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Goh LY, Limbachia K, Moonim M, Morley AMS. Primary lacrimal sac melanoma: a case report describing the novel use of fine needle aspiration cytology (FNAC) for diagnosis, together with literature review and immunotherapy treatment update. Orbit 2024; 43:270-279. [PMID: 36069101 DOI: 10.1080/01676830.2022.2119264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
Primary lacrimal sac melanoma (PLSM) is exceedingly rare and associated with high morbidity and mortality. Unfortunately, PLSM often presents insidiously resulting in delayed detection and poor prognosis. A 69-year-old Black man was suspected of having a lacrimal sac tumour following presentation with a left sided watery eye, bloody tears, and a lacrimal mass. Due to the patient's implantable pacemaker, defibrillator, and high anticoagulation, an ultrasound-guided FNAC was performed instead of incisional biopsy, revealing a PLSM. Diagnosis was confirmed following complete tumour resection with free flap reconstruction and neck dissection. Unfortunately, disease progression ensued despite further neck dissection and three cycles of both pembrolizumab and iplimumab. This is the first description of FNAC to accurately diagnose PLSM and highlights its use as an accurate, rapid, and minimally invasive technique that may allow an earlier screening diagnosis of lacrimal sac tumours. We also discuss the outcome of immunotherapy in recent similar cases.
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Affiliation(s)
- Li Yen Goh
- Department of Ophthalmology, Guy's and St Thomas' Hospital NHS Trust, London, UK
| | - Ketan Limbachia
- Department of Ophthalmology, Guy's and St Thomas' Hospital NHS Trust, London, UK
| | - Mufaddal Moonim
- Department of Histopathology, Guy's and St Thomas' Hospital NHS Trust, London, UK
| | - Ana M S Morley
- Department of Ophthalmology, Guy's and St Thomas' Hospital NHS Trust, London, UK
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2
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Alhaskawi A, Ezzi SHA, Dong Y, Zhou H, Wang Z, Lai J, Yao C, Kota VG, Abdulla MHAH, Lu H. Recent advancements in the diagnosis and treatment of acral melanoma. J Zhejiang Univ Sci B 2024; 25:106-122. [PMID: 38303495 PMCID: PMC10835211 DOI: 10.1631/jzus.b2300221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/21/2023] [Indexed: 02/03/2024]
Abstract
Acral melanoma (AM) is the most common histologic subtype of melanoma in dark-skinned patients and is associated with a worse prognosis and a high mortality rate, largely due to the inconspicuous nature of early-stage lesions, which can lead to late diagnosis. Because of the overlapping clinical and histopathological features of AM with other forms of cutaneous melanomas, early detection of AM requires a multidisciplinary approach that integrates various diagnostic modalities, including clinical examination, dermoscopy, histopathology, molecular testing, radiological imaging, and blood tests. While surgery is the preferred method of treatment for AM, other therapeutic options may be employed based on the stage and underlying etiology of the disease. Immune checkpoint inhibitors, molecular targeted therapy, radiotherapy, chemotherapy, and oncolytic virotherapy represent promising advanced treatment options for AM. In this review, we provide an overview of the latest advancements in diagnostic and therapeutic methods for AM, highlighting the importance of early detection and the prompt, individualized management of this challenging disease.
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Affiliation(s)
- Ahmad Alhaskawi
- Department of Orthopedics, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | | | - Yanzhao Dong
- Department of Orthopedics, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Haiying Zhou
- Department of Orthopedics, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Zewei Wang
- Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Jingtian Lai
- Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Chengjun Yao
- Zhejiang University School of Medicine, Hangzhou 310058, China
| | | | | | - Hui Lu
- Department of Orthopedics, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
- Alibaba-Zhejiang University Joint Research Center of Future Digital Healthcare, Zhejiang University, Hangzhou 310058, China.
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3
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Kim KH, Jung M, Lee HJ, Lee SJ, Kim M, Ahn MS, Choi MY, Lee NR, Shin SJ. A phase II study on the efficacy of regorafenib in treating patients with c-KIT-mutated metastatic malignant melanoma that progressed after previous treatment (KCSG-UN-14-13). Eur J Cancer 2023; 193:113312. [PMID: 37741071 DOI: 10.1016/j.ejca.2023.113312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/14/2023] [Accepted: 08/22/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND c-KIT mutations are found in approximately 15% of patients with malignant melanoma in the Asian population. Regorafenib, an oral multikinase inhibitor, acts against both wild-type and mutant KIT. OBJECTIVE This multi-institutional, phase II, single-arm study aimed to evaluate the efficacy of regorafenib against metastatic malignant melanoma harbouring c-KIT mutations. METHODS Patients with metastatic melanoma positive for c-KIT mutations, upon progression after at least one line of systemic treatment, were enroled. Patients received oral regorafenib 160 mg once daily for 3 weeks (4-week cycle). The primary endpoint was disease control rate (DCR), and secondary endpoints were safety, overall response rate (ORR), progression-free survival (PFS), and overall survival (OS). RESULTS In total, 23 patients were enrolled. c-KIT mutations were frequently reported in exon 11 (14/23, 60.9%), followed by exons 13, 17, and 9 in 5 (21.7%), 5 (21.7%), and 2 (8.7%) patients, respectively. DCR at 8 weeks was 73.9%, with 2 patients (8.7%) achieving complete response, 5 (21.7%) achieving partial response, and 10 (43.5%) showing stable disease. ORR was 30.4% (7/23). The median follow-up period was 15.7 months (95% confidence interval [CI], 9.6-21.3), and median OS and PFS were 21.5 months (95% CI, 15.1-27.9) and 7.1 months (95% CI, 5.0-9.2), respectively. Circulating tumour DNA analysis in selected patients showed high c-KIT correlation (85.7%) with tissue-based tumour mutational profiles. The most common adverse events (AEs) were skin reactions, including palmar-plantar erythrodysesthesia (52.2%), and grade 3 AEs were reported in 39.1% (9/23) of the patients. CONCLUSION Regorafenib in second- or later-line settings demonstrated significant activity in patients with metastatic melanoma harbouring c-KIT mutations.
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Affiliation(s)
- Kyoo Hyun Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Minkyu Jung
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo Jin Lee
- Department of Internal Medicine and Cancer Research Institute, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Su Jin Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Divison of Hematology-Oncology, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Miso Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University Cancer Research Institute, Seoul, Republic of Korea
| | - Mi Sun Ahn
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Moon Young Choi
- Department of Internal Medicine, Hemato-Oncology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Na-Ri Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Sang Joon Shin
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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4
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Jung S, Armstrong E, Wei AZ, Ye F, Lee A, Carlino MS, Sullivan RJ, Carvajal RD, Shoushtari AN, Johnson DB. Clinical and genomic correlates of imatinib response in melanomas with KIT alterations. Br J Cancer 2022; 127:1726-1732. [PMID: 35999272 PMCID: PMC9596433 DOI: 10.1038/s41416-022-01942-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/19/2022] [Accepted: 07/29/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Imatinib is an active agent for some patients with melanoma harbouring c-KIT alterations. However, the genetic and clinical features that correlate with imatinib sensitivity are not well-defined. METHODS We retrospectively evaluated 38 KIT-altered melanoma patients from five medical centres who received imatinib, and pooled data from prospective studies of imatinib in 92 KIT-altered melanoma patients. Baseline patient and disease characteristics, and clinical outcomes were assessed. RESULTS In the pooled analysis (N = 130), alterations in exons 11/13 had the highest response rates (38% and 33%); L576P (N = 23) and K642E (N = 12) mutations had ORR of 52% and 42%, respectively. ORR was 38% (mucosal), 25% (acral), and 8% (unknown-primary). PFS appeared longer in exon 11/13 vs. exon 17 alterations (median 4.3 and 4.5 vs. 1.1 months; p = 0.19), with similar superiority in OS (median 19.7 and 15.4 vs. 12.1 months; p = 0.20). By histology, median PFS was 4.5 months (mucosal), 2.7 (acral), and 5.0 (unknown-primary) [p = 0.36]. Median OS was 18.0 months (mucosal), 21.8 (acral), 11.5 (unknown-primary) [p = 0.26]. In multivariate analyses, mucosal melanoma was associated with higher PFS and exon 17 mutations were associated with reduced PFS. CONCLUSION This multicenter study highlights KIT-alterations sensitive to imatinib and augments evidence for imatinib in subsets of KIT-altered melanoma.
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Affiliation(s)
- Seungyeon Jung
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Emma Armstrong
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexander Z Wei
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Fei Ye
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aaron Lee
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matteo S Carlino
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Ryan J Sullivan
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Richard D Carvajal
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center and Vanderbilt Ingram Cancer Center, Nashville, TN, USA.
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Darmawan CC, Ohn J, Mun J, Kim S, Lim Y, Jo SJ, Kim Y, Kim B, Seong M, Kim BJ, Lee C, Kwak Y, Chung HJ, Virós A, Lee D. Diagnosis and treatment of nail melanoma: A review of the clinicopathologic, dermoscopic, and genetic characteristics. J Eur Acad Dermatol Venereol 2022; 36:651-660. [DOI: 10.1111/jdv.17975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/20/2021] [Accepted: 01/07/2022] [Indexed: 12/01/2022]
Affiliation(s)
- C. C. Darmawan
- Department of Dermatology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Institute of Human‐Environment Interface Biology Seoul National University 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - J. Ohn
- Department of Dermatology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Institute of Human‐Environment Interface Biology Seoul National University 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - J.‐H. Mun
- Department of Dermatology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Institute of Human‐Environment Interface Biology Seoul National University 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Department of Dermatology Seoul National University Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Skin Cancer/Chemotherapy Skin Care Center Seoul National University Cancer Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - S. Kim
- Department of Dermatology Seoul National University Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - Y. Lim
- Department of Dermatology Seoul National University Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Skin Cancer/Chemotherapy Skin Care Center Seoul National University Cancer Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - S. J. Jo
- Department of Dermatology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Institute of Human‐Environment Interface Biology Seoul National University 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Department of Dermatology Seoul National University Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Skin Cancer/Chemotherapy Skin Care Center Seoul National University Cancer Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - Y.‐g. Kim
- Department of Laboratory Medicine Green Cross Genomic Laboratories 107 Ihyeonro 30beon‐gil Giheng‐gu Yongin‐Si Gyeonggi‐do 16924 Korea
| | - B. Kim
- Department of Laboratory Medicine Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - M.‐W. Seong
- Department of Laboratory Medicine Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - B. J. Kim
- Department of Plastic and Reconstructive Surgery Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - C. Lee
- Department of Pathology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - Y. Kwak
- Department of Pathology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - H. J. Chung
- Department of Dermatology Harvard Medical School Boston Massachusetts 02215 USA
| | - A. Virós
- Skin Cancer and Ageing Lab Cancer Research UK Manchester Institute The University of Manchester Manchester SK10 4TG UK
| | - D.Y. Lee
- Department of Dermatology Samsung Medical Center Sungkyunkwan University 81 Irwon‐Ro, Gangnam‐gu Seoul 06351 Korea
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Anorectal and Genital Mucosal Melanoma: Diagnostic Challenges, Current Knowledge and Therapeutic Opportunities of Rare Melanomas. Biomedicines 2022; 10:biomedicines10010150. [PMID: 35052829 PMCID: PMC8773579 DOI: 10.3390/biomedicines10010150] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 02/05/2023] Open
Abstract
Mucosal melanomas (MM) are rare tumors, being less than 2% of all diagnosed melanomas, comprising a variegated group of malignancies arising from melanocytes in virtually all mucosal epithelia, even if more frequently found in oral and sino-nasal cavities, ano-rectum and female genitalia (vulva and vagina). To date, there is no consensus about the optimal management strategy of MM. Furthermore, the clinical rationale of molecular tumor characterization regarding BRAF, KIT or NRAS, as well as the therapeutic value of immunotherapy, chemotherapy and targeted therapy, has not yet been deeply explored and clearly established in MM. In this overview, focused on anorectal and genital MM as models of rare melanomas deserving of a multidisciplinary approach, we highlight the need of referring these patients to centers with experts in melanoma, anorectal and uro-genital cancers treatments. Taking into account the rarity, the poor outcomes and the lack of effective treatment options for MM, tailored research needs to be promptly promoted.
