Influence of adjuvant therapies on organ‐specific recurrence of cutaneous melanoma: A multicenter study on 1383 patients of the prospective DeCOG registry ADOReg

This study investigated whether adjuvant treatments in stage III cutaneous melanoma (CM) influenced patterns of recurrence. Patients with primary ( n = 1033) or relapsed CM ( n = 350) who received adjuvant therapies with Nivolumab (N), Pembrolizumab (P), or Dabrafenib and Trametinib (D + T) were extracted from the prospective multicenter real‐world skin cancer registry ADOReg. Endpoints were progression‐free survival (PFS), distant metastasis‐free survival (DMFS), organ‐specific DMFS, and overall survival (OS). For primary cases, D + T indicated an improved PFS (1‐ and 2‐year PFS: 90.9%; 82.7%) as compared to P (81.0%, 73.9%; p = .0208), or N (83.8%, 75.2%; p = .0539). BRAF ‐mutated(mut) CM demonstrated significantly lower PFS ( p = .0022) and decreased DMFS ( p = .0580) when treated with immune checkpoint inhibitor (ICI) instead of D + T. Besides, NRAS ‐mut CM tended to perform worse than wt CM upon ICI (PFS: p = .1349; DMFS: p = .0540 ) . OS was similar between the groups. Relapsed cases showed decreased PFS, DMFS, and OS in comparison to primary (all: p < .001), without significant differences between the subgroups. Organ‐specific DMFS was significantly altered for primary cases with bone ( p = .0367) or brain metastases ( p = .0202). In relapsed CM, the frequency of liver (D + T: 1.5%; P: 12%; N: 9%) and LN metastases (D + T: 1.5%; P: 12%; N: 10.2%) was significantly lower with adjuvant D + T than ICI. NRAS ‐mut CM showed increased recurrence in primary and relapsed cases. These data show that adjuvant D + T is superior to ICI in primary BRAF ‐mut CM.