Lactate dehydrogenase is an effective outcome predictive factor for melanoma treatment with PD-1 agents

This study investigated whether changes in lactate dehydrogenase (LDH) levels in the blood could predict treatment response to PD-1 agents. Researchers suggested that LDH could be a useful factor to predict treatment outcomes in patients with advanced melanoma.  

The use of PD-1 agents to treat melanoma is rapidly increasing. These treatments stimulate the immune system to attack cancer cells by blocking the PD-1 receptor. Recent studies have suggested that PD-1 agents are more active in treating advanced melanoma than chemotherapy alone.

Blood levels of LDH are a prognostic factor for survival and part of the staging decision for stage 4 melanoma. However, whether LDH level is predictive of PD-1 treatment response and outcomes is unclear.  

The objective of this study was to determine if blood levels of LDH is a reliable predictive factor to predict the response to treatment with a PD-1 agent.

This study included 66 patients with advanced melanoma treated with either pembrolizumab (Keytruda) or nivolumab (Opdivo). Blood levels of LDH were measured within 3 days before treatment. 51.5% of patients had an elevated LDH at the treatment start.

Patients with elevated LDH had a shorter 12 month overall survival (44.2%) when compared to patients with normal levels of LDH (71.5%). Among the patients with elevated LDH levels, the LDH change during the treatment was associated with treatment response. Patients with partial response (32%) had a 27.3% reduction in LDH levels. In contrast, patients with progressive cancer had an increase of 39% in LDH levels. Patients with an increase of over 10% of LDH had a shorter OS (4.3 months) when compared to patients with a less than 10% change (15.7 months).  

This study showed that an increasing LDH during the first weeks of treatment with PD-1 agents can predict melanoma progression and is associated with a decreased survival.