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Maul LV, Jamiolkowski D, Lapides RA, Mueller AM, Hauschild A, Garbe C, Lorigan P, Gershenwald JE, Ascierto PA, Long GV, Wang-Evers M, Scolyer RA, Saravi B, Augustin M, Navarini AA, Legge S, Németh IB, Jánosi ÁJ, Mocellin S, Feller A, Manstein D, Zink A, Maul JT, Buja A, Adhikari K, Roider E. Health Economic Consequences Associated With COVID-19-Related Delay in Melanoma Diagnosis in Europe. JAMA Netw Open 2024; 7:e2356479. [PMID: 38363565 PMCID: PMC10873772 DOI: 10.1001/jamanetworkopen.2023.56479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/26/2023] [Indexed: 02/17/2024] Open
Abstract
Importance The COVID-19 pandemic resulted in delayed access to medical care. Restrictions to health care specialists, staff shortages, and fear of SARS-CoV-2 infection led to interruptions in routine care, such as early melanoma detection; however, premature mortality and economic burden associated with this postponement have not been studied yet. Objective To determine the premature mortality and economic costs associated with suspended melanoma screenings during COVID-19 pandemic lockdowns by estimating the total burden of delayed melanoma diagnoses for Europe. Design, Setting, and Participants This multicenter economic evaluation used population-based data from patients aged at least 18 years with invasive primary cutaneous melanomas stages I to IV according to the American Joint Committee on Cancer (AJCC) seventh and eighth editions, including melanomas of unknown primary (T0). Data were collected from January 2017 to December 2021 in Switzerland and from January 2019 to December 2021 in Hungary. Data were used to develop an estimation of melanoma upstaging rates in AJCC stages, which was verified with peripandemic data. Years of life lost (YLL) were calculated and were, together with cost data, used for financial estimations. The total financial burden was assessed through direct and indirect treatment costs. Models were building using data from 50 072 patients aged 18 years and older with invasive primary cutaneous melanomas stages I to IV according to the AJCC seventh and eighth edition, including melanomas of unknown primary (T0) from 2 European tertiary centers. Data from European cancer registries included patient-based direct and indirect cost data, country-level economic indicators, melanoma incidence, and population rates per country. Data were analyzed from July 2021 to September 2022. Exposure COVID-19 lockdown-related delay of melanoma detection and consecutive public health and economic burden. As lockdown restrictions varied by country, lockdown scenario was defined as elimination of routine medical examinations and severely restricted access to follow-up examinations for at least 4 weeks. Main Outcomes and Measures Primary outcomes were the total burden of a delay in melanoma diagnosis during COVID-19 lockdown periods, measured using the direct (in US$) and indirect (calculated as YLL plus years lost due to disability [YLD] and disability-adjusted life-years [DALYs]) costs for Europe. Secondary outcomes included estimation of upstaging rate, estimated YLD, YLL, and DALY for each European country, absolute direct and indirect treatment costs per European country, proportion of the relative direct and indirect treatment costs for the countries, and European health expenditure. Results There were an estimated 111 464 (range, 52 454-295 051) YLL due to pandemic-associated delay in melanoma diagnosis in Europe, and estimated total additional costs were $7.65 (range, $3.60 to $20.25) billion. Indirect treatment costs were the main cost driver, accounting for 94.5% of total costs. Estimates for YLD in Europe resulted in 15 360 years for the 17% upstaging model, ranging from 7228 years (8% upstaging model) to 40 660 years (45% upstaging model). Together, YLL and YLD constitute the overall disease burden, ranging from 59 682 DALYs (8% upstaging model) to 335 711 DALYs (45% upstaging model), with 126 824 DALYs for the real-world 17% scenario. Conclusions and Relevance This economic analysis emphasizes the importance of continuing secondary skin cancer prevention measures during pandemics. Beyond the personal outcomes of a delayed melanoma diagnosis, the additional economic and public health consequences are underscored, emphasizing the need to include indirect economic costs in future decision-making processes. These estimates on DALYs and the associated financial losses complement previous studies highlighting the cost-effectiveness of screening for melanoma.
