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Yacoub I, Rayn K, Choi JI, Bakst R, Chhabra A, Qian JY, Johnstone P, Simone CB. The Role of Radiation, Immunotherapy, and Chemotherapy in the Management of Locally Advanced or Metastatic Cutaneous Malignancies. Cancers (Basel) 2024; 16:3920. [PMID: 39682109 PMCID: PMC11640331 DOI: 10.3390/cancers16233920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Revised: 10/31/2024] [Accepted: 11/21/2024] [Indexed: 12/18/2024] Open
Abstract
INTRODUCTION Skin cancer impacts a significant proportion of the population. While surgical management is often the mainstay of treatment, advanced or metastatic cutaneous malignancies require additional local and/or systemic therapies. METHODS A review of the literature was performed studying the use of radiation therapy, chemotherapy, and immunotherapy for locally advanced or metastatic cutaneous malignancies. RESULTS A summary of the present literature on the management of locally advanced or metastatic cutaneous malignancies is presented across cutaneous head and neck basal cell carcinoma, squamous cell carcinoma, melanoma, and Merkel cell carcinoma. The addition of multidisciplinary therapies to resection is often associated with improved outcomes. CONCLUSION The management of cutaneous head and neck malignancies requires an approach integrating multiple specialties, to optimize outcomes and minimize toxicities.
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Affiliation(s)
| | - Kareem Rayn
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - J. Isabelle Choi
- New York Proton Center, New York, NY 10035, USA
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Richard Bakst
- New York Proton Center, New York, NY 10035, USA
- Department of Radiation Oncology, Mount Sinai Medical Center, New York, NY 10029, USA
| | - Arpit Chhabra
- New York Proton Center, New York, NY 10035, USA
- Department of Radiation Oncology, Mount Sinai Medical Center, New York, NY 10029, USA
| | - Joshua Y. Qian
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Peter Johnstone
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Charles B. Simone
- New York Proton Center, New York, NY 10035, USA
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Amin T, Hossain A, Jerin N, Mahmud I, Rahman MA, Rafiqul Islam SM, Islam SMBUL. Immunoediting Dynamics in Glioblastoma: Implications for Immunotherapy Approaches. Cancer Control 2024; 31:10732748241290067. [PMID: 39353594 PMCID: PMC11459535 DOI: 10.1177/10732748241290067] [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: 02/20/2024] [Revised: 09/14/2024] [Accepted: 09/23/2024] [Indexed: 10/04/2024] Open
Abstract
Glioblastoma is an aggressive primary brain tumor that poses many therapeutic difficulties because of the high rate of proliferation, genetic variability, and its immunosuppressive microenvironment. The theory of cancer immunoediting, which includes the phases of elimination, equilibrium, and escape, offers a paradigm for comprehending interactions between the immune system and glioblastoma. Immunoediting indicates the process by which immune cells initially suppress tumor development, but thereafter select for immune-resistant versions leading to tumor escape and progression. The tumor microenvironment (TME) in glioblastoma is particularly immunosuppressive, with regulatory T cells and myeloid-derived suppressor cells being involved in immune escape. To achieve an efficient immunotherapy for glioblastoma, it is crucial to understand these mechanisms within the TME. Existing immunotherapeutic modalities such as chimeric antigen receptor T cells and immune checkpoint inhibitors have been met with some level of resistance because of the heterogeneous nature of the immune response to glioblastoma. Solving these issues is critical to develop novel strategies capable of modulating the TME and re-establishing normal immune monitoring. Further studies should be conducted to identify the molecular and cellular events that underlie the immunosuppressive tumor microenvironment in glioblastoma. Comprehending and modifying the stages of immunoediting in glioblastoma could facilitate the development of more potent and long-lasting therapies.
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Affiliation(s)
- Tasbir Amin
- Department of Biochemistry & Microbiology, North South University, Dhaka, Bangladesh
| | - Amana Hossain
- Department of Biochemistry & Microbiology, North South University, Dhaka, Bangladesh
| | - Nusrat Jerin
- Department of Biochemistry & Microbiology, North South University, Dhaka, Bangladesh
| | - Imteaz Mahmud
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Md Ahasanur Rahman
- Department of Physiology and Biophysics, Howard University, College of Medicine, Washington, DC, USA
| | - SM Rafiqul Islam
- Surgery Branch, National Cancer Institute, National Institute of Health, Bethesda, USA
| | - S M Bakhtiar UL Islam
- Department of Biochemistry & Microbiology, North South University, Dhaka, Bangladesh
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Sharon S, Daher-Ghanem N, Zaid D, Gough MJ, Kravchenko-Balasha N. The immunogenic radiation and new players in immunotherapy and targeted therapy for head and neck cancer. FRONTIERS IN ORAL HEALTH 2023; 4:1180869. [PMID: 37496754 PMCID: PMC10366623 DOI: 10.3389/froh.2023.1180869] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/27/2023] [Indexed: 07/28/2023] Open
Abstract
Although treatment modalities for head and neck cancer have evolved considerably over the past decades, survival rates have plateaued. The treatment options remained limited to definitive surgery, surgery followed by fractionated radiotherapy with optional chemotherapy, and a definitive combination of fractionated radiotherapy and chemotherapy. Lately, immunotherapy has been introduced as the fourth modality of treatment, mainly administered as a single checkpoint inhibitor for recurrent or metastatic disease. While other regimens and combinations of immunotherapy and targeted therapy are being tested in clinical trials, adapting the appropriate regimens to patients and predicting their outcomes have yet to reach the clinical setting. Radiotherapy is mainly regarded as a means to target cancer cells while minimizing the unwanted peripheral effect. Radiotherapy regimens and fractionation are designed to serve this purpose, while the systemic effect of radiation on the immune response is rarely considered a factor while designing treatment. To bridge this gap, this review will highlight the effect of radiotherapy on the tumor microenvironment locally, and the immune response systemically. We will review the methodology to identify potential targets for therapy in the tumor microenvironment and the scientific basis for combining targeted therapy and radiotherapy. We will describe a current experience in preclinical models to test these combinations and propose how challenges in this realm may be faced. We will review new players in targeted therapy and their utilization to drive immunogenic response against head and neck cancer. We will outline the factors contributing to head and neck cancer heterogeneity and their effect on the response to radiotherapy. We will review in-silico methods to decipher intertumoral and intratumoral heterogeneity and how these algorithms can predict treatment outcomes. We propose that (a) the sequence of surgery, radiotherapy, chemotherapy, and targeted therapy should be designed not only to annul cancer directly, but to prime the immune response. (b) Fractionation of radiotherapy and the extent of the irradiated field should facilitate systemic immunity to develop. (c) New players in targeted therapy should be evaluated in translational studies toward clinical trials. (d) Head and neck cancer treatment should be personalized according to patients and tumor-specific factors.
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Affiliation(s)
- Shay Sharon
- Department of Oral and Maxillofacial Surgery, Hadassah Medical Center, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- The Institute of Biomedical and Oral Research, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Oral and Maxillofacial Surgery, Boston University and Boston Medical Center, Boston, MA, United States
| | - Narmeen Daher-Ghanem
- The Institute of Biomedical and Oral Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Deema Zaid
- The Institute of Biomedical and Oral Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael J. Gough
- Earle A. Chiles Research Institute, Robert W. Franz Cancer Center, Providence Portland Medical Center, Portland, OR, United States
| | - Nataly Kravchenko-Balasha
- The Institute of Biomedical and Oral Research, The Hebrew University of Jerusalem, Jerusalem, Israel
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4
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Garbe C, Amaral T, Peris K, Hauschild A, Arenberger P, Basset-Seguin N, Bastholt L, Bataille V, Del Marmol V, Dréno B, Fargnoli MC, Forsea AM, Grob JJ, Hoeller C, Kaufmann R, Kelleners-Smeets N, Lallas A, Lebbé C, Lytvynenko B, Malvehy J, Moreno-Ramirez D, Nathan P, Pellacani G, Saiag P, Stratigos AJ, Van Akkooi ACJ, Vieira R, Zalaudek I, Lorigan P. European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment - Update 2022. Eur J Cancer 2022; 170:256-284. [PMID: 35623961 DOI: 10.1016/j.ejca.2022.04.018] [Citation(s) in RCA: 132] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A unique collaboration of multidisciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO), and the European Organization of Research and Treatment of Cancer (EORTC) was formed to make recommendations on cutaneous melanoma diagnosis and treatment, based on the systematic literature reviews and the experts' experience. Cutaneous melanomas are excised with one to 2-cm safety margins. Sentinel lymph node dissection shall be performed as a staging procedure in patients with tumor thickness ≥1.0 mm or ≥0.8 mm with additional histological risk factors, although there is as yet no clear survival benefit for this approach. Therapeutic decisions in stage III/IV patients should be primarily made by an interdisciplinary oncology team ("tumor board"). Adjuvant therapies can be proposed in stage III/completely resected stage IV patients and are primarily anti-PD-1, independent of mutational status, or alternatively dabrafenib plus trametinib for BRAF mutant patients. In distant metastases (stage IV), either resected or not, systemic treatment is always indicated. For first-line treatment particularly in BRAF wild-type patients, immunotherapy with PD-1 antibodies alone or in combination with CTLA-4 antibodies shall be considered. In stage IV melanoma with a BRAF-V600 E/K mutation, first-line therapy with BRAF/MEK inhibitors can be offered as an alternative to immunotherapy. In patients with primary resistance to immunotherapy and harboring a BRAF-V600 E/K mutation, this therapy shall be offered as second-line therapy. Systemic therapy in stage III/IV melanoma is a rapidly changing landscape, and it is likely that these recommendations may change in the near future.
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Affiliation(s)
- Claus Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany.
| | - Teresa Amaral
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Ketty Peris
- Institute of Dermatology, Università Cattolica, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Nicole Basset-Seguin
- Université Paris Cite, AP-HP, Department of Dermatology INSERM U 976 Hôpital, Saint Louis Paris France
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London, SE1 7EH, United Kingdom
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Brigitte Dréno
- Dermatology Department, CHU Nantes, CIC 1413, CRCINA, University Nantes, Nantes, France
| | - Maria C Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ana-Maria Forsea
- Dermatology Department, Elias University Hospital, Carol Davila University of Medicine and Pharmacy Bucharest, Romania
| | | | | | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | | | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Celeste Lebbé
- Université Paris Cite, AP-HP, Department of Dermatology INSERM U 976 Hôpital, Saint Louis Paris France
| | - Bodhan Lytvynenko
- Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Josep Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - David Moreno-Ramirez
- Medical-&-Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Paul Nathan
- Mount-Vernon Cancer Centre, Northwood United Kingdom
| | | | - Philippe Saiag
- University Department of Dermatology, Université de Versailles-Saint Quentin en Yvelines, APHP, Boulogne, France
| | - Alexander J Stratigos
- First Department of Dermatology, University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Alexander C J Van Akkooi
- Melanoma Institute Australia, The University of Sydney, and Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Ricardo Vieira
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Paul Lorigan
- The University of Manchester, Oxford Rd, Manchester, M13 9PL, United Kingdom
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van Akkooi ACJ, Zijlker LP, Wouters MWJM. Neoadjuvant Immune Checkpoint Inhibitor Therapy in Melanoma: Efficacy, Safety and Timing. BioDrugs 2022; 36:373-380. [PMID: 35397089 PMCID: PMC9148869 DOI: 10.1007/s40259-022-00525-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 11/27/2022]
Abstract
The introduction of effective systemic therapies has significantly changed the treatment of stage III and IV melanoma. Both immune checkpoint inhibitors and targeted therapies have improved recurrence-free survival in the adjuvant setting. Recent interest has sparked for neoadjuvant systemic therapy with immune checkpoint inhibitors. The intended benefit of pre-operative treatment with immunotherapy is amongst others to enable tailoring of the surgery and adjuvant systemic therapy according to the treatment response. Most importantly, recurrence-free survival might be improved by neoadjuvant systemic therapy over the current standard of care of surgery followed by adjuvant systemic therapy. The first phase I and II trials investigating anti-PD1 inhibitors, both as a single agent and in combination with anti-CTLA-4 inhibitors or other therapeutic agents, have shown promising results. Pathological complete response on neoadjuvant systemic therapy seems a valid surrogate endpoint for relapse-free and overall survival. Pathological complete response rates in these trials vary between 30 and 70%. The optimal dose with respect to efficacy and toxicity and the interval between systemic and surgical treatment remain important issues to address. Accumulating follow-up data and ongoing phase III studies must prove if neoadjuvant systemic therapy is superior to surgery followed by standard-of-care adjuvant therapy.
