So far, 2024 has proven to be another year full of advancements in the treatment of melanoma. It’s not so much that we have had many new treatments fill our war chest in this fight, but it is much more to do with how we use the existing treatment therapies and the sequencing of these drug therapies. I would be remiss if I didn’t extend our heart felt appreciation to our oncologists across this country that have been instrumental in getting new avenues open to use our immunotherapies earlier in the treatment sequencing. To give you an idea of the change that has occurred, we have to look at the use of three of our most common immunotherapies – nivolumab (Opdivo), ipilimumab (Yervoy), and pembrolizumab (Keytruda).
Neoadjuvant Use of Drug Therapies: These immunotherapies are most often used in patients with advanced or metastatic disease – stage III & IV, and are provided after surgery, when surgery is possible. We all know how often there are or have been delays in surgery, even more so throughout the pandemic, and still hospitals are playing catch up.
Research over the last few years has shown that starting neoadjuvant treatment (meaning the drug therapy is started for a few rounds before surgery) with nivolumab (Opdivo), or pembrolizumab (Keytruda) may help to not only shrink tumours sooner, perhaps reducing the amount of surgery and in some cases the need for it, but also helps prevent recurrence of disease or further spread in some cases. This is a small but incredibly important advancement in treatment for patients. It not only can reduce burden of disease and prevent recurrence or spread but also helps reduce the anxiety and stress on patients having to wait so long for treatment. Pembrolizumab (Keytruda) has been approved for neoadjuvant use in treatment of adult patients with stage III or stage IV melanoma, and we have just submitted documentation in support of the use of nivolumab (Opdivo) and ipilimumab (Yervoy) for the same indication for stage III melanoma. We are hopeful that this change will be approved as soon as possible. Our doctors led the charge on this important improvement and Melanoma Canada provided input in support of this change with help from our patient and caregiver community.
Ipilimumab + Nivolumab -1st line unresectable melanoma for patients with metastatic melanoma that have progression of disease within 6 months of adjuvant therapy: This is another physician-led improvement that allows for use of the combination therapy if there is progression of disease within 6 months of adjuvant therapy. Prior to this option, patients would have run out of options for treatment when there still may be time to defeat this disease. It is an important addition to the treatment pathway for patients at a critical juncture.
New Drug Access:
Nivolumab Monotherapy – Stage IIB & IIC: This is an improvement that opens access to nivolumab for stage IIB and IIC patients after surgery. This is an important change as this group of patients that have a significant likelihood of recurrence of disease now have access and an option for treatment. Again, an important life saving improvement for patients.
Nivolumab + Relatlimab (Opdualag): For the treatment of unresectable or metastatic melanoma who either have not received prior systemic therapy or for patients who had prior adjuvant or neoadjuvant therapy if the therapy was completed at least 6 months before the date of recurrence. Relatlimab is a new immunotherapy used in combination with nivolumab and will provide another option for use that tends to have less side effects than nivolumab (Opdivo) and ipilimumab (Yervoy) used together. We welcome this advancement for our patient community. This therapy is pending provincial price negotiations, but we are hoping this will be available shortly.
New Quality Indicators for Ontario: In the last year, I had the pleasure to participate in the first process to identify and select melanoma quality indicators for reporting in Ontario. Using a very disciplined process, provincial and international panelists with clinical expertise in melanoma collaborated to select and prioritize 10 quality and outcome indicators to support the development of the Cancer System Quality Index (CSQI) report. Perspectives and input from a broad range of stakeholders, including patient experiences, were taken into consideration throughout the process.
Overall, this process resulted in the selection of ten quality and outcome indicators for melanoma for provincial cancer system reporting. This will aid all of us as we try to improve timely access to treatment and look to improve outcomes as well for all patients using standardized measures. I am looking forward to seeing the impact of this work in the very near future.
As always, please check with your physician for your treatment options. Options may vary by province and provincial funding. If you have any questions, do not hesitate to reach out to Melanoma Canada through support@melanomacanada.ca. I want to extend a big thank-you to all that have participated in our numerous surveys – I know at times it must seem like an endless ask for your opinions and feedback but let me tell you that it has a made a definite impact on our patient community’s access to improved treatment for melanoma in Canada.
Stay vigilant! Check your skin. Share your knowledge with others and help support Melanoma Canada – we make a difference together,
Annette Cyr, Founder and Honorary Chair.
