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Hindmarch JJ, Coker DJ, Waugh R, Kam PCA, Thompson JF, Saw RPM. Treatment of in-transit Merkel cell carcinoma by isolated limb infusion with cytotoxic drugs. J Surg Case Rep 2022; 2022:rjac172. [PMID: 35422991 PMCID: PMC9005209 DOI: 10.1093/jscr/rjac172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/28/2022] [Indexed: 12/05/2022] Open
Abstract
Merkel cell carcinoma of the skin is a rare but aggressive malignancy, which predominantly affects older adults with fair skin. Isolated limb infusion (ILI) using melphalan and actinomycin D was first developed as a minimally invasive treatment option to treat unresectable metastatic melanoma confined to the limb. We report on a 62-year-old male with in-transit metastases (ITMs) treated with ILI to highlight the ongoing role this treatment has when all other therapies have been exhausted. At presentation, the patient had widespread ITMs in the right leg. Positron emission tomography scan demonstrated recurrent disease in the thigh and pelvis, and it was decided to treat the patient with ILI. The patient progressed well in the immediate post-operative period. The patient was able to mobilize from Day 6 post-ILI and was discharged on Day 10. There was an immediate clinical response seen in the lesions, with necrosis developing in the larger lesions.
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Affiliation(s)
- Jake J Hindmarch
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
| | - David J Coker
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
| | - Richard Waugh
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Peter C A Kam
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
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Ricco G, Andrini E, Siepe G, Mosconi C, Ambrosini V, Ricci C, Casadei R, Campana D, Lamberti G. Multimodal Strategy in Localized Merkel Cell Carcinoma: Where Are We and Where Are We Heading? Int J Mol Sci 2021; 22:ijms221910629. [PMID: 34638968 PMCID: PMC8508588 DOI: 10.3390/ijms221910629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 02/07/2023] Open
Abstract
Merkel cell carcinoma (MCC) is an aggressive neuroendocrine tumor of the skin whose incidence is rising. Multimodal treatment is crucial in the non-metastatic, potentially curable setting. However, the optimal management of patients with non-metastatic MCC is still unclear. In addition, novel insights into tumor biology and newly developed treatments (e.g., immune checkpoint inhibitors) that dramatically improved outcomes in the advanced setting are being investigated in earlier stages with promising results. Nevertheless, the combination of new strategies with consolidated ones needs to be clarified. We reviewed available evidence supporting the current treatment recommendations of localized MCC with a focus on potentially ground-breaking future strategies. Advantages and disadvantages of the different treatment modalities, including surgery, radiotherapy, chemotherapy, and immunotherapy in the non-metastatic setting, are analyzed, as well as those of different treatment modalities (adjuvant as opposed to neoadjuvant). Lastly, we provide an outlook of remarkable ongoing studies and of promising agents and strategies in the treatment of patients with non-metastatic MCC.
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Affiliation(s)
- Gianluca Ricco
- Department of Experimental Diagnostic and Specialized Medicine (DIMES), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (G.R.); (E.A.); (V.A.); (G.L.)
- NET Team Bologna—ENETS Center of Excellence, 40138 Bologna, Italy; (C.M.); (C.R.); (R.C.)
| | - Elisa Andrini
- Department of Experimental Diagnostic and Specialized Medicine (DIMES), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (G.R.); (E.A.); (V.A.); (G.L.)
- NET Team Bologna—ENETS Center of Excellence, 40138 Bologna, Italy; (C.M.); (C.R.); (R.C.)
| | - Giambattista Siepe
- Radiation Oncology, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy;
| | - Cristina Mosconi
- NET Team Bologna—ENETS Center of Excellence, 40138 Bologna, Italy; (C.M.); (C.R.); (R.C.)
- Department of Radiology, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy
| | - Valentina Ambrosini
- Department of Experimental Diagnostic and Specialized Medicine (DIMES), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (G.R.); (E.A.); (V.A.); (G.L.)
- NET Team Bologna—ENETS Center of Excellence, 40138 Bologna, Italy; (C.M.); (C.R.); (R.C.)
- IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40139 Bologna, Italy
| | - Claudio Ricci
- NET Team Bologna—ENETS Center of Excellence, 40138 Bologna, Italy; (C.M.); (C.R.); (R.C.)
- IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40139 Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Riccardo Casadei
- NET Team Bologna—ENETS Center of Excellence, 40138 Bologna, Italy; (C.M.); (C.R.); (R.C.)
- IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40139 Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Davide Campana
- Department of Experimental Diagnostic and Specialized Medicine (DIMES), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (G.R.); (E.A.); (V.A.); (G.L.)
- NET Team Bologna—ENETS Center of Excellence, 40138 Bologna, Italy; (C.M.); (C.R.); (R.C.)
- Division of Medical Oncology, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy
- Correspondence: ; Tel.: +39-051-2142886
| | - Giuseppe Lamberti
- Department of Experimental Diagnostic and Specialized Medicine (DIMES), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (G.R.); (E.A.); (V.A.); (G.L.)
- NET Team Bologna—ENETS Center of Excellence, 40138 Bologna, Italy; (C.M.); (C.R.); (R.C.)
- Division of Medical Oncology, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy
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Guadagni S, Farina AR, Cappabianca LA, Sebastiano M, Maccarone R, Zelli V, Clementi M, Chiominto A, Bruera G, Ricevuto E, Fiorentini G, Sarti D, Mackay AR. Multidisciplinary Treatment, Including Locoregional Chemotherapy, for Merkel-Polyomavirus-Positive Merkel Cell Carcinomas: Perspectives for Patients Exhibiting Oncogenic Alternative Δ exon 6-7 TrkAIII Splicing of Neurotrophin Receptor Tropomyosin-Related Kinase A. Int J Mol Sci 2020; 21:ijms21218222. [PMID: 33153070 PMCID: PMC7662965 DOI: 10.3390/ijms21218222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 01/19/2023] Open
Abstract
Merkel cell carcinomas (MCCs) are rare, aggressive, cutaneous neuroendocrine tumours, approximately 80% of which are caused by the genomic integration of Merkel cell polyomavirus (MCPyV). MCPyV-positive MCCs carry poor prognosis in approximately 70% of cases, highlighting the need for greater understanding of the oncogenic mechanisms involved in pathogenesis, progression and post-therapeutic relapse, and translation into novel therapeutic strategies. In a previous pilot study, we reported a potential relationship between MCPyV gene expression and oncogenic alternative Δ exon 6–7 TrkAIII splicing in formalin-fixed paraffin-embedded (FFPE) MCC tissues from a 12-patient cohort of >90% MCPyV-positive MCCs, diagnosed at San Salvatore Hospital, L’Aquila, Italy, characterising a new MCC subgroup and unveiling a novel potential MCPyV oncogenic mechanism and therapeutic target. This, however, could not be fully verified due to poor RNA quality and difficulty in protein extraction from FFPE tissues. Here, therefore, we extend our previous observations to confirm the relationship between MCPyV and oncogenic alternative Δ exon 6–7 TrkAIII splicing in fresh, nonfixed, MCPyV-positive MCC metastasis by detecting sequence-verified RT-PCR products, including full-length Δ exon 6–7 TrkAIII, and by Western blot detection of a 100 kDa TrkA protein isoform of identical size to 100 kDa Δ exon 6–7 TrkAIII expressed by stable transfected SH-SY5Y cells. We also report that in three MCC patients submitted for multidisciplinary treatment, including locoregional chemotherapy, MCPyV large T-antigen mRNA expression, Δ exon 6–7 TrkAIII mRNA expression and intracellular indirect immunofluorescence (IF) TrkA and phosphorylation protein isoform(s) immunoreactivity in FFPE tissues were not reduced in postchemotherapeutic-relapsed MCCs compared to pretherapeutic MCCs, extending the possible roles of this novel potential MCPyV oncogenic mechanism from MCC pathogenesis to post-therapeutic relapse and progression. Detection of alternative Δ exon 6–7 TrkAIII splicing in MCC, therefore, not only characterises a new MCPyV-positive MCC subgroup and unveils a novel potential MCPyV oncogenic mechanism but also identifies patients who may benefit from inhibitors of MCPyV T-antigen and/or TrkAIII expression or clinically approved Trk kinase inhibitors such as larotrectinib or entrectinib, which are known to inhibit activated TrkA oncogenes and to elicit durable responses in TrkA-fusion oncogene-driven cancers, supporting the call for a large-scale multicentre clinical study.
