Researchers reported a number of important findings in the treatment of melanoma at the 2018 Annual Meeting of the American Society of Clinical Oncology:

Studies evaluated benefit of complete lymph node dissection after cancer found in sentinel nodes

It is currently standard practice to perform a complete nymph node dissection (CLND) immediately after the detection of cancer in the sentinel nodes, with the thought that it helps prevent recurrence (cancer returning) and lowers the risk of the melanoma metastasizing (spreading).

Two multicenter randomized trials, DeCOG-SLT and MSLT-II, showed there was no improvement in melanoma-specific survival or overall survival in patients who underwent immediate CLND after a biopsy detected cancer in the sentinel nodes.

What Patients Need to Know

The results of these two studies showed that observation of the non-sentinel nodes, with a complete lymph node dissection only if cancer was detected, was as effective as immediate removal.

Combination of encorafenib and binimetinib shown to improve progression-free survival

The phase III COLUMBUS trial showed the combination of the BRAF inhibitor encorafenib with the MEK inhibitor binimetinib improved progression-free survival in patients with advanced BRAF V600-mutant melanoma, as compared to the BRAF inhibitor vemurafenib.

BRAF V600 mutations occur in 35 to 50 percent of people with melanoma.

What Patients Need to Know

In June 2018, the combination of encorafenib and binimetinib was approved by the FDA for the treatment of people with unresectable (cannot be completely removed though surgery) or advanced melanoma that has a BRAF V600E or V600K mutation.

Combination immunotherapy compared in neoadjuvant and adjuvant settings

The phase Ib OpACIN trial compared the combination of the immunotherapies nivolumab and ipilimumab as neoadjuvant (prior to surgery) therapy versus adjuvant (after surgery) therapy and found the neoadjuvant therapy was superior.

After a median follow-up of 24 months, none of the patients in the neoadjuvant group who had responded to the nivolumab and ipilimumab combination had experienced a return of their melanoma, compared to a 40 percent recurrence rate (the rate of which the cancer returns) for patients in the adjuvant group.

What Patients Need to Know

Adverse events were significant in both groups, and a phase II trial is being planned to identify dosing options to reduce adverse events and maximize benefits.