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Preis S, Ziehfreund S, Biedermann T, Horster S, Zink A. A systematic review of sex and gender differences in treatment outcome of inflammatory skin diseases: Is it time for new guidelines? J Eur Acad Dermatol Venereol 2024. [PMID: 39078087 DOI: 10.1111/jdv.20256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 06/07/2024] [Indexed: 07/31/2024]
Abstract
Gender- and sex-specific differences in medicine were long-time disregarded. Despite numerous indications of gender- and sex-specific influences on the treatment of dermatological conditions, these have not yet been systematically investigated. To meet this unmet need, we conducted the present systematic review on the topic of gender and sex differences in the treatement outcome of skin diseases. Embase (via Ovid), PubMed Medline and Web of Science were searched, in between January 2001 and December 2022. English and german randomized controlled trials, prospective and retrospective cohorts and case-control studies that examined differences between men and women in treatment outcomes of skin diseases were included. Two authors independently screened the reports for eligibility, one extracted all data (the second double-checked) and critically appraised the quality and risk of bias of the studies. Eighty-three reports were included. The largest share of the identified publications focused on gender differences in psoriasis and psoriatic arthritis (n = 49), followed by melanoma (n = 8) and sporadic studies (n < 5) of inflammatory, infectious and autoimmune skin diseases. The main topics in which gender differences could be identified were choice of treatment, time to initiation of treatment, therapy response, adverse events, adherence and treatment satisfaction. For psoriasis, gender differences could be found in all aspects, while for the other skin diseases specific publications on gender differences are still missing. This systematic review shows numerous gender differences but also reveals major gaps in gender-specific care in dermatology which should be narrowed in the upcoming years to optimize a patient-centred, individualized, gender-equal healthcare. PROSPERO Registration: CRD42022306626.
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Affiliation(s)
- S Preis
- Department of Dermatology and Allergy, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health LMU Munich, Munich, Germany
| | - S Ziehfreund
- Department of Dermatology and Allergy, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - T Biedermann
- Department of Dermatology and Allergy, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - S Horster
- Department of Gastroenterology and Hepatology, University Hospital Munich, Munich, Germany
| | - A Zink
- Department of Dermatology and Allergy, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
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2
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Petersen SK, Hansen CR, Ellebaek E, Schmidt H, Haslund CA, Ruhlmann CH, Bastholt L. Does patient sex affect the treatment outcome of immune checkpoint inhibitors? A Danish, observational melanoma study. Eur J Cancer 2024; 205:114099. [PMID: 38754294 DOI: 10.1016/j.ejca.2024.114099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/18/2024]
Abstract
AIM The objective of this study was to evaluate whether patient biological sex influences treatment outcomes in patients with metastatic melanoma (MM) undergoing first-line immune checkpoint inhibitor (ICI) therapy. METHODS The Danish Metastatic Melanoma Database (DAMMED) was employed to identify patients who underwent first-line ICI therapy for MM in Denmark from 2013 to 2021. Excluding adjuvant treatment, uveal and mucosal histological subtypes, the study conducted univariable and multivariable analyses to evaluate the influence of patient sex in survival analyses. Further, landmark survival of this real-world national cohort was described for progression free survival (PFS), overall survival (OS) and melanoma-specific survival (MSS). RESULTS The analysis encompassed a cohort of 1378 patients with MM. Compared to male sex, females had significantly improved OS (p = 0.003) when tested in univariable testing. Multivariable analyses, controlling for age, performance status, lactate dehydrogenase level, BRAF status, M-stage, and number of metastatic sites revealed significant favourable outcomes associated with female sex irrespective of the considered survival metrics (pPFS = 0.014, pOS = 0.002, and pMSS = 0.03). The observed five-year OS rates of the entire cohort were 47% and 38%, while melanoma-specific survival were 50% and 45% for female and male, respectively. CONCLUSION In this nationwide cohort of patients with MM undergoing first-line ICI treatment females exhibited superior treatment outcomes compared to males. Sex was identified as an independent predictive variable for treatment outcomes, irrespective of the chosen outcome measures considered. Our analyses are not able to conclude whether the differences in outcome is attributable to differences in biology or to treatment strategy.
