Question for the peanut gallery (especially you Celeste)

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  • Post
    • March 28, 2015 at 12:35 am
    BrianP
    Participant

      A little background. I'm a pilot and unfortunately due to my stage IV melanoma dx in May 2012 I lost my FAA medical. Last week marked my one year anniversary of stable disease. I was told by a doctor that one year of stability and no new mets would be the absolute minimum the FAA would accept if they were to approve my medical. I think it's a long shot at best but I feel great and I'm optimistic about the future so I thought I would go ahead and submit a request to get my medical back. The worst that can happen is they say no. What I wanted to ask is if anyone has seen any data or charts on Anti-PD1 drugs which gives an indication that if you make it to the one year mark your chances of recurrence are greatly reduced.  Due to the drug being so new I’m not sure the data is mature enough to be able to draw that conclusion.  The only thing I’ve seen that somewhat shows the durability is from a Dr. Hodi presenation (page 8 lower left).

      http://tatcongress.org/wp-content/uploads/2014/05/140305-hodi.pdf

      Thanks for input anyone might have.

      Brian

       

    Viewing 5 reply threads
    • Replies
        • March 28, 2015 at 1:42 pm
        Bubbles
        Participant

          Hey Brian,

          Whew!  No pressure!  HA!  First of all, major congrats on 1 full year of stable disease!  That is really great.  Overall, the data for all immunotherapies shows that the longer a patient goes without development of additional disease the better they do.  However, as far as long, long term survival with anti-PD1, it is hard to say given how few of us have taken the drugs and how recently we started that journey….overall.  However, here's what I have…keeping in mind that the data can't be taken very far out and generalization to all patients taking anti-PD1 is not yet clear.

          Here is an article from October 2014 by Dermott, Lebbe, Hodi, Weber, Wolchok, Balch, et al. addressing durable benefit in immunotherapy for melanoma:

          http://www.cancertreatmentreviews.com/article/S0305-7372%2814%2900122-4/fulltext

          If you look at the section – 'Refining assessment of clinical benefit' there kaplan meier curves (which echo page 9 in the report you posted) and these are to ipi.

          If you look at the 'discussion' section of this post you will find data related to survival regarding the folks in my nivo study….keeping in mind that this is talking about the resected arm:

          http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2014/12/cest-moi-results-from-33-raties-in-my.html

          Here are the related Kaplan Meier curves:

          http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2014/12/survival-graphs-for-my-adjuvant.html

          Here is an article by lots of melanoma big dogs talking about survival and durable tumor remission in melanoma patients given Nivo from June 2014 at ASCO:

          http://jco.ascopubs.org/content/32/10/1020.full

          Here are the Kaplan Meier curves from that article:

          http://jco.ascopubs.org/content/32/10/1020/F1.expansion.html

          So, looking at the Kaplan Meier curves, 1 year out is good, but a bigger separation of the curves occurs at 2 years.  Every day that passes with no development of disease makes prognosis better.  I just recently put up a post regarding long term, progression free survival after ipi on my blog.  It stands to reason that anti-PD1 with its greater response rate would have at least as good durability…but we just aren't that far yet.  Don't know if I helped or just made things more confusing!!!

          Bottom line, I say go for it.  You're right…the worst that can happen is the folks rating your physical for the FAA can say no.  If they do….you show up a year from now, tell them to stuff it, and apply again!!!  I'm betting on you!  Celeste

           

           

            • March 30, 2015 at 4:47 pm
            BrianP
            Participant

              Thanks Celeste!  I knew you'd be up to the challenge :).

              I have never noticed the statistical significance of the two year mark with Ipi.  Like you I'd like to think the anti-PD1 drugs will have a similar curve if not better.

              The FAA is pretty conservative with things like this, which is probably a good thing, but if they say no they should at least give me a timeline which will help me at least attempt to plan my life.

              Thanks again.

              Brian

               

              • March 30, 2015 at 4:47 pm
              BrianP
              Participant

                Thanks Celeste!  I knew you'd be up to the challenge :).

                I have never noticed the statistical significance of the two year mark with Ipi.  Like you I'd like to think the anti-PD1 drugs will have a similar curve if not better.

                The FAA is pretty conservative with things like this, which is probably a good thing, but if they say no they should at least give me a timeline which will help me at least attempt to plan my life.

