1
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Ba H, Zhu F, Zhang X, Mei Z, Zhu Y. Comparison of efficacy and tolerability of adjuvant therapy for resected high-risk stage III-IV cutaneous melanoma: a systemic review and Bayesian network meta-analysis. Ther Adv Med Oncol 2023; 15:17588359221148918. [PMID: 36743526 PMCID: PMC9893404 DOI: 10.1177/17588359221148918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 12/15/2022] [Indexed: 01/25/2023] Open
Abstract
Background Although immune checkpoint inhibitors (ICIs) and targeted therapies have been widely used as adjuvant treatment for resected melanoma, the optimal therapy remains controversial. Therefore, we conducted this updated network meta-analysis (NMA) to assess the efficacy and tolerability of adjuvant therapies for cutaneous melanoma. Methods PubMed, Embase, Cochrane library, and Web of Science were systematically searched for relevant literatures published in the last 30 years. Disease-free survival (DFS), overall survival (OS), and serious adverse events were considered as the efficacy and tolerability outcomes. Results In all, 27 randomized controlled trials (RCTs) including 16,709 stage III-IV melanoma patients were enrolled in this NMA. For BRAF wild-type melanoma, our analysis showed that both nivolumab and pembrolizumab demonstrated significantly better DFS and tolerability than ipilimumab (10 mg/kg). Nivolumab, pembrolizumab, ipilimumab (3 mg/kg), and ipilimumab (10 mg/kg) all appeared to be effective in prolonging OS, but no therapy demonstrated significantly better OS than ipilimumab (10 mg/kg). Nivolumab + ipilimumab showed the best DFS, but did not appear to be effective in improving OS and ranked only seventh in tolerability. Vaccines and granulocyte-macrophage colony-stimulating factor therapies were well tolerated, but all failed to improve the DFS or OS in stage III melanoma patients. In terms of BRAF mutation-positive melanoma, ICIs (nivolumab + ipilimumab, nivolumab, pembrolizumab, ipilimumab; 10 mg/kg) exhibited comparable efficacy to dabrafenib + trametinib, and all these therapies showed significantly better DFS than placebo. Conclusion Considering efficacy and tolerability, nivolumab and pembrolizumab seem to be preferable adjuvant therapies for patients with stage III-IV melanoma. For BRAF mutation-positive patients, more RCTs are still required to determine which is better between ICIs and targeted therapy.
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Affiliation(s)
- He Ba
- Department Chinese and Western Medicine Integrated Oncology, the First Affiliated Hospital of Anhui Medical University, No. 120 Wansui Road, Hefei 230000, Anhui Province, China
| | - Fangyuan Zhu
- Department Chinese and Western Medicine Integrated Oncology, the First Affiliated Hospital of Anhui Medical University, No. 120 Wansui Road, Hefei 230000, Anhui Province, China
| | - Xiaoze Zhang
- Department Chinese and Western Medicine Integrated Oncology, the First Affiliated Hospital of Anhui Medical University, No. 120 Wansui Road, Hefei 230000, Anhui Province, China
| | | | - Yaodong Zhu
- Department Chinese and Western Medicine Integrated Oncology, the First Affiliated Hospital of Anhui Medical University, No. 120 Wansui Road, Hefei 230000, Anhui Province, China
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2
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Garbe C, Amaral T, Peris K, Hauschild A, Arenberger P, Basset-Seguin N, Bastholt L, Bataille V, Del Marmol V, Dréno B, Fargnoli MC, Forsea AM, Grob JJ, Hoeller C, Kaufmann R, Kelleners-Smeets N, Lallas A, Lebbé C, Lytvynenko B, Malvehy J, Moreno-Ramirez D, Nathan P, Pellacani G, Saiag P, Stratigos AJ, Van Akkooi ACJ, Vieira R, Zalaudek I, Lorigan P. European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment - Update 2022. Eur J Cancer 2022; 170:256-284. [PMID: 35623961 DOI: 10.1016/j.ejca.2022.04.018] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A unique collaboration of multidisciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO), and the European Organization of Research and Treatment of Cancer (EORTC) was formed to make recommendations on cutaneous melanoma diagnosis and treatment, based on the systematic literature reviews and the experts' experience. Cutaneous melanomas are excised with one to 2-cm safety margins. Sentinel lymph node dissection shall be performed as a staging procedure in patients with tumor thickness ≥1.0 mm or ≥0.8 mm with additional histological risk factors, although there is as yet no clear survival benefit for this approach. Therapeutic decisions in stage III/IV patients should be primarily made by an interdisciplinary oncology team ("tumor board"). Adjuvant therapies can be proposed in stage III/completely resected stage IV patients and are primarily anti-PD-1, independent of mutational status, or alternatively dabrafenib plus trametinib for BRAF mutant patients. In distant metastases (stage IV), either resected or not, systemic treatment is always indicated. For first-line treatment particularly in BRAF wild-type patients, immunotherapy with PD-1 antibodies alone or in combination with CTLA-4 antibodies shall be considered. In stage IV melanoma with a BRAF-V600 E/K mutation, first-line therapy with BRAF/MEK inhibitors can be offered as an alternative to immunotherapy. In patients with primary resistance to immunotherapy and harboring a BRAF-V600 E/K mutation, this therapy shall be offered as second-line therapy. Systemic therapy in stage III/IV melanoma is a rapidly changing landscape, and it is likely that these recommendations may change in the near future.
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Affiliation(s)
- Claus Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany.
| | - Teresa Amaral
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Ketty Peris
- Institute of Dermatology, Università Cattolica, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Nicole Basset-Seguin
- Université Paris Cite, AP-HP, Department of Dermatology INSERM U 976 Hôpital, Saint Louis Paris France
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London, SE1 7EH, United Kingdom
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Brigitte Dréno
- Dermatology Department, CHU Nantes, CIC 1413, CRCINA, University Nantes, Nantes, France
| | - Maria C Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ana-Maria Forsea
- Dermatology Department, Elias University Hospital, Carol Davila University of Medicine and Pharmacy Bucharest, Romania
| | | | | | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | | | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Celeste Lebbé
- Université Paris Cite, AP-HP, Department of Dermatology INSERM U 976 Hôpital, Saint Louis Paris France
| | - Bodhan Lytvynenko
- Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Josep Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - David Moreno-Ramirez
- Medical-&-Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Paul Nathan
- Mount-Vernon Cancer Centre, Northwood United Kingdom
| | | | - Philippe Saiag
- University Department of Dermatology, Université de Versailles-Saint Quentin en Yvelines, APHP, Boulogne, France
| | - Alexander J Stratigos
- First Department of Dermatology, University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Alexander C J Van Akkooi
- Melanoma Institute Australia, The University of Sydney, and Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Ricardo Vieira
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Paul Lorigan
- The University of Manchester, Oxford Rd, Manchester, M13 9PL, United Kingdom
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3
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Bersanelli M, Petrelli F, Buti S, Stanganelli I. Immune checkpoint inhibitors in adjuvant setting after radical resection of melanoma: a meta-analysis of the pivotal trials. Hum Vaccin Immunother 2022; 18:1902723. [PMID: 33881961 PMCID: PMC9122382 DOI: 10.1080/21645515.2021.1902723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/13/2021] [Accepted: 03/07/2021] [Indexed: 11/03/2022] Open
Abstract
Beyond the overall relapse-free survival (RFS) advantage demonstrated in randomized trials (RCT) of adjuvant anti-PD-1 immunotherapy in radically resected stage III-IV melanoma, key issues about subgroups of interest have been raised in recent years, with non-conclusive results when considering single studies. In the present meta analysis, we pooled all RCT data in this setting, analyzing, overall, 3043 patients. The RFS benefit of adjuvant immunotherapy over the comparator (placebo or anti-CTLA-4) was strongly confirmed in the pooled analysis, and it was statistically significant in most subgroups, excluding patients with stage IIIA and stage IV M1c melanoma. Nevertheless, the relative benefit was not statistically significantly different when considering their IIIB-IIIC and M1a-M1b counterparts. Future trials in this setting should consider subgroups of interest for tailoring the adjuvant strategy in terms of duration and drug combination in light of literature data.
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Affiliation(s)
- Melissa Bersanelli
- Medicine and Surgery Department, University of Parma, Parma, Italy
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Ignazio Stanganelli
- Medicine and Surgery Department, University of Parma, Parma, Italy
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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4
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Schuitevoerder D, Vining CC, Tseng J. Adjuvant Therapy for Cutaneous Melanoma. Surg Oncol Clin N Am 2021; 29:455-465. [PMID: 32482320 DOI: 10.1016/j.soc.2020.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article presents the current data supporting adjuvant therapy for patients with cutaneous melanoma. With the recent development of novel immunotherapy agents as well as targeted therapy, there are strong data to support the use of these therapies in patients at high risk of developing recurrent or metastatic disease.
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Affiliation(s)
- Darryl Schuitevoerder
- Department of Surgery, University of Chicago, 5841 South Maryland Avenue # MC5094, Chicago, IL 60637, USA
| | - Charles C Vining
- Department of Surgery, University of Chicago, 5841 South Maryland Avenue # MC5094, Chicago, IL 60637, USA
| | - Jennifer Tseng
- Department of Surgery, University of Chicago, 5841 South Maryland Avenue # MC5094, Chicago, IL 60637, USA.
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5
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Nebhan CA, Johnson DB. Pembrolizumab in the adjuvant treatment of melanoma: efficacy and safety. Expert Rev Anticancer Ther 2021; 21:583-590. [PMID: 33504219 PMCID: PMC8238788 DOI: 10.1080/14737140.2021.1882856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
Introduction: Regional or distant metastases from melanoma may be surgically resected but remain at high-risk of recurrence. Over the last few years, several treatments have been approved to mitigate this risk. These include anti-PD-1 agents, specifically pembrolizumab and nivolumab.Areas covered: Herein, we will discuss the landscape of pembrolizumab safety and efficacy used in the adjuvant setting for high-risk, resected melanoma. We place this in context with other available adjuvant therapies, and discuss subgroup analyses.Expert opinion: Anti-PD-1 therapy with either pembrolizumab or nivolumab has become a standard of care for patients with resected stage III or IV melanoma. In our practice, we generally offer these agents (which have comparable safety and efficacy profiles) to patients with resected stage IIIb-IV melanoma regardless of BRAF mutation status.
