My dad may be starting a trial combining keytruda and lenvatinib. He hasn’t undergone any genomic testing and I’m not sure he will respond on the basis that while it can be effective for a small subgroup I wonder if there is a more appropriate trial he should be considering? We have pushed for g testing but oncologist says that while it’s good at identifying mutations he explains there are no real treatments for those mutations??? He does have small % of nepc. Any thoughts on this trial or keytruda in general
Thank you
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Poppi07
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There are many Keynote trials of Keytruda -which one is he interested in?
There is only one clear indication that you can glean from genomic testing - that is whether he has a mutation in his BRCA gene. Also, there are two different types of genomic testing - germline and somatic. If he is BRCA- on a germline test, his cancer still may be vulnerable to a PARP inhibitor on a somatic test.
Probably more important than a genomic test would be IHC testing of metastasis biopsy tissue. They could check for markers of NEPC which would indicate clinical trials. Markers for MSI-hi/dMMR as well as presence of PD-L1 might indicate that Keytruda would be effective for him.
Thank you for your thoughts. Recently completed BRCA testing which was negative and ruled him out of parp inhibitor. Perhaps they will do biopsy that could indicate whether this trial could be appropriate. Yes this trial has many arms to it one which includes nepc. He hasn’t declined genomic testing just saying there aren’t treatments available to address any underlying mutations. We are in Australia.
Can't imagine a trial without genetic testing. Foundation One gives complete report on mutations and suggests what drugs will work. Something does not add up here.
I should have added that I have nepc as well but have learned that it is now a mixed tumor with some adenocarcinoma active yet. Very few of us transform to pure nepc.
Thanks den doc. Yes his too is mixed. I guess I’m trying to understand the process of clinical trials and maybe they will be that prior to see if he’s a candidate?
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