Andrea Marie Ibrahim1, Melanie Le May2, Dominick Bossé3, Horia Marginean1, Xinni Song3, Carolyn Nessim4, Michael Ong5. 1. Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. 2. Division of Internal Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada. 3. Division of Medical Oncology, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada. 4. Division of General Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada. 5. Division of Medical Oncology, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada. mong@toh.ca.
Abstract
BACKGROUND: Intensive imaging in melanoma remains controversial because its survival impact is unknown. We investigated the impact of imaging intensity on the rates of asymptomatic surveillance-detected recurrence (ASDR) and subsequent treatment outcomes in patients with access to immune checkpoint inhibitors (ICIs) and targeted therapy (TT). METHODS: Patients with resected malignant melanoma undergoing imaging surveillance at a single center between 2006 and 2016 were identified. Surveillance and recurrence characteristics (imaging, symptom, treatment, and survival data) were retrospectively collected. Univariate (t test, Chi square test) and multivariate Cox regression analyses were conducted. RESULTS: Of 353 high-risk melanoma patients (stage IIB, 24%; IIC, 19%; IIIA, 27%; IIIB, 16%; IIIC, 14%), 71 (45%) had ASDR and 88 (55%) had symptomatic recurrence (SR). Shorter imaging intervals identified more ASDR (57%, 0-6 months; 34%, 6-12 months; 33%, > 12 months; p = 0.03). ASDR had better prognostic factors than SR [fewer than three metastatic sites (43 vs. 21%, p = 0.003), normal lactate dehydrogenase (LDH; 53 vs. 38%, p = 0.09), brain metastases (11 vs. 40%, p < 0.001)] and received more systemic treatment (72 vs. 49%, p = 0.003; ICIs 55 vs. 31%, p = 0.002; TT 8 vs. 13%, p = 0.41). ASDR had better survival outcomes on ICI treatment (2-year OS, 56 vs. 31%, p < 0.001). Median OS from surveillance start was 39.6 vs. 22.8 months (p < 0.001). ASDR was independently associated with survival (hazard ratio 0.47, 95% confidence interval 0.29-0.78, p = 0.003), adjusting for stage, sex, age, disease burden, LDH, era of recurrence, brain metastases, and ICI/TT treatment. CONCLUSIONS: These real-world data support further study on intensified imaging surveillance protocols for high-risk resected melanoma, as ASDR was associated with superior survival outcomes from ICI therapy.
BACKGROUND: Intensive imaging in melanoma remains controversial because its survival impact is unknown. We investigated the impact of imaging intensity on the rates of asymptomatic surveillance-detected recurrence (ASDR) and subsequent treatment outcomes in patients with access to immune checkpoint inhibitors (ICIs) and targeted therapy (TT). METHODS: Patients with resected malignant melanoma undergoing imaging surveillance at a single center between 2006 and 2016 were identified. Surveillance and recurrence characteristics (imaging, symptom, treatment, and survival data) were retrospectively collected. Univariate (t test, Chi square test) and multivariate Cox regression analyses were conducted. RESULTS: Of 353 high-risk melanoma patients (stage IIB, 24%; IIC, 19%; IIIA, 27%; IIIB, 16%; IIIC, 14%), 71 (45%) had ASDR and 88 (55%) had symptomatic recurrence (SR). Shorter imaging intervals identified more ASDR (57%, 0-6 months; 34%, 6-12 months; 33%, > 12 months; p = 0.03). ASDR had better prognostic factors than SR [fewer than three metastatic sites (43 vs. 21%, p = 0.003), normal lactate dehydrogenase (LDH; 53 vs. 38%, p = 0.09), brain metastases (11 vs. 40%, p < 0.001)] and received more systemic treatment (72 vs. 49%, p = 0.003; ICIs 55 vs. 31%, p = 0.002; TT 8 vs. 13%, p = 0.41). ASDR had better survival outcomes on ICI treatment (2-year OS, 56 vs. 31%, p < 0.001). Median OS from surveillance start was 39.6 vs. 22.8 months (p < 0.001). ASDR was independently associated with survival (hazard ratio 0.47, 95% confidence interval 0.29-0.78, p = 0.003), adjusting for stage, sex, age, disease burden, LDH, era of recurrence, brain metastases, and ICI/TT treatment. CONCLUSIONS: These real-world data support further study on intensified imaging surveillance protocols for high-risk resected melanoma, as ASDR was associated with superior survival outcomes from ICI therapy.
Authors: Annette Pflugfelder; Corinna Kochs; Andreas Blum; Marcus Capellaro; Christina Czeschik; Therese Dettenborn; Dorothee Dill; Edgar Dippel; Thomas Eigentler; Petra Feyer; Markus Follmann; Bernhard Frerich; Maria-Katharina Ganten; Jan Gärtner; Ralf Gutzmer; Jessica Hassel; Axel Hauschild; Peter Hohenberger; Jutta Hübner; Martin Kaatz; Ulrich R Kleeberg; Oliver Kölbl; Rolf-Dieter Kortmann; Albrecht Krause-Bergmann; Peter Kurschat; Ulrike Leiter; Hartmut Link; Carmen Loquai; Christoph Löser; Andreas Mackensen; Friedegund Meier; Peter Mohr; Matthias Möhrle; Dorothee Nashan; Sven Reske; Christian Rose; Christian Sander; Imke Satzger; Meinhard Schiller; Heinz-Peter Schlemmer; Gerhard Strittmatter; Cord Sunderkötter; Lothar Swoboda; Uwe Trefzer; Raymond Voltz; Dirk Vordermark; Michael Weichenthal; Andreas Werner; Simone Wesselmann; Ansgar J Weyergraf; Wolfgang Wick; Claus Garbe; Dirk Schadendorf Journal: J Dtsch Dermatol Ges Date: 2013-08 Impact factor: 5.584