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Borgers JSW, Burgers FH, Schina A, Van Not OJ, van den Eertwegh AJM, Blank CU, Aarts MJB, van den Berkmortel FWPJ, de Groot JWB, Hospers GAP, Kapiteijn E, Piersma D, van Rijn RS, Boer AMSD, van der Veldt AAM, Vreugdenhil G, Boers-Sonderen MJ, Wouters MWJM, Suijkerbuijk KPM, van Thienen JV, Haanen JBAG. Seasonal variation of anti-PD-1 outcome in melanoma-Results from a Dutch patient cohort. Pigment Cell Melanoma Res 2024; 37:15-20. [PMID: 37554041 DOI: 10.1111/pcmr.13117] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/09/2023] [Accepted: 07/22/2023] [Indexed: 08/10/2023]
Abstract
Despite the improved survival rates of patients with advanced stage melanoma since the introduction of ICIs, many patients do not have (long-term) benefit from these treatments. There is evidence that the exposome, an accumulation of host-extrinsic factors including environmental influences, could impact ICI response. Recently, a survival benefit was observed in patients with BRAF wild-type melanoma living in Denmark who initiated immunotherapy in summer as compared to winter. As the Netherlands lies in close geographical proximity to Denmark and has comparable seasonal differences, a Dutch validation cohort was established using data from our nationwide melanoma registry. In this study, we did not observe a similar seasonal difference in overall survival and are therefore unable to confirm the Danish findings. Validation of either the Dutch or Danish findings in (combined) patient cohorts from other countries would be necessary to determine whether this host-extrinsic factor influences the response to ICI-treatment.
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Affiliation(s)
- J S W Borgers
- Department of Medical Oncology, Antoni van Leeuwenhoek-The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - F H Burgers
- Department of Medical Oncology, Antoni van Leeuwenhoek-The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Schina
- National Center for Cancer Immune Therapy, Department of Oncology, Copenhagen University Hospital, Herlev, Denmark
| | - O J Van Not
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A J M van den Eertwegh
- Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - C U Blank
- Department of Medical Oncology, Antoni van Leeuwenhoek-The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M J B Aarts
- Department of Medical Oncology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | | | - G A P Hospers
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - E Kapiteijn
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - D Piersma
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - R S van Rijn
- Department of Internal Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | | | - A A M van der Veldt
- Department of Medical Oncology and Radiology & Nuclear Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - G Vreugdenhil
- Department of Internal Medicine, Maxima Medical Center, Veldhoven, The Netherlands
| | - M J Boers-Sonderen
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M W J M Wouters
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Surgical Oncology, Antoni van Leeuwenhoek-The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - K P M Suijkerbuijk
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J V van Thienen
- Department of Medical Oncology, Antoni van Leeuwenhoek-The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J B A G Haanen
- Department of Medical Oncology, Antoni van Leeuwenhoek-The Netherlands Cancer Institute, Amsterdam, The Netherlands
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2
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Castelo-Branco L, Pellat A, Martins-Branco D, Valachis A, Derksen JWG, Suijkerbuijk KPM, Dafni U, Dellaporta T, Vogel A, Prelaj A, Groenwold RHH, Martins H, Stahel R, Bliss J, Kather J, Ribelles N, Perrone F, Hall PS, Dienstmann R, Booth CM, Pentheroudakis G, Delaloge S, Koopman M. ESMO Guidance for Reporting Oncology real-World evidence (GROW). Ann Oncol 2023; 34:1097-1112. [PMID: 37848160 DOI: 10.1016/j.annonc.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023] Open
Affiliation(s)
- L Castelo-Branco
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland.
| | - A Pellat
- Department of Gastroenterology and Digestive Oncology, Hôpital Cochin AP-HP, Université Paris Cité, Paris; Centre d'Épidémiologie Clinique, Hôtel Dieu, Paris, France
| | - D Martins-Branco
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland; Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Academic Trials Promoting Team (ATPT), Brussels, Belgium
| | - A Valachis
- Department of Oncology, Faculty of Medicine and Health, Örebro University Hospital, Örebro University, Örebro, Sweden
| | - J W G Derksen
- Julius Center for Health Sciences and Primary Care, Department of Epidemiology and Health Economics, University Medical Centre Utrecht, Utrecht University, Utrecht
| | - K P M Suijkerbuijk
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - U Dafni
- Laboratory of Biostatistics, Department of Nursing, National and Kapodistrian University of Athens, Athens; Frontier Science Foundation Hellas, Athens, Greece
| | - T Dellaporta
- Frontier Science Foundation Hellas, Athens, Greece
| | - A Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School of Hannover, Hannover, Germany; Toronto Center of Liver Disease, Toronto General Hospital, University Health Network, Toronto; Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - A Prelaj
- AI-ON-Lab, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan; NEARLab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - R H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - H Martins
- Business Research Unit, ISCTE Business School, ISCTE-IUL, Lisbon, Portugal
| | - R Stahel
- ETOP IBCSG Partners Foundation, Berne, Switzerland
| | - J Bliss
- ICR-CTSU, Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - J Kather
- Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden; Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - N Ribelles
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - F Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - P S Hall
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - R Dienstmann
- Oncoclinicas Precision Medicine, Oncoclinicas Group, São Paulo, Brazil; Oncology Data Science Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - C M Booth
- Department of Oncology; Department of Public Health Sciences, Queen's University, Kingston, Canada
| | - G Pentheroudakis
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - S Delaloge
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - M Koopman
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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3
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Egeler MD, van de Poll-Franse LV, Tissier R, Rogiers A, Boers-Sonderen MJ, van den Eertwegh AJ, Hospers GA, de Groot JWB, Aarts MJB, Kapiteijn E, Piersma D, Vreugdenhil G, van der Veldt AA, Suijkerbuijk KPM, Neyns B, Janssen KJ, Blank CU, Retèl VP, Boekhout AH. Health-state utilities in long-term advanced melanoma survivors comparable with the general population. Qual Life Res 2023; 32:2517-2525. [PMID: 37079262 DOI: 10.1007/s11136-023-03427-9] [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] [Accepted: 04/16/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Checkpoint inhibitors have been shown to substantially improve the survival of patients with advanced melanoma. With this growing group of survivors treated with immunotherapies, assessing their health-state utilities is essential and can be used for the calculation of quality-adjusted life years and for cost-effectiveness analyses. Therefore, we evaluated the health-state utilities in long-term advanced melanoma survivors. METHODS Health-state utilities were evaluated in a cohort of advanced melanoma survivors 24-36 months (N = 37) and 36-plus months (N = 47) post-ipilimumab monotherapy. In addition, the health-state utilities of the 24-36 months survivor group were assessed longitudinally, and utilities of the combined survival groups (N = 84) were compared with a matched control population (N = 168). The EQ-5D was used to generate health-state utility values, and quality-of-life questionnaires were used to establish correlations and influencing factors of utility scores. RESULTS Health-state utility scores were similar between the 24-36 months'- and the 36-plus months' survival group (0.81 vs 0.86; p = .22). In survivors, lower utility scores were associated with symptoms of depression (β = - .82, p = .022) and fatigue burden (β = - .29, p = .007). Utility scores did not significantly change after 24-36 months of survival, and the utilities of survivors were comparable to the matched control population (0.84 vs 0.87; p = .07). DISCUSSION Our results show that long-term advanced melanoma survivors treated with ipilimumab monotherapy experience relatively stable and high health-state utility scores.
