TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

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LMighty
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Location: Hong Kong

TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

Postby LMighty » Tue Jul 11, 2017 3:36 am

HI everyone,

With the help and support from members on this board (particularly Maia -- the info you shared is crucial!) and our VERY accommodating, supportive oncologist, treatment with TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for my mom (stage IV, KRAS wild-type, MSS; failed Xelox + Avastin & Irinotecan + Erbitux in less than a year) finally starts today. The regimen is based on the initial data of the well-known pivotal clinical trial (http://oncologypro.esmo.org/Meeting-Resources/ESMO-2016/Efficacy-and-safety-of-cobimetinib-cobi-and-atezolizumab-atezo-in-an-expanded-phase-1b-study-of-microsatellite-stable-MSS-metastatic-colorectal-cancer-mCRC).

I am creating this thread as a record of the efficacy of this daring regimen as I am sure caregivers and fellow patients (especially with MSS) on this board would be interested. I will post updates regularly.
Supporter to my mom (64 yr); KRAS wild type; MSS

2012: DX Stage I, rectal cancer; resection and colostomy, no chemo
5/16: DX Stage III, mets found; right groin lymph node and soft tissue nodules
5-6/16: Radiation + Xeloda
7/16: DX Stage IV, pleural effusion; cancer cells found in fluid
7-12/16: Xelox + Avastin X 6
1/17: Clean PET scan, NED
2/17: Pleural effusion; recurrence
4/17: Iri + Erb X 3
5/17: Ascites; Chemo failed
6/17: Keytruda X 1
7/17: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib)

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Maia
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Re: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

Postby Maia » Tue Jul 11, 2017 9:07 am

Ohhh, our messages crossed paths --I just posted in your previous thread.
Sending my best thoughts for a good response. But more important: how is your mom feeling? Does she feel like pursing this treatment, how is her spirit, and physical condition?

LMighty
Posts: 82
Joined: Sun Aug 28, 2016 6:16 am
Location: Hong Kong

Re: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

Postby LMighty » Tue Jul 11, 2017 9:43 am

Hey Maia,

Thanks for your concern! My mom is still in hospital for pleural fluid and ascites drainage and it has been a month. We are leaving the drains in so we can remove the fluid at home.

X-rays from a few days ago showed a bit more shadow especially in the left lung. Our onc's interpretation is that the cancer seems to have spread to the trachea, and her left lung has only about 30% of function left. He thinks there is no immediate danger for now but things can go south unexpectedly at an alarming rate, and if the immune system friendly fires the lungs after treatment (although not too likely), it would be life threatening. She has been on small dose of steroids to boost lung function until taking the new drugs today.

My mom in general feels tired everyday due to all the breathing and sleeping problems but she is accepting the treatment. She and I think the first infusion of Keytruda may have worked a bit as the amount of pleural fluid and ascites seem to be decreasing at a slow rate recently, so we are both hopeful that the new regimen will work even better. We are taking one step at a time -- first goal is to go home ASAP! Her lungs performance in the coming days will determine when she is going home and it seems to be slowly improving.

Keeping fingers crossed!
Supporter to my mom (64 yr); KRAS wild type; MSS

2012: DX Stage I, rectal cancer; resection and colostomy, no chemo
5/16: DX Stage III, mets found; right groin lymph node and soft tissue nodules
5-6/16: Radiation + Xeloda
7/16: DX Stage IV, pleural effusion; cancer cells found in fluid
7-12/16: Xelox + Avastin X 6
1/17: Clean PET scan, NED
2/17: Pleural effusion; recurrence
4/17: Iri + Erb X 3
5/17: Ascites; Chemo failed
6/17: Keytruda X 1
7/17: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib)

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Maia
Posts: 2369
Joined: Fri Aug 24, 2012 8:00 am

Re: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

Postby Maia » Tue Jul 11, 2017 11:38 am

Oh, glad to hear about the slight decrease in pleural fluids and ascites!! I'm sending my best thoughts so she can be at the comfort of her home ASAP!

Lee
Posts: 4920
Joined: Sun Apr 16, 2006 4:09 pm

Re: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

Postby Lee » Tue Jul 11, 2017 12:46 pm

Just wanted to wish your Mom good luck, hope this puts her in NEDville,

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 10 years and counting!

[Ana & Alex]
Posts: 63
Joined: Tue Feb 14, 2017 5:14 pm
Location: Austria

Re: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

Postby [Ana & Alex] » Tue Jul 11, 2017 10:50 pm

Dear LMighty,

I've been silently accompanying your journey with your mom. I hope the treatment works for her, I really do.

Just wanted to wish very good luck!
Thinking of you and sending out positive vibes..

