Melanoma Relapse Can Be Reduced By Immune Therapy

Patients with high-risk melanoma who had a course of Pembrolizumab after their surgery had a long time before their disease recurred than patients who got either Ipilimumab or high-dose interferon after surgery.

Patients with high-risk melanoma who had a course of Pembrolizumab after their surgery had a long time before their disease recurred than patients who got either Ipilimumab or high-dose interferon after surgery as per a large SWOG Cancer Research Network clinical trial, S1404, to be presented at the ASCO annual meeting.

The study enrolled randomized 1,345 adult patients with stage III or IV melanoma who had undergone surgery to remove their tumors and were assigned at random to either the Pembrolizumab arm or the control arm.

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‘Patients with high-risk melanoma who had a course of Pembrolizumab after their surgery had a long time before their disease recurred than patients who got either Ipilimumab or high-dose interferon after surgery. Thus the immune therapy after surgery is shown to lower the relapse risk in high-risk melanoma patients with a 32% rate of side effects for Pembrolizumab and 58% for those on Ipilimumab.’

Those on the control arm decided with their physicians whether to follow a course of high-dose interferon or a course of Ipilimumab, (both FDA approved).The overall survival was also measured.

Pembrolizumab Vs Ipilimumab

The high-dose interferon and Ipilimumab are the standard of care treatments for these patients at the start of the study, often come with serious side effects. Whereas, Pembrolizumab is an immunotherapy drug known as a PD-1 inhibitor, that was chosen for the trial because of its comparatively low toxicity, its activity in metastatic disease, and recurrence-free survival benefit when compared to a placebo.

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It was shown that there was no statistically significant difference in overall survival rates between the two groups of patients three and one-half years after the last patient enrolled in the trial.

However, patients taking Pembrolizumab had fewer serious side effects than those treated with either high-dose interferon or Ipilimumab (72% had severe side effects of grade 3 or higher adverse events). Thus the rate of such side effects was about 58% for those on Ipilimumab, but only about 32% for Pembrolizumab.

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Skin cancer is an abnormal growth of skin cells. It can develop due to a continuous exposure to sun over the years.

"The recurrence-free survival advantage and improved safety profile over the previous standard of care make this therapy a continued standard for treating patients with high-risk resected melanoma. The overall survival analysis was performed at a pre-defined time point with only approximately 50% of events needed for a fully powered analysis. We suspect that effective use of PD-1 blockade and other improved therapies for stage IV disease improved outcomes of relapsing patients on the control arm such that overall survival was not different between the two groups," says Kenneth F. Grossmann, MD, Ph.D., of the Huntsman Cancer Institute at the University of Utah Medical Center and chair of SWOG's Melanoma Committee and the lead investigator on the study.

The authors affirm that further data are required to evaluate pre-treatment predictors of treatment benefits, quality of life and better understand the impact of relapse in patients with high-risk resectable melanoma.

Source-Medindia