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Yamada K, Takeuchi M, Fukumoto T, Suzuki M, Kato A, Mizuki Y, Yamada N, Kaneko T, Mizuki N, Horita N. Immune checkpoint inhibitors for metastatic uveal melanoma: a meta-analysis. Sci Rep 2024; 14:7887. [PMID: 38570507 PMCID: PMC10991441 DOI: 10.1038/s41598-024-55675-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 02/26/2024] [Indexed: 04/05/2024] Open
Abstract
Several studies have evaluated immune checkpoint inhibitors (ICIs) for metastatic uveal melanoma; however, the efficacy of ICIs in the previous studies varied greatly. In this systematic review, we searched for prospective or retrospective studies on single or dual-ICIs for metastatic uveal melanoma treatment. A random-effect model meta-analysis with generic inverse-variance was conducted, and 36 articles representing 41 cohorts of 1414 patients with metastatic uveal melanoma were included. The pooled outcomes were as follows: objective response rate (ORR) was 5.6% (95% confidence interval [95%CI] 3.7-7.5%; I2, 36%), disease control rate (DCR) was 32.5% (95% CI 27.2-37.7%; I2, 73%), median progression-free survival was 2.8 months (95% CI 2.7-2.9 months; I2, 26%), and median overall survival (OS) was 11.2 months (95% CI 9.6-13.2 months; I2, 74%). Compared to single-agent ICI, dual ICI led to better ORR (single-agent: 3.4% [95% CI 1.8-5.1]; dual-agent: 12.4% [95% CI 8.0-16.9]; P < 0.001), DCR (single-agent: 29.3%, [95% CI 23.4-35.2]; dual-agent: 44.3% [95% CI 31.7-56.8]; P = 0.03), and OS (single-agent: 9.8 months [95% CI 8.0-12.2]; dual-agent: 16.3 months [95% CI 13.5-19.7]; P < 0.001). Our analysis provided treatment outcomes as described above. Dual-ICIs appear better than single-agent ICIs for the treatment of metastatic uveal melanoma.
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Affiliation(s)
- Kayoko Yamada
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Masaki Takeuchi
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Takeshi Fukumoto
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Minako Suzuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Ai Kato
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yuki Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Norihiro Yamada
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Nobuyuki Horita
- Chemotherapy Center, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
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2
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Dubus M, Charles J, Leccia MT, Mouret S, Trabelsi S. Long-term response of vulvar mucosal melanoma treated with neoadjuvant nivolumab. JAAD Case Rep 2023; 38:14-16. [PMID: 37600735 PMCID: PMC10433322 DOI: 10.1016/j.jdcr.2023.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Affiliation(s)
- Margaux Dubus
- Dermatology Department, Grenoble Alpes University Hospital, La Tronche, France
| | - Julie Charles
- Dermatology Department, Grenoble Alpes University Hospital, La Tronche, France
| | | | - Stéphane Mouret
- Dermatology Department, Grenoble Alpes University Hospital, La Tronche, France
| | - Sabiha Trabelsi
- Dermatology Department, Grenoble Alpes University Hospital, La Tronche, France
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3
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Tan XL, Le A, Tang H, Brown M, Scherrer E, Han J, Jiang R, Diede SJ, Shui IM. Burden and Risk Factors of Brain Metastases in Melanoma: A Systematic Literature Review. Cancers (Basel) 2022; 14:6108. [PMID: 36551594 PMCID: PMC9777047 DOI: 10.3390/cancers14246108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Melanoma can frequently metastasize to the brain with severe consequences. However, variation of melanoma brain metastases (MBM) development among populations is not well studied, and underlying mechanisms and risk factors for MBM development are not consistently documented. We conducted a systematic literature review (SLR) including a total of 39 articles to evaluate the proportion of melanoma patients who are diagnosed with, or develop, brain metastases, and summarize the risk factors of MBM. The average proportion of MBM was calculated and weighted by the sample size of each study. Meta-analyses were conducted for the selected risk factors using a random-effects model. The proportion of MBM at diagnosis was 33% (975 with MBM out of 2948 patients) among patients with cutaneous melanoma (excluding acral) and 23% (651/2875) among patients with cutaneous mixed with other types of melanoma. The proportion at diagnosis was lower among populations with mucosal (9/96, 9%) or uveal (4/184, 2%) melanoma and among populations outside the United States and Europe. Meta-analysis demonstrated that male vs. female gender and left-sided tumors vs. right-sided were significantly associated with increased risk of melanoma brain metastases. These data may help clinicians to assess an individual patient's risk of developing melanoma brain metastases.
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Affiliation(s)
| | - Amy Le
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN 46202, USA
| | - Huilin Tang
- Integrative Precision Health, LLC, Carmel, IN 46032, USA
| | - Madeline Brown
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN 46202, USA
| | - Emilie Scherrer
- Merck & Co., Inc., Rahway, NJ 07065, USA
- Seagen Inc., Bothell, WA 98021, USA
| | - Jiali Han
- Integrative Precision Health, LLC, Carmel, IN 46032, USA
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4
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Aamdal E, Jacobsen KD, Straume O, Kersten C, Herlofsen O, Karlsen J, Hussain I, Amundsen A, Dalhaug A, Nyakas M, Schuster C, Hagene KT, Holmsen K, Russnes HG, Skovlund E, Kaasa S, Aamdal S, Kyte JA, Guren TK. Ipilimumab in a real-world population: A prospective Phase IV trial with long-term follow-up. Int J Cancer 2022; 150:100-111. [PMID: 34449877 DOI: 10.1002/ijc.33768] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/29/2021] [Accepted: 07/07/2021] [Indexed: 12/19/2022]
Abstract
Ipilimumab was the first treatment that improved survival in advanced melanoma. Efficacy and toxicity in a real-world setting may differ from clinical trials, due to more liberal eligibility criteria and less intensive monitoring. Moreover, high costs and lack of biomarkers have raised cost-benefit concerns about ipilimumab in national healthcare systems and limited its use. Here, we report the prospective, interventional study, Ipi4 (NCT02068196), which aimed to investigate the toxicity and efficacy of ipilimumab in a real-world population with advanced melanoma. This national, multicentre, phase IV trial included 151 patients. Patients received ipilimumab 3 mg/kg intravenously and were followed for at least 5 years or until death. Treatment interruption or cessation occurred in 38%, most frequently due to disease progression (19%). Treatment-associated grade 3 to 4 toxicity was observed in 28% of patients, and immune-related toxicity in 56%. The overall response rate was 9%. Median overall survival was 12.1 months (95% CI: 8.3-15.9); and progression-free survival 2.7 months (95% CI: 2.6-2.8). After 5 years, 20% of patients were alive. In a landmark analysis from 6 months, improved survival was associated with objective response (HR 0.16, P = .001) and stable disease (HR 0.49, P = .005) compared to progressive disease. Poor performance status, elevated lactate dehydrogenase and C-reactive protein were identified as biomarkers. This prospective trial represents the longest reported follow-up of a real-world melanoma population treated with ipilimumab. Results indicate safety and efficacy comparable to phase III trials and suggest that the use of ipilimumab can be based on current cost-benefit estimates.
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Affiliation(s)
- Elin Aamdal
- Department of Oncology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | - Kari D Jacobsen
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Oddbjørn Straume
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway.,Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Oluf Herlofsen
- Department of Oncology, Ålesund Hospital, Ålesund, Norway
| | - Jarle Karlsen
- The Cancer Clinic, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Israr Hussain
- Department of Hematology and Oncology, Stavanger University Hospital, Stavanger, Norway
| | - Anita Amundsen
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - Astrid Dalhaug
- Department of Oncology and Palliative Medicine, Nordland Hospital, Norway
| | - Marta Nyakas
- Department of Oncology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Cornelia Schuster
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway.,Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Kjersti Holmsen
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Hege G Russnes
- Department of Pathology, Oslo University Hospital, Oslo, Norway.,Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Eva Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Stein Kaasa
- Department of Oncology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Steinar Aamdal
- Department of Oncology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jon A Kyte
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Tormod K Guren
- Department of Oncology, Oslo University Hospital, Oslo, Norway
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5
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Dalle S, Mortier L, Corrie P, Lotem M, Board R, Arance AM, Meiss F, Terheyden P, Gutzmer R, Buysse B, Oh K, Brokaw J, Le TK, Mathias SD, Scotto J, Lord-Bessen J, Moshyk A, Kotapati S, Middleton MR. Long-term real-world experience with ipilimumab and non-ipilimumab therapies in advanced melanoma: the IMAGE study. BMC Cancer 2021; 21:642. [PMID: 34051732 PMCID: PMC8164785 DOI: 10.1186/s12885-021-08032-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/15/2021] [Indexed: 12/14/2022] Open
Abstract
Background Ipilimumab has shown long-term overall survival (OS) in patients with advanced melanoma in clinical trials, but robust real-world evidence is lacking. We present long-term outcomes from the IMAGE study (NCT01511913) in patients receiving ipilimumab and/or non-ipilimumab (any approved treatment other than ipilimumab) systemic therapies. Methods IMAGE was a multinational, prospective, observational study assessing adult patients with advanced melanoma treated with ipilimumab or non-ipilimumab systemic therapies between June 2012 and March 2015 with ≥3 years of follow-up. Adjusted OS curves based on multivariate Cox regression models included covariate effects. Safety and patient-reported outcomes were assessed. Results Among 1356 patients, 1094 (81%) received ipilimumab and 262 (19%) received non-ipilimumab index therapy (systemic therapy [chemotherapy, anti–programmed death 1 antibodies, or BRAF ± MEK inhibitors], radiotherapy, and radiosurgery). In the overall population, median age was 64 years, 60% were male, 78% were from Europe, and 78% had received previous treatment for advanced melanoma. In the ipilimumab-treated cohort, 780 (71%) patients did not receive subsequent therapy (IPI-noOther) and 314 (29%) received subsequent non-ipilimumab therapy (IPI-Other) on study. In the non-ipilimumab–treated cohort, 205 (78%) patients remained on or received other subsequent non-ipilimumab therapy (Other-Other) and 57 (22%) received subsequent ipilimumab therapy (Other-IPI) on study. Among 1151 patients who received ipilimumab at any time during the study (IPI-noOther, IPI-Other, and Other-IPI), 296 (26%) reported CTCAE grade ≥ 3 treatment-related adverse events, most occurring in year 1. Ipilimumab-treated and non-ipilimumab–treated patients who switched therapy (IPI-Other and Other-IPI) had longer OS than those who did not switch (IPI-noOther and Other-Other). Patients with prior therapy who did not switch therapy (IPI-noOther and Other-Other) showed similar OS. In treatment-naive patients, those in the IPI-noOther group tended to have longer OS than those in the Other-Other group. Patient-reported outcomes were similar between treatment cohorts. Conclusions With long-term follow-up (≥ 3 years), safety and OS in this real-world population of patients treated with ipilimumab 3 mg/kg were consistent with those reported in clinical trials. Patient-reported quality of life was maintained over the study period. OS analysis across both pretreated and treatment-naive patients suggested a beneficial role of ipilimumab early in treatment. Trial registration ClinicalTrials.gov, NCT01511913. Registered January 19, 2012 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT01511913 Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08032-y.
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Affiliation(s)
- Stéphane Dalle
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, 69495, Pierre-Bénite, France.
| | - Laurent Mortier
- Université de Lille, INSERM U1189, CHRU Lille, 59037, Lille, France
| | - Pippa Corrie
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB0 2QQ, UK
| | - Michal Lotem
- Hadassah Hebrew University Hospital, 91120, Jerusalem, Israel
| | - Ruth Board
- Royal Preston Hospital, Preston, PR2 9HT, UK
| | | | - Frank Meiss
- Department of Dermatology, Faculty of Medicine, Medical Center - University of Freiburg, 79104, Freiburg, Germany
| | | | - Ralf Gutzmer
- Medizinische Hochschule Hannover, 30625, Hanover, Germany
| | | | - Kelly Oh
- Syneos Health, Morrisville, NC, 27560, USA
| | - Jane Brokaw
- Bristol Myers Squibb, Princeton, NJ, 08543, USA
| | - T Kim Le
- Bristol Myers Squibb, Princeton, NJ, 08543, USA
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6
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Borysowski J, Górski A. Public availability of results of ClinicalTrials.gov-registered expanded access studies. Br J Clin Pharmacol 2021; 87:4701-4708. [PMID: 33971033 DOI: 10.1111/bcp.14890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/16/2021] [Accepted: 04/27/2021] [Indexed: 11/27/2022] Open
Abstract
AIMS Expanded access is the use of investigational treatments outside of clinical trials. Results of expanded access studies provide insights into how investigational treatments work in real-world settings. The objective of this study was to evaluate public availability of results of expanded access studies. METHODS Eligible expanded access studies were identified in ClinicalTrials.gov (CT.gov). Publications matching records of individual studies were searched for in Medline and Embase. In addition, we assessed whether results of the included studies were publicly available from other sources including CT.gov, sponsor web sites and conference proceedings. RESULTS After median time of 49.5 (interquartile range, 36.7-64.7) months from study completion, the results of 69 out of the 152 included studies (45.39%) were publicly available, either as a journal publication (53 studies; 34.87%) or from other source (16 studies; 10.52%). The percentage of studies whose results were available as a journal publication after 12, 24, 36 and 48 months from study completion was 13.2, 21.1, 33.1 and 35.7%, respectively. The percentage of studies whose results were publicly available from any source (including journal publications) at 12, 24, 36 and 48 months were 19.1, 29.6, 43.2 and 47.5%, respectively. CONCLUSION Results of a considerable proportion of expanded access studies are not publicly available. In view of the growing importance of real-world data, sponsors and principal investigators of those studies should always consider making their findings public.
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Affiliation(s)
- Jan Borysowski
- Department of Clinical Immunology, Medical University of Warsaw, Warsaw, Poland.,Centre for Studies on Research Integrity, Institute of Law Studies, Polish Academy of Sciences, Warsaw, Poland
| | - Andrzej Górski
- Laboratory of Bacteriophages, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wrocław, Poland
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7
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Ogata D, Haydu LE, Glitza IC, Patel SP, Tawbi HA, McQuade JL, Diab A, Ekmekcioglu S, Wong MK, Davies MA, Amaria RN. The efficacy of anti-programmed cell death protein 1 therapy among patients with metastatic acral and metastatic mucosal melanoma. Cancer Med 2021; 10:2293-2299. [PMID: 33686688 PMCID: PMC7982611 DOI: 10.1002/cam4.3781] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/26/2020] [Accepted: 01/28/2021] [Indexed: 12/18/2022] Open
Abstract
Background Anti‐programmed cell death protein 1 (PD‐1) antibodies are a standard treatment for metastatic melanoma patients. However, the understanding of the efficacy of anti‐PD‐1 for acral melanoma (AM) and mucosal melanoma (MM) is limited as these subtypes are relatively rare compared to cutaneous melanoma (CM). Methods This single institution, retrospective cohort study included patients with advanced AM and MM who underwent anti‐PD‐1 therapy for metastatic melanoma between 2012 and 2018. Objective responses were determined using the investigator‐assessed Response Evaluation Criteria in Solid Tumors version 1.1. Progression‐free survival (PFS) and overall survival (OS) were assessed using the Kaplan–Meier method. A Cox regression analysis was performed to identify the factors associated with survival outcomes. Results Ninety‐seven patients were identified, 38 (39%) with AM and 59 (61%) with MM. The objective response rates (ORRs) were 21.0% and 15.2% in patients with AM and MM, respectively. The median PFS and OS were 3.6 and 25.7 months for AM patients, and 3.0 and 20.1 months for MM patients, respectively. Elevated serum lactate dehydrogenase (LDH) (AM: hazard ratio [HR], 0.22; 95% confidence interval [CI], 0.06–0.87; p = 0.03, MM: HR, 0.20; 95% CI, 0.08–0.53; p = 0.001) was significantly associated with shorter OS for both subtypes. Conclusions The ORR, PFS, and OS with anti‐PD‐1 therapy were poor in patients with AM and MM compared to those previously reported clinical trials for nonacral CM. High serum LDH was associated with significantly shorter OS.
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Affiliation(s)
- Dai Ogata
- Department of Melanoma Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA.,Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Lauren E Haydu
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Isabella C Glitza
- Department of Melanoma Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Sapna P Patel
- Department of Melanoma Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Hussein A Tawbi
- Department of Melanoma Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer L McQuade
- Department of Melanoma Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Adi Diab
- Department of Melanoma Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Suhendan Ekmekcioglu
- Department of Melanoma Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Michael K Wong
- Department of Melanoma Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Michael A Davies
- Department of Melanoma Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Rodabe N Amaria
- Department of Melanoma Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
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8
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Real-world treatment practice in patients with advanced melanoma. Contemp Oncol (Pozn) 2020; 24:118-124. [PMID: 32774137 PMCID: PMC7403768 DOI: 10.5114/wo.2020.97607] [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] [Received: 04/04/2020] [Accepted: 05/11/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction The treatment outcomes of patients with advanced/metastatic melanoma were poor before the use of new therapeutic options. Material and methods A retrospective analysis was conducted among 287 patients with unresectable stage III and stage IV melanoma treated at the Maria Sklodowska-Curie National Research Institute of Oncology Cracow Branch, from 2013 to 2019. All enrolled patients were treated with immunotherapy (IT; consisting of pembrolizumab/nivolumab, or ipilimumab) or target therapy (TT; consisting of vemurafenib ±cobimetinib or dabrafenib ±trametinib) in at least one treatment line. Results mutation was detected in 152 (55%) patients. In general, the majority of patients (92%) were in very good or good condition (Eastern Cooperative Oncology Group [ECOG] 0 or 1). Brain metastasis was detected in 64 (22%) patients. Median OS and PFS in the experimental group from the beginning of the first-line treatment were 14.9 and 6.7 months, respectively. Across the study population, as a first-line treatment patients received IT, TT as well as CHT, and the median OS was 19.2, 12.6 and 15.9 months, respectively. Multivariate analysis confirmed that normal LDH levels, no brain metastases, ECOG 0, and objective response to the treatment were strong predictors of longer OS. For PFS, absence of brain metastases, ECOG 0, and treatment response were found to be predictive factors on multivariate analysis. Conclusions The administration of new therapies for the treatment of patients with advanced/disseminated melanoma significantly prolonged survival in this group of patients. Nevertheless, further studies should be conducted to assess the effectiveness of various sequences of treatment.
