1
|
Wyss N, Berner F, Walter V, Jochum AK, Purde MT, Abdou MT, Sinnberg T, Hofmeister K, Pop OT, Hasan Ali O, Bauer J, Cheng HW, Lütge M, Klümper N, Diem S, Kosaloglu-Yalcin Z, Zhang Y, Sellmer L, Macek B, Karbach J, König D, Läubli H, Zender L, Meyer BS, Driessen C, Schürch CM, Jochum W, Amaral T, Heinzerling L, Cozzio A, Hegazy AN, Schneider T, Brutsche MH, Sette A, Lenz TL, Walz J, Rammensee HG, Früh M, Jäger E, Becher B, Tufman A, Nuñez N, Joerger M, Flatz L. Autoimmunity Against Surfactant Protein B Is Associated with Pneumonitis During Checkpoint Blockade. Am J Respir Crit Care Med 2024. [PMID: 38626354 DOI: 10.1164/rccm.202311-2136oc] [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: 11/21/2023] [Accepted: 04/16/2024] [Indexed: 04/18/2024] Open
Abstract
RATIONALE Immune checkpoint inhibitor-related pneumonitis is a serious autoimmune event affecting up to 20% of patients with non-small cell lung cancer, yet the factors underpinning its development in some patients and not others are poorly understood. OBJECTIVES To investigate the role of autoantibodies and autoreactive T cells against surfactant-related proteins in the development of pneumonitis. METHODS The study cohort consisted of non-small cell lung cancer patients who gave blood samples before and during immune checkpoint inhibitor treatment. Serum was used for proteomics analyses and to detect autoantibodies present during pneumonitis. T cell stimulation assays and single-cell RNA sequencing were performed to investigate the specificity and functionality of peripheral autoreactive T cells. The findings were confirmed in a validation cohort comprising patients with non-small cell lung cancer and patients with melanoma. MEASUREMENTS AND MAIN RESULTS Across both cohorts, patients who developed pneumonitis had higher pre-treatment levels of immunoglobulin G autoantibodies targeting surfactant protein-B. At the onset of pneumonitis, these patients also exhibited higher frequencies of CD4+ interferon-gamma-positive surfactant protein B-specific T cells, and expanding T cell clonotypes recognizing this protein, accompanied by a pro-inflammatory serum proteomic profile. CONCLUSIONS Our data suggest that the co-occurrence of surfactant protein-B-specific immunoglobulin G autoantibodies and CD4+ T cells is associated with the development of pneumonitis during ICI therapy. Pre-treatment levels of these antibodies may represent a potential biomarker for elevated risk of developing pneumonitis and on-treatment levels may provide a diagnostic aid.
Collapse
Affiliation(s)
- Nina Wyss
- Institute of Immunobiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Fiamma Berner
- Kantonsspital St Gallen, 30883, Sankt Gallen, SG, Switzerland
| | - Vincent Walter
- University of Tübingen, 9188, Tubingen, Baden-Württemberg, Germany
| | | | - Mette T Purde
- Kantonsspital St Gallen, 30883, Sankt Gallen, SG, Switzerland
| | | | - Tobias Sinnberg
- University Hospital Tübingen, Dermatology, Tübingen, Germany
| | - Kathrin Hofmeister
- University of Tübingen, 9188, Dermatology, Tubingen, Baden-Württemberg, Germany
| | - Oltin T Pop
- Cantonal Hospital St. Gallen, Immunobiology, St. Gallen, Switzerland
| | - Omar Hasan Ali
- Kantonsspital St Gallen, 30883, Sankt Gallen, SG, Switzerland
| | - Jens Bauer
- University Hospital Tübingen, 27203, Tubingen, Germany
| | - Hung-Wei Cheng
- Kantonsspital St Gallen, 30883, Sankt Gallen, SG, Switzerland
| | - Mechthild Lütge
- Kantonsspital St Gallen, 30883, Sankt Gallen, SG, Switzerland
| | - Niklas Klümper
- University Hospital Bonn, 39062, Bonn, Nordrhein-Westfalen, Germany
| | - Stefan Diem
- Kantonsspital St Gallen, 30883, Sankt Gallen, SG, Switzerland
| | | | - Yizheng Zhang
- University of Tübingen, 9188, Tubingen, Baden-Württemberg, Germany
| | | | - Boris Macek
- University of Tübingen, 9188, Proteome Center, Tubingen, Baden-Württemberg, Germany
| | - Julia Karbach
- Krankenhaus Nordwest, 9152, Frankfurt, Hessen, Germany
| | - David König
- University Hospital Basel, 30262, Basel, BS, Switzerland
| | - Heinz Läubli
- University Hospital Basel, 30262, Basel, BS, Switzerland
| | - Lars Zender
- University of Tübingen, 9188, Tubingen, Baden-Württemberg, Germany
| | | | | | - Christian M Schürch
- University Hospital Tübingen Institute of Pathology and Neuropathology, 155911, Institute of Pathology, Tubingen, Baden-Württemberg, Germany
| | - Wolfram Jochum
- Cantonal Hospital St. Gallen, Pathology, St. Gallen, United States
| | - Teresa Amaral
- University Hospital Tübingen, 27203, Tubingen, Germany
| | | | - Antonio Cozzio
- Kantonsspital St Gallen, 30883, Sankt Gallen, SG, Switzerland
| | - Ahmed N Hegazy
- Charite University Hospital Berlin, 14903, Berlin, Germany
| | - Tino Schneider
- Cantonal Hospital St. Gallen, Division of Pneumology, St. Gallen, Switzerland
| | - Martin H Brutsche
- Cantonal Hospital St.Gallen, Division of Pulmonary Medicine, St.Gallen, Switzerland
| | - Alessandro Sette
- La Jolla Institute for Immunology, 7113, La Jolla, California, United States
| | | | - Juliane Walz
- University of Tübingen, 9188, Tubingen, Baden-Württemberg, Germany
| | | | - Martin Früh
- Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Elke Jäger
- Krankenhaus Nordwest, 9152, Frankfurt, Hessen, Germany
| | | | | | - Nicolas Nuñez
- National University of Cordoba, 28217, Cordoba, Argentina
| | - Markus Joerger
- Kantonsspital St Gallen, 30883, Sankt Gallen, SG, Switzerland
| | - Lukas Flatz
- Universitätsklinikum Tübingen, 27203, Hautklinik, Tubingen, Germany;
| |
Collapse
|
2
|
Amaral T, Nanz L, Stadler R, Berking C, Ulmer A, Forschner A, Meiwes A, Wolfsperger F, Meraz-Torres F, Chatziioannou E, Martus P, Flatz L, Garbe C, Leiter U. Isolated melanoma cells in sentinel lymph node in stage IIIA melanoma correlate with a favorable prognosis similar to stage IB. Eur J Cancer 2024; 201:113912. [PMID: 38368742 DOI: 10.1016/j.ejca.2024.113912] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND The American Joint Committee on Cancer 8th edition (AJCC v8) defines sentinel lymph nodes (SLN) containing any tumor cells as positive SLN. Consequently, even thin melanomas with isolated tumor cells (ic) in SLN are classified as stage IIIA, making them candidates for adjuvant therapy. OBJECTIVES AND ENDPOINTS We aimed to evaluate survival outcomes of melanoma stage IIIA (ic) and compare them with stage IIIA with lymph node (LN) metastases > 0.1 mm. Primary endpoints were relapse-free survival (RFS) and distant metastases-free survival (DMFS). Secondary endpoint was melanoma specific survival (MSS). RESULTS The discovery cohort from the Department of Dermatology, University Hospital Tuebingen, included 237 patients; confirmation cohort included 143 patients from the DeCOG trial. The Tuebingen cohort included 95 patients with stage IIIA (ic) and 142 patients with stage IIIA. The DeCOG trial included 39 patients with stage IIIA (ic) and 104 patients with stage IIIA. In the Tuebingen cohort, 10-year RFS rates for stage IIIA (ic) and IIIA were 84% (95% CI 75-94) and 49% (95% CI 39-59), respectively (p < 0.001). 10-year DMFS rates for stage IIIA (ic) and IIIA were 89% (95% CI 81-97) and 56% (95% CI 45-67), respectively; (p < 0.001). In the DeCOG cohort, 10-year RFS for stage IIIA (ic) and stage IIIA were 88% (95% CI 78-99) and 35% (95% CI 7-62), respectively; (p = 0.009). 10-year DMFS for stage IIIA (ic) and IIIA was 88% (95% CI 77-99) and 60% (95% CI 39-80), respectively (p = 0.061). CONCLUSION Stage IIIA (ic) melanoma exhibits a prognosis similar to stage IB. Recommendation of adjuvant therapy in Stage IIIA (ic) warrants thorough discussion.
Collapse
Affiliation(s)
- Teresa Amaral
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany; Cluster of Excellence iFIT (EXC 2180), Tübingen, Germany.
| | - Lena Nanz
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Rudolf Stadler
- University Medical Center Minden, Minden Germany of Dermatology Johannes Wesling University Medical Center, Minden, Germany
| | - Carola Berking
- Department of Dermatology, Uniklinikum Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nürnberg, Erlangen, Germany
| | - Anja Ulmer
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Andrea Forschner
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Andreas Meiwes
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Frederik Wolfsperger
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Francisco Meraz-Torres
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Eftychia Chatziioannou
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Lukas Flatz
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany; Postdoctoral Fellow, Institute for Immunobiology, Kantonsspital St Gallen, St Gallen, Switzerland; Department of Dermatology and Allergology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Claus Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Ulrike Leiter
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| |
Collapse
|
3
|
Wagner NB, Knierim SM, Luttermann F, Metzler G, Yazdi AS, Bauer J, Gassenmaier M, Forschner A, Leiter U, Amaral T, Garbe C, Eigentler TK, Forchhammer S, Flatz L. Histopathologic regression in patients with primary cutaneous melanoma undergoing sentinel lymph node biopsy is associated with favorable survival and, after metastasis, with improved progression-free survival on immune checkpoint inhibitor therapy: A single-institutional cohort study. J Am Acad Dermatol 2024; 90:739-748. [PMID: 38043594 DOI: 10.1016/j.jaad.2023.11.040] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/01/2023] [Accepted: 11/12/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Histopathologic regression of cutaneous melanoma is considered a favorable prognostic factor, but its significance in clinical practice remains controversial. OBJECTIVE To investigate the prognostic importance of regression in patients with primary cutaneous melanoma undergoing sentinel lymph node (SLN) biopsy and to assess its significance in patients progressing to an unresectable stage requiring systemic therapy. METHODS We retrospectively reviewed patients with newly diagnosed melanoma undergoing SLN biopsy between 2010 and 2015 and available information on histopathologic regression (n = 1179). Survival data and associations of clinical variables with SLN status were assessed. RESULTS Patients with regressive melanoma showed favorable relapse-free (hazard ratio [HR], 0.52; P = .00013), distant metastasis-free (HR, 0.56; P = .0020), and melanoma-specific survival (HR, 0.35; P = .00053). Regression was associated with negative SLN (odds ratio, 0.48; P = .0077). In patients who progressed to an unresectable stage, regression was associated with favorable progression-free survival under immune checkpoint inhibition (HR, 0.43; P = .031) but not under targeted therapy (HR, 1.14; P = .73) or chemotherapy (HR, 3.65; P = .0095). LIMITATIONS Retrospective, single-institutional design. CONCLUSIONS Regression of cutaneous melanoma is associated with improved prognosis in patients eligible for SLN biopsy as well as in patients with unresectable disease receiving systemic therapy with immune checkpoint inhibitors.
Collapse
Affiliation(s)
- Nikolaus B Wagner
- Department of Dermatology, Venereology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany.
| | - Sarah M Knierim
- Department of Dermatology, Venereology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Felix Luttermann
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Gisela Metzler
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany; Center for Dermatohistopathology and Oral Pathology, Tuebingen/Wuerzburg, Tuebingen, Germany
| | - Amir S Yazdi
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany; Department of Dermatology and Allergology, RWTH University Hospital Aachen, Aachen, Germany
| | - Jürgen Bauer
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Maximilian Gassenmaier
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany; MVZ Dermatopathology, Friedrichshafen/Bodensee PartG, Friedrichshafen, Germany
| | - Andrea Forschner
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Ulrike Leiter
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Teresa Amaral
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Claus Garbe
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Thomas K Eigentler
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany; Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stephan Forchhammer
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Lukas Flatz
- Department of Dermatology, Venereology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| |
Collapse
|
4
|
Ruf T, Kramer R, Forschner A, Leiter U, Meier F, Reinhardt L, Dücker P, Ertl C, Tomsitz D, Tietze JK, Gutzmer R, Dabrowski E, Zimmer L, Gesierich A, Zierold S, French LE, Eigentler T, Amaral T, Heinzerling L. Second-line therapies for steroid-refractory immune-related adverse events in patients treated with immune checkpoint inhibitors. Eur J Cancer 2024; 203:114028. [PMID: 38652976 DOI: 10.1016/j.ejca.2024.114028] [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: 01/10/2024] [Revised: 03/03/2024] [Accepted: 03/12/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) induce adverse events (irAEs) that do not respond to steroids, i.e. steroid-refractory (sr) irAEs, and irAEs in which steroids cannot be tapered, i.e. steroid-dependent (sd) irAEs, in about 10% of cases. An evidence-based analysis of the effectiveness of second-line immunosuppressive agents with regard to irAE and tumor control is lacking. METHODS The international web-based Side Effect Registry Immuno-Oncology (SERIO; http://serio-registry.org) is a collaborative initiative with the Paul-Ehrlich-Institute to document rare, severe, complex or therapy-refractory immunotherapy-induced side effects. The registry was queried on August 1, 2023 for cases of irAEs which were treated with second-line therapies. RESULTS From a total of 1330 cases, 217 patients (16.3%) received 249 second-line therapies. A total of 19 different second-line therapies were employed, including TNF-alpha antagonists (46.5%), intravenous immunoglobulins (IVIG; 19.1%), mycophenolate mofetil (15.9%), and methotrexate (3.6%). Therapy choices were determined by the type of irAE. The time to onset of sr-/sd-irAEs after ICI initiation did not consistently differ from steroid-responsive irAEs. While 74.3% of sr-/sd-irAEs resolved and 13.1% had improved, 4.3% persisted, 3.9% resulted in permanent sequelae, and 4.3% in death with ongoing symptoms. Infliximab exhibited potential for earlier symptom improvement compared to mycophenolate mofetil or IVIG. Tumor response in patients with second-line treated sd-/sr-irAE was similar to patients with irAEs treated with steroids only. CONCLUSION Several second-line therapies are effective against sr-/sd-irAEs, the second-line therapies show no clear negative impact on tumor response, and infliximab shows potential for faster improvement of symptoms. However, prospective comparative data are needed.
