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. 2020 Oct 26;12(11):3131.
doi: 10.3390/cancers12113131.

Multimodal Treatment of Advanced Mucosal Melanoma in the Era of Modern Immunotherapy

Pawel Teterycz  1 , Anna M Czarnecka  1 , Alice Indini  2 , Mateusz J Spałek  1 , Alice Labianca  2 , Pawel Rogala  1 , Bożena Cybulska-Stopa  3 , Pietro Quaglino  4 , Umberto Ricardi  5 , Serena Badellino  6 , Anna Szumera-Ciećkiewicz  7   8 , Slawomir Falkowski  1 , Mario Mandala  2 , Piotr Rutkowski  1
Affiliations

Multimodal Treatment of Advanced Mucosal Melanoma in the Era of Modern Immunotherapy

Pawel Teterycz et al. Cancers (Basel). .

Abstract

Mucosal melanoma is a rare disease epidemiologically and molecularly distinct from cutaneous melanoma developing from melanocytes located in mucosal membranes. Little is known about its therapy. In this paper, we aimed to evaluate the results of immunotherapy and radiotherapy in a group of patients with advanced mucosal melanoma, based on the experience of five high-volume centers in Poland and Italy. There were 82 patients (53 female, 29 male) included in this retrospective study. The median age in this group was 67.5 (IQR: 57.25-75.75). All patients received anti-PD1 or anti-CTLA4 antibodies in the first or second line of treatment. Twenty-three patients received radiotherapy during anti-PD1 treatment. In the first-line treatment, the median progression-free survival (PFS) reached six months in the anti-PD1 group, which was statistically better than 3.1 months in the other modalities group (p = 0.004). The median overall survival (OS) was 16.3 months (CI: 12.1-22.3) in the whole cohort. Patients who received radiotherapy (RT) during the anti-PD1 treatment had a median PFS of 8.9 months (CI: 7.4-NA), whereas patients treated with single-modality anti-PD1 therapy had a median PFS of 4.2 months (CI: 3.0-7.8); this difference was statistically significant (p = 0.047). Anti-PD1 antibodies are an effective treatment option in advanced mucosal melanoma (MM). The addition of RT may have been beneficial in the selected subgroup of mucosal melanoma patients.

Keywords: ipilimumab; mucosal melanoma; nivolumab; pembrolizumab; radiotherapy.

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Conflict of interest statement

Pawel Teterycz travel, accommodations, expenses—Bristol-Myers Squibb, MSD, Novartis, Roche. Anna Malgorzata Czarnecka Speakers’ Bureau—Bristol-Myers Squibb, Pierre Fabre. Research Funding—Bristol-Myers Squibb; Travel, Accommodations, Expenses—Bristol-Myers Squibb, MSD, Novartis, Pierre Fabre, Roche. Pawel Rogala Travel, Accommodations, Expenses—Bristol-Myers Squibb, MSD, Novartis, Roche. Mario Mandala: Consulting or Advisory Role—Bristol-Myers Squibb, MSD Brazil, Pierre Fabre, Roche; Research Funding—Bristol-Myers Squibb, Novartis pharma SAS; Roche. Pietro Quaglino is on the advisory board of Novartis, BMS, MSD, and Pierre Fabre and received fees for lectures from Novartis, BMS, MSD, and Pierre Fabre. Piotr Rutkowski has received honoraria for lectures and Advisory Boards from BMS, MSD, Novartis, Roche, Pierre Fabre, Amgen, Merck, Sanofi, Blueprint Medicines outside of the scope of the study. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. Mateusz Spalek, Sławomir Falkowski, Alice Indini, Umberto Ricardi, Serena Badellino, Anna Szumera-Ciećkiewicz, Alice Labiance declare no conflict of interest.

Figures

Figure 1
Figure 1
Swimmer plot for the duration of response to the anti-PD1 immunotherapy. Each bar represents a case; arrows represent an ongoing response. LDH level = lactic dehydrogenase activity at the start of treatment. overULN = over upper limit normal. RTH intent = intention of radiotherapy. Oligo = radiotherapy due to oligometastatic/oligoprogressive disease. Radiotherapy after progressive disease according to Response Evaluation Criteria in Solid Tumours (RECIST) 1.1 is not shown.
Figure 2
Figure 2
Progression-free survival (A) and overall survival (B) in mucosal melanoma patients in subgroups treated with anti-PD1 therapy (red curve) or other modality (blue curve) in first-line.
Figure 3
Figure 3
Progression-free survival (A) and overall survival (B) since the start of anti-PD1 therapy according to radiotherapy use.
See this image and copyright information in PMC

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