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Affiliation(s)
- Alexander C J van Akkooi
- Melanoma Institute Australia, The University of Sydney, Crows Nest, PO Box 1479, Sydney, NSW, 1585, Australia.
- Royal Prince Alfred Hospital, Sydney, NSW, Australia.
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | | | - Michel W J M Wouters
- Netherlands Cancer Institute, Amsterdam, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
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6
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Kumar P, Brazel D, DeRogatis J, Valerin JBG, Whiteson K, Chow WA, Tinoco R, Moyers JT. The cure from within? a review of the microbiome and diet in melanoma. Cancer Metastasis Rev 2022; 41:261-280. [PMID: 35474500 PMCID: PMC9042647 DOI: 10.1007/s10555-022-10029-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/28/2022] [Indexed: 12/17/2022]
Abstract
Therapy for cutaneous melanoma, the deadliest of the skin cancers, is inextricably linked to the immune system. Once thought impossible, cures for metastatic melanoma with immune checkpoint inhibitors have been developed within the last decade and now occur regularly in the clinic. Unfortunately, half of tumors do not respond to checkpoint inhibitors and efforts to further exploit the immune system are needed. Tantalizing associations with immune health and gut microbiome composition suggest we can improve the success rate of immunotherapy. The gut contains over half of the immune cells in our bodies and increasingly, evidence is linking the immune system within our gut to melanoma development and treatment. In this review, we discuss the importance the skin and gut microbiome may play in the development of melanoma. We examine the differences in the microbial populations which inhabit the gut of those who develop melanoma and subsequently respond to immunotherapeutics. We discuss the role of dietary intake on the development and treatment of melanoma. And finally, we review the landscape of published and registered clinical trials therapeutically targeting the microbiome in melanoma through dietary supplements, fecal microbiota transplant, and microbial supplementation.
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Affiliation(s)
- Priyanka Kumar
- Department of Medicine, University of California Irvine, Orange, CA, USA
| | - Danielle Brazel
- Department of Medicine, University of California Irvine, Orange, CA, USA
| | - Julia DeRogatis
- Department of Molecular Biology and Biochemistry, School of Biological Sciences, University of California, Irvine, CA, USA
| | - Jennifer B Goldstein Valerin
- Division of Hematology and Oncology, Department of Medicine, University of California Irvine, 101 The City Drive South, Building 200, Orange, CA, 92868, USA
| | - Katrine Whiteson
- Department of Molecular Biology and Biochemistry, School of Biological Sciences, University of California, Irvine, CA, USA
| | - Warren A Chow
- Division of Hematology and Oncology, Department of Medicine, University of California Irvine, 101 The City Drive South, Building 200, Orange, CA, 92868, USA
| | - Roberto Tinoco
- Department of Molecular Biology and Biochemistry, School of Biological Sciences, University of California, Irvine, CA, USA
| | - Justin T Moyers
- Division of Hematology and Oncology, Department of Medicine, University of California Irvine, 101 The City Drive South, Building 200, Orange, CA, 92868, USA.
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7
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Ernst M, Giubellino A. The Current State of Treatment and Future Directions in Cutaneous Malignant Melanoma. Biomedicines 2022; 10:822. [PMID: 35453572 PMCID: PMC9029866 DOI: 10.3390/biomedicines10040822] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 02/01/2023] Open
Abstract
Malignant melanoma is the leading cause of death among cutaneous malignancies. While its incidence is increasing, the most recent cancer statistics show a small but clear decrease in mortality rate. This trend reflects the introduction of novel and more effective therapeutic regimens, including the two cornerstones of melanoma therapy: immunotherapies and targeted therapies. Immunotherapies exploit the highly immunogenic nature of melanoma by modulating and priming the patient's own immune system to attack the tumor. Treatments combining immunotherapies with targeted therapies, which disable the carcinogenic products of mutated cancer cells, have further increased treatment efficacy and durability. Toxicity and resistance, however, remain critical challenges to the field. The present review summarizes past treatments and novel therapeutic interventions and discusses current clinical trials and future directions.
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Affiliation(s)
| | - Alessio Giubellino
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA;
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8
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Babbush KM, Damanpour S. Melanoma Diagnosis and Treatment in the Elderly. CURRENT GERIATRICS REPORTS 2020. [DOI: 10.1007/s13670-020-00330-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Goepfert RP, Myers JN, Gershenwald JE. Updates in the evidence-based management of cutaneous melanoma. Head Neck 2020; 42:3396-3404. [PMID: 33463835 DOI: 10.1002/hed.26398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 06/02/2020] [Accepted: 07/14/2020] [Indexed: 11/11/2022] Open
Abstract
Treatment of cutaneous melanoma is changing with significant developments over the past several years that promise to reshape the field of melanoma surgical oncology. Modifications to the staging system based on analysis of a large international dataset, the timing and extent of regional lymphadenectomy, the emergence of effective systemic therapies in the neoadjuvant and adjuvant setting, and the role of adjuvant radiation are all undergoing a data-driven evolution. Surgeon engagement in multidisciplinary decision making remains an essential component of contemporary management for patients across all stages of melanoma and demands specific involvement of head and neck surgical oncologists.
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Affiliation(s)
- Ryan P Goepfert
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey N Myers
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, Department of Melanoma Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Testori AAE, Chiellino S, van Akkooi AC. Adjuvant Therapy for Melanoma: Past, Current, and Future Developments. Cancers (Basel) 2020; 12:cancers12071994. [PMID: 32708268 PMCID: PMC7409361 DOI: 10.3390/cancers12071994] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/02/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023] Open
Abstract
This review describes the progress that the concept of adjuvant therapies has undergone in the last 50 years and focuses on the most recent development where an adjuvant approach has been scientifically evaluated in melanoma clinical trials. Over the past decade the development of immunotherapies and targeted therapies has drastically changed the treatment of stage IV melanoma patients. These successes led to trials studying the same therapies in the adjuvant setting, in high risk resected stage III and IV melanoma patients. Adjuvant immune checkpoint blockade with anti-CTLA-4 antibody ipilimumab was the first drug to show an improvement in recurrence-free and overall survival but this was accompanied by high severe toxicity rates. Therefore, these results were bypassed by adjuvant treatment with anti-PD-1 agents nivolumab and pembrolizumab and BRAF-directed target therapy, which showed even better recurrence-free survival rates with more favorable toxicity rates. The whole concept of adjuvant therapy may be integrated with the new neoadjuvant approaches that are under investigation through several clinical trials. However, there is still no data available on whether the effective adjuvant therapy that patients finally have at their disposal could be offered to them while waiting for recurrence, sparing at least 50% of them a potentially long-term toxic side effect but with the same rate of overall survival (OS). Adjuvant therapy for melanoma has radically changed over the past few years—anti-PD-1 or BRAF-directed therapy is the new standard of care.
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Affiliation(s)
- Alessandro A. E. Testori
- Department of Dermatology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Correspondence: or
| | - Silvia Chiellino
- Department of Medical Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Alexander C.J. van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute–Antoni van Leeuwenhoek, 1066cx Amsterdam, The Netherlands;
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11
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Baetz TD, Fletcher GG, Knight G, McWhirter E, Rajagopal S, Song X, Petrella TM. Systemic adjuvant therapy for adult patients at high risk for recurrent melanoma: A systematic review. Cancer Treat Rev 2020; 87:102032. [PMID: 32473511 DOI: 10.1016/j.ctrv.2020.102032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/27/2022]
Abstract
Cutaneous melanoma is typically treated with wide local excision and, when appropriate, a sentinel node biopsy. Many patients are cured with this approach but for patients who have cancers with high risk features there is a significant risk of local and distant relapse and death. Interferon-based adjuvant therapy was recommended in the past but had modest results with significant toxicity. Recently, new therapies (immune checkpoint inhibitors and targeted therapies) have been found to be effective in the treatment of patients with metastatic melanoma and many of these therapies have been evaluated and found to be effective in the adjuvant treatment of high risk patients with melanoma. This systematic review of adjuvant therapies for cutaneous and mucosal melanoma was conducted for Ontario Health (Cancer Care Ontario) as the basis of a clinical practice guideline to address the question of whether patients with completely resected melanoma should be considered for adjuvant systemic therapy and which adjuvant therapy should be used.
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Affiliation(s)
- Tara D Baetz
- Department of Oncology, Queen's University, Kingston, ON, Canada; Cancer Centre of Southeastern Ontario/Kingston General Hospital, Kingston, ON, Canada.
| | - Glenn G Fletcher
- Program in Evidence-Based Care, McMaster University, Hamilton, ON, Canada
| | - Gregory Knight
- Department of Oncology, McMaster University, Hamilton, ON, Canada; Grand River Regional Cancer Centre, Kitchener, ON, Canada
| | - Elaine McWhirter
- Department of Oncology, McMaster University, Hamilton, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada
| | | | - Xinni Song
- Department of Internal Medicine, Division of Medical Oncology, University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Teresa M Petrella
- University of Toronto, Toronto, ON, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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12
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Franke V, van Akkooi ACJ. The extent of surgery for stage III melanoma: how much is appropriate? Lancet Oncol 2020; 20:e167-e174. [PMID: 30842060 DOI: 10.1016/s1470-2045(19)30099-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 12/19/2022]
Abstract
Since the first documented lymph node dissection in 1892, many trials have investigated the potential effect of this surgical procedure on survival in patients with melanoma. Two randomised controlled trials were unable to demonstrate improved survival with completion lymph node dissection versus nodal observation in patients with sentinel node-positive disease, although patients with larger sentinel node metastases (>1 mm) might benefit more from observation than from dissection, and could potentially be considered for adjuvant systemic therapy instead of complete dissection. Adjuvant immunotherapy with high-dose ipilimumab has led to improvements in overall survival, whereas therapy with nivolumab and pembrolizumab has improved relapse-free survival with greater safety. Furthermore, adjuvant-targeted therapy with dabrafenib and trametinib has improved survival outcomes in BRAFV600E and BRAFV600K-mutated melanomas. Three neoadjuvant trials have all shown high response rates, including complete responses, after short-term combination therapy with ipilimumab and nivolumab with no recurrences so far, although follow-up is still short. Despite the absence of a survival benefit with completion lymph node dissection in patients with sentinel node-positive or negative disease, the use of sentinel node staging will increase because of the introduction of effective adjuvant therapies. However, routine completion lymph node dissection for sentinel node-positive disease should be reconsidered. Accordingly, existing clinical guidelines are currently being revised. For palpable (macroscopic) nodal disease, the type and extent of surgery could be reduced if the index node can accurately predict the response and if studies show that lymph node dissection can be safely foregone in patients with a complete response. Overall, the appropriate type and extent of surgery for stage III melanoma is changing and becoming more personalised.
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Affiliation(s)
- Viola Franke
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Alexander C J van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands.
