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Promising research on immunotherapy drugs for melanoma

A combination of two immunotherapy drugs has shown good effects on advanced stages of the skin cancer called melanoma

There has been many headlines in the media recently, talking about a “breakthrough” and a “new era” in cancer treatment. Sometimes headlines can be a bit ‘hyped up’ as they are meant to catch your eye and draw you into reading the story. Having said that, there are a lot of promising findings from research into treatments for various cancers these days, but we must remember that ‘promising new treatments’ doesn’t usually mean a cure. The particular research that got so much focus in the media recently was about two drugs that were tested on a group of people who had the skin cancer melanoma at a stage where it had spread to other parts of the body. The two drugs are called ipilimumab and nivolumab and they are called immunotherapy drugs because they help the body’s immune system to specifically attack and kill cancer cells.

Researchers from England, Wales and other European and international institutions carried out a so-called randomised controlled trial (RCT). It involved 945 adults with advanced melanoma and they were split into three groups. One group was given the immunotherapy drug called ipilimumab, the second group was given a new immunotherapy drug called nivolumab and the third group was given both these drugs. Neither the researchers nor the patients who were in the three groups knew which drug they were given as the drugs were given codes instead of their real names and no-one knew which group received which treatment regime. Then at various time points the researchers compared the three groups to see who had the best outcome, i.e. which group of melanoma patients lived the longest without their cancer getting worse.

The researchers found that the group who were given both the drugs had the best result, i.e. they had the longest period of time (11.5 months) where their cancer was under control and didn’t progress (get worse). The group of people who were only given the new drug called nivolumab showed the second best results (6.9 months) whereas the group who were only given the drug called ipilimumab had only 2.9 months before their cancer started to get worse. These are the overall average results for the groups and then of course there are individual variations within these groups where some people do better than the group average and some people do worse than the average. Overall, the conclusion of the research was that people with melanoma could be treated more effectively if they were given a combination of these two immunotherapy drugs. The study is still ongoing so that the researchers can see the effect of these drugs on longer term, i.e. which group of patients actually live the longest and also to learn more about the side effects of the different treatments.

In the UK at the moment, only the drug ipilimumab is licensed to treat people with melanoma. The other drug – nivolumab – is not licensed in the UK yet but is going through an ‘authorisation’ process before it can be allowed to be used in Europe, including the UK. In the UK, it is the National Institute for Health and Care Excellence (NICE) who will advise the government whether new drugs such as nivolumab should be licensed (allowed to be used) in the UK. They will look at all available research evidence for a particular drug and compare that to existing treatments. Then of course the cost of the drug also has to be considered as new drugs are often very expensive and the health budget cannot possibly pay for everything that is available of treatments for all diseases in our society. These are very difficult decisions as everybody feel that the treatment they need should be available on the NHS…

NOTE: In February 2016, NICE recommended that nivolumab should be given to treat adults with advanced melanoma and NHS England decided to fund the treament.

You can read more about the study at NHS Choices Health News website where you will also find other relevant links, including a link to the PDF version of the study publication. (That will be quite technical reading though!)

This article was first published : 9.6.2015

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