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Reinhardt ME, Sun T, Pan CX, Schmults CD, Lee EH, Waldman AB. A systematic review of patient-reported outcome measures for advanced skin cancer patients. Arch Dermatol Res 2023; 315:1473-1480. [PMID: 36469125 DOI: 10.1007/s00403-022-02479-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/07/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
Abstract
Many patient-reported outcome measures (PROMs) have been used to study quality of life (QOL) in the skin cancer population. Advanced melanoma and non-melanoma skin cancer (NMSC) may be associated with increased morbidity, mortality, and treatment side effects; however, it is unclear which PROM is valid and appropriate to use in these populations for both clinical and research purposes. We aimed to identify the PROMs that have been used to measure QOL in advanced skin cancer patients and determine which of these PROMs have been validated to assess QOL outcomes in this population. A PubMed and EMBASE search was conducted from its inception to March 2021 according to PRISMA guidelines with a comprehensive list of search terms under three main topics: (1) PROM; (2) advanced skin cancer; and (3) staging and interventions. We included articles utilizing a PROM measuring QOL and having a patient population with advanced skin cancer defined as melanoma stage > T1a or non-melanoma AJCC stage T3 or greater. Advanced skin cancer patients were also defined as those with metastasis or requiring adjuvant therapy (systemic chemotherapy, radiation, and immunotherapy). Studies were excluded according to the following criteria: mix of low-risk and advanced skin cancer patients in the study population without stratification into low-risk and advanced groups, stage T1a melanoma or mix of stages without stratification, low-risk NMSC, no PROM (i.e., study specific questionnaires), non-English publication, review article or protocol paper, conference abstract, or populations including non-skin cancers. A total of 1,998 articles were identified. 82 met our inclusion criteria resulting in 22 PROMs: five generic health-related (QWB-SA, AQoL-8D, EQ-5D, SF-36, and PRISM), six general cancer (EORTC QLQ-C30, EORTC QLQ-C36, LASA, IOC, Rotterdam Symptom Checklist, and FACT-G), nine disease-focused or specialized (EORTC QLQ-H&N35, EORTC QLQ-MEL38, EORTC QLQ-BR23, Facial Disability Index, FACT-H&N, FACT-BRM, FACT-B, FACT-M, and scqolit), and two general dermatology (Skindex-16 and DLQI) PROMs. All PROMs have been generally validated except for EORTC QLQ-MEL38. Only two PROMs have been validated in the advanced melanoma population: FACT-M and EORTC QLQ-C36. No PROMS have been validated in the advanced NMSC population. The PROMs that were validated in the advanced melanoma population do not include QOL issues unique to advanced skin tumors such as odor, bleeding, itching, wound care burden, and public embarrassment. Breast cancer and head and neck cancer instruments were adapted but not validated for use in the advanced skin cancer population due to the lack of an adequate instrument for this population. This study highlights the need for PROM instrument validation or creation specifically geared toward the advanced skin cancer population. Future studies should aim to develop and validate a PROM to assess QOL in this population.
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Affiliation(s)
- Myrna Eliann Reinhardt
- Department of Dermatology, Brigham and Women's Hospital, 1153 Centre Street, Suite 4J, Boston, MA, 02130, USA.
