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Open AccessArticle

Multimodal Treatment of Advanced Mucosal Melanoma in the Era of Modern Immunotherapy

1
Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
2
Melanoma Unit, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
3
Maria Skłodowska-Curie National Research Institute—Oncology Center, Krakow Branch, 31-115 Krakow, Poland
4
Department of Medical Sciences, Dermatologic Clinic, University of Turin, 10126 Turin, Italy
5
Department of Oncology, Radiation Oncology, University of Turin, 10126 Turin, Italy
6
Department of Oncology, Radiotherapy Unit, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
7
Department of Pathology and Laboratory Medicine Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, 02-781 Warsaw, Poland
8
Department of Diagnostic Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
These authors contributed equally to this work, senior authors.
Cancers 2020, 12(11), 3131; https://doi.org/10.3390/cancers12113131
Received: 30 August 2020 / Revised: 11 October 2020 / Accepted: 19 October 2020 / Published: 26 October 2020
(This article belongs to the Special Issue Advances and Novel Treatment Options in Metastatic Melanoma)
Immunotherapy revolutionized the treatment of cutaneous melanoma and greatly improved treatment outcomes in this group of patients. Mucosal melanoma is a rare disease, biologically distinct from the cutaneous subtype. There is little real-world data on immunotherapy efficacy in mucosal melanoma. Therefore, we aimed to analyze and describe experiences in mucosal melanoma treatment in five high volume oncology centers in Europe. Furthermore, we evaluated if concomitant radiotherapy may improve the outcomes of these patients. We conclude that immunotherapy with anti-PD1 antibodies is a safe and effective treatment of mucosal melanoma. Concomitant radiotherapy may be beneficial in a selected subgroup of patients with advanced mucosal melanoma.
Mucosal melanoma is a rare disease epidemiologically and molecularly distinct from cutaneous melanoma developing from melanocytes located in mucosal membranes. Little is known about its therapy. In this paper, we aimed to evaluate the results of immunotherapy and radiotherapy in a group of patients with advanced mucosal melanoma, based on the experience of five high-volume centers in Poland and Italy. There were 82 patients (53 female, 29 male) included in this retrospective study. The median age in this group was 67.5 (IQR: 57.25–75.75). All patients received anti-PD1 or anti-CTLA4 antibodies in the first or second line of treatment. Twenty-three patients received radiotherapy during anti-PD1 treatment. In the first-line treatment, the median progression-free survival (PFS) reached six months in the anti-PD1 group, which was statistically better than 3.1 months in the other modalities group (p = 0.004). The median overall survival (OS) was 16.3 months (CI: 12.1–22.3) in the whole cohort. Patients who received radiotherapy (RT) during the anti-PD1 treatment had a median PFS of 8.9 months (CI: 7.4–NA), whereas patients treated with single-modality anti-PD1 therapy had a median PFS of 4.2 months (CI: 3.0–7.8); this difference was statistically significant (p = 0.047). Anti-PD1 antibodies are an effective treatment option in advanced mucosal melanoma (MM). The addition of RT may have been beneficial in the selected subgroup of mucosal melanoma patients. View Full-Text
Keywords: mucosal melanoma; nivolumab; pembrolizumab; ipilimumab; radiotherapy mucosal melanoma; nivolumab; pembrolizumab; ipilimumab; radiotherapy
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Teterycz, P.; Czarnecka, A.M.; Indini, A.; Spałek, M.J.; Labianca, A.; Rogala, P.; Cybulska-Stopa, B.; Quaglino, P.; Ricardi, U.; Badellino, S.; Szumera-Ciećkiewicz, A.; Falkowski, S.; Mandala, M.; Rutkowski, P. Multimodal Treatment of Advanced Mucosal Melanoma in the Era of Modern Immunotherapy. Cancers 2020, 12, 3131.

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