Prolonged overall survival following metastasectomy in stage IV melanoma

2019 ◽  
Vol 33 (9) ◽  
pp. 1719-1725 ◽  
Author(s):  
M.L. Elias ◽  
S. Behbahani ◽  
S. Maddukuri ◽  
A.M. John ◽  
R.A. Schwartz ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stage Iv ◽  
Stage Iv Melanoma

Survival of melanoma patients with brain metastases treated with ipilimumab combined with stereotactic radiosurgery.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20019-e20019
Author(s):  
Karim Tazi ◽  
Cody Chiuzan ◽  
Keisuke Shirai
Keyword(s):  
Overall Survival ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Performance Status ◽  
Survival Rates ◽  
Stage Iv ◽  
Rank Test ◽  
Group A ◽  
Stage Iv Melanoma

e20019 Background: Historically, melanoma with brain metastases has a poor prognosis and is a major contributor to patient morbidity and mortality. Recently, the use of ipilimumab has improved overall survival in stage IV melanoma; however, the outcome of patients with brain metastases remains unclear. In this retrospective medical record review, we report the outcome of patients with stage IV melanoma with brain metastases treated with ipilimumab and brain stereotactic radiosurgery (SRS). Methods: All patients with metastatic melanoma treated with ipilimumab from April 2010 to March 2012 were identified and stratified by presence (A) or absence (B) of brain metastases. All patients with brain metastases received SRS. Performance status, dates of stage IV diagnosis, brain SRS and cycle 1 of ipilimumab administration were recorded. We used the Disease Specific Graded Prognostic Assessment (DS-GPA) to estimate the predicted survival. Overall survival was defined as time (months) from the date of the stage IV diagnosis and the time of ipilimumab administration to death or last follow-up. Survival curves were estimated using the Kaplan-Meier method, and compared using a two-tailed log-rank test. Results: Twelve of 30 patients treated with ipilimumab had brain metastases. Median age was 66 years. Median DS-GPA score was 3 (estimated mean survival of 8.7 months). Four patients (33%) in group A and 6 patients (33%) in group B died as of last follow-up. Median number of SRS treatment was 1 (1 to 4), and median total treated lesions were 3 (1-14). Median survivals from date of Stage IV for A and B were 29.1 and 32.9 months, respectively (p=0.67). The estimated 2 year survival rates from date of cycle 1 ipilimumab administration for A and B were 58% (95% CI: 32-100%) and 55% (95% CI: 32-93%), respectively. Ten out of 12 patients in group A maintained an ECOG PS of 0-1 as of last follow-up. Conclusions: Survival of patients with melanoma brain metastases treated with ipilimumab combined with SRS may be comparable to patients without brain metastases. Ipilimumab and SRS do not seem to adversely impact quality of life.

Immune gene polymorphisms predict overall survival for stage IV melanoma patients treated with biochemotherapy

2004 ◽  
Vol 22 (14_suppl) ◽  
pp. 7550-7550
Author(s):  
D. Liu ◽  
S. J. O'Day ◽  
D. Yang ◽  
P. Boasberg ◽  
R. Milford ◽  
...  
Keyword(s):  
Overall Survival ◽  
Gene Polymorphisms ◽  
Stage Iv ◽  
Immune Gene ◽  
Melanoma Patients ◽  
Stage Iv Melanoma

Progression-free and overall survival analysis in patients with metastatic melanoma undergoing first- versus second-line therapy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9078-9078
Author(s):  
J. B. Allred ◽  
V. Suman
Keyword(s):  
Overall Survival ◽  
Clinical Trials ◽  
Metastatic Melanoma ◽  
Clinical Outcomes ◽  
Proportional Hazards ◽  
Stage Iv ◽  
Cox Proportional Hazards ◽  
Line Therapy ◽  
The Relationship ◽  
Stage Iv Melanoma

