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Czarnecka AM, Ostaszewski K, Borkowska A, Szumera-Ciećkiewicz A, Kozak K, Świtaj T, Rogala P, Kalinowska I, Koseła-Paterczyk H, Zaborowski K, Teterycz P, Tysarowski A, Makuła D, Rutkowski P. Efficacy of Neoadjuvant Targeted Therapy for Borderline Resectable III B-D or IV Stage BRAF V600 Mutation-Positive Melanoma. Cancers (Basel) 2021; 14:cancers14010110. [PMID: 35008274 PMCID: PMC8744603 DOI: 10.3390/cancers14010110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Neoadjuvant therapy for locally advanced disease or potentially resectable metastatic melanoma is expected to improve operability and clinical outcomes over upfront surgery. 46 patients were treated with BRAFi/MEKi or BRAFi before surgery with 78% R0 resection. In patients with a major pathological response with no, or less than 10%, viable cells in the tumor, median DFS and PFS were significantly longer than in patients with a minor pathological response. Abstract Neoadjuvant therapy for locally advanced disease or potentially resectable metastatic melanoma is expected to improve operability and clinical outcomes over upfront surgery and adjuvant treatment as it is for sarcoma, breast, rectal, esophageal, or gastric cancers. Patients with locoregional recurrence after initial surgery and those with advanced regional lymphatic metastases are at a high risk of relapse and melanoma-related death. There is an unmet clinical need to improve the outcomes for such patients. Patients with resectable bulky stage III or resectable stage IV histologically confirmed melanoma were enrolled and received standard-dose BRAFi/MEKi for at least 12 weeks before feasible resection of the pre-therapy target and then received at least for the next 40 weeks further BRAFi/MEKi. Of these patients, 37 were treated with dabrafenib and trametinib, three were treated with vemurafenib and cobimetinib, five with vemurafenib, and one with dabrafenib alone. All patients underwent surgery with 78% microscopically margin-negative resection (R0) resection. Ten patients achieved a complete pathological response. In patients with a major pathological response with no, or less than 10%, viable cells in the tumor, median disease free survival and progression free survival were significantly longer than in patients with a minor pathological response. No patient discontinued neoadjuvant BRAFi/MEKi due to toxicity. BRAFi/MEKi pre-treatment did not result in any new specific complications of surgery. Fourteen patients experienced disease recurrence or progression during post-operative treatment. We confirmed that BRAFi/MEKi combination is an effective and safe regimen in the perioperative treatment of melanoma. Pathological response to neoadjuvant treatment may be considered as a surrogate biomarker of disease recurrence.
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Affiliation(s)
- Anna M. Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (K.O.); (A.B.); (K.K.); (T.Ś.); (P.R.); (I.K.); (H.K.-P.); (K.Z.); (P.T.); (P.R.)
- Correspondence: or ; Tel.: +48-22-546-24-55; Fax: +48-22-643-93-75
| | - Krzysztof Ostaszewski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (K.O.); (A.B.); (K.K.); (T.Ś.); (P.R.); (I.K.); (H.K.-P.); (K.Z.); (P.T.); (P.R.)
| | - Aneta Borkowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (K.O.); (A.B.); (K.K.); (T.Ś.); (P.R.); (I.K.); (H.K.-P.); (K.Z.); (P.T.); (P.R.)
| | - Anna Szumera-Ciećkiewicz
- Department of Pathology and Laboratory Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.S.-C.); (A.T.)
| | - Katarzyna Kozak
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (K.O.); (A.B.); (K.K.); (T.Ś.); (P.R.); (I.K.); (H.K.-P.); (K.Z.); (P.T.); (P.R.)
| | - Tomasz Świtaj
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (K.O.); (A.B.); (K.K.); (T.Ś.); (P.R.); (I.K.); (H.K.-P.); (K.Z.); (P.T.); (P.R.)
