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Livingstone E, Gogas H, Kandolf-Sekulovic L, Meier F, Eigentler TK, Ziemer M, Terheyden PAM, Gesierich AH, Herbst RA, Kähler KC, Ziogas DC, Mijuskovic Z, Garzarolli M, Garbe C, Roesch A, Ugurel S, Gutzmer R, Grob JJ, Kiecker F, Utikal J, Windemuth-Kieselbach C, Eckhardt S, Zimmer L, Schadendorf D. Early switch from run-in treatment with vemurafenib plus cobimetinib to atezolizumab after 3 months leads to rapid loss of tumour control in patients with advanced BRAFV600-positive melanoma: The ImmunoCobiVem phase 2 randomised trial. Eur J Cancer 2023; 190:112941. [PMID: 37482012 DOI: 10.1016/j.ejca.2023.112941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 07/25/2023]
Abstract
AIM ImmunoCobiVem investigated whether a planned switch to atezolizumab after achieving tumour control during run-in with vemurafenib + cobimetinib improves progression-free survival (PFS) and overall survival (OS) compared to continuous targeted therapy (TT) in patients with previously untreated advanced BRAFV600-mutated melanoma. METHODS In this multicenter phase 2 study, patients received vemurafenib plus cobimetinib. After 3months, patients without progressive disease (PD) were randomly assigned (1:1) to continue vemurafenib + cobimetinib (Arm A) or switch to atezolizumab (Arm B) until first documented PD (PD1). Primary outcome was PFS1 (time from start of run-in until PD1 or death). OS and safety were also assessed. RESULTS Of 185 patients enroled between November 2016 and December 2019, 135 were randomly assigned after the run-in period (Arm A, n = 69; Arm B, n = 66). Median PFS1 was significantly longer in Arm A versus Arm B (13.9 versus 5.9months; hazard ratio [HR] 0.55; 95% confidence interval [CI], 0.37-0.84; PStratified=0.001). Median OS was not reached in either arm (HR 1.22; 95%CI, 0.69-2.16; PStratified=0.389); 2-year OS was higher in Arm B versus Arm A (67%; 95%CI, 53-78 versus 58%; 95%CI, 45-70). Grade 3/4 AEs occurred in 55% of patients in Arm A and 64% in Arm B; treatment-related AEs led to discontinuation of any drug in 7% and 9% of patients, respectively. CONCLUSION In patients with BRAFV600-mutated advanced melanoma who achieve tumour control with TT, early switch at 3months to atezolizumab led to rapid loss of tumour control but provided a numerical OS benefit at 2years compared with continued TT.
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Affiliation(s)
- E Livingstone
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site Essen, Essen, Germany
| | - H Gogas
- First Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - L Kandolf-Sekulovic
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - F Meier
- Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Skin Cancer Center at the University Cancer Centre and National Center for Tumor Diseases, Dresden, Germany
| | - T K Eigentler
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - M Ziemer
- Department of Dermatology, University of Leipzig Medical Center, Leipzig, Germany
| | | | - A H Gesierich
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | | | - K C Kähler
- Department of Dermatology, Venerology, and Allergology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - D C Ziogas
- First Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Z Mijuskovic
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - M Garzarolli
- Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - C Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - A Roesch
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site Essen, Essen, Germany
| | - S Ugurel
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site Essen, Essen, Germany
| | - R Gutzmer
- Department of Dermatology, Skin Cancer Center Hannover, Hannover Medical School, Hannover, Germany; Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany
| | - J J Grob
- Aix-Marseille University, Timone Hospital (APHM), Marseille, France
| | - F Kiecker
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Dermatology and Venereology, Vivantes Hospital Neukölln, Berlin, Germany
| | - J Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany; DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
| | | | | | - L Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site Essen, Essen, Germany
| | - D Schadendorf
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site Essen, Essen, Germany.
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Garbe C, Peris K, Soura E, Forsea AM, Hauschild A, Arenbergerova M, Bylaite M, Del Marmol V, Bataille V, Samimi M, Gandini S, Saiag P, Eigentler TK, Lallas A, Zalaudek I, Lebbe C, Grob JJ, Hoeller C, Robert C, Dréno B, Arenberger P, Kandolf-Sekulovic L, Kaufmann R, Malvehy J, Puig S, Leiter U, Ribero S, Papadavid E, Quaglino P, Bagot M, John SM, Richard MA, Trakatelli M, Salavastru C, Borradori L, Marinovic B, Enk A, Pincelli C, Ioannides D, Paul C, Stratigos AJ. The evolving field of Dermato-oncology and the role of dermatologists: Position Paper of the EADO, EADV and Task Forces, EDF, IDS, EBDV-UEMS and EORTC Cutaneous Lymphoma Task Force. J Eur Acad Dermatol Venereol 2020; 34:2183-2197. [PMID: 32840022 DOI: 10.1111/jdv.16849] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/13/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The incidence of skin cancers has been increasing steadily over the last decades. Although there have been significant breakthroughs in the management of skin cancers with the introduction of novel diagnostic tools and innovative therapies, skin cancer mortality, morbidity and costs heavily burden the society. OBJECTIVE Members of the European Association of Dermato-Oncology, European Academy of Dermatology and Venereology, International Dermoscopy Society, European Dermatology Forum, European Board of Dermatovenereology of the European Union of Medical Specialists and EORTC Cutaneous Lymphoma Task Force have joined this effort to emphasize the fundamental role that the specialist in Dermatology-Venereology has in the diagnosis and management of different types of skin cancer. We review the role of dermatologists in the prevention, diagnosis, treatment and follow-up of patients with melanoma, non-melanoma skin cancers and cutaneous lymphomas, and discuss approaches to optimize their involvement in effectively addressing the current needs and priorities of dermato-oncology. DISCUSSION Dermatologists play a crucial role in virtually all aspects of skin cancer management including the implementation of primary and secondary prevention, the formation of standardized pathways of care for patients, the establishment of specialized skin cancer treatment centres, the coordination of an efficient multidisciplinary team and the setting up of specific follow-up plans for patients. CONCLUSION Skin cancers represent an important health issue for modern societies. The role of dermatologists is central to improving patient care and outcomes. In view of the emerging diagnostic methods and treatments for early and advanced skin cancer, and considering the increasingly diverse skills, knowledge and expertise needed for managing this heterogeneous group of diseases, dermato-oncology should be considered as a specific subspecialty of Dermatology-Venereology.
