"Sendeep"~KEYTRUDA (immunotherapy) approved 4 some gastric cancers plus info re Esophageal Cancer &

LorettaMarshall
LorettaMarshall Member Posts: 662 Member
edited April 2018 in Esophageal Cancer #1

Dear “Sendeep”

Your letter is a sad one, like so many others here.  However, I note that you have written in a topic forum that began 5 years ago, and isn’t really active today.  Only one lady, “Sandy1943” posted here in May of 2017.  I know Sandy and she is still a survivor, and we have been “EC friends” for years, however she doesn’t post regularly.  So in fact, Paul61 is the only current contributor that has posted answers on this particular topic.  We make it our business to find the "newbies" although they often post on an old forum that isn't active for the most part.  And so in the future, I think it would be wise if you would start your very OWN personal topic forum.  So I am going to take the liberty of posting my answer to your latest post on a separate topic forum here.  If you would post further comments here, I believe it will help us to keep up with you on a current basis.

          Now I see that you have posted another comment since Paul61 answered you.  https://csn.cancer.org/comment/1624008#comment-1624008

Therefore, since we have other patients just like you who always wonder if they are getting the best treatments at the best hospitals equipped to perform the least invasive Esophagectomies, I’ve decided to post my answer to you in a separate topic because I think the information here will be helpful to all.  So here is your latest post.  My comments follow:

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“J Tube planned for future

Thanks Paul for sharing your experience. It's been two years now since we're fighting this battle and your story has given me new hope that my father can still beat cancer and come out stronger.

Today he is getting discharged from hospital. I'm glad that his neck wound has healed which lead doctors to remove jtube however they were reluctant to take it out initially. Doctors are hoping that he gains some weight during this time. In case he starts to face difficulty eating they plan to put jtube back again so ensure he gets proper nourishment after which chemo and immuno might start. I'm especially hopeful of immunotherapy as I have heard it's targeted and less harmful on the body. Please let me in case you have any experience to share on this 

Apr 05, 2018 - 11:29 pm”

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 I see that you have posted another comment since Paul answered you here:  https://csn.cancer.org/comment/1623937#comment-1623937

  If this were my father, I would ask for the J-tube to be put back in “sooner rather than later.”  In my view, the doctors should have stuck with their first inclination.  For a man weighing now 77#, he needs all the help he can get.  You mention immunotherapy, and we all get our hopes up when we read articles or hear testimonies about the latest attempts to beat cancer.  And some have been successful.

Now I see that you have posted another comment since Paul61 answered you.  https://csn.cancer.org/comment/1624008#comment-1624008

Therefore, since we have other patients just like you who always wonder if they are getting the best treatments at the best hospitals equipped to perform the least invasive Esophagectomies, the references I’ve included here will be of help to them as well. I know that we have many “lurkers” here who read but never post themselves.  Some have never posted here, but have taken the info we who are knowledgeable about Esophageal Cancer have shared here.  We’re happy to know that they are wise enough to “research” EC and make the best decisions.  It is best to be a “realist” and not live in “Denial”.  The only way to do that is “take ownership of the cancer—research it with reputable sources—ask questions—keep records—be your own advocate—get a second opinion, etc.

          Below my name I will share several links with you.  Relative to your question about possible immunotherapy for your Dad, it seems that KEYTRUDA has now been approved and recommended for certain types of gastric cancers--Esophageal Cancer included.    That is great news! 

And I would also ask you, “Have you had a SECOND opinion at a leading hospital that treats Esophageal Cancer?”

I’m not too pleased with these doctors who removed your father’s J-tube.  If it were me, I would have “TOLD” them that I did NOT want the J-tube removed!  My husband was diagnosed with EC Stage III (T3N1M0).  He weighed 275 at the time of diagnosis and was 65 years old.  His surgery (Ivor Lewis Minimally Invasive Esophagectomy, aka MIE] was performed at the University of Pittsburgh Medical Center, by Dr. James D. Luketich, the pioneer of the MIE.  Now I know your father has already had an esophagectomy and has now had a recurrence, but you still need to be at the best hospital where a medical team can review your dad’s records, and decide which adjuvant (post-op) treatment holds the most promise for him. 

