Routine imaging guided by a 31-gene expression profile assay results in earlier detection of melanoma with decreased metastatic tumor burden compared to patients without surveillance imaging studies

Abstract

Patients with early-stage disease typically have a good prognosis, but still have a risk of recurrence, even with negative sentinel lymph node biopsy (SLNB). This study explores the utility of routine imaging to detect metastases in patients with negative SLNB but high-risk 31 gene expression profile (31-GEP) scores. We retrospectively identified melanoma patients with negative SLNBs. Patients with high-risk GEP results were placed in the experimental group and patients without GEP testing were placed in the control group. Among both cohorts, recurrent melanoma groups were identified. The tumor burden at the time of recurrence and the time to recurrence were compared between experimental group patients with routine imaging and control group patients without imaging schedules. We identified 327 control patients and 307 experimental patients, of which 14.1% versus 20.5% had melanoma recurrence, respectively. Of the patients with recurrent melanoma, those in the experimental group were older (65.75 versus 59.20), had higher Breslow depths (3.72 mm versus 3.31 mm), and had advanced tumor staging (89.5% versus 71.4% of patients presenting clinical stage ≥ II) compared to the control group at primary diagnosis. However, melanoma recurrence was detected earlier (25.50 months versus 35.35 months) in the experimental group at a lower overall tumor burden (73.10 mm versus 27.60 mm). A higher percentage of experimental patients started immunotherapy when offered (76.3% and 67.9%). Patients who received routine imaging after high-risk GEP test scores had an earlier recurrence diagnosis with lower tumor burden, leading to better clinical outcomes.

31-Gene Expression Profile Testing in Cutaneous Melanoma and Survival Outcomes in a Population-Based Analysis: A SEER Collaboration

“… 28 The clinical impact of the prognostic 31-GEP has been previously demonstrated in multiple clinical utility studies, 27 , 29 and a recent study found that sentinel lymph node biopsy (SLNB)-negative patients with high-risk 31-GEP results who received routine imaging surveillance had recurrence detected earlier with lower tumor burden at recurrence detection and had higher survival rates after recurrence than those who did not have 31-GEP testing and routine imaging. 30 Thus, although the current analysis cannot conclusively determine the mechanism whereby 31-GEP testing is associated with better outcomes, one potential possibility is that clinical action in response to this specific molecular prognostic test supports patient survival. However, a limitation of the SEER data set is that data regarding treatment, surveillance, or other management actions are not available.…”

Prognostic gene expression profile testing to inform use of adjuvant therapy: A survey of melanoma experts

“… 6 , 7 A recent study revealed that non‐randomized Stage I–II patients with high‐risk GEP test results, when subjected to scheduled imaging, had earlier detection of recurrences and lower tumor burden than those without GEP testing or scheduled imaging. 8 On the other hand, it is not clear whether GEP testing provides greater prognostic accuracy than AJCC staging across all melanoma stages, and the optimal timing of adjuvant therapy for unresectable metastatic disease is unknown. Thus, it remains unclear if and how patients should be selected for adjuvant therapy based on GEP test results.…”