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Affiliation(s)
- C Garbe
- Center for Dermato-oncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - K Peris
- Dermatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Soura
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodestrian University of Athens, Athens, Greece
| | - A M Forsea
- Department of Oncologic Dermatology, University Hospital Elias, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - A Hauschild
- Department of Dermatology, University of Kiel, Kiel, Germany
| | - M Arenbergerova
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, University Hospital of Kralovske Vinohrady, Prague, Czech Republic
| | - M Bylaite
- Faculty of Medicine, Centre of Dermatovenereology, Clinic of Infectious Diseases and Dermatovenereology, Vilnius University, Vilnius, Lithuania
| | - V Del Marmol
- Dermatology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - V Bataille
- Dermatology Department, West Herts NHS Trust, London, UK.,Twin Research and Genetic Epidemiology Department, Kings College London, London, UK
| | - M Samimi
- Departments of Dermatology, University Hospital of Tours, Tours, France
| | - S Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - P Saiag
- Department of General and Oncologic Dermatology, Ambroise-Paré Hospital, APHP, & EA 4340, 'Biomarkers in Cancerology and Hemato-Oncology', UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - T K Eigentler
- Departments of Dermatology, University Hospital Tübingen, Tubingen, Germany
| | - A Lallas
- First Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - I Zalaudek
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - C Lebbe
- Department of Dermatology, AP-HP Saint Louis Hospital, Paris, France
| | - J-J Grob
- Timone Hospital, Aix-Marseille University, Marseille, France
| | - C Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - C Robert
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France.,Paris-Saclay University, Le Kremlin Bicêtre, France
| | - B Dréno
- Department of Dermatolo-Cancerology, CHU Nantes, CIC 1413, CRCINA, University Nantes, Nantes, France
| | - P Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, University Hospital of Kralovske Vinohrady, Prague, Czech Republic
| | - L Kandolf-Sekulovic
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, University of Defense, Belgrade, Serbia
| | - R Kaufmann
- Department of Dermatology, Venerology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - J Malvehy
- Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Biomedical Research Networking Centre on rarae disease (CIBERER), ISCIII, Barcelona, Spain
| | - S Puig
- Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Biomedical Research Networking Centre on rarae disease (CIBERER), ISCIII, Barcelona, Spain
| | - U Leiter
- Center for Dermato-oncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - S Ribero
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - E Papadavid
- 2nd Department of Dermatology-Venereology, ATTIKON Hospital, National and Kapodistrian Univeristy of Athens, Athens, Greece
| | - P Quaglino
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - M Bagot
- Department of Dermatology, AP-HP Saint Louis Hospital, Paris, France
| | - S M John
- Department Dermatology, Environmental Medicine, Health Theory, University of Osnabrueck, Osnabrueck, Germany
| | - M-A Richard
- Timone Hospital, Aix-Marseille University, Marseille, France
| | - M Trakatelli
- 2nd Department of Dermatology-Venerology, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - C Salavastru
- Pediatric Dermatology Discipline, Dermato-oncology Research Facility, Colentina Clinical Hospital, Bucharest, Romania
| | - L Borradori
- Department of Dermatology, University Hospital of Bern, Inselspital, Bern, Switzerland
| | - B Marinovic
- Department of Dermatology and Venereology, University Hospital Center Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
| | - A Enk
- Department of Dermatology, University Hospital of Heidelberg, Heidelberg, Germany
| | - C Pincelli
- DermoLab, Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - D Ioannides
- First Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - C Paul
- Department of Dermatology, Toulouse University, Toulouse, France
| | - A J Stratigos
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodestrian University of Athens, Athens, Greece
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Sarac E, Amaral T, Keim U, Leiter U, Forschner A, Eigentler TK, Garbe C. Prognostic factors in 161 patients with mucosal melanoma: a study of German Central Malignant Melanoma Registry. J Eur Acad Dermatol Venereol 2020; 34:2021-2025. [PMID: 32078189 DOI: 10.1111/jdv.16306] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 01/29/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Mucosal melanoma is a rare malignancy which represents approximately 1% of all melanomas. It is shown that mucosal melanomas have a different biology and less favourable prognosis than its cutaneous counterpart. OBJECTIVES Predictive and prognostic factors of survival for mucosal melanoma have not yet been elucidated. The aim of this study was to investigate risk factors affecting the course of mucosal melanoma patients followed in our clinic. METHODS One hundred and sixty-one patients with mucosal melanoma prospectively documented in the German Central Malignant Melanoma Registry (CMMR) were included in this study. Gender, age, localization, stage at first medical examination, tumour thickness and mutational status were documented. The American Joint Committee on Cancer (AJCC), 7th edition was used to define tumour stage. Kaplan-Meier survival curves were evaluated compared with the log-rank test. Multivariate Cox proportional hazard models were used to identify significant independent prognostic factors. RESULTS According to the localization, patients were categorized in 44.7% oral-nasal, 28.6% genital, 20.5% anorectal and 6.2% visceral. Genital mucosal melanomas had the most favourable 5-year OS rate (58.6%) followed by visceral (58.3%) and oral-nasal (39.3%). Anorectal melanomas had the worst OS time (median: 21 ± 4.8 months) and 5-year survival rate (22.7%). Patients <60 years had a better survival than the older group (P = 0.013). Tumour stage at the time of the first medical examination was also a significant factor for survival (P = 0.001). Gender and mutational status were found to have no effect on survival. Age (<60 years vs. ≥60 years; HR = 2.1) and stage at first medical examination (Stage I vs. Stage IV; HR = 8.2) are shown to be significant independent prognostic factors on multivariate Cox regression analysis, but not localization. CONCLUSION In this study, we observed that older age and advanced stage have significant negative effects on the survival of mucosal melanoma. Thus, the AJCC staging system is applicable for mucosal melanoma.
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Affiliation(s)
- E Sarac
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,Department of Dermatology, Koc University Hospital, Istanbul, Turkey
| | - T Amaral
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,Health Care Direction, Portuguese Air Force, Lisbon, Portugal
| | - U Keim
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - U Leiter
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - A Forschner
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - T K Eigentler
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - C Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
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Sarac E, Wilhelmi J, Thomas I, Leiter U, Keim U, Eigentler TK, Garbe C, Amaral T. Late recurrence of melanoma after 10 years - Is the course of the disease different from early recurrences? J Eur Acad Dermatol Venereol 2019; 34:977-983. [PMID: 31758713 DOI: 10.1111/jdv.16106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/17/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND It is known that melanoma can metastasize and recur many years after the first diagnosis. Although predictive and prognostic factors for melanoma are well defined, there is still insufficient information about the factors affecting the recurrence period and the effect of the recurrence time to survival. OBJECTIVES This study investigates the course of melanoma to show prognostic factors comparing early and late recurrence patients. The main objective is to uncover the effect of the recurrence time on the progression of the disease. METHODS In this retrospective study, late recurrence (LR) was defined as melanoma recurrence 10 years after the first diagnosis and early recurrence (ER) was defined as recurrence within 10 years. Gender, age, localization of primary tumour, time to first metastasis, survival rates, histological subtype, stage, tumour thickness, invasion level, ulceration and regression of the primary melanoma were documented. Survival curves were evaluated using the Kaplan-Meier and compared with the log-rank test. Multivariate Cox proportional hazard models were used to identify significant independent prognostic factors for melanoma-specific survival (MSS). RESULTS A total of 1537 melanoma patients were analysed. Early metastasis was developed in 1438 patients (93.6%), and 99 patients (6.4%) developed late metastasis. Late recurrence patients were younger (P < 0.001) and had fewer ulcerated (P = 0.005), fewer head/neck localized (P = 0.009) and thinner (P < 0.001) melanomas than ER patients. The MSS time (mean ± SD) was nearly identical for LR (31 ± 4.4 months 95% CI [22.3-39.7]) and ER (32 ± 1.9 months [28.3-35.7]). Multivariate regression analysis revealed male gender (hazard ratio [HR = 1.4, P < 0.001), truncal tumour localization (HR = 1.7, P < 0.001), tumour thickness (HR = 1.4, P < 0.045) and ulceration (HR = 1.3, P < 0.008) as significant independent prognostic factors for MSS. CONCLUSION Although ER and LR patients are found to have different clinicopathologic features, the time of the first recurrence after diagnosis do not seem to have an effect on the survival.
