University of Cincinnati researchers have uncovered a potentially more beneficial treatment regimen for patients with metastatic melanoma. The team, in collaboration with a group at Winship Cancer Institute at Emory University, revealed that radiation before immunotherapy can possibly prolong lives of patients with melanoma that has spread to the brain.
Published in the International Journal of Radiation Oncology, Biology and Physics, the research deals with the fact that “Melanoma brain metastases occur in 50% of melanoma patients,” reports corresponding author Dr. Soma Sengupta, associate professor of neurology at University of Cincinnati (UC), UC Health physician and co-director of the UC Gardner Neuroscience Institute’s Brain Tumor Center.
The team conducted a retrospective analysis of patients with surgically removed melanoma brain metastases who underwent either radiation, immunotherapy or a combination of both between 2010 and 2018. Of the 79 specimens, only 17 samples were eligible for this study. The team studied the gene expression between patients who received radiation therapy before receiving immune checkpoint inhibitors (immunotherapy) in comparison to the other way around, reported Daniel Pomeranz Krummel, research associate professor of neurology at UC and the study’s lead author. Krummel noted that they employed a “melanoma brain metastases animal model for validation experiments as well” during this study.
The researchers’ retrospective analysis revealed that the combination of radiation therapy and immune checkpoint inhibitors correlated to better patient survival when compared to radiation therapy alone. More to the point, the results of the study reveal, at least for this small sample in this retrospective analysis, that radiation followed by immunotherapy was superior as opposed to immunotherapy first and then radiation therapy. The researchers validated this in the animal model as well. Pomeranz Krummel reports that “More genetic analysis of the tissue showed that radiation therapy followed by immunotherapy showed that the genes causing cell death signaling, usually fighting the cancer, were restricted and key indicators of inflammation were present.” Sengupta added, “Our study provides initial insights into the optimal sequence of treatment following surgical removal of melanoma brain metastases.”
The researchers acknowledge that they are working from a small sample and, hence, to fully validate this hypothesis, they would need to conduct clinical trials to example the optimal sequence.
This study was funded by the National Institutes of Health (National Institute of Neurological Disorders and Stroke, the Melanoma Fund, Winship Cancer Institute at Emory University and the Schott Chair for Molecular Therapeutics, University of Cincinnati.
Dr. Soma Sengupta, associate professor of neurology at University of Cincinnati (UC), UC Health physician and co-director of the UC Gardner Neuroscience Institute’s Brain Tumor Center
Daniel Pomeranz Krummel, research associate professor of neurology at UC and the study’s lead author