High-risk Stage III melanoma patients to benefit from Australia/Netherlands collaboration
23 October 2018
Research that could change clinical practice for high-risk Stage III melanoma patients has been presented at the European Society for Medical Oncology (ESMO) Congress in Munich.
The OpACIN-Neo study, led by a team out of the Netherlands with a large number of patients recruited from Melanoma Institute Australia, showed a modified combination of the immunotherapies ipilimumab and nivolumab given prior to surgery produced a response in over 70% of patients. Importantly, there were drastically reduced side effects for patients and remarkably, none of these patients have relapsed to date.
Stage III patients are those whose melanoma has spread to their lymph nodes. Standard therapy for these patients is to undergo surgery to remove their melanoma, however those who undergo surgery alone have a significant risk (40-70%) of their disease recurring and progressing to Stage IV. Research in Stage IV melanoma patients demonstrates that combining ipilimumab and nivolumab is more effective than nivolumab alone, however this combination of drugs often causes extreme side effects for patients with many unable to continue treatment. Extrapolating from this data, the OpACIN-Neo study aimed to modify the dose of combined ipilimumab and nivolumab to reduce the incidence of toxicity while extending the efficacy seen in Stage IV patients to those with high-risk Stage III disease.
Previous research has shown that giving immunotherapy prior to surgery shrank the number of melanoma cells and increased long-term relapse-free survival. Neoadjuvant (pre-surgery) ipilimumab and nivolumab was also found to induce a stronger immune response, leading researchers to believe that when the immunotherapy is able to see the melanoma cells, they are able to assist the immune system to mount a more effective response.
In the OpACIN-Neo trial, researchers modified the standard dosing schedule by decreasing the dose of ipilimumab and increasing the dose of nivolumab and gave these prior to surgery. They found that after six weeks of therapy, the toxicity of the combination therapy was drastically reduced (only 20% of patients suffered a severe toxicity compared with those who received the standard dosing in that 6 weeks) while the efficacy was largely unchanged with a pathologic response seen in 77% of patients.
"These results are promising in that they provide an insight into the effects of altering the dosage and timing of giving combination immunotherapy to Stage III melanoma patients," said Co-Medical Director of Melanoma Institute Australia, Professor Georgina Long. "To have such a high level of response, coupled with greatly reduced toxicity for patients, means we are heading in the right direction with this vital area of immunotherapy research. The high rate of pathological response is exciting, as we know from a pilot study that those patients who had a pathological response haven’t had disease recurrence."
Stage III melanoma patients with bulky lymph node disease have the worst prognosis of Stage III patients, with 70-80% of them expected to recur within the first two years. After three years of follow-up in this pilot study, every patient who presented with a pathological response is yet to recur.
Promising results from a host of clinical trials investigating the use of neoadjuvant therapies in metastatic melanoma are being analysed by the International Neoadjuvant Melanoma Consortium, which also met at ESMO. This international group of researchers and clinicians aims to increase collaboration and standardise efforts in neoadjuvant treatment for melanoma. "This is one of the most exciting things happening in drug therapy in melanoma and has the capacity to ultimately change clinical practice around the world," Professor Long added.
A must-read personal account by Garry Maddox in The Sydney Morning Herald of how immunotherapy is revolutionising melanoma treatment.
On Friday, a publication that lays out the steps needed to find out if a systematic screening program for melanoma would benefit all Australians was published in the Australia & New Zealand Journal of Public Health.
Melanoma March events have been cancelled. A Virtual March will be held on Sunday 29th March. Read this statement from MIA CEO Matthew Browne.
Thank you to the thousands of Aussies who bought ‘Game On Mole‘ t-shirts, took selfies, shared t-shirt pics on social media and started lifesaving conversations around sun safety and skin health.
Melanoma patients now have greater access to subsidised immunotherapy thanks to additional treatments today being listed on the PBS.
Brisbane couple Leon and Tamra Betts were, like thousands of others around Australia, on the couch watching MAFS when newlywed Natasha ran through her weekly beauty routine. When they heard the 26-year-old mention solarium use, they were shocked, and then saddened, prompting this open letter to all young Australians.
Professor Richard Scolyer, Co-Medical Director of Melanoma Institute Australia, will welcome international attendees this weekend to a sold-out, two-day course on ‘Pigmented Lesions and Other Hot Topics in Dermatopathology’.
It is time for a reality check on solariums.
They have no place in anyone’s beauty routine.
Throughout January our community created, hosted and participated in some amazing events, each of them helping us on our quest to reach zero deaths from melanoma.
Australian television presenter, interior designer and mother Kyly Clarke has been announced as the new Ambassador for Melanoma Institute Australia (MIA) and its national awareness and fundraising campaign Melanoma March.
Melanoma Institute Australia has recently partnered with three other organisations to boost support for melanoma patients and their carers across Australia.
Melanoma patients and their families across Western Australia will benefit from strengthened and expanded services with the merging of melanomaWA and Melanoma Institute Australia.
Australian researchers have played a critical role in the discovery of a potential new test to predict which early stage melanoma patients are at high risk of their disease recurring and progressing.
We are extremely grateful for our community fundraisers, who, even in this difficult time, have given up their time and effort to fundraise so we can continue to work towards our goal of zero deaths from melanoma.
Melanoma patients are set to benefit from subsidised access to immunotherapy treatment for high risk early-stage and advanced-stage melanoma patients.
An informative article on how immunotherapy is revolutionising cancer treatment, written by Jill Margo and featured in the Australian Financial Review.
Melanoma patients and their families in the Riverina will benefit from strengthened and sustained melanoma services with the merger of the Amie St Clair Melanoma Trust and Melanoma Institute Australia.
Belmont High School at Lake Macquarie has been announced winner of the 2019 SunSafe Student Ambassador Program video competition.
It’s time again to say thank you to our amazing community fundraisers!
Videos of the sessions at the recent Patient Information Evening co-hosted by Melanoma Institute Australia (MIA) and Melanoma Patients Australia (MPA) are now available for viewing.