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Cherkas E, Kalafatis NE, Marous MR, Shields CL. Iris melanoma: Review of clinical features, risks, management, and outcomes. Clin Dermatol 2024; 42:62-70. [PMID: 37865279 DOI: 10.1016/j.clindermatol.2023.10.009] [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: 10/23/2023]
Abstract
Primary uveal melanoma is rare and affects approximately 8,000 persons per year worldwide. This malignancy can involve the iris, ciliary body, and choroid. Of these three structures, the iris is the least commonly affected site, representing only 4% of all uveal melanomas. Iris melanoma can arise from iris melanocytic nevus, iris melanocytosis, or de novo. In a longitudinal study of 1,611 patients with iris nevus, transformation into melanoma, using Kaplan-Meier estimates, was found in 2.6% by five years and in 4.1% by 10 years. The factors that predicted growth of iris melanocytic nevus into melanoma are denoted by a letter (ABCDEF) guide: A for age ≤40 years old at presentation (hazard ratio [HR] = 3, P = .01), B for blood (hyphema) (HR = 9, P < .0004), C for clock hour of tumor inferiorly (tumor location) (HR = 9, P = .03), D for diffuse flat tumor configuration (HR = 14, P = .02), E for ectropion uveae (HR = 4, P = .002), and F for feathery ill-defined margins (HR = 3, P = .02). At diagnosis, iris melanoma has a mean cross-sectional diameter of 5.5 mm and thickness of 2.1 mm, often with tumor seeding (28%) and secondary glaucoma (35%). We provide a comprehensive review of iris nevus and melanoma to explore relevant demographic and clinical data, risk factors for tumor growth, management, and prognosis, with the hope that clinicians will be more comfortable in understanding this rare malignant condition.
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Affiliation(s)
- Elliot Cherkas
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nicholas E Kalafatis
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Molly R Marous
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York, USA
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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2
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Zheng DX, Soldozy S, Mulligan KM, Levoska MA, Cohn EF, Finberg A, Alsaloum P, Cwalina TB, Hanft SJ, Scott JF, Rothermel LD, Nambudiri VE. Epidemiology, management, and treatment outcomes of metastatic spinal melanoma. World Neurosurg X 2023; 18:100156. [PMID: 36875322 PMCID: PMC9976572 DOI: 10.1016/j.wnsx.2023.100156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/29/2022] [Accepted: 01/19/2023] [Indexed: 01/22/2023] Open
Abstract
Metastatic spinal melanoma is a rare and aggressive disease process with poor prognosis. We review the literature on metastatic spinal melanoma, focusing on its epidemiology, management, and treatment outcomes. Demographics of metastatic spinal melanoma are similar to those for cutaneous melanoma, and cutaneous primary tumors tend to be most common. Decompressive surgical intervention and radiotherapy have traditionally been considered mainstays of treatment, and stereotactic radiosurgery has emerged as a promising approach in the operative management of metastatic spinal melanoma. While survival outcomes for metastatic spinal melanoma remain poor, they have improved in recent years with the advent of immune checkpoint inhibition, used in conjunction with surgery and radiotherapy. New treatment options remain under investigation, especially for patients with disease refractory to immunotherapy. We additionally explore several of these promising future directions. Nevertheless, further investigation of treatment outcomes, ideally incorporating high-quality prospective data from randomized controlled trials, is needed to identify optimal management of metastatic spinal melanoma.
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Affiliation(s)
- David X Zheng
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States.,Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Sauson Soldozy
- Department of Neurological Surgery, University of Miami, Miami, FL, United States.,Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| | - Kathleen M Mulligan
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Melissa A Levoska
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Erin F Cohn
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Ariel Finberg
- Department of Neurological Surgery, University of Miami, Miami, FL, United States
| | - Peter Alsaloum
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Thomas B Cwalina
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Simon J Hanft
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| | - Jeffrey F Scott
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Luke D Rothermel
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Vinod E Nambudiri
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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3
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Howlett S, Carter TJ, Shaw HM, Nathan PD. Tebentafusp: a first-in-class treatment for metastatic uveal melanoma. Ther Adv Med Oncol 2023; 15:17588359231160140. [PMID: 36970111 PMCID: PMC10031621 DOI: 10.1177/17588359231160140] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/06/2023] [Indexed: 03/24/2023] Open
Abstract
Tebentafusp is a first-in-class immunotherapy agent that comprises an engineered T-cell receptor targeting a gp100 epitope presented by human leukocyte antigen-A*02:01 cells, fused to an anti-CD3 single-chain variable fragment. Tebentafusp is both the first bispecific T-cell engager to show efficacy in the treatment of advanced solid cancer and the first anti-cancer treatment to demonstrate an overall survival benefit in patients with uveal melanoma (UM). This review article will focus on the clinical development of tebentafusp, the mechanism of action and resultant evolution of the management of advanced UM.
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Affiliation(s)
- Sarah Howlett
- Mount Vernon Cancer Centre, Northwood,
Middlesex, UK
| | | | - Heather M. Shaw
- Mount Vernon Cancer Centre, Northwood,
Middlesex, UK
- University College London Hospital, London,
UK
| | - Paul D. Nathan
- Mount Vernon Cancer Centre, Rickmansworth Road,
Northwood, Middlesex HA6 2RN, UK
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4
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Targeting IRS-1/2 in Uveal Melanoma Inhibits In Vitro Cell Growth, Survival and Migration, and In Vivo Tumor Growth. Cancers (Basel) 2022; 14:cancers14246247. [PMID: 36551732 PMCID: PMC9777326 DOI: 10.3390/cancers14246247] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Uveal melanoma originating in the eye and metastasizing to the liver is associated with poor prognosis and has only one approved therapeutic option. We hypothesized that liver-borne growth factors may contribute to UM growth. Therefore, we investigated the role of IGF-1/IGF-1R signaling in UM. Here, we found that IRS-1, the insulin receptor substrate, is overexpressed in both UM cells and tumors. Since we previously observed that IGF-1R antibody therapy was not clinically effective in UM, we investigated the potential of NT157, a small molecule inhibitor of IRS-1/2, in blocking this pathway in UM. NT157 treatment of multiple UM cell lines resulted in reduced cell growth and migration and increased apoptosis. This treatment also significantly inhibited UM tumor growth in vivo, in the chicken egg chorioallantoic membrane (CAM) and subcutaneous mouse models, validating the in vitro effect. Mechanistically, through reverse phase protein array (RPPA), we identified significant proteomic changes in the PI3K/AKT pathway, a downstream mediator of IGF-1 signaling, with NT157 treatment. Together, these results suggest that NT157 inhibits cell growth, survival, and migration in vitro, and tumor growth in vivo via inhibiting IGF-1 signaling in UM.
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5
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Chi H, Peng G, Yang J, Zhang J, Song G, Xie X, Strohmer DF, Lai G, Zhao S, Wang R, Yang F, Tian G. Machine learning to construct sphingolipid metabolism genes signature to characterize the immune landscape and prognosis of patients with uveal melanoma. Front Endocrinol (Lausanne) 2022; 13:1056310. [PMID: 36568076 PMCID: PMC9772281 DOI: 10.3389/fendo.2022.1056310] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
Background Uveal melanoma (UVM) is the most common primary intraocular malignancy in adults and is highly metastatic, resulting in a poor patient prognosis. Sphingolipid metabolism plays an important role in tumor development, diagnosis, and prognosis. This study aimed to establish a reliable signature based on sphingolipid metabolism genes (SMGs), thus providing a new perspective for assessing immunotherapy response and prognosis in patients with UVM. Methods In this study, SMGs were used to classify UVM from the TCGA-UVM and GEO cohorts. Genes significantly associated with prognosis in UVM patients were screened using univariate cox regression analysis. The most significantly characterized genes were obtained by machine learning, and 4-SMGs prognosis signature was constructed by stepwise multifactorial cox. External validation was performed in the GSE84976 cohort. The level of immune infiltration of 4-SMGs in high- and low-risk patients was analyzed by platforms such as CIBERSORT. The prediction of 4-SMGs on immunotherapy and immune checkpoint blockade (ICB) response in UVM patients was assessed by ImmuCellAI and TIP portals. Results 4-SMGs were considered to be strongly associated with the prognosis of UVM and were good predictors of UVM prognosis. Multivariate analysis found that the model was an independent predictor of UVM, with patients in the low-risk group having higher overall survival than those in the high-risk group. The nomogram constructed from clinical characteristics and risk scores had good prognostic power. The high-risk group showed better results when receiving immunotherapy. Conclusions 4-SMGs signature and nomogram showed excellent predictive performance and provided a new perspective for assessing pre-immune efficacy, which will facilitate future precision immuno-oncology studies.
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Affiliation(s)
- Hao Chi
- Clinical Medical College, Southwest Medical University, Luzhou, China
| | - Gaoge Peng
- Clinical Medical College, Southwest Medical University, Luzhou, China
| | - Jinyan Yang
- School of Stomatology, Southwest Medical University, Luzhou, China
| | - Jinhao Zhang
- School of Stomatology, Southwest Medical University, Luzhou, China
| | - Guobin Song
- School of Stomatology, Southwest Medical University, Luzhou, China
| | - Xixi Xie
- School of Stomatology, Southwest Medical University, Luzhou, China
| | - Dorothee Franziska Strohmer
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Guichuan Lai
- Department of Epidemiology and Health Statistics, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Songyun Zhao
- Department of Neurosurgery, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Rui Wang
- Clinical Medical College, Southwest Medical University, Luzhou, China
| | - Fang Yang
- Department of Ophthalmology, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Gang Tian
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Wei AZ, Uriel M, Porcu A, Manos MP, Mercurio AC, Caplan MM, Hulse L, Seedor RS, Holovatska M, Francis J, Khan SA, McDonnell DE, Bogomolny D, Sato T, Marr BP, Haq R, Orloff M, Shoushtari A, Carvajal RD. Characterizing metastatic uveal melanoma patients who develop symptomatic brain metastases. Front Oncol 2022; 12:961517. [PMID: 36212499 PMCID: PMC9540230 DOI: 10.3389/fonc.2022.961517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
Metastatic uveal melanoma (mUM) is an advanced ocular malignancy characterized by a hepatotropic pattern of spread. As the incidence of brain metastases (BM) in mUM patients has been thought to be low, routine CNS surveillance has not been recommended. Notably, no formal assessment of BM incidence in mUM has to date been published to support this clinical practice. We aimed to determine the true rate of BM in mUM and to clarify the clinical and genomic risk factors associated with BM patients through a collaborative multicenter, retrospective research effort. Data collected from 1,845 mUM patients in databases across four NCI-designated comprehensive cancer centers from 2006-2021 were retrospectively analyzed to identify patients with BM. Brain imaging in most cases were performed due to onset of neurological symptoms and not for routine surveillance. An analysis of demographics, therapies, gene expression profile, tumor next generation sequencing (NGS) data, time to metastasis (brain or other), and survival in the BM cohort was completed. 116/1,845 (6.3%) mUM patients were identified with BM. The median age at time of UM diagnosis was 54 years old (range: 18-77). The median time to any metastasis was 4.2 years (range: 0-30.8). The most common initial metastatic site was the liver (75.9%). 15/116 (12.9%) BM patients presented with BM at the time of initial metastatic diagnosis. Median survival after a diagnosis of BM was 7.6 months (range: 0.4-73.9). The median number of organs involved at time of BM diagnosis was 3 (range: 1-9). DecisionDX-UM profiling was completed on 13 patients: 10-Class 2, 2-Class 1B, and 1-Class 1A. NGS and cytogenetic data were available for 34 and 21 patients, respectively. BM was identified in 6.3% of mUM cases and was associated with high disease burden and a median survival of under 8 months once diagnosed. Since most patients in this cohort were symptomatic, the incidence of asymptomatic BM remains unknown. These data suggest the use of routine brain imaging in all mUM patients at risk for developing BM for early detection.
