Adjuvant therapy - Dr. Roda Amaria
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Dr. Roda Amaria presents the latest on adjuvant therapy for melanoma at the MRF's Patient Symposium at MD Anderson Cancer Center on January 31, 2015.
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Adjuvant therapy - Dr. Roda Amaria
- 1. Adjuvant and Neoadjuvant Therapy in Melanoma R. Amaria, MD Assistant Professor, Melanoma Medical Oncology 1/31/2015
- 2. • Adjuvant therapy: additional cancer treatment given after surgery is complete to lower the risk of the cancer returning • Neoadjuvant therapy: treatment given as a first step to shrink a tumor before surgery is performed
- 3. Adjuvant Therapy for Stage III Disease Surgery Adjuvant therapy
- 4. Ideal Adjuvant Therapy • Effective in destroying microscopic deposits of melanoma that could potentially be present after surgery • Has limited or easily manageable toxicity
- 5. FDA Approved Medical Adjuvant Therapy • Interferon-α and Pegylated interferon
- 6. Clinical Trials for Adjuvant Therapy • Vaccines • New immunotherapies-ipilimumab, anti PD-1 antibodies Patients with Surgically Removed Stage IIIa-IIIc melanoma Ipilimumab 10mg/kg Placebo Placebo Ipilimumab Median time to relapse 17 months 26 months Median overall survival Not statistically different Not statistically different Significant toxicity rate 2% 49%
- 7. Neoadjuvant Therapy for Stage III Disease and Limited Stage IV disease Surgery Adjuvant therapy Neoadjuvant Therapy
- 8. Ideal Neoadjuvant Therapy • Effective in shrinking down tumor rapidly • Has easily manageable or predictable toxicity profile • Facilitates understanding of mechanisms of response to therapy
- 9. 87yo man with stage IIIc BRAF Mutated Melanoma November 2014 January 2015 BRAF/MEK Inhibition
- 10. November 2014 January 2015 2 cycles of biochemotherapy 60 year old man with locally advanced sinonasal melanoma
- 11. Patients with stage IIIB/IIIC or oligometastatic stage IV (<3 lesions), + BRAF mutation Blood draw and tumor biopsy Pre-treatment Neoadjuvant BRAF/MEK x 8 weeks Blood draw and tumor biopsy at surgery Restaging CT scans every 3 months with blood draws Arm A Upfront surgery Arm B Neoadjuvant BRAFi/MEKI Surgical resection Restaging via CTs followed by surgical resection Scheduled within 0-4 weeks On treatment biopsy / blood draw (arm B only) Adjuvant BRAF/MEK x 44 weeks Standard of care adjuvant therapy (interferon vs. observation) Follow up Neoadjuvant Therapy Clinical Trials Follow up
- 12. Patients with stage IIIB/IIIC or oligometastatic stage IV (≤3 lesions) Blood draw and tumor biopsy Pre-treatment Blood draw and tumor harvested at surgery Restaging CT scans every 12 weeks n=20 n=20 Arm A Neoadjuvant Nivolumab (4 doses) Surgery On treatment biopsy / blood draw (prior to dose 2 and dose 3) Adjuvant Nivolumab x 6 months Arm B Neoadjuvant Ipilimumab & Nivolumab (3 doses) Surgery Adjuvant Nivolumab x 6 months Follow up Follow up Neoadjuvant Therapy Clinical Trials
- 13. Adjuvant and Neoadjuvant Therapy Summary • Adjuvant therapy is administered after surgery to lessen the risk of melanoma recurring – Interferon/Pegylated Interferon are FDA approved options – Clinical trials are ongoing • Neoadjuvant therapy is given to shrink tumor down before surgery – Multiple clinical trials are ongoing or planned
- 14. Thank you for your attention Questions?