Prognostic factors for survival in patients with metastatic malign melanoma treated with ipilimumab: Turkish Oncology Group study

Abstract

Purpose Studies in the last decade show survival improvement with checkpoint blocker therapy in patients with metastatic malign melanoma. Our purpose was to define the efficacy of ipilimumab according to the patient's baseline characteristics including absolute lymphocytes count. Methods We collected the data of 97 patients with advanced malign melanoma treated with ipilimumab (3 mg/kg, q3w) retrospectively. Log-rank test was used to analyze the univariate effects of patient's characteristics (age, gender, metastatic sites, ECOG PS, type of melanoma, lactic dehydrogenase levels, anemia, lymphocytes (L), neutrophils (N), N/L ratio), c-kit and BRAF status. Survival analyses were estimated with Kaplan–Meier method. Cox regression analysis was used to assess the possible factors identified with log-rank test. Results The median age was 58, and 58% were male and 90% of patients had at least one prior systemic therapy. The median survival was 9.7 months for all patients; and the 12- and 24-month survival rates were 43% and 19%, respectively. Absolute lymphocytes count, lactic dehydrogenase level, bone metastasis, the number of metastatic sites, and RECIST response were significantly related to survival. After Cox regression analysis, RECIST response (complete or partial response), absolute lymphocytes count (more than 1500/mm3) and the number of metastatic sites (less than three sites) remained as significant independent prognostic factors for longer survival. Conclusion Ipilimumab improved survival of patients with metastatic malign melanoma. However, patients with fewer metastatic sites and higher absolute lymphocytes count have a significantly better benefit. To determine if these markers could be used to direct patient therapy, further validation analysis is needed.

Lymphopenia predicts 30-day morbidity and mortality following spinal metastasis surgery

“…A low TLC level before any medical intervention is a well-known predictor of mortality [5] , [6] , [7] , [8] , [9] , [10] . Studies have shown an increased risk of death in ICU-acquired pneumonia (hazard ratio, HR 1.41; TLC < 595 cells/µL) [5] , cardiac surgery (OR 1.01 for each reduction of 10 cells/µL in TLC) [7] , intestinal surgery (HR 9.09; no cut-off point was defined) [10] , gastric cancer surgery (HR 1.97; TLC < 1462 cells/µL) [6] , chemotherapy for melanoma (unspecified risk; TLC < 1500 cells/µL) [23] , clinical treatment of lung cancer (HR 1.81; TLC < 1900 cells/µL) [8] , surgery for femoral neck fractures (OR 1.45 for each reduction of 100 cells/µL in TLC) [9] , and surgery for appendicular pathological fractures (unspecified risk; TLC < 600 cells/µL) [19] .…”

Re: Combination of radiotherapy and immunotherapy? Do timing and dose matter?

“…We thank Yilmaz and colleagues for their comments on our study that was evaluated ''Prognostic factors for survival in patients with metastatic malign melanoma treated with ipilimumab: Turkish Oncology Group study''. 1 The authors specifically question whether radiotherapy is associated with ipilimumab clinical efficacy in our study.…”

“…Cox regression analysis revealed that Response Evaluation Criteria in Solid Tumors (RECIST) response (complete or partial response), absolute lymphocytes count (more than 1500/mm 3 ) and the number of metastatic sites (less than three sites) were independent prognostic factors for longer survival. 1 In our cohort, 36 patients (37%) received radiotherapy, vast majority of patients received palliative radiation (34 patients) therapy. In 39% of patients, radiation was administered within three months of ipilimumab administration.…”

“…Cox regression analysis revealed that Response Evaluation Criteria in Solid Tumors (RECIST) response (complete or partial response), absolute lymphocytes count (more than 1500/mm 3 ) and the number of metastatic sites (less than three sites) were independent prognostic factors for longer survival. 1…”

Comments on “Prognostic factors for survival in patients with metastatic malign melanoma treated with ipilimumab: Turkish Oncology Group study”

“…We read the article entitled “Prognostic factors for survival in patients with metastatic malign melanoma treated with ipilimumab: Turkish Oncology Group study” with great interest. 1 We want to congratulate the authors for their effort to detect prognostic factors for overall survival in patients with metastatic malign melanoma using ipilimumab. For those of us who have witnessed the opening of the era of immunotherapy, series with a large number of patients should be appreciated, while even the smallest information crumbs are worthwhile to understand this new treatment modality.…”