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Ferner RE, Aronson JK. Competing Benefits and Competing Hazards: The Benefit to Harm Balance in Individual Patients in Rational Therapeutics. Drug Saf 2024:10.1007/s40264-024-01428-2. [PMID: 38691321 DOI: 10.1007/s40264-024-01428-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2024] [Indexed: 05/03/2024]
Abstract
For any therapeutic intervention in an individual, there is a balance between the potential benefits and the possible harms. The extent to which the benefits are desirable in a given condition depends on the efficacy of the intervention, the chance of obtaining it and the seriousness and intensity of the condition. The extent to which the harms are undesirable depends on the nature of the hazard that can lead to harm, the chance that the harm will occur and its seriousness and intensity. Rational therapeutic decisions require clinicians to consider competing courses of action, with potential benefits of different desirability and potential harms of different undesirability. They also have a duty to explain to the patient, for the contemplated interventions, both the possible benefits and the potential harms that the patient may consider significant. In an individual patient, it is necessary to consider (a) the probabilities of benefit from both intervention and non-intervention and (b) the probabilities of harm from both intervention and non-intervention. However, there are several potential problems. Here, we consider how failure to distinguish maximum benefits from probable benefits, or hazards (potential harms) from probable harms, and failure to consider all the competing probabilities may lead to imperfect therapeutic decisions. We also briefly discuss methods to assess the benefit to harm balance.
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Affiliation(s)
- Robin E Ferner
- Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
- Clinical Pharmacology Section, University College London, London, UK.
| | - Jeffrey K Aronson
- Nuffield Department of Primary Care Health Sciences, Centre for Evidence-Based Medicine, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
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2
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Affiliation(s)
- Eric C T Geijteman
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Evelien J M Kuip
- Department of Medical Oncology and Department of Anesthesiology, Pain and Palliative Care, Radboudumc, Nijmegen, The Netherlands
| | | | - Diana Lees
- Department of Respiratory Medicine, Liverpool University Foundation Teaching Hospital, United Kingdom
| | - Eduardo Bruera
- Department of Palliative Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, USA
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3
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Wu HM, Huang YY, Xu YQ, Xiang WL, Yang C, Liu RY, Li D, Guo XF, Zhang ZB, Bei CH, Tan SK, Zhu XN. Comprehensive analysis of the protein phosphatase 2A regulatory subunit B56ε in pan-cancer and its role and mechanism in hepatocellular carcinoma. World J Gastrointest Oncol 2024; 16:475-492. [PMID: 38425404 PMCID: PMC10900161 DOI: 10.4251/wjgo.v16.i2.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/10/2023] [Accepted: 01/08/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND B56ε is a regulatory subunit of the serine/threonine protein phosphatase 2A, which is abnormally expressed in tumors and regulates various tumor cell functions. At present, the application of B56ε in pan-cancer lacks a comprehensive analysis, and its role and mechanism in hepatocellular carcinoma (HCC) are still unclear. AIM To analyze B56ε in pan-cancer, and explore its role and mechanism in HCC. METHODS The Cancer Genome Atlas, Genotype-Tissue Expression, Gene Expression Profiling Interactive Analysis, and Tumor Immune Estimation Resource databases were used to analyze B56ε expression, prognostic mutations, somatic copy number alterations, and tumor immune characteristics in 33 tumors. The relationships between B56ε expression levels and drug sensitivity, immunotherapy, immune checkpoints, and human leukocyte antigen (HLA)-related genes were further analyzed. Gene Set Enrichment Analysis (GSEA) was performed to reveal the role of B56ε in HCC. The Cell Counting Kit-8, plate cloning, wound healing, and transwell assays were conducted to assess the effects of B56ε interference on the malignant behavior of HCC cells. RESULTS In most tumors, B56ε expression was upregulated, and high B56ε expression was a risk factor for adrenocortical cancer, HCC, pancreatic adenocarcinoma, and pheochromocytoma and paraganglioma (all P < 0.05). B56ε expression levels were correlated with a variety of immune cells, such as T helper 17 cells, B cells, and macrophages. There was a positive correlation between B56ε expression levels with immune checkpoint genes and HLA-related genes (all P < 0.05). The expression of B56ε was negatively correlated with the sensitivity of most chemotherapy drugs, but a small number showed a positive correlation (all P < 0.05). GSEA analysis showed that B56ε expression was related to the cancer pathway, p53 downstream pathway, and interleukin-mediated signaling in HCC. Knockdown of B56ε expression in HCC cells inhibited the proliferation, migration, and invasion capacity of tumor cells. CONCLUSION B56ε is associated with the microenvironment, immune evasion, and immune cell infiltration of multiple tumors. B56ε plays an important role in HCC progression, supporting it as a prognostic marker and potential therapeutic target for HCC.
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Affiliation(s)
- Hong-Mei Wu
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, Guilin Medical University, Guilin 541199, Guangxi Zhuang Autonomous Region, China
| | - Yuan-Yuan Huang
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, Guilin Medical University, Guilin 541199, Guangxi Zhuang Autonomous Region, China
| | - Yu-Qiu Xu
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, Guilin Medical University, Guilin 541199, Guangxi Zhuang Autonomous Region, China
| | - Wei-Lai Xiang
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, Guilin Medical University, Guilin 541199, Guangxi Zhuang Autonomous Region, China
| | - Chang Yang
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, Guilin Medical University, Guilin 541199, Guangxi Zhuang Autonomous Region, China
| | - Ru-Yuan Liu
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, Guilin Medical University, Guilin 541199, Guangxi Zhuang Autonomous Region, China
| | - Di Li
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, Guilin Medical University, Guilin 541199, Guangxi Zhuang Autonomous Region, China
| | - Xue-Feng Guo
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, Guilin Medical University, Guilin 541199, Guangxi Zhuang Autonomous Region, China
| | - Zheng-Bao Zhang
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, Guilin Medical University, Guilin 541199, Guangxi Zhuang Autonomous Region, China
| | - Chun-Hua Bei
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, Guilin Medical University, Guilin 541199, Guangxi Zhuang Autonomous Region, China
| | - Sheng-Kui Tan
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, Guilin Medical University, Guilin 541199, Guangxi Zhuang Autonomous Region, China
| | - Xiao-Nian Zhu
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, Guilin Medical University, Guilin 541199, Guangxi Zhuang Autonomous Region, China
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Smith A, Boby JM, Benny SJ, Ghazali N, Vermeulen E, George M. Immunotherapy in Older Patients with Cancer: A Narrative Review. Int J Gen Med 2024; 17:305-313. [PMID: 38298248 PMCID: PMC10830099 DOI: 10.2147/ijgm.s435001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/09/2024] [Indexed: 02/02/2024] Open
Abstract
Purpose Immunotherapies have revolutionized cancer treatment; however, relatively little is known about their efficacy and toxicity in the elderly, a cohort accounting for more than half of total cancer cases. In this review, we aim to provide insight into the current knowledge base regarding the clinical utility and side effects of immunotherapies in the geriatric population as well as identify key gaps in the literature where further research is essential. Methods We conducted a rapid critical review of available literature, focusing on studies reporting on use of immunotherapy in cancer patients aged ≥65 years. The review assessed studies that included different types of cancer, were of multiple study types (although predominantly retrospective), had different study duration, and reported different outcomes of interest. Owing to this heterogeneity, meta-analysis and a direct comparison between studies were not feasible. Results Overall, the review findings indicate that certain malignancies have shown comparable survival rates in younger and older age groups when managed with immunotherapeutic drugs, the incidence of immunotherapy-related side effects varies only slightly by age groups, and in general there is a lack of studies on the determinants of the clinical outcomes of immunotherapy in or including geriatric patients. Conclusion Enhanced clinical benefits along with better tolerability associated with immunotherapies make it an attractive alternative to conventional chemotherapeutic drugs, especially in elderly patients. There is currently a limited number of studies assessing the clinical outcomes of immunotherapies, particularly in the elderly. Overall, our findings reflect a need for further prospective studies focussing on geriatric patients representative of the real-life population, in order to derive a more precise understanding of the clinical utility, toxicity profile, and cost-effectiveness of immune checkpoint inhibitors in older patients with cancer.
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Affiliation(s)
- Alexandra Smith
- Tamworth Hospital, Hunter New England Local Health District (NSW Health), Tamworth, NSW, Australia
| | | | | | | | - Elke Vermeulen
- Tamworth Hospital, Hunter New England Local Health District (NSW Health), Tamworth, NSW, Australia
| | - Mathew George
- Tamworth Hospital, Hunter New England Local Health District (NSW Health), Tamworth, NSW, Australia
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Zhang M, Zuo Y, Guo J, Yang L, Wang Y, Tan M, Guo X. A novel signature for predicting prognosis and immune landscape in cutaneous melanoma based on anoikis-related long non-coding RNAs. Sci Rep 2023; 13:16332. [PMID: 37770477 PMCID: PMC10539372 DOI: 10.1038/s41598-023-39837-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/31/2023] [Indexed: 09/30/2023] Open
Abstract
Anoikis is a unique form of apoptosis associated with vascularization and distant metastasis in cancer. Eliminating anoikis resistance in tumor cells could be a promising target for improving the prognosis of terminal cancer patients. However, current studies have not elaborated on the prognosis effect of anoikis-related long non-coding RNAs (lncRNAs) in cutaneous melanoma. Pre-processed data, including RNA sequences and clinical information, were retrieved from TCGA and GTEx databases. After a series of statistical analyses, anoikis-related lncRNAs with prognostic significance were identified, and a unique risk signature was constructed. Risk scores were further analyzed in relation to the tumor microenvironment, tumor immune dysfunction and exclusion, immune checkpoint genes, and RNA methylation genes. The indicators were also used to predict the potentially sensitive anti-cancer drugs. An anoikis-related lncRNAs risk signature consisting of LINC01711, POLH-AS1, MIR205HG, and LINC02416 was successfully established in cutaneous melanoma. Overall survival and progression-free survival of patients were strongly linked with the risk score, independently of other clinical factors. The low-risk group exhibited a more beneficial immunological profile, was less affected by RNA methylation, and was more sensitive to the majority of anti-cancer drugs, all of which indicated a better prognostic outcome. The 4 hub lncRNAs may be fundamental to studying the mechanism of anoikis in cutaneous melanoma and provide personalized therapy for salvaging drug resistance.
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Affiliation(s)
- Miao Zhang
- Department of Plastic and Burns Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yuzhi Zuo
- Department of Plastic and Burns Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Jian Guo
- Vascular Surgery Department, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Lushan Yang
- Department of Plastic and Burns Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yizhi Wang
- Department of Plastic and Burns Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Meiyun Tan
- Department of Orthopaedics, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
| | - Xing Guo
- Department of Plastic and Burns Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
- Center of Ambulatory Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
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Andrianova EP, Marmion RA, Shvartsman SY, Zhulin IB. Evolutionary history of MEK1 illuminates the nature of deleterious mutations. Proc Natl Acad Sci U S A 2023; 120:e2304184120. [PMID: 37579140 PMCID: PMC10450672 DOI: 10.1073/pnas.2304184120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/24/2023] [Indexed: 08/16/2023] Open
Abstract
Mutations in signal transduction pathways lead to various diseases including cancers. MEK1 kinase, encoded by the human MAP2K1 gene, is one of the central components of the MAPK pathway and more than a hundred somatic mutations in the MAP2K1 gene were identified in various tumors. Germline mutations deregulating MEK1 also lead to congenital abnormalities, such as the cardiofaciocutaneous syndrome and arteriovenous malformation. Evaluating variants associated with a disease is a challenge, and computational genomic approaches aid in this process. Establishing evolutionary history of a gene improves computational prediction of disease-causing mutations; however, the evolutionary history of MEK1 is not well understood. Here, by revealing a precise evolutionary history of MEK1, we construct a well-defined dataset of MEK1 metazoan orthologs, which provides sufficient depth to distinguish between conserved and variable amino acid positions. We matched known and predicted disease-causing and benign mutations to evolutionary changes observed in corresponding amino acid positions and found that all known and many suspected disease-causing mutations are evolutionarily intolerable. We selected several variants that cannot be unambiguously assessed by automated prediction tools but that are confidently identified as "damaging" by our approach, for experimental validation in Drosophila. In all cases, evolutionary intolerant variants caused increased mortality and severe defects in fruit fly embryos confirming their damaging nature. We anticipate that our analysis will serve as a blueprint to help evaluate known and novel missense variants in MEK1 and that our approach will contribute to improving automated tools for disease-associated variant interpretation.
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Affiliation(s)
- Ekaterina P. Andrianova
- Department of Microbiology, The Ohio State University, Columbus, OH43210
- Translational Data Analytics Institute, The Ohio State University, Columbus, OH43210
| | - Robert A. Marmion
- The Lewis-Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ08544
| | - Stanislav Y. Shvartsman
- The Lewis-Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ08544
- Department of Molecular Biology, Princeton University, Princeton, NJ08544
- Flatiron Institute, Simons Foundation, New York, NY10010
| | - Igor B. Zhulin
- Department of Microbiology, The Ohio State University, Columbus, OH43210
- Translational Data Analytics Institute, The Ohio State University, Columbus, OH43210
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Young JN, Griffith‐Bauer K, Hill E, Latour E, Samatham R, Leachman S. The benefit of early-stage diagnosis: A registry-based survey evaluating the quality of life in patients with melanoma. SKIN HEALTH AND DISEASE 2023; 3:e237. [PMID: 37538330 PMCID: PMC10395626 DOI: 10.1002/ski2.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 08/05/2023]
Abstract
Background The morbidity associated with advanced stage melanoma is an important consideration in the dialog surrounding early detection and overdiagnosis. Few studies have stratified melanoma patient quality of life (QoL) by stage at diagnosis. Objective We sought to investigate if melanoma stage is independently associated with changes in QoL within a large, community-based melanoma registry. Secondarily, we investigated whether demographic factors such as age, geographic location or level of education are associated with changes in QoL in the same population. Methods 1108 melanoma patients were surveyed over a three-month period using the QoL in Adult Cancer Survivors Survey, consisting of 47 items on a 7-point frequency scale. Data were analysed using both descriptive statistical models and adjusted multivariate logistic regression. Results There were 677 respondents generating a 61% response rate. Overall, higher stage at diagnosis correlated with the largest decreases in QoL as it pertained to both general (p = 0.001) and Cancer-Specific stressors (p < 0.001). Education level (p = 0.020), age (p < 0.001), rural area code designation (p = 0.020) and family history of melanoma (p = 0.017) were also independently associated with changes in QoL. Conclusion Earlier stage at melanoma diagnosis is associated with better QoL and thus represents a crucial intervention in patient care. Given our findings and the growing body of evidence surrounding morbidity in late-stage melanoma, it is essential that QoL be included in assessing the benefits of early detection.
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Affiliation(s)
- Jade N. Young
- Department of DermatologyOregon Health and Science UniversityPortlandOregonUSA
| | - Kelly Griffith‐Bauer
- Department of DermatologyOregon Health and Science UniversityPortlandOregonUSA
- The PolyclinicSeattleWashingtonUSA
| | - Emma Hill
- Department of DermatologyOregon Health and Science UniversityPortlandOregonUSA
| | - Emile Latour
- Department of DermatologyOregon Health and Science UniversityPortlandOregonUSA
- Biostatistics Shared ResourceKnight Cancer InstituteOregon Health and Science UniversityPortlandOregonUSA
| | - Ravikant Samatham
- Department of DermatologyOregon Health and Science UniversityPortlandOregonUSA
| | - Sancy Leachman
- Department of DermatologyOregon Health and Science UniversityPortlandOregonUSA
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8
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Zhang M, Yang L, Wang Y, Zuo Y, Chen D, Guo X. Comprehensive prediction of immune microenvironment and hot and cold tumor differentiation in cutaneous melanoma based on necroptosis-related lncRNA. Sci Rep 2023; 13:7299. [PMID: 37147395 PMCID: PMC10163022 DOI: 10.1038/s41598-023-34238-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023] Open
Abstract
As per research, causing cancer cells to necroptosis might be used as a therapy to combat cancer drug susceptibility. Long non-coding RNA (lncRNA) modulates the necroptosis process in Skin Cutaneous Melanoma (SKCM), even though the precise mechanism by which it does so has yet been unknown. RNA sequencing and clinical evidence of SKCM patients were accessed from The Cancer Genome Atlas database, and normal skin tissue sequencing data was available from the Genotype-Tissue Expression database. Person correlation analysis, differential screening, and univariate Cox regression were successively utilized to identify necroptosis-related hub lncRNAs. Following this, we adopt the least absolute shrinkage and selection operator regression analysis to construct a risk model. The model was evaluated on various clinical characteristics using many integrated approaches to ensure it generated accurate predictions. Through risk score comparisons and consistent cluster analysis, SKCM patients were sorted either high-risk or low-risk subgroups as well as distinct clusters. Finally, the effect of immune microenvironment, m7G methylation, and viable anti-cancer drugs in risk groups and potential clusters was evaluated in further detail. Included USP30-AS1, LINC01711, LINC00520, NRIR, BASP1-AS1, and LINC02178, the 6 necroptosis-related hub lncRNAs were utilized to construct a novel prediction model with excellent accuracy and sensitivity, which was not influenced by confounding clinical factors. Immune-related, necroptosis, and apoptosis pathways were enhanced in the model structure, as shown by Gene Set Enrichment Analysis findings. TME score, immune factors, immune checkpoint-related genes, m7G methylation-related genes, and anti-cancer drug sensitivity differed significantly between the high-risk and low-risk groups. Cluster 2 was identified as a hot tumor with a better immune response and therapeutic effect. Our study may provide potential biomarkers for predicting prognosis in SKCM and provide personalized clinical therapy for patients based on hot and cold tumor classification.
