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Lochrin SE, Cugliari MK, Yeh R, Shoushtari AN. Efficacy of axitinib in a US cohort of patients with programmed cell death protein 1-resistant mucosal melanoma. Melanoma Res 2024; 34:450-456. [PMID: 38953532 DOI: 10.1097/cmr.0000000000000988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
Mucosal melanoma is a rare melanoma subtype, accounting for about 1% of all diagnosed melanomas. It is characterized by an aggressive phenotype with a poor prognosis and a low response rate to approved treatments. We retrospectively analyzed the clinical features, treatments, and outcomes of patients diagnosed with mucosal melanoma treated with axitinib ± anti-programmed cell death protein 1 (PD-1) therapy at a single US referral center between 2018 and 2021. Radiologic response was assessed according to Response Evaluation Criteria in Solid Tumors (RECIST), v1.1. Twenty-three patients were included in this study. In all, 78% were females with a median age of 62 years. The originating site of mucosal melanoma was the sinonasal (35%), genitourinary (35%), and gastrointestinal (30%) tracts. Sixty-five percent of patients had M1c or M1d disease and 0% had BRAF V600 mutations detected. The majority (96%) had prior treatment inclusive of anti-PD-1, with a median of 2 prior lines, and 78% of patients received a combination of axitinib and PD-1 and the median duration of treatment was 3.2 months. The overall response rate was 13% and the disease control rate was 26%. The median progression-free survival was 3.2 months, and the median overall survival was 8.2 months. Overall, the regimen was well tolerated with 39% of patients requiring dose reduction and 9% requiring treatment cessation. Axitinib with anti-PD-1 therapy has modest clinical activity in heavily pretreated patients with mucosal melanoma outside of Asia, including some with long-term benefits. This data supports the worldwide clinical trials evaluating this combination and the role of incorporating vascular endothelial growth factor-based therapy in the therapeutic paradigm for patients with mucosal melanoma.
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Affiliation(s)
| | | | - Randy Yeh
- Radiology, Memorial Sloan Kettering Cancer Center
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Boleti APDA, Jacobowski AC, Monteiro-Alfredo T, Pereira APR, Oliva MLV, Maria DA, Macedo MLR. Cutaneous Melanoma: An Overview of Physiological and Therapeutic Aspects and Biotechnological Use of Serine Protease Inhibitors. Molecules 2024; 29:3891. [PMID: 39202970 PMCID: PMC11357276 DOI: 10.3390/molecules29163891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/11/2024] [Accepted: 08/14/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND Metastatic melanoma stands out as the most lethal form of skin cancer because of its high propensity to spread and its remarkable resistance to treatment methods. METHODS In this review article, we address the incidence of melanoma worldwide and its staging phases. We thoroughly investigate the different melanomas and their associated risk factors. In addition, we underscore the principal therapeutic goals and pharmacological methods that are currently used in the treatment of melanoma. RESULTS The implementation of targeted therapies has contributed to improving the approach to patients. However, because of the emergence of resistance early in treatment, overall survival and progression-free periods continue to be limited. CONCLUSIONS We provide new insights into plant serine protease inhibitor therapeutics, supporting high-throughput drug screening soon, and seeking a complementary approach to explain crucial mechanisms associated with melanoma.
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Affiliation(s)
- Ana Paula De Araújo Boleti
- Laboratory of Protein Purification and Their Biological Functions, Food Technology and Public Health Unit, Federal University of Mato Grosso do Sul (UFMS), Campo Grande 79070-900, MS, Brazil; (A.P.D.A.B.); (A.C.J.); (T.M.-A.); (A.P.R.P.)
| | - Ana Cristina Jacobowski
- Laboratory of Protein Purification and Their Biological Functions, Food Technology and Public Health Unit, Federal University of Mato Grosso do Sul (UFMS), Campo Grande 79070-900, MS, Brazil; (A.P.D.A.B.); (A.C.J.); (T.M.-A.); (A.P.R.P.)
| | - Tamaeh Monteiro-Alfredo
- Laboratory of Protein Purification and Their Biological Functions, Food Technology and Public Health Unit, Federal University of Mato Grosso do Sul (UFMS), Campo Grande 79070-900, MS, Brazil; (A.P.D.A.B.); (A.C.J.); (T.M.-A.); (A.P.R.P.)
| | - Ana Paula Ramos Pereira
- Laboratory of Protein Purification and Their Biological Functions, Food Technology and Public Health Unit, Federal University of Mato Grosso do Sul (UFMS), Campo Grande 79070-900, MS, Brazil; (A.P.D.A.B.); (A.C.J.); (T.M.-A.); (A.P.R.P.)
| | - Maria Luiza Vilela Oliva
- Departamento de Bioquímica, Universidade Federal de São Paulo (UNIFESP), São Paulo 04023-062, SP, Brazil;
| | - Durvanei Augusto Maria
- Divisão de Ciências Fisiológicas e Químicas, Serviço de Bioquímica, Instituto Butantan, São Paulo 05585-000, SP, Brazil;
| | - Maria Lígia Rodrigues Macedo
- Laboratory of Protein Purification and Their Biological Functions, Food Technology and Public Health Unit, Federal University of Mato Grosso do Sul (UFMS), Campo Grande 79070-900, MS, Brazil; (A.P.D.A.B.); (A.C.J.); (T.M.-A.); (A.P.R.P.)
