Survival of patients with stage IIIC and IIID melanomas with nodal metastases in the light of new therapies

Abstract

Introduction: Within stage III melanoma prognosis and outcomes significantly vary. Advances in systemic therapy improved prognosis in metastatic melanoma. Adjuvant therapy in stage III significantly lowered relapses, although the effect on survival is less evident. Analysis of treatment results in stage IIIC and IIID before introduction of the modern adjuvant therapy, but after introduction of the effective systemic therapy in metastatic relapse, is needed. Aim: To analyse the clinical outcomes in patients with stage IIIC and IIID melanoma before the introduction of the novel adjuvant therapy. Material and methods: Consecutive stage IIIC and IIID melanoma patients treated in 2015-2018 in 4 reference centres in Poland were enrolled in the analysis of RFS and OS (in-transit metastases excluded). Median follow-up was 26.6 months (1.7-67. 2).Results: There were 224 stage IIIC and 49 stage IIID patients. Recurrence was observed in 170 (62.2%); 102 (45.5%) deaths in stage IIIC and 28 (57.1%) in stage IIID were reported. RFS and OS were better in stage IIIC compared to stage IIID. RFS and OS in the IIIC group were 19.7 and 36.2 months, respectively, and in IIID -8.9 and 27.8 months, respectively. Conclusions: The survival of patients with high-risk melanomas has improved in recent years, however, it is still unsatisfactory. The major changes in melanoma management related to the introduction of the adjuvant therapy require further careful observation.

Incidence of different types of cancer in the follow-up period after primary diagnosis and treatment of melanoma. Single-center 4-years follow-up on a population of 709 patients

“…There are reports of varying strengths of evidence for correlations of skin cancer induction with drugs and in recent years rheumatological treatment has been indicated as an area requiring special attention in terms of skin cancer induction [ 19 ]. What is more important BRAF inhibitors, commonly used in advanced or metastatic melanoma treatment, may also induce precancerous lesions and SCC [ 18 , 20 ].…”

The Current Treatment Trends and Survival Patterns in Melanoma Patients with Positive Sentinel Lymph Node Biopsy (SLNB): A Multicenter Nationwide Study

“…The results of these landmark studies have changed clinical practice, and CLND is no longer the standard of treatment in all melanoma patients with involved lymph nodes without distant metastases (stage III). These changes coincided with the increasingly important role of adjuvant systemic therapy in this group and an introduction of a wide pool of novel regimens [10][11][12][13]. Currently, the most common regimens of adjuvant therapy are based on a combination of dabrafenib (BRAF inhibitor) and trametinib (MEK inhibitor) in patients with BRAF V600 mutation, as well as nivolumab or pembrolizumab (targeting programmed death receptor 1) in melanoma patients with or without BRAF V600 mutation [14][15][16][17][18][19].…”