lnsights into Adjuvant Systemic Treatment Selection for Patients with Stage III Melanoma: Data from the Dutch Cancer Registry

• Published in: Targeted oncology Vol. 19; no. 5; pp. 735 - 745
• Main Authors: Aldenhoven, Loeki, van Weezelenburg, Merel A. Spiekerman, van den Berkmortel, Franchette W. P. J., Servaas, Nick, Janssen, Alfred, Vissers, Yvonne L. J., van Haaren, Elisabeth R. M., Beets, Geerard L., van Bastelaar, James
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.09.2024; Springer Nature B.V
• Subjects: Adjuvants; Biomedicine; Immunotherapy; Medicine; Medicine & Public Health; Melanoma; Oncology; Original Research Article
• ISSN: 1776-2596; 1776-260X; 1776-260X
• DOI: 10.1007/s11523-024-01090-9

Background Patient demographics and shared decision making might influence the choice of adjuvant therapy for stage III melanoma. Objective To identify factors for treatment selection of patients diagnosed with stage III melanoma to better understand current treatment decisions and improve further treatment counseling. Patients and Methods Data from 2007 patients diagnosed with stage III melanoma, between December 2018 and 2021, sourced from the Dutch Cancer Registry, were analyzed. Results Among the cohort, 48.7% received no therapy, 45.8% received checkpoint inhibition, and 5.5% received targeted therapy (TT). Patients foregoing therapy were significantly older [67.0 years (range 53.0–77.0) vs. 62.0 year (range 52.0–72.0)], had poorer performance scores (PS), and higher Charlson Comorbidity Index scores compared to those receiving therapy ( p  < 0.001). Patients undergoing therapy had significantly higher median Breslow thickness (3.3 mm vs. 2.2 mm) and higher prevalence of ulceration (49.9% vs. 38.1%). Those with connective tissue disease and/or congestive heart disease were more likely to receive TT [odds ration (OR) 8.1; 95% confidence interval (CI) 1.7–37.6 and OR 9.3; 95% CI 1.2–72.2, respectively]. Median treatment time among strata for disease recurrence was 4.26 months (3.69–4.82) for immunotherapy and 3.1 months (0.85–5.36) for TT ( p  = 0.298). Patients who developed recurrent disease were equal across treatment types (p = 0.656). The number of patients with grade 3 complications was different for each treatment type [immunotherapy: 17.8% vs. TT: 37.3% ( p  < 0.001)]. Conclusions Age, PS, and Breslow thickness seem to influence adjuvant treatment decisions. Clinicians’ preference for immunotherapy might play a role in counseling BRAF-positive patients for adjuvant therapy, this however, cannot be confirmed in this dataset. Overall, only a small proportion of patients completed adjuvant treatment.