Volume 197 - Issue 9
Drug treatment for melanoma: progress, but who pays?
Author: Richard F Kefford
Med J Aust 2012; 197 (9): 491-492. || doi: 10.5694/mja12.11469
Published online: 5 November 2012
Published online: 5 November 2012
In reply: The letters of Morgan and Fullerton correctly emphasise the importance of palliative care in the management of patients with metastatic melanoma. They also draw attention to the immense cost of new drugs for melanoma, and their limited efficacy in life extension - something I also emphasised.1 Much ignored in this debate is the rapid and dramatic improvement in quality of life experienced by ...
In reply: The letters of Morgan and Fullerton correctly emphasise the importance of palliative care in the management of patients with metastatic melanoma. They also draw attention to the immense cost of new drugs for melanoma, and their limited efficacy in life extension — something I also emphasised.1 Much ignored in this debate is the rapid and dramatic improvement in quality of life experienced by nearly all melanoma patients on BRAF inhibitors,2 an example of where medical oncology and palliative care should, and must, work hand in hand in optimising patient comfort. We strive toward this goal in our multidisciplinary teams. However, it is in the adjuvant setting that the new antimelanoma drugs are likely to show large improvements in survival and where reimbursement of drug costs will become an increasing challenge.
Morgan refers to the utility of adjuvant radiation therapy for cerebral metastases and quotes an uncontrolled retrospective series, from which, due to selection bias and other factors, only highly restricted conclusions can be made. Prospective randomised evidence for the benefit of adjuvant whole-brain radiation therapy awaits completion of an ongoing study by the Australia and New Zealand Melanoma Trials Group.
Competing interests
I have received institutional reimbursement for membership of advisory boards on drug development from Roche, GlaxoSmithKline and Bristol-Myers Squibb and travel assistance from GlaxoSmithKline to present clinical trial data.
References
- Kefford RF. Drug treatment for melanoma: progress, but who pays? Med J Aust 2012; 197: 198-199. CHDFIGCB
- Flaherty K, Puzanov J, Sosman J, et al. Phase I study of PLX4032: proof of concept for V600E BRAF mutation as a therapeutic target in human cancer. J Clin Oncol 2009; 27 (Suppl): abstract no. 9000.