| | - Paweł Rogala
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (K.O.); (A.B.); (K.K.); (T.Ś.); (P.R.); (I.K.); (H.K.-P.); (K.Z.); (P.T.); (P.R.)
| | - Iwona Kalinowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (K.O.); (A.B.); (K.K.); (T.Ś.); (P.R.); (I.K.); (H.K.-P.); (K.Z.); (P.T.); (P.R.)
| | - Hanna Koseła-Paterczyk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (K.O.); (A.B.); (K.K.); (T.Ś.); (P.R.); (I.K.); (H.K.-P.); (K.Z.); (P.T.); (P.R.)
| | - Konrad Zaborowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (K.O.); (A.B.); (K.K.); (T.Ś.); (P.R.); (I.K.); (H.K.-P.); (K.Z.); (P.T.); (P.R.)
| | - Paweł Teterycz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (K.O.); (A.B.); (K.K.); (T.Ś.); (P.R.); (I.K.); (H.K.-P.); (K.Z.); (P.T.); (P.R.)
| | - Andrzej Tysarowski
- Department of Pathology and Laboratory Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.S.-C.); (A.T.)
- Department of Molecular and Translational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Donata Makuła
- Department of Radiology I, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland;
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (K.O.); (A.B.); (K.K.); (T.Ś.); (P.R.); (I.K.); (H.K.-P.); (K.Z.); (P.T.); (P.R.)
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2
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Eroglu Z, Eatrides J, Naqvi SMH, Kim Y, Rich J, Babacan NA, Brohl AS, Markowitz J, Sarnaik A, Zager J, Khushalani NI, Sondak VK, Messina J. Neoadjuvant BRAF-targeted therapy in regionally advanced and oligometastatic melanoma. Pigment Cell Melanoma Res 2020; 33:86-95. [PMID: 31329344 PMCID: PMC6928428 DOI: 10.1111/pcmr.12813] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/02/2019] [Accepted: 07/04/2019] [Indexed: 12/11/2022]
Abstract
Current management of locoregional and oligometastatic melanoma is typically with surgery; however, some patients are unable to undergo resection due to location/size of their tumors and/or the anticipated morbidity of the surgery. While there are currently no established guidelines for neoadjuvant therapy in melanoma, neoadjuvant BRAF-targeted therapy may make resection more feasible. A retrospective analysis was conducted of 23 patients with BRAFV600-mutant, stage III/IV melanoma treated with BRAF-targeted therapy prior to surgery, with no adjuvant treatment. Surgical specimens, preoperative imaging, and clinical outcomes were evaluated. Results: Ten of 23 patients (44%) attained a pathologic complete response (pCR), with no correlation between RECIST response based on preoperative imaging and pathologic response. After a median of 43-month follow-up, only 1 patient (10%) with a pCR recurred, while 8 of 13 (62%) patients without a pCR recurred. Patients with a pCR had significantly improved relapse-free (RFS) and overall survival (OS) compared to patients with residual tumor. Neoadjuvant BRAF-targeted therapy is associated with a high pCR rate in patients with stage III-IV melanoma, which may correlate with improved RFS and OS.