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Affiliation(s)
- Lara V. Maul
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Dagmar Jamiolkowski
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
- Division of Pediatric Dermatology, Children’s Hospital Auf der Bult, Hannover, Germany
| | - Rebecca A. Lapides
- Robert Larner, MD, College of Medicine at the University of Vermont, Burlington, Vermont
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown
| | - Alina M. Mueller
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
| | - Axel Hauschild
- Department of Dermatology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Claus Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Paul Lorigan
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jeffrey E. Gershenwald
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | | | - Georgina V. Long
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
- Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Michael Wang-Evers
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown
| | - Richard A. Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
- Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Babak Saravi
- Department of Orthopedics and Trauma Surgery, Medical Center–University of Freiburg, Germany
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Stefan Legge
- Institute of Law and Economics, University of St Gallen, St Gallen, Switzerland
| | - István B. Németh
- Department of Dermatology and Allergology, University of Szeged, Szent-Györgyi Albert Medical School, Szeged, Hungary
| | - Ágnes J. Jánosi
- Department of Dermatology and Allergology, University of Szeged, Szent-Györgyi Albert Medical School, Szeged, Hungary
| | - Simone Mocellin
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Istituto Oncologico Veneto – IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Anita Feller
- National Agency for Cancer Registration, University of Zurich, Zurich, Switzerland
- Foundation National Institute for Cancer Epidemiology and Registration, University of Zurich, Zurich, Switzerland
| | - Dieter Manstein
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown
| | - Alexander Zink
- Department of Dermatology and Allergy, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Alessandra Buja
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan, Padova, Italy
| | - Kaustubh Adhikari
- School of Mathematics and Statistics, Faculty of Science, Technology, Engineering and Mathematics, The Open University, Milton Keynes, United Kingdom
- Department of Genetics, Evolution and Environment, and UCL Genetics Institute, University College London, London, United Kingdom
| | - Elisabeth Roider
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown
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Tejera-Vaquerizo A, Cañueto J, Nagore E. [Translated article] Tumor Doubling Time in Skin Cancer: Can It Be Estimated and Is It Useful? ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T247-T252. [PMID: 36717070 DOI: 10.1016/j.ad.2022.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/09/2022] [Indexed: 01/30/2023] Open
Abstract
Skin cancer, like other cancers, is characterized by the uncontrolled growth of transformed cells. Tumor growth has been studied for decades. We review different methods for measuring skin tumor growth and propose a new system for estimating tumor doubling time that could be useful in the management of skin cancer.
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Affiliation(s)
- A Tejera-Vaquerizo
- Unidad de Oncología Cutánea, Hospital San Juan de Dios, Córdoba, Spain; Instituto Dermatológico GlobalDerm, Palma del Río (Córdoba), Spain; Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Spain.
| | - J Cañueto
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Spain; Servicio de Dermatología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - E Nagore
- Unidad de Oncología Cutánea, Hospital San Juan de Dios, Córdoba, Spain; Instituto Dermatológico GlobalDerm, Palma del Río (Córdoba), Spain; Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Spain; Servicio de Dermatología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
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Tejera-Vaquerizo A, Cañueto J, Nagore E. Tumor Doubling Time in Skin Cancer: Can It Be Estimated and Is it Useful? ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:247-252. [PMID: 36273551 DOI: 10.1016/j.ad.2022.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/04/2022] [Accepted: 10/09/2022] [Indexed: 12/15/2022] Open
Abstract
Skin cancer, like other cancers, is characterized by the uncontrolled growth of transformed cells. Tumor growth has been studied for decades. We review different methods for measuring skin tumor growth and propose a new system for estimating tumor doubling time that could be useful in the management of skin cancer.
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Affiliation(s)
- A Tejera-Vaquerizo
- Unidad de Oncología Cutánea, Hospital San Juan de Dios, Córdoba, España; Instituto Dermatológico GlobalDerm, Palma del Río (Córdoba), España; Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
| | - J Cañueto
- Servicio de Dermatología, Complejo Asistencial Universitario de Salamanca, Salamanca, España; Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - E Nagore
- Unidad de Oncología Cutánea, Hospital San Juan de Dios, Córdoba, España; Instituto Dermatológico GlobalDerm, Palma del Río (Córdoba), España; Servicio de Dermatología, Complejo Asistencial Universitario de Salamanca, Salamanca, España; Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
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Toma AO, Prodan M, Reddyreddy AR, Seclaman E, Crainiceanu Z, Bloanca V, Bratosin F, Dumitru C, Pilut CN, Alambaram S, Vasamsetti NG, Decean L, Pricop M. The Epidemiology of Malignant Melanoma during the First Two Years of the COVID-19 Pandemic: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:305. [PMID: 36612627 PMCID: PMC9819675 DOI: 10.3390/ijerph20010305] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
It is hypothesized that the COVID-19 pandemic had a major impact on the epidemiology of malignant melanoma owing to diminished screening, diagnostic, and treatment capacities, resulting in a more advanced stage at initial presentation. The goal of this study is to undertake a systematic analysis of all epidemiological and clinical data on the trends and patient outcomes with malignant melanoma during the ongoing pandemic. Records were identified from PubMed, Cochrane, and Web of Science, selecting a total of 39 articles, narrative reviews, and editorial letters, following the PRISMA guidelines. The vast majority of the studies were published in Europe (28/39), and North America (7/39). A total of 99,860 patients were analyzed during 2020 and 2021 of the COVID-19 pandemic, and it was observed that malignant melanoma TNM staging increased significantly compared to the pre-pandemic period. Before the pandemic, 25.88% of patients had TNM stage II or above, compared to 36.25% during 2020-2021. During the COVID-19 pandemic, the malignant melanoma Breslow depth index grew from 1.59 mm before 2020 to 1.86 mm in 2020 and 2021. Patients decreased by 19.58% in 2020 and 2021 compared to pre-pandemic numbers. The patient-loss ratio indicated lower screening activity and patient addressability to dermatology and plastic surgery departments with skin cancer concerns during the COVID-19 pandemic. This systematic study shows that the identification and management of malignant melanoma during the COVID-19 pandemic faced major challenges which should alert medical systems to the high number of patients with advanced disease stages who may need emergency treatment and become incurable.
