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Versluis JM, Hoefsmit EP, Shehwana H, Dimitriadis P, Sanders J, Broeks A, Blank CU. Tumor characteristics of dissociated response to immune checkpoint inhibition in advanced melanoma. Cancer Immunol Immunother 2024; 73:28. [PMID: 38280045 PMCID: PMC10821835 DOI: 10.1007/s00262-023-03581-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/14/2023] [Indexed: 01/29/2024]
Abstract
INTRODUCTION Immune checkpoint inhibition (ICI) has improved patients' outcomes in advanced melanoma, often resulting in durable response. However, not all patients have durable responses and the patients with dissociated response are a valuable subgroup to identify mechanisms of ICI resistance. METHODS Stage IV melanoma patients treated with ICI and dissociated response were retrospectively screened for available samples containing sufficient tumor at least at two time-points. Included were one patient with metachronous regressive and progressive lesions at the same site, two patients with regressive and novel lesion at different sites, and three patients with regressive and progressive lesions at different sites. In addition, four patients with acquired resistant tumor samples without a matched second sample were included. RESULTS In the majority of patients, the progressive tumor lesion contained higher CD8+ T cell counts/mm2 and interferon-gamma (IFNγ) signature level, but similar tumor PD-L1 expression. The tumor mutational burden levels were in 2 out 3 lesions higher compared to the corresponding regressive tumors lesion. In the acquired tumor lesions, high CD8+/mm2 and relatively high IFNγ signature levels were observed. In one patient in both the B2M and PTEN gene a stop gaining mutation and in another patient a pathogenic POLE mutation were found. CONCLUSION Intrapatient comparison of progressive versus regressive lesions indicates no defect in tumor T cell infiltration, and in general no tumor immune exclusion were observed.
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Affiliation(s)
- J M Versluis
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E P Hoefsmit
- Division of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H Shehwana
- Division of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - P Dimitriadis
- Division of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J Sanders
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Broeks
- Core Facility Molecular Pathology and Biobanking, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C U Blank
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
- Division of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
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Borgers JSW, Burgers FH, Schina A, Van Not OJ, van den Eertwegh AJM, Blank CU, Aarts MJB, van den Berkmortel FWPJ, de Groot JWB, Hospers GAP, Kapiteijn E, Piersma D, van Rijn RS, Boer AMSD, van der Veldt AAM, Vreugdenhil G, Boers-Sonderen MJ, Wouters MWJM, Suijkerbuijk KPM, van Thienen JV, Haanen JBAG. Seasonal variation of anti-PD-1 outcome in melanoma-Results from a Dutch patient cohort. Pigment Cell Melanoma Res 2024; 37:15-20. [PMID: 37554041 DOI: 10.1111/pcmr.13117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/09/2023] [Accepted: 07/22/2023] [Indexed: 08/10/2023]
Abstract
Despite the improved survival rates of patients with advanced stage melanoma since the introduction of ICIs, many patients do not have (long-term) benefit from these treatments. There is evidence that the exposome, an accumulation of host-extrinsic factors including environmental influences, could impact ICI response. Recently, a survival benefit was observed in patients with BRAF wild-type melanoma living in Denmark who initiated immunotherapy in summer as compared to winter. As the Netherlands lies in close geographical proximity to Denmark and has comparable seasonal differences, a Dutch validation cohort was established using data from our nationwide melanoma registry. In this study, we did not observe a similar seasonal difference in overall survival and are therefore unable to confirm the Danish findings. Validation of either the Dutch or Danish findings in (combined) patient cohorts from other countries would be necessary to determine whether this host-extrinsic factor influences the response to ICI-treatment.
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Affiliation(s)
- J S W Borgers
- Department of Medical Oncology, Antoni van Leeuwenhoek-The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - F H Burgers
- Department of Medical Oncology, Antoni van Leeuwenhoek-The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Schina
- National Center for Cancer Immune Therapy, Department of Oncology, Copenhagen University Hospital, Herlev, Denmark
| | - O J Van Not
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A J M van den Eertwegh
- Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - C U Blank
- Department of Medical Oncology, Antoni van Leeuwenhoek-The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M J B Aarts
- Department of Medical Oncology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | | | - G A P Hospers
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - E Kapiteijn
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - D Piersma
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - R S van Rijn
- Department of Internal Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | | | - A A M van der Veldt
- Department of Medical Oncology and Radiology & Nuclear Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - G Vreugdenhil
- Department of Internal Medicine, Maxima Medical Center, Veldhoven, The Netherlands
| | - M J Boers-Sonderen
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M W J M Wouters
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Surgical Oncology, Antoni van Leeuwenhoek-The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - K P M Suijkerbuijk
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J V van Thienen
- Department of Medical Oncology, Antoni van Leeuwenhoek-The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J B A G Haanen
- Department of Medical Oncology, Antoni van Leeuwenhoek-The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Schmitt C, Hoefsmit EP, Fangmeier T, Kramer N, Kabakci C, Vera González J, Versluis JM, Compter A, Harrer T, Mijočević H, Schubert S, Hundsberger T, Menzies AM, Scolyer RA, Long GV, French LE, Blank CU, Heinzerling LM. Immune checkpoint inhibitor-induced neurotoxicity is not associated with seroprevalence of neurotropic infections. Cancer Immunol Immunother 2023; 72:3475-3489. [PMID: 37606856 PMCID: PMC10576679 DOI: 10.1007/s00262-023-03498-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/07/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) substantially improve outcome for patients with cancer. However, the majority of patients develops immune-related adverse events (irAEs), which can be persistent and significantly reduce quality of life. Neurological irAEs occur in 1-5% of patients and can induce severe, permanent sequelae or even be fatal. In order to improve the diagnosis and treatment of neurological irAEs and to better understand their pathogenesis, we assessed whether previous neurotropic infections are associated with neurological irAEs. METHODS Neurotropic infections that might predispose to ICI-induced neurological irAEs were analyzed in 61 melanoma patients from 3 countries, the Netherlands, Australia and Germany, including 24 patients with neurotoxicity and 37 control patients. In total, 14 viral, 6 bacterial, and 1 protozoal infections previously reported to trigger neurological pathologies were assessed using routine serology testing. The Dutch and Australian cohorts (NL) included pre-treatment plasma samples of patients treated with neoadjuvant ICI therapy (OpACIN-neo and PRADO trials; NCT02977052). In the Dutch/Australian cohort a total of 11 patients with neurological irAEs were compared to 27 control patients (patients without neurological irAEs). The German cohort (LMU) consisted of serum samples of 13 patients with neurological irAE and 10 control patients without any documented irAE under ICI therapy. RESULTS The association of neurological irAEs with 21 possible preceding infections was assessed by measuring specific antibodies against investigated agents. The seroprevalence of all the tested viral (cytomegalovirus, Epstein-Barr-Virus, varicella-zoster virus, measles, rubella, influenza A and B, human herpes virus 6 and 7, herpes simplex virus 1 and 2, parvovirus B19, hepatitis A and E and human T-lymphotropic virus type 1 and 2), bacterial (Borrelia burgdorferi sensu lato, Campylobacter jejuni, Mycoplasma pneumoniae, Coxiella burnetti, Helicobacter pylori, Yersinia enterocolitica and Y. pseudotuberculosis) and protozoal (Toxoplasma gondii) infections was similar for patients who developed neurological irAEs as compared to control patients. Thus, the analysis provided no evidence for an association of described agents tested for seroprevalence with ICI induced neurotoxicity. CONCLUSION Previous viral, bacterial and protozoal neurotropic infections appear not to be associated with the development of neurological irAEs in melanoma patients who underwent therapy with ICI across 3 countries. Further efforts are needed to unravel the factors underlying neurological irAEs in order to identify risk factors for these toxicities, especially with the increasing use of ICI in earlier stage disease.
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Affiliation(s)
- C Schmitt
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - E P Hoefsmit
- Department of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - T Fangmeier
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - N Kramer
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - C Kabakci
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - J Vera González
- Department of Dermatology, Uniklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - J M Versluis
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Compter
- Department of Neuro-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - T Harrer
- Department of Internal Medicine 3, Infectious Diseases and Immunodeficiency Section, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Deutsches Zentrum Für Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - H Mijočević
- Max Von Pettenkofer Institute of Hygiene and Medical Microbiology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - S Schubert
- Max Von Pettenkofer Institute of Hygiene and Medical Microbiology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - T Hundsberger
- Departments of Neurology and Medical Oncology/Haematology, Cantonal Hospital, St. Gallen, Switzerland
| | - A M Menzies
- Melanoma Institute of Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - R A Scolyer
- Melanoma Institute of Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - G V Long
- Melanoma Institute of Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - L E French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
- Dr. Philip Frost, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - C U Blank
- Department of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - L M Heinzerling
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany.
- Department of Dermatology, Uniklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany.
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Egeler MD, van de Poll-Franse LV, Tissier R, Rogiers A, Boers-Sonderen MJ, van den Eertwegh AJ, Hospers GA, de Groot JWB, Aarts MJB, Kapiteijn E, Piersma D, Vreugdenhil G, van der Veldt AA, Suijkerbuijk KPM, Neyns B, Janssen KJ, Blank CU, Retèl VP, Boekhout AH. Health-state utilities in long-term advanced melanoma survivors comparable with the general population. Qual Life Res 2023; 32:2517-2525. [PMID: 37079262 DOI: 10.1007/s11136-023-03427-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Checkpoint inhibitors have been shown to substantially improve the survival of patients with advanced melanoma. With this growing group of survivors treated with immunotherapies, assessing their health-state utilities is essential and can be used for the calculation of quality-adjusted life years and for cost-effectiveness analyses. Therefore, we evaluated the health-state utilities in long-term advanced melanoma survivors. METHODS Health-state utilities were evaluated in a cohort of advanced melanoma survivors 24-36 months (N = 37) and 36-plus months (N = 47) post-ipilimumab monotherapy. In addition, the health-state utilities of the 24-36 months survivor group were assessed longitudinally, and utilities of the combined survival groups (N = 84) were compared with a matched control population (N = 168). The EQ-5D was used to generate health-state utility values, and quality-of-life questionnaires were used to establish correlations and influencing factors of utility scores. RESULTS Health-state utility scores were similar between the 24-36 months'- and the 36-plus months' survival group (0.81 vs 0.86; p = .22). In survivors, lower utility scores were associated with symptoms of depression (β = - .82, p = .022) and fatigue burden (β = - .29, p = .007). Utility scores did not significantly change after 24-36 months of survival, and the utilities of survivors were comparable to the matched control population (0.84 vs 0.87; p = .07). DISCUSSION Our results show that long-term advanced melanoma survivors treated with ipilimumab monotherapy experience relatively stable and high health-state utility scores.