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Affiliation(s)
- Alexander Z. Wei
- Division of Hematology & Oncology Columbia University Irving Medical Center, New York, NY, United States
| | - Matan Uriel
- Division of Hematology & Oncology Columbia University Irving Medical Center, New York, NY, United States
| | - Agata Porcu
- Department of Medical Oncology Thomas Jefferson University Hospitals, Philadelphia, PA, United States
| | | | - Ann C. Mercurio
- Division of Hematology & Oncology Columbia University Irving Medical Center, New York, NY, United States
| | - Michael M. Caplan
- Division of Hematology & Oncology Columbia University Irving Medical Center, New York, NY, United States
| | - Liam Hulse
- Department of Medical Oncology Thomas Jefferson University Hospitals, Philadelphia, PA, United States
| | - Rino S. Seedor
- Department of Medical Oncology Thomas Jefferson University Hospitals, Philadelphia, PA, United States
| | | | - Jasmine Francis
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Shaheer A. Khan
- Division of Hematology & Oncology Columbia University Irving Medical Center, New York, NY, United States
| | - Diana E. McDonnell
- Division of Hematology & Oncology Columbia University Irving Medical Center, New York, NY, United States
| | - Dmitry Bogomolny
- Division of Hematology & Oncology Columbia University Irving Medical Center, New York, NY, United States
| | - Takami Sato
- Department of Medical Oncology Thomas Jefferson University Hospitals, Philadelphia, PA, United States
| | - Brian P. Marr
- Division of Hematology & Oncology Columbia University Irving Medical Center, New York, NY, United States
| | - Rizwan Haq
- Dana-Farber Cancer Institute, Boston, MA, United States
| | - Marlana Orloff
- Department of Medical Oncology Thomas Jefferson University Hospitals, Philadelphia, PA, United States
| | | | - Richard D. Carvajal
- Division of Hematology & Oncology Columbia University Irving Medical Center, New York, NY, United States
- *Correspondence: Richard D. Carvajal,
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7
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Rola AC, Kalirai H, Taktak AFG, Eleuteri A, Krishna Y, Hussain R, Heimann H, Coupland SE. A Retrospective Analysis of 10 Years of Liver Surveillance Undertaken in Uveal Melanoma Patients Treated at the Supraregional "Liverpool Ocular Oncology Centre", UK. Cancers (Basel) 2022; 14:cancers14092187. [PMID: 35565316 PMCID: PMC9102800 DOI: 10.3390/cancers14092187] [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] [Received: 03/18/2022] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary Around 45% of patients with uveal melanoma (UM) develop liver metastases on average 3 years after diagnosis of the primary tumour. After clinical detection of metastases, median patient survival is approximately one year. Early identification of metastases through liver surveillance is important so that targeted treatment can benefit affected patients, aiming to prolong their survival. The aim of our retrospective study was to investigate and correlate the characteristics of UM patients diagnosed and treated at a UK supraregional referral center, the Liverpool Ocular Oncology Centre (LOOC), and who were included in the Centre’s liver screening programs for screening for liver metastases. “Real-world” data on the frequency of liver screening in patients after diagnosis and treatment of primary UM are lacking. Through the liver screening program, we found that metastases were detected in 37% of the 615 UM patients studied. A new output based on the prognostic indices of the Liverpool Uveal Melanoma Prognosticator Online version 3 (LUMPO3) model was fitted to the dataset of these patients and accurately estimated the time of onset of metastases. Abstract Purpose: To determine liver screening frequency and modality in UM patients following primary treatment, and the characteristics of detected metastases. Methods: A 10-year retrospective study of 615 UM patients undergoing liver surveillance in Liverpool. Information was collected from liver scan reports of these patients. Results: Of 615 UM patients analyzed, there were 337 men (55%) and 278 women (45%). Median age at primary treatment was 61 years (range, 22–94). At study end, median follow-up was 5.1 years, with 375 patients (61%) alive and 240 deceased (39%). Of the deceased patients, 187 (78%) died due to metastatic UM; 24 (10%) deaths were due to other causes; and 29 (12%) patients died of unknown conditions. In total, 3854 liver scans were performed in the 615 UM patients, with a median of 6.2 scans per patient (range, 1–40). Liver MRI was most frequently performed (62.8%). In total, 229 (37%) UM patients developed metastases during the study period: 150 were detected via liver surveillance and 79 were observed post-mortem. Conclusions: Metastatic UM onset is related to the size and genetic profiles of the primary UM, and can be predicted using the model LUMPO3. Regular liver surveillance allowed for timely detection of metastases, and through metastasectomy can lead to prolongation of life in some patients.
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Affiliation(s)
- Alda Cunha Rola
- Liverpool Ocular Oncology Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of System Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, William Henry Duncan Building, Liverpool L7 8TX, UK; (A.C.R.); (H.K.); (A.F.G.T.); (A.E.); (Y.K.); (R.H.); (H.H.)
| | - Helen Kalirai
- Liverpool Ocular Oncology Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of System Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, William Henry Duncan Building, Liverpool L7 8TX, UK; (A.C.R.); (H.K.); (A.F.G.T.); (A.E.); (Y.K.); (R.H.); (H.H.)
- Liverpool Clinical Laboratories, Department of Cellular Pathology, Liverpool University Hospitals Foundation Trust, Liverpool L7 8XP, UK
| | - Azzam F. G. Taktak
- Liverpool Ocular Oncology Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of System Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, William Henry Duncan Building, Liverpool L7 8TX, UK; (A.C.R.); (H.K.); (A.F.G.T.); (A.E.); (Y.K.); (R.H.); (H.H.)
- Department of Medical Physics and Clinical Engineering, Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Antonio Eleuteri
- Liverpool Ocular Oncology Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of System Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, William Henry Duncan Building, Liverpool L7 8TX, UK; (A.C.R.); (H.K.); (A.F.G.T.); (A.E.); (Y.K.); (R.H.); (H.H.)
- Department of Medical Physics and Clinical Engineering, Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Yamini Krishna
- Liverpool Ocular Oncology Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of System Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, William Henry Duncan Building, Liverpool L7 8TX, UK; (A.C.R.); (H.K.); (A.F.G.T.); (A.E.); (Y.K.); (R.H.); (H.H.)
- Liverpool Clinical Laboratories, Department of Cellular Pathology, Liverpool University Hospitals Foundation Trust, Liverpool L7 8XP, UK
| | - Rumana Hussain
- Liverpool Ocular Oncology Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of System Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, William Henry Duncan Building, Liverpool L7 8TX, UK; (A.C.R.); (H.K.); (A.F.G.T.); (A.E.); (Y.K.); (R.H.); (H.H.)
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK
| | - Heinrich Heimann
- Liverpool Ocular Oncology Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of System Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, William Henry Duncan Building, Liverpool L7 8TX, UK; (A.C.R.); (H.K.); (A.F.G.T.); (A.E.); (Y.K.); (R.H.); (H.H.)
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK
| | - Sarah E. Coupland
- Liverpool Ocular Oncology Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of System Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, William Henry Duncan Building, Liverpool L7 8TX, UK; (A.C.R.); (H.K.); (A.F.G.T.); (A.E.); (Y.K.); (R.H.); (H.H.)
- Liverpool Clinical Laboratories, Department of Cellular Pathology, Liverpool University Hospitals Foundation Trust, Liverpool L7 8XP, UK
- Correspondence: ; Tel.: +44-0151-794-9104
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8
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Minor DR, Kim KB, Tong RT, Wu MC, Kashani-Sabet M, Orloff M, Eschelman DJ, Gonsalves CF, Adamo RD, Anne PR, Luke JJ, Char D, Sato T. A Pilot Study of Hepatic Irradiation with Yttrium 90 Microspheres Followed by Immunotherapy with Ipilimumab and Nivolumab for Metastatic Uveal Melanoma. Cancer Biother Radiopharm 2022; 37:11-16. [PMID: 35021863 PMCID: PMC8861913 DOI: 10.1089/cbr.2021.0366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Liver metastases from uveal melanoma carry a very poor prognosis. Hepatic artery infusions with Yttrium-90 (90Y) resin microspheres have some activity in this disease, and radiation and immunotherapy may be synergistic. The primary objective of this study was to determine the safety and tolerability of sequential 90Y resin microspheres and immunotherapy with ipilimumab and nivolumab in metastatic uveal melanoma. Materials and Methods: Twenty-six patients with uveal melanoma with hepatic metastases were entered into a pilot study. Treatment consisted of two infusions of 90Y resin microspheres, one to each lobe of the liver, followed in 2–4 weeks by immunotherapy with ipilimumab and nivolumab every 3 weeks for four doses, then maintenance immunotherapy with nivolumab alone. Results: Initial dosing of both 90Y and immunotherapy resulted in excessive toxicity. With decreasing the dosage of 90Y to limit the normal liver dose to 35Gy and lowering the ipilimumab dose to 1 mg/kg, the toxicity was tolerable, with no apparent change in efficacy. There was one complete and four confirmed partial responses, for an objective response rate of 20% and a disease control rate of 68%. The median progression-free survival was 5.5 months (95% confidence interval [CI]: 1.3–9.7 months), with a median overall survival of 15 months (95% CI: 9.7–20.1 months). Conclusions: With dose reductions, sequential therapy with 90Y and immunotherapy with ipilimumab and nivolumab is safe and tolerable, and has activity in metastatic uveal melanoma. These results justify a controlled trial to demonstrate whether 90Y resin microspheres add to the utility of combination immunotherapy in this disease. Clinical Trial Registration number: NCT02913417.
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Affiliation(s)
- David R Minor
- Center for Melanoma Research and Treatment, California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Kevin B Kim
- Departments of Medicine, Radiology, and Ophthalmology, California Pacific Medical Center, San Francisco, California, USA
| | - Ricky T Tong
- Departments of Medicine, Radiology, and Ophthalmology, California Pacific Medical Center, San Francisco, California, USA
| | - Max C Wu
- Departments of Medicine, Radiology, and Ophthalmology, California Pacific Medical Center, San Francisco, California, USA
| | - Mohammed Kashani-Sabet
- Center for Melanoma Research and Treatment, California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Marlana Orloff
- Departments of Medicine and Radiology, Thomas Jefferson Medical School, Philadelphia, Pennsylvania, USA
| | - David J Eschelman
- Departments of Medicine and Radiology, Thomas Jefferson Medical School, Philadelphia, Pennsylvania, USA
| | - Carlin F Gonsalves
- Departments of Medicine and Radiology, Thomas Jefferson Medical School, Philadelphia, Pennsylvania, USA
| | - Robert D Adamo
- Departments of Medicine and Radiology, Thomas Jefferson Medical School, Philadelphia, Pennsylvania, USA
| | - Pramila R Anne
- Departments of Medicine and Radiology, Thomas Jefferson Medical School, Philadelphia, Pennsylvania, USA
| | - Jason J Luke
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Devron Char
- Departments of Medicine, Radiology, and Ophthalmology, California Pacific Medical Center, San Francisco, California, USA
| | - Takami Sato
- Departments of Medicine and Radiology, Thomas Jefferson Medical School, Philadelphia, Pennsylvania, USA
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9
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Svendsen HA, Meling TR, Nygaard V, Waagene S, Russnes H, Juell S, Rogne SG, Pahnke J, Helseth E, Fodstad Ø, Mælandsmo GM. Novel human melanoma brain metastasis models in athymic nude fox1 nu mice: Site-specific metastasis patterns reflecting their clinical origin. Cancer Med 2021; 10:8604-8613. [PMID: 34612023 PMCID: PMC8633237 DOI: 10.1002/cam4.4334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malignant melanomas frequently metastasize to the brain, but metastases in the cerebellum are underrepresented compared with metastases in the cerebrum. METHODS We established animal models by injecting intracardially in athymic nude fox1nu mice two human melanoma cell lines, originating from a cerebral metastasis (HM19) and a cerebellar metastasis (HM86). RESULTS Using magnetic resonance imaging (MRI), metastases were first detected after a mean of 34.5 days. Mean survival time was 59.6 days for the mice in the HM86 group and significantly shorter (43.7 days) for HM19-injected animals (p < 0.001). In the HM86 group, the first detectable metastasis was located in the cerebellum in 15/55 (29%) mice compared with none in the HM19 group (p < 0.001). At sacrifice, cerebellar metastases were found in 34/55 (63%) HM86-injected mice compared with 1/53 (2%) in the HM19-injected (p < 0.001) mice. At that time, all mice in both groups had detectable metastases in the cerebrum. Comparing macroscopic and histologic appearances of the brain metastases with their clinical counterparts, the cell line-based tumors had kept their original morphologic characteristics. CONCLUSIONS The present work demonstrates that human brain-metastatic melanoma cells injected intracardially in mice had retained inherent characteristics also in reproducing interaction with subtle microenvironmental brain tissue compartment-specific features. The models offer new possibilities for investigating tumor- and host-associated factors involved in determining tissue specificity of brain metastasis.
