The American Academy of Dermatology (AAD) Annual Meeting at Denver, CO has been covering the latest updates on new treatments in skin health. One of those updates has been the discovery of new treatments for advanced melanoma.
The purpose of this presentation was to examine the new immunotherapeutics and molecularly targeted therapies that show hope in stopping the progression of advanced melanoma and prolonging life.
Dr. Delphine J. Lee, MD, PhD, FAAD-Dermatological Center for Skin Health at SJHC Director and member of the American Academy of Dermatology talked to Brandi Walker about what advanced melanoma is, the updates of the new therapeutic treatments of this skin condition, and the overall benefits these therapies have for people with advanced melanoma.
1. What is advanced melanoma? Melanoma is the deadliest form of skin cancer. When detected early and treated before it spreads to the lymph nodes, the five-year survival rate is approximately 98 percent.
Advanced melanoma means the disease has spread beyond the skin to other parts of the body, such as the lymph nodes or internal organs. When this happens, the five-year survival rate drops considerably—62 percent in patients whose melanoma has spread to the lymph nodes and only 16 percent in patients whose melanoma has spread to other organs.
2. What are the latest updates of these new therapeutic treatments of this condition? In January 2014, two new melanoma drugs—dabrafenib and trametinib—(previously approved in May 2013 for individual use) were granted accelerated approval by the Food and Drug Administration (FDA) for use as a combination therapy. (This FDA program is important because it allows patients earlier access to promising new drugs while the drug manufacturers confirm drug benefits through clinical trials).
Another very personalized cancer therapy that is being offered in only select treatment centers across the country is adoptive cell therapy.
3. Are these treatments only available in a doctor's office? Some therapies for melanoma must be administered at the doctor's office or hospital, others are taken in pill form.
4. How do these therapies work? Dabrafenib is a drug that targets a specific gene mutation known as BRAF, which is present in about half of melanomas and causes them to grow. Now, patients with melanoma can be tested for this gene mutation with a biopsy.
If patients test positive for this mutation, this personalized cancer therapy can work for them by temporarily blocking one pathway that melanoma uses to spread to other areas of the body (slowing its progression and growth)
Trametinib works similar to dabrafenib by blocking another pathway (located downstream from BRAF) known as MEK, which melanoma also can use to spread the disease to other organs.
Adoptive cell therapy begins by taking and growing the patient’s T-cells (cells in the immune system that protect the body from infection and aid in fighting diseases) in a laboratory. Once the supply of T cells has expanded, the cells are then given back to the patient to help the immune system fight melanoma.
5. How do these treatments benefit people with advanced melanoma? Any drug that can prolong life – even for a short period of time – and stop the spread of tumor growth gives patients the opportunity to try another therapy or participate in a new clinical trial that could help them live even longer.
Dabrafenib is the second BRAF inhibitor drug available to treat advanced melanoma, which brings competition to the market and helps bring down the cost of this type of drug, making it more accessible for melanoma patients.
Trametinib helps further delay the progression of advanced melanomas that have effectively surpassed the temporary roadblock set up by dabrafenib.
While combination therapy of dabrafenib and trametinib has not been shown to improve overall survival rates, it is an important new therapy because a higher percent of melanoma patients have experienced a positive response to this therapy, resulting in an increase in the number of months patients are disease free before melanoma recurs. Initial studies showed that 76 percent of patients treated with this combination therapy experienced a reduction in size or disappearance of their melanoma that lasted an average of 10.5 months.
The response to this combination therapy is referred to as “progression-free survival.” During this time, patients may experience a quality-of-life improvement and, in some cases, be able to start another therapy that may actually prolong life.
While not everyone responds to adoptive cell therapy, the patients that do – although not cured – experience a long-lasting response, which is substantially longer than other melanoma therapies currently available.
For more information on the advanced melanoma presentation, please visit the American Academy of Dermatology at www.aad.org