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Groenewegen B, Terveer EM, Joosse A, Barnhoorn MC, Zwittink RD. Fecal Microbiota Transplantation for Immune Checkpoint Inhibitor-Induced Colitis Is Safe and Contributes to Recovery: Two Case Reports. J Immunother 2023; 46:216-220. [PMID: 37216289 DOI: 10.1097/cji.0000000000000474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 04/08/2023] [Indexed: 05/24/2023]
Abstract
Immune checkpoint inhibitors (ICIs) have improved the prognosis in multiple cancer types. However, ICIs can induce immune-related adverse events such as immune-mediated enterocolitis (IMC). The gut microbiota may be implicated in IMC development. Therefore, we investigated fecal microbiota transplantation (FMT) as a treatment option for 2 patients with metastatic cancer suffering from refractory IMC. The patients were treated with, respectively, 1 and 3 FMTs after vancomycin pre-treatment. We monitored defecation frequency, fecal calprotectin, and microbiota composition. After FMT, both patients improved in defecation frequency, were discharged from the hospital, and received lower dosage of immunosuppressive therapy. Patient 1 developed an invasive pulmonary aspergillosis deemed to be related to prolonged steroid exposure. Patient 2 suffered from a Campylobacter jejuni infection after the first FMT and was treated with meropenem, resulting in a low-diversity microbiota profile and increased calprotectin levels and defecation frequency. After a second and third FMT, bacterial diversity increased and defecation frequency and calprotectin levels decreased. Pre-FMT, both patients showed low bacterial richness, but varying bacterial diversity. After FMT, diversity and richness were similar to healthy donor levels. In conclusion, FMT resulted in improvement of IMC symptoms and corresponding microbial changes in 2 cancer patients with refractory IMC. While more research is warranted, microbiome-modulation could be a promising new therapeutic option for IMC.
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Affiliation(s)
- Bas Groenewegen
- Department of Medical Microbiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The Netherlands
| | - Elisabeth M Terveer
- Department of Medical Microbiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The Netherlands
| | - Arjen Joosse
- Department of Oncology, Erasmus Medical Center, Doctor Molewaterplein 40, 3015GD Rotterdam, The Netherlands
| | - Marieke C Barnhoorn
- Department of Gastroenterology and Hepatology, Haga Hospital, Els Borst-Eilersplein 275, 2545AA The Hague, The Netherlands
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The Netherlands
| | - Romy D Zwittink
- Department of Medical Microbiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The Netherlands
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2
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Kamminga NCW, Wakkee M, De Bruin RJ, van der Veldt AAM, Joosse A, Reeder SWI, Plaisier PW, Nijsten T, Lugtenberg M. Oncological healthcare providers' perspectives on appropriate melanoma survivorship care: a qualitative focus group study. BMC Cancer 2023; 23:278. [PMID: 36973713 PMCID: PMC10042579 DOI: 10.1186/s12885-023-10759-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND The increasing group of melanoma survivors reports multiple unmet needs regarding survivorship care (SSC). To optimise melanoma SSC, it is crucial to take into account the perspectives of oncological healthcare providers (HCPs) in addition to those of patients. The aim of this study is to gain an in-depth understanding of HCPs' perspectives on appropriate melanoma SSC. METHODS Four online focus groups were conducted with mixed samples of oncological HCPs (dermatologists, surgeons, oncologists, oncological nurse practitioners, support counsellors and general practitioners) (total n = 23). A topic guide was used to structure the discussions, focusing on perspectives on both SSC and survivorship care plans (SCPs). All focus groups were recorded, transcribed verbatim, and subjected to an elaborate thematic content analysis. RESULTS Regarding SSC, HCPs considered the current offer minimal and stressed the need for broader personalised SSC from diagnosis onwards. Although hardly anyone was familiar with SCPs, they perceived various potential benefits of SCPs, such as an increase in the patients' self-management and providing HCPs with an up-to-date overview of the patient's situation. Perceived preconditions for successful implementation included adequate personalisation, integration in the electronic health record and ensuring adequate funding to activate and provide timely updates. CONCLUSIONS According to HCPs there is considerable room for improvement in terms of melanoma SSC. SCPs can assist in offering personalised and broader i.e., including psychosocial SSC. Aside from personalisation, efforts should be focused on SCPs' integration in clinical practice, and their long-term maintenance.
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Affiliation(s)
- Nadia C W Kamminga
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marlies Wakkee
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rianne J De Bruin
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Astrid A M van der Veldt
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arjen Joosse
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Suzan W I Reeder
- Department of Dermatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Peter W Plaisier
- Department of Surgical Oncology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Tamar Nijsten
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marjolein Lugtenberg
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
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van der Kooij MK, Joosse A, Suijkerbuijk KPM, Aarts MJB, van den Berkmortel FWPJ, Blank CU, Boers-Sonderen MJ, van den Eertwegh AJM, de Groot JWB, Haanen JBAG, Hospers GAP, Piersma D, van Rijn RS, van der Veldt AAM, Vreugdenhil G, Westgeest HM, Wouters MWJM, Dekkers OM, Kapiteijn E. Failure to validate existing clinical prediction scale for response to PD-1 monotherapy in advanced melanoma in national cohort study. Br J Cancer 2023; 128:707-710. [PMID: 36564561 PMCID: PMC9977837 DOI: 10.1038/s41416-022-02088-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 11/04/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Monique K van der Kooij
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, PO box 9600, 2300 RC, Leiden, The Netherlands
| | - Arjen Joosse
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3000 CA, Rotterdam, The Netherlands
| | - Karijn P M Suijkerbuijk
- Department of Medical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Maureen J B Aarts
- Department of Medical Oncology, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands
| | | | - Christian U Blank
- Department of Medical Oncology, Netherlands Cancer Institute- Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Marye J Boers-Sonderen
- Department of Medical Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands
| | - Alfonsus J M van den Eertwegh
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, 1081 HZ, Amsterdam, The Netherlands
| | | | - John B A G Haanen
- Department of Medical Oncology, Netherlands Cancer Institute- Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Geke A P Hospers
- Department of Medical Oncology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Djura Piersma
- Department of Medical Oncology, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, The Netherlands
| | - Rozemarijn S van Rijn
- Department of Medical Oncology, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands
| | - Astrid A M van der Veldt
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3000 CA, Rotterdam, The Netherlands
| | - Gerard Vreugdenhil
- Department of Medical Oncology, Maxima Medical Center, de Run 4600, 5500 MB, Veldhoven, The Netherlands
| | - Hans M Westgeest
- Department of Medical Oncology, Amphia Ziekenhuis, Langendijk 175, 4819 EV, Breda, The Netherlands
| | - Michel W J M Wouters
- Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA, Leiden, The Netherlands
- Department of Surgical Oncology, Netherlands Cancer Institute- Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, PO box 9600, 2300 RC, Leiden, The Netherlands
| | - Ellen Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, PO box 9600, 2300 RC, Leiden, The Netherlands.