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Affiliation(s)
- Henrik A. Svendsen
- Institute of Clinical MedicineFaculty of MedicineUniversity of OsloOsloNorway
- Department of NeurosurgeryOslo University HospitalOsloNorway
- Department of Tumor BiologyInstitute for Cancer ResearchOslo University Hospital‐RadiumhospitaletOsloNorway
| | - Torstein R. Meling
- Institute of Clinical MedicineFaculty of MedicineUniversity of OsloOsloNorway
- Department of NeurosurgeryOslo University HospitalOsloNorway
- Department of NeurosurgeryGeneva University HospitalsGenevaSwitzerland
- Faculty of MedicineUniversity of GenevaGenevaSwitzerland
| | - Vigdis Nygaard
- Department of Tumor BiologyInstitute for Cancer ResearchOslo University Hospital‐RadiumhospitaletOsloNorway
| | - Stein Waagene
- Department of Tumor BiologyInstitute for Cancer ResearchOslo University Hospital‐RadiumhospitaletOsloNorway
| | - Hege Russnes
- Department of PathologyOslo University HospitalOsloNorway
| | - Siri Juell
- Department of Tumor BiologyInstitute for Cancer ResearchOslo University Hospital‐RadiumhospitaletOsloNorway
| | - Siril G. Rogne
- Department of NeurosurgeryOslo University HospitalOsloNorway
| | - Jens Pahnke
- Institute of Clinical MedicineFaculty of MedicineUniversity of OsloOsloNorway
- Department of PathologyOslo University HospitalOsloNorway
- LIEDUniversity of LübeckJenaGermany
- Department of PharmacologyMedical FacultyUniversity of LatviaRigaLatvia
| | - Eirik Helseth
- Institute of Clinical MedicineFaculty of MedicineUniversity of OsloOsloNorway
- Department of NeurosurgeryOslo University HospitalOsloNorway
| | - Øystein Fodstad
- Institute of Clinical MedicineFaculty of MedicineUniversity of OsloOsloNorway
- Department of Tumor BiologyInstitute for Cancer ResearchOslo University Hospital‐RadiumhospitaletOsloNorway
- Østfold Hospital TrustGrålumNorway
| | - Gunhild M. Mælandsmo
- Department of Tumor BiologyInstitute for Cancer ResearchOslo University Hospital‐RadiumhospitaletOsloNorway
- Institute of Medical BiologyFaculty of Health SciencesUniversity of Tromsø ‐ The Arctic University of NorwayTromsøNorway
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Soltantoyeh T, Akbari B, Karimi A, Mahmoodi Chalbatani G, Ghahri-Saremi N, Hadjati J, Hamblin MR, Mirzaei HR. Chimeric Antigen Receptor (CAR) T Cell Therapy for Metastatic Melanoma: Challenges and Road Ahead. Cells 2021; 10:cells10061450. [PMID: 34207884 PMCID: PMC8230324 DOI: 10.3390/cells10061450] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/31/2021] [Accepted: 06/09/2021] [Indexed: 12/11/2022] Open
Abstract
Metastatic melanoma is the most aggressive and difficult to treat type of skin cancer, with a survival rate of less than 10%. Metastatic melanoma has conventionally been considered very difficult to treat; however, recent progress in understanding the cellular and molecular mechanisms involved in the tumorigenesis, metastasis and immune escape have led to the introduction of new therapies. These include targeted molecular therapy and novel immune-based approaches such as immune checkpoint blockade (ICB), tumor-infiltrating lymphocytes (TILs), and genetically engineered T-lymphocytes such as chimeric antigen receptor (CAR) T cells. Among these, CAR T cell therapy has recently made promising strides towards the treatment of advanced hematological and solid cancers. Although CAR T cell therapy might offer new hope for melanoma patients, it is not without its shortcomings, which include off-target toxicity, and the emergence of resistance to therapy (e.g., due to antigen loss), leading to eventual relapse. The present review will not only describe the basic steps of melanoma metastasis, but also discuss how CAR T cells could treat metastatic melanoma. We will outline specific strategies including combination approaches that could be used to overcome some limitations of CAR T cell therapy for metastatic melanoma.
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Affiliation(s)
- Tahereh Soltantoyeh
- Department of Medical Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran 1417613151, Iran; (T.S.); (B.A.); (G.M.C.); (N.G.-S.); (J.H.)
| | - Behnia Akbari
- Department of Medical Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran 1417613151, Iran; (T.S.); (B.A.); (G.M.C.); (N.G.-S.); (J.H.)
| | - Amirali Karimi
- School of Medicine, Tehran University of Medical Sciences, Tehran 1417613151, Iran;
| | - Ghanbar Mahmoodi Chalbatani
- Department of Medical Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran 1417613151, Iran; (T.S.); (B.A.); (G.M.C.); (N.G.-S.); (J.H.)
| | - Navid Ghahri-Saremi
- Department of Medical Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran 1417613151, Iran; (T.S.); (B.A.); (G.M.C.); (N.G.-S.); (J.H.)
| | - Jamshid Hadjati
- Department of Medical Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran 1417613151, Iran; (T.S.); (B.A.); (G.M.C.); (N.G.-S.); (J.H.)
| | - Michael R. Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein 2028, South Africa;
- Radiation Biology Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Hamid Reza Mirzaei
- Department of Medical Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran 1417613151, Iran; (T.S.); (B.A.); (G.M.C.); (N.G.-S.); (J.H.)
- Correspondence: ; Tel.: +98-21-64053268; Fax: +98-21-66419536
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11
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Tosi A, Cappellesso R, Dei Tos AP, Rossi V, Aliberti C, Pigozzo J, Fabozzi A, Sbaraglia M, Blandamura S, Del Bianco P, Chiarion-Sileni V, Rosato A. The immune cell landscape of metastatic uveal melanoma correlates with overall survival. J Exp Clin Cancer Res 2021; 40:154. [PMID: 33947438 PMCID: PMC8097926 DOI: 10.1186/s13046-021-01947-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/13/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Uveal melanoma (UM) represents the most common primary intra-ocular malignancy in adults. Up to 50% of the patients develop distant metastases within 10 years from diagnosis, with the liver as the most common site. Upon metastatization, life expectancy strongly reduces and immune checkpoint inhibitors that prove effective in cutaneous melanoma do not modify clinical outcome. To date, few studies have focused on deciphering the immunomodulatory features of metastatic UM microenvironment, and there are no prognostic models for clinical use. This highlights the urgent need to understand the delicate interplay between tumor and immune cells acting at the site of metastasis. METHODS We collected a patient cohort comprising 21 metastatic UM patients. Hepatic and extra-hepatic UM metastasis samples were studied by multiplex immunofluorescence to assess the tumor immune cell composition. Quantitative analyses were performed to correlate immune cell densities with treatment response, metastasis site and patient survival. RESULTS Compared to patients with progressive disease, those with controlled disease had a higher intra-tumoral/peritumoral ratio of CD8 + Granzyme B+ cells, higher density of intra-tumoral CD8+ cytotoxic T lymphocytes (CTL) and an increased percentage of UM cells in close proximity to T lymphocytes, reflecting a role of tumor-killing T cells in the disease. In liver metastases (LM), the intra-tumoral densities of CD163+ tumor-associated macrophages (TAM) and of total CD8+ T cells were higher than in extra-hepatic UM metastases, but the percentage of Granzyme B+ CTL was lower. Moreover, LM displayed more UM cells adjacent to both CTL and TAM, and also more T cells in proximity to TAM, all signs of an impaired immune response. The percentage of activated CTL within the tumor represented a prognostic indicator, as patients with a higher intra-tumoral percentage of CD8 + Granzyme B+ cells had the better outcome. A temptative Immunoscore was generated and proved capable to stratify patients with improved survival. Finally, CD4 + FoxP3+ T cells appeared a crucial population for response to immunotherapy. CONCLUSION The results of this study underly the clinical relevance and functional importance of composition and localization of antitumor effector cells for the progression of UM metastasis.
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Affiliation(s)
- Anna Tosi
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Rocco Cappellesso
- Pathological Anatomy Unit, Padova University Hospital, Padova, Italy
| | - Angelo Paolo Dei Tos
- Pathological Anatomy Unit, Padova University Hospital, Padova, Italy
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padova, Padova, Italy
| | - Valentina Rossi
- Immunology and Molecular Oncology Diagnostics, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128, Padova, Italy
| | - Camillo Aliberti
- Departement of Diagnostic & Interventive Radiology-Pederzoli Hospital, Peschiera, VR, Italy
| | - Jacopo Pigozzo
- Melanoma Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Alessio Fabozzi
- Department of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Marta Sbaraglia
- Pathological Anatomy Unit, Padova University Hospital, Padova, Italy
| | - Stella Blandamura
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padova, Padova, Italy
| | - Paola Del Bianco
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | | | - Antonio Rosato
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
- Immunology and Molecular Oncology Diagnostics, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35128, Padova, Italy.
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12
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Tang HKC, Peters C, Rao A, Patel P, Bryant A. Immunotherapy for intracranial metastatic melanoma. Hippokratia 2021. [DOI: 10.1002/14651858.cd014588] [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]
Affiliation(s)
| | - Christina Peters
- General Internal Medicine; Chesterfield Royal Hospital; Derbyshire UK
| | - Ankit Rao
- Oncology; Nottingham City Hospital; Nottingham UK
| | - Poulam Patel
- Oncology; Nottingham City Hospital; Nottingham UK
| | - Andrew Bryant
- Institute of Health & Society; Newcastle University; Newcastle upon Tyne UK
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13
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Garg G, Finger PT, Kivelä TT, Simpson ER, Gallie BL, Saakyan S, Amiryan AG, Valskiy V, Chin KJ, Semenova E, Seregard S, Filì M, Wilson M, Haik B, Caminal JM, Catala-Mora J, Gutiérrez C, Pelayes DE, Folgar AM, Jager MJ, Doğrusöz M, Luyten GPM, Singh AD, Suzuki S. Patients presenting with metastases: stage IV uveal melanoma, an international study. Br J Ophthalmol 2021; 106:510-517. [PMID: 33452185 PMCID: PMC8961763 DOI: 10.1136/bjophthalmol-2020-317949] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To analyse ocular and systemic findings of patients presenting with systemic metastasis. METHODS AND ANALYSIS It is an international, multicentre, internet-enabled, registry-based retrospective data analysis. Patients were diagnosed between 2001 and 2011. Data included: primary tumour dimensions, extrascleral extension, ciliary body involvement, American Joint Committee on Cancer (AJCC)-tumour, node, metastasis staging, characteristics of metastases. RESULTS Of 3610 patients with uveal melanoma, 69 (1.9%; 95% CI 1.5 to 2.4) presented with clinical metastasis (stage IV). These melanomas originated in the iris, ciliary body and choroid in 4%, 16% and 80% of eyes, respectively. Using eighth edition AJCC, 8 (11%), 20 (29%), 24 (35%), and 17 (25%) belonged to AJCC T-categories T1-T4. Risk of synchronous metastases increased from 0.7% (T1) to 1.5% (T2), 2.6% (T3) and 7.9% (T4). Regional lymph node metastases (N1a) were detected in 9 (13%) patients of whom 6 (67%) had extrascleral extension. Stage of systemic metastases (known for 40 (59%) stage IV patients) revealed 14 (35%), 25 (63%) and 1 (2%) had small (M1a), medium-sized (M1b) and large-sized (M1c) metastases, respectively. Location of metastases in stage IV patients were liver (91%), lung (16%), bone (9%), brain (6%), subcutaneous tissue (4%) and others (5%). Multiple sites of metastases were noted in 24%. Compared with the 98.1% of patients who did not present with metastases, those with synchronous metastases had larger intraocular tumours, more frequent extrascleral extension, ciliary body involvement and thus a higher AJCC T-category. CONCLUSIONS Though higher AJCC T-stage was associated with risk for metastases at diagnosis, even small T1 tumours were stage IV at initial presentation. The liver was the most common site of metastases; however, frequent multiorgan involvement supports initial whole-body staging.
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Affiliation(s)
- Gaurav Garg
- Department of Ocular Tumor, Orbital Disease, Ophthalmic Radiation Therapy, New York Eye Cancer Center, New York, New York, USA
| | - Paul T Finger
- Department of Ocular Tumor, Orbital Disease, Ophthalmic Radiation Therapy, New York Eye Cancer Center, New York, New York, USA
| | - Tero T Kivelä
- Ocular Oncology Service, Helsinki University Central Hospital, Helsinki, Finland
| | - E Rand Simpson
- Department of Ocular Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Brenda L Gallie
- Departments of Molecular Medical Genetics, Medical Biophysics, and Ophthalmology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Svetlana Saakyan
- Department of Ophthalmic Oncology and Radiology, Moscow Helmholtz Research Institute of Eye Diseases, Moskva, Russian Federation
| | - Anush G Amiryan
- Department of Ophthalmic Oncology and Radiology, Moscow Helmholtz Research Institute of Eye Diseases, Moskva, Russian Federation
| | - Vladimir Valskiy
- Department of Ophthalmic Oncology and Radiology, Moscow Helmholtz Research Institute of Eye Diseases, Moskva, Russian Federation
| | - Kimberly J Chin
- Department of Ocular Tumor, Orbital Disease, Ophthalmic Radiation Therapy, New York Eye Cancer Center, New York, New York, USA
| | - Ekaterina Semenova
- Department of Ocular Tumor, Orbital Disease, Ophthalmic Radiation Therapy, New York Eye Cancer Center, New York, New York, USA
| | - Stefan Seregard
- Department of Ophthalmic Pathology and Oncology, Saint Eriks Eye Hospital, Stockholm, Sweden
| | - Maria Filì
- Department of Ophthalmic Pathology and Oncology, Saint Eriks Eye Hospital, Stockholm, Sweden
| | - Matthew Wilson
- The Ophthalmic Oncology Service, Hamilton Eye Institute, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Barrett Haik
- The Ophthalmic Oncology Service, Hamilton Eye Institute, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Josep Maria Caminal
- Ocular Oncology Service, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jaume Catala-Mora
- Ocular Oncology Service, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Gutiérrez
- Ocular Oncology Service, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - David E Pelayes
- Department of Ophthalmic Oncology, Hospital General de Agudos Carlos G Durand, Buenos Aires, Argentina
| | - Anibal Martin Folgar
- Department of Ophthalmic Oncology, Hospital General de Agudos Carlos G Durand, Buenos Aires, Argentina
| | - Martine Johanna Jager
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mehmet Doğrusöz
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gregorius P M Luyten
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arun D Singh
- Department of Ophthalmic Oncology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Shigenobu Suzuki
- Department of Ophthalmic Oncology, National Cancer Center Hospital, Tokyo, Japan
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14
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Role of Natural Killer Cells in Uveal Melanoma. Cancers (Basel) 2020; 12:cancers12123694. [PMID: 33317028 PMCID: PMC7764114 DOI: 10.3390/cancers12123694] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 12/16/2022] Open
Abstract
Simple Summary Metastatic Uveal Melanoma (MUM) is a lethal malignancy with no durable treatment available to date. A vast majority of patients with MUM present with liver metastasis. The liver harbors metastatic disease with an apparent lack of a cytotoxic T cell response. It is becoming evident that MUM is not an immunologically silent malignancy and the investigation of non-T cell anti-tumor immunity is warranted. In this review, we highlight the relevance of Natural Killer (NK) cells in the biology and treatment of MUM. Potent anti-NK cell immunosuppression employed by uveal melanoma alludes to its vulnerability to NK cell cytotoxicity. On the contrary, micro-metastasis in the liver survive for several years within close vicinity of a plethora of circulating and liver-resident NK cells. This review provides unique perspectives into the potential role of NK cells in control or progression of uveal melanoma. Abstract Uveal melanoma has a high mortality rate following metastasis to the liver. Despite advances in systemic immune therapy, treatment of metastatic uveal melanoma (MUM) has failed to achieve long term durable responses. Barriers to success with immune therapy include the immune regulatory nature of uveal melanoma as well as the immune tolerant environment of the liver. To adequately harness the anti-tumor potential of the immune system, non-T cell-based approaches need to be explored. Natural Killer (NK) cells possess potent ability to target tumor cells via innate and adaptive responses. In this review, we discuss evidence that highlights the role of NK cell surveillance and targeting of uveal melanoma. We also discuss the repertoire of intra-hepatic NK cells. The human liver has a vast and diverse lymphoid population and NK cells comprise 50% of the hepatic lymphocytes. Hepatic NK cells share a common niche with uveal melanoma micro-metastasis within the liver sinusoids. It is, therefore, crucial to understand and investigate the role of intra-hepatic NK cells in the control or progression of MUM.