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Affiliation(s)
- Miao Zhang
- Department of Plastic and Burns Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Lushan Yang
- Department of Plastic and Burns Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yizhi Wang
- Department of Plastic and Burns Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yuzhi Zuo
- Department of Plastic and Burns Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Dengdeng Chen
- Department of Plastic and Burns Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Xing Guo
- Department of Plastic and Burns Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
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9
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Pham JP, Joshua AM, da Silva IP, Dummer R, Goldinger SM. Chemotherapy in Cutaneous Melanoma: Is There Still a Role? Curr Oncol Rep 2023; 25:609-621. [PMID: 36988735 PMCID: PMC10164011 DOI: 10.1007/s11912-023-01385-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 03/30/2023]
Abstract
Abstract
Purpose of Review
In the preceding decade, the management of metastatic cutaneous melanoma has been revolutionised with the development of highly effective therapies including immune checkpoint inhibitors (specifically CTLA-4 and PD-1 inhibitors) and targeted therapies (BRAF and MEK inhibitors). The role of chemotherapy in the contemporary management of melanoma is undefined.
Recent Findings
Extended analyses highlight substantially improved 5-year survival rates of approximately 50% in patients with metastatic melanoma treated with first-line therapies. However, most patients will progress on these first-line treatments. Sequencing of chemotherapy following failure of targeted and immunotherapies is associated with low objective response rates and short progression-free survival, and thus, meaningful benefits to patients are minimal.
Summary
Chemotherapy has limited utility in the contemporary management of cutaneous melanoma (with a few exceptions, discussed herein) and should not be the standard treatment sequence following failure of first-line therapies. Instead, enrolment onto clinical trials should be standard-of-care in these patients.
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Affiliation(s)
- James P Pham
- Medical Oncology, The Kinghorn Cancer Centre, St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
- School of Clinical Medicine, UNSW Medicine and Health, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Anthony M Joshua
- Medical Oncology, The Kinghorn Cancer Centre, St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
- School of Clinical Medicine, UNSW Medicine and Health, St Vincent's Hospital, Darlinghurst, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Wollstonecraft, NSW, Australia
| | - Ines P da Silva
- Melanoma Institute Australia, The University of Sydney, Wollstonecraft, NSW, Australia
- Medical Oncology, Blacktown Hospital, Blacktown, NSW, Australia
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Simone M Goldinger
- Department of Dermatology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.
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Alshaebi F, Safi M, Algabri YA, Al-Azab M, Aldanakh A, Alradhi M, Reem A, Zhang C. Interleukin-34 and immune checkpoint inhibitors: Unified weapons against cancer. Front Oncol 2023; 13:1099696. [PMID: 36798830 PMCID: PMC9927403 DOI: 10.3389/fonc.2023.1099696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/09/2023] [Indexed: 02/03/2023] Open
Abstract
Interleukin-34 (IL-34) is a cytokine that is involved in the regulation of immune cells, including macrophages, in the tumor microenvironment (TME). Macrophages are a type of immune cell that can be found in large numbers within the TME and have been shown to have a role in the suppression of immune responses in cancer. This mmune suppression can contribute to cancer development and tumors' ability to evade the immune system. Immune checkpoint inhibitors (ICIs) are a type of cancer treatment that target proteins on immune cells that act as "checkpoints," regulating the activity of the immune system. Examples of these proteins include programmed cell death protein 1 (PD-1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4). ICIs work by blocking the activity of these proteins, allowing the immune system to mount a stronger response against cancer cells. The combination of IL-34 inhibition with ICIs has been proposed as a potential treatment option for cancer due to the role of IL-34 in the TME and its potential involvement in resistance to ICIs. Inhibiting the activity of IL-34 or targeting its signaling pathways may help to overcome resistance to ICIs and improve the effectiveness of these therapies. This review summarizes the current state of knowledge concerning the involvement of IL-34-mediated regulation of TME and the promotion of ICI resistance. Besides, this work may shed light on whether targeting IL-34 might be exploited as a potential treatment option for cancer patients in the future. However, further research is needed to fully understand the mechanisms underlying the role of IL-34 in TME and to determine the safety and efficacy of this approach in cancer patients.
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Affiliation(s)
- Fadhl Alshaebi
- Department of Respiratory, Shandong Second Provincial General Hospital, Shandong University, Jinan, Shandong, China
| | - Mohammed Safi
- Department of Respiratory, Shandong Second Provincial General Hospital, Shandong University, Jinan, Shandong, China,*Correspondence: Mohammed Safi, ; Caiqing Zhang,
| | - Yousif A. Algabri
- Department of Biomedical Engineering, School of Control Science and Engineering, Shandong University, Jinan, Shandong, China
| | - Mahmoud Al-Azab
- Department of Immunology, Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou Medical University, Guangzhou, China
| | - Abdullah Aldanakh
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Mohammed Alradhi
- Department of Urology, The Affiliated Hospital of Qingdao Binhai University, Qingdao, Shandong, China
| | - Alariqi Reem
- Faculty of Medicine and Health Sciences, Amran University, Amran, Yemen
| | - Caiqing Zhang
- Department of Respiratory, Shandong Second Provincial General Hospital, Shandong University, Jinan, Shandong, China,*Correspondence: Mohammed Safi, ; Caiqing Zhang,
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11
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Gorry C, McCullagh L, O'Donnell H, Barrett S, Schmitz S, Barry M, Curtin K, Beausang E, Barry R, Coyne I. Neoadjuvant treatment for stage III and IV cutaneous melanoma. Cochrane Database Syst Rev 2023; 1:CD012974. [PMID: 36648215 PMCID: PMC9844053 DOI: 10.1002/14651858.cd012974.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Cutaneous melanoma is amongst the most aggressive of all skin cancers. Neoadjuvant treatment is a form of induction therapy, given to shrink a cancerous tumour prior to the main treatment (usually surgery). The purpose is to improve survival and surgical outcomes. This review systematically appraises the literature investigating the use of neoadjuvant treatment for stage III and IV cutaneous melanoma. OBJECTIVES To assess the effects of neoadjuvant treatment in adults with stage III or stage IV melanoma according to the seventh edition American Joint Committee on Cancer (AJCC) staging system. SEARCH METHODS We searched the following databases up to 10 August 2021 inclusive: Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, LILACS and four trials registers, together with reference checking and contact with study authors to identify additional studies. We also handsearched proceedings from specific conferences from 2016 to 2020 inclusive. SELECTION CRITERIA Randomised controlled trials (RCTs) of people with stage III and IV melanoma, comparing neoadjuvant treatment strategies (using targeted treatments, immunotherapies, radiotherapy, topical treatments or chemotherapy) with any of these agents or current standard of care (SOC), were eligible for inclusion. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Primary outcomes were overall survival (OS) and adverse effects (AEs). Secondary outcomes included time to recurrence (TTR), quality of life (QOL), and overall response rate (ORR). We used GRADE to evaluate the certainty of the evidence. MAIN RESULTS We included eight RCTs involving 402 participants. Studies enrolled adults, mostly with stage III melanoma, investigated immunotherapies, chemotherapy, or targeted treatments, and compared these with surgical excision with or without adjuvant treatment. Duration of follow-up and therapeutic regimens varied, which, combined with heterogeneity in the population and definitions of the endpoints, precluded meta-analysis of all identified studies. We performed a meta-analysis including three studies. We are very uncertain if neoadjuvant treatment increases OS when compared to no neoadjuvant treatment (hazard ratio (HR) 0.43, 95% confidence interval (CI) 0.15 to 1.21; 2 studies, 171 participants; very low-certainty evidence). Neoadjuvant treatment may increase the rate of AEs, but the evidence is very uncertain (26% versus 16%, risk ratio (RR) 1.58, 95% CI 0.97 to 2.55; 2 studies, 162 participants; very low-certainty evidence). We are very uncertain if neoadjuvant treatment increases TTR (HR 0.51, 95% CI 0.22 to 1.17; 2 studies, 171 participants; very low-certainty evidence). Studies did not report ORR as a comparative outcome or measure QOL data. We are very uncertain whether neoadjuvant targeted treatment with dabrafenib and trametinib increases OS (HR 0.28, 95% CI 0.03 to 2.25; 1 study, 21 participants; very low-certainty evidence) or TTR (HR 0.02, 95% CI 0.00 to 0.22; 1 study, 21 participants; very low-certainty evidence) when compared to surgery. The study did not report comparative rates of AEs and overall response, and did not measure QOL. We are very uncertain if neoadjuvant immunotherapy with talimogene laherparepvec increases OS when compared to no neoadjuvant treatment (HR 0.49, 95% CI 0.15 to 1.64; 1 study, 150 participants, very low-certainty evidence). It may have a higher rate of AEs, but the evidence is very uncertain (16.5% versus 5.8%, RR 2.84, 95% CI 0.96 to 8.37; 1 study, 142 participants; very low-certainty evidence). We are very uncertain if it increases TTR (HR 0.75, 95% CI 0.31 to 1.79; 1 study, 150 participants; very low-certainty evidence). The study did not report comparative ORRs or measure QOL. OS was not reported for neoadjuvant immunotherapy (combined ipilimumab and nivolumab) when compared to the combination of ipilimumab and nivolumab as adjuvant treatment. There may be little or no difference in the rate of AEs between these treatments (9%, RR 1.0, 95% CI 0.75 to 1.34; 1 study, 20 participants; low-certainty evidence). The study did not report comparative ORRs or measure TTR and QOL. Neoadjuvant immunotherapy (combined ipilimumab and nivolumab) likely results in little to no difference in OS when compared to neoadjuvant nivolumab monotherapy (P = 0.18; 1 study, 23 participants; moderate-certainty evidence). It may increase the rate of AEs, but the certainty of this evidence is very low (72.8% versus 8.3%, RR 8.73, 95% CI 1.29 to 59; 1 study, 23 participants); this trial was halted early due to observation of disease progression preventing surgical resection in the monotherapy arm and the high rate of treatment-related AEs in the combination arm. Neoadjuvant combination treatment may lead to higher ORR, but the evidence is very uncertain (72.8% versus 25%, RR 2.91, 95% CI 1.02 to 8.27; 1 study, 23 participants; very low-certainty evidence). It likely results in little to no difference in TTR (P = 0.19; 1 study, 23 participants; low-certainty evidence). The study did not measure QOL. OS was not reported for neoadjuvant immunotherapy (combined ipilimumab and nivolumab) when compared to neoadjuvant sequential immunotherapy (ipilimumab then nivolumab). Only Grade 3 to 4 immune-related AEs were reported; fewer were reported with combination treatment, and the sequential treatment arm closed early due to a high incidence of severe AEs. The neoadjuvant combination likely results in a higher ORR compared to sequential neoadjuvant treatment (60.1% versus 42.3%, RR 1.42, 95% CI 0.87 to 2.32; 1 study, 86 participants; low-certainty evidence). The study did not measure TTR and QOL. No data were reported on OS, AEs, TTR, or QOL for the comparison of neoadjuvant interferon (HDI) plus chemotherapy versus neoadjuvant chemotherapy. Neoadjuvant HDI plus chemotherapy may have little to no effect on ORR, but the evidence is very uncertain (33% versus 22%, RR 1.75, 95% CI 0.62 to 4.95; 1 study, 36 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS We are uncertain if neoadjuvant treatment increases OS or TTR compared with no neoadjuvant treatment, and it may be associated with a slightly higher rate of AEs. There is insufficient evidence to support the use of neoadjuvant treatment in clinical practice. Priorities for research include the development of a core outcome set for neoadjuvant trials that are adequately powered, with validation of pathological and radiological responses as intermediate endpoints, to investigate the relative benefits of neoadjuvant treatment compared with adjuvant treatment with immunotherapies or targeted therapies.
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Affiliation(s)
- Claire Gorry
- National Centre for Pharmacoeconomics, St James's Hospital, Dublin, Ireland
| | - Laura McCullagh
- National Centre for Pharmacoeconomics, St James's Hospital, Dublin, Ireland
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - Helen O'Donnell
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - Sarah Barrett
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity St James's Cancer Institute, Trinity College Dublin, Dublin, Ireland
| | - Susanne Schmitz
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - Michael Barry
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - Kay Curtin
- Melanoma Support Ireland, Dublin, Ireland
| | - Eamon Beausang
- Plastic and Reconstructive Surgery, St James's Hospital, Dublin, Ireland
| | - Rupert Barry
- Department of Dermatology, St James's Hospital, Dublin, Ireland
| | - Imelda Coyne
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
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12
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Esimbekova AR, Palkina NV, Zinchenko IS, Belenyuk VD, Savchenko AA, Sergeeva EY, Ruksha T. Focal adhesion alterations in
G0
‐positive melanoma cells. Cancer Med 2022; 12:7294-7308. [PMID: 36533319 PMCID: PMC10067123 DOI: 10.1002/cam4.5510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/23/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Melanoma is a highly heterogeneous malignant tumor that exhibits various forms of drug resistance. Recently, reversal transition of cancer cells to the G0 phase of the cell cycle under the influence of therapeutic drugs has been identified as an event associated with tumor dissemination. In the present study, we investigated the ability of chemotherapeutic agent dacarbazine to induce a transition of melanoma cells to the G0 phase as a mechanism of chemoresistance. METHODS We used the flow cytometry to analyze cell distribution within cell cycle phases after dacarbazine treatment as well as to identifyG0 -positive cells population. Transcriptome profiling was provided to determine genes associated with dacarbazine resistance. We evaluated the activity of β-galactosidase in cells treated with dacarbazine by substrate hydrolysis. Cell adhesion strength was measured by centrifugal assay application with subsequent staining of adhesive cells with Ki-67 monoclonal antibodies. Ability of melanoma cells to metabolize dacarbazine was determined by expressional analysis of CYP1A1, CYP1A2, CYP2E1 followed by CYP1A1 protein level evaluation by the ELISA method. RESULTS The present study determined that dacarbazine treatment of melanoma cells could induce an increase in the percentage of cells in G0 phase without alterations of β-galactosidase positive cells which corresponded to the fraction of the senescent cells. Transcriptomic profiling of cells under dacarbazine induction of G0 -positive cells percentage revealed that 'VEGFA-VEGFR2 signaling pathway' and 'Cell cycle' signaling were mostly enriched by dysregulated genes. 'Focal adhesion' signaling was also found to be triggered by dacarbazine. In melanoma cells treated with dacarbazine, an increase in G0 -positive cells among adherent cells was found. CONCLUSIONS Dacarbazine induces the alteration in a percentage of melanoma cells residing in G0 phase of a cell cycle. The altered adhesive phenotype of cancer cells under transition in the G0 phase may refer to a specific intercellular communication pattern of quiescent/senescent cancer cells.
