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Albrecht LJ, Dimitriou F, Grover P, Hassel JC, Erdmann M, Forschner A, Johnson DB, Váraljai R, Lodde G, Placke JM, Krefting F, Zaremba A, Ugurel S, Roesch A, Schulz C, Berking C, Pöttgen C, Menzies AM, Long GV, Dummer R, Livingstone E, Schadendorf D, Zimmer L. Anti-PD-(L)1 plus BRAF/MEK inhibitors (triplet therapy) after failure of immune checkpoint inhibition and targeted therapy in patients with advanced melanoma. Eur J Cancer 2024; 202:113976. [PMID: 38484692 DOI: 10.1016/j.ejca.2024.113976] [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: 12/28/2023] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Effective treatment options are limited for patients with advanced melanoma who have progressed on immune checkpoint inhibitors (ICI) and targeted therapies (TT). Preclinical models support the combination of ICI with TT; however, clinical trials evaluating the efficacy of triplet combinations in first-line setting showed limited advantage compared to TT only. METHODS We conducted a retrospective, multicenter study, that included patients with advanced melanoma who were treated with BRAF/MEK inhibitors in combination with an anti-PD-(L)1 antibody (triplet therapy) after failure of at least one anti-PD-(L)1-based therapy and one TT in seven major melanoma centers between February 2016 and July 2022. RESULTS A total of 48 patients were included, of which 32 patients, 66.7% had brain metastases, 37 patients (77.1%) had three or more metastatic organs and 21 patients (43.8%) had three or more treatment lines. The median follow-up time was 31.4 months (IQR, 22.27-40.45 months). The treatment with triplet therapy resulted in an ORR of 35.4% (n = 17) and a DCR of 47.9% (n = 23). The median DOR was 5.9 months (range, 3.39-14.27 months). Patients treated with BRAF/MEK inhibitors as the last treatment line showed a slightly lower ORR (29.6%) compared to patients who received ICI or chemotherapy last (ORR: 42.9%). Grade 3-4 treatment-related adverse events occurred in 25% of patients (n = 12), with seven patients (14.6%) requiring discontinuation of treatment with both or either drug. CONCLUSIONS Triplet therapy has shown activity in heavily pretreated patients with advanced melanoma and may represent a potential treatment regimen after failure of ICI and TT.
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Affiliation(s)
- Lea Jessica Albrecht
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Florentia Dimitriou
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Piyush Grover
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Jessica C Hassel
- Department of Dermatology and National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Erdmann
- Department of Dermatology, Uniklinikum Erlangen and the Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Andrea Forschner
- Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
| | - Douglas B Johnson
- Department of Medicine, Division of Hematology and Oncology, VUMC, and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Renáta Váraljai
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Georg Lodde
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Jan Malte Placke
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Frederik Krefting
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Anne Zaremba
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Selma Ugurel
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Alexander Roesch
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Carsten Schulz
- Department of Dermatology and National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen and the Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Christoph Pöttgen
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, Essen, Germany
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Reinhard Dummer
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Elisabeth Livingstone
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany; National Center for Tumor Diseases (NCT)-West, Campus Essen, & Research Alliance Ruhr, Research Center One Health, University Duisburg-Essen, Essen, Germany
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany.
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Jacques SK, McKeown J, Grover P, Johnson DB, Zaremba A, Dimitriou F, Weiser R, Farid M, Namikawa K, Sullivan RJ, Rutkowski P, Lebbe C, Hamid O, Zager JS, Michielin O, Neyns B, Nakamura Y, Robert C, Mehnert J, Ascierto PA, Bhave P, Park B, Zimmer L, Mangana J, Mooradian M, Placzke J, Allayous C, Glitza Oliva IC, Mehmi I, Depalo D, Wicky A, Schwarze JK, Roy S, Boatwright C, Vanella V, Long GV, Menzies AM, Lo SN, Carlino MS. Outcomes of patients with resected stage III/IV acral or mucosal melanoma, treated with adjuvant anti-PD-1 based therapy. Eur J Cancer 2024; 199:113563. [PMID: 38278007 DOI: 10.1016/j.ejca.2024.113563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/02/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024]
Abstract
IMPORTANCE Acral (AM) and mucosal melanomas (MM) are rare subtypes with a poor prognosis. In those with advanced disease, anti-PD-1 (PD1) therapy has reduced activity compared to that seen in non-acral cutaneous melanoma. OBJECTIVE To determine the efficacy of adjuvant PD1 in resected AM or MM. DESIGN An international, retrospective cohort study SETTING: Data up to November 2021 collected from 20 centres across 10 countries. PARTICIPANTS One hundred and ninety four patients with resected stage III or IV1 AM or MM who received adjuvant PD1 were included and compared to matched patients from the Melanoma Institute Australia (MIA) database using a propensity score matching analysis. MAIN OUTCOMES AND MEASURES Recurrence-free survival (RFS), distant metastasis-free survival (DMFS) and overall survival (OS) were investigated. RESULTS Forty five of 139 (32%) AM and 9 of 55 (16%) MM patients completed adjuvant therapy. The main reason for early treatment cessation in both groups was disease recurrence: 51 (37%) and 30 (55%) in the AM and MM groups, respectively. In the AM group adjuvant PD1 was associated with a longer RFS [HR-0.69 (0.52-0.92, p = 0.0127)], DMFS [HR0.58 (0.38-0.89, p = 0.0134)] and OS [HR of 0.59 (0.38-0.92, p-value 0.0196)] when compared to the historical cohort. In the MM group there was no statistical difference in RFS [HR1.36 (0.69-2.68,p-value 0.3799], DMFS or OS. CONCLUSION AND RELEVANCE After adjuvant PD1, both AM and MM have a high risk of recurrence. Our data suggests a benefit to using adjuvant PD1 therapy in resected AM but not in resected MM. Additional studies to investigate the efficacy of adjuvant PD1 for MM are needed.
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Affiliation(s)
- Sarah K Jacques
- Department of Medical Oncology, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Janet McKeown
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Piyush Grover
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | | | - Anne Zaremba
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany
| | - Florentia Dimitriou
- Department of Dermatology, University Hospital of Zurich and Faculty of Medicine, University of Zürich, Zurich, Switzerland
| | - Roi Weiser
- MD Anderson Cancer Center, Houston, TX, USA
| | | | - Kenjiro Namikawa
- Department of Dermatologic Oncology, National Cancer Center, Tokyo, Japan
| | - Ryan J Sullivan
- Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Piotr Rutkowski
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Celeste Lebbe
- Université Paris Cite,AP-HP Dermato-oncology, Cancer institute APHP.nord Paris cité, INSERM U976, Saint Louis Hospital, Paris, France
| | - Omid Hamid
- The Angeles Clinic, A Cedars-Sinai Affiliate, Los Angeles, CA, USA
| | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffit Cancer Center, Tampa, FL, USA
| | - Olivier Michielin
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Bart Neyns
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Yasuhiro Nakamura
- Department of Skin Oncology/Dermatology, Comprehensive Cancer Center, Saitama Medical University International Medical Center, Saitama, Japan
| | - Caroline Robert
- Institute Gustave Roussy and Paris Saclay University, Villejuif Cedex, France
| | | | - Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Prachi Bhave
- Sir Peter MacCallum Cancer Centre Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Benjamin Park
- Vanderbilt University Medical Centre, Nashville, TN, USA
| | - Lisa Zimmer
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany
| | - Joanna Mangana
- Department of Dermatology, University Hospital of Zurich and Faculty of Medicine, University of Zürich, Zurich, Switzerland
| | - Megan Mooradian
- Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Joanna Placzke
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Clare Allayous
- Université Paris Cite,AP-HP Dermato-oncology, Cancer institute APHP.nord Paris cité, INSERM U976, Saint Louis Hospital, Paris, France
| | | | - Inderjit Mehmi
- The Angeles Clinic, A Cedars-Sinai Affiliate, Los Angeles, CA, USA
| | - Danielle Depalo
- Department of Cutaneous Oncology, Moffit Cancer Center, Tampa, FL, USA
| | - Alexandre Wicky
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Severine Roy
- Institute Gustave Roussy and Paris Saclay University, Villejuif Cedex, France
| | | | - Vito Vanella
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Matteo S Carlino
- Department of Medical Oncology, Westmead and Blacktown Hospitals, Sydney, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, Australia.
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3
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Taylor AM, McKeown J, Dimitriou F, Jacques SK, Zimmer L, Allayous C, Yeoh HL, Haydon A, Ressler JM, Galea C, Woodford R, Kahler K, Hauschild A, Festino L, Hoeller C, Schwarze JK, Neyns B, Wicky A, Michielin O, Placzke J, Rutkowski P, Johnson DB, Lebbe C, Dummer R, Ascierto PA, Lo S, Long GV, Carlino MS, Menzies AM. Efficacy and safety of 'Second Adjuvant' therapy with BRAF/MEK inhibitors after local therapy for recurrent melanoma following adjuvant PD-1 based immunotherapy. Eur J Cancer 2024; 199:113561. [PMID: 38278009 DOI: 10.1016/j.ejca.2024.113561] [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: 11/20/2023] [Revised: 01/14/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Anti-PD-1 antibodies and BRAK/MEK inhibitors (BRAF/MEKi) reduce the risk of recurrence for patients with resected stage III melanoma. BRAFV600-mutated (BRAFmut) melanoma patients who recur with isolated disease following adjuvant therapy may be suitable for 'second adjuvant' treatment after local therapy. We sought to examine the efficacy and safety of 'second adjuvant' BRAF/MEKi. PATIENTS AND METHODS Patients with BRAFmut melanoma treated with adjuvant PD-1 based immunotherapy who recurred, underwent definitive local therapy and were then treated with adjuvant BRAF/MEKi were identified retrospectively from 13 centres (second adjuvant group). Demographics, disease and treatment characteristics and outcome data were examined. Outcomes were compared to BRAFmut patients who did not receive 'second adjuvant' therapy (no second adjuvant group). RESULTS 73 patients were included; 61 who received 'second adjuvant' therapy and 12 who did not. Most initially recurred on PD-1 therapy (66%). There were no differences in characteristics between groups. 92% of second adjuvant group received dabrafenib and trametinib and median duration of therapy was 11.8 months (0.4, 34.5). 72% required dose adjustments, 23% had grade 3 + toxicity and 38% permanently discontinued drug due to toxicity. After median 26.1 months (1.9, 56.3) follow-up, recurrence-free survival (RFS) was improved in second adjuvant group versus no second adjuvant group (median 30.8 vs 4 months, HR 0.35; p = 0.014), largely driven by a delay in early recurrence, with no difference in overall survival (p = 0.59). CONCLUSION This is the first study examining outcomes of 'second adjuvant' targeted therapy for melanoma, after failure of adjuvant PD-1 based immunotherapy. Data suggest a short-term improvement in RFS, but at the cost of toxicity. Alternative strategies and more data on sequencing adjuvant therapies are required to improve outcomes.
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Affiliation(s)
- Amelia M Taylor
- Melanoma Institute Australia, The University of Sydney, Australia
| | - Janet McKeown
- Melanoma Institute Australia, The University of Sydney, Australia
| | - Florentia Dimitriou
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Sarah K Jacques
- Crown Princess Mary Cancer Centre, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Clara Allayous
- Université Paris Cite,AP-HP Dermato-oncology, Cancer institute APHP.nord Paris cité, INSERM U976, Saint Louis Hospital, Paris, France
| | | | | | - Julia M Ressler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Claire Galea
- Melanoma Institute Australia, The University of Sydney, Australia
| | - Rachel Woodford
- Melanoma Institute Australia, The University of Sydney, Australia
| | - Katharina Kahler
- University Hospital (UKSH), Campus Kiel, Department of Dermatology, Kiel, Germany
| | - Axel Hauschild
- University Hospital (UKSH), Campus Kiel, Department of Dermatology, Kiel, Germany
| | - Lucia Festino
- Melanoma. Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Napoli, Italy
| | - Christoph Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Bart Neyns
- Department of Medical Oncology, Brussels, Belgium
| | - Alexandre Wicky
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Michielin
- Precision Oncology Center, Lausanne University Hospital, Switzerland
| | - Joanna Placzke
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Celeste Lebbe
- Université Paris Cite,AP-HP Dermato-oncology, Cancer institute APHP.nord Paris cité, INSERM U976, Saint Louis Hospital, Paris, France
| | - Reinhard Dummer
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Paolo A Ascierto
- Melanoma. Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Napoli, Italy
| | - Serigne Lo
- Melanoma Institute Australia, The University of Sydney, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| | - Matteo S Carlino
- Melanoma Institute Australia, The University of Sydney, Australia; Crown Princess Mary Cancer Centre, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia.
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Rogiers A, Dimitriou F, Lobon I, Harvey C, Vergara IA, Pires da Silva I, Lo SN, Scolyer RA, Carlino MS, Menzies AM, Long GV. Seasonal patterns of toxicity in melanoma patients treated with combination anti-PD-1 and anti-CTLA-4 immunotherapy. Eur J Cancer 2024; 198:113506. [PMID: 38184928 DOI: 10.1016/j.ejca.2023.113506] [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: 09/11/2023] [Revised: 12/06/2023] [Accepted: 12/19/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Immune checkpoint inhibitors are frequently associated with the development of immunotherapy-related adverse events (irAEs). The exact etiology, including the role of environmental factors, remains incompletely understood. METHODS We analyzed the records of 394 melanoma patients from three centers (northern and southern hemisphere). Patients had received at least one cycle of anti-PD-1/anti-CTLA-4 with a minimum follow-up of 3 months. We study the distribution and time to irAEs onset throughout the calendar year. RESULTS 764 irAEs were recorded; the most frequent were skin rash (35%), hepatitis (32%) and colitis (30%). The irAEs incidence was the highest in autumn and winter, and the ratio for the 'number of irAEs' per 'therapies commenced' was the highest in winter and lowest in summer (2.4 and 1.7, respectively). Season-specific patterns in the time of irAEs onset were observed for pneumonitis (shorter time to onset in autumn, p = 0.025), hepatitis (shorter time to onset in spring, p = 0.016) and sarcoid-like immune reaction (shorter time to onset in autumn, p = 0.041). Season-specific patterns for early-onset irAEs were observed for hepatitis (spring, p = 0.023) and nephritis (summer, p = 0.017). Early-onset pneumonitis was more frequent in autumn-winter (p = 0.008) and early-onset nephritis in spring-summer (p = 0.004). CONCLUSIONS Environmental factors that are associated with particular seasons may contribute to the development of certain irAEs and suggest the potential effect of environmental triggers. The identification of these factors may enhance preventive and therapeutic strategies to reduce the morbidity of irAEs.
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Affiliation(s)
- Aljosja Rogiers
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Florentia Dimitriou
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Irene Lobon
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, United Kingdom
| | - Catriona Harvey
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Charles Perkin Centre, The University of Sydney, Sydney, NSW, Australia
| | - Ismael A Vergara
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Charles Perkin Centre, The University of Sydney, Sydney, NSW, Australia
| | - Ines Pires da Silva
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Westmead and Blacktown Hospitals, Sydney, New South Wales, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Matteo S Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Westmead and Blacktown Hospitals, Sydney, New South Wales, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia.
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5
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Maurer A, Gstrein NA, Dimitriou F, Sartoretti T, Schaab JA, Looman EL, Balermpas P, Rupp NJ, Freiberger SN, Soyka MB, Holzmann D, Mauthe T, Mueller SA, Beintner-Skawran S, Messerli M, Kenkel D, Huellner MW, Meerwein CM. Sinonasal mucosal melanoma treatment response assessment to immune checkpoint inhibitors using hybrid positron emission tomography imaging. Sci Rep 2023; 13:18847. [PMID: 37914764 PMCID: PMC10620201 DOI: 10.1038/s41598-023-45705-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023] Open
Abstract
The purpose of this retrospective study was to investigate response of sinonasal mucosal melanoma (SMM) patients to treatment with immune checkpoint inhibitors (ICI), using hybrid PET imaging. Fifteen SMM patients underwent hybrid PET imaging before and three months after initiation of ICI. The disease-specific survival (DSS) was calculated. Quantitative PET parameters of the primary tumor and their association with DSS and therapy response were investigated. Nine of the fifteen (60%) patients responded to ICI therapy. Patients with therapy response depicted on hybrid PET imaging had better DSS than those without (p = 0.0058). Quantitative PET parameters of the initial PET harbored no association with DSS or therapy response. However, these findings lack of sufficient statistical power and must be interpreted with caution. The first restaging PET-imaging after ICI initiation can help stratify patients with regard to DSS.