| | - Tiffany Sun
- Department of Dermatology, Brigham and Women's Hospital, 1153 Centre Street, Suite 4J, Boston, MA, 02130, USA
| | | | - Chrysalyne D Schmults
- Department of Dermatology, Brigham and Women's Hospital, 1153 Centre Street, Suite 4J, Boston, MA, 02130, USA
| | - Erica H Lee
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Abigail B Waldman
- Department of Dermatology, Brigham and Women's Hospital, 1153 Centre Street, Suite 4J, Boston, MA, 02130, USA
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Lindqvist Bagge AS, Wesslau H, Cizek R, Holmberg CJ, Moncrieff M, Katsarelias D, Carlander A, Olofsson Bagge R. Health-related quality of life using the FACT-M questionnaire in patients with malignant melanoma: A systematic review. Eur J Surg Oncol 2021; 48:312-319. [PMID: 34600786 DOI: 10.1016/j.ejso.2021.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/20/2021] [Accepted: 09/16/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Since there are no formal definition of health-related quality of life (HRQOL) there may be a lack of coherence and understanding of how to interpret HRQOL-data. The aim of this study is to summarize HRQOL-results that have used the FACT-M questionnaire in patients with melanoma, and specifically to summarize FACT-M between tumor stage. METHODS This review was conducted in accordance with the PRISMA guidelines. INCLUSION CRITERIA original studies on cutaneous melanoma between 2005 and 2020, written in English, containing "Functional Assessment of Cancer Therapy Melanoma" OR "Functional Assessment of Cancer Therapy M" OR FACT-M OR FACT/M OR FACTM OR "FACT M" OR FACT-melanoma OR "FACT Melanoma" together with FACT-M numbered data and basic patient characteristics, using the databases Scopus, Web of Science, PubMed and PsycINFO. RESULTS 16 articles describing 14 patient cohorts published 2008-2020 were included. The majority of the studies did not report subscale scores in accordance with FACT-M guidelines. The results did indicate that FACT-M total scores were inversely correlated with AJCC stage. Subscale analysis demonstrated varying degrees of correlation with AJCC stage. The Melanoma Surgery Subscale score was lowest in stage III patients, probably reflecting more advanced surgical procedures in this group of patients. CONCLUSIONS Though this review is based on a questionnaire limited to the assessment of melanoma patients, it highlights the universal need for clinical studies to describe their selected HRQOL-questionnaires, its definition of HRQOL and its dimensions, as well as comply with the questionnaire's guidelines when reporting HRQOL-data.
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Affiliation(s)
- Ann-Sophie Lindqvist Bagge
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Psychology, Gothenburg University, Gothenburg, Sweden.
| | - Hanna Wesslau
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Roza Cizek
- Department of Psychology, Gothenburg University, Gothenburg, Sweden
| | - Carl Jacob Holmberg
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Marc Moncrieff
- Department of Plastic & Reconstructive Surgery, Norfolk & Norwich University Hospital, Norwich, UK
| | - Dimitrios Katsarelias
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Anders Carlander
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden; SOM Institute. University of Gothenburg, Gothenburg, Sweden
| | - Roger Olofsson Bagge
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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Teras J, Carr MJ, Zager JS, Kroon HM. Molecular Aspects of the Isolated Limb Infusion Procedure. Biomedicines 2021; 9:biomedicines9020163. [PMID: 33562337 PMCID: PMC7915579 DOI: 10.3390/biomedicines9020163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/30/2021] [Accepted: 01/31/2021] [Indexed: 01/19/2023] Open
Abstract
For decades, isolated limb infusion (ILI) and hyperthermic isolated limb perfusion (HILP) have been used to treat melanoma in-transit metastases and unresectable sarcoma confined to the limb utilizing the effect of loco-regional high-dose chemotherapy to the isolated limb. Both procedures are able to provide high response rates in patients with numerous or bulky lesions in whom other loco-regional treatments are becoming ineffective. In comparison to systemic therapies, on the other hand, ILI and HILP have the advantage of not being associated with systemic side-effects. Although in principle ILI and HILP are similar procedures, ILI is technically simpler to perform and differs from HILP in that it takes advantage of the hypoxic and acidotic environment that develops in the isolated limb, potentiating anti-tumour activity of the cytotoxic agents melphalan +/− actinomycin-D. Due to its simplicity, ILI can be used in both preclinical and clinical studies to test new cytotoxic regimens and combinations with the aim to overcome tumour resistance. In the future, administration of cytotoxic agents by ILI, in combination with systemic treatments such as BRAF/MEK/KIT inhibitors, immunotherapy (CTLA-4 blockade), and/or programmed death (PD-1) pathway inhibitors, has the potential to improve responses further by inducing increased tumour cell death while limiting the ability of the tumour to suppress the immune response.