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Bian SX, Hwang L, Hwang J, Ragab O, In GK, Peng D, Lin E. Acral lentiginous melanoma-Population, treatment, and survival using the NCDB from 2004 to 2015. Pigment Cell Melanoma Res 2021; 34:1049-1061. [PMID: 34273249 PMCID: PMC8599631 DOI: 10.1111/pcmr.12999] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/21/2021] [Accepted: 07/07/2021] [Indexed: 12/27/2022]
Abstract
Acral lentiginous melanoma (ALM) is a rare histological subtype of cutaneous malignant melanoma that typically presents on the palms and soles. To characterize the demographic and treatment characteristics of ALM, we used the National Cancer Database (NCDB) to describe a large multi-institutional cohort of ALM patients, consisting of 4,796 ALM patients from 2004 to 2015. ALM was more likely to be diagnosed at a later stage overall compared with non-ALM cutaneous melanomas, and more likely to be thicker, ulcerated, lymph node positive, and have lymphovascular invasion and positive margins. When stratified by stage, ALM had worse survival compared with non-ALM patients, most notably in stage III patients with 5-year survival of 47.5% versus 56.7%, respectively (p < .001). In ALM patients, older age, male sex, higher comorbidity burden, increased tumor thickness and ulceration, positive lymph nodes, and positive metastasis were independently associated with lower 5-year survival. Multimodality therapy, defined as surgery in addition to systemic therapy and/or radiation therapy, was associated with higher survival in stage III patients but not in other stages. These results call for further investigation into possible treatment intensification in the ALM population in the future.
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Affiliation(s)
- Shelly X Bian
- Department of Radiation Oncology, University of Southern California, Los Angeles, CA, USA
| | - Lindsay Hwang
- Department of Radiation Oncology, University of Southern California, Los Angeles, CA, USA
| | - Jennifer Hwang
- Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Omar Ragab
- Department of Radiation Oncology, University of Southern California, Los Angeles, CA, USA
| | - Gino K In
- Department of Medicine, Division of Oncology, University of Southern California, Los Angeles, CA, USA
- Department of Dermatology, University of Southern California, Los Angeles, CA, USA
| | - David Peng
- Department of Dermatology, University of Southern California, Los Angeles, CA, USA
| | - Eugene Lin
- Department of Medicine, Division of Nephrology, University of Southern California, Los Angeles, CA, USA
- Leonard D Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
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8
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Foster BM, Langsten KL, Mansour A, Shi L, Kerr BA. Tissue distribution of stem cell factor in adults. Exp Mol Pathol 2021; 122:104678. [PMID: 34450114 PMCID: PMC8516741 DOI: 10.1016/j.yexmp.2021.104678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/22/2021] [Accepted: 08/22/2021] [Indexed: 11/22/2022]
Abstract
Stem cell factor (SCF) is an essential cytokine during development and is necessary for gametogenesis, hematopoiesis, mast cell development, stem cell function, and melanogenesis. Here, we measure SCF concentration and distribution in adult humans and mice using gene expression analysis, tissue staining, and organ protein lysates. We demonstrate continued SCF expression in many cell types and tissues into adulthood. Tissues with high expression in adult humans included stomach, spleen, kidney, lung, and pancreas. In mice, we found high SCF expression in the esophagus, ovary, uterus, kidney, and small intestine. Future studies may correlate our findings of increased, organ-specific SCF concentrations within adult tissues with increased risk of SCF/CD117-related disease.
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Affiliation(s)
- Brittni M Foster
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States of America
| | - Kendall L Langsten
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States of America
| | - Ammar Mansour
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States of America
| | - Lihong Shi
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States of America
| | - Bethany A Kerr
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States of America; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157, United States of America.
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Ren Z, Hou X, Xue Z, Zhang L, Wang B, Wen J, Chu X. The relationship between the number of circulating tumor cells and the prognosis in patients with esophageal squamous cell carcinoma. J Gastrointest Oncol 2021; 12:1265-1276. [PMID: 34532086 DOI: 10.21037/jgo-21-409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/10/2021] [Indexed: 12/12/2022] Open
Abstract
Background Esophageal cancer (EC) is one of the most common malignancies worldwide, with high morbidity and mortality rates. Circulating tumor cell (CTC) detection has become a novel approach in clinical study of EC. In this study, the relationship between CTCs/c-Kit expression of CTCs and the prognosis of EC patients was analyzed in EC. Methods A total of 43 EC patients with R0 resection were recruited for this study. The CanPatrol method was used to detect the CTC number in the peripheral blood of patients before and after operations, and the epithelial/interstitial type was classified. Multiple RNA in situ hybridization (RNA-ISH) was used to observethe c-Kit expression of CTCs. Post-operation follow-up occurred over 3 years. Logistic regression or the Cox proportional risk regression model was applied to analyze the relationship between CTC number, CTCs and disease characteristics, pathological stages and prognosis of patients with EC, and changes in CTCs before and after operations. c-Kit expression in different CTCs and the relationship between c-Kit expression and prognosis were also studied. Results The detection rate of CTCswas 81% (35/43). The detection rates of epithelial-, mixed- and stromal-type CTCs were 53%, 63%, and 33%, respectively. The 3-year overall survival rate was 67%. A CTC level of >2 indicated an increased risk of recurrence, metastasis, and death (P=0.018, 0.002, respectively). Following the operations, the total number of CTCs decreased in 29 cases. Of these, 6 cases were unchanged, and 8 cases demonstrated elevated CTCs. There was a significant difference in the positive rate of mixed-type CTCs before and after the operations. The rate of c-Kit expression in CTCs of EC patients was 46% pre-operation. No statistically significant correlations were found between c-Kit expression and postoperative recurrence/metastasis/survival of EC patients. Conclusions Preoperative CTC numbers, especially interstitial CTCs, were used as an auxiliary index in the prognosis of EC patients. The mRNA expression of c-Kit was detected in CTCs preoperatively in patients with EC, but no significant correlation between the c-Kit expression and the prognosis of EC patients was found.
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Affiliation(s)
- Zhipeng Ren
- Department of Thoracic Surgery, First Medical Center, General Hospital of Chinese PLA, Beijing, China
| | - Xiaobin Hou
- Department of Thoracic Surgery, First Medical Center, General Hospital of Chinese PLA, Beijing, China
| | - Zhiqiang Xue
- Department of Thoracic Surgery, First Medical Center, General Hospital of Chinese PLA, Beijing, China
| | - Lianbin Zhang
- Department of Thoracic Surgery, First Medical Center, General Hospital of Chinese PLA, Beijing, China
| | - Bo Wang
- Department of Thoracic Surgery, First Medical Center, General Hospital of Chinese PLA, Beijing, China
| | - Jiaxin Wen
- Department of Thoracic Surgery, First Medical Center, General Hospital of Chinese PLA, Beijing, China
| | - Xiangyang Chu
- Department of Thoracic Surgery, First Medical Center, General Hospital of Chinese PLA, Beijing, China
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10
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Ma Y, Xia R, Ma X, Judson-Torres RL, Zeng H. Mucosal Melanoma: Pathological Evolution, Pathway Dependency and Targeted Therapy. Front Oncol 2021; 11:702287. [PMID: 34350118 PMCID: PMC8327265 DOI: 10.3389/fonc.2021.702287] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/02/2021] [Indexed: 12/16/2022] Open
Abstract
Mucosal melanoma (MM) is a rare melanoma subtype that originates from melanocytes within sun-protected mucous membranes. Compared with cutaneous melanoma (CM), MM has worse prognosis and lacks effective treatment options. Moreover, the endogenous or exogenous risk factors that influence mucosal melanocyte transformation, as well as the identity of MM precursor lesions, are ambiguous. Consequently, there remains a lack of molecular markers that can be used for early diagnosis, and therefore better management, of MM. In this review, we first summarize the main functions of mucosal melanocytes. Then, using oral mucosal melanoma (OMM) as a model, we discuss the distinct pathologic stages from benign mucosal melanocytes to metastatic MM, mapping the possible evolutionary trajectories that correspond to MM initiation and progression. We highlight key areas of ambiguity during the genetic evolution of MM from its benign lesions, and the resolution of which could aid in the discovery of new biomarkers for MM detection and diagnosis. We outline the key pathways that are altered in MM, including the MAPK pathway, the PI3K/AKT pathway, cell cycle regulation, telomere maintenance, and the RNA maturation process, and discuss targeted therapy strategies for MM currently in use or under investigation.
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Affiliation(s)
- Yanni Ma
- Department of Oncology, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Institute of Precision Medicine, Shanghai, China
| | - Ronghui Xia
- Department of Oral Pathology, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xuhui Ma
- Department of Oral & Maxillofacial - Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Robert L Judson-Torres
- Department of Dermatology, University of Utah, Salt Lake City, UT, United States.,Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Hanlin Zeng
- Department of Oncology, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Institute of Precision Medicine, Shanghai, China
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11
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Chacón M, Pfluger Y, Angel M, Waisberg F, Enrico D. Uncommon Subtypes of Malignant Melanomas: A Review Based on Clinical and Molecular Perspectives. Cancers (Basel) 2020; 12:E2362. [PMID: 32825562 PMCID: PMC7565756 DOI: 10.3390/cancers12092362] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/25/2020] [Accepted: 07/29/2020] [Indexed: 12/26/2022] Open
Abstract
Malignant melanoma represents the most aggressive type of skin cancer. Modern therapies, including targeted agents and immune checkpoint inhibitors, have changed the dismal prognosis that characterized this disease. However, most evidence was obtained by studying patients with frequent subtypes of cutaneous melanoma (CM). Consequently, there is an emerging need to understand the molecular basis and treatment approaches for unusual melanoma subtypes. Even a standardized definition of infrequent or rare melanoma is not clearly established. For that reason, we reviewed this challenging topic considering clinical and molecular perspectives, including uncommon CMs-not associated with classical V600E/K BRAF mutations-malignant mucosal and uveal melanomas, and some unusual independent entities, such as amelanotic, desmoplastic, or spitzoid melanomas. Finally, we collected information regarding melanomas from non-traditional primary sites, which emerge from locations as unique as meninges, dermis, lymph nodes, the esophagus, and breasts. The aim of this review is to summarize and highlight the main scientific evidence regarding rare melanomas, with a particular focus on treatment perspectives.
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Affiliation(s)
- Matías Chacón
- Department of Medical Oncology, Alexander Fleming Cancer Institute, Buenos Aires 1426, Argentina; (Y.P.); (M.A.); (F.W.); (D.E.)