          You’ve asked how long it takes for a patient to gain weight after their surgery.  My husband lost 60 # in the first 9 months.  After that he maintained a weight range of 205 to 215.  He is now in his 15th year of survival with no recurrence.  We give God the credit for leading us to UPMC and for my husband’s continued cancer-free status.  However, he has had two mini-strokes in the last 3 years, and now the heart doctors want him to try to stay around the 203# mark.

Personally, since you ask, I would think that there is no way your father will gain weight quickly without a J-tube.  And let’s face it, chemotherapy is often brutal.  The longer father waits to have more treatments, the more the cancer has a chance to run wild.  Time is of the essence. 

Loretta (Wife of William, a 15-yr. EC Stage III (T3N1M0) survivor with no recurrence so far.  We thank God.)

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1.     http://news.cancerconnect.com/us-food-drug-administration-expanded-approval-precision-cancer-medicine-keytruda-treatment-gastric-cancer/

“The US Food and Drug Administration has Expanded the Approval of the Precision Cancer Medicine Keytruda for Treatment of Gastric Cancer

Keytruda (Pembrolizumab) is now indicated for patients with recurrent locally advanced or metastatic gastric or gastro-esophageal junction adenocarcinoma.

Patients eligible for keytruda therapy under this new indication must have PD-L1-expressing tumors, and must demonstrate disease progression after two or more prior lines of therapy – including fluoropyrimidine- and platinum-containing chemotherapy and, in some cases, HER2/neu-targeted therapy.

Keytruda is a monoclonal antibody that helps to restore the body’s immune system in fighting cancer. 

It creates its anti-cancer effects by blocking a specific protein used by cancer cells called PD-L1, to escape an attack by the immune system. Once PD-L1 is blocked, cells of the immune system are able to identify cancer cells as a threat, and initiate an attack to destroy the cancer. Keytruda is also approved for the treatment of certain types of metastatic melanoma, lung, and head and neck cancer.

The new indication for treatment of gastric and gastric esophageal junction cancers came following an accelerated approval designation based on tumor response rate and durability of response. Continued approval for this indication is contingent on verification of clinical benefit in the confirmatory trials.

http://news.cancerconnect.com/keytruda-immunotherapy-appears-promising-advanced-gastric-cancer/

“Keytruda is now the first PD-1 checkpoint inhibitor approved in the United States for previously treated advanced gastric or GEJ cancer, helping to address a recognized treatment gap,” said Roger M Perlmutter, president, Merck Research Laboratories, in a statement (September 24, 2017).

 “This approval marks another milestone – the tenth new indication for Keytruda in just three years – which further demonstrates both our commitment to patients and the progress we have made in the fight against many cancers.”

Copyright © 2018 CancerConnect. All Rights Reserved.”

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2.     http://news.cancerconnect.com/types-of-cancer/esophageal-cancer/esophageal-cancer-overview/

Management of Esophageal Cancer

Esophageal Cancer News

Esophageal Cancer Links…”

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3.          http://www.gomn.com/news/mayo-clinic-says-get-a-second-opinion-first-ones-are-frequently-wrong/

“MAYO CLINIC SAYS GET A SECOND OPINION – FIRST ONES ARE FREQUENTLY WRONG

By Melissa Turtinen - April 4, 2017 12:17 pm

The Mayo Clinic in Rochester did a study (published in a medical journal Tuesday) and found as many as 88 percent of patients who came to the clinic for a second opinion for a complex condition left with a new or more refined diagnosis, a news release says.

The Mayo Clinic says a different or more detailed diagnosis can change someone’s care plan “and potentially their lives.”

