Scientific article
Review
OA Policy
English

Evolving impact of long-term survival results on metastatic melanoma treatment

Published inJournal for immunotherapy of cancer, vol. 8, no. 2, e000948
Publication date2020-10
Abstract

Melanoma treatment has been revolutionized over the past decade. Long-term results with immuno-oncology (I-O) agents and targeted therapies are providing evidence of durable survival for a substantial number of patients. These results have prompted consideration of how best to define long-term benefit and cure. Now more than ever, oncologists should be aware of the long-term outcomes demonstrated with these newer agents and their relevance to treatment decision-making. As the first tumor type for which I-O agents were approved, melanoma has served as a model for other diseases. Accordingly, discussions regarding the value and impact of long-term survival data in patients with melanoma may be relevant in the future to other tumor types. Current findings indicate that, depending on the treatment, over 50% of patients with melanoma may gain durable survival benefit. The best survival outcomes are generally observed in patients with favorable prognostic factors, particularly normal baseline lactate dehydrogenase and/or a low volume of disease. Survival curves from melanoma clinical studies show a plateau at 3 to 4 years, suggesting that patients who are alive at the 3-year landmark (especially in cases in which treatment had been stopped) will likely experience prolonged cancer remission. Quality-of-life and mixture-cure modeling data, as well as metrics such as treatment-free survival, are helping to define the value of this long-term survival. In this review, we describe the current treatment landscape for melanoma and discuss the long-term survival data with immunotherapies and targeted therapies, discussing how to best evaluate the value of long-term survival. We propose that some patients might be considered functionally cured if they have responded to treatment and remained treatment-free for at least 2 years without disease progression. Finally, we consider that, while there have been major advances in the treatment of melanoma in the past decade, there remains a need to improve outcomes for the patients with melanoma who do not experience durable survival.

Keywords
  • CTLA-4 antigen
  • Immunomodulation
  • Immunotherapy
  • Programmed cell death 1 receptor
  • Review
  • Humans
  • Immunomodulation / immunology
  • Immunotherapy / methods
  • Melanoma / drug therapy
  • Melanoma / mortality
  • Survival Analysis
  • Survivors
Affiliation entities Not a UNIGE publication
Citation (ISO format)
MICHIELIN, Olivier et al. Evolving impact of long-term survival results on metastatic melanoma treatment. In: Journal for immunotherapy of cancer, 2020, vol. 8, n° 2, p. e000948. doi: 10.1136/jitc-2020-000948
Main files (1)
Article (Published version)
Identifiers
Additional URL for this publicationhttps://jitc.bmj.com/content/8/2/e000948
Journal ISSN2051-1426
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33downloads

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