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Schumann K, Mauch C, Klespe KC, Loquai C, Nikfarjam U, Schlaak M, Akçetin L, Kölblinger P, Hoellwerth M, Meissner M, Mengi G, Braun AD, Mengoni M, Dummer R, Mangana J, Sindrilaru MA, Radmann D, Hafner C, Freund J, Rappersberger K, Weihsengruber F, Meiss F, Reinhardt L, Meier F, Rainer B, Richtig E, Ressler JM, Höller C, Eigentler T, Amaral T, Peitsch WK, Hillen U, Harth W, Ziller F, Schatton K, Gambichler T, Susok L, Maul LV, Läubli H, Debus D, Weishaupt C, Börger S, Sievers K, Haferkamp S, Zenderowski V, Nguyen VA, Wanner M, Gutzmer R, Terheyden P, Kähler K, Emmert S, Thiem A, Sachse M, Gercken-Riedel S, Kaune KM, Thoms KM, Heinzerling L, Heppt MV, Tratzmiller S, Hoetzenecker W, Öllinger A, Steiner A, Peinhaupt T, Podda M, Schmid S, Wollina U, Biedermann T, Posch C. Real-world outcomes using PD-1 antibodies and BRAF + MEK inhibitors for adjuvant melanoma treatment from 39 skin cancer centers in Germany, Austria and Switzerland. J Eur Acad Dermatol Venereol 2022; 37:894-906. [PMID: 36433688 DOI: 10.1111/jdv.18779] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Programmed death-1 (PD-1) antibodies and BRAF + MEK inhibitors are widely used for adjuvant therapy of fully resected high-risk melanoma. Little is known about treatment efficacy outside of phase III trials. This real-world study reports on clinical outcomes of modern adjuvant melanoma treatment in specialized skin cancer centers in Germany, Austria and Switzerland. METHODS Multicenter, retrospective study investigating stage III-IV melanoma patients receiving adjuvant nivolumab (NIV), pembrolizumab (PEM) or dabrafenib + trametinib (D + T) between 1/2017 and 10/2021. The primary endpoint was 12-month recurrence-free survival (RFS). Further analyses included descriptive and correlative statistics, and a multivariate linear-regression machine learning model to assess the risk of early melanoma recurrence. RESULTS In total, 1198 patients from 39 skin cancer centers from Germany, Austria and Switzerland were analysed. The vast majority received anti PD-1 therapies (n = 1003). Twelve-month RFS for anti PD-1 and BRAF + MEK inhibitor-treated patients were 78.1% and 86.5%, respectively (hazard ratio [HR] 1.998 [95% CI 1.335-2.991]; p = 0.001). There was no statistically significant difference in overall survival (OS) in anti PD-1 (95.8%) and BRAF + MEK inhibitor (96.9%) treated patients (p > 0.05) during the median follow-up of 17 months. Data indicates that anti PD-1 treated patients who develop immune-related adverse events (irAEs) have lower recurrence rates compared to patients with no irAEs (HR 0.578 [95% CI 0.443-0.754], p = 0.001). BRAF mutation status did not affect overall efficacy of anti PD-1 treatment (p > 0.05). In both, anti PD-1 and BRAF + MEK inhibitor treated cohorts, data did not show any difference in 12-month RFS and 12-month OS comparing patients receiving total lymph node dissection (TLND) versus sentinel lymph node biopsy only (p > 0.05). The recurrence prediction model reached high specificity but only low sensitivity with an AUC = 0.65. No new safety signals were detected. Overall, recorded numbers and severity of adverse events were lower than reported in pivotal phase III trials. CONCLUSIONS Despite recent advances in adjuvant melanoma treatment, early recurrence remains a significant clinical challenge. This study shows that TLND does not reduce the risk of early melanoma recurrence and should only be considered in selected patients. Data further highlight that variables collected during clinical routine are unlikely to allow for a clinically relevant prediction of individual recurrence risk.
