Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
Eur J Cancer. 2021 Jul;151:72-83. doi: 10.1016/j.ejca.2021.04.003. Epub 2021 May 7.
In patients with metastatic melanoma, progression of a single tumour lesion (solitary progression) after response to immune checkpoint inhibition (ICI) is increasingly treated with local therapy. We evaluated the role of local therapy for solitary progression in melanoma.
Patients with metastatic melanoma treated with ICI between 2010 and 2019 with solitary progression as first progressive event were included from 17 centres in 9 countries. Follow-up and survival are reported from ICI initiation.
We identified 294 patients with solitary progression after stable disease in 15%, partial response in 55% and complete response in 30%. The median follow-up was 43 months; the median time to solitary progression was 13 months, and the median time to subsequent progression after treatment of solitary progression (TTSP) was 33 months. The estimated 3-year overall survival (OS) was 79%; median OS was not reached. Treatment consisted of systemic therapy (18%), local therapy (36%), both combined (42%) or active surveillance (4%). In 44% of patients treated for solitary progression, no subsequent progression occurred. For solitary progression during ICI (n = 143), the median TTSP was 29 months. Both TTSP and OS were similar for local therapy, ICI continuation and both combined. For solitary progression post ICI (n = 151), the median TTSP was 35 months. TTSP was higher for ICI recommencement plus local therapy than local therapy or ICI recommencement alone (p = 0.006), without OS differences.
Almost half of patients with melanoma treated for solitary progression after initial response to ICI had no subsequent progression. This study suggests that local therapy can benefit patients and is associated with favourable long-term outcomes.
在接受免疫检查点抑制剂（ICI）治疗后出现单一肿瘤病变进展（单发进展）的转移性黑色素瘤患者中，越来越多地采用局部治疗。我们评估了局部治疗在黑色素瘤单发进展中的作用。
从 9 个国家的 17 个中心纳入了 2010 年至 2019 年期间接受 ICI 治疗且首次进展事件为单发进展的转移性黑色素瘤患者。ICI 起始时报告随访和生存情况。
我们在 15%的患者中发现疾病稳定后出现单发进展，55%的患者出现部分缓解，30%的患者出现完全缓解。中位随访时间为 43 个月；单发进展的中位时间为 13 个月，治疗单发进展后的中位后续进展时间（TTSP）为 33 个月。估计 3 年总生存率（OS）为 79%；中位 OS 尚未达到。治疗包括全身治疗（18%）、局部治疗（36%）、两者联合（42%）或积极监测（4%）。在 44%接受单发进展治疗的患者中，未发生后续进展。对于 ICI 期间的单发进展（n=143），TTSP 的中位时间为 29 个月。局部治疗、ICI 持续治疗和两者联合治疗的 TTSP 和 OS 相似。对于 ICI 后单发进展（n=151），TTSP 的中位时间为 35 个月。ICI 重新开始联合局部治疗的 TTSP 高于单独局部治疗或 ICI 重新开始（p=0.006），但 OS 无差异。
在初始 ICI 治疗后出现单发进展的黑色素瘤患者中，近一半接受治疗的患者无后续进展。本研究表明，局部治疗可使患者受益，并与良好的长期结果相关。
