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Stege HM, Haist M, Schultheis S, Fleischer MI, Mohr P, Ugurel S, Terheyden P, Thiem A, Kiecker F, Leiter U, Becker JC, Meissner M, Kleeman J, Pföhler C, Hassel J, Grabbe S, Loquai C. Response durability after cessation of immune checkpoint inhibitors in patients with metastatic Merkel cell carcinoma: a retrospective multicenter DeCOG study. Cancer Immunol Immunother 2021; 70:3313-3322. [PMID: 33870464 PMCID: PMC8505278 DOI: 10.1007/s00262-021-02925-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/23/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) have led to a prolongation of progression-free and overall survival in patients with metastatic Merkel cell carcinoma (MCC). However, immune-mediated adverse events due to ICI therapy are common and often lead to treatment discontinuation. The response duration after cessation of ICI treatment is unknown. Hence, this study aimed to investigate the time to relapse after discontinuation of ICI in MCC patients. METHODS We analyzed 20 patients with metastatic MCC who have been retrospectively enrolled at eleven skin cancer centers in Germany. These patients have received ICI therapy and showed as best overall response (BOR) at least a stable disease (SD) upon ICI therapy. All patients have discontinued ICI therapy for other reasons than disease progression. Data on treatment duration, tumor response, treatment cessation, response durability, and tumor relapse were recorded. RESULTS Overall, 12 of 20 patients (60%) with MCC relapsed after discontinuation of ICI. The median response durability was 10.0 months. Complete response (CR) as BOR to ICI-treatment was observed in six patients, partial response (PR) in eleven, and SD in three patients. Disease progression was less frequent in patients with CR (2/6 patients relapsed) as compared to patients with PR (7/11) and SD (3/3), albeit the effect of initial BOR on the response durability was below statistical significance. The median duration of ICI therapy was 10.0 months. Our results did not show a correlation between treatment duration and the risk of relapse after treatment withdrawal. Major reasons for discontinuation of ICI therapy were CR (20%), adverse events (35%), fatigue (20%), or patient decision (25%). Discontinuation of ICI due to adverse events resulted in progressive disease (PD) in 71% of patients regardless of the initial response. A re-induction of ICI was initiated in 8 patients upon tumor progression. We observed a renewed tumor response in 4 of these 8 patients. Notably, all 4 patients showed an initial BOR of at least PR. CONCLUSION Our results from this contemporary cohort of patients with metastatic MCC indicate that MCC patients are at higher risk of relapse after discontinuation of ICI as compared to melanoma patients. Notably, the risk of disease progression after discontinuation of ICI treatment is lower in patients with initial CR (33%) as compared to patients with initial PR (66%) or SD (100%). Upon tumor progression, re-induction of ICI is a feasible option. Our data suggest that the BOR to initial ICI therapy might be a potential predictive clinical marker for a successful re-induction.
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Affiliation(s)
- H M Stege
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
| | - M Haist
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - S Schultheis
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - M I Fleischer
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - P Mohr
- Department of Dermatology, Elbe-Kliniken Buxtehude, Buxtehude, Germany
| | - S Ugurel
- Department of Dermatology, University Medical Center Essen, Essen, Germany
| | - P Terheyden
- Department of Dermatology, Allergology and Venerology, University Lübeck, Lübeck, Germany
| | - A Thiem
- Department of Dermatology, University Medical Center Würzburg, Würzburg, Germany
- Department of Dermatology, University Medical Center Rostock, Rostock, Germany
| | - F Kiecker
- Department of Dermatology and Allergology at the Charité, University Medical Center Berlin, Berlin, Germany
| | - U Leiter
- Dermato-Oncology, Department of Dermatology, University Medical Center Tübingen, Tübingen, Germany
| | - J C Becker
- Department of Dermatology, University Medical Center Essen, Essen, Germany
- German Consortium for Translational Oncology (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Meissner
- Department of Dermatology, University Medical Center Frankfurt, Frankfurt, Germany
| | - J Kleeman
- Department of Dermatology, University Medical Center Frankfurt, Frankfurt, Germany
| | - C Pföhler
- Department of Dermatology, University Medical Center Homburg, Homburg, Germany
| | - J Hassel
- Department of Dermatology, University Medical Center Heidelberg, Heidelberg, Germany
| | - S Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - C Loquai
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Gutzmer R, Eigentler T, Mohr P, Weichenthal M, Dücker P, Gebhardt C, Göppner D, Grimmelmann I, Haferkamp S, Kähler K, Meier F, Pföhler C, Sickmann T, Sindrilaru A, Terheyden P, Ugurel S, Ulrich J, Utikal J, Weishaupt C, Schadendorf D. 1079P Comparison of effectiveness and safety of nivolumab monotherapy or in combination therapy with ipilimumab in therapy-naïve and pretreated patients with advanced melanoma within the German noninterventional study NICO. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1464] [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: 10/20/2022] Open
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Maris I, Dölle‐Bierke S, Renaudin J, Lange L, Koehli A, Spindler T, Hourihane J, Scherer K, Nemat K, Kemen C, Neustädter I, Vogelberg C, Reese T, Yildiz I, Szepfalusi Z, Ott H, Straube H, Papadopoulos NG, Hämmerling S, Staden U, Polz M, Mustakov T, Cichocka‐Jarosz E, Cocco R, Fiocchi AG, Fernandez‐Rivas M, Worm M, Grünhagen J, Wittenberg M, Beyer K, Henschel A, Küper S, Möser A, Fuchs T, Ruëff F, Wedi B, Hansen G, Buck T, Büsselberg J, Drägerdt R, Pfeffer L, Dickel H, Körner‐Rettberg C, Merk H, Lehmann S, Bauer A, Nordwig A, Zeil S, Hannapp C, Wagner N, Rietschel E, Hunzelmann N, Huseynow I, Treudler R, Aurich S, Prenzel F, Klimek L, Pfaar O, Reider N, Aberer W, Varga E, Bogatu B, Schmid‐Grendelmeier P, Guggenheim R, Riffelmann F, Kreft B, Kinaciyan K, Hartl L, Ebner C, Horak F, Brehler R, Witte J, Buss M, Hompes S, Bieber T, Gernert S, Bücheler M, Rabe U, Brosi W, Nestoris S, Hawranek T, Lang R, Bruns R, Pföhler C, Eng P, Schweitzer‐Krantz S, Meller S, Rebmann H, Fischer J, Stichtenoth G, Thies S, Gerstlauer M, Utz P, Neustädter I, Klinge J, Volkmuth S, Plank‐Habibi S, Schilling B, Kleinheinz A, Brückner A, Schäkel K, Manolaraki I, Kowalski M, Solarewicz‐Madajek K, Tscheiller S, Seidenberg J, Cardona V, Garcia B, Bilo M, Cabañes Higuero N, Vega Castro A, Poziomkowska‐Gęsicka I, Büsing S, Virchow C, Christoff G, Jappe U, Müller S, Knöpfel F, Correard A, Rogala B, Montoro A, Brandes A, Muraro A, Zimmermann N, Hernandez D, Minale P, Niederwimmer J, Zahel B, Dahdah L, Arasi S, Reissig A, Eitelberger F, Asero R, Hermann F, Zeidler S, Pistauer S, Geißler M, Ensina L, Plaza Martin A, Meister J, Stieglitz S, Hamelmann E. Peanut-induced anaphylaxis in children and adolescents: Data from the European Anaphylaxis Registry. Allergy 2021; 76:1517-1527. [PMID: 33274436 DOI: 10.1111/all.14683] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/26/2020] [Accepted: 11/10/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Peanut allergy has a rising prevalence in high-income countries, affecting 0.5%-1.4% of children. This study aimed to better understand peanut anaphylaxis in comparison to anaphylaxis to other food triggers in European children and adolescents. METHODS Data was sourced from the European Anaphylaxis Registry via an online questionnaire, after in-depth review of food-induced anaphylaxis cases in a tertiary paediatric allergy centre. RESULTS 3514 cases of food anaphylaxis were reported between July 2007 - March 2018, 56% in patients younger than 18 years. Peanut anaphylaxis was recorded in 459 children and adolescents (85% of all peanut anaphylaxis cases). Previous reactions (42% vs. 38%; p = .001), asthma comorbidity (47% vs. 35%; p < .001), relevant cofactors (29% vs. 22%; p = .004) and biphasic reactions (10% vs. 4%; p = .001) were more commonly reported in peanut anaphylaxis. Most cases were labelled as severe anaphylaxis (Ring&Messmer grade III 65% vs. 56% and grade IV 1.1% vs. 0.9%; p = .001). Self-administration of intramuscular adrenaline was low (17% vs. 15%), professional adrenaline administration was higher in non-peanut food anaphylaxis (34% vs. 26%; p = .003). Hospitalization was higher for peanut anaphylaxis (67% vs. 54%; p = .004). CONCLUSIONS The European Anaphylaxis Registry data confirmed peanut as one of the major causes of severe, potentially life-threatening allergic reactions in European children, with some characteristic features e.g., presence of asthma comorbidity and increased rate of biphasic reactions. Usage of intramuscular adrenaline as first-line treatment is low and needs to be improved. The Registry, designed as the largest database on anaphylaxis, allows continuous assessment of this condition.