All the best,
Ana
29 yo. Mum (22. Mo) & Wife

12/2016: RecAdenoCa G2. CEA 4.3. RAS Wildtyp. MSS. IIIB.
01 - 03/2017: 28 RTx + CHT 2500 mg/d Capecitabine
03 - 06/2017: Suplemments and Cimetidine.
05/2017: TME/TAMIS + permanent Colostomy CEA 0.5
05/2017: ypT2N2aM0 (4/15), good cCR, limited pCR
06 - 7/2017: 2 full x XelOx, 1x Oxi reduced to 80%
08 -11/2017:Xeloda only (4 to go)

LMighty
Posts: 82
Joined: Sun Aug 28, 2016 6:16 am
Location: Hong Kong

Re: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

Postby LMighty » Fri Jul 14, 2017 3:49 am

Hi everyone,

Thank you so much for your kind words!

I have an encouraging update. Since Wednesday the ascites reduced from 300-500ml daily to virtually zero. Not even detectable by ultrasound. Our onc said it's good news but it's too early to tell if it represents response. We will see if it stays this way in the coming days. Other vitals are also improving.

We can really use some good news after a month of scares!
Supporter to my mom (64 yr); KRAS wild type; MSS

2012: DX Stage I, rectal cancer; resection and colostomy, no chemo
5/16: DX Stage III, mets found; right groin lymph node and soft tissue nodules
5-6/16: Radiation + Xeloda
7/16: DX Stage IV, pleural effusion; cancer cells found in fluid
7-12/16: Xelox + Avastin X 6
1/17: Clean PET scan, NED
2/17: Pleural effusion; recurrence
4/17: Iri + Erb X 3
5/17: Ascites; Chemo failed
6/17: Keytruda X 1
7/17: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib)

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LPL
Posts: 267
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

Postby LPL » Fri Jul 14, 2017 5:11 am

LMighty,
Like [Ana & Axel] I have been following your posts and I am So Happy for you that things are looking better :)
Kind Regards /L
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma pt 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a Stage IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED for now :D
:!: Steroid induced hyperglycemia dx after 3chemo .. hospitalized, insulin -> Metformin
Surgeries (open):
3/18 Emergency colostomy 5/23 Primary+gallbl+colostomy reversal (+port) 9/01 Liver mets

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Maia
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Re: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

Postby Maia » Fri Jul 14, 2017 8:10 am

LMighty, so happy to hear! An actual step in the right direction!
Is your mom feeling more comfortable now? Not needing the drainage is itself such a relief.

LMighty
Posts: 82
Joined: Sun Aug 28, 2016 6:16 am
Location: Hong Kong

Re: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

Postby LMighty » Sat Jul 15, 2017 8:40 am

Maia wrote:LMighty, so happy to hear! An actual step in the right direction!
Is your mom feeling more comfortable now? Not needing the drainage is itself such a relief.

Yes she is. Her energy level is slowly recovering with the help of low dose of supplementary oxygen. She has intestinal cramps and mild diahhrea that have lasted for a few days and the cause is unknown. Our onc suggests wait & see and does not want to make any assumption. It seems to lessen little by little over time. We hope it has nothing to do with the cancer!
Supporter to my mom (64 yr); KRAS wild type; MSS

2012: DX Stage I, rectal cancer; resection and colostomy, no chemo
5/16: DX Stage III, mets found; right groin lymph node and soft tissue nodules
5-6/16: Radiation + Xeloda
7/16: DX Stage IV, pleural effusion; cancer cells found in fluid
7-12/16: Xelox + Avastin X 6
1/17: Clean PET scan, NED
2/17: Pleural effusion; recurrence
4/17: Iri + Erb X 3
5/17: Ascites; Chemo failed
6/17: Keytruda X 1
7/17: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib)

LMighty
Posts: 82
Joined: Sun Aug 28, 2016 6:16 am
Location: Hong Kong

Re: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

Postby LMighty » Tue Jul 25, 2017 12:48 pm

Update #2: It has been 2 weeks since the start of the new regimen. Today's X-ray showed slight decrease of shadowy area in both lungs. Our onc said it's a very positive and miraculous response considering we are only 2 weeks in!

Fluids seem to build up again in the lungs and abdomen but at a much slower rate, and our onc thinks that the fluids are from cancer cell death. My mom also get swollen feet and choroidal effusion, among other mild discomforts like wheezing, rapid heart rate and abdominal cramps, all probably from cobimetinib. She was hospitalized earlier today after being discharged only 3 days ago. The purpose is to relieve symptoms and drain fluids until she finishes the last week of cobimetinib. Although my mom feels quite tired due to the side effects and have difficulty sleeping, she is determined to "get it done".

I may post another update after further scans tomorrow.
Supporter to my mom (64 yr); KRAS wild type; MSS

2012: DX Stage I, rectal cancer; resection and colostomy, no chemo
5/16: DX Stage III, mets found; right groin lymph node and soft tissue nodules
5-6/16: Radiation + Xeloda
7/16: DX Stage IV, pleural effusion; cancer cells found in fluid
7-12/16: Xelox + Avastin X 6
1/17: Clean PET scan, NED
2/17: Pleural effusion; recurrence
4/17: Iri + Erb X 3
5/17: Ascites; Chemo failed
6/17: Keytruda X 1
7/17: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib)

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Maia
Posts: 2369
Joined: Fri Aug 24, 2012 8:00 am

Re: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

Postby Maia » Tue Jul 25, 2017 6:59 pm

LMighty wrote:Update #2: It has been 2 weeks since the start of the new regimen. Today's X-ray showed slight decrease of shadowy area in both lungs. Our onc said it's a very positive and miraculous response considering we are only 2 weeks in!
(...)
I may post another update after further scans tomorrow.


