Shortened progression free and overall survival to immune-checkpoint inhibitors in BRAF-, RAS- and NF1- (“Triple”) wild type melanomas

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Philipp Jansen - , University of Duisburg-Essen, University of Bonn (Author)
  • Wolfgang Galetzka - , University of Duisburg-Essen (Author)
  • Georg C. Lodde - , University of Duisburg-Essen (Author)
  • Fabian Standl - , University of Duisburg-Essen (Author)
  • Anne Zaremba - , University of Duisburg-Essen (Author)
  • Rudolf Herbst - , Fresenius AG (Author)
  • Patrick Terheyden - , Universitätsklinikum Schleswig-Holstein - Campus Lübeck (Author)
  • Jochen Utikal - , Heidelberg University  (Author)
  • Claudia Pföhler - , Saarland University (Author)
  • Jens Ulrich - , Otto von Guericke University Magdeburg (Author)
  • Alexander Kreuter - , Witten/Herdecke University (Author)
  • Peter Mohr - , Elbe Clinics Stade/Buxtehude (Author)
  • Ralf Gutzmer - , Ruhr University Bochum (Author)
  • Friedegund Meier - , Department of Dermatology, University Hospital Carl Gustav Carus Dresden (Author)
  • Edgar Dippel - , Klinikum Ludwigshafen (Author)
  • Michael Weichenthal - , University Hospital Schleswig-Holstein Campus Kiel (Author)
  • Jan Malte Placke - , University of Duisburg-Essen (Author)
  • Jennifer Landsberg - , University of Bonn (Author)
  • Inga Möller - , University of Duisburg-Essen (Author)
  • Antje Sucker - , University of Duisburg-Essen (Author)
  • Annette Paschen - , University of Duisburg-Essen (Author)
  • Eva Hadaschik - , University of Duisburg-Essen (Author)
  • Lisa Zimmer - , University of Duisburg-Essen (Author)
  • Elisabeth Livingstone - , University of Duisburg-Essen (Author)
  • Dirk Schadendorf - , University of Duisburg-Essen (Author)
  • Selma Ugurel - , University of Duisburg-Essen (Author)
  • Andreas Stang - , University of Duisburg-Essen (Author)
  • Klaus G. Griewank - , University of Duisburg-Essen (Author)

Abstract

Background: Melanomas lacking mutations in BRAF, NRAS and NF1 are frequently referred to as “triple wild-type” (tWT) melanomas. They constitute 5–10 % of all melanomas and remain poorly characterized regarding clinical characteristics and response to therapy. This study investigates the largest multicenter collection of tWT-melanomas to date. Methods: Targeted next-generation sequencing of the TERT promoter and 29 melanoma-associated genes were performed on 3109 melanoma tissue samples of the prospective multicenter study ADOREG/TRIM of the DeCOG revealing 292 patients suffering from tWT-melanomas. Clinical characteristics and mutational patterns were analyzed. As subgroup analysis, we analyzed 141 tWT-melanoma patients receiving either anti-CTLA4 plus anti-PD1 or anti PD1 monotherapy as first line therapy in AJCC stage IV. Results: 184 patients with cutaneous melanomas, 56 patients with mucosal melanomas, 34 patients with acral melanomas and 18 patients with melanomas of unknown origin (MUP) were included. A TERT promoter mutation could be identified in 33.2 % of all melanomas and 70.5 % of all tWT-melanomas harbored less than three mutations per sample. For the 141 patients with stage IV disease, mPFS independent of melanoma type was 6.2 months (95 % CI: 4–9) and mOS was 24.8 months (95 % CI: 14.2–53.4) after first line anti-CTLA4 plus anti-PD1 therapy. After first-line anti-PD1 monotherapy, mPFS was 4 months (95 %CI: 2.9–8.5) and mOS was 29.18 months (95 % CI: 17.5–46.2). Conclusions: While known prognostic factors such as TERT promoter mutations and TMB were equally distributed among patients who received either anti-CTLA4 plus anti-PD1 combination therapy or anti-PD1 monotherapy as first line therapy, we did not find a prolonged mPFS or mOS in either of those. For both therapy concepts, mPFS and mOS were considerably shorter than reported for melanomas with known oncogene mutations.

Details

Original languageEnglish
Article number114208
JournalEuropean journal of cancer
Volume208
Publication statusPublished - Sept 2024
Peer-reviewedYes

External IDs

PubMed 39018633
ORCID /0000-0003-4340-9706/work/169643427

Keywords

ASJC Scopus subject areas

Keywords

  • Immune therapy, Melanoma, Mutation profiling, Triple wild type