TY - JOUR
T1 - Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection
AU - Eroglu, Zeynep
AU - Broman, Kristy K.
AU - Thompson, John F.
AU - Nijhuis, Amanda
AU - Hieken, Tina J.
AU - Kottschade, Lisa
AU - Farma, Jeffrey M.
AU - Hotz, Meghan
AU - Deneve, Jeremiah
AU - Fleming, Martin
AU - Bartlett, Edmund K.
AU - Sharma, Avinash
AU - Dossett, Lesly
AU - Hughes, Tasha
AU - Gyorki, David E.
AU - Downs, Jennifer
AU - Karakousis, Giorgos
AU - Song, Yun
AU - Lee, Ann
AU - Berman, Russell S.
AU - Van Akkooi, Alexander
AU - Stahlie, Emma
AU - Han, Dale
AU - Vetto, John
AU - Beasley, Georgia
AU - Farrow, Norma E.
AU - Hui, Jane Yuet Ching
AU - Moncrieff, Marc
AU - Nobes, Jenny
AU - Baecher, Kirsten
AU - Perez, Matthew
AU - Lowe, Michael
AU - Ollila, David W.
AU - Collichio, Frances A.
AU - Bagge, Roger Olofsson
AU - Mattsson, Jan
AU - Kroon, Hidde M.
AU - Chai, Harvey
AU - Teras, Jyri
AU - Sun, James
AU - Carr, Michael J.
AU - Tandon, Ankita
AU - Babacan, Nalan Akgul
AU - Kim, Younchul
AU - Naqvi, Mahrukh
AU - Zager, Jonathan
AU - Khushalani, Nikhil I.
N1 - Publisher Copyright:
© Author(s)(or their employer(s)) 2022.
PY - 2022/8/24
Y1 - 2022/8/24
N2 - 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.
AB - 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.
KW - Adjuvants, Immunologic
KW - Melanoma
UR - http://www.scopus.com/inward/record.url?scp=85136468593&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85136468593&partnerID=8YFLogxK
U2 - 10.1136/jitc-2021-004417
DO - 10.1136/jitc-2021-004417
M3 - Article
C2 - 36002183
AN - SCOPUS:85136468593
SN - 2051-1426
VL - 10
JO - Journal for immunotherapy of cancer
JF - Journal for immunotherapy of cancer
IS - 8
M1 - e004417
ER -