26
|
Long GV, Atkinson V, Ascierto PA, Robert C, Hassel JC, Rutkowski P, Savage KJ, Taylor F, Coon C, Gilloteau I, Dastani HB, Waxman IM, Abernethy AP. Effect of nivolumab on health-related quality of life in patients with treatment-naïve advanced melanoma: results from the phase III CheckMate 066 study. Ann Oncol 2016; 27:1940-6. [PMID: 27405322 PMCID: PMC5035785 DOI: 10.1093/annonc/mdw265] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/29/2016] [Indexed: 01/14/2023] Open
Abstract
In patients with advanced melanoma in the CheckMate 066 study, baseline health-related quality of life (HRQoL) with nivolumab was maintained over time, with statistically significant and clinically meaningful improvements in some exploratory analyses, and no HRQoL improvements with dacarbazine. Added to the survival benefit of nivolumab, the benefit-to-risk ratio favors nivolumab over dacarbazine. Background Nivolumab has shown significant survival benefit and a favorable safety profile compared with dacarbazine chemotherapy among treatment-naïve patients with metastatic melanoma in the CheckMate 066 phase III study. Results from the health-related quality of life (HRQoL) analyses from CheckMate 066 are presented. Patients and methods HRQoL was evaluated at baseline and every 6 weeks while on treatment using the European Organisation for Research and Treatment of Care (EORTC) Core Quality of Life Questionnaire (QLQ-C30) and the EuroQoL Five Dimensions Questionnaire (EQ-5D). Via a multi-step statistical plan, data were analyzed descriptively, cross-sectionally, and longitudinally, adjusting for baseline covariates, in patients having baseline plus ≥1 post-baseline assessment. Results Baseline-adjusted completion rates for all HRQoL questionnaires across treatment arms were 65% and 70% for dacarbazine and nivolumab, respectively, and remained similar throughout treatment. The mean baseline HRQoL scores were similar for patients treated with nivolumab and dacarbazine. Baseline HRQoL levels with nivolumab were maintained over time. This exploratory analysis showed a between-arm difference in favor of nivolumab on the EQ-5D utility index and clinically meaningful EQ-5D improvements from baseline at several time points for patients receiving nivolumab. Patients treated with nivolumab did not show increased symptom burden as assessed by the EORTC QLQ-C30. No HRQoL change was noted with dacarbazine patients up to week 43, although the high attrition rate after week 13 did not allow any meaningful analyses. Patients receiving nivolumab deteriorated significantly later than those receiving dacarbazine on several EORTC QLQ-C30 scales and the EQ-5D utility index. Conclusions In addition to prolonged survival, these exploratory HRQoL results show that nivolumab maintains baseline HRQoL levels to provide long-term quality of survival benefit, compared with dacarbazine in patients with advanced melanoma.
Collapse
|
27
|
De Divitiis C, von Arx C, Grimaldi AM, Cicala D, Tatangelo F, Arcella A, Romano GM, Simeone E, Iaffaioli RV, Ascierto PA, Tafuto S. Metronomic temozolomide as second line treatment for metastatic poorly differentiated pancreatic neuroendocrine carcinoma. J Transl Med 2016; 14:113. [PMID: 27142424 PMCID: PMC4855772 DOI: 10.1186/s12967-016-0857-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 04/10/2016] [Indexed: 12/22/2022] Open
Abstract
Neuroendocrine Neoplasms (NEN) are a group of heterogeneous malignancies derived from neuroendocrine cell compartment, with different roles in both endocrine and nervous system. Most NETs have gastroentero-pancreatic (GEP) origin, arising in the foregut, midgut, or hindgut. The 2010 WHO classification divides GEP-NETs into two main subgroups, neuroendocrine tumors (NET) and neuroendocrine carcinomas (NEC), according with Ki-67 levels. NET are tumors with low (<20 %) Ki-67 value, and NECs, including small cell lung carcinomas and Merkel Cell carcinomas, are all NETs with high Ki-67 levels (>20 %–G3). Poorly differentiated neuroendocrine carcinomas (NEC) are usually treated with cisplatin-based chemotherapy regimens. Here we present a case of a patient with pancreatic NEC progressing after cisplatin and etoposide, treated with temozolomide as palliative, second line treatment. According with the poor Performance Status (PS = 2) and to reduce the toxicity of the treatment was chosen an intermittent dosing regimen of metronomic temozolomide (75 mg/m2/day—one-week-on/on-week-off). MGMT resulted methylated. On July 2014 the patient started the treatment. On August 2014 the patient obtained a significant clinical benefit (PS = 0) and the total body CT scan performed on October 2014 showed a RECIST partial response on all the sites of disease. No drug-related side effects were reported by the patient. After 18 months of therapy the treatment continues without significant toxicity, and with further remission of the metastases. Treatment with metronomic “one-week-on/on-week-off” Temozolomide can be considered a good treatment option in patients with poor performance status, affected by pNEC with MGMT methylation.
