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

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 un...

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Autores principales: Eroglu, Zeynep, Broman, Kristy K, Thompson, John F, Nijhuis, Amanda, Hieken, Tina J, Kottschade, Lisa, Farma, Jeffrey M, Hotz, Meghan, Deneve, Jeremiah, Fleming, Martin, Bartlett, Edmund K, Sharma, Avinash, Dossett, Lesly, Hughes, Tasha, Gyorki, David E, Downs, Jennifer, Karakousis, Giorgos, Song, Yun, Lee, Ann, Berman, Russell S, van Akkooi, Alexander, Stahlie, Emma, Han, Dale, Vetto, John, Beasley, Georgia, Farrow, Norma E, Hui, Jane Yuet Ching, Moncrieff, Marc, Nobes, Jenny, Baecher, Kirsten, Perez, Matthew, Lowe, Michael, Ollila, David W, Collichio, Frances A, Bagge, Roger Olofsson, Mattsson, Jan, Kroon, Hidde M, Chai, Harvey, Teras, Jyri, Sun, James, Carr, Michael J, Tandon, Ankita, Babacan, Nalan Akgul, Kim, Younchul, Naqvi, Mahrukh, Zager, Jonathan, Khushalani, Nikhil I
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9413295/
https://www.ncbi.nlm.nih.gov/pubmed/36002183
http://dx.doi.org/10.1136/jitc-2021-004417
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author Eroglu, Zeynep
Broman, Kristy K
Thompson, John F
Nijhuis, Amanda
Hieken, Tina J
Kottschade, Lisa
Farma, Jeffrey M
Hotz, Meghan
Deneve, Jeremiah
Fleming, Martin
Bartlett, Edmund K
Sharma, Avinash
Dossett, Lesly
Hughes, Tasha
Gyorki, David E
Downs, Jennifer
Karakousis, Giorgos
Song, Yun
Lee, Ann
Berman, Russell S
van Akkooi, Alexander
Stahlie, Emma
Han, Dale
Vetto, John
Beasley, Georgia
Farrow, Norma E
Hui, Jane Yuet Ching
Moncrieff, Marc
Nobes, Jenny
Baecher, Kirsten
Perez, Matthew
Lowe, Michael
Ollila, David W
Collichio, Frances A
Bagge, Roger Olofsson
Mattsson, Jan
Kroon, Hidde M
Chai, Harvey
Teras, Jyri
Sun, James
Carr, Michael J
Tandon, Ankita
Babacan, Nalan Akgul
Kim, Younchul
Naqvi, Mahrukh
Zager, Jonathan
Khushalani, Nikhil I
author_facet Eroglu, Zeynep
Broman, Kristy K
Thompson, John F
Nijhuis, Amanda
Hieken, Tina J
Kottschade, Lisa
Farma, Jeffrey M
Hotz, Meghan
Deneve, Jeremiah
Fleming, Martin
Bartlett, Edmund K
Sharma, Avinash
Dossett, Lesly
Hughes, Tasha
Gyorki, David E
Downs, Jennifer
Karakousis, Giorgos
Song, Yun
Lee, Ann
Berman, Russell S
van Akkooi, Alexander
Stahlie, Emma
Han, Dale
Vetto, John
Beasley, Georgia
Farrow, Norma E
Hui, Jane Yuet Ching
Moncrieff, Marc
Nobes, Jenny
Baecher, Kirsten
Perez, Matthew
Lowe, Michael
Ollila, David W
Collichio, Frances A
Bagge, Roger Olofsson
Mattsson, Jan
Kroon, Hidde M
Chai, Harvey
Teras, Jyri
Sun, James
Carr, Michael J
Tandon, Ankita
Babacan, Nalan Akgul
Kim, Younchul
Naqvi, Mahrukh
Zager, Jonathan
Khushalani, Nikhil I
author_sort Eroglu, Zeynep
collection PubMed
description 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.
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spelling pubmed-94132952022-09-12 Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection Eroglu, Zeynep Broman, Kristy K Thompson, John F Nijhuis, Amanda Hieken, Tina J Kottschade, Lisa Farma, Jeffrey M Hotz, Meghan Deneve, Jeremiah Fleming, Martin Bartlett, Edmund K Sharma, Avinash Dossett, Lesly Hughes, Tasha Gyorki, David E Downs, Jennifer Karakousis, Giorgos Song, Yun Lee, Ann Berman, Russell S van Akkooi, Alexander Stahlie, Emma Han, Dale Vetto, John Beasley, Georgia Farrow, Norma E Hui, Jane Yuet Ching Moncrieff, Marc Nobes, Jenny Baecher, Kirsten Perez, Matthew Lowe, Michael Ollila, David W Collichio, Frances A Bagge, Roger Olofsson Mattsson, Jan Kroon, Hidde M Chai, Harvey Teras, Jyri Sun, James Carr, Michael J Tandon, Ankita Babacan, Nalan Akgul Kim, Younchul Naqvi, Mahrukh Zager, Jonathan Khushalani, Nikhil I J Immunother Cancer Clinical/Translational Cancer Immunotherapy 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. BMJ Publishing Group 2022-08-24 /pmc/articles/PMC9413295/ /pubmed/36002183 http://dx.doi.org/10.1136/jitc-2021-004417 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Clinical/Translational Cancer Immunotherapy
Eroglu, Zeynep
Broman, Kristy K
Thompson, John F
Nijhuis, Amanda
Hieken, Tina J
Kottschade, Lisa
Farma, Jeffrey M
Hotz, Meghan
Deneve, Jeremiah
Fleming, Martin
Bartlett, Edmund K
Sharma, Avinash
Dossett, Lesly
Hughes, Tasha
Gyorki, David E
Downs, Jennifer
Karakousis, Giorgos
Song, Yun
Lee, Ann
Berman, Russell S
van Akkooi, Alexander
Stahlie, Emma
Han, Dale
Vetto, John
Beasley, Georgia
Farrow, Norma E
Hui, Jane Yuet Ching
Moncrieff, Marc
Nobes, Jenny
Baecher, Kirsten
Perez, Matthew
Lowe, Michael
Ollila, David W
Collichio, Frances A
Bagge, Roger Olofsson
Mattsson, Jan
Kroon, Hidde M
Chai, Harvey
Teras, Jyri
Sun, James
Carr, Michael J
Tandon, Ankita
Babacan, Nalan Akgul
Kim, Younchul
Naqvi, Mahrukh
Zager, Jonathan
Khushalani, Nikhil I
Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection
title Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection
title_full Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection
title_fullStr Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection
title_full_unstemmed Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection
title_short Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection
title_sort outcomes with adjuvant anti-pd-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection
topic Clinical/Translational Cancer Immunotherapy
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9413295/
https://www.ncbi.nlm.nih.gov/pubmed/36002183
http://dx.doi.org/10.1136/jitc-2021-004417
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