nikolaos

Hello David. Ipilimumab does not attack tumors itself. It stimulates immune system so that it recognize melanoma and produces lymphocytes that attack tumors. Those lymphocytes can hopefully cross the brain barrier and do the job. At early trials there have been no study references to agree with that statement- however most of them (i think all of them) did not include in the study patients with brain metastases..

However i have come across one study which suggests that ipilimumab has the same level (or at least almost the same) of activity in central nervous system like in extracranial sites.. Here is the link to the study. Look at the conclusion.

http://www.asco.org/ascov2/Meetings/Abstracts?&vmview=abst_detail_view&confID=74&abstractID=50834

Conclusions: Ipi has a similar level of activity in brain and non-CNS lesions. This is the first study to prospectively evaluate Ipi in advanced melanoma pts with brain mets, and the data support its potential use as a treatment for these pts. The analyses are ongoing and final data will be presented.

Hello David. Ipilimumab does not attack tumors itself. It stimulates immune system so that it recognize melanoma and produces lymphocytes that attack tumors. Those lymphocytes can hopefully cross the brain barrier and do the job. At early trials there have been no study references to agree with that statement- however most of them (i think all of them) did not include in the study patients with brain metastases..

However i have come across one study which suggests that ipilimumab has the same level (or at least almost the same) of activity in central nervous system like in extracranial sites.. Here is the link to the study. Look at the conclusion.

http://www.asco.org/ascov2/Meetings/Abstracts?&vmview=abst_detail_view&confID=74&abstractID=50834

Conclusions: Ipi has a similar level of activity in brain and non-CNS lesions. This is the first study to prospectively evaluate Ipi in advanced melanoma pts with brain mets, and the data support its potential use as a treatment for these pts. The analyses are ongoing and final data will be presented.

Hello David. Ipilimumab does not attack tumors itself. It stimulates immune system so that it recognize melanoma and produces lymphocytes that attack tumors. Those lymphocytes can hopefully cross the brain barrier and do the job. At early trials there have been no study references to agree with that statement- however most of them (i think all of them) did not include in the study patients with brain metastases..

However i have come across one study which suggests that ipilimumab has the same level (or at least almost the same) of activity in central nervous system like in extracranial sites.. Here is the link to the study. Look at the conclusion.

http://www.asco.org/ascov2/Meetings/Abstracts?&vmview=abst_detail_view&confID=74&abstractID=50834

Conclusions: Ipi has a similar level of activity in brain and non-CNS lesions. This is the first study to prospectively evaluate Ipi in advanced melanoma pts with brain mets, and the data support its potential use as a treatment for these pts. The analyses are ongoing and final data will be presented.

Good morning. In official yervoy page it says the following:

Permanently discontinue YERVOY for any of the following

• Persistent moderate adverse reactions or inability to reduce corticosteroid dose to
  7.5 mg prednisone or equivalent per day.

Personally i think you have to ask the doctors wether you can reduse your father's dose or if it is possible  to stop it for a while. As far as i know oderate consumption does not reduce yervoy's significance.

Good morning. In official yervoy page it says the following:

Permanently discontinue YERVOY for any of the following

• Persistent moderate adverse reactions or inability to reduce corticosteroid dose to
  7.5 mg prednisone or equivalent per day.

Personally i think you have to ask the doctors wether you can reduse your father's dose or if it is possible  to stop it for a while. As far as i know oderate consumption does not reduce yervoy's significance.

Good morning. In official yervoy page it says the following:

Permanently discontinue YERVOY for any of the following

• Persistent moderate adverse reactions or inability to reduce corticosteroid dose to
  7.5 mg prednisone or equivalent per day.

Personally i think you have to ask the doctors wether you can reduse your father's dose or if it is possible  to stop it for a while. As far as i know oderate consumption does not reduce yervoy's significance.

Greetings,

Glewis since the lung mets seem resolved i would asssume that zelboraf is doing great job! I do not think that it would be valuable at that point to discontinue it. As i understand it melanoma tends to grow in areas where it has the most potential to do so, since zelboraf is in action, brain is the best place concerning it is difficult for drugs to get there. One plan to consider is having a gamma knife procedure to resolve the brain mets and maybe another ipi reinduction. Ipi after zelboraf could be the knock out punch- or in combination with zelboraf if that is possible, i think there are some studies in which they combine the two drugs with guite promising results. .

One other guestion i would like to make is edema symptomatic? If not maybe you can consider not to take any steroids for a while and maybe wait wether it can be resolved by its own. Is not possible to have the largest brain again zapped? As i see its size is not guite big for srs.. I hope every best.

