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Goldinger SM, Buder-Bakhaya K, Lo SN, Forschner A, McKean M, Zimmer L, Khoo C, Dummer R, Eroglu Z, Buchbinder EI, Ascierto PA, Gutzmer R, Rozeman EA, Hoeller C, Johnson DB, Gesierich A, Kölblinger P, Bennannoune N, Cohen JV, Kähler KC, Wilson MA, Cebon J, Atkinson V, Smith JL, Michielin O, Long GV, Hassel JC, Weide B, Haydu LE, Schadendorf D, McArthur G, Ott PA, Blank C, Robert C, Sullivan R, Hauschild A, Carlino MS, Garbe C, Davies MA, Menzies AM. Chemotherapy after immune checkpoint inhibitor failure in metastatic melanoma: a retrospective multicentre analysis. Eur J Cancer 2021; 162:22-33. [PMID: 34952480 DOI: 10.1016/j.ejca.2021.11.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Despite remarkably improved outcomes with immune checkpoint inhibition, many patients with metastatic melanoma will eventually require further therapy. Chemotherapy has limited activity when used first-line but can alter the tumour microenvironment and does improve efficacy when used in combination with immunotherapy in lung cancer. Whether chemotherapy after checkpoint inhibitor failure has relevant activity in patients with metastatic melanoma is unknown. METHODS Patients with metastatic melanoma treated with chemotherapy after progression on immunotherapy with checkpoint inhibitors were identified retrospectively from 24 melanoma centres. Objective response rate (ORR), progression-free survival (PFS), overall survival (OS) and safety were examined. RESULTS In total, 463 patients were treated between 2007 and 2017. Fifty-six per cent had received PD-1-based therapy before chemotherapy. Chemotherapy regimens included carboplatin + paclitaxel (32%), dacarbazine (25%), temozolomide (15%), taxanes (9%, nab-paclitaxel 4%), fotemustine (6%) and others (13%). Median duration of therapy was 7.9 weeks (0-108). Responses included 0.4% complete response (CR), 12% partial response (PR), 21% stable disease (SD) and 67% progressive disease (PD). Median PFS was 2.6 months (2.2, 3.0), and median PFS in responders was 8.7 months (6.3, 16.3), respectively. Twelve-month PFS was 12% (95% CI 2-15%). In patients who had received anti-PD-1 before chemotherapy, the ORR was 11%, and median PFS was 2.5 months (2.1, 2.8). The highest activity was achieved with single-agent taxanes (N = 40), with ORR 25% and median PFS 3.9 months (2.1, 6.2). Median OS from chemotherapy start was 7.1 months (6.5, 8.0). Subsequent treatment with checkpoint inhibitors achieved a response rate of 16% with a median PFS of 19.1 months (2.0-43.1 months). No unexpected toxicities were observed. CONCLUSION Chemotherapy has a low response rate and short PFS in patients with metastatic melanoma who have failed checkpoint inhibitor therapy, although activity varied between regimens. Chemotherapy has a limited role in the management of metastatic melanoma.
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Affiliation(s)
- Simone M Goldinger
- University of Zurich, Department of Dermatology, Gloriastrasse 31 Zurich, 8091, Switzerland; Melanoma Institute Australia, The University of Sydney, The Poche Centre, 40 Rocklands Road North Sydney NSW 2060, Australia.
| | - Kristina Buder-Bakhaya
- University Hospital Heidelberg, Department of Dermatology and National Center for Cancer (NCT), Im Neuenheimer Feld 460 Heidelberg, 69120, Germany.
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, The Poche Centre, 40 Rocklands Road North Sydney NSW 2060, Australia.
| | - Andrea Forschner
- University of Tuebingen, Department of Dermatology, Liebermeisterstrasse 25, Tübingen, 72076, Germany.
| | - Meredith McKean
- University of Texas MD Anderson Cancer Center, Department of Melanoma Medical Oncology and Department of Surgical Oncology, 1400 Pressler Street, Houston, TX 77006 USA.
| | - Lisa Zimmer
- University Hospital Essen, Department of Dermatology, Essen & German Cancer Consortium, Partner Site Essen, Germany.
| | - Chloe Khoo
- Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - Reinhard Dummer
- University of Zurich, Department of Dermatology, Gloriastrasse 31 Zurich, 8091, Switzerland.
| | - Zeynep Eroglu
- Moffitt Cancer Center, Department of Cutaneous Oncology, 12902 Magnolia Drive, Tampa, FL 33612, USA.