9078 Background: A frequently discussed topic at meetings of oncologists is the question of expected clinical outcomes for patients with metastatic melanoma undergoing 1st vs 2nd line systemic therapy. Differing outcomes in these two patient populations could affect interpretation of non-randomized clinical trials involving both patient populations. Some have suggested superior clinical outcome in patients undergoing 2nd line therapy. As there is little data addressing this issue, we sought to answer the question by comparing the clinical outcomes of patients with metastatic melanoma treated on 1st vs 2nd line therapy across clinical trials conducted at our institution. Methods: Data were collected from 10 phase II clinical trials for patients with stage IV melanoma for which Mayo Clinic was the data center. The 10 trials included three categories of treatments: cytotoxic chemotherapy (4), cancer vaccines (4), and biologic agents (2). In all studies, eligibility criteria required: stage IV melanoma, life expectancy >3 months, reasonable hematology and serum chemistry laboratory results, and an ECOG performance status of ≤2. Cox proportional hazards models were fit to assess the relationship between patients' “therapy” status (1st vs 2nd line) and time to events, both overall survival (OS) and progression free survival (PFS), for each treatment category. Results: We identified 318 unique eligible patients across 10 trials. Removed from the analysis were 55 patients (ocular melanoma and/or metastases involving the central nervous system) leaving 263. Cox proportional hazards results demonstrated no differences in PFS or OS for 1st vs 2nd line patients for either “chemotherapy” or “vaccine” treatment regimens. However, patient treated on “biologic” trials as 1st line therapy appeared to demonstrate a PFS advantage over 2nd line treatments (HR=1.98, p-value=0.02). There was a suggestion of an OS benefit for 1st line patients in this category, however, the relationship was not significant (HR=1.77, p=0.07). Conclusions: The presented data suggest that there is no PFS/OS difference in stage IV melanoma patients receiving 1st vs 2nd line therapy (no PFS/OS advantage to patients treated in 2nd line vs. 1st line). No significant financial relationships to disclose.

Pretreatment Levels of Peripheral Neutrophils and Leukocytes As Independent Predictors of Overall Survival in Patients With American Joint Committee on Cancer Stage IV Melanoma: Results of the EORTC 18951 Biochemotherapy Trial

2007 ◽  
Vol 25 (12) ◽  
pp. 1562-1569 ◽  
Author(s):  
Henrik Schmidt ◽  
Stefan Suciu ◽  
Cornelis J.A. Punt ◽  
Martin Gore ◽  
Wim Kruit ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factor ◽  
Interleukin 2 ◽  
Stage Iv ◽  
Progression Free Survival ◽  
Independent Prognostic Factor ◽  
Short Overall Survival ◽  
Leukocyte Counts ◽  
Melanoma Patients ◽  
Stage Iv Melanoma

Purpose An elevated count of blood neutrophils and monocytes recently was shown independently to predict short survival in patients with stage IV melanoma undergoing interleukin-2–based immunotherapy. In this study, we aimed to validate this finding in a large cohort of stage IV melanoma patients. Patients and Methods For this retrospective prognostic study, the data from the European Organisation for the Research and Treatment of Cancer 18951 study were used. Patients were randomly assigned between treatment with dacarbazine, cisplatin, and interferon alfa with or without interleukin-2. Counts of neutrophils and leukocytes were analyzed together with other known prognostic factors: serum lactate dehydrogenase, performance status, metastatic site, and sex. Two multivariate prognostic factor analyses were carried out in the model: one with leukocyte counts and one with neutrophil counts. Results A total of 363 patients were randomly assigned and baseline blood neutrophil and leukocyte counts were available from 316 and 350 patients, respectively. A high neutrophil count (> 7.5 × 109/L) was an independent prognostic factor for short overall survival (hazard ratio [HR], 1.5; 95% CI, 1.1 to 2.1; P = 0.02), and a high leukocyte count (> 10 × 109/L) was an independent prognostic factor of both short overall survival (HR, 1.7; 95% CI, 1.3 to 2.4; P = 0.0005) and short progression-free survival (HR, 1.5; 95% CI, 1.1 to 2.1; P = 0.008). Conclusion A high pretreatment count of neutrophils in blood was confirmed as an independent prognostic factor for short overall survival in stage IV melanoma patients undergoing interleukin-2–based immunotherapy. Furthermore, a high count of leukocytes was an independent prognostic factor for short overall survival and progression-free survival. Both parameters should be useful as stratification factors in clinical trials.

