Clinical profile and outcomes of malignant melanoma in patients from an Indian institute: A retrospective analysis
Sorun Shishak1, Abhenil Mittal2, Harshal Aswar2, Rambha Pandey1, Kaushal Kalra2, Aarushi Gupta3, Adarsh Barwad4, Ekta Dhamija5, Shamim Ahmed Shamim6, Aditi Aggarwal7, Soorej Balan Kaliyath1, Sameer Rastogi2
1 Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
2 Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
3 Department of Radiodiagnosis, ABVIMS and Dr. RML Hospital, New Delhi, India
4 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
5 Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
6 Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
7 Department of Radiation Oncology, Paras Hospital, Gurugram, Haryana, India
Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
Background: The profile of patients with malignant melanoma in Asian countries is distinctly disparate from that of those in Western countries. Malignant melanoma is a rare malignancy with scarce literature from India.
Objectives: We aimed to describe the clinical profiles and outcomes of Indian patients with advanced malignant melanoma.
Materials and Methods: We retrospectively analyzed the data of consecutive patients with malignant melanoma who presented to the bone and soft tissue sarcoma clinic at the All India Institute of Medical Sciences, New Delhi, between January 2016 and March 2019. Our primary endpoint was to evaluate the clinical profile of the patients and the patterns of treatment. The secondary endpoints were response rate, progression-free survival (PFS), and overall survival (OS).
Results: We included 93 patients in the cohort, with a median age of 53 years (range, 25–85). The majority of patients were men (61.3%); almost half had an Eastern Cooperative Oncology Group performance status of 2 or greater. Most (89.2%) patients had metastases at presentation. The most common primary sites were anorectal (24.7%), acral (24.7%), ocular (17.2%), head and neck (15.1%), and thigh (9.7%). The median number of metastatic sites at presentation was 2, with the most common sites of metastases being the lymph nodes (57%), lung (48.3%), liver (35.5%), and bone (25.8%). BRAF V600E mutation was present in three out of four tested patients, while c-KIT mutation was present in two out of seven tested patients. At a median follow-up of 18 months, the median PFS was 2 months (95% confidence interval, 1.2–2.7 months) and median OS was 7 months.
Conclusion: Acral/mucosal melanoma is the most common melanoma among Indians and has poor outcomes. Limited access of patients with melanoma to standard-of-care therapeutic options remains an important issue in a resource-constrained country like India.