Jeffrey S. Weber, MD, PhD, discusses the evolution of the treatment paradigm in melanoma.
Jeffrey S. Weber, MD, PhD, the deputy director of NYU Langone Health’s Perlmutter Cancer Center; Laura and Isaac Perlmutter Professor of Oncology in the Department of Medicine at NYU Grossman School of Medicine; and the 2016 Giant of Cancer Care® in Melanoma, discusses the evolution of the treatment paradigm in melanoma.
Over the past decade, multiple new drugs and combinations have been approved for melanoma, and more are in development, says Weber. Going back 10 to 15 years, chemotherapy and high-dose interleukin-2 were among the only approaches available; there were very few options for the treatment of metastatic disease and they they did not significantly lengthen survival, adds Weber. Today, with the immunotherapy combination comprised of ipilimumab (Yervoy) and nivolumab (Opdivo), the median overall survival is more than 5 years, which is substantial, according to Weber.
Now, if a patient has a BRAF V600 mutation, BRAF and MEK agents are available, with 3 different combination therapies to choose from, says Weber. For patients with local or regional disease, talimogene laherparepvec (Imlygic) with or without a PD-1 inhibitor serves as a potential option, adds Weber. Additionally, if a patient has a BRAF wild-type mutation, they can receive a single-agent PD-1 inhibitor. If that approach is not effective, they can receive ipilimumab/nivolumab, says Weber.
Multiple trials examining additional innovative approaches were presented during the 2020 ASCO Virtual Scientific Program and ESMO Virtual Congress and results appear to be promising, according to Weber. For patients who progressed on some of the available treatments, a phase 2 trial is examining a tumor-infiltrating lymphocytic strategy that appears to be encouraging, according to Weber. The field has come a long way, concludes Weber.