Adjuvant Immunotherapy Improves Survival in Melanoma

Adjuvant immunotherapy induced improved survival compared with those who did not in patients with stage 3 melanoma, according to data from a large real-world database presented at the American Association for Cancer Research (AACR) Virtual Annual Meeting II.

Justin Moyers, MD, fellow at Loma Linda University in California, and colleagues aimed to determine the percentage of patients receiving immunotherapy after surgery in the real-world setting, using data from the National Cancer Database (NCDB), a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society.

The researchers analyzed treatment data from melanoma cases diagnosed in 2015 and 2016, and survival data from cases diagnosed in 2015. All patients had stage 3 melanoma that was surgically removed.

Patients were a median 60.3 years of age. The majority of patients were white (96.9%), male (61.0%), had a Charlson-Deyo score of 0 (80.8%), and were privately insure (50.6%). Between 2015 and 2016, patients who received immunotherapy increased from 24.8% 30.6%.

Patients who received systemic therapies prior to surgery, and those who received chemotherapy after surgery were excluded.

Of the 4,093 patients who met the study criteria, 25% (n= 1014) received immunotherapy. Median overall survival (OS) has yet to be reached for either treatment group. The 24-month OS rate was 83% (95% CI, 82%-84%) for those receiving adjuvant immunotherapy versus 80% (95% CI, 79%-81%) when immunotherapy was not given (P = .051).

Patients with stage 3C resected melanoma who received adjuvant immunotherapy experienced improved survival (32.8 months vs 28.0 months; P < .01).

Of the 8,160 patients who met inclusion criteria for treatment pattern analysis, 28% (n = 2260) received immunotherapy after surgery. Increasing Charlson-Deyo Scores of 1-3, lower income, lower high school graduation rate, 2015 as the year of diagnosis, and Medicare as the primary payer were associated with decreased percentage of patients receiving immunotherapy.

Antoni Ribas, MD, PhD, FAACR, professor of medicine, surgery, and molecular and medical pharmacology at the University of California Los Angeles, commented on the study, highlighting the negative impact that disparities have on access to therapy.

“Patients with Medicare insurance and comorbid conditions are less likely to receive an immunotherapy and there was a trend for patients with lower income and lower high school graduation rates also receive less access to immunotherapy,” he said. “Together, this data highlights the negative impact of social economic background and having access to proven therapy that benefits patients, both in clinical trials in the real world.”

Moyer acknowledged the study was limited because the NCDB is not a population database, but instead a cohort database. Therefore, disease-specific survival and recurrence/progression-free survival estimates cannot be made, he added.

“We found a survival benefit for immunotherapy given after surgery in stage 3 melanoma at the 24-month landmark analysis. Although not yet statistically significant, it was however significant for stage 3 disease at 24 months,” Moyer said. “Our analysis is the first of the NCDB in the years since the FDA approved immunotherapy after curative intent surgery. Further analysis should be done in subsequent releases of the database to demonstrate real world benefit or benefit of adjunct immunotherapy.”

Reference:

Moyers JT, Chong EG, Mitchell J, et al. mmunotherapy in resected stage III melanoma: An analysis of the National Cancer Database. Presented at: AACR Virtual Annual Meeting II; June 22-24, 2020.