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Troiani T, De Falco V, Napolitano S, Trojaniello C, Ascierto PA. How we treat locoregional melanoma. ESMO Open 2021; 6:100136. [PMID: 33930656 PMCID: PMC8100625 DOI: 10.1016/j.esmoop.2021.100136] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/02/2021] [Indexed: 12/19/2022] Open
Abstract
Cutaneous melanoma is the most lethal form of skin cancer and its incidence has been increasing in the past 30 years. Although this is completely resectable in most cases, thicker melanoma and those with regional lymph-node involvement are at a high risk of relapse. In recent years, the management of locoregional disease has drastically changed. In particular, in the 8th Edition of the American Joint Committee on Cancer (AJCC), subgroup classification of TNM (tumor–node–metastasis) has been modified, with the addition of the IIID stage. Furthermore, in recent randomized trials, completion lymph node dissection in case of sentinel lymph node biopsy positivity has not been shown to offer any improvement in overall survival versus observation. Consequently, radical dissection has been recommended as the standard treatment, but only in patients with palpable nodal metastases. However, the major novelty in the treatment of locally advanced melanoma has been the introduction of drugs, already used for metastatic disease, that have also shown clinical efficacy in the adjuvant setting. In fact, immunotherapies and, in the case of BRAF V600E/K-mutated melanoma, combination treatment of BRAF and MEK inhibitors have improved recurrence-free survival in these patients. In this paper, we will describe the current management of a patient with radically resectable melanoma and discuss the key points in light of the latest scientific evidence. Melanoma is the deadliest of skin cancers, although most cases are resectable at diagnosis. Use of targeted therapies and immunotherapies as adjuvant treatment revolutionized the scenario in stage III melanoma. In this review, we summarize all current evidence about locoregional melanoma, including open issues and future directions.
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Affiliation(s)
- T Troiani
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania 'Luigi Vanvitelli', Napoli, Italy.
| | - V De Falco
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania 'Luigi Vanvitelli', Napoli, Italy
| | - S Napolitano
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania 'Luigi Vanvitelli', Napoli, Italy
| | - C Trojaniello
- Melanoma, Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale dei Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - P A Ascierto
- Melanoma, Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale dei Tumori IRCCS Fondazione Pascale, Napoli, Italy.
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Bhave P, Pallan L, Long GV, Menzies AM, Atkinson V, Cohen JV, Sullivan RJ, Chiarion-Sileni V, Nyakas M, Kahler K, Hauschild A, Plummer R, Trojaniello C, Ascierto PA, Zimmer L, Schadendorf D, Allayous C, Lebbe C, Maurichi A, Santinami M, Roy S, Robert C, Lesimple T, Patel S, Versluis JM, Blank CU, Khattak A, Van der Westhuizen A, Carlino MS, Shackleton M, Haydon A. Melanoma recurrence patterns and management after adjuvant targeted therapy: a multicentre analysis. Br J Cancer 2021; 124:574-580. [PMID: 33087895 PMCID: PMC7851118 DOI: 10.1038/s41416-020-01121-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/07/2020] [Accepted: 10/02/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Adjuvant targeted therapy (TT) improves relapse free survival in patients with resected BRAF mutant stage III melanoma. The outcomes and optimal management of patients who relapse after adjuvant TT is unknown. METHODS Patients from twenty-one centres with recurrent melanoma after adjuvant TT were included. Disease characteristics, adjuvant therapy, recurrence, treatment at relapse and outcomes were examined. RESULTS Eighty-five patients developed recurrent melanoma; nineteen (22%) during adjuvant TT. Median time to first recurrence was 18 months and median follow-up from first recurrence was 31 months. Fifty-eight (68%) patients received immunotherapy (IT) or TT as 1st line systemic therapy at either first or subsequent recurrence and had disease that was assessable for response. Response to anti-PD-1 (±trial agent), combination ipilimumab-nivolumab, TT rechallenge and ipilimumab monotherapy was 63%, 62% 25% and 10% respectively. Twenty-eight (33%) patients had died at census, all from melanoma. Two-year OS was 84% for anti-PD-1 therapy (±trial agent), 92% for combination ipilimumab and nivolumab, 49% for TT and 45% for ipilimumab monotherapy (p = 0.028). CONCLUSIONS Patients who relapse after adjuvant TT respond well to subsequent anti-PD-1 based therapy and have outcomes similar to those seen when first line anti-PD-1 therapy is used in stage IV melanoma.
