› Forums › General Melanoma Community › Washout period?
- This topic has 15 replies, 5 voices, and was last updated 9 years, 9 months ago by
Polymath.
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- July 24, 2014 at 7:52 pm
After going Stage 4, I went on Zel (Dabrafenib) being BRAF positive. Horrendedous side effects, but very effective in dissolving tumors. But after only 3 months I progressed. I took a 2-week break off all meds and immediaily began to recover from the Zel side-effects. Then started the TAF/MEK combo, which has had virtually no side-effects but has been much less effective. Stable for a couple of months, but by 3rd month progressing again. So I am again going to do a washout, this time for 3-weeks or more before beginning Yervoy. My question is have others had what they feel as better experirinces and results with the cleansing period between drug therapies, or do I run a serious a serious risk of rapid tumor grouth with no inhibitors at work?
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- July 24, 2014 at 10:44 pm
Polymath
That is very interesting.
I'm switching from Taf/Mek combo (after 7 months) to Yervoy aswell.
When I saw my melanoma guy he said stop the oral combo tonight…and the goal is to get you on Yervoy asap.
It is in with insurance and scheduling. But i have been stopped off combo for 9 days now.
Matt
PS. I think my doctor felt the risk of rapid growth….in the room he told my wife and I….I want this Yervoy in you fast.
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- July 24, 2014 at 10:44 pm
Polymath
That is very interesting.
I'm switching from Taf/Mek combo (after 7 months) to Yervoy aswell.
When I saw my melanoma guy he said stop the oral combo tonight…and the goal is to get you on Yervoy asap.
It is in with insurance and scheduling. But i have been stopped off combo for 9 days now.
Matt
PS. I think my doctor felt the risk of rapid growth….in the room he told my wife and I….I want this Yervoy in you fast.
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- July 24, 2014 at 10:44 pm
Polymath
That is very interesting.
I'm switching from Taf/Mek combo (after 7 months) to Yervoy aswell.
When I saw my melanoma guy he said stop the oral combo tonight…and the goal is to get you on Yervoy asap.
It is in with insurance and scheduling. But i have been stopped off combo for 9 days now.
Matt
PS. I think my doctor felt the risk of rapid growth….in the room he told my wife and I….I want this Yervoy in you fast.
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- July 25, 2014 at 8:03 am
I'm wondering why you need the washout as well? Yervoy is already approved and is not a clinical trial (I understand where many studies require washouts and their rules are more stringent).
To answer your question, I am on a current clinical trial right now (Anti-PD1) and I did went through a washout period coming off BRAF drugs. I was on Zelboraf for 13 months, which work great, and then switched to Taf/MEK combo when my tumors started progressing again. The Taf/MEK didn't work at all and then I was fortunate to get into the trial. I had the same questions as you: will my tumors grow fast and will my health decline sharply, or will I actually feel better while being off medication? In my case the tumors got really aggressive. I noticed many new or larger sub cutaneous tumors so I knew the melanoma was growing fast. During the washout, and just before the trial, my scans showed a lot of tumors and a heavy burden. I think that month was the first time when I became weak from the cancer itself – and I've been stage 4 now for a good few years.
Fortunately your doctor is saying 3 weeks for your washout, and I'm not sure how your strength is now, but you will be starting on the Yervoy before you know it.
Best of luck,
Shane
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- July 25, 2014 at 8:03 am
I'm wondering why you need the washout as well? Yervoy is already approved and is not a clinical trial (I understand where many studies require washouts and their rules are more stringent).
To answer your question, I am on a current clinical trial right now (Anti-PD1) and I did went through a washout period coming off BRAF drugs. I was on Zelboraf for 13 months, which work great, and then switched to Taf/MEK combo when my tumors started progressing again. The Taf/MEK didn't work at all and then I was fortunate to get into the trial. I had the same questions as you: will my tumors grow fast and will my health decline sharply, or will I actually feel better while being off medication? In my case the tumors got really aggressive. I noticed many new or larger sub cutaneous tumors so I knew the melanoma was growing fast. During the washout, and just before the trial, my scans showed a lot of tumors and a heavy burden. I think that month was the first time when I became weak from the cancer itself – and I've been stage 4 now for a good few years.
Fortunately your doctor is saying 3 weeks for your washout, and I'm not sure how your strength is now, but you will be starting on the Yervoy before you know it.
Best of luck,
Shane
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- July 25, 2014 at 8:03 am
I'm wondering why you need the washout as well? Yervoy is already approved and is not a clinical trial (I understand where many studies require washouts and their rules are more stringent).
To answer your question, I am on a current clinical trial right now (Anti-PD1) and I did went through a washout period coming off BRAF drugs. I was on Zelboraf for 13 months, which work great, and then switched to Taf/MEK combo when my tumors started progressing again. The Taf/MEK didn't work at all and then I was fortunate to get into the trial. I had the same questions as you: will my tumors grow fast and will my health decline sharply, or will I actually feel better while being off medication? In my case the tumors got really aggressive. I noticed many new or larger sub cutaneous tumors so I knew the melanoma was growing fast. During the washout, and just before the trial, my scans showed a lot of tumors and a heavy burden. I think that month was the first time when I became weak from the cancer itself – and I've been stage 4 now for a good few years.
Fortunately your doctor is saying 3 weeks for your washout, and I'm not sure how your strength is now, but you will be starting on the Yervoy before you know it.