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Loss-of-function variants in FSIP1 identified by targeted sequencing are associated with one particular subtype of mucosal melanoma. Gene 2020; 759:144964. [PMID: 32717308 DOI: 10.1016/j.gene.2020.144964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/04/2020] [Accepted: 07/13/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Mucosal melanoma is a tumor caused by the malignant transformation of pigment-producing cells and can arise from any mucosal tissue where melanocytes are present. Due to its rarity, the mucosal melanoma subtype is poorly described, and its genetic characteristics are infrequently studied. The discovery or confirmation of new mucosal melanoma susceptibility genes will provide important insights for the study of its pathogenesis. MATERIALS AND METHODS We performed deep targeted sequencing of 100 previously reported melanoma-related genes in 39 mucosal melanoma samples and a gene-level loss-of-function (LOF) variant enrichment analysis for mucosal melanoma from different incidence sites. RESULTS We detected 7,589 variants in these samples, and 484 were LOF variants (gain or loss of a stop codon, missense, and splice site). Four different gene-level enrichment analyses revealed that FSIP1 (fibrous sheath interacting protein 1) is a susceptibility gene for oral mucosal melanoma (OR = 0.33, PChi = 4.05 × 10-2, Pburden = 3.06 × 10-2, Pskat = 3.01 × 10-2, Pskato = 3.01 × 10-2), whereas the different methods did not detect a significant susceptibility gene for the other subtypes. CONCLUSIONS In our study, a susceptibility gene for oral mucosal melanoma was confirmed in a Chinese Han population, and these findings contribute to a better genetic understanding of mucosal melanoma of different subtypes.
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13
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Borkowska A, Szumera-Ciećkiewicz A, Spałek M, Teterycz P, Czarnecka A, Kowalik A, Rutkowski P. Mutation profile of primary subungual melanomas in Caucasians. Oncotarget 2020; 11:2404-2413. [PMID: 32637031 PMCID: PMC7321700 DOI: 10.18632/oncotarget.27642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Specific genomic profile of cutaneous melanomas is related to UVR exposure, which exerts biological and therapeutic impact. Subungual melanoma (SUM) is an exceedingly rare disease; therefore, it is not well characterized. SUM pathogenesis is not related to UVR induced DNA damage and expected to differ from other melanoma subtypes. Our study aimed to define the mutation profile of SUM in Caucasians. Materials and Methods: Next-generation sequencing-based genomic analysis was used to identify frequently mutated loci in 50 cancer-related genes in 31 SUM primary tumors. Results: The most abundant mutations in SUM were found in KIT – in 13% of cases and NRAS – also in 13%, while BRAF - only in 3% of cases. Conclusions: Our findings confirmed a high frequency of KIT and NRAS mutations in SUM, as well as a low incidence of BRAF mutations. We reported novel KRAS, CTNNB1, TP53, ERBB2, and SMAD4 mutations in SUM. Our findings provide new insights into the molecular pathogenesis of SUM.
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Affiliation(s)
- Aneta Borkowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Anna Szumera-Ciećkiewicz
- Department of Pathology and Laboratory Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Diagnostic Hematology Department, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Mateusz Spałek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Paweł Teterycz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Anna Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Artur Kowalik
- Department of Molecular Diagnostics, Holy Cross Cancer Centre, Kielce, Poland.,Division of Medical Biology, Institute of Biology, Jan Kochanowski University, Kielce, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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14
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Comodo-Navarro AN, Fernandes M, Barcelos D, Carapeto FCL, Guimarães DP, de Sousa Moraes L, Cerutti J, Iwamura ESM, Landman G. Intratumor Heterogeneity of KIT Gene Mutations in Acral Lentiginous Melanoma. Am J Dermatopathol 2020; 42:265-271. [PMID: 31393283 DOI: 10.1097/dad.0000000000001475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Melanoma is an aggressive skin malignancy, and the acral lentiginous melanoma (ALM) subtype affects non-sun-exposed sites such as the volar surface of the hands and feet and the subungual region and is most common in Asians, Hispanics, and Afro-descendants. The presence of different clones within the same tumor seems to influence the aggressiveness of tumors. Patients with mutations in the KIT gene have shown a good response to tyrosine kinase inhibitor therapy. We tested the hypothesis of intratumor heterogeneity through analysis of KIT gene mutations in ALM and determined the correlation between KIT mutations and demographic, clinical, and histopathological variables. Twenty-five ALM samples were examined. We selected up to four different regions per tumor for sequencing by the Sanger method for analysis of KIT gene exon 11 and exon 13 mutations. Advanced lesions were predominant, and the main histopathological characteristics of lesions were Breslow index >4.0 mm (17/25, 68%), Clark level IV/V (21/25, 84%), ulceration (16/25, 64%), and >3 mitoses/mm (8/25, 32%). KIT gene mutations were detected in 11/25 cases (44%), and all these 11 cases displayed intratumor heterogeneity, that is, at least 2 tumor regions had different mutational profiles. The predicted effect of most mutations detected was detrimental to protein function. No significant correlations between histopathological variables and either KIT mutations or intratumor heterogeneity were observed. The hypothesis of intratumor heterogeneity of KIT gene mutations in acral lentiginous melanoma was supported.
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Affiliation(s)
| | - Mariana Fernandes
- Departamento de Patologia, Universidade Federal de São Paulo, São Paulo, Brazil; and
| | - Denise Barcelos
- Departamento de Patologia, Universidade Federal de São Paulo, São Paulo, Brazil; and
| | | | | | - Lais de Sousa Moraes
- Departamento de Morfologia e Genética, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Janete Cerutti
- Departamento de Morfologia e Genética, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Gilles Landman
- Departamento de Patologia, Universidade Federal de São Paulo, São Paulo, Brazil; and
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15
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Na'ara S, Mukherjee A, Billan S, Gil Z. Contemporary Multidisciplinary Management of Sinonasal Mucosal Melanoma. Onco Targets Ther 2020; 13:2289-2298. [PMID: 32214828 PMCID: PMC7083634 DOI: 10.2147/ott.s182580] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/12/2020] [Indexed: 12/31/2022] Open
Abstract
Sinonasal mucosal melanoma (SNMM) is a rare tumor, comprising less than 10% of sinonasal malignancies. SNMM most frequently occurs in the nasal cavity (70%) and maxillary sinus (14%), typically as black patches. Overall, SNMM harbors a very poor prognosis; 5-year survival is less than 30%. Nasal cavity tumors confer a better prognosis than sinus melanoma. The primary management for SNMM is surgery, when feasible, followed by adjuvant radiotherapy. Recent studies suggest that immunotherapy may confer survival benefit to patients with advanced disease. The multidisciplinary team approach has been shown to optimize treatment, reduce costs, and minimize adverse events, while maximizing the chances for cure.
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Affiliation(s)
- Shorook Na'ara
- The Laboratory for Applied Cancer Research, Department of Otolaryngology Head and Neck Surgery, Technion-Israel Institute of Technology, Rambam Healthcare Campus, Haifa, Israel.,The Head and Neck Center, Rambam Healthcare Campus, Clinical Research Institute at Rambam, Rappaport Institute of Medicine and Research, Technion-Israel Institute of Technology, Haifa, Israel
| | - Abhishek Mukherjee
- Department of Genetics and Developmental Biology, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Salem Billan
- The Head and Neck Center, Rambam Healthcare Campus, Clinical Research Institute at Rambam, Rappaport Institute of Medicine and Research, Technion-Israel Institute of Technology, Haifa, Israel.,The Oncology Institute, Rambam Health Care Campus, Haifa, Israel
| | - Ziv Gil
- The Laboratory for Applied Cancer Research, Department of Otolaryngology Head and Neck Surgery, Technion-Israel Institute of Technology, Rambam Healthcare Campus, Haifa, Israel.,The Head and Neck Center, Rambam Healthcare Campus, Clinical Research Institute at Rambam, Rappaport Institute of Medicine and Research, Technion-Israel Institute of Technology, Haifa, Israel
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16
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Abstract
Immunohistochemistry (IHC) is routinely performed in most laboratories, and other than purchase of commercially available antibodies, requires no additional equipment or reagents. As such, IHC is an accessible and relatively inexpensive test and one that can be performed quite quickly. This is in sharp contrast to genomic or mutational testing methodologies that are routinely "send out" tests as they require specialized equipment and reagents as well as individuals with expertise in the performance of the tests and analysis of the results, resulting in a prolonged turn-round-time and enhanced associated costs. However, many open questions remain in a rapidly changing therapeutic and scientific landscape with most obvious one being what exactly is the utility of "good old fashioned" IHC in the age of targeted therapy? For molecular applications, is a negative immunohistochemical result enough as a stand-alone diagnostic or predictive product? Is a positive immunohistochemical result perhaps more suitable for a role in screening for molecular alterations rather than a definitive testing modality? This review is an attempt to answer those very questions. We elucidate the broad range of entities in which IHC is currently used as a molecular surrogate and underscore pearls and pitfalls associated with each. Special attention is given to entities for which targeted therapies are currently available and to entities in which molecular data is of clinical utility as a prognosticator.
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17
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Gong Y, He X, Li Q, He J, Bian B, Li Y, Ge L, Zeng Y, Xu H, Yin ZQ. SCF/SCFR signaling plays an important role in the early morphogenesis and neurogenesis of human embryonic neural retina. Development 2019; 146:dev.174409. [PMID: 31548215 DOI: 10.1242/dev.174409] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 09/16/2019] [Indexed: 12/20/2022]
Abstract
The stem cell factor receptor (SCFR) has been demonstrated to be expressed in the neural retina of mice, rat and human for decades. Previous reports indicated that the SCFR correlates with glia differentiation of late retinal progenitor cells (RPCs), retinal vasculogenesis and homeostasis of the blood-retinal barrier. However, the role of SCF/SCFR signaling in the growth and development of the neural retina (NR), especially in the early embryonic stage, remains poorly understood. Here, we show that SCF/SCFR signaling orchestrates invagination of the human embryonic stem cell (hESC)-derived NR via regulation of cell cycle progression, cytoskeleton dynamic and apical constriction of RPCs in the ciliary marginal zone (CMZ). Furthermore, activation of SCF/SCFR signaling promotes neurogenesis in the central-most NR via acceleration of the migration of immature ganglion cells and repressing apoptosis. Our study reveals an unreported role for SCF/SCFR signaling in controlling ciliary marginal cellular behaviors during early morphogenesis and neurogenesis of the human embryonic NR, providing a new potential therapeutic target for human congenital eye diseases such as anophthalmia, microphthalmia and congenital high myopia.
