Melanoma accounts for less than two percent of all skin cancers but it is the cause of most skin cancer deaths. Just over 10,000 patients a year die from the disease. These sober statistics sparked a focus on new treatments to decrease mortality rates, such as BRAF and MEK inhibitors. The FDA has approved two BRAF and one MEK inhibitor.
A CME course from OMedLive.com dives into reviews of efficacy and safety data from recent clinical trials investigating emerging and potential therapeutic combinations. Watch a pearl from the session, “Melanoma: Immune Related Adverse Effects” here:
Signaling pathways in melanoma define targetable mutations; one of these critical pathways is the RAS-RAF-MEK-ERK MAP kinase pathway. Historically, RAS inhibitors are not successful, but BRAF inhibitors have shown clear activity in melanoma.
To set the stage for further exploration, Dr. Jeffrey S. Weber, MD, PhD, Director of the Donald A. Adam Comprehensive Melanoma Center in Tampa, FL poses the question, “Should all patients with melanoma, regardless of BRAF mutation status, be treated with BRAF inhibitor?” To help answer the question, Dr. Weber explores Vemurafenib vs Dacarbazibe (DTIC), Dabrafenib vs DTIC, and Trametineb (MEKi) vs DTIC or Paclitaxel.
Combination Therapies for Melanoma
As with other cancer treatment regimens, combination therapy as a viable alternative to monotherapies is given close consideration. Overall survival (OS) is measured and discussed with several combinations vs monotherapy vs placebo. The presentation weighed outcomes against toxicity, appropriateness, and response rates. Dr. Weber states, “Ultimately, the patients have to hear the data” in order for the patient and their clinicians to make the best treatment decision.
Part of the comparison between IPI + NIVO vs IPI alone treatment modalities includes a table listing adverse events (AE) reported in >= 10% of patients. In these patients, not only were AEs considered, but safety was evaluated in all patients receiving at least one dose of study treatment using ALT and AST lab values.
A randomized, double-blind, phase III study compared NVO + IPI or NIVO alone to IPI alone. Nine hundred forty-five previously untreated patients with unresectable or metastatic melanoma were studied, randomized 1:1:1. Treatment continued until progression or unacceptable toxicity levels were reached. Researchers compared adverse events for each regimen; the toxicities should not be underestimated, fewer than half of responding patients remained on treatment past 24 weeks.
To help find out which options are best for you and your patients, watch this CME offering from OMedLive. “Combining Emerging Immunotherapies and Targeted Drugs for the Treatment of Melanoma” poses meaningful questions and shows detailed, OS, toxicity related, and response rate driven results.
Disclaimer: All OMedLive articles, reports, summaries, and recaps of events are for informational purposes. The quotes and opinions of the speakers covered are not to be taken as direct advice for individual patients. Patients should always seek care from qualified, properly accredited healthcare professionals.