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13
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Eggermont AMM, Rutkowski P, Dutriaux C, Hofman-Wellenhof R, Dziewulski P, Marples M, Grange F, Lok C, Pennachioli E, Robert C, van Akkooi ACJ, Bastholt L, Minisini A, Marshall E, Salès F, Grob JJ, Bechter O, Schadendorf D, Marreaud S, Kicinski M, Suciu S, Testori AAE. Adjuvant therapy with pegylated interferon-alfa2b vs observation in stage II B/C patients with ulcerated primary: Results of the European Organisation for Research and Treatment of Cancer 18081 randomised trial. Eur J Cancer 2020; 133:94-103. [PMID: 32470710 DOI: 10.1016/j.ejca.2020.04.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Subgroup analyses of two large EORTC adjuvant interferon-alpha2b (IFNα-2b) vs observation randomised trials demonstrated that a treatment benefit was observed only in patients with an ulcerated melanoma without palpable nodes (hazard ratio [HR] for recurrence-free survival [RFS] was 0.69). This was confirmed by a meta-analysis of 15 adjuvant IFN trials (HR: 0.79). PATIENTS AND METHODS In the EORTC 18081 trial, sentinel node-negative stage II patients with an ulcerated primary melanoma were 1:1 randomised between pegylated (PEG)-IFNα-2b at 3 μg/kg/week subcutaneously and observation, for 2 years, or until disease recurrence or unacceptable toxicity in spite of dose adjustments to maintain an Eastern Cooperative Oncology Group performance status of 0 or 1. Main end-point was RFS. Secondary end-points included distant metastasis-free survival (DMFS), overall survival, and safety (EudraCT Number: 2009-010273-20). RESULTS Between February 2013 and January 2017, only 112 patients were randomised, 56 in each arm. The trial was stopped early for lack of recruitment. At a 3.4-year median follow-up, the estimated HR for the PEG-IFNα-2b group compared with the observation group regarding RFS was 0.66 (95% confidence interval [CI]: 0.32-1.37), and the 3-year RFS rate was 80.0% (95% CI: 65.7-88.8%) and 72.9% (95% CI: 58.3-83.0%), respectively. DMFS was prolonged: HR: 0.39 (95% CI: 0.15-0.97), and the 3-year DMFS rate was 90.6% (95% CI: 78.9-96.0%) vs 76.4% (95% CI: 62.1-85.9%). One patient in the PEG-IFNα-2b group died compared with 4 in the observation group. Fifty-four patients started PEG-IFNα-2b treatment, 16 (29%) completed 2 years of treatment, 2 (4%) stopped due to recurrence, 23 (43%) due to toxicity and 14 (25%) due to other reasons. CONCLUSIONS The EORTC 18081 PEG-IFNα-2b randomised trial, observed a similar HR (0.69) for RFS as the previous EORTC trials (0.69). In countries without access to new drugs, adjuvant (PEG)-IFNα-2b treatment is an option for patients with ulcerated melanomas without palpable nodes.
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Affiliation(s)
| | - Piotr Rutkowski
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
| | - Caroline Dutriaux
- CHU de Bordeaux, Groupe Hospitalier Saint-André, Hopital Saint-André, Bordeaux, France.
| | | | - Peter Dziewulski
- Mid Essex Hospitals, Broomfield Hospital, Broomfield, United Kingdom.
| | - Maria Marples
- Leeds Teaching Hospitals NHS Trust, St. James's University Hospital, Leeds, United Kingdom.
| | | | | | | | - Caroline Robert
- Gustave Roussy, Villejuif & Paris-Saclay University, Saint-Aubin, France.
| | | | | | | | - Ernest Marshall
- St Helens & Knowsley NHS Trust, Whiston Hospital, Prescot, United Kingdom.
| | - François Salès
- Institut Jules Bordet-Hopital Universitaire ULB, Brussels, Belgium.
| | - Jean-Jacques Grob
- Assistance Publique, Hopitaux de Marseille, Hôpital de La Timone (APHM), Marseille, France.
| | - Oliver Bechter
- Department of General Medical Oncology, University Hospitals Leuven, Campus Gasthuisberg, Leuven, Belgium.
| | - Dirk Schadendorf
- University Hospital Essen, Essen & German Cancer Consortium, Heidelberg, Germany.
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14
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Garbe C, Amaral T, Peris K, Hauschild A, Arenberger P, Bastholt L, Bataille V, Del Marmol V, Dréno B, Fargnoli MC, Grob JJ, Höller C, Kaufmann R, Lallas A, Lebbé C, Malvehy J, Middleton M, Moreno-Ramirez D, Pellacani G, Saiag P, Stratigos AJ, Vieira R, Zalaudek I, Eggermont AMM. European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment - Update 2019. Eur J Cancer 2019; 126:159-177. [PMID: 31866016 DOI: 10.1016/j.ejca.2019.11.015] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 12/19/2022]
Abstract
A unique collaboration of multidisciplinary experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization for Research and Treatment of Cancer (EORTC) was formed to make recommendations on cutaneous melanoma diagnosis and treatment, based on systematic literature reviews and the experts' experience. Cutaneous melanomas are excised with 1- to 2-cm safety margins. Sentinel lymph node dissection shall be performed as a staging procedure in patients with tumour thickness ≥1.0 mm or ≥0.8 mm with additional histological risk factors, although there is as yet no clear survival benefit for this approach. Therapeutic decisions in stage III/IV patients should be primarily made by an interdisciplinary oncology team ("Tumor Board"). Adjuvant therapies in stage III/IV patients are primarily anti-PD-1, independent of mutational status, or dabrafenib plus trametinib for BRAF-mutant patients. In distant metastasis, either resected or not, systemic treatment is indicated. For first-line treatment, particularly in BRAF wild-type patients, immunotherapy with PD-1 antibodies alone or in combination with CTLA-4 antibodies shall be considered. In particular scenarios for patients with stage IV melanoma and a BRAF-V600 E/K mutation, first-line therapy with BRAF/MEK inhibitors can be offered as an alternative to immunotherapy. In patients with primary resistance to immunotherapy and harbouring a BRAF-V600 E/K mutation, this therapy shall be offered in second-line. Systemic therapy in stage III/IV melanoma is a rapidly changing landscape, and it is likely that these recommendations may change in the near future.
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Affiliation(s)
- Claus Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany.
| | - Teresa Amaral
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany; Portuguese Air Force Health Care Direction, Lisbon, Portugal
| | - Ketty Peris
- Institute of Dermatology, Università Cattolica, Rome, Italy; Fondazione Policlinico Universitario A, Gemelli - IRCCS, Rome, Italy
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - Petr Arenberger
- Department of Dermatovenerology, Third Faculty of Medicine, Charles University of Prague, Prague, Czech Republic
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Denmark
| | - Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London, SE1 7EH, UK
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Brigitte Dréno
- Dermatology Department, CHU Nantes, CIC 1413, CRCINA, University Nantes, Nantes, France
| | | | | | - Christoph Höller
- Department of Dermatology, Medical University of Vienna, Austria
| | - Roland Kaufmann
- Department of Dermatology, Venerology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Celeste Lebbé
- APHP Department of Dermatology, INSERM U976, University Paris 7 Diderot, Saint-Louis University Hospital, Paris, France
| | - Josep Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Mark Middleton
- NIHR Biomedical Research Centre, University of Oxford, UK
| | - David Moreno-Ramirez
- Medical-&-Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Philippe Saiag
- University Department of Dermatology, Université de Versailles-Saint Quentin en Yvelines, APHP, Boulogne, France
| | - Alexander J Stratigos
- 1st Department of Dermatology, University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Ricardo Vieira
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
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15
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Sharma R, Koruth R, Kanters S, Druyts E, Tarhini A. Comparative efficacy and safety of dabrafenib in combination with trametinib versus competing adjuvant therapies for high-risk melanoma. J Comp Eff Res 2019; 8:1349-1363. [PMID: 31778073 DOI: 10.2217/cer-2019-0061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim To conduct a systematic literature review of high-risk resectable cutaneous melanoma adjuvant therapeutics and compare safety and efficacy. Methods: The systematic literature review included randomized controlled trials investigating: dabrafenib plus trametinib (DAB + TRAM), nivolumab, pembrolizumab, ipilimumab, vemurafenib, chemotherapy and interferons. Outcomes included overall survival (OS), relapse-free survival, distant metastasis-free survival and safety. All outcomes were synthesized using Bayesian network meta-analysis. Results: Across relapse-free survival, distant metastasis-free survival and OS, DAB + TRAM had the lowest estimated hazards of respective events relative to all other treatments (exception relative to nivolumab in OS). Differences were significant relative to placebo, chemotherapy, interferons and ipilimumab. Conclusion: DAB + TRAM has improved efficacy over historical treatment options (ipilimumab, interferons and chemotherapy) and comparable efficacy with other targeted and immune checkpoint inhibitors.
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Affiliation(s)
- Rohini Sharma
- Precision Xtract, Vancouver, British Columbia, V6H 3Y4, Canada
| | - Roy Koruth
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936, USA
| | - Steve Kanters
- Precision Xtract, Vancouver, British Columbia, V6H 3Y4, Canada
| | - Eric Druyts
- Precision Xtract, Vancouver, British Columbia, V6H 3Y4, Canada
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936, USA
- Moffitt Comprehensive Cancer Center, Tampa, FL 33612, USA
| | - Ahmad Tarhini
- Moffitt Comprehensive Cancer Center, Tampa, FL 33612, USA
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16
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Gamboa AC, Lowe M, Yushak ML, Delman KA. Surgical Considerations and Systemic Therapy of Melanoma. Surg Clin North Am 2019; 100:141-159. [PMID: 31753109 DOI: 10.1016/j.suc.2019.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Recent advances in effective medical therapies have markedly improved the prognosis for patients with advanced melanoma. This article aims to highlight the current era of integrated multidisciplinary care of patients with advanced melanoma by outlining current approved therapies, including immunotherapy, targeted therapy, radiation therapy, and other strategies used in both the adjuvant and the neoadjuvant setting as well as the evolving role of surgical intervention in the changing landscape of advanced melanoma.
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Affiliation(s)
- Adriana C Gamboa
- Division of Surgical Oncology, Emory University School of Medicine, 1365B Clifton Road Northeast, Suite B4000, Atlanta, GA 30322, USA
| | - Michael Lowe
- Division of Surgical Oncology, Emory University School of Medicine, 1365B Clifton Road Northeast, Suite B4000, Atlanta, GA 30322, USA
| | - Melinda L Yushak
- Division of Medical Oncology, Emory University School of Medicine, 1365B4 Clifton Road Northeast, Suite B4000, Atlanta, GA 30322, USA
| | - Keith A Delman
- Division of Surgical Oncology, Emory University School of Medicine, 1365B Clifton Road Northeast, Suite B4000, Atlanta, GA 30322, USA.
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17
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Spagnolo F, Boutros A, Tanda E, Queirolo P. The adjuvant treatment revolution for high-risk melanoma patients. Semin Cancer Biol 2019; 59:283-289. [PMID: 31445219 DOI: 10.1016/j.semcancer.2019.08.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/05/2019] [Accepted: 08/20/2019] [Indexed: 01/06/2023]
Abstract
The past 5 years have witnessed the results of many practice-changing studies that have dramatically improved the landscape of adjuvant therapy in patients with resected, high-risk melanoma. After a 20-year era of adjuvant interferon, the anti-CTLA-4 and anti-PD-1 immune-checkpoint inhibitors, and MAPK-directed targeted therapy brought a revolution into the adjuvant treatment of melanoma. These results came along with the practice-changing results of two large multicenter studies showing no benefit in terms of overall survival for completion lymph node dissection after positive sentinel node biopsy. In this review, we summarized the current state of the art of the adjuvant treatment of high-risk melanoma, with a view on future perspectives.
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Affiliation(s)
| | - Andrea Boutros
- Skin Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Enrica Tanda
- Skin Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Paola Queirolo
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, IEO, European Institute of Oncology IRCCS, Milan, Italy.
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18
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Abstract
OPINION STATEMENT In recent years, the number of patients with malignant melanoma has continued to increase globally; surgery remains the first treatment option for patients with resectable melanoma. Adjuvant therapy for patients with stage III and IV melanoma following surgical resection has gradually been approved. After complete resection, these patients can probably derive significant benefit from adjuvant therapy. New treatments that improve the long-term survival of patients with unresectable advanced or metastatic melanoma are currently under evaluation in adjuvant therapy to increase relapse-free survival and overall survival. We here review several relevant clinical trials of radiotherapy, systemic immune therapies, molecular-targeted therapies, and neoadjuvant therapies in order to shed light on most suitable adjuvant therapy. The findings of this review include the following: The use of interferon-α2b will be restricted for patients with ulcerated primary melanoma in countries with no access to new drugs in adjuvant therapy. Ipilimumab should not be considered as the first-line therapy due to its lower efficacy and severe toxicity. The use of anti-programmed death-1 antibody would be a relevant adjuvant therapy for patients without BRAF mutation. If the BRAF mutation status is positive, the combination of dabrafenib and trametinib is a plausible option. The establishment of appropriate therapeutic planning and clinical endpoints in adjuvant therapy should affect the standard of care. The choice of optimal adjuvant therapy for individual patients is an important issue.