Best of luck,
Shane
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- July 25, 2014 at 11:23 am
There definitely seems to be some confusion around the need for any sort of washout period between various treatment regiments, especially the immunotherapies and targeted therapies, and unfortunately, the confusion extends to some medical professionals, I've heard about the need for some period between terminating one treatment and beginning another. The origin may be in the rules of specific clinical trials so as not to influence results and perhaps some doctors and patients have interpreted that need for a "washout" as some potential for a negative drug interaction if both are present in the system. I have never seen anything official stating such, but it's easy to see how someone could arrive at such a conclusion, and it would also explain the lack of a standard washout period. I think there are studies that have examined the increased toxicity of simultaneous treatment with, for example, ipilimumab and vemurafenib, and that, too, may contribute to some thinking that there must be a gap between discontinuing one and beginning another.
Unfortunately, it doesn't sound like there is a hard-and-fast guideline for even the need for a washout, let alone the length for such a washout period. Very frustrating, I'm sure.
Joe
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- July 25, 2014 at 11:23 am
There definitely seems to be some confusion around the need for any sort of washout period between various treatment regiments, especially the immunotherapies and targeted therapies, and unfortunately, the confusion extends to some medical professionals, I've heard about the need for some period between terminating one treatment and beginning another. The origin may be in the rules of specific clinical trials so as not to influence results and perhaps some doctors and patients have interpreted that need for a "washout" as some potential for a negative drug interaction if both are present in the system. I have never seen anything official stating such, but it's easy to see how someone could arrive at such a conclusion, and it would also explain the lack of a standard washout period. I think there are studies that have examined the increased toxicity of simultaneous treatment with, for example, ipilimumab and vemurafenib, and that, too, may contribute to some thinking that there must be a gap between discontinuing one and beginning another.
Unfortunately, it doesn't sound like there is a hard-and-fast guideline for even the need for a washout, let alone the length for such a washout period. Very frustrating, I'm sure.
Joe
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- July 25, 2014 at 11:23 am
There definitely seems to be some confusion around the need for any sort of washout period between various treatment regiments, especially the immunotherapies and targeted therapies, and unfortunately, the confusion extends to some medical professionals, I've heard about the need for some period between terminating one treatment and beginning another. The origin may be in the rules of specific clinical trials so as not to influence results and perhaps some doctors and patients have interpreted that need for a "washout" as some potential for a negative drug interaction if both are present in the system. I have never seen anything official stating such, but it's easy to see how someone could arrive at such a conclusion, and it would also explain the lack of a standard washout period. I think there are studies that have examined the increased toxicity of simultaneous treatment with, for example, ipilimumab and vemurafenib, and that, too, may contribute to some thinking that there must be a gap between discontinuing one and beginning another.
Unfortunately, it doesn't sound like there is a hard-and-fast guideline for even the need for a washout, let alone the length for such a washout period. Very frustrating, I'm sure.
Joe
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- July 25, 2014 at 7:23 pm
Thanks so much to those of you who chimed in on this topic. For the record, the reason for this longer washout period does have to do with scheduling, rather than any recommendation from my Dr. Coming off the Zel, which had devastating side-effects was such a relief, and now, that TAF/MEK which had minimal effectiveness has also run its course, this decision had more to do with me, and a little common sense voice that says given the toxic nature of these chemo drugs, allowing the body the clean up, before the next regime just feels like it makes sense. According to most of the comments, I am starting to doubt my own logic, and perhaps I do run the risk of accelerated tumor growth during this time. But as noted, because of scheduling issues, I don't think I have a choice. I am looking forward to cleaning up, and feeling normal before embarking into another unknown when I start on Yervoy. Thanks again for sharing, this forum is amazing.
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- July 25, 2014 at 7:23 pm
Thanks so much to those of you who chimed in on this topic. For the record, the reason for this longer washout period does have to do with scheduling, rather than any recommendation from my Dr. Coming off the Zel, which had devastating side-effects was such a relief, and now, that TAF/MEK which had minimal effectiveness has also run its course, this decision had more to do with me, and a little common sense voice that says given the toxic nature of these chemo drugs, allowing the body the clean up, before the next regime just feels like it makes sense. According to most of the comments, I am starting to doubt my own logic, and perhaps I do run the risk of accelerated tumor growth during this time. But as noted, because of scheduling issues, I don't think I have a choice. I am looking forward to cleaning up, and feeling normal before embarking into another unknown when I start on Yervoy. Thanks again for sharing, this forum is amazing.
-
- July 25, 2014 at 7:23 pm
Thanks so much to those of you who chimed in on this topic. For the record, the reason for this longer washout period does have to do with scheduling, rather than any recommendation from my Dr. Coming off the Zel, which had devastating side-effects was such a relief, and now, that TAF/MEK which had minimal effectiveness has also run its course, this decision had more to do with me, and a little common sense voice that says given the toxic nature of these chemo drugs, allowing the body the clean up, before the next regime just feels like it makes sense. According to most of the comments, I am starting to doubt my own logic, and perhaps I do run the risk of accelerated tumor growth during this time. But as noted, because of scheduling issues, I don't think I have a choice. I am looking forward to cleaning up, and feeling normal before embarking into another unknown when I start on Yervoy. Thanks again for sharing, this forum is amazing.
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