What’s new in treatment of cutaneous T cell lymphoma – Rudolf Stadler (Germany)

In advanced-stage cutaneous T-cell lymphoma (CTCL), the current therapeutic options rarely provide long-lasting responses, leaving allogenic stem-cell transplantation the only potentially curative option for highly selected patients. It is therefore important to take all available measures in good time. An individual therapeutic concept should be established and taken into account whether it is an early advanced or late advanced cutaneous T-cell Lymphoma.

The traditionally used recombinant Interferon alpha has been replaced by pegylated Interferon, which seems to induce favorable results in combination with UV phototherapy or radiotherapy.

The pillars of modern targeted therapy are the CCR4 receptor-targeting mogamulizumab, as well as the CD30-targeting brentuximab vedotin. 

The therapeutic option for future therapy is Lacutamab, a first-in-class cytotoxic–inducing antibody, currently in clinical evaluation. Atezolizumab (anti-PD-L1) showed moderate activity in pre-treated advanced cutaneous T-cell Lymphoma. Among single agent chemotherapeutics, Gemcitabine is an effective single-agent used in advanced stages of CTCL.  Low dose regimens have recently been shown to induce high and long-lasting remission rates. Moreover, Ifosfamid and Etoposid is a valuable therapeutic option in patients with advanced, refractory CTCL.

Management of stage I and II melanoma – Zsuzsanna Lengyel (Hungary)

Melanoma represents 5% of malignant skin cancers. The incidence of melanoma is increasing worldwide, especially in fair skinned people with excessive sun exposure. In Europe, the incidence rate counts between 10 to 25 new melanoma cases per 100,000 inhabitants. The majority of new cases are in early stages (I and II) (70%) and have a favorable outcome. 

The eighth edition of American Joint Committee on Cancer (AJCC) staging system for cutaneous melanoma has been implemented in everyday care since 2018.  

According to the AJCC stages of primary tumor staging, examinations and further surgical interventions are needed.  This lecture highlights when to perform sentinel lymph node biopsy, as it is an important component of melanoma staging to identify occult regional lymph node disease among patients with clinical stage I or II diseases.   

Patient surveillance is also an important part of patient care. Today there is no available data from randomised clinical trials regarding an optimal follow-up scheme. There are various recommended schemes, and I will cover the latest recommendations by the European consensus-based interdisciplinary guideline. 

Patients with stage II disease, especially IIB and IIC, have worse prognosis than AJCC 8th stages III A and III B. 

The higher incidence of distant/regional metastases in these stages led to clinical trials to assess the efficacy of adjuvant therapies already approved in stage III diseases in completely resected high-risk stage II melanoma. 

Management of BRAF-mutant melanoma – Pietro Quaglino (Italy)

The introduction in the clinical practice of new drug compounds, both targeted therapies anti-BRAF and check point inhibitors, has largely improved our potential to manage advanced metastatic melanoma patients, inducing a significant improvement in terms of response rates and particularly overall survival (OS). The long-term results of trials with follow-up data of patients treated with targeted or immunotherapies reported median OS rates around 24 months, with 5-year survival rates around 35-40%. 

As to the drugs currently available and reimbursed by the Italian National Health System, three combinations of anti-BRAF/anti-MEK inhibitors are available (dabrafenib/trametinib, vemurafenib/cobimetinib and the most recently introduced encorafenib/binimetinib). 

As to check point inhibitors, first line immunotherapy is represented by anti-PD1 blockers (nivolumab and pembrolizumab), whilst the anti-CTLA-4 ipilimumab can be used as second line. The decision-making factors to define the best treatment approach in a patient with stage IV metastatic melanoma are represented by: mutation pattern, performance status, high/low tumour load, brain metastases, progression pattern (low/fast) and availability of clinical trials.

This presentation will analyse the therapeutic tools available for the treatment of patients with BRAF-mutant metastatic melanoma and will focus on an update of results obtained by the new treatments (check-point inhibitors and targeted therapies) which can be used in the clinical daily practice.