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Powell N, Ibraheim H, Raine T, Speight RA, Papa S, Brain O, Green M, Samaan MA, Spain L, Yousaf N, Hunter N, Eldridge L, Pavlidis P, Irving P, Hayee B, Turajlic S, Larkin J, Lindsay JO, Gore M. British Society of Gastroenterology endorsed guidance for the management of immune checkpoint inhibitor-induced enterocolitis. Lancet Gastroenterol Hepatol 2020; 5:679-697. [PMID: 32553146 DOI: 10.1016/s2468-1253(20)30014-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 12/15/2022]
Abstract
Immune checkpoint inhibitors are a novel class of cancer treatment that have improved outcomes for a subset of cancer patients. They work by antagonising inhibitory immune pathways, thereby augmenting immune-mediated antitumour responses. However, immune activation is not cancer-specific and often results in the activation of immune cells in non-cancer tissues, resulting in off-target immune-mediated injury and organ dysfunction. Diarrhoea and gastrointestinal tract inflammation are common and sometimes serious side-effects of this type of therapy. Prompt recognition of gastrointestinal toxicity and, in many cases, rapid institution of anti-inflammatory or biologic therapy (or both) is required to reverse these complications. Management of organ-specific complications benefits from multidisciplinary input, including engagement with gastroenterologists for optimal management of immune checkpoint inhibitor-induced enterocolitis. In this British Society of Gastroenterology endorsed guidance document, we have developed a consensus framework for the investigation and management of immune checkpoint inhibitor-induced enterocolitis.
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MESH Headings
- Adrenal Cortex Hormones/therapeutic use
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antibodies, Monoclonal, Humanized/toxicity
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/therapeutic use
- Antineoplastic Agents, Immunological/toxicity
- Consensus
- Endoscopy/methods
- Endoscopy, Digestive System/methods
- Enterocolitis/chemically induced
- Enterocolitis/drug therapy
- Enterocolitis/metabolism
- Gastroenterology/organization & administration
- Gastrointestinal Diseases/chemically induced
- Gastrointestinal Diseases/diagnostic imaging
- Gastrointestinal Diseases/pathology
- Guidelines as Topic
- Humans
- Infliximab/therapeutic use
- Lactoferrin/metabolism
- Leukocyte L1 Antigen Complex/metabolism
- Neoplasms/drug therapy
- Patient Care Management/methods
- Societies, Medical/organization & administration
- Tumor Necrosis Factor-alpha/antagonists & inhibitors
- United Kingdom/epidemiology
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Affiliation(s)
- Nick Powell
- Division of Digestive Diseases, Faculty of Medicine, Imperial College London, UK; The Royal Marsden Hospital, London, UK.
| | - Hajir Ibraheim
- Division of Digestive Diseases, Faculty of Medicine, Imperial College London, UK; The Royal Marsden Hospital, London, UK
| | - Tim Raine
- Addenbrooke's Hospital, Cambridge University Teaching Hospitals NHS Foundation Trust, Cambridge, UK
| | - Richard A Speight
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK; Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - Sophie Papa
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK; Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Oliver Brain
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Michael Green
- Department of Histopathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mark A Samaan
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | | | - Polychronis Pavlidis
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK; Centre for Inflammation and Cancer Immunology, King's College London, London, UK
| | - Peter Irving
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Bu'Hussain Hayee
- Department of Gastroenterology, King's College Hospital, London, UK
| | - Samra Turajlic
- The Royal Marsden Hospital, London, UK; Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK
| | | | - James O Lindsay
- The Royal London Hospital, Barts Health NHS Trust, London, UK; Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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10
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Yamazaki N, Kiyohara Y, Uhara H, Tsuchida T, Maruyama K, Shakunaga N, Itakura E, Komoto A. Real-world safety and efficacy data of ipilimumab in Japanese radically unresectable malignant melanoma patients: A postmarketing surveillance. J Dermatol 2020; 47:834-848. [PMID: 32515086 PMCID: PMC7496696 DOI: 10.1111/1346-8138.15388] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/19/2020] [Indexed: 12/16/2022]
Abstract
Treatment with immune checkpoint inhibitors has improved prognosis among patients with cutaneous melanoma, but there are still unmet medical needs in Japan, especially for mucosal melanoma and acral lentiginous melanoma (ALM) subtypes. Ipilimumab, a fully human monoclonal antibody that specifically blocks cytotoxic T‐lymphocyte‐associated antigen 4 and potentiates antitumor T‐cell response, was approved in Japan in 2015 for the treatment of radically unresectable malignant melanoma. This postmarketing surveillance (prospective, non‐interventional, multicenter, observational study) evaluated the safety (occurrence of adverse drug reactions [ADR]) and efficacy (overall survival [OS]) of ipilimumab in a real‐world setting in Japan. All patients with radically unresectable malignant melanoma undergoing treatment with ipilimumab in Japan during the registration period between August 2015 and February 2017 were enrolled. In total, 547 patients were analyzed; 67.5% were 60 years old or more, 85.7% had an Eastern Cooperative Oncology Group performance status of 0–1, 50.3% had melanoma of the skin (mainly of the ALM subtype) and 73.5% had negative BRAF mutation status. Most patients had experienced recurrence and received multiple treatments. The overall incidence of ADR and serious ADR was 69.5% and 40.8%, respectively. The most common ADR and serious ADR were liver disorder, colitis and diarrhea. The most common ADR of special interest were liver‐related ADR (22.5%), skin‐related ADR (22.1%), gastrointestinal‐related ADR (20.3%) and endocrine system‐related ADR (16.3%). Most of these events had recovered or were in remission by the last evaluation. The median OS was 7.52 months (95% confidence interval, 6.47–8.74). Median OS was 6.31 and 8.44 months in patients with mucosal melanoma and melanoma of the skin; 9.43 and 3.75 months in patients with and without ADR; and 10.32 and 6.11 months in patients with and without serious ADR, respectively. Ipilimumab was tolerable and showed efficacy in improving OS for these patients.
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Affiliation(s)
- Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshio Kiyohara
- Dermatology Division, Shizuoka Cancer Center Hospital, Nagaizumi, Japan
| | - Hisashi Uhara
- Department of Dermatology, Sapporo Medical University, Sapporo, Japan
| | - Tetsuya Tsuchida
- Department of Dermatology, Saitama Medical University, Moroyama, Japan
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11
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Brahm CG, van Linde ME, Enting RH, Schuur M, Otten RH, Heymans MW, Verheul HM, Walenkamp AM. The Current Status of Immune Checkpoint Inhibitors in Neuro-Oncology: A Systematic Review. Cancers (Basel) 2020; 12:cancers12030586. [PMID: 32143288 PMCID: PMC7139638 DOI: 10.3390/cancers12030586] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 12/14/2022] Open
Abstract
The introduction of immune checkpoint inhibitors (ICI), as a novel treatment modality, has transformed the field of oncology with unprecedented successes. However, the efficacy of ICI for patients with glioblastoma or brain metastases (BMs) from any tumor type is under debate. Therefore, we systematically reviewed current literature on the use of ICI in patients with glioblastoma and BMs. Prospective and retrospective studies evaluating the efficacy and survival outcomes of ICI in patients with glioblastoma or BMs, and published between 2006 and November 2019, were considered. A total of 88 studies were identified (n = 8 in glioblastoma and n = 80 in BMs). In glioblastoma, median progression-free (PFS) and overall survival (OS) of all studies were 2.1 and 7.3 months, respectively. In patients with BMs, intracranial responses have been reported in studies with melanoma and non-small-cell lung cancer (NSCLC). The median intracranial and total PFS in these studies were 2.7 and 3.0 months, respectively. The median OS in all studies for patients with brain BMs was 8.0 months. To date, ICI demonstrate limited efficacy in patients with glioblastoma or BMs. Future research should focus on increasing the local and systemic immunological responses in these patients.
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Affiliation(s)
- Cyrillo G. Brahm
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands;
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, location VUmc, 1007 MB Amsterdam, The Netherlands; (M.E.v.L.); (H.M.W.V.)
| | - Myra E. van Linde
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, location VUmc, 1007 MB Amsterdam, The Netherlands; (M.E.v.L.); (H.M.W.V.)
| | - Roelien H. Enting
- Department of Neurology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands;
| | - Maaike Schuur
- Department of Neurology, Cancer Center Amsterdam, Amsterdam University Medical Centers, location VUmc, 1007 MB Amsterdam, The Netherlands;
| | - René H.J. Otten
- University Library, Vrije Universiteit Amsterdam, 1007 MB Amsterdam, The Netherlands;
| | - Martijn W. Heymans
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, location VUmc, 1007 MB Amsterdam, The Netherlands;
| | - Henk M.W. Verheul
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, location VUmc, 1007 MB Amsterdam, The Netherlands; (M.E.v.L.); (H.M.W.V.)
- Department of Medical Oncology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Annemiek M.E. Walenkamp
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands;
- Correspondence: ; Tel.: +31-50-3612821; Fax: +31-50-3614862
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12
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Guven DC, Aktas BY, Simsek C, Aksoy S. Gut microbiota and cancer immunotherapy: prognostic and therapeutic implications. Future Oncol 2020; 16:497-506. [PMID: 32100550 DOI: 10.2217/fon-2019-0783] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The immune checkpoint inhibitors have opened new horizons in oncology. Although the indications for the use of Immune checkpoint inhibitors in cancer patients are expanding, there is still a need for markers that can aid in patient selection. Gastrointestinal microbiota can be among these markers. Recently, gastrointestinal microbiota stated to have a bidirectional relation with cancer immunotherapy with roles in both prognostic and therapeutic sides. Preclinical data suggest that modulation of the microbiota could become a novel strategy for improving the efficacy of immunotherapy. However, its labile structure prone to be affected by many factors. Further research can delineate the mechanisms of the relationship between microbiota and immunotherapy can have clinical implications.
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Affiliation(s)
- Deniz Can Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06100, Turkey
| | - Burak Yasin Aktas
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06100, Turkey
| | - Cem Simsek
- Department of Gastroenterology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06100, Turkey
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13
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Otsuka M, Sugihara S, Mori S, Hamada K, Sasaki Y, Yoshikawa S, Kiyohara Y. Immune-related adverse events correlate with improved survival in patients with advanced mucosal melanoma treated with nivolumab: A single-center retrospective study in Japan. J Dermatol 2020; 47:356-362. [PMID: 31984569 DOI: 10.1111/1346-8138.15246] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 12/26/2019] [Indexed: 02/03/2023]
Abstract
Immune-related adverse events (irAE) were reported to be associated with better outcomes in various cancers treated with the immune checkpoint inhibitor nivolumab. Considering that their development depends on host immune activation, irAE may reflect antitumor response in mucosal melanoma (MM). This single-center retrospective study including patients with advanced MM receiving nivolumab monotherapy between August 2014 and September 2018 investigated whether the development of irAE was associated with clinical efficacy. The study patients were divided into those with and without irAE, and treatment efficacy and safety were evaluated. The study cohort of 27 patients included 20 (74%), six (22%) and one (4%) patient with primary MM in the head and neck, genitourinary and anorectal regions, respectively. The irAE onset was not significantly associated with the objective response rate in patients while it was significantly associated with the disease control rate. The median progression-free survival in patients with and without irAE was 301 and 63 days, respectively. The median overall survival (OS) in patients with and without irAE was 723 and 199 days, respectively. According to the timing of irAE onset, the OS was better in seven patients who developed irAE after 180 days than in nine patients who developed irAE within 180 days. Although 16 patients (59%) experienced any grade irAE, including three (11%) with grade 3 or more irAE, there were no treatment-related deaths. These results indicated that the development of irAE may correlate with improved survival in patients with MM treated with nivolumab monotherapy. Further studies are necessary to confirm these findings.
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Affiliation(s)
- Masaki Otsuka
- Department of Dermatology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Satoru Sugihara
- Department of Dermatology, Shizuoka Cancer Center, Shizuoka, Japan.,Department of Dermatology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Shoichiro Mori
- Department of Dermatology, Shizuoka Cancer Center, Shizuoka, Japan.,Department of Dermatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Kengo Hamada
- Department of Dermatology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yosuke Sasaki
- Department of Dermatology, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Yoshio Kiyohara
- Department of Dermatology, Shizuoka Cancer Center, Shizuoka, Japan
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14
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Horta E, Bongiorno C, Ezzeddine M, Neil EC. Neurotoxicity of antibodies in cancer therapy: A review. Clin Neurol Neurosurg 2019; 188:105566. [PMID: 31731087 DOI: 10.1016/j.clineuro.2019.105566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 09/13/2019] [Accepted: 10/20/2019] [Indexed: 01/17/2023]
Abstract
The objective of this manuscript is to identify the neurological side effect profile associated with different classes of antibodies used in cancer pharmacotherapy and to estimate the frequency in which these neurotoxicity occurs. A systematic review of the literature was conducted using OVID MEDLINE and EMBASE databases for articles written between January of 2010 till August of 2018. The spectrum of neurotoxicity was searched using expanded terminology, medical subject headings, truncation, spelling variations and database specific controlled vocabulary. 2134 citations were retrieved that were narrowed down to 151 when SORT 1 or SORT 2 critical appraisal tool was applied to articles with human subjects. Meta-analysis using random effect model was done to estimate the prevalence of neurological symptoms per class of antibody described in SORT1 and SORT2 articles. It was found that the most common neurotoxicity per antibody class are as follows; Bi-specific T-cell engagers was headache 38% [35-40%; I2 0%]; anti-CD20, neuropathy, 16% [7-24%, I2 65%]; anti-CD30, neuropathy 57% [46-68%, I2 72%]; anti-CD52, neuropathy 5-15%; anti-CTL4, headache 12% [7-16%, I2 49%]; anti-EGFR, headache 25% [11-38%, I2 92%]; anti-Her2, neuropathy 33% [18-49%, I2 98%]; anti-PD1 and PDL1, headache 3% [2-5%, I2 85%]; and anti-VEGF, headache 25% [16-35%, I2 73%]. Therefore, all classes of antibodies used in cancer pharmacotherapy have associated neurotoxicity with a wide spectrum of effects afflicting the nervous system as a whole. The specific side effects and the frequency at which they occur differ per class of antibody. Broader and more severe symptoms were noted to effect patients with preexisting brain lesions.
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Affiliation(s)
- Erika Horta
- Department of Neurology of University of Minnesota, 516 Delaware St SE, Minneapolis, MN, 5545, USA; Department of Neurosurgery, 2799 W Grand Blvd, Henry Ford Health System, Detroit, MI 48202 USA.
| | - Connie Bongiorno
- University of Minnesota Biomedicine Library, 505 Essex St SE, Minneapolis, MN 55455, USA
| | - Mustapha Ezzeddine
- Department of Neurology of University of Minnesota, 516 Delaware St SE, Minneapolis, MN, 5545, USA
| | - Elizabeth C Neil
- Department of Neurology of University of Minnesota, 516 Delaware St SE, Minneapolis, MN, 5545, USA
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15
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Real-World Impact of Immune Checkpoint Inhibitors in Metastatic Uveal Melanoma. Cancers (Basel) 2019; 11:cancers11101489. [PMID: 31623302 PMCID: PMC6826482 DOI: 10.3390/cancers11101489] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/30/2019] [Accepted: 09/30/2019] [Indexed: 12/16/2022] Open
Abstract
Uveal melanoma (UM) is the most common intraocular malignancy in adults and shows a high rate of metastatic spread. As randomized clinical trials with immune checkpoint inhibitors (ICI) have not been performed in patients with metastatic UM, we analyzed the real-world outcomes in a nationwide population-based study. Clinical data of patients with UM were extracted from the Danish Metastatic Melanoma database, a nationwide database containing unselected records of patients diagnosed with metastatic melanoma in Denmark. Survival before (pre-ICI, n = 32) and after (post-ICI, n = 94) the approval of first-line treatment with ICI was analyzed. A partial response to first-line treatment was observed in 7% of patients treated with anti-programmed cell death protein (PD)-1 monotherapy and in 21% with combined anti-cytotoxic T lymphocyte antigen (CTLA)-4 plus anti-PD-1 therapy. Median progression-free survival was 2.5 months for patients treated in the pre-ICI era compared to 3.5 months in the post-ICI era (hazard ratio (HR) 0.43; 95% confidence interval (CI) 0.28–0.67; p < 0.001). The estimated one-year overall survival rate increased from 25.0% to 41.9% and the median overall survival improved from 7.8 months to 10.0 months, respectively (HR 0.52; 95% CI 0.34–0.79; p = 0.003). Thus, the introduction of ICI as first-line treatment appears to have significantly improved the real-world survival of patients with metastatic UM, despite relatively low response rates compared to cutaneous melanoma. With the lack of therapies proven effective in randomized trials, these data support the current treatment with ICI in patients with metastatic UM.
