Melanoma
Jenny H. Chang, MD (she/her/hers)
Resident
Cleveland Clinic
Cleveland, Ohio, United States
Jenny H. Chang, MD (she/her/hers)
Resident
Cleveland Clinic
Cleveland, Ohio, United States
Jenny H. Chang, MD (she/her/hers)
Resident
Cleveland Clinic
Cleveland, Ohio, United States
Daphne Remulla, MD
Resident
Cleveland Clinic, United States
Chase J. Wehrle, MD
Resident
Cleveland Clinic
Cleveland, Ohio, United States
Kimberly P. Woo, MD
Resident
Cleveland Clinic, United States
Daniel Joyce, MBBCh
Surgeon
Cleveland Clinic, United States
Samer A. naffouje, MD
Assistant Professor of Surgery
Cleveland Clinic Foundation
Tampa, Florida, United States
Immunotherapy is emerging as a promising option for other locally advanced and metastatic cutaneous malignancies. However, the role of neoadjuvant immunotherapy (NIO) in Merkel Cell Carcinoma (MCC) with clinically-detected regional lymph node metastasis (CDRLNM) has not been fully elucidated.
Methods: MCC patients with CDRLNM who underwent surgical excision were selected in the National Cancer Database (NCDB). Those receiving NIO were propensity-matched to those who did not, and Kaplan-Meier was used to compare overall survival (OS).
Results: From the NCDB, 1,809 patients were selected. Median age was 75 years. 1,259 (69.6%) were males and 144 (8.0%) were immunosuppressed. 356 (19.7%) received NIO. 1,306 patients (72.2%) underwent lymph node dissection (LND) compared to 398 with no nodal management (22.0%) and 580 (32.1%) undergoing sentinel lymph node biopsy after NIO. Of those who received NIO and primary excision (n=356), the rate of complete primary response (ypT0) was 45.2%. In the subgroup receiving lymph node dissection (n=223), complete nodal response (ypN0) was 17.9% and pathologic complete response (ypT0 ypN0) was 7.2%. Subsequently, 151 pairs were matched between NIO and no-NIO groups (only patients with LND were included). Kaplan-Meier analysis in Figure 1 showed a significant OS improvement with NIO (median not reached vs. 35.0 ± 8.0 months; p=0.025). Five-year OS was 57% in NIO vs. 44% in no-NIO groups (p=0.021).
Conclusions: Our study suggests that NIO in MCC with CDRLNM provides improved OS in addition to promising rates of primary and nodal complete response which can change the profile of surgical resection. NIO for MCC with CDRLNM should be further investigated in trial setting.