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Affiliation(s)
- E Sarac
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,Department of Dermatology, Koc University Hospital, Istanbul, Turkey
| | - J Wilhelmi
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - I Thomas
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - U Leiter
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - U Keim
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - T K Eigentler
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - C Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - T Amaral
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,Portuguese Air Force, Health Care Direction, Lisbon, Portugal
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Garbe C, Keim U, Eigentler TK, Amaral T, Katalinic A, Holleczek B, Martus P, Leiter U. Time trends in incidence and mortality of cutaneous melanoma in Germany. J Eur Acad Dermatol Venereol 2019; 33:1272-1280. [DOI: 10.1111/jdv.15322] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 09/27/2018] [Indexed: 01/11/2023]
Affiliation(s)
- C. Garbe
- Centre for Dermato‐Oncology Department of Dermatology Eberhard‐Karls University Tuebingen Germany
| | - U. Keim
- Centre for Dermato‐Oncology Department of Dermatology Eberhard‐Karls University Tuebingen Germany
| | - T. K. Eigentler
- Centre for Dermato‐Oncology Department of Dermatology Eberhard‐Karls University Tuebingen Germany
| | - T. Amaral
- Centre for Dermato‐Oncology Department of Dermatology Eberhard‐Karls University Tuebingen Germany
- Portuguese Air Force Health Care Direction Lisbon Portugal
| | - A. Katalinic
- Institute of Social Medicine and Epidemiology University Hospital Schleswig‐Holstein Luebeck Germany
| | | | - P. Martus
- Institute for Clinical Epidemiology und Applied Biostatistics Eberhard‐Karls University Tuebingen Germany
| | - U. Leiter
- Centre for Dermato‐Oncology Department of Dermatology Eberhard‐Karls University Tuebingen Germany
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Teramoto Y, Keim U, Gesierich A, Schuler G, Fiedler E, Tüting T, Ulrich C, Wollina U, Hassel JC, Gutzmer R, Goerdt S, Zouboulis C, Leiter U, Eigentler TK, Garbe C. Acral lentiginous melanoma: a skin cancer with unfavourable prognostic features. A study of the German central malignant melanoma registry (CMMR) in 2050 patients. Br J Dermatol 2018; 178:443-451. [PMID: 28707317 DOI: 10.1111/bjd.15803] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acral lentiginous melanoma (ALM) is one of the four major subtypes in cutaneous melanoma (CM). Although ALM has a poorer prognosis than other CM subtypes, the prognostic factors associated with ALM have only been verified in small-sized cohorts because of the low incidence of ALM worldwide. OBJECTIVES To investigate the clinical characteristics of ALM and to evaluate their prognostic values based on a large dataset from the Central Malignant Melanoma Registry (CMMR) of the German Dermatologic Society. METHODS The Kaplan-Meier method was used to estimate the potential influence of clinical and histological parameters on ALM disease-specific survival (DSS) curves, which were compared using the log-rank test. A Cox proportional hazards model was used to identify independent prognostic factors for DSS. RESULTS In total, 2050 patients with ALM were identified from 58 949 patients with CM recorded by the CMMR with follow-up data. In multivariate analyses, age (P = 0·006), ulceration (P = 0·013), tumour thickness (P < 0·001) and tumour spread (P < 0·001) turned out to be significant prognostic factors for DSS in ALM whereas sex, nevus association and level of invasion were not independent factors. CONCLUSIONS ALM has the same prognostic factors as other subtypes of melanoma. Unfavourable prognosis probably derives from the delay in diagnosis in comparison with other melanoma subtypes.
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Affiliation(s)
- Y Teramoto
- Division for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
- Department of Skin Oncology/Dermatology, Comprehensive Cancer Centre, Saitama Medical University International Medical Centre, Saitama, Japan
| | - U Keim
- Division for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
- Central Malignant Melanoma Registry, University Hospital Tuebingen, Tuebingen, Germany
| | - A Gesierich
- Department of Dermatology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - G Schuler
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - E Fiedler
- Skin Cancer Centre, Department of Dermatology, University Hospital Halle, Halle, Germany
| | - T Tüting
- Department of Dermatology, University Hospital Magdeburg, Magdeburg, Germany
| | - C Ulrich
- Skin Cancer Centre, Department of Dermatology, Charité Berlin, Berlin, Germany
| | - U Wollina
- Department of Dermatology and Allergology, Hospital Dresden Friedrichsstadt, Dresden, Germany
| | - J C Hassel
- Department of Dermatology and National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - R Gutzmer
- Skin Cancer Centre, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - S Goerdt
- Department of Dermatology, University Hospital Mannheim, Mannheim, Germany
| | - C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Centre, Medical University of Brandenburg, Dessau, Germany
| | - U Leiter
- Division for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
| | - T K Eigentler
- Division for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
| | - C Garbe
- Division for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
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7
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Eigentler TK, Gutzmer R, Hauschild A, Heinzerling L, Schadendorf D, Nashan D, Hölzle E, Kiecker F, Becker J, Sunderkötter C, Moll I, Richtig E, Pönitzsch I, Pehamberger H, Kaufmann R, Pföhler C, Vogt T, Berking C, Praxmarer M, Garbe C. Adjuvant treatment with pegylated interferon α-2a versus low-dose interferon α-2a in patients with high-risk melanoma: a randomized phase III DeCOG trial. Ann Oncol 2016; 27:1625-32. [PMID: 27287206 DOI: 10.1093/annonc/mdw225] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 04/26/2016] [Accepted: 05/30/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Adjuvant treatment with interferon (IFN)-α-2a improved disease-free survival (DFS) and showed a trend for improving overall survival (OS) in melanoma. This trial was designed to examine whether PEG-IFN is superior to IFN with regard to distant metastasis-free survival (DMFS), DFS and OS. PATIENTS AND METHODS In this multicenter, open-label, prospective randomized phase III trial, patients with resected cutaneous melanoma stage IIA(T3a)-IIIB (AJCC 2002) were randomized to receive PEG-IFN (180 μg subcutaneously 1×/week; 24 months) or IFN α-2a (3MIU subcutaneously 3×/week; 24 months). Randomization was stratified for stage, number of metastatic nodes, age and previous IFN treatment. The primary end point was DMFS; secondary end points were OS, DFS, quality of life (QoL) and tolerability. RESULTS A total of 909 patients were enrolled (451 PEG-IFN versus 458 IFN). Neither 5-year DMFS [PEG-IFN 61.0% versus IFN 67.3%; hazard ratio (HR) 1.16, P = 0.21] nor 5-year OS (PEG-IFN 73.2% versus IFN 75.2%; HR 1.05, P = 0.70) nor 5-year DFS (PEG-IFN 57.3% versus IFN 60.9%; HR 1.09, P = 0.40) showed significant differences. Subgroup analyses in patients ± ulcerated primaries and of different tumor stages did not find differences in DMFS, OS or DFS between the treatment groups. One hundred and eighteen patients (26.2%) in the PEG-IFN and 61 patients (13.3%) in the IFN population did not receive the full dosage and length of treatment due to adverse events (P < 0.001). Leukopenia and elevation of liver enzymes were more common in the PEG-IFN arm (56% versus 23.5% LCP; 19.1% versus 9.4% AST; 33.0% versus 16.5% ALT). QoL was identical for nearly all domains. CONCLUSION PEG-IFN did not improve the outcome over IFN. A higher percentage of patients under PEG-IFN discontinued treatment due to toxicity. CLINICAL TRIALSGOV IDENTIFIER NCT00204529.
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Affiliation(s)
- T K Eigentler
- Department of Dermatology, Center for Dermatooncology, University Medical Center Tübingen, Tübingen
| | - R Gutzmer
- Department of Dermatology and Allergy, Hannover Medical School, Hannover
| | - A Hauschild
- Department of Dermatology, University Hospital Kiel, Kiel
| | - L Heinzerling
- Department of Dermatology, University Hospital Erlangen, Erlangen
| | - D Schadendorf
- Department of Dermatology, University Essen-Duisburg, Essen
| | - D Nashan
- Department of Dermatology, Hospital Dortmund, Dortmund
| | - E Hölzle
- Department of Dermatology, Hospital Oldenburg, Oldenburg
| | - F Kiecker
- Department of Dermatology, Charité Berlin, Berlin
| | - J Becker
- Department of Dermatology, University Essen-Duisburg, Essen
| | - C Sunderkötter
- Department of Dermatology, University Hospital Münster, Münster
| | - I Moll
- Department of Dermatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E Richtig
- Department of Dermatology, University Hospital Graz, Graz, Austria
| | - I Pönitzsch
- Department of Dermatology, University Hospital Leipzig, Leipzig, Germany
| | - H Pehamberger
- Department of Dermatology, AKH Wien, University Hospital Vienna, Vienna, Austria
| | - R Kaufmann
- Department of Dermatology, University Hospital Frankfurt am Main, Frankfurt/Main
| | - C Pföhler
- Department of Dermatology, Saarland University Medical School, Homburg/Saar
| | - T Vogt
- Department of Dermatology, Saarland University Medical School, Homburg/Saar
| | - C Berking
- Department of Dermatology and Allergy, University Hospital of Munich, Munich, Germany
| | | | - C Garbe
- Department of Dermatology, Center for Dermatooncology, University Medical Center Tübingen, Tübingen
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Taran-Munteanu L, Hartkopf A, Eigentler TK, Vogel U, Brucker S, Taran FA. A Case of Choroidal Melanoma Metastatic to the Breast. Geburtshilfe Frauenheilkd 2016; 76:579-581. [PMID: 27239068 DOI: 10.1055/s-0042-105956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
A 61-year-old woman developed blurred vision in her left eye in December 2006. A clinical diagnosis of choroidal melanoma was made. The patient underwent excision of the left lens, followed by vitrectomy and stereotactic radiotherapy. She remained systemically healthy until 50 months later when, during a CT scan done for staging purposes, a newly visible lump was noted in the lower quadrant of her left breast. Core needle biopsy of the lesion in the left breast was performed, and histologic examination revealed metastasis from the choroidal melanoma. The patient underwent breast-conserving surgery of the left breast. Definitive histological examination showed clear tumor margins in the resected specimen and one sentinel lymph node without evidence of metastatic cells. Twenty-nine months after surgery, a similar nodule was detected in the upper quadrant of the left breast. Core biopsy again showed metastatic melanoma, and similar breast-conserving surgery was performed. Systemic examination, including magnetic resonance imaging of the head and computed tomography of the pelvis, abdomen, and chest, was done regularly and revealed no significant findings. Solitary breast metastases from choroidal melanoma are extremely rare. Nevertheless, clinicians should be aware of this rare form of metastasis when treating patients with suspicious breast lesions and a history of choroidal melanoma. If solitary metastasis is confirmed, then breast-conserving surgery may be recommended.