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4
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Derks SHAE, Jongen JLM, van der Meer EL, Ho LS, Slagter C, Joosse A, de Jonge MJA, Schouten JW, Oomen-de Hoop E, van den Bent MJ, van der Veldt AAM. Impact of Novel Treatments in Patients with Melanoma Brain Metastasis: Real-World Data. Cancers (Basel) 2023; 15:cancers15051461. [PMID: 36900253 PMCID: PMC10000692 DOI: 10.3390/cancers15051461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Melanoma brain metastasis (MBM) is associated with poor outcome, but targeted therapies (TTs) and immune checkpoint inhibitors (ICIs) have revolutionized treatment over the past decade. We assessed the impact of these treatments in a real-world setting. METHODS A single-center cohort study was performed at a large, tertiary referral center for melanoma (Erasmus MC, Rotterdam, the Netherlands). Overall survival (OS) was assessed before and after 2015, after which TTs and ICIs were increasingly prescribed. RESULTS There were 430 patients with MBM included; 152 pre-2015 and 278 post-2015. Median OS improved from 4.4 to 6.9 months (HR 0.67, p < 0.001) after 2015. TTs and ICIs prior to MBM diagnosis were associated with poorer median OS as compared to no prior systemic treatment (TTs: 2.0 vs. 10.9 and ICIs: 4.2 vs. 7.9 months, p < 0.001). ICIs directly after MBM diagnosis were associated with improved median OS as compared to no direct ICIs (21.5 vs. 4.2 months, p < 0.001). Stereotactic radiotherapy (SRT; HR 0.49, p = 0.013) and ICIs (HR 0.32, p < 0.001) were independently associated with improved OS. CONCLUSION After 2015, OS significantly improved for patients with MBM, especially with SRT and ICIs. Demonstrating a large survival benefit, ICIs should be considered first after MBM diagnosis, if clinically feasible.
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Affiliation(s)
- Sophie H. A. E. Derks
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Joost L. M. Jongen
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Edgar L. van der Meer
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Li Shen Ho
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Cleo Slagter
- Department of Radiotherapy, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Arjen Joosse
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Maja J. A. de Jonge
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Joost W. Schouten
- Department of Neurosurgery, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Esther Oomen-de Hoop
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Martin J. van den Bent
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Astrid A. M. van der Veldt
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
- Correspondence: ; Tel.: +31-10-704-02-52
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de Joode K, Veenbergen S, Kransse C, Kortleve D, Debets R, Mathijssen RHJ, Joosse A, Schreurs MWJ, Van der Veldt AAM. Suitability of tumor-associated antibodies as predictive biomarker for response to immune checkpoint inhibitors in patients with melanoma: a short report. J Immunother Cancer 2023; 11:jitc-2022-006467. [PMID: 36750254 PMCID: PMC9906380 DOI: 10.1136/jitc-2022-006467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 02/09/2023] Open
Abstract
In 2019, Fässler et al showed in this journal that the presence of tumor-associated antibodies correlated with response to immune checkpoint inhibitor treatment in patients with metastatic melanoma. The results of this study suggested that tumor-associated antibodies directed against melanocyte-differentiation antigens and the cancer-germline antigen NY-ESO-1 should be further investigated as candidate biomarkers for response to immune checkpoint inhibitors. The aim of the current study was to validate and extend these previous findings. Therefore, we examined the correlation between serum levels of tumor-associated antibodies and tumor response after treatment with immune checkpoint inhibitors in patients with metastatic melanoma.All patients included in this prospective study were diagnosed with advanced stage melanoma and treated with nivolumab or pembrolizumab monotherapy. Blood samples were collected before and during treatment. Serum levels of tumor-associated antibodies against the melanocyte differentiation antigen Melan-A and the cancer germline antigens NY-ESO-1, MAGE-C2, MAGE-A6 and ROPN1B were measured at baseline and during treatment. Differences between responders and non-responders were assessed using the Mann-Whitney U-test, and differences between different overall survival categories with the Kruskal-Wallis test. P values ≤0.05 were considered significant.Serum samples of 58 patients with advanced melanoma with long-term follow-up (>3 years) were collected. In contrast to the findings of Fässler et al, for all antibodies tested, we found no significant differences between serum levels of responders and non-responders before or during treatment with immune checkpoint inhibitors. In addition, no significant differences were found in serum levels of tumor-associated antibodies for different overall survival groups.Although our study included a larger and more mature cohort of patients with longer follow-up, we could not externally validate the findings of Fässler et al In addition, we were not able to identify other cancer germline antigens as predictive biomarkers of response to immune checkpoint inhibitors in patients advanced melanoma. Based on the results of the present study, clinical applicability of tumor-associated antibodies directed against tumor antigens as predictive biomarkers for immune checkpoint inhibitors in patients with advanced melanoma is not feasible.
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Affiliation(s)
- Karlijn de Joode
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Sharon Veenbergen
- Laboratory of Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Claudia Kransse
- Laboratory of Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Dian Kortleve
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Reno Debets
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Arjen Joosse
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Marco W J Schreurs
- Laboratory of Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Astrid A M Van der Veldt
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands .,Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Basak EA, de Joode K, Uyl TJ, van der Wal R, Schreurs MW, van den Berg SA, Oomen-de Hoop E, van der Leest CH, Chaker L, Feelders RA, van der Veldt AA, Joosse A, Koolen SL, Aerts JG, Mathijssen RH, Bins S. The course of C-peptide levels in patients developing diabetes during anti-PD-1 therapy. Biomed Pharmacother 2022; 156:113839. [DOI: 10.1016/j.biopha.2022.113839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/01/2022] [Accepted: 10/06/2022] [Indexed: 11/02/2022] Open
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Derks S, de Joode K, Mulder E, Ho L, Joosse A, de Jonge M, Verhoef C, Grünhagen D, Smits M, van den Bent M, van der Veldt A. The meaning of screening: detection of brain metastasis in the adjuvant setting for stage III melanoma. ESMO Open 2022; 7:100600. [PMID: 36265261 PMCID: PMC9808474 DOI: 10.1016/j.esmoop.2022.100600] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/07/2022] [Accepted: 09/11/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The incidence of melanoma is increasing and 37% of patients with metastatic melanoma eventually have brain metastasis (BM). Currently, there is no consensus on screening for BM in patients with resected stage III melanoma. However, given the high incidence of BM, routine screening magnetic resonance imaging (MRI) of the brain is considered in patients with completely resected stage III melanoma before the start of adjuvant treatment. The aim of this study was to assess the yield of screening for BM in these patients. MATERIALS AND METHODS A single-center cohort study was carried out in the Erasmus MC, Rotterdam, The Netherlands, a large tertiary referral center for patients with melanoma. Eligible patients with complete resection of stage III melanoma and a screening MRI of the brain, made within 12 weeks after resection and before adjuvant treatment (programmed cell death protein 1 inhibitors, dabrafenib-trametinib), available between 1 August 2018 and 1 January 2021, were included. RESULTS A total of 202 patients were included. Eighteen (8.9%) of 202 patients had extracranial metastasis at screening. Two (1.1%) of the remaining 184 patients had BM at screening, resulting in a switch from adjuvant treatment to ipilimumab-nivolumab. At a median follow-up of 21.2 months, BM was detected in another 4 (2.4%) of 166 patients who started with adjuvant treatment. CONCLUSIONS The yield of screening MRI of the brain is low after complete resection of stage III melanoma, before the start of adjuvant treatment. Therefore, routine screening MRI is not recommended in this setting.
