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Salman P, de Melo AC, Rico-Restrepo M, Rodriguez J, Russi A, Schmerling RA, Zambrano A, Cinat G. Addressing the unmet needs of patients with BRAF-mutated melanoma in Latin America: Expert perspective. Front Oncol 2023; 13:1032300. [PMID: 36998456 PMCID: PMC10043339 DOI: 10.3389/fonc.2023.1032300] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Abstract
Melanoma represents an increasing public health burden with extensive unmet needs in Latin America (LA). A mutation in the BRAF gene is present in approximately 50% of all melanomas in White populations and is a target of precision medicine, with the potential to dramatically improve patient outcomes. Thus, increased access to BRAF testing and therapy is LA must be explored. At a multi-day conference, a panel of Latin American experts in oncology and dermatology were provided with questions to address the barriers limiting access to testing for BRAF mutation in patients with melanoma in LA, who may be eligible for targeted therapy to improve their prognosis. During the conference, responses were discussed and edited until a consensus on addressing the barriers was achieved. Identified challenges included ignorance of BRAF-status implications, limited human and infrastructural resources, affordability and reimbursement, fragmented care delivery, pitfalls in the sample journey, and lack of local data. Despite the clear benefits of targeted therapies for BRAF-mutated melanoma in other regions, there is no clear path to prepare LA for a sustainable personalized medicine approach to this disease. Due to melanoma’s time-sensitive nature, LA must aim to provide early access to BRAF testing and consider mutational status within treatment decision making. To this end, recommendations are provided and include establishing multidisciplinary teams and melanoma referral centers and improving access to diagnosis and treatment.
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Affiliation(s)
- Pamela Salman
- Oncology Department, Oncovida Cancer Center, Santiago, Chile
- *Correspondence: Pamela Salman,
| | | | | | | | - Andrea Russi
- Departamento de Oncología, Hospital Universitario San Ignacio, Centro Javeriano de Oncología, Bogotá, Colombia
| | | | - Angela Zambrano
- Departamento de Oncología, Fundación Valle del Lili, Cali, Colombia
| | - Gabriela Cinat
- Instituto de Oncología Ángel Roffo, Universidad de Buenos Aires, Fundación CIDEA, Buenos Aires, Argentina
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Munhoz RR, Cayol F, Corrales L, Gerson R, Tilli M, Barreto EO, Sánchez Castillo JO, Schmerling RA, Cinat G. Merkel cell carcinoma in Latin America: a contribution from an expanded access program for avelumab to address issues from experts' recommendations. Cancer Immunol Immunother 2020; 70:1031-1036. [PMID: 33104838 DOI: 10.1007/s00262-020-02756-9] [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: 07/15/2020] [Accepted: 10/14/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is an aggressive malignancy, associated with poor outcomes in patients with metastatic disease (mMCC). Management has been dramatically altered as a result of incorporating immune checkpoint blockade agents. MCC data from Latin America (LATAM) come from case-series or individual records. Regional registries are lacking. A need for better registries to improve current knowledge about MCC is highlighted. Our objectives were to describe a real-world experience with avelumab as a second-line (or first-line in unfit patients) treatment in a subset of LATAM participants enrolled in a global Expanded Access Program (EAP) for patients with mMCC, and to evaluate its contribution to the resolution of the concerns described in a recent regional experts review. MATERIALS AND METHODS We reviewed data of LATAM participants in an avelumab EAP for mMCC treatment (NCT03089658). EAP patient had unresectable or mMCC with progressive disease after one line of chemotherapy, and were ineligible for clinical trials or unfit for chemotherapy. RESULTS 46 patients (median age: 71.6 years; 60.9% males; median treatment duration: 7.9 months) were included in the LATAM EAP. Physician-assessed objective responses were available for 19 patients. Complete response rate was 15.8% and partial response rate reached 42.1%, summarizing an objective response rate of 57.9%. Stable disease rate was 10.5%, with a disease control response of 68.4%. CONCLUSION Avelumab showed robust efficacy and a safety profile consistent with global EAP data. Results are aimed to improve current knowledge about mMCC treatment and access to immunooncologic strategies for treating LATAM patients.
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Affiliation(s)
- Rodrigo Ramella Munhoz
- Sarcoma and Melanoma Group, Oncology Center and Coordinator of the Medical Oncology Fellowship Program, Instituto do Cancer do Estado de São Paulo, Hospital Sirio Libanes, São Paulo, Brazil
| | - Federico Cayol
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Luis Corrales
- Hospital Clínica Bíblica, CIMCA (Centro de Investigación y Manejo del Cáncer), San José, Costa Rica
| | | | - Malena Tilli
- An affiliate of Merck KGaA, Merck SA, Tronador 4890, Buenos Aires, Argentina.