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Affiliation(s)
- Maiko Wada-Ohno
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, -1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Takamichi Ito
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, -1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masutaka Furue
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, -1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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19
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Abstract
PURPOSE OF REVIEW We review the results from relevant clinical trials and discuss current strategies in the melanoma adjuvant setting. RECENT FINDINGS The favorable therapeutic efficacy and the significant less toxicity of nivolumab compared with ipilimumab, fully substitutes today's approval of ipilimumab, regardless mutation status, whereas in BRAF-mutated patients, dabrafenib and trametinib seem to confirm their high efficacy also in adjuvant setting. The use of interferon is restricted to patients with ulcerated melanoma and countries with no access to the new drugs. SUMMARY Systemic adjuvant treatment after complete disease resection in high-risk melanoma patients aims to increase relapse-free survival (RFS) and overall survival (OS). According to the eighth edition of melanoma classification of American Joint Committee on Cancer (AJCC), the prognosis in stage III patients is heterogeneous and depends not only on N (nodal) but also on T (tumor thickness) category criteria. Recent data from randomized, phase-3 clinical trials analyzing the use of adjuvant anti-programmed death-1 and targeted therapies ultimately affect the standard of care and change the landscape of the adjuvant treatment.
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20
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Suarez-Kelly LP, Levine KM, Olencki TE, Del Campo SEM, Streacker EA, Brooks TR, Karpa VI, Markowitz J, Bingman AK, Geyer SM, Kendra KL, Carson WE. A pilot study of interferon-alpha-2b dose reduction in the adjuvant therapy of high-risk melanoma. Cancer Immunol Immunother 2019; 68:619-629. [PMID: 30725205 PMCID: PMC6447692 DOI: 10.1007/s00262-019-02308-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 01/22/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Lorena P Suarez-Kelly
- Comprehensive Cancer Center, The Ohio State University, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, N924 Doan Hall 410 W. 10th Ave, Columbus, OH, 43210-1228, USA
| | - Kala M Levine
- Comprehensive Cancer Center, The Ohio State University, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, N924 Doan Hall 410 W. 10th Ave, Columbus, OH, 43210-1228, USA
| | - Thomas E Olencki
- Medical Oncology, Department of Internal Medicine, The Ohio State University, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
| | | | | | - Taylor R Brooks
- Division of Rheumatology and Center for Autoimmune Genomics and Etiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Volodymyr I Karpa
- Comprehensive Cancer Center, The Ohio State University, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, N924 Doan Hall 410 W. 10th Ave, Columbus, OH, 43210-1228, USA
| | - Joseph Markowitz
- Comprehensive Cancer Center, The Ohio State University, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, N924 Doan Hall 410 W. 10th Ave, Columbus, OH, 43210-1228, USA
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Anissa K Bingman
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
- Hematology, Department of Internal Medicine, The Ohio State University, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
| | - Susan M Geyer
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
- Hematology, Department of Internal Medicine, The Ohio State University, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
| | - Kari L Kendra
- Medical Oncology, Department of Internal Medicine, The Ohio State University, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
| | - William E Carson
- Comprehensive Cancer Center, The Ohio State University, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, N924 Doan Hall 410 W. 10th Ave, Columbus, OH, 43210-1228, USA.
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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21
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Coit DG, Thompson JA, Albertini MR, Barker C, Carson WE, Contreras C, Daniels GA, DiMaio D, Fields RC, Fleming MD, Freeman M, Galan A, Gastman B, Guild V, Johnson D, Joseph RW, Lange JR, Nath S, Olszanski AJ, Ott P, Gupta AP, Ross MI, Salama AK, Skitzki J, Sosman J, Swetter SM, Tanabe KK, Wuthrick E, McMillian NR, Engh AM. Cutaneous Melanoma, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 17:367-402. [PMID: 30959471 DOI: 10.6004/jnccn.2019.0018] [Citation(s) in RCA: 284] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Cutaneous melanoma have been significantly revised over the past few years in response to emerging data on immune checkpoint inhibitor therapies and BRAF-targeted therapy. This article summarizes the data and rationale supporting extensive changes to the recommendations for systemic therapy as adjuvant treatment of resected disease and as treatment of unresectable or distant metastatic disease.
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Affiliation(s)
| | - John A Thompson
- 2Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - William E Carson
- 4The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Carlo Contreras
- 5University of Alabama at Birmingham Comprehensive Cancer Center
| | | | | | - Ryan C Fields
- 8Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Martin D Fleming
- 9St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | - Brian Gastman
- 12Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | - Julie R Lange
- 16The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | - Patrick Ott
- 19Dana-Farber/Brigham and Women's Cancer Center
| | | | | | | | | | - Jeffrey Sosman
- 20Robert H. Lurie Comprehensive Cancer Center of Northwestern University
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22
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Grob JJ, Garbe C, Ascierto P, Larkin J, Dummer R, Schadendorf D. Adjuvant melanoma therapy with new drugs: should physicians continue to focus on metastatic disease or use it earlier in primary melanoma? Lancet Oncol 2018; 19:e720-e725. [DOI: 10.1016/s1470-2045(18)30596-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 02/06/2023]
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23
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McKean MA, Amaria RN. Multidisciplinary treatment strategies in high-risk resectable melanoma: Role of adjuvant and neoadjuvant therapy. Cancer Treat Rev 2018; 70:144-153. [DOI: 10.1016/j.ctrv.2018.08.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 08/27/2018] [Accepted: 08/28/2018] [Indexed: 12/17/2022]
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24
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Sullivan RJ, Atkins MB, Kirkwood JM, Agarwala SS, Clark JI, Ernstoff MS, Fecher L, Gajewski TF, Gastman B, Lawson DH, Lutzky J, McDermott DF, Margolin KA, Mehnert JM, Pavlick AC, Richards JM, Rubin KM, Sharfman W, Silverstein S, Slingluff CL, Sondak VK, Tarhini AA, Thompson JA, Urba WJ, White RL, Whitman ED, Hodi FS, Kaufman HL. An update on the Society for Immunotherapy of Cancer consensus statement on tumor immunotherapy for the treatment of cutaneous melanoma: version 2.0. J Immunother Cancer 2018; 6:44. [PMID: 29848375 PMCID: PMC5977556 DOI: 10.1186/s40425-018-0362-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/17/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cancer immunotherapy has been firmly established as a standard of care for patients with advanced and metastatic melanoma. Therapeutic outcomes in clinical trials have resulted in the approval of 11 new drugs and/or combination regimens for patients with melanoma. However, prospective data to support evidence-based clinical decisions with respect to the optimal schedule and sequencing of immunotherapy and targeted agents, how best to manage emerging toxicities and when to stop treatment are not yet available. METHODS To address this knowledge gap, the Society for Immunotherapy of Cancer (SITC) Melanoma Task Force developed a process for consensus recommendations for physicians treating patients with melanoma integrating evidence-based data, where available, with best expert consensus opinion. The initial consensus statement was published in 2013, and version 2.0 of this report is an update based on a recent meeting of the Task Force and extensive subsequent discussions on new agents, contemporary peer-reviewed literature and emerging clinical data. The Academy of Medicine (formerly Institute of Medicine) clinical practice guidelines were used as a basis for consensus development with an updated literature search for important studies published between 1992 and 2017 and supplemented, as appropriate, by recommendations from Task Force participants. RESULTS The Task Force considered patients with stage II-IV melanoma and here provide consensus recommendations for how they would incorporate the many immunotherapy options into clinical pathways for patients with cutaneous melanoma. CONCLUSION These clinical guidleines provide physicians and healthcare providers with consensus recommendations for managing melanoma patients electing treatment with tumor immunotherapy.
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Affiliation(s)
- Ryan J. Sullivan
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| | | | | | - Sanjiv S. Agarwala
- St. Luke’s Cancer Center and Temple University, Center Valley, PA 18034 USA
| | | | | | | | | | | | | | - Jose Lutzky
- Mt. Sinai Medical Center, Miami Beach, FL 33140 USA
| | | | | | | | - Anna C. Pavlick
- New York University Cancer Institute, New York, NY 10016 USA
| | | | - Krista M. Rubin
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| | - William Sharfman
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD 21231 USA
| | | | | | - Vernon K. Sondak
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612 USA
| | | | | | - Walter J. Urba
- Earle A. Chiles Research Institute, Providence Cancer Center, Portland, OR 97213 USA
| | | | | | | | - Howard L. Kaufman
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
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25
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Patel PM, Ottensmeier CH, Mulatero C, Lorigan P, Plummer R, Pandha H, Elsheikh S, Hadjimichael E, Villasanti N, Adams SE, Cunnell M, Metheringham RL, Brentville VA, Machado L, Daniels I, Gijon M, Hannaman D, Durrant LG. Targeting gp100 and TRP-2 with a DNA vaccine: Incorporating T cell epitopes with a human IgG1 antibody induces potent T cell responses that are associated with favourable clinical outcome in a phase I/II trial. Oncoimmunology 2018; 7:e1433516. [PMID: 29872563 PMCID: PMC5980353 DOI: 10.1080/2162402x.2018.1433516] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/22/2018] [Accepted: 01/22/2018] [Indexed: 02/08/2023] Open
Abstract
A DNA vaccine, SCIB1, incorporating two CD8 and two CD4 epitopes from TRP-2/gp100 was evaluated in patients with metastatic melanoma. Each patient received SCIB1 via intramuscular injection with electroporation. The trial was designed to find the safest dose of SCIB1 which induced immune/clinical responses in patients with or without tumour. Fifteen patients with tumor received SCIB1 doses of 0.4-8 mg whilst 20 fully-resected patients received 2-8 mg doses. Twelve patients elected to continue immunization every 3 months for up to 39 months. SCIB1 induced dose-dependent T cell responses in 88% of patients with no serious adverse effects or dose limiting toxicities. The intensity of the T cell responses was significantly higher in patients receiving 4 mg doses without tumor when compared to those with tumor (p < 0.01). In contrast, patients with tumor showed a significantly higher response to the 8 mg dose than the 4 mg dose (p < 0.03) but there was no significant difference in the patients without tumor. One of 15 patients with measurable disease showed an objective tumor response and 7/15 showed stable disease. 5/20 fully-resected patients have experienced disease recurrence but all remained alive at the cut-off date with a median observation time of 37 months. A positive clinical outcome was associated with MHC-I and MHC-II expression on tumors prior to therapy (p = 0.027). We conclude that SCIB1 is well tolerated and stimulates potent T cell responses in melanoma patients. It deserves further evaluation as a single agent adjuvant therapy or in combination with checkpoint inhibitors in advanced disease.
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Affiliation(s)
- Poulam M Patel
- Academic Department of Clinical Oncology, Division of Cancer & Stem Cells, University of Nottingham, Nottingham, UK
| | - Christian H Ottensmeier
- Southampton Experimental Cancer Medicine Centre and Southampton University Hospitals, Faculty of Medicine, Southampton, UK
| | | | - Paul Lorigan
- Institute of Cancer Sciences, University of Manchester, The Christie NHS Foundation Trust, Manchester, UK
| | - Ruth Plummer
- Northern Institute for Cancer Research, Medical School, University of Newcastle-upon-Tyne and Wear, UK
| | - Hardev Pandha
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Somaia Elsheikh
- University of Nottingham, School of Medicine Queen's Medical Centre, Nottingham, UK
| | | | - Naty Villasanti
- University of Nottingham, School of Medicine Queen's Medical Centre, Nottingham, UK
| | - Sally E Adams
- Scancell Limited, Academic Department of Clinical Oncology, University of Nottingham, Nottingham, UK
| | - Michelle Cunnell
- Academic Department of Clinical Oncology, Division of Cancer & Stem Cells, University of Nottingham, Nottingham, UK
| | - Rachael L Metheringham
- Scancell Limited, Academic Department of Clinical Oncology, University of Nottingham, Nottingham, UK
| | - Victoria A Brentville
- Scancell Limited, Academic Department of Clinical Oncology, University of Nottingham, Nottingham, UK
| | - Lee Machado
- Scancell Limited, Academic Department of Clinical Oncology, University of Nottingham, Nottingham, UK
| | - Ian Daniels
- Scancell Limited, Academic Department of Clinical Oncology, University of Nottingham, Nottingham, UK
| | - Mohamed Gijon
- Scancell Limited, Academic Department of Clinical Oncology, University of Nottingham, Nottingham, UK
| | | | - Lindy G Durrant
- Academic Department of Clinical Oncology, Division of Cancer & Stem Cells, University of Nottingham, Nottingham, UK.,Scancell Limited, Academic Department of Clinical Oncology, University of Nottingham, Nottingham, UK
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Bello DM, Ariyan CE. Adjuvant Therapy in the Treatment of Melanoma. Ann Surg Oncol 2018; 25:1807-1813. [PMID: 29468608 DOI: 10.1245/s10434-018-6376-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Danielle M Bello
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Charlotte E Ariyan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
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27
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Malaguarnera G, Madeddu R, Catania VE, Bertino G, Morelli L, Perrotta RE, Drago F, Malaguarnera M, Latteri S. Anorectal mucosal melanoma. Oncotarget 2018; 9:8785-8800. [PMID: 29492238 PMCID: PMC5823579 DOI: 10.18632/oncotarget.23835] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 12/26/2017] [Indexed: 02/05/2023] Open
Abstract
Anorectal melanoma is an uncommon and aggressive mucosal melanocytic malignancy. Due to its rarity, the pre-operative diagnosis remains difficult. The first symptoms are non-specific such as anal bleeding, anal mass or pain. Although anorectal melanoma carries a poor prognosis; optimal therapeutics strategies are unclear. Surgical resection remains the mainstay of treatment. The optimal surgical procedure for primary tumours is controversial and can vary from wide local excision or endoscopic mucosal resection (EMR) to an abdomino-perineal resection. A high degree of uncertainly exists regarding the benefit of radiation therapy or chemotherapy. The treatment of advanced melanoma is evolving rapidly with better understanding of the disease biology and immunology. Considerable effort has been devoted to the identification of molecular determinants of response to target therapies and immunotherapy.
