Treating melanoma in adolescents and young adults: challenges and solutions

Abstract

Systemic therapy of melanoma has made tremendous progress recently for advanced stage patients in terms of excellent, temporary responses through targeting underlying biology of BRAF V600E mutation and affected pathways. A significant subset of patients with advanced disease also has durable responses from immunomodulation through immune checkpoint blockade of CTLA-4 and the PDL-1/PD-1 axis. Clinical trials of these agents included patients as young as 18 years but generally excluded younger adolescents. Ongoing trials in 12-17 year olds have not been accruing as robustly, and as a result available options for these patients are often lagging years behind their adult counterparts. We herein summarize the epidemiology, diagnosis, and multidisciplinary management of adolescents and young adults with melanoma. We offer recommendations to improve the care for adolescent patients with melanoma agespecific evaluations and by including them in up-front melanoma trials.

Higher than reported adolescent and young adult clinical trial enrollment during the “Golden Age” of melanoma clinical trials

“…Positive registration clinical trials with checkpoint immunotherapy and MEK/BRAF pathway-targeted agents in metastatic melanoma have changed a nearly invariably fatal diagnosis to one with significant, even long-term remissions and improvements in overall survival (20)(21)(22)(23)(24)(25)(26)(27)(28). Young adults, but not adolescents under age 18, had an opportunity to participate in these trials that would have improved their melanoma outcomes (29).…”

“…Lee Moffitt Cancer Center (Moffitt) is a high volume NCI-designated Comprehensive Cancer Center (NCI-CCC) with a melanoma center of excellence. The Cutaneous Oncology Program provides care for many pediatric and adolescent referrals along with clinical collaborators, and has a track record of publications in pediatric and AYA melanoma (29,32,33). In this paper, we report AYA enrollment into therapeutic melanoma clinical trials at Moffitt from 1986 to 2015 and examine the relevant factors impacting enrollment.…”