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Affiliation(s)
| | - Nadezhda V. Palkina
- Department of Pathophysiology Krasnoyarsk State Medical University Krasnoyarsk Russia
| | - Ivan S. Zinchenko
- Department of Pathophysiology Krasnoyarsk State Medical University Krasnoyarsk Russia
| | - Vasiliy D. Belenyuk
- Laboratory of Cell Molecular Physiology and Pathology Federal Research Center, Krasnoyarsk Science Center of The Siberian Branch of The Russian Academy of Sciences Krasnoyarsk Russia
| | - Andrey A. Savchenko
- Laboratory of Cell Molecular Physiology and Pathology Federal Research Center, Krasnoyarsk Science Center of The Siberian Branch of The Russian Academy of Sciences Krasnoyarsk Russia
| | - Ekaterina Yu Sergeeva
- Department of Pathophysiology Krasnoyarsk State Medical University Krasnoyarsk Russia
| | - Tatiana G. Ruksha
- Department of Pathophysiology Krasnoyarsk State Medical University Krasnoyarsk Russia
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13
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Liu JY, Liu LP, Li Z, Luo YW, Liang F. The role of cuproptosis-related gene in the classification and prognosis of melanoma. Front Immunol 2022; 13:986214. [PMID: 36341437 PMCID: PMC9632664 DOI: 10.3389/fimmu.2022.986214] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background Melanoma, as one of the most aggressive and malignant cancers, ranks first in the lethality rate of skin cancers. Cuproptosis has been shown to paly a role in tumorigenesis, However, the role of cuproptosis in melanoma metastasis are not clear. Studying the correlation beteen the molecular subtypes of cuproptosis-related genes (CRGs) and metastasis of melanoma may provide some guidance for the prognosis of melanoma. Methods We collected 1085 melanoma samples in The Cancer Genome Atlas(TCGA) and Gene Expression Omnibus(GEO) databases, constructed CRGs molecular subtypes and gene subtypes according to clinical characteristics, and investigated the role of CRGs in melanoma metastasis. We randomly divide the samples into train set and validation set according to the ratio of 1:1. A prognostic model was constructed using data from the train set and then validated on the validation set. We performed tumor microenvironment analysis and drug sensitivity analyses for high and low risk groups based on the outcome of the prognostic model risk score. Finally, we established a metastatic model of melanoma. Results According to the expression levels of 12 cuproptosis-related genes, we obtained three subtypes of A1, B1, and C1. Among them, C1 subtype had the best survival outcome. Based on the differentially expressed genes shared by A1, B1, and C1 genotypes, we obtained the results of three gene subtypes of A2, B2, and C2. Among them, the B2 group had the best survival outcome. Then, we constructed a prognostic model consisting of 6 key variable genes, which could more accurately predict the 1-, 3-, and 5-year overall survival rates of melanoma patients. Besides, 98 drugs were screened out. Finally, we explored the role of cuproptosis-related genes in melanoma metastasis and established a metastasis model using seven key genes. Conclusions In conclusion, CRGs play a role in the metastasis and prognosis of melanoma, and also provide new insights into the underlying pathogenesis of melanoma.
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Affiliation(s)
- Jin-Ya Liu
- Department of Plastic Surgery, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Le-Ping Liu
- Department of Blood Transfusion, The Third Xiangya Hospital of Central South University, Changsha, China,Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Ze Li
- Department of Hematology and Critical Care Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yan-Wei Luo
- Department of Blood Transfusion, The Third Xiangya Hospital of Central South University, Changsha, China,*Correspondence: Fang Liang, ; Yan-Wei Luo,
| | - Fang Liang
- Department of Hematology and Critical Care Medicine, The Third Xiangya Hospital, Central South University, Changsha, China,*Correspondence: Fang Liang, ; Yan-Wei Luo,
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14
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Ruiz JI, Singh G, Erck M, Geng Y, Suarez-Almazor ME, Lopez-Olivo MA. Quality and content evaluation of websites with information about immune checkpoint inhibitors: An environmental scan. PLoS One 2022; 17:e0275676. [PMID: 36215234 PMCID: PMC9550065 DOI: 10.1371/journal.pone.0275676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/21/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Trustworthy educational information for patients is critical for increasing their knowledge base and preparing them for shared decision making with clinicians. As the internet has become an important source of health information for many patients, the purpose of this study was to assess the quality and content of websites with educational content about immune checkpoint inhibitors. METHODS We performed an environmental scan of the currently available websites providing educational information for patients about immune checkpoint inhibitors. We used three search engines: Google, Bing, and Yahoo! (9/20/2021). Two independent investigators selected relevant uniform resource locators (URLs), appraised the quality of the websites, and collected their characteristics. We evaluated the accuracy, completeness, technical elements, design and aesthetics, readability, usability, and accessibility of the websites. The user experience was also evaluated. RESULTS We identified 37 websites for analysis. In 10 websites (27%), it was not possible to know the source of the information provided. Thirty-three (89%) provided a definition with a simple explanation of cancer and treatment and 30 (81%) on complications of immune checkpoint inhibitors; only seven (19%) provided information about the balance between risks and benefits. Thirty-five (95%) provided a statement of purpose. Regarding the design, all 37 (100%) had appropriate visual aspects, typography, and grammar. Thirty-six (97%) were well organized. For most of the websites (n = 35, 95%) the content was easy to find. Only two websites had a readability score of 6, while the others had higher scores. Regarding the user experience, the overall quality of websites was rated as excellent in 16 (43%), good in 14 (38%), and fair in 7 (19%). CONCLUSIONS Our findings reveal that websites with information about immune checkpoint inhibitors mostly have general information about cancer, the treatments, and adverse events. Few websites provide information about the balance between harms and benefits of treatment, costs, the source of the information, or the hierarchy of evidence. These findings identify the gap in the quality and content of websites for patients treated with immune checkpoint inhibitors and can help website creators and developers.
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Affiliation(s)
- Juan Ignacio Ruiz
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Gagandeep Singh
- Division of Gastroenterology & Hepatology, Johns Hopkins University, Baltimore, MD, United States of America
| | - McKenna Erck
- Texas A&M University, College Station, TX, United States of America
| | - Yimin Geng
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Maria E. Suarez-Almazor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Maria A. Lopez-Olivo
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
- * E-mail:
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15
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Early Effects of Nivolumab and Ipilimumab Combined Immunotherapy in the Treatment of Metastatic Melanoma in Poland: A Multicenter Experience. Biomedicines 2022; 10:biomedicines10102528. [PMID: 36289790 PMCID: PMC9598919 DOI: 10.3390/biomedicines10102528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 11/24/2022] Open
Abstract
Nivolumab and ipilimumab combination became the first-line standard in advanced melanoma. We assessed its efficacy in a real-life study in Poland. In a one-year follow-up, we evaluated the medical records of 50 melanoma patients treated with that modality in five oncology centers. We recorded therapy outcomes and adverse events (AEs) after 3 and 12 months of therapy. At the first checkpoint, the disease control rate (DCR) was recorded in 58% (n = 29) of patients, but the same number of patients (n = 29, 58%) stopped immunotherapy due to disease progression (PD, n = 14, 48.3%), toxicity (n = 11, 37.9%) or death (n = 4, 13.8%). Among patients with DCR after the induction phase, 8 (27.6%) terminated due to toxicity, and 21 (72.4%) continued. However, at the 12-month checkpoint, only 14 patients (27% of all) were still receiving immunotherapy. In 7 (33.3%) it was discontinued due to PD (n = 2), toxicity (n = 2, 28.6% each), or death (n = 3, 42.9%). AEs occurred in 66.7% (n = 34) of patients; severe (grade 3 or 4) in half of them. Interestingly, those with AEs had an 80% lower risk of death (hazard ratio [HR] 0.2, 95% confidence interval [CI] 0.07−0.57, p = 0.001) and PD (HR 0.2, 95%CI 0.09−0.47, p < 0.0001). In the entire group of patients, after a 12-month follow-up, the median overall survival was not reached (NR, range: 6.8 months-NR) and progression-free survival was 6.3 (range: 3-NR) months. Our results demonstrate that combined immunotherapy is less effective in real-life than in pivotal trials. However, early responders will likely continue the therapy after a one-year follow-up. AEs occurrence might be a predictor of clinical effectiveness.
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16
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Pino PG, Moreo A, Lestuzzi C. Differential diagnosis of cardiac tumors: General consideration and echocardiographic approach. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1177-1193. [PMID: 36218203 PMCID: PMC9828386 DOI: 10.1002/jcu.23309] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
Cardiac tumors may be primary (either benign or malignant) or secondary (malignant) and are first detected by echocardiography in most cases. The cardiologist often challenges their identification, the differential diagnosis and the best therapeutic approach. Malignant tumors have usually a poor prognosis, which may be significantly improved by appropriate and timely therapies. The echocardiographic aspects of benign and malignant cardiac tumors described in this article, along with a clinical evaluation may orient the differential diagnosis and aid in choosing the further steps useful to define the nature of the mass.
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Affiliation(s)
- Paolo G. Pino
- Former Chief of Non Invasive Cardiovascular Diagnostics DepartmentOspedale San CamilloRomeItaly
| | - Antonella Moreo
- Cardiology IV, 'A.De Gasperis'DepartmentNiguarda Ca' Granda HospitalMilanItaly
| | - Chiara Lestuzzi
- Cardio‐oncological Rehabilitation Service, Azienda Sanitaria Friuli Occidentale (ASFO)c/o National Cancer Institute (CRO), IRCCSAvianoItaly
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17
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Pradeep J, Win TT, Aye SN, Sreeramareddy CT. Efficacy and Safety of Immune Checkpoint Inhibitors for Advanced Malignant Melanoma: A Meta-Analysis on Monotherapy Vs Combination Therapy. J Cancer 2022; 13:3091-3102. [PMID: 36046644 PMCID: PMC9414012 DOI: 10.7150/jca.72210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Immune checkpoint inhibitors (ICIs) are approved as cancer immunotherapeutic agents for advanced malignant melanoma (MM) in recent years, and nivolumab and ipilimumab are the most widely used ICIs either alone or in combination. However, their efficacy and safety between single and combined ICIs are not clear. This meta-analysis (MA) is aimed to update the efficacy and safety of ICIs by comparing monotherapy and combination therapy in the treatment of advanced MM. Method: We searched PubMed, Embase, EbscoHost and ClinicalTrials.gov for the eligible randomized controlled trials (RCTs) which compared the efficacy and safety of ICIs between a single ICI and combined ICIs. The outcomes analyzed included overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and treatment-related adverse events (AEs). A fixed-effect or random-effects model was adopted depending on the study heterogeneity. Results: A total of nine RCTs were included in this MA. Regarding the efficacy, combined nivolumab and ipilimumab therapy showed statistically significant prolonged OS and PFS with HR 0.65, 95% CI [0.53, 0.79], p <0.0001 and HR 0.48, 95% CI [0.38, 0.60], p<0.0001 respectively. Combination therapy with nivolumab and ipilimumab also showed statistically significant longer ORR than monotherapy; with RR 2.15, 95% CI [1.63, 2.84], p <0.00001. In terms of safety, the incidence of all AEs which include any AEs, high-grade, haematological, gastrointestinal, dermatological, pulmonary, liver and endocrine AEs were significantly lower with monotherapy (either nivolumab or ipilimumab) of ICI compared to combination ICI therapy with a p-value <0.00001 to 0.03. Conclusion: Efficacy of the combined nivolumab and ipilimumab was better than a single ICI, especially in the treatment of advanced MM. Although combination therapy showed better efficacy than monotherapy, monotherapy (either nivolumab or ipilimumab) was safer than combination therapy as it tended to decrease the incidence of most of the treatment-related AEs.
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Affiliation(s)
- Jnaneshwari Pradeep
- School of Medicine, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | - Thin Thin Win
- Pathology Department, School of Medicine, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | - Saint Nway Aye
- Pathology Department, School of Medicine, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | - Chandrashekhar T Sreeramareddy
- Community Medicine Department, School of Medicine, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
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18
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VEGF-A promotes the motility of human melanoma cells through the VEGFR1-PI3K/Akt signaling pathway. In Vitro Cell Dev Biol Anim 2022; 58:758-770. [PMID: 35997849 PMCID: PMC9550759 DOI: 10.1007/s11626-022-00717-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022]
Abstract
Vascular endothelial growth factor A (VEGF-A) and its receptors (VEGFR1 and R2) play important roles in the progression of malignant melanoma through tumor angiogenesis. However, it is not clear whether the VEGF-A/VEGFR1 signaling pathway is involved in the proliferation and migration of melanoma cells. Thus, the effect of VEGF-A on cell migration was investigated in human melanoma cell lines. Of several splicing variants of VEGF-A, VEGF165 is the most abundant and responsible for VEGF-A biological potency. VEGF165 facilitated the migration of melanoma cells in both a chemotactic and chemokinetic manner, but cell proliferation was not affected by VEGF165. VEGF165 also induced the phosphorylation of Akt. In addition, VEGF165-induced cell migration was inhibited significantly by VEGFR1/2 or a VEGFR1-neutralizing antibody. Furthermore, the downregulation of VEGFR1 via the transfection of VEGFR1-targeting antisense oligonucleotides suppressed VEGF165-induced cell migration. Moreover, wortmannin, an inhibitor of phosphatidylinositol-3 kinase (PI3K) in the PI3K/Akt pathway, suppressed VEGF165-induced Akt phosphorylation and VEGF165-induced cell migration. These findings suggest that the motility of melanoma cells is regulated by signals mediated through the PI3K/Akt kinase pathway with the activation of VEGFR1 tyrosine kinase by VEGF165. Thus, the downregulation of signaling via VEGF-A/VEGFR1 might be an effective therapeutic approach that could prevent the progression of malignant melanoma.
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19
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Radiation therapy for melanoma brain metastases: a systematic review. Radiol Oncol 2022; 56:267-284. [PMID: 35962952 PMCID: PMC9400437 DOI: 10.2478/raon-2022-0032] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/17/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Radiation therapy (RT) for melanoma brain metastases, delivered either as whole brain radiation therapy (WBRT) or as stereotactic radiosurgery (SRS), is an established component of treatment for this condition. However, evidence allowing comparison of the outcomes, advantages and disadvantages of the two RT modalities is scant, with very few randomised controlled trials having been conducted. This has led to considerable uncertainty and inconsistent guideline recommendations. The present systematic review identified 112 studies reporting outcomes for patients with melanoma brain metastases treated with RT. Three were randomised controlled trials but only one was of sufficient size to be considered informative. Most of the evidence was from non-randomised studies, either specific treatment series or disease cohorts. Criteria for determining treatment choice were reported in only 32 studies and the quality of these studies was variable. From the time of diagnosis of brain metastasis, the median survival after WBRT alone was 3.5 months (IQR 2.4-4.0 months) and for SRS alone it was 7.5 months (IQR 6.7-9.0 months). Overall patient survival increased over time (pre-1989 to 2015) but this was not apparent within specific treatment groups. CONCLUSIONS These survival estimates provide a baseline for determining the incremental benefits of recently introduced systemic treatments using targeted therapy or immunotherapy for melanoma brain metastases.
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20
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Hynes MC, Nguyen P, Groome PA, Asai Y, Mavor ME, Baetz TD, Hanna TP. A population-based validation study of the 8th edition UICC/AJCC TNM staging system for cutaneous melanoma. BMC Cancer 2022; 22:720. [PMID: 35778691 PMCID: PMC9248086 DOI: 10.1186/s12885-022-09781-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/15/2022] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The 8th edition UICC/AJCC TNM8 (Tumour, Nodes, Metastasis) melanoma staging system introduced several modifications from the 7th edition (TNM7), resulting in changes in survival and subgroup composition. We set out to address the limited validation of TNM8 (stages I-IV) in large population-based datasets. METHODS This retrospective cohort-study included 6,414 patients from the population-based Ontario Cancer Registry diagnosed with cutaneous melanoma between January 1, 2007 and December 31, 2012. Kaplan-Meier curves estimated the melanoma-specific survival (MSS) and overall survival (OS). Cox proportional hazard models were used to estimate adjusted hazard ratios for MSS and OS across stage groups. The Schemper-Henderson measure was used to assess the variance explained in the Cox regression. RESULTS In our sample, 21.3% of patients were reclassified with TNM8 from TNM7; reclassifications in stage II were uncommon, and 44.1% of patients in stage III were reclassified to a higher subgroup. Minimal changes in MSS curves were observed between editions, but the stage IIB curve decreased and the stage IIIC curve increased. For TNM8, Stage I (n = 4,556), II (n = 1,206), III (n = 598), and IV (n = 54) had an estimated 5-year MSS of 98.4%, 82.5%, 66.4%, and 14.4%, respectively. Within stage III, IIIA 5-year MSS was 91.7% while stage IIID was 23.5%. HRs indicated that TNM8 more evenly separates subgroups once adjusted for patient- and disease-characteristics. The variance in MSS explained by TNM7 and TNM8 is 18.9% and 19.7%, respectively. CONCLUSION TNM8 performed well in our sample, with more even separation of stage subgroups and a modest improvement in predictive ability compared to TNM7.
