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Lodde GC, Hassel J, Wulfken LM, Meier F, Mohr P, Kähler K, Hauschild A, Schilling B, Loquai C, Berking C, Hüning S, Eckardt J, Gutzmer R, Reinhardt L, Glutsch V, Nikfarjam U, Erdmann M, Beckmann CL, Stang A, Kowall B, Galetzka W, Roesch A, Ugurel S, Zimmer L, Schadendorf D, Forschner A, Livingstone E. Adjuvant treatment and outcome of stage III melanoma patients: Results of a multicenter real-world German Dermatologic Cooperative Oncology Group (DeCOG) study. Eur J Cancer 2023; 191:112957. [PMID: 37487400 DOI: 10.1016/j.ejca.2023.112957] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE Clinical trials demonstrated significantly improved recurrence-free survival (RFS) of melanoma patients receiving adjuvant treatment. As data from controlled trials are based on selected populations, we investigated adjuvantly treated stage III melanoma patients under real-world conditions. PATIENTS AND METHODS In a prior multicenter cohort study, stage III-IV melanoma patients were analysed for their choice of adjuvant therapy. In this follow-up study, we examined RFS, overall and melanoma-specific survival (MSS) and response to the subsequent treatment of 589 stage III patients (232 BRAF-mutated) receiving adjuvant PD-1 inhibitors (PD1; n = 479) or targeted therapy (TT; n = 110). RESULTS The median follow-up of the total cohort was 25.7 months. The main reason for premature discontinuation of adjuvant therapy was disease progression in PD1- (28.8%, n = 138/479) and adverse events in TT-treated patients (28.2%, n = 31/110). Among BRAF-mutated patients, RFS at 24 months was 49% (95% CI 40.6-59.0%) for PD1- and 67% (95% CI 58-77%) for TT-treated patients. The risk of recurrence was higher for BRAF-mutated PD1 than TT (hazard ratio 1.99; 95% CI 1.34-2.96; hazard ratio adjusted for age, sex and tumour stage, 2.21; 95% CI 1.48-3.30). Twenty-four months MSS was 87% (95% CI 81.0-94.1) for PD1 and 92% (95% CI 86.6-97.0) for TT. Response to subsequent systemic treatment for unresectable disease was 22% for all PD1- and 16% for TT-treated patients. CONCLUSIONS PD1-treated patients had more and earlier recurrences than TT patients. In BRAF-mutated patients, adjuvant TT might prevent early recurrences more effectively than PD1 treatment. Management of recurrence despite adjuvant treatment is challenging, with low response to current therapeutic options.
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Affiliation(s)
- Georg C Lodde
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Northrhine-Westphalia, Germany
| | - Jessica Hassel
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Lena M Wulfken
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Venereology and Allergology, University Hospital Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Friedegund Meier
- Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Dresden, Department of Dermatology, University Hospital Carl Gustav Carus, TU, Dresden, Saxony, Germany
| | - Peter Mohr
- Department of Dermatology, Elbe Kliniken Stade-Buxtehude, Buxtehude, Niedersachsen, Germany
| | - Katharina Kähler
- Department of Dermatology, Venereology and Allergology, University Hospital Kiel, Kiel, Schleswig Holstein, Germany
| | - Axel Hauschild
- Department of Dermatology, Venereology and Allergology, University Hospital Kiel, Kiel, Schleswig Holstein, Germany
| | - Bastian Schilling
- Department of Dermatology, Venereology and Allergology, University Hospital Wuerzburg, Wuerzburg, Bavaria, Germany
| | - Carmen Loquai
- Department of Dermatology, University Hospital Mainz, Mainz, Rhineland Palatinate, Germany
| | - Carola Berking
- Department of Dermatology, Universitätsklinikum Erlangen, CCC-Comprehensive Cancer Center Erlangen-EMN, Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Deutsches Zentrum Immuntherapie (DZI), Erlangen, Bavaria, Germany
| | - Svea Hüning
- Department of Dermatology, Klinikum Dortmund gGmbH, Dortmund, Northrhine-Westphalia, Germany
| | - Julia Eckardt
- Department of Dermatology, University Hospital Tuebingen, Tuebingen, Baden-Württemberg, Germany
| | - Ralf Gutzmer
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Venereology and Allergology, University Hospital Hannover Medical School, Hannover, Niedersachsen, Germany; Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Niedersachsen, Germany
| | - Lydia Reinhardt
- Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Dresden, Department of Dermatology, University Hospital Carl Gustav Carus, TU, Dresden, Saxony, Germany
| | - Valerie Glutsch
- Department of Dermatology, Venereology and Allergology, University Hospital Wuerzburg, Wuerzburg, Bavaria, Germany
| | - Ulrike Nikfarjam
- Department of Dermatology, University Hospital Mainz, Mainz, Rhineland Palatinate, Germany
| | - Michael Erdmann
- Department of Dermatology, Universitätsklinikum Erlangen, CCC-Comprehensive Cancer Center Erlangen-EMN, Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Deutsches Zentrum Immuntherapie (DZI), Erlangen, Bavaria, Germany
| | - Catharina L Beckmann
- Department of Computer Science, University of Applied Sciences and Arts Dortmund (FH Dortmund), Dortmund, Northrhine-Westphalia, Germany
| | - Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Northrhine-Westphalia, Germany
| | - Bernd Kowall
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Northrhine-Westphalia, Germany
| | - Wolfgang Galetzka
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Northrhine-Westphalia, Germany
| | - Alexander Roesch