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Affiliation(s)
- Alexander Maurer
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nathalie A Gstrein
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland
| | - Florentia Dimitriou
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Sartoretti
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jan A Schaab
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Esmée L Looman
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Niels J Rupp
- Department of Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sandra N Freiberger
- Department of Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael B Soyka
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland
| | - David Holzmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland
| | - Tina Mauthe
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland
| | - Simon A Mueller
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland
| | - Stephan Beintner-Skawran
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - David Kenkel
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin W Huellner
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian M Meerwein
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland.
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Mallardo D, Woodford R, Menzies AM, Zimmer L, Williamson A, Ramelyte E, Dimitriou F, Wicky A, Wallace R, Mallardo M, Cortellini A, Budillon A, Atkinson V, Sandhu S, Olivier M, Dummer R, Lorigan P, Schadendorf D, Long GV, Simeone E, Ascierto PA. The role of diabetes in metastatic melanoma patients treated with nivolumab plus relatlimab. J Transl Med 2023; 21:753. [PMID: 37880788 PMCID: PMC10601323 DOI: 10.1186/s12967-023-04607-4] [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: 10/06/2023] [Accepted: 10/08/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND The combination of nivolumab + relatlimab is superior to nivolumab alone in the treatment of naive patients and has activity in PD-1 refractory melanoma. We had previously observed a reduced expression of LAG3 in melanoma tissue from patients with type 2 diabetes. METHOD To evaluate the impact of diabetes on oncological outcomes of patients with advanced melanoma treated with nivolumab plus the LAG3 inhibitor relatlimab we performed a retrospective multicenter study. RESULTS Overall, 129 patients were included: 88 without diabetes before the treatment, 37 who were diagnosed with type 2 diabetes before the start of treatment, and 4 without diabetes before treatment who developed immune checkpoint inhibitor-induced diabetes (ICI-DM). PFS was 21.71 months (95% CI: 15.61-27.81) in patients without diabetes, 10.23 months (95% CI: 5.81-14.66) in patients with type 2 diabetes, and 50.85 months (95% CI: 23.04-78.65) in patients who developed ICI-DM. OS was 37.94 months (95% CI: 31.02-44.85) in patients without diabetes, 22.12 months (95% CI: 14.41-29.85) in those with type 2 diabetes and 57.64 months (95% CI: 42.29-72.99) in those who developed ICI-DM. Multivariate analysis showed that the presence of diabetes and LDH was correlated with OS and PFS. The mean OS was 64.63 months in subjects with low levels of glucose (< 137 mg/dl) and 36.27 months in those with high levels (hazard ratio 0.16, 95% CI: 0.04-0.58; p = 0.005). The patients whose glucose blood level increased after 3 months of treatment with nivolumab + relatinib compared to baseline (ratio of blood level at baseline/after 3 months > 1.5) had a worse prognosis than those whose glucose level had not increased. This result was observed also in subgroups treated either in first line or further lines. Patients who developed ICI-DM during the study period had better outcomes than the overall population and patients without diabetes. CONCLUSIONS LAG3 inhibition for treating metastatic or unresectable melanoma has a reduced efficacy in patients with type 2 diabetes, possibly due to a low expression of LAG3 in tumor tissue. Higher level evidence should be obtained.
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Affiliation(s)
- Domenico Mallardo
- Melanoma, Cancer Immunotherapy, and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Via Mariano Semmola, 53, 80131, Naples, Italy
| | - Rachel Woodford
- Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, NCT-West, German Cancer Consortium, Partner Site Essen and University Alliance Ruhr, Research Center One Health, Essen, Germany
| | - Andrew Williamson
- Christie NHS Foundation Trust and Division of Cancer Services, University of Manchester, Manchester, UK
| | - Egle Ramelyte
- Department of Dermatology, University of Zurich, Zurich, Switzerland
| | | | - Alexandre Wicky
- Department of Oncology, Precision Oncology Center, Lausanne University Hospital, Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | | | - Mario Mallardo
- Melanoma, Cancer Immunotherapy, and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Via Mariano Semmola, 53, 80131, Naples, Italy
| | - Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W120HS, UK
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Biomedico, Rome, Italy
| | - Alfredo Budillon
- Scientific Director, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Victoria Atkinson
- Greenslopes Private Hospital, University of Queensland QLD, Greenslopes, Australia
| | | | - Michielin Olivier
- Department of Oncology, Precision Oncology Center, Lausanne University Hospital, Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University of Zurich, Zurich, Switzerland
| | - Paul Lorigan
- Christie NHS Foundation Trust and Division of Cancer Services, University of Manchester, Manchester, UK
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, NCT-West, German Cancer Consortium, Partner Site Essen and University Alliance Ruhr, Research Center One Health, Essen, Germany
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Ester Simeone
- Melanoma, Cancer Immunotherapy, and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Via Mariano Semmola, 53, 80131, Naples, Italy
| | - Paolo A Ascierto
- Melanoma, Cancer Immunotherapy, and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Via Mariano Semmola, 53, 80131, Naples, Italy.
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7
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Tsai YC, Schlaepfer T, Ignatova D, Chang YT, Valaperti A, Amarov B, Blanchard G, Pehr K, Vonow-Eisenring M, Urosevic-Maiwald M, Hoetzenecker W, Pascolo S, Iselin C, Fassnacht C, Dimitriou F, Bobrowicz M, Guenova E. Boost of innate immunity cytokines as biomarkers of response to extracorporeal photopheresis in patients with leukaemic cutaneous T-cell lymphoma. Br J Dermatol 2023; 189:603-611. [PMID: 37409661 DOI: 10.1093/bjd/ljad220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/28/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Extracorporeal photopheresis (ECP) has emerged as a systemic first-line immunomodulatory therapy in leukaemic cutaneous T-cell lymphoma (L-CTCL) and is now beginning to be utilized in other T-cell-mediated diseases. Although ECP has been used for nearly 30 years, its mechanisms of action are not sufficiently understood, and biomarkers for response are scarce. OBJECTIVES We aimed to investigate the immunomodulatory effects of ECP on cytokine secretion patterns in patients with L-CTCL, to help elucidate its mechanism of action. METHODS A total of 25 patients with L-CTCL and 15 healthy donors (HDs) were enrolled in this retrospective cohort study. Concentrations of 22 cytokines were simultaneously quantified by using multiplex bead-based immunoassays. Neoplastic cells in patients' blood were evaluated by flow cytometry. RESULTS Firstly, we observed a distinct cytokine profile pattern difference between L-CTCLs and HDs. There was a significant loss of tumour necrosis factor (TNF)-α, and significant increase of interleukins (IL)-9, IL-12 and IL-13 in the sera of patients with L-CTCL compared with HDs. Secondly, patients with L-CTCL who received ECP were classified as treatment responders and nonresponders according to the quantitative reduction of malignant burden in their blood. We evaluated cytokine levels in culture supernatants from patients' peripheral blood mononuclear cells (PBMCs) at baseline and 27 weeks after ECP initiation. Strikingly, PBMCs purified from ECP responders released statistically higher concentrations of innate immune cytokines IL-1α, IL-1β, granulocyte-macrophage colony-stimulating factor (GM-CSF) and TNF-α in comparison with ECP nonresponders. In parallel, responders showed clearance of erythema, reduction of malignant clonal T cells in the blood, and a potent boost of relevant innate immune cytokines in individual patients with L-CTCL. CONCLUSIONS Taken together, our results demonstrate that ECP stimulates the innate immune network, and facilitates redirection of the tumour-biased immunosuppressive microenvironment towards proactive antitumour immune responses. The alterations of IL-1α, IL-1β, GM-CSF and TNF-α can be used as biomarkers of response to ECP in patients with L-CTCL.
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Affiliation(s)
- Yi-Chien Tsai
- Department of Dermatology, Lausanne University Hospital (CHUV), and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | | | | | - Yun-Tsan Chang
- Department of Dermatology, Lausanne University Hospital (CHUV), and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | | | - Boyko Amarov
- Institute of Statistics and Econometrics, Faculty of Economics and Business Administration, Sofia University 'St Kliment Ohridski', Sofia, Bulgaria
| | - Gabriela Blanchard
- Department of Dermatology, Lausanne University Hospital (CHUV), and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Kevin Pehr
- Division of Dermatology, McGill University, Jewish General Hospital, and Lady Davis Institute for Medical Research, Montreal, Canada
| | | | | | | | | | - Christoph Iselin
- Department of Dermatology, Lausanne University Hospital (CHUV), and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | | | | | | | - Emmanuella Guenova
- Department of Dermatology, Lausanne University Hospital (CHUV), and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Departments of Dermatology
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8
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Ensle F, Schaab JA, Dimitriou F, Huellner MW, Maurer A. Internal Thoracic Vein Tumor Thrombus From Sternal Melanoma Metastasis on 18 F-FDG PET/CT. Clin Nucl Med 2023; 48:540-541. [PMID: 37019114 DOI: 10.1097/rlu.0000000000004644] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 04/07/2023]
Abstract
ABSTRACT We present 18 F-FDG PET/CT findings of an internal thoracic vein tumor thrombus from melanoma in a 76-year-old woman. Restaging 18 F-FDG PET/CT shows a progressive disease with an internal thoracic vein tumor thrombus from a sternal bone metastasis. Although cutaneous malignant melanoma may metastasize to any body part, a direct tumor invasion of veins and the formation of a tumor thrombus represent an extremely rare complication.
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Affiliation(s)
- Falko Ensle
- From the Institute of Diagnostic and Interventional Radiology
| | | | - Florentia Dimitriou
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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9
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Looman EL, Cheng PF, Lai-Kwon J, Morgan L, Wakkee M, Dummer R, Dimitriou F. Health-related quality of life in survivors of advanced melanoma treated with anti-PD1-based immune checkpoint inhibitors. Cancer Med 2023. [PMID: 37119050 DOI: 10.1002/cam4.5967] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/11/2023] [Accepted: 04/06/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have significantly improved survival in advanced melanoma but are associated with immune-related adverse events (irAEs). This single center, cross-sectional survey aimed to describe the long-term symptom burden and impact on health-related quality of life (HRQL) of advanced melanoma patients with sustained disease control following treatment with ICIs. METHODS Advanced melanoma patients (stage IIB, III or IV, AJCCv8), treated with anti-PD1-based ICIs, who were off-treatment and had at least 6 months follow-up from their last infusion with an ongoing response in the metastatic setting or no evidence of disease recurrence in the adjuvant setting. A paper-based questionnaire, consisting of the EORTC QLQ-C30, EORTC QLQ-FA12, and the PRO-CTCAE was administered. RESULTS Of 90 participants, 61 (68%) completed the questionnaire; 40 received single-agent anti-PD1, and 21 anti-PD1/anti-CTLA4. Thirty-three (54%) were treated in the adjuvant setting. At the time of enrolment, 31 (51%) participants had active treatment for a previous irAE. Overall, 18/61 (30%) participants reported long-term symptoms and trouble in physical and emotional functioning. Physical fatigue was common and interfered with daily activities (n = 12, 20%). In the PRO-CTCAE questionnaire, muscle ache (n = 12, 20%) and joint ache (n = 9, 15%) were commonly reported. Despite this, participants reported overall good health (6.00, range 2.00-7.00) and reasonable level of HRQL (6.00, range 3.00-7.00). DISCUSSION Melanoma survivors experience long-term symptoms in physical and psychosocial HRQL domains after ICI treatment. These results underline the importance to address existing gaps in survivorship care, implement these findings in clinical practice and increase awareness for long-term symptoms in these patients.
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Affiliation(s)
- E L Looman
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - P F Cheng
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - J Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - L Morgan
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - M Wakkee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - R Dummer
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - F Dimitriou
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
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10
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Rossi VA, Gawinecka J, Dimitriou F, von Eckardstein A, Dummer R, Ruschitzka F, Matter CM. Value of troponin T versus I in the diagnosis of immune checkpoint inhibitor-related myocarditis and myositis: rechallenge? ESC Heart Fail 2023. [PMID: 37021424 PMCID: PMC10375180 DOI: 10.1002/ehf2.14360] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/21/2023] [Accepted: 03/05/2023] [Indexed: 04/07/2023] Open
Abstract
A 54-year old patient with metastatic melanoma presented with asymptomatic myositis and myocarditis after combined immune checkpoint inhibitors (ICI) therapy (anti-programmed cell death receptor-1, anti-lymphocyte activating gene-3, and anti-indoleamine 2,3-dioxygenase-1). The diagnosis was based on the typical time window after ICI, recurrence upon re-challenge, elevations of CK, high-sensitive troponin T (hs-TnT) and I (hs-TnI), mild NT-proBNP increase, and positive magnetic resonance imaging criteria. Notably, hsTnI was found to more rapidly increase and fall and to be more heart-specific than TnT in the context of ICI-related myocarditis. This led to ICI therapy withdrawal and switch to a less effective systemic therapy. This case report highlights the differential value of hs-TnT and hs-TnI for diagnosis and monitoring of ICI-related myositis and myocarditis.
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Affiliation(s)
- Valentina A Rossi
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Joanna Gawinecka
- Institute of Clinical Chemistry, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | - Arnold von Eckardstein
- Institute of Clinical Chemistry, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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11
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Lai-Kwon J, Jacques S, Carlino M, Benannoune N, Robert C, Allayous C, Baroudjian B, Lebbe C, Zimmer L, Eroglu Z, Topcu TO, Dimitriou F, Haydon A, Lo SN, Menzies AM, Long GV. Efficacy of ipilimumab 3mg/kg following progression on low dose ipilimumab in metastatic melanoma. Eur J Cancer 2023; 186:12-21. [PMID: 37018924 DOI: 10.1016/j.ejca.2023.03.006] [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] [Received: 12/11/2022] [Revised: 02/15/2023] [Accepted: 03/04/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Differing doses of ipilimumab (IPI) are used in combination with an anti-PD1 antibody in advanced melanoma. There is no data on the outcomes of patients who progress following low-dose IPI (< 3 mg/kg) and are subsequently treated with IPI 3 mg/kg (IPI3). We conducted a multicentre retrospective survey to assess the efficacy of this strategy. METHODS Patients with resected stage III, unresectable stage III or IV melanoma who received low dose IPI (< 3 mg/kg) with an anti-PD1 antibody with recurrence (neo/adjuvant) or progressive disease (metastatic), who then received IPI3± anti-PD1 antibody were eligible. Best investigator-determined Response Evaluation Criteria in Solid Tumours response, progression-free survival (PFS) and overall survival (OS) were analysed. RESULTS Total 36 patients received low-dose IPI with an anti-PD1 antibody, 18 (50%) in the neo/adjuvant and 18 (50%) in the metastatic setting. Of which, 20 (56%) had primary resistance and 16 (44%) had acquired resistance. All patients received IPI3 for unresectable stage III or IV melanoma; median age 60 (29-78), 18 (50%) M1d disease, 32 (89%) Eastern Cooperative Oncology Group performance status 0-1. Around 35 (97%) received IPI3 with nivolumab and 1 received IPI3 alone. The response rate to IPI3 was 9/36 (25%). In patients with primary resistance, the response rate was 6/20 (30%). After a median follow-up of 22 months (95% CI: 15-27 months), the median PFS and OS were not reached in patients who responded; 1-year PFS and OS were 73% and 100%, respectively. CONCLUSIONS IPI3 following recurrence/progression on low dose IPI has clinical activity, including in primary resistance. IPI dosing is therefore critical in a subset of patients.
