Background
Both adjuvant targeted therapy (TT) and immune check point inhibitors (ICI) have demonstrated improved recurrence-free survival (RFS) in resected melanoma. This study aimed to explore the real world impact of these treatments in an unselected population.
Methods
This retrospective cohort study included patients with resected stage IIIB-IV melanoma, diagnosed between May 2018 and December 2021 at Royal Brisbane and Women’s Hospital. Demographics, adjuvant therapy details, recurrence characteristics and outcomes were recorded.
Results
68 patients with resected disease were included (57 with stage III and 11 stage IV disease). BRAF mutation was identified in 27 patients (39.7%). The majority received adjuvant ICI (n=47, 69%), with the remainder receiving TT (n=16, 24%) or no therapy (n=5, 7%). With a median follow-up of 22.1 months the 12 and 24 month RFS was 70.4% and 53.2% respectively in the overall population. 24 month RFS rate was higher with ICI (63.7%) than TT (39.3%) though this difference did not reach statistical significance, HR 0.61 (95% CI 0.24-1.51, p=0.30). 16 patients treated with adjuvant ICI experienced recurrence with 12 (75%) recurring during adjuvant ICI. 7 patients underwent complete resection of radiologically evident disease (of which 4 remain alive and disease-free) and 7 underwent systemic therapy. Of those patients who received TT, 7 experienced recurrence with 3 of these during adjuvant treatment (42.9%). At a median follow-up of 27.2 months 12 and 24 month survival rates were 92.3 and 72.8% respectively in the overall population.
Conclusion
Uptake of adjuvant therapies has been high and outcomes in our unselected real-world population were comparable to published literature. Within the limitation of a small sample size, there was a trend toward improved 24 month RFS with adjuvant ICI than TT, though of those with recurrence this was more likely to occur during adjuvant treatment for those receiving ICI.