Immunotherapy in sinonasal melanoma: treatment patterns and outcomes compared to cutaneous melanoma

Abstract

Background Although treatment with checkpoint blockade is now accepted as standard of care for cutaneous melanoma, few studies have investigated its role in sinonasal melanoma (SNM). We aimed to evaluate whether immunotherapy was associated with improved survival in SNM and to compare the effect of immunotherapy in metastatic sinonasal and cutaneous melanoma. Methods This was a cohort study of patients included in the United States National Cancer Database who had been diagnosed with sinonasal or cutaneous melanoma between 2012 and 2015 and had complete information regarding immunotherapy status. The primary outcome was overall survival. The influence of immunotherapy on overall survival was compared by Kaplan‐Meier and Cox proportional hazards models. Propensity score matched analyses between SNM patients who received immunotherapy and those who did not were based on clinicopathological covariates associated with survival in univariate Cox models. Results The analytic cohort consisted of 704 patients with SNM, 94 of whom were treated with immunotherapy and 152,896 patients with cutaneous melanoma, 8055 of whom were treated with immunotherapy. Immunotherapy was not associated with survival in the propensity‐score matched cohort (n = 195; hazard ratio [HR] = 1.0; 95% confidence interval [CI], 0.7 to 1.5; p = 0.88) or in adjusted Cox proportional hazards model (n = 549; HR = 1.0; 95% CI, 0.74 to 1.4; p = 0.88). Regimens including immunotherapy were associated with improved overall survival in metastatic cutaneous melanoma (HR = 0.57; 95% CI, 0.49 to 0.66; p < 0.0001), but not metastatic SNM (HR = 1.1; 95% CI, 0.67 to 1.7; p = 0.75). Conclusion Compared to current standard of care therapy, inclusion of immunotherapy as first‐line therapy was not associated with improved survival in SNM.

Melanoma and Nanotechnology-Based Treatment

“…Moreover, in patients with advanced melanoma, which is associated with a poor prognosis and a lack of effective treatments, systemic treatment based on internal medicine is typically applied. In recent years, breakthroughs in individualized targeted therapies and immunotherapies have led to improved outcomes in patients with advanced melanoma (13)(14)(15)(16).…”

CDK4 and TERT amplification in head and neck mucosal melanoma

“…However, the effects of immunotherapy and targeted therapy on HNMM were less robust than their effects on cutaneous melanoma 5 . Several recent studies have revealed that immunotherapy has limited efficacy in mucosal melanoma 6,7 . Moreover, HNMM lacks a common melanoma‐related mutation for targeted therapy 8 , thus, few patients with HNMM may benefit from currently available targeted agents for cutaneous melanoma.…”

International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors

“…Although data on immunotherapy specifically for SNMM are scarce, a pooled NCDB data multivariate analysis demonstrated that survival following immunotherapy was improved for patients with metastatic disease, but not those without metastases (HR 0.14, 95% CI: 0.04–0.49) 366 . A separate NCDB database study comparing the efficacy of immunotherapy for SNMM compared to cutaneous melanoma found that the addition of immunotherapy improved OS in metastatic cutaneous melanoma (HR 0.57; 95% CI: 0.49–0.66; p < 0.0001) but not in metastatic SNMM (HR 1.1; 95% CI: 0.67–1.7; p = 0.75) 1563 . Another NCDB analysis of head and neck mucosal melanoma (79% of which were sinonasal) found that immunotherapy was associated with improved OS on multivariate analysis after controlling for tumor stage, size, site, age, and comorbidities 1503 .…”