Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection

Zeynep Eroglu, Kristy K. Broman, John F. Thompson, Amanda Nijhuis, Tina J. Hieken, Lisa Kottschade, Jeffrey M. Farma, Meghan Hotz, Jeremiah Deneve, Martin Fleming, Edmund K. Bartlett, Avinash Sharma, Lesly Dossett, Tasha Hughes, David E. Gyorki, Jennifer Downs, Giorgos Karakousis, Yun Song, Ann Lee, Russell S. BermanAlexander Van Akkooi, Emma Stahlie, Dale Han, John Vetto, Georgia Beasley, Norma E. Farrow, Jane Yuet Ching Hui, Marc Moncrieff, Jenny Nobes, Kirsten Baecher, Matthew Perez, Michael Lowe, David W. Ollila, Frances A. Collichio, Roger Olofsson Bagge, Jan Mattsson, Hidde M. Kroon, Harvey Chai, Jyri Teras, James Sun, Michael J. Carr, Ankita Tandon, Nalan Akgul Babacan, Younchul Kim, Mahrukh Naqvi, Jonathan Zager, Nikhil I. Khushalani

Research output: Contribution to journalArticlepeer-review

Abstract

Until recently, most patients with sentinel lymph node-positive (SLN+) melanoma underwent a completion lymph node dissection (CLND), as mandated in published trials of adjuvant systemic therapies. Following multicenter selective lymphadenectomy trial-II, most patients with SLN+ melanoma no longer undergo a CLND prior to adjuvant systemic therapy. A retrospective analysis of clinical outcomes in SLN+ melanoma patients treated with adjuvant systemic therapy after July 2017 was performed in 21 international cancer centers. Of 462 patients who received systemic adjuvant therapy, 326 patients received adjuvant anti-PD-1 without prior immediate (IM) CLND, while 60 underwent IM CLND. With median follow-up of 21 months, 24-month relapse-free survival (RFS) was 67% (95% CI 62% to 73%) in the 326 patients. When the patient subgroups who would have been eligible for the two adjuvant anti-PD-1 clinical trials mandating IM CLND were analyzed separately, 24-month RFS rates were 64%, very similar to the RFS rates from those studies. Of these no-CLND patients, those with SLN tumor deposit >1 mm, stage IIIC/D and ulcerated primary had worse RFS. Of the patients who relapsed on adjuvant anti-PD-1, those without IM CLND had a higher rate of relapse in the regional nodal basin than those with IM CLND (46% vs 11%). Therefore, 55% of patients who relapsed without prior CLND underwent surgery including therapeutic lymph node dissection (TLND), with 30% relapsing a second time; there was no difference in subsequent relapse between patients who received observation vs secondary adjuvant therapy. Despite the increased frequency of nodal relapses, adjuvant anti-PD-1 therapy may be as effective in SLN+ pts who forego IM CLND and salvage surgery with TLND at relapse may be a viable option for these patients.

Original languageEnglish (US)
Article numbere004417
JournalJournal for immunotherapy of cancer
Volume10
Issue number8
DOIs
StatePublished - Aug 24 2022

Keywords

  • Adjuvants, Immunologic
  • Melanoma

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Molecular Medicine
  • Oncology
  • Pharmacology
  • Cancer Research

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