Collapse
|
28
|
Chiarion-Sileni V, Pigozzo J, Ascierto PA, Simeone E, Maio M, Calabrò L, Marchetti P, De Galitiis F, Testori A, Ferrucci PF, Queirolo P, Spagnolo F, Quaglino P, Carnevale Schianca F, Mandalà M, Di Guardo L, Del Vecchio M. Ipilimumab retreatment in patients with pretreated advanced melanoma: the expanded access programme in Italy. Br J Cancer 2014; 110:1721-6. [PMID: 24619072 PMCID: PMC3974075 DOI: 10.1038/bjc.2014.126] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 02/14/2014] [Accepted: 02/17/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Retreatment with ipilimumab has been shown to re-establish disease control in some patients with disease progression. Here, we report the efficacy and safety of retreatment with ipilimumab 3 mg kg(-1) among patients participating in an expanded access programme in Italy. METHODS Patients who achieved disease control during induction therapy were retreated with ipilimumab upon progression (3 mg kg(-1) every 3 weeks for up to four doses), providing they had not experienced toxicity that precluded further dosing. Tumour assessments were conducted after retreatment, and patients were monitored throughout for adverse events. RESULTS Of 855 patients treated with ipilimumab, 51 were retreated upon disease progression. Of these, 28 (55%) regained disease control upon retreatment and 42% were alive 2 years after the first induction dose of ipilimumab; median overall survival was 21 months. Eleven patients (22%) had a treatment-related adverse event of any grade during retreatment. These were generally mild-to-moderate and resolved within a median of 4 days. No new types of toxicity were reported. CONCLUSIONS For patients who meet predefined criteria, retreatment with ipilimumab is generally well tolerated and can translate into clinical benefit. This strategy should be compared with other therapeutic options in randomised controlled trials.
Collapse
|
29
|
Maio M, Danielli R, Chiarion-Sileni V, Pigozzo J, Parmiani G, Ridolfi R, De Rosa F, Del Vecchio M, Di Guardo L, Queirolo P, Picasso V, Marchetti P, De Galitiis F, Mandalà M, Guida M, Simeone E, Ascierto PA. Efficacy and safety of ipilimumab in patients with pre-treated, uveal melanoma. Ann Oncol 2013; 24:2911-5. [PMID: 24067719 DOI: 10.1093/annonc/mdt376] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Patients with advanced uveal melanoma have a poor prognosis and limited treatment options. Ipilimumab is approved for pre-treated adult patients with advanced melanoma. However, because previous clinical trials with ipilimumab have excluded patients with uveal melanoma, data in this patient population are limited. PATIENTS AND METHODS Pre-treated patients with advanced uveal melanoma received ipilimumab 3 mg/kg through an expanded access programme, every 3 weeks for four doses. Tumour assessments were conducted at baseline and after completion of treatment and patients were monitored throughout for adverse events. RESULTS Among 82 assessable patients, 4 (5%) had an immune-related objective response and 24 (29%) had immune-related stable disease lasting ≥3 months for an immune-related disease control rate of 34%. With a median follow-up of 5.6 months, median overall survival (OS) was 6.0 months and median progression-free survival (PFS) was 3.6 months. The 1-year rates of OS and PFS were 31% and 11%, respectively. The safety profile of ipilimumab was similar to that in patients with cutaneous melanoma. CONCLUSIONS These data suggest ipilimumab 3 mg/kg is a feasible option in pre-treated patients with metastatic uveal melanoma. Evidence of disease control and a 1-year survival rate of 31% indicate the need for further investigation in randomised, controlled trials to determine the optimal timing and use of ipilimumab in this patient population.
