Immune, Targeted Therapies Plus Radiation Ups Survival in Melanoma Patients With Brain Metastases

Researchers at Moffitt Cancer Center in Tampa, Fla., demonstrated how novel immune and targeted therapies with radiation therapy may improve the outcomes of patients with melanoma who have brain metastases.

First reported in the Annals of Oncology, this positive news may help patients with melanoma, the deadliest form of skin cancer, that has spread to the brain survive longer than the median survival of only 4 to 5 months.

In 2016, more than 144,000 people in the United States will be be diagnosed with melanoma. Of these, approximately, 76,000 will be diagnosed with invasive (stage I, II, III or IV) melanoma and another 66,000 will be diagnosed with melanoma in situ (stage 0), according to the Melanoma Research Foundation. Because melanoma can extend beyond the skin (eyes, scalp, nails, feet, mouth, and other places), early detection and new therapies are crucial to slow this disease.

“Conventional chemotherapy has failed to improve outcomes in patients with melanoma brain metastases,” said Kamran A. Ahmed, MD, lead study author and resident in the Department of Radiation Oncology at Moffitt, in a news release. And because of this, the team has studied new methods of treatment.

Previous studies out of Moffitt show the immunotherapy agent, nivolumab (Opdivo), which targets the protein PD-1, combined with stereotactic radiation therapy, is effective and safe in patients with melanoma brain metastases.  

Dr. Ahmed and his team analyzed data from 96 patients with melanoma brain metastases who were treated with stereotactic radiation therapy within 3 months of targeted therapies (anti–PD-1 therapy, anti–CTLA-4 therapy, BRAF inhibitor plus a MEK inhibitor, or a BRAF inhibitor alone) or chemotherapy.

Their findings showed that targeted treatments were able to control tumor growth outside the irradiated field in the brain better than standard chemotherapy. Patients who were treated with radiation therapy after anti–PD-1 therapy or BRAF/MEK inhibitors had the best tumor control out of all treatment groups analyzed.

Patients treated with stereotactic radiation and either anti–PD-1 therapy or BRAF/MEK inhibitors also had improved survival when compared to the survival of other treatment groups. Forty-one percent of patients treated with anti–PD-1 therapy and 39% of patients treated with BRAF/MEK inhibitors survived 1 year without systemic disease progression. However, 5% of patients given conventional chemotherapy survived 1 year without systemic disease progression. Patients in the anti-PD-1 therapy arm experienced similar overall survival rates of 1 year, 65% for BRAF/MEK inhibitors, and 10% for conventional chemotherapy.

Having this additional 12 months may be very meaningful for patients and their families.