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Affiliation(s)
- Ana-Olivia Toma
- Department of Microbiology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Mihaela Prodan
- Department of Plastic Surgery, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Akash Reddy Reddyreddy
- School of General Medicine, Bhaskar Medical College, Amdapur Road 156-162, Hyderabad 500075, India
| | - Edward Seclaman
- Department of Biochemistry and Pharmacology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Center for Complex Networks Science, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Zorin Crainiceanu
- Department of Plastic Surgery, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Vlad Bloanca
- Department of Plastic Surgery, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Felix Bratosin
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Catalin Dumitru
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ciprian Nicolae Pilut
- Kaloji Narayana Rao University of Health Sciences, Nizampura, Warangal, Telangana 506007, India
| | - Satish Alambaram
- School of General Medicine, Bhaskar Medical College, Amdapur Road 156-162, Hyderabad 500075, India
| | | | - Luminita Decean
- Faculty of General Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Strada Gheorghe Marinescu 38, 540139 Targu Mures, Romania
| | - Marius Pricop
- Discipline of Oral and Maxillo-Facial Surgery, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
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Sangers TE, Wakkee M, Kramer‐Noels EC, Nijsten T, Louwman MW, Jaspars EH, Hollestein LM. Limited impact of COVID-19-related diagnostic delay on cutaneous melanoma and squamous cell carcinoma tumour characteristics: a nationwide pathology registry analysis. Br J Dermatol 2022; 187:196-202. [PMID: 35141890 PMCID: PMC9111693 DOI: 10.1111/bjd.21050] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/02/2022] [Accepted: 02/06/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic reduced the number of skin cancer diagnoses, potentially causing a progression to unfavourable tumour stages. OBJECTIVES To identify the impact of delayed diagnostics on primary invasive melanoma and cutaneous squamous cell carcinoma (cSCC) by comparing tumour (pT) stage, Breslow thickness and invasion depth from before to after the first and second lockdown periods. METHODS In this population-based cohort study, histopathology reports registered between 1 January 2018 and 22 July 2021 were obtained from the nationwide histopathology registry in the Netherlands. The Breslow thickness of melanomas, invasion depth of cSCCs, and pT stage for both tumour types were compared across five time periods: (i) pre-COVID, (ii) first lockdown, (iii) between first and second lockdowns, (iv) second lockdown and (v) after second lockdown. Breslow thickness was compared using an independent t-test. pT-stage groups were compared using a χ2 -test. Outcomes were corrected for multiple testing using the false discovery rate. RESULTS In total, 20 434 primary invasive melanomas and 68 832 cSCCs were included in this study. The mean primary melanoma Breslow thickness of the prepandemic era (period i) and the following time periods (ii-v) showed no significant difference. A small shift was found towards unfavourable pT stages during the first lockdown compared with the pre-COVID period: pT1 52·3% vs. 58·6%, pT2 18·9% vs. 17·8%, pT3 13·2% vs. 11·0%, pT4 9·1% vs. 7·3% (P = 0·001). No relevant changes were seen in subsequent periods. No significant change in pT stage distribution was observed between the pre-COVID (i) and COVID-affected periods (ii-v) for cSCCs. CONCLUSIONS To date, the diagnostic delay caused by COVID-19 has not resulted in relatively more unfavourable primary tumour characteristics of melanoma or cSCC. Follow-up studies in the coming years are needed to identify a potential impact on staging distribution and survival in the long term.
