Melanoma Dispatch
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Cost-Benefit Analysis Questions Treating Medicaid Patients with Vemurafenib

The impressive, but still short-term, benefits of vemurafenib for melanoma patients may not justify the hefty cost to a Massachusetts Medicaid program, according to an analysis presented at an American Society of Health-System Pharmacists meeting. Vemurafenib targets the most common mutation of BRAF, which is one of the genes that is most often abnormal in melanomas. The analysis noted that vemurafenib boosted 6-month survival rates over those of the conventional chemotherapy drug dacarbazine (84% and 64%, respectively). However, vemurafenib is also more expensive than dacarbazine, with relative per patient costs estimated at $9,995 and $1,811 per month, respectively. 

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MedPage Today | Dec 7, 2012

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Blood Test Could Predict When Melanomas Will Come Back

A new blood test could show whether melanomas are likely to return in patients who are clinically free of the disease, according to a study in the Journal of Clinical Oncology. Cancer cells that break off tumors can enter blood vessels and this test identifies three tumor cell biomarkers in blood. The researchers periodically tested blood samples of 322 patients and found those with up to one cancer biomarker were more likely to be melanoma-free compared to those with two or more cancer biomarkers (73% vs. 59%). This test could show which patients would benefit from aggressive treatments.

 

Primary source: http://jco.ascopubs.org/content/30/31/3819.abstract?sid=85400172-d445-4d85-958c-f7bda75450b6

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OncLive | Jan 9, 2013

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First Report that Vemurafenib Can Trigger Leukemia

A melanoma patient treated with vemurafenib also developed leukemia temporarily, according to a case report in The New England Journal of Medicine. This drug was already known to cause squamous cell skin cancers in some people with melanomas that have BRAF mutations. Vemurafenib activates proteins called extracellular-signal-regulated kinases (ERK), which are involved in cell division and can lead to cancer in cells that have RAS mutations. The leukemia in the vemurafenib-treated patient had a RAS mutation and disappeared after treatment ended. The patient’s melanoma tumors, which did not have a RAS mutation, shrank during treatment.

 

Primary source: http://www.nejm.org/doi/full/10.1056/NEJMoa1208958

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MedPage Today | Nov 8, 2012

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Combining Dabrafenib and Trametinib Increases Melanoma Patient Survival

People with melanoma lived longer when treated with a combination of dabrafenib (a BRAF inhibitor) and trametinib (a MEK inhibitor) than with dabrafenib alone, according to research in The New England Journal of Medicine. The study included 247 people with melanomas that had BRAF V600E mutations. Treatment with both drugs increased survival to 9.4 months, compared to 5.8 months with dabrafenib alone. In addition, tumors were not evident or shrank considerably in 76% of people treated with both drugs, compared to 54% of those treated with dabrafenib alone.


Primary source: http://www.nejm.org/doi/full/10.1056/NEJMoa1210093

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The ASCO Post | Nov 1, 2012

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Vemurafenib Boosts Immunotherapy against Melanoma in Mice

Vemurafenib increases the effectiveness of a treatment that uses immune system cells modified to target cancer cells, according to a study in Cancer Research. When combined with vemurafenib, which targets melanomas with the most common BRAF mutations (V600), this immunotherapy treatment killed more melanoma cells in mice. The combination treatment was also more successful than vemurafenib alone. The researchers conclude that their work supports testing this combination treatment in people with melanomas that have BRAF V600 mutations.

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Cancer Research | Jun 12, 2012

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Scans May Reveal Early Drug Resistance in Melanomas

Preliminary results suggest that an imaging technique can give early signs of drug resistance in melanomas. A Journal of Clinical Oncology study found that PET/CT scans correlated with standard measures of tumor response in seven melanoma patients treated with vemurafenib. The scans also showed that during the third and fourth weeks of treatment, tumors in three patients began to take up and metabolize more of a sugar. This is a sign of cell activity, suggesting that these tumors were starting to resist the drug.

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Journal of Clinical Oncology | May 2012

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Vemurafenib Benefits People Previously Treated for Melanoma

A New England Journal of Medicine study found that vemurafenib, which was approved by the FDA in 2011, controlled melanomas in about half of people who had been previously treated for this disease. The trial included 132 repeat patients; tumors shrank in 47% of the patients and were not evident in 6% during the course of the trial. Vemurafenib is a BRAF inhibitor and about half of melanoma patients have BRAF mutations. While 26% of patients developed another kind of skin cancer called squamous cell carcinoma, these lesions were successfully removed surgically.


Primary source: http://www.nejm.org/doi/pdf/10.1056/NEJMoa1112302

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MedPage Today | Feb 22, 2012

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Dabrafenib Bests Chemotherapy and May be Safer than Vemurafenib

A clinical trial found that dabrafenib, a BRAF inhibitor, was far more effective in treating melanomas that have BRAF mutations than the chemotherapy drug dacarbazine, according to a report at an American Society of Clinical Oncology meeting. Patients treated with this drug lived without getting worse for 70% longer than those treated with dacarbazine (5.1 vs. 2.7 months, respectively). Moreover, compared to those treated with vemurafenib in other studies, dabrafenib-treated patients had less risk of another kind of skin cancer called squamous cell carcinoma. This suggests that dabrafenib, which is experimental, could be safer than vemurafenib, which is FDA approved.

