Long-Term Survival in Patients With Advanced Melanoma

Olivier J van Not ^1,2, Alfons J M van den Eertwegh ³, Hilde Jalving ⁴

¹Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, the Netherlands.
²Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
³Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, the Netherlands.
⁴Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
⁵Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
⁶Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
⁷Department of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
⁸Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands.
⁹Department of Medical Oncology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands.
¹⁰Department of Medical Oncology, Zuyderland Medical Center Sittard, Sittard-Geleen, the Netherlands.
¹¹Department of Medical Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
¹²Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.
¹³Isala Oncology Center, Isala, Zwolle, the Netherlands.
¹⁴Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
¹⁵Department of Health Technology Assessment, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
¹⁶Erasmus Center for Health Economics Rotterdam, Erasmus University Rotterdam, Rotterdam, the Netherlands.
¹⁷Department of Internal Medicine, Medisch Spectrum Twente, Enschede, the Netherlands.
¹⁸Department of Internal Medicine, Amphia Hospital, Breda, the Netherlands.
¹⁹Department of Medical Oncology and Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.
²⁰Department of Internal Medicine, Maxima Medical Center, Eindhoven, the Netherlands.
²¹Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.

⁰Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, the Netherlands.

Jama Network Open +

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August 14, 2024

View abstract on PubMed

Summary

Immune checkpoint inhibitors (ICIs) show long-term survival benefits for advanced melanoma patients in real-world settings, similar to clinical trials. These findings support guiding surveillance and informing patients about treatment outcomes.

Area Of Science

Oncology
Immunotherapy
Clinical Research

Background

Long-term survival curves for advanced melanoma patients treated with immune checkpoint inhibitors (ICIs) in clinical trials suggest a plateau, indicating potential for durable responses.
Real-world data are crucial to validate these findings outside controlled trial environments.

Purpose Of The Study

To evaluate long-term survival outcomes in patients with advanced melanoma receiving first-line ICIs in a real-world clinical setting.
To identify factors influencing progression-free survival (PFS) after achieving partial or complete response.

Main Methods

A nationwide cohort study utilized prospectively collected data from the Dutch Melanoma Treatment Registry (2012-2019).
Analysis included 2490 patients treated with first-line ipilimumab-nivolumab, anti-PD-1 antibodies, or ipilimumab.
Progression-free survival and melanoma-specific survival were analyzed using Cox proportional hazards models.

Main Results

Five-year overall survival was 35.9% (95% CI, 33.9%-38.0%) and 5-year progression-free survival was 19.7% (95% CI, 18.0%-21.4%).
Survival plateaus were observed, comparable to clinical trial data.
Patients with metastases in three or more organ sites had a higher risk of progression after response (aHR, 1.37; 95% CI, 1.11-1.69).

Conclusions

Real-world data confirm that immune checkpoint inhibitors lead to long-term survival plateaus in advanced melanoma patients.
Findings support the use of these results in clinical practice for surveillance strategies and patient counseling.
The study highlights the sustained efficacy of ICIs in managing advanced melanoma beyond clinical trial populations.

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