Immunotherapy continues to demonstrate its potential to improve long-term survival across various cancer types, according to results from multiple international studies presented at ESMO 2024. The studies highlight the durable benefits of immunotherapy in advanced melanoma, triple-negative breast cancer (TNBC), and muscle-invasive bladder cancer.
Advanced Melanoma: Potential for Cure with Immunotherapy
Data from a phase III trial (CheckMate 067) evaluating anti-PD-1 therapy showed a sustained survival advantage in advanced melanoma patients. After a minimum follow-up of 10 years, the median overall survival reached 71.9 months in patients treated with nivolumab plus ipilimumab. Notably, a 96% melanoma-specific survival rate was observed at 10 years in patients who showed a good initial response and remained progression-free for at least three years, suggesting the potential for cure in this subset.
"The results from this trial do confirm the potential for cure with immunotherapy in patients with advanced melanoma," said Dr. Marco Donia, Associate Professor of Clinical Oncology at the National Center for Cancer Immune Therapy of Denmark, Copenhagen University Hospital Herlev. He emphasized that patients without disease progression beyond three years exhibit a very high melanoma-specific survival rate.
Triple-Negative Breast Cancer: Improved Outcomes with Combination Therapy
In early-stage TNBC, a statistically significant and clinically meaningful improvement in overall survival was observed with the addition of immunotherapy to chemotherapy in the neoadjuvant and adjuvant settings. The five-year overall survival rate was 86.6% in patients receiving immunotherapy plus chemotherapy, compared to 81.2% in the placebo group.
Dr. Alessandra Curioni-Fontecedro, Professor of Oncology at the University of Fribourg and Director of Oncology at the Hospital of Fribourg, Switzerland, noted, "This study shows improvements with immunotherapy in patients with the most aggressive subtype of breast cancer, where previously we could only offer chemotherapy." She suggested that the combination of immunotherapy and chemotherapy might sensitize TNBC to immunotherapy.
Muscle-Invasive Bladder Cancer: Durvalumab Demonstrates Survival Benefit
The phase III NIAGARA study investigated the use of durvalumab, an anti-PD-L1 antibody, in combination with chemotherapy as neoadjuvant therapy for muscle-invasive bladder cancer. Patients treated with durvalumab plus chemotherapy before radical cystectomy, followed by adjuvant durvalumab, experienced significantly longer event-free survival (HR 0.68, 95% CI 0.56-0.82, p<0.001) and overall survival (HR 0.75, 95% CI 0.59-0.93, p=0.0106) compared to those receiving chemotherapy alone. The researchers also reported that neoadjuvant immunotherapy did not compromise the feasibility of radical cystectomy.
Addressing Resistance to Immunotherapy
Despite the promising results, challenges remain in understanding and overcoming resistance to immunotherapy. Dr. Curioni-Fontecedro emphasized the need to investigate why cancers recur in some patients despite initial responses to immunotherapy and to elucidate the mechanisms of resistance. She called for collaborative efforts between clinical researchers and pharmaceutical companies to address this critical issue and improve treatment strategies for the future.
