An observational study of 10,592 patients from the National Cancer Database with stage IIB/IIC melanoma who had undergone surgical resection demonstrated a significant survival advantage with immunotherapy. The research was presented by Wong et al at the Society of Surgical Oncology 2021 International Conference on Surgical Cancer Care (Poster 58).
The risk of locoregional and distant recurrence of stage IIB/IIC cutaneous melanoma is high, and limited evidence exists on the clinical benefit of adjuvant immunotherapy. This is the first retrospective study to evaluate the utilization patterns and survival benefit of adjuvant immunotherapy for high-risk stage II melanoma.
Database Analysis
Researchers examined information on 10,592 patients from the National Cancer Database with IIB/IIC melanoma who had undergone surgical resection between 2013 and 2017. Out of the nearly 10,600 patients, 419 (4.0%) received adjuvant immunotherapy.
Female patients or patients aged 40 to 65 were more likely to receive adjuvant immunotherapy than male patients or those over age 65 (odds ratio [OR] = 1.34, OR = 2.89, respectively, P < .05). Patients with pT4b disease or positive surgical margins were more likely to receive adjuvant immunotherapy than patients with pT3b disease or negative margins (OR = 2.81, OR = 3.13, respectively, P < .001).
Patients who received adjuvant immunotherapy showed significant improvement in 3-year overall survival compared to those who did not receive adjuvant immunotherapy (82.7% vs 71.6%, P < .001). The Cox proportional hazard model also demonstrated that receipt of adjuvant immunotherapy was associated with better survival (hazard ratio [HR] = 0.66, P < .002). Survival disadvantages were noted in patients with government-issued insurance (HR = 1.5) and among those receiving care in community cancer hospitals (HR = 1.46) compared to patients with private insurance and receiving care in academic/research hospitals (all P < .05).
“This large observational study demonstrates a significant survival advantage with immunotherapy, which should be considered for the postoperative treatment of stage IIB/IIC melanoma. In addition, socioeconomic differences in the care of patients with high-risk stage II melanoma warrant further attention,” reported the research team.
