Combination of nivolumab and radiotherapy in patients with locally advanced melanoma.

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.  

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. 

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

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.