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MESH Headings
- Aged
- Aged, 80 and over
- Alternative Splicing/genetics
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Carcinoma, Merkel Cell/diagnosis
- Carcinoma, Merkel Cell/genetics
- Carcinoma, Merkel Cell/mortality
- Carcinoma, Merkel Cell/therapy
- Cell Transformation, Neoplastic/genetics
- Combined Modality Therapy
- Drug Administration Routes
- Female
- Humans
- Interdisciplinary Communication
- Italy/epidemiology
- Male
- Merkel cell polyomavirus/isolation & purification
- Merkel cell polyomavirus/physiology
- Middle Aged
- Molecular Diagnostic Techniques
- Mutation
- Patient Care Team
- Polyomavirus Infections/diagnosis
- Polyomavirus Infections/genetics
- Polyomavirus Infections/mortality
- Polyomavirus Infections/therapy
- Prognosis
- Receptor, trkA/genetics
- Skin Neoplasms/diagnosis
- Skin Neoplasms/genetics
- Skin Neoplasms/mortality
- Skin Neoplasms/therapy
- Survival Analysis
- Tumor Virus Infections/diagnosis
- Tumor Virus Infections/genetics
- Tumor Virus Infections/mortality
- Tumor Virus Infections/therapy
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Affiliation(s)
- Stefano Guadagni
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (A.R.F.); (L.A.C.); (M.S.); (R.M.); (V.Z.); (M.C.); (A.C.); (G.B.); (E.R.); (A.R.M.)
- Correspondence:
| | - Antonietta Rosella Farina
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (A.R.F.); (L.A.C.); (M.S.); (R.M.); (V.Z.); (M.C.); (A.C.); (G.B.); (E.R.); (A.R.M.)
| | - Lucia Annamaria Cappabianca
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (A.R.F.); (L.A.C.); (M.S.); (R.M.); (V.Z.); (M.C.); (A.C.); (G.B.); (E.R.); (A.R.M.)
| | - Michela Sebastiano
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (A.R.F.); (L.A.C.); (M.S.); (R.M.); (V.Z.); (M.C.); (A.C.); (G.B.); (E.R.); (A.R.M.)
| | - Rita Maccarone
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (A.R.F.); (L.A.C.); (M.S.); (R.M.); (V.Z.); (M.C.); (A.C.); (G.B.); (E.R.); (A.R.M.)
| | - Veronica Zelli
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (A.R.F.); (L.A.C.); (M.S.); (R.M.); (V.Z.); (M.C.); (A.C.); (G.B.); (E.R.); (A.R.M.)
| | - Marco Clementi
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (A.R.F.); (L.A.C.); (M.S.); (R.M.); (V.Z.); (M.C.); (A.C.); (G.B.); (E.R.); (A.R.M.)
| | - Alessandro Chiominto
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (A.R.F.); (L.A.C.); (M.S.); (R.M.); (V.Z.); (M.C.); (A.C.); (G.B.); (E.R.); (A.R.M.)
| | - Gemma Bruera
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (A.R.F.); (L.A.C.); (M.S.); (R.M.); (V.Z.); (M.C.); (A.C.); (G.B.); (E.R.); (A.R.M.)
| | - Enrico Ricevuto
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (A.R.F.); (L.A.C.); (M.S.); (R.M.); (V.Z.); (M.C.); (A.C.); (G.B.); (E.R.); (A.R.M.)
| | - Giammaria Fiorentini
- Department of Onco-Hematology, Azienda Ospedaliera “Ospedali Riuniti Marche Nord”, 61122 Pesaro, Italy; (G.F.); (D.S.)
| | - Donatella Sarti
- Department of Onco-Hematology, Azienda Ospedaliera “Ospedali Riuniti Marche Nord”, 61122 Pesaro, Italy; (G.F.); (D.S.)
| | - Andrew Reay Mackay
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (A.R.F.); (L.A.C.); (M.S.); (R.M.); (V.Z.); (M.C.); (A.C.); (G.B.); (E.R.); (A.R.M.)