Collapse
Affiliation(s)
- Theresa Ruf
- Department of Dermatology and Allergology, University Hospital, LMU Munich, Munich, Germany; SERIO registry
| | - Rafaela Kramer
- Department of Dermatology, University Clinic Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; SERIO registry
| | - Andrea Forschner
- Department of Dermatology, Eberhard-Karls-University of Tübingen, Tübingen, Germany
| | - Ulrike Leiter
- Department of Dermatology, Eberhard-Karls-University of Tübingen, Tübingen, Germany
| | - Friedegund Meier
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Germany
| | - Lydia Reinhardt
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Germany
| | - Pia Dücker
- Department of Dermatology, Hospital Dortmund, Dortmund, Germany
| | - Carolin Ertl
- Department of Dermatology and Allergology, University Hospital, LMU Munich, Munich, Germany; SERIO registry
| | - Dirk Tomsitz
- Department of Dermatology and Allergology, University Hospital, LMU Munich, Munich, Germany
| | - Julia K Tietze
- Clinic for Dermatology and Venerology, University Medical Center Rostock, Rostock, Germany
| | - Ralf Gutzmer
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr-University Bochum, Minden, Germany
| | | | - Lisa Zimmer
- Department of Dermatology, Essen University Hospital, West German Cancer Center, University of Duisburg-Essen and the German Cancer Consortium (DKTK), Partner site Essen/Düsseldorf, Germany
| | - Anja Gesierich
- Department of Dermatology, University Hospital Würzburg, Germany
| | - Sarah Zierold
- Department of Dermatology and Allergology, University Hospital, LMU Munich, Munich, Germany; SERIO registry
| | - Lars E French
- Department of Dermatology and Allergology, University Hospital, LMU Munich, Munich, Germany; Dr. Philip Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Thomas Eigentler
- Department of Dermatology, Charité University Medicine Berlin, Berlin, Germany
| | - Teresa Amaral
- Department of Dermatology, Eberhard-Karls-University of Tübingen, Tübingen, Germany; Cluster of Excellence iFIT (EXC 2180), Tübingen, Germany
| | - Lucie Heinzerling
- Department of Dermatology and Allergology, University Hospital, LMU Munich, Munich, Germany; Department of Dermatology, University Clinic Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; SERIO registry.
| |
Collapse
|
5
|
Fortuna A, Amaral T. Multidisciplinary approach and treatment of acral and mucosal melanoma. Front Oncol 2024; 14:1340408. [PMID: 38469235 PMCID: PMC10926023 DOI: 10.3389/fonc.2024.1340408] [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: 11/17/2023] [Accepted: 01/29/2024] [Indexed: 03/13/2024] Open
Abstract
Acral and mucosal melanoma are uncommon variants of melanoma. Acral melanoma has an age-adjusted incidence of approximately 1.8 cases per million individuals per year, accounting for about 2% to 3% of all melanoma cases. On the other hand, mucosal melanoma, with an incidence of 2.2 cases per million per year, makes up around 1.3% of all melanoma cases. These melanomas, in addition to being biologically and clinically distinct from cutaneous melanoma, share certain clinical and pathologic characteristics. These include a more aggressive nature and a less favorable prognosis. Furthermore, they exhibit a different mutational pattern, with KIT mutations being more prevalent in acral and mucosal melanomas. This divergence in mutational patterns may partially account for the relatively poorer prognosis, particularly to immune checkpoint inhibitors. This review explores various aspects of acral and mucosal melanoma, including their clinical presentation, pathologic features, mutational profiles, current therapeutic approaches, outcomes associated with systemic therapy, and potential strategies to address resistance to existing treatments.
Collapse
Affiliation(s)
- Ana Fortuna
- Oncology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Teresa Amaral
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
- Cluster of Excellence Image-Guided and Functionally Instructed Tumor Therapies (iFIT) (EXC 2180), Tübingen, Germany
| |
Collapse
|
6
|
Meraz-Torres F, Niessner H, Plöger S, Riel S, Schörg B, Casadei N, Kneilling M, Schaller M, Flatz L, Macek B, Eigentler T, Rieß O, Garbe C, Amaral T, Sinnberg T. Augmenting MEK inhibitor efficacy in BRAF wild-type melanoma: synergistic effects of disulfiram combination therapy. J Exp Clin Cancer Res 2024; 43:30. [PMID: 38263136 PMCID: PMC10804659 DOI: 10.1186/s13046-023-02941-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/26/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND MEK inhibitors (MEKi) were shown to be clinically insufficiently effective in patients suffering from BRAF wild-type (BRAF WT) melanoma, even if the MAPK pathway was constitutively activated due to mutations in NRAS or NF-1. Thus, novel combinations are needed to increase the efficacy and duration of response to MEKi in BRAF WT melanoma. Disulfiram and its metabolite diethyldithiocarbamate are known to have antitumor effects related to cellular stress, and induction of endoplasmic reticulum (ER) stress was found to synergize with MEK inhibitors in NRAS-mutated melanoma cells. Therefore, we investigated the combination of both therapeutics to test their effects on BRAF-WT melanoma cells and compared them with monotherapy using the MEKi trametinib. METHODS The effects of combined therapy with disulfiram or its metabolite diethyldithiocarbamate and the MEKi trametinib were evaluated in a series of BRAF-WT melanoma cell lines by measuring cell viability and apoptosis induction. Cytotoxicity was additionally assessed in 3D spheroids, ex vivo melanoma slice cultures, and in vivo xenograft mouse models. The response of melanoma cells to treatment was studied at the RNA and protein levels to decipher the mode of action. Intracellular and intratumoral copper measurements were performed to investigate the role of copper ions in the antitumor cytotoxicity of disulfiram and its combination with the MEKi. RESULTS Diethyldithiocarbamate enhanced trametinib-induced cytotoxicity and apoptosis induction in 2D and 3D melanoma culture models. Mechanistically, copper-dependent induction of oxidative stress and ER stress led to Janus kinase (JNK)-mediated apoptosis in melanoma cells. This mechanism was also detectable in patient-derived xenograft melanoma models and resulted in a significantly improved therapeutic effect compared to monotherapy with the MEKi trametinib. CONCLUSIONS Disulfiram and its metabolite represent an attractive pharmaceutical approach to induce ER stress in melanoma cells that potentiates the antitumor effect of MEK inhibition and may be an interesting candidate for combination therapy of BRAF WT melanoma.
Collapse
Affiliation(s)
| | - Heike Niessner
- Department of Dermatology, Tübingen University Hospital, Tübingen, Germany
- Cluster of Excellence iFIT (EXC 2180) Image Guided and Functionally Instructed Tumor Therapies, University Hospital Tübingen, Tübingen, 72076, Germany
| | - Sarah Plöger
- Department of Dermatology, Tübingen University Hospital, Tübingen, Germany
| | - Simon Riel
- Department of Dermatology, Tübingen University Hospital, Tübingen, Germany
| | - Barbara Schörg
- Department of Preclinical Imaging and Radiopharmacy, Laboratory for Preclinical Imaging and Imaging Technology of the Werner Siemens-Foundation, University of Tübingen, Tübingen, 72076, Germany
| | - Nicolas Casadei
- NGS Competence Center Tübingen, Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Manfred Kneilling
- Department of Dermatology, Tübingen University Hospital, Tübingen, Germany
- Cluster of Excellence iFIT (EXC 2180) Image Guided and Functionally Instructed Tumor Therapies, University Hospital Tübingen, Tübingen, 72076, Germany
- Department of Preclinical Imaging and Radiopharmacy, Laboratory for Preclinical Imaging and Imaging Technology of the Werner Siemens-Foundation, University of Tübingen, Tübingen, 72076, Germany
| | - Martin Schaller
- Department of Dermatology, Tübingen University Hospital, Tübingen, Germany
| | - Lukas Flatz
- Department of Dermatology, Tübingen University Hospital, Tübingen, Germany
| | - Boris Macek
- Proteome Center Tübingen, University of Tübingen, Tübingen, Germany
| | - Thomas Eigentler
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Olaf Rieß
- NGS Competence Center Tübingen, Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Claus Garbe
- Department of Dermatology, Tübingen University Hospital, Tübingen, Germany
| | - Teresa Amaral
- Department of Dermatology, Tübingen University Hospital, Tübingen, Germany
- Cluster of Excellence iFIT (EXC 2180) Image Guided and Functionally Instructed Tumor Therapies, University Hospital Tübingen, Tübingen, 72076, Germany
| | - Tobias Sinnberg
- Department of Dermatology, Tübingen University Hospital, Tübingen, Germany.
- Cluster of Excellence iFIT (EXC 2180) Image Guided and Functionally Instructed Tumor Therapies, University Hospital Tübingen, Tübingen, 72076, Germany.
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany.
| |
Collapse
|
7
|
Reitmajer M, Leiter U, Nanz L, Amaral T, Flatz L, Garbe C, Forschner A. Long-term survival of stage IV melanoma patients: evaluation on 640 melanoma patients entering stage IV between 2014 and 2017. J Cancer Res Clin Oncol 2024; 150:15. [PMID: 38238578 PMCID: PMC10796594 DOI: 10.1007/s00432-023-05533-0] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/14/2023] [Indexed: 01/22/2024]
Abstract
PURPOSE Since the introduction of immune checkpoint inhibitors (ICI) and targeted therapies (TT), survival rates of metastatic melanoma patients have increased significantly and complete remissions are no longer rarities. Consequently, there is an increasing number of long-term survivors who have not yet been comprehensively characterized. METHODS We included melanoma patients who entered stage IV between 2014 and 2017 and survived at least 5 years after entering stage IV. Descriptive statistics were performed to characterize the applied systemic therapies, response rates and to report which of these patients are still alive today. RESULTS 640 patients entered stage IV at the University Hospital Tuebingen. Of these, 207 patients (32%) were still alive at least 5 years after entering stage IV. Details of applied therapies and response rates were available in 176 patients (85%). About 90% of patients (n = 159) were still alive at the time of analysis. Median survival since first stage IV diagnosis was 6.0 years (range 5-9 years). An impressive majority of patients (n = 146, 83%) were no longer receiving systemic therapy at the time of evaluation. Complete remission under first line systemic therapy was seen in 36% of the patients. CONCLUSION This dataset comprises the largest available cohort of long-term surviving stage IV melanoma patients. Since 90% of patients in our cohort are still alive today, we expect an increasing number of long-term survivors in the future. Our data indicate the need for specific follow-up programs addressing the needs of long-term survivors.
Collapse
Affiliation(s)
- Markus Reitmajer
- Department of Dermatology, University Hospital Tuebingen, Liebermeisterstraße 25, 72076, Tuebingen, Germany.
| | - Ulrike Leiter
- Department of Dermatology, University Hospital Tuebingen, Liebermeisterstraße 25, 72076, Tuebingen, Germany
| | - Lena Nanz
- Department of Dermatology, University Hospital Tuebingen, Liebermeisterstraße 25, 72076, Tuebingen, Germany
| | - Teresa Amaral
- Department of Dermatology, University Hospital Tuebingen, Liebermeisterstraße 25, 72076, Tuebingen, Germany
| | - Lukas Flatz
- Department of Dermatology, University Hospital Tuebingen, Liebermeisterstraße 25, 72076, Tuebingen, Germany
| | - Claus Garbe
- Department of Dermatology, University Hospital Tuebingen, Liebermeisterstraße 25, 72076, Tuebingen, Germany
| | - Andrea Forschner
- Department of Dermatology, University Hospital Tuebingen, Liebermeisterstraße 25, 72076, Tuebingen, Germany
| |
Collapse
|
8
|
Peisen F, Gerken A, Dahm I, Nikolaou K, Eigentler T, Amaral T, Moltz JH, Othman AE, Gatidis S. Pre-treatment 18F-FDG-PET/CT parameters as biomarkers for progression free survival, best overall response and overall survival in metastatic melanoma patients undergoing first-line immunotherapy. PLoS One 2024; 19:e0296253. [PMID: 38180971 PMCID: PMC10769042 DOI: 10.1371/journal.pone.0296253] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/08/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Checkpoint inhibitors have drastically improved the therapy of patients with advanced melanoma. 18F-FDG-PET/CT parameters might act as biomarkers for response and survival and thus can identify patients that do not benefit from immunotherapy. However, little literature exists on the association of baseline 18F-FDG-PET/CT parameters with progression free survival (PFS), best overall response (BOR), and overall survival (OS). MATERIALS AND METHODS Using a whole tumor volume segmentation approach, we investigated in a retrospective registry study (n = 50) whether pre-treatment 18F-FDG-PET/CT parameters of three subgroups (tumor burden, tumor glucose uptake and non-tumoral hematopoietic tissue metabolism), can act as biomarkers for the primary endpoints PFS and BOR as well as for the secondary endpoint OS. RESULTS Compared to the sole use of clinical parameters, baseline 18F-FDG-PET/CT parameters did not significantly improve a Cox proportional-hazard model for PFS (C-index/AIC: 0.70/225.17 and 0.68/223.54, respectively; p = 0.14). A binomial logistic regression analysis for BOR was not statistically significant (χ2(15) = 16.44, p = 0.35), with a low amount of explained variance (Nagelkerke's R2 = 0.38). Mean FDG uptake of the spleen contributed significantly to a Cox proportional-hazard model for OS (HR 3.55, p = 0.04). CONCLUSIONS The present study could not confirm the capability of the pre-treatment 18F-FDG-PET/CT parameters tumor burden, tumor glucose uptake and non-tumoral hematopoietic tissue metabolism to act as biomarkers for PFS and BOR in metastatic melanoma patients receiving first-line immunotherapy. The documented potential of 18F-FDG uptake by immune-mediating tissues such as the spleen to act as a biomarker for OS has been reproduced.
Collapse
Affiliation(s)
- Felix Peisen
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen University Hospital, Tuebingen, Germany
| | | | - Isabel Dahm
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen University Hospital, Tuebingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen University Hospital, Tuebingen, Germany
- Image-guided and Functionally Instructed Tumor Therapies (iFIT), The Cluster of Excellence (EXC 2180), Tuebingen, Germany
| | - Thomas Eigentler
- Center of Dermato-Oncology, Department of Dermatology, Eberhard Karls University, Tuebingen University Hospital, Tuebingen, Germany
- Department of Dermatology, Venereology and Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humbolt-Universität zu Berlin, Berlin, Germany
| | - Teresa Amaral
- Center of Dermato-Oncology, Department of Dermatology, Eberhard Karls University, Tuebingen University Hospital, Tuebingen, Germany
| | | | - Ahmed E. Othman
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen University Hospital, Tuebingen, Germany
- Institute of Neuroradiology, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - Sergios Gatidis
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen University Hospital, Tuebingen, Germany
- Max Planck Institute for Intelligent Systems, Tuebingen, Germany
| |
Collapse
|
9
|
Wagner NB, Lenders MM, Kühl K, Reinhardt L, Fuchß M, Ring N, Stäger R, Zellweger C, Ebel C, Kimeswenger S, Oellinger A, Amaral T, Forschner A, Leiter U, Klumpp B, Hoetzenecker W, Terheyden P, Mangana J, Loquai C, Cozzio A, Garbe C, Meier F, Eigentler TK, Flatz L. Baseline metastatic growth rate is an independent prognostic marker in patients with advanced BRAF V600 mutated melanoma receiving targeted therapy. Eur J Cancer 2024; 196:113425. [PMID: 38039778 DOI: 10.1016/j.ejca.2023.113425] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/17/2023] [Accepted: 10/27/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Targeted therapy (TT) of BRAF V600 mutated unresectable melanoma with inhibitors of the MAPK pathway achieves response rates of up to 76%, but most patients develop secondary resistance. Albeit TT is strikingly efficacious during the first days of treatment, even in advanced cases, long-term survival is highly unlikely, especially in patients with unfavorable baseline characteristics like elevated lactate dehydrogenase (LDH). In patients treated with anti-PD-1 immune checkpoint inhibitors, elevated baseline metastatic growth rate (MGR) was the most important prognostic factor. Here, we aimed at investigating the prognostic impact of MGR in patients with unresectable melanoma receiving TT. METHODS Clinical records of 242 patients with at least one measurable target lesion (TL) receiving TT at seven skin cancer centers were reviewed. Baseline MGR was determined measuring the largest TL at baseline and at one earlier timepoint. RESULTS Overall survival (OS) and progression-free survival (PFS) were significantly impaired in patients with an MGR > 3.9 mm/month (median OS: 11.4 vs. 35.5 months, P < 0.0001; median PFS: 4.8 vs. 9.2 months, P < 0.0001). Multivariable analysis of OS and PFS revealed that the prognostic impact of elevated MGR was independent of LDH, presence of brain and liver metastases, tumor burden, and line of treatment. The prognostic significance of elevated MGR was highest in patients with normal LDH. CONCLUSIONS Baseline MGR is an important independent prognostic marker for OS and PFS in melanoma patients treated with TT. Its implementation in clinical routine is easy and could facilitate the prognostic stratification.
