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Yervoy or DTIC/Temodar? Please help
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Yervoy or DTIC/Temodar? Please help

› Forums › General Melanoma Community › Yervoy or DTIC/Temodar? Please help

  • Post
    • September 18, 2011 at 11:45 pm
    cwu
    Participant

      Hi,

      My father is 83 years old and was diagnosed with Stage III melanoma which originated in the sole of his foot.  He had surgery a year ago and his cancer came back in the form of lesions on his calf this year.  There are hundreds of them and scans showed that it hasn't metastasize to his organs. He tried a targeted chemo drug, Dasatanib, but it didnt work after two months. He has a c-kit mutation.

      Hi,

      My father is 83 years old and was diagnosed with Stage III melanoma which originated in the sole of his foot.  He had surgery a year ago and his cancer came back in the form of lesions on his calf this year.  There are hundreds of them and scans showed that it hasn't metastasize to his organs. He tried a targeted chemo drug, Dasatanib, but it didnt work after two months. He has a c-kit mutation.

      We now have two options, Yervoy or DTIC/Temodar.  His oncologist recommends Yervoy however the side effects seems so scary.  I have been learning everything I could about Yervoy but dont know as much about DTIC/Temodar. Yervoy seems to offer the hope of prolonging life longer but I also saw somewhere that it works on only about 15%.  Does any know the statistics for DTIC/Temodar (I am an accountant so my instinct is to look at the numbers first 🙂 ). 

      If you have tried both DTIC and Yervoy, please let me know how they compared and what worked for you. Also, does it make a difference which treatment you should try first?  Thank you.

    Viewing 5 reply threads
    • Replies
        • September 19, 2011 at 2:31 am
        Lisa13
        Participant

          Sorry to hear your father has advanced to Stage 4.  There are a few promising treatments such as Yervoy that are new and show promise more than the traditional chemo.

          I tried dacarbazine for my lung mets back in June and July and it didn't work for me. The rate of success with this chemo is about 10-15% and works for approx. 6-9 months. Keep in mind that these are just numbers.  I'm currently on Yervoy and have had no side effects as of yet other than itchy skin and an occasional upset stomach which I take nothing for. Dacarbazine can have side effects and the big drawback is that it kills healthy cells and your immune system – Yervoy does not.  Yervoy's side effects do seem scary, but if you notify the Dr of any symptoms early, they will be managed early before they get worse and then very serious.

          In trials, the numbers for Yervoy arn't outstanding, but those who've had a complete response have a durable remission for 2 years and counting.  There are several people on this board who've watched their sub q's like your father's disappear, so there is hope. 

          Keep in mind your fathers age and current health and whether he would be able to withstand the toxic nature of dacarbazine/Temodar.  Both of these chemo are a "milder" version of chemo, but still wreck havoc on your immune system. Yervoy does have the potential to cause problems, but as long as your father is diligent about reporting side effects to the Dr, he can be watched closely.

          Best of luck!

          Lisa – Stage 4

          • September 19, 2011 at 2:31 am
          Lisa13
          Participant

            Sorry to hear your father has advanced to Stage 4.  There are a few promising treatments such as Yervoy that are new and show promise more than the traditional chemo.

            I tried dacarbazine for my lung mets back in June and July and it didn't work for me. The rate of success with this chemo is about 10-15% and works for approx. 6-9 months. Keep in mind that these are just numbers.  I'm currently on Yervoy and have had no side effects as of yet other than itchy skin and an occasional upset stomach which I take nothing for. Dacarbazine can have side effects and the big drawback is that it kills healthy cells and your immune system – Yervoy does not.  Yervoy's side effects do seem scary, but if you notify the Dr of any symptoms early, they will be managed early before they get worse and then very serious.

            In trials, the numbers for Yervoy arn't outstanding, but those who've had a complete response have a durable remission for 2 years and counting.  There are several people on this board who've watched their sub q's like your father's disappear, so there is hope. 

            Keep in mind your fathers age and current health and whether he would be able to withstand the toxic nature of dacarbazine/Temodar.  Both of these chemo are a "milder" version of chemo, but still wreck havoc on your immune system. Yervoy does have the potential to cause problems, but as long as your father is diligent about reporting side effects to the Dr, he can be watched closely.

