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Zager JS, Orloff M, Ferrucci PF, Choi J, Eschelman DJ, Glazer ES, Ejaz A, Howard JH, Richtig E, Ochsenreither S, Reddy SA, Lowe MC, Beasley GM, Gesierich A, Bender A, Gschnell M, Dummer R, Rivoire M, Arance A, Fenwick SW, Sacco JJ, Haferkamp S, Weishaupt C, John J, Wheater M, Ottensmeier CH. Efficacy and Safety of the Melphalan/Hepatic Delivery System in Patients with Unresectable Metastatic Uveal Melanoma: Results from an Open-Label, Single-Arm, Multicenter Phase 3 Study. Ann Surg Oncol 2024:10.1245/s10434-024-15293-x. [PMID: 38704501 DOI: 10.1245/s10434-024-15293-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/25/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Uveal melanoma (UM) has a poor prognosis once liver metastases occur. The melphalan/Hepatic Delivery System (melphalan/HDS) is a drug/device combination used for liver-directed treatment of metastatic UM (mUM) patients. The purpose of the FOCUS study was to assess the efficacy and safety of melphalan/HDS in patients with unresectable mUM. METHODS Eligible patients with mUM received treatment with melphalan (3.0 mg/kg ideal body weight) once every 6 to 8 weeks for a maximum of six cycles. The primary end point was the objective response rate (ORR). The secondary end points included duration of response (DOR), overall survival (OS), and progression-free survival (PFS). RESULTS The study enrolled 102 patients with mUM. Treatment was attempted in 95 patients, and 91 patients received treatment. In the treated population (n = 91), the ORR was 36.3 % (95 % confidence interval [CI], 26.44-47.01), including 7.7 % of patients with a complete response. Thus, the study met its primary end point because the lower bound of the 95 % CI for ORR exceeded the upper bound (8.3 %) from the benchmark meta-analysis. The median DOR was 14 months, and the median OS was 20.5 months, with an OS of 80 % at 1 year. The median PFS was 9 months, with a PFS of 65 % at 6 months. The most common serious treatment-emergent adverse events were thrombocytopenia (15.8 %) and neutropenia (10.5 %), treated mostly on an outpatient basis with observation. No treatment-related deaths were observed. CONCLUSION Treatment with melphalan/HDS provides a clinically meaningful response rate and demonstrates a favorable benefit-risk profile in patients with unresectable mUM (study funded by Delcath; ClinicalTrials.gov identifier: NCT02678572; EudraCT no. 2015-000417-44).
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Affiliation(s)
- Jonathan S Zager
- Departments of Cutaneous Oncology and Sarcoma, Moffitt Cancer Center, Tampa, FL, USA.
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
| | | | | | - Junsung Choi
- Departments of Cutaneous Oncology and Sarcoma, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | | | - Evan S Glazer
- The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Aslam Ejaz
- The Ohio State University, Columbus, OH, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Ana Arance
- Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Joseph J Sacco
- The Clatterbridge Cancer Center, University of Liverpool, Liverpool, UK
| | | | | | | | - Matthew Wheater
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Schaper-Gerhardt K, Gutzmer R, Angela Y, Zimmer L, Livingstone E, Schadendorf D, Hassel JC, Weishaupt C, Remes B, Kubat L, Spassova I, Becker JC. The RANKL inhibitor denosumab in combination with dual checkpoint inhibition is associated with increased CXCL-13 serum concentrations. Eur J Cancer 2024; 202:113984. [PMID: 38479119 DOI: 10.1016/j.ejca.2024.113984] [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: 01/11/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Recent evidence suggests additional immunomodulatory properties of RANKL inhibition possibly boosting the clinical efficacy of immune checkpoint inhibitors (ICI). METHODS We conducted a prospective, multicentre clinical trial in unresectable stage IV melanoma patients with bone metastases who received denosumab in parallel with dual ICI (BONEMET) and performed comprehensive immune monitoring at baseline and 4, 12, and 24 weeks after initiation of therapy. Secondary endpoints included tolerability and efficacy. For comparison, biospecimens from melanoma patients treated with dual ICI without denosumab were analyzed accordingly and served as retrospective reference cohort. RESULTS In both the BONEMET (n = 16) and the reference cohort (n = 18) serum levels of 17 cytokines, including IFNγ were significantly increased after 4 weeks of treatment. Patients who received ICI and denosumab showed a significantly higher increase in serum CXCL-13 and a significant decrease in VEGFc compared with the reference cohort. While no changes in T cell composition were observed at 4 weeks, patients in the BONEMET cohort showed a significant decrease in the peripheral naïve T-cell population and an increase in CD8+ effector cells after 12 weeks. Treatment-related adverse events occurred with comparable frequency (93.8% in the BONEMET cohort versus 83.3% in the reference cohort). 7/16 patients in the BONEMET cohort and 8/18 patients in the reference cohort achieved disease control. CONCLUSION Denosumab in combination with dual ICI modulates cytokine expression and T-cell composition in peripheral blood. The upregulation of CXCL-13, a key factor for initiating tertiary lymphoid structures, strengthens the hypothesis that denosumab indeed boost immunological effects.
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Affiliation(s)
- Katrin Schaper-Gerhardt
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum, Campus Minden, Minden, Germany; Department of Dermatology and Allergy, Medical School Hannover, Hannover, Germany.
| | - Ralf Gutzmer
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum, Campus Minden, Minden, Germany; Department of Dermatology and Allergy, Medical School Hannover, Hannover, Germany
| | - Yenny Angela
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum, Campus Minden, Minden, Germany; Department of Dermatology and Allergy, Medical School Hannover, Hannover, Germany
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany; Westdeutsches Tumorzentrum, Essen, Germany, & University Alliance Ruhr, Research Center One Health, University Duisburg-Essen, Essen, Germany; German Cancer Consortium, Essen & National Center for Tumor Diseases, Campus Essen (NCT-West), Essen, Germany
| | - Elisabeth Livingstone
- Department of Dermatology, University Hospital Essen, Essen, Germany; Westdeutsches Tumorzentrum, Essen, Germany, & University Alliance Ruhr, Research Center One Health, University Duisburg-Essen, Essen, Germany; German Cancer Consortium, Essen & National Center for Tumor Diseases, Campus Essen (NCT-West), Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, Essen, Germany; Westdeutsches Tumorzentrum, Essen, Germany, & University Alliance Ruhr, Research Center One Health, University Duisburg-Essen, Essen, Germany; German Cancer Consortium, Essen & National Center for Tumor Diseases, Campus Essen (NCT-West), Essen, Germany
| | - Jessica C Hassel
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | | | - Linda Kubat
- Westdeutsches Tumorzentrum, Essen, Germany, & University Alliance Ruhr, Research Center One Health, University Duisburg-Essen, Essen, Germany; Translational Skin Cancer Research (TSCR), University Medicine Essen, Germany
| | - Ivelina Spassova
- Westdeutsches Tumorzentrum, Essen, Germany, & University Alliance Ruhr, Research Center One Health, University Duisburg-Essen, Essen, Germany; Translational Skin Cancer Research (TSCR), University Medicine Essen, Germany
| | - Jürgen C Becker
- Department of Dermatology, University Hospital Essen, Essen, Germany; Westdeutsches Tumorzentrum, Essen, Germany, & University Alliance Ruhr, Research Center One Health, University Duisburg-Essen, Essen, Germany; Translational Skin Cancer Research (TSCR), University Medicine Essen, Germany
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Elsayad K, Weishaupt C, Moustakis C, Danzer MF, Müller EC, Rolf D, Stranzenbach R, Livingstone E, Booken N, Stadler R, Eich HT. Ultrahypofractionated Low-Dose Total Skin Electron Beam in Advanced-Stage Mycosis Fungoides and Sézary Syndrome. Int J Radiat Oncol Biol Phys 2023; 117:164-170. [PMID: 36893819 DOI: 10.1016/j.ijrobp.2023.02.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/20/2023] [Accepted: 02/25/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE The aim of this study was to assess the safety and efficacy of an ultrahypofractionated low-dose total skin electron beam therapy (TSEBT) regimen in patients with advanced mycosis fungoides (MF) or Sézary syndrome (SS). METHODS AND MATERIALS In this multicenter observational study from 5 German centers, 18 total patients with MF or SS underwent TSEBT with a total dose of 8 Gy in 2 fractions. The primary endpoint was the overall response rate. RESULTS Fifteen of 18 patients with stage IIB-IV MF or SS were heavily pretreated with a median of 4 prior systemic therapies. The overall response rate was 88.9% (95% confidence interval [CI], 65.3-98.6), with 3 complete responses (16.9%; 95% CI, 3.6-41.4). At a median follow-up period of 13 months, the median time to next treatment (TTNT) was 12 months (95% CI, 8.2-15.8), and the median progression-free survival was 8 months (95% CI, 2-14). A significant reduction in the modified severity-weighted assessment tool, total Skindex-29 score (Bonferroni-corrected P < .005), and all subdomains (Bonferroni-corrected P < .05) was observed after TSEBT. Half of the irradiated patients (n = 9) developed grade 2 acute and subacute toxicities. One patient had confirmed grade 3 acute toxicity. Chronic grade 1 toxicity has been observed in 33% of patients. Patients with erythroderma/SS or prior radiation therapy appear at higher risk of skin toxicities. CONCLUSIONS TSEBT with 8 Gy in 2 fractions achieves good disease control and symptom palliation with acceptable toxicity, greater convenience, and fewer hospital visits.
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Affiliation(s)
- Khaled Elsayad
- Department of Radiation Oncology, University Hospital of Muenster, Muenster, Germany.
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital of Muenster, Munster, Germany
| | - Christos Moustakis
- Department of Radiation Oncology, University Hospital of Muenster, Muenster, Germany
| | - Moritz Fabian Danzer
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | | | - Daniel Rolf
- Department of Radiation Oncology, University Hospital of Muenster, Muenster, Germany
| | - Rene Stranzenbach
- Department of Dermatology, University Hospital of Bochum, Bochum, Germany
| | | | - Nina Booken
- Department of Dermatology and Venereology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Rudolf Stadler
- Department of Dermatology, Johannes Wesling Medical Centre, University of Bochum, Minden, German
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital of Muenster, Muenster, Germany
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Zaremba A, Mohr P, Gutzmer R, Meier F, Pföhler C, Weichenthal M, Terheyden P, Forschner A, Leiter U, Ulrich J, Utikal J, Welzel J, Kaatz M, Gebhardt C, Herbst R, Sindrilaru A, Dippel E, Sachse M, Meiss F, Heinzerling L, Haferkamp S, Weishaupt C, Löffler H, Kreft S, Griewank K, Livingstone E, Schadendorf D, Ugurel S, Zimmer L. Immune checkpoint inhibition in patients with NRAS mutated and NRAS wild type melanoma: a multicenter Dermatologic Cooperative Oncology Group study on 637 patients from the prospective skin cancer registry ADOREG. Eur J Cancer 2023; 188:140-151. [PMID: 37245442 DOI: 10.1016/j.ejca.2023.04.008] [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: 02/19/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Melanomas frequently harbour somatic mutations in BRAF (40%) or NRAS (20%). Impact of NRAS mutations on the therapeutic outcome of immune checkpoint inhibitors (ICI) remains controversial. Potential correlation of the NRAS mutational status and programmed cell death ligand-1 (PD-L1) expression in melanoma is unknown. PATIENTS AND METHODS Advanced, non-resectable melanoma patients with known NRAS mutation status treated with first-line ICI between 06/2014 and 05/2020 in the prospective multicenter skin cancer registry ADOREG were included. Overall response rate (ORR), progression-free survival (PFS), and overall survival (OS) according to NRAS status were analysed. A multivariate Cox model was used to analyse factors associated with PFS and OS; survival was analysed using the Kaplan-Meier approach. RESULTS Among 637 BRAF wild-type patients, 310 (49%) had an NRAS mutation with Q61R (41%) and Q61K (32%). NRAS-mutated (NRASmut) melanomas were significantly more often located on the lower extremities and trunk (p = 0.001); nodular melanoma was the most common subtype (p < 0.0001). No significant differences were found for PFS and OS for anti-PD1 monotherapy (2-year PFS 39%, [95% confidence interval (CI), 33-47] in NRASmut patients and 41% [95% CI, 35-48] in NRAS-wild type (NRASwt) patients; 2-year OS was 54% [95% CI, 48-61] in NRASmut patients and 57% [95% CI, 50-64] in NRASwt patients) and anti-PD1 plus anti-CTLA4 therapy between both cohorts (2-year PFS was 54% [95% CI, 44-66] in NRASmut patients and 53% [95% CI, 41-67] in NRASwt patients; 2-year OS was 58% [95% CI, 49-70] in NRASmut patients and 62% [95% CI, 51-75] in NRASwt patients). The ORR to anti-PD1 was 35% for NRASwt patients and 26% for NRASmut patients and 34% compared to 32% for combinational therapy. Data on PD-L1 expression was available in 82 patients (13%). PD-L1 expression (>5%) was not correlated to NRAS mutational status. In multivariate analysis, elevated lactate dehydrogenase, Eastern Cooperative Oncology Group performance status ≥ 1, and brain metastases were significantly associated with a higher risk of death in all patients. CONCLUSIONS The PFS and OS were not affected by NRAS mutational status in patients treated with anti-PD1-based ICI. Similar ORR was seen in NRASwt and NRASmut patients. Tumour PD-L1 expression did not correlate with NRAS mutational status.
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Affiliation(s)
- Anne Zaremba
- Department of Dermatology, University Hospital Essen, Essen, Germany.
| | - Peter Mohr
- Department of Dermatology, Elbe Clinic Buxtehude, Buxtehude, Germany
| | - Ralf Gutzmer
- Department of Dermatology, Hannover Medical School, Skin Cancer Centre Hannover, Hannover, 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; National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Claudia Pföhler
- Saarland University Medical Center, Department of Dermatology, Homburg, Saarland, Germany
| | - Michael Weichenthal
- Department of Dermatology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | | | - Andrea Forschner
- Division of Dermatooncology, Department of Dermatology, University Medical Center, Tuebingen, Germany
| | - Ulrike Leiter
- Division of Dermatooncology, Department of Dermatology, University Medical Center, Tuebingen, Germany
| | - Jens Ulrich
- Department of Dermatology, Harz Clinic Quedlinburg, Quedlinburg, Germany
| | - Jochen Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany; DKFZ Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
| | - Julia Welzel
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
| | - Martin Kaatz
- Department of Dermatology, Wald-Klinikum Gera, Gera, Germany
| | - Christoffer Gebhardt
- Department of Dermatology, University Hospital Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Rudolf Herbst
- Department of Dermatology, Helios Klinikum Erfurt GmbH, Erfurt, Germany
| | - Anca Sindrilaru
- Department of Dermatology, University Hospital Ulm, Ulm, Germany
| | - Edgar Dippel
- Department of Dermatology, Clinic of the City of Ludwigshafen on the Rhine gGmbH, Ludwigshafen am Rhein, Germany
| | - Michael Sachse
- Department of Dermatology, Bremerhaven Reinkenheide Hospital gGmbH, Bremerhaven, Germany
| | - Frank Meiss
- Department of Dermatology and Venereology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lucie Heinzerling
- Department of Dermatology, University Hospital Munich, Munich, Germany; Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Harald Löffler
- Department of Dermatology, SLK Hospital Heilbronn, Heilbronn, Germany
| | - Sophia Kreft
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Klaus Griewank
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | | | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK), partner site Essen/Düsseldorf, Dresden, Germany
| | - Selma Ugurel
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK), partner site Essen/Düsseldorf, Dresden, Germany
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany
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Weide LM, Schedel F, Weishaupt C. Neutrophil Extracellular Traps Correlate with Tumor Necrosis and Size in Human Malignant Melanoma Metastases. Biology (Basel) 2023; 12:822. [PMID: 37372107 DOI: 10.3390/biology12060822] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/02/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023]
Abstract
Neutrophil extracellular traps (NETs) are web-like structures released by neutrophils that kill invading microorganisms. However, NETs also promote tumor growth and impair the functionality of T-cells in cancer. Therefore, this study aimed at characterizing NET distribution within human melanoma metastases (n = 81 of 60 patients) by immunofluorescence staining for neutrophils (CD15) and NETs (H3Cit) in order to identify targets for NET-directed therapies. The results show that 49.3% of the metastases contained neutrophils (n = 40) and 30.8% (n = 25) contained NETs, 68% of them very densely infiltrated. A total of 75% of CD15-positive neutrophils and 96% of NET-containing metastases were necrotic while metastases without neutrophil infiltration were predominantly non-necrotic. A higher amount of NETs correlated significantly with greater tumor size. Consistently, all metastases with a cross-sectional area greater than 2.1 cm2 contained neutrophils. Analysis of metastasis from different sites revealed NETs to be present in skin, lymph node, lung and liver metastases. Taken together, our study was the first to observe NET infiltration in a larger cohort of human melanoma metastases. These results set the stage for further research regarding NET-directed therapies in metastatic melanoma.
