1
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Livingstone E, Gogas H, Kandolf-Sekulovic L, Meier F, Eigentler TK, Ziemer M, Terheyden PAM, Gesierich AH, Herbst RA, Kähler KC, Ziogas DC, Mijuskovic Z, Garzarolli M, Garbe C, Roesch A, Ugurel S, Gutzmer R, Grob JJ, Kiecker F, Utikal J, Windemuth-Kieselbach C, Eckhardt S, Zimmer L, Schadendorf D. Early switch from run-in treatment with vemurafenib plus cobimetinib to atezolizumab after 3 months leads to rapid loss of tumour control in patients with advanced BRAFV600-positive melanoma: The ImmunoCobiVem phase 2 randomised trial. Eur J Cancer 2023; 190:112941. [PMID: 37482012 DOI: 10.1016/j.ejca.2023.112941] [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: 05/08/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 07/25/2023]
Abstract
AIM ImmunoCobiVem investigated whether a planned switch to atezolizumab after achieving tumour control during run-in with vemurafenib + cobimetinib improves progression-free survival (PFS) and overall survival (OS) compared to continuous targeted therapy (TT) in patients with previously untreated advanced BRAFV600-mutated melanoma. METHODS In this multicenter phase 2 study, patients received vemurafenib plus cobimetinib. After 3months, patients without progressive disease (PD) were randomly assigned (1:1) to continue vemurafenib + cobimetinib (Arm A) or switch to atezolizumab (Arm B) until first documented PD (PD1). Primary outcome was PFS1 (time from start of run-in until PD1 or death). OS and safety were also assessed. RESULTS Of 185 patients enroled between November 2016 and December 2019, 135 were randomly assigned after the run-in period (Arm A, n = 69; Arm B, n = 66). Median PFS1 was significantly longer in Arm A versus Arm B (13.9 versus 5.9months; hazard ratio [HR] 0.55; 95% confidence interval [CI], 0.37-0.84; PStratified=0.001). Median OS was not reached in either arm (HR 1.22; 95%CI, 0.69-2.16; PStratified=0.389); 2-year OS was higher in Arm B versus Arm A (67%; 95%CI, 53-78 versus 58%; 95%CI, 45-70). Grade 3/4 AEs occurred in 55% of patients in Arm A and 64% in Arm B; treatment-related AEs led to discontinuation of any drug in 7% and 9% of patients, respectively. CONCLUSION In patients with BRAFV600-mutated advanced melanoma who achieve tumour control with TT, early switch at 3months to atezolizumab led to rapid loss of tumour control but provided a numerical OS benefit at 2years compared with continued TT.
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Affiliation(s)
- E Livingstone
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site Essen, Essen, Germany
| | - H Gogas
- First Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - L Kandolf-Sekulovic
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - F Meier
- Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Skin Cancer Center at the University Cancer Centre and National Center for Tumor Diseases, Dresden, Germany
| | - T K Eigentler
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - M Ziemer
- Department of Dermatology, University of Leipzig Medical Center, Leipzig, Germany
| | | | - A H Gesierich
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | | | - K C Kähler
- Department of Dermatology, Venerology, and Allergology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - D C Ziogas
- First Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Z Mijuskovic
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - M Garzarolli
- Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - C Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - A Roesch
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site Essen, Essen, Germany
| | - S Ugurel
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site Essen, Essen, Germany
| | - R Gutzmer
- Department of Dermatology, Skin Cancer Center Hannover, Hannover Medical School, Hannover, Germany; Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany
| | - J J Grob
- Aix-Marseille University, Timone Hospital (APHM), Marseille, France
| | - F Kiecker
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Dermatology and Venereology, Vivantes Hospital Neukölln, Berlin, Germany
| | - J Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany; DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
| | | | | | - L Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site Essen, Essen, Germany
| | - D Schadendorf
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site Essen, Essen, Germany.
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Grob JJ, Guminski A, Malvehy J, Basset-Seguin N, Bertrand B, Fernandez-Penas P, Kaufmann R, Zalaudek I, Gaudy-Marqueste C, Fargnoli MC, Tagliaferri L, Fertil B, Del Marmol V, Stratigos A, Garbe C, Peris K. Position statement on classification of basal cell carcinomas. Part 1: unsupervised clustering of experts as a way to build an operational classification of advanced basal cell carcinoma based on pattern recognition. J Eur Acad Dermatol Venereol 2021; 35:1949-1956. [PMID: 34432327 PMCID: PMC8518046 DOI: 10.1111/jdv.17466] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 02/13/2021] [Accepted: 05/18/2021] [Indexed: 12/01/2022]
Abstract
Background No simple classification system has emerged for ‘advanced basal cell carcinomas’, and more generally for all difficult‐to‐treat BCCs (DTT‐BCCs), due to the heterogeneity of situations, TNM inappropriateness to BCCs, and different approaches of different specialists. Objective To generate an operational classification, using the unconscious ability of experts to simplify the great heterogeneity of the clinical situations into a few relevant groups, which drive their treatment decisions. Method Non‐supervised independent and blinded clustering of real clinical cases of DTT‐BCCs was used. Fourteen international experts from different specialties independently partitioned 199 patient cases considered ‘difficult to treat’ into as many clusters they want (≤10), choosing their own criteria for partitioning. Convergences and divergences between the individual partitions were analyzed using the similarity matrix, K‐mean approach, and average silhouette method. Results There was a rather consensual clustering of cases, regardless of the specialty and nationality of the experts. Mathematical analysis showed that consensus between experts was best represented by a partition of DTT‐BCCs into five clusters, easily recognized a posteriori as five clear‐cut patterns of clinical situations. The concept of ‘locally advanced’ did not appear consistent between experts. Conclusion Although convergence between experts was not granted, this experiment shows that clinicians dealing with BCCs all tend to work by a similar pattern recognition based on the overall analysis of the situation. This study thus provides the first consensual classification of DTT‐BCCs. This experimental approach using mathematical analysis of independent and blinded clustering of cases by experts can probably be applied to many other situations in dermatology and oncology.
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Affiliation(s)
- J J Grob
- Dermatology and skin cancer Dpt APHM Timone, Aix-Marseille University, Marseille, France
| | - A Guminski
- Melanoma Institute Australia, Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia
| | - J Malvehy
- Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, Barcelona & CIBERER, Barcelona, Spain
| | | | - B Bertrand
- Plastic, Reconstructive and Aesthetic Surgery Department, Aix-Marseille University, APHM Conception, Marseille, France
| | - P Fernandez-Penas
- Centre for Translational Skin Research, The University of Sydney, Westmead, NSW, Australia.,Department of Dermatology, Westmead Hospital, Westmead, NSW, Australia
| | - R Kaufmann
- Department of Dermatology, Venereology and Allergology, University Hospital, Frankfurt, Germany
| | - I Zalaudek
- Dermatology Clinic, University of Trieste, Trieste, Italy
| | - C Gaudy-Marqueste
- Dermatology and skin cancer Dpt APHM Timone, Aix-Marseille University, Marseille, France
| | - M C Fargnoli
- Department of Dermatology, University of L'Aquila, L'Aquila, Italy
| | - L Tagliaferri
- Dipartimento di Scienze Radiologiche, Radioterapiche Ed Ematologiche, UOC di Radioterapia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - B Fertil
- Anapix Medical, Meyreuil, France
| | - V Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - A Stratigos
- Department of Dermatology- Venereology, School of Medicine, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - C Garbe
- Department of Dermatology, Centre for Dermatooncology, Eberhard-Karls University, Tuebingen, Germany
| | - K Peris
- Institute of Dermatology, Catholic University of the Sacred Heart, Italy.,IRCCS, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
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3
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Grob JJ, Gaudy-Marqueste C, Guminski A, Malvehy J, Basset-Seguin N, Bertrand B, Fernandez-Penas P, Kaufmann R, Zalaudek I, Fargnoli MC, Tagliaferri L, Fertil B, Del Marmol V, Stratigos A, Garbe C, Peris K. Position statement on classification of basal cell carcinomas. Part 2: EADO proposal for new operational staging system adapted to basal cell carcinomas. J Eur Acad Dermatol Venereol 2021; 35:2149-2153. [PMID: 34424580 PMCID: PMC8597032 DOI: 10.1111/jdv.17467] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 02/13/2021] [Accepted: 04/07/2021] [Indexed: 11/30/2022]
Abstract
Background No simple staging system has emerged for basal cell carcinomas (BCCs), since they do not follow the TNM process, and practitioners failed to agree on simple clinical or pathological criteria as a basis for a classification. Operational classification of BCCs is required for decision‐making, trials and guidelines. Unsupervised clustering of real cases of difficult‐to‐treat BCCs (DTT‐BCCs; part 1) has demonstrated that experts could blindly agree on a five groups classification of DTT‐BCCs based on five patterns of clinical situations. Objective Using this five patterns to generate an operational and comprehensive classification of BCCs. Method Testing practitioner's agreement, when using the five patterns classification to ensure that it is robust enough to be used in the practice. Generating the first version of a staging system of BCCs based on pattern recognition. Results Sixty‐two physicians, including 48 practitioners and the 14 experts who participated in the generation of the five different patterns of DTT‐BCCs, agreed on 90% of cases when classifying 199 DTT‐BCCs cases using the five patterns classification (part 1) attesting that this classification is understandable and usable in practice. In order to cover the whole field of BCCs, these five groups of DTT‐BCCs were added a group representing the huge number of easy‐to‐treat BCCs, for which sub‐classification has little interest, and a group of very rare metastatic cases, resulting in a four‐stage and seven‐substage staging system of BCCs. Conclusion A practical classification adapted to the specificities of BCCs is proposed. It is the first tumour classification based on pattern recognition of clinical situations, which proves to be consistent and usable. This EADO staging system version 1 will be improved step by step and tested as a decision tool and a prognostic instrument.
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Affiliation(s)
- J J Grob
- Aix-Marseille University, APHM, Marseille, France
| | | | - A Guminski
- Melanoma Institute Australia, Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia
| | - J Malvehy
- Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, Barcelona & CIBERER, Barcelona, Spain
| | | | - B Bertrand
- Plastic, Reconstructive and Aesthetic Surgery Department, La Conception Hospital, Marseille, France
| | - P Fernandez-Penas
- Centre for Translational Skin Research, The University of Sydney, Westmead, NSW, Australia.,Department of Dermatology, Westmead Hospital, Westmead, NSW, Australia
| | - R Kaufmann
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt, Germany
| | - I Zalaudek
- Dermatology Clinic, University of Trieste, Trieste, Italy
| | - M C Fargnoli
- Department of Dermatology, University of L'Aquila, L'Aquila, Italy
| | - L Tagliaferri
- Dipartimento di Scienze Radiologiche, Radioterapiche Ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Rome, Italy
| | - B Fertil
- Anapix Medical, Meyreuil, France
| | - V Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - A Stratigos
- Department of Dermatology- Venereology, National and Kapodistrian University of Athens, School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - C Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard-Karls University, Tuebingen, Germany
| | - K Peris
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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4
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Dessinioti C, Geller AC, Whiteman DC, Garbe C, Grob JJ, Kelly JW, Scolyer RA, Rawson RV, Lallas A, Pellacani G, Stratigos AJ. Not all melanomas are created equal: a review and call for more research into nodular melanoma. Br J Dermatol 2021; 185:700-710. [PMID: 33864261 DOI: 10.1111/bjd.20388] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 12/23/2022]
Abstract
Among the histogenic subtypes of melanoma, nodular melanoma (NM) is the major contributor for thicker and fatal melanomas and it has been associated with melanoma-specific death in thin tumours, highlighting an important subgroup of 'aggressive thin' melanomas. This review provides a synthesis of the distinct characteristics of NM, with respect to epidemiology and risk factors, clinical presentation, histopathology, molecular and dermoscopic aspects, and screening practices. The real challenges are to find better biomarkers of aggressiveness and to know whether the control of such aggressive melanomas can be influenced by targeted interventions such as early detection, drug interventions and preventive strategies.