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Affiliation(s)
- Katharina Schumann
- Department of Dermatology and Allergy, School of Medicine, German Cancer Consortium (DKTK), Technical University of Munich, Munich, Germany
| | - Cornelia Mauch
- Department for Dermatology and Venereology and CIO ABCD, University Hospital Köln, Köln, Germany
| | - Kai-Christian Klespe
- Department for Dermatology and Venereology and CIO ABCD, University Hospital Köln, Köln, Germany
| | - Carmen Loquai
- Department for Dermatology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Ulrike Nikfarjam
- Department for Dermatology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Max Schlaak
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Larissa Akçetin
- Department for Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
| | - Peter Kölblinger
- Department for Dermatology and Allergology, Paracelsus Medical University, Salzburg, Austria
| | - Magdalena Hoellwerth
- Department for Dermatology and Allergology, Paracelsus Medical University, Salzburg, Austria
| | - Markus Meissner
- Department for Dermatology, University Clinic Frankfurt, Frankfurt, Germany
| | - Guelcin Mengi
- Department for Dermatology, University Clinic Frankfurt, Frankfurt, Germany
| | | | - Miriam Mengoni
- Department of Dermatology, University Hospital Magdeburg, Magdeburg, Germany
| | - Reinhard Dummer
- Dermatology Clinic, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Joanna Mangana
- Dermatology Clinic, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | - Dan Radmann
- Department for Dermatology and Allergy, University Clinic Ulm, Ulm, Germany
| | - Christine Hafner
- Department of Dermatology, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Johann Freund
- Department of Dermatology, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | | | | | - Frank Meiss
- Department for Dermatology and Venereology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Lydia Reinhardt
- Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Dresden, Germany.,Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Friedegund Meier
- Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Dresden, Germany.,Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Barbara Rainer
- Department of Dermatology and Venereology, Medical University Graz, Graz, Austria
| | - Erika Richtig
- Department of Dermatology and Venereology, Medical University Graz, Graz, Austria
| | | | - Christoph Höller
- Department of Dermatology, Medical University Vienna, Vienna, Austria
| | - Thomas Eigentler
- 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, Interdisciplinary Skin Cancer Center, University Medical Center Tuebingen, Tuebingen, Germany
| | - Teresa Amaral
- Department of Dermatology, Interdisciplinary Skin Cancer Center, University Medical Center Tuebingen, Tuebingen, Germany
| | - Wiebke K Peitsch
- Departments of Dermatology and Phlebology, Vivantes Skin Cancer Center, Vivantes Clinic Friedrichshain, Neukölln and Spandau, Berlin, Germany
| | - Uwe Hillen
- Department of Dermatology and Venereology, Vivantes Skin Cancer Center, Klinikum Neukölln, Berlin, Germany
| | - Wolfgang Harth
- Department of Dermatology and Allergology, Vivantes Skin Cancer Center, Klinikum Spandau, Berlin, Germany
| | - Fabian Ziller
- Department for Dermatology, DRK Hospital Chemnitz-Rabenstein, Chemnitz, Germany
| | - Kerstin Schatton
- Department for Dermatology, University Clinic Düsseldorf, Düsseldorf, Germany
| | - Thilo Gambichler
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Laura Susok
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Lara Valeska Maul
- Department for Dermatology, University Hospital Basel, Basel, Switzerland
| | - Heinz Läubli
- Department for Oncology, University Hospital Basel, Basel, Switzerland
| | - Dirk Debus
- Department of Dermatology, Nuremberg General Hospital - Paracelsus Medical University, Nuremberg, Germany
| | - Carsten Weishaupt
- Department for Dermatology and Venereology, University Clinic Münster, Münster, Germany
| | | | | | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | | | - Van Anh Nguyen
- Department for Dermatology, Venereology and Allergology, Medical University Innsbruck, Innsbruck, Austria
| | - Mariana Wanner
- Department for Dermatology, Venereology and Allergology, Medical University Innsbruck, Innsbruck, Austria
| | - Ralf Gutzmer
- Department of Dermatology, Mühlenkreiskliniken Minden und Ruhr University Bochum, Minden, Germany
| | - Patrick Terheyden
- Department for Dermatology and Venereology, University Clinic Schleswig-Holstein, Lübeck, Germany
| | - Katharina Kähler
- Department for Dermatology and Venereology, University Clinic Schleswig-Holstein, Kiel, Germany
| | - Steffen Emmert
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
| | - Alexander Thiem
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
| | - Michael Sachse
- Department for Dermatology, Clinic Bremerhaven Reinkenheide, Bremerhaven, Germany
| | - Silke Gercken-Riedel
- Department for Dermatology, Clinic Bremerhaven Reinkenheide, Bremerhaven, Germany
| | - Kjell Matthias Kaune
- Dermatology, Dermatosurgery and Allergology Clinic, Bremen-Mitte Hospital, Bremen, Germany
| | - Kai-Martin Thoms
- Department for Dermatology, University Hospital Göttingen, Georg-August-University, Göttingen, Germany
| | - Lucie Heinzerling
- Department for Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany.,Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg and Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg, Erlangen, Germany
| | - Markus Vincent Heppt
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg and Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg, Erlangen, Germany
| | - Sabine Tratzmiller
- Department for Dermatology, Municipal Hospital Karlsruhe, Karlsruhe, Germany
| | - Wolfram Hoetzenecker
- Department of Dermatology, University Hospital Linz, Johannes Kepler University, Linz, Austria
| | - Angela Öllinger
- Department of Dermatology, University Hospital Linz, Johannes Kepler University, Linz, Austria
| | | | | | - Maurizio Podda
- Department for Dermatology, Clinic Darmstadt, Darmstadt, Germany
| | - Sabine Schmid
- Department for Dermatology, Clinic Darmstadt, Darmstadt, Germany
| | - Uwe Wollina
- Department for Dermatology and Allergology, Municipal Hospital Dresden, Dresden, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy, School of Medicine, German Cancer Consortium (DKTK), Technical University of Munich, Munich, Germany
| | - Christian Posch
- Department of Dermatology and Allergy, School of Medicine, German Cancer Consortium (DKTK), Technical University of Munich, Munich, Germany.,Faculty of Medicine, Sigmund Freud University Vienna, Vienna, Austria.,Department for Dermatology, Clinic Hietzing, Vienna Healthcare Group, Vienna, Austria
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Kölblinger P, Schöffl C. ÖGDV Preisträger stellen sich vor: Peter Kölblinger aus Salzburg und Clemens Schöffl aus Graz erhalten den Versorgungsforschungspreis der ÖGDV 2021. J Dtsch Dermatol Ges 2022; 20:741-742. [PMID: 35578424 DOI: 10.1111/ddg.14814_g] [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: 11/30/2022]
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Goldinger SM, Buder-Bakhaya K, Lo SN, Forschner A, McKean M, Zimmer L, Khoo C, Dummer R, Eroglu Z, Buchbinder EI, Ascierto PA, Gutzmer R, Rozeman EA, Hoeller C, Johnson DB, Gesierich A, Kölblinger P, Bennannoune N, Cohen JV, Kähler KC, Wilson MA, Cebon J, Atkinson V, Smith JL, Michielin O, Long GV, Hassel JC, Weide B, Haydu LE, Schadendorf D, McArthur G, Ott PA, Blank C, Robert C, Sullivan R, Hauschild A, Carlino MS, Garbe C, Davies MA, Menzies AM. Chemotherapy after immune checkpoint inhibitor failure in metastatic melanoma: a retrospective multicentre analysis. Eur J Cancer 2021; 162:22-33. [PMID: 34952480 DOI: 10.1016/j.ejca.2021.11.