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Karapetyan L, Gooding W, Li A, Yang X, Knight A, Abushukair HM, Vargas De Stefano D, Sander C, Karunamurthy A, Panelli M, Storkus WJ, Tarhini AA, Kirkwood JM. Sentinel Lymph Node Gene Expression Signature Predicts Recurrence-Free Survival in Cutaneous Melanoma. Cancers (Basel) 2022; 14:cancers14204973. [PMID: 36291758 PMCID: PMC9599365 DOI: 10.3390/cancers14204973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 11/16/2022] Open
Abstract
We sought to develop a sentinel lymph node gene expression signature score predictive of disease recurrence in patients with cutaneous melanoma. Gene expression profiling was performed on SLN biopsies using U133A 2.0 Affymetrix gene chips. The top 25 genes associated with recurrence-free survival (RFS) were selected and a penalized regression function was used to select 12 genes with a non-zero coefficient. A proportional hazards regression model was used to evaluate the association between clinical covariates, gene signature score, and RFS. Among the 45 patients evaluated, 23 (51%) had a positive SLN. Twenty-one (46.7%) patients developed disease recurrence. For the top 25 differentially expressed genes (DEG), 12 non-zero penalized coefficients were estimated (CLGN, C1QTNF3, ADORA3, ARHGAP8, DCTN1, ASPSCR1, CHRFAM7A, ZNF223, PDE6G, CXCL3, HEXIM1, HLA-DRB). This 12-gene signature score was significantly associated with RFS (p < 0.0001) and produced a bootstrap C index of 0.888. In univariate analysis, Breslow thickness, presence of primary tumor ulceration, SLN positivity were each significantly associated with RFS. After simultaneously adjusting for these prognostic factors in relation to the gene signature, the 12-gene score remained a significant independent predictor for RFS (p < 0.0001). This SLN 12-gene signature risk score is associated with melanoma recurrence regardless of SLN status and may be used as a prognostic factor for RFS.
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Affiliation(s)
- Lilit Karapetyan
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - William Gooding
- Hillman Cancer Center, Biostatistics Facility, Pittsburgh, PA 15213, USA
| | - Aofei Li
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Xi Yang
- Department of Medicine, Brigham and Women’s Hospital and Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Andrew Knight
- Department of Medicine, Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Hassan M. Abushukair
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Danielle Vargas De Stefano
- Department of Pathology, Division of Pediatric Pathology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Cindy Sander
- UPMC Hillman Cancer Center, Pittsburgh, PA 15213, USA
| | - Arivarasan Karunamurthy
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
- Departments of Dermatology and Pathology, Divisions of Dermatopathology and Molecular Genetic Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | | | - Walter J. Storkus
- Departments of Dermatology, Immunology, Pathology and Bioengineering, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Ahmad A. Tarhini
- Departments of Cutaneous Oncology and Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
- Correspondence: (A.A.T.); (J.M.K.)
| | - John M. Kirkwood
- UPMC Hillman Cancer Center, Pittsburgh, PA 15213, USA
- Department of Medicine, Division of Hematology/Oncology; University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, PA 15213, USA
- Correspondence: (A.A.T.); (J.M.K.)
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Lisovska N. Multilevel mechanism of immune checkpoint inhibitor action in solid tumors: History, present issues and future development (Review). Oncol Lett 2022; 23:190. [PMID: 35527781 PMCID: PMC9073577 DOI: 10.3892/ol.2022.13310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/31/2022] [Indexed: 11/12/2022] Open
Abstract
Immunotherapy with checkpoint inhibitors (antibodies that target and block immune checkpoints in the tumor microenvironment) is included in the standard of care for patients with different types of malignancy, such as melanoma, renal cell and urothelial carcinoma, lung cancer etc. The introduction of this new immunotherapy has altered the view on potential targets for treatment of solid tumors from tumor cells themselves to their immune microenvironment; this has led to a reconsideration of the mechanisms of tumor-associated immunity. However, only a subset of patients benefit from immunotherapy and patient response is often unpredictable, even with known initial levels of prognostic markers; the biomarkers for favorable response are still being investigated. Mechanisms of immune checkpoint inhibitors efficiency, as well as the origins of treatment failure, require further investigation. From a clinical standpoint, discrepancies between the theoretical explanation of inhibitors of immune checkpoint actions at the cellular level and their deployment at a tissue/organ level impede the effective clinical implementation of novel immune therapy. The present review assessed existing experimental and clinical data on functional activity of inhibitors of immune checkpoints to provide a more comprehensive picture of their mechanisms of action on a cellular and higher levels of biological organization.
