Half of patients now survive 'untreatable' melanoma
Author: Mark Gould
More than half of patients can now survive stage 4 metastatic melanoma - a progression that was considered untreatable just a decade ago, a new study has found.
Only around one in 20 patients with advanced melanoma survived 10 years ago, with many dying within six to nine months of diagnosis.
However, tests of a new combination of immune-boosting drugs found that 52 percent of patients survived, with 74 percent of those patients going treatment-free after five years.
Results from a new trial led by the Royal Marsden NHS Foundation Trust showed that when taken together, ipilimumab (Yervoy) and nivolumab (Opdivo) can stop or reverse the progression of advanced melanoma by helping patients’ immune systems recognise and destroy the cancerous cells.
Medical oncologist Professor James Larkin, who led the research and is also a professor at the Institute of Cancer Research, described the findings as a "huge milestone" in the battle against the disease.
The findings* of the study were presented at the European Society for Medical Oncology meeting in Barcelona, Spain, and published in The New England Journal of Medicine.
During the trials, three groups of patients were given various combinations of the drugs, with the first group, comprising of 314 participants, given both nivolumab and ipilimumab. A second group, with 316 test subjects, were given nivolumab plus a placebo while 315 patients in a third group received ipilimumab along with a placebo.
While the survival rate was over 52 percent for the first group, the overall survival for the nivolumab group was 44 percent and for the ipilimumab group it was 26 percent.
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.
Melanoma is the fifth most common cancer in the UK and kills more than 2,000 people every year. Around 16,000 people were diagnosed with the disease in 2016, according to the most recent figures available.
Professor Larkin said: "In the past, metastatic melanoma was regarded as untreatable. This is the first time we can say that the chances of being a long-term survivor of advanced melanoma are now over 50 percent, which is a huge milestone."
The treatment is now recommended by the National Institute for Health and Care Excellence (NICE) and is available on the NHS, following assessments by doctors.
Professor Larkin 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."
He added: "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."
*LBA68_PR ‘5-year survival outcomes of the CheckMate 067 phase 3 trial of nivolumab plus ipilimumab (NIVO+IPI) combination therapy in advanced melanoma‘. Presented by James M. Larkin during the Proffered Paper session on Saturday, 28 September, 2019, EMSO conference 2019.