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@ARTICLE{Lodde:277779,
      author       = {G. C. Lodde and J. Hassel and L. M. Wulfken and F. Meier
                      and P. Mohr and K. Kähler and A. Hauschild and B. Schilling
                      and C. Loquai and C. Berking and S. Hüning and J. Eckardt
                      and R. Gutzmer and L. Reinhardt and V. Glutsch and U.
                      Nikfarjam and M. Erdmann and C. L. Beckmann and A. Stang and
                      B. Kowall and W. Galetzka and A. Roesch$^*$ and S.
                      Ugurel$^*$ and L. Zimmer and D. Schadendorf$^*$ and A.
                      Forschner and E. Livingstone},
      title        = {{A}djuvant treatment and outcome of stage {III} melanoma
                      patients: {R}esults of a multicenter real-world {G}erman
                      {D}ermatologic {C}ooperative {O}ncology {G}roup ({D}e{COG})
                      study.},
      journal      = {European journal of cancer},
      volume       = {191},
      issn         = {0014-2964},
      address      = {Amsterdam [u.a.]},
      publisher    = {Elsevier},
      reportid     = {DKFZ-2023-01494},
      pages        = {112957},
      year         = {2023},
      abstract     = {Clinical trials demonstrated significantly improved
                      recurrence-free survival (RFS) of melanoma patients
                      receiving adjuvant treatment. As data from controlled trials
                      are based on selected populations, we investigated
                      adjuvantly treated stage III melanoma patients under
                      real-world conditions.In a prior multicenter cohort study,
                      stage III-IV melanoma patients were analysed for their
                      choice of adjuvant therapy. In this follow-up study, we
                      examined RFS, overall and melanoma-specific survival (MSS)
                      and response to the subsequent treatment of 589 stage III
                      patients (232 BRAF-mutated) receiving adjuvant PD-1
                      inhibitors (PD1; n = 479) or targeted therapy (TT; n =
                      110).The median follow-up of the total cohort was 25.7
                      months. The main reason for premature discontinuation of
                      adjuvant therapy was disease progression in PD1- $(28.8\%,$
                      n = 138/479) and adverse events in TT-treated patients
                      $(28.2\%,$ n = 31/110). Among BRAF-mutated patients, RFS at
                      24 months was $49\%$ $(95\%$ CI $40.6-59.0\%)$ for PD1- and
                      $67\%$ $(95\%$ CI $58-77\%)$ for TT-treated patients. The
                      risk of recurrence was higher for BRAF-mutated PD1 than TT
                      (hazard ratio 1.99; $95\%$ CI 1.34-2.96; hazard ratio
                      adjusted for age, sex and tumour stage, 2.21; $95\%$ CI
                      1.48-3.30). Twenty-four months MSS was $87\%$ $(95\%$ CI
                      81.0-94.1) for PD1 and $92\%$ $(95\%$ CI 86.6-97.0) for TT.
                      Response to subsequent systemic treatment for unresectable
                      disease was $22\%$ for all PD1- and $16\%$ for TT-treated
                      patients.PD1-treated patients had more and earlier
                      recurrences than TT patients. In BRAF-mutated patients,
                      adjuvant TT might prevent early recurrences more effectively
                      than PD1 treatment. Management of recurrence despite
                      adjuvant treatment is challenging, with low response to
                      current therapeutic options.The datasets generated during
                      and/or analysed during the current study are available for
                      qualified researchers from the corresponding authors upon
                      request.},
      keywords     = {Adjuvant treatment (Other) / BRAF (Other) / Immunotherapy
                      (Other) / Melanoma (Other) / PD1 (Other) / Real-world
                      (Other) / Targeted therapy (Other)},
      cin          = {ED01},
      ddc          = {610},
      cid          = {I:(DE-He78)ED01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:37487400},
      doi          = {10.1016/j.ejca.2023.112957},
      url          = {https://inrepo02.dkfz.de/record/277779},
}