Hussein A. Tawbi, MD, PhD, associate professor, The University of Texas MD Anderson Cancer Center, discusses the efficacy with checkpoint inhibition in the treatment of patients with melanoma.
Most cases of melanoma present on the skin, but there are some rare subtypes that present elsewhere, says Tawbi. Melanoma that starts on the skin typically has a high tumor mutation burden (TMB). This is largely due to sun exposure and ultraviolet radiation. Melanoma has approximately 8 times more mutations than the next highest cancer type, notes Tawbi.
All researchers had to do was determine why the immune system was unable to eradicate melanoma by itself. When the checkpoint CTLA-4 was discovered, researchers were able to develop checkpoint inhibitors, such as nivolumab (Opdivo) and ipilimumab (Yervoy) that elicited responses in select patients. Both immunotherapy agents are FDA approved for the adjuvant treatment of patients with completely resected melanoma with lymph node involvement or metastatic disease. Most recently, nivolumab was granted an approval in this setting in December 2017 as a result of data from the CheckMate-238 study.