According to one study, two combination therapies, ipilimumab and nivolumab, have positive results in patients with stage 4 melanoma-related brain metastases.
Cerebral metastasis is a cancer that comes from a cancer in another part of the body that spreads to the brain. Lung, breast, kidney, colon and melanoma cancers frequently cause brain metastases.
Melanoma is very often a cancer of the skin, but also mucous membranes (mouth, anal canal, vagina) or the eye. Melanoma is on the rise in Western countries. In France, there are 10,000 new cases each year. Researchers at the MD Anderson Cancer Center at the University of Texas conducted a study published in the New England Journal of Medicine. The latter reveals that combined immunotherapy has reduced the melanoma that has spread to the brain.
Significant improvement in survival rate
"Since the treatment of stage 4 melanoma has improved a lot in recent years, our patients with brain metastases have remained the most needy group, they have had the worst prognosis, so we are very excited about these results, "says Hussein Tawbi, lead author of the study.
Note that we speak of "stage 4" when melanoma has spread to other parts of the body. It's a serious condition. The researchers provided immunotherapy, combining ipilimumab and nivolumab with 94 patients. This treatment makes it possible to simultaneously tackle brain diseases, but also extra-cranial diseases. Hussein Tawbi continues: "Historically, the one-year overall survival rate for patients with brain metastases is less than 20%, with the combination of immunotherapy in this study it is 82%."
Immunotherapy for the benefit of radiotherapy
Another conclusion of the study, combined immunotherapy saves time. Indeed, radiotherapy is very effective in treating small metastases before initiating immunotherapy, with a four-week break between the two types of treatment.
However, very often the original metastases are destroyed, but new ones happen precisely during this four-week break. "We have shown that you do not have to wait for radiation, you can initiate early immunotherapy on all patients and wait for tumors in the brain to react, as well as those outside the brain," says the author. of the study.
Caution against side effects
The researchers particularly monitored the side effects associated with immunotherapy. A total of 34 patients experienced side effects related to the central nervous system. The headache was the most common. Among them, seven people had more serious consequences, such as swelling of the brain, cerebral hemorrhage and syncope. These side effects were similar to those of patients who received combined immunotherapy, but without having brain metastases.