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Su Z, Shi F, Zhang J, Liang W. Effect of interferon-α-2b and interleukin-2 combined with chemotherapy in metastatic melanoma. Panminerva Med 2024; 66:131-136. [PMID: 32700883 DOI: 10.23736/s0031-0808.20.03912-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To explore the efficacy and safety of interferon-α-2b and interleukin-2 combined with chemotherapy in treating patients with metastatic melanoma. METHODS The patients with metastatic melanoma in control group (N.=52) were treated with conventional DDAVC chemotherapy regimen, while those in combination group (N.=52) received biotherapy with interferon-α-2b and interleukin-2 in addition to the chemotherapy in control group. At the end of the treatments, the serum immune function indicators, short-term efficacy and incidence of adverse reactions were compared between the two groups of patients, and patient's survival was followed up and recorded. RESULTS At 1 week after treatment, it was found that the overall response rate in combination group was substantially higher than that in control group (P=0.027). Besides, according to the serologic test results at 1 week after the chemotherapy, T lymphocyte subset activity was enhanced in patients in combination group compared with that before chemotherapy, with no statistically significant difference (P>0.05), but it was notably weakened in control group in comparison with that before chemotherapy (P<0.05). Finally, it was discovered through the log-rank test that the overall survival (OS) rate in combination group was remarkably superior to that in control group (P=0.029), but there was no statistically significant difference in the progression-free survival (PFS) rate between the two groups (P=0.076). CONCLUSIONS Compared with chemotherapy alone, interferon-α-2b and interleukin-2 combined with chemotherapy can raise the clinical short-term efficacy and long-term OS rate in the patients with metastatic melanoma and alleviate their toxic side reactions, with higher safety.
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Affiliation(s)
- Zheng Su
- Department of Plastic and Reconstructive Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Fen Shi
- Department of Plastic and Reconstructive Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jian Zhang
- Department of Plastic and Reconstructive Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Weiqiang Liang
- Department of Plastic and Reconstructive Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China -
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2
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Al Hmada Y, Brodell RT, Kharouf N, Flanagan TW, Alamodi AA, Hassan SY, Shalaby H, Hassan SL, Haikel Y, Megahed M, Santourlidis S, Hassan M. Mechanisms of Melanoma Progression and Treatment Resistance: Role of Cancer Stem-like Cells. Cancers (Basel) 2024; 16:470. [PMID: 38275910 PMCID: PMC10814963 DOI: 10.3390/cancers16020470] [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: 12/05/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Melanoma is the third most common type of skin cancer, characterized by its heterogeneity and propensity to metastasize to distant organs. Melanoma is a heterogeneous tumor, composed of genetically divergent subpopulations, including a small fraction of melanoma-initiating cancer stem-like cells (CSCs) and many non-cancer stem cells (non-CSCs). CSCs are characterized by their unique surface proteins associated with aberrant signaling pathways with a causal or consequential relationship with tumor progression, drug resistance, and recurrence. Melanomas also harbor significant alterations in functional genes (BRAF, CDKN2A, NRAS, TP53, and NF1). Of these, the most common are the BRAF and NRAS oncogenes, with 50% of melanomas demonstrating the BRAF mutation (BRAFV600E). While the successful targeting of BRAFV600E does improve overall survival, the long-term efficacy of available therapeutic options is limited due to adverse side effects and reduced clinical efficacy. Additionally, drug resistance develops rapidly via mechanisms involving fast feedback re-activation of MAPK signaling pathways. This article updates information relevant to the mechanisms of melanoma progression and resistance and particularly the mechanistic role of CSCs in melanoma progression, drug resistance, and recurrence.
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Affiliation(s)
- Youssef Al Hmada
- Department of Pathology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA; (Y.A.H.); (R.T.B.)
| | - Robert T. Brodell
- Department of Pathology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA; (Y.A.H.); (R.T.B.)
| | - Naji Kharouf
- Institut National de la Santé et de la Recherche Médicale, University of Strasbourg, 67000 Strasbourg, France; (N.K.); (Y.H.)
- Department of Operative Dentistry and Endodontics, Dental Faculty, University of Strasbourg, 67000 Strasbourg, France
| | - Thomas W. Flanagan
- Department of Pharmacology and Experimental Therapeutics, LSU Health Sciences Center, New Orleans, LA 70112, USA;
| | - Abdulhadi A. Alamodi
- College of Health Sciences, Jackson State University, 310 W Woodrow Wilson Ave Ste 300, Jackson, MS 39213, USA;
| | - Sofie-Yasmin Hassan
- Department of Pharmacy, Faculty of Science, Heinrich-Heine University Duesseldorf, 40225 Dusseldorf, Germany;
| | - Hosam Shalaby
- Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112, USA;
| | - Sarah-Lilly Hassan
- Department of Chemistry, Faculty of Science, Heinrich-Heine University Duesseldorf, 40225 Dusseldorf, Germany;
| | - Youssef Haikel
- Institut National de la Santé et de la Recherche Médicale, University of Strasbourg, 67000 Strasbourg, France; (N.K.); (Y.H.)
- Department of Operative Dentistry and Endodontics, Dental Faculty, University of Strasbourg, 67000 Strasbourg, France
- Pôle de Médecine et Chirurgie Bucco-Dentaire, Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Mosaad Megahed
- Clinic of Dermatology, University Hospital of Aachen, 52074 Aachen, Germany;
| | - Simeon Santourlidis
- Epigenetics Core Laboratory, Medical Faculty, Institute of Transplantation Diagnostics and Cell Therapeutics, Heinrich Heine University Düsseldorf, 40225 Dusseldorf, Germany;
| | - Mohamed Hassan
- Institut National de la Santé et de la Recherche Médicale, University of Strasbourg, 67000 Strasbourg, France; (N.K.); (Y.H.)
- Department of Operative Dentistry and Endodontics, Dental Faculty, University of Strasbourg, 67000 Strasbourg, France
- Research Laboratory of Surgery-Oncology, Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA
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Seth R, Agarwala SS, Messersmith H, Alluri KC, Ascierto PA, Atkins MB, Bollin K, Chacon M, Davis N, Faries MB, Funchain P, Gold JS, Guild S, Gyorki DE, Kaur V, Khushalani NI, Kirkwood JM, McQuade JL, Meyers MO, Provenzano A, Robert C, Santinami M, Sehdev A, Sondak VK, Spurrier G, Swami U, Truong TG, Tsai KK, van Akkooi A, Weber J. Systemic Therapy for Melanoma: ASCO Guideline Update. J Clin Oncol 2023; 41:4794-4820. [PMID: 37579248 DOI: 10.1200/jco.23.01136] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/09/2023] [Indexed: 08/16/2023] Open
Abstract
PURPOSE To provide guidance to clinicians regarding the use of systemic therapy for melanoma. METHODS American Society of Clinical Oncology convened an Expert Panel and conducted an updated systematic review of the literature. RESULTS The updated review identified 21 additional randomized trials. UPDATED RECOMMENDATIONS Neoadjuvant pembrolizumab was newly recommended for patients with resectable stage IIIB to IV cutaneous melanoma. For patients with resected cutaneous melanoma, adjuvant nivolumab or pembrolizumab was newly recommended for stage IIB-C disease and adjuvant nivolumab plus ipilimumab was added as a potential option for stage IV disease. For patients with unresectable or metastatic cutaneous melanoma, nivolumab plus relatlimab was added as a potential option regardless of BRAF mutation status and nivolumab plus ipilimumab followed by nivolumab was preferred over BRAF/MEK inhibitor therapy. Talimogene laherparepvec is no longer recommended as an option for patients with BRAF wild-type disease who have progressed on anti-PD-1 therapy. Ipilimumab- and ipilimumab-containing regimens are no longer recommended for patients with BRAF-mutated disease after progression on other therapies.This full update incorporates the new recommendations for uveal melanoma published in the 2022 Rapid Recommendation Update.Additional information is available at www.asco.org/melanoma-guidelines.
