MPIP: Melanoma Patients Information Page

The MPIP is the oldest and largest community of people affected by melanoma hosted through the Melanoma Research Foundation. It is designed to provide support and information to caregivers, patients, family and friends. Once you have been touched by melanoma—either as a patient or as a family member or friend of a patient—you become part of a community. It is not a community anyone joins willingly. But if you must be part of this group, you will find no better place to find the tools you need in your journey with this cancer, and the friends who can make that journey more bearable.

The information on the bulletin board is open and accessible to everyone. To add a new topic or to post a reply, you must be a registered user. Please note that you will be able to post both topics and replies anonymously even though you are logged in. All posts must abide by MRF posting policies.

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bonnieb's picture
Replies 2
Last reply 10/24/2010 - 11:30pm
Replies by: Janner, Anonymous

But it just occured to me today that if only 7% of people have a second primary then why do we avoid the sun after diagnosis with the first?

Not that I am looking for an excuse to go tanning or anything but my Doctor seems so vague about everything and I just wondered about it. Does exposure to the sun increase the chance of melanoma returning?

Cheers,

BonnieB (diagnosed stage 1 Nov 09)

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ValinMtl's picture
Replies 11
Last reply 10/29/2010 - 6:05pm

Just to say that I attended the above last Friday and am so glad that I did.  I developed a huge respect for the doctors/researchers at Mass General..exciting news insofar as possibility of combining treatments such as B-RAF and ipi..coming up the pipeline. I also thoroughly enjoyed meeting up with some of my colleagues on the Bulletin Board...Tim/Shelby from MRF, Jerry from Cape Cod and Farm Girl.  Just wish it had been a two-day conference.  Keep on cycling Jerry..hope to get back to that myself next year...so good for the soul and health. I'm still chuckling about the comment from the 12-year old. Val xx

Live Laugh Love Nothing is worth more than this day!

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Anonymous's picture
Anonymous
Replies 2
Last reply 10/25/2010 - 8:51pm
Replies by: lhaley, Sharyn

Hi,

As luck would have it, I had full head to toe PET/CT scans in 9/10 to get into a trial but I did not have a 1cm tumor. I had 2 tumors 6mm & 4mm on thigh

Now, I have another recurrence on my thigh that is growing very fast.

I really do not want to have scans again  until I am ready to qualify for a trial and the scans are part of the trial requirement.

Question: Has anyone had their tumors measured by other macines besides CT like ultrasound or anything else that can measure the size of the tumor? Are these machine reliable/definitive??

If I can just determine when my tumor is 1 CM then I can contact trials I might qualify for!! I do not want to sign up for a trial assuming that my tumors are 1cm then go through the scans & not qualify because the scans come back with less than 1 CM tumors.

Thanks for taking the time to repsond to my post. Wishing everyone a NED status.

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fliberdy's picture
Replies 11
Last reply 10/29/2010 - 10:22pm

Can anyone tell me if the sentinel node biopsy is very painful? 

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fliberdy's picture
Replies 8
Last reply 10/24/2010 - 3:37pm
Replies by: fliberdy, Anonymous, Sharyn, teenagermom

I can not sleep and just discovered this site. I'm hoping to find some answers and encouragement here. I guess I don't really have a stage yet  The Dr thought  I was stage 1 but now they want to take more and do a sentinel node biopsy because the labs came back after surgery with rogue cells? Dr said my case is very odd, he has never seen this before. I am floundering here, anyone hear of something like this?

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Emerging concepts in biomarker discovery; The US-Japan workshop on immunological molecular markers in oncology

Howard Streicher (CTEP, Bethesda, MD, USA) presented an overview of biomarkers useful for patient selection, eligibility, stratification and immune monitoring. CTEP sponsors more than 150 protocols each year across many types of new agents, so that this program is familiar with the need to prioritize trials selection using biomarkers. Biomarkers are important for 1) patient selection and stratification for the best therapy; 2) identification of the most suitable targets of therapy; 3) measurement of treatment effect; 4) identification of mechanisms of drug action; 5) measurement of disease status or disease burden and; 6) identification of surrogate early markers of long-term treatment benefit [1].

