Combining Local Peripheral Treatment With Ipilimumab Doubles Survival in Melanoma

Surabhi Dangi-Garimella, PhD

Ipilimumab (Yervoy) was the first immune checkpoint inhibitor approved in oncology that revolutionized cancer treatment and significantly improved survival in patients with advanced melanoma. Now, a new study has found that combining ipilimumab with local peripheral treatments (LPT) such as radiotherapy or electrochemotherapy can significantly better survival in patients with melanoma.

Researchers at the Center of Integrated Oncology at the University Hospital of Cologne, Germany, analyzed data from 127 patients with malignant melanoma who were treated consecutively at 4 cancer centers in Germany and Switzerland. Of those, 82 were treated with ipilimumab as single agent and 45 received treatment with ipilimumab and LPT to relieve tumor-related symptoms.

Patients who received LPT in addition to the immune treatment had significantly better overall survival (OS): their median OS was 93 weeks compared with 42 weeks in patients who were treated with the drug alone (unadjusted Hazard Ratio, 0.46; P = .0028). The researchers then eliminated patients with brain metastases from the analysis, which improved the difference in survival by a greater margin: median OS was 117 weeks in those receiving ipilimumab with LPT, compared with 46 weeks in the ipilimumab-alone cohort.  

“This survival advantage seemed to overcome even traditional risk factors of poor outcomes. This suggests that this combination could be an option for all patients with malignant melanoma, and this is being tested in ongoing prospective clinical trials,” said Sebastian Theurich, MD, the lead author of the study in a statement. “We were also able to begin to investigate the potential immunologic mechanism underlying the benefit of adding local peripheral treatment to ipilimumab,” added Theurich. “It seems that local peripheral treatments activate immune cells, which are then able to attack tumors at sites away from the local treatment site. However, we are investigating this further in prospective studies.”

The study has been published in Cancer Immunology Research.
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