Tara C. Mitchell, MD, assistant professor of Medicine, Perelman School of Medicine at the Hospital of the University of Pennsylvania, discusses new combination regimens for patients with melanoma.

The combination of the oncolytic immunotherapy talimogene laherparepvec (T-VEC) combined with pembrolizumab (Keytruda) was shown to be safe and effective in a small phase I study, Gangadhar explains. It is now accruing patients with advanced melanoma in a randomized phase III study.

IDO inhibition with the oral inhibitor epacadostat in combination with pembrolizumab also showed excellent efficacy in a small early-phase study of melanoma with no evidence of added toxicity, Gangadhar adds.

Combining immunotherapy with a targeted therapy, such as with a PD-L1 blockade with atezolizumab (Tecentriq) with vemurafenib (Zelboraf) and cobimetinib (Cotellic), have preliminary results of safety and efficacy.

Videos

Dr. Gangadhar on Combination Regimens for Melanoma

Tara C. Mitchell, MD, assistant professor of Medicine, Perelman School of Medicine at the Hospital of the University of Pennsylvania, discusses atypical responses with immunotherapies in melanoma.

Compared to cytotoxic chemotherapy, responses can sometime be delayed with immunotherapy agents, says Mitchell.

On the first response assessment after immunotherapy, the tumor may appear larger or the same size as it was before treatment. This may be because the immunotherapy can take a longer time to work, or it could be due to immunotherapy-related inflammation in the tumor. This type of inflammation can sometimes look radiographically like a larger tumor, but a subsequent response assessment will reveal good tumor shrinkage and response, says Mitchell.

Tara C. Mitchell, MD, assistant professor of Medicine at the Hospital of the University of Pennsylvania, Perelman School of Medicine, discusses atypical responses with immunotherapies in melanoma.

Dr. Tara C. Gangadhar on Atypical Responses with Immunotherapies in Melanoma

Tara C. Mitchell, MD, Assistant Professor of Medicine at the Hospital of the University of Pennsylvania, discuses preliminary results from a phase I/11 study of epacadostat in combination with pembrolizumab.  

Epacadostat, an IDO inhibitor, and pembrolizumab, a PD-1 blockade, were tested in combination in patients with various advanced cancers to evaluate the safety of the drugs together.  

To date, 56 patients with advanced cancers have been treated with the combination, including 20 patients with melanoma.  

The combination of epacadostat and pembrolizumab was shown to be exceptionally well tolerated, says MItchell, with no treatment-related deaths or grade IV toxicity. Only six patients had grade III toxicities. The early data regarding efficacy was also promising, with a response rate of 53% in patients with melanoma, says Mitchell.  

Tara C. Mitchell, MD, Assistant Professor of Medicine at the Hospital of the University of Pennsylvania, discuses preliminary results from a phase I/11 study of epacadostat in combination with pembrolizumab.

Tara C. Mitchell, MD

Articles

Dr. Gangadhar on Combination Regimens for Melanoma

Dr. Tara C. Gangadhar on Atypical Responses with Immunotherapies in Melanoma

Dr. Tara Gangadhar on Epacadostat/ Pembrolizumab Combination