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Affiliation(s)
- M D Egeler
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - L V van de Poll-Franse
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Medical and Clinical Psychology, Center of Research On Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - R Tissier
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - A Rogiers
- Department of Psychiatry, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium
| | - M J Boers-Sonderen
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A J van den Eertwegh
- Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - G A Hospers
- Department of Medical Oncology, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - M J B Aarts
- Department of Medical Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - E Kapiteijn
- Leiden University Medical Centre, Leiden, The Netherlands
| | - D Piersma
- Medical Spectrum Twente, Enschede, The Netherlands
| | - G Vreugdenhil
- Department of Internal Medicine, Maxima Medical Centre, Eindhoven, The Netherlands
| | - A A van der Veldt
- Departments of Medical Oncology and Radiology & Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - K P M Suijkerbuijk
- Department of Medical Oncology, University Medical Cancer Center, Utrecht, The Netherlands
| | - B Neyns
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - K J Janssen
- Bristol-Myers Squibb, Utrecht, The Netherlands
| | - C U Blank
- Department of Medical Oncology, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - V P Retèl
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Health Technology & Services Research, University of Twente, Enschede, The Netherlands
| | - A H Boekhout
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Groenland SL, Janssen JM, Nijenhuis CM, de Vries N, Rosing H, Wilgenhof S, van Thienen JV, Haanen JBAG, Blank CU, Beijnen JH, Huitema ADR, Steeghs N. Exposure-response analyses of BRAF- and MEK-inhibitors dabrafenib plus trametinib in melanoma patients. Cancer Chemother Pharmacol 2023; 91:447-456. [PMID: 36947208 DOI: 10.1007/s00280-023-04517-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/25/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Dabrafenib and trametinib are currently administered at fixed doses, at which interpatient variability in exposure is high. The aim of this study was to investigate whether drug exposure is related to efficacy and toxicity in a real-life cohort of melanoma patients treated with dabrafenib plus trametinib. PATIENTS AND METHODS An observational study was performed in which pharmacokinetic samples were collected as routine care. Using estimated dabrafenib Area Under the concentration-time Curve and trametinib trough concentrations (Cmin), univariable and multivariable exposure-response analyses were performed. RESULTS In total, 140 patients were included. Dabrafenib exposure was not related to either progression-free survival (PFS) or overall survival (OS). Trametinib exposure was related to survival, with Cmin ≥ 15.6 ng/mL being identified as the optimal threshold. Median OS was significantly longer in patients with trametinib Cmin ≥ 15.6 ng/mL (22.8 vs. 12.6 months, P = 0.003), with a multivariable hazard ratio of 0.55 (95% CI 0.36-0.85, P = 0.007). Median PFS in patients with trametinib Cmin levels ≥ 15.6 ng/mL (37%) was 10.9 months, compared with 6.0 months for those with Cmin below this threshold (P = 0.06). Multivariable analysis resulted in a hazard ratio of 0.70 (95% CI 0.47-1.05, P = 0.082). Exposure to dabrafenib and trametinib was not related to clinically relevant toxicities. CONCLUSIONS Overall survival of metastasized melanoma patients with trametinib Cmin levels ≥ 15.6 ng/mL is ten months longer compared to patients with Cmin below this threshold. This would theoretically provide a rationale for therapeutic drug monitoring of trametinib. Although a high proportion of patients are underexposed, there is very little scope for dose increments due to the risk of serious toxicity.
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Affiliation(s)
- Stefanie L Groenland
- Division of Medical Oncology, Department of Clinical Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - J M Janssen
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C M Nijenhuis
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - N de Vries
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H Rosing
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S Wilgenhof
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J V van Thienen
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J B A G Haanen
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C U Blank
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J H Beijnen
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - A D R Huitema
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Pharmacology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - N Steeghs
- Division of Medical Oncology, Department of Clinical Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
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Versluis JM, Menzies AM, Sikorska K, Rozeman EA, Saw RPM, van Houdt WJ, Eriksson H, Klop WMC, Ch'ng S, van Thienen JV, Mallo H, Gonzalez M, Torres Acosta A, Grijpink-Ongering LG, van der Wal A, Bruining A, van de Wiel BA, Scolyer RA, Haanen JBAG, Schumacher TN, van Akkooi ACJ, Long GV, Blank CU. Survival update of neoadjuvant ipilimumab plus nivolumab in macroscopic stage III melanoma in the OpACIN and OpACIN-neo trials. Ann Oncol 2023; 34:420-430. [PMID: 36681299 DOI: 10.1016/j.annonc.2023.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/20/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Neoadjuvant ipilimumab plus nivolumab has yielded high response rates in patients with macroscopic stage III melanoma. These response rates translated to high short-term survival rates. However, data on long-term survival and disease recurrence are lacking. PATIENTS AND METHODS In OpACIN, 20 patients with macroscopic stage III melanoma were randomized to ipilimumab 3 mg/kg plus nivolumab 1 mg/kg q3w four cycles of adjuvant or split two cycles of neoadjuvant and two adjuvant. In OpACIN-neo, 86 patients with macroscopic stage III melanoma were randomized to arm A (2× ipilimumab 3 mg/kg plus nivolumab 1 mg/kg q3w; n = 30), arm B (2× ipilimumab 1 mg/kg plus nivolumab 3 mg/kg q3w; n = 30), or arm C (2× ipilimumab 3 mg/kg q3w plus 2× nivolumab 3 mg/kg q2w; n = 26) followed by surgery. RESULTS The median recurrence-free survival (RFS) and overall survival (OS) were not reached in either trial. After a median follow-up of 69 months for OpACIN, 1/7 patients with a pathologic response to neoadjuvant therapy had disease recurrence. The estimated 5-year RFS and OS rates for the neoadjuvant arm were 70% and 90% versus 60% and 70% for the adjuvant arm. After a median follow-up of 47 months for OpACIN-neo, the estimated 3-year RFS and OS rates were 82% and 92%, respectively. The estimated 3-year RFS rate for OpACIN-neo was 95% for patients with a pathologic response versus 37% for patients without a pathologic response (P < 0.001). In multiple regression analyses, pathologic response was the strongest predictor of disease recurrence. Of the 12 patients with distant disease recurrence after neoadjuvant therapy, 5 responded to subsequent anti-PD-1 and 8 to targeted therapy, although 7 patients showed progression after the initial response. CONCLUSIONS Updated data confirm the high survival rates after neoadjuvant combination checkpoint inhibition in macroscopic stage III melanoma, especially for patients with a pathologic response. Pathologic response is the strongest surrogate marker for long-term outcome.
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Affiliation(s)
- J M Versluis
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney; Faculty of Medicine and Health, The University of Sydney, Sydney; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, Australia
| | - K Sikorska
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E A Rozeman
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R P M Saw
- Melanoma Institute Australia, The University of Sydney, Sydney; Faculty of Medicine and Health, The University of Sydney, Sydney; Department of Surgery, Mater Hospital, Sydney; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - W J van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H Eriksson
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm; Department of Oncology/Skin Cancer Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - W M C Klop
- Departments of, Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - S Ch'ng
- Melanoma Institute Australia, The University of Sydney, Sydney; Department of Surgery, Mater Hospital, Sydney; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - J V van Thienen
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H Mallo
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M Gonzalez
- Melanoma Institute Australia, The University of Sydney, Sydney
| | - A Torres Acosta
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - A van der Wal
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Bruining
- Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - B A van de Wiel
- Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney; Faculty of Medicine and Health, The University of Sydney, Sydney; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney; Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - J B A G Haanen
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam
| | - T N Schumacher
- Department of Hematology, Leiden University Medical Center, Leiden; Division of Molecular Oncology and Immunology, Oncode Institute, Netherlands Cancer Institute, Amsterdam
| | - A C J van Akkooi
- Melanoma Institute Australia, The University of Sydney, Sydney; Faculty of Medicine and Health, The University of Sydney, Sydney; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - G V Long
- Melanoma Institute Australia, The University of Sydney, Sydney; Faculty of Medicine and Health, The University of Sydney, Sydney; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, Australia; Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - C U Blank
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam; Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands.
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Borgers JSW, Burgers FH, Terveer EM, van Leerdam ME, Korse CM, Kessels R, Flohil CC, Blank CU, Schumacher TN, van Dijk M, Henderickx JGE, Keller JJ, Verspaget HW, Kuijper EJ, Haanen JBAG. Conversion of unresponsiveness to immune checkpoint inhibition by fecal microbiota transplantation in patients with metastatic melanoma: study protocol for a randomized phase Ib/IIa trial. BMC Cancer 2022; 22:1366. [PMID: 36585700 PMCID: PMC9801532 DOI: 10.1186/s12885-022-10457-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The gut microbiome plays an important role in immune modulation. Specifically, presence or absence of certain gut bacterial taxa has been associated with better antitumor immune responses. Furthermore, in trials using fecal microbiota transplantation (FMT) to treat melanoma patients unresponsive to immune checkpoint inhibitors (ICI), complete responses (CR), partial responses (PR), and durable stable disease (SD) have been observed. However, the underlying mechanism determining which patients will or will not respond and what the optimal FMT composition is, has not been fully elucidated, and a discrepancy in microbial taxa associated with clinical response has been observed between studies. Furthermore, it is unknown whether a change in the microbiome itself, irrespective of its origin, or FMT from ICI responding donors, is required for reversion of ICI-unresponsiveness. To address this, we will transfer microbiota of either ICI responder or nonresponder metastatic melanoma patients via FMT. METHODS In this randomized, double-blinded phase Ib/IIa trial, 24 anti-PD1-refractory patients with advanced stage cutaneous melanoma will receive an FMT from either an ICI responding or nonresponding donor, while continuing anti-PD-1 treatment. Donors will be selected from patients with metastatic melanoma treated with anti-PD-1 therapy. Two patients with a good response (≥ 30% decrease according to RECIST 1.1 within the past 24 months) and two patients with progression (≥ 20% increase according to RECIST 1.1 within the past 3 months) will be selected as ICI responding or nonresponding donors, respectively. The primary endpoint is clinical benefit (SD, PR or CR) at 12 weeks, confirmed on a CT scan at 16 weeks. The secondary endpoint is safety, defined as the occurrence of grade ≥ 3 toxicity. Exploratory endpoints are progression-free survival and changes in the gut microbiome, metabolome, and immune cells. DISCUSSION Transplanting fecal microbiota to restore the patients' perturbed microbiome has proven successful in several indications. However, less is known about the potential role of FMT to improve antitumor immune response. In this trial, we aim to investigate whether administration of FMT can reverse resistance to anti-PD-1 treatment in patients with advanced stage melanoma, and whether the ICI-responsiveness of the feces donor is associated with its effectiveness. TRIAL REGISTRATION ClinicalTrials.gov: NCT05251389 (registered 22-Feb-2022). Protocol V4.0 (08-02-2022).
