SarahS wrote:As far as you understand, are PD-1 inhibitors better suited towards MSI tumors and PD-L1 likely to work better for MSS or is it as I suspect not that simple ?
Maia wrote:LMighty wrote:One thing -- did you mean even though we can't get Tecentriq in Hong Kong, the combination of Keytruda with Cotellic is thought to produce similar result without Tecentriq?
Yes. Tecentriq (atezolizumab) is an anti PD-L1. The 'L' in the name PD-1 stands for the Ligand in the tumour cells. Keytruda (pembrolizumab) is an anti PD-1.
PD-1 is on the T cells of the immune system, PD-L1 is on the tumor cells. So both drugs release the breaks of the immune system in a same pathway, but in different 'places'. They are not the same and probably some time from now we'll learn about the particularities but, right now, clinically, all the anti PD-1 and the anti PD -L1 have demonstrated similar results. Some are ahead in the 'race' because the pharmas started testing first one instead of other, or regarding one cancer or other.
You can read a better explanation here, and watch a video --it is about a type of lung cancer, because those drugs have been first tested for that: http://cancergrace.org/lung/2016/04/20/ ... d-1_pd-l1/
There are the approved ones, for different cancers --there are many more in trials, so one always can go to a trial for an equivalent:
Anti PD- 1: Keytruda (pembrolizumab) , Opdivo (nivolumab)
Anti PD- L1: Tecentriq (atezolizumab), Bavencio (avelumab), Imfinzi (durvalumab)
SarahS wrote:Sorry to butt in on your post LMighty, and wishing you and your Mom all the best, I went through similar with my mother last year
chrissyrice wrote:I am hoping for the best for your mom and so glad you have a good oncologist working with you and your mom.
Maia wrote:LMighty, so sorry about the need of repeated tapping for the ascites. I imagine your mom's frustration.
Too early to say about Keytruda's effects so let's just keep hoping for the best.
About Tecentriq, as I've said, maybe it is not worth the hassle, since she's getting Keytruda --an anti PD-1--, which is think to work equivalently to Tecentriq --and anti PD-L1.
Her onc is using already Keytruda off label, I have to say. IF he would think a combination of it with a MEK inhibitor is worth the try --trying to reproduce that trial we discussed previously--, other MEK inhibitor than Cotellic might work equally --as Mekinist, for example, if that one is approved in Hong Kong. But in any case it will be *always* off label, since it's not approved for CRC.
About ascites, I wanted to mention this, in case her onc has some knowledge/ connections about it. In Europe, since 2009 there is an approved intraperitoneal immunotherapy against peritoneal ascites: Catumaxomab, Removab. Removab has been used from the start at the Charité Hospital in Berlin. It is a bispecific (anti-EpCAM x anti-CD3) trifunctional antibody. There have been many trials that led to its approval.
Scroll down until 'Publications' to see a list of scientific literature about it: https://clinicaltrials.gov/ct2/show/NCT ... mab&rank=6
I'm mention this because I see it has been studied in HONG KONG. Maybe some of the authors of this article has some information for your mom's onc, about if it is available, somehow, there:
Vol.03 No.02(2014), Article ID:52919,8 pages
Intraperitoneal Chemotherapy for Gastric Cancer with Peritoneal Carcinomatosis: Is HIPEC the Only Answer?
Ka-On Lam1*, Betty Tsz-Ting Law2, Simon Ying-Kit Law2, Dora Lai-Wan Kwong1
1Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
2Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
Also, PIPAC viewtopic.php?f=1&t=56641 is now available in Singapore: http://medicine.nus.edu.sg/medsur/pipac.html as clinical trial https://clinicaltrials.gov/ct2/show/NCT03172416
Just now I also come across a trial by Novartis that is recruiting in Hong Kong: https://clinicaltrials.gov/ct2/show/record/NCT02460224
Not sure if it is promising as the drugs seem to be similar to Keytruda/Opdivo but worth discussing with our onc.
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