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

Posted By
10/9/2017 1:40am
Replies: 4

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.

2018 is a new year!

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