Role of time to switch from ipilimumab to anti-PD1 in anti-PD1 efficacy within the French national cohort, MelBase.

Authors

null

Clara Allayous

Dermatology, Hôpital Saint-Louis, Paris, France

Clara Allayous , Stéphane Dalle , Marie Thérèse Leccia , Francois Aubin , Laurent Mortier , Marie- Beylot-Barry , Philippe Saiag , Sophie Dalac-Rat , Jean Philippe Lacour , Eve Maubec , Vincent Descamps , Bernard Guillot , Thierry Lesimple , Julie De Quatrebarbes , Jean-Philippe Arnault , Pierre-Emmanuel Stoebner , Raphael Porcher , Alice Ballon , Bastien Oriano , Celeste Lebbe

Organizations

Dermatology, Hôpital Saint-Louis, Paris, France, Hospices Civils De Lyon, Cancer Research Center of Lyon, Claude Bernard University Lyon, Pierre Béninte, France, Dermatology, CHU of Grenoble, Grenoble, France, Dermatology, CHU de Besançon, Besançon, France, Universite Lille, Centre Hospitalier Regional Universitaire de Lille, Lille, France, CHU Bordeaux, Bordeaux, France, Université Versailles Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France, Dermatology, CHU Dijon, Dijon, France, Dermatology, Nice University Hospital, Nice, France, Hopital Bichat, Paris, France, Department of Dermatology, Bichat Hospital, Paris, France, Dermatology, CHU Montpellier, Montpellier, France, Centre Eugène Marquis, Rennes, France, Dermatology, CHR Annecy Genevois, Annecy, France, CHU Amiens Dermatology, Amiens, France, Dermatologie, CHU de Nimes, Nimes, France, Biostatistiques, AP-HP, Hotel-Dieu, Paris, France, Dermatology, Data Management, Assistance Publique Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France, Hôpital Saint-Louis - AP-HP, Paris, France

Research Funding

Other

Background: With increasing armamentarium in advanced melanoma management, the impact of various strategies remains to be determined including the importance of time to switch from one treatment to another. We report the impact of time to IPI/APD non-planned switch on APD efficacy in real life patients within MelBase (MB). Methods: MB is a French multicentric biobank dedicated to the prospective follow-up (FU) of unresectable stage III or IV melanoma with 1102 patients included since March 2013. Data were collected (Sept.2016) and analyzed (demography, overall survival (OS), progression-free survival (PFS), response rate, multivariate analysis, safety). Results: 71 patients were treated with IPI/APD sequence. 72% received 4 IPI injections. The median time to switch was 1.7 months (0.36-3). The characteristics at the initiation of APD are: mean age 64 yrs, PS 0-1 80%, elevated LDH 34%, BRAF WT 90%, brain metastasis 25%, ≥ 3 metastatic organ sites (MOS) 49%, median FU 11.9 months, OS 20 months (95%CI:12.6-NR), PFS 3.5 months (95%CI:2.9-6.2). The best overall response was 25%, disease control rate was 54% with a low toxicity profile (17% grade 3/4). In a multivariable analysis, longer time to switch was significantly associated with better OS (adjusted HR 0.38 per 1 more month, 95%CI:0.14-0.93), as well as ECOG 0-1 (aHR 3.11, 95%CI:0.99-9.72) and LDH < ULN (aHR 3.32, 95%CI:1.26-8.75). In addition, the association of time to switch with OS vary significantly according to the number of MOS ( < 3 MOS aHR 0.25, 95%CI:0.10-0.62; ≥3 MOS aHR 0.99 95%CI:0.41-2.39) and AJCC stage (M0/1a/1b aHR 0.06, 95%CI:0.01-0.43 ; M1c aHR 0.77, 95%CI:0.39-1.54). Conclusions: In patients who failed IPI treatment, longer survival after APD was associated to time to switch only in patients with favorable baseline factors. Such results are probably more related to the slow kinetics of the disease than to the delay itself. Our results are different from Blank et al.(ESMO 2016) who tested a planned switch, immediately after 2 IPI perfusions, and showed overall response rate close to IPI+APD association. We are currently conducting a similar study on the reverse sequence (APD/IPI) and the role on IPI efficacy.

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Abstract Details

Meeting

2017 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Melanoma/Skin Cancers

Track

Melanoma/Skin Cancers

Sub Track

Advanced/Metastatic Disease

Citation

J Clin Oncol 35, 2017 (suppl; abstr 9551)

DOI

10.1200/JCO.2017.35.15_suppl.9551

Abstract #

9551

Poster Bd #

159

Abstract Disclosures

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