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Affiliation(s)
- Caroline A. Nebhan
- Department of Medicine, Vanderbilt University Medical Center and Vanderbilt Ingram Cancer Center
| | - Douglas B. Johnson
- Department of Medicine, Vanderbilt University Medical Center and Vanderbilt Ingram Cancer Center
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6
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Toor K, Middleton MR, Chan K, Amadi A, Moshyk A, Kotapati S. Comparative efficacy and safety of adjuvant nivolumab versus other treatments in adults with resected melanoma: a systematic literature review and network meta-analysis. BMC Cancer 2021; 21:3. [PMID: 33402121 PMCID: PMC7784366 DOI: 10.1186/s12885-020-07538-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/16/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Immune checkpoint inhibitors and targeted therapies are approved for adjuvant treatment of patients with resected melanoma; however, they have not been compared in randomized controlled trials (RCTs). We compared the efficacy and safety of adjuvant nivolumab with other approved treatments using available evidence from RCTs in a Bayesian network meta-analysis (NMA). METHODS A systematic literature review was conducted through May 2019 to identify relevant RCTs evaluating approved adjuvant treatments. Outcomes of interest included recurrence-free survival (RFS)/disease-free survival (DFS), distant metastasis-free survival (DMFS), all-cause grade 3/4 adverse events (AEs), discontinuations, and discontinuations due to AEs. Time-to-event outcomes (RFS/DFS and DMFS) were analyzed both assuming that hazard ratios (HRs) are constant over time and that they vary. RESULTS Of 26 identified RCTs, 19 were included in the NMA following a feasibility assessment. Based on HRs for RFS/DFS, the risk of recurrence with nivolumab was similar to that of pembrolizumab and lower than that of ipilimumab 3 mg/kg, ipilimumab 10 mg/kg, or interferon. Risk of recurrence with nivolumab was similar to that of dabrafenib plus trametinib at 12 months, however, was lower beyond 12 months (HR [95% credible interval] at 24 months, 0.46 [0.27-0.78]; at 36 months, 0.28 [0.14-0.59]). Based on HRs for DMFS, the risk of developing distant metastases was lower with nivolumab than with ipilimumab 10 mg/kg or interferon and was similar to dabrafenib plus trametinib. CONCLUSION Adjuvant therapy with nivolumab provides an effective treatment option with a promising risk-benefit profile.
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Affiliation(s)
- Kabirraaj Toor
- Precision HEOR, 1505 West 2nd Avenue, Vancouver, BC, V6H 3Y4, Canada.
| | - Mark R Middleton
- University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford, OX3 7DQ, UK
| | - Keith Chan
- Precision HEOR, 1505 West 2nd Avenue, Vancouver, BC, V6H 3Y4, Canada
| | - Adenike Amadi
- Bristol Myers Squibb, Unit 2 Uxbridge Business Park, Uxbridge, UB8 1DH, UK
| | - Andriy Moshyk
- Bristol Myers Squibb, Route 206 and Province Line Road, Princeton, NJ, 08543, USA
| | - Srividya Kotapati
- Bristol Myers Squibb, Route 206 and Province Line Road, Princeton, NJ, 08543, USA
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7
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Aldrink JH, Polites S, Lautz TB, Malek MM, Rhee D, Bruny J, Christison-Lagay ER, Tracy ET, Abdessalam S, Ehrlich PF, Dasgupta R, Austin MT. What's new in pediatric melanoma: An update from the APSA cancer committee. J Pediatr Surg 2020; 55:1714-1721. [PMID: 31699434 DOI: 10.1016/j.jpedsurg.2019.09.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 09/25/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND/PURPOSE Melanoma is the most common skin cancer in children and often presents in an atypical fashion when compared to adults. The purpose of this review is to present an update on the epidemiology, surgical and medical management and prevention strategies in pediatric melanoma. METHODS A comprehensive review of the current literature on the epidemiology, surgical and medical management and prevention of adult and pediatric melanoma was performed by the authors and the results of this review are summarized in the manuscript. RESULTS Most recently, the incidence of melanoma in children has been declining, possibly owing to increased awareness and sun exposure prevention. The mainstay of therapy is surgical resection, often with sentinel lymph node biopsy. A positive sentinel node has prognostic value; however, completion node dissection is no longer recommended in the absence of clinically or radiographically positive nodes. Those with advanced disease also receive adjuvant systemic therapy using increasingly targeted immunologic therapies. CONCLUSIONS Sentinel lymph node positive patients no longer require completion lymph node dissection and instead may be followed by ultrasound. However, it is important to note that children have been excluded from most melanoma clinical trials to date, and therefore, recommendations for management are based on existing pediatric retrospective data and extrapolation from adult studies. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jennifer H Aldrink
- Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Stephanie Polites
- Division of Pediatric Surgery, Oregon Health and Science University, Portland, OR
| | - Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL
| | - Marcus M Malek
- Division of Pediatric General and Thoracic Surgery, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Daniel Rhee
- Division of Pediatric Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jennifer Bruny
- Division of Pediatric Surgery, University of Colorado, Children's Hospital Colorado, Aurora, CO
| | | | - Elisabeth T Tracy
- Division of Pediatric Surgery, Duke University Medical Center, Durham, NC
| | - Shahab Abdessalam
- Department of Pediatric Surgery, Boys Town National Research Hospital, Omaha, NE
| | - Peter F Ehrlich
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Childrens Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Mary T Austin
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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8
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Baetz TD, Fletcher GG, Knight G, McWhirter E, Rajagopal S, Song X, Petrella TM. Systemic adjuvant therapy for adult patients at high risk for recurrent melanoma: A systematic review. Cancer Treat Rev 2020; 87:102032. [PMID: 32473511 DOI: 10.1016/j.ctrv.2020.102032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/27/2022]
Abstract
Cutaneous melanoma is typically treated with wide local excision and, when appropriate, a sentinel node biopsy. Many patients are cured with this approach but for patients who have cancers with high risk features there is a significant risk of local and distant relapse and death. Interferon-based adjuvant therapy was recommended in the past but had modest results with significant toxicity. Recently, new therapies (immune checkpoint inhibitors and targeted therapies) have been found to be effective in the treatment of patients with metastatic melanoma and many of these therapies have been evaluated and found to be effective in the adjuvant treatment of high risk patients with melanoma. This systematic review of adjuvant therapies for cutaneous and mucosal melanoma was conducted for Ontario Health (Cancer Care Ontario) as the basis of a clinical practice guideline to address the question of whether patients with completely resected melanoma should be considered for adjuvant systemic therapy and which adjuvant therapy should be used.
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Affiliation(s)
- Tara D Baetz
- Department of Oncology, Queen's University, Kingston, ON, Canada; Cancer Centre of Southeastern Ontario/Kingston General Hospital, Kingston, ON, Canada.
| | - Glenn G Fletcher
- Program in Evidence-Based Care, McMaster University, Hamilton, ON, Canada
| | - Gregory Knight
- Department of Oncology, McMaster University, Hamilton, ON, Canada; Grand River Regional Cancer Centre, Kitchener, ON, Canada
| | - Elaine McWhirter
- Department of Oncology, McMaster University, Hamilton, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada
| | | | - Xinni Song
- Department of Internal Medicine, Division of Medical Oncology, University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Teresa M Petrella
- University of Toronto, Toronto, ON, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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9
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Garbe C, Amaral T, Peris K, Hauschild A, Arenberger P, Bastholt L, Bataille V, Del Marmol V, Dréno B, Fargnoli MC, Grob JJ, Höller C, Kaufmann R, Lallas A, Lebbé C, Malvehy J, Middleton M, Moreno-Ramirez D, Pellacani G, Saiag P, Stratigos AJ, Vieira R, Zalaudek I, Eggermont AMM. European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment - Update 2019. Eur J Cancer 2019; 126:159-177. [PMID: 31866016 DOI: 10.1016/j.ejca.2019.11.015] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 12/19/2022]
Abstract
A unique collaboration of multidisciplinary experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization for Research and Treatment of Cancer (EORTC) was formed to make recommendations on cutaneous melanoma diagnosis and treatment, based on systematic literature reviews and the experts' experience. Cutaneous melanomas are excised with 1- to 2-cm safety margins. Sentinel lymph node dissection shall be performed as a staging procedure in patients with tumour thickness ≥1.0 mm or ≥0.8 mm with additional histological risk factors, although there is as yet no clear survival benefit for this approach. Therapeutic decisions in stage III/IV patients should be primarily made by an interdisciplinary oncology team ("Tumor Board"). Adjuvant therapies in stage III/IV patients are primarily anti-PD-1, independent of mutational status, or dabrafenib plus trametinib for BRAF-mutant patients. In distant metastasis, either resected or not, systemic treatment is indicated. For first-line treatment, particularly in BRAF wild-type patients, immunotherapy with PD-1 antibodies alone or in combination with CTLA-4 antibodies shall be considered. In particular scenarios for patients with stage IV melanoma and a BRAF-V600 E/K mutation, first-line therapy with BRAF/MEK inhibitors can be offered as an alternative to immunotherapy. In patients with primary resistance to immunotherapy and harbouring a BRAF-V600 E/K mutation, this therapy shall be offered in second-line. Systemic therapy in stage III/IV melanoma is a rapidly changing landscape, and it is likely that these recommendations may change in the near future.