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Affiliation(s)
- Ioana Maris
- Bon Secours Hospital Cork/Paediatrics and Child HealthUniversity College Cork Cork Ireland
| | - Sabine Dölle‐Bierke
- Division of Allergy and Immunology Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | | | - Lars Lange
- Department of Paediatrics St. Marien‐Hospital Bonn Germany
| | - Alice Koehli
- Division of Allergology University Children’s Hospital Zurich Zürich Switzerland
| | - Thomas Spindler
- Department of Paediatrics Medical Campus Hochgebirgsklinik Davos Davos Switzerland
| | - Jonathan Hourihane
- Paediatrics and Child Health Royal College of Surgeons in Ireland Dublin Ireland
- Children’s Health Ireland Dublin Ireland
| | | | - Katja Nemat
- Practice for paediatric pneumology and allergology Kinderzentrum Dresden‐Friedrichstadt Dresden Germany
| | - C. Kemen
- Department of Paediatrics Children’s Hospital WILHELMSTIFT Hamburg Germany
| | - Irena Neustädter
- Department of Paediatrics Hallerwiese Cnopfsche Kinderklinik Nuremberg Germany
| | - Christian Vogelberg
- Department of Paediatrics Universitätsklinikum Carl Gustav CarusTechnical University Dresden Germany
| | - Thomas Reese
- Department of Paediatrics Mathias‐Spital Rheine Rheine Germany
| | - Ismail Yildiz
- Department of Paediatrics Friedrich‐Ebert‐Krankenhaus Neumuenster Germany
| | - Zsolt Szepfalusi
- Division of Paediatric Pulmonology, Allergology and Endocrinology Department of Paediatrics and Adolescent Medicine Competence Center Paediatrics Medical University of Vienna Vienna Austria
| | - Hagen Ott
- Division of Paediatric Dermatology and Allergology Epidermolysis bullosa‐Centre HannoverChildren’s Hospital AUF DER BULT Hanover Germany
| | - Helen Straube
- Division of Allergology Darmstädter Kinderkliniken Prinzessin Margaret Darmstadt Germany
| | - Nikolaos G. Papadopoulos
- Allergy Department 2nd Paediatric Clinic National and Kapodistrian University of Athens Athens Greece
- Division of Infection Immunity& Respiratory Medicine University of Manchester Manchester UK
| | - Susanne Hämmerling
- Division of Paediatric Pulmonology and Allergology University Children`s Hospital Heidelberg Heidelberg Germany
| | - Ute Staden
- Paediatric Pneumology & Allergology Medical practice Klettke/Staden Berlin Germany
| | - Michael Polz
- Department of Paediatrics GPR Klinikum Rüsselsheim Germany
| | - Tihomir Mustakov
- Chair of Allergy University Hospital Alexandrovska Sofia Bulgaria
| | - Ewa Cichocka‐Jarosz
- Department of Paediatrics Jagiellonian University Medical College Krakow Poland
| | - Renata Cocco
- Division of Allergy Clinical Immunology and Rheumatology Department of Paediatrics Federal University of São Paulo São Paulo Brazil
| | | | | | - Margitta Worm
- Division of Allergy and Immunology Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
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Ugurel S, Schadendorf D, Horny K, Sucker A, Schramm S, Utikal J, Pföhler C, Herbst R, Schilling B, Blank C, Becker JC, Paschen A, Zimmer L, Livingstone E, Horn PA, Rebmann V. Elevated baseline serum PD-1 or PD-L1 predicts poor outcome of PD-1 inhibition therapy in metastatic melanoma. Ann Oncol 2021; 31:144-152. [PMID: 31912789 DOI: 10.1016/j.annonc.2019.09.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [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: 04/09/2019] [Revised: 09/16/2019] [Accepted: 09/19/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Programmed cell death protein 1 (PD-1) checkpoint inhibition has recently advanced to one of the most effective treatment strategies in melanoma. Nevertheless, a considerable proportion of patients show upfront therapy resistance and baseline predictive biomarkers of treatment outcome are scarce. In this study we quantified PD-1 and programmed death-ligand 1 (PD-L1) in baseline sera from melanoma patients in relation to therapy response and survival. PATIENTS AND METHODS Sera taken at therapy baseline from a total of 222 metastatic melanoma patients (two retrospectively selected monocentric discovery cohorts, n = 130; one prospectively collected multicentric validation cohort, n = 92) and from 38 healthy controls were analyzed for PD-1 and PD-L1 concentration by sandwich enzyme-linked immunosorbent assay. RESULTS Melanoma patients showed higher serum concentrations of PD-1 (P = 0.0054) and PD-L1 (P < 0.0001) than healthy controls. Elevated serum PD-1 and PD-L1 levels at treatment baseline were associated with an impaired best overall response (BOR) to anti-PD-1 (P = 0.014, P = 0.041), but not to BRAF inhibition therapy. Baseline PD-1 and PD-L1 serum levels correlated with progression-free (PFS; P = 0.0081, P = 0.053) and overall survival (OS; P = 0.055, P = 0.0062) in patients who received anti-PD-1 therapy, but not in patients treated with BRAF inhibitors. By combining both markers, we obtained a strong discrimination between favorable and poor outcome of anti-PD-1 therapy, with elevated baseline serum levels of PD-1 and/or PD-L1 associated with an impaired BOR (P = 0.037), PFS (P = 0.048), and OS (P = 0.0098). This PD-1/PD-L1 combination serum biomarker was confirmed in an independent multicenter validation set of serum samples prospectively collected at baseline of PD-1 inhibition (BOR, P = 0.019; PFS, P = 0.038; OS, P = 0.022). Multivariable Cox regression demonstrated serum PD-1/PD-L1 as an independent predictor of PFS (P = 0.010) and OS (P = 0.003) in patients treated with PD-1 inhibitors. CONCLUSION Our findings indicate PD-1 and PD-L1 as useful serum biomarkers to predict the outcome of PD-1 inhibition therapy in melanoma patients and to select patients for PD-1-based versus BRAF-based therapy strategies.