            Best of luck!

            Lisa – Stage 4

              • September 19, 2011 at 3:21 pm
              cwu
              Participant

                Thanks for your insight Lisa, very good point about DTIC's impact on the immune system. Looking at it that way, it doesnt sound like the side effects of Yervoy is as bad.

                Are you done with your Yervoy treatment and what was the response.

                Thanks,

                Chau

                • September 19, 2011 at 3:21 pm
                cwu
                Participant

                  Thanks for your insight Lisa, very good point about DTIC's impact on the immune system. Looking at it that way, it doesnt sound like the side effects of Yervoy is as bad.

                  Are you done with your Yervoy treatment and what was the response.

                  Thanks,

                  Chau

                • September 19, 2011 at 2:37 am
                FormerCaregiver
                Participant

                  Welcome to our forum. If you could complete some details on the profile page for your father, that will help us to help you better.

                  Melanoma is unlike other cancers, and statistics are really not helpful in trying to predict any individual's prognosis. There are many people here who continue to defy the stats that you may have seen.

                  The treatment that is recommended can depend on the oncologist and the area in which you are located. Ordinary chemo such as DTIC/Temodar can be given as an intial treatment, to be followed by Yervoy.

                  As you may know, Yervoy is a promising new drug that was approved by the FDA early this year. I wonder if your father's melanoma has been tested for the BRAF mutation? Melanoma treatment is advancing rapidly, and more options are becoming available. As toxicity is a concern, I wonder if your father could try something like GM-CSF (Leukine) and/or a vaccine that is available in clinical trials?

                  Hope this helps.

                  Frank from Australia

                  • September 19, 2011 at 2:37 am
                  FormerCaregiver
                  Participant

                    Welcome to our forum. If you could complete some details on the profile page for your father, that will help us to help you better.

                    Melanoma is unlike other cancers, and statistics are really not helpful in trying to predict any individual's prognosis. There are many people here who continue to defy the stats that you may have seen.

                    The treatment that is recommended can depend on the oncologist and the area in which you are located. Ordinary chemo such as DTIC/Temodar can be given as an intial treatment, to be followed by Yervoy.

                    As you may know, Yervoy is a promising new drug that was approved by the FDA early this year. I wonder if your father's melanoma has been tested for the BRAF mutation? Melanoma treatment is advancing rapidly, and more options are becoming available. As toxicity is a concern, I wonder if your father could try something like GM-CSF (Leukine) and/or a vaccine that is available in clinical trials?

                    Hope this helps.

                    Frank from Australia

                      • September 19, 2011 at 3:27 pm
                      cwu
                      Participant

                        Hi Frank,

                        Thanks for your comments. My father does not have the BRAF mutation. Do you know if C-kit and BRAF mutations are mutually exclusive or can someone have both? I have not heard of the other meds you mentioned and his oncologist never mentioned them either so I will look them up.

                        Chau

                        • September 19, 2011 at 3:27 pm
                        cwu
                        Participant

                          Hi Frank,

                          Thanks for your comments. My father does not have the BRAF mutation. Do you know if C-kit and BRAF mutations are mutually exclusive or can someone have both? I have not heard of the other meds you mentioned and his oncologist never mentioned them either so I will look them up.

                          Chau

                          • September 20, 2011 at 1:37 am
                          FormerCaregiver
                          Participant

                            Chau, as Jerry has said and from what I have read C-kit and BRAF mutations are mutually
                            exclusive. From: http://jcp.bmj.com/content/62/7/613.abstract "Mutations in KIT, PDGFRA
                            and BRAF were mutually exclusive in this study."

                            As your father seems to have primary dermal melanoma, I feel that another treatment
                            worth considering is PV-10. See:
                            http://www.asco.org/ascov2/Meetings/Abstracts?&vmview=abst_detail_view&confID=65&abstractID=34524

                            Best wishes

                            Frank from Australia

                            • September 20, 2011 at 1:37 am
                            FormerCaregiver
                            Participant

                              Chau, as Jerry has said and from what I have read C-kit and BRAF mutations are mutually
                              exclusive. From: http://jcp.bmj.com/content/62/7/613.abstract "Mutations in KIT, PDGFRA
                              and BRAF were mutually exclusive in this study."

