1
|
Raemy A, May L, Sala N, Diezi M, Beck-Popovic M, Broome M. Anti-MAPK Targeted Therapy for Ameloblastoma: Case Report with a Systematic Review. Cancers (Basel) 2024; 16:2174. [PMID: 38927880 PMCID: PMC11201667 DOI: 10.3390/cancers16122174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 05/30/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
Ameloblastoma, a benign yet aggressive odontogenic tumor known for its recurrence and the severe morbidity from radical surgeries, may benefit from advancements in targeted therapy. We present a case of a 15-year-old girl with ameloblastoma successfully treated with targeted therapy and review the literature with this question: Is anti-MAPK targeted therapy safe and effective for treating ameloblastoma? This systematic review was registered in PROSPERO, adhered to PRISMA guidelines, and searched multiple databases up to December 2023, identifying 13 relevant studies out of 647 records, covering 23 patients treated with MAPK inhibitor therapies. The results were promising as nearly all patients showed a positive treatment response, with four achieving complete radiological remission and others showing substantial reductions in primary, recurrent, and metastatic ameloblastoma sizes. Side effects were mostly mild to moderate. This study presents anti-MAPK therapy as a significant shift from invasive surgical treatments, potentially enhancing life quality and clinical outcomes by offering a less invasive yet effective treatment alternative. This approach could signify a breakthrough in managing this challenging tumor, emphasizing the need for further research into molecular-targeted therapies.
Collapse
Affiliation(s)
- Anton Raemy
- Department of Maxillofacial Surgery, Lausanne University Hospital, 1011 Lausanne, Switzerland; (L.M.); (M.B.)
| | - Laurence May
- Department of Maxillofacial Surgery, Lausanne University Hospital, 1011 Lausanne, Switzerland; (L.M.); (M.B.)
| | - Nathalie Sala
- Institute of Pathology, Lausanne University Hospital, 1011 Lausanne, Switzerland;
| | - Manuel Diezi
- Department of Paediatric Oncology, Lausanne University Hospital, 1011 Lausanne, Switzerland; (M.D.); (M.B.-P.)
| | - Maja Beck-Popovic
- Department of Paediatric Oncology, Lausanne University Hospital, 1011 Lausanne, Switzerland; (M.D.); (M.B.-P.)
| | - Martin Broome
- Department of Maxillofacial Surgery, Lausanne University Hospital, 1011 Lausanne, Switzerland; (L.M.); (M.B.)
| |
Collapse
|
2
|
Tolerability of BRAF and MEK Inhibitors for Metastasized Melanoma after Intra-Class Switch: A Multicenter, Retrospective Study. Cancers (Basel) 2023; 15:cancers15051426. [PMID: 36900217 PMCID: PMC10001327 DOI: 10.3390/cancers15051426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023] Open
Abstract
Targeted therapy with BRAF and MEK inhibitors (BRAFi, MEKi) is one of the mainstays of melanoma treatment. When dose-limiting toxicity (DLT) is observed, an option represents the intra-class switch to a different BRAFi+MEKi combination. Currently, there is scarce evidence for this procedure. This is a multicenter, retrospective analysis from six German skin cancer centers of patients who received two different combinations of BRAFi and MEKi. In total, 94 patients were included: 38 patients (40%) were re-exposed with a different combination because of previous unacceptable toxicity, 51 (54%) were re-exposed after progression, and 5 (5%) were included for other reasons. Of the 44 patients with a DLT during their first BRAFi+MEKi combination, only five (11%) experienced the same DLT during their second combination. A new DLT was experienced by 13 patients (30%). Six patients (14%) had to discontinue the second BRAFi treatment due to its toxicity. Compound-specific adverse events were avoided in the majority of patients by switching to a different combination. Efficacy data were similar to historical cohorts of BRAFi+MEKi rechallenge, with an overall response rate of 31% for patients who had previously progressed to treatment. We conclude that switching to a different BRAFi+MEKi combination if dose-limiting toxicity occurs is a feasible and rational approach in patients with metastatic melanoma.
Collapse
|
3
|
Lee J, Ahmed T, Maurichi A, Di Guardo L, Stagno AM, Warburton L, Taylor AM, Livingstone E, Rehman S, Khattak A, Kahler KC, Vanella V, Atkinson V, Millward M, Schadendorf D, Johnson DB, Ascierto PA, Hauschild A, Lo SN, Long GV, Menzies AM, Carlino MS. BRAF inhibitor cessation prior to disease progression in metastatic melanoma: Long-term outcomes. Eur J Cancer 2023; 179:87-97. [PMID: 36509002 DOI: 10.1016/j.ejca.2022.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/01/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND BRAF mutant melanoma treated with BRAF ± MEK inhibitor (targeted therapy) has a high response rate; however, most patients progress (PD). Some patients have durable response, but it is unknown whether treatment can be discontinued in these patients. We describe the recurrence risk, progression patterns, response to subsequent treatment, and survival of patients with advanced melanoma who ceased targeted therapy prior to PD. PATIENTS AND METHODS Ninety-four patients who ceased targeted therapy without progression were identified retrospectively from 11 centres: 45 were male; 81 V600E; 88 stage IV. Fifty-nine were treated with BRAF + MEK inhibitor, and 35 were treated with BRAF inhibitor alone. Median treatment duration was 29.6 months (range 0.36-77.9). At cessation, 67 were in complete response, 21 in partial response, and 2 stable disease. RESULTS After median follow-up from cessation of 42.9 months (range 0.0-88.7), 36 (38%) progressed; median time to progression was 4.7 months (range 0.7-56.9); 30 (83%) were asymptomatic and 7 (19%) had new brain metastases. Progression rates did not differ by best response: 34% for complete response and 43% for partial response (P = 0.65). Treatment duration was strongly associated with risk of progression: Median treatment duration was 18.3 (range 0.85-65.7) months for those who progressed and 34.6 (range 0.36-77.9) months for those who did not (P = 0.0004). Twenty-two received further targeted therapy with 15 (68%) responses. CONCLUSION Risk of progression after cessation of targeted therapy is strongly associated with treatment duration. Response to retreatment with targeted therapy is high.