Collapse
|
30
|
Queirolo P, Morabito A, Laurent S, Lastraioli S, Piccioli P, Ascierto PA, Gentilcore G, Serra M, Marasco A, Tornari E, Dozin B, Pistillo MP. Association of CTLA-4 polymorphisms with improved overall survival in melanoma patients treated with CTLA-4 blockade: a pilot study. Cancer Invest 2013; 31:336-45. [PMID: 23641913 DOI: 10.3109/07357907.2013.793699] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
CTLA-4 blockade with monoclonal antibodies can lead to cancer regression in patients with metastatic melanoma (MM). CTLA-4 gene polymorphisms may influence the response to anti-CTLA-4 antibodies although few data are available regarding this issue. We analyzed six CTLA-4 single nucleotide polymorphisms (-1661A > G, -1577G > A, -658C > T, -319C > T, +49A > G, and CT60G > A) in 14 Italian MM patients and 45 healthy subjects. We found a significant association between the -1577G/A and CT60G/A genotypes and improved overall survival (Pc < 0.006, Bonferroni corrected), further confirmed by the diplotype analysis (-1577 & CT60 GG-AA diplotype, p < 0.001). A positive trend toward an association between these genotypes and response to therapy was also observed.
Collapse
|
31
|
Chapman PB, Hauschild A, Robert C, Larkin JMG, Haanen JBAG, Ribas A, Hogg D, O'Day S, Ascierto PA, Testori A, Lorigan P, Dummer R, Sosman JA, Garbe C, Lee RJ, Nolop KB, Nelson B, Hou J, Flaherty KT, McArthur GA. Phase III randomized, open-label, multicenter trial (BRIM3) comparing BRAF inhibitor vemurafenib with dacarbazine (DTIC) in patients with V600EBRAF-mutated melanoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.18_suppl.lba4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA4 Background: About 50% of melanomas have an activating V600EBRAF mutation which led to the hypothesis that inhibition of the mutated BRAF kinase may be of clinical benefit. Phase I and II trials with vemurafenib (previously PLX4032/RO5185426), an orally available inhibitor of oncogenic BRAF kinase, showed response rates (RR; CR+PR) >50% in V600EBRAF- mutated melanoma patients (pts). We conducted a phase III trial to determine if vemurafenib improved overall survival (OS) and progression-free survival (PFS) in melanoma pts with V600EBRAF mutation. Methods: Pts with previously untreated, unresectable stage IIIC or stage IV melanoma that tested positive for V600EBRAF mutation by the cobas 4800 BRAF V600 Mutation Test were randomized (1:1) to vemurafenib (960 mg po bid) or DTIC (1,000 mg/m2, IV, q3w). Randomization was stratified by PS, stage, LDH, and geographic region. Pts were assessed for tumor responses after weeks 6, 12, and then q9 weeks. Co-primary endpoints were OS and PFS on the intent-to-treat population; secondary endpoints included RR, response duration, and safety. Final analysis was planned at 196 deaths. Results: 675 pts were enrolled at 103 centers worldwide between Jan and Dec 2010. Treatment cohorts were well-balanced. At the pre-planned interim analysis (50% of deaths needed for final analysis), the hazard ratios for OS and PFS were 0.37 (95% CI 0.26 to 0.55; p<0.0001) and 0.26 (95% CI 0.20 to 0.33; p<0.0001), respectively, both in favor of vemurafenib. The confirmed RR was 48.4% and 5.5% to vemurafenib and DTIC, respectively, among the 65% of pts evaluable for RR to date. Benefit in OS, PFS, and RR was seen in all subgroups examined. Due to these data, the DTIC cohort has been allowed to cross over to vemurafenib. At the time of data analysis, 66% of vemurafenib pts and 25% DTIC pts were still on treatment. The most common toxicities of vemurafenib were: diarrhea, rash, alopecia, photosensitivity, fatigue, arthralgia, and keratoacanthoma/skin squamous cell carcinoma. Conclusions: Vemurafenib is associated with significantly improved OS and PFS compared to DTIC in pts with previously untreated, V600EBRAF-mutated metastatic melanoma.
