Combinations of Radiation Therapy and Immunotherapy for Melanoma: A Review of Clinical Outcomes

Abstract

Radiotherapy has long played a role in the management of melanoma. Recent advances have also demonstrated the efficacy of immunotherapy in the treatment of melanoma. Preclinical data suggest a biologic interaction between radiotherapy and immunotherapy. Several clinical studies corroborate these findings. This review will summarize the outcomes of studies reporting on patients with melanoma treated with a combination of radiotherapy and immunotherapy. Vaccine therapies often use irradiated melanoma cells, and may be enhanced by radiotherapy. The cytokines interferon-alpha and interleukin-2 have been combined with radiotherapy in several small studies, with some evidence suggesting increased toxicity and/or efficacy. Ipilimumab, a monoclonal antibody which blocks cytotoxic T-lymphocyte antigen-4, has been combined with radiotherapy in several notable case studies and series. Finally, pilot studies of adoptive cell transfer have suggested radiotherapy may improve the efficacy of treatment. The review will demonstrate that the combination of radiotherapy and immunotherapy has been reported in several notable case studies, series and clinical trials. These clinical results suggest interaction and the need for further study.

Durable complete responses off all treatment in patients with metastatic malignant melanoma after sequential immunotherapy followed by a finite course of BRAF inhibitor therapy

“…The RT was done both for palliation and for synergism with ipilimumab, as it could theoretically render the tumor more immunogenic. 14,15 She rapidly achieved a clinical response to vemurafenib (along with a pruritic rash requiring a dose reduction and a brief course of steroids). The patient developed fevers, chills and marked synovitis in a symmetric fashion, particularly in her wrists, hands and feet.…”

Successful Combination Therapy of Nivolumab and Radiation for Massive Mucosal Melanoma in Patient with Autoimmune-Myasthenia Gravis, Systemic Lupus Erythematosus and Rheumatoid Arthritis

“…Several cases have recently been reported in which combi-nation therapy with immune-checkpoint inhibitors and radiotherapy malignant melanoma was successful [6]. An abscopal effect is known to manifest as a synergistic effect when using immune-checkpoint inhibitors in combination with radiation therapy [6] [7] [8].…”

Programmed cell death 1 correlates with the occurrence and development of MG63 osteosarcoma

“…The migration, invasion, conglutination and growth analyses of cancer cells are the most commonly used methods to judge cytoactivity. These methods can reflect the fact that the tumor leaves the primary tumor extracellular matrix (11)(12)(13)(14)(15). In the present study, it was found that the reproduction rate of the tumor cells was relatively low in the early passage.…”