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.
Comments in favour of giving patients with BRAF-positive melanoma access to first-line immunotherapy need to be submitted online prior to October 9, 2019.
Jay's Longest Melanoma March documentary is screening this Sunday 22 September at 1pm (AEST) on Channel 10, capturing behind the scenes of the 2000km walk, Adelaide to Sydney in 50 days. Uniting to end melanoma.
It’s been a month since we highlighted some of our incredibly generous community fundraisers. We thought we’d have a look back at August and put the spotlight on more of the wonderful people who give up their time to fundraise for MIA, so we can continue to edge closer to our goal of zero deaths from melanoma.
They are a formidable team - in work and in play
This week, Melanoma Institute Australia hosted the first of six
Federal government urged
We want to thank every member of Team Melanoma and everyone who donated to them. With your help, we are moving closer to our goal of zero deaths from melanoma!
Lauren O'Brien tells us why she's running for a cause close to her heart
MIA could not do what we do without the incredible support and effort of our community fundraisers. We’d like to highlight some of the wonderful events organised by our community in
An international study, led by researchers from Melanoma Institute Australia, QIMR Berghofer Medical Research Institute and The University of Sydney as part of the Australian Melanoma Genome Project, has discovered that a drug traditionally used to treat a
Researchers from Melanoma Institute Australia took centre stage at the American Society of Clinical Oncology Annual Meeting in Chicago. Results presented by MIA’s contingent have the potential to create better patient outcomes and change the way advanced melanoma
Today is International Clinical Trials Day – a day to recognise and thank the amazing people who conduct, organise, and coordinate clinical trials.
“I’m the age Emma was when she passed away. It almost feels
As always, part of the PBAC process invites clinicians, patients and other stakeholders in the cancer community to make submissions
As always, part of the PBAC process invites clinicians, patients and other stakeholders in the cancer community to make submissions in support of the PBS listing.
MIA had four winners in the 2017 Premiers Awards. Find out how winning has influenced their work over the past year.
Cancer Council awards Melanoma Institute Australia researchers funding for ground-breaking cancer research projects
Almost $9 million of new funding was awarded to 13 ground-breaking cancer research projects at the 2019 Cancer Council NSW Research Awards.
Georgina V. Long is co-medical director of Melanoma Institute Australia and Chair of Melanoma Medical Oncology and Translational Research. She is the first woman president of the Society for Melanoma Research.
Quintessential Aussie girl and media personality Sophie Monk has been announced as a National Ambassador for Melanoma Institute Australia (MIA) and its national awareness and fundraising campaign, Melanoma March.