Effects of an immunosuppressive therapy on the efficacy of immune checkpoint inhibition in metastatic melanoma - An analysis of the prospective skin cancer registry ADOREG.

Background: The impact of immunosuppressive therapy (IST) on immune-checkpoint inhibition (ICI) is unclear.
Methods: Patients with unresectable advanced melanoma (MM) treated with ICI in the years 2011-2020 were identified from the prospective multicenter German skin cancer registry ADOREG. Patients with IST within 60 days before, or within 30 days after start of ICI were compared to patients without IST. End points were disease control rate (DCR), overall survival (OS) and progression-free survival (PFS) determined by Kaplan-Meier method. Prognostic factors were evaluated in a Cox regression model.
Results: Of 814 patients treated with ICI, 73 (9%) received concomitant IST, mainly steroids. Patients with brain metastases (BM) received IST more frequently (n = 34/130 patients; 26%), than patients without BM (39/684 patients; 6%). In patients without BM, IST initiated before, but not IST initiated after start of ICI was significantly associated with worse PFS (univariate hazard ratio (HR) 2.59, 95% confidence interval (95%-CI) 1.07-6.28, p = 0.035; multivariate HR 3.48, 95%-CI 1.26-9.6, p = 0.016). There was no association between IST and OS or DCR. In patients with BM, IST initiated before, but not after start of ICI was significantly associated with worse OS (univariate HR 2.06, 95%-CI 1.07-3.95, p = 0.031; multivariate HR 5.91, 95%-CI 1.74-20.14, p = 0.004). There was no association between IST and PFS or DCR.
Conclusion: Patients receiving IST 60 days before start of ICI showed a tendency to an impaired therapy outcome. IST initiated within 30 days after start of ICI, mainly due to early side effects, did not affect the efficacy of ICI therapy.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Corinna Kochanek: None. Catharina Gilde: None. Lisa Zimmer: served as consultant and/or has received honoraria from Bristol Myers Squibb, Merck Sharp & Dohme, Novartis, Pierre Fabre, Sanofi, and Sunpharma and travel support from Merck Sharp & Dohme, Bristol Myers Squibb, Pierre Fabre, Sunpharma, Sanofi and Novartis; outside the submitted work. Selma Ugurel: declares research support from Bristol Myers Squibb and Merck Serono; speakers and advisory board honoraria from Bristol Myers Squibb, Merck Sharp & Dohme, Merck Serono, and Novartis; and meeting and travel support from Almirall, Bristol-Myers Squibb, IGEA Clinical Biophysics, Merck Sharp & Dohme, Novartis, Pierre Fabre, and Sun Pharma; outside the submitted work. Friedegund Meier: has received travel support or/and speaker’s fees or/and advisor’s honoraria by Novartis, Roche, Bristol Myers Squibb, Merck Sharp & Dohme, Pierre Fabre, Sanofi and Immunocore and research funding from Novartis and Roche; outside the submitted work. Jochen Utikal: is on the advisory board or has received honoraria and travel support from Amgen, Bristol-Myers Squibb, GSK, Immunocore, LeoPharma, Merck Sharp and Dohme, Novartis, Pierre Fabre, Roche, Sanofi; outside the submitted work. Claudia Pföhler: received honoraria (speaker honoraria or honoraria as a consultant) and travel support from: Novartis, Bristol Myers Squibb, Merck Sharp & Dohme, Merck Serono, Celgene, AbbVie, Sunpharma, Pierre Fabre, UCB, Nutricia Milupa, Janssen and LEO; outside the submitted work. Rudolf Herbst: is an employee of Helios Kliniken Erfurt GmbH. Sebastian Haferkamp: declares research support from Bristol Myers Squibb speakers and advisory board honoraria from Bristol Myers Squibb, Merck Sharp & Dohme, Pierre Fabre and Novartis; outside the submitted work. Julia Welzel: has received honoraria and travel support from Almirall, Bristol Myers Squibb, Novartis, Pierre Fabre and Merck Sharp & Dohme; outside the submitted work. Pia Dücker: declares research support from Bristol Myers Squibb, Merck and Novartis. Speakers and advisory board honoraria from Bristol Myers Squibb, Roche, Sanofi-Aventis, AbbVie, Merck Sharp and Dohme and Pierre Fabre; outside the submitted work. Ulrike Leiter: reports research support from Merck Sharp and Dohme, consulting fees and honoraria from Sun Pharma, Sanofi (personal and institutional), Merck Sharp and Dohme (personal and institutional), Novartis, Roche, Almirall Hermal, support for attending meeting from Sun Pharma and participation on a Data Safety Monitoring Board or Advisory Board from Sun Pharma, Sanofi, Merck Sharp and Dohme, Novartis, Roche, Almirall Hermal; outside the submitted work. Michael Weichenthal: None. Imke von Wasielewski: Honoraria: Novartis, Bristol Myers Squibb, Merck Sharp & Dohme, Sanofi, Stemline, Kyowa Kirin. Consultant or Advisory Role: Bristol Myers Squibb, Merck Sharp & Dohme, Sanofi; Travel, Accommodations. Expenses: Novartis, Bristol Myers Squibb, Merck Sharp & Dohme, Sanofi, Stemline, Kyowa Kirin; outside the submitted work. Yenny Angela: None. Ralf Gutzmer: declares research support from Novartis, Amgen, Sanofi, Merck-Serono, Admiral, SUN Pharma and Kyowa-Kirin; honoraria for lectures from Roche Pharma, Bristol-Myers Squibb, Novartis, Merck Sharp & Dohme. Almirall, Amgen, Merck-Serono, SUN Pharma, Pierre-Fabre, and Sanofi; advisory honoraria from Roche Pharma, Bristol-Myers Squibb, Novartis, Merck Sharp & Dohme, Almirall, Amgen, Pierre-Fabre, Merck-Serono, 4SC, Sun Pharma, Merck-Serono, Sanofi, and Immunocore; outside the submitted work.
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