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Prenzler S, Rudrawar S, Waespy M, Kelm S, Anoopkumar-Dukie S, Haselhorst T. The role of sialic acid-binding immunoglobulin-like-lectin-1 (siglec-1) in immunology and infectious disease. Int Rev Immunol 2023; 42:113-138. [PMID: 34494938 DOI: 10.1080/08830185.2021.1931171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Siglec-1, also known as Sialoadhesin (Sn) and CD169 is highly conserved among vertebrates and with 17 immunoglobulin-like domains is Siglec-1 the largest member of the Siglec family. Expression of Siglec-1 is found primarily on dendritic cells (DCs), macrophages and interferon induced monocyte. The structure of Siglec-1 is unique among siglecs and its function as a receptor is also different compared to other receptors in this class as it contains the most extracellular domains out of all the siglecs. However, the ability of Siglec-1 to internalize antigens and to pass them on to lymphocytes by allowing dendritic cells and macrophages to act as antigen presenting cells, is the main reason that has granted Siglec-1's key role in multiple human disease states including atherosclerosis, coronary artery disease, autoimmune diseases, cell-cell signaling, immunology, and more importantly bacterial and viral infections. Enveloped viruses for example have been shown to manipulate Siglec-1 to increase their virulence by binding to sialic acids present on the virus glycoproteins allowing them to spread or evade immune response. Siglec-1 mediates dissemination of HIV-1 in activated tissues enhancing viral spread via infection of DC/T-cell synapses. Overall, the ability of Siglec-1 to bind a variety of target cells within the immune system such as erythrocytes, B-cells, CD8+ granulocytes and NK cells, highlights that Siglec-1 is a unique player in these essential processes.
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Affiliation(s)
- Shane Prenzler
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Santosh Rudrawar
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Mario Waespy
- Centre for Biomolecular Interactions Bremen, Department of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Sørge Kelm
- Centre for Biomolecular Interactions Bremen, Department of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Shailendra Anoopkumar-Dukie
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Thomas Haselhorst
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
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Alipour R, Iravani A, Hicks RJ. PET Imaging of Melanoma. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00123-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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3
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Asahi Y, Kamiyama T, Kakisaka T, Orimo T, Shimada S, Nagatsu A, Sakamoto Y, Ishikawa T, Kamachi H, Mitsuhashi T, Takeuchi S, Dosaka-Akita H, Taketomi A. Hepatectomy and immune checkpoint inhibitor treatment for liver metastasis originating from non-cutaneous melanoma: a report of three cases. Int Cancer Conf J 2021; 10:274-279. [PMID: 34567937 DOI: 10.1007/s13691-021-00495-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/10/2021] [Indexed: 12/12/2022] Open
Abstract
The outcomes of hepatectomy alone for liver metastasis derived from non-cutaneous melanoma are insufficient, and the outcomes of systemic therapy alone are also insufficient, even since the development of immune checkpoint inhibitors (ICIs). We report the cases of three patients, in whom liver metastasis derived from non-cutaneous melanoma was treated with hepatectomy combined with ICI therapy, which was administered in various settings. One patient received ICI treatment for recurrent melanoma and survived 107 months after the first hepatectomy, one patient received both preoperative and adjuvant ICI treatment and has been disease-free for 27 months, and another patient received postoperative ICI treatment after reduction hepatectomy and has been alive with disease for 47 months. Since long-term survival is possible, hepatectomy combined with ICI therapy should be considered for the treatment of liver metastasis derived from non-cutaneous melanoma.
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Affiliation(s)
- Yoh Asahi
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido 060-8638 Japan
| | - Toshiya Kamiyama
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido 060-8638 Japan
| | - Tatshiko Kakisaka
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido 060-8638 Japan
| | - Tatsuya Orimo
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido 060-8638 Japan
| | - Shingo Shimada
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido 060-8638 Japan
| | - Akihisa Nagatsu
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido 060-8638 Japan
| | - Yuzuru Sakamoto
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido 060-8638 Japan
| | - Takaya Ishikawa
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido 060-8638 Japan
| | - Hirofumi Kamachi
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido 060-8638 Japan
| | - Tomoko Mitsuhashi
- Department of Surgical Pathology, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido 060-8638 Japan
| | - Satoshi Takeuchi
- Department of Medical Oncology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido 060-8638 Japan
| | - Hirotoshi Dosaka-Akita
- Department of Medical Oncology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido 060-8638 Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido 060-8638 Japan
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Abstract
Stage IV melanoma has a 5-year survival rate of 6%, but considerable advances have been made in systemic therapies. Systemic immunotherapy has achieved durable responses in up to 40% of patients, with similar improvements with targeted therapies. This has reshaped the landscape for surgery in stage IV melanoma. Metastasectomy can be considered in patients on systemic immunotherapy or targeted therapy with responding, stable, or isolated progressing lesions, oligometastatic disease, or long disease-free intervals. Surgery plays a role in providing tumor tissue for preparation of tumor-infiltrating lymphocytes for adoptive cell therapy. Surgical palliation plays a role in patients with symptomatic metastases.
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Lynch KT, Young SJ, Meneveau MO, Wages NA, Engelhard VH, Slingluff CL, Mauldin IS. Heterogeneity in tertiary lymphoid structure B-cells correlates with patient survival in metastatic melanoma. J Immunother Cancer 2021; 9:e002273. [PMID: 34103353 PMCID: PMC8190052 DOI: 10.1136/jitc-2020-002273] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Tertiary lymphoid structures (TLSs) are immune aggregates in peripheral tissues that may support adaptive immune responses. Their presence has been associated with clinical response to checkpoint blockade therapy (CBT), but it is unknown whether TLS have prognostic significance independent of CBT in melanoma. We hypothesized that TLS in melanoma metastases would be associated with increased intratumoral lymphocyte infiltration, but that the intra-TLS immunological milieu would be distinct from the intratumoral immunological milieu. We also hypothesized that the presence of TLS would be associated with improved survival, and that TLS maturation or intra-TLS lymphocyte activity would also correlate with survival. METHODS Cutaneous melanoma metastases (CMM) from 64 patients were evaluated by multiplex immunofluorescence for the presence and maturation status of TLS. Intra-TLS lymphocyte density, proliferation and B-cell Ig somatic hypermutation (AID+) were analyzed, as were markers of T-cell exhaustion and Th1/Tc1 differentiation. Associations between TLS maturation and intra-TLS immunologic activity were assessed, as well as associations with intratumoral immune cell infiltration. Independent associations with overall survival (OS) were assessed using log-rank tests and Cox proportional hazards models. RESULTS TLS were identified in 30 (47%) of 64 CMM (TLS+) and were associated with increased intratumoral lymphocyte infiltration. However, proliferation of intra-TLS lymphocytes did not correlate with intratumoral lymphocyte proliferation. Most were early TLS; however, subsets of primary or secondary follicle-like TLS were also present. TLS+ lesions were associated with lower risk of tumor recurrence after metastasectomy and with improved OS in multivariate analyses (HR 0.51, p=0.04). OS was longer for TLS with low fractions of CD21+ B-cells (HR 0.29, p=0.02) and shorter for those with low AID+ fraction of B-cells (HR 2.74, p=0.03). CONCLUSIONS The presence of TLS in CMMs is associated with improved OS in patients treated with surgery before CBT, but TLS vary widely in maturation state, in proportions of proliferating T and B cells, and in markers of B cell function, including AID and CD21. Importantly, these features have additional prognostic significance, which suggest that some TLS may have regulatory function, while others functioning to support antigen-driven immune responses, depending on the cellular composition and activation status.
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Affiliation(s)
- Kevin T Lynch
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Samuel J Young
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Max O Meneveau
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Nolan A Wages
- Department of Public Health Sciences, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Victor H Engelhard
- Department of Microbiology, Immunology and Cancer Biology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Craig L Slingluff
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Ileana S Mauldin
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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Heidelberger V, Goldwasser F, Kramkimel N, Jouinot A, Franck N, Arrondeau J, Guégan S, Mansuet-Lupo A, Alexandre J, Damotte D, Avril MF, Dupin N, Aractingi S. Clinical parameters associated with anti-programmed death-1 (PD-1) inhibitors-induced tumor response in melanoma patients. Invest New Drugs 2017; 35:842-847. [PMID: 28569347 DOI: 10.1007/s10637-017-0476-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 05/24/2017] [Indexed: 12/25/2022]
Abstract
Background The identification of the melanoma patients sensitive to anti-PD-1 inhibitors, nivolumab or pembrolizumab, is a major therapeutic challenge and an urgent need. We hypothesized that the natural history of the disease might partly reflect the immune state of the patients. Methods We analyzed our cohort of melanoma patients treated with anti-PD-1 from August 2014 to January 2016 in our institution. Objective response was defined as a complete or partial response according to v1.1 RECIST criteria. Results Among 63 metastatic melanoma patients, the overall response rate was 43%. Median time from diagnosis to anti-PD-1 initiation was longer among responders than non-responders (64 months vs. 35 months, p = 0.02). The response rate was 10% in patients starting anti-PD-1 within 1 year, 35% after 1 to 5 years and 63% after 5 years. Performance status (PS) 0 was also associated with enhanced tumor response: 70% of responders were PS 0 vs. 36% of non-responders (p = 0.04). PS 0, normal LDH levels and wild-type BRAF status were significant predictors of progression free survival. Conclusion A long time lapse from diagnosis to anti-PD-1 initiation and PS 0 are associated with higher sensitivity to anti-PD-1 in melanoma patients. These two clinical features might reflect a potentially intact immune system of the host.