Collapse
|
32
|
Queirolo P, Morabito A, Piccioli P, Lastraioli S, Callegari S, Camoriano M, Ascierto PA, Laurent S, Dozin B, Pistillo MP. Analysis of CTLA-4 gene polymorphisms in patients with advanced melanoma treated with anti-CTLA-4 therapy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
33
|
Chapman PB, Hauschild A, Robert C, Larkin JMG, Haanen JBAG, Ribas A, Hogg D, O'Day S, Ascierto PA, Testori A, Lorigan P, Dummer R, Sosman JA, Garbe C, Lee RJ, Nolop KB, Nelson B, Hou J, Flaherty KT, McArthur GA. Phase III randomized, open-label, multicenter trial (BRIM3) comparing BRAF inhibitor RG7204 with dacarbazine in patients with V600E BRAF-mutated melanomas. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.lba4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
34
|
Petrini M, Ridolfi L, Fiammenghi L, Napolitano M, Granato AM, Ancarani V, Pancisi E, Guidoboni M, Nicoletti S, Valmorri L, Riccobon A, Migliori G, Venanzi FM, Ascierto PA, Ridolfi R. Dendritic cell (DC) vaccination with low dose temozolomide phase I/II trial in melanoma patients: Preliminary data on peripheral blood regulatory t-cells (Treg) and DC-TEM8 expression modulations. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
35
|
Colombino M, Capone M, Maio M, De Giorgi V, Cossu A, Lissia A, Rubino C, Massidda B, Staibano S, Nappi O, Botti G, Caraco C, Mozzillo N, Manca A, Sini M, Ascierto PA, Palmieri G. Mutation frequency in BRAF and NRAS genes among primary tumors and different types of metastasis from melanoma patients. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
36
|
Di Giacomo AM, Ascierto PA, Fonsatti E, Pittiglio E, Queirolo P, Pilla L, Ridolfi R, Santinami M, Testori A, Parmiani G, Maio M. A phase II study combining ipilimumab and fotemustine in patients with metastatic melanoma: The NIBIT-M1 trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps230] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
37
|
Ridolfi L, Fiammenghi L, Petrini M, Granato A, Ancarani V, Pancisi E, Guidoboni M, Riccobon A, Ascierto PA, Ridolfi R. Low-dose temozolomide modulation of peripheral blood regulatory T cells before dendritic cell-based vaccination in metastatic melanoma: Phase I/II study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.tps311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
38
|
Eggermont AM, Suciu S, Rutkowski P, Marsden J, Testori A, Corrie P, Aamdal S, Ascierto PA, Patel P, Spatz A. Randomized phase III trial comparing postoperative adjuvant ganglioside GM2-KLH/QS-21 vaccination versus observation in stage II (T3-T4N0M0) melanoma: Final results of study EORTC 18961. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8505] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
39
|
Palmieri G, Casula M, Budroni M, Cossu A, Tanda F, Ascierto PA, Canzanella S, Palomba G, Colombino M, Muggiano A. Correlation of polymorphic variants into the susceptibility of CDKN2 locus with melanoma outcome. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
40
|
Vozza A, Di Girolamo F, Montesarchio G, Capuano A, Ascierto PA, Vozza G. Kerion Celsi favored by the use of a tretinoin+minoxidil+betamethasone valerate lotion in a 28-year-old woman. GIORN ITAL DERMAT V 2010; 145:313-315. [PMID: 20467404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Kerion Celsi is a parasitic fungal skin infection that tends to occur mainly on the back of the neck, scalp or beard. It is caused by animal fungi. Sometimes the condition resolves itself in a matter of weeks but hair loss in the affected area may be permanent. We report a case of a young woman with Kerion Celsi favored by the use of a tretinoin+minoxidil+betametasone valerate lotion.
