If you are recently diagnosed (specially, in the metastatic setting) and you have not been informed your MS status OR if you have been diagnosed before and neither know, please watch / read the following, because your MSI / MSS status might have implications for treatment:
Really worth-watching: video (and transcript below), to be up-to-date. Mainly for MSI, but a reference to cobi + atezo+ avastin (which is a trial for MSS). Also, good material to explain to new fellow patients *why* they need to find out their MS status.
Note: "checkpoint drugs" (like pembrolizumab (Keytruda) and nivolumab (Opdivo)) are *immunotherapies*, not chemotherapies or "just" monoclonal antibodies.
Friday, Feb 17, 2017
"MSI Status and Immunotherapy in Advanced Colorectal Cancer"
"Why do we, all of a sudden in every patient with colon cancer, need MSI (microsatellite instability) testing? "
John Marshall, MD: Well, to be fair, let’s say I do this and I get back a positive result for MSI. I can just go get a checkpoint drug? What are you talking about?
Johanna Bendell, MD: So, interestingly enough, both pembrolizumab and nivolumab are compendia listed for patients with microsatellite-instable colorectal cancer. So, in some senses, yes, you can. I would actually recommend getting these folks on clinical trials.
John Marshall, MD: Should I give a frontline patient a checkpoint inhibitor right from the get-go?
Johanna Bendell, MD: That’s a huge question that we don’t know the answer to yet (...)
John Marshall, MD: Tony, I’m going to put you on the spot. You have a patient with metastatic colon cancer, it’s MSI-high, they’re a brand new diagnosis. What’s going to be your frontline treatment?
Tanios Bekaii-Saab, MD: I actually would use a PD-1 inhibitor. I’ve had more than just anecdotal experiences with patients who were very symptomatic, high tumor burden, who actually had significant responses to PD-1 inhibitors. Those are patients that do moderately well with chemotherapy, and we always have the opportunity to put them back on chemotherapy. (...)
Alan P. Venook, MD: (...) as Johanna said, though, the NCCN guidelines include both nivolumab and pembrolizumab, recommending MSI testing right off the bat. In fact, we’ve had no trouble getting either of those drugs for patients with metastatic colon cancer." (...)
John Marshall, MD: Could you just give us a little summary of where we are in developing immunotherapy for microsatellite colon cancer?
Johanna Bendell, MD: Microsatellite-instable colon cancer is only about 5% of patients with metastatic disease. So, what do we do for the other 95% of patients? Is there a way to convert these patients into responders for immunotherapy? That’s the big subject of research right now. I presented probably just the first crack at it, and certainly, there are a lot of studies that are coming that are looking for different ways to try to rev up the immune system to have more of an immune presence within the cancer cells, to bring T cells into the cancers to get that immune therapy going and working for those patients as well. This particular study was using a MEK inhibitor, cobimetinib, to do that, and we know that when you give a MEK inhibitor in tumor models, it increases CD8-positive T cells within the tumor, it increases expression of class 1 MHC. So, when we gave that in combination with a PD-L1 inhibitor, atezolizumab, we saw some responses in patients with microsatellite-stable colon cancer. It’s just the first step along the way, and I think there’s a lot more development to come. "
Panelists: John Marshall, MD, Lombardi Comprehensive Cancer Center; Alan P. Venook, MD, Helen Diller Family Comprehensive Cancer Center; Tanios Bekaii-Saab, MD, The Mayo Clinic; Johanna Bendell, MD, The Sarah Cannon Research Institute
Also, PLEASE watch Dr Alan Venook, from this past January:
http://www.oncologytube.com/video/which ... y/10000608
ASK YOUR ONC TO CHECK FOR MSS/MSI STATUS ASCO GI 2017 (ongoing now, Jan 21-22) coloncancersupport.colonclub.com/viewtopic.php?f=1&t=57011&p=450691
News for MSI-H Jan 24 ASCO GI2017: Nivolumab New Standard viewtopic.php?f=1&t=57021