Summary

In this episode of Melanoma Matters, James tells us about his path to oncology (thank you, Emma) via John Newsom-Davis, the Jeremy Bentham pub, and Hammersmith Hospital.

Later, hosts Sapna Patel and James Larkin discuss the COLUMBUS 7-year data of targeted therapy for metastatic melanoma - treatment efficacy, toxicity, and long-term patient management. They explore the nuances of treatment strategies, the importance of biomarkers, and the challenges of monitoring long-term patients on targeted therapies.

Takeaways

Time to next therapy is a valuable metric for assessing treatment success.

Long-term treatment decisions should consider patient quality of life.

Biomarkers are crucial for determining the duration of targeted therapy.

Compliance in clinical trials may not reflect real-world scenarios.

Monitoring for long-term toxicity is necessary for patients on extended therapy.

The combination of BRAF and MEK inhibitors may improve tolerability despite the COLUMBUS study showing a higher toxicity rate in the combination arm.

Congratulations to the European colleagues who led and executed this trial.

Keywords

BRAF MEK, targeted therapy, COLUMBUS study, melanoma, treatment efficacy, toxicity, long-term care, patient management

Titles

Exploring the COLUMBUS 7-Year Data

Oncology Journeys: Personal Stories and Insights

Sound Bites

"We need to know even the low-grade toxicities."

"There's nothing wrong with improving side effects."

"Kudos to our mainland European colleagues."

Chapters

00:00 Introduction

06:12 COLUMBUS 7-Year Overview

12:15 Historical context on study arms

17:55 Long-Term Treatment Considerations

21:29 Desperate... for a Biomarker

23:43 Any insights into development of CNS disease?

30:47 Fact Check for COLUMBUS 7-Year follow-up

32:50 Time to End of Next Line of Treatment in COLUMBUS (akin to PFS2)

35:32 Toxicity & Discontinuation Rate in COLUMBUS

Teaser: Find out Allison's favorite body part, had she been an orthopedic surgeon (and James' 2nd favorite.. from the movie Sleeper)

Summary

In this episode of Melanoma Matters, hosts Sapna Patel and James Larkin welcome Dr. Allison Betof-Warner, Director of the Advanced Melanoma Program at Stanford University. The conversation explores Dr. Betof-Warner's journey into oncology, her passion for CrossFit, and the significant role of exercise in cancer prevention and treatment. They discuss the emerging field of exercise oncology, the importance of strength training for cancer patients, and the latest advancements in cellular therapy for melanoma, particularly in patients with brain metastases. Hot take: physical activity is a vital component of cancer treatment.

Keywords

melanoma, oncology, exercise oncology, cancer prevention, cellular therapy, CrossFit, strength training, TIL therapy, patient care, health and wellness

Takeaways

Exercise is crucial throughout the cancer journey, from prevention to treatment.

The field of exercise oncology is growing, focusing on the benefits of physical activity for cancer patients.

Strength training is now recommended for cancer patients to maintain function and prevent cachexia.

Patients should be encouraged to engage in regular physical activity, even during treatment.

Research shows that exercise can improve tumor vascular structure and enhance chemotherapy delivery.

The safety of exercise during cancer treatment has been increasingly supported by research.

Cellular therapy is a promising area of research for melanoma, especially in patients with brain metastases.

Patient education regarding exercise during treatment is important.

A multidisciplinary approach to cancer care, including physical therapy, is essential for optimizing patient outcomes.

Titles

The Role of Exercise in Cancer Treatment

Cellular Therapy in Melanoma with Brain Metastasis

Sound Bites

"I shifted the direction of my research, did my PhD in cancer research."

"Exercise spans the cancer journey."

"Exercise helps prevent cancer cachexia."

Chapters

00:00 Introduction

03:24 Allison's Journey to Oncology and CrossFit

06:32 The Intersection of Exercise and Cancer

09:33 Exercise Oncology: Benefits and Guidelines

19:22 Safety and Efficacy of TIL Therapy for CNS disease

25:22 Patient Exercise During Cell Therapy

Summary

Gulf oysters and FATE get a shoutout in this episode of Melanoma Matters. Hosts James Larkin and Sapna Patel discuss the ADAPT-IT study, focusing on adaptive dosing strategies in immunotherapy for melanoma. They explore the study's design, results, and implications for clinical practice, including the potential for reduced dosing based on early response assessments.

Keywords

ADAPT-IT study, immunotherapy, melanoma, adaptive dosing, clinical efficacy, treatment response, toxicity management, cancer research

Takeaways

The ADAPT-IT study explores adaptive dosing in immunotherapy.

68% of patients showed favorable anti-tumor effects after two doses.

Early response assessments can guide treatment decisions.

The study suggests that two doses may be sufficient for some patients.

