Treatment patterns and outcomes in patients with advanced melanoma in France

BACKGROUND

Melanoma is associated with high mortality and poor response to standard chemotherapy. In order to benchmark benefits of recently introduced treatments, outcome with standard chemotherapy in everyday practice should be documented.

OBJECTIVES

To document treatment pathways in patients with advanced melanoma, to compare clinical outcomes between treatment lines, and to measure associated healthcare resource utilisation in terms of hospital visits and adverse event management.

METHODS

An observational, longitudinal survey of patients with unresectable stage III/IV melanoma in France evaluated 278 patients with ≥ 2 months follow-up. Data were collected retrospectively for 2-3 years following the index consultation. Treatment history was documented and outcomes determined for each treatment line. Complete and partial response rates were compared between treatment lines. Overall and progression-free survival were determined by Kaplan-Meier analysis. Health resource utilisation was documented hospitalisations, hospice stays, emergency room visits, outpatient visits and adverse event management.

RESULTS

In total, 271 patients (97.5%) received first-line therapy, 161 (57.9%) second-line therapy and 85 (30.6%) third-line therapy. The most frequent first-line therapy strategies were systemic treatment alone (46.5%) or in combination with surgery (22.9%). The most frequently used chemotherapy was dacarbazine monotherapy (62.3% of chemotherapy). Median duration of first-line systemic therapy was 11.9 (IQR: 6.6-24.0) weeks. First-line therapy was discontinued in 190 patients (68.3%), principally due to disease progression (150 patients). Median overall survival was 17.1 (95% CI: 14.6-20.1) months since diagnosis, 9.5 (95% CI: 6.7-12.8) months since initiation of first-line therapy and 5.3 (95% CI: 3.7-7.2) months since initiation of second-line therapy. Median progression-free survival time was 2.8 (95% CI: 2.5-3.3) months. Ninety-six patients (40.2%) received medication to manage adverse events and 131 patients (47.1%) required hospitalisation (mean: 3.1 hospitalisations; mean duration: 27 days).

STUDY LIMITATIONS

The retrospective data collection precludes ascertainment of medical information and completion of missing data.

CONCLUSIONS

Existing therapies provide limited survival benefit to patients with unresectable stage III/IV melanoma. New more effective treatment options are needed.

Prevalence and clinical significance of anti-laminin 332 autoantibodies detected by a novel enzyme-linked immunosorbent assay in mucous membrane pemphigoid

IMPORTANCE

A rare variant of mucous membrane pemphigoid (MMP) is characterized by circulating anti-laminin 332 (Lam332) autoantibodies and seems to be associated with concurrent malignant neoplasms.

OBJECTIVE

To determine the prevalence and clinical significance of anti-Lam332 autoantibody detection from a large series of patients with MMP.

DESIGN

Multicenter retrospective study.

SETTING

Four French national centers for autoimmune bullous diseases.

PARTICIPANTS

One hundred fifty-four patients with MMP and 89 individuals serving as controls were included.

INTERVENTIONS

Serum samples were analyzed by a new Lam332 enzyme-linked immunosorbent assay (ELISA); clinical and immunopathologic data were obtained from the patients' medical records.

MAIN OUTCOME MEASURES

The Lam332 ELISA scores were evaluated with respect to clinical characteristics, standard and salt-split indirect immunofluorescence, and bullous pemphigoid (BP) 230 and BP180-NC16A ELISAs.

RESULTS

The Lam332 ELISA score was positive (≥9 U/mL) in 20.1% of serum samples from patients with MMP, 1 of 50 patients with bullous pemphigoid (BP), none of 7 with pemphigus, and 3 of 32 other controls. No relationship was evidenced between a positive ELISA Lam332 score and age; sex ratio; oral, ocular, genital, skin, or esophageal/laryngeal involvement; internal malignant neoplasm; or BP180 ELISA score. Salt-split skin indirect immunofluorescence and ELISA BP230 results were more frequently positive when Lam332 ELISA results were positive (P = .04 and .02, respectively). Patients with a positive Lam332 ELISA score frequently had more severe MMP (67.8% vs 47.2%; P = .04).

CONCLUSIONS AND RELEVANCE

Results of this novel ELISA showed that serum anti-Lam332 autoantibodies are detected in 20.1% of patients with MMP. Anti-Lam332 autoantibodies are mainly detected in patients with severe MMP but not preferentially in those with a malignant neoplasm. The association between anti-Lam332 and anti-BP230 autoantibodies might arise from an epitope-spreading phenomenon.

Adjuvant prophylactic regional radiotherapy versus observation in stage I Merkel cell carcinoma: a multicentric prospective randomized study

BACKGROUND

The treatment of stage I Merkel cell carcinoma (MCC) usually includes wide local excision (WLE) combined with irradiation of the tumor bed (ITB). No randomized study has ever been conducted in MCC. The purpose of this study was to assess the efficacy and safety of prophylactic adjuvant radiotherapy on the regional nodes.

PATIENTS AND METHODS

In this randomized open controlled study, patients for a stage I MCC treated by WLE and ITB were randomly assigned to regional adjuvant radiotherapy versus observation. Overall survival (OS) and probability of regional recurrence (PRR) were primary end points. Progression-free survival (PFS) and tolerance of irradiation were secondary end points.

RESULTS

Eighty-three patients were included before premature interruption of the trial, due to a drop in the recruitment mainly due to the introduction of the sentinel node dissection in the management of MCC. No significant improvement in OS (P = 0.989) or PFS (P = 0.4) could be demonstrated after regional irradiation, which, however, significantly reduced the PRR (P = 0.007) with 16.7% regional recurrence rate in the observation arm versus 0% in the treatment arm. The treatment was well tolerated.

CONCLUSION

The adjuvant regional irradiation significantly decreased the PRR in MCC, but benefit in survival could not be demonstrated.

Blue light is phototoxic for B16F10 murine melanoma and bovine endothelial cell lines by direct cytocidal effect

The large number of studies devoted to the effect of ultraviolet light on biological systems, contrasts with the lack of experimental data concerning the direct effects of visible light. It has been shown that blue light inhibited the growth of B16F10 melanoma cell lines and reduced the percentage of S phase cells. Yet these effects are poorly understood.

MATERIALS AND METHODS

Two cell lines and irradiation with blue light were used. Cell mortality and a possible mechanism of action were investigated.

RESULTS

Exposure of B16F10 melanoma and bovine endothelial cells to blue light (wavelength 450 nm, 10 J/cm(2) from a Waldman lamp) induced a rapid and large reduction in viability followed by the death of virtually all the irradiated cells within 24 h. These results led us to expose a patient with haemorrhagic cutaneous melanoma metastasis to blue light. Irradiation led to an immediate arrest of haemorrhage, an inhibition of tumour growth and extensive tumour necrosis 24h after irradiation.

CONCLUSION

Exposure to blue light may offer new approaches to the treatment of superficial skin carcinomas in humans.