NATIONAL HARBOR, MD – Patients with stage IV melanoma treated with a combination of ipilimumab and surgical resection had a high rate of melanoma-specific and overall survival, a retrospective study of a single-center case series has shown.
"To our knowledge, this is the first report of 5-year melanoma-specific survival data on patients who have undergone surgical resection and ipilimumab treatment, and the data suggests that surgical resection and ipilimumab treatment may result in long-term survival in select metastatic melanoma patients," Dr. Junko Ozao-Choy said at the annual Society of Surgical Oncology Cancer Symposium.
Dr. Junko Ozao-Choy
Among 44 patients treated with the CTLA-4 (cytotoxic T-lymphocyte antigen 4) inhibitor ipilimumab (Yervoy) and surgical resection, the 5-year melanoma-specific survival (MSS) rate was 51% and the median overall survival duration was 60 months, reported Dr. Ozao-Choy of the John Wayne Cancer Institute at Saint John’s Health Center in Santa Monica, Calif.
For 24 patients who received ipilimumab before resection, the 5-year MSS was 61% at a median of 60 months, and for 18 of 20 patients treated with ipilimumab after surgery, the 5-year MSS was 42% at a median of 47 months, but this difference was not significant (data were incomplete for 2 patients in the latter group), she noted.
In a recent study of retrospective data on patients with metastatic melanoma treated at her center, the 4-year survival of patients who underwent resection of metastatic lesions with or without systemic medical therapy was 20.8%, compared with 7% for those who underwent systemic medical therapy alone. The study investigators concluded that more than half of patients with metastatic melanoma were eligible for metastasectomy (Ann. Surg. Oncol. 2012;19:2547-55).
Dr. Ozao-Choy and her colleagues reviewed the center’s records on patients with metastatic melanoma who underwent resection and had received ipilimumab, looking at disease-specific survival from the date of diagnosis of stage IV disease.
The groups were well balanced in terms of age, sex, mean Breslow thickness scores, and nodal status. However, significantly more patients who received ipilimumab before surgery had brain metastases (13 of 24 vs. 3 of 18, P = .001). In a univariate analysis, patients with brain metastases had a significantly worse 5-year MSS (31% vs. 60%, P = .049).
The only other significant variables associated in the univariate analysis with better survival were prior immunotherapy, with 69% of patients who had received any immunotherapy having a 5-year MSS of 69%, compared with 29% for those with no immunotherapy (P = .01), and previous number of resections, with more resections being associated with better survival (P = .01).
Neither previous treatment with Bacillus Calmette-Guérin vaccine, previous chemotherapy, T stage, N stage, or timing of ipilimumab were significantly associated with MSS.
In a multivariate analysis (which controlled for demographic and disease factors), only the previous number of resections remained a significant predictor of MSS (P = .01).
In the audience response segment following the presentation, Dr. Daniel G. Coit, a surgical oncologist at Memorial Sloan-Kettering Cancer Center in New York City, pointed out that the previous number of resections is a not an adequate independent predictor for survival. "One of the inescapable truths is that if you have to have more than one operation, you have to still be alive. ... Of necessity, older people live longer than younger people; people who die at an older age live longer than people who die at a younger age," he said.
The study was internally funded. Dr. Ozao-Choy and Dr. Coit reported having no relevant financial disclosures.