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Affiliation(s)
- S Ugurel
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - D Schadendorf
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - K Horny
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany; Translational Skin Cancer Research, German Consortium of Translational Cancer Research (DKTK), Essen, Germany
| | - A Sucker
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - S Schramm
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - J Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg and Department of Dermatology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - C Pföhler
- Department of Dermatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - R Herbst
- Department of Dermatology, Helios Klinikum Erfurt, Erfurt, Germany
| | - B Schilling
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | - C Blank
- Department of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J C Becker
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany; Translational Skin Cancer Research, German Consortium of Translational Cancer Research (DKTK), Essen, Germany
| | - A Paschen
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - L Zimmer
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - E Livingstone
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - P A Horn
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - V Rebmann
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Gutzmer R, Eigentler T, Mohr P, Weichenthal M, Dücker P, Gebhardt C, Göppner D, Haferkamp S, Kähler K, Meier F, Pföhler C, Satzger I, Sickmann T, Sindrilaru A, Terheyden P, Ugurel S, Ulrich J, Utikal J, Weishaupt C, Schadendorf D. 1104P Nivolumab (NIVO) monotherapy or combination therapy with ipilimumab (NIVO+IPI) in advanced melanoma patients with brain metastases: Real-world evidence from the German non-interventional study NICO. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1227] [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: 10/23/2022] Open
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Dickel H, Kuhlmann L, Bauer A, Bircher AJ, Breuer K, Fuchs T, Grabbe J, Mahler V, Pföhler C, Przybilla B, Rieker-Schwienbacher J, Schröder-Kraft C, Simon D, Treudler R, Weisshaar E, Worm M, Trinder E, Geier J. Atopy patch testing with aeroallergens in a large clinical population of dermatitis patients in Germany and Switzerland, 2000-2015: a retrospective multicentre study. J Eur Acad Dermatol Venereol 2020; 34:2086-2095. [PMID: 32003071 DOI: 10.1111/jdv.16250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 01/22/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The diagnostic significance of the atopy patch test for the management of dermatitis possibly triggered by aeroallergens is still controversial. However, sufficiently large studies with routinely tested standardized aeroallergen patch test preparations in dermatitis patients are lacking. OBJECTIVE To evaluate the reaction frequency and the reaction profiles of 10 until mid-2015 commercially available, standardized aeroallergen patch test preparations of the 'Stallerpatch' test series (Stallergenes, Antony Cedex, France) in a large multicentre patient cohort. METHODS A retrospective data analysis of patients with suspected aeroallergen-dependent eczematous skin lesions was performed, who were patch tested in 15 Information Network of Departments of Dermatology-associated clinics between 2000 and 2015. Patients were stratified according to their atopic dermatitis (AD) status. RESULTS The study group included 3676 patients (median age 41 years, 34.8% males, 54.5% AD). The most common aeroallergens causing positive patch test reactions were Dermatophagoides pteronyssinus (19.6%), Dermatophagoides farinae (16.9%), birch (6.2%), timothy grass (6.0%), cat dander (5.4%), mugwort (4.9%) and dog dander (4.6%). Reactions to other pollen allergen preparations, that is 5 grasses (3.2%), cocksfoot (2.1%) and plantain (1.6%), were less common. Positive patch test reactions to aeroallergens were consistently more frequent in patients with AD. These patients showed proportionally less dubious, follicular, irritant and weak positive reactions. Independent of AD status, a patient history of past or present allergic rhinitis was associated with an increased chance of a positive aeroallergen patch test reaction to pollen allergens. CONCLUSION The aeroallergen patch test is a useful add-on tool in clinical routine, especially in patients with AD and/or respiratory allergy. A patch test series comprising Dermatophagoides pteronyssinus, Dermatophagoides farinae, birch, timothy grass, cat dander and mugwort seems to be suitable. Controlled studies with specific provocation and elimination procedures are required to further evaluate the diagnostic significance of the proposed screening series.
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Affiliation(s)
- H Dickel
- Department of Dermatology, Venereology and Allergology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - L Kuhlmann
- Department of Gynaecology and Obstetrics, St. Vincenz Hospital, Vestische Caritas Clinics GmbH, Datteln, Germany
| | - A Bauer
- Department of Dermatology, University Allergy Centre, University of Dresden, Dresden, Germany
| | - A J Bircher
- Allergy Unit, Dermatology Clinic, University Hospital Basel, University of Basel, Basel, Switzerland
| | - K Breuer
- Department of Allergology, Dermatologikum Hamburg, Hamburg, Germany
| | - T Fuchs
- Department of Dermatology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - J Grabbe
- Department of Dermatology and Allergology, Kantonsspital Aarau, Aarau, Switzerland
| | - V Mahler
- Department of Dermatology, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - C Pföhler
- Department of Dermatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - B Przybilla
- Department of Dermatology and Allergology, Ludwig Maximilians University of Munich, Munich, Germany
| | - J Rieker-Schwienbacher
- Centre for Dermatology, Phlebology and Allergology, Hospital Stuttgart, Stuttgart, Germany
| | - C Schröder-Kraft
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), BG Hospital Hamburg, Hamburg, Germany
| | - D Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - R Treudler
- Department of Dermatology, Venerology and Allergology, University of Leipzig, Leipzig, Germany
| | - E Weisshaar
- Occupational Dermatology, Department of Dermatology, Ruprecht Karls University of Heidelberg, Heidelberg, Germany
| | - M Worm
- Division of Allergy and Immunology, Department of Dermatology, Allergy and Venerology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - E Trinder
- Department of Medicine I, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - J Geier
- Information Network of Departments of Dermatology (IVDK), University Medical Center Göttingen, Göttingen, Germany
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Pföhler C, Koch S, Weber L, Müller CSL, Vogt T. Autoimmunhämolytische Anämie als seltene Nebenwirkung einer Therapie mit Pembrolizumab bei metastasiertem Melanom. Aktuelle Dermatologie 2019. [DOI: 10.1055/a-1010-3409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
ZusammenfassungCheckpoint-Inhibitoren wie Pembrolizumab, Nivolumab und Ipilimumab stellen unverzichtbare Wirkstoffe zur Behandlung fortgeschrittener oder metastasierter Melanome dar. Durch eine Aktivierung zytotoxischer T-Zellen durch diese Substanzen kommt es neben einer antitumoralen Immunantwort bei vielen Patienten auch zu einer Vielzahl an immunvermittelten Nebenwirkungen, die jedes Organ des Körpers betreffen können. Neben häufigen autoimmun vermittelten Nebenwirkungen, wie z. B. einer Kolitis, einer Pneumonitis, einer Thyreoiditis und einer Hypophysitis, die in der Regel rasch erkannt werden, können auch seltene Nebenwirkungen auftreten, die initial oft nicht direkt als Nebenwirkung der Therapie interpretiert werden.Bei einer 66 Jahre alten Patientin wurde ein Melanom am linken Unterschenkel exzidiert (Typ NMM, Tumordicke 3 mm; BRAF, NRAS und c-Kit jeweils Wildtyp), Sentinelnodebiopsie inguinal positiv, darauffolgende Lymphknotendissektion ohne Metastasennachweis. Sechs Monate später traten inguinale Lymphknotenfiliae sowie mehrere kutane Metastasen am linken Bein auf. Es erfolgte eine knappe Resektion in toto mit anschließender adjuvanter Radiatio (inguinal und Knie links, GRD 45 Gy). Bereits einige Wochen später zeigten sich am linken Bein erneut mehrere kutane Filiae sowie Lymphknotenfiliae inguinal und iliakal links. Aufgrund des mittlerweile ausgebildeten massiven Lymphödems wurde bei nicht-operabler, lokoregionärer Metastasierung 2016 eine Therapie mit Pembrolizumab begonnen.Nach der 12. Gabe bildete sich eine normochrome, normozytäre Anämie mit transfusionsbedürftigem Hämoglobin (Hb)-Abfall bis auf 8,4 mg/dl aus. Gastro- und koloskopisch konnte keine Blutungsquelle nachgewiesen werden, mittels Knochenmarksbiopsie wurden eine Infiltration des Knochenmarks durch Melanomzellen sowie eine Pure Red Cell Aplasia ausgeschlossen. Bei erhöhter LDH, erniedrigten Werten für Haptoglobin und Retikulozyten sowie positivem direkten Coombs-Test für c3d wurde die Diagnose einer autoimmunhämolytischen Anämie (AIHA) mit Beteiligung aller Vorstufen der roten Reihe gestellt und eine Therapie mit Methylprednisolon begonnen. Bei jedem Versuch die Therapie mit Pembrolizumab nach Stabilisierung des Hb-Wertes fortzuführen, zeigte sich ein erneuter transfusionsbedürftiger Abfall auf Hb-Werte von bis zu 6 mg/dl. Wir entschieden uns die Therapie mit Pembrolizumab nach 15 Zyklen bei kompletter Remission der Metastasen zu beenden; seitdem zeigen sich in Laborkontrollen normwertige Hb-Werte. Da sich nach einigen Monaten erneut ein Progress ausbildete, wurde bei negativem BRAF-Mutationsstatus eine Therapie mit Nivolumab begonnen, hierunter kam es nicht zur erneuten Ausbildung einer AIHA.Die Entwicklung einer Anämie ist eine seltene Nebenwirkung einer Therapie mit Checkpoint-Inhibitoren. Als weitere Ursache wurde neben der hier gezeigten AIHA auch die aplastische Anämie als immunvermittelte Nebenwirkung beschrieben. In den wenigen bisher publizierten Fällen bildete sich die Anämie i. R. der Therapie mit Checkpoint-Inhibitoren frühzeitig aus und zeigte oft ein zögerliches Ansprechen auf Steroide. Bisher sind nur wenige Fälle beschrieben, bei denen eine Re-Exposition ohne erneutes Aufflammen der Anämie möglich war. Trotz immunsuppressiver Therapie sind letale Verläufe beschrieben. Dies verdeutlicht die Notwendigkeit regelmäßiger Laboruntersuchungen unter und nach der Therapie mit Checkpoint-Inhibitoren. In unserem Fall kam es erfreulicherweise nach erneuter Gabe eines Checkpoint-Inhibitors nicht zum erneuten Auftreten der AIHA. Ob dies dem Wechsel von Pembrolizumab zu Nivolumab geschuldet ist, muss derzeit leider unbeantwortet bleiben.