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Affiliation(s)
- Jüri Teras
- Department of Surgical Oncology, North Estonia Medical Centre Foundation, 13419 Tallinn, Estonia;
- Tallinn University of Technology, 12616 Tallinn, Estonia
| | - Michael J. Carr
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; (M.J.C.); (J.S.Z.)
| | - Jonathan S. Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; (M.J.C.); (J.S.Z.)
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA
| | - Hidde M. Kroon
- Department of Surgery, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, SA 5000, Australia
- Correspondence: ; Tel.: +61-8-7074-2163
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Khoury S, Knapp GC, Fyfe A, Monzon J, Temple-Oberle C, McKinnon GJ. Durability of Complete Response to Intralesional Interleukin-2 for In-Transit Melanoma. J Cutan Med Surg 2021; 25:364-370. [PMID: 33529083 PMCID: PMC8311908 DOI: 10.1177/1203475420988862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Intralesional injection of interleukin-2 (IL-2) for in-transit melanoma (ITM) is associated with a high rate of complete response. However, there is a paucity of data on treatment durability and long-term outcomes. Objectives To provide long-term data on patients with a complete response to IL-2 therapy for ITM. Methods Consecutive patients with ITM, treated with intralesional IL-2 therapy, at the Tom Baker Cancer Center were identified from April 2009 to August 2019. All patients received at least 4 cycles (every 2 weeks) of IL-2 (5 MIU/mL). Complete response was defined as sustained (ie, 3 months) clinical complete remission of all known in-transit disease. Results Sixty-five patients were treated with curative intent for in-transit disease with intralesional IL-2. Complete clinical response was identified in 44.6% (29/65). In this subset of patients, the median number of lesions per patient was 9 (range 1-40). The median total dose of IL-2 was 0.8 mL (IQR 0.4-1.5) per lesion. One patient received isolated limb infusion and 13.8% (4/29) received systemic immunotherapy as part of their initial management. At a median follow-up of 27 months (IQR 16-59), 34.5% (10/29) developed recurrent disease. Of these patients, 50.0% (5/10) presented with synchronous in-transit and distant metastases. The median time to recurrence was 10.5 months (IQR 5.8-16.3). Conclusion With long-term follow-up, 65.5% of complete responders have a durable response to intralesional IL-2 therapy. In this cohort of patients, local in-transit recurrence is most likely to occur within 12 months and is often associated with concomitant distant disease.
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Affiliation(s)
- Sami Khoury
- 70401 Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Gregory C Knapp
- 2129 Department of Oncology, Division of Surgical Oncology, University of Calgary, Calgary, AB, Canada
| | - Allison Fyfe
- 3146 Alberta Health Services, Tom Baker Cancer Center, Calgary, AB, Canada
| | - Jose Monzon
- Department of Oncology, Division of Medical Oncology, University of Calgary, Calgary, AB, Canada
| | - Claire Temple-Oberle
- Department of Surgery, Division of Plastic Surgery and Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Gregory J McKinnon
- 2129 Department of Oncology, Division of Surgical Oncology, University of Calgary, Calgary, AB, Canada
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Beasley GM, Zager JS, Thompson JF. The Landmark Series: Regional Therapy of Recurrent Cutaneous Melanoma. Ann Surg Oncol 2020; 27:35-42. [PMID: 31471842 DOI: 10.1245/s10434-019-07760-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Indexed: 01/20/2023]
Abstract
In-transit melanoma represents a distinct disease pattern in which melanoma recurs as dermal or subcutaneous nodules between the primary melanoma site and the draining regional lymph node basin. The disease pattern is often not amenable to complete surgical resection. Since the 1950s, regional therapies have been explored for the treatment of this disease entity, with the goal of maximizing delivery of the therapeutic agent to the tumor while minimizing systemic toxicity. We reviewed landmark studies describing and evaluating regional chemotherapy and intralesional therapies for patients with in-transit melanoma metastases.
