Immune-Based Therapy May Help When Melanoma Spreads to Brain
THURSDAY, July 12, 2018 -- A type of therapy that harnesses the immune system is giving new hope to people battling a once hopeless cancer -- melanoma that's spread to the brain.
New research involving more than 2,700 U.S. patients is confirming what specialists in the field have long known -- that "checkpoint blockade" treatment can beat back these devastating tumors.
"Physicians who treat patients with melanoma brain metastases have seen first-hand the dramatic improvements in survival that immunotherapy can achieve," said one such specialist, Dr. Jason Ellis.
"This study provides data to support our individual clinical observations," said Ellis, a neurosurgeon at Lenox Hill Hospital in New York City. He wasn't involved in the new study.
Checkpoint blockade agents are not chemotherapy -- instead of acting directly on tumor cells, they manipulate the patient's immune system so that it targets and destroys the melanoma cells.
This type of "immunotherapy" was approved by the U.S. Food and Drug Administration in 2011.
The new research was led by Dr. J. Bryan Iorgulescu, a postdoctoral fellow in pathology at Brigham and Women's Hospital/Harvard Medical School in Boston. His team explained that about one in every 54 Americans will develop a melanoma skin cancer in their lifetime.
Luckily, most cases are detected early and easily cured via surgery. But sometimes the tumor has had time to spread, even to the brain. In fact, advanced melanomas are now the third-leading cause of metastatic brain cancer, the research team noted.
In its analysis, Iorgulescu's group tracked outcomes from 2,753 patients with melanoma that had spread to the brain. The patients were treated at cancer centers nationwide between 2010 and 2015.
The study found that first-line treatment with checkpoint blockade immunotherapy was associated with a rise in median overall survival from 5.2 months to 12.4 months.
Treatment was also tied to an increase in the four-year overall survival rate: Just over 28 percent of patients who got the immunotherapy survived at least four years, compared to about 11 percent who didn't get the therapy, the findings showed.
The researchers noted that survival benefits were even greater for those patients whose melanoma had not already spread beyond the brain, to organs such as the liver or lungs.
"Our findings build on the revolutionary success of checkpoint blockade immunotherapy clinical trials for advanced melanoma, and demonstrate that their substantial survival benefits also extend to melanoma patients with brain metastases," Iorgulescu said in a Brigham and Women's news release.
Dr. Michael Schulder helps direct neurosurgery at Long Island Jewish Medical Center in New Hyde Park, N.Y. He wasn't involved in the new analysis, but agreed it confirms what many cancer specialists have long known, "namely, that the use of checkpoint inhibitors has revolutionized the treatment and outlook for patients with metastatic melanoma."
The Boston researchers did offer one caveat, however: Not every patient has equal access to this expensive treatment. Insurance status was a real barrier to immunotherapy for some patients with these advanced tumors, and uninsured patients were much less likely to get the treatment compared to people with private insurance or those on Medicare.
The findings were published July 12 in Cancer Immunology Research.
The U.S. National Cancer Institute has more on melanoma.
Posted: July 2018