More late line therapies in Stage 4 needed – Bettina Ryll
Back from ASCO2023 and back to one of my favourite mental exercises – the 3 things to remember for Melanoma and else (as with the usual attrition, one does retain the essentials over the years ;)).
1. More late line therapies in Stage 4 needed: Unfortunately, we aren’t making any progress in advanced advanced Melanoma. Once through SOC, there is neither a systematic follow-through let alone a strategic, aspiring approach- it’s ‘we should have treated earlier’ which doesn’t translate favourably for a patient in that very situation 🙁 A space where we need more options!!
2. Neo-antigens: MSD’s Keynote-942 with Moderna’s BNT-4157 looks promising but considering the first has their major asset going off patent and the second to prove their existence post-COVID: plenty of opportunity to mess up in the pricing department…especially with PD1 biologics and plenty of open source neo-antigen work coming. It’s only innovation when it is *in a patient*, so exciting science but already worried about lack of access. Really interesting poster on neo-antigen selection under therapy- abstract #413298- out-of-frame mutations are negatively selected, something to keep in mind as neo-antigen based vaccines at diagnosis might differ from those at progression.
3. Patient selection in early Melanoma: At ESMO2021, there supposedly were no samples collected for KEYNOTE-716 (PD1 in unselected Stage 2 Melanoma) but someone seems to have cleaned their drawers and- SURPRISE SURPRISE- discovered the matching biosamples, so we are now looking forward to the biomarker works. Patient selection in early Melanoma must be *the* most critical part as the degree of over-treatment and unnecessary toxicity is large.
4. Face-to-face meetings are so much better than online ones….