Associate Professor of Oncology, Roswell Park Cancer Institute,
Department of Medicine,
Elm & Carlton Streets,
Buffalo, New York;
Metastatic melanoma has historically been one of the most therapeutically challenging malignancies, with poor 5-year survival. Until recently, dacarbazine and high-dose interleukin-2 were the only agents approved by the FDA for metastatic melanoma. The year 2011 witnessed the approval of an anti-CTLA-4 antibody, ipilimumab, and a BRAF-targeted agent, vemurafenib, in advanced melanoma, which has led to a renaissance in melanoma therapeutics. This is an exciting phase for melanoma immunotherapy and holds important implications for clinicians, due to novel paradigms of treatment, assessment of response, and management of immune-related toxicities. This review seeks to summarize the data on approved immunotherapeutic options in metastatic melanoma, with a special focus on ipilimumab.
The incidence of cutaneous melanoma has been steadily rising in the United States, especially in Caucasian women under 40 years of age, in whom an increase of 50% occurred from 1980 until 2004. Approximately 9200 deaths from melanoma are estimated in 2012.1 Thickness of the primary tumor, ulceration, and nodal metastatic status are the most important determinants of prognosis for localized disease, for which surgery remains the mainstay of therapy. A selected subset of oligometastatic stage IV patients also may benefit from surgical resection. Metastatic melanoma has a dismal prognosis, with a median survival of 7 months and a 5-year survival rate of 15%.2,3
Until recently, therapeutic options centered on dacarbazine (DTIC), the only FDA-approved chemotherapeutic agent for metastatic melanoma since 1975.4 An active regimen that was commonly used until recently is carboplatin and paclitaxel, with response rates ranging from 11% to 26%.5-7 In 2011, ipilimumab and vemurafenib gained regulatory approval in the United States for the treatment of advanced melanoma based on positive randomized trials, ushering in a new era in melanoma therapy. This in turn has initiated a cascade of clinical trials that hopefully will build on this improvement and improve the outlook for this disease.
This review will summarize the role of immunotherapy in advanced melanoma, with a focus on the use of ipilimumab in the community practice setting.
|Title||Expiration Date||CME Credits|
|Community Practice Connections™: Precision Medicine for Community Oncologists: Assessing the Role of Tumor-Testing Technologies in Cancer Care||Nov 30, 2018||1.0|
|35th Annual Chemotherapy Foundation Symposium: Innovative Cancer Therapy for Tomorrow® Clinical Vignette Series||Jan 31, 2019||2.0|