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15
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Marvin DL, Heijboer R, ten Dijke P, Ritsma L. TGF-β signaling in liver metastasis. Clin Transl Med 2020; 10:e160. [PMID: 33252863 PMCID: PMC7701955 DOI: 10.1002/ctm2.160] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 12/12/2022] Open
Abstract
The presence of liver metastases drastically worsens the prognosis of cancer patients. The liver is the second most prevalent metastatic site in cancer patients, but systemic therapeutic opportunities that target liver metastases are still limited. To aid the discovery of novel treatment options for metastatic liver disease, we provide insight into the cellular and molecular steps required for liver colonization. For successful colonization in the liver, adaptation of tumor cells and surrounding stroma is essential. This includes the formation of a pre-metastatic niche, the creation of a fibrotic and immune suppressive environment, angiogenesis, and adaptation of tumor cells. We illustrate that transforming growth factor β (TGF-β) is a central cytokine in all these processes. At last, we devise that future research should focus on TGF-β inhibitory strategies, especially in combination with immunotherapy. This promising systemic treatment strategy has potential to eliminate distant metastases as the efficacy of immunotherapy will be enhanced.
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Affiliation(s)
- Dieuwke L Marvin
- Department of Cell and Chemical Biology and Oncode InstituteLeiden University Medical CenterLeidenThe Netherlands
| | - Rosan Heijboer
- Department of Cell and Chemical Biology and Oncode InstituteLeiden University Medical CenterLeidenThe Netherlands
| | - Peter ten Dijke
- Department of Cell and Chemical Biology and Oncode InstituteLeiden University Medical CenterLeidenThe Netherlands
| | - Laila Ritsma
- Department of Cell and Chemical Biology and Oncode InstituteLeiden University Medical CenterLeidenThe Netherlands
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16
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Jamison A, Connolly J, Cauchi P, Thum C, Chadha V. Multifocal Intraretinal Tumour Deposits following Treatment of an Ipsilateral Choroidal Melanoma. Ocul Oncol Pathol 2020; 6:410-415. [PMID: 33442549 DOI: 10.1159/000510575] [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: 01/03/2020] [Accepted: 07/02/2020] [Indexed: 11/19/2022] Open
Abstract
Background/Aims The aim of this study was to report a patient who, following plaque brachytherapy for a choroidal melanoma, developed two separate retinal foci of malignant melanoma in the same eye, and suggest possible mechanisms that might explain such an occurrence. Methods We conducted a retrospective case report. Results A 79-year-old Caucasian male developed a left inferotemporal choroidal melanoma in 2016 and subsequently underwent ruthenium-106 plaque brachytherapy under the care of the Scottish Ocular Oncology Service. Serial B-scan ultrasonography demonstrated a post-treatment reduction in tumour height to <2 mm. In 2018, 27 months after the treatment, the patient complained of a "black spot" in the centre of his left eye vision. His visual acuity had reduced to counting fingers from 6/24 (corrected Snellen visual acuity). Several new areas of pigmentation and elevation were observed, and uveal melanoma recurrence was initially suspected. Given the multifocal nature of the presentation, the multi-disciplinary team recommended enucleation. Histological examination of the enucleated eye revealed three discrete foci of malignant melanoma - the previously treated choroidal malignant melanoma, and two solitary deposits of malignant melanoma within the retina. Conclusion Retinoinvasive melanoma is a rare subtype of uveal melanoma, characterised by transvitreal melanoma invasion of the retina at a site non-contiguous with the uveal tumour, which may explain the clinical and pathological findings of the reported case.
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Affiliation(s)
- Aaron Jamison
- Scottish Ocular Oncology Service, Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, United Kingdom
| | - Julie Connolly
- Scottish Ocular Oncology Service, Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, United Kingdom
| | - Paul Cauchi
- Scottish Ocular Oncology Service, Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, United Kingdom
| | - Chee Thum
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Vikas Chadha
- Scottish Ocular Oncology Service, Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, United Kingdom
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17
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Bol KF, Donia M, Heegaard S, Kiilgaard JF, Svane IM. Genetic Biomarkers in Melanoma of the Ocular Region: What the Medical Oncologist Should Know. Int J Mol Sci 2020; 21:ijms21155231. [PMID: 32718045 PMCID: PMC7432371 DOI: 10.3390/ijms21155231] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 12/14/2022] Open
Abstract
Melanoma of the ocular region (ocular melanoma) comprises about 5% of all patients with melanoma and covers posterior uveal melanoma, iris melanoma, and conjunctival melanoma. The risk of metastasis is much higher in patients with ocular melanoma compared to a primary melanoma of the skin. The subtypes of ocular melanoma have distinct genetic features, which should be taken into consideration when making clinical decisions. Most relevant for current practice is the absence of BRAF mutations in posterior uveal melanoma, although present in some iris melanomas and conjunctival melanomas. In this review, we discuss the genetic biomarkers of the subtypes of ocular melanoma and their impacts on the clinical care of these patients.
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Affiliation(s)
- Kalijn Fredrike Bol
- National Center for Cancer Immune Therapy, Department of Oncology, Herlev Hospital, Copenhagen University Hospital, 2730 Herlev, Denmark; (K.F.B.); (M.D.)
| | - Marco Donia
- National Center for Cancer Immune Therapy, Department of Oncology, Herlev Hospital, Copenhagen University Hospital, 2730 Herlev, Denmark; (K.F.B.); (M.D.)
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (S.H.); (J.F.K.)
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Jens Folke Kiilgaard
- Department of Ophthalmology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (S.H.); (J.F.K.)
| | - Inge Marie Svane
- National Center for Cancer Immune Therapy, Department of Oncology, Herlev Hospital, Copenhagen University Hospital, 2730 Herlev, Denmark; (K.F.B.); (M.D.)
- Correspondence: ; Tel.: +45-3868-9339
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18
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Sharma A, Mishra DK, Kaliki S. Optic nerve invasion of non-juxtapapillary uveal melanoma: a rare occurrence. BMJ Case Rep 2020; 13:13/6/e234610. [PMID: 32595132 DOI: 10.1136/bcr-2020-234610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 44-year-old man presented with complaints of pain and discomfort in his left eye (OS). On examination, he had bare perception of light in OS and had a diffuse pigmented mass lesion in the nasal quadrant of the bulbar conjunctiva, associated with neovascularisation of the iris and iridocyclitis, with no fundus view. Intraocular pressure OS was 40 mm Hg. B-scan ultrasonography OS revealed an intraocular mass with thickened sclerochoroidal complex. A clinical diagnosis of OS ciliochoroidal melanoma with extraocular extension was made. He underwent OS extended enucleation with implant. Histopathological examination confirmed the diagnosis of ciliochoroidal melanoma with tumour extension into the optic nerve posteriorly and the extrascleral tissues anteriorly. There was no evidence of systemic metastasis. Even in a case of non-juxtapapillary uveal melanoma, poor vision and high intraocular pressure are clinical indicators of optic nerve tumour invasion.
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Affiliation(s)
- Abhimanyu Sharma
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India
| | - Dilip K Mishra
- Ophthalmic Pathology Service, LV Prasad Eye Institute, Hyderabad, India
| | - Swathi Kaliki
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India
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19
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Ramasamy P, Larkin AM, Linge A, Tiernan D, McAree F, Horgan N, Moriarty P, Beatty S, Murphy CC, Clynes M, Kennedy S, Meleady P. PRDX3 is associated with metastasis and poor survival in uveal melanoma. J Clin Pathol 2019; 73:408-412. [PMID: 31771972 DOI: 10.1136/jclinpath-2019-206173] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 10/25/2019] [Accepted: 11/08/2019] [Indexed: 01/31/2023]
Abstract
AIMS Uveal melanoma (UM) is the most common primary intraocular malignancy in adults, and 40% develop fatal metastatic disease. Overexpression of thioredoxin-dependent peroxidase reductase (PRDX3) has been implicated in several cancers, including prostate, breast, colorectal and lung cancer. The aim of this study was to compare the immunohistochemical expression of PRDX3 in formalin-fixed, paraffin-embedded (FFPE) primary UM tissues of patients who did and did not develop metastatic disease. METHODS Immunohistochemical staining of PRDX3 was performed on FFPE tissue microarray samples of 92 primary UM tumours from patients who did and did not develop metastatic disease. The immunohistochemical staining was assessed by two observers who were blinded to all clinicopathological and cytogenetic details including metastatic/non-metastatic information. Based on a scoring system, expression of PRDX3 was graded as high or low. RESULTS There were 55 tumours (59.8%) from patients who developed metastatic disease, while 37 (40.2%) were from patients who did not develop metastasis. A statistically significant difference in PRDX3 expression was observed in patients who did and did not develop metastasis (p=0.001). A significant positive correlation between high PRDX3 expression and metastasis was observed (p=0.001). A significant negative correlation between PRDX3 expression and survival was found (p=0.005). Kaplan-Meier survival analysis showed a statistically significant difference in overall survival between tumours that demonstrated low and high expression of PRDX3 (67.61 vs 130.64 months, respectively, p=0.013). CONCLUSIONS High immunohistochemical expression of PRDX3 in primary UM tissue is associated with metastasis and poor survival.
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Affiliation(s)
- Pathma Ramasamy
- Department of Ophthalmology, Royal College of Surgeons in Ireland, Dublin, Ireland .,National Institute for Cellular Biotechnology, Dublin, Ireland.,Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Anne-Marie Larkin
- National Institute for Cellular Biotechnology, Dublin, Ireland.,Department of Life Sciences, Institute of Technology Sligo, Sligo, Ireland
| | - Annett Linge
- National Institute for Cellular Biotechnology, Dublin, Ireland
| | | | | | - Noel Horgan
- Royal Victoria Eye and Ear Hospital, Dublins, Ireland
| | - Paul Moriarty
- Royal Victoria Eye and Ear Hospital, Dublins, Ireland
| | | | - Conor C Murphy
- Department of Ophthalmology, Royal College of Surgeons in Ireland, Dublin, Ireland.,Royal Victoria Eye and Ear Hospital, Dublins, Ireland
| | - Martin Clynes
- National Institute for Cellular Biotechnology, Dublin, Ireland.,Synthesis and Solid State Pharmaceutical Centre, Science Foundation Ireland, Dublin, Ireland
| | - Susan Kennedy
- Histopathology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Paula Meleady
- National Institute for Cellular Biotechnology, Dublin, Ireland
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20
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Reznitsky F, Klausen S, Donia M, Scheie D. Rare cause of spontaneous haemothorax: mediastinal and distant lymph node metastases from uveal melanoma. BMJ Case Rep 2019; 12:12/11/e231534. [PMID: 31753826 DOI: 10.1136/bcr-2019-231534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a rare case of isolated mediastinal and inferior mediastinal lymph node metastases from choroidal melanoma. The patient was treated for primary choroidal melanoma with local tumour resection and radioactive plaque brachytherapy. Eleven years later, he was diagnosed with metastatic disease. Molecular analysis of the metastatic tumour demonstrated a GNAQ Q209P mutation. There was no evidence of malignant blue naevus or primary melanoma of the central nervous system on physical examination or imaging. The rare modality of clinical presentation highlights the unpredictable nature of metastatic uveal melanoma.