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Affiliation(s)
- Georgia M Beasley
- Department of Surgery, Duke University, Durham, NC, USA.
- Duke University Medical Center, Durham, NC, USA.
| | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Surgery, University of South Florida Morsani School of Medicine, Tampa, FL, USA
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia
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Ekenberg M, Wesslau H, Olofsson Bagge R, Engström M. Patient experiences with isolated limb perfusion for malignant melanoma - A qualitative study. Eur J Oncol Nurs 2019; 43:101672. [PMID: 31614318 DOI: 10.1016/j.ejon.2019.101672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/26/2019] [Accepted: 10/02/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE In recent years, the incidence of malignant melanoma has rapidly increased worldwide. Among patients with recurrences, approximately 5% develop in-transit metastases, which can potentially be treated with isolated limb perfusion (ILP). However, little is known about patient experiences with this treatment. A more thorough understanding might guide future research and clinical care. In this study, we aimed to describe patients' experiences of ILP treatment. METHODS This study included eight patients who participated in a semi-structed interviewed, conducted at one occasion between 3 and 11 months after their ILP treatment. The mean interview duration was 26 min. Data were analyzed using qualitative inductive content analysis according to the methods of Elo-Kyngäs and Graneheim and Lundman. RESULTS Our analysis yielded three categories, each built on two subcategories: positive experiences after ILP treatment emerged from the sub-categories reduced tumor burden and living a less restricted life; negative experiences after ILP was built on the subcategories fear of relapse and complications and side effects; and experiences of healthcare was founded on the subcategories need for correct information and being viewed as sicker then experienced. CONCLUSION Participants showed greater focus on the healthy parts of their lives, even when negative symptoms occurred after ILP treatment. They also described how healthcare workers focused on their illness. Based on these findings, we suggest the following means of providing good nursing care to ILP patients: give correct information, strive to reduce patients' negative symptoms, support their daily living needs, and provide emotional support to reduce fear of recurrence.
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Affiliation(s)
- Monica Ekenberg
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hanna Wesslau
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Roger Olofsson Bagge
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - My Engström
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Health and Care Science, Sahlgrenska Academy at the University of Gothenburg, Sweden; Department of Gastrosurgical research and education, Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg, Sweden.
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7
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Chernyshov PV, Lallas A, Tomas-Aragones L, Arenbergerova M, Samimi M, Manolache L, Svensson A, Marron SE, Sampogna F, Spillekom-vanKoulil S, Bewley A, Forsea AM, Jemec GB, Szepietowski JC, Augustin M, Finlay AY. Quality of life measurement in skin cancer patients: literature review and position paper of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient Oriented Outcomes, Melanoma and Non-Melanoma Skin Cancer. J Eur Acad Dermatol Venereol 2019; 33:816-827. [PMID: 30963614 DOI: 10.1111/jdv.15487] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/18/2019] [Indexed: 12/13/2022]
Abstract
The European Academy of Dermatology and Venereology (EADV) Task Forces (TFs) on Quality of Life (QoL) and Patient Oriented Outcomes, Melanoma and Non-Melanoma Skin Cancer (NMSC) present a review of the literature and position statement on health-related (HR) QoL assessment in skin cancer patients. A literature search was carried out to identify publications since 1980 that included information about the impact of SC on QoL. Generic, dermatology-specific, cancer-specific, SC-specific, facial SC-specific, NMSC-specific, basal cell carcinoma-specific and melanoma-specific QoL questionnaires have been used to assess HRQoL in SC patients. HRQoL was assessed in the context of creation and validation of the HRQoL instruments, clinical trials, comparison of QoL in SC and other cancers, other diseases or controls, HRQoL assessment after treatment, comorbidities, behaviour modification, predictors of QoL and survival, supportive care needs, coping strategies and fear of cancer recurrence. The most widely used instruments for HRQoL assessment in SC patients are the European Organisation for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-C30), the Functional Assessment of Cancer Therapy-Melanoma (FACT-M), Skin Cancer Index (SCI), Short Form 36 Item Health Survey (SF-36) and the Dermatology Life Quality Index (DLQI). The TFs recommend the use of the cancer-specific EORTC QLQ-C30, especially in late stages of disease, and the melanoma-specific FACT-M and SC-specific SCI questionnaires. These instruments have been well validated and used in several studies. Other HRQoL instruments, also with good basic validation, are not currently recommended because the experience of their use is too limited. Dermatology-specific HRQoL instruments can be used to assess the impact of skin-related problems in SC. The TFs encourage further studies to validate HRQoL instruments for use in different stages of SC, in order to allow more detailed practical recommendations on HRQoL assessment in SC.