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Northrhine-Westphalia, Germany; German Consortium for Translational Cancer Research (DKTK), Partner Site Essen and German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg, Germany
| | - Selma Ugurel
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Northrhine-Westphalia, Germany; German Consortium for Translational Cancer Research (DKTK), Partner Site Essen and German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg, Germany
| | - Lisa Zimmer
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Northrhine-Westphalia, Germany
| | - Dirk Schadendorf
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Northrhine-Westphalia, Germany; German Consortium for Translational Cancer Research (DKTK), Partner Site Essen and German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg, Germany; NCT-West, Campus Essen and University Alliance Ruhr, Research Center One Health, Essen, Northrhine-Westphalia, Germany
| | - Andrea Forschner
- Department of Dermatology, University Hospital Tuebingen, Tuebingen, Baden-Württemberg, Germany
| | - Elisabeth Livingstone
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Northrhine-Westphalia, Germany.
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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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Nikfarjam U, Wegner J, Grabbe S, Schepler H, Juchems E. Die Bedeutung des gepulsten Farbstofflasers bei der Behandlung akraler infantiler Hämangiome. J Dtsch Dermatol Ges 2022; 20:95-101. [PMID: 35040573 DOI: 10.1111/ddg.14635_g] [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: 12/01/2022]
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Nikfarjam U, Grabbe S, Butsch F. [Snake bite of western hognose snake (Heterodon nasicus)]. Hautarzt 2021; 73:718-721. [PMID: 34860256 PMCID: PMC9427898 DOI: 10.1007/s00105-021-04923-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/27/2022]
Abstract
Es gibt bisher wenige beschriebene Fälle von Bissen durch die Hakennasennatter (Heterodon nasicus), die meist zu einer Lokalreaktion führten. Wir berichten über eine ausgeprägte Lokalreaktion nach dem Biss einer als Haustier gehaltenen Hakennasennatter (Heterodon nasicus). Eine antiseptische Lokaltherapie und Antibiose zur Infektionsprophylaxe sind zu empfehlen, ebenfalls Laborkontrollen zum Ausschluss einer systemischen Beteiligung. An die Überprüfung des Tetanusschutzes sollte gedacht werden.
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Affiliation(s)
- Ulrike Nikfarjam
- Hautklinik der Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - Stephan Grabbe
- Hautklinik der Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Florian Butsch
- Hautklinik der Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
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Nikfarjam U, Wegner J, Grabbe S, Schepler H, Juchems E. Significance of the pulsed dye laser in treatment of acral infantile hemangioma. J Dtsch Dermatol Ges 2021; 20:97-101. [PMID: 34850561 DOI: 10.1111/ddg.14635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ulrike Nikfarjam
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Joanna Wegner
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Hadrian Schepler
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Eva Juchems
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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Stege H, Haist M, Nikfarjam U, Schultheis M, Heinz J, Pemler S, Loquai C, Grabbe S. The Status of Adjuvant and Neoadjuvant Melanoma Therapy, New Developments and Upcoming Challenges. Target Oncol 2021; 16:537-552. [PMID: 34554353 PMCID: PMC8484171 DOI: 10.1007/s11523-021-00840-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 12/14/2022]
Abstract
The global incidence of malignant melanoma, the leading cause of skin cancer death, has steadily increased in recent years. Surgical excision is the treatment of choice for early-stage melanoma. However, 40-60% of patients with high-risk melanoma or with nodal involvement eventually experience loco-regional relapse or tumor progression. Adjuvant therapy aims to reduce the rate of recurrence in radically operated high-risk patients with melanoma and thus improves survival. Interferon-α has long been the only approved drug for adjuvant melanoma therapy, despite an unclear survival benefit. The landmark success of immune-checkpoint inhibitors and BRAF/MEK-directed targeted therapies in the treatment of patients with stage IV melanoma led to the initiation of clinical trials in the adjuvant setting. These trials demonstrated the efficacy of immune-checkpoint inhibitors and targeted therapies for the adjuvant treatment of high-risk patients with melanoma, as shown both by an increase in recurrence-free survival and the emergence of long-term survivors, finally resulting in the approval of the cytotoxic T-lymphocyte antigen 4 inhibitor ipilimumab, PD1 inhibitors (nivolumab, pembrolizumab), and BRAF/MEK inhibitors for adjuvant melanoma therapy. This review aims to delineate the advances in adjuvant melanoma therapy, issuing particularly recent results from clinical trials. Moreover, we also discuss pending issues and future challenges, which comprise the adequate selection of adjuvant regimens for patient subgroups and the identification of markers likely to predict the individual response to adjuvant treatments. Last, we outline the role of emerging neoadjuvant approaches, which may complement adjuvant strategies and are currently investigated in clinical trials.
