› Forums › Mucosal Melanoma Community › ASCO Updates
- This topic has 27 replies, 7 voices, and was last updated 7 years, 10 months ago by
Bubbles.
- Post
-
- June 5, 2016 at 2:58 pm
I am attending the annual meeting of the American Society for Clinical Oncology–a gathering of about 40,000 cancer doctors and practitioners who come together to discuss the latest research. The schedule is packed from early morning to late night (I finished my last meeting at 9:30 last night and attended a session at 8:00 this morning!). I thought I would offer a few comments here, and hopefully other updates over the next couple of days.
For many years ASCO was depressing for the melanoma community because of no progress at all. That changed in 2010 with positive data for the first time ever, and since then we have seen great new advances at every meeting. This year is a bit different. Nothing major is being announced, but instead we are seeing some consolidation of data around the new therapies that have come online since 2011. Still, I have heard some interesting information.
We continue to see very positive results with the "ipi-nivo" combination, but also see a lot of toxicities. Memorial Sloan Kettering reported that 61% of patients had to stop treatment because of side effects. And this is at a center that has a great deal of experience and expertise at managing these drugs. The concern is not for those patients at centers like this, but rather how well doctors who have very little experience will manage patients on this treatment.
I was surprised to see another report showed that showed doctors could use immunotherapy on patients who have autoimmune disease. I had suspected that ramping up the immune system in a patient with autoimmune disease would cause huge problems. The team that reported this data showed that while challenges did arise, they were largely manageable. That is good news for melanoma patients with lupus, arthritis, etc.
We are seeing more data that the anti-PD1 drugs (Opdivo and Keytruda) work in mucosal melanoma, though not nearly as well as they work in cutaneous melanoma. Clearly more research is needed in the mucosal and acral melanoma space.
And, this morning I heard a report combining the results of many different trials involving interferon. The presenter looked at Stage III patients who had all their tumor removed. Some received Interferon and others didn't . The Interferon group remained cancer free-longer. This was already widely known. This data showed, though, that the difference in overall survival at 5 years and at 10 years was about 3%, with the Interferon group doing better. Further analysis compared patients whose primary lesion was ulcerated vs. those whose lesion was not ulcerated. The survival benefit only applied to patients whose tumor was ulcerated.
Last comment (for now). The best melanoma doctors are all saying that we can have very good outcomes for at least 40% of patients with metastatic melanoma. One even said we can cure 35% of patients. The challenge remains of how to expand that number so we can have good outcomes for every patient. That progress can only happen through clinical trials. With several good drugs now on the market, researchers are concerned that patients will not agree to go into a trial and progress will stall. This is worth a great deal of thought.
Tim–MRF
- Replies
-
-
- June 5, 2016 at 4:55 pm
Tim thanks for the update!!!! So Interferon is offering a 3% better chance of being alive at 5 years for those with Ulceration. Did the presenter of the data say if it is finally "Time" to put Interferon on the self for everyone else? I did have to laugh a little at the spam posts on either side of your post trying to sell game of thrones videos!!!! When the king of MRF speaks people listen!!!! Enjoy Chicago!!!!Ed
-
- June 5, 2016 at 4:55 pm
Tim thanks for the update!!!! So Interferon is offering a 3% better chance of being alive at 5 years for those with Ulceration. Did the presenter of the data say if it is finally "Time" to put Interferon on the self for everyone else? I did have to laugh a little at the spam posts on either side of your post trying to sell game of thrones videos!!!! When the king of MRF speaks people listen!!!! Enjoy Chicago!!!!Ed
-
- June 5, 2016 at 4:55 pm
Tim thanks for the update!!!! So Interferon is offering a 3% better chance of being alive at 5 years for those with Ulceration. Did the presenter of the data say if it is finally "Time" to put Interferon on the self for everyone else? I did have to laugh a little at the spam posts on either side of your post trying to sell game of thrones videos!!!! When the king of MRF speaks people listen!!!! Enjoy Chicago!!!!Ed
-
- June 5, 2016 at 6:30 pm
Dear Tim, thank you for your post, made me feel really optimistic reading it…
also to read that about interferon (my father did the whole year and his tumor was ulcerated), thought we put him throuh it for nothing ( because it returned 3 years later), but now i'm more convinced it was a good choice…
Thank you again.
