Nature and management of melanoma recurrences following adjuvant anti-PD-1 based therapy
- Author(s)
- Woodford, R; McKeown, J; Hoeijmakers, LL; Mangana, J; Dimitriou, F; Allayous, C; Zaman, F; Aya, F; Marsiglio, J; Goodman, R; Rayson, V; Placzke, J; Kessels, J; Ramalyte, E; Haque, W; Wilson, I; Trojaniello, C; Benannoune, N; Roberts-Thomson, R; Robert, C; Blank, CU; Dummer, R; Lebbe, C; Haydon, A; Arance, A; Hu-Lieskovan, S; Johnson, DB; McArthur, GA; Rutkowski, P; Neyns, B; Sullivan, RJ; Weber, J; Carlino, MS; Ascierto, PA; Lo, S; Long, GV; Menzies, AM;
- Journal Title
- European Journal of Cancer
- Publication Type
- Research article
- Abstract
- INTRODUCTION: Approximately 50 % of resected stage II-IV melanoma patients develop recurrent disease by 5 years despite adjuvant anti-PD-1 therapy. Data to define best management of recurrences is lacking. METHODS: This was a multicentre, international, retrospective cohort study. Patients with resected stage II-IV melanoma who commenced adjuvant anti-PD-1-based therapy before January 2022 and later recurred were identified. Data on demographics, disease characteristics, recurrence patterns, management and outcomes were collected. RESULTS: 711 patients from 17 sites were included. Median age was 60 [range 16-92], 64 % were male, 2 % stage II, 91 % were stage III, 7 % stage IV. Median time to recurrence was 6.2 months (0-68.5) and median follow up time from recurrence was 19.8 months (range 0.2-73.1). 63 % recurred on anti-PD-1 therapy, 36 % off therapy [3 % < 6 months, 33 % > 6 months]. Initial recurrences were locoregional (LR) alone in 44 %, distant alone (DR) in 43 %, and 11 % in both sites. LR recurrences were managed with local therapy, alone (62 %) or with "second adjuvant" anti-PD-1 (14 %) or BRAF/MEK therapy (23 %); 12 m RFS2 was 25 %, 29 % and 69 % respectively (p = 0.0045). Definitive systemic therapy at first recurrence was given in 16 % LR and 86 % DR, with best outcomes for anti-CTLA4 + anti-PD-1 and trial combinations (24 m PFS 63 % and 69 %, respectively). The 24 m OS for the entire cohort was 65 %. CONCLUSION: Most recurrences following adjuvant anti-PD-1 based therapy occur early and while still on drug. Outcomes are poor, regardless of site, timing of recurrence, and subsequent treatment.
- Publisher
- Elsevier
- Keywords
- Adjuvant; Anti-PD-1 therapy; Distant recurrence; Immunotherapy; Immunotherapy resistance; Locoregional recurrence; Melanoma; Recurrent disease
- Department(s)
- Medical Oncology
- Publisher's Version
- https://doi.org/10.1016/j.ejca.2024.115055
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2024-11-12 06:11:14
Last Modified: 2024-11-12 06:12:19