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Affiliation(s)
- S.H.A.E. Derks
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands,Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands,Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - K. de Joode
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands,Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - E.E.A.P. Mulder
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands,Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - L.S. Ho
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - A. Joosse
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - M.J.A. de Jonge
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - C. Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - D.J. Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - M. Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - M.J. van den Bent
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - A.A.M. van der Veldt
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands,Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands,Correspondence to: Dr A. A. M. van der Veldt, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015GD Rotterdam, the Netherlands. Tel: +31-010-704 17 54
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8
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Basak EA, Vermeer NS, de Joode K, Hurkmans DP, Velthuis DEM, Oomen-de Hoop E, Schreurs MWJ, Bins S, Koolen SLW, Debets R, van der Veldt AAM, Aerts JGJV, Joosse A, Mathijssen RHJ. Associations between patient and disease characteristics and severe adverse events during immune checkpoint inhibitor treatment: An observational study. Eur J Cancer 2022; 174:113-120. [PMID: 35988409 DOI: 10.1016/j.ejca.2022.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 06/06/2022] [Revised: 07/10/2022] [Accepted: 07/12/2022] [Indexed: 12/17/2022]
Abstract
AIM With increasing use of immune checkpoint inhibitors (ICIs) more patients will develop severe and potentially life-threatening immune-related adverse events (irAEs). So far, predictive models for the occurrence of grade ≥3 irAEs are lacking. Therefore, we analysed associations between patient and disease characteristics, and the occurrence of grade ≥3 irAEs. METHODS Patients with cancer who were treated with anti-PD-1 (+/-anti-CTLA-4) between July 2015 and February 2020, and who were prospectively included in the MULTOMAB-trial, were eligible for this cohort study. Time to and occurrence of grade ≥3 irAEs according to CTCAE v5.0 were retrospectively registered. The associations between patient and disease characteristics and irAE occurrence were analysed using the competing risk cox-regression model of Fine and Gray. Analyses were performed separately in patients treated with monotherapy (anti-PD-1) and combination therapy (anti-PD-1 + anti-CTLA-4). Subgroup analyses were performed in tumour types with the highest number of patients; melanoma and NSCLC. RESULTS Out of 641 patients, 106 patients (17%) experienced grade ≥3 irAEs. None of the analysed factors were associated with grade ≥3 irAE occurrence in the monotherapy (n = 550) or the combination therapy (n = 91) groups, nor in the subgroup analyses. Of interest, none of the patients with NSCLC with a WHO performance status of 0 (n = 34) experienced grade ≥3 irAEs. Most common NSCLC histology types were adenocarcinoma (n = 99/55%) and squamous cell carcinoma (n = 39/22%). CONCLUDING STATEMENT This study shows that patient and disease characteristics are not able to predict the occurrence of serious AEs in patients treated with ICIs.
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Affiliation(s)
- Edwin A Basak
- Dept. of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | - Niels S Vermeer
- Dept. of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Karlijn de Joode
- Dept. of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Daan P Hurkmans
- Dept. of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Dorian E M Velthuis
- Dept. of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Esther Oomen-de Hoop
- Dept. of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Marco W J Schreurs
- Dept. of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Sander Bins
- Dept. of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Stijn L W Koolen
- Dept. of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Dept. of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Reno Debets
- Dept. of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Astrid A M van der Veldt
- Dept. of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Dept. of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Joachim G J V Aerts
- Dept. of Pulmonology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Arjen Joosse
- Dept. of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Ron H J Mathijssen
- Dept. of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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9
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Kamminga NCW, van der Veldt AAM, Joosen MCW, de Joode K, Joosse A, Grünhagen DJ, Nijsten TEC, Wakkee M, Lugtenberg M. Experiences of resuming life after immunotherapy and associated survivorship care needs: a qualitative study among patients with metastatic melanoma. Br J Dermatol 2022; 187:381-391. [PMID: 35596713 PMCID: PMC9545549 DOI: 10.1111/bjd.21670] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 11/30/2022]
Abstract
Background Immune checkpoint inhibitors (ICIs) have significantly improved the overall survival of patients with metastatic melanoma. It is unclear how the growing group of metastatic melanoma survivors resume their lives after treatment, and which needs they have regarding survivorship care (SSC). Objectives To gain an in‐depth understanding of metastatic melanoma survivors’ experiences of resuming life after ICIs and their associated SSC needs. Methods A qualitative study was conducted among 20 patients with metastatic melanoma in whom ICIs had been discontinued after ongoing tumour response. One focus group (n = 9) was held, which was complemented by 11 individual interviews. Purposive sampling was used to select a variable sample in terms of sex, age, time since discontinuation of ICIs, and perceived impact of the disease. A topic guide was used to structure the (group) interviews, which were transcribed verbatim and analysed in a thematic content analysis, using several phases of coding. Results In resuming life after ICIs, the prognosis switch often caused mixed feelings among patients, mainly because of the uncertainty about the future. Demands and expectations from self and others, persistent complaints and new problems in different life domains often make it challenging to proceed with life as it was prior to metastatic cancer. Patients indicated they needed to find a new balance, which included learning to cope with uncertainty and a changed perspective on life and close relationships. In terms of SSC needs, patients particularly stressed the need for more tailored patient information, available at one location. In addition, they emphasized the need to know who to turn to in case of questions and indicated the need for psychosocial support, also for their close relatives. Conclusions Metastatic melanoma survivors face various challenges in resuming life after ICIs and are left with several unmet SSC needs. Efforts should be focused on offering psychosocial supportive care in addition to medical care, from diagnosis onwards, taking into account the patient’s close relatives. A single point of contact and personalized survivorship care plan (SCP) could be of added value in guiding them through the patient journey, which is, given its multidisciplinary nature, particularly important in melanoma care. What is already known about this topic?Since the introduction of immune checkpoint inhibitors (ICIs) the overall survival of patients with metastatic melanoma has improved significantly, leading to a growing group of melanoma survivors. Melanoma survivors may face various problems and challenges in resuming life after treatment, which may be associated with unmet survivorship care (SSC) needs. An in‐depth understanding of their experiences with resuming life and the associated SSC needs is currently lacking.
What does this study add?Metastatic melanoma survivors experience various challenges after immunotherapy, from the uncertain prognosis switch to the struggle of finding a new balance in life. Besides negative aspects, such as complaints in different life domains, the patient journey is often accompanied by positive outcomes, for example a changed perspective on life. They stress the need for tailored patient information and broader supportive care, also for their close relatives.