Patrisa
-
- June 5, 2016 at 6:30 pm
Dear Tim, thank you for your post, made me feel really optimistic reading it…
also to read that about interferon (my father did the whole year and his tumor was ulcerated), thought we put him throuh it for nothing ( because it returned 3 years later), but now i'm more convinced it was a good choice…
Thank you again.
Patrisa
-
- June 5, 2016 at 6:30 pm
Dear Tim, thank you for your post, made me feel really optimistic reading it…
also to read that about interferon (my father did the whole year and his tumor was ulcerated), thought we put him throuh it for nothing ( because it returned 3 years later), but now i'm more convinced it was a good choice…
Thank you again.
Patrisa
-
- June 5, 2016 at 7:02 pm
Any thoughts of knowledge on stage 4 melanoma of Pons part of brainstem? Of course non-surgical, outcome is bleak.
-
- June 6, 2016 at 12:53 pm
I haven’t seen anything that specific on brain metastases. I did see one poster on using anti-PD1 drugs to treat these tumors. The results were positive, but not as good as tumors in other areas. Last fall the MRF convened a scientific meeting on brain metastases with the idea of defining the best focus of research that will result in better outcomes that paper will be published soon and should spark more research.Tim–MRF
-
- June 6, 2016 at 12:53 pm
I haven’t seen anything that specific on brain metastases. I did see one poster on using anti-PD1 drugs to treat these tumors. The results were positive, but not as good as tumors in other areas. Last fall the MRF convened a scientific meeting on brain metastases with the idea of defining the best focus of research that will result in better outcomes that paper will be published soon and should spark more research.Tim–MRF
-
- June 6, 2016 at 12:53 pm
I haven’t seen anything that specific on brain metastases. I did see one poster on using anti-PD1 drugs to treat these tumors. The results were positive, but not as good as tumors in other areas. Last fall the MRF convened a scientific meeting on brain metastases with the idea of defining the best focus of research that will result in better outcomes that paper will be published soon and should spark more research.Tim–MRF
-
- June 6, 2016 at 1:54 pm
There are many articles re brain mets on my blog…just use the search bubble. Both immunotherapy like anti-PD1 as well as BRAF inhibitors for BRAF positive patients have shown activity in melanoma brain mets. Here's and article: http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/04/yes-virginia-both-immunotherapy-and.html
Here's another along that line…with additional links within: http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2015/12/yep-immunotherapy-can-work-in-brainand.html
Both of these work better when combined with radiation like SRS (stereotactic radiation)…though given the location I don't know if that would be possible…but they can do amazing things to pin point radiation these days…so I would certainly see if radiation could be combined with one of the therapies I mentioned.
I wish you my best. Celeste
-
- June 6, 2016 at 1:54 pm
There are many articles re brain mets on my blog…just use the search bubble. Both immunotherapy like anti-PD1 as well as BRAF inhibitors for BRAF positive patients have shown activity in melanoma brain mets. Here's and article: http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/04/yes-virginia-both-immunotherapy-and.html
Here's another along that line…with additional links within: http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2015/12/yep-immunotherapy-can-work-in-brainand.html
Both of these work better when combined with radiation like SRS (stereotactic radiation)…though given the location I don't know if that would be possible…but they can do amazing things to pin point radiation these days…so I would certainly see if radiation could be combined with one of the therapies I mentioned.