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Affiliation(s)
- Giulia Malaguarnera
- Research Center "The Great Senescence", University of Catania, Catania, Italy
- Department of Biomedical and Biotechnological Science, University of Catania, Catania, Italy
| | - Roberto Madeddu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Vito Emanuele Catania
- Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, Catania, Italy
| | - Gaetano Bertino
- Hepatology Unit, Department of Clinical and Experimental Medicine, University of Catania, Policlinico "G. Rodolico", Catania, Italy
| | - Luca Morelli
- Department of Surgery, University of Pisa, Pisa, Italy
| | - Rosario Emanuele Perrotta
- Department of General Surgery and Medical-Surgery Specialties, University of Catania, Catania, Italy
| | - Filippo Drago
- Department of Biomedical and Biotechnological Science, University of Catania, Catania, Italy
| | - Michele Malaguarnera
- Research Center "The Great Senescence", University of Catania, Catania, Italy
- Department of Biomedical and Biotechnological Science, University of Catania, Catania, Italy
| | - Saverio Latteri
- Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, Catania, Italy
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28
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Suciu S, Eggermont AMM, Lorigan P, Kirkwood JM, Markovic SN, Garbe C, Cameron D, Kotapati S, Chen TT, Wheatley K, Ives N, de Schaetzen G, Efendi A, Buyse M. Relapse-Free Survival as a Surrogate for Overall Survival in the Evaluation of Stage II-III Melanoma Adjuvant Therapy. J Natl Cancer Inst 2018; 110:4091329. [PMID: 28922786 DOI: 10.1093/jnci/djx133] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/26/2017] [Indexed: 02/11/2024] Open
Abstract
Background We assessed whether relapse-free survival (RFS; time until recurrence/death) is a valid surrogate for overall survival (OS) among resected stage II-III melanoma patients through a meta-analysis of randomized controlled trials. Methods Individual patient data (IPD) on RFS and OS were collected from 5826 patients enrolled in 11 randomized adjuvant trials comparing interferon (IFN) to observation. In addition, IPD from two studies comparing IFN and vaccination in 989 patients were included. A two-level modeling approach was used for assessing Spearman's patient-level correlation (rho) of RFS and OS and the trial-level coefficient of determination (R²) of the treatment effects on RFS and on OS. The results were validated externally in 13 adjuvant studies without available IPD. We then tested the results on the European Organisation for Research and Treatment of Cancer (EORTC) 18071 double-blind trial comparing ipilimumab 10 mg/kg with placebo, which showed a statistically significant impact of the checkpoint inhibitor on RFS and OS. All statistical tests were two-sided. Results With a median follow-up of seven years, 12 of 13 trials showed a consistency between the IFN vs No IFN differences regarding RFS (hazard ratio [HR]RFS = 0.88) and OS (HROS = 0.91), but the small trial, Eastern Cooperative Oncology Group 2696, was an outlier (HRRFS = 0.72 vs HROS = 1.11). Therefore, even if rho was high, R² was low and could not reliably be estimated. Based on the 12 trials, rho remained high (0.89), and the hazard ratios for RFS and OS were strongly correlated (R² = 0.91). The surrogate threshold effect for RFS was estimated to be 0.77. For the EORTC 18071 trial, the hazard ratio for RFS was 0.75, predicting an effect of ipilimumab on OS. This was subsequently confirmed (HROS = 0.72, 95.1% confidence interval = 0.58 to 0.88, P = .001). Conclusions In high-risk stage II-III melanoma, RFS appeared to be a valid surrogate end point for OS for adjuvant randomized studies assessing interferon or a checkpoint inhibitor. In future similar adjuvant studies, a hazard ratio for RFS of 0.77 or less would predict a treatment impact on OS.
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Affiliation(s)
- Stefan Suciu
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Alexander M M Eggermont
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Paul Lorigan
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - John M Kirkwood
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Svetomir N Markovic
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Claus Garbe
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - David Cameron
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Srividya Kotapati
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Tai-Tsang Chen
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Keith Wheatley
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Natalie Ives
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Gaetan de Schaetzen
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Achmad Efendi
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
| | - Marc Buyse
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; The Christie NHS Foundation Trust, Manchester, UK; University of Pittsburgh Cancer Institute and School of Medicine, Pittsburgh, PA; Mayo Clinic Rochester, Rochester, MN; University of Tubingen, Tubingen, Germany; University of Edinburgh, Western General Hospital, Edinburgh, UK; Bristol-Myers Squibb, Wallingford, CT; Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK; Universitas Brawijaya, Malang, Indonesia; IDDI, Louvain-la-Neuve, Belgium
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Baird JR, Monjazeb AM, Shah O, McGee H, Murphy WJ, Crittenden MR, Gough MJ. Stimulating Innate Immunity to Enhance Radiation Therapy-Induced Tumor Control. Int J Radiat Oncol Biol Phys 2017; 99:362-373. [PMID: 28871985 PMCID: PMC5604475 DOI: 10.1016/j.ijrobp.2017.04.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/02/2017] [Indexed: 12/29/2022]
Abstract
Novel ligands that target Toll-like receptors and other innate recognition pathways represent a potent strategy for modulating innate immunity to generate antitumor immunity. Although many of the current clinically successful immunotherapies target adaptive T-cell responses, both preclinical and clinical studies suggest that adjuvants have the potential to enhance the scope and efficacy of cancer immunotherapy. Radiation may be a particularly good partner to combine with innate immune therapies, because it is a highly efficient means to kill cancer cells but may fail to send the appropriate inflammatory signals needed to act as an efficient endogenous vaccine. This may explain why although radiation therapy is a highly used cancer treatment, true abscopal effects-regression of disease outside the field without additional systemic therapy-are extremely rare. This review focuses on efforts to combine innate immune stimuli as adjuvants with radiation, creating a distinct and complementary approach from T cell-targeted therapies to enhance antitumor immunity.
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Affiliation(s)
- Jason R Baird
- Earle A. Chiles Research Institute, Providence Cancer Center, Portland, Oregon
| | - Arta M Monjazeb
- Department of Radiation Oncology, UC Davis Comprehensive Cancer Center, Sacramento, California; Laboratory of Cancer Immunology, UC Davis Comprehensive Cancer Center, Sacramento, California
| | - Omid Shah
- Division of Blood and Marrow Transplantation, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Heather McGee
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - William J Murphy
- Laboratory of Cancer Immunology, UC Davis Comprehensive Cancer Center, Sacramento, California
| | - Marka R Crittenden
- Earle A. Chiles Research Institute, Providence Cancer Center, Portland, Oregon; The Oregon Clinic, Portland, Oregon
| | - Michael J Gough
- Earle A. Chiles Research Institute, Providence Cancer Center, Portland, Oregon.
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30
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Eggermont AMM, Dummer R. The 2017 complete overhaul of adjuvant therapies for high-risk melanoma and its consequences for staging and management of melanoma patients. Eur J Cancer 2017; 86:101-105. [PMID: 28968566 DOI: 10.1016/j.ejca.2017.09.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/18/2017] [Indexed: 12/19/2022]
Abstract
The spectacular outcomes of the phase III trials regarding nivolumab versus ipilimumab in fully resected stage IIIB/C-IV and of the combination of dabrafenib (D) plus trametinib (T) in BRAF-mutant stage III patients demonstrate that effective treatments in advanced melanoma are also highly effective in the adjuvant setting. In 2016, an overall survival benefit with adjuvant high-dose ipilimumab was demonstrated, and the European Organisation for Research and Treatment of Cancer trial 1325 comparing pembrolizumab versus placebo will complete the picture in the early 2018. Toxicity profiles are in line with the experience in advanced melanoma, i.e. favourable for the anti-PD1 agents and for D + T and problematic for ipilimumab. The 2017 outcomes are practice changing and put an end to the use of interferon (IFN) and ipilimumab. In countries with only access to IFN, its use can be restricted to patients with ulcerated melanoma, based on the individual patient data meta-analysis recently published. Because of the results of the Melanoma Sentinel Lymph node Trial-2 (MSLT-2) trial, completion lymph node dissection (CLND) will decrease sharply, leading to a lack of optimal prognostic information. Prognosis in sentinel node-positive stage IIIA/B patients is extremely heterogeneous with 5-year survival rates varying from 90% to 40% and depends mostly on the number of positive nodes identified by CLND. This information is crucial for clinical decision-making. How to guarantee optimal staging information needs to be discussed urgently. Further improvements of adjuvant therapies will have to address all these questions as well as the exploration of neoadjuvant use of active drugs and combination approaches. Important paradigm shifts in the management of high-risk melanoma patients are upon us.
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Affiliation(s)
- Alexander M M Eggermont
- Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; Universite Paris-Sud, Kremlin-Bicêtre, France.
| | - Reinhard Dummer
- University Hospital Zürich, Department of Dermatology, Zürich, Switzerland
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31
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Ives NJ, Suciu S, Eggermont AM, Kirkwood J, Lorigan P, Markovic SN, Garbe C, Wheatley K, Bufalino R, Cameron D, Cascinelli N, Doherty V, Eggermont A, Garbe C, Gore M, Hancock B, Harrison R, Ives N, Kirkwood J, Kressig M, Lee S, Lorigan P, MacKie R, Markovic SN, Marsden J, Suciu S, Suman V, Turner L, Wheatley K. Adjuvant interferon-α for the treatment of high-risk melanoma: An individual patient data meta-analysis. Eur J Cancer 2017; 82:171-183. [DOI: 10.1016/j.ejca.2017.06.006] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 06/01/2017] [Indexed: 11/26/2022]
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32
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Schiller M, Tsianakas A, Sterry W, Dummer R, Hinke A, Nashan D, Stadler R. Dose-escalation study evaluating pegylated interferon alpha-2a in patients with cutaneous T-cell lymphoma. J Eur Acad Dermatol Venereol 2017; 31:1841-1847. [PMID: 28557110 DOI: 10.1111/jdv.14366] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 04/28/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND This open-label, multicenter, dose-escalation study evaluated the safety, tolerability, and efficacy of subcutaneous pegylated (40 kD) interferon α-2a (PEG-IFN α-2a) in patients with cutaneous T-cell lymphoma (CTCL). PATIENTS AND METHODS PEG-IFN α-2a was administered subcutaneously at 180 (n = 4), 270 (n = 6), or 360 μg (n = 3) once weekly for 12 weeks. Efficacy was assessed by the proportion of patients with complete response (CR) or partial response (PR). RESULTS PEG-IFN α-2a was generally well tolerated, with a moderate number of reductions or withholding of doses because of adverse events (AEs) (25% (n = 1), 66% (n = 4), and 0% (n = 0) in the 180-, 270-, and 360-μg/week groups, respectively). The only dose-limiting toxicity was a grade 3 elevation of liver enzymes in the 270-μg dose group. The most common AEs were fatigue, acute flu-like symptoms, and hepatic toxicity. The major response rate (CR or PR) was 50% in the 180-μg group (CR, 50%; PR, 0%), 83% in the 270-μg group (CR, 67%; PR, 17%), and 66% in the 360-μg group (CR, 33%; PR, 33%). CONCLUSION PEG-IFN α-2a at doses up to 360 μg once weekly was well tolerated in patients with CTCL up to the highest dose group and showed good response rates. Due to their good tolerance even in high doses, they might be an option for patients not tolerating standard IFN-α preparations. However, for this purpose and to evaluate comparability between standard and PEG-IFN larger clinical trials are needed, alone and in combination with oral photochemotherapy (PUVA).