Collapse
|
41
|
Casula M, Budroni M, Cossu A, Ascierto PA, Mozzillo N, Canzanella S, Muggiano A, Palmieri G. The susceptibility CDKN2 locus may have a role on prognosis of melanoma patients. Ann Oncol 2010; 21:1379-1380. [PMID: 20231302 DOI: 10.1093/annonc/mdq056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
42
|
Simeone E, Daponte A, De Feo G, Montesarchio V, Chiarion-Sileni V, De Michele I, Caracò C, Palmieri G, Mozzillo N, Ascierto PA. Metronomic schedule of temozolomide with conventional dose of cisplatin in metastatic melanoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20009 Background: Dacarbazine (DTIC) is the standard treatment for metastatic melanoma. Temozolomide (TMZ) is a potentially attractive chemotherapeutic agent for this disease because of the oral route of administration and efficacy similar to that of dacarbazine. Cisplatin is active against melanoma and might counteract mechanisms of resistance to TMZ. Metronomic administration of TMZ might be another way to overcome resistance. Patients and Methods: We reviewed data of metastatic melanoma patients treated at our Institutions with cisplatin (75 mg/m2 every 28 days) plus TMZ (75 mg/m2/die from day 2 for 21 days). Our practice included such scheme for patients younger than 75 years, with a performance status not worse than 2, and adequate bone marrow, liver and renal function. Assessment of response was done every 3 cycles. Toxicity was graded according to NCI-CTC. Results: From August 2007 to September 2008, 33 patients were treated with a median age of 44 years (18–74); primary melanoma was ulcerated in 19 cases (58%); most frequent sites of metastases were lung (18 cases), brain and lymph nodes (11 cases each); 29 patients were treated as first-line and 4 as second-line. The median number of delivered cycles was 4 (range 2- 8). Toxicity was mild, with no grade 4 event reported. Nausea and vomiting were the most frequent and severe toxic effects: grade 3 in 2 cases each and grade 2 in 16 and 9 cases, respectively. Other toxicities included thrombocytopenia (2 case grade 3 and 3 cases grade 2), anemia (1 grade 3 and 4 grade 2), neutropenia, and fatigue (1 grade 3 each). Overall, 6 patients had a partial response (18.2%; 95% exact CI: 7.0–35.5) and 8 (24%) had a disease stabilization. With a median follow-up of 20 weeks (95% CI: 19–57), there were 19 progressions and a median progression-free survival of 24 weeks (95% CI:16-nr); 9 patients died with a median survival of 50 weeks (95% CI 43-nr). Conclusions: Results obtained in clinical practice with metronomic temozolomide plus cisplatin in the treatment of patients with metastatic melanoma are encouraging, in light of the negative prognostic features of treated patients. We are now planning a formal phase II study. [Table: see text]
Collapse
|
43
|
Ascierto PA, Napolitano M, Celentano E, Simeone E, Gentilcore G, Capone M, Ciccarelli L, Palmieri G, Castello G, Mozzillo N. Reduction of circulating regulatory T cell (Treg) by intravenous high-dose interferon (HDI) treatment in melanoma patients. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9040 Background: T regulatory (Treg) cells are an immunoregulatory cell type which express high levels of surface CD25, CTLA-4, and GITR. Tregs have been shown to be present in tumor and tumor-draining lymph nodes, acting as an inhibitory population blocking effector cell function. Depletion or blockade of Tregs might be able to enhance antitumor immunity. Recent evidence has been reported about the possibility of High Dose Interferon (HDI) to act through an indirect immunomodulatory mechanism (Gogas, NEJM 2006; Moschos JCO 2006). We started a study to verify if iv HDI treatment in melanoma patients could be able to reduce the number of Treg cells in peripheral blood. Methods: Analysis was performed on melanoma pts referring to the National Cancer Institute of Naples since July 2006 and who addressed to Neoadjuvant or Adjuvant treatment with iv HDI (20 MUI/m2, 5 days per week) for 4 wks. Peripheral blood mononuclear cells (PBMC) were obtained from 22 consecutive melanoma pts. Blood draw was performed at days 