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Affiliation(s)
- P V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine
| | - A Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - L Tomas-Aragones
- Department of Psychology, University of Zaragoza, Zaragoza, Spain
| | - M Arenbergerova
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - M Samimi
- Dermatology Department, University of Tours, Tours, France
| | - L Manolache
- Dermatology, Dali Medical, Bucharest, Romania
| | - A Svensson
- Department of Dermatology and Venereology, Skane University Hospital, Malmö, Sweden
| | - S E Marron
- Department of Dermatology, Royo Villanova Hospital, Aragon Psychodermatology Research Group (GAI+PD), Zaragoza, Spain
| | - F Sampogna
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS FLMM, Rome, Italy
| | - S Spillekom-vanKoulil
- Radboud Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Bewley
- Whipps Cross University Hospital, London, UK.,The Royal London Hospital, London, UK
| | - A M Forsea
- Department of Oncologic Dermatology and Allergology, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - G B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, Wrocław, Poland
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Y Finlay
- Department of Dermatology and Wound Healing, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
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Read T, Lonne M, Sparks DS, David M, Wagels M, Schaider H, Soyer HP, Smithers BM. A systematic review and meta‐analysis of locoregional treatments for in‐transit melanoma. J Surg Oncol 2019; 119:887-896. [DOI: 10.1002/jso.25400] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 01/13/2019] [Accepted: 01/19/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Tavis Read
- Queensland Melanoma Project, Princess Alexandra HospitalBrisbane Queensland Australia
- The University of Queensland, Faculty of Medicine, Princess Alexandra HospitalBrisbane Queensland Australia
- Griffith University, School of MedicineGold Coast Queensland Australia
| | - Michael Lonne
- The University of Queensland, Faculty of Medicine, Princess Alexandra HospitalBrisbane Queensland Australia
| | - David S. Sparks
- The University of Queensland, Faculty of Medicine, Princess Alexandra HospitalBrisbane Queensland Australia
| | - Michael David
- The University of Queensland, School of Health and Rehabilitation SciencesBrisbane Queensland Australia
- The University of Newcastle, School of Medicine and Public HealthNewcastle New South Wales Australia
| | - Michael Wagels
- Queensland Melanoma Project, Princess Alexandra HospitalBrisbane Queensland Australia
- The University of Queensland, Faculty of Medicine, Princess Alexandra HospitalBrisbane Queensland Australia
| | - Helmut Schaider
- The University of Queensland, Dermatology Research CentreBrisbane Queensland Australia
| | - H. Peter Soyer
- The University of Queensland, Dermatology Research CentreBrisbane Queensland Australia
| | - B. Mark Smithers
- Queensland Melanoma Project, Princess Alexandra HospitalBrisbane Queensland Australia
- The University of Queensland, Faculty of Medicine, Princess Alexandra HospitalBrisbane Queensland Australia
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Read T, Webber S, Thomas J, Wagels M, Schaider H, Soyer HP, Smithers BM. Protocol for the TIDAL Melanoma Study: topical imiquimod or diphenylcyclopropenone for the management of cutaneous in-transit melanoma metastases-a phase II, single centre, randomised, pilot study. BMJ Open 2017; 7:e016816. [PMID: 28988173 PMCID: PMC5640002 DOI: 10.1136/bmjopen-2017-016816] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Patients with in-transit melanoma metastases present a therapeutic challenge. Complete surgical excision of localised disease is considered as the gold standard; however, surgery is not always acceptable and alternatives are required. Treatment results reported using imiquimod and diphenylcyclopropenone (DPCP) suggest that topical immunotherapies can be used to successfully treat select patients with melanoma metastases. A phase II, randomised, single centre, pilot study was designed to assess the clinical efficacy and safety of DPCP and imiquimod for the treatment of superficial, cutaneous in-transit melanoma metastases. METHODS AND ANALYSIS This is an open-label, non-superiority, pilot study with no treatment cross-over. Eligible patients are randomised in a 1:1 ratio to receive topical therapy for up to 12 months with a minimum follow-up period of 12 months. The target sample size