SEOM-GEINO clinical guideline of systemic therapy and management of brain central nervous system metastases (2021)

Central nervous system (CNS) dissemination is a severe complication in cancer and a leading cause of cancer-related mortality. Brain metastases (BMs) are the most common types of malignant intracranial tumors and are reported in approximately 25% of patients with metastatic cancers. The recent increase in incidence of BMs is due to several factors including better diagnostic assessments and the development of improved systemic therapies that have lower activity on the CNS. However, newer systemic therapies are being developed that can cross the blood-brain barrier giving us additional tools to treat BMs. The guidelines presented here focus on the efficacy of new targeted systemic therapies and immunotherapies on CNS BMs from breast, melanoma, and lung cancers.

Frequency and Clinicopathological Profile Associated with Braf Mutations in Patients with Advanced Melanoma in Spain

Real-world data on BRAF mutation frequency in advanced melanoma are lacking in Spain. Moreover, data available on clinicopathological profile of patients with advanced BRAF-mutant melanoma are currently limited. This study aimed to assess the frequency of BRAF V600 mutations in Spanish patients with advanced or metastatic melanoma and to identify clinical and histopathological features associated with BRAF-mutated tumors. A multicenter, cross-sectional epidemiological study was conducted in 33 Spanish hospitals in adult patients with stage IIIc/IV melanoma. A total of 264 patients were included. The median age was 68 years and 57% were male. Melanoma mainly involved skin with intermittent (40.4%) and low or no sun exposure (43.5%). Most patients (85.6%) had stage IV disease (M1a: 19.3%; M1b: 13.3%; M1c: 22.7%). Serum lactate dehydrogenase levels were elevated in 20% of patients. Superficial spreading melanoma was the most frequent histological type (29.9%). Samples were predominantly obtained from metastases (62.7%), mostly from skin and soft tissues (80%). BRAF mutation analysis was primarily performed using the Cobas 4800 BRAF V600 Mutation Test (92.8%) on formalin-fixed, paraffin-embedded tissue (95.8%). BRAF mutations were detected in 41.3% of samples. Multivariate analysis identified age (odd ratio [OR] 0.975) and stage IV M1a (OR 2.716) as independent factors associated with BRAF mutation. The frequency of BRAF mutations in tumor samples from patients with advanced or metastatic melanoma in Spain was 41.3%. BRAF mutations seem to be more frequent in younger patients and stage M1a patients.

This study provides the basis for further investigation regarding BRAF-mutated advanced melanoma in larger cohorts.

Abstract CT087: Early tumor immune microenvironment (TME) modulation by the BRAF inhibitor (BRAFi) dabrafenib (D) and/or the MEK inhibitor (MEKi) trametinib (T) in patients (pts) with BRAF V600E/K-mutant melanoma in the COMBAT trial

Several trials are evaluating combinations of BRAFi/MEKi and immunotherapy (IO) treatment (Tx) in melanoma. This descriptive biomarker study explored tumor cell and TME modification during BRAFi, MEKi or combination Tx in pts with BRAF V600E/K–mutant unresectable or metastatic melanoma and their potential impact on biomarkers implicated in response to IO. 48 pts enrolled and were randomized 1:1:1 to receive D+T, D, or T (n = 16 each). In the D and T arms, pts received D+T after 8 wk of D or T alone. Tumor biopsies were collected at baseline (BL), wk 2, 8, and 10, and at disease progression. Phosphorylated ERK (pERK), PD-L1, CD8, and CD68 protein expression was analyzed by IHC. RNA expression was assessed by NanoString immune profiling of 770 genes covering adaptive, innate, and humoral immune responses. The primary objectives were to evaluate pERK reduction from BL and characterize safety and efficacy in each Tx arm with changes in pERK H-score. At the final data cutoff, 21 pts (44%) completed the study, including 3 deaths and disease progression. Across Tx arms serious adverse events were reported in 19 pts (40%); no new safety signals were observed. In the biomarker population (pts with BL and ≥ 1 on-Tx biopsy; n = 42), the number of evaluable samples decreased with time due to insufficient tumor material (often due to good tumor response). Due to this limitation, the correlation between biomarker changes and clinical response could not be analyzed, but early biomarker changes are reported. pERK H-score, a MAPK pathway activity marker, decreased from BL to wk 2 in 13 of 17 pts (D, 4/5 pts; T, 6/7 pts; D+T, 3/5 pts) and from BL to wk 8 in 5 of 8 pts (D, 2/3 pts; T, 2/3 pts; D+T, 1/2 pts). IHC showed an early increase in CD8+ and CD68+ cells in the center of tumors compared with the periphery in all 3 arms. Innate immune response, chemotaxis, MHC class II antigen presentation, and complement pathway genes were upregulated. RNA expression of PD-L1, IFNγ pathway genes, and immunosuppressive cytokines IL-6 and CCL2 were slightly increased. Intriguingly, both M1 (IRF5) and M2 (CD163) macrophage genes were upregulated, with an increase of protumoral cytokines (eg, VEGF, TNF) and the MDSC-related cytokine CSF-1. These results indicate that D and T, alone or combined, induced early modification of the melanoma TME, with a tendency to recruit cytotoxic CD8+ cells and increase antigen presentation, which may, however, be offset by induction of immunosuppressive events. Early induction of complement pathways is a novel finding that needs further investigation as it can be both cytotoxic and cytoprotective for tumor cells. These findings provide additional rationale for evaluation of IO and/or agents targeting MDSC following or combined with BRAFi/MEKi in BRAF-mutant melanoma. Additional efficacy and safety analyses will be presented.

