NESS - Metastasectomy following immunotherapy with Adoptive Cell Transfer or Ipilimumab for patients with advanced melanoma

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Metastasectomy following immunotherapy with Adoptive Cell Transfer or Ipilimumab for patients with advanced melanoma
*Nicholas D Klemen, *Paul L Feingold, *Stephanie L Goff, *Marybeth S Hughes, *Udai S Kammula, *James C Yang, *David S Schrump, *Steven A Rosenberg, *Richard M Sherry
Surgery Branch, NCI, NIH, Bethesda, MD

Objective: Immunotherapy with adoptive cell transfer (ACT) and Ipilimumab can mediate complete and durable responses, as well as partial responses and prolonged disease stabilization. Unfortunately, many patients ultimately develop progressive melanoma. For these patients, metastasectomy can be considered if tumor progression is limited. Here we report our experience using surgery to treat progressive melanoma in patients who had evidence of an anti-tumor immune response to ACT or Ipilimumab.
Design: Case series of patients treated with metastasectomy for progressive melanoma after a response to immunotherapy.
Setting: Single institution (Surgery Branch, NCI)
Patients: Individuals with advanced melanoma treated with ACT or Ipilimumab, who had an objective response or stable disease for 6 months (SD6) before developing progressive disease.
Interventions: Surgical metastasectomy for progressive melanoma.
Main Outcome Measures: Progression free survival (PFS) and overall survival (OS) following surgery.
Results: After ACT, 115 patients met response criteria before developing progressive disease, and 26 (23%) had surgery. Median follow-up after surgery was 62 months. Median PFS after surgery was 11 months and five-year OS was 57%. After Ipilimumab, 32 patients met response criteria and progressed, and 6 (19%) had surgery. Median follow-up after surgery was 106 months. PFS and OS after surgery were 50%.
Conclusions: Prolonged PFS can be achieved by metastasectomy in selected patients with progressive melanoma following treatment with ACT or Ipilimumab. Metastasectomy may play an important role in treating advanced melanoma following effective immunotherapy.

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