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SSO 2018: Outcomes of Patients With Metastatic Melanoma Selected for Surgery After Immunotherapy

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Key Points

  • Median overall survival for the entire group was 23 months, while overall survival for the group that received immunotherapy and surgery was 21 months.
  • Resection to no evidence of disease (NED) at the first operation was associated with better survival over patients not resected to NED, with median OS that was not reached vs 10.8 months, respectively.

Immunotherapy has transformed the treatment of metastatic melanoma, with 3-year survival rates surpassing 50% for appropriate patients. However, many of these patients still require surgery, but very little research has been done on this group of patients to determine whether surgery after immunotherapy conveys any benefits. Danielle M. Bello, MD, of Memorial Sloan Kettering Cancer Center, and colleagues designed a study to examine the outcomes of surgical intervention for these patients. Its findings were presented at the 2018 Society of Surgical Oncology (SSO) Annual Cancer Symposium.

Study Methods

Dr. Bello and her team analyzed 620 unresectable stage II and IV melanoma patients treated with immunotherapy—including CTLA-4, programmed cell death protein 1 (PD-1), and programmed cell death ligand 1 (PD-L1) blockade—followed by resection from 2003 to 2017. They eliminated procedures which did not involve tissue resection for a cohort of 237 patients. Of these patients, 208 (88%) had stage IV melanoma and 29 (12%) had unresectable stage III melanoma. Researchers followed the patients for approximately 23 months.

Findings

Median overall survival for the entire group was 23 months, while overall survival for the group that received immunotherapy and surgery was 21 months.

Resection to no evidence of disease (NED) at the first operation (n = 87, 37%), was associated with better survival over patients not resected to NED (n = 150, 63%), with median OS that was not reached vs 10.8 months respectively (95% confidence interval = 7.3–14.8; P < .0001).

The researchers found that in a highly selected population of patients with advanced melanoma treated with immunotherapy, surgical resection is associated with good outcomes. This is especially true in those who have demonstrated a measurable response to immunotherapy and can undergo complete resection.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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