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Affiliation(s)
- Tobias E. Sangers
- Department of DermatologyErasmus MC Cancer Institute, University Medical CenterRotterdamthe Netherlands
| | - Marlies Wakkee
- Department of DermatologyErasmus MC Cancer Institute, University Medical CenterRotterdamthe Netherlands
| | | | - Tamar Nijsten
- Department of DermatologyErasmus MC Cancer Institute, University Medical CenterRotterdamthe Netherlands
| | | | | | - Loes M. Hollestein
- Department of DermatologyErasmus MC Cancer Institute, University Medical CenterRotterdamthe Netherlands
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[Translated article] How Has the COVID-19 Pandemic and Lockdown Affected Breslow Thickness in Cutaneous Melanoma? ACTAS DERMO-SIFILIOGRAFICAS 2022. [PMCID: PMC8811682 DOI: 10.1016/j.ad.2021.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Sarriugarte Aldecoa-Otalora J, Loidi Pascual L, Córdoba Iturriagagoitia A, Yanguas Bayona JI. How Has the COVID-19 Pandemic and Lockdown Affected Breslow Thickness in Cutaneous Melanoma? ACTAS DERMO-SIFILIOGRAFICAS 2021:S1578-2190(21)00305-X. [PMID: 34785817 PMCID: PMC8579715 DOI: 10.1016/j.adengl.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022] Open
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.ad.2021.05.025 . The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal
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Affiliation(s)
| | - L Loidi Pascual
- Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - J I Yanguas Bayona
- Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, Spain
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Prinke P, Haueisen J, Klee S, Rizqie MQ, Supriyanto E, König K, Breunig HG, Piątek Ł. Automatic segmentation of skin cells in multiphoton data using multi-stage merging. Sci Rep 2021; 11:14534. [PMID: 34267247 PMCID: PMC8282875 DOI: 10.1038/s41598-021-93682-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/27/2021] [Indexed: 01/10/2023] Open
Abstract
We propose a novel automatic segmentation algorithm that separates the components of human skin cells from the rest of the tissue in fluorescence data of three-dimensional scans using non-invasive multiphoton tomography. The algorithm encompasses a multi-stage merging on preprocessed superpixel images to ensure independence from a single empirical global threshold. This leads to a high robustness of the segmentation considering the depth-dependent data characteristics, which include variable contrasts and cell sizes. The subsequent classification of cell cytoplasm and nuclei are based on a cell model described by a set of four features. Two novel features, a relationship between outer cell and inner nucleus (OCIN) and a stability index, were derived. The OCIN feature describes the topology of the model, while the stability index indicates segment quality in the multi-stage merging process. These two new features, combined with the local gradient magnitude and compactness, are used for the model-based fuzzy evaluation of the cell segments. We exemplify our approach on an image stack with 200 × 200 × 100 μm3, including the skin layers of the stratum spinosum and the stratum basale of a healthy volunteer. Our image processing pipeline contributes to the fully automated classification of human skin cells in multiphoton data and provides a basis for the detection of skin cancer using non-invasive optical biopsy.
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Affiliation(s)
- Philipp Prinke
- Institute for Biomedical Engineering and Informatics, Technische Universität Ilmenau, 98693, Ilmenau, Germany.
| | - Jens Haueisen
- Institute for Biomedical Engineering and Informatics, Technische Universität Ilmenau, 98693, Ilmenau, Germany
| | - Sascha Klee
- Institute for Biomedical Engineering and Informatics, Technische Universität Ilmenau, 98693, Ilmenau, Germany.,Division Biostatistics and Data Science, Department of General Health Studies, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Muhammad Qurhanul Rizqie
- Institute for Biomedical Engineering and Informatics, Technische Universität Ilmenau, 98693, Ilmenau, Germany.,Informatics Engineering Program, Universitas Sriwijaya, Palembang, South Sumatera, Indonesia
| | - Eko Supriyanto
- Institute for Biomedical Engineering and Informatics, Technische Universität Ilmenau, 98693, Ilmenau, Germany.,IJN-UTM Cardiovascular Engineering Centre, Universiti Teknologi Malaysia, Johor Bahru, Johor, Malaysia
| | - Karsten König
- Department of Biophotonics and Laser Technology, Saarland University, Campus A5.1, 66123, Saarbrücken, Germany.,JenLab GmbH, Johann-Hittorf-Straße 8, 12489, Berlin, Germany
| | - Hans Georg Breunig
- Department of Biophotonics and Laser Technology, Saarland University, Campus A5.1, 66123, Saarbrücken, Germany.,JenLab GmbH, Johann-Hittorf-Straße 8, 12489, Berlin, Germany
| | - Łukasz Piątek
- Institute for Biomedical Engineering and Informatics, Technische Universität Ilmenau, 98693, Ilmenau, Germany.,Department of Artificial Intelligence, University of Information Technology and Management, H. Sucharskiego 2 Str, 35-225, Rzeszów, Poland
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How Has the COVID-19 Pandemic and Lockdown Affected Breslow Thickness in Cutaneous Melanoma? ACTAS DERMO-SIFILIOGRAFICAS 2021; 113:107-109. [PMID: 34052199 PMCID: PMC8158313 DOI: 10.1016/j.ad.2021.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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10
