Clinical Outcomes of Immune Checkpoint Blocker Therapy for Malignant Melanoma in Korean Patients: Potential Clinical Implications for a Combination Strategy Involving Radiotherapy

Abstract

PurposeWe investigated the clinical efficacy of immune checkpoint blocker (ICB) therapy for metastatic or advanced melanoma in Korean patients. As well, we assessed whether the effects of ICBs can be enhanced by combination therapy with palliative radiotherapy (RT).Materials and MethodsWe retrospectively reviewed the records of 127 patients with metastatic melanoma who received ICB with or without palliative RT between 2014 and 2018. The melanoma subtypes were classified as follows: chronic sun-damaged (CSD), acral, mucosal, and uveal. The primary endpoint was the objective response rate (ORR).ResultsThe overall ORR was 15%, with 11 complete and eight partial responses. ORRs for CSD, acral/mucosal, and uveal melanomas were 50%, 16.5%, and 0%, respectively (p=0.009). In addition to the subtype, stage at treatment, total tumor burden at treatment, and ICB type were significantly associated with ORR (all p < 0.05). Palliative RT was administered in 44% of patients during the treatment, and it did not affect ORR. Clinical responders to ICB therapy exhibited significantly higher 1-year progression-free and overall survival rates than nonresponders.ConclusionORR for ICB monotherapy in Korean patients with melanoma is relatively modest compared with that in Western patients because the non-CSD subtypes are predominant in the Korean population. Our findings regarding combination therapy with ICB provided a rationale for the initiation of our phase II study (NCT04017897).

Current therapeutic options for gastric adenocarcinoma

“…Immunological checkpoint inhibitions are one of the successful therapeutic approaches during malignancies ( Lee et al, 2020 ). Recent reports revealed the positive effects of immunotherapy for patients suffering from cancer where therapies associated with immune checkpoint inhibitors like programmed death-ligand 1 (PD-L1) inhibitor or anti-programmed death-1 receptor (PD-1) ( Park et al, 2019 ) (see Fig.…”

“…Despite several attainments in immune-checkpoint-blockade (ICB) to cure cancer, there are a few effective anticipating biomarkers in gastric cancer ( Lee et al, 2020 ). The functioning of two biomarkers of CNA (copy-number alterations) burden and TMB (tumor mutational burden) may help DCB (durable clinical benefit) patients grouping, thus giving a logical option for patients medicated with immune checkpoint blockade ( Lee et al, 2020 ). However, forecasting tumor reaction to PD‐1 blockade still remains complicated ( Ishikawa et al, 2018 ).…”

“…By estimating cytokines and relevant amounts of immune cells in blood serum, the diagnosis of patients with metastatic gastric cancer (mGC) can be determined ( Park et al, 2019 ). Gastric cancer patients responding to immune checkpoint blocker (ICB) therapy showed a remarkably higher one-year furtherance free and generally more survival rate than non-responders ( Lee et al, 2020 ).…”

Prediction of Immune-Checkpoint Blockade Monotherapy Response in Patients with Melanoma Based on Easily Accessible Clinical Indicators

“…The response rates for ipilimumab and pembrolizumab or nivolumab range from 11-19% [5,7] and 33-44% [2,5,6], respectively. We have previously reported that the objective response rate of ICB monotherapy in South Korean patients with melanoma is 15% [8].…”

Prediction of Immune-Checkpoint Blockade Monotherapy Response in Patients With Melanoma Based on Easily Accessible Clinical Indicators

“…The response rates for ipilimumab and pembrolizumab or nivolumab range from 11% to 19% ( 5 , 7 ) and 33% to 44% ( 2 , 5 , 6 ), respectively. We have previously reported that the objective response rate of ICB monotherapy in South Korean patients with melanoma is 15% ( 8 ).…”