Management of resected stage III/IV melanoma with adjuvant immunotherapy.

• DOI: 10.1200/jco.2021.39.15_suppl.9571
• Publication Date: 2021-06-02T15:06:20Z
• Authors: Rebecca Johnson; Victoria Atkinson; Prachi Bhave; Alison Margaret W...; Geoffrey David Pe...; Afaf Abed; Megan Lyle; Muhammad Adnan Kh...; Andrew Mark Haydon; Matteo S. Carlino; Shahneen Kaur Sandhu; Georgina V. Long; Alexander M. Menzies
• Keywords: Adjuvant Therapy

9571 Background: Adjuvant anti-PD1 therapy reduces the risk of recurrence in resected stage III/IV melanoma and is now standard care. Limited data exist beyond registration trials. We sought to explore use adjuvant immunotherapy routine clinical practice. Methods: Patients (pts) from 11 Australian centres who received nivolumab (nivo) for were included this study. Efficacy, toxicity, surveillance, characteristics, management further treatment outcomes examined. Results: 471 pts nivo between 8/2018 3/2020. 318 (68%) male, median age 64y (range 17-94), 28 (6%) AJCC v8 IIIA, 194 (41%) IIIB, 175 (37%) IIIC, (2%) IIID, 63 (13%) IV. 65 (14%) had in-transit only disease, 152 sentinel lymph node biopsy (SLNB+) 9 these CLND. 128 (27%) BRAF mutant (BRAFmt) melanoma. Median time resection start was 1.8 months (mo) 0.2-4.0). FU 17.5 mo. 256 (54%) completed 12 nivo, 86 (18%) ceased early 76 (16%) disease recurrence, 25 (5%) other reasons (COVID-19 8, co-morbidities 7, pt choice 10); still receiving at cut. duration 10.4 mo 0-16.8). 117 (25%) recurred; (65%) while ON 41 (35%) OFF ( > 1 month after last dose, including 20 stopped toxicity). 24 RFS 69%. 6.0 (95% CI 5.1, 7.5). 56 (48%) first with locoregional (LR) 61 (52%) distant +/- LR recurrence. Of those recurred only, 46/56 (82%) underwent surgery, 15/46 (33%) then radiotherapy, ‘second adjuvant’ BRAF/MEK inhibitors (15/21, 71% BRAFmt pts). 10/56 subsequently distantly. 58/80 (73%) systemic either 1st or subsequent unresectable For recurrences 18 combination ipilimumab (ipi) (ORR 44%), 4 ipi monotherapy 0%), 7 + investigational agent 57%), 82%). PD ongoing PD1 monotherapy. no patients responded alone (n = 1) an 1), ipi+nivo 3), 4) chemotherapy 2); 6 50%). 2-year OS 92%. Conclusions: Despite higher rates discontinuation due toxicity compared trial cohorts, efficacy appear similar. Most are distant, many soon recur distantly thereafter. Second line frequently used Both have activity