There is potential for one dose to be effective in certain cases.

Reimbursement policies may influence treatment strategies.

Correlative studies provide insights into treatment efficacy.

Management of toxicity is crucial in immunotherapy.

The conversation highlights the importance of clinical intuition.

Future research may refine dosing strategies further.

Sound Bites

"Is two cycles enough?"

"68% had a favorable anti-tumor effect."

"Could one dose be enough?"

Chapters

00:00 Introduction to the ADAPT-IT Study

04:12 FATE v non-FATE

06:03 Clinical Implications of Early Response Assessment

09:02 Results and Efficacy of the Study

11:50 Discussion

14:18 Exploring the Role of LDH in Treatment Decisions

17:32 Correlative Studies and Future Directions

20:14 Toxicity and Management Strategies

22:58 Correlatives (ctDNA)

30:54 Bit of good news about NADINA

Summary

In this episode of Melanoma Matters, hosts James Larkin and Sapna Patel engage with Bettina Ryll, founder of the Melanoma Patient Network Europe (MPNE). Bettina shares her personal journey from being a physician to becoming a patient advocate after her husband's battle with metastatic melanoma. The conversation explores the evolution of patient support networks, the challenges faced in healthcare systems, and complex adaptive systems. Bettina emphasizes the need for systemic change to improve patient access to treatments and highlights the importance of understanding the interconnectedness of healthcare, economics, and patient outcomes.

Keywords

melanoma, patient advocacy, healthcare systems, immunotherapy, patient networks, Bettina Ryll, MPNE, clinical trials, healthcare access, systemic change

Takeaways

Bettina Ryll founded MPNE after her husband's battle with melanoma.

Patient networks are crucial for sharing knowledge and support.

Understanding the healthcare system is key to advocating for patients.

Immunotherapy presents complex challenges that need addressing.

Systemic change is necessary for improving patient access to treatments.

The pharmaceutical landscape is influenced by economic factors.

Patients should not be treated as victims of their circumstances.

Action is often more effective than extensive planning.

Collaboration and community (and ferocious energy) are essential for driving change.

Sound Bites

"I just started explaining science."

"We are sentinels for issues."

"We must be standing for something."

Chapters

00:00 Introduction to Bettina Ryll

06:19 The Formation of Melanoma Patient Network Europe

11:51 Understanding Patient Needs and Systemic Issues

17:54 Challenges in Immunotherapy and Clinical Trials

23:47 Healthcare and Patient Access as Complex Adaptive Systems

29:25 The Role of Community and Collaboration in Change

SummaryIn this episode of Melanoma Matters, hosts James Larkin and Sapna Patel engage with Jedd Wolchok, a prominent figure in oncology, to discuss his journey into the field, the evolution of immunotherapy, particularly the Checkmate-067 trial, and the long-term outcomes for melanoma patients. The conversation highlights the importance of collaboration in clinical trials, the significance of understanding treatment decisions, and the future of melanoma treatment with a focus on biomarkers and patient follow-up. The discussion also reflects on the profound impact of Checkmate-067 on patient care and the oncology community.Keywordsmelanoma, immunotherapy, Checkmate-067, oncology, patient outcomes, long-term follow-up, biomarkers, cancer treatment, clinical trials, survivorshipTakeawaysJedd Wolchok's journey into oncology was influenced by family experiences with cancer.The Checkmate-067 trial was a pivotal moment in melanoma treatment.Collaboration among researchers is crucial for successful clinical trials.Long-term follow-up data from Checkmate-067 shows promising outcomes for patients.Understanding residual abnormalities in imaging is essential for treatment decisions.The need for biomarkers to assess immune system activation is critical.Patient follow-up strategies should be tailored to individual needs.The impact of Checkmate-067 extends beyond melanoma to other cancers.The evolution of immunotherapy has changed the landscape of cancer treatment.Mentorship and collaboration are key to advancing oncology research.TitlesReflections on a Career in OncologyThe Impact of Checkmate-067 on OncologySound Bites"This is something that we need to be doing.""We need to incorporate the symptomatic meaning.""Not every residual area of abnormality is cancer."Chapters00:00 Introduction to Melanoma Matters and Guest Background03:25 Journey into Oncology and Early Influences06:26 The Evolution of Immunotherapy: Checkmate-06709:14 The Significance of Phase One Trials12:25 Long-term Outcomes and Implications of Checkmate-06715:09 Understanding Treatment Responses and Patient Management18:06 The Future of Oncology: Biomarkers and Precision Medicine21:19 Survivorship and Patient Follow-up Strategies24:21 Reflections on the Impact of Checkmate-06727:24 Closing Thoughts and Acknowledgments

Summary

In this episode of Melanoma Matters, hosts James Larkin and Sapna Patel welcome Dr. Andreas Schmitt to discuss various aspects of melanoma treatment, including the importance of supplementary data in clinical trial reports, the implications of the TRICOTEL study, and the role of PD-L1 as a biomarker. The conversation highlights the significance of peer review and academic collaboration in oncology, as well as the impact of regulatory decisions on patient treatment options. The episode concludes with a discussion on the findings of the republished TRICOTEL study and the importance of inquiry in medical practice.

