During her session, “What’s New and Hot in Melanoma,” presented at the 2022 Fall Clinical Dermatology Conference, Laura K. Ferris, MD, PhD, went over the importance of immunotherapy, collaborative care, and more when treating patients with melanoma.

To start, she reviewed electrical impedance spectroscopy, or EIS ,which is a tool that is not brand new but is not used frequently despite being helpful in making better biopsy decisions by distinguishing a pigmented lesion that is benign versus melanoma. Through various studies she was showed that, whereas dermoscopy can somewhat increase the correct biopsy decisions, adding EIS has the potential to increase it even more.

Dr Ferris transitioned onto newer melanoma treatments by first discussing adjuvant and neoadjuvant therapy. She defined adjuvant therapy as a treatment given after the primary treatment; however, the patient still has a risk of recurrence. Neoadjuvant therapy is a treatment given before the primary therapy. She continued to introduce lymphocyte activation gene 3 (LAG3), an immune checkpoint inhibitor that is upregulated on tumor infiltrating lymphocytes and inhibits downstream signaling in the T-cell receptor. She shared that this treatment is now being studied not just in advanced disease, but also in the adjuvant setting.

Next, she showcased a preexisting drug that has been newly used for the adjuvant treatment of stage 2B/2C melanoma—pembrolizumab, which is a PD1 inhibitor. It has recently been US Fodd and Drug Administration approved for adjuvant treatment following a study that showed patients on pembrolizumab had a longer or better recurrence-free survival. She went on to show the use of pembrolizumab as a neoadjuvant treatment by presenting a study that showed when using the same amount of drug as in the adjuvant treatment, having immunotherapy with tumor present seemed to improve the response.

“We don't have overall survival data as they're not mature yet. The study is still ongoing, but I think this was really interesting,” she added.

She then went on to discuss how patients with BRAF mutated melanoma could get either of the following targeted therapies: BRAF MEK inhibitors or immunotherapy.

To address which therapies these patients should get first, Dr Ferris presented a study where patients received either immunotherapy ipilimumab/nivolumab induction followed by nivolumab maintenance, or darabfenib/trametinib as a BRAF MEK combination inhibitor. Results showed that overall survival was significantly better for patients if they got immunotherapy first. Dr Ferris stressed that the results of this study mean that a lot more patients are now going to be eligible for immunotherapy.

“It's going to be important that we as dermatology, medical oncology, surgical oncology really talk about weighing risks and benefits,” she stated. In fact, at her session’s conclusion, Dr Ferris argued that multidisciplinary care is critical, so physicians need to talk about their plans with their medical oncologists and/or surgical oncologists.

Reference
Ferris L. What's new and hot in melanoma. Presented at: Fall Clinical Dermatology Conference 2022; October 20–23, 2022; Las Vegas, NV.