1
|
Alter M, Gutzmer R. [Value of surgery for malignant melanoma in the context of current adjuvant and neoadjuvant treatment concepts]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2025; 76:365-370. [PMID: 40338298 DOI: 10.1007/s00105-025-05511-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/09/2025] [Indexed: 05/09/2025]
Abstract
The field of melanoma treatment is also dynamic with respect to surgical procedures. In the treatment of the primary tumor the safety margins have been reduced based on study data. In surgery of the regional lymph nodes elective lymph node dissection has been discontinued in favor of sentinel lymph node (SLN) extirpation. Whether SLN extirpation can even be dispensed with in view of adjuvant treatment, particularly in patients with thicker primary tumors, needs to be further investigated. In the stage of regional macrometastasis, neoadjuvant or perioperative drug treatment should be considered before surgical measures. In the case of distant metastasis and disseminated disease, systemic treatment is also the first choice and in the case of local complications or oligoprogression under systemic treatment, surgical measures can also be considered.
Collapse
Affiliation(s)
- Mareike Alter
- Klinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Johannes Wesling Klinikum, Mühlenkreiskliniken AöR, Universitätsklinikum der Ruhr Universität Bochum, Hans-Nolte-Str. 1, 32429, Minden, Deutschland.
| | - Ralf Gutzmer
- Klinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Johannes Wesling Klinikum, Mühlenkreiskliniken AöR, Universitätsklinikum der Ruhr Universität Bochum, Hans-Nolte-Str. 1, 32429, Minden, Deutschland
| |
Collapse
|
2
|
Janssen JC, Huibers AE, Grünhagen DJ, Bagge RO. Surgery in patients with metastatic melanoma treated with immune checkpoint inhibitors. Scand J Surg 2025:14574969251331663. [PMID: 40163346 DOI: 10.1177/14574969251331663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
Abstract
Surgery has historically played a pivotal role in the management of metastatic melanoma, evolving significantly with the advances of systemic therapies. The advent of immune checkpoint inhibitors initially diminished the role of surgery in treatment paradigms; however, there has been a resurgence of interest in its application within this setting. Several retrospective studies show a survival benefit for patients treated with immune checkpoint inhibitors who are resected to no evidence of disease, especially in case of an objective response to modern therapies. This narrative review explores the role of surgery as a treatment modality in metastatic melanoma before and in the era of immune checkpoint inhibitors, highlighting indications, outcomes, and integration with systemic treatment approaches.
Collapse
Affiliation(s)
- Joséphine C Janssen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Anne E Huibers
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Dirk J Grünhagen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Roger Olofsson Bagge
- Department of Surgery Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Surgery Sahlgrenska University Hospital 413 45 Gothenburg Sweden
| |
Collapse
|
3
|
Tompkins AG, Gray ZN, Dadey RE, Zenkin S, Batavani N, Newman S, Amouzegar A, Ak M, Ak N, Pak TY, Peddagangireddy V, Mamindla P, Amjadzadeh M, Behr S, Goodman A, Ploucha DL, Kirkwood JM, Zarour HM, Najjar YG, Davar D, Tatsuoka C, Colen RR, Luke JJ, Bao R. Radiomic analysis of patient and interorgan heterogeneity in response to immunotherapies and BRAF-targeted therapy in metastatic melanoma. J Immunother Cancer 2025; 13:e009568. [PMID: 39939139 PMCID: PMC11822426 DOI: 10.1136/jitc-2024-009568] [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: 04/26/2024] [Accepted: 01/21/2025] [Indexed: 02/14/2025] Open
Abstract
Variability in treatment response may be attributable to organ-level heterogeneity in tumor lesions. Radiomic analysis of medical images can elucidate non-invasive biomarkers of clinical outcome. Organ-specific radiomic comparison across immunotherapies and targeted therapies has not been previously reported. We queried the UPMC Hillman Cancer Center registry for patients with metastatic melanoma (MEL) treated with immune checkpoint inhibitors (ICI) (anti-programmed cell death protein-1 (PD-1)/cytotoxic T-lymphocyte associated protein 4 (CTLA-4) (ipilimumab+nivolumab; I+N) or anti-PD-1 monotherapy) or BRAF-targeted therapy. The best overall response was measured using Response Evaluation Criteria in Solid Tumors V.1.1. Lesions were segmented into discrete volume-of-interest with 400 radiomics features extracted. Overall and organ-specific machine-learning models were constructed to predict disease control (DC) versus progressive disease (PD) using XGBoost. 291 patients with MEL were identified, including 242 ICI (91 I+N, 151 PD-1) and 49 BRAF. 667 metastases were analyzed, including 541 ICI (236 I+N, 305 PD-1) and 126 BRAF. Across cohorts, baseline demographics included 39-47% women, 24%-29% M1C, 24-46% M1D, and 61-80% with elevated lactate dehydrogenase. Among ICI patients experiencing DC, the organs with the greatest reduction were liver (-66%±8%; mean±SEM) and lung (-63%±5%). For patients with multiple same-organ target lesions, the highest interlesion heterogeneity was observed in brain among patients who received ICI while no intraorgan heterogeneity was observed in BRAF. 221 ICI patients were included for radiomic modeling, consisting of 86 I+N and 135 PD-1. Models consisting of optimized radiomic signatures classified DC/PD across I+N (area under curve (AUC)=0.85) and PD-1 (0.71) and within individual organ sites (AUC=0.72~0.94). Integration of clinical variables improved the models' performance. Comparison of models between treatments and across organ sites suggested mostly non-overlapping DC or PD features. Skewness, kurtosis, and informational measure of correlation (IMC) were among the radiomic features shared between overall response models. Kurtosis and IMC were also used by multiple organ-site models. In conclusion, differential organ-specific response was observed across BRAF and ICI with within organ heterogeneity observed for ICI but not for BRAF. Radiomic features of organ-specific response demonstrated little overlap. Integrating clinical factors with radiomics improves the prediction of disease course outcome and prediction of tumor heterogeneity.