| | | | | | | | - Gabriela Cinat
- Instituto de Oncología Ángel H. Roffo, Buenos Aires, Argentina
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Schmerling RA, Casas JG, Cinat G, Ospina FEG, Kassuga LEBP, Tlahuel JLM, Mazzuoccolo LD. Burden of Disease, Early Diagnosis, and Treatment of Merkel Cell Carcinoma in Latin America. J Glob Oncol 2019; 4:1-11. [PMID: 30085832 PMCID: PMC6223512 DOI: 10.1200/jgo.18.00041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Rafael A Schmerling
- Rafael A. Schmerling, Beneficiência Portugesa de São Paulo, São Paulo; Luiza E.B.P. Kassuga, National Cancer Institute, Rio de Janeiro, Brazil; Jose G. Casas, Hospital Alemán de Buenos Aires; Gabriela Cinat, University of Buenos Aires; Luis Daniel Mazzuoccolo, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Fabio Ernesto Grosso Ospina, Centro Nacional de Oncología de Colombia, Bogotá, Colombia; and Jorge Luis Martinez Tlahuel, National Cancer Institute, Mexico City, Mexico
| | - Jose G Casas
- Rafael A. Schmerling, Beneficiência Portugesa de São Paulo, São Paulo; Luiza E.B.P. Kassuga, National Cancer Institute, Rio de Janeiro, Brazil; Jose G. Casas, Hospital Alemán de Buenos Aires; Gabriela Cinat, University of Buenos Aires; Luis Daniel Mazzuoccolo, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Fabio Ernesto Grosso Ospina, Centro Nacional de Oncología de Colombia, Bogotá, Colombia; and Jorge Luis Martinez Tlahuel, National Cancer Institute, Mexico City, Mexico
| | - Gabriela Cinat
- Rafael A. Schmerling, Beneficiência Portugesa de São Paulo, São Paulo; Luiza E.B.P. Kassuga, National Cancer Institute, Rio de Janeiro, Brazil; Jose G. Casas, Hospital Alemán de Buenos Aires; Gabriela Cinat, University of Buenos Aires; Luis Daniel Mazzuoccolo, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Fabio Ernesto Grosso Ospina, Centro Nacional de Oncología de Colombia, Bogotá, Colombia; and Jorge Luis Martinez Tlahuel, National Cancer Institute, Mexico City, Mexico
| | - Fabio Ernesto Grosso Ospina
- Rafael A. Schmerling, Beneficiência Portugesa de São Paulo, São Paulo; Luiza E.B.P. Kassuga, National Cancer Institute, Rio de Janeiro, Brazil; Jose G. Casas, Hospital Alemán de Buenos Aires; Gabriela Cinat, University of Buenos Aires; Luis Daniel Mazzuoccolo, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Fabio Ernesto Grosso Ospina, Centro Nacional de Oncología de Colombia, Bogotá, Colombia; and Jorge Luis Martinez Tlahuel, National Cancer Institute, Mexico City, Mexico
| | - Luiza E B P Kassuga
- Rafael A. Schmerling, Beneficiência Portugesa de São Paulo, São Paulo; Luiza E.B.P. Kassuga, National Cancer Institute, Rio de Janeiro, Brazil; Jose G. Casas, Hospital Alemán de Buenos Aires; Gabriela Cinat, University of Buenos Aires; Luis Daniel Mazzuoccolo, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Fabio Ernesto Grosso Ospina, Centro Nacional de Oncología de Colombia, Bogotá, Colombia; and Jorge Luis Martinez Tlahuel, National Cancer Institute, Mexico City, Mexico
| | - Jorge Luis Martinez Tlahuel
- Rafael A. Schmerling, Beneficiência Portugesa de São Paulo, São Paulo; Luiza E.B.P. Kassuga, National Cancer Institute, Rio de Janeiro, Brazil; Jose G. Casas, Hospital Alemán de Buenos Aires; Gabriela Cinat, University of Buenos Aires; Luis Daniel Mazzuoccolo, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Fabio Ernesto Grosso Ospina, Centro Nacional de Oncología de Colombia, Bogotá, Colombia; and Jorge Luis Martinez Tlahuel, National Cancer Institute, Mexico City, Mexico
| | - Luis Daniel Mazzuoccolo
- Rafael A. Schmerling, Beneficiência Portugesa de São Paulo, São Paulo; Luiza E.B.P. Kassuga, National Cancer Institute, Rio de Janeiro, Brazil; Jose G. Casas, Hospital Alemán de Buenos Aires; Gabriela Cinat, University of Buenos Aires; Luis Daniel Mazzuoccolo, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Fabio Ernesto Grosso Ospina, Centro Nacional de Oncología de Colombia, Bogotá, Colombia; and Jorge Luis Martinez Tlahuel, National Cancer Institute, Mexico City, Mexico
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Kandolf Sekulovic L, Guo J, Agarwala S, Hauschild A, McArthur G, Cinat G, Wainstein A, Caglevic C, Lorigan P, Gogas H, Alvarez M, Duncombe R, Lebbe C, Peris K, Rutkowski P, Stratigos A, Forsea AM, De La Cruz Merino L, Kukushkina M, Dummer R, Hoeller C, Gorry C, Bastholt L, Herceg D, Neyns B, Vieira R, Arenberger P, Bylaite-Bucinskiene M, Babovic N, Banjin M, Putnik K, Todorovic V, Kirov K, Ocvirk J, Zhukavets A, Ymeri A, Stojkovski I, Garbe C. Access to innovative medicines for metastatic melanoma worldwide: Melanoma World Society and European Association of Dermato-oncology survey in 34 countries. Eur J Cancer 2018; 104:201-209. [PMID: 30388700 DOI: 10.1016/j.ejca.2018.09.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 09/08/2018] [Accepted: 09/12/2018] [Indexed: 12/19/2022]
Abstract
According to data from recent studies from Europe, a large percentage of patients have restricted access to innovative medicines for metastatic melanoma. Melanoma World Society and European Association of Dermato-oncology conducted a Web-based survey on access to first-line recommended treatments for metastatic melanoma by current guidelines (National Comprehensive Center Network, European Society for Medical Oncology [ESMO] and European Organization for Research and Treatment of Cancer/European Association of Dermato-oncology/European dermatology Forum) among melanoma experts from 27 European countries, USA, China, Australia, Argentina, Brazil, Chile and Mexico from September 1st, 2017 to July 1st, 2018. Data on licencing and reimbursement of medicines and the number of patient treated were correlated with the data on health expenditure per capita (HEPC), Mackenbach score of health policy performance, health technology assessment (HTA), ASCO and ESMO Magnitude of clinical benefit scale (ESMO MCBS) scores of clinical benefit and market price of medicines. Regression analysis for evaluation of correlation between the parameters was carried out using SPSS software. The estimated number of patients without access in surveyed countries was 13768. The recommended BRAFi + MEKi combination and anti-PD1 immunotherapy were fully reimbursed/covered in 19 of 34 (55.8%) and 17 of 34 (50%) countries, and combination anti-CTLA4+anti-PD1 in was fully covered in 6 of 34 (17.6%) countries. Median delay in reimbursement was 991 days, and it was in significant correlation with ESMO MCBS (p = 0.02), median market price (p = 0.001), HEPC and Mackenbach scores (p < 0.01). Price negotiations or managed entry agreements (MEAs) with national authorities were necessary for reimbursement. In conclusion, great discrepancy exists in metastatic melanoma treatment globally. Access to innovative medicines is in correlation with economic parameters as well as with healthcare system performance parameters. Patient-oriented drug development, market access and reimbursement pathways must be urgently found.