I wish you my best. Celeste
-
- June 8, 2016 at 4:33 am
And there is this out of ASCO: http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/06/asco-2016-immunotherapy-in-melanoma.html
yours, c
-
- June 8, 2016 at 4:33 am
And there is this out of ASCO: http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/06/asco-2016-immunotherapy-in-melanoma.html
yours, c
-
- June 8, 2016 at 4:33 am
And there is this out of ASCO: http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/06/asco-2016-immunotherapy-in-melanoma.html
yours, c
-
- June 6, 2016 at 1:54 pm
There are many articles re brain mets on my blog…just use the search bubble. Both immunotherapy like anti-PD1 as well as BRAF inhibitors for BRAF positive patients have shown activity in melanoma brain mets. Here's and article: http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/04/yes-virginia-both-immunotherapy-and.html
Here's another along that line…with additional links within: http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2015/12/yep-immunotherapy-can-work-in-brainand.html
Both of these work better when combined with radiation like SRS (stereotactic radiation)…though given the location I don't know if that would be possible…but they can do amazing things to pin point radiation these days…so I would certainly see if radiation could be combined with one of the therapies I mentioned.
I wish you my best. Celeste
-
- June 6, 2016 at 3:37 am
Actually Tim, it is not all that much of a brain strain (your great deal of thought) .
Has the thought ever crossed your mind , that in essence, cliinical trials are scientific exeperiments that use human beings as test subjects?
Not everyone wants to be a lab rat.
Yeah, yeah………………….I know all the arguments about patient participation in clinical trials………access to emerging therapeutic approaches (experiments), hope for others in the future (personal sacrifice),
Having personally participated in clinical trials (which you have not), I can tell you that my motivation was not for others, but for myself to live.
That is where you and I and your post differ greatly. You want (rightfully so)to promote research for the future.
I want to see melanoma patients(rightfully so) live in the here and now.
You are a paid promoter; I am an unpaid sufferer.
You absolutely, just do not get it Tim , people sign up for clinical trials as a last resort because approved treatments offer no way forward.
Oh, wait!!!!!!!!!!!!!!!!!! Just not that many months ago you were on here beating your chest about current treatment approvals………………………….oh, I guess now those do not count.
Now we need more lab rats.
Maybe one of us do not want to leave a child without a mother or father.
Maybe one of us is a child and does not want to inflict the pain of a mother or father burying their child.
Maybe one of is not such much scared of death but of the process of dying and all the while suffering
And maybe one of us just flat out does not want to die just yet.
That you can even quote someone about hypothetical cure rates of 35% is irresponsible.
How about this instead?
Refine, analyze, granulate, where the current approved treatments stand and look at the big data from that.
Melanoma now, today………………as it always has been is a disease of management.
I can honestly say that as a fact, giving that this month of June marks 29 years since I was diagnosed with Stage III melanoma with an unknown primary , your tale of woe now is no different that what I heard in 1987………………."gee, the researchers are concerned that there will not be enough patients that enter trials and progress will stall"
Bullshit. You have been on KStreet in Washington DC and listening to the pharma lobby too much and now sound just like them…………………just like I heard 29 years ago.
Thousands of us have surrendered ourselves to medical research over the years and thousands now continue to do so via clinical trials and your concern is there are or will not be enough of us?
Make excuses for the future; what a shallow way of thinking .
And that is your reason for why we are no further along in the quest of a cure for melanoma?
It is interesting that there have been some posts here about the ACTUAL ASCO records and none of them had your editorial slant of we need more lab rats.
What a sad representation your post offers.
Charlie S
-
- June 6, 2016 at 11:50 am
Charlie
Just for you information the data about interferon and ulceration is from 2009. Here is a report from 2012.
J Clin Oncol. 2012 Nov 1;30(31):3810-8. doi: 10.1200/JCO.2011.41.3799. Epub 2012 Sep 24.Long-term results of the randomized phase III trial EORTC 18991 of adjuvant therapy with pegylated interferon alfa-2b versus observation in resected stage III melanoma.