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Affiliation(s)
| | - A Hartkopf
- Department of Gynecology, University Women's Clinic Tübingen
| | - T K Eigentler
- Department of Dermatology, University Clinic Tübingen
| | - U Vogel
- Department of Pathology, University Clinic Tübingen
| | - S Brucker
- Department of Gynecology, University Women's Clinic Tübingen
| | - F A Taran
- Department of Gynecology, University Women's Clinic Tübingen
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Livingstone E, Eigentler TK, Windemuth-Kieselbach C, Hauschild A, Rompel R, Trefzer U, Nashan D, Kilian K, Debus D, Kähler KC, Mauerer A, Möllenhoff K, Dippel E, Schadendorf D. Actual practice of melanoma follow-up and treatment in Germany: results of a prospective, longitudinal cohort study. Br J Dermatol 2015; 172:1646-1650. [PMID: 25495472 DOI: 10.1111/bjd.13612] [Citation(s) in RCA: 3] [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] [Indexed: 11/29/2022]
Affiliation(s)
- E Livingstone
- Department of Dermatology, University Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - T K Eigentler
- Department of Dermatology, University Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Germany
| | | | - A Hauschild
- Department of Dermatology, University Hopsital Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 7, 24105, Kiel, Germany
| | - R Rompel
- Department of Dermatology Kassel, Clinical Centre Kassel, Mönchebergstr. 41, 34125, Kassel, Germany
| | - U Trefzer
- Department of Dermatology, Charité Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - D Nashan
- Department of Dermatology, University Freiburg, Hauptstr. 7, 79104, Freiburg, Germany.,Department of Dermatology, Clinical Centre Mitte, Beurhausstraße 40, 44137, Dortmund, Germany
| | - K Kilian
- Department of Dermatology, Ludwig-Maximilians University Munich, Frauenlobstrasse 9-11, 80337, München, Germany
| | - D Debus
- Department of Dermatology, University Nürnberg, Prof.-Ernst-Nathan-Straße 1, 90419, Nürnberg, Germany
| | - K C Kähler
- Department of Dermatology, University Hopsital Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 7, 24105, Kiel, Germany
| | - A Mauerer
- Department of Dermatology, University Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - K Möllenhoff
- Department of Dermatology, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - E Dippel
- Department of Dermatology, Clinical Centre Ludwigshafen, Bremserstr. 79, 67073, Ludwigshafen, Germany
| | - D Schadendorf
- Department of Dermatology, University Essen, Hufelandstr. 55, 45122, Essen, Germany
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10
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Pflugfelder A, Andonov E, Weide B, Dirschka T, Schempp C, Stockfleth E, Stratigos A, Krüger-Krasagakis S, Bauer J, Garbe C, Eigentler TK. Lack of activity of betulin-based Oleogel-S10 in the treatment of actinic keratoses: a randomized, multicentre, placebo-controlled double-blind phase II trial. Br J Dermatol 2015; 172:926-32. [PMID: 25124939 DOI: 10.1111/bjd.13342] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Betulinic acid and other triterpenes have shown strong antitumour activity in vitro and in vivo. A triterpene extract of birch bark formed the base of Oleogel-S10 and allowed topical application. Two previous trials have shown efficacy and tolerability in the treatment of actinic keratoses (AKs) with betulin-based Oleogel-S10. OBJECTIVES To confirm the efficacy and tolerability/safety of Oleogel-S10 in the treatment of AKs in a multicentre placebo-controlled study. METHODS Patients (n = 165) were treated topically for 3 months in a four-arm parallel study design, randomly allocated to A (n = 53) Oleogel-S10 once daily, B (n = 51) Oleogel-S10 twice daily, or C (n = 25) or D (n = 28) placebo (petroleum jelly) once or twice daily, respectively. Clinical efficacy in this double-blind study was assessed by the investigators. Final and baseline biopsies were evaluated by central histopathology. RESULTS Complete clearance of the target lesions was seen in 4% of patients in group A and 7% in group B, but not in the placebo groups. A clearance rate of > 75% was seen for 15% and 18% of patients in groups A and B, respectively, and for 13% in the placebo groups. These differences were not statistically significant. Histopathologically, 43·9% of patients showed a downgrading or clearance of the marker AK with no significant differences between the groups. Treatment with Oleogel-S10 was well tolerated. The tolerability as assessed by the investigator was mostly 'very good' (78·8%), followed by 'good' (18·2%) and only 1·2% assessed it as 'intolerable'. Patient-assessed tolerability was graded mostly 'very good' (56·4%) or 'good' (34·5%). CONCLUSIONS Treatment with Oleogel-S10 was well tolerated during a treatment period of 3 months, yet was no better than placebo in terms of efficacy in the treatment of AKs.
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Affiliation(s)
- A Pflugfelder
- Center for Dermatooncology, Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
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11
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Livingstone E, Krajewski C, Eigentler TK, Windemuth-Kieselbach C, Benson S, Elsenbruch S, Hauschild A, Rompel R, Meiss F, Mauerer A, Kähler KC, Dippel E, Möllenhoff K, Kilian K, Mohr P, Utikal J, Schadendorf D. Prospective evaluation of follow-up in melanoma patients in Germany - results of a multicentre and longitudinal study. Eur J Cancer 2015; 51:653-67. [PMID: 25638778 DOI: 10.1016/j.ejca.2015.01.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 01/05/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patient numbers requiring long-term melanoma surveillance are constantly rising. Surveillance is costly and guideline recommendations vary substantially. METHODS In this German nationwide study, information on surveillance and treatment of patients diagnosed with melanoma and melanoma in situ (MMis) between April and June 2008 was prospectively collected over four years. Additionally, patient self-report questionnaires were evaluated to assess anxiety, depression, health-related quality of life, socio-demographic information and use of disease specific health information sources at year 4 after primary diagnosis. RESULTS Complete data was available for 668 patients from 67 centres, of whom 96.0% were in regular melanoma surveillance. In year 3-4 of surveillance, only 55.6% of locoregionary metastases were detected during surveillance visits. Only 33.3% were self-detected by the patient even though 69.4% were documented as being clinically visible or palpable. Costs of 4year surveillance of 550 patients without tumour recurrence (stage I-IIC and MMis) accumulated to 228,155.75 €. Guideline-adherence for follow-up frequency, lymph node ultrasound, S100 serum level tests and diagnostic imaging recommendations was approximately 60% in year 3-4 of surveillance. Multivariate regression analysis showed that certain patient/tumour characteristics and regional differences were significantly associated with guideline deviations. The percentage of patients who exceeded published cut-off scores indicating clinically relevant symptoms of anxiety and depression were significantly increased. Patients frequently reported lack of psychosocial support and education but ascribed great importance to these. CONCLUSIONS We recommend further reduction of melanoma follow-up in low-risk melanoma patients and improvement of psycho-social support and patient education for all melanoma patients.
