CHICAGO, IL—Patients with metastatic melanoma who undergo surgery to remove lesions that have spread into the abdomen live more than twice as long as those treated with drug therapy alone, according to novel research presented at the American College of Surgeons Clinical Congress 2015.
The study, by North Shore-Long Island Jewish Health System surgical oncologist Gary B. Deutsch, MD, MPH, is the first comprehensive look at the survival benefits of surgical resection for melanoma metastases in the abdomen since the advent of groundbreaking immunotherapies in recent years that stimulate patients’ immune systems to destroy cancer cells, improving once-dismal survival rates.
Deutsch’s study could immediately impact how oncologists across the United States approach metastatic melanoma cases in which the cancer has spread to abdominal organs.
“I think integrating surgical resection with newer drug therapies will greatly benefit patients with metastatic melanoma,” said Deutsch, who performed the research while a surgical oncology fellow at John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, California.
“There’s an opportunity to increase surgeon involvement in the treatment of these patients,” he added. “Now that there are better options systemically, the decision-making about treatment has become more complex. Having this data available could potentially impact discussions about treatment and benefit patients long-term.”
Approximately 74 000 new cases of melanoma are diagnosed in the United States each year, and approximately 10 000 patients die of the malignancy annually. Melanoma is the deadliest form of skin cancer, though it sometimes also begins in the eye.
Immunotherapies approved in just the past several years by the US Food and Drug Administration for the treatment of melanoma have offered alternatives to standard chemotherapy for cases of metastatic disease, which once were considered hopeless. Surgical resection in metastatic disease, which removes cancerous portions of organs, is seldom performed.
But Deutsch’s study offered a modern update to data tracked over 45 years. Of 1623 patients at John Wayne Cancer Institute, all of whom had melanoma metastases to the abdomen that might be operable, 392 underwent surgical resection. The surgery was done either as the sole treatment; combined with medical therapy; or, in some cases with liver involvement, combined with radiofrequency ablation or heat probe treatment to destroy cancer cells.
The liver was the sole site of cancer spread in 697 patients, 336 had metastases to the gastrointestinal (GI) tract, 138 to the adrenal glands, 109 to the spleen, and 38 to the pancreas. Another 305 patients’ cancer had spread to multiple abdominal organs.
The researchers found that the surgical group’s average survival was nearly 2.5 times as long, at 18 months, compared to only 7 months for the 1231 patients who did not undergo surgical resection.
“We suspected that this would be the case, but we didn’t really have updated data to back it up,” he said. “While we weren’t entirely surprised, the difference in survival between surgical and nonsurgical patients was much larger than expected.”
To examine whether treatment era affected survival, patients were divided into groups of before (1969 to 2003) and after (2003 to 2014) advances in systemic therapies. The latter group consisted of 320 patients, but Deutsch and his team unexpectedly found that systemically immunotherapies did not greatly improve survival rates compared with the earlier treatment era.
“A surgical cure is attainable if a patient can be left with no evidence of disease on the highest-quality imaging tests,” Deutsch said. “I think the combination of immunotherapy with surgical therapy … could potentially lead to curing more patients.”