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Affiliation(s)
- Rahul Seth
- SUNY Upstate Medical University, Syracuse, NY
| | - Sanjiv S Agarwala
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | | | | | - Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | | | | | - Matias Chacon
- Instituto Alexander Fleming, Buenos Aires, Argentina
| | - Nancy Davis
- Vanderbilt University Medical Center, Nashville, TN
| | - Mark B Faries
- The Angeles Clinic and Research Institute and Cedars Sinai Medical Center, Los Angeles, CA
| | | | | | | | | | | | | | - John M Kirkwood
- University of Pittsburgh School of Medicine and UPMC Hillman Cancer Institute, Pittsburgh, PA
| | | | - Michael O Meyers
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Caroline Robert
- Gustave Roussy Cancer Centre and Paris-Saclay University, Villejuif, France
| | - Mario Santinami
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Vernon K Sondak
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - Umang Swami
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Katy K Tsai
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | - Alexander van Akkooi
- Melanoma Institute Australia, University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia
| | - Jeffrey Weber
- Laura and Isaac Perlmutter Cancer Center at NYU Langone Health, New York, NY
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4
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Seth R, Messersmith H, Kaur V, Kirkwood JM, Kudchadkar R, McQuade JL, Provenzano A, Swami U, Weber J, Alluri KC, Agarwala S, Ascierto PA, Atkins MB, Davis N, Ernstoff MS, Faries MB, Gold JS, Guild S, Gyorki DE, Khushalani NI, Meyers MO, Robert C, Santinami M, Sehdev A, Sondak VK, Spurrier G, Tsai KK, van Akkooi A, Funchain P. Systemic Therapy for Melanoma: ASCO Guideline. J Clin Oncol 2020; 38:3947-3970. [PMID: 32228358 DOI: 10.1200/jco.20.00198] [Citation(s) in RCA: 169] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To provide guidance to clinicians regarding the use of systemic therapy for melanoma. METHODS ASCO convened an Expert Panel and conducted a systematic review of the literature. RESULTS A systematic review, one meta-analysis, and 34 additional randomized trials were identified. The published studies included a wide range of systemic therapies in cutaneous and noncutaneous melanoma. RECOMMENDATIONS In the adjuvant setting, nivolumab or pembrolizumab should be offered to patients with resected stage IIIA/B/C/D BRAF wild-type cutaneous melanoma, while either of those two agents or the combination of dabrafenib and trametinib should be offered in BRAF-mutant disease. No recommendation could be made for or against the use of neoadjuvant therapy in cutaneous melanoma. In the unresectable/metastatic setting, ipilimumab plus nivolumab, nivolumab alone, or pembrolizumab alone should be offered to patients with BRAF wild-type cutaneous melanoma, while those three regimens or combination BRAF/MEK inhibitor therapy with dabrafenib/trametinib, encorafenib/binimetinib, or vemurafenib/cobimetinib should be offered in BRAF-mutant disease. Patients with mucosal melanoma may be offered the same therapies recommended for cutaneous melanoma. No recommendation could be made for or against specific therapy for uveal melanoma. Additional information is available at www.asco.org/melanoma-guidelines.
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Affiliation(s)
- Rahul Seth
- State University of New York Upstate Medical University, Syracuse, NY
| | | | | | - John M Kirkwood
- University of Pittsburgh School of Medicine, Pittsburgh, PA
- University of Pittsburgh Medical Center, Hillman Cancer Institute, Pittsburgh, PA
| | | | | | | | - Umang Swami
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Jeffrey Weber
- Laura and Isaac Perlmutter Cancer Center at New York University, Langone Health, New York, NY
| | | | - Sanjiv Agarwala
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | | | - Nancy Davis
- Vanderbilt University Medical Center, Nashville, TN
| | | | - Mark B Faries
- The Angeles Clinic and Research Institute, Los Angeles, CA
- Cedars Sinai Medical Center, Los Angeles, CA
| | - Jason S Gold
- Veterans Administration Boston Healthcare System, West Roxbury, MA
| | | | - David E Gyorki
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Michael O Meyers
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Caroline Robert
- Gustave Roussy Cancer Centre, Villejuif, France
- Paris-Saclay University, Villejuif, France
| | - Mario Santinami
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Amikar Sehdev
- Indiana University School of Medicine, Indianapolis, IN
| | - Vernon K Sondak
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - Katy K Tsai
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
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5
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Franke V, van Akkooi ACJ. The extent of surgery for stage III melanoma: how much is appropriate? Lancet Oncol 2020; 20:e167-e174. [PMID: 30842060 DOI: 10.1016/s1470-2045(19)30099-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 12/19/2022]
Abstract
Since the first documented lymph node dissection in 1892, many trials have investigated the potential effect of this surgical procedure on survival in patients with melanoma. Two randomised controlled trials were unable to demonstrate improved survival with completion lymph node dissection versus nodal observation in patients with sentinel node-positive disease, although patients with larger sentinel node metastases (>1 mm) might benefit more from observation than from dissection, and could potentially be considered for adjuvant systemic therapy instead of complete dissection. Adjuvant immunotherapy with high-dose ipilimumab has led to improvements in overall survival, whereas therapy with nivolumab and pembrolizumab has improved relapse-free survival with greater safety. Furthermore, adjuvant-targeted therapy with dabrafenib and trametinib has improved survival outcomes in BRAFV600E and BRAFV600K-mutated melanomas. Three neoadjuvant trials have all shown high response rates, including complete responses, after short-term combination therapy with ipilimumab and nivolumab with no recurrences so far, although follow-up is still short. Despite the absence of a survival benefit with completion lymph node dissection in patients with sentinel node-positive or negative disease, the use of sentinel node staging will increase because of the introduction of effective adjuvant therapies. However, routine completion lymph node dissection for sentinel node-positive disease should be reconsidered. Accordingly, existing clinical guidelines are currently being revised. For palpable (macroscopic) nodal disease, the type and extent of surgery could be reduced if the index node can accurately predict the response and if studies show that lymph node dissection can be safely foregone in patients with a complete response. Overall, the appropriate type and extent of surgery for stage III melanoma is changing and becoming more personalised.
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Affiliation(s)
- Viola Franke
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Alexander C J van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands.
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6
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Sharma R, Koruth R, Kanters S, Druyts E, Tarhini A. Comparative efficacy and safety of dabrafenib in combination with trametinib versus competing adjuvant therapies for high-risk melanoma. J Comp Eff Res 2019; 8:1349-1363. [PMID: 31778073 DOI: 10.2217/cer-2019-0061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim To conduct a systematic literature review of high-risk resectable cutaneous melanoma adjuvant therapeutics and compare safety and efficacy. Methods: The systematic literature review included randomized controlled trials investigating: dabrafenib plus trametinib (DAB + TRAM), nivolumab, pembrolizumab, ipilimumab, vemurafenib, chemotherapy and interferons. Outcomes included overall survival (OS), relapse-free survival, distant metastasis-free survival and safety. All outcomes were synthesized using Bayesian network meta-analysis. Results: Across relapse-free survival, distant metastasis-free survival and OS, DAB + TRAM had the lowest estimated hazards of respective events relative to all other treatments (exception relative to nivolumab in OS). Differences were significant relative to placebo, chemotherapy, interferons and ipilimumab. Conclusion: DAB + TRAM has improved efficacy over historical treatment options (ipilimumab, interferons and chemotherapy) and comparable efficacy with other targeted and immune checkpoint inhibitors.
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Affiliation(s)
- Rohini Sharma
- Precision Xtract, Vancouver, British Columbia, V6H 3Y4, Canada
| | - Roy Koruth
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936, USA
| | - Steve Kanters
- Precision Xtract, Vancouver, British Columbia, V6H 3Y4, Canada
| | - Eric Druyts
- Precision Xtract, Vancouver, British Columbia, V6H 3Y4, Canada.,Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936, USA.,Moffitt Comprehensive Cancer Center, Tampa, FL 33612, USA
| | - Ahmad Tarhini
- Moffitt Comprehensive Cancer Center, Tampa, FL 33612, USA
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7
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Zhu C, Zou C, Guan G, Guo Q, Yan Z, Liu T, Shen S, Xu X, Chen C, Lin Z, Cheng W, Wu A. Development and validation of an interferon signature predicting prognosis and treatment response for glioblastoma. Oncoimmunology 2019; 8:e1621677. [PMID: 31428519 DOI: 10.1080/2162402x.2019.1621677] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/24/2019] [Accepted: 05/14/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Interferon treatment, as an important approach of anti-tumor immunotherapy, has been implemented in multiple clinical trials of glioma. However, only a small number of gliomas benefit from it. Therefore, it is necessary to investigate the clinical role of interferons and to establish robust biomarkers to facilitate its application. Materials and methods: This study reviewed 1,241 glioblastoma (GBM) and 1,068 lower grade glioma (LGG) patients from six glioma cohorts. The transcription matrix and clinical information were analyzed using R software, GraphPad Prism 7 and Medcalc, etc. Immunohistochemical (IHC) staining were performed for validation in protein level. Results: Interferon signaling was significantly enhanced in GBM. An interferon signature was developed based on five interferon genes with prognostic significance, which could reflect various interferon statuses. Survival analysis showed the signature could serve as an unfavorable prognostic factor independently. We also established a nomogram model integrating the risk signature into traditional prognostic factors, which increased the validity of survival prediction. Moreover, high-risk group conferred resistance to chemotherapy and high IFNB1 expression levels. Functional analysis showed that the high-risk group was associated with overloaded immune response. Microenvironment analysis and IHC staining found that high-risk group occupied a disorganized microenvironment which was characterized by an enrichment of M0 macrophages and neutrophils, but less infiltration of activated nature killing (NK) cells and M1 type macrophages. Conclusion: This interferon signature was an independent indicator for unfavorable prognosis and showed great potential for screening out patients who will benefit from chemotherapy and interferon treatment.