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12
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Troesch A, Magdalena H, Forchhammer S, Del Regno L, Lodde G, Turko P, Cheng PF, Levesque ML, Hadaschik E, Livingstone E, Peris K, Flatz L, Peter K, Dummer R, Dimitriou F. The impact of the COVID-19 pandemic on the diagnosis of cutaneous melanomas: A retrospective cohort study from five European skin cancer reference centres. J Eur Acad Dermatol Venereol 2023; 37:922-931. [PMID: 36785973 DOI: 10.1111/jdv.18953] [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: 11/13/2022] [Accepted: 02/02/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND The COVID-19 lockdown had a dramatic impact on primary care access and resulted in postponed skin cancer screenings. This raises concerns for a diagnostic delay on primary cutaneous melanomas, which can subsequently increase morbidity and mortality. OBJECTIVES The aim of the study was to investigate the impact of the COVID-19-related restrictions on the melanoma diagnosis in five European skin cancer reference centres in Switzerland, Germany, Austria and Italy. METHODS A total of 7865 cutaneous melanoma cases were collected between 01 September 2018 and 31 August 2021. The time period was stratified into pre-COVID (pre-lockdown) and post-COVID (lockdown and post-lockdown) according to the established restrictions in each country. The data collection included demographic, clinical and histopathological data from histologically confirmed cutaneous melanomas. Personal and family history of melanoma, and presence of immunosuppression were used to assess the diagnosis delay in high-risk individuals. RESULTS There was an overall increase of the Breslow tumour thickness (mean 1.25 mm vs. 1.02 mm) during the post-COVID period, as well as an increase in the proportion of T3-T4 melanomas, rates of ulceration and the number of mitotic rates ≥2 (all, p < 0.001). Patients with immunosuppression and personal history of melanoma showed a decrease in the mean log10-transformed Breslow during lockdown and post-COVID. In the multivariate analysis, age at melanoma diagnosis (p < 0.01) and personal history of melanoma (p < 0.01) showed significant differences in the mean Breslow thickness. CONCLUSIONS The study confirms the diagnostic delay in cutaneous melanomas due to the COVID-19 lockdown. High-risk individuals, such as patients with personal history of melanoma and elderly individuals, were more hesitant to restart their regular skin cancer screenings post-COVID. Further studies with longer follow-up are required to evaluate the consequences of this diagnostic delay in long-term outcomes.
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Affiliation(s)
- Alexander Troesch
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Hoellwerth Magdalena
- Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Stephan Forchhammer
- Department of Dermatology, Eberhard Karls University of Tübingen, Tuebingen, Germany
| | - Laura Del Regno
- Dermatology, Universita' Cattolica, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Georg Lodde
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Patrick Turko
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Phil F Cheng
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Mitchell L Levesque
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Eva Hadaschik
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Elisabeth Livingstone
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ketty Peris
- Dermatology, Universita' Cattolica, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Lukas Flatz
- Department of Dermatology, Eberhard Karls University of Tübingen, Tuebingen, Germany
| | - Koelblinger Peter
- Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Florentia Dimitriou
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
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13
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Nuñez NG, Berner F, Friebel E, Unger S, Wyss N, Gomez JM, Purde MT, Niederer R, Porsch M, Lichtensteiger C, Kramer R, Erdmann M, Schmitt C, Heinzerling L, Abdou MT, Karbach J, Schadendorf D, Zimmer L, Ugurel S, Klümper N, Hölzel M, Power L, Kreutmair S, Capone M, Madonna G, Cevhertas L, Heider A, Amaral T, Hasan Ali O, Bomze D, Dimitriou F, Diem S, Ascierto PA, Dummer R, Jäger E, Driessen C, Levesque MP, van de Veen W, Joerger M, Früh M, Becher B, Flatz L. Immune signatures predict development of autoimmune toxicity in patients with cancer treated with immune checkpoint inhibitors. Med (N Y) 2023; 4:113-129.e7. [PMID: 36693381 DOI: 10.1016/j.medj.2022.12.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [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: 11/29/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) are among the most promising treatment options for melanoma and non-small cell lung cancer (NSCLC). While ICIs can induce effective anti-tumor responses, they may also drive serious immune-related adverse events (irAEs). Identifying biomarkers to predict which patients will suffer from irAEs would enable more accurate clinical risk-benefit analysis for ICI treatment and may also shed light on common or distinct mechanisms underpinning treatment success and irAEs. METHODS In this prospective multi-center study, we combined a multi-omics approach including unbiased single-cell profiling of over 300 peripheral blood mononuclear cell (PBMC) samples and high-throughput proteomics analysis of over 500 serum samples to characterize the systemic immune compartment of patients with melanoma or NSCLC before and during treatment with ICIs. FINDINGS When we combined the parameters obtained from the multi-omics profiling of patient blood and serum, we identified potential predictive biomarkers for ICI-induced irAEs. Specifically, an early increase in CXCL9/CXCL10/CXCL11 and interferon-γ (IFN-γ) 1 to 2 weeks after the start of therapy are likely indicators of heightened risk of developing irAEs. In addition, an early expansion of Ki-67+ regulatory T cells (Tregs) and Ki-67+ CD8+ T cells is also likely to be associated with increased risk of irAEs. CONCLUSIONS We suggest that the combination of these cellular and proteomic biomarkers may help to predict which patients are likely to benefit most from ICI therapy and those requiring intensive monitoring for irAEs. FUNDING This work was primarily funded by the European Research Council, the Swiss National Science Foundation, the Swiss Cancer League, and the Forschungsförderung of the Kantonsspital St. Gallen.
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Affiliation(s)
- Nicolas Gonzalo Nuñez
- Institute of Experimental Immunology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Fiamma Berner
- Institute of Immunobiology, Medical Research Center, Kantonsspital St. Gallen, St.Gallen, Switzerland
| | - Ekaterina Friebel
- Institute of Experimental Immunology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Susanne Unger
- Institute of Experimental Immunology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Nina Wyss
- Institute of Immunobiology, Medical Research Center, Kantonsspital St. Gallen, St.Gallen, Switzerland; Department of Dermatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Julia Martinez Gomez
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mette-Triin Purde
- Institute of Immunobiology, Medical Research Center, Kantonsspital St. Gallen, St.Gallen, Switzerland
| | - Rebekka Niederer
- Institute of Immunobiology, Medical Research Center, Kantonsspital St. Gallen, St.Gallen, Switzerland; Department of Dermatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Maximilian Porsch
- Department of Radiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Christa Lichtensteiger
- Institute of Immunobiology, Medical Research Center, Kantonsspital St. Gallen, St.Gallen, Switzerland
| | - Rafaela Kramer
- Department of Dermatology, Uniklinikum Erlangen, Deutsches Zentrum Immuntherapie (DZI), Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Michael Erdmann
- Department of Dermatology, Uniklinikum Erlangen, Deutsches Zentrum Immuntherapie (DZI), Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Christina Schmitt
- Department of Dermatology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Lucie Heinzerling
- Department of Dermatology, Uniklinikum Erlangen, Deutsches Zentrum Immuntherapie (DZI), Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; Department of Dermatology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Marie-Therese Abdou
- Institute of Immunobiology, Medical Research Center, Kantonsspital St. Gallen, St.Gallen, Switzerland
| | - Julia Karbach
- Department of Oncology and Hematology, Krankenhaus Nordwest, Frankfurt, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen and German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Essen, Germany
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen and German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Essen, Germany
| | - Selma Ugurel
- Department of Dermatology, University Hospital Essen and German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Essen, Germany
| | - Niklas Klümper
- Institute for Experimental Oncology, University Hospital Bonn, Bonn, Germany; Center for Integrated Oncology Cologne/Bonn, University Hospital Bonn, Bonn, Germany; Department of Urology, University Hospital Bonn, Bonn, Germany
| | - Michael Hölzel
- Institute for Experimental Oncology, University Hospital Bonn, Bonn, Germany; Center for Integrated Oncology Cologne/Bonn, University Hospital Bonn, Bonn, Germany
| | - Laura Power
- Institute of Experimental Immunology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Stefanie Kreutmair
- Institute of Experimental Immunology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Mariaelena Capone
- Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Napoli, Italy
| | - Gabriele Madonna
- Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Napoli, Italy
| | - Lacin Cevhertas
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Department of Medical Immunology, Institute of Health Sciences, Bursa Uludag University, Bursa, Turkey
| | - Anja Heider
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Teresa Amaral
- Skin Cancer Center, Department of Dermatology, University Hospital Tübingen, Tübingen, Germany; iFIT Cluster of Excellence (EXC 2180), University of Tübingen, Tübingen, Germany
| | - Omar Hasan Ali
- Institute of Immunobiology, Medical Research Center, Kantonsspital St. Gallen, St.Gallen, Switzerland; Department of Dermatology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Medical Genetics, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada
| | - David Bomze
- Institute of Immunobiology, Medical Research Center, Kantonsspital St. Gallen, St.Gallen, Switzerland; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Florentia Dimitriou
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stefan Diem
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Elke Jäger
- Department of Oncology and Hematology, Krankenhaus Nordwest, Frankfurt, Germany
| | - Christoph Driessen
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Mitchell Paul Levesque
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Willem van de Veen
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Markus Joerger
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Martin Früh
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Burkhard Becher
- Institute of Experimental Immunology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland.
| | - Lukas Flatz
- Institute of Immunobiology, Medical Research Center, Kantonsspital St. Gallen, St.Gallen, Switzerland; Department of Dermatology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Universitäts-Hautklinik, University of Tübingen, 72016 Tübingen, Germany.
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Iselin C, Chang Y, Schlaepfer T, Fassnacht C, Dimitriou F, Nägeli M, Pascolo S, Hoetzenecker W, Bobrowicz M, Guenova E. 460 Enhancement of antibody-dependent cellular cytotoxicity is associated with treatment response to extracorporeal photopheresis in Sézary syndrome. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.474] [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: 11/19/2022]
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Jacques S, McKeown J, Grover P, Park B, Zaremba A, Dimitriou F, Harunal Rashid M, Namikawa K, Mooradian M, Placzke J, Allayous C, Mehmi I, DePalo D, Wicky A, Schwarze J, Nakamura Y, Benannoune N, Menzies A, Lo S, Carlino M. 809P Outcomes of patients with resected stage III/IV acral or mucosal melanoma treated with adjuvant anti-PD-1 therapy. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.935] [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: 11/01/2022] Open
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Dimitriou F, Hassel J, Orloff M, Hughes I, Kapiteijn E, Mehmi I, Montazeri K, Johnson D, Grover P, Gerard C, Simeone E, Gaudy Marqueste C, Cheng P, Long G, Carvajal R, Dummer R. 832P Treatment sequence with tebentafusp (tebe) and anti-PD1/ipilimumab (PD1+IPI) in HLA-A2*02:01 patients (pts) with metastatic uveal melanoma (mUM). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.958] [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: 11/25/2022] Open
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17
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Bhave P, Ahmed T, Lo SN, Shoushtari A, Zaremba A, Versluis JM, Mangana J, Weichenthal M, Si L, Lesimple T, Robert C, Trojanello C, Wicky A, Heywood R, Tran L, Batty K, Dimitriou F, Stansfeld A, Allayous C, Schwarze JK, Mooradian MJ, Klein O, Mehmi I, Roberts-Thomson R, Maurichi A, Yeoh HL, Khattak A, Zimmer L, Blank CU, Ramelyte E, Kähler KC, Roy S, Ascierto PA, Michielin O, Lorigan PC, Johnson DB, Plummer R, Lebbe C, Neyns B, Sullivan R, Hamid O, Santinami M, McArthur GA, Haydon AM, Long GV, Menzies AM, Carlino MS. Efficacy of anti-PD-1 and ipilimumab alone or in combination in acral melanoma. J Immunother Cancer 2022; 10:e004668. [PMID: 35793872 PMCID: PMC9260790 DOI: 10.1136/jitc-2022-004668] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Acral melanoma is a rare melanoma subtype with poor prognosis. Importantly, these patients were not identified as a specific subgroup in the landmark melanoma trials involving ipilimumab and the anti-programmed cell death protein-1 (PD-1) agents nivolumab and pembrolizumab. There is therefore an absence of prospective clinical trial evidence regarding the efficacy of checkpoint inhibitors (CPIs) in this population. Acral melanoma has lower tumor mutation burden (TMB) than other cutaneous sites, and primary site is associated with differences in TMB. However the impact of this on the effectiveness of immune CPIs is unknown. We examined the efficacy of CPIs in acral melanoma, including by primary site. METHODS Patients with unresectable stage III/IV acral melanoma treated with CPI (anti-PD-1 and/or ipilimumab) were studied. Multivariable logistic and Cox regression analyses were conducted. Primary outcome was objective response rate (ORR); secondary outcomes were progression-free survival (PFS) and overall survival (OS). RESULTS In total, 325 patients were included: 234 (72%) plantar, 69 (21%) subungual and 22 (7%) palmar primary sites. First CPI included: 184 (57%) anti-PD-1, 59 (18%) anti-PD-1/ipilimumab combination and 82 (25%) ipilimumab. ORR was significantly higher with initial anti-PD-1/ipilimumab compared with anti-PD-1 (43% vs 26%, HR 2.14, p=0.0004) and significantly lower with ipilimumab (15% vs 26%, HR 0.49, p=0.0016). Landmark PFS at 1 year was highest for anti-PD-1/ipilimumab at 34% (95% CI 24% to 49%), compared with 26% (95% CI 20% to 33%) with anti-PD-1 and 10% (95% CI 5% to 19%) with ipilimumab. Despite a trend for increased PFS, anti-PD-1/ipilimumab combination did not significantly improve PFS (HR 0.85, p=0.35) or OS over anti-PD-1 (HR 1.30, p=0.16), potentially due to subsequent therapies and high rates of acquired resistance. No outcome differences were found between primary sites. CONCLUSION While the ORR to anti-PD-1/ipilimumab was significantly higher than anti-PD-1 and PFS numerically higher, in this retrospective cohort this benefit did not translate to improved OS. Future trials should specifically include patients with acral melanoma, to help determine the optimal management of this important melanoma subtype.
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Affiliation(s)
- Prachi Bhave
- Sir Peter MacCallum Cancer Centre Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Tasnia Ahmed
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
| | - Alexander Shoushtari
- Medicine, Melanoma and Immunotherapeutics Service, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Anne Zaremba
- Dermatology, University Hospital Essen, Essen, Germany
| | - Judith M Versluis
- Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Joanna Mangana
- Dermatology, University Hospital Zürich, Zurich, Switzerland
| | - Michael Weichenthal
- Dermatology, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - Lu Si
- Melanoma and Sarcoma, Peking University Cancer Hospital, Beijing, China
| | - Thierry Lesimple
- Research and Medical Oncology, Centre Eugène Marquis, Rennes, France
| | | | - Claudia Trojanello
- Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione "G.Pascale", Napoli, Italy
| | - Alexandre Wicky
- Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Richard Heywood
- Christie NHS Foundation Trust and Division of Cancer Services, University of Manchester, Manchester, UK
| | - Lena Tran
- Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kathleen Batty
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
| | - Florentia Dimitriou
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
- Dermatology, University Hospital Zürich, Zurich, Switzerland
| | - Anna Stansfeld
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK
| | - Clara Allayous
- Dermatology, Saint-Louis hospital, INSERM U976, AP-HP, Paris, France
| | - Julia K Schwarze
- Medical Oncology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Meghan J Mooradian
- Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Oliver Klein
- Medical Oncology, Olivia Newton John Cancer Centre, Austin Health, Melbourne, Victoria, Australia
- Medical Oncology, Warrnambool Hospital, Warrnambool, Victoria, Australia
- Medical Oncology, Peninsula Health, Melbourne, Victoria, Australia
| | - Inderjit Mehmi
- The Angeles Clinic and Research Institute, a Cedars-Sinai Affiliate, Los Angeles, California, USA
| | | | - Andrea Maurichi
- Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Hui-Ling Yeoh
- Medical Oncology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Adnan Khattak
- Medical Oncology, Fiona Stanley Hospital & Edith Cowan Univserity, Perth, Western Australia, Australia
| | - Lisa Zimmer
- Dermatology, University Hospital Essen, Essen, Germany
| | - Christian U Blank
- Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Egle Ramelyte
- Dermatology, University Hospital Zürich, Zurich, Switzerland
| | - Katharina C Kähler
- Dermatology, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | | | - Paolo A Ascierto
- Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione "G.Pascale", Napoli, Italy
| | | | - Paul C Lorigan
- Christie NHS Foundation Trust and Division of Cancer Services, University of Manchester, Manchester, UK
| | - Douglas B Johnson
- Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ruth Plummer
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK
| | - Celeste Lebbe
- Université de Paris, AP-HP Department of Dermatology, Hôpital Saint-Louis, Paris, France
| | - Bart Neyns
- Medical Oncology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Ryan Sullivan
- Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Omid Hamid
- The Angeles Clinic and Research Institute, a Cedars-Sinai Affiliate, Los Angeles, California, USA
| | - Mario Santinami
- Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Grant A McArthur
- Sir Peter MacCallum Cancer Centre Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew M Haydon
- Medical Oncology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Georgina V Long
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Matteo S Carlino
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
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18
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Pires da Silva I, Zakria D, Ahmed T, Trojanello C, Dimitriou F, Allayous C, Gerard C, Zimmer L, Lo S, Michielin O, Lebbe C, Mangana J, Ascierto PA, Johnson DB, Carlino M, Menzies A, Long G. Efficacy and safety of anti-PD1 monotherapy or in combination with ipilimumab after BRAF/MEK inhibitors in patients with BRAF mutant metastatic melanoma. J Immunother Cancer 2022; 10:e004610. [PMID: 35798536 PMCID: PMC9263926 DOI: 10.1136/jitc-2022-004610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patients with V600BRAF mutant metastatic melanoma have higher rates of progression-free survival (PFS) and overall survival (OS) with first-line anti-PD1 (PD1]+anti-CTLA-4 (IPI) versus PD1. Whether this is also true after BRAF/MEKi therapy is unknown. We aimed to determine the efficacy and safety of PD1 versus IPI +PD1 after BRAF/MEK inhibitors (BRAF/MEKi). METHODS Patients with V600BRAF mutant metastatic melanoma treated with BRAF/MEKi who had subsequent PD1 versus IPI+PD1 at eight centers were included. The endpoints were objective response rate (ORR), PFS, OS and safety in each group. RESULTS Of 200 patients with V600E (75%) or non-V600E (25%) mutant metastatic melanoma treated with BRAF/MEKi (median time of treatment 7.6 months; treatment cessation due to progressive disease in 77%), 115 (57.5%) had subsequent PD1 and 85 (42.5%) had IPI+PD1. Differences in patient characteristics between PD1 and IPI+PD1 groups included, age (med. 63 vs 54 years), time between BRAF/MEKi and PD1±IPI (16 vs 4 days), Eastern Cooperative Oncology Group Performance Status (ECOG PS) of ≥1 (62% vs 44%), AJCC M1C/M1D stage (72% vs 94%) and progressing brain metastases at the start of PD1±IPI (34% vs 57%). Median follow-up from PD1±IPI start was 37.8 months (95% CI, 33.9 to 52.9). ORR was 36%; 34% with PD1 vs 39% with IPI+PD1 (p=0.5713). Median PFS was 3.4 months; 3.4 with PD1 vs 3.6 months with IPI+PD1 (p=0.6951). Median OS was 15.4 months; 14.4 for PD1 vs 20.5 months with IPI+PD1 (p=0.2603). The rate of grade 3 or 4 toxicities was higher with IPI+PD1 (31%) vs PD1 (7%). ORR, PFS and OS were numerically higher with IPI+PD1 vs PD1 across most subgroups except for females, those with <10 days between BRAF/MEKi and PD1±IPI, and those with stage III/M1A/M1B melanoma. The combination of ECOG PS=0 and absence of liver metastases identified patients with >3 years OS (area under the curve, AUC=0.74), while ECOG PS ≥1, progressing brain metastases and presence of bone metastases predicted primary progression (AUC=0.67). CONCLUSIONS IPI+PD1 and PD1 after BRAF/MEKi have similar outcomes despite worse baseline prognostic features in the IPI+PD1 group, however, IPI+PD1 is more toxic. A combination of clinical factors can identify long-term survivors, but less accurately those with primary resistance to immunotherapy after targeted therapy.
