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Livingstone E, Gogas H, Kandolf-Sekulovic L, Meier F, Eigentler TK, Ziemer M, Terheyden PAM, Gesierich AH, Herbst RA, Kähler KC, Ziogas DC, Mijuskovic Z, Garzarolli M, Garbe C, Roesch A, Ugurel S, Gutzmer R, Grob JJ, Kiecker F, Utikal J, Windemuth-Kieselbach C, Eckhardt S, Zimmer L, Schadendorf D. Early switch from run-in treatment with vemurafenib plus cobimetinib to atezolizumab after 3 months leads to rapid loss of tumour control in patients with advanced BRAFV600-positive melanoma: The ImmunoCobiVem phase 2 randomised trial. Eur J Cancer 2023; 190:112941. [PMID: 37482012 DOI: 10.1016/j.ejca.2023.112941] [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: 05/08/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 07/25/2023]
Abstract
AIM ImmunoCobiVem investigated whether a planned switch to atezolizumab after achieving tumour control during run-in with vemurafenib + cobimetinib improves progression-free survival (PFS) and overall survival (OS) compared to continuous targeted therapy (TT) in patients with previously untreated advanced BRAFV600-mutated melanoma. METHODS In this multicenter phase 2 study, patients received vemurafenib plus cobimetinib. After 3months, patients without progressive disease (PD) were randomly assigned (1:1) to continue vemurafenib + cobimetinib (Arm A) or switch to atezolizumab (Arm B) until first documented PD (PD1). Primary outcome was PFS1 (time from start of run-in until PD1 or death). OS and safety were also assessed. RESULTS Of 185 patients enroled between November 2016 and December 2019, 135 were randomly assigned after the run-in period (Arm A, n = 69; Arm B, n = 66). Median PFS1 was significantly longer in Arm A versus Arm B (13.9 versus 5.9months; hazard ratio [HR] 0.55; 95% confidence interval [CI], 0.37-0.84; PStratified=0.001). Median OS was not reached in either arm (HR 1.22; 95%CI, 0.69-2.16; PStratified=0.389); 2-year OS was higher in Arm B versus Arm A (67%; 95%CI, 53-78 versus 58%; 95%CI, 45-70). Grade 3/4 AEs occurred in 55% of patients in Arm A and 64% in Arm B; treatment-related AEs led to discontinuation of any drug in 7% and 9% of patients, respectively. CONCLUSION In patients with BRAFV600-mutated advanced melanoma who achieve tumour control with TT, early switch at 3months to atezolizumab led to rapid loss of tumour control but provided a numerical OS benefit at 2years compared with continued TT.
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Affiliation(s)
- E Livingstone
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site Essen, Essen, Germany
| | - H Gogas
- First Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - L Kandolf-Sekulovic
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - F Meier
- Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Skin Cancer Center at the University Cancer Centre and National Center for Tumor Diseases, Dresden, Germany
| | - T K Eigentler
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - M Ziemer
- Department of Dermatology, University of Leipzig Medical Center, Leipzig, Germany
| | | | - A H Gesierich
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | | | - K C Kähler
- Department of Dermatology, Venerology, and Allergology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - D C Ziogas
- First Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Z Mijuskovic
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - M Garzarolli
- Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - C Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - A Roesch
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site Essen, Essen, Germany
| | - S Ugurel
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site Essen, Essen, Germany
| | - R Gutzmer
- Department of Dermatology, Skin Cancer Center Hannover, Hannover Medical School, Hannover, Germany; Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany
| | - J J Grob
- Aix-Marseille University, Timone Hospital (APHM), Marseille, France
| | - F Kiecker
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Dermatology and Venereology, Vivantes Hospital Neukölln, Berlin, Germany
| | - J Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany; DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
| | | | | | - L Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site Essen, Essen, Germany
| | - D Schadendorf
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site Essen, Essen, Germany.