Examples of biomarkers predictive of immunotherapy efficacy (predictive classifiers) [4-7] are telomere length of adoptively transferred tumor infiltrating lymphocytes which is significantly correlated with likelihood of clinical response [8], serum levels of vascular endothelial growth factor (VEGF), which are negatively associated with response of patients with melanoma to high dose interleukin (IL)-2 administration [9] or K-ras mutations that predict ineffectiveness of cetuximab for the treatment of colorectal cancer [10]. Recently, the European Organization for Research and Treatment of Cancer (EORTC) reported a signature derived from pre-treatment tumor profiling that is predictive of clinical response to GSK/MAGE-A3 immunotherapy of melanoma. The signature includes the expression of CCL5/RANTES, CCL11/Eotaxin, interferon (IFN)-γ, ICOS and CD20 [11,12].

 

http://www.translational-medicine.com/content/7/1/45#B43

 

Take care

 

Jimmy B

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Has anyone heard how Jenna's doing. Lauren has not posted for awhile & I am worried. Thanks

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ValJaneMB's picture
Replies 29
Last reply 1/20/2011 - 9:24pm

Hi Everyone.  I have been lurking on this board for a few years now but now realize that by joining I will get the info. I need to help me decide on my next course of treatment.  As you can see by my profile, I am a 57-year old woman with what my Oncologist calls 'low bulk' disease even though it is Stage IV.  I would like to hear from anyone who has been through Interleuken 2 therapy.  As a Canadian, I will have to travel to Pittsburgh for treatments.  Right now, I do not know the hospital.  Everyone has posted lots of information on side effects, etc.  But how safe is it?  I have the following choices:  1.  wait and see with scans every 3 months.  2.  Dacarbazine treatment here in Winnipeg.  3.  Interleuken 2 treatment in Pittsburgh.  Which has a better chance of success?  Which treatment has the worst side effects?  Does anyone know how quickly melanoma progresses from the lymph nodes to other areas of the body?  That would help me with the 'wait and see' choice.  I forgot to mention that for some reason, the one year of Interferon does not make me eligible for IPI trials.  Only by trying and failing Dacarbazine or IL 2 will I be able to receive IPI.  Who knows why?  Anyway, I am thanking everyone in advance for responding to my questions.

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Carmon in NM's picture
Replies 5
Last reply 10/25/2010 - 9:47pm

Background: diagnosed 3b in 9/2008 with an upper left arm lesion. Clean scans through 11/2009. A sudden brain bleed 6/2010 turned out to be a metastatic tumor that hadn't shown on the 11/09 scans. An emergency craniotomy took care of the bleed and I had Gamma Knife Surgery 7/2010 for the primary tumor as well as one less than 4mm discovered at the same time. Full body scans done 6/2010 showed no other distant lesions.

S

Full body scans taken 9/2010 as a followup to Gamma Knife showed a new tumor on the right adrenal gland and we decided it was time for systemic therapy. We are waiting on the results of a biopsy taken 10/11/2010 and sent to France to see if I am c-kit positive and will qualify for a focused drug trial. Pathology done at the hospital (UNM Cancer Research Center) showed very sparsely scattered groups of 1 or 2 melanoma cells in the new tumor and my onc and I have decided to proceed with a Phase II trial of Carboplatin, Paclitaxel, and Temozolomide rather than wait the additional weeks for the c-kit analysis. If I am positive, I can always move on to that treatment.

I'll be getting the first infusion this coming Monday morning and I'm wondering if any of you who have experienced chemo have any suggestions or advice, things you wish someone had told you in advance. I'll be getting two 28-day courses before we do another set of scans. The goal is to find something this tumor will respond to, get it reduced in size, and then remove it surgically. I will have as many as six courses if we are seeing any improvement.

I have a great local Healing Team of a Dr of Chinese Medicine/Acupuncturist who is also an RN who has extensive experience with treating chemo side effects using needles. I also have a Homeopathic Doctor with advanced study and certification for using diet and supplements to assist with the side effects of chemo.

