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Salama AKS. Evolving pharmacotherapies for the treatment of metastatic melanoma. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2013; 7:137-49. [PMID: 23843723 PMCID: PMC3698188 DOI: 10.4137/cmo.s9565] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Metastatic melanoma remains a difficult disease to treat, and long term survivors are rare. Over the past few years, however, breakthroughs in both immunotherapy as well as targeted agents have had a tremendous impact on patients diagnosed with this disease. This review summarizes recent advances in systemic therapies for melanoma, including immune modulators directed against cytotoxic T lymphocyte associated antigen-4 (CTLA-4) and programmed death-1 (PD-1), as well as a number of targeted agents. These approaches hold great promise as the landscape of therapeutic options for advanced melanoma continues to evolve.
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Affiliation(s)
- April K S Salama
- Division of Medical Oncology, Duke University Medical Center, Durham NC, USA
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Pécuchet N, Lebbe C, Mir O, Billemont B, Blanchet B, Franck N, Viguier M, Coriat R, Tod M, Avril MF, Goldwasser F. Sorafenib in advanced melanoma: a critical role for pharmacokinetics? Br J Cancer 2012; 107:455-61. [PMID: 22767146 PMCID: PMC3405224 DOI: 10.1038/bjc.2012.287] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/16/2012] [Accepted: 05/30/2012] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Inter-patient pharmacokinetic variability can lead to suboptimal drug exposure, and therefore might impact the efficacy of sorafenib. This study reports long-term pharmacokinetic monitoring of patients treated with sorafenib and a retrospective pharmacodynamic/pharmacokinetic analysis in melanoma patients. PATIENTS AND METHODS Heavily pretreated patients with stage IV melanoma were started on sorafenib 400 mg twice daily (bid). In the absence of limiting toxicity, dose escalation of 200 mg bid levels was done every 2 weeks. Plasma sorafenib measurement was performed at each visit, allowing a retrospective pharmacodynamic/pharmacokinetic analysis for safety and efficacy. RESULTS In all, 19 of 30 patients underwent dose escalation over 400 mg bid, and 28 were evaluable for response. The overall disease control rate was 61% (95% confidence interval (CI): 42.6-78.8), including three confirmed responses (12%). Disease control rate and progression-free survival (PFS) were improved in patients with high vs low exposure (80% vs 32%, P=0.02, and 5.25 vs 2.5 months, P=0.005, hazard ratio (HR)=0.28 (95% CI: 0.11-0.73)). In contrast, drug dosing had no effect on PFS. In multivariate analysis, drug exposure was the only factor associated with PFS (HR=0.36 (95% CI: 0.13-0.99)). Diarrhoea and anorexia were correlated with drug dosing, while hypertension and hand-foot skin reaction were correlated with drug exposure. CONCLUSIONS Although sorafenib had modest efficacy in melanoma, these results suggest a correlation between exposure and efficacy of sorafenib. Therefore, dose optimisation in patients with low exposure at standard doses should be evaluated in validated indications.
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Affiliation(s)
- N Pécuchet
- Department of Medical Oncology, Centre for Research on Angiogenesis Inhibitors (CERIA), Cochin Teaching Hospital, Université Paris Descartes, Sorbonne Paris Cité, AP-HP, 27, rue du faubourg Saint Jacques, F75014 Paris, France
| | - C Lebbe
- Department of Dermatology and INSERM U976, Saint Louis Teaching Hospital, Université Paris Diderot, AP-HP, Paris, France
| | - O Mir
- Department of Medical Oncology, Centre for Research on Angiogenesis Inhibitors (CERIA), Cochin Teaching Hospital, Université Paris Descartes, Sorbonne Paris Cité, AP-HP, 27, rue du faubourg Saint Jacques, F75014 Paris, France
| | - B Billemont
- Department of Medical Oncology, Centre for Research on Angiogenesis Inhibitors (CERIA), Cochin Teaching Hospital, Université Paris Descartes, Sorbonne Paris Cité, AP-HP, 27, rue du faubourg Saint Jacques, F75014 Paris, France
| | - B Blanchet
- Department of Pharmacy, Cochin Teaching Hospital, AP-HP, Paris, France
| | - N Franck
- Department of Dermatology, Cochin Teaching Hospital, Université Paris Descartes, Sorbonne Paris Cité, AP-HP, Paris, France
| | - M Viguier
- Department of Dermatology and INSERM U976, Saint Louis Teaching Hospital, Université Paris Diderot, AP-HP, Paris, France
| | - R Coriat
- Department of Medical Oncology, Centre for Research on Angiogenesis Inhibitors (CERIA), Cochin Teaching Hospital, Université Paris Descartes, Sorbonne Paris Cité, AP-HP, 27, rue du faubourg Saint Jacques, F75014 Paris, France
| | - M Tod
- Department of Pharmacy, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - M-F Avril
- Department of Dermatology, Cochin Teaching Hospital, Université Paris Descartes, Sorbonne Paris Cité, AP-HP, Paris, France
| | - F Goldwasser
- Department of Medical Oncology, Centre for Research on Angiogenesis Inhibitors (CERIA), Cochin Teaching Hospital, Université Paris Descartes, Sorbonne Paris Cité, AP-HP, 27, rue du faubourg Saint Jacques, F75014 Paris, France
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Walraven M, Witteveen PO, Lolkema MPJ, van Hillegersberg R, Voest EE, Verheul HMW. Antiangiogenic tyrosine kinase inhibition related gastrointestinal perforations: a case report and literature review. Angiogenesis 2011; 14:135-41. [PMID: 21188500 PMCID: PMC3102838 DOI: 10.1007/s10456-010-9197-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 12/14/2010] [Indexed: 12/11/2022]
Abstract
Anti-VEGF (vascular endothelial growth factor) therapy with the monoclonal antibody bevacizumab can cause gastrointestinal (GI) perforations. In recent years it became apparent that GI perforations also occur during treatment with antiangiogenic tyrosine kinase inhibitors (TKIs). It is of clinical importance to consider (vague) abdominal complaints during antiangiogenic treatment as a sign of a GI perforation. To illustrate this serious complication, we report four cases of antiangiogenic treatment related GI perforations. In three cases this was due to antiangiogenic TKI treatment. Reported risk factors of GI perforations due to bevacizumab include the presence of a primary tumor in situ and recent history of endoscopy or abdominal radiotherapy. Pathology assessments of surgical removal of the perforated intestinal part reveal that perforations are predominantly seen at the tumor or anastomotic site, in case of carcinomatosis or diverticulitis or when GI obstruction or an intra-abdominal abscess is present. Whether the same risk factors may be involved in antiangiogenic TKI related GI perforations is unknown. The underlying mechanisms responsible for GI perforation during antiangiogenic treatment is unknown, but disturbance of host cell homeostasis of immune cells as well as platelet-endothelial cell interactions may play an important role. In conclusion, while clinical awareness that antiangiogenic treatment can cause GI perforations is critical for current medical practice, it is also very important to get more insight in its underlying mechanisms so that this life-threatening complication may be prevented in the near future.
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Affiliation(s)
- Maudy Walraven
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Martijn P. J. Lolkema
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R. van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Emile E. Voest
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H. M. W. Verheul
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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