› Forums › General Melanoma Community › The future of adjuvant therapy for melanoma
- This topic has 12 replies, 3 voices, and was last updated 14 years, 2 months ago by
JerryfromFauq.
- Post
-
- November 12, 2011 at 4:23 am
This is one of those abstracts I picked up today from the 2011 International Melanoma Symposium. I hate to type so I will put only one up tonight.
It will be presented Saturday Nov 12, 2011 by Paul B Chapman from Sloan-Kettering.
The future of adjuvant therapy for melanoma
This is one of those abstracts I picked up today from the 2011 International Melanoma Symposium. I hate to type so I will put only one up tonight.
It will be presented Saturday Nov 12, 2011 by Paul B Chapman from Sloan-Kettering.
The future of adjuvant therapy for melanoma
"Prior to 2011, treatment options for patients with metastatic melanoma were limited to single agents that had objective response rates ≤15% and complete response rates <5%. Such drugs would be expected to have a very limited efficacy in the adjuvant setting. Indeed, high does interferon-α, the only drug studied extensively in the adjuvant setting for melanoma, has shown only minimal ability to prolong progression-free survival with no detectable effect on overall survival. Combinations of chemotherapy have been shown to have higher response rates than single agents in metastatic melanoma patients, but in contrast to other malignancies such as colon and breast carcinoma, these combinations have not been tested in the adjuvant settings of melanoma.
The treatment landscape has changed dramatically for melanoma with the approval of ipilimumab and vemurafenib. Both drugs improve overall survival. The objective response rate to ipilimumab however is still around 15% while vemurafenib is associated with an objective response rate of approximately 50%. However, both drugs are prime candidates to be tested in the adjuvant setting. A large double-blind, placebo-controlled randomized adjuvant trail of ipilimumab has completed accrual and we await the results. Vemurafenib should also be tested in the adjuvant setting in a large double-blind, placebo-controlled trial with overall survival being the primary endpoint. Since both drugs are FDA-approved, patients randomized to placebo will likely receive, upon relapse, the drug being tested. This is appropriate and in no way diminishes the value of the adjuvant trial. The real question being asked is whether giving the drug to micrometastatic (i.e. adjuvant) setting is ultimately more likely to cure patients or at least improve survival significantly than treating of detectable disease. If the answer is yes, we should be treating patients in the adjuvant setting. If the answer is no, then the value of treating all patients in the adjuvant setting is less clear.
- Replies
-
-
- November 12, 2011 at 7:58 pm
Lynn, are you actually attending today (Saturday)? Would be interested if you go to this session (as I know it matches your situation) about what you hear beyond the abstract, and any other interesting stuff you hear about there.
Thanks!
-
- November 12, 2011 at 9:01 pm
Not today. I am feeling abit under the weather. Sometimes working and doing this trial gets the best of me. Seriously thinking I shold give it a rest and stop trying so hard to "be normal". Thi symposium was interesting but it was all medical professionals and I noticed most of them appeared anxious to go outside and play with their familes!! There are cruises etc for the attendees and assorted other distractions. I will post other abstracts as I type them up . I have one on BRAF combinations I will post now.
-
- November 12, 2011 at 9:01 pm
Not today. I am feeling abit under the weather. Sometimes working and doing this trial gets the best of me. Seriously thinking I shold give it a rest and stop trying so hard to "be normal". Thi symposium was interesting but it was all medical professionals and I noticed most of them appeared anxious to go outside and play with their familes!! There are cruises etc for the attendees and assorted other distractions. I will post other abstracts as I type them up . I have one on BRAF combinations I will post now.
-
- November 12, 2011 at 9:01 pm
Not today. I am feeling abit under the weather. Sometimes working and doing this trial gets the best of me. Seriously thinking I shold give it a rest and stop trying so hard to "be normal". Thi symposium was interesting but it was all medical professionals and I noticed most of them appeared anxious to go outside and play with their familes!! There are cruises etc for the attendees and assorted other distractions. I will post other abstracts as I type them up . I have one on BRAF combinations I will post now.
-
- November 12, 2011 at 9:05 pm
PS we need the oncologists and researchers to come together for us…the people who have this disease- to come together and teach us once a year in a conference. Are we not the reason they do this…or is it the bucks from the drug companies and earning a name in medical history…Many drug reps were there yesterday as well and I heard deals going down…
Next year they have this in Hollywood and if for no other reason then to see the HOLLYWOOD sign, I want to go!
-
- November 12, 2011 at 9:05 pm
PS we need the oncologists and researchers to come together for us…the people who have this disease- to come together and teach us once a year in a conference. Are we not the reason they do this…or is it the bucks from the drug companies and earning a name in medical history…Many drug reps were there yesterday as well and I heard deals going down…
Next year they have this in Hollywood and if for no other reason then to see the HOLLYWOOD sign, I want to go!
