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Switching from TAF/MEK combo to Yervoy/Opdivo combo
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Switching from TAF/MEK combo to Yervoy/Opdivo combo

› Forums › General Melanoma Community › Switching from TAF/MEK combo to Yervoy/Opdivo combo

  • Post
    • September 19, 2018 at 3:14 pm
    Belltown
    Participant

      Found this board many months ago and have found it incredibly helpful.  This is my first post.  

      My younger brother, age 57, has Stage IV Melanoma and has been on oral targeted therapy (dabrafenib and trametinib) for 10 months (since November 2017.)   His oncologist just told him today that he wants to switch him to ipilimumab and nivolumab via I.V. infusions.  I have done enough reading to have a good sense of what this means and why, but I can't find anything that indicates the interval between stopping the oral regimen and starting the I.V. regimen.   Does anyone have a sense of what that could be?  Thank you.

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        • September 19, 2018 at 3:26 pm
        jennunicorn
        Participant

          The targeted treatments, while they work great, are known for not being effective after a period of time. There could be two reasons his oncologist wants to switch him over: either he has progressed, meaning the targeted treament stopped working or his oncologist wants to be ahead of the game and switch him before it stops working. 10 months is a good amount of time, for some those drugs only work for about 6 months. On the rare occasion some have been able to stay on targeted treatment for years, but that's not the norm. Hope this gave you some idea of what the oncologist might be thinking.

            • September 19, 2018 at 3:49 pm
            Belltown
            Participant

              Thanks very much for the quick response, Jenn.  Do you happen to know what is the typical interval, or "rest period," between stopping the TAF/MEK and stariing the Yervoy/Opdivo?  

              • September 19, 2018 at 5:24 pm
              marta010
              Participant

                My husband has been taking dabrafenib concurrently with Keytruda.  There does not need to be a wash out period between the two treatments.

                Ann

                • September 21, 2018 at 12:02 pm
                Mat
                Participant

                  Correct, but they do need a short washout period between ipi and MEK.

                • September 20, 2018 at 1:38 am
                MelanomaMike
                Participant
                  Hi Belltown, so your brothers doctor did not mention either to him or you as to “Why” of the switch? Seems odd, but, there are percentages of Dr’s out there that wont be as Verbal as they should with patients, its our LIVES for crying out loud!..thats why “WE” need to be pro active & ask questions, i put em on paper if need be before i see my Oncologist…Jen put it pretty well…Mike
                    • September 20, 2018 at 1:56 pm
                    Belltown
                    Participant

                      Hi MelanomaMike,  It was the PA who called my brother with the results of his last scan and she is the one that told him that his oncologist wants to take him off of the TAF/MEK and switch him to Yervoy/Opdivo.  To your point, this sent us all into "what the heck and why?" mode.  My brother meets with the onc next week, so we will get more then.  But, again to your point, I personally don't see much value in the PA mentioning the potential shift.  It just puts us all on edge until the meeting with the doctor.  In the meantime, I was hoping to get some info from people on this board who actually went from TAF/MEK to Yervoy/Opdivo.   FYI – My brother's scan was mostly encouraging.  4 of 5 mets on his liver continued to shrink.  One was slightly larger.  His last blood test results were beautiful and his LDH remains well below 200.  And, no, I am not in the medical field, but am versed in looking at numbers, their ranges and trends.  

                      Thanks again.

                       

                      • September 20, 2018 at 2:38 pm
                      ed williams
                      Participant

                        4 out of 5 tumors reducing is great news, and one slightly larger could be followed until next scan before making a big decision of switching especially if LDH is good. Some thing to consider is a lot of trials are now doing triplets of two targeted therapy drugs plus a Pd-1 drug together. Examples are Combi I trial, Trilligy trial,and Keynote022 trial. Some times in cases on mixed reponses it can get pretty tricky in making a decision of " is this clear progression and is it time to switch drugs" not a topic to be having over the phone by a PA in my opinion. Here is a link to Onclive panel of oncologist talking about using targeted therapy or Pd-1 at stage 4, at the3:00 min mark they talk about staying on targeted therapy and for how long. Best Wishes!!!Ed https://www.youtube.com/watch?time_continue=1&v=IpAAVBZzxaY

                        • September 20, 2018 at 5:23 pm
                        MelanomaMike
                        Participant
                          Hi Belltown, give your post a few more days, we have a lot of knowledgeable folks here (like Ed who just replied) that can give you GOOD honest info from the sidelines of actual patients that are either talking the said medication or know about them. Just remember this, YOU & YOUR BRO have the power & Right to make decisions of what to do next for him, of course if its an “absurd” request on your part, they will put the brakes on it..Pleeeease keep us posted ok? we truelly care for our own..Mike
                          • September 20, 2018 at 9:06 pm
                          Belltown
                          Participant

                            Thank you everyone for the helpful and supportive responses so far.  And I do hope they keep coming.  My brother's doc app't is on Tues, 9/25, and I will be going with him.  I am already far better prepared for that app't than I was a mere two days ago, thanks to all of you.

                            • September 22, 2018 at 5:21 pm
                            MelanomaMike
                            Participant
                              Fingers Crossed for your bro! As you may have read lately, I too am in the middle of a possible “Switch” or upgrade to another plan of attack (Meds) so, lets take it day by day & just be greatful we woke up this morning feeling somewhat good! Have your notes ready for Tuesday! we will be waiting for your update..:)
                            • September 21, 2018 at 11:57 am
                            Mat
                            Participant

                              I did this.  The period between the treatments was short.  Maybe like 10 days.

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