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Affiliation(s)
- J. S. W. Borgers
- grid.430814.a0000 0001 0674 1393Department of Medical Oncology, Antoni Van Leeuwenhoek, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - F. H. Burgers
- grid.430814.a0000 0001 0674 1393Department of Medical Oncology, Antoni Van Leeuwenhoek, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - E. M. Terveer
- grid.10419.3d0000000089452978Netherlands Donor Feces Bank, Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands ,grid.10419.3d0000000089452978Center for Microbiome Analyses and Therapeutics at Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M. E. van Leerdam
- grid.430814.a0000 0001 0674 1393Department of Gastrointestinal Oncology, Antoni Van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands ,grid.10419.3d0000000089452978Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - C. M. Korse
- grid.430814.a0000 0001 0674 1393Department of Laboratory Medicine, Antoni Van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R. Kessels
- grid.430814.a0000 0001 0674 1393Department of Biometrics, Antoni Van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C. C. Flohil
- grid.430814.a0000 0001 0674 1393Department of Pathology, Antoni Van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C. U. Blank
- grid.430814.a0000 0001 0674 1393Department of Medical Oncology, Antoni Van Leeuwenhoek, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - T. N. Schumacher
- grid.430814.a0000 0001 0674 1393Division of Molecular Oncology and Immunology, Oncode Institute, The Netherlands Cancer Institute, Amsterdam, The Netherlands ,grid.10419.3d0000000089452978Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - M. van Dijk
- grid.430814.a0000 0001 0674 1393Clinical Trial Service Unit, Antoni Van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J. G. E. Henderickx
- grid.10419.3d0000000089452978Center for Microbiome Analyses and Therapeutics at Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J. J. Keller
- grid.10419.3d0000000089452978Netherlands Donor Feces Bank, Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands ,grid.10419.3d0000000089452978Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands ,grid.414842.f0000 0004 0395 6796Department of Gastroenterology, Haaglanden Medical Center, Den Haag, The Netherlands
| | - H. W. Verspaget
- grid.10419.3d0000000089452978Netherlands Donor Feces Bank, Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands ,grid.10419.3d0000000089452978Department of Biobanking, Leiden University Medical Center, Leiden, The Netherlands
| | - E. J. Kuijper
- grid.10419.3d0000000089452978Netherlands Donor Feces Bank, Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands ,grid.10419.3d0000000089452978Center for Microbiome Analyses and Therapeutics at Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J. B. A. G. Haanen
- grid.430814.a0000 0001 0674 1393Department of Medical Oncology, Antoni Van Leeuwenhoek, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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8
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Dimitriou F, Namikawa K, Reijers ILM, Buchbinder EI, Soon JA, Zaremba A, Teterycz P, Mooradian MJ, Armstrong E, Nakamura Y, Vitale MG, Tran LE, Bai X, Allayous C, Provent-Roy S, Indini A, Bhave P, Farid M, Kähler KC, Mehmi I, Atkinson V, Klein O, Stonesifer CJ, Zaman F, Haydon A, Carvajal RD, Hamid O, Dummer R, Hauschild A, Carlino MS, Mandala M, Robert C, Lebbe C, Guo J, Johnson DB, Ascierto PA, Shoushtari AN, Sullivan RJ, Cybulska-Stopa B, Rutkowski P, Zimmer L, Sandhu S, Blank CU, Lo SN, Menzies AM, Long GV. Single-agent anti-PD-1 or combined with ipilimumab in patients with mucosal melanoma: an international, retrospective, cohort study. Ann Oncol 2022; 33:968-980. [PMID: 35716907 DOI: 10.1016/j.annonc.2022.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/15/2022] [Accepted: 06/07/2022] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Mucosal melanoma (MM) is a rare melanoma subtype with distinct biology and poor prognosis. Data on the efficacy of immune checkpoint inhibitors (ICIs) is limited. We determined the efficacy of ICIs in MM, analysed by primary site and ethnicity/race. PATIENTS AND METHODS Retrospective cohort study from 25 cancer centres in Australia, Europe, USA and Asia. Patients with histologically confirmed MM were treated with anti-PD1+/-ipilimumab. Primary endpoints were response rate (RR), progression-free survival (PFS), overall survival (OS) by primary site (naso-oral, urogenital, anorectal, other), ethnicity/race (Caucasian, Asian, Other) and treatment. Univariate and multivariate Cox proportional hazard model analyses were conducted. RESULTS In total, 545 patients were included: 331 (63%) Caucasian, 176 (33%) Asian and 20 (4%) Other. Primary sites included 113 (21%) anorectal, 178 (32%) urogenital, 206 (38%) naso-oral and 45 (8%) other. 348 (64%) received anti-PD1 and 197 (36%) anti-PD1/ipilimumab. RR, PFS and OS did not differ by primary site, ethnicity/race or treatment. RR for naso-oral was numerically higher for anti-PD1/ipilimumab (40%, 95% CI 29-54%) compared with anti-PD1 (29%, 95% CI 21-37%). 35% of patients that initially responded progressed. Median duration of response (mDOR) was 26 months (95% CI 18-NR [Not Reached]). Factors associated with short PFS were ECOG PS ≥3 (p<0.01), LDH >ULN (p=0.01), lung metastases (p<0.01) and ≥1 previous treatments (p<0.01). Factors associated with short OS were ECOG PS ≥1 (p<0.01), LDH >ULN (p=0.03), lung metastases (p<0.01) and ≥1 previous treatments (p<0.01). CONCLUSIONS MM has poor prognosis. Treatment efficacy of anti-PD1+/-ipilimumab was similar and did not differ by ethnicity/race. Naso-oral primaries had numerically higher response to anti-PD1/ipilimumab, without difference in survival. The addition of ipilimumab did not show greater benefit over anti-PD1 for other primary sites. In responders, mDOR was short and acquired resistance was common. Other factors, including site and number of metastases were associated with survival.
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Affiliation(s)
- F Dimitriou
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Department of Dermatology, University Hospital Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - K Namikawa
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - I L M Reijers
- Department of Medical Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E I Buchbinder
- Melanoma Disease Center, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02481, USA
| | - J A Soon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - A Zaremba
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - P Teterycz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, 49585Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - M J Mooradian
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - E Armstrong
- Department of Medicine, Melanoma Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Y Nakamura
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
| | - M G Vitale
- Istituto Nazionale Tumori IRCCS Fondazione 'G. Pascale', Napoli, Italy
| | - L E Tran
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - X Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - C Allayous
- APHP Hôpital Saint-Louis, Dermatology Department, DMU ICARE, Paris, France
| | - S Provent-Roy
- Dermatology Service, Department of Medicine, Gustave Roussy and Paris-Saclay University, Villejuif, France
| | - A Indini
- Unit of Medical Oncology, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - P Bhave
- Westmead and Blacktown Hospitals, Sydney, New South Wales, Australia
| | - M Farid
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - K C Kähler
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - I Mehmi
- Department of Hematology/Oncology, The Angeles Clinic and Research Institute, a Cedars-Sinai Affiliate, 11800 Wilshire Blvd Suite 300, Los Angeles, CA, 90025, USA
| | - V Atkinson
- Princess Alexandra Hospital, Greenslopes Private Hospital, University of Queensland, Queensland, Australia
| | - O Klein
- Department of Medical Oncology, Austin Health, Melbourne, Australia; Olivia Newton-John Cancer Research Institute, Melbourne, Victoria
| | - C J Stonesifer
- Columbia University Irving Medical Center, New York City, New York, USA
| | - F Zaman
- Alfred Hospital, Melbourne, Victoria, Australia
| | - A Haydon
- Alfred Hospital, Melbourne, Victoria, Australia
| | - R D Carvajal
- Columbia University Irving Medical Center, New York City, New York, USA
| | - O Hamid
- Department of Hematology/Oncology, The Angeles Clinic and Research Institute, a Cedars-Sinai Affiliate, 11800 Wilshire Blvd Suite 300, Los Angeles, CA, 90025, USA
| | - R Dummer
- Department of Dermatology, University Hospital Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland
| | - A Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - M S Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Westmead and Blacktown Hospitals, Sydney, New South Wales, Australia
| | - M Mandala
- Unit of Medical Oncology, University of Perugia, Perugia, Italy
| | - C Robert
- Dermatology Service, Department of Medicine, Gustave Roussy and Paris-Saclay University, Villejuif, France
| | - C Lebbe
- Université de Paris, APHP Hôpital Saint-Louis, Dermatology Department, DMU ICARE, INSERM U-976, Paris, France
| | - J Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - D B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - P A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione 'G. Pascale', Napoli, Italy
| | - A N Shoushtari
- Department of Medicine, Melanoma Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - R J Sullivan
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - B Cybulska-Stopa
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Poland
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, 49585Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - L Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - S Sandhu
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - C U Blank
- Department of Medical Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - A M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - G V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia.
