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PD-L1 Therapy for Metastatic Triple Negative

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pj123 View Drop Down
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    Posted: Apr 29 2017 at 1:39pm
Follow up on http://forum.tnbcfoundation.org/topic13067_post130990.html

Recently the doctor suggested to get a test for PD-L1 expression for my aunt. I wanted to ask if anyone has undergone this therapy for Metastatic Triple negative breast cancer. If yes it would be valuable if they can share their experience. 

Another question was there are many different tests of PD-L1 for various cancer, I think for breast cancer "PD-L1, IHC with Interpretation" (http://www.questdiagnostics.com/testcenter/TestDetail.action?ntc=94007) is the one that should be done, am I right ? Also, if test shows that the therapy is applicable then the doctor suggested that "Avelumab" drug will be used which I guess the doctor will tell us how and where to get it from.

Thank You.
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gordon15 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote gordon15 Quote  Post ReplyReply Direct Link To This Post Posted: Apr 30 2017 at 10:28am
Has she had any molecular genetic testing of the tissue? My wife's doctor sent out to FoundationOne lab, they found "EGFR" (F795C) gene mutation and recommended "Lapatinib" (FDA approved in her cancer type) should she have recurrence. They even listed the approved therapy drugs "in other cancer types" Of course, we have no idea what will work in the future, but this is latest research (Moores Cancer Cntr)

Also sent to Carris.,
 sorry... I don't see anything about PD-LI in her results. She is 66 yrs old, your aunt is younger, perhaps inquire?
wife: IDC/Lobular Stage2B 2008 lumpectomy/TAC+rads
TNBC Stage 3A/w/metaplastic/squamous Nov2015 Carboplatin-Gemzar chemo/masectomy Taxolchemo+rads 4-16
PET scan stable 9-2016/ 1-2017
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pj123 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote pj123 Quote  Post ReplyReply Direct Link To This Post Posted: Apr 30 2017 at 11:06am
Thank you for the reply. 

No molecular genetic testing has been done so far in her case. Yes, she is younger (52 years old). When you said "perhaps inquire" did you mean inquire with the doctor to get her genetic testing done or something else ?

Thank You
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gordon15 View Drop Down
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Post Options Post Options   Thanks (1) Thanks(1)   Quote gordon15 Quote  Post ReplyReply Direct Link To This Post Posted: Apr 30 2017 at 11:16am
yes, inquire with the doctor .
wife: IDC/Lobular Stage2B 2008 lumpectomy/TAC+rads
TNBC Stage 3A/w/metaplastic/squamous Nov2015 Carboplatin-Gemzar chemo/masectomy Taxolchemo+rads 4-16
PET scan stable 9-2016/ 1-2017
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123Donna View Drop Down
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Post Options Post Options   Thanks (1) Thanks(1)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: May 01 2017 at 8:09am
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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pj123 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote pj123 Quote  Post ReplyReply Direct Link To This Post Posted: May 01 2017 at 9:37am
Thank you for all the information. It is certainly helpful.
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123Donna View Drop Down
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Post Options Post Options   Thanks (1) Thanks(1)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Jun 05 2017 at 9:49pm

Keytruda Shows Meaningful Clinical Benefit When Combined with Standard Therapy 


DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (1) Thanks(1)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Jun 09 2017 at 11:29am

Cancer Drug Proves to Be Effective Against Multiple Tumors

DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Jun 09 2017 at 7:17pm
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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pj123 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote pj123 Quote  Post ReplyReply Direct Link To This Post Posted: Jun 09 2017 at 10:52pm
Thanks 123Donna, I believe this drug is effective on patients with PD-L1 positive. However, my aunt was tested for PD-L1 and the result was negative. 
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123Donna View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Jun 10 2017 at 12:08pm
pj123,

You are correct.  It's most promising in patients who's tumors tests positive for the PD-1 mutation.  I'm sorry your aunt couldn't benefit from this drug.

"The patients all carried genetic mutations that kept their cells from fixing damaged DNA. Pembrolizumab (Keytruda) is known as a PD-1 blocker, an emerging type of immunotherapy drug that helps the immune system find cancer cells and attack tumors."
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Manchubby Quote  Post ReplyReply Direct Link To This Post Posted: Jun 15 2017 at 5:23pm
Dear PJ123,

I share your disappointment that your aunt tested negative for the PD-L1 mutation with respect to Keytruda's effectiveness. To add to yours and Donna's observations one not only has to test positive for PD-L1 but it also has to have a strong expression. My wife tested positive for PD-L1 but it was weak and her trial with Keytruda was subsequently stopped after 3 cycles due to disease progression. Sorry if this does not sound very positive but I thought I'd share this for what its worth. 

I wish your aunt the best in her treatment.

Best regards,

Manc_hubby
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Jun 16 2017 at 9:47am

Data from I-SPY 2 TRIAL shows potential of a new precision medicine drug therapy for breast cancer patients


DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote gordon15 Quote  Post ReplyReply Direct Link To This Post Posted: Jun 16 2017 at 6:04pm
Thanks for you comments. My wife has a genetic mutation "EGFR" with the doctors recommending (1) FDA approved drug, should she have a recurrence.

Her latest blood-marker tests from Guardant lab show positive for BRCA2 which wasn't their before. Don't know what to make of this.
wife: IDC/Lobular Stage2B 2008 lumpectomy/TAC+rads
TNBC Stage 3A/w/metaplastic/squamous Nov2015 Carboplatin-Gemzar chemo/masectomy Taxolchemo+rads 4-16
PET scan stable 9-2016/ 1-2017
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