Keywords

melanoma, oncology, clinical trials, PD-L1, TRICOTEL study, symptomatic brain metastasis, supplementary data, peer review, academic collaboration, cancer treatment, biomarkers

Takeaways

The importance of looking at supplementary data in clinical trials is a recurring theme in this podcast.

The TRICOTEL study revealed significant findings regarding treatment for symptomatic brain metastasis, but there was controversy over the coding of these patients as symptomatic.

Peer review and academic collaboration are crucial in addressing discrepancies in clinical data.

PD-L1 expression may not be a reliable biomarker for treatment decisions in melanoma.

Regulatory decisions can impact patient access to effective treatments.

The objective response rate in the TRICOTEL republication was lower than in the initial (retracted) report.

Inquiring and questioning data is an essential feature of an intrepid (F)ellow.

Continuous reading and inquiry are vital for oncologists to stay informed.

Sound Bites

"Why I'm an oncologist?"

"Look at the supplementaries!"

"We redesigned the SWOG S2000 study after the TRICOTEL presentation to drop the asymptomatic cohort."

Chapters

00:00 Introduction and Lighthearted Banter

00:30 Meet the Guests: Andreas Schmitt

01:34 Always read the Supplemental Appendix!

06:31 The TRICOTEL Controversy Unveiled

10:43 Symptomatic Cohort in TRICOTEL

18:35 Peer Review in Publications

20:20 Republication of the TRICOTEL data

22:08 Editorial(s) on PD-L1 as a Biomarker

32:38 Concluding Thoughts on PD-L1

Summary

*Warning* with apologies! There is a change in sound at 11:11 mark that might necessitate a lower volume output.

Hosts James Larkin has a beef with the first word of the cemiplimab + fianlimab JCO publication. He's living vicariously through Sapna's snowboarding plans for the season (if the record high temps ever stop). They continue to struggle with Farenheit to Centrigrade conversion.

In this episode of Melanoma Matters, James and Sapna discuss the recent publication on cemiplimab and fianlimab, focusing on their efficacy in various patient cohorts, particularly those who are PD-1 naive. They discuss if all LAG-3 antibodies are created equal, and one host is busted for not reading the Supplementary Appendix to the publication.

Keywords

melanoma, cemiplimab, fianlimab, LAG-3, PD-1, cancer therapy, clinical trials, efficacy, adverse events, immunotherapy

Takeaways

• Objective response rates are promising in various cohorts.
• Semiplimab and Thiamlimab show efficacy in PD-1 naive patients.
• The study highlights the need for larger randomized trials.
• Comparative efficacy of LAG-3 therapies remains to be seen.
• Adverse events like infusion reactions are noteworthy.
• The conversation emphasizes the importance of ongoing research.
• Understanding patient selection criteria is crucial for interpreting results.
• The hosts discuss the implications of the findings for future treatments.
• There is excitement about the potential of these new therapies.
• The episode underscores the evolving landscape of melanoma treatment.
• ALWAYS READ THE SUPPLEMENTARY APPENDIX

Titles

Understanding LAG-3 Therapies in Melanoma

The Promise of LAG-3 in Advanced Melanoma

Sound Bites

"Objective response rate in all these cohorts looks good"

"This is a paper about a novel (anti) LAG- 3 + PD-1 combination"

"The objective response rate is topping 50%"

Chapters

00:00 Introduction

04:56 Discussion on Cemiplimab and Fianlimab

07:48 Exploring Phase One Trial Data

10:56 Comparative Analysis of LAG-3 Therapies

11:11 *Warning* Volume / Sound Change

14:16 Understanding Patient Cohorts and Response Rates

16:50 Comparative Analysis of Treatment Options

20:10 Safety and Adverse Effects of New Combinations

23:11 Future Trials with This Combination

Summary

Left siding, Starfishing, and Superstitions! We make a hidden shoutout to Owen and a subtle callout to Zayd ... if you're listening

In this episode of Melanoma Matters, hosts Sapna Patel and James Larkin delve into the Keynote 006 study, exploring its implications for melanoma treatment, long-term follow-up, and patient outcomes. The conversation highlights the importance of understanding CR versus PR in treatment and the need for better data collection on re-treatment. The episode concludes with reflections on the challenges of conducting such extensive research and the importance of collaboration in the field.