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Affiliation(s)
- M Schiller
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany.,Dermatological Office Professor Schiller, Coesfeld, Germany
| | - A Tsianakas
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - W Sterry
- Department of Dermatology, Charité, Berlin, Germany
| | - R Dummer
- Department of Dermatology, University Hospital, Zurich, Switzerland
| | - A Hinke
- WiSP Wissenschaftlicher Service Pharma GmbH, Langenfeld, Germany
| | - D Nashan
- Department of Dermatology, Klinikum Dortmund, Dortmund, Germany
| | - R Stadler
- Department of Dermatology, Johannes Wesling Klinikum Minden, University Hospital of Ruhr University of Bochum, Bochum, Germany
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Trinh VA, Zobniw C, Hwu WJ. The efficacy and safety of adjuvant interferon-alfa therapy in the evolving treatment landscape for resected high-risk melanoma. Expert Opin Drug Saf 2017. [DOI: 10.1080/14740338.2017.1343301] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Van Anh Trinh
- Division of Pharmacy, Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chrystia Zobniw
- Division of Pharmacy, Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wen-Jen Hwu
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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34
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Emens LA, Ascierto PA, Darcy PK, Demaria S, Eggermont AMM, Redmond WL, Seliger B, Marincola FM. Cancer immunotherapy: Opportunities and challenges in the rapidly evolving clinical landscape. Eur J Cancer 2017. [PMID: 28623775 DOI: 10.1016/j.ejca.2017.01.035] [Citation(s) in RCA: 396] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cancer immunotherapy is now established as a powerful way to treat cancer. The recent clinical success of immune checkpoint blockade (antagonists of CTLA-4, PD-1 and PD-L1) highlights both the universal power of treating the immune system across tumour types and the unique features of cancer immunotherapy. Immune-related adverse events, atypical clinical response patterns, durable responses, and clear overall survival benefit distinguish cancer immunotherapy from cytotoxic cancer therapy. Combination immunotherapies that transform non-responders to responders are under rapid development. Current challenges facing the field include incorporating immunotherapy into adjuvant and neoadjuvant cancer therapy, refining dose, schedule and duration of treatment and developing novel surrogate endpoints that accurately capture overall survival benefit early in treatment. As the field rapidly evolves, we must prioritise the development of biomarkers to guide the use of immunotherapies in the most appropriate patients. Immunotherapy is already transforming cancer from a death sentence to a chronic disease for some patients. By making smart, evidence-based decisions in developing next generation immunotherapies, cancer should become an imminently treatable, curable and even preventable disease.
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Affiliation(s)
- Leisha A Emens
- Johns Hopkins University School of Medicine, Department of Oncology, Graduate Program in Pathobiology, Baltimore, MD 21287, USA.
| | - Paolo A Ascierto
- Istituto Nazionale Tumori Fondazione G. Pascale, Melanoma, Cancer Immunotherapy and Innovative Therapy Unit, Napoli, Italy
| | - Phillip K Darcy
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville 3010, Australia
| | - Sandra Demaria
- Weill Cornell Medical College, Department of Radiation Oncology, New York, NY 10065, USA
| | - Alexander M M Eggermont
- Cancer Institute Gustave-Roussy, 114 Rue Edouard Vaillant, Villejuif/Paris-Sud 94800, France
| | - William L Redmond
- Robert W. Franz Cancer Research Center, Earle A. Chiles Research Institute, Providence Portland Medical Center, Portland, OR 97213, USA
| | - Barbara Seliger
- Martin Luther University, Institute for Medical Immunology, Magdeburger Str. 2, 06112 Halle, Germany
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Eigentler TK, Mühlenbein C, Follmann M, Schadendorf D, Garbe C. S3-Leitlinie Diagnostik, Therapie und Nachsorge des Melanoms - Update 2015/2016, Kurzversion 2.0. J Dtsch Dermatol Ges 2017; 15:e1-e41. [DOI: 10.1111/ddg.13247] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Systemic adjuvant therapy for surgically resected cutaneous melanoma that is at high risk for disease recurrence and death targets residual micrometastatic disease which is the source of future local or distant relapse. Interferon-alfa (IFNα) has been the most extensively studied in regimens that varied by dosage, route of administration, formulation, and duration of therapy. Most regimens have demonstrated improvements in relapse-free survival (RFS), while the regimen administered at high dosage (HDI) showed improvements in overall survival (OS) in two out of three RCTs. HDI benefits as measured by the hazard ratios (HR) in E1684 (vs. observation), E1690 (vs. observation), and E1694 (vs. vaccine) trials were estimated at 0.61, 0.78, and 0.67 (RFS) and 0.67, 1.0, and 0.72 (OS) when first reported with lesser estimates on later updates. Pegylated IFNα (peg-IFN) as studied in the European Organisation for Research and Treatment of Cancer (EORTC) 18991 trial in patients with stage III melanoma significantly reduced the risk of relapse (HR 0.87) with no impact on OS. More recently (EORTC 18071), ipilimumab at the high dose of 10 mg/kg was shown to significantly improve RFS (HR 0.76) and OS (HR 0.72) of stage III melanoma patients but at a significant cost in terms of immune-related toxicities. Ongoing adjuvant studies are testing ipilimumab at 3 or 10 mg/kg versus HDI (E1609) and the anti-PD-1 antibodies nivolumab (CheckMate 238) and pembrolizumab (KEYNOTE-054 and S1404).
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Babiker HM, Riaz IB, Husnain M, Borad MJ. Oncolytic virotherapy including Rigvir and standard therapies in malignant melanoma. Oncolytic Virother 2017; 6:11-18. [PMID: 28224120 PMCID: PMC5308590 DOI: 10.2147/ov.s100072] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The treatment of metastatic melanoma has evolved from an era where interferon and chemotherapy were the mainstay of treatments to an era where immunotherapy has become the frontline. Ipilimumab (IgG1 CTLA-4 inhibitor), nivolumab (IgG4 PD-1 inhibitor), pembrolizumab (IgG4 PD-1 inhibitor) and nivolumab combined with ipilimumab have become first-line therapies in patients with metastatic melanoma. In addition, the high prevalence of BRAF mutations in melanoma has led to the discovery and approval of targeted molecules, such as vemurafenib (BRAF kinase inhibitor) and trametinib (MEK inhibitor), as they yielded improved responses and survival in malignant melanoma patients. This is certainly a burgeoning time in immunotherapy drug development, and the aforementioned efforts along with the recent US Food and Drug Administration approval of talimogene laherparepvec (T-VEC), a recombinant oncolytic herpes virus, have paved the way to exploring the role of additional oncolytic viruses, such as the echovirus Rigvir, as new and innovative treatment modalities in patients with melanoma. Herein, we discuss the current standard of care treatment in melanoma with an emphasis on immunotherapy and oncolytic viruses in development.
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Affiliation(s)
| | - Irbaz Bin Riaz
- Department of Internal Medicine, University of Arizona, Tucson
| | | | - Mitesh J Borad
- Division of Hematology-Oncology, Mayo Clinic Cancer Center, Scottsdale, AZ; Department of Molecular Medicine, Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
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Agarwala SS, Lee SJ, Yip W, Rao UN, Tarhini AA, Cohen GI, Reintgen DS, Evans TL, Brell JM, Albertini MR, Atkins MB, Dakhil SR, Conry RM, Sosman JA, Flaherty LE, Sondak VK, Carson WE, Smylie MG, Pappo AS, Kefford RF, Kirkwood JM. Phase III Randomized Study of 4 Weeks of High-Dose Interferon-α-2b in Stage T2bNO, T3a-bNO, T4a-bNO, and T1-4N1a-2a (microscopic) Melanoma: A Trial of the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group (E1697). J Clin Oncol 2017; 35:885-892. [PMID: 28135150 DOI: 10.1200/jco.2016.70.2951] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To test the efficacy of 4 weeks of intravenous (IV) induction with high-dose interferon (IFN) as part of the Eastern Cooperative Oncology Group regimen compared with observation (OBS) in patients with surgically resected intermediate-risk melanoma. Patients and Methods In this intergroup international trial, eligible patients had surgically resected cutaneous melanoma in the following categories: (1) T2bN0, (2) T3a-bN0, (3) T4a-bN0, and (4) T1-4N1a-2a (microscopic). Patients were randomly assigned to receive IFN α-2b at 20 MU/m2/d IV for 5 days (Monday to Friday) every week for 4 weeks (IFN) or OBS. Stratification factors were pathologic lymph node status, lymph node staging procedure, Breslow depth, ulceration of the primary lesion, and disease stage. The primary end point was relapse-free survival. Secondary end points included overall survival, toxicity, and quality of life. Results A total of 1,150 patients were randomly assigned. At a median follow-up of 7 years, the 5-year relapse-free survival rate was 0.70 (95% CI, 0.66 to 0.74) for OBS and 0.70, (95% CI, 0.66 to 0.74) for IFN ( P = .964). The 5-year overall survival rate was 0.83 (95% CI, 0.79 to 0.86) for OBS and 0.83 (95% CI, 0.80 to 0.86) for IFN ( P = .558). Treatment-related grade 3 and higher toxicity was 4.6% versus 57.9% for OBS and IFN, respectively ( P < .001). Quality of life was worse for the treated group. Conclusion Four weeks of IV induction as part of the Eastern Cooperative Oncology Group high-dose IFN regimen is not better than OBS alone for patients with intermediate-risk melanoma as defined in this trial.
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Affiliation(s)
- Sanjiv S Agarwala
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Sandra J Lee
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Waiki Yip
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Uma N Rao
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Ahmad A Tarhini
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Gary I Cohen
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Douglas S Reintgen
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Terry L Evans
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Joanna M Brell
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Mark R Albertini
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Michael B Atkins
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Shaker R Dakhil
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Robert M Conry
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Jeffrey A Sosman
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Lawrence E Flaherty
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Vernon K Sondak
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - William E Carson
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Michael G Smylie
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Alberto S Pappo
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - Richard F Kefford
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
| | - John M Kirkwood
- Sanjiv S. Agarwala, Saint Luke's University Hospital, Easton; Uma N. Rao, Ahmad A. Tarhini, Terry L. Evans, and John M. Kirkwood, University of Pittsburgh Medical Center, Pittsburgh, PA; Sandra J. Lee, and Waiki Yip, Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA; Gary I. Cohen, Greater Baltimore Medical Center, Baltimore, MD; Douglas S. Reintgen, Lakeland Regional Cancer Center, Lakeland; Vernon K. Sondak, H. Lee Moffitt Cancer Center, Tampa, FL; Joanna M. Brell, MetroHealth Medical Center, Cleveland; William E. Carson, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mark R. Albertini, University of Wisconsin Hospital, Madison, WI; Michael B. Atkins, Georgetown Medical Center, Washington, DC; Shaker R. Dakhil, Cancer Center of Kansas, Wichita, KS; Robert M. Conry, University of Alabama at Birmingham, Birmingham, AL; Jeffrey A. Sosman, Vanderbilt University, Nashville; Alberto S. Pappo, Saint Jude Children's Research Hospital Oncology, Memphis, TN; Lawrence E. Flaherty, Wayne State University/Karmanos Cancer Institute, Detroit, MI; Michael G. Smylie, Cross Cancer Institute, Edmonton, Canada; and Richard F. Kefford, Sydney West Area Health Service, Westmead, Australia
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van Akkooi ACJ, Atkins MB, Agarwala SS, Lorigan P. Surgical Management and Adjuvant Therapy for High-Risk and Metastatic Melanoma. Am Soc Clin Oncol Educ Book 2017; 35:e505-14. [PMID: 27249760 DOI: 10.1200/edbk_159087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Wide local excision is considered routine therapy after initial diagnosis of primary melanoma to reduce local recurrences, but it does not impact survival. Sentinel node staging is recommended for melanomas of intermediate thickness, but it has also not demonstrated any indisputable therapeutic effect on survival. The prognostic value of sentinel node staging has been long established and is therefore considered routine, especially in light of the eligibility criteria for adjuvant therapy (trials). Whether completion lymph node dissection after a positive sentinel node biopsy improves survival is the question of current trials. The MSLT-2 study is best powered to show a potential benefit, but it has not yet reported any data. Another study, the German DECOG study, presented at the 2015 American Society of Clinical Oncology (ASCO) Annual Meeting did not show any benefit but is criticized for the underpowered design and insufficient follow-up. There is no consensus on the use of adjuvant interferon in melanoma. This topic has been the focus of many studies with different regimens (low-, intermediate-, or high-dose and/or short- or long-term treatment). Adjuvant interferon has been shown to improve relapse-free survival but failed to improve overall survival. More recently, adjuvant ipilimumab has also demonstrated an improved relapse-free survival. Overall survival data have not yet been reported due to insufficient follow-up. Currently, studies are ongoing to analyze the use of adjuvant anti-PD-1 and molecular targeted therapies (vemurafenib, dabrafenib, and trametinib). In the absence of unambiguously positive approved agents, clinical trial participation remains a priority. This could change in the near future.
