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https://hdl.handle.net/2440/140277
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Type: | Journal article |
Title: | Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection |
Author: | Eroglu, Z. Broman, K.K. Thompson, J.F. Nijhuis, A. Hieken, T.J. Kottschade, L. Farma, J.M. Hotz, M. Deneve, J. Fleming, M. Bartlett, E.K. Sharma, A. Dossett, L. Hughes, T. Gyorki, D.E. Downs, J. Karakousis, G. Song, Y. Lee, A. Berman, R.S. et al. |
Citation: | Journal for ImmunoTherapy of Cancer, 2022; 10(8):e004417-1-e004417-7 |
Publisher: | BMJ Publishing Group |
Issue Date: | 2022 |
ISSN: | 2051-1426 2051-1426 |
Statement of Responsibility: | Zeynep Eroglu ... Hidde M Kroon ... et al. |
Abstract: | Until recently, most patients with sentinel lymph node-positive (SLN+) melanoma underwent a completion lymph node dissection (CLND), as mandated in published trials of adjuvant systemic therapies. Following multicenter selective lymphadenectomy trial-II, most patients with SLN+ melanoma no longer undergo a CLND prior to adjuvant systemic therapy. A retrospective analysis of clinical outcomes in SLN+ melanoma patients treated with adjuvant systemic therapy after July 2017 was performed in 21 international cancer centers. Of 462 patients who received systemic adjuvant therapy, 326 patients received adjuvant anti-PD-1 without prior immediate (IM) CLND, while 60 underwent IM CLND. With median follow-up of 21 months, 24-month relapse-free survival (RFS) was 67% (95% CI 62% to 73%) in the 326 patients. When the patient subgroups who would have been eligible for the two adjuvant anti-PD-1 clinical trials mandating IM CLND were analyzed separately, 24-month RFS rates were 64%, very similar to the RFS rates from those studies. Of these no-CLND patients, those with SLN tumor deposit >1 mm, stage IIIC/D and ulcerated primary had worse RFS. Of the patients who relapsed on adjuvant anti-PD-1, those without IM CLND had a higher rate of relapse in the regional nodal basin than those with IM CLND (46% vs 11%). Therefore, 55% of patients who relapsed without prior CLND underwent surgery including therapeutic lymph node dissection (TLND), with 30% relapsing a second time; there was no difference in subsequent relapse between patients who received observation vs secondary adjuvant therapy. Despite the increased frequency of nodal relapses, adjuvant anti-PD-1 therapy may be as effective in SLN+ pts who forego IM CLND and salvage surgery with TLND at relapse may be a viable option for these patients. |
Keywords: | Adjuvants, Immunologic Melanoma |
Rights: | © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. |
DOI: | 10.1136/jitc-2021-004417 |
Published version: | http://dx.doi.org/10.1136/jitc-2021-004417 |
Appears in Collections: | Surgery publications |
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hdl_140277.pdf | Published version | 1.99 MB | Adobe PDF | View/Open |
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