Monday, September 30, 2019

Immunotherapy drugs when combined prevent melanoma progression

In a new trial, researchers have discovered that a combination of 2 immunotherapy drugs-ipilimumab and nivolumab- is capable of reversing or preventing the progression of advanced melanoma for 5 years or more in every 2 patients.

Just 10 years ago, only 1 in 20 patients with advanced melanoma would survive for 5 years- with many living for just 6-9 months.


The results of the trial,  represent the longest phase 3 trial follow-up for checkpoint inhibitor combination therapy.


In the past, metastatic melanoma was regarded as untreatable. Oncologists considered melanoma different to other cancers-- it couldn't be treated once it had spread. This is the first time we can say that the chances of being a long-term survivor of advanced melanoma are now over 50%, said one of the researcher.


Researchers incorporated 945 patients with advanced melanoma randomised into 3 groups- 314 patients received the ' double-hit' of nivolumab + ipilimumab; 316 patients received nivolumab + a placebo; and 315 patients received ipilimumab + placebo.


Each nivolumab arm was compared to ipilimumab by itself, and was administered until the disease progressed or until any side-effects became unacceptable.


The 5 year overall survival rate for the combination of nivolumab + ipilimumab was 52 %, with 74 % of those patients treatment-free after 5 years. The overall survival for nivolumab was 44 % and 26% for ipilimumab.


The Prof. explained, by giving these drugs together you're effectively taking 2 brakes off the immune system rather than one so that the immune system is able to recognise tumours it wasn't previously recognising and react to that and destroy them.


Importantly, for those patients who stopped treatment because of side-effects such as fatigue, skin rashes and diarrhea, the outcome was just as good as it was for those who were on the combination for longer.


One of the key points about immunotherapies is that the immune system can be re-educated even with a short duration of treatment. This is in contrast to other treatments like chemotherapy which can require a full course to be as effective.


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