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Despite remarkably improved outcomes with immune checkpoint inhibition, many patients with metastatic melanoma will eventually require further therapy. Chemotherapy has limited activity when used first-line but can alter the tumour microenvironment and does improve efficacy when used in combination with immunotherapy in lung cancer. Whether chemotherapy after checkpoint inhibitor failure has relevant activity in patients with metastatic melanoma is unknown. METHODS Patients with metastatic melanoma treated with chemotherapy after progression on immunotherapy with checkpoint inhibitors were identified retrospectively from 24 melanoma centres. Objective response rate (ORR), progression-free survival (PFS), overall survival (OS) and safety were examined. RESULTS In total, 463 patients were treated between 2007 and 2017. Fifty-six per cent had received PD-1-based therapy before chemotherapy. Chemotherapy regimens included carboplatin + paclitaxel (32%), dacarbazine (25%), temozolomide (15%), taxanes (9%, nab-paclitaxel 4%), fotemustine (6%) and others (13%). Median duration of therapy was 7.9 weeks (0-108). Responses included 0.4% complete response (CR), 12% partial response (PR), 21% stable disease (SD) and 67% progressive disease (PD). Median PFS was 2.6 months (2.2, 3.0), and median PFS in responders was 8.7 months (6.3, 16.3), respectively. Twelve-month PFS was 12% (95% CI 2-15%). In patients who had received anti-PD-1 before chemotherapy, the ORR was 11%, and median PFS was 2.5 months (2.1, 2.8). The highest activity was achieved with single-agent taxanes (N = 40), with ORR 25% and median PFS 3.9 months (2.1, 6.2). Median OS from chemotherapy start was 7.1 months (6.5, 8.0). Subsequent treatment with checkpoint inhibitors achieved a response rate of 16% with a median PFS of 19.1 months (2.0-43.1 months). No unexpected toxicities were observed. CONCLUSION Chemotherapy has a low response rate and short PFS in patients with metastatic melanoma who have failed checkpoint inhibitor therapy, although activity varied between regimens. Chemotherapy has a limited role in the management of metastatic melanoma.
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Affiliation(s)
- Simone M Goldinger
- University of Zurich, Department of Dermatology, Gloriastrasse 31 Zurich, 8091, Switzerland; Melanoma Institute Australia, The University of Sydney, The Poche Centre, 40 Rocklands Road North Sydney NSW 2060, Australia.
| | - Kristina Buder-Bakhaya
- University Hospital Heidelberg, Department of Dermatology and National Center for Cancer (NCT), Im Neuenheimer Feld 460 Heidelberg, 69120, Germany.
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, The Poche Centre, 40 Rocklands Road North Sydney NSW 2060, Australia.
| | - Andrea Forschner
- University of Tuebingen, Department of Dermatology, Liebermeisterstrasse 25, Tübingen, 72076, Germany.
| | - Meredith McKean
- University of Texas MD Anderson Cancer Center, Department of Melanoma Medical Oncology and Department of Surgical Oncology, 1400 Pressler Street, Houston, TX 77006 USA.
| | - Lisa Zimmer
- University Hospital Essen, Department of Dermatology, Essen & German Cancer Consortium, Partner Site Essen, Germany.
| | - Chloe Khoo
- Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - Reinhard Dummer
- University of Zurich, Department of Dermatology, Gloriastrasse 31 Zurich, 8091, Switzerland.
| | - Zeynep Eroglu
- Moffitt Cancer Center, Department of Cutaneous Oncology, 12902 Magnolia Drive, Tampa, FL 33612, USA.
| | | | - Paolo A Ascierto
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Napoli, Italy.
| | - Ralf Gutzmer
- Skin Cancer Center, Department of Dermatology, Mühlenkreiskliniken, Ruhr University Bochum Campus Minden, Germany.
| | - Elisa A Rozeman
- Antoni van Leeuwenhoek Hospital - The Netherlands Cancer Institute, Department of Medical Oncology and Immunology, Plesmanlaan 121 Amsterdam, 1066 CX, the Netherlands.
| | - Christoph Hoeller
- Medical University of Vienna, Department of Dermatology, Waehringer Guertel 18-20, Vienna, 1090, Austria.
| | - Douglas B Johnson
- Vanderbilt University Medical Center, Department of Medicine, Nashville, TN, USA.
