Drug combo ‘transformative’ for breast cancer and melanoma treatment

A drug combination given to breast cancer and melanoma patients before surgery may dramatically improve their outcomes and rewrite the treatment rule book, a world-first study has revealed.

Giving immunotherapy drugs before surgery “dramatically improves” outcomes for some breast cancer and melanoma patients with advanced or difficult to treat disease.

That is the finding of two new studies, involving Victorian researchers and patients, presented on Monday at the prestigious American Society of Clinical Oncology (ASCO) scientific conference in Chicago.

Both studies used a combination of two immunotherapy drugs called nivolumab and ipilimumab. Immunotherapy helps the body’s immune system kill cancer cells and this is the first time the two have been used to boost that potential before surgery.

Experts say the results will help rewrite the treatment rule book and opens the door for further investigation for use in other cancer treatments.

The study looked at the use of two immunotherapy drugs given to patients before surgery. Picture: Supplied

The Peter MacCallum Cancer Centre, which recruited many of the people in the melanoma trial — known as NADINA — says the results would likely change the way advanced melanoma is treated in future.

Last year the journal Nature Medicine named it as being among one of the top dozen clinical trials likely to affect global medicine.

The 420 trial patients had melanoma that had spread to their lymph nodes.

Professor Shahneen Sandhu led the recruitment of patients at Peter Mac and said in a statement said the results of the immuntherapy drugs were “transformative for advanced melanoma”.

“It will lead to similar approaches being evaluated in multiple other tumour types,” Professor Sandhu said.

Peter Mac’s Professor Sherene Loi says the results of the study, developed by Breast Cancer Trials, are exciting.

“These data support the use of immunotherapy before surgery as opposed to following surgery for patients with resectable, high-risk stage III melanomas.”

Melanoma Institute Australia surgeon Professor Alex van Akkooi says this trial has flipped the traditional ‘surgery then drugs’ rationale on its head, “and melanoma patients across the world will now benefit”.

In another presentation at ASCO on Monday the Head of the Translational Breast Cancer Genomics and Therapeutics Laboratory at the Peter Mac outlined how giving these two drugs pre-surgery with a chemotherapy drug was showing “promising results” for patients with treatment resistant, early-stage triple negative breast cancer.

Professor Sherene Loi is the study chair of the world-first CHARIOT clinical trial. Developed by Breast Cancer Trials, it recruited 34 patients Australia-wide.

The goal was to see if using the immunotherapy drugs with a standard chemotherapy drug was not only safe and effective, but could stimulate the body’s immune system to kill cancer cells.

The group presented its primary results at the same conference three years ago and on Monday gave an update.

The study found 24 per cent of participants achived a complete disappearance of their cancer within the breast and lympth nodes before their surgery. Three years on it said these patients were less likely to have a breast cancer recurrence and had better overall survival.

“These results demonstrate that for those women who have complete disappearance of their cancer by the time they have surgery are more likely to experience enduring long term breast cancer free survival,” Professor Loi said.

Importantly, in those women where the tests indicated they should be the best responders to immunotherapy, 100 per cent were alive and free from any breast cancer at three years.

Professor Loi said these “very exciting results” were impressive and warranted furhter research.

The results of both trials were published Monday in the New England Journal of Medicine.