Collapse
Affiliation(s)
| | - Tasnia Ahmed
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Andrea Maurichi
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Lorenzo Di Guardo
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Anna M Stagno
- SC Medical Oncology/ASST-Monza San Gerardo Hospital, Monza, Italy
| | | | - Amelia M Taylor
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | | | - Saba Rehman
- Vanderbilt University Medical Centre, Nashville, USA
| | - Adnan Khattak
- Fiona Stanley Hospital, Perth, Australia; Edith Cowan University, Perth, Australia
| | | | - Vito Vanella
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Victoria Atkinson
- Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia; Greenslopes Private Hospital, Brisbane, Australia
| | - Michael Millward
- School of Medicine/University of Western Australia, Perth, Australia
| | - Dirk Schadendorf
- University Hospital Essen & German Cancer Consortium, Partner Site Essen, Germany
| | | | - Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Axel Hauschild
- University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health/The University of Sydney, Sydney, Australia; Royal North Shore & Mater Hospitals, Sydney, Australia; Charles Perkins Centre/The University of Sydney, Sydney, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health/The University of Sydney, Sydney, Australia; Royal North Shore & Mater Hospitals, Sydney, Australia
| | - Matteo S Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health/The University of Sydney, Sydney, Australia; Blacktown and Westmead Hospitals, Sydney, Australia.
| |
Collapse
|
4
|
Managing stage 4 ameloblastoma with dual BRAF/MEK inhibition: A case report with 8-year clinical follow-up. Oral Oncol 2022; 128:105854. [PMID: 35447565 DOI: 10.1016/j.oraloncology.2022.105854] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/03/2022] [Indexed: 12/25/2022]
Abstract
We present 8-year follow-up on the first patient with stage 4 ameloblastoma carrying a BRAF V600E mutation treated with dual BRAF/MEK inhibition (BRAF/MEKi). He experienced a durable clinical response while on dabrafenib (BRAFi) and trametinib (MEKi) without toxicity nor evidence for drug-resistant tumor progression. He was asymptomatic when he self-discontinued therapy after 4 years of sustained clinical response. He did not return for follow-up until 2.5 years later with onset of painful mandibular tumor recurrence associated with recurrent bilateral lung metastases. He was rechallenged with dabrafenib/trametinib and experienced another prompt tumor response and remains in a second durable clinical remission (currently > 16 months) on continuous dual targeted therapy. We discuss the implications of this case study for future treatment strategies.
Collapse
|
5
|
Bédouelle E, Nguyen JM, Varey E, Khammari A, Dreno B. Should Targeted Therapy Be Continued in BRAF-Mutant Melanoma Patients after Complete Remission? Dermatology 2021; 238:517-526. [PMID: 34818219 DOI: 10.1159/000518718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Targeted therapy is used to treat patients with a BRAF-mutated metastatic melanoma and is continued until disease progression or severe toxicity. No robust data on the management of patients achieving a complete remission (CR) are available. MAIN OBJECTIVE To determine the relapse rate in the first year after targeted therapy discontinuation in patients in CR. SECONDARY OBJECTIVES To determine the relapse rates throughout the follow-up and to identify prognostic factors for relapse at 1 year. METHODS A retrospective, monocentric observational study was conducted in patients with advanced melanoma included in the RIC-Mel database who discontinued targeted therapy after achieving a CR confirmed by CT scan and PET/CT scan. RESULTS Twenty-nine patients were included. Seventeen (58.6%) patients were treated with BRAF inhibitor (BRAFi) alone and 12 (41.4%) with a BRAFi combined with a MEK inhibitor (BRAFi + MEKi). The median treatment duration was 9.7 months. The relapse rates after discontinuation were 69% at 12 months (BRAFi: 70.6%; BRAFi + MEKi: 66.7%) and 76% at 36 months (BRAFi: 76.5%; BRAFi + MEKi: 75%). A non-significant trend towards a higher risk of relapse was found in women (p = 0.1; RR 3.36; 95% CI 0.77-17.07), in patients with an LDH level greater than the upper limits of normal (p = 0.58; RR 2.43; 95% CI 0.10-56.71), and when more than two metastatic sites were involved (p = 0.19; RR 4.6; 95% CI 0.46-46.51). After relapse, targeted therapy was resumed in 17 patients (7 with BRAFi; 10 with BRAFi + MEKi) with a response rate of 53%. CONCLUSIONS This real-life study provided long-term data in patients who discontinued targeted therapy after CR. Most patients experienced a relapse in the first year after targeted therapy discontinuation, of whom 50% were in the first 3 months. After targeted therapy resumption, 53% of relapsing patients achieved an objective response. Patients should be followed during the first year after treatment discontinuation. In addition, patients with less than 3 metastatic sites, a baseline LDH level with normal ranges, men, and patients responding rapidly to treatment would be more likely to maintain a CR after treatment discontinuation.
