Patrick Hwu, MD: Melanoma Treatment Update from AACR 2012

Dr. Patrick Hwu gives a melanoma treatment update at the American Association for Cancer Research (AACR) Annual 2012 meeting in Chicago.

Patrick Hwu, MD is the Department Chair, Department of Melanoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX. Dr. Hwu is considered one of the leading tumor immunologists in the country, and a primary force in the development of novel vaccine and adoptive T-cell therapies.

The Group Room at the American Association for Cancer Research (AACR) Annual Meeting 2012 was made possible, in part, by:

VIDEO TRANSCRIPT

Selma Schimmel, Founder & CEO, Vital Options International

This is Selma Schimmel reporting for the Group Room at AACR, the annual meeting of the American Association for Cancer Research in Chicago, happy to be joined now by Doctor Patrick Hwu, Department Chair in the Department of Melanoma Medical Oncology, Division of Cancer Medicine at the University of Texas, MD Anderson Cancer Center in Houston, Texas.

Hi, Doctor Hwu.

Patrick Hwu, MD, Chair, Dept. of Melanoma, MD Anderson Cancer Center, Houston, TX

Hi. Thanks for having me in today, Selma.

Selma Schimmel:

Let’s talk about the treatment modalities that are available for metastatic disease.

Patrick Hwu, MD:

Once the disease has spread we do a number of things; there are cutting-edge clinical trials and in the last year after over 20 years with no new drug there have been two new drugs that have been approved for advanced melanoma. One of them is a targeted therapy that targets a mutation called B-Raf; we can think about these mutations as light switches so if those light switches are flipped on some of these pills can flip those off.

Selma Schimmel:

These are oral compounds?

Patrick Hwu, MD:

They’re oral medications taken twice a day. So about half the patients have the right kind of light switch called a B-Raf mutation that would match our pill that can turn off that light switch. And patients can have dramatic responses. They’re not often durable but they can have still dramatic responses that can last about seven months on average.

The other drug that’s very exciting is called Yervoy, which is an immune agent stimulating the immune system. It takes and breaks off the immune system. It’s an antibody infusion given every three weeks and it stimulates and activates the body’s immune cells so then go fight the cancer. The response rate is on the low side, about 10 percent, but the good news is some of the patients who are treated with the advanced cancers have their disease go away and stay away forever and we’ve talked to patients from ten years ago when I was at the National Cancer Institute and some of those patients are still doing well today.

Selma Schimmel:

How is that therapy delivered?

Patrick Hwu, MD:

Intravenously, every three weeks.

Selma Schimmel:

And side effects?

Patrick Hwu, MD:

The side effects that can stimulate your body’s immune system you can get immune toxic side effects. The most serious is colitis, which is manifested by diarrhea. You could get skin rashes, and you can also get an immune attack of some of your endocrine organs, one called the pituitary but that is – as long as it’s caught early – can be easily remedied by getting hormone replacement.

Selma Schimmel:

And what about the BRAF immuno-therapy side effects?

Patrick Hwu, MD:

Generally that’s fairly well tolerated; we can get some issues with the skin. The most serious is that it brings out squamous cell cancers that were probably harboring there but it helps them grow, so a patient on a BRAF inhibitor needs to see a dermatologist and after about eight to twelve weeks we usually see the squamous cell cancers that are growing and can cut those out and usually have very minimal adverse effects but we do need to have close collaboration with the dermatologist.

Selma Schimmel:

How do you determine if one has the BRAF mutation?

Patrick Hwu, MD:

It’s done by taking the tumor samples and isolating the DNA and then sequencing that DNA to know if that light switch is turned on or not. So it’s from the DNA of the tumor biopsy.

Selma Schimmel:

So if the patient do not have the BRAF mutation you would then treat them with the Yervoy?

Patrick Hwu, MD:

Yes, we would treat with the Yervoy and try to stimulate the immune system and there are other agents that we can treat with, one called Interlucon-2, which is a natural protein that stimulates the body’s immune system. Again the response rates aren’t that high but some of the patients are cured with these immune therapies, and so that’s why we want to always try them. There are always other investigational agents that are very exciting, such as our T-Cell therapy.

Selma Schimmel:

And would you ever integrate all of these therapies together?

Patrick Hwu, MD:

Yes, I think it’s very important and that’s actually what I spoke about today at our conference, which was combining targeted therapies plus immuno-therapies. I think there’s significant potential because our targeted therapies that turn off the light switch we have a very high response rate, over 50%, but they don’t last very long. And the immuno-therapies have a low response rate but they can last forever so putting them together hopefully we’ll get the best of both worlds and there’s a lot of scientific rationale now that those two will work fairly well together.

Selma Schimmel:

What kind of survival outcomes have you seen with the therapies?

Patrick Hwu, MD:

For the targeted therapies patients with advanced melanoma, the median survival is just reported to be about 15 months. With Yervoy if patients don’t respond they’re not going to have an increased survival, but if they do; there is increased survival overall if you compare the patients who get Yervoy with those that don’t, and if they do have a great response that can last for years and years and years and they can have survival over ten years or longer.

So that’s what we call a tale of the curve, the tale of survival – that’s where every patient wants to be, is essentially cured with long-term survival. And I think we can get there with even more patients. For example, we’re doing a therapy called T-Cell therapy where we’re taking tumors to our laboratory and trying to isolate the immune cells called tumor-infiltrating lymphocytes, or TIL, from those tumors we grow billions and we give them back. And in patients who receive that therapy we can have response rates of about 50%.

Selma Schimmel:

Is Yervoy the trade name or the generic name?

Patrick Hwu, MD:

There’s so many names for these drugs. Scientifically it’s Anti-CTLA4, for cytotoxic-T lymphocyte antigen 4, so that’s what scientists will call it. And then it was called Ipilimumab for a while, and then once it got approved they changed it to Yervoy, which I think sounds like a Russian space ship myself.

Selma Schimmel:

Any last thoughts that you’d like to share about the future of melanoma research?

Patrick Hwu, MD:

I think it’s very bright. We had a period of time when everyone was working extremely hard but we had no new FDA approved drugs for over 20 years. That was frustrating in the clinic but now we have two new drugs and one in targeted therapy, one in immuno-therapy and now that’s the tip of the iceberg. The pipeline is healthy, there’re many new targeted therapies and immuno-therapies and we just have to move as fast as we can because if you ever come to clinic with me, you’ll see these patients and their families want us to move quickly with urgency and that’s what we should do. And I’m optimistic that we’re going to be able to solve this issue in a few years and hopefully take what we’ve learned from melanoma into other kinds of cancers and learn to treat them as well, such as colon cancer.

Selma Schimmel:

And I imagine these new successes is sort of kind of a fuel and inspiration to move forward because it’s been so long since you’d seen some positive results in the lab.

Patrick Hwu, MD:

I think it’s inspired the whole community.

Selma Schimmel:

Thank you very much, Doctor Patrick Hwu, Department Chair, Department of Melanoma Medical Oncology in the Division of Cancer Medicine at the University of Texas, MD Anderson Cancer Center in Houston, Texas.

Patrick Hwu, MD:

Thank you for inviting me.

Selma Schimmel:

My pleasure.

END OF VIDEO

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