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16
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Cowey CL, Liu FX, Black-Shinn J, Stevinson K, Boyd M, Frytak JR, Ebbinghaus SW. Pembrolizumab Utilization and Outcomes for Advanced Melanoma in US Community Oncology Practices. J Immunother 2019; 41:86-95. [PMID: 29252916 PMCID: PMC5811239 DOI: 10.1097/cji.0000000000000204] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The programmed death-1 inhibitor pembrolizumab has demonstrated efficacy and safety in clinical trials for treating advanced (unresectable/metastatic) melanoma. We investigated the real-world utilization of pembrolizumab and associated patient outcomes for advanced melanoma in US community oncology practices. This retrospective, observational study used deidentified data from electronic health records for adult patients with advanced melanoma who received pembrolizumab at The US Oncology Network sites from September 2014 through December 2015, with follow-up through September 2016. Patients enrolled in clinical trials were excluded. Overall survival (OS) and physician-stated progression-free survival (PFS) were analyzed from pembrolizumab initiation using Kaplan-Meier, and associations between pembrolizumab therapy and OS/PFS, using multivariable Cox regression. Of 168 patients studied, 110 (65%) were male; the median age was 66 years (range, 26–over 90). Pembrolizumab was prescribed as first-line, second-line, and third-line/later for 39 (23%), 87 (52%), and 42 (25%) patients, respectively. In total, 41 patients (24%) had brain metastases. At pembrolizumab initiation, 21/129 (16%) had Eastern Cooperative Oncology Group performance status (ECOG PS) >1; 51/116 (44%) had elevated lactate dehydrogenase. Median follow-up was 10.5 months (range, 0–25.1); median OS was 19.4 months (95% confidence interval, 14.0–not reached); median PFS was 4.2 months (95% confidence interval, 2.9–5.3). Brain metastases, ECOG PS>1, elevated lactate dehydrogenase, and third-line/later (vs. first-line) pembrolizumab were significant predictors (P<0.01) of decreased survival. Treatment-related toxicity was a discontinuation reason for 25% (29/117) of patients, and for 10 of these 29 patients (6% of the full-study cohort) treatment-related toxicity was the only reported reason. The real-world effectiveness and safety of pembrolizumab for advanced melanoma are consistent with clinical trial findings.
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Affiliation(s)
- C Lance Cowey
- McKesson Specialty Health/The US Oncology Network, The Woodlands.,Skin Malignancy Research and Treatment Center, Baylor University Medical Center.,Texas Oncology PA, Dallas, TX
| | | | | | | | - Marley Boyd
- McKesson Specialty Health/The US Oncology Network, The Woodlands
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17
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Zhou AY, Wang DY, McKee S, Ye F, Wen CC, Wallace DE, Ancell KK, Conry RM, Johnson DB. Correlates of response and outcomes with talimogene laherperpvec. J Surg Oncol 2019; 120:558-564. [PMID: 31264725 PMCID: PMC7449595 DOI: 10.1002/jso.25601] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients with in-transit or limited cutaneous metastatic melanoma may benefit from intralesional injections with talimogene laherparepvec (TVEC), a modified oncolytic herpesvirus. However, its use in patients with adverse prognostic scores in a real-life clinical setting has not been studied. METHODS We performed a two-center retrospective analysis of 40 patients with metastatic melanoma treated with TVEC from 2015-2017. Demographics, overall response, and survival after therapy were noted. RESULTS Overall, there was a durable response rate of 40%; median progression-free survival (PFS) was 10.5 months and median overall survival (OS) was not reached. Bulky disease was associated with decreased OS (15.7 months vs not reached, P < .05) and mPFS (2.3 months vs not reached, P < .05), when compared with smaller tumors. Poor performance status (ECOG 2-3) was associated with worse OS (10.2 months vs not reached, P < .05) and PFS (2.1 months vs not reached, P < .05) compared to patients with ECOG 0-1. There was no difference in the outcomes with age greater than 75 or with prior therapies. Adverse events were relatively tolerable. CONCLUSIONS These findings demonstrate that TVEC is an effective and safe treatment for metastatic melanoma in a real-life clinical setting, and suggest parameters to aid in appropriate therapy selection for optimal response.
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Affiliation(s)
- Alice Y Zhou
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel Y Wang
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Svetlana McKee
- Department of Medicine, University of Alabama, Birmingham, Alabama
| | - Fei Ye
- Department of Biostatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chun-Che Wen
- Department of Biostatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Debbie E Wallace
- Department of Medicine, Vanderbilt University Medical Center and Vanderbilt Ingram Cancer Center, Nashville, Tennessee
| | - Kristin K Ancell
- Department of Medicine, Vanderbilt University Medical Center and Vanderbilt Ingram Cancer Center, Nashville, Tennessee
| | - Robert M Conry
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center and Vanderbilt Ingram Cancer Center, Nashville, Tennessee
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18
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Analysis of the survival of patients receiving systemic treatment for melanoma of the skin: a retrospective population study with patients treated in Poland in 2011-2015. Postepy Dermatol Alergol 2019; 36:438-441. [PMID: 31616218 PMCID: PMC6791149 DOI: 10.5114/ada.2019.83368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/01/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction In Poland, it is uniquely possible to assess real effects of the introduction of new oncological therapies on the overall survival in patients as such therapies are funded by one payer only – the National Health Fund (NHF). Data collected by the NHF make it possible to analyse the survival of all patients who were diagnosed with melanoma. Aim The paper presents findings of a retrospective analysis of the efficacy of systemic treatment in patients with malignant melanoma of the skin in Poland with regard to the overall survival. Material and methods The analysis of the overall survival was performed with the Kaplan-Meier method in the population receiving systemic treatment. Three groups of patients were analysed. Group 1 included all patients who had started systemic treatment between 1 March 2011 and 1 March 2015: 1,258 patients. The median overall survival was 8.4 months. Group 2 included 444 patients who had started systemic treatment between 1 March 2011 and 28 February 2013. The median overall survival was 6.6 months in this group. Group 3 included 814 patients who had started systemic treatment between 1 March 2013 and 1 March 2015 and included 546 patients who were also treated in drug programmes with ipilimumab and vemurafenib (approx. 67%). The median overall survival was 9.4 months. Results A difference in the overall survival between group 3 and 2 was statistically significant (p < 0.05). Conclusions The introduction of vemurafenib and ipilimumab into systemic treatment in Poland using public funds had a significant effect on the prolongation of the overall survival in patients with malignant melanoma of the skin.
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Prognostic and predictive role of elevated lactate dehydrogenase in patients with melanoma treated with immunotherapy and BRAF inhibitors: a systematic review and meta-analysis. Melanoma Res 2019; 29:1-12. [PMID: 30308577 DOI: 10.1097/cmr.0000000000000520] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Levels of serum lactate dehydrogenase (LDH) are a recognized prognostic factor in malignant melanoma (MM). It is relevant to confirm its prognostic role in patients treated with targeted therapies [BRAF inhibitors (BRAFi) and MEK inhibitors (MEKi)] and immunotherapy (IT). Furthermore, its role as a predictive marker in patients treated with these drugs had still not been investigated. We performed an electronic search for studies reporting information on overall survival (OS) or progression-free survival (PFS) according to LDH levels and on their predictive effect in patients treated with targeted therapies (BRAFi and MEKi) and IT. Data were pooled using hazard ratios (HRs) for OS and HRs for PFS according to a fixed-effect or a random-effect model. For predictive analysys, effect of new agents versus standard therapy was evaluated in LDH high population. A total of 71 publications were retrieved for a total of 16 159 patients. Overall, elevated LDH levels were associated with an HR for OS of 1.72 [95% confidence interval (CI): 1.6-1.85; P<0.0001]. Similarly, HR for PFS was 1.83 (95% CI: 1.53-2.2; P<0.0001). In the LDH elevated subgroup, new agents improved OS significantly (HR: 0.71; 95% CI: 0.62-0.82; P<0.0001) and PFS (HR: 0.63; 95% CI: 0.55-0.72; P<0.0001). In advanced MM treated with IT or BRAFi±MEKi, elevated LDH level at baseline represents a poor prognostic factor. However, patients with increased LDH levels and treated with these drugs gain significant benefits in terms of PFS and OS.
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20
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Ibrahim T, Mateus C, Baz M, Robert C. Older melanoma patients aged 75 and above retain responsiveness to anti-PD1 therapy: results of a retrospective single-institution cohort study. Cancer Immunol Immunother 2018; 67:1571-1578. [PMID: 30056599 PMCID: PMC11028036 DOI: 10.1007/s00262-018-2219-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 07/25/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The utility of immunotherapy in elderly melanoma patients is debated. We aimed in this study to evaluate the efficacy and tolerability of immunotherapy among elderly patients. METHOD This is a retrospective single-institution cohort study. Patients aged 75 years and above who had been treated with nivolumab, pembrolizumab or ipilimumab for advanced or metastatic melanoma, were included. Patients and disease characteristics were collected using electronic medical records. Objective response was determined according to the immune-related response criteria. Drug-related toxicities (DRT) were graded according to the CTCAE v4.03. RESULTS 99 patients were included with a mean age of 80 years (SD = 4). One patient received nivolumab and ipilimumab combination, but died because of drug-related diverticulitis. Median PFS on pembrolizumab, nivolumab or ipilimumab were equal to 11.9 (95% CI 5.4-18.4), 1.4 (95% CI 0.01-2.8), and 2.8 months (95% CI 2.6-3), respectively, while objective response rates were equal to 51.6, 12.5, and 17.3%, respectively. Median OS was not reached in patients who received only pembrolizumab, 8.7 months in the ipilimumab only group, and 23 months in patients receiving several immune therapies sequentially. Pembrolizumab, nivolumab, and ipilimumab grade 3-4 DRT rates were equal to 24.2, 62.5, and 32.7% respectively, while discontinuation rates were equal to 43.5, 62.5, and 28.8%, respectively. CONCLUSIONS Our study suggests that immunotherapy is effective and well tolerated in the elderly. The PFS on pembrolizumab was greater than expected, a finding that needs to be investigated further.
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Affiliation(s)
- Tony Ibrahim
- Department of Medical Oncology, Gustave Roussy Institut, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
| | - Christine Mateus
- Dermatology Department, Gustave Roussy Institut, Villejuif, France
| | - Maria Baz
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Caroline Robert
- Dermatology Department, Gustave Roussy Institut, Villejuif, France
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21
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Whitman ED, Liu FX, Cao X, Diede SJ, Haiderali A, Abernethy AP. Treatment patterns and outcomes for patients with advanced melanoma in US oncology clinical practices. Future Oncol 2018; 15:459-471. [PMID: 30251550 DOI: 10.2217/fon-2018-0620] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIM To describe recent evolution in treatment patterns and outcomes for advanced melanoma (AMel). METHODS This retrospective observational study analyzed de-identified electronic health record data from the Flatiron Health database for 1140 adult patients who initiated first-line therapy for AMel from 1 January 2014 to 30 June 2016 with follow-up through 28 February 2017. RESULTS The most common first-line regimens were ipilimumab-based therapies (34%), anti-PD-1 monotherapy (26%) and BRAF/MEK inhibitor(s) (20%). First-line ipilimumab-based and BRAF inhibitor regimens decreased after the third quarter of 2014 (3Q2014), and by 2Q2016, 55 and 91% of BRAF-mutant and BRAF wild-type cohorts, respectively, received a first-line anti-PD-1 regimen. Median overall survival from first-line initiation for all patients was 18.8 months (95% CI: 16.3-23.3). CONCLUSION Results illustrate changing paradigms of therapy and real-world patient outcomes for AMel.
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Affiliation(s)
- Eric D Whitman
- Atlantic Melanoma Center, Atlantic Health System Cancer Care, 100 Madison Ave., Morristown, NJ 07960, USA
| | | | - Xiting Cao
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Scott J Diede
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Amin Haiderali
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Amy P Abernethy
- Flatiron Health, Inc., 233 Spring St, New York, NY 10013, USA
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22
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Liede A, Hernandez RK, Wade SW, Bo R, Nussbaum NC, Ahern E, Dougall WC, Smyth MJ. An observational study of concomitant immunotherapies and denosumab in patients with advanced melanoma or lung cancer. Oncoimmunology 2018; 7:e1480301. [PMID: 30524886 DOI: 10.1080/2162402x.2018.1480301] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 05/20/2018] [Indexed: 02/08/2023] Open
Abstract
After a case report of profound clinical response in a melanoma patient following treatment with an immune checkpoint inhibitor (ICI) and RANK-ligand inhibitor denosumab, we identified similar patients from electronic health records (EHR) and described patient characteristics and outcomes. This 2017 observational study used Flatiron Health's EHR database from ~255 US cancer clinics. Included were advanced melanoma or non-small-cell lung cancer (NSCLC) patients who received denosumab within 30 days of CTLA-4 (ipilimumab) or PD1 (pembrolizumab, nivolumab) inhibitors start with a minimum of 6 months of follow up. Real-world tumor response (rwTR) was analyzed for scans available up to 30 days after concomitant therapy. Preclinical experiments evaluated sequencing of ICI, denosumab vs monotherapy or control. Melanoma (n = 66) patients received concomitant denosumab/ICI for a mean 4.0 months, 3.1 months for NSCLC (n = 241). Two-thirds of patients had best rwTR evaluable (complete [CR], partial response [PR], stable disease [SD], or disease progression [PD]). Longer mean duration of concomitant exposure was associated with overall response rate (ORR; CR+PR) in melanoma (p = 0.0172), NSCLC (p < .0001), and combined cohorts (p < .0001). The disease control rate (ORR plus SD) was 56% amongst melanoma patients and 58% amongst NSCLC patients. Longer concomitant therapy was associated with increased overall survival, primarily in NSCLC (p < .0001). Preclinical data suggest that ICI initiated before or at same time as denosumab was optimal. Results provide proof-of-concept that rwTR is associated with concomitant denosumab/ICI. Crude survival analyses supported the association of concomitant therapy and improved outcomes outside of clinical trials and warrant comparative study.
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Affiliation(s)
- Alexander Liede
- Center for Observational Research, Amgen Inc., Thousand Oaks and South San Francisco, California, USA
| | - Rohini K Hernandez
- Center for Observational Research, Amgen Inc., Thousand Oaks and South San Francisco, California, USA
| | - Sally W Wade
- Center for Observational Research, Amgen Inc., Thousand Oaks and South San Francisco, California, USA.,Wade Outcomes Research and Consulting, Salt Lake City, Utah, USA
| | - Ronghai Bo
- Center for Observational Research, Amgen Inc., Thousand Oaks and South San Francisco, California, USA
| | - Nathan C Nussbaum
- Flatiron Health, New York, USA.,Department of Medicine, New York University School of Medicine, New York, USA
| | - Elizabeth Ahern
- Immunology in Cancer and Infection Laboratory, QIMR Berghofer Medical Research Institute, Herston, Australia.,Medical Oncology, Royal Brisbane and Women's Hospital, Herston, Australia
| | - William C Dougall
- Immuno-oncology Discovery Laboratory, QIMR Berghofer Medical Research Institute, Herston, Australia
| | - Mark J Smyth
- Immunology in Cancer and Infection Laboratory, QIMR Berghofer Medical Research Institute, Herston, Australia
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23
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Cost Estimate of Immune-Related Adverse Reactions Associated with Innovative Treatments of Metastatic Melanoma. Clin Drug Investig 2018; 38:967-976. [DOI: 10.1007/s40261-018-0690-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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24
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Cardiac Complications Associated With Checkpoint Inhibition: A Systematic Review of the Literature in an Important Emerging Area. Can J Cardiol 2018; 34:1059-1068. [DOI: 10.1016/j.cjca.2018.03.012] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 03/06/2018] [Accepted: 03/16/2018] [Indexed: 01/22/2023] Open
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25
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Jochems A, Leeneman B, Franken MG, Schouwenburg MG, Aarts MJB, van Akkooi ACJ, van den Berkmortel FWPJ, van den Eertwegh AJM, Groenewegen G, de Groot JWB, Haanen JBAG, Hospers GAP, Kapiteijn E, Koornstra RH, Kruit WHJ, Louwman MWJ, Piersma D, van Rijn RS, Ten Tije AJ, Vreugdenhil G, Wouters MWJM, Uyl-de Groot CA, van der Hoeven KJM. Real-world use, safety, and survival of ipilimumab in metastatic cutaneous melanoma in The Netherlands. Anticancer Drugs 2018; 29:572-578. [PMID: 29659371 DOI: 10.1097/cad.0000000000000629] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Phase III trials with ipilimumab showed an improved survival in patients with metastatic melanoma. We evaluated the use and safety of ipilimumab, and the survival of all patients with metastatic cutaneous melanoma (N=807) receiving ipilimumab in real-world clinical practice in The Netherlands using data from the Dutch Melanoma Treatment Registry. Patients who were registered between July 2012 and July 2015 were included and analyzed according to their treatment status: treatment-naive (N=344) versus previously-treated (N=463). Overall, 70% of treatment-naive patients and 62% of previously-treated patients received all four planned doses of ipilimumab. Grade 3 and 4 immune-related adverse events occurred in 29% of treatment-naive patients and 21% of previously-treated patients. No treatment-related deaths occurred. Median time to first event was 5.4 months [95% confidence interval (CI): 4.7-6.5 months] in treatment-naive patients and 4.4 months (95% CI: 4.0-4.7 months) in previously-treated patients. Median overall survival was 14.3 months (95% CI: 11.6-16.7 months) in treatment-naive patients and 8.7 months (95% CI: 7.6-9.6 months) in previously-treated patients. In both patient groups, an elevated lactate dehydrogenase level (hazard ratio: 2.25 and 1.70 in treatment-naive and previously-treated patients, respectively) and American Joint Committee on Cancer M1c-stage disease (hazard ratio: 1.81 and 1.83, respectively) were negatively associated with overall survival. These real-world outcomes of ipilimumab slightly differed from outcomes in phase III trials. Although phase III trials are crucial for establishing efficacy, real-world data are of great added value enhancing the generalizability of outcomes of ipilimumab in clinical practice.