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Affiliation(s)
- Lennard Marten Weide
- Department of Dermatology, Skin Cancer Center, University Clinic Münster, Von-Esmarch-Str. 58, 48149 Münster, Germany
| | - Fiona Schedel
- Department of Dermatology, Skin Cancer Center, University Clinic Münster, Von-Esmarch-Str. 58, 48149 Münster, Germany
| | - Carsten Weishaupt
- Department of Dermatology, Skin Cancer Center, University Clinic Münster, Von-Esmarch-Str. 58, 48149 Münster, Germany
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Helbig D, Dippel E, Erdmann M, Frisman A, Kage P, Leiter U, Mentzel T, Seidel C, Weishaupt C, Ziemer M, Ugurel S. S1-Leitlinie dermales und subkutanes Leiomyosarkom. J Dtsch Dermatol Ges 2023; 21:555-564. [PMID: 37183752 DOI: 10.1111/ddg.14989_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: 05/16/2023]
Affiliation(s)
- Doris Helbig
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Köln
| | - Edgar Dippel
- Klinik für Dermatologie und Venerologie, Klinikum der Stadt Ludwigshafen
| | - Michael Erdmann
- Hautklinik, Universitätsklinikum Erlangen, CCC Erlangen EMN, Erlangen
| | - Alexander Frisman
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Leipzig
| | - Paula Kage
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig
| | - Ulrike Leiter
- Zentrum für Dermatoonkologie, Universitäts-Hautklinikum, Eberhard-Karls-Universität Tübingen
| | - Thomas Mentzel
- MVZ Dermatopathologie Friedrichshafen/Bodensee, Friedrichshafen
| | - Clemens Seidel
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Leipzig
| | | | - Mirjana Ziemer
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig
| | - Selma Ugurel
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
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Franklin C, Mohr P, Bluhm L, Meier F, Garzarolli M, Weichenthal M, Kähler K, Grimmelmann I, Gutzmer R, Utikal J, Terheyden P, Herbst R, Haferkamp S, Pfoehler C, Forschner A, Leiter U, Ziller F, Meiss F, Ulrich J, Kreuter A, Gebhardt C, Welzel J, Schilling B, Kaatz M, Scharfetter-Kochanek K, Dippel E, Nashan D, Sachse M, Weishaupt C, Löffler H, Gambichler T, Loquai C, Heinzerling L, Grabbe S, Debus D, Schley G, Hassel JC, Weyandt G, Trommer M, Lodde G, Placke JM, Zimmer L, Livingstone E, Becker JC, Horn S, Schadendorf D, Ugurel S. Brain metastasis and survival outcomes after first-line therapy in metastatic melanoma: a multicenter DeCOG study on 1704 patients from the prospective skin cancer registry ADOREG. J Immunother Cancer 2023; 11:e005828. [PMID: 37028819 PMCID: PMC10083858 DOI: 10.1136/jitc-2022-005828] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Despite the availability of effective systemic therapies, a significant number of advanced melanoma patients develops brain metastases. This study investigated differences in incidence and time to diagnosis of brain metastasis and survival outcomes dependent on the type of first-line therapy. METHODS Patients with metastatic, non-resectable melanoma (AJCCv8 stage IIIC-V) without brain metastasis at start of first-line therapy (1L-therapy) were identified from the prospective multicenter real-world skin cancer registry ADOREG. Study endpoints were incidence of brain metastasis, brain metastasis-free survival (BMFS), progression-free survival (PFS), and overall survival (OS). RESULTS Of 1704 patients, 916 were BRAF wild-type (BRAFwt) and 788 were BRAF V600 mutant (BRAFmut). Median follow-up time after start of 1L-therapy was 40.4 months. BRAFwt patients received 1L-therapy with immune checkpoint inhibitors (ICI) against CTLA-4+PD-1 (n=281) or PD-1 (n=544). In BRAFmut patients, 1L-therapy was ICI in 415 patients (CTLA-4+PD-1, n=108; PD-1, n=264), and BRAF+MEK targeted therapy (TT) in 373 patients. After 24 months, 1L-therapy with BRAF+MEK resulted in a higher incidence of brain metastasis compared with PD-1±CTLA-4 (BRAF+MEK, 30.3%; CTLA-4+PD-1, 22.2%; PD-1, 14.0%). In multivariate analysis, BRAFmut patients developed brain metastases earlier on 1L-therapy with BRAF+MEK than with PD-1±CTLA-4 (CTLA-4+PD-1: HR 0.560, 95% CI 0.332 to 0.945, p=0.030; PD-1: HR 0.575, 95% CI 0.372 to 0.888, p=0.013). Type of 1L-therapy, tumor stage, and age were independent prognostic factors for BMFS in BRAFmut patients. In BRAFwt patients, tumor stage was independently associated with longer BMFS; ECOG Performance status (ECOG-PS), lactate dehydrogenase (LDH), and tumor stage with OS. CTLA-4+PD-1 did not result in better BMFS, PFS, or OS than PD-1 in BRAFwt patients. For BRAFmut patients, multivariate Cox regression revealed ECOG-PS, type of 1L-therapy, tumor stage, and LDH as independent prognostic factors for PFS and OS. 1L-therapy with CTLA-4+PD-1 led to longer OS than PD-1 (HR 1.97, 95% CI 1.122 to 3.455, p=0.018) or BRAF+MEK (HR 2.41, 95% CI 1.432 to 4.054, p=0.001), without PD-1 being superior to BRAF+MEK. CONCLUSIONS In BRAFmut patients 1L-therapy with PD-1±CTLA-4 ICI resulted in a delayed and less frequent development of brain metastasis compared with BRAF+MEK TT. 1L-therapy with CTLA-4+PD-1 showed superior OS compared with PD-1 and BRAF+MEK. In BRAFwt patients, no differences in brain metastasis and survival outcomes were detected for CTLA-4+PD-1 compared with PD-1.
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Affiliation(s)
- Cindy Franklin
- Department of Dermatology and Venereology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf (CIO ABCD), Cologne, Germany
| | - Peter Mohr
- Department of Dermatology, Elbe-Kliniken Buxtehude, Buxtehude, Germany
| | - Leonie Bluhm
- Department of Dermatology, Elbe-Kliniken Buxtehude, Buxtehude, Germany
| | - Friedegund Meier
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden and, Skin Cancer Center at the University Cancer Center Dresden and National Center for Tumor Diseases (NCT), Dresden, Germany
| | - Marlene Garzarolli
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden and, Skin Cancer Center at the University Cancer Center Dresden and National Center for Tumor Diseases (NCT), Dresden, Germany
| | - Michael Weichenthal
- Department of Dermatology, Skin Cancer Center, Schleswig-Holstein University Hospital, Campus Kiel, Kiel, Germany
| | - Katharina Kähler
- Department of Dermatology, Skin Cancer Center, Schleswig-Holstein University Hospital, Campus Kiel, Kiel, Germany
| | - Imke Grimmelmann
- Skin Cancer Center Hannover, Department of Dermatology, Hannover Medical School, Hanover, Germany
| | - Ralf Gutzmer
- Department of Dermatology, Muehlenkreiskliniken Minden and Ruhr University Bochum, Minden, Germany
| | - Jochen Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ) and Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Patrick Terheyden
- Department of Dermatology, University of Lübeck and Schleswig-Holstein University Hospital, Campus Lübeck, Lübeck, Germany
| | - Rudolf Herbst
- Department of Dermatology, HELIOS Klinikum Erfurt, Erfurt, Germany
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Claudia Pfoehler
- Department of Dermatology, Saarland University Medical School, Homburg, Homburg/Saar, Germany
| | - Andrea Forschner
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - Ulrike Leiter
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - Fabian Ziller
- Department of Dermatology, DRK Hospital Chemnitz-Rabenstein, Chemnitz, Germany
| | - Frank Meiss
- Department of Dermatology and Venereology, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Jens Ulrich
- Department of Dermatology and Skin Cancer Center, Harzklinikum Dorothea Christiane Erxleben, Quedlinburg, Germany
| | - Alexander Kreuter
- Department of Dermatology, Venereology and Allergology, Helios St. Elisabeth Klinik Oberhausen, University Witten-Herdecke, Oberhausen, Germany
| | - Christoffer Gebhardt
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Welzel
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
| | - Bastian Schilling
- Department of Dermatology and Venereology, University Hospital Würzburg, Würzburg, Germany
| | - Martin Kaatz
- Department of Dermatology, SRH Wald-Klinikum Gera, Gera, Germany
| | | | - Edgar Dippel
- Department of Dermatology, Ludwigshafen Medical Center, Ludwigshafen, Germany
| | - Dorothee Nashan
- Department of Dermatology, Hospital of Dortmund, Dortmund, Germany
| | - Michael Sachse
- Skin Cancer Center, Department of Dermatology, Klinikum Bremerhaven Reinkenheide, Bremerhaven, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - Harald Löffler
- Department of Dermatology, SLK-Kliniken Heilbronn, Heilbronn, Germany
| | - Thilo Gambichler
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Carmen Loquai
- Department of Dermatology, Klinikum Bremen-Ost, Gesundheit Nord gGmbH, Bremen, Germany
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Lucie Heinzerling
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Dirk Debus
- Department of Dermatology, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Gaston Schley
- Department of Dermatology and Venereology, Helios Klinikum Schwerin, Schwerin, Germany
| | - Jessica C Hassel
- National Center for Tumor Diseases (NCT), Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Gerhard Weyandt
- Department of Dermatology and Allergology, Hospital Bayreuth, Bayreuth, Germany
| | - Maike Trommer
- Department of Radiation Oncology and Cyberknife Center, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Georg Lodde
- Department of Dermatology, Venereology and Allergology, University Hospital Essen and German Cancer Consortium (DKTK) Partner Site Essen, Essen, Germany
| | - Jan-Malte Placke
- Department of Dermatology, Venereology and Allergology, University Hospital Essen and German Cancer Consortium (DKTK) Partner Site Essen, Essen, Germany
| | - Lisa Zimmer
- Department of Dermatology, Venereology and Allergology, University Hospital Essen and German Cancer Consortium (DKTK) Partner Site Essen, Essen, Germany
| | - Elisabeth Livingstone
- Department of Dermatology, Venereology and Allergology, University Hospital Essen and German Cancer Consortium (DKTK) Partner Site Essen, Essen, Germany
| | - Jürgen Christian Becker
- Department of Dermatology, Venereology and Allergology, University Hospital Essen and German Cancer Consortium (DKTK) Partner Site Essen, Essen, Germany
- Translational Skin Cancer Research, German Cancer Consortium (DKTK), Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Susanne Horn
- Department of Dermatology, Venereology and Allergology, University Hospital Essen and German Cancer Consortium (DKTK) Partner Site Essen, Essen, Germany
- Rudolf-Schönheimer-Institute of Biochemistry, Medical Faculty of the University Leipzig, Leipzig, Germany
| | - Dirk Schadendorf
- Department of Dermatology, Venereology and Allergology, University Hospital Essen and German Cancer Consortium (DKTK) Partner Site Essen, Essen, Germany
| | - Selma Ugurel
- Department of Dermatology, Venereology and Allergology, University Hospital Essen and German Cancer Consortium (DKTK) Partner Site Essen, Essen, Germany
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8
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Helbig D, Dippel E, Erdmann M, Frisman A, Kage P, Leiter U, Mentzel T, Seidel C, Weishaupt C, Ziemer M, Ugurel S. S1-guideline cutaneous and subcutaneous leiomyosarcoma. J Dtsch Dermatol Ges 2023; 21:555-563. [PMID: 36999582 DOI: 10.1111/ddg.14989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/04/2022] [Indexed: 04/01/2023]
Abstract
Superficial leiomyosarcomas (LMS) are rare skin cancers (2-3% of cutaneous sarcomas) that originate from dermally located hair follicle muscles, dartos or areolar muscles (cutaneous/dermal LMS), or from vascular muscle cells of the subcutaneous adipose tissue (subcutaneous LMS). These superficial LMS are distinct from LMS of the deep soft tissues. Leiomyosarcomas are typically localized at the lower extremities, trunk or capillitium, and present as painful, erythematous to brownish nodules. Diagnosis is made by histopathology. The treatment of choice for primary LMS is complete (R0) microscopically controlled excision, with safety margins of 1 cm in dermal LMS, and 2 cm in subcutaneous LMS, if possible. Non-resectable or metastatic LMS require individual treatment decisions. After R0 resection with 1 cm safety margins, the local recurrence rate of dermal LMS is very low, and metastasis is very rare. Subcutaneous LMS, very large, or incompletely excised LMS recur and metastasize more frequently. For this reason, clinical follow-up examinations are recommended every six months for cutaneous LMS, and every three months for subcutaneous LMS within the first two years (in subcutaneous LMS including locoregional lymph node sonography). Imaging such as CT/MRI is indicated only in primary tumors with special features, recurrences, or already metastasized tumors.
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Affiliation(s)
- Doris Helbig
- Hospital and Clinic for Dermatology and Venereology, University Hospital Cologne
| | - Edgar Dippel
- Hospital for Dermatology and Venereology, Ludwigshafen Hospital
| | - Michael Erdmann
- Department of Dermatology, University Hospital Erlangen, CCC Erlangen EMN, Erlangen
| | - Alexander Frisman
- Hospital and Clinic for Radiation Therapy, University Hospital Leipzig
| | - Paula Kage
- Department of Dermatology, Venereology and Allergology, University Hospital Leipzig
| | - Ulrike Leiter
- Center for Dermatooncology, University Hospital for Dermatology, Eberhard-Karls University Tübingen
| | - Thomas Mentzel
- MVZ Dermatopathology Friedrichshafen/Bodensee, Friedrichshafen
| | - Clemens Seidel
- Hospital and Clinic for Radiation Therapy, University Hospital Leipzig
| | | | - Mirjana Ziemer
- Department of Dermatology, Venereology and Allergology, University Hospital Leipzig
| | - Selma Ugurel
- Department of Dermatology, Venereology and Allergology, University Hospital Essen
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9
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Beylot-Barry M, Booken N, Weishaupt C, Scarisbrick J, Wu W, Rosen JP, Medley MC. Impact of blood involvement on efficacy and time to response with mogamulizumab in mycosis fungoides and Sézary syndrome. J Eur Acad Dermatol Venereol 2023; 37:311-316. [PMID: 35993803 PMCID: PMC10087984 DOI: 10.1111/jdv.18549] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/05/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Cutaneous T-cell lymphomas (CTCL) are rare types of non-Hodgkin lymphoma, which present in skin. Mycosis fungoides (MF) and Sézary syndrome (SS) are subtypes which make up two-thirds of all CTCL cases. The phase 3 MAVORIC study (NCT01728805) compared mogamulizumab to vorinostat in MF and SS patients, with post hoc data showing a trend for higher efficacy in mogamulizumab-treated patients as baseline blood tumour burden increases. OBJECTIVES The aim of this study was to use updated post hoc analyses in order to examine the efficacy of mogamulizumab and vorinostat in MF patients when stratified by baseline blood involvement and to determine what factors affect time-to-global and time-to-skin response to inform clinical follow-up. METHODS Post hoc analyses were carried out using data from MAVORIC. Overall response rate (ORR), progression-free survival (PFS) and time-to-next-treatment (TTNT) data were used to assess efficacy in patients with MF. Time-to-global response (TTR) was examined by disease subtype, by blood involvement in MF patients, and time-to-skin response was examined by blood involvement in MF patients. RESULTS Numerically superior results were seen for ORR, PFS and TTNT in mogamulizumab-treated patients with MF compared with vorinostat, with a trend for outcomes improving with increasing baseline blood class. Statistically significant results for mogamulizumab compared with vorinostat were seen for MF B1 pts for PFS (8.43 vs. 2.83 months, p = 0.003) and TTNT (11.9 vs. 3.13 months, p = 0.002), and for MF B2 pts for ORR (46.2 vs. 9.1 months, p = 0.033). CONCLUSIONS In mogamulizumab-treated MF patients, ORR and PFS were seen to improve with increasing blood involvement, which led to improved TTNT. TTR was more predictable for mogamulizumab-treated MF patients with blood involvement, and skin response may take longer than previously reported in some patients.
