Real-world effectiveness of chemotherapy regimens after immunotherapy in patients with advanced melanoma in Spain: Results from the GEM1801 study.

BACKGROUND

Chemotherapy schemes have historically shown low efficacy in patients with metastatic melanoma and have been replaced by immunotherapy and targeted therapy. This work aimed to study whether chemotherapy remains an option after progression to immunotherapy in specific contexts.

METHODS

The GEM1801 registry includes patients with advanced melanoma in Spain. For this substudy, patients with metastatic melanoma who received chemotherapy after immunotherapy were selected. Baseline characteristics and treatment outcomes were analyzed.

RESULTS

Of the 1316 patients included, with a median time of 4.8 months (range, 0.0-35.8) from the first immunotherapy, 92 received chemotherapy: 12 after adjuvant immunotherapy (cohort A), 45 subsequently to immunotherapy (cohort B), and 35 after receiving bridge therapies (cohort C). The median age was 66 years (range, 35-94), and 55.4% of the patients were male. Most patients had an Eastern Cooperative Oncology Group (ECOG) status of ≤1 (65.2%), whereas only 21.7% had ECOG 2. Among the patients, 54.3% had elevated lactate dehydrogenase levels. Chemotherapy regimens received were taxane/platinum-based therapies (47.8%), dimethyl triazeno imidazol carboxamide (DTIC) (26.1%), fotemustine (17.4%), and other alkylating agents such as temozolomide (8.7%). With a median follow-up of 31.9 months, the objective response rate was 12%, the median progression-free survival was 3.5 months (95% CI, 2.9-4.8), and the median overall survival was 6.1 months (95% CI, 5.3-9.2).

CONCLUSIONS

As in previous studies, patients treated with chemotherapy after immunotherapy failure had poor outcomes, similar to those from pre-immunotherapy era, and should be used when no other options are available.