Those are some pretty positive news!!!
I'm sorry she's back to hospital, she really deserves a break and being comfy at home. But I'm glad she's in an active attitude.
Oh, sending my best thoughts for good news on the scans!! xoxo

sdino
Posts: 24
Joined: Tue Mar 28, 2017 5:32 pm

Re: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

Postby sdino » Wed Jul 26, 2017 6:39 am

Good news LMighty ! I could not access your link. Maia Is this for only Kras Wild type ? My wife is Kras Mutant. We have a CT scan today @ Roswell after a 3 month chemo break with some success with FolFox. As u can imagine I'm nervous as hell. Wishing everyone the best ! thx.
Caregiver for Wife 52 yrs old
DX: 11/16-CC sigmoid colon 3 cm, Lung Bio-Adenocarcinoma Stg IV
Mets: 1.2 cm now 7 mm lung w/14 other nodules less than 6 mm.
MSS, KRAS-mut G12D; TP53;
Completed 12 rounds Folfox/Avastin + Oxi 11/16 to 5/17
CT Scans: 11/16; 1/17 lung mets/colon shrinkage; 3/17 lung mets no change, shrinkage lymph/colon tumor, 5/17 colon & lung met shrinkage
CEA: 16 - 11/16; 4 – 12/16; 0.7 – 1/17; 0.5 – 2/17; 0.6 - 5/17

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Maia
Posts: 2369
Joined: Fri Aug 24, 2012 8:00 am

Re: TECENTRIQ (atezolizumab) + COTELLIC (cobimetinib) for Stage IV, starting 11/7/2017

Postby Maia » Wed Jul 26, 2017 8:05 am

sdino wrote: Maia Is this for only Kras Wild type ? My wife is Kras Mutant. .


It is thought to work at least for some MSS, independently of KRAS status, BUT in the original small study the results were seen mainly in KRAS MUTANT patients:
Clinical activity and safety of cobimetinib (cobi) and atezolizumab in colorectal cancer (CRC).
Johanna C. Bendell, Tae Won Kim, Boon C. Goh, Jeffrey Wallin, Do-Youn Oh, Sae-Won Han, Carrie B. Lee, Matthew David Hellmann, Jayesh Desai, Jeremy Howard Lewin, Benjamin J. Solomon, Laura Quan Man Chow, Wilson H. Miller, Justin F. Gainor, Keith Flaherty, Jeffrey R. Infante, Meghna Das-Thakur, Paul Foster, Edward Cha, and Yung-Jue Bang
Journal of Clinical Oncology 2016 34:15_suppl, 3502-3502

...
Results: As of October 12, 2015, 23 CRC (22 KRAS mutant, 1 WT) pts were enrolled during escalation and expansion. No dose-limiting toxicities were observed, and expansion occurred at atezo 800 mg q2w and cobi 60 mg. Median follow-up for safety in CRC pts was 3.78 mo (range, 1.1-11.7). The most common treatment-related AEs included diarrhea (69.6%), fatigue (52.2%), dermatitis acneiform (43.5%), rash (34.8%), maculopapular rash (26.1%), pruritus (26.1%) and nausea (26.1%). Incidence of treatment-related G3-4 AEs was 34.8%. The only treatment-related G3-4 AE in ≥ 2 pts was diarrhea (8.7%). No G5 AEs were reported. The ORR was 17% (4 PR, 5 SD). Three responses were ongoing (range, 4.0 to 7.7 mo at time of data cutoff). Three responders were mismatch repair-proficient [that means: MSS], and 1 was unknown. Response was not associated with baseline PD-L1 expression. Results from the serial biopsy cohort showed enhanced PD-L1 upregulation, CD8 T-cell infiltration and MHC I expression on treatment, providing mechanistic rationale for the combination.
Conclusions: The combination of cobi and atezo in CRC is well tolerated at the maximum administered doses. These results show that pts with MSS CRC can respond to the combination of cobi and atezo, and provide support for continued evaluation of the combination. Clinical trial information: NCT01988896.
http://ascopubs.org/doi/abs/10.1200/JCO ... suppl.3502


A news outlet in more layman's terms: Cobimetinib/Atezolizumab Combo Achieves Response in Advanced Colorectal Cancer June 7, 2016: http://www.targetedonc.com/conference/a ... tal-cancer

We have a fellow at this forum, ACPdiddy, who is in that trial, and he's KRAS mutant: Atezolizumab & Cobimetinib in microsatellite stable: viewtopic.php?f=1&t=57849

Best of luck to your wife today, sdino!


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