Prognostic significance of the CP-GEP assay combining clinicopathologic factors and gene expression profiling in patients (pts) with AJCC v8 stage I/II cutaneous melanoma (CM).

Authors

Teresa Amaral

Teresa Maria Santos Amaral

Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany

Teresa Maria Santos Amaral , Tobias Sinnberg , Eftychia Chatziioannou , Heike Niessner , Ulrike M. Leiter , Ulrike Keim , Andrea Forschner , Jvalini Dwarkasing , Lisette Meerstein-Kessel , Thomas Rademaker , Renske Wever , Alexander M. Eggermont , Lukas Flatz , Stephan Forchhammer

Organizations

Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany, Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tübingen, Germany, Department of Dermatology and Oncology, University of Tuebingen, Tuebingen, Germany, Dept. of Dermatology, University of Tuebingen, Tuebingen, Germany, Department of Dermatology Eberhard-Karls University of Tuebingen, Tuebingen, Germany, SkylineDX B.V., Rotterdam, Netherlands, SkylineDx BV, Rotterdam, Netherlands, Comprehensive Cancer Center Munich, Princess Máxima Center & University Medical Center Utrecht, Utrecht, Netherlands, Department of Dermatology, University Hospital of Tuebingen, Tuebingen, Germany, Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany, Tuebingen, Germany

Research Funding

Other

Background: AJCC v8 includes Breslow thickness and ulceration to subdivide stage I and II CM pts into risk groups. In light of the results from adjuvant therapy in stage II CM, it has been discussed that pts’ follow-up and eventually treatment should consider additional markers, namely CP-GEP, to further refine the risk classification provided by the AJCC v8. The aim of this single center study was to clinically validate a prognostic CP-GEP-based risk score for stage I/II CMs combining Breslow, age and the expression of 8 genes SERPINE2, GDF15, ITGB3, CXCL8, LOXL4,TGFBR1, PLAT and MLANA. Methods: All obtainable formalin-fixed paraffin-embedded primaries of stage I/II CMs with negative sentinel lymph node (SLN) from the Central Malignant Melanoma Registry of Germany diagnosed between 2000-2017 and archived in Tuebingen were included. Study hypothesis and protocol were prospectively formulated. Tumors were analyzed blinded to clinical outcome. Quantitative reverse transcription polymerase chain reaction of the 8 genes was performed and combined with age and tumor thickness to define CP-GEP low- vs. high-score groups. Relapse-free survival (RFS), distant metastasis free survival (DMFS) and overall survival (OS) were evaluated using Kaplan-Meier curves. CP-GEP score performance was tested using multivariate Cox regression adjusted for tumor thickness, ulceration and age. Results: We included 543 pts with Stage IA (n=78); IB (n=223); IIA (n= 123); IIB (n=73); IIC (n=46). 43% were females, median Breslow was 1.7mm and 25% of tumors had ulceration. The median follow-up was 78 months (IQR 47-116). 311 (57%) patients had a high-risk CP-GEP score. The 5-y RFS rate was 71% and 92% (HR 4.2; p<0.001), the 5-y DMFS rate was 86% and 96% (HR 4.35; p<0.001) and the 5-y OS was 85% and 95% (HR 3.2; p=0.001), respectively for high and low-risk CP-GEP score. In multivariate Cox regression analysis for RFS including Breslow thickness, ulceration and age, contribution of CP-GEP score remained independently significant (HR 2.75; p=0.0008) compared to age (HR 1.03; p<0.0007), Breslow (HR 1.21; p<0.0001) and ulceration (HR 1.37; p=0.1694). Conclusions: CP-GEP risk score is a non-invasive and independent prognostic model for risk of relapse in stage I/II melanoma validated in this study. It identifies SLN negative pts at high risk of relapse and should be considered for complementing AJCC classification and for inclusion in future clinical trials.

5y-RFS, DMFS and OS rates.


CP-GEP high

N=311
CP-GEP low

N=232
IA

N=78
IB

N=223
IIA

N=123
IIB

N=73
IIC

N=46
All

N=543
5y RFS %

(95% CI)
71
(65-76)
92
(87-95)
96

(85-99)
89

(83-92)
75

(65-82)
69

(57-79)
41

(25-55)
80

(76-83)
5y DMFS %

(95% CI)
86
(81-90)
96
(92-98)
96

(84-99)
96

(92-98)
91

(84-96)
82

(69-90)
60

(42-74)
90

(87-93)
5y OS%

(95% CI)
85
(80-89)
95
(91-97)
97

(90-99)
97

(93-98)
86

(77-91)
80

(68-88)
65

(48-78)
89

(86-92)

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Abstract Details

Meeting

2022 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Melanoma/Skin Cancers

Track

Melanoma/Skin Cancers

Sub Track

Biologic Correlates

Citation

J Clin Oncol 40, 2022 (suppl 16; abstr 9564)

DOI

10.1200/JCO.2022.40.16_suppl.9564

Abstract #

9564

Poster Bd #

157

Abstract Disclosures