Lim Agnes Yeok-Loo, Chan Jason Yongsheng, Oh Choon Chiat
Department of Dermatology, Singapore General Hospital, Singapore 169608, Singapore.
Duke-NUS Medical School, Singapore 169857, Singapore.
Diagnostics (Basel). 2024 Jul 25;14(15):1601. doi: 10.3390/diagnostics14151601.
Programmed cell death-1 (PD1) inhibitors, a form of immune checkpoint inhibitor, are efficacious for metastatic melanoma but are associated with cutaneous adverse reactions (CARs). Studies in Europe and North America showed that CARs are associated with an increased overall survival. However, studies from Asia showed mixed results. There is a paucity of data regarding the efficacy of PD1 inhibitors and the effect of CARs on overall survival from Southeast Asia. A retrospective study of patients in the National Cancer Centre Singapore who were diagnosed with melanoma between 2015 and 2020 was conducted. Patients were included in the study if they had stage IV melanoma (advanced melanoma). Sixty-two patients were included in the study. The median age was 62.5 years and acral melanoma was the commonest subtype. Forty-three patients received PD1 inhibitors. Comparing patients who did not receive PD1 inhibitors to patients who received PD1 inhibitors, the former had a median overall survival of 6 months (95% CI: 5.07, 6.93), whereas the latter had a median overall survival of 21 months (95% CI: 13.33, 28.67; < 0.001) (Hazard ratio 0.32; 95% CI: 0.16, 0.63; = 0.001). Amongst patients who received PD1 inhibitors, patients who developed CARs had a greater median overall survival of 33 months (95% CI: 17.27, 48.73) compared to 15 months (95% CI: 9.20, 20.80; = 0.013) for patients who did not (HR 0.29; 95% CI: 0.098, 0.834; = 0.022). This study provides insight into the outcomes of metastatic melanoma in Singapore, and adds to the body of evidence supporting the use of PD1 inhibitors in Asians.
程序性细胞死亡蛋白1（PD1）抑制剂作为免疫检查点抑制剂的一种形式，对转移性黑色素瘤有效，但会引发皮肤不良反应（CARs）。欧洲和北美的研究表明，皮肤不良反应与总体生存率提高相关。然而，亚洲的研究结果不一。关于东南亚地区PD1抑制剂的疗效以及皮肤不良反应对总体生存率影响的数据较少。对新加坡国立癌症中心2015年至2020年间被诊断为黑色素瘤的患者进行了一项回顾性研究。如果患者患有IV期黑色素瘤（晚期黑色素瘤），则纳入该研究。共有62名患者纳入研究。中位年龄为62.5岁，肢端黑色素瘤是最常见的亚型。43名患者接受了PD1抑制剂治疗。将未接受PD1抑制剂治疗的患者与接受PD1抑制剂治疗的患者进行比较，前者的中位总生存期为6个月（95%CI：5.07，6.93），而后者的中位总生存期为21个月（95%CI：13.33，28.67；<0.001）（风险比0.32；95%CI：0.16，0.63；=0.001）。在接受PD1抑制剂治疗的患者中，出现皮肤不良反应的患者中位总生存期更长，为33个月（95%CI：17.27，48.73），而未出现皮肤不良反应的患者为15个月（95%CI：9.20，20.80；=0.013）（风险比0.29；95%CI：0.098，0.834；=0.022）。本研究深入了解了新加坡转移性黑色素瘤的治疗结果，并为支持亚洲人使用PD1抑制剂的证据体系增添了内容。
