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Another failed trial

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Another failed trial

Posted By
sks2019
7/24/2020 1:21am
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Replies: 8

Hello family,

Back here to seek help from you all. I posted in Jan for my mom diagnosed in Oct 2018. failed nivo, pi/nivo with mets to liver, lungs and vaginal area. She started on a trial of PARP inhibitor niraparib in feb , we thought her liver lesion was shrinking ( as the scan said there is less activity in the middle of tumor and it looks necrotic ) another scan in June released shows lesions back in the vaginal wall. She is kicked out of the trial for progression so we are back to choosing another trial out of two options provided. One being the XmAb20717 which as I understand is ipi/nivo ( I am concerned why she is being offered the same thing when we have only seen progression on it before. ) Can it do any good when ipi/nivo caused a significant progression in the liver ?

the second option is injecting a herpes virus into the vaginal lesions biweekly and scan after 12 weeks , i asked the onco will it help with the lesions in the lungs and liver and the reply is theoretically it should.
Please pour in your opinions and thoughts. I know ultimately we have to make a decision but would like to know what would you choose if you were faced with these two options.

I am really concerned with mom feeling very fatigued and low on energy.

ed williams - (7/24/2020 - 8:31am)

Hi SKS2019, a couple of ideas on injectables, masterkey 318 is combining t-vec plus pembro injected into liver. Following video covers injectables starting at 9:34 min mark with t-vec at 12:38 min mark. You will notice tlr-9 as another injectable that has shown promise. As to trial Xencor XmAb20717 is a bispecific also discussed in first video at 19:20 min mark but another drug from Immununocore not Xencor. https://www.youtube.com/watch?v=fbSHUEbhTho&feature=youtu.be

Bubbles - (7/24/2020 - 9:14am)

I am sorry that you and your mom have to continue to search for and struggle with these treatments. There are many intralesional treatments (treatments that are injected directly into tumors. Here is a list of some:

CAVATAK - derived from the Coxsackievirus
T-VEC - also called OncoVEX, Imlygic, or Talimogene Laherparepvec - uses the herpes virus with GM-CSF
PV-10 - derived from Rose Bengal
HF10 - also derived from HSV
SD101 - a TLR9 agonist
IL-2 - is also being used

Here are LOTS of reports on them: https://chaoticallypreciselifeloveandmelanoma.blogspot.com/search?q=intr...

Hope that helps. c

Mark_DC - (7/24/2020 - 9:17pm)

Dear sks2019,

One year of TVEC plus pembro worked for me, following one year of pembro where I experienced gradual progression (but still localized). It seemed like a miracle, my hospital had just started to offer this treatment, however my understanding is that it did not work for others at my hospital (I think their tumour burden was greater). So I would go for TVEC (or some other intralesional) plus pembro not TVEC alone. It might work on the vaginal lesions and then you hope that it also cleans up the other lesions by the abscopal effect or because the pembro kicks in. TVEC plus pembro took time for me to work - for the first few weeks my tumour was inflamed, after three months we were back where we started but the direction was the right one.

I think intralesional plus ummunotherapy is a promising approach. I dont know about the other trial you were mentioning.
I hope one of these will work for your mother
Best wishes Mark

Mark_DC - (7/24/2020 - 9:17pm)

Dear sks2019,

One year of TVEC plus pembro worked for me, following one year of pembro where I experienced gradual progression (but still localized). It seemed like a miracle, my hospital had just started to offer this treatment, however my understanding is that it did not work for others at my hospital (I think their tumour burden was greater). So I would go for TVEC (or some other intralesional) plus pembro not TVEC alone. It might work on the vaginal lesions and then you hope that it also cleans up the other lesions by the abscopal effect or because the pembro kicks in. TVEC plus pembro took time for me to work - for the first few weeks my tumour was inflamed, after three months we were back where we started but the direction was the right one.

I think intralesional plus ummunotherapy is a promising approach. I dont know about the other trial you were mentioning.
I hope one of these will work for your mother
Best wishes Mark

Bubbles - (7/24/2020 - 9:33am)

Just as an outside chance and so you can know what else is out there, here is a link to clinicaltrials.gov with the parameters of Stage IV melanoma and solid tumors with the "recruiting" box checked and limited to the US: https://clinicaltrials.gov/ct2/results?recrs=ab&cond=Stage+IV+Melanoma&t...

Clearly, some of these are not applicable to your mom due to BRAF status and other factors, but you might find some treatments and meds you'd like to speak to her doc about. c

gopher38 - (7/24/2020 - 9:52am)

There must be more to the XmAb20717 study, because they don't need to do a trial on ipi/nivo, which is already approved, right? So I guess it depends on what is being added. I think I've heard this Duad fellow at UCSF is one of the leaders, so I'd follow his advice. Just my gut feel (which is as far as my expertize goes), but I think I've heard good things about these intralesionals, so I'd be inclined to try something new.

ed williams - (7/24/2020 - 10:58am)

There are called bispecific, here is company prom. on how it works. https://www.xencor.com/pipeline/xmab20717/