Advances in the Treatment of Malignant Melanoma - Episode 17

Treatment Optimization for Patients With Melanoma

, , , ,


Jeffrey S. Weber, MD, PhD: Thanks to all of you for this rich and informative discussion. Before we conclude, I’d like to get final thoughts from each of you. Dr Chandra?

Sunandana Chandra, MD: This is a great time to be a melanoma medical oncologist. I think with our group of colleagues, it’s really been at the forefront of the field of immunotherapy. The more we’re learning, I think the more questions we have. We’ve discussed a lot today about how to best plan algorithms. Should we do sequential? Should we do combinatorial? Which combinations for which patients? Should we do IO [immunotherapy], or targeted therapy? We have so many options.

I do think we need to be thoughtful as a community in moving forward. We have limited patients, limited resources. Throwing the kitchen sink at patients doesn’t make sense. We need more biologic rationale and more scientific rationale in the trials that we do design and put our patients on.

Today, we haven’t even talked about some of the unmet needs besides melanoma brain metastases, such as uveal melanoma, and mucosal melanoma, in which there were some great data presented at ASCO [the American Society of Clinical Oncology annual meeting] this year. I do think we have a long way to go. I’m very excited about how far we’ve come.

Jeffrey S. Weber, MD, PhD: Great. Dr Daud?

Adil Daud, MD: To take up on what Su was saying, I think we’ve made a huge amount of progress. I look forward to having more than just 1 tool in our immunotherapy toolbox. Right now, for lack of better description as just PD-1, I feel like we need to understand how to really stimulate effector T cells. We’ve used IL-2 [interleukin-2], but most of us, when push comes to shove, don’t really want to get up in the middle of the night and make those IL-2 decisions. I still have PTSD [post-traumatic stress disorder] from those times. Jeff, I’m sure you do.

Jeffrey S. Weber, MD, PhD: I hear what you’re saying.

Adil Daud, MD: I think in terms of medical oncology friendly tools that we can actually give in the here and now, I think it would be nice to have some more maybe inhibiting Tregs [regulatory T cells]. I think there’s a lot of exciting preclinical data. I feel like we haven’t really been able to exploit Treg inhibition, unless you consider ipilimumab to be a Treg suppressive drug. I feel like the next 5 years will be exciting also.

Jeffrey S. Weber, MD, PhD: Great. Dr Luke?

Jason J. Luke, MD, FACP: I would quickly say that I think as we talked about with lifileucel, trying to identify the patients who are not going to benefit from the therapies that we have. We have these outstanding 5-year data for some patients. Realize that 50% survival, when you flip it over, it means 50% not survival, right? We don’t have time to talk about it here, but a lot of next-generation genomic approaches are starting to inform our ability to know who’s going to respond to some of these treatments. We ought to think about designing trials to go after those populations of patients who we know are not going to respond because that’s really the big unmet medical need. Those are the patients we stay up all night thinking about.

Jeffrey S. Weber, MD, PhD: Dr Sullivan?

Ryan J. Sullivan, MD: I don’t have a whole lot more to add. It’s been said, but finding out which patients are going to benefit, and more importantly as Dr Luke said, which patients aren’t, is critical. Despite all the progress, we still have a lot of progress to make. That means we have a job for a while, and we haven’t fixed this disease and are ready to move on to another one. We can cure some patients, and that’s amazing, but we’ll keep working at it until we can cure all.

Jeffrey S. Weber, MD, PhD: Great. Well, thank you again. Thanks to our viewing audience, and we hope that you found this OncLive Peer Exchange® discussion to be useful and informative.

Transcript Edited for Clarity