1
|
Rajagopal S, Yao X, Abadir W, Baetz TD, Easson AM, Knight G, McWhirter E, Nessim C, Rosen CF, Sun A, Wright FC, Petrella TM. An Ontario Health (Cancer Care Ontario) Clinical Practice Guideline: Surveillance Strategies in Patients with Stage I, II, III or Resectable IV Melanoma Who Were Treated with Curative Intent. Clin Oncol (R Coll Radiol) 2024; 36:243-253. [PMID: 38336503 DOI: 10.1016/j.clon.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/20/2023] [Accepted: 01/15/2024] [Indexed: 02/12/2024]
Abstract
AIMS To make recommendations on managing the surveillance of patients with stage I, II, III or resectable IV melanoma who are clinically free of disease following treatment with curative intent. MATERIALS AND METHODS This guideline was developed by Ontario Health's (Cancer Care Ontario's) Program in Evidence-Based Care and the Melanoma Disease Site Group (including seven medical oncologists, four surgical oncologists, three dermatologists, one radiation oncologist and one patient representative). The MEDLINE, EMBASE, Cochrane Library, PROSPERO databases and the main relevant guideline websites were searched. Internal and external reviews were conducted, with final approval by the Program in Evidence-Based Care and the Melanoma Disease Site Group. The Grading of Recommendations, Assessment, Development and Evaluation approach was followed, and the Modified Delphi method was used. RESULTS Based on the current evidence (eight eligible original study papers and four relevant guidelines) and the clinical opinions of the authors of this guideline, the initial recommendations were made. To reach 75% agreement for each recommendation, the Melanoma Disease Site Group (16 members) voted twice and one recommendation was voted on three times. After a comprehensive internal and external review process (including national and international reviewers), 12 recommendations, three weak recommendations and six qualified statements were ultimately made. CONCLUSIONS After a systematic review, a comprehensive internal and external review process and a consensus process, the current guideline has been created. The guideline authors believe that this guideline will help clinicians, patients and policymakers make well-informed healthcare decisions that will guide them in clinical melanoma surveillance and ultimately assist in improving patient outcomes.
Collapse
Affiliation(s)
- S Rajagopal
- Trillium Health Partners, Credit Valley Hospital, Peel Regional Cancer Centre, Mississauga, Ontario, Canada.
| | - X Yao
- Department of Oncology, Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Program in Evidence-Based Care, Ontario Health (Cancer Care Ontario), Hamilton, Ontario, Canada.
| | - W Abadir
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - T D Baetz
- Cancer Centre of Southeastern Ontario, Queen's Cancer Research Institute, Kingston, Ontario, Canada
| | - A M Easson
- Department of Surgery, Marvelle Koffler Breast Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - G Knight
- Department of Oncology, Grand River Regional Cancer Centre, Grand River Hospital, Kitchener, Ontario, Canada
| | - E McWhirter
- Department of Medical Oncology, Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - C Nessim
- Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - C F Rosen
- Division of Dermatology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - A Sun
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - F C Wright
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - T M Petrella
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
| |
Collapse
|
2
|
Petrella TM, Fletcher GG, Knight G, McWhirter E, Rajagopal S, Song X, Baetz TD. Systemic adjuvant therapy for adult patients at high risk for recurrent cutaneous or mucosal melanoma: an Ontario Health (Cancer Care Ontario) clinical practice guideline. Curr Oncol 2020; 27:e43-e52. [PMID: 32218667 PMCID: PMC7096195 DOI: 10.3747/co.27.5933] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Indexed: 02/07/2023] Open
Abstract
Background Previous versions of the guideline from the Program in Evidence-Based Care (pebc) at Ontario Health (Cancer Care Ontario) recommended that the use of high-dose interferon alfa 2b therapy be discussed and offered to patients with resected cutaneous melanoma with a high risk of recurrence. Subsequently, several clinical trials in patients with resected or metastatic melanoma found that immune checkpoint inhibitors and targeted therapies have a benefit greater than that with interferon. It was therefore considered timely for an update to the guideline about adjuvant systemic therapy in melanoma. Methods The present guideline was developed by the pebc and the Melanoma Disease Site Group (dsg). Based on a systematic review from a literature search conducted using medline, embase, and the Evidence Based Medicine Reviews databases for the period 1996 to 28 May 2019, the Working Group drafted recommendations. The systematic review and recommendations were then circulated to the Melanoma dsg and the pebc Report Approval Panel for internal review; the revised document underwent external review. Recommendations For patients with completely resected cutaneous or mucosal melanoma with a high risk of recurrence, the recommended adjuvant therapies are nivolumab, pembrolizumab, or dabrafenib-trametinib for patients with BRAF V600E or V600K mutations; nivolumab or pembrolizumab are recommend for patients with BRAF wild-type disease. Use of ipilimumab is not recommended. Molecular testing should be conducted to help guide treatment decisions. Interferon alfa, chemotherapy regimens, vaccines, levamisole, bevacizumab, bacillus Calmette-Guérin, and isolated limb perfusion are not recommended for adjuvant treatment of cutaneous melanoma except as part of a clinical trial.
Collapse
Affiliation(s)
- T M Petrella
- University of Toronto and Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
| | - G G Fletcher
- Program in Evidence-Based Care, Ontario Health (Cancer Care Ontario), and Department of Oncology, McMaster University, Hamilton, ON
| | - G Knight
- Department of Oncology, McMaster University, Hamilton, and Grand River Regional Cancer Centre, Kitchener, ON
| | - E McWhirter
- Department of Oncology, Division of Medical Oncology, McMaster University, and Juravinski Cancer Centre, Hamilton, ON
| | | | - X Song
- Department of Internal Medicine, Division of Medical Oncology, University of Ottawa, and The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - T D Baetz
- Department of Oncology, Queen's University, and Cancer Centre of Southeastern Ontario-Kingston General Hospital, Kingston, ON
| |
Collapse
|
3
|
Altwairgi AK, Booth C, Hopman W, Baetz TD. Discordance between conclusions in the abstract and conclusions stated in the body of the article: An analysis of randomized controlled trials (RCTs) of lung cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.6046] [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
|
4
|
Tsvetkova EV, Chapman JW, Baetz TD, Burnell MJ, Gelmon KA, Pu N, O'Brien P, Shepherd LE, Goodwin PJ. Characterization of 25-OH vitamin D (Vit D) and factors associated with obesity in patients with high-risk breast cancer (BC): NCIC CTG MA.21. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1578] [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
|