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Affiliation(s)
- Soeren Kjaer Petersen
- Department of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern, Denmark.
| | - Christian Rønn Hansen
- Department of Clinical Research, University of Southern, Denmark; Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - Eva Ellebaek
- National Centre for Cancer Immune Therapy, Department of Oncology, Copenhagen University Hospital, Herlev, Denmark
| | - Henrik Schmidt
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Christina H Ruhlmann
- Department of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern, Denmark
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
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Ravix A, Bandiera C, Cardoso E, Lata-Pedreira A, Chtioui H, Decosterd LA, Wagner AD, Schneider MP, Csajka C, Guidi M. Population Pharmacokinetics of Trametinib and Impact of Nonadherence on Drug Exposure in Oncology Patients as Part of the Optimizing Oral Targeted Anticancer Therapies Study. Cancers (Basel) 2024; 16:2193. [PMID: 38927898 PMCID: PMC11201946 DOI: 10.3390/cancers16122193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Trametinib is a targeted therapy used for the treatment of solid tumours, with significant variability reported in real-life studies. This variability increases the risk of suboptimal exposure, which can lead to treatment failure or increased toxicity. Using model-based simulation, this study aims to characterize and investigate the pharmacokinetics and the adequacy of the currently recommended doses of trametinib. Additionally, the simulation of various suboptimal adherence scenarios allowed for an assessment of the impact of patients' drug adherence on the treatment outcome. The population data collected in 33 adult patients, providing 113 plasmatic trametinib concentrations, were best described by a two-compartment model with linear absorption and elimination. The study also identified a significant positive effect of fat-free mass and a negative effect of age on clearance, explaining 66% and 21% of the initial associated variability, respectively. Simulations showed that a maximum dose of 2 mg daily achieved the therapeutic target in 36% of male patients compared to 72% of female patients. A dose of 1.5 mg per day in patients over 65 years of age achieved similar rates, with 44% and 79% for male and female patients, respectively, reaching the therapeutic target. Poor adherence leads to a significant drop in concentrations and a high risk of subtherapeutic drug levels. These results underline the importance of interprofessional collaboration and patient partnership along the patient's journey to address patients' needs regarding trametinib and support medication adherence.
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Affiliation(s)
- Anne Ravix
- Centre for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Carole Bandiera
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, 1211 Geneva, Switzerland (M.P.S.)
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, 1211 Geneva, Switzerland
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 1011 Lausanne, Switzerland
| | - Evelina Cardoso
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, 1211 Geneva, Switzerland (M.P.S.)
| | - Adrian Lata-Pedreira
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, 1211 Geneva, Switzerland (M.P.S.)
| | - Haithem Chtioui
- Service of Clinical Pharmacology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Laurent Arthur Decosterd
- Laboratory of Clinical Pharmacology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Anna Dorothea Wagner
- Department of Oncology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Marie Paule Schneider
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, 1211 Geneva, Switzerland (M.P.S.)
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, 1211 Geneva, Switzerland
| | - Chantal Csajka
- Centre for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, 1211 Geneva, Switzerland (M.P.S.)
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, 1211 Geneva, Switzerland
| | - Monia Guidi
- Centre for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, 1211 Geneva, Switzerland (M.P.S.)
- Service of Clinical Pharmacology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
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4
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Choi Y, Kim N. Sex Difference of Colon Adenoma Pathway and Colorectal Carcinogenesis. World J Mens Health 2024; 42:256-282. [PMID: 37652658 PMCID: PMC10949019 DOI: 10.5534/wjmh.230085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/09/2023] [Indexed: 09/02/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most common causes of cancer morbidity in both sexes but shows sex differences. First, sex-specific differences in tumor recurrence and survival rates have been reported. For example, the development of CRC is found about 1.5 times higher and 4-8 years earlier in males compared to females, suggesting the protective role of estrogen in the disease. Furthermore, female patients have a higher risk of developing right-sided (proximal) colon cancer than male patients, which is known to have more aggressive clinical character compared to left-sided (distal) colon cancer. That is, left and right CRCs show differences in carcinogenic mechanism, that the chromosomal instability pathway is more common in left colon cancer while the microsatellite instability and serrated pathways are more common in right colon cancer. It is thought that there are sex-based differences on the background of carcinogenesis of CRC. Sex differences of CRC have two aspects, sexual dimorphism (biological differences in hormones and genes) and gender differences (non-biological differences in societal attitudes and behavior). Recently, sex difference of colon adenoma pathway and sexual dimorphism in the biology of gene and protein expression, and in endocrine cellular signaling in the CRC carcinogenesis have been accumulated. In addition, behavioral patterns can lead to differences in exposure to risk factors such as drinking or smoking, diet and physical activity. Therefore, understanding sex/gender-related biological and sociocultural differences in CRC risk will help in providing strategies for screening, treatment and prevention protocols to reduce the mortality and improve the quality of life. In this review, sex/gender differences in colon adenoma pathway and various aspects such as clinicopathological, biological, molecular, and socio-cultural aspects of CRC were described.