Collapse
Affiliation(s)
- Alexandra G Tompkins
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Zane N Gray
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rebekah E Dadey
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Serafettin Zenkin
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nasim Batavani
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sarah Newman
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Afsaneh Amouzegar
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Murat Ak
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nursima Ak
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Taha Yasin Pak
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Vishal Peddagangireddy
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Priyadarshini Mamindla
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mohammadreza Amjadzadeh
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sarah Behr
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Amy Goodman
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | | | - John M Kirkwood
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hassane M Zarour
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yana G Najjar
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Diwakar Davar
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Curtis Tatsuoka
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rivka R Colen
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jason John Luke
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Riyue Bao
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
4
|
Handel EE, McKeown J, Wei J, Kankaria RA, Burnette H, Johnson DB, Lawless A, Czapla J, Sullivan RJ, Albrecht LJ, Zimmer L, Mangana J, Dummer R, Kessels JI, Neyns B, Allayous C, Lebbe C, Boatwright C, Mehnert JM, Ottaviano M, Ascierto PA, Czarnecka AM, Rutkowski P, Lo SN, Long GV, Menzies AM, Carlino MS. Outcomes following long-term disease control with immune checkpoint inhibitors in patients with advanced melanoma. Eur J Cancer 2025; 215:115171. [PMID: 39667250 DOI: 10.1016/j.ejca.2024.115171] [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: 09/18/2024] [Revised: 11/14/2024] [Accepted: 11/22/2024] [Indexed: 12/14/2024]
Abstract
Immune checkpoint inhibitors (ICI) can achieve durable responses in patients with advanced melanoma, and results from clinical trials suggest cure may be possible for a subset of patients. Despite clinical trial data, little is known about the risk, character, and clinical outcome of late recurrences after ICI. This study aimed to explore the disease outcomes and survival in a cohort of patients with long-term responses to ICI. We retrospectively identified patients treated with ICI for advanced melanoma with long-term disease control, defined as not requiring a subsequent line of systemic therapy within 3 years of ICI commencement. We analysed disease characteristics, treatment, toxicity, recurrence patterns, management, and outcomes. A total of 567 patients were identified with a median follow-up of 7.1 years: 504 (89 %) without disease progression within 3 years (cohort 1) and 63 (11.1 %) with disease progression within 3 years managed without a change in systemic therapy (cohort 2). Subsequent progression after 3 years occurred for 39 (7.7 %) patients in cohort 1, compared to 14 (22 %) in cohort 2. Predictors for late progression after 3 years were a non-complete radiological response (CR) best response and prior progression within 3 years. Thirty-two patients (5.6 %) died during follow-up, 8 (1.4 %) from melanoma, 6 (1.2 %) from cohort 1 and 2 (3.2 %) from cohort 2. In this population of patients with advanced melanoma with long-term disease control from ICI, the risk of subsequent disease progression and death was low. This suggests that a significant proportion of long-term ICI responders are likely cured and may inform the frequency and duration of follow-up.
Collapse
Affiliation(s)
- Eleanor E Handel
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, NSW, Australia.
| | - Janet McKeown
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Joe Wei
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | | | | | | | | | | | | | | | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Joanna Mangana
- Department of Dermatology, Comprehensive Cancer Center Zurich (CCCZ), University Hospital Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, Comprehensive Cancer Center Zurich (CCCZ), University Hospital Zurich, Switzerland
| | - Jolien I Kessels
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Bart Neyns
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Clara Allayous
- Dermatology Department, APHP Hôpital Saint-Louis, Paris, France
| | - Celeste Lebbe
- Université Paris Cite, AP-HP Dermato-oncology, Cancer institute APHP Nord Paris cité, INSERM U976, Saint Louis Hospital, Paris, France
| | | | | | | | - Paolo A Ascierto
- Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Anna M Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Matteo S Carlino
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| |
Collapse
|
5
|
Campana LG, Tauceri F, Bártolo J, Calabrese S, Odili J, Carrara G, Farricha V, Piazzalunga D, Bottyán K, Bisarya K, Mascherini M, Clover JA, Sestini S, Bošnjak M, Kis E, Fantini F, Covarelli P, Brizio M, Sayed L, Cabula C, Careri R, Fabrizio T, Eisendle K, MacKenzie Ross A, Schepler H, Borgognoni L, Sersa G, Valpione S. Treatment strategies with electrochemotherapy for limb in-transit melanoma: Real-world outcomes from a European, retrospective, cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024:108740. [PMID: 39448361 DOI: 10.1016/j.ejso.2024.108740] [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: 05/13/2024] [Revised: 09/04/2024] [Accepted: 10/01/2024] [Indexed: 10/26/2024]
Abstract
BACKGROUND This study analysed treatment strategies with electrochemotherapy (ECT) in melanoma with limb in-transit metastases (ITM). METHODS We audited AJCC v.8 stage IIIB-IIID patients treated across 22 centres (2006-2020) within the International Network for Sharing Practices of ECT (InspECT). RESULTS 452 patients were included, 58 % pre-treated (93 % had lower limb ITM, 44 % had ≤10 metastases [median size 1.5 cm]. Treatment strategies included first-line ECT (n = 145, 32 %), ECT with concurrent locoregional/systemic treatment (n = 163, 36 %), and salvage ECT (n = 144, 32 %). The objective response rate was 63 % (complete response [CR], 24 %), increasing to 74 % (CR, 39 %) following retreatment (median two ECT, range 1-8). CR rate in treatment-naïve and pre-treated patients was 50 % vs 32 % (p < 0.001). Bleomycin de-escalation was associated with lower CR (p = 0.004). Small tumour number and size, hexagonal electrode, retreatment, and post-ECT skin ulceration predicted response in multivariable analysis. At a median follow-up of 61 months, local and locoregional recurrence occurred in 55 % and 81 % of patients. Median local progression-free, new lesions-free, and regional recurrence-free survival were 32.9, 6.9, and 7.7 months. Grade-3 toxicity was 15 %. Concurrent treatment and CR correlated with improved regional control and survival. Concomitant checkpoint inhibition did not impact toxicity or survival outcomes. The median overall survival was 5.7 years. CONCLUSIONS Among patients with low-burden limb-only ITM, standard-dose bleomycin ECT results in durable local response. Treatment naivety, low tumour volume, hexagonal electrode application, retreatment, and post-ECT ulceration predict response. CR and concurrent treatment correlate with improved regional control and survival outcomes. Combination with checkpoint inhibitors is safe but lacks conclusive support.
