› Forums › General Melanoma Community › Brain mets while on DP1 – what next
- This topic has 12 replies, 4 voices, and was last updated 9 years, 1 month ago by
kylez.
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- July 25, 2016 at 10:37 am
My wife is a stage 4 patient. She was diagnosed with melanoma 1.5 years ago having multiple lesions in lungs. They were successfully resolved with Dabra+Tram cobmo. In Feb 2016 she added Keytruda to this combination because one brain met was found. The lesion was successfully treated with gamma-knife. Last MRI showed 8 new lesions in her brain which appeared very quickly – only within 1 last month. Seems that Keyt+Dabra+Tram are not working.
My question is which therapy can we consider next?Ipilimumab? or chemotherapy with cisplatin+carboplatina or temozol?
or any other clinical trial?
Thank you!
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- July 25, 2016 at 1:58 pm
I think IPI is a natural next step, in combination with gamma knife if possible. Some doctors are reluctant to treat mulitple brain mets with gamma knife or SRS, but some patients have had a much larger number of mets than 8 treated with gamma knife successfully, so you may have to shop around to find somebody who'll do it.
I'm not personally aware of trials that are currently active for melanoma brain metastases, but I'd do some research (asking your doctors, looking on clinicaltrials.gov) to see if there are any clinical trial options that look good in case your wife doesn't respond to Ipi or progresses further. Hopefully others might have more info.
Also, if you're not already seeing one, you should make sure your wife is seeing a Melanoma expert who will have a better grasp on available options, dealing with side effects, and be up on the latest research.
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- July 25, 2016 at 1:58 pm
I think IPI is a natural next step, in combination with gamma knife if possible. Some doctors are reluctant to treat mulitple brain mets with gamma knife or SRS, but some patients have had a much larger number of mets than 8 treated with gamma knife successfully, so you may have to shop around to find somebody who'll do it.
I'm not personally aware of trials that are currently active for melanoma brain metastases, but I'd do some research (asking your doctors, looking on clinicaltrials.gov) to see if there are any clinical trial options that look good in case your wife doesn't respond to Ipi or progresses further. Hopefully others might have more info.
Also, if you're not already seeing one, you should make sure your wife is seeing a Melanoma expert who will have a better grasp on available options, dealing with side effects, and be up on the latest research.
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- July 25, 2016 at 1:58 pm
I think IPI is a natural next step, in combination with gamma knife if possible. Some doctors are reluctant to treat mulitple brain mets with gamma knife or SRS, but some patients have had a much larger number of mets than 8 treated with gamma knife successfully, so you may have to shop around to find somebody who'll do it.
I'm not personally aware of trials that are currently active for melanoma brain metastases, but I'd do some research (asking your doctors, looking on clinicaltrials.gov) to see if there are any clinical trial options that look good in case your wife doesn't respond to Ipi or progresses further. Hopefully others might have more info.
Also, if you're not already seeing one, you should make sure your wife is seeing a Melanoma expert who will have a better grasp on available options, dealing with side effects, and be up on the latest research.
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- July 25, 2016 at 11:32 pm
Sorry for what your wife is going through. You can certainly attain SRS for numerous brain mets…there are those on this forum who have had as many as 15 dealt with in this manner. You could consider ipi as the next systemic treatment…however, I recently posted about this trial, currently recruiting, for those who progress while on immunotherapy: http://chaoticallypreciselifeloveandmelanoma.blogspot.ca/2016/07/new-trial-recruiting-pembro-plus-mga271.html
The brain mets would have to be resolved via srs or othere means and she would have to still have measureable disease, which I'm not sure she would have after the brain mets are treated.
Here is a look at multiple trial combo's that might be helpful for your wife, presented by a recognized melanoma expert: http://chaoticallypreciselifeloveandmelanoma.blogspot.ca/2016/03/immunology-updatewebinar-for-melanoma.html
Perhaps these links will at least give you some treatment options to discuss with your wife's oncologist who I presume is a melanoma expert. You can use the search bubble at the top left of my blog to look for additional information if you are interested.
I wish you both my best. Celeste
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- July 25, 2016 at 11:32 pm
Sorry for what your wife is going through. You can certainly attain SRS for numerous brain mets…there are those on this forum who have had as many as 15 dealt with in this manner. You could consider ipi as the next systemic treatment…however, I recently posted about this trial, currently recruiting, for those who progress while on immunotherapy: http://chaoticallypreciselifeloveandmelanoma.blogspot.ca/2016/07/new-trial-recruiting-pembro-plus-mga271.html
The brain mets would have to be resolved via srs or othere means and she would have to still have measureable disease, which I'm not sure she would have after the brain mets are treated.
