Ipilimumab Goes the Distance in Melanoma Survival

Antoni Ribas, MD, PhD; Caroline Robert, MD, PhD


October 08, 2013

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Antoni Ribas, MD, PhD: Hello. I am Antoni Ribas, Professor of Medicine at the David Geffen School of Medicine at the University of California Los Angeles. Welcome to this edition of Medscape Oncology Insights on melanoma, coming to you from the 2013 European Cancer Conference in Amsterdam. I am joined by Dr. Caroline Robert, Chief of the Department of Dermatology at the Institut Gustave Roussy in France. Welcome, Caroline.

Yesterday, you presented how the paradigms are changing in melanoma.[1] There is a lot of activity. We have BRAF inhibitors, the BRAF plus MEK combinations, ipilimumab, PD-1, and PD-L1 antibodies. We have heard important updates at this meeting. Let's start with the long-term updates on ipilimumab. How is that adding to what we know?

Extended Survival With Ipilimumab

Caroline Robert, MD, PhD: We have new weapons. We have come very far, and now we have drugs that we can use and are available, and we will have combination treatments that are going to be even better. Very often our treatments are associated with adverse events that can be used in some cases for the benefit of the patient or that can counteract. You showed that the paradoxical effect of BRAF activators can be deleterious on the skin because we know they can cause tumors,[2] but they can have good effects on the lymphocytes,[3] and this is particularly important when we think about combining these approaches.

Returning to the new results with ipilimumab, we were happy to see that plateau with the ipilimumab. We would like to have more patients responding, but we are happy to see that when patients survive at 3 years, the odds are that they are still going to survive at 5 years. We heard from Stephen Hodi[4] in the late-breaking abstract telling us that when you pool together all the studies -- it is more than 1800 patients, and then when you add the expanded-access program, it is more than 4000 patients -- we still see this plateau, so it is a good thing.

Dr. Ribas: You and I have talked many times about this hallmark of immunotherapy -- that when you have a good immune response to the cancer, that can be extremely durable. And now we are seeing that play out with ipilimumab, which is great information.

You also talked about the combination of BRAF and MEK inhibitors. Can you tell us a little bit about the biology of that and how it is improving on what we have with BRAF inhibitors alone?


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