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Kandolf-Sekulovic L, Peris K, Stratigos A, Hauschild A, Forsea AM, Lebbe C, Lallas A, Grob JJ, Harwood C, Gogas H, Rutkowski P, Olah J, Kelleners-Smeets NWJ, Paoli J, Dummer R, Moreno-Ramirez D, Bastholt L, Putnik K, Karls R, Hoeller C, Vandersleyen V, Vieira R, Arenberger P, Bylaite-Buckinskiene M, Ocvirk J, Situm M, Weinlich G, Banjin M, Todorovic V, Ymeri A, Zhukavets A, Garbe C. Which medical disciplines diagnose and treat melanoma in Europe in 2019? A survey of experts from melanoma centres in 27 European countries. J Eur Acad Dermatol Venereol 2020; 35:1119-1132. [PMID: 33326646 DOI: 10.1111/jdv.17086] [Citation(s) in RCA: 4] [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: 04/07/2020] [Accepted: 11/20/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The incidence of melanoma is increasing. This places significant burden on societies to provide efficient cancer care. The European Cancer Organisation recently published the essential requirements for quality melanoma care. The present study is aimed for the first time to roughly estimate the extent to which these requirements have been met in Europe. MATERIALS AND METHODS A web-based survey of experts from melanoma centres in 27 European countries was conducted from 1 February to 1 August 2019. Data on diagnostic techniques, surgical and medical treatment, organization of cancer care and education were collected and correlated with national health and economic indicators and mortality-to-incidence ratio (MIR) as a surrogate for survival. Univariate linear regression analysis was performed to evaluate the correlations. SPSS software was used. Statistical significance was set at P < 0.05. RESULTS The MIR was lower in countries with a high health expenditure per capita and with a higher numbers of general practitioners (GPs) and surgeons (SURG) per million inhabitants. In these countries, GPs and dermatologists (DER) were involved in melanoma detection; high percentage of DER used dermatoscopy and were involved in the follow-up of all melanoma stages; both medical oncologists (ONC) and dermato-oncologists administered systemic treatments; and patients had better access to sentinel lymph node biopsy and were treated within multidisciplinary tumour boards. CONCLUSION Based on these first estimates, the greater involvement of GPs in melanoma detection; the greater involvement of highly trained DER in dermatoscopy, dermatosurgery, follow-up and the systemic treatment of melanoma; and the provision of ongoing dermato-oncology training for pathologists, SURG, DER and ONC are necessary to provide an optimal melanoma care pathway. A comprehensive analysis of the melanoma care pathway based on clinical melanoma registries will be needed to more accurately evaluate these first insights.
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Affiliation(s)
- L Kandolf-Sekulovic
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - K Peris
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - A Stratigos
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - A Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - A-M Forsea
- Elias University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania
| | - C Lebbe
- APHP Dermatology Department, University Paris 7 Diderot, INSERM U976, Paris, France
| | - A Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - J-J Grob
- Service de Dermatologie et Cancérologie Cutanée, Hopital de la Timone, Marseille, France
| | - C Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - H Gogas
- 1st Department of Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - P Rutkowski
- Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
| | - J Olah
- Department of Oncotherapy, Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - N W J Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - J Paoli
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - R Dummer
- UniversitätsSpital Zürich-Skin Cancer Center, University Hospital, Zürich, Switzerland
| | - D Moreno-Ramirez
- Department of Clinical Oncology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - L Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - K Putnik
- North Estonia Medical Centre, Tallinn, Estonia
| | - R Karls
- Derma Clinic Riga, Riga, Latvia
| | - C Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - V Vandersleyen
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - R Vieira
- Department of Dermatology, Medical Faculty, University of Coimbra, Coimbra, Portugal
| | - P Arenberger
- Department of Dermatovenereology, Charles University 3rd Faculty of Medicine and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | | | - J Ocvirk
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - M Situm
- Department of Oncology, University Hospital Zagreb, Zagreb, Croatia