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Affiliation(s)
- E Livingstone
- Dept. of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Hufelandstr. 55, 45122 Essen, Germany.
| | - C Krajewski
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - T K Eigentler
- Dept. of Dermatology, University Tübingen, Liebermeisterstr. 25, 72076 Tübingen, Germany
| | | | - S Benson
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - S Elsenbruch
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - A Hauschild
- Dept. of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 7, 24105 Kiel, Germany
| | - R Rompel
- Dept. of Dermatology Kassel, Clinical Centre Kassel, Mönchebergstr. 41, 34125 Kassel, Germany
| | - F Meiss
- Dept. of Dermatology, University Medical Centre Freiburg, Hauptstr. 7, 79104 Freiburg, Germany
| | - A Mauerer
- Dept. of Dermatology, University Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - K C Kähler
- Dept. of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 7, 24105 Kiel, Germany
| | - E Dippel
- Dept. of Dermatology, Clinical Centre Ludwigshafen, Bremserstr. 79, 67073 Ludwigshafen, Germany
| | - K Möllenhoff
- Dept. of Dermatology, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - K Kilian
- Dept. of Dermatology, Ludwig-Maximilians University Munich, Frauenlobstrasse 9-11, 80337 München, Germany
| | - P Mohr
- Dept. of Dermatology, Elbekliniken Stade-Buxtehude GmbH, Am Krankenhaus 1, 21614 Buxtehude, Germany
| | - J Utikal
- Skin Cancer Unit, German Cancer Research Centre (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim, Ruprecht-Karl University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - D Schadendorf
- Dept. of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Hufelandstr. 55, 45122 Essen, Germany
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12
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Eigentler TK, Weide B, Spitaleri G, De Braud FG, Romanini A, Gonzales-Inglesias R, Tasciotti A, Giovannoni L, Schwager K, Lovato V, Kaspar M, Trachsel E, Neri D, Menssen HD, Garbe C. A dose confirmation and signal-generating study of the immunocytokine L19-IL2 in combination with dacarbazine in patients with metastatic melanoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.2531] [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: 11/20/2022] Open
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13
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Pflugfelder A, Welter AK, Leiter U, Weide B, Held L, Eigentler TK, Dirschka T, Stockfleth E, Nashan D, Garbe C. Open label randomized study comparing 3 months vs. 6 months treatment of actinic keratoses with 3% diclofenac in 2.5% hyaluronic acid gel: a trial of the German Dermatologic Cooperative Oncology Group. J Eur Acad Dermatol Venereol 2011; 26:48-53. [PMID: 21414035 DOI: 10.1111/j.1468-3083.2011.04005.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Actinic keratoses (AK) are carcinomata in situ with the potential to develop into invasive carcinoma. Several studies have demonstrated that 3% diclofenac in 2.5% hyaluronic acid gel (HA) is effective and well tolerated in the treatment of AK. To date there are no large randomized multicentre trials with treatment durations longer than 90 days and histopathological control of treatment outcome. OBJECTIVE The aim of this study was to investigate whether a prolonged treatment with diclofenac in HA of 6 vs. 3 months adds to the efficacy in treatment for AK and if this will influence tolerability and quality of life (QoL). METHODS This was a multicentre, randomized open-label study in which 418 patients with mild to moderate AKs were randomized into two treatment groups. Group A received diclofenac in HA for 3 months and group B for 6 months. Treatment efficacy was assessed by size measurement and a final biopsy of a defined marker AK. Quality of life was measured using the Dermatology Life Quality Index questionnaire. RESULTS Clinical complete clearance was observed in 40% in group A and in 45% in group B (P = 0.38). Histopathological clearance was confirmed in 30% in group A and in 40% in group B (P = 0.16). Treatment was well tolerated and QoL was significantly improved after treatment in both treatment groups. CONCLUSION Treatment with diclofenac in HA is effective and well tolerated during a treatment period of 3 months as well as 6 months. Prolongation of the treatment duration did not significantly affect treatment outcome.
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Affiliation(s)
- A Pflugfelder
- Centre for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, Berlin, Germany.
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14
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Weide B, Eigentler TK, Romanini A, De Braud FG, Giovannoni L, Neri D, Menssen H, Garbe C. Tumor-targeting human L19IL2 monoclonal antibody-cytokine fusion protein in combination with DTIC in chemotherapy-naïve stage IV melanoma patients. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Held L, Eigentler TK, Garbe C. [Early recognition and prevention of skin cancer]. MMW Fortschr Med 2009; 151:31-33. [PMID: 19831192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- L Held
- Sektion Dermatologische Onkologie, Universitäts-Hautklinik Tübingen
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Garbe C, Romanini A, Spitaleri G, Giovannoni L, Zardi L, Neri D, Shaw A, Menssen HD, deBraud F, Eigentler TK. Phase I/II study of the tumor-targeting human L19-IL2 monoclonal antibody-cytokine fusion protein in combination with DTIC in metastatic melanoma patients. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9064] [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
9064 Background:L19-IL2 is a tumor targeted immunocytokine constituted by a single chain Fragment variable (scFv) format directed against the ED-B domain of fibronectin and the human cytokine interleukin-2 (IL2). The recommended dose (RD) for monotherapy of advanced solid cancer patients was established to be 22.5 Mio IU IL2 equivalent on day 1, 3, and 5 of a 21-day cycle. Here we report clinical results of the dose escalation part of a phase I/II study assessing L19-IL2 in combination with DTIC chemotherapy in metastatic melanoma patients. Methods: L19-IL2 was administered as an i.v. infusion at doses of 10 (n=3), 15 (n=3) and 22.5 MioIU IL2 equivalent dose (n=4) on days 1, 3 and 5 every 21 days in combination with DTIC 1000 mg/m2 on Day 1 for up to 6 treatment cycles. Serum samples for PK evaluation and induction of human antifusion antibodies to L19 (HAFA) were collected. Flow cytometry (T and NK/B cell panels) was performed. Data on safety and activity were evaluated using CTC v3.0 and RECIST criteria, respectively. Results: All 10 patients had progressive metastatic melanoma and the majority had already received prior systemic therapy. Median age at start of treatment was 62 years (52–74). There were no treatment related deaths and the treatment was well tolerated, details of CTC evaluation will be presented. The dose of 22.5 Mio IU day 1, 3, and 5 in combination with 1000 mg DTIC/m2 on day 1, repeated on day 22 was defined as the RD for up to 6 treatment cycles. 10 patients were evaluable for response. We observed 1 partial remission at the 15 Mio IL2 dose level after 4 treatment cycles. Immunophenotyping analysis showed transient stimulation of NK cells, T4 cells, and CTLs. Pharmacokinetic data will be presented. Conclusions: L19-IL2 at a dose of 22.5 Mio IU IL2 equivalent on days 1, 3, and 5 of a 3-weekly schedule can be safely combined with standard DTIC in metastatic melanoma patients. Toxicity was manageable and reversible. Preliminary evaluation suggests clinical activity of the L19IL2/DTIC regimen in metastatic melanoma patients. [Table: see text]
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Affiliation(s)
- C. Garbe
- University of Tuebingen, Tuebingen, Germany; Santa Chiara University Hospital, Pisa, Italy; European Institute of Oncology, Milan, Italy; Philogen SPA, Siena, Italy; Istituto Giannina Gaslini, Genoa, Italy; Swiss Federal Institute of Technology, Zurich, Switzerland; Bayer HealthCare Pharmaceuticals, Montville, NJ
| | - A. Romanini