Collapse
Affiliation(s)
- Luca G Campana
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester, UK; Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy.
| | - Francesca Tauceri
- General and Oncological Surgery Unit, Morgagni-Pierantoni Hospital, Forli, Italy
| | - Joana Bártolo
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Sarah Calabrese
- Department of Plastic Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Joy Odili
- Department of Plastic and Reconstructive Surgery, St Georges University Hospitals NHS Foundation Trust, London, UK
| | - Giulia Carrara
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Victor Farricha
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Dario Piazzalunga
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Kriszta Bottyán
- Department of Dermatology and Allergology, University of Szeged, H-6720, Szeged, Hungary
| | - Kamal Bisarya
- Department of Plastic Surgery, Hull Royal Infirmary, Hull, UK
| | - Matteo Mascherini
- Department of Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - James A Clover
- Department of Plastic Surgery, Cork University Hospital, Cork, Ireland
| | - Serena Sestini
- Plastic and Reconstructive Surgery, Melanoma & Skin Cancer Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Maša Bošnjak
- Institute of Oncology Ljubljana, Department of Experimental Oncology, Ljubljana, Slovenia
| | - Erika Kis
- Department of Dermatology and Allergology, University of Szeged, H-6720, Szeged, Hungary
| | - Fabrizio Fantini
- Dermatology Unit, ASST Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - Piero Covarelli
- Surgical Oncology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Matteo Brizio
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Italy
| | - Leela Sayed
- Plastic Surgery Unit, Salisbury District Hospital, Salisbury, UK
| | - Carlo Cabula
- Chirurgia Senologica Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Rosanna Careri
- Department of Dermatology and Plastic Surgery, University La Sapienza, Rome, Italy
| | - Tommaso Fabrizio
- Plastic Surgery Unit, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), Rionero in Vulture, Italy
| | - Klaus Eisendle
- Department of Dermatology and Venerology, Central Teaching Hospital Bolzano, Bolzano, Italy
| | | | - Hadrian Schepler
- Department of Dermatology, University Clinic Mainz, Mainz, Germany
| | - Lorenzo Borgognoni
- Plastic and Reconstructive Surgery, Melanoma & Skin Cancer Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Sara Valpione
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Oncological Sciences, The University of Manchester, Manchester, UK; Cancer Research UK National Biomarker Centre, The University of Manchester, Manchester, UK
| |
Collapse
|
6
|
Liu TH, Chen SC, Rau KM, Lu LC, Lin PT, Su YY, Teng W, Lai SW, Yeh RH, Kao TM, Lee PC, Wu CJ, Chen CH, Hsu CH, Lin SM, Huang YH, Chen LT, Cheng AL, Shen YC, on behalf of Taiwan Liver Cancer Association Research Group (TRG). Outcomes of Post-Immunotherapy Durable Responders of Advanced Hepatocellular Carcinoma- with Emphasis on Locoregional Therapy for Oligoprogression. Liver Cancer 2024; 13:509-521. [PMID: 39435270 PMCID: PMC11493387 DOI: 10.1159/000536549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/29/2024] [Indexed: 10/23/2024] Open
Abstract
Introduction The progression patterns, dispositions, and outcomes of patients with advanced hepatocellular carcinoma (HCC) who achieved durable responses with immunotherapy remain poorly characterized. Methods Patients with advanced HCC who received immune checkpoint inhibitor (ICI)-based immunotherapy and achieved durable responses were retrospectively included. A durable response was defined as partial response (PR) or stable disease (SD) per RECIST 1.1 for more than 8 months after initiation of immunotherapy. Oligoprogression and polyprogression were defined as progression at ≤3 and >3 lesions, respectively. Results A total of 91 durable responders (63 PR and 28 SD) were identified. The majority had chronic viral hepatitis (n = 69, 75.8%). Forty-seven (51.6%) and 44 (48.4%) patients received the index immunotherapy as first-line and second- or beyond-line therapy, respectively. Fifty-four (59.3%) patients subsequently developed progression, with a predominant pattern of oligoprogression (66.7%). The median overall survival (OS) was 46.2 months (95% CI: 34.1-58.3). For patients with subsequent progression, employment of locoregional therapy (LRT) for progression was associated with prolonged OS (univariate analysis: hazard ratio [HR] 0.397, p = 0.009; multivariate analysis: HR 0.363, p = 0.050). Patients with oligoprogression who received LRT showed longer median OS than those who did not (48.4 vs. 20.5 months, p < 0.001). In contrast, the median OS of patients with polyprogression who received LRT was not different from those without LRT (27.7 vs. 25.5 months, p = 0.794). Conclusion Approximately 60% of the post-immunotherapy durable responders of HCC subsequently develop progression. Proactive LRT may further rescue patients who develop subsequent oligoprogression. Prospective studies are mandatory to clarify the proper management of durable responders with subsequent progression.
Collapse
Affiliation(s)
- Tsung-Hao Liu
- Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - San-Chi Chen
- Division of Medical Oncology, Center of Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Kun-Ming Rau
- Department of Hematology-Oncology, E-Da Cancer Hospital, Kaohsiung City, Taiwan
| | - Li-Chun Lu
- Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Po-Ting Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Yeh Su
- National Institute of Cancer Research, National Health Research Institute, Zhunan, Miaoli County, Taiwan
| | - Wei Teng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shiue-Wei Lai
- Division of Hematology and Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Ren-Hua Yeh
- Division of Hematology and Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Tsui-Mai Kao
- Department of Oncology, National Taiwan University Hospital Yunlin Branch, Douliu City, Taiwan
| | - Pei-Chang Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Chi-Jung Wu
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Chien-Hung Chen
- Department of Medicine, National Taiwan University Cancer Center, Taipei City, Taiwan
| | - Chih-Hung Hsu
- Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Shi-Ming Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
- Health Care and Service Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Institute of Clinical Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Li-Tzong Chen
- National Institute of Cancer Research, National Health Research Institute, Zhunan, Miaoli County, Taiwan
- Division of Hematology and Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Ann-Lii Cheng
- Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei City, Taiwan
- Department of Medical Oncology, National Taiwan University Cancer Center, Taipei City, Taiwan
| | - Ying-Chun Shen
- Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei City, Taiwan
- Department of Medical Oncology, National Taiwan University Cancer Center, Taipei City, Taiwan
| | - on behalf of Taiwan Liver Cancer Association Research Group (TRG)
- Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei City, Taiwan
- Division of Medical Oncology, Center of Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei City, Taiwan
- Department of Hematology-Oncology, E-Da Cancer Hospital, Kaohsiung City, Taiwan
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- National Institute of Cancer Research, National Health Research Institute, Zhunan, Miaoli County, Taiwan
- Division of Hematology and Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- Department of Oncology, National Taiwan University Hospital Yunlin Branch, Douliu City, Taiwan
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
- Department of Medicine, National Taiwan University Cancer Center, Taipei City, Taiwan
- Health Care and Service Center, Taipei Veterans General Hospital, Taipei City, Taiwan
- Institute of Clinical Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Department of Medical Oncology, National Taiwan University Cancer Center, Taipei City, Taiwan
| |
Collapse
|
7
|
Dann AM, Ariyan C. The Role of Surgery for Stage IV Melanoma. Adv Surg 2024; 58:223-234. [PMID: 39089779 DOI: 10.1016/j.yasu.2024.04.013] [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] [Indexed: 08/04/2024]
Abstract
Historically, stage IV melanoma carried a dismal prognosis and surgical resection was the only potential treatment offering long-term survival or palliation of symptomatic disease. With modern systemic therapies that can provide durable disease control for many patients with metastatic disease, we are actively redefining the role of surgery in metastatic melanoma. Contemporary treatment strategies can employ surgical resection in the upfront setting followed by adjuvant therapy, or used in tailored approach following systemic therapy. The combination of surgical resection and modern therapies has been associated with good long-term survival.