                Thanks again.

                Brian

                 

                • March 30, 2015 at 4:47 pm
                BrianP
                Participant

                  Thanks Celeste!  I knew you'd be up to the challenge :).

                  I have never noticed the statistical significance of the two year mark with Ipi.  Like you I'd like to think the anti-PD1 drugs will have a similar curve if not better.

                  The FAA is pretty conservative with things like this, which is probably a good thing, but if they say no they should at least give me a timeline which will help me at least attempt to plan my life.

                  Thanks again.

                  Brian

                   

                • March 28, 2015 at 1:42 pm
                Bubbles
                Participant

                  Hey Brian,

                  Whew!  No pressure!  HA!  First of all, major congrats on 1 full year of stable disease!  That is really great.  Overall, the data for all immunotherapies shows that the longer a patient goes without development of additional disease the better they do.  However, as far as long, long term survival with anti-PD1, it is hard to say given how few of us have taken the drugs and how recently we started that journey….overall.  However, here's what I have…keeping in mind that the data can't be taken very far out and generalization to all patients taking anti-PD1 is not yet clear.

                  Here is an article from October 2014 by Dermott, Lebbe, Hodi, Weber, Wolchok, Balch, et al. addressing durable benefit in immunotherapy for melanoma:

                  http://www.cancertreatmentreviews.com/article/S0305-7372%2814%2900122-4/fulltext

                  If you look at the section – 'Refining assessment of clinical benefit' there kaplan meier curves (which echo page 9 in the report you posted) and these are to ipi.

                  If you look at the 'discussion' section of this post you will find data related to survival regarding the folks in my nivo study….keeping in mind that this is talking about the resected arm:

                  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2014/12/cest-moi-results-from-33-raties-in-my.html

                  Here are the related Kaplan Meier curves:

                  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2014/12/survival-graphs-for-my-adjuvant.html

                  Here is an article by lots of melanoma big dogs talking about survival and durable tumor remission in melanoma patients given Nivo from June 2014 at ASCO:

                  http://jco.ascopubs.org/content/32/10/1020.full

                  Here are the Kaplan Meier curves from that article:

                  http://jco.ascopubs.org/content/32/10/1020/F1.expansion.html

                  So, looking at the Kaplan Meier curves, 1 year out is good, but a bigger separation of the curves occurs at 2 years.  Every day that passes with no development of disease makes prognosis better.  I just recently put up a post regarding long term, progression free survival after ipi on my blog.  It stands to reason that anti-PD1 with its greater response rate would have at least as good durability…but we just aren't that far yet.  Don't know if I helped or just made things more confusing!!!

                  Bottom line, I say go for it.  You're right…the worst that can happen is the folks rating your physical for the FAA can say no.  If they do….you show up a year from now, tell them to stuff it, and apply again!!!  I'm betting on you!  Celeste

                   

                   

                  • March 28, 2015 at 1:42 pm
                  Bubbles
                  Participant

                    Hey Brian,

                    Whew!  No pressure!  HA!  First of all, major congrats on 1 full year of stable disease!  That is really great.  Overall, the data for all immunotherapies shows that the longer a patient goes without development of additional disease the better they do.  However, as far as long, long term survival with anti-PD1, it is hard to say given how few of us have taken the drugs and how recently we started that journey….overall.  However, here's what I have…keeping in mind that the data can't be taken very far out and generalization to all patients taking anti-PD1 is not yet clear.

                    Here is an article from October 2014 by Dermott, Lebbe, Hodi, Weber, Wolchok, Balch, et al. addressing durable benefit in immunotherapy for melanoma:

                    http://www.cancertreatmentreviews.com/article/S0305-7372%2814%2900122-4/fulltext

                    If you look at the section – 'Refining assessment of clinical benefit' there kaplan meier curves (which echo page 9 in the report you posted) and these are to ipi.

