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Smithers BM, Saw RPM, Gyorki DE, Martin RCW, Atkinson V, Haydon A, Roberts-Thomson R, Thompson JF. Contemporary management of locoregionally advanced melanoma in Australia and New Zealand and the role of adjuvant systemic therapy. ANZ J Surg 2021; 91 Suppl 2:3-13. [PMID: 34288329 DOI: 10.1111/ans.17051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/17/2021] [Accepted: 06/22/2021] [Indexed: 12/19/2022]
Abstract
Australia and New Zealand have the highest incidence and mortality rates for melanoma in the world. Local surgery is still the standard treatment of primary cutaneous melanoma, and it is therefore important that surgeons understand the optimal care pathways for patients with melanoma. Accurate staging is critical to ensure a reliable assessment of prognosis and to guide treatment selection. Sentinel node biopsy (SNB) plays an important role in staging and the provision of reliable prognostic estimates for patients with cutaneous melanoma. Patients with stage III melanoma have a substantial risk of disease recurrence following surgery, leading to poor long-term outcomes. Systemic immunotherapies and targeted therapies, known to be effective for stage IV melanoma, have now also been shown to be effective as adjuvant post-surgical treatments for resected stage III melanoma. These patients should be made aware of this and preferably managed in an integrated multidisciplinary model of care, involving the surgeon, medical oncologists and radiation oncologists. This review considers the impact of a recent update to the American Joint Committee on Cancer (AJCC) staging system, the role of SNB for patients with high-risk primary melanoma and recent advances in adjuvant systemic therapies for high-risk patients.
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Affiliation(s)
- B Mark Smithers
- Queensland Melanoma Project, Faculty of Medicine, University of Queensland and Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - David E Gyorki
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Victoria Atkinson
- Queensland Melanoma Project, Faculty of Medicine, University of Queensland and Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | | | - John F Thompson
- Melanoma Institute Australia, The University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Yokota K, Uchi H, Uhara H, Yoshikawa S, Takenouchi T, Inozume T, Ozawa K, Ihn H, Fujisawa Y, Qureshi A, de Pril V, Otsuka Y, Weber J, Yamazaki N. Adjuvant therapy with nivolumab versus ipilimumab after complete resection of stage III/IV melanoma: Japanese subgroup analysis from the phase 3 CheckMate 238 study. J Dermatol 2019; 46:1197-1201. [PMID: 31638282 PMCID: PMC6916343 DOI: 10.1111/1346-8138.15103] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/05/2019] [Indexed: 11/29/2022]
Abstract
The multinational phase 3 CheckMate 238 trial compared adjuvant therapy with nivolumab versus ipilimumab among patients with resected stage III or IV melanoma (N = 906). In this Japanese subgroup analysis of CheckMate 238 (n = 28; nivolumab, n = 18; ipilimumab, n = 10), both the 12‐ and 18‐month recurrence‐free survival rates were 56% for nivolumab and 30% for ipilimumab (hazard ratio, 0.66; 97.56% confidence interval, 0.19–2.24; P = 0.4390). No new safety signals were reported for Japanese patients. Results were consistent with those from the CheckMate 238 global population, indicating that nivolumab has the potential to be a treatment option for Japanese patients with resected melanoma who are at high risk of recurrence.
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Affiliation(s)
| | | | | | | | | | | | - Kentaro Ozawa
- National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | | | | | | | | | | | - Jeffrey Weber
- Perlmutter Cancer Center, NYU Langone Health, New York, USA
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Chen YW, Niu YH, Wang DQ, Li H, Pokhrel G, Xu H, Wang T, Wang SG, Liu JH. Effect of adjuvant drug therapy after varicocelectomy on fertility outcome in males with varicocele-associated infertility: Systematic review and meta-analysis. Andrologia 2018; 50:e13070. [PMID: 29993131 DOI: 10.1111/and.13070] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/07/2018] [Accepted: 05/14/2018] [Indexed: 02/01/2023] Open
Abstract
Varicocele is one of the common correctable causes of male infertility. Recent studies have demonstrated varicocelectomy in males with abnormal semen parameters was associated with better fertility outcome, but the effect of adjuvant drug therapy after varicocelectomy on fertility outcome in patients with varicocele-associated infertility remains undefined. Hence, the present meta-analysis was performed to assess the efficacy of adjuvant drug therapy after varicocelectomy. The protocol was registered with PROSPERO (No. CRD42018093749). Ten randomised controlled trails containing 533 patients with adjuvant drug therapy after varicocelectomy and 368 patients with no medical treatment after varicocelectomy were included. Our analysis revealed that the improvement in pregnancy rate after adjuvant drug therapy was insignificant. (OR = 1.70, 95%CI = 0.99-2.91), but resulted in significant improvements in sperm concentration (MD = 13.71, 95%CI = 5.80-21.63) and motility (MD = 4.77, 95%CI = 3.98-5.56) at 3 months, sperm DNA integrity (SMD = 3.13, 95%CI = 1.50-4.75) and serum FSH level (MD = -1.02, 95%CI = -1.79 to -0.24). Therefore, compared to no medical treatment, the adjuvant drug therapy, especially the use of antioxidants seems to be associated with better fertility outcome. However, more evidences with high-quality studies are necessary to conform its benefits.
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Affiliation(s)
- Yin-Wei Chen
- Department of Urology, Wuhan, Hubei, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yong-Hua Niu
- Department of Urology, Wuhan, Hubei, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dao-Qi Wang
- Department of Urology, Wuhan, Hubei, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hao Li
- Department of Urology, Wuhan, Hubei, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Gaurab Pokhrel
- Department of Urology, Wuhan, Hubei, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hao Xu
- Department of Urology, Wuhan, Hubei, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tao Wang
- Department of Urology, Wuhan, Hubei, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shao-Gang Wang
- Department of Urology, Wuhan, Hubei, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ji-Hong Liu
- Department of Urology, Wuhan, Hubei, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Abstract
Lung cancer continues to be the leading cause of cancer death worldwide. Recently, immunotherapy for non-small cell lung cancer (NSCLC) has emerged as a powerful treatment option for advanced lung cancer. The relative success of programmed death 1 (PD-1) and/or programmed death ligand 1 (PD-L1) antibodies in metastatic disease have increased interest in expanding their use to earlier stage NSCLC. The complex and diverse nature of stage III disease also invites the incorporation of immunotherapy into treatment plans in both the neoadjuvant and consolidation settings. Currently available data of anti-PD-(L)1 therapies in stage III NSCLC are limited. However, interim results from two studies are encouraging: a phase II neoadjuvant nivolumab trial demonstrated early signals of efficacy, and the phase III PACIFIC trial of durvalumab recently showed significant improvement in progression-free survival (PFS). Preliminary results for the phase II DETERRED trial of durvalumab have also been reported. Many studies are testing anti-PD-(L)1 therapies in the neoadjuvant and consolidation settings for stage III NSCLC, and will be discussed. As these studies mature they may provide further treatment options in management of stage III NSCLC.
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Affiliation(s)
- Justin Yeh
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Kristen A Marrone
- Upper Aerodigestive Malignancies Division, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Patrick M Forde
- Upper Aerodigestive Malignancies Division, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
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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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