Collapse
Affiliation(s)
- Eve Bédouelle
- Department of Dermatology, CHU Nantes, CIC 1413, CRCINA Inserm U 1232, Nantes University, Nantes, France
| | | | - Emilie Varey
- Department of Dermatology, CHU Nantes, CIC 1413, CRCINA Inserm U 1232, Nantes University, Nantes, France
| | - Amir Khammari
- Department of Dermatology, CHU Nantes, CIC 1413, CRCINA Inserm U 1232, Nantes University, Nantes, France
| | - Brigitte Dreno
- Department of Dermatology, CHU Nantes, CIC 1413, CRCINA Inserm U 1232, Nantes University, Nantes, France
| |
Collapse
|
6
|
Pham JP, Star P, Phan K, Loh Y, Joshua AM, Smith A. Review BRAF inhibition and the spectrum of granulomatous reactions. J Am Acad Dermatol 2021; 87:605-613. [PMID: 34715287 DOI: 10.1016/j.jaad.2021.10.030] [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: 08/23/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 12/01/2022]
Abstract
BRAF-inhibitors have emerged as a promising targeted therapy for malignancies with BRAF mutations, particularly metastatic melanoma. However, granulomatous reactions including sarcoidosis and sarcoid-like-reactions have been reported as a consequence of BRAF-inhibition. It is important to adequately characterise these granulomatous reactions including cutaneous manifestations and systemic involvement, in order to guide investigations and management. A literature review was conducted to characterise the spectrum of granulomatous reactions associated with BRAF-inhibitors - identifying 55 reactions affecting 51 patients, with 37 reactions limited to cutaneous involvement. Further, possible correlation with cancer response, mechanisms of granuloma formation, as well as a proposed workup and management approach for these granulomatous reactions are presented.
Collapse
Affiliation(s)
- James P Pham
- St. Vincent's Hospital, Sydney, NSW, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia.
| | - Phoebe Star
- St. Vincent's Hospital, Sydney, NSW, Australia
| | - Kevin Phan
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia
| | - Yanni Loh
- St. Vincent's Hospital, Sydney, NSW, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Anthony M Joshua
- St. Vincent's Hospital, Sydney, NSW, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia; Melanoma Institute of Australia, North Sydney, NSW, Australia; Medical Oncology, The Kinghorn Cancer Centre, Sydney, NSW, Australia
| | - Annika Smith
- St. Vincent's Hospital, Sydney, NSW, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia; Melanoma Institute of Australia, North Sydney, NSW, Australia; The Mater Hospital, North Sydney, NSW, Australia
| |
Collapse
|
7
|
Battaglia L, Scomparin A, Dianzani C, Milla P, Muntoni E, Arpicco S, Cavalli R. Nanotechnology Addressing Cutaneous Melanoma: The Italian Landscape. Pharmaceutics 2021; 13:1617. [PMID: 34683910 PMCID: PMC8540596 DOI: 10.3390/pharmaceutics13101617] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/22/2021] [Accepted: 09/29/2021] [Indexed: 12/20/2022] Open
Abstract
Cutaneous melanoma is one of the most aggressive solid tumors, with a low survival for the metastatic stage. Currently, clinical melanoma treatments include surgery, chemotherapy, targeted therapy, immunotherapy and radiotherapy. Of note, innovative therapeutic regimens concern the administration of multitarget drugs in tandem, in order to improve therapeutic efficacy. However, also, if this drug combination is clinically relevant, the patient's response is not yet optimal. In this scenario, nanotechnology-based delivery systems can play a crucial role in the clinical treatment of advanced melanoma. In fact, their nano-features enable targeted drug delivery at a cellular level by overcoming biological barriers. Various nanomedicines have been proposed for the treatment of cutaneous melanoma, and a relevant number of them are undergoing clinical trials. In Italy, researchers are focusing on the pharmaceutical development of nanoformulations for malignant melanoma therapy. The present review reports an overview of the main melanoma-addressed nanomedicines currently under study in Italy, alongside the state of the art of melanoma therapy. Moreover, the latest Italian advances concerning the pre-clinical evaluation of nanomedicines for melanoma are described.
Collapse
Affiliation(s)
- Luigi Battaglia
- . Department of Drug Science and Technology, University of Torino, 10125 Turin, Italy; (L.B.); (A.S.); (C.D.); (P.M.); (E.M.); (S.A.)
| | - Anna Scomparin
- . Department of Drug Science and Technology, University of Torino, 10125 Turin, Italy; (L.B.); (A.S.); (C.D.); (P.M.); (E.M.); (S.A.)
- . Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Chiara Dianzani
- . Department of Drug Science and Technology, University of Torino, 10125 Turin, Italy; (L.B.); (A.S.); (C.D.); (P.M.); (E.M.); (S.A.)
| | - Paola Milla
- . Department of Drug Science and Technology, University of Torino, 10125 Turin, Italy; (L.B.); (A.S.); (C.D.); (P.M.); (E.M.); (S.A.)
| | - Elisabetta Muntoni
- . Department of Drug Science and Technology, University of Torino, 10125 Turin, Italy; (L.B.); (A.S.); (C.D.); (P.M.); (E.M.); (S.A.)
| | - Silvia Arpicco
- . Department of Drug Science and Technology, University of Torino, 10125 Turin, Italy; (L.B.); (A.S.); (C.D.); (P.M.); (E.M.); (S.A.)
| | - Roberta Cavalli
- . Department of Drug Science and Technology, University of Torino, 10125 Turin, Italy; (L.B.); (A.S.); (C.D.); (P.M.); (E.M.); (S.A.)
