Brandcast have been immersed in the world of melanoma this year, and our most recent trip took us to Munich for the European Post ASCO Meeting, where over 400 melanoma specialists gathered with ‘A list’ opinion leaders to discuss the latest clinical trial results and debate emerging issues such as patient selection, side effect management and future combination options with emerging new therapeutics.
We brought together and filmed an eminent panel of experts for a roundtable discussion to be published on ecancer.tv, chaired by Axel Hauschild, Professor of Dermatology, Department of Dermatology, University of Kiel, Germany, with colleagues Dr Paul Lorigan, Senior Lecturer and Consultant in Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK, Michele Maio, Professor of Oncology, Department of Oncology, University Hospital of Siena, Italy, Dirk Schadendorf, Professor of Dermatology, Director Department of Dermatology, University Hospital Essen, Germany. The experts discuss their expectations for a significant improvement of the treatment options for melanoma patients in the near future. New immunotherapeutic and targeted agents will be used either apart, or in combination.
Axel Hauschild opened the discussion stating that at ASCO 2011 survival data was presented for both ipilimumab (IPI) and vemurafenib, providing two new options for patient with advanced melanoma for the first time in over three decades. There is now a shift away from traditional chemotherapy towards molecular therapy – immunotherapy and targeted molecules – providing a personalised approach to medicine in these patients.
Metastatic melanoma is still considered a deadly disease that is extremely hard to treat, according to Dirk Schadendorf – it shows a dismal prognosis and mainly effects middle-aged women and men. The current treatment options, apart from clinical trial participation are very limited according to Paul Lorigan as new treatment modalities for this disease have not been approved for decades, highlighting a significant medical need.
Michele Maio stated that IPI now has two trials – in both pre-treated and no prior-treatment patients – that have demonstrated a long-term clinical response. The most recent Phase III study presented at ASCO demonstrated a durable survival advantage in some patients for up to 4 years follow-up against the current reference standard (DTIC) as first-line treatment, supporting the notion of disease stabilisation with IPI. Paul Lorigan noted that the most notable side effects seen with IPI were immune response related. The management of these side effects will be very important once IPI is licensed – it was good to hear that BMS have done an excellent job educating investigators in this area and it is anticipated that a great deal of work will need to be done educating both healthcare professionals, including those in primary care and patients themselves.
There was also great excitement expressed about the recent vemurafenib data presented at ASCO. The Phase III (BRIM3) trial comparing BRAF inhibitor vemurafenib with dacarbazine (DTIC) in patients with V600EBRAF-mutated melanoma showed that vemurafenib is associated with significantly improved OS and PFS compared to DTIC alone. According to Dirk Schadendorf, this is a major breakthrough in personalising treatment, as around 50% of melanomas have an activating V600EBRAF mutation. The major side effect discussed by the group was secondary cancers – particularly skin squamous cell carcinoma. Michele Maio stated that this could be managed by surgery to remove the carcinoma.
Finally, the group discussed patient selection and how they anticipate IPI and vemurafenib to be used in the future – agreeing with the conclusion made by Kim Margolin in the ASCO Melanoma plenary session ‘Melanoma Therapy Great News…and New Challenge’ (see conclusion slide below).
So, after 30 years of drought, the treatment landscape in melanoma is changing significantly, offering hope for patients with this terrible disease. Axel Hauschild concluded the discussion “with these two new treatment options and others in the pipeline, we hope that through clinical trials to investigate sequencing and combination options we will find the answers that will help us turn melanoma from a deadly cancer in to a long-term chronic disease.”
The next panel discussion will be held in Stockholm at the ECCO-ESMO multidisciplinary congress in September.
You can view the ASCO expert panel discussion ‘The changing landscape of melanoma therapies: indications of better patient outcome’ with Prof Alexander Eggermont, Dr Caroline Robert, Prof John Haanen and Prof Reinhard Dummer on ecancer.tv.