                    If you look at the 'discussion' section of this post you will find data related to survival regarding the folks in my nivo study….keeping in mind that this is talking about the resected arm:

                    http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2014/12/cest-moi-results-from-33-raties-in-my.html

                    Here are the related Kaplan Meier curves:

                    http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2014/12/survival-graphs-for-my-adjuvant.html

                    Here is an article by lots of melanoma big dogs talking about survival and durable tumor remission in melanoma patients given Nivo from June 2014 at ASCO:

                    http://jco.ascopubs.org/content/32/10/1020.full

                    Here are the Kaplan Meier curves from that article:

                    http://jco.ascopubs.org/content/32/10/1020/F1.expansion.html

                    So, looking at the Kaplan Meier curves, 1 year out is good, but a bigger separation of the curves occurs at 2 years.  Every day that passes with no development of disease makes prognosis better.  I just recently put up a post regarding long term, progression free survival after ipi on my blog.  It stands to reason that anti-PD1 with its greater response rate would have at least as good durability…but we just aren't that far yet.  Don't know if I helped or just made things more confusing!!!

                    Bottom line, I say go for it.  You're right…the worst that can happen is the folks rating your physical for the FAA can say no.  If they do….you show up a year from now, tell them to stuff it, and apply again!!!  I'm betting on you!  Celeste

                     

                     

                    • March 28, 2015 at 3:24 pm
                    ed williams
                    Participant

                      Good Morning Brian, glad to see that you are doing well. Nice to see you gave Celeste a challenge!  I just wanted to add a couple of ideas to what has already been given. One if you can find any publication by Dr.Antoni Ribas of UCLA at ASCO 2014 where he presented " Efficacy and Safety of the anti Pd-1 Monocional Antibody MK-3475 in 411 Patients with Melanoma". I have watched the presentation on Youtube and he gives data on survival going out about 18 months. Second there is a webinar with Dr. Jedd Wolchok of Memorial Sloan-Kettering titled " Tools and Strategies Driving Cancer Immunotherapy" on youtube published Jan 12, 2015 that could be helpful. Dr. Wolchok might be the best source for data on Nivolumab. Finally I think this years ASCO is going to be pretty important with early data from the phase 3 trial of Ipi and Nivo indivually or combined will be presented. I think there are about 1000 patients in the study. Wishing you the best in getting back to work. Ed 

                        • March 30, 2015 at 4:35 pm
                        BrianP
                        Participant

                          Thanks Ed.  I'll check out those two presentations.

                          • March 30, 2015 at 4:35 pm
                          BrianP
                          Participant

                            Thanks Ed.  I'll check out those two presentations.

                            • March 30, 2015 at 4:35 pm
                            BrianP
                            Participant

                              Thanks Ed.  I'll check out those two presentations.

                            • March 28, 2015 at 3:24 pm
                            ed williams
                            Participant

                              Good Morning Brian, glad to see that you are doing well. Nice to see you gave Celeste a challenge!  I just wanted to add a couple of ideas to what has already been given. One if you can find any publication by Dr.Antoni Ribas of UCLA at ASCO 2014 where he presented " Efficacy and Safety of the anti Pd-1 Monocional Antibody MK-3475 in 411 Patients with Melanoma". I have watched the presentation on Youtube and he gives data on survival going out about 18 months. Second there is a webinar with Dr. Jedd Wolchok of Memorial Sloan-Kettering titled " Tools and Strategies Driving Cancer Immunotherapy" on youtube published Jan 12, 2015 that could be helpful. Dr. Wolchok might be the best source for data on Nivolumab. Finally I think this years ASCO is going to be pretty important with early data from the phase 3 trial of Ipi and Nivo indivually or combined will be presented. I think there are about 1000 patients in the study. Wishing you the best in getting back to work. Ed 

                              • March 28, 2015 at 3:24 pm
                              ed williams
                              Participant

                                Good Morning Brian, glad to see that you are doing well. Nice to see you gave Celeste a challenge!  I just wanted to add a couple of ideas to what has already been given. One if you can find any publication by Dr.Antoni Ribas of UCLA at ASCO 2014 where he presented " Efficacy and Safety of the anti Pd-1 Monocional Antibody MK-3475 in 411 Patients with Melanoma". I have watched the presentation on Youtube and he gives data on survival going out about 18 months. Second there is a webinar with Dr. Jedd Wolchok of Memorial Sloan-Kettering titled " Tools and Strategies Driving Cancer Immunotherapy" on youtube published Jan 12, 2015 that could be helpful. Dr. Wolchok might be the best source for data on Nivolumab. Finally I think this years ASCO is going to be pretty important with early data from the phase 3 trial of Ipi and Nivo indivually or combined will be presented. I think there are about 1000 patients in the study. Wishing you the best in getting back to work. Ed 

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