Adjuvant treatment with anti-PD-1 in acral melanoma: A nationwide study

Manja Bloem*, Olivier J. van Not, Maureen J.B. Aarts, Franchette W.P.J. van den Berkmortel, Christian U. Blank, Willeke A.M. Blokx, Marye J. Boers-Sonderen, Johannes J. Bonenkamp, Jan Willem B. de Groot, John B. Haanen, Geke A.P. Hospers, Ellen W. Kapiteijn, Melissa M. de Meza, Djura Piersma, Rozemarijn S. van Rijn, Marion A.M. Stevense-den Boer, Astrid A.M. van der Veldt, Gerard Vreugdenhil, Alfons J.M. van den Eertwegh, Karijn P.M. SuijkerbuijkMichel W.J.M. Wouters

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Previous studies demonstrated limited efficacy of immune checkpoint inhibitors in unresectable acral melanoma (AM); it remains unclear how this translates to the adjuvant setting. This study investigates clinical outcomes of acral compared to cutaneous melanoma (CM) patients treated with adjuvant anti-PD-1 after complete resection. All stages III–IV AM and CM patients receiving adjuvant anti-PD-1 after complete resection between 2018 and 2022 were included from the prospective nationwide Dutch Melanoma Treatment Registry. We analyzed recurrence-free survival (RFS), distant metastasis-free survival (DMFS), and overall survival (OS). A multivariable Cox regression analysis of RFS was performed to adjust for potential confounders. We included 1958 (86 AM and 1872 CM) patients. At baseline, AM patients more frequently had KIT mutations, higher disease stages, and Eastern Cooperative Oncology Group Performance Status, and fewer BRAF and NRAS mutations. Median RFS was 14.8 months (95% confidence interval [CI]: 11.5–29.3) in AM and 37.4 months (95% CI: 34.6 to not reached) in CM (p =.002). After correcting for potential confounders, AM remained associated with a higher risk of recurrence (HRadj 1.53; 95% CI: 1.07–2.17; p =.019). Two-year DMFS tended to be worse for AM than for CM: 64.5% versus 79.7% (p =.050). Two-year OS was significantly lower in AM (71.5% vs. 84.3%; p =.027). The results of this study suggest a poorer outcome of adjuvant-treated AM compared to CM. Studies assessing the added value of adjuvant treatment in AM are needed. Future research should investigate alternative treatment strategies to improve outcomes of high-risk AM.

Original languageEnglish
Pages (from-to)1455-1465
Number of pages11
JournalInternational Journal of Cancer
Volume155
Issue number8
Early online date24 Jun 2024
DOIs
Publication statusE-pub ahead of print - 24 Jun 2024

Keywords

  • acral melanoma
  • adjuvant
  • immune checkpoint inhibitors
  • immunotherapy
  • melanoma

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