Half of patients now surviving ‘untreatable’ advanced melanoma
Two immunotherapy drugs taken together prevented the progression of advanced melanoma in one in two patients.
A combination therapy that uses two powerful drugs to help the immune system fight melanoma can increase a patient’s long-term survival chances by 50%, a study suggests.
Results from a new trial led by the Royal Marsden NHS Foundation Trust has revealed when taken together, ipilimumab (Yervoy) and nivolumab (Opdivo) can stop or reverse the progression of advanced melanoma – a form of skin cancer known for their mole-like appearance caused by uncontrolled growth of pigment-producing cells in the skin – for five years or more in one in two patients.
Both are immunotherapy drugs that work by helping the immune system find and destroy cancer cells as they spread.
This treatment is recommended by National Institute for Health and Care Excellence and is available in this combined way on the NHS, following assessments by doctors.
Professor James Larkin, consultant medical oncologist at the Royal Marsden NHS Foundation Trust and a professor at the Institute of Cancer Research, said: “By giving these drugs together you are effectively taking two 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.”
The findings will be presented at the European Society for Medical Oncology meeting in Barcelona, Spain, and published in The New England Journal of Medicine.
A decade ago, only one in 20 patients with advanced melanoma would survive for five years, with many living for just six to nine months.
Prof Larkin said: “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%, which is a huge milestone.”
Patients taking part in the Checkmate 067 trial were divided into three groups.
The first group, comprising of 314 participants, were given nivolumab and ipilimumab.
The second group, with 316 test subjects, were given nivolumab plus a placebo while 315 patients in the third group received ipilimumab along with a placebo.
The five-year overall survival rate for the combination group was 52%, with 74% of those patients going treatment-free after five years.
The overall survival for the nivolumab group was 44%, while for the ipilimumab group, it was 26%.
Importantly, for those patients who stopped treatment because of side-effects such as fatigue, skin rashes and diarrhoea, the outcome was just as good as it was for those who were on the combination for longer, the researchers said.
However, Prof Larkin warns there is currently no method to predict which patients are most likely to benefit from combination immunotherapy.
He said: “The decision on which treatments to give is a matter for doctors to discuss with individual patients and their families.
“The two drugs together definitely have a role in treating metastatic melanoma and will be the choice for some patients. For others, the decision may be to give the drugs in sequence.”
Melanoma accounts for around 2,300 deaths in the UK every year. Around 16,000 people were diagnosed with the disease in 2016, the most recent figures available.