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Affiliation(s)
- L Kandolf Sekulovic
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia.
| | - J Guo
- Department of Urology and Melanoma, Peking University Cancer Hospital & Institute, Beijing, PR China
| | - S Agarwala
- St. Luke's University Hospital and Temple University, Bethlehem, USA
| | - A Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - G McArthur
- Divisions of Research and Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - G Cinat
- Médica Oncóloga Instituto de Oncología Angel Roffo, Universidad de Buenos Aires Fundación CIDEA, Buenos Aires, Argentina
| | - A Wainstein
- Institute of Post-graduation, Faculdade de Ciências Médicas de Minas Gerais (FCM-MG) - Belo Horizonte (MG), Brazil
| | - C Caglevic
- Medical Oncology Service, Oncology Department, Clinica Alemana Santiago, Faculty of Medicine Clinica Alemana-Universidad Del Desarrollo, Santiago, Chile
| | - P Lorigan
- Institute of Cancer Sciences, University of Manchester, The Christie NHS Foundation Trust, Manchester, UK
| | - H Gogas
- 1(st)Department of Internal Medicine, Laiko Hospital and 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - M Alvarez
- Medico en Instituto Nacional de Cancerologia, Mexico City Area, Mexico
| | - R Duncombe
- Institute of Cancer Sciences, University of Manchester, The Christie NHS Foundation Trust, Manchester, UK
| | - C Lebbe
- APHP Dermatology Department, University Paris 7 Diderot, INSERM U976, PARIS, France
| | - K Peris
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - P Rutkowski
- Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
| | - A Stratigos
- 1(st)Department of Internal Medicine, Laiko Hospital and 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - A-M Forsea
- Carol Davila University of Medicine and Pharmacy, Elias University Hospital Bucharest, Romania
| | - L De La Cruz Merino
- Department of Clinical Oncology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - R Dummer
- UniversitätsSpital Zürich-Skin Cancer Center, University Hospital, Zürich, Switzerland
| | - C Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - C Gorry
- National Centre for Pharmacoeconomics, Old Stone Building, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland
| | - L Bastholt
- Department of Oncology, Odense University Hospital, Denmark
| | - D Herceg
- Department of Oncology, University Hospital Zagreb, Croatia
| | - B Neyns
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - R Vieira
- Department of Dermatology, Medical Faculty, University of Coimbra, Portugal
| | - P Arenberger
- Department of Dermatovenereology, Charles University 3rd Faculty of Medicine and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | | | - N Babovic
- Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - M Banjin
- Department of Oncology, University Hospital Sarajevo, Bosnia and Herzegovina
| | - K Putnik
- North Estonia Medical Centre, Tallinn, Estonia
| | - V Todorovic
- Clinic for Oncology and Radiotherapy, Podgorica, Montenegro
| | - K Kirov
- Clinic of Oncodermatology, National Cancer Center, Sofia, Bulgaria
| | - J Ocvirk
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - A Zhukavets
- Belarusian Medical Academy of Postgraduate Education (BelMAPE), Minsk, Belarus
| | - A Ymeri
- University Hospital Mother Theresa, Tirana, Albania
| | - I Stojkovski
- University Clinic of Radiotherapy and Oncology, Skopje, Macedonia
| | - C Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
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Kandolf Sekulovic L, Agarwala S, Hauschild A, Guo J, McArthur G, Lorigan P, Cinat G, Caglevich C, Lebbe C, Rutkowski P, Gogas H, Dummer R, Neyns B, Bastholt L, Wainstein A, Herceg D, Banjin M, Zhukavets A, Ocvirk J, Garbe C. Major determinants of delayed access to innovative medicines for metastatic melanoma: The results of Melanoma World Society and European Association of Dermato-Oncology survey. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy297.004] [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: 11/14/2022] Open
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Dreno B, Thompson JF, Smithers BM, Santinami M, Jouary T, Gutzmer R, Levchenko E, Rutkowski P, Grob JJ, Korovin S, Drucis K, Grange F, Machet L, Hersey P, Krajsova I, Testori A, Conry R, Guillot B, Kruit WHJ, Demidov L, Thompson JA, Bondarenko I, Jaroszek J, Puig S, Cinat G, Hauschild A, Goeman JJ, van Houwelingen HC, Ulloa-Montoya F, Callegaro A, Dizier B, Spiessens B, Debois M, Brichard VG, Louahed J, Therasse P, Debruyne C, Kirkwood JM. MAGE-A3 immunotherapeutic as adjuvant therapy for patients with resected, MAGE-A3-positive, stage III melanoma (DERMA): a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Oncol 2018; 19:916-929. [PMID: 29908991 DOI: 10.1016/s1470-2045(18)30254-7] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [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: 12/19/2017] [Revised: 03/16/2018] [Accepted: 03/21/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite newly approved treatments, metastatic melanoma remains a life-threatening condition. We aimed to evaluate the efficacy of the MAGE-A3 immunotherapeutic in patients with stage IIIB or IIIC melanoma in the adjuvant setting. METHODS DERMA was a phase 3, double-blind, randomised, placebo-controlled trial done in 31 countries and 263 centres. Eligible patients were 18 years or older and had histologically proven, completely resected, stage IIIB or IIIC, MAGE-A3-positive cutaneous melanoma with macroscopic lymph node involvement and an Eastern Cooperative Oncology Group performance score of 0 or 1. Randomisation and treatment allocation at the investigator sites were done centrally via the internet. We randomly assigned patients (2:1) to receive up to 13 intramuscular injections of recombinant MAGE-A3 with AS15 immunostimulant (MAGE-A3 immunotherapeutic; 300 μg MAGE-A3 antigen plus 420 μg CpG 7909 reconstituted in AS01B to a total volume of 0·5 mL), or placebo, over a 27-month period: five doses at 3-weekly intervals, followed by eight doses at 12-weekly intervals. The co-primary outcomes were disease-free survival in the overall population and in patients with a potentially predictive gene signature (GS-positive) identified previously and validated here via an adaptive signature design. The final analyses included all patients who had received at least one dose of study treatment; analyses for efficacy were in the as-randomised population and for safety were in the as-treated population. This trial is registered with ClinicalTrials.gov, number NCT00796445. FINDINGS Between Dec 1, 2008, and Sept 19, 2011, 3914 patients were screened, 1391 randomly assigned, and 1345 started treatment (n=895 for MAGE-A3 and n=450 for placebo). At final analysis (data cutoff May 23, 2013), median follow-up was 28·0 months [IQR 23·3-35·5] in the MAGE-A3 group and 28·1 months [23·7-36·9] in the placebo group. Median disease-free survival was 11·0 months (95% CI 10·0-11·9) in the MAGE-A3 group and 11·2 months (8·6-14·1) in the placebo group (hazard ratio [HR] 1·01, 0·88-1·17, p=0·86). In the GS-positive population, median disease-free survival was 9·9 months (95% CI 5·7-17·6) in the MAGE-A3 group and 11·6 months (5·6-22·3) in the placebo group (HR 1·11, 0·83-1·49, p=0·48). Within the first 31 days of treatment, adverse events of grade 3 or worse were reported by 126 (14%) of 894 patients in the MAGE-A3 group and 56 (12%) of 450 patients in the placebo group, treatment-related adverse events of grade 3 or worse by 36 (4%) patients given MAGE-A3 vs six (1%) patients given placebo, and at least one serious adverse event by 14% of patients in both groups (129 patients given MAGE-A3 and 64 patients given placebo). The most common adverse events of grade 3 or worse were neoplasms (33 [4%] patients in the MAGE-A3 group vs 17 [4%] patients in the placebo group), general disorders and administration site conditions (25 [3%] for MAGE-A3 vs four [<1%] for placebo) and infections and infestations (17 [2%] for MAGE-A3 vs seven [2%] for placebo). No deaths were related to treatment. INTERPRETATION An antigen-specific immunotherapeutic alone was not efficacious in this clinical setting. Based on these findings, development of the MAGE-A3 immunotherapeutic for use in melanoma has been stopped. FUNDING GlaxoSmithKline Biologicals SA.
