Hi all, my mother, Ursula’s, scans showed new tumors with more uptake than previously seen on this course of Vem Cobi so Onc is suggesting either ipi /Nivo though there is a low chance /little known for this population of patients who have failed ipi (adjuvant) and keytruda twice. Maybe 20% if I understood right. Decarbazine was floated (%15). Or a trial. I have to connect with the MRF navigator to search. MSK will search too and mentioned NEKTAR. She also needs radiation now for her sacral tumor that shows new uptake after being dead for months.
Any thoughts on ipi/Nivo after failing both individually?
Any thoughts on trials after IO and targeted meds? Close enough to eastern PA area /NYC?
We are FINALLY getting advanced genetic testing too..
Thank you and wishing you all well. Nadia
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Your mom is in a tough spot, and like my husband, kind of outside the known science at this point. It's a disappointing place, but I see you are in your usual seek and find mode to find next steps, which I hope brings results.
The genetic testing sounds potentially helpful. Going through the navigators for clinical trials a great idea. Have you looked at the vaccine trials?
The NEKTAR reports for use of epacadostat seem mostly underwhelming, but with some longterm potentials from the 2019 ASCO meeeting with a small cohort: fiercebiotech.com/biotech/c...
The folks I know on the Ipi-Nivo combo have either done extremely well, or had much worse side effects. As you know, there is controversy currently as to whether the combo works because it IS a combo, of if because the individual patient is more responsive to one or the other drug (we don't know how to tell who will respond best yet to which immunotherapy).
I can't really read this article, but you probably can, about anti-Lag-3 technology. I think Johns Hopkins is doing a clinical trial with it you could look into:
J13101: A Phase 1/2a Dose Escalation and Cohort Expansion Study of the Safety, Tolerability, and Efficacy of Anti-LAG-3 Monoclonal Antibody (BMS-986016) Administered Alone and in Combination with Anti-PD-1 Monoclonal Antibody (Nivolumab, BMS-936558) in Advanced Solid Tumors. This study tests BMS-986016 (Anti-LAG-3) and BMS-936558 (nivolumab, anti-PD-1) in patients with advanced melanoma. Anti-LAG-3 and nivolumab are drugs that help to activate the immune system. Patients may have received prior treatment with anti-PD-1 and must:
have unresectable or metastatic melanoma
provide a baseline tumor biopsy and be willing to undergo an on-treatment tumor biopsy
I believe the MSK trial that will be researched is 2 Nektar drugs together:
A Study of NKTR-262 in Combination With NKTR-214 and With NKTR-214 Plus Nivolumab
I know some centers pre- test projected likelihood of IO drugs but MSK seems not too - I would like to know what that type of testing would show before deciding on trying the combo or a trial.
IDO /Lag3- very interesting, Missy, and thanks to you I think I have a working (ie civilian) idea about it to pursue! Here is an article that goes in deep about the failure of IDO Epacadostat in Phase 3 trials and why other trials such as BMS- 986205 that you mention at John’s Hopkins might be more positive. The one that combines with Relatlimab Anti Lag 3 looks interesting. I think I’ll have to reach out to Celeste (aka Bubbles) on this!
Hi Dorothe, thank you for replying. You and Frans have been through a lot (even if there is always someone else who has been through more). I guess you don’t know if he got the relatlimab? For someone who has failed pembro twice, the case would have to be a good one for doing it again with another agent. Adding the anti Lag3to the mix seems more interesting..
Nadia, you are right, we don't know what he took; since he is a near complete responder and despite the severe AE's, there was no reason to unblind. But in both arms of the trial there was nivolumab involved, so I am just thinking that it might be worth a try for your mom. Although pembro and nivo both are pd1 inhibitors, there are different reactions being reported. Plus the chance of ending up in the relatlimab arm. I am not sure if they are still recruiting though, would have to check that.
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New member — husband stage IV melanoma
Full brain radiation and immunotherapy questions
Brother with stage 3 melanoma 
My daughter has passed