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Affiliation(s)
- Henner Stege
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
| | - Maximilian Haist
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Ulrike Nikfarjam
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Michael Schultheis
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Jaqueline Heinz
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Saskia Pemler
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Carmen Loquai
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Lodde G, Forschner A, Hassel J, Wulfken LM, Meier F, Mohr P, Kähler K, Schilling B, Loquai C, Berking C, Hüning S, Schatton K, Gebhardt C, Eckardt J, Gutzmer R, Reinhardt L, Glutsch V, Nikfarjam U, Erdmann M, Stang A, Kowall B, Roesch A, Ugurel S, Zimmer L, Schadendorf D, Livingstone E. Factors Influencing the Adjuvant Therapy Decision: Results of a Real-World Multicenter Data Analysis of 904 Melanoma Patients. Cancers (Basel) 2021; 13:2319. [PMID: 34065995 PMCID: PMC8151445 DOI: 10.3390/cancers13102319] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022] Open
Abstract
Adjuvant treatment of melanoma patients with immune-checkpoint inhibition (ICI) and targeted therapy (TT) significantly improved recurrence-free survival. This study investigates the real-world situation of 904 patients from 13 German skin cancer centers with an indication for adjuvant treatment since the approval of adjuvant ICI and TT. From adjusted log-binomial regression models, we estimated relative risks for associations between various influence factors and treatment decisions (adjuvant therapy yes/no, TT vs. ICI in BRAF mutant patients). Of these patients, 76.9% (95% CI 74-80) opted for a systemic adjuvant treatment. The probability of starting an adjuvant treatment was 26% lower in patients >65 years (RR 0.74, 95% CI 68-80). The most common reasons against adjuvant treatment given by patients were age (29.4%, 95% CI 24-38), and fear of adverse events (21.1%, 95% CI 16-28) and impaired quality of life (11.9%, 95% CI 7-16). Of all BRAF-mutated patients who opted for adjuvant treatment, 52.9% (95% CI 47-59) decided for ICI. Treatment decision for TT or ICI was barely associated with age, gender and tumor stage, but with comorbidities and affiliated center. Shortly after their approval, adjuvant treatments have been well accepted by physicians and patients. Age plays a decisive role in the decision for adjuvant treatment, while pre-existing autoimmune disease and regional differences influence the choice between TT or ICI.
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Affiliation(s)
- Georg Lodde
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, 45147 Essen, Germany; (G.L.); (A.R.); (S.U.); (L.Z.); (D.S.)
| | - Andrea Forschner
- Department of Dermatology, University Hospital Tuebingen, 72076 Tuebingen, Germany; (A.F.); (J.E.)
| | - Jessica Hassel
- Department of Dermatology, University Hospital Heidelberg, 69120 Heidelberg, Germany;
| | - Lena M. Wulfken
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Venereology and Allergology, University Hospital Hannover Medical School, 30625 Hannover, Germany; (L.M.W.); (R.G.)
| | - Friedegund Meier
- Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, 01307 Dresden, Germany; (F.M.); (L.R.)
| | - Peter Mohr
- Department of Dermatology, Elbe Kliniken Stade-Buxtehude, 21614 Buxtehude, Germany;
| | - Katharina Kähler
- Department of Dermatology, Venereology and Allergology, University Hospital Kiel, 24105 Kiel, Germany;
| | - Bastian Schilling
- Department of Dermatology, Venereology and Allergology, University Hospital Wuerzburg, 97080 Wuerzburg, Germany; (B.S.); (V.G.)
