Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection Journal Article
| Authors: | 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.; van Akkooi, A.; Stahlie, E.; Han, D.; Vetto, J.; Beasley, G.; Farrow, N. E.; Hui, J. Y. C.; Moncrieff, M.; Nobes, J.; Baecher, K.; Perez, M.; Lowe, M.; Ollila, D. W.; Collichio, F. A.; Bagge, R. O.; Mattsson, J.; Kroon, H. M.; Chai, H.; Teras, J.; Sun, J.; Carr, M. J.; Tandon, A.; Babacan, N. A.; Kim, Y.; Naqvi, M.; Zager, J.; Khushalani, N. I. |
| Article Title: | Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection |
| 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. © Author(s)(or their employer(s)) 2022. |
| Keywords: | controlled study; retrospective studies; overall survival; clinical trial; systemic therapy; cancer radiotherapy; outcome assessment; follow up; lymph node metastasis; lymph node dissection; sentinel lymph node; lymph node excision; sentinel lymph node biopsy; tumor localization; ipilimumab; melanoma; neoplasm recurrence, local; skin neoplasms; tumor volume; pathology; retrospective study; skin tumor; multicenter study; tumor recurrence; adjuvant chemotherapy; adjuvants, immunologic; cutaneous melanoma; recurrence free survival; programmed death 1 receptor; clinical outcome; nivolumab; extranodal extension; humans; human; male; female; article; pembrolizumab; positron emission tomography-computed tomography; sentinel lymph node positive melanoma |
| Journal Title: | Journal for ImmunoTherapy of Cancer |
| Volume: | 10 |
| Issue: | 8 |
| ISSN: | 2051-1426 |
| Publisher: | Biomed Central Ltd |
| Date Published: | 2022-08-01 |
| Start Page: | e004417 |
| Language: | English |
| DOI: | 10.1136/jitc-2021-004417 |
| PUBMED: | 36002183 |
| PROVIDER: | scopus |
| PMCID: | PMC9413295 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 3 October 2022 -- Source: Scopus |
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