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Affiliation(s)
- Matthew C Hynes
- School of Medicine, Queen's University, Kingston, ON, Canada
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Paul Nguyen
- ICES Queen's, Queen's University, Kingston, ON, Canada
| | - Patti A Groome
- Division of Cancer Care and Epidemiology, Department of Public Health Sciences, Queen's Cancer Research Institute, Queen's University, 10 Stuart Street, 2nd Level, Kingston, ON, K7L 3N6, Canada
| | - Yuka Asai
- School of Medicine, Queen's University, Kingston, ON, Canada
- Division of Dermatology, Department of Medicine, School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Meaghan E Mavor
- Division of Cancer Care and Epidemiology, Department of Public Health Sciences, Queen's Cancer Research Institute, Queen's University, 10 Stuart Street, 2nd Level, Kingston, ON, K7L 3N6, Canada
| | - Tara D Baetz
- School of Medicine, Queen's University, Kingston, ON, Canada
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Timothy P Hanna
- School of Medicine, Queen's University, Kingston, ON, Canada.
- ICES Queen's, Queen's University, Kingston, ON, Canada.
- Division of Cancer Care and Epidemiology, Department of Public Health Sciences, Queen's Cancer Research Institute, Queen's University, 10 Stuart Street, 2nd Level, Kingston, ON, K7L 3N6, Canada.
- Department of Oncology, Queen's University, Kingston, ON, Canada.
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21
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Strang P. Palliative oncology and palliative care. Mol Oncol 2022; 16:3399-3409. [PMID: 35762045 PMCID: PMC9533690 DOI: 10.1002/1878-0261.13278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/23/2022] [Accepted: 06/25/2022] [Indexed: 12/02/2022] Open
Abstract
New therapeutic approaches can produce promising results even in severely ill cancer patients. But they also pose new challenges with respect to prognostication, as patients who were once not eligible for treatment, due to age or comorbidities, now are. Palliative oncology constitutes a major part of oncological care, with life prolongation and quality of life as its main goals. Palliative care specialists are experts in symptom control and psychosocial and existential support, and the integration of their expertise early on in patient care can prolong survival. In this article, I discuss the need to integrate specialist palliative care into early cancer treatment plans to achieve quality of life for patients. I also discuss the ways in which palliative care specialists balance the benefits of novel treatments against their adverse effects for patients, particularly for the elderly, the frail and those in advance stages of disease. I highlight the need to ensure equal access to palliative care to improve cancer patients' quality of life but also why futile, burdensome treatments should be avoided especially in the frail, elderly patients. Further, I discuss benefits and problems related to nutritional support in patients with cachexia and exemplify why translational research is needed to link basic research with clinical oncology and effective symptom control.
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Affiliation(s)
- Peter Strang
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm's Sjukhem Foundation, Stockholm, and R & D Department, Sweden
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22
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Reichrath J, Biersack F, Wagenpfeil S, Schöpe J, Pföhler C, Saternus R, Vogt T. Low Vitamin D Status Predicts Poor Clinical Outcome in Advanced Melanoma Treated With Immune Checkpoint or BRAF/MEK Inhibitors: A Prospective Non-Interventional Side-by-Side Analysis. Front Oncol 2022; 12:839816. [PMID: 35669434 PMCID: PMC9166268 DOI: 10.3389/fonc.2022.839816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/31/2022] [Indexed: 12/04/2022] Open
Abstract
In melanoma and other malignancies, low vitamin D status is associated with increased risk and poor prognosis. However, there are limited data of the impact of 25(OH)D serum concentration (s.c.) on clinical outcome in advanced melanoma. We tested the hypothesis that vitamin D status is predictive of efficacy and safety in patients treated for metastasized melanoma with B-rapidly accelerated fibrosarcoma (BRAF), mitogen-activated protein kinase kinase (MEK), cytotoxic T lymphocyte-associated protein-4 (CTLA-4), and/or programmed cell death protein-1 (PD-1) inhibitors. Severe vitamin D deficiency [defined as 25(OH)D s.c. <10 ng/ml] was associated with markedly reduced overall (OS) and progress-free (PFS) survival, with increased tumor load [TL; measured as s.c. of S100 protein or lactate dehydrogenase (LDH)], and with a trend for higher frequency of adverse events (AEs). An increase in average 25(OH)D s.c. of 1 ng/ml was associated with a 3.9% reduced risk for progressive disease [hazard ratio (HR) = 0.961, p = 0.044], with a reduction of LDH s.c. of 3.86 U/l (p = 0.034, indicating a reduction of TL), and with a trend for reduced frequency of AEs (AE ratio -0.005; p = 0.295). Patients with average 25(OH)D s.c. ≥10 ng/ml and BRAF-mutant melanoma showed a trend for a higher frequency of AEs as compared to individuals with BRAF wild-type melanomas. Our data indicate that vitamin D deficiency is associated with poor clinical outcome in patients treated for metastasized melanoma with BRAF/MEK inhibitors or immunotherapy. Although it needs to be proven in future interventional trials whether optimizing serum 25(OH)D improves clinical outcome in these patients, we recommend that 25(OH)D s.c. should be analyzed and vitamin D deficiency treated in all patients with advanced melanoma.
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Affiliation(s)
- Jörg Reichrath
- Department of Dermatology, Saarland University Medical Center, Homburg, Germany
| | - Florian Biersack
- Department of Dermatology, Saarland University Medical Center, Homburg, Germany
| | - Stefan Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, Homburg, Germany
| | - Jakob Schöpe
- Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, Homburg, Germany
| | - Claudia Pföhler
- Department of Dermatology, Saarland University Medical Center, Homburg, Germany
| | - Roman Saternus
- Department of Dermatology, Saarland University Medical Center, Homburg, Germany
| | - Thomas Vogt
- Department of Dermatology, Saarland University Medical Center, Homburg, Germany
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23
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Casalou C, Moreiras H, Mayatra JM, Fabre A, Tobin DJ. Loss of 'Epidermal Melanin Unit' Integrity in Human Skin During Melanoma-Genesis. Front Oncol 2022; 12:878336. [PMID: 35574390 PMCID: PMC9097079 DOI: 10.3389/fonc.2022.878336] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/09/2022] [Indexed: 12/13/2022] Open
Abstract
Cutaneous melanoma can be a most challenging neoplasm of high lethality, in part due to its extreme heterogeneity and characteristic aggressive and invasive nature. Indeed, its moniker 'the great masquerader' reflects that not all melanomas are created equal in terms of their originating cellular contexts, but also that melanoma cells in the malignant tumor can adopt a wide range of different cell states and variable organotropism. In this review, we focus on the early phases of melanomagenesis by discussing how the originating pigment cell of the melanocyte lineage can be influenced to embark on a wide range of tumor fates with distinctive microanatomical pathways. In particular, we assess how cells of the melanocyte lineage can differ by maturation status (stem cell; melanoblast; transiently amplifying cell; differentiated; post-mitotic; terminally-differentiated) as well as by micro-environmental niche (in the stratum basale of the epidermis; within skin appendages like hair follicle, eccrine gland, etc). We discuss how the above variable contexts may influence the susceptibility of the epidermal-melanin unit (EMU) to become unstable, which may presage cutaneous melanoma development. We also assess how unique features of follicular-melanin unit(s) (FMUs) can, by contrast, protect melanocytes from melanomagenesis. Lastly, we postulate how variable melanocyte fates in vitiligo, albinism, psoriasis, and alopecia areata may provide new insights into immune-/non immune-mediated outcomes for melanocytes in cutaneous melanin units.
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Affiliation(s)
- Cristina Casalou
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin, Ireland
| | - Hugo Moreiras
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin, Ireland
| | - Jay M Mayatra
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin, Ireland
| | - Aurelie Fabre
- Department of Histopathology, St Vincent's University Hospital, Dublin, Ireland.,UCD School of Medicine, University College Dublin, Dublin, Ireland.,The Conway Institute of Biomedical and Biomolecular Science, University College Dublin, Dublin, Ireland
| | - Desmond J Tobin
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin, Ireland.,The Conway Institute of Biomedical and Biomolecular Science, University College Dublin, Dublin, Ireland
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24
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Ji ZH, Ren WZ, Yang S, Wang DX, Jiang ZP, Lin C, Jin Y, Tian WT. Identification of immune-related biomarkers associated with tumorigenesis and prognosis in skin cutaneous melanoma. Am J Cancer Res 2022; 12:1727-1739. [PMID: 35530289 PMCID: PMC9077068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/17/2022] [Indexed: 06/14/2023] Open
Abstract
Skin cutaneous melanoma (SKCM) is one of the most malignant and aggressive forms of cancer. Investigating the mechanisms of carcinogenesis further could lead to the discovery of prognostic biomarkers that could be used to guide cancer treatment. In this study, we conducted integrative bioinformatics analyses of TCGA database, STRING, cBioPortal, TRRUST, The Human Protein Atlas, and DGIdb to determine which hub genes contributed to tumor progression and the cancer-associated immunology of SKCM. The results show that immune-related 873 differential genes grouped SKCM samples into subtypes. The initial results showed that the optimal number of clusters was two subgroups. Further analysis showed that there were significant differences in survival rate and immune infiltration level between the two subgroups. Subsequently, obtaining the different genes between groups, construct PPI to screen 6 hub genes (HLA-DPA1, HLA-DPB1, HLA-DQA1, HLA-DRA, HLA-DRB1, HLA-DRB5). In total, 6 MHC class II molecules were significantly related to overall survival. We then analyzed the expression of these genes along with their mutation landscapes, transcription factor regulation, and drug regulatory networks. In summary, our study identified 6 MHC class II molecules (HLA-DPA1, HLA-DPB1, HLA-DQA1, HLA-DRA, HLA-DRB1, HLA-DRB5) as important biomarkers in the occurrence and progression of SKCM tumors. Their expression levels are closely related to prognosis and immune infiltration and can help us better understand the tumorigenesis of SKCM.
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Affiliation(s)
- Zhong-Hao Ji
- Department of Hand and Foot Surgery, First Hospital Jilin UniversityChangchun, Jilin, China
- Department of Laboratory Animals, College of Animal Sciences, Jilin UniversityChangchun, Jilin, China
- Department of Basic Medicine, Changzhi Medical CollegeChangzhi 046000, Shanxi, China
| | - Wen-Zhi Ren
- Department of Laboratory Animals, College of Animal Sciences, Jilin UniversityChangchun, Jilin, China
| | - Shuo Yang
- Department of Laboratory Animals, College of Animal Sciences, Jilin UniversityChangchun, Jilin, China
| | - Dong-Xu Wang
- Department of Laboratory Animals, College of Animal Sciences, Jilin UniversityChangchun, Jilin, China
| | - Zi-Ping Jiang
- Department of Hand and Foot Surgery, First Hospital Jilin UniversityChangchun, Jilin, China
- Department of Laboratory Animals, College of Animal Sciences, Jilin UniversityChangchun, Jilin, China
| | - Chao Lin
- School of Grain Science and Technology, Jilin Business and Technology CollegeChangchun, China
| | - Ye Jin
- Department of Pharmacy, Changchun University of Chinese MedicineChangchun, China
| | - Wen-Tai Tian
- Department of Hand and Foot Surgery, First Hospital Jilin UniversityChangchun, Jilin, China
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25
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Follow-up of primary melanoma patients with high risk of recurrence: recommendations based on evidence and consensus. Clin Transl Oncol 2022; 24:1515-1523. [PMID: 35349041 DOI: 10.1007/s12094-022-02822-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/27/2022] [Indexed: 10/18/2022]
Abstract
In spite of the good prognosis of patients with early-stage melanoma, there is a substantial proportion of them that develop local or distant relapses. With the introduction of targeted and immune therapies for advanced melanoma, including at the adjuvant setting, early detection of recurrent melanoma and/or second primary lesions is crucial to improve clinical outcomes. However, there is a lack of universal guidelines regarding both frequency of surveillance visits and diagnostic imaging and/or laboratory evaluations. In this article, a multidisciplinary expert panel recommends, after careful review of relevant data in the field, a consensus- and experience-based follow-up strategy for melanoma patients, taking into account prognostic factors and biomarkers and the high-risk periods and patterns of recurrence in each (sub) stage of the disease. Apart from the surveillance intensity, healthcare professionals should focus on patients' education to perform regular self-examinations of the skin and palpation of lymph nodes.
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26
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da Silva GB, Yamauchi MA, Zanini D, Bagatini MD. Novel possibility for cutaneous melanoma treatment by means of rosmarinic acid action on purinergic signaling. Purinergic Signal 2022; 18:61-81. [PMID: 34741236 PMCID: PMC8570242 DOI: 10.1007/s11302-021-09821-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/12/2021] [Indexed: 12/14/2022] Open
Abstract
Cancer cases have increased significantly in Brazil and worldwide, with cutaneous melanoma (CM) being responsible for nearly 57,000 deaths in the world. Thus, this review article aims at exploring and proposed hypotheses with respect to the possibility that RA can be a promising and alternative compound to be used as an adjuvant in melanoma treatment, acting on purinergic signaling. The scarcity of articles evidencing the action of this compound in this signaling pathway requires further studies. Considering diverse evidence found in the literature, we hypothesize that RA can be an effective candidate for the treatment of CM acting as a modulating molecule of purinergic cellular pathway through P2X7 blocking, mitigating the Warburg effect, and as antagonic molecule of the P2Y12 receptor, reducing the formation of adhesive molecules that prevent adherence in tumor cells. In this way, our proposals for CM treatment based on targeting purinergic signaling permeate the integral practice, going from intracell to extracell. Undoubtedly, much is still to be discovered and elucidated about this promising compound, this paper being an interesting work baseline to support more research studies.
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Affiliation(s)
- Gilnei Bruno da Silva
- Graduate Program in Biomedical Sciences, Universidade Federal da Fronteira Sul, Fronteira Sul, Chapecó, SC, 89815-899, Brazil
| | - Milena Ayumi Yamauchi
- Graduate Program in Biomedical Sciences, Universidade Federal da Fronteira Sul, Fronteira Sul, Chapecó, SC, 89815-899, Brazil
| | - Daniela Zanini
- Graduate Program in Biomedical Sciences, Universidade Federal da Fronteira Sul, Fronteira Sul, Chapecó, SC, 89815-899, Brazil
| | - Margarete Dulce Bagatini
- Graduate Program in Biomedical Sciences, Universidade Federal da Fronteira Sul, Fronteira Sul, Chapecó, SC, 89815-899, Brazil.
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27
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Makunda N, Vallabhaneni S, Lefebvre B, Fradley MG. Cardiotoxicity of Systemic Melanoma Treatments. Curr Treat Options Oncol 2022; 23:240-253. [PMID: 35192138 DOI: 10.1007/s11864-021-00924-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 12/19/2022]
Abstract
OPINION STATEMENT Melanoma is the least common but most dangerous skin cancer, accounting for 75% of all deaths from a primary cutaneous malignancy, with incidence rates rising significantly over the last decade. Traditional treatments for melanoma including interferon and cytotoxic chemotherapy had marginal efficacy. With the advent of targeted and immunotherapies, the prognosis for patients with advanced melanoma has significantly improved including those with metastatic disease to the heart. BRAF and MEK inhibitors as well as immune checkpoint inhibitors have become front line therapy for eligible patients with metastatic melanoma and have led to long-term durable response and in some cases can be curative. Despite these oncologic advances, various treatment-limiting side effects can occur. In particular, cardiovascular toxicities can contribute to overall morbidity and mortality in these patients. Toxicities range from asymptomatic QT prolongation and mild LV dysfunction to fulminant myocarditis and potentially life-threatening arrhythmias. A multidisciplinary approach to the care of these patients which includes cardio-oncology evaluation is necessary to develop both risk mitigation and treatment strategies to ensure patients continue receiving necessary and effective melanoma treatments while minimizing long-term adverse cardiovascular effects.