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Affiliation(s)
- Valentine Heidelberger
- Department of Medical Oncology, Teaching Hospital Cochin, AP-HP, University Paris Descartes, 123 Bd Port Royal, 75 679, Paris Cedex 14, France
| | - François Goldwasser
- Department of Medical Oncology, Teaching Hospital Cochin, AP-HP, University Paris Descartes, 123 Bd Port Royal, 75 679, Paris Cedex 14, France.
- Medical Oncology, Paris Descartes University, Bat Copernic, 5ème, 123 Bd Port Royal, 75 679, Paris Cedex 14, France.
| | - Nora Kramkimel
- Department of Dermatology, Teaching Hospital Cochin, AP-HP, University Paris Descartes, 123 Bd Port Royal, 75 679, Paris Cedex 14, France
| | - Anne Jouinot
- Department of Medical Oncology, Teaching Hospital Cochin, AP-HP, University Paris Descartes, 123 Bd Port Royal, 75 679, Paris Cedex 14, France
| | - Nathalie Franck
- Department of Dermatology, Teaching Hospital Cochin, AP-HP, University Paris Descartes, 123 Bd Port Royal, 75 679, Paris Cedex 14, France
| | - Jennifer Arrondeau
- Department of Medical Oncology, Teaching Hospital Cochin, AP-HP, University Paris Descartes, 123 Bd Port Royal, 75 679, Paris Cedex 14, France
| | - Sarah Guégan
- Department of Dermatology, Teaching Hospital Cochin, AP-HP, University Paris Descartes, 123 Bd Port Royal, 75 679, Paris Cedex 14, France
| | - Audrey Mansuet-Lupo
- Department of Pathology, Teaching Hospital Cochin, AP-HP, University Paris Descartes, 27, rue du Faubourg Saint Jacques, F75014, Paris, France
| | - Jérôme Alexandre
- Department of Medical Oncology, Teaching Hospital Cochin, AP-HP, University Paris Descartes, 123 Bd Port Royal, 75 679, Paris Cedex 14, France
| | - Diane Damotte
- Department of Pathology, Teaching Hospital Cochin, AP-HP, University Paris Descartes, 27, rue du Faubourg Saint Jacques, F75014, Paris, France
| | - Marie-Françoise Avril
- Department of Dermatology, Teaching Hospital Cochin, AP-HP, University Paris Descartes, 123 Bd Port Royal, 75 679, Paris Cedex 14, France
| | - Nicolas Dupin
- Department of Dermatology, Teaching Hospital Cochin, AP-HP, University Paris Descartes, 123 Bd Port Royal, 75 679, Paris Cedex 14, France
| | - Sélim Aractingi
- Department of Dermatology, Teaching Hospital Cochin, AP-HP, University Paris Descartes, 123 Bd Port Royal, 75 679, Paris Cedex 14, France
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7
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18F-FDG-PET/CT in the Staging and Management of Melanoma: A Prospective Multicenter Ontario PET Registry Study. Clin Nucl Med 2016; 41:189-93. [PMID: 26447374 DOI: 10.1097/rlu.0000000000000996] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The Ontario PET Registry was established to provide evidence on the clinical impact of 18-FDG-PET/CT (PET) imaging to inform Ontario Health Insurance Plan funding decisions. The melanoma registry assessed the use of melanoma staging by PET in advanced or high-risk melanoma as a useful adjunct to clinical and standard radiologic investigation. MATERIALS AND METHODS Between January 2011 and July 2013, approximately 319 consecutive patients with potentially resectable localized high-risk melanoma or recurrent disease under consideration for metastasectomy underwent PET imaging for staging across 9 institutions in Ontario. Pre-PET stage information was provided by the referring clinician and compared with post-PET stage. The ability of PET to reclassify disease from M0 to M1 status was assessed. The registry data were then linked to provincial administrative databases using deidentified health insurance numbers to determine PET stage-based rates of systemic therapy, radiotherapy, and surgery. RESULTS There was a significant increase in stage to M1 status after PET in 56 of 319 patients (17.6%) (P < 0.0001). There was no significant relationship between upstaging with PET and the proportion of patients receiving radiation therapy (P = 0.066) or systemic therapy (P = 0.072). There was a significant relationship between upstaging with PET and the proportion of patients undergoing surgical resection of metastases distant to the primary melanoma site (P = 0.034). CONCLUSIONS This prospective, multicenter registry of high-risk or advanced melanoma found that PET significantly upstages patients and impacts surgical management.
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Ascierto PA, Atkins M, Bifulco C, Botti G, Cochran A, Davies M, Demaria S, Dummer R, Ferrone S, Formenti S, Gajewski TF, Garbe C, Khleif S, Kiessling R, Lo R, Lorigan P, Arthur GM, Masucci G, Melero I, Mihm M, Palmieri G, Parmiani G, Puzanov I, Romero P, Schilling B, Seliger B, Stroncek D, Taube J, Tomei S, Zarour HM, Testori A, Wang E, Galon J, Ciliberto G, Mozzillo N, Marincola FM, Thurin M. Future perspectives in melanoma research: meeting report from the "Melanoma Bridge": Napoli, December 3rd-6th 2014. J Transl Med 2015; 13:374. [PMID: 26619946 PMCID: PMC4665874 DOI: 10.1186/s12967-015-0736-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 11/19/2015] [Indexed: 12/27/2022] Open
Abstract
The fourth "Melanoma Bridge Meeting" took place in Naples, December 3-6th, 2014. The four topics discussed at this meeting were: Molecular and Immunological Advances, Combination Therapies, News in Immunotherapy, and Tumor Microenvironment and Biomarkers. Until recently systemic therapy for metastatic melanoma patients was ineffective, but recent advances in tumor biology and immunology have led to the development of new targeted and immunotherapeutic agents that prolong progression-free survival (PFS) and overall survival (OS). New therapies, such as mitogen-activated protein kinase (MAPK) pathway inhibitors as well as other signaling pathway inhibitors, are being tested in patients with metastatic melanoma either as monotherapy or in combination, and all have yielded promising results. These include inhibitors of receptor tyrosine kinases (BRAF, MEK, and VEGFR), the phosphatidylinositol 3 kinase (PI3K) pathway [PI3K, AKT, mammalian target of rapamycin (mTOR)], activators of apoptotic pathway, and the cell cycle inhibitors (CDK4/6). Various locoregional interventions including radiotherapy and surgery are still valid approaches in treatment of advanced melanoma that can be integrated with novel therapies. Intrinsic, adaptive and acquired resistance occur with targeted therapy such as BRAF inhibitors, where most responses are short-lived. Given that the reactivation of the MAPK pathway through several distinct mechanisms is responsible for the majority of acquired resistance, it is logical to combine BRAF inhibitors with inhibitors of targets downstream in the MAPK pathway. For example, combination of BRAF/MEK inhibitors (e.g., dabrafenib/trametinib) have been demonstrated to improve survival compared to monotherapy. Application of novel technologies such sequencing have proven useful as a tool for identification of MAPK pathway-alternative resistance mechanism and designing other combinatorial therapies such as those between BRAF and AKT inhibitors. Improved survival rates have also been observed with immune-targeted therapy for patients with metastatic melanoma. Immune-modulating antibodies came to the forefront with anti-CTLA-4, programmed cell death-1 (PD-1) and PD-1 ligand 1 (PD-L1) pathway blocking antibodies that result in durable responses in a subset of melanoma patients. Agents targeting other immune inhibitory (e.g., Tim-3) or immune stimulating (e.g., CD137) receptors and other approaches such as adoptive cell transfer demonstrate clinical benefit in patients with melanoma as well. These agents are being studied in combination with targeted therapies in attempt to produce longer-term responses than those more typically seen with targeted therapy. Other combinations with cytotoxic chemotherapy and inhibitors of angiogenesis are changing the evolving landscape of therapeutic options and are being evaluated to prevent or delay resistance and to further improve survival rates for this patient population. This meeting's specific focus was on advances in combination of targeted therapy and immunotherapy. Both combination targeted therapy approaches and different immunotherapies were discussed. Similarly to the previous meetings, the importance of biomarkers for clinical application as markers for diagnosis, prognosis and prediction of treatment response was an integral part of the meeting. The overall emphasis on biomarkers supports novel concepts toward integrating biomarkers into contemporary clinical management of patients with melanoma across the entire spectrum of disease stage. Translation of the knowledge gained from the biology of tumor microenvironment across different tumors represents a bridge to impact on prognosis and response to therapy in melanoma.
