Can removal of metastasis improve overall survival in patients with melanoma who responded to targeted therapy?

This study was carried out to assess the effectiveness of metastasectomy (ME; surgical removal of tumors that have spread from the original tumor location) for patients with advanced melanoma who responded to targeted or immunotherapy. The authors found that ME for melanoma is associated with a longer overall survival (OS) in these patients. 

Melanoma is a form of aggressive skin cancer that originated from melanocytes (pigment-producing cells). Current treatment for advanced melanoma involves immune therapy or targeted molecular therapy. These treatments stimulate the immune system to attack and kill cancer cells or target certain proteins on cancer cells that block their growth and spread.

Before these therapies existed, ME could provide some control in patients with advanced melanoma. However, the role of ME after targeted or immunotherapy in patients with advanced melanoma has not been investigated.

There were 128 patients with advanced melanoma in this study. All patients were treated with a targeted therapy such as vemurafenib (Zelboraf), dabrafenib (Tafinlar), and trametinib (Mekinist) or an immunotherapy such as ipilimumab (Yervoy), pembrolizumab (Keytruda), nivolumab (Opdivo), and tremelimumab. 73 patients underwent ME. The average follow-up was 26.6 months. 73 patients underwent 111 MEs. 49 of these patients underwent the surgical removal of a single tumor, 15 patients had 2 tumors removed. 9 patients had at least 3 tumors removed. 

Overall, stabe stable disease or better was achieved by 75% of the patients in the ME group and 80% in the control group. The average OS time in patients who underwent ME before receiving drug therapy was 34.4 months versus 31.3 months in those who did not undergo ME. In patients who responded to drug therapy, those who also underwent ME had an OS of 84.3 months compared to 42.9 months in patients who did not undergo ME and only received drug therapy.

The authors concluded that the use of ME in patients with advanced melanoma should be used particularly in those who respond to targeted and immunotherapy.

This study was based on medical recods. Information such as the size and number of tumors was missing. This might have affected the results.