is 30 patients, with 15 allocated to each treatment arm. The primary endpoint is the number of patients experiencing a complete response of treated lesions as determined clinically using Response Evaluation Criteria in Solid Tumours. This trial incorporates health-related quality of life measures and biological tissue collection for further experimental substudies. The study will also facilitate a health economic analysis. ETHICS AND DISSEMINATION Approval was obtained from the Human Research Ethics Committee at the participating centre, and recruitment has commenced. The results of this study will be submitted for formal publication within a peer-reviewed journal. TRIAL REGISTRATION NUMBER Prospectively registered on 16 October 2015 with the Australian New Zealand Clinical Trials Registry (ACTRN12615001088538). This study conforms to WHO Trial Registration Data Set.
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Affiliation(s)
- Tavis Read
- Queensland Melanoma Project, Princess Alexandra Hospital, Queensland Health, Brisbane, Australia
- Department of Surgery, The University of Queensland, School of Medicine, Princess Alexandra Hospital, Brisbane, Australia
- Griffith University, School of Medicine, Gold Coast, Australia
| | - Scott Webber
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Australia
- Department of Dermatology, The University of Queensland, School of Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - Janine Thomas
- Queensland Melanoma Project, Princess Alexandra Hospital, Queensland Health, Brisbane, Australia
| | - Michael Wagels
- Queensland Melanoma Project, Princess Alexandra Hospital, Queensland Health, Brisbane, Australia
- Department of Surgery, The University of Queensland, School of Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - Helmut Schaider
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Australia
- Department of Dermatology, The University of Queensland, School of Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Australia
- Department of Dermatology, The University of Queensland, School of Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - B Mark Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, Queensland Health, Brisbane, Australia
- Department of Surgery, The University of Queensland, School of Medicine, Princess Alexandra Hospital, Brisbane, Australia
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10
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Read T, Webber S, Tan J, Wagels M, Schaider H, Soyer HP, Smithers BM. Diphenylcyclopropenone for the treatment of cutaneous in-transit melanoma metastases - results of a prospective, non-randomized, single-centre study. J Eur Acad Dermatol Venereol 2017. [PMID: 28626861 DOI: 10.1111/jdv.14422] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Current treatments for in-transit melanoma (ITM) metastases are frequently invasive and do not improve overall survival. Recently, there has been increasing investigation into the use of topical agents. Diphenylcyclopropenone or diphencyprone (DPCP) is a novel, topical therapy that has been reported to have immune-sensitizing properties useful in the treatment of ITM. OBJECTIVE To assess the clinical outcomes of patients treated within a prospective, non-randomized, non-comparative study using DPCP for cutaneous ITM metastases. METHODS A review was conducted assessing the outcomes of 58 patients prospectively treated using DPCP. Patients had satellite or in-transit disease (stage IIIB+), with all lesion morphology types included. The patients were treated through a single, specialized clinic with regular outpatient follow-up. DPCP was topically applied as an aqueous cream in 0.005-1% concentrations once to twice per week for up to 24-48 h of duration. To assess variables associated with response, a per-protocol statistical analysis was performed. RESULTS Fifty-four patients were treated who satisfied eligibility criteria for analysis. The overall response rates were as follows: complete response 22%, partial response 39%, stable disease 24% and progressive disease 15%. The mean time to complete response was 10.5 months, mean duration (disease-free interval) 12.3 months and recurrence rate in complete responders 41%. Lesion morphology was predictive of clinical benefit with a higher response in epidermotropic disease (P < 0.05). CONCLUSIONS DPCP provided a well-tolerated, convenient and efficacious treatment for cutaneous ITM metastases. Identifying patterns of response may assist treatment selection and improve patient-rated outcomes.
