Melanoma | Oncology Today with Dr Neil Love: Melanoma Edition

published 2 weeks ago by Dr Neil Love

A roundtable discussion with Drs Jason J Luke, Michael A Postow and Ryan J Sullivan on recent developments in the treatment of melanoma, including these topics: Case (Dr Sullivan): A woman in her late teens presents with a nodule on her chin and is diagnosed with Stage IIIA melanoma (00:00) Association between the use of tanning beds and risk of melanoma (02:38) Clinical care of patients with Stage IIIA melanoma (05:21) Risk of recurrence for patients with Stage III melanoma (08:16) Perspective on the benefits and risks of adjuvant therapy for patients with melanoma (09:57) Case (Dr Luke): A man in his early 50s with locally advanced melanoma with a BRAF V600E tumor mutation receives adjuvant dabrafenib and trametinib (15:57) BRAF tumor mutation testing for patients with melanoma (16:56) Therapeutic options in the adjuvant setting for patients with melanoma (18:47) Efficacy and tolerability of immunotherapy in the adjuvant setting (21:51) Choice of dabrafenib/trametinib versus immune checkpoint inhibition as adjuvant therapy for melanoma with BRAF mutation (24:50) Tolerability of and quality of life with BRAF/MEK inhibitor combinations versus immunotherapy (26:48) Monitoring and management of side effects associated with BRAF/MEK inhibitors (30:59) Counseling patients who are receiving BRAF/MEK inhibitors about sun exposure (33:28) Selection of anti-PD-1 antibody therapy for patients with locally advanced melanoma (36:16) Role of vemurafenib in the adjuvant setting (37:26) Case (Dr Postow): A woman in her early 30s with Stage III melanoma with a BRAF V600E tumor mutation receives adjuvant dabrafenib and trametinib (40:33) Reduction in the risk of recurrence with adjuvant therapy for patients with Stage III melanoma (43:29) Recurrence-free survival benefit with adjuvant nivolumab, alone or in combination with ipilimumab, compared to placebo for patients with Stage IV melanoma and no evidence of disease in the Phase II IMMUNED study (45:26) Tumor mutation burden and other potential biomarkers of response to targeted therapy or immune checkpoint inhibition in the adjuvant setting (50:43) Optimal duration of adjuvant therapy with dabrafenib/trametinib and immune checkpoint inhibitor therapy (54:19) Ongoing investigation of neoadjuvant therapy for locally advanced melanoma (58:01) Effect of BRAF/MEK inhibitors on the tumor microenvironment (1:03:28) Challenges with identifying immune-related adverse events (1:06:06) Management of immune-related adverse events in patients receiving immune checkpoint inhibitor therapy (1:07:57) Neurologic toxicities associated with the use of immune checkpoint inhibitors (1:10:42) Multidisciplinary team approach in the management of immune-related adverse events (1:12:45) Educating patients and emergency room personnel about immunotherapy and the potential for immune-related adverse events (1:15:59) Response to immune checkpoint inhibition in noninvasive solid tumors (1:18:34) Incidence and management of nonmelanoma skin cancer (1:20:26) Perspective on the utility of immune checkpoint inhibitors for patients with melanoma who have undergone transplants (1:24:10) Risks and benefits of immunotherapy for patients with metastatic melanoma who have received solid-organ transplants (1:26:30) Monitoring and care of patients with melanoma and preexisting autoimmune disease receiving immune checkpoint inhibitors (1:28:33) Case (Dr Sullivan): A man in his late 50s with Stage IIIC, BRAF wild-type melanoma on his arm experiences intermittent tingling of his mouth during treatment with adjuvant nivolumab (1:33:36) Cranial neuropathy associated with immune checkpoint blockade (1:36:15) Counseling patients about the benefits and risks of immune checkpoint inhibitors in the adjuvant setting (1:38:35) Correlation between toxicity and benefit with immune checkpoint inhibitors (1:42:24) Selection among the BRAF/MEK inhibitor combinations dabrafenib/trametinib, vemurafenib/cobimetinib and encorafenib/binimetinib for patients with metastatic melanoma with BRAF tumor mutations (1:45:46) Advantages of the encorafenib/binimetinib combination for patients with melanoma with BRAF tumor mutations (1:46:42) Use of encorafenib/binimetinib versus dabrafenib/trametinib versus vemurafenib/cobimetinib in clinical practice (1:47:34) COLUMBUS: Results of a Phase III trial comparing encorafenib/binimetinib, vemurafenib and encorafenib for patients with melanoma with BRAF tumor mutations (1:49:08) Case (Dr Luke): A man in his mid-50s with metastatic melanoma with a BRAF V600E tumor mutation experiences a complete resolution of CNS lesions after receiving ipilimumab with nivolumab (1:50:38) Therapeutic approach for patients with melanoma who develop brain metastases (1:52:07) Locoregional versus systemic therapy for patients with brain metastases (1:56:27) Activity and tolerability of nivolumab/ipilimumab in patients with CNS metastases (1:58:58) Management of colitis associated with immune checkpoint inhibitors (2:00:30) Efficacy of radiation therapy for brain metastases in melanoma (2:03:15) Optimal type of radiation therapy for patients with CNS metastases (2:05:39) Radiation necrosis with the combination of stereotactic radiation and immune checkpoint blockade (2:08:02) Case (Dr Postow): A man in his late 60s with low-volume metastatic mucosal melanoma and 1 incidental brain metastasis receives nivolumab/ipilimumab (2:09:39) Response to nivolumab/ipilimumab in patients with brain metastases (2:11:33) Side effects with nivolumab/ipilimumab (2:13:50) Management of hyperthyroidism associated with immunotherapy (2:15:42) Monitoring for endocrinopathy in patients receiving immune checkpoint inhibitors (2:19:03) BRAF tumor mutation status and benefit from nivolumab/ipilimumab (2:21:00) Correlation of PD-L1 expression and benefit from immune checkpoint blockade in patients with BRAF wild-type melanoma (2:23:47) Role of tumor mutation burden and PD-L1 expression as predictive markers of benefit with immune checkpoint blockade (2:26:10) CME information and select publications

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