Sören Reinhard, Jochen Sven Utikal, Anne Zaremba, Georg Lodde, Imke von Wasielewski, Kai Christian Klespe, Friedegund Meier, Sebastian Haferkamp, Katharina C. Kähler, Rudolf Herbst, Christoffer Gebhardt, Anca Sindrilaru, Edgar Dippel, Yenny Angela, Peter Mohr, Claudia Pfoehler, Andrea Forschner, Martin Kaatz, Beatrice Schell, Anja Gesierich, Carmen Loquai, Jessica C. Hassel, Jens Ulrich, Frank Meiss, Gaston Schley, Lucie M. Heinzerling, Michael Sachse, Julia Welzel, Carsten Weishaupt, Cord Sunderkötter, Christiane Michl, Harm-Henning Lindhof, Alexander Kreuter, Markus V. Heppt, Saskia Wenk, Cornelia Mauch, Carola Berking, Annekathrin Silvia Nedwed, Ralf Gutzmer, Ulrike Leiter, Dirk Schadendorf, Selma Ugurel, Michael Weichenthal, Maximilian Haist, Maria Isabel Fleischer, Berenice Lang, Stephan Grabbe, Henner Stege
- Background
Melanoma is the main cause of skin cancer-related death. Treatment with immune checkpoint inhibitors (CPI) has improved the prognosis in recent years. However, subtypes of melanoma differ in their response. Acral lentiginous melanoma (ALM) has a worse prognosis compared to cutaneous melanoma other than ALM (CM) and is therefore of particular relevance.
Aims
To evaluate the efficacy of CPI in first-line treatment of patients with advanced ALM compared CM.
Methods
Retrospective analysis of patients with metastatic ALM (n = 45) or CM (n = 328) who received first-line CPI therapy from the multicenter prospective skin cancer registry ADOREG. Study endpoints were best overall response (BOR), progression-free survival (PFS) and overall survival (OS).
Results
ALM patients had significantly higher rates of ulcerated tumors, loco regional metastases and fewer BRAF-mutated tumors compared to CM patients. Combined CPI was administered in 48.9 % ALM patients and 39.3 % of CMBackground
Melanoma is the main cause of skin cancer-related death. Treatment with immune checkpoint inhibitors (CPI) has improved the prognosis in recent years. However, subtypes of melanoma differ in their response. Acral lentiginous melanoma (ALM) has a worse prognosis compared to cutaneous melanoma other than ALM (CM) and is therefore of particular relevance.
Aims
To evaluate the efficacy of CPI in first-line treatment of patients with advanced ALM compared CM.
Methods
Retrospective analysis of patients with metastatic ALM (n = 45) or CM (n = 328) who received first-line CPI therapy from the multicenter prospective skin cancer registry ADOREG. Study endpoints were best overall response (BOR), progression-free survival (PFS) and overall survival (OS).
Results
ALM patients had significantly higher rates of ulcerated tumors, loco regional metastases and fewer BRAF-mutated tumors compared to CM patients. Combined CPI was administered in 48.9 % ALM patients and 39.3 % of CM patients, while the remaining patients received PD-1 monotherapy. OS trended to be shorter in patients with ALM (18.1 vs. 43.8 months, p = 0.10) with no significant differences in PFS (7.0 vs. 11.5 months, p = 0.21). In patients with CM, median OS with combined CPI was not reached, whereas the median OS after PD-1 monotherapy was 37.8 months (p = 0.22). Conversely, in patients with ALM, OS with combined CPI was 17.8 months, compared to 26 months with PD-1 monotherapy (p = 0.15). There were no significant differences in BOR between patients with ALM or CM.
Conclusion
Analysis of this real-world cohort of patients with metastatic melanoma showed a trend towards poorer survival outcomes upon first-line treatment with CPI in ALM compared to cutaneous melanoma of other subtypes.…