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Affiliation(s)
- Marie Beylot-Barry
- University of Bordeaux, UMR 1312 INSERM, Bordeaux, France.,Dermatology Department, CHU Bordeaux, Bordeaux, France
| | - Nina Booken
- Department of Dermatology and Venereology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | | | - Wende Wu
- Kyowa Kirin, Inc, Princeton, New Jersey, USA
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10
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Peters AF, Kusche Y, Gerdkamp H, Nattkemper E, Vischedyk K, Münck NA, Weishaupt C, Roth J, Barczyk-Kahlert K, Sunderkötter C, Ehrchen JM. UVA1 radiation attenuates pro-inflammatory functions in human monocytes. J Dermatol 2023; 50:46-56. [PMID: 36184911 DOI: 10.1111/1346-8138.16600] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 08/22/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022]
Abstract
UVA1 therapy is effective in the treatment of inflammatory and autoimmune skin diseases. The mode of action of UVA1 therapy is not completely understood and especially data on cells of the innate immune system like monocytes, which are critically involved in many inflammatory processes, are sparse. We wanted to answer the question whether UVA1 irradiation alters functional properties of human monocytes. We treated human peripheral blood monocytes in vitro with 2 J/cm2 UVA1 light, incubated the cells for 48 h and examined both functional properties and alterations in the gene and protein expression profile. While UVA1 did not alter cell viability or susceptibility to apoptosis inducing agents, it decreased the capacity of monocytes for phagocytosis and to eliminate infectious agents like Leishmania major. Moreover, we measured a significantly reduced production of interleukin (IL)-1β mRNA in lipopolysaccharide activated monocytes after UVA1 treatment. Importantly, UVA1-treated monocytes not only produce less IL-1β, but also upregulate expression of the anti-inflammatory IL-1β decoy receptor. Our data provide evidence that UVA1 radiation not only interferes with fundamental monocyte properties like phagocytosis, pathogen killing and activation, but could also specifically attenuate pro-inflammatory IL-1 effects. This might constitute a hitherto unknown anti-inflammatory mechanism of UVA1 in human monocytes.
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Affiliation(s)
- Anna Franziska Peters
- Department of Dermatology, University of Münster, Münster, Germany.,Institute of Immunology, University of Münster, Münster, Germany
| | - Yvonne Kusche
- Department of Dermatology, University of Münster, Münster, Germany.,Institute of Immunology, University of Münster, Münster, Germany
| | - Henrike Gerdkamp
- Institute of Immunology, University of Münster, Münster, Germany
| | - Eva Nattkemper
- Department of Dermatology, University of Münster, Münster, Germany
| | - Kerstin Vischedyk
- Department of Dermatology, University of Münster, Münster, Germany.,Institute of Immunology, University of Münster, Münster, Germany
| | - Niels-Arne Münck
- Department of Dermatology, University of Münster, Münster, Germany.,Institute of Immunology, University of Münster, Münster, Germany
| | | | - Johannes Roth
- Institute of Immunology, University of Münster, Münster, Germany
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11
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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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12
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Braasch S, Weishaupt C, Spukti E, Böhm M, Braun SA. Scarring Alopecia Under Immune Checkpoint Blockade: a Report of Three Cases. Acta Derm Venereol 2022; 102:adv00792. [DOI: 10.2340/actadv.v102.2311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract is missing (Short communication)
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Franklin C, Mohr P, Bluhm L, Grimmelmann I, Gutzmer R, Meier F, Garzarolli M, Weichenthal M, Pfoehler C, Herbst R, Terheyden P, Utikal J, Ulrich J, Debus D, Haferkamp S, Kaatz M, Forschner A, Leiter U, Nashan D, Kreuter A, Sachse M, Welzel J, Heinzerling L, Meiss F, Weishaupt C, Gambichler T, Weyandt G, Dippel E, Schatton K, Celik E, Trommer M, Helfrich I, Roesch A, Zimmer L, Livingstone E, Schadendorf D, Horn S, Ugurel S. Impact of radiotherapy and sequencing of systemic therapy on survival outcomes in melanoma patients with previously untreated brain metastasis: a multicenter DeCOG study on 450 patients from the prospective skin cancer registry ADOREG. J Immunother Cancer 2022; 10:jitc-2022-004509. [PMID: 35688555 PMCID: PMC9189852 DOI: 10.1136/jitc-2022-004509] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Accepted: 04/04/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Despite of various therapeutic strategies, treatment of patients with melanoma brain metastasis (MBM) still is a major challenge. This study aimed at investigating the impact of type and sequence of immune checkpoint blockade (ICB) and targeted therapy (TT), radiotherapy, and surgery on the survival outcome of patients with MBM. METHOD We assessed data of 450 patients collected within the prospective multicenter real-world skin cancer registry ADOREG who were diagnosed with MBM before start of the first non-adjuvant systemic therapy. Study endpoints were progression-free survival (PFS) and overall survival (OS). RESULTS Of 450 MBM patients, 175 (38.9%) received CTLA-4+PD-1 ICB, 161 (35.8%) PD-1 ICB, and 114 (25.3%) BRAF+MEK TT as first-line treatment. Additional to systemic therapy, 67.3% of the patients received radiotherapy (stereotactic radiosurgery (SRS); conventional radiotherapy (CRT)) and 24.4% had surgery of MBM. 199 patients (42.2%) received a second-line systemic therapy. Multivariate Cox regression analysis revealed the application of radiotherapy (HR for SRS: 0.213, 95% CI 0.094 to 0.485, p<0.001; HR for CRT: 0.424, 95% CI 0.210 to 0.855, p=0.016), maximal size of brain metastases (HR for MBM >1 cm: 1.977, 95% CI 1.117 to 3.500, p=0.019), age (HR for age >65 years: 1.802, 95% CI 1.016 to 3.197, p=0.044), and ECOG performance status (HR for ECOG ≥2: HR: 2.615, 95% CI 1.024 to 6.676, p=0.044) as independent prognostic factors of OS on first-line therapy. The type of first-line therapy (ICB vs TT) was not independently prognostic. As second-line therapy BRAF+MEK showed the best survival outcome compared with ICB and other therapies (HR for CTLA-4+PD-1 compared with BRAF+MEK: 13.964, 95% CI 3.6 to 54.4, p<0.001; for PD-1 vs BRAF+MEK: 4.587 95% CI 1.3 to 16.8, p=0.022 for OS). Regarding therapy sequencing, patients treated with ICB as first-line therapy and BRAF+MEK as second-line therapy showed an improved OS (HR for CTLA-4+PD-1 followed by BRAF+MEK: 0.370, 95% CI 0.157 to 0.934, p=0.035; HR for PD-1 followed by BRAF+MEK: 0.290, 95% CI 0.092 to 0.918, p=0.035) compared with patients starting with BRAF+MEK in first-line therapy. There was no significant survival difference when comparing first-line therapy with CTLA-4+PD-1 ICB with PD-1 ICB. CONCLUSIONS In patients with MBM, the addition of radiotherapy resulted in a favorable OS on systemic therapy. In BRAF-mutated MBM patients, ICB as first-line therapy and BRAF+MEK as second-line therapy were associated with a significantly prolonged OS.
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Affiliation(s)
- Cindy Franklin
- Department of Dermatology and Venereology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Peter Mohr
- Department of Dermatology, Elbe Kliniken Buxtehude, Buxtehude, Germany
| | - Leonie Bluhm
- Department of Dermatology, Elbe Kliniken Buxtehude, Buxtehude, Germany
| | - Imke Grimmelmann
- Department of Dermatology, Hannover Medical School, Hannover, Germany
| | - Ralf Gutzmer
- Department of Dermatology, Muehlenkreiskliniken Minden and Ruhr University Bochum, Minden, 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, Dresden, Germany
| | - Marlene Garzarolli
- 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, Dresden, Germany
| | - Michael Weichenthal
- Department of Dermatology, Skin Cancer Center, Schleswig-Holstein University Hospital, Campus Kiel, Kiel, Germany
| | - Claudia Pfoehler
- Department of Dermatology, Saarland University Medical School, Homburg/Saar, Germany
| | - Rudolf Herbst
- Department of Dermatology, HELIOS Klinikum Erfurt, Erfurt, Germany
| | | | - Jochen Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Heidelberg, Germany
| | - Jens Ulrich
- Department of Dermatology and Skin Cancer Center, Harzklinikum Dorothea Christiane Erxleben, Quedlinburg, Germany
| | - Dirk Debus
- Department of Dermatology, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Martin Kaatz
- Department of Dermatology, SRH Wald-Klinikum Gera, Gera, Germany
| | - Andrea Forschner
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - Ulrike Leiter
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - Dorothee Nashan
- Department of Dermatology, Hospital of Dortmund, Dortmund, Germany
| | - Alexander Kreuter
- Department of Dermatology, Venereology and Allergology, HELIOS St. Elisabeth Klinik Oberhausen, University Witten-Herdecke, Herdecke, Germany
| | - Michael Sachse
- Department of Dermatology, Klinikum Bremerhaven Reinkenheide, Bremerhaven, Germany
| | - Julia Welzel
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
| | - Lucie Heinzerling
- Department of Dermatology and Allergology, Ludwig-Maximilian University, München, Germany
| | - Frank Meiss
- Department of Dermatology and Venereology, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital of Münster, Münster, Germany
| | - Thilo Gambichler
- Department of Dermatology, Ruhr University Bochum, Bochum, Germany
| | - Gerhard Weyandt
- Department of Dermatology and Allergology, Hospital Bayreuth, Bayreuth, Germany
| | - Edgar Dippel
- Department of Dermatology, Ludwigshafen Medical Center, Ludwigshafen, Germany
| | - Kerstin Schatton
- Department of Dermatology, Heinrich Heine University, Düsseldorf, Germany
| | - Eren Celik
- Department of Radiation Oncology and Cyberknife Center, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Maike Trommer
- Department of Radiation Oncology and Cyberknife Center, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Iris Helfrich
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany and German Cancer Consortium (DKTK) partner site Essen/Düsseldorf, Essen, Germany
| | - Alexander Roesch
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany and German Cancer Consortium (DKTK) partner site Essen/Düsseldorf, Essen, Germany
| | - Lisa Zimmer
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany and German Cancer Consortium (DKTK) partner site Essen/Düsseldorf, Essen, Germany
| | - Elisabeth Livingstone
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany and German Cancer Consortium (DKTK) partner site Essen/Düsseldorf, Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany and German Cancer Consortium (DKTK) partner site Essen/Düsseldorf, Essen, Germany
| | - Susanne Horn
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany and German Cancer Consortium (DKTK) partner site Essen/Düsseldorf, Essen, Germany.,Rudolf-Schönheimer-Institute of Biochemistry, Medical Faculty of the University Leipzig, Leipzig, Germany
| | - Selma Ugurel
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany and German Cancer Consortium (DKTK) partner site Essen/Düsseldorf, Essen, Germany
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Kreft S, Glutsch V, Zaremba A, Schummer P, Mohr P, Grimmelmann I, Gutzmer R, Meier F, Pföhler C, Sachse MM, Meiss F, Forschner A, Haferkamp S, Welzel J, Terheyden P, Herbst R, Utikal J, Kaatz M, Weishaupt C, Kreuter A, Debus D, Duecker P, Sindrilaru A, Löffler H, Schley G, Weichenthal M, Schadendorf D, Ugurel S, Gesierich A, Schilling B. MAPKinase inhibition after failure of immune checkpoint blockade in patients with advanced melanoma - An evaluation of the multicenter prospective skin cancer registry ADOREG. Eur J Cancer 2022; 167:32-41. [PMID: 35366571 DOI: 10.1016/j.ejca.2022.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/13/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Forty to sixty percent of patients with advanced melanoma show primary resistance to PD-1-based immunotherapy, 30-40% of initial responders also progress. Here, we evaluated the outcome of second-line targeted therapy (TT) after progression on PD-1-based immune checkpoint inhibition (ICI) in BRAFV600-mutated melanoma. In addition, we report data on the activity of re-exposure with PD-1-based regimes. METHODS Patients with advanced (non-resectable stage III or IV, AJCC 2017, 8th edition) melanoma progressing on PD-1-based ICI (nivolumab, pembrolizumab or ipilimumab plus nivolumab) and receiving second-line BRAF plus MEK inhibition were identified from the prospective multicenter skin cancer registry ADOREG. RESULTS We identified 108 patients with unresectable stage III or stage IV melanoma progressing on first-line ICI (nivolumab, pembrolizumab or ipilimumab plus nivolumab) and receiving second-line combined BRAF/MEK inhibition. Seventy-three percent of the cohort presented with primary PD-1 resistant disease. Median progression-free survival (PFS) on ICI was 2.6 (95% CI 2.2-2.9) months. Median PFS on subsequent TT was 6.6 (95% CI 5.4-7.8) months. Median OS from start of second-line TT was 16.0 (95% CI 11.2-20.8) months. The 3-year PFS and OS rates on second-line TT were 16% and 30%. The objective response rate (ORR) and disease control rate (DCR) to TT were 42.6% and 55.6%. In patients with brain metastases, the ORR and DCR were 31.4% and 43.1%. Patients without brain metastases showed an ORR and DCR of 52.6% and 66.7%, respectively. Response to first-line ICI was associated with a numerically higher ORR and DCR to second-line TT and improved OS on TT. Twenty-three patients received third-line ICI of whom two patients showed an objective response. CONCLUSIONS BRAF plus MEK inhibition shows meaningful activity and outcome in patients with advanced melanoma resistant to anti-PD-1-based immunotherapy. Rates of long-term benefit and survival in our study were similar to those reported for treatment-naïve patients receiving first-line MAPKi.
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Affiliation(s)
- Sophia Kreft
- Department of Dermatology, University Hospital Essen & German Cancer Consortium (DKTK), Partner Site Essen, Germany
| | - Valerie Glutsch
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Anne Zaremba
- Department of Dermatology, University Hospital Essen & German Cancer Consortium (DKTK), Partner Site Essen, Germany
| | - Patrick Schummer
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Peter Mohr
- Department of Dermatology, Elbe Kliniken Buxtehude, Buxtehude, Germany
| | - Imke Grimmelmann
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Ralf Gutzmer
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany; Department of Dermatology, Mühlenkreiskliniken, Johannes Wesling Medical Center, Ruhr-University, Minden, 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, Germany
| | - Claudia Pföhler
- Saarland University Medical School, Department of Dermatology, Homburg/Saar, Germany
| | - Michael Max Sachse
- Department of Dermatology, Allergology and Phlebology, Klinikum Bremerhaven Reinkenheide, Bremerhaven, Germany
| | - Frank Meiss
- Department of Dermatology and Venereology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andrea Forschner
- Department of Dermatology, University Medical Center Tübingen, Tübingen, Germany
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Julia Welzel
- Department of Dermatology, University Hospital Augsburg, Augsburg, Germany
| | - Patrick Terheyden
- Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany
| | - Rudolf Herbst
- Department of Dermatology, Helios Klinikum Erfurt, Erfurt, Germany
| | - Jochen Utikal
- Department of Dermatology, Venerology, and Allergology, University Medical Center, Ruprecht-Karl University of Heidelberg, Mannheim, Germany; Skin Cancer Unit, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Martin Kaatz
- Department of Dermatology, Wald-Klinikum Gera, Gera, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - Alexander Kreuter
- Department of Dermatology, Venereology and Allergology, Helios St. Elisabeth Klinik Oberhausen, University Witten-Herdecke, Oberhausen, Germany
| | - Dirk Debus
- Department of Dermatology, Paracelsus Medical University Nuremberg, Nuremberg General Hospital, Nuremberg, Germany
| | - Pia Duecker
- Department of Dermatology, Hospital Dortmund, Dortmund, Germany
| | - Anca Sindrilaru
- Department of Dermatology, University Hospital of Ulm, Ulm, Germany
| | - Harald Löffler
- Department of Dermatology, SLK Hospital Heilbronn, Heilbronn, Germany
| | - Gaston Schley
- Department of Dermatology, Helios Klinikum Schwerin, Schwerin, Germany
| | | | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen & German Cancer Consortium (DKTK), Partner Site Essen, Germany
| | - Selma Ugurel
- Department of Dermatology, University Hospital Essen & German Cancer Consortium (DKTK), Partner Site Essen, Germany
| | - Anja Gesierich
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Bastian Schilling
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany.
