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Efficacy and toxicity of adjuvant radiotherapy in recurrent melanoma after adjuvant immunotherapy

医学 黑色素瘤 佐剂 肿瘤科 内科学 辅助治疗 易普利姆玛 放射治疗 淋巴结切除术 外科 阶段(地层学) 淋巴结 免疫疗法 癌症 癌症研究 古生物学 生物
作者
Prachi Bhave,Angela Hong,Serigne Lo,Rebecca Johnson,Johanna Mangana,Douglas B. Johnson,Özgecan Dülgar,Zeynep Eroglu,Hui‐Ling Yeoh,Andrew Haydon,Georg Lodde,Elisabeth Livingstone,Adnan Khattak,Katharina C. Kähler,Axel Hausschild,Grant A. McArthur,Alexander M. Menzies,Georgina V. Long,Wei Wang,Matteo S. Carlino
出处
期刊:Journal for ImmunoTherapy of Cancer [BMJ]
卷期号:11 (3): e006629-e006629 被引量:10
标识
DOI:10.1136/jitc-2022-006629
摘要

Background In patients with stage III melanoma, despite surgical resection and adjuvant systemic therapy, locoregional recurrences still occur. The randomized, phase III Trans-Tasman Radiation Oncology Group (TROG) 02.01 trial demonstrated that adjuvant radiotherapy (RT) after complete lymphadenectomy (CLND) halves the incidence of melanoma recurrence within local nodal basins without improving overall survival or quality of life. However, the study was conducted prior to the current era of adjuvant systemic therapies and when CLND was the standard approach for microscopic nodal disease. As such, there is currently no data on the role of adjuvant RT in patients with melanoma who recur during or after adjuvant immunotherapy, including those that may or may not have undergone prior CLND. In this study, we aimed to answer this question. Methods Patients with resected stage III melanoma who received adjuvant anti-programmed cell death protein-1 (PD-1) (±ipilimumab) immunotherapy with a subsequent locoregional (lymph node and/or in-transit metastases) recurrence were retrospectively identified. Multivariable logistic and Cox regression analyses were conducted. Primary outcome was rate of subsequent locoregional recurrence; secondary outcomes were locoregional recurrence-free survival (lr-RFS2) and overall RFS (RFS2) to second recurrence. Results In total, 71 patients were identified: 42 (59%) men, 30 (42%) BRAF V600E mutant, 43 (61%) stage IIIC at diagnosis. Median time to first recurrence was 7 months (1–44), 24 (34%) received adjuvant RT and 47 (66%) did not. Thirty-three patients (46%) developed a second recurrence at a median of 5 months (1–22). The rate of locoregional relapse at second recurrence was lower in those who received adjuvant RT (8%, 2/24) compared with those who did not (36%, 17/47, p=0.01). Adjuvant RT at first recurrence was associated with an improved lr-RFS2 (HR 0.16, p=0.015), with a trend towards an improved RFS2 (HR 0.54, p = 0.072) and no effect on risk of distant recurrence or overall survival. Conclusion This is the first study to investigate the role of adjuvant RT in patients with melanoma with locoregional disease recurrence during or after adjuvant anti-PD-1-based immunotherapy. Adjuvant RT was associated with improved lr-RFS2, but not risk of distant recurrence, demonstrating a likely benefit in locoregional disease control in the modern era. Further prospective studies are required to validate these results.
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