› Forums › General Melanoma Community › Treatment of brain mets wit h PD-1
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lbkimball.
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- June 16, 2014 at 1:14 pm
Can anyone provide any information on treatments of brain mets with PD-1? I am aware that Yale University is just starting a study with patients who have brain mets , but my question is has anyone seen any prior evidence or prior experience that PD-1 does address brain mets? Any information will help. Thanks, Daniel
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- June 16, 2014 at 1:58 pm
I believe you'll find here and elsewhere people who have had responses to anti-PD-1 for brain mets, although it's somewhat limited because of the stricter controls around brain mets and many of the clinical trials — hence the new studies that are relaxing some of those eligibility criteria to further study this. Additionally, there is similar evidence with the other immunotherapies, including ipilimumab, IL-2, and TIL. I was in a TIL trial in 2010-11 and the inclusion criteria then disallowed any brain mets, but newer trials have relaxed that somewhat, allowing total tumor size under a certain limit and stable for some period of time. Theoretically, it makes sense that the immunotherapies would cause a response in brain mets. While the blood-brain barrier can prevent some medications from reaching the brain, again in theory the immunotherapies wouldn't have this limitation — the medications don't have to reach the brain directly, only cause an immune response into the brain, where the immune system is active. That's no guarantee, but the general thinking is that there is a good possibility that this class of treatments can work for brain metastases… and of course, further studies, like this one at Yale (Dr. Sznol, I believe) will hopefully shed more light on this.
Joe
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- June 16, 2014 at 1:58 pm
I believe you'll find here and elsewhere people who have had responses to anti-PD-1 for brain mets, although it's somewhat limited because of the stricter controls around brain mets and many of the clinical trials — hence the new studies that are relaxing some of those eligibility criteria to further study this. Additionally, there is similar evidence with the other immunotherapies, including ipilimumab, IL-2, and TIL. I was in a TIL trial in 2010-11 and the inclusion criteria then disallowed any brain mets, but newer trials have relaxed that somewhat, allowing total tumor size under a certain limit and stable for some period of time. Theoretically, it makes sense that the immunotherapies would cause a response in brain mets. While the blood-brain barrier can prevent some medications from reaching the brain, again in theory the immunotherapies wouldn't have this limitation — the medications don't have to reach the brain directly, only cause an immune response into the brain, where the immune system is active. That's no guarantee, but the general thinking is that there is a good possibility that this class of treatments can work for brain metastases… and of course, further studies, like this one at Yale (Dr. Sznol, I believe) will hopefully shed more light on this.
Joe
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- June 16, 2014 at 4:46 pm
I just emailed Dr. Sznol on this matter, I'll share his response. I'm on NYU's list, starting Sloan's info-gathering procedure, and now this. In a brief email because he was away last week, Dr. Sznol said I should be on PD1 right away. That's what I'm trying for! It's my understanding that the problem getting started is now with the hospitals.
How many will die before getting PD1?
Karen
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- June 16, 2014 at 4:46 pm
I just emailed Dr. Sznol on this matter, I'll share his response. I'm on NYU's list, starting Sloan's info-gathering procedure, and now this. In a brief email because he was away last week, Dr. Sznol said I should be on PD1 right away. That's what I'm trying for! It's my understanding that the problem getting started is now with the hospitals.
How many will die before getting PD1?
Karen
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- June 17, 2014 at 1:20 am
Karen, thanksgiving for your response, your contributions here are great. You responded to me just over a year ago when my wife was having a terrible response to yervoy. You suggested Remmicade and were right on what resulted in getting her under control. She now has brain mets and has had WBRt in the past so her only option is gamma knife or cyber life treatment. I was hoping she could make it to PD-1. As others have said how many must die before PD-1 is available for all.
thanks, Karen
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- June 17, 2014 at 1:20 am
Karen, thanksgiving for your response, your contributions here are great. You responded to me just over a year ago when my wife was having a terrible response to yervoy. You suggested Remmicade and were right on what resulted in getting her under control. She now has brain mets and has had WBRt in the past so her only option is gamma knife or cyber life treatment. I was hoping she could make it to PD-1. As others have said how many must die before PD-1 is available for all.
thanks, Karen
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- June 17, 2014 at 1:20 am
Karen, thanksgiving for your response, your contributions here are great. You responded to me just over a year ago when my wife was having a terrible response to yervoy. You suggested Remmicade and were right on what resulted in getting her under control. She now has brain mets and has had WBRt in the past so her only option is gamma knife or cyber life treatment. I was hoping she could make it to PD-1. As others have said how many must die before PD-1 is available for all.
thanks, Karen
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- July 17, 2014 at 3:52 am
I am starting PD-1 treatment through the expanded access program at UCSF tomorrow. I have many brain mets (30+) and Tafinlar has been keeping them stable. I'm hoping to see PD1 eviscerate them!
From what they told me at UCSF, approximately 4,300 people across the US will have access, which breaks down to about 40 patients per clinic (or something like that.)
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- July 17, 2014 at 3:52 am
I am starting PD-1 treatment through the expanded access program at UCSF tomorrow. I have many brain mets (30+) and Tafinlar has been keeping them stable. I'm hoping to see PD1 eviscerate them!
From what they told me at UCSF, approximately 4,300 people across the US will have access, which breaks down to about 40 patients per clinic (or something like that.)
