Meredith McKean, MD, MPH, Director of Melanoma and Skin Cancer Research for Sarah Cannon Research Institute at Tennessee Oncology, shares exciting developments for both the research and treatment of melanoma.
Top advances in melanoma research
The past year has been an active and exciting time for research and treatment options for patients with melanoma, including advances for both patients with melanoma of the skin and eye (uveal melanoma).
There is a new FDA-approved treatment for patients with stage IV melanoma of the skin, relatlimab/nivolumab. This will be an IV treatment given every four weeks, and it was approved because it has a higher response rate and a longer time until progression compared to nivolumab alone. The side effects are similar to the immune-related toxicities that a patient may experience with nivolumab or pembrolizumab.
Pembrolizumab has now been approved for patients with stage IIB and IIC melanoma. This is great news for patients with a deep primary tumor that has not metastasized (spread). Researchers knew that these patients were at a high risk of recurrence, but until now, the only treatment option was interferon, which was highly toxic and rarely administered. Now, pembrolizumab is a great option to consider for this patient population to help at least delay, if not prevent, the melanoma from returning.
The third exciting advancement in melanoma is for patients with uveal melanoma - the first FDA-approved drug for patients with metastatic uveal melanoma. Tebentafusp was approved for the 50% of patients who have HLA A02 typing. This is different than a patient’s blood type, but it is a protein on the cells that helps the body determine self and non-self. The treatment is weekly and often causes side effects such as fever, chills, nausea, rash, and fatigue; however, it did demonstrate that it can help patients live longer.
It is encouraging to have many new options for patients, and it is worthwhile for patients to ask their doctors if there are any updates or new treatments available.
Upcoming melanoma research
For patients with melanoma of the skin and of the eye, there is ongoing research to continue to find more treatment options. A patient should ask their doctor if their tumor has been “profiled,” which is testing that is done on a tumor that has been removed or on a blood sample. This looks at the DNA of the tumor to identify the drivers of the cancer that may make patients eligible for clinical trials. There is an increasing number of clinical trials that match treatments to the specific drivers of a patient’s cancer. In cutaneous melanoma, this includes NRAS and any BRAF mutation, including BRAF mutations that are not eligible for the standard of care targeted therapy.
Despite the advances for patients with metastatic melanoma with relatlimab/opdivo and offering pembrolizumab to more patients including patients with stage II disease, there is a need for additional immune therapy options for patients who either do not respond - or do not have tumor shrinkage with - the treatments that are currently available, and many clinical trials are exploring new immune therapies.
For patients with uveal melanoma, researchers are exploring more personalized or targeted therapies. It is exciting to offer specific, personalized treatment options to patients with less common tumors.
Again, patients should have testing completed either by blood or in their tumor to best understand their disease. There are now clinical trials targeting BAP1, GNAQ/11, SF3B1, and PRAME among other DNA or protein targets.
There are many reasons to be hopeful despite a cancer diagnosis with recent drug approvals and many ongoing trials available.
If you have questions about melanoma, call askSARAH at 844-482-4812 or visit askSARAH online.