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Affiliation(s)
- Paolo A Ascierto
- Istituto Nazionale Tumori, Fondazione "G. Pascale", Naples, Italy.
| | - Michael Atkins
- Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC, USA.
| | - Carlo Bifulco
- Translational Molecular Pathology, Earle A. Chiles Research Institute, Providence Cancer Center, Portland, OR, USA.
| | - Gerardo Botti
- Istituto Nazionale Tumori, Fondazione "G. Pascale", Naples, Italy.
| | - Alistair Cochran
- Departments of Pathology and Laboratory Medicine and Surgery, David Geffen School of Medicine at University of California Los Angeles (UCLA), John Wayne Cancer Institute, Santa Monica, CA, USA.
| | - Michael Davies
- Department of Melanoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Sandra Demaria
- Departments of Radiation Oncology and Pathology, Weill Cornell Medical College, New York, NY, USA.
| | - Reinhard Dummer
- Skin Cancer Unit, Department of Dermatology, University Hospital Zürich, 8091, Zurich, Switzerland.
| | - Soldano Ferrone
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Silvia Formenti
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, USA.
| | - Thomas F Gajewski
- Departments of Medicine and of Pathology, Immunology and Cancer Program, The University of Chicago Medicine, Chicago, IL, USA.
| | - Claus Garbe
- Department of Dermatology, Center for Dermato Oncology, University of Tübingen, Tübingen, Germany.
| | - Samir Khleif
- Georgia Regents University Cancer Center, Georgia Regents University, Augusta, GA, USA.
| | - Rolf Kiessling
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.
| | - Roger Lo
- Departments of Medicine and Molecular and Medical Pharmacology, David Geffen School of Medicine and Jonsson Comprehensive Cancer Center at the University of California Los Angeles (UCLA), Los Angeles, CA, USA.
| | - Paul Lorigan
- University of Manchester/Christie NHS Foundation Trust, Manchester, UK.
| | - Grant Mc Arthur
- Peter MacCallum Cancer Centre and University of Melbourne, Victoria, Australia.
| | - Giuseppe Masucci
- Department of Oncology-Pathology, The Karolinska Hospital, Stockholm, Sweden.
| | - Ignacio Melero
- Centro de Investigación Médica Aplicada, and Clinica Universidad de Navarra, Pamplona, Navarra, Spain.
| | - Martin Mihm
- Department of Dermatology, Harvard Medical School, Boston, MA, USA.
| | - Giuseppe Palmieri
- Unit of Cancer Genetics, Institute of Biomolecular Chemistry, National Research Council, Sassari, Italy.
| | - Giorgio Parmiani
- Division of Molecular Oncology, Unit of Bio-Immunotherapy of Solid Tumors, San Raffaele Institute, Milan, Italy.
| | - Igor Puzanov
- Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Pedro Romero
- Ludwig Cancer Research Center, University of Lausanne, Lausanne, Switzerland.
| | - Bastian Schilling
- Department of Dermatology, University Hospital, West German Cancer Center, University Duisburg-Essen, Essen, Germany. .,German Cancer Consortium (DKTK), Essen, Germany.
| | - Barbara Seliger
- Institute of Medical Immunology, Martin Luther University Halle-Wittenberg, Halle, Germany.
| | - David Stroncek
- Cell Processing Section, Department of Transfusion Medicine, Clinical Center, NIH, Bethesda, MD, USA.
| | - Janis Taube
- Department of Dermatology, Johns Hopkins University SOM, Baltimore, MD, USA.
| | - Sara Tomei
- Division of Translational Medicine, Sidra Medical and Research Center, Doha, Qatar.
| | - Hassane M Zarour
- Departments of Medicine, Immunology and Dermatology, University of Pittsburgh, Pittsburgh, PA, USA.
| | | | - Ena Wang
- Division of Translational Medicine, Sidra Medical and Research Centre, Doha, Qatar.
| | - Jérôme Galon
- INSERM, UMRS1138, Laboratory of Integrative Cancer Immunology, Université Paris Descartes, Sorbonne Paris Cité, Centre de Recherche des Cordeliers, Paris, France.
| | | | - Nicola Mozzillo
- Istituto Nazionale Tumori, Fondazione "G. Pascale", Naples, Italy.
| | | | - Magdalena Thurin
- Cancer Diagnosis Program, National Cancer Institute, NIH, Bethesda, MD, USA.
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Tee CL, Basedow M, Strekozov B. Intra-abdominal metastatic melanoma presenting as intussusception. ANZ J Surg 2014; 86:520-2. [PMID: 24943260 DOI: 10.1111/ans.12728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Chin Li Tee
- Department of Surgery, Caboolture Hospital, Caboolture, Queensland, Australia
| | - Michael Basedow
- Department of Surgery, Caboolture Hospital, Caboolture, Queensland, Australia
| | - Boris Strekozov
- Department of Surgery, Caboolture Hospital, Caboolture, Queensland, Australia
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10
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Faries MB, Leung A, Morton DL, Hari D, Lee JH, Sim MS, Bilchik AJ. A 20-year experience of hepatic resection for melanoma: is there an expanding role? J Am Coll Surg 2014; 219:62-8. [PMID: 24952441 DOI: 10.1016/j.jamcollsurg.2014.04.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 04/22/2014] [Accepted: 04/29/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Melanoma liver metastasis is most often fatal, with a 4- to 6-month median overall survival (OS). Over the past 20 years, surgical techniques have improved in parallel with more effective systemic therapies. We reviewed our institutional experience of hepatic melanoma metastases. STUDY DESIGN Overall and disease-specific survivals were calculated from hepatic metastasis diagnosis. Potential prognostic factors including primary tumor type, depth, medical treatment response, location, and surgical approach were evaluated. RESULTS Among 1,078 patients with melanoma liver metastases treated at our institution since 1991, 58 (5.4%) received surgical therapy (resection with or without ablation). Median and 5-year OS were 8 months and 6.6 %, respectively, for 1,016 nonsurgical patients vs 24.8 months and 30%, respectively, for surgical patients (p < 0.001). Median OS was similar among patients undergoing ablation (with or without resection) relative to those undergoing surgery alone. On multivariate analysis of surgical patients, completeness of surgical therapy (hazard ratio [HR] 3.4, 95% CI 1.4 to 8.1, p = 0.007) and stabilization of melanoma on therapy before surgery (HR 0.38, 95% CI 0.19 to 0.78, p = 0.008) predicted OS. CONCLUSIONS In this largest single-institution experience, patients selected for surgical therapy experienced markedly improved survival relative to those receiving only medical therapy. Patients whose disease stabilized on medical therapy enjoyed particularly favorable results, regardless of the number or size of their metastases. The advent of more effective systemic therapy in melanoma may substantially increase the fraction of patients who are eligible for surgical intervention, and this combination of treatment modalities should be considered whenever it is feasible in the context of a multidisciplinary team.
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Affiliation(s)
- Mark B Faries
- Department of Surgical Oncology, The John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA.
| | - Anna Leung
- Department of Surgical Oncology, The John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA
| | - Donald L Morton
- Department of Surgical Oncology, The John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA
| | - Danielle Hari
- Department of Surgical Oncology, The John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA
| | - Ji-Hey Lee
- Department of Biostatistics, The John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA
| | - Myung-shin Sim
- Department of Biostatistics, The John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA
| | - Anton J Bilchik
- Department of Surgical Oncology, The John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA
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11
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Birnbaum DJ, Moutardier V, Turrini O, Gonçalves A, Delpero JR. Isolated pancreatic metastasis from malignant melanoma: is pancreatectomy worthwile? J Surg Tech Case Rep 2014; 5:82-4. [PMID: 24741425 PMCID: PMC3977330 DOI: 10.4103/2006-8808.128733] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Isolated pancreatic metastasis from malignant melanoma (IPMMM) is rare because most melanoma patients already have a widespread disease at diagnosis. No adjuvant systemic treatment is known to be efficient in this setting. Experience with pancreatic resection for IPMMM is limited and controversial. We report here the case of an IPMMM patient successfully treated by pancreaticoduodenectomy with a prolonged survival of 6 years.
