TY - JOUR
T1 - Systemic Therapy in Advanced Nodular Melanoma versus Superficial Spreading Melanoma
T2 - A Nation-Wide Study of the Dutch Melanoma Treatment Registry
AU - Rauwerdink, Daan Jan Willem
AU - van Doorn, Remco
AU - van der Hage, Jos
AU - Van den Eertwegh, Alfonsus J M
AU - Haanen, John B A G
AU - Aarts, Maureen
AU - Berkmortel, Franchette
AU - Blank, Christian U
AU - Boers-Sonderen, Marye J
AU - De Groot, Jan Willem B
AU - Hospers, Geke A P
AU - de Meza, Melissa
AU - Piersma, Djura
AU - Van Rijn, Rozemarijn S
AU - Stevense, Marion
AU - Van der Veldt, Astrid
AU - Vreugdenhil, Gerard
AU - Wouters, Michel W J M
AU - Suijkerbuijk, Karijn
AU - van der Kooij, Monique
AU - Kapiteijn, Ellen
N1 - Publisher Copyright:
© 2022 by the authors.
PY - 2022/11/19
Y1 - 2022/11/19
N2 - Nodular melanoma (NM) is associated with a higher locoregional and distant recurrence rate compared with superficial spreading melanoma (SSM); it is unknown whether the efficacy of systemic therapy is limited. Here, we compare the efficacy of immunotherapy and BRAF/MEK inhibitors (BRAF/MEKi) in advanced NM to SSM. Patients with advanced stage IIIc and stage IV NM and SSM treated with anti-CTLA-4 and/or anti-PD-1, or BRAF/MEKi in the first line, were included from the prospective Dutch Melanoma Treatment Registry. The primary objectives were distant metastasis-free survival (DMFS) and overall survival (OS). In total, 1086 NM and 2246 SSM patients were included. DMFS was significantly shorter for advanced NM patients at 1.9 years (CI 95% 0.7-4.2) compared with SSM patients at 3.1 years (CI 95% 1.3-6.2) (p < 0.01). Multivariate survival analysis for immunotherapy and BRAF/MEKi demonstrated a hazard ratio for immunotherapy of 1.0 (CI 95% 0.85-1.17) and BRAF/MEKi of 0.95 (CI 95% 0.81-1.11). A shorter DMFS for NM patients developing advanced disease compared with SSM patients was observed, while no difference was observed in the efficacy of systemic immunotherapy or BRAF/MEKi between NM and SSM patients. Our results suggests that the worse overall survival of NM is mainly driven by propensity of metastatic outgrowth of NM after primary diagnosis.
AB - Nodular melanoma (NM) is associated with a higher locoregional and distant recurrence rate compared with superficial spreading melanoma (SSM); it is unknown whether the efficacy of systemic therapy is limited. Here, we compare the efficacy of immunotherapy and BRAF/MEK inhibitors (BRAF/MEKi) in advanced NM to SSM. Patients with advanced stage IIIc and stage IV NM and SSM treated with anti-CTLA-4 and/or anti-PD-1, or BRAF/MEKi in the first line, were included from the prospective Dutch Melanoma Treatment Registry. The primary objectives were distant metastasis-free survival (DMFS) and overall survival (OS). In total, 1086 NM and 2246 SSM patients were included. DMFS was significantly shorter for advanced NM patients at 1.9 years (CI 95% 0.7-4.2) compared with SSM patients at 3.1 years (CI 95% 1.3-6.2) (p < 0.01). Multivariate survival analysis for immunotherapy and BRAF/MEKi demonstrated a hazard ratio for immunotherapy of 1.0 (CI 95% 0.85-1.17) and BRAF/MEKi of 0.95 (CI 95% 0.81-1.11). A shorter DMFS for NM patients developing advanced disease compared with SSM patients was observed, while no difference was observed in the efficacy of systemic immunotherapy or BRAF/MEKi between NM and SSM patients. Our results suggests that the worse overall survival of NM is mainly driven by propensity of metastatic outgrowth of NM after primary diagnosis.
U2 - 10.3390/cancers14225694
DO - 10.3390/cancers14225694
M3 - Article
C2 - 36428787
SN - 2072-6694
VL - 14
JO - Cancers
JF - Cancers
IS - 22
M1 - 5694
ER -