Anna C. Pavlick, DO
For patients who have higher-risk melanoma, including those who are in stages IIb to IIIc or resected stage IV disease, the primary concern is that they will experience disease recurrence or relapse. The best option for these patients is to receive effective adjuvant therapy, but there are challenges in deciding which agent is best for this patient population.
During the 2017 OncLive®
State of the Science SummitTM
on Melanoma and Immuno-Oncology, Anna C. Pavlick, DO, associate professor of hematology and medical oncology and medical director of the Clinical Trials Office at the Perlmutter Cancer Center at NYU Langone Medical Center, discussed adjuvant therapy for patients with high-risk melanoma.
“I reviewed the historical data looking at interferon as the only adjuvant we had for many years, and now we have the checkpoint inhibitor ipilimumab (Yervoy) that has been approved to be given in the adjuvant setting for stage III patients,” Pavlick said in an interview during the meeting.
Pavlick emphasized the importance of clinical trials, adding that increased participation in clinical trials will bring effective change in what treating physicians can offer patients, as well as coming to a better understanding on what are the best options to treat high-risk melanoma.
OncLive®: You lectured on the utility of interferon in the adjuvant setting for melanoma treatment. How often is this therapy used today?
: There are very isolated groups throughout the United States that believe that data. If looking at the East coast and West coast regions of the country, we are “non-interferon believers.” However, the middle of the country is still using interferon. If you talk to an oncologist on the East coast, we would say that we don’t really use it. I would never say “never;” however, I haven’t administered it to patients in the past 3 to 5 years. I would rather put patients on a clinical trial and look for something much more promising with less toxicity—with the hope that it will impact their survival—when I know that interferon with its toxicity is not going to impact their survival.
What trends are we seeing in ongoing clinical trials, and what types of patients that would be best for each type of trial?
Depending upon a patient’s stage of disease, the earlier-stage high-risk patients—like those with IIb, IIc, and IIIa disease—are those who may be interested in a vaccine trial. We look at different peptides that may be able to immunize patients to decrease their risk of recurrence. We don’t know if a certain peptide is going to benefit the patients. However, most vaccines have very minimal toxicities, they’re tolerable, and patients can come in and receive the vaccine and then go to work afterward since they are not sick. We are hoping that we are able to find one that may be able to help them.
For patients that have high-risk disease—such as IIIb, IIIc, and resected stage IV disease—we are looking at the usefulness of using checkpoint inhibitors in an earlier setting rather than waiting for patients to develop metastatic disease. There are plenty of clinical trials that are looking at single-agent PD-1 inhibitors, comparing interferon or ipilimumab with a PD-1 inhibitor, or there are combination trials looking at what we call “flip doses.”