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Affiliation(s)
| | - Siri Klausen
- Department of Pathology, Herlev Hospital, Herlev, Denmark
| | - Marco Donia
- Department of Oncology, Herlev Hospital, Herlev, Denmark
| | - David Scheie
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark
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21
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Zhang H, Xie T, Shui Y, Qi Y. Knockdown of PLCB2 expression reduces melanoma cell viability and promotes melanoma cell apoptosis by altering Ras/Raf/MAPK signals. Mol Med Rep 2019; 21:420-428. [PMID: 31746389 DOI: 10.3892/mmr.2019.10798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/29/2019] [Indexed: 11/05/2022] Open
Abstract
Malignant melanoma has the highest malignancy rate among all skin cancer and is characterized by an insidious onset, high invasion and poor patient prognosis. Yet, the mechanisms involved remain unclear and warrant further investigation. Based on bioinformatic analysis, phospholipase C β2 (PLCB2) has been found to be correlated with melanoma growth. The present study was the first to demonstrate that PLCB2 is a key factor affecting melanoma proliferation and apoptosis. Here, microarray datasets from the publicly available Gene Expression Omnibus (GEO) database were employed, and gene set enrichment analysis (GSEA) was introduced to identify candidate transcription factors. PLCB2 was identified as a crucial gene in the protein‑protein interaction (PPI) network. The expression of PLCB2 mRNA in various cancer lines was analyzed by reverse transcription‑polymerase chain reaction (RT‑PCR). In addition, the proliferation ability and apoptosis rate in human melanoma cells overexpressing or not overexpressing PLCB2 were assessed using colony formation assay, flow cytometry and the Cell Counting Kit‑8 (CCK‑8) assay. Cell viability and apoptosis‑related factors, such as p53, Bcl‑2, Bax and caspase‑3 were significantly regulated. Knockdown of PLCB2 suppressed the activation of the Ras/Raf/MAPK signaling pathway. In conclusion, knockdown of PLCB2 suppressed cell viability and promoted cell apoptosis by activating the Ras/Raf/MAPK pathway. Thus, PLCB2 may utilized as a potential therapeutic target in patients with melanoma.
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Affiliation(s)
- Huahui Zhang
- Department of Plastic Surgery, Zhejiang Hospital, Hangzhou, Zhejiang 310007, P.R. China
| | - Tao Xie
- Department of Orthopedics, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China
| | - Yongjie Shui
- Department of Radiotherapy, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Yiying Qi
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
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22
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Differential expression of p52 and RelB proteins in the metastatic and non-metastatic groups of uveal melanoma with patient outcome. J Cancer Res Clin Oncol 2019; 145:2969-2982. [PMID: 31612319 DOI: 10.1007/s00432-019-03052-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/04/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Non-canonical NFκB (NC-NFκB) pathway plays an influential role in metastasis, which promotes cancer proliferation and progression. The aim of the study was to examine the expression of NC-NFκB proteins and their correlation with clinicopathological factors associated with metastatic cases of uveal melanoma (UM) and with the patient outcome. METHOD Expression of NC-NFκB proteins (p52, RelB, and co-expression of p52/RelB) was evaluated in 75 formalin-fixed cases of uveal melanoma by immunohistochemistry. Validation of nuclear immunoreactivity was done by western blotting. Transcriptional status of NC-NFκB genes was assessed in 60 fresh tumor tissues by quantitative real-time PCR. Co-immunoprecipitation was performed to determine the presence of native p52/RelB heterodimer in UM. Prognostic relevance was determined using Cox proportional hazard and Kaplan-Meier methods. RESULTS Immunohistochemical expression of p52, RelB, and their co-expression was observed in 81%, 68.7%, 56.2% of metastatic cases, respectively, while their expression was seen only in 38%, 33% and 30% of non-metastatic cases. Loss of BAP-1 was correlated with expression of p52 and RelB proteins. Co-immunoprecipitation assay confirmed the putative interaction of p52 with RelB protein in metastatic cases of uveal melanoma. Co-expression of p52/RelB and expression of p52 protein was significantly correlated with decreased metastasis-free survival (MFS) (p = 0.004; p = 0.002) and overall survival (OS) (p = 0.004; p = 0.032), while the RelB expression only correlated with reduced MFS (p = 0.003). CONCLUSION Our data showed that non-canonical NFκB proteins were significantly higher in metastatic cases and associated with poor outcome of the patients. Furthermore, the p52 protein could be used as a potential therapeutic biomarker for metastatic cases in uveal melanoma.
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23
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García Tirado A, Asencio Durán M, Berjón A, Ruiz Bravo-Burguillos E, Peralta Calvo J. Clinical and histopathological features of choroidal melanoma-related enucleated eyes in a Spanish tertiary hospital. ACTA ACUST UNITED AC 2019; 94:225-231. [PMID: 30904338 DOI: 10.1016/j.oftal.2018.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To study clinical and pathological variables leading to a poor prognosis in a sample of uveal malignant melanoma patients who required eyeball enucleation as final treatment approach. All patients were seen and treated in the same public tertiary hospital in Madrid (Spain) within a 6-year time-period. MATERIALS AND METHODS Longitudinal observational retrospective study. The presence of clinical and pathologic factors known to be linked to poor prognosis, as well as other features, was assessed in 30 malignant melanoma: 20 de novo-enucleated malignant melanoma eyes (group A), and 10 in eyes that received radiotherapy prior to enucleation (group B). The diagnostic reliability of magnetic resonance imaging was assessed by comparing it with the histology results (gold standard) as a means to detect scleral and extra-scleral extension. RESULTS Tumour size, Bruch's membrane rupture, scleral infiltration, and distance to the optic nerve were the most decisive factors for a poor prognosis in the study sample. In 93% of cases the condition was under control, with a 6% incidence rate of metastatic spread and a 100% rate of overall survival for a mean follow-up period of 3±1.5 (range 1.2-6) years. In the study population, the sensitivity of the magnetic resonance imaging to detect scleral infiltration was 27%, which increased to 100% for identifying extra-scleral involvement. CONCLUSIONS The analyses of the clinical and pathological data collected within the framework of this study justify enucleation as the treatment of choice for the patients of this study. Magnetic resonance imaging was not found to be an optimum screening method to detect scleral infiltration in this study sample.
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Affiliation(s)
- A García Tirado
- Servicio de Oftalmología, Hospital Universitario La Paz, IdiPaz, Madrid, España.
| | - M Asencio Durán
- Servicio de Oftalmología, Hospital Universitario La Paz, IdiPaz, Madrid, España
| | - A Berjón
- Servicio de Anatomía Patológica, Hospital Universitario La Paz, Madrid, España
| | | | - J Peralta Calvo
- Servicio de Oftalmología, Hospital Universitario La Paz, IdiPaz, Madrid, España
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24
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Lorenzo D, Piulats JM, Ochoa M, Arias L, Gutiérrez C, Català J, Cobos E, Garcia-Bru P, Dias B, Padrón-Pérez N, Caminal JM. Clinical predictors of survival in metastatic uveal melanoma. Jpn J Ophthalmol 2019; 63:197-209. [PMID: 30796549 DOI: 10.1007/s10384-019-00656-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 12/25/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE To determine the clinical factors that influence survival in patients with metastatic uveal melanoma. STUDY DESIGN Single-center, retrospective review of patients' medical records. METHODS The following data of ninety-nine consecutive patients (49 men, 50 women) with metastatic uveal melanoma were registered: patient demographics; primary tumor characteristics; features of first melanoma-related metastasis; symptoms and patient status at distant disease debut and metastasis treatment. Overall survival was analyzed by Kaplan-Meier estimates. A Cox proportional hazards regression model was applied to identify independent predictors associated with survival. RESULTS Mean patient age at metastatic diagnosis was 60.7 years (standard deviation, 12.8). The liver was the first metastatic site in most (92.9%) cases. The median disease-free interval was 26 months (interquartile range, 34). Median overall survival after detection of the first metastasis was 8 months (interquartile range, 14). The baseline characteristics of the primary uveal melanoma were not associated with survival in patients with stage IV disease. In the multivariate analysis, the following factors at first metastatic diagnosis were associated with improved overall survival: disease-free interval > 36 months; better performance status; and normal serum lactate dehydrogenase and gamma glutamyl transpeptidase levels. Overall survival was not influenced by specific metastatic treatment. CONCLUSION Although metastatic uveal melanoma has a poor prognosis, this study reveals the existence of several independent prognostic factors for prolonged overall survival. These findings may help improve survival estimates in patients with advanced disease.
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Affiliation(s)
- Daniel Lorenzo
- Department of Ophthalmology, Bellvitge University Hospital, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | | | - María Ochoa
- Department of Oncology, Catalan Institute of Oncology, Barcelona, Spain
| | - Luis Arias
- Department of Ophthalmology, Bellvitge University Hospital, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Gutiérrez
- Department of Brachytherapy, Catalan Institute of Oncology, Barcelona, Spain
| | - Jaume Català
- Department of Ophthalmology, Bellvitge University Hospital, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Estefanía Cobos
- Department of Ophthalmology, Bellvitge University Hospital, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pere Garcia-Bru
- Department of Ophthalmology, Bellvitge University Hospital, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Bruno Dias
- Department of Ophthalmology, Bellvitge University Hospital, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Noel Padrón-Pérez
- Department of Ophthalmology, Bellvitge University Hospital, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Maria Caminal
- Department of Ophthalmology, Bellvitge University Hospital, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
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25
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Ewens KG, Lalonde E, Richards-Yutz J, Shields CL, Ganguly A. Comparison of Germline versus Somatic BAP1 Mutations for Risk of Metastasis in Uveal Melanoma. BMC Cancer 2018; 18:1172. [PMID: 30477459 PMCID: PMC6260582 DOI: 10.1186/s12885-018-5079-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 11/12/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Germline mutations in BAP1 have been associated with BAP1-Tumor Predisposition Syndrome (BAP1-TPDS), a predisposition to multiple tumors within a family that includes uveal melanoma (UM), cutaneous melanoma, malignant mesothelioma and renal cell carcinoma. Alternatively, somatic mutations in BAP1 in UM have been associated with high risk for metastasis. In this study, we compare the risk of metastasis in UM that carry germline versus somatic BAP1 mutations and mutation-negative tumors. METHODS DNA extracted from 142 UM and matched blood samples was sequenced using Sanger or next generation sequencing to identify BAP1 gene mutations. RESULTS Eleven of 142 UM (8%) carried germline BAP1 mutations, 43 (30%) had somatic mutations, and 88 (62%) were mutation-negative. All BAP1 mutations identified in blood samples were also present in the matched UM. There were 52 unique mutations in 54 tumors. All were pathogenic or likely pathogenic. A comparison of tumors carrying somatic vs. germline mutations, or no mutations, showed a higher frequency of metastasis in tumors carrying somatic mutations: 74% vs. 36%, P=0.03 and 74% vs. 26% P<0.001, respectively. Tumors with a somatic mutation compared to mutation-negative had an older age of diagnosis of (61.8 vs. 52.2 years, P=0.002), and shorter time to metastasis (16 vs. 26 months, P=0.04). Kaplan-Meier analysis further showed that tumors with somatic (vs. germline) mutations demonstrated a greater metastatic risk (P=0.03). Cox multivariate analysis showed in addition to chromosome-3 monosomy and larger tumor diameter, the presence of BAP1 somatic, but not germline mutations, was significantly associated with risk of metastasis(P=0.02). Personal or family history of BAP1-TPDS was available for 79 of the cases. All eight cases with germline mutations reported a history of BAP1-TPDS, which was significantly greater than what was observed in cases with somatic mutations (10 of 23, P=0.009) or mutation-negative cases (11 of 48, P<0.001). CONCLUSIONS Defining germline vs. somatic nature of BAP1 mutations in UM can inform the individual about both the risk of metastasis, and the time to metastasis, which are critically important outcomes for the individual. This information can also change the cascade screening and surveillance of family members.
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Affiliation(s)
- K. G. Ewens
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, 415 Curie Blvd, Philadelphia, Pennsylvania 19104-6145 United States
| | - E. Lalonde
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, 415 Curie Blvd, Philadelphia, Pennsylvania 19104-6145 United States
| | - J. Richards-Yutz
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, 415 Curie Blvd, Philadelphia, Pennsylvania 19104-6145 United States
| | - C. L. Shields
- Oncology Services, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut St, Suite #1440, Philadelphia, Pennsylvania 19107 United States
| | - A. Ganguly
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, 415 Curie Blvd, Philadelphia, Pennsylvania 19104-6145 United States
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26
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Patrone S, Maric I, Rutigliani M, Lanza F, Puntoni M, Banelli B, Rancati S, Angelini G, Amaro A, Ligorio P, Defferrari C, Castagnetta M, Bandelloni R, Mosci C, DeCensi A, Romani M, Pfeffer U, Viaggi S, Coviello DA. Prognostic value of chromosomal imbalances, gene mutations, and BAP1 expression in uveal melanoma. Genes Chromosomes Cancer 2018; 57:387-400. [PMID: 29689622 DOI: 10.1002/gcc.22541] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/06/2018] [Accepted: 04/09/2018] [Indexed: 12/27/2022] Open
Abstract
Uveal melanoma (UM) exhibits recurring chromosomal abnormalities and gene driver mutations, which are related to tumor evolution/progression. Almost half of the patients with UM develop distant metastases, predominantly to the liver, and so far there are no effective adjuvant therapies. An accurate UM genetic profile could assess the individual patient's metastatic risk, and provide the basis to determine an individualized targeted therapeutic strategy for each UM patient. To investigate the presence of specific chromosomal and gene alterations, BAP1 protein expression, and their relationship with distant progression free survival (DPFS), we analyzed tumor samples from 63 UM patients (40 men and 23 women, with a median age of 64 years), who underwent eye enucleation by a single cancer ophthalmologist from December 2005 to June 2016. UM samples were screened for the presence of losses/gains in chromosomes 1p, 3, 6p, and 8q, and for mutations in GNAQ, GNA11, BAP1, SF3B1, and EIF1AX. BAP1 protein expression was detected by immunohistochemistry (IHC). Multivariate analysis showed that the presence of monosomy 3, 8q gain, and loss of BAP1 protein were significantly associated to DPFS, while BAP1 gene mutation was not, mainly due to the presence of metastatic UM cases with negative BAP1 IHC and no BAP1 mutation detected by Sanger sequencing. Loss of BAP1 protein expression and monosomy 3 represent the strongest predictors of metastases, and may have important implications for implementation of patient surveillance, properly designed clinical trials enrollment, and adjuvant therapy.
