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Immunotherapy Drug Combination Shows Promise in Melanoma

Immunotherapy Drug Combination Shows Promise in Melanoma
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Published on August 3, 2021

New Therapies Improve Progression-Free Survival in Melanoma

Approximately 106,110 people in the United States will be diagnosed with melanoma in 2021. New drugs including immunotherapies and targeted therapies have improved outcomes for people diagnosed with this form of skin cancer. Between 2014 and 2018, the death rate in the U.S. from melanoma decreased by 4.4 percent annually for women and 5.7 percent annually for men — the sharpest decrease in deaths from any cancer type during this period.

“Over the last decade or so, drugs that target the immune checkpoints, like PD-1, have dramatically improved survival rates for patients with a wide variety of cancers, including melanoma,” said Evan Lipson, MD, a melanoma and immunotherapy expert at Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine. There are currently four immune checkpoint inhibitors approved by the U.S. Food and Drug Administration (FDA) for the treatment of melanoma.

Dr. Lipson spoke while presenting results at the American Society of Clinical Oncology (ASCO) Annual Meeting, held June 4-8, on a novel combination of two immunotherapy drugs being studied in people with metastatic melanoma. Nivolumab (Opdivo) has been approved for patients with advanced melanoma since 2014 and works by binding to the protein PD-1, which is found on the exteriors of immune cells. Blocking PD-1 spurs the immune cells to attack and kill cancer cells. The second drug, relatlimab, has not been approved by the FDA and targets LAG-3, another protein found on immune cells, also with a goal of spurring the immune system to attack the cancer.

For the study, researchers randomly assigned 355 participants to take a combination of relatlimab and nivolumab and 359 patients to take nivolumab alone. Approximately 40 percent of the participants had brain metastases. The median progression-free survival (PFS) was months longer with the novel combination of immunotherapy drugs than with nivolumab alone, with patients living 10.1 versus 4.6 months without their cancer growing, respectively. At one year, PFS rates were 48 percent for patients receiving the immunotherapy combination and 36 percent for those receiving nivolumab alone.

“In general, the treatment-related adverse events associated with rela plus nivo were manageable and reflected the safety profile typically seen in the immune checkpoint inhibitors,” Dr. Lipson said. More than 85 percent experienced itching and fatigue. Lower numbers of participants experienced rash, joint pain, hypothyroidism, diarrhea, and vertigo.

“In conclusion, administration of rela plus nivo in patients with previously untreated, unresectable or metastatic melanoma led to a significant improvement in progression-free survival compared to nivo alone,” Dr. Lipson said.

The results also bode well for people with different cancer types. “Additionally, our results further validate a LAG-3 immune checkpoint as a therapeutic target in cancer and support the continued development of rela in patients with other malignancies,” Dr. Lipson added.

~Lauren Evoy Davis

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