Meredith McKean, MD, MPH, the associate director of the Sarah Cannon Research Institute's Melanoma and Skin Cancer Research Program at Tennessee Oncology, discussed new melanoma studies and treatment developments.
Meredith McKean, MD, MPH, of Tennessee Oncology discussed new melanoma studies and treatment developments she presented at The American Journal of Managed Care®’s Institute for Value-Based Medicine® hosted by Minnesota Oncology in Minneapolis, MN on September 12. McKean is the associate director of the Sarah Cannon Research Institute's Melanoma and Skin Cancer Research Program at Tennessee Oncology. She specializes in skin cancer treatment and research, as well as phase 1 drug development.
Can you briefly describe the new melanoma studies that you discussed at the Minnesota Oncology IVBM?
I really tried to take the audience through the range of studies that are coming through, because I think what's so exciting in melanoma is that we've gone from trying to advance treatments for patients with metastatic disease to now trying to advance patients with very early stage disease in the neoadjuvant setting, adjuvant setting, and metastatic setting.
We walked through some of the ongoing platform studies in the neoadjuvant setting. For patients in the adjuvant setting, looking at some of the combination studies that are ongoing with LAG-3, with personalized cancer vaccines. Then, in the metastatic setting, I think the main areas are the ongoing vaccine studies, other combination or immune therapy options for patients that have failed anti–PD-1.
Then, looking at the targeted therapies. We haven't previously had treatments for patients with NRAS or some of the atypical class II and III BRAF mutations or alterations, and so we walked through some of the different trials ongoing specifically for those patients.
Of those discussed, which new melanoma studies are you most excited about?
We certainly need more immune therapies for patients. I think what I'm most excited about are the trials that are personalized for patients—our specific targeted trials. So, obviously, the mRNA-4157, the personalized cancer vaccine that's been in development with Moderna and Merck I think is an exciting option to be able to follow moving forward. I think the idea of being able to personalize the vaccine to a patient's tumors, especially in the adjuvant setting, is really exciting.
There are several great trials ongoing targeting the NRAS and atypical BRAF mutation. I think some of those exciting trials would be like naporafenib on the SEACRAFT studies, belvarafenib, bocodepsin, and exarafenib.
This is really game changing. We've had trial options for patients with the v600BRAF mutations, but for the 20% of patients that have NRAS mutations, and for those rare patients that have the atypical BRAF [mutations], we just haven't had trial options for them before. I think it's going to be really exciting moving forward because each of those drugs has shown some responses, and I think they're really narrowing in on which patients might benefit most.
Overall, how do you predict these new melanoma studies to improve treatment and outcomes in patients?
Well, the biggest needs for patients with metastatic melanoma would certainly be immune therapy options for patients that fail anti–PD-1, and then options for patients that have pretty significant toxicities and can't receive further immune therapy.
That's where the targeted therapies really come in. I think having options for patients that have failed combination BRAF-MEK and then having those options for the patients with more rare NRAS mutations, BRAF alterations, MTAP loss, CDKN2AB loss.
We're past the point of saying, “Hey, let's profile everyone.” Well, now we're profiling patients, and now we need those trials and those treatment options specifically for those patients. I think that's what we're seeing now is some of these really exciting trials trying to address those needs for our patients.
What was your biggest takeaway from the Minnesota Oncology IVBM?
It was a great session and a really engaged audience. I think it was exciting to hear the perspectives from a multidisciplinary group. From our plastic surgeon that was able to say how his area is trying to fill that need for patients that want and need a surgical oncologist that's able to also give a cosmetically pleasing surgical option, to Thomas Amatruda, MD, going over all the advances that we've had in melanoma.
But then I also really enjoyed the presentation on toxicities. I think that's going to continue to be really important, because we still don't know exactly which patients are going to benefit and which patients are going to have toxicities, so we're going to have to help manage all those patients. I think it was really exciting to see how the team at Mayo is managing patients with toxicities and trying to keep them out of the hospital. I think that was really exciting to hear that presentation, as well.
What are you currently working on that you're excited to share?
I'm a clinical investigator, and so I’m a part of a number of different clinical trials. I think it's really gratifying to be able to offer other options for patients, like I said, that can't get immune therapy anymore, maybe have some of these rarer mutations. I think it's important to know those trial options are out there and ongoing for patients. I think there's certainly a bright future for melanoma treatments.