MEDI4736

This topic contains 69 replies, has 19 voices, and was last updated by  mickh 1 week, 5 days ago.

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August 5, 2014 at 10:47 am  #1265281    
Dr West
Dr West

Yes, exactly right. Some cancers can be left untreated for months, even (rarely) a year or more without needing treatment. Others will progress in under two months, and sometimes over just a few weeks. It it’s a matter of just 2-3 weeks to clarify what might be the best treatment option, it’s typically quite appropriate to seek the best treatment a little later vs. just the most readily available treatment, even if it’s not the best. On the other hand, unless someone has a cancer that is known to be slow-growing, waiting more than a month gets into a range for delay that becomes increasingly concerning.

The most important variable, though, is the underlying pace of the cancer and the relative appeal of the later potential option vs. the “bird in the hand”.

Good luck.

-Dr. West

August 7, 2014 at 2:56 pm  #1265319    

andy123

Hi Bethw,

Thanks for sharing your experience.

We have been tracking the medi4736 + Tremelimumab study as well (for solid tumors, as I have a family member who has ovarian cancer), though that study is going very slow – they saw some toxicities early on and there is a very long wait list for that trial. Possible reason for toxicities – different dose/schedule and different patient population.

So happy to learn that you are responding so well to the combination. What dose levels are you on right now? (And was it part of the escalation phase or the expansion phase?) Did you experience any side-effects like colitis, etc ( which I understand are primarily from Tremelimumab). Wishing you continued good results

Considering the combination has pd-L1 drug (compared to anti-pd1 drug Ipi in the Nivo/IPI combination which seemed more toxic in the NSCLC population, presented at ASCO this year), many are hoping this will be a relatively more tolerable combination while improving the benefit rate viz. anti-pdl1 agent alone.

I understand Dr. Creelan is running this combination trial along with a few colleagues; and would be very appreciative of his insights on the experience they have had so far.

many thanks in advance

August 7, 2014 at 6:59 pm  #1265323    
catdander forum moderator
catdander forum moderator

Just in case Dr. Creelan doesn’t see your post andy123 I’ll let him know you’ve asked for his input.


My husband, 8/09 53 @ dx stage III squam nsclc R. pancoast tumor
Destruction of 3 ribs, touching brachial plexus.
6/09-8/09 2 core and 1 VATS undx biopsies. Open thoracotomy for 1 positive biopsy (unresectable)
9/09 Chemo/rads curative intent
11/09 MRI by pancoast specialist surgeon spine met found undiagnosed Rad to spine, Chemo continued thru 6 cycles
Tarceva maintenance 2/10
11/10 3cm tumor L lung, undx core bx w/collapsed lung. Gemzar, 12/10 through 7/12
NED 3/12, stop tx 7/12. Remains NED as of 9/16
Unanswerable question. Was it ever metastatic?

August 10, 2014 at 5:29 pm  #1265367    

Dr. Ben Creelan

To address question of anti-CTLA-4 plus either PD-1 vs. anti-PD-L1:
We do have several of these Phase I trials for lung cancer open at our center for past year or so (eg nivo/ipi and also tremi/medi).

I believe most would agree that this combination concept is more potent. My understanding is that there are several advantages to the combination: for example, based on scant information so far, the responses seem to be independent of PD-L1 status. There also seems to be a higher proportion of responders as well, although still not as high as we want, which is 100%. At the same time, the combinations do seem to have more autoimmune side-effects as well: GI, skin, endocrine, for example. These are usually quite manageable with courses of steroids or hormone supplementation. Nonetheless, in contrast to chemo where almost everyone has some cumulative toxicity, most patients cruise along with few problems. At the end of the day, most patients are wiling to accept a higher risk of these auto-immune side effects, if it means NOT talking about recurrent lung cancer. Hope this helps.

August 11, 2014 at 1:17 pm  #1265375    

bethw

Hi, Andy123–

The “study doctor” for the trial I’m in at Moffitt is Dr. Scott Antonia. It’s in the dose escalation phase and my cohort gets 10 mg/kg MEDI4736 + 3 mg/kg tremelimumab. I’ve not had much in the way of side effects (see below).

I feel fortunate that I just happened to enroll when that MEDI dose was on the table, given that 10mg/kg was chosen for the dose expansion phase of the MEDI4736-only trial for which I was wait-listed at Moffitt.