Phase III Comparison of Vitespen, an Autologous Tumor-Derived Heat Shock Protein gp96 Peptide Complex Vaccine, With Physician's Choice of Treatment for Stage IV Melanoma: The C-100-21 Study Group

2008 ◽  
Vol 26 (6) ◽  
pp. 955-962 ◽  
Author(s):  
Alessandro Testori ◽  
Jon Richards ◽  
Eric Whitman ◽  
G. Bruce Mann ◽  
Jose Lutzky ◽  
...  
Keyword(s):  
Overall Survival ◽  
Heat Shock ◽  
Heat Shock Protein ◽  
Interleukin 2 ◽  
Stage Iv ◽  
Phase Iii ◽  
Autologous Tumor ◽  
Heat Shock Protein Gp96 ◽  
To Receive ◽  
Stage Iv Melanoma

Purpose To assess the antitumor activity of vitespen (autologous, tumor- derived heat shock protein gp96 peptide complexes) by determining whether patients with stage IV melanoma treated with vitespen experienced longer overall survival than patients treated with physician's choice. Patients and Methods Patients (N = 322) were randomly assigned 2:1 to receive vitespen or physician's choice (PC) of a treatment containing one or more of the following: dacarbazine, temozolomide, interleukin-2, or complete tumor resection. This open-label trial was conducted at 71 centers worldwide. Patients were monitored for safety and overall survival. Results Therapy with vitespen is devoid of significant toxicity. Patients randomly assigned to the vitespen arm received variable number of injections (range, 0 to 87; median, 6) in part because of the autologous nature of vitespen therapy. Intention-to-treat analysis showed that overall survival in the vitespen arm is statistically indistinguishable from that in the PC arm. Exploratory landmark analyses show that patients in the M1a and M1b substages receiving a larger number of vitespen immunizations survived longer than those receiving fewer such treatments. Such difference was not detected for substage M1c patients. Conclusion These results are consistent with the immunologic mechanism of action of vitespen, indicating delayed onset of clinical activity after exposure to the vaccine. The results suggest patients with M1a and M1b disease who are able to receive 10 or more doses of vitespen as the candidate population for a confirmatory study.

Metastatic site-specific utilization and outcome of immunotherapy in stage IV melanoma: A national perspective.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21525-e21525
Author(s):  
Lifen Cao ◽  
Jonathan T. Bliggenstorfer ◽  
Christopher W. Towe ◽  
Ankit Mangla ◽  
Megan E. Miller ◽  
...  
Keyword(s):  
Overall Survival ◽  
Liver Metastasis ◽  
Bone Metastasis ◽  
Brain Metastasis ◽  
Metastatic Melanoma ◽  
Lung Metastasis ◽  
Stage Iv ◽  
Kaplan Meier ◽  
Metastatic Sites ◽  
Stage Iv Melanoma

