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Lactate Dehydrogenase (LDH) as a Prognostic Marker for Complete Response in Melanoma Treatment
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.
LDH Levels and Treatment Outcomes
A recent study examined the role of lactate dehydrogenase (LDH) levels in predicting complete response (CR) in melanoma patients undergoing anti-PD-1 therapy such as pembrolizumab. Researchers found that patients with LDH levels two times above the normal limit or higher had a significantly lower rate of complete response—with only one out of 105 patients in this group achieving a full remission.
In contrast, most complete responses were observed in patients who had normal LDH or whose LDH levels were only up to twice the upper limit of normal.
LDH has emerged as a strong prognostic factor for achieving complete remission, especially when analyzed alongside PD-L1 expression and tumor burden. Tumor burden itself is already known to play a critical role in determining both treatment response and long-term survival with PD-1 blockade therapies.
BRAF Mutation, Performance Status, and Tumor Location
The study also revealed several other key factors associated with a higher chance of complete response:
- BRAF Wild-Type: Patients without BRAF mutations (wild-type) had a higher rate of complete response.
- Performance Status (ECOG 0): Patients with a performance status of 0 (fully active) had better overall response rates than those with a status of 1.
- Metastatic Pattern: Patients with lung-only, subcutaneous, or skin-only metastases—classified as M1a stage—had a greater likelihood of achieving complete response compared to those with liver metastases, which remain a poor prognostic factor in the context of PD-1 immunotherapy.
Tumor Burden and Albumin: Indicators of Response
The overall tumor burden continues to be one of the most important indicators of a patient’s ability to achieve complete response and enjoy long-term survival while receiving PD-1 blockade therapy. In addition, a decline in albumin levels was found to be associated with poorer outcomes.Lactate dehydrogenase for assessing the complete response
Long-Term Prognosis After Complete Response
In a cohort of 655 melanoma patients, 16% achieved a complete response to PD-1 inhibitors. Importantly, those who achieved CR had a very high likelihood of maintaining remission for at least two years.
Oncologists now suggest that patients who remain in complete response for two years or more may actually be considered cured—a concept that is gaining ground in the era of immunotherapy.
In fact, for the first time in modern oncology, physicians are beginning to speak of a possible cure for melanoma—a disease once considered nearly untreatable at advanced stages.
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.
Source: Medscape / Immunotherapy Metastatic Melanoma Cures. Jeffrey S. Weber, MD, PhD