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Tejera-Vaquerizo A, Cañueto J, Toll A, Santos-Juanes J, Jaka A, Ferrandiz C, Sanmartín O, Ribero S, Moreno-Ramírez D, Almazán F, Fuente MJ, Podlipnik S, Nagore E. Estimated Effect of COVID-19 Lockdown on Skin Tumor Size and Survival: An Exponential Growth Model. ACTAS DERMO-SIFILIOGRAFICAS 2020. [PMID: 34012154 PMCID: PMC7502279 DOI: 10.1016/j.adengl.2020.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background and objectives Spain is in a situation of indefinite lockdown due to the ongoing coronavirus disease 2019 (COVID-19) pandemic. One of the consequences of this lockdown is delays in medical and surgical procedures for common diseases. The aim of this study was to model the impact on survival of tumor growth caused by such delays in patients with squamous cell carcinoma (SCC) and melanoma. Material and methods Multicenter, retrospective, observational cohort study. We constructed an exponential growth model for both SCC and melanoma to estimate tumor growth between patient-reported onset and surgical excision at different time points. Results Data from 200 patients with SCC of the head and neck and 1000 patients with cutaneous melanoma were included. An exponential growth curve was calculated for each tumor type and we estimated tumor size after 1, 2, and 3 months of potential surgical delay. The proportion of patients with T3 SCC (diameter > 4 cm or thickness > 6 mm) increased from 41.5% (83 patients) in the initial study group to an estimated 58.5%, 70.5%, and 72% after 1, 2, and 3 months of delay. Disease-specific survival at 2, 5, and 10 years in patients whose surgery was delayed by 3 months decreased by 6.2%, 8.2%, and 5.2%, respectively. The proportion of patients with ultrathick melanoma (> 6 mm) increased from 6.9% in the initial study group to 21.9%, 30.2%, and 30.2% at 1, 2, and 3 months. Five- and 10-year disease-specific survival both decreased by 14.4% in patients treated after a potential delay of 3 months. Conclusions In the absence of adequate diagnosis and treatment of SCC and melanoma in the current lockdown situation in Spain, we can expect to see to a considerable increase in large and thick SCCs and melanomas. Efforts must be taken to encourage self-examination and facilitate access to dermatologists in order to prevent further delays.
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Affiliation(s)
- A Tejera-Vaquerizo
- Servicio de Dermatología, Instituto Dermatológico GlobalDerm, Palma del Río Córdoba, Spain
| | - J Cañueto
- Servicio de Dermatología, Hospital Universitario de Salamanca, Salamanca, Spain
| | - A Toll
- Servicio de Dermatología, Hospital Clìnic de Barcelona, Barcelona, Spain
| | - J Santos-Juanes
- Servicio de Dermatología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - A Jaka
- Servicio de Dermatología, Hospital Germans Trial i Pujol, Badalona, Barcelona, Spain
| | - C Ferrandiz
- Servicio de Dermatología, Hospital de la Vall d'Hebron, Barcelona, Spain
| | - O Sanmartín
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Spain
| | - S Ribero
- Departamento de Dermatología, Hospital Universitario de Turín, Turín, Italy
| | - D Moreno-Ramírez
- Unidad de Melanoma, Servicio de Dermatología Médico-Quirúrgica, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - F Almazán
- Unidad de Gestión Clínica de Dermatología, Hospital Universitario San Cecilio, Granada, Spain
| | - M J Fuente
- Servicio de Dermatología, Hospital Germans Trial i Pujol, Badalona, Barcelona, Spain
| | - S Podlipnik
- Servicio de Dermatología, Hospital Clìnic de Barcelona, Barcelona, Spain
| | - E Nagore
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Spain
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11
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¿Por qué no disminuye la mortalidad por melanoma cutáneo? ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:450-452. [DOI: 10.1016/j.ad.2019.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/05/2019] [Indexed: 11/21/2022] Open
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12
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Tejera-Vaquerizo A, Boada A, Nagore E. Why is the Cutaneous Melanoma Mortality Rate not Falling? ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2019.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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13
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Abstract
Rapid growth of cutaneous melanoma is associated with aggressive histopathologic features and poor prognosis. However, the impact of growth rate (GR) in acral melanoma (AM) remains largely unknown.We performed this study to identify the impact of GR on lymph node metastasis and survival in AM.We analyzed cases of invasive AM diagnosed at our institution between 1998 and 2017. We investigated the impact of GR on the prognosis of AM.A total of 126 cases of invasive AM were included. Log (GR) was significant associated with lymph node metastasis in the univariate logistic regression analysis (P = .005). The log-rank test revealed statistically significant differences in disease-free survival (DFS) and disease-specific survival (DSS) among the GR quartiles. In the Cox regression analysis, log (GR) was an independent predictor for DFS (P = .041), but not for DSS in multivariate analysis. In the subgroup analysis, log (GR) was an independent predictor for early-stage (≤2A) AM (DFS, P = .002; DSS, P = .004).The limitations of this study include the retrospective design of the study and possible recall bias.Our results suggest that GR is an important prognostic factor for DFS and DSS in AM patients and an independent predictor for early-stage AM.
