What’s New in Melanoma Treatment in 2019?


It has been over a year since I last wrote about new developments in treatment of melanoma, and it is time for an update. There is certainly some good news for melanoma patients!

Neoadjuvant (before surgery) treatments for resectable melanoma

Stage III—and more rarely, stage IV—melanoma tumors that have not spread widely can be sometimes treated surgically. Last year a small clinical trial showed that, in BRAF-mutant melanoma, treatment with the BRAF/MEK inhibitors dabrafenib and trametinib (D/T) before and after surgery provides a significant improvement over just post-surgery treatment, by preventing later recurrence.

Later in 2018, researchers reported that using the immune checkpoint drugs nivolumab and ipilimumab prior to surgery led to tumor reduction in 73% of patients treated in a clinical trial. After surgery, they remained disease-free for 2 years (the reported time of observation). Treatment with nivolumab alone was not nearly as active in this randomized trial, with only 25% of patients responding to neoadjuvant nivolumab; still, 75% were disease-free within the 2-year observation period.

An interesting trial tested a single dose of the drug pembrolizumab given three weeks prior to surgery. Of 27 patients who received this single infusion, eight (29%) had a complete or major pathological response, meaning that their tumors were reduced by 90% or more. These eight patients continued on pembrolizumab after surgery and were disease-free for over 2 years. Continue reading…


Experimental Drug Helps Women With Deadly Type of Breast Cancer

Excerpt:

An experimental drug has shown promise in extending the lives of women suffering from a particularly aggressive and deadly type of breast cancer, according to the results of a phase 2 trial.

“Right now, the standard treatment of chemotherapy for metastatic triple-negative breast cancer has not been very effective. That might change with the new drug, called sacituzumab govitecan, which combines an antibody with a chemotherapy drug to better target cancer cells.”

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Targeted Radiation Therapy Yields High Response Rates in Metastatic Prostate Cancer

Excerpt:

“The targeted radiation therapy Lutetium-177 PSMA-617 produced high response rates among men with prostate-specific membrane antigen-positive metastatic, castration-resistant prostate cancer, according to results of a single-arm, phase 2 trial scheduled for presentation at Genitourinary Cancers Symposium.

“The treatment also appeared well-tolerated among these men, whose disease had progressed after multiple standard therapies.”

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Lung-MAP Precision Medicine Trial Expands

Excerpt:

The Lung Cancer Master Protocol (Lung-MAP), the first precision medicine trial in lung cancer supported by the National Cancer Institute (NCI), is undergoing a major expansion to include patients with all non–small cell lung cancers (NSCLCs).

“The trial previously tested treatments for people with advanced-stage squamous cell lung cancer. Opening the trial to all types of advanced-stage NSCLCs means that thousands of new patients will be eligible to enroll.”

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Aggressive RT, Surgery Doubles OS in NSCLC With Limited Mets

Excerpt:

“Aggressive local consolidation in stage IV non-small lung cancer (NSCLC) drastically improved overall survival over standard care in patients with up to three metastatic lesions, a small randomized study found.

“Among 49 patients whose disease had not progressed after initial systemic therapy, overall survival was 41.2 months in those treated with radiotherapy or surgery compared with 17.0 months in those on standard maintenance therapy (P=0.017), reported Daniel Gomez, MD, of MD Anderson Cancer Center in Houston, at a press briefing here at the American Society for Radiation Oncology (ASTRO) meeting.”

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Novartis Drug Cut Death Risk by 35 Percent in Gene Mutation Breast Cancer

Excerpt:

“An experimental cancer drug that Novartis hopes will raise the profile of its oncology portfolio cut the risk of death or disease progression by more than a third in breast cancer patients with a hard-to-target gene mutation.

“The Swiss drugmaker’s BYL719, a so-called PI3K inhibitor also known as alpelisib, combined with hormone therapy fulvestrant boosted median progression-free survival (PFS) to 11 months, up from 5.7 months for patients who got only hormone therapy, the company said on Saturday.”

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Dual Neoadjuvant Checkpoint Blockade Feasible in Melanoma

Excerpt:

“Combination neoadjuvant immune checkpoint blockade therapy yielded promising outcomes in high-risk resectable melanoma, although toxicity was an issue, according to a phase II trial.

“The combination of ipilimumab (Yervoy) and nivolumab (Opdivo) led to improved progression-free survival (PFS), distant metastasis-free survival (DMFS), and overall survival (OS) versus neoadjuvant nivolumab monotherapy in 23 patients with high-risk resectable melanoma, reported Jennifer A. Wargo, MD, of MD Anderson Cancer Center in Houston, and colleagues in Nature Medicine.”

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Biomarker Selects TNBC Patients for Targeted Therapy

Excerpt:

“A tumor necrosis-based gene expression signature (GS) successfully identified patients with triple-negative breast cancer (TNBC) responsive to neoadjuvant therapy with the novel targeted agent LCL161, according to researchers.

“The international, randomized phase II trial of 207 patients with localized TNBC showed that of the 30.1% with GS-positive disease, a significantly higher pathologic complete response (pCR) was seen in those treated with paclitaxel plus the inhibitor of apoptosis antagonist LCL161 compared with those treated with paclitaxel alone (38.2% versus 17.2%).”

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Pembrolizumab Plus Chemotherapy Prolongs OS, PFS for Metastatic Lung Cancer

Excerpt:

“The addition of pembrolizumab to chemotherapy extended OS and PFS compared with chemotherapy alone among patients with metastatic, squamous, non-small-cell lung cancer, according to results of the randomized phase 3 KEYNOTE-407 trial presented at International Association for the Study of Lung Cancer’s World Conference on Lung Cancer.

“The double-blind study included 559 treatment-naive patients with metastatic, squamous NSCLC. Patients who had symptomatic central nervous system metastases, a history of noninfectious pneumonitis that required the use of glucocorticoids, active autoimmune disease or who were receiving systemic immunosuppressive treatment were excluded.”

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