Collapse
Affiliation(s)
- Amanda M Dann
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390-8548, USA.
| | - Charlotte Ariyan
- Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| |
Collapse
|
8
|
Czarnecka AM, Ostaszewski K, Błoński P, Szumera-Ciećkiewicz A, Kozak K, Placzke J, Borkowska A, Terlecka A, Rogala P, Świtaj T, Sałamacha M, Mitręga-Korab B, Krotewicz M, Dudzisz-Śledź M, Rutkowski P. Preoperative-postoperative immunotherapy as treatment of borderline resectable and oligoprogressive stage III B-D and IV melanoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108382. [PMID: 38763112 DOI: 10.1016/j.ejso.2024.108382] [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: 11/19/2023] [Revised: 04/11/2024] [Accepted: 04/30/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Perioperative therapy has gained significant importance in patients with advanced melanoma. Currently, there is little data on the routine use of preoperative immunotherapy in metastatic melanoma outside clinical trials. This study aimed to evaluate the effectiveness of preoperative treatment in patients with borderline resectable stage III or IV melanoma as well as in oligoprogressing stage IV cases; the secondary aim is to describe the safety of surgery after immunotherapy. MATERIALS AND METHODS Since 1/Jan/2016 seventeen patients were treated with curative intent neoadjuvant immunotherapy, surgery, and adjuvant immunotherapy, while nineteen patients were operated due to oligoprogression while treted with immunotherapy. Survival was analyzed using the Kaplan-Meier method and association between variables was tested using the chi-squared test. RESULTS R0 resection was achieved in 76.5 % of cases after neoadjuvant immunotherapy. 24 % of patients achieved objective RECIST response and 35 % complete or major pathological response. At the median follow-up time of 51.4 months, 64.7 % of patients were free of PD after perioperative treatment, while 3-year RFS and OS rates were 68 % and 80.9 %, respectively. R0 resection was achieved in 73.7 % of oligo-progressing nodules. The median time to PD on immunotherapy after the first oligoprogression was 10.3 months. Immunotherapy did not result in any unexpected surgical complications. No patient died during preoperative treatment due to immunotherapy toxicity or disease progression. CONCLUSIONS We confirmed treatment safety and long-term disease control after perioperative immunotherapy. Patients with borderline resectable melanoma should be referred to reference centers using neoadjuvant immunotherapy.
Collapse
Affiliation(s)
- Anna M Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
| | - Krzysztof Ostaszewski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Piotr Błoński
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Anna Szumera-Ciećkiewicz
- Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Katarzyna Kozak
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Joanna Placzke
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Aneta Borkowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Department of Radiology I, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Anna Terlecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Rogala
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Tomasz Świtaj
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Maciej Sałamacha
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Beata Mitręga-Korab
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Maria Krotewicz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Monika Dudzisz-Śledź
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| |
Collapse
|
9
|
Tompkins A, Gray ZN, Dadey RE, Zenkin S, Batavani N, Newman S, Amouzegar A, Ak M, Ak N, Pak TY, Peddagangireddy V, Mamindla P, Behr S, Goodman A, Ploucha DL, Kirkwood JM, Zarour HM, Najjar YG, Davar D, Colen R, Luke JJ, Bao R. Radiomic analysis of patient and inter-organ heterogeneity in response to immunotherapies and BRAF targeted therapy in metastatic melanoma. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.26.24306411. [PMID: 38712112 PMCID: PMC11071587 DOI: 10.1101/2024.04.26.24306411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Background Variability in treatment response may be attributable to organ-level heterogeneity in tumor lesions. Radiomic analysis of medical images can elucidate non-invasive biomarkers of clinical outcome. Organ-specific radiomic comparison across immunotherapies and targeted therapies has not been previously reported. Methods We queried UPMC Hillman Cancer Center registry for patients with metastatic melanoma (MEL) treated with immune checkpoint inhibitors (ICI) (anti-PD1/CTLA4 [ipilimumab+nivolumab; I+N] or anti-PD1 monotherapy) or BRAF targeted therapy. Best overall response was measured using RECIST v1.1. Lesions were segmented into discrete volume-of-interest with 400 radiomics features extracted. Overall and organ-specific machine-learning models were constructed to predict disease control (DC) versus progressive disease (PD) using XGBoost. Results 291 MEL patients were identified, including 242 ICI (91 I+N, 151 PD1) and 49 BRAF. 667 metastases were analyzed, including 541 ICI (236 I+N, 305 PD1) and 126 BRAF. Across cohorts, baseline demographics included 39-47% female, 24-29% M1C, 24-46% M1D, and 61-80% with elevated LDH. Among patients experiencing DC, the organs with the greatest reduction were liver (-88%±12%, I+N; mean±S.E.M.) and lung (-72%±8%, I+N). For patients with multiple same-organ target lesions, the highest inter-lesion heterogeneity was observed in brain among patients who received ICI while no intra-organ heterogeneity was observed in BRAF. 267 patients were kept for radiomic modeling, including 221 ICI (86 I+N, 135 PD1) and 46 BRAF. Models consisting of optimized radiomic signatures classified DC/PD across I+N (AUC=0.85) and PD1 (0.71) and within individual organ sites (AUC=0.72∼0.94). Integration of clinical variables improved the models' performance. Comparison of models between treatments and across organ sites suggested mostly non-overlapping DC or PD features. Skewness, kurtosis, and informational measure of correlation (IMC) were among the radiomic features shared between overall response models. Kurtosis and IMC were also utilized by multiple organ-site models. Conclusions Differential organ-specific response was observed across BRAF and ICI with within organ heterogeneity observed for ICI but not for BRAF. Radiomic features of organ-specific response demonstrated little overlap. Integrating clinical factors with radiomics improves the prediction of disease course outcome and prediction of tumor heterogeneity.