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15
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Dietze L, Metze D, Weishaupt C, Kerkhoff A, Böhm M. Cutaneous lymphangiosis carcinomatosa of gastric cancer triggered by herpes zoster. Int J Dermatol 2022; 61:e321-e322. [PMID: 35353918 DOI: 10.1111/ijd.16187] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/10/2022] [Accepted: 03/11/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Lena Dietze
- Department of Dermatology, University of Münster, Münster, Germany
| | - Dieter Metze
- Department of Dermatology, University of Münster, Münster, Germany
| | | | - Andrea Kerkhoff
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University of Münster, Münster, Germany
| | - Markus Böhm
- Department of Dermatology, University of Münster, Münster, Germany
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16
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Elsayad K, Rolf D, Sunderkötter C, Weishaupt C, Müller EC, Nawar T, Stranzenbach R, Livingstone E, Stadler R, Steinbrink K, Moritz RKC, Eich HT. Niedrig dosierte Ganzhautelektronenbestrahlung mit oraler Bexaroten-Erhaltungstherapie beim kutanen T-Zell-Lymphom. J Dtsch Dermatol Ges 2022; 20:279-286. [PMID: 35304957 DOI: 10.1111/ddg.14657_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/13/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Khaled Elsayad
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Münster
| | - Daniel Rolf
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Münster
| | - Cord Sunderkötter
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie - Universitätsklinikum Halle
| | | | | | - Tarek Nawar
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Münster
| | - Rene Stranzenbach
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Bochum
| | | | - Rudolf Stadler
- Universitätsklinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Johannes Wesling Klinikum Minden, Universität Bochum, Minden
| | | | - Rose K C Moritz
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie - Universitätsklinikum Halle
| | - Hans Theodor Eich
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Münster
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17
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Helbig D, Ziemer M, Dippel E, Erdmann M, Hillen U, Leiter U, Mentzel T, Osterhoff G, Ugurel S, Utikal J, von Bubnoff D, Weishaupt C, Grabbe S. S1‐Leitlinie Atypisches Fibroxanthom (AFX) und pleomorphes dermales Sarkom (PDS). J Dtsch Dermatol Ges 2022; 20:235-245. [PMID: 35146874 DOI: 10.1111/ddg.14700_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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)
- Doris Helbig
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Köln
| | - Mirjana Ziemer
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig
| | - Edgar Dippel
- Klinik für Dermatologie und Venerologie, Klinikum der Stadt Ludwigshafen
| | - Michael Erdmann
- Hautklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen
| | - Uwe Hillen
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Berlin Neukölln
| | - Ulrike Leiter
- Zentrum für Dermatoonkologie, Universitäts-Hautklinikum, Eberhard-Karls-Universität Tübingen
| | | | - Georg Osterhoff
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig AöR
| | - Selma Ugurel
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
| | - Jochen Utikal
- Klinische Kooperationseinheit Dermatoonkologie des Deutschen Krebsforschungszentrum Heidelberg (DKFZ) und der Klinik für Dermatologie, Venerologie und Allergologie, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg
| | - Dagmar von Bubnoff
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | | | - Stephan Grabbe
- Hautklinik der Universitätsmedizin, Johannes Gutenberg Universität Mainz
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Helbig D, Ziemer M, Dippel E, Erdmann M, Hillen U, Leiter U, Mentzel T, Osterhoff G, Ugurel S, Utikal J, von Bubnoff D, Weishaupt C, Grabbe S. S1-guideline atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS). J Dtsch Dermatol Ges 2022; 20:235-243. [PMID: 35099104 DOI: 10.1111/ddg.14700] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Abstract
Atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS) are rare cutaneous neoplasms representing histomorphological, genetic as well as epigenetic variants of a disease spectrum. Both tumors typically manifest as nonspecific, often ulcerated, skin- to flesh-colored nodules in chronically sun-damaged skin of elderly male patients. AFX is a rather well demarcated, often rapidly growing tumor. PDS tumors are poorly circumscribed and are characterized by aggressive infiltrative growth. Fast as well as slow growth behavior has been reported for both tumors. Histologically, both are composed of spindle-shaped and epithelioid tumor cells with pleomorphic nuclei as well as atypical multinucleated giant cells. Atypical mitoses are common. In contrast to AFX, PDS involves relevant parts of the subcutis and shows areas of tumor necrosis and/or perineural infiltration. Due to the poorly differentiated nature of AFX/PDS (Grade 3), histopathologically similar cutaneous sarcomas, undifferentiated carcinomas, melanomas and other diseases have to be excluded by immunohistochemical analysis. The treatment of choice is micrographically controlled surgery. In cases of AFX, a cure can be assumed after complete excision. Local recurrence rates are low as long as PDS tumors are surgically removed with a safety margin of 2 cm. Metastasis is rare and mostly associated with very thick or incompletely excised tumors; it mainly affects the skin and lymph nodes. Distant metastasis is even more rare. No approved and effective systemic therapy has been established.
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Affiliation(s)
- Doris Helbig
- Department of Dermatology and Venereology, University Hospital Cologne, Germany
| | - Mirjana Ziemer
- Department of Dermatology, Venereology, and Allergology, University Hospital Leipzig, Germany
| | - Edgar Dippel
- Department of Dermatology and Venereology, University Hospital Ludwigshafen, Germany
| | - Michael Erdmann
- Department of Dermatology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen - European Metropolis Region Nürnberg, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Uwe Hillen
- Department of Dermatology and Venereology, Vivantes Klinikum Berlin Neukölln, Berlin, Germany
| | - Ulrike Leiter
- Center for Dermato-Oncology, University Hospital Dermatology, Eberhard-Karls-Universität Tübingen, Germany
| | | | - Georg Osterhoff
- Department and Clinic for Orthopedics, Trauma Surgery, and Plastic Surgery, University Hospital Leipzig AöR, Germany
| | - Selma Ugurel
- Department of Dermatology, Venereology, and Allergology, University Hospital Essen, Germany
| | - Jochen Utikal
- Clinical Cooperation Unit Dermatology of the German Cancer Research Institute Heidelberg (DKFZ) and the Department of Dermatology, Venereology, and Allergology, Medical Faculty Mannheim, Ruprecht-Karls-Universität Heidelberg, Germany
| | - Dagmar von Bubnoff
- Department of Dermatology, Venereology, and Allergology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | | | - Stephan Grabbe
- Department of Dermatology, University Hospital, Johannes Gutenberg University Mainz, Germany
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19
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Elsayad K, Rolf D, Sunderkötter C, Weishaupt C, Müller EC, Nawar T, Stranzenbach R, Livingstone E, Stadler R, Steinbrink K, Moritz RKC, Eich HT. Low-dose total skin electron beam therapy plus oral bexarotene maintenance therapy for cutaneous T-cell lymphoma. J Dtsch Dermatol Ges 2022; 20:279-285. [PMID: 34984837 DOI: 10.1111/ddg.14657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/13/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Total skin electron beam therapy (TSEBT) combined with systemic therapy or maintenance treatment is a reasonable approach to enhance the remission rate and duration in mycosis fungoides (MF) and Sézary syndrome (SS). This study assesses the efficacy of oral bexarotene therapy after low-dose TSEBT for patients with MF and SS. METHODS In this prospective observational study, we recruited MF/SS patients for treatment with low-dose total skin electron beam therapy (TSEBT) with or without bexarotene therapy to describe outcomes and toxicities. RESULTS Forty-six subjects with MF or SS underwent TSEBT between 2016 and 2021 at our institute. Following TSEBT, 27 patients (59 %) received oral bexarotene treatment. The median follow-up was 13 months. The overall response rate (ORR) for the cohort was 85 %. The response rate was significantly higher with combined modality (CM) than TSEBT alone (96 % vs. 68 %, p = 0.03). Median progression-free survival (PFS) for the CM was 17 months versus five months following TSEBT alone (p = 0.001). One patient (4 %) in the retinoid group discontinued the bexarotene therapy because of adverse events. The administration of bexarotene therapy did not increase radiation-related toxicities. CONCLUSIONS Response rate and progression-free survival might be improved with TSEBT in combination with oral bexarotene compared to TSEBT alone.
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Affiliation(s)
- Khaled Elsayad
- Department of Radiation Oncology, University Hospital of Muenster, Munster, Germany
| | - Daniel Rolf
- Department of Radiation Oncology, University Hospital of Muenster, Munster, Germany
| | - Cord Sunderkötter
- Department of Dermatology and Venerology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital of Muenster, Munster, Germany
| | | | - Tarek Nawar
- Department of Radiation Oncology, University Hospital of Muenster, Munster, Germany
| | - Rene Stranzenbach
- Department of Dermatology, University Hospital of Bochum, Bochum, Germany
| | | | - Rudolf Stadler
- Department of Dermatology, Johannes Wesling Medical Centre, University of Bochum, Minden, German
| | - Kerstin Steinbrink
- Department of Dermatology, University Hospital of Muenster, Munster, Germany
| | - Rose K C Moritz
- Department of Dermatology and Venerology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital of Muenster, Munster, Germany
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Codó P, Eigentler T, Heinzerling L, Krauss J, Weishaupt C, Ochsenreither S, Lebbe C, Mohr P, Oliva M, Oberoi H, Terheyden P, Pérez JT, Bauernfeind FG, Fluck M, Richtig E, Soria A, Gonzalez M, Funkner F, Wengenmayer P, Vahrenhorst D, Seibel T, Quintini G, Schmitt-Bormann B, Scheel B, Falk M, Gnad-Vogt U. 473 Immune profiling of patients with advanced solid tumors treated with intratumorally administered CV8102 as a single-agent or in combination with anti-PD-1 antibodies in phase I clinical trial. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundCV8102 is a non-coding, non-capped RNA complexed with a carrier peptide activating the innate (via TLR7/8, RIG-I) and adaptive immune system.1 2 An ongoing phase I trial is investigating the intratumoral (i.t.) administration of CV8102 in patients with advanced cutaneous melanoma (cMEL), squamous cell carcinoma of the skin (cSCC) or head and neck (hnSCC) and adenoid cystic carcinoma (ACC), either as a single agent or in combination with systemic anti-PD-1 antibodies. Preliminary immune profiling results will be reported.MethodsAn open-label, cohort-based, dose escalation and expansion study in patients with advanced cMEL, cSCC, hnSCC or ACC is ongoing investigating CV8102 i.t. as single agent and in combination with anti-PD-1 antibodies. Eight i.t. injections of CV8102 were administered over a 12 week period with optional continuing treatment in case of clinical benefit. In the initial dose escalation part, the recommended phase II dose for subsequent cohort expansion was defined. Blood samples for immune cell phenotyping, RNA sequencing (RNAseq) and serum cytokine/chemokine analysis were collected at baseline and multiple time points during the treatment period. For characterization of the tumor microenvironment (TME), optional core needle biopsies of injected and/or non-injected lesions were taken before, during and after treatment. Changes on various tumor-infiltrating immune cells were assessed by multiplex immunofluorescence (MultiOmyx < sup >TM</sup > ) and immune-related gene expression profiling using nCounter® Pan Cancer IO360 < sup >TM</sup > panel (NanoString).ResultsDuring the dose escalation part, 33 patients received CV8102 (dose range of 25–900 µg) as single agent and 25 patients received CV8102 in combination with an anti-PD-1 antibody. A dose of 600 µg was selected as recommended phase II dose. Serum cytokine/chemokine and blood RNAseq analysis showed transient increases in several markers like interferons alpha and gamma after the first dose. First analyses of paired biopsies showed changes in the TME of injected and non-injected lesions. Complete results of cytokine and chemokine analysis in serum and blood RNAseq for the dose escalation cohorts will be presented. Multiplex immunofluorescence and gene expression profiling from paired biopsies from individual patients will be also included.ConclusionsIntratumoral injection of CV8102 activated several cytokine/chemokine pathways in the peripheral blood and showed immunological changes in the tumor microenvironment of injected and non-injected lesions.Trial RegistrationNCT03291002ReferencesZiegler A, Soldner C, Lienenklaus S, Spanier J, Trittel S, Riese P, Kramps T, Weiss S, Heidenreich R, Jasny E, Guzmán CA, Kallen KJ, Fotin-Mleczek M, Kalinke U. A New RNA-Based Adjuvant Enhances Virus-Specific Vaccine Responses by Locally Triggering TLR- and RLH-Dependent Effects. J Immunol 2017;198(4):1595–1605. doi: 10.4049/jimmunol.1601129.Heidenreich R, Jasny E, Kowalczyk A, Lutz J, Probst J, Baumhof P, Scheel B, Voss S, Kallen KJ, Fotin-Mleczek M. A novel RNA-based adjuvant combines strong immunostimulatory capacities with a favorable safety profile. Int J Cancer 2015 Jul 15;137(2):372–84. doi: 10.1002/ijc.29402.Ethics ApprovalThe study was approved by the Central Ethics Committees in Tuebingen, Germany under 785/2016AMG1, in France by the COMITE DE PROTECTION DES PERSONNES SUD-EST I under 2019–49, approval dated 17-May-2019, in Barcelona, Spain by the CEC COMITÉ DE ÉTICA DE INVESTIGACIÓN CLÍNICA CON MEDICAMENTOS del Hospital Universitari Vall d’Hebron, approval date 28-Nov-2019 under the EUdraCT number, in Austria by the Central Ethics Committee in Graz under 31–426 ex 18/19 approved on 19-Sep-2019.ConsentWritten informed consent from the patient was obtained for publication of this abstract and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.
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Beylot-Barry M, Booken N, Weishaupt C, Medley M, Sun W, Rosen JP. Efficacy of mogamulizumab in mycosis fungoides by patient blood involvement and time to response analysis in mycosis fungoides and Sézary syndrome: a post hoc analysis of the MAVORIC study. Eur J Cancer 2021; 156 Suppl 1:S47-S48. [PMID: 34649657 DOI: 10.1016/s0959-8049(21)00714-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marie Beylot-Barry
- Univ. Bordeaux, INSERM, BaRITOn, U1053, Bordeaux, France; Department of Dermatology, CHU Bordeaux, Bordeaux, France
| | - Nina Booken
- Department of Dermatology and Venereology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - Michael Medley
- Kyowa Kirin International, Buckinghamshire, United Kingdom
| | - Wei Sun
- Kyowa Kirin Pharmaceutical Development, Princeton, NJ, United States
| | - Jan-Paul Rosen
- Kyowa Kirin International, Buckinghamshire, United Kingdom
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Gutzmer R, Eigentler T, Mohr P, Weichenthal M, Dücker P, Gebhardt C, Göppner D, Grimmelmann I, Haferkamp S, Kähler K, Meier F, Pföhler C, Sickmann T, Sindrilaru A, Terheyden P, Ugurel S, Ulrich J, Utikal J, Weishaupt C, Schadendorf D. 1079P Comparison of effectiveness and safety of nivolumab monotherapy or in combination therapy with ipilimumab in therapy-naïve and pretreated patients with advanced melanoma within the German noninterventional study NICO. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1464] [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: 10/20/2022] Open
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Knispel S, Stang A, Zimmer L, Lax H, Gutzmer R, Heinzerling L, Weishaupt C, Pföhler C, Gesierich A, Herbst R, Kaehler KC, Weide B, Berking C, Loquai C, Utikal J, Terheyden P, Kaatz M, Schlaak M, Kreuter A, Ulrich J, Mohr P, Dippel E, Livingstone E, Becker JC, Weichenthal M, Chorti E, Gronewold J, Schadendorf D, Ugurel S. Impact of a preceding radiotherapy on the outcome of immune checkpoint inhibition in metastatic melanoma: a multicenter retrospective cohort study of the DeCOG. J Immunother Cancer 2021; 8:jitc-2019-000395. [PMID: 32371460 PMCID: PMC7228559 DOI: 10.1136/jitc-2019-000395] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2020] [Indexed: 12/16/2022] Open
Abstract
Background Immune checkpoint inhibition (ICI) is an essential treatment option in melanoma. Its outcome may be improved by a preceding radiation of metastases. This study aimed to investigate the impact of a preceding radiotherapy on the clinical outcome of ICI treatment. Methods This multicenter retrospective cohort study included patients who received anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) or anti-programmed cell death protein 1 (PD-1) ICI with or without preceding radiotherapy for unresectable metastatic melanoma. ICI therapy outcome was measured as best overall response (BOR), progression-free (PFS) and overall survival (OS). Response and survival analyses were adjusted for confounders identified by directed acyclic graphs. Adjusted survival curves were calculated using inverse probability treatment weighting. Results 835 patients who received ICI (anti-CTLA-4, n=596; anti-PD-1, n=239) at 16 centers were analyzed, whereof 235 received a preceding radiotherapy of metastatic lesions in stage IV disease. The most frequent organ sites irradiated prior to ICI therapy were brain (51.1%), lymph nodes (17.9%) and bone (17.9%). After multivariable adjustment for confounders, no relevant differences in ICI therapy outcome were observed between cohorts with and without preceding radiotherapy. BOR was 8.7% vs 13.0% for anti-CTLA-4 (adjusted relative risk (RR)=1.47; 95% CI=0.81 to 2.65; p=0.20), and 16.5% vs 25.3% for anti-PD-1 (RR=0.93; 95% CI=0.49 to 1.77; p=0.82). Survival probabilities were similar for cohorts with and without preceding radiotherapy, for anti-CTLA-4 (PFS, adjusted HR=1.02, 95% CI=0.86 to 1.25, p=0.74; OS, HR=1.08, 95% CI=0.81 to 1.44, p=0.61) and for anti-PD-1 (PFS, HR=0.84, 95% CI=0.57 to 1.26, p=0.41; OS, HR=0.73, 95% CI=0.43 to 1.25, p=0.26). Patients who received radiation last before ICI (n=137) revealed no better survival than those who had one or more treatment lines between radiation and start of ICI (n=86). In 223 patients with brain metastases, we found no relevant survival differences on ICI with and without preceding radiotherapy. Conclusions This study detected no evidence for a relevant favorable impact of a preceding radiotherapy on anti-CTLA-4 or anti-PD-1 ICI treatment outcome in metastatic melanoma.