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Affiliation(s)
- Ines Pires da Silva
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Blacktown & Westmead Hospital, Sydney, New South Wales, Australia
| | - Danny Zakria
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tasnia Ahmed
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
| | - Claudia Trojanello
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Florentia Dimitriou
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Clara Allayous
- Dermatolo-Oncology AP-HP Hôpital Saint-Louis, INSERM U976, Paris, France
| | | | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Serigne Lo
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
| | | | - Celeste Lebbe
- Université Paris Cite, Dermatolo-Oncology AP-HP Hôpital Saint-Louis, INSERM U976, Paris, France
| | - Johanna Mangana
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Paolo Antonio Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | | | - Matteo Carlino
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
- Blacktown & Westmead Hospital, Sydney, New South Wales, Australia
| | - Alexander Menzies
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Georgina Long
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
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19
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Holmberg CJ, Ny L, Hieken TJ, Block MS, Carr MJ, Sondak VK, Örtenwall C, Katsarelias D, Dimitriou F, Menzies AM, Saw RPM, Rogiers A, Straker RJ, Karakousis G, Applewaite R, Pallan L, Han D, Vetto JT, Gyorki DE, Tie EN, Vitale MG, Ascierto PA, Dummer R, Cohen J, Hui JYC, Schachter J, Asher N, Helgadottir H, Chai H, Kroon H, Coventry B, Rothermel LD, Sun J, Carlino MS, Duncan Z, Broman K, Weber J, Lee AY, Berman RS, Teras J, Ollila DW, Long GV, Zager JS, van Akkooi A, Olofsson Bagge R. The efficacy of immune checkpoint blockade for melanoma in-transit with or without nodal metastases - A multicenter cohort study. Eur J Cancer 2022; 169:210-222. [PMID: 35644725 PMCID: PMC9975793 DOI: 10.1016/j.ejca.2022.03.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/16/2022] [Accepted: 03/31/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Guidelines addressing melanoma in-transit metastasis (ITM) recommend immune checkpoint inhibitors (ICI) as a first-line treatment option, despite the fact that there are no efficacy data available from prospective trials for exclusively ITM disease. The study aims to analyze the outcome of patients with ITM treated with ICI based on data from a large cohort of patients treated at international referral clinics. METHODS A multicenter retrospective cohort study of patients treated between January 2015 and December 2020 from Australia, Europe, and the USA, evaluating treatment with ICI for ITM with or without nodal involvement (AJCC8 N1c, N2c, and N3c) and without distant disease (M0). Treatment was with PD-1 inhibitor (nivolumab or pembrolizumab) and/or CTLA-4 inhibitor (ipilimumab). The response was evaluated according to the RECIST criteria modified for cutaneous lesions. RESULTS A total of 287 patients from 21 institutions in eight countries were included. Immunotherapy was first-line treatment in 64 (22%) patients. PD-1 or CTLA-4 inhibitor monotherapy was given in 233 (81%) and 23 (8%) patients, respectively, while 31 (11%) received both in combination. The overall response rate was 56%, complete response (CR) rate was 36%, and progressive disease (PD) rate was 32%. Median PFS was ten months (95% CI 7.4-12.6 months) with a one-, two-, and five-year PFS rate of 48%, 33%, and 18%, respectively. Median MSS was not reached, and the one-, two-, and five-year MSS rates were 95%, 83%, and 71%, respectively. CONCLUSION Systemic immunotherapy is an effective treatment for melanoma ITM. Future studies should evaluate the role of systemic immunotherapy in the context of multimodality therapy, including locoregional treatments such as surgery, intralesional therapy, and regional therapies.
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Affiliation(s)
- Carl-Jacob Holmberg
- Sahlgrenska Center for Cancer Research, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Sweden,Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Ny
- Sahlgrenska Center for Cancer Research, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tina J. Hieken
- Department of Surgery, Mayo Clinic, Rochester, USA,Mayo Clinic Cancer Center, Rochester, USA
| | - Matthew S. Block
- Mayo Clinic Cancer Center, Rochester, USA,Department of Oncology, Mayo Clinic, Rochester, USA
| | - Michael J. Carr
- Department of Cutaneous Oncology Moffitt Cancer Center, Tampa, USA
| | - Vernon K. Sondak
- Department of Cutaneous Oncology Moffitt Cancer Center, Tampa, USA
| | - Christoffer Örtenwall
- Sahlgrenska Center for Cancer Research, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Dimitrios Katsarelias
- Sahlgrenska Center for Cancer Research, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Florentia Dimitriou
- Melanoma Institute Australia, The University of Sydney, Sydney Australia,Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland
| | - Alexander M. Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney Australia,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia,Royal North Shore and Mater Hospitals, Sydney, Australia
| | - Robyn PM. Saw
- Melanoma Institute Australia, The University of Sydney, Sydney Australia,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia,Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Aljosja Rogiers
- Melanoma Institute Australia, The University of Sydney, Sydney Australia
| | - Richard J. Straker
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Giorgos Karakousis
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Rona Applewaite
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Lalit Pallan
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dale Han
- Division of Surgical Oncology, Department of Surgery, Oregon Health & Science University, Portland, USA
| | - John T. Vetto
- Division of Surgical Oncology, Department of Surgery, Oregon Health & Science University, Portland, USA
| | - David E. Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre and Sir Peter MacCallum Department, University of Melbourne, Melbourne, Australia
| | - Emilia Nan Tie
- Division of Cancer Surgery, Peter MacCallum Cancer Centre and Sir Peter MacCallum Department, University of Melbourne, Melbourne, Australia
| | - Maria Grazia Vitale
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Paulo A. Ascierto
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Reinhard Dummer
- Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland
| | - Jade Cohen
- Department of Surgery, University of Minnesota, Minneapolis, USA
| | - Jane YC. Hui
- Department of Surgery, University of Minnesota, Minneapolis, USA
| | - Jacob Schachter
- The Ella Lemelbaum Institite for Immuno-oncology, Sheba Medical Center, Tel Aviv, Israel
| | - Nethanel Asher
- The Ella Lemelbaum Institite for Immuno-oncology, Sheba Medical Center, Tel Aviv, Israel
| | - H. Helgadottir
- Theme Cancer, Karolinska University Hospital, Stockholm, Sweden,Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | - Harvey Chai
- Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Hidde Kroon
- Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Brendon Coventry
- Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Luke D. Rothermel
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA,Case Western Reserve University, Cleveland, USA
| | - James Sun
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA,Case Western Reserve University, Cleveland, USA
| | - Matteo S. Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney Australia,Department of Medical Oncology, Westmead and Blacktown Hospitals, The Crown Princess Mary Cancer Centre, Sydney, Australia
| | - Zoey Duncan
- University of Alabama at Birmingham, Birmingham, USA
| | - Kristy Broman
- University of Alabama at Birmingham, Birmingham, USA
| | - Jeffrey Weber
- Laura and Isaac Perlmutter Cancer Center at NYU Langone Health, New York, USA
| | - Ann Y. Lee
- Laura and Isaac Perlmutter Cancer Center at NYU Langone Health, New York, USA,NYU Grossman School of Medicine, Department of Surgery, New York, USA
| | - Russell S. Berman
- Laura and Isaac Perlmutter Cancer Center at NYU Langone Health, New York, USA,NYU Grossman School of Medicine, Department of Surgery, New York, USA
| | - Jüri Teras
- North Estonian Medical Centre Foundation, Tallinn, Estonia
| | - David W. Ollila
- Division of Surgical Oncology and Endocrine Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Georgina V. Long
- Melanoma Institute Australia, The University of Sydney, Sydney Australia,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia,Royal North Shore and Mater Hospitals, Sydney, Australia
| | - Jonathan S. Zager
- Department of Cutaneous Oncology Moffitt Cancer Center, Tampa, USA,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Alexander van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Roger Olofsson Bagge
- Sahlgrenska Center for Cancer Research, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
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20
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Dimitriou F, Namikawa K, Reijers ILM, Buchbinder EI, Soon JA, Zaremba A, Teterycz P, Mooradian MJ, Armstrong E, Nakamura Y, Vitale MG, Tran LE, Bai X, Allayous C, Provent-Roy S, Indini A, Bhave P, Farid M, Kähler KC, Mehmi I, Atkinson V, Klein O, Stonesifer CJ, Zaman F, Haydon A, Carvajal RD, Hamid O, Dummer R, Hauschild A, Carlino MS, Mandala M, Robert C, Lebbe C, Guo J, Johnson DB, Ascierto PA, Shoushtari AN, Sullivan RJ, Cybulska-Stopa B, Rutkowski P, Zimmer L, Sandhu S, Blank CU, Lo SN, Menzies AM, Long GV. Single-agent anti-PD-1 or combined with ipilimumab in patients with mucosal melanoma: an international, retrospective, cohort study. Ann Oncol 2022; 33:968-980. [PMID: 35716907 DOI: 10.1016/j.annonc.2022.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 03/09/2022] [Revised: 05/15/2022] [Accepted: 06/07/2022] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Mucosal melanoma (MM) is a rare melanoma subtype with distinct biology and poor prognosis. Data on the efficacy of immune checkpoint inhibitors (ICIs) is limited. We determined the efficacy of ICIs in MM, analysed by primary site and ethnicity/race. PATIENTS AND METHODS Retrospective cohort study from 25 cancer centres in Australia, Europe, USA and Asia. Patients with histologically confirmed MM were treated with anti-PD1+/-ipilimumab. Primary endpoints were response rate (RR), progression-free survival (PFS), overall survival (OS) by primary site (naso-oral, urogenital, anorectal, other), ethnicity/race (Caucasian, Asian, Other) and treatment. Univariate and multivariate Cox proportional hazard model analyses were conducted. RESULTS In total, 545 patients were included: 331 (63%) Caucasian, 176 (33%) Asian and 20 (4%) Other. Primary sites included 113 (21%) anorectal, 178 (32%) urogenital, 206 (38%) naso-oral and 45 (8%) other. 348 (64%) received anti-PD1 and 197 (36%) anti-PD1/ipilimumab. RR, PFS and OS did not differ by primary site, ethnicity/race or treatment. RR for naso-oral was numerically higher for anti-PD1/ipilimumab (40%, 95% CI 29-54%) compared with anti-PD1 (29%, 95% CI 21-37%). 35% of patients that initially responded progressed. Median duration of response (mDOR) was 26 months (95% CI 18-NR [Not Reached]). Factors associated with short PFS were ECOG PS ≥3 (p<0.01), LDH >ULN (p=0.01), lung metastases (p<0.01) and ≥1 previous treatments (p<0.01). Factors associated with short OS were ECOG PS ≥1 (p<0.01), LDH >ULN (p=0.03), lung metastases (p<0.01) and ≥1 previous treatments (p<0.01). CONCLUSIONS MM has poor prognosis. Treatment efficacy of anti-PD1+/-ipilimumab was similar and did not differ by ethnicity/race. Naso-oral primaries had numerically higher response to anti-PD1/ipilimumab, without difference in survival. The addition of ipilimumab did not show greater benefit over anti-PD1 for other primary sites. In responders, mDOR was short and acquired resistance was common. Other factors, including site and number of metastases were associated with survival.
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Affiliation(s)
- F Dimitriou
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Department of Dermatology, University Hospital Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - K Namikawa
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - I L M Reijers
- Department of Medical Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E I Buchbinder
- Melanoma Disease Center, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02481, USA
| | - J A Soon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - A Zaremba
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - P Teterycz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, 49585Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - M J Mooradian
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - E Armstrong
- Department of Medicine, Melanoma Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Y Nakamura
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
| | - M G Vitale
- Istituto Nazionale Tumori IRCCS Fondazione 'G. Pascale', Napoli, Italy
| | - L E Tran
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - X Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - C Allayous
- APHP Hôpital Saint-Louis, Dermatology Department, DMU ICARE, Paris, France
| | - S Provent-Roy
- Dermatology Service, Department of Medicine, Gustave Roussy and Paris-Saclay University, Villejuif, France
| | - A Indini
- Unit of Medical Oncology, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - P Bhave
- Westmead and Blacktown Hospitals, Sydney, New South Wales, Australia
| | - M Farid
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - K C Kähler
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - I Mehmi
- Department of Hematology/Oncology, The Angeles Clinic and Research Institute, a Cedars-Sinai Affiliate, 11800 Wilshire Blvd Suite 300, Los Angeles, CA, 90025, USA
| | - V Atkinson
- Princess Alexandra Hospital, Greenslopes Private Hospital, University of Queensland, Queensland, Australia
| | - O Klein
- Department of Medical Oncology, Austin Health, Melbourne, Australia; Olivia Newton-John Cancer Research Institute, Melbourne, Victoria
| | - C J Stonesifer
- Columbia University Irving Medical Center, New York City, New York, USA
| | - F Zaman
- Alfred Hospital, Melbourne, Victoria, Australia
| | - A Haydon
- Alfred Hospital, Melbourne, Victoria, Australia
| | - R D Carvajal
- Columbia University Irving Medical Center, New York City, New York, USA
| | - O Hamid
- Department of Hematology/Oncology, The Angeles Clinic and Research Institute, a Cedars-Sinai Affiliate, 11800 Wilshire Blvd Suite 300, Los Angeles, CA, 90025, USA
| | - R Dummer
- Department of Dermatology, University Hospital Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland
| | - A Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - M S Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Westmead and Blacktown Hospitals, Sydney, New South Wales, Australia
| | - M Mandala
- Unit of Medical Oncology, University of Perugia, Perugia, Italy
| | - C Robert
- Dermatology Service, Department of Medicine, Gustave Roussy and Paris-Saclay University, Villejuif, France
| | - C Lebbe
- Université de Paris, APHP Hôpital Saint-Louis, Dermatology Department, DMU ICARE, INSERM U-976, Paris, France
| | - J Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - D B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - P A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione 'G. Pascale', Napoli, Italy
| | - A N Shoushtari
- Department of Medicine, Melanoma Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - R J Sullivan
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - B Cybulska-Stopa
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Poland
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, 49585Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - L Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - S Sandhu
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - C U Blank
- Department of Medical Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - A M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - G V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia.