The study looked at 286 patients who were referred from primary care providers to Mayo Clinic’s General Internal Medicine Division in Rochester between Jan. 1, 2009, and Dec. 31, 2010. Here’s how the types of diagnostic errors breaks down:

       Only 12 percent of patients left the Mayo Clinic with the same diagnosis.

       In 21 percent of cases, the diagnosis was changed completely.

       In 66 percent of patients, their diagnosis was refined or redefined.

“Effective and efficient treatment depends on the right diagnosis,” Dr.  James Naessens said in the release. “Knowing that more than 1 out of every 5 referral patients may be completely [and] incorrectly diagnosed is troubling – not only because of the safety risks for these patients prior to correct diagnosis, but also because of the patients we assume are not being referred at all.”

A lot of people don’t consider getting a second opinion because they either don’t know that’s something you can do, or because it can be expensive for people to see another doctor who may not be in their health insurance’s network, the Mayo Clinic says.

“Total diagnostic costs for cases resulting in a different final diagnosis were significantly higher than those for confirmed or refined diagnoses, but the alternative could be deadly,” Naessens said.

HOW TO ASK FOR A SECOND OPINION

It may seem a little awkward to ask your doctor for a referral to get a second opinion, but don’t worry – asking for a second opinion is pretty normal, U.S. News and World Report says, noting any doctor who is good at what they do will welcome a second opinion.

Here are some tips about seeking a second opinion:

– Don’t worry about asking for a second opinion for the minor things. Instead, seek a second opinion for serious or chronic issues, especially if you’re unsure about your doctor’s diagnosis or if the treatment for the issue is experimental or risky, U.S. News and World Report notes. But it’s important not to wait too long to get a second opinion, because you don’t want to delay treatment for too long, the Patient Advocate Foundation says.

– When asking for the second opinion, tell your doctor you just want to be fully informed about your diagnosis, prognosis and treatment, Compass Healthcare Solutions suggests. You can ask your doctor for a referral to see a specific doctor you have in mind, but WebMD says don’t see a doctor that is affiliated with your initial doctor – they probably won’t contradict them.

– Before you go see the new doctor, make sure you get a copy of your medical records and test results, the Patient Advocate Foundation says. Sometimes tests can be wrong, though so WebMD says you can ask for a second medical opinion and for the lab or pathologist to do the tests again.

– When you go in for your second opinion, remember you’re looking to confirm your current diagnosis – the second opinion isn’t always right, U.S. News and World Report says. Doctors may differ on your diagnosis or a treatment plan, and ultimately it’s your choice to decide what’s best for you, the Patient Advocate Foundation says.

For more information on when and how to get a second opinion, click here."

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4.     https://health.usnews.com/health-care/best-hospitals/articles/faq-how-and-why-we-rank-and-rate-hospitals#best-hospitals

[My note:  Not all hospitals are capable to treating Esophageal Cancer patients equally.  Just because a hospital includes “Cancer” in the name of their hospital, it does NOT mean that they have the expertise and state of the art equipment and the best trained Thoracic surgeons to treat a patient.]

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5.     https://health.usnews.com/best-hospitals/rankings/gastroenterology-and-gi-surgery

[My note:  Here is a list of the best hospitals equipped to take care of Esophageal Cancer patients.

If Dad can travel, and your insurance will pay for a SECOND opinion, you would do well to be certain that you choose one of these hospitals.  Most often when patients write here, they are not at the best hospital for their particular cancer.  Esophageal cancer comes under the category of “Gastroenterology and GI surgery.  I’m certain after reading this that you are probably saying, “I wish we had known this 2 years ago—but now you must make the best with where you find yourselves at this time.  I’m glad you are asking questions. 

Note the stipulations outlined in Reference 1 for a patient to qualify for Keytruda.  Since you are especially interested in immunotherapy, as we all are, it just might be that your dad meets those qualifications. ]

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6.     http://www.cancernet.co.uk/herceptin.htm

Many Esophageal cancer patients find that they have a special cancer gene that is “over expressive”.  Although this article references Breast Cancer patients, the FDA also approved it for Esophageal Cancer patients back in 2010.  Originally it was thought that only BC patients had this gene that multiplied rapidly, but it was later discovered that when tested EC about 25% of Esophageal Cancer patients exhibited the same over-active gene.  So I would ask if your Dad has been tested to see if he is HER2 positive.  If so, he should be getting this along with his chemotherapy whatever that turns out to be.

