Any discussion about emerging issues in the treatment of patients with late-stage melanoma should start with a bit of perspective. It was just 5 years ago that the FDA gave ipilimumab (Yervoy) a green light, describing the groundbreaking immune checkpointtargeting antibody as the first drug the agency had ever approved that increased survival for patients with metastatic melanoma.
Today, there are multiple choices of regimens in two different modalities that can either prolong survival or allow patients to live without disease progression or recurrence for several years.
Now, the conversation has changed from whether it is possible to develop a therapy that extends the lifespan of a patient with metastatic melanoma to which agent or regimen in a medicine chest full of options is the best choice and in what sequence.
Those considerations were among the hot topics when some of the world’s leading experts in melanoma research gathered recently for the 12th Annual International Symposium on Melanoma and Other Cutaneous Malignancies,® as we report in this issue in the article entitled “The New Front Line in Melanoma: Immunotherapy or Targeted Agents
These questions are critical, of course, for patients with melanoma who want their doctors to know how best to administer the new therapies so that they have the opportunity to live without disease recurrence and possibly even to be cured.
Unfortunately, it is probably going to take a long time to get the answers. A pending clinical trial that will explore the sequencing of combination therapies in a first-line treatment setting is off to a slow start and, at best, will take 2 years to report the first results.
In the meantime, oncology researchers will be parsing the data from ongoing clinical trials, looking for clues in subgroups, examining differences in patient cohorts, and searching for biomarkers. Although we may grow impatient with the process of vetting these therapeutic options, we are grateful to have come this far. In many ways, it is a good problem to have.