My scan results last week were good, though not as good as I had hoped. (Give me an inch and I want a mile!) Most of my mets shrunk a bit more (10-17%) but the rate of shrinkage seems to be slowing. A couple mets and my primary tumor were “stable.” (Stable is good, stable is good, stable is good…)

One lymph node apparently grew a bit but trial coordinator is chalking that up to measurement error (went from 1.0 x 0.5 cm to 0.8 x 0.7 cm). The radiologist indicated that another similarly-sized lymph node they’ve been tracking was “difficult to measure.”

I did get another piece of what seems like very good news: I’ve had a bunch of scattered nodules or lesions in both lungs and docs disagree re what they are. Whatever they are, they’ve all decreased in size!

Maybe my immune system was busy with those :)
_____________________________

Knock on wood: I’ve only had minor side effects including the usual fatigue (and who knows what that’s from — could be this treatment, prior treatment, the cancer itself, and/or the fact that I’m no spring chicken!) Also a little bit of itching and dermatitis…

The latter seems to be part of a pattern in which my immune system is overreacting a bit to minor insults: e.g., I had a bout of dermatitis in my outer ear which I think stemmed from a mosquito bite (to which I usually have little reaction), and a tiny shallow cut with a clean kitchen knife seemed to call up an armada of white cells!

Interesting (to biology geeks like me)… but definitely not serious!

— Beth

August 11, 2014 at 1:33 pm  #1265376    

bethw

I should clarify this: Dr. Antonia is the study doctor at Moffitt for the trial I’m in. I don’t believe he’s in charge of this 4-site trial as a whole.

Clinicaltrials.gov lists a doctor from MedImmune, Joyson J. Karakunnel, MD, as the study director/PI.

August 11, 2014 at 2:08 pm  #1265379    
catdander forum moderator
catdander forum moderator

Great input Beth! I love it, give me an inch and I want a mile :wink: When I read these results I like to keep in mind that these drugs seem to have more of a rise and fall to their efficacy pattern so your mile is still on the table.
Thanks for helping us bring science and the practice of treating lung cancer a step…or 2 further.
Janine


My husband, 8/09 53 @ dx stage III squam nsclc R. pancoast tumor
Destruction of 3 ribs, touching brachial plexus.
6/09-8/09 2 core and 1 VATS undx biopsies. Open thoracotomy for 1 positive biopsy (unresectable)
9/09 Chemo/rads curative intent
11/09 MRI by pancoast specialist surgeon spine met found undiagnosed Rad to spine, Chemo continued thru 6 cycles
Tarceva maintenance 2/10
11/10 3cm tumor L lung, undx core bx w/collapsed lung. Gemzar, 12/10 through 7/12
NED 3/12, stop tx 7/12. Remains NED as of 9/16
Unanswerable question. Was it ever metastatic?

November 4, 2014 at 7:31 am  #1266927    

Bill

Hi again Mike,

How are you doing man?

I had a full round of taxotere infusions, and my nodes have not grown. So I was on a chemo break for three months, I had a scan last week – no progress in the nodes again. So, still no reason (i guess) to go back on a chemo plan.

I am still looking for a MEDI4736 and tremelimumab trail….no luck so far. I’m also lookign for and Ipi and Nivo trail for guys like us.

I have no symptoms – eating well, not losing weight. I feel fine actually.

My warm regards,

Bill

November 4, 2014 at 8:22 am  #1266933    
JimC Forum Moderator
JimC Forum Moderator

Hi Bill,

Great to hear the encouraging scan results, as well as the fact that you feel fine…congratulations!! Thanks for sharing such a positive update.

Good luck on your trial search.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

November 4, 2014 at 8:41 am  #1266937    

Bill

Thanks for your kind remarks Jim.

I’m working on a National Barrett’s and EC early detection awareness campaign.

I’ve teamed up with Rhonda Small, President of the Esophageal Cancer Awareness Association, http://www.ecaware.org/, and Dr. Jonathan Aviv of NY, NY.

https://www.youtube.com/watch?v=uBhV5BHCHN4.

I’m a 25 year veteran advertising/communications director, and feel that this campaign will be very effective in getting out the word for early detection for folks at risk. Maybe same some lives.

