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Rim CH, Lee JS, Kim SY, Seong J. Comparison of radiofrequency ablation and ablative external radiotherapy for the treatment of intrahepatic malignancies: A hybrid meta-analysis. JHEP Rep 2023; 5:100594. [PMID: 36561128 DOI: 10.1016/j.jhepr.2022.100594] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 02/01/2023] Open
Abstract
Background & Aims Radiofrequency ablation (RFA) and ablative external beam radiotherapy (ablative RT) are commonly used to treat small intrahepatic malignancies. We meta-analysed oncologic outcomes and systematically reviewed the clinical consideration of tumour location and size. Methods PubMed, Medline, Embase, and Cochrane Library databases were searched on February 24, 2022. Studies comparing RFA and ablative RT, providing one of the endpoints (local control or survival), and encompassing ≥5 patients in each arm were included. Results Twenty-one studies involving 4,638 patients were included. Regarding survival, the odds ratio (OR) was 1.204 (p = 0.194, favouring RFA, not statistically significant) among all studies, 1.253 (p = 0.153) among hepatocellular carcinoma (HCC) studies, and 1.002 (p = 0.996) among colorectal cancer metastasis studies. Regarding local control, the OR was 0.458 (p <0.001, favouring ablative RT) among all studies, 0.452 (p <0.001) among HCC studies, favouring the ablative RT arm, and 0.649 (p = 0.484) among colorectal cancer metastasis studies. Pooled 1- and 2-year survival rates for HCC studies were 91.8% and 77.7% after RFA, and 89.0% and 76.0% after ablative RT, respectively; and for metastasis studies were 88.2% and 66.4% after RFA and 82.7% and 60.6% after RT, respectively. Literature analysis suggests that ablative RT can be more effective than RFA for tumours larger than 2-3 cm or for specific sublocations in the liver (e.g. subphrenic or perivascular sites), with moderate quality of evidence (reference to the grading system of the American Society for Radiation Oncology Primary Liver Cancer Clinical Guidelines). The pooled grade ≥3 complication rates were 2.9% and 2.8% in the RFA and ablative RT arms, respectively (p = 0.952). Conclusions Our study shows that ablative RT can yield oncologic outcomes similar to RFA, and suggests that it can be more effective for the treatment of tumours in locations where RFA is difficult to perform or for large-sized tumours. Systematic Review Registration This study was registered with PROSPERO (Protocol No: CRD42022332997). Impact and implications Radiofrequency ablation (RFA) and ablative radiotherapy (RT) are non-surgical modalities for the treatment of small intrahepatic malignancies. Ablative RT showed oncologic outcomes at least similar to those of RFA, and was more effective at specific locations (e.g. perivascular or subphrenic locations).
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Key Words
- ASCO, American Society of Clinical Oncology
- ASTRO, American Society for Radiation Oncology
- CIRSE, cardiovascular and interventional radiological society of Europe
- CRC, colorectal cancer
- EBRT, external beam radiation therapy
- EQD2, Equivalent dose, 2 Gy per Fraction
- External beam radiation therapy
- HCC, hepatocellular carcinoma
- HFRT, hypofractionated radiotherapy
- IPTW, inverse probability of treatment weighting
- Intrahepatic malignancy
- LC, local control
- LT, liver transplantation
- Liver cancer
- MWA, microwave ablation
- NCDB, national cancer database
- OS, overall survival
- P, prospective
- PBT, proton beam therapy
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- PSM, propensity score matching
- R, retrospective
- RCT, randomised controlled trial
- RFA, radiofrequency ablation
- RT, radiotherapy
- Radiofrequency ablation
- SBRT, stereotactic body radiotherapy
- TACE, transarterial chemoembolisation
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Lak E, Mohammadi MJ, Yousefi H. Impact of COVID-19 acute respiratory disease on the risk factors attributed to cancer patients. Toxicol Rep 2021; 9:46-52. [PMID: 34934636 PMCID: PMC8674635 DOI: 10.1016/j.toxrep.2021.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/28/2021] [Revised: 11/26/2021] [Accepted: 12/15/2021] [Indexed: 12/13/2022] Open
Abstract
Communicable diseases (CDs) based on Health organization reported are one of the most threat for human health. SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is the main pandemic that nowadays it threatens the health of people around the world, especially cancer patients. The purpose of this study was to investigate the effects of COVID-19 acute respiratory disease (COVID-19 ARD) on risk factors related to health of cancer patients. A review study of was conducted to base on results of various studies published. Nine hundred and eighty articles were retrieved based on various databases: Science Direct, Taylor & Francis, Google Scholar, Elsevier, PubMed and BMJ. In this study, were used the results of research on COVID-19 and its effects on risk factors attributed to cancer patients. The literature signs a notable undesirable affect from COVID-19 on risk factors attributed to health of cancer patients. Result showed that transfer SARS-CoV-2 viruses can endanger health of cancer patients due to interruption of the disease treatment process and increase number of deaths between in this patents. The survey requires the need to act creating healthy conditions to continue the treatment process and vaccination coverage among these patients in order to decrease the transmission of COVID-19 acute respiratory disease and increase the success rate of cancer treatment.