Now it may be that if he goes where doctors recommend KEYTRUDA, I’m not certain if any other drugs would be included as well.  Herceptin is NOT a chemotherapy drug.  But how it fits in with those receiving the KEYTRUDA treatment, I could NOT tell you.  It might mean that in that case, it would not accompany this immunotherapy treatment.

However, if the standard chemo is what is recommended for Dad, then by all means I would want to have him tested for HER2 status.

I note that we have a Stage IV EC patient here who attributes his longevity to the addition of HERCEPTIN TO HIS ongoing treatments.  His tag is “DeathorGlory” and his name is ED.  He has lived as long as any of the Stage IV patients that I’ve read about on this post.  So I would say if KEYTRUDA treatments cannot be given, then definitely ask about Herceptin.

But it just might be that KEYTRUDA would be something for which your Dad might qualify.  If so, if it were me, I would certainly try the KEYTRUDA.  However, it is not available to me as a Peritoneal Carcinomatosis/Ovarian Cancer Stage IV patient.  But my spirits are always lifted when I see some immunotherapy treatment that holds promise, since the standard drugs to treat Esophageal patients have been around for a long time. 

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7.     https://www.keytruda.com/gastric-cancer/

“…KEYTRUDA IS AN IMMUNOTHERAPY TO TREAT ADVANCED GASTRIC CANCER

For patients with a kind of stomach cancer called gastric or gastroesophageal junction (GEJ) adenocarcinoma whose tumor tested positive for PD‑L1, whose cancer has returned or spread (advanced gastric cancer), and who tried but did not respond to or stopped responding to 2 or more types of chemotherapy, and a HER2/neu‑targeted medicine if appropriate.  

  Find out if KEYTRUDA is right for you…”

____________________End of references______________

 

 

 

 

 

Comments

  • Sendeep
    Sendeep Member Posts: 4
    #2
    Appreciate.your advise

    Thank you Lorretta Marshall for such an in-depth information

    Reason for taking off jtube was we wanted him to taste food again. This may be a normal thing for others but a person who hasn't tasted food trully knows how much it means to him. So decision to remove jtube comes to me as I had insisted doctor to think about this option. However I'm ruining it now after bringing him home today and  He was hardly able to eat and was having101 Celsius fever. Ever since this surgery his lungs are getting infected and to doctor surprise his latest culture test has shown resistance towards al major antibotics. In these conditions, it seems doctor might not be able to continue with further treatment as strong lungs are required to bear chemo.

    I wish  if his weight and lungs would have been better then things would have been much better

    I m still hopeful that God will help me somehow to get my father 

     

    Regards, 

    Sendeep

  • LorettaMarshall
    LorettaMarshall Member Posts: 662 Member
    #3
    Don't blame yourself about J-tube U were just trying 2 help Dad

    Dear Sendeep~

     

    Often I see that the caregivers, try as they may, attempt to coax the sick one to eat.  Often taste buds change and things that once tasted good are no longer "desired."  Moreover, there are many days that the patient is so sick that it makes them nauseated to even think about or "smell" food.  That is why it is so important for the patient to have a "J tube" during treatment. 

     Moreover, to avoid constant needle sticks, a medi-port is a real lifesaver.  Repeated "vein sticks" can break down the veins and the patient has to sit "patiently" while one nurse calls in another nurse to "help" find a vein.

     Moreover, a medi-port is excellent for medications that need to be given.  I was in the hospital for 42 days after my Cytoreductive Surgery, and I was given all my meds through my mediport. 

