Adjuvant nivolumab therapy may not improve disease‐free survival in resected acral lentiginous melanoma patients: A retrospective case series

Maeda, Takuya; Yanagi, Teruki; Miyamoto, Kazuo; Tokuchi, Keiko; Kitamura, Shinya; Ujiie, Hideyuki

doi:10.1111/dth.15817

Cited by 5 publications

(2 citation statements)

References 19 publications

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“…evaluated 27 patients with ALM treated in the adjuvant setting; 5 patients were treated with nivolumab and 22 patients were treated with either chemotherapy (n = 4), interferon beta (n = 12), or observation (n = 6). This study found no difference in disease-free survival between the groups, although the small sample size limits any clinically significant conclusions ( 41 ).…”

Section: Managementmentioning

confidence: 64%

Management of acral lentiginous melanoma: current updates and future directions

Dugan,

Perez,

Karapetyan

et al. 2024

Front. Oncol.

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Acral lentiginous melanoma is a rare subtype of melanoma generally associated with poor outcomes, even when diagnosed at an early stage. The tumor genetic profile remains poorly understood, but it is known to have a suppressed immune environment compared to that of non-acral cutaneous melanomas, which limits therapy options. There is significant attention on the development of novel therapeutic approaches, although studies are limited due to disease rarity. For local disease, wide local excision remains the standard of care. Due to frequent under-staging on preoperative biopsy, wider margins and routine sentinel lymph node biopsy may be considered if morbidity would not be increased. For advanced disease, anti-PD1 monotherapy or combination therapy with anti-PD1 and anti-CTLA4 agents have been used as first-line treatment modalities. Anti-PD1 and anti-CTLA4 combination therapies have been shown to be particularly beneficial for patients with BRAF-mutant acral lentiginous melanoma. Other systemic combination regimens and targeted therapy options may be considered, although large studies with consistent results are lacking. Regional and intralesional therapies have shown promise for cutaneous melanomas, but studies generally have not reported results for specific histologic subtypes, especially for acral melanoma. Overall, the unique histologic and genetic characteristics of acral lentiginous melanoma make therapy options significantly more challenging. Furthermore, studies are limited, and data reporting has been inconsistent. However, more prospective studies are emerging, and alternative therapy pathways specific to acral lentiginous melanoma are being investigated. As further evidence is discovered, reliable treatment guidelines may be developed.

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Section: Managementmentioning

confidence: 64%

Management of acral lentiginous melanoma: current updates and future directions

Dugan,

Perez,

Karapetyan

et al. 2024

Front. Oncol.

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“…The acral type was an independent worse prognostic factor on multivariate analysis ( p = 0.015) [ 84 ]. A single-center retrospective study in Japan investigated adjuvant nivolumab ( n = 5) and other treatments ( n = 22; 12 patients with interferon β, 4 with chemotherapy, 6 with no treatment) and did not find a superior disease-free survival in the adjuvant nivolumab group over the non-nivolumab group [ 85 ]. These results suggest that the adjuvant anti-PD-1 inhibitor monotherapy exert an anti-tumor effect for acral melanoma, but may be less effective than for other types of cutaneous melanoma.…”

Section: Treatmentmentioning

confidence: 99%

Nail Apparatus Melanoma: Current Management and Future Perspectives

Ito

Hashimoto

Kaku-Ito

et al. 2023

JCM

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Nail apparatus melanoma (NAM) is a rare type of cutaneous melanoma that belongs to the acral melanoma subtype. NAM is managed principally in accordance with the general treatment for cutaneous melanoma, but there is scarce evidence in support of this in the literature. Acral melanoma is genetically different from non-acral cutaneous melanoma, while recently accumulated data suggest that NAM also has a different genetic background from acral melanoma. In this review, we focus on recent advances in the management of NAM. Localized NAM should be surgically removed; amputation of the digit and digit-preserving surgery have been reported. Sentinel lymph node biopsy can be considered for invasive NAM for the purpose of accurate staging. However, it is yet to be clarified whether patients with metastatic sentinel lymph nodes can be safely spared completion lymph node dissection. Similar to cutaneous melanoma, immune checkpoint inhibitors and BRAF/MEK inhibitors are used as the first-line treatment for metastatic NAM, but data on the efficacy of these therapies remain scarce. The therapeutic effects of immune checkpoint inhibitors could be lower for NAM than for cutaneous melanoma. This review highlights the urgent need to accumulate data to better define the optimal management of this rare melanoma.

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Adjuvant treatment with anti‐PD‐1 in acral melanoma: A nationwide study

Bloem,

van Not,

Aarts

et al. 2024

Intl Journal of Cancer

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Previous studies demonstrated limited efficacy of immune checkpoint inhibitors in unresectable acral melanoma (AM); it remains unclear how this translates to the adjuvant setting. This study investigates clinical outcomes of acral compared to cutaneous melanoma (CM) patients treated with adjuvant anti‐PD‐1 after complete resection. All stages III–IV AM and CM patients receiving adjuvant anti‐PD‐1 after complete resection between 2018 and 2022 were included from the prospective nationwide Dutch Melanoma Treatment Registry. We analyzed recurrence‐free survival (RFS), distant metastasis‐free survival (DMFS), and overall survival (OS). A multivariable Cox regression analysis of RFS was performed to adjust for potential confounders. We included 1958 (86 AM and 1872 CM) patients. At baseline, AM patients more frequently had KIT mutations, higher disease stages, and Eastern Cooperative Oncology Group Performance Status, and fewer BRAF and NRAS mutations. Median RFS was 14.8 months (95% confidence interval [CI]: 11.5–29.3) in AM and 37.4 months (95% CI: 34.6 to not reached) in CM (p = .002). After correcting for potential confounders, AM remained associated with a higher risk of recurrence (HRadj 1.53; 95% CI: 1.07–2.17; p = .019). Two‐year DMFS tended to be worse for AM than for CM: 64.5% versus 79.7% (p = .050). Two‐year OS was significantly lower in AM (71.5% vs. 84.3%; p = .027). The results of this study suggest a poorer outcome of adjuvant‐treated AM compared to CM. Studies assessing the added value of adjuvant treatment in AM are needed. Future research should investigate alternative treatment strategies to improve outcomes of high‐risk AM.

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Adjuvant nivolumab therapy may not improve disease‐free survival in resected acral lentiginous melanoma patients: A retrospective case series

Cited by 5 publications

References 19 publications

Management of acral lentiginous melanoma: current updates and future directions

Management of acral lentiginous melanoma: current updates and future directions

Nail Apparatus Melanoma: Current Management and Future Perspectives

Adjuvant treatment with anti‐PD‐1 in acral melanoma: A nationwide study

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