A phase 2 trial of complete resection for stage IV melanoma: Results of Southwest Oncology Group Clinical Trial S9430

Jeffrey A. Sosman, James Moon, Ralph J. Tuthill, James A. Warneke, John Vetto, Bruce G. Redman, P. Y. Liu, Joseph M. Unger, Lawrence E. Flaherty, Vernon K. Sondak

    Research output: Contribution to journalArticle

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    Abstract

    BACKGROUND: On the basis of retrospective experience at individual centers, it appears that patients with stage IV melanoma who undergo complete resection have a favorable outcome compared with patients with disseminated stage IV disease. The Southwest Oncology Group (SWOG) performed a prospective trial in patients with metastatic melanoma who were enrolled before complete resection of their metastatic disease and provided prospective outcomes in the cooperative group setting. METHODS: Based on their physical examination and radiologic imaging studies, patients with a stage IV melanoma judged amenable to complete resection underwent surgery within 28 days of enrollment. All eligible patients were followed with scans (computed tomography or positron emission tomography) every 6 months until relapse and death. RESULTS: Seventy-seven patients were enrolled from 18 different centers. Of those, 5 patients were ineligible; 2 had stage III disease alone; and 3 had no melanoma in their surgical specimen. In addition, 8 eligible patients had incompletely resected tumor. Therefore, the primary analysis included 64 completely resected patients. Twenty patients (31%) had visceral disease. With a median follow-up of 5 years, the median relapse-free survival was 5 months (95% CI, 3-7 months) whereas median overall survival was 21 months (95% CI, 16-34 months). Overall survivals at 3 and 4 years were 36% and 31%, respectively. CONCLUSIONS: In a prospective multicenter setting, appropriately selected patients with stage IV melanoma achieved prolonged overall survival after complete surgical resection. Although median relapse-free survival was only 5 months, patients could still frequently undergo subsequent surgery for isolated recurrences. This patient population is appropriate for aggressive surgical therapy and for trials evaluating adjuvant therapy. Cancer 2011;. © 2011 American Cancer Society. One of the only prospective analyses of surgery for metastatic disease in patients with stage IV disease, this article reports on a multicenter cooperative group trial with enrollment of patients from 18 different institutions. Incorporating consistent monitoring is a hallmark of cooperative group trials.

    Original languageEnglish (US)
    Pages (from-to)4740-4746
    Number of pages7
    JournalCancer
    Volume117
    Issue number20
    DOIs
    StatePublished - Oct 15 2011

    Fingerprint

    Melanoma
    Clinical Trials
    Survival
    Recurrence
    Physical Examination
    Neoplasms

    Keywords

    • clinical trial
    • melanoma
    • prognosis
    • surgery

    ASJC Scopus subject areas

    • Cancer Research
    • Oncology

    Cite this

    Sosman, J. A., Moon, J., Tuthill, R. J., Warneke, J. A., Vetto, J., Redman, B. G., ... Sondak, V. K. (2011). A phase 2 trial of complete resection for stage IV melanoma: Results of Southwest Oncology Group Clinical Trial S9430. Cancer, 117(20), 4740-4746. https://doi.org/10.1002/cncr.26111

    A phase 2 trial of complete resection for stage IV melanoma : Results of Southwest Oncology Group Clinical Trial S9430. / Sosman, Jeffrey A.; Moon, James; Tuthill, Ralph J.; Warneke, James A.; Vetto, John; Redman, Bruce G.; Liu, P. Y.; Unger, Joseph M.; Flaherty, Lawrence E.; Sondak, Vernon K.

    In: Cancer, Vol. 117, No. 20, 15.10.2011, p. 4740-4746.

    Research output: Contribution to journalArticle

    Sosman, JA, Moon, J, Tuthill, RJ, Warneke, JA, Vetto, J, Redman, BG, Liu, PY, Unger, JM, Flaherty, LE & Sondak, VK 2011, 'A phase 2 trial of complete resection for stage IV melanoma: Results of Southwest Oncology Group Clinical Trial S9430', Cancer, vol. 117, no. 20, pp. 4740-4746. https://doi.org/10.1002/cncr.26111
    Sosman, Jeffrey A. ; Moon, James ; Tuthill, Ralph J. ; Warneke, James A. ; Vetto, John ; Redman, Bruce G. ; Liu, P. Y. ; Unger, Joseph M. ; Flaherty, Lawrence E. ; Sondak, Vernon K. / A phase 2 trial of complete resection for stage IV melanoma : Results of Southwest Oncology Group Clinical Trial S9430. In: Cancer. 2011 ; Vol. 117, No. 20. pp. 4740-4746.
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    abstract = "BACKGROUND: On the basis of retrospective experience at individual centers, it appears that patients with stage IV melanoma who undergo complete resection have a favorable outcome compared with patients with disseminated stage IV disease. The Southwest Oncology Group (SWOG) performed a prospective trial in patients with metastatic melanoma who were enrolled before complete resection of their metastatic disease and provided prospective outcomes in the cooperative group setting. METHODS: Based on their physical examination and radiologic imaging studies, patients with a stage IV melanoma judged amenable to complete resection underwent surgery within 28 days of enrollment. All eligible patients were followed with scans (computed tomography or positron emission tomography) every 6 months until relapse and death. RESULTS: Seventy-seven patients were enrolled from 18 different centers. Of those, 5 patients were ineligible; 2 had stage III disease alone; and 3 had no melanoma in their surgical specimen. In addition, 8 eligible patients had incompletely resected tumor. Therefore, the primary analysis included 64 completely resected patients. Twenty patients (31{\%}) had visceral disease. With a median follow-up of 5 years, the median relapse-free survival was 5 months (95{\%} CI, 3-7 months) whereas median overall survival was 21 months (95{\%} CI, 16-34 months). Overall survivals at 3 and 4 years were 36{\%} and 31{\%}, respectively. CONCLUSIONS: In a prospective multicenter setting, appropriately selected patients with stage IV melanoma achieved prolonged overall survival after complete surgical resection. Although median relapse-free survival was only 5 months, patients could still frequently undergo subsequent surgery for isolated recurrences. This patient population is appropriate for aggressive surgical therapy and for trials evaluating adjuvant therapy. Cancer 2011;. {\circledC} 2011 American Cancer Society. One of the only prospective analyses of surgery for metastatic disease in patients with stage IV disease, this article reports on a multicenter cooperative group trial with enrollment of patients from 18 different institutions. Incorporating consistent monitoring is a hallmark of cooperative group trials.",
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    AU - Warneke, James A.

    AU - Vetto, John

    AU - Redman, Bruce G.

    AU - Liu, P. Y.

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