Jeffrey S. Weber, MD, PhD, the Laura and Isaac Perlmutter Professor of Oncology, co-director of the Melanoma Research Program, deputy director of the Perlmutter Cancer Center, NYU Langone Medical Center, and a 2016 Giant of Cancer Care® in Melanoma, discusses exciting abstracts presented at the 2018 ASCO Annual Meeting.
Physicians now know that drugs like TLR9 and TLR4 agonists can be directly injected into tumors and show activity both alone and in combination with immunologic drugs. Weber states that the abscopal effect seen with these agonists is great for patients who show resistance to immunologic agents.
NKTR-214 is a pegylated variant of interleukin-2. When polyethylene glycol is added to chemicals that are injected into patients, it is not metabolized as rapidly. Therefore, physicians can inject a much lower dose of the medication and still stimulate immune T cells. Weber states that this approach has been used extensively with nivolumab (Opdivo) in renal cell carcinoma. It has demonstrated efficacy in melanoma in both the frontline and second-line setting.
Most of the oral abstracts presented longer follow-up of previously reported findings, Weber says. Some of these areas include sentinel lymph node biopsy outcomes in the absence of a complete lymphadenectomy, and patient outcomes following single-agent pembrolizumab (Keytruda). Weber states that many of these studies will reassure physicians that they are in fact curing patients of their diseases.
CheckMate-238 is a phase III, randomized, 2-arm trial in the adjuvant setting in high-risk patients with resected melanoma. Longer follow-up was presented on the use of single-agent nivolumab versus single-agent ipilimumab (Yervoy). The primary endpoint of relapse-free survival (RFS) was superior for nivolumab with a much better rate of adverse events, says Weber. The follow-up showed that the benefit of RFS and rate of distant metastasis-free survival continued. Weber says that if the trend continues, physicians will see a significant survival advantage.