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Eroglu Z, Eatrides J, Naqvi SMH, Kim Y, Rich J, Babacan NA, Brohl AS, Markowitz J, Sarnaik A, Zager J, Khushalani NI, Sondak VK, Messina J. Neoadjuvant BRAF-targeted therapy in regionally advanced and oligometastatic melanoma. Pigment Cell Melanoma Res 2020; 33:86-95. [PMID: 31329344 PMCID: PMC6928428 DOI: 10.1111/pcmr.12813] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/02/2019] [Accepted: 07/04/2019] [Indexed: 12/11/2022]
Abstract
Current management of locoregional and oligometastatic melanoma is typically with surgery; however, some patients are unable to undergo resection due to location/size of their tumors and/or the anticipated morbidity of the surgery. While there are currently no established guidelines for neoadjuvant therapy in melanoma, neoadjuvant BRAF-targeted therapy may make resection more feasible. A retrospective analysis was conducted of 23 patients with BRAFV600-mutant, stage III/IV melanoma treated with BRAF-targeted therapy prior to surgery, with no adjuvant treatment. Surgical specimens, preoperative imaging, and clinical outcomes were evaluated. Results: Ten of 23 patients (44%) attained a pathologic complete response (pCR), with no correlation between RECIST response based on preoperative imaging and pathologic response. After a median of 43-month follow-up, only 1 patient (10%) with a pCR recurred, while 8 of 13 (62%) patients without a pCR recurred. Patients with a pCR had significantly improved relapse-free (RFS) and overall survival (OS) compared to patients with residual tumor. Neoadjuvant BRAF-targeted therapy is associated with a high pCR rate in patients with stage III-IV melanoma, which may correlate with improved RFS and OS.
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Affiliation(s)
- Zeynep Eroglu
- Department of Cutaneous Oncology, Moffitt Cancer Center,
Tampa, FL
| | | | | | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, Moffitt
Cancer Center, Tampa, FL
| | - Jeani Rich
- Department of Cutaneous Oncology, Moffitt Cancer Center,
Tampa, FL
| | | | - Andrew S Brohl
- Department of Cutaneous Oncology, Moffitt Cancer Center,
Tampa, FL
| | - Joseph Markowitz
- Department of Cutaneous Oncology, Moffitt Cancer Center,
Tampa, FL
| | - Amod Sarnaik
- Department of Cutaneous Oncology, Moffitt Cancer Center,
Tampa, FL
| | - Jonathan Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center,
Tampa, FL
| | | | - Vernon K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center,
Tampa, FL
| | - Jane Messina
- Department of Cutaneous Oncology, Moffitt Cancer Center,
Tampa, FL
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Faut M, Jalving M, Diercks GF, Hospers GA, van Leeuwen BL, Been LB. Preoperative BRAF inhibition in patients with irresectable locally advanced stage III melanoma. Melanoma Manag 2018; 5:MMT08. [PMID: 30459939 PMCID: PMC6240848 DOI: 10.2217/mmt-2018-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/19/2018] [Indexed: 11/21/2022] Open
Abstract
Aim Neoadjuvant treatment of locally advanced disease with BRAF inhibitors is expected to increase the likelihood of a R0 resection. We present six patients with stage III unresectable melanoma, neoadjuvantly treated with BRAF inhibitors. Methods Patients with unresectable, BRAF-mutated, stage III melanoma, were treated with BRAF inhibitors between 2012 and 2015. Unresectability was determined based on clinical and/or radiological findings. At maximal response, resection was performed. The specimen was reviewed to determine the degree of response. Results In five of six patients a radical resection was achieved. Postoperative complications were unremarkable. In five of six resected specimens, vital tumor tissue was found. Conclusion Neoadjuvant BRAF inhibitor treatment of locally advanced melanoma is feasible and has the potential to facilitate an R0 resection.
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Affiliation(s)
- Marloes Faut
- Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands.,Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - Mathilde Jalving
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands.,Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - Gilles F Diercks
- Department of Pathology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands.,Department of Pathology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - Geke A Hospers
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands.,Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands.,Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - Lukas B Been
- Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands.,Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands
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McQuade J, Davies MA. Converting biology into clinical benefit: lessons learned from BRAF inhibitors. Melanoma Manag 2015; 2:241-254. [PMID: 26594316 PMCID: PMC4649930 DOI: 10.2217/mmt.15.18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The identification and pharmacological targeting of activating BRAF mutations in melanoma has led to significant improvements in patient outcomes. This perspective paper illustrates the lessons learned from the study of BRAF mutations and the development of BRAF inhibitors. The relevance of these lessons to the development of future targeted therapies is highlighted.
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Affiliation(s)
- Jennifer McQuade
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Michael A Davies
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
- *Author for correspondence: Tel.: +1 713 792 3454; Fax: +1 713 563 3454;
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