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Background We conducted a retrospective exploratory analysis to evaluate the effects of baseline tumour immune infiltrate on disease-free survival (DFS) outcomes in patients with fully resected stage IIC–IIIC melanoma receiving adjuvant vemurafenib monotherapy or placebo in the BRIM8 study. Patients and methods BRIM8 was a phase III, international, double-blind, randomised, placebo-controlled study. Eligible patients with BRAFV600 mutation–positive, completely resected melanoma were randomly assigned to oral vemurafenib (960 mg twice daily) or matching placebo for 52 weeks. The primary end point was DFS. The association of CD8+ T-cell infiltration and programmed death ligand 1 (PD-L1) expression with DFS, as measured by immunohistochemistry, was explored retrospectively. Results Four hundred ninety-eight patients were randomly assigned to receive adjuvant vemurafenib (n = 250) or placebo (n = 248); tumour samples were available for biomarker analysis for approximately 60% of patients. In the pooled biomarker population, placebo-treated patients with Conclusions The presence of CD8+ T cells and PD-L1+IC are favourable prognostic factors for DFS. Treatment with adjuvant vemurafenib may overcome the poor DFS prognosis associated with low CD8+ T-cell count or PD-L1 expression. ClinicalTrials.gov identifier NCT01667419

Pembrolizumab demonstrated durable antitumor activity in 233 patients with previously treated advanced microsatellite instability high (MSI-H) or mismatch repair deficient (dMMR) advanced solid tumors in the phase II multicohort KEYNOTE-158 (NCT02628067) study. Herein, we report safety and efficacy outcomes with longer follow-up for more patients with previously treated advanced MSI-H/dMMR noncolorectal cancers who were included in cohort K of the KEYNOTE-158 (NCT02628067) study.Eligible patients with previously treated advanced noncolorectal MSI-H/dMMR solid tumors, measurable disease as per RECIST v1.1, and Eastern Cooperative Oncology Group performance status of 0 or 1 received pembrolizumab 200 mg Q3W for 35 cycles or until disease progression or unacceptable toxicity. The primary endpoint was objective response rate (ORR) as per RECIST v1.1 by independent central radiologic review.Three hundred and fifty-one patients with various tumor types were enrolled in KEYNOTE-158 cohort K. The most common tumor types were endometrial (22.5%), gastric (14.5%), and small intestine (7.4%). Median time from first dose to database cut-off (5 October 2020) was 37.5 months (range, 0.2-55.6 months). ORR among 321 patients in the efficacy population (patients who received ≥1 dose of pembrolizumab enrolled ≥6 months before the data cut-off date) was 30.8% [95% confidence interval (CI) 25.8% to 36.2%]. Median duration of response was 47.5 months (range, 2.1+ to 51.1+ months; '+' indicates no progressive disease by the time of last disease assessment). Median progression-free survival was 3.5 months (95% CI 2.3-4.2 months) and median overall survival was 20.1 months (95% CI 14.1-27.1 months). Treatment-related adverse events (AEs) occurred in 227 patients (64.7%). Grade 3-4 treatment-related AEs occurred in 39 patients (11.1%); 3 (0.9%) had grade 5 treatment-related AEs (myocarditis, pneumonia, and Guillain-Barre syndrome, n = 1 each).Pembrolizumab demonstrated clinically meaningful and durable benefit, with a high ORR of 30.8%, long median duration of response of 47.5 months, and manageable safety across a range of heavily pretreated, advanced MSI-H/dMMR noncolorectal cancers, providing support for use of pembrolizumab in this setting.

Cutaneous melanoma is the most lethal form of skin cancer and its incidence has been increasing in the past 30 years. Although this is completely resectable in most cases, thicker melanoma and those with regional lymph-node involvement are at a high risk of relapse. In recent years, the management of locoregional disease has drastically changed. In particular, in the 8th Edition of the American Joint Committee on Cancer (AJCC), subgroup classification of TNM (tumor–node–metastasis) has been modified, with the addition of the IIID stage. Furthermore, in recent randomized trials, completion lymph node dissection in case of sentinel lymph node biopsy positivity has not been shown to offer any improvement in overall survival versus observation. Consequently, radical dissection has been recommended as the standard treatment, but only in patients with palpable nodal metastases. However, the major novelty in the treatment of locally advanced melanoma has been the introduction of drugs, already used for metastatic disease, that have also shown clinical efficacy in the adjuvant setting. In fact, immunotherapies and, in the case of BRAF V600E/K-mutated melanoma, combination treatment of BRAF and MEK inhibitors have improved recurrence-free survival in these patients. In this paper, we will describe the current management of a patient with radically resectable melanoma and discuss the key points in light of the latest scientific evidence.