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- July 17, 2014 at 3:52 am
I am starting PD-1 treatment through the expanded access program at UCSF tomorrow. I have many brain mets (30+) and Tafinlar has been keeping them stable. I'm hoping to see PD1 eviscerate them!
From what they told me at UCSF, approximately 4,300 people across the US will have access, which breaks down to about 40 patients per clinic (or something like that.)
-
- June 16, 2014 at 4:46 pm
I just emailed Dr. Sznol on this matter, I'll share his response. I'm on NYU's list, starting Sloan's info-gathering procedure, and now this. In a brief email because he was away last week, Dr. Sznol said I should be on PD1 right away. That's what I'm trying for! It's my understanding that the problem getting started is now with the hospitals.
How many will die before getting PD1?
Karen
-
- June 16, 2014 at 1:58 pm
I believe you'll find here and elsewhere people who have had responses to anti-PD-1 for brain mets, although it's somewhat limited because of the stricter controls around brain mets and many of the clinical trials — hence the new studies that are relaxing some of those eligibility criteria to further study this. Additionally, there is similar evidence with the other immunotherapies, including ipilimumab, IL-2, and TIL. I was in a TIL trial in 2010-11 and the inclusion criteria then disallowed any brain mets, but newer trials have relaxed that somewhat, allowing total tumor size under a certain limit and stable for some period of time. Theoretically, it makes sense that the immunotherapies would cause a response in brain mets. While the blood-brain barrier can prevent some medications from reaching the brain, again in theory the immunotherapies wouldn't have this limitation — the medications don't have to reach the brain directly, only cause an immune response into the brain, where the immune system is active. That's no guarantee, but the general thinking is that there is a good possibility that this class of treatments can work for brain metastases… and of course, further studies, like this one at Yale (Dr. Sznol, I believe) will hopefully shed more light on this.
Joe
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- June 17, 2014 at 4:34 am
Sorry for the stuggles all of you are facing. This is a conundrum proposed so often that I dedicated a blog post to it. While there are no definitive answers because patients with brain mets have long been denied access to anti-PD1 trials as well as the expanded access program…here and there (Moffitt did allow one arm for patients with brain mets in their nivo trial) data is seeping in. The point to remember is: Anti-PD1 doesn't kill melanoma cells…the T-cells it releases does….in the brain or anywhere else. Here is a post with documentation to support those facts:
Additionally, here is something Sznol said a while ago:
From presentation and interview given by Sznol at ASCO:Published: Wednesday, June 05, 2013Melanoma: Long Overall Survival in Patients Receiving NivolumabBY RABIYA S. TUMA, PHD…Asked about the likelihood that the drug works on brain metastases. Sznol noted that this trial excluded patients with active brain lesions, but accepted patients with previously-treated central nervous system tumors. Therefore the answer to the question remains unknown. "But we have long-term responders who didn't develop any brain metastases, so that suggests that maybe we are controlling disease in the brain," he said.Hope that helps. Yours, Celeste'
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- June 17, 2014 at 4:34 am
Sorry for the stuggles all of you are facing. This is a conundrum proposed so often that I dedicated a blog post to it. While there are no definitive answers because patients with brain mets have long been denied access to anti-PD1 trials as well as the expanded access program…here and there (Moffitt did allow one arm for patients with brain mets in their nivo trial) data is seeping in. The point to remember is: Anti-PD1 doesn't kill melanoma cells…the T-cells it releases does….in the brain or anywhere else. Here is a post with documentation to support those facts:
Additionally, here is something Sznol said a while ago:
From presentation and interview given by Sznol at ASCO:Published: Wednesday, June 05, 2013Melanoma: Long Overall Survival in Patients Receiving NivolumabBY RABIYA S. TUMA, PHD…Asked about the likelihood that the drug works on brain metastases. Sznol noted that this trial excluded patients with active brain lesions, but accepted patients with previously-treated central nervous system tumors. Therefore the answer to the question remains unknown. "But we have long-term responders who didn't develop any brain metastases, so that suggests that maybe we are controlling disease in the brain," he said.Hope that helps. Yours, Celeste'
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- June 17, 2014 at 4:34 am
Sorry for the stuggles all of you are facing. This is a conundrum proposed so often that I dedicated a blog post to it. While there are no definitive answers because patients with brain mets have long been denied access to anti-PD1 trials as well as the expanded access program…here and there (Moffitt did allow one arm for patients with brain mets in their nivo trial) data is seeping in. The point to remember is: Anti-PD1 doesn't kill melanoma cells…the T-cells it releases does….in the brain or anywhere else. Here is a post with documentation to support those facts:
Additionally, here is something Sznol said a while ago:
From presentation and interview given by Sznol at ASCO:Published: Wednesday, June 05, 2013Melanoma: Long Overall Survival in Patients Receiving NivolumabBY RABIYA S. TUMA, PHD…Asked about the likelihood that the drug works on brain metastases. Sznol noted that this trial excluded patients with active brain lesions, but accepted patients with previously-treated central nervous system tumors. Therefore the answer to the question remains unknown. "But we have long-term responders who didn't develop any brain metastases, so that suggests that maybe we are controlling disease in the brain," he said.Hope that helps. Yours, Celeste'
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