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Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection

Authors :
Yun Song
John F Thompson
Frances A Collichio
Tasha Hughes
John Vetto
Dale Han
Jonathan Zager
Zeynep Eroglu
Jennifer Downs
David E Gyorki
Nikhil I Khushalani
Alexander van Akkooi
Georgia Beasley
Lisa Kottschade
Hidde M Kroon
Ann Lee
Norma E Farrow
Giorgos Karakousis
Michael Lowe
Avinash Sharma
Kristy K Broman
Amanda Nijhuis
Tina J Hieken
Jeffrey M Farma
Meghan Hotz
Jeremiah Deneve
Martin Fleming
Edmund K Bartlett
Lesly Dossett
Russell S Berman
Emma Stahlie
Jane Yuet Ching Hui
Marc Moncrieff
Jenny Nobes
Kirsten Baecher
Matthew Perez
David W Ollila
Roger Olofsson Bagge
Jan Mattsson
Harvey Chai
Jyri Teras
James Sun
Michael J Carr
Ankita Tandon
Nalan Akgul Babacan
Younchul Kim
Mahrukh Naqvi
Source :
Journal for ImmunoTherapy of Cancer, Vol 10, Iss 8 (2022)
Publication Year :
2022
Publisher :
BMJ Publishing Group, 2022.

Abstract

Until recently, most patients with sentinel lymph node-positive (SLN+) melanoma underwent a completion lymph node dissection (CLND), as mandated in published trials of adjuvant systemic therapies. Following multicenter selective lymphadenectomy trial-II, most patients with SLN+ melanoma no longer undergo a CLND prior to adjuvant systemic therapy. A retrospective analysis of clinical outcomes in SLN+ melanoma patients treated with adjuvant systemic therapy after July 2017 was performed in 21 international cancer centers. Of 462 patients who received systemic adjuvant therapy, 326 patients received adjuvant anti-PD-1 without prior immediate (IM) CLND, while 60 underwent IM CLND. With median follow-up of 21 months, 24-month relapse-free survival (RFS) was 67% (95% CI 62% to 73%) in the 326 patients. When the patient subgroups who would have been eligible for the two adjuvant anti-PD-1 clinical trials mandating IM CLND were analyzed separately, 24-month RFS rates were 64%, very similar to the RFS rates from those studies. Of these no-CLND patients, those with SLN tumor deposit >1 mm, stage IIIC/D and ulcerated primary had worse RFS. Of the patients who relapsed on adjuvant anti-PD-1, those without IM CLND had a higher rate of relapse in the regional nodal basin than those with IM CLND (46% vs 11%). Therefore, 55% of patients who relapsed without prior CLND underwent surgery including therapeutic lymph node dissection (TLND), with 30% relapsing a second time; there was no difference in subsequent relapse between patients who received observation vs secondary adjuvant therapy. Despite the increased frequency of nodal relapses, adjuvant anti-PD-1 therapy may be as effective in SLN+ pts who forego IM CLND and salvage surgery with TLND at relapse may be a viable option for these patients.

Details

Language :
English
ISSN :
20511426
Volume :
10
Issue :
8
Database :
Directory of Open Access Journals
Journal :
Journal for ImmunoTherapy of Cancer
Publication Type :
Academic Journal
Accession number :
edsdoj.5e2609c2e5e44274aabf900f1ff2c1c7
Document Type :
article
Full Text :
https://doi.org/10.1136/jitc-2021-004417