Results for Stage III melanoma peeps who recurred after adjuvant targeted therapy

The positive benefits noted in yesterday's update on adjuvant therapy for Stage III melanoma - utilizing immuotherapy as well as targeted therapy in the form of BRAF/MEK inhibitor combos - have been practically miraculous in preventing many melanoma patients from advancing to Stage IV and even death.  Despite the benefits, there are still those whose melanoma does recurr.  This report addresses outcomes of melanoma peeps who advanced after taking BRAF/MEKi as adjuvant targeted therapy.

Melanoma recurrence patterns and management after adjuvant targeted therapy: a multicentre analysis.  Bhave, Pallan, Long, et al.  Br J Cancer. Feb 2021.

Background: Adjuvant targeted therapy (TT) improves relapse free survival in patients with resected BRAF mutant stage III melanoma. The outcomes and optimal management of patients who relapse after adjuvant TT is unknown.

Methods: Patients from twenty-one centres with recurrent melanoma after adjuvant TT were included. Disease characteristics, adjuvant therapy, recurrence, treatment at relapse and outcomes were examined.

Results: Eighty-five patients developed recurrent melanoma; nineteen (22%) during adjuvant TT. Median time to first recurrence was 18 months and median follow-up from first recurrence was 31 months. Fifty-eight (68%) patients received immunotherapy (IT) or TT as 1st line systemic therapy at either first or subsequent recurrence and had disease that was assessable for response. Response to anti-PD-1 (±trial agent), combination ipilimumab-nivolumab, TT rechallenge and ipilimumab monotherapy was 63%, 62% 25% and 10% respectively. Twenty-eight (33%) patients had died at census, all from melanoma. Two-year OS was 84% for anti-PD-1 therapy (±trial agent), 92% for combination ipilimumab and nivolumab, 49% for TT and 45% for ipilimumab monotherapy.

Conclusions: Patients who relapse after adjuvant TT respond well to subsequent anti-PD-1 based therapy and have outcomes similar to those seen when first line anti-PD-1 therapy is used in stage IV melanoma.

So - in folks who were given targeted therapy as adjuvant treatment for their Stage III melanoma - 22% recurred.  Recognizing the small numbers in this break down - responses to treatment that they were given at that relapse point follows:

anti-PD-1 garnered a 63% response rate

ipi/nivo  = 62% RR

targeted therapy rechallenge = 25% RR

ipi as a single agent = 10% RR

33% of the relapsed patient died of melanoma.  

The two year overall survival for those treated with anti-PD-1 = 84%, ipi/nivo = 92%, targeted therapy = 49%, ipi alone = 45%.

Pretty clear to me.  If you relapse, go for the ipi/nivo combo.  Not that we didn't already know that! - c