In melanoma care....we've come a long way baby!!!

Real-world treatment practice in patients with advanced melanoma in the era before ipilimuab:  results from the IMAGE study.  Middleton, Dalle, Claveau, et al.  Cancer Med 2016 4/26. 

The therapeutic landscape for advanced melanoma has recently been transformed by several novel agents (immune checkpoint inhibitors and molecular-targeted agents). The prospective, multi-site, observational study IMAGE (ipilimumab: management of advanced melanoma in real practice) included a retrospective cohort to describe real-world treatment prior to approval of the immune checkpoint inhibitor ipilimumab. This retrospective cohort of patients, who started second-line/subsequent treatment for advanced melanoma within 3 years before ipilimumab approval, was selected randomly by chart review. Collected data included treatment history, patient outcomes, and healthcare resource utilization. All patients had ≥1 year of follow-up data. This analysis included 177 patients from Europe (69%) and North America (31%). The most common index therapies (used alone or in combination) were fotemustine (23%), d
acarbazine (21%), temozolomide (14%), and platinum-based chemotherapy (14%). Most patients (89%) discontinued treatment during the study period; the most common reason was disease progression (59%). Among patients with tumor assessment (153/177; 86%), 2% had complete response, 5% had partial response, and 12% had stable disease on last tumor assessment. At 1-year study follow-up, median progression-free survival was 2.6 months and median overall survival was 8.8 months. During follow-up, 95% of the patients had healthcare visits for advanced melanoma, 74% of whom were hospitalized or admitted to a hospice facility. These results provide insights into patient care with advanced melanoma in the era before ipilimumab and may serve as a benchmark for new agents in future real-world studies.

So this was 177 folks being treated from 2008 - 2010....not that long ago.....before ipi, BRAFi and anti-PD1 were FDA approved.  And "at 1-year study follow-up, median progression-free survival was 2.6 months and median overall survival was 8.8 months."   While in this study:  Pembro/keytruda's overall response  Pembro provided a "12-month progression-free survival rate of 35%, and median overall survival of 23 months."  And here:  Nivolumab/Opdivo shows impressive OS  "the median OS was 20.3 months, the 5-year OS rate was 35.3% and the 30-month PFS rate was 25.7%."  We know the benefits BRAFi can provide...if only short term....but with some adjustments others are reaping their benefits and managing side effects for years.  Additionally, work continues to be done by researchers and ratties in the area of immunotherapy combo's, IDO inhibitors, LAG3, CDK4/6 inhibitors, various meds/treatments that prevent tumor resistance to BRAFi, DNA pcr and tumor testing that may help determine who will respond to what treatment....

But...it is not enough....not nearly enough.  Holding many of my amazing peeps in my heart today....Dfeng, Charlie S, Josh, John and so many others....hang in there guys....hang in there. love, c