Dr. Reinhard Dummer

Highlights from Society of Melanoma Research Congress, San Francisco November 18-21 2015

Clinicians don’t understand what’s happening and why it’s happening- but they are trying to understand.  How is immunotherapy working, what causes resistance, how will sequencing be undertaken, what does the future look like- will biomarkers increase predictably of which treatment strategies will be more effective for which patients, are there more biomarkers to be researched, what role will oncolytics play in the treatment of melanoma and what therapies will emerge in the neo-adjuvant and adjuvant setting. What is understood is that melanoma is not one disease but various diseases. And with so many variables existing when dealing with melanoma, the key will be to have a variety of treatment options to create the best possible patient outcomes.

Increasingly the notion of the right treatment for the right patient at the right time is being adopted, however an understanding of the biology of the tumour and its environment is necessary in order to put this into application. Immunotherapy is expected to work in 30% of the patient population- while there is not a clear understanding of why it works in some patients and not in others, it is clear that a better understanding of pathways and biomarkers are going to be an important area of research.

Targeted therapy will continue to have an important role to play in the treatment of metastatic melanoma and while targeted therapy activates an immediate response in a BRAF mutation population, sequencing is still not fully understood. When time is of the essence what will treatment will physicians use? 

Biomarkers are going to be critical for future success of melanoma therapeutics- will there be a way to make predictions based on these biomarkers rather than waiting for three years for clinical benefit or loss to emerge for clinical trials. Research increasingly suggests that tumour expression can be scored prior to treatment, including PD-L1, CD8 T cells, and markers of activation or inactivity in the tumour cell.  

BRAF inhibitor based therapies continue to be the most impactful by far. Currently all clinical evidence has been performed on the V600 mutation population which represents 45% of patients with advanced melanoma.  Another 5% of BRAF mutations exists and are not currently being studied.

Updated results from three randomized trials of the recently FDA approved combination of vemurafenib (Zelboraf) in combination with cobimetinib (Cotellic) substantially improving overall survival rate as well as progression free survival and response rate. Similar results are seen in the Dabrafenib (Tafinlar) combination with trametinib (Mekinist) which was approved by the FDA two years ago and based on two large randomized trials.  This data set is also allowing researchers to see longer term outcome data.

Factors affecting outcome include patient disease burden, serum LDH (which correlates with aggressiveness of the tumour).  Patients with high LDH levels can benefit from the treatment but unlikely to be long-term respondents.  Whereas patients with low disease burden are seeing great outcomes on this combination therapy.  These factors hold true for both targeted therapies and immunotherapies as well.

LDH has a predictive ability and a lot of work needs to be done for patients presenting with high HDL levels.

While BRAF inhibitors have significantly enhanced melanoma treatment an understanding of BRAF resistance mechanisms to devise treatment regimens that provide durable tumour control is still necessary. Scientists are attempting to learn the mechanisms of resistance from static biomarkers before deploying patients to therapy. An understanding of the baseline features of tumours and adaptations of tumours during therapy that make them resistant will determine which patients are likely to develop resistance and should receive more aggressive treatments.

Despite recent advances in the treatment of metastatic melanoma through targeted and immunotherapy, the majority of patients do not achieve a durable response. Research efforts to better understand responses are underway, and numerous molecular mechanisms of resistance to targeted therapy have been identified.

See What Dr. Reinhard Dummer, University of Zurich has to say here

Dr. Winson Cheung, BC Cancer Agency presents Highlights from SMR here

Participation at the Society for Melanoma Research Congress was provided by funding received from Novartis Canada.

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Professor Dr. Reinhard Dummer Shares Opinion on Successful Takeaways from the Society of Melanoma Research (SMR) 2015 Congress in San Francisco

Save Your Skin Foundation was in San Francisco last week for the Society of Melanoma Research’s (SMR) 2015 Congress. During the Congress, Save Your Skin Foundation met with leading oncologists from across the globe to discuss data coming out of SMR 2015 and what it means for patient care and treatment today.

During our discussions, Professor Dr. Reinhard Dummer shared his thoughts on the significant shift of focus on melanoma research. He explains that Melanoma has attracted the great brains of science today. We have achieved some improvements to patient care and this is in large part due to research results.

Melanoma research matters and the energy going into the first class work being done by researches will result in a better clinical outcome.

Professor Reinhard Dummer is Professor of the University of Zurich and Vice-Chairman of the Department of Dermatology in the University Hospital of Zürich, Switzerland and is a key thought leader in worldwide cutaneous oncology. Currently he is heading of the Skin Cancer Unit and the Clinical Trial Unit of the Department of Dermatology.

He is Board Certified in allergology, clinical immunology, dermatology and dermatopathology.

Professor Dummer’s principal research interests are molecular biology, immunology and immunotherapy of cutaneous malignancies, including cutaneous lymphomas and melanomas. He has published more than 550 papers with a cumulative impact factor of more than 4700. He has been President of the Melanoma Project Group of the Swiss Institute for Applied Cancer Research since 1999, is board member of the Society for Melanoma Research and past President of the International Society for Cutaneous Lymphomas. He is a founding and board member of the European Association of Dermato-Oncology (EADO), and past President of the European Society for Dermatological Research (ESDR).

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