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Affiliation(s)
- Brigitte Dreno
- Department of Dermatooncology, Hotel Dieu Nantes University Hospital, Nantes, France
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Bernard Mark Smithers
- Queensland Melanoma Project, Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Mario Santinami
- Melanoma Sarcoma Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Thomas Jouary
- Service d'Oncologie Médicale, Hôpital François Mitterrand, Pau, France
| | - Ralf Gutzmer
- Skin Cancer Center Hannover, Department of Dermatology, Hannover Medical School, Hannover, Germany
| | | | - Piotr Rutkowski
- Department of Soft Tissue, Bone Sarcoma, and Melanoma, Maria Sklodowska-Curie Institute, Oncology Center, Warsaw, Poland
| | - Jean-Jacques Grob
- Department of Dermatology and Skin Cancers, La Timone APHM Hospital, Aix-Marseille University, Marseille, France
| | - Sergii Korovin
- Department of Skin and Soft Tissue Tumours, National Cancer Institute, Kiev, Ukraine
| | - Kamil Drucis
- Swissmed Centrum Zdrowia, Gdansk, Poland; Department of Surgical Oncology, Gdansk Medical University, Gdansk, Poland
| | - Florent Grange
- Dermatology Department, Hôpital Robert Debré, Université de Reims Champagne-Ardenne, Reims, France
| | - Laurent Machet
- Department of Dermatology, Centre Hospitalier Universitaire, Tours, France; UFR de Médecine, Université François-Rabelais, Tours, France
| | - Peter Hersey
- Melanoma Immunology and Oncology Group, Centenary Institute, University of Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, Sydney, NSW, Australia
| | - Ivana Krajsova
- Dermato-oncology Department, General University Hospital, Prague, Czech Republic
| | | | - Robert Conry
- Division of Hematology & Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bernard Guillot
- Département de Dermatologie, Centre Hospitalier Universitaire, Hôpital Saint-Éloi, Montpellier, France
| | - Wim H J Kruit
- Department of Medical Oncology, Erasmus MC Cancer institute, Rotterdam, Netherlands
| | | | - John A Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
| | - Igor Bondarenko
- Department of Oncology and Medical Radiology, Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine
| | - Jaroslaw Jaroszek
- Centrum Medyczne Bieńkowski, Klinika Chirurgii Plastycznej, Bydgoszcz, Poland; Department of Oncological Surgery, Oncology Center, Bydgoszcz, Poland
| | - Susana Puig
- Melanoma Unit, Dermatology Department, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain
| | - Gabriela Cinat
- Instituto de Oncología Ángel H Roffo, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Axel Hauschild
- Department of Dermatology, Venereology, and Allergology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jelle J Goeman
- Medical Statistics, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Hans C van Houwelingen
- Medical Statistics, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | | | | | - Benjamin Dizier
- GlaxoSmithKline, Rixensart, Belgium; Immunology Translational Medicine, UCB, Brussels, Belgium
| | - Bart Spiessens
- GlaxoSmithKline, Rixensart, Belgium; Biostatistics Department, Janssen Research & Development, Beerse, Belgium
| | | | - Vincent G Brichard
- GlaxoSmithKline, Rixensart, Belgium; ViaNova Biosciences, Brussels, Belgium
| | | | - Patrick Therasse
- GlaxoSmithKline, Rixensart, Belgium; Laboratoires Servier, Paris, France
| | - Channa Debruyne
- GlaxoSmithKline, Rixensart, Belgium; University Hospitals Leuven, Leuven, Belgium
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Kandolf Sekulovic L, Guo J, Agarwala SS, Hauschild A, McArthur GA, Cinat G, Caglevic C, Lorigan P, Lebbe C, Rutkowski P, Gogas H, Stratigos A, Dummer R, Neyns B, Bastholt L, Herceg D, Banjin M, Stojkovski IR, Zhukavets A, Garbe C. Access to innovative medicines for metastatic melanoma worldwide: Melanoma World Society and European Association of Dermato-oncology survey in 34 countries. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Jun Guo
- Peking University Cancer Hospital and Institute, Beijing, China
| | | | | | - Grant A. McArthur
- Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia
| | - Gabriela Cinat
- Instituto Angel H Roffo, Capital Federal, Buenos Aires, Argentina
| | | | - Paul Lorigan
- University of Manchester and the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Celeste Lebbe
- AP-HP Dermatology and CIC department, INSERM U976, Faculté Paris 7 Diderot, Saint-Louis hospital, AP-HP, Paris, France, Paris, France
| | - Piotr Rutkowski
- Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
| | - Helen Gogas
- First Department of Medicine, Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Reinhard Dummer
- University of Zurich Hospital, Department of Dermatology, Zurich, Switzerland
| | - Bart Neyns
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | | | - Maja Banjin
- Clinical of Oncology, Sarajevo, Federation, Bosnia and Herzegovina
| | | | | | - Claus Garbe
- Eberhard Karls University, Tübingen, Germany
