Death rates from melanoma started falling immediately after the introduction of immunotherapies, and they fell fast, a recent study suggested.
The study, published in Cancer, compared cancer deaths in those diagnosed within 1 of 3 time periods: 2007 to 2008, 2009 to 2010, and 2011 to 2012.1 The immunotherapy ipilimumab wasn’t approved by the US Food and Drug Administration until 2011,2 but by the end of the following year, the first hints of success were visible in the time-series comparison.
From 2007 to 2012, 2-year survival increased 3.4 percentage points for patients with advanced melanoma, which was based on the Surveillance, Epidemiology, and End Results (SEER) 18 database. This repository, which includes data from regional cancer registries, represents approximately 28% of the US population. When only adults younger than 65 years were included, the 2-year survival rate for advanced melanoma increased by nearly 7 percentage points.
Results improved across several cancer types during the study period. But patients with melanoma saw a more marked improvement than was seen in patients with lung cancer, whose 2-year survival rate increased by 3 percentage points over the time period — and this was even higher than the survival rate improvement seen in patients with breast cancer: for these patients, the survival rate rose by 2.7 percentage points.
The 5-year survival rates have improved dramatically since then, said Sapna Patel, MD, an associate professor at the University of Texas MD Anderson Cancer Center in Houston. She credits the advances to the approval of second-generation checkpoint inhibitors, which take the brakes off the immune system to allow it to fight cancer, as well as targeted therapies for patients whose tumors have specific mutations. Immune system-based therapies have also moved to earlier stages in treatment cycles, giving patients an opportunity to try them when they are in (generally) better shape.
While not even 5% of her patients survived a decade or more ago, Dr Patel said she’s now seeing survival rates of 20% for those treated with immune therapies alone, and roughly 33% for patients who received treatment with both an immune therapy and a targeted therapy.
That’s changing the dynamics in her waiting room, Dr Patel observed.
“It used to be that we would hold a metastatic melanoma patient on our roster for a year or 2 years and they’d be replaced by new patients,” because of deaths, Dr Patel said. “In the last 3 years, particularly at major academic centers, these new patient referrals have dried up.”