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Melanoma

E304: Real World Experience with Regional Lymphadenectomy for Clinical Stage III Malignant Melanoma in the Setting of Immunotherapy

    ePoster Abstract Author(s)

  • Michael J. Kirsch, II, MD, MS

    Resident Physician
    University of Colorado Anschutz Medical Campus
    Denver, Colorado, United States

    • Submitter(s)

  • Michael J. Kirsch, II, MD, MS

    Resident Physician
    University of Colorado Anschutz Medical Campus
    Denver, Colorado, United States

    • Author(s)

  • Michael J. Kirsch, II, MD, MS

    Resident Physician
    University of Colorado Anschutz Medical Campus
    Denver, Colorado, United States

  • Elliott J. Yee, MD (he/him/his)

    General Surgery Resident
    University of Colorado - Anschutz, CO
    Denver, Colorado, United States

  • WR

    William Robinson, MD PhD

    Professor
    University of Colorado - Anschutz, CO, United States

  • TM

    Theresa Medina, MD

    Associate Professor
    University of Colorado Anschutz Medical Campus, Department of Medicine, Division of Medical Oncology, United States

  • LM

    Luke Mantle, MD

    Assistant Professor
    University of Colorado Anschutz Medical Campus, Department of Medicine, Division of Medical Oncology, United States

  • PH

    Patrick Hosokawa, MS

    Senior Professional Research Assistant
    University of Colorado Anschutz Medical Campus, Department of Surgery, Surgical Outcomes and Applied Research, United States

  • Jh

    John hamner, MD

    Assistant Professor
    University of Colorado Anschutz Medical Campus, Department of Surgery, Divison of Surgical Oncology
    Colorado Springs, Colorado, United States

  • Martin D. McCarter, MD

    Professor of Surgery
    University of Colorado, Department of Surgery, United States

  • Camille L. Stewart, MD, FSSO, FACS (she/her/hers)

    Surgical oncologist
    CommonSpirit Health, St. Anthony Hospital
    Lakewood, Colorado, United States

Introduction:

The advent of effective immunotherapy and de-escalation of regional lymphadenectomy have changed the treatment landscape for stage III malignant melanoma. Using a large, real world clinical database, we aimed to directly compare the clinical disease outcomes of patients who underwent lymphadenectomy with those who did not, in the setting of immunotherapy.

Methods:

We performed a retrospective analysis of prospectively collected clinical data from the Flatiron Database. Flatiron is a health data company that works with more than 280 community cancer centers and 8 major academic cancer centers across the US. Specifically, we evaluated patients who presented with clinical stage III melanoma from 2018 to 2021. We compared patients who underwent lymphadenectomy followed by immunotherapy to those who received up-front immunotherapy with or without subsequent lymphadenectomy.


Results:

There were 1,794 patients who met the inclusion criteria: 432 (24.1%) underwent lymphadenectomy prior to immunotherapy (Before Group), 106 (5.9%) underwent lymphadenectomy after immunotherapy (After Group), and 1256 (70.0%) did not undergo lymphadenectomy (Never Group). Patients in the Never Group had significantly less disease progression (34%, n=429) during the study period than those in the Before Group (46%, n=198), or those in the After Group (96%, n=102), p< 0.0001. Patients in the Never Group had no difference in overall survival when compared to both the Before and After Groups (p=0.6473) (Figure 1). Of the patients in the After Group, 69 (65%) underwent lymphadenectomy (at a median of 11.1 months) after experiencing disease progression.


Conclusions:

Using a real world clinical database with short-term follow-up, we observed a common trend: up-front immunotherapy is prevalent among patients with clinical stage III melanoma. Patients who received up-front immunotherapy without subsequent lymphadenectomy had no difference in overall survival when compared with patients who received up-front lymphadenectomy followed by immunotherapy or up-front immunotherapy followed by lymphadenectomy.

Learning Objectives:

  • Upon completion, participants will be able to describe the changes in treatment for stage III melanoma.
  • Upon completion, participants will be able to describe outcomes of patients who do not undergo lymphadenectomy in the setting of immunotherapy.
  • Upon completion, participants will be able to describe differences between survival of patients who receive immunotherapy and do or do not undergo lymphadenectomy.