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Key Words
- AACR, American Association of Cancer Research
- ASCO, American Society of Clinical Oncology
- Acute respiratory disease
- CCC-19, COVID-19 and Cancer Consortium
- CDs, Communicable diseases
- COVID-19
- COVID-19 ARD, acute respiratory disease
- COVID-19, coronavirus disease 2019
- Cancer
- Communicable diseases
- ESCA, Esophageal carcinoma
- ESMO, European Society for Medical Oncology
- Health
- ICU, Intensive Care Unit
- KICH, Kidney Chromophobe
- KIRP, Kidney renal papillary cell carcinoma
- LUAD, Lung adenocarcinoma
- PCR, Real-time Polymerase Chain Reaction
- PRAD, Prostate adenocarcinoma
- Risk factors
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- UCEC, Uterine Corpus Endometrial Carcinoma
- WHO, World Health Organization
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Affiliation(s)
- Elena Lak
- Assistant Professor of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Javad Mohammadi
- Department of Environmental Health Engineering, School of Health AND Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Homayon Yousefi
- Assistant Professor of Pediatric Hematology and Oncology, Department of Internal Medicine, School of Medicine AND Thalassemia & Hemoglobinopathy Research center, Health research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Gervaso L, Dave H, Khorana AA. Venous and Arterial Thromboembolism in Patients With Cancer: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2021; 3:173-190. [PMID: 34396323 PMCID: PMC8352228 DOI: 10.1016/j.jaccao.2021.03.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [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: 11/18/2020] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 12/20/2022] Open
Abstract
Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, represents a major cause of morbidity and mortality in patients with cancer. Arterial thromboembolism, including myocardial infarction and stroke, is also prevalent. Risk differs in subgroups, with higher rates observed in specific cancers including pancreas, stomach, and multiple myeloma. Thromboprophylaxis is recommended for most patients with active cancer hospitalized for medical illnesses and after major cancer surgery. Outpatient thromboprophylaxis is not routinely recommended, but emerging data suggest that a high-risk population that benefits from pharmacological thromboprophylaxis can be identified using a validated risk tool. Direct oral anticoagulants are emerging as the preferred new option for the treatment of cancer-associated VTE, although low-molecular-weight heparin remains a standard for patients at high bleeding risk. Management of VTE beyond the first 6 months and challenging clinical situations including intracranial metastases and thrombocytopenia require careful management in balancing the benefits and risks of anticoagulation and remain major knowledge gaps in evidence.
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Key Words
- ASCO, American Society of Clinical Oncology
- ASH, American Society of Hematology
- AT, antithrombin
- ATE, arterial thromboembolism
- CAT, cancer-associated thrombosis
- CI, confidence interval
- CRNMB, clinically relevant nonmajor bleeding
- CVA, cerebrovascular event
- DOAC, direct oral anticoagulant
- DVT, deep venous thrombosis
- ESMO, European Society of Medical Oncology
- GI, gastrointestinal
- HR, hazard ratio
- ICH, intracranial hemorrhage
- ISTH, International Society on Thrombosis and Haemostasis
- KS, Khorana score
- LMWH, low-molecular-weight heparin
- MI, myocardial infarction
- MM, multiple myeloma
- NNT, number needed to treat
- PE, pulmonary embolism
- PPV, positive predictive value
- RAM, risk assessment model
- SPE, segmental pulmonary embolism
- SSC, Scientific and Standardization Committee
- SSPE, subsegmental pulmonary embolism
- UHF, unfractionated heparin
- VKA, vitamin K antagonist
- VTE, venous thromboembolism
- VVT, visceral vein thrombosis
- arterial thromboembolism
- cancer-associated thrombosis
- prophylaxis
- risk assessment models
- treatment
- venous thromboembolism
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Affiliation(s)
- Lorenzo Gervaso
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, Istituto Europeo di Oncologia, European Institute of Oncology, Milan, Italy
- Molecular Medicine Department, University of Pavia, Pavia, Italy
| | - Heloni Dave
- Maharaja Sayajirao University, Medical College, Vadodara, Gujarat, India
| | - Alok A. Khorana
- Taussig Cancer Institute and Case Comprehensive Cancer Center, Cleveland Clinic, Cleveland, Ohio, USA
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Papakonstantinou E, Stamatopoulos A, I Athanasiadis D, Kenanidis E, Potoupnis M, Haidich AB, Tsiridis E. Limb-salvage surgery offers better five-year survival rate than amputation in patients with limb osteosarcoma treated with neoadjuvant chemotherapy. A systematic review and meta-analysis. J Bone Oncol 2020; 25:100319. [PMID: 33088699 DOI: 10.1016/j.jbo.2020.100319] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/26/2020] [Accepted: 09/09/2020] [Indexed: 02/04/2023] Open