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Affiliation(s)
- Serena Patrone
- Department of Internal Medicine (DIMI), University of Genoa, Genova, Italy
| | - Irena Maric
- Department of Earth Sciences, Environment, and Life (DISTAV), University of Genoa, Genova, Italy.,Department of Biotherapy, Ospedale Policlinico San Martino, Genova, Italy
| | | | - Francesco Lanza
- Department of Ocular Oncology Unit, E.O. Ospedali Galliera, Genova, Italy
| | - Matteo Puntoni
- Department of Clinical Trial Unit/Scientific Direction, E.O. Ospedali Galliera, Genova, Italy
| | - Barbara Banelli
- Department of Tumor Epigenetics Unit, Ospedale Policlinico San Martino, Genova, Italy.,Department of Health Sciences, University of Genoa, Genova, Italy
| | - Silvia Rancati
- Department of Earth Sciences, Environment, and Life (DISTAV), University of Genoa, Genova, Italy
| | - Giovanna Angelini
- Department of Molecular Pathology Unit, Ospedale Policlinico San Martino, Genova, Italy
| | - Adriana Amaro
- Department of Molecular Pathology Unit, Ospedale Policlinico San Martino, Genova, Italy
| | - Paolo Ligorio
- Department of Ocular Oncology Unit, E.O. Ospedali Galliera, Genova, Italy
| | | | - Mauro Castagnetta
- Department of Human Genetics Laboratory, E.O. Ospedali Galliera, Genova, Italy
| | | | - Carlo Mosci
- Department of Ocular Oncology Unit, E.O. Ospedali Galliera, Genova, Italy
| | - Andrea DeCensi
- Department of Medical Oncology Unit, E.O. Ospedali Galliera, Genova, Italy
| | - Massimo Romani
- Department of Tumor Epigenetics Unit, Ospedale Policlinico San Martino, Genova, Italy
| | - Urlich Pfeffer
- Department of Molecular Pathology Unit, Ospedale Policlinico San Martino, Genova, Italy
| | - Silvia Viaggi
- Department of Earth Sciences, Environment, and Life (DISTAV), University of Genoa, Genova, Italy.,Department of Human Genetics Laboratory, E.O. Ospedali Galliera, Genova, Italy
| | - Domenico A Coviello
- Department of Human Genetics Laboratory, E.O. Ospedali Galliera, Genova, Italy
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27
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Cantore M, Fiorentini G, Aitini E, Davitti B, Cavazzini G, Rabbi C, Lusenti A, Bertani M, Morandi C, Benedini V. Intra-Arterial Hepatic Carboplatin-Based Chemotherapy for Ocular Melanoma Metastatic to the Liver. Report of a Phase II Study. TUMORI JOURNAL 2018; 80:37-9. [PMID: 8191596 DOI: 10.1177/030089169408000107] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background ocular melanoma tends to metastasize to the liver, sparing for a long time the rest of the organism. Therefore, a regional treatment is especially indicated. Methods eight patients with ocular melanoma metastatic to the liver were treated with intraarterial hepatic carboplatin-based chemotherapy at the dose of 300 mg/m2 once every two weeks at an outpatient clinic. All the patients were submitted to laparotomy with surgical implantation of an arterial port device through the gastroduodenal artery. Results the overall response rate was 38% with a median survival time of 15 months. The regimen was well tolerated and the principle toxicity was myelosuppression; any instance of hepatic and/ or cholangitic damage was reported. Conclusions Carboplatin seems suitable for intraarterial hepatic chemotherapy and active in ocular melanoma metastic to the liver.
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Affiliation(s)
- M Cantore
- Oncology Department, Civil Hospital of Mantova, Italy
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28
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Dynamic contrast-enhanced MRI coupled with a subtraction technique is useful for treatment response evaluation of malignant melanoma hepatic metastasis. Oncotarget 2018; 7:38513-38522. [PMID: 27229529 PMCID: PMC5122407 DOI: 10.18632/oncotarget.9567] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/08/2016] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To determine whether contrast-enhanced MRI including subtraction sequences can predict the treatment response of melanoma liver metastasis. RESULTS High precontrast T1 signal intensity (SI) of melanoma lesions obscured detection of enhancement after contrast injection. It was impossible to determine whether or not enhancement occurred in the majority of lesions (85.4%, n = 35/41) without including the subtraction technique. Positive enhancement was identified in 14.6% (n = 6/41) of patients without subtraction images, but increased to 68.3% (n = 28/41) by including subtraction images. Follow-up studies determined lesion progression in 34.1% (n = 14/41) of patients. Positive enhancement on the subtraction image (odds ratio = 12.1, P = 0.048) and intermediate high T2 SI (odds ratio = 8.16, P = 0.040) were significantly associated with higher risk of lesion progression. MATERIALS AND METHODS Patients who underwent MRI for melanoma liver metastases between January 2007 and February 2015 were enrolled. The study analyzed 41 liver metastases in 15 patients [11 male and four female; median age 56 years (range 21-81)] for size, lesion enhancement with and without subtraction images, and T2 SI. Follow-up imaging studies were used to determine treatment response. Data were analyzed with generalized estimating equations. CONCLUSIONS MRI including the subtraction technique is useful for determining the treatment response of melanoma liver metastases. Lesion contrast enhancement and intermediate high T2 SI increased the risk of lesion progression.
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29
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Hirani A, Grover A, Lee YW, Pathak Y, Sutariya V. Nanotechnology for Omics-Based Ocular Drug Delivery. Ophthalmology 2018. [DOI: 10.4018/978-1-5225-5195-9.ch017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Millions of people suffer from ocular diseases that impair vision and can lead to blindness. Advances in genomics and proteomics have revealed a number of different molecular markers specific for different ocular diseases, thereby optimizing the processes of drug development and discovery. Nanotechnology can increase the throughput of data obtained in omics-based studies and allows for more sensitive diagnostic techniques as more efficient drug delivery systems. Biocompatible and biodegradable nanomaterials developed through omics-based research are able to target reported molecular markers for different ocular diseases and offer novel alternatives to conventional drug therapy. In this chapter, the authors review the pathophysiology, current genomic and proteomic information, and current nanomaterial-based therapies of four ocular diseases: glaucoma, uveal melanoma, age-related macular degeneration, and diabetic retinopathy. Omics-based research can be used to elucidate specific genes and proteins and develop novel nanomedicine formulations to prevent, halt, or cure ocular diseases at the transcriptional or translational level.
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Affiliation(s)
- Anjali Hirani
- University of South Florida, USA & Virginia Tech-Wake Forest University, USA
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30
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Dynamic Contrast-Enhanced Magnetic Resonance Imaging of Ocular Melanoma as a Tool to Predict Metastatic Potential. J Comput Assist Tomogr 2017; 41:823-827. [PMID: 28448404 DOI: 10.1097/rct.0000000000000598] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study explores the capability of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to differentiate tumor characteristics of metastatic and nonmetastatic choroidal melanoma as a potential tool for patient management. MATERIALS AND METHODS A total of 13 patients (69 ± 9 years) with choroidal melanoma were imaged using DCE-MRI on a 3-T MRI system with a 16-channel head coil. The Tofts 2-compartment model was chosen for quantification, and parameters K (the transfer constant from the blood plasma to the extracellular space) and Kep (the transfer constant from the extracellular space to the blood plasma) were calculated and compared. Metastasis was excluded by subsequent clinical work-up or confirmed by histology after targeted biopsy. RESULTS Six patients were diagnosed with metastatic melanoma and 7 without. All orbital tumors were at least larger than 2 mm. A significant difference was identified in K between patients with (0.73 ± 0.18/min) and without (1.00 ± 0.21/min) metastatic melanoma (P = 0.03), whereas the difference was not significantly shown in Kep (2.58 ± 1.54/min of metastatic patients vs 2.98 ± 1.83/min of nonmetastatic patients, P = 0.67). CONCLUSIONS Dynamic contrast-enhanced magnetic resonance imaging has the potential to differentiate orbital melanomas with metastatic and nonmetastatic spread. Thus, DCE-MRI has the potential to be an in vivo imaging technique to predict early which patients are prone to metastatic disease.
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31
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Hirani A, Grover A, Lee YW, Pathak Y, Sutariya V. Nanotechnology for Omics-Based Ocular Drug Delivery. Oncology 2017. [DOI: 10.4018/978-1-5225-0549-5.ch013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Millions of people suffer from ocular diseases that impair vision and can lead to blindness. Advances in genomics and proteomics have revealed a number of different molecular markers specific for different ocular diseases, thereby optimizing the processes of drug development and discovery. Nanotechnology can increase the throughput of data obtained in omics-based studies and allows for more sensitive diagnostic techniques as more efficient drug delivery systems. Biocompatible and biodegradable nanomaterials developed through omics-based research are able to target reported molecular markers for different ocular diseases and offer novel alternatives to conventional drug therapy. In this chapter, the authors review the pathophysiology, current genomic and proteomic information, and current nanomaterial-based therapies of four ocular diseases: glaucoma, uveal melanoma, age-related macular degeneration, and diabetic retinopathy. Omics-based research can be used to elucidate specific genes and proteins and develop novel nanomedicine formulations to prevent, halt, or cure ocular diseases at the transcriptional or translational level.
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Affiliation(s)
- Anjali Hirani
- University of South Florida, USA & Virginia Tech-Wake Forest University, USA
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32
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Zhao Y, Wang W, Min I, Wyrwas B, Moore M, Zarnegar R, Fahey TJ. BRAF V600E-dependent role of autophagy in uveal melanoma. J Cancer Res Clin Oncol 2016; 143:447-455. [PMID: 27928645 DOI: 10.1007/s00432-016-2317-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 11/28/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Autophagy can function in a dual role in cancer development and progression: It can be cytoprotective or contribute to cell death. Therefore, determining the contextual role of autophagy between these two opposing effects is important. So far, little is known about the role of autophagy in uveal melanoma. In the present study, we looked to investigate the autophagic process, as well as its effect on cell survival in uveal melanoma cell lines under stressed conditions (starvation). The possible role of autophagy during BRAF inhibition in uveal melanoma was also sought. METHODS Two human uveal melanoma cell lines, OCM1A, which harbors the BRAF mutation V600E and Mel 290, which is BRAF wild type, were studied. Autophagy levels were determined by Western blot assay with/without the addition of autophagic flux inhibitor (bafilomycin A1). Cell proliferation was assessed by an MTT assay. RESULTS Starvation triggered autophagy in BRAF V600E-mutant OCM1A cells but not in BRAF wild-type Mel 290 cells. Enhanced autophagy helped the OCM1A cells survive under stressed conditions. The BRAF inhibitor vemurafenib upregulated autophagy through suppression of the PI3K/Akt/mTOR/p70S6 K pathway in BRAF V600E-mutant uveal melanoma cells. Autophagy inhibition impaired the treatment efficacy of vemurafenib in BRAF V600E-mutant uveal melanoma cells. CONCLUSIONS Our data demonstrate that starvation-trigged autophagy, which is BRAF V600E dependent, promotes cancer cell survival in uveal melanoma. Vemurafenib induces autophagic cell death rather than adaptive cell survival in BRAF V600E-mutant melanoma.
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Affiliation(s)
- Yinu Zhao
- Department of Ophthalmology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.,Department of Surgery, New York Presbyterian Hospital and Weill Medical College of Cornell University, New York, NY, 10021, USA
| | - Weibin Wang
- Department of Surgery, New York Presbyterian Hospital and Weill Medical College of Cornell University, New York, NY, 10021, USA.,Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Irene Min
- Department of Surgery, New York Presbyterian Hospital and Weill Medical College of Cornell University, New York, NY, 10021, USA
| | - Brian Wyrwas
- Department of Surgery, New York Presbyterian Hospital and Weill Medical College of Cornell University, New York, NY, 10021, USA
| | - Maureen Moore
- Department of Surgery, New York Presbyterian Hospital and Weill Medical College of Cornell University, New York, NY, 10021, USA
| | - Rasa Zarnegar
- Department of Surgery, New York Presbyterian Hospital and Weill Medical College of Cornell University, New York, NY, 10021, USA
| | - Thomas J Fahey
- Department of Surgery, New York Presbyterian Hospital and Weill Medical College of Cornell University, New York, NY, 10021, USA.
