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. 2019 Sep 19;216(12):2701–2713. doi: 10.1084/jem.20190738

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© 2019 Tokunaga et al.

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Figure 5. — Low-mutation burden and early corticosteroid administration in patients treated with anti–CTLA-4 mAb are associated with poor prognosis. (A) Kaplan–Meier curve for OS of 86 malignant melanoma patients treated with anti–CTLA-4 mAb. (B) Kaplan–Meier curves for OS by corticosteroid treatment; 7 wk (used steroids, n = 23, did not use steroids, n = 62, right) and 16 wk (used steroids, n = 38, did not use steroids, n = 42, left). (C–E) Kaplan–Meier curves for OS of corticosteroid-treated patients, classified on the basis of high (>22 mutations)/low (≤ 22 mutations)–mutation burdens determined by MSK-IMPACT, a next-generation sequencing technique that can identify alterations in 468 cancer-associated genes, to identify tumor mutation burden (C); any corticosteroid administration to patients with high-/low-mutation burdens (high-mutation/used corticosteroids, n = 15, high-mutation/not used corticosteroids, n = 10, low-mutation/used corticosteroids, n = 22, low-mutation/not used corticosteroids, n = 21; D), and early (≤7 wk)/late (>7 wk) corticosteroid administration to patients with high-/low-mutation burdens (high-mutation/early, n = 8, high-mutation/late, n = 7, low-mutation/early, n = 12, low-mutation/late, n = 10; E). (F) Representative computed tomography scans of early corticosteroid-treated patient with low-mutation burden before (left) and 14 wk after anti–CTLA-4 mAb treatment with evidence of new and progressive pulmonary metastases (right). Scale bars, 50 mm. (G) Representative positron emission tomography images of late corticosteroid-treated patient with high-mutation burden before (left) and 134 wk after anti–CTLA-4 mAb treatment (right). Statistical analysis by log-rank test.