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4
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Guadagni S, Chiominto A, Mackay AR, Farina AR, Cappabianca L, Puccica I, Valiyeva S, Clementi M. Advanced Merkel cell carcinoma of the lower extremity treated with surgery and isolated pelvic and limb perfusion using Melphalan: A case of unexpected long-term survival. Int J Surg Case Rep 2019; 61:4-8. [PMID: 31302319 PMCID: PMC6626978 DOI: 10.1016/j.ijscr.2019.06.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 06/27/2019] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Merkel cell carcinoma (MCC) is a rare, neuroendocrine skin tumor, with high frequency of locoregional recurrence, metastases, and poor prognosis. Locoregional MCC recurrence in the extremities can pose considerable treatment challenges. We report a case of long-term survival in a female patient with recurrent MCC of the leg, treated with surgery and locoregional chemotherapy. PRESENTATION OF CASE A 73-year-old female with cirrhosis and hepatitis C, developed cutaneous MCC in the left inferior limb. This patient initially received surgical treatment, with subsequent negative sentinel lymph-node biopsy in another center, one-month prior recovery in our department, and arrived with 4 new limb nodules, cranially to the previously treated area, without distant metastases or inguinal lymph node recurrence. This patient was not eligible for immunotherapy due to active hepatitis upon treatment with NS5B inhibitors, or eligible for systemic chemotherapy or radiotherapy due to severe neutropenia and was, therefore, subjected to surgical resection combined with Isolated Pelvic and Limb Perfusion (IPLP) with Melphalan. Histological evaluation confirmed MCC diagnosis and during the following 4 months, she developed further locoregional recurrences with homolateral inguinal lymph node involvement and was subjected to two additional rounds of surgery plus IPLP. DISCUSSION All procedures were tolerated, systemic toxicities were temporary and subsequent clinical and radiological follow-up, following the last combined treatment, indicated that this patient was still alive and disease-free, at 56 months. CONCLUSION In this case, surgery combined with locoregional Melphalan chemotherapy was an effective and repeatable treatment for recurrent MMC and resulted in unexpected long-term survival.
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Affiliation(s)
- S Guadagni
- Department of Applied Clinical Sciences and Biotechnology, Section General Surgery, University of L'Aquila, 67100, L'Aquila, Italy; Alma Mater Europaea-European Center, Maribor, Slovenia.
| | - A Chiominto
- Department of Pathology, San Salvatore Hospital, L'Aquila, Italy.
| | - A R Mackay
- Department of Applied Clinical Sciences and Biotechnology, Section of Pathology and Clinical Molecular Oncology, University of L'Aquila, 67100, L'Aquila, Italy.
| | - A R Farina
- Department of Applied Clinical Sciences and Biotechnology, Section of Pathology and Clinical Molecular Oncology, University of L'Aquila, 67100, L'Aquila, Italy.
| | - L Cappabianca
- Department of Applied Clinical Sciences and Biotechnology, Section of Pathology and Clinical Molecular Oncology, University of L'Aquila, 67100, L'Aquila, Italy.
| | - I Puccica
- Department of Applied Clinical Sciences and Biotechnology, Section General Surgery, University of L'Aquila, 67100, L'Aquila, Italy.
| | - S Valiyeva
- Department of Applied Clinical Sciences and Biotechnology, Section General Surgery, University of L'Aquila, 67100, L'Aquila, Italy.
| | - M Clementi
- Department of Applied Clinical Sciences and Biotechnology, Section General Surgery, University of L'Aquila, 67100, L'Aquila, Italy.