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21
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Dimitriou F, Hauschild A, Mehnert JM, Long GV. Double Trouble: Immunotherapy Doublets in Melanoma-Approved and Novel Combinations to Optimize Treatment in Advanced Melanoma. Am Soc Clin Oncol Educ Book 2022; 42:1-22. [PMID: 35658500 DOI: 10.1200/edbk_351123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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]
Abstract
Immune checkpoint inhibitors, particularly anti-PD-1-based immune checkpoint inhibitors, have dramatically improved outcomes for patients with advanced melanoma and are currently deemed a standard of care. Ipilimumab/nivolumab is the first combination of immune checkpoint inhibitors to improve progression-free survival and overall survival in the first-line setting, with durable responses and the longest median overall survival, 72.1 months, of any drug therapy approved for advanced melanoma. However, its use is limited by the high rate of severe (grade 3-4) treatment-related adverse events. More recently, the novel immune checkpoint inhibitor combination of nivolumab/relatlimab (anti-PD-1/anti-LAG3) showed improved progression-free survival compared with nivolumab alone in the first-line setting and was well tolerated; thus, it is likely this combination will be added to the armamentarium as a first-line treatment for advanced melanoma. These changes in the treatment landscape have several treatment implications for decision-making. The choice of first-line systemic drug therapy, and the decision between immune checkpoint inhibitor monotherapy or combination therapy, requires a comprehensive assessment of disease-related factors and patient characteristics. Despite this striking progress, many patients' disease still progresses. Several new agents and therapeutic approaches are under investigation in clinical trials. Intralesional treatments hold promise for accessible metastases, although their broad application in the clinic will be limited. Prognostic and predictive biomarkers, as well as strategies to reduce treatment-related toxicities and overcome resistance, are required and are now the focus of clinical and translational research.
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Affiliation(s)
- Florentia Dimitriou
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Janice M Mehnert
- NYU Grossman School of Medicine and Perlmutter Cancer Center, New York, NY
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, Australia
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22
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Lai-Kwon JE, Jacques S, Carlino MS, Benannoune N, Robert C, Allayous C, Baroudjian B, Lebbe C, Zimmer L, Eroglu Z, Ozturk Topcu T, Dimitriou F, Haydon AM, Lo SN, Menzies AM, Long GV. Efficacy of ipilimumab 3mg/kg following progression on low dose ipilimumab in metastatic melanoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e21533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
e21533 Background: Anti-cytotoxic T lymphocyte-associated antigen 4 inhibitors, such as ipilimumab (IPI), are commonly used in melanoma management. Whilst a clear dose-toxicity relationship exists, and a dose-response relationship is seen with monotherapy in people with anti PD-1 antibody-naïve melanoma, there is no data on the outcomes of patients who progress following low dose IPI and are subsequently treated with standard dose IPI. We conducted a multicentre, retrospective review to assess the efficacy of this strategy. Methods: Patients with resected stage III, unresectable stage III or IV melanoma who received low dose IPI (< 3mg/kg) with an anti-PD1 antibody in the neoadjuvant, adjuvant or metastatic setting with recurrence (neo/adjuvant) or progressive disease (metastatic) as best response, who then received standard dose IPI (3mg/kg, IPI3) alone or in combination with an anti-PD1 antibody were eligible. IPI dose, frequency and best investigator-assessed RECIST response were collected. Progression free survival (PFS) and overall survival (OS) were analysed using the Kaplan Meier method. Results: 36 patients from 8 centres; 27 (75%) male, BRAF V600 mutant (18, 50%). All patients received low dose IPI with an anti-PD1 antibody, 18 (50%) in the neo/adjuvant and 18 (50%) in the metastatic setting; 15 (42%) received IPI 1mg/kg every 6 weeks, 13 (36%) IPI 1mg/kg every 3 weeks, 3 (8%) IPI 50mg every 6 weeks or 100mg every 12 weeks respectively, and 2 (6%) IPI 1mg/kg every 8 weeks. 23 (64%) received >1 intervening line of systemic therapy prior to IPI3. The most common intervening therapy was BRAF/MEK inhibitors; 14/23 (61%) as 2nd line treatment, 4/8 (50%) as 3rd line treatment, and all progressed. All patients received standard dose IPI3 for unresectable stage III or stage IV melanoma; median age 60 (29-78), 18 (50%) had M1d disease, 32 (89%) ECOG 0-1, 18 (50%) normal lactate dehydrogenase. 35 (97%) received IPI3 with nivolumab and 1 received single agent IPI3. 15 (42%) received 4 cycles of IPI3. The most common reason for IPI3 cessation was progressive disease (16, 44%). The response rate to IPI3 following progression on low dose IPI was 9/36 (25%); the disease control rate was 12/36 (33%). After a median follow up of 22 months (95% CI: 15-27 months), the median PFS and OS were not reached in patients who responded;1-year PFS and OS were 73% and 100% respectively. 13/36 (36%) had grade 3-4 immune-related adverse events (irAE). In 3/36 (8%), the same irAE was observed at low dose IPI and IPI3, and 1 patient had the same irAE (rash) at a higher grade with IPI3 compared to low dose IPI. Conclusions: Standard dose IPI3 following progression on low dose IPI has clinical activity.This is a reasonable treatment strategy for patients who progress on low dose IPI and provides further evidence of a dose-response relationship for IPI. Further research is needed to manage resistance to IPI with anti-PD1.
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Affiliation(s)
| | - Sarah Jacques
- Crown Princess Mary Cancer Centre, Sydney, Australia
| | | | | | - Caroline Robert
- Gustave Roussy and Paris-Saclay University, Villejuif-Paris, France
| | - Clara Allayous
- AP-HP Hôpital Saint-Louis Dermatology Department, Paris, France
| | | | - Celeste Lebbe
- Universite de Paris, AP-HP Hôpital Saint-Louis, Dermatology Department, Paris, France
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | | | | | | | | | - Serigne N. Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Alexander M. Menzies
- Melanoma Institute Australia, The University of Sydney, and Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Georgina V. Long
- Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
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23
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Taylor AM, Galea C, Lo SN, Dimitriou F, Jacques S, Allayous C, Yeoh HL, Ressler JM, Kähler KC, Festino L, Schwarze JK, Wicky AM, Placzke J, Johnson DB, Zimmer L, Lebbe C, Dummer R, Carlino MS, Long GV, Menzies AM. Efficacy and safety of "second adjuvant" therapy with BRAF/MEK inhibitors after resection of recurrent melanoma following adjuvant PD-1–based immunotherapy. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
9575 Background: Both anti-PD-1 antibodies and BRAK/MEK inhibitors (BRAF/MEKi) reduce the risk of recurrence for patients with resected stage III melanoma. For patients with V600 BRAF-mutated melanoma who recur with resectable disease on or after adjuvant, many may be suitable for ‘second adjuvant' treatment after surgery. We sought to examine the efficacy and safety of ‘second adjuvant’ BRAF/MEKi in patients who recurred despite adjuvant PD-1 based immunotherapy. Methods: Patients with V600 BRAF-mutated melanoma treated with adjuvant PD-1 based immunotherapy for resected stage III/IV disease who recurred, underwent resection of recurrence and were then treated with adjuvant BRAF/MEKi were identified retrospectively from 13 centres. Demographics, disease characteristics, treatment details, and outcome data were examined. Results: 55 patients were included; median age at commencement of PD-1 was 53y, most were V600E (91%) and had IIIB (42%) or IIIC (44%) melanoma. PD-1 based adjuvant therapy included nivolumab (71%), nivolumab plus ipilimumab (14%), pembrolizumab (13%) and pembrolizumab plus mRNA-4157 vaccine (2%). Patients had initial recurrence after mean 8.4 months (95% CI 7.4-10.6), mainly while on treatment (65%), in regional nodes (42%), in-transit metastases (ITMs; 38%), both regional nodes and ITMs (7%) and distant metastases (13%). Surgical management included CLND (36%), selected nodal resection (11%), ITM resection (33%) and resection of distant metastasis (13%). A minority had adjuvant radiotherapy (17%). Stage at start of second adjuvant BRAF/MEKi included IIIB (29%), IIIC (53%) IIID (4%) and IV (15%). Patients received dabrafenib and trametinib (95%, N = 52) and encorafenib and binimetinib (5%, N = 3). After a median follow up of 21.4 months (19.7-25.4), 17 (31%) patients have recurred again. Mean duration of treatment was 9 months (95% CI 7.4-10.6); 20% ceased for toxicity, 7% for recurrence and 35% were on treatment at last follow up. The most common toxicity was pyrexia (43%) and 21% patients experienced a severe (G3-4) adverse event. Median RFS was 33.4 months (14.3.7-NR) and median DMFS was not reached. At 12 months, 72% (59-88) of patients were recurrence free and 90% (81-100) were free of distant recurrence. For those whose disease recurred again, most recurred after cessation of second adjuvant BRAF/MEKi (13/17, 76%). 7 (41%) recurred locally and 8 (47%) recurred with new metastatic disease but none had brain metastases. Conclusions: This is the first study examining outcomes of patients receiving second adjuvant targeted therapy for melanoma, after failure of adjuvant PD-1 based immunotherapy. While RFS appears shorter compared to first line trials, second adjuvant treatment with BRAF/MEKi appears safe and active in preventing further recurrence. Further data on sequencing adjuvant therapies are needed.
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Affiliation(s)
| | | | - Serigne N. Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | | | - Sarah Jacques
- Crown Princess Mary Cancer Centre, Sydney, Australia
| | | | | | - Julia M. Ressler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Katharina C. Kähler
- University Hospital (UKSH), Campus Kiel, Department of Dermatology, Kiel, Germany
| | - Lucia Festino
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Julia Katharina Schwarze
- Department of Medical Oncology, Vrije Universiteit Brussel (VUB)/ Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Alexandre M. Wicky
- Precision Oncology Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Joanna Placzke
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Celeste Lebbe
- Universite de Paris, AP-HP Hôpital Saint-Louis, Dermatology Department, Paris, France
| | | | | | - Georgina V. Long
- Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Alexander M. Menzies
- Melanoma Institute Australia, The University of Sydney, and Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
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24
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Zehnder M, Amarov B, Abrunhosa-Branquinho AN, Maiwald-Urosevic M, Mühleisen B, Saulite I, Anzengruber F, Imhof L, Navarini AA, Cozzio A, Dummer R, Dimitriou F, Guenova E. Radiotherapy as a Treatment Option for Local Disease Control in Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type. Dermatology 2022; 238:967-976. [PMID: 35158362 DOI: 10.1159/000522053] [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: 04/02/2021] [Accepted: 12/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL, LT) is an aggressive lymphoma variant. Anthracycline-based chemotherapy with rituximab is recommended as first-line treatment. Radiotherapy (RT) has been considered as a therapeutic option for local disease control in patients with solitary or localized lesions. METHODS We report the results of a retrospective analysis of PCDLBC, LT patients treated either with RT alone or with physician's decision as first-line treatment, aiming to assess disease progression and/or first recurrence in these treatment groups. RESULTS We retrospectively analyzed 20 patients treated either with RT alone (n = 8) or with investigator's choice treatment (n = 12), which included chemotherapy alone or combined with local therapy (RT and wide local excision). Complete response (CR) was achieved in 8 patients from the first group and 9 patients from the second group, with 1 treatment failure. Six patients treated with RT alone progressed with a median time to progression (TTP) of 12.5 months. In the second group, 5 patients progressed with a median TTP of 5.2 months. RT showed good local disease control in both groups without any skin relapses during the follow-up period. CONCLUSION RT as first-line monotherapy followed by watchful waiting did not significantly improve the overall risk of disease progression but resulted in good local disease control. After progression, RT could still easily be combined with systemic treatment. The strength of this analysis needs to be evaluated in a larger patient cohort.
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Affiliation(s)
- Mara Zehnder
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Department of Dermatology, University of Basel, Basel, Switzerland
| | - Boyko Amarov
- Institute of Statistics and Econometrics, Sofia University "St. Kliment Ohridski", Faculty of Economics and Business Administration, Sofia, Bulgaria
| | - André N Abrunhosa-Branquinho
- Serviço de Radioterapia, Hospital Santa Maria - Centro Hospitalar Universitário Lisboa Norte (CHULN) E.P.E., Lisbon, Portugal
| | | | - Beda Mühleisen
- Department of Dermatology, University of Basel, Basel, Switzerland
| | - Ieva Saulite
- Department of Dermatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Florian Anzengruber
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Laurence Imhof
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | | | - Antonio Cozzio
- Department of Dermatology, Kantonsspital St. Gallen, St. Gallen, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Florentia Dimitriou
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland, .,Faculty of Medicine, University of Zurich, Zurich, Switzerland,
| | - Emmanuella Guenova
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Department of Dermatology, Lausanne University Hospital (CHUV) and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
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25
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Halle BR, Betof Warner A, Zaman FY, Haydon A, Bhave P, Dewan AK, Ye F, Irlmeier R, Mehta P, Kurtansky NR, Lacouture ME, Hassel JC, Choi JS, Sosman JA, Chandra S, Otto TS, Sullivan R, Mooradian MJ, Chen ST, Dimitriou F, Long G, Carlino M, Menzies A, Johnson DB, Rotemberg VM. Immune checkpoint inhibitors in patients with pre-existing psoriasis: safety and efficacy. J Immunother Cancer 2021; 9:jitc-2021-003066. [PMID: 34635495 PMCID: PMC8506877 DOI: 10.1136/jitc-2021-003066] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 08/31/2021] [Indexed: 12/14/2022] Open
Abstract
Background Immune checkpoint inhibitors (ICIs) are approved to treat multiple cancers. Retrospective analyses demonstrate acceptable safety of ICIs in most patients with autoimmune disease, although disease exacerbation may occur. Psoriasis vulgaris is a common, immune-mediated disease, and outcomes of ICI treatment in patients with psoriasis are not well described. Thus we sought to define the safety profile and effectiveness of ICIs in patients with pre-existing psoriasis. Methods In this retrospective cohort study, patients from eight academic centers with pre-existing psoriasis who received ICI treatment for cancer were evaluated. Main safety outcomes were psoriasis exacerbation and immune-related adverse events (irAEs). We also assessed progression-free survival (PFS) and overall survival. Results Of 76 patients studied (50 (66%) male; median age 67 years; 62 (82%) with melanoma, 5 (7%) with lung cancer, 2 (3%) with head and neck cancer, and 7 (9%) with other cancers; median follow-up 25.1 months (range=0.2–99 months)), 51 (67%) received anti-PD-1 antibodies, 8 (11%) anti-CTLA-4, and 17 (22%) combination of anti-PD-1/CTLA-4. All patients had pre-existing psoriasis, most frequently plaque psoriasis (46 patients (61%)) and 15 (20%) with psoriatic arthritis. Forty-one patients (54%) had received any prior therapy for psoriasis although only two (3%) were on systemic immunosuppression at ICI initiation. With ICI treatment, 43 patients (57%) experienced a psoriasis flare of cutaneous and/or extracutaneous disease after a median of 44 days of receiving ICI. Of those who experienced a flare, 23 patients (53%) were managed with topical therapy only; 16 (21%) needed systemic therapy. Only five patients (7%) required immunotherapy discontinuation for psoriasis flare. Forty-five patients (59%) experienced other irAEs, 17 (22%) of which were grade 3/4. PFS with landmark analysis was significantly longer in patients with a psoriasis flare versus those without (39 vs 8.7 months, p=0.049). Conclusions In this multicenter study, ICI therapy was associated with frequent psoriasis exacerbation, although flares were manageable with standard psoriasis treatments and few required ICI discontinuation. Patients who experienced disease exacerbation performed at least as well as those who did not. Thus, pre-existing psoriasis should not prevent patients from receiving ICIs for treatment of malignancy.