| |
Collapse
|
8
|
Di Guardo L, Randon G, Corti F, Vallacchi V, Raimondi A, Fucà G, Bini M, Maurichi A, Patuzzo R, Gallino G, Mattavelli I, Ruggeri R, Angi M, Cossa M, Valeri B, Cimminiello C, Santinami M, Rivoltini L, de Braud F, Rodolfo M, Vecchio MD. Liquid biopsy and radiological response predict outcomes following discontinuation of targeted therapy in patients with BRAF mutated melanoma. Oncologist 2021; 26:1079-1084. [PMID: 34355463 PMCID: PMC8649022 DOI: 10.1002/onco.13926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/23/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Outcomes of patients with metastatic melanoma discontinuing BRAF-targeted therapy for cumulative toxicity after sustained response are unknown. PATIENTS AND METHODS This retrospective case series analysis conducted at a single Cancer Center in Italy included patients with BRAF mutated metastatic melanoma treated with a BRAF inhibitor as a single agent or in combination with a MEK inhibitor between June 1, 2011 and January 1, 2020 and interrupting treatment after achieving complete response (CR) or long-lasting partial response (PR - i.e. > 12 months) due to cumulative toxicity. RESULTS We included 24 patients with a median treatment duration of 59.4 months (95%CI 55.4-63.4 - range 12-88). CR and PR were achieved in 71% and 29% of patients, respectively. At a median follow-up after treatment discontinuation of 37.8 months (95%CI 33.7-41.9), 12-months progression free survival after discontinuation (dPFS) rate was 70.8% (95%CI 54.8 - 91.6) and 24-months dPFS rate was 58.3% (95%CI 41.6 - 81.8). Baseline patients and tumor characteristics as well as treatment duration and best response did not significantly impact on dPFS. Patients with CR and negative circulating tumor DNA (ctDNA) at time of discontinuation had a significantly improved dPFS compared to patients with either radiological residual disease or ctDNA positivity (P = 0.007). No patient in CR with undetectable ctDNA experienced progression. CONCLUSION The risk of progression is high even in patients with sustained sensitivity to BRAF/MEK inhibitors. Integration of liquid biopsy in clinical trials investigating optimal management of patients with sustained sensitivity to BRAF/MEK inhibitors is warranted. IMPLICATIONS FOR PRACTICE Outcomes of patients with metastatic melanoma discontinuing BRAF-targeted therapy for cumulative toxicity are unknown. We analyzed patients with sustained responses (median treatment duration 59.4 months). Twelve and 24-months progression free survival following discontinuation were 70.8% and 58.3% respectively. Complete response and negative ctDNA at time of discontinuation are promising prognostic biomarkers in this setting.
Collapse
Affiliation(s)
- Lorenza Di Guardo
- Department of Medical OncologyFondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei TumoriMilanItaly
| | - Giovanni Randon
- Department of Medical OncologyFondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei TumoriMilanItaly
| | - Francesca Corti
- Department of Medical OncologyFondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei TumoriMilanItaly
| | - Viviana Vallacchi
- Unit of Immunotherapy of Human TumorsFondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei TumoriMilanItaly
| | - Alessandra Raimondi
- Department of Medical OncologyFondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei TumoriMilanItaly
| | - Giovanni Fucà
- Department of Medical OncologyFondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei TumoriMilanItaly
| | - Marta Bini
- Department of Medical OncologyFondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei TumoriMilanItaly
| | - Andrea Maurichi
- Melanoma and Sarcoma Surgery UnitFondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei TumoriMilanItaly
| | - Roberto Patuzzo
- Department of Medical OncologyFondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei TumoriMilanItaly
| | - Gianfrancesco Gallino
- Melanoma and Sarcoma Surgery UnitFondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei TumoriMilanItaly
| | - Ilaria Mattavelli
- Melanoma and Sarcoma Surgery UnitFondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei TumoriMilanItaly
| | - Roberta Ruggeri
- Melanoma and Sarcoma Surgery UnitFondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei TumoriMilanItaly
| | - Martina Angi
- Ocular Oncology Service, Department of SurgeryFondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei TumoriMilanItaly
| | - Mara Cossa
- Department of PathologyFondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei TumoriMilanItaly
| | - Barbara Valeri
- Department of PathologyFondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei TumoriMilanItaly
| | - Carolina Cimminiello
- Department of Medical OncologyFondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei TumoriMilanItaly
| | - Mario Santinami
- Melanoma and Sarcoma Surgery UnitFondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei TumoriMilanItaly
| | - Licia Rivoltini
- Unit of Immunotherapy of Human TumorsFondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei TumoriMilanItaly
| | - Filippo de Braud
- Department of Medical OncologyFondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei TumoriMilanItaly
- Oncology and Hemato‐Oncology DepartmentUniversity of MilanMilanItaly
| | - Monica Rodolfo
- Unit of Immunotherapy of Human TumorsFondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei TumoriMilanItaly
| | - Michele Del Vecchio
- Department of Medical OncologyFondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei TumoriMilanItaly
| |
Collapse
|
9
|
Discontinuation of BRAF/MEK-Directed Targeted Therapy after Complete Remission of Metastatic Melanoma-A Retrospective Multicenter ADOReg Study. Cancers (Basel) 2021; 13:cancers13102312. [PMID: 34065877 PMCID: PMC8151093 DOI: 10.3390/cancers13102312] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 12/13/2022] Open
Abstract
The advent of BRAF/MEK inhibitors (BRAFi/MEKi) has significantly improved progression-free (PFS) and overall survival (OS) for patients with advanced BRAF-V600-mutant melanoma. Long-term survivors have been identified particularly among patients with a complete response (CR) to BRAF/MEK-directed targeted therapy (TT). However, it remains unclear which patients who achieved a CR maintain a durable response and whether treatment cessation might be a safe option in these patients. Therefore, this study investigated the impact of treatment cessation on the clinical course of patients with a CR upon BRAF/MEK-directed-TT. We retrospectively selected patients with BRAF-V600-mutant advanced non-resectable melanoma who had been treated with BRAFi ± MEKi therapy and achieved a CR upon treatment out of the multicentric skin cancer registry ADOReg. Data on baseline patient characteristics, duration of TT, treatment cessation, tumor progression (TP) and response to second-line treatments were collected and analyzed. Of 461 patients who received BRAF/MEK-directed TT 37 achieved a CR. TP after initial CR was observed in 22 patients (60%) mainly affecting patients who discontinued TT (n = 22/26), whereas all patients with ongoing TT (n = 11) maintained their CR. Accordingly, patients who discontinued TT had a higher risk of TP compared to patients with ongoing treatment (p < 0.001). However, our data also show that patients who received TT for more than 16 months and who discontinued TT for other reasons than TP or toxicity did not have a shorter PFS compared to patients with ongoing treatment. Response rates to second-line treatment being initiated in 21 patients, varied between 27% for immune-checkpoint inhibitors (ICI) and 60% for BRAFi/MEKi rechallenge. In summary, we identified a considerable number of patients who achieved a CR upon BRAF/MEK-directed TT in this contemporary real-world cohort of patients with BRAF-V600-mutant melanoma. Sustained PFS was not restricted to ongoing TT but was also found in patients who discontinued TT.