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Affiliation(s)
- Anouk Jochems
- Department of Medical Oncology, Leiden University Medical Center
- Dutch Institute for Clinical Auditing, Leiden
| | - Brenda Leeneman
- Department of Health Technology Assessment, Erasmus School of Health Policy & Management
| | - Margreet G Franken
- Institute for Medical Technology Assessment, Erasmus University Rotterdam
| | - Maartje G Schouwenburg
- Department of Medical Oncology, Leiden University Medical Center
- Dutch Institute for Clinical Auditing, Leiden
| | - Maureen J B Aarts
- Department of Medical Oncology, Maastricht University Medical Center, Maastricht
| | | | | | - Alfonsus J M van den Eertwegh
- Dutch Institute for Clinical Auditing, Leiden
- Department of Medical Oncology, VU University Medical Center, Amsterdam
| | | | | | - John B A G Haanen
- Dutch Institute for Clinical Auditing, Leiden
- Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital
| | - Geke A P Hospers
- Department of Medical Oncology, University Medical Center Groningen, Groningen
| | - Ellen Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center
| | - Rutger H Koornstra
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen
| | - Wim H J Kruit
- Department for Medical Oncology, Erasmus MC Cancer Institute, Rotterdam
| | | | - Djura Piersma
- Department of Internal Medicine, Medical Spectrum Twente, Enschede
| | | | | | - Gerard Vreugdenhil
- Department of Internal Medicine, Maxima Medical Center, Veldhoven, The Netherlands
| | | | - Carin A Uyl-de Groot
- Department of Health Technology Assessment, Erasmus School of Health Policy & Management
- Institute for Medical Technology Assessment, Erasmus University Rotterdam
| | - Koos J M van der Hoeven
- Dutch Institute for Clinical Auditing, Leiden
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen
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26
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Multicenter, real-life experience with checkpoint inhibitors and targeted therapy agents in advanced melanoma patients in Switzerland. Melanoma Res 2018; 27:358-368. [PMID: 28509765 PMCID: PMC5633326 DOI: 10.1097/cmr.0000000000000359] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Metastatic melanoma is a highly aggressive disease. Recent progress in immunotherapy (IT) and targeted therapy (TT) has led to significant improvements in response and survival rates in metastatic melanoma patients. The current project aims to determine the benefit of the introduction of these new therapies in advanced melanoma across several regions of Switzerland. This is a retrospective multicenter analysis of 395 advanced melanoma patients treated with standard chemotherapy, checkpoint inhibitors, and kinase inhibitors from January 2008 until December 2014. The 1-year survival was 69% (n=121) in patients treated with checkpoint inhibitors (IT), 50% in patients treated with TTs (n=113), 85% in the IT+TT group (n=66), and 38% in patients treated with standard chemotherapy (n=95). The median overall survival (mOS) from first systemic treatment in the entire study cohort was 16.9 months. mOS of patients treated either with checkpoint or kinase inhibitors (n=300, 14.6 months) between 2008 and 2014 was significantly improved (P<0.0001) compared with patients treated with standard chemotherapy in 2008–2009 (n=95, 7.4 months). mOS of 61 patients with brain metastases at stage IV was 8.1 versus 12.5 months for patients without at stage IV (n=334), therefore being significantly different (P=0.00065). Furthermore, a significant reduction in hospitalization duration compared with chemotherapy was noted. Treatment with checkpoint and kinase inhibitors beyond clinical trials significantly improves the mOS in real life and the results are consistent with published prospective trial data.
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27
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Valpione S, Pasquali S, Campana LG, Piccin L, Mocellin S, Pigozzo J, Chiarion-Sileni V. Sex and interleukin-6 are prognostic factors for autoimmune toxicity following treatment with anti-CTLA4 blockade. J Transl Med 2018; 16:94. [PMID: 29642948 PMCID: PMC5896157 DOI: 10.1186/s12967-018-1467-x] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/30/2018] [Indexed: 11/30/2022] Open
Abstract
Background Ipilimumab is a licensed immunotherapy for metastatic melanoma patients and, in the US, as adjuvant treatment for high risk melanoma radically resected. The use of ipilimumab is associated with a typical but unpredictable pattern of side effects. The purpose of this study was to identify clinical features and blood biomarkers capable of predicting ipilimumab related toxicity. Methods We performed a prospective study aimed at analyzing potential clinical and biological markers associated with immune-related toxicity in patients treated with ipilimumab (3 mg/kg, q3w). We enrolled 140 consecutive melanoma patients treated with ipilimumab for metastatic disease. The following prospectively collected data were utilized: patient characteristics, previous therapies, level of circulating biomarkers associated with tumour burden or immune-inflammation status (lactic dehydrogenase, C-reactive protein, β2-microglobulin, vascular endothelial growth factor, interleukin-2, interleukin-6, S-100, alkaline phosphatase, transaminases) and blood cells subsets (leukocyte and lymphocyte subpopulations). Logistic regression was used for multivariate analysis of data. Results Out of 140 patients, 36 (26%) experienced a severe adverse event, 33 (24%) discontinued treatment for severe toxicity. Among the immune-profile biomarkers analyzed, only interleukin-6 was associated with the risk of toxicity. Female patients had a further increase of immune-related adverse events. Low baseline interleukin-6 serum levels (OR = 2.84, 95% CI 1.34–6.03, P = 0.007) and sex female (OR = 1.5, 95% CI 1.06–2.16 P = 0.022) and were significant and independent risk factors for immune related adverse events. Conclusions Baseline IL6 serum levels and female sex were significantly and independently associated with higher risk of severe toxicity and could be exploited in clinical practice to personalize toxicity surveillance in patients treated with ipilimumab. Electronic supplementary material The online version of this article (10.1186/s12967-018-1467-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sara Valpione
- CRUK Manchester Institute and The Christie NHS Foundation Trust, The University of Manchester, Manchester, M20 4GJ, UK. .,Melanoma and Esophageal Cancer Unit, Istituto Oncologico Veneto-IRCCS, Via Gattamelata 64, 35128, Padua, Italy. .,Department of Surgery, Oncology and Gastroenterology, University of Padova, 64 Gattamelata St, 35128, Padua, Italy.
| | - Sandro Pasquali
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 64 Gattamelata St, 35128, Padua, Italy.,Surgical Oncology, Veneto Oncology Institute, Via Gattamelata 64, 35128, Padua, Italy.,Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, via G Venezian 1, 20133, Milan, Italy
| | - Luca Giovanni Campana
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 64 Gattamelata St, 35128, Padua, Italy.,Surgical Oncology, Veneto Oncology Institute, Via Gattamelata 64, 35128, Padua, Italy
| | - Luisa Piccin
- Melanoma and Esophageal Cancer Unit, Istituto Oncologico Veneto-IRCCS, Via Gattamelata 64, 35128, Padua, Italy.,Department of clinical medicine and surgery, Medical Oncology Unit, University of Naples Federico II, Via S Pansini 5, 80131, Naples, Italy
| | - Simone Mocellin
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 64 Gattamelata St, 35128, Padua, Italy.,Surgical Oncology, Veneto Oncology Institute, Via Gattamelata 64, 35128, Padua, Italy
| | - Jacopo Pigozzo
- Melanoma and Esophageal Cancer Unit, Istituto Oncologico Veneto-IRCCS, Via Gattamelata 64, 35128, Padua, Italy
| | - Vanna Chiarion-Sileni
- Melanoma and Esophageal Cancer Unit, Istituto Oncologico Veneto-IRCCS, Via Gattamelata 64, 35128, Padua, Italy
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28
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Lim KHJ, Spain L, Barker C, Georgiou A, Walls G, Gore M, Turajlic S, Board R, Larkin JM, Lorigan P. Contemporary outcomes from the use of regular imaging to detect relapse in high-risk cutaneous melanoma. ESMO Open 2018; 3:e000317. [PMID: 29531842 PMCID: PMC5844377 DOI: 10.1136/esmoopen-2017-000317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Agreement on the utility of imaging follow-up in patients with high-risk melanoma is lacking. A UK consensus statement recommends a surveillance schedule of CT or positron-emission tomography-CT and MRI brain (every 6 months for 3 years, then annually in years 4 and 5) as well as clinical examination for high-risk resected Stages II and III cutaneous melanoma. Our aim was to assess patterns of relapse and whether imaging surveillance could be of clinical benefit. PATIENTS AND METHODS A retrospective study of patients enrolled between July 2013 and June 2015 from three UK tertiary cancer centres followed-up according to this protocol was undertaken. We evaluated time-to-recurrence (TTR), recurrence-free survival (RFS), method of detection and characteristics of recurrence, treatment received and overall survival (OS). RESULTS A total of 173 patients were included. Most (79%) had treated Stages IIIB and IIIC disease. With a median follow-up of 23.3 months, 82 patients (47%) had relapsed. Median TTR was 10.1 months and median RFS was 21.2 months. The majority of recurrences (66%) were asymptomatic and detected by scheduled surveillance scan. Fifty-six (68%) patients recurred with Stage IV disease, with a median OS of 25.3 months; 26 (31.7%) patients had a locoregional recurrence, median OS not reached (P=0.016). Patients who underwent surgery at recurrence for either Stage III (27%) or IV (18%) disease did not reach their median OS. The median OS for the 33 patients (40%) who received systemic therapy was 12.9 months. CONCLUSION Imaging appears to reliably detect subclinical disease and identify patients suitable for surgery, conferring favourable outcomes. The short median TTR provides rationale to intensify imaging schedule in the first year of surveillance. The poor OS of patients treated with systemic therapy probably reflects the relatively inferior treatment options during this time and requires further evaluation in the current era.
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Affiliation(s)
- Kok Haw Jonathan Lim
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Lavinia Spain
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Claire Barker
- Department of Medical Oncology, Royal Preston Hospital, Preston, Lancashire, UK
| | - Alexandros Georgiou
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Gerard Walls
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Martin Gore
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Samra Turajlic
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
- Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - Ruth Board
- Department of Medical Oncology, Royal Preston Hospital, Preston, Lancashire, UK
| | - James M Larkin
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Paul Lorigan
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Institute of Cancer Sciences, The University of Manchester, Manchester, UK
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29
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Brzozowska M, Wierzba W, Śliwczyński A, Świerkowski M, Potemski P, Marczak M. Analysis of survival of patients treated with vemurafenib, ipilimumab and dabrafenib for advanced skin melanoma in daily clinical practice (Real-World Data): retrospective analysis of patients treated under drug/reimbursement programmes in Poland in 2013-2016. Melanoma Res 2018; 28:52-55. [PMID: 29120964 DOI: 10.1097/cmr.0000000000000408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Vemurafenib, ipilimumab and dabrafenib were registered for the treatment of advanced skin melanoma pursuant to the results of randomized phase III clinical trials. Real-world data on survival time for patients treated with those drugs in daily clinical practice are so far limited. Patients with advanced skin melanoma treated under reimbursement programmes (drug programmes), for which they were qualified pursuant to uniform inclusion criteria in force in all oncology centres in Poland. Data were obtained from the electronic databases of the national payer (NFZ) responsible for the implementation and monitoring of reimbursement (drug) programmes. The analysis included all patients included for treatment with vemurafenib (since March of 2013), ipilimumab (since March of 2014) and dabrafenib (since July of 2015) until December 2016. The end date of the observation was set to 31 December 2016. The total survival analysis was performed using the Kaplan-Meier estimator. Until 31 December 2016, 759 patients were treated with vemurafenib, 370 with ipilimumab and 181 with dabrafenib. The overall survival (OS) median was 9.8 months for patients treated with vemurafenib (95% confidence interval: 8.8-10.6) and 6.9 months for patients treated with ipilimumab (95% confidence interval: 5.7-9.2). For patients treated with dabrafenib, the OS median was not reached because of an overly short observation period. The probability of surviving 12 months in the group of patients treated with vemurafenib was 40.5%, ipilimumab was 35.1% and dabrafenib was 60.7%. The probability of surviving 24 and 36 months in the group of patients treated with vemurafenib or ipilimumab amounted to, respectively, 20.1, 15.4 and 21, 18.8%. OS of patients with advanced melanoma treated in daily clinical practice may be comparable to the ones achieved in registration trials. The use of appropriate treatment inclusion criteria may affect the obtained OS.
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Affiliation(s)
| | - Waldemar Wierzba
- Satellite Campus in Warsaw, University of Humanities and Economics, Lodz
| | | | | | - Piotr Potemski
- Copernicus Memorial Hospital in Lodz, Comprehensive Cancer Center and Traumatology, Medical University of Lodz
| | - Michał Marczak
- Division of Quality Services, Procedures and Medical Standards
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30
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Wood O, Clarke J, Woo J, Mirza AH, Woelk CH, Thomas GJ, Vijayanand P, King E, Ottensmeier CH. Head and Neck Squamous Cell Carcinomas Are Characterized by a Stable Immune Signature Within the Primary Tumor Over Time and Space. Clin Cancer Res 2017; 23:7641-7649. [PMID: 28951517 DOI: 10.1158/1078-0432.ccr-17-0373] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/07/2017] [Accepted: 09/22/2017] [Indexed: 11/16/2022]
Abstract
Purpose: Genetic and morphologic heterogeneity is well-documented in solid cancers. Immune cells are also variably distributed within the tumor; this heterogeneity is difficult to assess in small biopsies, and may confound our understanding of the determinants of successful immunotherapy. We examined the transcriptomic variability of the immunologic signature in head and neck squamous cell carcinoma (HNSCC) within individual tumors using transcriptomic and IHC assessments.Experimental Design: Forty-four tumor biopsies from 16 HNSCC patients, taken at diagnosis and later at resection, were analyzed using RNA-sequencing. Variance filtering was used to identify the top 4,000 most variable genes. Principal component analysis, hierarchical clustering, and correlation analysis were performed. Gene expression of CD8A was correlated to IHC analysis.Results: Analysis of immunologic gene expression was highly consistent in replicates from the same cancer. Across the cohort, samples from the same patient were most similar to each other, both spatially (at diagnosis) and, notably, over time (diagnostic biopsy compared with resection); comparison of global gene expression by hierarchical clustering (P ≤ 0.0001) and correlation analysis [median intrapatient r = 0.82; median interpatient r = 0.63]. CD8A gene transcript counts were highly correlated with CD8 T-cell counts by IHC (r = 0.82).Conclusions: Our data demonstrate that in HNSCC the global tumor and adaptive immune signatures are stable between discrete parts of the same tumor and also at different timepoints. This suggests that immunologic heterogeneity may not be a key reason for failure of immunotherapy and underpins the use of transcriptomics for immunologic evaluation of novel agents in HNSCC patients. Clin Cancer Res; 23(24); 7641-9. ©2017 AACR.
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Affiliation(s)
- Oliver Wood
- Cancer Sciences & NIHR and CRUK Experimental Cancer Sciences Unit, University of Southampton, Southampton, United Kingdom
| | - James Clarke
- Cancer Sciences & NIHR and CRUK Experimental Cancer Sciences Unit, University of Southampton, Southampton, United Kingdom
| | - Jeongmin Woo
- Clinical & Experimental Sciences, University of Southampton, Southampton, United Kingdom
| | - Adal H Mirza
- Cancer Sciences & NIHR and CRUK Experimental Cancer Sciences Unit, University of Southampton, Southampton, United Kingdom
- Department of Otolaryngology, Poole Hospital NHS Foundation Trust, Poole, Dorset, United Kingdom
| | - Christopher H Woelk
- Clinical & Experimental Sciences, University of Southampton, Southampton, United Kingdom
| | - Gareth J Thomas
- Cancer Sciences & NIHR and CRUK Experimental Cancer Sciences Unit, University of Southampton, Southampton, United Kingdom
| | - Pandurangan Vijayanand
- Clinical & Experimental Sciences, University of Southampton, Southampton, United Kingdom
- La Jolla Institute for Allergy and Immunology, La Jolla, California
| | - Emma King
- Cancer Sciences & NIHR and CRUK Experimental Cancer Sciences Unit, University of Southampton, Southampton, United Kingdom
- Department of Otolaryngology, Poole Hospital NHS Foundation Trust, Poole, Dorset, United Kingdom
| | - Christian H Ottensmeier
- Cancer Sciences & NIHR and CRUK Experimental Cancer Sciences Unit, University of Southampton, Southampton, United Kingdom.
