LMighty wrote:Great info. What about Keytruda's effectiveness to MSS though?
My mom is starting Keytruda soon but her MS status is not yet determined so I am wondering about its efficacy. From what I have read so far, it seems Keytruda only benefits those with MSI-H which is a really small percentage of stage IV patients?
You're right: as monotherapy, that is, alone, on its own, pembrolizumab (Keytruda) benefits to those MSI-High, which is about 10-15% of all CRC patients. A very little number of MSS has benefit from a checkpoint inhibitor of anti PD-1/ L1 --like pembrolizumab, nivolumab, atezolizumab, duravalumab, avelumab.
It is thought that those immunotherapies will work for MSS in some sort of combination: with other immunotherapies, chemotherapies, targeted agents, etc.
For that reason, you will see that the current most promising clinical trials for MSS have such design, more often:immunotherapy
+ [something else]
I see in your other post that your mom's oncologist is willing to try Keytruda, regardless of MSS status. That is fantastic, there are reports of some MSS patients with responses from 'just' it. A really good thing is that from the moment he's able to get her the immunotherapy
, it will be possible also combine it with 'something else', mimicking some of the ongoing trials.
Just as an example:Keytruda+ Erbitux
, that she was taking, as seen in your signature. Remember it failed in other combo; that doesn't mean the drug itself is not longer of use. A trial with that combination is ongoing at Roswell Park:
Cetuximab and Pembrolizumab in Treating Patients With Colorectal Cancer That is Metastatic or Cannot Be Removed by Surgery https://clinicaltrials.gov/ct2/show/NCT02713373Keytruda + Folfox
Study of Pembrolizumab in Combination With Chemotherapy for Patients With Advanced Colorectal Cancer https://clinicaltrials.gov/ct2/show/NCT02375672
This study is presenting the results in a couple of weeks at ASCO 17. Abstract to print for her doc: http://abstracts.asco.org/199/AbstView_199_183499.html
Opdivo (nivolumab, other brand of anti PD-1) + Lonsurf
: A Study Evaluating TAS-102 Plus Nivolumab in Patients With MSS CRC https://clinicaltrials.gov/ct2/show/NCT02860546
So, just without participating in a clinical trial, that you mention you have not in a location near you, those combination would be possible.
And some more. If your mom oncologist is willing to, he could explore the MSS clinical trial finder:http://trialfinder.fightcrc.org/
I wish you and your mom the best!!