Collapse
|
10
|
Guruprasad P, Lee YG, Kim KH, Ruella M. The current landscape of single-cell transcriptomics for cancer immunotherapy. J Exp Med 2021; 218:e20201574. [PMID: 33601414 PMCID: PMC7754680 DOI: 10.1084/jem.20201574] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/28/2020] [Accepted: 12/02/2020] [Indexed: 12/28/2022] Open
Abstract
Immunotherapies such as immune checkpoint blockade and adoptive cell transfer have revolutionized cancer treatment, but further progress is hindered by our limited understanding of tumor resistance mechanisms. Emerging technologies now enable the study of tumors at the single-cell level, providing unprecedented high-resolution insights into the genetic makeup of the tumor microenvironment and immune system that bulk genomics cannot fully capture. Here, we highlight the recent key findings of the use of single-cell RNA sequencing to deconvolute heterogeneous tumors and immune populations during immunotherapy. Single-cell RNA sequencing has identified new crucial factors and cellular subpopulations that either promote tumor progression or leave tumors vulnerable to immunotherapy. We anticipate that the strategic use of single-cell analytics will promote the development of the next generation of successful, rationally designed immunotherapeutics.
Collapse
Affiliation(s)
- Puneeth Guruprasad
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Department of Medicine, Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Yong Gu Lee
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Department of Medicine, Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Ki Hyun Kim
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Department of Medicine, Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Marco Ruella
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Department of Medicine, Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
11
|
Clinical Implications of Acquired BRAF Inhibitors Resistance in Melanoma. Int J Mol Sci 2020; 21:ijms21249730. [PMID: 33419275 PMCID: PMC7766699 DOI: 10.3390/ijms21249730] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 12/13/2022] Open
Abstract
Understanding the role of mitogen-activated protein kinase (MAPK) pathway-activating mutations in the development and progression of melanoma and their possible use as therapeutic targets has substantially changed the management of this neoplasm, which, until a few years ago, was burdened by severe mortality. However, the presence of numerous intrinsic and extrinsic mechanisms of resistance to BRAF inhibitors compromises the treatment responses’ effectiveness and durability. The strategy of overcoming these resistances by combination therapy has proved successful, with the additional benefit of reducing side effects derived from paradoxical activation of the MAPK pathway. Furthermore, the use of other highly specific inhibitors, intermittent dosing schedules and the association of combination therapy with immune checkpoint inhibitors are promising new therapeutic strategies. However, numerous issues related to dose, tolerability and administration sequence still need to be clarified, as is to be expected from currently ongoing trials. In this review, we describe the clinical results of using BRAF inhibitors in advanced melanoma, with a keen interest in strategies aimed at overcoming resistance.
Collapse
|
12
|
Warburton L, Meniawy TM, Calapre L, Pereira M, McEvoy A, Ziman M, Gray ES, Millward M. Stopping targeted therapy for complete responders in advanced BRAF mutant melanoma. Sci Rep 2020; 10:18878. [PMID: 33139839 PMCID: PMC7606504 DOI: 10.1038/s41598-020-75837-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/21/2020] [Indexed: 12/27/2022] Open
Abstract
BRAF inhibitors revolutionised the management of melanoma patients and although resistance occurs, there is a subgroup of patients who maintain durable disease control. For those cases with durable complete response (CR) it is not clear whether it is safe to cease therapy. Here we identified 13 patients treated with BRAF +/- MEK inhibitors, who cease therapy after prolonged CR (median = 34 months, range 20-74). Recurrence was observed in 3/13 (23%) patients. In the remaining 10 patients with sustained CR off therapy, the median follow up after discontinuation was 19 months (range 8-36). We retrospectively measured ctDNA levels using droplet digital PCR (ddPCR) in longitudinal plasma samples. CtDNA levels were undetectable in 11/13 cases after cessation and remained undetectable in patients in CR (10/13). CtDNA eventually became detectable in 2/3 cases with disease recurrence, but remained undetectable in 1 patient with brain only progression. Our study suggests that consideration could be given to ceasing targeted therapy in the context of prolonged treatment, durable response and no evidence of residual disease as measured by ctDNA.
