Article
作者: Zimmer, L ; Enk, A ; Welzel, J ; Santinami, M ; Eigentler, T K ; Covelli, A ; Hauschild, A ; Meier, F ; Röcken, C ; Schadendorf, D ; Rutkowski, P ; Neri, D ; von Wasielewski, I ; Robert, C ; Simon, J-C ; Garzarolli, M ; Maio, M ; Haferkamp, S ; Livingstone, E ; Pizzichi, B ; Malissen, N ; Parca, A ; Russano, F ; Garbe, C ; Kähler, K C ; Ascierto, P A ; Ziemer, M ; Flatz, L ; Lorizzo, K ; Hassel, J C ; Zalaudek, I ; Mulatto, S ; Amaral, T ; Elia, G ; Gaudy-Marqueste, C ; Quaglino, P ; Świtaj, T
BACKGROUND:This phase III trial assessed daromun, a combination of two fibronectin-targeting immunocytokines (L19IL2 and L19TNF), as a neoadjuvant treatment for patients with clinically detectable stage IIIB/C melanoma [American Joint Committee on Cancer (AJCC) version 7].
PATIENTS AND METHODS:Patients were randomized to weekly intralesional daromun administrations (13 million IU of L19IL2 and 400 μg of L19TNF) for 4 weeks followed by surgery, or upfront surgery. Pretreatment with approved adjuvant agents was allowed. The primary endpoint was recurrence-free survival (RFS): events were disease recurrence or death from any cause after complete surgical tumor resection (ClinicalTrials.gov NCT02938299).
RESULTS:A total of 246 patients were randomized and included in the intention-to-treat analysis: 74% had undergone two or more prior surgical resections and 35% had received prior systemic therapy. At a median follow-up of 21 months, the neoadjuvant group (n = 122) had a significantly longer RFS than the upfront surgery group (n = 124), with a median RFS of 16.7 months and 6.8 months, respectively [hazard ratio (HR) 0.59, 95% confidence interval (CI 0.41-0.86), P = 0.005, log-rank test]. The risk of distant recurrence was reduced by 40% in the neoadjuvant arm (HR 0.60, 95% CI 0.37-0.95, P = 0.029). Grade ≥3 treatment-related adverse events (TRAEs) were 6.7% in the surgery-alone arm and 27.1% in the daromun arm, mostly injection site reactions.
CONCLUSIONS:Neoadjuvant daromun resulted in a significantly longer RFS than upfront surgery in patients with locally advanced melanoma. TRAEs were transient and manageable. Neoadjuvant daromun is a new therapeutic option for patients with stage III melanoma, including those with locoregional recurrence after surgery and previous adjuvant therapy.