- Department of Pharmaceutical Sciences, Food, and Nutrition, Federal University of Mato Grosso do Sul, Campo Grande 79070-900, MS, Brazil
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Cornejo KM, Goyal A, Valencia Guerrero A, Astudillo M, Dias-Santagata D, Johnson MM, Feldman AS, Hoang MP. Clinicopathological and Molecular Features of Penile Melanoma With a Proposed Staging System. Am J Surg Pathol 2024; 48:825-833. [PMID: 38808927 DOI: 10.1097/pas.0000000000002247] [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: 05/30/2024]
Abstract
Penile melanomas (PM) are an exceedingly rare subtype of mucosal melanoma (MM), and we reviewed the clinicopathologic features and molecular profile in 8 PMs. The patient ages ranged from 46 to 78 (mean: 62.8) years with involvement on the glans (n=5; 62.5%), penile urethra (n=2; 25%), and foreskin (n=1, 12.5%). Tumor depth ranged from 1.6 to 10.0 (mean: 5.25) mm. Most of the patients underwent partial penectomy (n=6; 75%) and sentinel lymph node (LN) biopsy N=7; 87.5%). Seven patients had metastatic disease at diagnosis, 6 involving LNs and 1 the adrenal gland, and 4 died of disease with a mean follow-up period of 40.5 (2 to 95) months. Five of 7 (71%) cases identified 15 molecular alterations within KIT , CDKN2A , NF1 , PTEN , and APC (n=2 each), and NRAS , MAP3K1 , CDH1 , MSH6 , and TERT (n=1 each). Two cases were not found to harbor genetic aberrations, and 1 case failed testing. In addition, we reviewed the English literature and included 93 cases with a reported depth of invasion and follow-up. A total of 101 PMs were analyzed for prognostic parameters, and the overall survival was significantly worse in patients with LN metastasis (P=0.0008), distant metastasis (P=0.0016), and greater depth of invasion (P=0.0222) based upon T-stage. While T4 conferred substantially worse survival, the delineation of the survival curves between T2 and T3 was less clear, and combining T2+T3 disease had a strong prognostic impact ( P =0.0024). Prognostic parameters used in the staging of cutaneous melanomas may also be used in PMs. An alternative staging system expanding the inclusion criteria for T2 might provide a more accurate prognostic stratification.
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Affiliation(s)
- Kristine M Cornejo
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Amrita Goyal
- Department of Dermatology, University of Minnesota, Minneapolis, MN
| | | | | | - Dora Dias-Santagata
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | - Adam S Feldman
- Department of Urology, Massachusetts General Hospital, Boston, MA
| | - Mai P Hoang
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Samba S, Soufia EO, Bouhout T, Al Jarroudi O, Berhili S, Moukhlissi M, Brahmi SA, Serji B, Afqir S, Mezouar L. A Pigmented Lesion of the Vulva Revealing Aggressive Melanoma: A Case Report. Cureus 2024; 16:e60257. [PMID: 38872659 PMCID: PMC11170315 DOI: 10.7759/cureus.60257] [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] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
Vulvar melanoma (VM) is a rare and aggressive malignancy presenting unique challenges in diagnosis and management. This report presents the case of a 61-year-old female patient and explores the clinical characteristics, diagnostic modalities, treatment strategies, and prognosis associated with VM. The patient presented with a painless mass on the labia majora, which turned out to be an undifferentiated malignant tumor process consistent with melanoma on examination. Immunohistochemical analysis confirmed the diagnosis and subsequent imaging revealed metastatic disease necessitating palliative chemotherapy following radiotherapy. VM is a rare and aggressive form of melanoma. While surgery is the standard of care for early stages, advanced stages require a combination of immunotherapy and targeted treatments. Clinical trials are vital to improve our understanding of this condition and the various aspects of its care. Collaboration among experts is essential to achieve progress in managing these patients.
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Affiliation(s)
- Soumiya Samba
- Department of Radiation Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - El Ouardani Soufia
- Department of Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Tariq Bouhout
- Department of Surgical Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Ouissam Al Jarroudi
- Department of Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Soufiane Berhili
- Department of Radiation Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Mohamed Moukhlissi
- Department of Radiation Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Sami Aziz Brahmi
- Department of Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Badr Serji
- Department of Surgical Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Said Afqir
- Department of Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Loubna Mezouar
- Department of Radiation Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
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Hanba C, Hanna E. Head and Neck Mucosal Melanoma: Where Are We Now? Curr Oncol Rep 2024; 26:421-425. [PMID: 38512416 DOI: 10.1007/s11912-024-01513-w] [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] [Accepted: 02/29/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE OF REVIEW To highlight recent and relevant treatment considerations while managing mucosal melanoma. RECENT FINDINGS Evidence is building to support the use of targeted therapy and immunotherapy while managing mucosal melanoma. Surgical resection with postoperative radiotherapy plays a major role in managing resectable disease. Recent studies evaluate the addition of targeted, and immunotherapies with an attempt to determine the most efficacious sequence of treatment.
