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Grossman D, Okwundu N, Bartlett EK, Marchetti MA, Othus M, Coit DG, Hartman RI, Leachman SA, Berry EG, Korde L, Lee SJ, Bar-Eli M, Berwick M, Bowles T, Buchbinder EI, Burton EM, Chu EY, Curiel-Lewandrowski C, Curtis JA, Daud A, Deacon DC, Ferris LK, Gershenwald JE, Grossmann KF, Hu-Lieskovan S, Hyngstrom J, Jeter JM, Judson-Torres RL, Kendra KL, Kim CC, Kirkwood JM, Lawson DH, Leming PD, Long GV, Marghoob AA, Mehnert JM, Ming ME, Nelson KC, Polsky D, Scolyer RA, Smith EA, Sondak VK, Stark MS, Stein JA, Thompson JA, Thompson JF, Venna SS, Wei ML, Swetter SM. Prognostic Gene Expression Profiling in Cutaneous Melanoma: Identifying the Knowledge Gaps and Assessing the Clinical Benefit. JAMA Dermatol 2020; 156:1004-1011. [PMID: 32725204 PMCID: PMC8275355 DOI: 10.1001/jamadermatol.2020.1729] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance Use of prognostic gene expression profile (GEP) testing in cutaneous melanoma (CM) is rising despite a lack of endorsement as standard of care. Objective To develop guidelines within the national Melanoma Prevention Working Group (MPWG) on integration of GEP testing into the management of patients with CM, including (1) review of published data using GEP tests, (2) definition of acceptable performance criteria, (3) current recommendations for use of GEP testing in clinical practice, and (4) considerations for future studies. Evidence Review The MPWG members and other international melanoma specialists participated in 2 online surveys and then convened a summit meeting. Published data and meeting abstracts from 2015 to 2019 were reviewed. Findings The MPWG members are optimistic about the future use of prognostic GEP testing to improve risk stratification and enhance clinical decision-making but acknowledge that current utility is limited by test performance in patients with stage I disease. Published studies of GEP testing have not evaluated results in the context of all relevant clinicopathologic factors or as predictors of regional nodal metastasis to replace sentinel lymph node biopsy (SLNB). The performance of GEP tests has generally been reported for small groups of patients representing particular tumor stages or in aggregate form, such that stage-specific performance cannot be ascertained, and without survival outcomes compared with data from the American Joint Committee on Cancer 8th edition melanoma staging system international database. There are significant challenges to performing clinical trials incorporating GEP testing with SLNB and adjuvant therapy. The MPWG members favor conducting retrospective studies that evaluate multiple GEP testing platforms on fully annotated archived samples before embarking on costly prospective studies and recommend avoiding routine use of GEP testing to direct patient management until prospective studies support their clinical utility. Conclusions and Relevance More evidence is needed to support using GEP testing to inform recommendations regarding SLNB, intensity of follow-up or imaging surveillance, and postoperative adjuvant therapy. The MPWG recommends further research to assess the validity and clinical applicability of existing and emerging GEP tests. Decisions on performing GEP testing and patient management based on these results should only be made in the context of discussion of testing limitations with the patient or within a multidisciplinary group.
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Affiliation(s)
- Douglas Grossman
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Dermatology, University of Utah, Salt Lake City
- Department of Oncological Sciences, University of Utah, Salt Lake City
| | | | - Edmund K Bartlett
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Megan Othus
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Daniel G Coit
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rebecca I Hartman
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Sancy A Leachman
- Department of Dermatology and Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Elizabeth G Berry
- Department of Dermatology and Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Larissa Korde
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Sandra J Lee
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
- Department of Data Sciences, Harvard Medical School, Boston, Massachusetts
| | - Menashe Bar-Eli
- Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston
| | - Marianne Berwick
- Departments of Dermatology and Internal Medicine, University of New Mexico Cancer Center, University of New Mexico, Albuquerque
| | - Tawnya Bowles
- Department of Surgery, Division of Surgical Oncology, University of Utah, Salt Lake City
| | - Elizabeth I Buchbinder
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
- Department of Internal Medicine, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth M Burton
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Emily Y Chu
- Department of Dermatology, Perelman School of Medicine University of Pennsylvania, Philadelphia
| | | | - Julia A Curtis
- Department of Dermatology, University of Utah, Salt Lake City
| | - Adil Daud
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
- Department of Hematology/Oncology, University of California, San Francisco
| | - Dekker C Deacon
- Department of Dermatology, University of Utah, Salt Lake City
| | - Laura K Ferris
- Department of Dermatology and University of Pittsburgh Clinical and Translational Science Institute, Pittsburgh, Pennsylvania
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Kenneth F Grossmann