What are the clinical implications of this work?In addition to medical care, efforts should be focused on offering psychosocial supportive care, including return‐to‐work issues, from diagnosis onwards, ideally taking into account the patient’s close relatives. To guide them through the patient journey, a single point of contact and a personalized survivorship care plan (SCP) could be of added value. The latter is particularly important in melanoma care, given its multidisciplinary nature.
With this qualitative study we provided an in‐depth understanding of metastatic melanoma survivors' experiences of resuming life after ICIs and their associated SSC needs. They face various challenges in resuming life and efforts should be focused on offering psychosocial supportive care, in addition to medical care, from diagnosis onwards, taking into account the patient's close relatives. A single point of contact and personalized survivorship care plan (SCP) could be of added value in guiding them through the patiënt journey which is, given its multidisciplinary nature, particularly important in melanoma care. Linked Comment:E.N. Clarke. Br J Dermatol 2022; 187:286–287.
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Affiliation(s)
- Nadia C W Kamminga
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands
| | - Astrid A M van der Veldt
- Department of Medical Oncology and Radiology & Nuclear Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands
| | - Margot C W Joosen
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Karlijn de Joode
- Department of Medical Oncology and Radiology & Nuclear Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands
| | - Arjen Joosse
- Department of Medical Oncology and Radiology & Nuclear Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - Tamar E C Nijsten
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands
| | - Marlies Wakkee
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands
| | - Marjolein Lugtenberg
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands.,Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Derks SHAE, Jongen JLM, Slagter C, Joosse A, Schouten JW, van den Bent MJ, van der Veldt AAM. P14.25 Melanoma brain metastases in the era of novel therapies: a single-center, Dutch cohort study. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Until recently, patients with melanoma brain metastases (MBMs) had limited therapeutic options. With the arrival of immune checkpoint inhibitors (ICIs), targeted therapy (TT) and advances in stereotactic radiotherapy (SRT), treatment has improved. We evaluated treatments and patient outcome before and after the introduction of these novel therapies.
MATERIAL AND METHODS
In this retrospective, single-center study, patients presenting with MBMs at the Erasmus MC between November 2005 and January 2021 with sufficient follow-up were included. Overall survival (OS), measured from date of MBM diagnosis, was calculated using the Kaplan-Meier method. Patients were stratified according to MBM diagnosis before and after January 1, 2016, since novel therapies were mostly prescribed in our clinic after this date. Results were significant (p<0.05), unless otherwise stated.
RESULTS
Overall, 413 patients were included. Median [IQR] age was 56.6 years [52–71] with a 60% male predominance. A BRAF mutation was present in 46.7% of patients. A single MBM was found in 29.3% and ≥4 MBMs were found in 49.0% of patients. Before January 1, 2016, 191 patients were treated, and 222 patients after that date. Chemotherapy was more frequently used before 2016, both prior to (3.9% pre-2016 vs. 0.9% post-2016) and after (7.0% vs. 0.0%) the diagnosis of MBMs. In contrast, treatment with TT was more frequent after 2016, both prior to (3.7% vs. 16.2%) and after (7.9% vs. 41.4%) the diagnosis of MBMs. Comparable changes were observed for treatment with ICIs (prior to MBM diagnosis: 0.5% vs. 25.2%; after MBM diagnosis: 18.3% vs 39.2%). The application of SRT did not differ significantly before and after 2016 (12.0% vs. 19.4%, p=0.89), while the application of whole brain radiotherapy (WBRT) decreased (52.4% vs. 13.5%). Surgical resection was not significantly different between those periods (15.7% vs. 16.7%, p=0.90). Before 2016, median OS [IQR] was shorter than after 2016 (4.6 [1.9–10.9] vs. 6.6 [1.8–24.5] months). The effect of novel therapies on OS was further analysed in patients diagnosed after 2016; treatment vs. no treatment was compared. ICI treatment prior to MBM diagnosis was associated with worse OS (median OS 4.0 vs. 7.5 months). ICI treatment after MBM diagnosis was associated with better OS (median OS 24.5 vs. 3.0 months). In patients with a BRAF mutation, TT before MBM diagnosis was associated with worse OS (median OS 1.8 vs. 9.4 months). TT after MBM diagnosis in those patients was not significantly associated with improved OS (median OS 7.6 vs. 5.2 months, p=0.96).
CONCLUSION
Recent therapeutic advances for MBM replaced WBRT and chemotherapy with SRT, TT and ICIs. In that period, prognosis of MBM patients increased significantly. OS in patients treated with ICIs or TT prior to MBM diagnosis is still poor, but OS is improved in patients treated with ICIs after the diagnosis of MBM.
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Affiliation(s)
| | - J L M Jongen
- Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - C Slagter
- Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - A Joosse
- Erasmus MC Cancer Institute, Rotterdam, Netherlands
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Basak E, Vermeer N, Joode K, Hurkmans D, Velthuis D, Oomen-de Hoop E, Schreurs M, Bins S, van der Leest C, Joosse A, Koolen S, Debets R, van der Veldt A, Aerts J, Mathijssen R. 1863P Incidence and predictors of severe adverse events during anti-PD-1 treatment. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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12
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Basak EA, van der Meer JWM, Hurkmans DP, Schreurs MWJ, Oomen-de Hoop E, van der Veldt AAM, Bins S, Joosse A, Koolen SLW, Debets R, Peeters RP, Aerts JGJV, Mathijssen RHJ, Medici M. Overt Thyroid Dysfunction and Anti-Thyroid Antibodies Predict Response to Anti-PD-1 Immunotherapy in Cancer Patients. Thyroid 2020; 30:966-973. [PMID: 32151195 DOI: 10.1089/thy.2019.0726] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Thyroid dysfunction is among the most common adverse effects during anti-programmed cell death 1 (PD-1) immunotherapy, and alongside correlations with elevated anti-thyroid antibodies (ATAb), studies have found correlations with survival. However, the exact relations remain to be clarified. We, therefore, aimed at clarifying the relationship between thyroid dysfunction, ATAbs, and survival in anti-PD-1 treated cancer patients. Methods: We included 168 patients with nonsmall-cell lung carcinoma, renal cell carcinoma, and metastatic melanoma treated with nivolumab or pembrolizumab. Thyrotropin and free T4 (fT4) levels were measured before each anti-PD-1 infusion. ATAb levels (anti-thyroid peroxidase [TPO] and anti-thyroglobulin [Tg]) were measured at baseline and after two months of treatment. Although the vast majority of patients had detectable levels of ATABs, only a few patients had positive ATAbs when using conventional cut-offs. To study the consequences of detectable ATABs, the cut-off levels were a priori set at the median concentrations at baseline in the study population. Tumor progression was classified according to RECIST v1.1. Results: Patients who acquired overt thyroid dysfunction during treatment had significantly higher overall survival (OS) (hazard ratio [HR] = 0.18 confidence interval [CI: 0.04-0.76]; p = 0.020) and progression-free survival (PFS) (HR = 0.39 [0.15-0.998]; p = 0.050) than patients without thyroid dysfunction with 1-year OS rates of 94% vs. 59% and 1-year PFS rates of 64% vs. 34%. During treatment, patients with ATAb levels above the median had a higher OS (HR = 0.39 [0.21-0.72]; p = 0.003) and PFS (HR = 0.52 [0.33-0.81]; p = 0.004) than patients with ATAb levels below the median, with 1-year OS rates of 83% vs. 49% and PFS rates of 54% vs. 20%, respectively. When analyzing ATAb levels over time, patients with a persistent ATAb level above the median had a higher OS (HR = 0.41 [0.19-0.89], p = 0.025) and PFS (HR = 0.54 [0.31-0.95], p = 0.032) compared with patients with a persistent ATAb level below the median. Patients whose ATAb levels increased above the median during treatment had an improved OS (HR = 0.27 [0.06-1.22], p = 0.088) and PFS (HR = 0.24 [0.07-0.77], p = 0.017) compared with patients whose ATAb levels decreased below the median. Conclusions: Acquired overt thyroid toxicity and above median ATAb levels during anti-PD-1 treatment are associated with improved PFS and OS. In addition, our results suggest that ATAb levels at baseline are of clinical relevance for PFS and OS.
