Antoine Moya-Plana1,2, Ruth Gabriela Herrera Gómez3, Caroline Rossoni4, Laurent Dercle5, Samy Ammari6, Isabelle Girault7, Séverine Roy7, Jean-Yves Scoazec7,8, Stephan Vagner7, François Janot9, Alexander M M Eggermont10,11, Caroline Robert7,11,12. 1. Head and Neck Surgery Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France. antoine.moya-plana@gustaveroussy.fr. 2. Inserm U981, Melanoma Group, Gustave Roussy Cancer Campus, Villejuif, France. antoine.moya-plana@gustaveroussy.fr. 3. Medical Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France. 4. Biostatistics Department, Gustave Roussy Cancer Campus, Villejuif, France. 5. Radiology Department, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA. 6. Radiology Department, Gustave Roussy Cancer Campus, Villejuif, France. 7. Inserm U981, Melanoma Group, Gustave Roussy Cancer Campus, Villejuif, France. 8. Pathology Department, Gustave Roussy Cancer Campus, Villejuif, France. 9. Head and Neck Surgery Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France. 10. Gustave Roussy Cancer Campus, Villejuif, France. 11. Université Paris-Saclay, Villejuif, France. 12. Onco-dermatology Department, Gustave Roussy Cancer Campus, Grand Paris, France.
Abstract
BACKGROUND: Immune checkpoint inhibitors are now standard-of-care treatments for metastatic cutaneous melanoma. However, for rare sub-groups, such as mucosal melanomas, few published data are available, and with no established therapeutic guidelines. Our objective was to assess the response to anti-CTLA4 and anti-PD1 immunotherapy in patients with mucosal melanomas. METHODS: We performed a single-center, prospective cohort analysis of patients with non-surgical locally advanced and/or metastatic mucosal melanoma receiving anti-CTLA4 and/or anti-PD1 immunotherapy from 2010 to 2016. RESULTS: Forty-four patients were enrolled, including 18 (40.9%) with head and neck, 12 (27.3%) with vulvo-vaginal and 14 (31.8%) with ano-rectal primary tumours. Eleven (25%) patients had stage 3 disease, and 11 (25%) had distant metastases. The first-line immunotherapy was ipilimumab in 24 patients and pembrolizumab in 20. The objective response rate (ORR) was 8.2% (one complete response) for ipilimumab and 35% (four complete responses) for pembrolizumab. No significant difference was observed for primary tumour location. The median follow-up was 24 months (range 4-73). The median progression-free survival (PFS) in the first-line ipilimumab and pembrolizumab groups was 3 months [95% confidence interval (CI) 2.5-4.6] and 5 months (95% CI 2.6-33.1), respectively (p = 0.0147). CONCLUSION: In the patients with unresectable and/or metastatic mucosal melanoma, we found ORR and PFS rates comparable to those in patients with cutaneous melanoma, with no significant differences in the types of mucosal surfaces involved. Anti-PD1 therapy has a more favorable benefit-risk ratio than ipilimumab and should be used preferentially.
BACKGROUND: Immune checkpoint inhibitors are now standard-of-care treatments for metastatic cutaneous melanoma. However, for rare sub-groups, such as mucosal melanomas, few published data are available, and with no established therapeutic guidelines. Our objective was to assess the response to anti-CTLA4 and anti-PD1 immunotherapy in patients with mucosal melanomas. METHODS: We performed a single-center, prospective cohort analysis of patients with non-surgical locally advanced and/or metastatic mucosal melanoma receiving anti-CTLA4 and/or anti-PD1 immunotherapy from 2010 to 2016. RESULTS: Forty-four patients were enrolled, including 18 (40.9%) with head and neck, 12 (27.3%) with vulvo-vaginal and 14 (31.8%) with ano-rectal primary tumours. Eleven (25%) patients had stage 3 disease, and 11 (25%) had distant metastases. The first-line immunotherapy was ipilimumab in 24 patients and pembrolizumab in 20. The objective response rate (ORR) was 8.2% (one complete response) for ipilimumab and 35% (four complete responses) for pembrolizumab. No significant difference was observed for primary tumour location. The median follow-up was 24 months (range 4-73). The median progression-free survival (PFS) in the first-line ipilimumab and pembrolizumab groups was 3 months [95% confidence interval (CI) 2.5-4.6] and 5 months (95% CI 2.6-33.1), respectively (p = 0.0147). CONCLUSION: In the patients with unresectable and/or metastatic mucosal melanoma, we found ORR and PFS rates comparable to those in patients with cutaneous melanoma, with no significant differences in the types of mucosal surfaces involved. Anti-PD1 therapy has a more favorable benefit-risk ratio than ipilimumab and should be used preferentially.
Authors: So-Woon Kim; Young Il Kim; Bilal Mustafa; Mi-Ju Kim; Gowun Jeong; Sung-Min Ahn; Seok-Byung Lim; Chang Sik Yu; Jin Cheon Kim; Seung-Mo Hong; In Ja Park Journal: Mod Pathol Date: 2020-07-24 Impact factor: 7.842
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