385P - The search for viable biochemical and clinical prognostic markers for patients with inoperable melanoma being treated with Anti CTLA-4 therapy (385P)

Date 18 November 2017
Event ESMO Asia 2017 Congress
Session Poster lunch
Topics Immunotherapy
Skin cancers
Translational Research
Melanoma
Basic Principles in the Management and Treatment (of cancer)
Therapy
Presenter Jason Chow
Citation Annals of Oncology (2017) 28 (suppl_10): x113-x116. 10.1093/annonc/mdx667
Authors J. Chow1, D. Alrifai1, A. Shields2, R. Kandassamy2, B. Tan2
  • 1Medical Oncology, Guy's and St. Thomas' Hospital NHS Trust, SE1 9RT - London/GB
  • 2Medical Oncology, St Georges Hospital, SW17 0QT - QT/GB

Abstract

Background

There is an unmet need for the identification of prognostic markers in metastatic melanoma. Response rates for immunotherapies, though potentially durable are low with a risk of significant morbidity due to treatment toxicity. Being able to identify which patients may derive clinical benefit and develop a durable response with immunotherapy is important for treatment planning and patient counselling. Several publications have reported performance status, lactate dehydrogenase and white cell counts as being significantly associated with clinical outcome after treatment with immunotherapies.

Methods

This retrospective dual centre study evaluated “real world” data of 86 patients who were treated with ipilimumab. Data was collected on patient baseline characteristics such as performance status and number of sites of metastasis (number of organs involved- NOI). Baseline laboratory data was collected such as total white cell count, neutrophil/lymphocyte ratio (NLR) and lactate dehydrogenase (LDH). The values of NLR were dichotomised between ≤3.1 and >3.1 (where 3.1 was the median). LDH was dichotomised to normal or high (with the cut off value being 250 U/L). Statistical calculations were carried out using Kaplan Meir and Cox Regression analysis.

Results

86 patients were included in the analysis. Median progression free survival was 1.97 months. 6 month survival being at 31.4% and 1 year survival at 10.5%. A performance status of zero, low NOI, absence of bone metastasis, low/normal LDH and low NLR (of less than 3.1) were significantly associated with a longer PFS on univariate analysis. Using multivariate analysis, a significant association was found between PFS and three of the above factors: performance status (HR 1.809 95% CI 1.250-2.617), NOI (1.489 95% CI 1.220-1.817) and NLR (HR 2.734 95% CI 1.626-4.597).

Conclusions

A good performance status, low NOI and low NLR were all found to be significantly associated with a prolonged PFS in patients with metastatic melanoma treated with ipilimumab. These results should be further validated in prospective randomised control trials in patients with inoperable melanoma treated with immunotherapy.

Clinical trial identification

Legal entity responsible for the study

Guys & St Thomas NHS Trust

Funding

None

Disclosure

All authors have declared no conflicts of interest.