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Affiliation(s)
- Claus Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany.
| | - Teresa Amaral
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany; Portuguese Air Force Health Care Direction, Lisbon, Portugal
| | - Ketty Peris
- Institute of Dermatology, Università Cattolica, Rome, Italy; Fondazione Policlinico Universitario A, Gemelli - IRCCS, Rome, Italy
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - Petr Arenberger
- Department of Dermatovenerology, Third Faculty of Medicine, Charles University of Prague, Prague, Czech Republic
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Denmark
| | - Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London, SE1 7EH, UK
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Brigitte Dréno
- Dermatology Department, CHU Nantes, CIC 1413, CRCINA, University Nantes, Nantes, France
| | | | | | - Christoph Höller
- Department of Dermatology, Medical University of Vienna, Austria
| | - Roland Kaufmann
- Department of Dermatology, Venerology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Celeste Lebbé
- APHP Department of Dermatology, INSERM U976, University Paris 7 Diderot, Saint-Louis University Hospital, Paris, France
| | - Josep Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Mark Middleton
- NIHR Biomedical Research Centre, University of Oxford, UK
| | - David Moreno-Ramirez
- Medical-&-Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Philippe Saiag
- University Department of Dermatology, Université de Versailles-Saint Quentin en Yvelines, APHP, Boulogne, France
| | - Alexander J Stratigos
- 1st Department of Dermatology, University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Ricardo Vieira
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
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10
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Lorenzi M, Arndorfer S, Aguiar-Ibañez R, Scherrer E, Liu FX, Krepler C. An indirect treatment comparison of the efficacy of pembrolizumab versus competing regimens for the adjuvant treatment of stage III melanoma. J Drug Assess 2019; 8:135-145. [PMID: 31489255 PMCID: PMC6713115 DOI: 10.1080/21556660.2019.1649266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/10/2019] [Indexed: 01/04/2023] Open
Abstract
Objective: To determine the efficacy of pembrolizumab relative to other treatments used in stage III melanoma by conducting a systematic literature review (SLR) and network meta-analysis (NMA). Methods: A SLR was conducted to identify randomized clinical trials (RCTs) evaluating approved adjuvant treatments including interferon-containing regimens, BRAF-inhibitors, and PD-L1 inhibitors in stage III melanoma patients. Relative treatment effects for recurrence-free survival (RFS) were synthesized with Bayesian NMA models that allowed for hazard ratios (HRs) to vary over time. Results: Included studies formed a connected network of evidence composed of eight trials. In high-risk stage III patients, the HR for pembrolizumab vs observation decreased significantly over time with the superiority of pembrolizumab over observation becoming statistically meaningful before 3 months. By 9 months, the HR for pembrolizumab vs observation was statistically significantly lower than the HR for most other treatments vs observation, with the exception of ipilimumab and biochemotherapy due to overlapping 95% credible intervals. In BRAF + patients, pembrolizumab was statistically significantly better than observation after 3 months. The HR for both BRAF-inhibitors vs observation increased significantly over time and pembrolizumab was statistically superior to both BRAF-inhibitors after 15 months. Conclusions: Pembrolizumab results in statistically significantly improved RFS compared to all competing regimens after 9 months, except ipilimumab and biochemotherapy, for the adjuvant treatment of stage III melanoma. However, point estimate HRs vs observation for pembrolizumab are much lower than those for ipilimumab. In BRAF + patients, the advantage of pembrolizumab versus competing interventions increases over time with respect to RFS.
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11
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Abstract
PURPOSE OF REVIEW We review the results from relevant clinical trials and discuss current strategies in the melanoma adjuvant setting. RECENT FINDINGS The favorable therapeutic efficacy and the significant less toxicity of nivolumab compared with ipilimumab, fully substitutes today's approval of ipilimumab, regardless mutation status, whereas in BRAF-mutated patients, dabrafenib and trametinib seem to confirm their high efficacy also in adjuvant setting. The use of interferon is restricted to patients with ulcerated melanoma and countries with no access to the new drugs. SUMMARY Systemic adjuvant treatment after complete disease resection in high-risk melanoma patients aims to increase relapse-free survival (RFS) and overall survival (OS). According to the eighth edition of melanoma classification of American Joint Committee on Cancer (AJCC), the prognosis in stage III patients is heterogeneous and depends not only on N (nodal) but also on T (tumor thickness) category criteria. Recent data from randomized, phase-3 clinical trials analyzing the use of adjuvant anti-programmed death-1 and targeted therapies ultimately affect the standard of care and change the landscape of the adjuvant treatment.
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12
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Lazear HM, Schoggins JW, Diamond MS. Shared and Distinct Functions of Type I and Type III Interferons. Immunity 2019; 50:907-923. [PMID: 30995506 PMCID: PMC6839410 DOI: 10.1016/j.immuni.2019.03.025] [Citation(s) in RCA: 657] [Impact Index Per Article: 131.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 03/18/2019] [Accepted: 03/25/2019] [Indexed: 12/12/2022]
Abstract
Type I interferons (IFNs) (IFN-α, IFN-β) and type III IFNs (IFN-λ) share many properties, including induction by viral infection, activation of shared signaling pathways, and transcriptional programs. However, recent discoveries have revealed context-specific functional differences. Here, we provide a comprehensive review of type I and type III IFN activities, highlighting shared and distinct features from molecular mechanisms through physiological responses. Beyond discussing canonical antiviral functions, we consider the adaptive immune priming, anti-tumor, and autoimmune functions of IFNs. We discuss a model wherein type III IFNs serve as a front-line defense that controls infection at epithelial barriers while minimizing damaging inflammatory responses, reserving the more potent type I IFN response for when local responses are insufficient. In this context, we discuss current therapeutic applications targeting these cytokine pathways and highlight gaps in understanding of the biology of type I and type III IFNs in health and disease.
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Affiliation(s)
- Helen M Lazear
- Department of Microbiology and Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - John W Schoggins
- Department of Microbiology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Michael S Diamond
- Departments of Medicine, Pathology & Immunology, and Molecular Microbiology, and The Andrew M. and Jane M. Bursky Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, Saint Louis, MO 63110, USA.
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13
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Suarez-Kelly LP, Levine KM, Olencki TE, Del Campo SEM, Streacker EA, Brooks TR, Karpa VI, Markowitz J, Bingman AK, Geyer SM, Kendra KL, Carson WE. A pilot study of interferon-alpha-2b dose reduction in the adjuvant therapy of high-risk melanoma. Cancer Immunol Immunother 2019; 68:619-629. [PMID: 30725205 PMCID: PMC6447692 DOI: 10.1007/s00262-019-02308-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 01/22/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Lorena P Suarez-Kelly
- Comprehensive Cancer Center, The Ohio State University, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, N924 Doan Hall 410 W. 10th Ave, Columbus, OH, 43210-1228, USA
| | - Kala M Levine
- Comprehensive Cancer Center, The Ohio State University, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, N924 Doan Hall 410 W. 10th Ave, Columbus, OH, 43210-1228, USA
| | - Thomas E Olencki
- Medical Oncology, Department of Internal Medicine, The Ohio State University, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
| | | | | | - Taylor R Brooks
- Division of Rheumatology and Center for Autoimmune Genomics and Etiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Volodymyr I Karpa
- Comprehensive Cancer Center, The Ohio State University, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, N924 Doan Hall 410 W. 10th Ave, Columbus, OH, 43210-1228, USA
| | - Joseph Markowitz
- Comprehensive Cancer Center, The Ohio State University, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, N924 Doan Hall 410 W. 10th Ave, Columbus, OH, 43210-1228, USA
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Anissa K Bingman
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
- Hematology, Department of Internal Medicine, The Ohio State University, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
| | - Susan M Geyer
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
- Hematology, Department of Internal Medicine, The Ohio State University, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
| | - Kari L Kendra
- Medical Oncology, Department of Internal Medicine, The Ohio State University, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
| | - William E Carson
- Comprehensive Cancer Center, The Ohio State University, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, N924 Doan Hall 410 W. 10th Ave, Columbus, OH, 43210-1228, USA.
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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14
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Coit DG, Thompson JA, Albertini MR, Barker C, Carson WE, Contreras C, Daniels GA, DiMaio D, Fields RC, Fleming MD, Freeman M, Galan A, Gastman B, Guild V, Johnson D, Joseph RW, Lange JR, Nath S, Olszanski AJ, Ott P, Gupta AP, Ross MI, Salama AK, Skitzki J, Sosman J, Swetter SM, Tanabe KK, Wuthrick E, McMillian NR, Engh AM. Cutaneous Melanoma, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 17:367-402. [PMID: 30959471 DOI: 10.6004/jnccn.2019.0018] [Citation(s) in RCA: 265] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Cutaneous melanoma have been significantly revised over the past few years in response to emerging data on immune checkpoint inhibitor therapies and BRAF-targeted therapy. This article summarizes the data and rationale supporting extensive changes to the recommendations for systemic therapy as adjuvant treatment of resected disease and as treatment of unresectable or distant metastatic disease.
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Affiliation(s)
| | - John A Thompson
- 2Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - William E Carson
- 4The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Carlo Contreras
- 5University of Alabama at Birmingham Comprehensive Cancer Center
| | | | | | - Ryan C Fields
- 8Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Martin D Fleming
- 9St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | - Brian Gastman
- 12Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | - Julie R Lange
- 16The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | - Patrick Ott
- 19Dana-Farber/Brigham and Women's Cancer Center
| | | | | | | | | | - Jeffrey Sosman
- 20Robert H. Lurie Comprehensive Cancer Center of Northwestern University
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15
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Lee S, Son WS, Yang HB, Rajasekaran N, Kim SS, Hong S, Choi JS, Choi JY, Song K, Shin YK. A Glycoengineered Interferon-β Mutein (R27T) Generates Prolonged Signaling by an Altered Receptor-Binding Kinetics. Front Pharmacol 2019; 9:1568. [PMID: 30733680 PMCID: PMC6353837 DOI: 10.3389/fphar.2018.01568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 12/24/2018] [Indexed: 12/15/2022] Open
Abstract
The glycoengineering approach is used to improve biophysical properties of protein-based drugs, but its direct impact on binding affinity and kinetic properties for the glycoengineered protein and its binding partner interaction is unclear. Type I interferon (IFN) receptors, composed of IFNAR1 and IFNAR2, have different binding strengths, and sequentially bind to IFN in the dominant direction, leading to activation of signals and induces a variety of biological effects. Here, we evaluated receptor-binding kinetics for each state of binary and ternary complex formation between recombinant human IFN-β-1a and the glycoengineered IFN-β mutein (R27T) using the heterodimeric Fc-fusion technology, and compared biological responses between them. Our results have provided evidence that the additional glycan of R27T, located at the binding interface of IFNAR2, destabilizes the interaction with IFNAR2 via steric hindrance, and simultaneously enhances the interaction with IFNAR1 by restricting the conformational freedom of R27T. Consequentially, altered receptor-binding kinetics of R27T in the ternary complex formation led to a substantial increase in strength and duration of biological responses such as prolonged signal activation and gene expression, contributing to enhanced anti-proliferative activity. In conclusion, our findings reveal N-glycan at residue 25 of R27T is a crucial regulator of receptor-binding kinetics that changes biological activities such as long-lasting activation. Thus, we believe that R27T may be clinically beneficial for patients with multiple sclerosis.