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Affiliation(s)
- Sarah Knispel
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Stang
- Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hildegard Lax
- Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Ralf Gutzmer
- Skin Cancer Center Hannover, Department of Dermatology, Hannover Medical School, Hannover, Germany
| | - Lucie Heinzerling
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Claudia Pföhler
- Department of Dermatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Anja Gesierich
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | - Rudolf Herbst
- Department of Dermatology, Helios Klinikum Erfurt, Erfurt, Germany
| | | | - Benjamin Weide
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - Carola Berking
- Department of Dermatology, Ludwig-Maximilians University Munich, Munich, Germany
| | - Carmen Loquai
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Jochen Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ) and Department of Dermatology, Venereology and Allergology, niversity Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - Patrick Terheyden
- Department of Dermatology, University Hospital Lübeck, Lübeck, Germany
| | - Martin Kaatz
- Department of Dermatology, Wald-Klinikum Gera, Gera, Germany
| | - Max Schlaak
- Department of Dermatology, Ludwig-Maximilians University Munich, Munich, Germany.,Department of Dermatology, Skin Cancer Center at CIO Koeln/Bonn, University Hospital Cologne, Cologne, Germany
| | - Alexander Kreuter
- Department of Dermatology, Helios St. Elisabeth Hospital Oberhausen, University of Witten-Herdecke, Oberhausen, Germany
| | - Jens Ulrich
- Department of Dermatology, Klinikum Quedlinburg, Quedlinburg, Germany
| | - Peter Mohr
- Department of Dermatology, Elbe-Klinikum Buxtehude, Buxtehude, Germany
| | - Edgar Dippel
- Department of Dermatology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Elisabeth Livingstone
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jürgen C Becker
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Translational Skin Cancer Research, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Deutsches Konsortium für Translationale Krebsforschung (DKTK), Essen, Germany
| | | | - Eleftheria Chorti
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Janine Gronewold
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Selma Ugurel
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Zaremba A, Philip M, Hassel JC, Glutsch V, Fiocco Z, Loquai C, Rafei-Shamsabadi D, Gutzmer R, Utikal J, Haferkamp S, Reinhardt L, Kähler KC, Weishaupt C, Moreira A, Thoms KM, Wilhelm T, Pföhler C, Roesch A, Ugurel S, Zimmer L, Stadtler N, Sucker A, Kiecker F, Heinzerling L, Meier F, Meiss F, Schlaak M, Schilling B, Horn S, Schadendorf D, Livingstone E. Clinical characteristics and therapy response in unresectable melanoma patients stage IIIB-IIID with in-transit and satellite metastases. Eur J Cancer 2021; 152:139-154. [PMID: 34102453 DOI: 10.1016/j.ejca.2021.04.032] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/07/2021] [Accepted: 04/22/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Cutaneous melanoma is notorious for the development of in-transit metastases (ITM). For unknown biological reasons, ITM remain the leading tumour manifestation without progression to distant sites in some patients. METHODS In total, 191 patients with initially unresectable stage III ITM and satellite metastases from 16 skin cancer centres were retrospectively evaluated for their tumour characteristics, survival and therapy response. Three groups according to disease kinetics (no distant progress, slow (>6 months) and fast (<6 months) distant progression) were analysed separately. RESULTS Median follow-up time was 30.5 (range 0.8-154.0) months from unresectable ITM. Progression to stage IV was observed in 56.5% of cases. Patients without distant metastasis were more often female, older (>70 years) and presented as stage III with lymph node or ITM at initial diagnosis in 45.7% of cases. Melanoma located on the leg had a significantly better overall survival (OS) from time of initial diagnosis compared to non-leg localised primaries (hazard ratio [HR] = 0.61, 95% confidence interval [CI] 0.40-0.91; p = 0.017), but not from diagnosis of unresectable stage III (HR = 0.67, 95% CI 0.45-1.02; p = 0.06). Forty percent of patients received local therapy for satellite and ITM. Overall response rate (ORR) to all local first-line treatments was 38%; disease control rate (DCR) was 49%. In total, 72.3% of patients received systemic therapy for unresectable stage IIIB-D. ORR for targeted therapy (n = 19) was highest with 63.2% and DCR was 84.2% compared to an ORR of 31.4% and a DCR of 54.3% in PD-1 treated patients (n = 70). Patients receiving PD-1 and intralesional talimogene laherparepvec (n = 12) had an ORR of 41.7% and a DCR of 75%. CONCLUSION Patients with unresectable ITM and without distant progression are more often female, older, and have a primary on the leg. Response to PD-1 inhibitors in this cohort was lower than expected, but further investigation is required to elucidate the biology of ITM development and the interplay with the immune system.
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Affiliation(s)
- Anne Zaremba
- Dept. of Dermatology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany.
| | - Manuel Philip
- Dept. of Dermatology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Jessica C Hassel
- Dept. of Dermatology, National Center for Tumor Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Valerie Glutsch
- Dept. of Dermatology, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - Zeno Fiocco
- Dept. of Dermatology and Allergology, University Hospital, LMU Munich, Frauenlobstraße 9-11, 80337 Munich, Germany
| | - Carmen Loquai
- Dept. of Dermatology, Venerology and Allergology, University Medical Center Mainz, Germany
| | | | - Ralf Gutzmer
- Dept. of Dermatology, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Jochen Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 58167, Mannheim, Germany
| | | | - Lydia Reinhardt
- Skin Cancer Center at the University Cancer Centre Dresden, National Center for Tumor Diseases, Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Katharina C Kähler
- Dept. of Dermatology, Venerology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Carsten Weishaupt
- Dept. of Dermatology, University Hospital Münster, Von Esmarch Str. 58, 48149, Münster, Germany
| | - Alvaro Moreira
- Dept. of Dermatology, Venerology and Allergology, University Hospital Erlangen, Germany; The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; The Kimberly and Eric J. Waldman Department of Dermatology at Mount Sinai, New York, NY, 10029, USA
| | - Kai-Martin Thoms
- Dept. of Dermatology, University Medical Center Goettingen Goettingen, Germany
| | - Tabea Wilhelm
- Clinic for Dermatology, Venerology and Allergology, Havelklinik Berlin, Germany
| | - Claudia Pföhler
- Saarland University Medical School, Department of Dermatology, Homburg, Saar, Germany
| | - Alexander Roesch
- Dept. of Dermatology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Selma Ugurel
- Dept. of Dermatology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Lisa Zimmer
- Dept. of Dermatology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Nadine Stadtler
- Dept. of Dermatology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Antje Sucker
- Dept. of Dermatology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Felix Kiecker
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Dermatology, Venerology and Allergology, Berlin, Germany
| | - Lucie Heinzerling
- Dept. of Dermatology and Allergology, University Hospital, LMU Munich, Frauenlobstraße 9-11, 80337 Munich, Germany; Dept. of Dermatology, Venerology and Allergology, University Hospital Erlangen, Germany
| | - Friedegund Meier
- Skin Cancer Center at the University Cancer Centre Dresden, National Center for Tumor Diseases, Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Frank Meiss
- Dept. of Dermatology, Venerology and Allergology, University Hospital Freiburg, Germany
| | - Max Schlaak
- Dept. of Dermatology and Allergology, University Hospital, LMU Munich, Frauenlobstraße 9-11, 80337 Munich, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Dermatology, Venerology and Allergology, Berlin, Germany
| | - Bastian Schilling
- Dept. of Dermatology, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - Susanne Horn
- Dept. of Dermatology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany; Rudolf-Schönheimer-Institute of Biochemistry, Medical Faculty of the University Leipzig, Johannisallee 30, 04103, Leipzig, Germany
| | - Dirk Schadendorf
- Dept. of Dermatology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Elisabeth Livingstone
- Dept. of Dermatology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany
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25
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Knispel S, Gassenmaier M, Menzies AM, Loquai C, Johnson DB, Franklin C, Gutzmer R, Hassel JC, Weishaupt C, Eigentler T, Schilling B, Schummer P, Sirokay J, Kiecker F, Owen CN, Fleischer MI, Cann C, Kähler KC, Mohr P, Bluhm L, Niebel D, Thoms KM, Goldinger SM, Reinhardt L, Meier F, Berking C, Reinhard R, Susok L, Ascierto PA, Drexler K, Pföhler C, Tietze J, Heinzerling L, Livingstone E, Ugurel S, Long GV, Stang A, Schadendorf D, Zimmer L. Outcome of melanoma patients with elevated LDH treated with first-line targeted therapy or PD-1-based immune checkpoint inhibition. Eur J Cancer 2021; 148:61-75. [PMID: 33735811 DOI: 10.1016/j.ejca.2021.01.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 11/27/2020] [Revised: 01/24/2021] [Accepted: 01/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Elevated lactate dehydrogenase (LDH) is a known predictive and prognostic factor for a poor outcome in patients with metastatic melanoma. It is unclear whether first-line targeted therapy (TT) or immune checkpoint inhibition (ICI) is more beneficial in melanoma patients with elevated LDH because prospective studies in this area are lacking. METHODS This multicentre retrospective cohort study was conducted at 25 melanoma centres worldwide to analyse progression-free survival (PFS) and overall survival (OS) among melanoma patients with elevated LDH. The role of confounders was addressed by using inverse probability of treatment weighting. RESULTS Among 173 BRAFV600-mutant patients, PFS at 12 months in the TT group was 22% compared with 52% in the combined anti-PD-1 and anti-CTLA-4 group (HR 0.6, 95% CI 0.4-1.0, p = 0.07) and 18% in the anti-PD-1 monotherapy group (HR 1.8, 95% CI 1.2-2.8, p = 0.003). Twelve months' OS was 48% in the TT group compared with 83% in the combined anti-PD-1 and anti-CTLA-4 group (HR 0.5, 95% CI 0.3-1.0, p = 0.03) and 50% in the anti-PD-1 monotherapy group (HR 1.2, 95% CI 0.8-2.0, p = 0.37). The ORR in the TT group was 63%, compared with 55% and 20% in the combined anti-PD-1 and anti-CTLA-4 and anti-PD-1 monotherapy group, respectively. Among 314 patients receiving ICI first-line, PFS at 12 months was 33% in the anti-PD-1 group versus 38% in the combined anti-PD-1 and anti-CTLA-4 group (HR 0.8, 95% CI 0.6-1.0; p = 0.07). OS at 12 months was 54% in the anti-PD-1 group versus 66% in the combined ICI group (HR 0.7, 95% CI 0.5-1.0; p = 0.03). The ORR was 30% in the anti-PD-1 monotherapy group and 43% in the combined anti-PD-1 and anti-CTLA-4 group. Results from multivariate analysis confirmed the absence of qualitative confounding. CONCLUSIONS Among BRAF-mutant patients with elevated LDH, combined anti-PD-1 and anti-CTLA-4 blockade seems to be associated with prolonged OS compared with first-line TT. Among patients receiving ICI as a first-line treatment, OS appears to be longer for the combination of anti-PD-1 and anti-CTLA-4 than for anti-PD-1 alone.
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Affiliation(s)
- Sarah Knispel
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | | | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, Australia
| | - Carmen Loquai
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | | | - Cindy Franklin
- Department of Dermatology and Venereology, Skin Cancer Center at the Center of Integrated Oncology (CIO) Köln Bonn, University Hospital of Cologne, Cologne, Germany
| | - Ralf Gutzmer
- Department of Dermatology and Allergy, Skin Cancer Center Hannover, Hannover Medical School, Hannover, Germany
| | - Jessica C Hassel
- Skin Cancer Center, Department of Dermatology and National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - Thomas Eigentler
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - Bastian Schilling
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | - Patrick Schummer
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | - Judith Sirokay
- Department of Dermatology, University Hospital Bonn, Bonn, Germany
| | - Felix Kiecker
- Department of Dermatology, University Hospital Charité Berlin, Berlin, Germany
| | - Carina N Owen
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Maria I Fleischer
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | | | - Katharina C Kähler
- Department of Dermatology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Peter Mohr
- Department of Dermatology, Elbe-Klinikum Buxtehude, Buxtehude, Germany
| | - Leonie Bluhm
- Department of Dermatology, Elbe-Klinikum Buxtehude, Buxtehude, Germany
| | - Dennis Niebel
- Department of Dermatology, University Hospital Bonn, Bonn, Germany
| | - Kai-Martin Thoms
- Department of Dermatology, University Medical Center Goettingen, Göttingen, Germany
| | - Simone M Goldinger
- Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - Lydia Reinhardt
- Department of Dermatology, Skin Cancer Center at the National Center for Tumor Diseases, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Friedegund Meier
- Department of Dermatology, Skin Cancer Center at the National Center for Tumor Diseases, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Carola Berking
- Department of Dermatology, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen - Metropolitan Region of Nuremberg, Deutsches Zentrum Immuntherapie, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Raphael Reinhard
- Skin Cancer Unit, German Cancer Research Center (DKFZ) and Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Mannheim, Germany
| | - Laura Susok
- Department of Dermatology, St. Josef-Hospital Bochum, Bochum, Germany
| | - Paolo A Ascierto
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Konstantin Drexler
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Claudia Pföhler
- Department of Dermatology, Saarland University Medical School, Homburg/Saar, Germany
| | - Julia Tietze
- Department of Dermatology, University Hospital Rostock, Rostock, Germany
| | - Lucie Heinzerling
- Department of Dermatology, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen - Metropolitan Region of Nuremberg, Deutsches Zentrum Immuntherapie, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Elisabeth Livingstone
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Selma Ugurel
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, Australia
| | - Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
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Nawar T, Elsayad K, Müller EC, Rolf D, Moritz RKC, Bormann E, Weishaupt C, Stranzenbach R, Stadler R, Moustakis C, Assaf C, Livingstone E, Sunderkötter C, Steinbrink K, Eich HT. Quality of life in patients with mycosis fungoides and Sézary syndrome undergoing low-dose total skin electron beam therapy with or without maintenance therapy. J Am Acad Dermatol 2021; 86:889-891. [PMID: 33722549 DOI: 10.1016/j.jaad.2021.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/17/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Tarek Nawar
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Khaled Elsayad
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany.
| | | | - Daniel Rolf
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Rose K C Moritz
- Department of Dermatology and Venereology, University Hospital Halle, Halle (Saale), Germany
| | - Eike Bormann
- Institute for Biometrics and Clinical Research, University of Muenster, Muenster, Germany
| | - Carsten Weishaupt
- Department of Dermatology and Venereology, University Hospital Muenster, Muenster, Germany
| | - René Stranzenbach
- Department of Dermatology and Venereology, University Hospital Bochum, Bochum, Germany
| | - Rudolf Stadler
- Department of Dermatology, Johannes Wesling Medical Centre, Minden, Germany
| | - Christos Moustakis
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Chalid Assaf
- Department of Dermatology, HELIOS Klinikum Krefeld, Krefeld, Germany
| | | | - Cord Sunderkötter
- Department of Dermatology and Venereology, University Hospital Halle, Halle (Saale), Germany
| | - Kerstin Steinbrink
- Department of Dermatology and Venereology, University Hospital Muenster, Muenster, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
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van Akkooi ACJ, Haferkamp S, Papa S, Franke V, Pinter A, Weishaupt C, Huber MA, Loquai C, Richtig E, Gokani P, Öhrling K, Louie KS, Mohr P. A Retrospective Chart Review Study of Real-World Use of Talimogene Laherparepvec in Unresectable Stage IIIB-IVM1a Melanoma in Four European Countries. Adv Ther 2021; 38:1245-1262. [PMID: 33368016 PMCID: PMC7889564 DOI: 10.1007/s12325-020-01590-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Received: 10/09/2020] [Accepted: 11/28/2020] [Indexed: 01/08/2023]
Abstract
Introduction Talimogene laherparepvec (T-VEC; IMLYGIC®, Amgen Inc.) is an oncolytic immunotherapy approved in Europe for the treatment of unresectable metastatic melanoma (stage IIIB–IVM1a). This study characterised real-world use of T-VEC in four European countries. Methods Data on demographics, treatment pattern, safety, and clinical effectiveness were examined in a retrospective chart review of patients with stage IIIB–IVM1a unresectable melanoma treated with T-VEC in surgical (the Netherlands) and medical (Austria, Germany, UK) oncology settings. Results Overall, 66 patients were included (the Netherlands: n = 31; Austria, Germany, UK: n = 35). The median age was 69 years and 59.1% were female. At the time of T-VEC initiation, 47 patients (71.2%) had stage IIIB/C disease; of these, 30 were from the Netherlands. Although 72.7% patients overall received T-VEC as first-line therapy, this was higher in the Netherlands than the other countries (93.5% vs 54.3%). Of the 47 patients who discontinued T-VEC, 26 (55.3%) had no remaining injectable lesions (potentially indicating complete response); 20/26 of these patients were from the Netherlands. One patient discontinued T-VEC due to toxicity. Conclusion This study is the first comprehensive multinational evaluation of the use of T-VEC to treat unresectable stage IIIB/C–IVM1a melanoma in real-world clinical practice in Europe. The differences between European countries were apparent, with physicians in the Netherlands using T-VEC in patients with earlier advanced disease stage and in the first-line setting compared with other countries. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-020-01590-w.
