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Roshardt Prieto NM, Turko P, Zellweger C, Nguyen-Kim TDL, Staeger R, Bellini E, Levesque MP, Dummer R, Ramelyte E. Patterns of radiological response to tebentafusp in patients with metastatic uveal melanoma. Melanoma Res 2024; 34:166-174. [PMID: 38126339 PMCID: PMC10906186 DOI: 10.1097/cmr.0000000000000952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023]
Abstract
Metastatic uveal melanoma (mUM) is a rare type of melanoma with poor outcomes. The first systemic treatment to significantly prolong overall survival (OS) in patients with mUM was tebentafusp, a bispecific protein that can redirect T-cells to gp-100 positive cells. However, the objective response rate according to Response Evaluation Criteria in Solid Tumors (RECIST) may underestimate the clinical impact of tebentafusp. As metabolic response assessed by PET Response Criteria in Solid Tumors (PERCIST) has been reported to better correlate with clinical outcome, we here compared the patterns of radiological and morphological responses in HLA-A*02:01-positive patients with mUM treated with tebentafusp. In the 19 enrolled patients, RECIST showed an overall response rate (ORR) of 10%, median progression-free survival of 2.8 months (95% CI 2.5-8.4), and median OS (mOS) of 18.8 months. In 10 patients, where both RECIST and PERCIST evaluation was available, the ORR was 10% for both; however, the PFS was longer for PERCIST compared to RECIST, 3.1 and 2.4 months, respectively. A poor agreement between the criteria was observed at all assessments (Cohen's kappa ≤0), yet they differed significantly only at the first on-treatment imaging ( P = 0.037). Elevated baseline LDH and age were associated with an increased risk for RECIST progression, while lymphocyte decrease after the first infusions correlated to reduced risk of RECIST progression. Detectable ctDNA at baseline did not correlate with progression. Early response to tebentafusp may be incompletely captured by conventional imaging, leading to a need to consider both tumor morphology and metabolism.
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Affiliation(s)
| | - Patrick Turko
- Department of Dermatology, University Hospital Zurich
- Medical Faculty, University of Zurich
| | - Caroline Zellweger
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich
| | - Thi Dan Linh Nguyen-Kim
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich
- Institute for Radiology and Nuclear Medicine Waid Municipal Hospital, Zurich, Switzerland
| | - Ramon Staeger
- Department of Dermatology, University Hospital Zurich
- Medical Faculty, University of Zurich
| | | | - Mitchell P. Levesque
- Department of Dermatology, University Hospital Zurich
- Medical Faculty, University of Zurich
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich
- Medical Faculty, University of Zurich
| | - Egle Ramelyte
- Department of Dermatology, University Hospital Zurich
- Medical Faculty, University of Zurich
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Fischer RA, Ryan I, De La Torre K, Barnett C, Sehgal VS, Levy JB, Luke JJ, Poklepovic AS, Hurlbert MS. US physician perspective on the use of biomarker and ctDNA testing in patients with melanoma. Crit Rev Oncol Hematol 2024; 196:104289. [PMID: 38341119 DOI: 10.1016/j.critrevonc.2024.104289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/12/2024] Open
Abstract
New treatments have increased survival of patients with melanoma, and methods to monitor patients throughout the disease process are needed. Circulating tumor DNA (ctDNA) is a predictive and prognostic biomarker that may allow routine, real-time monitoring of disease status. We surveyed 44 US physicians to understand their preferences and practice patterns for biomarker and ctDNA testing in their patients with melanoma. Tumor biomarker testing was often ordered in stage IIIA-IV patients. Barriers to biomarker testing include insufficient tissue (60%) and lack of insurance coverage (54%). ctDNA testing was ordered by 16-18% of physicians for stages II-IV. Reasons for not using ctDNA testing included lack of prospective data (41%), ctDNA testing used for research only (18%), and others. Physicians (≥74%) believed that ctDNA assays could help with monitoring and treatment selection throughout the disease process. Physicians consider ctDNA testing potentially valuable for clinical decision-making but cited concerns that should be addressed.
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Affiliation(s)
- Rachel A Fischer
- Melanoma Research Alliance, 730 15th St NW, Washington, DC 20005, USA
| | - Isabel Ryan
- Melanoma Research Alliance, 730 15th St NW, Washington, DC 20005, USA
| | | | - Cody Barnett
- Melanoma Research Alliance, 730 15th St NW, Washington, DC 20005, USA
| | - Viren S Sehgal
- Melanoma Research Alliance, 730 15th St NW, Washington, DC 20005, USA
| | - Joan B Levy
- Melanoma Research Alliance, 730 15th St NW, Washington, DC 20005, USA
| | - Jason J Luke
- Cancer Immunotherapeutics Center, University of Pittsburgh Medical Center, 5150 Centre Avenue, Pittsburgh, PA 15232, USA
| | - Andrew S Poklepovic
- Virginia Commonwealth University Health System Massey Cancer Center, 401 College Street, Richmond, VA 23298-0037, USA
| | - Marc S Hurlbert
- Melanoma Research Alliance, 730 15th St NW, Washington, DC 20005, USA.
