Long-Term Survival in Patients With Advanced Melanoma.

Autor:	van Not OJ; Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, the Netherlands.; Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands., van den Eertwegh AJM; Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, the Netherlands., Jalving H; Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands., Bloem M; Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, the Netherlands.; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.; Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands., Haanen JB; Department of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands., van Rijn RS; Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands., Aarts MJB; Department of Medical Oncology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands., van den Berkmortel FWPJ; Department of Medical Oncology, Zuyderland Medical Center Sittard, Sittard-Geleen, the Netherlands., Blank CU; Department of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands.; Department of Medical Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands., Boers-Sonderen MJ; Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands., de Groot J W B JW; Isala Oncology Center, Isala, Zwolle, the Netherlands., Hospers GAP; Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands., Kapiteijn E; Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands., Leeneman B; Department of Health Technology Assessment, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.; Erasmus Center for Health Economics Rotterdam, Erasmus University Rotterdam, Rotterdam, the Netherlands., D P; Department of Internal Medicine, Medisch Spectrum Twente, Enschede, the Netherlands., Stevense-den Boer M; Department of Internal Medicine, Amphia Hospital, Breda, the Netherlands., van der Veldt AAM; Department of Medical Oncology and Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands., Vreugdenhil G G; Department of Internal Medicine, Maxima Medical Center, Eindhoven, the Netherlands., Wouters MWJM; Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, the Netherlands.; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.; Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands., Blokx WAM; Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands., Suijkerbuijk KPM; Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2024 Aug 01; Vol. 7 (8), pp. e2426641. Date of Electronic Publication: 2024 Aug 01.
DOI:	10.1001/jamanetworkopen.2024.26641
Abstrakt:	Importance: Long-term survival data from clinical trials show that survival curves of patients with advanced melanoma treated with immune checkpoint inhibitors (ICIs) gradually reach a plateau, suggesting that patients have a chance of achieving long-term survival. Objective: To investigate long-term survival in patients with advanced melanoma treated with ICIs outside clinical trials. Design, Setting, and Participants: Cohort study using prospectively collected data from the nationwide Dutch Melanoma Treatment Registry, including patients in the Netherlands with advanced melanoma treated with first-line ICIs from 2012 to 2019. Data were analyzed from January to September 2023. Exposures: Patients were treated with first-line ipilimumab-nivolumab, antibodies that target programmed cell death (anti-PD-1), or ipilimumab. Main Outcomes and Measures: Progression-free survival (PFS) and melanoma-specific survival were analyzed, and a Cox proportional hazards model was used to investigate factors associated with PFS after reaching partial response (PR) or complete response (CR). Results: A total of 2490 patients treated with first-line ICIs were included (median [IQR] age, 65.0 [55.3-73.0] years; 1561 male patients [62.7%]). Most patients had an Eastern Cooperative Oncology Group Performance Status of 1 or lower (2202 patients [88.5%]) and normal lactate dehydrogenase levels (1715 patients [68.9%]). PFS for all patients was 23.4% (95% CI, 21.7%-25.2%) after 3 years and 19.7% (95% CI, 18.0%-21.4%) after 5 years. Overall survival for all patients was 44.0% (95% CI, 42.1%-46.1%) after 3 years and 35.9% (95% CI, 33.9%-38.0%) after 5 years. Patients with metastases in 3 or more organ sites had a significantly higher hazard of progression after reaching PR or CR (adjusted hazard ratio, 1.37; 95% CI, 1.11-1.69). Conclusions and Relevance: This cohort study of patients with advanced melanoma treated with ICIs in clinical practice showed that their survival reached a plateau, comparable with patients participating in clinical trials. These findings can be used in daily clinical practice to guide long-term surveillance strategies and inform both physicians and patients regarding long-term treatment outcomes.
Databáze:	MEDLINE
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