Collapse
Affiliation(s)
- Nikolaus B Wagner
- Department of Dermatology, Venereology and Allergology, Kantonsspital St. Gallen, Switzerland; Department of Dermatology, University Hospital Tuebingen, Germany.
| | - Max M Lenders
- Department of Dermatology, University Hospital Tuebingen, Germany
| | - Kathrin Kühl
- Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Dresden, Germany
| | - Lydia Reinhardt
- Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Dresden, Germany
| | - Milena Fuchß
- Department of Dermatology, University Medical Center Mainz, Germany
| | - Natalie Ring
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Germany
| | - Ramon Stäger
- Department of Dermatology, University Hospital of Zurich, Switzerland
| | - Caroline Zellweger
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Switzerland
| | - Chiara Ebel
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Germany
| | - Susanne Kimeswenger
- Department of Dermatology, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Angela Oellinger
- Department of Dermatology, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Teresa Amaral
- Department of Dermatology, University Hospital Tuebingen, Germany
| | - Andrea Forschner
- Department of Dermatology, University Hospital Tuebingen, Germany
| | - Ulrike Leiter
- Department of Dermatology, University Hospital Tuebingen, Germany
| | - Bernhard Klumpp
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Germany; Institute for Radiology, Rems-Murr-Kliniken, Winnenden, Germany
| | - Wolfram Hoetzenecker
- Department of Dermatology, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Patrick Terheyden
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Germany
| | - Joanna Mangana
- Department of Dermatology, University Hospital of Zurich, Switzerland
| | - Carmen Loquai
- Department of Dermatology, University Medical Center Mainz, Germany
| | - Antonio Cozzio
- Department of Dermatology, Venereology and Allergology, Kantonsspital St. Gallen, Switzerland
| | - Claus Garbe
- Department of Dermatology, University Hospital Tuebingen, Germany
| | - Friedegund Meier
- Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Dresden, Germany
| | - Thomas K Eigentler
- Department of Dermatology, University Hospital Tuebingen, Germany; Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Lukas Flatz
- Department of Dermatology, Venereology and Allergology, Kantonsspital St. Gallen, Switzerland; Department of Dermatology, University Hospital Tuebingen, Germany
| |
Collapse
|
10
|
Lim KHJ, Westphalen CB, Mateo J, Lambertini M, Amaral T. Response to the letter entitled 'On finding acceptance'. ESMO Open 2023; 8:102059. [PMID: 37925847 PMCID: PMC10660007 DOI: 10.1016/j.esmoop.2023.102059] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023] Open
Affiliation(s)
- K H J Lim
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester; Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK.
| | - C B Westphalen
- Department of Internal Medicine III, University Hospital LMU Munich, Comprehensive Cancer Centre Munich and German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - J Mateo
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital Campus, Barcelona, Spain
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa; Department of Medical Oncology, U.O. Clinical di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - T Amaral
- Centre for Dermatooncology, Eberhard Karls University of Tübingen, Tübingen; Cluster of Excellence IFIT (EXC2180), Tübingen, Germany
| |
Collapse
|
11
|
Nübel C, Amaral T, Leiter U, Flatz L, Forschner A. Outcome and treatment-related adverse events of combined immune checkpoint inhibition with flipped dosing in a real-world cohort of 79 patients with metastasized melanoma. Front Oncol 2023; 13:1256800. [PMID: 38098509 PMCID: PMC10720648 DOI: 10.3389/fonc.2023.1256800] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction Combined immune checkpoint inhibition (ICI) with ipilimumab and nivolumab is a widely used treatment regimen for metastatic melanoma with non-resectable metastases. Nevertheless, the standard dose of ipilimumab 3 mg/kg bw and nivolumab 1 mg/kg bw is associated with a high rate of treatment-related adverse events (trAEs) (59% grade 3-4). In the CheckMate 511 study, it could be shown that flipped dosing with ipilimumab 1 mg/kg bw and nivolumab 3 mg/kg bw resulted in a significant reduction of trAE. Methods We have also used this regimen in the clinical setting and report the trAE, progression-free survival, and overall survival for 79 patients with metastatic melanoma who started combined ICI in the flipped dosing between March 2019 and April 2020. Results in total, 40 patients started first-line, 50% of whom had an elevated lactate dehydrogenase level at baseline. The disease control rate of these patients was 50%. The 2-year overall survival rate 67%. Moreover, 33% of the patients suffered grade 3 or 4 treatment related adverse events. Discussion The results of our study correspond very well to the results of the CheckMate 511 study (2-year OS: 65%, grade 3-4 immune-related side effects: 35%). Combined ICI with ipilimumab 1 mg/kg bw and nivolumab 3 mg/kg bw seems to be an equally effective but better-tolerated therapy regimen for metastasized melanoma patients, also in a real-world cohort.
Collapse
Affiliation(s)
| | | | | | | | - Andrea Forschner
- Department of Dermatology, University Hospital of Tübingen, Tübingen, Germany
| |
Collapse
|
12
|
Leiter U, Heppt MV, Steeb T, Alter M, Amaral T, Bauer A, Bechara FG, Becker JC, Breitbart EW, Breuninger H, Diepgen T, Dirschka T, Eigentler T, El Gammal AKS, Felcht M, Flaig MJ, Follmann M, Fritz K, Grabbe S, Greinert R, Gutzmer R, Hauschild A, Hillen U, Ihrler S, John SM, Kofler L, Koelbl O, Krause-Bergmann A, Kraywinkel K, Krohn S, Langer T, Loquai C, Löser CR, Mohr P, Nashan D, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies RM, Ulrich C, Voelter-Mahlknecht S, Vordermark D, Weichenthal M, Welzel J, Wermker K, Wiegand S, Garbe C, Berking C. S3-Leitlinie "Aktinische Keratose und Plattenepithelkarzinom der Haut" - Update 2023, Teil 2: Epidemiologie und Ätiologie, Diagnostik, Therapie des invasiven Plattenepithelkarzinoms der Haut, Nachsorge und Prävention: S3 guideline "actinic keratosis and cutaneous squamous cell carcinoma" - update 2023, part 2: epidemiology and etiology, diagnostics, surgical and systemic treatment of cutaneous squamous cell carcinoma (cSCC), surveillance and prevention. J Dtsch Dermatol Ges 2023; 21:1422-1434. [PMID: 37946644 DOI: 10.1111/ddg.15256_g] [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] [Received: 03/11/2023] [Accepted: 08/18/2023] [Indexed: 11/12/2023]
Abstract
ZusammenfassungAktinische Keratosen (AK) sind häufige Hautveränderungen bei hellhäutigen Menschen mit dem Potenzial, in ein kutanes Plattenepithelkarzinom (PEK) überzugehen. Beide Erkrankungen können mit erheblicher Morbidität verbunden sein und stellen eine große Krankheitslast insbesondere in der älteren Bevölkerung dar. Um einen evidenzbasierten Rahmen für die klinische Entscheidungsfindung zu schaffen, wurde die S3‐Leitlinie "Aktinische Keratose und kutanes Plattenepithelkarzinom" aktualisiert und um die Themen Plattenepithelkarzinom in situ (Morbus Bowen) und Cheilitis actinica, die Manifestation der AK am Lippenrot, erweitert. Die Leitlinie richtet sich dabei an Dermatologen, Allgemeinmediziner, HNO‐Ärzte, Chirurgen, Onkologen, Radiologen und Strahlentherapeuten in Klinik und Praxis sowie an andere medizinische Fachgebiete, politische Entscheidungsträger und Versicherungsgesellschaften, die sich mit der Diagnose und Behandlung von Patienten mit nicht‐melanozytärem Hautkrebs befassen. Für Patienten und deren Angehörige existiert eine gesonderte Patientenleitlinie. In diesem Teil behandeln wir die Themen Epidemiologie und Ätiologie, Diagnostik, Therapie des invasiven Plattenepithelkarzinoms der Haut, Nachsorge und Prävention.
Collapse
Affiliation(s)
- Ulrike Leiter
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Markus V Heppt
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
- Comprehensive Cancer Center Europäische Metropolregion Erlangen-Nürnberg (CCC ER-EMN), Erlangen
| | - Theresa Steeb
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
- Comprehensive Cancer Center Europäische Metropolregion Erlangen-Nürnberg (CCC ER-EMN), Erlangen
| | - Mareike Alter
- Universitätsklinik für Dermatologie, Allergologie, Venerologie und Phlebologie, Johannes Wesling Klinikum, Ruhr-Universität Bochum Campus Minden
| | - Teresa Amaral
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Falk G Bechara
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Ruhr-Universität Bochum
| | - Jürgen C Becker
- Translationale Hautkrebsforschung (TSCR), DKTK Essen/Düsseldorf, Universitätsmedizin Essen
| | | | - Helmut Breuninger
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Thomas Diepgen
- Institut für Klinische Sozialmedizin, Universität Heidelberg
| | | | - Thomas Eigentler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin
| | | | - Moritz Felcht
- Zentrum für Dermatochirurgie, St. Josefskrankenhaus Heidelberg GmbH, Heidelberg
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim
| | - Michael J Flaig
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München
| | - Markus Follmann
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e.V., Berlin
| | - Klaus Fritz
- Zentrum für Dermatologie, Laser und Ästhetische Medizin, Landau
| | - Stephan Grabbe
- Hautklinik der Universitätsmedizin, Johannes Gutenberg Universität Mainz
| | | | - Ralf Gutzmer
- Universitätsklinik für Dermatologie, Allergologie, Venerologie und Phlebologie, Johannes Wesling Klinikum, Ruhr-Universität Bochum Campus Minden
| | - Axel Hauschild
- Hautklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Uwe Hillen
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin
| | | | - Swen Malte John
- Abteilung Dermatologie und Umweltmedizin, Universität Osnabrück, Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück
| | - Lukas Kofler
- Studienzentrum Operative Dermatologie, Universitäts-Hautklinik, Eberhard-Karls-Universität, Tübingen
| | - Oliver Koelbl
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Regensburg
| | - Albrecht Krause-Bergmann
- Klinik für Unfall- und Wiederherstellungschirurgie, Orthopädie, Plastische-, Ästhetische- und Handchirurgie, Sektion für Plastische-, Ästhetische- und Handchirurgie, Gütersloh
| | | | - Steffen Krohn
- Deutsche Gesetzliche Unfallversicherung e.V. (DGUV), Berlin
| | - Thomas Langer
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e.V., Berlin
| | - Carmen Loquai
- Klinikum Bremen-Ost, Klinik für Dermatologie, Dermatochirurgie, Dermatoonkologie und Allergologie, Hautkrebszentrum Bremen
| | - Christoph R Löser
- Hautklinik, Hauttumorzentrum, Klinikum Ludwigshafen gGmbH, Ludwigshafen
| | - Peter Mohr
- Elbe Kliniken Stade Buxtehude, Klinikum Buxtehude
| | | | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Institut für Medizinisches Wissensmanagement, c/o Philipps Universität Marburg
| | - Christina Pfannenberg
- Klinik für Diagnostische und Interventionelle Radiologie, Eberhard-Karls-Universität Tübingen
| | - Carmen Salavastru
- Klinik für Kinderdermatologie, Onkologische Dermatologie - Forschungseinheit, Colentina Universitätsklinikum, Bucharest, "Carol Davila" Universitätsmedizin, Bukarest, Rumänien
| | - Lutz Schmitz
- CentroDerm Wuppertal, Heinz-Fangman-Straße 57, Wuppertal
| | - Eggert Stockfleth
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Ruhr-Universität Bochum
| | | | | | - Susanne Voelter-Mahlknecht
- Institut für Arbeitsmedizin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin
| | - Dirk Vordermark
- Universitätsklinik für Strahlentherapie, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale
| | | | - Julia Welzel
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg Medizincampus Süd, Augsburg
| | - Kai Wermker
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Plastische und Ästhetische Operationen, Klinikum Osnabrück
| | - Susanne Wiegand
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Leipzig
| | - Claus Garbe
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Carola Berking
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
- Comprehensive Cancer Center Europäische Metropolregion Erlangen-Nürnberg (CCC ER-EMN), Erlangen
| |
Collapse
|
13
|
Leiter U, Heppt MV, Steeb T, Alter M, Amaral T, Bauer A, Bechara FG, Becker JC, Breitbart EW, Breuninger H, Diepgen T, Dirschka T, Eigentler T, ElGammal AKS, Felcht M, Flaig MJ, Follmann M, Fritz K, Grabbe S, Greinert R, Gutzmer R, Hauschild A, Hillen U, Ihrler S, John SM, Kofler L, Koelbl O, Krause-Bergmann A, Kraywinkel K, Krohn S, Langer T, Loquai C, Löser CR, Mohr P, Nashan D, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies RM, Ulrich C, Voelter-Mahlknecht S, Vordermark D, Weichenthal M, Welzel J, Wermker K, Wiegand S, Garbe C, Berking C. S3 guideline "actinic keratosis and cutaneous squamous cell carcinoma" - update 2023, part 2: epidemiology and etiology, diagnostics, surgical and systemic treatment of cutaneous squamous cell carcinoma (cSCC), surveillance and prevention. J Dtsch Dermatol Ges 2023; 21:1422-1433. [PMID: 37840404 DOI: 10.1111/ddg.15256] [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: 03/11/2023] [Accepted: 08/18/2023] [Indexed: 10/17/2023]
Abstract
Actinic keratosis (AK) are common lesions in light-skinned individuals that can potentially progress to cutaneous squamous cell carcinoma (cSCC). Both conditions may be associated with significant morbidity and constitute a major disease burden, especially among the elderly. To establish an evidence-based framework for clinical decision making, the guideline "actinic keratosis and cutaneous squamous cell carcinoma" was updated and expanded by the topics cutaneous squamous cell carcinoma in situ (Bowen's disease) and actinic cheilitis. The guideline is aimed at dermatologists, general practitioners, ear nose and throat specialists, surgeons, oncologists, radiologists and radiation oncologists in hospitals and office-based settings, as well as other medical specialties, policy makers and insurance funds involved in the diagnosis and treatment of patients with AK and cSCC. A separate guideline exists for patients and their relatives. In this part, we will address aspects relating to epidemiology and etiology, diagnostics, surgical and systemic treatment of cutaneous squamous cell carcinoma (cSCC), surveillance and prevention.
