C. Puza1, P. Mosca1, A. K. Salama2, H. Howard3, D. Agnese3, A. Terando3, D. G. Blazer1, R. Scheri1, G. Beasley1 1Duke University,Department Of Surgery,Durham, NC, USA 2Duke University,Division Of Medical Oncology,Durham, NC, USA 3Ohio State University,Division Of Surgical Oncology,Columbus, OH, USA
Introduction: The emergence of novel ICI has resulted in dramatic improvements in survival for patients with metastatic melanoma. Relative to traditional chemotherapy, the types of disease response patterns to ICI therapy can be more complex, including mixed responses and pseudoprogression. Specifically, some lesions may regress while new lesions appear, or tumors may remain stable in size for long periods of time. As the role of surgery in these scenarios is continuing to evolve, the purpose of this study was to explore outcomes associated with surgery following ICI therapy.
Methods: A retrospective study was conducted at two centers and included patients with melanoma who underwent surgery following treatment with monotherapy or combination therapy with anti-PD-1 and/or anti CTLA-4 checkpoint blockade. Data collected included: treatment regimen, toxicities, operative reports, pathology, and clinical plus radiographic follow-up.
Results: Of 17 identified patients, 7 patients had received anti-CTLA-4 therapy, 4 anti-PD-1 therapy, and 6 anti-CTLA-4 therapy plus anti-PD-1 therapy before surgery. Five patients were being treated in the adjuvant setting and developed new lesions while 12 patients were being treated for metastatic disease and underwent surgery for persistent disease on imaging. Seventeen patients underwent 18 operations including: 4 small bowel resections, 2 splenectomies, 4 wide local excisions, 4 groin dissections, 1 craniectomy, 1 mesenteric mass resection, 1 axillary dissection, and 1 lung nodule resection. There were no major reported complications from surgery. Seventeen of 18 masses were confirmed to be persistent melanoma on surgical pathology while 1 was a desmoid tumor. At median follow up of 10-months, 1 patient has died, 8 are alive with known disease, and 8 continue to have no further evidence of disease since the time of surgery.
Conclusion: In this small group of patients receiving ICI therapy for melanoma, surgery was well tolerated. Surgery may benefit select patients with mixed responses to ICI therapy. Indications for surgery in this population warrant further exploration.