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Affiliation(s)
- Natalya Lisovska
- Chemotherapy Department, Center of Oncology, ‘Cyber Clinic of Spizhenko’, Kapitanovka, Kyiv 08112, Ukraine
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Paganelli A, Garbarino F, Toto P, Martino GD, D’Urbano M, Auriemma M, Giovanni PD, Panarese F, Staniscia T, Amerio P, Paganelli R. Serological landscape of cytokines in cutaneous melanoma. Cancer Biomark 2019; 26:333-342. [DOI: 10.3233/cbm-190370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Alessia Paganelli
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medicine and Aging Sciences, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Federico Garbarino
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medicine and Aging Sciences, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Toto
- Private practice, Chieti, Italy
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Di Martino
- Department of Medicine and Aging Sciences, Section of Hygiene, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy
| | - Marika D’Urbano
- Department of Medicine and Aging Sciences, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy
| | - Matteo Auriemma
- Department of Medicine and Aging Sciences, Section of Dermatology, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy
| | - Pamela Di Giovanni
- Department of Pharmacy, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy
| | - Fabrizio Panarese
- Department of Medicine and Aging Sciences, Section of Dermatology, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy
| | - Tommaso Staniscia
- Department of Medicine and Aging Sciences, Section of Hygiene, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy
| | - Paolo Amerio
- Department of Medicine and Aging Sciences, Section of Dermatology, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy
| | - Roberto Paganelli
- Department of Medicine and Aging Sciences, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy
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Lisovska N, Shanazarov N. Tumor progression mechanisms: Insights from the central immune regulation of tissue homeostasis. Oncol Lett 2019; 17:5311-5318. [PMID: 31186747 PMCID: PMC6507387 DOI: 10.3892/ol.2019.10218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 03/07/2019] [Indexed: 11/29/2022] Open
Abstract
Knowledge of the mechanisms underlying the spread of cancer at the cellular and molecular levels is expanding rapidly. However, the central regulators governing the initiation and the rate of tumor growth remain poorly established. The fundamental principles of innate and adaptive immunity may explain how immune cells generate a specific response to tumor tissue. In the current review, the functional features of the immune system that contribute to the maintenance of normal tissue homeostasis, as well as their disruption in malignant transformations, were analyzed. Experimental and clinical studies previously demonstrated the involvement of regulatory T-cells in the process of tumor metastasis in a tissue-specific manner. An understanding of the cross talk between lymphoid and tumor cells may provide an insight into cancer evolution in terms of the mechanisms of T-cell competency formation. Elucidating the mechanisms of tumor progression via central immune regulation has implications for the development of novel therapeutic agents that target immune checkpoints.