Collapse
Affiliation(s)
- Ulrike Leiter
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Markus V Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuernberg, (CCC ER-EMN), Erlangen, Germany
| | - Theresa Steeb
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuernberg, (CCC ER-EMN), Erlangen, Germany
| | - Mareike Alter
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
| | - Teresa Amaral
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Falk G Bechara
- Department of Dermatology, Venerology, and Allergology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jürgen C Becker
- Translational Skin Cancer Research (TSCR), DKTK Essen/Düsseldorf, University Medicine Essen, Essen, Germany
| | | | - Helmut Breuninger
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Thomas Diepgen
- Institute of Clinical Social Medicine, University Heidelberg, Heidelberg, Germany
| | | | - Thomas Eigentler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | | | - Moritz Felcht
- Department of Dermatosurgery, St. Josefhospital Heidelberg GmbH, Heidelberg, Germany
- Department of Dermatology, Venereology und Allergy, University Medicine Mannheim, Mannheim, Germany
| | - Michael J Flaig
- Department of Dermatology and Allergy, University Hospital, LMU Munich, München, Germany
| | - Markus Follmann
- German Guideline Program in Oncology, German Cancer Society, Berlin, Germany
| | - Klaus Fritz
- Dermatology and Laser Consultation Center, Landau, Germany
| | - Stephan Grabbe
- Department of Dermatology, Mainz University Medical School, Mainz, Germany
| | - Rüdiger Greinert
- Elbe Clinics Stade Buxtehude GmbH, Medical Center Buxtehude, Buxtehude, Germany
| | - Ralf Gutzmer
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Uwe Hillen
- Department of Dermatology & Venerology, Vivantes Hospital Neukölln, Berlin, Germany
| | | | - Swen Malte John
- Department of Dermatology and Environmental Medicine, University of Osnabrueck, Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrueck, Osnabrück, Germany
| | - Lukas Kofler
- Study Center for Dermatosurgery, University Hospital Tuebingen, Eberhard-Karls-University, Tübingen, Germany
| | - Oliver Koelbl
- Clinic and Polyclinic for Radiooncology, University Medical Center Regensburg, Regensburg, Germany
| | - Albrecht Krause-Bergmann
- Clinic for Trauma-, Orthopedics-, and Plastic Surgery, Department for Plastic-, Aesthetic- and Handsurgery, Gütersloh, Germany
| | | | - Steffen Krohn
- German Social Accident Insurance (DGUV), Berlin, Germany
| | - Thomas Langer
- German Guideline Program in Oncology, German Cancer Society, Berlin, Germany
| | - Carmen Loquai
- Department of Dermatology, Medical Center Bremen-Ost, Bremen, Germany
| | - Christoph R Löser
- Skin Hospital, Skin Cancer Center, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Peter Mohr
- Elbe Clinics Stade Buxtehude GmbH, Medical Center Buxtehude, Buxtehude, Germany
| | - Dorothée Nashan
- Department of Dermatology, Klinikum Dortmund, Dortmund, Germany
| | - Monika Nothacker
- Association of the Scientific Medical Societies in Germany (AWMF), Institute for Medical Knowledge Management, c/o Philipps Universität Marburg, Marburg, Germany
| | - Christina Pfannenberg
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Carmen Salavastru
- Pediatric Dermatology Discipline, Dermato-oncology Research Facility, "Colentina" Clinical Hospital, Bucharest 020125, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Rumania
| | | | - Eggert Stockfleth
- Department of Dermatology, Venerology, and Allergology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Rolf-Markus Szeimies
- Department of Dermatology and Allergology, Klinikum Vest GmbH, Recklinghausen, Germany
| | - Claas Ulrich
- Dermatologie am Regierungsviertel, Berlin, Germany
| | - Susanne Voelter-Mahlknecht
- Institute of Occupational Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Dirk Vordermark
- Department of Radiation Oncology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Michael Weichenthal
- Department of Dermatology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Julia Welzel
- Department of Dermatology, University Hospital Augsburg, Augsburg, Germany
| | - Kai Wermker
- Klinikum Osnabrueck, Department for Oral and Maxillofacial Surgery, Plastic and Aesthetic Operations, Osnabrück, Germany
| | - Susanne Wiegand
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Claus Garbe
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuernberg, (CCC ER-EMN), Erlangen, Germany
| |
Collapse
|
14
|
Amaral T, Pop OT, Chatziioannou E, Sinnberg T, Niessner H, Zhao J, Ring SS, Joerger M, Schroeder C, Armeanu-Ebinger S, Cozzio A, Leiter U, Thomas I, Jochum W, Garbe C, Forchhammer S, Levesque M, Mangana J, Hölzel M, Dummer R, Schürch CM, Forschner A, Flatz L. EGFR expression is associated with relapse in a melanoma cohort receiving adjuvant PD-1-based immunotherapy. J Am Acad Dermatol 2023; 89:1072-1074. [PMID: 37487833 DOI: 10.1016/j.jaad.2023.06.057] [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] [Received: 02/28/2023] [Revised: 06/14/2023] [Accepted: 06/22/2023] [Indexed: 07/26/2023]
Affiliation(s)
- Teresa Amaral
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany; Cluster of Excellence iFIT (EXC 2180), Tübingen, Germany
| | - Oltin Tiberiu Pop
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Eftychia Chatziioannou
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Tobias Sinnberg
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany; Cluster of Excellence iFIT (EXC 2180), Tübingen, Germany; Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Heike Niessner
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany; Cluster of Excellence iFIT (EXC 2180), Tübingen, Germany
| | - Jing Zhao
- Department of Pathology and Neuropathology, University Hospital and Comprehensive Cancer Center Tübingen, Tübingen, Germany
| | - Sandra Stephanie Ring
- Institute of Clinical Chemistry and Pathobiochemistry, Central Institute for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
| | - Markus Joerger
- Department of Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Christopher Schroeder
- Institute for Medical Genetics and Applied Genomics, University Hospital Tübingen, Tübingen, Germany
| | - Sorin Armeanu-Ebinger
- Institute for Medical Genetics and Applied Genomics, University Hospital Tübingen, Tübingen, Germany
| | - Antonio Cozzio
- Department of Dermatology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Ulrike Leiter
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Ioannis Thomas
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Wolfram Jochum
- Institute of Pathology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Claus Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Stephan Forchhammer
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Mitchell Levesque
- Department of Dermatology, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Joanna Mangana
- Department of Dermatology, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Michael Hölzel
- Institute of Experimental Oncology, University Hospital of Bonn, Bonn, Germany
| | - Reinhard Dummer
- Department of Dermatology, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Christian M Schürch
- Department of Pathology and Neuropathology, University Hospital and Comprehensive Cancer Center Tübingen, Tübingen, Germany
| | - Andrea Forschner
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Lukas Flatz
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany; Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Dermatology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
| |
Collapse
|
15
|
Peisen F, Gerken A, Hering A, Dahm I, Nikolaou K, Gatidis S, Eigentler TK, Amaral T, Moltz JH, Othman AE. Can Whole-Body Baseline CT Radiomics Add Information to the Prediction of Best Response, Progression-Free Survival, and Overall Survival of Stage IV Melanoma Patients Receiving First-Line Targeted Therapy: A Retrospective Register Study. Diagnostics (Basel) 2023; 13:3210. [PMID: 37892030 PMCID: PMC10605712 DOI: 10.3390/diagnostics13203210] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate whether the combination of radiomics and clinical parameters in a machine-learning model offers additive information compared with the use of only clinical parameters in predicting the best response, progression-free survival after six months, as well as overall survival after six and twelve months in patients with stage IV malignant melanoma undergoing first-line targeted therapy. METHODS A baseline machine-learning model using clinical variables (demographic parameters and tumor markers) was compared with an extended model using clinical variables and radiomic features of the whole tumor burden, utilizing repeated five-fold cross-validation. Baseline CTs of 91 stage IV malignant melanoma patients, all treated in the same university hospital, were identified in the Central Malignant Melanoma Registry and all metastases were volumetrically segmented (n = 4727). RESULTS Compared with the baseline model, the extended radiomics model did not add significantly more information to the best-response prediction (AUC [95% CI] 0.548 (0.188, 0.808) vs. 0.487 (0.139, 0.743)), the prediction of PFS after six months (AUC [95% CI] 0.699 (0.436, 0.958) vs. 0.604 (0.373, 0.867)), or the overall survival prediction after six and twelve months (AUC [95% CI] 0.685 (0.188, 0.967) vs. 0.766 (0.433, 1.000) and AUC [95% CI] 0.554 (0.163, 0.781) vs. 0.616 (0.271, 1.000), respectively). CONCLUSIONS The results showed no additional value of baseline whole-body CT radiomics for best-response prediction, progression-free survival prediction for six months, or six-month and twelve-month overall survival prediction for stage IV melanoma patients receiving first-line targeted therapy. These results need to be validated in a larger cohort.
Collapse
Affiliation(s)
- Felix Peisen
- Department of Diagnostic and Interventional Radiology, Tuebingen University Hospital, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany; (I.D.); (K.N.); (S.G.); (A.E.O.)
| | - Annika Gerken
- Fraunhofer MEVIS, Max-von-Laue-Straße 2, 28359 Bremen, Germany; (A.G.); (A.H.); (J.H.M.)
| | - Alessa Hering
- Fraunhofer MEVIS, Max-von-Laue-Straße 2, 28359 Bremen, Germany; (A.G.); (A.H.); (J.H.M.)
- Diagnostic Image Analysis Group, Radboud University Medical Center (Radboudumc), Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Isabel Dahm
- Department of Diagnostic and Interventional Radiology, Tuebingen University Hospital, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany; (I.D.); (K.N.); (S.G.); (A.E.O.)
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Tuebingen University Hospital, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany; (I.D.); (K.N.); (S.G.); (A.E.O.)
- Image-Guided and Functionally Instructed Tumor Therapies (iFIT), The Cluster of Excellence (EXC 2180), 72076 Tuebingen, Germany
| | - Sergios Gatidis
- Department of Diagnostic and Interventional Radiology, Tuebingen University Hospital, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany; (I.D.); (K.N.); (S.G.); (A.E.O.)
- Max Planck Institute for Intelligent Systems, Max-Planck-Ring 4, 72076 Tuebingen, Germany
| | - Thomas K. Eigentler
- Center of Dermato-Oncology, Department of Dermatology, Tuebingen University Hospital, Eberhard Karls University, Liebermeisterstraße 25, 72076 Tuebingen, Germany; (T.K.E.); (T.A.)
- Department of Dermatology, Venereology and Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humbolt-Universität zu Berlin, Luisenstraße 2, 10117 Berlin, Germany
| | - Teresa Amaral
- Center of Dermato-Oncology, Department of Dermatology, Tuebingen University Hospital, Eberhard Karls University, Liebermeisterstraße 25, 72076 Tuebingen, Germany; (T.K.E.); (T.A.)
| | - Jan H. Moltz
- Fraunhofer MEVIS, Max-von-Laue-Straße 2, 28359 Bremen, Germany; (A.G.); (A.H.); (J.H.M.)
| | - Ahmed E. Othman
- Department of Diagnostic and Interventional Radiology, Tuebingen University Hospital, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany; (I.D.); (K.N.); (S.G.); (A.E.O.)
- Institute of Neuroradiology, Johannes Gutenberg University Hospital Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| |
Collapse
|
16
|
Jasper S, Keim U, Leiter U, Amaral T, Flatz L, Forschner A. Die Prognose des Melanoms im Kopf-Hals-Bereich im Stadium II hängt vom histologischen Subtyp ab. J Dtsch Dermatol Ges 2023; 21:1137-1147. [PMID: 37845056 DOI: 10.1111/ddg.15164_g] [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] [Received: 10/21/2022] [Accepted: 05/28/2023] [Indexed: 10/18/2023]
Abstract
ZusammenfassungHintergrund und ZieleDie Melanom‐Leitlinie basiert hauptsächlich auf dem AJCC‐Stadium. Hierbei wird nicht zwischen den histologischen Subtypen wie dem superfiziell spreitenden Melanom (SSM), dem Lentigo‐maligna‐Melanom (LMM) oder dem nodulären malignen Melanom (NM) unterschieden. Ziel der Studie war es zu untersuchen, ob sich Patienten mit LMM im klinischen Verlauf von Patienten mit SSM/NM unterscheiden. Dies ist aktuell besonders wichtig, da die adjuvante Anti‐PD‐1‐Therapie für Melanome im Stadium IIB und IIC zugelassen wurde.Patienten und MethodikDie Daten wurden aus dem Zentralregister „malignes Melanom“ entnommen. Es wurden nur Patienten mit LMM, SSM oder NM des Kopf‐Hals‐Bereichs und Primärdiagnose zwischen dem 01.01.2000 und dem 31.12.2019 eingeschlossen. Das progressionsfreie Überleben (PFÜ), das melanomspezifische Überleben (MSÜ) und das Metastasierungsmuster wurden für die Gruppe der LMM im Vergleich zur Gruppe der SSM/NM analysiert.ErgebnisseDie LMM‐Kohorte (n = 902) hatte ein signifikant besseres MSÜ als die SSM/NM‐Kohorte (n = 604). Beim PFÜ gab es keinen Unterschied. Das 5‐Jahres‐MSÜ der LMM‐Kohorte im Stadium II betrug 88,5 % (95 % KI 81,4–95,6), im Vergleich dazu das der SSM/NM‐Kohorte im Stadium II 79,7 % (95 % KI 72,8–86,6).SchlussfolgerungEs scheint nicht angebracht zu sein, eine adjuvante Therapie bei LMM‐Patienten im Stadium II im gleichen Umfang durchzuführen, wie bei Patienten mit SSM/NM.
Collapse
Affiliation(s)
- Sophie Jasper
- Abteilung für Dermatologie, Zentrum für Dermatoonkologie, Universitätsklinikum Tübingen
| | - Ulrike Keim
- Abteilung für Dermatologie, Zentrum für Dermatoonkologie, Universitätsklinikum Tübingen
| | - Ulrike Leiter
- Abteilung für Dermatologie, Zentrum für Dermatoonkologie, Universitätsklinikum Tübingen
| | - Teresa Amaral
- Abteilung für Dermatologie, Zentrum für Dermatoonkologie, Universitätsklinikum Tübingen
| | - Lukas Flatz
- Abteilung für Dermatologie, Zentrum für Dermatoonkologie, Universitätsklinikum Tübingen
| | - Andrea Forschner
- Abteilung für Dermatologie, Zentrum für Dermatoonkologie, Universitätsklinikum Tübingen
| |
Collapse
|
17
|
Jasper S, Keim U, Leiter U, Amaral T, Flatz L, Forschner A. Prognosis in stage II melanoma of the head and neck depends on the histological subtype. J Dtsch Dermatol Ges 2023; 21:1137-1146. [PMID: 37485634 DOI: 10.1111/ddg.15164] [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: 10/21/2022] [Accepted: 05/28/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND AND OBJECTIVES The melanoma guideline is mainly based on the AJCC stage. There is no difference according to histological subtypes such as superficial spreading melanoma (SSM), lentigo maligna melanoma (LMM) or nodular malignant melanoma (NM). We aimed to evaluate whether patients with LMM have a different clinical course from patients with SSM/NM. This is particularly important as adjuvant anti-PD-1 therapy is approved for stage IIB and IIC melanoma. PATIENTS AND METHODS Data were extracted from the Central Registry of Malignant Melanoma. Only patients with LMM, SSM, and NM of the head and neck with primary diagnosis between 01/01/2000 and 12/31/2019 were included. Progression-free survival (PFS), melanoma-specific survival (MSS), and pattern of metastases were analyzed for the LMM group compared to SSM/NM. RESULTS The LMM cohort (n = 902) had significantly better MSS than the SSM/NM cohort (n = 604). There was no difference in PFS. The 5-year MSS of the stage II LMM cohort was 88.5% (95% CI 81.4-95.6) compared to 79.7% (95% CI 72.8-86.6) in the stage II SSM/NM cohort. CONCLUSION It does not appear appropriate to use adjuvant therapy in stage II LMM patients to the same extent as in patients with SSM/NM.