0, 8, 15, 22 and 29. PBMC were thawed and labeled with anti-CD4 and anti-CD25hi (BD, San Diego, CA) and anti-FoxP3 (eBioscience, San Diego, CA). Labeled cells were analyzed using a FACScalibur (Becton Dickinson). Results: Fifteen (68.2%) out of 22 pts showed a decrease of Treg cells in peripheral blood. The average value at day 0 for circulating Treg (cTreg) was 2.7%. The average percentage at day 29 was 1.4%. The average reduction was 1,4 (50% reduction in the average value of cTreg). Statistical analysis showed an average decrease of 0.29% per week of treatment. Despite of this clear trend in reducing cTreg by HDI, statistical significance was not reached (probably due to the power of the study). Moreover, it has been observed great differences between the disease status, the prognosis (recurred/not recurred pts, alive/deceased) and an increased basal percentage of cTreg. Our preliminary data are consistent for an effect of HDI on reducing cTreg, although no conclusion about the role of such reduction in terms of response to treatment or as prognostic markers of better/worse disease can be inferred. Further data are awaited in order to verify if the Treg reduction after a HDI treatment may indeed contribute to the antitumor response. [Table: see text]
Collapse
|
44
|
Pisano M, Baldinu P, Sini MC, Ascierto PA, Tanda F, Palmieri G. Targeting Bcl-2 protein in treatment of melanoma still requires further clarifications. Ann Oncol 2008; 19:2092-3. [PMID: 18977852 DOI: 10.1093/annonc/mdn672] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
45
|
Eggermont AM, Suciu S, Ruka W, Marsden J, Testori A, Corrie P, Aamdal S, Ascierto PA, Patel P, Spatz A. EORTC 18961: Post-operative adjuvant ganglioside GM2-KLH21 vaccination treatment vs observation in stage II (T3-T4N0M0) melanoma: 2nd interim analysis led to an early disclosure of the results. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9004] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
46
|
Palmieri G, Sini MC, Casula M, Baldinu P, Palomba G, Colombino M, Ascierto PA, Botti G, Caracò C, Cossu A, Tanda F. Molecular classification for the management of melanoma patients. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.20028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
47
|
Palmieri G, Casula M, Sini MC, Ascierto PA, Cossu A. Issues affecting molecular staging in the management of patients with melanoma. J Cell Mol Med 2008; 11:1052-68. [PMID: 17979882 PMCID: PMC4401272 DOI: 10.1111/j.1582-4934.2007.00091.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Prediction of metastatic potential remains one of the main goals to be pursued in order to better assess the risk subgroups of patients with melanoma. Detection of occult melanoma cells in peripheral blood (circulating metastatic cells [CMC]) or in sentinel lymph nodes (sentinel node metastatic cells [SNMC]), could significantly contribute to better predict survival in melanoma patients. An overview of the numerous published studies indicate the existence of several drawbacks about either the reliability of the approaches for identification of occult melanoma cells or the clinical value of CMC and SNMC as prognostic factors among melanoma patients. In this sense, characterization of the molecular mechanisms involved in development and progression of melanoma (referred to as melanomagenesis) could contribute to better classify the different subsets of melanoma patients. Increasing evidence suggest that melanoma develops as a result of accumulated abnormalities in genetic pathways within the melanocytic lineage. The different molecular mechanisms may have separate roles or cooperate during all evolutionary phases of melanocytic tumourigenesis, generating different subsets of melanoma patients with distinct aggressiveness, clinical behaviour, and response to therapy. All these features associated with either the dissemination of occult metastatic cells or the melanomagenesis might be useful to adequately manage the melanoma patients with different prognosis as well as to better address the different melanoma subsets toward more appropriate therapeutic approaches.