| | - G Weinlich
- Department of Dermatology, Venerology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Banjin
- Department of Oncology, University Hospital Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - V Todorovic
- Clinic for Oncology and radiotherapy, Podgorica, Montenegro
| | - A Ymeri
- University Hospital Mother Theresa, Tirana, Albania
| | - A Zhukavets
- Belarusian Medical Academy of Postgraduate Education (BelMAPE), Minsk, Belarus
| | - C Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
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Garbe C, Peris K, Soura E, Forsea AM, Hauschild A, Arenbergerova M, Bylaite M, Del Marmol V, Bataille V, Samimi M, Gandini S, Saiag P, Eigentler TK, Lallas A, Zalaudek I, Lebbe C, Grob JJ, Hoeller C, Robert C, Dréno B, Arenberger P, Kandolf-Sekulovic L, Kaufmann R, Malvehy J, Puig S, Leiter U, Ribero S, Papadavid E, Quaglino P, Bagot M, John SM, Richard MA, Trakatelli M, Salavastru C, Borradori L, Marinovic B, Enk A, Pincelli C, Ioannides D, Paul C, Stratigos AJ. The evolving field of Dermato-oncology and the role of dermatologists: Position Paper of the EADO, EADV and Task Forces, EDF, IDS, EBDV-UEMS and EORTC Cutaneous Lymphoma Task Force. J Eur Acad Dermatol Venereol 2020; 34:2183-2197. [PMID: 32840022 DOI: 10.1111/jdv.16849] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/13/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The incidence of skin cancers has been increasing steadily over the last decades. Although there have been significant breakthroughs in the management of skin cancers with the introduction of novel diagnostic tools and innovative therapies, skin cancer mortality, morbidity and costs heavily burden the society. OBJECTIVE Members of the European Association of Dermato-Oncology, European Academy of Dermatology and Venereology, International Dermoscopy Society, European Dermatology Forum, European Board of Dermatovenereology of the European Union of Medical Specialists and EORTC Cutaneous Lymphoma Task Force have joined this effort to emphasize the fundamental role that the specialist in Dermatology-Venereology has in the diagnosis and management of different types of skin cancer. We review the role of dermatologists in the prevention, diagnosis, treatment and follow-up of patients with melanoma, non-melanoma skin cancers and cutaneous lymphomas, and discuss approaches to optimize their involvement in effectively addressing the current needs and priorities of dermato-oncology. DISCUSSION Dermatologists play a crucial role in virtually all aspects of skin cancer management including the implementation of primary and secondary prevention, the formation of standardized pathways of care for patients, the establishment of specialized skin cancer treatment centres, the coordination of an efficient multidisciplinary team and the setting up of specific follow-up plans for patients. CONCLUSION Skin cancers represent an important health issue for modern societies. The role of dermatologists is central to improving patient care and outcomes. In view of the emerging diagnostic methods and treatments for early and advanced skin cancer, and considering the increasingly diverse skills, knowledge and expertise needed for managing this heterogeneous group of diseases, dermato-oncology should be considered as a specific subspecialty of Dermatology-Venereology.
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Affiliation(s)
- C Garbe
- Center for Dermato-oncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - K Peris
- Dermatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Soura
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodestrian University of Athens, Athens, Greece
| | - A M Forsea
- Department of Oncologic Dermatology, University Hospital Elias, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - A Hauschild
- Department of Dermatology, University of Kiel, Kiel, Germany
| | - M Arenbergerova
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, University Hospital of Kralovske Vinohrady, Prague, Czech Republic
| | - M Bylaite
- Faculty of Medicine, Centre of Dermatovenereology, Clinic of Infectious Diseases and Dermatovenereology, Vilnius University, Vilnius, Lithuania
| | - V Del Marmol
- Dermatology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - V Bataille
- Dermatology Department, West Herts NHS Trust, London, UK.,Twin Research and Genetic Epidemiology Department, Kings College London, London, UK
| | - M Samimi
- Departments of Dermatology, University Hospital of Tours, Tours, France
| | - S Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - P Saiag
- Department of General and Oncologic Dermatology, Ambroise-Paré Hospital, APHP, & EA 4340, 'Biomarkers in Cancerology and Hemato-Oncology', UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - T K Eigentler