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Affiliation(s)
- Neha Makunda
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Srilakshmi Vallabhaneni
- Cardio-Oncology Center of Excellence, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Benedicte Lefebvre
- Cardio-Oncology Center of Excellence, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Michael G Fradley
- Cardio-Oncology Center of Excellence, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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28
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An Easily Expandable Multi-Drug LC-MS Assay for the Simultaneous Quantification of 57 Oral Antitumor Drugs in Human Plasma. Cancers (Basel) 2021; 13:cancers13246329. [PMID: 34944950 PMCID: PMC8699473 DOI: 10.3390/cancers13246329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022] Open
Abstract
Simple Summary Oral antitumor therapy has significantly improved clinical outcomes in multiple tumor entities. However, following a standard dosing regime, strong interindividual variability in patients’ plasma concentrations can be observed for many oral antitumor drugs. This results in risks of reduced therapeutic effect and increased side effects. Monitoring these variable plasma concentrations is an important tool in evaluating multiple factors influencing drug exposure and, if necessary, adjusting therapeutic doses. Here, we developed a method for the simultaneous measurement of 57 oral antitumor drug plasma concentrations. Detection and quantification were achieved using liquid chromatography coupled to an Orbitrap mass spectrometer, which can be easily expanded to newly approved oral antitumor drugs in the future. Applicability of the method was proven by measuring 71 plasma samples from 39 patients undergoing oral antitumor therapy. In summary, the developed method provides an important tool for exposure measurements of oral antitumor drugs. Abstract Oral anticancer drugs have led to significant improvements in the treatment of multiple tumor entities. However, in patients undergoing oral antitumor therapy, plasma concentrations are highly variable, resulting in risks of reduced therapeutic effects or an increase in side effects. One important tool to reduce this variability is therapeutic drug monitoring. In this work we describe a method to simultaneously quantify the plasma concentrations of 57 oral antitumor agents. Quantification of these drugs was achieved using liquid chromatography coupled to an Orbitrap mass spectrometer. The method was fully validated according to the FDA guidelines and constitutes a simple and robust way for exposure monitoring of a wide variety of oral anticancer drugs. Applicability to clinical routine was demonstrated by the analysis of 71 plasma samples taken from 39 patients. In summary, this new multi-drug method allows simultaneous quantification of 57 oral antitumor drugs, which can be applied to exposure monitoring in clinical studies, taking into account the broad variety of oral antitumor drugs prescribed in clinical routine.
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29
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Harkemanne E, Duyver C, Leconte S, Bugli C, Thomas L, Baeck M, Tromme I. Melanoma Diagnostic Practices of French-Speaking Belgian General Practitioners and the Prospective Study of Their Pigmented Skin Lesion Diagnostic Accuracy and Management. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:1316-1324. [PMID: 32448923 DOI: 10.1007/s13187-020-01770-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
General practitioners (GPs) are among the main actors involved in early melanoma diagnosis. However, melanoma diagnostic accuracy and management are reported to be insufficient among GPs in Europe. The primary aim of this observational prospective study was to shed light on melanoma diagnostic practices among French-speaking Belgian GPs. The second aim was to specifically analyse these GPs' pigmented skin lesion diagnostic accuracy and management. GPs from the five French-speaking districts of Belgium were asked to complete a questionnaire, before taking part in a melanoma diagnostic training session. First, we assessed the GPs' current melanoma diagnostic practices. Then, their pigmented skin lesion diagnostic accuracy and management were evaluated, through basic theoretical questions and clinical images. These results were subsequently analysed, according to the GPs' sociodemographic characteristics and medical practice type. In total, 89 GPs completed the questionnaire. Almost half of the GPs (43%; CI = [33;54]) were confronted with a suspicious skin lesion as the main reason for consultation once every 3 months, while 33% (CI = [24;43]) were consulted for a suspicious lesion as a secondary reason once a month. Prior to training, one-third of the GPs exhibited suboptimal diagnostic accuracy in at least one of six "life-threatening" clinical cases among two sets of 10 clinical images of pigmented skin lesions, which can lead to inadequate patient management (i.e. incorrect treatment and/or inappropriate reinsurance). This study underlines the need to train GPs in melanoma diagnosis. GPs' pigmented skin lesion diagnostic accuracy and management should be improved to increase early melanoma detection.
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Affiliation(s)
- E Harkemanne
- Dermatology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium.
| | - C Duyver
- Centre Académique de Médecine Générale (CAMG), UCLouvain, Brussels, Belgium
| | - S Leconte
- Centre Académique de Médecine Générale (CAMG), UCLouvain, Brussels, Belgium
| | - C Bugli
- Statistical Methodology and Computing Service (SMCS), Louvain-la-Neuve, Belgium
| | - L Thomas
- Dermatology Department, Lyon Cancer Research Center INSERM, Université Lyon 1, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - M Baeck
- Dermatology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium
| | - I Tromme
- Dermatology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium
- King Albert II Cancer and Hematology Institute, Cliniques universitaires Saint-Luc, Brussels, Belgium
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30
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Amabile S, Roccuzzo G, Pala V, Tonella L, Rubatto M, Merli M, Fava P, Ribero S, Fierro MT, Queirolo P, Quaglino P. Clinical Significance of Distant Metastasis-Free Survival (DMFS) in Melanoma: A Narrative Review from Adjuvant Clinical Trials. J Clin Med 2021; 10:jcm10235475. [PMID: 34884176 PMCID: PMC8658595 DOI: 10.3390/jcm10235475] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/04/2021] [Accepted: 11/17/2021] [Indexed: 12/26/2022] Open
Abstract
Cutaneous melanoma is the most dangerous skin cancer, with high death rates in advanced stages. To assess the impact of each treatment on patient outcomes, most studies use relapse-free survival (RFS) as a primary endpoint and distant metastasis-free survival (DMFS) as a secondary endpoint. The aim of this narrative review of the main adjuvant studies for resected stage III/IV melanoma, with a specific focus on DMFS, is to evaluate DMFS trends and their potential association with RFS, identify which treatments are possibly associated with better outcomes in terms of DMFS and their potential predictive factors, and discuss DMFS trends in terms of patient management in daily practice. We outline the impact of each available treatment option on DMFS and RFS according to the years of follow-up and compare data from different studies. Overall, the trends of DMFS closely follow those of RFS, with most patients relapsing at visceral rather than regional sites. As it captures the burden of patients who develop distant relapse, DMFS could be considered a primary endpoint, in addition to RFS, in adjuvant trials, identifying patients whose relapse is associated with a worse prognosis and who may need further systemic treatment.
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Affiliation(s)
- Simone Amabile
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.A.); (V.P.); (L.T.); (M.R.); (M.M.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Gabriele Roccuzzo
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.A.); (V.P.); (L.T.); (M.R.); (M.M.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
- Correspondence: ; Tel.: +39-01-1633-5843
| | - Valentina Pala
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.A.); (V.P.); (L.T.); (M.R.); (M.M.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Luca Tonella
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.A.); (V.P.); (L.T.); (M.R.); (M.M.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Marco Rubatto
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.A.); (V.P.); (L.T.); (M.R.); (M.M.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Martina Merli
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.A.); (V.P.); (L.T.); (M.R.); (M.M.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Paolo Fava
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.A.); (V.P.); (L.T.); (M.R.); (M.M.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Simone Ribero
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.A.); (V.P.); (L.T.); (M.R.); (M.M.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Maria Teresa Fierro
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.A.); (V.P.); (L.T.); (M.R.); (M.M.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Paola Queirolo
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, European Institute of Oncology (IEO), European Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy;
| | - Pietro Quaglino
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.A.); (V.P.); (L.T.); (M.R.); (M.M.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
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31
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Schnog JJB, Samson MJ, Gans ROB, Duits AJ. An urgent call to raise the bar in oncology. Br J Cancer 2021; 125:1477-1485. [PMID: 34400802 PMCID: PMC8365561 DOI: 10.1038/s41416-021-01495-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 06/09/2021] [Accepted: 07/09/2021] [Indexed: 02/07/2023] Open
Abstract
Important breakthroughs in medical treatments have improved outcomes for patients suffering from several types of cancer. However, many oncological treatments approved by regulatory agencies are of low value and do not contribute significantly to cancer mortality reduction, but lead to unrealistic patient expectations and push even affluent societies to unsustainable health care costs. Several factors that contribute to approvals of low-value oncology treatments are addressed, including issues with clinical trials, bias in reporting, regulatory agency shortcomings and drug pricing. With the COVID-19 pandemic enforcing the elimination of low-value interventions in all fields of medicine, efforts should urgently be made by all involved in cancer care to select only high-value and sustainable interventions. Transformation of medical education, improvement in clinical trial design, quality, conduct and reporting, strict adherence to scientific norms by regulatory agencies and use of value-based scales can all contribute to raising the bar for oncology drug approvals and influence drug pricing and availability.
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Affiliation(s)
- John-John B. Schnog
- Department of Hematology-Medical Oncology, Curaçao Medical Center, Willemstad, Curaçao ,Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
| | - Michael J. Samson
- Department of Radiation Oncology, Curaçao Medical Center, Willemstad, Curaçao
| | - Rijk O. B. Gans
- grid.4494.d0000 0000 9558 4598Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ashley J. Duits
- Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao ,grid.4494.d0000 0000 9558 4598Institute for Medical Education, University Medical Center Groningen, Groningen, The Netherlands ,Red Cross Blood Bank Foundation, Willemstad, Curaçao
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Fink M, Vittrup AS, Bastholt L, Svane IM, Donia M, Luczak AA, Ruhlmann CH, Guldbrandt LM, Koehler UH, Winther ML, Ellebaek E, Haslund CA, Schmidt H. Comparison of Efficacy in Patients with Metastatic Melanoma Treated with Ipilimumab and Nivolumab Who Did or Did Not Discontinue Treatment Due to Immune-Related Adverse Events: A Real-World Data Study. Cancers (Basel) 2021; 13:cancers13215550. [PMID: 34771712 PMCID: PMC8583558 DOI: 10.3390/cancers13215550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 01/02/2023] Open
Abstract
Simple Summary This retrospective study of real-world patients with metastatic melanoma shows that discontinuing treatment with combination immunotherapy due to adverse events does not result in a poorer outcome compared to patients that did not discontinue due to toxicity. This is important knowledge for clinicians and patients, as discontinuing treatment may cause great anxiety for patients because they believe that it may limit the response. Abstract Immune-related adverse events (irAEs) are very prevalent when treating patients with ipilimumab and nivolumab in combination, and 30–40% of patients discontinue the treatment for this reason. It is of high clinical relevance to investigate the consequences of discontinuing the treatment early since combination therapy with ipilimumab and nivolumab is the first line of treatment for many patients with metastatic melanoma. In this follow-up study, with real-world data from the nationwide DAMMED database, we investigated whether there was a difference in progression-free survival (PFS) and overall survival (OS) for patients who discontinued or did not discontinue treatment within the first four doses of treatment due to irAEs. In total, 448 patients were treated with ipilimumab and nivolumab. Of these, 133 patients discontinued due to irAEs in the induction phase. Using the Cox proportional hazards model, there was no significant difference in PFS when comparing the group that discontinued with the group that did not discontinue. The group that discontinued had a significantly longer OS than the group that received the full length of treatment. Therefore, we conclude that there is no significant negative impact on efficacy for patients who discontinue due to irAEs in the induction phase of combination immunotherapy for metastatic melanoma.
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Affiliation(s)
- Morten Fink
- Department of Oncology, Aarhus University Hospital, 8200 Aarhus, Denmark; (A.S.V.); (L.M.G.); (U.H.K.); (H.S.)
- Correspondence: or
| | - Anders Schwartz Vittrup
- Department of Oncology, Aarhus University Hospital, 8200 Aarhus, Denmark; (A.S.V.); (L.M.G.); (U.H.K.); (H.S.)
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, 5000 Odense, Denmark; (L.B.); (M.L.W.)
| | - Inge Marie Svane
- National Center for Cancer Immuno Therapy, CCIT-DK, Department of Oncology, Copenhagen University Hospital, 2730 Herlev, Denmark; (I.M.S.); (M.D.); (E.E.)
| | - Marco Donia
- National Center for Cancer Immuno Therapy, CCIT-DK, Department of Oncology, Copenhagen University Hospital, 2730 Herlev, Denmark; (I.M.S.); (M.D.); (E.E.)
| | - Adam A. Luczak
- Department of Oncology, Aalborg University Hospital, 9100 Aalborg, Denmark; (A.A.L.); (C.A.H.)
| | - Christina H. Ruhlmann
- Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark;
| | - Louise Mahncke Guldbrandt
- Department of Oncology, Aarhus University Hospital, 8200 Aarhus, Denmark; (A.S.V.); (L.M.G.); (U.H.K.); (H.S.)
| | - Ulrich Heide Koehler
- Department of Oncology, Aarhus University Hospital, 8200 Aarhus, Denmark; (A.S.V.); (L.M.G.); (U.H.K.); (H.S.)
| | - Mette Lerche Winther
- Department of Oncology, Odense University Hospital, 5000 Odense, Denmark; (L.B.); (M.L.W.)
| | - Eva Ellebaek
- National Center for Cancer Immuno Therapy, CCIT-DK, Department of Oncology, Copenhagen University Hospital, 2730 Herlev, Denmark; (I.M.S.); (M.D.); (E.E.)
| | | | - Henrik Schmidt
- Department of Oncology, Aarhus University Hospital, 8200 Aarhus, Denmark; (A.S.V.); (L.M.G.); (U.H.K.); (H.S.)
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Carbon ion radiotherapy boosts anti-tumour immune responses by inhibiting myeloid-derived suppressor cells in melanoma-bearing mice. Cell Death Discov 2021; 7:332. [PMID: 34732697 PMCID: PMC8566527 DOI: 10.1038/s41420-021-00731-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 01/02/2023] Open
Abstract
Numerous studies have shown that carbon ion radiotherapy (CIRT) induces anti-cancer immune responses in melanoma patients, yet the mechanism remains elusive. The abundance of myeloid-derived suppressor cells (MDSC) in the tumour microenvironment is associated with therapeutic efficacy and disease outcome. This study analysed the changes in the immune contexture in response to the carbon ion treatment. The murine melanoma B16, MelanA, and S91 tumour models were established in syngeneic immunocompetent mice. Then, the tumours were irradiated with carbon ion beams, and flow cytometry was utilised to observe the immune contexture changes in the bone marrow, peripheral blood, spleen, and tumours. The immune infiltrates in the tumour tissues were further assessed using haematoxylin/eosin staining and immunohistochemistry. The immunoblot detected the expression of proteins associated with the JAK/STAT signalling pathway. The secretion of immune-related cytokines was examined using ELISA. Compared to conventional radiotherapy, particle beams have distinct advantages in cancer therapy. Here, the use of carbon ion beams (5 GyE) for melanoma-bearing mice was found to reduce the population of MDSC in the bone marrow, peripheral blood, and spleen of the animals via a JAK2/STAT3-dependent mechanism. The percentage of CD3+, CD4+, CD8+ T cells, macrophages, and natural killer cells increased after radiation, resulting in reduced tumour growth and prolonged overall survival in the three different mouse models of melanoma. This study, therefore, substantiated that CIRT boosts anti-tumour immune responses via the inhibition of MDSC.