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Affiliation(s)
- Alexander C J van Akkooi
- From the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; St. Luke's University Hospital, Temple University, Allentown, PA; University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Michael B Atkins
- From the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; St. Luke's University Hospital, Temple University, Allentown, PA; University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Sanjiv S Agarwala
- From the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; St. Luke's University Hospital, Temple University, Allentown, PA; University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Paul Lorigan
- From the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; St. Luke's University Hospital, Temple University, Allentown, PA; University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom
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40
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Abstract
Childhood melanoma is a rare pediatric malignancy, with fewer than 500 new diagnoses annually. The incidence is increasing, particularly in the adolescent population. This review highlights the epidemiology, clinical presentation, and histopathologic challenges of pediatric melanoma. Surgical resection remains the cornerstone for localized and regionally advanced disease. Adjuvant therapies, including current options and potential novel therapeutics for this unique population will be discussed.
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Affiliation(s)
- Elisabeth T Tracy
- Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children׳s Hospital, The Ohio State University College of Medicine, Nationwide Children׳s Dr, FB Suite 6B.1, Columbus, Ohio 43205.
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Garbe C, Peris K, Hauschild A, Saiag P, Middleton M, Bastholt L, Grob JJ, Malvehy J, Newton-Bishop J, Stratigos AJ, Pehamberger H, Eggermont AM. Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline - Update 2016. Eur J Cancer 2016; 63:201-17. [PMID: 27367293 DOI: 10.1016/j.ejca.2016.05.005] [Citation(s) in RCA: 281] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 05/16/2016] [Indexed: 01/12/2023]
Abstract
Cutaneous melanoma (CM) is potentially the most dangerous form of skin tumour and causes 90% of skin cancer mortality. A unique collaboration of multi-disciplinary experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organisation of Research and Treatment of Cancer was formed to make recommendations on CM diagnosis and treatment, based on systematic literature reviews and the experts' experience. Diagnosis is made clinically using dermoscopy and staging is based upon the AJCC system. CMs are excised with 1-2 cm safety margins. Sentinel lymph node dissection is routinely offered as a staging procedure in patients with tumours >1 mm in thickness, although there is as yet no clear survival benefit for this approach. Interferon-α treatment may be offered to patients with stage II and III melanoma as an adjuvant therapy, as this treatment increases at least the disease-free survival and less clear the overall survival (OS) time. The treatment is however associated with significant toxicity. In distant metastasis, all options of surgical therapy have to be considered thoroughly. In the absence of surgical options, systemic treatment is indicated. For first-line treatment particularly in BRAF wild-type patients, immunotherapy with PD-1 antibodies alone or in combination with CTLA-4 antibodies should be considered. BRAF inhibitors like dabrafenib and vemurafenib in combination with the MEK inhibitors trametinib and cobimetinib for BRAF mutated patients should be offered as first or second line treatment. Therapeutic decisions in stage IV patients should be primarily made by an interdisciplinary oncology team ('Tumour Board').
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Affiliation(s)
- Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany.
| | - Ketty Peris
- Institute of Dermatology, Catholic University, Rome, Italy
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - Philippe Saiag
- University Department of Dermatology, Université de Versailles-Saint Quentin en Yvelines, APHP, Boulogne, France
| | - Mark Middleton
- NIHR Biomedical Research Centre, University of Oxford, UK
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Denmark
| | | | - Josep Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Julia Newton-Bishop
- Section of Biostatistics and Epidemiology, Leeds Institute of Cancer and Pathology, University of Leeds, UK
| | - Alexander J Stratigos
- 1(st) Department of Dermatology, University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece
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42
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Eigentler TK, Gutzmer R, Hauschild A, Heinzerling L, Schadendorf D, Nashan D, Hölzle E, Kiecker F, Becker J, Sunderkötter C, Moll I, Richtig E, Pönitzsch I, Pehamberger H, Kaufmann R, Pföhler C, Vogt T, Berking C, Praxmarer M, Garbe C. Adjuvant treatment with pegylated interferon α-2a versus low-dose interferon α-2a in patients with high-risk melanoma: a randomized phase III DeCOG trial. Ann Oncol 2016; 27:1625-32. [PMID: 27287206 DOI: 10.1093/annonc/mdw225] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 05/30/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Adjuvant treatment with interferon (IFN)-α-2a improved disease-free survival (DFS) and showed a trend for improving overall survival (OS) in melanoma. This trial was designed to examine whether PEG-IFN is superior to IFN with regard to distant metastasis-free survival (DMFS), DFS and OS. PATIENTS AND METHODS In this multicenter, open-label, prospective randomized phase III trial, patients with resected cutaneous melanoma stage IIA(T3a)-IIIB (AJCC 2002) were randomized to receive PEG-IFN (180 μg subcutaneously 1×/week; 24 months) or IFN α-2a (3MIU subcutaneously 3×/week; 24 months). Randomization was stratified for stage, number of metastatic nodes, age and previous IFN treatment. The primary end point was DMFS; secondary end points were OS, DFS, quality of life (QoL) and tolerability. RESULTS A total of 909 patients were enrolled (451 PEG-IFN versus 458 IFN). Neither 5-year DMFS [PEG-IFN 61.0% versus IFN 67.3%; hazard ratio (HR) 1.16, P = 0.21] nor 5-year OS (PEG-IFN 73.2% versus IFN 75.2%; HR 1.05, P = 0.70) nor 5-year DFS (PEG-IFN 57.3% versus IFN 60.9%; HR 1.09, P = 0.40) showed significant differences. Subgroup analyses in patients ± ulcerated primaries and of different tumor stages did not find differences in DMFS, OS or DFS between the treatment groups. One hundred and eighteen patients (26.2%) in the PEG-IFN and 61 patients (13.3%) in the IFN population did not receive the full dosage and length of treatment due to adverse events (P < 0.001). Leukopenia and elevation of liver enzymes were more common in the PEG-IFN arm (56% versus 23.5% LCP; 19.1% versus 9.4% AST; 33.0% versus 16.5% ALT). QoL was identical for nearly all domains. CONCLUSION PEG-IFN did not improve the outcome over IFN. A higher percentage of patients under PEG-IFN discontinued treatment due to toxicity. CLINICAL TRIALSGOV IDENTIFIER NCT00204529.
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Affiliation(s)
- T K Eigentler
- Department of Dermatology, Center for Dermatooncology, University Medical Center Tübingen, Tübingen
| | - R Gutzmer
- Department of Dermatology and Allergy, Hannover Medical School, Hannover
| | - A Hauschild
- Department of Dermatology, University Hospital Kiel, Kiel
| | - L Heinzerling
- Department of Dermatology, University Hospital Erlangen, Erlangen
| | - D Schadendorf
- Department of Dermatology, University Essen-Duisburg, Essen
| | - D Nashan
- Department of Dermatology, Hospital Dortmund, Dortmund
| | - E Hölzle
- Department of Dermatology, Hospital Oldenburg, Oldenburg
| | - F Kiecker
- Department of Dermatology, Charité Berlin, Berlin
| | - J Becker
- Department of Dermatology, University Essen-Duisburg, Essen
| | - C Sunderkötter
- Department of Dermatology, University Hospital Münster, Münster
| | - I Moll
- Department of Dermatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E Richtig
- Department of Dermatology, University Hospital Graz, Graz, Austria
| | - I Pönitzsch
- Department of Dermatology, University Hospital Leipzig, Leipzig, Germany
| | - H Pehamberger
- Department of Dermatology, AKH Wien, University Hospital Vienna, Vienna, Austria
| | - R Kaufmann
- Department of Dermatology, University Hospital Frankfurt am Main, Frankfurt/Main
| | - C Pföhler
- Department of Dermatology, Saarland University Medical School, Homburg/Saar
| | - T Vogt
- Department of Dermatology, Saarland University Medical School, Homburg/Saar
| | - C Berking
- Department of Dermatology and Allergy, University Hospital of Munich, Munich, Germany
| | | | - C Garbe
- Department of Dermatology, Center for Dermatooncology, University Medical Center Tübingen, Tübingen
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Ben-Ami E, Schachter J. Adjuvant treatment for stage III melanoma in the era of targeted medicine and immunotherapy. Melanoma Manag 2016; 3:137-147. [PMID: 30190882 DOI: 10.2217/mmt-2016-0002] [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: 01/22/2016] [Accepted: 03/21/2016] [Indexed: 11/21/2022] Open
Abstract
The accelerated development in the treatment of metastatic melanoma, both in molecular targeted therapy and immunotherapy, is already starting to impact on adjuvant therapy in stage III melanoma. Following the approval of ipilimumab for adjuvant therapy in melanoma, clinical trials assessing other checkpoint modulators and MAPK pathway inhibitors as adjuvant treatments for melanoma are currently ongoing. As results from these trials mature in the next few years, a change in the landscape of adjuvant treatment for melanoma is expected, resulting in new challenges in treatment decisions such as optimizing patients selection through predictive and prognostic biomarkers, and management of treatment related adverse events, in particular immune related toxicities.
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Affiliation(s)
- Eytan Ben-Ami
- Ella Lemelbaum Institute for Melanoma, Division of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Center for Sarcoma & Bone Oncology, Dana Farber Cancer Institute, Boston, MA, USA.,Ella Lemelbaum Institute for Melanoma, Division of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Center for Sarcoma & Bone Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Jacob Schachter
- Ella Lemelbaum Institute for Melanoma, Division of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Ella Lemelbaum Institute for Melanoma, Division of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel
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44
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Hribernik A, Cemazar M, Sersa G, Bosnjak M, Snoj M. Effectiveness of electrochemotherapy after IFN-α adjuvant therapy of melanoma patients. Radiol Oncol 2016; 50:21-7. [PMID: 27069446 PMCID: PMC4825333 DOI: 10.1515/raon-2015-0048] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 11/30/2015] [Indexed: 12/21/2022] Open
Abstract
Background The combination of electrochemotherapy with immuno-modulatory treatments has already been explored and proven effective. However, the role of interferon alpha (IFN-α) adjuvant therapy of melanoma patients and implication on electrochemotherapy effectiveness has not been explored yet. Therefore, the aim of the study was to retrospectively evaluate the effectiveness and safety of electrochemotherapy after the previous adjuvant treatment with IFN-α in melanoma patients. Patients and methods The study was a retrospective single-center observational analysis of the patients with advanced melanoma, treated with electrochemotherapy after previous IFN-α adjuvant therapy. Five patients, treated between January 2008 and December 2014, were included into the study, regardless of the time point of IFN-α adjuvant therapy. Results Electrochemotherapy of recurrent melanoma after the IFN-α adjuvant therapy proved to be a safe and effective treatment. Patients with one or two metastases responded completely. Among patients with multiple metastases, there was a variable response rate. In one patient all 23 metastases responded completely, in second patient more than 85% of all together 80 metastases responded completely and in third patient all 5 metastases had partial response. Taking into account all metastases from all patients together there was an 85% complete response rate. Conclusions The study showed that electrochemotherapy of recurrent melanoma after the IFN-α adjuvant therapy is a safe and effective treatment modality, which results in a high complete response rate, not only in single metastasis, but also in multiple metastases. The high complete response rate might be due to an IFN-α immune-editing effect, however, further studies with a larger number of patients are needed to support this presumption.
