According to a story from AJMC, there are a number of factors in play when determining the path forward for the treatment of advanced melanoma. For this story, Dr. Omid Hamid went into detail about the process of evaluating these melanoma patients for treatment, and addresses considerations such as toxicity, intolerance to immunotherapy, and determining if a patient could benefit from immune checkpoint inhibitors.
Melanoma is a form of skin cancer which develops from pigment cells, which are called melanocytes. This cancer also less commonly affects the eyes, intestines, or mouth. The lesions often appear on the legs of women and backs of men and develop from atypical moles in some cases. The cause of this skin cancer can be traced to DNA damage as a result of UV radiation as well as certain genetic characteristics. Signs and symptoms include changes in the color or shape of a mole or the appearance of a lump on the skin. Moles may itch or bleed in later stages. In metastatic disease, symptoms such as fatigue, appetite loss, vomiting, and nausea may appear. This cancer may be treated in a variety of ways, such as surgery, radiation, chemotherapy, immunotherapy, and targeted therapies. Rates of this disease are increasing and it is most common in areas with predominantly white European populations. To learn more about melanoma, click here.
Factors for Selecting Treatment in Advanced Disease
Toxicity is a major consideration, especially when adjuvant therapy, which is an additional therapeutic given alongside a primary treatment to boost its effectiveness, is a possibility. Dr. Hamid emphasizes the importance of patients understanding the potential risks and benefits. Targeted therapies, such as BRAF or MEK inhibitors, can be effective in patients with the relevant mutations, but they carry the risk of vision problems, interstitial lung disease, and more. Most of these adverse effects can be reversed, but some of the less common ones may not be.
Dr. Hamid also emphasizes the capabilities of immune checkpoint inhibitors, which can improve overall survival and progression free survival in many advanced melanoma patients. He says that unless there is a specific contraindication, this class of therapies should be strongly considered for most patients. Targeted therapies would be a strong alternative for patients that can’t tolerate immune checkpoint inhibitors.
The presence of the BRAF mutation in a case of advanced melanoma is an important consideration for treatment. This mutation opens up several combination treatments that can give patients a substantial survival advantage. Dual checkpoint inhibition should be the first line treatment for this group of patients. Dr. Hamid also points out that there are some very important trials for melanoma going on at the moment as well. Adoptive T-cell therapy, for example, is showing great potential for melanoma patients that fail to respond to checkpoint inhibitors.