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Affiliation(s)
- Yonghoon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
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5
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Poletto S, Paruzzo L, Nepote A, Caravelli D, Sangiolo D, Carnevale-Schianca F. Predictive Factors in Metastatic Melanoma Treated with Immune Checkpoint Inhibitors: From Clinical Practice to Future Perspective. Cancers (Basel) 2023; 16:101. [PMID: 38201531 PMCID: PMC10778365 DOI: 10.3390/cancers16010101] [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: 10/10/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
The introduction of immunotherapy revolutionized the treatment landscape in metastatic melanoma. Despite the impressive results associated with immune checkpoint inhibitors (ICIs), only a portion of patients obtain a response to this treatment. In this scenario, the research of predictive factors is fundamental to identify patients who may have a response and to exclude patients with a low possibility to respond. These factors can be host-associated, immune system activation-related, and tumor-related. Patient-related factors can vary from data obtained by medical history (performance status, age, sex, body mass index, concomitant medications, and comorbidities) to analysis of the gut microbiome from fecal samples. Tumor-related factors can reflect tumor burden (metastatic sites, lactate dehydrogenase, C-reactive protein, and circulating tumor DNA) or can derive from the analysis of tumor samples (driver mutations, tumor-infiltrating lymphocytes, and myeloid cells). Biomarkers evaluating the immune system activation, such as IFN-gamma gene expression profile and analysis of circulating immune cell subsets, have emerged in recent years as significantly correlated with response to ICIs. In this manuscript, we critically reviewed the most updated literature data on the landscape of predictive factors in metastatic melanoma treated with ICIs. We focus on the principal limits and potentiality of different methods, shedding light on the more promising biomarkers.
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Affiliation(s)
- Stefano Poletto
- Department of Oncology, University of Turin, AOU S. Luigi Gonzaga, 10043 Orbassano, Italy;
| | - Luca Paruzzo
- Department of Oncology, University of Turin, 10124 Turin, Italy; (L.P.); (D.S.)
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Alessandro Nepote
- Department of Oncology, University of Turin, AOU S. Luigi Gonzaga, 10043 Orbassano, Italy;
| | - Daniela Caravelli
- Medical Oncology Division, Candiolo Cancer Institute, FPO-IRCCs, 10060 Candiolo, Italy; (D.C.); (F.C.-S.)
| | - Dario Sangiolo
- Department of Oncology, University of Turin, 10124 Turin, Italy; (L.P.); (D.S.)
