Treatment management for BRAF-mutant melanoma patients with tumor recurrence on adjuvant therapy: a multicenter study from the prospective skin cancer registry ADOREG

Haist M, Stege H, Rogall F, Tan Y, von Wasielewski I, Klespe KC, Meier F, Mohr P, Kähler KC, Weichenthal M, Hauschild A, Schadendorf D, Ugurel S, Lodde G, Zimmer L, Gutzmer R, Debus D, Schilling B, Kreuter A, Ulrich J, Meiss F, Herbst R, Forschner A, Leiter U, Pfoehler C, Kaatz M, Ziller F, Hassel JC, Tronnier M, Sachse M, Dippel E, Terheyden P, Berking C, Heppt M, Kiecker F, Haferkamp S, Gebhardt C, Simon JC, Grabbe S, Loquai C (2023)

Publication Type: Journal article

Publication year: 2023

Journal

Book Volume: 11

Journal Issue: 9

DOI: 10.1136/jitc-2023-007630

Abstract

BACKGROUND: Adjuvant therapy with immune-checkpoint inhibitors (CPI) or BRAF/MEK-directed targeted therapy (TT) improves recurrence-free survival (RFS) for patients with advanced, BRAFV600-mutant (BRAFmut) resected melanoma. However, 40% of these patients will develop distant metastases (DM) within 5 years, which require systemic therapy. Little data exist to guide the choice of upfront adjuvant therapy or treatment management upon DM. This study evaluated the efficacy of subsequent treatments following tumor recurrence upon upfront adjuvant therapy. METHODS: For this multicenter cohort study, we identified 515 BRAFmut patients with resected stage III melanoma who were treated with PD-1 inhibitors (anti-PD1) or TT in the adjuvant setting. Disease characteristics, treatment regimens, details on tumor recurrence, subsequent treatment management, and survival outcomes were collected within the prospective, real-world skin cancer registry ADOReg. Primary endpoints included progression-free survival (PFS) following DM and best tumor response to first-line (1L) treatments. RESULTS: Among 515 eligible patients, 273 patients received adjuvant anti-PD1 and 242 adjuvant TT. At a median follow-up of 21 months, 54.6% of anti-PD1 patients and 36.4% of TT patients recurred, while 39.6% (anti-PD1) and 29.3% (TT) developed DM. Risk of recurrence was significantly reduced in patients treated with TT compared with anti-PD1 (adjusted HR 0.52; 95% CI 0.40 to 0.68, p<0.001). Likewise, median RFS was significantly longer in TT-treated patients (31 vs 17 months, p<0.001). Patients who received TT as second adjuvant treatment upon locoregional recurrence had a longer RFS2 as compared with adjuvant CPI (41 vs 6 months, p=0.009). Patients who recurred at distant sites following adjuvant TT showed favorable response rates (42.9%) after switching to 1L ipilimumab+nivolumab (ipi+nivo). Patients with DM during adjuvant anti-PD1 achieved response rates of 58.7% after switching to 1L TT and 35.3% for 1L ipi+nivo. Overall, median PFS was significantly longer in patients who switched treatments for stage IV disease (median PFS 9 vs 5 months, p=0.004). CONCLUSIONS: BRAFmut melanoma patients who developed DM upon upfront adjuvant therapy achieve favorable tumor control and prolonged PFS after switching treatment modalities in the first-line setting of stage IV disease. Patients with locoregional recurrence benefit from complete resection of recurrence followed by a second adjuvant treatment with TT.

Authors with CRIS profile

Involved external institutions

Universitätsmedizin der Johannes Gutenberg-Universität Mainz Germany (DE) Stanford University United States (USA) (US) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Universitätsklinikum Carl Gustav Carus Dresden Germany (DE) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) Deutsches Krebsforschungszentrum (DKFZ) Germany (DE) Ruhr-Universität Bochum (RUB) Germany (DE) Klinikum Nürnberg Germany (DE) Universitätsklinikum Würzburg Germany (DE) Universität Witten/Herdecke Germany (DE) Harzklinikum Dorothea Christiane Erxleben Germany (DE) Universitätsklinikum Freiburg Germany (DE) HELIOS Kliniken Germany (DE) Eberhard Karls Universität Tübingen Germany (DE) Universitätsklinikum des Saarlandes (UKS) Germany (DE) DRK Krankenhaus Chemnitz-Rabenstein Germany (DE) Universitätsklinikum Heidelberg Germany (DE) Klinikum Bremerhaven-Reinkenheide Germany (DE) Klinikum der Stadt Ludwigshafen am Rhein gGmbH Germany (DE) Vivantes - Netzwerk für Gesundheit GmbH Germany (DE) Universitätsklinikum Regensburg Germany (DE) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Universitätsklinikum Leipzig Germany (DE)

How to cite

APA:

Haist, M., Stege, H., Rogall, F., Tan, Y., von Wasielewski, I., Klespe, K.C.,... Loquai, C. (2023). Treatment management for BRAF-mutant melanoma patients with tumor recurrence on adjuvant therapy: a multicenter study from the prospective skin cancer registry ADOREG. Journal for ImmunoTherapy of Cancer, 11(9). https://doi.org/10.1136/jitc-2023-007630

MLA:

Haist, Maximilian, et al. "Treatment management for BRAF-mutant melanoma patients with tumor recurrence on adjuvant therapy: a multicenter study from the prospective skin cancer registry ADOREG." Journal for ImmunoTherapy of Cancer 11.9 (2023).

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