Movements in melanoma management

In his talk at the Irish Melanoma Forum 11th Annual Scientific Meeting, Prof Paul Lorigan, Professor of Medical Oncology at the University of Manchester, discussed research and treatment advances in melanoma management, providing an overview of data from some key trials, including KEYNOTE and CHECKMATE76K. “There is a need for other trials and one of my take-home messages is that management shouldn’t be just immunotherapy, or more immunotherapy; we do need to have the option of targeted therapy,” said Prof Lorigan. “Many patients are not suitable for immunotherapy, perhaps because of connective tissue disease, or younger people in particular may be concerned about [longer-term immunotherapy] affecting their fertility, for example.”  

He presented data from other studies, some of which are still in the recruitment stage, and he also briefly discussed de-escalation strategies, as well as the potential benefits of neoadjuvant therapy. “When you think about it, it makes sense,” Prof Lorigan told the conference. “When you remove the tumour, there is less there for the immune system to recognise when you give your adjuvant therapy to prime your immune system; so fewer antigens, fewer T-cells and lower response. If you leave the tumour in for a period of time, you allow the immune system to see it when we give a PD1 inhibitor, then we remove the tumour, but you have lots of expanded tumour-recognising T-cells left behind. That’s the theory and in practise, that’s what happens.”

Prof Lorigan said that there have been exciting advances in stage II disease management, but there remains a need to refine these advances and improve on patient selection. “I think neoadjuvant therapy is on the cusp of being approved as the standard of care,” he told the delegates. “In the metastatic setting, immunotherapy is the standard of care and in the first-line setting for the majority of patients, it’s hard to beat. Also, personalised treatment based on targeting neoantigens has huge potential and is likely to be one of the next developments coming down the line.”