Survival outcomes after metastasectomy in melanoma patients categorized by response to checkpoint blockade Journal Article
| Authors: | Bello, D. M.; Panageas, K. S.; Hollmann, T.; Shoushtari, A. N.; Momtaz, P.; Chapman, P. B.; Postow, M. A.; Callahan, M. K.; Wolchok, J. D.; Brady, M. S.; Coit, D. G.; Ariyan, C. E. |
| Article Title: | Survival outcomes after metastasectomy in melanoma patients categorized by response to checkpoint blockade |
| 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. © 2019, Society of Surgical Oncology. |
| Keywords: | adult; cancer survival; treatment outcome; treatment response; aged; unclassified drug; major clinical study; systemic therapy; follow up; lymph node metastasis; prospective study; cytotoxic t lymphocyte antigen 4 antibody; cancer immunotherapy; cohort analysis; minimal residual disease; brain metastasis; soft tissue metastasis; metastatic melanoma; central nervous system metastasis; programmed death 1 receptor antibody; metastasis resection; human; male; female; article; immunological antineoplastic agent |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 27 |
| Issue: | 4 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2020-04-01 |
| Start Page: | 1180 |
| End Page: | 1188 |
| Language: | English |
| DOI: | 10.1245/s10434-019-08099-9 |
| PUBMED: | 31848819 |
| PROVIDER: | scopus |
| PMCID: | PMC7112166 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 April 2020 -- Source: Scopus |
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