Comparative analysis of progression free survival and treatment maintenance in patients with advanced melanoma responding to first-line treatment

Abstract Background Specific data regarding Progression-Free Survival (PFS) and treatment maintenance estimated by Time To Next Treatment (TTNT) in patients with advanced melanoma responding to first-line treatments are scarce. Objective To evaluate and compare in a real-life setting PFS and overall TTNT in patients with advanced melanoma responding to first-line treatment within three therapeutic subsets: BRAF and MEK inhibitors (group 1), anti-PD1 (group 2) and anti-PD1/Anti-CTLA4 immunotherapies (group 3); and to perform comparative analyses of PFS and TTNT according to response depth (complete or partial response), brain metastases (BM), and per-treatment disease progression. Patients and Methods Patients with unresectable stage III or IV melanoma registered in the French nationwide multicenter Melbase database and responding to first-line immunotherapy or targeted therapy were retrospectively included. Overall and situation-specific PFS and TTNT were assessed and compared within and between therapeutic groups. Results Median PFS was 10.7 months, 84.6 months, and not reached in group 1, 2 and 3 respectively. No obvious difference was observed between PFS and TTNT for patients receiving targeted therapies (TT) and combined anti-PD1/CTLA4 immunotherapy. Conversely, TTNT largely exceeded PFS in patients receiving anti-PD1 alone, with an increasing gap over time. Similar trends were observed in patients with BM and in those experiencing per-treatment disease progression. Conclusion First-line combined anti-PD1/Anti-CTLA4 immunotherapy was associated with the most durable response in patients with advanced melanoma considered as responders, compared with anti-PD1 alone or targeted therapy, independently of BM status. Anti-PD1 monotherapy was frequently maintained beyond disease progression, in contrast to targeted therapy.