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Hamp A, Anderson J, Sivesind TE, Szeto MD, Hadjinicolaou A. From the Cochrane Library: Systemic Treatments for Metastatic Cutaneous Melanoma. JMIR DERMATOLOGY 2021; 4:e30270. [PMID: 37632820 PMCID: PMC10334959 DOI: 10.2196/30270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/23/2021] [Accepted: 09/12/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Austin Hamp
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, United States
| | - Jarett Anderson
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, United States
| | - Torunn E Sivesind
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Mindy D Szeto
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Andreas Hadjinicolaou
- Human Immunology Unit, Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
- Medical Research Council Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
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Ma J, Han W, Lu K. Comprehensive Pan-Cancer Analysis and the Regulatory Mechanism of ASF1B, a Gene Associated With Thyroid Cancer Prognosis in the Tumor Micro-Environment. Front Oncol 2021; 11:711756. [PMID: 34490109 PMCID: PMC8417739 DOI: 10.3389/fonc.2021.711756] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/23/2021] [Indexed: 12/24/2022] Open
Abstract
Background The incidence of thyroid cancer, whose local recurrence and metastasis lead to death, has always been high and the pathogenesis of papillary thyroid carcinoma (PTC) has not been clearly elucidated. Therefore, the research for more accurate prognosis-related predictive biomarkers is imminent, and a key gene can often be a prognostic marker for multiple tumors. Methods Gene expression profiles of various cancers in the TCGA and GTEx databases were downloaded, and genes significantly associated with the prognosis of THCA were identified by combining differential analysis with survival analysis. Then, a series of bioinformatics tools and methods were used to analyze the expression of the gene in each cancer and the correlation of each expression with prognosis, tumor immune microenvironment, immune neoantigens, immune checkpoints, DNA repair genes, and methyltransferases respectively. The possible biological mechanisms were also investigated by GSEA enrichment analysis. Results 656 differentially expressed genes were identified from two datasets and 960 DEGs that were associated with disease-free survival in THCA patients were screened via survival analysis. The former and the latter were crossed to obtain 7 key genes, and the gene with the highest risk factor, ASF1B, was selected for this study. Differential analysis of multiple databases showed that ASF1B was commonly and highly expressed in pan-cancer. Survival analysis showed that high ASF1B expression was significantly associated with poor patient prognosis in multiple cancers. In addition, ASF1B expression levels were found to be associated with tumor immune infiltration in THCA, KIRC, LGG, and LIHC, and with tumor microenvironment in BRCA, LUSC, STAD, UCEC, and KIRC. Further analysis of the relationship between ASF1B expression and immune checker gene expression suggested that ASF1B may regulate tumor immune patterns in most tumors by regulating the expression levels of specific immune checker genes. Finally, GSEA enrichment analysis showed that ASF1B high expression was mainly enriched in cell cycle, MTORC1 signaling system, E2F targets, and G2M checkpoints pathways. Conclusions ASF1B may be an independent prognostic marker for predicting the prognosis of THCA patients. The pan-cancer analysis suggested that ASF1B may play an important role in the tumor micro-environment and tumor immunity and it has the potential of serving as a predictive biomarker for multiple cancers.
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Affiliation(s)
- Jing Ma
- Department of Thyroid and Breast Surgery, Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Nanjing, China
| | - Wei Han
- Department of Thyroid and Breast Surgery, Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Nanjing, China
| | - Kai Lu
- Department of Thyroid and Breast Surgery, Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Nanjing, China
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Antonsen KW, Hviid CVB, Hagensen MK, Sørensen BS, Møller HJ. Soluble PD-1 (sPD-1) is expressed in human macrophages. Cell Immunol 2021; 369:104435. [PMID: 34482260 DOI: 10.1016/j.cellimm.2021.104435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/17/2021] [Accepted: 08/25/2021] [Indexed: 01/01/2023]
Abstract
The PD-1/PD-L1 axis plays a crucial role in regulating the anti-tumour immune response. A soluble PD-1 protein (sPD-1) has previously been observed, which could block the binding of PD-L1 to PD-1. Tumour associated macrophages are abundant in tumours, and evidence suggest they express PD-1. However, whether they also express sPD-1 remains unclear. The objective of this study was to investigate expression of sPD-1 in two in vitro models of human macrophages: THP-1 cells and monocyte-derived macrophages (MDM). Cells were polarised with either LPS + IFN-γ or IL-4 + IL-13 or left unpolarised. PD-1 and sPD-1 mRNAs were measured using droplet digital PCR, sPD-1 protein by electrochemiluminescence immunoassay and PD-1 by flow cytometry. sPD-1 mRNA was induced in both THP-1 cells and MDM after polarisation with LPS + IFN-γ, while IL-4 + IL-13 induced sPD-1 mRNA in MDM only. sPD-1 protein was measurable in culture supernatants. These findings show that macrophages can be induced to express sPD-1.
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Affiliation(s)
- Kristian W Antonsen
- Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Claus V B Hviid
- Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Mette K Hagensen
- Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Boe S Sørensen
- Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Holger J Møller
- Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
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Wohlmuth C, Wohlmuth-Wieser I. Vulvar Melanoma: Molecular Characteristics, Diagnosis, Surgical Management, and Medical Treatment. Am J Clin Dermatol 2021; 22:639-651. [PMID: 34125416 PMCID: PMC8421300 DOI: 10.1007/s40257-021-00614-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 12/13/2022]
Abstract
Ten percent of all women have pigmented vulvar lesions. Fortunately, most of these are benign but 1% of all melanomas in women affect the vulva. While the mortality rate of cutaneous melanoma has dropped by 7% annually during the last 5 years, the prognosis of vulvar melanoma remains dismal: the 5-year overall survival rate is 47% compared with 92% for cutaneous melanoma. The current evidence suggests that this likely results from a combination of delayed diagnosis and different tumor biology, treatment strategies, and treatment response. Although many landmark trials on checkpoint inhibitors included mucosal and vulvar melanomas, the results were often not reported separately. Post-hoc analyses indicate overall response rates between 19 and 37% for checkpoint inhibitors. A recently published retrospective study on vulvar melanomas suggests an objective response in 33.3% with a similar safety profile to cutaneous melanoma. Tyrosine kinase inhibitors may be considered in recurrent disease if a c-KIT mutation is present.
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Affiliation(s)
- Christoph Wohlmuth
- Department of Obstetrics and Gynecology, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.
| | - Iris Wohlmuth-Wieser
- Department of Dermatology and Allergology, Paracelsus Medical University, Salzburg, Austria
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Teixeira LR, Pega F, Dzhambov AM, Bortkiewicz A, da Silva DTC, de Andrade CAF, Gadzicka E, Hadkhale K, Iavicoli S, Martínez-Silveira MS, Pawlaczyk-Łuszczyńska M, Rondinone BM, Siedlecka J, Valenti A, Gagliardi D. The effect of occupational exposure to noise on ischaemic heart disease, stroke and hypertension: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-Related Burden of Disease and Injury. ENVIRONMENT INTERNATIONAL 2021; 154:106387. [PMID: 33612311 PMCID: PMC8204276 DOI: 10.1016/j.envint.2021.106387] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 12/24/2020] [Accepted: 01/07/2021] [Indexed: 05/21/2023]
Abstract
BACKGROUND The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large number of individual experts. Evidence from mechanistic data suggests that occupational exposure to noise may cause cardiovascular disease (CVD). In this paper, we present a systematic review and meta-analysis of parameters for estimating the number of deaths and disability-adjusted life years from CVD that are attributable to occupational exposure to noise, for the development of the WHO/ILO Joint Estimates. OBJECTIVES We aimed to systematically review and meta-analyse estimates of the effect of any (high) occupational exposure to noise (≥85 dBA), compared with no (low) occupational exposure to noise (<85 dBA), on the prevalence, incidence and mortality of ischaemic heart disease (IHD), stroke, and hypertension. DATA SOURCES A protocol was developed and published, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic academic databases for potentially relevant records from published and unpublished studies up to 1 April 2019, including International Trials Register, Ovid MEDLINE, PubMed, Embase, Lilacs, Scopus, Web of Science, and CISDOC. The MEDLINE and Pubmed searches were updated on 31 January 2020. We also searched grey literature databases, Internet search engines and organizational websites; hand-searched reference lists of previous systematic reviews and included study records; and consulted additional experts. STUDY ELIGIBILITY AND CRITERIA We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (<15 years) and unpaid domestic workers. We included randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the effect of any occupational exposure to noise on CVD prevalence, incidence or mortality, compared with the theoretical minimum risk exposure level (<85 dBA). STUDY APPRAISAL AND SYNTHESIS METHODS At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. We prioritized evidence from cohort studies and combined relative risk estimates using random-effect meta-analysis. To assess the robustness of findings, we conducted sensitivity analyses (leave-one-out meta-analysis and used as alternative fixed effects and inverse-variance heterogeneity estimators). At least two review authors assessed the risk of bias, quality of evidence and strength of evidence, using Navigation Guide tools and approaches adapted to this project. RESULTS Seventeen studies (11 cohort studies, six case-control studies) met the inclusion criteria, comprising a total of 534,688 participants (39,947 or 7.47% females) in 11 countries in three WHO regions (the Americas, Europe, and the Western Pacific). The exposure was generally assessed with dosimetry, sound level meter and/or official or company records. The outcome was most commonly assessed using health records. We are very uncertain (low quality of evidence) about the effect of occupational exposure to noise (≥85 dBA), compared with no occupational exposure to noise (<85 dBA), on: having IHD (0 studies); acquiring IHD (relative risk (RR) 1.29, 95% confidence interval (95% CI) 1.15 to 1.43, two studies, 11,758 participants, I2 0%); dying from IHD (RR 1.03, 95% CI 0.93-1.14, four studies, 198,926 participants, I2 26%); having stroke (0 studies); acquiring stroke (RR 1.11, 95% CI 0.82-1.65, two studies, 170,000 participants, I2 0%); dying from stroke (RR 1.02, 95% CI 0.93-1.12, three studies, 195,539 participants, I2 0%); having hypertension (0 studies); acquiring hypertension (RR 1.07, 95% CI 0.90-1.28, three studies, four estimates, 147,820 participants, I2 52%); and dying from hypertension (0 studies). Data for subgroup analyses were missing. Sensitivity analyses supported the main analyses. CONCLUSIONS For acquiring IHD, we judged the existing body of evidence from human data to provide "limited evidence of harmfulness"; a positive relationship is observed between exposure and outcome where chance, bias, and confounding cannot be ruled out with reasonable confidence. For all other included outcomes, the bodies of evidence were judged as "inadequate evidence of harmfulness". Producing estimates for the burden of CVD attributable to occupational exposure to noise appears to not be evidence-based at this time. PROTOCOL IDENTIFIER 10.1016/j.envint.2018.09.040. PROSPERO REGISTRATION NUMBER CRD42018092272.
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Affiliation(s)
- Liliane R Teixeira
- Workers' Health and Human Ecology Research Center, National School of Public Health Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
| | - Frank Pega
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland.
| | - Angel M Dzhambov
- Department of Hygiene, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria; Institute for Highway Engineering and Transport Planning, Graz University of Technology, Graz, Austria.
| | - Alicja Bortkiewicz
- Department of Work Physiology and Ergonomics, Nofer Institute of Occupational Medicine, Lodz, Poland.
| | - Denise T Correa da Silva
- Workers' Health and Human Ecology Research Center, National School of Public Health Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
| | - Carlos A F de Andrade
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil; School of Medicine, Universidade de Vassouras, Vassouras, RJ, Brazil.
| | - Elzbieta Gadzicka
- Department of Work Physiology and Ergonomics, Nofer Institute of Occupational Medicine, Lodz, Poland.
| | - Kishor Hadkhale
- Faculty of Social Sciences, University of Tampere, Tampere, Finland.
| | - Sergio Iavicoli
- Inail, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Monte Porzio Catone, Rome, Italy.
| | | | | | - Bruna M Rondinone
- Inail, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Monte Porzio Catone, Rome, Italy.
| | - Jadwiga Siedlecka
- Department of Work Physiology and Ergonomics, Nofer Institute of Occupational Medicine, Lodz, Poland.
| | - Antonio Valenti
- Inail, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Monte Porzio Catone, Rome, Italy.
| | - Diana Gagliardi
- Inail, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Monte Porzio Catone, Rome, Italy.
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Vukadin S, Khaznadar F, Kizivat T, Vcev A, Smolic M. Molecular Mechanisms of Resistance to Immune Checkpoint Inhibitors in Melanoma Treatment: An Update. Biomedicines 2021; 9:biomedicines9070835. [PMID: 34356899 PMCID: PMC8301472 DOI: 10.3390/biomedicines9070835] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/22/2021] [Accepted: 07/14/2021] [Indexed: 12/12/2022] Open
Abstract
Over the past decade, immune checkpoint inhibitors (ICI) have revolutionized the treatment of advanced melanoma and ensured significant improvement in overall survival versus chemotherapy. ICI or targeted therapy are now the first line treatment in advanced melanoma, depending on the tumor v-raf murine sarcoma viral oncogene homolog B1 (BRAF) mutational status. While these new approaches have changed the outcomes for many patients, a significant proportion of them still experience lack of response, known as primary resistance. Mechanisms of primary drug resistance are not fully elucidated. However, many alterations have been found in ICI-resistant melanomas and possibly contribute to that outcome. Furthermore, some tumors which initially responded to ICI treatment ultimately developed mechanisms of acquired resistance and subsequent tumor progression. In this review, we give an overview of tumor primary and acquired resistance mechanisms to ICI and discuss future perspectives with regards to new molecular targets and combinatorial therapies.
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Affiliation(s)
- Sonja Vukadin
- Department of Pharmacology and Biochemistry, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (S.V.); (F.K.)
- Department of Pharmacology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Farah Khaznadar
- Department of Pharmacology and Biochemistry, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (S.V.); (F.K.)
| | - Tomislav Kizivat
- Clinical Institute of Nuclear Medicine and Radiation Protection, University Hospital Osijek, 31000 Osijek, Croatia;
- Department of Nuclear Medicine and Oncology, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Aleksandar Vcev
- Department of Pathophysiology, Physiology and Immunology, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia;
- Department of Pathophysiology, Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Internal Medicine, University Hospital Osijek, 31000 Osijek, Croatia
| | - Martina Smolic
- Department of Pharmacology and Biochemistry, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (S.V.); (F.K.)
- Department of Pharmacology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Correspondence:
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Betancourt LH, Gil J, Sanchez A, Doma V, Kuras M, Murillo JR, Velasquez E, Çakır U, Kim Y, Sugihara Y, Parada IP, Szeitz B, Appelqvist R, Wieslander E, Welinder C, de Almeida NP, Woldmar N, Marko‐Varga M, Eriksson J, Pawłowski K, Baldetorp B, Ingvar C, Olsson H, Lundgren L, Lindberg H, Oskolas H, Lee B, Berge E, Sjögren M, Eriksson C, Kim D, Kwon HJ, Knudsen B, Rezeli M, Malm J, Hong R, Horvath P, Szász AM, Tímár J, Kárpáti S, Horvatovich P, Miliotis T, Nishimura T, Kato H, Steinfelder E, Oppermann M, Miller K, Florindi F, Zhou Q, Domont GB, Pizzatti L, Nogueira FCS, Szadai L, Németh IB, Ekedahl H, Fenyö D, Marko‐Varga G. The Human Melanoma Proteome Atlas-Complementing the melanoma transcriptome. Clin Transl Med 2021; 11:e451. [PMID: 34323402 PMCID: PMC8299047 DOI: 10.1002/ctm2.451] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 12/12/2022] Open
Abstract
The MM500 meta-study aims to establish a knowledge basis of the tumor proteome to serve as a complement to genome and transcriptome studies. Somatic mutations and their effect on the transcriptome have been extensively characterized in melanoma. However, the effects of these genetic changes on the proteomic landscape and the impact on cellular processes in melanoma remain poorly understood. In this study, the quantitative mass-spectrometry-based proteomic analysis is interfaced with pathological tumor characterization, and associated with clinical data. The melanoma proteome landscape, obtained by the analysis of 505 well-annotated melanoma tumor samples, is defined based on almost 16 000 proteins, including mutated proteoforms of driver genes. More than 50 million MS/MS spectra were analyzed, resulting in approximately 13,6 million peptide spectrum matches (PSMs). Altogether 13 176 protein-coding genes, represented by 366 172 peptides, in addition to 52 000 phosphorylation sites, and 4 400 acetylation sites were successfully annotated. This data covers 65% and 74% of the predicted and identified human proteome, respectively. A high degree of correlation (Pearson, up to 0.54) with the melanoma transcriptome of the TCGA repository, with an overlap of 12 751 gene products, was found. Mapping of the expressed proteins with quantitation, spatiotemporal localization, mutations, splice isoforms, and PTM variants was proven not to be predicted by genome sequencing alone. The melanoma tumor molecular map was complemented by analysis of blood protein expression, including data on proteins regulated after immunotherapy. By adding these key proteomic pillars, the MM500 study expands the knowledge on melanoma disease.
