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Adjuvant treatment of in-transit melanoma: Narrowing the knowledge gap left by clinical trials

Melissa M de Meza1,2,3, Willeke A M Blokx4, Han J Bonenkamp5

  • 1Dutch Institute for Clinical Auditing, Leiden, The Netherlands.

International Journal of Cancer
|February 27, 2023
PubMed

Insights

Adjuvant systemic therapy for in-transit melanoma (ITM) shows promising results. Patients with ITM only have similar recurrence-free survival to those with nodal disease only, and better overall survival than those with both ITM and nodal disease.

Area of Science:

  • Oncology
  • Dermatology
  • Clinical Trials

Background:

  • Adjuvant systemic treatment efficacy for in-transit melanoma (ITM) is understudied.
  • Real-world data on adjuvant systemic therapy for ITM patients is limited.
  • Understanding outcomes for ITM patients in the adjuvant setting is crucial for treatment optimization.

Purpose of the Study:

  • To describe adjuvant systemic therapy outcomes for in-transit melanoma (ITM) patients outside of clinical trials.
  • To compare recurrence patterns, recurrence-free survival (RFS), and overall survival (OS) among stage III melanoma patients with nodal disease only, ITM only, and combined ITM and nodal disease.
  • To provide insights into the real-world effectiveness of adjuvant systemic treatments for ITM.

Main Methods:

  • Retrospective analysis of stage III adjuvant-treated melanoma patients from the Dutch Melanoma Treatment Registry (July 2018 - December 2020).
  • Patients categorized into three groups: nodal disease only, ITM only, and ITM with nodal disease.
  • Analysis of recurrence patterns, 12-month recurrence-free survival (RFS), and 12-month overall survival (OS).

Main Results:

  • In a cohort of 1037 patients, 16.7% had ITM only and 16.2% had ITM with nodal disease.
  • 12-month RFS was comparable between nodal only (72.2%) and ITM only (70.1%) groups, but lower in ITM and nodal disease patients (57.8%).
  • ITM-only patients had significantly less distant recurrence (18.8%) and superior 12-month OS (97.6%) compared to ITM and nodal disease patients (36.0% distant recurrence, 91.0% OS).

Conclusions:

  • Adjuvant-treated in-transit melanoma (ITM) patients with ITM only demonstrate recurrence-free survival rates similar to non-ITM nodal disease patients.
  • ITM-only patients exhibit better overall survival and a lower rate of distant recurrence compared to patients with both ITM and nodal disease.
  • These findings support the evaluation of adjuvant systemic therapies in ITM patients, highlighting distinct prognostic implications based on disease extent.
Keywords:
adjuvant treatmentcheckpoint inhibition therapyimmunotherapyin-transit melanomamelanoma

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