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Affiliation(s)
- Zeynep Eroglu
- Department of Cutaneous Oncology, Moffitt Cancer Center,
Tampa, FL
| | | | | | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, Moffitt
Cancer Center, Tampa, FL
| | - Jeani Rich
- Department of Cutaneous Oncology, Moffitt Cancer Center,
Tampa, FL
| | | | - Andrew S Brohl
- Department of Cutaneous Oncology, Moffitt Cancer Center,
Tampa, FL
| | - Joseph Markowitz
- Department of Cutaneous Oncology, Moffitt Cancer Center,
Tampa, FL
| | - Amod Sarnaik
- Department of Cutaneous Oncology, Moffitt Cancer Center,
Tampa, FL
| | - Jonathan Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center,
Tampa, FL
| | | | - Vernon K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center,
Tampa, FL
| | - Jane Messina
- Department of Cutaneous Oncology, Moffitt Cancer Center,
Tampa, FL
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3
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Sun J, Kirichenko DA, Zager JS, Eroglu Z. The emergence of neoadjuvant therapy in advanced melanoma. Melanoma Manag 2019; 6:MMT27. [PMID: 31807278 PMCID: PMC6891937 DOI: 10.2217/mmt-2019-0007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2019] [Indexed: 12/27/2022] Open
Abstract
The discovery of immunotherapy and targeted therapy has introduced new and effective treatment options for advanced melanoma, providing therapeutic options where none existed before. The natural extension of these novel therapies is to identify their role in the neoadjuvant setting. Neoadjuvant therapy for advanced melanoma is still in its infancy, with a wealth of clinical trials underway. Early results are promising, allowing for management of a disease that previously had few options. We review the current literature and interim results from several ongoing investigations to understand the current state of neoadjuvant treatment options and what is to come. These studies pave the way for further advancements in melanoma therapy.
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Affiliation(s)
- James Sun
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Dennis A Kirichenko
- Univeristy of South Florida, Morsani College of Medicine, Tampa, FL 33612, USA
| | - Jonathan S Zager
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Zeynep Eroglu
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
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4
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Faut M, Jalving M, Diercks GF, Hospers GA, van Leeuwen BL, Been LB. Preoperative BRAF inhibition in patients with irresectable locally advanced stage III melanoma. Melanoma Manag 2018; 5:MMT08. [PMID: 30459939 PMCID: PMC6240848 DOI: 10.2217/mmt-2018-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/19/2018] [Indexed: 11/21/2022] Open
Abstract
Aim Neoadjuvant treatment of locally advanced disease with BRAF inhibitors is expected to increase the likelihood of a R0 resection. We present six patients with stage III unresectable melanoma, neoadjuvantly treated with BRAF inhibitors. Methods Patients with unresectable, BRAF-mutated, stage III melanoma, were treated with BRAF inhibitors between 2012 and 2015. Unresectability was determined based on clinical and/or radiological findings. At maximal response, resection was performed. The specimen was reviewed to determine the degree of response. Results In five of six patients a radical resection was achieved. Postoperative complications were unremarkable. In five of six resected specimens, vital tumor tissue was found. Conclusion Neoadjuvant BRAF inhibitor treatment of locally advanced melanoma is feasible and has the potential to facilitate an R0 resection.
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Affiliation(s)
- Marloes Faut
- Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands.,Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - Mathilde Jalving
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands.,Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - Gilles F Diercks
- Department of Pathology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands.,Department of Pathology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - Geke A Hospers
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands.,Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands.,Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - Lukas B Been
- Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands.,Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands
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5
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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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6
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Danielli R, Patuzzo R, Di Giacomo AM, Gallino G, Maurichi A, Di Florio A, Cutaia O, Lazzeri A, Fazio C, Miracco C, Giovannoni L, Elia G, Neri D, Maio M, Santinami M. Intralesional administration of L19-IL2/L19-TNF in stage III or stage IVM1a melanoma patients: results of a phase II study. Cancer Immunol Immunother 2015; 64:999-1009. [PMID: 25971540 PMCID: PMC11028725 DOI: 10.1007/s00262-015-1704-6] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 04/23/2015] [Indexed: 11/26/2022]
Abstract
The intratumoral injection of cytokines, in particular IL2, has shown promise for cutaneous melanoma patients with unresectable disease or continuous recurrence despite surgery. We recently reported that the intralesional injection of L19-IL2, an immunocytokine combining IL2 and the human monoclonal antibody fragment L19, resulted in efficient regional control of disease progression, increased time to distant metastasis and evidence of effect on circulating immune cell populations. We have also shown in preclinical models of cancer a remarkable synergistic effect of the combination of L19-IL2 with L19-TNF, a second clinical-stage immunocytokine, based on the same L19 antibody fused to TNF. Here, we describe the results of a phase II clinical trial based on the intralesional administration of L19-IL2 and L19-TNF in patients with stage IIIC and IVM1a metastatic melanoma, who were not candidate to surgery. In 20 efficacy-evaluable patients, 32 melanoma lesions exhibited complete responses upon intralesional administration of the two products, with mild side effects mainly limited to injection site reactions. Importantly, we observed complete responses in 7/13 (53.8 %) non-injected lesions (4 cutaneous, 3 lymph nodes), indicating a systemic activity of the intralesional immunostimulatory treatment. The intralesional administration of L19-IL2 and L19-TNF represents a simple and effective method for the local control of inoperable melanoma lesions, with a potential to eradicate them or make them suitable for a facile surgical removal of the residual mass.