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Affiliation(s)
- Alexander C J van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, The Netherlands.
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Sophie Papa
- Department of Medical Oncology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Viola Franke
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek (NKI-AVL), Amsterdam, The Netherlands
| | - Andreas Pinter
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - Margit A Huber
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | - Carmen Loquai
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | | | | | | | | | - Peter Mohr
- Department of Dermatology, Elbe-Klinikum Buxtehude, Buxtehude, Germany
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Striebel J, Vorobii M, Kumar R, Liu HY, Yang B, Weishaupt C, Rodriguez-Emmenegger C, Fuchs H, Hirtz M, Riehemann K. Controlled Surface Adhesion of Macrophages via Patterned Antifouling Polymer Brushes. Adv NanoBio Res 2020. [DOI: 10.1002/anbr.202000029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Johannes Striebel
- Physical Institute and Center for Nanotechnology (CeNTech) University of Münster Wilhelm-Klemm-Straße 10 48149 Münster Germany
| | - Mariia Vorobii
- DWI – Leibniz Institute for Interactive Materials and Institute of Technical and Macromolecular Chemistry RWTH Aachen University Forckenbeckstraße 50 52074 Aachen Germany
| | - Ravi Kumar
- Institute of Nanotechnology (INT) and Karlsruhe Nano Micro Facility (KNMF) Karlsruhe Institute of Technology (KIT) Hermann-von-Helmholtz-Platz 1 76344 Eggenstein Leopoldshafen Germany
| | - Hui-Yu Liu
- Institute of Nanotechnology (INT) and Karlsruhe Nano Micro Facility (KNMF) Karlsruhe Institute of Technology (KIT) Hermann-von-Helmholtz-Platz 1 76344 Eggenstein Leopoldshafen Germany
| | - Bingquan Yang
- Institute of Nanotechnology (INT) and Karlsruhe Nano Micro Facility (KNMF) Karlsruhe Institute of Technology (KIT) Hermann-von-Helmholtz-Platz 1 76344 Eggenstein Leopoldshafen Germany
| | - Carsten Weishaupt
- Department of Dermatology University Hospital of Münster Von-Esmarch-Straße 58 48149 Münster Germany
| | - Cesar Rodriguez-Emmenegger
- DWI – Leibniz Institute for Interactive Materials and Institute of Technical and Macromolecular Chemistry RWTH Aachen University Forckenbeckstraße 50 52074 Aachen Germany
| | - Harald Fuchs
- Physical Institute and Center for Nanotechnology (CeNTech) University of Münster Wilhelm-Klemm-Straße 10 48149 Münster Germany
| | - Michael Hirtz
- Institute of Nanotechnology (INT) and Karlsruhe Nano Micro Facility (KNMF) Karlsruhe Institute of Technology (KIT) Hermann-von-Helmholtz-Platz 1 76344 Eggenstein Leopoldshafen Germany
| | - Kristina Riehemann
- Physical Institute and Center for Nanotechnology (CeNTech) University of Münster Wilhelm-Klemm-Straße 10 48149 Münster Germany
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29
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Weishaupt C, Goerge T, Loser K. Activated melanoma vessels: A sticky point for successful immunotherapy. Exp Dermatol 2020; 29:1046-1054. [PMID: 32998178 DOI: 10.1111/exd.14203] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/07/2020] [Accepted: 09/21/2020] [Indexed: 11/30/2022]
Abstract
Metastatic melanoma is a devastating disease with a marginal-albeit increasing-hope for cure. Melanoma has a high mutation rate which correlates to the expression of numerous neo-antigens and thus is associated with the potential to induce and strengthen effective antitumoral immunity. However, the incomplete and potentially insufficient response to established immunotherapies (response rates usually do not markedly exceed 60%) already points to the need of further studies to improve treatment strategies. Multiple tumor escape mechanisms that allow melanoma to evade from antitumoral immune responses have been characterized and must be overcome to achieve a better clinical efficacy of immunotherapies. Recently, promising progress has been made in targeting tumor vasculature to control and increase the infiltration of tumors with effector lymphocytes. It has been hypothesized that amplified lymphocytic infiltrates in melanoma metastases result in a switch of the tumor microenvironment from a non-inflammatory to an inflammatory state. In this view point essay, we discuss the requirements for successful homing of lymphocytes to melanoma tissue and we present a mouse melanoma xenograft model that allows the investigation of human tumor vessels in vivo. Furthermore, current clinical studies dealing with the activation of melanoma vasculature for enhanced effectiveness of immunotherapy protocols are presented and open questions for routine clinical application are addressed.
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Affiliation(s)
- Carsten Weishaupt
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - Tobias Goerge
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - Karin Loser
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany.,Institute of Immunology, University of Oldenburg, Oldenburg, Germany
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30
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Gutzmer R, Eigentler T, Mohr P, Weichenthal M, Dücker P, Gebhardt C, Göppner D, Haferkamp S, Kähler K, Meier F, Pföhler C, Satzger I, Sickmann T, Sindrilaru A, Terheyden P, Ugurel S, Ulrich J, Utikal J, Weishaupt C, Schadendorf D. 1104P Nivolumab (NIVO) monotherapy or combination therapy with ipilimumab (NIVO+IPI) in advanced melanoma patients with brain metastases: Real-world evidence from the German non-interventional study NICO. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1227] [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: 10/23/2022] Open
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Weishaupt C, Mastrofrancesco A, Metze D, Kemper B, Stegemann A, Picardo M, Klein-Szanto AJP, Böhm M. Paired Basic Amino Acid-cleaving Enzyme 4 (PCSK6): An Emerging New Target Molecule in Human Melanoma. Acta Derm Venereol 2020; 100:adv00157. [PMID: 32449780 PMCID: PMC9137352 DOI: 10.2340/00015555-3525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although recent therapeutic developments raise hope, melanoma remains a devastating disease with a need for new treatment targets. In other tumours prohormone convertases have been shown to be pro-tumourigenic as they are involved in processing preforms of matrix-metalloproteinases, growth factors and adhesion molecules. The aim of this study was to look for new treatment options for melanoma, by investigating the role of the prohormone convertase Paired basic Amino acid-Cleaving Enzyme 4 (PACE4/PCSK6) in melanoma cell lines and human melanoma tissue. PACE4-transfected A375 melanoma cells displayed significantly increased proliferation, MMP-2 production, gelatinase activity and migratory capacity in vitro compared with sham-transfected cells. In vivo, elevated PACE4 expression resulted in significantly increased tumour growth on immunodeficient mice. In the majority of 45 human primary melanomas and melanoma metastases ex vivo PACE4 immunoreactivity was detectable, while it was absent in in situ melanomas. These results indicate PACE4 as a regulator of melanoma cell aggressiveness.
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Affiliation(s)
- Carsten Weishaupt
- Department of Dermatology, University Hospital of Muenster, DE-48149 Münster, Germany. E-mail:
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Eigentler T, Bauernfeind FG, Becker JC, Brossart P, Fluck M, Heinzerling L, Krauss J, Mohr P, Ochsenreither S, Schreiber JS, Terheyden P, Weide B, Weishaupt C, Funkner F, Muth A, Kays SK, Stosnach C, Daehling A, Quintini G, Gnad-Vogt SU. A phase I dose-escalation and expansion study of intratumoral CV8102 as single-agent or in combination with anti-PD-1 antibodies in patients with advanced solid tumors. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.3096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3096 Background: CV8102 is a non-coding, non-capped RNA that activates the innate (via TLR7/8, RIG-I) and adaptive immunity dose-dependently. CV8102 injected intratumorally (i.t.), as a single agent or combined with systemic anti-PD-1 antibody (Ab) led to tumor growth inhibition in animal models and showed synergism with PD-1 blockade. Methods: An open-label, cohort-based, dose escalation and expansion study in patients with advanced cutaneous melanoma (cMEL), cutaneous squamous cell carcinoma (cSCC), head and neck squamous cell carcinoma (hnSCC) or adenoid cystic carcinoma (ACC) is ongoing investigating i.t. CV8102 as single agent and in combination with anti-PD-1 antibodies. [NCT03291002]. Results: As of December 2019, 23 patients in the cohort A (single agent) and 13 patients in cohort C (combination with anti-PD-1 Ab) were exposed to at least one dose of CV8102 at dose levels of 25-600 µg (single agent) and 25-450 µg (combination). No dose limiting toxicities (DLTs) were observed within the first two weeks of study drug treatment. Most frequent TEAEs were G1/2 fatigue, fever, chills and headache. 4 (17%) patients (pts) in cohort A and 3 (23%) pts in cohort C experienced related G3 TEAEs that were manageable with supportive treatment (liver enzyme increases (3), abscess at injection site (1), hypertension (1), asymptomatic elevation of pancreatic enzymes (2)). In cohort A, 2 cMEL patients experienced an objective response according to RECIST 1.1 (1 CR in a PD-1 naïve pt and 1 PR in a PD-1 refractory pt) and 2 further pts (cMEL, hnSCC) showed SD with shrinkage of tumor lesions. Conclusions: CV8102 i.t. was well tolerated without dose limiting toxicities to date and showed evidence of single agent activity. Updated results on safety, efficacy and serum biomarkers will be presented. Clinical trial information: NCT03291002 .
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Affiliation(s)
- Thomas Eigentler
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - Franz G Bauernfeind
- Department of Internal Medicine III, Oncology, Hematology and Rheumatology, University Clinic Bonn, Bonn, Germany
| | - Jürgen C. Becker
- Translational Skin Cancer Research, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Essen, Germany
| | - Peter Brossart
- Department of Internal Medicine III, Oncology, Hematology and Rheumatology, University Clinic Bonn, Bonn, Germany
| | - Michael Fluck
- Department of Internal Medicine, Fachklinik Hornheide, Münster, Germany
| | - Lucie Heinzerling
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Germany, Erlangen, Germany
| | - Jürgen Krauss
- Department of Medical Oncology, National Center for Tumor Diseases (NT), Heidelberg, Germany
| | - Peter Mohr
- Center for Dermatology, Elbe Medical Center, Buxtehude, Germany
| | - Sebastian Ochsenreither
- Department of Hematology, Oncology, and Tumor Immunology, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Jutta Sylvina Schreiber
- Department of Medical Oncology, National Center for Tumor Diseases (NT), Heidelberg, Germany
| | - Patrick Terheyden
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
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Krensel M, Petersen J, Mohr P, Weishaupt C, Augustin J, Schäfer I. Schätzung der Prävalenz und Inzidenz von Hautkrebs in Deutschland. J Dtsch Dermatol Ges 2019; 17:1239-1250. [PMID: 31885173 DOI: 10.1111/ddg.14002_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/02/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Magdalene Krensel
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Jana Petersen
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Peter Mohr
- Klinik für Dermatologie, Elbe Kliniken Buxtehude, Buxtehude
| | | | - Jobst Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Ines Schäfer
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
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34
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Krensel M, Petersen J, Mohr P, Weishaupt C, Augustin J, Schäfer I. Estimating prevalence and incidence of skin cancer in Germany. J Dtsch Dermatol Ges 2019; 17:1239-1249. [PMID: 31885171 DOI: 10.1111/ddg.14002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/02/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of the present study was to determine the prevalence and incidence of skin cancer. PATIENTS AND METHODS We calculated prevalence and incidence for cutaneous melanoma (CM) and non-melanoma skin cancer (NMSC) in 2012 in Germany, using claims data of 2.1 million insured persons. In order to allow statements concerning differences between subgroups, we calculated 95 % confidence intervals. Finally, we standardized prevalence and incidence with regard to the German population. RESULTS The prevalence and incidence of CM amounted to 0.12 % and 0.04 % and increased with age. For NMSC these measures were 0.65 % and 0.15 %. Of the prevalent and incident patients, 88.9 % and 87.4 % (CM) and 99.4 % and 98.8 % (NMSC) respectively were at early stages. A projection on the whole population resulted in 75,419 persons affected by CM and 376,004 persons affected by NMSC, including 24,075 (CM) and 84,618 (NMSC) incident patients. CONCLUSIONS In this study, we defined epidemiological measures according to the number of patients affected by skin cancer and having a medical consultation indicating a need for treatment. These results can serve in future research as a data basis for analysis of health service demand in skin cancer patients and the associated costs.
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Affiliation(s)
- Magdalene Krensel
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jana Petersen
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Peter Mohr
- Department of Dermatology, Elbe Kliniken Buxtehude, Buxtehude, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Jobst Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ines Schäfer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Elsayad K, Reinartz G, Oertel M, Rehn S, Eismann J, Scobioala S, Berssenbrügge H, Eter N, Weishaupt C, Schmidt HH, Friedrichs B, Grünewald I, Hartmann W, Lenz G, Wardelmann E, Willich N, Eich HT. Radiotherapy of extranodal low-grade follicular and marginal zone lymphomas: long-term follow-up of 159 patients. Strahlenther Onkol 2019; 196:117-125. [PMID: 31732783 DOI: 10.1007/s00066-019-01538-2] [Citation(s) in RCA: 5] [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: 09/01/2019] [Accepted: 10/23/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate clinical, histopathologic, and radiation (RT) dose parameters in patients with extranodal low-grade (ENLG) non-Hodgkin lymphoma (NHL) and their possible impact on local control (LC) and survival. MATERIALS AND METHODS The medical records of 159 patients with 181 histologically confirmed ENLG-NHL lesions treated at our institution were reviewed retrospectively. RESULTS The predominant histological subtype (73%) was marginal zone lymphoma (MZL). Common lesion sites were the gastrointestinal tract (GIT; 33%), skin (26%), and orbit (21%). The majority of patients (88%) presented with stage I/II disease. Thirty-three (20%) lesions were treated with reduced-dose RT (≤30.6 Gy) and 148 lesions (80%) with conventional-dose RT (>30.6 Gy), with an overall median dose of 39.6 Gy (range 4-63). The median follow-up period was 72 months. The 10-year local control (LC), Progression-free survival (PFS), and overall survival (OS) rates were 96, 65, and 82%, respectively. Higher overall response rate (ORR; 98% vs. 94%, p = 0.001) and complete response rate (CRR; 95% vs. 73%, p = 0.001) were observed in patients treated with conventional-dose regimens than in those treated with reduced-dose regimens. Ten-year PFS (p = 0.90) and OS (p = 0.40) was similar between the two dose groups. RT was well tolerated in both dose groups, with no grade 4/5 toxicities. In the multivariate analysis, RT dose and timing (upfront or salvage) were related to LC, whereas age, histology, and complete response (CR) to RT were associated with PFS. Patient age and radiation field size impacted OS. CONCLUSION RT is an effective and curative local treatment for early-stage FL and MZL at conventional and reduced radiation doses. Conventional-doses seems to be associated with local response improvement, without significant differences in PFS rates. Age, histology, and response to RT may influence the PFS.
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Affiliation(s)
- Khaled Elsayad
- Radiation Oncology Department, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
| | - Gabriele Reinartz
- Radiation Oncology Department, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - Michael Oertel
- Radiation Oncology Department, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - Stephan Rehn
- Radiation Oncology Department, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - Jens Eismann
- Radiation Oncology Department, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - Sergiu Scobioala
- Radiation Oncology Department, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - Hendrik Berssenbrügge
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Muenster, Muenster, Germany
| | - Nicole Eter
- Department of Ophthalmology, University Hospital Muenster, Muenster, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital Muenster, Muenster, Germany
| | - Hartmut H Schmidt
- Department of Medicine B for Gastroenterology and Hepatology, University Hospital Muenster, Muenster, Germany
| | - Birte Friedrichs
- Department of Medicine A, University Hospital Muenster, Muenster, Germany
| | - Inga Grünewald
- Gerhard-Domagk-Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Wolfgang Hartmann
- Gerhard-Domagk-Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Georg Lenz
- Department of Medicine A, University Hospital Muenster, Muenster, Germany
| | - Eva Wardelmann
- Gerhard-Domagk-Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Normann Willich
- Radiation Oncology Department, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - Hans Theodor Eich
- Radiation Oncology Department, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
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Elsayad K, Kroeger K, Greve B, Moustakis C, Assaf C, Stadler R, Lenz G, Weishaupt C, Eich HT. Low-dose total skin electron beam therapy: Quality of life improvement and clinical impact of maintenance and adjuvant treatment in patients with mycosis fungoides or Sezary syndrome. Strahlenther Onkol 2019; 196:77-84. [PMID: 31591658 DOI: 10.1007/s00066-019-01517-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 03/25/2019] [Accepted: 09/10/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Total skin electron beam therapy (TSEBT) has proved to be a safe and effective treatment for cutaneous T‑cell lymphomas. Here, we examined the impact of this treatment on patient quality of life and outcome. PATIENTS AND METHODS Forty-four patients with mycosis fungoides (MF) or Sezary syndrome (SS) received 48 TSEBT courses with a median dose of 12 Gy within the past 8 years at our institute. Patient and treatment characteristics for these cases as well as the impact of TSEBT on quality of life and duration of response were retrospectively analyzed and compared. RESULTS The median modified Severity-Weighted Assessment Tool score before the start of TSEBT was 44. The overall response rate was 88%, with a complete response (CR) rate of 33%. The median follow-up period was 13 months. The median duration of response (DOR) and progression-free survival (PFS) for the entire cohort were 10 months and 9 months, respectively. Patient-reported symptom burden was measured with the Dermatological Life Quality Index and Skindex-29 questionnaires. The mean symptom reductions were 6 ± 8 (P = 0.005) and 21 ± 24 (P = 0.002), respectively. In the Functional Assessment of Cancer Therapy-General Assessment, significant improvements in the emotional (P = 0.03) domains were observed after TSEBT. Patients who received maintenance or adjuvant treatments had a longer PFS (P = 0.01). CONCLUSION TSEBT improved disease symptoms and significantly improved emotional domains of patients' quality of life in patients with MF or SS. In addition, our results indicate that maintenance or adjuvant therapy after TSEBT may improve the PFS.
