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Adjuvant therapy - Dr. Roda Amaria
The document discusses adjuvant and neoadjuvant therapies for melanoma, explaining that adjuvant therapy aims to reduce cancer recurrence risk after surgery using FDA-approved options like interferon and ongoing clinical trials, while neoadjuvant therapy is intended to shrink tumors before surgery with similar ongoing trials. It provides case examples of patients undergoing these therapies, focusing on their treatment protocols and outcomes. Both approaches are crucial in managing melanoma, with ongoing research to enhance their effectiveness.
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Adjuvant therapy - Dr. Roda Amaria
- 1. Adjuvant and NeoadjuvantTherapy in Melanoma R. Amaria, MD Assistant Professor, Melanoma Medical Oncology 1/31/2015
- 2. • Adjuvant therapy:additional cancer treatment given after surgery is complete to lower the risk of the cancer returning • Neoadjuvant therapy: treatment given as a first step to shrink a tumor before surgery is performed
- 3. Adjuvant Therapy forStage III Disease Surgery Adjuvant therapy
- 4. Ideal Adjuvant Therapy •Effective in destroying microscopic deposits of melanoma that could potentially be present after surgery • Has limited or easily manageable toxicity
- 5. FDA Approved MedicalAdjuvant Therapy • Interferon-α and Pegylated interferon
- 6. Clinical Trials forAdjuvant Therapy • Vaccines • New immunotherapies-ipilimumab, anti PD-1 antibodies Patients with Surgically Removed Stage IIIa-IIIc melanoma Ipilimumab 10mg/kg Placebo Placebo Ipilimumab Median time to relapse 17 months 26 months Median overall survival Not statistically different Not statistically different Significant toxicity rate 2% 49%
- 7. Neoadjuvant Therapy for StageIII Disease and Limited Stage IV disease Surgery Adjuvant therapy Neoadjuvant Therapy
- 8. Ideal Neoadjuvant Therapy •Effective in shrinking down tumor rapidly • Has easily manageable or predictable toxicity profile • Facilitates understanding of mechanisms of response to therapy
- 9. 87yo man withstage IIIc BRAF Mutated Melanoma November 2014 January 2015 BRAF/MEK Inhibition
- 10. November 2014 January 2015 2cycles of biochemotherapy 60 year old man with locally advanced sinonasal melanoma
- 11. Patients with stage IIIB/IIICor oligometastatic stage IV (<3 lesions), + BRAF mutation Blood draw and tumor biopsy Pre-treatment Neoadjuvant BRAF/MEK x 8 weeks Blood draw and tumor biopsy at surgery Restaging CT scans every 3 months with blood draws Arm A Upfront surgery Arm B Neoadjuvant BRAFi/MEKI Surgical resection Restaging via CTs followed by surgical resection Scheduled within 0-4 weeks On treatment biopsy / blood draw (arm B only) Adjuvant BRAF/MEK x 44 weeks Standard of care adjuvant therapy (interferon vs. observation) Follow up Neoadjuvant Therapy Clinical Trials Follow up
- 12. Patients with stage IIIB/IIICor oligometastatic stage IV (≤3 lesions) Blood draw and tumor biopsy Pre-treatment Blood draw and tumor harvested at surgery Restaging CT scans every 12 weeks n=20 n=20 Arm A Neoadjuvant Nivolumab (4 doses) Surgery On treatment biopsy / blood draw (prior to dose 2 and dose 3) Adjuvant Nivolumab x 6 months Arm B Neoadjuvant Ipilimumab & Nivolumab (3 doses) Surgery Adjuvant Nivolumab x 6 months Follow up Follow up Neoadjuvant Therapy Clinical Trials
- 13. Adjuvant and NeoadjuvantTherapy Summary • Adjuvant therapy is administered after surgery to lessen the risk of melanoma recurring – Interferon/Pegylated Interferon are FDA approved options – Clinical trials are ongoing • Neoadjuvant therapy is given to shrink tumor down before surgery – Multiple clinical trials are ongoing or planned
- 14. Thank you foryour attention Questions?