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Affiliation(s)
- Natalya Lisovska
- Department of Chemotherapy, Center of Oncology, Cyber Clinic of Spizhenko, Kyiv 08112, Ukraine, Republic of Kazakhstan
| | - Nasrulla Shanazarov
- Department of General Surgery, Medical Center Hospital of The President's Affairs Administration of The Republic of Kazakhstan, Astana 010000, Republic of Kazakhstan
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van den Hout MFCM, Koster BD, Sluijter BJR, Molenkamp BG, van de Ven R, van den Eertwegh AJM, Scheper RJ, van Leeuwen PAM, van den Tol MP, de Gruijl TD. Melanoma Sequentially Suppresses Different DC Subsets in the Sentinel Lymph Node, Affecting Disease Spread and Recurrence. Cancer Immunol Res 2017; 5:969-977. [PMID: 28935649 DOI: 10.1158/2326-6066.cir-17-0110] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/16/2017] [Accepted: 09/15/2017] [Indexed: 11/16/2022]
Abstract
Melanoma exerts immune-suppressive effects to facilitate tumor progression and metastatic spread. We studied these effects on dendritic cell (DC) and T-cell subsets in 36 melanoma sentinel lymph node (SLN) from 28 stage I-III melanoma patients and determined their clinical significance. Four conventional DC subsets, plasmacytoid DCs, and CD4+, CD8+, and regulatory T cells (Tregs), were analyzed by flow cytometry. We correlated these data to clinical parameters and determined their effect on local and distant melanoma recurrence, with a median follow-up of 75 months. In stage I and II melanoma, increased Breslow thickness (i.e., invasion depth of the primary melanoma) was associated with progressive suppression of skin-derived migratory CD1a+ DC subsets. In contrast, LN-resident DC subsets and T cells were only affected once metastasis to the SLN had occurred. In stage III patients, increased CD4:CD8 ratios in concert with the accumulation of Tregs resulted in decreased CD8:Treg ratios. On follow-up, lower frequencies of migratory DC subsets proved related to local melanoma recurrence, whereas reduced maturation of LN-resident DC subsets was associated with distant recurrence and melanoma-specific survival. In conclusion, melanoma-mediated suppression of migratory DC subsets in the SLN precedes local spread, whereas suppression of LN-resident DC subsets follows regional spread and precedes further melanoma dissemination to distant sites. This study offers a rationale to target migratory as well as LN-resident DC subsets for early immunotherapeutic interventions to prevent melanoma recurrence and spread. Cancer Immunol Res; 5(11); 969-77. ©2017 AACR.
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Affiliation(s)
- Mari F C M van den Hout
- Department of Pathology, VU University Medical Center/Cancer Center Amsterdam, De Boelelaan, Amsterdam, the Netherlands.,Department of Pathology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Bas D Koster
- Department of Medical Oncology, VU University Medical Center/Cancer Center Amsterdam, De Boelelaan, Amsterdam, the Netherlands
| | - Berbel J R Sluijter
- Department of Surgical Oncology, VU University Medical Center/Cancer Center Amsterdam, De Boelelaan, Amsterdam, the Netherlands
| | - Barbara G Molenkamp
- Department of Surgical Oncology, VU University Medical Center/Cancer Center Amsterdam, De Boelelaan, Amsterdam, the Netherlands
| | - Rieneke van de Ven
- Department of Medical Oncology, VU University Medical Center/Cancer Center Amsterdam, De Boelelaan, Amsterdam, the Netherlands
| | - Alfons J M van den Eertwegh
- Department of Medical Oncology, VU University Medical Center/Cancer Center Amsterdam, De Boelelaan, Amsterdam, the Netherlands
| | - Rik J Scheper
- Department of Pathology, VU University Medical Center/Cancer Center Amsterdam, De Boelelaan, Amsterdam, the Netherlands
| | - Paul A M van Leeuwen
- Department of Surgical Oncology, VU University Medical Center/Cancer Center Amsterdam, De Boelelaan, Amsterdam, the Netherlands
| | - M Petrousjka van den Tol
- Department of Surgical Oncology, VU University Medical Center/Cancer Center Amsterdam, De Boelelaan, Amsterdam, the Netherlands
| | - Tanja D de Gruijl
- Department of Medical Oncology, VU University Medical Center/Cancer Center Amsterdam, De Boelelaan, Amsterdam, the Netherlands.