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Affiliation(s)
- Chen Zhu
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Cunyi Zou
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Gefei Guan
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Qing Guo
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zihao Yan
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Tianqi Liu
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shuai Shen
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaoyan Xu
- Department of Pathophysiology, College of Basic Medicine Science, China Medical University, Shenyang, Liaoning, China
| | - Chen Chen
- The Research Center for Medical Genomics, Key Laboratory of Cell Biology, Ministry of Public Health, Key Laboratory of Medical Cell Biology, Ministry of Education, College of Basic Medical Science, China Medical University, Shenyang, Liaoning, China
| | - Zhiguo Lin
- Department of Neurosurgery, The First Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Wen Cheng
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Anhua Wu
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
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Chen X, Wang K, Chen S, Chen Y. Effects of mesenchymal stem cells harboring the Interferon-β gene on A549 lung cancer in nude mice. Pathol Res Pract 2019; 215:586-593. [PMID: 30683475 DOI: 10.1016/j.prp.2019.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/25/2018] [Accepted: 01/12/2019] [Indexed: 12/26/2022]
Abstract
Interferon-β (IFN-β) exhibits a tumor-killing effect; however, injection of IFN-β alone for lung cancer is often accompanied by side effects. This study investigated the possibility of using umbilical cord mesenchymal stem cells (MSCs) as cellular carriers of IFN-β. Isolated umbilical cord MSCs were transfected with a lentivirus packaging IFN-β-overexpression plasmid. A549 cells were subcutaneously injected into nude mice to establish a non-small cell lung cancer (NSCLC) mouse model. A total of 50 mice were randomly assigned to 5 different groups: a control group, IFN-β group, IFN-β-MSCs group, MSCs-lentivirus group, and MSCs group. Next, the IFN-β-MSCs, MSCs-lentivirus, and MSCs were injected into the A549 lung cancer-bearing mice in the IFN-β-MSCs, MSCs-lentivirus and MSCs groups, respectively. Mice in the control and IFN-β groups were injected with solvent or IFN-β solution. The tumors in nude mice in the IFN-β and IFN-β-MSCs groups grew at significantly slower rates than tumors in the control group, and tumors in the MSCs-lentivirus and MSC groups also grew slowly. The rates of tumor cell apoptosis in the IFN-β and IFN-β-MSCs groups were significantly higher than those in the MSCs-lentivirus and MSCs groups. The livers, lungs, and kidneys of nude mice in the IFN-β group displayed hyperemia, exudation, and pathological lesions, while those of nude mice in the IFN-β-MSCs group showed no abnormal changes. Both INF-β-MSCs and INF-β inhibited the growth of subcutaneously implanted lung tumors; however, INF-β-MSCs specifically targeted the tumor cells, and did not produce the damage to internal organs caused by the use of INF-β alone.
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Affiliation(s)
- Xiao Chen
- Department of Geratology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, PR China; School of Medicine, Shandong University, Jinan, Shandong, PR China
| | - Kangwu Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, PR China
| | - Shijun Chen
- Department of Respiratory Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, PR China
| | - Yuqing Chen
- Department of Geratology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, PR China; Department of Respiratory Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, PR China.
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9
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Suciu S, Eggermont AMM, Lorigan P, Kirkwood JM, Markovic SN, Garbe C, Cameron D, Kotapati S, Chen TT, Wheatley K, Ives N, de Schaetzen G, Efendi A, Buyse M. Relapse-Free Survival as a Surrogate for Overall Survival in the Evaluation of Stage II-III Melanoma Adjuvant Therapy. J Natl Cancer Inst 2018; 110:4091329. [PMID: 28922786 DOI: 10.1093/jnci/djx133] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/26/2017] [Indexed: 02/11/2024] Open
Abstract
Background We assessed whether relapse-free survival (RFS; time until recurrence/death) is a valid surrogate for overall survival (OS) among resected stage II-III melanoma patients through a meta-analysis of randomized controlled trials. Methods Individual patient data (IPD) on RFS and OS were collected from 5826 patients enrolled in 11 randomized adjuvant trials comparing interferon (IFN) to observation. In addition, IPD from two studies comparing IFN and vaccination in 989 patients were included. A two-level modeling approach was used for assessing Spearman's patient-level correlation (rho) of RFS and OS and the trial-level coefficient of determination (R²) of the treatment effects on RFS and on OS. The results were validated externally in 13 adjuvant studies without available IPD. We then tested the results on the European Organisation for Research and Treatment of Cancer (EORTC) 18071 double-blind trial comparing ipilimumab 10 mg/kg with placebo, which showed a statistically significant impact of the checkpoint inhibitor on RFS and OS. All statistical tests were two-sided. Results With a median follow-up of seven years, 12 of 13 trials showed a consistency between the IFN vs No IFN differences regarding RFS (hazard ratio [HR]RFS = 0.88) and OS (HROS = 0.91), but the small trial, Eastern Cooperative Oncology Group 2696, was an outlier (HRRFS = 0.72 vs HROS = 1.11). Therefore, even if rho was high, R² was low and could not reliably be estimated. Based on the 12 trials, rho remained high (0.89), and the hazard ratios for RFS and OS were strongly correlated (R² = 0.91). The surrogate threshold effect for RFS was estimated to be 0.77. For the EORTC 18071 trial, the hazard ratio for RFS was 0.75, predicting an effect of ipilimumab on OS. This was subsequently confirmed (HROS = 0.72, 95.1% confidence interval = 0.58 to 0.88, P = .001). Conclusions In high-risk stage II-III melanoma, RFS appeared to be a valid surrogate end point for OS for adjuvant randomized studies assessing interferon or a checkpoint inhibitor. In future similar adjuvant studies, a hazard ratio for RFS of 0.77 or less would predict a treatment impact on OS.
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Affiliation(s)
- Stefan Suciu
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Alexander M M Eggermont
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Paul Lorigan
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - John M Kirkwood
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Svetomir N Markovic
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Claus Garbe
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - David Cameron
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Srividya Kotapati
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Tai-Tsang Chen
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Keith Wheatley
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Natalie Ives
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Gaetan de Schaetzen
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Achmad Efendi
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Marc Buyse
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
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10
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Hanna T, Baetz T, Xu J, Miao Q, Earle C, Peng Y, Booth C, Petrella T, McKay D, Nguyen P, Langley H, Eisenhauer E. Mental health services use by melanoma patients receiving adjuvant interferon: association of pre-treatment mental health care with early discontinuation. Curr Oncol 2017; 24:e503-e512. [PMID: 29270059 PMCID: PMC5736489 DOI: 10.3747/co.24.3685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although high-dose interferon (hd-ifn) is the sole approved adjuvant systemic treatment for melanoma in many jurisdictions, it is toxic. We sought to assess the population-level effects of hd-ifn toxicity, particularly neuropsychiatric toxicity, hypothesizing that such toxicity would have the greatest effect on mental health services use in advanced resected melanoma. METHODS This retrospective population-based registry study considered all melanoma patients receiving adjuvant hd-ifn in Ontario during 2008-2012. Toxicity was investigated through health services use compatible with hd-ifn toxicity (for example, mental health physician billings). Using stage data reported from cancer centres about a subset of patients (stages iib-iiic), a propensity-matched analysis compared such service use in patients who did and did not receive hd-ifn. Associations between early hd-ifn discontinuation and health services use were examined. RESULTS Of 718 melanoma patients who received hd-ifn, 12% were 65 years of age and older, and 83% had few or no comorbidities. One third of the patients experienced 1 or more toxicity-associated health care utilization events within 1 year of starting hd-ifn. Of 420 utilization events, 364 (87%) were mental health-related, with 54% being family practitioner visits, and 39% being psychiatrist visits. In the propensity-matched analysis, patients receiving hd-ifn were more likely than untreated matched controls to use a mental health service (p = 0.01), with 42% of the control group and 51% of the hd-ifn group using a mental health service in the period spanning the 12 months before to the 24 months after diagnosis. In the multivariable analysis, early drug discontinuation was more likely in the presence of pre-existing mental health issues (odds ratio: 2.0; 95% confidence limits: 1.1, 3.4). CONCLUSIONS Stage iib-iiic melanoma patients carry a substantial burden of mental health services use whether or not receiving hd-ifn, highlighting an important survivorship issue for these patients. High-dose interferon is associated with more use of mental health services, and pre-treatment use of mental health services is associated with treatment discontinuation. That association should be kept in mind when hd-ifn is being considered.
