Melanoma, a form of skin cancer, accounts for about 1% of all skin cancer cases and a vast majority of skin cancer deaths. In Stage IV melanoma more than 60% of patients will develop brain metastases, which is difficult to treat and carries an overall survival of about 4-5 months. A recent study out of Boston, MA looked at checkpoint blockade immunotherapies in treatment of melanoma brain metastases.
Melanoma begins in melanocytes, the cells that produce pigment that colors skin, hair and eyes. Melanomas left undetected can spread to other sites of the body, referred to as metastatic melanoma, such as the liver, lungs, brain and bones. Almost 90% of melanoma cases are linked to ultraviolet rays, both from natural and artificial sources, but can also be influenced by family history, genetics and environmental factors. Preventative methods include avoiding/reducing UV exposure, as well as early identification and diagnosis of melanoma. Reducing UV exposure includes applying sunscreen (at least SPF 30), wearing protective clothing, avoiding sun burns and tanning beds, and getting plenty of vitamin D. Medications can also cause increased sensitivity to sunlight, being aware of what medications you may be taking is an important factor in avoiding melanoma. Early detection of melanoma includes monthly self-skin examinations and yearly skins examinations by a dermatologist, early detection can mean the difference between life and death in some cases (self-screening guide).
Melanoma treatment options currently include surgery, radiation, immunotherapy, targeted therapy, and chemotherapy. In the recent study published in Cancer Immunology Research investigators evaluated data from 1,500 cancer programs across the country to determine the effectiveness of a particular immunotherapy, checkpoint blockade immunotherapies. Previous studies have shown that these checkpoint blockade immunotherapies are successful in treating advanced melanoma, but this study sought to build on that and extend to melanoma patients with brain metastases.
The study utilized data from a large national cohort of over 2,753 patients. Patients that received checkpoint blockade immunotherapy had an average survival of 12.4 months and a four-year survival rate of 28.1%, compared to 5.2 months and 11.1% in those that did not receive the therapy. Of note, the insurance status of patients was a barrier to receiving immunotherapy, uninsured patients were less likely to receive the treatment than those who were privately insured. Additional efforts are needed to ensure immunotherapy is accessible to all patients. "Historically, central nervous system metastases from melanoma as well as other solid tumor types have proven particularly challenging to treat, with most therapeutic approaches providing minimal clinical benefit for patients," said co-author David Reardon, MD, clinical director of the Center for Neuro-Oncology at Dana-Farber and professor of medicine at Harvard Medical School. "The results of our analyses indicate that immune checkpoint inhibitors can achieve a meaningful therapeutic benefit for metastatic melanoma, including spread to the central nervous system. At the same time, not all patients benefit, indicating that much research is still required to optimize the potential of anti-tumor immune responses for CNS metastatic disease."
To read this study click here. To learn more about how Checkpoint Blockade Immunotherapy works watch the video below!