Immunotherapy Continues to Advance in Melanoma and Other Solid Tumors

The use of immunotherapy in other solid tumor types will soon catch up to its use in melanoma as the field continues to advance, says Omid Hamid, M.D.

In an interview with CURE at the 34^th Annual Chemotherapy Foundation Symposium, Hamid, the chief of Translational Research and Immuno-oncology at the Angeles Clinic in Los Angeles, recently discussed some exciting prospects in immunotherapy, as well as questions that remain unanswered.

“Checkpoint inhibition and immuno-oncology has moved from melanoma and renal cell carcinoma (RCC) to other tumors. As you can see in some of the lung cancer talks, we're beginning where we were with melanoma one to two years ago, and these melanoma talks now are broader immuno-oncology talks with the approvals in head and neck cancer, approvals coming in merkel cell, renal and our focus on other solid tumors,” Hamid said. “I think the melanoma talks are top-notch this year and give an infrastructure to think about how we review our treatment paradigms for other solid tumors.”

As drugs such as Yervoy (ipilimumab) and Opdivo (nivolumab) continue to prove beneficial in melanoma — both as single agents and in combination – the question researchers are now asking is how to determine which treatment is best for each individual patient.

“So what we'll be looking at is some of these newer assays that go beyond PD-L1 staining, looking at mutational load, whether it exists or doesn't,” Hamid said. New biomarkers that are being explored for the treatment of melanoma include OX40 and 4-1BB.

Hamid also mentioned that there are some phase 3 trials that he is particularly excited about. The first is observing epacadostat, an IDO-inhibitor, with Keytruda (pembrolizumab) compared to Keytruda alone. In the phase 1 and 2 trials leading up to the phase 3 trial, there was about a 58 percent response rate when the combination was used in the frontline, Hamid said.

Another exciting phase 3 trial is MASTERKEY-265, exploring the recently approved Imlygic (T-VEC) with Yervoy versus Yervoy alone in advanced melanoma. The study showed that the combination had improved both objective response rates (ORR) and complete response (CR).

“Both will give us a greater insight as to what types of patients will respond and they move forward this paradigm of combinatorial immunotherapeutics, which has started somewhat in melanoma and will be moving to other solid tumors,” Hamid said.

More trials are morphing from examining single agents to combination therapies, as well as attempting to re-invigorate the immune system in refractory patients who either did not respond or responded and then later relapsed on checkpoint inhibitors — something that Hamid finds particularly exciting.

“Those trials will give us more of an opportunity,” Hamid said. “That is important because the majority of patients being treated with checkpoint inhibition are not those that benefit-- we'd like to improve those numbers.”