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9
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Tong TML, van der Kooij MK, Speetjens FM, van Erkel AR, van der Meer RW, Lutjeboer J, van Persijn van Meerten EL, Martini CH, Zoethout RWM, Tijl FGJ, Blank CU, Burgmans MC, Kapiteijn E. Combining Hepatic Percutaneous Perfusion with Ipilimumab plus Nivolumab in advanced uveal melanoma (CHOPIN): study protocol for a phase Ib/randomized phase II trial. Trials 2022; 23:137. [PMID: 35152908 PMCID: PMC8842930 DOI: 10.1186/s13063-022-06036-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/16/2022] [Indexed: 12/23/2022] Open
Abstract
Background While immune checkpoint inhibition (ICI) has revolutionized the treatment of metastatic cutaneous melanoma, no standard treatments are available for patients with metastatic uveal melanoma (UM). Several locoregional therapies are effective in the treatment of liver metastases, such as percutaneous hepatic perfusion with melphalan (M-PHP). The available literature suggests that treatment with ICI following locoregional treatment of liver UM metastases can result in clinical response. We hypothesize that combining M-PHP with ICI will lead to enhanced antigen presentation and increased immunomodulatory effect, improving control of both hepatic and extrahepatic disease. Methods Open-label, single-center, phase Ib/randomized phase II trial, evaluating the safety and efficacy of the combination of M-PHP with ipilimumab (anti-CTLA-4 antibody) and nivolumab (anti-PD-1 antibody) in patients with unresectable hepatic metastases of UM in first-line treatment, with or without the limited extrahepatic disease. The primary objective is to determine the safety, toxicity, and efficacy of the combination regimen, defined by maximum tolerated dose (MTD) and progression-free survival (PFS) at 1 year. Secondary objectives include overall survival (OS) and overall response rate (ORR). A maximum of 88 patients will be treated in phase I and phase II combined. Baseline characteristics will be described with descriptive statistics (t-test, chi-square test). To study the association between risk factors and toxicity, a logistic regression model will be applied. PFS and OS will be summarized using Kaplan-Meier curves. Discussion This is the first trial to evaluate this treatment combination by establishing the maximum tolerated dose and evaluating the efficacy of the combination treatment. M-PHP has shown to be a safe and effective treatment for UM patients with liver metastases and became the standard treatment option in our center. The combination of ICI with M-PHP is investigated in the currently described trial which might lead to a better treatment response both in and outside the liver. Trial Registration This trial was registered in the US National Library of Medicine with identifier NCT04283890. Registered as per February 2020 - Retrospectively registered. EudraCT registration number: 2018-004248-49. Local MREC registration number: NL60508.058.19.
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10
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Suijkerbuijk KPM, Haanen JBAG, Boers-Sonderen MJ, Hospers GAP, Blank CU, van den Berkmortel FWPJ, de Groot JWB, Piersma D, Aarts MJB, van Rijn RS, Vreugdenhil G, Westgeest HM, Kapiteijn E, van der Veldt AAM, van den Eertwegh AJM. Survival of stage IV melanoma in Belgium and the Netherlands. J Eur Acad Dermatol Venereol 2021; 36:e118-e119. [PMID: 34536304 DOI: 10.1111/jdv.17668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/11/2021] [Indexed: 12/31/2022]
Affiliation(s)
- K P M Suijkerbuijk
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J B A G Haanen
- Department of Medical Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M J Boers-Sonderen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G A P Hospers
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - C U Blank
- Department of Medical Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | - D Piersma
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - M J B Aarts
- Department of Medical Oncology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R S van Rijn
- Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - G Vreugdenhil
- Department of Internal Medicine, Maxima Medical Center, Eindhoven, The Netherlands
| | - H M Westgeest
- Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands
| | - E Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - A A M van der Veldt
- Departments of Medical Oncology and Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A J M van den Eertwegh
- Department of Medical Oncology, Amsterdam UMC, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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11
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Owen CN, Bai X, Quah T, Lo SN, Allayous C, Callaghan S, Martínez-Vila C, Wallace R, Bhave P, Reijers ILM, Thompson N, Vanella V, Gerard CL, Aspeslagh S, Labianca A, Khattak A, Mandala M, Xu W, Neyns B, Michielin O, Blank CU, Welsh SJ, Haydon A, Sandhu S, Mangana J, McQuade JL, Ascierto PA, Zimmer L, Johnson DB, Arance A, Lorigan P, Lebbé C, Carlino MS, Sullivan RJ, Long GV, Menzies AM. Delayed immune-related adverse events with anti-PD-1-based immunotherapy in melanoma. Ann Oncol 2021; 32:917-925. [PMID: 33798657 DOI: 10.1016/j.annonc.2021.03.204] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/09/2021] [Accepted: 03/28/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Immune-related adverse events (irAEs) typically occur within 4 months of starting anti-programmed cell death protein 1 (PD-1)-based therapy [anti-PD-1 ± anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA4)], but delayed irAEs (onset >12 months after commencement) can also occur. This study describes the incidence, nature and management of delayed irAEs in patients receiving anti-PD-1-based immunotherapy. PATIENTS AND METHODS Patients with delayed irAEs from 20 centres were studied. The incidence of delayed irAEs was estimated as a proportion of melanoma patients treated with anti-PD-1-based therapy and surviving >1 year. Onset, clinical features, management and outcomes of irAEs were examined. RESULTS One hundred and eighteen patients developed a total of 140 delayed irAEs (20 after initial combination with anti-CTLA4), with an estimated incidence of 5.3% (95% confidence interval 4.0-6.9, 53/999 patients at sites with available data). The median onset of delayed irAE was 16 months (range 12-53 months). Eighty-seven patients (74%) were on anti-PD-1 at irAE onset, 15 patients (12%) were <3 months from the last dose and 16 patients (14%) were >3 months from the last dose of anti-PD-1. The most common delayed irAEs were colitis, rash and pneumonitis; 55 of all irAEs (39%) were ≥grade 3. Steroids were required in 80 patients (68%), as well as an additional immunosuppressive agent in 27 patients (23%). There were two irAE-related deaths: encephalitis with onset during anti-PD-1 and a multiple-organ irAE with onset 11 months after ceasing anti-PD-1. Early irAEs (<12 months) had also occurred in 69 patients (58%), affecting a different organ from the delayed irAE in 59 patients (86%). CONCLUSIONS Delayed irAEs occur in a small but relevant subset of patients. Delayed irAEs are often different from previous irAEs, may be high grade and can lead to death. They mostly occur in patients still receiving anti-PD-1. The risk of delayed irAE should be considered when deciding the duration of treatment in responding patients. However, patients who stop treatment may also rarely develop delayed irAE.
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Affiliation(s)
- C N Owen
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - X Bai
- Massachusetts General Hospital, Boston, USA; Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - T Quah
- Westmead and Blacktown Hospitals, Sydney, Australia
| | - S N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - C Allayous
- Dermatology Department, Université de Paris, AP-HP Saint-Louis Hospital, INSERM, Paris, France
| | - S Callaghan
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - R Wallace
- Peter MacCallum Cancer Centre and the University of Melbourne, Melbourne, Australia
| | - P Bhave
- The Alfred Hospital, Melbourne, Australia
| | - I L M Reijers
- Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - N Thompson
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - V Vanella
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - C L Gerard
- Lausanne University Hospital, Lausanne, Switzerland
| | - S Aspeslagh
- University Hospital Brussels, Brussels, Belgium
| | - A Labianca
- Papa Giovanni XXIII Cancer Center Hospital, Bergamo, Italy
| | - A Khattak
- Fiona Stanley Hospital and Edith Cowan University, Perth, Australia
| | - M Mandala
- University of Perugia, Unit of Medical Oncology, Santa Maria misericordia hospital, Perugia, Italy
| | - W Xu
- Princess Alexandra Hospital and The University of Queensland, Brisbane, Australia
| | - B Neyns
- University Hospital Brussels, Brussels, Belgium
| | - O Michielin
- Lausanne University Hospital, Lausanne, Switzerland
| | - C U Blank
- Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S J Welsh
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Haydon
- The Alfred Hospital, Melbourne, Australia
| | - S Sandhu
- Peter MacCallum Cancer Centre and the University of Melbourne, Melbourne, Australia
| | - J Mangana
- Dermatology, Department of Dermato-Oncology, University Hospital Zurich, Zürich, Switzerland
| | - J L McQuade
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - P A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - L Zimmer
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - D B Johnson
- Vanderbilt University Medical Center, Nashville, USA
| | - A Arance
- Hospital Clinic Barcelona, Barcelona, Spain
| | - P Lorigan
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
| | - C Lebbé
- Dermatology Department, Université de Paris, AP-HP Saint-Louis Hospital, INSERM, Paris, France
| | - M S Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Westmead and Blacktown Hospitals, Sydney, Australia
| | | | - G V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia.
| | - A M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
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Rawson RV, Adhikari C, Bierman C, Lo SN, Shklovskaya E, Rozeman EA, Menzies AM, van Akkooi ACJ, Shannon KF, Gonzalez M, Guminski AD, Tetzlaff MT, Stretch JR, Eriksson H, van Thienen JV, Wouters MW, Haanen JBAG, Klop WMC, Zuur CL, van Houdt WJ, Nieweg OE, Ch'ng S, Rizos H, Saw RPM, Spillane AJ, Wilmott JS, Blank CU, Long GV, van de Wiel BA, Scolyer RA. Pathological response and tumour bed histopathological features correlate with survival following neoadjuvant immunotherapy in stage III melanoma. Ann Oncol 2021; 32:766-777. [PMID: 33744385 DOI: 10.1016/j.annonc.2021.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Guidelines for pathological evaluation of neoadjuvant specimens and pathological response categories have been developed by the International Neoadjuvant Melanoma Consortium (INMC). As part of the Optimal Neo-adjuvant Combination Scheme of Ipilimumab and Nivolumab (OpACIN-neo) clinical trial of neoadjuvant combination anti-programmed cell death protein 1/anti-cytotoxic T-lymphocyte-associated protein 4 immunotherapy for stage III melanoma, we sought to determine interobserver reproducibility of INMC histopathological assessment principles, identify specific tumour bed histopathological features of immunotherapeutic response that correlated with recurrence and relapse-free survival (RFS) and evaluate proposed INMC pathological response categories for predicting recurrence and RFS. PATIENTS AND METHODS Clinicopathological characteristics of lymph node dissection specimens of 83 patients enrolled in the OpACIN-neo clinical trial were evaluated. Two methods of assessing histological features of immunotherapeutic response were evaluated: the previously described immune-related pathologic response (irPR) score and our novel immunotherapeutic response score (ITRS). For a subset of cases (n = 29), cellular composition of the tumour bed was analysed by flow cytometry. RESULTS There was strong interobserver reproducibility in assessment of pathological response (κ = 0.879) and percentage residual viable melanoma (intraclass correlation coefficient = 0.965). The immunotherapeutic response subtype with high fibrosis had the strongest association with lack of recurrence (P = 0.008) and prolonged RFS (P = 0.019). Amongst patients with criteria for pathological non-response (pNR, >50% viable tumour), all who recurred had ≥70% viable melanoma. Higher ITRS and irPR scores correlated with lack of recurrence in the entire cohort (P = 0.002 and P ≤ 0.0001). The number of B lymphocytes was significantly increased in patients with a high fibrosis subtype of treatment response (P = 0.046). CONCLUSIONS There is strong reproducibility for assessment of pathological response using INMC criteria. Immunotherapeutic response of fibrosis subtype correlated with improved RFS, and may represent a biomarker. Potential B-cell contribution to fibrosis development warrants further study. Reclassification of pNR to a threshold of ≥70% viable melanoma and incorporating additional criteria of <10% fibrosis subtype of response may identify those at highest risk of recurrence, but requires validation.