Collapse
Affiliation(s)
- Sophie Jasper
- Department of Dermatology, Center for Dermatooncology, University Hospital Tübingen, Tübingen, Germany
| | - Ulrike Keim
- Department of Dermatology, Center for Dermatooncology, University Hospital Tübingen, Tübingen, Germany
| | - Ulrike Leiter
- Department of Dermatology, Center for Dermatooncology, University Hospital Tübingen, Tübingen, Germany
| | - Teresa Amaral
- Department of Dermatology, Center for Dermatooncology, University Hospital Tübingen, Tübingen, Germany
| | - Lukas Flatz
- Department of Dermatology, Center for Dermatooncology, University Hospital Tübingen, Tübingen, Germany
| | - Andrea Forschner
- Department of Dermatology, Center for Dermatooncology, University Hospital Tübingen, Tübingen, Germany
| |
Collapse
|
18
|
Heppt MV, Leiter U, Steeb T, Alter M, Amaral T, Bauer A, Bechara FG, Becker JC, Breitbart EW, Breuninger H, Diepgen T, Dirschka T, Eigentler T, El Gammal AKS, Felcht M, Flaig MJ, Follmann M, Fritz K, Grabbe S, Greinert R, Gutzmer R, Hauschild A, Hillen U, Ihrler S, John SM, Kofler L, Koelbl O, Krause-Bergmann A, Kraywinkel K, Krohn S, Langer T, Loquai C, Löser CR, Mohr P, Nashan D, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies RM, Ulrich C, Voelter-Mahlknecht S, Vordermark D, Weichenthal M, Welzel J, Wermker K, Wiegand S, Garbe C, Berking C. S3-Leitlinie "Aktinische Keratose und Plattenepithelkarzinom der Haut" - Update 2023, Teil 1: Therapie der aktinischen Keratose, Morbus Bowen, Cheilitis actinica, berufsbedingte Erkrankung und Versorgungsstrukturen: S3 guideline "actinic keratosis and cutaneous squamous cell carcinoma"- update 2023, part 1: treatment of actinic keratosis, actinic cheilitis, cutaneous squamous cell carcinoma in situ (Bowen's disease), occupational disease and structures of care. J Dtsch Dermatol Ges 2023; 21:1249-1262. [PMID: 37845050 DOI: 10.1111/ddg.15231_g] [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: 03/04/2023] [Accepted: 07/27/2023] [Indexed: 10/18/2023]
Abstract
ZusammenfassungAktinische Keratosen (AK) sind häufige Hautveränderungen bei hellhäutigen Menschen mit dem Potenzial, in ein kutanes Plattenepithelkarzinom (PEK) überzugehen. Beide Erkrankungen können mit erheblicher Morbidität verbunden sein und stellen eine große Krankheitslast insbesondere in der älteren Bevölkerung dar. Um eine evidenzbasierte Grundlage für die klinische Entscheidungsfindung zu schaffen, wurde die S3‐Leitlinie „Aktinische Keratose und kutanes Plattenepithelkarzinom“ aktualisiert und um die Themen Plattenepithelkarzinom in situ (Morbus Bowen) und Cheilitis actinica, die Manifestation der AK am Lippenrot, erweitert. Die Leitlinie richtet sich dabei an Dermatologen, Allgemeinmediziner, HNO‐Ärzte, Chirurgen, Onkologen, Radiologen und Strahlentherapeuten in Klinik und Praxis sowie an andere medizinische Fachgebiete, politische Entscheidungsträger und Versicherungsgesellschaften, die sich mit der Diagnose und Behandlung von Patienten mit nichtmelanozytärem Hautkrebs befassen. Für Patienten und deren Angehörige existiert eine gesonderte Patientenleitlinie. In diesem Teil behandeln wir die Themen Therapie der aktinischen Keratose, Morbus Bowen, Cheilitis actinica, berufsbedingte Erkrankung an AK und PEK sowie Versorgungsstrukturen.
Collapse
Affiliation(s)
- Markus V Heppt
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
- Comprehensive Cancer Center Europäische Metropolregion Erlangen-Nürnberg (CCC ER-EMN), Erlangen
| | - Ulrike Leiter
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Theresa Steeb
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
- Comprehensive Cancer Center Europäische Metropolregion Erlangen-Nürnberg (CCC ER-EMN), Erlangen
| | - Mareike Alter
- Universitätsklinik für Dermatologie, Allergologie, Venerologie und Phlebologie, Johannes Wesling Klinikum, Ruhr-Universität Bochum Campus Minden
| | - Teresa Amaral
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Falk G Bechara
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Ruhr-Universität Bochum
| | - Jürgen C Becker
- Translationale Hautkrebsforschung (TSCR), DKTK Essen/Düsseldorf, Universitätsmedizin Essen
| | | | - Helmut Breuninger
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Thomas Diepgen
- Institut für Klinische Sozialmedizin, Universität Heidelberg
| | | | - Thomas Eigentler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin
| | | | - Moritz Felcht
- Zentrum für Dermatochirurgie, St. Josefskrankenhaus Heidelberg GmbH, Heidelberg
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim
| | - Michael J Flaig
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München
| | - Markus Follmann
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e.V., Berlin
| | - Klaus Fritz
- Zentrum für Dermatologie, Laser und Ästhetische Medizin, Landau
| | - Stephan Grabbe
- Hautklinik der Universitätsmedizin, Johannes Gutenberg Universität Mainz
| | | | - Ralf Gutzmer
- Universitätsklinik für Dermatologie, Allergologie, Venerologie und Phlebologie, Johannes Wesling Klinikum, Ruhr-Universität Bochum Campus Minden
| | - Axel Hauschild
- Hautklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Uwe Hillen
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin
| | | | - Swen Malte John
- Abteilung Dermatologie und Umweltmedizin, Universität Osnabrück, Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück
| | - Lukas Kofler
- Studienzentrum Operative Dermatologie, Universitäts-Hautklinik, Eberhard-Karls-Universität, Tübingen
| | - Oliver Koelbl
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Regensburg
| | - Albrecht Krause-Bergmann
- Klinik für Unfall- und Wiederherstellungschirurgie, Orthopädie, Plastische-, Ästhetische- und Handchirurgie, Sektion für Plastische-, Ästhetische- und Handchirurgie, Gütersloh
| | | | - Steffen Krohn
- Deutsche Gesetzliche Unfallversicherung e.V. (DGUV), Berlin
| | - Thomas Langer
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e.V., Berlin
| | - Carmen Loquai
- Klinikum Bremen-Ost, Klinik für Dermatologie, Dermatochirurgie, Dermatoonkologie und Allergologie, Hautkrebszentrum Bremen
| | - Christoph R Löser
- Hautklinik, Hauttumorzentrum, Klinikum Ludwigshafen gGmbH, Ludwigshafen
| | - Peter Mohr
- Elbe Kliniken Stade Buxtehude, Klinikum Buxtehude
| | | | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Institut für Medizinisches Wissensmanagement, c/o Philipps Universität Marburg
| | - Christina Pfannenberg
- Klinik für Diagnostische und Interventionelle Radiologie, Eberhard-Karls-Universität Tübingen
| | - Carmen Salavastru
- Klinik für Kinderdermatologie, Onkologische Dermatologie - Forschungseinheit, Colentina Universitätsklinikum, "Carol Davila" Universitätsmedizin, Bucharest, Bukarest, Rumänien
| | - Lutz Schmitz
- CentroDerm Wuppertal, Heinz-Fangman-Straße 57, Wuppertal
| | - Eggert Stockfleth
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Ruhr-Universität Bochum
| | | | | | - Susanne Voelter-Mahlknecht
- Institut für Arbeitsmedizin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin
| | - Dirk Vordermark
- Universitätsklinik für Strahlentherapie, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale
| | | | - Julia Welzel
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg Medizincampus Süd, Augsburg
| | - Kai Wermker
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Plastische und Ästhetische Operationen, Klinikum Osnabrück
| | - Susanne Wiegand
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Leipzig
| | - Claus Garbe
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Carola Berking
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
- Comprehensive Cancer Center Europäische Metropolregion Erlangen-Nürnberg (CCC ER-EMN), Erlangen
| |
Collapse
|
19
|
Lim KHJ, Westphalen CB, Berghoff AS, Cardone C, Connolly EA, Güven DC, Kfoury M, Kocakavuk E, Mandó P, Mariamidze E, Matikas A, Moutafi M, Oing C, Pihlak R, Punie K, Sánchez-Bayona R, Sobczuk P, Starzer AM, Tečić Vuger A, Zhu H, Cruz-Ordinario MVB, Altuna SC, Canário R, Vuylsteke P, Banerjee S, de Azambuja E, Cervantes A, Lambertini M, Mateo J, Amaral T. Young oncologists' perspective on the role and future of the clinician-scientist in oncology. ESMO Open 2023; 8:101625. [PMID: 37659290 PMCID: PMC10480053 DOI: 10.1016/j.esmoop.2023.101625] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 09/04/2023] Open
Affiliation(s)
- K H J Lim
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester; Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK.
| | - C B Westphalen
- Department of Internal Medicine III, University Hospital LMU Munich, Comprehensive Cancer Centre Munich and German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - A S Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - C Cardone
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - E A Connolly
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, Australia
| | - D C Güven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - M Kfoury
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - E Kocakavuk
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - P Mandó
- Clinical Oncology Department, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - E Mariamidze
- Todua Clinic Department of Oncology and Haematology, Tbilisi, Georgia
| | - A Matikas
- Breast Center, Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - M Moutafi
- Department of Oncology, Attikon University Hospital, Athens, Greece
| | - C Oing
- Translational and Clinical Research Institute, Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK; Mildred Scheel Cancer Career Centre HaTriCS4, University Cancer Centre Hamburg, University Medical Centre Eppendorf, Hamburg, Germany
| | - R Pihlak
- Medical Oncology Department, St Bartholomew's Hospital, London, UK
| | - K Punie
- Department of Medical Oncology, GZA Hospitals Sint-Augustinus, Wilrijk, Belgium
| | - R Sánchez-Bayona
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Sobczuk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - A M Starzer
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - A Tečić Vuger
- Breast Cancer Unit, Medical Oncology Department, University Hospital for Tumors, Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia
| | - H Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - M V B Cruz-Ordinario
- Section of Medical Oncology, Cancer Institute, St. Luke's Medical Center, Quezon City, Metro Manila, the Philippines
| | - S C Altuna
- Department of Medical Oncology, Oncomédica, Caracas, Venezuela
| | - R Canário
- Cancer Metastasis, i3S-Institute for Research & Innovation in Health, Porto; Research Centre, Portuguese Oncology Institute of Porto, Porto; ICBAS, School of Medicine and Biomedical Sciences, Porto, Portugal
| | - P Vuylsteke
- Department of Internal Medicine, University of Botswana, Gaborone, Botswana
| | - S Banerjee
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London; The Institute of Cancer Research, London, UK
| | - E de Azambuja
- Institut Jules Bordet and L'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - A Cervantes
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Salud Carlos III, Madrid; Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria (INCLIVA), Universidad Valencia, Valencia, Spain
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa; Department of Medical Oncology, U.O. Clinical di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - J Mateo
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital Campus, Barcelona, Spain
| | - T Amaral
- Centre for Dermatooncology, Eberhard Karls University of Tübingen, Tübingen; Cluster of Excellence IFIT (EXC2180), Tübingen, Germany
| |
Collapse
|
20
|
Heppt MV, Leiter U, Steeb T, Alter M, Amaral T, Bauer A, Bechara FG, Becker JC, Breitbart EW, Breuninger H, Diepgen T, Dirschka T, Eigentler T, El Gammal AKS, Felcht M, Flaig MJ, Follmann M, Fritz K, Grabbe S, Greinert R, Gutzmer R, Hauschild A, Hillen U, Ihrler S, John SM, Kofler L, Koelbl O, Krause-Bergmann A, Kraywinkel K, Krohn S, Langer T, Loquai C, Löser CR, Mohr P, Nashan D, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies RM, Ulrich C, Voelter-Mahlknecht S, Vordermark D, Weichenthal M, Welzel J, Wermker K, Wiegand S, Garbe C, Berking C. S3 guideline "actinic keratosis and cutaneous squamous cell carcinoma"- update 2023, part 1: treatment of actinic keratosis, actinic cheilitis, cutaneous squamous cell carcinoma in situ (Bowen's disease), occupational disease and structures of care. J Dtsch Dermatol Ges 2023; 21:1249-1262. [PMID: 37845077 DOI: 10.1111/ddg.15231] [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: 03/04/2023] [Accepted: 07/27/2023] [Indexed: 10/18/2023]
Abstract
SummaryActinic keratosis (AK) are common lesions in light‐skinned individuals that can potentially progress to cutaneous squamous cell carcinoma (cSCC). Both conditions may be associated with significant morbidity and constitute a major disease burden, especially among the elderly. To establish an evidence‐based framework for clinical decision making, the guideline “actinic keratosis and cutaneous squamous cell carcinoma” was updated and expanded by the topics cutaneous squamous cell carcinoma in situ (Bowen's disease) and actinic cheilitis. The guideline is aimed at dermatologists, general practitioners, ear nose and throat specialists, surgeons, oncologists, radiologists and radiation oncologists in hospitals and office‐based settings, as well as other medical specialties, policy makers and insurance funds involved in the diagnosis and treatment of patients with AK and cSCC. A separate guideline exists for patients and their relatives. In this part, we will address aspects relating to AK, actinic cheilitis, Bowen's disease, occupational disease and care structures.
