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Evolving impact of long-term survival results on metastatic melanoma treatment

Melanoma treatment has been revolutionized over the past decade. Long-term results with immuno-oncology (I-O) agents and targeted therapies are providing evidence of durable survival for a substantial number of patients. These results have prompted consideration of how best to define long-term benef...

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Autores principales: Michielin, Olivier, Atkins, Michael B, Koon, Henry B, Dummer, Reinhard, Ascierto, Paolo Antonio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549477/
https://www.ncbi.nlm.nih.gov/pubmed/33037115
http://dx.doi.org/10.1136/jitc-2020-000948
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author Michielin, Olivier
Atkins, Michael B
Koon, Henry B
Dummer, Reinhard
Ascierto, Paolo Antonio
author_facet Michielin, Olivier
Atkins, Michael B
Koon, Henry B
Dummer, Reinhard
Ascierto, Paolo Antonio
author_sort Michielin, Olivier
collection PubMed
description Melanoma treatment has been revolutionized over the past decade. Long-term results with immuno-oncology (I-O) agents and targeted therapies are providing evidence of durable survival for a substantial number of patients. These results have prompted consideration of how best to define long-term benefit and cure. Now more than ever, oncologists should be aware of the long-term outcomes demonstrated with these newer agents and their relevance to treatment decision-making. As the first tumor type for which I-O agents were approved, melanoma has served as a model for other diseases. Accordingly, discussions regarding the value and impact of long-term survival data in patients with melanoma may be relevant in the future to other tumor types. Current findings indicate that, depending on the treatment, over 50% of patients with melanoma may gain durable survival benefit. The best survival outcomes are generally observed in patients with favorable prognostic factors, particularly normal baseline lactate dehydrogenase and/or a low volume of disease. Survival curves from melanoma clinical studies show a plateau at 3 to 4 years, suggesting that patients who are alive at the 3-year landmark (especially in cases in which treatment had been stopped) will likely experience prolonged cancer remission. Quality-of-life and mixture-cure modeling data, as well as metrics such as treatment-free survival, are helping to define the value of this long-term survival. In this review, we describe the current treatment landscape for melanoma and discuss the long-term survival data with immunotherapies and targeted therapies, discussing how to best evaluate the value of long-term survival. We propose that some patients might be considered functionally cured if they have responded to treatment and remained treatment-free for at least 2 years without disease progression. Finally, we consider that, while there have been major advances in the treatment of melanoma in the past decade, there remains a need to improve outcomes for the patients with melanoma who do not experience durable survival.
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spelling pubmed-75494772020-10-19 Evolving impact of long-term survival results on metastatic melanoma treatment Michielin, Olivier Atkins, Michael B Koon, Henry B Dummer, Reinhard Ascierto, Paolo Antonio J Immunother Cancer Review Melanoma treatment has been revolutionized over the past decade. Long-term results with immuno-oncology (I-O) agents and targeted therapies are providing evidence of durable survival for a substantial number of patients. These results have prompted consideration of how best to define long-term benefit and cure. Now more than ever, oncologists should be aware of the long-term outcomes demonstrated with these newer agents and their relevance to treatment decision-making. As the first tumor type for which I-O agents were approved, melanoma has served as a model for other diseases. Accordingly, discussions regarding the value and impact of long-term survival data in patients with melanoma may be relevant in the future to other tumor types. Current findings indicate that, depending on the treatment, over 50% of patients with melanoma may gain durable survival benefit. The best survival outcomes are generally observed in patients with favorable prognostic factors, particularly normal baseline lactate dehydrogenase and/or a low volume of disease. Survival curves from melanoma clinical studies show a plateau at 3 to 4 years, suggesting that patients who are alive at the 3-year landmark (especially in cases in which treatment had been stopped) will likely experience prolonged cancer remission. Quality-of-life and mixture-cure modeling data, as well as metrics such as treatment-free survival, are helping to define the value of this long-term survival. In this review, we describe the current treatment landscape for melanoma and discuss the long-term survival data with immunotherapies and targeted therapies, discussing how to best evaluate the value of long-term survival. We propose that some patients might be considered functionally cured if they have responded to treatment and remained treatment-free for at least 2 years without disease progression. Finally, we consider that, while there have been major advances in the treatment of melanoma in the past decade, there remains a need to improve outcomes for the patients with melanoma who do not experience durable survival. BMJ Publishing Group 2020-10-09 /pmc/articles/PMC7549477/ /pubmed/33037115 http://dx.doi.org/10.1136/jitc-2020-000948 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Review
Michielin, Olivier
Atkins, Michael B
Koon, Henry B
Dummer, Reinhard
Ascierto, Paolo Antonio
Evolving impact of long-term survival results on metastatic melanoma treatment
title Evolving impact of long-term survival results on metastatic melanoma treatment
title_full Evolving impact of long-term survival results on metastatic melanoma treatment
title_fullStr Evolving impact of long-term survival results on metastatic melanoma treatment
title_full_unstemmed Evolving impact of long-term survival results on metastatic melanoma treatment
title_short Evolving impact of long-term survival results on metastatic melanoma treatment
title_sort evolving impact of long-term survival results on metastatic melanoma treatment
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549477/
https://www.ncbi.nlm.nih.gov/pubmed/33037115
http://dx.doi.org/10.1136/jitc-2020-000948
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