Dermatologists weigh in on emerging therapies for metastatic melanoma

Key Points

Today, there seems to be a renewed flourish of interest. The National Cancer Institute lists 100 clinical trials for melanoma vaccines and immunotherapy treatments. Some of the medications, such as an oncolytic vaccine therapy, granulocyte colony-stimulating factor (GM-CSF)-encoding oncolytic herpes simplex virus (OncoVEX^GM-CSF, BioVex), have reached stage 3 clinical trials, while others, such as ipilimumab (Bristol-Myers Squibb), have been fast-tracked by the Food and Drug Administration (FDA).

On Call wondered how dermatologists view this flurry of activity around melanoma therapies. We asked whether they are waiting with bated breath, or if are they taking a more measured approach to the new treatment options.

Cautious optimism

Given that there were headlines 20 years ago touting research breakthroughs on melanoma vaccines, Scott G. Green, M.D., in Fort Dodge, Iowa, says he's cautiously excited about the promising reports coming out, but with one big caveat.

"We've been down this road before where we've had high hopes about a melanoma drug, and it hasn't met our expectations. That's where I am right now. I'm not convinced that we have any good drugs that will do us any good in the long-term for melanoma," he says.

In practice for 22 years, Dr. Green voices the concerns of most of the dermatologists who spoke to On Call in the strongest terms.

"We need to pursue these options, and we still need hope, but, again, we've been down this road before and I'm worried we'll be right back where we started. I hope I'm wrong, but I don't think we're going to be using them in the next five years," Dr. Green says.

Unanswered questions

Robert A. Guardiano, M.D., a practitioner for six years at Dartmouth-Hitchcock Clinic in Keene, N.H., says that even if the therapies are being fast-tracked, a lot of questions remain unanswered.

"Any day we can figure out the different mechanisms that cause different cancers and try to target those areas and treatment, we're definitely making improvements toward the future," he says. "These therapies have shown promise, but I don't think anything has been proven yet, from the studies I've seen.

"We have to keep our options open and look at the different cellular mechanisms and how we can partner those to improve treatment and survival of melanoma. Right now, the treatment is obviously surgical. You're really talking more about metastatic melanoma when looking at these therapies, and that's very difficult to treat. Once patients show higher cure rates and survival rates, these medical therapies will definitely become part of our everyday arsenal against melanoma," Dr. Guardiano says.