Dr. André Cruz

Oncologist

Adjuvant immunotherapy for the treatment of Cutaneous Melanoma

An innovative oncology conquest
HPA Magazine 10

In the Day Hospital of the Gambelas Unit of the HPA, the first patient in the country is being treated with an adjuvant immunology treatment – Nivolumab (Opdivo®), after surgical resection of cutaneous melanoma.

This new indication, approved by the FDA in December 2017, is a great advance in the treatment of this aggressive pathology, which has a high probability rate of recurrence following surgery. 
Until now, in Europe, there has not been a standard adjuvant therapy recommended after melanoma surgery, because the treatment approved in the USA in 2015 - Ipilimumab (Yervoy®) – caused significant adverse effects in high-risk patients. The CheckMate-238 study compared Nivolumab vs. Ipilimumab and showed quite a significant reduction in recurrence of the disease and risk of death in stage 3 operations (melanoma with node involvement).
After this approval, additional evidence recently came from the KEYNOTE-054 study, which showed a benefit similar to Pembrolizumab (Keytruda®), another immunotherapy drug, in patients with similar characteristics. Therefore, we are witnessing an evolution that exceeds the indications and approvals for immunotherapy in advanced cancer (metastatic/stage 4) – melanoma, lung cancer, kidney cancer, Hodgkin’s lymphoma, cancer of the head and neck – for other pathologies and for earlier stages, which means that we can reduce the risk of this lethal disease recurring after curative surgery, without significant toxicity.
This fact can be explained by the mechanism of action of these drugs. Rather than having a direct cytotoxic effect on the cancerous cells (and also on the healthy cells) as happens with chemotherapy, immunotherapy (also an endovenous drug) acts by unblocking the inhibition of our immune system caused by the cancer and stimulates its cytotoxic action. Thus, in administering a 1-hour simple endovenous treatment, it can be given with a very manageable toxicity profile. At the moment, there are hundreds of clinical trials being carried out to explore the potential of this treatment in earlier stages in the most varied pathologies, isolated or in combination with standard treatments, with extremely promising results.
The HPA is proud to have its Oncology Unit involved in this process, especially the possibility to offer our patients the most advanced oncology treatments available.