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Posted by on May 30, 2019 in Melanoma | 0 comments

In a nutshell

This article investigated the safety and effectiveness of nivolumab (Opdivo) in combination with stereotactic body radiotherapy (SBRT) for patients with locally advanced melanoma unsuitable for surgery. The authors concluded that this therapy is effective with manageable side effects in these patients.  

Some background

Melanoma is a cancer of melanocytes. These are a type of skin cell responsible for skin color. Nivolumab is a standard treatment for patients with inoperable melanoma (unsuitable for surgery) and metastatic melanoma (spread from the original site to another place in the body). It is a monoclonal antibody (laboratory-produced molecules engineered to stimulate the immune system to destroy cancer cells). However, most patients do not respond to this treatment alone. 

An alternative treatment is combining it with radiotherapy. Stereotactic body radiotherapy (SBRT) uses high doses of radiation from different angles to meet on the tumor and kill cancer cells and shrink tumors. The long term effects of combining nivolumab and SBRT in patients with high-risk melanoma unsuitable for surgery remain under investigation. 

Methods & findings

The study involved 20 patients with inoperable or metastatic melanoma. Patients were given nivolumab injections every 2 weeks along with SBRT in 3 sessions. The first session was after 48 hours, the second at 96 hours and the last one the day before the second cycle of nivolumab. The outcomes measured were overall response rate and side effects. The average follow-up was 13.1 months.

The overall response rate was 45%. The average survival time without cancer growing or spreading was 6.5 months.

17 (85%) patients experienced itch, tiredness, nausea, skin rash, low white blood cells, and inflammation of the thyroid. 1 patient experienced inflammation of the lung due to the radiation. 2 patients experienced lung inflammation not related to the radiation. 4 (20%) patients stoped treatment due to the side effects. No life-threatening side effects occurred.

The bottom line

The authors concluded that nivolumab and SBRT combination is effective with manageable side effects in patients with advanced melanoma.  

The fine print

The number of participants was very small. Also, there was no comparison group. Further studies are needed to determine the effectiveness of this treatment combination.

Published By :

International journal of radiation oncology, biology, physics

Date :

Apr 02, 2019

Original Title :

Phase 2 trial of nivolumab combined with stereotactic body radiotherapy in patients with metastatic or locally advanced inoperable melanoma.

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