Abstract 859P
Background
Patients diagnosed with hematologic malignancies (HM) have a higher risk of developing subsequent solid tumors, such as melanoma. Patients with HM were mostly excluded from clinical trials but could derive less benefit from immune checkpoint inhibition due to disease or treatment-related T- or B-cell dysfunction.
Methods
All advanced stage IIIc and IV melanoma patients treated with anti-PD-1 or ipilimumab-nivolumab between 2015 and 2021 were included from the prospective nationwide Dutch Melanoma Treatment Registry. Progression-free survival (PFS), overall survival (OS), and melanoma-specific survival (MSS) were analyzed for patients with HM (HM+) and without HM (HM-). A cox model was used to account for confounders associated with PFS and OS.
Results
Fifty-seven HM+ patients and 2506 HM- patients were included. Twenty-two patients were diagnosed with leukemia, 26 with malignant lymphoma, three with multiple myeloma, and six had a different type of HM. Forty-four percent received curative treatment for their HM. In the anti-PD-1 cohort, median PFS was 2.8 months for HM+ and 9.9 months for HM- (p=0.01). MSS was 41.2 months for HM+ and 58.1 months for HM- (p=0.00086). In multivariable analysis, the presence of a HM was significantly associated with a higher risk of melanoma progression (HRadj 1.68; 95%CI 1.24-2.29; p<0.001) and death (HRadj 1.76; 95%CI 1.25-2.47; p<0.001). Median PFS, OS, and MSS for anti-PD-1 and ipilimumab-nivolumab can be seen in the table. Table: 859P
Median progression-free survival, overall survival, and melanoma-specific survival in months, stratified by hematologic malignancy and treatment type
| Median PFS in months (95% CI) | Median OS in months (95% CI) | Median MSS in months (95% CI) | |
| Anti-PD-1 and HM+ (n=46) | 2.8 (2.6-7.3) | 12.8 (6.2-NR) | 41.2 (12.8-NR) |
| Anti-PD-1 and HM (n=1717) | 9.9 (8.6-11.8) | 31.0 (28.5-35.0) | 58.1 (47.5-NR) |
| Ipilimumab-nivolumab and HM+ (n=11) | 2.3 (2.0-NR) | 4.6 (2.4-NR) | 4.6 (2.4-NR) |
| Ipilimumab-nivolumab and HM- (n=789) | 6.9 (5.5-9.2) | 31.7 (22.1-39.0) | 46.1 (33.4-NR) |
Conclusions
Patients with hematologic malignancy and advanced melanoma show significantly worse melanoma-related survival than patients with advanced melanoma alone. Larger numbers of patients are needed to look into the different subtypes of HM.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
For the Dutch Melanoma Treatment Registry (DMTR), the Dutch Institute for Clinical Auditing foundation received a start-up grant from governmental organization The Netherlands Organization for Health Research and Development (ZonMW, project number 836002002). The DMTR is structurally funded by Bristol Myers Squibb, Merck Sharpe & Dohme, Novartis, and Roche Pharma. Roche Pharma stopped funding in 2019, and Pierre Fabre started funding the DMTR in 2019. For this work, no funding was granted.
Disclosure
F. Van Den Eertwegh: Non-Financial Interests, Advisory Role: Amgen, BMS, Roche, Novartis, MSD, Pierre Fabre, Sanofi, Pfizer, Ipsen, Merck; Non-Financial Interests, Research Grant: Sanofi, Roche, BMS, Idera, TEVA; Non-Financial Interests, Other, travel expenses: MSD Oncology, Roche, Pfizer, Sanofi; Non-Financial Interests, Invited Speaker: BMS, Novartis. J.B.A.G. Haanen: Non-Financial Interests, Advisory Role: Aimm, Achilles Therapeutics, Amgen, AstraZeneca, Bayer, BMS, BioNTech, GSK, Immunocore, Ipsen, MSD, Merck Serono, Molecular Partners, Novartis, Neogene Therapeutics, Pfizer, Roche/Genetech, Sanofi, Seattle Genetics, Third Rock Ventures, Vaximm; Non-Financial Interests, Research Grant: Amgen, BMS, MSD, BioNTech, Neogene Therapeutics, Novartis. R.S. van Rijn: Non-Financial Interests, Advisory Role: Pfizer; Non-Financial Interests, Other, Expert meeting fee: Roche. M. Aarts: Non-Financial Interests, Advisory Role: Amgen, BMS, Novartis, MSD-Merck, Merck-Pfizer, Pierre Fabre, Sanofi, Astellas, Bayer; Non-Financial Interests, Research Grant: Merck-Pfizer. C.U. Blank: Financial Interests, Institutional, Advisory Board: BMS, MSD, Roche, Novartis, GSK, AZ, Pfizer, Lilly, GenMab, Pierre Fabre; Financial Interests, Personal, Expert Testimony: Third Rock Ventures; Financial Interests, Personal, Stocks/Shares: Uniti Cars, co-founder Immagene BV; Financial Interests, Institutional, Invited Speaker: BMS, Novartis, NanoString, 4SC. M. Boers-Sonderen: Non-Financial Interests, Advisory Role: Pierre Fabre, MSD, Novartis. J.W.B. de Groot: Non-Financial Interests, Advisory Role: BMS, Pierre Fabre, Servier, MSD, Novartis. G. Hospers: Non-Financial Interests, Advisory Role: Amgen, BMS, Roche, MSD, Pfizer, Novartis, Pierre Fabre; Non-Financial Interests, Research Grant: BMS, Seerave. E. Kapiteijn: Financial Interests, Institutional, Advisory Board: BMS, Novartis, Pierre Fabre, Merck, Delcath, Bayer; Financial Interests, Institutional, Invited Speaker: BMS. A.A.M. Van der Veldt: Non-Financial Interests, Advisory Role: BMS, MSD, Roche, Novartis, Pierre Fabre, Pfizer, Sanofi, Ipsen, Eisai, Merck. K.P.M. Suijkerbuijk: Non-Financial Interests, Advisory Role: BMS, Novartis, MSD, Pierre Fabre, AbbVie; Non-Financial Interests, Other, honoraria: Novartis, MSD, Roche. All other authors have declared no conflicts of interest.