Personalized Cancer Vaccines and Immunotherapy Advance Melanoma Care

In this interview with Pharmacy Times at Oncology Pharmacists Connect in Austin, TX, Heidi Finnes, PharmD, BCOP, FHOPA, Director, Clinical Ambulatory Pharmacy Practice, Mayo Clinic, discusses recent advances in cutaneous oncology, highlighting the growing role of personalized immunotherapy and neoantigen-based cancer vaccines. She reviews emerging data on individualized mRNA vaccine approaches designed to enhance responses to pembrolizumab in melanoma, underscoring the potential for more durable disease control and improved patient outcomes. Finnes also emphasizes the critical role of oncology pharmacists in managing treatment-related toxicities associated with novel targeted therapies and immunotherapies, including adverse events requiring close monitoring and supportive care. Drawing from both her professional expertise and personal experience as a metastatic melanoma survivor, she reflects on the dramatic improvements in survival outcomes over the past two decades while highlighting the need to improve equitable access to innovative therapies.

Pharmacy Times: The treatment landscape for cutaneous malignancies has evolved significantly in recent years. Which recent advances do you believe have been the most practice-changing, and how are they influencing treatment decisions in clinical practice?

Heidi Finnes, PharmD, BCOP, FHOPA: I think the most exciting treatment advances are those involving immunotherapy that is becoming increasingly personalized for patients with melanoma, as well as for patients with other types of skin cancer.

One of the abstracts we discussed focused on intismeran, a personalized mRNA vaccine composed of 34 neoantigens that are specific to an individual patient's tumor. The vaccine is designed to enhance the immune response to pembrolizumab and further strengthen antitumor activity.

I think this approach has the potential to further reduce the risk of recurrence in patients with melanoma. More broadly, it represents an important step forward in the evolution of immunotherapy by making treatment more personalized and potentially creating more durable, long-lasting responses. It is an exciting example of how advances in precision medicine and immunotherapy are continuing to reshape the treatment landscape for skin cancers.

Pharmacy Times: As novel immunotherapies and targeted therapies continue to expand treatment options for patients with cutaneous cancers, what are some of the most important considerations for oncology pharmacists when monitoring and managing treatment-related toxicities?

Finnes: I think there are many opportunities for oncology pharmacists as these treatments continue to evolve. Many pharmacists are already heavily involved in the management of immune-related adverse events associated with immunotherapies and targeted therapies. However, we are also beginning to see increasingly personalized treatment approaches that are tailored to a patient's specific genomic profile.

For example, we discussed a clinical trial in uveal melanoma evaluating darovasertib, a novel PKC inhibitor. Although the agent is associated with significant adverse effects, many of these toxicities are familiar to oncology pharmacists and include diarrhea, hypotension, peripheral edema, skin toxicities, and nausea and vomiting.

Because pharmacists have extensive experience managing these adverse effects, we are well positioned to help patients tolerate these therapies more effectively through proactive monitoring and more frequent follow-up. These advances also create additional opportunities for collaboration with specialty pharmacy colleagues to support patients throughout treatment.

As the treatment landscape for cutaneous malignancies continues to evolve, I believe there will be many opportunities for pharmacists to contribute to toxicity management, patient education, treatment adherence, and multidisciplinary care coordination, ultimately helping patients achieve better outcomes.

Pharmacy Times: Many patients with advanced skin cancers now have access to therapies that were unavailable just a few years ago. How has this shift affected patient outcomes, and where do you still see unmet needs in cutaneous oncology care?

Finnes: I will share a personal story. I am actually a metastatic melanoma survivor and a patient myself. I was diagnosed in 2008, and at that time, the immunotherapies we have today were not available. Patients were primarily treated with older immunotherapy agents such as interleukin and interferon, as well as chemotherapy.

The advances that have occurred since then have been remarkable. By the time I developed metastatic disease in 2015, immunotherapy had become available. I was also treated at a larger institution, where I received an autologous vaccine created from my own cancer cells. The transformation in melanoma treatment over that period has been extraordinary and has helped patients live significantly longer.

In 2008, survival rates for patients with metastatic melanoma were less than 10%. Today, survival rates are approximately 35% to 40% for patients with metastatic disease. The science has advanced tremendously, and treatments are becoming increasingly personalized to a patient's individual tumor biology. This personalization creates opportunities for patients to achieve longer and more durable survival outcomes, and I think that is one of the most encouraging developments in oncology.

One concern I do have is ensuring equitable access to these highly individualized therapies. Many patients receive care in community settings, and it is important to consider whether all patients will have access to personalized vaccines and other advanced immunotherapy approaches in the same way that patients treated at major academic centers or enrolled in clinical trials do. As pharmacists, we have an important responsibility to advocate for our patients and help ensure that these advances are accessible to everyone who may benefit from them.

Pharmacy Times: Looking ahead, what emerging research areas or therapeutic approaches in cutaneous oncology are you most excited about, and what developments should oncology pharmacists be watching closely over the next few years?

Finnes: In cutaneous malignancies, I think the future will involve a combination of targeted therapies, immunotherapies, and personalized vaccines developed from melanoma or other skin cancer–specific cells. All of these approaches have the potential to play an important role in improving patient outcomes.

What we still do not fully understand is the optimal sequencing of these treatments. Determining when targeted therapies, immunotherapies, and personalized vaccine approaches should be used, and in what order, remains an important unanswered question.

I am excited to see how the field continues to evolve as we make further advances in harnessing the immune system to fight cancer. While the progress to date has been remarkable, I think we are still in the early stages of understanding how best to integrate these treatment modalities. There is still much to learn, and I look forward to seeing how future research helps define the next steps for the treatment of cutaneous malignancies.