                              As your father seems to have primary dermal melanoma, I feel that another treatment
                              worth considering is PV-10. See:
                              http://www.asco.org/ascov2/Meetings/Abstracts?&vmview=abst_detail_view&confID=65&abstractID=34524

                              Best wishes

                              Frank from Australia

                            • September 19, 2011 at 1:00 pm
                            JerryfromFauq
                            Participant

                              Since your father is C-kit positive, that rules out the BRAF mutation.  Given the two choicesyou haave presented here, I personally would go for the Yervoy (Ipi).  In generl it is more effective than the DTIC/Temodar.  The thing about Melanoma is that they are not yet at the point that they can tell just what will have what effect on each  individual.  in a smaller % of people the DTIC/Temodar has worked.  Any none targeted treatment can be rough on the recipiant.  In most people the Yervoy has milder side effects that regular chemo as well as haviing a higher percentage of benefit.  I am sorry that the C-kit meds didn't work.  Other options that may be available woould be to try a PD-1 trial or a MEK Trial.  (I would vote for the PD-1).

                              • September 19, 2011 at 1:00 pm
                              JerryfromFauq
                              Participant

                                Since your father is C-kit positive, that rules out the BRAF mutation.  Given the two choicesyou haave presented here, I personally would go for the Yervoy (Ipi).  In generl it is more effective than the DTIC/Temodar.  The thing about Melanoma is that they are not yet at the point that they can tell just what will have what effect on each  individual.  in a smaller % of people the DTIC/Temodar has worked.  Any none targeted treatment can be rough on the recipiant.  In most people the Yervoy has milder side effects that regular chemo as well as haviing a higher percentage of benefit.  I am sorry that the C-kit meds didn't work.  Other options that may be available woould be to try a PD-1 trial or a MEK Trial.  (I would vote for the PD-1).

                                  • September 19, 2011 at 3:37 pm
                                  cwu
                                  Participant

                                    Hi Jerry,

                                    So c-kit and BRAF mutations are mutually exclusive? You have one or the other and dont have both? You have very good comments, I was leaning toward Yervoy and your comments made me more comfortable. I have not heard of the other two options that you mentioned but I will check them out.  Thanks again for helping.

                                    Wish you all the best with your treatment,

                                    Chau

                                    • September 19, 2011 at 3:37 pm
                                    cwu
                                    Participant

                                      Hi Jerry,

                                      So c-kit and BRAF mutations are mutually exclusive? You have one or the other and dont have both? You have very good comments, I was leaning toward Yervoy and your comments made me more comfortable. I have not heard of the other two options that you mentioned but I will check them out.  Thanks again for helping.

                                      Wish you all the best with your treatment,

                                      Chau

                                      • September 21, 2011 at 5:14 am
                                      JerryfromFauq
                                      Participant

                                        Most of the articles I have read  on the subject and several Oncologists that I have spoken with say that BRAF and C-Kit are mutually exclusive.  The other articles say that the two have never been found to co-exist in the same melanoma patient.  So, while I cannot say one CANNOT have both, I will say that nothiing has been found and reported to indicate that one can have both.

                                        • September 21, 2011 at 5:14 am
                                        JerryfromFauq
                                        Participant

                                          Most of the articles I have read  on the subject and several Oncologists that I have spoken with say that BRAF and C-Kit are mutually exclusive.  The other articles say that the two have never been found to co-exist in the same melanoma patient.  So, while I cannot say one CANNOT have both, I will say that nothiing has been found and reported to indicate that one can have both.

                                          • September 21, 2011 at 5:16 am
                                          JerryfromFauq
                                          Participant

                                            How the heck did I click anonymous on the above?  OOPS.

                                            • September 21, 2011 at 5:16 am
                                            JerryfromFauq
                                            Participant

                                              How the heck did I click anonymous on the above?  OOPS.

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