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Affiliation(s)
- Yu Gong
- Southwest Hospital/ Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, PR China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, PR China
| | - Xiangyu He
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, PR China
| | - Qiyou Li
- Southwest Hospital/ Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, PR China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, PR China
| | - Juncai He
- Southwest Hospital/ Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, PR China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, PR China
| | - Baishijiao Bian
- Southwest Hospital/ Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, PR China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, PR China
| | - Yijian Li
- Southwest Hospital/ Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, PR China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, PR China
| | - Linlin Ge
- Southwest Hospital/ Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, PR China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, PR China
| | - Yuxiao Zeng
- Southwest Hospital/ Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, PR China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, PR China
| | - Haiwei Xu
- Southwest Hospital/ Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, PR China .,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, PR China
| | - Zheng Qin Yin
- Southwest Hospital/ Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, PR China .,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, PR China
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18
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DeWane ME, Kelsey A, Oliviero M, Rabinovitz H, Grant-Kels JM. Melanoma on chronically sun-damaged skin: Lentigo maligna and desmoplastic melanoma. J Am Acad Dermatol 2019; 81:823-833. [DOI: 10.1016/j.jaad.2019.03.066] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/17/2019] [Accepted: 03/22/2019] [Indexed: 02/01/2023]
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19
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Primary malignant melanoma of esophagus: clinicopathologic characterization of 20 cases including molecular genetic profiling of 15 tumors. Mod Pathol 2019; 32:957-966. [PMID: 30760858 PMCID: PMC8210848 DOI: 10.1038/s41379-018-0163-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/01/2018] [Accepted: 10/01/2018] [Indexed: 02/08/2023]
Abstract
Primary malignant melanoma of esophagus is very rare, and its clinicopathologic and genetic features have not been extensively investigated. In this study, 20 tumors from 14 male and 6 female patients (40-79 years old) were evaluated. Dysphagia, chest pain, and weight loss were frequent symptoms. Thirteen melanomas, including two with multiple lesions, involved the distal third of esophagus. The median tumor diameter was 6 cm. Epithelioid morphology, moderate atypia, and pigmentation were typical findings. None of the patients had melanoma elsewhere, and all tumors exhibited a junctional peri-epithelial component consistent with a primary lesion. The median mitotic activity was 11 per 10 high-power fields (range, 0-31). Nine patients died of tumor within 4-22 months, however, two showed long-term (96 and 104 months) survival. In 15 cases, tissue for further immunohistochemical and molecular studies were available. BRAF, KIT, and NRAS mutation status was assessed by Sanger sequencing in all 15 tumors. The next-generation sequencing of 50 or 409 genes was performed in five and three cases, respectively. IGF1R expression indicating activation of the IGF axis was seen in 82% (9/11) of tumors. However, no BRAF mutations were identified. In 33% (5/15) of tumors, NRAS mutations were detected. KIT expression was seen in 50% (7/14) of melanomas including single KIT mutant. Two of three tumors evaluated with 409 genes panel revealed multiple driver mutations indicating sub-clonal expansion, whereas a single mutation (TSC1 p.H371Q) was the sole change in the third case. SF3B1 p.K666T and p.R625C mutations were detected in two cases. However, no co-occurrence of SF3B1 and GNAQ or GNA11 mutations, seen in uveal melanoma, was detected. FBXW7 p.R465C and p.R479G mutations, linked to cancer progression, were found in two of eight tumors. In summary, esophageal melanoma mutation profile indicates complexity of molecular mechanisms underlying its pathogenesis.
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20
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Meng D, Carvajal RD. KIT as an Oncogenic Driver in Melanoma: An Update on Clinical Development. Am J Clin Dermatol 2019; 20:315-323. [PMID: 30707374 DOI: 10.1007/s40257-018-0414-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Metastatic melanoma is a heterogenous disease that has served as a model for the development of both targeted therapy and immunotherapy. KIT-mutated melanoma represents a rare subset, most commonly arising from acral, mucosal, and chronically sun-damaged skin. Additionally, KIT alterations are enriched in the triple wild-type subtype of cutaneous melanoma. Activating alterations of KIT-a transmembrane receptor tyrosine kinase important for cell development, growth, and differentiation-have been shown to be critical to oncogenesis across many tumor subtypes. Following the successes of BRAF-targeted therapy in melanoma and KIT-targeted therapy in gastrointestinal stromal tumors, small-molecule tyrosine kinase inhibitors targeting KIT have been examined in KIT-mutated melanoma. KIT inhibitors that have been investigated in relevant clinical trials in advanced melanoma include imatinib, sunitinib, dasatinib, and nilotinib. In these studies, selected patients with KIT-mutated melanoma were shown to be responsive to therapy with KIT inhibition, especially patients with L576P and K642E mutations. This has led to the incorporation of KIT-targeted therapy in the National Comprehensive Cancer Network guidelines for systemic therapy for metastatic or unresectable melanoma. Current research and development efforts include novel KIT-targeted therapies and testing KIT inhibitors in combination with immunotherapy.
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21
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Miyake S, Irikura D, Yamasaki T. Specific Detection of c-Kit Expressed on Human Cell Surface by Immunosensor Based on Surface Plasmon Resonance. ANAL SCI 2019; 35:223-225. [PMID: 30745512 DOI: 10.2116/analsci.18n022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
An immunosensor based on surface plasmon resonance was developed for detection of c-Kit expressed on a cell surface. The combination of the antibody solution modified with gelatin before immobilization to the sensor chip and its blocking with gelatin drastically decreased the nonspecific reaction. The condition may be useful for the detection of various cells by using antibody against cell surface marker including the c-Kit.
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Affiliation(s)
- Shiro Miyake
- Department of Food and Life Science, Azabu University.,Research & Development Division, Horiba, Ltd
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22
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Quek C, Rawson RV, Ferguson PM, Shang P, Silva I, Saw RPM, Shannon K, Thompson JF, Hayward NK, Long GV, Mann GJ, Scolyer RA, Wilmott JS. Recurrent hotspot SF3B1 mutations at codon 625 in vulvovaginal mucosal melanoma identified in a study of 27 Australian mucosal melanomas. Oncotarget 2019; 10:930-941. [PMID: 30847022 PMCID: PMC6398173 DOI: 10.18632/oncotarget.26584] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/16/2018] [Indexed: 02/03/2023] Open
Abstract
Introduction Clinical outcomes for mucosal melanomas are often poor due to a lack of effective systemic drug therapies. Identifying driver genes in mucosal melanoma may enhance the understanding of disease pathogenesis and provide novel opportunities to develop effective therapies. Results Somatic variant analysis identified SF3B1 (6 of 27: 22%) as the most commonly mutated gene, followed by KIT (3 of 27: 11%). Other less frequently mutated genes (4% otherwise stated) included BRAF (7%), NRAS (7%), ARID2, CTNNB1, DICER1, MAP2K1, NF1, PTEN, SETD2 and TP53. Recurrent SF3B1 p.R625 hotspot mutations were exclusively detected in vulvovaginal (5 of 19: 26%) and anorectal melanomas (3 of 5:60%). The only other SF3B1 mutation was a p.C1123Y mutation that occurred in a conjunctival mucosal melanoma. SF3B1-mutated patients were associated with shorter overall survival (OS; 34.9 months) and progression-free survival (PFS; 16.9 months) compared to non-SF3B1-mutated patients (OS: 79.7 months, log-rank P = 0.1172; PFS: 35.7 months, log-rank P = 0.0963). Conclusion Molecular subgroups of mucosal melanoma with SF3B1 mutations occurred predominantly in the vulvovaginal region. SF3B1 mutations may have a negative prognostic impact. Methods Formalin-fixed biopsies were collected from 27 pathologically-confirmed mucosal melanomas. Genomic DNA was isolated from the tumor tissue and sequenced using a novel dual-strand amplicon sequencing technique to determine the frequency and types of mutations across 45 target genes.
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Affiliation(s)
- Camelia Quek
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Robert V Rawson
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Hospital, Sydney, Australia
| | - Peter M Ferguson
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Hospital, Sydney, Australia
| | - Ping Shang
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Ines Silva
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Hospital, Sydney, Australia
| | - Kerwin Shannon
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Hospital, Sydney, Australia.,Centre for Cancer Research, Westmead Institute for Medical Research, Sydney, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Hospital, Sydney, Australia
| | - Nicholas K Hayward
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia.,Royal North Shore Hospital, Sydney, Australia
| | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia.,Centre for Cancer Research, Westmead Institute for Medical Research, Sydney, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Hospital, Sydney, Australia
| | - James S Wilmott
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
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23
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Tyrosine Kinase Inhibitor and Immune Checkpoint Inhibitor Responses in KIT-Mutant Metastatic Melanoma. J Invest Dermatol 2018; 139:728-731. [PMID: 30798855 DOI: 10.1016/j.jid.2018.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/28/2018] [Accepted: 10/14/2018] [Indexed: 11/20/2022]
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24
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Exploring major signaling cascades in melanomagenesis: a rationale route for targetted skin cancer therapy. Biosci Rep 2018; 38:BSR20180511. [PMID: 30166456 PMCID: PMC6167501 DOI: 10.1042/bsr20180511] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/14/2018] [Accepted: 08/24/2018] [Indexed: 02/06/2023] Open
Abstract
Although most melanoma cases may be treated by surgical intervention upon early diagnosis, a significant portion of patients can still be refractory, presenting low survival rates within 5 years after the discovery of the illness. As a hallmark, melanomas are highly prone to evolve into metastatic sites. Moreover, melanoma tumors are highly resistant to most available drug therapies and their incidence have increased over the years, therefore leading to public health concerns about the development of novel therapies. Therefore, researches are getting deeper in unveiling the mechanisms by which melanoma initiation can be triggered and sustained. In this context, important progress has been achieved regarding the roles and the impact of cellular signaling pathways in melanoma. This knowledge has provided tools for the development of therapies based on the intervention of signal(s) promoted by these cascades. In this review, we summarize the importance of major signaling pathways (mitogen-activated protein kinase (MAPK), phosphoinositide 3-kinase (PI3K)-Akt, Wnt, nuclear factor κ-light-chain-enhancer of activated B cell (NF-κB), Janus kinase (JAK)-signal transducer and activator of transcription (STAT), transforming growth factor β (TGF-β) and Notch) in skin homeostasis and melanoma progression. Available and developing melanoma therapies interfering with these signaling cascades are further discussed.
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25
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Abstract
OPINION STATEMENT Melanoma is one of the most aggressive malignant skin tumors and its incidence has been increasing worldwide in recent decades. Among the four subtypes, acral lentiginous melanoma (ALM) shows the highest incidence in Asian countries, whereas ALM comprises only 1% of all melanomas in white populations. Early clinical diagnosis of ALM is essential, but early ALM lesions are often difficult to diagnose because the pigmentation of the lesions sometimes follows the skin marking of the palms and soles, resulting in an asymmetrical appearance and an irregular border in both ALM and benign melanocytic nevus. To overcome this difficulty, dermoscopy was introduced, and determination of the patterns by this method is essential for accurate clinical diagnosis of ALM. Although recent clinical trials have demonstrated that immune checkpoint inhibitors and BRAF/MEK inhibitors showed significantly improved overall survival of patients with advanced melanoma, ALM may be less susceptible to immune checkpoint inhibitors because of the poor immune response to the tumor. Therefore, strategies for enhancing the immune response to the tumor cells may be required when we apply immune checkpoint inhibitors in advanced ALM. In this context, imiquimod, dacarbazine, or interferon are possible therapies that may enhance the effectiveness of the immune checkpoint inhibitors. In addition to being known to have poor immunogenicity, ALM is also known to have infrequent BRAF mutation. Therefore, the majority of ALM patients may not benefit from therapy with BRAF/MEK inhibitors. However, some ALMs have mutations such as KIT and NRAS mutations, and therefore, targeted therapies may improve the survival of ALM patients in the future.