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Affiliation(s)
| | | | | | - Andrew Haydon
- Department of Medical Oncology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Prachi Bhave
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Anna K Dewan
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Fei Ye
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rebecca Irlmeier
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paras Mehta
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | - Jessica C Hassel
- Department of Dermatology, NCT, University Hospital Heidelberg, Heidelberg, Germany
| | - Jacob S Choi
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jeffrey A Sosman
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sunandana Chandra
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tracey S Otto
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA.,Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Ryan Sullivan
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Meghan J Mooradian
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Steven T Chen
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Florentia Dimitriou
- Melanoma Institute Australia, North Sydney, New South Wales, Australia.,Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Georgina Long
- Melanoma Institute Australia, North Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Matteo Carlino
- Melanoma Institute Australia, North Sydney, New South Wales, Australia.,Westmead Hospital, Westmead, New South Wales, Australia
| | - Alexander Menzies
- Melanoma Institute Australia, North Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Douglas B Johnson
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Tsai YC, Schlaepfer T, Chang YT, Valaperti A, Vonow-Eisenring M, Boyman O, Maiwald M, Hoetzenecker W, Pascolo S, Iselin C, Fassnacht C, Dimitriou F, Bobrowicz M, Guenova E. Boost of innate immunity cytokines as biomarkers of response to extracorporeal photopheresis in leukemic cutaneous T-cell lymphoma patients. Eur J Cancer 2021. [DOI: 10.1016/s0959-8049(21)00704-8] [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: 11/29/2022]
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Pires da Silva I, Zakria D, Ahmed T, Trojaniello C, Dimitriou F, Allayous C, Gerard C, Zimmer L, Lo S, Michielin O, Lebbe C, Mangana J, Ascierto P, Johnson D, Carlino M, Menzies A, Long G. 1042P Anti-PD1 (PD1) monotherapy or in combination with ipilimumab (IPI) after BRAF/MEK inhibitors (BRAF/MEKi) in BRAF mutant metastatic melanoma (MM) patients (pts). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1427] [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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Dimitriou F, Namikawa K, Teterycz P, Reijers I, Buchbinder E, Soon J, Zimmer L, Mooradian M, Vitale M, Armstrong E, Johnson D, Guo J, Lebbe C, Robert C, Mandala M, Bhave P, Farid M, Kähler K, Lo S, Long G. 1049P Clinical models to predict response in mucosal melanoma (MM) patients (pts) treated with anti-PD-1 (PD1) or combined with ipilimumab (PD1+IPI). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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29
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Dimitriou F, Lo S, Tan A, Emmett L, Kapoor R, Carlino M, Long G, Menzies A. 1054P FDG-PET to predict long-term outcome from anti-PD1 (PD1) therapy in metastatic melanoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1439] [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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30
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Kudura K, Dimitriou F, Basler L, Förster R, Mihic-Probst D, Kutzker T, Dummer R, Mangana J, Burger IA, Kreissl MC. Prediction of Early Response to Immune Checkpoint Inhibition Using FDG-PET/CT in Melanoma Patients. Cancers (Basel) 2021; 13:cancers13153830. [PMID: 34359730 PMCID: PMC8345158 DOI: 10.3390/cancers13153830] [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] [Received: 06/30/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 11/22/2022] Open
Abstract
Simple Summary Melanoma has become the most rapidly increasing cancer in Caucasian populations, causing 90% of skin cancer mortality. FDG-PET/CT has been recommended by the European 2019 guidelines for melanoma for staging and treatment response assessment in advanced melanoma highlighting the need for new outcome predictive biomarkers. In the context of melanoma, the evidence on the predictive value of semiquantitative parameters derived from FDG-PET/CT is still very limited. We here provide evidence, in a large cohort of metastatic melanoma patients, that FDG-PET/CT can be used to predict the early response to immune checkpoint inhibition. On a patient-basis, total tumor volume and semiquantitative parameters, such as total metabolic tumor volume MTV and total lesion glycolysis TLG of all metastases three months after treatment start are promising predictive biomarkers for the outcome in metastatic melanoma patients. Also, early complete response on a metastasis- and patient-level seems to be predictive for lasting complete response. Abstract We aimed to investigate, whether 18F-2-fluoro-2-desoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) scans performed at baseline (time point 0; TP 0) and three months after initiation of immunotherapy (time point 1; TP 1) can be used on a metastasis- and patient-level to predict the response to immune-checkpoint inhibition using FDG-PET/CT six months after treatment start (time point 2; TP 2) in metastatic melanoma patients. This single-center retrospective study considered metastatic melanoma patients treated with immune checkpoint inhibition from TP 0 to TP 2. An analysis on a metastasis- and patient-level was carried out. Tumor volume, standardized uptake values SUV (mean, maximum, and peak), metabolic tumor volume MTV and total lesion glycolysis TLG of each included metastasis were recorded at each time point, respectively TP 0, TP 1 and TP 2. Total tumor volume, total metabolic tumor volume and total lesion glycolysis per patient were also calculated at TP 0, TP 1 and TP 2. Treatment response was assessed at metastasis- and patient-level based on FDG-PET/CT scans at TP 2. 612 melanoma metastases in 111 patients were included. The analysis on a metastasis-level showed that metastatic SUVpeak at TP 1 and volume variation between TP 0 and TP 1 were the strongest negative predictive biomarkers for response. However, at TP 0, metastatic SUVmean and SUVpeak indicated a low negative prediction power, whereas initial metastatic volume was not a predictive biomarker. Also, melanoma metastases located in bone structures had a negative influence on the outcome at TP 2, particularly in women. The analysis on a patient-level showed, that total tumor volume, total metastatic tumor volume and total lesion glycolysis of all metastases three months after treatment initiation were strong negative predictive biomarkers for response to immunotherapy six months after initiation. Age and female sex were also found to be negative predictive biomarkers with lower predictive power. Interestingly, total tumor volume at TP 0 and number of metastases at TP 0 as well as the occurrence of early immune-related adverse events between TP 0 and TP 2 did not have any predictive value for early treatment response. FDG-PET/CT performed for treatment response assessment three months after initiation of immune checkpoint inhibition in metastatic melanoma patients can also be used to predict early response to treatment. On a metastasis-level SUV peak and volume variation of metastases are strong outcome predictive biomarkers. On a patient-level total tumor volume and semiquantitative parameters such as total metabolic tumor volume MTV and total lesion glycolysis TLG of all metastases are promising outcome predictive biomarkers. Also, early complete response on a metastasis- and patient-level seems to be predictive for lasting complete response.
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Affiliation(s)
- Ken Kudura
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland;
- Correspondence:
| | - Florentia Dimitriou
- Department of Dermatology, University Hospital Zurich, 8091 Zurich, Switzerland; (F.D.); (R.D.); (J.M.)
| | - Lucas Basler
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland;
| | - Robert Förster
- Institute of Radiation Oncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland;
| | - Daniela Mihic-Probst
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Tim Kutzker
- Faculty of Applied Statistics, Humboldt University Berlin, 10117 Berlin, Germany;
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, 8091 Zurich, Switzerland; (F.D.); (R.D.); (J.M.)
| | - Joanna Mangana
- Department of Dermatology, University Hospital Zurich, 8091 Zurich, Switzerland; (F.D.); (R.D.); (J.M.)
| | - Irene A. Burger
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland;
- Department of Nuclear Medicine, Cantonal Hospital Baden, 5404 Baden, Switzerland
| | - Michael C. Kreissl
- Department of Radiology and Nuclear Medicine, Division of Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany;
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Dimitriou F, Long G, Menzies A. Novel adjuvant options for cutaneous melanoma. Ann Oncol 2021; 32:854-865. [DOI: 10.1016/j.annonc.2021.03.198] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/13/2021] [Accepted: 03/09/2021] [Indexed: 01/10/2023] Open
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Papadavid E, Kapniari E, Pappa V, Nikolaou V, Iliakis T, Dalamaga M, Jonak C, Porkert S, Engelina S, Quaglino P, Ortiz-Romero PL, Vico C, Cozzio A, Dimitriou F, Guiron R, Guenova E, Hodak E, Bagot M, Scarisbrick J. Multicentric EORTC retrospective study shows efficacy of brentuximab vedotin in patients who have mycosis fungoides and Sézary syndrome with variable CD30 positivity. Br J Dermatol 2021; 185:1035-1044. [PMID: 34137025 DOI: 10.1111/bjd.20588] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Brentuximab vedotin (BV) was approved as a therapy for mycosis fungoides (MF) based on the ALCANZA trial. Little real-world data, however, are available. OBJECTIVES To evaluate the efficacy and safety of BV in patients with MF/Sézary Syndrome (SS) with variable CD30 positivity in a real-world cohort and to explore potential predictors of response. METHODS Data from 72 patients with MF/SS across nine EORTC (European Organization for Research and Treatment of Cancer) centres were included. The primary endpoint was to evaluate the proportion of patients with: overall response (ORR), ORR lasting over 4 months (ORR4), time to response (TTR), response duration (RD), progression-free survival (PFS) and time to next treatment (TTNT). Secondary aims included a safety evaluation and the association of clinicopathological features with ORR, RD and TTNT. RESULTS All 72 patients had received at least one systemic treatment. ORR was achieved in 45 of 67; ORR4 in 28 of 67 with a median TTR of 8 weeks [interquartile range (IQR) 5·5-14] and with a median RD of 9 months (IQR 3·4-14). Median PFS was 7 months (IQR 2-12) and median TTNT was 30 days (6-157·5). Patient response, RD, PFS and TTNT were not associated with any clinicopathological characteristics. In the MF group, patients with stage IIB/III vs. IV achieved longer PFS and had a higher percentage of ORR4. There was a statistically significant association between large-cell transformation and skin ORR (P = 0·03). ORR4 was more frequently achieved in patients without lymph node involvement (P = 0·04). CONCLUSIONS BV is an effective option for patients with MF/SS, including those with variable CD30 positivity, large-cell transformation, SS, longer disease duration and who have been treated previously with several therapies.
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Affiliation(s)
- E Papadavid
- 1st and 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - E Kapniari
- 1st and 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - V Pappa
- 1st and 2nd Propaedeutic Department, Hematology Units, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - V Nikolaou
- 1st and 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - T Iliakis
- 1st and 2nd Propaedeutic Department, Hematology Units, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - M Dalamaga
- 1st Department of Biological Chemistry, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - C Jonak
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - S Porkert
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - S Engelina
- Division of Dermatology, Tel Aviv University, Israel
| | - P Quaglino
- Division of Dermatology, Tel Aviv University, Israel
| | - P L Ortiz-Romero
- Dermatologic Clinic, Department of Medical Sciences, University of Turin Medical School, Turin, Italy
| | - C Vico
- Department of Dermatology, 12 de Octubre Hospital, Medical School, University Compultense, Madrid, Spain
| | - A Cozzio
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - F Dimitriou
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - R Guiron
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Tel Aviv University, Israel
| | - E Guenova
- Department of Dermatology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - E Hodak
- Division of Dermatology, Tel Aviv University, Israel
| | - M Bagot
- Dermatology Department, APHP, Saint-Louis Hospital, Université de Paris, Paris, France.,Inserm U976, Paris, France
| | - J Scarisbrick
- Department of Dermatology, Centre for Rare Diseases, University Hospital Birmingham, Birmingham, UK
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Dimitriou F, Staeger R, Ak M, Maissen M, Kudura K, Barysch MJ, Levesque MP, Cheng PF, Dummer R, Mangana J. Frequency, Treatment and Outcome of Immune-Related Toxicities in Patients with Immune-Checkpoint Inhibitors for Advanced Melanoma: Results from an Institutional Database Analysis. Cancers (Basel) 2021; 13:2931. [PMID: 34208218 PMCID: PMC8230729 DOI: 10.3390/cancers13122931] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/04/2021] [Accepted: 06/09/2021] [Indexed: 12/19/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) can induce immune-related adverse events (irAEs), which may result in treatment discontinuation. We sought to describe the onset, frequency, and kinetics of irAEs in melanoma patients in a real-life setting and to further investigate the prognostic role of irAEs in treatment outcomes. In this retrospective single-center cohort study, we included 249 melanoma patients. Onset, grade, and resolution of irAEs and their treatment were analyzed. A total of 191 (74.6%) patients in the non-adjuvant and 65 (25.3%) in the adjuvant treatment setting were identified. In the non-adjuvant setting, 29 patients (59.2%) with anti-CTLA4, 43 (58.1%) with anti-PD1, and 54 (79.4%) with anti-PD1/anti-CTLA4 experienced some grade of irAE and these had an improved outcome. In the adjuvant setting, the frequency of irAEs was 84.6% in anti-CTLA4 and 63.5% in anti-PD1, but no correlation with disease relapse was observed. Patients with underlying autoimmune conditions have a risk of disease exacerbation. Immunomodulatory agents had no impact on treatment efficacy. IrAEs are correlated with increased treatment efficacy in the non-adjuvant setting. Application of steroids and immunomodulatory agents, such as anti-TNF-alpha or anti-IL6, did not affect ICI efficacy. These data support irAEs as possible prognostic markers for ICI treatment.
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Affiliation(s)
- Florentia Dimitriou
- Department of Dermatology, University Hospital of Zurich, 8091 Zurich, Switzerland; (F.D.); (R.S.); (M.A.); (M.J.B.); (M.P.L.); (P.F.C.); (J.M.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland;
| | - Ramon Staeger
- Department of Dermatology, University Hospital of Zurich, 8091 Zurich, Switzerland; (F.D.); (R.S.); (M.A.); (M.J.B.); (M.P.L.); (P.F.C.); (J.M.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland;
| | - Melike Ak
- Department of Dermatology, University Hospital of Zurich, 8091 Zurich, Switzerland; (F.D.); (R.S.); (M.A.); (M.J.B.); (M.P.L.); (P.F.C.); (J.M.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland;
| | - Matias Maissen
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland;
| | - Ken Kudura
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Marjam J. Barysch
- Department of Dermatology, University Hospital of Zurich, 8091 Zurich, Switzerland; (F.D.); (R.S.); (M.A.); (M.J.B.); (M.P.L.); (P.F.C.); (J.M.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland;
| | - Mitchell P. Levesque
- Department of Dermatology, University Hospital of Zurich, 8091 Zurich, Switzerland; (F.D.); (R.S.); (M.A.); (M.J.B.); (M.P.L.); (P.F.C.); (J.M.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland;
| | - Phil F. Cheng
- Department of Dermatology, University Hospital of Zurich, 8091 Zurich, Switzerland; (F.D.); (R.S.); (M.A.); (M.J.B.); (M.P.L.); (P.F.C.); (J.M.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland;
| | - Reinhard Dummer
- Department of Dermatology, University Hospital of Zurich, 8091 Zurich, Switzerland; (F.D.); (R.S.); (M.A.); (M.J.B.); (M.P.L.); (P.F.C.); (J.M.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland;
| | - Joanna Mangana
- Department of Dermatology, University Hospital of Zurich, 8091 Zurich, Switzerland; (F.D.); (R.S.); (M.A.); (M.J.B.); (M.P.L.); (P.F.C.); (J.M.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland;
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Dimitriou F, Hogan SA, Cheng PF, Dummer R, Menzies AM, Long GV. IL-6 blockade for prophylaxis and management of immune-related adverse events (irAEs) with anti-PD-1 based immunotherapy. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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
9553 Background: Immune checkpoint inhibitors (ICIs) have activity across many tumor types, but activation of the immune system may also lead to significant, often steroid-refractory irAEs. We sought to determine the activity of tocilizumab, an anti-IL6R monoclonal antibody (mAb), in treatment or prevention of auto-immune irAE in ICI-treated patients (pts). Methods: Institutional databases from 2 melanoma centers were reviewed for pts treated with ICIs and tocilizumab. Treatment and melanoma outcomes were prospectively assessed. Longitudinal assessment of c-reactive protein (CRP) and assessment of clinical improvement (defined as irAE resolution to grade ≤1 CTCAEv5) or prophylaxis (absence of flare, defined as ≥ grade 2) were utilized to evaluate the benefit of tocilizumab. Paired Wilcoxon rank test was used to compare CRP levels prior to ICI administration, at the onset of irAEs and after tocilizumab administration. Results: 22 pts were identified. 2 pts were treated prophylactically (pre-existing dermatomyositis [n = 1] and giant cell arteritis [GCA, n = 1]) before the administration of PD1. 20 pts were treated for management of irAEs due to PD1 +/-CTLA4 (multiple concurrent irAEs [n = 3], steroid refractory irAES [hepatitis & pancreatitis, n = 2], steroid+anti-TNFα refractory colitis [n = 2], steroid+other immunosuppressive-refractory hepatitis [n = 1], cytokine release syndrome-related AEs [n = 6], musculoskeletal irAEs [n = 6]). 15 (68.2%) pts with irAEs required hospitalization and of those, 13 (86.7%) received tocilizumab whilst inpatient. Median time to irAE onset from ICI start was 48 days (range 8-786) and from irAE onset to tocilizumab administration 32 days (range 1-192). Median time to irAE resolution from tocilizumab administration was 7 days (range 1-799). Clinical improvement/benefit was demonstrated in 21/22 patients; one patient with ir-hepatitis did not respond. Median CRP prior to ICI administration was 32mg/L (range 0.3-99), at the onset of irAE 49.5mg/L (range 0.3-251, p = 0.055) and after the tocilizumab administration 18mg/L (range 0.3-18, p = 0.0015). Tocilizumab was well tolerated with self-limiting and transient toxicities in 17 (77.3%) patients. There were two grade 4 events; gastrointestinal tract perforation and Fournier gangrene, the latter unrelated to tocilizumab. Two (9%) patients died due to melanoma. From start of ICI, median progression-free survival (PFS) was 5.88 months and median overall survival (OS) was not reached. Conclusions: Tocilizumab was a well-tolerated and effective steroid-sparing treatment for both management of irAEs, as well as prevention of a flare of pre-existing auto-immune disorders during ICI administration. Prospective trials to evaluate its efficacy and impact on cancer outcomes compared with standard strategies are required.
