Adjuvant immunotherapy (IO) or targeted treatment (TT) in fully resected Stage III and IV melanoma patients: Single centre analysis.


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Lani Walshaw1, Peter Wilson1, Abolore Amuludun1, Donna Wynter1, Sukaina Rashid1, Shanthini Crusz1
1St Bartholomew’s Hospital

Abstract

Background

Adjuvant treatment improves recurrence free survival in melanoma patients (pts) with fully resected i) Stage III disease treated with Pembrolizumab (pembro) / Dabrafenib and Trametinib (D+T) (in BRAF-mutated disease (mBRAF)) or ii) Stage III and IV disease treated with Nivolumab (nivo). We describe real-world data and outcomes of pts referred for adjuvant treatment. 

Method

We undertook retrospective analysis of electronic health records in fully resected Stage III or IV melanoma pts referred to the adjuvant clinic at St Bartholomews Hospital, London between 01/12/2018 – 01/12/2020. Data cut-off was 01/06/2021.

Results

Referred pts; 31/41 received treatment, 24 were Stage III (3A 3%; 3B 18%; 3C 53%; 3D 3%) and 7 (21%) were Stage IV. Median age of pts receiving treatment was 57yrs (range 26-80). 5 pts declined, 2 progressed prior to initiation of adjuvant treatment and treatment was contraindicated in 3.

All pts with mBRAF (n=11) received D+T. In BRAF wildtype (wtBRAF) pts; n=13 Stage III received pembro and n=7 Stage IV received nivo. 

Treated pts; 29% continue on adjuvant treatment, 35% completed 1yr, 16% discontinued due to toxicity, 16% discontinued due to progression (Table 1). 3% (n=1) transferred care and 3% (n=1) have progressed after completing 1yr (9m post nivo).

Table 1: Patient outcomes on adjuvant treatment - median follow up of 13m (range 6-29m)

 

Continues treatment

Completed 1yr adjuvant

Stopped <1yr adjuvant due to toxicity

Stopped <1yr adjuvant due to progression

D+T

2

8

1

0

Pembro

6

2

2

3

Nivo

1

2

2

2

 

Pts on D+T were less likely to progress during 1yr of treatment compared to IO (p=0.012) or pembro alone (p=0.012).  Pts were more likely to stop treatment early due to toxicity with IO compared to TT (p=0.079).

Median time on treatment was 9m, median disease free survival on D+T is 16m, pembro is 10m and nivo is 9m. 


Conclusion

We note that pts were more likely to progress on treatment or discontinue due to toxicity with IO compared to TT. Limitations include small pt numbers and lack of data maturity / follow-up.

Impact statement

We describe increased toxicity and progression with IO vs TT in pts receiving adjuvant melanoma treatment