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The Emerging Role of Surgery for Patients With Advanced Melanoma Treated With Immunotherapy.

Publication ,  Journal Article
Puza, CJ; Bressler, ES; Terando, AM; Howard, JH; Brown, MC; Hanks, B; Salama, AKS; Beasley, GM
Published in: J Surg Res
April 2019

BACKGROUND: The emergence of immune checkpoint inhibitors (ICIs) has improved survival for patients with metastatic melanoma. The types of disease-response patterns to ICI therapy can be more complex relative to traditional chemotherapy and include mixed responses, pseudoprogression, and oligoprogression. The potential benefit of surgery after incomplete response to ICI therapy has not been explored. The purpose of this study was to explore outcomes of surgery after ICI therapy in patients with metastatic melanoma. METHODS: A retrospective study was conducted at two centers and included patients with melanoma who underwent surgery after treatment with monotherapy or combination therapy with anti-programmed cell death protein (PD) 1 and/or anti-cytotoxic T-lymphocyte associated protein (CTLA)-4 checkpoint blockade. RESULTS: Of 25 patients, nine received anti-CTLA-4 therapy, eight received anti-PD-1 therapy, and eight received both anti-CTLA-4 and anti-PD-1 therapies before surgery. Five patients were treated in the adjuvant setting and developed new lesions, whereas 20 patients were treated for metastatic disease and underwent surgery for persistent disease on imaging after ICI therapy. Twenty-five patients underwent 30 operations without complications. Twenty-seven of 30 masses were confirmed to be melanoma on pathology, one was a desmoid tumor and two were necrosis. At a median follow-up of 14.2 months, 2 patients died, 8 were alive with a known disease, and 15 continued to have no further evidence of disease. CONCLUSIONS: Surgery was well tolerated in this cohort of patients receiving ICI therapy for melanoma. Surgery may benefit select patients with an oligoprogressive disease after ICI therapy. After a mixed response, surgery remains the only definitive method to render some patients free of disease.

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Published In

J Surg Res

DOI

EISSN

1095-8673

Publication Date

April 2019

Volume

236

Start / End Page

209 / 215

Location

United States

Related Subject Headings

  • Survival Analysis
  • Surgical Procedures, Operative
  • Surgery
  • Skin Neoplasms
  • Skin
  • Retrospective Studies
  • Progression-Free Survival
  • Programmed Cell Death 1 Receptor
  • Neoplasm Staging
  • Neoadjuvant Therapy
 

Citation

APA
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MLA
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Puza, C. J., Bressler, E. S., Terando, A. M., Howard, J. H., Brown, M. C., Hanks, B., … Beasley, G. M. (2019). The Emerging Role of Surgery for Patients With Advanced Melanoma Treated With Immunotherapy. J Surg Res, 236, 209–215. https://doi.org/10.1016/j.jss.2018.11.045
Puza, Charles J., Elizabeth Schell Bressler, Alicia M. Terando, John Harrison Howard, Michael C. Brown, Brent Hanks, April K. S. Salama, and Georgia M. Beasley. “The Emerging Role of Surgery for Patients With Advanced Melanoma Treated With Immunotherapy.J Surg Res 236 (April 2019): 209–15. https://doi.org/10.1016/j.jss.2018.11.045.
Puza CJ, Bressler ES, Terando AM, Howard JH, Brown MC, Hanks B, et al. The Emerging Role of Surgery for Patients With Advanced Melanoma Treated With Immunotherapy. J Surg Res. 2019 Apr;236:209–15.
Puza, Charles J., et al. “The Emerging Role of Surgery for Patients With Advanced Melanoma Treated With Immunotherapy.J Surg Res, vol. 236, Apr. 2019, pp. 209–15. Pubmed, doi:10.1016/j.jss.2018.11.045.
Puza CJ, Bressler ES, Terando AM, Howard JH, Brown MC, Hanks B, Salama AKS, Beasley GM. The Emerging Role of Surgery for Patients With Advanced Melanoma Treated With Immunotherapy. J Surg Res. 2019 Apr;236:209–215.
Journal cover image

Published In

J Surg Res

DOI

EISSN

1095-8673

Publication Date

April 2019

Volume

236

Start / End Page

209 / 215

Location

United States

Related Subject Headings

  • Survival Analysis
  • Surgical Procedures, Operative
  • Surgery
  • Skin Neoplasms
  • Skin
  • Retrospective Studies
  • Progression-Free Survival
  • Programmed Cell Death 1 Receptor
  • Neoplasm Staging
  • Neoadjuvant Therapy