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31
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Ozaki Y, Shindoh J, Miura Y, Nakajima H, Oki R, Uchiyama M, Masuda J, Kinowaki K, Kondoh C, Tanabe Y, Tanaka T, Haruta S, Ueno M, Kitano S, Fujii T, Udagawa H, Takano T. Serial pseudoprogression of metastatic malignant melanoma in a patient treated with nivolumab: a case report. BMC Cancer 2017; 17:778. [PMID: 29162045 PMCID: PMC5696908 DOI: 10.1186/s12885-017-3785-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 11/14/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Pseudoprogression refers to a specific pattern of response sometimes observed in malignant melanoma patients receiving treatment with immune-checkpoint inhibitors. Although cases with pseudoprogression documented once have been reported previously, there have been no case reports yet of pseudoprogression events documented twice during treatment. CASE PRESENTATION A 55-year-old man underwent surgery for locally advanced esophageal malignant melanoma and received postoperative adjuvant interferon therapy. However, he presented with multiple liver and bone metastases at 6 months after the surgery, and was initiated on treatment with nivolumab 2 mg/kg every 3 weeks as the first-line treatment for recurrent disease. Follow-up computed tomography revealed that the liver metastases initially increased transiently in size, but eventually regressed. However, while the liver metastases continued to shrink, a new peritoneal nodule emerged, that also subsequently shrinked during the course of treatment with nivolumab. With only grade 1 pruritus, the patient continues to be on nivolumab treatment at 15 months after the induction therapy, with no progression observed after the second episode of pseudoprogression in the liver and peritoneal nodule. CONCLUSIONS We present the case of a patient with metastatic malignant melanoma who showed the unique response pattern of serial pseudoprogression during treatment with nivolumab. This case serves to highlight the fact that development of a new lesion may not always signify failure of disease control during treatment with nivolumab.
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Affiliation(s)
- Yukinori Ozaki
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470 Japan
- Okinaka Memorial Institute for Medical Disease, Tokyo, Japan
| | - Junichi Shindoh
- Hepatobiliary-pancreatic Surgery Division, Department of Digestive Surgery, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Disease, Tokyo, Japan
| | - Yuji Miura
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470 Japan
| | - Hiromichi Nakajima
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470 Japan
| | - Ryosuke Oki
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470 Japan
| | - Miyuki Uchiyama
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470 Japan
| | - Jun Masuda
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470 Japan
| | | | - Chihiro Kondoh
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470 Japan
| | - Yuko Tanabe
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470 Japan
| | - Tsuyoshi Tanaka
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Shusuke Haruta
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Masaki Ueno
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Shigehisa Kitano
- Department of Experimental Therapeutics, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Tokyo, Tsukiji Japan
| | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Harushi Udagawa
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Toshimi Takano
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470 Japan
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32
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Jessurun CAC, Vos JAM, Limpens J, Luiten RM. Biomarkers for Response of Melanoma Patients to Immune Checkpoint Inhibitors: A Systematic Review. Front Oncol 2017; 7:233. [PMID: 29034210 PMCID: PMC5625582 DOI: 10.3389/fonc.2017.00233] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/11/2017] [Indexed: 01/08/2023] Open
Abstract
Background Immune checkpoint inhibitors (ICIs), targeting CTLA-4 or PD-1 molecules, have shown impressive therapeutic results. However, only 20–40% of advanced melanoma patients have durable responses to ICI, and these positive effects must be balanced against severe off-target immune toxicity and high costs. This urges the development of predictive biomarkers for ICI response to select patients with likely clinical benefit from treatment. Although many candidate biomarkers exist, a systematic overview of biomarkers and their usefulness is lacking. Objectives Here, we systematically review the current literature of clinical data of ICI treatment to provide an overview of candidate predictive biomarkers for ICI in melanoma patients. Methods To identify studies on biomarkers for clinical response or survival to ICI therapy in melanoma patients, we performed a systematic search in OVID MEDLINE and retrieved 429 publications, of which 67 met the eligibility criteria. Results Blood and genomic biomarkers were mainly studied for CTLA-4 ICI, while tumor tissue markers were analyzed for both CTLA-4 and PD-1 ICI. Blood cytology and soluble factors correlated more frequently to overall survival (OS) than to response, indicating their prognostic rather than predictive nature. Systemic T-cell response and regulation markers correlated to response, but progression-free survival or OS were not analyzed. Tumor tissue analyses revealed response correlations with mutational load, neoantigen load, immune-related gene expression, and CD8+ T-cell infiltration at the invasive margin. The predictive value of PD-L1 varied, possibly due to the influence of T-cell infiltration on tumor PD-L1 expression. Genomic biomarker studies addressed CTLA-4 and other immune-related genes. Conclusion This review outlines all published biomarkers for ICI therapy and highlights potential candidate markers for future research. To date, PD-L1 is the best studied biomarker for PD-1 ICI response. The most promising candidate predictive biomarkers for ICI response have not yet been identified. Variations in outcome parameters, statistical power, and analyses hampered summary of the results. Further investigation of biomarkers in larger patient cohorts using standardized objectives and outcome measures is recommended.
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Affiliation(s)
- Charissa A C Jessurun
- Department of Dermatology and Netherlands Institute for Pigment Disorders, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Julien A M Vos
- Department of Dermatology and Netherlands Institute for Pigment Disorders, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Jacqueline Limpens
- Medical Library, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Rosalie M Luiten
- Department of Dermatology and Netherlands Institute for Pigment Disorders, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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Gaudy-Marqueste C, Dussouil AS, Carron R, Troin L, Malissen N, Loundou A, Monestier S, Mallet S, Richard MA, Régis JM, Grob JJ. Survival of melanoma patients treated with targeted therapy and immunotherapy after systematic upfront control of brain metastases by radiosurgery. Eur J Cancer 2017; 84:44-54. [PMID: 28783540 DOI: 10.1016/j.ejca.2017.07.017] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/16/2017] [Accepted: 07/11/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Targeted therapy (TT) and immunotherapies (ITs) have dramatically improved survival in metastatic melanoma (MM). However, their efficacy on brain metastasis (BM) remains limited and poorly documented. PATIENTS AND METHODS Retrospective cohort of consecutive MM patients (pts) with BMs, all systematically upfront treated by Gamma-Knife (GK) at first BM and retreated in case of new BMs, from 2010 to 2015 at the time when ipilimumab BRAF ± MEK inhibitors and anti-PD1 were introduced in practice. Survival after 1st GK (OSGK1) according to prognostic factors and treatment. RESULTS Among 179 consecutive pts treated by GK, 109 received IT and/or TT after the 1st GK. Median OSGK1 was 10.95 months and 1- and 2-year survival rates were 49.5% and 27.4%, respectively, versus a median overall survival (OS) of 2.29 months (p < .001) in those who did not receive IT or TT. In pts who initially had a single BM, median OS and 1- and 2-year survival rates were 14.46 months, 66.7% and 43.4%, respectively; in pts with 2-3 BMs: 8.85 months, 46.4% and 31%, respectively; in pts with >3 BMs: 7.25 months, 37.2% and 11.9%, respectively. Multivariate analysis for OSGK1 confirmed that IT and TT were significantly and highly protective. Best OSGK1 was observed in BRAF-wild-type pts receiving anti-PD1 or in BRAF-mutated pts receiving BRAF-inhibitors and anti-PD1 (12.26 and 14.82 months, respectively). CONCLUSION In real-life MM pts with BMs, a strategy aiming at controlling BM with GK together with TT and/or TT seems to achieve unprecedented survival rates.
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Affiliation(s)
- C Gaudy-Marqueste
- Dermatology and Skin Cancers Department, UMR911 CRO2, Aix-Marseille University, APHM, Marseille, France
| | - A S Dussouil
- Dermatology and Skin Cancers Department, UMR911 CRO2, Aix-Marseille University, APHM, Marseille, France
| | - R Carron
- Department of Stereotaxic and Functional Neurosurgery, Gamma-knife Unit, Inserm U751, Aix-Marseille University, APHM, Marseille, France
| | - L Troin
- Dermatology and Skin Cancers Department, UMR911 CRO2, Aix-Marseille University, APHM, Marseille, France
| | - N Malissen
- Dermatology and Skin Cancers Department, UMR911 CRO2, Aix-Marseille University, APHM, Marseille, France
| | - A Loundou
- Public Health Department, Aix-Marseille University, APHM, Marseille, France
| | - S Monestier
- Dermatology and Skin Cancers Department, UMR911 CRO2, Aix-Marseille University, APHM, Marseille, France
| | - S Mallet
- Dermatology and Skin Cancers Department, UMR911 CRO2, Aix-Marseille University, APHM, Marseille, France
| | - M A Richard
- Dermatology and Skin Cancers Department, UMR911 CRO2, Aix-Marseille University, APHM, Marseille, France
| | - J M Régis
- Department of Stereotaxic and Functional Neurosurgery, Gamma-knife Unit, Inserm U751, Aix-Marseille University, APHM, Marseille, France
| | - J J Grob
- Dermatology and Skin Cancers Department, UMR911 CRO2, Aix-Marseille University, APHM, Marseille, France.
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Utter K, Goldman C, Weiss SA, Shapiro RL, Berman RS, Wilson MA, Pavlick AC, Osman I. Treatment Outcomes for Metastatic Melanoma of Unknown Primary in the New Era: A Single-Institution Study and Review of the Literature. Oncology 2017; 93:249-258. [PMID: 28746931 DOI: 10.1159/000478050] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/28/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Metastatic melanoma of unknown primary (MUP) is uncommon, biologically ill defined, and clinically understudied. MUP outcomes are seldom reported in clinical trials. In this study, we analyze responses of MUP patients treated with systemic therapy in an attempt to inform treatment guidelines for this unique population. METHODS New York University (NYU)'s prospective melanoma database was searched for MUP patients treated with systemic therapy. PubMed and Google Scholar were searched for MUP patients treated with immunotherapy or targeted therapy reported in the literature, and their response and survival data were compared to the MUP patient data from NYU. Both groups' response data were compared to those reported for melanoma of known primary (MKP). RESULTS The MUP patients treated at NYU had better outcomes on immunotherapy but worse on targeted therapy than the MUP patients in the literature. The NYU MUP patients and those in the literature had worse outcomes than the majority-MKP populations in 10 clinical trial reports. CONCLUSIONS Our study suggests that MUP patients might have poorer outcomes on systemic therapy as compared to MKP patients. Our cohort was small and limited data were available, highlighting the need for increased reporting of MUP outcomes and multi-institutional efforts to understand the mechanism behind the observed differences.
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Affiliation(s)
- Kierstin Utter
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
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CASE STUDY ON AN IPILIMUMAB COST-CONTAINMENT STRATEGY IN AN ITALIAN HOSPITAL. Int J Technol Assess Health Care 2017; 33:199-205. [PMID: 28703084 DOI: 10.1017/s0266462317000332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Ipilimumab is the first licensed immune checkpoint inhibitor for treatment of melanoma. The promising results of the registration clinical study need confirmation in real practice and its clinical success comes together with a relevant budget impact due to the high price of this drug. The aim of this work is to describe a new model of economical sustainability of ipilimumab developed in an Italian reference center for melanoma treatment. METHODS This retrospective, observational, and monocentric study was carried out at the Veneto Institute of Oncology. Ipilimumab was administered to fifty-seven patients with advanced melanoma. Overall survival, progression free survival, and toxicity were evaluated. A local management procedure was evaluated together with the cost-saving strategies implemented by the Italian Medicines Agency (AIFA). RESULTS We demonstrated that the use of ipilimumab for metastatic melanoma in real practice had an efficacy and toxicity similar to that reported in the literature. In this scenario, our management model (centralization of compounding + drug-day) permitted savings up to the 11.1 percent of the gross cost for the drug (calculated assuming that no cost saving procedures were applied) while the policy of cost containment designed by AIFA produced an additional 6.2 percent of savings. CONCLUSIONS In real practice conditions, the centralized administration of ipilimumab allows to replicate the results of clinical studies and in the meantime to contain the cost associated with this drug. The local strategy of management can be readily applied to most of the high cost drugs compounded in the hospital pharmacy. Impact of findings on practice: (i) We describe a new model of economic sustainability (drug-day, centralization of compounding, payback systems) of an expensive and innovative drug, ipilimumab, for treatment of melanoma within an Italian cancer center. (ii) This pivotal study demonstrated that a cost containment strategy is feasible and it needs the cooperation of all healthcare providers (oncologists, pharmacists, nurses, and technicians) to guarantee the full efficiency of the process.
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Tan AC, Heimberger AB, Menzies AM, Pavlakis N, Khasraw M. Immune Checkpoint Inhibitors for Brain Metastases. Curr Oncol Rep 2017; 19:38. [DOI: 10.1007/s11912-017-0596-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Russi A, Damuzzo V, Chiumente M, Pigozzo J, Cesca M, Chiarion-Sileni V, Palozzo AC. Ipilimumab in real-world clinical practice: efficacy and safety data from a multicenter observational study. J Chemother 2017; 29:245-251. [DOI: 10.1080/1120009x.2017.1311444] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Alberto Russi
- Hospital Pharmacy, Veneto Institute of Oncology – IRCCS, Padua, Italy
| | - Vera Damuzzo
- School of Hospital Pharmacy, University of Padua, Padua, Italy
| | - Marco Chiumente
- Italian Society for Clinical Pharmacy and Therapeutics, Milan, Italy
| | - Jacopo Pigozzo
- Melanoma and Esophageal Oncology Unit, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | - Marco Cesca
- Hospital Pharmacy, Veneto Institute of Oncology – IRCCS, Padua, Italy
| | - Vanna Chiarion-Sileni
- Melanoma and Esophageal Oncology Unit, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
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Yang L, Yu H, Dong S, Zhong Y, Hu S. Recognizing and managing on toxicities in cancer immunotherapy. Tumour Biol 2017; 39:1010428317694542. [PMID: 28351299 DOI: 10.1177/1010428317694542] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Over the past 4 years, cancer immunotherapy has significantly prolonged survival time of patients with prostate cancer, melanoma, lung cancer, and liver cancer, but its side effects are also impressive. Different types of the immune therapeutic agents have different on-target or off-target toxicity due to high affinity or weak specificity, respectively. Treatment toxicity spectrums vary greatly even in patients with the same type of cancer. Common toxicities are fevers, chills, diarrhea colitis, maculopapular rash, hepatitis, and hormone gland disorder; therefore, routine monitoring of thyroid function, liver function, renal function, and complete blood count are absolutely necessary once treatment begins. Some side effects are reversible, and can be processed through the standard medicines. However, serious toxicities are lethal, which should be frequently followed-up, identified at an early stage and immediately symptomatic treated by high-dose immunosuppressors. In this case, thereafter, the same agent should not be challenged again.
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Affiliation(s)
- Liu Yang
- Department of Cancer Biotherapy Center, Hubei Cancer Hospital, Wuhan, China
| | - Huifang Yu
- Department of Cancer Biotherapy Center, Hubei Cancer Hospital, Wuhan, China
| | - Shuang Dong
- Department of Cancer Biotherapy Center, Hubei Cancer Hospital, Wuhan, China
| | - Yi Zhong
- Department of Cancer Biotherapy Center, Hubei Cancer Hospital, Wuhan, China
| | - Sheng Hu
- Department of Cancer Biotherapy Center, Hubei Cancer Hospital, Wuhan, China
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Bagley SJ, Kothari S, Aggarwal C, Bauml JM, Alley EW, Evans TL, Kosteva JA, Ciunci CA, Gabriel PE, Thompson JC, Stonehouse-Lee S, Sherry VE, Gilbert E, Eaby-Sandy B, Mutale F, DiLullo G, Cohen RB, Vachani A, Langer CJ. Pretreatment neutrophil-to-lymphocyte ratio as a marker of outcomes in nivolumab-treated patients with advanced non-small-cell lung cancer. Lung Cancer 2017; 106:1-7. [PMID: 28285682 DOI: 10.1016/j.lungcan.2017.01.013] [Citation(s) in RCA: 353] [Impact Index Per Article: 50.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 01/04/2017] [Accepted: 01/21/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Efficient use of nivolumab in non-small-cell lung cancer (NSCLC) has been limited by the lack of a definitive predictive biomarker. In patients with metastatic melanoma treated with ipilimumab, a pretreatment neutrophil-to-lymphocyte ratio (NLR)<5 has been associated with improved survival. This retrospective cohort study aimed to determine whether the pretreatment NLR was associated with outcomes in NSCLC patients treated with nivolumab. METHODS We reviewed the medical records of all patients with previously treated advanced NSCLC who received nivolumab between March 2015 and March 2016 outside of a clinical trial at the University of Pennsylvania. Patients were dichotomized according to pretreatment NLR<5 vs. ≥5. Multivariable logistic regression and Cox proportional hazards models were used to assess the impact of pretreatment NLR on overall survival (OS), progression-free survival (PFS), and overall response rate (ORR). RESULTS 175 patients were treated. Median age was 68 (range, 33-88); 54% were female. Twenty-five percent of patients had an Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≥2; 46% had received ≥2 prior systemic therapies. In multivariate analyses, pretreatment neutrophil-to-lymphocyte ratio (NLR) ≥5 was independently associated with inferior OS (median 5.5 vs. 8.4 months; HR 2.07, 95% CI 1.3-3.3; p=0.002) and inferior PFS (median 1.9 vs. 2.8 months; HR 1.43, 95% CI 1.02-2.0; p=0.04). CONCLUSIONS In a cohort of patients with NSCLC treated with nivolumab in routine practice, pretreatment NLR≥5 was associated with inferior outcomes. It is unclear whether this marker is predictive or prognostic. Prospective studies are warranted to determine the utility of NLR in the context of other biomarkers of programmed death-1 (PD-1) therapy.