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Affiliation(s)
- R V Rawson
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Departments of Tissue Pathology and Diagnostic Oncology, Sydney, Australia; Department of Melanoma Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia; NSW Health Pathology, Sydney, Australia
| | - C Adhikari
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Departments of Tissue Pathology and Diagnostic Oncology, Sydney, Australia; Department of Melanoma Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia; NSW Health Pathology, Sydney, Australia
| | - C Bierman
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - E Shklovskaya
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - E A Rozeman
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| | | | - K F Shannon
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Departments of Tissue Pathology and Diagnostic Oncology, Sydney, Australia; Department of Melanoma Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - M Gonzalez
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - A D Guminski
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| | - M T Tetzlaff
- Department of Pathology, Dermatopathology and Oral Pathology Unit, The University of California, San Francisco, San Francisco, USA; Department of Dermatology, Dermatopathology and Oral Pathology Unit, The University of California, San Francisco, San Francisco, USA
| | - J R Stretch
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Departments of Tissue Pathology and Diagnostic Oncology, Sydney, Australia; Department of Melanoma Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| | - H Eriksson
- Theme Cancer, Skin Cancer Center/Department of Oncology, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - J V van Thienen
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M W Wouters
- The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - J B A G Haanen
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - W M C Klop
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C L Zuur
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - W J van Houdt
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - O E Nieweg
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Departments of Tissue Pathology and Diagnostic Oncology, Sydney, Australia; Department of Melanoma Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| | - S Ch'ng
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Departments of Tissue Pathology and Diagnostic Oncology, Sydney, Australia; Department of Melanoma Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| | - H Rizos
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - R P M Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Departments of Tissue Pathology and Diagnostic Oncology, Sydney, Australia; Department of Melanoma Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| | - A J Spillane
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| | - J S Wilmott
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - C U Blank
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - G V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| | - B A van de Wiel
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Departments of Tissue Pathology and Diagnostic Oncology, Sydney, Australia; Department of Melanoma Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia; NSW Health Pathology, Sydney, Australia.
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Boekhout AH, Rogiers A, Jozwiak K, Boers-Sonderen MJ, van den Eertwegh AJ, Hospers GA, de Groot JWB, Aarts MJB, Kapiteijn E, ten Tije AJ, Piersma D, Vreugdenhil G, van der Veldt AA, Suijkerbuijk KPM, Rozeman EA, Neyns B, Janssen KJ, van de Poll-Franse LV, Blank CU. Health-related quality of life of long-term advanced melanoma survivors treated with anti-CTLA-4 immune checkpoint inhibition compared to matched controls. Acta Oncol 2021; 60:69-77. [PMID: 32924708 DOI: 10.1080/0284186x.2020.1818823] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Checkpoint inhibitors have changed overall survival for patients with advanced melanoma. However, there is a lack of data on health-related quality of life (HRQoL) of long-term advanced melanoma survivors, years after treatment. Therefore, we evaluated HRQoL in long-term advanced melanoma survivors and compared the study outcomes with matched controls without cancer. MATERIAL AND METHODS Ipilimumab-treated advanced melanoma survivors without evidence of disease and without subsequent systemic therapy for a minimum of two years following last administration of ipilimumab were eligible for this study. The European Organization for Research and Treatment of Cancer quality of life questionnaire Core 30 (EORTC QLQ-C30), the Multidimensional Fatigue Inventory (MFI), the Hospital Anxiety and Depression Scale (HADS), and the Functional Assessment of Cancer Therapy-Melanoma questionnaire (FACT-M) were administered. Controls were individually matched for age, gender, and educational status. Outcomes of survivors and controls were compared using generalized estimating equations, and differences were interpreted as clinically relevant according to published guidelines. RESULTS A total of 89 survivors and 265 controls were analyzed in this study. After a median follow-up of 39 (range, 17-121) months, survivors scored significantly lower on physical (83.7 vs. 89.8, difference (diff) = -5.80, p=.005), role (83.5 vs. 90, diff = -5.97, p=.02), cognitive (83.7 vs. 91.9, diff = -8.05, p=.001), and social functioning (86.5 vs. 95.1, diff = -8.49, p= <.001) and had a higher symptom burden of fatigue (23.0 vs. 15.5, diff = 7.48, p=.004), dyspnea (13.3 vs. 6.7, diff = 6.47 p=.02), diarrhea (7.9 vs. 4.0, diff = 3.78, p=.04), and financial impact (10.5 vs. 2.5, diff = 8.07, p=.001) than matched controls. Group differences were indicated as clinically relevant. DISCUSSION Compared to matched controls, long-term advanced melanoma survivors had overall worse functioning scores, more physical symptoms, and financial difficulties. These data may contribute to the development of appropriate survivorship care.
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Affiliation(s)
- A. H. Boekhout
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - A. Rogiers
- Centre Hospitalier Universitaire Brugmann, Brussels, Belgium
| | - K. Jozwiak
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - M. J. Boers-Sonderen
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - G. A. Hospers
- Department of Medical Oncology, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - M. J. B. Aarts
- Department of Medical Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - E. Kapiteijn
- Leiden University Medical Centre, Leiden,The Netherlands
| | - A. J. ten Tije
- Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands
| | - D. Piersma
- Medical Spectrum Twente, Enschede,The Netherlands
| | - G. Vreugdenhil
- Department of Internal Medicine, Maxima Medical Centre, Eindhoven,The Netherlands
| | | | - K. P. M. Suijkerbuijk
- Department of Medical Oncology, University Medical Cancer Center, Utrecht, The Netherlands
| | - E. A. Rozeman
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - B. Neyns
- Universitair Ziekenhuis Brussel, Brussel, Belgium
| | | | - L. V. van de Poll-Franse
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - C. U. Blank
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Keilholz U, Ascierto PA, Dummer R, Robert C, Lorigan P, van Akkooi A, Arance A, Blank CU, Chiarion Sileni V, Donia M, Faries MB, Gaudy-Marqueste C, Gogas H, Grob JJ, Guckenberger M, Haanen J, Hayes AJ, Hoeller C, Lebbé C, Lugowska I, Mandalà M, Márquez-Rodas I, Nathan P, Neyns B, Olofsson Bagge R, Puig S, Rutkowski P, Schilling B, Sondak VK, Tawbi H, Testori A, Michielin O. ESMO consensus conference recommendations on the management of metastatic melanoma: under the auspices of the ESMO Guidelines Committee. Ann Oncol 2020; 31:1435-1448. [PMID: 32763453 DOI: 10.1016/j.annonc.2020.07.004] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 12/19/2022] Open
Abstract
The European Society for Medical Oncology (ESMO) held a consensus conference on melanoma on 5-7 September 2019 in Amsterdam, The Netherlands. The conference included a multidisciplinary panel of 32 leading experts in the management of melanoma. The aim of the conference was to develop recommendations on topics that are not covered in detail in the current ESMO Clinical Practice Guideline and where available evidence is either limited or conflicting. The main topics identified for discussion were (i) the management of locoregional disease; (ii) targeted versus immunotherapies in the adjuvant setting; (iii) targeted versus immunotherapies for the first-line treatment of metastatic melanoma; (iv) when to stop immunotherapy or targeted therapy in the metastatic setting; and (v) systemic versus local treatment for brain metastases. The expert panel was divided into five working groups to each address questions relating to one of the five topics outlined above. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel for further discussion and amendment before voting. This manuscript presents the results relating to the management of metastatic melanoma, including findings from the expert panel discussions, consensus recommendations and a summary of evidence supporting each recommendation. All participants approved the final manuscript.
