In a nutshell
This study compared the frequency of allergic reactions to different doses of three biological therapies in patients with advanced melanoma. The authors found that different doses of the three drugs reduced the number of allergic reactions.
Biological therapy has significantly improved treatment results for patients with advanced melanoma. The major biological drugs are ipilimumab (Yervoy), pembrolizumab (Keytruda), and nivolumab (Opdivo). These work by stopping cancer cells from switching off the immune system. The immune system can then kill cancer cells. However, some patients develop allergic reactions. Little is known about how common allergic reactions are to the three main biological drugs and their different doses.
Methods & findings
Data from 9 studies with 5051 patients with advanced melanoma were examined. Patients received either high dose (10mg/kg) pembrolizumab every 2 weeks or 3 weeks or a low dose (2mg/kg) every 3 weeks. Other patients received a high dose (3mg/kg) nivolumab every 3 weeks. Others received high dose (10mg/kg) or low dose (3mg/kg) ipilimumab every 3 weeks. Some patients received low dose (1mg/kg) nivolumab plus low dose (3 mg/kg) ipilimumab every 3 weeks. Patients were followed for 5 to 38 months.
High dose nivolumab, low dose pembrolizumab, and high dose pembrolizumab every 3 weeks were the treatments that caused the least amount of allergic reactions. High dose nivolumab reduced patients’ risk of allergic reactions by 66% compared to high dose ipilimumab.
Low dose ipilimumab reduced patients’ risk of severe allergic reactions by 65% compared to high dose ipilimumab. High dose pembrolizumab every 2 weeks reduced patients’ risk of severe allergic reactions by 78% compared to high dose ipilimumab. Both high dose nivolumab and high dose pembrolizumab every 3 weeks reduced patients’ risk of severe allergic reactions by 80% compared to high dose ipilimumab.
High dose pembrolizumab every 2 weeks reduced patients’ risk of severe allergic reactions by 84% compared to low dose nivolumab plus dose ipilimumab.
High dose nivolumab was associated with the lowest risk of skin allergic reactions. High dose nivolumab was also had the lowest risk of gut allergic reactions such as diarrhea. Low dose ipilimumab had the lowest risk of allergic reactions in the liver and hypothyroidism. High dose pembrolizumab every 2 weeks was associated with the lowest risk of lung allergic reactions.
The bottom line
The authors concluded that high dose nivolumab, low dose or high dose pembrolizumab may be the preferred options for patients with a high risk of allergic reactions.
The fine print
The studies used in this analysis had different setups which limits confidence in the results. Many studies had short follow-up periods.
Published By :
JAMA network open
Mar 02, 2020