Collapse
Affiliation(s)
- Markus V Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuernberg, (CCC ER-EMN), Erlangen, Germany
| | - Ulrike Leiter
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Theresa Steeb
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuernberg, (CCC ER-EMN), Erlangen, Germany
| | - Mareike Alter
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
| | - Teresa Amaral
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Falk G Bechara
- Department of Dermatology, Venerology, and Allergology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jürgen C Becker
- Translational Skin Cancer Research (TSCR), DKTK Essen/Düsseldorf, University Medicine Essen, Essen, Germany
| | | | - Helmut Breuninger
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Thomas Diepgen
- Institute of Clinical Social Medicine, University Heidelberg, Heidelberg, Germany
| | | | - Thomas Eigentler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | | | - Moritz Felcht
- Department of Dermatosurgery, St. Josefhospital Heidelberg GmbH, Heidelberg, Germany
- Department of Dermatology, Venereology und Allergy, University Medicine Mannheim, Mannheim, Germany
| | - Michael J Flaig
- Department of Dermatology and Allergy, University Hospital, LMU Munich, München, Germany
| | - Markus Follmann
- German Guideline Program in Oncology, German Cancer Society, Berlin, Germany
| | - Klaus Fritz
- Dermatology and Laser Consultation Center, Landau, Germany
| | - Stephan Grabbe
- Department of Dermatology, Mainz University Medical School, Mainz, Germany
| | - Rüdiger Greinert
- Elbe Clinics Stade Buxtehude GmbH, Medical Center Buxtehude, Buxtehude, Germany
| | - Ralf Gutzmer
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Uwe Hillen
- Department of Dermatology & Venerology, Vivantes Hospital Neukölln, Berlin, Germany
| | | | - Swen Malte John
- Department of Dermatology and Environmental Medicine, University of Osnabrueck, Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrueck, Osnabrück, Germany
| | - Lukas Kofler
- Study Center for Dermatosurgery, University Hospital Tuebingen, Eberhard-Karls-University, Tübingen, Germany
| | - Oliver Koelbl
- Clinic and Polyclinic for Radiooncology, University Medical Center Regensburg, Regensburg, Germany
| | - Albrecht Krause-Bergmann
- Clinic for Trauma-, Orthopedics-, and Plastic Surgery, Department for Plastic-, Aesthetic- and Handsurgery, Gütersloh, Germany
| | | | - Steffen Krohn
- German Social Accident Insurance (DGUV), Berlin, Germany
| | - Thomas Langer
- German Guideline Program in Oncology, German Cancer Society, Berlin, Germany
| | - Carmen Loquai
- Department of Dermatology, Medical Center Bremen-Ost, Bremen, Germany
| | - Christoph R Löser
- Skin Hospital, Skin Cancer Center, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Peter Mohr
- Elbe Clinics Stade Buxtehude GmbH, Medical Center Buxtehude, Buxtehude, Germany
| | - Dorothée Nashan
- Department of Dermatology, Klinikum Dortmund, Dortmund, Germany
| | - Monika Nothacker
- Association of the Scientific Medical Societies in Germany (AWMF), Institute for Medical Knowledge Management, c/o Philipps Universität Marburg, Marburg, Germany
| | - Christina Pfannenberg
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Carmen Salavastru
- Pediatric Dermatology Discipline, Dermato-oncology Research Facility, "Colentina" Clinical Hospital, Bucharest 020125, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Rumania
| | | | - Eggert Stockfleth
- Department of Dermatology, Venerology, and Allergology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Rolf-Markus Szeimies
- Department of Dermatology and Allergology, Klinikum Vest GmbH, Recklinghausen, Germany
| | - Claas Ulrich
- Dermatologie am Regierungsviertel, Berlin, Germany
| | - Susanne Voelter-Mahlknecht
- Institute of Occupational Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Dirk Vordermark
- Department of Radiation Oncology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Michael Weichenthal
- Department of Dermatology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Julia Welzel
- Department of Dermatology, University Hospital Augsburg, Augsburg, Germany
| | - Kai Wermker
- Klinikum Osnabrueck, Department for Oral and Maxillofacial Surgery, Plastic and Aesthetic Operations, Osnabrück, Germany
| | - Susanne Wiegand
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Claus Garbe
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuernberg, (CCC ER-EMN), Erlangen, Germany
| |
Collapse
|
21
|
Roitberg F, Amaral T, Cherny NI, Giuliani R, Latino NJ, Galotti M, Bricalli G, Curigliano G, Pentheroudakis G, Trapani D. Essential cancer medicines: adding feasibility to the magnitude of clinical benefit value chain. ESMO Open 2023; 8:101617. [PMID: 37672862 PMCID: PMC10594014 DOI: 10.1016/j.esmoop.2023.101617] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/25/2023] [Accepted: 07/07/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Cancer is a global public health problem, requiring efficient health system investments to deliver sustainable impact on population health. Access to medicines is a critical component of health systems, having a crucial role in delivering therapeutic benefits. Since 1977, the World Health Organization (WHO) has published a Model List of Essential Medicines (EML) that includes key health interventions for the prevention and control of conditions of public health relevance. Essential medicines are selected for inclusion in the EML based on the evidence of efficacy, safety, therapeutic value, and the potential to impact population health. With the rapid changes in the therapeutic landscape of cancer treatment with new medicine approvals, there is a critical need to select and prioritise specific cancer interventions based on their intrinsic value. MATERIALS AND METHODS The European Society for Medical Oncology (ESMO) has developed a decisional methodology based on a threshold with a minimum set of technical specifications and a consensus-based procedure for decisions to select candidate cancer medicines to be submitted to the WHO for consideration for the WHO EML. RESULTS ESMO recognises the WHO EML as an important reference guide for medicines that all countries should include in their national EMLs. Cancer medicines on the WHO EML are used in the treatment of the majority of cancers, and are recommended in the evidence-based ESMO Clinical Practice Guidelines that medical oncologists use to treat patients. ESMO's submissions to the WHO EML in 2019 and 2021 and their respective outcomes are presented in the manuscript. CONCLUSION Due to the rising costs associated with newly available therapies, structured, reproducible, and field-tested tools to evaluate the added clinical benefit from these therapies need to be implemented in pre-selecting potential candidate medicines to be included in the WHO EML. ESMO is proud to collaborate closely with WHO on this important global public health initiative.
Collapse
Affiliation(s)
- F Roitberg
- Hospital Sírio Libanês, São Paulo, Brazil.
| | - T Amaral
- Interdisciplinary Skin Cancer Center, Department of Dermatology, University Medical Centre Tübingen, Tübingen, Germany. https://twitter.com/TeresaSAmaral
| | - N I Cherny
- Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel. https://twitter.com/ChernyNathan
| | - R Giuliani
- Guy's and St Thomas's NHS Foundation Trust, London, UK; European Society for Medical Oncology (ESMO), Lugano, Switzerland. https://twitter.com/RosGiuliani
| | - N J Latino
- European Society for Medical Oncology (ESMO), Lugano, Switzerland. https://twitter.com/NicolaJaneLatino
| | - M Galotti
- European Society for Medical Oncology (ESMO), Lugano, Switzerland. https://twitter.com/MartinaGalotti
| | - G Bricalli
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - G Curigliano
- European Institute of Oncology, IRCCS, Milan; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy. https://twitter.com/curijoey
| | - G Pentheroudakis
- European Society for Medical Oncology (ESMO), Lugano, Switzerland. https://twitter.com/GPentheroudakis
| | - D Trapani
- European Institute of Oncology, IRCCS, Milan; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy. https://twitter.com/darioT_
| |
Collapse
|
22
|
Váraljai R, Zimmer L, Al-Matary Y, Kaptein P, Albrecht LJ, Shannan B, Brase JC, Gusenleitner D, Amaral T, Wyss N, Utikal J, Flatz L, Rambow F, Reinhardt HC, Dick J, Engel DR, Horn S, Ugurel S, Sondermann W, Livingstone E, Sucker A, Paschen A, Zhao F, Placke JM, Klose JM, Fendler WP, Thommen DS, Helfrich I, Schadendorf D, Roesch A. Author Correction: Interleukin 17 signaling supports clinical benefit of dual CTLA-4 and PD-1 checkpoint inhibition in melanoma. Nat Cancer 2023; 4:1395. [PMID: 37580519 PMCID: PMC10518252 DOI: 10.1038/s43018-023-00632-w] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Affiliation(s)
- Renáta Váraljai
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Yahya Al-Matary
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Paulien Kaptein
- Division of Molecular Oncology and Immunology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Lea J Albrecht
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Batool Shannan
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | | | | | - Teresa Amaral
- Department of Dermatology, University Hospital of Tübingen, Tübingen, Germany
| | - Nina Wyss
- Institute of Immunobiology, Kantonsspital St. Gallen, Switzerland, Switzerland
| | - Jochen Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht Karls University of Heidelberg, Mannheim, Germany
- DKFZ Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
| | - Lukas Flatz
- Department of Dermatology, University Hospital of Tübingen, Tübingen, Germany
- Institute of Immunobiology, Kantonsspital St. Gallen, Switzerland, Switzerland
| | - Florian Rambow
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
- Department of Applied Computational Cancer Research, Institute for AI in Medicine (IKIM), University Hospital Essen, Essen, Germany
| | - Hans Christian Reinhardt
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, Essen, Germany
- Center for Medical Biotechnology (ZMB), University of Duisburg-Essen, Essen, Germany
| | - Jenny Dick
- Department of Immunodynamics, Institute of Experimental Immunology and Imaging, University Hospital Essen, Essen, Germany
| | - Daniel R Engel
- Department of Immunodynamics, Institute of Experimental Immunology and Imaging, University Hospital Essen, Essen, Germany
| | - Susanne Horn
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
- Rudolf Schönheimer Institute of Biochemistry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Selma Ugurel
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Wiebke Sondermann
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Elisabeth Livingstone
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Antje Sucker
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Annette Paschen
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
- Center for Medical Biotechnology (ZMB), University of Duisburg-Essen, Essen, Germany
| | - Fang Zhao
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Jan M Placke
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Jasmin M Klose
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Daniela S Thommen
- Division of Molecular Oncology and Immunology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Iris Helfrich
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
- Department of Dermatology and Allergology, Ludwig Maximilian University Munich, Munich, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
- Center for Medical Biotechnology (ZMB), University of Duisburg-Essen, Essen, Germany
- NCT West, Campus Essen and University Alliance Ruhr, Research Center One Health, University Duisburg-Essen, Essen, Germany
| | - Alexander Roesch
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany.
- Center for Medical Biotechnology (ZMB), University of Duisburg-Essen, Essen, Germany.
| |
Collapse
|
23
|
Váraljai R, Zimmer L, Al-Matary Y, Kaptein P, Albrecht LJ, Shannan B, Brase JC, Gusenleitner D, Amaral T, Wyss N, Utikal J, Flatz L, Rambow F, Reinhardt HC, Dick J, Engel DR, Horn S, Ugurel S, Sondermann W, Livingstone E, Sucker A, Paschen A, Zhao F, Placke JM, Klose JM, Fendler WP, Thommen DS, Helfrich I, Schadendorf D, Roesch A. Interleukin 17 signaling supports clinical benefit of dual CTLA-4 and PD-1 checkpoint inhibition in melanoma. Nat Cancer 2023; 4:1292-1308. [PMID: 37525015 PMCID: PMC10518254 DOI: 10.1038/s43018-023-00610-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 07/06/2023] [Indexed: 08/02/2023]
Abstract
Recent studies suggest that BRAFV600-mutated melanomas in particular respond to dual anti-programmed cell death protein 1 (PD-1) and anti-cytotoxic T lymphocyte-associated protein 4 (CTLA-4) immune checkpoint inhibition (ICI). Here we identified an over-representation of interleukin (IL)-17-type 17 helper T (TH17) gene expression signatures (GES) in BRAFV600-mutated tumors. Moreover, high baseline IL-17 GES consistently predicted clinical responses in dual-ICI-treated patient cohorts but not in mono anti-CTLA-4 or anti-PD-1 ICI cohorts. High IL-17 GES corresponded to tumor infiltration with T cells and neutrophils. Accordingly, high neutrophil infiltration correlated with clinical response specifically to dual ICI, and tumor-associated neutrophils also showed strong IL-17-TH17 pathway activity and T cell activation capacity. Both the blockade of IL-17A and the depletion of neutrophils impaired dual-ICI response and decreased T cell activation. Finally, high IL-17A levels in the blood of patients with melanoma indicated a higher global TH17 cytokine profile preceding clinical response to dual ICI but not to anti-PD-1 monotherapy, suggesting a future role as a biomarker for patient stratification.
Collapse
Affiliation(s)
- Renáta Váraljai
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Yahya Al-Matary
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Paulien Kaptein
- Division of Molecular Oncology and Immunology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Lea J Albrecht
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Batool Shannan
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | | | | | - Teresa Amaral
- Department of Dermatology, University Hospital of Tübingen, Tübingen, Germany
| | - Nina Wyss
- Institute of Immunobiology, Kantonsspital St. Gallen, Switzerland, Switzerland
| | - Jochen Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht Karls University of Heidelberg, Mannheim, Germany
- DKFZ Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
| | - Lukas Flatz
- Department of Dermatology, University Hospital of Tübingen, Tübingen, Germany
- Institute of Immunobiology, Kantonsspital St. Gallen, Switzerland, Switzerland
| | - Florian Rambow
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
- Department of Applied Computational Cancer Research, Institute for AI in Medicine (IKIM), University Hospital Essen, Essen, Germany
| | - Hans Christian Reinhardt
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, Essen, Germany
- Center for Medical Biotechnology (ZMB), University of Duisburg-Essen, Essen, Germany
| | - Jenny Dick
- Department of Immunodynamics, Institute of Experimental Immunology and Imaging, University Hospital Essen, Essen, Germany
| | - Daniel R Engel
- Department of Immunodynamics, Institute of Experimental Immunology and Imaging, University Hospital Essen, Essen, Germany
| | - Susanne Horn
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
- Rudolf Schönheimer Institute of Biochemistry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Selma Ugurel
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Wiebke Sondermann
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Elisabeth Livingstone
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Antje Sucker
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Annette Paschen
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
- Center for Medical Biotechnology (ZMB), University of Duisburg-Essen, Essen, Germany
| | - Fang Zhao
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Jan M Placke
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Jasmin M Klose
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Daniela S Thommen
- Division of Molecular Oncology and Immunology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Iris Helfrich
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
- Department of Dermatology and Allergology, Ludwig Maximilian University Munich, Munich, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
- Center for Medical Biotechnology (ZMB), University of Duisburg-Essen, Essen, Germany
- NCT West, Campus Essen and University Alliance Ruhr, Research Center One Health, University Duisburg-Essen, Essen, Germany
| | - Alexander Roesch
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany.
- Center for Medical Biotechnology (ZMB), University of Duisburg-Essen, Essen, Germany.
| |
Collapse
|
24
|
Chatziioannou E, Roßner J, Aung TN, Rimm DL, Niessner H, Keim U, Serna-Higuita LM, Bonzheim I, Kuhn Cuellar L, Westphal D, Steininger J, Meier F, Pop OT, Forchhammer S, Flatz L, Eigentler T, Garbe C, Röcken M, Amaral T, Sinnberg T. Deep learning-based scoring of tumour-infiltrating lymphocytes is prognostic in primary melanoma and predictive to PD-1 checkpoint inhibition in melanoma metastases. EBioMedicine 2023; 93:104644. [PMID: 37295047 PMCID: PMC10363450 DOI: 10.1016/j.ebiom.2023.104644] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 05/15/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Recent advances in digital pathology have enabled accurate and standardised enumeration of tumour-infiltrating lymphocytes (TILs). Here, we aim to evaluate TILs as a percentage electronic TIL score (eTILs) and investigate its prognostic and predictive relevance in cutaneous melanoma. METHODS We included stage I to IV cutaneous melanoma patients and used hematoxylin-eosin-stained slides for TIL analysis. We assessed eTILs as a continuous and categorical variable using the published cut-off of 16.6% and applied Cox regression models to evaluate associations of eTILs with relapse-free, distant metastasis-free, and overall survival. We compared eTILs of the primaries with matched metastasis. Moreover, we assessed the predictive relevance of eTILs in therapy-naïve metastases according to the first-line therapy. FINDINGS We analysed 321 primary cutaneous melanomas and 191 metastatic samples. In simple Cox regression, tumour thickness (p < 0.0001), presence of ulceration (p = 0.0001) and eTILs ≤16.6% (p = 0.0012) were found to be significant unfavourable prognostic factors for RFS. In multiple Cox regression, eTILs ≤16.6% (p = 0.0161) remained significant and downgraded the current staging. Lower eTILs in the primary tissue was associated with unfavourable relapse-free (p = 0.0014) and distant metastasis-free survival (p = 0.0056). In multiple Cox regression adjusted for tumour thickness and ulceration, eTILs as continuous remained significant (p = 0.019). When comparing TILs in primary tissue and corresponding metastasis of the same patient, eTILs in metastases was lower than in primary melanomas (p < 0.0001). In therapy-naïve metastases, an eTILs >12.2% was associated with longer progression-free survival (p = 0.037) and melanoma-specific survival (p = 0.0038) in patients treated with anti-PD-1-based immunotherapy. In multiple Cox regression, lactate dehydrogenase (p < 0.0001) and eTILs ≤12.2% (p = 0.0130) were significantly associated with unfavourable melanoma-specific survival. INTERPRETATION Assessment of TILs is prognostic in primary melanoma samples, and the eTILs complements staging. In therapy-naïve metastases, eTILs ≤12.2% is predictive of unfavourable survival outcomes in patients receiving anti-PD-1-based therapy. FUNDING See a detailed list of funding bodies in the Acknowledgements section at the end of the manuscript.