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Lim MJR, Tan EEK, Wong RX, Chang KTE, Fortier MV, Cheong TM, Ng LP, Low SYY. Pediatric Primary Intracranial Malignant Melanoma: Case Report and Literature Review. Pediatr Neurosurg 2023; 58:223-230. [PMID: 37315550 DOI: 10.1159/000531544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Primary intracranial malignant melanoma (PIMM) is an extremely rare primary brain tumor with most cases diagnosed in adults. To date, there are only a few cases reported in the pediatric population. Owing to its infrequency, there are no established guidelines to treat this aggressive neoplasm. Recent insights suggest that PIMM are molecularly different between adults and children, whereby NRAS mutations drive tumor growth in the latter group. We present a unique case of PIMM in a pediatric patient and discuss the case in corroboration with current literature. CASE PRESENTATION A previously well 15-year-old male presented with progressive symptoms of raised intracranial pressure. Neuroimaging reported a large solid-cystic lesion with significant mass effect. He underwent gross total resection of the lesion that was reported to be a PIMM with pathogenic single nucleotide variant NRAS p.Gln61Lys. Further workup for cutaneous, uveal, and visceral malignant melanoma was negative. A trial of whole-brain radiotherapy followed by dual immune checkpoint inhibitors was commenced. Despite concerted efforts, the patient had aggressive tumor progression and eventually demised from his disease. CONCLUSION We therein report a case of pediatric PIMM, in the context of the patient's clinical, radiological, histopathological, and molecular findings. This case highlights the therapeutic difficulties faced in disease management and contributes to the very limited pool of medical literature for this devastating primary brain tumor.
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Affiliation(s)
- Mervyn J R Lim
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Enrica E K Tan
- Paediatric Haematology/Oncology Service, KK Women's and Children's Hospital, Singapore, Singapore
- SingHealth Duke-NUS Paediatrics Academic Clinical Program, Singapore, Singapore
| | - Ru Xin Wong
- Department of Radiation Oncology, National Cancer Centre, Singapore, Singapore
| | - Kenneth T E Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Marielle V Fortier
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore
| | - Tien Meng Cheong
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Lee Ping Ng
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Sharon Y Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore, Singapore
- SingHealth Duke-NUS Paediatrics Academic Clinical Program, Singapore, Singapore
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
- SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore, Singapore
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Eroglu Z, Krinshpun S, Kalashnikova E, Sudhaman S, Ozturk Topcu T, Nichols M, Martin J, Bui KM, Palsuledesai CC, Malhotra M, Olshan P, Markowitz J, Khushalani NI, Tarhini AA, Messina JL, Aleshin A. Circulating tumor DNA-based molecular residual disease detection for treatment monitoring in advanced melanoma patients. Cancer 2023; 129:1723-1734. [PMID: 36869646 DOI: 10.1002/cncr.34716] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 03/05/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have substantially improved overall survival in patients with advanced melanoma; however, the lack of biomarkers to monitor treatment response and relapse remains an important clinical challenge. Thus, a reliable biomarker is needed that can risk-stratify patients for disease recurrence and predict response to treatment. METHODS A retrospective analysis using a personalized, tumor-informed circulating tumor DNA (ctDNA) assay on prospectively collected plasma samples (n = 555) from 69 patients with advanced melanoma was performed. Patients were divided into three cohorts: cohort A (N = 30), stage III patients receiving adjuvant ICI/observation; cohort B (N = 29), unresectable stage III/IV patients receiving ICI therapy; and cohort C (N = 10), stage III/IV patients on surveillance after planned completion of ICI therapy for metastatic disease. RESULTS In cohort A, compared to molecular residual disease (MRD)-negative patients, MRD-positivity was associated with significantly shorter distant metastasis-free survival (DMFS; hazard ratio [HR], 10.77; p = .01). Increasing ctDNA levels from the post-surgical or pre-treatment time point to after 6 weeks of ICI were predictive of shorter DMFS in cohort A (HR, 34.54; p < .0001) and shorter progression-free survival (PFS) in cohort B (HR, 22; p = .006). In cohort C, all ctDNA-negative patients remained progression-free for a median follow-up of 14.67 months, whereas ctDNA-positive patients experienced disease progression. CONCLUSION Personalized and tumor-informed longitudinal ctDNA monitoring is a valuable prognostic and predictive tool that may be used throughout the clinical course of patients with advanced melanoma.
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Affiliation(s)
- Zeynep Eroglu
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | | | | | | | - Turkan Ozturk Topcu
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Matt Nichols
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Justin Martin
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Katherine M Bui
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | | | | | | | - Joseph Markowitz
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Nikhil I Khushalani
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Ahmad A Tarhini
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Jane L Messina
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA
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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.
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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.
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