New test to predict melanoma at risk for metastatic recurrence

Australian researchers have played a critical role in the discovery of a new test to predict which early stage melanoma patients are at high risk of their disease recurring and progressing.

A joint study led by researchers from Melanoma Institute Australia, The University of Sydney, Harvard Medical School, Sydney Local Health District and Adaptive Biotechnology analysed immune cells (known as T-cells) in primary melanoma samples taken from 209 patients, 164 of whom came from MIA.

The study, recently published in Nature Cancer, found that patients with a T-cell fraction (TCFr) of less than 20% in their primary melanoma were 2.5 times more likely to have disease progression than those with more than 20% TCFr.

The prognostic accuracy of molecular TCFr by HTS was superior to conventional TIL (tumor-infiltrating lymphocytes) assessment by histopathology.

The study was jointly led by Dr James Wilmott and Co-Medical Director Professor Richard Scolyer from Melanoma Institute Australia and researchers from Harvard Medical School.

‘These findings suggest analysing TCFr in primary melanomas is a valuable tool for predicting which patients are at risk of developing metastatic melanoma, ’ Dr Wilmott said.

‘This could enable us to personalise treatment for each patient based on their individual risk of recurrence and progression, and potentially target them earlier with immunotherapy,’ Professor Scolyer added.

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Australia has one of the highest melanoma rates in the world, with one person diagnosed every 30 minutes and one person dying every five hours from disease.

While 90% of early stage melanomas are cured with surgery alone, a subset of T2-T4 primary melanomas will recur metastatically within 5 years.

Recent advances in targeted and immunotherapies such as Nivolumab (Opdivo) and Ipilimumab (Yervoy) have significantly improved outcomes for Stage IV melanoma patients. However, the management of primary melanoma has remained relatively unchanged, with prognosis based principally on histopathological factors such as tumour thickness and ulceration.

‘This test offers the ability to identify primary melanoma patients at high risk of developing metastatic disease at their initial diagnosis,’ Dr Wilmott said. ‘These patients may benefit from close monitoring or the addition of adjuvant treatments to prevent their disease progressing.’

The authors concluded ‘In this fashion, measuring the TCFr of primary melanomas could help move the field towards individualised tumour treatment by matching patients with their optimal immunotherapeutic approach.’

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