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Affiliation(s)
- C Dessinioti
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Athens, Greece
| | - A C Geller
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - D C Whiteman
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - C Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - J J Grob
- Department of Dermatology and Skin Cancers, APHM Timone Hospital Aix-Marseille University, Marseille, France
| | - J W Kelly
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Australia
| | - R A Scolyer
- Melanoma Institute Australia, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - R V Rawson
- Melanoma Institute Australia, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - A Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - A J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Athens, Greece
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5
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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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6
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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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Amatore F, Macagno N, Mailhe M, Demarez B, Gaudy-Marqueste C, Grob JJ, Raoult D, Brouqui P, Richard MA. SARS-CoV-2 infection presenting as a febrile rash. J Eur Acad Dermatol Venereol 2020; 34:e304-e306. [PMID: 32330336 PMCID: PMC7267606 DOI: 10.1111/jdv.16528] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- F Amatore
- Department of Dermatology, Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - N Macagno
- Department of Pathology, Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - M Mailhe
- IHU-Méditerranée Infection, Marseille, France.,IRD, APHM, MEPHI, Aix-Marseille University, Marseille, France
| | - B Demarez
- Department of Dermatology, Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - C Gaudy-Marqueste
- Department of Dermatology, Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - J J Grob
- Department of Dermatology, Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - D Raoult
- IHU-Méditerranée Infection, Marseille, France.,IRD, APHM, MEPHI, Aix-Marseille University, Marseille, France
| | - P Brouqui
- IHU-Méditerranée Infection, Marseille, France.,IRD, APHM, MEPHI, Aix-Marseille University, Marseille, France
| | - M A Richard
- CEReSS-EA 3279, Research Centrer in Health Services and Quality of Life Aix Marseille University, Dermatology Department, Universitary Hospital Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France
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8
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Kandel M, Allayous C, Dalle S, Mortier L, Dalac S, Dutriaux C, Leccia MT, Guillot B, Saiag P, Lacour JP, Legoupil D, Lesimple T, Aubin F, Beylot-Barry M, Brunet-Possenti F, Arnault JP, Granel-Brocard F, Stoebner PE, Dupuy A, Maubec E, Grob JJ, Dreno B, Rotolo F, Ballon A, Michiels S, Lebbe C, Borget I. Update of survival and cost of metastatic melanoma with new drugs: Estimations from the MelBase cohort. Eur J Cancer 2018; 105:33-40. [PMID: 30384014 DOI: 10.1016/j.ejca.2018.09.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 05/28/2018] [Revised: 08/16/2018] [Accepted: 09/24/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE Since 2011, significant progress was observed in metastatic melanoma (MM), with the commercialisation of seven immunotherapies or targeted therapies, which showed significant improvement in survival. In France, in 2004, the cost of MM was estimated at €1634 per patient; this cost has not been re-estimated since. This study provided an update on survival and cost in real-life clinical practice. METHODS Clinical and economic data (treatments, hospitalisations, radiotherapy sessions, visits, imaging and biological exams) were extracted from the prospective MelBase cohort, collecting individual data in 955 patients in 26 hospitals, from diagnosis of metastatic disease until death. Survival was estimated by the Kaplan-Meier method. Costs were calculated from the health insurance perspective using French tariffs. For live patients, survival and costs were extrapolated using a multistate model, describing the 5-year course of the disease according to patient prognostic factors and number of treatment lines. RESULTS Since the availability of new drugs, the mean survival time of MM patients has increased to 23.6 months (95%confidence interval [CI] :21.2;26.6), with 58% of patients receiving a second line of treatment. Mean management costs increased to €269,682 (95%CI:244,196;304,916) per patient. Drugs accounted for 80% of the total cost. CONCLUSION This study is the first that evaluated the impact of immunotherapies and targeted therapies both on survival and cost in real-life conditions. Alongside the introduction of breakthrough therapies in the first and subsequent lines, MM has been associated with a significant increase in survival but also in costs, raising the question of financial sustainability.
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Affiliation(s)
- M Kandel
- Gustave Roussy, Service de Biostatistique et D'Epidémiologie, Villejuif, France; University Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.
| | - C Allayous
- Dermatology and CIC, Assistance Publique des Hôpitaux de Paris, INSERM U976, University Paris Diderot-Saint-Louis Hospital, Paris, France
| | - S Dalle
- Dermatology, Hospices Civils de Lyon Hospital, Cancer Research Center of Lyon, Claude Bernard University, Lyon France
| | - L Mortier
- Dermatology, Lille Hospital, Lille, France
| | - S Dalac
- Dermatology, Dijon Hospital, Dijon, France
| | - C Dutriaux
- Dermatology, Bordeaux Saint-André Hospital, Bordeaux, France
| | - M T Leccia
- Dermatology, Grenoble Hospital, Grenoble, France
| | - B Guillot
- Dermatology, Montpellier Hospital, Montpellier, France
| | - P Saiag
- Dermatology, Assistance Publique des Hôpitaux de Paris, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - J P Lacour
- Dermatology, Nice Hospital, Nice, France
| | - D Legoupil
- Dermatology, Brest Hospital, Brest, France
| | | | - F Aubin
- Dermatology, Besançon Hospital, Besançon, France
| | - M Beylot-Barry
- Dermatology, Bordeaux Haut-L'évêque Hospital, Bordeaux, France
| | - F Brunet-Possenti
- Dermatology, Assistance Publique des Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - J P Arnault
- Dermatology, Amiens Hospital, Amiens, France
| | | | | | - A Dupuy
- Dermatology, Rennes Hospital, Rennes, France
| | - E Maubec
- Dermatology, Assistance Publique des Hôpitaux de Paris, Avicennes Hospital, University Paris 13, France
| | - J J Grob
- Dermatology, La Timone Hospital, Marseille, France
| | - B Dreno
- Dermatology, Nantes Hospital, Nantes, France
| | - F Rotolo
- Gustave Roussy, Service de Biostatistique et D'Epidémiologie, Villejuif, France; University Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - A Ballon
- Dermatology and CIC, Assistance Publique des Hôpitaux de Paris, INSERM U976, University Paris Diderot-Saint-Louis Hospital, Paris, France
| | - S Michiels
- Gustave Roussy, Service de Biostatistique et D'Epidémiologie, Villejuif, France; University Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - C Lebbe
- Dermatology and CIC, Assistance Publique des Hôpitaux de Paris, INSERM U976, University Paris Diderot-Saint-Louis Hospital, Paris, France
| | - I Borget
- Gustave Roussy, Service de Biostatistique et D'Epidémiologie, Villejuif, France; University Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France; GRADES, University Paris-Sud, France
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9
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Gaudy-Marqueste C, Dussouil AS, Carron R, Troin L, Malissen N, Loundou A, Monestier S, Mallet S, Richard MA, Régis JM, Grob JJ. Survival of melanoma patients treated with targeted therapy and immunotherapy after systematic upfront control of brain metastases by radiosurgery. Eur J Cancer 2017; 84:44-54. [PMID: 28783540 DOI: 10.1016/j.ejca.2017.07.017] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [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: 04/06/2017] [Revised: 06/16/2017] [Accepted: 07/11/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Targeted therapy (TT) and immunotherapies (ITs) have dramatically improved survival in metastatic melanoma (MM). However, their efficacy on brain metastasis (BM) remains limited and poorly documented. PATIENTS AND METHODS Retrospective cohort of consecutive MM patients (pts) with BMs, all systematically upfront treated by Gamma-Knife (GK) at first BM and retreated in case of new BMs, from 2010 to 2015 at the time when ipilimumab BRAF ± MEK inhibitors and anti-PD1 were introduced in practice. Survival after 1st GK (OSGK1) according to prognostic factors and treatment. RESULTS Among 179 consecutive pts treated by GK, 109 received IT and/or TT after the 1st GK. Median OSGK1 was 10.95 months and 1- and 2-year survival rates were 49.5% and 27.4%, respectively, versus a median overall survival (OS) of 2.29 months (p < .001) in those who did not receive IT or TT. In pts who initially had a single BM, median OS and 1- and 2-year survival rates were 14.46 months, 66.7% and 43.4%, respectively; in pts with 2-3 BMs: 8.85 months, 46.4% and 31%, respectively; in pts with >3 BMs: 7.25 months, 37.2% and 11.9%, respectively. Multivariate analysis for OSGK1 confirmed that IT and TT were significantly and highly protective. Best OSGK1 was observed in BRAF-wild-type pts receiving anti-PD1 or in BRAF-mutated pts receiving BRAF-inhibitors and anti-PD1 (12.26 and 14.82 months, respectively). CONCLUSION In real-life MM pts with BMs, a strategy aiming at controlling BM with GK together with TT and/or TT seems to achieve unprecedented survival rates.
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Affiliation(s)
- C Gaudy-Marqueste
- Dermatology and Skin Cancers Department, UMR911 CRO2, Aix-Marseille University, APHM, Marseille, France
| | - A S Dussouil
- Dermatology and Skin Cancers Department, UMR911 CRO2, Aix-Marseille University, APHM, Marseille, France
| | - R Carron
- Department of Stereotaxic and Functional Neurosurgery, Gamma-knife Unit, Inserm U751, Aix-Marseille University, APHM, Marseille, France
| | - L Troin
- Dermatology and Skin Cancers Department, UMR911 CRO2, Aix-Marseille University, APHM, Marseille, France
| | - N Malissen
- Dermatology and Skin Cancers Department, UMR911 CRO2, Aix-Marseille University, APHM, Marseille, France
| | - A Loundou
- Public Health Department, Aix-Marseille University, APHM, Marseille, France
| | - S Monestier
- Dermatology and Skin Cancers Department, UMR911 CRO2, Aix-Marseille University, APHM, Marseille, France
| | - S Mallet
- Dermatology and Skin Cancers Department, UMR911 CRO2, Aix-Marseille University, APHM, Marseille, France
| | - M A Richard
- Dermatology and Skin Cancers Department, UMR911 CRO2, Aix-Marseille University, APHM, Marseille, France
| | - J M Régis
- Department of Stereotaxic and Functional Neurosurgery, Gamma-knife Unit, Inserm U751, Aix-Marseille University, APHM, Marseille, France
| | - J J Grob
- Dermatology and Skin Cancers Department, UMR911 CRO2, Aix-Marseille University, APHM, Marseille, France.
