title: Metastasectomy Following Immunotherapy with Adoptive Cell Transfer for Patients with Advanced Melanoma.
abstract: BACKGROUND
  Immunotherapeutic treatment strategies including adoptive cell transfer (ACT) for metastatic melanoma are capable of mediating complete and durable responses, as well as partial responses and prolonged disease stabilization. Unfortunately, many patients ultimately develop progressive disease. The role of salvage metastasectomy in managing these patients has not been evaluated.
  
  
  METHODS
  Records of patients with metastatic melanoma treated with ACT at a single institution between 2000 and 2014 were reviewed. Patients with an objective response by RECIST criteria or disease stabilization of at least 6 months and who subsequently developed progressive melanoma and were managed with metastasectomy as the next therapeutic strategy were studied for progression-free survival (PFS) and overall survival (OS). Five additional clinical parameters were also reviewed for association with outcomes.
  
  
  RESULTS
  Of 115 patients treated with ACT who met our response criteria and then developed progressive disease, 26 (23%) had surgery. There were no mortalities related to surgical intervention. Median follow-up after surgery was 62 months. Median PFS after surgery was 11 months and five-year OS was 57%. The development of a new site of metastasis after ACT was associated with poor PFS and OS.
  
  
  CONCLUSIONS
  Surgery after immunotherapy is safe. Long PFS and OS can be achieved by metastasectomy in selected patients with progressive melanoma following treatment with ACT. Clinical variables important for patient selection for metastasectomy after immunotherapy remain largely undefined. Improvements in immunotherapeutic treatment strategies may increase the role of surgery for patients with advanced disease.
authors.affiliation: Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Klemen
authors.affiliation: Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Feingold
authors.affiliation: Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Goff
authors.affiliation: Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Marybeth S
authors.initials: MS
authors.lastname: Hughes
authors.affiliation: Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Udai S
authors.initials: US
authors.lastname: Kammula
authors.affiliation: Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: James C
authors.initials: JC
authors.lastname: Yang
authors.affiliation: Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Schrump
authors.affiliation: Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Rosenberg
authors.affiliation: Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. SherryR@mail.nih.gov.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Sherry
mesh_terms: D019264:Adoptive Transfer; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000628:therapy*; D059146:Metastasectomy; D008875:Middle Aged; D016879:Salvage Therapy; D015996:Survival Rate; D016896:Treatment Outcome