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Affiliation(s)
- T.P. Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen’s University, Kingston
- Department of Oncology, Queen’s University, Kingston
- Institute for Clinical Evaluative Sciences, Queen’s University, Kingston
| | - T. Baetz
- Department of Oncology, Queen’s University, Kingston
| | - J. Xu
- Institute for Clinical Evaluative Sciences, Queen’s University, Kingston
- Johnson and Johnson, Raritan, NJ, U.S.A
| | - Q. Miao
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen’s University, Kingston
- Institute for Clinical Evaluative Sciences, Queen’s University, Kingston
| | - C.C. Earle
- Faculty of Medicine, University of Toronto, Toronto
- Institute for Clinical Evaluative Sciences, Toronto
| | - Y. Peng
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen’s University, Kingston
- Department of Mathematics and Statistics, Queen’s University, Kingston
| | - C.M. Booth
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen’s University, Kingston
- Department of Oncology, Queen’s University, Kingston
- Institute for Clinical Evaluative Sciences, Queen’s University, Kingston
| | | | - D.R. McKay
- Department of Surgery, Queen’s University, Kingston; and
| | - P. Nguyen
- Institute for Clinical Evaluative Sciences, Queen’s University, Kingston
| | - H. Langley
- South East Regional Cancer Program, Kingston General Hospital, Kingston, ON
| | - E. Eisenhauer
- Department of Oncology, Queen’s University, Kingston
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11
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Trinh VA, Zobniw C, Hwu WJ. The efficacy and safety of adjuvant interferon-alfa therapy in the evolving treatment landscape for resected high-risk melanoma. Expert Opin Drug Saf 2017. [DOI: 10.1080/14740338.2017.1343301] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Van Anh Trinh
- Division of Pharmacy, Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chrystia Zobniw
- Division of Pharmacy, Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wen-Jen Hwu
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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12
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Sanlorenzo M, Vujic I, Carnevale-Schianca F, Quaglino P, Gammaitoni L, Fierro MT, Aglietta M, Sangiolo D. Role of interferon in melanoma: old hopes and new perspectives. Expert Opin Biol Ther 2017; 17:475-483. [PMID: 28274138 DOI: 10.1080/14712598.2017.1289169] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Interferons (IFNs) play a key role in modulating anti-microbial and antitumor immune responses. In oncology, past attempts to exploit IFNs therapeutically did not fulfill expectations, and had only modest clinical results, mostly limited to adjuvant melanoma treatment. The recent successes of immunotherapy in oncology have brought new attention to the potential of immune-modulatory agents like the IFNs. Areas covered: The authors review the biological effects of IFN on melanoma and immune cells. Then, the authors summarize the clinical results of adjuvant and therapeutic IFN in melanoma, giving focus to possible prognostic factors and new on-going clinical trials. Expert opinion: IFNs offer intriguing opportunities for synergism between conventional treatments and recently introduced molecular-targeted and immunotherapy approaches. However, the full comprehension of all IFN effects and their multiple biologic links is challenging. A strong commitment toward parallel translational research is needed to facilitate the interpretation of IFN's expected and unexpected effects, guiding the rational design of informative clinical studies.
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Affiliation(s)
- Martina Sanlorenzo
- a Department of Oncology , University of Torino , Candiolo , Torino , Italy.,b Department of Medical Sciences, Section of Dermatology , University of Turin , Torino , Italy.,c Division of Medical Oncology, Experimental Cell Therapy , Candiolo Cancer Institute , Candiolo , Torino , Italy
| | - Igor Vujic
- d School of Medicine , Sigmund Freud University , Vienna , Austria.,e Department of Dermatology , The Rudolfstiftung Hospital, Academic Teaching Hospital, Medical University Vienna , Vienna , Austria
| | - Fabrizio Carnevale-Schianca
- c Division of Medical Oncology, Experimental Cell Therapy , Candiolo Cancer Institute , Candiolo , Torino , Italy
| | - Pietro Quaglino
- b Department of Medical Sciences, Section of Dermatology , University of Turin , Torino , Italy
| | - Loretta Gammaitoni
- c Division of Medical Oncology, Experimental Cell Therapy , Candiolo Cancer Institute , Candiolo , Torino , Italy
| | - Maria Teresa Fierro
- b Department of Medical Sciences, Section of Dermatology , University of Turin , Torino , Italy
| | - Massimo Aglietta
- a Department of Oncology , University of Torino , Candiolo , Torino , Italy.,c Division of Medical Oncology, Experimental Cell Therapy , Candiolo Cancer Institute , Candiolo , Torino , Italy
| | - Dario Sangiolo
- a Department of Oncology , University of Torino , Candiolo , Torino , Italy.,c Division of Medical Oncology, Experimental Cell Therapy , Candiolo Cancer Institute , Candiolo , Torino , Italy
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13
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Agarwala SS, Lee SJ, Yip W, Rao UN, Tarhini AA, Cohen GI, Reintgen DS, Evans TL, Brell JM, Albertini MR, Atkins MB, Dakhil SR, Conry RM, Sosman JA, Flaherty LE, Sondak VK, Carson WE, Smylie MG, Pappo AS, Kefford RF, Kirkwood JM. Phase III Randomized Study of 4 Weeks of High-Dose Interferon-α-2b in Stage T2bNO, T3a-bNO, T4a-bNO, and T1-4N1a-2a (microscopic) Melanoma: A Trial of the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group (E1697). J Clin Oncol 2017; 35:885-892. [PMID: 28135150 DOI: 10.1200/jco.2016.70.2951] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To test the efficacy of 4 weeks of intravenous (IV) induction with high-dose interferon (IFN) as part of the Eastern Cooperative Oncology Group regimen compared with observation (OBS) in patients with surgically resected intermediate-risk melanoma. Patients and Methods In this intergroup international trial, eligible patients had surgically resected cutaneous melanoma in the following categories: (1) T2bN0, (2) T3a-bN0, (3) T4a-bN0, and (4) T1-4N1a-2a (microscopic). Patients were randomly assigned to receive IFN α-2b at 20 MU/m2/d IV for 5 days (Monday to Friday) every week for 4 weeks (IFN) or OBS. Stratification factors were pathologic lymph node status, lymph node staging procedure, Breslow depth, ulceration of the primary lesion, and disease stage. The primary end point was relapse-free survival. Secondary end points included overall survival, toxicity, and quality of life. Results A total of 1,150 patients were randomly assigned. At a median follow-up of 7 years, the 5-year relapse-free survival rate was 0.70 (95% CI, 0.66 to 0.74) for OBS and 0.70, (95% CI, 0.66 to 0.74) for IFN ( P = .964). The 5-year overall survival rate was 0.83 (95% CI, 0.79 to 0.86) for OBS and 0.83 (95% CI, 0.80 to 0.86) for IFN ( P = .558). Treatment-related grade 3 and higher toxicity was 4.6% versus 57.9% for OBS and IFN, respectively ( P < .001). Quality of life was worse for the treated group. Conclusion Four weeks of IV induction as part of the Eastern Cooperative Oncology Group high-dose IFN regimen is not better than OBS alone for patients with intermediate-risk melanoma as defined in this trial.
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Affiliation(s)
- Sanjiv S Agarwala
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Sandra J Lee
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Waiki Yip
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Uma N Rao
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Ahmad A Tarhini
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Gary I Cohen
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Douglas S Reintgen
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Terry L Evans
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Joanna M Brell
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Mark R Albertini
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Michael B Atkins
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Shaker R Dakhil
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Robert M Conry
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Jeffrey A Sosman
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Lawrence E Flaherty
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Vernon K Sondak
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - William E Carson
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Michael G Smylie
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Alberto S Pappo
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Richard F Kefford
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - John M Kirkwood
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
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14
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van Akkooi ACJ, Atkins MB, Agarwala SS, Lorigan P. Surgical Management and Adjuvant Therapy for High-Risk and Metastatic Melanoma. Am Soc Clin Oncol Educ Book 2017; 35:e505-14. [PMID: 27249760 DOI: 10.1200/edbk_159087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Wide local excision is considered routine therapy after initial diagnosis of primary melanoma to reduce local recurrences, but it does not impact survival. Sentinel node staging is recommended for melanomas of intermediate thickness, but it has also not demonstrated any indisputable therapeutic effect on survival. The prognostic value of sentinel node staging has been long established and is therefore considered routine, especially in light of the eligibility criteria for adjuvant therapy (trials). Whether completion lymph node dissection after a positive sentinel node biopsy improves survival is the question of current trials. The MSLT-2 study is best powered to show a potential benefit, but it has not yet reported any data. Another study, the German DECOG study, presented at the 2015 American Society of Clinical Oncology (ASCO) Annual Meeting did not show any benefit but is criticized for the underpowered design and insufficient follow-up. There is no consensus on the use of adjuvant interferon in melanoma. This topic has been the focus of many studies with different regimens (low-, intermediate-, or high-dose and/or short- or long-term treatment). Adjuvant interferon has been shown to improve relapse-free survival but failed to improve overall survival. More recently, adjuvant ipilimumab has also demonstrated an improved relapse-free survival. Overall survival data have not yet been reported due to insufficient follow-up. Currently, studies are ongoing to analyze the use of adjuvant anti-PD-1 and molecular targeted therapies (vemurafenib, dabrafenib, and trametinib). In the absence of unambiguously positive approved agents, clinical trial participation remains a priority. This could change in the near future.
