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VIDEO: Intralesional monotherapies may not have a role for severe unresectable melanoma

NEW YORK — In a debate at HemOnc Today Melanoma and Cutaneous Malignancies, Robert H.I. Andtbacka, MD, CM, FACS, FRCSC, surgical oncologist at Huntsman Cancer Institute, suggested combinations of intralesional therapies should be used over these agents as monotherapy for the treatment of unresectable melanoma.

The randomized phase 3 OPTiM study compared talimogene laherparepvec (Imlygic, Amgen), also known as T-VEC, administered intralesionally vs. granulocyte-macrophage colony-stimulating factor given subcutaneously. Results showed patients with late-stage disease demonstrated a nondurable response.

“In early-stage patients, there is a role for monotherapy,” Andtbacka told HemOnc Today. “However, in patients with more severe disease, we really need to look at combination studies.”

Andtbacka also discussed a newly initiated phase 3 study, in which patients with unresectable melanoma were randomly assigned to receive pembrolizumab (Keytruda, Merck) with T-VEC or placebo.

“The data from this will take quite a few years to report out, but really it’s a new step in trying to use these oncologic immunotherapies in combination with checkpoint inhibitors to activate the immune system, and to have a better response without the toxicity,” Andtbacka said.

NEW YORK — In a debate at HemOnc Today Melanoma and Cutaneous Malignancies, Robert H.I. Andtbacka, MD, CM, FACS, FRCSC, surgical oncologist at Huntsman Cancer Institute, suggested combinations of intralesional therapies should be used over these agents as monotherapy for the treatment of unresectable melanoma.

The randomized phase 3 OPTiM study compared talimogene laherparepvec (Imlygic, Amgen), also known as T-VEC, administered intralesionally vs. granulocyte-macrophage colony-stimulating factor given subcutaneously. Results showed patients with late-stage disease demonstrated a nondurable response.

“In early-stage patients, there is a role for monotherapy,” Andtbacka told HemOnc Today. “However, in patients with more severe disease, we really need to look at combination studies.”

Andtbacka also discussed a newly initiated phase 3 study, in which patients with unresectable melanoma were randomly assigned to receive pembrolizumab (Keytruda, Merck) with T-VEC or placebo.

“The data from this will take quite a few years to report out, but really it’s a new step in trying to use these oncologic immunotherapies in combination with checkpoint inhibitors to activate the immune system, and to have a better response without the toxicity,” Andtbacka said.

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