Collapse
|
10
|
Hepner A, Versluis JM, Wallace R, Allayous C, Brown LJ, Trojaniello C, Gerard CL, Jansen YJ, Bhave P, Neyns B, Haydon A, Michielin O, Mangana J, Klein O, Shoushtari AN, Warner AB, Ascierto PA, McQuade JL, Carlino MS, Zimmer L, Lebbe C, Johnson DB, Sandhu S, Atkinson V, Blank CU, Lo SN, Long GV, Menzies AM. The features and management of acquired resistance to PD1-based therapy in metastatic melanoma. Eur J Cancer 2024; 196:113441. [PMID: 37988842 PMCID: PMC11270881 DOI: 10.1016/j.ejca.2023.113441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Anti-PD-1 therapy (PD1) either alone or with anti-CTLA-4 (CTLA4), has high initial response rates, however 20% of patients (pts) with complete response (CR) and 30% with partial response (PR) within 12 months of treatment experience subsequent disease progression by 6 years. The nature and optimal management of this acquired resistance (AR) remains unknown. METHODS Pts from 16 centres who responded to PD1-based therapy and who later progressed were examined. Demographics, disease characteristics and subsequent treatments were evaluated. RESULTS 299 melanoma pts were identified, median age 64y, 44% BRAFV600m. 172 (58%) received PD1 alone, 114 (38%) PD1/CTLA4 and 13 (4%) PD1 and an investigational drug. 90 (30%) pts had CR, 209 (70%) PR. Median time to AR was 12.6 mo (95% CI, 11.3, 14.2). Most (N = 193, 65%) progressed in a single organ site, and in a solitary lesion (N = 151, 51%). The most frequent sites were lymph nodes (38%) and brain (25%). Management at AR included systemic therapy (ST, 45%), local therapy (LT) +ST (31%), LT alone (21%), or observation (3%). There was no statistical difference in PFS2 or OS based on management, however, PFS2 was numerically superior for pts treated with ST alone who progressed off PD1 therapy than those who progressed on PD1 (2-year PFS2 42% versus 25%, p = 0.249). mOS from AR was 38.0 months (95% CI, 29.5-NR); longer in single-site versus multi-site progression (2-year OS 70% vs 54%, p < 0·001). CONCLUSIONS Acquired resistance to PD1 therapy in melanoma is largely oligometastatic, and pts may have a favorable survival outcome following salvage treatment.
Collapse
Affiliation(s)
- Adriana Hepner
- Melanoma Institute Australia, The University of Sydney, NSW, Australia; Instituto do Cancer do Estado de Sao Paulo, SP, Brazil
| | | | - Roslyn Wallace
- Sir Peter MacCallum Cancer Centre Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Clara Allayous
- Université Paris Cite, Dermato-Oncology AP-HP Hôpital Saint Louis, INSERM U976, F-75010 Paris, France
| | - Lauren Julia Brown
- Crown Princess Mary Cancer Centre Westmead and Blacktown Hospitals, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Camille Lea Gerard
- Precision Oncology Center Oncology department, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Yanina Jl Jansen
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven 3000, Belgium
| | - Prachi Bhave
- Sir Peter MacCallum Cancer Centre Department of Oncology, The University of Melbourne, Melbourne, Australia; Department of Medical Oncology, Alfred Health, Melbourne, Australia
| | - Bart Neyns
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Andrew Haydon
- Department of Medical Oncology, Alfred Health, Melbourne, Australia; Monash University, Melbourne, Australia
| | - Olivier Michielin
- Precision Oncology Center Oncology department, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | | | - Oliver Klein
- Olivia Newton-John Cancer Centre and Austin Health, Melbourne, Australia
| | - Alexander N Shoushtari
- Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | | | | | | | | | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Celeste Lebbe
- Université Paris Cite, Dermato-Oncology AP-HP Hôpital Saint Louis, INSERM U976, F-75010 Paris, France
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville TN, USA
| | - Shahneen Sandhu
- Sir Peter MacCallum Cancer Centre Department of Oncology, The University of Melbourne, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Victoria Atkinson
- University of Queensland and Princess Alexandra and Greenslopes Private Hospital, Brisbane, Australia
| | - Christian U Blank
- Netherlands Cancer Institute (NKI), Amsterdam, the Netherlands; Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal North Shore and Mater Hospitals, NSW, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal North Shore and Mater Hospitals, NSW, Australia.
| |
Collapse
|
11
|
Mishra R, Sukhbaatar A, Mori S, Kodama T. Metastatic lymph node targeted CTLA4 blockade: a potent intervention for local and distant metastases with minimal ICI-induced pneumonia. J Exp Clin Cancer Res 2023; 42:132. [PMID: 37259163 DOI: 10.1186/s13046-023-02645-w] [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: 01/20/2023] [Accepted: 03/14/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Immune checkpoint blockade (ICB) elicits a strong and durable therapeutic response, but its application is limited by disparate responses and its associated immune-related adverse events (irAEs). Previously, in a murine model of lymph node (LN) metastasis, we showed that intranodal administration of chemotherapeutic agents using a lymphatic drug delivery system (LDDS) elicits stronger therapeutic responses in comparison to systemic drug delivery approaches, while minimizing systemic toxicity, due to its improved pharmacokinetic profile at the intended site. Importantly, the LN is a reservoir of immunotherapeutic targets. We therefore hypothesized that metastatic LN-targeted ICB can amplify anti-tumor response and uncouple it from ICB-induced irAEs. METHODS To test our hypothesis, models of LN and distant metastases were established with luciferase expressing LM8 cells in MXH10/Mo-lpr/lpr mice, a recombinant inbred strain of mice capable of recapitulating ICB-induced interstitial pneumonia. This model was used to interrogate ICB-associated therapeutic response and immune related adverse events (irAEs) by in vivo imaging, high-frequency ultrasound imaging and histopathology. qPCR and flowcytometry were utilized to uncover the mediators of anti-tumor immunity. RESULTS Tumor-bearing LN (tbLN)-directed CTLA4 blockade generated robust anti-tumor response against local and systemic metastases, thereby improving survival. The anti-tumor effects were accompanied by an upregulation of effector CD8T cells in the tumor-microenvironment and periphery. In comparison, non-specific CTLA4 blockade was found to elicit weaker anti-tumor effect and exacerbated ICI-induced irAEs, especially interstitial pneumonia. Together these data highlight the importance of tbLN-targeted checkpoint blockade for efficacious response. CONCLUSIONS Intranodal delivery of immune checkpoint inhibitors to metastatic LN can potentiate therapeutic response while minimizing irAEs stemming from systemic lowering of immune activation threshold.
