The changing landscape of melanoma treatment

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Published: 22 Nov 2018
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Dr Eva Muñoz-Couselo - University Hospital Vall d'Hebron

Dr Eva Muñoz-Couselo speaks with ecancer at the EADO 2018 congress in Barcelona about the changing landscape of melanoma treatment.

Dr Muñoz-Couselo discusses target agents such as the BRAF inhibitor and that the agent must be combined with a MEK inhibitor.

She believes that combination treatments are the future but that superior biomarkers are needed to better determine which treatment is best for patients.

ecancer's filming has been kindly supported by Amgen through the ecancer Global Foundation. ecancer is editorially independent and there is no influence over content.

The truth is that melanoma has changed quite a lot in the past 5-10 years and we have had several treatments which have changed the paradigm of this disease. We had a survival of less than one year and nowadays we are talking about more than 50% who are alive after three or four years receiving different treatments and, of course, regarding immunotherapy which is one of the treatments which has changed its paradigm.

Are targeted agents also being used?

The ones that are approved and the ones that we are using are the BRAF inhibitors which must be combined with a MEK inhibitor because we have several clinical trials that have demonstrated that combination is better than just a BRAF inhibitor because it has more efficacy and less toxicity. This is one of the standards for the BRAF mutated patients but also we have the option to give them immunotherapy, whether immunotherapy as an anti-PD-1 treatment or with the combination of ipilimumab plus nivolumab. But also we have several combinations which are now being developed just to open the landscape of options in this field.

What is the future for melanoma care?

The rise, of course, I think that there will be combinations, as we have talked together today in the symposium, because also monotherapies are giving us pretty good results. Of course we are not achieving 100% of survival that we, of course, would like to have for our patients. The problem with combinations is that there are several ones that are being developed but we don’t have pretty good biomarkers just to have the ability to identify which treatment is better for which patients and in the right time just to give it to them. There is so much work being done in research for looking for biomarkers.

Can you explain the effect of staging for neoadjuvant and adjuvant therapies?

One of the things that has changed quite a lot in the past one or two years is that we have introduced treatments which have been very positive in the metastatic setting, we have translated into the adjuvant setting and nowadays in the neoadjuvant. We are seeing that these treatments are pretty active also in the adjuvant and neoadjuvant setting and the future is to develop treatments in the early stages just to avoid patients to be metastatic. Of course also combinations are being tested in these settings as well.

What is your take home message from the presentations?

The most hot topic now in melanoma is that we have very pretty good treatments but we have to improve. The future will be for combinations but there’s a huge need for biomarkers and a lot of effort must be done just to identify the hot test that we will have just to give the better treatment for each patient at the right time.