Adjuvant sunitinib use tied to better overall survival in uveal melanoma
Use of adjuvant sunitinib appears to improve overall survival in high-risk patients with primary uveal melanoma, suggests a recent study.
A total of 128 patients from the Wills Eye Hospital Oncology Service Uveal Melanoma Cytogenetic Database met the selection and exclusion criteria of this study, which had a median follow-up of 52.7 months (range, 0.26‒108 months).
Fifty-four patients (median age 56 years; range, 29‒81 years; 48 percent men) received sunitinib. In the same risk category, 74 historical controls (median age 62 years; range, 21‒80 years; 48 percent men) were identified.
Patients in the sunitinib group, compared with historical controls, were younger, had smaller tumour sizes (T3‒4; 56 percent vs 83 percent; p=0.001), and had worse cytogenetic or molecular features (monosomy 3 and 8q amplification or class 2; 87 percent vs 57 percent; p<0.001). Fifty-one deaths occurred, 14 (26 percent) in the sunitinib group and 37 (50 percent) in the control group.
Univariate analysis revealed that overall survival was longer in the sunitinib group (hazard ratio, 0.53; 95 percent CI, 0.29‒0.99; p=0.041). Multivariate Cox regression analysis showed highly significant interaction between sunitinib use and age as a dichotomous variable (p=0.003).
Cytogenetic/molecular status (p=0.015), T-size category (p=0.022), gender (p=0.040) and adjuvant sunitinib in patients aged <60 years (p=0.004) statistically correlated with prediction of overall survival. In addition, propensity score analysis confirmed these results.
In this retrospective cohort study, researchers compared a cohort of patients who intended to receive adjuvant sunitinib for 6 months with institutional historical controls with the same risk factors. Selection criteria were 1) monosomy 3 and 8q amplification by cytogenetic or DecisionDx-UM Class 2 and (2) monosomy 3 and large tumour size (T3‒4 by American Joint Committee on Cancer classification). Exclusion criteria were date of diagnosis before 2007 or after 2013, and age <18 years.
The outcome of overall survival was analysed using Kaplan-Meier and Cox proportional hazards models. Propensity score was used to adjust for nonrandom assignment to sunitinib.