Prognostic markers in Stage IIIC melanoma

Not really news....but.....

Clinical prognostic markers in stage IIIC melanoma.  Madu, Schopman, Berger, et al.J Surg Oncol. 2017 Apr 15. 

Although the EORTC 18071-trial has shown a clear survival benefit for adjuvant ipilimumab, accurately selecting patients for this toxic adjuvant therapy is important. We aimed to identify prognostic factors for death and disease recurrence in AJCC stage IIIC melanoma patients.

Retrospective analysis of patients who underwent lymph node dissection (LND) for stage IIIC melanoma in our institution between 2000 and 2016. Baseline characteristics, melanoma-specific survival (MSS), and disease-free survival (DFS) were assessed, and prognostic factors for recurrence and survival were analyzed using uni- and multivariable analysis.
A total of 205 patients were included. Median follow-up was 20 months (interquartile range 11-43 months), median MSS was 28 months, and median DFS was 11 months. Five-year MSS was 33% and 5-year DFS was 23%. N3 (greater or = to 4 involved lymph nodes) and extracapsular extension (ECE) carried an increased risk of disease recurrence after LND and death by melanoma. Patients with both N3 and ECE had virtually no long-term survival.

Although survival for patients with stage IIIC is poor in general, patients with both N3 disease and ECE constitute the group with the worst prognosis and should be considered for adjuvant therapy with ipilimumab or any other future effective adjuvant therapy (study).

So....we already knew that folks with more positive nodes and melanoma extended beyond the nodes were certainly more vulnerable to progression.

However, we also know this:  Prolonged survival in Stage III melanoma treated with ipi as adjuvant!!!

Yet, when faced with this conundrum - this data would give me pause:  Sequential nivo then ipi = ORR of 41%. Ipi followed by nivo = ORR of 20%!!!! 

Hang in there ratties.  It pays to have long tails.  Wishing you all my best. - c