TY - JOUR
T1 - Clinically Significant Risk Thresholds in the Management of Primary Cutaneous Melanoma
T2 - A Survey of Melanoma Experts
AU - Bartlett, Edmund K.
AU - Grossman, Douglas
AU - Swetter, Susan M.
AU - Leachman, Sancy A.
AU - Curiel-Lewandrowski, Clara
AU - Dusza, Stephen W.
AU - Gershenwald, Jeffrey E.
AU - Kirkwood, John M.
AU - Tin, Amy L.
AU - Vickers, Andrew J.
AU - Marchetti, Michael A.
N1 - Funding Information:
This research was funded in part through the MSKCC institutional NIH/NCI Cancer Center Support Grant P30 CA008748. The material is the result of work supported with resources and the use of facilities at the VA Palo Alto Health Care System in Palo Alto, CA (SMS). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Funding Information:
Susan M. Swetter, Clara Curiel-Lewandrowski, Stephen W. Dusza, Amy L. Tin, Andrew J. Vickers, and Michael A. Marchetti report no conflicts of interest. Edmund K. Bartlett reports receiving institutional research funding from SkylineDx and an honorarium from Excite International unrelated to the content of this work. Jeffrey E. Gershenwald has been on an advisory board and/or consultant for Merck, Bristol Myers Squibb, and Regeneron in the past 24 months, unrelated to the content of this work. Douglas Grossman is an investigator for Dermtech, Inc. and Orlucent, Inc., and serves on the advisory board for Orlucent, Inc., all unrelated to the content of this work. Sancy A. Leachman receives research support from Orlucent, Inc., DermDetect, and Myriad Genetics Laboratory, and serves on an advisory board for Orlucent, Inc., VeriSkin, Inc., and Merck. John M. Kirkwood has been on an advisory board and/or consultant for Amgen Inc., Ankyra Therapeutics, Axio Research, Becker Pharmaceutical, Bristol Myers Squibb, Checkmate Pharmaceuticals, DermTech, Elsevier, Fenix Group International, Harbour Biomed, Immunocore LLC, Intellisphere LLC, Iovance Biotherapeutics, IQVIA, Istari Oncology, Merck, Millennium Pharmaceuticals, Natera Inc., Novartis Pharmaceuticals, OncoCyte Corp., OncoSec Medical Inc., Pfizer, Replimune, Scopus BioPharma, and SR One Capital Management, and receives institutional research support from Amgen, Bristol Myers Squibb, Castle Biosciences, Checkmate Pharmaceuticals, Immvira Pharma Co., Immunocore LLC, Iovance Biotherapeutics, Lion Biotechnologies, Merck, Novartis Pharmaceuticals, and Schering-Plough, all unrelated to the content of this work.
Publisher Copyright:
© 2022, Society of Surgical Oncology.
PY - 2022
Y1 - 2022
N2 - Background: Risk-based thresholds to guide management are undefined in the treatment of primary cutaneous melanoma but are essential to advance the field from traditional stage-based treatment to more individualized care. Methods: To estimate treatment risk thresholds, hypothetical clinical melanoma scenarios were developed and a stratified random sample was distributed to expert melanoma clinicians via an anonymous web-based survey. Scenarios provided a defined 5-year risk of recurrence and asked for recommendations regarding clinical follow-up, imaging, and adjuvant therapy. Marginal probability of response across the spectrum of 5-year recurrence risk was estimated. The risk at which 50% of respondents recommended a treatment was defined as the risk threshold. Results: The overall response rate was 56% (89/159). Three separate multivariable models were constructed to estimate the recommendations for clinical follow-up more than twice/year, for surveillance cross-sectional imaging at least once/year, and for adjuvant therapy. A 36% 5-year risk of recurrence was identified as the threshold for recommending clinical follow-up more than twice/year. The thresholds for recommending cross-sectional imaging and adjuvant therapy were 30 and 59%, respectively. Thresholds varied with the age of the hypothetical patient: at younger ages they were constant but increased rapidly at ages 60 years and above. Conclusions: To our knowledge, these data provide the first estimates of clinically significant treatment thresholds for patients with cutaneous melanoma based on risk of recurrence. Future refinement and adoption of thresholds would permit assessment of the clinical utility of novel prognostic tools and represents an early step toward individualizing treatment recommendations.
AB - Background: Risk-based thresholds to guide management are undefined in the treatment of primary cutaneous melanoma but are essential to advance the field from traditional stage-based treatment to more individualized care. Methods: To estimate treatment risk thresholds, hypothetical clinical melanoma scenarios were developed and a stratified random sample was distributed to expert melanoma clinicians via an anonymous web-based survey. Scenarios provided a defined 5-year risk of recurrence and asked for recommendations regarding clinical follow-up, imaging, and adjuvant therapy. Marginal probability of response across the spectrum of 5-year recurrence risk was estimated. The risk at which 50% of respondents recommended a treatment was defined as the risk threshold. Results: The overall response rate was 56% (89/159). Three separate multivariable models were constructed to estimate the recommendations for clinical follow-up more than twice/year, for surveillance cross-sectional imaging at least once/year, and for adjuvant therapy. A 36% 5-year risk of recurrence was identified as the threshold for recommending clinical follow-up more than twice/year. The thresholds for recommending cross-sectional imaging and adjuvant therapy were 30 and 59%, respectively. Thresholds varied with the age of the hypothetical patient: at younger ages they were constant but increased rapidly at ages 60 years and above. Conclusions: To our knowledge, these data provide the first estimates of clinically significant treatment thresholds for patients with cutaneous melanoma based on risk of recurrence. Future refinement and adoption of thresholds would permit assessment of the clinical utility of novel prognostic tools and represents an early step toward individualizing treatment recommendations.
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U2 - 10.1245/s10434-022-11869-7
DO - 10.1245/s10434-022-11869-7
M3 - Article
C2 - 35583689
AN - SCOPUS:85130066096
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
SN - 1068-9265
ER -