Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection
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 un...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2022-08-01
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| Series: | Journal for ImmunoTherapy of Cancer |
| Online Access: | https://jitc.bmj.com/content/10/8/e004417.full |
| _version_ | 1818514019331342336 |
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| author | Yun Song John F Thompson Frances A Collichio Tasha Hughes John Vetto Dale Han Jonathan Zager Zeynep Eroglu Jennifer Downs David E Gyorki Nikhil I Khushalani Alexander van Akkooi Georgia Beasley Lisa Kottschade Hidde M Kroon Ann Lee Norma E Farrow Giorgos Karakousis Michael Lowe Avinash Sharma Kristy K Broman Amanda Nijhuis Tina J Hieken Jeffrey M Farma Meghan Hotz Jeremiah Deneve Martin Fleming Edmund K Bartlett Lesly Dossett Russell S Berman Emma Stahlie Jane Yuet Ching Hui Marc Moncrieff Jenny Nobes Kirsten Baecher Matthew Perez David W Ollila Roger Olofsson Bagge Jan Mattsson Harvey Chai Jyri Teras James Sun Michael J Carr Ankita Tandon Nalan Akgul Babacan Younchul Kim Mahrukh Naqvi |
| author_facet | Yun Song John F Thompson Frances A Collichio Tasha Hughes John Vetto Dale Han Jonathan Zager Zeynep Eroglu Jennifer Downs David E Gyorki Nikhil I Khushalani Alexander van Akkooi Georgia Beasley Lisa Kottschade Hidde M Kroon Ann Lee Norma E Farrow Giorgos Karakousis Michael Lowe Avinash Sharma Kristy K Broman Amanda Nijhuis Tina J Hieken Jeffrey M Farma Meghan Hotz Jeremiah Deneve Martin Fleming Edmund K Bartlett Lesly Dossett Russell S Berman Emma Stahlie Jane Yuet Ching Hui Marc Moncrieff Jenny Nobes Kirsten Baecher Matthew Perez David W Ollila Roger Olofsson Bagge Jan Mattsson Harvey Chai Jyri Teras James Sun Michael J Carr Ankita Tandon Nalan Akgul Babacan Younchul Kim Mahrukh Naqvi |
| author_sort | Yun Song |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-11T00:09:31Z |
| format | Article |
| id | doaj.art-5e2609c2e5e44274aabf900f1ff2c1c7 |
| institution | Directory Open Access Journal |
| issn | 2051-1426 |
| language | English |
| last_indexed | 2024-12-11T00:09:31Z |
| publishDate | 2022-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Journal for ImmunoTherapy of Cancer |
| spelling | doaj.art-5e2609c2e5e44274aabf900f1ff2c1c72022-12-22T01:28:10ZengBMJ Publishing GroupJournal for ImmunoTherapy of Cancer2051-14262022-08-0110810.1136/jitc-2021-004417Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissectionYun Song0John F Thompson1Frances A Collichio2Tasha Hughes3John Vetto4Dale Han5Jonathan Zager6Zeynep Eroglu7Jennifer Downs8David E Gyorki9Nikhil I Khushalani10Alexander van Akkooi11Georgia Beasley12Lisa Kottschade13Hidde M Kroon14Ann Lee15Norma E Farrow16Giorgos Karakousis17Michael Lowe18Avinash Sharma19Kristy K Broman20Amanda Nijhuis21Tina J Hieken22Jeffrey M Farma23Meghan Hotz24Jeremiah Deneve25Martin Fleming26Edmund K Bartlett27Lesly Dossett28Russell S Berman29Emma Stahlie30Jane Yuet Ching Hui31Marc Moncrieff32Jenny Nobes33Kirsten Baecher34Matthew Perez35David W Ollila36Roger Olofsson Bagge37Jan Mattsson38Harvey Chai39Jyri Teras40James Sun41Michael J Carr42Ankita Tandon43Nalan Akgul Babacan44Younchul Kim45Mahrukh Naqvi46National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaMelanoma Institute Australia, Sydney, New South Wales, AustraliaAff2 grid.10698.360000000122483208The University of Carolina at Chapel Hill Chapel Hill NC USAAff1 grid.240684.c0000000107053621Rush University Medical Center Chicago IL USAAff365 grid.5288.70000000097585690Knight Cancer Institute, Oregon Health and Science University Portland OR USAAff4 0000 0000 9758 5690grid.5288.7Division of Surgical OncologyOregon Health and Science University Portland OR USAAff1 grid.170693.a000000012353285XH. Lee Moffitt Cancer Center Tampa FL USADepartments of Cutaneous Oncology and Immunology, H. Lee Moffitt Cancer Center and Research Center Inc, Tampa, Florida, USA1 Center for Global Health, Weill Cornell Medical College, New York, New York, USAPeter MacCallum Cancer