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Wang X, Luo Z, Chen J, Chen Y, Ji D, Fan L, Chen L, Zhao Q, Hu P, Sun P, Jia Z, Guo J, Si L. First-in-human phase I dose-escalation and dose-expansion trial of the selective MEK inhibitor HL-085 in patients with advanced melanoma harboring NRAS mutations. BMC Med 2023; 21:2. [PMID: 36600247 PMCID: PMC9814429 DOI: 10.1186/s12916-022-02669-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 11/18/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND HL-085 is a selective, orally administered MEK1/2 inhibitor. We aimed to evaluate the safety and efficacy of HL-085 in patients with advanced melanoma harboring NRAS mutations. METHODS This was a multicenter phase 1 study. HL-085 was administered twice daily in a standard 3 + 3 dose-escalation design (10 dose cohorts; 0.5-18 mg twice daily), followed by dose expansion at the recommended phase II dose (RP2D). The primary endpoints included tolerability, dose-limiting toxicity (DLT), maximum tolerated dose (MTD) and RP2D. RESULTS Between September 13, 2017, and January 18, 2021, 42 patients were enrolled (dose escalation phase: n = 30; dose expansion phase: n = 12). No DLT was reported during dose escalation and MTD was not reached with HL-085 doses up to 18 mg twice daily. The RP2D was 12 mg twice daily. The most common all-grade drug-related adverse events (AEs) across all dose levels were rash (61.9%), increased creatine phosphokinase (CK, 59.5%), face edema (50.0%), increased aspartate aminotransferase (47.6%), peripheral edema (40.5%), diarrhea (33.3%), alanine aminotransferase (33.3%), and paronychia (19.0%), most of which were grade 1 and 2. Most frequency of grade ≥ 3 AEs were CK (14.2%), asthenia (7.1%), peripheral edema (4.8%), and acneiform dermatitis (4.8%). In the cohort of 12 mg twice daily dose (15 patients), confirmed objective response rate was 26.7%; disease control rate was 86.7%; median duration of response was 2.9 months; median progression-free survival was 3.6 months. CONCLUSIONS The HL-085 showed acceptable tolerability and substantial clinical activity in patients with advanced melanoma harboring NRAS mutations. TRIAL REGISTRATION Trial registration ClinicalTrials.gov number: NCT03973151.
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Affiliation(s)
- Xuan Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Research Institute, Beijing, China
| | - Zhiguo Luo
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jing Chen
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Chen
- Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Dongmei Ji
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Li Fan
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Chen
- Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Qian Zhao
- Clinical Pharmacology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, NMPA Key Laboratory for Clinical Research and Evaluation of Drug, Beijing Key Laboratory of Clinical PK and PD Investigation for Innovative Drugs, Beijing, China
| | - Pei Hu
- Clinical Pharmacology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, NMPA Key Laboratory for Clinical Research and Evaluation of Drug, Beijing Key Laboratory of Clinical PK and PD Investigation for Innovative Drugs, Beijing, China
| | - Peng Sun
- Department of Clinical Research and Development, Shanghai Kechow Pharma, Inc., Shanghai, China
| | - Zhongwei Jia
- Department of Clinical Research and Development, Shanghai Kechow Pharma, Inc., Shanghai, China
| | - Jun Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Research Institute, Beijing, China.
| | - Lu Si
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Research Institute, Beijing, China.
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Khan M, Thompson J, Kiiskila L, Oboh O, Truong T, Prentice A, Assifi MM, Chung M, Wright GP. Timing and necessity of staging imaging in clinical stage II cutaneous melanoma: Cost-effectiveness and clinical decision analysis. Am J Surg 2023; 225:93-98. [PMID: 36400601 DOI: 10.1016/j.amjsurg.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 10/02/2022] [Accepted: 10/12/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Preoperative imaging in clinical stage II melanoma is not indicated per National Comprehensive Cancer Network (NCCN) guidelines but remains common in clinical practice. METHODS Patients presenting with cutaneous clinical stage II melanoma from 2007 to 2019 were retrospectively reviewed. A clinical decision analysis with cost data was designed to understand ideal practice patterns in managing stage II melanoma, with pre-versus selective post-operative imaging as the initial decision node. RESULTS There were 277 subjects included, and 143 underwent preoperative imaging (49.5%). This changed management (i.e. no surgery) in one patient (0.4%). Overall, 16 patients had additional findings on imaging (5.8%). Upfront surgery with selective postoperative imaging was a more cost-effective strategy than routine performance of preoperative imaging, with savings of $1677 per patient. CONCLUSION Preoperative imaging is a low yield, costly approach for patients with clinical stage II melanoma with minimal impact on the decision to proceed with surgical management.
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Affiliation(s)
- Mariam Khan
- Spectrum Health General Surgery Residency Program, 100 Michigan St. NE, Grand Rapids, MI, USA, 49503.
| | - Jessica Thompson
- Spectrum Health General Surgery Residency Program, 100 Michigan St. NE, Grand Rapids, MI, USA, 49503.
| | - Lindsey Kiiskila
- Department of Surgery, Michigan State University College of Human Medicine, 15 Michigan St. NE, Grand Rapids, MI, USA, 49503.
| | - Oselenonome Oboh
- Department of Surgery, Michigan State University College of Human Medicine, 15 Michigan St. NE, Grand Rapids, MI, USA, 49503.
| | - Thao Truong
- Department of Surgery, Michigan State University College of Human Medicine, 15 Michigan St. NE, Grand Rapids, MI, USA, 49503.
| | - Anthony Prentice
- Spectrum Health Department of Nursing, Surgical Services, 100 Michigan St. NE, Grand Rapids, MI, USA, 49503.
| | - M Mura Assifi
- Division of Surgical Oncology, Spectrum Health Medical Group, 145 Michigan St. NE Suite 5500, Grand Rapids, MI, USA, 49503.
| | - Mathew Chung
- Division of Surgical Oncology, Spectrum Health Medical Group, 145 Michigan St. NE Suite 5500, Grand Rapids, MI, USA, 49503.
| | - G Paul Wright
- Division of Surgical Oncology, Spectrum Health Medical Group, 145 Michigan St. NE Suite 5500, Grand Rapids, MI, USA, 49503.
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Glaun MDE, Feng Z, Lango M. Management of Regional Lymph Nodes in Head and Neck Melanoma. Oral Maxillofac Surg Clin North Am 2022; 34:273-281. [PMID: 35400571 DOI: 10.1016/j.coms.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The utilization of sentinel lymph node (SLN) biopsy has transformed the workup and staging of intermediate-thickness cutaneous melanomas. SLN biopsy, performed at the time of primary tumor excision, accurately maps lymph nodes at risk of harboring occult metastatic deposits from head and neck cutaneous melanomas and represents the current standard of care. Completion lymphadenectomy identifies additional tumor in 12% to 24% of SLN biopsy positive cases but does not affect melanoma-specific survival.
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Affiliation(s)
- Mica D E Glaun
- Department of Otolaryngology, Baylor College of Medicine, 1977 Butler Boulevard, Suite E5.200, Houston, TX 77030, USA; Department of Head and Neck Surgery, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Zipei Feng
- Department of Otolaryngology, Baylor College of Medicine, 1977 Butler Boulevard, Suite E5.200, Houston, TX 77030, USA; Department of Head and Neck Surgery, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Miriam Lango
- Department of Head and Neck Surgery, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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