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Affiliation(s)
- Khaled Elsayad
- Department of Radiation Oncology, University Hospital Muenster, Building A1, 1 Albert-Schweitzer-Campus, 48149, Muenster, Germany.
| | - Kai Kroeger
- Department of Radiation Oncology, University Hospital Muenster, Building A1, 1 Albert-Schweitzer-Campus, 48149, Muenster, Germany
| | - Burkhard Greve
- Department of Radiation Oncology, University Hospital Muenster, Building A1, 1 Albert-Schweitzer-Campus, 48149, Muenster, Germany
| | - Christos Moustakis
- Department of Radiation Oncology, University Hospital Muenster, Building A1, 1 Albert-Schweitzer-Campus, 48149, Muenster, Germany
| | - Chalid Assaf
- Department of Dermatology, Helios Klinikum, Krefeld, Germany
| | - Rudolf Stadler
- Department of Dermatology, Johannes-Wesling-Klinikum Minden, Minden, Germany
| | - Georg Lenz
- Department of Medicine A, University Hospital Muenster, Muenster, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital Muenster, Muenster, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Muenster, Building A1, 1 Albert-Schweitzer-Campus, 48149, Muenster, Germany
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Knispel S, Gassenmaier M, Menzies A, Loquai C, Johnson D, Franklin C, Gutzmer R, Hassel J, Weishaupt C, Eigentler T, Schummer P, Kiecker F, Owen C, Schmidgen M, Kähler K, Cann C, Niebel D, Mohr P, Schadendorf D, Zimmer L. Outcome of patients with elevated LDH treated with first-line targeted therapy (TT) or PD-1 based immune checkpoint inhibitors (ICI). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz255.034] [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: 11/14/2022] Open
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Krauss J, Eigentler T, Schreiber J, Weishaupt C, Terheyden P, Heinzerling L, Mohr P, Weide B, Ochsenreither S, Gutzmer R, Becker J, Kiecker F, Funkner F, Heidenreich R, Kays SK, Klinkhardt U, Gnad-Vogt U, Scheel B, Schönborn-Kellenberger O, Seibel T. A phase I dose-escalation and expansion trial of intratumorally administered CV8102, alone and in combination with anti-PD-1 in patients with advanced solid tumours. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz244.071] [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: 11/14/2022] Open
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Weishaupt C, Steinert M, Brunner G, Schulze HJ, Fuhlbrigge RC, Goerge T, Loser K. Activation of human vascular endothelium in melanoma metastases induces ICAM-1 and E-selectin expression and results in increased infiltration with effector lymphocytes. Exp Dermatol 2019; 28:1258-1269. [PMID: 31444891 DOI: 10.1111/exd.14023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 03/01/2019] [Revised: 07/18/2019] [Accepted: 08/15/2019] [Indexed: 12/12/2022]
Abstract
Lymphocytic infiltration into melanoma tissue is an important prerequisite for effective antitumoral immunity. However, analysis of human metastatic melanoma has shown that leucocyte adhesion receptor expression on melanoma blood vessels is very low or absent, thereby impairing the entry of cytotoxic lymphocytes into tumor tissue. We hypothesized that adhesion molecules can be induced on melanoma vasculature allowing better infiltration of cytotoxic lymphocytes. Quantitative real-time PCR and immunofluorescence staining indicated that the adhesion molecules ICAM-1 (CD54) and E-selectin (CD62E) can be significantly induced by intralesional application of TNF alpha in tissue from human melanoma metastases either in vitro or in vivo when grafted onto immunodeficient NSG (NOD.Cg-PrkdcscidIl2rgtm1Wjl/SzJ) mice that preserved human vessels. Furthermore, activated human autologous CD3+ lymphocytes were injected intravenously into mice bearing melanoma xenografts treated with TNF-α or PBS in addition to the leucocyte chemoattractant TARC (CCL17). Significantly increased numbers of CD8+ cells were detected in TNF-α-treated melanoma metastases compared with PBS-treated controls. In addition, tumor cell apoptosis was enhanced and melanoma cell proliferation reduced as shown by TUNEL assay and KI-67 staining. We conclude that adhesion molecules can be induced on human melanoma vasculature resulting in significantly improved homing of activated autologous cytotoxic T cells to melanoma tissue and inhibition of melanoma cell proliferation. These observations should be considered when designing protocols for immunotherapy of malignant melanoma.
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Affiliation(s)
- Carsten Weishaupt
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - Meike Steinert
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - Georg Brunner
- Department of Cancer Research, Fachklinik Hornheide, Münster, Germany
| | | | - Robert C Fuhlbrigge
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tobias Goerge
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - Karin Loser
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany.,CRC1009, CRC-TR128 and Interdisciplinary Center of Clinical Research (IZKF), University of Münster, Münster, Germany
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Schedel F, Mayer-Hain S, Pappelbaum KI, Metze D, Stock M, Goerge T, Loser K, Sunderkötter C, Luger TA, Weishaupt C. Evidence and impact of neutrophil extracellular traps in malignant melanoma. Pigment Cell Melanoma Res 2019; 33:63-73. [PMID: 31402559 DOI: 10.1111/pcmr.12818] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [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: 07/25/2018] [Revised: 06/08/2019] [Accepted: 07/23/2019] [Indexed: 12/14/2022]
Abstract
Ulceration of melanoma is associated with neutrophil infiltrates and lower survival rates opposite to non-ulcerated melanoma. Neutrophils release neutrophil extracellular traps (NETs) that are chromatin structures loaded with antimicrobial proteins. Since NETs have been correlated with tumor progression, we investigated whether NETs appear in melanoma and affect melanoma cells. Indeed, human primary melanoma biopsies revealed neutrophils releasing NETs in all of 27 ulcerated melanomas, whereas NETs were absent in all of 7 non-ulcerated melanomas. However, the quantity of intratumoral NETs did not correlate with tumor progression of melanoma. Interestingly, in vitro assays showed that melanoma cells attach to NETs via integrin-mediated adhesion and that NETs inhibit tumor cell migration. Moreover, co-culturing of NETs and melanoma cells had a cytotoxic effect on melanoma cells resulting in necrosis. Hence, we discovered in vitro an antineoplastic role of NETs in melanoma.
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Affiliation(s)
- Fiona Schedel
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - Sarah Mayer-Hain
- Department of Translational Dermatoinfectiology, University Hospital of Muenster, Muenster, Germany
| | - Karin Ingrid Pappelbaum
- Department of Translational Dermatoinfectiology, University Hospital of Muenster, Muenster, Germany
| | - Dieter Metze
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - Martin Stock
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - Tobias Goerge
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - Karin Loser
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - Cord Sunderkötter
- Department of Translational Dermatoinfectiology, University Hospital of Muenster, Muenster, Germany.,Department of Dermatology, University Medicine Halle (Saale), Halle (Saale), Germany
| | - Thomas Anton Luger
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
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Angela Y, Haferkamp S, Weishaupt C, Ugurel S, Becker JC, Oberndörfer F, Alar V, Satzger I, Gutzmer R. Combination of denosumab and immune checkpoint inhibition: experience in 29 patients with metastatic melanoma and bone metastases. Cancer Immunol Immunother 2019; 68:1187-1194. [PMID: 31187176 PMCID: PMC11028174 DOI: 10.1007/s00262-019-02353-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 10/04/2018] [Accepted: 06/03/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND PD-1 inhibition (PD-1i) is the standard of care in melanoma and other malignancies. In patients with bone metastases of solid tumors, the monoclonal antibody denosumab directed against RANKL is approved for the prevention of skeletal-related events. However, RANKL is not only relevant in osteoclastogenesis, but also has immunological effects. Hence, we aimed at investigating, whether the combination of PD-1i and denosumab produces synergistic effects in metastatic melanoma treatment. METHODS We retrospectively collected and analyzed clinical data of metastatic melanoma patients with bone metastases, who received PD-1i and denosumab therapy. RESULTS 29 patients were identified with a median age of 60.7 years: 20 were male and 9 were female. 20 patients (69%) were in stage IV M1c and 9 (31%) in stage IV M1d; 52% had an increased serum LDH. 24 patients (83%) received PD-1i as first-line therapy and five patients (17%) as second- or third-line therapy. 13 patients received the triple combination nivolumab, ipilimumab and denosumab (N + I+D), 16 patients received PD-1i and denosumab (PD-1i + D). Within a median follow-up time of 19.8 months, 17 patients progressed with a median time to progression of 6 months. The objective response rate was 54% in the N + I + D group and 50% in the PD-1i + D group. Recalcification of bone metastases was radiologically observed in 18 (62%) patients. No unexpected treatment-related adverse events emerged. CONCLUSIONS The combination therapy of metastatic melanoma with PD-1i and denosumab was feasible without unexpected safety issues and showed a promising efficacy signal. Further investigation in prospective studies is needed.
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Affiliation(s)
- Yenny Angela
- Department of Dermatology and Allergy, Skin Cancer Center Hannover, Medizinische Hochschule Hannover, Carl Neuberg Str. 1, 30625, Hannover, Germany.
| | | | | | - Selma Ugurel
- Department of Dermatology, University of Duisburg-Essen, Essen, Germany
| | - Jürgen C Becker
- Department of Dermatology, University of Duisburg-Essen, Essen, Germany
- Translational Skin Cancer Research (TSCR), German Cancer Consortium (DKTK), Essen/Düsseldorf, Germany
| | - Florian Oberndörfer
- Department of Dermatology and Allergy, Skin Cancer Center Hannover, Medizinische Hochschule Hannover, Carl Neuberg Str. 1, 30625, Hannover, Germany
| | - Vesna Alar
- Department of Dermatology and Allergy, Skin Cancer Center Hannover, Medizinische Hochschule Hannover, Carl Neuberg Str. 1, 30625, Hannover, Germany
| | - Imke Satzger
- Department of Dermatology and Allergy, Skin Cancer Center Hannover, Medizinische Hochschule Hannover, Carl Neuberg Str. 1, 30625, Hannover, Germany
| | - Ralf Gutzmer
- Department of Dermatology and Allergy, Skin Cancer Center Hannover, Medizinische Hochschule Hannover, Carl Neuberg Str. 1, 30625, Hannover, Germany
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Eigentler T, Krauss J, Schreiber J, Weishaupt C, Terheyden P, Heinzerling L, Mohr P, Weide B, Gutzmer R, Becker JC, Kiecker F, Daehling A, Funkner F, Heidenreich R, Kays SK, Klinkhardt U, Scheel B, Schoenborn-Kellenberger O, Seibel T, Stosnach C, Strack T, Gnad-Vogt U. Abstract LB-021: Intratumoral RNA-based TLR-7/-8 and RIG-I agonist CV8102 alone and in combination with anti-PD-1 in a Phase I dose-escalation and expansion trial in patients with advanced solid tumors. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-lb-021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
CV8102 comprises a single-stranded non-coding RNA complexed with a cationic peptide. It acts as an agonist to TLR-7/-8 and RIG-I (Ziegler 2018) to stimulate the innate and adaptive immune system. CV8102 was shown to induce an upregulation of inflammatory cytokines, chemokines and IFN-γ related genes at the injection site along with an activation of T, NK, NKT and migratory dendritic cells in the draining lymph nodes (Heidenreich 2015). Intratumoral (IT) CV8102 demonstrated dose-dependent anti-tumor activity and synergized with systemic PD-1 inhibition in preclinical models.
Methods This Phase I study investigates IT CV8102 as single agent and in combination with systemic anti-PD-1 antibodies (as per product label). Patients (pts) with advanced inoperable melanoma (MEL), cutaneous/head and neck squamous cell or adenoid cystic carcinoma (cSCC, SCCHN, ACC) are eligible for single agent CV8102, pts with MEL and SCCHN who did not respond or slowly progressed on anti-PD-1 therapy are eligible for the combination. CV8102 is administered for up to 8 IT injections into a single accessible tumor lesion over a 12-week period. A Bayesian logistic regression model with overdose control is used for the dose escalation parts. Response is assessed by RECIST 1.1/irRECIST (injected and non-injected target lesions). Pre- and on-treatment samples are collected for biomarker analyses.
Results A total of 20 pts have been treated with either CV8102 alone (N=15: 6 MEL, 2 SCCHN, 5 ACC, 2 cSCC) or CV8102 in combination with anti-PD-1 (N=5: 4 MEL, 1 SCCHN). Dose cohorts with doses up to 150 µg (CV8102 alone) and 100µg (CV8102+anti-PD-1) have been completed. Most common AEs were mild to moderate flu-like symptoms and injection site reactions. No dose limiting toxicities (DLT) were observed during the DLT period of the first two weeks of treatment. 12 pts treated with CV8102 alone were evaluable for response assessment. 1 MEL pt treated at 150µg experienced a complete regression of injected and non-injected lesions. This patient also experienced a marked increase of IL-6 and CRP at 6 and 24 hours after the first injection, respectively. 7 pts achieved stable disease, with two pts treated at 100 µg (SCCHN pt) and 200µg (MEL pt who had developed acquired resistance to previous anti-PD-1 therapy) showing regression of non-injected lymph node lesions. Dose escalation parts are continuing, updated safety and efficacy results will be presented.
Conclusion Intratumoral single agent CV8102 appears well tolerated and showed preliminary evidence of clinical efficacy with shrinkage of injected and non-injected lesions.
Citation Format: Thomas Eigentler, Juergen Krauss, Jutta Schreiber, Carsten Weishaupt, Patrick Terheyden, Lucie Heinzerling, Peter Mohr, Benjamin Weide, Ralf Gutzmer, Juergen C. Becker, Felix Kiecker, Angelika Daehling, Fatma Funkner, Regina Heidenreich, Sarah-Katharina Kays, Ute Klinkhardt, Birgit Scheel, Oliver Schoenborn-Kellenberger, Tobias Seibel, Claudia Stosnach, Tanja Strack, Ulrike Gnad-Vogt. Intratumoral RNA-based TLR-7/-8 and RIG-I agonist CV8102 alone and in combination with anti-PD-1 in a Phase I dose-escalation and expansion trial in patients with advanced solid tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr LB-021.
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Affiliation(s)
| | - Juergen Krauss
- 2Nationales Centrum für Tumorerkrankungen (NCT) Heidelberg, Heidelberg, Germany
| | - Jutta Schreiber
- 2Nationales Centrum für Tumorerkrankungen (NCT) Heidelberg, Heidelberg, Germany
| | | | | | | | - Peter Mohr
- 6Elbe-Klinikum-Buxtehude, Buxtehude, Germany
| | | | - Ralf Gutzmer
- 7Medizinische Hochschule Hannover, Hannover, Germany
| | - Juergen C. Becker
- 8Deutsches Konsortium für Translationale Krebsforschung - DKTK, Heidelberg, Germany
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Weishaupt C, Strölin A, Kahle B, Kreuter A, Schneider SW, Gerss J, Eveslage M, Drabik A, Goerge T. Characteristics, risk factors and treatment reality in livedoid vasculopathy - a multicentre analysis. J Eur Acad Dermatol Venereol 2019; 33:1784-1791. [PMID: 31009111 DOI: 10.1111/jdv.15639] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/09/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Livedoid vasculopathy (LV) is a rare cutaneous thrombotic disease. It is characterized by occlusion of dermal vessels resulting in livedo racemosa, ulceration and atrophie blanche. Clear guidelines for diagnosis and treatment are missing. OBJECTIVE The purpose of this study was to better characterize epidemiology, clinical appearance and treatment reality of LV in a well-defined patient cohort. METHODS The cohort was allocated within a prospective, multicentre, phase IIa trial that investigated the effect of rivaroxaban in LV. RESULTS Analysis of 27 patients revealed that LV patients had an increased Body Mass Index (BMI; 11/27), hypertension (19/27) and increased levels of lipoprotein (a) (5/12) and homocysteine (10/12) in the blood. The female-to-male ratio was 2.1 : 1, and the median age was 53.0 years [interquartile range (IQR) 40.5-68]. Investigation of the clinical appearance found that 82% of patients had livedo racemosa, and the ankle region was most likely to be affected by ulceration (56-70%). The analysis of patient treatment history showed that heparin was most effective (12/17), while anti-inflammatory regimens were, although often used (17/24), not effective (0/17). CONCLUSION We add clinical clues for a data supported diagnosis of LV, and we provide evidence that anticoagulants should be administered in monotherapy first line (EudraCT number 2012-000108-13-DE).
