Judith M Versluis1, Anne M Hendriks2, Alison M Weppler3, Lauren J Brown4, Karlijn de Joode5, Karijn P M Suijkerbuijk6, Lisa Zimmer7, Ellen W Kapiteijn8, Clara Allayous9, Douglas B Johnson10, Adriana Hepner11, Joanna Mangana12, Prachi Bhave13, Yanina J L Jansen14, Claudia Trojaniello15, Victoria Atkinson16, Lucy Storey17, Paul Lorigan17, Paolo A Ascierto15, Bart Neyns14, Andrew Haydon13, Alexander M Menzies18, Georgina V Long18, Celeste Lebbe9, Astrid A M van der Veldt19, Matteo S Carlino20, Shahneen Sandhu3, Harm van Tinteren21, Elisabeth G E de Vries2, Christian U Blank22, Mathilde Jalving23. 1. Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands. 2. Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands. 3. Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia. 4. Department of Medical Oncology, Westmead and Blacktown Hospitals, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW 2145, Australia. 5. Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands. 6. Department of Medical Oncology, University Medical Center Utrecht Cancer Center, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands. 7. Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany. 8. Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 AZ, Leiden, the Netherlands. 9. AP-HP Dermatology Department, Saint-Louis Hospital, Université de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France. 10. Department of Medical Oncology, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, United States. 11. Melanoma Institute Australia, 40 Rocklands Rds, Wollstonecraft, NSW 2065, Australia; Medical Oncology Service, Instituto Do Cancer Do Estado de Sao Paulo, Av Dr Amaldo, 251 Cerqueira César, Sao Paulo 01246-000, Brazil. 12. Department of Dermatology, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland. 13. Department of Medical Oncology, Alfred Hospital, 55 Commercial Rd, Melbourne, VIC 3004, Australia. 14. Department of Surgical Oncology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium. 15. Department of Medical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Via Mariano Semmola, 80131 Napoli, NA, Italy. 16. Department of Medical Oncology, Princess Alexandra Hospital, University of Queensland, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia. 17. University of Manchester and Christie NHS Foundation Trust, Wimslow Rd, Manchester M20 4BX, United Kingdom. 18. Melanoma Institute Australia, 40 Rocklands Rds, Wollstonecraft, NSW 2065, Australia; University of Sydney, Camperdown, NSW 2006, Australia; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Reserve Rd, St Leonards, NSW 2065, Australia. 19. Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands; Department of Radiology & Nuclear Medicine Erasmus MC Cancer Institute, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands. 20. Department of Medical Oncology, Westmead and Blacktown Hospitals, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW 2145, Australia; Melanoma Institute Australia, 40 Rocklands Rds, Wollstonecraft, NSW 2065, Australia; University of Sydney, Camperdown, NSW 2006, Australia. 21. Department of Biometrics, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands. 22. Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 AZ Leiden, the Netherlands. 23. Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands. Electronic address: m.jalving@umcg.nl.
Abstract
INTRODUCTION: In patients with metastatic melanoma, progression of a single tumour lesion (solitary progression) after response to immune checkpoint inhibition (ICI) is increasingly treated with local therapy. We evaluated the role of local therapy for solitary progression in melanoma. PATIENTS AND METHODS: Patients with metastatic melanoma treated with ICI between 2010 and 2019 with solitary progression as first progressive event were included from 17 centres in 9 countries. Follow-up and survival are reported from ICI initiation. RESULTS: We identified 294 patients with solitary progression after stable disease in 15%, partial response in 55% and complete response in 30%. The median follow-up was 43 months; the median time to solitary progression was 13 months, and the median time to subsequent progression after treatment of solitary progression (TTSP) was 33 months. The estimated 3-year overall survival (OS) was 79%; median OS was not reached. Treatment consisted of systemic therapy (18%), local therapy (36%), both combined (42%) or active surveillance (4%). In 44% of patients treated for solitary progression, no subsequent progression occurred. For solitary progression during ICI (n = 143), the median TTSP was 29 months. Both TTSP and OS were similar for local therapy, ICI continuation and both combined. For solitary progression post ICI (n = 151), the median TTSP was 35 months. TTSP was higher for ICI recommencement plus local therapy than local therapy or ICI recommencement alone (p = 0.006), without OS differences. CONCLUSION: Almost half of patients with melanoma treated for solitary progression after initial response to ICI had no subsequent progression. This study suggests that local therapy can benefit patients and is associated with favourable long-term outcomes.
INTRODUCTION: In patients with metastatic melanoma, progression of a single tumour lesion (solitary progression) after response to immune checkpoint inhibition (ICI) is increasingly treated with local therapy. We evaluated the role of local therapy for solitary progression in melanoma. PATIENTS AND METHODS: Patients with metastatic melanoma treated with ICI between 2010 and 2019 with solitary progression as first progressive event were included from 17 centres in 9 countries. Follow-up and survival are reported from ICI initiation. RESULTS: We identified 294 patients with solitary progression after stable disease in 15%, partial response in 55% and complete response in 30%. The median follow-up was 43 months; the median time to solitary progression was 13 months, and the median time to subsequent progression after treatment of solitary progression (TTSP) was 33 months. The estimated 3-year overall survival (OS) was 79%; median OS was not reached. Treatment consisted of systemic therapy (18%), local therapy (36%), both combined (42%) or active surveillance (4%). In 44% of patients treated for solitary progression, no subsequent progression occurred. For solitary progression during ICI (n = 143), the median TTSP was 29 months. Both TTSP and OS were similar for local therapy, ICI continuation and both combined. For solitary progression post ICI (n = 151), the median TTSP was 35 months. TTSP was higher for ICI recommencement plus local therapy than local therapy or ICI recommencement alone (p = 0.006), without OS differences. CONCLUSION: Almost half of patients with melanoma treated for solitary progression after initial response to ICI had no subsequent progression. This study suggests that local therapy can benefit patients and is associated with favourable long-term outcomes.
Authors: Pim P van de Donk; Sjoukje F Oosting; Daan G Knapen; Anthonie J van der Wekken; Adrienne H Brouwers; Marjolijn N Lub-de Hooge; Derk-Jan A de Groot; Elisabeth Ge de Vries Journal: J Immunother Cancer Date: 2022-08 Impact factor: 12.469