The aim of this study is to understand subsequent lines of therapy and outcomes in patients with metastatic melanoma who progress after receiving first line immunotherapy. (IT)
Data was collected from a single centre (Princess Alexandra Hospital) from the electronic medical records system and IT prescribing software. Patient demographics, lines of therapy and outcomes were recorded from 2015-2019. Eligible patients had to have received 1st IT and have experienced disease progression. Patients were allowed to have had targeted therapy (TT) prior to 1st line immunotherapy if BRAF mutant (BRmt).
87 patients were identified, median age was 64.2 years, 64% male. The majority were AJCC 8th Edition Stage IVd 33% (n=29) or IVc 32% (n=28). 54% had BRAF wild type melanoma (n=47, 8 of these had uveal melanoma), 46% had BRmt disease. All BRmt patients except 3 had TT before 1st line IT. 1st line IT was PD-1 based in 68% (n=59), CTLA4+PD-1 in 28.7% (n=25) and 2% (n=3) received CTLA4 alone. Post progression on IT, the majority (62%) had no further systemic therapy, 7% (n=6) had CTLA4 monotherapy, 8% (n=7) had CTLA4+PD-1, 13% (n=11) had TT and 9% (n=8) participated in a clinical trial. Eight patients subsequently proceeded to further line(s) of systemic therapy post 2nd episode of progression. Median overall survival post-progression of 1st line IT is 168.5 days. 3 patients have experienced a CR and are in long term follow up, 11 are on ongoing therapy, 5 were lost to follow up and the rest of the cohort are deceased.
Outcomes post 1st line IT are not well described, the long-term outcomes post-progression remain poor with the majority of patients succumbing to their disease despite subsequent lines of therapy.