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Affiliation(s)
- Saehyung Lee
- Laboratory of Molecular Pathology and Cancer Genomics, Research Institute of Pharmaceutical Sciences and College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Woo Sung Son
- Department of Pharmacy, College of Pharmacy, CHA University, Pocheon, South Korea
| | - Ho Bin Yang
- Laboratory of Molecular Pathology and Cancer Genomics, Research Institute of Pharmaceutical Sciences and College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Nirmal Rajasekaran
- Laboratory of Molecular Pathology and Cancer Genomics, Research Institute of Pharmaceutical Sciences and College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Sung-Su Kim
- The Center for Companion Diagnostics, LOGONE Bio Convergence Research Foundation, Seoul, South Korea
| | - Sungyoul Hong
- Laboratory of Molecular Pathology and Cancer Genomics, Research Institute of Pharmaceutical Sciences and College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Joon-Seok Choi
- College of Pharmacy, Daegu Catholic University, Gyeongsan, South Korea
| | | | - Kyoung Song
- The Center for Companion Diagnostics, LOGONE Bio Convergence Research Foundation, Seoul, South Korea
| | - Young Kee Shin
- Laboratory of Molecular Pathology and Cancer Genomics, Research Institute of Pharmaceutical Sciences and College of Pharmacy, Seoul National University, Seoul, South Korea.,Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Suwon, South Korea
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16
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Oliver DE, Sondak VK, Strom T, Zager JS, Naghavi AO, Sarnaik A, Messina JL, Caudell JJ, Trotti AM, Torres-Roca JF, Khushalani NI, Harrison LB. Interferon is associated with improved survival for node-positive cutaneous melanoma: a single-institution experience. Melanoma Manag 2018; 5:MMT02. [PMID: 30190928 PMCID: PMC6122528 DOI: 10.2217/mmt-2017-0025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 02/22/2017] [Indexed: 02/05/2023] Open
Abstract
Aim: We assessed the role of adjuvant interferon on relapse-free survival (RFS), distant metastasis-free survival (DMFS) and overall survival (OS) in node-positive melanoma patients. Methods: We retrospectively reviewed 385 node-positive patients without distant metastatic disease treated from 1998 to 2015. The surgery was therapeutic lymph node dissection (LND, n = 86) or sentinel lymph node biopsy ± completion LND (n = 270). 128 patients (33.2%) received adjuvant interferon. Results: After a median follow-up of 70 months, interferon was associated with improved RFS (hazard ratio [HR]: 0.55; p < 0.001), DMFS (HR: 0.59; p < 0.001) and OS (HR: 0.61; p = 0.003), controlling for tumor and nodal stage, node size, sex, primary site, adjuvant therapy and extracapsular extension. In an exploratory age-matched comparison of patients treated with (n = 67) and without (n = 233) adjuvant immunotherapy, interferon still showed improved RFS, DMFS and OS. Conclusion: Adjuvant interferon appears to improve OS among node-positive melanoma patients in a modern experience, providing context for comparison in the adjuvant therapy landscape.
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Affiliation(s)
- Daniel E Oliver
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Vernon K Sondak
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Tobin Strom
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX 75390, USA.,Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Jonathan S Zager
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Arash O Naghavi
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA
| | - Amod Sarnaik
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Jane L Messina
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Departments of Pathology & Cell Biology & Dermatology, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Departments of Pathology & Cell Biology & Dermatology, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA
| | - Jimmy J Caudell
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA
| | - Andy M Trotti
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA
| | - Javier F Torres-Roca
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA
| | - Nikhil I Khushalani
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Louis B Harrison
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA
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17
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Suciu S, Eggermont AMM, Lorigan P, Kirkwood JM, Markovic SN, Garbe C, Cameron D, Kotapati S, Chen TT, Wheatley K, Ives N, de Schaetzen G, Efendi A, Buyse M. Relapse-Free Survival as a Surrogate for Overall Survival in the Evaluation of Stage II-III Melanoma Adjuvant Therapy. J Natl Cancer Inst 2018; 110:4091329. [PMID: 28922786 DOI: 10.1093/jnci/djx133] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/26/2017] [Indexed: 02/11/2024] Open
Abstract
Background We assessed whether relapse-free survival (RFS; time until recurrence/death) is a valid surrogate for overall survival (OS) among resected stage II-III melanoma patients through a meta-analysis of randomized controlled trials. Methods Individual patient data (IPD) on RFS and OS were collected from 5826 patients enrolled in 11 randomized adjuvant trials comparing interferon (IFN) to observation. In addition, IPD from two studies comparing IFN and vaccination in 989 patients were included. A two-level modeling approach was used for assessing Spearman's patient-level correlation (rho) of RFS and OS and the trial-level coefficient of determination (R²) of the treatment effects on RFS and on OS. The results were validated externally in 13 adjuvant studies without available IPD. We then tested the results on the European Organisation for Research and Treatment of Cancer (EORTC) 18071 double-blind trial comparing ipilimumab 10 mg/kg with placebo, which showed a statistically significant impact of the checkpoint inhibitor on RFS and OS. All statistical tests were two-sided. Results With a median follow-up of seven years, 12 of 13 trials showed a consistency between the IFN vs No IFN differences regarding RFS (hazard ratio [HR]RFS = 0.88) and OS (HROS = 0.91), but the small trial, Eastern Cooperative Oncology Group 2696, was an outlier (HRRFS = 0.72 vs HROS = 1.11). Therefore, even if rho was high, R² was low and could not reliably be estimated. Based on the 12 trials, rho remained high (0.89), and the hazard ratios for RFS and OS were strongly correlated (R² = 0.91). The surrogate threshold effect for RFS was estimated to be 0.77. For the EORTC 18071 trial, the hazard ratio for RFS was 0.75, predicting an effect of ipilimumab on OS. This was subsequently confirmed (HROS = 0.72, 95.1% confidence interval = 0.58 to 0.88, P = .001). Conclusions In high-risk stage II-III melanoma, RFS appeared to be a valid surrogate end point for OS for adjuvant randomized studies assessing interferon or a checkpoint inhibitor. In future similar adjuvant studies, a hazard ratio for RFS of 0.77 or less would predict a treatment impact on OS.
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Affiliation(s)
- Stefan Suciu
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Alexander M M Eggermont
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Paul Lorigan
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - John M Kirkwood
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Svetomir N Markovic
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Claus Garbe
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - David Cameron
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Srividya Kotapati
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Tai-Tsang Chen
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Keith Wheatley
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Natalie Ives
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Gaetan de Schaetzen
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Achmad Efendi
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Marc Buyse
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
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Ives NJ, Suciu S, Eggermont AM, Kirkwood J, Lorigan P, Markovic SN, Garbe C, Wheatley K, Bufalino R, Cameron D, Cascinelli N, Doherty V, Eggermont A, Garbe C, Gore M, Hancock B, Harrison R, Ives N, Kirkwood J, Kressig M, Lee S, Lorigan P, MacKie R, Markovic SN, Marsden J, Suciu S, Suman V, Turner L, Wheatley K. Adjuvant interferon-α for the treatment of high-risk melanoma: An individual patient data meta-analysis. Eur J Cancer 2017; 82:171-183. [DOI: 10.1016/j.ejca.2017.06.006] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 06/01/2017] [Indexed: 11/26/2022]
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Agarwala SS, Lee SJ, Yip W, Rao UN, Tarhini AA, Cohen GI, Reintgen DS, Evans TL, Brell JM, Albertini MR, Atkins MB, Dakhil SR, Conry RM, Sosman JA, Flaherty LE, Sondak VK, Carson WE, Smylie MG, Pappo AS, Kefford RF, Kirkwood JM. Phase III Randomized Study of 4 Weeks of High-Dose Interferon-α-2b in Stage T2bNO, T3a-bNO, T4a-bNO, and T1-4N1a-2a (microscopic) Melanoma: A Trial of the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group (E1697). J Clin Oncol 2017; 35:885-892. [PMID: 28135150 DOI: 10.1200/jco.2016.70.2951] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To test the efficacy of 4 weeks of intravenous (IV) induction with high-dose interferon (IFN) as part of the Eastern Cooperative Oncology Group regimen compared with observation (OBS) in patients with surgically resected intermediate-risk melanoma. Patients and Methods In this intergroup international trial, eligible patients had surgically resected cutaneous melanoma in the following categories: (1) T2bN0, (2) T3a-bN0, (3) T4a-bN0, and (4) T1-4N1a-2a (microscopic). Patients were randomly assigned to receive IFN α-2b at 20 MU/m2/d IV for 5 days (Monday to Friday) every week for 4 weeks (IFN) or OBS. Stratification factors were pathologic lymph node status, lymph node staging procedure, Breslow depth, ulceration of the primary lesion, and disease stage. The primary end point was relapse-free survival. Secondary end points included overall survival, toxicity, and quality of life. Results A total of 1,150 patients were randomly assigned. At a median follow-up of 7 years, the 5-year relapse-free survival rate was 0.70 (95% CI, 0.66 to 0.74) for OBS and 0.70, (95% CI, 0.66 to 0.74) for IFN ( P = .964). The 5-year overall survival rate was 0.83 (95% CI, 0.79 to 0.86) for OBS and 0.83 (95% CI, 0.80 to 0.86) for IFN ( P = .558). Treatment-related grade 3 and higher toxicity was 4.6% versus 57.9% for OBS and IFN, respectively ( P < .001). Quality of life was worse for the treated group. Conclusion Four weeks of IV induction as part of the Eastern Cooperative Oncology Group high-dose IFN regimen is not better than OBS alone for patients with intermediate-risk melanoma as defined in this trial.
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Affiliation(s)
- Sanjiv S Agarwala
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Sandra J Lee
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Waiki Yip
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Uma N Rao
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Ahmad A Tarhini
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Gary I Cohen
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Douglas S Reintgen
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Terry L Evans
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Joanna M Brell
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Mark R Albertini
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Michael B Atkins
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Shaker R Dakhil
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Robert M Conry
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Jeffrey A Sosman
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Lawrence E Flaherty
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Vernon K Sondak
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - William E Carson
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Michael G Smylie
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Alberto S Pappo
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Richard F Kefford
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - John M Kirkwood
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
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Abstract
Childhood melanoma is a rare pediatric malignancy, with fewer than 500 new diagnoses annually. The incidence is increasing, particularly in the adolescent population. This review highlights the epidemiology, clinical presentation, and histopathologic challenges of pediatric melanoma. Surgical resection remains the cornerstone for localized and regionally advanced disease. Adjuvant therapies, including current options and potential novel therapeutics for this unique population will be discussed.
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Affiliation(s)
- Elisabeth T Tracy
- Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children׳s Hospital, The Ohio State University College of Medicine, Nationwide Children׳s Dr, FB Suite 6B.1, Columbus, Ohio 43205.
