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Chitnis SD, Seim NB, Kendra K. Local intralesional talimogene laherparepvec therapy with complete local response in oral palatine mucosal melanoma: a case report. J Med Case Rep 2024; 18:257. [PMID: 38778387 PMCID: PMC11112787 DOI: 10.1186/s13256-024-04554-8] [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: 11/08/2023] [Accepted: 04/17/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Mucosal melanoma, an aggressive type of malignancy different from the cutaneous melanomas commonly seen in the head and neck region, represents < 1% of all malignant melanomas. The pathogenesis of mucosal melanoma is unknown. Targetable mutations commonly seen in cutaneous melanoma, such as in the BRAF and NRAS genes, have a lower incidence in mucosal melanoma. Mucosal melanoma carries a distinct mutational pattern from cutaneous melanoma. Surgery with negative margins is the first-line treatment for mucosal melanoma, and systemic therapy is not well defined. Talimogene laherparepvec, an oncolytic viral immunotherapy, is United States Food and Drug Administration approved for the treatment of advanced malignant cutaneous melanoma, with local therapeutic benefits. Mucosal melanoma was initially excluded from talimogene laherparepvec's initial phase III clinical trial. CASE PRESENTATION We present the case of a white female patient in her 40s with past medical history of systemic lupus erythematous, scleroderma, and estrogen-receptor-positive invasive ductal breast carcinoma. Following a bilateral mastectomy, the patient was found to have BRAF-negative mucosal melanoma of her hard palate with a soft palate skip lesion. Owing to the presence of a skip mucosal lesion as well as the anticipated defect and need for free-flap reconstructive surgery, nonsurgical management was considered. The patient was referred to medical oncology, where-based on the patient's complicated medical history and the risk of immunotherapy possibly worsening her prior autoimmune diseases-local talimogene laherparepvec injections were chosen as the primary therapy for her mucosal lesions. Though talimogene laherparepvec is approved for the treatment of cutaneous melanoma, there are limited data available on the use of talimogene laherparepvec in mucosal melanomas. CONCLUSION The patient had a complete local tumor response at both the primary lesion as well as the skip lesion with the local injections. She had no side effects and maintained a high quality of life during treatment.
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Affiliation(s)
- Saurabh D Chitnis
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
| | - Nolan B Seim
- Department of Otolaryngology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kari Kendra
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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Djafari AA, Javanmard B, Samenezhad S, Eslami AH, Rakhshan A. Primary malignant melanoma of the female urethra A rare histopathology case report. Urol Case Rep 2024; 52:102642. [PMID: 38269298 PMCID: PMC10805634 DOI: 10.1016/j.eucr.2023.102642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/14/2023] [Accepted: 12/22/2023] [Indexed: 01/26/2024] Open
Abstract
Malignant melanoma in the urethra is a rare tumor that is difficult to diagnose and treat, leading to a poor prognosis. In this paper, we present the case of a 36-year-old woman with history of invasive rectal adenocarcinoma (PT2N0Mx) who was tumor free for 5 years presented to urology outpatient with history of poor stream, dysuria, and dyspareuria. On examination, there was a huge mass in the meatus of urethra. Urethral malignant melanoma shows a high rate of local recurrence, about 60 % in 1 year. Overall survival in a series of 11 cases at 3 years was 27 %.