Collapse
Affiliation(s)
- L Warburton
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - T M Meniawy
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia
| | - L Calapre
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - M Pereira
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - A McEvoy
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - M Ziman
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- School of Biomedical Science, University of Western Australia, Crawley, WA, Australia
| | - E S Gray
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
| | - M Millward
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia
| |
Collapse
|
13
|
Repeated complete response with long-term control of BRAF-mutant melanoma by multiple rechallenges with dabrafenib plus trametinib. Eur J Cancer 2020; 139:37-40. [DOI: 10.1016/j.ejca.2020.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/17/2020] [Accepted: 08/05/2020] [Indexed: 11/22/2022]
|
14
|
Melanoma stem cell maintenance and chemo-resistance are mediated by CD133 signal to PI3K-dependent pathways. Oncogene 2020; 39:5468-5478. [PMID: 32616888 DOI: 10.1038/s41388-020-1373-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 05/28/2020] [Accepted: 06/16/2020] [Indexed: 12/13/2022]
Abstract
Melanoma stem cells (MSCs) are characterized by their unique cell surface proteins and aberrant signaling pathways. These stemness properties are either in a causal or consequential relationship to melanoma progression, treatment resistance and recurrence. The functional analysis of CD133+ and CD133- cells in vitro and in vivo revealed that melanoma progression and treatment resistance are the consequences of CD133 signal to PI3K pathway. CD133 signal to PI3K pathway drives two downstream pathways, the PI3K/Akt/MDM2 and the PI3K/Akt/MKP-1 pathways. Activation of PI3K/Akt/MDM2 pathway results in the destabilization of p53 protein, while the activation of PI3K/Akt/MKP-1 pathway results in the inhibition of mitogen-activated protein kinases (MAPKs) JNK and p38. Activation of both pathways leads to the inhibition of fotemustine-induced apoptosis. Thus, the disruption of CD133 signal to PI3K pathway is essential to overcome Melanoma resistance to fotemustine. The pre-clinical verification of in vitro data using xenograft mouse model of MSCs confirmed the clinical relevance of CD133 signal as a therapeutic target for melanoma treatment. In conclusion, our study provides an insight into the mechanisms regulating MSCs growth and chemo-resistance and suggested a clinically relevant approach for melanoma treatment.
Collapse
|
15
|
Li K, Zhao S, Long J, Su J, Wu L, Tao J, Zhou J, Zhang J, Chen X, Peng C. A novel chalcone derivative has antitumor activity in melanoma by inducing DNA damage through the upregulation of ROS products. Cancer Cell Int 2020; 20:36. [PMID: 32021565 PMCID: PMC6993520 DOI: 10.1186/s12935-020-1114-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/17/2020] [Indexed: 12/11/2022] Open
Abstract
Background Melanoma is one of the most aggressive tumors with the remarkable characteristic of resistance to traditional chemotherapy and radiotherapy. Although targeted therapy and immunotherapy benefit advanced melanoma patient treatment, BRAFi (BRAF inhibitor) resistance and the lower response rates or severe side effects of immunotherapy have been observed, therefore, it is necessary to develop novel inhibitors for melanoma treatment. Methods We detected the cell proliferation of lj-1-59 in different melanoma cells by CCK 8 and colony formation assay. To further explore the mechanisms of lj-1-59 in melanoma, we performed RNA sequencing to discover the pathway of differential gene enrichment. Western blot and Q-RT-PCR were confirmed to study the function of lj-1-59 in melanoma. Results We found that lj-1-59 inhibits melanoma cell proliferation in vitro and in vivo, induces cell cycle arrest at the G2/M phase and promotes apoptosis in melanoma cell lines. Furthermore, RNA-Seq was performed to study alterations in gene expression profiles after treatment with lj-1-59 in melanoma cells, revealing that this compound regulates various pathways, such as DNA replication, P53, apoptosis and the cell cycle. Additionally, we validated the effect of lj-1-59 on key gene expression alterations by Q-RT-PCR. Our findings showed that lj-1-59 significantly increases ROS (reactive oxygen species) products, leading to DNA toxicity in melanoma cell lines. Moreover, lj-1-59 increases ROS levels in BRAFi -resistant melanoma cells, leading to DNA damage, which caused G2/M phase arrest and apoptosis. Conclusions Taken together, we found that lj-1-59 treatment inhibits melanoma cell growth by inducing apoptosis and DNA damage through increased ROS levels, suggesting that this compound is a potential therapeutic drug for melanoma treatment.
Collapse
Affiliation(s)
- Keke Li
- 1The Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan China.,2Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan China.,3Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, Hunan China
| | - Shuang Zhao
- 1The Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan China.,2Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan China.,3Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, Hunan China
| | - Jing Long
- 1The Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan China.,2Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan China.,3Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, Hunan China
| | - Juan Su
- 1The Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan China.,2Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan China.,3Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, Hunan China
| | - Lisha Wu
- 1The Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan China.,2Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan China.,3Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, Hunan China
| | - Juan Tao
- 4Department of Dermatology, Affiliated Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianda Zhou
- 5Department of Plastic Surgery of Third Xiangya Hospital, Central South University, Changsha, China
| | - JiangLin Zhang
- 1The Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan China.,2Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan China.,3Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, Hunan China
| | - Xiang Chen
- 1The Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan China.,2Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan China.,3Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, Hunan China
| | - Cong Peng
- 1The Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan China.,2Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan China.,3Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, Hunan China
| |
Collapse
|
16
|
Palmieri G. Circulating driver gene mutations: what is the impact on melanoma patients' management? Ann Oncol 2019; 30:669-671. [PMID: 30887019 DOI: 10.1093/annonc/mdz090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- G Palmieri
- Unit of Cancer Genetics, Institute of Biomolecular Chemistry (ICB), National Research Council (CNR), Sassari, Italy.
