I've posted about the chemicals and vaccines. Now it's time to put the information to use to clarify my treatment options that I posted on August 13, 2009.
Option 1: Gleevec (
Imatinib Mesylate). This drug is a protein-kinase inhibitor, specifically
tyrosine kinase. It has been FDA-approved previously for the treatment of chronic myeloid leukemia (CML). It specifically targets an enzyme that allows the growth of cancer cells. This drug has been shown to significantly reduce the number of CML cells in treated patients within one to three months. The purpose of this trial is to determine how effective Gleevec is for melanoma that has spread from the skin to other parts of the body. The spread of melanoma cells is facilitated by the protein C-KIT, which is expressed as the result of a genetic defect in the tumor cells.
Gleevec is thought to bind to these defective cells and stop the spread of cancer. Side effects include fluid retention and edema, rashes, nausea and vomiting, diarrhea, heartburn, and headache. More serious side effects, which occur less frequently, include liver toxicity and internal bleeding.
This trial is available in Boston or Chapel Hill, NC. About one person in five whose melanoma began on the skin (as mine did)is expected to manifest the C-KIT mutation. My tumor tissues have been sent to a lab to determine if I have the C-KIT mutation present. If not, I'll proceed to Option 2.
Option 2: Temodar + ABT-888. Temodar (
temozolomide) is classed as a lipid-soluble alkylating agent which crosses the blood-brain barrier, and has been used previously for treating certain brain tumors. ABT-888 is a PARP (Poly ADT-ribose polymerase) inhibitor. The PARP enzyme is active in cell growth and repair. Blocking PARP, may prevent the cancer cell from growing or repairing itself. Using the two in combination may make Temodar more effective.
This is a randomized, double-blind study with three arms, two of which use both agents in different dosages; the third (control) arm uses Temodar alone. Possible side effects include low platelet count increasing the possibility of bleeding, fatigue, constipation, nausea, diarrhea, vomiting, anorexia, and headaches.
This option is available in Charlotte, NC.
Option 3: Biovex. The lead product of Biovex Inc., now a part of Triathlon Medical Ventures, is OncoVEX, a manufactured, virus-containing vaccine to “carefully pollute cancer cells” while leaving other cells unaffected. The virus appears to be able to affect melanoma cells even after metastasis has begun. The assumption is that the cell pollution will lead to apoptosis or senescence.
The chief drawback of this trial is the there most be one or more tumors on or sufficiently near the skin surface for periodic biopsies to track the vaccine effect, a condition which I do not have at the moment. Side effects are unknown at this point. This treatment would be available in Chapel Hill.
Option 4: Avastin + Ipilimumab. Avastin (bevacizumab) is a monoclonal antibody produced in a laboratory and used in the treatment of colorectal cancers. It is classed as an Angiogenesis inhibitor. Avastin functions by blocking the action of the VEGF protein (vascular endothelial growth factor) which stimulates the growth of new blood vessels (angiogenesis); therby, denying new blood needed for tumor growth.
Avastin side effects include increased blood pressure, fatigue, muscle weakness, blood clots in veins, diarrhea, nausea, loss of appetite, low white cell count, headache, nosebleeds, and pain at the tumor site. More serious, less frequent effects include perforations, inability of wounds to heal, internal bleeding especially in patients with lung cancer, bleeding in the brain resulting in strokes, blood clots in arteries, uncontrolled high blood pressure, and kidney damage.
Ipilimumab is a human monoclonal antibody that binds to to a molecule on T cells (
CTLA-4)that plays an important role in activating and regulation the immune system. Ipilimumab blocks CTLA-4 function, which otherwise suppresses the immune system. Maintaining an active immune system should make the Avastin treatment more effective and less debilitating.
In prior trial uses Of Ipilimumab, there has been about a 2% fatality rate and 20% auto-immune response. This trial is currently not recruiting, but might be available again in Boston in November.
Option 5: Temodar (temozolomide). This is currently the standard treatment for metastatic melanoma. Its function and effect would be the same as Arm 3 of Option 2 above.
This creates a quandary for me. If I chose Option 2, there is one chance in three of getting the same treatment as Option 5. The only differences are that I will have to go the Charlotte rather than Chapel Hill and participate in a significant number of procedures (exams, scans, blood tests) the only purpose of which would be to maintain the integrity of the double blind research design.
This point is irrelevant if my tumor profile shows the C-KIT mutation needed for participation in Option 1, so I’m holding my breath for another few days to get the answer.