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Affiliation(s)
- Andrejc Hribernik
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Maša Bosnjak
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Marko Snoj
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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Guo J, Qin S, Liang J, Lin T, Si L, Chen X, Chi Z, Cui C, Du N, Fan Y, Gu K, Li F, Li J, Li Y, Liang H, Liu J, Lu M, Lu A, Nan K, Niu X, Pan H, Ren G, Ren X, Shu Y, Song X, Tao M, Wang B, Wei W, Wu D, Wu L, Wu A, Xu X, Zhang J, Zhang X, Zhang Y, Zhu H. Chinese Guidelines on the Diagnosis and Treatment of Melanoma (2015 Edition). ANNALS OF TRANSLATIONAL MEDICINE 2016; 3:322. [PMID: 26734632 DOI: 10.3978/j.issn.2305-5839.2015.12.23] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Jun Guo
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Shukui Qin
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Jun Liang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Tongyu Lin
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Lu Si
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Xiaohong Chen
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Zhihong Chi
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Chuanliang Cui
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Nan Du
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Yun Fan
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Kangsheng Gu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Fang Li
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Junling Li
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Yongheng Li
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Houjie Liang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Jiwei Liu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Man Lu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Aiping Lu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Kejun Nan
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Xiaohui Niu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Hongming Pan
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Guoxin Ren
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Xiubao Ren
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Yongqian Shu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Xin Song
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Min Tao
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Baocheng Wang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Wenbin Wei
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Di Wu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Lingying Wu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Aiwen Wu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Xiaolin Xu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Junyi Zhang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Xiaoshi Zhang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Yiping Zhang
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
| | - Huiyan Zhu
- 1 Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 People's Liberation Army (PLA) 81 Hospital, Nanjing 210002, China ; 3 Peking University International Hospital, Beijing 100089, China ; 4 Sun Yat-sen University Cancer Center, Guangzhou 510060, China ; 5 Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730, China ; 6 PLA General Hospital (304 Hospital), Beijing 100048, China ; 7 Zhejiang Provincial Tumor Hospital, Hangzhou 310022, China ; 8 First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Cancer Institute & Hospital, China Academy of Medical Sciences, Beijing 100021, China ; 10 Southwest Hospital & Third Military Medical University Affiliated First Hospital, Chongqing 400038, China ; 11 First Affiliated Hospital of Dalian Medical University, Dalian 116011, China ; 12 Sichuan Provincial People's Hospital, Chengdu 610072, China ; 13 Xi'an Jiao Tong University Affiliated First Hospital, Xi'an 710061, China ; 14 Beijing Jishuitan Hospital & Fourth Clinical College of Peking University, Beijing 100035, China ; 15 Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China ; 16 Nineth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China ; 17 Tianjin Medical University Affiliated Tumor Hospital, Tianjin 300321, China ; 18 Jiangsu Provincial People's Hospital & First affiliated hospital of Nanjing Medical University, Nanjing 210036, China ; 19 Yunnan Provincial Tumor Hospital, Nanjing 210029, China ; 20 First Affiliated Hospital of Suzhou University, Suzhou 215006, China ; 21 General Hospital of Jinan Military Command, Jinan 250031, China ; 22 Jilin University First Hospital, Changchun 130021, China ; 23 Southern Hospital, Southern Medical University, Guangzhou 510515, China ; 24 Fudan University Affiliated Tumor Hospital, Shanghai 200032, China
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Abstract
The incidence of melanoma is rapidly increasing, especially in younger female and older male patients. Recent fundamental advances in our knowledge of melanoma tumorigenesis have established roles for inhibitors of the MAPK pathway and regulatory immune checkpoints CTLA-4 and PD-1/PD-L1. However, the majority of patients continue to present with non-metastatic disease-typically managed with surgical resection and adjuvant therapy. High-dose IFN-α2b (HDI) is the main adjuvant therapeutic mainstay in high-risk disease following definitive resection. In this chapter, we review the evidence supporting the use of adjuvant HDI in high-risk melanoma. We also discuss some of the other treatment modalities that have been evaluated including vaccines, chemotherapy, and radiotherapy.
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Berrocal A, Arance A, Espinosa E, Castaño AG, Cao MG, Larriba JLG, Martín JAL, Márquez I, Soria A, Algarra SM. SEOM guidelines for the management of Malignant Melanoma 2015. Clin Transl Oncol 2015; 17:1030-5. [PMID: 26669314 PMCID: PMC4689745 DOI: 10.1007/s12094-015-1450-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 11/06/2015] [Indexed: 11/27/2022]
Abstract
All melanoma patients must be confirmed histologically and resected according to Breslow. Sentinel node biopsy must be done when tumor is over 1 mm or if less with high-risk factors. Adjuvant therapy with interferon must be offered for patients with high-risk melanoma and in selected cases radiotherapy can be added. Metastatic melanoma treatment is guided by mutational BRAF status. BRAF wild type patients must receive anti-PD1 therapy and BRAF mutated patients BRAF/MEK inhibitors or anti-PD1 therapy. Up to 10 years follow up is recommended for melanoma patients with dermatologic examinations and physical exams.
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Affiliation(s)
- A Berrocal
- Servicio de Oncología Médica, Consorcio Hospital General Universitario de Valencia, Avda. Tres Cruces 2, 46014, Valencia, Spain.
| | - A Arance
- Hospital Clinic I Provincial de Barcelona, Barcelona, Spain
| | - E Espinosa
- Hospital Universitario la Paz, Madrid, Spain
| | - A G Castaño
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - M G Cao
- Hospital Universitario Quirón Dexeus, Barcelona, Spain
| | - J L G Larriba
- Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - J A L Martín
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - I Márquez
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - A Soria
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - S M Algarra
- Clínica Universitaria de Navarra, Pamplona, Spain
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Mohr P, Hauschild A, Trefzer U, Enk A, Tilgen W, Loquai C, Gogas H, Haalck T, Koller J, Dummer R, Gutzmer R, Brockmeyer N, Hölzle E, Sunderkötter C, Mauch C, Stein A, Schneider LA, Podda M, Göppner D, Schadendorf D, Weichenthal M. Intermittent High-Dose Intravenous Interferon Alfa-2b for Adjuvant Treatment of Stage III Melanoma: Final Analysis of a Randomized Phase III Dermatologic Cooperative Oncology Group Trial. J Clin Oncol 2015; 33:4077-84. [PMID: 26503196 DOI: 10.1200/jco.2014.59.6932] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023] Open
Abstract
PURPOSE To evaluate the efficacy, safety, tolerability, and quality of life (QoL) in patients receiving intravenous, intermittent high-dose interferon alfa-2b (IFN-α-2b [iHDI]) compared with standard high-dose IFN-α-2b (HDI). PATIENT AND METHODS Patients with stage III resected lymph node or in-transit metastasis from cutaneous malignant melanoma were randomly assigned to receive either a standard HDI regimen or three courses of IFN-α-2b 20 MIU/m(2) administered intravenously 5 days a week for 4 weeks then repeated every 4 months. Distant metastasis-free survival was the primary end point for efficacy analysis. In addition, relapse-free survival, overall survival, safety as determined by Common Terminology Criteria for Adverse Events criteria, and QoL were secondary end points. RESULTS Of 649 patients enrolled, 22 patients were excluded from the intent-to-treat analysis. The remaining 627 patients were well balanced between the arms according to sex, age, and stage. After a median follow-up of 55 months, a multivariable Cox model revealed no significant differences for distant metastasis-free survival (hazard ratio [HR], 1.21; P = .12) or overall survival (HR, 1.01; P = .85). In contrast, the difference for relapse-free survival was significant (HR, 1.27; P = .03), favoring standard HDI. Early termination of treatment because of adverse events or QoL occurred significantly more often with HDI than with iHDI (26.0% v 14.8%; P < .001). CONCLUSION Although the safety and QoL profiles for the intermittent regimen were favorable, no significant difference was observed for survival while the HR for relapse with iHDI was increased. Therefore, an iHDI regimen, as tested here, cannot be recommended as adjuvant treatment for high-risk melanoma.
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Affiliation(s)
- Peter Mohr
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland.
| | - Axel Hauschild
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Uwe Trefzer
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Alexander Enk
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Wolfgang Tilgen
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Carmen Loquai
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Helen Gogas
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Thomas Haalck
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Josef Koller
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Ralf Gutzmer
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Norbert Brockmeyer
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Erhard Hölzle
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Cord Sunderkötter
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Cornelia Mauch
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Annette Stein
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Lars A Schneider
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Maurizio Podda
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Daniela Göppner
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Dirk Schadendorf
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
| | - Michael Weichenthal
- Peter Mohr, Elbe-Klinikum Buxtehude, Buxtehude; Axel Hauschild and Michael Weichenthal, University Hospital Schleswig-Holstein, Kiel; Uwe Trefzer, Charité-Universitätsmedizin Berlin, Berlin; Alexander Enk, University Hospital Heidelberg, Heidelberg; Wolfgang Tilgen, University Hospital, Homburg/Saarland; Carmen Loquai, University of Mainz, Mainz; Thomas Haalck, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Ralf Gutzmer, Hannover Medical School, Hannover; Norbert Brockmeyer, Ruhr-Universität Bochum, Bochum; Erhard Hölzle, Oldenburg Hospital, Oldenburg; Cord Sunderkötter, University of Münster, Münster; Cornelia Mauch, University of Cologne, Cologne; Annette Stein, Universitätsklinikum Carl Gustav Carus, Dresden; Lars A. Schneider, University of Ulm, Ulm; Maurizio Podda, Darmstadt Hospital, Darmstadt; Daniela G[uml]oppner, University Hospital Magdeburg, Magdeburg; Dirk Schadendorf, University Hospital Essen, Essen, Germany; Helen Gogas, Hellenic Cooperative Oncology Group, Athens, Greece; Josef Koller, Paracelsus Medical University, Salzburg, Austria; and Reinhard Dummer, University Hospital of Zurich, Zurich, Switzerland
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Schneble EJ, Yu X, Wagner TE, Peoples GE. Novel dendritic cell-based vaccination in late stage melanoma. Hum Vaccin Immunother 2015; 10:3132-8. [PMID: 25483650 DOI: 10.4161/hv.29110] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Dendritic cells (DCs) are professional antigen-presenting cells (APCs) that play an important role in stimulating an immune response of both CD4(+) T helper cells and CD8(+) cytotoxic T lymphocytes (CTLs). As such, DCs have been studied extensively in cancer immunotherapy for their capability to induce a specific anti-tumor response when loaded with tumor antigens. However, when the most relevant antigens of a tumor remain to be identified, alternative approaches are required. Formation of a dentritoma, a fused DC and tumor cells hybrid, is one strategy. Although initial studies of these hybrid cells are promising, several limitations interfere with its clinical and commercial application. Here we present early experience in clinical trials and an alternative approach to manufacturing this DC/tumor cell hybrid for use in the treatment of late stage and metastatic melanoma.
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Affiliation(s)
- Erika J Schneble
- a San Antonio Military Medical Center; Department of General Surgery ; San Antonio , TX USA
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Abstract
Metastatic melanoma has a poor prognosis; the median survival for patients with stage IV melanoma ranges from 8 to 18 months after diagnosis. Interferon-α provides significant improvement in disease-free survival at the cost of poor tolerability. Identifying patients who benefit the most may improve the cost:benefit ratio. In addition, no data exist for the role of adjuvant therapy in noncutaneous melanoma. Molecular profiles may help to identify patients who benefit the most from adjuvant interferon therapy. In this review, the American Joint Commission on Cancer 2009 staging criteria and emerging biomarker data to guide adjuvant treatment decisions will be discussed. Several criteria to guide selection of patients are discussed in detail. These include Breslow thickness, number of positive lymph nodes, whether or not the primary lesion has ulcerated, immunologic markers, and cytokine profiles. Substantial progress has been made in deciding which patients benefit from interferon-α adjuvant therapy. Interferon-α is the only agent currently approved for the adjuvant treatment of this deadly disease, despite its side effect profile. More effective drugs with better tolerability are needed.
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