Forum Replies Created
-
AuthorPosts
-
This was such exciting news. We haven’t taken anyone off of their current BRAF/MEK therapy, but if they develop side effects, we will certainly consider transitioning them to another. Also, we will certainly consider this combo front line now depending upon the patient circumstances.
Also, THC is highly protein bound, so it certainly could compete with other drugs in that aspect as well. These are certainly things to think about as these type of alternative therapies become more and more popular.
We’ve gone the clinical trial route for a lot of these patients – I agree that responses typically aren’t as robust, if there is even a response. But, I do have one exception – he’s been on BRAF therapy for 6 years! Crazy!
We try to have them avoid herbals. It’s required when on a trial, but even when on standard therapy, it’s best. I usually just explain that we’re unsure of the side effects of the herbals and that they’re not studied by the FDA. I had one patient on Tafinlar plus Mekinist that had been on it for years when his ALT and AST spiked….high. We were so worried about tox or PD. Then he admitted that he had started herbals. He held them and about a week later, LFTs were significantly better. Just one example, but again, best to avoid!
I’m also really hoping that there will be a push to educate referring providers (surgeons, particularly) to help save time, especially given that there can be a wait to get in the door for an appointment at some institutions. Of course the surgeons that we routinely work with will be aware, and it will probably become a default with the pathologists at our institution, but in the community, this will certainly be important.
We’re now having to notify patients that the trial didn’t reach its endpoint and take them off the IDO. This is really tough for those patients that have been on this in Phase 1 for quite some time……especially considering that some did REALLY WELL!
I also agree with you all. I think that providers will start with IO unless it is contraindicated (pre-existing autoimmune disease, etc.). Plus, we all know how horribly the disease “explodes” once resistant to BRAF therapy. It will be interesting to see how it plays out, though.
I haven’t seen any apps specific to melanoma drugs. It would be helpful for those tech-savvy patients. We still use calendars, alarm reminders, etc.
So true! We have been SO fortunate to have gained such ground in melanoma over the last several years!
That’s interesting…..we haven’t utilized MTX or Plaquenil for non-psoriasis rashes nor have I seen our local derms use them. A lot of our patients are on trial, however, and these drugs would not be preferred for a trial patient unless in some extenuating circumstance. But, it makes sense and is very interesting. I think we would definitely punt prescribing these to a specialist, though.
Yeah…..I guess we still had patients on it in the phase 1 setting that were eager. They’ve obviously done well if still on it in Phase 1, but I think some of them were hoping it would be approved so they could get through local oncologist.
We’re having a harder and harder time getting them paid for. We do have a nonclinical precert team as well, which is helpful. However, I notice that sometimes they don’t include pertinent terms such as metastatic, etc. when submitting requests.
I’m losing my mind with the fact that I can’t call and do a peer-to-peer at my convenience anymore and instead have to schedule them. It’s MADDENING! We’re busy enough, and anytime I have one scheduled, I inevitably have something come up in clinic and miss them. It’s even more frustrating when I learn about the peer-to-peer the day or two prior.
I agree with Krista that many of physician reviewers are not oncologists, which further complicates the issue. INSURANCE!!!
I haven’t seen such a thing, but I’d consider gabapentin to help. Keep us posted!
Maybe chronic fatigue, chronic taste changes, financial impact and ability to get disability insurance to protect family, sexual impairment with endocrinopathies (hypophysitis etc).
Oh, wow! We have not seen this either. It sounds like it could be from an autoimmune process, though. Have you all utilized steroids yet? Keep us posted on how this evolves. Very interested. I hope that it turns out well for the patient involved.
-
AuthorPosts
