Surgery for Unresectable Stage IIIC and IV Melanoma in the Era of New Systemic Therapy

• Published in: Cancers Vol. 12; no. 5; p. 1176
• Main Authors: Blankenstein, Stephanie A, Aarts, Maureen J B, van den Berkmortel, Franchette W P J, Boers-Sonderen, Marye J, van den Eertwegh, Alfons J M, Franken, Margreet G, de Groot, Jan Willem B, Haanen, John B A G, Hospers, Geke A P, Kapiteijn, Ellen, Piersma, Djura, van Rijn, Rozemarijn S, Suijkerbuijk, Karijn P M, Ten Tije, Albert J, van der Veldt, Astrid A M, Vreugdenhil, Gerard, Wouters, Michel W J M, van Akkooi, Alexander C J
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 07.05.2020; MDPI
• Subjects: Disease control; Drug development; Immunotherapy; Medical prognosis; Melanoma; Metastases; Metastasis; Patients; Response rates; Surgery; Survival; systemic therapy; Dutch Melanoma Treatment Registry; metastatic melanoma; surgery
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers12051176

Opportunities for surgical treatment in metastatic melanoma patients have re-emerged due to the development of novel systemic therapeutics over the past decade. The aim of this study is to present data on outcomes of surgery in patients with unresectable stage IIIC and IV melanoma, who have previously been treated with immunotherapy or targeted therapy. Data was extracted from the Dutch Melanoma Treatment Registry (DMTR) on 154 patients obtaining disease control to systemic therapy and undergoing subsequent surgery. Disease control was defined as a complete response (CR), which was seen in 3.2% of patients; a partial response (PR), seen in 46.1% of patients; or stable disease (SD), seen in 44.2% of patients. At a median follow-up of 10.0 months (interquartile range 4-22) after surgery, the median overall survival (OS) had not been reached in our cohort and median progression-free survival (PFS) was 9.0 months (95% CI 6.3-11.7). A CR or PR at first follow-up after surgery was associated with both a better OS and PFS compared to stable or progressive disease ( < 0.001). We conclude that selected patients can benefit from surgery after achieving disease control with systemic therapy.