Top Banner

Click here to load reader

Adjuvant therapy - Dr. Roda Amaria

Jul 16, 2015

ReportDownload

Education

  • Adjuvant and Neoadjuvant Therapy in Melanoma

    R. Amaria, MD

    Assistant Professor, Melanoma Medical Oncology

    1/31/2015

  • 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

  • Adjuvant Therapy for Stage III Disease

    Surgery Adjuvant therapy

  • Ideal Adjuvant Therapy

    Effective in destroying microscopic deposits of melanoma that could potentially be present after surgery

    Has limited or easily manageable toxicity

  • FDA Approved Medical Adjuvant Therapy

    Interferon- and Pegylated interferon

  • Clinical Trials for Adjuvant Therapy

    Vaccines New immunotherapies-ipilimumab, anti PD-1 antibodies

    Patients with Surgically Removed Stage IIIa-IIIc melanoma

    Ipilimumab10mg/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%

  • Neoadjuvant Therapy for Stage III Disease and Limited Stage IV disease

    Surgery Adjuvant therapyNeoadjuvant Therapy

  • Ideal Neoadjuvant Therapy

    Effective in shrinking down tumor rapidly Has easily manageable or predictable toxicity profile Facilitates understanding of mechanisms of

    response to therapy

  • 87yo man with stage IIIc BRAF Mutated Melanoma

    November 2014 January 2015

    BRAF/MEKInhibition

  • November 2014January 2015

    2 cycles of biochemotherapy

    60 year old man with locally advanced sinonasal melanoma

  • Patients with stage IIIB/IIIC or oligometastatic stage IV (
  • Patients with

    stage IIIB/IIIC or

    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 ANeoadjuvant Nivolumab(4 doses)

    Surgery

    On treatment

    biopsy /

    blood draw

    (prior to

    dose 2 and

    dose 3)

    Adjuvant

    Nivolumab x 6

    months

    Arm BNeoadjuvant Ipilimumab

    & Nivolumab(3 doses)

    Surgery

    Adjuvant

    Nivolumab x 6

    months

    Follow up

    Follow up

    Neoadjuvant Therapy Clinical Trials

  • Adjuvant and Neoadjuvant Therapy 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

  • Thank you for your attention

    Questions?