A Message of Hope for New Combination Therapies in Melanoma

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Topics include: Treatment and Understanding

In this replay, melanoma specialist and medical oncologist Dr. Michael Postow joins Patient Power host Andrew Schorr online from Memorial Sloan Kettering Cancer Center to discuss combination therapies for patients with advanced melanoma. In the online chat, Andrew and Dr. Postow discuss how patients can get life-extending treatments and the important initial things that patients can understand about their disease and diagnosis. "There are better treatments for metastatic melanoma now than we've had ever before, and that's really exciting," says Dr. Postow.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Andrew Schorr:

Hello and welcome to Patient Power.  I'm Andrew Schorr, and we're delighted to be producing this program in association with AACR, and I'm with a noted physician from Memorial Sloan Kettering in New York, a melanoma specialist, a medical oncologist, Dr. Michael Postow.  Thank you so much for joining us. 

Dr. Postow:

Thank you very much for having me.  It's a pleasure. 

Andrew Schorr:

So let's talk about where we are now with combination therapies for people with advanced melanoma.  These conditions have been so serious, but you've made tremendous progress.  What are we learning now so patients can get life-extending treatments? 

Dr. Postow:

There are better treatments for metastatic melanoma now than we've had ever before, and that's really exciting, because we are rewriting all of the old rules that we had about this disease.  We're making strides with immune therapy approaches, so not even giving chemotherapy initially to patients but using strategies to boost patients' immune systems to help them fight melanoma, and also learning more and more about each individual patient's type of melanoma so that we can hopefully find a drug that matches that individual patient so that they can have personalized treatment. 

But there are so many new drugs either given alone or in different combinations that are incredibly changing the outlook so a really hopeful time for people that are diagnosed with this disease. 

Andrew Schorr:

What I'm hearing is it's not a one-size-fits-all approach, so how personalized are we getting?  Is one person's advanced melanoma the same as the other person, or you're having to do precision medicine testing, if you will, to really get a clear picture for that patient? 

Dr. Postow:

It's a really important question, because every patient has their own type of melanoma, and every patient is different.  So it is important that patients that do have a diagnosis of melanoma have their melanoma tumors tested for certain types of mutations so that the doctors can be as personalized as possible in deciding the best treatment for that individual patient.  

Even though every patient is a little bit different, there are some patients that come into big buckets of kinds of melanoma, and about 40 to 50 percent of patients will have a certain kind of melanoma called BRAF melanoma. And that's a kind of melanoma that there's a drug that's available to be given to these patients.  And so it's important really to talk to doctors that are taking care of a patient with melanoma to really make sure that they test for this type of melanoma among other types of melanoma. 

But it's an exact, perfect example of personalized medicine where we're learning as much as we can from each individual patient so that we can design the treatment option that is best for them. 

Andrew Schorr:

Okay.  Now let's talk about combination therapy.  You've done a lot of work in what you might call immune therapy and also in combination using really breakthrough medicines to see if you can affect the cancer in different ways.  First of all about immune therapy, is it the idea that you can help the patient's immune system fight the cancer with the addition of a drug that sort of stimulates that?  Is that the idea?  

Dr. Postow:

That's exactly the idea.  Our immune systems have the ability to eradicate cancer or keep it under control, and for whatever reason in patients that are fighting cancer for some reason the immune system just isn't fighting hard enough.  So immunotherapy is a strategy where we give patients certain types of drugs to boost their own immune system so that they can fight off the cancer better themselves. 

Andrew Schorr:

Okay.  So what's the idea behind combination therapy then?  It would seem like if you have just one immune?stimulating drug, you're good.  Why do you need more?  

Dr. Postow:

I wish one drug was perfect for every individual patient.  Some people have really great responses just to one drug, and we're trying to understand why one drug for certain people is all that they need.  However, the idea with combination immune therapy is that if you boost the immune system in different strategies using drug A and drug B, it may be that those patients have both types of immune stimuli going. And those patients kind of double cover for their immune system, and in some ways it's been shown that that kind of combination can really be even more powerful in certain contexts than given single drugs by themselves. 

So hopefully we can learn who can have the benefits just from one drug, and we can get away with giving some people just one drug. But some people really benefit from both drugs together, and that's the idea of combination therapy. 

Andrew Schorr:

Dr. Postow, so you've been using this both in trials and some now with approved medications.  How dramatic can the improvement be for a patient? 

Dr. Postow:

Incredibly dramatic.  I've had people that have come in to clinic really, really feeling poorly with their melanoma, either having pain, having some bleeding, feeling tired, lots of different types of symptoms that people can have.  Once we get them started on a treatment if hopefully it works really well, people can feel better very, very quickly, days if not weeks after getting started. 

