演題抄録

International Session

開催概要
開催回
第54回・2016年・横浜
 

Management of advanced melanoma in the United States: Year in review

演題番号 : IS17-2

[筆頭演者]
Pennock Gregory:1 

1:Baptist MD Anderson Cancer Center, USA・Hematology/Oncology

 

The approval of several agents in the United States has made the management of patients with metastatic melanoma increasingly complex. The choice of first line therapy often hinges on the presence or absence of a BRAF mutation. In patients with BRAF-mutated tumors, particularly those with a high tumor burden, data clearly support the use of combined BRAF and MEK inhibition rather than a single agent BRAF inhibitor. In patients with metastatic BRAF wild type melanoma, immunotherapy has become the treatment modality of choice. Trials such as CheckMate 067 demonstrate improved progression-free survival with combined immunotherapy (nivolumab + ipilimumab) compared to either drug as a single agent. However, the incidence of immune-mediated toxicities is certainly higher with the combination immunotherapy approach. Awareness of these potential toxicities is key for both patients and physicians. In patients who are not candidates for combined immunotherapy, anti-PD1 therapies such as nivolumab or pembrolizumab appear superior to anti-CTLA4 therapy (ipilimumab) in terms of response rate and survival. Patients with brain metastases remain a challenge. The optimal treatment of patients with brain metastases has yet to be determined, even with the approval of both targeted agents and immunotherapy.
In patients with stage III (node positive) melanoma, ipilimumab has been approved and adjuvant treatment, but based on European demonstrating superiority over observation. We anxiously await the results of the ECOG 1609 trial, comparing the efficiacy of ipilimumab versus high-dose interferon alfa 2b, which has long been the standard in the United States.

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