Cancers (Sep 2023)

Modern Approach to Melanoma Adjuvant Treatment with Anti-PD1 Immune Check Point Inhibitors or <i>BRAF/MEK</i> Targeted Therapy: Multicenter Real-World Report

  • Joanna Placzke,
  • Magdalena Rosińska,
  • Paweł Sobczuk,
  • Marcin Ziętek,
  • Natasza Kempa-Kamińska,
  • Bożena Cybulska-Stopa,
  • Grażyna Kamińska-Winciorek,
  • Wiesław Bal,
  • Jacek Mackiewicz,
  • Łukasz Galus,
  • Manuela Las-Jankowska,
  • Michał Jankowski,
  • Robert Dziura,
  • Kamil Drucis,
  • Aneta Borkowska,
  • Tomasz Świtaj,
  • Paweł Rogala,
  • Katarzyna Kozak,
  • Anna Klimczak,
  • Paulina Jagodzińska-Mucha,
  • Anna Szumera-Ciećkiewicz,
  • Hanna Koseła-Paterczyk,
  • Piotr Rutkowski

DOI
https://doi.org/10.3390/cancers15174384
Journal volume & issue
Vol. 15, no. 17
p. 4384

Abstract

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Background: The landscape of melanoma management changed as randomized trials have launched adjuvant treatment. Materials and Methods: An analysis of data on 248 consecutive melanoma stage III and IV patients given adjuvant therapy in eight centers (February 2019 to January 2021) was conducted. Results: The analyzed cohort comprised 147 melanoma patients given anti-PD1 (33% nivolumab, 26% pembrolizumab), and 101 (41%) were given dabrafenib plus trametinib (DT). The 2-year overall survival (OS), relapse-free survival (RFS), and distant-metastases-free survival (DMFS) rates were 86.7%, 61.4%, and 70.2%, respectively. The disease stage affected only the RFS rate; for stage IV, it was 52.2% (95% CI: 33.4–81.5%) vs. 62.5% (95% CI: 52.3–74.8%) for IIIA-D, p = 0.0033. The type of lymph node surgery before adjuvant therapy did not influence the outcomes. Completion of lymph node dissection cessation after positive SLNB did not affect the results in terms of RFS or OS. Treatment-related adverse events (TRAE) were associated with longer 24-month RFS, with a rate of 68.7% (55.5–84.9%) for TRAE vs. 56.6% (45.8–70%) without TRAE, p = 0.0031. For TRAE of grade ≥ 3, a significant decline in OS to 60.6% (26.9–100%; p = 0.004) was observed. Conclusions: Melanoma adjuvant therapy with anti-PD1 or DT outside clinical trials appears to be effective and comparable with the results of registration studies. Our data support a de-escalating surgery approach in melanoma treatment.

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