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Affiliation(s)
| | | | | | - Reinhard Dummer
- Skin Cancer Center, University Hospital of Zürich, Zürich, Switzerland
| | - Alexander M. Menzies
- Melanoma Institute Australia, The University of Sydney, and Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Georgina V. Long
- Melanoma Institute Australia, University of Sydney, and Royal North Shore and Mater Hospitals, Sydney, Australia
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Kudura K, Dimitriou F, Mihic-Probst D, Muehlematter UJ, Kutzker T, Basler L, Förster R, Dummer R, Mangana J, Husmann L, Burger IA, Kreissl MC. Malignancy Rate of Indeterminate Findings on FDG-PET/CT in Cutaneous Melanoma Patients. Diagnostics (Basel) 2021; 11:diagnostics11050883. [PMID: 34063555 PMCID: PMC8156636 DOI: 10.3390/diagnostics11050883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/09/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The use of 18F-2-Fluor-2-desoxy-D-glucose Positron Emission Tomography/Computed Tomography FDG-PET/CT in clinical routine for staging, treatment response monitoring and post treatment surveillance in metastatic melanoma patients has noticeably increased due to significant improvement of the overall survival rate in melanoma patients. However, determining the dignity of the findings with increased metabolic activity on FDG-PET/CT can be sometimes challenging and may need further investigation. PURPOSE We aimed to investigate the malignancy rate of indeterminate findings on FDG-PET/CT in metastatic cutaneous melanoma patients. METHODS This single-center retrospective study included cutaneous melanoma patients who underwent FDG-PET/CT in clinical routine between 2015 and 2017 with findings reported as indeterminate and therefore requiring further evaluation. The dignity of the included findings was determined by subsequent imaging and, if required, additional histopathology. The impact of the outcome on the clinical management was also reported. RESULTS A total of 842 FDG-PET/CT reports of 244 metastatic cutaneous melanoma patients were reviewed. Sixty indeterminate findings were included. Almost half of all indeterminate findings were lymph nodes, lung nodules and cerebral lesions. In total, 43.3% of all included findings proved to be malignant. 81% of all malignant lesions were metastases of cutaneous melanoma, while 19% of all malignant lesions could be attributed to other primary malignancies, such as lung, breast, thyroid and colorectal cancers. Malignant findings influenced clinical management in 60% of the cases. CONCLUSION Indeterminate findings on FDG-PET/CT in metastatic cutaneous melanoma patients should be further investigated. Almost one out of every two indeterminate findings on FDG-PET/CT is malignant. The majority of the findings are melanoma manifestations, however, in a significant percentage, other primary tumors are found. Upon verification, patient management is changed in most cases.
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Affiliation(s)
- Ken Kudura
- Department of Nuclear Medicine, University Hospital Zurich, 8006 Zurich, Switzerland; (U.J.M.); (L.H.); (I.A.B.)
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Correspondence:
| | - Florentia Dimitriou
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Department of Dermatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Daniela Mihic-Probst
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Urs J. Muehlematter
- Department of Nuclear Medicine, University Hospital Zurich, 8006 Zurich, Switzerland; (U.J.M.); (L.H.); (I.A.B.)
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
| | - Tim Kutzker
- Faculty of Applied Statistics, Humboldt University Berlin, 10117 Berlin, Germany;
| | - Lucas Basler
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Robert Förster
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Institute of Radiation Oncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
| | - Reinhard Dummer
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Department of Dermatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Joanna Mangana
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Department of Dermatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Lars Husmann
- Department of Nuclear Medicine, University Hospital Zurich, 8006 Zurich, Switzerland; (U.J.M.); (L.H.); (I.A.B.)
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
| | - Irene A. Burger
- Department of Nuclear Medicine, University Hospital Zurich, 8006 Zurich, Switzerland; (U.J.M.); (L.H.); (I.A.B.)
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
| | - Michael Christoph Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany;
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Dimitriou F, Zaremba A, Allayous C, Kähler KC, Gerard CL, Festino L, Schäfer S, Toussaint F, Heinzerling L, Hassel JC, Ascierto PA, Michielin O, Hauschild A, Lebbe C, Livingstone E, Ramelyte E, Cheng PF, Dummer R, Mangana J. Sustainable responses in metastatic melanoma patients with and without brain metastases after elective discontinuation of anti-PD1-based immunotherapy due to complete response. Eur J Cancer 2021; 149:37-48. [PMID: 33823361 DOI: 10.1016/j.ejca.2021.02.037] [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: 11/12/2020] [Revised: 02/05/2021] [Accepted: 02/24/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anti-PD1-based immunotherapy is currently used in most patients with advanced melanoma. Despite the remarkable data regarding overall survival, the optimal treatment duration is still unknown. METHODS We evaluated the outcome of 125 patients with advanced melanoma with and without brain metastases (MBM), treated either with anti-PD1 monotherapy (N = 97) or combined with anti-CTLA4 (N = 28) after elective treatment discontinuation due to complete response (CR) (group A, N = 86), or treatment-limiting toxicity (N = 33) and investigator's decision (ID, N = 6) (group B) with subsequent CR. RESULTS For group A, median duration of treatment (mDoT) was 22 months (range 5-49) and median time to CR 9 months (range 2-47). Accordingly, mDoT for group B was 3 months (range 0-36) and median time to CR 7 months (range 1-32). Seven patients from group A and three from group B experienced disease recurrence. Off-treatment survival was not reached. Median off-treatment response time (mOTRt) was 19 months (range 0-42) and 25 months (range 0-66), respectively. For MBM, mOTRt was 17 months (range 7-41) and 28 months (range 9-39), respectively. After a median follow-up of 38 months (range 9-70), seven (5.6%) patients had deceased, one (0.8%) due to melanoma. CONCLUSIONS Treatment discontinuation is feasible also in patients with MBM. Efficacy outcomes seemed to be similar in both groups of patients who achieved CR, regardless of reason for discontinuation. In patients who experienced disease relapse, treatment re-challenge with anti-PD1 resulted in subsequent renewed response.
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Affiliation(s)
| | - Anne Zaremba
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Clara Allayous
- APHP Department of Dermatology, Paris University Saint-Louis Hospital, U976, Paris, France
| | - Katharina C Kähler
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Camille L Gerard
- Precision Oncology Center, Department of Oncology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Lucia Festino
- Melanoma Unit, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Sarah Schäfer
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Frédéric Toussaint
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Germany
| | - Lucie Heinzerling
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Germany
| | - Jessica C Hassel
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Paolo A Ascierto
- Melanoma Unit, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Olivier Michielin
- Precision Oncology Center, Department of Oncology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Céleste Lebbe
- APHP Department of Dermatology, Paris University Saint-Louis Hospital, U976, Paris, France
| | | | - Egle Ramelyte
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Phil F Cheng
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
| | - Joanna Mangana
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
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Dimitriou F, Urner-Bloch U, Eggenschwiler C, Mitsakakis N, Mangana J, Dummer R, Urner M. The association between immune checkpoint or BRAF/MEK inhibitor therapy and uveitis in patients with advanced cutaneous melanoma. Eur J Cancer 2021; 144:215-223. [PMID: 33373866 DOI: 10.1016/j.ejca.2020.11.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/20/2020] [Accepted: 11/15/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Treatment with immune checkpoint and BRAF/MEK inhibitors has significantly improved the survival of patients with advanced cutaneous melanoma and other metastatic malignancies. Therapy-related uveitis is a rare ocular adverse event, which may potentially lead to legal blindness. The epidemiology of treatment-related uveitis is currently insufficiently known. PATIENTS AND METHODS In this cohort study, we asked whether exposure to either immune checkpoint or BRAF/MEK inhibitors was associated with a higher risk of developing uveitis compared with the general population. Based on a Bayesian framework, we estimated the probability of developing uveitis with a right-censored, exponential survival model using data from the Zurich Melanoma Registry. The registry included all adult patients treated for advanced cutaneous melanoma between January 2008 and December 2018 at the University Hospital of Zurich, Switzerland. RESULTS In total, 304 patients (64%) were treated with immune checkpoint and 186 patients (38%) with BRAF/MEK inhibitors. Median follow-up time was 74 days (interquartile range: 57-233 days). Eleven patients developed uveitis and 30 patients died. We estimated the probability of developing uveitis per year in the general population as 0.05% (95% credibility interval [CrI]: 0.02%-0.1%). Corresponding posterior probabilities of treatment-related uveitis were 3.48% (95% CrI: 0.93%-7.49%) and 5.04% (95% CrI: 2.07%-9.19%) for immune checkpoint or BRAF/MEK inhibitors (posterior probability for difference: 76%). CONCLUSIONS Immune checkpoint and particularly BRAF/MEK inhibitor therapies are associated with an increase in the risk of developing uveitis. Treatment-related uveitis is not associated with systemic adverse events of immune checkpoint or BRAF/MEK inhibitors.
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Affiliation(s)
- Florentia Dimitriou
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Ursula Urner-Bloch
- Private Ophthalmic Practice in Cooperation with the Skin Cancer Unit, University Hospital of Zurich, Zurich, Switzerland
| | | | - Nicholas Mitsakakis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Joanna Mangana
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.
| | - Martin Urner
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
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38
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Iselin C, Chang YT, Schlaepfer T, Fassnacht C, Dimitriou F, Nägeli M, Pascolo S, Hoetzenecker W, Bobrowicz M, Guenova E. Enhancement of antibody-dependent cellular cytotoxicity is associated with treatment response to extracorporeal photopheresis in Sézary syndrome. Oncoimmunology 2021; 10:1873530. [PMID: 33643690 PMCID: PMC7872039 DOI: 10.1080/2162402x.2021.1873530] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Sézary syndrome (SS) is a rare, leukemic type of cutaneous T-cell lymphoma (CTCL), for which extracorporeal photopheresis (ECP) is a first-line therapy. Reliable biomarkers to objectively monitor the response to ECP in patients with SS are missing. We examined the quantitative and qualitative impact of ECP on natural killer (NK) cell activity in SS patients, and especially their functional ability for antibody-dependent cell-mediated cytotoxicity (ADCC). Further, we addressed the question whether the magnitude of the effect on ADCC can be associated with the anti-cancer efficacy of ECP in SS patients. We assessed numbers of NK cells, ADCC activity, and treatment response based on blood tumor staging in a cohort of 13 SS patients (8 women, 5 men) treated with ECP as a first-line therapy. Blood samples were collected before treatment start and after an average of 9 months of uninterrupted ECP treatment. NK cell numbers were reduced in SS patients compared to healthy individuals and showed a tendency of recovery after long-term ECP treatment, independent of the clinical response to treatment. Patients with marginal increase (≤1.5 AU-fold) or lack of increase in ADCC activity failed to respond clinically to treatment, while patients with an increased ADCC activity showed a reduction in blood tumor burden. NK-mediated ADCC is selectively enhanced and might be a mechanism underlying the effect of ECP while in addition it can possibly serve as a reliable biomarker to objectively monitor response to ECP in patients with SS.
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Affiliation(s)
- Christoph Iselin
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Yun-Tsan Chang
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Dermatology, Lausanne University Hospital CHUV, University of Lausanne, Lausanne, Switzerland
| | - Tanja Schlaepfer
- Department of Dermatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Christina Fassnacht
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Dermatology, Kepler University Hospital, Linz, Austria
| | - Florentia Dimitriou
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mirjam Nägeli
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Steve Pascolo
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Malgorzata Bobrowicz
- Department of Dermatology, Lausanne University Hospital CHUV and Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland
| | - Emmanuella Guenova
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Dermatology, Lausanne University Hospital CHUV, University of Lausanne, Lausanne, Switzerland
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Dimitriou F, Schanz U, Nair G, Kimeswenger S, Brüggen MC, Hoetzenecker W, French LE, Dummer R, Cozzio A, Guenova E. Long-Term Disease Control After Allogeneic Hematopoietic Stem Cell Transplantation in Primary Cutaneous T-Cell Lymphoma; Results From a Single Institution Analysis. Front Med (Lausanne) 2020; 7:290. [PMID: 32714935 PMCID: PMC7344271 DOI: 10.3389/fmed.2020.00290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/22/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Allogeneic hematopoietic stem cell transplantation (alloHSCT) has been proposed as curative approach for advanced cutaneous T–cell lymphomas (CTCL). Currently, there is no established consensus for the management of disease relapse after alloHSCT. Results: Ten patients, previously treated with multiple lines of systemic treatment, received alloHSCT. Six patients had achieved partial response (PR, N = 5) and complete response (CR, N = 1) prior to HSCT. Post—HSCT, seven patients (N = 7) relapsed after a median time of 3.3 months (0.5–7.4 months) and were subsequently treated with radiotherapy (RT, N = 1), RT and adoptive T-cell transfer with EBV specific cells (N = 1), R-CHOP (N = 1) and interferon alpha−2a combined either with donor lymphocyte infusion (N = 1) or with brentuximab—vedotin (N = 1). One patient (N = 1) achieved PR only after reducing the immunosuppression. Two patients relapsed again and received interferon alpha−2a and brentuximab—vedotin, respectively. After a median follow-up time of 12.6 months (3.5–73.7 months) six patients were alive (60%) and four had deceased, three (N = 3) due to CTCL and one (N = 1) due to GVHD. Conclusion: Disease relapse after alloHSCT can be controlled with available treatments. For most patients who ultimately relapsed, reduction of immunosuppression and interferon alpha−2a either administered alone or in combination with another systemic agent were preferred. Although interferon alpha−2a, similarly to immunosuppression reduction, may be beneficial for the achievement of graft–vs.–lymphoma effect, the risk of simultaneous worsening of GVHD must be carefully evaluated and taken into consideration.
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Affiliation(s)
- Florentia Dimitriou
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Urs Schanz
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Gayathri Nair
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Susanne Kimeswenger
- Department of Dermatology, Kepler University Hospital Linz, Linz, Austria.,Department of Soft Matter Physics, Institute for Experimental Physics, Johannes Kepler University, Linz, Austria
| | - Marie-Charlotte Brüggen
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | | | - Lars E French
- Department of Dermatology, University Hospital Munich (LMU), Munich, Germany
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Antonio Cozzio
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Dermatology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Emmanuella Guenova
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Lausanne University Hospital (CHUV) and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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40
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Bobrowicz M, Fassnacht C, Ignatova D, Chang YT, Dimitriou F, Guenova E. Pathogenesis and Therapy of Primary Cutaneous T-Cell Lymphoma: Collegium Internationale Allergologicum (CIA) Update 2020. Int Arch Allergy Immunol 2020; 181:733-745. [PMID: 32690848 DOI: 10.1159/000509281] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 11/19/2022] Open
Abstract
Cutaneous T-cell lymphoma (CTCL) is a heterogeneous disease group of unknown etiology with a complex immunological background. As CTCL arises from T cells that have a vital role in the antitumor response, their therapy is largely aimed at reversing the immunological mechanisms leading to or manifesting during this malignancy. Early disease stages can be controlled with skin-directed therapy in most CTCL cases. Still, advanced CTCL has a dismal prognosis and warrants systemic therapy. Despite considerable progress in understanding the pathophysiology of the disease and the numerous systemic treatment options available, long-term remission rates with conventional treatments alone are still low. Allogeneic hematopoietic stem cell transplantation is currently the only curative option for advanced CTCL, including mycosis fungoides and Sézary syndrome. The aims of this review is to summarize the recent findings on the immunology of this heterogeneous disease and to present the advances in its clinical management.