November 4, 2014 at 8:44 am  #1266939    

Bill

November 4, 2014 at 8:44 am  #1266941    

Bill

November 4, 2014 at 2:11 pm  #1266947    
catdander forum moderator
catdander forum moderator

Bill this is fantastic! I’m so glad and everyone is so lucky you’re stable 3 months out from treatment. That’s exciting by itself but what you’re doing to get the word out is where everyone else gets lucky.

Congratulations Man!


My husband, 8/09 53 @ dx stage III squam nsclc R. pancoast tumor
Destruction of 3 ribs, touching brachial plexus.
6/09-8/09 2 core and 1 VATS undx biopsies. Open thoracotomy for 1 positive biopsy (unresectable)
9/09 Chemo/rads curative intent
11/09 MRI by pancoast specialist surgeon spine met found undiagnosed Rad to spine, Chemo continued thru 6 cycles
Tarceva maintenance 2/10
11/10 3cm tumor L lung, undx core bx w/collapsed lung. Gemzar, 12/10 through 7/12
NED 3/12, stop tx 7/12. Remains NED as of 9/16
Unanswerable question. Was it ever metastatic?

November 4, 2014 at 4:40 pm  #1266953    

mrkenney

Hey Bill et al,
I am no longer receiving MEDI4736 as I have completed the one year of infusions with miraculously flying colors. Tears of Joy Yesterday I had my 30 day post treatment checkup and am officially a “boring patient”.

I’m glad to read that you’re doing well Bill and I’m mightily impressed with your Please Look campaign.

Warm regards,
Mike

  • This reply was modified 2 years, 4 months ago by  mrkenney.
  • This reply was modified 2 years, 4 months ago by  mrkenney.
November 4, 2014 at 6:44 pm  #1266959    
JimC Forum Moderator
JimC Forum Moderator

Congratulations, Mike! Thanks for another great report!

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

November 4, 2014 at 8:50 pm  #1266976    
Dr West
Dr West

Yes, congratulations! And the campaign looks very well done.

Interesting that one of the big questions with immunotherapies is whether you need to be on them indefinitely or whether a fixed duration of a few months or a year could be all that is needed. We simply don’t know, but there are quite a few people who completed fixed courses or needed to stop treatments due to challenging side effects and continue to do very well for a long time.

-Dr. West

February 22, 2015 at 9:44 am  #1268600    

jimdunkle

Hello all,

I am new to this website / group but wanted to express my appreciation to all for the comments and feedback on MEDI4736.

After two years of chemo, my wife (metastatic bladder cancer) started treatments in January 2015 at Moffitt Cancer Center (Tampa FL) for the MEDI4736 clinical trials. She has now had two of the treatments and next week will get treatment number three. Her scheduled treatment plan is infusion every two weeks for the duration of one year. We are very early into the program.

To those pursuing immunotherapy in clinical trials, I encourage you to stay proactive in your pursuit for as it was mentioned earlier in this thread, they do fill up quickly. We met with an oncologist at Mayo Clinic in Jacksonville and while Karen was a great candidate for their program, unfortunately it was at accrual. We made contact and multiple trips to MCC and also was talking with MD Anderson in Houston for possible trials treatment. She was screened for one program at MCC but was not qualified for it but placed on a waiting list for another program for which she was accepted. I spent many hours searching the clinical trials website for possible locations for her treatment, and it took a couple of months to get her into a program.

So far the side effects have been a bit harder on her than we anticipated, mainly fatigue. Fortunately, the side effects are much easier on her than the previous chemo series’.

Best wishes to all,
Jim

March 8, 2015 at 10:45 am  #1268789    

Bill

Hi Mike,

How are you doing?

I’m fine – still on chemo vacation. No complications. Scans showing no progress.

– Bill

PS: I’ve become a member of the board of the ECAA, working with Rhonda Small on a national early detection awareness campaign. I will keep you posted!

May 23, 2015 at 3:20 pm  #1269934    

annek

Hi Bill,

Just wondering if you were able to get on this trial? Any info would be appreciated. My husband has adenocarcinoma of the gastroesophogeal junction that has metastasized to his peritoneum. He has gone through two lines of therapy, so we are at crossroads right now. Looks like radiation therapy is next and them ramucirumab/paclitaxel. We are very interested in immunotherapy, though.

Thanks,

Anne

July 26, 2015 at 3:50 pm  #1270610    

mickh

hi all

British started medi4376 in April week 8 showing good signs

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