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Maio M, Lewis K, Demidov L, Mandalà M, Bondarenko I, Ascierto PA, Herbert C, Mackiewicz A, Rutkowski P, Guminski A, Goodman GR, Simmons B, Ye C, Yan Y, Schadendorf D, Cinat G, Fein LE, Brown M, Guminski A, Haydon A, Khattak A, McNeil C, Parente P, Power J, Roberts-Thomson R, Sandhu S, Underhill C, Varma S, Berger T, Awada A, Blockx N, Buyse V, Mebis J, Franke FA, Jobim de Azevedo S, Silva Lazaretti N, Jamal R, Mihalcioiu C, Petrella T, Savage K, Song X, Wong R, Dabelic N, Plestina S, Vojnovic Z, Arenberger P, Kocak I, Krajsova I, Kubala E, Melichar B, Vantuchova Y, Putnik K, Dreno B, Dutriaux C, Grob JJ, Joly P, Lacour JP, Meyer N, Mortier L, Thomas L, Fluck M, Gambichler T, Hassel J, Hauschild A, Schadendorf D, Donnellan P, McCaffrey J, Power D, Ariad S, Bar-Sela G, Hendler D, Ron I, Schachter J, Ascierto P, Berruti A, Bianchi L, Chiarion Sileni V, Cognetti F, Danielli R, Di Giacomo AM, Gianni L, Goldhirsch A, Guida M, Maio M, Mandalà M, Marchetti P, Queirolo P, Santoro A, Kapiteijn E, Mackiewicz A, Rutkowski P, Ferreira P, Demidov L, Gafton G, Makarova Y, Andric Z, Babovic N, Jovanovic D, Kandolf Sekulovic L, Cohen G, Dreosti L, Vorobiof D, Curiel Garcia MT, Diaz Beveridge R, Majem Tarruella M, Marquez Rodas I, Puliats Rodriguez JM, Rueda Dominguez A, Maroti M, Papworth K, Michielin O, Bondarenko I, Brown E, Corrie P, Harries M, Herbert C, Kumar S, Martin-Clavijo A, Middleton M, Patel P, Talbot T, Agarwala S, Chapman P, Conry R, Doolittle G, Gangadhar T, Hallmeyer S, Hamid O, Hernandez-Aya L, Johnson D, Kass F, Kolevska T, Lewis K, Lunin S, Salama A, Sikic B, Somer B, Spigel D, Whitman E. Adjuvant vemurafenib in resected, BRAF V600 mutation-positive melanoma (BRIM8): a randomised, double-blind, placebo-controlled, multicentre, phase 3 trial. Lancet Oncol 2018; 19:510-520. [DOI: 10.1016/s1470-2045(18)30106-2] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
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9
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Llanos A, Savignano M, Cinat G. Maintenance treatment with chemotherapy and immunotherapy in non-small cell lung cancer: a case report. Front Oncol 2012; 2:152. [PMID: 23112957 PMCID: PMC3481158 DOI: 10.3389/fonc.2012.00152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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: 09/03/2012] [Accepted: 10/08/2012] [Indexed: 01/28/2023] Open
Abstract
A 53-years-old woman was diagnosed with lung adenocarcinoma state IV (synchronous pleural involvement) in April 2009. First-line systemic treatment included six cycles of Carboplatin, Paclitaxel, and Bevacizumab. Partial response was achieved. Maintenance therapy with Bevacizumab and Pemetrexed was given from September 2009 to February 2010. No response changes were observed. Immunotherapy was initiated, and then Pemetrexed was given with the same disease status. Both treatments were well tolerated. Immunotherapy toxicity included reaction at the site of injection grade 2. At present, the patient is still on this treatment. Given the poor prognosis of patients with advanced lung cancer, the combination of both treatments during the stable phase of the disease may improve progression-free survival.
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Affiliation(s)
- Anabella Llanos
- Department of Sarcoma and Melanoma, Instituto Angel H. Roffo Buenos Aires, Argentina
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10
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Schmerling RA, Loria D, Cinat G, Ramos WE, Cardona AF, Sánchez JL, Martinez-Said H, Buzaid AC. Cutaneous melanoma in Latin America: the need for more data. Rev Panam Salud Publica 2011; 30:431-8. [DOI: 10.1590/s1020-49892011001100005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 06/19/2011] [Indexed: 11/22/2022] Open
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11
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Abstract
Tissue factor (TF) is a molecular marker that is up-regulated in cancer cells and aids tumoral dissemination. Our purpose was to develop a nested RT-PCR strategy against TF for detecting blood-borne tumour cells. Our method detected TF expression in a minimum of 1.5 pg total RNA from MCF7 cells. A preliminary study in blood samples from 16 advanced breast carcinoma patients showed that 80% of patients with high TF load progressed and died, while only 18% with low TF load showed the same behaviour. Kaplan-Meier analysis confirmed worse overall survival in patients with high TF load.
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Affiliation(s)
- L L Otero
- Laboratory of Molecular Oncology, Department of Science and Technology, Quilmes National University, Buenos Aires, Argentina
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12
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Hersey P, Bastholt L, Chiarion-Sileni V, Cinat G, Dummer R, Eggermont AMM, Espinosa E, Hauschild A, Quirt I, Robert C, Schadendorf D. Small molecules and targeted therapies in distant metastatic disease. Ann Oncol 2009; 20 Suppl 6:vi35-40. [PMID: 19617296 PMCID: PMC2712592 DOI: 10.1093/annonc/mdp254] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Chemotherapy, biological agents or combinations of both have had little impact on survival of patients with metastatic melanoma. Advances in understanding the genetic changes associated with the development of melanoma resulted in availability of promising new agents that inhibit specific proteins up-regulated in signal cell pathways or inhibit anti-apoptotic proteins. Sorafenib, a multikinase inhibitor of the RAF/RAS/MEK pathway, elesclomol (STA-4783) and oblimersen (G3139), an antisense oligonucleotide targeting anti-apoptotic BCl-2, are in phase III clinical studies in combination with chemotherapy. Agents targeting mutant B-Raf (RAF265 and PLX4032), MEK (PD0325901, AZD6244), heat-shock protein 90 (tanespimycin), mTOR (everolimus, deforolimus, temsirolimus) and VEGFR (axitinib) showed some promise in earlier stages of clinical development. Receptor tyrosine-kinase inhibitors (imatinib, dasatinib, sunitinib) may have a role in treatment of patients with melanoma harbouring c-Kit mutations. Although often studied as single agents with disappointing results, new targeted drugs should be more thoroughly evaluated in combination therapies. The future of rational use of new targeted agents also depends on successful application of analytical techniques enabling molecular profiling of patients and leading to selection of likely therapy responders.
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Affiliation(s)
- P Hersey
- Immunology and Oncology Unit, Calvary Mater Newcastle Hospital, New South Wales, Australia.