| | - Carmen Loquai
- Department of Dermatology, University Hospital Mainz, 55131 Mainz, Germany; (C.L.); (U.N.)
| | - Carola Berking
- Department of Dermatology, University Hospital Erlangen, CCC-Comprehensive Cancer Center Erlangen-EMN, Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Deutsches Zentrum Immuntherapie (DZI), 91054 Erlangen, Germany; (C.B.); (M.E.)
| | - Svea Hüning
- Department of Dermatology, Klinikum Dortmund gGmbH, 44137 Dortmund, Germany;
| | - Kerstin Schatton
- Department of Dermatology, Medical Faculty, Heinrich Heine University, 40225 Düsseldorf, Germany;
| | - Christoffer Gebhardt
- Department of Dermatology, Venereology and Allergology, University Hospital Hamburg, 20246 Hamburg, Germany;
| | - Julia Eckardt
- Department of Dermatology, University Hospital Tuebingen, 72076 Tuebingen, Germany; (A.F.); (J.E.)
| | - Ralf Gutzmer
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Venereology and Allergology, University Hospital Hannover Medical School, 30625 Hannover, Germany; (L.M.W.); (R.G.)
| | - Lydia Reinhardt
- Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, 01307 Dresden, Germany; (F.M.); (L.R.)
| | - Valerie Glutsch
- Department of Dermatology, Venereology and Allergology, University Hospital Wuerzburg, 97080 Wuerzburg, Germany; (B.S.); (V.G.)
| | - Ulrike Nikfarjam
- Department of Dermatology, University Hospital Mainz, 55131 Mainz, Germany; (C.L.); (U.N.)
| | - Michael Erdmann
- Department of Dermatology, University Hospital Erlangen, CCC-Comprehensive Cancer Center Erlangen-EMN, Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Deutsches Zentrum Immuntherapie (DZI), 91054 Erlangen, Germany; (C.B.); (M.E.)
| | - Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, 45122 Essen, Germany; (A.S.); (B.K.)
| | - Bernd Kowall
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, 45122 Essen, Germany; (A.S.); (B.K.)
| | - Alexander Roesch
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, 45147 Essen, Germany; (G.L.); (A.R.); (S.U.); (L.Z.); (D.S.)
- German Consortium for Translational Cancer Research (DKTK), Partner Site Essen and German Cancer Research Center (DKFZ), 45147 Essen, Germany
| | - Selma Ugurel
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, 45147 Essen, Germany; (G.L.); (A.R.); (S.U.); (L.Z.); (D.S.)
| | - Lisa Zimmer
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, 45147 Essen, Germany; (G.L.); (A.R.); (S.U.); (L.Z.); (D.S.)
| | - Dirk Schadendorf
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, 45147 Essen, Germany; (G.L.); (A.R.); (S.U.); (L.Z.); (D.S.)
- German Consortium for Translational Cancer Research (DKTK), Partner Site Essen and German Cancer Research Center (DKFZ), 45147 Essen, Germany
| | - Elisabeth Livingstone
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, 45147 Essen, Germany; (G.L.); (A.R.); (S.U.); (L.Z.); (D.S.)
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Nikfarjam U, Wegner J, Grabbe S, Staubach P. Grüntee‐Extrakt als erfolgreiche topische Behandlungsoption bei Kindern mit Condylomata acuminata im Perianalbereich. J Dtsch Dermatol Ges 2021; 19:113-115. [PMID: 33491885 DOI: 10.1111/ddg.14173_g] [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: 11/30/2022]
Affiliation(s)
- Ulrike Nikfarjam
- Hautklinik, Universitätsmedizin der Johannes Gutenberg--Universität Mainz
| | - Joanna Wegner
- Hautklinik, Universitätsmedizin der Johannes Gutenberg--Universität Mainz
| | - Stephan Grabbe
- Hautklinik, Universitätsmedizin der Johannes Gutenberg--Universität Mainz
| | - Petra Staubach
- Hautklinik, Universitätsmedizin der Johannes Gutenberg--Universität Mainz
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Nikfarjam U, Wegner J, Grabbe S, Staubach P. Green tea extract as a successful topical treatment option in children with perianal condylomata. J Dtsch Dermatol Ges 2020; 19:113-115. [PMID: 32666694 DOI: 10.1111/ddg.14173] [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: 11/27/2022]
Affiliation(s)
- Ulrike Nikfarjam
- Department of Dermatology, University Medical Center Mainz, Germany
| | - Joanna Wegner
- Department of Dermatology, University Medical Center Mainz, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center Mainz, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Center Mainz, Germany
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