Collapse
|
48
|
Sini MC, Manca A, Cossu A, Budroni M, Botti G, Ascierto PA, Cremona F, Muggiano A, D'Atri S, Casula M, Baldinu P, Palomba G, Lissia A, Tanda F, Palmieri G. Molecular alterations at chromosome 9p21 in melanocytic naevi and melanoma. Br J Dermatol 2007; 158:243-50. [PMID: 18028495 DOI: 10.1111/j.1365-2133.2007.08310.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The chromosome 9p21 and its CDKN locus, with the p16 tumour suppressor gene (CDKN2A), are recognized as the genomic regions involved in the pathogenesis of melanoma. OBJECTIVES To elucidate further the role of such regions during the different phases of melanocytic tumorigenesis. METHODS Tissue sections from naevi, primary and metastatic melanomas were investigated by fluorescence in situ hybridization for allelic loss at the 9p21 chromosome and by immunochemistry for p16CDKN2A expression. RESULTS Dysplastic naevi and primary or secondary melanomas were found to carry hemizygous deletions within the entire 9p21 region at similar frequencies (varying from 55% to 62%). Allelic deletion spanning the CDKN locus was observed at significantly increased rates moving from early (7%) to advanced (28%) primary melanomas and to secondary melanoma lesions (37%) (P=0.018). Also, inactivation of the p16 gene (CDKN2A) was absent in naevi and present at steadily increasing rates moving from primary melanomas (7% early lesions to 17% advanced lesions) to melanoma metastases (62%) (P=0.004). CONCLUSIONS Our findings indicate that, in a model of sequential accumulation of genetic alterations, 9p21 deletions may play a role in melanocytic transformation and tumour initiation whereas rearrangements at the CDKN locus, and p16 gene (CDKN2A) inactivation may contribute to tumour progression.
Collapse
|
49
|
Ascierto PA, Budroni M, Cossu A, Scala S, Simeone E, Giuliano P, Satriano SM, Caracò C, Casula M, Palmieri G. Serial RT-PCR detection of circulating tumour cells as a marker of disease progression in patients with malignant melanoma. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.18009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
18009 Background: Detection of circulating malignant cells (CMCs) through a reverse transcriptase-polymerase chain reaction (RT-PCR) assay seems to be a demonstration of systemic disease. We here evaluated the prognostic role of RT-PCR assays in serially-taken peripheral blood samples from patients with malignant melanoma (MM). Methods: One hundred forty-nine melanoma patients with disease stage ranging from I to III were consecutively collected in 1997. A multi-marker RT-PCR assay was used on peripheral blood samples obtained at time of diagnosis and every 6 months during the first two years of follow-up (total: 5 samples). Univariate and multivariate analyses were performed after 83 months of median follow-up. Results: Detection of at least one circulating mRNA marker was considered a signal of the presence of CMC (referred to as PCR-positive assay). A significant correlation was found between the rate of recurrences and the increasing number of PCR-positive assays (P = 0.007). Presence of CMC in a high number (≥2) of analysed blood samples was significantly correlated with a poor clinical outcome (disease-free survival: P = 0.019; overall survival: P = 0.034). Multivariate analysis revealed that presence of a PCR-positive status does play a role as independent prognostic factors for overall survival in melanoma patients, adding precision to the predictive power of the disease stage. Conclusions: Our findings indicated that serial RT-PCR assay may identify a high risk subset of melanoma patients with occult cancer cells constantly detected in blood circulation. Prolonged presence of CMCs seems to act as a surrogate marker of disease progression or a sign of more aggressive disease. No significant financial relationships to disclose.
Collapse
|
50
|
Palmieri G, Casula M, Colombino M, Satta MP, Rozzo C, Ascierto PA, Castello G, Bianchi-Scarrà G, Cossu A, Tanda F. BRAF gene contributes to melanoma pathogenesis but not to melanoma susceptibility. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.9584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|