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Affiliation(s)
- M D Egeler
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - L V van de Poll-Franse
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Medical and Clinical Psychology, Center of Research On Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - R Tissier
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - A Rogiers
- Department of Psychiatry, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium
| | - M J Boers-Sonderen
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A J van den Eertwegh
- Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - G A Hospers
- Department of Medical Oncology, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - M J B Aarts
- Department of Medical Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - E Kapiteijn
- Leiden University Medical Centre, Leiden, The Netherlands
| | - D Piersma
- Medical Spectrum Twente, Enschede, The Netherlands
| | - G Vreugdenhil
- Department of Internal Medicine, Maxima Medical Centre, Eindhoven, The Netherlands
| | - A A van der Veldt
- Departments of Medical Oncology and Radiology & Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - K P M Suijkerbuijk
- Department of Medical Oncology, University Medical Cancer Center, Utrecht, The Netherlands
| | - B Neyns
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - K J Janssen
- Bristol-Myers Squibb, Utrecht, The Netherlands
| | - C U Blank
- Department of Medical Oncology, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - V P Retèl
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Health Technology & Services Research, University of Twente, Enschede, The Netherlands
| | - A H Boekhout
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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4
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van Tol FR, Kamm IMLP, Versteeg AL, Suijkerbuijk KPM, Verkooijen HM, Oner FC, Verlaan JJ. The use of red flags during the referral chain of patients surgically treated for symptomatic spinal metastases. Neurooncol Pract 2023; 10:301-306. [PMID: 37188160 PMCID: PMC10180360 DOI: 10.1093/nop/npad013] [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: 03/09/2023] Open
Abstract
Abstract
Background
The use of so-called ‘red flags’ may be beneficial in identifying patients with metastatic spinal disease. This study examined the utility and efficacy of these red flags in the referral chain of patients surgically treated for spinal metastases.
Methods
The referral chains from the onset of symptoms until surgical treatment for all patients receiving surgery for spinal metastases between March 2009 and December 2020 were reconstructed. The documentation of red flags, as defined by the Dutch National Guideline on Metastatic Spinal Disease, was assessed for each healthcare provider involved.
Results
A total of 389 patients were included in the study. On average, 33.3% of red flags were documented as present, 3.6% were documented as absent and 63.1% were undocumented. A higher rate of red flags documented as present was associated with a longer time to diagnosis, but a shorter time to definitive treatment by a spine surgeon. Moreover, red flags were documented as present more often in patients who developed neurological symptoms at any point during the referral chain than those who remained neurologically intact.
Conclusions
The association of red flags with developing neurological deficits highlights their significance in clinical assessment. However, the presence of red flags was not found to decrease delays prior to referral to a spine surgeon, indicating that their relevance is currently not sufficiently recognized by healthcare providers. Raising awareness of symptoms indicative of spinal metastases may expedite timely (surgical) treatment and thus improve treatment outcome.
