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Another trial option opening up

Another trial option opening up

Posted By
sks2019
2/7/2020 3:10pm
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Replies: 6

Hello folks,
Those who have been following my posts can relate but I will give a summary again
Mom diagnosed with Vaginal melanoma Oct 2018 with metastsis to lymph nodes.
Surgery done to remove vaginal tumor.
Started Opdivo/Nivo Feb 6 ,2019 , Stable scans in May
August scans reveal two 1x1 cm lesions in liver
Sept 2019 started Ipi and Nivo combo.
Nov 2019 3rd dose of ipi/nivo
Severe colitis and hospitalization
dec 2019 scans again show tumor growth to 4 cm and more new lesions in liver
Jan 2019 , PET CT shows tumor grown to 7 cm
Melanoma doc at UCSF proposed trial Xmab20717 ( basically ipi/nivo with a different delivery way)
Radiation oncologist offered Y90 radio embolisation to liver
CPMC Melanoma doc is proposing another Trial https://clinicaltrials.gov/ct2/show/NCT03925350 basically a trial for Niraparib ( never heard of it before )

Now ..the real dilemma
Melanoma doc at UCSF wants to giver her ipi/nivo again with Y90 to see if it helps. ( Ipi/nivo gave her colitis and actually we saw disease progression after that )
Melanoma doc at CPMC wants to try the Niraparib as she hs a ATR mutation and Niraparib seemed to be promising for this mutation in Ovarian cancer patients and is more targeted.

As I have not heard of anybody on this board talking any of these. I am updating as well as seeking advice on what you feel should be a reasonable choice here.

For what it is worth here are a couple of the trials that looked at Niraparib but not in melanoma or little mice with melanoma so this would be really exploratory!!! https://www.fda.gov/drugs/resources-information-approved-drugs/fda-appro... https://www.jnj.com/janssen-announces-u-s-fda-breakthrough-therapy-desig...

There is also this article, where it seems that they add this to chemo vs chemo and placebo. With the melanoma trial is it just Niraparib alone or is it combined with an immunotherapy drug? https://www.nejm.org/doi/full/10.1056/NEJMoa1910962

Ed, It's going to be Niraparib drug only . His thought process is to target the ATRX gene mutation which he thinks is targeted by Niraparib.

thanks for always helping Ed.
It is exploraroty ! but then again other option is getting 4th dose of ipi/nivo which we already know she didint responded to in the first three cycles and she is still struggling with the side effects. . I am confused as to why he even offered it to us again. Has he given up already and just want to continue the treatment or has there ever been anyone who continued even after toxicity and disease progression.

This video is from 2016 and at the 3:20 min mark Dr. Weber talks about giving ipi again even after side effects but they must have resolved (gotten better). Again this is before all the stage 3 adjuvant approvals of immunotherapy drugs in 2018 and 2019. I think different dr.s look at things differently and there is no one way to go. Dr. Weber is one of the leading Dr. in the melanoma world so there is that!!! https://www.youtube.com/watch?v=iJP2ztMQjHk

Thanks Ed not sure what to make out of it. I am so down right now thinking about it. Ipi/nivo vs Niraparib. Niraparib is exploratory and Ipi/nivo showed only progression so far.