Some good news - a brain MRI done last Saturday showed the primary brain tumor (2 by3 centimeters originally) has reduced by 50% and the small one has stayed stable at less than 4mm and my onc feels it is most likely just a bit of scar tissue now.

Is there anything you found helpful to do before infusion? Eat or not eat? If eat, what was helpful? Anything that you brought that helped you to be more comfortable during a three hour infusion? How about the best things you found to do after treatment? Anything you can think of that you wish you had known will be greatly appreciate.

Thanks in advance - Carmon in NM

Carmon in NM: Stage IIIB 9/2008; Stage IV 6/2010 with brain and adrenal mets; NED since 4/13/2011. It’s not what happens to you, but how you react to it that matters. ~ Epictetus

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glewis923's picture
Replies 1
Last reply 10/25/2010 - 9:26pm
Replies by: Anonymous

Dear Fellow Mellas:    I've called some more #'s and found that I am in grevious error in what i thought i heard from a head research person from a major cancer center.  I've been under stress and a little hard of hearing (too much Rock-n-Roll and drum playing).  I was wrong, wrong, wrong and should never have put up something of that importance unless i was 1000% true!

Please accept my idiotcy.  

Love to ALL-  Shady-Grady.

I'm Here for Now, I've got the rest of my life to die; and if so, old age could be overated and God does exist.

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glewis923's picture
Replies 2
Last reply 10/23/2010 - 2:25pm
Replies by: glewis923

Sorry- I made typo and added extra "0" in previous post.  Guess the wonderful FDA considered this particular trial to be too compassionate!  Damn stinking beurocrats and trial lawyers!!!!!!!!!!!

I'm Here for Now, I've got the rest of my life to die; and if so, old age could be overated and God does exist.

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This was recommended as an optional treatment alternative by Estabrooke Cancer Cent. in Omaha.  I know they are doing this study at Sarah Cannon Cancer Cent. in Nashville.

Would Love to know if anyone has done this protocal.  

 

Thanks & Love,  Shady-Grady.

I'm Here for Now, I've got the rest of my life to die; and if so, old age could be overated and God does exist.

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Dear Fellow Mellos;

Just talked with VERY helpful folks at Eastabrooke cancer center in Omaha.  They told me the GSK 2118436 B-raf drug trial phase II (NCT 011537630) had been pulled (terminated?) by FDA nationwide.  MDAnderson cannot seem to give me an answer at all.  I waited 5 long weeks for MDA to lemme know i was B-raf positive.  Now my CT scan 2 days ago show 3 Nodules OVER 1 cm. as well as the continued others.  I completed 1 yr. I-feron 3 mths. ago.

Does ANYONE know of a viable active B-raf trial available via GSK, Novartis, Roche, Bayer?, anyplace anywhere?  

I know i could get IPI, but i'm just not too impressed with the stats on it- maybe i'm wrong.  At least the B-raf drugs showed miraculous results- albeit short term;  AND  traditional IL-2 shows Proven long term results on around 10% of people.  I really wanted to do B-raf drug to at least buy some somewhat guaranteed time.

Any suggestions or trial knowledge greatly appreciated!

Love, Shady-Grady.

I'm Here for Now, I've got the rest of my life to die; and if so, old age could be overated and God does exist.

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jross's picture
Replies 1
Last reply 10/23/2010 - 8:02am
Replies by: Fen

Does anyone have information on the long-term side effects of interferon. I am still here 6 years after my 45 weeks of regular injections. Have searched and can't find anything specific. AAny recommendations on search terms would be helpful since I have struck out using long term and chronic. Your assistance would be appreciated. JRoss

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Jim,
First of all thank you for replying to my post. I usually don’t get many replies. When I talk to my wife about this, within the first five minutes she is telling me “I am loosing her.” It has taken me close to three years to get to where my knowledge on melanoma and the immune system is today. I don’t mean to talk over patient heads. It is just the scientist in me. I worked at Eastman Kodak’s Research laboratories for 25 years.

Now to answer you first question:

You have said that the most effective durable treatment for advanced melanoma would consist of Ipilimumab combined with IL2 - is that correct?