e21525 Background: Metastatic melanoma is an aggressive disease with a rapid systemic dissemination. We evaluated the effect of metastatic sites on the utilization immunotherapy and survival outcomes in stage IV melanoma. Methods: The National Cancer Database from 2010-2017 was queried for stage IV melanoma. Those with missing relevant data were excluded. Patients were grouped into five categories based on metastatic sites: lung metastasis only, brain metastasis only, liver metastasis only, bone metastasis only and multiple sites metastasis. Multivariable logistic regression was used to predict use of immunotherapy. Effects of immunotherapy on overall survival were assessed using Kaplan-Meier curves and Cox proportional hazards model. Results: A total 12, 315 were included in the study, among whom 2206 (17.9%) had lung metastasis only, 1,873 (15.2%) had brain metastasis only, 785 (6.4%) had liver metastasis only, 662 (5.4%) had bone metastasis only and 5,983 (48.6%) presented with multiple metastatic sites. Surgery at primary site was performed in 34.3% of patients with bone metastasis (p<0.001), and radiation therapy was delivered to 69.2% patients with brain metastasis (p<0.001). Site of metastatic disease was associated with immunotherapy utilization, with multiple sites (OR = 1.149, p=0.012), and distant lymph nodes (OR=2.867, p<0.001) demonstrating the strongest association, while patients with oligo brain metastasis were less likely to receive immunotherapy (OR = 0.486, p<0.001). Immunotherapy is associated with superior survival among metastatic melanoma patients (HR=0.433, P<0.001). The Kaplan-Meier curves showed the median overall survival among the immunotherapy group was 33.7 months for lung metastasis (vs. 13.4 months without immunotherapy, HR=0.633, p<0.001), 25 months for brain metastasis (vs. 6.7 months without immunotherapy, HR=0.447, P<0.001), 16.8 months for liver metastasis (vs. 4.2 months without immunotherapy, HR=0.449, P<0.001), 18.3 months in bone metastasis (vs. 7.6 months without immunotherapy, HR=0.615, p<0.001) and 12.1 months in multiple metastasis (vs. 3.8 months without immunotherapy, HR=0.338, p<0.001). Conclusions: Utilization of immunotherapy is influenced by location of metastatic disease in stage IV melanoma. Overall survival is improved for patients treated with immunotherapy.[Table: see text]

Improved Survival with Immunotherapy but Lack of Synergistic Effect with Radiation for Stage IV Melanoma of the Head and Neck

2019 ◽  
Vol 85 (10) ◽  
pp. 1118-1124
Author(s):  
Blake Babcock ◽  
Medora Rodrigues ◽  
Donovan Kearns ◽  
Naveenraj Solomon ◽  
Mark E. Reeves ◽  
...  
Keyword(s):  
Overall Survival ◽  
Synergistic Effect ◽  
Head And Neck ◽  
Cutaneous Melanoma ◽  
Survival Benefit ◽  
Retrospective Studies ◽  
Cox Regression ◽  
Stage Iv ◽  
National Cancer Database ◽  
Stage Iv Melanoma

Prospective randomized studies have demonstrated a survival benefit of immunotherapy in stage IV cutaneous melanoma. Some retrospective studies have hypothesized a synergistic effect of radiation and immunotherapy. Our objective was to identify whether there is a survival benefit for patients treated with radiation and immunotherapy in stage IV cutaneous melanoma of the head and neck (CMHN). The National Cancer Database was used to identify patients with stage IV CMHN between 2012 and 2014. These patients were stratified based on receipt of radiation and immunotherapy. Adjusted Cox regression was used to analyze overall survival. A total of 542 patients were identified with stage IV CMHN, of whom 153 (28%) patients received immunotherapy. Receipt of immunotherapy (hazard ratio [HR] 0.69, P = 0.02) and negative LNs (HR 0.50, P = 0.002) were independently associated with improved survival, whereas radiation conferred no survival benefit (HR 1.17, P = 0.26). Patients who received immunotherapy without radiation were associated with significantly improved survival compared with those who received immunotherapy with radiation ( P < 0.0001). However, of patients who received radiation, the addition of immunotherapy did not seem to improve survival ( P = 0.979). In stage IV CMHN, immunotherapy confers a 32 per cent survival benefit. The use of immunotherapy in patients who require radiation, however, is not associated with improved survival.

