Treating advanced melanoma with immune checkpoint inhibitors (ICIs) can be safe and effective in patients with concomitant chronic lymphocytic leukemia (CLL), according to a study published in Annals of Oncology.
The study did show, however, that patients who received prior or concurrent treatment for CLL had worse outcomes of ICI treatment than patients who were under observation for CLL.
In this retrospective analysis, researchers examined electronic health record data from 58 patients who had both CLL and advanced melanoma and were treated with an ICI during 1997-2020. The patients were from the United States (n=39) and Australia (n=19).
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A majority of patients (64%) did not have prior or concurrent CLL treatment at the time of ICI receipt, but 19% received chemoimmunotherapy, and 17% received targeted therapy.
All 58 patients received first-line ICI treatment for melanoma, including anti-PD-1 (n=34), anti-CTLA-4 (n=18), and combination (n=6) therapies. Some patients also received ICIs as subsequent treatment (n=21).
Among 56 evaluable patients, the objective response rate (ORR) after first-line ICI treatment was 41%, and the median duration of response was 18 months. Among the 19 evaluable patients who received subsequent ICI treatment, the ORR was 21%.
Patients who received prior or concurrent treatment for CLL had a worse ORR than patients who were under observation for CLL. For first-line ICI treatment, the ORR was 21% among patients with prior/concurrent CLL treatment and 51% among patients under observation (P =.044). For any ICI treatment, the ORR was 19% and 45%, respectively (P =.042).
In the entire cohort, there were 29 deaths, 25 of which were related to melanoma, and none of which were related to CLL. The median overall survival (OS) from ICI initiation was 26 months, and the median progression-free survival (PFS) for all ICI treatments was 5 months. For first-line ICIs only, the median OS was 26 months, and the median PFS was 7 months.
There was a significant difference in PFS and OS with first-line ICI treatment for patients who had prior/concurrent treatment for CLL and patients who were under observation only.
The median PFS was 15 months for patients on observation for CLL, 4 months for all patients who received CLL treatment (P =.005), 3 months for patients who received chemoimmunotherapy for CLL (P =.003), and 4 months for patients who received targeted therapy for CLL (P =.089).
The median OS was 52 months for patients on observation, 7 months among all CLL-treated patients (P =.002), 7 months among patients who received chemoimmunotherapy for CLL (P =.002), and 18 months for patients who received targeted therapy for CLL (P =.009).
Immune-related adverse events (irAEs) occurred in 39% of patients treated with ICIs, but there was no significant difference in rates of irAEs according to CLL treatment (P =.48).
The researchers also compared outcomes in the 19 Australian patients with advanced melanoma and CLL to outcomes in a control cohort of 148 Australian patients with advanced melanoma who did not have CLL.
The ORR to ICI treatment was 53% in the patients with CLL and 48% in the control cohort (P =.81). The median PFS was 8 months among patients with CLL and 13 months in the control cohort (P =.32). The median OS was 31 months in patients with CLL and 46 months in the control cohort (P =.46).
“Treatment with ICI resulted in frequent durable clinical responses of AM [advanced melanoma] without exacerbation of CLL or clearly increased irAEs, and thus should be considered a valuable therapeutic option in patients with concomitant CLL and melanoma,” the researchers concluded. “Our results also suggest that prior treatment for CLL may impact ICI efficacy and AM outcomes, and should be considered in patient management.”
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Cass SH, Tobin JWD, Seo YD, et al. Efficacy of immune checkpoint inhibitors for the treatment of advanced melanoma in patients with concomitant chronic lymphocytic leukemia. Ann Oncol. Published online July 4, 2023. doi:10.1016/j.annonc.2023.06.007
This article originally appeared on Cancer Therapy Advisor