Based on my research today, IL-2 and Anti-CTLA-4 (Ipilimumab) are most durable as we speak. A new phase I therapy is showing great promise with less side effects. That is anti-PD-1 Therapy. These therapies don’t need a specific HLA type to get into the trials.

There is also a very, very ,very new therapy that is still in translational stage. Translational research is a way of thinking about and conducting scientific research to make the results of research applicable to the population under study and is practised in the natural and biological, behavioural, and social sciences. It is usally conduted with animals like rats, mice, monkies.

Anyway this therapy combines the Anti-CTLA-4 and Anti-PD-1. It has shown syenergnic results.

 

If you have c-Kit or BRAF mutations, then targeted therapy may used but may not be durable.

If you are HLA-02 Positive, You have the option of ACT therapy with Dr. Rosenberg or Dr. Patrick Hwu at NCI or MD Anderson. They have gotten 72 % response rate with I think about 36 % complete response is I am not mistaken.

        Second Question:

There are no studies currently availble that combine Ipi and IL2, is that correct?
Define combine? There was a clinical study done by Dr. Rosenberg and colleages.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

As you can see in the graph above, IL-2 was added prior to the maximum propagation of the CD4+ T helper cells. IL-2 is known as a growth factor. So what I believe happened in this trial, they grew the Tregs.

IL-2 treatment during the expansion phase was detrimental to the survival of rapidly dividing effector T cells. In contrast, IL-2 therapy was highly beneficial during the death phase, resulting in increased proliferation and survival of Tumor-specific T cells. IL-2 treatment also increased proliferation of resting memory T cells in the host that controlled the disease. A tumor-specific T cell in chronically infected Host also responds to IL-2 resulting in decreased tumor burden. Thus, timing of IL-2 administration and differentiation status of the T cell are critical parameters in designing IL-2 therapies (Blattman et al., 2003).

So what I am trying to say is you do the Ipilimumab therapy first. Wash out for about 50 days, and then start IL-2 Therapy.

Take away:   It is a systemic combination with dosing and timing involved. Systemic Combinatorial Therapy.

Question 3:

If someone were to choose to do a combination treatment on their own (i.e. get IL2 following a course of Ipi through one of the clinical trials), would there be an advantage
to starting IL2 as soon as possible after stopping Ipi? Is there a time frame after which there would be no advantage to having received Ipi prior to taking IL2?

Base on papers from ITOH etal and others, 49 days after activation is at the maximum growth phase for the CD8- T-cells that mature into Cytotic T Lymphocytes.

<strong>Results: Graph setup</strong>

Kinetic Study of rIL-2-induced Expansion. In all 12 metastatic melanomas tested, a substantial proportion of TIL was present in tumor cell suspensions.
The ratio of lymphocytes to tumor cells ranged from 0.03 to 1.25 with an average ratio of 0.40 t 0.37. By fluorescence analysis,
TIL consisted of 78 days 11% CD3
T cells, 33 days 10% CD4+
<strong>T cells, 49 days 17% CD8+</strong>
Their CD4/CD8 ratio was 0.67.
(ITOH et al., 1988)

It was also reported that there is a time factor involved.
Our results show that T4 + human T cells differ substantially from T8 + cells with respect to their IL-2 responsiveness. T4 + cells cease to proliferate well before T8 + cells during a primary response. (GULLBERG AND SMITH et al.,1986)

<strong>Is there a time frame after which there would be no advantage to having received Ipi prior to taking IL2?</strong>

Yes, Ipilimumab has a half life of 15 days. So say you get one dose at 3.0 mg/Kg.

Days-- concentration
0-- 3
15-- 1.5
30-- 0.75
45-- 0.375
60-- 0.1875
75-- 0.09375
90-- 0.04687
105-- 0.02343
120-- 0.01171
135-- 0.00587
150-- 0.00292
165-- 0.00146
180-- 0.00073

It gets more complicated when you get multiple doses. Four dose regiment.

