LDH analysis for melanoma treatment prognosis – study
A recent study, which appeared in the Journal of Clinical Oncology, may shed light on whether immunotherapy can really cure melanoma patients.
This study provides data about treatment prognosis and patient survival using such a predictive factor as lactate dehydrogenase (LDH). These study was carried out for patients with stage IV metastatic melanoma who had previously received treatment, or (as part of a study) had not received treatment. In 16% (or 105 patients) there was a complete response (CR) to treatment with Keytruda (Pembrolizumab) in the original KEYNOTE-001 study.
Keytruda increases relapse-free survival
86% of patients with an average follow-up of 43 months, and on average more than 2 years after achieving complete remission, stopped treatment, about 15% of them continued treatment (on average over 40 months of therapy), and 63% stopped treatment for the purpose of observation.
The 2-year relapse-free survival rate was very high – 91%. Those who were under observation had a survival rate of 90% of survival without disease.
Lactate dehydrogenase for assessing the complete response
The researchers studied the levels of lactate dehydrogenase (LDH) and found that the frequency of CR in patients whose LDH is twice the normal or higher was very low; and only one patient out of 105 had a complete response (CR). The majority of CRs were among those who had normal LDH or those whose LDH was 1-2 times higher than the upper limit of normal. In fact, the LDH index came out of the register as a prognostic factor for a complete response, when programmed death ligand 1 (PD-L1) and tumor load were taken into account. It is known that tumor load is a very important factor when considering the ability to have a good response and long-term survival with a drug such as pembrolizumab (blocker to PD-1).
Complete response rate was increased in patients with wild-type BRAF. As was to be expected, those patients whose performance status was 0 had a higher overall response rate than those whose status was 1.
The study also showed evidence that those who had metastases only in the lungs, or only subcutaneous or skin metastases, or patients with M1a were more likely in terms of a complete response to melanoma therapy than patients whose disease was in the liver. Liver metastases tend to be a rather poor prognostic factor for those receiving treatment with PD-1 blocker.
The burden of the disease is a very impressive indicator related to the ability to achieve a complete response to the treatment of melanoma and to have a long-term survival rate for the overall PD-1 blockade. Decrease in albumin levels is associated with a worse outcome.
When the patient achieves a complete response (16% of all patients in a study of 655 patients), his chance of remaining at the same level is very high after at least 2 years. According to the prognosis of oncologists, many of those who have been in complete response within 2 years are more likely to be cured of melanoma. In addition, in the era of immunotherapy, doctors start talking about curing patients with melanoma in general.
Source: Medscape / Immunotherapy Metastatic Melanoma Cures. Jeffrey S. Weber, MD, PhD