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In “Year of Melanoma,” meeting offers information, innovation
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The HemOnc Today Melanoma and Cutaneous Malignancies Meeting, being held June 25-26 in New York City, is a unique meeting dedicated specifically to melanoma and other cutaneous malignacies. Targeted to benefit a wide range of practitioners, including oncologists, dermatologists, general surgeons and specialty surgical oncologists, attendees will earn continuing medical education credits through attending interactive presentations and discussions on the specialty. Scheduled 2 weeks following ASCO 2011, attendees will also have an opportunity to analyze late-breaking news from the conference with experts who will explain its utility in clinical practice.
According to Sanjiv S. Agarwala, MD, course director of the meeting and a HemOnc Today editorial board member, “discussions become quite involved,” as meeting faculty has advanced expertise in oncology and dermatology and can provide comprehensive exposure to all pertinent aspects of the management and biology of melanoma and other cutaneous malignancies. Attendees will learn about disease prevention, current and emerging diagnostic technologies, genetic testing, adjuvant therapy, emerging therapies for regional disease and systemic therapies, among other topics.
Vernon K. Sondak, MD, department chair of cutaneous oncology at H. Lee Moffitt Cancer Center in Tampa, Fla., and a member of the planning committee for the meeting, summed up the event in one word: Excitement.
“We’re very excited about all of the sessions that have been developed,” he said. “This is the culmination of years of research, of major advances in our understanding of the biology of melanoma and the biology of the immune system,” said Sondak, also a HemOnc Today editorial board member.
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Topics certain to be on the agenda are two recently FDA-approved treatments: ipilimumab and peginterferon alfa-2b. Another new approach, the Hepatic CHEMOSAT Delivery System, recently received notice of European regulatory approval. “So we have three new agents [approved by these] regulatory agencies that we’ll be discussing, as well as other exciting new drugs we hope will not be far behind them,” Sondak said. “We’re calling this the ‘year of melanoma.’”
As recently reported in HemOnc Today, ipilimumab (Yervoy, Bristol-Myers Squibb) blocks cytotoxic T-lymphocyte antigen or (CTLA-4) and is administered intravenously. In a randomized, international study, 676 patients with metastatic melanoma were assigned to combination therapy with ipilimumab plus gp100 or gp100 alone. Patients on the combination therapy lived an average of 10 months, compared with those who were assigned only the vaccine, who lived an average of 6.5 months.
The FDA also recently approved peginterferon alfa-2b (Sylatron, Schering) for use in patients who have undergone definitive surgical resection for stage III melanoma. The approval covers patients with microscopic or gross nodal involvement.
Approval was based on results from the EORTC 18991 trial, in which patients with surgically resected melanoma were assigned to peginterferon alfa-2b (n=628) or observation (n=628). Researchers noted median estimated relapse-free survival was 34.8 months in the peginterferon alfa-2b arm vs. 25.5 months in the control arm.
On Saturday at the conference, Jonathan Zager, MD, assistant professor of surgery and oncologic sciences at H. Lee Moffitt Cancer Center, will present on locoregional therapy of the liver. He will discuss the Hepatic CHEMOSAT Delivery System (Delcath Systems), which recently received the CE mark with an indication for the percutaneous intra-arterial administration of melphalan hydrochloride to the liver in patients with metastatic melanoma. CHEMOSAT delivers high-dose chemotherapy and other therapeutic agents while controlling systemic exposure of those agents.
In a phase 3 metastatic melanoma study presented at ASCO in 2010, 93 patients were enrolled to receive either percutaneous hepatic perfusion of melphalan hydrochloride to the liver (n=44) or standard of care (n=49). The PHP treatment included four to six PHP procedures at 28- to 35-day intervals, in which melphalan hydrochloride was delivered in a 30-minute hepatic artery infusion using the CHEMOSAT delivery system. Median H-PFS was 245 days for patients receiving melphalan hydrochloride vs. 49 days for patients on standard of care. OS was also significantly improved for patients receiving the treatment (34.1% for PHP vs. 2% for standard of care [P<0.001]).
In addition to these recent developments, “everyone on the planning committee for the conference believes there are more new treatments on the way,” Sondak said. “There’s a lot of phase 2 and 3 trial data already for BRAF inhibitors that will be discussed in a Sunday session. And there are new data for ipilimumab beyond the study that led to its approval that will be presented.” However, the sessions won’t only focus on new drugs, but also on all aspects of melanoma diagnosis and treatment.
“To just focus on only the most advanced disease is missing out on the excitement of innovative treatment,” said Sondak. “It’s essential for everybody who gets involved in the management of melanoma, whether it’s a dermatologist, general surgeon, specialty surgical oncologist, melanoma medical oncologist, or just a medical oncologist out in practice who only sees occasional melanoma…it’s going to be important for everyone to get caught up on the newest developments in melanoma diagnosis and treatment.”
Sondak will be moderating a panel on Saturday to discuss the creation of an international consensus on treatment strategies. “We believe it’s not just with metastatic disease that we see improvement. There are changes in surgery and adjuvant therapy that are also important, maybe not as high-profile, but certainly important in their own right,” he said. “That particular session is going to look at these areas in which traditionally there has been big differences in what the Europeans have done, and what the Australians have done and what the Americans have done. Everything is being re-examined. This panel discussion is going to put these new developments in perspective, and help us try to achieve an international consensus for 2011.”
Another session at the meeting will be the relationship between pregnancy and melanoma risk, presented by Mary S. Brady, MD, FACS, associate attending physician, department of surgery at Memorial Sloan-Kettering Cancer Center. Along with breast cancer and possibly Hodgkin’s disease, melanoma is one of the most common cancers diagnosed in pregnant women, according to Sondak.
“We know that pregnancy and the hormones of pregnancy affect your pigmentation,” he said. “We have seen patients whose melanoma seems to get more aggressive while they’re pregnant. Should we tell these young people not to get pregnant after they’ve been diagnosed? Or if they have a history of melanoma and they get pregnant, what is it going to mean for them and what should we as practitioners do differently? I believe very strongly that if we have the knowledge, we can make this a more manageable situation.”
Sondak also highlighted a Saturday update session entitled, New Data on Old Technology: Update on Sunscreens, Melanoma and Tanning Risk. “As a profession, we’re fighting against tanning beds and trying to convince legislators that they should be banned for minors. The landscape has changed a great deal recently,” he said, citing a prospective randomized trial showing fewer melanomas in Australians who used sunscreen regularly than in people who did not. “There’s a lot of new data on an old topic; that title was deliberate,” he said.
Sondak noted discussions on CTLA-4 and BRAF inhibitors during Sunday’s sessions, as well as another Sunday session on managing locally advanced and metastatic basal cell carcinoma and a separate panel on the controversies inherent in genetic testing for melanoma.
“This meeting is focused on getting the knowledge out to the whole spectrum of physicians and practitioners involved in taking care of patients,” said Agarwala. “The goal has always been so everybody who is interested in melanoma — even if they only occasionally see a patient with melanoma — will get something valuable from the experience.” – by Carey Cowles
The 2012 HemOnc Today Melanoma and Cutaneous Malignancies Meeting will be held April 13-14 at the Grand Hyatt, New York, NY. Learn more at HemOncToday.com/melanoma.