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Hao H, Xiao D, Pan J, Qu J, Egger M, Waigel S, Sanders MAG, Zacharias W, Rai SN, McMasters KM. Sentinel Lymph Node Genes to Predict Prognosis in Node-Positive Melanoma Patients. Ann Surg Oncol 2016; 24:108-116. [DOI: 10.1245/s10434-016-5575-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Indexed: 11/18/2022]
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Ryan M, Crow J, Kahmke R, Fisher SR, Su Z, Lee WT. FoxP3 and indoleamine 2,3-dioxygenase immunoreactivity in sentinel nodes from melanoma patients. Am J Otolaryngol 2014; 35:689-94. [PMID: 25212103 DOI: 10.1016/j.amjoto.2014.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 08/20/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVE 1) Assess FoxP3/indoleamine 2,3-dioxygenase immunoreactivity in head and neck melanoma sentinel lymph nodes and 2) correlate FoxP3/indoleamine 2,3-dioxygenase with sentinel lymph node metastasis and clinical recurrence. STUDY DESIGN Retrospective cohort study. METHODS Patients with sentinel lymph node biopsy for head and neck melanoma between 2004 and 2011 were identified. FoxP3/indoleamine 2,3-dioxygenase prevalence and intensity were determined from the nodes. Poor outcome was defined as local, regional or distant recurrence. The overall immunoreactivity score was correlated with clinical recurrence and sentinel lymph node metastasis using the chi-square test for trend. RESULTS Fifty-six sentinel lymph nodes were reviewed, with 47 negative and 9 positive for melanoma. Patients with poor outcomes had a statistically significant trend for higher immunoreactivity scores (p=0.03). Positive nodes compared to negative nodes also had a statistically significant trend for higher immunoreactivity scores (p=0.03). Among the negative nodes, there was a statistically significant trend for a poor outcome with higher immunoreactivity scores (p=0.02). CONCLUSION FoxP3/indoleamine 2,3-dioxygenase immunoreactivity correlates with sentinel lymph node positivity and poor outcome. Even in negative nodes, higher immunoreactivity correlated with poor outcome. Therefore higher immunoreactivity may portend a worse prognosis even without metastasis in the sentinel lymph node. This could identify a subset of patients that may benefit from future trials and treatment for melanoma through Treg and IDO suppression.
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Vallacchi V, Vergani E, Camisaschi C, Deho P, Cabras AD, Sensi M, De Cecco L, Bassani N, Ambrogi F, Carbone A, Crippa F, Vergani B, Frati P, Arienti F, Patuzzo R, Villa A, Biganzoli E, Canevari S, Santinami M, Castelli C, Rivoltini L, Rodolfo M. Transcriptional profiling of melanoma sentinel nodes identify patients with poor outcome and reveal an association of CD30(+) T lymphocytes with progression. Cancer Res 2014; 74:130-40. [PMID: 24395820 DOI: 10.1158/0008-5472.can-13-1672] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sentinel lymph nodes set the stance of the immune system to a localized tumor and are often the first site to be colonized by neoplastic cells that metastasize. To investigate how the presence of neoplastic cells in sentinel lymph nodes may trigger pathways associated with metastatic progression, we analyzed the transcriptional profiles of archival sentinel node biopsy specimens obtained from melanoma patients. Biopsies from positive nodes were selected for comparable tumor infiltration, presence or absence of further regional node metastases, and relapse at 5-year follow-up. Unsupervised analysis of gene expression profiles revealed immune response to be a major gene ontogeny represented. Among genes upregulated in patients with progressing disease, the TNF receptor family member CD30/TNFRSF8 was confirmed in biopsy specimens from an independent group of patients. Immunohistochemical analysis revealed higher numbers of CD30(+) lymphocytes in nodes from progressing patients compared with nonprogressing patients. Phenotypic profiling demonstrated that CD30(+) lymphocytes comprised a broad population of suppressive or exhausted immune cells, such as CD4(+)Foxp3(+) or PD1(+) subpopulations and CD4(-)CD8(-) T cells. CD30(+) T lymphocytes were increased in peripheral blood lymphocytes of melanoma patients at advanced disease stages. Our findings reinforce the concept that sentinel nodes act as pivotal sites for determining progression patterns, revealing that the presence of CD30(+) lymphocytes at those sites associate positively with melanoma progression.