Collapse
Affiliation(s)
- Eftychia Chatziioannou
- Department of Dermatology, University of Tübingen, Liebermeisterstr. 25, 72076 Tübingen, Germany; Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies", Tübingen, Germany
| | - Jana Roßner
- Department of Dermatology, University of Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Thazin New Aung
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - David L Rimm
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Heike Niessner
- Department of Dermatology, University of Tübingen, Liebermeisterstr. 25, 72076 Tübingen, Germany; Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies", Tübingen, Germany
| | - Ulrike Keim
- Department of Dermatology, University of Tübingen, Liebermeisterstr. 25, 72076 Tübingen, Germany
| | - Lina Maria Serna-Higuita
- Department of Clinical Epidemiology and Applied Biostatistics, Eberhard Karls University of Tübingen, 72076 Tübingen, Germany
| | - Irina Bonzheim
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen, 72076 Tübingen, Germany
| | - Luis Kuhn Cuellar
- Quantitative Biology Center (QBiC), University of Tübingen, Tübingen, Germany
| | - Dana Westphal
- Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Skin Cancer Center at the University Cancer Center and National Center for Tumor Diseases, Technical University Dresden, 01307 Dresden, Germany
| | - Julian Steininger
- Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Skin Cancer Center at the University Cancer Center and National Center for Tumor Diseases, Technical University Dresden, 01307 Dresden, Germany
| | - Friedegund Meier
- Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Skin Cancer Center at the University Cancer Center and National Center for Tumor Diseases, Technical University Dresden, 01307 Dresden, Germany
| | - Oltin Tiberiu Pop
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Stephan Forchhammer
- Department of Dermatology, University of Tübingen, Liebermeisterstr. 25, 72076 Tübingen, Germany
| | - Lukas Flatz
- Department of Dermatology, University of Tübingen, Liebermeisterstr. 25, 72076 Tübingen, Germany; Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Thomas Eigentler
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Claus Garbe
- Department of Dermatology, University of Tübingen, Liebermeisterstr. 25, 72076 Tübingen, Germany
| | - Martin Röcken
- Department of Dermatology, University of Tübingen, Liebermeisterstr. 25, 72076 Tübingen, Germany; Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies", Tübingen, Germany
| | - Teresa Amaral
- Department of Dermatology, University of Tübingen, Liebermeisterstr. 25, 72076 Tübingen, Germany; Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies", Tübingen, Germany
| | - Tobias Sinnberg
- Department of Dermatology, University of Tübingen, Liebermeisterstr. 25, 72076 Tübingen, Germany; Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies", Tübingen, Germany; Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| |
Collapse
|
25
|
Gaißler A, Bochem J, Spreuer J, Ottmann S, Martens A, Amaral T, Wagner NB, Claassen M, Meier F, Terheyden P, Garbe C, Eigentler T, Weide B, Pawelec G, Wistuba-Hamprecht K. Early decrease of blood myeloid-derived suppressor cells during checkpoint inhibition is a favorable biomarker in metastatic melanoma. J Immunother Cancer 2023; 11:e006802. [PMID: 37286306 PMCID: PMC10254874 DOI: 10.1136/jitc-2023-006802] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The need for reliable clinical biomarkers to predict which patients with melanoma will benefit from immune checkpoint blockade (ICB) remains unmet. Several different parameters have been considered in the past, including routine differential blood counts, T cell subset distribution patterns and quantification of peripheral myeloid-derived suppressor cells (MDSC), but none has yet achieved sufficient accuracy for clinical utility. METHODS Here, we investigated potential cellular biomarkers from clinical routine blood counts as well as several myeloid and T cell subsets, using flow cytometry, in two independent cohorts of a total of 141 patients with stage IV M1c melanoma before and during ICB. RESULTS Elevated baseline frequencies of monocytic MDSCs (M-MDSC) in the blood were confirmed to predict shorter overall survival (OS) (HR 2.086, p=0.030) and progression-free survival (HR 2.425, p=0.001) in the whole patient cohort. However, we identified a subgroup of patients with highly elevated baseline M-MDSC frequencies that fell below a defined cut-off during therapy and found that these patients had a longer OS that was similar to that of patients with low baseline M-MDSC frequencies. Importantly, patients with high M-MDSC frequencies exhibited a skewed baseline distribution of certain other immune cells but these did not influence patient survival, illustrating the paramount utility of MDSC assessment. CONCLUSION We confirmed that in general, highly elevated frequencies of peripheral M-MDSC are associated with poorer outcomes of ICB in metastatic melanoma. However, one reason for an imperfect correlation between high baseline MDSCs and outcome for individual patients may be the subgroup of patients identified here, with rapidly decreasing M-MDSCs on therapy, in whom the negative effect of high M-MDSC frequencies was lost. These findings might contribute to developing more reliable predictors of late-stage melanoma response to ICB at the individual patient level. A multifactorial model seeking such markers yielded only MDSC behavior and serum lactate dehydrogenase as predictors of treatment outcome.
Collapse
Affiliation(s)
- Andrea Gaißler
- Department of Dermatology, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Internal Medicine I, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Jonas Bochem
- Department of Dermatology, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Internal Medicine I, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Janine Spreuer
- Department of Dermatology, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Internal Medicine I, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Shannon Ottmann
- Department of Dermatology, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Alexander Martens
- Department of Dermatology, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Teresa Amaral
- Department of Dermatology, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Cluster of Excellence iFIT (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", Tübingen, Germany
| | - Nikolaus Benjamin Wagner
- Department of Dermatology, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Department of Dermatology, Venereology and Allergology, Kantonsspital St Gallen, Sankt Gallen, Switzerland
| | - Manfred Claassen
- Internal Medicine I, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Department of Computer Science, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Friedegund Meier
- Skin Cancer Center at the University Cancer Centre and National Center for Tumor Diseases Dresden; Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | | | - Claus Garbe
- Department of Dermatology, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Thomas Eigentler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Berlin, Germany
| | - Benjamin Weide
- Department of Dermatology, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Graham Pawelec
- Department of Immunology, Interfaculty Institute for Cell Biology, Eberhard Karls University Tübingen, Tübingen, Germany
- Health Sciences North Research Institute, Sudbury, Ontario, Canada
| | - Kilian Wistuba-Hamprecht
- Department of Dermatology, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Internal Medicine I, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Department of Immunology, Interfaculty Institute for Cell Biology, Eberhard Karls University Tübingen, Tübingen, Germany
| |
Collapse
|
26
|
Garbe C, Dummer R, Amaral T, Amaria RN, Ascierto PA, Burton EM, Dreno B, Eggermont AMM, Hauschild A, Hoeller C, Kaufmann R, Lebbe C, Mandala M, Menzies AM, Moreno D, Michielin O, Nathan P, Patel SP, Robert C, Schadendorf D, Lorigan PC, Scolyer RA, Tawbi HA, van de Wiel BA, Blank C, Long GV. Neoadjuvant immunotherapy for melanoma is now ready for clinical practice. Nat Med 2023:10.1038/s41591-023-02336-1. [PMID: 37193799 DOI: 10.1038/s41591-023-02336-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Affiliation(s)
- Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany.
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zürich (USZ), Zürich, Switzerland.
- Faculty of Medicine, University of Zürich (UZH), Zürich, Switzerland.
| | - Teresa Amaral
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Rodabe N Amaria
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paolo A Ascierto
- Department of Skin Cancer, Cancer Immunotherapy and Development Therapeutics, Instituto Nazionale Tumouri IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Elizabeth M Burton
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Alexander M M Eggermont
- Faculty of Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Comprehensive Cancer Centre Munich of the Technical University Munich and the Ludwig Maximilians University, Munich, Germany
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Christoph Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Roland Kaufmann
- Department of Dermatology, Venerology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Celeste Lebbe
- Université Paris Cite, AP-HP Department of Dermatology, Hôpital Saint-Louis Paris, Paris, France
| | - Mario Mandala
- Department of Surgery and Medicine, Unit of Medical Oncology, University of Perugia, Perugia, Italy
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
- Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia
| | - David Moreno
- Medical & Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Olivier Michielin
- Department of Medical Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Sapna P Patel
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Caroline Robert
- Department of Medical Oncology, Gustave Roussy and Paris-Saclay University, Villejuif, France
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, Essen, Germany
- German Cancer Consortium, Heidelberg Partner Site Essen, Essen, Germany
| | | | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
- Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia
| | - Hussein A Tawbi
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bart A van de Wiel
- Department of Pathology, Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands
| | - Christian Blank
- Department of Medical Oncology, Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands
- Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
- Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
27
|
Chatziioannou E, Leiter U, Thomas I, Keim U, Seeber O, Meiwes A, Boessenecker I, Gonzalez SS, Torres FM, Niessner H, Sinnberg T, Forschner A, Flatz L, Amaral T. Features and Long-Term Outcomes of Stage IV Melanoma Patients Achieving Complete Response Under Anti-PD-1-Based Immunotherapy. Am J Clin Dermatol 2023; 24:453-467. [PMID: 37142875 DOI: 10.1007/s40257-023-00775-7] [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] [Accepted: 03/25/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Immune checkpoint inhibition (ICI) has changed the melanoma treatment spectrum. Few studies have examined the characteristics and long-term outcomes of patients achieving complete response (CR) under ICI. MATERIALS AND METHODS We evaluated patients with unresectable stage IV melanoma treated with first-line ICI. The characteristics of those achieving CR were compared with those not achieving CR. Progression-free survival (PFS) and overall survival (OS) were assessed. Late-onset toxicities, response to second-line treatment, the prognostic value of clinicopathologic features, and blood markers were examined. RESULTS A total of 265 patients were included; 41 (15.5%) achieved CR, while 224 (84.5%) had progressive disease, stable disease, or partial response. At the therapy start, those who had CR were more likely to be older than 65 years of age (p = 0.013), have a platelet-to-lymphocyte ratio below 213 (p = 0.036), and have lower lactate dehydrogenase levels (p = 0.008) than those not achieving a CR. For those who discontinued therapy after CR, the median follow-up time after CR was 56 months (interquartile range [IQR] 52-58) and the median time from CR to therapy end was 10 months (IQR 1-17). Five-year PFS after CR was 79% and 5-year OS was 83%. Most complete responders had a normalization of S100 at the time of CR (p < 0.001). In simple Cox regression analysis, age below 77 years at CR (p = 0.04) was associated with better prognosis after CR. Eight patients received second-line ICI; disease control was seen in 63%. Late immune-related toxicities occurred in 25% of patients, most being cutaneous immune-related toxicities. CONCLUSIONS Response, according to the Response Evaluation Criteria in Solid Tumors (RECIST) criteria, is, until now, the most important prognostic factor, and CR is a valid surrogate marker for long-term survival in patients treated with ICI. Our results highlight the importance of investigating the optimal therapy duration in complete responders.
Collapse
Affiliation(s)
- Eftychia Chatziioannou
- Center for Dermato-Oncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Liebermeisterstrasse 25, 72076, Tuebingen, Germany
| | - Ulrike Leiter
- Center for Dermato-Oncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Liebermeisterstrasse 25, 72076, Tuebingen, Germany
| | - Ioannis Thomas
- Center for Dermato-Oncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Liebermeisterstrasse 25, 72076, Tuebingen, Germany
| | - Ulrike Keim
- Center for Dermato-Oncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Liebermeisterstrasse 25, 72076, Tuebingen, Germany
| | - Olivia Seeber
- Center for Dermato-Oncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Liebermeisterstrasse 25, 72076, Tuebingen, Germany
| | - Andreas Meiwes
- Center for Dermato-Oncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Liebermeisterstrasse 25, 72076, Tuebingen, Germany
| | - Isabell Boessenecker
- Center for Dermato-Oncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Liebermeisterstrasse 25, 72076, Tuebingen, Germany
| | - Stephanie Sanchez Gonzalez
- Center for Dermato-Oncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Liebermeisterstrasse 25, 72076, Tuebingen, Germany
| | - Francisco Merraz Torres
- Center for Dermato-Oncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Liebermeisterstrasse 25, 72076, Tuebingen, Germany
| | - Heike Niessner
- Center for Dermato-Oncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Liebermeisterstrasse 25, 72076, Tuebingen, Germany
- Cluster of Excellence iFIT (EXC 2180), Tuebingen, Germany
| | - Tobias Sinnberg
- Center for Dermato-Oncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Liebermeisterstrasse 25, 72076, Tuebingen, Germany
- Cluster of Excellence iFIT (EXC 2180), Tuebingen, Germany
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea Forschner
- Center for Dermato-Oncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Liebermeisterstrasse 25, 72076, Tuebingen, Germany
| | - Lukas Flatz
- Center for Dermato-Oncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Liebermeisterstrasse 25, 72076, Tuebingen, Germany
- Institute for Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Teresa Amaral
- Center for Dermato-Oncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Liebermeisterstrasse 25, 72076, Tuebingen, Germany.
- Cluster of Excellence iFIT (EXC 2180), Tuebingen, Germany.
| |
Collapse
|
28
|
Perez-Gracia JL, Penel N, Calvo E, Arkenau HT, Amaral T, Grünwald V, Sanmamed MF. Reply to letter to the editor "Bureaucracy or Streamlining the Rules in "Good Clinical Practice (GCP)" - Has Equipoise Occurred?" by H. K. Kotikonda, V. G. Jonnalagadda and S. R. Venna. Ann Oncol 2023; 34:498-499. [PMID: 37121610 DOI: 10.1016/j.annonc.2023.02.003] [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] [Received: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 05/02/2023] Open
Affiliation(s)
- J L Perez-Gracia
- Department of Oncology, University Clinic of Navarra and Health Research Institute of Navarra (IdiSNA), Pamplona, Spain.
| | - N Penel
- Centre Oscar Lambret, Lille, France; Medical School, Lille University, Lille, France
| | - E Calvo
- START Madrid-CIOCC, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | | | - T Amaral
- Division of Dermato-oncology, Department of Dermatology, University of Tuebingen, Tuebingen, Germany; Cluster of Excellence iFIT (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", Tuebingen, Germany
| | - V Grünwald
- University Hospital Essen, Clinic for Medical Oncology and Clinic for Urology, Essen, Germany
| | - M F Sanmamed
- Department of Oncology, University Clinic of Navarra and Health Research Institute of Navarra (IdiSNA), Pamplona, Spain
| |
Collapse
|
29
|
Amaral T, Sinnberg T, Chatziioannou E, Niessner H, Leiter U, Keim U, Forschner A, Dwarkasing J, Tjien-Fooh F, Wever R, Flatz L, Eggermont A, Forchhammer S. Identification of stage I/II melanoma patients at high risk for recurrence using a model combining clinicopathologic factors with gene expression profiling (CP-GEP). Eur J Cancer 2023; 182:155-162. [PMID: 36739215 DOI: 10.1016/j.ejca.2022.12.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 10/31/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE Patients with cutaneous melanoma stage I/IIA disease are currently not eligible for adjuvant therapy, despite their risk for relapses and death. This study validates the ability of a model combining clinicopathologic factors with gene expression profiling (CP-GEP) to identify patients at high risk for disease recurrence in stage I/II and subgroup stage I/IIA. PATIENTS AND METHODS 543 patients with stage I/II primary cutaneous melanoma from the University of Tuebingen diagnosed between 2000 and 2017 were analysed. All patients received sentinel lymph node biopsy (SLNB). Analysis was conducted for a separate group of 80 patients who did not undergo SLNB. RESULTS CP-GEP stratified 424 stage I/IIA patients (78% of the cohort) according to their risk for recurrence, with five-year relapse-free survival (RFS) rates of 77.8% and 93% for CP-GEP high risk (195 patients) and low risk (229 patients), respectively, and hazard ratio of 3.53 (p-value <0.001). In patients who did not receive SLNB biopsy, CP-GEP captured 6 out of 7 relapses. CONCLUSION CP-GEP can be used to identify primary cutaneous melanoma patients with a high risk for disease recurrence - especially for stage I/IIA, who are considered low risk by AJCC 8th. These patients may benefit from adjuvant therapy. Also, in the future, when SLNB may become irrelevant, CP-GEP may serve as a risk stratification tool.
