2019 ASCO Annual Meeting!
Session: Melanoma/Skin Cancers
Type: Oral Abstract Session
Time: Tuesday June 4, 9:45 AM to 12:45 PM
Salvage therapy after failure from anti-PD-1 single agent treatment: A Study by the German ADOReg melanoma registry.
2019 ASCO Annual Meeting
J Clin Oncol 37, 2019 (suppl; abstr 9505)
Author(s): Michael Weichenthal, Selma Ugurel, Ulrike M. Leiter, Imke Satzger, Katharina C. Kähler, Julia Welzel, Claudia Pföhler, Ingrid Feldmann-Böddeker, Friedegund Elke Meier, Patrick Terheyden, Sebastian Haferkamp, Rudolf Herbst, Jens Ulrich, Jochen Utikal, Alexander Kreuter, Ralf Gutzmer, Dirk Schadendorf, Peter Mohr; University Department of Dermatology, Kiel, Germany; Department of Dermatology, University Hospital Erlangen and Department of Dermatology, University of Würzburg, Essen, Germany; Department of Dermatooncology, University of Tübingen, Tuebingen, Germany; Hannover Medical School, Hannover, Germany; Universitats-Hautklinik Kiel, Kiel, Germany; Klinikum Augsburg, Augsburg, Germany; Department of Dermatology, Saarland University Medical Center, Homburg/Saar, Germany; DRK Hospital Chemnitz-Rabenstein, Chemnitz, Germany; Department of Dermatology, University Hospital Dresden, Dresden, Germany; Department of Dermatology University of Lübeck, Lübeck, Germany; Department of Dermatology, University Hospital Regensburg, Regensburg, Germany; HELIOS Hauttumorzentrum Erfurt, Erfurt, Germany; Medical Center Quedlinburg, Quedlinburg, Germany; Skin Cancer Unit, German Cancer Research Center (DKFZ), and Department of Dermatology, Venerology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany; HELIOS St. Elisabeth Hospital Oberhausen, University Witten/Herdecke, Oberhausen, Germany; Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany; Universitaetsklinikum Essen & German Cancer Consortium, Essen, Germany; Elbe Kliniken Buxtehude, Buxtehude, Germany
Background: In melanoma, potential benefits of therapies after PD-1 inhibitor failure, including those BRAF positive patients who have already received combined BRAF-/MEK inhibitors before anti PD-1 are poorly defined. We therefore analyzed the treatment patterns and outcome of systemic therapies for patients after anti-PD-1 failure. Methods: From the ADOReg registry, patients fulfilling the following inclusion criteria were consecutively included until a number of 200 cases was reached. 1) Ipilimumab naive patients with unresectable metastatic cutaneous or mucosal melanoma. 2) Failure from treatment with a single agent anti PD-1 antibody. 3) Known BRAF status and, in case of BRAF-V600 mutation, BRAF-/MEK-inhibitor treatment prior to anti PD-1 treatment. 4) Consecutive systemic treatment started within a maximum of 6 months after anti PD-1 failure. Objectives: Rate of objective remissions (ORR), disease control (DCR), survival (OS), tolerability and disease patterns correlated to the use of different treatments after PD-1 treatment failure in real-life conditions in Germany. Results: In total 23.5 % of the patients received ipilimumab single agent, 38.5 % received the combination of ipilimumab and nivolumab (Ipi/Nivo), and the remaining various regimens. (Table) Ipi/Nivo resulted in an ORR significantly higher than for Ipi alone (p=0.02). In 18 patients receiving BRAF-/MEK inhibitor re-challenge, ORR was comparable to Ipi/Nivo. Conventional Chemotherapy was still in frequent use (dacarbazine n =33; other n=17), but response rates were low (ORR 6%). Some remission were also achieved by use of talimogene laherparepvec (n=2 out of 4). Conclusions: Treatment patterns of patients after anti-PD-1 failure differ remarkably. Although lower than reported in treatment naive patients, the combination of Ipilimumab and Nivolumab appeared favorable as compared to all other regimens, except for BRAF-/MEK inhibitor re-challenge which produced similar remission rates. Still, chemotherapies including dacarbazine are in clinical practice, though giving only poor outcome.
|Median age [years]||71.0||61.0||68.5||73.0||68.0|
|Objective remissions||2 (4.2%)||15 (19.5%)||4 (22.2%)||7 (12.1%)||28 (14.0%)|
|Disease control rate||9 (17.0%)||34 (44.2%)||7 (38.9%)||14 (24.2%)||64 (32.0%)|