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Detroit M, Collier M, Beeker N, Willems L, Decroocq J, Deau-Fischer B, Vignon M, Birsen R, Moufle F, Leclaire C, Balladur E, Deschamps P, Chauchet A, Batista R, Limat S, Treluyer JM, Ricard L, Stocker N, Hermine O, Choquet S, Morel V, Metz C, Bouscary D, Kroemer M, Zerbit J. Predictive Factors of Response to Immunotherapy in Lymphomas: A Multicentre Clinical Data Warehouse Study (PRONOSTIM). Cancers (Basel) 2023; 15:4028. [PMID: 37627056 PMCID: PMC10452259 DOI: 10.3390/cancers15164028] [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: 07/10/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Immunotherapy (IT) is a major therapeutic strategy for lymphoma, significantly improving patient prognosis. IT remains ineffective for a significant number of patients, however, and exposes them to specific toxicities. The identification predictive factors around efficacy and toxicity would allow better targeting of patients with a higher ratio of benefit to risk. PRONOSTIM is a multicenter and retrospective study using the Clinical Data Warehouse (CDW) of the Greater Paris University Hospitals network. Adult patients with Hodgkin lymphoma or diffuse large-cell B lymphoma treated with immune checkpoint inhibitors or CAR T (Chimeric antigen receptor T) cells between 2017 and 2022 were included. Analysis of covariates influencing progression-free survival (PFS) or the occurrence of grade ≥3 toxicity was performed. In total, 249 patients were included. From this study, already known predictors for response or toxicity of CAR T cells such as age, elevated lactate dehydrogenase, and elevated C-Reactive Protein at the time of infusion were confirmed. In addition, male gender, low hemoglobin, and hypo- or hyperkalemia were demonstrated to be potential predictive factors for progression after CAR T cell therapy. These findings prove the attractiveness of CDW in generating real-world data, and show its essential contribution to identifying new predictors for decision support before starting IT.
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Affiliation(s)
- Marion Detroit
- Pharmacy Department, Pitié-Salpêtrière Hospital, Greater Paris University Hospitals (AP-HP), Sorbonne University, 75013 Paris, France; (M.D.); (C.M.)
| | - Mathis Collier
- Clinical Research Unit, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (M.C.); (N.B.); (J.-M.T.)
| | - Nathanaël Beeker
- Clinical Research Unit, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (M.C.); (N.B.); (J.-M.T.)
| | - Lise Willems
- Hematology Department, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (L.W.); (J.D.); (B.D.-F.); (M.V.); (R.B.); (D.B.)
| | - Justine Decroocq
- Hematology Department, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (L.W.); (J.D.); (B.D.-F.); (M.V.); (R.B.); (D.B.)
| | - Bénédicte Deau-Fischer
- Hematology Department, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (L.W.); (J.D.); (B.D.-F.); (M.V.); (R.B.); (D.B.)
| | - Marguerite Vignon
- Hematology Department, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (L.W.); (J.D.); (B.D.-F.); (M.V.); (R.B.); (D.B.)
| | - Rudy Birsen
- Hematology Department, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (L.W.); (J.D.); (B.D.-F.); (M.V.); (R.B.); (D.B.)
| | - Frederique Moufle
- Adult Department, Hospital at Home, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (F.M.); (C.L.); (E.B.)
| | - Clément Leclaire
- Adult Department, Hospital at Home, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (F.M.); (C.L.); (E.B.)
| | - Elisabeth Balladur
- Adult Department, Hospital at Home, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (F.M.); (C.L.); (E.B.)
| | - Paul Deschamps
- Hematology Oncology Department, André Mignot Hospital, 78157 Le Chesnay, France;
| | - Adrien Chauchet
- Hematology Department, University Hospital of Besançon, 25000 Besançon, France;
| | - Rui Batista
- Pharmacy Department, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France;
| | - Samuel Limat
- Pharmacy Department, University Hospital of Besançon, 25000 Besançon, France; (S.L.); (M.K.)
- French National Institute of Health and Medical Research (INSERM), Etablissement Français du Sang Bourgogne Franche-Comte (EFS BFC), UMR1098, RIGHT, University of Bourgogne Franche-Comté, 25000 Besançon, France
| | - Jean-Marc Treluyer
- Clinical Research Unit, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (M.C.); (N.B.); (J.-M.T.)
- Regional Pharmacovigilance Center, Pharmacology Department, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France
| | - Laure Ricard
- Hematology Department, Saint Antoine Hospital, AP-HP, INSERM UMRs 938, Sorbonne University, 75012 Paris, France; (L.R.); (N.S.)
| | - Nicolas Stocker
- Hematology Department, Saint Antoine Hospital, AP-HP, INSERM UMRs 938, Sorbonne University, 75012 Paris, France; (L.R.); (N.S.)
| | - Olivier Hermine
- Hematology Department, Necker Hospital, AP-HP, Centre Paris-Cité University, 75015 Paris, France;
| | - Sylvain Choquet
- Hematology Department, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 75013 Paris, France; (S.C.); (V.M.)
