Mayo Clinic, Rochester, MN
Jesus Vera Aguilera, Jonas Paludo, Jarrett Failing, Robert R. McWilliams, Lisa A. Kottschade, Matthew Stephen Block, Svetomir Markovic, Roxana Stefania Dronca, Yiyi Yan
Background: Clinical management of metastatic melanoma (MM) after PD-1 blockade failure remains challenging and lacks a standard of care. Chemo-immunotherapy (CIT) combinations have demonstrated favorable efficacy and safety profiles in lung cancer patients. In this study, we compared the clinical outcomes of CIT with immunotherapy or chemotherapy alone after PD-1 blockade failure. Methods: We reviewed MM patients seen at Mayo Clinic between Jan, 2012 and Jun, 2018 who failed anti-PD1 therapy and received subsequent CIT, or immune checkpoint inhibitors (ICI) or chemotherapy alone. A total of 60 patients were analyzed, the CIT cohort [n=33 (55%)] treatment consisted of carboplatin/paclitaxel (n=29), nab-paclitaxel (n=2), paclitaxel (n=1), and temozolomide (n=1). In the ICI (n=9) or chemotherapy alone cohort (n=18) [n=27 (45%)], treatment consisted of carboplatin/paclitaxel (n=11), temozolomide (n=4), nab-paclitaxel (n=3), ipilimumab/nivolumab (n=4), pembrolizumab (n=4), or nivolumab (n=1). Results: Patients in the CIT cohort had a median OS of 3.5 years (95% CI: 1.7-NR) compared to 1.8 years (95% CI: 0.9-2) in the ICI or chemotherapy alone cohort, p=0.02. The median EFS following CIT was 7.6 months (95% CI: 6-10) compared to 3.4 months (95% CI: 2.8-4.1) following either ICI or chemotherapy alone, p=0.0005. A trend towards longer median EFS with use of CIT was seen in patients with BRAF wild-type [median 9 months (95% CI: 6-12)] compared to those harboring a BRAF mutation [median 6.5 months (95% CI: 1.8-9.1), p=0.29]. Side effects were similar among both groups. Conclusions: In MM patients who have failed anti-PD-1 therapy, the CIT combination showed favorable clinical outcomes and acceptable safety profile. This regimen should be considered for MM pts in this setting who have limited treatment options.
CIT (n=33) | ICI or Chemotherapy Alone (n=27) | p value | |
---|---|---|---|
Age, median (range) | 56 (23-77) | 58 (21-77) | 0.97 |
Male sex, n (%) | 23 (70) | 16 (59) | 0.40 |
Brain metastasis, n (%) | 12 (36) | 8 (30) | 0.58 |
BRAF mutation, n (%) | 12 (36) | 9 (33) | 0.80 |
ORR, n (%) | 19 (59) | 4 (15) | 0.0003 |
Response, n (%) | 5 (15) | 2 (7) | |
CR | 14 (43) | 2 (7) | |
PR | 1 (3) | 1 (4) | |
SD | 12 (36) | 22 (82) | |
PD | 1 (3) | 0 | |
Unknown |
Disclaimer
This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org
Abstract Disclosures
2020 ASCO Virtual Scientific Program
First Author: Vincent The-Luc Ma
2023 ASCO Annual Meeting
First Author: Sekwon Jang
2023 ASCO Annual Meeting
First Author: Jared Cohen
2018 ASCO Annual Meeting
First Author: Jesus Vera Aguilera