Abstract
Multiple primary malignancies (MPM) are described as two or more primary tumors within the same individual. The impact of MPM on the tumor microenvironment among patients with melanoma is poorly understood. Here, we describe this unique group of patients who have both advanced melanoma and at least one other primary malignancy and report their survival outcomes. In this study, patients with advanced melanoma and a second primary malignancy were identified. Medical records were reviewed for cancer treatment history. Kaplan-Meier methods were used to derive survival curves and estimate overall survival (OS), and log-rank tests were used to compare OS. Among 11 MPM patients, the most common non-melanoma cancers were breast (n = 3) and thyroid (n = 3). Median OS was 153.5 months for all patients. Median OS for synchronous MPM (sMPM) and metachronous MPM (mMPM) were 83.1 and 196.7 months, respectively (p= 0.10). Median OS was not reached when melanoma was diagnosed first, and 153.5 months when diagnosed second (p= 0.45). For six patients receiving immunotherapy for melanoma, there was a 100% complete response rate. In conclusion, patients with melanoma are at risk of secondary malignancies, including breast and thyroid cancer. The timing of secondary malignancies may impact prognosis. Further study of the impact of immunotherapy on MPM is warranted.
Highlights
Multiple primary malignancies (MPM) describe two or more primary tumors arising in the same individual [1,2,3]
Similar to other studies [3,14,15], we found that metachronous MPM (mMPM) were more common than synchronous MPM (sMPM) (54.5% vs 45.5%); we noted a trend of improved survival for mMPM
This study highlights the fact that patients with advanced melanoma are at risk for multiple primary malignancies including breast and thyroid cancer
Summary
Multiple primary malignancies (MPM) describe two or more primary tumors arising in the same individual [1,2,3]. Risk factors for MPM include hereditary syndromes, environmental exposures, hormonal factors, immune deficiency, infection, carcinogenic effects of prior cancer therapies, and/or a combination of these [4]. The development of more than two MPM is increasingly rare with only 1.4% of patients diagnosed with three malignancies and 0.2% with four or more [5]. The co-occurrence of lung cancer and head/neck cancer is a well-described pattern among patients with a history of smoking. For cancers that do not have a common carcinogenic exposure, patterns of MPM incidence are less clear. Prior cancer therapies, such as radiotherapy or chemotherapy, may lead to development of a second cancer
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