Immunotherapy after chemotherapy shows promising results in advanced melanoma

The authors aimed to determine survival and response rates of patients treated with immunotherapy following regional chemotherapy.

Regional chemotherapy is chemotherapy that targets a specific area in the body. It is carried out using isolated limb infusion (isolates blood flow to the limb to allow for a more concentrated chemotherapy) or hyperthermic isolated limb perfusion (delivers targeted treatment to the diseased limb to decrease damage caused to the rest of the body), which deliver high concentrations of chemotherapy drugs to a specific site.

Immunotherapy is a treatment that uses the bodies own immune system to fight against cancer cells by either stopping, enhancing  or promoting an immune response. IL-2 (Aldesleukin, Proleukin or Interleukin 2) and ipilimumab (Yervoy) are drugs used in immunotherapy that target and treat melanoma.

The aim of this study was to determine safety and efficacy of using immunotherapy after regional chemotherapy in in-transit (cancer cells are more than 2cm from the primary tumor site) advanced melanoma.

33 patients were used in this study who underwent both regional chemotherapy followed by immunotherapy (at least one dose of IL-2 and/or ipilimumab). 15 patients received IL-2 treatment (IL-2 alone or in combination with another drug), 12 received ipilimumab treatment (ipilimumab alone or in combination with another drug) and 6 patients received IL-2 followed by ipililmumab.

Treated with IL-2 alone, 100% (15/15) of patients experienced cancer progression. When treated with ipilimumab alone, 75% (9/12) experienced cancer progression and 25% (3/12) experienced a complete response to treatment (all signs of cancer disappear in response to treatment).

6 patients were treated with both drugs. Each patient received IL-2 first followed by ipilimumab. 4 patients experienced cancer progression and 2 experienced stable disease (cancer has not spread and there are no new tumors) when treated primarily with IL-2. When further treated with ipilimumab, 50% experienced cancer progression while 50% experienced a complete response.

Overall, complete response occurred in 33% (6/18) patients treated with ipilimumab at any time compared to no complete responses when treated with IL-2 alone. Disease-free survival (time after treatment where patient survives without signs or symptoms of cancer) when treated with ipilimumab was 16.2 months compared to 15.3 months when treated with IL-2 followed by ipilimumab. Average survival time from immunotherapy with patients treated with any ipilimumab was 13.4 months compared to 10.1 months with IL-2.

The authors conclude that patients who experience cancer progression after regional chemotherapy will benefit from immunotherapy.

IL-2 treatment data varied to include patients who received IL-2 alone, IL-2 at high dosages and IL-2 as part of a combination therapy so results may not be comparable. 

If you would like further information on immunotherapy as a treatment following chemotherapy, please consult your doctor.