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Affiliation(s)
- T Read
- Queensland Melanoma Project, Princess Alexandra Hospital, Queensland Health, Brisbane, Qld, Australia.,Discipline of Surgery, School of Medicine, The University of Queensland, Brisbane, Qld, Australia.,School of Medicine, Griffith University, Gold Coast, Qld, Australia
| | - S Webber
- Department of Dermatology, Princess Alexandra Hospital, Queensland Health, Brisbane, Qld, Australia
| | - J Tan
- Department of Dermatology, Princess Alexandra Hospital, Queensland Health, Brisbane, Qld, Australia
| | - M Wagels
- Queensland Melanoma Project, Princess Alexandra Hospital, Queensland Health, Brisbane, Qld, Australia.,Discipline of Surgery, School of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - H Schaider
- Department of Dermatology, Princess Alexandra Hospital, Queensland Health, Brisbane, Qld, Australia.,Dermatology Research Centre, School of Medicine, Translational Research Institute, The University of Queensland, Brisbane, Qld, Australia
| | - H P Soyer
- Department of Dermatology, Princess Alexandra Hospital, Queensland Health, Brisbane, Qld, Australia.,Dermatology Research Centre, School of Medicine, Translational Research Institute, The University of Queensland, Brisbane, Qld, Australia
| | - B M Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, Queensland Health, Brisbane, Qld, Australia.,Discipline of Surgery, School of Medicine, The University of Queensland, Brisbane, Qld, Australia
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11
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A Single-Center Experience With Isolated Limb Infusion: An Interventional Oncology Opportunity. AJR Am J Roentgenol 2016; 208:663-668. [PMID: 27897028 DOI: 10.2214/ajr.16.16344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This retrospective review details our experience with isolated limb infusion for the treatment of melanoma, squamous cell carcinoma, and sarcoma in-transit metastases performed entirely in the interventional radiology suite. Eleven patients were treated over a 3-year period. Treatment response was assessed clinically and with PET/CT. CONCLUSION Eight patients had either complete or partial response, giving an overall response rate of 72%. Isolated limb infusion can efficiently be performed entirely in the interventional radiology suite.