Collapse
Affiliation(s)
- Radhika Mishra
- Laboratory of Biomedical Engineering for Cancer, Graduate School of Biomedical Engineering, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan
| | - Ariunbuyan Sukhbaatar
- Laboratory of Biomedical Engineering for Cancer, Graduate School of Biomedical Engineering, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan
- Biomedical Engineering Cancer Research Center, Graduate School of Biomedical Engineering, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan
- Division of Oral and Maxillofacial Oncology and Surgical Sciences, Graduate School of Dentistry, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan
| | - Shiro Mori
- Laboratory of Biomedical Engineering for Cancer, Graduate School of Biomedical Engineering, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan
- Biomedical Engineering Cancer Research Center, Graduate School of Biomedical Engineering, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan
- Division of Oral and Maxillofacial Oncology and Surgical Sciences, Graduate School of Dentistry, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan
| | - Tetsuya Kodama
- Laboratory of Biomedical Engineering for Cancer, Graduate School of Biomedical Engineering, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan.
- Biomedical Engineering Cancer Research Center, Graduate School of Biomedical Engineering, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi, 980-8575, Japan.
| |
Collapse
|
12
|
Malissen N, Grob JJ. Treatment of Recurrent Melanoma Following Adjuvant Therapy. Am J Clin Dermatol 2023; 24:333-341. [PMID: 36890427 DOI: 10.1007/s40257-023-00762-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 03/10/2023]
Abstract
In the era of effective therapies in melanoma, notably the widespread use of two types of adjuvant treatments: anti-PD-1 immunotherapies and therapies targeting the mitogen-activated protein kinase pathway, for BRAF-mutant patients, an important question arises about how to treat these patients in case of recurrent melanoma following adjuvant therapy. Prospective data are lacking in this area and might be difficult to obtain due to the constant progress being made in the field. Therefore, we reviewed available data suggesting that the initial adjuvant treatment received and the following events provide information about the biology of the disease and the probability of response to following systemic treatments. Thus, in case of relapse during or just after adjuvant anti-PD-1, immune resistance is probable, an anti-PD-1 monotherapy rechallenge has a low likelihood of clinical benefit, and escalation with a combination of immunotherapies should be given priority. In case of relapse during treatment with BRAF plus MEK inhibitors, there may be a risk of lower efficacy of immunotherapy than in naïve patients since this relapse attests not only to a resistance to BRAF-MEK inhibition, but also the introduction of immunotherapy to rescue a progression on targeted therapy. In case of relapse long after adjuvant treatment cessation, whatever the treatment received, no conclusion can be drawn about the efficacy of these drugs, and these patients can be treated like naïve patients. Thus, a combination of anti-PD-1 and anti-CTLA4 is probably the best solution, and the following line can be BRAF-MEK inhibitors in BRAF-mutated patients. Finally, in case of recurrent melanoma following adjuvant therapy, given the promising upcoming strategies, inclusion in a clinical trial should be offered as frequently as possible.
Collapse
Affiliation(s)
- Nausicaa Malissen
- Dermatology and Skin Cancer Department, Aix Marseille University, APHM, CRCM Inserm U1068, CNRS U7258, CHU Timone, 13005, Marseille, France.
| | - Jean-Jacques Grob
- Dermatology and Skin Cancer Department, Aix Marseille University, APHM, CRCM Inserm U1068, CNRS U7258, CHU Timone, 13005, Marseille, France
| |
Collapse
|
13
|
Bodensohn R, Werner S, Reis J, Pazos Escudero M, Kaempfel AL, Hadi I, Forbrig R, Manapov F, Corradini S, Belka C, Theurich S, Heinzerling L, Schlaak M, Niyazi M. Stereotactic radiosurgery and combined immune checkpoint therapy with ipilimumab and nivolumab in patients with melanoma brain metastases: A retrospective monocentric toxicity analysis. Clin Transl Radiat Oncol 2023; 39:100573. [PMID: 36655118 PMCID: PMC9841023 DOI: 10.1016/j.ctro.2022.100573] [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: 08/15/2022] [Revised: 12/28/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023] Open
Abstract
Purpose and objective Adding stereotactic radiosurgery (SRS) to combined immune checkpoint therapy with ipilimumab and nivolumab (IPI + NIVO) has led to promising results for patients with melanoma brain metastases (MBM). This study retrospectively analyzes the toxicity profile depending on the timing of SRS with regard to IPI + NIVO. Materials and methods For this study, the clinical database was searched for all patients with MBM who were treated with SRS and IPI + NIVO. The patients were separated into three groups: group A completed IPI + NIVO (usually up to four cycles) >14 days before SRS, in group B IPI + NIVO was initiated>14 days after SRS, and group C received SRS concurrently to IPI + NIVO. Treatment related toxicity was obtained from clinical and neuroradiological records. Analyses were performed using the Fisher-Yates-test. Results 31 patients were assessed including six (19.4 %), seven (22.6 %) and 18 (58.1 %) patients, in groups A, B and C, respectively. Baseline prognostic markers between groups were balanced. In total, five (16.1 %) patients experienced neurological grade 3 toxicities related to SRS. All of these five patients were in group C, which was near-significantly correlated with a risk for grade 3 toxicities (p = 0.058). Post-hoc analyses showed that a maximum time period of seven days between SRS and IPI + NIVO was significantly correlated with grade 3 toxicity (p = 0.048). Conclusion Application of SRS to IPI + NIVO within a seven-day span was related to higher toxicity rates in this retrospective analysis. After previous studies focused on immune checkpoint monotherapies with SRS and declared it as safe, this study indicates that concomitant application of IPI + NIVO and SRS might increase side effects. Prospective validation is warranted to corroborate these findings.
Collapse
Key Words
- AE, Adverse events
- CTCAE, Common Terminology Criteria for Adverse Events
- Checkpoint inhibition
- GPA, graded prognostic assessment
- IPI, ipilimumab
- Intracranial hemorrhage
- Ipilimumab
- LDH, lactate dehydrogenase
- MBM, Melanoma brain metastases
- MRI, magnet resonance imaging
- NIVO, nivolumab
- Nivolumab
- OS, overall survival
- PFS, progression-free survival
- RN, radiation necrosis
- Radiation necrosis
- SRS, Stereotactic radiosurgery
- SRT, Stereotactic radiotherapy
- Side effects
- Stereotactic radiosurgery
Collapse
Affiliation(s)
- Raphael Bodensohn
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Simone Werner
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Jonas Reis
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Montserrat Pazos Escudero
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Anna-Lena Kaempfel
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Indrawati Hadi
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Robert Forbrig
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Farkhad Manapov
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany,German Cancer Consortium (DKTK), Partner Site, Munich, Germany
| | - Sebastian Theurich
- Department of Medicine III, University Hospital, LMU Munich, Ziemssenstraße 1, 80336 Munich, Germany
| | - Lucie Heinzerling
- Department of Dermatology and Allergology, University Hospital, LMU Munich, Frauenlobstraße 9-11, 80337 Munich, Germany,Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Ulmenweg 18, 91052 Erlangen, Germany
| | - Max Schlaak
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Charitéplatz 1, 10117 Berlin, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany,German Cancer Consortium (DKTK), Partner Site, Munich, Germany,Corresponding author at: Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany.
