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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...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2022
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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. |
format | Online Article Text |
id | pubmed-9413295 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
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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