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Affiliation(s)
- F R van Tol
- Department of Orthopaedic Surgery, UMC Utrecht, Heidelberglaan 100 , 3584 CX Utrecht, The Netherlands
| | - I M L P Kamm
- Department of Orthopaedic Surgery, UMC Utrecht, Heidelberglaan 100 , 3584 CX Utrecht, The Netherlands
| | - A L Versteeg
- Imaging Division, UMC Utrecht, Heidelberglaan 100 , 3584 CX Utrecht, The Netherlands
- University of Toronto, 27 King's College Cir, Toronto , ON M5S, Canada
| | - K P M Suijkerbuijk
- Department of Medical Oncology, UMC Utrecht, Heidelberglaan 100 , 3584 CX Utrecht, The Netherlands
| | - H M Verkooijen
- Imaging Division, UMC Utrecht, Heidelberglaan 100 , 3584 CX Utrecht, The Netherlands
| | - F C Oner
- Department of Orthopaedic Surgery, UMC Utrecht, Heidelberglaan 100 , 3584 CX Utrecht, The Netherlands
| | - J J Verlaan
- Department of Orthopaedic Surgery, UMC Utrecht, Heidelberglaan 100 , 3584 CX Utrecht, The Netherlands
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Franken MG, Leeneman B, Aarts MJB, van Akkooi ACJ, van den Berkmortel FWPJ, Boers-Sonderen MJ, van den Eertwegh AJM, de Groot JWB, Hospers GAP, Kapiteijn E, Piersma D, van Rijn RS, Suijkerbuijk KPM, van der Veldt AAM, Westgeest HM, Wouters MWJM, Haanen JBAG, Uyl-de Groot CA. Trends in survival and costs in metastatic melanoma in the era of novel targeted and immunotherapeutic drugs. ESMO Open 2021; 6:100320. [PMID: 34856511 PMCID: PMC8639434 DOI: 10.1016/j.esmoop.2021.100320] [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: 04/21/2021] [Revised: 10/08/2021] [Accepted: 11/01/2021] [Indexed: 11/17/2022] Open
Abstract
Background The objective of this study was to evaluate trends in survival and health care costs in metastatic melanoma in the era of targeted and immunotherapeutic drugs. Materials and methods Data on survival and health care resource use were retrieved from the Dutch Melanoma Treatment Registry. The Kaplan–Meier method was used to estimate overall survival. Health care costs and budget impact were computed by applying unit costs to individual patient resource use. All outcomes were stratified by year of diagnosis. Results Baseline characteristics were balanced across cohort years. The percentage of patients receiving systemic treatment increased from 73% in 2013 to 90% in 2018. Patients received on average 1.85 [standard deviation (SD): 1.14] lines of treatment and 41% of patients received at least two lines of treatment. Median survival increased from 11.8 months in 2013 [95% confidence interval (CI): 10.7-13.7 months] to 21.1 months in 2018 (95% CI: 18.2 months-not reached). Total mean costs were €100 330 (SD: €103 699); systemic treatments accounted for 84% of the total costs. Costs for patients who received systemic treatment [€118 905 (SD: €104 166)] remained reasonably stable over the years even after the introduction of additional (combination of) novel drugs. From mid-2013 to 2018, the total budget impact for all patients was €452.79 million. Conclusion Our study shows a gain in survival in the era of novel targeted and immunotherapeutic drugs. These novel drugs came, however, along with substantial health care costs. Further insights into the cost-effectiveness of the novel drugs are crucial for ensuring value for money in the treatment of patients with metastatic melanoma. The median survival of patients with metastatic melanoma increased from 11.8 months in 2013 to 21.1 months in 2018. The gain in survival came along with substantial health care costs; health care costs were on average €100 300 per patient. Costs were much higher for patients with systemic treatment (€118 905) than for patients without systemic treatment (€8316). Costs for patients who received systemic treatment remained stable even after the introduction of additional novel drugs. Insights into the cost-effectiveness of the novel drugs are crucial for ensuring value for money in metastatic melanoma.
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Affiliation(s)
- M G Franken
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - B Leeneman
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - M J B Aarts
- Department of Medical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A C J van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | | - M J Boers-Sonderen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A J M van den Eertwegh
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - G A P Hospers
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - E Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - D Piersma
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - R S van Rijn
- Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - K P M Suijkerbuijk
- Department of Medical Oncology, UMC Utrecht Cancer Center, Utrecht, The Netherlands
| | - A A M van der Veldt
- Department of Medical Oncology and Radiology & Nuclear Medicine, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - H M Westgeest
- Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands
| | - M W J M Wouters
- Department of Surgical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands; Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - J B A G Haanen
- Department of Medical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - C A Uyl-de Groot
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Suijkerbuijk KPM, Haanen JBAG, Boers-Sonderen MJ, Hospers GAP, Blank CU, van den Berkmortel FWPJ, de Groot JWB, Piersma D, Aarts MJB, van Rijn RS, Vreugdenhil G, Westgeest HM, Kapiteijn E, van der Veldt AAM, van den Eertwegh AJM. Survival of stage IV melanoma in Belgium and the Netherlands. J Eur Acad Dermatol Venereol 2021; 36:e118-e119. [PMID: 34536304 DOI: 10.1111/jdv.17668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/11/2021] [Indexed: 12/31/2022]
Affiliation(s)
- K P M Suijkerbuijk
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J B A G Haanen
- Department of Medical Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M J Boers-Sonderen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G A P Hospers
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - C U Blank
- Department of Medical Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | - D Piersma
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - M J B Aarts
- Department of Medical Oncology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R S van Rijn
- Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - G Vreugdenhil
- Department of Internal Medicine, Maxima Medical Center, Eindhoven, The Netherlands
| | - H M Westgeest
- Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands
| | - E Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - A A M van der Veldt
- Departments of Medical Oncology and Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A J M van den Eertwegh
- Department of Medical Oncology, Amsterdam UMC, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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7
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Suijkerbuijk KPM, May AM, van Eijs MJM. Checkpoint inhibition: protecting against or predisposing for second primary tumors? Ann Oncol 2021; 32:935. [PMID: 33794292 DOI: 10.1016/j.annonc.2021.03.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/10/2021] [Accepted: 03/22/2021] [Indexed: 02/04/2023] Open
Affiliation(s)
- K P M Suijkerbuijk
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - A M May
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - M J M van Eijs
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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8