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Olofsson Bagge R, Carlson P, Razzazian R, Hansson C, Hjärpe A, Mattsson J, Katsarelias D. Minimally invasive isolated limb perfusion – technical details and initial outcome of a new treatment method for limb malignancies. Int J Hyperthermia 2018; 35:667-673. [DOI: 10.1080/02656736.2018.1522000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Roger Olofsson Bagge
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Carlson
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Roya Razzazian
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christoffer Hansson
- Department of Thoracic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Hjärpe
- Department of Thoracic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan Mattsson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Dimitrios Katsarelias
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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O'Donoghue C, Perez MC, Mullinax JE, Hardman D, Sileno S, Naqvi SMH, Kim Y, Gonzalez RJ, Zager JS. Isolated Limb Infusion: A Single-Center Experience with Over 200 Infusions. Ann Surg Oncol 2017; 24:3842-3849. [PMID: 29019175 DOI: 10.1245/s10434-017-6107-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Isolated limb infusion (ILI) is a minimally invasive technique for delivering regional chemotherapy to an extremity for patients with locally advanced cutaneous malignancies and sarcoma. METHODS A single-institution, prospectively collected database was analyzed for intention-to-treat with ILI. RESULTS From 2007 to 2016, 163 patients underwent 205 procedures (201 were successfully completed), and four malignancies were treated: melanoma (72.1% of all ILIs), sarcoma (23.4%), squamous cell carcinoma (SCC; 2.0%) and Merkel cell carcinoma (MCC; 2.5%). A median grade II regional Wieberdink toxicity score was observed, with 88.1% of patients experiencing grade II or less. Median follow-up was 21.8 months, and overall response rate (ORR) was 59.0% for melanoma, 48.9% for sarcoma, 50.0% for SCC, and 60.0% for MCC. A significant difference (p = 0.04) between upper (76.9%) and lower extremity (55.1%) ORR was observed in patients with melanoma. When comparing responders with nonresponders, patients with melanoma had significantly longer in-field progression-free survival (IPFS; 14.1 vs. 3.2 months, p < 0.001), distant metastatic-free survival (DMFS; not reached vs. 25.8 months, p = 0.006), and overall survival (OS; 56.0 vs. 26.7 months, p = 0.0004). Sarcoma responders had a significantly longer IPFS (13.0 vs. 2.7 months, p < 0.0001), but no significant distant metastatic or OS advantage. Over a median follow-up of 19.3 months, sarcoma patients had an overall limb salvage rate of 68.4%. CONCLUSION ILI is a well-tolerated procedure for patients with locally advanced melanoma, sarcoma, and other cutaneous malignancies. ILI responders had a significantly longer time to IPFS, while melanoma responders also had a DMFS and OS advantage.
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Affiliation(s)
| | - Matthew C Perez
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - John E Mullinax
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Danielle Hardman
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Sean Sileno
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | | | - Youngchul Kim
- Department of Biostatistics, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA.
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Belgrano V, Ben-Shabat I, Bergh P, Olofsson Bagge R. Isolated limb perfusion as a treatment option for rare types of tumours. Int J Hyperthermia 2016; 32:595-9. [PMID: 27269515 DOI: 10.1080/02656736.2016.1188999] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Isolated limb perfusion (ILP) is an established and effective treatment for advanced melanoma and soft tissue sarcomas of the extremities with a high overall response rate. The aim of this study was to describe our experience of ILP for more rare types of tumours. METHODS Patients with Merkel cell carcinoma (MCC) (n = 4), squamous cell carcinoma (SCC) (n = 2), B-cell lymphoma (n = 1), desmoid tumours (n = 3), pigmented villonodular synovitis (PVNS) (n = 1) and giant cell tumour (n = 1) were treated with ILP and analysed retrospectively. RESULTS The four patients with in-transit MCC had three complete responses (CR) and one partial response (PR); the two patients with SCC had one CR and one stable disease (SD); the patients with desmoid tumours had two PR and one SD. A CR was also observed for the patient with a giant cell tumour, but the patient with PVNS had a SD. The patient with cutaneous metastases of B-cell lymphoma showed a CR, however with rapid systemic progression. Local toxicity according to Wieberdink was grade II in 10 patients (83%) and grade III in two patients (17%). CONCLUSIONS These results show that ILP can be used as a treatment option also for more rare disease entities when other treatments have failed.
