Patient, disease and treatment characteristics at second recurrence
| Characteristics at second recurrence | Patient N=33 (%) | No adjuvant RT at first recurrence N=26 (%) | Adjuvant RT at first recurrence N=7 (%) | P value |
| Median time to second recurrence-months, (range) | 5 (1–22) | 5 (1–17) | 6 (4–22) | <0.001 |
| ECOG at recurrence—no. (%) | 0.46 | |||
| 0 | 23 (70) | 19 (73) | 4 (57) | |
| 1 | 8 (24) | 5 (19) | 3 (43) | |
| 2 | 2 (6) | 2 (8) | 0 (0) | |
| LDH—no. (%) | 0.35 | |||
| Above ULN | 6 (18) | 6 (23) | 0 (0) | |
| Below ULN | 12 (36) | 8 (31) | 4 (57) | |
| Unknown | 15 (46) | 12 (46) | 3 (43) | |
| Stage (AJCC eighth edition)—no. (%) | 0.37 | |||
| IIIB | 1 (3) | 1 (4) | 0 (0) | |
| IIIC | 18 (55) | 16 (62) | 2 (39) | |
| IV | 14 (42) | 9 (35) | 5 (71) | |
| Recurrence detected by—no. (%) | 0.26 | |||
| Symptoms | 5 (15) | 4 (15) | 1 (14) | |
| Clinical examination | 13 (39) | 12 (46) | 1 (14) | |
| Imaging | 15 (46) | 10 (39) | 5 (72) | |
| Recurrence site—no. (%) | 0.11 | |||
| Locoregional | 19 (58) | 17 (65) | 2 (29) | |
| Distant | 14 (42) | 9 (35) | 5 (71) | |
| Locoregional recurrence site (n=19)—no. (%) | 0.10 | |||
| Nodal only | 5 | 5 | 0 | |
| In-transit only | 13 | 11 | 2 | |
| Nodal and in-transit | 1 | 1 | 0 | |
| Systemic therapy—no. (%) | 0.22 | |||
| New agent started | 16 (48) | 11 (42) | 5 (71) | |
| BRAF/MEK inhibition | 5 | 3 | 2 | |
| Ipilimumab-nivolumab combination | 8 | 5 | 3 | |
| Other | 3 | 3 | 0 | |
| Pembrolizumab+TVEC | 1 | 1 | 0 | |
| TVEC | 1 | 1 | 0 | |
| Clinical trial (anti-PD-1+trial agent) | 1 | 1 | 0 | |
| Nil | 17 (52) | 15 (58) | 2 (29) |
Bold text signifies p<0.05
AJCC, American Joint Committee on Cancer; ECOG, Eastern Cooperative Oncology Group ; LDH, lactate dehydrogenase ; PD-1, programmed cell death protein-1 ; RT, radiotherapy; TVEC, talimogene laherparepvec; ULN, upper limit of normal.