Keytruda? Does it work?

[spinosa]

I ran across an article stating Keytruda was being investigated at the Oregon Health Sciences center for its efficacy in fighting prostate cancer. How old is this idea? Does it work?

[spinosa]

Hmmm...interesting...thanks!

[Tall_Allen]

Some early results look good:

ascopubs.org/doi/abs/10.120...

If your tumor has a genetic defects known as MRSI-hi or dMMR, Keytruda may work very well, and it is FDA approved for it. There are a couple of dozen clinical trials of Keytruda or similar anti-PD-L1 drugs in combination with other therapeutic drugs (e.g., PARP inhibitors, chemo, hormonals, growth inhibitors or other immunotherapies)

[spinosa in reply to Tall_Allen]

Thank you for the specifics...

[spinosa in reply to Tall_Allen]

and, as always, genetic testing seems paramount...

[Tall_Allen in reply to spinosa]

Unfortunately, genetic testing is usually unproductive at this stage of development.

[spinosa in reply to Tall_Allen]

Would it be prudent to have genetic testing prior to... reaching a stage of development, as you put it?

[Tall_Allen in reply to spinosa]

I meant that for advanced PC, there are really very few treatments (only Keytruda, Carboplatin or PARP inhibitor) that can be done based on the genomic profile of the tumor, and the genomics that have therapies (e.g., MRSI-hi/dMMR, BRCA2, and a few other DNA-repair defects) are rare in tumors of men with prostate cancer. Hopefully, we will develop more therapies and be able to treat a wider array of genomic abnormalities in the future. Also a patient's tumors tested now will have a different genomic profile from his tumors if tested later. The tumor tests are expensive and insurance may not cover it, so it's a judgment call. It is better if one qualifies for a clinical trial where they include testing.

[spinosa in reply to Tall_Allen]

no getting around that this is a bummer

[Emak1]

I think it is in early trial for PCa, part of the broader Keynote trial, as Tall mentioned it zeros in on certain genetic defects.

However, a very good friend of mine was on of the first patient on trial for melanoma, late 30s, stage 4, bone, lung, colon, give 6-12 months. Had surgery on lung and colon to de-bulk, went on Keytruda, 2 yrs later, full remission, clean scans. No idea if it will hold, hoping for the best. And I think in his trial it was 30% effective. So he was on the miracle side of results.

But it did work. Hopefully, one day they can zero in on the criteria and say yup, you have genetic defect ABC, take a combination of XYZ and you are good, but for now it is trial and error.

[spinosa in reply to Emak1]

yes - it "all depends," doesn't it? Still, as you note, perhaps some doorways are being opened, some path forward may lie in wait...

[wifeofvet]

my husband was year 8 out of 13 when he presented wiith a second cancer that responded to Keytruda and was still responding to keytruda when he died of his aggressive PCa. whether it worked at all on his PCa is hard to tell.

[spinosa in reply to wifeofvet]

thank you - sorry for your loss

[JimBarringer]

I was actually one of the clinical trial patients. It is my understanding they are really trying to discover what genetic markers respond. They required an Xtandi failure before acceptance and had me on the Xtandi throughout the four keytruda infusions. While on keytruda PSA did drop from 56.17 in Oct 2017 to a low of 18.84 in Jan 18, three weeks after last infusion. Unfortunately there were no long term benefits for me as my PSA was 177.1 this week and I start chemo today. Well, I was beating the beast for thirteen years so now it’s just time to beat down another attack. By the way Spinosa, there are many in the study who are having great results.

Jim

[spinosa]

Such a confounding disease, no matter its form...why did they keep you ON Xtandi if it had failed? Is there research that a synergistic effect is possible via this route? I continue to root for you and all of us.

[JimBarringer in reply to spinosa]

I was confounded by that as well but it was just part of the trial. Dr Julie Graff is the lead investigator at OHSU

[spinosa]

Yes, Dr. Julie Graff...I've read of her...

[j-o-h-n]

It's working for my Lung melanoma.

Good Luck and Good Health.

j-o-h-n Thursday 04/26/2018 6:25 PM EDT