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Affiliation(s)
- Edwin A Basak
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Jan W M van der Meer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Daan P Hurkmans
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Pulmonology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marco W J Schreurs
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Esther Oomen-de Hoop
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Astrid A M van der Veldt
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, and Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sander Bins
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Arjen Joosse
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Stijn L W Koolen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Reno Debets
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine and Erasmus MC Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joachim G J V Aerts
- Department of Pulmonology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marco Medici
- Department of Internal Medicine and Erasmus MC Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Meer W, Basak E, Hurkmans D, Schreurs M, Oomen-de Hoop E, Van der Veldt A, Bins S, Joosse A, Koolen S, Debets R, Peeters R, Aerts J, Mathijssen R, Medici M. Thyroid toxicity and anti-thyroid antibodies as predictive markers for patients treated with anti-PD1 checkpoint therapy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz253.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Hurkmans DP, Verhoeven JGHP, de Leur K, Boer K, Joosse A, Baan CC, von der Thüsen JH, van Schaik RHN, Mathijssen RHJ, van der Veldt AAM, Hesselink DA. Donor-derived cell-free DNA detects kidney transplant rejection during nivolumab treatment. J Immunother Cancer 2019; 7:182. [PMID: 31300068 PMCID: PMC6626432 DOI: 10.1186/s40425-019-0653-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 06/26/2019] [Indexed: 01/03/2023] Open
Abstract
Background In solid organ transplant (SOT) recipients, transplant rejection during immune checkpoint inhibitor (ICI) treatment for cancer is a clinical problem. Donor-derived cell-free DNA (dd-cfDNA) can be detected in blood and is a sensitive biomarker for diagnosis of acute rejection in SOT recipients. To our best knowledge, this is the first case report of a kidney transplant recipient with advanced cancer treated with ICI who was monitored with dd-cfDNA. Case presentation A 72-year old female with a long-standing renal transplant was diagnosed with advanced melanoma in 2018 and was treated with the anti-PD1 antibody nivolumab. Within 12 days after the first administration of nivolumab, dd-cfDNA ratio increased to 23%, suggesting allograft rejection. Her kidney transplant function deteriorated and acute rejection was confirmed by renal transplant biopsy. As the rejection could not be controlled despite immunosuppressive treatment, a transplant nephrectomy was necessary and haemodialysis was started. Immunological analysis of the renal explant showed infiltration of alloreactive, nivolumab-saturated, PD1+ cytotoxic T cells. After transplant nephrectomy, she experienced nivolumab-related toxicity and rapid disease progression. Conclusion Clinicians prescribing ICIs should be aware that SOT recipients are at risk of transplant rejection as a result of T cell activation. Dd-cfDNA is a sensitive biomarker and should be further studied for early detection of transplant rejection. Immunological analysis of the kidney explant showed marked graft infiltration with alloreactive PD-1+ cytotoxic T cells that were saturated with nivolumab.
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Affiliation(s)
- Daan P Hurkmans
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Jeroen G H P Verhoeven
- Department of Internal Medicine, Division of Nephrology and Transplantation, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rotterdam Transplant Group, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kitty de Leur
- Department of Internal Medicine, Division of Nephrology and Transplantation, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rotterdam Transplant Group, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Karin Boer
- Department of Internal Medicine, Division of Nephrology and Transplantation, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rotterdam Transplant Group, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arjen Joosse
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Carla C Baan
- Department of Internal Medicine, Division of Nephrology and Transplantation, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rotterdam Transplant Group, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan H von der Thüsen
- Department of Pathology, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ron H N van Schaik
- Department of Clinical Chemistry, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Astrid A M van der Veldt
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dennis A Hesselink
- Department of Internal Medicine, Division of Nephrology and Transplantation, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rotterdam Transplant Group, University Medical Center Rotterdam, Rotterdam, The Netherlands
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van der Kooij MK, Joosse A, Speetjens FM, Hospers GAP, Bisschop C, de Groot JWB, Koornstra R, Blank CU, Kapiteijn E. Anti-PD1 treatment in metastatic uveal melanoma in the Netherlands. Acta Oncol 2017; 56:101-103. [PMID: 27911126 DOI: 10.1080/0284186x.2016.1260773] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- M. K. van der Kooij
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - A. Joosse
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - F. M. Speetjens
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - G. A. P. Hospers
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - C. Bisschop
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - R. Koornstra
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - C. U. Blank
- Department of Medical Oncology, Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - E. Kapiteijn
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
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Testori A, Suciu S, Van Akkooi A, Suppa M, Eggermont A, De Vries E, Joosse A, Madu M. 106. Lymph node ratio as a prognostic factor in melanoma: Results from the EORTC 18871, 18952 and 18991 studies. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Joosse A, van der Ploeg APT, Haydu LE, Nijsten TEC, de Vries E, Scolyer RA, Eggermont AMM, Coebergh JWW, Thompson JF. Sex Differences in Melanoma Survival are Not Related to Mitotic Rate of the Primary Tumor. Ann Surg Oncol 2014; 22:1598-603. [DOI: 10.1245/s10434-014-4166-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Indexed: 11/18/2022]
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Livingstone E, Hollestein LM, van Herk-Sukel MPP, van de Poll-Franse L, Joosse A, Schilling B, Nijsten T, Schadendorf D, de Vries E. Statin use and its effect on all-cause mortality of melanoma patients: a population-based Dutch cohort study. Cancer Med 2014; 3:1284-93. [PMID: 24935402 PMCID: PMC4302678 DOI: 10.1002/cam4.285] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 04/15/2014] [Accepted: 04/16/2014] [Indexed: 01/01/2023] Open
Abstract
Preclinical data showed anticancer effects of statins in melanoma, but meta-analyses could not demonstrate a reduced melanoma incidence in statin users. Rather than preventing occurrence, statins might reduce growth and metastatic spread of melanomas and ultimately improve survival. In this population-based study, we investigated the relationship between statin use and survival of melanoma patients. Patients ≥18 years who were diagnosed with cutaneous melanoma (Breslow thickness >1 mm) and registered in the Eindhoven Cancer Registry and in PHARMO Database Network between 1 January 1998 and 31 December 2010 were eligible. The hazard ratio (HR) of all-cause mortality was calculated by employing adjusted time-dependent and time-fixed Cox proportional hazard models. Disease-specific survival was estimated by means of 3-year relative survival rates (RSR). A control cohort of randomly selected patients using statins from PHARMO Database Network matched on age and gender was used to compare RSR of statin users to the general population. After melanoma diagnosis, 171 of 709 patients used statins. Use of statins showed a nonsignificantly decreased hazard of death (adjusted HR 0.76, 95% confidence interval [CI] 0.50–1.61). After stratification for gender, male but not female statin users showed a favorable outcome compared to nonusers (HR 0.57, 95% CI 0.32–0.99; HR 1.22, 95% CI 0.62–2.38, respectively). Three-year RSR for male statin users tended to be higher than for nonusers (91% vs. 80.5%, P = 0.06), no differences were observed in women (87.1% vs. 92.5%, P = 0.76). Statin use was not associated with an improved survival of melanoma patients. The trend for better survival of male in contrast to female statin users warrants further research.