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Affiliation(s)
- Anahita Ansari Djafari
- Shahid Beheshti University of Medical Sciences Laser Application in Medical Sciences Research Center, Urology, Tehran, Tehran, Iran
| | - Babak Javanmard
- Shahid Beheshti University of Medical Sciences Laser Application in Medical Sciences Research Center, Urology, Tehran, Tehran, Iran
| | - Sina Samenezhad
- Shahid Beheshti University of Medical Sciences Laser Application in Medical Sciences Research Center, Urology, Tehran, Tehran, Iran
| | - Amir Hossein Eslami
- Shahid Beheshti University of Medical Sciences Laser Application in Medical Sciences Research Center, Urology, Tehran, Tehran, Iran
| | - Azadeh Rakhshan
- Department of Pathology, Shohada-e-tajrish Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Huang Y, Wei L, Huang Y, Wen S, Liu T, Duan X, Wang Y, Zhang H, Fan B, Hu B. Identification of distinct genomic features reveals frequent somatic AHNAK and PTEN mutations predominantly in primary malignant melanoma presenting in the ureter. Jpn J Clin Oncol 2022; 52:930-943. [PMID: 35578896 DOI: 10.1093/jjco/hyac061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 04/07/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Primary malignant melanoma of the ureter is extremely rare. Genetic variants to the increased risk of developing the disease have not yet been investigated. METHODS Tumour mutation profiling for primary malignant melanoma of the ureter was performed by whole-exome sequencing. Immunohistochemistry was performed to verify histopathological features and the variants of predisposing genes and driver mutation genes. Furthermore, we conducted a literature review and Surveillance, Epidemiology and End Result-based study by searching public databases. RESULTS We identified 38 somatic single nucleotide variants and 9 somatic insertions and deletions (INDELs) in tumour specimens. After filtering with the Cancer Gene Census database, seven predisposing genes and two driver mutation genes were identified. Moreover, the immunohistochemical profile showed that tumour cells were positive for Melan-A, melanoma gp100 human melanoma black 45 (HMB45), S100 beta and P53. The expression levels of two driver mutation genes (phosphatase and tensin homolog (PTEN) and desmoyokin (AHNAK) and five predisposing genes (AT-rich interaction domain 1B (ARID1B), catalase, eukaryotic translation initiation factor 4 gamma 3 (EIF4G3), ANK3 and collagen type I) were significantly downregulated in tumour tissues compared to paracancerous tissues. In the literature review and Surveillance, Epidemiology and End Results-based study, patients with primary malignant melanoma of the urinary tract had worse clinical outcomes than patients with primary urothelial carcinoma after 1:2 propensity score matching (P = 0.010). Additionally, Cox multivariate analysis for patients with primary malignant melanoma of the urinary tract indicated that distant metastasis (hazard ratio = 1.185; P = 0.044) was an independent predictor for overall survival, and tumour focality (hazard ratio = 0.602; P = 0.017) and non-surgery (hazard ratio = 0.434; P = 0.003) were independent factors for tumour progression. CONCLUSIONS Our study is the first to provide evidence that the distinct phenotypes of primary malignant melanoma of the ureter may be due to different genetic variations. The prognosis of primary malignant melanoma of the urinary tract was poorer than that of primary urothelial carcinoma of the urinary tract.
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Affiliation(s)
- Yan Huang
- Department of Urology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
| | - Lai Wei
- Department of Radiology, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan, China
| | - Yuanbin Huang
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Shuang Wen
- Department of Pathology, Dalian Friendship Hospital, Dalian, Liaoning, China
| | - Tianqing Liu
- Department of Pathology, Dalian Friendship Hospital, Dalian, Liaoning, China
| | - Xu Duan
- First Clinical College, Dalian Medical University, Dalian, Liaoning, China
| | - Yutong Wang
- First Clinical College, Dalian Medical University, Dalian, Liaoning, China
| | - Hongshuo Zhang
- Department of Biochemistry, Institute of Glycobiology, Dalian Medical University, Dalian, Liaoning, China
| | - Bo Fan
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Bin Hu
- Department of Urology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
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Combination Therapy of Novel Oncolytic Adenovirus with Anti-PD1 Resulted in Enhanced Anti-Cancer Effect in Syngeneic Immunocompetent Melanoma Mouse Model. Pharmaceutics 2021; 13:pharmaceutics13040547. [PMID: 33919827 PMCID: PMC8070801 DOI: 10.3390/pharmaceutics13040547] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/10/2021] [Accepted: 04/11/2021] [Indexed: 12/24/2022] Open
Abstract
Malignant melanoma, an aggressive form of skin cancer, has a low five-year survival rate in patients with advanced disease. Immunotherapy represents a promising approach to improve survival rates among patients at advanced stage. Herein, the aim of the study was to design and produce, by using engineering tools, a novel oncolytic adenovirus AdV-D24- inducible co-stimulator ligand (ICOSL)-CD40L expressing potent co-stimulatory molecules enhancing clinical efficacy through the modulation of anti-cancer immune responses. Firstly, we demonstrated the vector's identity and genetic stability by restriction enzyme assay and sequencing, then, by performing in vitro and in vivo pre-clinical studies we explored the anti-cancer efficacy of the virus alone or in combination with anti PD-1 inhibitor in human melanoma cell lines, i.e., MUG Mel-1 and MUG Mel-2, and in immunocompetent C57BL/6 melanoma B16V mouse model. We showed that both monotherapy and combination approaches exhibit enhanced anti-cancer ability and immunogenic cell death in in vitro settings. Furthermore, AdV-D24-ICOSL-CD40L combined with anti PD-1 revealed a fall in tumor volume and 100% survival in in vivo context, thus suggesting enhanced efficacy and survival via complementary anti-cancer properties of those agents in melanoma therapy. Collectively, the novel oncolytic vector AdV-D24-ICOSL-CD40L alone or in combination with anticancer drugs, such as check point inhibitors, may open novel therapeutic perspectives for the treatment of melanoma.
