Immunotherapy Suggested as Best First-line Treatment for Advanced Melanoma

Immunotherapy Suggested as Best First-line Treatment for Advanced Melanoma

Combining immunotherapy options in patients diagnosed in advanced stages of cutaneous melanoma, a deadly skin cancer, improves survival and decreases the risk of serious adverse events, according to a new study published in the journal JAMA Oncology.

The study, which evaluated a number of targeted therapies and immunotherapies as first-line treatment for advanced melanoma patients, is titled “Systemic Therapy for Previously Untreated Advanced BRAF-Mutated Melanoma” and was conducted by researchers from McMaster University in Canada.

Cutaneous melanoma is an aggressive form of skin cancer that accounts for 3.3 percent of new cancer cases in Canada every year. If discovered in its early stages, melanoma can be cured with surgery, but most patients find out about the disease in a more advanced stage, when surgery is no longer possible and drug therapy is the only option available.

Because most cases of cutaneous melanoma have a mutation in the BRAF protein, many treatments target this protein. There are two types of treatment available for BRAF melanoma: targeted therapy, which blocks cancer growth, and immunotherapy, which helps the immune system attack cancer cells. But it has been unclear which of these treatments was best for newly diagnosed patients with advanced BRAF-mutated melanoma.

“This is the first analysis to draw [a] comparison between targeted and immune therapies for BRAF-mutated melanomas,” Feng Xie, the senior author of the study, said in a news release. “Our results will help patients and clinicians choose treatments.”

Researchers sought to compare the effectiveness and safety of these therapies in patients with advanced BRAF-mutated melanoma who had not not yet received any treatment. They analyzed the results from 15 trials published from 2011 to 2015, evaluating the effects of targeted therapies or immunotherapies in 6,662 patients with metastatic melanoma, or whose cancer had spread to the lymph nodes and to whom surgery was not an option.

The analysis showed that BRAF/MEK targeted therapies and PD-1 checkpoint inhibitors were equally effective in improving patients’ overall survival. But while combined inhibition of both BRAF and MEK was the most effective in improving progression-free survival, inhibition of PD-1 was associated with lower risk of serious adverse events.

This suggested that immunotherapies targeting the PD-1/PD-L1 pathway can be used as first-line therapy for BRAF-mutated advanced melanoma patients in whom quick action is not a priority.

“While the data in our study represents best available evidence, using more than one kind of immunotherapy shows promise in early outcomes in clinical trials and could change the treatment landscape once longer-term results are published,” Xie said.