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Cancer: Fight against malignant melanoma

For the first time, two drugs have, each in turn, increase the survival of patients with metastatic forms
For the first time, two drugs have, each in turn, increase the survival of patients with metastatic forms

For the first time, two drugs have, each in turn, increase the survival of patients with metastatic forms. The results of these two international studies, regarded as one of the events of the 47th Congress of the American Society of Clinical Oncology (ASCO) held in Chicago. Meanwhile, these two trials were published in The New England Journal of Medicine.

Constantly increasing, melanoma is cured in most cases with surgical treatment. But with inoperable tumors or metastases have a terrible prognosis, because so far they are resistant to all treatments. Placed on the market in 1975, dacarbazine, which is the standard chemotherapy, has an effect in only 10% of patients. And multiple attempts for decades to combat these cancers by stimulating the immune system, for example vaccines, have never obtained very convincing results.

The two new carrier molecules are acting completely different. The first, vemurafenib, developed by Roche Laboratories, targets a mutation of a gene called braf. In the presence of this genetic abnormality seen in 50% of melanomas, tumor cells are growing faster. The second, ipilimumab (Labs Bristol-Myers Squibb) is a monoclonal antibody that stimulates certain immune cells to help the body eliminate cancer cells.

A year ago, the vemurafenib had obtained promising preliminary results in patients carrying the BRAF mutation. These promises are confirmed in a Phase 3 (final stage before commercialization) on 675 patients who received either the targeted treatment, or dacarbazine.

With a few months down the vemurafenib decreased by 63% mortality compared to chemotherapy, and has allowed a significant extension of survival without tumor progression: more than five months against 1.6 with chemotherapy. Nearly one in two patients responded to treatment target, while the response rate was 5% for chemotherapy. The results were so conclusive that all patients in the chemotherapy group were placed under vemurafenib.

This targeted therapy, which is taken in tablet form, however, induces various side effects: liver problems, joint pain, skin disorders in 12% of patients, other skin cancers are less severe than melanoma. Despite a decline which is still limited (about two years maximum), the vemurafenib should soon be allowed in the U.S. and Europe.

The other study, also from phase 3, compared with 500 patients treated with chemotherapy alone to the combination ipilimumab chemotherapy. This approach has significantly reduced mortality, with results persist over time. With a decline in three years, the survival rate was still twice as high in the group receiving the combination of two drugs against the chemotherapy only group. The monoclonal antibody is not active in all patients and can lead to potentially severe side effects, including hepatitis. It has already been approved by the U.S. authorities.


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