Abstract
Background Osteosarcoma is the most common primary bone sarcoma. Currently, the main treatment option for high-grade osteosarcomas is neoadjuvant chemotherapy, followed by surgical resection of the lesion and adjuvant chemotherapy. Limb salvage surgery (LSS) and amputation are the main surgical techniques; however, controversy still exists concerning the best surgical method. Our meta-analysis compared the effectiveness of LSS and amputation combined with neoadjuvant chemotherapy in patients with limb osteosarcoma, in terms of 5-year overall survival (OS), 5-year disease-free survival (DFS) and local recurrence rate. Methods Following the established methodology of PRISMA guidelines, a literature search was conducted in PubMed, Cochrane, Google Scholar from 1975 until January 2020. Two independent reviewers evaluated the study quality based on the Newcastle-Ottawa scale. Odds ratio and 95% confidence interval of the OS, DFS and local recurrence rate were calculated. Results Thirteen studies were finally included with a total of 2884 patients; 1986 patients undergone LSS and 898 amputations. Five-year overall survival was almost 2-fold in patients treated with LSS than those treated with amputation (OR: 1.99; 95% CI: 1.35-2.93; I2 = 74%, p < 0.001). No difference was found in 5-year DFS between LSS patients and amputees (OR: 1.24; 95% CI: 0.55-2.79; I2 = 67%, p = 0.01). The odds of local recurrence was numerically higher in LSS compared to amputation but not statistically significant (OR: 2.29; 95% CI: 0.95-5.53; I2 = 47%, p = 0.05). However, the included studies did not clearly define differences in the stages of patients of the two groups. Conclusion Our study demonstrated that in patients with limb osteosarcoma treated with neoadjuvant chemotherapy, LSS is associated with a higher 5-year overall survival and the odds of local recurrence may be increased but these results should be interpreted with caution due to high heterogeneity.
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Key Words
- AJCC, American Joint Cancer Committee
- ASCO, American Society of Clinical Oncology
- Amputation
- CATS, Computed Assisted Tumor Surgery
- CCG, Children’s Cancer Group
- CI, Confidence Interval
- COSS, Cooperative Osteosarcoma Study Group
- CT, Computed Tomography
- DFS, Disease Free Survival
- FNA, Fine Needle Aspiration
- LSS, Limb Salvage Surgery
- Limb-salvage surgery
- MAP, MTX, Adriamycin, Cisplatin
- MRI, Magnetic Resonance Imaging
- MSKCC, Memorial Sloan Kattering Cancer Center
- MSTS, Musculoskeletal Tumor Society
- NCCN, National Comprehensive Cancer Network
- NOS, Newcastle–Ottawa scale
- NPCR, National Program of Cancer Registries
- Neoadjuvant chemotherapy
- OR, Odds Ratio
- OS, Overall Survival
- Osteosarcoma
- PET, Positron Emission Tomography
- POG, Pediatric Oncology Group
- RCT, Randomized Controlled Trials
- Rev-Man, Review Manager
- SEER, Surveillance, Epidemiology, and End Results
- SIOP, International Society of Paediatric Oncology
- Tc-MDP, Methylene diphosphonate with technetium-99m
- VICC, Vanderbilt-Ingram Cancer Center
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Zimmer K, Kocher F, Spizzo G, Salem M, Gastl G, Seeber A. Treatment According to Molecular Profiling in Relapsed/Refractory Cancer Patients: A Review Focusing on Latest Profiling Studies. Comput Struct Biotechnol J 2019; 17:447-453. [PMID: 31007870 PMCID: PMC6453774 DOI: 10.1016/j.csbj.2019.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 12/21/2022] Open
Abstract
In this review we aim to summarize studies investigating the impact of a molecular profiling (MP)-guided treatment approach in heavily pretreated cancer patients. In summary, many independent single- and multicenter studies showed a significant benefit of MP-guided treatment regarding response rates and survival. However, in the only randomized trial conducted so far, no benefit of MP-guided targeted therapy was observed. Notably, various profiling approaches were conducted in the respective studies: some studies used a single analytic approach (i.e. next-generation sequencing), others applied multiple analytic methods to perform comprehensive molecular profiling. It seems that multiplatform profiling analyses, detected an increased number of druggable molecular targets or signaling pathway alterations and that a higher proportion of patients was treated according to the molecular cancer profile. Even though no randomized study has shown a benefit of molecular profiling so far, many studies indicate that MP-guided treatment can be beneficial in patients with relapsed and/or refractory cancer. Currently ongoing large randomized trials (i.e. NCI-MATCH, TAPUR) will add evidence to the role of profiling-guided cancer treatment.
