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DePalo DK, Dugan MM, Naqvi SMH, Ollila DW, Hieken TJ, Block MS, van Houdt WJ, Wouters MWJM, Reijers SJM, Asher N, Broman KK, Duncan Z, Anderson M, Gyorki DE, Snow H, Held J, Farma JM, Vetto JT, Hui JYC, Kolbow M, Saw RPM, Lo SN, Long GV, Thompson JF, Kim Y, Karapetyan L, Ny L, van Akkooi ACJ, Olofsson Bagge R, Zager JS. A comparison of isolated limb infusion/perfusion, immune checkpoint inhibitors, and intralesional therapy as first-line treatment for patients with melanoma in-transit metastases. Cancer 2025; 131:e35636. [PMID: 39522025 DOI: 10.1002/cncr.35636] [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: 07/26/2024] [Revised: 10/04/2024] [Accepted: 10/07/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Isolated limb infusion and perfusion (ILI/ILP) has been a mainstay treatment for unresectable melanoma in-transit metastases (ITM), but increased use of immune checkpoint inhibitors (ICI) and intralesional therapy (talimogene laherparepvec [TVEC]) introduced several different management options. This study compares first-line ILI/ILP, ICI, and TVEC. METHODS Retrospective review from 12 international institutions included patients treated from 1990 to 2022 with first-line ILI/ILP, ICI, or TVEC for unresectable melanoma ITM. RESULTS A total of 551 patients were treated, with ILI/ILP (n = 356), ICI (n = 125), and TVEC (n = 70) with median follow-up of 5.5 years. Tumor burden was highest with ILI/ILP and lowest with TVEC (p = .002). Breslow thickness was lowest with TVEC (p = .007). TVEC was mostly used in stage IIIB disease versus IIIC for ILI/ILP and ICI (p = .01). Using ICI as the reference category, TVEC had the highest odds of a complete response (CR) (odds ratio, 1.96; p = .029) and a longer local progression-free survival (PFS) (hazard ratio [HR], 0.40; p = .003). ILI/ILP had shorter local PFS (HR, 1.72; p = .012), PFS (HR, 1.79; p < .001), distant metastasis-free survival (DMFS) (HR, 1.75; p = .014), overall survival (HR, 1.82; p = .009), and melanoma-specific survival (HR, 2.29; p = .004). Stage IIIB disease had longer DMFS (HR, 0.24; p < .001) compared to IIIC/D. CONCLUSIONS TVEC as first-line therapy for unresectable melanoma ITM was associated with superior CR rates and local PFS. Notably, TVEC was used in patients with a lower Breslow thickness, disease stage, and tumor burden. Therefore, when compared to ILI/ILP and ICI, TVEC should be considered as first-line therapy for unresectable stage IIIB melanoma ITM with minimal tumor burden and lower Breslow thickness.
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Affiliation(s)
- Danielle K DePalo
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Michelle M Dugan
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | | | - David W Ollila
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Tina J Hieken
- Mayo Clinic Comprehensive Cancer Center, Rochester, Minnesota, USA
| | - Matthew S Block
- Mayo Clinic Comprehensive Cancer Center, Rochester, Minnesota, USA
| | | | | | | | - Nethanel Asher
- Skin Cancer and Melanoma Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Kristy K Broman
- University of Alabama at Birmingham, Birmingham, Alabama, USA
- United States Department of Veterans Affairs, Birmingham VA Medical Center, Birmingham, Alabama, USA
| | - Zoey Duncan
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Matilda Anderson
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - David E Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Hayden Snow
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Jenny Held
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | | | - John T Vetto
- Oregon Health and Science University, Portland, Oregon, USA
| | - Jane Y C Hui
- University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Youngchul Kim
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Lilit Karapetyan
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Lars Ny
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alexander C J van Akkooi
- Netherlands Cancer Institute, Amsterdam, Netherlands
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Roger Olofsson Bagge
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA
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Dona AC, Jewett PI, Hwee S, Brown K, Solomon M, Gupta A, Teoh D, Yang G, Wolfson J, Fan Y, Blaes AH, Vogel RI. Logistic burdens of cancer care: A qualitative study. PLoS One 2024; 19:e0300852. [PMID: 38573993 PMCID: PMC10994350 DOI: 10.1371/journal.pone.0300852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
Cancer treatment often creates logistic conflicts with everyday life priorities; however, these challenges and how they are subjectively experienced have been largely unaddressed in cancer care. Our goal was to describe time and logistic requirements of cancer care and whether and how they interfered with daily life and well-being. We conducted interviews with 20 adults receiving cancer-directed treatment at a single academic cancer center. We focused on participants' perception of the time, effort, and energy-intensiveness of cancer care activities, organization of care requirements, and preferences in how to manage the logistic burdens of their cancer care. Participant interview transcripts were analyzed using an inductive thematic analysis approach. Burdens related to travel, appointment schedules, healthcare system navigation, and consequences for relationships had roots both at the system-level (e.g. labs that were chronically delayed, protocol-centered rather than patient-centered bureaucratic requirements) and in individual circumstances (e.g. greater stressors among those working and/or have young children versus those who are retired) that determined subjective burdensomeness, which was highest among patients who experienced multiple sources of burdens simultaneously. Our study illustrates how objective burdens of cancer care translate into subjective burden depending on patient circumstances, emphasizing that to study burdens of care, an exclusive focus on objective measures does not capture the complexity of these issues. The complex interplay between healthcare system factors and individual circumstances points to clinical opportunities, for example helping patients to find ways to meet work and childcare requirements while receiving care.
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Affiliation(s)
- Allison C. Dona
- School of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Patricia I. Jewett
- Department of Obstetrics, Gynecology, and Women’s Health, University of Minnesota, Minneapolis, Minnesota, United States of America
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Sharon Hwee
- Division of Pediatric Hematology and Oncology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Katherine Brown
- Department of Obstetrics, Gynecology, and Women’s Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Matia Solomon
- Department of Obstetrics, Gynecology, and Women’s Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Arjun Gupta
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Deanna Teoh
- Department of Obstetrics, Gynecology, and Women’s Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Guang Yang
- Daynamica, Inc., Chanhassen, Minnesota, United States of America
| | - Julian Wolfson
- Daynamica, Inc., Chanhassen, Minnesota, United States of America
- Division of Biostatistics and Health Data Science, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Yingling Fan
- Daynamica, Inc., Chanhassen, Minnesota, United States of America
- Humphrey School of Public Affairs, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Anne H. Blaes
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Rachel I. Vogel
- Department of Obstetrics, Gynecology, and Women’s Health, University of Minnesota, Minneapolis, Minnesota, United States of America
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