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10
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Gutzmer R, Rivoltini L, Levchenko E, Testori A, Utikal J, Ascierto PA, Demidov L, Grob JJ, Ridolfi R, Schadendorf D, Queirolo P, Santoro A, Loquai C, Dreno B, Hauschild A, Schultz E, Lesimple TP, Vanhoutte N, Salaun B, Gillet M, Jarnjak S, De Sousa Alves PM, Louahed J, Brichard VG, Lehmann FF. Safety and immunogenicity of the PRAME cancer immunotherapeutic in metastatic melanoma: results of a phase I dose escalation study. ESMO Open 2016; 1:e000068. [PMID: 27843625 PMCID: PMC5070281 DOI: 10.1136/esmoopen-2016-000068] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [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] [Received: 04/21/2016] [Accepted: 04/22/2016] [Indexed: 12/23/2022] Open
Abstract
Purpose The PRAME tumour antigen is expressed in several tumour types but in few normal adult tissues. A dose-escalation phase I/II study (NCT01149343) assessed the safety, immunogenicity and clinical activity of the PRAME immunotherapeutic (recombinant PRAME protein (recPRAME) with the AS15 immunostimulant) in patients with advanced melanoma. Here, we report the phase I dose-escalation study segment. Patients and methods Patients with stage IV PRAME-positive melanoma were enrolled to 3 consecutive cohorts to receive up to 24 intramuscular injections of the PRAME immunotherapeutic. The RecPRAME dose was 20, 100 or 500 µg in cohorts 1, 2 and 3, respectively, with a fixed dose of AS15. Adverse events (AEs), including predefined dose-limiting toxicity (DLT) and the anti-PRAME humoral response (ELISA), were coprimary end points. Cellular immune responses were evaluated using in vitro assays. Results 66 patients were treated (20, 24 and 22 in the respective cohorts). AEs considered by the investigator to be causally related were mostly grade 1 or 2 injection site symptoms, fatigue, chills, fever and headache. Two DLTs (grade 3 brain oedema and proteinuria) were recorded in two patients in two cohorts (cohorts 2 and 3). All patients had detectable anti-PRAME antibodies after four immunisations. Percentages of patients with predefined PRAME-specific-CD4+T-cell responses after four immunisations were similar in each cohort. No CD8+ T-cell responses were detected. Conclusions The PRAME immunotherapeutic had an acceptable safety profile and induced similar anti-PRAME-specific humoral and cellular immune responses in all cohorts. As per protocol, the phase II study segment was initiated to further evaluate the 500 µg PRAME immunotherapeutic dose. Trial registration number NCT01149343, Results.
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Affiliation(s)
- R Gutzmer
- Skin Cancer Center Hannover , Hannover Medical School , Hannover , Germany
| | - L Rivoltini
- Unit of Immunotherapy of Human Tumors , Fondazione RCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - E Levchenko
- Petrov Research Institute of Oncology , St. Petersburg , Russia
| | - A Testori
- Istituto Europeo Di Oncologia , Milano , Italy
| | - J Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - P A Ascierto
- Melanoma, Cancer Immunotherapy and Innovative Therapies Unit , Istituto Nazionale Tumori Fondazione Pascale , Naples , Italy
| | - L Demidov
- Cancer Research Center , Moscow , Russia
| | - J J Grob
- Aix Marseille University Hôpital de la Timone, Service de Dermatologie , Marseille , France
| | - R Ridolfi
- Immunotherapy Unit , Romagna Cancer Institute IRST- IRCCS , Meldola , Italy
| | - D Schadendorf
- Department of Dermatology , University Hospital Essen , Essen , Germany
| | - P Queirolo
- Istituto Nazionale per la Ricerca sul Cancro Oncologia Medica , Genova , Italy
| | - A Santoro
- Humanitas Cancer Center, Istituto Clinico Humanitas IRCCS , Rozzano , Italy
| | - C Loquai
- Department of Dermatology , University of Mainz , Mainz , Germany
| | - B Dreno
- Dermatology Clinic , Hôpital Hôtel-Dieu, CHU Nantes , Nantes , France
| | - A Hauschild
- Department of Dermatology , Skin Cancer Center, Schleswig-Holstein University Hospital , Kiel , Germany
| | - E Schultz
- Department of Dermatology , Paracelsus Medical University, Klinikum Nuremberg , Nuremberg , Germany
| | - T P Lesimple
- Département d'Oncologie Médicale , Centre Eugène Marquis , Rennes , France
| | | | - B Salaun
- GSK Vaccines , Rixensart , Belgium
| | - M Gillet
- GSK Vaccines , Rixensart , Belgium
| | | | - P M De Sousa Alves
- GSK Vaccines, Rixensart, Belgium; Celyad, Mont-Saint-Guibert, Rixensart, Belgium
| | | | - V G Brichard
- GSK Vaccines, Rixensart, Belgium; Vianova-Biosciences, Lasne, Belgium
| | - F F Lehmann
- GSK Vaccines, Rixensart, Belgium; Celyad, Mont-Saint-Guibert, Rixensart, Belgium
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11
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Le Tourneau C, Dreno B, Kirova Y, Grob JJ, Jouary T, Dutriaux C, Thomas L, Lebbé C, Mortier L, Saiag P, Avril MF, Maubec E, Joly P, Bey P, Cosset JM, Sun JS, Asselain B, Devun F, Marty ME, Dutreix M. First-in-human phase I study of the DNA-repair inhibitor DT01 in combination with radiotherapy in patients with skin metastases from melanoma. Br J Cancer 2016; 114:1199-205. [PMID: 27140316 PMCID: PMC4891504 DOI: 10.1038/bjc.2016.120] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 02/04/2016] [Revised: 03/11/2016] [Accepted: 04/08/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND DT01 is a DNA-repair inhibitor preventing recruitment of DNA-repair enzymes at damage sites. Safety, pharmacokinetics and preliminary efficacy through intratumoural and peritumoural injections of DT01 were evaluated in combination with radiotherapy in a first-in-human phase I trial in patients with unresectable skin metastases from melanoma. METHODS Twenty-three patients were included and received radiotherapy (30 Gy in 10 sessions) on all selected tumour lesions, comprising of two lesions injected with DT01 three times a week during the 2 weeks of radiotherapy. DT01 dose levels of 16, 32, 48, 64 and 96 mg were used, in a 3+3 dose escalation design, with an expansion cohort at 96 mg. RESULTS The median follow-up was 180 days. All patients were evaluable for safety and pharmacokinetics. No dose-limiting toxicity was observed and the maximum-tolerated dose was not reached. Most frequent adverse events were reversible grades 1 and 2 injection site reactions. Pharmacokinetic analyses demonstrated a systemic passage of DT01. Twenty-one patients were evaluable for efficacy on 76 lesions. Objective response was observed in 45 lesions (59%), including 23 complete responses (30%). CONCLUSIONS Intratumoural and peritumoural DT01 in combination with radiotherapy is safe and pharmacokinetic analyses suggest a systemic passage of DT01.
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Affiliation(s)
- C Le Tourneau
- Department of Medical Oncology, Institut Curie, Paris & Saint-Cloud 75005, France.,EA7285, Versailles-Saint-Quentin-en-Yvelines University, Versailles 78000, France
| | - B Dreno
- CHU de Nantes-Hôtel Dieu, Nantes 44093, France
| | - Y Kirova
- Radiotherapy Department, Institut Curie, Paris 75005, France
| | - J J Grob
- La Timone Hospital-APHM, Aix-Marseille University, Marseille 13385, France
| | - T Jouary
- Dermatology department, Saint-André Hospital, CHU de Bordeaux, Bordeaux 33000, France
| | - C Dutriaux
- Dermatology department, Saint-André Hospital, CHU de Bordeaux, Bordeaux 33000, France
| | - L Thomas
- Lyon Sud Hospital Center, Lyon 1 University, Pierre Benite 69495, France
| | - C Lebbé
- Saint-Louis Hospital, APHP, Paris 75010, France
| | - L Mortier
- Dermatology department, CHRU of Lille, Lille 59037, France
| | - P Saiag
- Ambroise Paré Hospital, Boulogne Billancourt 92104, France
| | - M F Avril
- Cochin hospital, APHP, Paris 75014, France
| | - E Maubec
- Bichat Hospital, Paris 75877, France
| | - P Joly
- CHU Rouen, Charles-Nicolle, Rouen 76000, France
| | - P Bey
- Institut Curie, Paris 75005, France
| | - J M Cosset
- Radiotherapy Department, Institut Curie, Paris 75005, France
| | - J S Sun
- DNA Therapeutics, Evry 91058, France
| | - B Asselain
- Department of Biostatistics, Institut Curie, Paris 75005, France
| | - F Devun
- DNA Therapeutics, Evry 91058, France.,Institut Curie, Orsay 91405, France
| | - M E Marty
- Saint-Louis Hospital, APHP, Paris 75010, France
| | - M Dutreix
- Institut Curie, Orsay 91405, France.,CNRS-UMR3347, INSERM-U1021, Paris-Sud University, Orsay 91405, France
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12
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Hersh EM, Del Vecchio M, Brown MP, Kefford R, Loquai C, Testori A, Bhatia S, Gutzmer R, Conry R, Haydon A, Robert C, Ernst S, Homsi J, Grob JJ, Kendra K, Agarwala SS, Li M, Clawson A, Brachmann C, Karnoub M, Elias I, Renschler MF, Hauschild A. A randomized, controlled phase III trial of nab-Paclitaxel versus dacarbazine in chemotherapy-naïve patients with metastatic melanoma. Ann Oncol 2015; 26:2267-74. [PMID: 26410620 PMCID: PMC6279094 DOI: 10.1093/annonc/mdv324] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [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: 12/09/2014] [Revised: 05/08/2015] [Accepted: 07/21/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The efficacy and safety of nab-paclitaxel versus dacarbazine in patients with metastatic melanoma was evaluated in a phase III randomized, controlled trial. PATIENTS AND METHODS Chemotherapy-naïve patients with stage IV melanoma received nab-paclitaxel 150 mg/m(2) on days 1, 8, and 15 every 4 weeks or dacarbazine 1000 mg/m(2) every 3 weeks. The primary end point was progression-free survival (PFS) by independent radiologic review; the secondary end point was overall survival (OS). RESULTS A total of 529 patients were randomized to nab-paclitaxel (n = 264) or dacarbazine (n = 265). Baseline characteristics were well balanced. The majority of patients were men (66%), had an Eastern Cooperative Oncology Group status of 0 (71%), and had M1c stage disease (65%). The median PFS (primary end point) was 4.8 months with nab-paclitaxel and 2.5 months with dacarbazine [hazard ratio (HR), 0.792; 95.1% confidence interval (CI) 0.631-0.992; P = 0.044]. The median OS was 12.6 months with nab-paclitaxel and 10.5 months with dacarbazine (HR, 0.897; 95.1% CI 0.738-1.089; P = 0.271). Independently assessed overall response rate was 15% versus 11% (P = 0.239), and disease control rate (DCR) was 39% versus 27% (P = 0.004) for nab-paclitaxel versus dacarbazine, respectively. The most common grade ≥3 treatment-related adverse events were neuropathy (nab-paclitaxel, 25% versus dacarbazine, 0%; P < 0.001), and neutropenia (nab-paclitaxel, 20% versus dacarbazine, 10%; P = 0.004). There was no correlation between secreted protein acidic and rich in cysteine (SPARC) status and PFS in either treatment arm. CONCLUSIONS nab-Paclitaxel significantly improved PFS and DCR compared with dacarbazine, with a manageable safety profile.