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13
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Schadendorf D, Algarra SM, Bastholt L, Cinat G, Dreno B, Eggermont AMM, Espinosa E, Guo J, Hauschild A, Petrella T, Schachter J, Hersey P. Immunotherapy of distant metastatic disease. Ann Oncol 2009; 20 Suppl 6:vi41-50. [PMID: 19617297 PMCID: PMC2712591 DOI: 10.1093/annonc/mdp253] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Immunotherapy of metastatic melanoma consists of various approaches leading to specific or non-specific immunomodulation. The use of FDA-approved interleukin (IL)-2 alone, in combination with interferon alpha, and/or with various chemotherapeutic agents (biochemotherapy) is associated with significant toxicity and poor efficacy that does not improve overall survival of 96% of patients. Many studies with allogeneic and autologous vaccines have demonstrated no clinical benefit, and some randomised trials even showed a detrimental effect in the vaccine arm. The ongoing effort to develop melanoma vaccines based on dendritic cells and peptides is driven by advances in understanding antigen presentation and processing, and by new techniques of vaccine preparation, stabilisation and delivery. Several agents that have shown promising activity in metastatic melanoma including IL-21 and monoclonal antibodies targeting cytotoxic T lymphocyte-associated antigen 4 (anti-CTLA-4) or CD137 are discussed. Recent advances of intratumour gene transfer technologies and adoptive immunotherapy, which represents a promising although technically challenging direction, are also discussed.
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Affiliation(s)
- D Schadendorf
- Department of Dermatology, University Hospital Essen, Essen, Germany.
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14
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Castro MA, Cinat G, Guthmann M, Gabri MR, Alonso DF, Fainbom L. A phase II trial of N-Acetyl-GM3/VSSP vaccine in high-risk resected melanoma patients (pts). Does vaccination modify melanoma outcome after relapse? J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.3026] [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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15
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Gabri MR, Vazquez V, Otero LL, Castro MA, Cinat G, Gomez DE, Alonso DF. Circulating tyrosinase mRNA detection in a preclinical xenograft mouse melanoma model and in advanced melanoma patients. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.22204] [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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16
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Gabri M, Vazquez V, Girón S, Castro M, Cinat G, Gomez R, Santoro F, Gomez D, Alonso D. Molecular detection of circulating tyrosinase mRNA: Optimization in a preclinical xenograft mouse melanoma model and further evaluation in samples from advanced melanoma patients. Int J Mol Med 2008. [DOI: 10.3892/ijmm.21.5.555] [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: 11/06/2022] Open
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17
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Gabri MR, Vazquez V, Girón S, Castro MA, Cinat G, Gomez RE, Santoro FM, Gomez DE, Alonso DF. Molecular detection of circulating tyrosinase mRNA: optimization in a preclinical xenograft mouse melanoma model and further evaluation in samples from advanced melanoma patients. Int J Mol Med 2008; 21:555-559. [PMID: 18425346] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
We designed high-affinity primers for the mRNA sequence of human tyrosinase to test the value of molecular detection of circulating melanoma cells by reverse transcription-polymerase chain reaction (RT-PCR). The optimization process included in vitro settings and in vivo studies in a xenograft mouse model. We detected tyrosinase expression with at least 40 pg and 1.5 pg of total RNA extracted from cultured SKmel human melanoma cells, using a first round of PCR amplification and nested PCR, respectively. Human tyrosinase expression was found in the blood of nude mice bearing subcutaneous SKmel tumors, and the expression bands were stronger after manipulation of the tumor mass. We also examined the fate of circulating melanoma cells in the present melanoma model. Tyrosinase expression declined in blood 6 h after a direct intravenous injection of SKmel cells. A preliminary study in human blood samples demonstrated a baseline positive tyrosinase determination in 64% (16/25) of advanced melanoma patients using the RT-PCR nested assay. Baseline tyrosinase expression was significantly associated with disease progression after 12 months, and sequential determination during follow-up of the remaining disease-free patients showed a progressive increase of negative results.
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Affiliation(s)
- Mariano R Gabri
- Laboratory of Molecular Oncology, Quilmes National University, Buenos Aires, Argentina
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18
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Alvarez AM, Quiroga MNG, Cinat G, Iturbe J, Nissi TS, Lacava J, Cuartero V, Vallejo C, Leone B, Mickiewicz E. Retrospective analysis on patients with male breast cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.19681] [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: 11/20/2022] Open
Abstract
19681 Background: Male breast cancer is uncommon, 1%(0.7 %)of all breast cancer. Nevertheless, the incidence has climbed 26% over the past 25 years. Objetive: Analyze the form of presentation and clinical evolution of patients with male breast cancer studied from 1977 to 2005. Methods: From 1977 to 2005 53 charts were analyzed: age, clinical presentation, stage (st), histological characteristics and nodal involvement. Results: Age: 33 years to 83 years (median= 59 years). Mean durations of symptoms before presentations: 11 months (m) (range 1 - 84 m.) . Forty-six (86.7%) patients (pts) had history of breast lumps, 9 (17%) were painful. Skin involvement and ulceration were present in 5 (9.43%) and 4 (7.54 %) respectively. One case of bilateralism was found. Seven (13.2%) st. I; 18 (33.96%) st. II; 20 (37.73%) st. III and 7 (13.2%) st. IV. Radical mastectomy was done in 41 pts (77.35%). Invasive ductal carcinoma was the most common histological type in 45 (84.9%). One case of lobular carcinoma was found. 60.4% of tumours expressed hormonal receptor. Adyuvant treatment: Adriamycin-based chemotherapy in 20 pts and CMF in 8 pts. Hormonotherapy was offered in 10 (19%) pts of the previous group, radiotherapy to 12 pts. twenthy pts (37.73%) presented recurrence; most common was bone in 10. The st. I and II estimated 5-year survival rate was 68% IC 95% (44–84%), st. III was 44% IC 95% (23 - 67%), st. IV (median = 24 m) with range (16 - 56 m). The 72% IC 95% (48–88%) patients st. I and II was free of disease at the 5-years, st. III was free 24% IC 95% (9–49%), st. IV (median = 7,5 m) with range (7–14 m). Conclusions: The media age at diagnosis was 59 years (10 years less than the international bibliography). (IB). Our group had longer time to presentation: 11 vs. 6 m., (IB) and most of them where in st. III. Hormonal receptore were positive in 60%. No significant financial relationships to disclose.