224 Outcomes of stage IV melanoma in the era of immunotherapy: a national cancer database (NCDB) analysis

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A243-A243
Author(s):  
Tamara Sussman ◽  
Wei Wei ◽  
Pauline Funchain ◽  
Brian Gastman
Keyword(s):  
Overall Survival ◽  
Median Survival ◽  
Private Insurance ◽  
Academic Research ◽  
Stage Iv ◽  
Advanced Melanoma ◽  
List Type ◽  
Research Centers ◽  
Factors Associated ◽  
Stage Iv Melanoma

BackgroundImmunotherapy (IO) has revolutionized the treatment landscape for metastatic melanoma and is now the mainstay of treatment since the approval of ipilimumab in 2011 and anti-PD-1 therapies (nivolumab and pembrolizumab) in 2015. The majority of data stems from trials that have specific inclusion criteria, and often exclude important populations. In this analysis, we present the first real-world evidence of outcomes for stage IV patients with cutaneous melanoma receiving IO from 2015–2016 and factors associated with receipt of IO, and compare these outcomes with patients receiving IO (likely interferon and interleukin-2) from 2004–2010, and IO (addition of ipilimumab) from 2011–2014.MethodsNCDB was analyzed to identify stage IV patients with melanoma from 2004–2016. Patients were categorized into receipt of IO or not during time periods from 2004–2010, 2011–2014, and 2015–2016. Patients treated with and without IO were propensity matched on age, gender, and stage. Overall survival (OS) analysis was done by Kaplan-Meier and Cox proportional hazard models; log-rank test was used for between-group OS comparisons.ResultsA total of 21,696 patients with stage IV melanoma were analyzed from 2004–2016. Overall, patients (n = 3,852) who received IO had improved median survival (mOS 17.2 vs. 7.3 mos; p<0.0001). All patients had improved median survival as time progressed (mOS 7.9 mos in 2004–2010 vs. 9.1 mos 2011–2014 vs. 11.9 mos 2015–2016; p<0.0001). Among patients who received IO, 2-year OS significantly improved by 2015 (40% [95%CI, 37–42%] for both 2004–2010 and 2011–2014 vs. 48% [95%CI, 44–51%] in 2015; p=0.01) (figure 1). In the overall cohort, younger patients (<60 years), female gender, private insurance, no comorbidities, and treatment at academic/research centers were associated with better OS (p<0.0001 for all). Receipt of radiation therapy and lack of surgery were both associated with worse OS (p<0.0001 for both). Race and area of residence (metro/rural/urban) were not associated with differences in OS (p=0.09 and p=0.07, respectively). In 2015–2016, receipt of IO was associated with younger age (<60 years), lack of comorbidities, private insurance, higher median income (=$38,000), residence in metro area, and treatment at academic/research centers (p<0.0001 for all) (table 1).Abstract 224 Figure 1OS in patients with melanoma treated with IOAbstract 224 Table 1Factors associated with receipt of IO for patients diagnosed in 2015ConclusionsSurvival was improved in stage IV patients with melanoma receiving IO, especially in 2015, with the approvals of pembrolizumab and nivolumab. Our findings are consistent with recent trials, like KEYNOTE 006 and CheckMate 067 where 2-year OS for anti-PD-1 therapy was 55% and 60%, respectively.1, 2 Significant socioeconomic factors may impact receipt of IO and survival.ReferencesRobert C, Ribas A, Schachter J, et al. Pembrolizumab versus ipilimumab in advanced melanoma (KEYNOTE-006): post-hoc 5-year results from an open-label, multicentre, randomised, controlled, phase 3 study. Lancet Oncol 2019; 20: 1239–1251.Wolchok JD, Chiarion-Sileni V, Gonzalez R, et al. Overall Survival with Combined Nivolumab and Ipilimumab in Advanced Melanoma. N Engl J Med 2017; 377: 1345–1356.

Sign in / Sign up

Export Citation Format

Share Document