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Survival Outcomes After Metastasectomy in Melanoma Patients Categorized by Response to Checkpoint Blockade

  • Melanoma
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Abstract

Introduction

Checkpoint inhibitors have improved outcomes in metastatic melanoma, with 4-year overall survival (OS) of 46% for anti-PD-1 alone or 53% in combination with anti-CTLA-4. However, the median progression free survival is 6.9 and 11.5 months, respectively. Many who progress have gone on to alternative treatments, including surgery, yet the outcome of patients selected for surgery after checkpoint blockade remains unclear.

Methods

Patients who were treated with checkpoint blockade from 2003 to 2017, followed by metastasectomy, were identified from a prospectively maintained institutional melanoma database. Response to immunotherapy was assessed at the time of surgery. Patients were categorized as having responding, isolated progressing, or multiple progressing lesions.

Results

Of the 237 total patients identified, 208 (88%) had stage IV disease, and 29 (12%) had unresectable stage III disease at the start of immunotherapy. Median OS following first resection was 21 months. Median follow-up among survivors was 23 months. Complete resection at the first operation (n = 87, 37%) was associated with improved survival compared with patients with incomplete resection (n = 150, 63%) [median OS not reached (NR) vs. 10.8 months, respectively; 95% CI: 7.3, 14.8; p < 0.0001]. Patients resected for an isolated progressing or responding tumor had a longer median survival compared with those with multiple progressing lesions (NR vs. 7.8 months, 95% CI: 6.2, 11.2; p < 0.0001).

Conclusions

Patients selected for surgical resection following checkpoint blockade have a relatively favorable survival, especially if they had a response to immunotherapy and undergo complete resection of isolated progressing or responding disease.

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Acknowledgment

This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748, Ludwig Collaborative and Swim Across America Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY; Parker Institute for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medicine, New York, NY.

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Authors and Affiliations

  1. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA

    Danielle M. Bello MD, Mary S. Brady MD, Daniel G. Coit MD & Charlotte E. Ariyan MD, PhD

  2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Katherine S. Panageas DrPH

  3. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Travis Hollmann MD

  4. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Alexander N. Shoushtari MD, Parisa Momtaz MD, Paul B. Chapman MD, Michael A. Postow MD, Margaret K. Callahan MD, PhD & Jedd D. Wolchok MD, PhD

Authors
  1. Danielle M. Bello MD
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  2. Katherine S. Panageas DrPH
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  3. Travis Hollmann MD
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  4. Alexander N. Shoushtari MD
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  9. Jedd D. Wolchok MD, PhD
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Corresponding author

Correspondence to Danielle M. Bello MD.

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Disclosures

This study was presented in plenary podium format at the 71st Annual Meeting of the Society of Surgical Oncology, March 21–24, 2018, Chicago, IL. Drs. Hollmann, Coit, and Brady have no disclosures. Dr. Bello has worked as a consultant for survivornet. Dr. Panageas has stock ownership in Johnson and Johnson, Pfizer, Viking Therapeutics, and Catalyst Biotech. Dr. Shoushtari serves on the advisory board for Bristol-Myers Squibb (BMS), Castle Biosciences, and Immunocore. He receives institutional research support from BMS, Immunocore, AstraZeneca, and Xcovery. Dr. Chapman receives consulting, advisory, or speaking compensation from Immunocore, Merck, Cell Medica, Takeda Millenium, and AstraZeneca. He holds stock in Rgenix. He receives research support from Pfizer. Dr. Postow has worked as a consultant for: BMS, Merck, Array BioPharma, Novartis, Incyte, NewLink Genetics, Aduro. He has received honoraria from: BMS and Merck. He receives institutional research support from: RGenix, Infinity, BMS, Merck, Array BioPharma, Novartis, and AstraZeneca. Dr. Callahan reports grants from and employment of a family member by BMS; personal fees for advisory/consulting role from AstraZeneca/MedImmune, Incyte, Moderna and Merck. Dr. Wolchok is a consultant for: Adaptive Biotech, Advaxis, Amgen, Apricity, Array BioPharma, Ascentage Pharma, Astellas, Bayer, Beigene, BMS, Celgene, Chugai, Elucida, Eli Lilly, F Star, Genentech, Imvaq, Janssen, Kleo Pharma, Linneaus, MedImmune, Merck, Neon Therapeutics, Ono Pharmaceuticals, Polaris Pharma, Polynoma, Psioxus, Puretech, Recepta, Sellas Life Sciences, Serametrix, Surface Oncology, Syndax. He receives research support from: BMS, Medimmune, Genentech. He has equity in: Potenza Therapeutics, Tizona Pharmaceuticals, Adaptive Biotechnologies, Elucida, Imvaq, Beigene, Trieza, Serametrix, Linneaus. He receives honorarium from: Esanex. Dr. Ariyan served on an advisory board for BMS.

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Bello, D.M., Panageas, K.S., Hollmann, T. et al. Survival Outcomes After Metastasectomy in Melanoma Patients Categorized by Response to Checkpoint Blockade. Ann Surg Oncol 27, 1180–1188 (2020). https://doi.org/10.1245/s10434-019-08099-9

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