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Affiliation(s)
- Viviana Vallacchi
- Authors' Affiliations: Immunotherapy Unit; Department of Pathology; Functional Genomics Unit; Immunobiology of Human Tumors Unit; Department of Medical Statistics and University of Milan, Medical Statistics Biometry and Bioinformatics Unit; Department of Surgery, Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan; Microscopy and Image Analysis, University of Milan Bicocca, Milan; Department of Immunohematology and Transfusion Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Durante M, Reppingen N, Held KD. Immunologically augmented cancer treatment using modern radiotherapy. Trends Mol Med 2013; 19:565-82. [DOI: 10.1016/j.molmed.2013.05.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 05/27/2013] [Accepted: 05/28/2013] [Indexed: 10/26/2022]
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Takeuchi H, Kitagawa Y. Sentinel node and mechanism of lymphatic metastasis. Ann Vasc Dis 2013; 5:249-57. [PMID: 23555522 DOI: 10.3400/avd.ra.12.00033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 06/08/2012] [Indexed: 12/26/2022] Open
Abstract
The validity and clinical usefulness of the sentinel node (SN) concept for breast cancer has been confirmed, and individualized limited surgery based on diagnosis of SN metastasis is presently performed. In the future, SN navigation surgery (SNNS) will be actively applied to the treatment of early gastric cancer, and an intraoperative real-time reverse transcription-polymerase chain reaction (RT-PCR) assay to detect SN micrometastasis of gastric cancer is under development. Not only anatomical factors, but also many other factors such as local immunosuppression in the SN and lymphoangiogenesis may be involved in development of SN micrometastasis, and clarification of the mechanisms of metastasis and development of treatment methods are awaited. (*English Translation of J Jpn Col Angiol 2008; 48: 137-142.).
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Affiliation(s)
- Hiroya Takeuchi
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Harden JL, Egilmez NK. Indoleamine 2,3-dioxygenase and dendritic cell tolerogenicity. Immunol Invest 2013; 41:738-64. [PMID: 23017144 DOI: 10.3109/08820139.2012.676122] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This article summarizes the molecular and cellular mechanisms that regulate the activity of indoleamine 2,3-dioxygenase (IDO), a potent immune-suppressive enzyme, in dendritic cells (DCs). Specific attention is given to differential up-regulation of IDO in distinct DC subsets, its function in immune homeostasis/autoimmunity, infection and cancer; and the associated immunological outcomes. The review will conclude with a discussion of the poorly defined mechanisms that mediate the long-term maintenance of IDO-expression in response to inflammatory stimuli and how selective modulation of IDO activity may be used in the treatment of disease.
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Affiliation(s)
- Jamie L Harden
- The State University of New York at Buffalo, Buffalo, New York 14214, USA.
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Abstract
Melanoma is an immunogenic tumor that has developed methods to successfully evade immune recognition, while paradoxically spreading through the lymphatic system. Increasing evidence supports that melanoma-derived factors suppress regional immunity within the host. At a very early stage, melanoma communicates with the tumor-draining lymph nodes, and prepares them for seeding of metastatic disease by stimulating lymphangiogenesis and downregulation of the sentinel lymph node immunity well before the malignant cells arrive. Investigations have demonstrated that the induction of suppressor cells, peripheral tolerance, and a less tumor-responsive Th2 cytokine environment may provide a hospitable environment for subsequent lymphatic metastasis. Patients with early-stage disease may benefit from the restoration of the regional immune function to a level that controls the progression of residual occult metastases and ensures a durable clinical response. Herein we provide a succinct summary of the current progress in this field in order to guide future investigations.
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