| | | | - Paolo A Ascierto
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Napoli, Italy.
| | - Ralf Gutzmer
- Skin Cancer Center, Department of Dermatology, Mühlenkreiskliniken, Ruhr University Bochum Campus Minden, Germany.
| | - Elisa A Rozeman
- Antoni van Leeuwenhoek Hospital - The Netherlands Cancer Institute, Department of Medical Oncology and Immunology, Plesmanlaan 121 Amsterdam, 1066 CX, the Netherlands.
| | - Christoph Hoeller
- Medical University of Vienna, Department of Dermatology, Waehringer Guertel 18-20, Vienna, 1090, Austria.
| | - Douglas B Johnson
- Vanderbilt University Medical Center, Department of Medicine, Nashville, TN, USA.
| | - Anja Gesierich
- University Hospital Wuerzburg, Department of Dermatology, Wuerzburg, Germany.
| | - Peter Kölblinger
- Department of Dermatology and Allergology, Paracelsus Medical University, Salzburg, Austria.
| | - Naima Bennannoune
- Gustave Roussy and Paris-Saclay University, 114 rue Edouard Vaillant Villejuif Cedex, 94805, France.
| | - Justine V Cohen
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
| | - Katharina C Kähler
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Strasse 3, Haus C, Kiel, 24105, Germany.
| | - Melissa A Wilson
- Perlmutter Cancer Center, NYU Langone Health, NYU School of Medicine, 160 E. 34th Street, New York, NY 10016, USA.
| | - Jonathan Cebon
- Olivia Newton-John Cancer Research Institute, Austin Health, School of Cancer Medicine, La Trobe University, 145 Studley Road, Heidelberg VIC, Melbourne, 3084, Australia.
| | - Victoria Atkinson
- University of QLD, Princess Alexandra Hospital, Greenslopes Private Hospital, 199 Ipswich Rd, Woolloongabba QLD 4102, Australia.
| | - Jessica L Smith
- Crown Princess Mary Cancer Centre Westmead, Sydney, NSW, Australia.
| | - Olivier Michielin
- Lausanne University Hospital, Department of Oncology, Precision Oncology Center, Rue du Bugnon 21, Lausanne, 1011, Switzerland.
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, The Poche Centre, 40 Rocklands Road North Sydney NSW 2060, Australia; Royal North Shore Hospital, Reserve Road St Leonards NSW 2065, Australia; Mater Hospital, 25 Rocklands Road, North Sydney NSW 2060, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Charles Perkins Centre, The University of Sydney, Australia.
| | - Jessica C Hassel
- University Hospital Heidelberg, Department of Dermatology and National Center for Cancer (NCT), Im Neuenheimer Feld 460 Heidelberg, 69120, Germany.
| | - Benjamin Weide
- University of Tuebingen, Department of Dermatology, Liebermeisterstrasse 25, Tübingen, 72076, Germany.
| | - Lauren E Haydu
- University of Texas MD Anderson Cancer Center, Department of Melanoma Medical Oncology and Department of Surgical Oncology, 1400 Pressler Street, Houston, TX 77006 USA.
| | - Dirk Schadendorf
- University Hospital Essen, Department of Dermatology, Essen & German Cancer Consortium, Partner Site Essen, Germany.
| | | | - Patrick A Ott
- Dana Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA.
| | - Christian Blank
- Antoni van Leeuwenhoek Hospital - The Netherlands Cancer Institute, Department of Medical Oncology and Immunology, Plesmanlaan 121 Amsterdam, 1066 CX, the Netherlands.
| | - Caroline Robert
- Gustave Roussy and Paris-Saclay University, 114 rue Edouard Vaillant Villejuif Cedex, 94805, France.
| | - Ryan Sullivan
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Strasse 3, Haus C, Kiel, 24105, Germany.
| | - Matteo S Carlino
- Crown Princess Mary Cancer Centre Westmead, Sydney, NSW, Australia.
| | - Claus Garbe
- University of Tuebingen, Department of Dermatology, Liebermeisterstrasse 25, Tübingen, 72076, Germany.
| | - Michael A Davies
- University of Texas MD Anderson Cancer Center, Department of Melanoma Medical Oncology and Department of Surgical Oncology, 1400 Pressler Street, Houston, TX 77006 USA.
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, The Poche Centre, 40 Rocklands Road North Sydney NSW 2060, Australia; Royal North Shore Hospital, Reserve Road St Leonards NSW 2065, Australia; Mater Hospital, 25 Rocklands Road, North Sydney NSW 2060, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
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