Researchers propose a simple prognostic score for survival that consists of 3 risk groups in patients with advanced melanoma treated with ipilimumab using readily available clinical parameters, according to a study published in the European Journal of Cancer.1

Although immunotherapies like ipilimumab, a cytotoxic T-lymphocyte antigen 4 inhibitor, demonstrate durable clinical benefit in patients with advanced melanoma, there are no reliable prognostic markers or risk scores in this era of immunotherapy.

For the study, researchers collected characteristics and outcomes on 134 patients with metastatic melanoma who received ipilimumab between 2011 and 2014 at a single institution.

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After a median follow-up of 16.1 months, the median overall survival was 7.1 months (95% CI: 6.5-9.8). Of the 134 patients, 19 experienced tumor remissions, with 16 achieving partial responses and 3 achieving complete responses. Three-quarters of the patients had progressive disease.

The researchers identified 3 independent adverse factors for overall survival: elevated lactate dehydrogenase (LDH) (HR, 1.03; 95% CI: 1.02-1.04), Eastern Cooperative Oncology Group (ECOG) performance status greater than 0 (HR, 1.91; 95% CI: 1.10-3.30), and number of organs involved (HR, 1.51; 95% CI: 1.22-1.86).

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The investigators then built an easy-to-apply risk score to create 3 prognostic groups: favorable (no adverse factors), intermediate (1 adverse factor), and poor prognosis (2 or more adverse factors). These prognostic groups were associated with respective 12- and 18-month overall survival rates of 85% and 73% (favorable), 41% and 29% (intermediate), and 12% and 6% (poor) (P < .001).

The findings suggest that this easy-to-apply prognostic score could be helpful for counseling patients and guiding treatment decisions.

Reference

  1. Diem S, Kasenda B, Martin-Liberal J, et al. Prognostic score for patients with advanced melanoma treated with ipilimumab [published online ahead of print November 17, 2015]. Eur J Cancer. doi: 10.1016/j.ejca.2015.09.007.

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Melanoma Skin Cancer