# Immune checkpoint inhibitor outcomes and prognostic factors in gynecologic tract melanoma: a single-center analysis

## TL;DR

This study examines the effectiveness of immune checkpoint inhibitors in treating gynecologic tract melanoma and identifies factors that may influence patient survival.

## Contribution

The study provides insights into the limited efficacy of immune checkpoint inhibitors in gynecologic tract melanoma and identifies potential prognostic factors for survival.

## Key findings

- Immune checkpoint inhibitors showed limited efficacy in treating gynecologic tract melanoma.
- Lactate dehydrogenase levels were significantly associated with overall survival in multivariate analysis.
- Family history of cancer and AJCC stage were associated with better outcomes in univariate analysis.

## Abstract

Gynecologic tract melanoma (GTM) is a rare and aggressive malignancy with limited treatment options and poor prognosis. This study aims to evaluate the outcomes of immune checkpoint inhibitors (ICIs) in patients with GTM and identify prognostic factors influencing survival.

A retrospective analysis was conducted on 45 patients diagnosed with GTM at West China Second University Hospital from January 2019 to September 2024. Data on demographics, clinical characteristics, treatments, and outcomes were collected. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier curves and Cox proportional-hazards models.

Among 45 patients, 24 had vaginal melanoma, 18 had vulvar melanoma, and 3 had cervical melanoma. ICIs were administered to 21 patients, but no significant survival benefit was observed. The 1-, 3-, and 5-year survival rates were 87%, 63%, and 31%, respectively. Univariate analysis revealed that patients with a family history of cancer (FHC) and those with lactate dehydrogenase (LDH) levels ≤230 had better PFS. Additionally, FHC, American Joint Committee on Cancer (AJCC) stage I-II, absence of pelvic lymph node metastasis, and LDH levels ≤230 were associated with improved OS. However, in multivariate analysis, only LDH was significantly associated with OS.

This single-center study suggests that ICIs have limited efficacy in treating GTM, emphasizing the need for further investigation through larger, multicenter clinical trials. Prognostic factors such as FHC, AJCC stage, lymph node involvement, and LDH levels may aid in risk stratification and personalized treatment planning. However, due to the nature of this study, external cohorts are still needed for validation.