Recent Advances in Melanoma Treatment

Dr Vincent Geldhof, a medical oncologist at AZ KLINA Brasschaat, discussed some interesting novelties in melanoma treatment. These promising developments focused on novel immunotherapies, treatment strategies for BRAF-mutated melanoma, and updated insights into therapy-related toxicity.

One key study, the INTRIM trial, investigated the use of a single intradermal dose of a toll-like receptor (TLR) agonist in patients with stage pT3 or pT4 melanoma, administered one week before sentinel lymph node biopsy. Results showed a significant reduction in the number of positive sentinel nodes and an extension of relapse-free survival. Mechanistically, this is believed to be linked to the activation of B-cells and dendritic cells in the draining lymph nodes, enhancing anti-tumour immunity.

The IGNYTE trial, led by researchers in Barcelona, explored a new approach for patients with melanoma refractory to anti-PD1 therapy. It combined intratumoral injection of an oncolytic virus with systemic nivolumab. Preliminary findings suggest encouraging safety and efficacy, although more extensive phase 3 trials are required to confirm its potential.

A large Danish cohort study (DAMMED) assessed outcomes in patients with BRAF-mutated metastatic melanoma who discontinued BRAF/MEK inhibitor therapy after two years of continuous treatment. Approximately 50% of patients maintained their response off treatment, while the other half experienced relapse. However, reintroducing BRAF/MEK inhibitors was effective in 75% of these relapsed cases, suggesting a viable retreatment strategy. 

Additionally, researchers from Aarhus University in Denmark conducted a large retrospective study on the cardiotoxicity associated with BRAF/MEK inhibitors. Findings revealed a higher-than-expected rate of cardiac side effects, especially during the first year of treatment. These results underscore the importance of close cardiac monitoring in patients undergoing this therapy.

These studies mark meaningful progress in both understanding and managing melanoma, particularly in tailoring treatment duration and improving outcomes for resistant or high-risk patient populations.