BACKGROUND: Immune-related adverse events (irAEs) typically occur within 4 months of starting anti-programmed cell death protein 1 (PD-1)-based therapy [anti-PD-1 ± anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA4)], but delayed irAEs (onset >12 months after commencement) can also occur. This study describes the incidence, nature and management of delayed irAEs in patients receiving anti-PD-1-based immunotherapy.PATIENTS AND METHODS: Patients with delayed irAEs from 20 centres were studied. The incidence of delayed irAEs was estimated as a proportion of melanoma patients treated with anti-PD-1-based therapy and surviving >1 year. Onset, clinical features, management and outcomes of irAEs were examined.RESULTS: One hundred and eighteen patients developed a total of 140 delayed irAEs (20 after initial combination with anti-CTLA4), with an estimated incidence of 5.3% (95% confidence interval 4.0-6.9, 53/999 patients at sites with available data). The median onset of delayed irAE was 16 months (range 12-53 months). Eighty-seven patients (74%) were on anti-PD-1 at irAE onset, 15 patients (12%) were 3 months from the last dose of anti-PD-1. The most common delayed irAEs were colitis, rash and pneumonitis; 55 of all irAEs (39%) were ≥grade 3. Steroids were required in 80 patients (68%), as well as an additional immunosuppressive agent in 27 patients (23%). There were two irAE-related deaths: encephalitis with onset during anti-PD-1 and a multiple-organ irAE with onset 11 months after ceasing anti-PD-1. Early irAEs (CONCLUSIONS: Delayed irAEs occur in a small but relevant subset of patients. Delayed irAEs are often different from previous irAEs, may be high grade and can lead to death. They mostly occur in patients still receiving anti-PD-1. The risk of delayed irAE should be considered when deciding the duration of treatment in responding patients. However, patients who stop treatment may also rarely develop delayed irAE.

Background: We assessed mortality risk by COVID-19 (C19) infection among treated cancer patients (pts) and the impact of anti-cancer treatment (tx) on mortality. Methods: Optum de-identified Electronic Health Record dataset (2021-01-07 release) were used to find cancer pts with a C19 positive (ICD-9/10-CM codes U071/U072 or positive test result) or negative (negative test and no positive test at any time after the first negative result) status on the first test/diagnosis date (ie the “index date”). Pts with

The European Society for Medical Oncology (ESMO) held a consensus conference on melanoma on 5-7 September 2019 in Amsterdam, The Netherlands. The conference included a multidisciplinary panel of 32 leading experts in the management of melanoma. The aim of the conference was to develop recommendations on topics that are not covered in detail in the current ESMO Clinical Practice Guideline and where available evidence is either limited or conflicting. The main topics identified for discussion were: (i) the management of locoregional disease; (ii) targeted versus immunotherapies in the adjuvant setting; (iii) targeted versus immunotherapies for the first-line treatment of metastatic melanoma; (iv) when to stop immunotherapy or targeted therapy in the metastatic setting; and (v) systemic versus local treatment of brain metastases. The expert panel was divided into five working groups in order to each address questions relating to one of the five topics outlined above. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel for further discussion and amendment before voting. This manuscript presents the results relating to the management of locoregional melanoma, including findings from the expert panel discussions, consensus recommendations and a summary of evidence supporting each recommendation. All participants approved the final manuscript.

We established an international consortium to review and discuss relevant clinical evidence in order to develop expert consensus statements related to cancer management during the severe acute respiratory syndrome coronavirus 2-related disease (COVID-19) pandemic. The steering committee prepared 10 working packages addressing significant clinical questions from diagnosis to surgery. During a virtual consensus meeting of 62 global experts and one patient advocate, led by the European Society for Medical Oncology, statements were discussed, amended and voted upon. When consensus could not be reached, the panel revised statements until a consensus was reached. Overall, the expert panel agreed on 28 consensus statements that can be used to overcome many of the clinical and technical areas of uncertainty ranging from diagnosis to therapeutic planning and treatment during the COVID-19 pandemic.

