Combined cancer drugs show promise for melanoma
1st June 2015 – A combination of 2 immunotherapy cancer medications could help around 60% of people with advanced melanoma, according to a UK-led trial.
The scientists found that a higher proportion of patients with melanoma – the most serious type of skin cancer – responded to a combination of ipilimumab and nivolumab than when only given ipilimumab.
However, many of the patients who received both drugs underwent significant side-effects and a significant proportion abandoned the trial.
Immune response to cancer
Both ipilimumab – which is also known by its brand name Yervoy – and nivolumab – which is also known as Opdivo – work by targeting proteins on a patient's immune cells that allow them to more effectively hunt down and destroy cancer cells.
Trials have shown this type of treatment can be very effective – although not for all patients.
The latest study, published in the New England Journal of Medicine and presented at the American Society of Clinical Oncology, is one of a number of recently published trials of immunotherapy that is seen as an exciting development in cancer treatment.
Phase III trial
The international trial involved 945 patients with advanced melanoma who were randomly assigned to 3 groups to receive ipilimumab alone, nivolumab alone or a combination of both.
Of the 314 people receiving the combination, 57.6% saw a significant reduction in tumour size compared with 43.7 of those receiving nivolumab by itself and 19% of those given ipilimumab.
This meant that patients receiving both medications seeing their tumours either stable or shrinking for an average of 11.5 months. Those receiving nivolumab alone had the same outcome for 6.9 months, while those on just ipilimumab could only expect tumours to be stable or shrink for 2.9 months.
The study, which was funded by Bristol-Myers Squibb which makes both medications, was led by Dr James Larkin, a consultant medical oncologist from The Royal Marsden Hospital in London.
Co-author Dr Jedd Wolchok, from the Memorial Sloan Kettering Cancer Center in the US, says in a statement: "All the early preclinical and clinical work supported the idea that combining these two immunotherapy drugs could result in better outcomes for patients.
"We're encouraged by the progression-free survival data we're currently reporting. It is a testament to how drastically immunotherapy has altered the prognostic landscape for some advanced melanoma patients. Just 5 years ago, many of these patients would have been expected to live for only 7 months following diagnosis – but it's important to remember that overall survival data for this group is not yet available."
The trial also revealed serious side effects, the most common of which were diarrhoea and colitis. These side-effects were serious enough for over a third of the participants receiving both medications to pull out of the trial.
Commenting on the results in a statement, Henry Scowcroft, senior science information manager at Cancer Research UK, says: "Harnessing the power of our immune system to fight cancer will be an essential part of future treatments. New and emerging immunotherapies are already making a real difference for patients, and we’re looking forward to seeing more exciting developments over the coming months and years.
"There are two key issues that urgently need addressing: identifying which patients will benefit most, and understanding how to manage the side effects, which – for a minority – can be quite serious.
Last week, another immunotherapy study showed how a genetically modified herpes virus could spark the immune system into action, helping to combat advanced melanoma.