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Affiliation(s)
- C Weishaupt
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - A Strölin
- Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
| | - B Kahle
- Department of Dermatology, University Hospital Luebeck, Luebeck, Germany
| | - A Kreuter
- Department of Dermatology, Venereology and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University Witten/Herdecke, Oberhausen, Germany
| | - S W Schneider
- Department of Dermatology, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | - J Gerss
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - M Eveslage
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - A Drabik
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - T Goerge
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
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Mohr P, Haferkamp S, Pinter A, Weishaupt C, Huber MA, Downey G, Öhrling K, Loquai C, Louie KS. Real-World Use of Talimogene Laherparepvec in German Patients with Stage IIIB to IVM1a Melanoma: A Retrospective Chart Review and Physician Survey. Adv Ther 2019; 36:101-117. [PMID: 30536143 PMCID: PMC6318239 DOI: 10.1007/s12325-018-0850-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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] [Received: 10/16/2018] [Indexed: 02/07/2023]
Abstract
Introduction Talimogene laherparepvec is a first-in-class oncolytic immunotherapy for intratumoral injection with proven efficacy and tolerability in patients with unresectable early metastatic melanoma (stage IIIB–IVM1a) in the pivotal phase III OPTiM study. The objective was to characterize melanoma patients treated with talimogene laherparepvec in routine clinical practice in Germany. Methods A retrospective chart review was conducted in unresectable stage IIIB–IVM1a melanoma patients. Data on demographics, disease and medical history, and use of talimogene laherparepvec were collected. A survey was also conducted to understand physician treatment decisions. Results Data for 27 patients who initiated talimogene laherparepvec between June 2016 and July 2017 were analyzed (median age 68; stage IIIB/C disease 56%). All patients had prior surgery, and over half had repeated resections for recurrent disease (median 3). Overall, 48% of patients received at least one prior local treatment, mainly radiation therapy or electrochemotherapy. Talimogene laherparepvec was first-line systemic therapy in 63% of patients. The most frequent prior systemic treatment was immunotherapy (7/27 patients). At end of follow-up, 13 patients were still on talimogene laherparepvec and 14 patients had discontinued treatment. Among those who discontinued, 8 (57%) did not receive subsequent systemic therapy. Only one patient receiving first-line talimogene laherparepvec received a subsequent systemic therapy. Three patients stopped treatment because of no remaining injectable lesions. Median treatment duration was 22.1 weeks overall and 27.9 weeks in stage IIIB/C disease patients. Nearly all cutaneous lesions (93%) were injected with talimogene laherparepvec compared to subcutaneous (83%) and nodal lesions (77%). No new safety signals were reported. The main reasons given in the physician survey for treating with talimogene laherparepvec were good tolerability, overall efficacy, and lack of contraindications. Conclusion Talimogene laherparepvec is now included as a routine treatment option for unresectable early metastatic melanoma in Germany. This study characterizes the first patients treated with talimogene laherparepvec in Europe and confirms the good tolerability observed in clinical trials. Trial Registration EUPAS registry, EUPAS17410. Funding Amgen Inc. Electronic supplementary material The online version of this article (10.1007/s12325-018-0850-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peter Mohr
- Department of Dermatology, Elbe-Klinikum Buxtehude, Buxtehude, Germany.
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Andreas Pinter
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - Margit A Huber
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | | | | | - Carmen Loquai
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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Terheyden P, Weishaupt C, Heinzerling L, Klinkhardt U, Krauss J, Mohr P, Kiecker F, Becker J, Dähling (Submitter A, Döner F, Heidenreich R, Scheel B, Schönborn-Kellenberger O, Seibel T, Gnad-Vogt U. Phase I dose-escalation and expansion study of intratumoral CV8102, a RNA-based TLR- and RIG-1 agonist in patients with advanced solid tumors. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy289.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tietze JK, Forschner A, Loquai C, Mitzel-Rink H, Zimmer L, Meiss F, Rafei-Shamsabadi D, Utikal J, Bergmann M, Meier F, Kreuzberg N, Schlaak M, Weishaupt C, Pföhler C, Ziemer M, Fluck M, Rainer J, Heppt MV, Berking C. The efficacy of re-challenge with BRAF inhibitors after previous progression to BRAF inhibitors in melanoma: A retrospective multicenter study. Oncotarget 2018; 9:34336-34346. [PMID: 30344946 PMCID: PMC6188134 DOI: 10.18632/oncotarget.26149] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 02/28/2018] [Accepted: 08/20/2018] [Indexed: 12/20/2022] Open
Abstract
BRAF and MEK inhibition is efficient in patients with BRAF V600-mutated metastatic melanoma, but due to acquired resistance the duration of response (DoR) is often only short-lived. In this retrospective multicenter study with 60 patients suffering from inoperable or metastatic melanoma we evaluated the efficacy of re-challenge with a BRAF inhibitor (BRAF2) with or without MEK-inhibition after progressive disease upon previous treatment with a BRAF inhibitor (BRAF1) with or without MEK inhibition. Treatment with BRAF1 led to a disease control rate (DCR) of 90% with 12% complete responses (CR), 58% partial responses (PR) and 20% stable diseases (SD), the median progression-free survival (PFS) was 9.9 and DoR 10.7 months. BRAF2 with (68%) or without (32%) additional MEK inhibition was initiated after a median interval of 3.4 months. DCR after re-challenge with BRAF2 was 57%, 8% CR, 20% PR and 28% SD, median PFS was 5.0 and DoR 14.0 months. The duration of the treatment interval or the treatment in the interval did not influence the DCR or PFS to BRAF2. The only predictive factor for response to BRAF2 was previous response to BRAF1; all patients with CR to BRAF1 achieved disease control with BRAF2, but only 60% of the patients with PR to BRAF1 (p=0.002). Addition of MEK inhibition to BRAF2 after treatment with BRAF1 as monotherapy did not significantly increase the DCR or PFS compared to patients treated solely with mono- or combination therapy. In conclusion re-challenge with a BRAF inhibitor is a meaningful therapeutic option for patients with BRAF V600-mutated metastatic melanoma.
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Affiliation(s)
- Julia K Tietze
- Department of Dermatology and Allergy, University Hospital Munich (LMU), 80337 Munich, Germany
| | - Andrea Forschner
- Department of Dermatology, Center for Dermatooncology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Carmen Loquai
- Department of Dermatology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Heidrun Mitzel-Rink
- Department of Dermatology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, University of Essen, 45147 Essen, Germany
| | - Frank Meiss
- Department of Dermatology and Venereology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany
| | - David Rafei-Shamsabadi
- Department of Dermatology and Venereology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany
| | - Jochen Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ) and Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, 68167 Mannheim, Germany
| | - Maike Bergmann
- Department of Dermatology, Skin Cancer Center, National Center for Tumor Diseases, Medical Faculty and University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
| | - Friedegund Meier
- Department of Dermatology, Skin Cancer Center, National Center for Tumor Diseases, Medical Faculty and University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
| | - Nicole Kreuzberg
- Department of Dermatology, University of Cologne, 50937 Cologne, Germany
| | - Max Schlaak
- Department of Dermatology, University of Cologne, 50937 Cologne, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University of Münster, 48149 Münster, Germany
| | - Claudia Pföhler
- Department of Dermatology, Saarland University Medical Center, 66421 Homburg/Saar, Germany
| | - Mirjana Ziemer
- Department of Dermatology, Venereology, and Allergology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Michael Fluck
- Department of Internal Medical Oncology, Clinic Hornheide, 48157 Münster, Germany
| | - Jessica Rainer
- Deparment of Dermatology, Klinikum Süd, 86179 Augsburg, Germany
| | - Markus V Heppt
- Department of Dermatology and Allergy, University Hospital Munich (LMU), 80337 Munich, Germany
| | - Carola Berking
- Department of Dermatology and Allergy, University Hospital Munich (LMU), 80337 Munich, Germany
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Hillen U, Leiter U, Haase S, Kaufmann R, Becker J, Gutzmer R, Terheyden P, Krause-Bergmann A, Schulze HJ, Hassel J, Lahner N, Wollina U, Ziller F, Utikal J, Hafner C, Ulrich J, Machens HG, Weishaupt C, Hauschild A, Mohr P, Pföhler C, Maurer J, Wolff P, Windemuth-Kieselbach C, Schadendorf D, Livingstone E. Advanced cutaneous squamous cell carcinoma: A retrospective analysis of patient profiles and treatment patterns-Results of a non-interventional study of the DeCOG. Eur J Cancer 2018; 96:34-43. [PMID: 29665511 DOI: 10.1016/j.ejca.2018.01.075] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [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: 12/15/2017] [Accepted: 01/15/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Advanced cutaneous squamous cell carcinoma (aSCC) is an area of unmet medical need and no treatment standards are established. Recently, an anti-PD-1 inhibitor received FDA breakthrough therapy designation. The aim of the study was to describe the clinical course, therapeutic management and prognosis of aSCC under real-life conditions. PATIENTS AND METHODS In a retrospective study performed in 24 German and Austrian hospitals and doctor's offices, patient and tumour characteristics of patients diagnosed with aSCC between January 1, 2010 and December 31, 2011 and their disease course was documented. Advanced SCC comprised either locally advanced SCCs (laSCC) or metastatic SCCs (mSCC) with any kind of metastatic spread. RESULTS Data of 190 patients with aSCC were analysed. Median age at time of diagnosis of aSCC was 78 years. LaSCC was diagnosed in 76 patients (40%), 114 patients (60%) had mSCC. Once diagnosed with laSCC, most patients (59%) did not receive any therapy, whereas in 92% of mSCC patients at least one type of therapy was performed. Only 32 patients (29 mSCC, 3 laSCC) received systemic antitumour therapies, mostly EGFR inhibitor-based regimens. Mean duration of response was short (17-months laSCC patients, 3-months mSCC patients). Only 2 patients achieved a complete response, 27% had a partial response, 43% disease stabilisation. At diagnosis of aSCC, ECOG status was 0-1 in most patients. Non-malignant comorbidities influenced the decision on SCC-specific therapy in 39 patients (21%). CONCLUSIONS Our data show the high medical need for efficient and tolerable antitumour therapies and demonstrate that despite older age and comorbidities, most patients can be expected to be fit for treatment. This study provides a historical context for emerging aSCC treatments.
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Affiliation(s)
- Uwe Hillen
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; Department of Dermatology and Venerology, Vivantes Klinikum Neukölln, 12351 Berlin, Germany.
| | - Ulrike Leiter
- Department of Dermatology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Sylvie Haase
- Department of Dermatology, University Hospital Frankfurt, 60590 Frankfurt, Germany; Hautärzte in Konstanz, 78462 Konstanz, Germany
| | - Roland Kaufmann
- Department of Dermatology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Jürgen Becker
- Department of Dermatology, University Hospital Graz, 8036 Graz, Austria; Translational Skin Cancer Research, German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Essen, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ralf Gutzmer
- Skin Cancer Center, Department of Dermatology and Allergy, Hannover Medical School, 30625 Hannover, Germany
| | - Patrick Terheyden
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany
| | | | | | - Jessica Hassel
- Department of Dermatology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Nina Lahner
- Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Uwe Wollina
- Department of Dermatology, University Hospital Dresden, 01067 Dresden, Germany
| | - Fabian Ziller
- Department of Dermatology, DRK Krankenhaus Rabenstein, 09117 Chemnitz, Germany
| | - Jochen Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - Christine Hafner
- Dept. of Dermatology, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, 3500 St. Pölten, Austria; Karl Landsteiner Institute of Dermatological Research, Karl Landsteiner Gesellschaft, 3500 St. Pölten, Austria
| | - Jens Ulrich
- Department of Dermatology, Harzklinikum Dorothea Christiane Erxleben, 06484 Quedlinburg, Germany
| | - Hans-Günther Machens
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital Münster, 48149 Münster, Germany
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Peter Mohr
- Department of Dermatology, Elbe-Kliniken, 21614 Buxtehude, Germany
| | - Claudia Pföhler
- Department of Dermatology, Saarland University Medical School, 66421 Homburg/Saar, Germany
| | - Jan Maurer
- Department of ENT, Katholisches Klinikum Marienhof, 56073 Koblenz, Germany
| | - Patrick Wolff
- Alcedis GmbH, Medical Research Institute, 35394 Gießen, Germany
| | | | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; Translational Skin Cancer Research, German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Essen, Germany
| | - Elisabeth Livingstone
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
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Moritz RK, Metze D, Wiebe S, Kerkhoff A, Berdel WE, Weishaupt C. Exacerbation of mycosis fungoides leading to the diagnosis of chronic myelomonocytic leukemia. JAAD Case Rep 2018; 4:270-273. [PMID: 29687069 PMCID: PMC5909678 DOI: 10.1016/j.jdcr.2017.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hecht M, Meier F, Zimmer L, Polat B, Loquai C, Weishaupt C, Forschner A, Gutzmer R, Utikal JS, Goldinger SM, Geier M, Hassel JC, Balermpas P, Kiecker F, Rauschenberg R, Dietrich U, Clemens P, Berking C, Grabenbauer G, Schadendorf D, Grabbe S, Schuler G, Fietkau R, Distel LV, Heinzerling L. Clinical outcome of concomitant vs interrupted BRAF inhibitor therapy during radiotherapy in melanoma patients. Br J Cancer 2018; 118:785-792. [PMID: 29438368 PMCID: PMC5886123 DOI: 10.1038/bjc.2017.489] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 12/11/2017] [Accepted: 12/15/2017] [Indexed: 02/08/2023] Open
Abstract
Background: Concomitant radiation with BRAF inhibitor (BRAFi) therapy may increase radiation-induced side effects but also potentially improve tumour control in melanoma patients. Methods: A total of 155 patients with BRAF-mutated melanoma from 17 European skin cancer centres were retrospectively analysed. Out of these, 87 patients received concomitant radiotherapy and BRAFi (59 vemurafenib, 28 dabrafenib), while in 68 patients BRAFi therapy was interrupted during radiation (51 vemurafenib, 17 dabrafenib). Overall survival was calculated from the first radiation (OSRT) and from start of BRAFi therapy (OSBRAFi). Results: The median duration of BRAFi treatment interruption prior to radiotherapy was 4 days and lasted for 17 days. Median OSRT and OSBRAFi in the entire cohort were 9.8 and 12.6 months in the interrupted group and 7.3 and 11.5 months in the concomitant group (P=0.075/P=0.217), respectively. Interrupted vemurafenib treatment with a median OSRT and OSBRAFi of 10.1 and 13.1 months, respectively, was superior to concomitant vemurafenib treatment with a median OSRT and OSBRAFi of 6.6 and 10.9 months (P=0.004/P=0.067). Interrupted dabrafenib treatment with a median OSRT and OSBRAFi of 7.7 and 9.8 months, respectively, did not differ from concomitant dabrafenib treatment with a median OSRT and OSBRAFi of 9.9 and 11.6 months (P=0.132/P=0.404). Median local control of the irradiated area did not differ in the interrupted and concomitant BRAFi treatment groups (P=0.619). Skin toxicity of grade ≥2 (CTCAE) was significantly increased in patients with concomitant vemurafenib compared to the group with treatment interruption (P=0.002). Conclusions: Interruption of vemurafenib treatment during radiation was associated with better survival and less toxicity compared to concomitant treatment. Due to lower number of patients, the relevance of treatment interruption in dabrafenib treated patients should be further investigated. The results of this analysis indicate that treatment with the BRAFi vemurafenib should be interrupted during radiotherapy. Prospective studies are desperately needed.
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Affiliation(s)
- Markus Hecht
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Friedegund Meier
- Department of Dermatology, University Hospital Dresden, Dresden, Germany
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Bülent Polat
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - Carmen Loquai
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Andrea Forschner
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - Ralf Gutzmer
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Jochen S Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - Simone M Goldinger
- Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - Michael Geier
- Department of Radiation Oncology, Ordensklinikum Linz, Linz, Austria
| | - Jessica C Hassel
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt, Germany
| | - Felix Kiecker
- Department of Dermatology, University Hospital Berlin, Berlin, Germany
| | | | - Ursula Dietrich
- Department of Dermatology, University Hospital Dresden, Dresden, Germany
| | - Patrick Clemens
- Department of Radiation Oncology, Hospital Feldkirch, Feldkirch, Austria
| | - Carola Berking
- Department of Dermatology, University Hospital LMU Munich, München, Germany
| | | | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Gerold Schuler
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Luitpold V Distel
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Lucie Heinzerling
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
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