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Garbe C, Peris K, Hauschild A, Saiag P, Middleton M, Bastholt L, Grob JJ, Malvehy J, Newton-Bishop J, Stratigos AJ, Pehamberger H, Eggermont AM. Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline - Update 2016. Eur J Cancer 2016; 63:201-17. [PMID: 27367293 DOI: 10.1016/j.ejca.2016.05.005] [Citation(s) in RCA: 273] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 05/16/2016] [Indexed: 01/12/2023]
Abstract
Cutaneous melanoma (CM) is potentially the most dangerous form of skin tumour and causes 90% of skin cancer mortality. A unique collaboration of multi-disciplinary experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organisation of Research and Treatment of Cancer was formed to make recommendations on CM diagnosis and treatment, based on systematic literature reviews and the experts' experience. Diagnosis is made clinically using dermoscopy and staging is based upon the AJCC system. CMs are excised with 1-2 cm safety margins. Sentinel lymph node dissection is routinely offered as a staging procedure in patients with tumours >1 mm in thickness, although there is as yet no clear survival benefit for this approach. Interferon-α treatment may be offered to patients with stage II and III melanoma as an adjuvant therapy, as this treatment increases at least the disease-free survival and less clear the overall survival (OS) time. The treatment is however associated with significant toxicity. In distant metastasis, all options of surgical therapy have to be considered thoroughly. In the absence of surgical options, systemic treatment is indicated. For first-line treatment particularly in BRAF wild-type patients, immunotherapy with PD-1 antibodies alone or in combination with CTLA-4 antibodies should be considered. BRAF inhibitors like dabrafenib and vemurafenib in combination with the MEK inhibitors trametinib and cobimetinib for BRAF mutated patients should be offered as first or second line treatment. Therapeutic decisions in stage IV patients should be primarily made by an interdisciplinary oncology team ('Tumour Board').
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Affiliation(s)
- Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany.
| | - Ketty Peris
- Institute of Dermatology, Catholic University, Rome, Italy
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - Philippe Saiag
- University Department of Dermatology, Université de Versailles-Saint Quentin en Yvelines, APHP, Boulogne, France
| | - Mark Middleton
- NIHR Biomedical Research Centre, University of Oxford, UK
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Denmark
| | | | - Josep Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Julia Newton-Bishop
- Section of Biostatistics and Epidemiology, Leeds Institute of Cancer and Pathology, University of Leeds, UK
| | - Alexander J Stratigos
- 1(st) Department of Dermatology, University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece
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22
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Ben-Ami E, Schachter J. Adjuvant treatment for stage III melanoma in the era of targeted medicine and immunotherapy. Melanoma Manag 2016; 3:137-147. [PMID: 30190882 DOI: 10.2217/mmt-2016-0002] [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: 01/22/2016] [Accepted: 03/21/2016] [Indexed: 11/21/2022] Open
Abstract
The accelerated development in the treatment of metastatic melanoma, both in molecular targeted therapy and immunotherapy, is already starting to impact on adjuvant therapy in stage III melanoma. Following the approval of ipilimumab for adjuvant therapy in melanoma, clinical trials assessing other checkpoint modulators and MAPK pathway inhibitors as adjuvant treatments for melanoma are currently ongoing. As results from these trials mature in the next few years, a change in the landscape of adjuvant treatment for melanoma is expected, resulting in new challenges in treatment decisions such as optimizing patients selection through predictive and prognostic biomarkers, and management of treatment related adverse events, in particular immune related toxicities.
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Affiliation(s)
- Eytan Ben-Ami
- Ella Lemelbaum Institute for Melanoma, Division of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Center for Sarcoma & Bone Oncology, Dana Farber Cancer Institute, Boston, MA, USA.,Ella Lemelbaum Institute for Melanoma, Division of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Center for Sarcoma & Bone Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Jacob Schachter
- Ella Lemelbaum Institute for Melanoma, Division of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Ella Lemelbaum Institute for Melanoma, Division of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel
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23
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Adjuvant Autologous Melanoma Vaccine for Macroscopic Stage III Disease: Survival, Biomarkers, and Improved Response to CTLA-4 Blockade. J Immunol Res 2016; 2016:8121985. [PMID: 27294163 PMCID: PMC4887652 DOI: 10.1155/2016/8121985] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/30/2016] [Accepted: 04/17/2016] [Indexed: 11/30/2022] Open
Abstract
Background. There is not yet an agreed adjuvant treatment for melanoma patients with American Joint Committee on Cancer stages III B and C. We report administration of an autologous melanoma vaccine to prevent disease recurrence. Patients and Methods. 126 patients received eight doses of irradiated autologous melanoma cells conjugated to dinitrophenyl and mixed with BCG. Delayed type hypersensitivity (DTH) response to unmodified melanoma cells was determined on the vaccine days 5 and 8. Gene expression analysis was performed on 35 tumors from patients with good or poor survival. Results. Median overall survival was 88 months with a 5-year survival of 54%. Patients attaining a strong DTH response had a significantly better (p = 0.0001) 5-year overall survival of 75% compared with 44% in patients without a strong response. Gene expression array linked a 50-gene signature to prognosis, including a cluster of four cancer testis antigens: CTAG2 (NY-ESO-2), MAGEA1, SSX1, and SSX4. Thirty-five patients, who received an autologous vaccine, followed by ipilimumab for progressive disease, had a significantly improved 3-year survival of 46% compared with 19% in nonvaccinated patients treated with ipilimumab alone (p = 0.007). Conclusion. Improved survival in patients attaining a strong DTH and increased response rate with subsequent ipilimumab suggests that the autologous vaccine confers protective immunity.
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Guo J, Qin S, Liang J, Lin T, Si L, Chen X, Chi Z, Cui C, Du N, Fan Y, Gu K, Li F, Li J, Li Y, Liang H, Liu J, Lu M, Lu A, Nan K, Niu X, Pan H, Ren G, Ren X, Shu Y, Song X, Tao M, Wang B, Wei W, Wu D, Wu L, Wu A, Xu X, Zhang J, Zhang X, Zhang Y, Zhu H. Chinese Guidelines on the Diagnosis and Treatment of Melanoma (2015 Edition). ANNALS OF TRANSLATIONAL MEDICINE 2016; 3:322. [PMID: 26734632 DOI: 10.3978/j.issn.2305-5839.2015.12.23] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Jun Guo
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Shukui Qin
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Jun Liang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Tongyu Lin
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Lu Si
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Xiaohong Chen
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Zhihong Chi
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Chuanliang Cui
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Nan Du
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Yun Fan
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Kangsheng Gu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Fang Li
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Junling Li
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Yongheng Li
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Houjie Liang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Jiwei Liu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Man Lu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Aiping Lu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Kejun Nan
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Xiaohui Niu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Hongming Pan
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Guoxin Ren
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Xiubao Ren
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Yongqian Shu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Xin Song
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Min Tao
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Baocheng Wang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Wenbin Wei
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Di Wu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Lingying Wu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Aiwen Wu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Xiaolin Xu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Junyi Zhang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Xiaoshi Zhang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Yiping Zhang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Huiyan Zhu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
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Abstract
The incidence of melanoma is rapidly increasing, especially in younger female and older male patients. Recent fundamental advances in our knowledge of melanoma tumorigenesis have established roles for inhibitors of the MAPK pathway and regulatory immune checkpoints CTLA-4 and PD-1/PD-L1. However, the majority of patients continue to present with non-metastatic disease-typically managed with surgical resection and adjuvant therapy. High-dose IFN-α2b (HDI) is the main adjuvant therapeutic mainstay in high-risk disease following definitive resection. In this chapter, we review the evidence supporting the use of adjuvant HDI in high-risk melanoma. We also discuss some of the other treatment modalities that have been evaluated including vaccines, chemotherapy, and radiotherapy.
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Mohr P, Hauschild A, Trefzer U, Enk A, Tilgen W, Loquai C, Gogas H, Haalck T, Koller J, Dummer R, Gutzmer R, Brockmeyer N, Hölzle E, Sunderkötter C, Mauch C, Stein A, Schneider LA, Podda M, Göppner D, Schadendorf D, Weichenthal M. Intermittent High-Dose Intravenous Interferon Alfa-2b for Adjuvant Treatment of Stage III Melanoma: Final Analysis of a Randomized Phase III Dermatologic Cooperative Oncology Group Trial. J Clin Oncol 2015; 33:4077-84. [PMID: 26503196 DOI: 10.1200/jco.2014.59.6932] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023] Open
Abstract
PURPOSE To evaluate the efficacy, safety, tolerability, and quality of life (QoL) in patients receiving intravenous, intermittent high-dose interferon alfa-2b (IFN-α-2b [iHDI]) compared with standard high-dose IFN-α-2b (HDI). PATIENT AND METHODS Patients with stage III resected lymph node or in-transit metastasis from cutaneous malignant melanoma were randomly assigned to receive either a standard HDI regimen or three courses of IFN-α-2b 20 MIU/m(2) administered intravenously 5 days a week for 4 weeks then repeated every 4 months. Distant metastasis-free survival was the primary end point for efficacy analysis. In addition, relapse-free survival, overall survival, safety as determined by Common Terminology Criteria for Adverse Events criteria, and QoL were secondary end points. RESULTS Of 649 patients enrolled, 22 patients were excluded from the intent-to-treat analysis. The remaining 627 patients were well balanced between the arms according to sex, age, and stage. After a median follow-up of 55 months, a multivariable Cox model revealed no significant differences for distant metastasis-free survival (hazard ratio [HR], 1.21; P = .12) or overall survival (HR, 1.01; P = .85). In contrast, the difference for relapse-free survival was significant (HR, 1.27; P = .03), favoring standard HDI. Early termination of treatment because of adverse events or QoL occurred significantly more often with HDI than with iHDI (26.0% v 14.8%; P < .001). CONCLUSION Although the safety and QoL profiles for the intermittent regimen were favorable, no significant difference was observed for survival while the HR for relapse with iHDI was increased. Therefore, an iHDI regimen, as tested here, cannot be recommended as adjuvant treatment for high-risk melanoma.