| | - Véronique Morel
- Hematology Department, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 75013 Paris, France; (S.C.); (V.M.)
| | - Carole Metz
- Pharmacy Department, Pitié-Salpêtrière Hospital, Greater Paris University Hospitals (AP-HP), Sorbonne University, 75013 Paris, France; (M.D.); (C.M.)
| | - Didier Bouscary
- Hematology Department, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (L.W.); (J.D.); (B.D.-F.); (M.V.); (R.B.); (D.B.)
| | - Marie Kroemer
- Pharmacy Department, University Hospital of Besançon, 25000 Besançon, France; (S.L.); (M.K.)
- French National Institute of Health and Medical Research (INSERM), Etablissement Français du Sang Bourgogne Franche-Comte (EFS BFC), UMR1098, RIGHT, University of Bourgogne Franche-Comté, 25000 Besançon, France
| | - Jérémie Zerbit
- Cancer Treatment Unit, Pharmacy Department, Hospital at Home, AP-HP, Centre Paris-Cité University, 75014 Paris, France
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7
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Castellani G, Buccarelli M, Arasi MB, Rossi S, Pisanu ME, Bellenghi M, Lintas C, Tabolacci C. BRAF Mutations in Melanoma: Biological Aspects, Therapeutic Implications, and Circulating Biomarkers. Cancers (Basel) 2023; 15:4026. [PMID: 37627054 PMCID: PMC10452867 DOI: 10.3390/cancers15164026] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Melanoma is an aggressive form of skin cancer resulting from the malignant transformation of melanocytes. Recent therapeutic approaches, including targeted therapy and immunotherapy, have improved the prognosis and outcome of melanoma patients. BRAF is one of the most frequently mutated oncogenes recognised in melanoma. The most frequent oncogenic BRAF mutations consist of a single point mutation at codon 600 (mostly V600E) that leads to constitutive activation of the BRAF/MEK/ERK (MAPK) signalling pathway. Therefore, mutated BRAF has become a useful target for molecular therapy and the use of BRAF kinase inhibitors has shown promising results. However, several resistance mechanisms invariably develop leading to therapeutic failure. The aim of this manuscript is to review the role of BRAF mutational status in the pathogenesis of melanoma and its impact on differentiation and inflammation. Moreover, this review focuses on the mechanisms responsible for resistance to targeted therapies in BRAF-mutated melanoma and provides an overview of circulating biomarkers including circulating tumour cells, circulating tumour DNA, and non-coding RNAs.
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Affiliation(s)
- Giorgia Castellani
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy; (G.C.); (M.B.); (M.B.A.); (S.R.)
| | - Mariachiara Buccarelli
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy; (G.C.); (M.B.); (M.B.A.); (S.R.)
| | - Maria Beatrice Arasi
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy; (G.C.); (M.B.); (M.B.A.); (S.R.)
| | - Stefania Rossi
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy; (G.C.); (M.B.); (M.B.A.); (S.R.)
| | - Maria Elena Pisanu
- High Resolution NMR Unit, Core Facilities, Istituto Superiore di Sanità, 00161 Rome, Italy;
| | - Maria Bellenghi
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy;
| | - Carla Lintas
- Research Unit of Medical Genetics, Department of Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy;
- Operative Research Unit of Medical Genetics, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Claudio Tabolacci
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy; (G.C.); (M.B.); (M.B.A.); (S.R.)