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MedPage Today | Jun 4, 2012

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German Health Institute Says Ipilimumab Benefits Melanoma Patients

Melanoma patients live longer when treated with ipilimumab than with an experimental tumor vaccine called gp100, according to a study by the German Institute for Quality and Efficiency in Health Care. People treated with ipilimumab lived 10 months, while those who were not lived 6.5 months. In addition, ipilimumab did not make people’s quality of life worse. People had the same symptoms—nausea, vomiting, digestive disorders, fatigue, and pain—whether they were treated with the drug or with a placebo.

 

Primary source: https://www.iqwig.de/considerable-added-benefit-of-ipilimumab-in.1454.en.html?random=b17062

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Doctor Tipster | Nov 9, 2012

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Vemurafenib Extends Life up to 3 Years in Melanoma Trial

An ongoing clinical trial found that 26% of melanoma patients treated with vemurafenib (Zelboraf®) were alive at 3 years—far longer than the average survival time of 9 months with conventional chemotherapy. Vemurafenib is a BRAF inhibitor and this trial includes 32 people with the most common BRAF mutation (V600E). In addition, 5 people survived at 3 years and 4 months; 3 of them had no evidence of disease. 

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Drugs.com | Nov 9, 2012

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UK Health Institute Approves Vemurafenib and Ipilimumab for Melanomas

UK Health Institute Approves Vemurafenib and Ipilimumab for Melanomas | Melanoma Dispatch | Scoop.it

The National Institute for Health and Clinical Excellence recommends giving people in England and Wales access to vemurafenib and ipilimumab via the National Health Service. The FDA has already approved these drugs for treating metastatic melanoma in the U.S. Initially, the cost of these treatments was a stumbling block in the UK and the watchdog institute’s recommendation comes with the caveat that manufacturers must provide a discount to the NHS. 

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The Independent | Nov 2, 2012

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New Melanoma Mutation Frequent Enough for Routine Screening

Researchers identified a new mutation (BRAF L597) in a melanoma patient and then tested for it in 49 other melanomas that had no known cancer-linked mutations, which account for about half of all melanomas. They found that BRAF L597 occurred in 4% of the other melanomas tested. The study, which appeared in Cancer Discovery, also showed that tumors with this mutation respond to a MEK inhibitor called TAK-733. The existence of a targeted treatment, coupled with the new mutation’s relatively high incidence, lead the researchers to suggest routinely screening melanomas for BRAF L597.

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Cancer Discovery | Jul 13, 2012

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Trametinib Outperforms Chemotherapy for Melanomas with BRAF Mutations

A New England Journal of Medicine study reports a promising new approach to treating melanomas with BRAF mutations, which often respond to BRAF inhibitors for just a short time. Melanoma patients treated with trametinib were stable (i.e., did not get worse) for three times longer than those treated with dacarbazine, a conventional chemotherapy drug (4.8 vs. 1.5 months, respectively). Trametinib inhibits MEK, a protein that is activated by BRAF and is involved in cell division. The drug’s most common side effects were rash, diarrhea, and swelling in the legs, which could be controlled by periodically adjusting the dose.

 

Primary source: http://www.nejm.org/doi/full/10.1056/NEJMoa1203421

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MedPage Today | Jun 4, 2012

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Shaminder Singh's curator insight, July 26, 2013 4:56 AM

Academic Journal (Other type)

Shaminder Singh's comment, July 26, 2013 5:39 AM
This is a good news for those with skin cancer. This drug can inhibit the process for longer period of time than the conventional drug.
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Dabrafenib May Shrink Melanomas in the Brain

An early stage clinical trial suggests that dabrafenib, a BRAF inhibitor, could treat melanomas that have spread to the brain. The study, reported in The Lancet, included 10 people with brain metastases of melanomas that had BRAF mutations. Tumors shrank in 9 patients and were not evident in 4 patients. This is a surprise because the drug had not been expected to cross the blood-brain barrier effectively. Indeed, melanoma patients with brain metastases have been routinely excluded from previous trials of vemurafenib (Zelboraf) and other BRAF inhibitors.

 

Primary source: http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2812%2970269-3/abstract

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MedPage Today | May 18, 2012

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Drug Targets Two Common Melanoma Mutations

An experimental drug could help control some melanomas that have BRAF or NRAS mutations, according to a report at an American Society of Clinical Oncology meeting. Tumors shrank or did not get worse in 8 out of 35 patients with the most common BRAF mutation (V600E), and in 6 out of 28 patients with NRAS mutations. This is the first targeted treatment for melanomas that have NRAS mutations. BRAF and NRAS mutations can activate a protein called MEK that is involved in cell division. The experimental drug, which is called MEK162, is a MEK inhibitor. The side effects of MEK162, which included diarrhea, rashes and swelling, were manageable.

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MedPage Today | Jun 8, 2012

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Ipilimumab Could Treat Small Melanomas in the Brain

A study in The Lancet shows that the drug ipilimumab could treat melanomas that have spread to the brain, particularly in people who do yet not have neurological symptoms. Of 51 such patients treated with ipilimumab, 12 had tumors in the brain that shrank or did not get worse and 14 had tumors outside the brain that shrank or did not get worse. Ipilimumab (Yervoy) is an immune system booster that the FDA has approved for treating advanced melanomas.


Primary source: http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2812%2970090-6/abstract

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MedPage Today | Mar 30, 2012

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