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Affiliation(s)
- C. Pföhler
- Klinik für Dermatologie, Venerologie und Allergologie am Universitätsklinikum des Saarlandes, Homburg/Saar
| | - S. Koch
- Klinik für Dermatologie, Venerologie und Allergologie am Universitätsklinikum des Saarlandes, Homburg/Saar
| | - L. Weber
- Klinik für Dermatologie, Venerologie und Allergologie am Universitätsklinikum des Saarlandes, Homburg/Saar
| | - C. S. L. Müller
- Klinik für Dermatologie, Venerologie und Allergologie am Universitätsklinikum des Saarlandes, Homburg/Saar
| | - T. Vogt
- Klinik für Dermatologie, Venerologie und Allergologie am Universitätsklinikum des Saarlandes, Homburg/Saar
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Hoernecke D, Pföhler C, Wagenpfeil S, Vogt T, Müller C. Evaluation des Gesundheitsverhaltens und der Lebensqualität dermatoonkologischer Patienten nach operativer Therapie eines Hauttumors. Akt Dermatol 2018. [DOI: 10.1055/a-0685-6008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Zusammenfassung
Hintergrund In der Onkologie existieren unterschiedliche Erkenntnisse bzgl. einer Änderung im Gesundheitsverhalten der betroffenen Patienten nach Diagnosestellung eines malignen Tumors (z. B. beim kolorektalen Karzinom oder bei gynäkologischen Karzinomen). Derlei Daten existieren bislang nicht in größerem Umfang für dermatoonkologische Patienten.
Fragestellung Ziel dieser Querschnittstudie mittels Fragebogen und Korrelation mit retrospektiven Daten war es, herauszufinden, ob Hauttumorpatienten ihr Gesundheitsverhalten (Sonnenexposition, Freizeitverhalten, Raucherentwöhnung etc.) nach dermatochirurgischer Therapie/Behandlung ändern und damit den ärztlichen Empfehlungen folgen. Zudem wurde die Lebensqualität der Patienten nach operativer Therapie von Hauttumoren erfasst.
Material und Methoden In die Studie wurden 653 Patienten eingeschlossen, welche im Jahre 2013 unter stationären Bedingungen aufgrund eines oder mehrerer maligner Hauttumore operativ behandelt wurden. Mittels Fragebögen wurden die postoperative Lebensqualität sowie das Freizeit- und Gesundheitsverhalten erfasst und analysiert. Ergebnisse: 263/653 Patienten nahmen an der Befragung teil (Rücklaufquote 40,3 %). 62,0 % der Patienten waren männlich, 38,0 % weiblich. Der Altersdurchschnitt lag bei 69,8 Jahren. Überraschenderweise konnten wir eine Umstellung der Lebensweise hin zu gesünderen Eigenschaften (Reduktion des Alkoholkonsums, gesündere Ernährung) und Reduktion der Risikofaktoren (Reduktion der Sonnenexposition und Schutz vor UV-Strahlung) feststellen. Eine Abhängigkeit der Verhaltensänderungen vom Bildungsstand, Geschlecht oder dem Familienstand ergab sich hingegen nicht. Die Nutzung textilen Sonnenschutzes sowie der Umgang mit sportlicher Betätigung änderte sich nicht. Hinsichtlich der Lebensqualität zeigten sich unsere Patienten generell zufriedener als die deutsche Allgemeinbevölkerung. Weibliches Geschlecht, das Leben mit einem Partner, ein hohes Bildungsniveau sowie höheres Lebensalter wirkten sich bei unseren Patienten positiv auf die Lebensqualität aus.
Diskussion Vor dem Hintergrund einer weiter notwendigen Verbesserung der primären und auch sekundären Präventionsmaßnahmen erscheint auch eine Optimierung spezifischer Aufklärungsinhalte in der Dermatoonkologie notwendig. Insbesondere der Einfluss einer gesunden Lebensweise spielt hier eine Rolle. Die Auswirkungen der Hautkrebserkrankung auf die Lebensqualität waren geringer als von uns erwartet. Dies kann als Ursprung für den verminderten Antrieb zur Lebensstilveränderung gesehen werden.
Limitationen Der Homburger Gesundheitsbogen wurde eigens entwickelt und nicht in Testverfahren validiert. Die Patienten wurden nur einmalig angeschrieben. Erinnerungsmaßnahmen oder Incentives wurden nicht genutzt.
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Affiliation(s)
- D. Hoernecke
- Klinik für Gastroenterologie, Onkologie, Endokrinologie und Diabetologie, Medizinische Klinik I, Klinikum Friedrichshafen
| | - C. Pföhler
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - S. Wagenpfeil
- Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik, Universität des Saarlandes, Campus Homburg/Saar
- Zentrum für Klinische und Experimentelle Photodermatologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - T. Vogt
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Homburg/Saar
- Zentrum für Klinische und Experimentelle Photodermatologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - C. Müller
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Homburg/Saar
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Hassel J, Mangana J, Dummer R, Pföhler C, Wistuba-Hamprecht K, Weide B, Hakim-Meibodi L, Meier F, Roth J, Zucht HD, Budde P, Tuschen M, Schulz-Knappe P. Prediction of irAEs in ipilimumab-treated melanoma patients based on serum autoantibodies. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy269.132] [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: 11/13/2022] Open
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Worm M, Francuzik W, Renaudin J, Bilo MB, Cardona V, Scherer Hofmeier K, Köhli A, Bauer A, Christoff G, Cichocka‐Jarosz E, Hawranek T, Hourihane JO, Lange L, Mahler V, Muraro A, Papadopoulos NG, Pföhler C, Poziomkowska‐Gęsicka I, Ruëff F, Spindler T, Treudler R, Fernandez‐Rivas M, Dölle S. Factors increasing the risk for a severe reaction in anaphylaxis: An analysis of data from The European Anaphylaxis Registry. Allergy 2018; 73:1322-1330. [PMID: 29318637 DOI: 10.1111/all.13380] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Preventive measures to decrease the frequency and intensity of anaphylactic events are essential to provide optimal care for allergic patients. Aggravating factors may trigger or increase the severity of anaphylaxis and therefore need to be recognized and avoided. OBJECTIVE To identify and prioritize factors associated with an increased risk of developing severe anaphylaxis. METHODS Data from the Anaphylaxis Registry (122 centers in 11 European countries) were used in logistic regression models considering existing severity grading systems, elicitors, and symptoms to identify the relative risk of factors on the severity of anaphylaxis. RESULTS We identified higher age and concomitant mastocytosis (OR: 3.1, CI: 2.6-3.7) as the most important predictors for an increased risk of severe anaphylaxis. Vigorous physical exercise (OR: 1.5, CI: 1.3-1.7), male sex (OR: 1.2, CI: 1.1-1.3), and psychological burden (OR: 1.4, CI: 1.2-1.6) were more often associated with severe reactions. Additionally, intake of beta-blockers (OR: 1.9, CI: 1.5-2.2) and ACE-I (OR: 1.28, CI: 1.05, 1.51) in temporal proximity to allergen exposition was identified as an important factor in logistic regression analysis. CONCLUSION Our data suggest it may be possible to identify patients who require intensified preventive measures due to their relatively higher risk for severe anaphylaxis by considering endogenous and exogenous factors.
