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In less than a decade, we have witnessed what may turn out to be the start of a true paradigm shift in cancer therapy. The introduction of targeted and immune therapies has been rapid. In 2010, advanced melanoma had a median overall survival of 6–9 months and less than 20% could expect to be alive at 2 years. Palliative chemotherapy with dacarbazine, the standard of care, did not improve survival.1 They very much needed palliative care—for symptom management, advance care planning and multidisciplinary support to get the best out of their remaining time. But by 2018, the very same patients, if they receive combination CTLA-4 and PD-1 blocking agents, have a 3-year median survival of 58%. These outcomes are associated with 59% incidence of grade 3 or 4 treatment-related adverse events.2
Immunotherapy agents target a range of immune surveillance mechanisms that are active against cancer cells, and outcomes of a succession of quickly evolving protocols continue to improve as new regimens are trialled. In relation to melanoma, the words ‘durable response’ may indeed one day be replaced …
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