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Affiliation(s)
- Gwanghyun Jo
- Department of Dermatology, Seoul National University College of Medicine
- Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Republic of Korea
| | - Soo Ick Cho
- Department of Dermatology, Seoul National University College of Medicine
| | - Youngjoo Cho
- Department of Mathematical Sciences, The University of Texas at El Paso, El Paso, Texas, USA
| | - Jungyoon Ohn
- Department of Dermatology, Seoul National University College of Medicine
- Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Republic of Korea
- Laboratory of Cutaneous Aging and Hair Research, Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Je-Ho Mun
- Department of Dermatology, Seoul National University College of Medicine
- Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Republic of Korea
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14
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[Estimated Effect of COVID-19 Lockdown on Skin Tumor Size and Survival: An Exponential Growth Model]. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:629-638. [PMID: 32513393 PMCID: PMC7211725 DOI: 10.1016/j.ad.2020.05.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/05/2020] [Indexed: 01/17/2023] Open
Abstract
Antecedentes y objetivos La pandemia del coronavirus SARS-CoV-2 ha provocado un confinamiento indefinido. Una posible consecuencia de esta situación es un retraso en los procedimientos asistenciales de las enfermedades oncológicas. El objetivo de este estudio es estimar el hipotético impacto en la supervivencia que tendría el aumento del tamaño tanto para los carcinomas de células escamosas (CCE) como de los melanomas. Material y método Estudio observacional retrospectivo de cohorte multicéntrico. Se desarrolló un modelo de crecimiento exponencial para cada tumor basado en el tiempo de evolución que refiere el paciente. Resultados Se incluyeron un total de 200 pacientes con CCE localizados en la cabeza y el cuello y 1.000 pacientes con melanoma cutáneo. Se calculó una curva de crecimiento exponencial para cada tumor y se estimó el tamaño del tumor tras 1, 2 y 3 meses tras el diagnóstico. En la muestra, los CCE mayores de 4 cm o > 6 mm de grosor (definidos como T3) pasaron de 83 (41,5%) en el grupo de estudio real a una estimación del 58,5, 70,5 y 72% tras 1, 2 y 3 meses de retraso quirúrgico estimado, respectivamente. Se estimó una disminución de la supervivencia específica de enfermedad (SEE) de un 6,2, 8,2 y 5,2% a los 2, 5 y 10 años, respectivamente, tras 3 meses de retraso. Para los melanomas ultragruesos (> 6 mm de Breslow) pasaron del 6,9% en el grupo de estudio al 21,9, 30,2 y 30,2% tras 1, 2 y 3 meses de demora. La SEE a los 5 y 10 años del grupo de estudio descendió un 14,4% en ambos tiempos. Conclusiones En ausencia de un adecuado diagnóstico y tratamiento de los pacientes con CCE y melanoma en la actual situación de confinamiento en España, podemos llegar a asistir a un considerable aumento de los casos de CCE y melanomas gruesos y de gran tamaño. Se deben fomentar los esfuerzos para promocionar la autoexploración y facilitar el acceso a los dermatólogos para no aumentar la demora de estos pacientes.
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15
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Calomarde-Rees L, García-Calatayud R, Requena Caballero C, Manrique-Silva E, Traves V, García-Casado Z, Soriano V, Kumar R, Nagore E. Risk Factors for Lymphatic and Hematogenous Dissemination in Patients With Stages I to II Cutaneous Melanoma. JAMA Dermatol 2020; 155:679-687. [PMID: 31042264 DOI: 10.1001/jamadermatol.2019.0069] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance The lymphatic and the hematogenous pathways have been proposed for disease progression in cutaneous melanoma, but association with recurrence has not been studied separately to date. Objective To identify the risk factors associated with lymphatic and hematogenous metastasis. Design, Setting, and Participants This retrospective cohort study included 1177 patients with malignant melanoma treated at Instituto Valenciano de Oncología, València, Spain. Data were retrieved from the melanoma database from January 1, 2000, through December 31, 2015, and analyzed from June 1 to 30, 2018. Exposure Malignant melanoma at stages I to II. Main Outcomes and Measures Analyses of survival free of lymphatic and hematogenous metastasis were performed using Kaplan-Meier curves and Cox proportional hazards regression. Results For the 1177 patients included in the study analysis (51.1% women; median age at diagnosis, 55 years [interquartile range, 42-68 years), median follow-up was 75 months (interquartile range, 33-121 months); 108 (9.2%) developed lymphatic metastasis, and 108 (9.2%) developed hematogenous metastasis. In the multivariate analysis, being older than 55 years (hazard ratio [HR], 1.9; 95% CI, 1.2-3.1), tumor in the head/neck (HR, 1.7; 95% CI, 1.0-2.9) and acral locations (HR, 2.4; 95% CI, 1.3-4.5), greater Breslow thickness (HR for >4.00 mm, 5.4; 95% CI, 2.4-12.4), and presence of vascular invasion (HR, 3.2; 95% CI, 0.9-10.6) were associated with lymphatic spreading. Hematogenous metastasis was associated with greater Breslow thickness (HR for >4.00 mm, 10.4; 95% CI, 3.6-29.7), the absence of regression (HR, 0.1; 95% CI, 0.0-1.0), TERT promoter mutations (HR, 2.9; 95% CI, 1.5-5.7), and BRAF mutations (HR, 1.9; 95% CI, 1.1-3.6). Conclusions and Relevance Risk factors associated with lymphatic and hematogenous metastasis differ. Follow-up and adjuvant treatment strategies may therefore need to be adapted to individual clinical, histopathologic, and molecular characteristics.
