Richard D. Carvajal, MD, discusses what he sees as the leading factors in making outcomes worse for patients with mucosal melanoma and how the disease differs from treatment for patients with cutaneous melanoma.
Richard D. Carvajal, MD, deputy physician-in-chief and director of medical oncology at the Northwell Health Cancer Institute and R. J. Zuckerberg Chair in Medical Oncology, discusses the factors that lead to poorer outcomes for patients with mucosal melanoma.
Mucosal melanoma is a rare cancer that is aggressive in patients and often goes undiagnosed until the advanced stage of the disease. Like cutaneous melanoma, mucosal melanoma starts in the pigmented melanocytes cells and makes up about 1.4% of all melanoma cases. It is often invasive and metastatic but has yet to be linked to specific causes the way other skin cancers can result from too much exposure to UV rays in sunlight. Most patients diagnosed with this type of melanoma are 70 years old and the rate of diagnosis of this disease has not increased the same way skin cancer has overall.
According to Carvajal, the rate of survival for these patients is just poor with a 5-year overall survival rate from the time of diagnosis being just about 25%. In comparison, survival for patients with cutaneous melanoma has increased as targeted therapies have proven to be effective in this patient population. Here, Carvajal discusses which factors play the most significant role in making outcomes worse for patients with mucosal melanoma and which therapies have yet to prove their effectiveness. Moreover, this highlights the need for further study and discovery in this field of treatment.
0:08 | Another factor, I think, leading to the worst outcomes is the fact that we just don't have effective therapies for this disease. The advances that have been made in melanoma have been primarily for [patients with] cutaneous disease, and of course, that progress has been remarkable and dramatic since 2011 when we had ipilimumab [Yervoy] and vemurafenib [Zelboraf]. And since that time, another dozen or so therapies and regimens for [patients with] cutaneous disease that's led to the significant improvements in clinical outcomes. Whereas for [patients with] mucosal melanoma, which we know is clinically and biologically distinct, we don't have specific therapies for that disease.
0:57 | And so, certainly when patients present with high-risk primary disease, we're not entirely sure what to do in the adjuvant setting, with very little data to help guide us, and when patients have metastatic disease, we'll extrapolate from what we know from cutaneous melanoma [and we] will do checkpoint blockade, either a single agent PD-1 or combination [treatment]. If there's an actionable alteration, we'll do that, but even when you look at the mucosal melanoma patients treated with checkpoint blockade, they do worse than the patient's [with] cutaneous melanoma.