TY - JOUR
T1 - Long-Term Survival in Patients With Advanced Melanoma
AU - van Not, Olivier J
AU - van den Eertwegh, Alfons J M
AU - Groningen, University
AU - Bloem, Manja
AU - Haanen, John B
AU - van Rijn, Rozemarijn S
AU - Aarts, Maureen J B
AU - van den Berkmortel, Franchette W P J
AU - Blank, Christian U
AU - Boers-Sonderen, Marye J
AU - de Groot J W B, Jan Willem
AU - Hospers, Geke A P
AU - Kapiteijn, Ellen
AU - Leeneman, Brenda
AU - D, Piersma
AU - Stevense-den Boer, Marion
AU - van der Veldt, Astrid A M
AU - Vreugdenhil G, Gerard
AU - Wouters, Michel W J M
AU - Blokx, Willeke A M
AU - Suijkerbuijk, Karijn P M
N1 - Publisher Copyright:
© 2024 van Not OJ et al.
PY - 2024/8/1
Y1 - 2024/8/1
N2 - IMPORTANCE: Long-term survival data from clinical trials show that survival curves of patients with advanced melanoma treated with immune checkpoint inhibitors (ICIs) gradually reach a plateau, suggesting that patients have a chance of achieving long-term survival.OBJECTIVE: To investigate long-term survival in patients with advanced melanoma treated with ICIs outside clinical trials.DESIGN, SETTING, AND PARTICIPANTS: Cohort study using prospectively collected data from the nationwide Dutch Melanoma Treatment Registry, including patients in the Netherlands with advanced melanoma treated with first-line ICIs from 2012 to 2019. Data were analyzed from January to September 2023.EXPOSURES: Patients were treated with first-line ipilimumab-nivolumab, antibodies that target programmed cell death (anti-PD-1), or ipilimumab.MAIN OUTCOMES AND MEASURES: Progression-free survival (PFS) and melanoma-specific survival were analyzed, and a Cox proportional hazards model was used to investigate factors associated with PFS after reaching partial response (PR) or complete response (CR).RESULTS: A total of 2490 patients treated with first-line ICIs were included (median [IQR] age, 65.0 [55.3-73.0] years; 1561 male patients [62.7%]). Most patients had an Eastern Cooperative Oncology Group Performance Status of 1 or lower (2202 patients [88.5%]) and normal lactate dehydrogenase levels (1715 patients [68.9%]). PFS for all patients was 23.4% (95% CI, 21.7%-25.2%) after 3 years and 19.7% (95% CI, 18.0%-21.4%) after 5 years. Overall survival for all patients was 44.0% (95% CI, 42.1%-46.1%) after 3 years and 35.9% (95% CI, 33.9%-38.0%) after 5 years. Patients with metastases in 3 or more organ sites had a significantly higher hazard of progression after reaching PR or CR (adjusted hazard ratio, 1.37; 95% CI, 1.11-1.69).CONCLUSIONS AND RELEVANCE: This cohort study of patients with advanced melanoma treated with ICIs in clinical practice showed that their survival reached a plateau, comparable with patients participating in clinical trials. These findings can be used in daily clinical practice to guide long-term surveillance strategies and inform both physicians and patients regarding long-term treatment outcomes.
AB - IMPORTANCE: Long-term survival data from clinical trials show that survival curves of patients with advanced melanoma treated with immune checkpoint inhibitors (ICIs) gradually reach a plateau, suggesting that patients have a chance of achieving long-term survival.OBJECTIVE: To investigate long-term survival in patients with advanced melanoma treated with ICIs outside clinical trials.DESIGN, SETTING, AND PARTICIPANTS: Cohort study using prospectively collected data from the nationwide Dutch Melanoma Treatment Registry, including patients in the Netherlands with advanced melanoma treated with first-line ICIs from 2012 to 2019. Data were analyzed from January to September 2023.EXPOSURES: Patients were treated with first-line ipilimumab-nivolumab, antibodies that target programmed cell death (anti-PD-1), or ipilimumab.MAIN OUTCOMES AND MEASURES: Progression-free survival (PFS) and melanoma-specific survival were analyzed, and a Cox proportional hazards model was used to investigate factors associated with PFS after reaching partial response (PR) or complete response (CR).RESULTS: A total of 2490 patients treated with first-line ICIs were included (median [IQR] age, 65.0 [55.3-73.0] years; 1561 male patients [62.7%]). Most patients had an Eastern Cooperative Oncology Group Performance Status of 1 or lower (2202 patients [88.5%]) and normal lactate dehydrogenase levels (1715 patients [68.9%]). PFS for all patients was 23.4% (95% CI, 21.7%-25.2%) after 3 years and 19.7% (95% CI, 18.0%-21.4%) after 5 years. Overall survival for all patients was 44.0% (95% CI, 42.1%-46.1%) after 3 years and 35.9% (95% CI, 33.9%-38.0%) after 5 years. Patients with metastases in 3 or more organ sites had a significantly higher hazard of progression after reaching PR or CR (adjusted hazard ratio, 1.37; 95% CI, 1.11-1.69).CONCLUSIONS AND RELEVANCE: This cohort study of patients with advanced melanoma treated with ICIs in clinical practice showed that their survival reached a plateau, comparable with patients participating in clinical trials. These findings can be used in daily clinical practice to guide long-term surveillance strategies and inform both physicians and patients regarding long-term treatment outcomes.
KW - Aged
KW - Cohort Studies
KW - Female
KW - Humans
KW - Immune Checkpoint Inhibitors/therapeutic use
KW - Ipilimumab/therapeutic use
KW - Male
KW - Melanoma/drug therapy
KW - Middle Aged
KW - Netherlands/epidemiology
KW - Nivolumab/therapeutic use
KW - Progression-Free Survival
KW - Prospective Studies
KW - Registries
KW - Skin Neoplasms/drug therapy
U2 - 10.1001/jamanetworkopen.2024.26641
DO - 10.1001/jamanetworkopen.2024.26641
M3 - Article
C2 - 39141388
SN - 2574-3805
VL - 7
JO - JAMA network open
JF - JAMA network open
IS - 8
M1 - e2426641
ER -