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8
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van der Kooij MK, Joosse A, Suijkerbuijk KPM, Aarts MJB, van den Berkmortel FWPJ, Blank CU, Boers-Sonderen MJ, van den Eertwegh AJM, de Groot JWB, Haanen JBAG, Hospers GAP, Piersma D, van Rijn RS, van der Veldt AAM, Vreugdenhil G, Westgeest HM, Wouters MWJM, Dekkers OM, Kapiteijn E. Failure to validate existing clinical prediction scale for response to PD-1 monotherapy in advanced melanoma in national cohort study. Br J Cancer 2023; 128:707-710. [PMID: 36564561 PMCID: PMC9977837 DOI: 10.1038/s41416-022-02088-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 11/04/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Monique K van der Kooij
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, PO box 9600, 2300 RC, Leiden, The Netherlands
| | - Arjen Joosse
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3000 CA, Rotterdam, The Netherlands
| | - Karijn P M Suijkerbuijk
- Department of Medical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Maureen J B Aarts
- Department of Medical Oncology, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands
| | | | - Christian U Blank
- Department of Medical Oncology, Netherlands Cancer Institute- Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Marye J Boers-Sonderen
- Department of Medical Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands
| | - Alfonsus J M van den Eertwegh
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, 1081 HZ, Amsterdam, The Netherlands
| | | | - John B A G Haanen
- Department of Medical Oncology, Netherlands Cancer Institute- Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Geke A P Hospers
- Department of Medical Oncology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Djura Piersma
- Department of Medical Oncology, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, The Netherlands
| | - Rozemarijn S van Rijn
- Department of Medical Oncology, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands
| | - Astrid A M van der Veldt
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3000 CA, Rotterdam, The Netherlands
| | - Gerard Vreugdenhil
- Department of Medical Oncology, Maxima Medical Center, de Run 4600, 5500 MB, Veldhoven, The Netherlands
| | - Hans M Westgeest
- Department of Medical Oncology, Amphia Ziekenhuis, Langendijk 175, 4819 EV, Breda, The Netherlands
| | - Michel W J M Wouters
- Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA, Leiden, The Netherlands
- Department of Surgical Oncology, Netherlands Cancer Institute- Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, PO box 9600, 2300 RC, Leiden, The Netherlands
| | - Ellen Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, PO box 9600, 2300 RC, Leiden, The Netherlands.
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Cosci I, Grande G, Di Nisio A, Rocca MS, Del Fiore P, Benna C, Mocellin S, Ferlin A. Cutaneous Melanoma and Hormones: Focus on Sex Differences and the Testis. Int J Mol Sci 2022; 24:ijms24010599. [PMID: 36614041 PMCID: PMC9820190 DOI: 10.3390/ijms24010599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/24/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022] Open
Abstract
Cutaneous melanoma, the most aggressive type of skin cancer, remains one the most represented forms of cancer in the United States and European countries, representing, in Australia, the primary cause of cancer-related deaths. Recently, many studies have shown that sex disparities previously observed in most cancers are particularly accentuated in melanoma, where male sex is consistently associated with an increased risk of disease progression and a higher mortality rate. The causes of these sex differences rely on biological mechanisms related to sex hormones, immune homeostasis and oxidative processes. The development of newer therapies, such as immune checkpoint inhibitors (ICIs) (i.e., anti-PD-1 and anti-CTLA-4 monoclonal antibodies) has dramatically changed the treatment landscape of metastatic melanoma patients, though ICIs can interfere with the immune response and lead to inflammatory immune-related adverse events (irAEs). Recently, some studies have shown a potential adverse influence of this immunotherapy treatment also on male fertility and testicular function. However, while many anticancer drugs are known to cause defects in spermatogenesis, the effects of ICIs therapy remain largely unknown. Notwithstanding the scarce and conflicting information available on this topic, the American Society of Clinical Oncology guidelines recommend sperm cryopreservation in males undergoing ICIs. As investigations regarding the long-term outcomes of anticancer immunotherapy on the male reproductive system are still in their infancy, this review aims to support and spur future research in order to understand a potential gonadotoxic effect of ICIs on testicular function, spermatogenesis and male fertility.
