B. Neyns MD, PhD

Highlights in melanoma

Summary

Over the last decade, the treatment of advanced melanoma underwent a dramatic improvement. Initially, immune checkpoint inhibitors and targeted agents proved their worth in the treatment of advanced, unresectable melanoma patients. More recently, however, interest grew in combining both these therapeutic approaches in patients with BRAF mutant advanced melanoma. During ASCO 2020, results were presented of two clinical trials evaluating this strategy. Following the initial successes in the unresectable melanoma setting, immune checkpoint inhibition and targeted therapy were also evaluated as adjuvant therapy in patients with resected stage III melanoma. At ASCO 2020, updated results were presented of two pivotal trials in this setting, while other studies looked into the potential benefit of using immune checkpoint inhibitors as neoadjuvant therapies, rather than in the postoperative setting. In addition to this, immunotherapy also proved to have potential in the treatment of patients with mucosal melanoma, or leptomeningeal disease.

(BELG J MED ONCOL 2020;14(5):209-15)

Highlights in melanoma

ASCO 2019 featured the presentation of several interesting studies in patients with metastatic melanoma. In addition to this, new data in the (neo)-adjuvant setting were presented.

BSMO Immunomanager program

Immunotherapy has become a standard of care for patients with many different advanced solid tumors. However, boosting the immune system can induce immune related side effects, referred to as “immune-related adverse events” (irAEs). Because oncologists are not always familiar with these inflammatory autoimmune syndromes, the BSMO immunotaskforce has launched the immunomanager website which summarizes the treatment options for the most frequent irAEs including endocrine (e.g. hypo- and hyperthyroidism), digestive (e.g. colitis), pneumological (e.g. pneumonitis), dermatological and other types of irAEs. In the near future, the BSMO immunotaskforce plans to review these recommendations with Belgian organ specialists and their associations. We believe that through collaborations between organ specialists and oncologists we will be able to establish better recommendations, resulting in a better outcome for cancer patients who develop an irAE during immunotherapy.

Immunotherapy Highlights

This article will summarize the key data in the field of immunotherapy presented during the 2018 annual meeting of the American Society of Clinical Oncology (ASCO).

BSMO Immunomanager program

Immunotherapy has become a standard of care for patients with many different advanced solid tumors. However, boosting the immune system can induce immune related side effects, referred to as “immune-related adverse events” (irAEs). Because oncologists are not always familiar with these inflammatory autoimmune syndromes, the BSMO immunotaskforce has launched the immunomanager website which summarizes the treatment options for the most frequent irAEs including endocrine (e.g. hypo- and hyperthyroidism), digestive (e.g. colitis), pneumological (e.g. pneumonitis), dermatological and other types of irAEs. In the near future, the BSMO immunotaskforce plans to review these recommendations with Belgian organ specialists and their associations. We believe that through collaborations between organ specialists and oncologists we will be able to establish better recommendations, resulting in a better outcome for cancer patients who develop an irAE during immunotherapy.

Long-term survival in immunotherapy treated patients with unresectable advanced melanoma

Over the past 10 years, several effective new therapies have been developed for patients with advanced melanoma. Since 2010, the primary endpoint of every major phase III trial in this setting has been met, revolutionizing the treatment options and survival for patients with unresectable advanced melanoma. With increasing numbers of patients experiencing durable remissions with these agents, even without continuing therapy, the issue of melanoma survival care becomes of relevance to more patients than ever before.

Immune checkpoint inhibitors in clinical practice: management of immune-related toxicities

The initial use of immune checkpoint blockade was mainly limited to a fraction of physicians involved in the treatment of malignant melanoma. With the proof of principle and efficacy established in this disease process, these agents were being extensively investigated in other malignancies including lung cancer, renal cell carcinoma, gastric cancer, bladder cancer, ovarian cancer, and hematologic malignancies. Early results from some of these investigations are extremely encouraging and will likely lead to more indications in addition to the approved indications for the treatment of malignant melanoma, non-small cell lung cancer (NSCLC) and renal cell carcinoma. It is therefore essential that the oncology community is aware of immune-related adverse events (irAEs), to recognize them in a timely fashion and be well-versed with their management. To discuss the specific toxicity profile associated with these agents, we consulted Prof. Dr. Bart Neyns, melanoma specialist at the UZ Brussel, with a vast experience in the use of immune-checkpoint inhibitors.