| |
Collapse
|
14
|
Lei X, Zhang Y, Mao L, Jiang P, Huang Y, Gu J, Tai N. Prognostic value of receptor tyrosine kinases in malignant melanoma patients: A systematic review and meta-analysis of immunohistochemistry. Front Oncol 2022; 12:819051. [PMID: 36212475 PMCID: PMC9538722 DOI: 10.3389/fonc.2022.819051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 09/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background Substantial evidence suggests that receptor tyrosine kinases (RTKs) are overexpressed in tumors; however, few studies have focused on the prognostic value of RTKs in melanoma. Objectives The objective of this study is to evaluate the association between overexpression of RTKs and survival in melanoma patients based on immunohistochemistry (IHC) analysis. Methods Our review is registered on PROSPERO (http://www.crd.york.ac.uk/PROSPERO), registration number CRD42021261460. Seven databases were searched, and data were extracted. We used IHC to measure the association between overexpression of RTKs and overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), and clinicopathology in melanoma patients. Pooled analysis was conducted to assess the differences between Hazard Ratios along with 95% confidence intervals. Results Of 5,508 publications examined following the database search, 23 publications were included in this study, which included data from a total of 2,072 patients. Vascular endothelial growth factor receptor 2 (VEGF-R2) overexpression was associated with worse OS and DFS in melanoma. Furthermore, there was an association between OS and the expression of several RTKs, including epidermal growth factor receptor (EGFR), mesenchymal-epithelial transition factor (MET), vascular endothelial growth factor receptor 1 (VEGF-R1), and insulin-like growth factor 1 receptor (IGF-1R). There were no significant correlations between EGFR overexpression and worse DFS or PFS. EGFR overexpression was associated with worse OS cutaneous and nasal melanoma, but not uveal melanoma. However, MET overexpression was related to worse OS in both cutaneous and uveal melanoma. Furthermore, EGFR overexpression was associated with a worse OS in Europe compared to other geographic areas. Moreover, EGFR and MET overexpression showed significant prognostic value in patients with the cut-off “≥10% staining”. Conclusions Our findings build concrete evidence that overexpression of RTKs is associated with poor prognosis and clinicopathology in melanoma, highlighting RTK expression has the potential to inform individualized combination therapies and accurate prognostic evaluation.
Collapse
Affiliation(s)
- Xuan Lei
- Department of Burns and Plastic Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Yiming Zhang
- Department of Orthopedics, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Lianghao Mao
- Department of Orthopedics, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Pan Jiang
- Department of Orthopedics, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Yumeng Huang
- Department of Burns and Plastic Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Jia Gu
- Department of Burns and Plastic Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Ningzheng Tai
- Department of Burns and Plastic Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, China
- *Correspondence: Ningzheng Tai,
| |
Collapse
|
15
|
Kispál M, Jánváry LZ, Balatoni T, Gábor S, Fedorcsák I, Katalin B, Kenessey I, Liszkay G. The Role of Stereotactic Radiotherapy in the Management of Melanoma, A Retrospective Single Institute Preliminary Study of 30 Patients. Pathol Oncol Res 2022; 28:1610550. [PMID: 36157171 PMCID: PMC9492835 DOI: 10.3389/pore.2022.1610550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022]
Abstract
Cutaneous melanoma is the third most common type of skin cancer in the world. The incidence of melanoma is increasing in most countries, however, mortality seems to be slowly decreasing. The treatment of advanced cutaneous melanoma changed radically since 2011. The new therapeutic modalities, such as immuno- and targeted therapies give a chance to successfully reach more prolonged progression-free survival (PFS) and overall survival (OS) in patients with metastatic melanoma. Despite the great therapeutic benefit, most patients eventually develop resistance to these therapies, and the disease will progress. In some cases oligoprogression develops. In those cases local therapy, such as stereotactic radiotherapy can make it possible to continue the previously applied effective medical treatment for the benefit of patients. In our study of a total of 30 patients-20 of them received pre-treatment with systemic medical therapy-received stereotactic radiotherapy using various systems, in the National Institute of Oncology, Hungary, Budapest. We managed to prolong the systemic therapy for 12.5 months median period with the assistance of CyberKnife technique. Therapy related adverse events were mostly tolerable with only 3% of Grade 3 toxicity. We concluded that stereotactic radiotherapy and stereotactic radiosurgery, are safe, and effective therapeutic modalities for regional tumor control in cases of oligoprogression.
Collapse
Affiliation(s)
- Mihály Kispál
- Department of Dermato-Oncology, National Institute of Oncology, Budapest, Hungary
| | - Levente Zsolt Jánváry
- Department of Radiotherapy Centre, National Institute of Oncology, Budapest, Hungary
| | - Tímea Balatoni
- Department of Dermato-Oncology, National Institute of Oncology, Budapest, Hungary
| | - Stelczer Gábor
- Department of Radiotherapy Centre, National Institute of Oncology, Budapest, Hungary
| | - Imre Fedorcsák
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Bőcs Katalin
- Department of Radiology, National Institute of Oncology, Budapest, Hungary
| | - István Kenessey
- National Cancer Registry, National Institute of Oncology, Budapest, Hungary
| | - Gabriella Liszkay
- Department of Dermato-Oncology, National Institute of Oncology, Budapest, Hungary
| |
Collapse
|
16
|
van de Donk PP, Oosting SF, Knapen DG, van der Wekken AJ, Brouwers AH, Lub-de Hooge MN, de Groot DJA, de Vries EG. Molecular imaging to support cancer immunotherapy. J Immunother Cancer 2022; 10:e004949. [PMID: 35922089 PMCID: PMC9352987 DOI: 10.1136/jitc-2022-004949] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 11/04/2022] Open
Abstract
The advent of immune checkpoint inhibitors has reinvigorated the field of immuno-oncology. These monoclonal antibody-based therapies allow the immune system to recognize and eliminate malignant cells. This has resulted in improved survival of patients across several tumor types. However, not all patients respond to immunotherapy therefore predictive biomarkers are important. There are only a few Food and Drug Administration-approved biomarkers to select patients for immunotherapy. These biomarkers do not consider the heterogeneity of tumor characteristics across lesions within a patient. New molecular imaging tracers allow for whole-body visualization with positron emission tomography (PET) of tumor and immune cell characteristics, and drug distribution, which might guide treatment decision making. Here, we summarize recent developments in molecular imaging of immune checkpoint molecules, such as PD-L1, PD-1, CTLA-4, and LAG-3. We discuss several molecular imaging approaches of immune cell subsets and briefly summarize the role of FDG-PET for evaluating cancer immunotherapy. The main focus is on developments in clinical molecular imaging studies, next to preclinical studies of interest given their potential translation to the clinic.