Greetings,

Glewis since the lung mets seem resolved i would asssume that zelboraf is doing great job! I do not think that it would be valuable at that point to discontinue it. As i understand it melanoma tends to grow in areas where it has the most potential to do so, since zelboraf is in action, brain is the best place concerning it is difficult for drugs to get there. One plan to consider is having a gamma knife procedure to resolve the brain mets and maybe another ipi reinduction. Ipi after zelboraf could be the knock out punch- or in combination with zelboraf if that is possible, i think there are some studies in which they combine the two drugs with guite promising results. .

One other guestion i would like to make is edema symptomatic? If not maybe you can consider not to take any steroids for a while and maybe wait wether it can be resolved by its own. Is not possible to have the largest brain again zapped? As i see its size is not guite big for srs.. I hope every best.

Greetings,

Glewis since the lung mets seem resolved i would asssume that zelboraf is doing great job! I do not think that it would be valuable at that point to discontinue it. As i understand it melanoma tends to grow in areas where it has the most potential to do so, since zelboraf is in action, brain is the best place concerning it is difficult for drugs to get there. One plan to consider is having a gamma knife procedure to resolve the brain mets and maybe another ipi reinduction. Ipi after zelboraf could be the knock out punch- or in combination with zelboraf if that is possible, i think there are some studies in which they combine the two drugs with guite promising results. .

One other guestion i would like to make is edema symptomatic? If not maybe you can consider not to take any steroids for a while and maybe wait wether it can be resolved by its own. Is not possible to have the largest brain again zapped? As i see its size is not guite big for srs.. I hope every best.

Good afternoon to all. Trisha i think it would be useful if you could provide us with some more information. For example has your father had any liver mets noticeable in any scans? Curently is he recieving ipilimumab as monotherapy or in combination with decarbazine? As far as i know now ipilimumab is used mostly as monotherapy.

As for the liver numbers it is a bit strange to me that they were normal in previous bloodwork and in 3 weeks time they got so high.. It does not seem (at least to me) to be related with melanoma rather than it might be a counteraction of ipilimumab's action, inflamations in liver for example. It makes sense to wait some time untill they got to a normal range and then proceed to the next dose. In case that this does not happen and they still are high do not get upset, maybe ipilimumab does already what is meant to do. The recomended ipilimumab's dose is 4 infusions in total- however i doubt that this is always the case. Different people have different immune system, hopefully your father's immune system is kicking melanoma and do not need more ipilimumab..

However it sounds really promising that your father's tumors respond to ipilimumab! That is great Trisha and i suggest you rather focus on that and do not upset yourself so much concerning liver numbers. I hope everything goes just fine Trisha.

Good afternoon to all. Trisha i think it would be useful if you could provide us with some more information. For example has your father had any liver mets noticeable in any scans? Curently is he recieving ipilimumab as monotherapy or in combination with decarbazine? As far as i know now ipilimumab is used mostly as monotherapy.

As for the liver numbers it is a bit strange to me that they were normal in previous bloodwork and in 3 weeks time they got so high.. It does not seem (at least to me) to be related with melanoma rather than it might be a counteraction of ipilimumab's action, inflamations in liver for example. It makes sense to wait some time untill they got to a normal range and then proceed to the next dose. In case that this does not happen and they still are high do not get upset, maybe ipilimumab does already what is meant to do. The recomended ipilimumab's dose is 4 infusions in total- however i doubt that this is always the case. Different people have different immune system, hopefully your father's immune system is kicking melanoma and do not need more ipilimumab..

However it sounds really promising that your father's tumors respond to ipilimumab! That is great Trisha and i suggest you rather focus on that and do not upset yourself so much concerning liver numbers. I hope everything goes just fine Trisha.

Good afternoon to all. Trisha i think it would be useful if you could provide us with some more information. For example has your father had any liver mets noticeable in any scans? Curently is he recieving ipilimumab as monotherapy or in combination with decarbazine? As far as i know now ipilimumab is used mostly as monotherapy.

As for the liver numbers it is a bit strange to me that they were normal in previous bloodwork and in 3 weeks time they got so high.. It does not seem (at least to me) to be related with melanoma rather than it might be a counteraction of ipilimumab's action, inflamations in liver for example. It makes sense to wait some time untill they got to a normal range and then proceed to the next dose. In case that this does not happen and they still are high do not get upset, maybe ipilimumab does already what is meant to do. The recomended ipilimumab's dose is 4 infusions in total- however i doubt that this is always the case. Different people have different immune system, hopefully your father's immune system is kicking melanoma and do not need more ipilimumab..

However it sounds really promising that your father's tumors respond to ipilimumab! That is great Trisha and i suggest you rather focus on that and do not upset yourself so much concerning liver numbers. I hope everything goes just fine Trisha.

Also as far as i know, melanoma is radioresistant so WBRT is normally not so affective.

Also as far as i know, melanoma is radioresistant so WBRT is normally not so affective.

Also as far as i know, melanoma is radioresistant so WBRT is normally not so affective.