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Affiliation(s)
- E M Hersh
- Department of Medicine, Arizona Cancer Center, Tucson, USA
| | - M Del Vecchio
- Department of Medical Oncology, Fondazione IRCCS National Tumor Institute, Milan, Italy
| | - M P Brown
- Cancer Clinical Trials Unit, Royal Adelaide Hospital and School of Medicine, University of Adelaide, Adelaide
| | - R Kefford
- Sydney West Cancer Trials Centre/Westmead Hospital and Melanoma Institute Australia, University of Sydney, North Sydney, Australia
| | - C Loquai
- Department of Dermatology, University of Mainz, Mainz, Germany
| | - A Testori
- Melanoma and Muscle Cutaneous Sarcoma Division, European Institute of Oncology, Milan, Italy
| | - S Bhatia
- Department of Medicine, Seattle Cancer Care Alliance, Seattle, USA
| | - R Gutzmer
- Department of Dermatology and Oncology, Hannover Medical School, Hannover, Germany
| | - R Conry
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, USA
| | - A Haydon
- Department of Medical Oncology, Alfred Hospital, Melbourne, Australia
| | - C Robert
- Demartology Unit, Department of Medicine, The Gustave Roussy Cancer Institute, Villejuif, France
| | - S Ernst
- Department of Medical Oncology, London Health Sciences Center-London Regional Cancer Program, London, Canada
| | - J Homsi
- Department of Medical Oncology, Banner MD Anderson Cancer Center, Gilbert, USA
| | - J J Grob
- Department of Dermatology, Timone Hospital, APHM and Aix-Marseille University, Marseille, France
| | - K Kendra
- Department of Internal Medicine, Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, Columbus
| | - S S Agarwala
- Department of Hematology and Oncology, St Luke's Cancer Center and Temple University, Bethlehem
| | - M Li
- Biometrics and Data Operations/Translational Medicine/Biometrics and Data Operations/Clinical Research & Development/Global Medical Affairs, Celgene Corporation, Summit, USA
| | - A Clawson
- Biometrics and Data Operations/Translational Medicine/Biometrics and Data Operations/Clinical Research & Development/Global Medical Affairs, Celgene Corporation, Summit, USA
| | - C Brachmann
- Biometrics and Data Operations/Translational Medicine/Biometrics and Data Operations/Clinical Research & Development/Global Medical Affairs, Celgene Corporation, Summit, USA
| | - M Karnoub
- Biometrics and Data Operations/Translational Medicine/Biometrics and Data Operations/Clinical Research & Development/Global Medical Affairs, Celgene Corporation, Summit, USA
| | - I Elias
- Biometrics and Data Operations/Translational Medicine/Biometrics and Data Operations/Clinical Research & Development/Global Medical Affairs, Celgene Corporation, Summit, USA
| | - M F Renschler
- Biometrics and Data Operations/Translational Medicine/Biometrics and Data Operations/Clinical Research & Development/Global Medical Affairs, Celgene Corporation, Summit, USA
| | - A Hauschild
- Department of Dermatology, University Medical Center Schleswig-Holstein, Kiel, Germany
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Gaudy-Marqueste C, Carron R, Delsanti C, Loundou A, Monestier S, Archier E, Richard MA, Regis J, Grob JJ. On demand Gamma-Knife strategy can be safely combined with BRAF inhibitors for the treatment of melanoma brain metastases. Ann Oncol 2014; 25:2086-2091. [PMID: 25057167 DOI: 10.1093/annonc/mdu266] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [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: 11/14/2022] Open
Abstract
BACKGROUND Both Gamma-Knife radiosurgery (GKRS) and BRAF inhibitors (BRAF-I) have been shown to be useful in melanoma patients with brain metastases (BMs), thus suggesting that it could be interesting to combine their respective advantages. However, cases of radiosensitization following conventional radiation therapy in BRAF-I treated patients have raised serious concerns about the real feasibility and risk/benefit ratio of this combination. PATIENTS AND METHODS Review by two independent observers of brain magnetic resonance imaging (MRI) follow-up pictures, and volume and edema quantifications, and survival assessment in all patients who had been treated by GKRS and BRAF-I at a single institution. RESULTS Among 53 GKRS carried out in 30 patients who ever received BRAF-I and GKRS, 33 GKRS were carried out in 24 patients while under BRAF-I treatment, from which only 4 with an interruption of BRAF-I. The 20 other GKRS were carried out in 15 patients (including 9 of the 24) before initiation of BRAF-I treatment. No case of radiation-induced necrosis and no scalp radiation dermatitis occurred. A >20% increase in volume was observed in 35 of the 263 BM treated by GKRS (13.3%), but only 3 clear-cut edemas and 3 hemorrhages were detected within 2 months after GKRS, and 4 edemas and 7 hemorrhages later. Neither the MRI features nor the incidence of the volume changes, hemorrhage and edema were deemed unexpected for melanoma BM treated by GKRS. Median survival from first GKRS under BRAF-I and first dose of BRAF-I were 24.8 and 48.8 weeks, respectively. CONCLUSION This series does not show immediate radiotoxicity nor radiation recall, in melanoma patients with BRAF-I whose BMs are treated by GKRS. Interrupting BRAF-I for stereotactic radiosurgery (SRS) of BM seems useless, although it is still advised for other radiation therapies. The potential benefit of combining SRS and BRAF-I can be safely tested.
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Affiliation(s)
| | - R Carron
- Department of Stereotaxic and Functional Neurosurgery, Gammaknife Unit, Inserm U751
| | - C Delsanti
- Department of Stereotaxic and Functional Neurosurgery, Gammaknife Unit, Inserm U751
| | - A Loundou
- Department of Public Health, Aix-Marseille University, APHM, Marseille, France
| | - S Monestier
- Department of Dermatology and Skin Cancers, UMR911 CRO2
| | - E Archier
- Department of Dermatology and Skin Cancers, UMR911 CRO2
| | - M A Richard
- Department of Dermatology and Skin Cancers, UMR911 CRO2
| | - J Regis
- Department of Stereotaxic and Functional Neurosurgery, Gammaknife Unit, Inserm U751
| | - J J Grob
- Department of Dermatology and Skin Cancers, UMR911 CRO2
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Lagier A, Pénicaud M, Le Corroller T, Guenoun D, Cammilleri S, Champsaur P, Dessi P, Grob JJ, Giovanni A, Fakhry N. [Lymphatic drainage of skin areas of head and neck: in vivo approach by the location of the sentinel node]. Morphologie 2014; 98:32-9. [PMID: 24637042 DOI: 10.1016/j.morpho.2014.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/24/2013] [Revised: 01/01/2014] [Accepted: 01/07/2014] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The objective of the study was to determine the preferential territories of drainage of skin areas of the face and neck. This knowledge can guide the strategies of diagnostic (search for primary tumor skin to cervical lymphadenopathy) and treatment (determination of the extent of neck dissection to achieve in case of skin tumor). MATERIALS AND METHODS This is a retrospective study of the surgical procedures of sentinel node research between January 2003 and April 2011. The lymphoscintigraphic and intraoperative localization of the initial tumor site and sentinel lymph node were collected. RESULTS AND DISCUSSION One hundred and thirty-seven patients were included in the study. The parotid gland is a privileged territory of drainage of the head and neck skin. At cervical level, the submental region drains the lower and median part of the face (lips and chin). The posterior segments (IIb and V sector) were represented for the posterior locations of the head (ear, vertex), and cervical region.
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Affiliation(s)
- A Lagier
- Laboratoire d'anatomie, faculté de médecine de Marseille, Aix-Marseille université, 27, boulevard Jean-Moulin, 13385 Marseille cedex 05, France; Service d'ORL et chirurgie cervico-faciale, CHU Timone Adultes, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
| | - M Pénicaud
- Service d'ORL et chirurgie cervico-faciale, CHU Timone Adultes, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - T Le Corroller
- Laboratoire d'anatomie, faculté de médecine de Marseille, Aix-Marseille université, 27, boulevard Jean-Moulin, 13385 Marseille cedex 05, France
| | - D Guenoun
- Laboratoire d'anatomie, faculté de médecine de Marseille, Aix-Marseille université, 27, boulevard Jean-Moulin, 13385 Marseille cedex 05, France
| | - S Cammilleri
- Service de médecine nucléaire, CHU Timone Adultes, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - P Champsaur
- Laboratoire d'anatomie, faculté de médecine de Marseille, Aix-Marseille université, 27, boulevard Jean-Moulin, 13385 Marseille cedex 05, France
| | - P Dessi
- Service d'ORL et chirurgie cervico-faciale, CHU Timone Adultes, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - J J Grob
- Service de dermatologie et cancérologie cutanée, CHU Timone Adultes, 264, rue Saint-Pierre, 13885 Marseille cedex 05, France
| | - A Giovanni
- Service d'ORL et chirurgie cervico-faciale, CHU Timone Adultes, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - N Fakhry
- Service d'ORL et chirurgie cervico-faciale, CHU Timone Adultes, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
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Penicaud M, Cammilleri S, Giorgi R, Grob JJ, Taïeb D, Giovanni A, Dessi P, Fakhry N. Sentinel lymph node biopsy in head and neck melanoma: A single institution analysis. Rev Laryngol Otol Rhinol (Bord) 2014; 135:115-20. [PMID: 26521353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The aim of our study was to analyze a series of patients from our institution who underwent surgery for head and neck cutaneous melanoma and who received sentinel lymph node biopsy (SLNB). MATERIAL AND METHODS A single-center observational cohort of 120 head and neck melanoma patients was investigated from 2002 to 2011. RESULTS Among the 107 patients (89.2%) with lymph node identified during lymphoscintigraphy, at least one node was collected and analyzed in 96 patients (90.6%). A positive sentinel lymph node was found in 9.4% of patients. Our data showed higher failure rate of lymphoscintigraphic identification (11.7%), lower rate of SLN positivity (9.4%), and higher false-negative rate of SLNB (24.1%) than the usualfigures established for malignant melanomas in other locations. After a mean follow-up of 38.1 months, the disease-free survival (DFS) rate in the positive SLN group was 53% vs 75% for the negative SLN after 2 years of follow-up and 53% vs 48% after 5 years (p = 0.44). CONCLUSION The complexity of lymphatic drainage and the anatomy of the cervical region probably accounts for a specificities which result in a lower predictive value of SLNB in head and neck melanoma than in MM in other locations.
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Penicaud M, Cammilleri S, Giorgi R, Taïeb D, Grob JJ, Giovanni A, Dessi P, Fakhry N. [Prognostic value of sentinel lymph node in Merkel cell carcinoma of the head and neck]. Rev Laryngol Otol Rhinol (Bord) 2013; 134:75-79. [PMID: 24683816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Merkel cell carcinoma (MCC) is a rare neuroendocrine skin tumor. The aim of our study was to analyze the prognosis of patients operated on for CCM and having no lymph node involvement after analysis of sentinel lymph node (SLN). MATERIAL AND METHOD This was a retrospective study of 10 cases of CCM stage I or II who received the SLN technique in our institution between 2003 and 2010. RESULTS Among the 10 patients, 7 had an identification of at least one SLN, among which the node could be surgically removed in 6 cases. In cases of failure of SLN technique, a neck dissection +/- parotidectomy was performed. No lymph node metastasis was found in our series. Mean follow-up was 38 months. The overall survival rate was 100% at 2 years and 50% at 5 years. The Disease-free survival was 85% at 2 and 5 years. CONCLUSION Our results show that the technique of sentinel lymph node is a reliable tool for evaluating nodal status of patients with CCM and that pN0 patients have a good prognosis.
