Leiden University Scholarly Publications

Persistent URL of this record https://hdl.handle.net/1887/3753837

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Duin, I.A.J. van; Elias, S.G.; Eertwegh, A.J.M. van den; Groot, J.W.B. de; Blokx, W.A.M.; Diest, P.J. van; ... ; Suijkerbuijk, K.P.M. (2023)

Time interval from primary melanoma to first distant recurrence in relation to patient outcomes in advanced melanoma

Article / Letter to editor
Since the introduction of BRAF(/MEK) inhibition and immune checkpoint inhibition (ICI), the prognosis of advanced melanoma has greatly improved. Melanoma is known for its remarkably long time to first distant recurrence (TFDR), which can be decades in some patients and is partly attributed to immune-surveillance. We investigated the relationship between TFDR and patient outcomes after systemic treatment for advanced melanoma. We selected patients undergoing first-line systemic therapy for advanced melanoma from the nationwide Dutch Melanoma Treatment Registry. The association between TFDR and progression-free survival (PFS) and overall survival (OS) was assessed by Cox proportional hazard regression models. The TFDR was modeled categorically, linearly, and flexibly using restricted cubic splines. Patients received anti-PD-1-based treatment (n = 1844) or BRAF(/MEK) inhibition (n = 1618). For ICI-treated patients with a TFDR <2 years, median OS was 25.0 months, compared to 37.3...Show more Since the introduction of BRAF(/MEK) inhibition and immune checkpoint inhibition (ICI), the prognosis of advanced melanoma has greatly improved. Melanoma is known for its remarkably long time to first distant recurrence (TFDR), which can be decades in some patients and is partly attributed to immune-surveillance. We investigated the relationship between TFDR and patient outcomes after systemic treatment for advanced melanoma. We selected patients undergoing first-line systemic therapy for advanced melanoma from the nationwide Dutch Melanoma Treatment Registry. The association between TFDR and progression-free survival (PFS) and overall survival (OS) was assessed by Cox proportional hazard regression models. The TFDR was modeled categorically, linearly, and flexibly using restricted cubic splines. Patients received anti-PD-1-based treatment (n = 1844) or BRAF(/MEK) inhibition (n = 1618). For ICI-treated patients with a TFDR <2 years, median OS was 25.0 months, compared to 37.3 months for a TFDR >5 years (P = .014). Patients treated with BRAF(/MEK) inhibition with a longer TFDR also had a significantly longer median OS (8.6 months for TFDR <2 years compared to 11.1 months for >5 years, P = .004). The hazard of dying rapidly decreased with increasing TFDR until approximately 5 years (HR 0.87), after which the hazard of dying further decreased with increasing TFDR, but less strongly (HR 0.82 for a TFDR of 10 years and HR 0.79 for a TFDR of 15 years). Results were similar when stratifying for type of treatment. Advanced melanoma patients with longer TFDR have a prolonged PFS and OS, irrespective of being treated with first-line ICI or targeted therapy.
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BRAF(/MEK) inhibition
immune checkpoint inhibition
immunotherapy
melanoma
prognosis
All authors
Duin, I.A.J. van; Elias, S.G.; Eertwegh, A.J.M. van den; Groot, J.W.B. de; Blokx, W.A.M.; Diest, P.J. van; Leiner, T.; Verhoeff, J.J.C.; Verheijden, R.J.; Not, O.J. van; Aarts, M.J.B.; Berkmortel, F.W.P.J. van den; Blank, C.U.; Haanen, J.B.A.G.; Hospers, G.A.P.; Kamphuis, A.M.; Piersma, D.; Rijn, R.S. van; Veldt, A.A.M. van der; Vreugdenhil, G.; Wouters, M.W.J.M.; Stevense-den Boer, M.A.M.; Boers-Sonderen, M.J.; Kapiteijn, E.; Suijkerbuijk, K.P.M.
Date
2023-03-04
Journal
International Journal of Cancer
Volume
152
Issue
12
Pages
2493 - 2502
DOI
doi:10.1002/ijc.34479
Link
https://onlinelibrary.wiley.com/doi/10.1002/ijc.34479