- University of Tuebingen, Tuebingen, Germany; Santa Chiara University Hospital, Pisa, Italy; European Institute of Oncology, Milan, Italy; Philogen SPA, Siena, Italy; Istituto Giannina Gaslini, Genoa, Italy; Swiss Federal Institute of Technology, Zurich, Switzerland; Bayer HealthCare Pharmaceuticals, Montville, NJ
| | - G. Spitaleri
- University of Tuebingen, Tuebingen, Germany; Santa Chiara University Hospital, Pisa, Italy; European Institute of Oncology, Milan, Italy; Philogen SPA, Siena, Italy; Istituto Giannina Gaslini, Genoa, Italy; Swiss Federal Institute of Technology, Zurich, Switzerland; Bayer HealthCare Pharmaceuticals, Montville, NJ
| | - L. Giovannoni
- University of Tuebingen, Tuebingen, Germany; Santa Chiara University Hospital, Pisa, Italy; European Institute of Oncology, Milan, Italy; Philogen SPA, Siena, Italy; Istituto Giannina Gaslini, Genoa, Italy; Swiss Federal Institute of Technology, Zurich, Switzerland; Bayer HealthCare Pharmaceuticals, Montville, NJ
| | - L. Zardi
- University of Tuebingen, Tuebingen, Germany; Santa Chiara University Hospital, Pisa, Italy; European Institute of Oncology, Milan, Italy; Philogen SPA, Siena, Italy; Istituto Giannina Gaslini, Genoa, Italy; Swiss Federal Institute of Technology, Zurich, Switzerland; Bayer HealthCare Pharmaceuticals, Montville, NJ
| | - D. Neri
- University of Tuebingen, Tuebingen, Germany; Santa Chiara University Hospital, Pisa, Italy; European Institute of Oncology, Milan, Italy; Philogen SPA, Siena, Italy; Istituto Giannina Gaslini, Genoa, Italy; Swiss Federal Institute of Technology, Zurich, Switzerland; Bayer HealthCare Pharmaceuticals, Montville, NJ
| | - A. Shaw
- University of Tuebingen, Tuebingen, Germany; Santa Chiara University Hospital, Pisa, Italy; European Institute of Oncology, Milan, Italy; Philogen SPA, Siena, Italy; Istituto Giannina Gaslini, Genoa, Italy; Swiss Federal Institute of Technology, Zurich, Switzerland; Bayer HealthCare Pharmaceuticals, Montville, NJ
| | - H. D. Menssen
- University of Tuebingen, Tuebingen, Germany; Santa Chiara University Hospital, Pisa, Italy; European Institute of Oncology, Milan, Italy; Philogen SPA, Siena, Italy; Istituto Giannina Gaslini, Genoa, Italy; Swiss Federal Institute of Technology, Zurich, Switzerland; Bayer HealthCare Pharmaceuticals, Montville, NJ
| | - F. deBraud
- University of Tuebingen, Tuebingen, Germany; Santa Chiara University Hospital, Pisa, Italy; European Institute of Oncology, Milan, Italy; Philogen SPA, Siena, Italy; Istituto Giannina Gaslini, Genoa, Italy; Swiss Federal Institute of Technology, Zurich, Switzerland; Bayer HealthCare Pharmaceuticals, Montville, NJ
| | - T. K. Eigentler
- University of Tuebingen, Tuebingen, Germany; Santa Chiara University Hospital, Pisa, Italy; European Institute of Oncology, Milan, Italy; Philogen SPA, Siena, Italy; Istituto Giannina Gaslini, Genoa, Italy; Swiss Federal Institute of Technology, Zurich, Switzerland; Bayer HealthCare Pharmaceuticals, Montville, NJ
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Eigentler TK, Figl A, Krex D, Mohr P, Kurschat P, Tilgen W, Bostroem A, Heese O, Garbe C, Schadendorf D. Multicenter study on prognostic factors in 692 patients with brain metastases of malignant melanoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9081] [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
9081 Background: This multicenter study aimed to identify prognostic factors in patients with brain metastases from malignant melanoma (BM-MM). Methods: In a retrospective survey in nine cancer centres of the German Cancer Society 692 patients were identified with BM-MM during the period 1986–2007. Overall survival was analysed using Kaplan-Meier estimator and compared by log-rank analysis. Cox proportional hazards models were used to identify prognostic factors significant for survival. Results: The median overall survival of the entire cohort was 5.0 months (95%CI: 4–5). Prognostic factors in the univariate Kaplan- Meier analysis were: Karnofsky Performance Status (≥ 70 vs. <70; p<0.001), number of BM-MM (single vs. multiple; p<0.001), pre-treatment levels of serum LDH (normal vs. elevated; p<0.001), pre-treatment levels of S100 (normal vs. elevated; p<0.001), Prognostic groups according to Radiation Therapy Oncology Group (Class I vs. Class II vs. Class III; p=0.0485), kind of applied treatment (for the cohort with single BM-MM, only) (stereotactic radiotherapy or neurosurgical metastasectomy vs. others; p=0.036). Cox proportional hazards models revealed pre-treatment elevated level of serum LDH (HR: 1.6, 95%CI: 1.3–2.0; p=0.00013) and number of BM-MM (HR: 1.6, 95%CI: 1.3–2.0; p=0.00011) in the whole cohort of patients as independent prognostic variables, whereas in patients with single BM-MM the kind of applied treatment (stereotactic radiotherapy or neurosurgical metastasectomy vs. others; HR: 1.5, 95%CI: 1.1–1.9; p=0.0061) was identified as unique prognostic factor. Conclusions: Overall survival of patients with BM-MM mainly depends on the number of metastases and pre-treatment levels of LDH. In case of a single brain metastasis the application of stereotactic radiotherapy or neurosurgical metastasectomy is by far the most important factor for improving survival. No significant financial relationships to disclose.
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Affiliation(s)
- T. K. Eigentler
- University-Hospital Tuebingen, Tuebingen, Germany; Skin Cancer Unit, German Cancer Research Center, Mannheim, Germany; Carl Gustav Carus University Hospital, Dresden, Germany; Elbeklinikum Buxtehude, Buxtehude, Germany; Dept. of Dermatology, University Cologne, Cologne, Germany; The Saarland University Hospital, Homburg/Saar, Germany; University of Bonn Medical Center, Bonn, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany
| | - A. Figl
- University-Hospital Tuebingen, Tuebingen, Germany; Skin Cancer Unit, German Cancer Research Center, Mannheim, Germany; Carl Gustav Carus University Hospital, Dresden, Germany; Elbeklinikum Buxtehude, Buxtehude, Germany; Dept. of Dermatology, University Cologne, Cologne, Germany; The Saarland University Hospital, Homburg/Saar, Germany; University of Bonn Medical Center, Bonn, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany
| | - D. Krex
- University-Hospital Tuebingen, Tuebingen, Germany; Skin Cancer Unit, German Cancer Research Center, Mannheim, Germany; Carl Gustav Carus University Hospital, Dresden, Germany; Elbeklinikum Buxtehude, Buxtehude, Germany; Dept. of Dermatology, University Cologne, Cologne, Germany; The Saarland University Hospital, Homburg/Saar, Germany; University of Bonn Medical Center, Bonn, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany
| | - P. Mohr
- University-Hospital Tuebingen, Tuebingen, Germany; Skin Cancer Unit, German Cancer Research Center, Mannheim, Germany; Carl Gustav Carus University Hospital, Dresden, Germany; Elbeklinikum Buxtehude, Buxtehude, Germany; Dept. of Dermatology, University Cologne, Cologne, Germany; The Saarland University Hospital, Homburg/Saar, Germany; University of Bonn Medical Center, Bonn, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany
| | - P. Kurschat
- University-Hospital Tuebingen, Tuebingen, Germany; Skin Cancer Unit, German Cancer Research Center, Mannheim, Germany; Carl Gustav Carus University Hospital, Dresden, Germany; Elbeklinikum Buxtehude, Buxtehude, Germany; Dept. of Dermatology, University Cologne, Cologne, Germany; The Saarland University Hospital, Homburg/Saar, Germany; University of Bonn Medical Center, Bonn, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany
| | - W. Tilgen
- University-Hospital Tuebingen, Tuebingen, Germany; Skin Cancer Unit, German Cancer Research Center, Mannheim, Germany; Carl Gustav Carus University Hospital, Dresden, Germany; Elbeklinikum Buxtehude, Buxtehude, Germany; Dept. of Dermatology, University Cologne, Cologne, Germany; The Saarland University Hospital, Homburg/Saar, Germany; University of Bonn Medical Center, Bonn, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany
| | - A. Bostroem