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Affiliation(s)
- A. M. Alvarez
- Angel H. Roffo, Buenos Aires, Argentina; Grupo Oncologico Cooperativo del Sur, Neuquen, Argentina
| | - M. N. Gandur Quiroga
- Angel H. Roffo, Buenos Aires, Argentina; Grupo Oncologico Cooperativo del Sur, Neuquen, Argentina
| | - G. Cinat
- Angel H. Roffo, Buenos Aires, Argentina; Grupo Oncologico Cooperativo del Sur, Neuquen, Argentina
| | - J. Iturbe
- Angel H. Roffo, Buenos Aires, Argentina; Grupo Oncologico Cooperativo del Sur, Neuquen, Argentina
| | - T. Said Nissi
- Angel H. Roffo, Buenos Aires, Argentina; Grupo Oncologico Cooperativo del Sur, Neuquen, Argentina
| | - J. Lacava
- Angel H. Roffo, Buenos Aires, Argentina; Grupo Oncologico Cooperativo del Sur, Neuquen, Argentina
| | - V. Cuartero
- Angel H. Roffo, Buenos Aires, Argentina; Grupo Oncologico Cooperativo del Sur, Neuquen, Argentina
| | - C. Vallejo
- Angel H. Roffo, Buenos Aires, Argentina; Grupo Oncologico Cooperativo del Sur, Neuquen, Argentina
| | - B. Leone
- Angel H. Roffo, Buenos Aires, Argentina; Grupo Oncologico Cooperativo del Sur, Neuquen, Argentina
| | - E. Mickiewicz
- Angel H. Roffo, Buenos Aires, Argentina; Grupo Oncologico Cooperativo del Sur, Neuquen, Argentina
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19
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Porcela H, Gianni S, Alvarez AM, De Dios D, Mickiewicz E, Roth B, Cinat G, Menendez P, Bonomi M. Concurrent chemoradiation (CCR) for locally advanced or relapsed vulvar carcinoma (VC) treatment: An alternative to pelvic exenteration (PE). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.15021] [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: 11/20/2022] Open
Abstract
15021 Background: PE is the standard treatment for locally advanced or relapsed VC that involves the anus or rectovaginal wall, with high morbidity and the consequent loss of Qol. Objective: Locoregional response, toxicity, disease free survival (DFS) and survival (SV) achieved with concurrent chemoradiation in locally advanced or relapsed VC was prospectively evaluated. Methods: From 7/93 to 05/05, 32 pts which would have required some kind of PE were treated with mitomycin C (10 mg./m2 d1) + 5-Fluoruracil (800 mg/m2 d 1–4) IV continuous infusion, plus concurrent external radiotherapy (50 Gy) to the vulva, pelvis and groin. An additional boost (15–20 Gy) was added when a less than complete clinical response (CR) was achieved. Multiple biopsies of the tumor bed were performed to confirm complete pathologic responses (CPR). Results: 30 pts (94%) completed treatment as planned. Overall, locoregional response was obtained in 25/30 (83.3%) pts: 20 (66.6%) CR, 5 (16.6%) partial response (PR). 3 (10%) pts had stable disease and 2 (6.6%) progresive disease. 14/30 (46.6%) had CPR. Radical vulvectomy or radical local excision was performed in 7 pts for residual disease after CCR (4/6 with CR and microscopic residual disease and 3/5 with PR), 2 pts with PR were lost after having completed CCR and 2 pts with CR and microscopic residual disease refused further treatment. None of the responding patients required PE. Treatment was well tolerated with mild to moderate toxicity, attributed to radiotherapy. No treatment deaths were recorded. 28 pts with a median follow-up of 25.5 months (range 6–126) showed a 5-year cumulative DFS (34%) and SV (49%). Conclusion: CCR is a safe therapeutic option with results comparable to those obtained with PE, with significant improvement of Qol. CCR has become the standard treatment for locally advanced or relapsed VC at our center. No significant financial relationships to disclose.
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Affiliation(s)
| | - S. Gianni
- Angel H. Roffo, Buenos Aires, Argentina
| | | | | | | | - B. Roth
- Angel H. Roffo, Buenos Aires, Argentina
| | - G. Cinat
- Angel H. Roffo, Buenos Aires, Argentina
| | | | - M. Bonomi
- Angel H. Roffo, Buenos Aires, Argentina
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20
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Guthmann MD, Castro MA, Cinat G, Venier C, Koliren L, Bitton RJ, Vázquez AM, Fainboim L. Cellular and humoral immune response to N-Glycolyl-GM3 elicited by prolonged immunotherapy with an anti-idiotypic vaccine in high-risk and metastatic breast cancer patients. J Immunother 2006; 29:215-23. [PMID: 16531822 DOI: 10.1097/01.cji.0000188502.11348.34] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In this study, the immunogenicity and toxicity profile of 1E10, an anti-idiotypic vaccine mimicking the N-glycolyl-GM3 ganglioside, was investigated with an extended vaccination protocol. The year-long vaccination scheme consisted of 6 biweekly intradermal injections (induction phase), followed by 10 monthly boosters (maintenance). Nineteen patients with high-risk (stage III) or metastatic breast cancer were vaccinated with different dose levels of 1E10 (0.5, 1, and 2 mg). The humoral and cellular responses to 1E10 and the targeted ganglioside were assessed at baseline and throughout the treatment. Local skin reactions represented the most common adverse event (National Cancer Institute Toxicity Criteria (NCIC) grades I and II), followed by mild flu-like symptoms lasting for 1 to 2 days. Two patients were removed from the study because of vaccine-related hypersensitivity reactions. A third patient was removed from the study after a transient loss of consciousness with uncertain relation to the vaccine. All patients showed a strong antibody response to the targeted ganglioside. In addition, ganglioside-specific T-cell responses were recorded in 5 of 13 evaluable patients. Vaccination with 1E10 was immunogenic and relatively well tolerated. Because similar results were observed with the 3 tested dose levels, the 0.5-mg dose level was selected for future trials.
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Affiliation(s)
- Marcelo D Guthmann
- Hospital de Clínicas José de San Martín, University of Buenos Aires, Buenos Aires, Argentina.