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Affiliation(s)
- David Jérémie Birnbaum
- Department of Surgical Oncology, Institute Paoli-Calmettes and University of the Mediterranée, Marseille, France
| | - Vincent Moutardier
- Department of Surgical Oncology, Institute Paoli-Calmettes and University of the Mediterranée, Marseille, France
| | - Olivier Turrini
- Department of Surgical Oncology, Institute Paoli-Calmettes and University of the Mediterranée, Marseille, France
| | - Anthony Gonçalves
- Department of Medical Oncology, Institute Paoli-Calmettes and University of the Mediterranée, Marseille, France
| | - Jean Robert Delpero
- Department of Surgical Oncology, Institute Paoli-Calmettes and University of the Mediterranée, Marseille, France
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12
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Hall S, Murchie P. Can we use technology to encourage self-monitoring by people treated for melanoma? A qualitative exploration of the perceptions of potential recipients. Support Care Cancer 2014; 22:1663-71. [DOI: 10.1007/s00520-014-2133-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 01/13/2014] [Indexed: 11/24/2022]
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13
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Moses KA, Sfakianos JP, Winer A, Bernstein M, Russo P, Dalbagni G. Non-squamous cell carcinoma of the penis: single-center, 15-year experience. World J Urol 2013; 32:1347-53. [PMID: 24292119 DOI: 10.1007/s00345-013-1216-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 11/19/2013] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Penile cancer is a rare malignancy with less than 5 % being non-squamous cell carcinoma (SCC) primary malignancies. We report our 15-year experience of treating non-SCC penile cancer at a tertiary care cancer center. METHODS We identified 12 patients with non-SCC of the penis from 1996 to 2012. Demographic and clinical data were abstracted, including histological type, surgical treatment, adjuvant therapy, and clinical course. RESULTS Five patients had sarcoma (three leiomyosarcoma, one spindle cell carcinoma, and one epithelioid sarcoma), four had melanoma, two had extramammary Paget's disease (EPD), and one had sebaceous carcinoma. Median follow-up was 37.5 months (mean 45.8 months). Tumor staging for melanoma was pT1aN3, pTisNx, pTxNxM1b, and pT3bN0. Patients with melanoma were treated with penile sparing surgery; two are alive without disease, one is alive with disease, and one patient with metastasis at presentation died of disease at 16.3 months. The patients with sarcoma and deep-seated or node-positive disease died of disease at a mean of 49.7 months. Two patients with EPD were treated with wide local excision of the lesions and were both pT1Nx. The remaining patient had sebaceous carcinoma treated with excisional biopsy and was free of disease at 32.0 months. CONCLUSIONS Non-SCC of the penis is primarily treated surgically, with the goal of complete excision at the time of treatment. The utilization of lymphadenectomy is less clear in these malignancies, but aggressive approaches should be considered in appropriate patients. Tumor stage and nodal status are important in determining patient outcomes.
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Affiliation(s)
- Kelvin A Moses
- Division of Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA,
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14
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Barros MAP, de Castro NSR, Mourão TC. [Acute abdomen as initial manifestation of metastatic melanoma]. Rev Col Bras Cir 2013; 40:263-5. [PMID: 23912378 DOI: 10.1590/s0100-69912013000300018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Accepted: 06/30/2007] [Indexed: 11/22/2022] Open
Abstract
The malignant melanoma is a relatively common neoplasia, with origin generally in the melanocytics cells in the skin, but with presentation of other possible primary lesions, being presented in this, a case witnessed of liver and mesentery metastases with unknown primary sites.
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15
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Cananzi FCM, Mudan S, Dunne M, Belonwu N, Dalgleish AG. Long-term survival and outcome of patients originally given Mycobacterium vaccae for metastatic malignant melanoma. Hum Vaccin Immunother 2013; 9:2427-33. [PMID: 23863507 DOI: 10.4161/hv.25618] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The long-term prognosis of patients with stage IV AJCC melanoma is extremely poor. We have previously published short-term clinical outcome and immunological responses to a heat killed Mycobacterium vaccae-based vaccine. RESULTS In this study we report on a better than expected long-term survival (3-y DSS 29·6%, 5-y, and 7-y DSS both 23·9%) relative to historical controls in the patients who received the vaccine in these trials, published in 1999 and 2003. Although the complete or partial response was only 10%, it was the remarkable response to other interventions upon relapse, such as surgery and radiotherapy followed by stable disease that was previously unexpected. METHODS We reviewed the outcome of 72 patients who were treated with M. vaccae for metastatic melanoma between January 1996 and July 2004. CONCLUSION Given this remarkable outcome in stage IV metastatic melanoma and its lack of toxicity we propose that this would make a promising candidate for randomized trials for stage III fully resected melanoma.
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16
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Aubin JM, Rekman J, Vandenbroucke-Menu F, Lapointe R, Fairfull-Smith RJ, Mimeault R, Balaa FK, Martel G. Systematic review and meta-analysis of liver resection for metastatic melanoma. Br J Surg 2013; 100:1138-47. [DOI: 10.1002/bjs.9189] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2013] [Indexed: 12/13/2022]
Abstract
Abstract
Background
The multidisciplinary management of metastatic melanoma now occasionally includes major hepatic resection. The objective of this work was to conduct a systematic review of the literature on liver resection for metastatic melanoma.
Methods
MEDLINE, Embase, the Cochrane Library and Scopus were searched (1990 to December 2012). Studies with at least ten patients undergoing liver resection for metastatic melanoma were included. Data on the outcomes of overall survival (OS) and/or disease-free survival (DFS) were abstracted and synthesized. Hazard ratios (HRs) were derived from survival curves and subjected to meta-analysis using random-effects models.
Results
Twenty-two studies involving 579 patients (13 per cent weighted resection rate) who underwent liver resection were included. Study quality was poor to moderate. Median follow-up ranged from 9 to 59 months. Median DFS ranged from 8 to 23 months, and median OS ranged from 14 to 41 months (R0, 22–66 months, R2, 10–16 months; R0versus R1/R2: HR 0.52, 95 per cent confidence interval (c.i.) 0.37 to 0.73). The OS rate was 56–100 per cent at 1 year, 34–53 per cent at 3 years and 11–36 per cent at 5 years. Median OS with non-operative management ranged from 4 to 12 months. Comparison of OS with resection and non-operative management favoured resection (HR 0.32, 95 per cent c.i. 0.22 to 0.46).
Conclusion
Radical resection of liver metastases from melanoma appears to improve overall survival compared with non-operative management or incomplete resection, but this observation requires future confirmation as selection bias may have confounded the results.
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Affiliation(s)
- J-M Aubin
- Liver and Pancreas Unit, Division of General Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - J Rekman
- Liver and Pancreas Unit, Division of General Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - F Vandenbroucke-Menu
- HPB Surgery and Liver Transplantation Unit, Hôpital Saint-Luc, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - R Lapointe
- HPB Surgery and Liver Transplantation Unit, Hôpital Saint-Luc, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - R J Fairfull-Smith
- Liver and Pancreas Unit, Division of General Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - R Mimeault
- Liver and Pancreas Unit, Division of General Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - F K Balaa
- Liver and Pancreas Unit, Division of General Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - G Martel
- Liver and Pancreas Unit, Division of General Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- HPB Surgery and Liver Transplantation Unit, Hôpital Saint-Luc, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
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17
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Batus M, Waheed S, Ruby C, Petersen L, Bines SD, Kaufman HL. Optimal management of metastatic melanoma: current strategies and future directions. Am J Clin Dermatol 2013; 14:179-94. [PMID: 23677693 PMCID: PMC3913474 DOI: 10.1007/s40257-013-0025-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Melanoma is increasing in incidence and remains a major public health threat. Although the disease may be curable when identified early, advanced melanoma is characterized by widespread metastatic disease and a median survival of less than 10 months. In recent years, however, major advances in our understanding of the molecular nature of melanoma and the interaction of melanoma cells with the immune system have resulted in several new therapeutic strategies that are showing significant clinical benefit. Current therapeutic approaches include surgical resection of metastatic disease, chemotherapy, immunotherapy, and targeted therapy. Dacarbazine, interleukin-2, ipilimumab, and vemurafenib are now approved for the treatment of advanced melanoma. In addition, new combination chemotherapy regimens, monoclonal antibodies blocking the programmed death-1 (PD-1)/PD-ligand 1 pathway, and targeted therapy against CKIT, mitogen-activated protein/extracellular signal-regulated kinase (MEK), and other putative signaling pathways in melanoma are beginning to show promise in early-phase clinical trials. Further research on these modalities alone and in combination will likely be the focus of future clinical investigation and may impact the outcomes for patients with advanced melanoma.
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Affiliation(s)
- Marta Batus
- Rush University Melanoma Program and Departments of Medicine, General Surgery and Immunology and Microbiology, Rush University Medical Center, 1725 W. Harrison Street, Room 845, Chicago, IL 60612, USA
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18
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Finn L, Markovic SN, Joseph RW. Therapy for metastatic melanoma: the past, present, and future. BMC Med 2012; 10:23. [PMID: 22385436 PMCID: PMC3308914 DOI: 10.1186/1741-7015-10-23] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 03/02/2012] [Indexed: 02/07/2023] Open
Abstract
Metastatic melanoma is the most aggressive form of skin cancer with a median overall survival of less than one year. Advancements in our understanding of how melanoma evades the immune system as well as the recognition that melanoma is a molecularly heterogeneous disease have led to major improvements in the treatment of patients with metastatic melanoma. In 2011, the US Food and Drug Administration (FDA) approved two novel therapies for advanced melanoma: a BRAF inhibitor, vemurafenib, and an immune stimulatory agent, ipilimumab. The success of these agents has injected excitement and hope into patients and clinicians and, while these therapies have their limitations, they will likely provide excellent building blocks for the next generation of therapies. In this review we will discuss the advantages and limitations of the two new approved agents, current clinical trials designed to overcome these limitations, and future clinical trials that we feel hold the most promise.
