Educated Patient® Skin Cancer Summit Basics of Immunotherapy Presentation: June 18, 2022

Since the first checkpoint inhibitor was approved to treat melanoma in 2011, this type of immunotherapy has radically changed the lifespan of patients with metastatic melanoma, according to Dr. Jedd Wolchok.

Wolchok, chief of immuno-oncology service, HOPP, and director of the Parker Institute for Cancer Immunotherapy at Memorial Sloan Kettering Cancer Center, in New York City, recently discussed immunotherapy’s impact on melanoma at the CURE® Educated Patient® Skin Cancer summit.

The first checkpoint inhibitor approved by the Food and Drug Administration (FDA) in the space was Yervoy (ipilimumab) in 2011. Then, other drugs like Opdivo (nivolumab) and Keytruda (pembrolizumab) followed suit and were approved for advanced melanoma.

These drugs work by inhibiting certain proteins that help shield cancer cells from the immune system.

“In some cancers, like melanoma and squamous cell cancer… the immune system is poised and ready to respond,” Wolchok said in an interview with CURE. “All it needs is a little bit of a push.”

That push has led to drastically improved outcomes for patients with the disease.

“Between 2011 and 2021, we’ve seen the median life expectance of someone with metastatic melanoma go from seven months to just over six years,” Wolchok explained. “That doesn’t mean our work is over. We still have many people who need treatments, and, importantly, we also need to balance better risk with benefit.”

Immunotherapy Side Effects

However, while checkpoint inhibitors are helping patients live longer, they do come with their own set of risks that patients and clinicians must discuss before deciding on a care plan. Notably, since these agents activate the immune system, patients can experience inflammation in any organ system, from the gastrointestinal tract (which can present as diarrhea) to the skin (which will usually appear in the form of a rash).

When immunotherapy causes damage to the endocrine orangs within the body — such as the thyroid, pituitary or the pancreas — patients may need to undergo hormone replacement therapy, according to Wolchok.

When it comes to reporting side effects, Wolchok urged patients not to make the distinction themselves over whether a side effect is serious; maintaining open lines of communication with the care team is critical.

“Our goal is to have (side effects) never become an emergency,” Wolchok said. “I personally think that the better and the more frequent the communication is between the patient, their family and their care team, the less severe the toxicities are to manage.”

When Is Immunotherapy Use Appropriate?

For patients with metastatic disease that has spread to other organs, there’s a clear case for immunotherapy use, according to Wolchok. However, though the FDA has approved checkpoint inhibitors for use in resected, stage 2 and stage 3 melanoma, the lines of best practice are a bit fuzzier here.

“There's a fundamental difference in those populations compared to the people with metastatic disease, the stage 2 and stage 3 patients, some of them have already been cured by virtue of surgery alone,” Wolchok said. “And we're exposing them to the possibility of having a side effect when they wouldn't need the treatment to begin with.”

Wolchok explained that there are new types of blood tests that are being studied that may be able to tell if a person has traces of disease in their blood after they have undergone surgery. Something like this can help decide if a patient would benefit from immunotherapy or not, though these tests are still being developed and are not yet available.

Whatever decision patients make, they should know that they are living in an era where there are more therapies available than ever before — “a time of great hope,” as Wolchok said.

“We've accomplished a lot using immunotherapy to treat skin cancers, but we still have a ways to go. For those who are interested in participating, clinical research is an important part of how we get there.”

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