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Mulder EEAP, de Joode K, Litière S, Ten Tije AJ, Suijkerbuijk KPM, Boers-Sonderen MJ, Hospers GAP, de Groot JWB, van den Eertwegh AJM, Aarts MJB, Piersma D, van Rijn RS, Kapiteijn E, Vreugdenhil G, van den Berkmortel FWPJ, Hoop EOD, Franken MG, Ryll B, Rutkowski P, Sleijfer S, Haanen JBAG, van der Veldt AAM. Early discontinuation of PD-1 blockade upon achieving a complete or partial response in patients with advanced melanoma: the multicentre prospective Safe Stop trial. BMC Cancer 2021; 21:323. [PMID: 33765967 PMCID: PMC7993897 DOI: 10.1186/s12885-021-08018-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/09/2021] [Indexed: 12/26/2022] Open
Abstract
Background The introduction of programmed cell death protein 1 (PD-1) blockers (i.e. nivolumab and pembrolizumab) has significantly improved the prognosis of patients with advanced melanoma. However, the long treatment duration (i.e. two years or longer) has a high impact on patients and healthcare systems in terms of (severe) toxicity, health-related quality of life (HRQoL), resource use, and healthcare costs. While durable tumour responses have been observed and PD-1 blockade is discontinued on an individual basis, no consensus has been reached on the optimal treatment duration. The objective of the Safe Stop trial is to evaluate whether early discontinuation of first-line PD-1 blockade is safe in patients with advanced and metastatic melanoma who achieve a radiological response. Methods The Safe Stop trial is a nationwide, multicentre, prospective, single-arm, interventional study in the Netherlands. A total of 200 patients with advanced and metastatic cutaneous melanoma and a confirmed complete response (CR) or partial response (PR) according to response evaluation criteria in solid tumours (RECIST) v1.1 will be included to early discontinue first-line monotherapy with nivolumab or pembrolizumab. The primary objective is the rate of ongoing responses at 24 months after discontinuation of PD-1 blockade. Secondary objectives include best overall and duration of response, need and outcome of rechallenge with PD-1 blockade, and changes in (serious) adverse events and HRQoL. The impact of treatment discontinuation on healthcare resource use, productivity losses, and hours of informal care will also be assessed. Results will be compared to those from patients with CR or PR who completed 24 months of treatment with PD-1 blockade and had an ongoing response at treatment discontinuation. It is hypothesised that it is safe to early stop first-line nivolumab or pembrolizumab at confirmed tumour response while improving HRQoL and reducing costs. Discussion From a patient, healthcare, and economic perspective, shorter treatment duration is preferred and overtreatment should be prevented. If early discontinuation of first-line PD-1 blockade appears to be safe, early discontinuation of PD-1 blockade may be implemented as the standard of care in a selected group of patients. Trial registration The Safe Stop trial has been registered in the Netherlands Trial Register (NTR), Trial NL7293 (old NTR ID: 7502), https://www.trialregister.nl/trial/7293. Date of registration September 30, 2018.
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Affiliation(s)
- E E A P Mulder
- Department of Medical Oncology, Erasmus Medical Centre Cancer Institute, Rotterdam, The Netherlands.,Department of Surgical Oncology, Erasmus Medical Centre Cancer Institute, Rotterdam, The Netherlands
| | - K de Joode
- Department of Medical Oncology, Erasmus Medical Centre Cancer Institute, Rotterdam, The Netherlands
| | - S Litière
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - A J Ten Tije
- Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands
| | - K P M Suijkerbuijk
- Department of Medical Oncology, University Medical Centre Utrecht Cancer Centre, Utrecht, The Netherlands
| | - M J Boers-Sonderen
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - G A P Hospers
- Department of Medical Oncology, University Medical Centre Groningen, Groningen, The Netherlands
| | - J W B de Groot
- Department of Medical Oncology, Isala Oncological Centre, Zwolle, The Netherlands
| | - A J M van den Eertwegh
- Department of Medical Oncology, Amsterdam University Medical Centre - location VU, Amsterdam, The Netherlands
| | - M J B Aarts
- Department of Medical Oncology, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - D Piersma
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - R S van Rijn
- Department of Internal Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - E Kapiteijn
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - G Vreugdenhil
- Department of Internal Medicine, Máxima Medical Centre, Veldhoven, The Netherlands
| | | | - E Oomen-de Hoop
- Department of Medical Oncology, Erasmus Medical Centre Cancer Institute, Rotterdam, The Netherlands
| | - M G Franken
- Institute for Medical Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - B Ryll
- Melanoma Patient Network Europe, Uppsala, Sweden
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - S Sleijfer
- Department of Medical Oncology, Erasmus Medical Centre Cancer Institute, Rotterdam, The Netherlands
| | - J B A G Haanen
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - A A M van der Veldt
- Department of Medical Oncology, Erasmus Medical Centre Cancer Institute, Rotterdam, The Netherlands. .,Department of Radiology & Nuclear Medicine, Erasmus Medical Centre Cancer Institute, Rotterdam, The Netherlands.
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9
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Boekhout AH, Rogiers A, Jozwiak K, Boers-Sonderen MJ, van den Eertwegh AJ, Hospers GA, de Groot JWB, Aarts MJB, Kapiteijn E, ten Tije AJ, Piersma D, Vreugdenhil G, van der Veldt AA, Suijkerbuijk KPM, Rozeman EA, Neyns B, Janssen KJ, van de Poll-Franse LV, Blank CU. Health-related quality of life of long-term advanced melanoma survivors treated with anti-CTLA-4 immune checkpoint inhibition compared to matched controls. Acta Oncol 2021; 60:69-77. [PMID: 32924708 DOI: 10.1080/0284186x.2020.1818823] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Checkpoint inhibitors have changed overall survival for patients with advanced melanoma. However, there is a lack of data on health-related quality of life (HRQoL) of long-term advanced melanoma survivors, years after treatment. Therefore, we evaluated HRQoL in long-term advanced melanoma survivors and compared the study outcomes with matched controls without cancer. MATERIAL AND METHODS Ipilimumab-treated advanced melanoma survivors without evidence of disease and without subsequent systemic therapy for a minimum of two years following last administration of ipilimumab were eligible for this study. The European Organization for Research and Treatment of Cancer quality of life questionnaire Core 30 (EORTC QLQ-C30), the Multidimensional Fatigue Inventory (MFI), the Hospital Anxiety and Depression Scale (HADS), and the Functional Assessment of Cancer Therapy-Melanoma questionnaire (FACT-M) were administered. Controls were individually matched for age, gender, and educational status. Outcomes of survivors and controls were compared using generalized estimating equations, and differences were interpreted as clinically relevant according to published guidelines. RESULTS A total of 89 survivors and 265 controls were analyzed in this study. After a median follow-up of 39 (range, 17-121) months, survivors scored significantly lower on physical (83.7 vs. 89.8, difference (diff) = -5.80, p=.005), role (83.5 vs. 90, diff = -5.97, p=.02), cognitive (83.7 vs. 91.9, diff = -8.05, p=.001), and social functioning (86.5 vs. 95.1, diff = -8.49, p= <.001) and had a higher symptom burden of fatigue (23.0 vs. 15.5, diff = 7.48, p=.004), dyspnea (13.3 vs. 6.7, diff = 6.47 p=.02), diarrhea (7.9 vs. 4.0, diff = 3.78, p=.04), and financial impact (10.5 vs. 2.5, diff = 8.07, p=.001) than matched controls. Group differences were indicated as clinically relevant. DISCUSSION Compared to matched controls, long-term advanced melanoma survivors had overall worse functioning scores, more physical symptoms, and financial difficulties. These data may contribute to the development of appropriate survivorship care.