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Affiliation(s)
- Ilaria Cosci
- Veneto Institute of Oncology IOV-IRCCS, 35128 Padova, Italy
| | - Giuseppe Grande
- Unit of Andrology and Reproductive Medicine, University Hospital of Padova, 35128 Padova, Italy
| | - Andrea Di Nisio
- Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Maria Santa Rocca
- Unit of Andrology and Reproductive Medicine, University Hospital of Padova, 35128 Padova, Italy
| | - Paolo Del Fiore
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
| | - Clara Benna
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
- Department of Surgical, Oncological and Gastroenterological Sciences (DISCOG), University of Padua, 35128 Padova, Italy
| | - Simone Mocellin
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
- Department of Surgical, Oncological and Gastroenterological Sciences (DISCOG), University of Padua, 35128 Padova, Italy
| | - Alberto Ferlin
- Unit of Andrology and Reproductive Medicine, University Hospital of Padova, 35128 Padova, Italy
- Department of Medicine, University of Padova, 35128 Padova, Italy
- Correspondence: ; Tel.: +39-049-8212723
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Morgese F, Cognigni V, Scortichini L, Ranallo N, Lunerti V, Migliore A, Tronconi F, Berardi R. Potential immune‑related adverse events during dabrafenib and trametinib treatment: A case series of patients with BRAF V600E melanoma. Mol Clin Oncol 2022; 18:2. [PMID: 36545211 PMCID: PMC9756019 DOI: 10.3892/mco.2022.2598] [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: 04/07/2022] [Accepted: 07/27/2022] [Indexed: 11/24/2022] Open
Abstract
In recent years, BRAF inhibitors (BRAFi) and MEK inhibitors (MEKi), together with immune checkpoint inhibitors (ICIs), have changed the therapeutic strategy of cutaneous melanoma, both in adjuvant and metastatic settings. These inhibitors have significantly improved the clinical outcome for patients with melanoma, including in both BRAF-mutated and BRAF-wild type disease. Some preclinical and clinical studies have revealed that BRAFi and MEKi are able to influence T- and B-cell activation, and to modulate immune system activation within the tumor microenvironment. Dabrafenib and trametinib have been shown to enhance the expression of melanoma antigens on BRAF-mutated cells, and to favor both a cytotoxic and immune response against melanoma cells. Thereby, the present study described a case series of five women treated with BRAFi and MEKi, in both adjuvant and metastatic settings, that experienced potential immune-related adverse events. In particular, these patients exhibited sarcoidosis, mesenteric panniculitis, lymphocytic colitis and neuropathy of phrenic nerve. Considering that T and B cells are responsible for immune-related adverse events, as observed in patients treated with ICIs, the present study suggested a possible role of BRAFi and MEKi as triggers of immune system activation and subsequent immune-related toxicities.
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Affiliation(s)
- Francesca Morgese
- Oncology Clinic, Polytechnic University of Marche, United Hospitals of Ancona, I-60126 Ancona, Italy,Correspondence to: Dr Francesca Morgese, Oncology Clinic, Polytechnic University of Marche, United Hospitals of Ancona, Via Conca 71, I-60126 Ancona, Italy
| | - Valeria Cognigni
- Oncology Clinic, Polytechnic University of Marche, United Hospitals of Ancona, I-60126 Ancona, Italy
| | - Laura Scortichini
- Oncology Clinic, Polytechnic University of Marche, United Hospitals of Ancona, I-60126 Ancona, Italy,Oncology Unit, Macerata Hospital, I-62100 Macerata, Italy
| | - Nicoletta Ranallo
- Osteoncology and Rare Tumors Center, IRCCS Romagna Scientific Institute for Cancer Research and Care ‘Dino Amadori’, I-47014 Meldola, Italy
| | - Valentina Lunerti
- Oncology Clinic, Polytechnic University of Marche, United Hospitals of Ancona, I-60126 Ancona, Italy
| | - Antonella Migliore
- Oncology Clinic, Polytechnic University of Marche, United Hospitals of Ancona, I-60126 Ancona, Italy
| | - Francesca Tronconi
- Oncology Clinic, Polytechnic University of Marche, United Hospitals of Ancona, I-60126 Ancona, Italy,Institute of Obstetrics and Gynecology, Catholic University of The Sacred Heart, I-00168 Roma, Italy
| | - Rossana Berardi
- Oncology Clinic, Polytechnic University of Marche, United Hospitals of Ancona, I-60126 Ancona, Italy