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Bonerandi JJ, Beauvillain C, Caquant L, Chassagne JF, Chaussade V, Clavère P, Desouches C, Garnier F, Grolleau JL, Grossin M, Jourdain A, Lemonnier JY, Maillard H, Ortonne N, Rio E, Simon E, Sei JF, Grob JJ, Martin L. Guidelines for the diagnosis and treatment of cutaneous squamous cell carcinoma and precursor lesions. J Eur Acad Dermatol Venereol 2012; 25 Suppl 5:1-51. [PMID: 22070399 DOI: 10.1111/j.1468-3083.2011.04296.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- J J Bonerandi
- Department of Dermatology, La Timone University Hospital, Marseille, France
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Jouary T, Leyral C, Dreno B, Doussau A, Sassolas B, Beylot-Barry M, Renaud-Vilmer C, Guillot B, Bernard P, Lok C, Bedane C, Cambazard F, Misery L, Estève E, Dalac S, Machet L, Grange F, Young P, Granel-Brocard F, Truchetet F, Vergier B, Delaunay MM, Grob JJ. Adjuvant prophylactic regional radiotherapy versus observation in stage I Merkel cell carcinoma: a multicentric prospective randomized study. Ann Oncol 2011; 23:1074-80. [PMID: 21750118 DOI: 10.1093/annonc/mdr318] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The treatment of stage I Merkel cell carcinoma (MCC) usually includes wide local excision (WLE) combined with irradiation of the tumor bed (ITB). No randomized study has ever been conducted in MCC. The purpose of this study was to assess the efficacy and safety of prophylactic adjuvant radiotherapy on the regional nodes. PATIENTS AND METHODS In this randomized open controlled study, patients for a stage I MCC treated by WLE and ITB were randomly assigned to regional adjuvant radiotherapy versus observation. Overall survival (OS) and probability of regional recurrence (PRR) were primary end points. Progression-free survival (PFS) and tolerance of irradiation were secondary end points. RESULTS Eighty-three patients were included before premature interruption of the trial, due to a drop in the recruitment mainly due to the introduction of the sentinel node dissection in the management of MCC. No significant improvement in OS (P = 0.989) or PFS (P = 0.4) could be demonstrated after regional irradiation, which, however, significantly reduced the PRR (P = 0.007) with 16.7% regional recurrence rate in the observation arm versus 0% in the treatment arm. The treatment was well tolerated. CONCLUSION The adjuvant regional irradiation significantly decreased the PRR in MCC, but benefit in survival could not be demonstrated.
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Affiliation(s)
- T Jouary
- Skin Cancer Unit, Dermatology Department, Hôpital Saint André, Bordeaux, France.
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Baiardini I, Braido F, Bindslev-Jensen C, Bousquet PJ, Brzoza Z, Canonica GW, Compalati E, Fiocchi A, Fokkens W, Gerth van Wijk R, Giménez-Arnau A, Godse K, Grattan C, Grob JJ, La Grutta S, Kalogeromitros D, Kocatürk E, Lombardi C, Mota-Pinto A, Ridolo E, Saini SS, Sanchez-Borges M, Senna GE, Terreehorst I, Todo Bom A, Toubi E, Bousquet J, Zuberbier T, Maurer M. Recommendations for assessing patient-reported outcomes and health-related quality of life in patients with urticaria: a GA(2) LEN taskforce position paper. Allergy 2011; 66:840-4. [PMID: 21385184 DOI: 10.1111/j.1398-9995.2011.02580.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [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: 11/30/2022]
Abstract
The aim of this Global Allergy and Asthma European Network (GA(2)LEN) consensus report is to provide recommendations and suggestions for assessing patient-reported outcomes (PROs) including health-related quality of life in patients with urticaria. We recommend that PROs should be used both in clinical trials and routine practice for the evaluation of urticaria patients. We suggest that PROs should be considered as the primary outcome of future clinical trials. Two validated and disease-specific instruments for assessing PROs are available, the urticaria activity score (for symptoms) and the chronic urticaria questionnaire on quality of life CU-Q(2)oL. This latter tool, CU-Q(2)oL, is available in many languages and should be preferred, where available, over more generic instruments for assessing urticaria-specific effects on quality of life. CU-Q(2)oL is only suited for the investigation of patients with chronic spontaneous urticaria. Similar instruments for other forms of urticaria have yet to be developed and validated. Also, tools for assessing other chronic spontaneous urticaria PROs besides quality of life and symptoms are needed.
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Affiliation(s)
- I Baiardini
- Allergy and Respiratory Diseases, Department of Internal Medicine, University of Genoa, Genoa, Italy
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Bedikian AY, Lebbé C, Robert C, Agarwala SS, Cousin T, Wu J, Garbe C, Grob JJ. Survival in a phase III, randomized, double-blind study of dacarbazine with or without oblimersen (Bcl-2 antisense) in patients with advanced melanoma and low-normal serum lactate dehydrogenase (LDH; AGENDA). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8531] [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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Abstract
AbstractWe report on p-SiC thin layer synthesis by carbon ion implantation at high temperature. Infra-red and RBS analysis were performed on samples implanted at temperatures ranging from 200 to 900°C and for carbon doses varying in the range 1017to2.1018 cm . RBS analysis does not reveal any diffusion or segregation of carbon up to 900°C. At this temperature we obtained the optimum Infra-red signature. The (3-SiC formation is shown to be a thermally activated process with an energy of 0.1 eV leading us to speculate that the diffusion of point defects could be the limiting factor of the process.
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Claeys A, Gaudy-Marqueste C, Pauly V, Pelletier F, Truchetet F, Boye T, Aubin F, Schmutz JL, Grob JJ, Richard MA. Management of pain associated with debridement of leg ulcers: a randomized, multicentre, pilot study comparing nitrous oxide-oxygen mixture inhalation and lidocaïne-prilocaïne cream. J Eur Acad Dermatol Venereol 2010; 25:138-44. [DOI: 10.1111/j.1468-3083.2010.03720.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Grob JJ, Jouary T, Dreno B, Gutzmer R, Hauschild A, Leccia MT, Landthaler M, Asselineau J, Garbe C, Pehamberger HE. Adjuvant therapy with pegylated interferon alfa-2b (36 months) versus low-dose interferon alfa-2b (18 months) in melanoma patients without macro-metastatic nodes: EADO trial. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.18_suppl.lba8506] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA8506 Background: Adjuvant therapy with low-dose adjuvant interferon alfa-2b (IFN) as well as with pegylated interferon alfa-2b (PEG-IFN) were both shown to be superior to observation in melanoma (M) patients (pts) without macro-metastatic nodes. However, the two strategies have never been assessed head to head. Weekly injection of PEG-IFN facilitates a longer duration of treatment which may be critical for benefit. We thus compared adjuvant therapy of flat low-dose PEG-IFN (36 months) versus low-dose IFN (18 months) in intermediate-risk M pts without macro-metastatic nodes. Methods: In this multicenter, open-label, prospective randomized phase III trial, pts with resected M ≥ 1.5 mm in thickness and without clinically detectable nodes were randomized either to IFN (3 MU subcutaneously [sc] 3 times a week for 18 months) or to PEG-IFN (100 mcg sc once weekly for 36 months). Sentinel node procedure (SNP) was not a standard in 2003 and thus was optional. Approach was consistent by center. Randomization was stratified for centers and SNP procedure. Primary endpoint was relapse-free survival (RFS), and secondary were distant metastasis-free survival (DMFS), overall survival (OS), and grade 3-4 severe adverse events (SAE). Sample size (890 pts) was calculated to detect a 10% difference (power >80%, type I error of 5%, 2-sided) for RFS. Analysis describes 5-year probability of survival. Comparisons were done by intent-to-treat using Cox proportional models. Results: Of 898 pts enrolled, 896 (443 PEG vs 453 IFN) were eligible for evaluation after a median follow-up of 4.7 years. SLNB was performed in 68.2% of pts. Neither RFS (PEG-IFN 66.2% vs IFN 64.8%, p=0.43; HR, 0.91; 95% CI, 0.73 to 1.15) nor DMFS (71.3% vs 72.6%, p=0.86; HR, 1.02; 95% CI, 0.80 to 1.32) or OS (77.0% vs 78.4%, p=0.55; HR, 1.09; 95% CI, 0.82 to 1.45) showed statistical difference. There was an excess of SAE grade 3-4 in PEG-IFN arm (44.6% vs 26.6% in the first 18 months) which impacted on median duration of treatment (17.8 months in IFN arm; 19.2 in PEG-IFN arm, with only 28% completing 36 months treatment). Conclusions: Flat low-dose PEG-IFN did not show superiority over conventional low dose IFN. Attempts to increase benefit by prolonging treatment with PEG-IFN over 3 years were hampered by a high rate of treatment discontinuation possibly linked to SAEs with PEG-IFN. [Table: see text]
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Affiliation(s)
- J. J. Grob
- Dermatology Department, University Hospital APHM, Marseille, France; University Hospital Bordeaux Saint Andrá, Bordeaux, France; University Hospital Nantes, Nantes, France; Medical School, Hannover, Germany; University of Kiel, Kiel, Germany; University Hospital Grenoble, Grenoble, France; University Hospital of Regensburg, Regensburg, Germany; Universitá Victor Segalen, Bordeaux, France; Department of Dermatology, University of Tübingen, Tübingen, Germany; Medical University of Vienna, Vienna General
| | - T. Jouary
- Dermatology Department, University Hospital APHM, Marseille, France; University Hospital Bordeaux Saint Andrá, Bordeaux, France; University Hospital Nantes, Nantes, France; Medical School, Hannover, Germany; University of Kiel, Kiel, Germany; University Hospital Grenoble, Grenoble, France; University Hospital of Regensburg, Regensburg, Germany; Universitá Victor Segalen, Bordeaux, France; Department of Dermatology, University of Tübingen, Tübingen, Germany; Medical University of Vienna, Vienna General
| | - B. Dreno
- Dermatology Department, University Hospital APHM, Marseille, France; University Hospital Bordeaux Saint Andrá, Bordeaux, France; University Hospital Nantes, Nantes, France; Medical School, Hannover, Germany; University of Kiel, Kiel, Germany; University Hospital Grenoble, Grenoble, France; University Hospital of Regensburg, Regensburg, Germany; Universitá Victor Segalen, Bordeaux, France; Department of Dermatology, University of Tübingen, Tübingen, Germany; Medical University of Vienna, Vienna General
| | - R. Gutzmer
- Dermatology Department, University Hospital APHM, Marseille, France; University Hospital Bordeaux Saint Andrá, Bordeaux, France; University Hospital Nantes, Nantes, France; Medical School, Hannover, Germany; University of Kiel, Kiel, Germany; University Hospital Grenoble, Grenoble, France; University Hospital of Regensburg, Regensburg, Germany; Universitá Victor Segalen, Bordeaux, France; Department of Dermatology, University of Tübingen, Tübingen, Germany; Medical University of Vienna, Vienna General
| | - A. Hauschild
- Dermatology Department, University Hospital APHM, Marseille, France; University Hospital Bordeaux Saint Andrá, Bordeaux, France; University Hospital Nantes, Nantes, France; Medical School, Hannover, Germany; University of Kiel, Kiel, Germany; University Hospital Grenoble, Grenoble, France; University Hospital of Regensburg, Regensburg, Germany; Universitá Victor Segalen, Bordeaux, France; Department of Dermatology, University of Tübingen, Tübingen, Germany; Medical University of Vienna, Vienna General