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Gandini S, De Vries E, Tosti G, Botteri E, Spadola G, Maisonneuve P, Martinoli C, Joosse A, Ferrucci PF, Baldini F, Cocorocchio E, Pennacchioli E, Cataldo F, Bazolli B, Clerici A, Barberis M, Bataille V, Testori A. Sunny holidays before and after melanoma diagnosis are respectively associated with lower Breslow thickness and lower relapse rates in Italy. PLoS One 2013; 8:e78820. [PMID: 24223851 PMCID: PMC3817085 DOI: 10.1371/journal.pone.0078820] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 09/16/2013] [Indexed: 12/14/2022] Open
Abstract
Background Previous studies have reported an association between sun exposure and improved cutaneous melanoma (CM) survival. We analysed the association of UV exposure with prognostic factors and outcome in a large melanoma cohort. Methods A questionnaire was given to 289 (42%) CM patients at diagnosis (Group 1) and to 402 CM patients (58%) during follow-up (Group 2). Analyses were carried out to investigate the associations between sun exposure and melanoma prognostic factors and survival. Results Holidays in the sun two years before CM diagnosis were significantly associated with lower Breslow thickness (p=0.003), after multiple adjustment. Number of weeks of sunny holidays was also significantly and inversely associated with thickness in a dose-dependent manner (p=0.007). However when stratifying by gender this association was found only among women (p=0.0004) the risk of CM recurrence in both sexes was significantly lower in patients (n=271) who had holidays in the sun after diagnosis, after multiple adjustment including education: HR=0.30 (95%CI:0.10-0.87; p=0.03) conclusions: Holidays in the sun were associated with thinner melanomas in women and reduced rates of relapse in both sexes. However, these results do not prove a direct causal effect of sun exposure on survival since other confounding factors, such as vitamin D serum levels and socio-economic status, may play a role. Other factors in sun seeking individuals may also possibly affect these results.
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Affiliation(s)
- Sara Gandini
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
- * E-mail:
| | - Esther De Vries
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Giulio Tosti
- Division of Melanoma and Muscle-Cutaneous Sarcomas, European Institute of Oncology, Milan, Italy
| | - Edoardo Botteri
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Giuseppe Spadola
- Division of Melanoma and Muscle-Cutaneous Sarcomas, European Institute of Oncology, Milan, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Chiara Martinoli
- Department of Medical Oncology, European Institute of Oncology, Milan, Italy
| | - Arjen Joosse
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Federica Baldini
- Division of Melanoma and Muscle-Cutaneous Sarcomas, European Institute of Oncology, Milan, Italy
| | - Emilia Cocorocchio
- Department of Medical Oncology, European Institute of Oncology, Milan, Italy
| | - Elisabetta Pennacchioli
- Division of Melanoma and Muscle-Cutaneous Sarcomas, European Institute of Oncology, Milan, Italy
| | - Francesco Cataldo
- Division of Melanoma and Muscle-Cutaneous Sarcomas, European Institute of Oncology, Milan, Italy
| | - Barbara Bazolli
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Alessandra Clerici
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Massimo Barberis
- Department of Pathology and Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, King’s College, London, United Kingdom
| | - Alessandro Testori
- Division of Melanoma and Muscle-Cutaneous Sarcomas, European Institute of Oncology, Milan, Italy
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Joosse A, Collette S, Suciu S, Nijsten T, Patel PM, Keilholz U, Eggermont AM, Coebergh JWW, de Vries E. Sex Is an Independent Prognostic Indicator for Survival and Relapse/Progression-Free Survival in Metastasized Stage III to IV Melanoma: A Pooled Analysis of Five European Organisation for Research and Treatment of Cancer Randomized Controlled Trials. J Clin Oncol 2013; 31:2337-46. [DOI: 10.1200/jco.2012.44.5031] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Purpose To study sex differences in survival and progression in patients with stage III or IV metastatic melanoma and to compare our results with published literature. Patients and Methods Data were retrieved from three large, randomized, controlled trials of the European Organisation for Research and Treatment of Cancer in patients with stage III and two trials in patients with stage IV melanoma. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% CIs for females compared with males, adjusted for different sets of confounders for stage III and stage IV, respectively. Results In 2,734 stage III patients, females had a superior 5-year disease-specific survival (DSS) rate compared with males (51.5% v 43.3%), an adjusted HR for DSS of 0.85 (95% CI, 0.76 to 0.95), and an adjusted HR for relapse-free survival of 0.86 (95% CI, 0.77 to 0.95). In 1,306 stage IV patients, females also exhibited an advantage in DSS (2-year survival rate, 14.1% v 19.0%; adjusted HR, 0.81; 95% CI, 0.72 to 0.92) as well as for progression-free survival (adjusted HR, 0.79; 95% CI, 0.70 to 0.88). This female advantage was consistent across pre- and postmenopausal age categories and across different prognostic subgroups. However, the female advantage seems to become smaller in patients with higher metastatic tumor load. Conclusion The persistent independent female advantage, even after metastasis to lymph nodes and distant sites, contradicts theories about sex behavioral differences as an explanation for this phenomenon. A biologic sex trait seems to profoundly influence melanoma progression and survival, even in advanced disease.
