60: Management and outcomes of patients with recurrence of cutaneous melanoma during or after completion of adjuvant immunotherapy: a multicenter study

Thursday, March 21, 2024

1:57pm - 2:07pm ET

Location: C102

Abstract Presenter(s)

Sophia McKinley, MD EdM (she/her/hers)

Surgical Oncologist
Massachusetts General Hospital, United States

Submitter(s)

Sophia McKinley, MD EdM (she/her/hers)

Surgical Oncologist
Massachusetts General Hospital, United States

Author(s)

Sophia McKinley, MD EdM (she/her/hers)

Surgical Oncologist
Massachusetts General Hospital, United States
HK

Hannah L. Kalvin, MSPH

Biostatistician
Memorial Sloan Kettering Cancer Center, United States
MS

Mackenzie L. Shindorf, MD

Fellow
University of Louisville
Louisville, Kentucky, United States
Kristen E. Rhodin, MD, MHS

General Surgery Resident
Duke University Medical Center
Durham, North Carolina, United States
MS

Murtuza Saifuddin, MD

Research fellow
Sunnybrook Health Sciences Centre, United States
CT

Christine Tran, BA

Research fellow
UVA, United States
GS

Gabrielle Schwartzman, MD

Research fellow
UVA, United States
Cimarron E. Sharon, MD

Resident
University of Pennsylvania
Philadelphia, Pennsylvania, United States
AL

Aleigha Lawless, BA

Clinical Research Manager
Massachusetts General Hospital
Boston, Massachusetts, United States
Giorgos Karakousis, MD

Professor of Surgery
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States
EG

Elizabeth Gaughan, MD

Medical oncologist
UVA, United States
CS

Craig Slingluff, MD

Surgical oncologist
UVA, United States
FW

Frances C. Wright, MD MEd

Surgical oncologist, Professor
Sunnybrook Health Sciences Centre, United States
Genevieve M. Boland, MD, PhD

Section Head, Melanoma/Sarcoma Surgery
Massachusetts General Hospital
Boston, Massachusetts, United States
KP

Katherine Panageas, DrPH

Statistician
MSKCC, United States
Georgia M. Beasley, MD MHS (she/her/hers)

Associate Professor of Surgery with tenure
Duke University Medical Center
Durham, North Carolina, United States
Michael E. Egger, MD, MPH

Surgical oncologist
University of Louisville
Louisville, Kentucky, United States
Edmund Bartlett, MD

Surgical oncologist
MSKCC
New York, New York, United States

Disclosure(s):

Sophia McKinley, MD EdM: No financial relationships to disclose

Genevieve M. Boland, MD, PhD: Ankyra Therapeutics: Advisor (Ongoing), Consultant (Ongoing), Stocks (Ongoing); InterVenn Bioscience: Consultant (Terminated, January 2, 2023), Research Grant (Terminated, January 2, 2023); Iovance Biotherapeutics: Advisor (Terminated, June 1, 2023), Consultant (Terminated, June 1, 2023); Merck: Advisor (Terminated, June 1, 2023), Consultant (Terminated, June 1, 2023); Nektar Therapeutics: Advisor (Terminated, January 1, 2022); Olink Proteomics: Research Grant (Ongoing); Palleon Pharmaceuticals: Research Grant (Terminated, January 2, 2023); Teiko Bio: Research Grant (Ongoing)

Georgia M. Beasley, MD MHS: Asana BioSciences, LLC; Bristol-Myers Squibb; Merck & Co., Inc.; Novartis Pharmaceuticals Corporation; and Replimune Group Inc: Research Grant (Terminated, September 13, 2023), Speaker (Terminated, September 13, 2023)

Edmund Bartlett, MD: Qbiotic Group: Research Grant (Ongoing); SkylineDx: Research Grant (Ongoing)

Introduction: While adjuvant immunotherapy improves recurrence-free survival in high-risk resected cutaneous melanoma, there is a persistent need to identify the best treatment strategy when adjuvant immunotherapy fails to prevent recurrence. This study describes patterns of recurrence including distribution of sites of recurrence, subsequent management, and outcomes of patients who recur during or after adjuvant immunotherapy.

Methods: Patients with cutaneous melanoma who recurred during or after completion of adjuvant immunotherapy were retrospectively identified from six academic medical centers. Patterns of recurrence, subsequent treatment, and patient survival were analyzed. Kaplan-Meier methods were used to describe overall survival (OS) from time of first recurrence. Log-rank p-values were used to compare OS by groups of interest.

Results: 250 patients with recurrent melanoma were included. The majority of patients were stage III (n=242, 97%) and received adjuvant anti-PD1 therapy (n=210, 84%). Median time to recurrence was 9.4 months (IQR: 5.6,16.8) after initial surgical resection. Recurrence while on adjuvant therapy occurred in 134 patients (55%). Median OS from time of first recurrence was 5.2 (95%CI: 3.7-NR) years. Three-year OS after 1st recurrence was 61% (53,70). Across the entire cohort, 117 patients (47%) underwent curative intent surgical resection, and 208 patients (84%) received further systemic therapy for treatment of their initial recurrence. The distribution of sites of first recurrence and common subsequent treatments are depicted in Figure 1. Site of first recurrence was associated with significantly different OS (log-rank p=0.035; 3 yr est: Local/Intransit (LCIT) 73% (60,88), Nodal+LCIT 76% (58,100), Node-only 45% (29,72), systemic 56% (44,70)). First recurrence that occurred during adjuvant therapy as opposed to following discontinuation was not associated with OS on univariate analysis (log-rank p=0.5).

Conclusions: Melanoma recurrence following adjuvant immunotherapy was associated with survival similar to the front-line metastatic setting. Site of recurrence, but not whether recurrence occurred during vs after adjuvant immunotherapy, was associated with OS. These outcomes may inform future clinical trial design in this previously treated patient population.
Learning Objectives:
Describe distribution of site of first recurrence of resected cutaneous melanoma during or after adjuvant immunotherapy.
List most commonly selected subsequent treatments of cutaneous melanoma that recurred during or after adjuvant immunotherapy.
Describe association of site of recurrence on long term survival of cutaneous melanoma that recurred during or after adjuvant immunotherapy.