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Affiliation(s)
- A. H. Boekhout
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - A. Rogiers
- Centre Hospitalier Universitaire Brugmann, Brussels, Belgium
| | - K. Jozwiak
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - M. J. Boers-Sonderen
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - G. A. Hospers
- Department of Medical Oncology, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - M. J. B. Aarts
- Department of Medical Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - E. Kapiteijn
- Leiden University Medical Centre, Leiden,The Netherlands
| | - A. J. ten Tije
- Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands
| | - D. Piersma
- Medical Spectrum Twente, Enschede,The Netherlands
| | - G. Vreugdenhil
- Department of Internal Medicine, Maxima Medical Centre, Eindhoven,The Netherlands
| | | | - K. P. M. Suijkerbuijk
- Department of Medical Oncology, University Medical Cancer Center, Utrecht, The Netherlands
| | - E. A. Rozeman
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - B. Neyns
- Universitair Ziekenhuis Brussel, Brussel, Belgium
| | | | - L. V. van de Poll-Franse
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - C. U. Blank
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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10
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van Zeijl MCT, de Wreede LC, van den Eertwegh AJM, Wouters MWJM, Jochems A, Schouwenburg MG, Aarts MJB, van Akkooi ACJ, van den Berkmortel FWPJ, de Groot JWB, Hospers GAP, Kapiteijn E, Piersma D, van Rijn RS, Suijkerbuijk KPM, Ten Tije AJ, van der Veldt AAM, Vreugdenhil G, van der Hoeven JJM, Haanen JBAG. Survival outcomes of patients with advanced melanoma from 2013 to 2017: Results of a nationwide population-based registry. Eur J Cancer 2020; 144:242-251. [PMID: 33373869 DOI: 10.1016/j.ejca.2020.11.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 03/04/2020] [Revised: 10/15/2020] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The treatment landscape has completely changed for advanced melanoma. We report survival outcomes and the differential impact of prognostic factors over time in daily clinical practice. METHODS From a Dutch nationwide population-based registry, patients with advanced melanoma diagnosed from 2013 to 2017 were analysed (n = 3616). Because the proportional hazards assumption was violated, a multivariable Cox model restricted to the first 6 months and a multivariable landmark Cox model from 6 to 48 months were used to assess overall survival (OS) of cases without missing values. The 2017 cohort was excluded from this analysis because of the short follow-up time. RESULTS Median OS of the 2013 and 2016 cohort was 11.7 months (95% confidence interval [CI]: 10.4-13.5) and 17.7 months (95% CI: 14.9-19.8), respectively. Compared with the 2013 cohort, the 2016 cohort had superior survival in the Cox model from 0 to 6 months (hazard ratio [HR] = 0.55 [95% CI: 0.43-0.72]) and in the Cox model from 6 to 48 months (HR = 0.68 [95% CI: 0.57-0.83]). Elevated lactate dehydrogenase levels, distant metastases in ≥3 organ sites, brain and liver metastasis and Eastern Cooperative Oncology Group performance score of ≥1 had stronger association with inferior survival from 0 to 6 months than from 6 to 48 months. BRAF-mutated melanoma had superior survival in the first 6 months (HR = 0.50 [95% CI: 0.42-0.59]). CONCLUSION(S) Prognosis for advanced melanoma in the Netherlands has improved from 2013 to 2016. Prognostic importance of most evaluated factors was higher in the first 6 months after diagnosis. BRAF-mutated melanoma was only associated with superior survival in the first 6 months.