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21
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de Dios D, Alvarez A, Cinat G, Porcella H, Gianni S, Gandur Quiroga A, Cuartero V, Nicolas C, Roth B, Menendez P, Mickiewicz E. Concurrent chemotherapy and radiotherapy in locally advanced cervical carcinoma (LACC): Anályis of two different radiosensitizer schedules. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.5113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - G. Cinat
- I. Roffo, Buenos Aires, Argentina
| | | | | | | | | | | | - B. Roth
- I. Roffo, Buenos Aires, Argentina
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22
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Alvarez AM, Rodger J, Cinat G, Porcella H, de Dios D, Gianni S, Gandur Quiroga A, Roth B, Menendez P, Cuartero V, Mickiewicz E. Fifty months follow-up in patients with locally advanced cervical carcinoma (LACC) treated with low dose bi-weekly (ldbw) gemcitabine and cisplatin plus concurrent accelerated radiotherapy (AR). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.5074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - G. Cinat
- I. Roffo, Buenos Aires, Argentina
| | | | | | | | | | - B. Roth
- I. Roffo, Buenos Aires, Argentina
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23
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Castro MA, Guthmann M, Cinat G, Venier C, Bitton R, Koliren L, Alvarez AM, Fainbom L. Evidence of immunogenicity with the anti-idiotypic monoclonal antibody vaccine 1E10. Results from a phase I clinical trial in breast cancer patients. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.2561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. A. Castro
- Inst Angel H. Roffo, Buenos Aires, Argentina; Hosp de Clínicas Jose de San Martin, Buenos Aires, Argentina; Hosp Durand, Buenos Aires, Argentina
| | - M. Guthmann
- Inst Angel H. Roffo, Buenos Aires, Argentina; Hosp de Clínicas Jose de San Martin, Buenos Aires, Argentina; Hosp Durand, Buenos Aires, Argentina
| | - G. Cinat
- Inst Angel H. Roffo, Buenos Aires, Argentina; Hosp de Clínicas Jose de San Martin, Buenos Aires, Argentina; Hosp Durand, Buenos Aires, Argentina
| | - C. Venier
- Inst Angel H. Roffo, Buenos Aires, Argentina; Hosp de Clínicas Jose de San Martin, Buenos Aires, Argentina; Hosp Durand, Buenos Aires, Argentina
| | - R. Bitton
- Inst Angel H. Roffo, Buenos Aires, Argentina; Hosp de Clínicas Jose de San Martin, Buenos Aires, Argentina; Hosp Durand, Buenos Aires, Argentina
| | - L. Koliren
- Inst Angel H. Roffo, Buenos Aires, Argentina; Hosp de Clínicas Jose de San Martin, Buenos Aires, Argentina; Hosp Durand, Buenos Aires, Argentina
| | - A. M. Alvarez
- Inst Angel H. Roffo, Buenos Aires, Argentina; Hosp de Clínicas Jose de San Martin, Buenos Aires, Argentina; Hosp Durand, Buenos Aires, Argentina
| | - L. Fainbom
- Inst Angel H. Roffo, Buenos Aires, Argentina; Hosp de Clínicas Jose de San Martin, Buenos Aires, Argentina; Hosp Durand, Buenos Aires, Argentina
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24
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Guthmann MD, Bitton RJ, Carnero AJL, Gabri MR, Cinat G, Koliren L, Lewi D, Fernandez LE, Alonso DF, Gómez DE, Fainboim L. Active specific immunotherapy of melanoma with a GM3 ganglioside-based vaccine: a report on safety and immunogenicity. J Immunother 2005; 27:442-51. [PMID: 15534488 DOI: 10.1097/00002371-200411000-00004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A novel cancer vaccine was obtained by combining GM3 ganglioside with Neisseria meningitidis outer membrane protein complex to obtain very-small-size proteoliposomes (GM3/VSSP). The authors report the results of a phase 1 study of intramuscular administration of GM3/VSSP/Montanide ISA 51 to patients with metastatic melanoma. Twenty-six patients were included in three dose-level cohorts of 120, 240, and 360 mug. The first five doses (induction phase) were given at 2-week intervals, and the remaining four doses were given monthly. Patients were evaluated for dose-related toxicities and antitumor effects. In addition, serum and peripheral blood mononuclear cells were obtained at baseline and throughout treatment to evaluate humoral and cellular immune responses. One episode of severe hypotension and fever was observed in a patient included at the highest dose level. Other toxicities consisted of local reactions at the site of injection and mild fever and chills. Five doses of GM3/VSSP induced an anti-GM3 IgM response in 44% of patients. Serum reactivity was also observed against melanoma cell lines and tumor biopsies. GM3/VSSP was shown to induce very strong in vitro IFNgamma secretion in all evaluated melanoma patients. Furthermore, in one patient IFNgamma secretion was shown to be GM3-specific. A 62% reduction of a mediastinal mass was documented in one patient (partial response), while a second patient benefited from initial disease stabilization followed by tumor reduction in nonmeasurable soft tissue lesions accompanied by vitiligo.
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Affiliation(s)
- Marcelo D Guthmann
- Immunogenetics Division, Hospital de Clínicas, University of Buenos Aires, Buenos Aires, Argentina
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25
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Van Kooten M, Traine G, Cinat G, Cazap E, Comba AZ, Vicente H, Sena S, Nievas OR, Orlando M. Single-agent gemcitabine in pretreated patients with non-small-cell lung cancer: results of an Argentinean multicentre phase II trial. Br J Cancer 1999; 81:846-9. [PMID: 10555756 PMCID: PMC2374290 DOI: 10.1038/sj.bjc.6690774] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The activity and mild toxicity profile of single-agent gemcitabine therapy in untreated (chemonaive) patients with non-small-cell lung cancer (NSCLC) is well documented. This phase II trial was conducted to determine the objective tumour response rate and toxicity profile of single-agent gemcitabine in pretreated patients with NSCLC. Patients with histological evidence of advanced NCSLC stage IIIB or IV; at least one prior chemotherapy regimen including a platinum or taxane analogue; an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2; clinically measurable disease; adequate bone marrow reserve; and adequate renal function; received 1000 mg m(-2) gemcitabine administered over 30 min on days 1, 8 and 15 of a 28-day cycle defined as 3 weekly treatments followed by 1 week of rest. Twenty-nine patients were evaluated for efficacy and 32 for toxicity. One patient achieved a complete response and five patients had a partial response resulting in a total response rate of 20.6% (95% confidence interval (CI) 6-34). Median response duration was 7 months (range 4-11 months). Twelve (41%) patients reached stable disease after two cycles of therapy and 11 (38%) patients had disease progression. Median progression-free survival time was 3 months and median overall survival time was 5.5 months. Toxicity was generally mild (grades 0-2). Severe (grade 3 or 4) haematological toxicities included grade 3 anaemia in one patient and grade 3 thrombocytopenia in two patients. Severe non-haematological toxicities included one patient each with grade 3 liver transaminase elevations, nausea/vomiting and diarrhoea. This study confirms the activity and safety of single-agent gemcitabine in pretreated patients with advanced NSCLC who are refractory or sensitive to first-line therapy.
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Affiliation(s)
- M Van Kooten
- Alexander Fleming Institute, Buenos Aires, Argentina
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