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Key Words
- ASCO, American Society of Clinical Oncology
- Abl, Abelson murine leukemia viral oncogene homolog 1
- Bcr, Breakpoint cluster region
- CGH, Comparative genomic hybridization
- CISH, Chromogenic in-situ hybridization
- CR, Complete response
- DNA, Deoxyribonucleic acid
- FDA, Food and Drug Administration
- FGFR, Fibroblast growth factor receptor
- FISH, Fluorescence in-situ hybridization
- HER2, Human epidermal growth factor receptor 2
- HR, Hazard Ratio
- IHC, Immunohistochemistry
- MEK, Mitogen-activated protein kinase
- MP, Molecular profile
- MSI, Microsatellite Instability
- Metastatic cancer
- Molecular profiling
- NCI, National Cancer Institute
- NGS, Next generation sequencing
- ORR, Overall response rate
- OS, Overall Survival
- PCR, Polymerase chain reaction
- PFS, Progression-free survival
- PIK3CA, Phosphatidylinositol-4,5-bisphosphate-3-kinase catalytic subunit alpha
- PR, Partial Response
- PTEN, Phosphatase and tensin homolog
- Personalized medicine
- Precision oncology
- R/R, Refractory/Relapsed
- RAF, Rapidly growing fibrosarcoma - protein
- RNA, Ribonucleic acid
- SD, Stable Disease
- TTF, Time to treatment failure
- WES, Whole-exome sequencing
- mTOR, Mammalian target of Rapamycin
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Affiliation(s)
- Kai Zimmer
- Department of Haematology and Oncology, Medical University of Innsbruck, Austria
| | - Florian Kocher
- Department of Haematology and Oncology, Medical University of Innsbruck, Austria
| | - Gilbert Spizzo
- Department of Haematology and Oncology, Medical University of Innsbruck, Austria
| | - Mohamed Salem
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, USA
| | - Guenther Gastl
- Department of Haematology and Oncology, Medical University of Innsbruck, Austria
| | - Andreas Seeber
- Department of Haematology and Oncology, Medical University of Innsbruck, Austria
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Conde-Moreno AJ, García-Gómez R, Albert-Antequera M, Almendros-Blanco P, De Las Peñas-Bataller R, González-Vidal V, López-Torrecilla JL, Ferrer-Albiach C. Fractionated stereotactic radiotherapy plus bevacizumab after response to bevacizumab plus irinotecan as a rescue treatment for high-grade gliomas. Rep Pract Oncol Radiother 2015; 20:231-8. [PMID: 25949228 DOI: 10.1016/j.rpor.2015.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/04/2014] [Accepted: 01/28/2015] [Indexed: 11/16/2022] Open
Abstract
AIM To evaluate the possibility of implementing a new scheme of rescue treatment after relapse or progression of high-grade glioma (HGG) treated at the first-line with bevacizumab and irinotecan (BVZ+CPT11), evaluating the response and toxicity of associating BVZ and fractionated stereotactic radiotherapy (BVZ+FSRT). MATERIALS AND METHODS We retrospectively analysed data from 59 patients with relapse of HGG. Nine patients with HGG relapse after treatment using the Stupp protocol that were treated with BVZ+CPT11 for progression between July 2007 and August 2012, after which the response was assessed according to the Revised Assessment in Neuro-Oncology (RANO) criteria. BVZ was administered at a dose of 10 mg/kg and FSRT up to a prescribed dose of 30 Gy, 500 cGy per fraction, three days a week. The median follow-up was 38 months. RESULTS The treatment was well-tolerated by all patients. The response after nuclear magnetic resonance imaging (MRI) at 3-6 months was progression in two patients, stable disease in four, and three patients had a partial response. The median overall survival (OS) from diagnosis until death or the last control was 36.8 months. The median progression-free survival (PFS) was 10.8 months. The results from tumour sub-group analysis indicated that the PFS was not statistically significant although it seemed that it was higher in grade-III. The OS was higher in grade-III gliomas. CONCLUSIONS The combination of BVZ+FSRT as a second-line HGG relapse rescue treatment is well-tolerated and seems to offer promising results. We believe that multi-centre prospective studies are needed to determine the long-term efficacy and toxicity of this therapeutic approach.