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Affiliation(s)
- Alexander C J van Akkooi
- From the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; St. Luke's University Hospital, Temple University, Allentown, PA; University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Michael B Atkins
- From the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; St. Luke's University Hospital, Temple University, Allentown, PA; University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Sanjiv S Agarwala
- From the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; St. Luke's University Hospital, Temple University, Allentown, PA; University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Paul Lorigan
- From the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; St. Luke's University Hospital, Temple University, Allentown, PA; University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom
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15
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Interferon Alpha Subtype-Specific Suppression of HIV-1 Infection In Vivo. J Virol 2016; 90:6001-6013. [PMID: 27099312 DOI: 10.1128/jvi.00451-16] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 04/13/2016] [Indexed: 01/29/2023] Open
Abstract
UNLABELLED Although all 12 subtypes of human interferon alpha (IFN-α) bind the same receptor, recent results have demonstrated that they elicit unique host responses and display distinct efficacies in the control of different viral infections. The IFN-α2 subtype is currently in HIV-1 clinical trials, but it has not consistently reduced viral loads in HIV-1 patients and is not the most effective subtype against HIV-1 in vitro We now demonstrate in humanized mice that, when delivered at the same high clinical dose, the human IFN-α14 subtype has very potent anti-HIV-1 activity whereas IFN-α2 does not. In both postexposure prophylaxis and treatment of acute infections, IFN-α14, but not IFN-α2, significantly suppressed HIV-1 replication and proviral loads. Furthermore, HIV-1-induced immune hyperactivation, which is a prognosticator of disease progression, was reduced by IFN-α14 but not IFN-α2. Whereas ineffective IFN-α2 therapy was associated with CD8(+) T cell activation, successful IFN-α14 therapy was associated with increased intrinsic and innate immunity, including significantly higher induction of tetherin and MX2, increased APOBEC3G signature mutations in HIV-1 proviral DNA, and higher frequencies of TRAIL(+) NK cells. These results identify IFN-α14 as a potent new therapeutic that operates via mechanisms distinct from those of antiretroviral drugs. The ability of IFN-α14 to reduce both viremia and proviral loads in vivo suggests that it has strong potential as a component of a cure strategy for HIV-1 infections. The broad implication of these results is that the antiviral efficacy of each individual IFN-α subtype should be evaluated against the specific virus being treated. IMPORTANCE The naturally occurring antiviral protein IFN-α2 is used to treat hepatitis viruses but has proven rather ineffective against HIV in comparison to triple therapy with the antiretroviral (ARV) drugs. Although ARVs suppress the replication of HIV, they fail to completely clear infections. Since IFN-α acts by different mechanism than ARVs and has been shown to reduce HIV proviral loads, clinical trials are under way to test whether IFN-α2 combined with ARVs might eradicate HIV-1 infections. IFN-α is actually a family of 12 distinct proteins, and each IFN-α subtype has different efficacies toward different viruses. Here, we use mice that contain a human immune system, so they can be infected with HIV. With this model, we demonstrate that while IFN-α2 is only weakly effective against HIV, IFN-α14 is extremely potent. This discovery identifies IFN-α14 as a more powerful IFN-α subtype for use in combination therapy trials aimed toward an HIV cure.
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16
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Xu MM, Pu Y, Zhang Y, Fu YX. The Role of Adaptive Immunity in the Efficacy of Targeted Cancer Therapies. Trends Immunol 2016; 37:141-153. [PMID: 26778079 DOI: 10.1016/j.it.2015.12.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 12/10/2015] [Accepted: 12/13/2015] [Indexed: 01/22/2023]
Abstract
Accumulating evidence indicates that the efficacy of tumor-targeted therapies relies on the host immune response, including targeted small-molecule and antibody approaches that were not previously thought to have an immune component. Here, we review the current understanding of how targeted therapies on tumor cells could have a major impact on the immune response, and how this relates to the therapeutic efficacy of these approaches. In this context, we evaluate different strategies that combine targeted therapies with immunotherapy approaches, and discuss past and ongoing clinical trials. We highlight gaps in knowledge, and argue that significant progress for combined therapies will require a better understanding of the complex interactions between immune cells, the tumor, and the tumor microenvironment (TME) in different cancer settings.
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Affiliation(s)
- Meng Michelle Xu
- Department of Pathology and Committee on Immunology, University of Chicago, Chicago, IL 60637, USA
| | - Yang Pu
- Department of Pathology and Committee on Immunology, University of Chicago, Chicago, IL 60637, USA
| | - Yuan Zhang
- Department of Pathology and Committee on Immunology, University of Chicago, Chicago, IL 60637, USA
| | - Yang-Xin Fu
- Department of Pathology and Committee on Immunology, University of Chicago, Chicago, IL 60637, USA; Department of Pathology and Immunology, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA.
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17
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Guo J, Qin S, Liang J, Lin T, Si L, Chen X, Chi Z, Cui C, Du N, Fan Y, Gu K, Li F, Li J, Li Y, Liang H, Liu J, Lu M, Lu A, Nan K, Niu X, Pan H, Ren G, Ren X, Shu Y, Song X, Tao M, Wang B, Wei W, Wu D, Wu L, Wu A, Xu X, Zhang J, Zhang X, Zhang Y, Zhu H. Chinese Guidelines on the Diagnosis and Treatment of Melanoma (2015 Edition). ANNALS OF TRANSLATIONAL MEDICINE 2016; 3:322. [PMID: 26734632 DOI: 10.3978/j.issn.2305-5839.2015.12.23] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Jun Guo
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Shukui Qin
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Jun Liang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Tongyu Lin
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Lu Si
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Xiaohong Chen
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Zhihong Chi
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Chuanliang Cui
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Nan Du
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Yun Fan
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Kangsheng Gu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Fang Li
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Junling Li
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Yongheng Li
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Houjie Liang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Jiwei Liu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Man Lu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Aiping Lu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Kejun Nan
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Xiaohui Niu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Hongming Pan
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Guoxin Ren
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Xiubao Ren
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Yongqian Shu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Xin Song
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Min Tao
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Baocheng Wang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Wenbin Wei
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Di Wu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Lingying Wu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Aiwen Wu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Xiaolin Xu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Junyi Zhang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Xiaoshi Zhang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Yiping Zhang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Huiyan Zhu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
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Abstract
The incidence of melanoma is rapidly increasing, especially in younger female and older male patients. Recent fundamental advances in our knowledge of melanoma tumorigenesis have established roles for inhibitors of the MAPK pathway and regulatory immune checkpoints CTLA-4 and PD-1/PD-L1. However, the majority of patients continue to present with non-metastatic disease-typically managed with surgical resection and adjuvant therapy. High-dose IFN-α2b (HDI) is the main adjuvant therapeutic mainstay in high-risk disease following definitive resection. In this chapter, we review the evidence supporting the use of adjuvant HDI in high-risk melanoma. We also discuss some of the other treatment modalities that have been evaluated including vaccines, chemotherapy, and radiotherapy.