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Affiliation(s)
- Yoshiyuki Nakamura
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Yasuhiro Fujisawa
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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26
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Oba J, Kim SH, Wang WL, Macedo MP, Carapeto F, McKean MA, Van Arnam J, Eterovic AK, Sen S, Kale CR, Yu X, Haymaker CL, Routbort M, Haydu LE, Bernatchez C, Lazar AJ, Grimm EA, Hong DS, Woodman SE. Targeting the HGF/MET Axis Counters Primary Resistance to KIT Inhibition in KIT-Mutant Melanoma. JCO Precis Oncol 2018; 2018. [PMID: 30094412 DOI: 10.1200/po.18.00055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Junna Oba
- Junna Oba, Sun-Hee Kim, Wei-Lien Wang, Mariana P. Macedo, Fernando Carapeto, Meredith A McKean, John Van Arnam, Agda K. Eterovic, Shiraj Sen, Charuta R. Kale, Xiaoxing Yu, Cara L. Haymaker, Mark Routbort, Lauren E. Haydu, Chantale Bernatchez, Alexander J. Lazar, Elizabeth A. Grimm, David S. Hong, and Scott E. Woodman, The University of Texas MD Anderson Cancer Center, Houston, TX; and Mariana P. Macedo, AC Camargo Cancer Center, São Paulo, Brazil
| | - Sun-Hee Kim
- Junna Oba, Sun-Hee Kim, Wei-Lien Wang, Mariana P. Macedo, Fernando Carapeto, Meredith A McKean, John Van Arnam, Agda K. Eterovic, Shiraj Sen, Charuta R. Kale, Xiaoxing Yu, Cara L. Haymaker, Mark Routbort, Lauren E. Haydu, Chantale Bernatchez, Alexander J. Lazar, Elizabeth A. Grimm, David S. Hong, and Scott E. Woodman, The University of Texas MD Anderson Cancer Center, Houston, TX; and Mariana P. Macedo, AC Camargo Cancer Center, São Paulo, Brazil
| | - Wei-Lien Wang
- Junna Oba, Sun-Hee Kim, Wei-Lien Wang, Mariana P. Macedo, Fernando Carapeto, Meredith A McKean, John Van Arnam, Agda K. Eterovic, Shiraj Sen, Charuta R. Kale, Xiaoxing Yu, Cara L. Haymaker, Mark Routbort, Lauren E. Haydu, Chantale Bernatchez, Alexander J. Lazar, Elizabeth A. Grimm, David S. Hong, and Scott E. Woodman, The University of Texas MD Anderson Cancer Center, Houston, TX; and Mariana P. Macedo, AC Camargo Cancer Center, São Paulo, Brazil
| | - Mariana P Macedo
- Junna Oba, Sun-Hee Kim, Wei-Lien Wang, Mariana P. Macedo, Fernando Carapeto, Meredith A McKean, John Van Arnam, Agda K. Eterovic, Shiraj Sen, Charuta R. Kale, Xiaoxing Yu, Cara L. Haymaker, Mark Routbort, Lauren E. Haydu, Chantale Bernatchez, Alexander J. Lazar, Elizabeth A. Grimm, David S. Hong, and Scott E. Woodman, The University of Texas MD Anderson Cancer Center, Houston, TX; and Mariana P. Macedo, AC Camargo Cancer Center, São Paulo, Brazil
| | - Fernando Carapeto
- Junna Oba, Sun-Hee Kim, Wei-Lien Wang, Mariana P. Macedo, Fernando Carapeto, Meredith A McKean, John Van Arnam, Agda K. Eterovic, Shiraj Sen, Charuta R. Kale, Xiaoxing Yu, Cara L. Haymaker, Mark Routbort, Lauren E. Haydu, Chantale Bernatchez, Alexander J. Lazar, Elizabeth A. Grimm, David S. Hong, and Scott E. Woodman, The University of Texas MD Anderson Cancer Center, Houston, TX; and Mariana P. Macedo, AC Camargo Cancer Center, São Paulo, Brazil
| | - Meredith A McKean
- Junna Oba, Sun-Hee Kim, Wei-Lien Wang, Mariana P. Macedo, Fernando Carapeto, Meredith A McKean, John Van Arnam, Agda K. Eterovic, Shiraj Sen, Charuta R. Kale, Xiaoxing Yu, Cara L. Haymaker, Mark Routbort, Lauren E. Haydu, Chantale Bernatchez, Alexander J. Lazar, Elizabeth A. Grimm, David S. Hong, and Scott E. Woodman, The University of Texas MD Anderson Cancer Center, Houston, TX; and Mariana P. Macedo, AC Camargo Cancer Center, São Paulo, Brazil
| | - John Van Arnam
- Junna Oba, Sun-Hee Kim, Wei-Lien Wang, Mariana P. Macedo, Fernando Carapeto, Meredith A McKean, John Van Arnam, Agda K. Eterovic, Shiraj Sen, Charuta R. Kale, Xiaoxing Yu, Cara L. Haymaker, Mark Routbort, Lauren E. Haydu, Chantale Bernatchez, Alexander J. Lazar, Elizabeth A. Grimm, David S. Hong, and Scott E. Woodman, The University of Texas MD Anderson Cancer Center, Houston, TX; and Mariana P. Macedo, AC Camargo Cancer Center, São Paulo, Brazil
| | - Agda K Eterovic
- Junna Oba, Sun-Hee Kim, Wei-Lien Wang, Mariana P. Macedo, Fernando Carapeto, Meredith A McKean, John Van Arnam, Agda K. Eterovic, Shiraj Sen, Charuta R. Kale, Xiaoxing Yu, Cara L. Haymaker, Mark Routbort, Lauren E. Haydu, Chantale Bernatchez, Alexander J. Lazar, Elizabeth A. Grimm, David S. Hong, and Scott E. Woodman, The University of Texas MD Anderson Cancer Center, Houston, TX; and Mariana P. Macedo, AC Camargo Cancer Center, São Paulo, Brazil
| | - Shiraj Sen
- Junna Oba, Sun-Hee Kim, Wei-Lien Wang, Mariana P. Macedo, Fernando Carapeto, Meredith A McKean, John Van Arnam, Agda K. Eterovic, Shiraj Sen, Charuta R. Kale, Xiaoxing Yu, Cara L. Haymaker, Mark Routbort, Lauren E. Haydu, Chantale Bernatchez, Alexander J. Lazar, Elizabeth A. Grimm, David S. Hong, and Scott E. Woodman, The University of Texas MD Anderson Cancer Center, Houston, TX; and Mariana P. Macedo, AC Camargo Cancer Center, São Paulo, Brazil
| | - Charuta R Kale
- Junna Oba, Sun-Hee Kim, Wei-Lien Wang, Mariana P. Macedo, Fernando Carapeto, Meredith A McKean, John Van Arnam, Agda K. Eterovic, Shiraj Sen, Charuta R. Kale, Xiaoxing Yu, Cara L. Haymaker, Mark Routbort, Lauren E. Haydu, Chantale Bernatchez, Alexander J. Lazar, Elizabeth A. Grimm, David S. Hong, and Scott E. Woodman, The University of Texas MD Anderson Cancer Center, Houston, TX; and Mariana P. Macedo, AC Camargo Cancer Center, São Paulo, Brazil
| | - Xiaoxing Yu
- Junna Oba, Sun-Hee Kim, Wei-Lien Wang, Mariana P. Macedo, Fernando Carapeto, Meredith A McKean, John Van Arnam, Agda K. Eterovic, Shiraj Sen, Charuta R. Kale, Xiaoxing Yu, Cara L. Haymaker, Mark Routbort, Lauren E. Haydu, Chantale Bernatchez, Alexander J. Lazar, Elizabeth A. Grimm, David S. Hong, and Scott E. Woodman, The University of Texas MD Anderson Cancer Center, Houston, TX; and Mariana P. Macedo, AC Camargo Cancer Center, São Paulo, Brazil
| | - Cara L Haymaker
- Junna Oba, Sun-Hee Kim, Wei-Lien Wang, Mariana P. Macedo, Fernando Carapeto, Meredith A McKean, John Van Arnam, Agda K. Eterovic, Shiraj Sen, Charuta R. Kale, Xiaoxing Yu, Cara L. Haymaker, Mark Routbort, Lauren E. Haydu, Chantale Bernatchez, Alexander J. Lazar, Elizabeth A. Grimm, David S. Hong, and Scott E. Woodman, The University of Texas MD Anderson Cancer Center, Houston, TX; and Mariana P. Macedo, AC Camargo Cancer Center, São Paulo, Brazil
| | - Mark Routbort
- Junna Oba, Sun-Hee Kim, Wei-Lien Wang, Mariana P. Macedo, Fernando Carapeto, Meredith A McKean, John Van Arnam, Agda K. Eterovic, Shiraj Sen, Charuta R. Kale, Xiaoxing Yu, Cara L. Haymaker, Mark Routbort, Lauren E. Haydu, Chantale Bernatchez, Alexander J. Lazar, Elizabeth A. Grimm, David S. Hong, and Scott E. Woodman, The University of Texas MD Anderson Cancer Center, Houston, TX; and Mariana P. Macedo, AC Camargo Cancer Center, São Paulo, Brazil
| | - Lauren E Haydu
- Junna Oba, Sun-Hee Kim, Wei-Lien Wang, Mariana P. Macedo, Fernando Carapeto, Meredith A McKean, John Van Arnam, Agda K. Eterovic, Shiraj Sen, Charuta R. Kale, Xiaoxing Yu, Cara L. Haymaker, Mark Routbort, Lauren E. Haydu, Chantale Bernatchez, Alexander J. Lazar, Elizabeth A. Grimm, David S. Hong, and Scott E. Woodman, The University of Texas MD Anderson Cancer Center, Houston, TX; and Mariana P. Macedo, AC Camargo Cancer Center, São Paulo, Brazil
| | - Chantale Bernatchez
- Junna Oba, Sun-Hee Kim, Wei-Lien Wang, Mariana P. Macedo, Fernando Carapeto, Meredith A McKean, John Van Arnam, Agda K. Eterovic, Shiraj Sen, Charuta R. Kale, Xiaoxing Yu, Cara L. Haymaker, Mark Routbort, Lauren E. Haydu, Chantale Bernatchez, Alexander J. Lazar, Elizabeth A. Grimm, David S. Hong, and Scott E. Woodman, The University of Texas MD Anderson Cancer Center, Houston, TX; and Mariana P. Macedo, AC Camargo Cancer Center, São Paulo, Brazil
| | - Alexander J Lazar
- Junna Oba, Sun-Hee Kim, Wei-Lien Wang, Mariana P. Macedo, Fernando Carapeto, Meredith A McKean, John Van Arnam, Agda K. Eterovic, Shiraj Sen, Charuta R. Kale, Xiaoxing Yu, Cara L. Haymaker, Mark Routbort, Lauren E. Haydu, Chantale Bernatchez, Alexander J. Lazar, Elizabeth A. Grimm, David S. Hong, and Scott E. Woodman, The University of Texas MD Anderson Cancer Center, Houston, TX; and Mariana P. Macedo, AC Camargo Cancer Center, São Paulo, Brazil
| | - Elizabeth A Grimm
- Junna Oba, Sun-Hee Kim, Wei-Lien Wang, Mariana P. Macedo, Fernando Carapeto, Meredith A McKean, John Van Arnam, Agda K. Eterovic, Shiraj Sen, Charuta R. Kale, Xiaoxing Yu, Cara L. Haymaker, Mark Routbort, Lauren E. Haydu, Chantale Bernatchez, Alexander J. Lazar, Elizabeth A. Grimm, David S. Hong, and Scott E. Woodman, The University of Texas MD Anderson Cancer Center, Houston, TX; and Mariana P. Macedo, AC Camargo Cancer Center, São Paulo, Brazil
| | - David S Hong
- Junna Oba, Sun-Hee Kim, Wei-Lien Wang, Mariana P. Macedo, Fernando Carapeto, Meredith A McKean, John Van Arnam, Agda K. Eterovic, Shiraj Sen, Charuta R. Kale, Xiaoxing Yu, Cara L. Haymaker, Mark Routbort, Lauren E. Haydu, Chantale Bernatchez, Alexander J. Lazar, Elizabeth A. Grimm, David S. Hong, and Scott E. Woodman, The University of Texas MD Anderson Cancer Center, Houston, TX; and Mariana P. Macedo, AC Camargo Cancer Center, São Paulo, Brazil
| | - Scott E Woodman
- Junna Oba, Sun-Hee Kim, Wei-Lien Wang, Mariana P. Macedo, Fernando Carapeto, Meredith A McKean, John Van Arnam, Agda K. Eterovic, Shiraj Sen, Charuta R. Kale, Xiaoxing Yu, Cara L. Haymaker, Mark Routbort, Lauren E. Haydu, Chantale Bernatchez, Alexander J. Lazar, Elizabeth A. Grimm, David S. Hong, and Scott E. Woodman, The University of Texas MD Anderson Cancer Center, Houston, TX; and Mariana P. Macedo, AC Camargo Cancer Center, São Paulo, Brazil
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27
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Genetics of metastasis: melanoma and other cancers. Clin Exp Metastasis 2018; 35:379-391. [PMID: 29722002 DOI: 10.1007/s10585-018-9893-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 04/18/2018] [Indexed: 12/13/2022]
Abstract
Melanoma is a malignant neoplasm of melanocytes that accounts for the majority of skin cancer deaths despite comprising less than 5% of all cutaneous malignancies. Its incidence has increased faster than that of any other cancer over the past half-century and the annual costs of treatment in the United States alone have risen rapidly. Although the majority of primary melanomas are cured with local excision, metastatic melanoma historically carries a grim prognosis, with a median survival of 9 months and a long-term survival rate of 10%. Given the urgent need to develop treatment strategies for metastatic melanoma and the explosion of genetic technologies over the past 20 years, there has been extensive research into the genetic alterations that cause melanocytes to become malignant. More recently, efforts have focused on the genetic changes that drive melanoma metastasis. This review aims to summarize the current knowledge of the genetics of primary cutaneous and ocular melanoma, the genetic changes associated with metastasis in melanoma and other cancer types, and non-genetic factors that may contribute to metastasis.
