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Cancer immunotherapies and targeted therapies have revolutionized the way clinicians treat patients with advanced skin cancer and have led to long-lasting therapeutic responses for many patients. between them. However, little is known about the impact of these therapies on survival for a large group of patients. Patients with melanoma with cancer that has spread to the brain have been excluded or underrepresented in clinical trials of immunotherapies due to concerns as to whether these drugs can cross the blood-brain barrier or interfere with other forms of treatment. A new study conducted by researchers at Brigham and Women's Hospital evaluates data from more than 1,500 cancer control programs across the country to gather a sufficiently important data set to determine the effectiveness control point blocking immunotherapies. The study found that these therapies have brought significant improvements in the overall survival of patients with melanoma brain metastases. Their findings are published this week in Cancer Immunology Research .
"Our results support the revolutionary success of the point-of-control blockade immunotherapy clinical trials for advanced melanoma and demonstrate that their substantial survival benefits also extend to patients with of melanoma. brain metastases, "said corresponding author J. Bryan Iorgulescu, MD, postdoctoral fellow at the Department of Pathology at Brigham and Women's Hospital / Harvard Medical School and at the Department of Oncology Dana-Farber Cancer Institute.
About 1 in 54 people will develop melanoma during their lifetime, most of them will be diagnosed early and cured by having the tumor removed surgically. But for patients with advanced disease, the median overall survival rate is less than one year. Advanced melanoma tends to spread to the brain and is the third most common cause of metastatic brain cancer.
The recent FDA approval of blocking immunotherapies for control points and targeted therapies, such as BFAF inhibitors, has added new options. These new therapies have produced interesting preliminary results in clinical trials of patients with advanced melanoma. However, many trials to date have excluded patients whose skin cancer has spread to the brain, making it unclear whether these benefits would extend to this patient population.
In this study, a research team consisting of Brigham and Dana-Cancer Cancer Institute compiled data from more than 2,753 cancer hospital patients across the country. Patients who received control point blocking immunotherapy had an average survival of 12.4 months (versus 5.2 months for those who did not receive immunotherapy) and a four-day survival rate. years of 28.1% (versus 11.1% for those who have not received immunotherapy)). For patients whose cancer did not spread beyond the brain (to the lungs and / or the liver, for example), these improvements were even more dramatic.
"Through the use of national cancer data, we can evaluate for the first time Timothy Smith, MD, Ph.D., MPH, director of the Computational Neuroscience Outcomes Center of the Department of Neurosurgery of the United States. Brigham and Women's Hospital / Harvard Medical School, said these exciting new therapies have an impact on the survival of patients with brain metastases. . "This highlights the power of demographics to help answer the critical but unanswered questions we face daily in clinical practice."
"Historically, metastases of the central nervous system of melanoma and other types of solid tumors," said Dr. David Reardon, MD, clinical director of the Dana-Farber Neuro-Oncology Center and professor of Medicine at Harvard Medical School. "The results of our analyzes indicate that immune checkpoint inhibitors may provide significant therapeutic benefit for metastatic melanoma, including spread to the central nervous system, but not all patients, indicates that much research is still needed to maximize the potential of anti-tumor immune responses for metastatic CNS disease. "
The authors note that the insurance status was a significant barrier to the receipt of the disease. Blockade immunotherapy control points in patients with melanoma brain metastases. Uninsured patients were significantly less likely to receive treatment than those who were insured privately or through Medicare – a situation suggesting that additional efforts are needed to ensure patients' access to these essential treatments.
Iorgulescu and Ms Cheryl Zogg received support from the National Institutes of Health (NIH NCI LRP 1L30-CA209256-01, NIH T32GM007205 Medical Research Training Program Training Award, respectively).
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