Eggermont AM1, Suciu S, Testori A, Santinami M, Kruit WH, Marsden J, Punt CJ, Salès F, Dummer R, Robert C, Schadendorf D, Patel PM, de Schaetzen G,Spatz A, Keilholz U.Abstract
PURPOSE:
Adjuvant pegylated interferon alfa-2b (PEG-IFN-α-2b) was approved for treatment of resected stage III melanoma in 2011. Here, we present long-term follow-up results of this pivotal trial. PATIENTS AND METHODS:
In all, 1,256 patients with resected stage III melanoma were randomly assigned to observation (n = 629) or PEG-IFN-α-2b (n = 627) for an intended duration of 5 years. Stratification factors were microscopic (N1) versus macroscopic (N2) nodal involvement, number of positive nodes, ulceration and tumor thickness, sex, and center. Recurrence-free survival (RFS; primary end point), distant metastasis-free survival (DMFS), and overall survival (OS) were analyzed for the intent-to-treat population. RESULTS:
At 7.6 years median follow-up, 384 recurrences or deaths had occurred with PEG-IFN-α-2b versus 406 in the observation group (hazard ratio [HR], 0.87; 95% CI, 0.76 to 1.00; P = .055); 7-year RFS rate was 39.1% versus 34.6%. There was no difference in OS (P = .57). In stage III-N1 ulcerated melanoma, RFS (HR, 0.72; 99% CI, 0.46 to 1.13; P = .06), DMFS (HR, 0.65; 99% CI, 0.41 to 1.04; P = .02), and OS (HR, 0.59; 99% CI, 0.35 to 0.97; P = .006) were prolonged with PEG-IFN-α-2b. PEG-IFN-α-2b was discontinued for toxicity in 37% of patients. CONCLUSION:
Adjuvant PEG-IFN-α-2b for stage III melanoma had a positive impact on RFS, which was marginally significant and slightly diminished versus the benefit seen at prior follow-up (median, 3.8 years). No significant increase in DMFS or OS was noted in the overall population. Patients with ulcerated melanoma and lower disease burden had the greatest benefit. Comment in
- How much of a good thing? What duration for interferon alfa-2b adjuvant therapy? [J Clin Oncol. 2012]
- PMID:
- 23008300
- [PubMed – indexed for MEDLINE]
Free full text
-
- June 6, 2016 at 11:50 am
Charlie
Just for you information the data about interferon and ulceration is from 2009. Here is a report from 2012.
J Clin Oncol. 2012 Nov 1;30(31):3810-8. doi: 10.1200/JCO.2011.41.3799. Epub 2012 Sep 24.Long-term results of the randomized phase III trial EORTC 18991 of adjuvant therapy with pegylated interferon alfa-2b versus observation in resected stage III melanoma.
Eggermont AM1, Suciu S, Testori A, Santinami M, Kruit WH, Marsden J, Punt CJ, Salès F, Dummer R, Robert C, Schadendorf D, Patel PM, de Schaetzen G,Spatz A, Keilholz U.Abstract
PURPOSE:
Adjuvant pegylated interferon alfa-2b (PEG-IFN-α-2b) was approved for treatment of resected stage III melanoma in 2011. Here, we present long-term follow-up results of this pivotal trial. PATIENTS AND METHODS:
In all, 1,256 patients with resected stage III melanoma were randomly assigned to observation (n = 629) or PEG-IFN-α-2b (n = 627) for an intended duration of 5 years. Stratification factors were microscopic (N1) versus macroscopic (N2) nodal involvement, number of positive nodes, ulceration and tumor thickness, sex, and center. Recurrence-free survival (RFS; primary end point), distant metastasis-free survival (DMFS), and overall survival (OS) were analyzed for the intent-to-treat population. RESULTS:
At 7.6 years median follow-up, 384 recurrences or deaths had occurred with PEG-IFN-α-2b versus 406 in the observation group (hazard ratio [HR], 0.87; 95% CI, 0.76 to 1.00; P = .055); 7-year RFS rate was 39.1% versus 34.6%. There was no difference in OS (P = .57). In stage III-N1 ulcerated melanoma, RFS (HR, 0.72; 99% CI, 0.46 to 1.13; P = .06), DMFS (HR, 0.65; 99% CI, 0.41 to 1.04; P = .02), and OS (HR, 0.59; 99% CI, 0.35 to 0.97; P = .006) were prolonged with PEG-IFN-α-2b. PEG-IFN-α-2b was discontinued for toxicity in 37% of patients. CONCLUSION:
Adjuvant PEG-IFN-α-2b for stage III melanoma had a positive impact on RFS, which was marginally significant and slightly diminished versus the benefit seen at prior follow-up (median, 3.8 years). No significant increase in DMFS or OS was noted in the overall population. Patients with ulcerated melanoma and lower disease burden had the greatest benefit. Comment in
- How much of a good thing? What duration for interferon alfa-2b adjuvant therapy? [J Clin Oncol. 2012]
- PMID:
- 23008300
- [PubMed – indexed for MEDLINE]
Free full text
-
- June 6, 2016 at 11:50 am
Charlie
Just for you information the data about interferon and ulceration is from 2009. Here is a report from 2012.
