Oligoprogression After Immunotherapy and Targeted Therapy in Metastatic Melanoma.

Citation metadata

From: Oncology(Vol. 35, Issue 9)
Publisher: Intellisphere, LLC
Document Type: Article
Length: 2,891 words
Lexile Measure: 1780L

Document controls

Main content

Article Preview :

Which of the following is true about the treatment of oligoprogressive disease in patients with metastatic melanoma?

A. Time from surgery to recurrence does not affect the benefit of a surgical approach.

B. Whole-brain radiotherapy (WBRT) is the standard of care over other radiotherapy techniques for central nervous system (CNS) disease control.

C. Both surgery and radiotherapy may extend the time of treatment with immunotherapy or targeted therapies beyond progression in selected patients.

D. All patients with progressive disease after a systemic therapy should switch to a different systemic therapy regardless of the type of progression.

CORRECT ANSWER: C

Cutaneous melanoma is the third leading cause of skin cancer worldwide and is among the most aggressive types of cancer. In 2020, approximately 324,635 new cases of melanoma were reported worldwide. (1) Melanoma rates have increased in recent decades; an estimated 5.8% more new melanoma cases were diagnosed in 2021 than in 2020. (2) In the United States, where more than 80% of patients are diagnosed with localized disease, the 5-year relative survival for melanoma patients is 93.3%. (3) This may not be the case for patients in middle-and low-income countries, where disease may be more likely to be diagnosed when it is regional or metastatic. Although the 5-year survival rate for localized melanoma is as high as 99.4%, 5-year survival for patients with distant disease decreases to 29.8%. (3)

Molecular evaluation has identified 4 main genomic subtypes of melanoma: BRAF mutated (50%), RAS mutated (28%), NF1 mutated (14%), and triple wild-type (8%). (4)

Although surgical treatment remains the mainstay of treatment for local and regional disease, the cornerstones of treatment for patients with BRAF-mutated metastatic melanoma have become immunotherapy (IO) and targeted therapy (TT), as they demonstrate durable responses and significant improvement in survival. (5,6) Nevertheless, several clinical questions regarding treatment optimization remain unanswered.

Although these newer treatments have great benefit, about 40% to 65% of patients treated with TT and 20% to 30% of those treated with IO will eventually develop resistance and will progress. (7,8) Most patients will present with multiple site progression.

Oligoprogressive disease has been described for multiple neoplasms. The concept of oligoprogression varies across tumors, but it is generally defined as a clinical situation in which a limited number of metastatic tumor sites have progressed, whereas all other metastases remain controlled by systemic therapy. (9) About 4.1% to 10% of patients with melanoma treated with IO or TT will develop oligoprogressive disease. (10,11) This pattern of progression reflects acquired focal resistance, which is biologically different from generalized progression caused by innate or secondary resistance of the disease. (12) Due to this characteristic, oligoprogression may be managed with local therapy; this limits the focal progression and allows continued systemic treatment, which maintains the benefit on the sites of disease that are already controlled. (13)

In contrast to IO, in which continuing treatment beyond progression without other local therapy has been associated with benefit in overall survival (OS) for certain populations, (14,15) TT is rarely continued beyond...

Source Citation

Source Citation   

Gale Document Number: GALE|A679525837