Department of Surgery, Duke University, Durham, North Carolina.
Department of Pathology and Department of Dermatology, Duke University, Durham, North Carolina.
J Surg Res. 2019 Apr;236:209-215. doi: 10.1016/j.jss.2018.11.045. Epub 2018 Dec 20.
The emergence of immune checkpoint inhibitors (ICIs) has improved survival for patients with metastatic melanoma. The types of disease-response patterns to ICI therapy can be more complex relative to traditional chemotherapy and include mixed responses, pseudoprogression, and oligoprogression. The potential benefit of surgery after incomplete response to ICI therapy has not been explored. The purpose of this study was to explore outcomes of surgery after ICI therapy in patients with metastatic melanoma.
A retrospective study was conducted at two centers and included patients with melanoma who underwent surgery after treatment with monotherapy or combination therapy with anti-programmed cell death protein (PD) 1 and/or anti-cytotoxic T-lymphocyte associated protein (CTLA)-4 checkpoint blockade.
Of 25 patients, nine received anti-CTLA-4 therapy, eight received anti-PD-1 therapy, and eight received both anti-CTLA-4 and anti-PD-1 therapies before surgery. Five patients were treated in the adjuvant setting and developed new lesions, whereas 20 patients were treated for metastatic disease and underwent surgery for persistent disease on imaging after ICI therapy. Twenty-five patients underwent 30 operations without complications. Twenty-seven of 30 masses were confirmed to be melanoma on pathology, one was a desmoid tumor and two were necrosis. At a median follow-up of 14.2 months, 2 patients died, 8 were alive with a known disease, and 15 continued to have no further evidence of disease.
Surgery was well tolerated in this cohort of patients receiving ICI therapy for melanoma. Surgery may benefit select patients with an oligoprogressive disease after ICI therapy. After a mixed response, surgery remains the only definitive method to render some patients free of disease.
免疫检查点抑制剂 (ICIs) 的出现改善了转移性黑色素瘤患者的生存。与传统化疗相比，ICI 治疗的疾病反应模式类型可能更为复杂，包括混合反应、假性进展和寡进展。ICI 治疗不完全反应后手术的潜在获益尚未得到探索。本研究旨在探讨 ICI 治疗后转移性黑色素瘤患者手术的结果。
在两个中心进行了一项回顾性研究，纳入了接受单药或联合抗程序性死亡蛋白 1 (PD-1) 和/或抗细胞毒性 T 淋巴细胞相关蛋白 4 (CTLA-4) 检查点阻断剂治疗后接受手术的黑色素瘤患者。
在 25 名患者中，9 名接受了抗 CTLA-4 治疗，8 名接受了抗 PD-1 治疗，8 名在手术前同时接受了抗 CTLA-4 和抗 PD-1 治疗。5 名患者接受辅助治疗并出现新病灶，20 名患者接受转移性疾病治疗，并在 ICI 治疗后影像学上出现持续性疾病而行手术。25 名患者进行了 30 次手术，无并发症。30 个肿块中有 27 个在病理上被确认为黑色素瘤，1 个为硬纤维瘤，2 个为坏死组织。在中位随访 14.2 个月时，2 名患者死亡，8 名患者疾病已知但存活，15 名患者继续无疾病进一步证据。
在接受 ICI 治疗黑色素瘤的患者中，手术耐受良好。手术可能对 ICI 治疗后寡进展疾病的选择患者有益。在混合反应后，手术仍然是使一些患者无疾病的唯一明确方法。