Days-- concentration
0-- 3
15-- 1.5
30-- 3.7
45-- 4.85
60-- 5.425
75-- 2.7125
90-- 1.35625
105-- 0.68
120-- 0.34
135-- 0.17
150-- 0.08
165-- 0.04
180-- 0.021

I am not sure where the limited threshold is but, at day 49 you have close to the maximum concentration of Ipilimumab in your body.

Since I used Tremelimumab with Half Life = 21 days and did 15mg/Kg

I had at day 50 approximately 2.17 mg/Kg anti-CTLA-4 level in my body

<strong>If I had to venture an educational guess, I would say after a four dose regime, you have 75 days to do the HD IL-2.</strong>

To back this theory up, we will use a chart from Dr. Wolchok experience the Ipilimumab.

It is a chart with the Absolute Lymphocyte count. (ALC). It is the CD4+ T-cells and CD8+ T cells combined.

 

 

 

 

 

 

 

 

 

 

 

 

As you can see from the graph, the maximum ALC was about week 7.
Week seven correlates to 49 days. That is when CD8+ T cells are at their maximum growth.

 

Question 4:

Last, is there any evidence that IL2's efficacy is enhanced by combining it with other agents (i.e. Biochemotherapy), either with or without first receiving Ipi?

This my take on the situation. You need the <strong>tumor-specific antigen</strong> to presented to the T-cells as signal 1. That could be a vaccine, radiation therapy or chemo to shed the antigen.
<strong>Secondly you need the costimulation of the CD28/B7 interface</strong>. By using Ipilimumab that blocks the CTLA-4 receptor from binding to the B7 molecule and shutting down the response.
Anti-CTLA-4 (ipilimumab) also blocks the CTLA-4 receptor on the Treg cells subduing their surpress function.

Third you need a “Danger Signal”  to get the cell to migrate to the tumor site. This may be done with inflammatory Cytokines like IL2, IL17, IL-1,IL-12,IFN gamma that act directly on the T-cells. This signal was found to optimally activate the Th1 differentiation and lead to the clonal expansion of the T-cells.
It has come to light recently that Ipilimumab helps also in the differentiation by tilting the balance towards Th17 cells. These cells secrete IL-17 which recruite the neutrophils. This all takes place at the tumor’s microenviroment. The neutrophils secrete chemokines that are chemoattractants.

These chemokines, MIP-1alpha, MIP-1beta, and MCP-1 are recently reported to serve as chemoattractants for Th1 cells. MIP-1alpha and MCP-1 are also reported to enhance antigen-specific (CTL) Cytotoxic T Lymphocyte induction. Studies revealed that MIP-1alpha /beta released from neutrophils are involved in recruitment of macrophages, T cells, monocytes, dendritic cells (DC), neutrophils and NK cells.
MIP-1 attracts predominantly CD8+ T cells while MIP-1 attracts CD4+ cells, although there is some overlap between subsets in response to both chemokines.
The other Chemokine MCP-1, binds to CCR2 to accumulate monocytes/macrophages, DC, T cells, and NK cells, thereby playing an important role in innate and adaptive immunity. CCR2 is Chemokine receptor that is key determinant of leucocyte trafficking.

IL-2 strongly upregulates expression of CCR2. With the MCP-1/CCR2 interface, the cells can traffic towards the tumor’s microenvironment. The trafficking of the cells and inflammatory cytokines present the perfect storm in the tumor’s microenvironment to induce the right immune response to eradicate the cancer, Melanoma.
So to answer your question, is there any evidence that IL2's efficacy is enhanced by combining it with other agents (i.e. Biochemotherapy), either with or without first receiving Ipi? yes if you know and take a systemic approach. You need to activate the t-cells before introducing IL-2. IL-2 can be the activator for small patient population.

As for Ipilimumab going it alone, like IL-2 can be the activator for small patient population. But when you do a systematic combinatorial therapy, there can be a synergetic result, complete response.

I hope I answered you questions, and please don’t hesitate to ask them. I do all this time by requesting reseach papers from around the world. Each question is a learning tool. There are no stupid questions. Knowledge is power to make an educated decision. Your Life may depend on it. There are many paths to take. Just follow the yellow brick road to complete response.

 

“It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.”

~Charles Darwin~
Take Care,
Jimmy B

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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