Sure! I’ll Be a Guinea Pig

Jim and I had an appointment with my oncologist yesterday. She reiterated what we had seen in the scan results: the tumors in my liver and lungs are not super concerning yet. However, there are numerous new tumors in my muscles, on my scalp, and in various locations in my bones, particularly within my vertebrae.

As we discussed the next steps for treatment, she proposed a combination of immunotherapy (infusions) and a daily pill that "disrupts tumor growth." In combination, these have shown promising results in approximately 30% of patients. While that may seem low to some, it is actually quite good compared to the success rates of chemotherapy treatments available for Leiomyosarcoma.

I had some bloodwork done this morning, and we will see the doctor again in three weeks. At that appointment, we will receive a schedule for the immunotherapy treatments.

Dr. Ganjoo is proposing a "novel therapeutic strategy." That means it's still not specifically approved for LMS and is still being studied, but showing some good results in some patients. For those of you who like the technical stuff: ChatGPT did a great job of summarizing the recent and ongoing studies being conducted about the exact treatment plan that Dr. Ganjoo is suggesting ...

Recent studies have explored the combination of nivolumab (Opdivo), ipilimumab (Yervoy), and cabozantinib (Cabometyx) in treating metastatic soft tissue sarcomas, including leiomyosarcoma. This regimen aims to enhance anti-tumor activity by leveraging the synergistic effects of these agents.

Study Findings:

• Phase II Trial Results: A randomized phase II trial evaluated cabozantinib combined with PD-1 and CTLA-4 inhibition versus cabozantinib alone in metastatic soft tissue sarcoma. The combination of cabozantinib with nivolumab and ipilimumab demonstrated improved progression-free survival and disease control rates compared to cabozantinib alone.
  ascopubs.org

Mechanism of Action:

• Nivolumab and Ipilimumab: These are immune checkpoint inhibitors targeting PD-1 and CTLA-4 pathways, respectively, enhancing the immune system's ability to attack cancer cells.

• Cabozantinib: A tyrosine kinase inhibitor that disrupts tumor growth and angiogenesis by inhibiting multiple pathways, including MET, VEGFR, and AXL.

Safety and Efficacy:

• The combination has shown a manageable safety profile, with adverse events consistent with the known effects of each drug. Common side effects include fatigue, diarrhea, and elevated liver enzymes. The observed clinical benefits suggest that this regimen may be a promising option for patients with advanced soft tissue sarcomas.

Ongoing Research:

• Further studies are underway to confirm these findings and to identify which patient populations may benefit the most from this combination therapy. Patients interested in this treatment approach should consult with their oncologists to discuss eligibility for clinical trials or off-label use considerations.

In summary, the combination of nivolumab, ipilimumab, and cabozantinib represents a novel therapeutic strategy in the management of metastatic leiomyosarcoma, with preliminary studies indicating potential efficacy and a tolerable safety profile.