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12
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Dunn J, Watson M, Aitken JF, Hyde MK. Systematic review of psychosocial outcomes for patients with advanced melanoma. Psychooncology 2016; 26:1722-1731. [PMID: 27696578 DOI: 10.1002/pon.4290] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 09/19/2016] [Accepted: 09/29/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND New advanced melanoma therapies are associated with improved survival; however, quality of survivorship, particularly psychosocial outcomes, for patients overall and those treated with newer therapies is unclear. OBJECTIVE Synthesize qualitative and quantitative evidence about psychosocial outcomes for advanced (stage III/IV) melanoma patients. METHODS Five databases were searched (01/01/1980 to 31/01/2016). Inclusion criteria were as follows: advanced melanoma patients or sub-group analysis; assessed psychosocial outcomes; and English language. RESULTS Fifty-two studies met review criteria (4 qualitative, 48 quantitative). Trials comprise mostly medical not psychosocial interventions, with psychosocial outcomes assessed within broader quality of life measures. Patients receiving chemotherapy or IFN-alpha showed decreased emotional and social function and increased distress. Five trials of newer therapies appeared to show improvements in emotional and social function. Descriptive studies suggest that patients with advanced, versus localized disease, had decreased emotional and social function and increased distress. Contributors to distress were largely unexplored, and no clear framework described coping/adjustment trajectories. Patients with advanced versus localized disease had more supportive care needs, particularly amount, quality, and timing of melanoma-related information, communication with and emotional support from clinicians. Limitations included: lack of theoretical underpinnings guiding study design; inconsistent measurement approaches; small sample sizes; non-representative sampling; and cross-sectional design. CONCLUSIONS Quality trial evidence is needed to clarify the impact of treatment innovations for advanced melanoma on patients' psychosocial well-being. Survivorship research and subsequent translation of that knowledge into programs and services currently lags behind gains in the medical treatment of advanced melanoma, a troubling circumstance that requires immediate and focused attention.
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Affiliation(s)
- Jeff Dunn
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,School of Social Science, The University of Queensland, St Lucia, Queensland, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Australia
| | - Maggie Watson
- Pastoral and Psychological Care, Royal Marsden Hospital, Sutton, Surrey, UK
| | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Melissa K Hyde
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Bagge ASL, Ben-Shabat I, Belgrano V, Olofsson Bagge R. Health-Related Quality of Life for Patients Who have In-Transit Melanoma Metastases Treated with Isolated Limb Perfusion. Ann Surg Oncol 2016; 23:2062-9. [DOI: 10.1245/s10434-016-5103-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Indexed: 11/18/2022]
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14
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The Role of Regional Therapies for in-Transit Melanoma in the Era of Improved Systemic Options. Cancers (Basel) 2015; 7:1154-77. [PMID: 26140669 PMCID: PMC4586763 DOI: 10.3390/cancers7030830] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 06/17/2015] [Accepted: 06/24/2015] [Indexed: 12/21/2022] Open
Abstract
The incidence of melanoma has been increasing at a rapid rate, with 4%–11% of all melanoma recurrences presenting as in-transit disease. Treatments for in-transit melanoma of the extremity are varied and include surgical excision, lesional injection, regional techniques and systemic therapies. Excision to clear margins is preferred; however, in cases of widespread disease, this may not be practical. Historically, intralesional therapies were generally not curative and were often used for palliation or as adjuncts to other therapies, but recent advances in oncolytic viruses may change this paradigm. Radiation as a regional therapy can be quite locally toxic and is typically relegated to disease control and symptom relief in patients with limited treatment options. Regional therapies such as isolated limb perfusion and isolated limb infusion are older therapies, but offer the ability to treat bulky disease for curative intent with a high response rate. These techniques have their associated toxicities and can be technically challenging. Historically, systemic therapy with chemotherapies and biochemotherapies were relatively ineffective and highly toxic. With the advent of novel immunotherapeutic and targeted small molecule agents for the treatment of metastatic melanoma, the armamentarium against in-transit disease has expanded. Given the multitude of options, many different combinations and sequences of therapies can be offered to patients with in-transit extremity melanoma in the contemporary era. Reported response and survival rates of the varied treatments may offer valuable information regarding treatment decisions for patients with in-transit melanoma and provide rationale for these decisions.
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15
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Beasley G, Tyler D. In-transit melanoma metastases: incidence, prognosis, and the role of lymphadenectomy. Ann Surg Oncol 2014; 22:358-60. [PMID: 25266867 DOI: 10.1245/s10434-014-4110-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Indexed: 11/18/2022]
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