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Affiliation(s)
- Stephen J Bagley
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Shawn Kothari
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Charu Aggarwal
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Joshua M Bauml
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Evan W Alley
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Tracey L Evans
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - John A Kosteva
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Christine A Ciunci
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Peter E Gabriel
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jeffrey C Thompson
- Division of Pulmonary, Allergy and Critical Care Medicine, Thoracic Oncology Group, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Susan Stonehouse-Lee
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Victoria E Sherry
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Elizabeth Gilbert
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Beth Eaby-Sandy
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Faith Mutale
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Gloria DiLullo
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Roger B Cohen
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Anil Vachani
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Corey J Langer
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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D'Angelo SP, Larkin J, Sosman JA, Lebbé C, Brady B, Neyns B, Schmidt H, Hassel JC, Hodi FS, Lorigan P, Savage KJ, Miller WH, Mohr P, Marquez-Rodas I, Charles J, Kaatz M, Sznol M, Weber JS, Shoushtari AN, Ruisi M, Jiang J, Wolchok JD. Efficacy and Safety of Nivolumab Alone or in Combination With Ipilimumab in Patients With Mucosal Melanoma: A Pooled Analysis. J Clin Oncol 2016; 35:226-235. [PMID: 28056206 DOI: 10.1200/jco.2016.67.9258] [Citation(s) in RCA: 404] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose Mucosal melanoma is an aggressive malignancy with a poor response to conventional therapies. The efficacy and safety of nivolumab (a programmed death-1 checkpoint inhibitor), alone or combined with ipilimumab (a cytotoxic T-lymphocyte antigen-4 checkpoint inhibitor), have not been reported in this rare melanoma subtype. Patients and Methods Data were pooled from 889 patients who received nivolumab monotherapy in clinical studies, including phase III trials; 86 (10%) had mucosal melanoma and 665 (75%) had cutaneous melanoma. Data were also pooled for patients who received nivolumab combined with ipilimumab (n = 35, mucosal melanoma; n = 326, cutaneous melanoma). Results Among patients who received nivolumab monotherapy, median progression-free survival was 3.0 months (95% CI, 2.2 to 5.4 months) and 6.2 months (95% CI, 5.1 to 7.5 months) for mucosal and cutaneous melanoma, with objective response rates of 23.3% (95% CI, 14.8% to 33.6%) and 40.9% (95% CI, 37.1% to 44.7%), respectively. Median progression-free survival in patients treated with nivolumab combined with ipilimumab was 5.9 months (95% CI, 2.8 months to not reached) and 11.7 months (95% CI, 8.9 to 16.7 months) for mucosal and cutaneous melanoma, with objective response rates of 37.1% (95% CI, 21.5% to 55.1%) and 60.4% (95% CI, 54.9% to 65.8%), respectively. For mucosal and cutaneous melanoma, respectively, the incidence of grade 3 or 4 treatment-related adverse events was 8.1% and 12.5% for nivolumab monotherapy and 40.0% and 54.9% for combination therapy. Conclusion To our knowledge, this is the largest analysis of data for anti-programmed death-1 therapy in mucosal melanoma to date. Nivolumab combined with ipilimumab seemed to have greater efficacy than either agent alone, and although the activity was lower in mucosal melanoma, the safety profile was similar between subtypes.
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Affiliation(s)
- Sandra P D'Angelo
- Sandra P. D'Angelo, Alexander N. Shoushtari, and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; James Larkin, Royal Marsden Hospital, London; Paul Lorigan, University of Manchester, Manchester, United Kingdom; Jeffrey A. Sosman, Vanderbilt University Medical Center, Nashville, TN; Celeste Lebbé, Saint-Louis Hospital, Institut National de la Santé et de la Recherche Médicale U976, Université Paris Diderot, Paris; Julie Charles, Grenoble University Hospital, Grenoble Alps University, Grenoble, France; Benjamin Brady, Cabrini Health, Melbourne, Australia; Bart Neyns, Universitair Ziekenhuis Brussel, Brussels, Belgium; Henrik Schmidt, Århus University, Åarhus, Denmark; Jessica C. Hassel, University Hospital Heidelberg, Heidelberg; Peter Mohr, Elbe Kliniken Buxtehude, Buxtehude; Martin Kaatz, SRH Waldklinikum Gera, University Hospital Jena, Jena, Germany; F. Stephen Hodi, Dana-Farber Cancer Institute, Boston, MA; Kerry J. Savage, BC Cancer Agency, University of British Columbia, Vancouver; Wilson H. Miller Jr, Lady Davis Institute and Jewish General Hospital, McGill University, Montreal, Canada; Ivan Marquez-Rodas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Jeffrey S. Weber, Moffitt Cancer Center, Tampa, FL; and Mary Ruisi and Joel Jiang, Bristol-Myers Squibb, Princeton, NJ
| | - James Larkin
- Sandra P. D'Angelo, Alexander N. Shoushtari, and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; James Larkin, Royal Marsden Hospital, London; Paul Lorigan, University of Manchester, Manchester, United Kingdom; Jeffrey A. Sosman, Vanderbilt University Medical Center, Nashville, TN; Celeste Lebbé, Saint-Louis Hospital, Institut National de la Santé et de la Recherche Médicale U976, Université Paris Diderot, Paris; Julie Charles, Grenoble University Hospital, Grenoble Alps University, Grenoble, France; Benjamin Brady, Cabrini Health, Melbourne, Australia; Bart Neyns, Universitair Ziekenhuis Brussel, Brussels, Belgium; Henrik Schmidt, Århus University, Åarhus, Denmark; Jessica C. Hassel, University Hospital Heidelberg, Heidelberg; Peter Mohr, Elbe Kliniken Buxtehude, Buxtehude; Martin Kaatz, SRH Waldklinikum Gera, University Hospital Jena, Jena, Germany; F. Stephen Hodi, Dana-Farber Cancer Institute, Boston, MA; Kerry J. Savage, BC Cancer Agency, University of British Columbia, Vancouver; Wilson H. Miller Jr, Lady Davis Institute and Jewish General Hospital, McGill University, Montreal, Canada; Ivan Marquez-Rodas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Jeffrey S. Weber, Moffitt Cancer Center, Tampa, FL; and Mary Ruisi and Joel Jiang, Bristol-Myers Squibb, Princeton, NJ
| | - Jeffrey A Sosman
- Sandra P. D'Angelo, Alexander N. Shoushtari, and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; James Larkin, Royal Marsden Hospital, London; Paul Lorigan, University of Manchester, Manchester, United Kingdom; Jeffrey A. Sosman, Vanderbilt University Medical Center, Nashville, TN; Celeste Lebbé, Saint-Louis Hospital, Institut National de la Santé et de la Recherche Médicale U976, Université Paris Diderot, Paris; Julie Charles, Grenoble University Hospital, Grenoble Alps University, Grenoble, France; Benjamin Brady, Cabrini Health, Melbourne, Australia; Bart Neyns, Universitair Ziekenhuis Brussel, Brussels, Belgium; Henrik Schmidt, Århus University, Åarhus, Denmark; Jessica C. Hassel, University Hospital Heidelberg, Heidelberg; Peter Mohr, Elbe Kliniken Buxtehude, Buxtehude; Martin Kaatz, SRH Waldklinikum Gera, University Hospital Jena, Jena, Germany; F. Stephen Hodi, Dana-Farber Cancer Institute, Boston, MA; Kerry J. Savage, BC Cancer Agency, University of British Columbia, Vancouver; Wilson H. Miller Jr, Lady Davis Institute and Jewish General Hospital, McGill University, Montreal, Canada; Ivan Marquez-Rodas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Jeffrey S. Weber, Moffitt Cancer Center, Tampa, FL; and Mary Ruisi and Joel Jiang, Bristol-Myers Squibb, Princeton, NJ
| | - Celeste Lebbé
- Sandra P. D'Angelo, Alexander N. Shoushtari, and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; James Larkin, Royal Marsden Hospital, London; Paul Lorigan, University of Manchester, Manchester, United Kingdom; Jeffrey A. Sosman, Vanderbilt University Medical Center, Nashville, TN; Celeste Lebbé, Saint-Louis Hospital, Institut National de la Santé et de la Recherche Médicale U976, Université Paris Diderot, Paris; Julie Charles, Grenoble University Hospital, Grenoble Alps University, Grenoble, France; Benjamin Brady, Cabrini Health, Melbourne, Australia; Bart Neyns, Universitair Ziekenhuis Brussel, Brussels, Belgium; Henrik Schmidt, Århus University, Åarhus, Denmark; Jessica C. Hassel, University Hospital Heidelberg, Heidelberg; Peter Mohr, Elbe Kliniken Buxtehude, Buxtehude; Martin Kaatz, SRH Waldklinikum Gera, University Hospital Jena, Jena, Germany; F. Stephen Hodi, Dana-Farber Cancer Institute, Boston, MA; Kerry J. Savage, BC Cancer Agency, University of British Columbia, Vancouver; Wilson H. Miller Jr, Lady Davis Institute and Jewish General Hospital, McGill University, Montreal, Canada; Ivan Marquez-Rodas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Jeffrey S. Weber, Moffitt Cancer Center, Tampa, FL; and Mary Ruisi and Joel Jiang, Bristol-Myers Squibb, Princeton, NJ
| | - Benjamin Brady
- Sandra P. D'Angelo, Alexander N. Shoushtari, and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; James Larkin, Royal Marsden Hospital, London; Paul Lorigan, University of Manchester, Manchester, United Kingdom; Jeffrey A. Sosman, Vanderbilt University Medical Center, Nashville, TN; Celeste Lebbé, Saint-Louis Hospital, Institut National de la Santé et de la Recherche Médicale U976, Université Paris Diderot, Paris; Julie Charles, Grenoble University Hospital, Grenoble Alps University, Grenoble, France; Benjamin Brady, Cabrini Health, Melbourne, Australia; Bart Neyns, Universitair Ziekenhuis Brussel, Brussels, Belgium; Henrik Schmidt, Århus University, Åarhus, Denmark; Jessica C. Hassel, University Hospital Heidelberg, Heidelberg; Peter Mohr, Elbe Kliniken Buxtehude, Buxtehude; Martin Kaatz, SRH Waldklinikum Gera, University Hospital Jena, Jena, Germany; F. Stephen Hodi, Dana-Farber Cancer Institute, Boston, MA; Kerry J. Savage, BC Cancer Agency, University of British Columbia, Vancouver; Wilson H. Miller Jr, Lady Davis Institute and Jewish General Hospital, McGill University, Montreal, Canada; Ivan Marquez-Rodas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Jeffrey S. Weber, Moffitt Cancer Center, Tampa, FL; and Mary Ruisi and Joel Jiang, Bristol-Myers Squibb, Princeton, NJ
| | - Bart Neyns
- Sandra P. D'Angelo, Alexander N. Shoushtari, and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; James Larkin, Royal Marsden Hospital, London; Paul Lorigan, University of Manchester, Manchester, United Kingdom; Jeffrey A. Sosman, Vanderbilt University Medical Center, Nashville, TN; Celeste Lebbé, Saint-Louis Hospital, Institut National de la Santé et de la Recherche Médicale U976, Université Paris Diderot, Paris; Julie Charles, Grenoble University Hospital, Grenoble Alps University, Grenoble, France; Benjamin Brady, Cabrini Health, Melbourne, Australia; Bart Neyns, Universitair Ziekenhuis Brussel, Brussels, Belgium; Henrik Schmidt, Århus University, Åarhus, Denmark; Jessica C. Hassel, University Hospital Heidelberg, Heidelberg; Peter Mohr, Elbe Kliniken Buxtehude, Buxtehude; Martin Kaatz, SRH Waldklinikum Gera, University Hospital Jena, Jena, Germany; F. Stephen Hodi, Dana-Farber Cancer Institute, Boston, MA; Kerry J. Savage, BC Cancer Agency, University of British Columbia, Vancouver; Wilson H. Miller Jr, Lady Davis Institute and Jewish General Hospital, McGill University, Montreal, Canada; Ivan Marquez-Rodas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Jeffrey S. Weber, Moffitt Cancer Center, Tampa, FL; and Mary Ruisi and Joel Jiang, Bristol-Myers Squibb, Princeton, NJ
| | - Henrik Schmidt
- Sandra P. D'Angelo, Alexander N. Shoushtari, and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; James Larkin, Royal Marsden Hospital, London; Paul Lorigan, University of Manchester, Manchester, United Kingdom; Jeffrey A. Sosman, Vanderbilt University Medical Center, Nashville, TN; Celeste Lebbé, Saint-Louis Hospital, Institut National de la Santé et de la Recherche Médicale U976, Université Paris Diderot, Paris; Julie Charles, Grenoble University Hospital, Grenoble Alps University, Grenoble, France; Benjamin Brady, Cabrini Health, Melbourne, Australia; Bart Neyns, Universitair Ziekenhuis Brussel, Brussels, Belgium; Henrik Schmidt, Århus University, Åarhus, Denmark; Jessica C. Hassel, University Hospital Heidelberg, Heidelberg; Peter Mohr, Elbe Kliniken Buxtehude, Buxtehude; Martin Kaatz, SRH Waldklinikum Gera, University Hospital Jena, Jena, Germany; F. Stephen Hodi, Dana-Farber Cancer Institute, Boston, MA; Kerry J. Savage, BC Cancer Agency, University of British Columbia, Vancouver; Wilson H. Miller Jr, Lady Davis Institute and Jewish General Hospital, McGill University, Montreal, Canada; Ivan Marquez-Rodas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Jeffrey S. Weber, Moffitt Cancer Center, Tampa, FL; and Mary Ruisi and Joel Jiang, Bristol-Myers Squibb, Princeton, NJ
| | - Jessica C Hassel
- Sandra P. D'Angelo, Alexander N. Shoushtari, and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; James Larkin, Royal Marsden Hospital, London; Paul Lorigan, University of Manchester, Manchester, United Kingdom; Jeffrey A. Sosman, Vanderbilt University Medical Center, Nashville, TN; Celeste Lebbé, Saint-Louis Hospital, Institut National de la Santé et de la Recherche Médicale U976, Université Paris Diderot, Paris; Julie Charles, Grenoble University Hospital, Grenoble Alps University, Grenoble, France; Benjamin Brady, Cabrini Health, Melbourne, Australia; Bart Neyns, Universitair Ziekenhuis Brussel, Brussels, Belgium; Henrik Schmidt, Århus University, Åarhus, Denmark; Jessica C. Hassel, University Hospital Heidelberg, Heidelberg; Peter Mohr, Elbe Kliniken Buxtehude, Buxtehude; Martin Kaatz, SRH Waldklinikum Gera, University Hospital Jena, Jena, Germany; F. Stephen Hodi, Dana-Farber Cancer Institute, Boston, MA; Kerry J. Savage, BC Cancer Agency, University of British Columbia, Vancouver; Wilson H. Miller Jr, Lady Davis Institute and Jewish General Hospital, McGill University, Montreal, Canada; Ivan Marquez-Rodas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Jeffrey S. Weber, Moffitt Cancer Center, Tampa, FL; and Mary Ruisi and Joel Jiang, Bristol-Myers Squibb, Princeton, NJ
| | - F Stephen Hodi
- Sandra P. D'Angelo, Alexander N. Shoushtari, and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; James Larkin, Royal Marsden Hospital, London; Paul Lorigan, University of Manchester, Manchester, United Kingdom; Jeffrey A. Sosman, Vanderbilt University Medical Center, Nashville, TN; Celeste Lebbé, Saint-Louis Hospital, Institut National de la Santé et de la Recherche Médicale U976, Université Paris Diderot, Paris; Julie Charles, Grenoble University Hospital, Grenoble Alps University, Grenoble, France; Benjamin Brady, Cabrini Health, Melbourne, Australia; Bart Neyns, Universitair Ziekenhuis Brussel, Brussels, Belgium; Henrik Schmidt, Århus University, Åarhus, Denmark; Jessica C. Hassel, University Hospital Heidelberg, Heidelberg; Peter Mohr, Elbe Kliniken Buxtehude, Buxtehude; Martin Kaatz, SRH Waldklinikum Gera, University Hospital Jena, Jena, Germany; F. Stephen Hodi, Dana-Farber Cancer Institute, Boston, MA; Kerry J. Savage, BC Cancer Agency, University of British Columbia, Vancouver; Wilson H. Miller Jr, Lady Davis Institute and Jewish General Hospital, McGill University, Montreal, Canada; Ivan Marquez-Rodas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Jeffrey S. Weber, Moffitt Cancer Center, Tampa, FL; and Mary Ruisi and Joel Jiang, Bristol-Myers Squibb, Princeton, NJ
| | - Paul Lorigan
- Sandra P. D'Angelo, Alexander N. Shoushtari, and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; James Larkin, Royal Marsden Hospital, London; Paul Lorigan, University of Manchester, Manchester, United Kingdom; Jeffrey A. Sosman, Vanderbilt University Medical Center, Nashville, TN; Celeste Lebbé, Saint-Louis Hospital, Institut National de la Santé et de la Recherche Médicale U976, Université Paris Diderot, Paris; Julie Charles, Grenoble University Hospital, Grenoble Alps University, Grenoble, France; Benjamin Brady, Cabrini Health, Melbourne, Australia; Bart Neyns, Universitair Ziekenhuis Brussel, Brussels, Belgium; Henrik Schmidt, Århus University, Åarhus, Denmark; Jessica C. Hassel, University Hospital Heidelberg, Heidelberg; Peter Mohr, Elbe Kliniken Buxtehude, Buxtehude; Martin Kaatz, SRH Waldklinikum Gera, University Hospital Jena, Jena, Germany; F. Stephen Hodi, Dana-Farber Cancer Institute, Boston, MA; Kerry J. Savage, BC Cancer Agency, University of British Columbia, Vancouver; Wilson H. Miller Jr, Lady Davis Institute and Jewish General Hospital, McGill University, Montreal, Canada; Ivan Marquez-Rodas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Jeffrey S. Weber, Moffitt Cancer Center, Tampa, FL; and Mary Ruisi and Joel Jiang, Bristol-Myers Squibb, Princeton, NJ
| | - Kerry J Savage