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Karde SR, Bhand PR, Ramesh N, Arockiam S. Metastatic melanoma after 23 years of primary ocular melanoma. BMJ Case Rep 2016; 2016:bcr-2016-217503. [PMID: 27881589 PMCID: PMC5174817 DOI: 10.1136/bcr-2016-217503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We describe a case of 52-year-old man who presented with an episode of tonic–clonic seizures. He had right ocular melanoma 23 years ago with subsequent enucleation which was the standard treatment at that time. CT scans of the brain and of the thorax-abdomen-pelvis revealed widespread metastatic lesions in the brain, lung and liver. Further investigations including bronchoscopy with cytopathology uncovered that the metastatic disease was a recurrence of ocular melanoma. He received palliative radiotherapy and died 6 months later. Ocular melanoma is often associated with fulminant metastatic disease after a period of dormancy. Thus, despite successful treatment of the localised disease at initial presentation, an effort is needed for optimal long-term follow-up plan in order to improve survival in case of recurrence.
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Affiliation(s)
- Supriya Ramesh Karde
- Department of General Medicine, Midlands Regional Hospital, Portlaoise, Portlaoise, County Laois, Ireland
| | - Prashant Ramesh Bhand
- Department of General Medicine, Midlands Regional Hospital, Portlaoise, Portlaoise, County Laois, Ireland
| | | | - Sacchin Arockiam
- Department of General Medicine, Midlands Regional Hospital, Portlaoise, Portlaoise, County Laois, Ireland
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Kivelä TT, Piperno-Neumann S, Desjardins L, Schmittel A, Bechrakis N, Midena E, Leyvraz S, Zografos L, Grange JD, Ract-Madoux G, Marshall E, Damato B, Eskelin S. Validation of a Prognostic Staging for Metastatic Uveal Melanoma: A Collaborative Study of the European Ophthalmic Oncology Group. Am J Ophthalmol 2016; 168:217-226. [PMID: 27296487 DOI: 10.1016/j.ajo.2016.06.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 02/03/2023]
Abstract
PURPOSE To validate a staging system for metastatic uveal melanoma that will facilitate planning, reporting, and interpreting the results of clinical trials. DESIGN Reliability and validity study. METHODS The performance index, the largest diameter of the largest metastasis and alkaline phosphatase level at the time of diagnosis of metastases, and overall survival of 249 patients from 7 ocular oncology centers who died of dissemination were analyzed. Predicted median survival time calculated according to the Helsinki University Hospital Working Formulation was used to assign patients to stages IVa, IVb, and IVc, which correspond to predicted survival times of ≥12, <12-6, and <6 months, respectively. The predictions were compared against observed survival. RESULTS The 3 variables used to assign stage were independent predictors of survival in the validation dataset. Of the 249 patients, 110 (44%), 109 (44%), and 30 (12%) were classified to Working Formulation stages IVa, IVb, and IVc, respectively. Corresponding median observed survival times were 18.6, 10.7, and 4.6 months and worsened by increasing stage (P < .001). Of 201 patients managed without surgical resection of metastases, 83 (41%), 89 (44%), and 29 (15%) were classified to stages IVa, IVb, and IVc, respectively, and their median observed survival times were 17.2, 10.0, and 4.6 months (P < .001). Survival of 47 patients who underwent resection did not differ by working formulation stage (P = .69). CONCLUSIONS This multicenter study confirms that the Working Formulation is a reliable and valid, repeatable system for dividing metastatic uveal melanoma into distinct prognostic subgroups, especially for stage-specific reporting of survival in prospective clinical trials.
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Affiliation(s)
- Tero T Kivelä
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | | | | | | | | | - Edoardo Midena
- Department of Ophthalmology, University of Padova, Padova, Italy
| | - Serge Leyvraz
- Department of Oncology, University Hospital, Lausanne, Switzerland
| | | | - Jean-Daniel Grange
- Department of Ophthalmology, Croix-Rousse Hospital and Centre Léon Bérard, Lyon, France
| | - Guillaume Ract-Madoux
- Department of Ophthalmology, Croix-Rousse Hospital and Centre Léon Bérard, Lyon, France
| | - Ernest Marshall
- Clatterbridge Centre for Oncology, Bebington, Wirral, Merseyside, United Kingdom
| | - Bertil Damato
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Sebastian Eskelin
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Abstract
Mutation of SF3B1 has been identified in low-grade uveal melanoma with a good prognosis. In this study, we compare chromosomal aberrations and gene mutations between a primary uveal melanoma and its multiple hepatic and peripancreatic metastases. DNA was isolated from a large primary uveal melanoma after fractionated stereotactic radiotherapy and three distinct metastases (two liver samples and one peripancreatic lymph node) to perform single-nucleotide polymorphism array and fluorescent in-situ hybridization. We analyzed mutations in uveal melanoma target genes BAP1, GNAQ, GNA11, SF3B1, and EIF1AX. The primary tumor showed no abnormalities in chromosome 3, whereas metastases showed deletion of at least 3q12.1-q24 and the BAP1 gene was not mutated. All samples indicated the following consistent chromosomal aberrations: loss of 1p, gain of 6p, and gain of 8q. Subsequently, heterozygous SF3B1 and heterozygous GNA11 mutations were observed. The metastases showed more genetic aberrations than the primary tumor and may therefore represent the genetic status of the tumor before irradiation, whereas the current primary tumor shows presumably irradiation artifacts. An early occurring mutation in GNA11 was observed in all samples. The SF3B1 mutation seems to predispose for late metastatic disease in the absence of a BAP1 mutation.
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36
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Choroid Melanoma Metastasis to Spine: A Rare Case Report. Case Rep Ophthalmol Med 2016; 2016:2732105. [PMID: 26989537 PMCID: PMC4775780 DOI: 10.1155/2016/2732105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/02/2016] [Indexed: 11/18/2022] Open
Abstract
Metastatic choroid melanoma is a highly malignant disease with a limited life expectancy. The liver is the most common site for metastasis of uveal melanoma followed by lung, bone, skin, and subcutaneous tissue. Metastasis from choroidal melanoma usually occurs within the first five years of treatment for primary tumours. Metastatic choroid melanoma to the spine/vertebrae is extremely rare. We report the first case of spinal metastasis from choroid melanoma in a 61-year-old man who had been treated for primary ocular melanoma three years earlier with radioactive plaque brachytherapy. Synchronously, at the time of metastasis, he was also diagnosed as having a new primary lung adenocarcinoma as well. The only other case reported on vertebral metastasis from malignant melanoma of choroid in literature in which primary choroid melanoma was enucleated.
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Abstract
Melanoma is a malignancy most commonly arising from the skin; therefore, primary melanoma characteristics are usually the first cutaneous manifestations of melanoma. Cutaneous metastases, which can occur locally or diffusely, are important to detect in a timely manner as treatments for advanced melanoma that impact survival are now available. Melanoma can be associated with local or diffuse pigmentation changes, including depigmentation associated with the leukodermas and hyperpigmentation associated with diffuse melanosis cutis. The leukodermas occur frequently, illustrate the immunogenic nature of melanoma, and may impact prognosis. Paraneoplastic syndromes in association with melanoma are rare, though can occur.
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Affiliation(s)
- Ritva Vyas
- Department of Dermatology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jacqueline Selph
- Department of Dermatology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Meg R Gerstenblith
- Department of Dermatology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
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Nathan P, Cohen V, Coupland S, Curtis K, Damato B, Evans J, Fenwick S, Kirkpatrick L, Li O, Marshall E, McGuirk K, Ottensmeier C, Pearce N, Salvi S, Stedman B, Szlosarek P, Turnbull N. Uveal Melanoma UK National Guidelines. Eur J Cancer 2015; 51:2404-12. [PMID: 26278648 DOI: 10.1016/j.ejca.2015.07.013] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 07/10/2015] [Indexed: 01/09/2023]
Abstract
The United Kingdom (UK) uveal melanoma guideline development group used an evidence based systematic approach (Scottish Intercollegiate Guidelines Network (SIGN)) to make recommendations in key areas of uncertainty in the field including: the use and effectiveness of new technologies for prognostication, the appropriate pathway for the surveillance of patients following treatment for primary uveal melanoma, the use and effectiveness of new technologies in the treatment of hepatic recurrence and the use of systemic treatments. The guidelines were sent for international peer review and have been accredited by NICE. A summary of key recommendations is presented. The full documents are available on the Melanoma Focus website.
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Affiliation(s)
- P Nathan
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK.
| | - V Cohen
- Ocular Oncology Service, St Bartholomew's and Moorfields Eye Hospital, London, UK
| | - S Coupland
- Department Molecular and Clinical Cancer Medicine, University of Liverpool, UK
| | | | - B Damato
- Royal Liverpool University Hospital, Liverpool, UK
| | - J Evans
- Royal Liverpool University Hospital, Liverpool, UK
| | - S Fenwick
- University Hospital Aintree, Liverpool, UK
| | | | - O Li
- Moorfields Eye Hospital, London, UK
| | - E Marshall
- The Clatterbridge Cancer Centre, NHS Foundation Trust, Liverpool, UK
| | | | - C Ottensmeier
- Southampton University Hospitals and University of Southampton, UK
| | - N Pearce
- University Hospital Southampton, Southampton, UK
| | - S Salvi
- Royal Hallamshire Hospital, Sheffield, UK
| | - B Stedman
- Southampton University Hospitals, NHS Trust, Southampton, UK
| | - P Szlosarek
- St Bartholomew's Hospital, UK; Barts Cancer Institute, Queen Mary University of London, London, UK
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Metastatic Ocular Melanoma Presenting as a Heart-Compressing Mediastinal Mass. Ann Thorac Surg 2015; 100:1448-50. [DOI: 10.1016/j.athoracsur.2014.12.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 12/02/2014] [Accepted: 12/05/2014] [Indexed: 11/18/2022]
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Arterial Blood, Rather Than Venous Blood, is a Better Source for Circulating Melanoma Cells. EBioMedicine 2015; 2:1821-6. [PMID: 26870807 PMCID: PMC4740300 DOI: 10.1016/j.ebiom.2015.09.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/07/2015] [Accepted: 09/11/2015] [Indexed: 12/21/2022] Open
Abstract
Background CTCs provide prognostic information and their application is under investigation in multiple tumor types. Of the multiple variables inherent in any such process, none is more important to outcome than the appropriateness of the sample source. To address this question, we investigated CTCs in paired peripheral venous and arterial blood specimens obtained from stage IV uveal melanoma patients. Methods Blood specimens were obtained from both common femoral arteries and antecubital veins in 17 uveal melanoma patients with multiple hepatic metastases for CTC measurements. Finding CTCs were detectable with greater frequency (100%) and in larger numbers (median 5, range 1 to 168) in all arterial blood specimens than in venous samples (52.9%; median 1, range 0 to 8). Patients with hepatic as well as extra-hepatic metastasis showed higher number of arterial CTCs, compared to patients with liver-only metastasis (p = 0.003). There was no significant association between the number of arterial CTCs and the tumor burden within the liver in patients who had liver-only metastases. Interpretation Our data indicate that arterial blood specimens might be a better source of circulating uveal melanoma cells. Although less conveniently processed, perhaps arterial blood should be evaluated as sample source for measurement of CTCs. CTCs were detectable in 100% of arterial blood obtained from metastatic uveal melanoma patients, while only 53% of venous blood was positive for CTCs.
CTCs have been investigated to provide prognostic information in multiple tumor types. Of the multiple variables, none is more important than the appropriateness of the sample source. Blood specimens were obtained from both femoral arteries and antecubital veins in 17 uveal melanoma patients with multiple hepatic metastases. CTCs were detectable with greater frequency (100%) and in larger numbers in all arterial blood specimens than in venous samples (52.9%). Our data indicate that arterial blood specimens might be a better source of circulating uveal melanoma cells. Although less convenient, arterial blood should be evaluated as sample source for measurement of CTCs.
