Ipilimumab plus surgery boosted advanced melanoma survival
AT SSO 2013
Major finding: The 5-year melanoma-specific survival rate was 51%, and the median overall survival duration was 60 months for patients with advanced melanoma treated with ipilimumab and resection.
Data source: A retrospective study of a single-center case series of 44 patients.
Disclosures: The study was internally funded. Dr. Ozao-Choy and Dr. Coit reported having no relevant financial disclosures.
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.
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).