Lynn M. Schuchter, MD, Chief, Hematology Oncology, Department of Medicine, University of Pennsylvania, describes two trials presented at the 2013 ASCO Meeting looking at nivolumab in patients with melanoma.

Updated phase I data showed a 31% response rate in patients with melanoma treated with nivolumab. These responses were sustained, Schuchter says, with almost half of the patients still alive at two years.

Even more exciting was the data on nivolumab in combination with ipilimumab. The combination of two targeted therapies both aimed at the CTLA-4 pathway showed a response rate as high as 70% with manageable toxicity.

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Lynn M. Schuchter, MD, from the University of Pennsylvania, describes two trials presented at the 2013 ASCO Meeting looking at nivolumab in patients with melanoma.

Dr. Schuchter Discusses Nivolumab in Melanoma

Lynn M. Schuchter, MD, Chief, Hematology Oncology, Department of Medicine, University of Pennsylvania, discusses the treatment of advanced melanoma.

Schuchter notes that it is important to determine the BRAF status of every patient with advanced melanoma. If a patient has a large disease burden, a physician should start treatment with targeted therapy to achieve a fast response. Conversely, if a patient is not in need of immediate treatment, immunotherapy should be considered.

Schuchter says that it is truly remarkable that chemotherapy is no longer considered in the first or second line. Data presented at this year's ASCO meeting enhances the knowledge of the impact of new immunotherapies.

Dr. Schuchter Discusses the Treatment of Melanoma

Lynn M. Schuchter, MD, division chief of hematology-oncology at the Abramson Cancer Center at the University of Pennsylvania in Philadelphia describes how treatment in melanoma has advanced over the past 25 years, starting with the first drugs approved for the disease and advancing into the modern era.

Dr. Lynn M. Schuchter from Penn Medicine on the Progression of Melanoma Care over the past 25 years

Dr. Schuchter on the Progression of Melanoma Care

Lynn M. Schuchter, MD, division chief of hematology-oncology at the Abramson Cancer Center at the University of Pennsylvania in Philadelphia discusses managing the ipilimumab (Yervoy) side effects. She specifically mentions the risk management evaluation and mitigation strategy (REMS) program that the FDA required as part of its approval and what can be done above the REMS program.

Dr. Schuchter says specific education was given to patients and physicians, a clear history was taken at the beginning to understand the symptoms patients had, and the patients were monitored closely. She adds that it requires good communication between the patient, physician, and nurse practitioner. In delivering this care, it's important to understand the side effects, when to stop and when to intervene with steroids.

Dr. Lynn Schuchter from Penn Medicine Discusses Managing Ipilimumab's (Yervoy) Side Effects with the REMS program

Dr. Schuchter on Managing Ipilimumab's Side Effects

Lynn M. Schuchter, MD, division chief of hematology-oncology at the Abramson Cancer Center at the University of Pennsylvania in Philadelphia on the next steps in melanoma research which include combination of targeted therapies, combination with immunotherapies, and developing therapies for earlier stages of melanoma.

Dr. Lynn M. Schuchter from Penn Med on the Next Steps in Melanoma Research

Dr. Schuchter on the Next Steps in Melanoma Research

Lynn M. Schuchter, MD, division chief of hematology-oncology at the Abramson Cancer Center at the University of Pennsylvania in Philadelphia describes why she reserves BRAF testing for only advanced melanoma. She describes her concerns over the limited tumor sample size and explains that routine testing would consume too much of the sample to be viable given the limited benefit but that it is very important in late stage cancer.

Dr. Schuchter says there may be a small amount of tumor material from the original primary tumor on the skin, and the amount of tumor can be small. Unless there is a clinical reason to know the information, she says she does not do routine testing because other genes will be identified and if all the tumor block is spent and all the DNA is spent, then the testing is not able to be done. Dr. Schuchter says she tests every patient with stage IV melanoma to see if the patient has the mutated gene.

Dr. Lynn Schuchter chief of Hematology Oncology at Penn Medicine Reserves BRAF Testing for Advanced Melanoma

Dr. Schuchter Limits BRAF Testing to Advanced Melanoma

Lynn M. Schuchter, MD, division chief of hematology-oncology at the Abramson Cancer Center at the University of Pennsylvania in Philadelphia provides information for community oncologists about BRAF mutation testing in melanoma.

Dr. Schuchter says that community oncologists have a good understanding of mutations that occur in cancer and have information about melanoma as a new potential area to think about targeted therapies. She says they need information about finding out if a patient has a mutated BRAF gene. There needs to be close communication with the pathologist and the medical oncologist about collecting the right tumor specimen to be able to submit it for testing. The company is planning a diagnostic test so that a physician can collect a patient's block, send it to the company for testing and determine if a patient has a BRAF inhibitor.

Dr. Schuchter chief of Hematology Oncology at Penn Medicine on Testing for a BRAF Mutation in Melanoma

Lynn M. Schuchter, MD

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