Immunotherapy has become an important way to treat cancer, especially for people with malignant melanoma, a serious and advanced form of skin cancer.
However, these treatments often come with strong side effects that make it hard for patients to continue.
Now, researchers from Karolinska Institutet in Sweden have found that using smaller doses of one of the common immunotherapy drugs may actually work better—and cause fewer side effects. The study is published in JNCI: Journal of the National Cancer Institute.
In most countries, the standard treatment for advanced melanoma includes two drugs: nivolumab and ipilimumab. These are given at full doses based on what drug agencies have approved. But ipilimumab is known to cause more side effects and is also the most expensive part of the treatment.
In Sweden, doctors are allowed more flexibility in how they prescribe medication. Because of this, many Swedish cancer clinics started giving patients a smaller dose of ipilimumab.
The new study looked at how well this lower-dose treatment worked compared to the full standard dose. Nearly 400 people with advanced melanoma took part in the research. They were treated either with the full dose or with the lower dose of ipilimumab.
The researchers wanted to see how the cancer responded, how long patients lived without the disease getting worse, and how many people had serious side effects.
The results were surprising and promising. In the group that got the lower dose, 49% of patients responded to the treatment. In the group that got the full dose, only 37% responded.
The patients who got the lower dose also lived longer without the disease progressing—on average, 9 months compared to just 3 months for those on the standard dose. Even more importantly, the patients in the lower-dose group lived much longer overall. Their average survival was 42 months, while it was just 14 months in the full-dose group.
Side effects were also different. Only 31% of patients on the lower dose experienced serious side effects. In contrast, more than half—51%—of those on the full dose had serious problems. This is important because serious side effects often force patients to stop treatment early, reducing their chances of recovery.
Dr. Hildur Helgadottir, who led the study, explained that serious side effects from these powerful drugs can sometimes be life-threatening or long-lasting. By lowering the dose of ipilimumab, more patients were able to stay on treatment longer. That may have helped them get better results in the long run.
It’s important to note that this study was observational. That means the researchers looked back at what happened rather than running a controlled experiment.
While they did account for factors like patient age and how far the cancer had spread, they can’t say for sure that the lower dose caused the better results. Still, the findings are strong and suggest that using lower doses could be a better way to treat many patients.
This research shows how sometimes, less really can be more. By reducing the dose of a powerful cancer drug, doctors may be able to help patients live longer, feel better, and avoid serious side effects. More studies are needed, but this could lead to big changes in how advanced melanoma is treated around the world.
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