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…


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.”

Go to full article.

If you’re wondering whether this story applies to your own cancer case or a loved one’s, we invite you to use our ASK Cancer Commons service.


A Minimally Invasive, High-Performance Intervention for Staging Lung Cancer

Editor’s note: Many lung cancer patients undergo surgery to determine the stage of their cancer. However, surgery is a serious procedure, and a less invasive staging method could help patients avoid complications. A new technique called endoscopic biopsy is less invasive and potentially more accurate than surgical staging.

“Endoscopic biopsy of lymph nodes between the two lungs (mediastinum) is a sensitive and accurate technique that can replace mediastinal surgery for staging lung cancer in patients with potentially resectable tumours. Such were the conclusions of a prospective controlled trial conducted under Dr. Moishe Liberman, a researcher at the CHUM Research Centre (CRCHUM) and an Associate Professor at the Université de Montréal. Moreover, the study showed that it is not necessary to perform surgery to confirm negative results obtained through the endoscopic approach during the pre-operative evaluation of patients with this type of cancer. This discovery has many advantages for both the patients and the health-care system.

“Endoscopic biopsy of the is a minimally invasive, non-surgical intervention that has recently begun to be used to stage lung cancer. The study conducted by Dr. Liberman’s team involved 166 with confirmed or suspected non small cell , and was designed to compare the new approach to surgical staging under general anesthesia, as prescribed in current guidelines for this type of cancer. The findings, which were recently published in Chest journal, the official publication of the American College of Chest Physicians, show that the endoscopy approach is not only sensitive and accurate, but also leads to improved staging compared to surgical staging due to its ability to biopsy lymph nodes and metastases not attainable with surgical techniques.”