Best of the Best Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2020

Melanoma Recurrence Patterns and Management after Adjuvant Targeted Therapy: A Multicentre Analysis (#30)

Prachi Bhave 1 , Lalit Pallan 2 , Georgina V Long 2 3 , Alexander M Menzies 2 3 , Victoria Atkinson 4 5 , Justine V Cohen 6 , Ryan J Sullivan 6 , Vanna Chiarion-Sileni 7 , Marta Nyakas 8 , Katharina Kaehler 9 , Axel Hauschild 9 , Ruth Plummer 10 , Claudia Trojaniello 11 , Paolo A Ascieto 11 , Lisa Zimmer 12 , Dirk Schadendorf 12 , Clara Allayous 13 , Celeste Lebbe 13 , Andrea Maurichi 14 , Mario Santinami 14 , Severine Roy 15 , Caroline Robert 15 , Thierry Lesimple 16 , Sapna Patel 17 , Judith M Versluis 18 , Christian U Blank 18 , Adnan Khattak 19 , Andre van der Westhuizen 20 , Matteo S Carlino 2 21 , Mark Shackleton 1 22 , Andrew Haydon 1 22
  1. Medical Oncology , Alfred Hospital , Melbourne , Victoria, Australia
  2. Medical Oncology, Melanoma Institute Australia, Sydney, NSW, Australia
  3. Medical Oncology , Royal North Shore Hospital , Sydney , NSW, Australia
  4. Medical Oncology, Princess Alexandra Hospital, Brisbane, QLD, Australia
  5. Medical Oncology , Greenslopes Private Hospital , Brisbane, QLD, Australia
  6. Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
  7. Melanoma Oncology Unit, Veneto Institute of Oncology-IRCCS, Padova, Italy
  8. Oncology, Oslo University Hospital, Oslo, Norway
  9. Dermatology , University Hospital Schleswig-Holstein, Kiel, Germany
  10. Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK
  11. Melanoma and Cancer Immunotherapy, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
  12. Dermatology, University Hospital Essen, Heidelberg, Germany
  13. AP-HP Dermatology, Saint-Louis Hospital, Paris, France
  14. Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
  15. Dermatology, Gustave Roussy and Paris-Saclay Institute, Villejuif, France
  16. Medical Oncology, Centre Eugène Marqui, Rennes, France
  17. Melanoma Medical Oncology, MD Anderson Cancer Centre, Texas, United States of America
  18. Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
  19. Medical Oncology, Fiona Stanley Hospital, Perth, Western Australia, Australia
  20. Medical Oncology, Calvary Mater, Newcastle, New South Wales, Australia
  21. Medical Oncology, Westmead Hospital, Sydney, New South Wales, Australia
  22. Central Clinical School, Monash University, Melbourne , Victoria, Australia


Adjuvant targeted therapy (TT) improves relapse free survival in patients with resected BRAF mutant stage III melanoma. The outcomes and optimal management of patients who relapse after adjuvant TT is unknown.


Patients from twenty-one centres with recurrent melanoma after adjuvant TT were included. Disease characteristics, adjuvant therapy, recurrence, treatment at relapse and outcomes were examined.


Eighty-five patients developed recurrent melanoma; nineteen (22%) during adjuvant TT. Median time to first recurrence was 18 months and median follow up from first recurrence was 31 months. Twenty-nine (34%) patients recurred locoregionally, fifty (59%) patients had distant recurrence and six (7%) patients recurred in both sites concurrently. Of those who recurred locoregionally, twenty-three (23/29, 79%) patients underwent surgery to no evidence of disease and fourteen (14/29, 48%) patients later developed distant disease. Twenty-eight (33%) patients had died at census, all due to melanoma. Fifty-eight (68%) patients received immunotherapy (IT) or TT as 1st line systemic therapy at either first or subsequent recurrence and had disease that was assessable for response. Response to anti-PD-1 therapy (+/- trial agent), combination ipilimumab and nivolumab, TT rechallenge and ipilimumab monotherapy was 63%, 62% 25% and 10% respectively. Twenty-eight (33%) patients had died at census, all from melanoma. Median overall survival (OS) from date of first recurrence for all patients was not reached. OS varied by drug class received as 1st line systemic therapy after relapse. Two-year OS was 84% for anti-PD-1 therapy  (+/- trial agent), 92% for combination ipilimumab and nivolumab, 49% for TT and 45% for ipilimumab monotherapy (p=0.028).


This study demonstrates that patients who relapse after adjuvant TT respond well to subsequent anti-PD-1 therapy and have outcomes similar to those seen when first line anti-PD-1 therapy is used in stage IV melanoma.