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Martel A, Lassalle S, Picard-Gauci A, Gastaud L, Montaudie H, Bertolotto C, Nahon-Esteve S, Poissonnet G, Hofman P, Baillif S. New Targeted Therapies and Immunotherapies for Locally Advanced Periocular Malignant Tumours: Towards a New 'Eye-Sparing' Paradigm? Cancers (Basel) 2021; 13:2822. [PMID: 34198863 PMCID: PMC8201354 DOI: 10.3390/cancers13112822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 12/26/2022] Open
Abstract
The management of periocular skin malignant tumours is challenging. Surgery remains the mainstay of treatment for localised eyelid cancers. For more locally advanced cancers, especially those invading the orbit, orbital exenteration has long been considered the gold standard; however, it is a highly disfiguring and traumatic surgery. The last two decades have been marked by the emergence of a new paradigm shift towards the use of 'eye-sparing' strategies. In the early 2000s, the first step consisted of performing wide conservative eyelid and orbital excisions. Multiple flaps and grafts were needed, as well as adjuvant radiotherapy in selected cases. Although being incredibly attractive, several limitations such as the inability to treat the more posteriorly located orbital lesions, as well as unbearable diplopia, eye pain and even secondary eye loss were identified. Therefore, surgeons should distinguish 'eye-sparing' from 'sight-sparing' strategies. The second step emerged over the last decade and was based on the development of targeted therapies and immunotherapies. Their advantages include their potential ability to treat almost all tumours, regardless of their locations, without performing complex surgeries. However, several limitations have been reported, including their side effects, the appearance of primary or secondary resistances, their price and the lack of consensus on treatment regimen and exact duration. The aim of this article was to review the evolution of the management of locally advanced periocular malignant tumours over the last three decades and highlight the new paradigm shift towards the use of 'eye-sparing' strategies.
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Affiliation(s)
- Arnaud Martel
- Department of Ophthalmology, University Hospital of Nice, Cote d’Azur University, 06000 Nice, France; (S.N.-E.); (S.B.)
- FHU OncoAge, Institute for Research on Cancer and Aging, Nice (IRCAN), Cote d’Azur University, 06000 Nice, France; (S.L.); (P.H.)
| | - Sandra Lassalle
- FHU OncoAge, Institute for Research on Cancer and Aging, Nice (IRCAN), Cote d’Azur University, 06000 Nice, France; (S.L.); (P.H.)
- Biobank BB-0033-00025, FHU OncoAge, IRCAN, Laboratory of Clinical and Experimental Pathology, University Hospital of Nice, 06000 Nice, France
| | - Alexandra Picard-Gauci
- Department of Dermatology, Archet 2 Hospital, 151 Route de Saint-Antoine, 06200 Nice, France; (A.P.-G.); (H.M.)
| | - Lauris Gastaud
- Department of Oncology, Antoine Lacassagne Cancer Centre, 06000 Nice, France;
| | - Henri Montaudie
- Department of Dermatology, Archet 2 Hospital, 151 Route de Saint-Antoine, 06200 Nice, France; (A.P.-G.); (H.M.)
| | - Corine Bertolotto
- Department of Biology and Pathologies of Melanocytes, Team1, Equipe Labellisée Ligue 2020 and Equipe Labellisée ARC 2019, Centre Méditerranéen de Médecine Moléculaire, Inserm, 06200 Nice, France;
| | - Sacha Nahon-Esteve
- Department of Ophthalmology, University Hospital of Nice, Cote d’Azur University, 06000 Nice, France; (S.N.-E.); (S.B.)
| | - Gilles Poissonnet
- Cervicofacial Surgery Department, Antoine Lacassagne Cancer Centre, 06000 Nice, France;
| | - Paul Hofman
- FHU OncoAge, Institute for Research on Cancer and Aging, Nice (IRCAN), Cote d’Azur University, 06000 Nice, France; (S.L.); (P.H.)
- Biobank BB-0033-00025, FHU OncoAge, IRCAN, Laboratory of Clinical and Experimental Pathology, University Hospital of Nice, 06000 Nice, France
| | - Stephanie Baillif
- Department of Ophthalmology, University Hospital of Nice, Cote d’Azur University, 06000 Nice, France; (S.N.-E.); (S.B.)
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van Poppelen NM, van Ipenburg JA, van den Bosch Q, Vaarwater J, Brands T, Eussen B, Magielsen F, Dubbink HJ, Paridaens D, Brosens E, Naus N, de Klein A, Kiliç E, Verdijk RM. Molecular Genetics of Conjunctival Melanoma and Prognostic Value of TERT Promoter Mutation Analysis. Int J Mol Sci 2021; 22:ijms22115784. [PMID: 34071371 PMCID: PMC8198138 DOI: 10.3390/ijms22115784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 12/16/2022] Open
Abstract
The aim of this study was exploration of the genetic background of conjunctival melanoma (CM) and correlation with recurrent and metastatic disease. Twenty-eight CM from the Rotterdam Ocular Melanoma Study group were collected and DNA was isolated from the formalin-fixed paraffin embedded tissue. Targeted next-generation sequencing was performed using a panel covering GNAQ, GNA11, EIF1AX, BAP1, BRAF, NRAS, c-KIT, PTEN, SF3B1, and TERT genes. Recurrences and metastasis were present in eight (29%) and nine (32%) CM cases, respectively. TERT promoter mutations were most common (54%), but BRAF (46%), NRAS (21%), BAP1 (18%), PTEN (14%), c-KIT (7%), and SF3B1 (4%) mutations were also observed. No mutations in GNAQ, GNA11, and EIF1AX were found. None of the mutations was significantly associated with recurrent disease. Presence of a TERT promoter mutation was associated with metastatic disease (p-value = 0.008). Based on our molecular findings, CM comprises a separate entity within melanoma, although there are overlapping molecular features with uveal melanoma, such as the presence of BAP1 and SF3B1 mutations. This warrants careful interpretation of molecular data, in the light of clinical findings. About three quarter of CM contain drug-targetable mutations, and TERT promoter mutations are correlated to metastatic disease in CM.
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Affiliation(s)
- Natasha M. van Poppelen
- Department of Ophthalmology, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (J.V.); (T.B.); (B.E.); (D.P.); (N.N.); (E.K.)
- Department of Clinical Genetics, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (F.M.); (E.B.); (A.d.K.)
| | - Jolique A. van Ipenburg
- Department of Pathology, Section Ophthalmic Pathology, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (J.A.v.I.); (Q.v.d.B.); (H.J.D.)
- Department of Pathology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Quincy van den Bosch
- Department of Pathology, Section Ophthalmic Pathology, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (J.A.v.I.); (Q.v.d.B.); (H.J.D.)
| | - Jolanda Vaarwater
- Department of Ophthalmology, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (J.V.); (T.B.); (B.E.); (D.P.); (N.N.); (E.K.)
- Department of Clinical Genetics, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (F.M.); (E.B.); (A.d.K.)
| | - Tom Brands
- Department of Ophthalmology, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (J.V.); (T.B.); (B.E.); (D.P.); (N.N.); (E.K.)
- Department of Clinical Genetics, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (F.M.); (E.B.); (A.d.K.)
| | - Bert Eussen
- Department of Ophthalmology, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (J.V.); (T.B.); (B.E.); (D.P.); (N.N.); (E.K.)
- Department of Clinical Genetics, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (F.M.); (E.B.); (A.d.K.)
| | - Frank Magielsen
- Department of Clinical Genetics, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (F.M.); (E.B.); (A.d.K.)
| | - Hendrikus J. Dubbink
- Department of Pathology, Section Ophthalmic Pathology, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (J.A.v.I.); (Q.v.d.B.); (H.J.D.)
| | - Dion Paridaens
- Department of Ophthalmology, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (J.V.); (T.B.); (B.E.); (D.P.); (N.N.); (E.K.)
- Department of Ocular Oncology, The Rotterdam Eye Hospital, Schiedamse Vest 180, 3011 BH Rotterdam, The Netherlands
| | - Erwin Brosens
- Department of Clinical Genetics, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (F.M.); (E.B.); (A.d.K.)
| | - Nicole Naus
- Department of Ophthalmology, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (J.V.); (T.B.); (B.E.); (D.P.); (N.N.); (E.K.)
| | - Annelies de Klein
- Department of Clinical Genetics, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (F.M.); (E.B.); (A.d.K.)
| | - Emine Kiliç
- Department of Ophthalmology, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (J.V.); (T.B.); (B.E.); (D.P.); (N.N.); (E.K.)
| | - Robert M. Verdijk
- Department of Pathology, Section Ophthalmic Pathology, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (J.A.v.I.); (Q.v.d.B.); (H.J.D.)
- Department of Ocular Oncology, The Rotterdam Eye Hospital, Schiedamse Vest 180, 3011 BH Rotterdam, The Netherlands
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Correspondence:
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Gene Instability-Related lncRNA Prognostic Model of Melanoma Patients via Machine Learning Strategy. JOURNAL OF ONCOLOGY 2021; 2021:5582920. [PMID: 34122546 PMCID: PMC8169244 DOI: 10.1155/2021/5582920] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/30/2021] [Accepted: 05/08/2021] [Indexed: 12/03/2022]
Abstract
Background Melanoma is a common tumor characterized by a high mortality rate in its late stage. After metastasis, current treatment methods are relatively ineffective. Many studies have shown that long noncoding RNA (lncRNA) may participate in gene mutation and genomic instability in cancer. Methods We downloaded transcriptome data, mutation data, and clinical follow-up data of melanoma patients from The Cancer Genome Atlas. We divided samples into groups according to the number of somatic cell mutations and then performed a differential analysis to screen out the differentially expressed genes. We then divided samples into genomic unstable and genomic stable groups. We compared lncRNA expression profiles in these groups and constructed a protein-coding genes network coexpressed with selected lncRNA to analyze the pathways enriched by these genes. Two machine learning methods, least absolute shrinkage and selector operation (LASSO) and support vector machine-recursive feature elimination (SVM-RFE), were applied to conduct the lncRNA-related prognostic model. Afterward, we performed survival analysis, risk correlation analysis, independent prognostic analysis, and clinical subgroup model validation. Finally, through wound healing assay and transwell assay, the function of AATBC was verified by A375 cell lines. Results We screened 61 prognostic-related lncRNAs and constructed an lncRNA-mRNA coexpression network based on these lncRNAs. Seven lncRNAs were selected as common characteristic factors based on the two machine learning methods. The model formula was as follows: risk score = 0.085∗AATBC + 0.190∗ AC026689.1−0.117∗AC083799.1 + 0.036∗ AC091544.6−0.039∗ LINC01287−0.291∗ SPRY4.AS1 + 0.056∗ ZNF667.AS1. The seven lncRNAs in this formula are key candidates. Cell experiments have verified that knocking down AATBC in A375 cell lines can reduce the proliferation and invasion ability of melanoma cells. Conclusion The lncRNA we identified provides a new way to study lncRNA's role in the genomic instability of melanoma. Our findings may provide essential candidate biomarkers for the diagnosis and treatment of melanoma.
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Zhang H, Zhang A, Gupte AA, Hamilton DJ. Plumbagin Elicits Cell-Specific Cytotoxic Effects and Metabolic Responses in Melanoma Cells. Pharmaceutics 2021; 13:pharmaceutics13050706. [PMID: 34066184 PMCID: PMC8151164 DOI: 10.3390/pharmaceutics13050706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/13/2021] [Accepted: 05/08/2021] [Indexed: 12/13/2022] Open
Abstract
Melanoma is one of the most malignant skin cancers that require comprehensive therapies, including chemotherapy. A plant-derived drug, plumbagin (PLB), exhibits an anticancer property in several cancers. We compared the cytotoxic and metabolic roles of PLB in A375 and SK-MEL-28 cells, each with different aggressiveness. In our results, they were observed to have distinctive mitochondrial respiratory functions. The primary reactive oxygen species (ROS) source of A375 can be robustly attenuated by cell membrane permeabilization. A375 cell viability and proliferation, migration, and apoptosis induction are more sensitive to PLB treatment. PLB induced metabolic alternations in SK-MEL-28 cells, which included increasing mitochondrial oxidative phosphorylation (OXPHOS), mitochondrial ATP production, and mitochondrial mass. Decreasing mitochondrial OXPHOS and total ATP production with elevated mitochondrial membrane potential (MMP) were observed in PLB-induced A375 cells. PLB also induced ROS production and increased proton leak and non-mitochondria respiration in both cells. This study reveals the relationship between metabolism and cytotoxic effects of PLB in melanoma. PLB displays stronger cytotoxic effects on A375 cells, which exhibit lower respiratory function than SK-MEL-28 cells with higher respiratory function, and triggers cell-specific metabolic changes in accordance with its cytotoxic effects. These findings indicate that PLB might serve as a promising anticancer drug, targeting metabolism.
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Affiliation(s)
- Haoran Zhang
- Center for Bioenergetics, Houston Methodist Research Institute, Houston, TX 77030, USA; (H.Z.); (A.Z.); (A.A.G.)
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Aijun Zhang
- Center for Bioenergetics, Houston Methodist Research Institute, Houston, TX 77030, USA; (H.Z.); (A.Z.); (A.A.G.)
- Molecular Biology Research in Medicine, Houston Methodist Research Institute, Weill Cornell Medicine Affiliate, Houston, TX 77030, USA
| | - Anisha A. Gupte
- Center for Bioenergetics, Houston Methodist Research Institute, Houston, TX 77030, USA; (H.Z.); (A.Z.); (A.A.G.)
- Department of Medicine, Houston Methodist, Weill Cornell Medicine Affiliate, Houston, TX 77030, USA
| | - Dale J. Hamilton
- Center for Bioenergetics, Houston Methodist Research Institute, Houston, TX 77030, USA; (H.Z.); (A.Z.); (A.A.G.)
- Department of Medicine, Houston Methodist, Weill Cornell Medicine Affiliate, Houston, TX 77030, USA
- Correspondence: ; Tel.: +1-(713)-441-4483
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Baumgartner A, Stepien N, Mayr L, Madlener S, Dorfer C, Schmook MT, Traub-Weidinger T, Lötsch-Gojo D, Kirchhofer D, Reisinger D, Hedrich C, Arshad S, Irschik S, Boztug H, Engstler G, Bernkopf M, Rifatbegovic F, Höller C, Slavc I, Berger W, Müllauer L, Haberler C, Azizi AA, Peyrl A, Gojo J. Novel Insights into Diagnosis, Biology and Treatment of Primary Diffuse Leptomeningeal Melanomatosis. J Pers Med 2021; 11:292. [PMID: 33921303 PMCID: PMC8069125 DOI: 10.3390/jpm11040292] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/08/2021] [Indexed: 12/17/2022] Open
Abstract
Primary diffuse leptomeningeal melanomatosis (PDLMM) is an extremely rare and aggressive cancer type for which best treatment strategies remain to be elucidated. Herein, we present current and prospective diagnostic strategies and treatment management of PDLMM. Against the background of an extensive literature review of published PDLMM cases and currently employed therapeutic strategies, we present an illustrative case of a pediatric patient suffering from PDLMM. We report the first case of a pediatric patient with PDLMM who received combination treatment including trametinib and everolimus, followed by intravenous nivolumab and ipilimumab with concomitant intensive intraventricular chemotherapy, resulting in temporary significant clinical improvement and overall survival of 7 months. Following this clinical experience, we performed a comprehensive literature review, identifying 26 additional cases. By these means, we provide insight into current knowledge on clinical and molecular characteristics of PDLMM. Analysis of these cases revealed that the unspecific clinical presentation, such as unrecognized increased intracranial pressure (present in 67%), is a frequent reason for the delay in diagnosis. Mortality remains substantial despite diverse therapeutic approaches with a median overall survival of 4 months from diagnosis. On the molecular level, to date, the only oncogenic driver reported so far is mutation of NRAS (n = 3), underlining a close biological relation to malignant melanoma and neurocutaneous melanosis. We further show, for the first time, that this somatic mutation can be exploited for cerebrospinal fluid liquid biopsy detection, revealing a novel potential biomarker for diagnosis and monitoring of PDLMM. Last, we use a unique patient derived PDLMM cell model to provide first insights into in vitro drug sensitivities. In summary, we provide future diagnostic and therapeutic guidance for PDLMM and first insights into the use of liquid biopsy and in vitro models for this orphan cancer type.
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Affiliation(s)
- Alicia Baumgartner
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (N.S.); (L.M.); (S.M.); (D.R.); (C.H.); (S.A.); (S.I.); (I.S.); (A.A.A.); (A.P.)
| | - Natalia Stepien
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (N.S.); (L.M.); (S.M.); (D.R.); (C.H.); (S.A.); (S.I.); (I.S.); (A.A.A.); (A.P.)
| | - Lisa Mayr
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (N.S.); (L.M.); (S.M.); (D.R.); (C.H.); (S.A.); (S.I.); (I.S.); (A.A.A.); (A.P.)
- Comprehensive Cancer Center-Central Nervous System Tumors Unit, Medical University of Vienna, 1090 Vienna, Austria; (D.L.-G.); (W.B.)
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria;
| | - Sibylle Madlener
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (N.S.); (L.M.); (S.M.); (D.R.); (C.H.); (S.A.); (S.I.); (I.S.); (A.A.A.); (A.P.)