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Affiliation(s)
- Arjen Joosse
- Arjen Joosse, Tamar Nijsten, Jan Willem W. Coebergh, and Esther de Vries, Erasmus University Medical Center, Rotterdam, the Netherlands; Sandra Collette and Stefan Suciu, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Poulam M. Patel, University of Nottingham, Nottingham, United Kingdom; Ullrich Keilholz, Charité Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany; and Alexander M.M. Eggermont, Institut de Cancerologie Gustave Roussy,
| | - Sandra Collette
- Arjen Joosse, Tamar Nijsten, Jan Willem W. Coebergh, and Esther de Vries, Erasmus University Medical Center, Rotterdam, the Netherlands; Sandra Collette and Stefan Suciu, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Poulam M. Patel, University of Nottingham, Nottingham, United Kingdom; Ullrich Keilholz, Charité Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany; and Alexander M.M. Eggermont, Institut de Cancerologie Gustave Roussy,
| | - Stefan Suciu
- Arjen Joosse, Tamar Nijsten, Jan Willem W. Coebergh, and Esther de Vries, Erasmus University Medical Center, Rotterdam, the Netherlands; Sandra Collette and Stefan Suciu, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Poulam M. Patel, University of Nottingham, Nottingham, United Kingdom; Ullrich Keilholz, Charité Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany; and Alexander M.M. Eggermont, Institut de Cancerologie Gustave Roussy,
| | - Tamar Nijsten
- Arjen Joosse, Tamar Nijsten, Jan Willem W. Coebergh, and Esther de Vries, Erasmus University Medical Center, Rotterdam, the Netherlands; Sandra Collette and Stefan Suciu, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Poulam M. Patel, University of Nottingham, Nottingham, United Kingdom; Ullrich Keilholz, Charité Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany; and Alexander M.M. Eggermont, Institut de Cancerologie Gustave Roussy,
| | - Poulam M. Patel
- Arjen Joosse, Tamar Nijsten, Jan Willem W. Coebergh, and Esther de Vries, Erasmus University Medical Center, Rotterdam, the Netherlands; Sandra Collette and Stefan Suciu, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Poulam M. Patel, University of Nottingham, Nottingham, United Kingdom; Ullrich Keilholz, Charité Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany; and Alexander M.M. Eggermont, Institut de Cancerologie Gustave Roussy,
| | - Ulrich Keilholz
- Arjen Joosse, Tamar Nijsten, Jan Willem W. Coebergh, and Esther de Vries, Erasmus University Medical Center, Rotterdam, the Netherlands; Sandra Collette and Stefan Suciu, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Poulam M. Patel, University of Nottingham, Nottingham, United Kingdom; Ullrich Keilholz, Charité Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany; and Alexander M.M. Eggermont, Institut de Cancerologie Gustave Roussy,
| | - Alexander M.M. Eggermont
- Arjen Joosse, Tamar Nijsten, Jan Willem W. Coebergh, and Esther de Vries, Erasmus University Medical Center, Rotterdam, the Netherlands; Sandra Collette and Stefan Suciu, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Poulam M. Patel, University of Nottingham, Nottingham, United Kingdom; Ullrich Keilholz, Charité Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany; and Alexander M.M. Eggermont, Institut de Cancerologie Gustave Roussy,
| | - Jan Willem W. Coebergh
- Arjen Joosse, Tamar Nijsten, Jan Willem W. Coebergh, and Esther de Vries, Erasmus University Medical Center, Rotterdam, the Netherlands; Sandra Collette and Stefan Suciu, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Poulam M. Patel, University of Nottingham, Nottingham, United Kingdom; Ullrich Keilholz, Charité Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany; and Alexander M.M. Eggermont, Institut de Cancerologie Gustave Roussy,
| | - Esther de Vries
- Arjen Joosse, Tamar Nijsten, Jan Willem W. Coebergh, and Esther de Vries, Erasmus University Medical Center, Rotterdam, the Netherlands; Sandra Collette and Stefan Suciu, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Poulam M. Patel, University of Nottingham, Nottingham, United Kingdom; Ullrich Keilholz, Charité Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany; and Alexander M.M. Eggermont, Institut de Cancerologie Gustave Roussy,
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Joosse A, Collette S, Suciu S, Nijsten T, Lejeune F, Kleeberg UR, Coebergh JWW, Eggermont AM, de Vries E. Superior Outcome of Women With Stage I/II Cutaneous Melanoma: Pooled Analysis of Four European Organisation for Research and Treatment of Cancer Phase III Trials. J Clin Oncol 2012; 30:2240-7. [DOI: 10.1200/jco.2011.38.0584] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Several studies observed a female advantage in the prognosis of cutaneous melanoma, for which behavioral factors or an underlying biologic mechanism might be responsible. Using complete and reliable follow-up data from four phase III trials of the European Organisation for Research and Treatment of Cancer (EORTC) Melanoma Group, we explored the female advantage across multiple end points and in relation to other important prognostic indicators. Patients and Methods Patients diagnosed with localized melanoma were included in EORTC adjuvant treatment trials 18832, 18871, 18952, and 18961 and randomly assigned during the period of 1984 to 2005. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% CIs for women compared with men, adjusted for age, Breslow thickness, body site, ulceration, performed lymph node dissection, and treatment. Results A total of 2,672 patients with stage I/II melanoma were included. Women had a highly consistent and independent advantage in overall survival (adjusted HR, 0.70; 95% CI, 0.59 to 0.83), disease-specific survival (adjusted HR, 0.74; 95% CI, 0.62 to 0.88), time to lymph node metastasis (adjusted HR, 0.70; 95% CI, 0.51 to 0.96), and time to distant metastasis (adjusted HR, 0.69; 95% CI, 0.59 to 0.81). Subgroup analysis showed that the female advantage was consistent across all prognostic subgroups (with the possible exception of head and neck melanomas) and in pre- and postmenopausal age groups. Conclusion Women have a consistent and independent relative advantage in all aspects of the progression of localized melanoma of approximately 30%, most likely caused by an underlying biologic sex difference.
