Strategies for Managing Patients With Melanoma

Marc S. Ernstoff, MD, chief for the ImmunoOncology branch of the Developmental Therapeutics Program, Division of Cancer Treatment and Diagnosis at the National Cancer Institute, provides recommendations for managing patients with metastatic melanoma.

According to Ernstoff, immune checkpoint inhibitors have shown to be durable and provide long-term disease control for patients with melanoma over the last 15 years.

Some of the key advances and developments in this space include agents targeting PD1 like nivolumab (Opdivo) and pembrolizumab (Keytruda), the anti-CTLA4 antibody ipilimumab (Yervoy), the anti-LAG3 antibody relatlimab combined with nivolumab (Opdualag), and more.

Additionally, Ernstoff notes the importance of molecular testing for patients with melanoma to determine whether or not they have a BRAF mutation. If they do, this then opens more doors and options on which therapeutic option to give.

Transcription:

0:08 | In 2022, patients with melanoma should have molecular testing to determine whether they have a BRAF mutation. If they have that mutation, it opens the therapeutic options up to both small molecule inhibitors of that pathway, as well as immunotherapy.

0:37 | For many years, we have known that of all the solid tumors, melanoma is one of the most immunogenic. [Historically], we used certain cytokines such as interferon alpha and interleukin 2, which showed small modest benefit of therapy and gave a clue that this tumor could be treated through an immunological approach.

1:11 | In the last 15 years, the identification of immune checkpoints or molecules that are involved with regulating the immune cytotoxic T lymphocytes [CTL] have been identified. Cancers [such as melanoma], can cause your CTLs to be exhausted and many times they can infiltrate into the tumor…Blocking antibodies to [3] of the immune checkpoints, CTLA-4, PD-1, and LAG-3 given alone or together can restore CTL function have been investigated and have been shown to demonstrate significant improvement in [melanoma] survival.