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Affiliation(s)
- U Keilholz
- Charité Comprehensive Cancer Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - P A Ascierto
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - R Dummer
- Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - C Robert
- Department of Dermatology, Gustave Roussy, Villejuif, France; Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - P Lorigan
- Division of Cancer Sciences, The University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - A van Akkooi
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - A Arance
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - C U Blank
- Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - V Chiarion Sileni
- Department of Experimental and Clinical Oncology, Istituto Oncologico Veneto, IOV-IRCCS, Padova, Italy
| | - M Donia
- National Center for Cancer Immune Therapy, Department of Oncology, Herlev and Gentofte Hospital, Herlev, Denmark; University of Copenhagen, Copenhagen, Denmark
| | - M B Faries
- Department of Surgery, The Angeles Clinic, Cedars Sinai Medical Center, Los Angeles, USA
| | - C Gaudy-Marqueste
- Department of Dermatology and Skin Cancer, Aix Marseille University, Hôpital De La Timone, Marseille, France
| | - H Gogas
- First Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - J J Grob
- Department of Dermatology and Skin Cancer, Aix Marseille University, Hôpital De La Timone, Marseille, France
| | - M Guckenberger
- Department of Radio-Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - J Haanen
- Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A J Hayes
- Department of Academic Surgery, Royal Marsden NHS Foundation Trust, London, UK
| | - C Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - C Lebbé
- AP-HP Dermatology, Université de Paris, Paris, France; INSERM U976, Hôpital Saint Louis, Paris, France
| | - I Lugowska
- Early Phase Clinical Trials Unit, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - M Mandalà
- Department of Oncology and Haematology, Papa Giovanni XXIII Cancer Center Hospital, Bergamo, Italy
| | - I Márquez-Rodas
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - P Nathan
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - B Neyns
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - R Olofsson Bagge
- Sahlgrenska Cancer Center, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden; Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Sweden
| | - S Puig
- Dermatology Service, Hospital Clínic of Barcelona and University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; CIBER, Instituto de Salud Carlos III, Barcelona, Spain
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - B Schilling
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | - V K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, USA
| | - H Tawbi
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A Testori
- Department of Dermatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - O Michielin
- Department of Oncology, University Hospital Lausanne, Lausanne, Switzerland
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Versluis JM, Rozeman EA, Menzies AM, Reijers ILM, Krijgsman O, Hoefsmit EP, van de Wiel BA, Sikorska K, Bierman C, Dimitriadis P, Gonzalez M, Broeks A, Kerkhoven RM, Spillane AJ, Haanen JBAG, van Houdt WJ, Saw RPM, Eriksson H, van Akkooi ACJ, Scolyer RA, Schumacher TN, Long GV, Blank CU. L3 Update of the OpACIN and OpACIN-neo trials: 36-months and 24-months relapse-free survival after (neo)adjuvant ipilimumab plus nivolumab in macroscopic stage III melanoma patients. J Immunother Cancer 2020. [DOI: 10.1136/jitc-2020-itoc7.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundBefore adjuvant checkpoint inhibition the 5-year overall survival (OS) rate was poor (<50%) in high-risk stage III melanoma patients. Adjuvant CTLA-4 (ipilimumab, IPI) and PD-1 (nivolumab, NIVO, or pembrolizumab) blockade have been shown to improve relapse-free survival (RFS) and OS (latter only for IPI so far). Due to a broader immune activation neoadjuvant therapy with checkpoint inhibitors might be more effective than adjuvant, as suggested in preclinical experiments. The OpACIN trial compared neoadjuvant versus adjuvant IPI plus NIVO, while the subsequent OpACIN-neo trial tested three different dosing schedules of neoadjuvant IPI plus NIVO without adjuvant therapy. High pathologic response rates of 74–78% were induced by neoadjuvant IPI plus NIVO. Here, we present the 36- and 24-months RFS of the OpACIN and OpACIN-neo trial, respectively.Materials and MethodsThe phase 1b OpACIN trial included 20 stage IIIB/IIIC melanoma patients, which were randomized to receive IPI 3 mg/kg plus NIVO 1 mg/kg either adjuvant 4 cycles or split 2 cycles neoadjuvant and 2 adjuvant. In the phase 2 OpACIN-neo trial, 86 patients were randomized to 2 cycles neoadjuvant treatment, either in arm A: 2x IPI 3 mg/kg plus NIVO 1 mg/kg q3w (n=30), arm B: 2x IPI 1 mg/kg plus NIVO 3 mg/kg q3w (n=30), or arm C: 2x IPI 3 mg/kg q3w followed immediately by 2x NIVO 3 mg/kg q3w (n=26). Pathologic response was defined as <50% viable tumor cells and in both trials centrally reviewed by a blinded pathologist. RFS rates were estimated using the Kaplan-Meier method.ResultsOnly 1 of 71 (1.4%) patients with a pathologic response on neoadjuvant therapy had relapsed, versus 16 of 23 patients (69.6%) without a pathologic response, after a median follow-up of 36 months for the OpACIN and 24 months for the OpACIN-neo trial. In the OpACIN trial, the estimated 3-year RFS rate for the neoadjuvant arm was 80% (95% CI: 59%-100%) versus 60% (95% CI: 36%-100%) for the adjuvant arm. Median RFS was not reached for any of the arms within the OpACIN-neo trial. Estimated 24-months RFS rate was 84% for all patients (95% CI: 76%-92%); 90% for arm A (95% CI: 80%-100%), 78% for arm B (95% CI: 63%-96%) and 83% for arm C (95% CI: 70%-100%). Baseline interferon-γ gene expression score and tumor mutational burden predict response.ConclusionsOpACIN for the first time showed a potential benefit of neoadjuvant IPI plus NIVO versus adjuvant immunotherapy, whereas the OpACIN-neo trial confirmed the high pathologic response rates that can be achieved by neoadjuvant IPI plus NIVO. Both trials show that pathologic response can function as a surrogate markers for RFS.Clinical trial informationNCT02437279, NCT02977052Disclosure InformationJ.M. Versluis: None. E.A. Rozeman: None. A.M. Menzies: F. Consultant/Advisory Board; Modest; BMS, MSD, Novartis, Roche, Pierre-Fabre. I.L.M. Reijers: None. O. Krijgsman: B. Research Grant (principal investigator, collaborator or consultant and pending grants as well as grants already received); Modest; BMS. E.P. Hoefsmit: None. B.A. van de Wiel: None. K. Sikorska: None. C. Bierman: None. P. Dimitriadis: None. M. Gonzalez: None. A. Broeks: None. R.M. Kerkhoven: None. A.J. Spillane: None. J.B.A.G. Haanen: B. Research Grant (principal investigator, collaborator or consultant and pending grants as well as grants already received); Modest; BMS, MSD, Neon Therapeutics, Novartis. F. Consultant/Advisory Board; Modest; BMS, MSD, Novartis, Pfizer, AZ/MedImmune, Rocher/Genentech, Ipsen, Bayer, Immunocore, SeattleGenetics, Neon Therapeutics, Celsius Therapeutics, Gadet, GSK. W.J. van Houdt: None. R.P.M. Saw: None. H. Eriksson: None. A.C.J. van Akkooi: B. Research Grant (principal investigator, collaborator or consultant and pending grants as well as grants already received); Modest; Amgen, BMS, Novartis. F. Consultant/Advisory Board; Modest; Amgen, BMS, Novartis, MSD Merck, Merck-Pfizer, 4SC. R.A. Scolyer: F. Consultant/Advisory Board; Modest; MSD, Neracare, Myriad, Novartis. T.N. Schumacher: B. Research Grant (principal investigator, collaborator or consultant and pending grants as well as grants already received); Modest; MSD, BMS, Merck. E. Ownership Interest (stock, stock options, patent or other intellectual property); Modest; AIMM Therapeutics, Allogene Therapeutics, Amgen, Merus, Neogene Therapeutics, Neon Therapeutics. F. Consultant/Advisory Board; Modest; Adaptive Biotechnologies, AIMM Therapeutics, Allogene Therapeutics, Amgen, Merus, Neon Therapeutics, Scenic Biotech. Other; Modest; Third Rock Ventures. G.V. Long: F. Consultant/Advisory Board; Modest; Aduro, Amgen, BMS, Mass-Array, Pierre-Fabre, Novartis, Merck MSD, Roche. C.U. Blank: B. Research Grant (principal investigator, collaborator or consultant and pending grants as well as grants already received); Modest; BMS, Novartis, NanoString. E. Ownership Interest (stock, stock options, patent or other intellectual property); Modest; Uniti Cars, Neon Therapeutics, Forty Seven. F. Consultant/Advisory Board; Modest; BMS, MSD, Roche, Novartis, GSK, AZ, Pfizer, Lilly, GenMab, Pierre-Fabre.
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Trebeschi S, Drago SG, Birkbak NJ, Kurilova I, Cǎlin AM, Delli Pizzi A, Lalezari F, Lambregts DMJ, Rohaan MW, Parmar C, Rozeman EA, Hartemink KJ, Swanton C, Haanen JBAG, Blank CU, Smit EF, Beets-Tan RGH, Aerts HJWL. Predicting response to cancer immunotherapy using noninvasive radiomic biomarkers. Ann Oncol 2020; 30:998-1004. [PMID: 30895304 PMCID: PMC6594459 DOI: 10.1093/annonc/mdz108] [Citation(s) in RCA: 305] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Immunotherapy is regarded as one of the major breakthroughs in cancer treatment. Despite its success, only a subset of patients responds-urging the quest for predictive biomarkers. We hypothesize that artificial intelligence (AI) algorithms can automatically quantify radiographic characteristics that are related to and may therefore act as noninvasive radiomic biomarkers for immunotherapy response. PATIENTS AND METHODS In this study, we analyzed 1055 primary and metastatic lesions from 203 patients with advanced melanoma and non-small-cell lung cancer (NSCLC) undergoing anti-PD1 therapy. We carried out an AI-based characterization of each lesion on the pretreatment contrast-enhanced CT imaging data to develop and validate a noninvasive machine learning biomarker capable of distinguishing between immunotherapy responding and nonresponding. To define the biological basis of the radiographic biomarker, we carried out gene set enrichment analysis in an independent dataset of 262 NSCLC patients. RESULTS The biomarker reached significant performance on NSCLC lesions (up to 0.83 AUC, P < 0.001) and borderline significant for melanoma lymph nodes (0.64 AUC, P = 0.05). Combining these lesion-wide predictions on a patient level, immunotherapy response could be predicted with an AUC of up to 0.76 for both cancer types (P < 0.001), resulting in a 1-year survival difference of 24% (P = 0.02). We found highly significant associations with pathways involved in mitosis, indicating a relationship between increased proliferative potential and preferential response to immunotherapy. CONCLUSIONS These results indicate that radiographic characteristics of lesions on standard-of-care imaging may function as noninvasive biomarkers for response to immunotherapy, and may show utility for improved patient stratification in both neoadjuvant and palliative settings.
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Affiliation(s)
- S Trebeschi
- Department of Radiology, Netherlands Cancer Institute, Amsterdam; GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands; Departments of Radiation Oncology; Radiology, Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - S G Drago
- Department of Radiology, Netherlands Cancer Institute, Amsterdam; Department of Radiology, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy
| | - N J Birkbak
- The Francis Crick Institute, London; University College London, London, UK; Department of Molecular Medicine, Aarhus University, Aarhus, Denmark
| | - I Kurilova
- Department of Radiology, Netherlands Cancer Institute, Amsterdam; GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands
| | - A M Cǎlin
- Department of Radiology, Netherlands Cancer Institute, Amsterdam; Affidea Romania, Cluj-Napoca, Romania
| | - A Delli Pizzi
- Department of Radiology, Netherlands Cancer Institute, Amsterdam; ITAB Institute for Advanced Biomedical Technologies, University G. d'Annunzio, Chieti, Italy
| | - F Lalezari
- Department of Radiology, Netherlands Cancer Institute, Amsterdam
| | - D M J Lambregts
- Department of Radiology, Netherlands Cancer Institute, Amsterdam
| | | | - C Parmar
- Departments of Radiation Oncology; Radiology, Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | | | | | - C Swanton
- The Francis Crick Institute, London; University College London, London, UK
| | | | | | - E F Smit
- Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Amsterdam; GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands
| | - H J W L Aerts
- Department of Radiology, Netherlands Cancer Institute, Amsterdam; Departments of Radiation Oncology; Radiology, Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
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17
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Michielin O, van Akkooi A, Lorigan P, Ascierto PA, Dummer R, Robert C, Arance A, Blank CU, Chiarion Sileni V, Donia M, Faries MB, Gaudy-Marqueste C, Gogas H, Grob JJ, Guckenberger M, Haanen J, Hayes AJ, Hoeller C, Lebbé C, Lugowska I, Mandalà M, Márquez-Rodas I, Nathan P, Neyns B, Olofsson Bagge R, Puig S, Rutkowski P, Schilling B, Sondak VK, Tawbi H, Testori A, Keilholz U. ESMO consensus conference recommendations on the management of locoregional melanoma: under the auspices of the ESMO Guidelines Committee. Ann Oncol 2020; 31:1449-1461. [PMID: 32763452 DOI: 10.1016/j.annonc.2020.07.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 02/06/2023] Open
Abstract
The European Society for Medical Oncology (ESMO) held a consensus conference on melanoma on 5-7 September 2019 in Amsterdam, The Netherlands. The conference included a multidisciplinary panel of 32 leading experts in the management of melanoma. The aim of the conference was to develop recommendations on topics that are not covered in detail in the current ESMO Clinical Practice Guideline and where available evidence is either limited or conflicting. The main topics identified for discussion were: (i) the management of locoregional disease; (ii) targeted versus immunotherapies in the adjuvant setting; (iii) targeted versus immunotherapies for the first-line treatment of metastatic melanoma; (iv) when to stop immunotherapy or targeted therapy in the metastatic setting; and (v) systemic versus local treatment of brain metastases. The expert panel was divided into five working groups in order to each address questions relating to one of the five topics outlined above. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel for further discussion and amendment before voting. This manuscript presents the results relating to the management of locoregional melanoma, including findings from the expert panel discussions, consensus recommendations and a summary of evidence supporting each recommendation. All participants approved the final manuscript.