| | - M. T. Leccia
- Dermatology Department, University Hospital APHM, Marseille, France; University Hospital Bordeaux Saint Andrá, Bordeaux, France; University Hospital Nantes, Nantes, France; Medical School, Hannover, Germany; University of Kiel, Kiel, Germany; University Hospital Grenoble, Grenoble, France; University Hospital of Regensburg, Regensburg, Germany; Universitá Victor Segalen, Bordeaux, France; Department of Dermatology, University of Tübingen, Tübingen, Germany; Medical University of Vienna, Vienna General
| | - M. Landthaler
- Dermatology Department, University Hospital APHM, Marseille, France; University Hospital Bordeaux Saint Andrá, Bordeaux, France; University Hospital Nantes, Nantes, France; Medical School, Hannover, Germany; University of Kiel, Kiel, Germany; University Hospital Grenoble, Grenoble, France; University Hospital of Regensburg, Regensburg, Germany; Universitá Victor Segalen, Bordeaux, France; Department of Dermatology, University of Tübingen, Tübingen, Germany; Medical University of Vienna, Vienna General
| | - J. Asselineau
- Dermatology Department, University Hospital APHM, Marseille, France; University Hospital Bordeaux Saint Andrá, Bordeaux, France; University Hospital Nantes, Nantes, France; Medical School, Hannover, Germany; University of Kiel, Kiel, Germany; University Hospital Grenoble, Grenoble, France; University Hospital of Regensburg, Regensburg, Germany; Universitá Victor Segalen, Bordeaux, France; Department of Dermatology, University of Tübingen, Tübingen, Germany; Medical University of Vienna, Vienna General
| | - C. Garbe
- Dermatology Department, University Hospital APHM, Marseille, France; University Hospital Bordeaux Saint Andrá, Bordeaux, France; University Hospital Nantes, Nantes, France; Medical School, Hannover, Germany; University of Kiel, Kiel, Germany; University Hospital Grenoble, Grenoble, France; University Hospital of Regensburg, Regensburg, Germany; Universitá Victor Segalen, Bordeaux, France; Department of Dermatology, University of Tübingen, Tübingen, Germany; Medical University of Vienna, Vienna General
| | - H. E. Pehamberger
- Dermatology Department, University Hospital APHM, Marseille, France; University Hospital Bordeaux Saint Andrá, Bordeaux, France; University Hospital Nantes, Nantes, France; Medical School, Hannover, Germany; University of Kiel, Kiel, Germany; University Hospital Grenoble, Grenoble, France; University Hospital of Regensburg, Regensburg, Germany; Universitá Victor Segalen, Bordeaux, France; Department of Dermatology, University of Tübingen, Tübingen, Germany; Medical University of Vienna, Vienna General
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Lebbé C, Grob JJ, Bedikian AY, Garbe C, Robert C, Itri L, Wu J, Agarwala SS, Eggermont AM. Relation between baseline LDH and tumor burden in advanced melanoma in two phase III trials of oblimersen-dacarbazine (OBL-DTIC) versus DTIC. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8557] [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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Bedikian AY, Lebbé C, Robert C, Agarwala SS, Wu J, Garbe C, Grob JJ. Results of pooled analyses from two phase III trials of 1,085 patients (pts) with advanced melanoma: Oblimersen (OBL) plus dacarbazine (DTIC) versus DTIC alone. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8573] [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: 11/20/2022] Open
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Meziane M, Hesse S, Chetaille B, Bien-Aimée A, Grob JJ, Richard MA. [Cutaneous large B-cell leg-type lymphoma occurring on a leg burn]. Ann Dermatol Venereol 2009; 136:791-4. [PMID: 19917431 DOI: 10.1016/j.annder.2009.02.005] [Citation(s) in RCA: 4] [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] [Received: 05/14/2008] [Accepted: 02/20/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Primary cutaneous B-cell lymphomas form a heterogeneous group of lymphoid proliferations found on the skin. We report a case of primary leg-type cutaneous large B-cell lymphoma occurring on the site a previous leg burn. A few rare cases of cutaneous lymphoma forming on burn scars have been described, but these concern primary cutaneous lymphomas of the T-cell phenotype. CASE REPORT An 85-year-old man with a history of a burn to the left leg 17 years ago, previously treated with several skin grafts, presented numerous ulcerative budding lesions on the scar area. Histological examination of the skin biopsy revealed the existence in the skin ulcers of atypical large lymphoid cells having an immunoblastic or centroblastic morphology and shown by immunohistochemistry to be of the B-cell phenotype, thereby evoking a diagnosis of large B-cell lymphoma. The lymphoma cells were positive for MUM1/IRF4 and BCL2, and more weakly for BCL6, but negative for CD10. The staging examination revealed only cortical lysis of the left tibia. Temporary initial regression was achieved by polychemotherapy comprising cyclophosphamide, vincristine and prednisone in combination with rituximab. DISCUSSION This case is novel in that it involves primary large B-cell lymphoma, leg type, occurring on burn scar tissue. Venous insufficiency and lymphatic stasis have already been incriminated in the genesis of this type of lymphoma; the prior injury and resulting immune dysregulation at the burn site may have also contributed to the development of this neoplasia.
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Affiliation(s)
- M Meziane
- Service de dermatologie, CHU de La Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
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Thuny C, Gaudy-Marqueste C, Nicol I, Gabert J, Costello R, Grob JJ, Richard MA. Chronic eosinophilic leukaemia revealed by lymphomatoid papulosis: the role of the FIP1-like 1-platelet-derived growth factor receptor alpha fusion gene. J Eur Acad Dermatol Venereol 2009; 24:234-5. [PMID: 19686260 DOI: 10.1111/j.1468-3083.2009.03382.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ahmed F, En Naciri A, Grob JJ, Stchakovsky M, Johann L. Dielectric function of ZnTe nanocrystals by spectroscopic ellipsometry. Nanotechnology 2009; 20:305702. [PMID: 19584414 DOI: 10.1088/0957-4484/20/30/305702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We have studied the optical properties of ZnTe nanocrystals (ZnTe-nc) by spectroscopic ellipsometry. The ZnTe-nc are embedded in a SiO2 matrix by an ion implantation technique. Two doses of 1 x 10(16) and 5 x 10(15) cm(-2) of tellurium and zinc ions are implanted in a 250 nm thick SiO2 layer thermally grown on silicon with respective implantation energies of 180 and 115 keV. Subsequent thermal treatments at 800 degrees C lead to the formation of ZnTe-nc. Their sizes are characterized by transmission electron microscopy. The ZnTe-nc obtained with the 1 x 10(16) cm(-2) dose are self-organized into two layers parallel to the surface. Their mean radius ranges between 4-17 nm and 7-17 nm. The ZnTe-nc obtained with the 5 x 10(15) cm(-2) dose are self-organized into one layer with a mean radius between 4-17 nm. A critical points (CPs) dispersion model is used to extract the optical responses of the ZnTe-nc. The optical properties such as the dielectric function and the second derivative of the dielectric function are presented and analyzed. The dielectric function spectra reveal distinct structures attributed to band gap and optical transitions at higher energy. The correlation between the optical responses and the size of the nanocrystals is also given.
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Affiliation(s)
- F Ahmed
- Université Paul Verlaine-Metz, Laboratoire LPMD, 1 Boulevard Arago, 57078 Metz, France
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Wolkenstein P, Revuz J, Roujeau JC, Bonnelye G, Grob JJ, Bastuji-Garin S. Psoriasis in France and associated risk factors: results of a case-control study based on a large community survey. Dermatology 2009; 218:103-9. [PMID: 19060463 DOI: 10.1159/000182258] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Accepted: 09/18/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Risk factors for psoriasis have been identified. OBJECTIVE To precisely define these associated factors. METHODS A survey was conducted using a questionnaire on a representative sample of the French population. A case-control study was conducted. Cases were persons who declared having had psoriasis during the previous 12 months. For each case, 3 matched controls were selected. Cases and controls were compared using univariate and multivariate analyses. RESULTS The questionnaire was filled out and returned by 6,887 (68.9%) of 10,000 subjects aged 15 years and over; 356 cases were identified. In multivariate analysis, a higher body mass index, current and former smoking habits and beta-blocker intake were independently associated with a higher risk of psoriasis; intake of statins was associated with a decreased risk (p < 0.05). CONCLUSIONS We confirmed the association of overweight, smoking habits and beta-blocker intake with psoriasis and reported a decreased risk associated with statin intake.
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Affiliation(s)
- P Wolkenstein
- Department of Dermatology, Albert Chenevier-Henri Mondor, Faculty of Medicine, Paris 12 University, Créteil, France.
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Gaudy-Marqueste C, Jouhet C, Castelain M, Brunet P, Berland Y, Grob JJ, Richard MA. Contact allergies in haemodialysis patients: a prospective study of 75 patients. Allergy 2009; 64:222-8. [PMID: 19178401 DOI: 10.1111/j.1398-9995.2008.01833.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [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
BACKGROUND Haemodialysis exposes patients to many potentially sensitizing allergens. OBJECTIVES The primary objective of this study was to evaluate the prevalence of delayed hypersensitivity in a population of haemodialysis patients. Secondary objectives were to identify the possible risk factors for contact sensitization and to propose a series of skin tests adapted to haemodialysis patients. METHODS A prospective monocentric study was carried out in a nonselected population of haemodialysis patients. For each patient, medical history of atopy and allergic contact dermatitis, ongoing treatments (including topical ones), presence of eczema at the site of vascular access for haemodialysis were recorded. Allergological investigation included delayed hypersensitivity tests (European Environmental and Contact Dermatitis Research Group battery, tests GERDA, additional list and a battery of antiseptics and other dialysis-specific allergens) and latex skin prick test. RESULTS Seventy-five patients (41 men, 34 women, mean age of 65 years old), with a mean 3.8 years under dialysis, were included. Nineteen patients (25%) had at least one positive skin test and 13 (17%) a positive patch test to at least one allergen relative to dialysis process including eight tests to lidocaine-prilocaine cream and three to povidone-iodine. Tests results seemed clinically relevant since nine patients had localized pruritus at the fistula site and six patients active eczema around it. CONCLUSION Contact sensitizations are frequent in haemodialysis patients and are linked to vascular access conditioning especially the use of lidocaine-prilocaine cream. Designing a specific test battery could help to diagnose the potential allergens and subsequently to give advice to avoid contact with sensitizing agents.