    And even though I could order anything I wanted to eat all during the day, I wasn't hungry, even though I was on an "ice-chip" diet for the first ten days after surgery.  Having been both a caregiver to my husband, and a Stage IV patient myself now since 2012, I have lived on both sides of the “sick bed”, and can now see the whole picture.  Shall I say from the "inside out?"  

    Now don't blame yourself for thinking that eating by mouth would be best.   Your dad is very sick but I venture to say he lacks an appetite.  Even though it makes the caregiver feel better if they fix something that the patient used to love—it doesn't do the same for the one with the cancer. Often the patient says “You know what would taste good right about now?”  Then you rush to fix it—they take 2 bites—and push the plate away.  I know that happens. 

    I have a dear friend now whose husband has been diagnosed with Pancreatic cancer.   She is constantly asking for prayer that her husband will have an appetite and that he will not be fatigued.  Little does she realize that lack of appetite and extreme fatigue are two of the villains with which we often cope.  The fatigue is with me ALL the time.  Most of the patients at my oncology lab are walking with canes as am I!  We are just plain TIRED all the time.  Chemo drains one of energy!  My mind tells me to “get up and go on with the things I want and need to be doing.  But my body is in rebellion!

    What kind of surgery did your dad have?  Did he have the OPEN Ivor Lewis surgery which is the most invasive and takes the longest time to recuperate?  Or did he have a less invasive one like the “TransHiatal” or the totally laparoscopic Ivor Lewis Minimally Invasive Esophagectomy (MIE)—just curios?

    So just be certain that your Dad is in the best place to receive care.  Example:  My friend's husband is going to a VA hospital here in Virginia.  They have one oncologist who "treats" all the patients, no matter the diagnosis.  She has to play "phone tag" to try to get answers because they live some distance away from the hospital although he is getting radiation locally.  They have not gone anywhere else for a second opinion, although they have Medicare A & B, Tri-care and BC/BS.  I have begged them to take him to Johns - Hopkins Hospital.  It is in Maryland and we live in Virginia.  

    And just to show you how qualified the VA Hospital is, after a biopsy was taken, they said they could NOT verify the results. Surprised After a week had gone by, the medical team, sent the biopsy to the VA in Houston, TX for an opinion.  Houston took 3 weeks to send a diagnosis.  YellAnd that was only after repeated calls from the wife to the VA Hospital here to see why Houston had not gotten back with them.  Meanwhile the Pancreatic Cancer is on a tear! 

     This is such a sad case.  Although my own husband served in the military for a time back in the 50's, I would never send him to a VA for Esophageal Cancer. Thank God we have excellent insurance, although we pay a pretty penny for it.  Both he and I have been served well by our Anthem BC/BS - Advantage Care-Plan D.  And no, we haven't had to resort to eating "dog food" to pay for the medicine.  I don't mean to disparage those who do not have the ability to have that kind of care, but we do make choices in our retirement years, and paying our medical premiums are a must.  We don't have the luxury of travel, for one thing my condition doesn't allow for that.  But we are blessed and thankful to have good care and that gives us the confidence that we're doing all we can do.  Stayin' alive becomes the priority Winkand in order to do that we must have doctors that graduated at the top of their class--not the bottom.

    So my advice would be to keep in close communication with Dad and let him tell you how he really feels.  He is telling you the truth.  And it's hurtful for everyone.  Stay in the loop and question the reason why the doctors recommend one treatment over another. 

    But my answer would still be the same.  Have the J-tube put back in ASAP.  I’m not certain as to how the lung problem will affect his return to the OR to have the J-Tube reinserted.  That may be something that keeps him from having it reinserted anytime soon, because he would certainly have to be sedated.

    I don't have fluid in my lungs, but I do have fluid around my lungs.  Not too long the doctors drained 1 ½ liters from that space, and I felt a lot of relief.  Fluid around the lungs hampers your ability to breathe and it gives me a sharp stinging pain in my back where my lungs are.  There was more than that much fluid but the doctor told me in advance, this is all I’m going to drain.  I also had my lungs drained during my hospitalization.  The process wasn’t painful.  The doctors let my husband take a video of the process when I was in the hospital in Pittsburgh.  I was in the “Passavant” Hospital and received excellent care. 