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Affiliation(s)
- Curtis Hanba
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Taiwan, Republic of China
- Department of Otolaryngology-Head and Neck Surgery, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Ehab Hanna
- Department of Otolaryngology-Head and Neck Surgery, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Stöth M, Scheich M, Hackenberg S, Scherzad A. [Diagnosis and therapy of sinonasal mucosal melanoma]. Laryngorhinootologie 2024; 103:59-69. [PMID: 38181776 DOI: 10.1055/a-2037-2954] [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: 01/07/2024]
Abstract
Sinonasal mucosal melanoma (SNMM) is a rare and aggressive disease representing only 4% of all sinonasal malignancies and 1.4% of all melanomas. With an incidence of approximately 0.2 to 2 cases per million, the disease represents a very rare cancer type. As a result, there is a lack of data and most of the evidence for this highly aggressive disease is based on retrospective observations and analyses. The standard of care is radical tumor resection followed by an adjuvant radiotherapy. Nevertheless, the rate of local recurrence is high, up to 50%. In addition, the majority of patients (up to 70%) develop distant metastases during the course of their disease. Both contribute to the extremely poor prognosis of the disease. Mucosal melanomas (SM) and cutaneous melanomas (CM) behave differently with respect to biology, clinic presentation and prognosis. Compared to CM, survival rates are significantly lower for SM. The 5-year survival rate is around 25% in SNMM but 39-97% in cutaneous melanoma. Similar to CM, immune checkpoint inhibitors achieve promising results in SM. However, response rates are lower in SM compared to CM. The goal of this CME article is to provide an overview on biology, diagnosis, therapy, and prognosis of SNMM.
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Sergi MC, Filoni E, Triggiano G, Cazzato G, Internò V, Porta C, Tucci M. Mucosal Melanoma: Epidemiology, Clinical Features, and Treatment. Curr Oncol Rep 2023; 25:1247-1258. [PMID: 37773078 PMCID: PMC10640506 DOI: 10.1007/s11912-023-01453-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/30/2023]
Abstract
PURPOSE OF REVIEW Summarize the writings published in the last years on the management and novel therapies of mucosal melanoma (MM). RECENT FINDINGS New research has demonstrated a difference between MM and cutaneous melanoma (CM) in their genomic and molecular landscapes, explaining the response's heterogeneity. Immunotherapy and targeted therapy have limited benefit, but novel therapies are rapidly expanding. MM is aggressive cancer occurring in gastrointestinal, respiratory, or urogenital mucosa; whose incidence is greater in the Asian population. The etiology and pathogenesis remain unclear since UV exposure is not a proven risk factor as in cutaneous melanoma. In contrast to CM, lesions on the mucosal surface are less likely to be recognized early; therefore, the disease is diagnosed in an advanced stage. Clinical manifestations, such as bleeding or pain, can help to detect this tumor, although the prognosis remains unfavorable with an overall 5-year survival rate of less than 20%. The mutational landscape of MM includes mutations of BRAF and NRAS, as well as mutations in the c-KIT/CD117 gene (in 50% of patients), thus limiting therapeutic interventions to immunotherapy. However, clinical studies show less responsiveness to immunotherapy compared to CM, therefore novel therapeutic strategies targeting new molecules are needed to improve the survival of patients with MM.
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Affiliation(s)
- Maria Chiara Sergi
- Department of Interdisciplinary Medicine, Oncology Unit, University of Bari "Aldo Moro", P.za Giulio Cesare, 11, 70124, Bari, Italy.
| | - Elisabetta Filoni
- Department of Interdisciplinary Medicine, Oncology Unit, University of Bari "Aldo Moro", P.za Giulio Cesare, 11, 70124, Bari, Italy
| | - Giacomo Triggiano
- Department of Interdisciplinary Medicine, Oncology Unit, University of Bari "Aldo Moro", P.za Giulio Cesare, 11, 70124, Bari, Italy
| | - Gerardo Cazzato
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", 70124, Bari, Italy
| | | | - Camillo Porta
- Department of Interdisciplinary Medicine, Oncology Unit, University of Bari "Aldo Moro", P.za Giulio Cesare, 11, 70124, Bari, Italy
| | - Marco Tucci
- Department of Interdisciplinary Medicine, Oncology Unit, University of Bari "Aldo Moro", P.za Giulio Cesare, 11, 70124, Bari, Italy
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