- University-Hospital Tuebingen, Tuebingen, Germany; Skin Cancer Unit, German Cancer Research Center, Mannheim, Germany; Carl Gustav Carus University Hospital, Dresden, Germany; Elbeklinikum Buxtehude, Buxtehude, Germany; Dept. of Dermatology, University Cologne, Cologne, Germany; The Saarland University Hospital, Homburg/Saar, Germany; University of Bonn Medical Center, Bonn, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany
| | - O. Heese
- University-Hospital Tuebingen, Tuebingen, Germany; Skin Cancer Unit, German Cancer Research Center, Mannheim, Germany; Carl Gustav Carus University Hospital, Dresden, Germany; Elbeklinikum Buxtehude, Buxtehude, Germany; Dept. of Dermatology, University Cologne, Cologne, Germany; The Saarland University Hospital, Homburg/Saar, Germany; University of Bonn Medical Center, Bonn, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany
| | - C. Garbe
- University-Hospital Tuebingen, Tuebingen, Germany; Skin Cancer Unit, German Cancer Research Center, Mannheim, Germany; Carl Gustav Carus University Hospital, Dresden, Germany; Elbeklinikum Buxtehude, Buxtehude, Germany; Dept. of Dermatology, University Cologne, Cologne, Germany; The Saarland University Hospital, Homburg/Saar, Germany; University of Bonn Medical Center, Bonn, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany
| | - D. Schadendorf
- University-Hospital Tuebingen, Tuebingen, Germany; Skin Cancer Unit, German Cancer Research Center, Mannheim, Germany; Carl Gustav Carus University Hospital, Dresden, Germany; Elbeklinikum Buxtehude, Buxtehude, Germany; Dept. of Dermatology, University Cologne, Cologne, Germany; The Saarland University Hospital, Homburg/Saar, Germany; University of Bonn Medical Center, Bonn, Germany; University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Essen, Essen, Germany
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Güler-Nizam E, Leiter U, Metzler G, Breuninger H, Garbe C, Eigentler TK. Clinical course and prognostic factors of Merkel cell carcinoma of the skin. Br J Dermatol 2009; 161:90-4. [PMID: 19438439 DOI: 10.1111/j.1365-2133.2009.09155.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare neuroendocrine malignancy of the skin first described by Toker as 'trabecular carcinoma of the skin' in 1972. To date, the origin of the tumour cells still remains unclear. OBJECTIVES The present study analyses prognostic factors of MCC. PATIENTS AND METHODS The medical records of 57 patients with MCC treated between 1988 and 2006 at the Department of Dermatology in Tübingen were reviewed. RESULTS We identified 26 (45.6%) male and 31 (54.4%) female patients with MCC; the age at diagnosis ranged from 26 to 97 years (median 71 years). Primary tumours were located mainly on the head and neck areas (27 cases, 47.4%) and upper extremities (14 cases, 24.6%); 11 tumours were found on the lower extremities (19.3%) and four lesions on the chest (7%); one patient had an unknown primary location. Forty-five (78.9%) patients were diagnosed at stage I of the disease, 11 (19.3%) at stage II, and one patient (1.8%) at stage III at initial presentation. Stage of the disease and age at initial presentation were statistically significant with regard to overall (P < 0.0001; P = 0.0327) and tumour-specific survival (P < 0.0001; P = 0.0156). Use of the Cox regression model revealed initial stage of the disease as the only significant factor in the multivariate analysis. Radiotherapy applied promptly after excision of the primary tumour extended the time to progression significantly (P = 0.0376) but did not prolong overall or tumour-specific survival. Other parameters such as sex, site of tumour, sentinel node biopsy, excision margins, skin and noncutaneous malignancies were found to be not significant. CONCLUSIONS Currently, early recognition of the disease seems to be the only method of ensuring overall survival. However, evidence-based treatment modalities are still urgently needed.
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Affiliation(s)
- E Güler-Nizam
- Department of Dermatology, University-Hospital Tübingen, Eberhard-Karls-University, Liebermeisterstrasse 25, Tübingen D-72076, Germany
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Weide B, Metzler G, Eigentler TK, Fehrenbacher B, Sönnichsen K, Garbe C. Inflammatory nodules around the axilla: an uncommon localization of orf virus infection. Clin Exp Dermatol 2008; 34:240-2. [PMID: 19120403 DOI: 10.1111/j.1365-2230.2007.02567.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
While the incidence of cutaneous melanoma (CM) continues to rise steadily, the mortality has stabilized. Risk factors for the development of CM are UV light exposure and individual characteristics relating to pigmentation, and especially the number of melanocytic nevi. The most important prognostic factor in CM is the vertical thickness of the primary tumor in the histological specimen. Excision of the primary tumor with adequate safety margins is the treatment of choice. In the case of a tumor 1.0 mm or more thick biopsy of the sentinel node is recommended. Interferon-alpha is currently the only adjuvant therapy shown to have significant benefit in prospective randomized trials. When distant metastases are present treatment is palliative and is aimed primarily at achieving tumor remission by operative, radiological, and pharmacological means. Dacarbazine is considered the standard drug for systemic treatment. Follow-up depends on the initial tumor parameters and the current stage of the disease.
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Affiliation(s)
- T K Eigentler
- Zentrum für Hauttumoren, Südwestdeutsches Tumorzentrum, Universitätshautklinik Tübingen, Germany.
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Eigentler TK, Gutzmer R, Hauschild A, Vogt T, Linse R, Garbe C. Safety data on adjuvant treatment of cutaneous melanoma patients with interferon-alpha2b and pegylated interferon-alpha2b: An interim analysis of 285 patients treated in Germany. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.8561] [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
8561 Background: A multicenter, prospective randomized, phase III trial (EADO 2002/CMII) evaluating efficacy of interferon-a2b (IFNa) and of pegylated interferon-a2b (PEGIFNa) was carried out in cutaneous melanoma patients. Patients were eligible for this trial after local excision of an intermediate risk cutaneous melanoma (tumor thickness >1,5mm) & the absence of regional nodal macrometastases). Methods: Interferon-a2b (IFNa) for 18 months (3x3MIU sc/week), and pegylated interferon-a2b (PEGIFNa) for 36 months (100 μg sc/week) were evaluated in 285 patients treated in Germany; 141 pts treated with PEGIFNa and 144 pts with IFNa. Safety data was analyzed and adverse events of the IFN-a treatment were monitored. Results: All relevant AEs appeared within the first year of treatment. The leading clinical adverse events observed in both arms were fatigue (27.7%) & myalgia (19.7%) (NCI-CTC2–3). There were no significant differences between both treatment arms in frequency and intensity for depression, fever, weight loss, erythema at injection site, nausea, constipation, hair loss, pain, cardiovascular function, pulmonal & nervous status (NCI-CTC2–3). There were no significant differences in terms of anemia, thrombocytopenia, bilirubinaemia, SGOT, SGPT, BUN & proteinaemia (NCI-CTC3). Leukocytopenia (NCI-CTC3) occurred in 2.4% of all cases, and was observed more frequently in the PEGIFNa arm (3.1% vs. 0.8%; p=0.09). Granulocytopenia (NCI-CTC3) was present in 6.7% of all treated patients, appearing more frequent in the PEGIFNa arm (11.0% vs. 2.3%; p=0.05), also. One patient in the PEGIFNa arm developed a grade 4 leuko- and granulocytopenia. In another case in the IFNa arm a grade 4 increase of the SGPT was observed. In 23.7% of all treated patients a dose reduction was performed. Conclusions: Both PEGIFNa and IFNa are well tolerated using these regimens for these treatment durations. There were few differences in the tolerability between PEGIFNa 100 μg sc/week and IFNa 3x3MIU sc/week. Only an increased myelosuppressive effects such as leuko- and granulocytopenia have been observed. A prolongation of PEGIFNa treatment to 3 years was not associated with an increase in AEs. No significant financial relationships to disclose.
