DiscoverBlood & CancerChoosing a melanoma therapy with Dr. Justine Cohen
Choosing a melanoma therapy with Dr. Justine Cohen

Choosing a melanoma therapy with Dr. Justine Cohen

Update: 2019-10-17
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Justine V. Cohen, DO, of the University of Pennsylvania, Philadelphia, joins Blood & Cancer host David H. Henry, MD, also of the University of Pennsylvania, to discuss a recent melanoma case in the adjuvant setting and when to consider targeted therapies or immune checkpoint inhibitors for these patients. 

Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about what happens when a patient’s anxiety threatens to get in the way of the clinician’s decision making.

Time stamps:

  • Meet the guest (00:51 )
  • This Week in Oncology (03:02 )
  • Interview with Dr. Justine Cohen (05:48 )
  • Clinical Correlation (26:25 )

This week in Oncology

FDA approves rivaroxaban for VTE prevention in hospitalized, acutely ill patients
by Lucas Franki

FDA approval for the new indication is based on results from the phase 3 MAGELLAN and MARINER trials, which included more than 20,000 hospitalized, acutely ill patients.

Therapies for melanoma

  • Classes of therapies for adjuvant melanoma include immune checkpoint inhibitors and targeted therapies.
  • Historically, high-dose interferon was the only available therapy for melanoma. This was associated with a lot of toxicities, without great benefits in terms of overall survival.
  • About 50% of melanomas are BRAF mutated and amendable to adjuvant treatment with the combination of BRAF/MEK inhibitors.
    • Immunotherapy can be used in BRAF mutated patients or BRAF wild type (no mutation).
  • Ipilimumab (anti-CTLA4) demonstrated recurrence-free survival benefit and an overall survival benefit.
    • Toxicity = grade 3 or grade 4 immune-related side effects.
  • Nivolumab and pembrolizumab (anti-PD1) have taken the place of ipilimumab.
    • They are associated with lower rates of toxicities (14%-15%).
  • Side effects of immunotherapy: “itis” (fever, ocular toxicity, lung, colon, rash, many others). These side effects may persist despite cessation of immunotherapy unlike targeted therapies, in which side effects resolve after stopping.
  • Treatment decisions following adverse events depend on how much therapy is delivered prior to the event and the severity of toxicity.

 

Drug

Class

Mechanism of action

Interferon

Antiviral

·   Inhibits protein synthesis

·   Inactivates viral RNA

·   Enhances phagocytic and  cytotoxic mechanisms

 

Ipilimumab

Checkpoint inhibitor

·   IgG1 monoclonal antibody against cytotoxic T-lymphocyte antigen 4

 

Nivolumab

Checkpoint inhibitor

·   Human IgG4 monoclonal antibody against programmed death 1 (PD-1)

 

Pembrolizumab

Checkpoint inhibitor

·   Human IgG4 monoclonal antibody against programmed death 1 (PD-1)

Dabrafenib

Targeted therapy

·   BRAF inhibitor

 

Vemurafenib

Targeted therapy

·   BRAF inhibitor

Trametinib

Targeted therapy

·   MEK inhibitor

  

Show notes by Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia.

References

Weber J et al. Adjuvant nivolumab versus ipilimumab in resected stage III or IV melanoma. N Engl J Med. 2017;377:18 24-35.

Eggermont AMM et al. Adjuvant pembrolizumab versus placebo in resected stage III melanoma. N Engl J Med. 2018;378:17 89-1801.

Long GV et al. Adjuvant dabrafenib plus trametinib in stage III BRAF-mutated melanoma. N Engl J Med. 2017;377:18 13-23.

 

For more MDedge Podcasts, go to mdedge.com/podcasts

Email the show: podcasts@mdedge.com

Interact with us on Twitter: @MDedgehemonc

Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

 

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Choosing a melanoma therapy with Dr. Justine Cohen

Choosing a melanoma therapy with Dr. Justine Cohen

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