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Affiliation(s)
- Valerio Belgrano
- a Department of Surgery , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden ;,b Department of Surgical Sciences and Integrated Diagnostics (DISC) , University of Genoa, IRCCS AOU San Martino-IST University-Hospital , Genoa , Italy
| | - Ilan Ben-Shabat
- a Department of Surgery , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
| | - Peter Bergh
- c Department of Orthopaedics , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
| | - Roger Olofsson Bagge
- a Department of Surgery , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
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Thiels CA, Gonzalez AB, Gray RJ, Jakub JW. Isolated limb perfusion in Merkel cell carcinoma offers high rate of complete response and durable local-regional control: Systematic review and institutional experience. J Surg Oncol 2016; 114:187-92. [PMID: 27189050 DOI: 10.1002/jso.24289] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/29/2016] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Hyperthermic isolated limb perfusion (HILP) has an established role in the management of melanoma, but its role for Merkel cell carcinoma (MCC) is less well defined. METHODS Retrospective review of our institutional experience with HILP for MCC was conducted (2009-2015). Literature search was performed through 04/2015 and 10 studies met inclusion criteria. RESULTS Four patients underwent HILP for MCC at our institution. There were no major complications and complete response was achieved in all patients. Early metastatic recurrence developed in two patients. The remaining two had no evidence of disease at last follow-up (36 months) or death (39 months). Systematic review identified an additional 12 pts that underwent HILP for MCC, for a total of 16 cases. Median age was 73 [IQR 69-78] years and 56% were men. Of the patients with reported follow-up, 12 (86%) had complete response, 1 had stable disease, and 1 partial response. Four patients developed local-regional recurrence and six distant metastases, all within 6 months. Overall median follow-up time was 15 [7-36] months. CONCLUSION Among a highly selective group of patients, regional perfusion for MCC is safe and has a high complete response rate. HILP is an acceptable therapeutic modality for obtaining durable loco-regional control but early distant metastatic disease remains a significant cause of mortality. J. Surg. Oncol. 2016;114:187-192. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | | | | | - James W Jakub
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
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Smith H, Hayes A. The role of regional chemotherapy in the management of extremity soft tissue malignancies. Eur J Surg Oncol 2016; 42:7-17. [DOI: 10.1016/j.ejso.2015.08.165] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/06/2015] [Accepted: 08/15/2015] [Indexed: 10/23/2022] Open
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Lebbe C, Becker JC, Grob JJ, Malvehy J, Del Marmol V, Pehamberger H, Peris K, Saiag P, Middleton MR, Bastholt L, Testori A, Stratigos A, Garbe C. Diagnosis and treatment of Merkel Cell Carcinoma. European consensus-based interdisciplinary guideline. Eur J Cancer 2015; 51:2396-403. [PMID: 26257075 DOI: 10.1016/j.ejca.2015.06.131] [Citation(s) in RCA: 176] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 06/15/2015] [Indexed: 10/23/2022]
Abstract
Merkel cell carcinoma (MCC) is a rare tumour of the skin of neuro-endocrine origin probably developing from neuronal mechanoreceptors. A collaborative group of multidisciplinary experts form the European Dermatology Forum (EDF), The European Association of Dermato-Oncology (EADO) and the European Organization of Research and Treatment of Cancer (EORTC) was formed to make recommendations on MCC diagnosis and management, based on a critical review of the literature, existing guidelines and expert's experience. Clinical features of the cutaneous/subcutaneous nodules hardly contribute to the diagnosis of MCC. The diagnosis is made by histopathology, and an incisional or excisional biopsy is mandatory. Immunohistochemical staining contributes to clarification of the diagnosis. Initial work-up comprises ultrasound of the loco-regional lymph nodes and total body scanning examinations. The primary tumour should be excised with 1-2cm margins. In patients without clinical evidence of regional lymph node involvement, sentinel node biopsy is recommended, if possible, and will be taken into account in a new version of the AJCC classification. In patients with regional lymph node involvement radical lymphadenectomy is recommended. Adjuvant radiotherapy might be considered in patients with multiple affected lymph nodes of extracapsular extension. In unresectable metastatic MCC mono- or poly-chemotherapy achieve high remission rates. However, responses are usually short lived. Treatment within clinical trials is regarded as a standard of care in disseminated MCC.
