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The value of local therapy in treatment of solitary melanoma progression upon immune checkpoint inhibition
Versluis, J. M. Hendriks, A. M. Weppler, A. Brown, L. de Joode, K. Suijkerbuijk, K. P. M. Zimmer, L. Kapiteijn, E. Allayous, C. Johnson, D. B.
Versluis, J. M.
Hendriks, A. M.
Weppler, A.
Brown, L.
de Joode, K.
Suijkerbuijk, K. P. M.
Zimmer, L.
Kapiteijn, E.
Allayous, C.
Johnson, D. B.
Citations
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Abstract
Background: Patients (pts) with stage IV melanoma can achieve long-term disease
control through treatment with immune checkpoint inhibition (ICI). Disease progression
in a single tumor lesion (solitary progression, SP) after initial response to ICI
is often treated with local therapy. This study aimed to evaluate the benefits of local
therapy for the treatment of SP during (on) or after cessation of (off) ICI.
Methods: Pts with stage IV melanoma with at least stable disease (SD) as best overall
response (BOR) upon ICI and SP as first progressive event were retrospectively
included from 17 centers in 9 countries.
Results: We included 294 pts with SP on anti-PD-1 (67%), anti-CTLA-4 (13%), anti-PD-
1 + anti-CTLA-4 (15%) and other ICI combinations (5%). BOR prior to SP was SD (15%),
partial response (55%) and complete response (30%). Local therapy was mainly surgery
(56%), radiotherapy (35%) or both (5%). Median follow-up from start ICI was 43
months (m), median time to SP 13m and median time to second progression after
treatment of SP (TTSP) 33m. Median overall survival (OS) was not reached, estimated
3-year OS was 79%. SP occurred in 143 pts on ICI (median 11m) and in 151 pts off ICI
(median 17m from start ICI, 9m from stop ICI). SP was treated with local + systemic
therapy (42%), local therapy (36%) or systemic therapy only (18%). Second progression
was mostly progression at multiple sites (64% and 65% for SP on and off ICI). In
pts with SP on ICI, median TTSP was 29m. Local therapy + ICI continuation (N¼94)
resulted in similar 3-year TTSP as local therapy (N¼15) or ICI continuation only
(N¼14, P¼0.971). OS at 3 years was superior for local therapy + ICI continuation
(P¼0.020). In pts with SP off ICI, median TTSP was 35m. ICI restart + local therapy
(N¼22, 85%) resulted in superior TTSP compared to local therapy (N¼90, 41%) or ICI
restart (N¼18, 56%, P¼0.002), without OS differences so far.
Conclusions: In pts with SP off ICI, the combination of local therapy + ICI restart was
most successful in delaying further progression, but did not improve OS so far
compared to single modality treatment. Local therapy + ICI continuation in pts with
SP on ICI did not improve TTSP, but did improve OS. This indicates that local therapy
can benefit pts.
Description
Date
2020
Publisher
Collections
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From UNPAYWALL
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Keywords
Type
Meetings and Proceedings
Citation
Versluis JM, Hendriks AM, Weppler A, Brown L, de Joode K, Suijkerbuijk KPM, et al. 1080MO The value of local therapy in treatment of solitary melanoma progression upon immune checkpoint inhibition. Annals of Oncology. 2020;31:S733-S4.