Not yet. Immunotherapies have shown efficacy in some people months past the time treatment was stopped. At the moment there's no trial setup in a way that tests this though we do know there that it happens with some people and not with others.
I will ask one of our faculty who has patients in immunotherapy trials to comment further.
A year on nivo (started in clinical trial). Always stable ct scans. Now neuro symptoms and 2 brain mets. Once treated, uncertain if recomendation will be to continue nivo or other options.
Do docs have any thoughts in general about patients on nivo and developing brain mets with stability elsewhere? Does nivo protect brain? (I m getting the impression the answer is no.)
I'm sorry to hear about the brain mets, and I hope that radiation will treat them effectively.
There's some evidence that nivolumab penetrates the blood brain barrier, although it's not known whether it gets there in sufficient concentrations to be effective. But as far as treatment after radiating the brain mets, since cancer in the rest of the body is stable, it seems reasonable to follow the approach of local treatment for oligometastases while continuing an otherwise effective systemic therapy such as nivolumab. That's an approach gaining favor in limited acquired resistance to targeted therapies, as discussed in a just-released podcast by Dr. Weiss, and it seems reasonable to.make the analogy to immunotherapies.
It's a great question and one I discussed with patient today, in fact. As Janine said above, we know tumors can continue to respond for some time after the drug is stopped, but I don't think anyone knows how long it can last or when it is safe to stop the drug. This will be an important question to answer as we learn more about these treatments. Sorry that I don't have something more to add!
Reply # - March 8, 2016, 02:15 PM
Hi jlk,
Hi jlk,
Not yet. Immunotherapies have shown efficacy in some people months past the time treatment was stopped. At the moment there's no trial setup in a way that tests this though we do know there that it happens with some people and not with others.
I will ask one of our faculty who has patients in immunotherapy trials to comment further.
All best,
Janine
Reply # - March 8, 2016, 07:13 PM
A year on nivo (started in
A year on nivo (started in clinical trial). Always stable ct scans. Now neuro symptoms and 2 brain mets. Once treated, uncertain if recomendation will be to continue nivo or other options.
Do docs have any thoughts in general about patients on nivo and developing brain mets with stability elsewhere? Does nivo protect brain? (I m getting the impression the answer is no.)
Reply # - March 9, 2016, 05:45 AM
Hi phillydaughter,
Hi phillydaughter,
I'm sorry to hear about the brain mets, and I hope that radiation will treat them effectively.
There's some evidence that nivolumab penetrates the blood brain barrier, although it's not known whether it gets there in sufficient concentrations to be effective. But as far as treatment after radiating the brain mets, since cancer in the rest of the body is stable, it seems reasonable to follow the approach of local treatment for oligometastases while continuing an otherwise effective systemic therapy such as nivolumab. That's an approach gaining favor in limited acquired resistance to targeted therapies, as discussed in a just-released podcast by Dr. Weiss, and it seems reasonable to.make the analogy to immunotherapies.
JimC
Forum moderator
Reply # - March 11, 2016, 01:09 PM
It's a great question and one
It's a great question and one I discussed with patient today, in fact. As Janine said above, we know tumors can continue to respond for some time after the drug is stopped, but I don't think anyone knows how long it can last or when it is safe to stop the drug. This will be an important question to answer as we learn more about these treatments. Sorry that I don't have something more to add!
Reply # - March 12, 2016, 11:09 AM
Janine and Dr Pennell,
Janine and Dr Pennell,
I appreciate the time you both spent responding to my question.
Best Regards,
Janet (JLK0479)