Treatment with programmed death receptor-1 ( PD-1 ) antibodies is associated with high response rates in patients with advanced melanoma. Reliable markers for early response and outcome are still sparse.
Researchers have evaluated 66 consecutive patients with advanced / metastatic melanoma treated with Nivolumab ( Opdivo ) or Pembrolizumab ( Keytruda ) between 2013 and 2014.
The main objectives of this study were to investigate whether, first, serum lactate dehydrogenase ( LDH ) at baseline ( normal vs above the upper limit of normal ) correlates with overall survival ( OS ), and, second, whether the change of LDH during treatment predicts response before the first scan and overall survival in patients with an elevated baseline lactate dehydrogenase.
After a median follow-up of 9 months, patients with an elevated baseline lactate dehydrogenase ( n=34 ) had a significantly shorter overall survival compared with patients with normal lactate dehydrogenase ( n=32; 6-month overall survival: 60.8% vs 81.6% and 12-month overall survival: 44.2% vs 71.5% ( log-rank P=0.0292 ).
In those 34 patients with elevated baseline lactate dehydrogenase, the relative change during treatment was significantly associated with an objective response on the first scan: the 11 ( 32% ) patients with partial remission had a mean reduction of -27.3% from elevated baseline lactate dehydrogenase.
In contrast, patients with progressive disease ( n=15 ) had a mean increase of +39%.
Patients with a relative increase over 10% from elevated baseline lactate dehydrogenase had a significantly shorter overall survival compared with patients with less than or equal to 10% change ( 4.3 vs 15.7 months, log-rank P less than 0.00623 ).
In conclusion, lactate dehydrogenase could be a useful marker at baseline and during treatment to predict early response or progression in patients with advanced melanoma who receive anti-PD-1 therapy. ( Xagena )
Diem S et al, Br J Cancer 2016;114:256-261