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Affiliation(s)
- Riccardo Danielli
- Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Siena, Italy
| | - Roberto Patuzzo
- Melanoma and Sarcoma Unit, Department of Surgery, National Tumor Institute, Via G. Venezian, 1, 20133 Milan, Italy
| | - Anna Maria Di Giacomo
- Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Siena, Italy
| | - Gianfranco Gallino
- Melanoma and Sarcoma Unit, Department of Surgery, National Tumor Institute, Via G. Venezian, 1, 20133 Milan, Italy
| | - Andrea Maurichi
- Melanoma and Sarcoma Unit, Department of Surgery, National Tumor Institute, Via G. Venezian, 1, 20133 Milan, Italy
| | - Annabella Di Florio
- Melanoma and Sarcoma Unit, Department of Surgery, National Tumor Institute, Via G. Venezian, 1, 20133 Milan, Italy
| | - Ornella Cutaia
- Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Siena, Italy
| | - Andrea Lazzeri
- Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Siena, Italy
| | - Carolina Fazio
- Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Siena, Italy
| | - Clelia Miracco
- Section of Pathological Anatomy, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | | | | | - Dario Neri
- Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Michele Maio
- Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Siena, Italy
| | - Mario Santinami
- Melanoma and Sarcoma Unit, Department of Surgery, National Tumor Institute, Via G. Venezian, 1, 20133 Milan, Italy
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7
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Abstract
High-dose interferon is the current standard of care for the adjuvant treatment of high-risk cutaneous melanoma. Despite numerous clinical trials using interferon in a variety of doses and schedules, none have demonstrated a meaningful clinical improvement relative to standard high-dose interferon. Recently however, a phase III trial using biochemotherapy demonstrated a superior relapse-free survival benefit over standard interferon. In addition, several agents approved for use in metastatic melanoma are being investigated in the adjuvant setting.
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Affiliation(s)
- Amy M Weise
- Karmanos Cancer Institute, 4100 John R. Rd., Detroit, MI, USA,
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8
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La Greca M, Grasso G, Antonelli G, Russo AE, Bartolotta S, D'Angelo A, Vitale FV, Ferraù F. Neoadjuvant therapy for locally advanced melanoma: new strategies with targeted therapies. Onco Targets Ther 2014; 7:1115-21. [PMID: 24971022 PMCID: PMC4069135 DOI: 10.2147/ott.s62699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Neoadjuvant chemotherapy has been successfully tested in several bulky solid tumors, but it has not been utilized in advanced cutaneous melanoma, primarily because effective medical treatments for this disease have been lacking. However, with the development of new immunotherapies (monoclonal antibodies specific for cytotoxic T lymphocyte-associated antigen 4 [anti-CTLA-4] and programmed death protein-1 [anti-PD1]) and small molecules interfering with intracellular pathways (anti-BRAF and mitogen-activated protein kinase kinase [anti- MEK]) the use of this approach is becoming a viable treatment strategy for locally advanced melanoma. The neoadjuvant setting provides a double opportunity for a better knowledge of these drugs: a short-term evaluation of their intrinsic activity, and a deeper analysis of their action and resistance-induction mechanisms. BRAF inhibitors seem to be ideal candidates for the neoadjuvant setting, because of their prompt, repeatedly confirmed response in V600E BRAF-mutant metastatic melanoma. In this report we summarize studies focused on the neoadjuvant use of traditional medical treatments in advanced melanoma and anecdotal cases of this approach with the use of biologic therapies. Moreover, we discuss our experience with neoadjuvant targeted therapy as a priming for radical surgery in a patient with BRAF V600E mutation-positive advanced melanoma.