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Affiliation(s)
- T. K. Eigentler
- University Hospital Tuebingen, Tuebingen, Germany; Hannover Medical School, Hannover, Germany; University of Kiel, Kiel, Germany; University of Regensburg, Regensburg, Germany; HELIOS Klinikum Erfurt, Erfurt, Germany
| | - R. Gutzmer
- University Hospital Tuebingen, Tuebingen, Germany; Hannover Medical School, Hannover, Germany; University of Kiel, Kiel, Germany; University of Regensburg, Regensburg, Germany; HELIOS Klinikum Erfurt, Erfurt, Germany
| | - A. Hauschild
- University Hospital Tuebingen, Tuebingen, Germany; Hannover Medical School, Hannover, Germany; University of Kiel, Kiel, Germany; University of Regensburg, Regensburg, Germany; HELIOS Klinikum Erfurt, Erfurt, Germany
| | - T. Vogt
- University Hospital Tuebingen, Tuebingen, Germany; Hannover Medical School, Hannover, Germany; University of Kiel, Kiel, Germany; University of Regensburg, Regensburg, Germany; HELIOS Klinikum Erfurt, Erfurt, Germany
| | - R. Linse
- University Hospital Tuebingen, Tuebingen, Germany; Hannover Medical School, Hannover, Germany; University of Kiel, Kiel, Germany; University of Regensburg, Regensburg, Germany; HELIOS Klinikum Erfurt, Erfurt, Germany
| | - C. Garbe
- University Hospital Tuebingen, Tuebingen, Germany; Hannover Medical School, Hannover, Germany; University of Kiel, Kiel, Germany; University of Regensburg, Regensburg, Germany; HELIOS Klinikum Erfurt, Erfurt, Germany
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Radny P, Bauer J, Caroli UM, Eigentler TK, Kamin A, Metzler G, Garbe C. Alopecia areata Induced by Adjuvant Treatment with Alpha-Interferon in Malignant Melanoma? Dermatology 2004; 209:249-50. [PMID: 15459547 DOI: 10.1159/000079904] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Radny P, Hehr T, Eigentler TK, Kamin A, Caroli UM, Blank G, Garbe C. Ganzhirnbestrahlung und stereotaktische Bestrahlung bei Patienten mit cerebralen Metastasen des malignen Melanoms: eine retrospektive Studie des interdisziplinären Hauttumorzentrums des Universitätsklinikums Tübingen. Akt Dermatol 2004. [DOI: 10.1055/s-2004-832568] [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: 10/19/2022]
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Radny P, Schlemmer HP, Eigentler TK, Kamin A, Blank G, Garbe C. Innovative Ganzkörper-Kernspintomographie (GK-MRT) vs. Ganzkörper-Computertomographie (GK-CT) im Staging bei Patienten mit metastasierten malignen Melanom: eine monozentrische prospektive Studie des interdisziplinären Hauttumorzentrums des Universitätsklinikums Tübingen. Akt Dermatol 2004. [DOI: 10.1055/s-2004-832565] [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: 10/19/2022]
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Eigentler TK, Radny P, Caroli UM, Kamin A, Garbe C. Adjuvante Therapie mit Interferon-alpha beim malignen Melanom. Ergebnisse einer Meta-Analyse. Akt Dermatol 2004. [DOI: 10.1055/s-2004-832533] [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: 10/19/2022]
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Abstract
Treatment of melanoma in the stage of distant metastasis aims on palliation and achievement of durable tumor remission with prolongation of survival. As long as metastasis is confined to one organ system and is removable, surgery remains the treatment of first choice. In limited metastasis radiotherapy may likewise be indicated, particularly in bone and brain metastasis. More extensive metastasis should be treated by chemotherapy or chemoimmunotherapy. Monochemotherapy with dacarbazine, temozolomide, fotemustine and vindesine or its combinations with interferon-alpha are currently preferred. Polychemotherapy or its combinations with interferon-alpha and interleukin-2 are suitable to produce higher response rates but failed to prolong survival. As these treatments are associated with substantially higher toxicity they have been widely abandoned. Combined treatment with dacarbazine and interferon-alpha obtain tumor responses or stable disease in 40-50% and objective tumor remissions in 15-20% of patients. Effective cancer vaccination strategies and blockade of melanoma specific target molecules are currently developed as new treatment options.
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Affiliation(s)
- C Garbe
- Sektion Dermatologische Onkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität, Tübingen.
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Radny P, Caroli UM, Bauer J, Paul T, Schlegel C, Eigentler TK, Weide B, Schwarz M, Garbe C. Phase II trial of intralesional therapy with interleukin-2 in soft-tissue melanoma metastases. Br J Cancer 2003; 89:1620-6. [PMID: 14583759 PMCID: PMC2394422 DOI: 10.1038/sj.bjc.6601320] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.5] [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] [Indexed: 11/09/2022] Open
Abstract
The objective of the present study was to validate the use of intralesional injection of interleukin-2 (IL-2) in patients with skin and soft-tissue melanoma metastases. A total of 24 patients with AJCC stage III or IV melanoma and single or multiple skin and soft-tissue metastases were included. Interleukin-2 injections were administered intralesionally into the total number of cutaneous and soft-tissue metastases accessible from the skin, 2-3 times weekly, over 1-57 weeks. Single doses varied from 0.6 to 6 x 10(6) IU, depending on lesion size. The clinical response was monitored by sonography and confirmed by histopathology; response evaluation was confined to the intralesionally treated tumours. Complete response (CR) of the treated metastases was achieved in 15 patients (62.5%), the longest remission lasting 38 months to date. In five patients, partial response (PR) was achieved (21%) and in another three patients, progressive disease was observed (one patient not assessable). A total of 245 metastases were treated with CR in 209 (85%), and PR in 21 (6%). The therapy was generally well tolerated; the observed adverse events were mainly of grade 1-2 severity. Immunohistochemical studies showed the tumour cells undergoing apoptosis and revealed a mixed character of the inflammatory infiltrate. The unusual high CR rate in metastatic melanoma of 62.5% and the limited toxicity suggest that treatment of skin and soft-tissue melanoma metastases with intralesional injection of IL-2 may be a safe and effective alternative to conventional therapies. The optimal dosage and duration of this therapy still remain to be defined in larger prospective multicentre trials.
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Affiliation(s)
- P Radny
- Department of Dermatology, Eberhard-Karls-University, Liebermeistersraße 20, Tübingen 72076, Germany
| | - U M Caroli
- Department of Dermatology, Eberhard-Karls-University, Liebermeistersraße 20, Tübingen 72076, Germany
| | - J Bauer
- Department of Dermatology, Eberhard-Karls-University, Liebermeistersraße 20, Tübingen 72076, Germany
| | - T Paul
- Department of Dermatology, Eberhard-Karls-University, Liebermeistersraße 20, Tübingen 72076, Germany
| | - C Schlegel
- Department of Dermatology, Eberhard-Karls-University, Liebermeistersraße 20, Tübingen 72076, Germany
| | - T K Eigentler
- Department of Dermatology, Eberhard-Karls-University, Liebermeistersraße 20, Tübingen 72076, Germany
| | - B Weide
- Department of Dermatology, Eberhard-Karls-University, Liebermeistersraße 20, Tübingen 72076, Germany
| | - M Schwarz
- Department of Dermatology, Eberhard-Karls-University, Liebermeistersraße 20, Tübingen 72076, Germany
| | - C Garbe
- Department of Dermatology, Eberhard-Karls-University, Liebermeistersraße 20, Tübingen 72076, Germany
- Department of Dermatology, Eberhard-Karls-University, Liebermeistersraße 20, Tübingen 72076, Germany. E-mail:
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Eigentler TK, Caroli UM, Möhrle M, Breuninger H, Radny P, Blank G, Garbe C. Eine randomisierte, offene Therapiestudie zur Überprüfung der Wirksamkeit und Sicherheit von Imiquimod 5%-Creme bei topischer Anwendung 3-mal wöchentlich über 8 oder 12 Wochen in der Behandlung des soliden Basalzellkarzinoms – Eine Analyse von 28 Patienten. Akt Dermatol 2003. [DOI: 10.1055/s-2003-822264] [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: 10/19/2022]
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Caroli UM, Eigentler TK, Radny P, Garbe C. Palliative Therapie bei metastasiertem malignen Melanom: Eine systematische Übersicht von 41 randomisierten Studien. Akt Dermatol 2003. [DOI: 10.1055/s-2003-822230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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