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Affiliation(s)
| | - Christina Fassnacht
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Desislava Ignatova
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Yun-Tsan Chang
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Dermatology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Florentia Dimitriou
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Emmanuella Guenova
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland, .,Faculty of Medicine, University of Zurich, Zurich, Switzerland, .,Department of Dermatology, Lausanne University Hospital (CHUV), Lausanne, Switzerland, .,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland,
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Boegeholz J, Brueggen CS, Pauli C, Dimitriou F, Haralambieva E, Dummer R, Manz MG, Widmer CC. Challenges in diagnosis and management of neutropenia upon exposure to immune-checkpoint inhibitors: meta-analysis of a rare immune-related adverse side effect. BMC Cancer 2020; 20:300. [PMID: 32290812 PMCID: PMC7155336 DOI: 10.1186/s12885-020-06763-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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] [Received: 07/22/2019] [Accepted: 03/17/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Cancer immunotherapy via immune-checkpoint inhibition (ICI) by antibodies against cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and cell death protein 1 (PD-1) have significantly improved the outcome of metastasized melanoma and of a rapidly increasing number of other cancer types. The anti-tumor effect is often accompanied by immune-related adverse events (irAE). Hematological irAE, specifically neutropenia, are rarely observed. However, neutropenia is associated with high morbidity and mortality due to infection complications. Thus, early detection and treatment is crucial. METHODS We present the clinical course of two patients with severe neutropenia after ICI therapy and demonstrate the difficulty of the diagnosis when a comedication of metamizole, a well-known analgesic drug used to treat cancer pain, is present. Further, we provide a comprehensive descriptive and statistical analysis of published data on diagnostics, treatment and infection complication in patients with at least grade 4 neutropenia by a systematic database search. RESULTS Finally, 34 patients were analyzed, including the two case reports from our cohort. The median onset of neutropenia was 10.5 weeks after first ICI administration (interquartile range: 6 weeks). In 76% (N = 26), a normalization of the neutrophil count was achieved after a median duration of neutropenia of 13 days. In a subsample of 22 patients with detailed data, the infection rate was 13%, proven by positive blood culture in 3 cases, but 68% (N = 15) presented with fever > 38 °C. Treatment regime differed relevantly, but mainly included G-CSF and intravenous corticosteroids. Death was reported in 14 patients (41%), 3 of whom (9%) were associated with hematological irAE but only two directly associated with neutropenia. CONCLUSION With an increasing number of cancer patients eligible to ICI therapy, the incidence of severe hematological toxicities may rise substantially over the next years. Clinicians working in the field of cancer immune therapies should be aware of neutropenia as irAE to provide immediate treatment.
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Affiliation(s)
- J Boegeholz
- Department of Medical Oncology and Hematology, University and University Hospital Zurich, Zurich, Switzerland
| | - C S Brueggen
- Department of Dermatology, University and University Hospital Zurich, Zurich, Switzerland
| | - C Pauli
- Department of Dermatology, University and University Hospital Zurich, Zurich, Switzerland
| | - F Dimitriou
- Department of Dermatology, University and University Hospital Zurich, Zurich, Switzerland
| | - E Haralambieva
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - R Dummer
- Department of Dermatology, University and University Hospital Zurich, Zurich, Switzerland
| | - M G Manz
- Department of Medical Oncology and Hematology, University and University Hospital Zurich, Zurich, Switzerland
| | - C C Widmer
- Department of Medical Oncology and Hematology, University and University Hospital Zurich, Zurich, Switzerland.
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42
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Saulite I, Ignatova D, Chang YT, Fassnacht C, Dimitriou F, Varypataki E, Anzengruber F, Nägeli M, Cozzio A, Dummer R, Scarisbrick J, Pascolo S, Hoetzenecker W, Bobrowicz M, Guenova E. Blockade of programmed cell death protein 1 (PD-1) in Sézary syndrome reduces Th2 phenotype of non-tumoral T lymphocytes but may enhance tumor proliferation. Oncoimmunology 2020; 9:1738797. [PMID: 32760603 PMCID: PMC7386859 DOI: 10.1080/2162402x.2020.1738797] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 07/02/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 02/08/2023] Open
Abstract
Sézary syndrome (SS) is an aggressive leukemic variant of cutaneous T-cell lymphoma (L-CTCL) that arises from malignant clonally derived skin-homing CD4+ T cells. Based on advancements in our understanding of the mechanisms underlying L-CTCL, boosting the suppressed immune response emerges as a promising strategy in SS management. Immune checkpoint inhibitory molecules have already demonstrated efficacy in a wide spectrum of malignancies. Currently, agents targeting the programmed death-1 (PD-1) axis are under evaluation in L-CTCL. Here we investigated the expression of PD-1 and its ligands, PD-L1 and PD-L2 in blood and skin from patients with L-CTCL. We demonstrate that PD-1 expression is markedly increased on tumor T cells compared to non-tumor CD4+ T cells from SS patients and to CD4+ cells from healthy individuals. In contrast, PD-L1 shows decreased expression on tumor T cells, while PD-L2 expression is low without significant differences between these groups. Functional PD-1 blockade in vitro resulted in reduced Th2 phenotype of non-tumor T lymphocytes, but enhanced the proliferation of tumor T cells from SS patients. Our study sheds some light on the PD-1 axis in both peripheral blood and skin compartments in SS patients, which may be relevant for the treatment of L-CTCL with immune checkpoint inhibitor.
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Affiliation(s)
- Ieva Saulite
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Dermatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Desislava Ignatova
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Yun-Tsan Chang
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christina Fassnacht
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Florentia Dimitriou
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Eleni Varypataki
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Florian Anzengruber
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mirjam Nägeli
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Antonio Cozzio
- Department of Dermatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Julia Scarisbrick
- Department of Dermatology, University Hospitals Birmingham, Birmingham, UK
| | - Steve Pascolo
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | | | - Emmanuella Guenova
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Dermatology, Lausanne University Hospital CHUV, University of Lausanne, Lausanne, Switzerland
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43
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Brüggen MC, Valencak J, Stranzenbach R, Li N, Stadler R, Jonak C, Bauer W, Porkert S, Blaschke A, Meiss F, Nicolay JP, Wehkamp U, Schlaak M, Nguyen VA, Romani N, Cozzio A, Gayathri N, Dimitriou F, French LE, Dummer R, Guenova E. Clinical diversity and treatment approaches to blastic plasmacytoid dendritic cell neoplasm: a retrospective multicentre study. J Eur Acad Dermatol Venereol 2020; 34:1489-1495. [PMID: 31955469 DOI: 10.1111/jdv.16215] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 12/04/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, aggressive type of haematologic precursor malignancy primarily often manifesting in the skin. We sought to provide a thorough clinical characterization and report our experience on therapeutic approaches to BPDCN. METHODS In the present multicentric retrospective study, we collected all BPDCN cases occurring between 05/1999 and 03/2018 in 10 secondary care centres of the German-Swiss-Austrian cutaneous lymphoma working group. RESULTS A total of 37 BPDCN cases were identified and included. Almost 90% of the patients had systemic manifestations (bone marrow, lymph nodes, peripheral blood) in addition to skin involvement. The latter presented with various types of cutaneous lesions: nodular (in more than 2/3) and bruise-like (in 1/3) skin lesions, but also maculopapular exanthema (in circa 1/6). Therapeutically, 22 patients received diverse combinations of chemotherapeutic regimens and/or radiotherapy. Despite initial responses, all of them ultimately relapsed and died from progressive disease. Eleven patients underwent haematopoietic stem cell transplantation (HSCT; autologous HSCT n = 3, allo-HSCT n = 8). The mortality rate among HSCT patients was only 33.33% with a median survival time of 60.5 months. CONCLUSION Our study demonstrates the clinical diversity of cutaneous BPDCN manifestations and the positive development observed after the introduction of HSCT.
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Affiliation(s)
- M-C Brüggen
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Medical Campus Davos, Davos, Switzerland
| | - J Valencak
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - R Stranzenbach
- Department of Dermatology, Venereology, Allergology and Phlebology, Johannes Wesling Medical Centre, University Hospital of Ruhr-University Bochum, Minden, Germany
| | - N Li
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - R Stadler
- Department of Dermatology, Venereology, Allergology and Phlebology, Johannes Wesling Medical Centre, University Hospital of Ruhr-University Bochum, Minden, Germany
| | - C Jonak
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - W Bauer
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - S Porkert
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - A Blaschke
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - F Meiss
- Department of Dermatology and Venereology, Faculty of Medicine, University Medical Center - University of Freiburg, Freiburg, Germany
| | - J P Nicolay
- Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - U Wehkamp
- Department of Dermatology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - M Schlaak
- Department of Dermatology and Venereology, University Hospital of Cologne, Cologne, Germany.,Department of Dermatology and Allergology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - V A Nguyen
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - N Romani
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - A Cozzio
- Department of Dermatology, Venereology and Allergology, Canton Hospital of St. Gallen, St. Gallen, Switzerland
| | - N Gayathri
- Department for Hematology, University Hospital of Zurich, Zurich, Switzerland
| | - F Dimitriou
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - L E French
- Department of Dermatology and Allergology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - R Dummer
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - E Guenova
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Dermatology, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
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44
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Dimitriou F, Mangana J, Curioni-Fontecedro A, Rechsteiner M, Turko P, Braun RP, Dummer R, Cheng PF. Melanoma patients with additional primary cancers: a single-center retrospective analysis. Oncotarget 2019; 10:3373-3384. [PMID: 31164959 PMCID: PMC6534365 DOI: 10.18632/oncotarget.26931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 03/28/2019] [Accepted: 04/29/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Recent progress in the diagnosis and treatment of primary and metastatic cutaneous melanoma (CM) has led to a significant increase in the patients` expectancy of life. The development of additional primary tumors (APT) other than CM represents an important survival issue. Results: Of a total of 1764 CM patients, 80 (4.5%) patients developed APT. For tumors diagnosed after CM, there was a 2.7 fold excess risk for APT compared to the swiss german population. A significantly increased risk was noted for female breast (SIR, 2.46), male larynx (SIR, 76.92), male multiple myeloma (SIR, 11.2), male oesophagus (SIR, 10.8) and thyroid on males (SIR, 58.8) and females (SIR, 38.1). All thyroid cancer cases had a common papillary histological subtype and a high rate of BRAFV600E mutation. Melanoma was the primary cause of death in the vast majority of patients. Methods: We used the cancer registry from the Comprehensive Cancer Center Zurich (CCCZ) and retrospectively analyzed patients with CM and APT between 2008 and 2018. We calculated the risk of APT compared to the swiss german population using the standardized incidence ratio (SIR). Conclusions: Patients with CM have an increased risk for hematologic and solid APT. Long-term follow-up is indicated.
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Affiliation(s)
- Florentia Dimitriou
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Joanna Mangana
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Alessandra Curioni-Fontecedro
- Department of Hematology and Oncology, Division of Oncology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Markus Rechsteiner
- Department of Pathology and Molecular Pathology, University Hospital of Zurich, Zurich, Switzerland
| | - Patrick Turko
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Ralph P Braun
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Phil F Cheng
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
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Dimitriou F, Ramelyte E, Allayous C, Gérard CL, Kähler KC, Toussaint F, Schäfer S, Hassel JC, Heinzerling L, Hauschild A, Michielin O, Lebbe C, Braun RP, Dummer R, Mangana J. Sustainable responses in metastatic melanoma patients with/without brain metastases after immunotherapy induced CR. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e21042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
e21042 Background: Immunotherapy (IT) has demonstrated an improved overall survival (OS) in advanced melanoma with 15% complete responses (CR) in treatment-naïve patients (pts) with brain metastases (met) in the anti-PD1/anti-CTLA4 combination. However, data on brain-met pts who discontinue treatment (EoT) after achieving a CR are lacking. Methods: Disease characteristics and clinical outcome were retrospectively collected from 6 centers on advanced melanoma pts treated with anti-PD1 or anti-PD1/anti-CTLA4. Pts were followed for at least 10 weeks (10.8 – 242). Off-treatment survival (OTS) was defined as time between last IT dose to disease progression or death. Results: Out of 890 pts, 62 achieved a CR; 40 pts stopped treatment due to CR, while 22 due to an adverse event (AE) (n = 19) or investigator decision (n = 3) with subsequent CR. 14 were treated with anti-PD1/anti-CTLA4 and 48 with anti-PD1. 24 had a BRAF mutation, of which 10 had previously received targeted therapy (TT). The median time to first CR was 31 weeks (6 – 138), median duration of response and OTS was 91.1 and 60.7 (10.6 – 242) weeks respectively. OTS was numerically longer for those pts with EoT after AE (85 weeks, 13-242) versus those with EoT due to CR (60 weeks, 11-130). Median OS was not reached. 6/62 (3%) progressed after EoT; 4 locoregionally while 2 were subsequently treated with IT. All pts were alive at last follow-up. 19 pts had brain mets. 8 were BRAF mutated. 10 were treatment naïve, 6 received previously anti-CTLA4, 1 chemotherapy and only 2 TT. Data on reasons for EoT and responses in brain mets are seen in the table. Conclusions: Early data suggest that OTS is numerically longer in patients with EoT due to AE with subsequent CR. EoT due to sustained CR is a feasible option also in brain mets. EoT due to AE with subsequent CR was a more frequent event in the combination treatment. [Table: see text]
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Affiliation(s)
| | | | - Clara Allayous
- APHP Department of Dermatology, Paris University Saint-Louis Hospital, U976 Paris, Paris, France
| | - Camille L. Gérard
- Department of Oncology, Lausanne University Hospital CHUV, Lausanne, Switzerland, Lausanne, Switzerland
| | | | - Frédéric Toussaint
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Germany, Erlangen, Germany
| | - Sarah Schäfer
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany, Heidelberg, Germany
| | - Jessica Cecile Hassel
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany, Heidelberg, Germany
| | - Lucie Heinzerling
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Germany, Erlangen, Germany
| | | | - Olivier Michielin
- Department of Oncology, Lausanne University Hospital CHUV, Lausanne, Switzerland, Lausanne, Switzerland
| | - Celeste Lebbe
- APHP Department of Dermatology, Paris University Saint-Louis Hospital, U976 Paris, Paris, France
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Dimitriou F, Nair G, Schanz U, French L, Dummer R, Cozzio A, Guenova E. Long-term disease control after stem cell transplantation in primary cutaneous T-cell lymphoma; a single-center analysis. Eur J Cancer 2019. [DOI: 10.1016/s0959-8049(19)30605-7] [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: 11/25/2022]
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Dimitriou F, Krattinger R, Ramelyte E, Barysch MJ, Micaletto S, Dummer R, Goldinger SM. The World of Melanoma: Epidemiologic, Genetic, and Anatomic Differences of Melanoma Across the Globe. Curr Oncol Rep 2018; 20:87. [PMID: 30250984 DOI: 10.1007/s11912-018-0732-8] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [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] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW As cancer remains an increasing problem in industrial countries, the incidence of melanoma has risen rapidly in many populations during the last decades and still continues to rise. Current strategies aiming to control the disease have largely focused on improving the understanding of the interplay of causal factors for this cancer. RECENT FINDINGS Cutaneous melanoma shows clear differences in incidence, mortality, genomic profile, and anatomic presentation, depending on the country of residence, ethnicity, and socioeconomic status. Known risk factors are multiple atypical nevi, positive family and/or personal history, immune suppressive diseases or treatments, and fair skin phenotype. Besides new adjuvant therapeutic options, changed attitude toward leisure and sun exposure, primary prevention, and early detection are major contributors to disease control. Melanoma is a disease of multifactorial causality and heterogeneous presentation. Its subtypes differ in origin, anatomical site, role of UV radiation, and mutational profile. Better understanding of these differences may improve prevention strategies and therapeutic developments.
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Affiliation(s)
- Florentia Dimitriou
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland
| | - Regina Krattinger
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland
| | - Egle Ramelyte
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland
| | - Marjam J Barysch
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland
| | - Sara Micaletto
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland
| | - Simone M Goldinger
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland.
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