J Clin Oncol. 2012 Nov 1;30(31):3810-8. doi: 10.1200/JCO.2011.41.3799. Epub 2012 Sep 24.Long-term results of the randomized phase III trial EORTC 18991 of adjuvant therapy with pegylated interferon alfa-2b versus observation in resected stage III melanoma.
Eggermont AM1, Suciu S, Testori A, Santinami M, Kruit WH, Marsden J, Punt CJ, Salès F, Dummer R, Robert C, Schadendorf D, Patel PM, de Schaetzen G,Spatz A, Keilholz U.Abstract
PURPOSE:
Adjuvant pegylated interferon alfa-2b (PEG-IFN-α-2b) was approved for treatment of resected stage III melanoma in 2011. Here, we present long-term follow-up results of this pivotal trial. PATIENTS AND METHODS:
In all, 1,256 patients with resected stage III melanoma were randomly assigned to observation (n = 629) or PEG-IFN-α-2b (n = 627) for an intended duration of 5 years. Stratification factors were microscopic (N1) versus macroscopic (N2) nodal involvement, number of positive nodes, ulceration and tumor thickness, sex, and center. Recurrence-free survival (RFS; primary end point), distant metastasis-free survival (DMFS), and overall survival (OS) were analyzed for the intent-to-treat population. RESULTS:
At 7.6 years median follow-up, 384 recurrences or deaths had occurred with PEG-IFN-α-2b versus 406 in the observation group (hazard ratio [HR], 0.87; 95% CI, 0.76 to 1.00; P = .055); 7-year RFS rate was 39.1% versus 34.6%. There was no difference in OS (P = .57). In stage III-N1 ulcerated melanoma, RFS (HR, 0.72; 99% CI, 0.46 to 1.13; P = .06), DMFS (HR, 0.65; 99% CI, 0.41 to 1.04; P = .02), and OS (HR, 0.59; 99% CI, 0.35 to 0.97; P = .006) were prolonged with PEG-IFN-α-2b. PEG-IFN-α-2b was discontinued for toxicity in 37% of patients. CONCLUSION:
Adjuvant PEG-IFN-α-2b for stage III melanoma had a positive impact on RFS, which was marginally significant and slightly diminished versus the benefit seen at prior follow-up (median, 3.8 years). No significant increase in DMFS or OS was noted in the overall population. Patients with ulcerated melanoma and lower disease burden had the greatest benefit. Comment in
- How much of a good thing? What duration for interferon alfa-2b adjuvant therapy? [J Clin Oncol. 2012]
- PMID:
- 23008300
- [PubMed – indexed for MEDLINE]
Free full text
-
- June 6, 2016 at 3:37 am
Actually Tim, it is not all that much of a brain strain (your great deal of thought) .
Has the thought ever crossed your mind , that in essence, cliinical trials are scientific exeperiments that use human beings as test subjects?
Not everyone wants to be a lab rat.
Yeah, yeah………………….I know all the arguments about patient participation in clinical trials………access to emerging therapeutic approaches (experiments), hope for others in the future (personal sacrifice),
Having personally participated in clinical trials (which you have not), I can tell you that my motivation was not for others, but for myself to live.
That is where you and I and your post differ greatly. You want (rightfully so)to promote research for the future.
I want to see melanoma patients(rightfully so) live in the here and now.
You are a paid promoter; I am an unpaid sufferer.
You absolutely, just do not get it Tim , people sign up for clinical trials as a last resort because approved treatments offer no way forward.