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Malczewski A, Marshall A, Payne MJ, Mao L, Bafaloukos D, Si L, Pectasides D, Fountzilas G, Guo J, Gogas H, Middleton MR. Intravenous high-dose interferon with or without maintenance treatment in melanoma at high risk of recurrence: meta-analysis of three trials. Cancer Med 2015; 5:17-23. [PMID: 26645567 PMCID: PMC4708899 DOI: 10.1002/cam4.563] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/07/2015] [Accepted: 09/11/2015] [Indexed: 12/21/2022] Open
Abstract
Resected stage IIB–IIIC malignant melanoma has a poor prognosis with a high risk of relapse and death. Treatment with adjuvant interferon alfa‐2b (IFN‐α‐2b) is associated with improved relapse‐free and overall survivals (OS), but the most appropriate dose and duration of treatment are unknown. In this article, we present an individual patient data random effects meta‐analysis of melanoma patients from the U.K., Greek, and Chinese randomized trials. All patients were randomized either to IFN‐α‐2b 15–20 MIU/m2IV daily 5 days per week for 4 weeks (IV) or to the same regimen followed by IFN‐α‐2b 9–10 MIU/m2 administered three times per week for 48 weeks (IV and SC). Allowing for dose interruptions and reductions, an equivalent total dose of IFN‐α‐2b was delivered in all three studies. We assessed whether IV was noninferior to IV and SC in terms of relapse‐free survival (RFS) and investigated tumor and patient characteristics that impacted on outcomes. Median follow‐up of 716 stage IIB–IIIC patients was 5.4 years. Noninferiority of IV compared to IV and SC could not be conferred for RFS (hazard ratio [HR] 1.16, 95% confidence interval [CI] 0.89–1.52; noninferior P = 0.17). Stage (P < 0.0001), site (acral vs. other, P < 0.0001), and Breslow thickness (P = 0.02) were significant predictors of RFS. The HR for death was 1.13 for IV compared to IV and SC, (95% CI 0.91–1.39). Stage (P < 0.0001) and Breslow thickness (P = 0.001) were significant independent predictors of OS. The available data suggest that where adjuvant high‐dose interferon is being considered there is no evidence to deviate from the year long regimen described in the Eastern Cooperative Oncology Group and Intergroup studies.
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Affiliation(s)
- Agnieszka Malczewski
- National Institute for Health Research Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Andrea Marshall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
| | - Miranda J Payne
- National Institute for Health Research Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Lili Mao
- Department of Renal Cancer and Melanoma, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital & Institute, Beijing, China
| | | | - Lu Si
- Department of Renal Cancer and Melanoma, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital & Institute, Beijing, China
| | | | | | - Jun Guo
- Department of Renal Cancer and Melanoma, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital & Institute, Beijing, China
| | - Helen Gogas
- Hellenic Co-operative Oncology Group, Athens, Greece
| | - Mark R Middleton
- National Institute for Health Research Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
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Mohr P, Hauschild A, Trefzer U, Enk A, Tilgen W, Loquai C, Gogas H, Haalck T, Koller J, Dummer R, Gutzmer R, Brockmeyer N, Hölzle E, Sunderkötter C, Mauch C, Stein A, Schneider LA, Podda M, Göppner D, Schadendorf D, Weichenthal M. Intermittent High-Dose Intravenous Interferon Alfa-2b for Adjuvant Treatment of Stage III Melanoma: Final Analysis of a Randomized Phase III Dermatologic Cooperative Oncology Group Trial. J Clin Oncol 2015; 33:4077-84. [PMID: 26503196 DOI: 10.1200/jco.2014.59.6932] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023] Open
Abstract
PURPOSE To evaluate the efficacy, safety, tolerability, and quality of life (QoL) in patients receiving intravenous, intermittent high-dose interferon alfa-2b (IFN-α-2b [iHDI]) compared with standard high-dose IFN-α-2b (HDI). PATIENT AND METHODS Patients with stage III resected lymph node or in-transit metastasis from cutaneous malignant melanoma were randomly assigned to receive either a standard HDI regimen or three courses of IFN-α-2b 20 MIU/m(2) administered intravenously 5 days a week for 4 weeks then repeated every 4 months. Distant metastasis-free survival was the primary end point for efficacy analysis. In addition, relapse-free survival, overall survival, safety as determined by Common Terminology Criteria for Adverse Events criteria, and QoL were secondary end points. RESULTS Of 649 patients enrolled, 22 patients were excluded from the intent-to-treat analysis. The remaining 627 patients were well balanced between the arms according to sex, age, and stage. After a median follow-up of 55 months, a multivariable Cox model revealed no significant differences for distant metastasis-free survival (hazard ratio [HR], 1.21; P = .12) or overall survival (HR, 1.01; P = .85). In contrast, the difference for relapse-free survival was significant (HR, 1.27; P = .03), favoring standard HDI. Early termination of treatment because of adverse events or QoL occurred significantly more often with HDI than with iHDI (26.0% v 14.8%; P < .001). CONCLUSION Although the safety and QoL profiles for the intermittent regimen were favorable, no significant difference was observed for survival while the HR for relapse with iHDI was increased. Therefore, an iHDI regimen, as tested here, cannot be recommended as adjuvant treatment for high-risk melanoma.
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Affiliation(s)
- Peter Mohr
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland.
| | - Axel Hauschild
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Uwe Trefzer
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Alexander Enk
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Wolfgang Tilgen
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Carmen Loquai
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Helen Gogas
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Thomas Haalck
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Josef Koller
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Ralf Gutzmer
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Norbert Brockmeyer
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Erhard Hölzle
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Cord Sunderkötter
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Cornelia Mauch
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Annette Stein
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Lars A Schneider
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Maurizio Podda
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Daniela Göppner
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Dirk Schadendorf
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Michael Weichenthal
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
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Zhang Y, Le TK, Shaw JW, Kotapati S. Retrospective analysis of drug utilization, health care resource use, and costs associated with IFN therapy for adjuvant treatment of malignant melanoma. CLINICOECONOMICS AND OUTCOMES RESEARCH 2015; 7:397-407. [PMID: 26229494 PMCID: PMC4516031 DOI: 10.2147/ceor.s78704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background This study examines real-world drug utilization patterns, health care resource use, and costs among patients receiving adjuvant treatment with IFN versus patients receiving no treatment (“observation”) for malignant melanoma following surgery. Methods A retrospective cohort study was conducted using administrative claims from Truven Health Analytics (MarketScan®) to identify all adjuvant melanoma patients (aged ≥18 years) diagnosed between June 2007 and June 2011 who had a lymph node dissection (ie, index surgery) and were treated with IFN or subsequently observed. Health care resource use and costs of services were converted to 2012 US dollars and were evaluated and compared using multivariable regression. Results Of 1,999 eligible subjects with melanoma surgery claims, 179 (9.0%) were treated with IFN and 1,820 (91.0%) were observed. The median duration (days) and number of doses of IFN therapy were 73 and 36, respectively. Among IFN-treated patients, only 10.6% completed ≥80% of maintenance therapy. The total average cost for patients treated with IFN was US$60,755±$3,972 (n=179); significantly higher than for patients undergoing observation ($31,641±$2,471; P<0.0001). Similar trends were observed when evaluating total cost components, including melanoma-related and non-melanoma–related medical costs. Among the melanoma-related medical costs, outpatient services, including office visits and laboratory testing, represented between 33% and 53% of total costs and demonstrated the largest difference between IFN-treated and observation patients. Outpatient service costs for IFN-treated patients were $32,414±$2,498, over three times greater than those for observation patients ($10,556±$1,128; P<0.0001). Conclusion The majority of adjuvant melanoma patients in this study was treated with observation versus IFN treatment. Among those who attempted IFN treatment, most could not complete the recommended course of therapy. Health care costs were significantly greater for patients treated with IFN, with the greatest differences being for melanoma-related medical cost components. These findings illustrate the significant economic burden borne by adjuvant melanoma patients and their health insurers.
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Affiliation(s)
- Ying Zhang
- Center for Observational Research and Data Sciences, Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Research and Development, Hopewell, NJ, USA
| | - Trong Kim Le
- Center for Observational Research and Data Sciences, Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Research and Development, Hopewell, NJ, USA
| | - James W Shaw
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Research and Development, Princeton, NJ, USA
| | - Srividya Kotapati
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Research and Development, Wallingford Center, CT, USA
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22
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Akman T, Oztop I, Unek IT, Koca D, Unal OU, Salman T, Yavuzsen T, Yilmaz AU, Somali I, Demir N, Ellidokuz H. Long-term outcomes and prognostic factors of high-risk malignant melanoma patients after surgery and adjuvant high-dose interferon treatment: a single-center experience. Chemotherapy 2015; 60:228-38. [PMID: 25870939 DOI: 10.1159/000371838] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 01/05/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Surgical excision constitutes an important part of the treatment of local advanced malignant melanoma. Due to the high recurrence risk, adjuvant high-dose interferon therapy is still the only therapy used in stage IIB and III high-risk melanoma patients. METHODS One hundred two high-risk malignant melanoma patients who received high-dose interferon-α-2b therapy were evaluated retrospectively. The clinicopathological features, survival times, and prognostic factors of the patients were determined. RESULTS The median disease-free and overall survival times were 25.2 and 60.8 months, respectively. Our findings revealed that male gender, advanced disease stage, lymph node involvement, lymphatic invasion, the presence of ulceration, and a high Clark level were significant negative prognostic factors. CONCLUSION In light of the favorable survival results obtained in this study, high-dose interferon treatment as adjuvant therapy for high-risk melanoma is still an efficient treatment and its possible side effects can be prevented by taking the necessary precautions.
