Abstract
Opportunities for surgical treatment in metastatic melanoma patients have re-emerged due to the development of novel systemic therapeutics over the past decade. The aim of this study is to present data on outcomes of surgery in patients with unresectable stage IIIC and IV melanoma, who have previously been treated with immunotherapy or targeted therapy. Data was extracted from the Dutch Melanoma Treatment Registry (DMTR) on 154 patients obtaining disease control to systemic therapy and undergoing subsequent surgery. Disease control was defined as a complete response (CR), which was seen in 3.2% of patients; a partial response (PR), seen in 46.1% of patients; or stable disease (SD), seen in 44.2% of patients. At a median follow-up of 10.0 months (interquartile range 4–22) after surgery, the median overall survival (OS) had not been reached in our cohort and median progression-free survival (PFS) was 9.0 months (95% CI 6.3–11.7). A CR or PR at first follow-up after surgery was associated with both a better OS and PFS compared to stable or progressive disease (p < 0.001). We conclude that selected patients can benefit from surgery after achieving disease control with systemic therapy.
Highlights
The prognosis of patients with unresectable stage III and IV melanoma has been poor, with a median overall survival (OS) of only 6.2 months [1,2]
The aim of this study is to present data on outcomes of surgery in patients with unresectable stage IIIC and IV melanoma, who have previously been treated with immunotherapy or targeted therapy
At the time of data extraction, the Dutch Melanoma Treatment Registry (DMTR) database consisted of 3959 patients, of whom 876 had undergone surgery during their treatment and 463 patients received systemic treatment prior to surgery
Summary
The prognosis of patients with unresectable stage III and IV melanoma has been poor, with a median overall survival (OS) of only 6.2 months [1,2]. Some patients with oligometastatic melanoma (up to three lesions) can be treated by surgery and achieve long-term survival of around. Over the past decade the development of new systemic options has drastically changed the treatment of metastatic melanoma and the prognosis of these patients. BRAF and MEK inhibitors in patients with BRAF-mutated melanoma have even higher overall response rates (70%), but fewer durable responses due to the development of resistance [19,20,21,22,23,24,25]
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