- Departments of Dermatology, University Hospital Tübingen, Tubingen, Germany
| | - A Lallas
- First Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - I Zalaudek
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - C Lebbe
- Department of Dermatology, AP-HP Saint Louis Hospital, Paris, France
| | - J-J Grob
- Timone Hospital, Aix-Marseille University, Marseille, France
| | - C Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - C Robert
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France.,Paris-Saclay University, Le Kremlin Bicêtre, France
| | - B Dréno
- Department of Dermatolo-Cancerology, CHU Nantes, CIC 1413, CRCINA, University Nantes, Nantes, France
| | - P Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, University Hospital of Kralovske Vinohrady, Prague, Czech Republic
| | - L Kandolf-Sekulovic
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, University of Defense, Belgrade, Serbia
| | - R Kaufmann
- Department of Dermatology, Venerology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - J Malvehy
- Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Biomedical Research Networking Centre on rarae disease (CIBERER), ISCIII, Barcelona, Spain
| | - S Puig
- Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Biomedical Research Networking Centre on rarae disease (CIBERER), ISCIII, Barcelona, Spain
| | - U Leiter
- Center for Dermato-oncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - S Ribero
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - E Papadavid
- 2nd Department of Dermatology-Venereology, ATTIKON Hospital, National and Kapodistrian Univeristy of Athens, Athens, Greece
| | - P Quaglino
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - M Bagot
- Department of Dermatology, AP-HP Saint Louis Hospital, Paris, France
| | - S M John
- Department Dermatology, Environmental Medicine, Health Theory, University of Osnabrueck, Osnabrueck, Germany
| | - M-A Richard
- Timone Hospital, Aix-Marseille University, Marseille, France
| | - M Trakatelli
- 2nd Department of Dermatology-Venerology, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - C Salavastru
- Pediatric Dermatology Discipline, Dermato-oncology Research Facility, Colentina Clinical Hospital, Bucharest, Romania
| | - L Borradori
- Department of Dermatology, University Hospital of Bern, Inselspital, Bern, Switzerland
| | - B Marinovic
- Department of Dermatology and Venereology, University Hospital Center Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
| | - A Enk
- Department of Dermatology, University Hospital of Heidelberg, Heidelberg, Germany
| | - C Pincelli
- DermoLab, Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - D Ioannides
- First Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - C Paul
- Department of Dermatology, Toulouse University, Toulouse, France
| | - A J Stratigos
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodestrian University of Athens, Athens, Greece
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Pasic S, Kandolf-Sekulovic L, Djuricic S, Zolotarevski L, Simic R, Abinun M. Necrobiotic cutaneous granulomas in Nijmegen breakage syndrome. J Investig Allergol Clin Immunol 2012; 22:138-140. [PMID: 22533239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Affiliation(s)
- S Pasic
- Department of Pediatric Immunology, Mother & Child Health Institute, Medical School, University of Belgrade, Serbia.
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Kandolf-Sekulovic L, Pavlovic MD, Glisic B, Petronijevic M, Ristic G, Mijuskovic Z, Zecevic RD, Stefanovic D. Adamantiades-Behçet's disease, deep venous thrombosis and anticardiolipin antibodies: report of two cases. J Eur Acad Dermatol Venereol 2005; 19:484-6. [PMID: 15987300 DOI: 10.1111/j.1468-3083.2005.01193.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 11/26/2022]
Abstract
Vascular thrombosis was found in different proportions of patients with Adamantiades-Behçet's disease (ABD), depending on the ethnicity of the population under study. Various thrombophilic factors, including the levels of anticardiolipin antibodies (ACA), were investigated for their role in the thrombotic process with conflicting results. The prevalence of ACA varies considerably in different studies, but their presence has not been associated with increased risk for vascular thrombosis. We present two cases with ABD, deep venous thrombosis (DVT) and elevated levels of ACA that fulfil the criteria for both ABD and antiphospholipid syndrome (APS).
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Affiliation(s)
- L Kandolf-Sekulovic
- Department of Dermatology, Military Medical Academy, 17 Crnotravska, 11002 Belgrade, Serbia and Montenegro.
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