Tuesday, 11 October 2016

Poster discussion session Melanoma

T-vec against Ipi trial phase 2
Ipi 3mg
82 patients had 48 weeks of follow up median 61 weeks
35% for combo against 17 for Ipi
CR the same
Side effects - Ipi tox 17 % grade 3-4
Improved ORR and same CR rates
efficacy better on low tumour burden
Masterkey 265 now recruiting
Pembro with Tvec had 56% in phase 1/2 - going to see phase 3 trial now

Atelizomab PDL1- 1b study  cobi and vem triple 
21 day run in of targeted and then atelizomab
ORR 83% unconfirmed
CD8+ infiltration followed the vem/cobi run in
single agent atelizumab is 33%
questions :
are these data good enough for phase 3 ?
biomarkers ?
TKI first or second ?
Trilogy trial starting soon - cob and vem plus/minus atelizumab - vem combo 21 days - (strange week of placebo to replace the cobi cos vem is 3 weeks and cobi 2) ??

26% CR - small sample
but encouraging
IDO high  & low expressors
LDH and number of organ sites is still a dilemma for all these trials - there is nothing good for the high LDH people

what do we know of all these therapies : duration of response is 2-3 years need 2 more years but PFS is good
should we do phase 2s in clever ways rather than risking failed phase 3s as  happened in Lung

Christian Blank

Pooled data of PDL1 expression in Ipi/Nivo - PDL1 is not good enough

PDL1 in elderly patients
PFS and OS similar small number (38) of >75

If you have 4  of the favourable biomarkers on Pembro - this leads to 60% response
CRP  should be used more often in these trials as a biomarker

anti PD1 and brain mets

Poor PD1 efficacy in BMs  - do corticosteroids  influence this fresh/old tissue difference in PDL1 ? no  -
Melbase showed 11 months of PFS on corticosteroids -
Leptomeningeal disease rarely lasts 3 months

multi morbid patients still  need thinking about

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