Treatment Plan

For your information– The trial they attempted last year was giving ipi and Zelboraf at the same time. That was toxic. Now they are trying to give Zelboraf followed by ipi (what they call "sequencing" rather than "combning"). We're hoping that works better. 

I thought that there is pretty convincing statistical evidence now that Ipi is way less  effective  if it follows zelboraf treatment, and that the sequence should be reversed in order to be effective.  I believe this was clearly presented in a melanomia symposium in Tampa (jerryfrom? posted a link to the conference) I've seen another paper also highlighting statistics that seem to back up the reason Zelboraf should be a last resort, even for those Braf positive.

From what I've read–not such a great idea to start on Zel, ride it to the end, and then switch to ipi (ipi not necessarily less effective–rather there isn't enough time for it to work).  That's quite different than using the drugs in combination or "sequence" as another poster put it.

From what I've read–not such a great idea to start on Zel, ride it to the end, and then switch to ipi (ipi not necessarily less effective–rather there isn't enough time for it to work).  That's quite different than using the drugs in combination or "sequence" as another poster put it.

From what I've read–not such a great idea to start on Zel, ride it to the end, and then switch to ipi (ipi not necessarily less effective–rather there isn't enough time for it to work).  That's quite different than using the drugs in combination or "sequence" as another poster put it.

This is important information. I would appreciate it if either you or Jerry could provide the citations for the studies you cite. 

I know that there is currently a clinical trial underway to test the sequence of ipi following Zelboraf. This is a short-term trial testing for adverse side effects of the sequence, not overall survival.

Other than that, I found 2 papers published last year by 2 different groups (one an abstract and one a full-length article) looking at overall survival with the sequence. Working with very few patients, both of these reports said that in about 50% of patients who become resistant to Zelboraf, their disease progresses so rapidly that the ipi does not have time to work. For the other 50% who did not experience rapid disease progression after failing Zelboraf, the ipi did work. Therefore, they recommend doing ipi first and then Zelboraf if necessary.

So from what I read, the problem is not that the ipi doesn't work, per se, it's that so many Zelboraf resistant tumors become very aggressive and the patients don't survive long enough for the ipi to work. That's not quite the same as saying that ipi doesn't work after Zelboraf.

All I can say about zelboraf I was on it 11 weeks and according to the pet scan in week 8 the mel continued to grow everywhere except where I had pallative radiation. Also had over 20 zel side affects. I'm now on 2nd dose of ipi and I feel great. There was 11 days between ending zelboraf and starting ipi. Scary 6 or so more weeks until next scan but I'm already seeing some ipi side affects which they say is good cause it means ipi is starting to work. Dunno if that helps. It is just my experience with the 2 meds and they tell me everyone is different. Out of over 1000 zel patients my onc had I'm only his 2nd that had mel grow on zel.

All I can say about zelboraf I was on it 11 weeks and according to the pet scan in week 8 the mel continued to grow everywhere except where I had pallative radiation. Also had over 20 zel side affects. I'm now on 2nd dose of ipi and I feel great. There was 11 days between ending zelboraf and starting ipi. Scary 6 or so more weeks until next scan but I'm already seeing some ipi side affects which they say is good cause it means ipi is starting to work. Dunno if that helps. It is just my experience with the 2 meds and they tell me everyone is different. Out of over 1000 zel patients my onc had I'm only his 2nd that had mel grow on zel.

All I can say about zelboraf I was on it 11 weeks and according to the pet scan in week 8 the mel continued to grow everywhere except where I had pallative radiation. Also had over 20 zel side affects. I'm now on 2nd dose of ipi and I feel great. There was 11 days between ending zelboraf and starting ipi. Scary 6 or so more weeks until next scan but I'm already seeing some ipi side affects which they say is good cause it means ipi is starting to work. Dunno if that helps. It is just my experience with the 2 meds and they tell me everyone is different. Out of over 1000 zel patients my onc had I'm only his 2nd that had mel grow on zel.

I believe this is covered it the presentation posted by Jerryfromfauq on 11/2/13

I believe this is covered it the presentation posted by Jerryfromfauq on 11/2/13

I believe this is covered it the presentation posted by Jerryfromfauq on 11/2/13

This is important information. I would appreciate it if either you or Jerry could provide the citations for the studies you cite. 

I know that there is currently a clinical trial underway to test the sequence of ipi following Zelboraf. This is a short-term trial testing for adverse side effects of the sequence, not overall survival.

Other than that, I found 2 papers published last year by 2 different groups (one an abstract and one a full-length article) looking at overall survival with the sequence. Working with very few patients, both of these reports said that in about 50% of patients who become resistant to Zelboraf, their disease progresses so rapidly that the ipi does not have time to work. For the other 50% who did not experience rapid disease progression after failing Zelboraf, the ipi did work. Therefore, they recommend doing ipi first and then Zelboraf if necessary.

So from what I read, the problem is not that the ipi doesn't work, per se, it's that so many Zelboraf resistant tumors become very aggressive and the patients don't survive long enough for the ipi to work. That's not quite the same as saying that ipi doesn't work after Zelboraf.

This is important information. I would appreciate it if either you or Jerry could provide the citations for the studies you cite. 

I know that there is currently a clinical trial underway to test the sequence of ipi following Zelboraf. This is a short-term trial testing for adverse side effects of the sequence, not overall survival.

Other than that, I found 2 papers published last year by 2 different groups (one an abstract and one a full-length article) looking at overall survival with the sequence. Working with very few patients, both of these reports said that in about 50% of patients who become resistant to Zelboraf, their disease progresses so rapidly that the ipi does not have time to work. For the other 50% who did not experience rapid disease progression after failing Zelboraf, the ipi did work. Therefore, they recommend doing ipi first and then Zelboraf if necessary.

So from what I read, the problem is not that the ipi doesn't work, per se, it's that so many Zelboraf resistant tumors become very aggressive and the patients don't survive long enough for the ipi to work. That's not quite the same as saying that ipi doesn't work after Zelboraf.

I thought that there is pretty convincing statistical evidence now that Ipi is way less  effective  if it follows zelboraf treatment, and that the sequence should be reversed in order to be effective.  I believe this was clearly presented in a melanomia symposium in Tampa (jerryfrom? posted a link to the conference) I've seen another paper also highlighting statistics that seem to back up the reason Zelboraf should be a last resort, even for those Braf positive.

I thought that there is pretty convincing statistical evidence now that Ipi is way less  effective  if it follows zelboraf treatment, and that the sequence should be reversed in order to be effective.  I believe this was clearly presented in a melanomia symposium in Tampa (jerryfrom? posted a link to the conference) I've seen another paper also highlighting statistics that seem to back up the reason Zelboraf should be a last resort, even for those Braf positive.

For your information– The trial they attempted last year was giving ipi and Zelboraf at the same time. That was toxic. Now they are trying to give Zelboraf followed by ipi (what they call "sequencing" rather than "combning"). We're hoping that works better. 

For your information– The trial they attempted last year was giving ipi and Zelboraf at the same time. That was toxic. Now they are trying to give Zelboraf followed by ipi (what they call "sequencing" rather than "combning"). We're hoping that works better.