    While I was home doing pre-op chemo, I was given a spirometer that I was to use several times a day.  That practice continued each day during my hospitalization, and all the while when I was in recuperation.  I hope that at least Dad has a spirometer to help with his lungs.  I had a major infection shortly after my surgery, and it took days and days for the doctors to analyze the bacteria, properly define it, and find the right antibiotic.  Thankfully all the meds were given through my medi-port.  

    I’m certain that all of us who here who have read your story are saying prayers for you and your family.  Nothing brings more tears Crythan when a family member has cancer, and seemingly nothing seems to be working.  Then a flood of precious memories begin to roll in and the thoughts of not having your Dad around after he has provided for you so many years at times seems unbearable. I hope he is the kind that can have a real heart-to-talk with you now about all the things he is thinking, and the same for you.  Being open and honest and sharing your deepest thoughts and hurts with one another is therapeutic I have found.  All our family members are open with each other, and they all know how my husband and I feel about our wishes when we die.  And at the rate I am progressing, it won't be way off in the future.  But I am prepared to meet the Lord, and I have peace in my soul even as the cancer spreads from one place to another.  I'm sorry that this cancer has now touched your family.  May God give you the spiritual and physical strength to carry on.

     Love & prayers,

    Loretta

     

  • Sendeep
    Sendeep Member Posts: 4
    #4
    Thank you Lorretta for your
    Thank you Lorretta for your support and guidance.
    It's really painful and frustrating. Being a caregiver I can only help but I can't imagine the difficulty my Dad is going through. Im from INDIA. We couldn't find any doctor who would perform minimal invasive surgery hence had to opt for Lewis surgery which I now understand has taken him further away from us.
    I'll go in a while to get jtube installed which will provide some relief to him. My Dad is a good man he did everything to give us better future and i still hope that God is with us.

    You're fighting a battle of you own and in these times also helping others like me . I really appreciate and admire efforts to make patient and caregivers better informed. Information which you've provided really helped me understand my situation
    I wish you good health to you and your family
    Regards,

    Sendeep

  • De05m
    De05m Member Posts: 7
    #5
    Hi is this available in India

    Hi is this available in India ? Please let me know 

     

  • LorettaMarshall
    LorettaMarshall Member Posts: 662 Member
    #6
    De05m~India has access to KEYTRUDA~?4U~R EC patients included?

    Hello “De05m”

    In my writing to “Sendeep” I used a reference about KEYTRUDA.  Am I to understand that you are asking ME if Keytruda is available in India, according to the references below—YES it is?  .  The problem for patients in India is seemingly finding the right doctors, as we have had other patients or their family members write to us here.  Moreover, is it affordable even when it is available in India?  And again is it currently only being prescribed for specific cancers in India?  Those are questions that would have to be asked.   

    We are blessed to live in America where so many drugs are being tested.  The sad part for many of us is that there is no “one drug cures all”—would to God that it were!  The last reference here is about President TRUMP signing “The Right to Try” legislation allowing terminally-ill patients the right to try experimental drugs not yet approved by the FDA.   Certainly I agree with that since that fits my own personal category as Stage IV Ovarian.  However, on the Esophageal Cancer forum I try to limit my discussions to my husband’s Stage III (T3N1M0) cancer.  He was first diagnosed in November of 2002, and is still cancer free as of this date.  So even though this far exceeds the stats for this awful cancer, patients need to know that they too, may just be one that has the neoadjuvant chemo/radiation treatments then the surgery, and are still alive to tell about it.  He is NOT debilitated in any way.  We need stories of hope and survival to offset much of the gloom and doom many face. 

    Love

    Loretta

    William’s wife – His Ivor Lewis Minimally Invasive Esophagectomy was performed by Dr. James D. Luketich at the University of Pittsburgh Medical Center on May 17, 2003.  William still cancer free as of this date August 30, 2018!

