Jung Minkyu, Lee Jeeyun, Kim Tae Min, Lee Dae Ho, Kang Jin Hyung, Oh Sung Young, Lee Soo Jung, Shin Sang Joon
Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Cancer Res Treat. 2017 Jan;49(1):44-53. doi: 10.4143/crt.2016.024. Epub 2016 Apr 27.
Ipilimumab improves survival in advanced melanoma patients. However, the efficacy and safety of ipilimumab has not been evaluated in Asian melanoma patients with a high frequency of mucosal and acral melanoma subtypes.
Advanced melanoma patients treated with 3 mg/kg ipilimumab in a Korean multicenter named-patient program (NPP) were evaluated between September 2014 and July 2015. Baseline characteristics and blood parameters including neutrophil to lymphocyte ratio (NLR) were assessed, and outcome and adverse events were evaluated according to subtypes.
A total of 104 advanced melanoma patients were treated. The primary sites were acral (31.7%), mucosal (26%), cutaneous (26%), uveal (9.6%), and unknown (6.7%). Sixty-eight patients (65.4%) experienced adverse events, and the most common toxicity was skin rash (22.1%), 10 patients (9.6%) experienced adverse events of grade 3 or higher. The median progression-free survival (PFS) was 2.73 months (95% confidence interval, 2.67 to 2.85), and there was no difference in PFS according to subtypes. Poor performance status, liver metastasis, and NLR (≥ 5) were independent poor prognostic factors by multivariate analysis.
In the Korean NPP cohort, ipilimumab showed similar efficacy and tolerability compared to Western patients, regardless of subtypes. All subtypes should benefit from ipilimumab with consideration of performance status, liver metastasis, and NLR.
伊匹单抗可改善晚期黑色素瘤患者的生存率。然而,伊匹单抗在黏膜和肢端黑色素瘤亚型发生率较高的亚洲黑色素瘤患者中的疗效和安全性尚未得到评估。
2014年9月至2015年7月期间,对在韩国一项多中心命名患者计划(NPP)中接受3mg/kg伊匹单抗治疗的晚期黑色素瘤患者进行了评估。评估了基线特征和包括中性粒细胞与淋巴细胞比值(NLR)在内的血液参数,并根据亚型评估了结局和不良事件。
共治疗了104例晚期黑色素瘤患者。主要发病部位为肢端(31.7%)、黏膜(26%)、皮肤(26%)、葡萄膜(9.6%)和不明(6.7%)。68例患者(65.4%)发生了不良事件,最常见的毒性反应是皮疹(22.1%),10例患者(9.6%)发生了3级或更高等级的不良事件。中位无进展生存期(PFS)为2.73个月(95%置信区间,2.67至2.85),各亚型的PFS无差异。多因素分析显示,体能状态差、肝转移和NLR(≥5)是独立的不良预后因素。
在韩国NPP队列中,无论亚型如何,伊匹单抗与西方患者相比显示出相似的疗效和耐受性。所有亚型患者在考虑体能状态、肝转移和NLR的情况下,都应能从伊匹单抗治疗中获益。