So now that we are underway with Plan B, it would probably be a good idea to give some more details on what exactly Plan B is and how it’s going to help me overcome this pesky melanoma nuisance. As the last blog post read, we started last Friday with the Merck PD-1 trial at Holy Cross Hospital here in Fort Lauderdale.
What is PD-1? PD-1 stands for Programmed Death-1 – nice, fellas, we couldn’t have picked something a little softer, just in case it was ever critical in treating cancer? Although commonly referred to as “PD-1”, the syntactically correct description of the infusion I am receiving is a “PD-1 antibody” or “anti-PD-1”. PD-1 is a protein found on the surface of T-cells (immune system cells) in our bodies; this protein binds with protein PD-L1 that is expressed in cancer cells, and together they protect the cancer cell from attack by our own immune system. Basically, we have an intruder in the midst and a turncoat in our army of immune cells that enables him to remain hidden.
Anti-PD-1 is an immunotherapy drug that targets breaking that PD-1/PD-L1 shield so the loyal soldiers can get in there and give these tumor cells a good old-fashioned beating – kind of like the whupping those responsible for the Boston Marathon tragedy yesterday are going to get. The antibody primarily prevents the binding of the PD-1 and PD-L1 proteins; I can’t fully articulate the biology behind it, but generally speaking, it keeps that connection from happening and thus enables the T cells to do their job and unleash hell on the cancer cells. Turncoat thwarted, enemy defeated.
No less than five major pharmaceutical companies are currently testing or investigating a PD-1 antibody: Bristol-Myers Squibb, Merck, Roche, GlaxoSmithKline, and Teva. I take this as a good omen, since the first three companies employed me as a consultant at one point (hmmm, maybe that isn’t such a good sign after all). Initial trial indications are that PD-1 antibodies may be doubly effective at treating Stage 4 melanoma (and certain lung and kidney cancers) as current FDA-approved melanoma treatments Zelboraf and Yervoy. Trials are now being run to assess anti-PD-1 as a stand-alone treatment and in conjunction with the above drugs; mine is just the PD-1 antibody and only for patients who had a negative response to Zelboraf/Yervoy. Being an immunotherapy medication, it also will keep me relatively healthy overall and work in conjunction with my immune system, which has remained remarkably strong through all of this.