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Affiliation(s)
- Laura Finn
- Division of Hematology and Oncology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Svetomir N Markovic
- Division of Hematology and Oncology, Mayo Clinic Rochester, Gonda Building 10 South, Rochester, MN 55905, USA
| | - Richard W Joseph
- Division of Hematology and Oncology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA
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19
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Leong SPL, Gershenwald JE, Soong SJ, Schadendorf D, Tarhini AA, Agarwala S, Hauschild A, Soon CWM, Daud A, Kashani-Sabet M. Cutaneous melanoma: a model to study cancer metastasis. J Surg Oncol 2011; 103:538-49. [PMID: 21480247 DOI: 10.1002/jso.21816] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Nodal status in melanoma is a critically important prognostic factor for patient outcome. The survival rate drops to <10% when melanoma has spread beyond the regional lymph nodes and includes visceral involvement. In general, the process of melanoma metastasis is progressive in that dissemination of melanoma from the primary site to the regional lymph nodes occurs prior to systemic disease. The goal of this review article is to describe melanoma as a clinical model to study cancer metastasis. A future challenge is to develop a molecular taxonomy to subgroup melanoma patients at various stages of tumor progression for more accurate targeted treatment.
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Affiliation(s)
- Stanley P L Leong
- Center for Melanoma Research and Treatment and Department of Surgery, California Pacific Medical Center and Research Institute, San Francisco, California 94115, USA.
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20
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Impact of [F-18] FDG-PET/CT in the restaging and management of patients with malignant melanoma. Nucl Med Commun 2010; 31:925-30. [DOI: 10.1097/mnm.0b013e32833f6137] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Evolution of locoregional treatment for peritoneal carcinomatosis: single-center experience of 308 procedures of cytoreductive surgery and perioperative intraperitoneal chemotherapy. Am J Surg 2010; 201:149-56. [PMID: 20832051 DOI: 10.1016/j.amjsurg.2010.02.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 02/15/2010] [Accepted: 02/15/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Peritoneal carcinomatosis imposes an enormous clinical burden to the oncologic community. This study reports the patterns of care of the locoregional approach of cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy as a curative procedure for peritoneal carcinomatosis from the experience of a single tertiary center in Australia. METHODS We performed a review of clinical records from a prospective database of patients who were treated at the St George Hospital Peritoneal Surface Malignancy Program according to a standard protocol. RESULTS A total of 308 CRS were performed in 249 patients with peritoneal surface malignancy; the mean age was 53 years and 55% were women. Over the years, we expanded the age limit for treatment (P = .03), reduced intensive care unit stays (P = .04), reduced amount of blood transfusion (P = .03), treated patients with a higher peritoneal cancer index (P < .001), achieved higher rates of complete cytoreduction (P = .003), increased use of PIC (P < .001), and improved complication rate (P = .02) and mortality rate (P = .01). The median survival of patients treated over the years also improved (P = .001). CONCLUSIONS We show the maturity of the treatment of peritoneal carcinomatosis with CRS and perioperative intraperitoneal chemotherapy in our institution after an initial learning curve with expansion of the selection criteria, improved perioperative outcomes, improved surgical results, and long-term survival outcomes.
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22
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Abstract
Metastatic melanoma remains a disease associated with poor outcomes. Traditionally, surgical intervention plays a minimal role in its treatment. However, more recent studies document that complete surgical resection of distant metastases is associated with 5-year survival rates of 15% to 30%. These rates are greater than that reported for single-agent or combination chemotherapy, biologic agents or immunotherapy. This case report outlines a unique presentation of stage IV melanoma within the gastrointestinal tract located in 2 different organs. On the basis of the patient's clinical findings, laparoscopic surgery was performed for palliation of intestinal obstruction and bleeding. This approach resulted in less postoperative pain, earlier mobilization, and a faster return to daily activities. To our knowledge, this case details the only known account that uses a laparoscopic approach to palliate stage IV melanoma at 2 synchronous sites; the stomach and small bowel. The literature regarding the treatment of metastatic melanoma is also briefly reviewed.
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23
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Krug B, Crott R, Roch I, Lonneux M, Beguin C, Baurain JF, Pirson AS, Vander Borght T. Cost-effectiveness analysis of FDG PET-CT in the management of pulmonary metastases from malignant melanoma. Acta Oncol 2010; 49:192-200. [PMID: 20059314 DOI: 10.3109/02841860903440254] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Most guidelines consider FDG PET-CT to detect occult extra-pulmonary disease prior to lung metastasectomy. A cost-effectiveness analysis, using a Markov model over a 10 year period, was performed to compare two different surveillance programs, either PET-CT or whole-body CT, in patients with suspected pulmonary metastasised melanoma. METHODS Data from published studies provided probabilities for the model. Complication and care costs were obtained from standardised administrative databases from 19 hospitals identified by DRG codes (reported in 2009 Euros). For the cost calculation of PET-CT we performed a microcosting analysis. All costs and benefits were yearly discounted at respectively 3% and 1.5%. Outcomes included life-months gained (LMG) and the number of futile surgeries avoided. Cost-effectiveness ratios were in Euros per LMG. Univariate and probabilistic sensitivity analyses addressed uncertainty in all model parameters. RESULTS The PET-CT strategy provided 86.29 LMG (95% CI: 81.50-90.88 LMG) at a discounted cost of euro3,974 (95% CI: euro1,339-12,303), while the conventional strategy provided 86.08 LMG (95% CI: 81.37-90.68 LMG) at a discounted cost of euro5,022 (95% CI: euro1,378-16,018). This PET-CT strategy resulted in a net saving of euro1,048 with a gain of 0.2 LMG. Based on PET-CT findings, 20% of futile surgeries could be avoided. CONCLUSION Integrating PET-CT in the management of patients with high risk MM appears to be less costly and more accurate by avoiding futile thoracotomies in one of five patients as well as by providing a small survival benefit at 10 years.
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Affiliation(s)
- Bruno Krug
- Nuclear Medicine Division, Mont-Godinne University Hospital, Université Catholique de Louvain, Yvoir, Belgium.
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24
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Kitajima K, Bardier-Dupas A, Breton S, Rousseau G, Siksik JM, Vaillant JC, Hannoun L. Variant on Manifestation of Duodenal Metastasis 26 Years after Initial Diagnosis of Primary Cutaneous Melanoma. Case Rep Gastroenterol 2010; 4:93-99. [PMID: 21103234 PMCID: PMC2988904 DOI: 10.1159/000290383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Malignant duodenal neoplasms are relatively rare, and the diagnosis is often delayed because of their vague and nonspecific symptoms. We report the case of a 79-year-old female who had a medical history of malignant melanoma of the cheek that had initially been diagnosed at 53 years of age. Work-up revealed severe stenosis of the duodenum caused by a large mass with ulceration at the tip of its mucosal surface. Tumor biopsy led to a histological diagnosis of extremely poorly differentiated carcinoma, but it was impossible to determine whether the lesion was a primary neoplasm or represented secondary involvement. Pancreatoduodenectomy was performed, and the surgical specimen showed a protuberant tumor in the nonampullary region of the second portion of the duodenum. Final diagnosis of metastatic duodenal melanoma was made by immunohistological examination. She is currently alive without recurrence 28 months after the surgical treatment.
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Affiliation(s)
- Kumiko Kitajima
- Department of Digestive and Hepato-Biliary-Pancreatic Surgery, Liver Transplantation Unit, Université Pierre et Marie Curie - Paris VI, Paris, France
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25
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Dengel LT, Slingluff CL. Short length of stay and rapid recovery to normal function after surgery for metastatic melanoma to abdominal and retroperitoneal viscera. J Surg Oncol 2009; 100:481-3. [PMID: 19653258 DOI: 10.1002/jso.21350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Metastatic melanoma to abdominal and retroperitoneal viscera carries a poor prognosis possibly resulting in reluctance to offer surgical management. There is value in defining the morbidity of such surgery. METHODS Review of a prospectively maintained database identified patients with metastatic melanoma to abdominal or retroperitoneal viscera who underwent surgery from 9/99 to 8/06. RESULTS Nineteen patients underwent surgery for metastasis to abdominal or retroperitoneal viscera detected by clinical symptoms (80%), or imaging (20%). The median length of stay was 7 days. There was no perioperative mortality. Surgical complications occurred in four patients. At initial follow-up, 13 patients (68%) had returned to baseline function, 7 of which reported improvement. Four patients (21%) had minimal symptoms, and only two patients (11%) had significantly limited function. Median follow-up was 35 months, at which time 9 of the 19 patients (47%) were still alive, with 3- and 5-year Kaplan-Meier survival estimates of 53% (SE 12) and 45% (SE 12), respectively, and 2 of the 19 patients are alive at over 8 years since surgery. CONCLUSION In selected cases, surgery may have both palliative benefit and curative potential for patients with visceral metastases of melanoma. Surgical management of such patients should be encouraged in appropriate clinical settings.
