Abstract
Simple SummaryImmunotherapy revolutionized the treatment of cutaneous melanoma and greatly improved treatment outcomes in this group of patients. Mucosal melanoma is a rare disease, biologically distinct from the cutaneous subtype. There is little real-world data on immunotherapy efficacy in mucosal melanoma. Therefore, we aimed to analyze and describe experiences in mucosal melanoma treatment in five high volume oncology centers in Europe. Furthermore, we evaluated if concomitant radiotherapy may improve the outcomes of these patients. We conclude that immunotherapy with anti-PD1 antibodies is a safe and effective treatment of mucosal melanoma. Concomitant radiotherapy may be beneficial in a selected subgroup of patients with advanced mucosal melanoma.Mucosal melanoma is a rare disease epidemiologically and molecularly distinct from cutaneous melanoma developing from melanocytes located in mucosal membranes. Little is known about its therapy. In this paper, we aimed to evaluate the results of immunotherapy and radiotherapy in a group of patients with advanced mucosal melanoma, based on the experience of five high-volume centers in Poland and Italy. There were 82 patients (53 female, 29 male) included in this retrospective study. The median age in this group was 67.5 (IQR: 57.25–75.75). All patients received anti-PD1 or anti-CTLA4 antibodies in the first or second line of treatment. Twenty-three patients received radiotherapy during anti-PD1 treatment. In the first-line treatment, the median progression-free survival (PFS) reached six months in the anti-PD1 group, which was statistically better than 3.1 months in the other modalities group (p = 0.004). The median overall survival (OS) was 16.3 months (CI: 12.1–22.3) in the whole cohort. Patients who received radiotherapy (RT) during the anti-PD1 treatment had a median PFS of 8.9 months (CI: 7.4–NA), whereas patients treated with single-modality anti-PD1 therapy had a median PFS of 4.2 months (CI: 3.0–7.8); this difference was statistically significant (p = 0.047). Anti-PD1 antibodies are an effective treatment option in advanced mucosal melanoma (MM). The addition of RT may have been beneficial in the selected subgroup of mucosal melanoma patients.
Highlights
Mucosal melanoma (MM) is a rare disease epidemiologically and molecularly distinct from cutaneous melanoma (CM) developing from melanocytes located in mucosal membranes.Overall, MM represents about 1 to 1.5% of all melanoma cases and 0.03% of all diagnosed cancers [1,2,3].MM incidence has been reported globally stable over the last 20 years [4,5]
In a retrospective analysis covering 25 dermatology departments in France, 75 MM patients were treated with first-line nivolumab or pembrolizumab and, out of these, fifteen achieved Objective response (OR), which corresponds to an ORR of 20% [28], which is lower than the 25% reported by us
The median progression-free survival (PFS) was 1.4 months [30], which is again inferior to the results reported by us
Summary
MM represents about 1 to 1.5% of all melanoma cases and 0.03% of all diagnosed cancers [1,2,3]. MM incidence has been reported globally stable over the last 20 years [4,5]. MM is diagnosed twice more often in Caucasians than in populations with darker skin colors, including African. Americans [6,7], but much rarer than in the Asian population. The risk of developing MM increases with age. The majority of patients diagnosed are 60 years of age and older. The median age at diagnosis is 70 years, except for MMs arising in the mouth that affect younger patients more frequently [6,8]
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