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Affiliation(s)
- Peter Mohr
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland.
| | - Axel Hauschild
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Uwe Trefzer
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Alexander Enk
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Wolfgang Tilgen
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Carmen Loquai
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Helen Gogas
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Thomas Haalck
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Josef Koller
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Ralf Gutzmer
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Norbert Brockmeyer
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Erhard Hölzle
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Cord Sunderkötter
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Cornelia Mauch
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Annette Stein
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Lars A Schneider
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Maurizio Podda
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Daniela Göppner
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Dirk Schadendorf
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Michael Weichenthal
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
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Schneble EJ, Yu X, Wagner TE, Peoples GE. Novel dendritic cell-based vaccination in late stage melanoma. Hum Vaccin Immunother 2015; 10:3132-8. [PMID: 25483650 DOI: 10.4161/hv.29110] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Dendritic cells (DCs) are professional antigen-presenting cells (APCs) that play an important role in stimulating an immune response of both CD4(+) T helper cells and CD8(+) cytotoxic T lymphocytes (CTLs). As such, DCs have been studied extensively in cancer immunotherapy for their capability to induce a specific anti-tumor response when loaded with tumor antigens. However, when the most relevant antigens of a tumor remain to be identified, alternative approaches are required. Formation of a dentritoma, a fused DC and tumor cells hybrid, is one strategy. Although initial studies of these hybrid cells are promising, several limitations interfere with its clinical and commercial application. Here we present early experience in clinical trials and an alternative approach to manufacturing this DC/tumor cell hybrid for use in the treatment of late stage and metastatic melanoma.
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Affiliation(s)
- Erika J Schneble
- a San Antonio Military Medical Center; Department of General Surgery ; San Antonio , TX USA
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Choobin H, Bamdad T, Soleimanjahi H, Razavinikoo H. Antitumor effect of mIFN-λ3 in C57BL/6 mice model for papilloma tumors. Mol Biol 2015. [DOI: 10.1134/s0026893315050064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Stiff A, Carson W. Investigations of interferon-lambda for the treatment of cancer. J Innate Immun 2015; 7:243-50. [PMID: 25661266 DOI: 10.1159/000370113] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 11/25/2014] [Indexed: 11/19/2022] Open
Abstract
Interferon-lambda (IFN-λ), a recently discovered cytokine, overlaps broadly with type I IFN signaling, producing antiviral, antiproliferative, and proapoptotic responses. In comparison to type I IFNs, IFN-λ has a limited spectrum of responsive tissues due to variation in expression of the IFN-λ receptor IFNLR1. Type I IFNs have been investigated for their antitumor effects and used in the clinical setting for a number of different cancers. Given the overlap in signaling and function between IFN-λ and type I IFNs, IFN-λ has also drawn interest for the treatment of cancer. To date, a number of studies using both murine and human models of cancer have investigated the antitumor effects of IFN-λ. These studies have found that IFN-λ is capable of directly targeting cancer cells to reduce their tumorigenicity, induce cell cycle arrest, and cause apoptosis. In addition, IFN-λ has been shown to have indirect effects against cancer cells through immune system responses and immune modulatory effects. This review aims to detail the findings of studies investigating IFN-λ for the treatment of cancer as well as suggest areas of potential interest for future studies.
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Affiliation(s)
- Andrew Stiff
- Biomedical Sciences Graduate Program, The Ohio State University, Columbus, Ohio, USA
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Di Trolio R, Simeone E, Di Lorenzo G, Buonerba C, Ascierto PA. The use of interferon in melanoma patients: a systematic review. Cytokine Growth Factor Rev 2014; 26:203-12. [PMID: 25511547 DOI: 10.1016/j.cytogfr.2014.11.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 11/11/2014] [Indexed: 11/17/2022]
Abstract
Interferon (IFN) and PEG-IFN are the only drugs approved as adjuvant therapy in patients with melanoma at high-risk of recurrence after surgical resection. Several clinical trials of adjuvant IFN, using different doses and durations of therapy, have been conducted in these patients. Results generally suggest relapse-free survival and overall survival benefits; however, questions over the optimal dose and duration of treatment and concerns over toxicity have limited its use. IFN exerts its biological activity in melanoma via multiple mechanisms of action, most of which can be considered as indirect immunomodulatory effects. As such, IFN may also be of benefit in the neoadjuvant setting, where it may have a role in melanoma patients with locally advanced disease for whom immediate surgical excision is not possible. However, this has not been well studied. The use of IFN in patients with metastatic melanoma is controversial, with limited data and no convincing evidence of a survival benefit. However, IFN therapy combined with novel biological and immunotherapies offers the potential for a synergistic effect and improved clinical outcomes. Predictive and prognostic factors to better select melanoma patients for IFN treatment have been identified (e.g. disease stage, ulceration, various cytokines) and may also enhance its therapeutic efficacy, but their incorporation into the clinical decision-making process requires validation in prospective trials. In conclusion, the modest efficacy of IFN shown in clinical trials is largely a reflection of differences in response between patients. Despite advancements in the understanding of its biological mechanisms of action, the huge potential of IFN remains to be fully explored and utilized in patients with melanoma.
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Affiliation(s)
- Rossella Di Trolio
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapies, Istituto Nazionale Tumori Fondazione G. Pascale, Napoli, Italy.
| | - Ester Simeone
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapies, Istituto Nazionale Tumori Fondazione G. Pascale, Napoli, Italy.
| | - Giuseppe Di Lorenzo
- Oncology Division, Department of Clinical Medicine, University "Federico II" of Naples, Italy.
| | - Carlo Buonerba
- Oncology Division, Department of Clinical Medicine, University "Federico II" of Naples, Italy.
| | - Paolo Antonio Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapies, Istituto Nazionale Tumori Fondazione G. Pascale, Napoli, Italy.
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Flaherty LE, Othus M, Atkins MB, Tuthill RJ, Thompson JA, Vetto JT, Haluska FG, Pappo AS, Sosman JA, Redman BG, Moon J, Ribas A, Kirkwood JM, Sondak VK. Southwest Oncology Group S0008: a phase III trial of high-dose interferon Alfa-2b versus cisplatin, vinblastine, and dacarbazine, plus interleukin-2 and interferon in patients with high-risk melanoma--an intergroup study of cancer and leukemia Group B, Children's Oncology Group, Eastern Cooperative Oncology Group, and Southwest Oncology Group. J Clin Oncol 2014; 32:3771-8. [PMID: 25332243 DOI: 10.1200/jco.2013.53.1590] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE High-dose interferon (IFN) for 1 year (HDI) is the US Food and Drug Administration-approved adjuvant therapy for patients with high-risk melanoma. Efforts to modify IFN dose and schedule have not improved efficacy. We sought to determine whether a shorter course of biochemotherapy would be more effective. PATIENTS AND METHODS S0008 (S0008: Chemotherapy Plus Biological Therapy in Treating Patients With Melanoma) was an Intergroup phase III trial that enrolled high-risk patients (stage IIIA-N2a through IIIC-N3), randomly assigning them to receive either HDI or biochemotherapy consisting of dacarbazine, cisplatin, vinblastine, interleukin-2, IFN alfa-2b (IFN-α-2b) and granulocyte colony-stimulating factor given every 21 days for three cycles. Coprimary end points were relapse-free survival (RFS) and overall survival (OS). RESULTS In all, 432 patients were enrolled. Grade 3 and 4 adverse events occurred in 57% and 7% of HDI patients and 36% and 40% of biochemotherapy patients, respectively. At a median follow-up of 7.2 years, biochemotherapy improved RFS (hazard ratio [HR], 0.75; 95% CI, 0.58 to 0.97; P = .015), with a median RFS of 4.0 years (95% CI, 1.9 years to not reached [NR]) versus 1.9 years for HDI (95% CI, 1.2 to 2.8 years) and a 5-year RFS of 48% versus 39%. Median OS was not different (HR, 0.98; 95% CI, 0.74 to 1.31; P = .55), with a median OS of 9.9 years (95% CI, 4.62 years to NR) for biochemotherapy versus 6.7 years (95% CI, 4.5 years to NR) for HDI and a 5-year OS of 56% for both arms. CONCLUSION Biochemotherapy is a shorter, alternative adjuvant treatment for patients with high-risk melanoma that provides statistically significant improvement in RFS but no difference in OS and more toxicity compared with HDI.
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Affiliation(s)
- Lawrence E Flaherty
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL.
| | - Megan Othus
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Michael B Atkins
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Ralph J Tuthill
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
| | - John A Thompson
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
| | - John T Vetto
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Frank G Haluska
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Alberto S Pappo
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Jeffrey A Sosman
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Bruce G Redman
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
| | - James Moon
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Antoni Ribas
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
| | - John M Kirkwood
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Vernon K Sondak
- Lawrence E. Flaherty, Wayne State University, Detroit; Bruce G. Redman, University of Michigan, Ann Arbor, MI; Megan Othus, James Moon, Southwest Oncology Group Statistical Center; John A. Thompson, Seattle Cancer Care Alliance, Seattle, WA; Michael B. Atkins, Georgetown University Hospital, Washington DC; Ralph J. Tuthill, Cleveland Clinic Foundation, Cleveland, OH; John T. Vetto, Oregon Health & Science University/Knight Cancer Institute, Portland, OR; Frank G. Haluska, Tufts-New England Medical Center, Boston, MA; Alberto S. Pappo, Texas Children's Cancer Center, Houston, TX; Jeffrey A. Sosman, Vanderbilt University School of Medicine Nashville, TN; Antoni Ribas, University of California Los Angeles, Los Angeles, CA; John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL
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Berrocal A, Cabañas L, Espinosa E, Fernández-de-Misa R, Martín-Algarra S, Martínez-Cedres JC, Ríos-Buceta L, Rodríguez-Peralto JL. Melanoma: diagnosis, staging, and treatment. Consensus group recommendations. Adv Ther 2014; 31:945-60. [PMID: 25145549 DOI: 10.1007/s12325-014-0148-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Indexed: 10/24/2022]
Abstract
The incidence of malignant melanoma is increasing worldwide. In Spain, its incidence is increasing faster than any other cancer type, with a 5-year survival rate of about 85%. The impact and characteristics of malignant melanoma in the Spanish population can be ascertained from the national melanoma registry of the Academia Española de Dermatología y Venereología. This review presents consensus group recommendations for the diagnosis, staging and treatment of malignant melanoma in Spain. Incidence and mortality are discussed, as well as evaluation of various prevention and treatment strategies. Prognostic factors, such as BRAF and C-KIT mutations, which are expected to become routine staging procedures over the next few years, are outlined, especially in relation to treatment options. The use of recently approved targeted agents such as ipilimumab, a cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) inhibitor, and vemurafenib, a BRAF inhibitor, in metastatic disease are also discussed.
