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Thread: Cure for patients with melanoma?

  1. #1
    Ludicus's Avatar Comes Limitis
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    Default Cure for patients with melanoma?

    A very interesting article in the Journal of Clinical Oncology sheds light on whether or not immunotherapy can actually cure patients with melanoma. Immunotherapy complete response data suggest metastatic melanoma cures.

    Durable Complete Response After Discontinuation of Pembrolizumab in Patients With Metastatic Melanoma.J Clin Oncol. 2018; 36(17):1668-1674 (ISSN: 1527-7755)

    Robert C; Ribas A; Hamid O; Daud A; Wolchok JD; Joshua AM; Hwu WJ; Weber JS; Gangadhar TC; Joseph RW; Dronca R; Patnaik A; Zarour H; Kefford R; Hersey P; Zhang J; Anderson J; Diede SJ; Ebbinghaus S; Hodi FS

    Purpose Pembrolizumab provides durable antitumor activity in metastatic melanoma, including complete response (CR) in about 15% of patients. Data are limited on potential predictors of CR and patient disposition after pembrolizumab discontinuation after CR. We describe baseline characteristics and long-term follow-up in patients who experienced CR with pembrolizumab in the KEYNOTE-001 study ( ClinicalTrials.gov identifier: NCT01295827). Patients and Methods Patients with ipilimumab-naive or -treated advanced/metastatic melanoma received one of three dose regimens of pembrolizumab. Eligible patients who received pembrolizumab for ≥ 6 months and at least two treatments beyond confirmed CR could discontinue therapy. Response was assessed every 12 weeks by central Response Evaluation Criteria in Solid Tumors version 1.1. For this analysis, CR was defined per investigator assessment, immune-related response criteria, and potential predictors of CR were evaluated using univariate and multivariate analyses. Results Of 655 treated patients, 105 (16.0%) achieved CR after median follow-up of 43 months. At data cutoff, 92 patients (87.6%) had CR, with median follow-up of 30 months from first CR. Fourteen (13.3%) patients continued to receive treatment for a median of ≥ 40 months. Pembrolizumab was discontinued by 91 patients (86.7%), including 67 (63.8%) who proceeded to observation without additional anticancer therapy. The 24-month disease-free survival rate from time of CR was 90.9% in all 105 patients with CR and 89.9% in the 67 patients who discontinued pembrolizumab after CR for observation. Tumor size and programmed death-ligand 1 status were among the baseline factors independently associated with CR by univariate analysis. Conclusion Patients with metastatic melanoma can have durable complete remission after discontinuation of pembrolizumab, and the low incidence of relapse after median follow-up of approximately 2 years from discontinuation provides hope for a cure for some patients. The mechanisms underlying durable CR require further investigation.
    According to Jeffrey Weber, medical oncologist at the Laura and Isaac Perlmutter Cancer Center at New York University Langone Health in New York City,

    What is the conclusion of this paper? It says if you achieve a CR (which is not so infrequent, occurring in 16% of all patients in a very large trial of 655 patients), your chance of staying there at least at 2 years is very high. My personal prediction is that many of those in CR at 2 years who stay there will probably be cured of their melanoma. Again, in the immunotherapy era, we can now begin to talk of cures for patients with melanoma
    Il y a quelque chose de pire que d'avoir une âme perverse. C’est d'avoir une âme habituée
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  2. #2

    Default Re: Cure for patients with melanoma?

    Hello Ludicus,

    Thanks for bringing up the topic. I find it also interesting to listen to the educative videos by Dr. Evan J. Lipson of Johns Hopkins Medicine. Especially, those dedicated to the latest immunotherapy options for melanoma. A lot of cases are mentioned in the CureMelanoma patient education fast papers resources and cure stories.

    Prof. Terry Lewis

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