TY - JOUR
T1 - Adjuvant treatment with anti-PD-1 in acral melanoma
T2 - A nationwide study
AU - Bloem, Manja
AU - van Not, Olivier J.
AU - Aarts, Maureen J.B.
AU - van den Berkmortel, Franchette W.P.J.
AU - Blank, Christian U.
AU - Blokx, Willeke A.M.
AU - Boers-Sonderen, Marye J.
AU - Bonenkamp, Johannes J.
AU - de Groot, Jan Willem B.
AU - Haanen, John B.
AU - Hospers, Geke A.P.
AU - Kapiteijn, Ellen W.
AU - de Meza, Melissa M.
AU - Piersma, Djura
AU - van Rijn, Rozemarijn S.
AU - Stevense-den Boer, Marion A.M.
AU - van der Veldt, Astrid A.M.
AU - Vreugdenhil, Gerard
AU - van den Eertwegh, Alfons J.M.
AU - Suijkerbuijk, Karijn P.M.
AU - Wouters, Michel W.J.M.
N1 - Publisher Copyright:
© 2024 The Author(s). International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.
PY - 2024/6/24
Y1 - 2024/6/24
N2 - 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.
AB - 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.
KW - acral melanoma
KW - adjuvant
KW - immune checkpoint inhibitors
KW - immunotherapy
KW - melanoma
UR - http://www.scopus.com/inward/record.url?scp=85196710286&partnerID=8YFLogxK
U2 - 10.1002/ijc.35060
DO - 10.1002/ijc.35060
M3 - Article
C2 - 38922879
AN - SCOPUS:85196710286
SN - 0020-7136
VL - 155
SP - 1455
EP - 1465
JO - International Journal of Cancer
JF - International Journal of Cancer
IS - 8
ER -