Here is a look at multiple trial combo's that might be helpful for your wife, presented by a recognized melanoma expert: http://chaoticallypreciselifeloveandmelanoma.blogspot.ca/2016/03/immunology-updatewebinar-for-melanoma.html
Perhaps these links will at least give you some treatment options to discuss with your wife's oncologist who I presume is a melanoma expert. You can use the search bubble at the top left of my blog to look for additional information if you are interested.
I wish you both my best. Celeste
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- July 25, 2016 at 11:32 pm
Sorry for what your wife is going through. You can certainly attain SRS for numerous brain mets…there are those on this forum who have had as many as 15 dealt with in this manner. You could consider ipi as the next systemic treatment…however, I recently posted about this trial, currently recruiting, for those who progress while on immunotherapy: http://chaoticallypreciselifeloveandmelanoma.blogspot.ca/2016/07/new-trial-recruiting-pembro-plus-mga271.html
The brain mets would have to be resolved via srs or othere means and she would have to still have measureable disease, which I'm not sure she would have after the brain mets are treated.
Here is a look at multiple trial combo's that might be helpful for your wife, presented by a recognized melanoma expert: http://chaoticallypreciselifeloveandmelanoma.blogspot.ca/2016/03/immunology-updatewebinar-for-melanoma.html
Perhaps these links will at least give you some treatment options to discuss with your wife's oncologist who I presume is a melanoma expert. You can use the search bubble at the top left of my blog to look for additional information if you are interested.
I wish you both my best. Celeste
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- July 26, 2016 at 10:40 pm
If it was myself, my first thought would probalby be pursue Gamma Knife. The larger institutions probably are better at pursuading insurance companies that use on > 3 mets is still the preferred option.
Here is a search at clinicaltrials.gov for condition=melanoma and title including "brain". It pulls up a number of trials, 21 of them.
The inclusion/exclusion qualification criteria can be tough for anybody, with or without brain mets.Also as a consideration, getting into a clinical trial isn't necessarily a rapid process. There may or may not be a washout period of, say, 30 days of no previous treatment. There can be delays in the trials themselves, e.g., put on pause because someone had an adverse reaction, or some other research consideration. Maybe they make recruitment happen faster for patients with active brain mets, but I really don't know. The trial I was just in excluded active brain mets.One of the trials is for the IPI + Nivo combination. But is that combination approved/available already for patients with brain mets? -
- July 26, 2016 at 10:40 pm
If it was myself, my first thought would probalby be pursue Gamma Knife. The larger institutions probably are better at pursuading insurance companies that use on > 3 mets is still the preferred option.
Here is a search at clinicaltrials.gov for condition=melanoma and title including "brain". It pulls up a number of trials, 21 of them.
The inclusion/exclusion qualification criteria can be tough for anybody, with or without brain mets.Also as a consideration, getting into a clinical trial isn't necessarily a rapid process. There may or may not be a washout period of, say, 30 days of no previous treatment. There can be delays in the trials themselves, e.g., put on pause because someone had an adverse reaction, or some other research consideration. Maybe they make recruitment happen faster for patients with active brain mets, but I really don't know. The trial I was just in excluded active brain mets.One of the trials is for the IPI + Nivo combination. But is that combination approved/available already for patients with brain mets? -
- July 26, 2016 at 10:40 pm
If it was myself, my first thought would probalby be pursue Gamma Knife. The larger institutions probably are better at pursuading insurance companies that use on > 3 mets is still the preferred option.
Here is a search at clinicaltrials.gov for condition=melanoma and title including "brain". It pulls up a number of trials, 21 of them.
The inclusion/exclusion qualification criteria can be tough for anybody, with or without brain mets.Also as a consideration, getting into a clinical trial isn't necessarily a rapid process. There may or may not be a washout period of, say, 30 days of no previous treatment. There can be delays in the trials themselves, e.g., put on pause because someone had an adverse reaction, or some other research consideration. Maybe they make recruitment happen faster for patients with active brain mets, but I really don't know. The trial I was just in excluded active brain mets.One of the trials is for the IPI + Nivo combination. But is that combination approved/available already for patients with brain mets?
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