| |
Collapse
|
17
|
Holbrook K, Lutzky J, Davies MA, Davis JM, Glitza IC, Amaria RN, Diab A, Patel SP, Amin A, Tawbi H. Intracranial antitumor activity with encorafenib plus binimetinib in patients with melanoma brain metastases: A case series. Cancer 2019; 126:523-530. [PMID: 31658370 PMCID: PMC7004095 DOI: 10.1002/cncr.32547] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/27/2019] [Accepted: 08/29/2019] [Indexed: 12/15/2022]
Abstract
Background Sixty percent of patients with stage IV melanoma may develop brain metastases, which result in significantly increased morbidity and a poor overall prognosis. Phase 3 studies of melanoma usually exclude patients with untreated brain metastases; therefore, clinical data for intracranial responses to treatments are limited. Methods A multicenter, retrospective case series investigation of consecutive BRAF‐mutant patients with melanoma brain metastases (MBMs) treated with a combination of BRAF inhibitor encorafenib and MEK inhibitor binimetinib was conducted to evaluate the antitumor response. Assessments included the intracranial, extracranial, and global objective response rates (according to the modified Response Evaluation Criteria in Solid Tumors, version 1.1); the clinical benefit rate; the time to response; the duration of response; and safety. Results A total of 24 patients with stage IV BRAF‐mutant MBMs treated with encorafenib plus binimetinib in 3 centers in the United States were included. Patients had received a median of 2.5 prior lines of treatment, and 88% had prior treatment with BRAF/MEK inhibitors. The intracranial objective response rate was 33%, and the clinical benefit rate was 63%. The median time to a response was 6 weeks, and the median duration of response was 22 weeks. Among the 21 patients with MBMs and prior BRAF/MEK inhibitor treatment, the intracranial objective response rate was 24%, and the clinical benefit rate was 57%. Similar outcomes were observed for extracranial and global responses. The safety profile for encorafenib plus binimetinib was similar to that observed in patients with melanoma without brain metastases. Conclusions Combination therapy with encorafenib plus binimetinib elicited intracranial activity in patients with BRAF‐mutant MBMs, including patients previously treated with BRAF/MEK inhibitors. Further prospective studies are warranted and ongoing. All clinical trials to date with encorafenib and binimetinib (US Food and Drug Administration–approved in June 2018 for BRAF‐mutated metastatic melanoma) have excluded untreated melanoma brain metastases. This case series provides the first clinical evidence of intracranial activity of the combination of encorafenib plus binimetinib in patients with BRAF‐mutant melanoma with active brain metastases. Intracranial clinical activity is observed for the first time in patients previously treated with BRAF/MEK inhibitors, a population that has not been previously investigated.
Collapse
Affiliation(s)
| | - Jose Lutzky
- Mount Sinai Comprehensive Cancer Center, Miami Beach, Florida
| | - Michael A Davies
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Rodabe N Amaria
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adi Diab
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sapna P Patel
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Asim Amin
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Hussein Tawbi
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
18
|
Schvartsman G, Taranto P, Glitza IC, Agarwala SS, Atkins MB, Buzaid AC. Management of metastatic cutaneous melanoma: updates in clinical practice. Ther Adv Med Oncol 2019; 11:1758835919851663. [PMID: 31205512 PMCID: PMC6535734 DOI: 10.1177/1758835919851663] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 04/29/2019] [Indexed: 12/20/2022] Open
Abstract
In recent years, several drugs have been approved for the treatment of patients with metastatic cutaneous melanoma, completely reshaping the landscape of this aggressive disease. Immune therapy with cytotoxic T-lymphocyte antigen 4 and programmed cell death-1 inhibitors yielded significant and durable responses, achieving long-term disease control in up to 40% of the patients. BRAF inhibitors (BRAFi), in combination with MEK inhibitors, also resulted in improved overall survival compared with single-agent BRAFi in patients with BRAFV600-mutated metastatic melanoma. The optimized sequencing and duration of treatment, however, is yet to be found. In this article, we thoroughly review current data and discuss how to best sequence the various treatment modalities available at present, based on four distinct clinical presentations commonly seen in clinic. In addition, we review treatment options beyond checkpoint inhibitors and targeted therapy, which may be required by patients failing such effective treatments.
