ASCO 2009: Advances in Melanoma Treatment, Part I

I was at the big annual conference for the American Society for Clinical Oncology (ASCO) this past weekend, a massive gathering of over 30,000 cancer researchers and doctors from around the world. It's always an exciting experience and those that go can't help but come away energized about the future of cancer treatment.

I attended as many of the hundreds of available skin cancer-related presentations as I could (thanks to many, many lattes!). Let's start out with some good news about advances in melanoma treatment:

• The positive results keep coming for the promising "biologic" drug ipilimumab: an 18-month update of previous clinical trials showed that the drug causes a much higher survival rate for patients with very advanced melanoma. Another study combined ipilimumab with the chemotherapy drug dacarbazine and showed similar promising survival rates.
• A new vaccine with the unwieldy name of gp100:209-217(210M) in combination with interleukin-2 has been shown to be superior to interleukin-2 alone. This is the first phase III trial of a vaccine ever to show a positive effect in patients with metastatic melanoma.
• A small phase II trial showed that melanoma patients with a specific genetic mutation (called "KIT") respond much better to the drug imatinib, a potentially promising result that requires further study.
• Other drugs showing promise in early-stage clinical trials include nab-paclitaxel, bevacizumab, aflibercept, CNTO 95, sagopilone, CR011-vcMMAE, arginine deiminase, TriMix-DC vaccine, lenalidomide, endostatin, sorafenib and temsirolimus. As you can tell, a LOT of effort is being expended to find an effective treatment for this devastating disease!

Of course, cutting-edge cancer research necessarily involves failure as well as success. For example:

• A study of 50 patients with stage IV melanoma showed that the targeted drug gefitinib only resulted in a partial response in 4% of patients, most likely not enough to continue developing it. Another melanoma drug bites the dust.
• Similarly, a phase II trial of dasatinib showed only a small effect in patients with stage III or IV melanoma and had unpleasant side effects including fatigue and various lung problems. Development of this drug may continue, but it's nothing to get too excited about so far.

Let's hope that some of these treatments make it to the doctor's office sooner than later! Remember, however, that results presented at conferences are preliminary and need to published in peer-reviewed medical journals before they are accepted by most doctors. Nonetheless, the future of advanced melanoma treatment may finally, after decades of failed attempts, be looking brighter.