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Key Words
- ASCO, American Society of Clinical Oncology
- BVZ, bevacizumab
- Bevacizumab
- CAT, computed axial tomography
- CI, confidence interval
- CPT11, irinotecan
- CR, complete response
- CTCAE, common terminology criteria for adverse events
- FLAIR, fluid-attenuated inversion recovery
- FSRT, fractionated stereotactic radiotherapy
- Fractionated stereotactic radiotherapy
- GTV, gross tumour volume
- HGG, high-grade glioma
- HR, hazard ratio
- High-grade glioma
- KPS, Karnofsky Performance Scale
- MGMT, O-6-methylguanine-DNA methyltransferase
- MRI, magnetic resonance imaging
- NA, not applicable
- OS, overall survival
- PD, progressive disease
- PET, positron emission tomography
- PFS, progression-free survival
- PR, partial response
- PTV, planning target volume
- RANO, revised Assessment in Neuro-Oncology
- Rescue treatment
- SD, stable disease
- SEOM, Sociedad Española de Oncología Médica
- SRS, stereotactic radiosurgery
- TMZ, temozolomide
- VEGF, vascular endothelial growth factor
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Affiliation(s)
| | - Raquel García-Gómez
- Consorcio Hospitalario Provincial de Castellón, Avda. Doctor Clarà 19, 12002 Castellón, Spain
| | - María Albert-Antequera
- Consorcio Hospitalario Provincial de Castellón, Avda. Doctor Clarà 19, 12002 Castellón, Spain
| | - Piedad Almendros-Blanco
- Consorcio Hospitalario Provincial de Castellón, Avda. Doctor Clarà 19, 12002 Castellón, Spain
| | | | - Verónica González-Vidal
- Consorcio Hospitalario Provincial de Castellón, Avda. Doctor Clarà 19, 12002 Castellón, Spain
| | | | - Carlos Ferrer-Albiach
- Consorcio Hospitalario Provincial de Castellón, Avda. Doctor Clarà 19, 12002 Castellón, Spain
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Abstract
Melanoma is the most serious form of skin cancer. Metastatic melanoma historically carries a poor prognosis and until recently there have been few effective agents available to treat widely disseminated disease. Recognition of the immunogenic nature of melanoma has resulted in the development of various immunotherapeutic approaches, especially with regards to the programmed cell death 1 (PD-1) receptor and its ligand (PD-L1). Antibodies targeting the PD-1 axis have shown enormous potential in the treatment of metastatic melanoma. Here, we will review the immune basis for the disease and discuss approved immunotherapeutic options for advanced melanoma, as well as the current state of development of PD-1 and PD-L1 antibodies and their importance in shaping the future of melanoma treatment.
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Key Words
- AE, adverse event
- APC, antigen presenting cell
- ASCO, American Society of Clinical Oncology
- BMS-936559
- CTLA-4, cytotoxic T-lymphocyte-associated protein 4
- FDA, Food and Drug Administration
- ITIM , immunoreceptor tyrosine-based inhibitory motif
- ITSM, immunoreceptor tyrosine-based switch motif
- Ig, immunoglobulin
- MAPK, mitogen-activated protein kinase
- MHC, major histocompatibility complex
- MPDL3280A
- NK, natural killer
- ORR, objective response rate
- OS, overall survival
- PD, progressive disease
- PD-1
- PD-1, programmed cell death 1
- PD-L1
- PD-L1, programmed cell death ligand 1
- PD-L2
- PFS, progression free survival
- TCR, T cell receptor
- TIL, tumor infiltrating lymphocyte
- gp100, glycoprotein 100 vaccine
- immunotherapy
- melanoma
- nivolumab
- pembrolizumab
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Affiliation(s)
- Katy K Tsai
- University of California San Francisco; San Francisco, CA USA
| | - Inés Zarzoso
- University of California San Francisco; San Francisco, CA USA
| | - Adil I Daud
- University of California San Francisco; San Francisco, CA USA
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