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Affiliation(s)
| | | | | | | | - Víctor Traves
- Department of Pathology, Instituto Valenciano de Oncología, València, Spain
| | - Zaida García-Casado
- Laboratory of Molecular Biology, Instituto Valenciano de Oncología, València, Spain
| | - Virtudes Soriano
- Department of Medical Oncology, Instituto Valenciano de Oncología, València, Spain
| | - Rajiv Kumar
- Division of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncología, València, Spain.,School of Medicine, Universidad Católica de Valencia San Vicente Mártir, València, Spain
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16
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Palangka CRAP, Hanaoka H, Yamaguchi A, Murakami T, Tsushima Y. Al 18F-labeled alpha-melanocyte-stimulating hormone (α-MSH) peptide derivative for the early detection of melanoma. Ann Nucl Med 2019; 33:733-739. [PMID: 31297699 DOI: 10.1007/s12149-019-01383-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 06/28/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Early detection plays a role in the prognosis of melanoma, the most aggressive skin cancer. 64Cu- and 68Ga-labeled alpha-melanocyte-stimulating hormone (α-MSH) analogs targeting the melanocortin-1 receptor are promising positron emission tomography (PET) tracers for detecting melanoma, and the use of 18F-labeling will further contribute to the detectability and availability. However, the high radiochemistry demand related to the conventional 18F-labeling methods has restricted the development of 18F-labeled α-MSH analogs. A recently developed radiofluorination method using aluminum-fluoride (Al18F) offers a simple, efficient, and time-saving labeling procedure compared to the conventional 18F-labeling methods. Herein, we sought to establish a simple preparation method for an 18F-labeled α-MSH analog using Al18F, and we examined its potential for the early detection of melanoma. METHODS A 1,4,7-triazacyclononane-N,N',N″-triacetic acid (NOTA)-conjugated α-MSH analog (NOTA-GGNle-CycMSHhex) was prepared by the Fmoc solid-phase strategy. NOTA-GGNle-CycMSHhex was labeled with Al18F by heating at 105 °C using a microwave synthesizer for 15 min. Biodistribution study was conducted on B16/F10-luc melanoma-bearing mice at 30 min, 1 h and 3 h after injection of Al18F-NOTA-GGNle-CycMSHhex. PET imaging was conducted on melanoma-bearing mice at 1 h post-injection. One day prior to the PET imaging, bioluminescence imaging was also performed. RESULTS Al18F-NOTA-GGNle-CycMSHhex was readily prepared with a high radiochemical yield (94.0 ± 2.8%). The biodistribution study showed a high accumulation of Al18F-NOTA-GGNle-CycMSHhex in the tumor at 30 min and 1 h post-injection (6.69 ± 1.49 and 7.70 ± 1.71%ID/g, respectively). The tumor-to-blood ratio increased with time: 3.46 ± 0.89, 12.67 ± 1.29, and 35.27 ± 9.12 at 30 min, 1 h, and 3 h post-injection, respectively. In the PET imaging, Al18F-NOTA-GGNle-CycMSHhex clearly visualized the tumors and depicted very small tumors (< 3 mm). CONCLUSIONS We successfully prepared Al18F-NOTA-GGNle-CycMSHhex in a simple and efficient manner. Al18F-NOTA-GGNle-CycMSHhex showed high tumor accumulation and clearly visualized very small tumors in melanoma-bearing mice. These findings suggest that Al18F-NOTA-GGNle-CycMSHhex will be a promising PET tracer for melanoma imaging at an earlier stage.
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Affiliation(s)
- Citra R A P Palangka
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, 371-8511, Japan
| | - Hirofumi Hanaoka
- Department of Bioimaging Information Analysis, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, 371-8511, Japan.
| | - Aiko Yamaguchi
- Department of Bioimaging Information Analysis, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, 371-8511, Japan
- Texas Therapeutics Institute, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, 77054, USA
| | - Takashi Murakami
- Faculty of Medicine, Saitama Medical University, 38 Moro-Hongo, Moroyama, 350-0495, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, 371-8511, Japan
- Research Program for Diagnostic and Molecular Imaging, Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research (GIAR), Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, 371-8511, Japan
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17
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Cañueto J, Martín-Vallejo J, Cardeñoso-Álvarez E, Fernández-López E, Pérez-Losada J, Román-Curto C. Rapid growth rate is associated with poor prognosis in cutaneous squamous cell carcinoma. Clin Exp Dermatol 2018; 43:876-882. [PMID: 29756221 DOI: 10.1111/ced.13570] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (cSCC) represents the most common form of skin cancer after basal cell carcinoma, and can be both locally invasive and metastatic to distant sites. Growth rate (GR) has been poorly evaluated in cSCC, despite clinical evidence suggesting that GR is an important risk factor in cSCC. AIM To analyse the influence of GR in cSCC prognosis. METHODS We retrospectively evaluated GR in a series of 90 cSCCs and tried to correlate GR with prognosis in cSCC. RESULTS We demonstrated that tumours with a GR of > 4 mm/month exhibit a higher risk of nodal progression and a shorter progression time to lymph node metastasis in cSCC than those with GR of < 4 mm/month. As expected, GR correlated with tumour proliferation, as determined by Ki-67 expression. CONCLUSIONS We consider a GR of 4 mm/month as the cutoff point that distinguishes between rapid- and slow-progressing tumours and, more importantly, to identify a subset of high-risk cSCCs.
