What to do following a year of success, then progression with Keytruda

Posted By
10/9/2017 1:40am
Replies: 3

So it looks like this may be the end of the road on Keytruda for me. I’ve had a more than 50% reduction in my Mets (mostly the lungs, liver and lymph nodes) on Keytruda, but recently had a medium sized new met pop up in a lymph node, possibly more than one. Looking at my options (based on doctor conversations and lurking), i see

1. Braf/mek inhibitors

2. Chemo or biochemo

3. TIL (although it’s unclear whether my Mets are harvestable)

4. Ipi + maybe Nivo

5. A pd-1 + experimental agent (lag-3, HDAC, IDO....others?) clinical trial

6. Something I’ve not heard of before - systemic vaccines? New mabs?

has anyone here had a durable CR after failing a year of Keytruda (that would be FANTASTIC to hear!)? What did you do? Anybody get a mixed response or durable remission afterwards? Any suggestions from the science-minded folks on here? Honestly BRAF targeted therapy is not very attractive to me since the disease is moving fairly slowly at the moment. I am not pain and/or brief misery averse.

I've been stable on ipi-nivo for 18 mos after progressing on Keytruda.  The success rate (stable or better) for patients of this type is around 20 percent based on a small MSK study.

Maybe also consider an intralesional (PV-10, T-VEC, others) to zap the lymph node. Doesn’t seem like a failure on Keytruda, most Melanoma has regressed. The lymph node is doing it’s job in catching the migrating melanoma cells. Sounds like you are close to success.

Diagnosed Jan 2017 (stage 3b with unknown primary). Radical neck dissection Feb 2017 (4 positive nodes in level 5A). Ipi started Mar 2017 - ended May 2017 (Hypophysitis), recurrence Sep 2017 (nodes in back of ear and parotid)

Thanks - they are hila lymph nodes so I’m not sure if they are accessible