-
- November 12, 2011 at 9:05 pm
PS we need the oncologists and researchers to come together for us…the people who have this disease- to come together and teach us once a year in a conference. Are we not the reason they do this…or is it the bucks from the drug companies and earning a name in medical history…Many drug reps were there yesterday as well and I heard deals going down…
Next year they have this in Hollywood and if for no other reason then to see the HOLLYWOOD sign, I want to go!
-
- November 14, 2011 at 11:47 pm
Lynn, Thanks for this post. I have long said that I believe that Melanoma must be attacked on more than one protein, mutation and signalig path at a time.
I do have a problem with some of the wording in many releases the go out of their way to ignore the proven results of IL-2 from 13 years ago and continuiing to today. Gee wonder where the 5-8% complete response rate number comes from and the 15% partial response rates come from (It's not from Interferon)? These are across the board number relating to IL-2 trials involving all types of melanomas, Maybe we should ask Rick, since he has had nothing since IL-2 20 years ago. Is this "extended survival"? and Jane and Debbie and me and dozens of others.
They say, "The treatment landscape has changed dramatically for melanoma with the approval of ipilimumab and vemurafenib. Both drugs improve overall survival. The objective response rate to ipilimumab however is still around 15% while vemurafenib is associated with an objective response rate of approximately 50%." I agree that the landscape has improved, but not as dramatically as this makes it appear. They do not clarify that the Ipi is an across the board treatment for multiple melanomas and that the vemurafenib is totally restricted to the 50% of certain types of melaoma that have the V600E oncoprotein and DNA mutation and that it's 50% of 50% rsponse rate i a partial response rate, most often not a complete response rate. Yes, a dramatic step in fighting melanoma, but no where near the major step nor the long term cure that is needed for most of us, and not even a small step for many of us individually.
-
- November 14, 2011 at 11:47 pm
Lynn, Thanks for this post. I have long said that I believe that Melanoma must be attacked on more than one protein, mutation and signalig path at a time.
I do have a problem with some of the wording in many releases the go out of their way to ignore the proven results of IL-2 from 13 years ago and continuiing to today. Gee wonder where the 5-8% complete response rate number comes from and the 15% partial response rates come from (It's not from Interferon)? These are across the board number relating to IL-2 trials involving all types of melanomas, Maybe we should ask Rick, since he has had nothing since IL-2 20 years ago. Is this "extended survival"? and Jane and Debbie and me and dozens of others.
They say, "The treatment landscape has changed dramatically for melanoma with the approval of ipilimumab and vemurafenib. Both drugs improve overall survival. The objective response rate to ipilimumab however is still around 15% while vemurafenib is associated with an objective response rate of approximately 50%." I agree that the landscape has improved, but not as dramatically as this makes it appear. They do not clarify that the Ipi is an across the board treatment for multiple melanomas and that the vemurafenib is totally restricted to the 50% of certain types of melaoma that have the V600E oncoprotein and DNA mutation and that it's 50% of 50% rsponse rate i a partial response rate, most often not a complete response rate. Yes, a dramatic step in fighting melanoma, but no where near the major step nor the long term cure that is needed for most of us, and not even a small step for many of us individually.
-
- November 14, 2011 at 11:47 pm
Lynn, Thanks for this post. I have long said that I believe that Melanoma must be attacked on more than one protein, mutation and signalig path at a time.
I do have a problem with some of the wording in many releases the go out of their way to ignore the proven results of IL-2 from 13 years ago and continuiing to today. Gee wonder where the 5-8% complete response rate number comes from and the 15% partial response rates come from (It's not from Interferon)? These are across the board number relating to IL-2 trials involving all types of melanomas, Maybe we should ask Rick, since he has had nothing since IL-2 20 years ago. Is this "extended survival"? and Jane and Debbie and me and dozens of others.
They say, "The treatment landscape has changed dramatically for melanoma with the approval of ipilimumab and vemurafenib. Both drugs improve overall survival. The objective response rate to ipilimumab however is still around 15% while vemurafenib is associated with an objective response rate of approximately 50%." I agree that the landscape has improved, but not as dramatically as this makes it appear. They do not clarify that the Ipi is an across the board treatment for multiple melanomas and that the vemurafenib is totally restricted to the 50% of certain types of melaoma that have the V600E oncoprotein and DNA mutation and that it's 50% of 50% rsponse rate i a partial response rate, most often not a complete response rate. Yes, a dramatic step in fighting melanoma, but no where near the major step nor the long term cure that is needed for most of us, and not even a small step for many of us individually.
-
- You must be logged in to reply to this topic.