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Affiliation(s)
- M C T van Zeijl
- Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, Leiden, 2333AA, the Netherlands; Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333ZA, the Netherlands
| | - L C de Wreede
- Department of Biomedical Data Sciences, Leiden University Medical Center, Einthovenweg 20, Leiden, 2333ZC, the Netherlands
| | - A J M van den Eertwegh
- Department of Medical Oncology, Amsterdam UMC, Location VU Medical Center (VUmc), Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, the Netherlands
| | - M W J M Wouters
- Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, Leiden, 2333AA, the Netherlands; Department of Surgical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066CX, the Netherlands
| | - A Jochems
- Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, Leiden, 2333AA, the Netherlands; Department of Medical Oncology, Haaglanden Medisch Centrum, Lijnbaan 32, Den Haag, 2512VA, the Netherlands
| | - M G Schouwenburg
- Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, Leiden, 2333AA, the Netherlands
| | - M J B Aarts
- Department of Medical Oncology, Maastricht University Medical Center, P. Debyelaan 25, Maastricht, 6229 HX, the Netherlands
| | - A C J van Akkooi
- Department of Surgical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066CX, the Netherlands
| | - F W P J van den Berkmortel
- Department of Medical Oncology, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162BG, the Netherlands
| | - J W B de Groot
- Department of Medical Oncology, Isala Clinics, Dokter van Heesweg 2, Zwolle, 8025AB, the Netherlands
| | - G A P Hospers
- Department of Medical Oncology, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713GZ, the Netherlands
| | - E Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333ZA, the Netherlands
| | - D Piersma
- Department of Internal Medicine, Medisch Spectrum Twente, Koningsplein 1, Enschede, 7512KZ, the Netherlands
| | - R S van Rijn
- Department of Internal Medicine, Medical Center Leeuwarden, Henri Dunantweg 2, Leeuwarden, 8934AD, the Netherlands
| | - K P M Suijkerbuijk
- Department of Medical Oncology, University Medical Center Utrecht, Cancer Center, Heidelberglaan 100, Utrecht, 3584CX, the Netherlands
| | - A J Ten Tije
- Department of Internal Medicine, Amphia Hospital, Molengracht 21, Breda, 4818CK, the Netherlands
| | - A A M van der Veldt
- Department of Medical Oncology, Erasmus MC Cancer Institute, 's-Gravendijkwal 230, Rotterdam, 3015CE, the Netherlands
| | - G Vreugdenhil
- Department of Internal Medicine, Maxima Medical Center, De Run 4600, Eindhoven, 5504DB, the Netherlands
| | - J J M van der Hoeven
- Department of Medical Oncology, Radboudumc, Geert Grooteplein Zuid 10, Nijmegen, 6525GA, the Netherlands
| | - J B A G Haanen
- Divisions of Medical Oncology and Molecular Oncology & Immunology, the Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066CX, the Netherlands.
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11
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El Sharouni MA, Stodell MD, Ahmed T, Suijkerbuijk KPM, Cust AE, Witkamp AJ, Sigurdsson V, van Diest PJ, Scolyer RA, Thompson JF, van Gils CH, Lo SN. Sentinel node biopsy in patients with melanoma improves the accuracy of staging when added to clinicopathological features of the primary tumor. Ann Oncol 2020; 32:375-383. [PMID: 33253862 DOI: 10.1016/j.annonc.2020.11.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 09/15/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND It has been claimed, without supporting evidence, that knowledge of sentinel node (SN) status does not provide more accurate prognostic information than basic clinicopathological features of a primary cutaneous melanoma. We sought to investigate this claim and to quantify any additional value of SN status in predicting survival outcome. PATIENTS AND METHODS Data for a Dutch population-based cohort of melanoma patients (n = 9272) and for a validation cohort from a large Australian melanoma treatment center (n = 5644) were analyzed. Patients were adults diagnosed between 2004 and 2014 with histologically-proven, primary invasive cutaneous melanoma who underwent SN biopsy. Multivariable Cox proportional hazards analyses were carried out in the Dutch cohort to assess recurrence-free survival (RFS), melanoma-specific survival (MSS) and overall survival (OS). The findings were validated using the Australian cohort. Discrimination (Harrell's C-statistic), net benefit using decision curve analysis and net reclassification index (NRI) were calculated. RESULTS The Dutch cohort showed an improved C-statistic from 0.74 to 0.78 for OS and from 0.74 to 0.76 for RFS when SN status was included in the model with Breslow thickness, sex, age, site, mitoses, ulceration, regression and melanoma subtype. In the Australian cohort, the C-statistic increased from 0.70 to 0.73 for OS, 0.70 to 0.74 for RFS and 0.72 to 0.76 for MSS. Decision curve analyses showed that the 3-year and 5-year risk of death or recurrence were more accurately classified with a model that included SN status. At 3 years, sensitivity increased by 12% for both OS and RFS in the development cohort, and by 10% and 6% for OS and RFS, respectively, in the validation cohort. CONCLUSIONS Knowledge of SN status significantly improved the predictive accuracy for RFS, MSS and OS when added to a comprehensive suite of established clinicopathological prognostic factors. However, clinicians and patients must consider the magnitude of the improvement when weighing up the advantages and disadvantages of SN biopsy for melanoma.
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Affiliation(s)
- M-A El Sharouni
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - M D Stodell
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Plastic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - T Ahmed
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - K P M Suijkerbuijk
- Department of Medical Oncology, University Medical Centre Cancer Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - A E Cust
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - A J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - V Sigurdsson
- Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - P J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - R A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - J F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
| | - C H van Gils
- Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - S N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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12
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Schuiveling M, Tonk EHJ, Verheijden RJ, Suijkerbuijk KPM. Hyperprogressive disease rarely occurs during checkpoint inhibitor treatment for advanced melanoma. Cancer Immunol Immunother 2020; 70:1491-1496. [PMID: 32929554 PMCID: PMC8053186 DOI: 10.1007/s00262-020-02716-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/31/2020] [Indexed: 01/01/2023]
Abstract
Introduction Hyperprogression, characterized by a rapid acceleration in tumor growth, is a novel pattern of progression recently described in patients treated with immune checkpoint inhibitors. This study aims to assess the incidence of hyperprogression in patients with advanced melanoma treated with checkpoint inhibitors. Methods Clinical and radiological findings of all advanced melanoma patients who started checkpoint inhibitors between January 2013 and March 2019 in a tertiary academic center in the Netherlands were analyzed. Change in tumor burden was calculated by assessing volumetric tumor growth using the criteria as defined by immune Response Evaluation Criteria in Solid Tumors version 1.1. Hyperprogression was defined as a time to treatment failure less than 2 months with doubling of tumor burden and a twofold increase in tumor growth rate during treatment. Possible hyperprogression was defined as the presence of the first two criteria in the absence of a pre-baseline scan. Results Out of 206 treatment episodes in 168 patients, 75 were evaluable for hyperprogression and 87 for possible hyperprogression. Hyperprogression was observed in one patient (1.3%) and possible hyperprogression was observed in one patient (1.1%). Conclusion Hyperprogression is rare in melanoma patients treated with immune checkpoint inhibitors. Our data question if hyperprogression really is a biological entity in metastatic melanoma.