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Affiliation(s)
- M. Worm
- Department of Dermatology and Allergology Charite‐Universitätsmedizin Berlin Berlin Germany
| | - W. Francuzik
- Department of Dermatology and Allergology Charite‐Universitätsmedizin Berlin Berlin Germany
| | - J.‐M. Renaudin
- Allergy Vigilance Network University Hospital Nancy Nancy France
| | - M. B. Bilo
- Department of Internal Medicine/Allergy Unit University Hospital Ospedali Riuniti Ancona Italy
| | - V. Cardona
- Allergy Section, Department of Internal Medicine Hospital Universitari Vall d'Hebron Barcelona Spain
| | | | - A. Köhli
- Division of Allergology University Children's Hospital Zurich Switzerland
| | - A. Bauer
- Department of Dermatology University Allergy Center University Hospital Carl Gustav Carus Technical University Dresden Dresden Germany
| | - G. Christoff
- Faculty of Public Health Medical University‐Sofia Sofia Bulgaria
- Tokuda Medical Centre Allergy Out‐patient Clinic Sofia Bulgaria
| | - E. Cichocka‐Jarosz
- Department of Pediatrics Jagiellonian University Medical College Krakow Poland
| | - T. Hawranek
- Department of Dermatology Paracelsus Private Medical University Salzburg Salzburg Austria
| | | | - L. Lange
- Department of Pediatrics St. Marien‐Hospital Bonn Germany
| | - V. Mahler
- Department of Dermatology University Hospital of Erlangen Friedrich‐Alexander‐University Erlangen Erlangen Germany
| | - A. Muraro
- Department of Mother and Child Health Padua General University Hospital Padua Italy
| | | | - C. Pföhler
- Department of Dermatology Saarland University Hospital Homburg/Saar Germany
| | | | - F. Ruëff
- Department of Dermatology and Allergology Klinikum der Universität München München Germany
| | - T. Spindler
- Department of Pediatric Pneumology and Allergology Lung Centre South‐West Wangen Germany
| | - R. Treudler
- Department of Dermatology, Venerology and Allergology LICA‐Comprehensive Allergy Center Universität Leipzig Leipzig Germany
| | | | - S. Dölle
- Department of Dermatology and Allergology Charite‐Universitätsmedizin Berlin Berlin Germany
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Müller C, Güvenc B, Henn W, Christmann A, Vogt T, Pföhler C. Familiäre Keratoakanthome vom Typ Ferguson-Smith: Ein Fallbericht mit Nachweis einer bislang nicht beschriebenen Mutation im TGFBR-1-Gen. Akt Dermatol 2016. [DOI: 10.1055/s-0042-113090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- C. Müller
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - B. Güvenc
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - W. Henn
- Institut für Humangenetik, Universitätsklinikum des Saarlandes, Homburg/Saar
| | | | - T. Vogt
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - C. Pföhler
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Homburg/Saar
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Müller C, Zdebik A, Pföhler C, Vogt T. Ichthyosiformer Morphenwandel einer erythrodermen Mycosis fungoides unter extrakorporaler Photopherese-Therapie – klinisch relevant? Akt Dermatol 2016. [DOI: 10.1055/s-0042-108619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- C. Müller
- Universitätsklinikum des Saarlandes, Klinik für Dermatologie, Venerologie und Allergologie, Homburg/Saar
| | - A. Zdebik
- Universitätsklinikum des Saarlandes, Klinik für Dermatologie, Venerologie und Allergologie, Homburg/Saar
| | - C. Pföhler
- Universitätsklinikum des Saarlandes, Klinik für Dermatologie, Venerologie und Allergologie, Homburg/Saar
| | - T. Vogt
- Universitätsklinikum des Saarlandes, Klinik für Dermatologie, Venerologie und Allergologie, Homburg/Saar
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Müller C, Kim YJ, Vogt T, Pföhler C. Diagnostik und histologische Besonderheiten von Systemvaskulitiden – Teil 2. Akt Dermatol 2016. [DOI: 10.1055/s-0042-111413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- C. Müller
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Y.-J. Kim
- Institut für Pathologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - T. Vogt
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - C. Pföhler
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum des Saarlandes, Homburg/Saar
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Affiliation(s)
- C. Müller
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - T. Vogt
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - C. Pföhler
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum des Saarlandes, Homburg/Saar
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Eigentler TK, Gutzmer R, Hauschild A, Heinzerling L, Schadendorf D, Nashan D, Hölzle E, Kiecker F, Becker J, Sunderkötter C, Moll I, Richtig E, Pönitzsch I, Pehamberger H, Kaufmann R, Pföhler C, Vogt T, Berking C, Praxmarer M, Garbe C. Adjuvant treatment with pegylated interferon α-2a versus low-dose interferon α-2a in patients with high-risk melanoma: a randomized phase III DeCOG trial. Ann Oncol 2016; 27:1625-32. [PMID: 27287206 DOI: 10.1093/annonc/mdw225] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 04/26/2016] [Accepted: 05/30/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Adjuvant treatment with interferon (IFN)-α-2a improved disease-free survival (DFS) and showed a trend for improving overall survival (OS) in melanoma. This trial was designed to examine whether PEG-IFN is superior to IFN with regard to distant metastasis-free survival (DMFS), DFS and OS. PATIENTS AND METHODS In this multicenter, open-label, prospective randomized phase III trial, patients with resected cutaneous melanoma stage IIA(T3a)-IIIB (AJCC 2002) were randomized to receive PEG-IFN (180 μg subcutaneously 1×/week; 24 months) or IFN α-2a (3MIU subcutaneously 3×/week; 24 months). Randomization was stratified for stage, number of metastatic nodes, age and previous IFN treatment. The primary end point was DMFS; secondary end points were OS, DFS, quality of life (QoL) and tolerability. RESULTS A total of 909 patients were enrolled (451 PEG-IFN versus 458 IFN). Neither 5-year DMFS [PEG-IFN 61.0% versus IFN 67.3%; hazard ratio (HR) 1.16, P = 0.21] nor 5-year OS (PEG-IFN 73.2% versus IFN 75.2%; HR 1.05, P = 0.70) nor 5-year DFS (PEG-IFN 57.3% versus IFN 60.9%; HR 1.09, P = 0.40) showed significant differences. Subgroup analyses in patients ± ulcerated primaries and of different tumor stages did not find differences in DMFS, OS or DFS between the treatment groups. One hundred and eighteen patients (26.2%) in the PEG-IFN and 61 patients (13.3%) in the IFN population did not receive the full dosage and length of treatment due to adverse events (P < 0.001). Leukopenia and elevation of liver enzymes were more common in the PEG-IFN arm (56% versus 23.5% LCP; 19.1% versus 9.4% AST; 33.0% versus 16.5% ALT). QoL was identical for nearly all domains. CONCLUSION PEG-IFN did not improve the outcome over IFN. A higher percentage of patients under PEG-IFN discontinued treatment due to toxicity. CLINICAL TRIALSGOV IDENTIFIER NCT00204529.
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Affiliation(s)
- T K Eigentler
- Department of Dermatology, Center for Dermatooncology, University Medical Center Tübingen, Tübingen
| | - R Gutzmer
- Department of Dermatology and Allergy, Hannover Medical School, Hannover
| | - A Hauschild
- Department of Dermatology, University Hospital Kiel, Kiel
| | - L Heinzerling
- Department of Dermatology, University Hospital Erlangen, Erlangen
| | - D Schadendorf
- Department of Dermatology, University Essen-Duisburg, Essen
| | - D Nashan
- Department of Dermatology, Hospital Dortmund, Dortmund
| | - E Hölzle
- Department of Dermatology, Hospital Oldenburg, Oldenburg
| | - F Kiecker
- Department of Dermatology, Charité Berlin, Berlin
| | - J Becker
- Department of Dermatology, University Essen-Duisburg, Essen
| | - C Sunderkötter
- Department of Dermatology, University Hospital Münster, Münster
| | - I Moll
- Department of Dermatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E Richtig
- Department of Dermatology, University Hospital Graz, Graz, Austria
| | - I Pönitzsch
- Department of Dermatology, University Hospital Leipzig, Leipzig, Germany
| | - H Pehamberger
- Department of Dermatology, AKH Wien, University Hospital Vienna, Vienna, Austria
| | - R Kaufmann
- Department of Dermatology, University Hospital Frankfurt am Main, Frankfurt/Main
| | - C Pföhler
- Department of Dermatology, Saarland University Medical School, Homburg/Saar
| | - T Vogt
- Department of Dermatology, Saarland University Medical School, Homburg/Saar
| | - C Berking
- Department of Dermatology and Allergy, University Hospital of Munich, Munich, Germany
| | | | - C Garbe
- Department of Dermatology, Center for Dermatooncology, University Medical Center Tübingen, Tübingen
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Pföhler C, Vogt T, Müller CSL. [Malignant head and neck melanoma : Part 1: Diagnosis and histological particularities]. HNO 2016; 63:523-34; quiz 535-6. [PMID: 26160004 DOI: 10.1007/s00106-015-0024-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
About 15% of all cutaneous melanomas develop in the head and neck region. Mucosal melanomas are rare and represent only 1% of all melanomas, however, most frequently, these are located in the nose, the paranasal sinuses and the oral cavity. Visual diagnosis and reflected-light microscopy are relevant for the evaluation of melanoma-suspect lesions. Histological investigation of resected tumors need special skills of the histopathologist and includes in case of high-risk tumors investigations of mutations in the tumor tissue concerning NRAS, BRAF and KIT. The risk of lymphatic or hematogeneous spread rises with increasing tumor thickness and the presence of further prognostic risk factors such as ulceration of the primary tumor or the presence of mitoses within the tumor.
