Of the three main skin cancers, melanoma presents the greatest public health concern: The number of Americans with melanoma has doubled about every 20 years; Oregon has the fifth highest incidence of melanoma in the U.S. Many systemic therapies have been tested for melanoma during the past 50 years, with generally disappointing results, but recent advancements in cancer immunotherapy research and clinical trials have spawned new therapies with significant survival benefits.
One such promising immunotherapy treatment is ipilimumab, a CTLA-4 blocking antibody administered as an intravenous infusion in the outpatient setting as first- or second-line therapy. Walter J. Urba, M.D., Ph.D., co-medical director of the Melanoma Program at Providence Cancer Center with Brendan D. Curti, M.D., led the global, multi-site clinical trial of ipilimumab. The study found that ipilimumab provided a significant survival benefit compared with standard therapies. In March 2011, the FDA approved ipilimumab under the brand name Yervoy. Current studies are evaluating ipilimumab’s effectiveness when combined with other immune boosting antibodies and melanoma therapies, and Providence researchers have been innovators in offering our patients immunotherapy combinations.
More recently, the FDA approved PD-1/PD-L1 blocking antibodies pembrolizumab and nivolumab for patients with metastatic melanoma under the brand names Keytruda and Opdivo. Both immunotherapies, which Providence Cancer Center tested in clinical trials, offer improved response and survival benefit as second- or third-line therapies. Before 2011, there were no second- or third-line treatments for patients with melanoma outside clinical trials, making the recent clinical breakthroughs a significant achievement in caring for melanoma patients. Current studies are evaluating the effectiveness of pembrolizumab and nivolumab as first-line therapies and in combination with other medications.
Providence has been an innovator in combination immunotherapy clinical trials. We were among the first to demonstrate the immune-boosting potential of Stereotactic Body Radiotherapy (SBRT) when given along with another immune booster, high-dose Interleukin-2, to patients with metastatic melanoma. We have many clinical trials for patients with stage III and IV melanoma that may again improve the standard of care for melanoma patients:
- intra-tumoral injections of viruses that can infect melanoma given with ipilimumab,
- medicines that can change the tumor microenvironment to promote immune response (GR-MD-02) with ipilimumab,
- vaccines for patients with earlier stages of melanoma (DEC205-NY-ESO-1),
- and combinations of T-cell checkpoint and immune boosting antibodies like ipilimumab and nivolumab
At Providence Cancer Center, melanoma patients and their families benefit from some of the most comprehensive cancer services in the world, including advanced diagnostic imaging, state-of-the-art treatments, nationally renowned research and compassionate care and counseling. Our team of medical, surgical and radiation oncologists partner with nurses, researchers, patient advocates and other caregivers to aggressively treat melanoma and to ensure that nobody has to face cancer alone.