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Affiliation(s)
- O Michielin
- Department of Oncology, University Hospital Lausanne, Lausanne, Switzerland.
| | - A van Akkooi
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - P Lorigan
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - P A Ascierto
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - R Dummer
- Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - C Robert
- Department of Medicine, Gustave Roussy, Villejuif, France; Paris-Saclay University, Le Kremlin-Bicêtre, Paris, France
| | - A Arance
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - C U Blank
- Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - V Chiarion Sileni
- Department of Experimental and Clinical Oncology, Istituto Oncologico Veneto, IOV-IRCCS, Padova, Italy
| | - M Donia
- National Center for Cancer Immune Therapy, Department of Oncology, Herlev and Gentofte Hospital, Herlev, Denmark; University of Copenhagen, Copenhagen, Denmark
| | - M B Faries
- Department of Surgery, The Angeles Clinic, Cedars Sinai Medical Center, Los Angeles, USA
| | - C Gaudy-Marqueste
- Department of Dermatology and Skin Cancer, Aix Marseille University, Hôpital Timone, Marseille, France
| | - H Gogas
- First Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - J J Grob
- Department of Dermatology and Skin Cancer, Aix Marseille University, Hôpital Timone, Marseille, France
| | - M Guckenberger
- Department of Radio-Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - J Haanen
- Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A J Hayes
- Department of Academic Surgery, Royal Marsden NHS Foundation Trust, London, UK
| | - C Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - C Lebbé
- AP-HP Dermatology, Université de Paris, Paris, France; INSERM U976, Hôpital Saint Louis, Paris, France
| | - I Lugowska
- Early Phase Clinical Trials Unit, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - M Mandalà
- Department of Oncology and Haematology, Papa Giovanni XXIII Cancer Center Hospital, Bergamo, Italy
| | - I Márquez-Rodas
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - P Nathan
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - B Neyns
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - R Olofsson Bagge
- Sahlgrenska Cancer Center, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden; Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - S Puig
- Dermatology Service, Hospital Clínic de Barcelona and University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August i Pi Sunyer, Barcelona, Spain; CIBERER, Instituto de Salud Carlos III, Barcelona, Spain
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - B Schilling
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | - V K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa
| | - H Tawbi
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A Testori
- Department of Dermatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - U Keilholz
- Charité Comprehensive Cancer Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
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18
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Owen CN, Shoushtari AN, Chauhan D, Palmieri DJ, Lee B, Rohaan MW, Mangana J, Atkinson V, Zaman F, Young A, Hoeller C, Hersey P, Dummer R, Khattak MA, Millward M, Patel SP, Haydon A, Johnson DB, Lo S, Blank CU, Sandhu S, Carlino MS, Larkin JMG, Menzies AM, Long GV. Management of early melanoma recurrence despite adjuvant anti-PD-1 antibody therapy ☆. Ann Oncol 2020; 31:1075-1082. [PMID: 32387454 PMCID: PMC9211001 DOI: 10.1016/j.annonc.2020.04.471] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/13/2020] [Accepted: 04/23/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Anti-programmed cell death protein 1 (PD-1) antibodies (PD1) prolong recurrence-free survival in high-risk resected melanoma; however, approximately 25%-30% of patients recur within 1 year. This study describes the pattern of recurrence, management and outcomes of patients who recur with adjuvant PD1 therapy. PATIENTS AND METHODS Consecutive patients from 16 centres who recurred having received adjuvant PD1 therapy for resected stage III/IV melanoma were studied. Recurrence characteristics, management and outcomes were examined; patients with mucosal melanoma were analysed separately. RESULTS Melanoma recurrence occurred in 147 (17%) of ∼850 patients treated with adjuvant PD1. In those with cutaneous melanoma (n = 136), median time to recurrence was 4.6 months (range 0.3-35.7); 104 (76%) recurred during (ON) adjuvant PD1 after a median 3.2 months and 32 (24%) following (OFF) treatment cessation after a median 12.5 months, including in 21 (15%) who ceased early for toxicity. Fifty-nine (43%) recurred with locoregional disease only and 77 (57%) with distant disease. Of those who recurred locally, 22/59 (37%) subsequently recurred distantly. Eighty-nine (65%) patients received systemic therapy after recurrence. Of those who recurred ON adjuvant PD1, none (0/6) responded to PD1 alone; 8/33 assessable patients (24%) responded to ipilimumab (alone or in combination with PD1) and 18/23 (78%) responded to BRAF/MEK inhibitors. Of those who recurred OFF adjuvant PD1, two out of five (40%) responded to PD1 monotherapy, two out of five (40%) responded to ipilimumab-based therapy and 9/10 (90%) responded to BRAF/MEK inhibitors. CONCLUSIONS Most patients who recur early despite adjuvant PD1 develop distant metastases. In those who recur ON adjuvant PD1, there is minimal activity of further PD1 monotherapy, but ipilimumab (alone or in combination with PD1) and BRAF/MEK inhibitors have clinical utility. Retreatment with PD1 may have activity in select patients who recur OFF PD1.
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Affiliation(s)
- C N Owen
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | | | - D Chauhan
- The Royal Marsden NHS Foundation Trust, London, UK
| | - D J Palmieri
- Westmead Hospital and Blacktown Hospitals, Sydney, Australia
| | - B Lee
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - M W Rohaan
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | - J Mangana
- University Hospital Zurich, Zürich, Switzerland
| | - V Atkinson
- Greenslopes Private Hospital, Princess Alexandra Hospital and The University of Queensland, Brisbane, Australia
| | - F Zaman
- The Alfred Hospital, Melbourne, Australia
| | - A Young
- Vanderbilt University Medical Center, Nashville, USA
| | - C Hoeller
- Medical University of Vienna, Vienna, Austria
| | - P Hersey
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - R Dummer
- University Hospital Zurich, Zürich, Switzerland
| | - M A Khattak
- Fiona Stanley Hospital, The University of Western Australia, Perth, Australia
| | - M Millward
- School of Medicine and Pharmacology, Nedlands, Australia
| | - S P Patel
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A Haydon
- The Alfred Hospital, Melbourne, Australia
| | - D B Johnson
- Vanderbilt University Medical Center, Nashville, USA
| | - S Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - C U Blank
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | - S Sandhu
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - M S Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Westmead Hospital and Blacktown Hospitals, Sydney, Australia
| | - J M G Larkin
- The Royal Marsden NHS Foundation Trust, London, UK
| | - A M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Royal North Shore and Mater Hospitals, Sydney, Australia
| | - G V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Royal North Shore and Mater Hospitals, Sydney, Australia.
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19
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Tetzlaff MT, Messina JL, Stein JE, Xu X, Amaria RN, Blank CU, van de Wiel BA, Ferguson PM, Rawson RV, Ross MI, Spillane AJ, Gershenwald JE, Saw RPM, van Akkooi ACJ, van Houdt WJ, Mitchell TC, Menzies AM, Long GV, Wargo JA, Davies MA, Prieto VG, Taube JM, Scolyer RA. Pathological assessment of resection specimens after neoadjuvant therapy for metastatic melanoma. Ann Oncol 2019; 29:1861-1868. [PMID: 29945191 DOI: 10.1093/annonc/mdy226] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Clinical trials have recently evaluated safety and efficacy of neoadjuvant therapy among patients with surgically resectable regional melanoma metastases. To capture informative prognostic data connected to pathological response in such trials, it is critical to standardize pathologic assessment and reporting of tumor response after this treatment. Methods The International Neoadjuvant Melanoma Consortium meetings in 2016 and 2017 assembled pathologists from academic centers to develop consensus guidelines for pathologic examination and reporting of surgical specimens from AJCC (8th edition) stage IIIB/C/D or oligometastatic stage IV melanoma patients treated with neoadjuvant-targeted or immune therapy. Patterns of pathologic response are provided context to inform these guidelines. Results Based on our collective experience and guided by efforts in well-established neoadjuvant settings like breast cancer, procedures directing handling of pre- and post-neoadjuvant therapy-treated melanoma specimens are provided to facilitate comparison of findings across different trials and centers. Definitions of pathologic response are provided together with guidelines for reporting and quantifying the extent of pathologic response. Finally, the spectrum of histopathologic responses observed following neoadjuvant-targeted and immune-checkpoint therapy is described and illustrated. Conclusions Standardizing pathologic evaluation of resected melanoma metastases following neoadjuvant-targeted or immune-checkpoint therapy allows more robust stratification of patient outcomes. This includes recognizing the spectrum of histopathologic response patterns to neoadjuvant therapy and a standard approach to grading pathologic responses. Such an approach will facilitate comparison of results across clinical trials and inform ongoing correlative studies into the mechanisms of response and resistance to agents applied in the neoadjuvant setting.
