Efficacy of salvage therapies after failure of adjuvant anti- PD-1 monotherapy for melanoma in Chinese population: A multi-institutional cohort study

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Abstract Background The majority of melanoma patients experienced relapse during the adjuvant therapy or after the end of the therapy. Method A total of sixty-one patients from 3 melanoma centres who recurred having received adjuvant pembrolizumab for resected stage III/IV melanoma were enrolled. Disease characteristics, recurrence characteristics, subsequent management and outcomes were noted. Result A total of sixty-one patients were enrolled in this study. Median time to first relapse from commencement of adjuvant pembrolizumab was 8 months (1–22 months). First recurrences were locoregional alone in 25 (41%), distant alone in 29 (47.5%) and concurrent locoregional and distant relapse in 7 (11.5%). 3 (60%) patients treated with adjuvant pembrolizumab following surgery, 2 (100%) patients treated with adjuvant chemotherapy, 2 (66.7%) patients treated with adjuvant chemotherapy and pembrolizumab combined and 3 (100%) patients treated with adjuvant radiotherapy and pembrolizumab combined had further recurrence. Of three patients treated with adjuvant BRAF/MEKi following first relapse, none have yet recurred. Of 8 patients treated with pembrolizumab alone, only one patient (12.5%) who recurred after ceasing adjuvant PD1 had a partial response. The overall response rate to BRAF/MEKi was 75%, 3/4, to pembrolizumab in combination with an oral multi-targeted receptor tyrosine kinase inhibitor was 22.2%, 2/9, to chemotherapeutic agents alone was 33.3%, 1/3 and to chemotherapeutic agents combined with pembrolizumab was 37.5%, 3/8. The patient treated with imatinib had progressive disease after 3 months of treatment. Of 6 patients who received temozolomide combined with pembrolizumab, 3 (3/6, 50%) had a partial response. The median OS of patients who relapsed locoregionally only was longer than patients who relapsed distally at first recurrence (35 months and 14 months, respectively; P < 0.01). Conclusion Outcomes of patients with disease recurrence during or after completion of 1-year adjuvant anti-PD1 were poor despite multimodality treatment.
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