Dr. Nicolas Acquavella: New Treatments for Melanoma Are on the Horizon
Nicolas Acquavella, M.D., is a board-certified medical oncologist at Sylvester Comprehensive Cancer Center, part of UHealth – the University of Miami Health System. He focuses on providing innovative and advanced treatment options to patients with advanced and metastatic melanoma. Here, he discusses unique treatments on the horizon.
What clinical trials for melanoma are you currently offering?
The future of melanoma treatment will rely upon how wisely we combine the different treatments that have been approved by the FDA over the last few years with those that are still in clinical development. At Sylvester Comprehensive Cancer Center, we offer a wide array of clinical studies involving the use of targeted therapy and immunotherapy. We have a strong focus on genetically engineered viruses designed to kill cancer cells and stimulate the immune system. These may turn out to be superior when paired with immunotherapy, and we now have studies in the clinic evaluating the combination of different oncolytic viruses with checkpoint inhibitors. Furthermore, given our collaborative research efforts with Bascom Palmer Eye Institute, we have a leading clinical program that offers novel treatments for patients with melanoma of the eye. This program involves cutting-edge clinical studies, some of which are the product of laboratory discoveries at Bascom Palmer that are now being moved into the clinic at Sylvester. This bench-to-bedside approach is unique to Sylvester here in South Florida.
Who can participate in these novel treatments that combine oncolytic viruses with immunotherapy?
These therapies are designed for patients with melanomas that have metastasized to the skin or lymph nodes and are either palpable or can be easily examined by ultrasound. The reason for this is that a sufficient volume of an oncolytic virus must be directly injected into a tumor for it to be effective, and superficial skin and lymph node tumors are easily accessible.
What new treatment options for melanoma are you excited about?
Immunotherapies have been an exciting development for the treatment of melanoma over the past years. However, these are not expected to be particularly potent as single agents but in combination with other immunotherapies or targeted therapies. Some of the novel potential combinations in the clinic include the combination with oncolytic viruses, Toll-like receptor agonists, indoleamine 2,3-dioxygenase inhibitors, stimulators of interferon genes agonists, targeted therapies, epigenetic modulators, agonistic and antagonistic molecules that target new checkpoints, T-cell receptor engineered and chimeric antigen receptor engineered adoptive cell transfer immunotherapies.
The question now is: Given the number of possible permutations in the clinic, how do we prioritize which therapies to combine to maximize the odds for success for our patients? At Sylvester, we also try to understand and develop predictive biomarkers of response to immunotherapy. We have seen that recent advances in immunotherapy can prolong the lives of patients with advanced melanoma for several years. However, not all patients respond to these new therapies, particularly those with advanced uveal melanoma. Accurate prediction of a positive outcome to immunotherapy is essential for maximizing therapeutic benefit and sparing patients from treatment-related toxicity and cost. Identification of a specific tumor biomarker will serve to rationalize the design of single or combined immunotherapies in a personalized manner.
Why should patients who are diagnosed with advanced or metastatic melanoma come to Sylvester for treatment?
At Sylvester, we approach each patient as an individual. One size doesn’t fit all in the treatment of cancer. Unlike any other hospital or cancer center in South Florida, patients at Sylvster are seen by a team of cancer experts from more than one specialty at the same time, if required. This allows for coordination of care among different expert physicians, which leads to a synergistic clinical approach. It also allows for patients to move rapidly from consultation to diagnosis and then to treatment. Once we understand the disease of a patient in a precise manner, we devise the best and most personalized treatment for that particular patient, including participation in cutting-edge immunotherapy clinical trials. This model leads to improved patient outcomes and stronger patient satisfaction.
For more information about clinical trials at Sylvester, visit sylvester.org/clinical-trials or call 800-545-2292.