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Boer FL, Ten Eikelder MLG, van Geloven N, Kapiteijn EH, Gaarenstroom KN, Hughes G, Nooij LS, Jozwiak M, Tjiong MY, de Hullu JMA, Galaal K, van Poelgeest MIE. Evaluation of treatment, prognostic factors, and survival in 198 vulvar melanoma patients: Implications for clinical practice. Gynecol Oncol 2021; 161:202-210. [PMID: 33514483 DOI: 10.1016/j.ygyno.2021.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/18/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To identify clinicopathological characteristics, treatment patterns, clinical outcomes and prognostic factors in patients with vulvar melanoma (VM). MATERIALS & METHODS This retrospective multicentre cohort study included 198 women with VM treated in eight cancer centres in the Netherlands and UK between 1990 and 2017. Clinicopathological features, treatment, recurrence, and survival data were collected. Overall and recurrence-free survival was estimated with the Kaplan-Meier method. Prognostic parameters were identified with multivariable Cox regression analysis. RESULTS The majority of patients (75.8%) had localized disease at diagnosis. VM was significantly associated with high-risk clinicopathological features, including age, tumour thickness, ulceration, positive resection margins and involved lymph nodes. Overall survival was 48% (95% CI 40-56%) and 31% (95% CI 23-39%) after 2 and 5 years respectively and did not improve in patients diagnosed after 2010 compared to patients diagnosed between 1990 and 2009. Recurrence occurred in 66.7% of patients, of which two-third was non-local. In multivariable analysis, age and tumour size were independent prognostic factors for worse survival. Prognostic factors for recurrence were tumour size and tumour type. Only the minority of patients were treated with immuno- or targeted therapy. CONCLUSION Our results show that even clinically early-stage VM is an aggressive disease associated with poor clinical outcome due to distant metastases. Further investigation into the genomic landscape and the immune microenvironment in VM may pave the way to novel therapies to improve clinical outcomes in these aggressive tumours. Clinical trials with immunotherapy or targeted therapy in patients with high-risk, advanced or metastatic disease are highly needed.
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Affiliation(s)
- Florine L Boer
- Department of Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands.
| | | | - Nan van Geloven
- Department of Biomedical Data Sciences, Leiden University Medical Centre, the Netherlands
| | - Ellen H Kapiteijn
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Katja N Gaarenstroom
- Department of Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Geoff Hughes
- Department of Gynaecology, Derriford hospital NHS Trust, Plymouth, United Kingdom
| | - Linda S Nooij
- Department of Gynaecology Oncology, Centre for Gynaecologic Oncology, the Netherlands Cancer Institute, Antoni van Leeuwenhoek, the Netherlands
| | - Marta Jozwiak
- Department of Gynaecology Oncology, Erasmus MC Cancer Institute, Erasmus Medical Centre, the Netherlands
| | - Ming Y Tjiong
- Department of Gynaecology Oncology, Amsterdam University Medical Centre, the Netherlands
| | - Joanne M A de Hullu
- Department of Gynaecology Oncology, Radboud University Medical Centre, the Netherlands
| | - Khadra Galaal
- Department of Gynaecology, Royal Cornwall hospital NHS trust, Truro, United Kingdom
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