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Kudura K, Basler L, Nussbaumer L, Foerster R. Sex-Related Differences in Metastatic Melanoma Patients Treated with Immune Checkpoint Inhibition. Cancers (Basel) 2022; 14:cancers14205145. [PMID: 36291928 PMCID: PMC9600302 DOI: 10.3390/cancers14205145] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: We aimed to investigate sex-related differences in patients with advanced melanoma treated with ICI by linking the assessment of inflammatory response in peripheral blood, onset of immune-related adverse events IRAEs during therapy and treatment response in short- and long-term. Methods: For the purpose of this single-center retrospective study metastatic melanoma patients treated with ICI were included. Baseline patient characteristics, blood sample tests and the onset of immune-related adverse events IRAEs were documented based on clinical records. The short-term treatment response was assessed with 18F-2-Fluor-2-desoxy-D-glucose Positron Emission Tomography/Computed Tomography FDG-PET/CT scans performed six months after initiation of ICI. The overall survival OS and progression-free survival PFS were used as endpoints to assess the long-term response to immunotherapy. Results: In total, 103 patients with advanced melanoma (mean age 68 ± 13.83 years) were included, 29 women (mean age 60.41 ± 14.57 years) and 74 men (mean age 65.66 ± 13.34 years). The primary tumor was located on a lower extremity in one out of three women and on the head/neck in one out of three men (p < 0.001). While the superficial spreading (41%) and nodular (36%) melanoma subtypes represented together 77% of the cases in male population, women showed a more heterogenous distribution of melanoma subtypes with the superficial spreading (35%), nodular (23%), acral lentiginous (19%) and mucosal (12%) melanoma subtypes being most frequent in female population (p < 0.001). Most differences between women and men with regards to inflammatory parameters were observed six months after initiation of ICI with a higher median NLR (p = 0.038), lower counts of lymphocytes (p = 0.004) and thrombocytes (p = 0.089) in addition to lower counts of erythrocytes (p < 0.001) and monocytes (p < 0.001) in women towards men. IRAEs were more frequent in women towards men (p = 0.013). Women were more likely to display endocrinological IRAEs, such as thyroiditis being the most frequent adverse event in women. Interestingly IRAEs of the gastrointestinal tract were the most frequent ones in men. Finally, men with advanced melanoma showed a significantly better response to immunotherapy in short- (p = 0.015) and long-term (OS p = 0.015 and PFS p < 0.001) than women. In fact, every fourth man died during the course of the disease, while every second woman did not survive. (p = 0.001). Conclusion: Men with advanced melanoma showed a significantly better response to immunotherapy in short- and long-term than women. Higher immune activation in peripheral blood before and after initiation ICI might be linked to favorable treatment response during and after ICI in favor of men and decoupled from the onset of IRAEs. Given the significantly higher immunotoxicity and worse outcome experienced by women compared to men the use of ICI should be chosen carefully in women with advanced melanoma.
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Affiliation(s)
- Ken Kudura
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland
- Correspondence:
| | - Lucas Basler
- Institute of Radiooncology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
| | - Lukas Nussbaumer
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland
| | - Robert Foerster
- Institute of Radiooncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
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GILT Expression in Human Melanoma Cells Enhances Generation of Antigenic Peptides for HLA Class II-Mediated Immune Recognition. Int J Mol Sci 2022; 23:ijms23031066. [PMID: 35162988 PMCID: PMC8835040 DOI: 10.3390/ijms23031066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/11/2022] [Indexed: 12/27/2022] Open
Abstract
Melanoma is an aggressive skin cancer that has become increasingly prevalent in western populations. Current treatments such as surgery, chemotherapy, and high-dose radiation have had limited success, often failing to treat late stage, metastatic melanoma. Alternative strategies such as immunotherapies have been successful in treating a small percentage of patients with metastatic disease, although these treatments to date have not been proven to enhance overall survival. Several melanoma antigens (Ags) proposed as targets for immunotherapeutics include tyrosinase, NY-ESO-1, gp-100, and Mart-1, all of which contain both human leukocyte antigen (HLA) class I and class II-restricted epitopes necessary for immune recognition. We have previously shown that an enzyme, gamma-IFN-inducible lysosomal thiol-reductase (GILT), is abundantly expressed in professional Ag presenting cells (APCs), but absent or expressed at greatly reduced levels in many human melanomas. In the current study, we report that increased GILT expression generates a greater pool of antigenic peptides in melanoma cells for enhanced CD4+ T cell recognition. Our results suggest that the induction of GILT in human melanoma cells could aid in the development of a novel whole-cell vaccine for the enhancement of immune recognition of metastatic melanoma.
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