Mario Sznol, MD
Combination regimens continue to push the field of melanoma further, following the success that has been seen with nivolumab (Opdivo) and ipilimumab (Yervoy), according to Mario Sznol, MD.
on Melanoma, Sznol discussed overall advances in the field of melanoma, as well as novel treatments with the potential to change the treatment paradigm.
OncLive: What exciting advancements have we recently seen in the field of melanoma?
Currently, the SOC is either single-agent anti–PD-1 or the combination of ipilimumab and nivolumab. In the future, it could involve different combinations, mostly centered around anti–PD-1. Those potential combinations are being studied in many ongoing phase III trials. We will be discussing the design of those studies and the new agents that might be approved within the next 1 or 2 years for the treatment of metastatic melanoma.
Since systemic therapies are so effective, this gives us options to be able to treat patients with regionally advanced disease with systemic therapies. We discussed whether one should approach these patients with surgery, systemic therapy, or both. We have case presentations that we will present, along with some of the controversies on how different physicians manage patients with metastatic melanoma.
Since the nivolumab-plus-ipilimumab combination has shown promise, can you describe some other combinations with PD-1 inhibitors that are creating similar excitement?
One of the combinations is with an IDO inhibitor. That phase III trial with pembrolizumab and epacadostat is ongoing. The results will be available sometime [in 2018]. We will discuss the phase II data that set up this trial.
There is a phase III trial with intratumoral talimogene laherparepvec (T-VEC; Imlygic) and pembrolizumab versus pembrolizumab alone. Again, intratumoral therapies are an interesting approach in melanoma. It is not yet clear how they will fit in with the overall treatment paradigm. I am not sure when the data from this trial will be available.
There are other agents that are being studied, such as 4-1BB ligands. There are promising data with anti–LAG-3 inhibitors in combination with PD-1 inhibitors in patients who had already progressed on anti–PD-1. There are different combinations that are moving into the clinic and are coming into phase III trials that could impact how we treat patients with melanoma. The advances have been so rapid that the SOC seems to change every 6 months. Maybe that pace will continue over the next 2 years.
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