TMB and BRAF mutation status are independent predictive factors in stage IIIC/D/IV melanoma patients receiving adjuvant PD-1 antibodies.

Authors

null

Andrea Forschner

Department of Dermatology, University Hospital of Tuebingen, Tuebingen, Germany

Andrea Forschner , Julia Eckardt , Peter Martus , Sorin Armeanu-Ebinger , Stephan Ossowski , Irina Bonzheim , Thomas Eigentler , Teresa Maria Santos Amaral , Lukas Flatz , Claus Garbe , Christopher Schroeder

Organizations

Department of Dermatology, University Hospital of Tuebingen, Tuebingen, Germany, Institute for Clinical Epidemiology and Applied Biometrics, University Hospital Tübingen, Tübingen, Germany, Institute for Medical Genetics and Applied Genomics University Hospital Tuebingen, Tübingen, Germany, Institute of Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany, Tübingen, Germany, Department of Dermatology, University Hospital Tübingen, Tübingen, Germany, Department of Dermatology, University of Tübingen, Tübingen, Germany

Research Funding

No funding received
None

Background: High tumor mutational burden (TMB) is associated with a favorable outcome in metastatic melanoma patients treated with immune checkpoint inhibitors. However, data are limited in the adjuvant setting. As BRAF mutated patients have an alternative with targeted adjuvant therapy, it is important to identify predictive factors for relapse and recurrence-free survival (RFS) in patients receiving adjuvant PD-1 antibodies. Methods: We systematically evaluated all melanoma patients who started adjuvant PD-1 antibody therapy at our center between March 2018 and September 2019 to identify predictive factors for outcome. The median follow-up time from start of adjuvant anti-PD-1 therapy was 22 months. Tumor and normal tissue of all stage IIIC/D/IV patients and of stage IIIA/B patients with relapse were sequenced using a 700 genes panel. Predictive factors for relapse and RFS were identified using univariate and multivariate logistic and Cox regression analysis. RFS was estimated by the Kaplan-Meier method. TMB high was defined as the top 20 % of the cohort, corresponding to TMB values ≥ 20 Var/Mb. Results: A total of 165 patients were included in this study. According to AJCC 8th the initial tumor stages at the beginning of adjuvant anti-PD-1 therapy were as follows: N = 80 stage IIIA/B (48 %), N = 85 stage IIIC/D/IV (52 %). 72/165 patients (44 %) suffered a relapse, 44/72 (61 %) with loco regional and 28/72 (39 %) with distant metastases. Sequencing results were available from 79 / 85 patients with stage IIIC/D/IV. Here we present the results of this cohort. TMB low (OR 17.46, 95%CI 4.03-75.55; p < 0.0001) or absence of BRAF V600E/K mutation (OR 4.13, 95%CI 1.36-12.53; p = 0.012) were statistically significant, independent predictive factors for relapse. Also, with regard to RFS, BRAF mutation status and TMB were statistically significant and independent predictive factors. In the table below we display results for the combined variables. Patients with BRAF V600E/K mutation and TMB high had the best outcome. Conclusions: We identified TMB high as positive predictive marker in stage IIIC/D/IVmelanoma patients with adjuvant PD-1 antibody therapy. In tumors with BRAF V600E/K mutation and concurrent low TMB, adjuvant targeted therapy with BRAF- and MEK-inhibitors may be an alternative. This is also supported by the data on adjuvant dabrafenib and trametinib, which showed a greater advantage in patients with low TMB, presumably due to less tumor heterogeneity.

Characteristic
No relapse N = 34
Relapse

N = 45
p
1-year RFS

(%; 95%CI)
2-year RFS

(%; 95%CI)
P
BRAF V600E/K mutation + TMB high
4
0
< 0.0001
100
100
< 0.0001
No BRAF V600E/K mutation + TMB high
11
3
86 (67-100)
78 (56-100)
BRAF V600E/K mutation + TMB low
12
13
56 (37-75)
42 (20-65)
No BRAF V600E/K mutation + TMB low
7
29
33 (18-49)
19 (6-32)

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Poster Discussion Session

Session Title

Melanoma/Skin Cancers

Track

Melanoma/Skin Cancers

Sub Track

Advanced/Metastatic Disease

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr 9524)

DOI

10.1200/JCO.2021.39.15_suppl.9524

Abstract #

9524

Abstract Disclosures

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