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Medicine, Division of Oncology, University of Utah, Salt Lake City
| | - Siwen Hu-Lieskovan
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Medicine, Division of Oncology, University of Utah, Salt Lake City
| | - John Hyngstrom
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Surgery, Division of Surgical Oncology, University of Utah, Salt Lake City
| | - Joanne M Jeter
- Department of Internal Medicine and The Ohio State University Comprehensive Cancer Center, Columbus
| | - Robert L Judson-Torres
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Dermatology, University of Utah, Salt Lake City
| | - Kari L Kendra
- Department of Internal Medicine and The Ohio State University Comprehensive Cancer Center, Columbus
| | - Caroline C Kim
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
- Partners Healthcare, Newton Wellesley Dermatology Associates, Wellesley, Massachusetts
| | - John M Kirkwood
- Department of Internal Medicine and UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David H Lawson
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | | | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Janice M Mehnert
- Department of Medical Oncology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey
- Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Michael E Ming
- Department of Dermatology, Perelman School of Medicine University of Pennsylvania, Philadelphia
| | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston
| | - David Polsky
- Department of Dermatology, Ronald O. Perelman Department of Dermatology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York University School of Medicine, New York, New York
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
| | - Eric A Smith
- Department of Pathology, University of Utah, Salt Lake City
| | - Vernon K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center & Research Institute, Tampa, Florida
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa
| | - Mitchell S Stark
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Australia
| | - Jennifer A Stein
- Department of Dermatology, Ronald O. Perelman Department of Dermatology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York University School of Medicine, New York, New York
| | - John A Thompson
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Oncology, University of Washington, Seattle
- Seattle Cancer Care Alliance, Seattle, Washington
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Suraj S Venna
- Inova Schar Cancer Institute, Department of Medicine, Virginia Commonwealth University, Fairfax
| | - Maria L Wei
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
- Department of Dermatology, University of California, San Francisco
- Dermatology Service, Veterans Affairs Medical Center, San Francisco, California
| | - Susan M Swetter
- Stanford University Medical Center and Cancer Institute, Stanford, California
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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Amaral TMS, Hoffmann MC, Sinnberg T, Niessner H, Sülberg H, Eigentler TK, Garbe C. Clinical validation of a prognostic 11-gene expression profiling score in prospectively collected FFPE tissue of patients with AJCC v8 stage II cutaneous melanoma. Eur J Cancer 2020; 125:38-45. [PMID: 31838403 DOI: 10.1016/j.ejca.2019.10.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/18/2019] [Accepted: 10/28/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Adjuvant therapies have been approved for patients with AJCC (American Joint Committee on Cancer) stage III and stage IV cutaneous melanoma (CM) after complete resection. These therapies might also be indicated for patients with high-risk stage II CM. MATERIAL AND METHODS We included patients diagnosed with stage II melanoma between 2000 and 2016 and for which primary tumour tissue was available. The prognostic value of the 11-gene expression profiling score (GEPS) was evaluated as a dichotomized parameter (GEPS ≤0 vs. >0). Endpoints of the analysis were melanoma specific survival (MSS), distant metastasis-free survival (DMFS) and relapse-free survival (RFS). RESULTS GEPS was determined in 245 patients ranging between -0.7 and 3.53. A total of 111 females and 134 males were included; the median follow-up was 41 months. Kaplan Meier analyses showed statistically significant survival differences between patients with high GEPS (n = 154) and low GEPS (n = 91) for MSS (p = 0.018), DMFS (p = 0.005) and RFS (p = 0.009). The 5-year and 10-year MSS was 92% in the low-GEPS and 82% and 67% in the high-GEPS group, respectively. Multivariate Cox regression analysis showed independent significance for MSS of GEPS (HR = 1.55; p = 0.006), tumor thickness (HR = 1.21; p < 0.001) and age (HR1.05; p = 0.002). CONCLUSION GEPS was validated as independent prognostic factor for MSS in stage II CM and could be used for therapeutic decisions when systemic therapies become available in stage II CM.
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Affiliation(s)
- Teresa M S Amaral
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany; Portuguese Air Force, Health Care Direction, Lisbon, Portugal
| | | | - Tobias Sinnberg
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Heike Niessner
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Heiko Sülberg
- X-act Cologne Clinical Research GmbH, Cologne, Germany
| | - Thomas K Eigentler
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Claus Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany; Central Malignant Melanoma Registry (CMMR) of Germany, Tuebingen, Germany.
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