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01-04-2020 | Melanoma | Melanoma

Survival Outcomes After Metastasectomy in Melanoma Patients Categorized by Response to Checkpoint Blockade

Authors: Danielle M. Bello, MD, Katherine S. Panageas, DrPH, Travis Hollmann, MD, Alexander N. Shoushtari, MD, Parisa Momtaz, MD, Paul B. Chapman, MD, Michael A. Postow, MD, Margaret K. Callahan, MD, PhD, Jedd D. Wolchok, MD, PhD, Mary S. Brady, MD, Daniel G. Coit, MD, Charlotte E. Ariyan, MD, PhD

Published in: Annals of Surgical Oncology | Issue 4/2020

Abstract

Introduction

Checkpoint inhibitors have improved outcomes in metastatic melanoma, with 4-year overall survival (OS) of 46% for anti-PD-1 alone or 53% in combination with anti-CTLA-4. However, the median progression free survival is 6.9 and 11.5 months, respectively. Many who progress have gone on to alternative treatments, including surgery, yet the outcome of patients selected for surgery after checkpoint blockade remains unclear.

Methods

Patients who were treated with checkpoint blockade from 2003 to 2017, followed by metastasectomy, were identified from a prospectively maintained institutional melanoma database. Response to immunotherapy was assessed at the time of surgery. Patients were categorized as having responding, isolated progressing, or multiple progressing lesions.

Results

Of the 237 total patients identified, 208 (88%) had stage IV disease, and 29 (12%) had unresectable stage III disease at the start of immunotherapy. Median OS following first resection was 21 months. Median follow-up among survivors was 23 months. Complete resection at the first operation (n = 87, 37%) was associated with improved survival compared with patients with incomplete resection (n = 150, 63%) [median OS not reached (NR) vs. 10.8 months, respectively; 95% CI: 7.3, 14.8; p < 0.0001]. Patients resected for an isolated progressing or responding tumor had a longer median survival compared with those with multiple progressing lesions (NR vs. 7.8 months, 95% CI: 6.2, 11.2; p < 0.0001).

Conclusions

Patients selected for surgical resection following checkpoint blockade have a relatively favorable survival, especially if they had a response to immunotherapy and undergo complete resection of isolated progressing or responding disease.

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Title: Survival Outcomes After Metastasectomy in Melanoma Patients Categorized by Response to Checkpoint Blockade
Authors: Danielle M. Bello, MD
Katherine S. Panageas, DrPH
Travis Hollmann, MD
Alexander N. Shoushtari, MD
Parisa Momtaz, MD
Paul B. Chapman, MD
Michael A. Postow, MD
Margaret K. Callahan, MD, PhD
Jedd D. Wolchok, MD, PhD
Mary S. Brady, MD
Daniel G. Coit, MD
Charlotte E. Ariyan, MD, PhD
Publication date: 01-04-2020
Publisher: Springer International Publishing
Keywords: Melanoma
Melanoma
Published in: Annals of Surgical Oncology / Issue 4/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-019-08099-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Survival Outcomes After Metastasectomy in Melanoma Patients Categorized by Response to Checkpoint Blockade

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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