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Fong Z, Tanabe K. Comparison of melanoma guidelines in the U.S.A., Canada, Europe, Australia and New Zealand: a critical appraisal and comprehensive review. Br J Dermatol 2014; 170:20-30. [DOI: 10.1111/bjd.12687] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2013] [Indexed: 12/24/2022]
Affiliation(s)
- Z.V. Fong
- Division of Surgical Oncology; Department of Surgery; Massachusetts General Hospital; Harvard Medical School; Boston MA U.S.A
| | - K.K. Tanabe
- Division of Surgical Oncology; Department of Surgery; Massachusetts General Hospital; Harvard Medical School; Boston MA U.S.A
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Abstract
Malignant melanoma is increasing in incidence worldwide, and many patients remain at a significant risk of recurrence following surgical resection. Over the past 30 years, interferon-alpha has been the only agent approved for adjuvant therapy of melanoma. This review summarizes the rationale for adjuvant therapy, and discusses the roles of interferon, immunotherapy, chemotherapy and radiation therapy in the adjuvant setting. New approaches and novel combinations that appear promising for the adjuvant therapy of malignant melanoma are also outlined.
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Affiliation(s)
- John P Stoutenburg
- Division of Medical Oncology, Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York 10032, USA
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36
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Cormier JN, Xing Y, Ross MI, Cantor SB. Interferon-α in high-risk melanoma patients. Expert Rev Pharmacoecon Outcomes Res 2014; 4:667-76. [DOI: 10.1586/14737167.4.6.667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Davar D, Tarhini AA, Gogas H, Kirkwood JM. Advances in adjuvant therapy: potential for prognostic and predictive biomarkers. Methods Mol Biol 2014; 1102:45-69. [PMID: 24258973 PMCID: PMC8591980 DOI: 10.1007/978-1-62703-727-3_4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Melanoma is the third most common skin cancer but accounts for the majority of skin cancer-related mortality. The rapidly rising incidence and younger age at diagnosis has made melanoma a leading cause of lost productive years of life and has increased the urgency of finding improved adjuvant therapy for melanoma. Interferon-α was approved for the adjuvant treatment of resected high-risk melanoma following studies that demonstrated improvements in relapse-free survival and overall survival that were commenced nearly 30 years ago. The clinical benefits associated with this agent have been consistently observed across multiple studies and meta-analyses in terms of relapse rate, and to a smaller and less-consistent degree, mortality. However, significant toxicity and lack of prognostic and/or predictive biomarkers that would allow greater risk-benefit ratio have limited the more widespread adoption of this modality.Recent success with targeted agents directed against components of the MAP-kinase pathway and checkpoint inhibitors have transformed the treatment landscape in metastatic disease. Current research efforts are centered around discovering predictive/prognostic biomarkers and exploring the options for more effective regimens, either singly or in combination.
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Affiliation(s)
- Diwakar Davar
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Ascierto PA, Chiarion-Sileni V, Muggiano A, Mandalà M, Pimpinelli N, Del Vecchio M, Rinaldi G, Simeone E, Queirolo P. Interferon alpha for the adjuvant treatment of melanoma: review of international literature and practical recommendations from an expert panel on the use of interferon. J Chemother 2013; 26:193-201. [PMID: 24621162 DOI: 10.1179/1973947813y.0000000154] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The degree to which interferon (IFN) alpha-2b offers real clinical benefits in the adjuvant therapy of melanoma at high risk of recurrence is a subject of debate. This, together with questions over optimal treatment scheme and concerns over toxicity, has limited its clinical use. On the basis of a review of the literature, an Italian Expert Panel has made practical recommendations for a consistent approach in the use of IFN. Although it is clear that more research into predictive factors to identify patients most likely to benefit from adjuvant IFN therapy is required, IFN remains the only currently available adjuvant option for melanoma. Based on meta-analyses of clinical trials, there is clear evidence that treatment with IFN is beneficial with regard to overall and recurrence-free survival (RFS). As such, IFN should be offered to patients who are at high risk of recurrence. Specific recommendations with regard to disease stage are provided.
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Abstract
The incidence of melanoma is increasing worldwide. Melanomas represent 3 percent of all skin cancers but 65 percent of skin cancer deaths. Melanoma is now the fifth most common cancer diagnosed in the United States. Excisional biopsy should be performed for lesions suspicious for melanoma. The pathologist's report provides essential information for surgical treatment; the most important information is the Breslow depth of the lesion. In addition to wide surgical excision of the primary lesion, sentinel lymph node biopsy is the standard of care for early identification of regional metastasis. Nodal metastasis found in the sentinel lymph node biopsy should be followed with a complete lymph node dissection. Although surgery remains the primary treatment of melanoma, recent advances in chemotherapy may offer further survival benefits to patients with metastatic disease.
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Mocellin S, Lens MB, Pasquali S, Pilati P, Chiarion Sileni V. Interferon alpha for the adjuvant treatment of cutaneous melanoma. Cochrane Database Syst Rev 2013; 2013:CD008955. [PMID: 23775773 PMCID: PMC10773707 DOI: 10.1002/14651858.cd008955.pub2] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Interferon alpha is the only agent approved for the postoperative adjuvant treatment of high-risk cutaneous melanoma. However, the survival advantage associated with this treatment is unclear, especially in terms of overall survival. Thus, adjuvant interferon is not universally considered a gold standard treatment by all oncologists. OBJECTIVES To assess the disease-free survival and overall survival effects of interferon alpha as adjuvant treatment for people with high-risk cutaneous melanoma. SEARCH METHODS We searched the following databases up to August 2012: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2012, issue 8), MEDLINE (from 2005), EMBASE (from 2010), AMED (from 1985), and LILACS (from 1982). We also searched trials databases in 2011, and proceedings of the ASCO annual meeting from 2000 to 2011. We checked the reference lists of selected articles for further references to relevant trials. SELECTION CRITERIA We included only randomised controlled trials (RCTs) comparing interferon alpha to observation (or any other treatment) for the postoperative (adjuvant) treatment of patients with high-risk skin melanoma, that is, people with regional lymph node metastasis (American Joint Committee on Cancer (AJCC) TNM (tumour, lymph node, metastasis) stage III) undergoing radical lymph node dissection, or people without nodal disease but with primary tumour thickness greater than 1 mm (AJCC TNM stage II). DATA COLLECTION AND ANALYSIS Two authors extracted data, and a third author independently verified the extracted data. The main outcome measure was the hazard ratio (HR), which is the ratio of the risk of the event occurring in the treatment arm (adjuvant interferon) compared to the control arm (no adjuvant interferon). The survival data were either entered directly into Review Manager (RevMan) or extrapolated from Kaplan-Meier plots and then entered into RevMan. Based on the presence of between-study heterogeneity, we applied a fixed-effect or random-effects model for calculating the pooled estimates of treatment efficacy. MAIN RESULTS Eighteen RCTs enrolling a total of 10,499 participants were eligible for the review. The results from 17 of 18 of these RCTs, published between 1995 and 2011, were suitable for meta-analysis and allowed us to quantify the therapeutic efficacy of interferon in terms of disease-free survival (17 trials) and overall survival (15 trials). Adjuvant interferon was associated with significantly improved disease-free survival (HR (hazard ratio) = 0.83; 95% CI (confidence interval) 0.78 to 0.87, P value < 0.00001) and overall survival (HR = 0.91; 95% CI 0.85 to 0.97; P value = 0.003). We detected no significant between-study heterogeneity (disease-free survival: I² statistic = 16%, Q-test P value = 0.27; overall survival: I² statistic = 6%; Q-test P value = 0.38).Considering that the 5-year overall survival rate for TNM stage II-III cutaneous melanoma is 60%, the number needed to treat (NNT) is 35 participants (95% CI = 21 to 108 participants) in order to prevent 1 death. The results of subgroup analysis failed to answer the question of whether some treatment features (i.e. dosage, duration) might have an impact on interferon efficacy or whether some participant subgroups (i.e. with or without lymph node positivity) might benefit differently from interferon adjuvant treatment.Grade 3 and 4 toxicity was observed in a minority of participants: In some trials, no-one had fever or fatigue of Grade 3 severity, but in other trials, up to 8% had fever and up to 23% had fatigue of Grade 3 severity. Less than 1% of participants had fever and fatigue of Grade 4 severity. Although it impaired quality of life, toxicity disappeared after treatment discontinuation. AUTHORS' CONCLUSIONS The results of this meta-analysis support the therapeutic efficacy of adjuvant interferon alpha for the treatment of people with high-risk (AJCC TNM stage II-III) cutaneous melanoma in terms of both disease-free survival and, though to a lower extent, overall survival. Interferon is also valid as a reference treatment in RCTs investigating new therapeutic agents for the adjuvant treatment of this participant population. Further investigation is required to select people who are most likely to benefit from this treatment.
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Affiliation(s)
- Simone Mocellin
- Meta-Analysis Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
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Agarwala SS. An update on pegylated IFN-α2b for the adjuvant treatment of melanoma. Expert Rev Anticancer Ther 2013; 12:1449-59. [PMID: 23249109 DOI: 10.1586/era.12.120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
For patients with localized melanoma, excision of the primary tumor, including lymphadenectomy for nodal metastases, is standard treatment. However, patients with large primary tumors (stage IIB and IIC) or stage III melanoma have a relatively poor prognosis owing to the high risk of recurrence. High-dose IFN-α2b and pegylated IFN-α2b (PEG-IFN-α2b) are the only approved options for adjuvant therapy of stage III melanoma, but the lack of comparative data has led to considerable confusion in choosing between these options. In this article, current evidence regarding the pharmacokinetics, efficacy, safety and tolerability of adjuvant PEG-IFN-α2b in patients with melanoma is reviewed, with frequent reference to and comparisons with data using IFN-α2b. Particular focus is given to the pharmacokinetic differences between IFN-α2b and PEG-IFN-α2b and their implications for the treatment of high-risk patients. In addition, emerging evidence suggests that PEG-IFN-α2b therapy may provide clinically significant overall survival benefit for selected high-risk patients.
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Affiliation(s)
- Sanjiv S Agarwala
- St Luke's Cancer Center, 801 Ostrum Street, Bethlehem, PA 18015, USA.
