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Timing of Adjuvant Immunotherapy in Stage III Melanoma, Does it Matter?

Publication ,  Journal Article
Rhodin, KE; Jung, S-H; Elleson, K; DePalo, D; Straker, R; McKinley, S; Beekman, K; Parker, L; Chen, S; Iyer, MK; Salama, AKS; Bartlett, E ...
Published in: Ann Surg Oncol
October 2023

BACKGROUND: The optimal time to initiate adjuvant immune checkpoint inhibitors (ICI) following resection remains undefined. Herein, we investigated the impact of time to adjuvant ICI on survival in patients with stage III melanoma. METHODS: Patients with resected stage III melanoma receiving adjuvant immune therapy were identified within a multi-institutional retrospective cohort. Patients were stratified by time to adjuvant ICI: within 6 weeks, 6-12 weeks, and greater than 12 weeks from surgery. Recurrence-free survival (RFS) was compared among time strata with Kaplan-Meier and Cox proportional hazards methods in the multi-institutional cohort. RESULTS: Altogether, 626 patients were identified within the multi-institutional cohort: 39% of patients initiated adjuvant ICI within 6 weeks, 42.2% within 6-12 weeks, and 18.8% greater than 12 weeks from surgery. In a multivariate Cox model, adjusting for histology, nodal tumor burden, and pathologic stage, we found that increased time to adjuvant ICI was associated with improved RFS. Patients who initiated adjuvant ICI within 6 weeks of surgery had worse RFS. These findings were preserved in a conditional landmark analysis and separate subgroups of patients with (1) new melanoma diagnoses, (2) occult stage III disease, and (3) those receiving anti-PD-1 monotherapy. CONCLUSIONS: Outcomes for patients with stage III melanoma are not compromised when adjuvant ICI is initiated beyond 6 weeks from resection. Additional work is needed to better understand the underlying mechanisms and implications of timing of adjuvant ICI on long-term outcomes.

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Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

October 2023

Volume

30

Issue

11

Start / End Page

6340 / 6352

Location

United States

Related Subject Headings

  • Skin Neoplasms
  • Retrospective Studies
  • Oncology & Carcinogenesis
  • Melanoma, Cutaneous Malignant
  • Melanoma
  • Immunotherapy
  • Humans
  • 3211 Oncology and carcinogenesis
  • 1112 Oncology and Carcinogenesis
 

Citation

APA
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Rhodin, K. E., Jung, S.-H., Elleson, K., DePalo, D., Straker, R., McKinley, S., … Beasley, G. M. (2023). Timing of Adjuvant Immunotherapy in Stage III Melanoma, Does it Matter? Ann Surg Oncol, 30(11), 6340–6352. https://doi.org/10.1245/s10434-023-13935-0
Rhodin, Kristen E., Sin-Ho Jung, Kelly Elleson, Danielle DePalo, Richard Straker, Sophia McKinley, Kate Beekman, et al. “Timing of Adjuvant Immunotherapy in Stage III Melanoma, Does it Matter?Ann Surg Oncol 30, no. 11 (October 2023): 6340–52. https://doi.org/10.1245/s10434-023-13935-0.
Rhodin KE, Jung S-H, Elleson K, DePalo D, Straker R, McKinley S, et al. Timing of Adjuvant Immunotherapy in Stage III Melanoma, Does it Matter? Ann Surg Oncol. 2023 Oct;30(11):6340–52.
Rhodin, Kristen E., et al. “Timing of Adjuvant Immunotherapy in Stage III Melanoma, Does it Matter?Ann Surg Oncol, vol. 30, no. 11, Oct. 2023, pp. 6340–52. Pubmed, doi:10.1245/s10434-023-13935-0.
Rhodin KE, Jung S-H, Elleson K, DePalo D, Straker R, McKinley S, Beekman K, Parker L, Chen S, Iyer MK, Salama AKS, Bartlett E, Karakousis G, Zager JS, Tyler DS, Beasley GM. Timing of Adjuvant Immunotherapy in Stage III Melanoma, Does it Matter? Ann Surg Oncol. 2023 Oct;30(11):6340–6352.
Journal cover image

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

October 2023

Volume

30

Issue

11

Start / End Page

6340 / 6352

Location

United States

Related Subject Headings

  • Skin Neoplasms
  • Retrospective Studies
  • Oncology & Carcinogenesis
  • Melanoma, Cutaneous Malignant
  • Melanoma
  • Immunotherapy
  • Humans
  • 3211 Oncology and carcinogenesis
  • 1112 Oncology and Carcinogenesis