Melanoma session at ASCO

I wanted to give the plenary presenters a standing ovation — that's how exciting the melanoma session was at ASCO this year.

Rather amazingly, it was also published online this week in The New England Journal of Medicine (word travels fast). If you haven't heard, this was the first truly positive melanoma study within 30 years.

The first study to be outside the CIs showing a real benefit with investigational treatment. The trial was a randomized study of ipilimumab with or without a vaccine gp100 vs. gp100 peptide vaccine alone in the control arm for previously treated stage III or IV melanoma. Long story short, the ipilimumab arm without gp100 did the best, with an impressive nearly 4 month improvement in OS when compared with the control arm. Ipilimumab inhibits t-lymphocyte antigen 4, basically allowing a very robust T-cell mediated anti-tumor effect.

Not surprisingly, the most challenging side effect of the intervention was immune-related adverse events, that were sometimes life threatening and described as "immune storm" by some. I would have liked to have heard more about that storm and it's optimal management during the plenary, but the study has more detail (subscription required) and most likely optimal management is a story yet to be written. As a friend of mine said who was watching the plenary with me, "This feels like a big moment." That it was. At the risk of sounding too optimistic, may this be the first step towards huge strides in treating this terrible disease that affects so many young people and is so difficult to treat.