| | - Anja Gesierich
- University Hospital Wuerzburg, Department of Dermatology, Wuerzburg, Germany.
| | - Peter Kölblinger
- Department of Dermatology and Allergology, Paracelsus Medical University, Salzburg, Austria.
| | - Naima Bennannoune
- Gustave Roussy and Paris-Saclay University, 114 rue Edouard Vaillant Villejuif Cedex, 94805, France.
| | - Justine V Cohen
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
| | - Katharina C Kähler
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Strasse 3, Haus C, Kiel, 24105, Germany.
| | - Melissa A Wilson
- Perlmutter Cancer Center, NYU Langone Health, NYU School of Medicine, 160 E. 34th Street, New York, NY 10016, USA.
| | - Jonathan Cebon
- Olivia Newton-John Cancer Research Institute, Austin Health, School of Cancer Medicine, La Trobe University, 145 Studley Road, Heidelberg VIC, Melbourne, 3084, Australia.
| | - Victoria Atkinson
- University of QLD, Princess Alexandra Hospital, Greenslopes Private Hospital, 199 Ipswich Rd, Woolloongabba QLD 4102, Australia.
| | - Jessica L Smith
- Crown Princess Mary Cancer Centre Westmead, Sydney, NSW, Australia.
| | - Olivier Michielin
- Lausanne University Hospital, Department of Oncology, Precision Oncology Center, Rue du Bugnon 21, Lausanne, 1011, Switzerland.
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, The Poche Centre, 40 Rocklands Road North Sydney NSW 2060, Australia; Royal North Shore Hospital, Reserve Road St Leonards NSW 2065, Australia; Mater Hospital, 25 Rocklands Road, North Sydney NSW 2060, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Charles Perkins Centre, The University of Sydney, Australia.
| | - Jessica C Hassel
- University Hospital Heidelberg, Department of Dermatology and National Center for Cancer (NCT), Im Neuenheimer Feld 460 Heidelberg, 69120, Germany.
| | - Benjamin Weide
- University of Tuebingen, Department of Dermatology, Liebermeisterstrasse 25, Tübingen, 72076, Germany.
| | - Lauren E Haydu
- University of Texas MD Anderson Cancer Center, Department of Melanoma Medical Oncology and Department of Surgical Oncology, 1400 Pressler Street, Houston, TX 77006 USA.
| | - Dirk Schadendorf
- University Hospital Essen, Department of Dermatology, Essen & German Cancer Consortium, Partner Site Essen, Germany.
| | | | - Patrick A Ott
- Dana Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA.
| | - Christian Blank
- Antoni van Leeuwenhoek Hospital - The Netherlands Cancer Institute, Department of Medical Oncology and Immunology, Plesmanlaan 121 Amsterdam, 1066 CX, the Netherlands.
| | - Caroline Robert
- Gustave Roussy and Paris-Saclay University, 114 rue Edouard Vaillant Villejuif Cedex, 94805, France.
| | - Ryan Sullivan
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Strasse 3, Haus C, Kiel, 24105, Germany.
| | - Matteo S Carlino
- Crown Princess Mary Cancer Centre Westmead, Sydney, NSW, Australia.
| | - Claus Garbe
- University of Tuebingen, Department of Dermatology, Liebermeisterstrasse 25, Tübingen, 72076, Germany.
| | - Michael A Davies
- University of Texas MD Anderson Cancer Center, Department of Melanoma Medical Oncology and Department of Surgical Oncology, 1400 Pressler Street, Houston, TX 77006 USA.
