Immunotherapy combo extends lives in metastatic melanoma

A new hope: Ipilimumab and Nivolumab for resistant melanoma.

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Advances in medical research have led to a significant breakthrough in treating metastatic melanoma, a severe form of skin cancer. A powerful combination of immunotherapy drugs has emerged as a promising solution, demonstrating the potential to extend the lives of patients facing this challenging condition.

Researchers from UCLA have found a new way to treat a tricky kind of skin cancer. They tried a combination of drugs that work with the immune system. These drugs helped patients with this cancer who didn’t respond to other treatments.

The doctors tested these drugs on patients and saw good results. The combination of drugs stopped the cancer from worsening for a longer time. It also helped patients who didn’t respond to the usual treatments. It means more people could benefit from this treatment.

The treatment used two drugs, ipilimumab and nivolumab. When used together, they worked better than just using ipilimumab. It is good news for people with this type of cancer.

A group called the SWOG Cancer Research Network did the study with support from the National Cancer Institute. They shared their findings in the journal Nature Medicine.

Dr. Antoni Ribas, the study’s senior author, a professor of medicine at the David Geffen School of Medicine at UCLA and director of the UCLA Health Jonsson Comprehensive Cancer Center’s Tumor Immunology Program, said, “The results are practice-changing. The combination approach should be the preferred drug regimen for cancer patients who have not responded to prior immunotherapy treatment.”

Two drugs, ipilimumab, and nivolumab, work together to help the immune system fight cancer. They block proteins that stop the immune system from attacking cancer cells. Nivolumab targets a protein called PD-1, and ipilimumab targets a protein called CTLA-4. It helps the immune system’s T cells attack cancer cells naturally.

People with tough skin cancer and metastatic melanoma are given PD-1 inhibitors first. But more than half of these cancers don’t respond to this treatment. When that happens, patients try CTLA-4 inhibitors.

Researchers wondered if patients who didn’t respond to PD-1 inhibitors could take both drugs or switch to CTLA-4 inhibitors. They found that combining both drugs could activate the immune system better, making it work against cancer. It could help those who didn’t respond to the PD-1 inhibitor alone.

The study was led by a researcher named Ribas. It was supported by the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research.

Scientists tested a new way to treat skin cancer that doesn’t respond to the usual treatments. They included 91 patients who had tried one therapy in their study, but it didn’t work. These patients had a severe type of skin cancer that didn’t get better with the first treatment.

They split the patients into two groups: one group got two drugs, ipilimumab and nivolumab, together. The other group got only ipilimumab. The doctors checked how long the patients lived without cancer worsening if the immune cells were fighting cancer, and how the patients’ bodies reacted to the treatment.

The group with both drugs had better results. Their cancer stayed the same or got better for longer compared to the group with only ipilimumab. More of them also saw their tumors getting so smaller.

The side effects of the treatment were similar to what doctors already knew about. Diarrhea was the main severe side effect, which happened at the same rate in both groups.

One of the researchers, Dr. Ribas, said, “About one-third of the patients on the combination treatment did better.” He explained that patients with this type of skin cancer can start with one drug and only add the other if needed. This way, only those who need the extra treatment get its side effects.

Grants from SWOG, the National Institutes of Health, and the National Cancer Institute supported the study. The study’s lead author is Dr. Ari VanderWalde from West Cancer Center and Research Institute.

Journal Reference:

  1. VanderWalde, A., Bellasea, S.L., Kendra, K.L. et al. Ipilimumab with or without nivolumab in PD-1 or PD-L1 blockade refractory metastatic melanoma: a randomized phase 2 trial. Nature Medicine. DOI: DOI: 10.1038/s41591-023-02498-y.