The risk of locoregional and distance recurrence of cutaneous melanoma in stage IIB/IIC is high and there is limited evidence on the clinical benefit of adjuvant immunotherapy.
Between March 18th and 19th, SSO 2021 (International Conference on Surgical Cancer Care) took place in virtual format. During this event, a large retrospective cohort trial using the National Cancer Database (NCDB) was presented to evaluate 10,592 patients with cutaneous melanoma in stage IIB/IIC who underwent resection between 2013-2017. In total, 419 (4.0%) patients received adjuvant immunotherapy.
Female patients or patients aged between 40 and 65 years were more likely to receive adjuvant immunotherapy than male patients or older than 65 years (OR = 1.34; OR = 2.89; respectively; P< 0.05). Patients with pT4b disease or positive surgical margins were more likely to receive adjuvant immunotherapy than patients with pT3b disease or negative margins (OR = 2.81; OR = 3.13; respectively; P< 0.001).
Patients who received adjuvant immunotherapy showed significant improvement in 3-year overall survival compared to those who did not receive adjuvant immunotherapy (82.7% versus 71.6%, P< 0.001). The Cox proportional hazard model also demonstrated that adjuvant immunotherapy was associated with better survival (HR = 0.66; P<0.002).
Survival disadvantages were observed in patients with government-issued insurance (HR = 1.5) and among those receiving cancer care in community hospitals (HR = 1.46) compared to patients who have private insurance or receive care in academic/research hospitals (P< 0.05).
The authors conclude that this is the first retrospective trial to assess the benefit of adjuvant immunotherapy in terms of survival in patients with high-risk stage II melanoma.