Back to Search Start Over

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

Authors :
Eroglu, Z
Broman, KK
Thompson, JF
Nijhuis, A
Hieken, TJ
Kottschade, L
Farma, JM
Hotz, M
Deneve, J
Fleming, M
Bartlett, EK
Sharma, A
Dossett, L
Hughes, T
Gyorki, DE
Downs, J
Karakousis, G
Song, Y
Lee, A
Berman, RS
van Akkooi, A
Stahlie, E
Han, D
Vetto, J
Beasley, G
Farrow, NE
Hui, JYC
Moncrieff, M
Nobes, J
Baecher, K
Perez, M
Lowe, M
Ollila, DW
Collichio, FA
Bagge, RO
Mattsson, J
Kroon, HM
Chai, H
Teras, J
Sun, J
Carr, MJ
Tandon, A
Babacan, NA
Kim, Y
Naqvi, M
Zager, J
Khushalani, N
Eroglu, Z
Broman, KK
Thompson, JF
Nijhuis, A
Hieken, TJ
Kottschade, L
Farma, JM
Hotz, M
Deneve, J
Fleming, M
Bartlett, EK
Sharma, A
Dossett, L
Hughes, T
Gyorki, DE
Downs, J
Karakousis, G
Song, Y
Lee, A
Berman, RS
van Akkooi, A
Stahlie, E
Han, D
Vetto, J
Beasley, G
Farrow, NE
Hui, JYC
Moncrieff, M
Nobes, J
Baecher, K
Perez, M
Lowe, M
Ollila, DW
Collichio, FA
Bagge, RO
Mattsson, J
Kroon, HM
Chai, H
Teras, J
Sun, J
Carr, MJ
Tandon, A
Babacan, NA
Kim, Y
Naqvi, M
Zager, J
Khushalani, N
Publication Year :
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

Database :
OAIster
Publication Type :
Electronic Resource
Accession number :
edsoai.on1372999581
Document Type :
Electronic Resource