And it's really one of the most rewarding aspects of being a doctor when you see a patient literally getting better right in front of your eyes.  I wish it was all patients that had that kind of incredible benefit, but the number of these patients that are having this benefit is greater really than it's ever been before. 

Andrew Schorr:

That's, of course, great news, but this is a field that's changing fast.  You're obviously a subspecialist at a major cancer center, but people have melanoma and seek care all over.  How can patients get what's right for them?  What questions would you recommend people ask now so that they get the latest that medical science has to offer, either with approved therapies, combination therapies or maybe even a clinical trial that might offer something, a promise of something even better?  

Dr. Postow:

I do think patients need to be strong advocates for themselves.  And I think the most important questions that they can ask their doctor when they're getting started on a treatment program for advanced melanoma, number one, do I have a BRAF mutation in my melanoma?  That's important to have that type of a testing performed. 

Two, asking about clinical trials.  Because there are so many new drugs that are out and so many new combinations, it would be really helpful for patients to ask their doctors if they've thought about clinical trials, testing new combinations to new approaches. 

And three, I think it's also an important question to ask if they're a candidate for immunotherapy and if not to really try and understand what it is that their doctor is not thinking about immune therapy for that particular patient, because in melanoma often immunotherapies are the first types of treatments that patients can receive. 

So I think pushing about the BRAF mutation, pushing about clinical trials, and really trying to push about whether immune therapy would be appropriate, I think those are the three most important initial things that patients can understand about their disease and diagnosis.  And I think maintaining a real hopeful attitude as doctors and patients approach their initial treatment is really always helpful as well. 

Andrew Schorr:

Is melanoma really almost a ground zero where we've had a lot of this immunotherapy progress?  It seems like, as I've heard about it over the last few years, it's been tremendous change. And so while no one wants a diagnosis of advanced metastatic melanoma, this is an area that's changing fast. 

Dr. Postow:

Absolutely.  Melanoma is almost a poster child for immunotherapy and BRAF?directed targeted therapy for patients with all kinds of different cancers.  So for patients with advanced melanoma, we were the first disease where drugs that boosted the immune system in this specific way were approved by the FDA, so patients with melanoma had had access to some of these newer drugs before anyone else with all of their different types of cancers. 

And it's been really rewarding as a melanoma oncologist to see that the same drugs we're giving our patients with advanced melanoma are now being given to patients with lung cancer, Hodgkin lymphoma, head and neck cancer, kidney cancer.  I could go on and on and on, and these immune therapy-boosting strategies are really not something that's specific to melanoma but are really showing efficacy in so many other different types of cancers, and a lot of this really began by treating patients with advanced melanoma.  

And I'm hopeful that in the future as we work with new strategies as well some of the advances we'll find in melanoma could also be exported to these other types of cancers as well to help even more patients.  

Andrew Schorr:

Okay.  So you are a melanoma specialist, and the way you feel about things is the barometer for patients and families as to whether they should be hopeful.  It sounds like you are extremely hopeful, and looking in what's in the lab, what's in development and what you have today you're feeling very positive. 

Dr. Postow:

Absolutely.  I think that's the best way to be.  We have come a long way from where we were, yet until 100 percent of patients are doing incredibly well we have more work to do.  So there's always something new coming up.  We're always working on new combinations, new strategies, new ways of understanding this disease, and I think that we're very a grateful for all of our patients in clinical trials that are helping us learn about advancing the field, and we're learning from every patient as much as we possibly can. 

And so I'm hopeful as we move forward it would be great to get rid of this problem altogether.  I'd be happy to take an early retirement with that kind of information in mind, but I think we've made big strides. But until we're 100 percent of the way, there there's more work to be done. 

Andrew Schorr:

All right.  And I think you said it best, is really thankful for patients who participated in trials. And if this field is moving fast, and it is, then I would just say to patients please ask about trials.  You mentioned it earlier, so important.  Is that a new addition to your combination therapy?  Is that a better medicine to help you and your personal situation with melanoma?  Did I get it right? 

Dr. Postow:

I think you got it exactly right.  Absolutely.  I think the most important issue about trials too is that a lot of patients will think trials might be a situation where some people get an active drug, and some people get a sugar pill or a placebo infusion.  Almost all trials that are out there give active treatment at least alone if not in new combinations, so I think a trial is always a good thing to ask about if that's appropriate. 

Andrew Schorr:

Okay.  Well, what a positive story we're able to tell how in melanoma, an evolving story.  Dr. Michael Postow from Memorial Sloan Kettering, specialist in melanoma, thank you for being with us.  And on behalf of Patient Power and AACR, all the best in your work in moving it forward further.  

Dr. Postow:

Thank you very much for having me. 

Andrew Schorr:

I'm Andrew Schorr.  Remember, knowledge can be the best medicine of all.  

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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Page last updated on June 7, 2017