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Affiliation(s)
- Celeste Lebbe
- APHP University Department of Dermatology, Saint-Louis Hospital, INSERM U976, Paris, France.
| | | | | | - Josep Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clinic, Barcelona, Spain
| | - Veronique Del Marmol
- University Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Ketty Peris
- University Department of Dermatology, L'Aquila, Italy
| | - Philippe Saiag
- University Department of Dermatology, Université de Versailles-Saint Quentin en Yvelines, APHP, Boulogne, France
| | - Mark R Middleton
- Department of Oncology, Oxford National Institute for Health Research Biomedical Research Centre, United Kingdom
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Denmark
| | - Alessandro Testori
- Istituto Europeo di Oncologia, Divisione dermato-oncologica, Milan, Italy
| | - Alexander Stratigos
- 1st Department of Dermatology, University of Athens, A. Sygros Hospital, Athens, Greece
| | - Claus Garbe
- University Department of Dermatology, Tuebingen, Germany
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Gunaratne DA, Howle JR, Veness MJ. Merkel cell carcinoma: A case of palliative upper limb amputation in a patient with refractory in-transit metastases. Australas J Dermatol 2015; 57:e53-6. [PMID: 25754425 DOI: 10.1111/ajd.12291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 11/03/2014] [Indexed: 11/25/2022]
Abstract
We report an unusual case of Merkel cell carcinoma in a 70-year-old woman with the rapid development of left upper limb in-transit and hepatic metastases. The patient had a preceding history of left-sided breast cancer. Palliative chemotherapy with carboplatin and etoposide produced a minimal response. The in-transit metastases rapidly progressed and were refractory to chemotherapy and a single fraction of palliative radiotherapy, leading to a marked impact on her quality of life, secondary to sepsis and bleeding. After lengthy discussion, she consented to an above-elbow amputation resulting in a marked improvement in her well-being. In this case, we believe that palliative amputation of the involved arm was justified and beneficial to the patient.
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Affiliation(s)
- Dakshika A Gunaratne
- Department of Surgery, Crown Princess Mary Cancer Care Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Julie R Howle
- Department of Surgical Oncology, Crown Princess Mary Cancer Care Centre, Westmead Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Michael J Veness
- Department of Radiation Oncology and Crown Princess Mary Cancer Care Centre, Westmead Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
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Kocatüurk E, Ülkümen PK, Kizitaç U, Yüksel T, Kunter AS, Erhan SŞ. In-Transit Metastasis from Primary Cutaneous Squamous Cell Carcinoma in a Nonimmunosuppressed Patient. J Cutan Med Surg 2015; 19:167-70. [DOI: 10.2310/7750.2014.14047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background In-transit metastases are dermal and subcutanous metastatic foci located between the tumor and the closest regional lymph node. Although in-transit metastasis has been commonly described for malignant melanoma, there have been some reports of in-transit metastases arising from primary cutaneous malignancies. The risk of development of in-transit metastases is higher in patients with high-risk squamous cell carcinoma. Case Report We present a case of in-transit metastasis in a nonimmunosuppressed patient with a primary cutaneous squamous cell carcinoma.
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Affiliation(s)
- Emek Kocatüurk
- Departments of Dermatology and Pathology, Okmeydam Training and Research Hospital, Istanbul, Turkey
| | - Pelin Kuteyla Ülkümen
- Departments of Dermatology and Pathology, Okmeydam Training and Research Hospital, Istanbul, Turkey
| | - Utkan Kizitaç
- Departments of Dermatology and Pathology, Okmeydam Training and Research Hospital, Istanbul, Turkey
| | - Tülin Yüksel
- Departments of Dermatology and Pathology, Okmeydam Training and Research Hospital, Istanbul, Turkey
| | - Ayşle Seza Kunter
- Departments of Dermatology and Pathology, Okmeydam Training and Research Hospital, Istanbul, Turkey
| | - Selma Şlengiz Erhan
- Departments of Dermatology and Pathology, Okmeydam Training and Research Hospital, Istanbul, Turkey
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Gill K, Ariyan C, Wang X, Brady MS, Pulitzer M. CD30-positive lymphoproliferative disorders arising after regional therapy for recurrent melanoma: A report of two cases and analysis of CD30 expression. J Surg Oncol 2014; 110:258-64. [DOI: 10.1002/jso.23636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 04/05/2014] [Indexed: 12/24/2022]
Affiliation(s)
- Kamraan Gill
- Department of Pathology; Memorial Sloan Kettering Cancer Center; New York New York
| | - Charlotte Ariyan