- Sandra P. D'Angelo, Alexander N. Shoushtari, and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; James Larkin, Royal Marsden Hospital, London; Paul Lorigan, University of Manchester, Manchester, United Kingdom; Jeffrey A. Sosman, Vanderbilt University Medical Center, Nashville, TN; Celeste Lebbé, Saint-Louis Hospital, Institut National de la Santé et de la Recherche Médicale U976, Université Paris Diderot, Paris; Julie Charles, Grenoble University Hospital, Grenoble Alps University, Grenoble, France; Benjamin Brady, Cabrini Health, Melbourne, Australia; Bart Neyns, Universitair Ziekenhuis Brussel, Brussels, Belgium; Henrik Schmidt, Århus University, Åarhus, Denmark; Jessica C. Hassel, University Hospital Heidelberg, Heidelberg; Peter Mohr, Elbe Kliniken Buxtehude, Buxtehude; Martin Kaatz, SRH Waldklinikum Gera, University Hospital Jena, Jena, Germany; F. Stephen Hodi, Dana-Farber Cancer Institute, Boston, MA; Kerry J. Savage, BC Cancer Agency, University of British Columbia, Vancouver; Wilson H. Miller Jr, Lady Davis Institute and Jewish General Hospital, McGill University, Montreal, Canada; Ivan Marquez-Rodas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Jeffrey S. Weber, Moffitt Cancer Center, Tampa, FL; and Mary Ruisi and Joel Jiang, Bristol-Myers Squibb, Princeton, NJ
| | - Wilson H Miller
- Sandra P. D'Angelo, Alexander N. Shoushtari, and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; James Larkin, Royal Marsden Hospital, London; Paul Lorigan, University of Manchester, Manchester, United Kingdom; Jeffrey A. Sosman, Vanderbilt University Medical Center, Nashville, TN; Celeste Lebbé, Saint-Louis Hospital, Institut National de la Santé et de la Recherche Médicale U976, Université Paris Diderot, Paris; Julie Charles, Grenoble University Hospital, Grenoble Alps University, Grenoble, France; Benjamin Brady, Cabrini Health, Melbourne, Australia; Bart Neyns, Universitair Ziekenhuis Brussel, Brussels, Belgium; Henrik Schmidt, Århus University, Åarhus, Denmark; Jessica C. Hassel, University Hospital Heidelberg, Heidelberg; Peter Mohr, Elbe Kliniken Buxtehude, Buxtehude; Martin Kaatz, SRH Waldklinikum Gera, University Hospital Jena, Jena, Germany; F. Stephen Hodi, Dana-Farber Cancer Institute, Boston, MA; Kerry J. Savage, BC Cancer Agency, University of British Columbia, Vancouver; Wilson H. Miller Jr, Lady Davis Institute and Jewish General Hospital, McGill University, Montreal, Canada; Ivan Marquez-Rodas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Jeffrey S. Weber, Moffitt Cancer Center, Tampa, FL; and Mary Ruisi and Joel Jiang, Bristol-Myers Squibb, Princeton, NJ
| | - Peter Mohr
- Sandra P. D'Angelo, Alexander N. Shoushtari, and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; James Larkin, Royal Marsden Hospital, London; Paul Lorigan, University of Manchester, Manchester, United Kingdom; Jeffrey A. Sosman, Vanderbilt University Medical Center, Nashville, TN; Celeste Lebbé, Saint-Louis Hospital, Institut National de la Santé et de la Recherche Médicale U976, Université Paris Diderot, Paris; Julie Charles, Grenoble University Hospital, Grenoble Alps University, Grenoble, France; Benjamin Brady, Cabrini Health, Melbourne, Australia; Bart Neyns, Universitair Ziekenhuis Brussel, Brussels, Belgium; Henrik Schmidt, Århus University, Åarhus, Denmark; Jessica C. Hassel, University Hospital Heidelberg, Heidelberg; Peter Mohr, Elbe Kliniken Buxtehude, Buxtehude; Martin Kaatz, SRH Waldklinikum Gera, University Hospital Jena, Jena, Germany; F. Stephen Hodi, Dana-Farber Cancer Institute, Boston, MA; Kerry J. Savage, BC Cancer Agency, University of British Columbia, Vancouver; Wilson H. Miller Jr, Lady Davis Institute and Jewish General Hospital, McGill University, Montreal, Canada; Ivan Marquez-Rodas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Jeffrey S. Weber, Moffitt Cancer Center, Tampa, FL; and Mary Ruisi and Joel Jiang, Bristol-Myers Squibb, Princeton, NJ
| | - Ivan Marquez-Rodas
- Sandra P. D'Angelo, Alexander N. Shoushtari, and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; James Larkin, Royal Marsden Hospital, London; Paul Lorigan, University of Manchester, Manchester, United Kingdom; Jeffrey A. Sosman, Vanderbilt University Medical Center, Nashville, TN; Celeste Lebbé, Saint-Louis Hospital, Institut National de la Santé et de la Recherche Médicale U976, Université Paris Diderot, Paris; Julie Charles, Grenoble University Hospital, Grenoble Alps University, Grenoble, France; Benjamin Brady, Cabrini Health, Melbourne, Australia; Bart Neyns, Universitair Ziekenhuis Brussel, Brussels, Belgium; Henrik Schmidt, Århus University, Åarhus, Denmark; Jessica C. Hassel, University Hospital Heidelberg, Heidelberg; Peter Mohr, Elbe Kliniken Buxtehude, Buxtehude; Martin Kaatz, SRH Waldklinikum Gera, University Hospital Jena, Jena, Germany; F. Stephen Hodi, Dana-Farber Cancer Institute, Boston, MA; Kerry J. Savage, BC Cancer Agency, University of British Columbia, Vancouver; Wilson H. Miller Jr, Lady Davis Institute and Jewish General Hospital, McGill University, Montreal, Canada; Ivan Marquez-Rodas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Jeffrey S. Weber, Moffitt Cancer Center, Tampa, FL; and Mary Ruisi and Joel Jiang, Bristol-Myers Squibb, Princeton, NJ
| | - Julie Charles
- Sandra P. D'Angelo, Alexander N. Shoushtari, and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; James Larkin, Royal Marsden Hospital, London; Paul Lorigan, University of Manchester, Manchester, United Kingdom; Jeffrey A. Sosman, Vanderbilt University Medical Center, Nashville, TN; Celeste Lebbé, Saint-Louis Hospital, Institut National de la Santé et de la Recherche Médicale U976, Université Paris Diderot, Paris; Julie Charles, Grenoble University Hospital, Grenoble Alps University, Grenoble, France; Benjamin Brady, Cabrini Health, Melbourne, Australia; Bart Neyns, Universitair Ziekenhuis Brussel, Brussels, Belgium; Henrik Schmidt, Århus University, Åarhus, Denmark; Jessica C. Hassel, University Hospital Heidelberg, Heidelberg; Peter Mohr, Elbe Kliniken Buxtehude, Buxtehude; Martin Kaatz, SRH Waldklinikum Gera, University Hospital Jena, Jena, Germany; F. Stephen Hodi, Dana-Farber Cancer Institute, Boston, MA; Kerry J. Savage, BC Cancer Agency, University of British Columbia, Vancouver; Wilson H. Miller Jr, Lady Davis Institute and Jewish General Hospital, McGill University, Montreal, Canada; Ivan Marquez-Rodas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Jeffrey S. Weber, Moffitt Cancer Center, Tampa, FL; and Mary Ruisi and Joel Jiang, Bristol-Myers Squibb, Princeton, NJ
| | - Martin Kaatz
- Sandra P. D'Angelo, Alexander N. Shoushtari, and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; James Larkin, Royal Marsden Hospital, London; Paul Lorigan, University of Manchester, Manchester, United Kingdom; Jeffrey A. Sosman, Vanderbilt University Medical Center, Nashville, TN; Celeste Lebbé, Saint-Louis Hospital, Institut National de la Santé et de la Recherche Médicale U976, Université Paris Diderot, Paris; Julie Charles, Grenoble University Hospital, Grenoble Alps University, Grenoble, France; Benjamin Brady, Cabrini Health, Melbourne, Australia; Bart Neyns, Universitair Ziekenhuis Brussel, Brussels, Belgium; Henrik Schmidt, Århus University, Åarhus, Denmark; Jessica C. Hassel, University Hospital Heidelberg, Heidelberg; Peter Mohr, Elbe Kliniken Buxtehude, Buxtehude; Martin Kaatz, SRH Waldklinikum Gera, University Hospital Jena, Jena, Germany; F. Stephen Hodi, Dana-Farber Cancer Institute, Boston, MA; Kerry J. Savage, BC Cancer Agency, University of British Columbia, Vancouver; Wilson H. Miller Jr, Lady Davis Institute and Jewish General Hospital, McGill University, Montreal, Canada; Ivan Marquez-Rodas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Jeffrey S. Weber, Moffitt Cancer Center, Tampa, FL; and Mary Ruisi and Joel Jiang, Bristol-Myers Squibb, Princeton, NJ
| | - Mario Sznol
- Sandra P. D'Angelo, Alexander N. Shoushtari, and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; James Larkin, Royal Marsden Hospital, London; Paul Lorigan, University of Manchester, Manchester, United Kingdom; Jeffrey A. Sosman, Vanderbilt University Medical Center, Nashville, TN; Celeste Lebbé, Saint-Louis Hospital, Institut National de la Santé et de la Recherche Médicale U976, Université Paris Diderot, Paris; Julie Charles, Grenoble University Hospital, Grenoble Alps University, Grenoble, France; Benjamin Brady, Cabrini Health, Melbourne, Australia; Bart Neyns, Universitair Ziekenhuis Brussel, Brussels, Belgium; Henrik Schmidt, Århus University, Åarhus, Denmark; Jessica C. Hassel, University Hospital Heidelberg, Heidelberg; Peter Mohr, Elbe Kliniken Buxtehude, Buxtehude; Martin Kaatz, SRH Waldklinikum Gera, University Hospital Jena, Jena, Germany; F. Stephen Hodi, Dana-Farber Cancer Institute, Boston, MA; Kerry J. Savage, BC Cancer Agency, University of British Columbia, Vancouver; Wilson H. Miller Jr, Lady Davis Institute and Jewish General Hospital, McGill University, Montreal, Canada; Ivan Marquez-Rodas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Jeffrey S. Weber, Moffitt Cancer Center, Tampa, FL; and Mary Ruisi and Joel Jiang, Bristol-Myers Squibb, Princeton, NJ
| | - Jeffrey S Weber
- Sandra P. D'Angelo, Alexander N. Shoushtari, and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; James Larkin, Royal Marsden Hospital, London; Paul Lorigan, University of Manchester, Manchester, United Kingdom; Jeffrey A. Sosman, Vanderbilt University Medical Center, Nashville, TN; Celeste Lebbé, Saint-Louis Hospital, Institut National de la Santé et de la Recherche Médicale U976, Université Paris Diderot, Paris; Julie Charles, Grenoble University Hospital, Grenoble Alps University, Grenoble, France; Benjamin Brady, Cabrini Health, Melbourne, Australia; Bart Neyns, Universitair Ziekenhuis Brussel, Brussels, Belgium; Henrik Schmidt, Århus University, Åarhus, Denmark; Jessica C. Hassel, University Hospital Heidelberg, Heidelberg; Peter Mohr, Elbe Kliniken Buxtehude, Buxtehude; Martin Kaatz, SRH Waldklinikum Gera, University Hospital Jena, Jena, Germany; F. Stephen Hodi, Dana-Farber Cancer Institute, Boston, MA; Kerry J. Savage, BC Cancer Agency, University of British Columbia, Vancouver; Wilson H. Miller Jr, Lady Davis Institute and Jewish General Hospital, McGill University, Montreal, Canada; Ivan Marquez-Rodas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Jeffrey S. Weber, Moffitt Cancer Center, Tampa, FL; and Mary Ruisi and Joel Jiang, Bristol-Myers Squibb, Princeton, NJ
| | - Alexander N Shoushtari
- Sandra P. D'Angelo, Alexander N. Shoushtari, and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; James Larkin, Royal Marsden Hospital, London; Paul Lorigan, University of Manchester, Manchester, United Kingdom; Jeffrey A. Sosman, Vanderbilt University Medical Center, Nashville, TN; Celeste Lebbé, Saint-Louis Hospital, Institut National de la Santé et de la Recherche Médicale U976, Université Paris Diderot, Paris; Julie Charles, Grenoble University Hospital, Grenoble Alps University, Grenoble, France; Benjamin Brady, Cabrini Health, Melbourne, Australia; Bart Neyns, Universitair Ziekenhuis Brussel, Brussels, Belgium; Henrik Schmidt, Århus University, Åarhus, Denmark; Jessica C. Hassel, University Hospital Heidelberg, Heidelberg; Peter Mohr, Elbe Kliniken Buxtehude, Buxtehude; Martin Kaatz, SRH Waldklinikum Gera, University Hospital Jena, Jena, Germany; F. Stephen Hodi, Dana-Farber Cancer Institute, Boston, MA; Kerry J. Savage, BC Cancer Agency, University of British Columbia, Vancouver; Wilson H. Miller Jr, Lady Davis Institute and Jewish General Hospital, McGill University, Montreal, Canada; Ivan Marquez-Rodas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Jeffrey S. Weber, Moffitt Cancer Center, Tampa, FL; and Mary Ruisi and Joel Jiang, Bristol-Myers Squibb, Princeton, NJ
| | - Mary Ruisi
- Sandra P. D'Angelo, Alexander N. Shoushtari, and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; James Larkin, Royal Marsden Hospital, London; Paul Lorigan, University of Manchester, Manchester, United Kingdom; Jeffrey A. Sosman, Vanderbilt University Medical Center, Nashville, TN; Celeste Lebbé, Saint-Louis Hospital, Institut National de la Santé et de la Recherche Médicale U976, Université Paris Diderot, Paris; Julie Charles, Grenoble University Hospital, Grenoble Alps University, Grenoble, France; Benjamin Brady, Cabrini Health, Melbourne, Australia; Bart Neyns, Universitair Ziekenhuis Brussel, Brussels, Belgium; Henrik Schmidt, Århus University, Åarhus, Denmark; Jessica C. Hassel, University Hospital Heidelberg, Heidelberg; Peter Mohr, Elbe Kliniken Buxtehude, Buxtehude; Martin Kaatz, SRH Waldklinikum Gera, University Hospital Jena, Jena, Germany; F. Stephen Hodi, Dana-Farber Cancer Institute, Boston, MA; Kerry J. Savage, BC Cancer Agency, University of British Columbia, Vancouver; Wilson H. Miller Jr, Lady Davis Institute and Jewish General Hospital, McGill University, Montreal, Canada; Ivan Marquez-Rodas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Jeffrey S. Weber, Moffitt Cancer Center, Tampa, FL; and Mary Ruisi and Joel Jiang, Bristol-Myers Squibb, Princeton, NJ
| | - Joel Jiang
- Sandra P. D'Angelo, Alexander N. Shoushtari, and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; James Larkin, Royal Marsden Hospital, London; Paul Lorigan, University of Manchester, Manchester, United Kingdom; Jeffrey A. Sosman, Vanderbilt University Medical Center, Nashville, TN; Celeste Lebbé, Saint-Louis Hospital, Institut National de la Santé et de la Recherche Médicale U976, Université Paris Diderot, Paris; Julie Charles, Grenoble University Hospital, Grenoble Alps University, Grenoble, France; Benjamin Brady, Cabrini Health, Melbourne, Australia; Bart Neyns, Universitair Ziekenhuis Brussel, Brussels, Belgium; Henrik Schmidt, Århus University, Åarhus, Denmark; Jessica C. Hassel, University Hospital Heidelberg, Heidelberg; Peter Mohr, Elbe Kliniken Buxtehude, Buxtehude; Martin Kaatz, SRH Waldklinikum Gera, University Hospital Jena, Jena, Germany; F. Stephen Hodi, Dana-Farber Cancer Institute, Boston, MA; Kerry J. Savage, BC Cancer Agency, University of British Columbia, Vancouver; Wilson H. Miller Jr, Lady Davis Institute and Jewish General Hospital, McGill University, Montreal, Canada; Ivan Marquez-Rodas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Jeffrey S. Weber, Moffitt Cancer Center, Tampa, FL; and Mary Ruisi and Joel Jiang, Bristol-Myers Squibb, Princeton, NJ
| | - Jedd D Wolchok
- Sandra P. D'Angelo, Alexander N. Shoushtari, and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; James Larkin, Royal Marsden Hospital, London; Paul Lorigan, University of Manchester, Manchester, United Kingdom; Jeffrey A. Sosman, Vanderbilt University Medical Center, Nashville, TN; Celeste Lebbé, Saint-Louis Hospital, Institut National de la Santé et de la Recherche Médicale U976, Université Paris Diderot, Paris; Julie Charles, Grenoble University Hospital, Grenoble Alps University, Grenoble, France; Benjamin Brady, Cabrini Health, Melbourne, Australia; Bart Neyns, Universitair Ziekenhuis Brussel, Brussels, Belgium; Henrik Schmidt, Århus University, Åarhus, Denmark; Jessica C. Hassel, University Hospital Heidelberg, Heidelberg; Peter Mohr, Elbe Kliniken Buxtehude, Buxtehude; Martin Kaatz, SRH Waldklinikum Gera, University Hospital Jena, Jena, Germany; F. Stephen Hodi, Dana-Farber Cancer Institute, Boston, MA; Kerry J. Savage, BC Cancer Agency, University of British Columbia, Vancouver; Wilson H. Miller Jr, Lady Davis Institute and Jewish General Hospital, McGill University, Montreal, Canada; Ivan Marquez-Rodas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Mario Sznol, Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT; Jeffrey S. Weber, Moffitt Cancer Center, Tampa, FL; and Mary Ruisi and Joel Jiang, Bristol-Myers Squibb, Princeton, NJ
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Rapoport BL, Vorobiof DA, Dreosti LM, Nosworthy A, McAdam G, Jordaan JP, Miller-Jansön H, de Necker M, de Beer JC, Duvenhage H. Ipilimumab in Pretreated Patients With Advanced Malignant Melanoma: Results of the South African Expanded-Access Program. J Glob Oncol 2016; 3:515-523. [PMID: 29094091 PMCID: PMC5646890 DOI: 10.1200/jgo.2016.006544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose The primary objective of this study was to evaluate 1- and 2-year survival rates and durable remissions in pretreated patients with advanced (unresectable or metastatic) malignant melanoma treated with ipilimumab in a South African expanded-access program (SA-EAP). Patients and Methods This multicenter, retrospective study obtained data from pretreated patients with advanced malignant melanoma who were eligible for the ipilimumab SA-EAP. Ipilimumab was administered at a dose of 3 mg/kg intravenously every 3 weeks for four cycles to adults with advanced melanoma for whom at least one line of treatment for metastatic disease had failed. Data from the medical records of 108 patients treated within the SA-EAP were collected and statistically analyzed to determine overall (OS) and progression-free survival (PFS) at 1 and 2 years. Results In the population of 108 patients, a median OS of 8.98 months (95% CI, 7.47 to 10.79 months) was observed. One-year OS was 36% (95% CI, 26% to 45%), and 2-year survival was observed as 20% (95% CI, 12% to 27%). The median survival without progression (ie, PFS) was 3.44 months (95% CI, 2.98 to 4.16 months), and 1- and 2-year PFS were 22% (95% CI, 14% to 29%) and 14% (95% CI, 8% to 21%), respectively. The longest recorded survival was 3.4 years. No independent prognostic variables were identified to predict for OS by multivariate Cox proportional hazards model. Conclusion In this multicenter South African setting, ipilimumab at a dose of 3 mg/kg was an effective treatment with long-term OS in a subset of patients with pretreated advanced malignant melanoma.