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Affiliation(s)
- Lynn T Dengel
- Department of Surgery, University of Virginia Health Systems, Charlottesville, Virginia 22908, USA
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26
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Mansfield AS, Markovic SN. Novel therapeutics for the treatment of metastatic melanoma. Future Oncol 2009; 5:543-57. [PMID: 19450181 DOI: 10.2217/fon.09.15] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Metastatic malignant melanoma is an incurable disease with a median survival of 8.5 months and a probability of surviving 5 years after the diagnosis of less than 5%. To date, no systemic therapy has meaningfully changed these survival end points. Currently, in the USA the FDA has approved three agents for the treatment of metastatic melanoma: hydroxyurea, dacarbazine and interleukin-2. None of these have demonstrated a meaningfully prolonged survival of patients with metastatic melanoma. Therefore, a number of innovative therapeutic strategies have been pursued to improve outcomes, including immune therapy, tyrosine kinase inhibitors and angiogenesis inhibitors. Herein, we review some of the recent advances in novel therapeutic developments for the treatment of metastatic melanoma.
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Affiliation(s)
- Aaron S Mansfield
- Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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27
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Smylie M, Claveau J, Alanen K, Taillefer R, George R, Wong R, Mason WP. Management of malignant melanoma: best practices. J Cutan Med Surg 2009; 13:55-73. [PMID: 19459245 DOI: 10.2310/7750.2008.08029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Melanoma is a commonly occurring cancer in Canada, with an estimated age-standardized incidence of 10 to 13 per 100,000. An estimated 4,300 new cases were diagnosed, and there were 800 reported deaths in 2005. OBJECTIVE AND CONCLUSION The Canadian Expert Panel on Malignant Melanoma has developed best practices to improve the management of malignant melanoma. Sections include recommendations on primary diagnosis, dermatopathologic assessment, and reporting; use of preoperative lymphoscintigraphy and an intraoperative gamma probe to map and biopsy the sentinel lymph node; indications for surgical resection, sentinel node biopsy, and surgery for advance disease; use of interferon-alpha adjuvant therapy and treatment options for stage IV disease; and management of central nervous system metastases.
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28
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von Holzen U, Viehl CT, Hamel CT, Oertli D. Ileal intussusception due to visceral malignant melanoma metastasis. Surgery 2009; 145:339-40. [PMID: 19231589 DOI: 10.1016/j.surg.2007.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2007] [Revised: 09/26/2007] [Accepted: 10/12/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Urs von Holzen
- Kantonsspital Olten, Department of Surgery, Olten, Switzerland.
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29
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El Marsafy S, Bagot M, Bensussan A, Mauviel A. Dendritic cells in the skin - potential use for melanoma treatment. Pigment Cell Melanoma Res 2009; 22:30-41. [DOI: 10.1111/j.1755-148x.2008.00532.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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30
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Rocha ME, Rodrigues GP, Borges SA, Santiago FG. Metastatic melanoma of the stomach. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2008. [DOI: 10.1590/s0102-67202008000400010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND: Metastatic melanoma of the stomach is a relatively rare entity with an unusual diagnosis during life. Surgery is the treatment of choice once it alleviates the symptoms in over 90% of the cases and increases the long-term survival. CASE REPORT: A 50y woman had presented a dark spot in the ungual bed of her right-hand thumb for two years, evolving into ulceration and bleeding. The biopsy diagnosed ungual malanocytic neoplasia compatible with lentiginous melanoma confirmed by immunohistochemistry, which presented positive pigmented HMB-45 cells. After an year and a half, the patient developed metastasis of the melanoma on her left thigh and extensive ulcerated lesion in the small gastric curvature, whose biopsy was compatible with metastatic melanoma of the stomach. The hemogram found discrete anemia (Hb: 11.1 and Ht: 33%) and LDH: 333 U/L. The patient underwent total gastrectomy with reconstruction in Roux-en-Y. There was a good evolution and on the 6th post-operative day, she was discharged home. At present, in the 12th month of follow up, the patient remains without complaints, with full relief of symptoms and all normal control exams. CONCLUSION: Surgical management should always be considered for the metastatic melanoma of the gastrointestinal tract, since the procedure shows low morbidity and mortality, besides providing relief of symptoms with the improvement of the quality of life and increase in the long-term survival.
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31
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Neuss H, Raue W, Koplin G, Schwenk W, Reetz C, Mall JW. Intraoperative application of fibrin sealant does not reduce the duration of closed suction drainage following radical axillary lymph node dissection in melanoma patients: a prospective randomized trial in 58 patients. World J Surg 2008; 32:1450-5. [PMID: 18373121 DOI: 10.1007/s00268-007-9461-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients suffering from malignant melanoma often require radical lymph node dissection of the axillary nodal basin. The effects of intraoperative application of fibrin sealant following radical axillary lymph node dissection (RALND) on the incidence of postoperative lymphatic secretion are discussed. To study the effect of intraoperatively applied fibrin sealant following RALND a randomized patient-blinded trial was carried out. METHODS Fifty-eight patients with axillary lymph node metastases of malignant melanoma underwent therapeutic RALND and were randomized into two groups: 29 patients received 2 cc of fibrin glue intraoperatively and 29 patients were only irrigated with 0.9% saline. The amount of drainage was recorded every 24 h. The main outcome criterion was the duration of drain placement in the wound. Minor criteria were the total amount of fluid and the length of hospital stay. Statistical analysis was performed using Spearman's log-rank correlation and paired t-test. RESULTS There was no significant difference between the nonfibrin group 5 days (range = 3.6-5.7 days) and the fibrin group 5 days (range = 4.1-8.5 days) (p = 0.701). The total amount of fluid for the nonfibrin group (410 cc, range = 362-727 cc) and that for the fibrin group (503 cc, range = 369-1098 cc) (p = 0.605) and the length of postoperative hospital stay of 6 days (range = 5.4-7) vs. 7 days (range = 5.9-10.7), respectively, were not different between both groups (p = 0.387). CONCLUSION Considering our study results, we cannot recommend the use of 2 cc of fibrin glue intraoperatively in the prevention of lymphatic secretion in patients undergoing RALND for metastatic melanoma.
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Affiliation(s)
- Heiko Neuss
- Department of General, Visceral, Thoracic and Vascular Surgery, Medical Faculty of Humboldt University, Charitè Universitaetsmedizin Berlin, Charitè, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
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Mcloughlin JM, Zager JS, Sondak VK, Berk LB. Treatment Options for Limited or Symptomatic Metastatic Melanoma. Cancer Control 2008; 15:239-47. [DOI: 10.1177/107327480801500307] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Patients who develop metastatic melanoma often have limited effective treatment options. However, a select group of patients will benefit from aggressive surgery or a multidisciplinary approach, depending on the site of metastasis. Methods The current literature was reviewed and summarized regarding the collective recommendations for staging and treating patients with metastatic melanoma. Results A thorough preoperative staging includes positron-emission tomography, MRI of the brain, and CT of the chest, abdomen, and pelvis. Tumor biology ultimately determines the success of intervention. A long disease-free interval is a good indicator of potential benefit from resection of metastatic disease. If surgery is performed, no less than a complete resection will affect the overall survival of the patient. Surgery and other multimodality treatment options can be used for symptomatic palliation but will not affect survival. Chemotherapy and radiation are often used to control the symptoms of brain and bony metastases but have limited if any impact on survival. Conclusions A select group of patients with metastatic melanoma will benefit from aggressive surgery. Identifying which patients will benefit from treatment requires good clinical judgment and a thorough radiologic evaluation to identify the true extent of disease.
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Affiliation(s)
| | - Jonathan S. Zager
- Cutaneous Oncology at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Sarcoma at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Vernon K. Sondak
- Cutaneous Oncology at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Sarcoma at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Immunology at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Lawrence B. Berk
- Radiation Oncology Programs at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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Abstract
In patients with melanoma, surgery is pivotal not only for the primary tumor but also for regional and often distant metastases. The minimally invasive technique of sentinel node (SN) biopsy has become standard for detection of occult regional node metastasis in patients with intermediate-thickness primary melanoma; in these patients it has a central role in determining prognosis and a significant impact on survival when biopsy results are positive. Its role in thin melanoma remains under evaluation. The regional tumor-draining SN also is a useful model for studies of melanoma-induced immunosuppression. Although completion lymphadenectomy remains the standard of care for patients with SN metastasis, results of ongoing phase III trials will indicate whether SN biopsy without further lymph node surgery is adequate therapy for certain patients with minimal regional node disease.
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Affiliation(s)
- Mark B Faries
- Division of Surgical Oncology and the Roy E. Coats Research Laboratories, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA 90404, USA.
