Potential for Long-Term Survival With ICIs in Melanoma

TOPLINE:

About 90% of patients with advanced melanoma who had a complete response to first-line immune checkpoint inhibitors survived more than 3 years, with survival curves plateauing over time, a large population-based analysis showed. This finding suggests the potential for long-term survival in this population of responders.

METHODOLOGY:

• Previous clinical trial research exploring survival trends in patients with advanced melanoma treated with frontline immune checkpoint inhibitors has shown that survival curves reach a plateau, suggesting that patients who respond to treatment may be able to sustain that response over the long term. However, long-term survival in clinical practice remains less clear.
• To investigate long-term survival in this population outside the clinical trial setting, researchers conducted a population-based analysis using data from the nationwide Dutch Melanoma Treatment Registry. The study included 2490 patients with stages III and IV melanoma in the Netherlands who received first-line immune checkpoint inhibitors. Data were analyzed from January to September 2023.
• Patients received first-line ipilimumab plus nivolumab (n = 480), ipilimumab monotherapy (n = 601), or an anti–programmed cell death (PD-1) inhibitor (n = 1409).
• Progression-free survival (PFS) and melanoma-specific survival were analyzed, and a Cox proportional hazards model was used to investigate factors associated with PFS among patients who achieved a partial or complete response. Median follow-up for the entire cohort was 55.8 months.

TAKEAWAY:

• Overall, 23.4% of all patients were progression free after 3 years, and 19.7% were progression free after 5 years. The 5-year PFS rate was highest for those on ipilimumab plus nivolumab (26.9%), followed closely by those on an anti–PD-1 (22.8%), with the lowest PFS rate observed among those on ipilimumab (6.5%).
• Overall survival for all patients was 44% after 3 years and 35.9% after 5 years. Like the PFS findings, the 5-year overall survival rate was highest for those on ipilimumab plus nivolumab (41.2%), followed by those on an anti–PD-1 (39.1%), and then those on ipilimumab (24.9%).
• More than 90% of patients who achieved a complete response on immune checkpoint inhibitors survived beyond 3 years (calculated from the time of complete response). Median melanoma-specific survival was 75.9 months among patients who achieved a partial response and not reached among those who achieved a complete response, while it was 29.9 months in the overall population.
• Patients with metastases in three or more organ sites had a significantly higher risk for progression after achieving a partial or complete response (adjusted hazard ratio [aHR], 1.37), as did those who were 65 years or older (aHR, 1.35).

IN PRACTICE:

This cohort study of patients with advanced melanoma in clinical practice showed that “their survival reached a plateau, comparable with patients participating in clinical trials,” the authors wrote. “These findings can be used in daily clinical practice to guide long-term surveillance strategies and inform both physicians and patients regarding long-term treatment outcomes.”

SOURCE:

The study, led by Olivier J. van Not, MD, Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, the Netherlands, was published online in JAMA Network Open.

LIMITATIONS:

The cohort was limited to patients in the Netherlands, which may have affected the generalizability of the findings, and was an observational study, which limited conclusions about the relative benefits of the different therapies assessed. The follow-up period may not be enough to fully capture long-term outcomes. Potential biases in data collection and patient selection could influence the results as well.

DISCLOSURES:

van Not disclosed receiving grants from Sanofi, Roche, BMS, Idera, and Teva. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.