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Affiliation(s)
- C Gaudy-Marqueste
- Department of Dermatology, Hôpital Sainte Marguerite, Marseille, France
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Fakhry N, Tessonnier L, Cohen F, Gras R, Grob JJ, Giovanni A, Mundler O, Zanaret M. Management of cervical lymph node recurrence of melanoma of the head and neck. Rev Laryngol Otol Rhinol (Bord) 2009; 130:211-214. [PMID: 20597399] [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: 05/29/2023]
Abstract
OBJECTIVES To compare the diagnostic accuracy between Positron emission tomography using 2-[fluorine-18] fluoro-2-deoxy-D-glucose (FDG-PET scan) and conventional work-up such as ultrasound (US) and/or Computed tomography (CT) in the detection of cervical lymph node recurrences of melanoma of the head and neck after initial cervical lymph node surgery. METHODS A retrospective review was performed on patients who presented with clinical and/or radiological suspicion of isolated cervical lymph node recurrence after lymph node surgery from April 2004 to January 2007. All patients underwent CT and/or US of the neck, and FDG-PET scan before salvage neck dissection. None of included patients had clinical or radiological detectable distant metastases at the time of the lymph node dissection. Performances of conventional imaging and FDG-PET scan in detection of lymph node recurrence were calculated and compared by using the histopathological results of lymphadenectomy as gold standard with Fischer's exact test. RESULTS Of the twelve cases in included in the study (9 patients, 3 of them had 2 consecutive lymph node redissection for a second lymph node recurrence), melanoma recurrence was found in 10 cases (83%). Sensitivity, specificity, positive predictive value and negative predictive values were 78.6%, 40%, 78.6%, and 40% respectively for conventional imaging and 85.7%, 40%, 80% and 50% for FDG-PET scan. No statistically significant difference was found between the 2 methods. CONCLUSION This is the first study that compares the diagnostic accuracy between FDG-PET scan and conventional imaging in the detection of cervical lymph node recurrence of melanoma of the head and neck. Our results showed that FDG-PET scan is actually not better than conventional imaging to detect these cervical lymphatic recurrences.
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Affiliation(s)
- N Fakhry
- CHU La Timone, Service d'ORL et de Chirurgie Cervico-Faciale, 264 rue Saint-Pierre, 13385 Marseille cedex 05, France.
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En Naciri A, Mansour M, Johann L, Grob JJ, Rinnert H. Influence of the implantation profiles of Si(+) on the dielectric function and optical transitions in silicon nanocrystals. J Chem Phys 2008; 129:184701. [PMID: 19045417 DOI: 10.1063/1.3009223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We report optical characterization of silicon nanocrystals embedded in silica thin films by spectroscopic ellipsometry (SE). Silicon nanocrystals (nc-Si) are produced by single energy ion implantation and multienergy Si(+) ion implantation into 250 nm of thermal oxide (SiO(2)) layers on silicon substrate. After thermal annealing, the obtained nc-Si have a Gaussian and uniform profiles for single and multienergy implantation, respectively. SE measurements are performed at room temperature at spectral range from 0.6 to 6.5 eV using the photoelastic modulated spectroscopic ellipsometer. Physical models based on the Maxwell-Garnet approximation combined with Forouhi-Bloomer dispersion formulas and wavelength by wavelength inversion are developed to extract the optical parameters of the layers. The complex dielectric function epsilon(E)=epsilon(r)(E)-iepsilon(i)(E) of nc-Si is determined and analyzed. The obtained epsilon(E) spectra of both uniform and Gaussian profiles are given and compared with those of bulk Si. The nc-Si exhibit a significant reduction of the dielectric function in comparison with bulk Si. We have determined the optical transitions E(1) and E(2) corresponding to Van Hove singularities in the joint density of states. A reduction of the amplitude of E(1) peak with a very weak shift of its energy position is observed. The transition E(2) is characterized by a rather broad peak; the amplitude of this peak is more important than that of E(1). The extended Forouhi-Bloomer model to semiconductor is also used to determine the dielectric functions of nc-Si and optical transitions. In epsilon(i)(E) spectra of nc-Si we have observed that not only the optical transition E(1) peak reduced but it tends to disappear and to form with E(2) only a single broad peak centered at around 4.3 eV. The influence of the distribution profile on the sample's structural and optical characteristics is also investigated. Defects caused by implantation are identified by analyzing the dielectric function behavior. For more reliability, photoluminescence analysis are used to obtain direct optical responses of nc-Si.
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Affiliation(s)
- A En Naciri
- Universite Paul Verlaine-Metz, Labo: LPMD, 1 Bd Arago, 57078 Metz, France.
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Maza A, Renard L, Monestier S, Grob JJ, Richard MA. [Fever with skin rash and polyarthralgia in a genetically black-skinned woman]. Med Trop (Mars) 2008; 68:297-299. [PMID: 18689326] [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: 05/26/2023]
Abstract
Adult onset Still's disease (AOSD) is a systemic disorder characterized by intermittent fever, evanescent rash, polyarthralgia or arthritis, and neutrophilic leucocytoclasis. Appearance of skin rash during fever episodes is the characteristic feature. An atypical form of AOSD with a fixed pigmented skin rash was described in 1994. Prognosis of the atypical form is thought to be more severe than that of the classic form. The purpose of this report is to describe the first case of atypical AOSD in a genetically black-skinned woman. Treatment required administration of high-dose systemic corticosteroids.
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Affiliation(s)
- A Maza
- Service de dermatologie, CHU Sainte Marguerite, Marseille.
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Grob JJ, Auquier P, Dreyfus I, Ortonne JP. Quality of life in adults with chronic idiopathic urticaria receiving desloratadine: a randomized, double-blind, multicentre, placebo-controlled study. J Eur Acad Dermatol Venereol 2008; 22:87-93. [PMID: 18181978 DOI: 10.1111/j.1468-3083.2007.02385.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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
OBJECTIVE To assess the effect of desloratadine on quality of life (QoL) in chronic idiopathic urticaria (CIU). STUDY POPULATION Patients with a history of CIU (pruritus and weals lasting = 6 weeks) were included in this multicentre, randomized, double-blind placebo-controlled study that took place in dermatology centres throughout France. During the study, patients were randomized to receive desloratadine 5 mg daily or placebo for 42 days. MAIN OUTCOME MEASURES Variation of the scores of two QoL dermatology-specific tools between baseline and day 42, the French translation version of the Dermatology Life Quality Index (DLQI) and the VQ-Dermato (a French-language scoring instrument). RESULTS The intent-to-treat population comprised 137 patients [desloratadine (n = 65) or placebo (n = 72)]. Desloratadine treatment was associated with significantly greater improvements from baseline to day 42 compared with placebo in DLQI overall score (-6 vs. -2.2 points; P < 0.002) and VQ-Dermato score (18.5 vs. 29.1 points; P = 0.009). Mean scores for sleep disruption and disruption of daily activities were significantly lower in the desloratadine group than in the placebo group from day 1 to the end of the study. CONCLUSIONS Desloratadine 5 mg/day was associated with significant improvements in two separate dermatology-specific measures of QoL in patients with CIU. QoL proved to be a relevant primary outcome measure for therapeutic trials in CIU.
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Affiliation(s)
- J J Grob
- Service de Dermatologie, Hôpital Ste Marguerite and Faculté de Médicine, Marseille, France.
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Langan SM, Bouwes Bavinck JN, Coenraads PJ, Diepgen T, Elsner P, Grob JJ, Linder D, Naldi L, Svensson A, Williams HC. Update on the Activities of the European Dermato-Epidemiology Network (EDEN). Dermatology 2006; 213:1-2. [PMID: 16778417 DOI: 10.1159/000092828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Négrier S, Saiag P, Guillot B, Verola O, Avril MF, Bailly C, Cupissol D, Dalac S, Danino A, Dreno B, Grob JJ, Leccia MT, Renaud-Vilmer C, Bosquet L. [Guidelines for clinical practice: Standards, Options and Recommendations 2005 for the management of adult patients exhibiting an M0 cutaneous melanoma, full report. National Federation of Cancer Campaign Centers. French Dermatology Society. Update of the 1995 Consensus Conference and the 1998 Standards, Options, and Recommendations]. Ann Dermatol Venereol 2005; 132:10S3-10S85. [PMID: 16521904] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
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Monestier S, Gaudy C, Gouvernet J, Richard MA, Grob JJ. Multiple senile lentigos of the face, a skin ageing pattern resulting from a life excess of intermittent sun exposure in dark-skinned caucasians: a case-control study. Br J Dermatol 2005; 154:438-44. [PMID: 16445772 DOI: 10.1111/j.1365-2133.2005.06996.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [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: 12/01/2022]
Abstract
BACKGROUND Different patterns of skin ageing can be described depending on the predominant lesions, i.e. wrinkles, laxity, atrophy, senile lentigos (SLs), etc. They may correspond to different epidemiological contexts. OBJECTIVES To identify and assess the epidemiological factors for a skin ageing pattern characterized by a high density of SLs on the face, or 'lentigo ageing pattern' (LAP). METHODS An age- and sex-matched case-control study was conducted in individuals aged between 60 and 80 years, comparing cases (n = 118) with a very high number of SLs on the face for their age, and controls (n = 118) with no or very few SLs for their age. The cases and controls were recruited in two hospitals. RESULTS In univariate and multivariate analysis, LAP was associated with skin types III and IV, with frequent sunburns, and with the part of the lifetime cumulative sun exposure which was received during vacations. Conversely, there was no link with the occupational and everyday exposures and the total cumulative exposure. LAP was associated with multiple solar lentigos of the upper back. No relationship was found with postmenopausal hormonal therapy, number of naevi, or freckles. CONCLUSIONS Different epidemiological factors may account for the different skin ageing patterns. LAP seems to develop preferentially in dark-skinned caucasians who have repeatedly received intermittent and intense sun irradiations throughout their life, and have often developed solar lentigos on the upper back earlier in life, whereas the 'prominent wrinkling' pattern is known to affect light-skinned people and smokers with a life excess of continuous exposure.
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Affiliation(s)
- S Monestier
- Department of Dermatology, Hôpital Ste Marguerite, Assistance Publique des Hôpitaux de Marseille and Research Unit LIMP EA 3291, Université de la Méditerranée, France
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Grob JJ. [Epidemiology of mycosis fungoides]. Ann Dermatol Venereol 2005; 132 Spec No 2:5S11-2. [PMID: 16385892] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- J J Grob
- Service de Dermatologie, Hôpital Sainte-Marguerite, I3000 Marseille, France
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Grob JJ, Revuz J, Ortonne JP, Auquier P, Lorette G. Comparative study of the impact of chronic urticaria, psoriasis and atopic dermatitis on the quality of life. Br J Dermatol 2005; 152:289-95. [PMID: 15727641 DOI: 10.1111/j.1365-2133.2005.06385.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.7] [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: 11/29/2022]
Abstract
BACKGROUND A better management of chronic skin disorders (CSDs) requires a knowledge of their impact from the patient's point of view. OBJECTIVES To determine which aspects of the patient's life are mainly impaired in the different CSDs, and provide comparative references to estimate better the real impact of the different CSDs. PATIENTS AND METHODS A prospective cross-sectional and matched study of 1356 adult outpatients to compare the health-related quality of life (HRQL) profile in chronic urticaria (466 CU), psoriasis (464 PSO) and atopic dermatitis (426 AD), using the VQ-Dermato, a multidimensional instrument in French validated for CSDs. RESULTS After adjustment for confounders, HRQL dimensions were differently affected in the three CSDs. The 'physical discomfort' dimension was more degraded in AD and CU than in PSO (P < 0.001), and 'leisure activities' more in PSO than in CU (P < 0.001). 'Self-perception' and 'treatment-induced restrictions' dimensions were much less affected in CU than in PSO and AD (P < 0.001). In PSO, the 'daily living activities' dimension was much less impaired than in CU and AD (P < 0.001). No aspect of HRQL was really spared in AD. CONCLUSIONS The comparison shows that CU, PSO and AD are characterized by completely different qualitative profiles of impact on HRQL, which are influenced by their clinical characteristics and usual treatment options. It underlines the severe impairment of CU which is often underestimated.
