Another Couple of Tidbits About Ipi

From an article published last June:

Monoclonal antibody treatment also shows several peculiarities. Unlike standard chemotherapy, side effects are a good sign, because they correlate with a strong antitumor response. And progressive disease may not always be a sign of treatment failure: Instead of stalling or shrinking, lesions may actually grow or increase in number during the course of ultimately successful treatment with ipilimumab. This unpredictability has led immunotherapy researchers to develop and adopt a system of immune-related response criteria, an alternative to the WHO's partial/complete response criteria for response to anticancer treatments.

I wrote about the first part of this a couple posts back. The last couple sentences are news to me. It's actually not relevant to my case, since I have been cancer free for quite a while now and don't have any lesions, but it's still interesting.

In related news, it's now been 10 months since I was first diagnosed.

Edit: turns out I first linked to that article on November 2.

Post Secret

I read postsecret.com from time to time. Every so often, I'll see a couple that resonate with me. This week, there were two that I can relate to in a way that I couldn't have this time last year. First, there's this:



Two people in particular come to mind when I see this, but I can think of about ten others who it could also apply to. I have the most wonderful people in my life.

I have mixed feelings about the other one:



I can't imagine trying to fight cancer without at least hoping that there's some reason that I've been put through hell. But sometimes having someone else assert that there's a reason for it can be quite frustrating. Enough said.

Ipilimumab: Let's not get ahead of ourselves

I read an interesting article today entitled "Ipilimumab for Advanced Melanoma: Let’s Not Throw Caution to the Winds." It's a bit technical, but it makes some good if obvious points.

First, there's only one Phase III trial showing benefits for using ipilimumab in patents with metastatic melanoma, so it's still possible that later trials will show less benefit, particularly in light of that first trial's unconventional design. (The control group was given an experimental vaccine, so if somehow that vaccine actually had a negative effect on survival, that could exaggerate the beneficial effects of ipi.) The authors provide the example of a drug called tremelimumab that (like ipi) targets CLTA-4 and showed some early promise but subsequently failed to show a significiant advantage in Phase III testing. Ipilimumab has more evidence backing its efficacy than tremelimumab ever did, but it is still very much an experimental treatment and later trials may have less positive results.

The other thing is that the side effects of ipilimumab can be very serious. In general, ipi isn't as toxic as chemotherapy, but it can still have side effects like colitis, hypophysitis, hepatitis, and a variety of other autoimmune conditions. In some patients (~1-5%) these side effects can be fatal. I've dealt with some moderate side effects myself, and there's a very real cost associated with that.

Despite lingering questions about its efficacy, ipilimumab still represents a tremendous advance. When I was first diagnosed with melanoma on March 29 of last year, no drug had ever showed an overall survival advantage in a Phase III study for patients with metastatic melanoma. That changed less than a month before my melanoma recurred when the initial paper showing the benefits of ipilimumab on June 5. I really can't get over how lucky I am to live when I do. It's awesome to be part of a trial that (hopefully) will provide more evidence for the efficacy of this drug.

I picked up one piece of information from the article that was pretty exciting to me. Apparently the drug seems to have more success in patients who have significant side effects. I've suspected that this is the case all along, and I'm glad that there's actually evidence to support that conclusion. It definitely makes sense. The drug's only direct effect (as far as I know) is to stimulate the immune system, so the cancer fighting effects and any side effects are going to be a function of how effectively it does that. Consequently, the extent of ipilimumab's side effects are a proxy for how much of an effect the ipi will have on the patient's cancer. I already knew that my side effects meant I'm on the drug rather than the placebo; it's good to know that they also mean the drug is working.