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Affiliation(s)
- M Schuiveling
- Department of Medical Oncology, University Medical Center Utrecht Cancer Center, Utrecht, The Netherlands
| | - E H J Tonk
- Department of Medical Oncology, University Medical Center Utrecht Cancer Center, Utrecht, The Netherlands
| | - R J Verheijden
- Department of Medical Oncology, University Medical Center Utrecht Cancer Center, Utrecht, The Netherlands
| | - K P M Suijkerbuijk
- Department of Medical Oncology, University Medical Center Utrecht Cancer Center, Utrecht, The Netherlands.
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13
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El Sharouni MA, Witkamp AJ, Sigurdsson V, van Diest PJ, Suijkerbuijk KPM. Thick melanomas without lymph node metastases: A forgotten group with poor prognosis. Eur J Surg Oncol 2019; 46:918-923. [PMID: 31901365 DOI: 10.1016/j.ejso.2019.11.510] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/16/2019] [Accepted: 11/26/2019] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Although adjuvant therapy is available for melanoma patients with sentinel lymph node (SLN) metastases (pN+), this is not the case for thick melanomas without SLN involvement (pN-). OBJECTIVES We assessed overall and relative survival (OS, RS) in patients with >4.0 mm Breslow thickness (BT) pN- and pN + melanomas and ≤4.0 mm pN+ patients. MATERIALS AND METHODS Clinicopathological data were retrieved from a cohort of >4.0 mm thick and/or pN + melanoma patients in The Netherlands from 2000 to 2014. OS and RS was compared using Kaplan-Meier-curves. A Cox-regression-model was developed to assess determinants of OS in >4.0 mm pN- patients. RESULTS In 54 645 patients, 3940 (7.2%) had >4.0 mm thick melanomas. SLN biopsy was performed in 1150 (29.2%) patients. Five-year OS was 70.5% for >4.0 mm pN- and 48.1% for >4.0 mm pN+ patients (p < 0.001), with a decreasing trend in OS for every mm BT. Five-year OS in 1877 ≤ 4.0 mm pN+ patients was 71.5%, which was not different from >4.0 mm pN- (p = 0.24). Higher age, higher BT category, ulceration and male gender were significantly associated with poor survival in >4.0 mm pN- patients. CONCLUSIONS Thick pN- melanomas have a poor prognosis, comparable to that of less thick pN + melanomas, which is not accounted for in current guidelines. We encourage including these high-risk patients in adjuvant trials.
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Affiliation(s)
- M A El Sharouni
- Department of Dermatology, University Medical Center Utrecht, Utrecht University, PO Box 85500 3508, GA, Utrecht, the Netherlands.
| | - A J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht University, PO Box 85500 3508, GA, Utrecht, the Netherlands
| | - V Sigurdsson
- Department of Dermatology, University Medical Center Utrecht, Utrecht University, PO Box 85500 3508, GA, Utrecht, the Netherlands
| | - P J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, PO Box 85500 3508, GA, Utrecht, the Netherlands
| | - K P M Suijkerbuijk
- Department of Medical Oncology, University Medical Center Cancer Center Utrecht, Utrecht University, PO Box 85500 3508, GA, Utrecht, the Netherlands
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14
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Suijkerbuijk KPM, van Halder FF, Jonges GN, Schreuder HWR. Dark ascites, an ovarian mass and a black dotted peritoneum. Neth J Med 2019; 77:124. [PMID: 31012433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- K P M Suijkerbuijk
- Departments of Medical Oncology, University Medical Center Utrecht, the Netherlands
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15
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de Groot JS, Moelans CB, Elias SG, Hennink A, Verolme B, Suijkerbuijk KPM, Jager A, Seynaeve C, Bos P, Witkamp AJ, Ausems MGEM, van Diest PJ, van der Wall E. Repeated nipple fluid aspiration: compliance and feasibility results from a prospective multicenter study. PLoS One 2015; 10:e0127895. [PMID: 26000714 PMCID: PMC4441497 DOI: 10.1371/journal.pone.0127895] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 04/21/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite intensive surveillance, a high rate of interval malignancies is still seen in women at increased breast cancer risk. Therefore, novel screening modalities aiming at early detection remain needed. The intraductal approach offers the possibility to directly sample fluid containing cells, DNA and proteins from the mammary ductal system where, in the majority of cases, breast cancer originates. Fluid from the breast can non-invasively be obtained by oxytocin-assisted vacuum aspiration, called nipple fluid aspiration (NFA). The goal of this feasibility study was to evaluate the potential of repeated NFA, which is a critical and essential step to evaluate its possible value as a breast cancer screening method. METHODS In this multicenter, prospective study, we annually collected nipple fluid for up to 5 consecutive years from women at increased breast cancer risk, and performed a questionnaire-based survey regarding discomfort of the aspiration. Endpoints of the current interim analyses were the feasibility and results of 994 NFA procedures in 451 women with total follow-up of 560 person years of observation. RESULTS In this large group of women at increased risk of breast cancer, repetitive NFA appeared to be feasible and safe. In 66.4% of aspirated breasts, nipple fluid was successfully obtained. Independent predictive factors for successful NFA were premenopausal status, spontaneous nipple discharge, smaller breast size, bilateral oophorectomy and previous use of hormone replacement therapy or anti-hormonal treatment. The procedure was well tolerated with low discomfort. Drop-out rate was 20%, which was mainly due to repeated unsuccessful aspiration attempts. Only 1.6% of women prematurely declined further participation because of side effects. CONCLUSIONS Repeated NFA in women at increased breast cancer risk is feasible and safe. Therefore, NFA is a promising method to non-invasively obtain a valuable source of potential breast cancer specific biomarkers.