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Ma X, Wu Y, Zhang T, Song H, Jv H, Guo W, Ren G. The clinical significance of c-Kit mutations in metastatic oral mucosal melanoma in China. Oncotarget 2017; 8:82661-82673. [PMID: 29137292 PMCID: PMC5669918 DOI: 10.18632/oncotarget.19746] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/20/2017] [Indexed: 01/14/2023] Open
Abstract
c-Kit mutations are frequently detected in mucosal melanomas, but their clinical significance in metastatic oral mucosal melanomas (OMM) remains unclear. The main purpose of this study was to investigate the clinical and pathological features of metastatic OMMs with c-Kit mutations and the efficiency of the tyrosine kinase inhibitor imatinib in treating metastatic OMMs. We found thatresidual primary lesion and neck lymph nodes could act as independent prognostic factors in metastatic OMM patients. c-Kit mutations were detected in 22 out of 139 (15.8%) metastatic OMM patients. Under chemotherapy, the overall survival (OS) of c-Kit mutant patients was significantly shorter than that of wild-type patients. The Ki67 expression was significantly higher in c-Kit mutant patients than in wild-type patients. In distant metastatic OMM patients with c-Kit mutations, the treatment with c-Kit inhibitor resulted in a better OS. In conclusion, residual primary lesion, cervical lymph nodes and c-Kit mutations act as adverse prognostic factors of metastatic OMMs. The Kit inhibitor imatinib could benefit metastatic OMM patients with c-Kit mutations.
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Affiliation(s)
- Xuhui Ma
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200011, China
| | - Yunteng Wu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200011, China
| | - Tian Zhang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200011, China
| | - Hao Song
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200011, China
| | - Houyu Jv
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200011, China
| | - Wei Guo
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200011, China
| | - Guoxin Ren
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200011, China
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29
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Vazquez VDL, Vicente AL, Carloni A, Berardinelli G, Soares P, Scapulatempo C, Martinho O, Reis RM. Molecular profiling, including TERT promoter mutations, of acral lentiginous melanomas. Melanoma Res 2016; 26:93-9. [PMID: 26709572 DOI: 10.1097/cmr.0000000000000222] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Acral lentiginous melanoma (ALM) is the less common subtype with singular characterization. TERT (human telomerase reverse transcriptase) promoter mutations have being described as recurrent in melanomas and infrequent in ALM, but their real incidence and clinical relevance is unclear. The objectives of this study were to describe the prevalence of TERT promoter mutations in ALM, and correlate with the molecular profile of other drive genes and clinical features. Sixty-one samples from 48 patients with ALM were analyzed. After DNA isolation, the mutation profiles of the hotspot region of BRAF, NRAS, KIT, PDGFRA, and TERT genes were determined by PCR amplification followed by direct Sanger sequencing. KIT, PDGFRA, and VEGFR2 gene amplification was performed by quantitative PCR. Clinical information such as survival, clinical stage, and Breslow tumor classification were obtained from medical records. TERT promoter mutations were found in 9.3% of the cases, BRAF in 10.3%, NRAS in 7.5%, KIT in 20.7%, and PDGFRA in 14.8% of ALM. None of the cases showed KIT, PDGFRA, or VEGFR2 gene amplification. We found an association between KIT mutations and advanced Clark level (IV and V, P=0.043) and TERT promoter mutations with low mitotic index. No other significant associations were observed between mutation profile and patients' clinical features nor survival rates. Oncogenic TERT promoter mutations are present in a fraction of ALMs. No relevant associations were found between TERT mutation status and clinical/molecular features nor survival. Mutations of KIT and PDGFRA are the most common genetic alterations, and they can be therapeutic targets for these patients.
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Affiliation(s)
- Vinicius de Lima Vazquez
- aMolecular Oncology Research Center bDepartment of Surgery, Melanoma and Sarcoma Unity cDepartment of Pathology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil dInstitute of Pathology and Molecular Immunology of University of Porto, (IPATIMUP), Porto eLife and Health Sciences Research Institute (ICVS), Health Sciences School, University of Minho fICVS/3B's-PT Government Associate Laboratory, Braga, Portugal
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30
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Castiglione R, Ihle MA, Heydt C, Schultheis AM, Merkelbach-Bruse S, Mauch C, Büttner R. The impact of sequencing on diagnosis and treatment of malignant melanoma. Expert Rev Mol Diagn 2016; 16:423-33. [PMID: 26822148 DOI: 10.1586/14737159.2016.1147958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Melanoma is one of the clinically most important cancer types considering its high mortality rate and that it is commonly diagnosed in relatively young people. With the advent of targeted therapies and, more recently, immune checkpoint inhibitors, more treatment options are available resulting in higher patient survival rates. However, the successful application of these targeted therapies critically depends on the reliable detection of molecular aberrations. Today, massively parallel sequencing techniques enable us to analyze large sets of genes in a relatively short time. It has allowed increased knowledge of acquired somatic mutations in melanoma and has helped to identify new targets for personalized therapy, and potentially may help to predict response to immune therapies. Described here are the development of sequencing techniques, how their improvement has changed diagnosis, prognosis and management of malignant melanoma and the future perspectives of melanoma diagnostics in the routine clinical setting.
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Affiliation(s)
| | - Michaela A Ihle
- a Institute of Pathology , University Hospital Cologne , Cologne , Germany
| | - Carina Heydt
- a Institute of Pathology , University Hospital Cologne , Cologne , Germany
| | - Anne M Schultheis
- a Institute of Pathology , University Hospital Cologne , Cologne , Germany
| | | | - Cornelia Mauch
- b Clinic for Dermatology , University Hospital Cologne , Cologne , Germany
| | - Reinhard Büttner
- a Institute of Pathology , University Hospital Cologne , Cologne , Germany
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Abstract
Mucosal melanoma is an exceedingly rare variant of cutaneous melanoma that, due to its rarity, is poorly described and infrequently studied. Primary sites of origin include the head and neck, anorectum and vulvovaginal regions. It is uniquely different from cutaneous melanoma with respect to epidemiology, etiology, pathogenesis and prognosis. The etiology and pathogenesis remain unclear. Unlike cutaneous melanoma, exposure to UV light is not an apparent risk factor. Furthermore, distinct molecular features including a lower incidence of BRAF oncogene mutations but a higher incidence of KIT oncogene mutations suggest divergent genetic etiologies. Mucosal melanomas generally present at a later stage, are more aggressive and carry a worse prognosis regardless of the stage at diagnosis. Establishing standardized treatment guidelines has been challenging due to the rarity of the disease. Early detection provides the best chance at survival but is often difficult due to anatomic location. Surgery remains the primary therapeutic intervention if complete resection is technically feasible given the anatomic location. Radiotherapy may be used to achieve local control when resection is not feasible, or adjuvantly to enhance locoregional control, but most studies have failed to demonstrate an improvement in overall survival. There are no consensus guidelines on the optimal systemic therapy, and regimens are often extrapolated from data based on therapies used to treat advanced cutaneous melanoma. Clinical trials, particularly utilizing newer targeted therapies and immunotherapies, are investigating novel treatment approaches.
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Mazurenko NN, Tsyganova IV, Lushnikova AA, Ponkratova DA, Anurova OA, Cheremushkin EA, Mikhailova IN, Demidov LV. The spectrum of oncogene mutations differs among melanoma subtypes. Mol Biol 2015. [DOI: 10.1134/s0026893315060163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Weiss S, Hanniford D, Hernando E, Osman I. Revisiting determinants of prognosis in cutaneous melanoma. Cancer 2015; 121:4108-23. [PMID: 26308244 PMCID: PMC4666819 DOI: 10.1002/cncr.29634] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/09/2015] [Accepted: 07/13/2015] [Indexed: 11/10/2022]
Abstract
The American Joint Committee on Cancer staging system for cutaneous melanoma is based on primary tumor thickness and the presence of ulceration, mitoses, lymph node spread, and distant metastases as determinants of prognosis. Although this cutaneous melanoma staging system has evolved over time to more accurately reflect patient prognosis, improvements are still needed, because current understanding of the particular factors (genetic mutation, expression alteration, host response, etc) that are critical for predicting patient outcomes is incomplete. Given the clinical and biologic heterogeneity of primary melanomas, new prognostic tools are needed to more precisely identify patients who are most likely to develop advanced disease. Such tools would affect clinical surveillance strategies and aid in patient selection for adjuvant therapy. The authors reviewed the literature on prognostic molecular and immunologic markers in primary cutaneous melanoma, their associations with clinicopathologic and survival outcomes, and their potential for incorporation into current staging models. Overall, the studies considered in this review did not define prognostic markers that could be readily incorporated into the current staging system. Therefore, efforts should be continued in these and other directions to maximize the likelihood of identifying clinically useful prognostic biomarkers for cutaneous melanoma.
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Affiliation(s)
- Sarah Weiss
- Department of Medical Oncology, New York University School of Medicine, New York, NY
- Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, NY
| | - Douglas Hanniford
- Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, NY
- Department of Pathology, New York University School of Medicine, New York, NY
| | - Eva Hernando
- Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, NY
- Department of Pathology, New York University School of Medicine, New York, NY
| | - Iman Osman
- Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, NY
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
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34
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Clinical characteristics associated with BRAF, NRAS and KIT mutations in Japanese melanoma patients. J Dermatol Sci 2015; 80:33-7. [DOI: 10.1016/j.jdermsci.2015.07.012] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 07/17/2015] [Accepted: 07/21/2015] [Indexed: 01/19/2023]
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35
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Abstract
PURPOSE AND DESIGN In recent years, there have been dramatic improvements in the diagnosis and treatment of patients with melanoma. The development of molecular markers and associated targeted therapies have given new hope to subsets of patients with advanced disease. Here we discuss the most important advances in molecular targeted therapy and how these developments are likely to affect the practice of the clinical surgeon. RESULTS AND CONCLUSIONS Germ-line and somatic mutations are common in melanoma and provide prognostic information that can now be harnessed to provide a more personalized approach to cancer treatment. BRAF mutation at the V600 position is the most commonly identified mutation in patients with melanoma. Treatment with targeted inhibitors in patients with BRAF-mutant melanoma has afforded dramatic responses in about half of selected patients. Unfortunately, disease control is not durable and recurrences are common. We predict an increasing role for the surgeon in the multidisciplinary treatment of patients with metastatic disease, as well as a role for molecular profiling in patients with high-risk early stage disease. Further, we are only beginning to understand the prognostic significance of various gene mutations in patients with melanoma.