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Lim J, Vadodaria S, Powell B. False positive diagnosis of malignant melanoma metastasis. J Plast Reconstr Aesthet Surg 2008; 61:218-20. [DOI: 10.1016/j.bjps.2007.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Revised: 02/16/2007] [Accepted: 09/24/2007] [Indexed: 10/22/2022]
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Abstract
A 54-year-old woman presented with neck pain and bilateral shoulder pain. The pain was of varying intensity and was present with activity as well as at night and at rest. She had weakness of her triceps and finger intrinsic muscles. Her past medical history included stage IV melanoma for which she underwent an excision from the right flank area 25 years ago. She was cleared from any disease 5 years after the excision. Magnetic resonance imaging of the cervical spine revealed increased signal intensity in the C7 vertebral body with soft tissue extension into the epidural space. Two weeks after initial presentation the patient underwent a C7 corpectomy and fusion. The C7 vertebral body was grossly pathologic and tissue samples revealed metastatic malignant melanoma. During the 2 weeks following the fusion the patient developed increasing pain and generalized weakness. Repeat MRI of the cervical spine revealed a large soft tissue intensity extending in the spinal canal from C6 to T2. Several days later the patient developed an acute onset of lower extremity weakness as well as urinary incontinence. The patient opted to pursue hospice care, and she died 3 weeks later, 8 weeks after the initial presentation.
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Affiliation(s)
- Jason C Eck
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA
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36
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Fifis T, Lam I, Lin D, Malcontenti-Wilson C, Christophi C, Loveland B. Vaccination with in vitro grown whole tumor cells induces strong immune responses and retards tumor growth in a murine model of colorectal liver metastases. Vaccine 2008; 26:241-9. [DOI: 10.1016/j.vaccine.2007.10.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Revised: 10/17/2007] [Accepted: 10/28/2007] [Indexed: 10/22/2022]
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Dréau D, Foster M, Hogg M, Culberson C, Nunes P, Wuthier RE. Inhibitory effects of fusarochromanone on melanoma growth. Anticancer Drugs 2007; 18:897-904. [PMID: 17667595 DOI: 10.1097/cad.0b013e3280d94298] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fusarochromanone is a toxic metabolite produced by Fusarium equiseti, a fungus present in decaying cereal plants in northern latitudes; it has been detected in various food grains. Fusarochromanone has been shown to have both stimulatory and inhibitory effects on various mammalian cells, depending on the concentration used. Whether these cytotoxic effects can be used in the clinical treatment of tumors remains to be established. Here, we evaluated the effects of fusarochromanone on the growth of human melanoma cells both in vitro and in vivo. In vitro, low concentrations (0.1-1 nmol/l) of fusarochromanone were found to be cytotoxic to many melanoma cell lines. In contrast, growth of normal melanocytes was inhibited only at much higher fusarochromanone concentrations (100-200 nmol/l). In vivo, the growth of melanoma cells implanted subcutaneously in immuno-compromised mice was significantly (P<0.05) reduced by daily administration of fusarochromanone. Immunohistological analyses indicated a significant (P<0.05) increase in the expression of active caspase-3 in tumor masses of mice treated with fusarochromanone, compared with controls. Together, these observations show that fusarochromanone increased apoptosis of tumor cells and reduced tumor growth in vivo. Therefore, the effects of fusarochromanone warrant further investigation as an adjuvant molecule to prevent growth and recurrence of melanomas.
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Affiliation(s)
- Didier Dréau
- Department of Biology, University of North Carolina-Charlotte , Charlotte, North Carolina 28223, USA.
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Neuman HB, Patel A, Hanlon C, Wolchok JD, Houghton AN, Coit DG. Stage-IV melanoma and pulmonary metastases: factors predictive of survival. Ann Surg Oncol 2007; 14:2847-53. [PMID: 17680317 DOI: 10.1245/s10434-007-9448-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Accepted: 04/11/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND We reviewed a contemporary, single-institution experience to evaluate the natural history of stage-IV melanoma metastatic to the lung and identify factors predictive of survival. METHODS A search of our prospective database was performed to identify patients with stage-IV melanoma and pulmonary metastases as the initial disease site; only patients seen at our institution prior to developing stage-IV disease and in whom treatment response was available were included. Patients' demographic, clinical, and treatment variables were recorded. Cox regression was used to identify factors independently predictive of survival. RESULTS The study cohort was comprised of 122 patients. Median survival was 14 months (5-year survival of 8%). Clinical factors at time of diagnosis of stage IV independently predictive of survival were a solitary pulmonary metastasis (HR 2.7, CI 1.6-4.4, P<0.0005) and absence of extra-pulmonary disease (HR 1.9, CI 1.2-3.1, P = 0.01). Among treatment factors, only metastasectomy was independently predictive of survival (HR 0.42, CI 0.21-0.87, P = 0.02). Of the patients, 26 (21%) underwent metastasectomy, with a median survival of 40 months compared with 13 months in patients not selected for surgical treatment. Of these 26, 23 (88%) experienced recurrence at a median of 5 months after the procedure. No survival difference was seen between responders and non-responders to systemic therapy (P = 0.55). CONCLUSIONS In stage-IV melanoma with pulmonary metastases, a solitary metastasis and absence of extra-pulmonary disease are predictive of survival. While these factors are often present in patients selected for pulmonary metastasectomy, this independently predicts survival. However, response to systemic therapy does not correlate with a survival difference.
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Affiliation(s)
- Heather B Neuman
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H1221, New York, New York 10021, USA
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Katz SC, Bowne WB, Wolchok JD, Busam KJ, Jaques DP, Coit DG. Surgical management of melanoma of the gallbladder: a report of 13 cases and review of the literature. Am J Surg 2007; 193:493-7. [PMID: 17368297 DOI: 10.1016/j.amjsurg.2006.06.033] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Revised: 06/14/2006] [Accepted: 06/14/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Melanoma has the potential to spread to virtually any organ, including the gallbladder. The role of intervention in this rare entity must be based on a thorough appreciation of the underlying disease biology. METHODS We present a review of all patients treated for gallbladder melanoma at Memorial Sloan-Kettering Cancer Center (MSKCC) between 1991 and 2003. RESULTS The study group consisted of 13 patients with melanoma metastatic to the gallbladder. The median survival was 12 months following the diagnosis, and only 1 patient survived more than 42 months. Factors associated with improved outcome included symptomatic metastases and metastatic disease confined to the gallbladder (P < .05). Cholecystectomy led to the resolution of right upper quadrant pain in all patients for the duration of their survival. CONCLUSIONS In patients with melanoma metastatic to the gallbladder, overall survival is determined more by the biology of the disease than treatment. In the presence of symptoms, cholecystectomy is often effective palliation in carefully selected patients.
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Affiliation(s)
- Steven C Katz
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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40
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Herman P, Machado MAC, Montagnini AL, D'Albuquerque LAC, Saad WA, Machado MCC. Selected patients with metastatic melanoma may benefit from liver resection. World J Surg 2007; 31:171-4. [PMID: 17171491 DOI: 10.1007/s00268-006-0375-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND In the last few years there has been expanding use of hepatic resection for non-colorectal metastases. The purpose of this study is to evaluate the experience of liver resection for patients with metastatic melanoma. METHODS Eighteen patients with metastatic melanoma were explored for possible surgical resection. All patients fitted the following criteria: absence of extra-hepatic disease after evaluation with CT/MRI and FDG-PET scans; disease-free interval longer than 24 months after the resection of the primary melanoma; presumed completely resectable lesions; absence of clinical co-morbidities. RESULTS Liver resection was performed in 10 patients; 8 out of 18 presented with irresectable tumors and/or peritoneal metastases and were not operated. One patient presented with postoperative biliary fistula and was conservatively managed. No other complications or postoperative mortality were observed. After a mean follow-up of 25.4 months, 5 patients are alive and without evidence of recurrence. Overall median survival was 22 months; overall survival and disease-free survival were 70% and 50% respectively. CONCLUSIONS Resection of liver metastases from melanoma in a selected group of patients may increase survival. Exploratory laparoscopy should be included in the preoperative armamentarium of diagnostic tools.
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Affiliation(s)
- Paulo Herman
- Department of Abdominal Surgery, A.C. Camargo Cancer Hospital, São Paulo, Brazil.
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41
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Riker AI, Kirksey L, Thompson L, Morris A, Cruse CW. Current surgical management of melanoma. Expert Rev Anticancer Ther 2007; 6:1569-83. [PMID: 17134362 DOI: 10.1586/14737140.6.11.1569] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The surgical management of melanoma has changed dramatically over the last few decades. Through the development and conduction of well-designed, prospective, randomized trials, we have been able to refine the way that we surgically manage patients with melanoma. Indeed, many important issues have been addressed through such trials: the proper surgical margins for the primary melanoma, utility of the elective lymph node dissection and the role for selective lymphadenectomy, to name a few. This review will also discuss what we have learned from past clinical trials and address several issues with regards to where we are going in the future.
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Affiliation(s)
- Adam I Riker
- Surgical Oncology Services and Associate Professor of Surgery, University of South Alabama--Mitchell Cancer Institute, Cutaneous Oncology Program, 307 North University Blvd, MSB 2015, Mobile, Alabama 36688, USA.
