion, it will help you in understanding pros and cons, other options and more importantly doctors should check for "misdiagnosis", but they need to look at all CDs of CT, PET and MRIs. If someone does not review images they would not be an oncologist I would choose.
Also, the brain MRI needs to be done and you need to know what the long term results for patients with each option is.. i.e. BRAF and MEK, Surgery with BRAF and MEK, Yervoy alone, Yervoy and SRS, Surgery with BRAF and MEK, Surgery with Yervoy and SRS and any other options available… (Surgery for lung, surgery for lung and lymph node removal too.) – When discussing surgery you also need to know the what the effects of removing lymph nodes can be. One friend had this done and she has had a number of problems and wish she had never done it because of the long term problems.
Your husband may decided to go with surgery if there is clear evidence that he could have much better results and the down time was limited. So, I recommend that you write down all the options you know and start asking more questions about pros and cons of each options the results of each procedure or treatment, how close any new options are close to being approved. (I would not wait to start treatment, but the doctor could tell you what is on the horizon to help you understand what is anticipated in the short term for approval.) One page for each option would be good with: Treatment, Results, Why this is recommended over X….
Also, check out http://www.ncbi.nlm.nih.gov/pmc/ to research options and results.
Best of Luck!
-
- June 30, 2015 at 4:55 pm
Rita and Charles,
This combination will only work for a period of time. In the vast majority of people their tumors will shrink and then at some point the therapy will no longer work and you need to find and start another treatment option.
This combo was an option for my Mom. (BRAF in Dec of 2013 and MEK and BRAF inhibitors in Jan of 2014.) However, we decided against BRAF and then BRAF and MEK because we knew Keytruda would soon be approved and that alone or combined it only worked for a short period of time. We also knew it would likely be just approved after Yervoy failure, which could mean that it worked, but side effects would not allow the continued use of Yervoy. In addition, when my Mom started treatment the evidence that ipi/Yervoy with SRS for patients with brain mets showed very good results for responders.
It is always good to know what is out there, but you need to get the whole picture and options in place before you decide what to do. Please get a second and third opinion, it will help you in understanding pros and cons, other options and more importantly doctors should check for "misdiagnosis", but they need to look at all CDs of CT, PET and MRIs. If someone does not review images they would not be an oncologist I would choose.
Also, the brain MRI needs to be done and you need to know what the long term results for patients with each option is.. i.e. BRAF and MEK, Surgery with BRAF and MEK, Yervoy alone, Yervoy and SRS, Surgery with BRAF and MEK, Surgery with Yervoy and SRS and any other options available… (Surgery for lung, surgery for lung and lymph node removal too.) – When discussing surgery you also need to know the what the effects of removing lymph nodes can be. One friend had this done and she has had a number of problems and wish she had never done it because of the long term problems.
Your husband may decided to go with surgery if there is clear evidence that he could have much better results and the down time was limited. So, I recommend that you write down all the options you know and start asking more questions about pros and cons of each options the results of each procedure or treatment, how close any new options are close to being approved. (I would not wait to start treatment, but the doctor could tell you what is on the horizon to help you understand what is anticipated in the short term for approval.) One page for each option would be good with: Treatment, Results, Why this is recommended over X….
Also, check out http://www.ncbi.nlm.nih.gov/pmc/ to research options and results.
Best of Luck!
-
- You must be logged in to reply to this topic.