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, The Poche Centre, 40 Rocklands Road North Sydney NSW 2060, Australia; Royal North Shore Hospital, Reserve Road St Leonards NSW 2065, Australia; Mater Hospital, 25 Rocklands Road, North Sydney NSW 2060, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
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Schweighofer-Zwink G, Manafi-Farid R, Kölblinger P, Hehenwarter L, Harsini S, Pirich C, Beheshti M. Prognostic value of 2-[ 18F]FDG PET-CT in metastatic melanoma patients receiving immunotherapy. Eur J Radiol 2021; 146:110107. [PMID: 34922117 DOI: 10.1016/j.ejrad.2021.110107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/25/2021] [Revised: 11/10/2021] [Accepted: 12/08/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE The 2-fluorodeoxyglucose positron emission tomography/computed tomography (2-[18F]FDG PET/CT) is used for the evaluation of response to immunotherapy in malignant melanoma. Here, we evaluated the prognostic value of various metabolic parameters in baseline and different time points after therapy. METHODS In this retrospective study, 51 metastatic melanoma patients, who had received immunotherapy, were included. Patients with baseline and two follow-up 2-[18F]FDG PET/CT studies (3 and 6 months after therapy) were selected. Multiple metabolic parameters and tumor-to-background ratios (TBRs) were extracted and correlated with OS. RESULTS The 3- and 5-year OS rates were 49% and 43.1%, respectively. On baseline 2-[18F]FDG PET/CT, only standardized uptake value corrected for lean body mass (SULmax and SULpeak), as well as most of the TBRs were predictive for 3- and 5-year OS rates. Metabolic tumor volume (MTV), total lesion glycolysis (TLG), and most of the TBRs were predictive on both follow-up studies. Also, the changes in values of MTV, TLG and most of the TBRs from the baseline to the 3-month and 6- month follow-up studies were prognostic. On multivariate analysis, all of the most predictive parameters for OS were derived from the 3-month follow-up study. The ratio of TBRmean to the mediastinum was the best factor (cutoff value of 2.15, sensitivity of 88.5% and specificity of 68.0% for 3-year survival). CONCLUSION Metabolic parameters derived from 2-[18F]FDG PET/CT are valuable tools for the prediction of 3- and 5-year OS rates in metastatic melanoma patients undergoing immunotherapy. The 3-month follow-up 2-[18F]FDG PET/CT is of particular importance in this regard.
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Affiliation(s)
- Gregor Schweighofer-Zwink
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Reyhaneh Manafi-Farid
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical sciences, 1411713135 Tehran, Iran
| | - Peter Kölblinger
- Department of Dermatology, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Lukas Hehenwarter
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Sara Harsini
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical sciences, 1411713135 Tehran, Iran; Association of Nuclear Medicine and Molecular Imaging (ANMMI), Universal Scientific Education and Research Network (USERN), 1419733151 Tehran, Iran
| | - Christian Pirich
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria.
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Cerezo-Wallis D, Contreras-Alcalde M, Troulé K, Catena X, Mucientes C, Calvo TG, Cañón E, Tejedo C, Pennacchi PC, Hogan S, Kölblinger P, Tejero H, Chen AX, Ibarz N, Graña-Castro O, Martinez L, Muñoz J, Ortiz-Romero P, Rodriguez-Peralto JL, Gómez-López G, Al-Shahrour F, Rabadán R, Levesque MP, Olmeda D, Soengas MS. Midkine rewires the melanoma microenvironment toward a tolerogenic and immune-resistant state. Nat Med 2020; 26:1865-1877. [PMID: 33077955 DOI: 10.1038/s41591-020-1073-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/20/2020] [Indexed: 12/14/2022]
Abstract
An open question in aggressive cancers such as melanoma is how malignant cells can shift the immune system to pro-tumorigenic functions. Here we identify midkine (MDK) as a melanoma-secreted driver of an inflamed, but immune evasive, microenvironment that defines poor patient prognosis and resistance to immune checkpoint blockade. Mechanistically, MDK was found to control the transcriptome of melanoma cells, allowing for coordinated activation of nuclear factor-κB and downregulation of interferon-associated pathways. The resulting MDK-modulated secretome educated macrophages towards tolerant phenotypes that promoted CD8+ T cell dysfunction. In contrast, genetic targeting of MDK sensitized melanoma cells to anti-PD-1/anti-PD-L1 treatment. Emphasizing the translational relevance of these findings, the expression profile of MDK-depleted tumors was enriched in key indicators of a good response to immune checkpoint blockers in independent patient cohorts. Together, these data reveal that MDK acts as an internal modulator of autocrine and paracrine signals that maintain immune suppression in aggressive melanomas.