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43
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Abstract
The prognosis for patients with melanoma has not improved over the last 30 years. So far, almost without exception, clinical trials conducted with single or multiple agent chemotherapy, biological therapy (interferon-alpha, interleukin-2), and biochemotherapy have failed to demonstrate consistent survival benefit. Without effective alternate treatments, surgery must be considered the primary treatment of melanoma, independent of disease stage. Although surgery is clearly favored as the treatment of localized melanoma, consensus opinion and clinician preference become divided once melanoma progresses beyond its primary site. Many physicians will adopt an attitude of resignation and hesitancy when treating metastatic melanoma. As a result, patients with advanced disease are often treated with medications that produce little survival or palliative benefit at the expense of significant toxicity. Numerous studies have demonstrated clear and durable survival advantages for patients undergoing complete resection of metastatic melanoma. Further, surgical resection can produce an immediate decrease in tumor burden with minimal morbidity and mortality at a reasonable cost.
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Affiliation(s)
- Shawn E Young
- Division of Surgical Oncology and the Roy E. Coats Research Laboratories, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, USA
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44
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Leong SPL, Cady B, Jablons DM, Garcia-Aguilar J, Reintgen D, Jakub J, Pendas S, Duhaime L, Cassell R, Gardner M, Giuliano R, Archie V, Calvin D, Mensha L, Shivers S, Cox C, Werner JA, Kitagawa Y, Kitajima M. Clinical patterns of metastasis. Cancer Metastasis Rev 2006; 25:221-32. [PMID: 16770534 DOI: 10.1007/s10555-006-8502-8] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In human solid cancer, lymph node status is the most important indicator for clinical outcome. Recent developments in the sentinel lymph node concept and technology have resulted in a more precise way of examining micrometastasis in the sentinel lymph node and the role of lymphovascular system in the facilitation of cancer metastasis. Different patterns of metastasis are described with respect to different types of solid cancer. Expect perhaps for papillary carcinoma and sarcoma, the overwhelming evidence is that solid cancer progresses in an orderly progression from the primary site to the regional lymph node or the sentinel lymph node in the majority of cases with subsequent dissemination to the systemic sites. The basic mechanisms of cancer metastasis through the lymphovascular system form the basis of rational therapy against cancer. Beyond the clinical patterns of metastasis, it is imperative to understand the biology of metastasis and to characterize patterns of metastasis perhaps due to heterogeneous clones based on their molecular signatures.
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Affiliation(s)
- Stanley P L Leong
- Department of Surgery, University of California, and UCSF Comprehensive Cancer Center, San Francisco, CA, USA.
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Jack A, Boyes C, Aydin N, Alam K, Wallack M. The treatment of melanoma with an emphasis on immunotherapeutic strategies. Surg Oncol 2006; 15:13-24. [PMID: 16815006 DOI: 10.1016/j.suronc.2006.05.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Melanoma continues to be one of the most difficult to treat of all solid tumors. Many new advances have been made in the surgical management of melanoma, including new guidelines for margins of excision, as well as sentinel node biopsy for the diagnosis of lymph node micrometastases. The search continues for an effective adjuvant melanoma treatment that can prevent local and distant recurrences. Melanoma is one of the most immunogenic of all tumors, and several clinical trials testing the immunotherapy of melanoma have been conducted, including trials in interferon, interleukin-2, and melanoma vaccines. Here we discuss many of the recent clinical trials in the surgical management of melanoma, in addition to the advances that have been made in the field of immunotherapy. A new second-generation melanoma vaccine, DC-MelVac (patent # 11221/5), has recently been granted FDA approval for Phase I clinical trials and will be introduced in this review.
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Affiliation(s)
- Angela Jack
- Surgery Research Laboratory, Department of Surgery, Saint Vincent's Catholic Medical Centers/New York Medical College, 153 West 11th Street, Cronin Building, Room 667, New York, NY 10011, USA
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Tagawa ST, Cheung E, Banta W, Gee C, Weber JS. Survival analysis after resection of metastatic disease followed by peptide vaccines in patients with Stage IV melanoma. Cancer 2006; 106:1353-7. [PMID: 16475151 DOI: 10.1002/cncr.21748] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Metastatic melanoma carries a poor prognosis, with a median survival of 7-9 months. Surgical resection of metastatic disease has been advocated to improve survival. Immunotherapy after metastasectomy may further improve the outcome for high-risk resected disease. METHODS Charts from patients treated on institutional vaccine trials were analyzed. Patients with American Joint Committee on Cancer (AJCC) Stage IV melanoma who underwent surgical resection of metastatic sites followed by treatment on a peptide vaccine trial were eligible for this study. Survival was calculated from the date of enrollment on the clinical trial. RESULTS Forty-one patients met inclusion criteria. The median age was 56.5 years, with approximately equal numbers of men and women. The ECOG performance status was 0 in all patients. Approximately 46% of patients underwent resection of visceral metastases before vaccine. The median follow-up was 5.6 years. The median overall survival was 3.8 years. CONCLUSIONS In selected patients with AJCC Stage IV melanoma, resection of metastatic disease followed by vaccine therapy can result in long-term survival.
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Affiliation(s)
- Scott T Tagawa
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Abstract
Cutaneous melanoma is one of the most deadly malignancies. Although it accounts for approximately 4% of all cancer cases, it ac-counts for approximately 79% of skin cancer-related deaths. In the past few years, the nuclear medicine platform used in the management of melanoma has extended to biochemical and structural imaging. In clinical practice, integrated positron emission tomography/CT devices allow anatomic and metabolic characterization of meta-static disease in a single study. Similarly, more accurate localization of sentinel nodes in a 3-D space now is feasible with hybrid single photon emission CT/CT system. In translational research, [18F]fluorodeoxyglucose probes have been designed to optimize the detection of melanoma tumor sites in vivo.
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Affiliation(s)
- Richard Essner
- Department of Surgical Oncology and Molecular Therapeutics, John Wayne Cancer Institute, Santa Monica, CA 90404, USA.
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Date RS, Griffiths EA, Pritchard SA, Welch IM. Combined endoscopic and laparoscopic approach for palliative resection of metastatic melanoma of the stomach. World J Surg Oncol 2006; 4:20. [PMID: 16573827 PMCID: PMC1440863 DOI: 10.1186/1477-7819-4-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2005] [Accepted: 03/30/2006] [Indexed: 02/02/2023] Open
Abstract
Background Metastatic tumours of the stomach present a clinical dilemma for the surgeon. Palliative surgical resection can alleviate symptoms and prolong survival in selected patients. However, previous studies have used open methods of surgical resection with potentially high morbidity and mortality. We describe the use of laparoscopic wedge resection of the stomach for palliative resection of metastatic melanoma to highlight the benefits of this technique. Case presentation A 58 year old male was investigated for iron deficiency anaemia while under treatment for pulmonary metastatic malignant melanoma. An upper gastrointestinal endoscopy revealed a 5 cm diameter ulcer on the anterior wall of the stomach, biopsies from the ulcer confirmed metastatic melanoma. Laparoscopic wedge resection of the stomach lesion was performed without complication. Conclusion Laparoscopic approach has many benefits and is useful for the palliative resection of rare tumours of the stomach in order to preserve the quality of life. Its use should be considered in selected patients.
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Affiliation(s)
- RS Date
- Department of Gastrointestinal Surgery, South Manchester University Hospital, NHS Trust, South Moor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - EA Griffiths
- Department of Gastrointestinal Surgery, South Manchester University Hospital, NHS Trust, South Moor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - SA Pritchard
- Department of Gastrointestinal Surgery, South Manchester University Hospital, NHS Trust, South Moor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - I McL Welch
- Department of Gastrointestinal Surgery, South Manchester University Hospital, NHS Trust, South Moor Road, Wythenshawe, Manchester, M23 9LT, UK
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Systemic Evaluation and Management of Patients with Choroidal Melanoma. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50049-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Background The burden of cancer metastases within an individual is commonly used to clinically characterize a tumor's biological behavior. Assessments like these implicitly assume that spurious effects can be discounted. Here the influence of chance on the burden of metastasis is studied to determine whether or not this assumption is valid. Methods Monte Carlo simulations were performed to estimate tumor burdens sustained by individuals with cancer, based upon empirically derived and validated models for the number and size distributions of metastases. Factors related to the intrinsic metastatic potential of tumors and their host microenvironments were kept constant, to more clearly demonstrate the contribution from chance. Results Under otherwise identical conditions, both the simulated numbers and the sizes of metastases were highly variable. Comparable individuals could sustain anywhere from no metastases to scores of metastases, and the sizes of the metastases ranged from microscopic to macroscopic. Despite the marked variability in the number and sizes of the metastases, their respective growth times were rather more narrowly distributed. In such situations multiple occult metastases could develop into fully overt lesions within a comparatively short time period. Conclusion Chance can have a major effect on the burden of metastases. Random variability can be so great as to make individual assessments of tumor biology unreliable, yet constrained enough to lead to the apparently simultaneous appearance of multiple overt metastases.
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Affiliation(s)
- Wayne S Kendal
- Division of Radiation Oncology, The Ottawa Hospital Regional Cancer Centre, 503 Smyth, Ottawa, Ontario, K1H 1C4 Canada.
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