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

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; Olofsson Bagge, R; Mattsson, J; Kroon, HM; Chai, H; Teras, J; Sun, J; Carr, MJ; Tandon, A; Babacan, NA; Kim, Y; Naqvi, M; Zager, J; Khushalani, NI

Author(s): 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; Olofsson Bagge, R; Mattsson, J; Kroon, HM; Chai, H; Teras, J; Sun, J; Carr, MJ; Tandon, A; Babacan, NA; Kim, Y; Naqvi, M; Zager, J; Khushalani, NI;
Details: Publication Year 2022-08,Volume 10,Issue #8,Page e004417
Journal Title: Journal for ImmunoTherapy of Cancer
Publication Type: Research article
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.
Keywords: Humans; Lymph Node Excision; *Melanoma/pathology; Neoplasm Recurrence, Local/pathology; Retrospective Studies; *Sentinel Lymph Node/pathology; Sentinel Lymph Node Biopsy; *Skin Neoplasms/drug therapy; Adjuvants, Immunologic; Melanoma
Department(s): Surgical Oncology
PubMed ID: 36002183
Publisher's Version: https://doi.org/10.1136/jitc-2021-004417
Open Access at Publisher's Site: https://doi.org/10.1136/jitc-2021-004417
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2024-10-24 04:09:58

Last Modified: 2024-10-24 04:10:44