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Affiliation(s)
- M T Tetzlaff
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA.
| | - J L Messina
- Departments of Anatomic Pathology and Cutaneous Oncology, Moffitt Cancer Center, Tampa, USA
| | - J E Stein
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - X Xu
- Department of Pathology and Laboratory Medicine, The Hospital of the University of Pennsylvania, Philadelphia, USA
| | - R N Amaria
- Melanoma Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - C U Blank
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - P M Ferguson
- Melanoma Institute of Australia, The University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia
| | - R V Rawson
- Melanoma Institute of Australia, The University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia
| | - M I Ross
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A J Spillane
- Melanoma Institute of Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, Australia
| | - J E Gershenwald
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - R P M Saw
- Melanoma Institute of Australia, The University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia
| | | | - W J van Houdt
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - T C Mitchell
- Department of Medicine, The Hospital of the University of Pennsylvania, Philadelphia, USA
| | - A M Menzies
- Melanoma Institute of Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, Australia
| | - G V Long
- Melanoma Institute of Australia, The University of Sydney, Royal North Shore Hospital, Sydney, Australia
| | - J A Wargo
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M A Davies
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA; Melanoma Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - V G Prieto
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA; Dermatology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J M Taube
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - R A Scolyer
- Melanoma Institute of Australia, The University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia
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20
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Jansen YJL, Rozeman EA, Mason R, Goldinger SM, Geukes Foppen MH, Hoejberg L, Schmidt H, van Thienen JV, Haanen JBAG, Tiainen L, Svane IM, Mäkelä S, Seremet T, Arance A, Dummer R, Bastholt L, Nyakas M, Straume O, Menzies AM, Long GV, Atkinson V, Blank CU, Neyns B. Discontinuation of anti-PD-1 antibody therapy in the absence of disease progression or treatment limiting toxicity: clinical outcomes in advanced melanoma. Ann Oncol 2019; 30:1154-1161. [PMID: 30923820 DOI: 10.1093/annonc/mdz110] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Programmed cell death protein 1 (PD-1) blocking monoclonal antibodies improve the overall survival of patients with advanced melanoma but the optimal duration of treatment has not been established. PATIENTS AND METHODS This academic real-world cohort study investigated the outcome of 185 advanced melanoma patients who electively discontinued anti-PD-1 therapy with pembrolizumab (N = 167) or nivolumab (N = 18) in the absence of disease progression (PD) or treatment limiting toxicity (TLT) at 14 medical centres across Europe and Australia. RESULTS Median time on treatment was 12 months (range 0.7-43). The best objective tumour response at the time of treatment discontinuation was complete response (CR) in 117 (63%) patients, partial response (PR) in 44 (24%) patients and stable disease (SD) in 16 (9%) patients; 8 (4%) patients had no evaluable disease (NE). After a median follow-up of 18 months (range 0.7-48) after treatment discontinuation, 78% of patients remained free of progression. Median time to progression was 12 months (range 2-23). PD was less frequent in patients with CR (14%) compared with patients with PR (32%) and SD (50%). Six out of 19 (32%) patients who were retreated with an anti-PD-1 at the time of PD obtained a new antitumour response. CONCLUSIONS In this real-world cohort of advanced melanoma patients discontinuing anti-PD-1 therapy in the absence of TLT or PD, the duration of anti-PD-1 therapy was shorter when compared with clinical trials. In patients obtaining a CR, and being treated for >6 months, the risk of relapse after treatment discontinuation was low. Patients achieving a PR or SD as best tumour response were at higher risk for progression after discontinuing therapy, and defining optimal treatment duration in such patients deserves further study. Retreatment with an anti-PD-1 at the time of progression may lead to renewed antitumour activity in some patients. CLINICAL TRIAL REGISTRATION NCT02673970 (https://clinicaltrials.gov/ct2/show/NCT02673970?cond=melanoma&cntry=BE&city=Jette&rank=3).
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Affiliation(s)
- Y J L Jansen
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussel, Belgium.
| | - E A Rozeman
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R Mason
- Department of Medical Oncology, Princess Alexandra Hospital, Brisbane; Greenslope Oncology, Greenslope Private Hospital, Brisbrane
| | - S M Goldinger
- Melanoma Institute Australia and The University of Syndey, Sydney, Australia; Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - M H Geukes Foppen
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L Hoejberg
- Department of Oncology, Odense University Hospital, Odense
| | - H Schmidt
- Department of Oncology, Aarhus Universitet, Aarhus, Denmark
| | - J V van Thienen
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J B A G Haanen
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L Tiainen
- Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - I M Svane
- Department of Oncology, Copenhagen University Hospital, Herlev, Denmark
| | - S Mäkelä
- Department of Oncology, University of Helsinki, Helsinki, Finland
| | - T Seremet
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - A Arance
- Department of Medical Oncology, Hospital Clínic Barcelona, Barcelona, Spain
| | - R Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - L Bastholt
- Department of Oncology, Odense University Hospital, Odense
| | - M Nyakas
- Department of Clinical Cancer Research, Oslo University Hospital, Oslo
| | - O Straume
- Department of Oncology, Universitetet Bergen, Bergen, Norway
| | - A M Menzies
- Melanoma Institute Australia and The University of Syndey, Sydney, Australia; Department of Medical Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney; Department of Medical Oncology, Mater Hospital, Sydney, Australia
| | - G V Long
- Melanoma Institute Australia and The University of Syndey, Sydney, Australia; Department of Medical Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney; Department of Medical Oncology, Mater Hospital, Sydney, Australia
| | - V Atkinson
- Greenslope Oncology, Greenslope Private Hospital, Brisbrane; Department of Medical Oncology, Princess Alexandra Hospital, Brisbane
| | - C U Blank
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - B Neyns
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussel, Belgium
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21
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Schermers B, Franke V, Rozeman EA, van de Wiel BA, Bruining A, Wouters MW, van Houdt WJ, Ten Haken B, Muller SH, Bierman C, Ruers TJM, Blank CU, van Akkooi ACJ. Surgical removal of the index node marked using magnetic seed localization to assess response to neoadjuvant immunotherapy in patients with stage III melanoma. Br J Surg 2019; 106:519-522. [PMID: 30882901 PMCID: PMC6593699 DOI: 10.1002/bjs.11168] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/16/2019] [Accepted: 02/12/2019] [Indexed: 12/11/2022]
Abstract
This pilot study explored the value of localized index node removal after neoadjuvant immunotherapy in patients with stage III melanoma, for use as a response indicator to guide the extent of completion lymph node dissection. Promising technology.
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Affiliation(s)
- B Schermers
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,MIRA Institute, University of Twente, Enschede, the Netherlands
| | - V Franke
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - E A Rozeman
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - B A van de Wiel
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - A Bruining
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M W Wouters
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - W J van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - B Ten Haken
- MIRA Institute, University of Twente, Enschede, the Netherlands
| | - S H Muller
- Department of Clinical Physics, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - C Bierman
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - T J M Ruers
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,MIRA Institute, University of Twente, Enschede, the Netherlands
| | - C U Blank
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - A C J van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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22
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van der Kooij MK, Joosse A, Speetjens FM, Hospers GAP, Bisschop C, de Groot JWB, Koornstra R, Blank CU, Kapiteijn E. Anti-PD1 treatment in metastatic uveal melanoma in the Netherlands. Acta Oncol 2017; 56:101-103. [PMID: 27911126 DOI: 10.1080/0284186x.2016.1260773] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- M. K. van der Kooij
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - A. Joosse
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - F. M. Speetjens
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - G. A. P. Hospers
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - C. Bisschop
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - R. Koornstra
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - C. U. Blank
- Department of Medical Oncology, Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - E. Kapiteijn
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
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23
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Steenbruggen TG, van den Heuvel MM, Blank CU, van Dieren JM, Haanen JBAG, Kok M. [No hair loss, but colitis or pneumonitis: unique side effects of immune checkpoint inhibitors for cancer]. Ned Tijdschr Geneeskd 2016; 160:A9873. [PMID: 27438388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Immunotherapy with checkpoint inhibitors is an effective strategy for several cancers. In some patients long-term remissions are seen. However, enhancement of the immune response can be accompanied by immune-related adverse events (irAEs). These patients often present with nonspecific symptoms. The most common irAEs are dermatitis, colitis, pneumonitis, hepatitis and endocrinopathies. IrAEs can occur in every organ, even simultaneously. Furthermore, irAEs can occur weeks or months after discontinuation of checkpoint inhibitors. Most irAEs can be well managed, but life-threatening situations do occur. General management involves supportive care, glucocorticoids and sometimes immunomodulatory drugs, such as infliximab. Early diagnosis and adequate team management can improve the course of irAEs without compromising the cancer treatment. Here, we present two cases: a melanoma patient with an ipilimumab-induced colitis and a lung cancer patient with pneumonitis after anti-PD-1.We then summarise the most common toxicities of checkpoint inhibitors, emphasising the need to familiarise the practitioner with irAEs of approved and emerging immunotherapies.
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24
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Scholtens A, Geukes Foppen MH, Blank CU, van Thienen JV, van Tinteren H, Haanen JB. Vemurafenib for BRAF V600 mutated advanced melanoma: results of treatment beyond progression. Eur J Cancer 2015; 51:642-52. [PMID: 25690538 DOI: 10.1016/j.ejca.2015.01.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 12/24/2014] [Accepted: 01/12/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Selective BRAF inhibition (BRAFi) by vemurafenib or dabrafenib has become approved standard treatment in BRAF V600 mutated advanced stage melanoma. While the response rate is high, the response duration is limited with a progression-free survival (PFS) of 5-6months. Our observation of accelerated disease progression within some patients after stopping vemurafenib treatment has fostered the idea of treatment beyond progression (BRAFi TBP). METHOD In this retrospective study, we analysed 70 metastatic melanoma patients, treated at our institute, who experienced progression after prior objective response upon treatment with vemurafenib. Thirty-five patients that continued treatment beyond progression are compared with 35 patients who stopped BRAFi treatment at disease progression. RESULTS Median overall survival beyond documented progression was found to be 5.2months versus 1.4months (95% confidence interval (CI): 3.8-7.4 versus 0.6-3.4; Log-Rank p=0.002) in favour of BRAFi TBP. In the multivariate survival analysis, stopping treatment at disease progression was significantly associated with shorter survival (hazard ratio: 1.92; 95% CI: 1.04-3.55; p=0.04). CONCLUSION Our results suggest that continuing vemurafenib treatment beyond progression may be beneficial in advanced melanoma patients, who prior to progression responded to vemurafenib.
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Affiliation(s)
- A Scholtens
- Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M H Geukes Foppen
- Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C U Blank
- Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J V van Thienen
- Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H van Tinteren
- Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J B Haanen
- Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Grünwald V, Karakiewicz PI, Bavbek SE, Miller K, Machiels JH, Lee S, Larkin JMG, Bono P, Rha SY, Castellano DE, Blank CU, Knox JJ, Hawkins R, Yuan RR, Rosamilia M, Booth JL, Bodrogi I. Final results of the international, expanded-access program of everolimus in patients with advanced renal cell carcinoma who progress after prior vascular endothelial growth factor receptor–tyrosine kinase inhibitor (VEGFr-TKI) therapy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Powles T, Kayani I, Blank CU, Chowdhury S, Horenblas S, Sarwar N, Nathan PD, Boleti E, Haanen JB, Bex A. The safety and efficacy of sunitinib prior to planned nephrectomy in metastatic clear cell renal cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4603] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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