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Affiliation(s)
- Michele La Greca
- Medical Oncology Department, San Vincenzo Hospital, Taormina, Messina, Italy
| | - Giuseppe Grasso
- Pathology Department, San Vincenzo Hospital, Taormina, Messina, Italy
| | - Giovanna Antonelli
- Medical Oncology Department, San Vincenzo Hospital, Taormina, Messina, Italy
| | - Alessia Erika Russo
- Medical Oncology Department, San Vincenzo Hospital, Taormina, Messina, Italy
| | | | - Alessandro D'Angelo
- Medical Oncology Department, San Vincenzo Hospital, Taormina, Messina, Italy
| | - Felice Vito Vitale
- Medical Oncology Department, San Vincenzo Hospital, Taormina, Messina, Italy
| | - Francesco Ferraù
- Medical Oncology Department, San Vincenzo Hospital, Taormina, Messina, Italy
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9
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10
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Kaidar-Person O, Eran A, Bar-Sela G. Complete pathologic response after neoadjuvant treatment with vemurafenib for malignant melanoma. J Am Acad Dermatol 2014; 70:e39-41. [PMID: 24438978 DOI: 10.1016/j.jaad.2013.09.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 09/15/2013] [Accepted: 09/23/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Orit Kaidar-Person
- Division of Oncology, Rambam Health Care Campus and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ayelet Eran
- Department of Radiology, Rambam Health Care Campus and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gil Bar-Sela
- Division of Oncology, Rambam Health Care Campus and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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11
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A new role of vemurafenib as a neoadjuvant treatment of axillary and brain melanoma metastases. Case Rep Oncol Med 2013; 2013:794239. [PMID: 24455362 PMCID: PMC3884783 DOI: 10.1155/2013/794239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 12/09/2013] [Indexed: 12/21/2022] Open
Abstract
Vemurafenib is approved by the FDA for the management of unresectable or metastatic melanoma. However, its role as a neoadjuvant therapy has not been determined. We present the first documented case in which vemurafenib induced complete tumor necrosis of both lymph node and brain metastases within one month or less, an outcome that indicated that the patient was a good candidate for excisional surgery.
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12
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Laks S, Brueske KA, Hsueh EC. Neoadjuvant treatment of melanoma: case reports and review. Exp Hematol Oncol 2013; 2:30. [PMID: 24499550 PMCID: PMC3832230 DOI: 10.1186/2162-3619-2-30] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/04/2013] [Indexed: 01/06/2023] Open
Abstract
Neoadjuvant therapy is an under-utilized regimen for the treatment of metastatic melanoma. The use of this approach has been increasing in other tumor types. Neoadjuvant therapy may reduce occult circulating tumor cell burden in the face of bulky disease and afford a real time evaluation of treatment effectiveness. Neoadjuvant approach can also provide preoperative histologic and molecular analysis of treated tissue that may guide the postoperative treatment planning in patients with resectable metastatic melanoma lesions. The putative benefits of better margin control and clearance of occult systemic disease would theoretically improve surgical outcome. With the advent of effective agents against metastatic melanoma, this common approach to the treatment of rectal cancer, metastatic colon cancer, and breast cancer should also be evaluated as a viable treatment strategy for advanced stage melanoma.
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Affiliation(s)
| | | | - Eddy C Hsueh
- Department of Surgery, Saint Louis University, 3635 Vista at Grand Blvd,, St, Louis, Missouri 63110, USA.
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