Adjuvant Stage 3 : Immunotherapy or Targeted therapy ?

If you watch the videos, you will see that these melanoma experts go over to positive and the negative factors with patients and then it is up to the patient to make the choice. Things to consider is age, and if you want to have children in the future, job and how treatment might influence energy or will side effects make things difficult, time ( can you make it to the hospital for treatments on a regular basis). Immunotherapy via IV at hospital vs pills and take them at home with targeted therapy. Side effects are more common with targeted therapy but when you stop the side effects generally go away. In a small % of patients who get immunotherapy drugs like nivo or pembro they can develop endocrine issue that they will more than likely have for the rest of their lives. You have to take the time and go over all these factors with your medical oncologist and then make a decision. Not easy but then again a few years ago there were no good options for stage 3 and adjuvant treatments.

Hi I’m from Toronto Canada near Ed Williams…we get immunotherapy adjuvant but via insurance only right now if you are NRAS…first line is Nivo and Ipi. But we get great targeted meds if you are Braf…hug abound..I have two insurance pairs Nivo adjuvant after mega 2 Srs surgeries on my T12 VERTEBRAE ogliometastic spot. Today had scan to see if this new tiny spot on lung is metastasis fme! after 12 almost months on NIVO ADJUVANT. I will know in 36 hours from Princess Margaret Cancer Center number one imaging centre in North America now…just need a break….please and thank you world hugs to you all

sorry can edit that part about 2 years pairs??

Nobody knows for sure. But, we do know that any small molecule drugs, such as BRAF inhibitors, will eventually stop working. There have been some rechallenges as was said before, but the truth is that the odds of response are small to modest at best, and duration of response is short. There has been no cures with BRAF inhibitors but there are potential cures with immunotherapy. That is why in my mind there is no question that immunotherapy is probably the best option, unless we have evidence to suggest otherwise.

By the way, there is another not so positive opinion on dabrafenib and trametinib in the adjuvant setting, check out this 2019 paper in the Journal of Clinical Oncology: https://ascopubs.org/doi/full/10.1200/JCO.18.01768

In summary, nobody knows for sure because these drugs are just too new to know. But the totality of evidence, to me, points to the potential superiority of immunotherapy. But ultimately, I think that you need to find a good melanoma oncologist and trust him or her. All the best!

Here is the response to the Hess article by the Melanoma Dr.s who wrote up Combi-AD trial and on a sad note it looks like Kenneth Hess died recently at 59. https://ascopubs.org/doi/full/10.1200/JCO.19.00004 https://gsbs.uth.edu/about/news/gsbs-news-details.htm?id=a6600b89-bc1c-47de-ae4d-6f65747007d7

Another potentially important thing to consider is the time to response. Immunotherapy can take up to 3 months to see a response, while BRAF/MEK inhibitors work much faster (like any small molecules). Therefore, if someone with BRAF+ melanoma comes in with a lot of symptoms, rapidly progressing disease, symptomatic metastases etc, these people cannot necessarily wait 3 months for immunotherapy to work. For these people, BRAF/MEK inhibitors are most often the best choice. Therefore, if it were me, I would have wanted BRAF/MEK inhibitors saved for as long as possible, in case I am ever in that situation. Hopefully, this will never happen to any of us, but with melanoma, you just never know.

Hi Ellie-82, a couple of things to consider in your comments about if you used targeted then 10 years later progressed that you wouldn’t be allowed to use it again is not accurate, in fact Dr. Michael Davies of MD Anderson has talked about this in the past where patients that progressed on targeted therapy then switched to immunotherapy then progressed were re-challenged with targeted therapy and had modest success. It has something to do with the high mutational aspect of melanoma and that the resistance that happen the first time with targeted therapy changes over time and when a patients months later is given targeted therapy again it works because the melanoma has continued to change “mutate” over time. I am a big fan of immunotherapy, since it has kept me alive for the last 5.5 years at stage 4 , but the statement of using immunotherapy a second time 10 years later if progression happens is not a fool poof method, more and more data is coming out showing that those that stop immunotherapy either due to IRAe’s or are complete responders and stop or if trial was set up with firm end date, are now showing if they progress that only a modest # have a response the second time. Again it is early days in figuring out what the best approach long term will be and no trials have been run comparing targeted therapy to immunotherpy. For your consideration is a link which features Dr. Long of Australia talking about long term stage 4 survival with targeted therapy.Second link also had Dr. Long as one of the authors and section of retreatment is interesting. One last point about your examples, being out 10 years from now and having melanoma come back would be a win in my books, by then my hope is we will have many more options and treatment will be more precise and based on accurate genetic profiles and ctDNA blood tests.https://www.onclive.com/web-exclusives/long-shares-insight-on-pivotal-data-in-brafmutant-melanoma https://academic.oup.com/annonc/article/30/7/1154/5421507

Oui, un an, j’ai presque fini. En tout cas, peu importe ton choix, je pense que l’important c’est que tu sois en paix avec la décision.

Bonjour Sissi,

Je suis de Montréal aussi et je suis curieux de savoir où tu es traitée. Je vais demain pour mon PET/CT scan au CUSM.

Allo Sole, même endroit! J’espère que le scan a bien été!