What Do Real-World Data Show for Adjuvant Immunotherapy in Melanoma?

June 26, 2020
AJMC Staff

Having lower socioeconomic status, comorbidities, or being covered by Medicare was associated with less receipt of immunotherapy for stage III melanoma.

An early look at a real-world analysis of US patients with stage III melanoma showed that those who received receive adjuvant immunotherapy trended towards improved survival compared with those who did not.

The results, looking at ipilimumab (Yervoy), were presented earlier this week at the American Association for Cancer Research (AACR) Virtual Annual Meeting II. Ipilimumab, an immune checkpoint inhibitor, was approved by FDA in 2015 as adjuvant treatment to reduce the risk of melanoma returning after surgery.

The study used data from the National Cancer Database (NCDB), a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The database is the largest clinical cancer registry in the world, covering 72% of new US cancer diagnoses.

The study looked at cases diagnosed in 2015 and 2016, and survival data from cases diagnosed in 2015. Of the 4093 patients who met the criteria for survival analysis, median overall survival was not reached at the time of the analysis in both the groups.

Twenty-five percent (n = 1014) of the total received immunotherapy. The 24-month survival rate was 83% (95% CI, 82%-84%) for those receiving adjuvant immunotherapy compared with 80% (95% CI, 79%-81%) who did not receive adjuvant immunotherapy, P = .051.

However, adjuvant immunotherapy given to resected stage IIIC patients improved survival 32.8 versus 28.0 months (P <.01); 8160 patients met inclusion criteria for treatment pattern analysis. Twenty-eight percent (n = 2260) received immunotherapy after surgery. Increasing Charlson-Deyo, or comorbidity, scores of 1-3, lower income, lower high school graduation rate, 2015 as year of diagnosis, and Medicare as primary payer were associated with a lower percentage of patients receiving immunotherapy.

According to the study's lead author, Justin Moyers, MD, patients with stage IIIC disease who received adjuvant immunotherapy had a statistically significant improvement in survival compared with those who did not, at 70% versus 59%, respectively (P <.01). Although survival rates were still higher in those with stage IIIA and stage IIIB disease who received immunotherapy after surgery, the benefit did not reach statistical significance.

The rates for immunotherapy-treated patients with stage IIIA and stage IIIB disease were 94% and 84%, respectively, versus 91% and 81%, respectively, for those who did not receive the treatment.

Reference

Moyers JT, Chong EG, Mitchell JM, et al. Immunotherapy in resected stage III melanoma: aAn analysis of the National Cancer Database. Presented at: 2020 AACR Virtual Annual Meeting; June 22-24, 2020; Virtual. Abstract 3410.