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Affiliation(s)
- Danielle K DePeralta
- Division of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Genevieve M Boland
- Division of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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36
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Kang XJ, Shi XH, Chen WJ, Pu XM, Sun ZZ, Halifu Y, Wu XJ, Yu SR, Liu WX, Liang JQ, Luo D, Ren DY. Analysis ofKITmutations and c-KIT expression in Chinese Uyghur and Han patients with melanoma. Clin Exp Dermatol 2015; 41:81-7. [PMID: 25917463 DOI: 10.1111/ced.12659] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2014] [Indexed: 11/29/2022]
Affiliation(s)
- X.-J. Kang
- Department of Dermatology; People's Hospital of Xinjiang; Uyghur Autonomous Region; Urumqi Xinjiang China
| | - X.-H. Shi
- Department of Dermatology; People's Hospital of Liaocheng; Liaocheng Shandong China
| | - W.-J. Chen
- Department of Dermatology; People's Hospital of Xinjiang; Uyghur Autonomous Region; Urumqi Xinjiang China
| | - X.-M. Pu
- Department of Dermatology; People's Hospital of Xinjiang; Uyghur Autonomous Region; Urumqi Xinjiang China
| | - Z.-Z. Sun
- Department of Pathology; People's Hospital of Xinjiang; Uyghur Autonomous Region; Urumqi Xinjiang China
| | - Y. Halifu
- Department of Dermatology; People's Hospital of Xinjiang; Uyghur Autonomous Region; Urumqi Xinjiang China
| | - X.-J. Wu
- Department of Dermatology; People's Hospital of Xinjiang; Uyghur Autonomous Region; Urumqi Xinjiang China
| | - S.-R. Yu
- Department of Dermatology; People's Hospital of Xinjiang; Uyghur Autonomous Region; Urumqi Xinjiang China
| | - W.-X. Liu
- Department of Dermatology; People's Hospital of Xinjiang; Uyghur Autonomous Region; Urumqi Xinjiang China
| | - J.-Q. Liang
- Department of Dermatology; People's Hospital of Xinjiang; Uyghur Autonomous Region; Urumqi Xinjiang China
| | - D. Luo
- Department of Dermatology; People's Hospital of Xinjiang; Uyghur Autonomous Region; Urumqi Xinjiang China
| | - D.-Y. Ren
- Department of Dermatology; Central Hospital of China National Petroleum Corporation; Langfang Hebei China
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37
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Hu Z, Wan X, Hao R, Zhang H, Li L, Li L, Xie Q, Wang P, Gao Y, Chen S, Wei M, Luan Z, Zhang A, Huang N, Chen L. Phosphorylation of mutationally introduced tyrosine in the activation loop of HER2 confers gain-of-function activity. PLoS One 2015; 10:e0123623. [PMID: 25853726 PMCID: PMC4390223 DOI: 10.1371/journal.pone.0123623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/19/2015] [Indexed: 01/09/2023] Open
Abstract
Amplification, overexpression, and somatic mutation of the HER2 gene have been reported to play a critical role in tumorigenesis of various cancers. The HER2 H878Y mutation was recently reported in 11% of hepatocellular carcinoma (HCC) patients. However, its functional impact on the HER2 protein and its role in tumorigenesis has not been determined. Here, we show that HER2 H878Y is a gain-of-function mutation. Y878 represents a phosphorylation site, and phospho-Y878 interacts with R898 residue to stabilize the active conformation of HER2, thereby enhancing its kinase activity. H878Y mutant is transforming and the transformed cells are sensitive to HER2 kinase inhibitors. Thus, our study reveals the following novel mechanism underlying the tumorigenic function of the HER2 H878Y mutation: the introduction of a tyrosine residue into the kinase activation loop via mutagenesis modulates the conformation of the kinase, thereby enhancing its activity.
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Affiliation(s)
- Zexi Hu
- College of Life Sciences, Beijing Normal University, Beijing, 100875, China
- National Institute of Biological Sciences, Beijing. Beijing, 102206, China
| | - Xiaobo Wan
- National Institute of Biological Sciences, Beijing. Beijing, 102206, China
| | - Rui Hao
- BeiGene (Beijing) Co., Ltd., Beijing, 102206, China
| | - Heng Zhang
- The Central Hospital of Lishui City, Zhejiang, 323000 China
| | - Li Li
- National Institute of Biological Sciences, Beijing. Beijing, 102206, China
| | - Lin Li
- National Institute of Biological Sciences, Beijing. Beijing, 102206, China
| | - Qiang Xie
- Fuzhou Pulmonary Hospital of Fujian, Fujian, 350008, China
| | - Peng Wang
- Beijing Ditan Hospital, Beijing, 100015, China
| | - Yibo Gao
- Department of Thoracic Surgery, Cancer Institute and Hospital Chinese Academy of Medical Sciences, Beijing, 100021, China
| | - She Chen
- National Institute of Biological Sciences, Beijing. Beijing, 102206, China
| | - Min Wei
- BeiGene (Beijing) Co., Ltd., Beijing, 102206, China
| | - Zhidong Luan
- Liaoning Medical University, Jinzhou, Liaoning, 121001, China
| | - Aiqun Zhang
- The General Hospital of People’s Liberation Army (301 Hospital), Fuxing Road, Beijing, 100853, China
| | - Niu Huang
- National Institute of Biological Sciences, Beijing. Beijing, 102206, China
| | - Liang Chen
- Collaborative Innovation Center of Cancer Medicine, National Institute of Biological Sciences, Beijing, Beijing, 102206, China
- * E-mail:
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38
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Oyama S, Funasaka Y, Watanabe A, Takizawa T, Kawana S, Saeki H. BRAF,KITandNRASmutations and expression of c-KIT, phosphorylated extracellular signal-regulated kinase and phosphorylated AKT in Japanese melanoma patients. J Dermatol 2015; 42:477-84. [DOI: 10.1111/1346-8138.12822] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 01/03/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Satomi Oyama
- Department of Dermatology; Graduate School of Medicine; Nippon Medical School; Tokyo Japan
| | - Yoko Funasaka
- Department of Dermatology; Graduate School of Medicine; Nippon Medical School; Tokyo Japan
| | - Atsushi Watanabe
- Department of Molecular and Medical Genetics; Graduate School of Medicine; Nippon Medical School; Tokyo Japan
| | - Toshihiro Takizawa
- Department of Molecular Medicine and Anatomy; Graduate School of Medicine; Nippon Medical School; Tokyo Japan
| | - Seiji Kawana
- Department of Dermatology; Graduate School of Medicine; Nippon Medical School; Tokyo Japan
| | - Hidehisa Saeki
- Department of Dermatology; Graduate School of Medicine; Nippon Medical School; Tokyo Japan
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39
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Abstract
Whereas thin melanomas have an excellent prognosis after sufficient surgical treatment, melanoma disease in advanced stages is still a therapeutic challenge. After decades of frustrating studies, new therapeutic strategies have come up in the past few years. On the one hand, increasing insights into the molecular aberrations in melanoma have led to specific “targeted” therapies to affect only the mutated tumor cells, as in many other types of cancers. Today there are few “targeted” substances which are already approved and successfully used for single or combination therapy, but many others are under development. While on the other hand, nonpersonalized strategy substances have been developed successfully inducing an immunologic tumor response. Both kinds of therapy have been found to result in an improvement not only of the response rate, but also of the overall survival in metastatic disease, which represents a milestone in melanoma therapy. However, using these therapies there is still much to learn regarding the effects, the side effects, and the limitations of these promising substances.
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Affiliation(s)
- Michael Tronnier
- Department of Dermatology, Klinikum Hildesheim GmbH, Hildesheim, Germany
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40
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Kim CY, Kim DW, Kim K, Curry J, Torres-Cabala C, Patel S. GNAQ mutation in a patient with metastatic mucosal melanoma. BMC Cancer 2014; 14:516. [PMID: 25030020 PMCID: PMC4223398 DOI: 10.1186/1471-2407-14-516] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 06/27/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Mucosal melanomas represent about 1% of all melanoma cases and classically have a worse prognosis than cutaneous melanomas. Due to the rarity of mucosal melanomas, only limited clinical studies with metastatic mucosal melanoma are available. Mucosal melanomas most commonly contain mutations in the gene CKIT, and treatments have been investigated using targeted therapy for this gene. Mutations in mucosal melanoma are less common than in cutaneous or uveal melanomas and occur in descending order of frequency as: CKIT (20%), NRAS (5%) or BRAF (3%). Mutations in G-alpha proteins, which are associated with activation of the mitogen-activated protein kinase pathway, have not been reported in mucosal melanomas. These G-alpha protein mutations occur in the genes GNAQ and GNA11 and are seen at a high frequency in uveal melanomas, those melanomas that begin in the eye. CASE PRESENTATION A 59-year old Caucasian male was diagnosed with a mucosal melanoma after evaluation for what was thought to be a hemorrhoid. Molecular analysis of the tumor revealed a GNAQ mutation. Ophthalmologic exam did not disclose a uveal melanoma. CONCLUSION Here we report, to our knowledge, the first known case of GNAQ mutation in a patient with metastatic mucosal melanoma.
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Affiliation(s)
- Chung-Young Kim
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dae Won Kim
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kevin Kim
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jonathan Curry
- Department of Dermatopathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos Torres-Cabala
- Department of Dermatopathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sapna Patel
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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41
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van Engen-van Grunsven AC, Küsters-Vandevelde HV, De Hullu J, van Duijn LM, Rijntjes J, Bovée JV, Groenen PJ, Blokx WA. NRAS mutations are more prevalent than KIT mutations in melanoma of the female urogenital tract—A study of 24 cases from the Netherlands. Gynecol Oncol 2014; 134:10-4. [DOI: 10.1016/j.ygyno.2014.04.056] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 04/18/2014] [Accepted: 04/29/2014] [Indexed: 02/03/2023]
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42
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Carvajal RD, Hamid O, Antonescu CR. Selecting patients for KIT inhibition in melanoma. Methods Mol Biol 2014; 1102:137-62. [PMID: 24258978 DOI: 10.1007/978-1-62703-727-3_9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
For many years, melanoma has been regarded as a single disease in terms of therapeutic considerations. The more recent identification of multiple molecular mechanisms underlying the development, progression, and prognosis of melanoma has led to a new paradigm for the management of this disease, has created new therapeutic opportunities, and has led to improved clinical outcomes. Such advances, however, are dependent upon methods that can reproducibly identify key molecular alterations within an individual tumor, define clinically relevant genetic subgroups of disease, and permit improved patient selection for targeted therapies.Melanomas harboring genetic alterations of KIT have been demonstrated to constitute one such molecular subgroup of disease. In this chapter, we will discuss the biology of KIT in melanoma, review the rationale for and clinical data regarding KIT inhibition in melanomas harboring activating alterations of KIT, propose guidelines for the selection of patients for KIT inhibitor therapy, and, finally, present laboratory methods for KIT assessment in melanoma.
