Patients are now able to get immunotherapies and targeted therapies at their local clinics, rather than having to travel to academic medical centers, she said, so she sees fewer newly diagnosed patients. Instead, doctors at places like MD Anderson are focusing more on existing and follow-up patients.
“Those patients that we do have, we’re keeping alive longer,” she said. “Instead of holding them on your panel for 1 to 2 years, you might be holding them for 5 years or longer.”
She said she now has nearly 10 different treatments to choose from for metastatic melanoma. If each gives a patient an additional 6 months, that adds up to a 5-year increase in survival time overall, she said.
Now scientists need to spread the success to more patients, said Keith Flaherty, MD, director of clinical research at the Massachusetts General Hospital Cancer Center and an associate professor of medicine at Harvard Medical School, Boston. Despite the incredible advances, these new treatments only provide long-term benefit to about 20% to 30% of patients, which means a large portion of patients still die.
“It’s been staring at us for the past several years,” Dr Flaherty said. “It’s frustrating to me how slow people have been to talk about it.”
Combination therapies will be key to extending the survival gains further, Dr Flaherty said, but so far it hasn’t been simple to figure out effective combinations. He said he was close to despair a few years ago when combination trial after combination trial failed. But more recently, it’s been shown that ipilimumab, a first-generation checkpoint inhibitor, can still help patients who aren’t helped by second-generation drugs, he said. And he’s hopeful that doctors will be able to improve results for patients who got a partial, but incomplete response from a checkpoint inhibitor. These patients almost always progress eventually, but today, nothing is done for them until that progression; Dr Flaherty thinks they are likely to fare better if they get follow-up care before that point.
Dr Patel predicted that survival rates will continue to increase as researchers get better at matching patients with therapies. “I’m optimistic,” she said.
- Pulte D, Weberpals J, Jansen L, Brenner H. Changes in population-level survival for advanced solid malignancies with new treatment options in the second decade of the 21st century [published online May 16, 2019]. Cancer. doi: 10.1002/cncr.32160
- US Food and Drug Administration (the Center for Drug Evaluation and Research). Ipilimumab. Updated November 27, 2015. Accessed July 9, 2019.