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Affiliation(s)
- J. S. de Groot
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C. B. Moelans
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S. G. Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A. Hennink
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B. Verolme
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - K. P. M. Suijkerbuijk
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A. Jager
- Department of Medical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - C. Seynaeve
- Department of Medical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - P. Bos
- Department of Medical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - A. J. Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M. G. E. M. Ausems
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P. J. van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E. van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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Abstract
The need for additional breast cancer screening tools is indisputably high, as one may conclude from the high rate of interval malignancies in women undergoing regular screening. DNA promoter methylation frequently occurs during breast carcinogenesis and is an early event in this process. Moreover, a field defect for methylation has been described and methylation values can reliably be assessed in limited amounts of DNA. Simultaneous detection of methylation of a panel of genes in breast fluids and/or blood derivatives could be both sufficiently specific and sensitive to be of additive value to current imaging-based screening methods. This review describes the recent developments in methylation detection in breast fluids, serum and plasma that paved the way for large prospective studies. These studies will provide us with the definite answer as to what will be the additive value of defining the methylation status of specific genes to current imaging-based screening methods.
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Affiliation(s)
| | | | - E van der Wall
- Division of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht, The Netherlands
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Suijkerbuijk KPM, Fackler MJ, Sukumar S, van Gils CH, van Laar T, van der Wall E, Vooijs M, van Diest PJ. Methylation is less abundant in BRCA1-associated compared with sporadic breast cancer. Ann Oncol 2008; 19:1870-4. [PMID: 18647968 DOI: 10.1093/annonc/mdn409] [Citation(s) in RCA: 64] [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] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Promoter methylation is a common epigenetic mechanism to silence tumor suppressor genes during breast cancer development. We investigated whether BRCA1-associated breast tumors show cancer-predictive methylation patterns similar to those found in sporadic tumors. PATIENTS AND METHODS Quantitative multiplex methylation-specific PCR of 11 genes involved in breast carcinogenesis (RARB, RASSF1, TWIST1, CCND2, ESR1, SCGB3A1, BRCA1, BRCA2, CDKN2A, APC, CDH1) was carried out on 32 BRCA1-associated and 46 sporadic breast carcinomas and on normal breast tissue from seven BRCA1 mutation carriers and 13 non-carriers. RESULTS The extent of cumulative methylation increased with age (P < 0.001). The median cumulative methylation index (CMI) of all studied genes was significantly higher in tumors (89) than in normal tissue (13, P < 0.001). The median CMI was significantly lower in BRCA1-associated (59) than in sporadic breast tumors (122, P = 0.001), in estrogen receptor (ER)-negative tumors (73) than in ER-positive tumors (122, P = 0.005) and in lymph node-negative (77) compared with lymph node-positive tumors (137, P = 0.007). In subgroup analysis, the effect of a BRCA1 germline mutation on methylation proved to be independent of ER status, lymph node status and age. CONCLUSIONS These data indicate that BRCA1-associated breast cancers show less promoter methylation compared with sporadic breast carcinomas indicating a difference in disease etiology.
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Affiliation(s)
- K P M Suijkerbuijk
- Department of Pathology, University Medical Center Utrecht, The Netherlands
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Gort EH, van Haaften G, Verlaan I, Groot AJ, Plasterk RHA, Shvarts A, Suijkerbuijk KPM, van Laar T, van der Wall E, Raman V, van Diest PJ, Tijsterman M, Vooijs M. The TWIST1 oncogene is a direct target of hypoxia-inducible factor-2alpha. Oncogene 2007; 27:1501-10. [PMID: 17873906 DOI: 10.1038/sj.onc.1210795] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [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: 01/28/2023]
Abstract
Hypoxia-inducible factors (HIFs) are highly conserved transcription factors that play a crucial role in oxygen homeostasis. Intratumoral hypoxia and genetic alterations lead to HIF activity, which is a hallmark of solid cancer and is associated with poor clinical outcome. HIF activity is regulated by an evolutionary conserved mechanism involving oxygen-dependent HIFalpha protein degradation. To identify novel components of the HIF pathway, we performed a genome-wide RNA interference screen in Caenorhabditis elegans, to suppress HIF-dependent phenotypes, like egg-laying defects and hypoxia survival. In addition to hif-1 (HIFalpha) and aha-1 (HIFbeta), we identified hlh-8, gska-3 and spe-8. The hlh-8 gene is homologous to the human oncogene TWIST1. We show that TWIST1 expression in human cancer cells is enhanced by hypoxia in a HIF-2alpha-dependent manner. Furthermore, intronic hypoxia response elements of TWIST1 are regulated by HIF-2alpha, but not HIF-1alpha. These results identify TWIST1 as a direct target gene of HIF-2alpha, which may provide insight into the acquired metastatic capacity of hypoxic tumors.
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Affiliation(s)
- E H Gort
- Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
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Suijkerbuijk KPM, van der Wall E, van Laar T, Vooijs M, van Diest PJ. [Epigenetic processes in malignant transformation: the role of DNA methylation in cancer development]. Ned Tijdschr Geneeskd 2007; 151:907-13. [PMID: 17500342] [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] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Defects in DNA that activate oncogenes or inactivate tumour-suppressor genes are regarded as a crucial step in tumour development. Understanding the processes that modulate gene activity, the so-called epigenetic processes, is gaining importance in the search for factors responsible for uncontrolled cell growth. Cell proliferation is determined by epigenetic and genetic processes. Abnormal patterns of methylation and other epigenetic processes, such as acetylation, nucleosome formation and compact chromatin structure, can suppress transcription and inactivate tumour-suppressor genes. Methylation status is a promising biomarker for malignancy because the process is not patient-specific, it occurs at an early stage oftumour development and may precede morphological changes.
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Affiliation(s)
- K P M Suijkerbuijk
- Afd. Pathologie, Universitair Medisch Centrum Utrecht, Postbus 85.500, 3508 GA Utrecht.
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