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Kirkwood JM, Davar D, Tarhini A. Adjuvant immunotherapy of melanoma and development of new approaches using the neoadjuvant approach. Clin Dermatol 2013; 31:237-50. [PMID: 23608443 PMCID: PMC3654101 DOI: 10.1016/j.clindermatol.2012.08.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Melanoma is the third most common skin cancer but the leading cause of death from cutaneous malignancies. Although early-stage disease is frequently cured by surgical resection with excellent long-term survival, patients with deeper primary lesions (AJCC stage IIB-C) and those with microscopic (IIIA) or clinically evident regional lymph node or in-transit metastases (IIIB-C) have an increased risk of relapse and death, the latter approaching 70% or more at 5 years. In patients at high risk of recurrence/metastases, adjuvant therapy with high-dose interferon alpha-2b (HDI) following definitive surgical resection has been shown to improve relapse-free and overall survival. Neoadjuvant chemotherapy and/or radiotherapy have offered the prospect to improve regional recurrence risk and overall survival in several solid tumors. The advent of effective new molecularly targeted therapies for metastatic disease and new immunotherapies that overcome checkpoints of immune response have augmented the range of new options that are in current trial evaluation to determine their role as potential adjuvant therapies, alone and in combination with one another, and the established modality of IFN-α. The differential characteristics of the host immune response between early and advanced melanoma provide a strong mechanistic rationale for the use of neoadjuvant immunotherapeutic approaches in melanoma, and the opportunity to evaluate the mechanism of action suggest neoadjuvant trial evaluation for each of the new candidate agents and combinations of interest. Several neoadjuvant trials have been conducted in the phase II setting, which have illuminated the mechanism of IFN-α, as well as providing insight to the effects of anti-CTLA4 blocking antibodies. These agents (anti-CTLA4 blocking antibody ipilimumab, and BRAF inhibitor vemurafenib) are likely to be followed by other immunotherapies that may overcome the PD-1 checkpoint (anti-PD1 and anti-PDL-1) as well as other molecularly targeted agents such as the BRAF inhibitor dabrafenib and the MEK inhibitors trametinib, selumetinib, and MEK162 in the near future. Evaluation of the clinical role of these agents as adjuvant therapy will take years to accomplish to ascertain the relapse-free survival benefits and overall survival benefits of these agents, but neoadjuvant exploration may provide early critical evidence of the therapeutic benefits, as well as clarifying the mechanisms of these agents alone and in combination.
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Affiliation(s)
- John M. Kirkwood
- Professor of Medicine, Dermatology and Translational Science, Division of Hematology-Oncology, University of Pittsburgh Medical Center, 5150 Centre Avenue, Pittsburgh, PA 15232, , Phone: 412-623-7707, Fax: 412-623-7704
| | - Diwakar Davar
- Division of General Internal Medicine, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, , Pager: 412-263-7622
| | - Ahmad Tarhini
- Assistant Professor of Medicine, Clinical and Translational Science, Division of Hematology-Oncology, University of Pittsburgh Medical Center, 5150 Centre Avenue, Pittsburgh PA 15232,
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Moreno Nogueira JA, Valero Arbizu M, Pérez Temprano R. Adjuvant treatment of melanoma. ISRN DERMATOLOGY 2013; 2013:545631. [PMID: 23476798 PMCID: PMC3588212 DOI: 10.1155/2013/545631] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 12/02/2012] [Indexed: 11/17/2022]
Abstract
Melanomas represent 4% of all malignant tumors of the skin, yet account for 80% of deaths from skin cancer.While in the early stages patients can be successfully treated with surgical resection, metastatic melanoma prognosis is dismal. Several oncogenes have been identified in melanoma as BRAF, NRAS, c-Kit, and GNA11 GNAQ, each capable of activating MAPK pathway that increases cell proliferation and promotes angiogenesis, although NRAS and c-Kit also activate PI3 kinase pathway, including being more commonly BRAF activated oncogene. The treatment of choice for localised primary cutaneous melanoma is surgery plus lymphadenectomy if regional lymph nodes are involved. The justification for treatment in addition to surgery is based on the poor prognosis for high risk melanomas with a relapse index of 50-80%. Patients included in the high risk group should be assessed for adjuvant treatment with high doses of Interferon- α 2b, as it is the only treatment shown to significantly improve disease free and possibly global survival. In the future we will have to analyze all these therapeutic possibilities on specific targets, probably associated with chemotherapy and/or interferon in the adjuvant treatment, if we want to change the natural history of melanomas.
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Affiliation(s)
- J. A. Moreno Nogueira
- Department of Oncology, Virgen del Rocio University Hospital, Royal Academy of Medicine, 41001 Seville, Spain
| | - M. Valero Arbizu
- Department of Oncology, Infanta Luisa Hospital, 41010 Seville, Spain
| | - R. Pérez Temprano
- Department of Medicine, Virgen Macarena University Hospital, 41014 Seville, Spain
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45
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Ascierto PA, Gogas HJ, Grob JJ, Algarra SM, Mohr P, Hansson J, Hauschild A. Adjuvant interferon alfa in malignant melanoma: An interdisciplinary and multinational expert review. Crit Rev Oncol Hematol 2013; 85:149-61. [DOI: 10.1016/j.critrevonc.2012.07.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 06/28/2012] [Accepted: 07/10/2012] [Indexed: 11/25/2022] Open
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Garbe C, Peris K, Hauschild A, Saiag P, Middleton M, Spatz A, Grob JJ, Malvehy J, Newton-Bishop J, Stratigos A, Pehamberger H, Eggermont AM. Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline--Update 2012. Eur J Cancer 2012; 48:2375-90. [PMID: 22981501 DOI: 10.1016/j.ejca.2012.06.013] [Citation(s) in RCA: 168] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 06/21/2012] [Indexed: 11/18/2022]
Abstract
Cutaneous melanoma (CM) is potentially the most dangerous form of skin tumour and causes 90% of skin cancer mortality. A unique collaboration of multi-disciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization of Research and Treatment of Cancer (EORTC) was formed to make recommendations on CM diagnosis and treatment, based on systematic literature reviews and the experts' experience. Diagnosis is made clinically and staging is based upon the AJCC system. CMs are excised with one to two centimetre safety margins. Sentinel lymph node dissection (SLND) is routinely offered as a staging procedure in patients with tumours more than 1mm in thickness, although there is as yet no clear survival benefit for this approach. Interferon-α treatment may be offered to patients with stage II and III melanoma as an adjuvant therapy, as this treatment increases at least the disease-free survival (DFS) and less clear the overall survival (OS) time. The treatment is however associated with significant toxicity. In distant metastasis, all options of surgical therapy have to be considered thoroughly. In the absence of surgical options, systemic treatment is indicated. BRAF inhibitors like vemurafenib for BRAF mutated patients as well as the CTLA-4 antibody ipilimumab offer new therapeutic opportunities apart from conventional chemotherapy. Therapeutic decisions in stage IV patients should be primarily made by an interdisciplinary oncology team ('tumour board').
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Affiliation(s)
- Claus Garbe
- University Department of Dermatology, Tuebingen, Germany.
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47
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Espinosa E, Berrocal A, López Martín JA, González Cao M, Cerezuela P, Mayordomo JI, Martín Algarra S. Advances in cutaneous melanoma. Clin Transl Oncol 2012; 14:325-32. [PMID: 22551537 DOI: 10.1007/s12094-012-0804-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
After several decades of slow progress in the field of melanoma, significant advances have been reported in recent years. These include a better understanding of the molecular biology of the tumour, a new staging classification system, insights into the patterns of relapse in early stage, and new drugs for the treatment of advanced disease. Ipilimumab and vemurafenib have just been approved and provide a survival benefit in stage IV. Both compounds are under evaluation in the adjuvant setting, where interferon remains the only drug with proven efficacy. Further investigation is required to treat patients with primary or secondary resistance to new drugs.
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Abstract
Estimates from the U.S. Surveillance, Epidemiology, and End Results registry suggest that melanoma incidence will reach 70,230 cases in 2011, of whom 8790 will die. The rising incidence and predilection for young individuals makes this tumor a leading source of lost productive years in the society.High-dose interferon-α-2b is the only agent approved for adjuvant therapy for melanoma; the improvement in relapse-free survival has been observed across nearly all published studies and meta-analyses. However, toxicity affects compliance, and current research is focusing on biomarkers that may allow selection of patients with greater likelihood of response and exploring new agents either singly or in combination that may improve on the benefit of interferon.In this article, we review the data for the adjuvant therapy for malignant melanoma--focusing on the results obtained with various regimens testing the several formulations of interferon-α2 and the adjuvant studies of vaccines and radiotherapy. Recent advances in the treatment of metastatic disease have established a role for CTLA-4 blockade and BRAF-inhibition, raising hopes that these agents may have a role in the adjuvant setting. At present, several trials investigating combinations of novel agents with existing immunomodulators are underway.
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49
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Stewart JH, Levine EA. Role of bacillus Calmette-Guérin in the treatment of advanced melanoma. Expert Rev Anticancer Ther 2012; 11:1671-6. [PMID: 22050015 DOI: 10.1586/era.11.163] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Early trials of Bacillus Calmette-Guérin (BCG)-based immunotherapy for melanoma consistently show a trend toward improved clinical outcomes in patients treated with BCG compared with observation alone. As an extension of these findings, investigators have initiated the Malignant Melanoma Active Immunotherapy (MMAIT) trials in patients with stage III (MMAIT-III) and stage IV (MMAIT-IV) disease. The overall survival of the patients receiving BCG plus placebo was much better than expected in both studies, thus suggesting a potential for BCG as an adjuvant after the resection of advanced disease. The work contained herein will explore the clinical rationale for adjuvant BCG in future trials focused on the treatment of patients with advanced malignant melanoma.
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Affiliation(s)
- John H Stewart
- Department of Surgery, Tumor Immunotherapy Program, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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Tietze JK, Sckisel GD, Hsiao HH, Murphy WJ. Antigen-specific versus antigen-nonspecific immunotherapeutic approaches for human melanoma: the need for integration for optimal efficacy? Int Rev Immunol 2012; 30:238-93. [PMID: 22053969 DOI: 10.3109/08830185.2011.598977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Due to its immunogenecity and evidence of immune responses resulting in tumor regression, metastatic melanoma has been the target for numerous immunotherapeutic approaches. Unfortunately, based on the clinical outcomes, even the successful induction of tumor-specific responses does not correlate with efficacy. Immunotherapies can be divided into antigen-specific approaches, which seek to induce T cells specific to one or several known tumor associated antigens (TAA), or with antigen-nonspecific approaches, which generally activate T cells to become nonspecifically lytic effectors. Here the authors critically review the different immunotherapeutic approaches in melanoma.
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Affiliation(s)
- Julia K Tietze
- Departments of Dermatology and Internal Medicine, University of California-Davis, Sacramento, CA 95817, USA
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