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Affiliation(s)
- Arjen Joosse
- Arjen Joosse, Tamar Nijsten, Jan Willem W. Coebergh, and Esther de Vries, Erasmus University Medical Center, Rotterdam, the Netherlands; Sandra Collette and Stefan Suciu, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Ferdy Lejeune, University Hospital, Lausanne, Switzerland; Ulrich R. Kleeberg, Tagesklinik Struensee-Haus, Hamburg, Germany; and Alexander M.M. Eggermont, Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - Sandra Collette
- Arjen Joosse, Tamar Nijsten, Jan Willem W. Coebergh, and Esther de Vries, Erasmus University Medical Center, Rotterdam, the Netherlands; Sandra Collette and Stefan Suciu, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Ferdy Lejeune, University Hospital, Lausanne, Switzerland; Ulrich R. Kleeberg, Tagesklinik Struensee-Haus, Hamburg, Germany; and Alexander M.M. Eggermont, Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - Stefan Suciu
- Arjen Joosse, Tamar Nijsten, Jan Willem W. Coebergh, and Esther de Vries, Erasmus University Medical Center, Rotterdam, the Netherlands; Sandra Collette and Stefan Suciu, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Ferdy Lejeune, University Hospital, Lausanne, Switzerland; Ulrich R. Kleeberg, Tagesklinik Struensee-Haus, Hamburg, Germany; and Alexander M.M. Eggermont, Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - Tamar Nijsten
- Arjen Joosse, Tamar Nijsten, Jan Willem W. Coebergh, and Esther de Vries, Erasmus University Medical Center, Rotterdam, the Netherlands; Sandra Collette and Stefan Suciu, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Ferdy Lejeune, University Hospital, Lausanne, Switzerland; Ulrich R. Kleeberg, Tagesklinik Struensee-Haus, Hamburg, Germany; and Alexander M.M. Eggermont, Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - Ferdy Lejeune
- Arjen Joosse, Tamar Nijsten, Jan Willem W. Coebergh, and Esther de Vries, Erasmus University Medical Center, Rotterdam, the Netherlands; Sandra Collette and Stefan Suciu, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Ferdy Lejeune, University Hospital, Lausanne, Switzerland; Ulrich R. Kleeberg, Tagesklinik Struensee-Haus, Hamburg, Germany; and Alexander M.M. Eggermont, Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - Ulrich R. Kleeberg
- Arjen Joosse, Tamar Nijsten, Jan Willem W. Coebergh, and Esther de Vries, Erasmus University Medical Center, Rotterdam, the Netherlands; Sandra Collette and Stefan Suciu, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Ferdy Lejeune, University Hospital, Lausanne, Switzerland; Ulrich R. Kleeberg, Tagesklinik Struensee-Haus, Hamburg, Germany; and Alexander M.M. Eggermont, Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - Jan Willem W. Coebergh
- Arjen Joosse, Tamar Nijsten, Jan Willem W. Coebergh, and Esther de Vries, Erasmus University Medical Center, Rotterdam, the Netherlands; Sandra Collette and Stefan Suciu, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Ferdy Lejeune, University Hospital, Lausanne, Switzerland; Ulrich R. Kleeberg, Tagesklinik Struensee-Haus, Hamburg, Germany; and Alexander M.M. Eggermont, Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - Alexander M.M. Eggermont
- Arjen Joosse, Tamar Nijsten, Jan Willem W. Coebergh, and Esther de Vries, Erasmus University Medical Center, Rotterdam, the Netherlands; Sandra Collette and Stefan Suciu, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Ferdy Lejeune, University Hospital, Lausanne, Switzerland; Ulrich R. Kleeberg, Tagesklinik Struensee-Haus, Hamburg, Germany; and Alexander M.M. Eggermont, Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - Esther de Vries
- Arjen Joosse, Tamar Nijsten, Jan Willem W. Coebergh, and Esther de Vries, Erasmus University Medical Center, Rotterdam, the Netherlands; Sandra Collette and Stefan Suciu, European Organisation for Research and Treatment of Cancer, Brussels, Belgium; Ferdy Lejeune, University Hospital, Lausanne, Switzerland; Ulrich R. Kleeberg, Tagesklinik Struensee-Haus, Hamburg, Germany; and Alexander M.M. Eggermont, Institut de Cancérologie Gustave Roussy, Villejuif, France
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Joosse A, Collette S, Suciu S, de Vries E, Nijsten T, Patel P, Kleeberg UR, Keilholz U, Eggermont AM, Coebergh JW. The impact of gender on the outcome of malignant melanoma: Overview of seven EORTC phase III trials. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Joosse A, de Vries E, Eckel R, Nijsten T, Eggermont AM, Hölzel D, Coebergh JWW, Engel J. Gender Differences in Melanoma Survival: Female Patients Have a Decreased Risk of Metastasis. J Invest Dermatol 2011; 131:719-26. [DOI: 10.1038/jid.2010.354] [Citation(s) in RCA: 179] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Joosse A, De Vries E, van Eijck CH, Eggermont AMM, Nijsten T, Coebergh JWW. Reactive oxygen species and melanoma: an explanation for gender differences in survival? Pigment Cell Melanoma Res 2010; 23:352-64. [PMID: 20218981 DOI: 10.1111/j.1755-148x.2010.00694.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Epidemiological research consistently shows a female advantage in melanoma survival. So far, no definite candidate for the explanation of this phenomenon has emerged. We propose that gender differences in oxidative stress caused by radical oxygen species (ROS) underlie these survival differences. It is known that males express lower amounts of anti-oxidant enzymes, resulting in more oxidative stress than females. The primary melanoma environment is characterized by high ROS levels, from exogenous sources as well as ROS production within melanoma cells themselves. ROS are known to be able to promote metastasis through a wide variety of mechanisms. We hypothesize that the higher levels of ROS in men enhance selection of ROS-resistance in melanoma cells. Subsequently, ROS can stimulate the metastatic potential of melanoma cells. In addition, due to the lower anti-oxidant defenses in men, ROS produced by melanoma cells cause more damage to healthy tissues surrounding the tumor, further stimulating metastasis. Therefore, ROS may explain the observed differences between males and females in melanoma survival.
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Affiliation(s)
- Arjen Joosse
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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Koomen E, Joosse A, Herings R, Casparie M, Guchelaar H, Nijsten T. Estrogens, oral contraceptives and hormonal replacement therapy increase the incidence of cutaneous melanoma: a population-based case–control study. Ann Oncol 2009; 20:358-64. [DOI: 10.1093/annonc/mdn589] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Koomen ER, Joosse A, Herings RMC, Casparie MK, Bergman W, Nijsten T, Guchelaar HJ. Is statin use associated with a reduced incidence, a reduced Breslow thickness or delayed metastasis of melanoma of the skin? Eur J Cancer 2007; 43:2580-9. [PMID: 17950596 DOI: 10.1016/j.ejca.2007.09.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Revised: 09/03/2007] [Accepted: 09/05/2007] [Indexed: 11/17/2022]
Abstract
BACKGROUND Statins show anticancer activity in melanoma cells. We investigated the association between statins and incidence and Breslow thickness of cutaneous melanoma (CM). METHODS Data were used from PHARMO, a pharmacy database, and PALGA, a pathological database, in the Netherlands. Cases had a primary CM diagnosis between January 1st 1991 and December 14th 2004, were 18 years and had 3 years of follow up in PHARMO before CM diagnosis. Controls were matched for gender, date of birth and geographic region. Analyses were adjusted for age, gender, year of diagnosis, number of medical diagnoses and the use of NSAIDs and oestrogens. FINDINGS Finally, 1318 cases and 6786 controls were selected. CM risk was not associated with statin use (> or = 0.5 years) (adjusted odds ratio (OR)=0.98, 95% confidence interval (CI)=0.78-1.2). However, statin use was associated with a reduced Breslow thickness (-19%, 95% CI=-33, -2.3, p=0.03). CONCLUSION Our study suggests protective effects of statins on melanoma progression.
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Affiliation(s)
- E R Koomen
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
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