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Wagner NB, Lenders MM, Kühl K, Reinhardt L, Fuchß M, Ring N, Stäger R, Zellweger C, Ebel C, Kimeswenger S, Oellinger A, Amaral T, Forschner A, Leiter U, Klumpp B, Hoetzenecker W, Terheyden P, Mangana J, Loquai C, Cozzio A, Garbe C, Meier F, Eigentler TK, Flatz L. Baseline metastatic growth rate is an independent prognostic marker in patients with advanced BRAF V600 mutated melanoma receiving targeted therapy. Eur J Cancer 2024; 196:113425. [PMID: 38039778 DOI: 10.1016/j.ejca.2023.113425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/17/2023] [Accepted: 10/27/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Targeted therapy (TT) of BRAF V600 mutated unresectable melanoma with inhibitors of the MAPK pathway achieves response rates of up to 76%, but most patients develop secondary resistance. Albeit TT is strikingly efficacious during the first days of treatment, even in advanced cases, long-term survival is highly unlikely, especially in patients with unfavorable baseline characteristics like elevated lactate dehydrogenase (LDH). In patients treated with anti-PD-1 immune checkpoint inhibitors, elevated baseline metastatic growth rate (MGR) was the most important prognostic factor. Here, we aimed at investigating the prognostic impact of MGR in patients with unresectable melanoma receiving TT. METHODS Clinical records of 242 patients with at least one measurable target lesion (TL) receiving TT at seven skin cancer centers were reviewed. Baseline MGR was determined measuring the largest TL at baseline and at one earlier timepoint. RESULTS Overall survival (OS) and progression-free survival (PFS) were significantly impaired in patients with an MGR > 3.9 mm/month (median OS: 11.4 vs. 35.5 months, P < 0.0001; median PFS: 4.8 vs. 9.2 months, P < 0.0001). Multivariable analysis of OS and PFS revealed that the prognostic impact of elevated MGR was independent of LDH, presence of brain and liver metastases, tumor burden, and line of treatment. The prognostic significance of elevated MGR was highest in patients with normal LDH. CONCLUSIONS Baseline MGR is an important independent prognostic marker for OS and PFS in melanoma patients treated with TT. Its implementation in clinical routine is easy and could facilitate the prognostic stratification.
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Affiliation(s)
- Nikolaus B Wagner
- Department of Dermatology, Venereology and Allergology, Kantonsspital St. Gallen, Switzerland; Department of Dermatology, University Hospital Tuebingen, Germany.
| | - Max M Lenders
- Department of Dermatology, University Hospital Tuebingen, Germany
| | - Kathrin Kühl
- Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Dresden, Germany
| | - Lydia Reinhardt
- Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Dresden, Germany
| | - Milena Fuchß
- Department of Dermatology, University Medical Center Mainz, Germany
| | - Natalie Ring
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Germany
| | - Ramon Stäger
- Department of Dermatology, University Hospital of Zurich, Switzerland
| | - Caroline Zellweger
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Switzerland
| | - Chiara Ebel
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Germany
| | - Susanne Kimeswenger
- Department of Dermatology, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Angela Oellinger
- Department of Dermatology, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Teresa Amaral
- Department of Dermatology, University Hospital Tuebingen, Germany
| | - Andrea Forschner
- Department of Dermatology, University Hospital Tuebingen, Germany
| | - Ulrike Leiter
- Department of Dermatology, University Hospital Tuebingen, Germany
| | - Bernhard Klumpp
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Germany; Institute for Radiology, Rems-Murr-Kliniken, Winnenden, Germany
| | - Wolfram Hoetzenecker
- Department of Dermatology, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Patrick Terheyden
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Germany
| | - Joanna Mangana
- Department of Dermatology, University Hospital of Zurich, Switzerland
| | - Carmen Loquai
- Department of Dermatology, University Medical Center Mainz, Germany
| | - Antonio Cozzio
- Department of Dermatology, Venereology and Allergology, Kantonsspital St. Gallen, Switzerland
| | - Claus Garbe
- Department of Dermatology, University Hospital Tuebingen, Germany
| | - Friedegund Meier
- Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Dresden, Germany
| | - Thomas K Eigentler
- Department of Dermatology, University Hospital Tuebingen, Germany; Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Lukas Flatz
- Department of Dermatology, Venereology and Allergology, Kantonsspital St. Gallen, Switzerland; Department of Dermatology, University Hospital Tuebingen, Germany
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