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    1.      https://economictimes.indiatimes.com/industry/healthcare/biotech/pharmaceuticals/msd-launches-blockbuster-cancer-drug-keytruda-in-india/articleshow/60487138.cms

    “MSD launches blockbuster cancer drug Keytruda in India

    Updated: Sep 13, 2017, 01.43 PM IST

     “NEW DELHI: US biopharmaceutical giant Merck, Sharpe and Dohme (MSD) has launched its blockbuster cancer drug ‘Keytruda’ (pembrolizumab) in India around a year after it first received approvals to market it, said persons aware of the development. The drug has so far only been approved here for a less prevalent type of cancer, while it is marketed in countries like the US to treat additional indications like a specific kind of lung cancer.


    Keytruda, hailed as a ‘game-changer’ therapy in oncology, is expected to help the immune system identify and selectively combat only cancerous cells instead of aggressively attacking cancer cells and risking healthy tissues in the process like existing therapies. The drug generated global sales of $1.4 billion during 2016.

    A person close to the development said the company had applied for approvals in India for unresectable or metastatic melanoma—types of malignant skin cancers that either cannot be removed by surgery or have spread to other parts of the body. In countries like the US, Keytruda is also approved for other types of cancers, including non-small cell lung cancer (NSCLC)…”

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    2.      https://www.moneycontrol.com/news/business/us-drug-giant-merck-brings-blockbuster-drug-keytruda-to-india-2385323.html

    “US drug giant Merck brings blockbuster drug Keytruda to India

    Merck says Keytruda will come with “India Specific Pricing And Patient Access Programs”. - Vikas Dandekar

     …Globally Keytruda leads its class, popularly called immunotherapy or checkpoint inhibitors, that works by blocking a protective mechanism on cancer cells and supports the inbuilt immunity of the body to kill those cancer cells. The drug marks a groundswell as an expanding list of marquee names such as Bristol Myers Squibb and Roche engage in an aggressive pursuit for new therapies using the same pathway. Merck itself has secured approvals for the drug to treat specific lung cancers and is being tested for a wide spectrum of cancers in combination with other drugs…”

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    3.     http://theconversation.com/weekly-dose-keytruda-may-be-a-miracle-cancer-drug-but-can-those-who-need-it-afford-it-74757

    “Weekly Dose: Keytruda may be a miracle cancer drug, but can those who need it afford it?

    April 11, 2018 3.39am EDT

    “…How it works

    Immunotherapy drugs work by increasing the patient’s own immune response. The most successful examples of immunotherapies are drugs that act as antibodies, which are natural molecules made by the immune system to fight harmful intruders.

    The immune system launches an attack on intruders by releasing killer cells called T-lymphocytes, or T-cells. When these T-cells attack cancer cells, a certain protein, called PD-1 accumulates on the T-cells. The cancer cells then have their own protein that binds to PD-1, and this interaction cleverly switches off the T-cells, stopping them from attacking the cancer.

    Keytruda works by binding to PD-1 and therefore blocking the cancer cells from using their own protein to slot into the same spot and switch off the immune cells. So with Keytruda, the T-cells do their job and effectively attack the cancer. Keytruda is also known as an anti PD-1 immunotherapy…”

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    4.     https://www.cbsnews.com/news/right-to-try-bill-trump-signing-will-it-help-terminally-ill-patients-today-2018-05-30/

    By MORTEN WENDELBO, TIMOTHY CALLAGHAN THE CONVERSATION

    “After a year in which President Trump devoted much of his health policy attention to efforts to repeal and replace the Affordable Care Act, Mr. Trump used part of his State of the Union address in January to press Congress to focus attention in 2018 on a new health priority -- the passage of "right to try" legislation. It passed, and the president signed it today.

    Right to try legislation gives terminally ill patients the right to use experimental medications that have not yet been approved by the Food and Drug Administration…”

    _________________End of references________________

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