Melanoma, particularly when metastatic is an aggressive disease. Australians are blessed with fantastic sunshine all year round – but it means that the highest rates of melanoma occur here as well. Here’s a round up of three exciting new therapies for melanoma that are changing the face of oncology.
First up is vemurafenib, a BRAF kinase inhibitor. You may have heard of this one from the phase I and II clinical trials that were in NEJM last year. Certain melanoma cell lines have a BRAF mutation, V600E, which activated the MAP kinase pathway. From the results, progression free survival and overall survival were both prolonged with 84% vs. 64% at 6 months. Here’s the first NEJM article to see, and watch this over at the BBC.
Ipilimumab (marketing as Yervoy), is a monoclonal antibody against CTLA-4 – cytotoxic T-lymphocyte associated antigen 4, also known as CD 152. This normally sends inhibitor signals to T cells, so by blocking this, the immune system is less tolerant toward the tumour. Sounds good – but does it work? Overall survival goes up by about 2 months, with an survival rates at 3 years of 20.8% vs 12.2% favouring the ipilimumab group, but it does have some pretty powerful potential adverse effects. Read this one here.
Last but not least, we have the gp100 vaccine combined with IL-2. Both of these stimulate T cells into action, and work synergistically, with the hope of inducing an anti-tumour effect. Certainly the combination of both resulted in improved outcomes over just the IL-2 alone; however the study may not be powered well enough to differentiate the treatment effect alone vs. other factors. This one’s here.
Immune and molecular therapies are invading all parts of medicine, and melanoma is a particular highlight. This is a great series of articles – have a flip when you get a minute. If you don’t have time for that right now, check out my favourite dermatology website here, and read the latest guidelines on melanoma, here.
Oh, and don’t forget to remind all your patients to get a skin check. Despite all this treatment, there’s nothing like picking it up early.
IMAGE National Cancer Institute