EADO 2017

Dr Testorri speaks with ecancer at EADO 2017 about preserving patient quality of life with loco-regional control of disease. He highlights the considerations of how best relieve patients of disease burden without unnecessary damage to healthy tissue, especially when lesions and scars would be highly visible. Dr Testorri reports successes with combining immune therapies with surgical interventions, and describes how electrochemotherapy can improve cytotoxic uptake into cancer cells.

Dr Testorri speaks with ecancer at EADO 2017 about using electrochemotherapy to improve cytotoxic uptake and promote tumour cell death. He describes how electro-stimulation around tumours results in greater uptake of bleomycin, as standard, enabling local treatment of skin cancers without the need for possibly destructive surgery.

Will Davies reports on EADO 2017, giving a few highlights from attending speakers.

Prof Hoeller speaks with ecancer at EADO 2017 about the timing of combination therapies using PD-1 and CTLA-4 targeted therapies to treat melanoma. While these targets have been subject to a great deal of investigation independently, Prof Hoeller notes that there is no trial assessing the two in a direct comparison for upfront combination, or one after the other. He considers the patient subgroups which may benefit most from these differing approaches, based on tumour infiltration and LDH levels, and weighs how toxicity may be managed. Prof Hoeller also considers how best to assess patient responses to targeted therapies, based on expression of molecular markers including circulating tumour DNA.

Dr Mohr speaks with ecancer at EADO 2017 about the suitability of chemotherapy for brain metastases of skin cancer. He notes ongoing research into combining chemotherapy with immunotherapy, and in the adjuvant setting, but ultimately chemotherapeutics offer no survival benefit. This does mean that patients with brain metastases may be more readily considered eligible for trials of new agents, but Dr Mohr cautions against any further use of chemotherapy beyond last-line and salvage efforts.

Prof Agarwala speaks with ecancer at EADO 2017 about intralesional therapies, including oncolytic talimogene laherparepvec (T-VEC), to treat melanoma. He highlights the complementary roles of intralesional therapies with systemic therapies including immunotherapeutics, and that local injections can 'warm up' tumours, increasing immune penetration. Prof Agarwala highlights upcoming trials in combination with pembrolizumab and ipilimumab, and his view of future combination or sequencing of combined treatments.

Dr Nghiem speaks with ecancer at EADO 2017 about recent updates in treatment options for Merkel cell carcinoma. He considers response rates to immunotherapy and ongoing biomarker surveillance as guidance for combination therapy.

Dr Lianidou speaks with ecancer at EADO 2017 about the clinical utility of melanoma patient blood samples to gain insight into disease progression and genotype. She describes how serial blood draws can be used to gain up-to-date insight into tumour biology, disease evolution over time, and the significance of determining new and known therapeutic targets. Dr Lianidou highlights the significance of quality control throughout the acquisition and analysis of patient samples, and introduces the Cancer-ID initiative.

Prof Hayward speaks with ecancer at EADO 2017 about genomic sequencing of families with a history of melanoma to determine high-risk genes. He notes candidates among DNA repair pathways which have been cut short, and which targeted therapies may offer clinical benefit for these, and other, mutations.

Prof Grob speaks with ecancer at EADO 2017 about successes with combined immunotherapy and radiotherapy to treat metastatic melanoma. By treating brain metastases with upfront Gammaknife radiosurgery followed by systemic therapy, he reports disease control beyond that achieved with targeted therapy along. While there is no long-term survival or toxicity data matured so far, Prof Grob notes that the gains in overall survival are still significant and offer patients improved short-term survival.

Dr Blank speaks with ecancer at EADO 2017 about targeting immune checkpoints in melanoma patients with anti-PD1 and anti-CTLA-4 drugs. Dr Blank describes how immune therapy is better suited to certain patient subtypes, and that combined checkpoint therapy may result in significant response or needless toxicity if applied without understanding the biology of the patient and cancer being treated.

Dr Schadendorf speaks with ecancer at EADO 2017 about objective response as a possible milestone for the administration of checkpoint immunotherapy. Taking current ipilimumab protocols as an example, he considers how long PD1 antibodies might be administered to achieve maximum clinical benefit. Based on data from KEYNOTE-001, Dr Schadendorf questions that patients who achieve complete response may be primed, or sensitive, to other immune therapies should they relapse. In Checkmate 69 and 67, combined ipilumumab and nivolumab resulted in nearly half of patients discontinuing due to toxicity, but there was little difference in PFS and response rate between those completing their course and those ceasing early, leading Dr Schadendorf to consider how long these potentially toxic courses are required for significant benefit. He goes on to consider the wider trial designs and health-care provider stakes in drug discontinuation.

Dr Ribero speaks with ecancer at EADO 2017 about the prognostic and diagnostic value of histologic regression in predicting and tracking immune response to skin cancers. He notes improved tumour infiltration by patients with regressed melanoma, and considers how this may guide immunotherapy treatments in the future. Dr Ribero also raises discussion about the role of nevi in regression.

Prof Garbe speaks with ecancer at EADO 2017 about targeted therapies for advanced and metastatic melanoma. He describes the tremendous improvements in survival for metastatic disease treated with targeted therapy, from ~5% to ~40%, and considers how tumour evolution may expose ways to subvert treatment resistance with new druggable targets. By combining multiple targets in combination or in sequence, Prof Garbe hopes for even greater survival improvements.

Dr Malvehy speaks with ecancer at EADO 2017 about advances in imaging to improve speed and accuracy of skin cancer diagnoses. He emphasises the clinical utility of reflectance confocal microscopy (RCM) for non-invasive, high resolution detection of cancerous skin cells within a matter of minutes, if not seconds. Dr Malvehy also notes the complementary use of RCM with other imaging techniques to gain consensus in diagnosis, though cautions about the cost and training associated.