Centre, Melbourne, Victoria, Australia22 Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USADepartment of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands1Duke University, DURHAM, NC, USADepartment of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USADepartment of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia2St Margaret`s Hospice, Somerset1 Department of Surgery, Duke University, Durham, North Carolina, USADepartment of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USAFiji School of Medicine, Fiji, and University of Newcastle, AustraliaSurgery, Memorial Sloan Kettering Cancer Center, New York, New York, USADepartment of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USAMelanoma Institute Australia, North Sydney, New South Wales, AustraliaDepartment of Surgery, Mayo Clinic, Rochester, New York, USADepartment of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USADepartment of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USADepartment of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USADepartment of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USADepartment of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USADepartment of Surgery, University of Michigan, Ann Arbor, Michigan, USADepartment of Surgery, New York University, New York, New York, USADepartment of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The NetherlandsDepartment of Surgery, University of Minnesota, Minneapolis, Minnesota, USANorfolk and Norwich University Hospital, Norwich, UKNorfolk and Norwich University Hospital, Norwich, UKDepartment of Surgery, Emory University, Atlanta, Georgia, USADepartment of Surgery, Emory University, Atlanta, Georgia, USADepartment of Surgery, University of North Carolina, Chapel Hill, North Carolina, USADepartment of Surgery, Sahlgrenska Center for Cancer Research, University of Gothenburg, Gothenburg, SwedenDepartment of Surgery, Sahlgrenska Center for Cancer Research, University of Gothenburg, Gothenburg, SwedenDepartment of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, AustraliaNorth Estonia Medical Centre Foundation, Tallinn, EstoniaDepartment of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USADepartment of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USAUniversity of South Florida, Tampa, Florida, USADepartment of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USADepartment of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USADepartment of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USAUntil 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.https://jitc.bmj.com/content/10/8/e004417.full |
| spellingShingle | Yun Song John F Thompson Frances A Collichio Tasha Hughes John Vetto Dale Han Jonathan Zager Zeynep Eroglu Jennifer Downs David E Gyorki Nikhil I Khushalani Alexander van Akkooi Georgia Beasley Lisa Kottschade Hidde M Kroon Ann Lee Norma E Farrow Giorgos Karakousis Michael Lowe Avinash Sharma Kristy K Broman Amanda Nijhuis Tina J Hieken Jeffrey M Farma Meghan Hotz Jeremiah Deneve Martin Fleming Edmund K Bartlett Lesly Dossett Russell S Berman Emma Stahlie Jane Yuet Ching Hui Marc Moncrieff Jenny Nobes Kirsten Baecher Matthew Perez David W Ollila Roger Olofsson Bagge Jan Mattsson Harvey Chai Jyri Teras James Sun Michael J Carr Ankita Tandon Nalan Akgul Babacan Younchul Kim Mahrukh Naqvi Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection Journal for ImmunoTherapy of Cancer |
| title | Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection |
| title_full | Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection |
| title_fullStr | Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection |
| title_full_unstemmed | Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection |
| title_short | Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection |
| title_sort | outcomes with adjuvant anti pd 1 therapy in patients with sentinel lymph node positive melanoma without completion lymph node dissection |
| url | https://jitc.bmj.com/content/10/8/e004417.full |
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