Collapse
Affiliation(s)
- Pim P van de Donk
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sjoukje F Oosting
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daan G Knapen
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anthonie J van der Wekken
- Department of Pulmonary Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Adrienne H Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marjolijn N Lub-de Hooge
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Derk-Jan A de Groot
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Elisabeth Ge de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
17
|
Czarnecka AM, Sobczuk P, Rogala P, Świtaj T, Placzke J, Kozak K, Mariuk-Jarema A, Spałek M, Dudzisz-Śledź M, Teterycz P, Borkowska A, Rutkowski P. Efficacy of immunotherapy beyond RECIST progression in advanced melanoma: a real-world evidence. Cancer Immunol Immunother 2022; 71:1949-1958. [PMID: 35075516 DOI: 10.1007/s00262-021-03132-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 12/13/2021] [Indexed: 11/24/2022]
Abstract
Immunotherapy (ITH) holds the possibility of tumor burden decrease after initial RECIST 1.1 defined progression. The clinical concept of treating selected patients (pts) beyond disease progression (PD) is supported by so-called pseudoprogression phenomenon. The aim of this study was to evaluate real-life practice and outcomes related to treatment beyond (RECIST) progression (TBP) in advanced melanoma patients. Of 584 subsequent melanoma pts analyzed 77 (13.2%) received TBP. In this cohort, the median time to first PD (TTFP) was 5.29 months (m), while time to second PD (TTSP)-8.02 m. On TBP 23.4% pts achieved an objective response (OR), and next 42.9%-stabilization of the disease (SD). 1st PD was reported most often as the development of a new lesion or increase (> 20%) of the diameter of three or more targets. In about 50% second PD was observed as an increase in the diameter of different targets that in 1st PD. Multimodal treatment resulted in 9.82 m TTSP, while ITH alone-4.93 m (p = 0.128). An oligoprogressive pattern of first PD was associated with longer TTSP (HR 0.55, 95% CI: 0.32-0.94). Median OS after first PD was 28.75 months and correlated with OR during TBP (HR 0.18, 95% CI: 0.004-0.76). Selected clinically fit melanoma patients, despite evidence of first radiographic progression, may benefit from continued treatment with PD-1 checkpoint inhibitors, but the findings should be validated in larger prospective trials. Multidisciplinary treatment should be offered to advanced melanoma patients, including radiosurgery or stereotactic radiotherapy of single loci progressing during immunotherapy.
Collapse
Affiliation(s)
- Anna Małgorzata Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 5 W.K. Roentgena Street, 02-781, Warsaw, Poland. .,Department of Experimental Pharmacology, Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland.
| | - Paweł Sobczuk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 5 W.K. Roentgena Street, 02-781, Warsaw, Poland.,Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Rogala
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 5 W.K. Roentgena Street, 02-781, Warsaw, Poland
| | - Tomasz Świtaj
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 5 W.K. Roentgena Street, 02-781, Warsaw, Poland
| | - Joanna Placzke
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 5 W.K. Roentgena Street, 02-781, Warsaw, Poland
| | - Katarzyna Kozak
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 5 W.K. Roentgena Street, 02-781, Warsaw, Poland
| | - Anna Mariuk-Jarema
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 5 W.K. Roentgena Street, 02-781, Warsaw, Poland
| | - Mateusz Spałek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 5 W.K. Roentgena Street, 02-781, Warsaw, Poland
| | - Monika Dudzisz-Śledź
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 5 W.K. Roentgena Street, 02-781, Warsaw, Poland
| | - Paweł Teterycz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 5 W.K. Roentgena Street, 02-781, Warsaw, Poland.,Departament of Computional Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Aneta Borkowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 5 W.K. Roentgena Street, 02-781, Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 5 W.K. Roentgena Street, 02-781, Warsaw, Poland
| |
Collapse
|
18
|
FDG-PET to predict long-term outcome from anti-PD-1 therapy in metastatic melanoma. Ann Oncol 2021; 33:99-106. [PMID: 34687894 DOI: 10.1016/j.annonc.2021.10.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/30/2021] [Accepted: 10/06/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We have previously shown that 75% of patients treated with programmed cell death protein 1 (PD-1) with or without CTLA4 who have not progressed by 1 year have complete metabolic response (CMR), including two-thirds of patients with partial response (PR). We now report 5-year outcomes. PATIENTS AND METHODS Retrospective analysis of 104 patients with baseline and 1-year positron emission tomography (PET) and computed tomography (CT). The 1-year response was determined using RECIST for CT and European Organisation for Research and Treatment of Cancer (EORTC) criteria for PET. Progression-free survival (PFS) and overall survival (OS) were determined from the 1-year landmark. RESULTS At the median follow-up of 61 months (range 58-64 months) from 1-year PET, 94% remained alive and all but one had discontinued treatment after a median treatment duration of 23 months (range 1-59 months). Disease progression occurred in 19 patients (18%): 10 (53%) while on treatment and 12 (63%) in solitary sites for which 8 (67%) received local treatment. RECIST PFS rate at 5 years after PET was higher in complete response (CR) compared with PR/stable disease (SD) (93% versus 76%, respectively) and CMR compared with non-CMR (90% versus 54%, respectively). In patients with PR, 5-year PFS rate was superior in CMR (88% and 59%). A total of 35 (34%) patients (14/29 in CR, 31/78 in CMR) discontinued treatment within 12 months, largely due to toxicity, with no impact on PFS rate compared with those that continued (84% versus 78%). Despite progression events, OS rate at 5 years was excellent and similar in patients with CR and PR/SD (100% versus 91%, respectively) as well as in those with CMR and non-CMR (96% versus 87%, respectively). CONCLUSIONS Five years after the 1-year PET, sustained responses are observed in the majority of patients, particularly in those with CMR. PET continues to predict progression better than CT, particularly in those with residual disease on CT. In the minority that progress, often in solitary sites and managed locally, OS rate remains excellent. PET is effective in evaluating residual lesions on CT and can predict long-term benefit.
Collapse
|