Citations 1
Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection
Eroglu, Zeynep , Thompson, John F. , Nijhuis, Amanda A. G. , Kottschade, Lisa A. , Farma, Jeffrey M. , Hotz, Meghan, Deneve, Jeremiah L. , Fleming, Martin D. , Sharma, Avinash , Dossett, Lesly A. , Downs, Jennifer , Karakousis, Giorgos C. , Akkooi, Alexander C. J. van , Han, Dale , Vetto, John T. , Hui, Jane Yuet Ching , Nobes, Jenny , Baecher, Kirsten , Ollila, David W. , Collichio, Frances A. , Bagge, Roger Olofsson , Kroon, Hidde M. , Chai, Harvey , Teras, Jyri , Carr, Michael J. , Babacan, Nalan Akgül , Kim, Younchul, Naqvi, Mahrukh, Thompson, John F , Kottschade, Lisa, Bartlett, Edmund K , Beasley, Georgia M , Hui, Jane Yuet Ching , Lowe, Michael C , Khushalani, Nikhil I , Olofsson Bagge, Roger , Broman, Kristy K. , Hieken, Tina J. , Bartlett, Edmund K. , Hughes, Tasha M. , Gyorki, David E. , Song, Yun , Lee, Ann , Berman, Russell S. , Stahlie, Emma H. A. , Beasley, Georgia M. , Farrow, Norma E. , Moncrieff, Marc D. , Perez, Matthew C , Mattsson, Jan , Sun, James X. , Tandon, Ankita, Zager, Jonathan S. , Khushalani, Nikhil I.
Journal for ImmunoTherapy of Cancer | August 24, 2022 | Volume: 10 | Issue: 8 | Pages: e004417
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.