A retrospective study reexamined the role of metastasectomy as a treatment for patients with stage IV melanoma in the modern era of therapeutic agents and found that metastasectomy is still associated with improved survival outcomes, suggesting surgical resection is still therapeutically relevant. The findings were published online in the Annals of Surgical Oncology.
The study included patients with stage IV melanoma who received systemic therapy alone or in combination with metastasectomy between 1965 and 2015, and patients were stratified by treatment era. The historical era was defined as 1965 to 2007 and included agents such as chemotherapy, biologic therapy, and biochemotherapy, while the modern era was defined as 2008 or later and included BRAF and/or MEK inhibitors and checkpoint inhibitors. The study researchers used a matched-pair design to assess outcomes of surgically treated patients and nonsurgically treated patients who received modern therapeutic agents.
A total of 2353 patients were eligible for the study and nearly half (45.2%) received metastasectomy. The proportion of patients who received metastasectomy appeared to increase over time, with the modern era having a statistically higher proportion of patients who underwent metastasectomy compared with the historical era (54.5% vs 44.7%; P =.02).
The matched-pair analysis revealed that patients who had metastasectomy followed by modern therapy had a higher rate of 5-year melanoma-specific survival (MSS) compared with patients who received modern therapy alone (58.8% vs 38.9%; P =.049)
In a multivariate analysis, the receipt of metastasectomy as a first-line treatment (hazard ratio [HR], 0.47; 95% CI, 0.23-0.98; P =.04) and treatment with modern immune or targeted therapies (HR, 0.29; 95% CI, 0.21-0.40; P <.001) were each independently correlated with longer MSS.
“While modern systemic agents have improved outcomes in stage IV melanoma, metastasectomy remains associated with favorable survival,” the study authors wrote in conclusion. “Resection remains a viable therapeutic approach, possibly worthy of prospective evaluation.”
- Nelson DW, Fischer TD, Graff-Baker AN, et al. Impact of effective systemic therapy on metastasectomy in stage IV melanoma: A matched-pair analysis [published online June 10, 2019]. Ann Surg Oncol. doi: 10.1245/s10434-019-07487-5