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Affiliation(s)
- J Cañueto
- Department of Dermatology, Hospital Universitario de Salamanca, Paseo de San Vicente, Salamanca, Spain.,Institute of Biomedical Medicine of Salamanca (IBSAL), Hospital Universitario de Salamanca, Paseo de San Vicente, Salamanca, Spain
| | - J Martín-Vallejo
- Department of Statistics, Facultad de Medicina, Universidad de Salamanca, Campus Miguel de Unamuno, Salamanca, Spain
| | - E Cardeñoso-Álvarez
- Department of Dermatology, Hospital Virgen de la Concha, Avenida de Requejo, Zamora, Spain
| | - E Fernández-López
- Department of Dermatology, Hospital Universitario de Salamanca, Paseo de San Vicente, Salamanca, Spain.,Institute of Biomedical Medicine of Salamanca (IBSAL), Hospital Universitario de Salamanca, Paseo de San Vicente, Salamanca, Spain
| | - J Pérez-Losada
- Institute of Biomedical Medicine of Salamanca (IBSAL), Hospital Universitario de Salamanca, Paseo de San Vicente, Salamanca, Spain.,Institute of Molecular and Cellular Cancer Biology (IBMCC), Centro de investigación del Cáncer (CIC), Instituto Mixto Universidad de Salamanca/CSIC, Campus Miguel de Unamuno, Salamanca, Spain
| | - C Román-Curto
- Department of Dermatology, Hospital Universitario de Salamanca, Paseo de San Vicente, Salamanca, Spain.,Institute of Biomedical Medicine of Salamanca (IBSAL), Hospital Universitario de Salamanca, Paseo de San Vicente, Salamanca, Spain
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18
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Tejera-Vaquerizo A, Meléndez JJ, Nagore E. Chronology of regional lymph node metastases in cutaneous melanoma: a model based on mitotic rate. J Eur Acad Dermatol Venereol 2018; 32:e289-e291. [PMID: 29377314 DOI: 10.1111/jdv.14824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A Tejera-Vaquerizo
- Departamento de Dermatología, Instituto Dermatológico GlobalDerm, Palma del Río, Córdoba, España
| | - J J Meléndez
- Departamento de Física e Instituto de Computación Científica Avanzada de Extremadura, Universidad de Extremadura, Badajoz, España
| | - E Nagore
- Departamento de Dermatología, Instituto Valenciano de Oncología, Valencia, España
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Lindauer A, Valiathan CR, Mehta K, Sriram V, de Greef R, Elassaiss-Schaap J, de Alwis DP. Translational Pharmacokinetic/Pharmacodynamic Modeling of Tumor Growth Inhibition Supports Dose-Range Selection of the Anti-PD-1 Antibody Pembrolizumab. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2016; 6:11-20. [PMID: 27863176 PMCID: PMC5270293 DOI: 10.1002/psp4.12130] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/29/2016] [Indexed: 12/30/2022]
Abstract
Pembrolizumab, a humanized monoclonal antibody against programmed death 1 (PD‐1), has a manageable safety profile and robust clinical activity against advanced malignancies. The lowest effective dose for evaluation in further dose‐ranging studies was identified by developing a translational model from preclinical mouse experiments. A compartmental pharmacokinetic model was combined with a published physiologically based tissue compartment, linked to receptor occupancy as the driver of observed tumor growth inhibition. Human simulations were performed using clinical pharmacokinetic data, literature values, and in vitro parameters for drug distribution and binding. Biological and mathematical uncertainties were included in simulations to generate expectations for dose response. The results demonstrated a minimal increase in efficacy for doses higher than 2 mg/kg. The findings of the translational model were successfully applied to select 2 mg/kg as the lowest dose for dose‐ranging evaluations.
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Affiliation(s)
- A Lindauer
- Merck & Co., Inc., Rahway, New Jersey, USA
| | | | - K Mehta
- Merck & Co., Inc., Rahway, New Jersey, USA
| | - V Sriram
- Merck & Co., Inc., Rahway, New Jersey, USA
| | - R de Greef
- Merck & Co., Inc., Rahway, New Jersey, USA
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