Keywords

melanoma, immunotherapy, pembrolizumab, Keynote 006, patient outcomes, superstitions, sleep habits, treatment duration, toxicity, CR vs PR, PFS vs TTP

Takeaways

• The Keynote 006 study provides valuable data on melanoma treatment.
• Long-term follow-up is crucial for understanding treatment efficacy.
• Re-treatment with pembrolizumab can be beneficial for certain patients.
• Understanding the difference between CR and PR is essential in treatment discussions.
• Toxicity profiles of treatments need to be monitored over time.
• Time to progression is a more relevant metric than PFS in some cases.
• Collaboration among researchers is vital for advancing melanoma treatment.

Sound Bites

"It's better to have a CR than have a PR."

"We need to stop doing PFS in long-term follow-ups."

"Patients are dying of other causes, not melanoma."

Chapters

00:00 Introduction and Greetings

03:25 Left side and Starfish

06:43 Superstitions and Their Impact on Behavior

09:35 Keynote 006 Study Overview

12:26 Long-term Follow-up and Treatment Insights

15:38 Re-treatment and Patient Outcomes

18:24 CR vs PR and Treatment Duration

25:07 Final Thoughts and Acknowledgments

28:21 Call to fellows (hearing us, Zayd?)

36:14 PFS v. TTP

Summary

More stories about medical emergencies! In this conversation, James Larkin and Sapna Patel discuss the complexities of tumor dynamics in patients treated with pembrolizumab beyond disease progression. They share personal anecdotes about medical emergencies on flights, which lead into a deeper exploration of treatment strategies and clinical trial methodologies. The discussion emphasizes the importance of understanding patient responses to treatment, the limitations of traditional assessment tools like RESIST, and the need for careful consideration in trial designs to avoid premature conclusions about new therapies.

Keywords

tumor dynamics, pembrolizumab, treatment beyond progression, medical emergencies, clinical trials, cancer treatment, immunotherapy, patient care, melanoma, PD-1

Takeaways

Treatment beyond progression can yield clinical benefits.

RECIST criteria may not accurately reflect patient responses to immunotherapy.

Understanding disease trajectory is crucial in treatment decisions.

Clinical trials must be designed to account for patient variability.

The importance of patient monitoring during treatment is emphasized.

AI could revolutionize tumor assessment in clinical practice.

Caution is advised when interpreting early trial results.

Stepwise progression in trial design can save resources.

Titles

Innovations in Tumor Assessment

Cautionary Tales in Cancer Research

Chapters

00:00 Medical Emergencies on Flights

10:46 Treatment Beyond Progression in Cancer

16:49 Clinical Trials and Patient Outcomes

26:47 Cautionary Tales in Cancer Treatment

Summary

In this episode of Melanoma Matters, Sapna and James discuss the importance of looking at Figure 1. They talk about in-flight medical emergencies, and James recalls a scene of carnage ... "blood everywhere."

They delve into the complexities of mucosal melanoma, discussing its unique characteristics, treatment options, and the latest research findings. They share personal anecdotes from their medical experiences, emphasizing the importance of understanding the nuances of this melanoma subtype. The conversation covers the efficacy of checkpoint inhibitors, the significance of various studies, and considerations for adjuvant and neoadjuvant therapies. The hosts also highlight the need for tailored approaches in treating mucosal melanoma patients, given the disease's heterogeneity and geographical variations.

Keywords

Mucosal Melanoma, Checkpoint Inhibitors, Adjuvant Therapy, Neoadjuvant Therapy, Oncology, Cancer Treatment, Medical Stories, Clinical Trials, Patient Care, Melanoma Research

Takeaways

Mucosal melanoma is a unique subtype that requires specific attention.

Checkpoint inhibitors have shown efficacy in treating mucosal melanoma.

Understanding geographical variations is crucial in melanoma treatment.

Clinical trials often exclude mucosal melanoma patients, impacting data.

Adjuvant therapy may be beneficial but is not universally applicable.

Neoadjuvant therapy could be a reasonable option for certain patients.

Response rates vary significantly based on the anatomical site of the melanoma.

Patient performance status plays a critical role in treatment decisions.

The importance of thorough data collection in clinical trials cannot be overstated.

Personal anecdotes from physicians highlight the unpredictable nature of medical emergencies.

Titles

Emergency Medical Stories: A Doctor's Perspective

Comparative Studies in Mucosal Melanoma Treatment

Sound Bites

"I think we actually missed this figure."

"Always look at Figure 1."

Chapters

00:00 Introduction to Mucosal Melanoma

05:21 Anecdotes from the Medical Field

08:19 Understanding Mucosal Melanoma

14:25 Sapna and James look at Figure 1

20:21 Comparative Analysis of Studies

26:30 Adjuvant and Neoadjuvant Therapies for Mucosal Melanoma