Oh, wait!!!!!!!!!!!!!!!!!! Just not that many months ago you were on here beating your chest about current treatment approvals………………………….oh, I guess now those do not count.
Now we need more lab rats.
Maybe one of us do not want to leave a child without a mother or father.
Maybe one of us is a child and does not want to inflict the pain of a mother or father burying their child.
Maybe one of is not such much scared of death but of the process of dying and all the while suffering
And maybe one of us just flat out does not want to die just yet.
That you can even quote someone about hypothetical cure rates of 35% is irresponsible.
How about this instead?
Refine, analyze, granulate, where the current approved treatments stand and look at the big data from that.
Melanoma now, today………………as it always has been is a disease of management.
I can honestly say that as a fact, giving that this month of June marks 29 years since I was diagnosed with Stage III melanoma with an unknown primary , your tale of woe now is no different that what I heard in 1987………………."gee, the researchers are concerned that there will not be enough patients that enter trials and progress will stall"
Bullshit. You have been on KStreet in Washington DC and listening to the pharma lobby too much and now sound just like them…………………just like I heard 29 years ago.
Thousands of us have surrendered ourselves to medical research over the years and thousands now continue to do so via clinical trials and your concern is there are or will not be enough of us?
Make excuses for the future; what a shallow way of thinking .
And that is your reason for why we are no further along in the quest of a cure for melanoma?
It is interesting that there have been some posts here about the ACTUAL ASCO records and none of them had your editorial slant of we need more lab rats.
What a sad representation your post offers.
Charlie S
-
- June 6, 2016 at 3:37 am
Actually Tim, it is not all that much of a brain strain (your great deal of thought) .
Has the thought ever crossed your mind , that in essence, cliinical trials are scientific exeperiments that use human beings as test subjects?
Not everyone wants to be a lab rat.
Yeah, yeah………………….I know all the arguments about patient participation in clinical trials………access to emerging therapeutic approaches (experiments), hope for others in the future (personal sacrifice),
Having personally participated in clinical trials (which you have not), I can tell you that my motivation was not for others, but for myself to live.
That is where you and I and your post differ greatly. You want (rightfully so)to promote research for the future.
I want to see melanoma patients(rightfully so) live in the here and now.
You are a paid promoter; I am an unpaid sufferer.
You absolutely, just do not get it Tim , people sign up for clinical trials as a last resort because approved treatments offer no way forward.
Oh, wait!!!!!!!!!!!!!!!!!! Just not that many months ago you were on here beating your chest about current treatment approvals………………………….oh, I guess now those do not count.
Now we need more lab rats.
Maybe one of us do not want to leave a child without a mother or father.
Maybe one of us is a child and does not want to inflict the pain of a mother or father burying their child.
Maybe one of is not such much scared of death but of the process of dying and all the while suffering
And maybe one of us just flat out does not want to die just yet.
That you can even quote someone about hypothetical cure rates of 35% is irresponsible.
How about this instead?
Refine, analyze, granulate, where the current approved treatments stand and look at the big data from that.
Melanoma now, today………………as it always has been is a disease of management.
I can honestly say that as a fact, giving that this month of June marks 29 years since I was diagnosed with Stage III melanoma with an unknown primary , your tale of woe now is no different that what I heard in 1987………………."gee, the researchers are concerned that there will not be enough patients that enter trials and progress will stall"
Bullshit. You have been on KStreet in Washington DC and listening to the pharma lobby too much and now sound just like them…………………just like I heard 29 years ago.
Thousands of us have surrendered ourselves to medical research over the years and thousands now continue to do so via clinical trials and your concern is there are or will not be enough of us?
Make excuses for the future; what a shallow way of thinking .
And that is your reason for why we are no further along in the quest of a cure for melanoma?
It is interesting that there have been some posts here about the ACTUAL ASCO records and none of them had your editorial slant of we need more lab rats.
What a sad representation your post offers.
Charlie S
-
Tagged: acral, cutaneous melanoma, mucosal melanoma
- You must be logged in to reply to this topic.