Adjuvant Immunotherapy Tied to Survival Benefit in Advanced Melanoma

By Megan Brooks

July 01, 2020

NEW YORK (Reuters Health) - Immunotherapy following surgery for stage-3 melanoma is associated with longer survival, but not all patients receive it, according to the first analysis of real-world data in the era of adjuvant immunotherapy in this patient population.

In 2015, the U.S. Food and Drug Administration (FDA) approved the immune-checkpoint inhibitor ipilimumab in patients with stage-3 melanoma when given in an adjuvant setting after surgery.

Using the National Cancer Database (NCDB), Dr. Justin Moyers of Loma Linda University in California and colleagues analyzed treatment data from melanoma cases diagnosed in 2015 and 2016 and survival data from cases diagnosed in 2015.

All patients had surgically resected stage-3 melanoma. Patients who received systemic therapies before surgery, and those who received chemotherapy after surgery were excluded.

The treatment-pattern analysis was based on 8,160 patients. Between 2015 and 2016, the percentage of patients who received immunotherapy increased from 24.8% to 30.6%.

Patients with higher Charlson-Deyo comorbidity scores (scores of 1 to 3 versus 0) and those with Medicare insurance were significantly less likely to receive immunotherapy, Dr. Moyers noted at a June 22 press briefing held in conjunction with the American Association for Cancer Research (AACR) Virtual Meeting II.

There was also a trend towards less use of immunotherapy in those with lower income and lower levels of education. This finding "highlight the negative impact of social economic background and having access to proven therapy that benefits patients, both in clinical trials and in the real world," said briefing co-moderator Dr. Antoni Ribas of the University of California, Los Angeles.

The survival analysis included 4,094 patients. When looking at survival for all stage-3 disease, there was a trend toward improved survival at 24 months in those who received immunotherapy after surgery versus those that did not (83% vs. 80%; P=0.051).

When separating by substages of disease, 24-month survival was significantly improved in patients with stage-3C disease who received immunotherapy relative to their peers who did not (70% vs. 59%; P<0.01). For stage 3A, the numbers were 94% and 91% (P=0.03), respectively, and for stage 3B, 84% and 81% (P=0.35).

"Patients with stage 3 melanoma tend to have poor prognosis even after curative-intent surgery. Based on our findings, immunotherapy after resected stage 3 melanoma appears to reveal a trend for real-world 24-month survival advantage compared with no therapy, supporting the role of adjuvant immunotherapy in the real-world setting," Dr. Moyers said in a conference statement.

The study had no commercial funding and the authors disclosed no conflicts of interest.

SOURCE: American Association for Cancer Research Virtual Meeting II, presented June 22, 2020.