Spencer Fox Eccles School of Medicine
81 Melanoma Patient Demographics and Tumor Genetic Information Used to Predict Treatment Response
Amy Jamison and Siwen Hu-Lieskovan
Faculty Mentor: Siwen Hu-Lieskovan (Internal Medicine, University of Utah)
Introduction
The largest percentage of melanoma is UV-related. However, there are several types of melanoma that are non-UV-related, including acral melanoma. Acral melanoma occurs on the palms of the hands and the soles of the feet, and its cause is still uncertain. Due to its less frequent occurrence, not as much information is known about acral melanoma. This also means that it is harder to predict how a patient will respond to treatment. Analyzing the patient demographics and tumor genetic information of an acral cohort is helpful to develop a better understanding of what factors may influence an acral patient’s disease progression and response to treatment.
In this particular analysis, several biomarkers, which have been found significant in common cutaneous melanomas, were explored within a cohort of acral patients, looking for patterns within the patients and their responses to treatment.
Methods
This project involved the extracting and analyzing of patient demographics and tumor genetic information from a cohort of 22 acral melanoma patients, which data can be used to better understand frequently seen characteristics among acral patients. Specifically, patients were divided into two groups: Non-Progression of Disease (No Evidence of Disease, Stable Disease, or Partial Response) and Progression of Disease. These two groups were then compared by demographics, presence of common biomarkers and tumor genetic information, and lines of treatment received.
Results
While statistical analysis is still needed to find significance, patterns were identified between several factors and tumor response to treatment. Within the cohort:
Gender: Males experienced disease progression less frequently
Age: Patients aged 61-79 were more likely to experience disease progression than ages 42-60 Location: Tumors with a primary location of heel often progressed, while primary location of toe did not Stage: Stage 3 patients experienced more frequent disease progression
NRAS: Presence of NRAS was seen more often in patients whose disease did not progress
TMB: Patients with TMB>3 experienced more frequent disease progression
In analyzing patient response to first line anti-PD1 treatment, most therapies used within the cohort had similar levels of benefit, as measured by Progression Free Survival (PFS) after that line of treatment. Each patient saw PFS of 0-2 years, with the exception of two patients. The adjuvant patient who received Cancer Vaccine Trial followed by Nivolumab, and the neoadjuvant patient who received Pembrolizumab+ oral CXCR4 antagonist, who both experienced 3-5 years of PFS.
Conclusion
Patient demographics and tumor genetic information in acral melanoma patients are a good predictor of how the patient may respond to treatment. While many of the patterns found in comparing characteristics between progressing and non-progressing patients were not statistically significant, further analysis with larger cohorts would be beneficial, and may provide more thorough results.
The analysis of the different lines of treatment demonstrates that perhaps combination therapies are more effective in treating acral melanoma, as well as points to the importance of continued research and trials in investigating new treatments for acral melanoma.
