› Forums › General Melanoma Community › Zelboraf or Chemo therapy?
- This topic has 8 replies, 5 voices, and was last updated 7 years, 9 months ago by
cancersnewnormal.
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- August 25, 2017 at 1:43 pm
Hello, my mother was diagnosed with Malignant Melanoma in 2014. She had undergone surgery wide excision and reconstruction on left lower part of abdomen and hip region. In 2016, she had left inguinal LN recurrence and went through Left ileo inguinal block dissection. Currently, she is detected with BRAF v600 mutation. PET scan shows metastatic liver, spleen and bone lesion.
The doctors are suggesting either to go with Zelboraf or Chemo therapy. Can you please suggest, will Chemo be useful in case of Malignant Melanoma?
If we go with Zelboraf 960mg, 4 tablets in every 12 hours, will this help? I wanted to check, how effective Zelboraf is, and will it help curing Malignant Melanoma? This medicine is not readily available in our country and if it is, the suppliers are sellig at a very high rate.
Can you please help me decide if I should go with Chemo therapy or Zelboraf?
Your quick respose is highly appreciated.
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- August 25, 2017 at 2:12 pm
I'm not sure what drug her doctors have in mind when you say "chemo". There are several new immunotherapy drugs available for metastatic patients here in the U.S., but they are not typically referred to as "chemo", because that term is too closely connected with out of date practices. Zelboraf would work for your mom, since she has been diagnosed with BRAF V600 mutation. Here is a link with some information about that drug from the manufacturer: https://www.gene.com/patients/medicines/zelboraf
What doctors are seeing with that type of medication is that they work rapidly to shrink/eliminate metastatic lesions. The downside of it, is that most patients will eventually begin to mutate around it, and have new tumor growth. For some people, this can be as quick as a few months, but for others, it may be a couple of years (in a few cases even longer!).
If by "chemo", her doctors are suggesting Opdivo (Nivolumab) or Keytruda (Pembrolizumab), these are the latest approved immunotherapy drugs here in the U.S. These medications have longer term success rates, but do not work for everyone. They are given by intravenous infusion at 2-3 week intervals, depending on which drug is used. The highest success rates with these medications has been found when Opdivo is given in combonation with Yervoy (Ipilimumab)…. however… that combonation also has the highest incidence of harsh side effects.
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- August 26, 2017 at 7:38 am
Thank you for your quick response. Really appreciate it!
The doctors have actually prescribed only Zelboraf not the combination of Vemurafenib (Zelboraf) and cobimetinib (Cotellic) or dabrafenib (Tafinlar) and trametinib (Mekinist). Whereas, after taking second opinion, the other doc asked to go us with the traditional chemo therapy (since Zelboraf is not readily available in India, and is very expensive, if imported).
Hence, I wanted to be sure that if I am spending on Zelboraf, how effective would it be, and what if the side effects would worsen the case? -
- August 29, 2017 at 4:24 pm
I was on the v/c combo. It shrunk my tumor after a few days! (I could tell as the tumor was pressing on my facial nerve and the relief from the pain was quite noticable) Unfortunately I had terrible side effects and had to discontinue treatment after only 8 and1/2 days. Ended up in the hospital for a day to get DRESS syndrome (caused by the zelboraf) under control. Hoping that my short experience and tumor shrinkage sticks.
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- August 25, 2017 at 4:28 pm
Here is a breakdown of a discussion by two melanoma experts regarding how to select treatment for melanoma patients: http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2015/09/pick-your-poison-weber-and-agarwala.html
I, too, hope that by "chemo" your mom's docs are referring to "immunotherapy" as old school chemo has been proven to be ineffective in melanoma.
Additionally, for BRAF positive patients…a BRAF inhibitor works best and has FEWER side effects AND less tumor work around when it is combined with a MEK inhibitor. Here is a report: http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2014/02/braf-inhibitors-for-melanoma-dabrafenib.html
BRAF inhibitors include: Vemurafenib (Velboraf), Dabrafenib (Tafinlar), Sorafenib (Nexavar)
MEK inhibitors include: Trametinib (Mekinist), Cobimetinib (Cotellic), and Binimetinib
Hope this helps. I wish you and your mom well. Celeste
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- August 26, 2017 at 7:41 am
Thank you for your response. Yes, it is the old school chemo the doctor is referring to. We are actually considering to go with Zelboraf, as you mentioned that chemo would be ineffective in melanoma. So, now if I only go with Zelboraf and not the cobination of BRAF inhibitors, would that help?
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- August 26, 2017 at 6:14 pm
Yes. BRAF inhibitors alone work about 70% of the time in BRAF positive melanoma. Often ridding the patient of disease. However, side effects are decreased while effectiveness and avoidance of tumor 'work around' are increased with the BRAF/MEK combo. The ultimate problem with most on BRAF inhibitors (even the combo), is that while they can be extremely effective initially, the tumors often learn to get around them and start to regrow in 7-9 months. Depsite that statistical fact, there are those who have been maintained on that sort of therapy for years. This post I put together regarding the basics of melanoma treatment may help you (there is a whole section on targeted therapy…which BRAF treatment is called):
Hope that helps. Would it be possible for you to order meds from abroad? I know that Canadian drugs can be purchased in the US if you have a doctor's order and even though we can't use our insurance to pay for them….they are often still cheaper when we buy them outright there – than the cost is to us when we use our insurance for the same drug in the US. However, I don't know that these kinds of drugs would be sold that way. Perhaps someone from Canada or one who is aware of other options might chime in.
I wish you my best. Celeste
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- August 27, 2017 at 10:39 pm
Why not immunotherapy? It is proven to be the best treatment for melanoma.-
- August 31, 2017 at 2:07 pm
I had this same question. Sadly… this article is likely very accurate. It comes down to cost vs benefit. Part of it seems as though the learning curve and spread of knowledge hasn't quite reached the levels that it has here in the U.S. and some other countries. https://www.quora.com/Why-is-Cancer-Immunotherapy-not-promoted-in-India
However, I did find a number of websites promoting immunotherapy treatments in India. Perhaps it is a matter of finding the more advanced hospitals/centers. Here is one center that specifically lists melanoma: http://www.indiancancercare.com/immunotherapy_india.html
Sadly… this article came out in June of this year, and mentions that in India, it is only approved for lung and kidney cancer…. and only after patients have exhausted other options. https://www.thequint.com/fit/immunotherapy-cancer-decoded-hope-for-cancer-treatment
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