- Department of Surgery; Memorial Sloan Kettering Cancer Center; New York New York
| | - Xuan Wang
- Department of Surgery; Memorial Sloan Kettering Cancer Center; New York New York
| | - Mary Sue Brady
- Department of Surgery; Memorial Sloan Kettering Cancer Center; New York New York
| | - Melissa Pulitzer
- Department of Pathology; Memorial Sloan Kettering Cancer Center; New York New York
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Garibyan L, Cotter SE, Hansen JL, Noell C, Dorosario A, O'Farrell DA, Devlin PM, Wang LC. Palliative treatment for in-transit cutaneous metastases of Merkel cell carcinoma using surface-mold computer-optimized high-dose-rate brachytherapy. Cancer J 2014; 19:283-7. [PMID: 23867506 DOI: 10.1097/ppo.0b013e31829e3566] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE The objective of this study was to evaluate the palliative treatment benefit of surface-mold computer-optimized high-dose-rate brachytherapy (SMBT) for in-transit cutaneous metastases of Merkel cell carcinoma (MCC). METHODS Ten patients with in-transit cutaneous MCC metastases were treated with SMBT at the Dana-Farber/Brigham & Women's Cancer Center between 2006 and 2012. RESULTS The median age at diagnosis was 76 years (range, 63-87 years). Seven patients had in-transit metastases on the lower extremities (70%), 2 patients on the head and neck (20%), and 1 patient on an upper extremity (10%). A total of 152 metastatic MCC lesions were treated with SMBT. All SMBT-treated lesions resolved clinically within a few weeks of therapy. The median follow-up was 34 months (range, 22-85 months). Two of 152 treated lesions recurred during the study period for a local control rate of 99%. Eight patients (80%) developed additional in-transit metastases outside the original SMBT fields. Five of these 8 patients underwent additional SMBT. At study conclusion, 3 patients (30%) are alive without disease, 3 patients (30%) are alive with disease, and 4 patients (40%) died of MCC. DISCUSSION Surface-mold computer-optimized high-dose-rate brachytherapy offers effective and durable palliation for cutaneous metastases of MCC, although it does not appear to alter disease course.
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Affiliation(s)
- Lilit Garibyan
- Department of Dermatology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 21202, USA.
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Sardi A, Jimenez W, Nieroda C, Sittig M, Shankar S, Gushchin V. Melphalan: A Promising Agent in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2013; 21:908-14. [DOI: 10.1245/s10434-013-3407-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Indexed: 01/19/2023]
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Grotz TE, Tarantola TI, Otley CC, Weaver AL, McGree ME, Jakub JW. Natural history of merkel cell carcinoma following locoregional recurrence. Ann Surg Oncol 2012; 19:2556-62. [PMID: 22453243 DOI: 10.1245/s10434-011-2161-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Indexed: 01/10/2023]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine malignancy with an ill-defined natural history following locoregional recurrence. METHODS This is a retrospective review of patients with MCC diagnosed at the Mayo Clinic from 1981 to 2008. For each outcome (subsequent locoregional recurrence, distant recurrence, and death) the survival-free of the outcome was estimated using the Kaplan-Meier method. Associations of patient and clinical characteristics with the outcomes were assessed by fitting Cox proportional hazards regression models. RESULTS Among the 240 patients diagnosed with MCC, 70 (29%) patients were identified who developed locoregional recurrence as the first site of recurrence. The median time from diagnosis to locoregional recurrence was 6 months. The pattern of first locoregional failure in this group includes 25 (10.4%) local, 18 (7.5%) in-transit, and 27 (11.3%) nodal recurrences. Recurrences were most commonly treated by surgery and radiation. At 3 years after the initial recurrence, locoregional recurrence-free survival was 75% and the distant recurrence-free survival was 56%. Locoregional recurrence is a poor prognostic sign associated with a 3-year overall survival of 39%. Nodal status at time of original surgery and time to first recurrence were important predictors of distant recurrence (P < 0.006) and overall survival following locoregional recurrence (P < 0.001). CONCLUSIONS Locoregional recurrence is a substantial problem in patients with MCC and is a poor prognostic sign. In those patients who experience a locoregional recurrence, aggressive efforts to regain locoregional control appear warranted and may result in long-term survival.
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Current World Literature. Curr Opin Oncol 2012; 24:197-202. [DOI: 10.1097/cco.0b013e32835164ff] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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