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Affiliation(s)
- Daniela Cerezo-Wallis
- Melanoma Laboratory, Molecular Oncology Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Marta Contreras-Alcalde
- Melanoma Laboratory, Molecular Oncology Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Kevin Troulé
- Bioinformatics Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Xavier Catena
- Melanoma Laboratory, Molecular Oncology Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Cynthia Mucientes
- Melanoma Laboratory, Molecular Oncology Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Tonantzin G Calvo
- Melanoma Laboratory, Molecular Oncology Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Estela Cañón
- Melanoma Laboratory, Molecular Oncology Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Cristina Tejedo
- Melanoma Laboratory, Molecular Oncology Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Paula C Pennacchi
- Melanoma Laboratory, Molecular Oncology Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Sabrina Hogan
- Department of Dermatology, University of Zurich Hospital, Zurich, Switzerland
| | - Peter Kölblinger
- Department of Dermatology, University of Zurich Hospital, Zurich, Switzerland
| | - Héctor Tejero
- Bioinformatics Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Andrew X Chen
- Program for Mathematical Genomics, Departament of Systems Biology, Departament of Biomedical Informatics, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Nuria Ibarz
- Proteomics Unit, Biotechnology Programme, Spanish National Cancer Research Centre (CNIO) and ProteoRed-ISCIII, Madrid, Madrid, Spain
| | - Osvaldo Graña-Castro
- Bioinformatics Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Lola Martinez
- Proteomics Unit, Biotechnology Programme, Spanish National Cancer Research Centre (CNIO) and ProteoRed-ISCIII, Madrid, Madrid, Spain
| | - Javier Muñoz
- Flow Cytometry Unit, Biotechnology Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Madrid, Spain
| | - Pablo Ortiz-Romero
- Dermatology Service, Hospital 12 de Octubre, Universidad Complutense Madrid Medical School, Madrid, Spain
| | - José L Rodriguez-Peralto
- Instituto de Investigación i+12, Hospital 12 de Octubre, Universidad Complutense Madrid Medical School, Madrid, Spain.,Pathology Service, Hospital 12 de Octubre, Universidad Complutense Madrid Medical School, Madrid, Spain
| | - Gonzalo Gómez-López
- Bioinformatics Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Fátima Al-Shahrour
- Bioinformatics Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Raúl Rabadán
- Program for Mathematical Genomics, Departament of Systems Biology, Departament of Biomedical Informatics, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Mitchell P Levesque
- Department of Dermatology, University of Zurich Hospital, Zurich, Switzerland
| | - David Olmeda
- Melanoma Laboratory, Molecular Oncology Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain.
| | - María S Soengas
- Melanoma Laboratory, Molecular Oncology Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain.
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6
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Harrer A, Lang R, Kölblinger P. Epitope competition and neutralizing antidrug antibodies: immune monitoring of antiprogrammed death‐1 therapies and lessons learned from natalizumab. Br J Dermatol 2020; 183:404. [DOI: 10.1111/bjd.19137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A. Harrer
- Department of Dermatology and Allergology Paracelsus Medical University Salzburg Austria
- Department of Neurology Paracelsus Medical University Salzburg Austria
| | - R. Lang
- Department of Dermatology and Allergology Paracelsus Medical University Salzburg Austria
| | - P. Kölblinger
- Department of Dermatology and Allergology Paracelsus Medical University Salzburg Austria
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7
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Clocchiatti A, Ghosh S, Procopio MG, Mazzeo L, Bordignon P, Ostano P, Goruppi S, Bottoni G, Katarkar A, Levesque M, Kölblinger P, Dummer R, Neel V, Özdemir BC, Dotto GP. Androgen receptor functions as transcriptional repressor of cancer-associated fibroblast activation. J Clin Invest 2018; 128:5531-5548. [PMID: 30395538 DOI: 10.1172/jci99159] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 09/26/2018] [Indexed: 01/16/2023] Open