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Müller C, Güvenc B, Vogt T, Pföhler C. Kutane Ablagerungsdermatosen – die Haut als Abfalleimer? Was muss der Kliniker wissen? Akt Dermatol 2016. [DOI: 10.1055/s-0041-107740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- C. Müller
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - B. Güvenc
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - T. Vogt
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - C. Pföhler
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Homburg/Saar
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Mauer S, Pföhler C, Vogt T, Müller C. Lumbales „ancient“ Schwannom – Fallbericht und Review einer seltenen Entität im dermatopathologischen Alltag. Akt Dermatol 2015. [DOI: 10.1055/s-0034-1392798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- S. Mauer
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes
| | - C. Pföhler
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes
| | - T. Vogt
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes
| | - C. Müller
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes
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Pföhler C, Müller CSL, Al-Kadah B, Vogt T. Neoadjuvante Therapie mit Vismodegib bei einem muskelinfiltrierenden sklerodermiformen Basalzellkarzinom der Nase. Akt Dermatol 2015. [DOI: 10.1055/s-0035-1558615] [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: 10/23/2022]
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Pföhler C, Vogt T, Müller CSL. [Malignant head and neck melanoma: Part 2: Therapy]. HNO 2015. [PMID: 26219523 DOI: 10.1007/s00106-015-0034-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Resection margins of melanomas in the head and neck region often have to be adapted according anatomical circumstances. In the case of thicker primary tumors or after complete resection of locoregional lymph node metastases, adjuvant therapy with interferon-α can be performed; in some cases, adjuvant radiotherapy may also be indicated. In the case of inoperable lymph node or distant metastases, systemic treatment is required. Beside well-established mono- or polychemotherapy regimens, newer targeted therapies with BRAF inhibitors (vemurafenib, dabrafenib), mitogenic-activated protein kinase (MEK) inhibitors (trametinib, binimetinib, and cobimetinib), and kinase inhibitors (imatinib, sunitinib, nilotinib, dasatinib) are also available.
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Affiliation(s)
- C Pföhler
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Kirrbergerstrasse, 66421, Homburg/Saar, Deutschland,
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Pföhler C, Schorn K, Skudlik C, Vogt T. Basistherapie des chronischen Handekzems mit Betulin-Emulsionen – Ergebnisse nicht-interventioneller Therapiestudien an 199 Patienten. Akt Dermatol 2015. [DOI: 10.1055/s-0034-1392110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- C. Pföhler
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | | | - C. Skudlik
- Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück
| | - T. Vogt
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Homburg/Saar
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Ugurel S, Loquai C, Kähler K, Hassel J, Berking C, Zimmer L, Haubitz I, Satzger I, Müller-Brenne T, Mikhaimer N, Becker J, Kilian K, Schadendorf D, Heinzerling L, Kaatz M, Utikal J, Göppner D, Pföhler C, Pflugfelder A, Mössner R, Gutzmer R. A multicenter DeCOG study on predictors of vemurafenib therapy outcome in melanoma: pretreatment impacts survival. Ann Oncol 2015; 26:573-82. [DOI: 10.1093/annonc/mdu573] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Breuer K, Lipperheide C, Lipke U, Zapf T, Dickel H, Treudler R, Molin S, Mahler V, Pföhler C, Löffler H, Schwantes H, Schnuch A. Contact allergy induced by bisphenol A diglycidyl ether leachables from aluminium tubes for pharmaceutical use. Allergy 2015; 70:220-6. [PMID: 25582652 DOI: 10.1111/all.12538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Aluminium tubes for pharmaceutical use are internally lacquered with epoxy resins (ER) based on bisphenol A diglycidyl ether (BADGE). Recently, it was shown that remnants of ER polymerization like BADGE are extractable from epoxy-based coatings of commercially available tubes and may leach into semi-solid drug preparations. We aimed to evaluate the safety of BADGE-contaminated macrogol ointments in individuals sensitized to ER based on BADGE by use tests. METHODS Repeated open application testing (ROAT) in 11 patients sensitized to ER based on BADGE with BADGE in macrogol ointments (3 mg/kg; 30 mg/kg, equivalent to BADGE concentration determined in macrogol ointment after storage in a commercially available tube; 300 mg/kg). RESULTS The 30 mg/kg BADGE ointment elicited reactions in three patients, and another three patients reacted to 300 mg/kg BADGE ointment. No reactions to the vehicle control and 3 mg/kg BADGE were observed. CONCLUSIONS Elevated BADGE concentrations in ER-coated aluminium tubes pose a risk of developing contact dermatitis to patients sensitized to ER based on BADGE. Quality standards are deemed necessary for the production of ER-coated aluminium tubes intended for pharmaceutical use and should consider the results of the present ROAT study.
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Affiliation(s)
- K. Breuer
- Department of Allergology and Occupational Dermatology; Dermatologikum Hamburg; Hamburg Germany
| | - C. Lipperheide
- Federal Institute for Drugs and Medical Devices (BfArM); Bonn Germany
| | - U. Lipke
- Federal Institute for Drugs and Medical Devices (BfArM); Bonn Germany
| | - T. Zapf
- Federal Institute for Drugs and Medical Devices (BfArM); Bonn Germany
| | - H. Dickel
- Department of Dermatology, Venereology and Allergology; St. Josef-Hospital; Ruhr-University Bochum; Bochum Germany
| | - R. Treudler
- Department of Dermatology, Venereology and Allergology; University of Leipzig; Leipzig Germany
| | - S. Molin
- Department of Dermatology and Allergology; Ludwig Maximilians University; Munich Germany
| | - V. Mahler
- Department of Dermatology; University Hospital of Erlangen; Erlangen Germany
| | - C. Pföhler
- Department of Dermatology; Saarland University Medical School; Homburg/Saar Germany
| | - H. Löffler
- Department of Dermatology; SLK-Kliniken; Heilbronn Germany
| | - H. Schwantes
- Department of Occupational Dermatology; Berufsgenossenschaftliche-Klinik Falkenstein; Falkenstein Germany
| | - A. Schnuch
- Information Network of Departments of Dermatology; University of Göttingen; Göttingen Germany
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Stanisz H, Pföhler C, Vogt T, Müller C. Erratum zu: Disseminierte infiltrierte juckende Läsionen am Körper. Hautarzt 2012. [DOI: 10.1007/s00105-012-2391-2] [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: 10/28/2022]
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Worm M, Edenharter G, Ruëff F, Scherer K, Pföhler C, Mahler V, Treudler R, Lang R, Nemat K, Koehli A, Niggemann B, Hompes S. Symptom profile and risk factors of anaphylaxis in Central Europe. Allergy 2012; 67:691-8. [PMID: 22335765 DOI: 10.1111/j.1398-9995.2012.02795.x] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anaphylaxis is the most severe manifestation of an IgE-dependent allergy. Standardized acquired clinical data from large cohorts of well-defined cases are not available. The aim of this study was to analyse the symptom profile and risk factors of anaphylaxis in a large Central European cohort. METHODS We acquired data from patients in Germany, Austria and Switzerland who experienced a severe allergic reaction defined by the onset of severe pulmonary and/or severe cardiovascular symptoms. The data were gained via an online questionnaire from 83 medical centres specialized in allergy. Data were collected from 2006 to 2010 and analysed by using a multinomial regression model. RESULTS A total of 2012 paediatric and adult patients were included into the present analysis. The skin (84%) was the most frequently affected organ followed by the cardiovascular (72%) and the respiratory (68%) system. The regression model analysing the onset of cardiovascular versus respiratory symptoms revealed a strong impact of age (adjusted OR = 6.08; 95% CI, 3.35-11.01; P < 0.001). Furthermore, the elicitor food (adjusted OR = 0.29; 95% CI, 0.21-0.41, P < 0.001) and the presence of atopic diseases (adjusted OR = 0.54; 95% CI, 0.40-0.73, P < 0.001) were significantly associated with the onset of respiratory symptoms. CONCLUSION Data from individuals who experienced anaphylaxis can support the identification of risk factors. The present study indicates that age, the elicitor itself and the presence of atopic diseases have an impact on the symptom profile of anaphylaxis. Identifying further risk factors of anaphylaxis is of significant importance for clinical practice in the future.
