First-Line Checkpoint Inhibitor Therapy in Metastatic Acral Lentiginous Melanoma Compared to Other Types of Cutaneous Melanoma: A Multicenter Study from the Prospective Skin Cancer Registry ADOREG
Menée à l'aide de données d'un registre multicentrique portant sur 45 patients atteints d'un mélanome acro-lentigineux (ALM) métastatique et 328 patients atteints d'un mélanome non-ALM, cette étude analyse l'efficacité, du point de vue de la réponse globale, de la survie sans progression et de la survie globale, d'un traitement de première ligne par inhibiteurs de point de contrôle immunitaire en fonction du type de mélanome
Background: Melanoma is the main cause of skin cancer-related death. Treatment with immune checkpoint inhibitors (CPI) has improved the prognosis in recent years. However, subtypes of melanoma differ in their response. Acral lentiginous melanoma (ALM) has a worse prognosis compared to cutaneous melanoma other than ALM (CM) and is therefore of particular relevance.
Aims: To evaluate the efficacy of CPI in first-line treatment of patients with advanced ALM compared CM.
Methods: Retrospective analysis of patients with metastatic ALM (n = 45) or CM (n = 328) who received first-line CPI therapy from the multicenter prospective skin cancer registry ADOREG. Study endpoints were best overall response (BOR), progression-free survival (PFS) and overall survival (OS).
Results: ALM patients had significantly higher rates of ulcerated tumors, loco regional metastases and fewer BRAF-mutated tumors compared to CM patients. Combined CPI was administered in 48.9% ALM patients and 39.3% of CM patients, while the remaining patients received PD-1 monotherapy. OS trended to be shorter in patients with ALM (18.1 vs. 43.8 months, p = 0.10) with no significant differences in PFS (7.0 vs. 11.5 months, p = 0.21). In patients with CM, median OS with combined CPI was not reached, whereas the median OS after PD-1 monotherapy was 37.8 months (p = 0.22). Conversely, in patients with ALM, OS with combined CPI was 17.8 months, compared to 26 months with PD-1 monotherapy (p = 0.15). There were no significant differences in BOR between patients with ALM or CM.
Conclusion: Analysis of this real-world cohort of patients with metastatic melanoma showed a trend towards poorer survival outcomes upon first-line treatment with CPI in ALM compared to cutaneous melanoma of other subtypes.
European Journal of Cancer , article en libre accès, 2025