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Affiliation(s)
- Richard D Carvajal
- Melanoma/Sarcoma Medical Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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43
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Lebron MB, Brennan L, Damoci CB, Prewett MC, O'Mahony M, Duignan IJ, Credille KM, DeLigio JT, Starodubtseva M, Amatulli M, Zhang Y, Schwartz KD, Burtrum D, Balderes P, Persaud K, Surguladze D, Loizos N, Paz K, Kotanides H. A human monoclonal antibody targeting the stem cell factor receptor (c-Kit) blocks tumor cell signaling and inhibits tumor growth. Cancer Biol Ther 2014; 15:1208-18. [PMID: 24921944 DOI: 10.4161/cbt.29523] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Stem cell factor receptor (c-Kit) exerts multiple biological effects on target cells upon binding its ligand stem cell factor (SCF). Aberrant activation of c-Kit results in dysregulated signaling and is implicated in the pathogenesis of numerous cancers. The development of more specific and effective c-Kit therapies is warranted given its essential role in tumorigenesis. In this study, we describe the biological properties of CK6, a fully human IgG1 monoclonal antibody against the extracellular region of human c-Kit. CK6 specifically binds c-Kit receptor with high affinity (EC 50 = 0.06 nM) and strongly blocks its interaction with SCF (IC 50 = 0.41 nM) in solid phase assays. Flow cytometry shows CK6 binding to c-Kit on the cell surface of human small cell lung carcinoma (SCLC), melanoma, and leukemia tumor cell lines. Furthermore, exposure to CK6 inhibits SCF stimulation of c-Kit tyrosine kinase activity and downstream signaling pathways such as mitogen-activated protein kinase (MAPK) and protein kinase B (AKT), in addition to reducing tumor cell line growth in vitro. CK6 treatment significantly decreases human xenograft tumor growth in NCI-H526 SCLC (T/C% = 57) and Malme-3M melanoma (T/C% = 58) models in vivo. The combination of CK6 with standard of care chemotherapy agents, cisplatin and etoposide for SCLC or dacarbazine for melanoma, more potently reduces tumor growth (SCLC T/C% = 24, melanoma T/C% = 38) compared with CK6 or chemotherapy alone. In summary, our results demonstrate that CK6 is a c-Kit antagonist antibody with tumor growth neutralizing properties and are highly suggestive of potential therapeutic application in treating human malignancies harboring c-Kit receptor.
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Affiliation(s)
- Maria B Lebron
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and Company; New York, NY USA
| | - Laura Brennan
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and Company; New York, NY USA
| | - Christopher B Damoci
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and Company; New York, NY USA
| | - Marie C Prewett
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and Company; New York, NY USA
| | - Marguerita O'Mahony
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and Company; New York, NY USA
| | - Inga J Duignan
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and Company; New York, NY USA
| | | | - James T DeLigio
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and Company; New York, NY USA
| | - Marina Starodubtseva
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and Company; New York, NY USA
| | - Michael Amatulli
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and Company; New York, NY USA
| | - Yiwei Zhang
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and Company; New York, NY USA
| | - Kaben D Schwartz
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and Company; New York, NY USA
| | - Douglas Burtrum
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and Company; New York, NY USA
| | - Paul Balderes
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and Company; New York, NY USA
| | - Kris Persaud
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and Company; New York, NY USA
| | - David Surguladze
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and Company; New York, NY USA
| | - Nick Loizos
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and Company; New York, NY USA
| | - Keren Paz
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and Company; New York, NY USA
| | - Helen Kotanides
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and Company; New York, NY USA
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44
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Update on primary mucosal melanoma. J Am Acad Dermatol 2014; 71:366-75. [PMID: 24815565 DOI: 10.1016/j.jaad.2014.03.031] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 03/10/2014] [Accepted: 03/15/2014] [Indexed: 12/11/2022]
Abstract
Mucosal melanomas are aggressive cancers of mucosal surfaces with clinical and pathologic characteristics distinct from cutaneous melanomas, warranting different staging systems and treatment approaches. Surgical resection is performed frequently for the primary tumor, although the utility of lymph node surgery and radiation therapy is not established. Therapies targeted against C-KIT activating mutations, identified in many mucosal melanomas, are emerging as promising treatments.
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45
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Shtivelman E, Davies MA, Hwu P, Yang J, Lotem M, Oren M, Flaherty KT, Fisher DE. Pathways and therapeutic targets in melanoma. Oncotarget 2014; 5:1701-52. [PMID: 24743024 PMCID: PMC4039128 DOI: 10.18632/oncotarget.1892] [Citation(s) in RCA: 165] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 04/07/2014] [Indexed: 02/07/2023] Open
Abstract
This review aims to summarize the current knowledge of molecular pathways and their clinical relevance in melanoma. Metastatic melanoma was a grim diagnosis, but in recent years tremendous advances have been made in treatments. Chemotherapy provided little benefit in these patients, but development of targeted and new immune approaches made radical changes in prognosis. This would not have happened without remarkable advances in understanding the biology of disease and tremendous progress in the genomic (and other "omics") scale analyses of tumors. The big problems facing the field are no longer focused exclusively on the development of new treatment modalities, though this is a very busy area of clinical research. The focus shifted now to understanding and overcoming resistance to targeted therapies, and understanding the underlying causes of the heterogeneous responses to immune therapy.
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Affiliation(s)
| | | | - Patrick Hwu
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James Yang
- National Cancer Institute, NIH, Washington DC, USA
| | - Michal Lotem
- Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Moshe Oren
- The Weizmann Institute of Science, Rehovot, Israel
| | | | - David E. Fisher
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
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46
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Bello DM, Dematteo RP, Ariyan CE. The GIST of targeted therapy for malignant melanoma. Ann Surg Oncol 2014; 21:2059-67. [PMID: 24531699 DOI: 10.1245/s10434-013-3373-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Indexed: 12/19/2022]
Abstract
The high response rates to the tyrosine kinase inhibitor imatinib in KIT-mutated gastrointestinal stromal tumors (GIST) has led to a paradigm shift in cancer treatment. In a parallel fashion, the field of melanoma is shifting with the utilization of targeted therapy to treat BRAF-mutated melanoma. We reviewed published literature in PubMed on GIST and melanoma, with a focus on both past and current clinical trials. The data presented centers on imatinib, vemurafenib, and most recently dabrafenib, targeting KIT and BRAF mutations and their outcomes in GIST and melanoma. The BRAF(V600E) melanoma mutation, like the KIT exon 11 mutation in GIST, has the highest response to therapy. High response rates with inhibition of KIT in GIST have not been recapitulated in KIT-mutated melanoma. Median time to resistance to targeted agents occurs in ~7 months with BRAF inhibitors and 2 years for imatinib in GIST. In GIST, the development of secondary mutations leads to resistance; however, there have been no similar gatekeeper mutations found in melanoma. Although surgery remains an important component of the treatment of early GIST and melanoma, surgeons will need to continue to define the thresholds and timing for operation in the setting of metastatic disease with improved targeted therapies. Combination treatment strategies may result in more successful clinical outcomes in the management of melanoma in the future.
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Affiliation(s)
- Danielle M Bello
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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47
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Le devenir des thérapeutiques ciblant la voie RAS/RAF/ MEK/ERK en cancérologie : l’exemple des mélanomes. BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2014. [DOI: 10.1016/s0001-4079(19)31345-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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48
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Tokuhisa Y, Lidsky ME, Toshimitsu H, Turley RS, Beasley GM, Ueno T, Sharma K, Augustine CK, Tyler DS. SRC family kinase inhibition as a novel strategy to augment melphalan-based regional chemotherapy of advanced extremity melanoma. Ann Surg Oncol 2013; 21:1024-30. [PMID: 24281418 DOI: 10.1245/s10434-013-3387-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Src kinase inhibition has been shown to augment the efficacy of chemotherapy. Dasatinib, a dual Src/Abl kinase inhibitor approved for the treatment of CML, is under investigation as monotherapy for tumors with abnormal Src signaling, such as melanoma. The goal of this study was to determine if Src kinase inhibition using dasatinib could enhance the efficacy of regionally administered melphalan in advanced extremity melanoma. METHODS The mutational status of c-kit and patterns of gene expression predictive of dysregulated Src kinase signaling were evaluated in a panel of 26 human melanoma cell lines. The effectiveness of dasatinib was measured by quantifying protein expression and activation of Src kinase, focal adhesion kinase, and Crk-associated substrate (p130(CAS)), in conjunction with in vitro cell viability assays using seven melanoma cell lines. Utilizing a rat model of regional chemotherapy, we evaluated the effectiveness of systemic dasatinib in conjunction with regional melphalan against the human melanoma cell line, DM443, grown as a xenograft. RESULTS Only the WM3211 cell line harbored a c-kit mutation. Significant correlation was observed between Src-predicted dysregulation by gene expression and sensitivity to dasatinib in vitro. Tumor doubling time for DM443 xenografts treated with systemic dasatinib in combination with regional melphalan (44.8 days) was significantly longer (p = 0.007) than either dasatinib (21.3 days) or melphalan alone (24.7 days). CONCLUSIONS Systemic dasatinib prior to melphalan-based regional chemotherapy markedly improves the efficacy of this alkylating agent in this melanoma xenograft model. Validation of this concept should be considered in the context of a regional therapy clinical trial.
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49
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Bello DM, Ariyan CE, Carvajal RD. Melanoma Mutagenesis and Aberrant Cell Signaling. Cancer Control 2013; 20:261-81. [DOI: 10.1177/107327481302000404] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Danielle M. Bello
- Department of Surgery Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Charlotte E. Ariyan
- Department of Surgery Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Richard D. Carvajal
- Department of Medical Oncology Memorial Sloan-Kettering Cancer Center, New York, New York
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50
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Zebary A, Omholt K, Vassilaki I, Höiom V, Lindén D, Viberg L, Kanter-Lewensohn L, Johansson CH, Hansson J. KIT, NRAS, BRAF and PTEN mutations in a sample of Swedish patients with acral lentiginous melanoma. J Dermatol Sci 2013; 72:284-9. [PMID: 23993026 DOI: 10.1016/j.jdermsci.2013.07.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 06/27/2013] [Accepted: 07/20/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Acral lentiginous melanoma (ALM) accounts for <10% of all melanomas in Caucasians. Although the involvement of KIT, NRAS and BRAF mutations is well known in ALM, the impact of these mutations on clinicopathological features has not been established. OBJECTIVE To define the KIT, NRAS, BRAF and PTEN mutation frequencies in Swedish patients with ALM and to evaluate the impact of mutation status on patient and tumor characteristics. METHODS Tumor cells were microdissected from 88 primary ALMs and 16 paired metastases and analyzed for KIT, NRAS and BRAF mutations. A subset of 25 ALMs was also evaluated for PTEN mutations. RESULTS BRAF mutations were identified in 17% of the primary ALMs. Both NRAS and KIT mutations were found at a similar frequency of 15%. Only one of the ALMs that were screened for PTEN harbored a mutation (4%). The KIT, NRAS and BRAF mutation status in paired primary and metastatic ALMs was identical. Patients with BRAF mutated tumors were significantly younger (57 years) than those with BRAF wild-type tumors (73 years, p=0.028). BRAF mutations were significantly more common in females (p=0.011) and more often found in tumors located on the feet (p=0.039). Anatomical site was an independent prognostic factor for overall survival; patients with ALMs on the hands or under fingernails had a better prognosis than those with tumors on the feet or under toenails (p=0.025). CONCLUSION Our results confirm the presence of KIT, NRAS and BRAF mutations in ALM and provide evidence that mutations in these genes occur at similar frequencies. Our results also show that PTEN is mutated in a small subset of ALM tumors.
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Affiliation(s)
- Abdlsattar Zebary
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
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