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Affiliation(s)
- M. Worm
- Department of Dermatology and Allergy; University Hospital Charité; Berlin; Germany
| | | | - F. Ruëff
- Department of Dermatology and Allergology; Ludwig-Maximilian-University; Munich; Germany
| | - K. Scherer
- Allergy Unit; Department of Dermatology; University Hospital; Basel; Switzerland
| | - C. Pföhler
- Department of Dermatology; Saarland University Hospital; Homburg/Saar; Germany
| | - V. Mahler
- Department of Dermatology; University Hospital; Erlangen; Germany
| | - R. Treudler
- Department of Dermatology; Venerology and Allergology, Universität Leipzig; Germany
| | - R. Lang
- Department of Dermatology; University Hospital; Paracelsus Medical University; Salzburg; Austria
| | - K. Nemat
- Department of Paediatrics; University Hospital Carl Gustav Carus; Technical University of Dresden; Dresden; Germany
| | - A. Koehli
- Division of Allergy; University Children's Hospital; Zurich; Switzerland
| | - B. Niggemann
- Paediatric Allergology and Pneumology; German Red Cross Hospital Westend; Berlin; Germany
| | - S. Hompes
- Department of Dermatology and Allergy; University Hospital Charité; Berlin; Germany
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Stanisz H, Pföhler C, Vogt T, Müller CSL. [Disseminated infiltrated cutaneous pruritis]. Hautarzt 2012; 63:230-2. [PMID: 22382306 DOI: 10.1007/s00105-012-2338-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The diagnosis of scabies is clinically not always simple without the detection of mites. Histology can be difficult, particularly without clinico-pathologic correlation. [corrected] Even after adequate antiscabies treatment the dermatological symptoms and complaints can persist and necessitate an [corrected] intensive follow-up treatment. The case example described here underlines that in consideration of the multifaceted clinical appearance and the sometimes difficult detection of mites, scabies should always be considered as a differential diagnosis in cases of persistent pruritis.
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Affiliation(s)
- H Stanisz
- Klinik für Dermatologie, Allergologie und Venerologie, Kirrberger Str., 66421, Homburg/Saar, Deutschland.
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Psaier S, Pföhler C, Vogt T, Müller C. Granulomatöse Fremdkörperreaktion nach Augmentation von Aknenarben – eine diagnostische und therapeutische Herkulesaufgabe. Akt Dermatol 2011. [DOI: 10.1055/s-0030-1256578] [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: 10/18/2022]
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Hinterberger L, Müller CSL, Vogt T, Pföhler C. [Reticulated teleangiectatic erythema after implantation of medical devices. An increasingly occurring phenomenon?]. Hautarzt 2011; 62:770-3. [PMID: 21437705 DOI: 10.1007/s00105-010-2125-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Reticulated telangiectatic erythema (RTE) is a rare skin reaction to extraneous materials. We present three cases in which asymptomatic persistent erythemas developed in the area of implantation after medical devices were inserted. Topical and systemic treatment did not improve the skin changes. Patch testing including applied materials showed negative results in all cases. Histological investigation of punch biopsy specimens showed moderate dilatated vessels and a slight lymphocytic infiltrate. Due to our findings and in synopsis with the clinical impression we diagnosed RTE. As RTE is asymptomatic in most cases, the devices need not be removed.
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Affiliation(s)
- L Hinterberger
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Homburg/Saar
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Weimann S, Vogt T, Pföhler C. Biss einer Ammendornfingerspinne - eine zukünftig häufiger zu stellende Diagnose? Akt Dermatol 2011. [DOI: 10.1055/s-0030-1256098] [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: 10/18/2022]
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Müller C, Schmaltz R, Vogt T, Pföhler C. Lichen striatus and blaschkitis: reappraisal of the concept of blaschkolinear dermatoses. Br J Dermatol 2010; 164:257-62. [DOI: 10.1111/j.1365-2133.2010.10053.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Müller CSL, Schmaltz R, Vogt T, Pföhler C. Expression of CD30 antigen in superficial mycotic infections of the skin: a possible non-specific finding without clinical relevance. Mycoses 2010; 54:e360-3. [DOI: 10.1111/j.1439-0507.2010.01924.x] [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: 11/29/2022]
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Müller C, Wagner A, Pföhler C, Tilgen W. Erythema elevatum et diutinum assoziiert mit pulmonalen Infiltraten und nekrotisierender Keratopathie – eine diagnostische Herausforderung! Akt Dermatol 2009. [DOI: 10.1055/s-0028-1119562] [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: 10/21/2022]
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Nürnberg B, Gräber S, Gärtner B, Geisel J, Pföhler C, Schadendorf D, Tilgen W, Reichrath J. Reduced serum 25-hydroxyvitamin D levels in stage IV melanoma patients. Anticancer Res 2009; 29:3669-3674. [PMID: 19667163] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Reduced serum 25-hydroxyvitamin D3 (25(OH)D) levels are associated with an increased incidence and an unfavorable outcome of various types of cancer. However, the influence of serum 25(OH)D on the incidence and outcome of patients with malignant melanoma is unknown. PATIENTS AND METHODS The association between serum 25(OH)D levels and clinical and histopathological data among 205 patients with malignant melanoma was examined. Additionally, 141 healthy controls were investigated. All the blood samples were taken between October and April to minimize seasonal variations; basal serum 25(OH)D levels were analyzed using the LIAISON 25-OH Vitamin D-Assay (DiaSorin, Dietzenbach, Germany). The study started in 1997. The patients were observed until death or March 2007, whichever came first. RESULTS Serum 25(OH)D levels were significantly reduced in stage IV melanoma patients as compared to stage I melanoma patients (p=0.006). A trend toward a greater tumor thickness of the primary cutaneous melanomas was seen in the patients with low (<10 ng/ml) serum 25(OH)D levels (median: 2.55 mm) as compared to those with 25(OH)D serum levels >20 ng/ml (median: 1.5 mm), although this difference was not statistically significant (p=0.078). The patients with low 25(OH)D serum levels (<10 ng/ml) had earlier distant metastatic disease (median: 24.37 months) as compared to those with 25(OH)D serum levels >20 ng/ml (median: 29.47 months), although this difference was also not statistically significant (p=0.641). CONCLUSION Among the patients with malignant melanoma, significantly reduced serum 25(OH)D levels were found in the stage IV patients as compared to stage I patients, and those with low 25(OH)D serum levels (<10 ng/ml) may develop earlier distant metastatic disease compared to those with higher 25(OH)D serum levels (>20 ng/ml). Further study of the vitamin D pathway and its influence on pathogenesis and progression of malignant melanoma is warranted.
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Affiliation(s)
- B Nürnberg
- Department of Dermatology, The Saarland University Hospital, Homburg, Germany
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Abstract
Bites by poisonous snakes are rare dermatologic emergencies. A 43-year-old woman was bitten on her right forefinger by an adder during a hiking vacation in Austria. Her right arm and chest wall became swollen and then hemorrhagic, but she responded well to analgesics and immobilization. Administration of a specific antiserum was not necessary because of the lack of a systemic reaction.
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Affiliation(s)
- C Pföhler
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Kirrbergerstr., 66421, Homburg/Saar, Deutschland.
