dr_jangSekwon Jang, MD, is board certified in internal medicine, hematology and medical oncology. He specializes in managing melanoma and other skin cancers. Dr. Jang is the director of Melanoma and Cutaneous Oncology Therapeutics and Research at the Inova Dwight and Martha Schar Cancer Institute. Read Dr. Jang’s profile.

As recently as five years ago, there was no reasonably effective treatment for patients with advanced melanoma that had metastasized. Recent innovations in immunotherapies, therapies that stimulate one’s immune system to destroy the cancer cells, have changed the way we treat cancer. Melanoma, more than any other cancer, has been affected by the development of these new immunotherapies. This is an exciting time to be a researcher and clinician who treats melanoma.

Treatment options for patients with advanced melanoma continue to expand:

  • Since 2011, seven new drugs have been approved in the U.S. for patients with melanoma, including:
    • Three targeted therapies (vemurafenib, dabrafenib and trametinib)
    • Four immunotherapies (pegylated interferon, ipilimumab, pembrolizumab and nivolumab)
  • In 2014, combination of two targeted agents (dabrafenib and trametinib) received approval.
  • On September 3, 2015, the first ever combination of immunotherapy (ipilimumab and nivolumab) received approval

Combination Therapy: Two Are Better Than One

Trials have demonstrated that the combination of ipilimumab and nivolumab can achieve significant tumor shrinkage in about 60 percent of patients. This is a much higher rate than we’ve achieved with either ipilimumab or nivolumab alone. In majority of patients whose tumor responded, their melanomas did not get worse during and even after the treatment.

We need more research to determine whether this combination will eventually improve survival rates compared to either ipilimumab or nivolumab. At Inova, we have a clinical trial of ipilimumab and nivolumab in patients with melanoma that has spread to the brain to find out whether this combination works in the brain as well.

New Treatment Protocol?

Is this combination going to be an option for everyone with advanced melanoma? I think the recommendation has to be made individually, based on a patient’s overall health and other conditions he or she may have. This therapy combination can cause serious side effects, including inflammation in the bowel, lung, liver and kidneys. The good news is that most of side effects are reversible with steroid treatment. As always, communication with the treatment team will be crucial in detecting and treating the side effects.

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