10 years ago, only one in 20 patients lived five more years after being diagnosed with advanced melanoma. Most died in a matter of months.
But now, more than half of patients can now survive a type of deadly skin cancer that until recently was considered intractable, according to a UK study.
Two drugs designed to take advantage of the body’s immune system —ipilimumab and nivolumab— allow 52% of patients to live at least five years after diagnosis, according to a clinical trial conducted by Royal Marsden Hospital of the UK National Health System.
Doctors said both drugs have led to” extraordinary transformation ” and rapid attention to melanoma, the most dangerous type of skin cancer.
How hard is it to treat melanoma?
According to the World Health Organization, two to three million cases of skin cancer are diagnosed in the world every year.
Of these, only 1% are melanoma, responsible for 90% of deaths from skin cancer.
If melanoma is detected in the early stages, the chances of survival are good.
But as the cancer becomes more aggressive and spreads throughout the body (known as metastatic cancer), survival collapses.
“In the past, metastatic melanoma was considered intractable,” says Professor James Larkin, an oncology consultant at Royal Marsden hospital and one of the authors of the research, funded by Bristol-Myers Squibb pharmaceutical.
“Oncologists believed that melanoma was different from other cancers, which could not be treated once it spread,” he explains.
People tended to live between six and nine months after diagnosis.
What were the results of the study?
The trial tested two immunotherapy drugs designed to improve the immune system and allow it to attack cancer.
There were 945 patients in the trial. One third received nivolumab, one third received ipilimumab and one third received both.
Doctors measured the proportion of patients who were still alive after five years.
It has been the most extraordinary transformation of a disease that was considered, among all cancers, to be the most difficult to treat and with the most serious prognosis,” he says.
Larkin says there is now “the possibility that 50% of people with stage four melanoma will still be alive five years after receiving immunotherapy treatment.”
The findings were presented this Saturday at a meeting of the European Society of Medical Oncology in Barcelona and published in the New England Journal of Medicine.
What do patients say?
Pam Smith, 67, from the UK, began participating in the clinical trial in January 2014.
She was” devastated “when she was told that her cancer was intractable and believes that she” would not have had a chance ” to survive without immunotherapy.
Smith received treatment once every two weeks for four months, but the drugs caused him diarrhea as severe as a side effect that he could no longer take.
The size of your tumor was halved after treatment and hasn’t grown since. Smith now feels”brilliant.”
“I might not have seen my grandchildren. Just over five years ago it happened and my youngest grandson turned six on the weekend, ” he tells the BBC. “I wouldn’t have seen him or my other grandchildren grow up.
Are the patients cured?
Saying “cured” is always difficult in cancer, but five-year survival is an enormously significant milestone.
Some patients who took the medicines are in total remission, with no signs of abnormality in the evaluations.
Others like Pam Smith still have a tumor inside their bodies, but it’s not growing anymore.
Of the patients who survived, 74% no longer need any type of cancer treatment.
How does immunotherapy work?
Immunotherapy is a Nobel Prize-winning science that makes the intractable treatable.
This technique is one of the most exciting in cancer treatment.
The immune system constantly patrols our bodies, fighting hostile invaders like viruses.
It should also attack cancers, but these are a corrupt version of healthy tissue and can develop ways to evade our defenses.
Ipilimumab and nivolumab prevent some cancers from hiding and allow the immune system to attack.
Both drugs disrupt the chemical signals cancer uses to evade our defenses.
Nivolumab blocks the white blood cell off switch called PD-1. Ipilimumab blocks a similar switch called CTLA-4.
In other words, they disable the brakes of the immune system.
“By administering these drugs together, we are effectively removing two brakes from the immune system instead of one so that the system can recognize tumors that it did not recognize before, react and destroy,” explains Professor Larkin.
Are there any side effects?
Yes, medicines change the way the immune system works inside the body and that can have consequences such as fatigue, skin rashes, and diarrhea.
Some effects are severe enough that patients like Pam Smith cannot complete a full course of treatment.
However, even a brief period of immunotherapy had a lasting benefit on the patients ‘ immune system.