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Nürnberg B, Schadendorf D, Gärtner B, Pföhler C, Herrmann W, Tilgen W, Reichrath J. Progression of malignant melanoma is associated with reduced 25-hydroxyvitamin D serum levels. Exp Dermatol 2008. [DOI: 10.1111/j.1600-0625.2008.00742_6.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Spieth K, Kaufmann R, Dummer R, Garbe C, Becker J, Hauschild A, Tilgen W, Ugurel S, Beyeler M, Bröcker E, Kaehler K, Pföhler C, Gille J, Leiter U, Schadendorf D. Temozolomide plus pegylated interferon alfa-2b as first-line treatment for stage IV melanoma: a multicenter phase II trial of the Dermatologic Cooperative Oncology Group (DeCOG). Ann Oncol 2008; 19:801-6. [DOI: 10.1093/annonc/mdm565] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Szabo N, Aßmann G, Pfeundschuh M, Tilgen W, Pföhler C. Untersuchungen zur Häufigkeit von Farbsehstörungen bei Patienten mit Autoimmunerkrankungen und entzündlich-rheumatischen Erkrankungen. Akt Dermatol 2007. [DOI: 10.1055/s-2007-1003064] [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: 10/21/2022]
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Müller TM, Lorenz MT, Müller H, Tilgen W, Pföhler C. Kreuzotterbiss – ein seltener dermatologischer Notfall. Akt Dermatol 2007. [DOI: 10.1055/s-2007-1003066] [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: 10/21/2022]
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Müller C, Wagner A, Stein U, Remberger K, Tilgen W, Pföhler C. Erythema gyratum repens bei einem Patienten mit großzelligem B-Zell-Non-Hodgkin-Lymphom des Hodens. Akt Dermatol 2007. [DOI: 10.1055/s-2007-966974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Denne C, Pföhler C, Sybrecht G. [Phototoxic skin changes caused by amiodarone]. Dtsch Med Wochenschr 2007; 132:497-8. [PMID: 17327997 DOI: 10.1055/s-2007-970365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- C Denne
- Innere Medizin V, Pneumologie, Universitätsklinikum Homburg, 66421 Homburg/Saar
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Deubel M, Ring J, Darsow U, Willi R, Pfab F, Ellwanger J, Sander I, van Heemst R, de Jong L, Houba R, Idema R, Belderbos H, Zahradnik E, Brüning T, Raulf-Heimsoth M, Eben R, Bauer C, Ruëff F, Ruzicka T, Przybilla B, Pföhler C, Hasselmann D, Müller C, Tilgen W, Buters J, Behrendt H, Zilker T. Kasuistiken. Allergo J 2007. [DOI: 10.1007/bf03370561] [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: 11/24/2022]
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Shannan B, Seifert M, Leskov K, Boothman D, Pföhler C, Tilgen W, Reichrath J. Clusterin (CLU) and melanoma growth: CLU is expressed in malignant melanoma and 1,25-dihydroxyvitamin D3 modulates expression of CLU in melanoma cell lines in vitro. Anticancer Res 2006; 26:2707-16. [PMID: 16886681] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND The glycoprotein clusterin (CLU) has two known isoforms generated in human cells. A nuclear form of CLU protein (nCLU) is pro-apoptotic, while a secretory form (sCLU) is pro-survival. CLU expression has been associated with tumorigenesis and the progression of various malignancies. MATERIALS AND METHODS The expression of CLU was studied immunohistochemically in paraffin sections of primary cutaneous malignant melanomas, metastases of malignant melanomas and acquired melanocytic naevi. Using PCR and Western blotting, the expression of CLU was also investigated in various vitamin D-responsive (MeWo, SK-MEL-28) and vitamin D-resistant melanoma cell lines (SK-MEL-5, SK-MEL-25), as well as in normal human melanocytes (NHM), along with 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] treatment. RESULTS In contrast to acquired melanocytic naevi, CLU immunoreactivity was found in primary cutaneous malignant melanomas and metastases of malignant melanomas in situ. Both CLU protein and RNA were detected in melanoma cell lines and NHM. Treatment with 1,25(OH)2D3 modulated CLU's expression in vitamin D-responsive but not in -resistant melanoma cell lines. CONCLUSION CLU may be of importance for the progression of malignant melanoma. The growth regulatory effects of 1,25(OH)2D3 in melanoma cell lines may, at least in part, be mediated via modulation of CLU expression.
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Affiliation(s)
- B Shannan
- Department of Dermatology, The Saarland University Hospital, 66421 Homburg, Germany
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Ladewig G, Reinhold U, Thirkill C, Kerber A, Tilgen W, Pföhler C. Incidence of antiretinal antibodies in melanoma: screening of 77 serum samples from 51 patients with American Joint Committee on Cancer stage I to IV. Am J Ophthalmol 2005. [DOI: 10.1016/j.ajo.2005.08.053] [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: 10/25/2022]
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Ladewig G, Reinhold U, Thirkill CE, Kerber A, Tilgen W, Pföhler C. Incidence of antiretinal antibodies in melanoma: screening of 77 serum samples from 51 patients with American Joint Committee on Cancer stage I-IV. Br J Dermatol 2005; 152:931-8. [PMID: 15888149 DOI: 10.1111/j.1365-2133.2005.06480.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with melanoma-associated retinopathy (MAR) experience different visual symptoms caused by the production of antitumoral antibodies that cross-react with retinal epitopes. Immunofluorescence assays of serum from patients with MAR on sectioned monkey or human retina characteristically reveal antibody activity located within the inner nuclear layer, with a focus of activity upon the membranes of bipolar cells. OBJECTIVES We inquired into the association with disease of this serological abnormality by evaluating sera from patients with melanoma with no MAR-like signs or symptoms. METHODS Groups of patients were selected with different stages of melanoma (American Joint Committee on Cancer stages I-IV). Seventy-seven serum samples from 51 patients with melanoma were examined by indirect immunohistochemical assay on sections of human retina. RESULTS Of the 77 serum samples, 53 were found to contain antibodies reactive with various components of retina. Eight were from 17 sera from patients in stage I or II, 14 were from 23 sera from patients in stage III, and 31 were from 37 sera from patients in stage IV. Statistical analysis revealed a correlation between antibody activity and the stage of disease, with a higher percentage of antibody activity in advanced stages (P = 0.002). CONCLUSIONS The presence of antiretinal antibodies in patients with melanoma without ocular symptoms appears to be more common than previously suspected. Antibody activity similar to that ascribed to the MAR syndrome appears in some patients with melanoma who have no MAR-like retinopathy. Follow-up studies will determine if patients with antiretinal antibodies go on to develop MAR and if staining intensity and staining patterns change over the course of the disease.
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Affiliation(s)
- G Ladewig
- Department of Dermatology, The Saarland University Hospital , 66421 Homburg/Saar, Germany
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Pföhler C, Rass K, Tilgen W. Glivec (Imatinib Mesylat) als neue Therapieoption des Dermatofibrosarcoma protuberans? Akt Dermatol 2004. [DOI: 10.1055/s-2004-832509] [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: 10/19/2022]
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Pföhler C, Steinhäuser S, Wagner A, Ugurel S, Tilgen W. Komplette Remission kutaner Satelliten- und In-transit-Filiae nach intral�sionaler Interleukin-2-Applikation bei 2�Patienten mit malignem Melanom. Hautarzt 2004; 55:171-5. [PMID: 14968328 DOI: 10.1007/s00105-003-0620-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Multiple cutaneous satellite and in-transit metastases of melanoma without involvement of lymph nodes or other organs are a challenge especially when they occur in elderly inoperable patients with multiple internal diseases. In this particular situation, intralesional application of interleukin-2 may represent an effective alternative to systemic chemo- or immunotherapy as it can be performed on an out-patient basis and has few side effects. We treated two elderly female patients with multiple cutaneous metastases of malignant melanoma with intra- and perilesional application of interleukin-2 (3 x 6-12 Mio IE) over 12 weeks and achieved a complete remission of these metastases. In follow-up biopsies, no viable tumor cells were found. Despite a slight burning at the injection side and a transient local inflammatory reaction, the therapy was well tolerated in both cases after premedication with paracetamol 500 mg orally and pretreatment of the injection site with a cream containing lidocaine and prilocaine. No systemic side effects were observed.
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Affiliation(s)
- C Pföhler
- Hautklinik und Poliklinik, Universitätskliniken des Saarlandes, Homburg/Saar.
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Pföhler C, Tschöp S, Steinhäuser S, Rass K, Tilgen W. Der Farnsworth-Panel D 15-Test – Ein einfaches Instrument zur Erkennung eines erhöhten Metastasierungsrisikos? Erste Ergebnisse einer Untersuchung an 300 Patienten mit malignem Melanom. Akt Dermatol 2003. [DOI: 10.1055/s-2003-822214] [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: 10/19/2022]
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Steinhäuser S, Wagner A, Pföhler C, Tilgen W, Rass K. Paraneoplastische Thrombophilie unter dem Bild einer multifokal nekrotisierenden Pannikulitis. Akt Dermatol 2003. [DOI: 10.1055/s-2003-822267] [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: 10/19/2022]
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