Background The present study was performed to evaluate the predictive capacity of the TNM-Immune (TNM-I) classification staging system vs. the 8th edition of the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC) tumor-node-metastasis (TNM8) staging system for survival of patients with colon cancer. Methods Data of eligible patients from the Society-for-Immunotherapy-of-Cancer (SITC) international-consortium from 13 countries were evaluated for the consensus Immunoscore in 3539 patients with AJCC/UICC-TNM stages I-III colon cancer. The primary-endpoint time-to-recurrence (TTR) and secondary-endpoint overall-survival (OS) were evaluated for 2650 patients with complete TNM staging and Immunoscore information. The consensus Immunoscore was predefined and previously published (Pages et al. Lancet 2018), and TNM-I categories (IA to IIID) were performed based on TNM8 plus consensus Immunoscore categories. Results A total of 1737 (64.8%) patients presented stage migration, including 1495 (55.8%) migrating to a lower stage and 242 (9.0%) to a higher stage. In TNM8 stage IIIB, patients migrated to all possible TNM-I stages from IA to IIID. A total of 563 Stage IIIB (67.0%) patients presented stage migration, including 181 (32.1%) migrating to a lower stage and 196 (34.8%) to a higher stage. TNM-I Hazard ratio for TTR between TNM-I stage IA and IIID was HR= 16.9 (95%CI 7.75-36.83), in contrast TNM8 TTR between IA and IIIC was only HR= 12.77 (95%CI 7.99-20.4), all P< 0.0001. TNM-I Hazard ratio for OS between TNM-I stage IA and IIID was HR= 5.95 (95%CI 3.17-11.19), in contrast, TNM8 OS between IA and IIIC was only HR= 3.16 (95%CI 2.38-4.18), all P< 0.0001. The TNM8 staging system exhibited prognostic discrepancies in discriminating stage IIB and IIC and between IIC and IIIA on survival curves from TTR and OS, which were improved in the TNM-I staging system. In cox multivariate analysis, the relative contribution of TNM-I was 90.3% in comparison to gender, sidedness, MSI, grade of differentiation, mucinous colloid, VELIPI. The TNM-I had a better predictive capability of survival, as evidenced by higher likelihood ratio scores, and smaller AIC values for TNM-I compared with those for TNM8 edition. Conclusion Therefore, the present study showed the importance of immuno-pathology and demonstrated that the TNM-Immune (TNM-I) classification staging system is superior (log-likelihood ratio test P< 0.0001) to the 8th edition of the AJCC/UICC-TNM staging system in predicting the TTR and OS of patients with colon cancer.

Introduction Le NIVO a demontre une amelioration de la survie sans recidive (SSR) vs l’IPI chez les patients (pts) atteints d’un melanome de stade III/IV operes dans l’etude de phase 3, CheckMate 238. Les donnees mises a jour de SSR, de survie sans metastases a distance (SSMD) et de SG a 48 mois sont presentees. Materiel et methodes Des pts âges de ≥ 15 ans avec un melanome de stade IIIB/C ou IV entierement reseque ont ete stratifies selon le stade et le statut PDL-1, et randomises selon un rapport 1 : 1 pour recevoir NIVO (3 mg/kg toutes les 2 semaines [sem] ; n = 453) ou IPI (10 mg/kg toutes les 3 sem pour 4 doses, puis toutes les 12 sem ; n = 453) pendant une duree maximale d’1 an ou jusqu’a recidive de la maladie/toxicite inacceptable. Le critere d’evaluation principal etait la SSR. Les criteres d’evaluation secondaires comprenaient la SG et la tolerance ; la SSMD pour le stade III de la maladie etait exploratoire. Resultats A 4 ans de suivi, NIVO a continue de demontrer une SSR superieure a l’IPI (HR : 0,71 ; IC95 % : 0,60–0,86 ; p = 0,0003). La SSMD chez les pts atteints d’une maladie de stade III etait en faveur du NIVO (HR : 0,79 ; IC95 % : 0,63–0,99). A 48 mois, le nombre d’evenements en SG (n = 211) etait plus faible que prevu (n = 302) et les taux de SG etaient comparables : 78 % (IC95 % : 73,7–81,5) avec NIVO et 77 % (IC95 % : 72,2–80,3) avec IPI (HR : 0,87 ; IC95 % : 0,66–1,14 ; p = 0,3148). Un traitement systemique ulterieur etait recu par 150 (33 %) pts traites par NIVO et 189 (42 %) pts traites par IPI ; plus de pts traites par IPI (34 % vs 23 %) ont recu une immunotherapie systemique ulterieure. Des evenements indesirables lies au traitement (EILT) d’apparition retardee (rapportes plus de 100 jours apres la derniere dose) et de tous grades confondus ont ete observes chez 18 (4 %) pts traites par NIVO et 25 (6 %) pts traites par IPI, avec un grade 3/4 dans 3 (1 %) et 7 (2 %) des cas, respectivement. Discussion Le NIVO a continue de demontrer une amelioration de la SSR et de la SSMD par rapport a l’IPI a 48 mois chez les pts avec un melanome de stade III/IV a haut risque de recidive. Les evenements de SG (n = 211) etaient inferieurs aux previsions (n = 302). Les taux de SG etaient similaires pour NIVO et IPI, bien que l’utilisation d’un traitement ulterieur par immunotherapie systemique ait ete plus elevee dans le bras IPI. Les EILT d’apparition tardive etaient conformes au profil de tolerance etabli pour NIVO et IPI, avec plus d’evenements rapportes avec IPI.