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Key Words
- AKTi, AKT inhibitor
- Ab, antibody
- Arterial venous
- BCNU, bischlorethylnitrosourea
- CTC count
- Circulating tumor cells
- DEBDOX, drug-eluting beads with doxorubicin
- EDTA, ethylenediaminetetraacetic acid
- HMW-MAA, high molecular weight melanoma associated antigen
- Hepatic metastasis
- Ipi, ipilimumab
- LN, lymph node
- MEKi, MEK inhibitor
- METi, MET inhibitor;
- Peripheral venous
- TACE, transarterial chemoembolization
- Uveal melanoma
- VPA, valproic acid
- XRT, radiation therapy
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Mabray MC, Behr SC, Naeger DM, Flavell RR, Glastonbury CM. Predictors of pathologic outcome of focal FDG uptake in the parotid gland identified on whole-body FDG PET imaging. Clin Imaging 2015; 39:1073-9. [PMID: 26324219 DOI: 10.1016/j.clinimag.2015.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/23/2015] [Accepted: 07/06/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose was to test whether patient's primary malignancy type and presence of F-18-fluorodeoxyglucose (FDG)-avid cervical lymph node(s) are predictors of pathologic outcome of incidental focal FDG-avid parotid lesions. BASIC PROCEDURES A retrospective cohort study of pathologically proven incidental cases was performed. MAIN FINDINGS Focal parotid FDG uptake in the setting of head and neck cancer/melanoma [odds ratio (OR)=24.6, P<.01], lymphoma (OR=7.2, P=.02), or FDG-avid cervical lymph node(s) (OR=3.6, P=.07) has a higher odds of representing metastases. No malignant primary parotid tumors were incidentally discovered. PRINCIPAL CONCLUSIONS In patients with head and neck cancer/melanoma, lymphoma, or FDG-avid cervical lymph node(s), there were higher odds that focal parotid FDG uptake was a metastasis.
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Affiliation(s)
- Marc C Mabray
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco CA 94143.
| | - Spencer C Behr
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco CA 94143
| | - David M Naeger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco CA 94143
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco CA 94143
| | - Christine M Glastonbury
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco CA 94143
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Kaur J, Malik MA, Gulati R, Azad SV, Goswami S. Genetic determinants of uveal melanoma. Tumour Biol 2014; 35:11711-7. [PMID: 25296731 DOI: 10.1007/s13277-014-2681-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 07/18/2013] [Indexed: 11/27/2022] Open
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Reznicek L, Stumpf C, Seidensticker F, Kampik A, Neubauer AS, Kernt M. Role of wide-field autofluorescence imaging and scanning laser ophthalmoscopy in differentiation of choroidal pigmented lesions. Int J Ophthalmol 2014; 7:697-703. [PMID: 25161946 DOI: 10.3980/j.issn.2222-3959.2014.04.21] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 04/21/2014] [Indexed: 01/15/2023] Open
Abstract
AIM To evaluate the diagnostic properties of wide-field fundus autofluorescence (FAF) scanning laser ophthalmoscope (SLO) imaging for differentiating choroidal pigmented lesions. METHODS A consecutive series of 139 patients were included, 101 had established choroidal melanoma with 13 untreated lesions and 98 treated with radiotherapy. Thirty-eight had choroidal nevi. All patients underwent a full ophthalmological examination, undilated wide-field imaging, FAF and standardized US examination. FAF images and imaging characteristics from SLO were correlated with the structural findings in the two patient groups. RESULTS Mean FAF intensity of melanomas was significantly lower than the FAF of choroidal nevi. Only 1 out of 38 included eyes with nevi touched the optic disc compared to 31 out of 101 eyes with melanomas. In 18 out of 101 melanomas subretinal fluid was seen at the pigmented lesion compared to none seen in eyes with confirmed choroidal nevi. In "green laser separation", a trend towards more mixed FAF appearance of melanomas compared to nevi was observed. The mean maximal and minimal transverse and longitudinal diameters of melanomas were significantly higher than those of nevi. CONCLUSION Wide-field SLO and FAF imaging may be an appropriate non-invasive diagnostic screening tool to differentiate benign from malign pigmented choroidal lesions.
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Affiliation(s)
- Lukas Reznicek
- Department of Ophthalmology, Ludwig Maximilians University Muenchen, Mathildenstr. 8, Munich 80336, Germany
| | - Carmen Stumpf
- Department of Ophthalmology, Ludwig Maximilians University Muenchen, Mathildenstr. 8, Munich 80336, Germany
| | - Florian Seidensticker
- Department of Ophthalmology, Ludwig Maximilians University Muenchen, Mathildenstr. 8, Munich 80336, Germany
| | - Anselm Kampik
- Department of Ophthalmology, Ludwig Maximilians University Muenchen, Mathildenstr. 8, Munich 80336, Germany
| | - Aljoscha S Neubauer
- Department of Ophthalmology, Ludwig Maximilians University Muenchen, Mathildenstr. 8, Munich 80336, Germany
| | - Marcus Kernt
- Department of Ophthalmology, Ludwig Maximilians University Muenchen, Mathildenstr. 8, Munich 80336, Germany
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Reddy SK, Kesmodel SB, Alexander HR. Isolated hepatic perfusion for patients with liver metastases. Ther Adv Med Oncol 2014; 6:180-94. [PMID: 25057304 DOI: 10.1177/1758834014529175] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Up to 80% of colorectal, melanoma, and neuroendocrine liver metastases are unresectable due to excessive tumor burden. Isolated hepatic perfusion (IHP) administers intensive therapy to the liver while limiting systemic toxicity and thus may have an important role in the management of unresectable liver metastases. This review s describes the development of IHP, initial clinical results, open and percutaneous IHP techniques, and contemporary long-term treatment outcomes. IHP with melphalan or tumor necrosis factor α (TNFα) has been shown to achieve hepatic response rates of greater than 50% with progression-free survival of greater than 12 months among patients with refractory ocular melanoma liver metastases. The only series describing outcomes of IHP for neuroendocrine liver metastases notes an overall response rate of 50% and a median actuarial overall survival of 48 months after IHP treatment with melphalan or TNFα. The majority of studies that have evaluated IHP have been performed in patients with colorectal cancer liver metastases (CRCLM). In aggregate, survival results from retrospective studies and phase I/II clinical trials suggest that IHP demonstrated no significant survival benefit compared with systemic chemotherapy alone as first-line therapy. In contrast, IHP does improve outcomes relative to that provided by second-line chemotherapy for CRCLM, with overall response rates of 60% and median duration of liver response of 12 months. Continued evaluation of IHP for unresectable liver metastases is necessary to establish its role in multidisciplinary treatment approaches.
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Affiliation(s)
- Srinevas K Reddy
- Division of General and Oncologic Surgery, Department of Surgery and the Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Susan B Kesmodel
- Division of General and Oncologic Surgery, Department of Surgery and the Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - H Richard Alexander
- Division of Surgical Oncology, Department of Surgery, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201, USA
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Vassallo E, Azzopardi C, Pullicino R, Grech R. Beware the person with the glass eye and the large liver. BMJ Case Rep 2014; 2014:bcr-2014-204563. [PMID: 24850560 DOI: 10.1136/bcr-2014-204563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Edith Vassallo
- Department of Medical Imaging, Mater Dei Hospital Malta, Msida, Malta
| | | | - Richard Pullicino
- Department of Medical Imaging, Mater Dei Hospital Malta, Msida, Malta
| | - Reuben Grech
- Department of Medical Imaging, Mater Dei Hospital Malta, Msida, Malta
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Zbytek B, Carlson JA, Granese J, Ross J, Mihm MC, Slominski A. Current concepts of metastasis in melanoma. ACTA ACUST UNITED AC 2014; 3:569-585. [PMID: 19649148 DOI: 10.1586/17469872.3.5.569] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The main cause of death in melanoma patients is widespread metastases. Staging of melanoma is based on the primary tumor thickness, ulceration, lymph node and distant metastases. Metastases develop in regional lymph nodes, as satellite or in-transit lesions, or in distant organs. Lymph flow and chemotaxis is responsible for the homing of melanoma cells to different sites. Standard pathologic evaluation of sentinel lymph nodes fails to find occult melanoma in a significant proportion of cases. Detection of small numbers of malignant melanoma cells in these and other sites, such as adjacent to the primary site, bone marrow or the systemic circulation, may be enhanced by immunohistochemistry, reverse transcription PCR, evaluation of lymphatic vessel invasion and proteomics. In the organs to which melanoma cells metastasize, extravasation of melanoma cells is regulated by adhesion molecules, matrix metalloproteases, chemokines and growth factors. Melanoma cells may travel along external vessel lattices. After settling in the metastatic sites, melanoma cells develop mechanisms that protect them against the attack of the immune system. It is thought that one of the reasons why melanoma cells are especially resistant to killing is the fact that melanocytes (cells from which melanoma cells derive) are resistant to such noxious factors as ultraviolet light and reactive oxygen species. Targeted melanoma therapies are, so far, largely unsuccessful, and new ones, such as adjuvant inhibition of melanogenesis, are under development.
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Affiliation(s)
- Blazej Zbytek
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, 930 Madison Avenue, Memphis, TN 38163, USA, Tel.: +1 901 448 6300, ,
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Ramasamy P, Murphy CC, Clynes M, Horgan N, Moriarty P, Tiernan D, Beatty S, Kennedy S, Meleady P. Proteomics in uveal melanoma. Exp Eye Res 2013; 118:1-12. [PMID: 24056206 DOI: 10.1016/j.exer.2013.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 09/06/2013] [Accepted: 09/10/2013] [Indexed: 12/20/2022]
Abstract
Uveal melanoma is the most common primary intraocular malignancy in adults, with an incidence of 5-7 per million per year. It is associated with the development of metastasis in about 50% of cases, and 40% of patients with uveal melanoma die of metastatic disease despite successful treatment of the primary tumour. The survival rates at 5, 10 and 15 years are 65%, 50% and 45% respectively. Unlike progress made in many other areas of cancer, uveal melanoma is still poorly understood and survival rates have remained similar over the past 25 years. Recently, advances made in molecular genetics have improved our understanding of this disease and stratification of patients into low risk and high risk for developing metastasis. However, only a limited number of studies have been performed using proteomic methods. This review will give an overview of various proteomic technologies currently employed in life sciences research, and discuss proteomic studies of uveal melanoma.
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Affiliation(s)
- Pathma Ramasamy
- Royal College of Surgeons Ireland, Stephen's Green, Dublin 2, Ireland; National Institute for Cellular Biotechnology, Dublin City University, Collins Avenue, Glasnevin, Dublin 9, Ireland.
| | - Conor C Murphy
- Royal College of Surgeons Ireland, Stephen's Green, Dublin 2, Ireland; Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin 2, Ireland.
| | - Martin Clynes
- National Institute for Cellular Biotechnology, Dublin City University, Collins Avenue, Glasnevin, Dublin 9, Ireland.
| | - Noel Horgan
- Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin 2, Ireland.
| | - Paul Moriarty
- Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin 2, Ireland.
| | - Damien Tiernan
- Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin 2, Ireland.
| | - Stephen Beatty
- Macular Pigment Research Group, Waterford Institute of Technology, Waterford, Ireland.
| | - Susan Kennedy
- Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin 2, Ireland.
| | - Paula Meleady
- National Institute for Cellular Biotechnology, Dublin City University, Collins Avenue, Glasnevin, Dublin 9, Ireland.
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48
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Komatsu T, Sowa T, Takahashi K, Fujinaga T. A case of solitary pulmonary metastasis of choroidal melanoma with an exceptionally long disease-free period. Int J Surg Case Rep 2013; 4:849-51. [PMID: 23959417 DOI: 10.1016/j.ijscr.2013.06.017] [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: 03/24/2013] [Revised: 06/02/2013] [Accepted: 06/10/2013] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Choroidal melanoma is the most common primary malignant intraocular tumor in adults. And its metastatic spread has been considered to be hematogenous with the liver being the most common site, and a solitary pulmonary metastasis without hepatic involvement is quite rare. PRESENTATION OF CASE We report the case of a 61-year-old woman with a solitary pulmonary metastasis from choroidal melanoma, which had been originally treated with enucleation 13 years ago. Video-assisted thoracoscopic surgery (VATS) right upper lobectomy was performed for the right upper lobe tumor, which was histopathologically confirmed to be metastatic choroidal melanoma. DISCUSSION Our case is quite unusual in 2 points; firstly, a solitary pulmonary metastasis without hepatic involvement is rare. Secondly, this mode of metastasis with an exceptionally long disease-free period (13 years) is also rare. CONCLUSION A pulmonary metastasis from choroidal melanoma is described with reference to relevant literature.
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Affiliation(s)
- Teruya Komatsu
- Department of General Thoracic Surgery, Nagara Medical Center, Gifu, Japan.
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49
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Miyamoto C, Balazsi M, Bakalian S, Fernandes BF, Burnier MN. Uveal melanoma: Ocular and systemic disease. Saudi J Ophthalmol 2013; 26:145-9. [PMID: 23960985 DOI: 10.1016/j.sjopt.2012.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Although rare, uveal melanoma is the most common intraocular tumor in adults. Most cases arise from the choroidal layer of the uvea, displaying a discoid, collar-button, or mushroom shaped growth. Histopathologically, neoplasms are classified by the dominant cell type: spindle, epithelioid or mixed spindle cell type. The most important prognostic factors are cell type, nucleolar size, largest tumor dimension, and mitotic figures. Patient prognosis is poor when metastases occur in the liver, one of the main reasons that despite advances in the diagnosis and treatment of uveal melanoma, the mortality rate has not change significantly since 1973.
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Affiliation(s)
- Cristina Miyamoto
- The Henry C. Witelson Ocular Pathology Laboratory, McGill University Health Center, Montreal, QC, Canada
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50
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Bilateral extraocular muscles metastases from a choroidal melanoma. Can J Ophthalmol 2013; 48:e74-6. [PMID: 23931487 DOI: 10.1016/j.jcjo.2013.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 01/15/2013] [Accepted: 01/24/2013] [Indexed: 10/26/2022]
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