Michiel C T van Zeijl1, Florine L Boer2, Mariëtte I E van Poelgeest2, Alfons J M van den Eertwegh3, Michel W J M Wouters4, Liesbeth C de Wreede5, Maureen J B Aarts6, Franchette W P J van den Berkmortel7, Jan Willem B de Groot8, Geke A P Hospers9, Djura Piersma10, Rozemarijn S van Rijn11, Karijn P M Suijkerbuijk12, Albert J Ten Tije13, Astrid A M van der Veldt14, Gerard Vreugdenhil15, Marye J Boers-Sonderen16, Ellen H W Kapiteijn17, John B A G Haanen18. 1. Scientific Department, Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, Leiden, 2333AA, the Netherlands; Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333ZA, the Netherlands. 2. Department of Gynaecology, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333ZA, the Netherlands. 3. Department of Medical Oncology, Amsterdam University Medical Centres (location VUmc), Cancer Centre Amsterdam, De Boelelaan 1117, 1081, HV Amsterdam, the Netherlands. 4. Scientific Department, Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, Leiden, 2333AA, the Netherlands; Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066CX, the Netherlands. 5. Department of Biomedical Data Sciences, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333ZA, the Netherlands. 6. Department of Medical Oncology, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht, 6229 HX, the Netherlands. 7. Department of Medical Oncology, Zuyderland Medical Centre Sittard, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162BG, the Netherlands. 8. Department of Medical Oncology, Isala Oncology Centre, Dokter van Heesweg 2, Zwolle, 8025AB, the Netherlands. 9. Department of Medical Oncology, University Medical Centre Groningen, Hanzeplein 1, Groningen, 9713GZ, the Netherlands. 10. Department of Internal Medicine, Medisch Spectrum Twente, Koningsplein 1, Enschede 7512KZ, the Netherlands. 11. Department of Internal Medicine, Medical Centre Leeuwarden, Henri Dunantweg 2, Leeuwarden, 8934AD, the Netherlands. 12. Department of Medical Oncology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, 3584CX, the Netherlands. 13. Department of Internal Medicine, Amphia Hospital, Molengracht 21, Breda, 4818CK, the Netherlands. 14. Departments of Medical Oncology and Radiology & Nuclear Medicine, Erasmus Medical Centre - Cancer Institute, 's-Gravendijkwal 230, Rotterdam, 3015CE, the Netherlands. 15. Department of Internal Medicine, Maxima Medical Centre, De Run 4600, Eindhoven, 5504DB, the Netherlands. 16. Department of Medical Oncology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, 6525GA, the Netherlands. 17. Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333ZA, the Netherlands. 18. Divisions of Medical Oncology and Molecular Oncology & Immunology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066CX, the Netherlands. Electronic address: j.haanen@nki.nl.
Abstract
BACKGROUND: Mucosal melanoma (MM) is rare and has a poor prognosis. Since 2011, new effective treatments are available for advanced melanoma. It is unclear whether patients with mucosal melanoma equally benefit from these new treatments compared with patients with cutaneous melanoma (CM). METHODS: Patients with advanced MM and CM diagnosed between 2013 and 2017 were included from a nationwide population-based registry - the Dutch Melanoma Treatment Registry. Overall survival (OS) was estimated with the Kaplan-Meier method (also for a propensity score-matched cohort). A Cox model was used to analyse the association of possible prognostic factors with OS. RESULTS: In total, 120 patients with MM and 2960 patients with CM were included. Median OS was 8.7 months and 14.5 months, respectively. Patients with MM were older (median age 70 versus 65 years) and more often female (60% versus 41%), compared with CM. In total, 77% and 2% of the MM patients were treated with first-line immunotherapy and targeted therapy, respectively, compared with 49% and 33% of the CM patients. In contrast to CM, OS for MM did not improve for patients diagnosed in 2015-2017, compared with 2013-2014. ECOG performance score ≥1 (HR = 1.99 [1.26-3.15; p = 0.003]) and elevated LDH level (HR = 1.63 [0.96-2.76]; p = 0.069) in MM were associated with worse survival. CONCLUSIONS: Within the era of immune and targeted therapies, prognosis for patients with advanced MM has not improved as much as for CM. Collaboration is necessary to enlarge sample size for research to improve immunotherapeutic strategies and identify targetable mutations.
BACKGROUND:Mucosal melanoma (MM) is rare and has a poor prognosis. Since 2011, new effective treatments are available for advanced melanoma. It is unclear whether patients with mucosal melanoma equally benefit from these new treatments compared with patients with cutaneous melanoma (CM). METHODS:Patients with advanced MM and CM diagnosed between 2013 and 2017 were included from a nationwide population-based registry - the Dutch Melanoma Treatment Registry. Overall survival (OS) was estimated with the Kaplan-Meier method (also for a propensity score-matched cohort). A Cox model was used to analyse the association of possible prognostic factors with OS. RESULTS: In total, 120 patients with MM and 2960 patients with CM were included. Median OS was 8.7 months and 14.5 months, respectively. Patients with MM were older (median age 70 versus 65 years) and more often female (60% versus 41%), compared with CM. In total, 77% and 2% of the MMpatients were treated with first-line immunotherapy and targeted therapy, respectively, compared with 49% and 33% of the CM patients. In contrast to CM, OS for MM did not improve for patients diagnosed in 2015-2017, compared with 2013-2014. ECOG performance score ≥1 (HR = 1.99 [1.26-3.15; p = 0.003]) and elevated LDH level (HR = 1.63 [0.96-2.76]; p = 0.069) in MM were associated with worse survival. CONCLUSIONS: Within the era of immune and targeted therapies, prognosis for patients with advanced MM has not improved as much as for CM. Collaboration is necessary to enlarge sample size for research to improve immunotherapeutic strategies and identify targetable mutations.
Authors: Qing-Qing Xu; Qing-Jie Li; Liu Chen; Xin-Yi Su; Jing-Xia Song; Juan Du; Lei Chen; Li-Xia Lu Journal: Cancer Cell Int Date: 2021-04-17 Impact factor: 5.722