This wasn't an ASCO of big Melanoma news but rather of a series of important updates, insights and 'keep-in-mind's
My (Bettina's) take-homes are here
Stage 3 and earlier
- Nivo better than Ipi adjuvant and no one should talk about Interferon in this context anymore
- Complete Lymph Node Dissection comes with side effects but is not better than observation when it comes to overall survival
- tumour burden </> 1mm in the sentinel node is an important prognostic factor for Stage 3A although it's not part of the new AJCC 8th classification
- adjuvant for Stage 2 is coming- so watch out for trials
Stage 4
- there is something about Ipi contributing to the long-term effect of immune therapy we need to keep an eye on
- several combinations have potential to work after resistance to PD1
- checkpoint therapy can be stopped upon complete response or stable disease, many patients remain stable but re-challenge works upon progression
- brain mets remain a major problem, still nothing satisfying for leptomeningeal disease
General
- We consider Stage 1 T1a and b Melanoma as the 'lucky ones' who are cured by surgery alone. However, there is more to the story and looking at 20 year overall survival is sobering- a figure G. Long showed:
Ref- https://link.springer.com/article/10.1245%2Fs10434-017-6325-1
- The idea that Melanoma first goes to the local lymph node and then spreads further is done with- Melanoma can unfortunately spread both via lymph and blood straight from the beginning.
- There remains a lot of work to do in terms of multi-disciplinary teams: we were in sessions where the surgeons wanted to operate, the radiologist to irradiate and the oncologist to drug. I'd like to see a long-term strategy that ensures that patients survive with as little side effects and long-term damage as possible.
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