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Affiliation(s)
- Tulay Akman
- Division of Medical Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
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23
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Dillon AB, Lin K, Kwong A, Ortiz S. Immunotherapy in Melanoma, Gastrointestinal (GI), and Pulmonary Malignancies. AIMS Public Health 2015; 2:86-114. [PMID: 29546098 PMCID: PMC5690372 DOI: 10.3934/publichealth.2015.1.86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 03/20/2015] [Indexed: 12/14/2022] Open
Abstract
Oncologic immunotherapy involves stimulating the immune system to more effectively identify and eradicate tumor cells that have successfully adapted to survive the body's natural immune defenses. Immunotherapy has shown great promise thus far by prolonging the lives of patients with a variety of malignancies, and has added a crucial new set of tools to the oncologists' armamentarium. The aim of this paper is to provide an overview of immunotherapy treatment options that are currently available and under active research for melanoma, gastrointestinal (esophageal, gastric, pancreatic, and colorectal), and pulmonary malignancies. Potential biomarkers that may predict favorable responses to immunotherapies are discussed where applicable, as are future avenues of research in this rapidly evolving field.
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Affiliation(s)
- Alexander B. Dillon
- Mount Zion Cancer Research Center, Department of Dermatology, University of California San Francisco, CA 94141, USA
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24
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Abstract
Metastases to the spleen are rare and are generally part of a multi-visceral metastatic disease. The most common sources of splenic metastases include breast, lung and colorectal malignancies as well as melanoma and ovarian carcinoma. Solitary splenic metastasis is very uncommon. We present a case of a 44-year-old man who presented at our department for gallstones symptoms. He had a past medical history of neck cutaneous melanoma (T3bN0M0--Stage IIb). He had not attended follow-up schedule for personal reasons. However, abdominal ultrasound revealed the presence of a solitary solid lesion in the spleen. Preoperative workup was completed with CT scan that confirmed the presence of a large splenic lesion with subcapsular fluid collection, also compatible with a post-traumatic lesion.Preoperative findings could not exclude malignancy and patient was therefore submitted to surgery. At laparoscopy, a condition of peritoneal melanosis was present. Splenectomy was carried out. Histological report confirmed the peritoneal melanosis and the diagnosis of metastatic spleen lesion from melanoma. Patient was observed, but died of metastatic disease 14 months after surgery. Splenic metastases are uncommon. Isolated metastases from melanoma are rare and could be found several months after primary diagnosis of melanoma. Surgery remains the most effective treatment, especially for metachronous disease, offering the best chance of long-term survival. Prognosis remains poor, as metachronous disease is indicative of aggressive widespread of the disease.
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Affiliation(s)
- Isabella Reccia
- From the Department of Surgery, Clinica Chirurgica, University of Cagliari, Policlinico Universitario di Monserrato, Sestu (CA), Italy (IR, AP, MP, AU)
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25
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Nieda M, Terunuma H, Eiraku Y, Deng X, Nicol AJ. Effective induction of melanoma-antigen-specific CD8+ T cells via Vγ9γδT cell expansion by CD56(high+) Interferon-α-induced dendritic cells. Exp Dermatol 2014; 24:35-41. [PMID: 25363560 DOI: 10.1111/exd.12581] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2014] [Indexed: 11/30/2022]
Abstract
Dendritic cells (DCs) can be differentiated from CD14+ monocytes in the presence of interferon-α (IFNα) and granulocyte/macrophage-colony stimulating factor (GM-CSF) in vitro and are known as IFN-DCs. Circulating blood CD56+ cells expressing high levels of CD14, HLA-DR and CD86 have been shown to spontaneously differentiate into DC-like cells in vitro after their isolation from blood. We show here that IFN-DCs expressing high levels of CD56 (hereafter, CD56(high+) IFN-DCs) can be differentiated in vitro from monocytes obtained as adherent cells from healthy donors and patients with metastatic melanoma. These cells expressed high levels of CD14, HLA-DR and CD86 and possessed many pseudopodia. These CD56(high+) IFN-DCs may be an in vitro counterpart of the circulating CD56+ CD14+ CD86+ HLA-DR+ cells in blood. Conventional mature DCs differentiated from monocytes as adherent cells in the presence of GM-CSF, IL-4 and TNF-α (hereafter, mIL-4DCs) did not express CD56 or CD14. In contrast to mIL-4DCs, the CD56(high+) IFN-DCs exhibited a stronger capacity to stimulate autologous CD56+ Vγ9γδT cells highly producing IFNγ in the presence of zoledronate and IL-2. The CD56(high+) IFN-DCs possessing HLA-A*0201 effectively induced Mart-1-modified melanoma peptide (A27L)-specific CD8+ T cells through preferential expansion of CD56+ Vγ9γδT cells in the presence of A27L, zoledronate and IL-2. Vaccination with CD56(high+) IFN-DCs copulsed with tumor antigens and zoledronate may orchestrate the induction of various CD56+ immune cells possessing high effector functions, resulting in strong immunological responses against tumor cells. This study may be relevant to the design of future clinical trials of CD56(high+) IFN-DCs-based immunotherapies for patients with melanoma.
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Affiliation(s)
- Mie Nieda
- Biotherapy Institute of Japan, Koutou-ku, Tokyo, Japan
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26
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Di Trolio R, Simeone E, Di Lorenzo G, Buonerba C, Ascierto PA. The use of interferon in melanoma patients: a systematic review. Cytokine Growth Factor Rev 2014; 26:203-12. [PMID: 25511547 DOI: 10.1016/j.cytogfr.2014.11.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 11/11/2014] [Indexed: 11/17/2022]
Abstract
Interferon (IFN) and PEG-IFN are the only drugs approved as adjuvant therapy in patients with melanoma at high-risk of recurrence after surgical resection. Several clinical trials of adjuvant IFN, using different doses and durations of therapy, have been conducted in these patients. Results generally suggest relapse-free survival and overall survival benefits; however, questions over the optimal dose and duration of treatment and concerns over toxicity have limited its use. IFN exerts its biological activity in melanoma via multiple mechanisms of action, most of which can be considered as indirect immunomodulatory effects. As such, IFN may also be of benefit in the neoadjuvant setting, where it may have a role in melanoma patients with locally advanced disease for whom immediate surgical excision is not possible. However, this has not been well studied. The use of IFN in patients with metastatic melanoma is controversial, with limited data and no convincing evidence of a survival benefit. However, IFN therapy combined with novel biological and immunotherapies offers the potential for a synergistic effect and improved clinical outcomes. Predictive and prognostic factors to better select melanoma patients for IFN treatment have been identified (e.g. disease stage, ulceration, various cytokines) and may also enhance its therapeutic efficacy, but their incorporation into the clinical decision-making process requires validation in prospective trials. In conclusion, the modest efficacy of IFN shown in clinical trials is largely a reflection of differences in response between patients. Despite advancements in the understanding of its biological mechanisms of action, the huge potential of IFN remains to be fully explored and utilized in patients with melanoma.
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Affiliation(s)
- Rossella Di Trolio
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapies, Istituto Nazionale Tumori Fondazione G. Pascale, Napoli, Italy.
| | - Ester Simeone
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapies, Istituto Nazionale Tumori Fondazione G. Pascale, Napoli, Italy.
| | - Giuseppe Di Lorenzo
- Oncology Division, Department of Clinical Medicine, University "Federico II" of Naples, Italy.
| | - Carlo Buonerba
- Oncology Division, Department of Clinical Medicine, University "Federico II" of Naples, Italy.
| | - Paolo Antonio Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapies, Istituto Nazionale Tumori Fondazione G. Pascale, Napoli, Italy.
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27
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Scientific surgery. Br J Surg 2014. [DOI: 10.1002/bjs.9704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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28
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Xu H, Xian J, Vire E, McKinney S, Wong J, Wei V, Tong R, Kouzarides T, Caldas C, Aparicio S. Up-regulation of the interferon-related genes in BRCA2 knockout epithelial cells. J Pathol 2014; 234:386-97. [PMID: 25043256 PMCID: PMC4882165 DOI: 10.1002/path.4404] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 07/03/2014] [Accepted: 07/06/2014] [Indexed: 12/30/2022]
Abstract
BRCA2 mutations are significantly associated with early-onset breast cancer, and the tumour-suppressing function of BRCA2 has been attributed to its involvement in homologous recombination (HR)-mediated DNA repair. In order to identify additional functions of BRCA2, we generated BRCA2-knockout HCT116 human colorectal carcinoma cells. Using genome-wide microarray analyses, we have discovered a link between the loss of BRCA2 and the up-regulation of a subset of interferon (IFN)-related genes, including APOBEC3F and APOBEC3G. The over-expression of IFN-related genes was confirmed in different human BRCA2(-/-) and mouse Brca2(-/-) tumour cell lines, and was independent of senescence and apoptosis. In isogenic wild-type BRCA2 cells, we observed over-expression of IFN-related genes after treatment with DNA-damaging agents, and following ionizing radiation. Cells with endogenous DNA damage because of defective BRCA1 or RAD51 also exhibited over-expression of IFN-related genes. Transcriptional activity of the IFN-stimulated response element (ISRE) was increased in BRCA2 knockout cells, and the expression of BRCA2 greatly decreased IFNα-stimulated ISRE reporter activity, suggesting that BRCA2 directly represses the expression of IFN-related genes through the ISRE. Finally, the colony-forming capacity of BRCA2 knockout cells was significantly reduced in the presence of either IFNβ or IFNγ, suggesting that IFNs may have potential as therapeutic agents in cancer cells with BRCA2 mutations. The GEO Accession No. for microarray analysis is GSE54830.
