In certain diseases such as Melanoma, standard chemotherapy had failed miserably, yes indeed Cisplatin and the Adriamycin of the world had failed to give us a result and combining them did not help either. For a while there, non specific immuno-modulation with interferon had been the standard approach but those days are gone also. Today it is the PD-1...and already Ipilimumab that enjoyed the center case in Metastatic Melanoma is moved a bit by the storm of Pembrolizumab and the Nivolumab. Clinician wonder now what to give first to a newly diagnosed patient, and whether clinical setting such as the location of the primary lesion should guide the drug selection. For the BRAF of the world, Vemurafenib/Zelboraf have had their time, but this drug effect is short lived given the relatively quick return of the lesion, and the need to remove surgically the eventual squamous (kerato-acantomatous )lesion that may result of their use. Like the Ibrutinib foe CLL, Pembrolizumab is now king in Melanoma. (and Nivolumab is moving already to lung cancers). The land is shifting, it is exciting to keep up. But frankly, is it right to treat liver infested by Melanoma from the skin, versus Melanoma from the Uveal origin when we know that one has the GNAQ gene. Yesterday I met a lady who had recurrent Melanoma in the Nostril...a PET is awaited. should I be able to offer directly Pembrolizumab arguing that the drug is said to be very easy on patients? (should my case turned to be Metastatic of course). Can the first treatment be a combination with Ipilimumab? Or is it too expensive...what cost can we afford?
In the Ovarian setting, anti-PARP are trying to enter the maintenance setting in Platinum sensitive disease, and BRCA status is pointing to responsive patients...should we use BRCA to make a case for Maintenance disease control with Olaparib. The FDA is waiting for result of a larger study...not the "19" study they say!!!! But May be this story is yet to be written...
On the Her-2 front, 2 is not better than 1 or is it?
and I could go on all night long....we live an exciting time in Oncology!
with news like this coming along: "
Ibrutinib Stands Center Stage in CLL" (medscape)
1 comment:
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