A Case Series of Multiple Primary Malignancies Among Patients With Advanced Melanoma

Abstract

Multiple primary malignancies (MPM) are described as two or more primary tumors within the same individual. The impact of MPM on the tumor microenvironment among patients with melanoma is poorly understood. Here, we describe this unique group of patients who have both advanced melanoma and at least one other primary malignancy and report their survival outcomes. In this study, patients with advanced melanoma and a second primary malignancy were identified. Medical records were reviewed for cancer treatment history. Kaplan-Meier methods were used to derive survival curves and estimate overall survival (OS), and log-rank tests were used to compare OS. Among 11 MPM patients, the most common nonmelanoma cancers were breast (n = 3) and thyroid (n = 3). Median OS was 153.5 months for all patients. Median OS for synchronous MPM (sMPM) and metachronous MPM (mMPM) were 83.1 and 196.7 months, respectively (p = 0.10). Median OS was not reached when melanoma was diagnosed first, and 153.5 months when diagnosed second (p = 0.45). For six patients receiving immunotherapy for melanoma, there was a 100% complete response rate. In conclusion, patients with melanoma are at risk of secondary malignancies, including breast and thyroid cancer. The timing of secondary malignancies may impact prognosis. Further study of the impact of immunotherapy on MPM is warranted.

Multiple Primary Melanoma Associated with CDKN2A Mutation—Case Report and Review of the Literature

“…A case series including patients with advanced melanomas and one or more other nonmelanoma oncological diseases explored the choice of therapeutic strategies employed for the melanocytic tumors, as well as for the non-cutaneous malignancies [22]. Concerning the treatment strategies used for melanoma, the majority of patients (90.9%) underwent surgery, systemic therapy including immunotherapy, targeted therapy and cytotoxic chemotherapy (81.8%) and a minority of them was exposed to radiation therapy (9.1%) [22].…”

“…A case series including patients with advanced melanomas and one or more other nonmelanoma oncological diseases explored the choice of therapeutic strategies employed for the melanocytic tumors, as well as for the non-cutaneous malignancies [22]. Concerning the treatment strategies used for melanoma, the majority of patients (90.9%) underwent surgery, systemic therapy including immunotherapy, targeted therapy and cytotoxic chemotherapy (81.8%) and a minority of them was exposed to radiation therapy (9.1%) [22]. A total of 54.5% of the patients received immune checkpoint inhibitors such as PD-1 and CTLA-4 inhibitors [22] and previous studies demonstrated that, even though the efficacy of these agents is significant on first primary melanomas, their interference with the development of second primary melanocytic malignant tumors or other non-cutaneous cancers remains controversial [22].…”

“…Concerning the treatment strategies used for melanoma, the majority of patients (90.9%) underwent surgery, systemic therapy including immunotherapy, targeted therapy and cytotoxic chemotherapy (81.8%) and a minority of them was exposed to radiation therapy (9.1%) [22]. A total of 54.5% of the patients received immune checkpoint inhibitors such as PD-1 and CTLA-4 inhibitors [22] and previous studies demonstrated that, even though the efficacy of these agents is significant on first primary melanomas, their interference with the development of second primary melanocytic malignant tumors or other non-cutaneous cancers remains controversial [22]. The analysis by Heudel et al revealed a lower risk of MPM in patients treated with immunotherapy for the first primary tumor, compared to those that followed a standard chemotherapy scheme [23].…”

Complete response to chemoimmunotherapy with bevacizumab in synchronous multiple primary cancers: pulmonary adenocarcinoma and sarcomatoid carcinoma

“…As the patient had pulmonary sarcomatoid carcinoma detected in the liver, it was also supported by the results of the IMpower 150 trial, in which the subgroup with previous liver metastasis had a median overall survival gain of four months, with ABCP ( Socinski et al 2021 ). The efficacy of immunotherapy in patients with multiple primary cancers is limited but one case series of patients with multiple primary malignancies with advanced melanoma showed that six out of 11 patients had complete response to immunotherapy ( Ebia et al 2021 ).…”