Collapse
Affiliation(s)
- Gustavo Schvartsman
- Centro de Oncologia e Hematologia - Hospital Israelita Albert Einstein, 627 Albert Einstein Avenue, São Paulo, SP 05653-120, Brazil
| | - Patricia Taranto
- Department of Medical Oncology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Isabella C Glitza
- Department of Melanoma Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Sanjiv S Agarwala
- Department of Hematology and Oncology, and Temple University, Easton, PA, USA
| | - Michael B Atkins
- Department of Oncology, Georgetown University School of Medicine, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Antonio C Buzaid
- Department of Medical Oncology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazila and Department of Medical Oncology, A Beneficência Portuguesa de São Paulo - BP, São Paulo, SP, Brazil
| |
Collapse
|
19
|
Reschke R, Simon J, Ziemer M. Reinduktion zielgerichteter Therapie beim metastasierten Melanom. J Dtsch Dermatol Ges 2019; 17:483-487. [DOI: 10.1111/ddg.13766_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/03/2018] [Indexed: 10/26/2022]
Affiliation(s)
- Robin Reschke
- Klinik für DermatologieVenerologie und AllergologieUniversitätsklinikum Leipzig
| | - Jan‐Christoph Simon
- Klinik für DermatologieVenerologie und AllergologieUniversitätsklinikum Leipzig
| | - Mirjana Ziemer
- Klinik für DermatologieVenerologie und AllergologieUniversitätsklinikum Leipzig
| |
Collapse
|
20
|
Reschke R, Simon J, Ziemer M. Rechallenge of targeted therapy in metastatic melanoma. J Dtsch Dermatol Ges 2019; 17:483-486. [DOI: 10.1111/ddg.13766] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/03/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Robin Reschke
- Department of DermatologyVenereology and AllergologyUniversity Medical Center Leipzig Germany
| | - Jan‐Christoph Simon
- Department of DermatologyVenereology and AllergologyUniversity Medical Center Leipzig Germany
| | - Mirjana Ziemer
- Department of DermatologyVenereology and AllergologyUniversity Medical Center Leipzig Germany
| |
Collapse
|
21
|
Viñal D, Martinez D, Espinosa E. Efficacy of rechallenge with BRAF inhibition therapy in patients with advanced BRAFV600 mutant melanoma. Clin Transl Oncol 2019; 21:1061-1066. [DOI: 10.1007/s12094-018-02028-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/21/2018] [Indexed: 02/06/2023]
|
22
|
Tietze JK, Forschner A, Loquai C, Mitzel-Rink H, Zimmer L, Meiss F, Rafei-Shamsabadi D, Utikal J, Bergmann M, Meier F, Kreuzberg N, Schlaak M, Weishaupt C, Pföhler C, Ziemer M, Fluck M, Rainer J, Heppt MV, Berking C. The efficacy of re-challenge with BRAF inhibitors after previous progression to BRAF inhibitors in melanoma: A retrospective multicenter study. Oncotarget 2018; 9:34336-34346. [PMID: 30344946 PMCID: PMC6188134 DOI: 10.18632/oncotarget.26149] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 08/20/2018] [Indexed: 12/20/2022] Open
Abstract
BRAF and MEK inhibition is efficient in patients with BRAF V600-mutated metastatic melanoma, but due to acquired resistance the duration of response (DoR) is often only short-lived. In this retrospective multicenter study with 60 patients suffering from inoperable or metastatic melanoma we evaluated the efficacy of re-challenge with a BRAF inhibitor (BRAF2) with or without MEK-inhibition after progressive disease upon previous treatment with a BRAF inhibitor (BRAF1) with or without MEK inhibition. Treatment with BRAF1 led to a disease control rate (DCR) of 90% with 12% complete responses (CR), 58% partial responses (PR) and 20% stable diseases (SD), the median progression-free survival (PFS) was 9.9 and DoR 10.7 months. BRAF2 with (68%) or without (32%) additional MEK inhibition was initiated after a median interval of 3.4 months. DCR after re-challenge with BRAF2 was 57%, 8% CR, 20% PR and 28% SD, median PFS was 5.0 and DoR 14.0 months. The duration of the treatment interval or the treatment in the interval did not influence the DCR or PFS to BRAF2. The only predictive factor for response to BRAF2 was previous response to BRAF1; all patients with CR to BRAF1 achieved disease control with BRAF2, but only 60% of the patients with PR to BRAF1 (p=0.002). Addition of MEK inhibition to BRAF2 after treatment with BRAF1 as monotherapy did not significantly increase the DCR or PFS compared to patients treated solely with mono- or combination therapy. In conclusion re-challenge with a BRAF inhibitor is a meaningful therapeutic option for patients with BRAF V600-mutated metastatic melanoma.
Collapse
Affiliation(s)
- Julia K Tietze
- Department of Dermatology and Allergy, University Hospital Munich (LMU), 80337 Munich, Germany
| | - Andrea Forschner
- Department of Dermatology, Center for Dermatooncology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Carmen Loquai
- Department of Dermatology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Heidrun Mitzel-Rink
- Department of Dermatology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, University of Essen, 45147 Essen, Germany
| | - Frank Meiss
- Department of Dermatology and Venereology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany
| | - David Rafei-Shamsabadi
- Department of Dermatology and Venereology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany
| | - Jochen Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ) and Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, 68167 Mannheim, Germany
| | - Maike Bergmann
- Department of Dermatology, Skin Cancer Center, National Center for Tumor Diseases, Medical Faculty and University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
| | - Friedegund Meier
- Department of Dermatology, Skin Cancer Center, National Center for Tumor Diseases, Medical Faculty and University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
| | - Nicole Kreuzberg
- Department of Dermatology, University of Cologne, 50937 Cologne, Germany
| | - Max Schlaak
- Department of Dermatology, University of Cologne, 50937 Cologne, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University of Münster, 48149 Münster, Germany
| | - Claudia Pföhler
- Department of Dermatology, Saarland University Medical Center, 66421 Homburg/Saar, Germany
| | - Mirjana Ziemer
- Department of Dermatology, Venereology, and Allergology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Michael Fluck
- Department of Internal Medical Oncology, Clinic Hornheide, 48157 Münster, Germany
| | - Jessica Rainer
- Deparment of Dermatology, Klinikum Süd, 86179 Augsburg, Germany
| | - Markus V Heppt
- Department of Dermatology and Allergy, University Hospital Munich (LMU), 80337 Munich, Germany
| | - Carola Berking
- Department of Dermatology and Allergy, University Hospital Munich (LMU), 80337 Munich, Germany
| |
Collapse
|
23
|
Rechallenge with BRAF-directed treatment in metastatic melanoma: A multi-institutional retrospective study. Eur J Cancer 2018; 91:116-124. [DOI: 10.1016/j.ejca.2017.12.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/02/2017] [Indexed: 12/11/2022]
|