Immune checkpoint blockade for metastatic uveal melanoma: patterns of response and survival according to the presence of hepatic and extrahepatic metastasis

  • Background: Since there is no standardized and effective treatment for advanced uveal melanoma (UM), the prognosis is dismal once metastases develop. Due to the availability of immune checkpoint blockade (ICB) in the real-world setting, the prognosis of metastatic UM has improved. However, it is unclear how the presence of hepatic and extrahepatic metastasis impacts the response and survival after ICB. Methods: A total of 178 patients with metastatic UM treated with ICB were included in this analysis. Patients were recruited from German skin cancer centers and the German national skin cancer registry (ADOReg). To investigate the impact of hepatic metastasis, two cohorts were compared: patients with liver metastasis only (cohort A, n = 55) versus those with both liver and extra-hepatic metastasis (cohort B, n = 123). Data were analyzed in both cohorts for response to treatment, progression-free survival (PFS), and overall survival (OS). The survival and progression probabilities were calculated with the Kaplan–Meier method. Log-rank tests, χ2 tests, and t-tests were performed to detect significant differences between both cohorts. Results: The median OS of the overall population was 16 months (95% CI 13.4–23.7) and the median PFS, 2.8 months (95% CI 2.5–3.0). The median OS was longer in cohort B than in cohort A (18.2 vs. 6.1 months; p = 0.071). The best objective response rate to dual ICB was 13.8% and to anti-PD-1 monotherapy 8.9% in the entire population. Patients with liver metastases only had a lower response to dual ICB, yet without significance (cohort A 8.7% vs. cohort B 16.7%; p = 0.45). Adverse events (AE) occurred in 41.6%. Severe AE were observed in 26.3% and evenly distributed between both cohorts. Conclusion: The survival of this large cohort of patients with advanced UM was more favorable than reported in previous benchmark studies. Patients with both hepatic and extrahepatic metastasis showed more favorable survival and higher response to dual ICB than those with hepatic metastasis only.

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Author:Elias Andreas Thomas KochGND, Anne Petzold, Anja WesselyORCiD, Edgar Dippel, Anja Heike Gesierich, Ralf GutzmerORCiDGND, Jessica C. Hassel, Sebastian Haferkamp, Bettina Hohberger, Katharina C. Kähler, Harald Knorr, Nicole Kreuzberg-Brenner, Ulrike Leiter-Stöppke, Carmen LoquaiGND, Friedegund MeierGND, Markus MeissnerORCiDGND, Peter Mohr, Claudia Ursula Pföhler, Farnaz Rahimi, Dirk Schadendorf, Beatrice Schell, Max Simon Schlaak, Patrick Terheyden, Kai-Martin Thoms, Beatrice Schuler-Thurner, Selma Ugurel, Jens Ulrich, Jochen UtikalORCiDGND, Michael Weichenthal, Fabian ZillerORCiDGND, Carola BerkingORCiDGND, Markus V. HepptORCiDGND
Parent Title (English):Cancers
Place of publication:Basel
Document Type:Article
Date of Publication (online):2021/07/04
Date of first Publication:2021/07/04
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Contributing Corporation:German Dermatologic Cooperative Oncology Group (DeCOG)
Release Date:2021/10/20
Tag:CTLA-4; PD-1; immune checkpoint blockade; liver metastasis; treatment resistance; uveal melanoma
Issue:13, art. 3359
Page Number:11
First Page:1
Last Page:11
M.V.H. was supported by the clinician scientist program awarded by the German Society of Dermatology (DDG) and the Arbeitsgemeinschaft Dermatologische Forschung (ADF).
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung 4.0