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Affiliation(s)
- Bernardo L Rapoport
- , Medical Oncology Centre of Rosebank; , Sandton Oncology Center; , Wits Oncology Donald Gordon Medical Center; , Bristol-Myers Squibb South Africa, Johannesburg; , University of Pretoria, Pretoria; , Rondebosch Oncology Medical Center, Cape Town; , Westridge Oncology Center, Durban; and , , and , HEXOR, Midrand, South Africa
| | - Daniel A Vorobiof
- , Medical Oncology Centre of Rosebank; , Sandton Oncology Center; , Wits Oncology Donald Gordon Medical Center; , Bristol-Myers Squibb South Africa, Johannesburg; , University of Pretoria, Pretoria; , Rondebosch Oncology Medical Center, Cape Town; , Westridge Oncology Center, Durban; and , , and , HEXOR, Midrand, South Africa
| | - Lydia M Dreosti
- , Medical Oncology Centre of Rosebank; , Sandton Oncology Center; , Wits Oncology Donald Gordon Medical Center; , Bristol-Myers Squibb South Africa, Johannesburg; , University of Pretoria, Pretoria; , Rondebosch Oncology Medical Center, Cape Town; , Westridge Oncology Center, Durban; and , , and , HEXOR, Midrand, South Africa
| | - Adam Nosworthy
- , Medical Oncology Centre of Rosebank; , Sandton Oncology Center; , Wits Oncology Donald Gordon Medical Center; , Bristol-Myers Squibb South Africa, Johannesburg; , University of Pretoria, Pretoria; , Rondebosch Oncology Medical Center, Cape Town; , Westridge Oncology Center, Durban; and , , and , HEXOR, Midrand, South Africa
| | - Georgina McAdam
- , Medical Oncology Centre of Rosebank; , Sandton Oncology Center; , Wits Oncology Donald Gordon Medical Center; , Bristol-Myers Squibb South Africa, Johannesburg; , University of Pretoria, Pretoria; , Rondebosch Oncology Medical Center, Cape Town; , Westridge Oncology Center, Durban; and , , and , HEXOR, Midrand, South Africa
| | - Johan P Jordaan
- , Medical Oncology Centre of Rosebank; , Sandton Oncology Center; , Wits Oncology Donald Gordon Medical Center; , Bristol-Myers Squibb South Africa, Johannesburg; , University of Pretoria, Pretoria; , Rondebosch Oncology Medical Center, Cape Town; , Westridge Oncology Center, Durban; and , , and , HEXOR, Midrand, South Africa
| | - Helen Miller-Jansön
- , Medical Oncology Centre of Rosebank; , Sandton Oncology Center; , Wits Oncology Donald Gordon Medical Center; , Bristol-Myers Squibb South Africa, Johannesburg; , University of Pretoria, Pretoria; , Rondebosch Oncology Medical Center, Cape Town; , Westridge Oncology Center, Durban; and , , and , HEXOR, Midrand, South Africa
| | - Margreet de Necker
- , Medical Oncology Centre of Rosebank; , Sandton Oncology Center; , Wits Oncology Donald Gordon Medical Center; , Bristol-Myers Squibb South Africa, Johannesburg; , University of Pretoria, Pretoria; , Rondebosch Oncology Medical Center, Cape Town; , Westridge Oncology Center, Durban; and , , and , HEXOR, Midrand, South Africa
| | - Janetta C de Beer
- , Medical Oncology Centre of Rosebank; , Sandton Oncology Center; , Wits Oncology Donald Gordon Medical Center; , Bristol-Myers Squibb South Africa, Johannesburg; , University of Pretoria, Pretoria; , Rondebosch Oncology Medical Center, Cape Town; , Westridge Oncology Center, Durban; and , , and , HEXOR, Midrand, South Africa
| | - Hennie Duvenhage
- , Medical Oncology Centre of Rosebank; , Sandton Oncology Center; , Wits Oncology Donald Gordon Medical Center; , Bristol-Myers Squibb South Africa, Johannesburg; , University of Pretoria, Pretoria; , Rondebosch Oncology Medical Center, Cape Town; , Westridge Oncology Center, Durban; and , , and , HEXOR, Midrand, South Africa
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Zaragoza J, Kervarrec T, Touzé A, Avenel-Audran M, Beneton N, Esteve E, Wierzbicka Hainaut E, Aubin F, Machet L, Samimi M. A high neutrophil-to-lymphocyte ratio as a potential marker of mortality in patients with Merkel cell carcinoma: A retrospective study. J Am Acad Dermatol 2016; 75:712-721.e1. [PMID: 27544490 DOI: 10.1016/j.jaad.2016.05.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 04/11/2016] [Accepted: 05/29/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND The prognostic relevance of a high blood neutrophil-to-lymphocyte ratio (NLR) has been reported in many cancers, although, to our knowledge, not investigated in patients with Merkel cell carcinoma (MCC) to date. OBJECTIVE We assessed whether the NLR at baseline was associated with specific survival and recurrence-free survival in MCC. METHODS We retrospectively included MCC cases between 1999 and 2015 and collected clinical data, blood cell count at baseline, and outcome. A Cox model was used to identify factors associated with recurrence and death from MCC. RESULTS Among the 75 patients included in the study, a high NLR at baseline (NLR ≥4) was associated with death from MCC in univariate (hazard ratio 2.76, 95% confidence interval 1.15-6.62, P = .023) and multivariate (hazard ratio 3.30, 95% confidence interval 1.21-9.01, P = .020) analysis, but not with recurrence. LIMITATIONS Because of the retrospective design, we excluded patients with missing data and not all confounding factors that may influence the NLR were available. CONCLUSION A high NLR at baseline was independently associated with specific mortality in patients with MCC. The NLR seems to constitute an easily available and inexpensive prognostic biomarker at baseline.
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Affiliation(s)
- Julia Zaragoza
- Department of Dermatology, Centre Hospitalier Universitaire Tours, Université François Rabelais, Tours, France
| | - Thibault Kervarrec
- Department of Pathology, Centre Hospitalier Universitaire Tours, Université François Rabelais, Tours, France
| | - Antoine Touzé
- Institut National de la Recherche Agronomique, Unité Mixte de Recherche 1282 Infectiologie et Santé Publique, Université François Rabelais, Tours, France
| | - Martine Avenel-Audran
- Dermatology Department, Centre Hospitalier Universitaire Angers, L'Université Nantes Angers Le Mans (LUNAM), Angers, France
| | - Nathalie Beneton
- Dermatology Department, Centre Hospitalier Régional Le Mans, Le Mans, France
| | - Eric Esteve
- Dermatology Department, Centre Hospitalier Régional Orléans, Orléans, France
| | | | - François Aubin
- Dermatology Department, Centre Hospitalier Universitaire Besançon, Université de Franche Comté, Equipe d'Accueil 3181, Institut Fédératif de Recherche 133, Besançon, France
| | - Laurent Machet
- Department of Dermatology, Centre Hospitalier Universitaire Tours, Université François Rabelais, Tours, France
| | - Mahtab Samimi
- Department of Dermatology, Centre Hospitalier Universitaire Tours, Université François Rabelais, Tours, France; Institut National de la Recherche Agronomique, Unité Mixte de Recherche 1282 Infectiologie et Santé Publique, Université François Rabelais, Tours, France.
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Savoia P, Astrua C, Fava P. Ipilimumab (Anti-Ctla-4 Mab) in the treatment of metastatic melanoma: Effectiveness and toxicity management. Hum Vaccin Immunother 2016; 12:1092-101. [PMID: 26889818 PMCID: PMC4963052 DOI: 10.1080/21645515.2015.1129478] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/19/2015] [Accepted: 12/04/2015] [Indexed: 12/25/2022] Open
Abstract
In the last years the onset of new therapies changed the management of malignant melanoma. Anti CTLA-4 antibody ipilimumab was the first drug to achieve a significant improvement in survival of advanced stage melanoma. This new therapeutic agent is characterized by a number of side effects that are totally different from those of traditional chemotherapy, mainly caused by the immune system activation. The purpose of this paper is to underline the central role of ipilimumab in the treatment of metastatic melanoma and to characterize related adverse events in terms of incidence, duration and severity of presentation. The early recognition of these side effects is crucial in order to ensure an appropriate management of the toxicities, thus reducing the long term clinical sequelae and the inappropriate treatment discontinuation.
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Affiliation(s)
- Paola Savoia
- Department of Medical Sciences, University of Turin, Turin, Italy
- Department of Health Science, “A. Avogadro” University of Eastern Piedmont, Novara, Italy
| | - Chiara Astrua
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paolo Fava
- Department of Medical Sciences, University of Turin, Turin, Italy
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Jung M, Lee J, Kim TM, Lee DH, Kang JH, Oh SY, Lee SJ, Shin SJ. Ipilimumab Real-World Efficacy and Safety in Korean Melanoma Patients from the Korean Named-Patient Program Cohort. Cancer Res Treat 2016; 49:44-53. [PMID: 27121719 PMCID: PMC5266404 DOI: 10.4143/crt.2016.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/06/2016] [Indexed: 12/28/2022] Open
Abstract
Purpose Ipilimumab improves survival in advanced melanoma patients. However, the efficacy and safety of ipilimumab has not been evaluated in Asian melanoma patients with a high frequency of mucosal and acral melanoma subtypes. Materials and Methods Advanced melanoma patients treated with 3 mg/kg ipilimumab in a Korean multicenter named-patient program (NPP) were evaluated between September 2014 and July 2015. Baseline characteristics and blood parameters including neutrophil to lymphocyte ratio (NLR) were assessed, and outcome and adverse events were evaluated according to subtypes. Results A total of 104 advanced melanoma patients were treated. The primary sites were acral (31.7%), mucosal (26%), cutaneous (26%), uveal (9.6%), and unknown (6.7%). Sixty-eight patients (65.4%) experienced adverse events, and the most common toxicity was skin rash (22.1%), 10 patients (9.6%) experienced adverse events of grade 3 or higher. The median progression-free survival (PFS) was 2.73 months (95% confidence interval, 2.67 to 2.85), and there was no difference in PFS according to subtypes. Poor performance status, liver metastasis, and NLR (≥ 5) were independent poor prognostic factors by multivariate analysis. Conclusion In the Korean NPP cohort, ipilimumab showed similar efficacy and tolerability compared to Western patients, regardless of subtypes. All subtypes should benefit from ipilimumab with consideration of performance status, liver metastasis, and NLR.
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Affiliation(s)
- Minkyu Jung
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jeeyun Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dae Ho Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Hyung Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Young Oh
- Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Soo Jung Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sang Joon Shin
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
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Nishijima TF, Muss HB, Shachar SS, Moschos SJ. Comparison of efficacy of immune checkpoint inhibitors (ICIs) between younger and older patients: A systematic review and meta-analysis. Cancer Treat Rev 2016; 45:30-7. [DOI: 10.1016/j.ctrv.2016.02.006] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 02/17/2016] [Accepted: 02/21/2016] [Indexed: 12/13/2022]
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Abstract
As calculated by the meta-analysis of Korn et al., the prognosis of metastatic melanoma in the pretarget and immunological therapy era was poor, with a median survival of 6.2 and a 1-year life expectancy of 25.5%. Nowadays, significant advances in melanoma treatment have been gained, and immunotherapy is one of the promising approaches to get to durable responses and survival improvement. The aim of the present review is to highlight the recent innovations in melanoma immunotherapy and to propose a critical perspective of the future directions of this enthralling oncology subspecialty.
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Affiliation(s)
- Sara Valpione
- Christie Hospital NHS Foundation Trust, 550 Wilmslow Rd, Manchester, M20 4BX, UK
| | - Luca G Campana
- Department of Surgery, Oncology & Gastroenterology, University of Padova, via Gattamelata 64, 35128 Padova, Italy
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Ajithkumar T, Parkinson C, Fife K, Corrie P, Jefferies S. Evolving treatment options for melanoma brain metastases. Lancet Oncol 2016; 16:e486-97. [PMID: 26433822 DOI: 10.1016/s1470-2045(15)00141-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 07/04/2015] [Accepted: 07/08/2015] [Indexed: 11/28/2022]
Abstract
Melanoma is a leading cause of lost productivity due to premature cancer mortality. Melanoma frequently spreads to the brain and is associated with rapid deterioration in quality and quantity of life. Until now, treatment options have been restricted to surgery and radiotherapy, although neither modality has been well studied in clinical trials. However, the new immune checkpoint inhibitors and molecularly targeted agents that have been introduced for treatment of metastatic melanoma are active against brain metastases and offer new opportunities to improve disease outcomes. New challenges arise, including how to integrate or sequence multiple treatment modalities, and current practice varies widely. In this Review, we summarise evidence for the treatment of melanoma brain metastases, and discuss the rationale and evidence for combination modalities, highlighting areas for future research.
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Affiliation(s)
- Thankamma Ajithkumar
- Department of Oncology, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK.
| | - Christine Parkinson
- Department of Oncology, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
| | - Kate Fife
- Department of Oncology, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
| | - Pippa Corrie
- Department of Oncology, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
| | - Sarah Jefferies
- Department of Oncology, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
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