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Affiliation(s)
- Prachi Bhave
- Department of Medical Oncology, Alfred Hospital, Melbourne, VIC, Australia.
| | - Lalit Pallan
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Victoria Atkinson
- Department of Medical Oncology, Princess Alexandra Hospital, Greenslopes Private Hospital and University of Queensland, Brisbane, QLD, Australia
| | - Justine V Cohen
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Ryan J Sullivan
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Marta Nyakas
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Katharina Kahler
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ruth Plummer
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK
| | - Claudia Trojaniello
- Department of Melanoma and Cancer Immunotherapy, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Paolo A Ascierto
- Department of Melanoma and Cancer Immunotherapy, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, Essen & German Cancer Consortium, Heidelberg, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, Essen & German Cancer Consortium, Heidelberg, Germany
| | - Clara Allayous
- AP-HP Dermatology Department, Saint-Louis Hospital, Paris, France
| | - Celeste Lebbe
- AP-HP Dermatology Department, Saint-Louis Hospital, Paris, France
| | - Andrea Maurichi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Mario Santinami
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Severine Roy
- Department of Dermatology, Gustave Roussy and Paris-Saclay Institute, Villejuif, France
| | - Caroline Robert
- Department of Dermatology, Gustave Roussy and Paris-Saclay Institute, Villejuif, France
| | - Thierry Lesimple
- Department of Medical Oncology, Centre Eugène Marqui, Rennes, France
| | - Sapna Patel
- Department of Melanoma Medical Oncology, MD Anderson Cancer Centre, Houston, TX, USA
| | - Judith M Versluis
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Christian U Blank
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Adnan Khattak
- Department of Medical Oncology, Fiona Stanley Hospital, Perth, WA, Australia
| | | | - Matteo S Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Oncology, Westmead Hospital, Sydney, NSW, Australia
| | - Mark Shackleton
- Department of Medical Oncology, Alfred Hospital, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Andrew Haydon
- Department of Medical Oncology, Alfred Hospital, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
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Moreira A, Heinzerling L, Bhardwaj N, Friedlander P. Current Melanoma Treatments: Where Do We Stand? Cancers (Basel) 2021; 13:E221. [PMID: 33435389 PMCID: PMC7827568 DOI: 10.3390/cancers13020221] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/31/2020] [Accepted: 01/01/2021] [Indexed: 01/16/2023] Open
Abstract
Groundbreaking research in immunology and cancer biology in the last few decades has led to the discovery and development of novel therapeutics, such as immune checkpoint inhibitors and targeted therapies, which have revolutionized the clinical care of patients with metastatic melanoma. Updated data from the largest clinical trials continue to support the use of these treatment modalities, both in the metastatic and in adjuvant settings, with studies showing the predicted plateau effect on survival curves. However, with growing evidence that neoadjuvant therapy is also associated with high rates of recurrence-free survival, the question about whether patients should receive adjuvant or neoadjuvant treatment raises new questions about therapeutic options. Finally, management after resistance and intervention with novel immunotherapies are newer challenges, particularly in the field of non-cutaneous melanoma.
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Affiliation(s)
- Alvaro Moreira
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (N.B.); (P.F.)
- The Kimberly and Eric J. Waldman Department of Dermatology at Mount Sinai, New York, NY 10029, USA
| | - Lucie Heinzerling
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Geschwister-Scholl-Platz 1, 80539 München, Germany;
| | - Nina Bhardwaj
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (N.B.); (P.F.)
- The Kimberly and Eric J. Waldman Department of Dermatology at Mount Sinai, New York, NY 10029, USA
| | - Philip Friedlander
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (N.B.); (P.F.)
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Krishnan T, Menzies AM, Roberts-Thomson R. Applying adjuvant therapy for melanoma into clinical practice. Expert Rev Anticancer Ther 2020; 21:129-133. [PMID: 33094675 DOI: 10.1080/14737140.2021.1841641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Tharani Krishnan
- Medical Oncology department, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Medical Oncology Department, Royal North Shore and Mater Hospitals, Sydney, Australia
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