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Affiliation(s)
- Hong Xu
- Department of Molecular Oncology, British Columbia Cancer Agency, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
| | - Jian Xian
- Department of Oncology, University of Cambridge and Cancer Research UK Cambridge Research Institute, Li Ka Shing Centre, Cambridge, CB2 0RE, UK
| | - Emmanuelle Vire
- Wellcome Trust/Cancer Research UK Gurdon Institute, The Henry Wellcome Building of Cancer and Developmental Biology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QN, UK
| | - Steven McKinney
- Department of Molecular Oncology, British Columbia Cancer Agency, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
| | - Jason Wong
- Department of Molecular Oncology, British Columbia Cancer Agency, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
| | - Vivien Wei
- Department of Microbiology and Immunology, University of British Columbia, 1365 - 2350 Health Sciences Mall, Vancouver, British Columbia, Canada, V6T 1Z3
| | - Rebecca Tong
- Department of Microbiology and Immunology, University of British Columbia, 1365 - 2350 Health Sciences Mall, Vancouver, British Columbia, Canada, V6T 1Z3
| | - Tony Kouzarides
- Wellcome Trust/Cancer Research UK Gurdon Institute, The Henry Wellcome Building of Cancer and Developmental Biology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QN, UK
| | - Carlos Caldas
- Department of Oncology, University of Cambridge and Cancer Research UK Cambridge Research Institute, Li Ka Shing Centre, Cambridge, CB2 0RE, UK
| | - Samuel Aparicio
- Department of Molecular Oncology, British Columbia Cancer Agency, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Wesbrook Mall, Vancouver, BC, V6T 2B5 Vancouver, BC
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Girotti MR, Saturno G, Lorigan P, Marais R. No longer an untreatable disease: how targeted and immunotherapies have changed the management of melanoma patients. Mol Oncol 2014; 8:1140-58. [PMID: 25178978 PMCID: PMC5528622 DOI: 10.1016/j.molonc.2014.07.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 07/31/2014] [Indexed: 12/23/2022] Open
Abstract
The discovery that BRAF is a driver oncogene in cancer, and complementary improvements in our understanding of the immune system have resulted in new targeted and immune-therapies for metastatic melanoma. Targeted therapies achieve impressive clinical results in carefully selected patients but the development of resistance seems inevitable in most cases. Conversely, immune-checkpoints inhibitors can achieve long-term remission and cures, but in a smaller proportion of patients, and biomarkers to predict which patients will respond are not available. Nevertheless, melanoma has led the evolution of cancer treatment from relatively nonspecific cytotoxic agents to highly selective therapies and here we review the lessons from this paradigm shift in treatment and the opportunities for further improvements in outcomes for melanoma patients.
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Affiliation(s)
- Maria Romina Girotti
- Molecular Oncology Group, Cancer Research UK Manchester Institute, Manchester, UK
| | - Grazia Saturno
- Molecular Oncology Group, Cancer Research UK Manchester Institute, Manchester, UK
| | - Paul Lorigan
- University of Manchester, Christie NHS Foundation Trust, Manchester, UK
| | - Richard Marais
- Molecular Oncology Group, Cancer Research UK Manchester Institute, Manchester, UK.
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30
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Adjuvant high-dose interferon therapy for melanoma: nothing has really changed. Melanoma Res 2014; 24:522-3. [PMID: 25185694 DOI: 10.1097/cmr.0000000000000101] [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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31
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Pasquali S, Spillane A. Contemporary controversies and perspectives in the staging and treatment of patients with lymph node metastasis from melanoma, especially with regards positive sentinel lymph node biopsy. Cancer Treat Rev 2014; 40:893-9. [PMID: 25023758 DOI: 10.1016/j.ctrv.2014.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/15/2014] [Accepted: 06/17/2014] [Indexed: 11/28/2022]
Abstract
The management of melanoma lymph node metastasis particularly when detected by sentinel lymph node biopsy (SLNB) is still controversial. Results of the only randomized trial conducted to assess the therapeutic value of SLNB, the Multicenter Selective Lymphadenectomy Trial (MSLT-1), have not conclusively proven the effectiveness of this procedure but are interpreted by the authors and guidelines as indicating SLNB is standard of care. After surgery, interferon alpha had a small survival benefit and radiotherapy has limited effectiveness for patient at high-risk of regional recurrence. New drugs, including immune modulating agents and targeted therapies, already shown to be effective in patients with distant metastasis, are being evaluated in the adjuvant setting. In this regard, ensuring high quality of surgery through the identification of reliable quality assurance indicators and improving the homogeneity of prognostic stratification of patients entered onto clinical trials is paramount. Here, we review the controversial issues regarding the staging and treatment of melanoma patients with lymph node metastasis, present a summary of important and potentially practice changing ongoing research and provide a commentary on what it all means at this point in time.
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Affiliation(s)
- Sandro Pasquali
- Department of Surgery, University Hospital of Birmingham, Edgbaston, Birmingham B15 2WB, UK
| | - Andrew Spillane
- Melanoma Institute Australia, Sydney, Australia; Mater Hospital North Sydney, 25 Rocklands Rd, Crows Nest 2065, Australia; Royal North Shore Hospital, Northern Sydney Cancer Centre, Reserve Rd, St Leonards, NSW 2065, Australia.
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32
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Sanlorenzo M, Vujic I, Posch C, Dajee A, Yen A, Kim S, Ashworth M, Rosenblum MD, Algazi A, Osella-Abate S, Quaglino P, Daud A, Ortiz-Urda S. Melanoma immunotherapy. Cancer Biol Ther 2014; 15:665-74. [PMID: 24651672 PMCID: PMC4049781 DOI: 10.4161/cbt.28555] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/11/2014] [Accepted: 03/16/2014] [Indexed: 12/29/2022] Open
Abstract
Immunotherapy is a cornerstone in the treatment of melanoma, and is intended to modulate the host immunity against the tumor. Immunotherapy can be used in an adjuvant setting, after complete surgical excision in patients with a high risk of disease relapse and as a treatment in advanced (unresectable or metastatic) stages. Development of novel therapeutic approaches and the optimization of existing therapies hold a great promise in the field of melanoma therapy research. Different clinical trials are ongoing, and immunotherapy is showing the ability to confirm durable clinical benefits in selected groups of melanoma patients. The aim of this review is to summarize different types of immunotherapy agents, as well as to discuss different strategies, complementary regimens, and possible biomarkers of response to the treatment.
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Affiliation(s)
- Martina Sanlorenzo
- University of California San Francisco; San Francisco, CA USA
- Department of Medical Sciences; Section of Dermatology; University of Turin; Turin, Italy
| | - Igor Vujic
- University of California San Francisco; San Francisco, CA USA
- The Rudolfstiftung Hospital; Vienna, Austria
| | - Christian Posch
- University of California San Francisco; San Francisco, CA USA
- The Rudolfstiftung Hospital; Vienna, Austria
| | - Akshay Dajee
- University of California San Francisco; San Francisco, CA USA
| | - Adam Yen
- University of California San Francisco; San Francisco, CA USA
| | - Sarasa Kim
- University of California San Francisco; San Francisco, CA USA
| | | | | | - Alain Algazi
- University of California San Francisco; San Francisco, CA USA
| | - Simona Osella-Abate
- Department of Medical Sciences; Section of Dermatology; University of Turin; Turin, Italy
| | - Pietro Quaglino
- Department of Medical Sciences; Section of Dermatology; University of Turin; Turin, Italy
| | - Adil Daud
- University of California San Francisco; San Francisco, CA USA
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33
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McArthur GA. Adjuvant Interferon in Melanoma: Is Duration of Therapy Important? J Clin Oncol 2014; 32:171-3. [DOI: 10.1200/jco.2013.53.5179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Grant A. McArthur
- Peter MacCallum Cancer Centre, East Melbourne; University of Melbourne, Parkville, Victoria, Australia
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