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria;
| | - Maria T. Schmook
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (M.T.S.); (T.T.-W.)
| | - Tatjana Traub-Weidinger
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (M.T.S.); (T.T.-W.)
| | - Daniela Lötsch-Gojo
- Comprehensive Cancer Center-Central Nervous System Tumors Unit, Medical University of Vienna, 1090 Vienna, Austria; (D.L.-G.); (W.B.)
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria;
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria;
| | - Dominik Kirchhofer
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria;
| | - Dominik Reisinger
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (N.S.); (L.M.); (S.M.); (D.R.); (C.H.); (S.A.); (S.I.); (I.S.); (A.A.A.); (A.P.)
| | - Cora Hedrich
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (N.S.); (L.M.); (S.M.); (D.R.); (C.H.); (S.A.); (S.I.); (I.S.); (A.A.A.); (A.P.)
| | - Saleha Arshad
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (N.S.); (L.M.); (S.M.); (D.R.); (C.H.); (S.A.); (S.I.); (I.S.); (A.A.A.); (A.P.)
| | - Stefan Irschik
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (N.S.); (L.M.); (S.M.); (D.R.); (C.H.); (S.A.); (S.I.); (I.S.); (A.A.A.); (A.P.)
| | - Heidrun Boztug
- Department of Pediatric Hematology and Oncology, St. Anna Children’s Hospital, Medical University of Vienna, 1090 Vienna, Austria; (H.B.); (G.E.)
| | - Gernot Engstler
- Department of Pediatric Hematology and Oncology, St. Anna Children’s Hospital, Medical University of Vienna, 1090 Vienna, Austria; (H.B.); (G.E.)
| | - Marie Bernkopf
- Children’s Cancer Research Institute, 1090 Vienna, Austria; (M.B.); (F.R.)
| | | | - Christoph Höller
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Irene Slavc
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (N.S.); (L.M.); (S.M.); (D.R.); (C.H.); (S.A.); (S.I.); (I.S.); (A.A.A.); (A.P.)
| | - Walter Berger
- Comprehensive Cancer Center-Central Nervous System Tumors Unit, Medical University of Vienna, 1090 Vienna, Austria; (D.L.-G.); (W.B.)
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria;
| | - Leonhard Müllauer
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Christine Haberler
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Amedeo A. Azizi
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (N.S.); (L.M.); (S.M.); (D.R.); (C.H.); (S.A.); (S.I.); (I.S.); (A.A.A.); (A.P.)
| | - Andreas Peyrl
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (N.S.); (L.M.); (S.M.); (D.R.); (C.H.); (S.A.); (S.I.); (I.S.); (A.A.A.); (A.P.)
| | - Johannes Gojo
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (N.S.); (L.M.); (S.M.); (D.R.); (C.H.); (S.A.); (S.I.); (I.S.); (A.A.A.); (A.P.)
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Gams P, Dolenc Stražar Z, Šoštarič M, Bošnjak M, Kšela J. Cardiac Melanoma Metastasis with ERBB2 Gene Amplification: A Potential for Future Targeted Therapy. Case Rep Oncol 2021; 14:622-627. [PMID: 33976644 PMCID: PMC8077454 DOI: 10.1159/000514981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 01/15/2023] Open
Abstract
Cardiac tumors are rare, and their treatment differs interindividually regarding the histopathological proprieties and the stage of disease. Authors present a case of symptomatic cardiac melanoma metastasis that expressed an ERBB2 (HER2) gene amplification in a course of the disease that has not yet been reported. The frail patient with a history of pulmonary and renal carcinoma, was admitted to the hospital due to a symptomatic left atrial tumor mass. The patient underwent a tumor-resecting cardiac surgery. At first mistaken for myxoma on echocardiography, the histopathological examination of the tumor revealed a melanoma of acral or mucosal origin. The melanoma metastasis was negative for common genetic mutations in BRAF, NRAS or KIT genes, and for the presence of NTRK genes fusions, but carried ERBB2 (HER2) gene amplification. The absence of standard gene mutations rendered it unresponsive to treatment with BRAF and MEK inhibitors. This molecular finding is rare in melanomas and represented a therapeutic target for off-label systemic treatment with drugs, primarily aimed at ERBB2 positive breast, gastric, and gastroesophageal junction cancers. A rare finding like this justifies molecular genetic analysis of unusual tumor specimen and guarantees optimal treatment for uncommon types of cardiac metastatic tumors.
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Affiliation(s)
- Polona Gams
- Department of Anesthesiology and Intensive Care, Surgery Bitenc, Golnik, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Maja Šoštarič
- Department of Anesthesiology and Intensive Care, Surgery Bitenc, Golnik, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Clinical Department of Anesthesiology and Intensive Care, University Medical Centre, Ljubljana, Slovenia
| | - Matic Bošnjak
- Institute of Pathology, Faculty of Medicine, Ljubljana, Slovenia
| | - Juš Kšela
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Cardiovascular Surgery, University Medical Centre, Ljubljana, Slovenia
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Benna C, Rajendran S, Spiro G, Menin C, Dall'Olmo L, Rossi CR, Mocellin S. Gender-specific associations between polymorphisms of the circadian gene RORA and cutaneous melanoma susceptibility. J Transl Med 2021; 19:57. [PMID: 33549124 PMCID: PMC7866430 DOI: 10.1186/s12967-021-02725-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/28/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Melanoma is the deadliest of skin cancers and has an increasing annual incidence worldwide. It is a multi-factorial disease most likely arising from both genetic predisposition and environmental exposure to ultraviolet light. Genetic variability of the components of the biological circadian clock is recognized to be a risk factor for different type of cancers. Moreover, two variants of a clock gene, RORA, have been associated with melanoma patient's prognosis. Our aim is to test the hypothesis that specific single nucleotide polymorphisms (SNPs) of the circadian clock genes may significantly influence the predisposition to develop cutaneous melanoma or the outcome of melanoma patients. METHODS We genotyped 1239 subjects, 629 cases of melanoma and 610 healthy controls in 14 known SNPs of seven selected clock genes: AANAT, CLOCK, NPAS2, PER1, PER2, RORA, and TIMELESS. Genotyping was conducted by q-PCR. Multivariate logistic regression was employed for susceptibility of melanoma assessment, modeled additively. Subgroup analysis was performed by gender. For the female subgroup, a further discrimination was performed by age. For prognosis of melanoma assessment, multivariate Cox proportional hazard regression was employed. The Benjamini-Hochberg method was utilized as adjustment for multiple comparisons. RESULTS We identified two RORA SNPs statistically significant with respect to the association with melanoma susceptibility. Considering the putative role of RORA as a nuclear steroid hormone receptor, we conducted a subgroup analysis by gender. Interestingly, the RORA rs339972 C allele was associated with a decreased predisposition to develop melanoma only in the female subgroup (OR 0.67; 95% CI 0.51-0.88; P = 0.003) while RORA rs10519097 T allele was associated with a decreased predisposition to develop melanoma only in the male subgroup (OR 0.62; 95% CI 0.44-0.87; P = 0.005). Moreover, the RORA rs339972 C allele had a decreased susceptibility to develop melanoma only in females aged over 50 years old (OR 0.67; 95% CI 0.54-0.83; P = 0.0002). None of the studied SNPs were significantly associated with the prognosis. CONCLUSIONS Overall, we cannot ascertain that circadian pathway genetic variation is involved in melanoma susceptibility or prognosis. Nevertheless, we identified an interesting relationship between melanoma susceptibility and RORA polymorphisms acting in sex-specific manner and which is worth further future investigation.
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Affiliation(s)
- Clara Benna
- Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy. .,First Surgical Clinic, Azienda Ospedaliera Padova, Padova, Italy.
| | - Senthilkumar Rajendran
- Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Giovanna Spiro
- Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Chiara Menin
- Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology (IOV - IRCCS), Padova, Italy
| | - Luigi Dall'Olmo
- Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy.,Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy
| | - Carlo Riccardo Rossi
- Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy.,Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy
| | - Simone Mocellin
- Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy.,Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy
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Leiter A, Carroll E, Brooks D, Ben Shimol J, Eisenberg E, Wisnivesky JP, Galsky MD, Gallagher EJ. Characterization of hyperglycemia in patients receiving immune checkpoint inhibitors: Beyond autoimmune insulin-dependent diabetes. Diabetes Res Clin Pract 2021; 172:108633. [PMID: 33347896 PMCID: PMC7940559 DOI: 10.1016/j.diabres.2020.108633] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 12/17/2022]
Abstract
AIMS Immune-mediated beta cell destruction is known to cause hyperglycemia in patients receiving immune checkpoint inhibitor (ICI) cancer therapy. However, it is uncommon, and little is known about the full spectrum of hyperglycemia in patients receiving ICIs. We aimed to characterize the prevalence and factors associated with hyperglycemia in patients treated with ICIs. METHODS We retrospectively analyzed patients receiving ICIs at an NCI-designated Cancer Center. We assessed the proportion of patients with new onset hyperglycemia (random glucose >11.1 mmol/L) after starting ICIs and used logistic regression to determine hyperglycemia predictors in patients without known diabetes. RESULTS Of 411 patients, 385 had post-ICI glucose data. 105 (27%) had hyperglycemia. Of this group, 29 (28%) had new onset hyperglycemia, 19 of whom had glucocorticoid-associated hyperglycemia. The remaining 10 had unexplained hyperglycemia and none had known autoimmune diabetes. Among patients without known diabetes, race/ethnicity, obesity, and pre-ICI hyperglycemia were significantly associated with hyperglycemia after starting ICIs. CONCLUSIONS We found that new hyperglycemia in patients receiving ICIs was most commonly related to glucocorticoids. A small patient subset had new unexplained hyperglycemia, suggesting ICIs might have a role in promoting hyperglycemia. Recognizing factors associated with hyperglycemia in this population is crucial for appropriate management.
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Affiliation(s)
- Amanda Leiter
- Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Emily Carroll
- Division of Rheumatology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Danielle Brooks
- Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jennifer Ben Shimol
- Department of Rheumatology, Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elliot Eisenberg
- Division of Pulmonology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Matthew D Galsky
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Emily J Gallagher
- Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Roy T, Boateng ST, Banang-Mbeumi S, Singh PK, Basnet P, Chamcheu RCN, Ladu F, Chauvin I, Spiegelman VS, Hill RA, Kousoulas KG, Nagalo BM, Walker AL, Fotie J, Murru S, Sechi M, Chamcheu JC. Synthesis, inverse docking-assisted identification and in vitro biological characterization of Flavonol-based analogs of fisetin as c-Kit, CDK2 and mTOR inhibitors against melanoma and non-melanoma skin cancers. Bioorg Chem 2021; 107:104595. [PMID: 33450548 PMCID: PMC7870562 DOI: 10.1016/j.bioorg.2020.104595] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/30/2020] [Accepted: 12/22/2020] [Indexed: 12/26/2022]
Abstract
Due to hurdles, including resistance, adverse effects, and poor bioavailability, among others linked with existing therapies, there is an urgent unmet need to devise new, safe, and more effective treatment modalities for skin cancers. Herein, a series of flavonol-based derivatives of fisetin, a plant-based flavonoid identified as an anti-tumorigenic agent targeting the mammalian targets of rapamycin (mTOR)-regulated pathways, were synthesized and fully characterized. New potential inhibitors of receptor tyrosine kinases (c-KITs), cyclin-dependent kinase-2 (CDK2), and mTOR, representing attractive therapeutic targets for melanoma and non-melanoma skin cancers (NMSCs) treatment, were identified using inverse-docking, in vitro kinase activity and various cell-based anticancer screening assays. Eleven compounds exhibited significant inhibitory activities greater than the parent molecule against four human skin cancer cell lines, including melanoma (A375 and SK-Mel-28) and NMSCs (A431 and UWBCC1), with IC50 values ranging from 0.12 to < 15 μM. Seven compounds were identified as potentially potent single, dual or multi-kinase c-KITs, CDK2, and mTOR kinase inhibitors after inverse-docking and screening against twelve known cancer targets, followed by kinase activity profiling. Moreover, the potent compound F20, and the multi-kinase F9 and F17 targeted compounds, markedly decreased scratch wound closure, colony formation, and heightened expression levels of key cancer-promoting pathway molecular targets c-Kit, CDK2, and mTOR. In addition, these compounds downregulated Bcl-2 levels and upregulated Bax and cleaved caspase-3/7/8 and PARP levels, thus inducing apoptosis of A375 and A431 cells in a dose-dependent manner. Overall, compounds F20, F9 and F17, were identified as promising c-Kit, CDK2 and mTOR inhibitors, worthy of further investigation as therapeutics, or as adjuvants to standard therapies for the control of melanoma and NMSCs.
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Affiliation(s)
- Tithi Roy
- School of Basic Pharmaceutical and Toxicological Sciences, College of Pharmacy, University of Louisiana-Monroe, Monroe, LA 71209-0497, USA
| | - Samuel T Boateng
- School of Basic Pharmaceutical and Toxicological Sciences, College of Pharmacy, University of Louisiana-Monroe, Monroe, LA 71209-0497, USA
| | - Sergette Banang-Mbeumi
- School of Basic Pharmaceutical and Toxicological Sciences, College of Pharmacy, University of Louisiana-Monroe, Monroe, LA 71209-0497, USA
| | - Pankaj K Singh
- Department of Chemistry and Pharmacy, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Pratik Basnet
- School of Basic Pharmaceutical and Toxicological Sciences, College of Pharmacy, University of Louisiana-Monroe, Monroe, LA 71209-0497, USA; Department of Chemistry, University of Louisiana-Monroe, Monroe, LA 71209-0497, USA
| | - Roxane-Cherille N Chamcheu
- School of Basic Pharmaceutical and Toxicological Sciences, College of Pharmacy, University of Louisiana-Monroe, Monroe, LA 71209-0497, USA
| | - Federico Ladu
- Department of Chemistry and Pharmacy, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Isabel Chauvin
- Department of Chemistry, University of Louisiana-Monroe, Monroe, LA 71209-0497, USA
| | - Vladimir S Spiegelman
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033-0850, USA
| | - Ronald A Hill
- School of Basic Pharmaceutical and Toxicological Sciences, College of Pharmacy, University of Louisiana-Monroe, Monroe, LA 71209-0497, USA
| | - Konstantin G Kousoulas
- Division of Biotechnology and Molecular Medicine, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, USA; Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Bolni Marius Nagalo
- Division of Hematology and Medical Oncology, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA
| | - Anthony L Walker
- School of Clinical Sciences, College of Pharmacy, University of Louisiana-Monroe, Monroe, LA 71209-0497, USA
| | - Jean Fotie
- Department of Chemistry and Physics, Southeastern Louisiana University, SELU, Hammond, LA 70402-0878, USA
| | - Siva Murru
- Department of Chemistry, University of Louisiana-Monroe, Monroe, LA 71209-0497, USA
| | - Mario Sechi
- Department of Chemistry and Pharmacy, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Jean Christopher Chamcheu
- School of Basic Pharmaceutical and Toxicological Sciences, College of Pharmacy, University of Louisiana-Monroe, Monroe, LA 71209-0497, USA.
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Abstract
Response evaluation for cancer treatment consists primarily of clinical and radiological assessments. In addition, a limited number of serum biomarkers that assess treatment response are available for a small subset of malignancies. Through recent technological innovations, new methods for measuring tumor burden and treatment response are becoming available. By utilization of highly sensitive techniques, tumor-specific mutations in circulating DNA can be detected and circulating tumor DNA (ctDNA) can be quantified. These so-called liquid biopsies provide both molecular information about the genomic composition of the tumor and opportunities to evaluate tumor response during therapy. Quantification of tumor-specific mutations in plasma correlates well with tumor burden. Moreover, with liquid biopsies, it is also possible to detect mutations causing secondary resistance during treatment. This review focuses on the clinical utility of ctDNA as a response and follow-up marker in patients with non-small cell lung cancer, melanoma, colorectal cancer, and breast cancer. Relevant studies were retrieved from a literature search using PubMed database. An overview of the available literature is provided and the relevance of ctDNA as a response marker in anti-cancer therapy for clinical practice is discussed. We conclude that the use of plasma-derived ctDNA is a promising tool for treatment decision-making based on predictive testing, detection of resistance mechanisms, and monitoring tumor response. Necessary steps for translation to daily practice and future perspectives are discussed.
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