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Affiliation(s)
- J J Grob
- Service de Dermatologie, Hôpital Henri Mondor, Créteil, France.
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Avril MF, Aamdal S, Grob JJ, Hauschild A, Mohr P, Bonerandi JJ, Weichenthal M, Neuber K, Bieber T, Gilde K, Guillem Porta V, Fra J, Bonneterre J, Saïag P, Kamanabrou D, Pehamberger H, Sufliarsky J, Gonzalez Larriba JL, Scherrer A, Menu Y. Fotemustine compared with dacarbazine in patients with disseminated malignant melanoma: a phase III study. J Clin Oncol 2004; 22:1118-25. [PMID: 15020614 DOI: 10.1200/jco.2004.04.165] [Citation(s) in RCA: 335] [Impact Index Per Article: 16.8] [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: 11/20/2022] Open
Abstract
PURPOSE To compare fotemustine and dacarbazine (DTIC) in terms of overall response rate (ORR) as primary end-point and overall survival, duration of responses, time to progression, time to occurrence of brain metastases (BM), and to assess safety and quality of life in patients with disseminated cutaneous melanoma. PATIENTS AND METHODS Patients received either intravenous fotemustine 100 mg/m2 weekly for 3 weeks or DTIC 250 mg/m2/d for 5 consecutive days every 4 weeks (two cycles). Nonprogressive patients received a maintenance treatment every 4 weeks (fotemustine 100 mg/m2 or DTIC 250 mg/m2 for 5 days). RESULTS Two hundred twenty-nine patients were randomly assigned to fotemustine or DTIC arms. The best ORR was higher in the fotemustine arm than in the DTIC arm in the intent-to-treat population (n=229; 15.2% v 6.8%; P=.043) and in full analysis set (n=221) (15.5% v 7.2%; P=.053). Similar median durations of responses (5.8 months with fotemustine v 6.9 months with DTIC) and time to progression (1.8 v 1.9 months, respectively) were observed. In patients without BM at inclusion, the median time to BM was 22.7 months with fotemustine versus 7.2 months with DTIC (P=.059). Median survival was 7.3 months with fotemustine versus 5.6 months with DTIC (P=.067). The main toxicity was grade 3 to 4 neutropenia (51% with fotemustine v 5% with DTIC) and thrombocytopenia (43% v 6%, respectively). No significant difference was noted for quality of life between arms. CONCLUSION ORR was higher in the fotemustine arm compared to the DTIC arm in first-line treatment of disseminated melanoma. A trend in favor of fotemustine in terms of overall survival and time to BM was evidenced.
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Affiliation(s)
- M F Avril
- Institut Gustave Roussy, 39, rue Camille Desmoulins, 94805 Villejiuf Cedex, France.
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Nicol I, Boye T, Carsuzaa F, Feier L, Collet Villette AM, Xerri L, Grob JJ, Richard MA. Post-transplant plasmablastic lymphoma of the skin. Br J Dermatol 2003; 149:889-91. [PMID: 14616390 DOI: 10.1046/j.1365-2133.2003.05544.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Grob JJ. La reconnaissance des mélanomes au milieude milliers de tumeurs noires : ≪ oublier ABCD ≫. Rev Med Interne 2003; 24 Suppl 1:11s-12s. [PMID: 14509031 DOI: 10.1016/s0248-8663(03)80004-8] [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: 11/17/2022]
Affiliation(s)
- J J Grob
- Service de dermatologie, hôpital Sainte-Marguerite, 270, boulevard de Sainte-Marguerite, 13274 Marseille
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Gueydan M, Folchetti G, Christofilis MA, Valéro R, Grob JJ, Vialettes B. [Impetigo herpetiformis, a rare manifestation of severe hypocalcemia]. Ann Endocrinol (Paris) 2002; 63:502-4. [PMID: 12527851] [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: 02/28/2023]
Abstract
A case of impetigo herpetiformis associated with profound hypocalcemia secondary to idiopathic hypoparathyroidism is reported. This clinical observation and the review of similar cases in the literature recall that this rare and severe skin disease related to psoriasis can be the first manifestation of hypoparathyroidism and responds very well to the calcium reloading.
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Affiliation(s)
- M Gueydan
- Service de Nutrition, Maladies métaboliques et Endocrinologie, Centre Hospitalo-Universitaire Sainte Marguerite et Université de la Méditerranée, Marseille, France
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Monestier S, Richard MA, Rey AC, Djemli A, Choux R, Grob JJ. [Multiple papules of the trunk]. Ann Dermatol Venereol 2002; 129:1315-6. [PMID: 12514525] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- S Monestier
- Service de Dermatologie, CHU Sainte-Marguerite, 270, boulevard de Sainte-Marguerite, 13009 Marseille
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Saiag P, Grob JJ, Grosshans E. [Epithelial and melanotic skin tumors. Melanomas]. Ann Dermatol Venereol 2002; 129:S143-8. [PMID: 12718142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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Wolkenstein P, Consoli S, Roujeau JC, Grob JJ. [The physician-patient relation. Reporting a severe disease. Education of a patient suffering from a chronic disease. Personalizing medical management]. Ann Dermatol Venereol 2002; 129:S7-10. [PMID: 12718118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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Basset-Seguin N, Dreno B, Grob JJ. [Epithelial and melanotic skin tumors. Epithelial carcinoma]. Ann Dermatol Venereol 2002; 129:S132-6. [PMID: 12718140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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Andreani V, Richard MA, Blaise D, Gouvernet J, Grob JJ. Naevi in allogeneic bone marrow transplantation recipients: the effect of graft-versus-host disease on naevi. Br J Dermatol 2002; 147:433-41. [PMID: 12207581 DOI: 10.1046/j.1365-2133.2002.04748.x] [Citation(s) in RCA: 21] [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] [Indexed: 11/20/2022]
Abstract
BACKGROUND Non-melanoma skin carcinoma is more common in transplant recipients, probably because of immunosuppression. An increased risk of developing melanoma could be a late effect of transplantation. The number of naevi, which is a risk marker for melanoma, is increased in renal transplant recipients of all ages and may be related to immunosuppression. The risk of melanoma has been suspected to be particularly high after bone marrow transplantation. Cutaneous graft-versus-host disease (GVHD) might be an interesting model for the study of interactions between naevi and the immune system. OBJECTIVE To assess whether aBMT exposes an individual to a particularly high risk of melanoma, using naevi as a surrogate measure of the risk. To improve our knowledge of the effect of the immune system on naevi, using GVHD as a model. METHODS We carried out an epidemiological case-control study with two age-, sex- and hair colour-matched controls for each case. The results were analysed with analysis of variance, a general linear model analysis and multivariate analysis. RESULTS The number of naevi was not significantly increased in aBMT patients, as compared with controls, although there was a significant excess on the palms and legs. In exploratory subgroup case-control comparisons and with the general linear model, patients who were conditioned with a combination of two alkylating drugs at high doses, and patients who had an aBMT before the age of 20 years tended to have a higher count of naevi (P = 0.002 and P = 0.06, respectively). Conversely, there was a trend in favour of a lower count of naevi in patients with diffuse skin lesions of chronic GVHD (P = 0.01). These data were corroborated by multivariate analysis, which showed that conditioning with high-dose chemotherapy, the absence of severe chronic cutaneous GVHD and a young age at transplantation were the main variables that independently predicted an excess of naevi. CONCLUSIONS This study of aBMT patients confirms that chemotherapy stimulates naevus growth. It also suggests for the first time that diffuse lesions of chronic cutaneous GVHD are associated with a decreased number of naevi. Whether allo-immunity, chronic skin inflammation or the masking of naevi by pigmentation and fibrosis is responsible for the decreased number of naevi requires further investigation. With respect to the long-term risk of melanoma in aBMT recipients, our results support an increased risk particularly when aBMT is performed at a young age, and when conditioning is with high doses of alkylating drugs.
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Affiliation(s)
- V Andreani
- Service de Dermatologie et LIMP (Laboratoire d'Investigation des Maladies de la Peau), Hôpital Sainte Marguerite, 270 Bd de Sainte Marguerite, Université de la Mediterranée, 13009 Marseille, France
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Abstract
INTRODUCTION First used as a sedative, thalidomide was taken out the market because of its teratogenicity. Despite other side effects, especially neuropathies, this drug is now again prescribed in various autoimmune and neoplasic diseases. Recently, venous or arterial thrombotic events have been described after the introduction of thalidomide. EXEGESIS In this report, we describe two new venous thrombosis cases occurring during a treatment with thalidomide. The first case is a 37-year-old man treated for a discoid lupus, who developed three deep-vein thrombosis and a massive pulmonary embolism, with recurrent thrombosis even with an efficient anticoagulation therapy until the final stop of thalidomide. The second one is a 66-year-old woman treated with thalidomide for a multiple myeloma and a melanoma in therapeutic escape, who developed a deep-vein thrombosis two months after the beginning of her treatment. Published reports suggest that most thrombotic events appeared under three months after the introduction of the treatment and that thalidomide could have acted as a precipitating or as a starting factor in a patient population already at risk of thrombosis. Those complications should be particularly severe, but the mechanism underlying thrombosis with thalidomide is unknown. CONCLUSION A complete coagulation check-up is advised before beginning a treatment with thalidomide.
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Affiliation(s)
- J Gachon
- Service de dermatologie, hôpital Sainte-Marguerite, CHU, 270, boulevard de Sainte-Marguerite, 13274 Marseille, France
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Richard MA, Saadallah S, Lefevre P, Poullin P, Buscaylet S, Grob JJ. [Extracorporeal photochemotherapy in therapy-refractory subacute lupus]. Ann Dermatol Venereol 2002; 129:1023-6. [PMID: 12442100] [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: 02/27/2023]
Abstract
BACKGROUND Extracorporeal photopheresis is a leukapheresis therapy that uses psoralen and ultraviolet A irradiation. We report the case of a woman with a refractory sub acute lupus which dramatically but transitionally responded to extracorporeal photopheresis. CASE REPORT This women, born in 1960, developed erythematous and squamous patches located on face and neckline, associated with hyperpigmented and atrophic lesions on the arms and shoulders. Investigations confirmed the diagnosis of subacute lupus without systemic disease. All lesions progressed, despite all conventional therapies leading to major aesthetic prejudice. Extracorporeal photopheresis was initiated, and after two months, all lesions, including atrophic and healing lesions had regressed, but laboratory abnormalities did not change. Extracorporeal photopheresis was well tolerated. However, treatment was discontinued nine months later, since the cutaneous lesions relapsed. COMMENTS Extracorporeal photopheresis could be efficient in the treatment of cutaneous autoimmune diseases through several immunomodulatory mechanisms. Extracorporeal photopheresis is a potent alternative agent in the therapy of refractory dermatological diseases
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Affiliation(s)
- M A Richard
- Service de Dermatologie, Hôpital Sainte Marguerite, Marseille, France.
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