Abstract
The aging-associated increase of cancer risk is linked with stromal fibroblast senescence and concomitant cancer-associated fibroblast (CAF) activation. Surprisingly little is known about the role of androgen receptor (AR) signaling in this context. We have found downmodulated AR expression in dermal fibroblasts underlying premalignant skin cancer lesions (actinic keratoses and dysplastic nevi) as well as in CAFs from the 3 major skin cancer types, squamous cell carcinomas (SCCs), basal cell carcinomas, and melanomas. Functionally, decreased AR expression in primary human dermal fibroblasts (HDFs) from multiple individuals induced early steps of CAF activation, and in an orthotopic skin cancer model, AR loss in HDFs enhanced tumorigenicity of SCC and melanoma cells. Forming a complex, AR converged with CSL/RBP-Jκ in transcriptional repression of key CAF effector genes. AR and CSL were positive determinants of each other's expression, with BET inhibitors, which counteract the effects of decreased CSL, restoring AR expression and activity in CAFs. Increased AR expression in these cells overcame the consequences of CSL loss and was by itself sufficient to block the growth and tumor-enhancing effects of CAFs on neighboring cancer cells. As such, the findings establish AR as a target for stroma-focused cancer chemoprevention and treatment.
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Affiliation(s)
- Andrea Clocchiatti
- Cutaneous Biology Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA
| | - Soumitra Ghosh
- Department of Biochemistry, University of Lausanne, Epalinges, Switzerland
| | | | - Luigi Mazzeo
- Department of Biochemistry, University of Lausanne, Epalinges, Switzerland
| | - Pino Bordignon
- Department of Biochemistry, University of Lausanne, Epalinges, Switzerland
| | - Paola Ostano
- Cancer Genomics Laboratory, Edo and Elvo Tempia Valenta Foundation, Biella, Italy
| | - Sandro Goruppi
- Cutaneous Biology Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA
| | - Giulia Bottoni
- Cutaneous Biology Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Atul Katarkar
- Department of Biochemistry, University of Lausanne, Epalinges, Switzerland
| | - Mitchell Levesque
- Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - Peter Kölblinger
- Department of Dermatology, University Hospital Zürich, Zürich, Switzerland.,Department of Dermatology, Paracelsus Medical University, Salzburg, Austria
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - Victor Neel
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Berna C Özdemir
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,International Cancer Prevention Institute, Epalinges, Switzerland
| | - G Paolo Dotto
- Cutaneous Biology Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Biochemistry, University of Lausanne, Epalinges, Switzerland.,International Cancer Prevention Institute, Epalinges, Switzerland
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8
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Kölblinger P, Lang R, Hintner H, Laimer M. Blasenbildende Dermatose bei einem fünf Monate alten Säugling. J Dtsch Dermatol Ges 2014. [DOI: 10.1111/ddg.12318_suppl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Peter Kölblinger
- Universitätsklinik für Dermatologie; Paracelsus Medizinische Privatuniversität; Salzburg Österreich
| | - Roland Lang
- Universitätsklinik für Dermatologie; Paracelsus Medizinische Privatuniversität; Salzburg Österreich
| | - Helmut Hintner
- Universitätsklinik für Dermatologie; Paracelsus Medizinische Privatuniversität; Salzburg Österreich
| | - Martin Laimer
- Universitätsklinik für Dermatologie; Paracelsus Medizinische Privatuniversität; Salzburg Österreich
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9
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Affiliation(s)
- Peter Kölblinger
- Universitätsklinik für Dermatologie; Paracelsus Medizinische Privatuniversität; Salzburg Austria
| | - Roland Lang
- Universitätsklinik für Dermatologie; Paracelsus Medizinische Privatuniversität; Salzburg Austria
| | - Helmut Hintner
- Universitätsklinik für Dermatologie; Paracelsus Medizinische Privatuniversität; Salzburg Austria
| | - Martin Laimer
- Universitätsklinik für Dermatologie; Paracelsus Medizinische Privatuniversität; Salzburg Austria
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