Citation Format: Caroline Robert, Shensi Shen, Delphine Allard, Ana Arance Fernández, Caroline Dutriaux, Egbert de Jong, Matthew Squires, Jean-Jacques Grob. Early tumor immune microenvironment (TME) modulation by the BRAF inhibitor (BRAFi) dabrafenib (D) and/or the MEK inhibitor (MEKi) trametinib (T) in patients (pts) with BRAF V600E/K-mutant melanoma in the COMBAT trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr CT087.

[The post-licensing efficacy of VA-MENGOC-BC in children under 6 in Holguín, Cuba. The first year of observation]

The assessment of the after-licensing efficacy of the Cuban vaccine VA-MENGOC-BC was performed one year after the mass immunization campaign was completed in children under 6 years of age in the Province of Holguín which had the second highest incidence rate of meningococcal disease during 1988 in Cuba. In the design of the study the following aspects were taking into account: case definition; case detection, determination of the state of vaccination, and comparability of exposure. The utilization of 2 case definitions with different sensitivity and specificity is introduced within the methodology, as well as 2 estimation methods. Incidence rates from exposed and nonexposed subjects, as well as the ratio of cases and of the vaccinated population are used. The impact of this prophylactic intervention was determined by the estimation of the percentual preventive population fraction. Among outstanding results, the high efficacy of more than 98% found in both variants of case definition is to be mentioned. It is evidenced that the effect of the vaccine accounts for more than 80% of the observed case reduction. Such reduction in the number of cases was obtained without changing diagnostic criteria since the isolation of the agents was hept at levels similar to the ones from previous years.

Incidence, epidemiology and control of bovine virus diarrhoea virus in South America

Outbreaks of diarrhoea associated with mucosal erosions of the mouth, tongue and digestive tract, clinically diagnosed as bovine virus diarrhoea-mucosal disease (BVD-MD), have been reported in Argentina and Brazil since the 1960's. However, primary isolation of the virus of BVD-MD is fairly recent, occurring in 1974 for Brazil, 1984 for Argentina, 1985 for Chile and 1981 for Colombia. In Argentina both cytopathogenic and non-cytopathogenic BVD virus strains have been identified. Elsewhere in South America this differentiation does not seem to have been carried out. Serological surveys have confirmed the existence of BVD virus infection in six countries (Argentina, Brazil, Chile, Colombia, Peru and Uruguay), with an incidence rate ranging between 37 and 77% of cattle in the areas surveyed. Diarrhoea in calves between 3 and 18 months of age, often associated with mucosal erosions, has been the most commonly observed syndrome. In some cases an upper respiratory tract involvement was described. In one epizootic, in the Sabana de Bogota plateau of Colombia, reproductive failure associated with abortions or birth of weak calves was the main clinical syndrome.

RNA fingerprinting of South American prototype aphthovirus strains

Aphthovirus strains used in South America for vaccine production or as reference for diagnostic purposes were analysed by RNA fingerprinting (RNase T1 maps, one- and two-dimensional gels). The results obtained constitute the basis for a data bank containing available information about the genome structure of strains of aphthovirus prevalent in this continent and can be used as an adjunct to serological and immunological information. These data are currently being used in South American countries to assess the genetic stability of strains during vaccine production; to establish possible vaccine origin of field outbreaks and to monitor the origin, behaviour and fate of new strains in the field.

External fixation of the leg using unilateral biplanar frames

A simple and reliable method is described for testing the stability of external fixators under stresses similar to those found in clinical practice. Unilateral uniplanar, unilateral biplanar, and bilateral uniplanar frames were used. It seemed important to measure deformations under bending stresses in different planes, because we have found a variable rigidity in some of the frames in the different planes. Our results show that a unilateral biplanar frame without transfixation pins can be set up with an overall rigidity as good as that of a bilateral frame. Using this on the leg, one can avoid putting pins through the anterolateral compartment.