Advancement in melanoma treatment found to significantly improve survival rates in patients
Clinical trial results have shown that when immunotherapy treatment is given before targeted drugs, this can increase survival rates by 20%.
Clinical trial results from ECOG-ARCIN Cancer research group have shown that immunotherapy treatment before targeted therapy can significantly improve the survival rates of advanced melanoma cases.
Michael Atkins, MD, an oncology professor, and deputy director of the Georgetown Lombardi Comprehensive Cancer Centre (WA, USA) has led a multicenter, Phase III trial DREAMseq ̶ sponsored by the National Cancer Institute. This research investigated the survival rates of metastatic melanoma patients in response to different treatment regimens (immunotherapy before targeted therapy vs targeted therapy alone). It was found that the 2-year overall survival rate for people who received immunotherapy before targeted therapy increased from 72% to 52%. This is a 20% increase in the progression-free survival rate whereby, the cancer status of patients remains stable or improving. These results were published in the Journal of Clinical Oncology (September 2022).
The trial started back in 2015, with 265 attendants each in the advanced stages of melanoma. Participants were randomly allocated into one of two groups, the first group was given the targeted therapy, in this case, dabrafenib and trametinib, and then immunotherapy if needed. Whilst the second group received immunotherapy treatment first (ipilimumab and nivolumab) before the targeted therapy treatment if needed. This trial finished early due to overwhelming evidence of the benefits of using immunotherapy first.
Michael Atkins, MD, commented on the results of the trial:
“In addition to DREAMseq, results from a major nationwide clinical trial (1) that enrolled patients at Georgetown Lombardi showed that if an immunotherapy called pembrolizumab was given both before and after, rather than after just surgery to remove tumor tissue, the two-year tumor-free survival rate increased from 49% to 72%. These two findings, along with other recent advances, point to significant promise for many people with melanoma.”
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This stark difference in survival rates with immunotherapy has been attributed to the association with the BRAF gene mutation BRAF V600 found in those with melanoma. It is thought that the combination of immunotherapy and targeted therapy enhances long-lasting tumor shrinkage, decreasing the progression of cancer into the central nervous system without interfering with the effectiveness of future alternative treatments. This combined approach of immunotherapy first, is thought to be more effective than solely prescribing drugs which target the BRAF V600 mutation.
There has been a dramatic decrease in the incidence of melanoma from 2015 – 2019 with an annual reduction of 4%. It is estimated that there will be 99,780 new cases of melanoma and 7650 deaths in 2022, according to the National Cancer Institute. The improved incidence and mortality rates are due to advancements in treatments such as those from Michael Adkins’ (MD) research group.
“While still a potentially devastating disease, advances in treatment for patients with metastatic melanoma have been nothing short of remarkable this past decade,”
However, there is further research to be done in this area. There are ongoing investigations into the treatment regimens of melanoma such as the sub-analysis of DREAMseq, looking into the effect on the quality of life of patients going through treatment. The initial findings have been presented with the full report to be available in 2023.
Other current research being conducted at Georgetown Lombardi Comprehensive Cancer Centre includes research by Geoffrey T. Gibney, MD looking into the biomarkers that may indicate when immunotherapy should be stopped to avoid toxicity and improve the quality of life for patients, by reducing visits to the oncology clinic.
These institutes for cancer research are vital to progress in the field, as stated by Andrew Pecora, MD, who led the clinical trial at John Theurer Cancer Center, (a part of Georgetown Lombardi):
“NCI-designated cancer centers and consortiums like ours are valuable and essential for practice-changing research […] Our clinical trial collaborations allow more opportunities for patients across a wider geographic area to have access to these important studies and that in turn leads to advances that can make a significant difference in people’s lives.”
Whilst there are still areas of melanoma treatment to be improved, as evidenced from this trial by the ECOG-ARCIN Cancer research group, the effectiveness of treatment is looking promising.
Source: Eurekalert press release, www.eurekalert.org/news-releases/965707