Collapse
Affiliation(s)
- Teresa Amaral
- Center for Dermatooncology, Eberhard Karls University of Tuebingen, Germany; Cluster of Excellence IFIT (EXC 2180), Tuebingen, Germany.
| | - Tobias Sinnberg
- Center for Dermatooncology, Eberhard Karls University of Tuebingen, Germany; Cluster of Excellence IFIT (EXC 2180), Tuebingen, Germany
| | | | - Heike Niessner
- Center for Dermatooncology, Eberhard Karls University of Tuebingen, Germany; Cluster of Excellence IFIT (EXC 2180), Tuebingen, Germany
| | - Ulrike Leiter
- Center for Dermatooncology, Eberhard Karls University of Tuebingen, Germany
| | - Ulrike Keim
- Center for Dermatooncology, Eberhard Karls University of Tuebingen, Germany
| | - Andrea Forschner
- Center for Dermatooncology, Eberhard Karls University of Tuebingen, Germany
| | | | | | | | - Lukas Flatz
- Center for Dermatooncology, Eberhard Karls University of Tuebingen, Germany
| | - Alexander Eggermont
- SkylineDx BV, Rotterdam, the Netherlands; Comprehensive Cancer Center München, Technical University Munich & Ludwig Maximiliaan University Munich, Germany; UMC Utrecht, the Netherlands
| | | |
Collapse
|
30
|
Nuñez NG, Berner F, Friebel E, Unger S, Wyss N, Gomez JM, Purde MT, Niederer R, Porsch M, Lichtensteiger C, Kramer R, Erdmann M, Schmitt C, Heinzerling L, Abdou MT, Karbach J, Schadendorf D, Zimmer L, Ugurel S, Klümper N, Hölzel M, Power L, Kreutmair S, Capone M, Madonna G, Cevhertas L, Heider A, Amaral T, Hasan Ali O, Bomze D, Dimitriou F, Diem S, Ascierto PA, Dummer R, Jäger E, Driessen C, Levesque MP, van de Veen W, Joerger M, Früh M, Becher B, Flatz L. Immune signatures predict development of autoimmune toxicity in patients with cancer treated with immune checkpoint inhibitors. Med (N Y) 2023; 4:113-129.e7. [PMID: 36693381 DOI: 10.1016/j.medj.2022.12.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [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: 11/29/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) are among the most promising treatment options for melanoma and non-small cell lung cancer (NSCLC). While ICIs can induce effective anti-tumor responses, they may also drive serious immune-related adverse events (irAEs). Identifying biomarkers to predict which patients will suffer from irAEs would enable more accurate clinical risk-benefit analysis for ICI treatment and may also shed light on common or distinct mechanisms underpinning treatment success and irAEs. METHODS In this prospective multi-center study, we combined a multi-omics approach including unbiased single-cell profiling of over 300 peripheral blood mononuclear cell (PBMC) samples and high-throughput proteomics analysis of over 500 serum samples to characterize the systemic immune compartment of patients with melanoma or NSCLC before and during treatment with ICIs. FINDINGS When we combined the parameters obtained from the multi-omics profiling of patient blood and serum, we identified potential predictive biomarkers for ICI-induced irAEs. Specifically, an early increase in CXCL9/CXCL10/CXCL11 and interferon-γ (IFN-γ) 1 to 2 weeks after the start of therapy are likely indicators of heightened risk of developing irAEs. In addition, an early expansion of Ki-67+ regulatory T cells (Tregs) and Ki-67+ CD8+ T cells is also likely to be associated with increased risk of irAEs. CONCLUSIONS We suggest that the combination of these cellular and proteomic biomarkers may help to predict which patients are likely to benefit most from ICI therapy and those requiring intensive monitoring for irAEs. FUNDING This work was primarily funded by the European Research Council, the Swiss National Science Foundation, the Swiss Cancer League, and the Forschungsförderung of the Kantonsspital St. Gallen.
Collapse
Affiliation(s)
- Nicolas Gonzalo Nuñez
- Institute of Experimental Immunology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Fiamma Berner
- Institute of Immunobiology, Medical Research Center, Kantonsspital St. Gallen, St.Gallen, Switzerland
| | - Ekaterina Friebel
- Institute of Experimental Immunology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Susanne Unger
- Institute of Experimental Immunology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Nina Wyss
- Institute of Immunobiology, Medical Research Center, Kantonsspital St. Gallen, St.Gallen, Switzerland; Department of Dermatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Julia Martinez Gomez
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mette-Triin Purde
- Institute of Immunobiology, Medical Research Center, Kantonsspital St. Gallen, St.Gallen, Switzerland
| | - Rebekka Niederer
- Institute of Immunobiology, Medical Research Center, Kantonsspital St. Gallen, St.Gallen, Switzerland; Department of Dermatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Maximilian Porsch
- Department of Radiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Christa Lichtensteiger
- Institute of Immunobiology, Medical Research Center, Kantonsspital St. Gallen, St.Gallen, Switzerland
| | - Rafaela Kramer
- Department of Dermatology, Uniklinikum Erlangen, Deutsches Zentrum Immuntherapie (DZI), Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Michael Erdmann
- Department of Dermatology, Uniklinikum Erlangen, Deutsches Zentrum Immuntherapie (DZI), Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Christina Schmitt
- Department of Dermatology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Lucie Heinzerling
- Department of Dermatology, Uniklinikum Erlangen, Deutsches Zentrum Immuntherapie (DZI), Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; Department of Dermatology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Marie-Therese Abdou
- Institute of Immunobiology, Medical Research Center, Kantonsspital St. Gallen, St.Gallen, Switzerland
| | - Julia Karbach
- Department of Oncology and Hematology, Krankenhaus Nordwest, Frankfurt, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen and German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Essen, Germany
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen and German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Essen, Germany
| | - Selma Ugurel
- Department of Dermatology, University Hospital Essen and German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Essen, Germany
| | - Niklas Klümper
- Institute for Experimental Oncology, University Hospital Bonn, Bonn, Germany; Center for Integrated Oncology Cologne/Bonn, University Hospital Bonn, Bonn, Germany; Department of Urology, University Hospital Bonn, Bonn, Germany
| | - Michael Hölzel
- Institute for Experimental Oncology, University Hospital Bonn, Bonn, Germany; Center for Integrated Oncology Cologne/Bonn, University Hospital Bonn, Bonn, Germany
| | - Laura Power
- Institute of Experimental Immunology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Stefanie Kreutmair
- Institute of Experimental Immunology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Mariaelena Capone
- Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Napoli, Italy
| | - Gabriele Madonna
- Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Napoli, Italy
| | - Lacin Cevhertas
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Department of Medical Immunology, Institute of Health Sciences, Bursa Uludag University, Bursa, Turkey
| | - Anja Heider
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Teresa Amaral
- Skin Cancer Center, Department of Dermatology, University Hospital Tübingen, Tübingen, Germany; iFIT Cluster of Excellence (EXC 2180), University of Tübingen, Tübingen, Germany
| | - Omar Hasan Ali
- Institute of Immunobiology, Medical Research Center, Kantonsspital St. Gallen, St.Gallen, Switzerland; Department of Dermatology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Medical Genetics, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada
| | - David Bomze
- Institute of Immunobiology, Medical Research Center, Kantonsspital St. Gallen, St.Gallen, Switzerland; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Florentia Dimitriou
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stefan Diem
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Elke Jäger
- Department of Oncology and Hematology, Krankenhaus Nordwest, Frankfurt, Germany
| | - Christoph Driessen
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Mitchell Paul Levesque
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Willem van de Veen
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Markus Joerger
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Martin Früh
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Burkhard Becher
- Institute of Experimental Immunology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland.
| | - Lukas Flatz
- Institute of Immunobiology, Medical Research Center, Kantonsspital St. Gallen, St.Gallen, Switzerland; Department of Dermatology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Universitäts-Hautklinik, University of Tübingen, 72016 Tübingen, Germany.
| |
Collapse
|
31
|
Zarkavelis G, Amylidi AL, Verbaanderd C, Cherny NI, Metaxas Y, de Vries EGE, Zygoura P, Amaral T, Jordan K, Strijbos M, Dafni U, Latino N, Galotti M, Lordick F, Giuliani R, Pignatti F, Pentheroudakis G. Off-label despite high-level evidence: a clinical practice review of commonly used off-patent cancer medicines. ESMO Open 2023; 8:100604. [PMID: 36870739 PMCID: PMC10024100 DOI: 10.1016/j.esmoop.2022.100604] [Citation(s) in RCA: 3] [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: 08/30/2022] [Accepted: 09/10/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Off-label use of medicines is generally discouraged. However, several off-patent, low-cost cancer medicines remain off-label for indications in which they are commonly used in daily practice, supported by high-level evidence based on results of phase III clinical trials. This discrepancy may generate prescription and reimbursement obstacles as well as impaired access to established therapies. METHODS A list of cancer medicines that remain off-label in specific indications despite the presence of high-level evidence was generated and subjected to European Society for Medical Oncology (ESMO) expert peer review to assess for accountability of reasonableness. These medicines were then surveyed on approval procedures and workflow impact. The most illustrative examples of these medicines were reviewed by experts from the European Medicines Agency to ascertain the apparent robustness of the supporting phase III trial evidence from a regulatory perspective. RESULTS A total of 47 ESMO experts reviewed 17 cancer medicines commonly used off-label in six disease groups. Overall, high levels of agreement were recorded on the off-label status and the high quality of data supporting the efficacy in the off-label indications, often achieving high ESMO-Magnitude of Clinical Benefit Scale (ESMO-MCBS) scores. When prescribing these medicines, 51% of the reviewers had to implement a time-consuming process associated with additional workload, in the presence of litigation risks and patient anxiety. Finally, the informal regulatory expert review identified only 2 out of 18 (11%) studies with significant limitations that would be difficult to overcome in the context of a potential marketing authorisation application without additional studies. CONCLUSIONS We highlight the common use of off-patent essential cancer medicines in indications that remain off-label despite solid supporting data as well as generate evidence on the adverse impact on patient access and clinic workflows. In the current regulatory framework, incentives to promote the extension of indications of off-patent cancer medicines are needed for all stakeholders.
Collapse
Affiliation(s)
- G Zarkavelis
- University of Ioannina-Department of Medical Oncology, Ioannina, Greece
| | - A L Amylidi
- University of Ioannina-Department of Medical Oncology, Ioannina, Greece
| | - C Verbaanderd
- European Medicines Agency, Amsterdam, the Netherlands
| | - N I Cherny
- Cancer Pain and Palliative Medicine Service, Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Y Metaxas
- Kantonsspital Münsterlingen, Münsterlingen, Switzerland
| | - E G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - P Zygoura
- Frontier Science Foundation-Hellas, Athens, Greece
| | - T Amaral
- Skin Cancer Center, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - K Jordan
- Department of Medicine V, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany; Department of Hematology, Oncology and Palliative Medicine, Ernst von Bergmann Hospital Potsdam, Potsdam, Germany
| | - M Strijbos
- GZA Ziekenhuizen Campus Sint-Augustinus, Antwerp, Belgium
| | - U Dafni
- Frontier Science Foundation-Hellas, Athens, Greece; Laboratory of Biostatistics, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - N Latino
- ESMO Head Office, Lugano, Switzerland
| | - M Galotti
- ESMO Head Office, Lugano, Switzerland
| | - F Lordick
- Department of Oncology, Gastroenterology, Hepatology, Pulmonology and Infectious Diseases, University Cancer Center Leipzig (UCCL), Leipzig University Medical Center, Leipzig, Germany
| | - R Giuliani
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - F Pignatti
- European Medicines Agency, Amsterdam, the Netherlands
| | | |
Collapse
|
32
|
Jordan K, De Azambuja E, Amaral T, Strijbos M, Curigliano G, Lordick F. Medical Oncology Education in Europe: Equipping Medical Oncologists to Provide the Best Care for Patients with Cancer. Oncol Res Treat 2023; 46:72-79. [PMID: 36642069 DOI: 10.1159/000529128] [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: 10/21/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND High-quality, evidence-based, and practice-relevant education is essential to equip medical oncologists to provide high-quality care for patients with cancer. The need for medical oncology education is growing due to a rapid development of new therapies with novel mechanisms of action. Moreover, the number of patients with cancer is increasing with the rising in incidence and improved survival for some cancers. Access to medical oncology education and training opportunities, particularly in research, varies considerably in different countries and regions. SUMMARY The European Society for Medical Oncology (ESMO), the European School of Oncology (ESO), and other relevant associations have developed a wide range of opportunities, resources, and measures to increase access to high-quality medical oncology education. Initiatives that are helping to achieve effective and consistent medical oncology education include the ESMO/ASCO (American Society of Medical Oncology) global curriculum in medical oncology. KEY MESSAGES There is great value in providing wider educational opportunities than local and national training to increase access and, potentially, quality and scope and reduce variations in medical oncology education. Pan-European and global educational initiatives open up the expertise, knowledge, and best practice on different tumour types and cross-sectional topics, such as supportive and palliative care that can be shared between medical oncologists from other countries.
Collapse
Affiliation(s)
- Karin Jordan
- Department of Hematology, Oncology and Palliative Medicine, Ernst von Bergmann Hospital, Potsdam, Germany.,Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - Evandro De Azambuja
- Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - Teresa Amaral
- Skin Cancer Center, Eberhard Karls University, Tubingen, Germany
| | | | - Giuseppe Curigliano
- Division of Early Drug Development, European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Florian Lordick
- University Cancer Center Leipzig (UCCL) and Department of Medicine II, University of Leipzig Medical Center, Leipzig, Germany
| |
Collapse
|
33
|
Mair MJ, Cardone C, Connolly L, Kfoury M, Lambertini M, Lim J, Mariamidze E, Matikas A, Pihlak R, Punie K, Oing C, Sánchez-Bayona R, Sobczuk P, Zhu H, Berghoff AS, Amaral T. Career and Professional Development for Young Oncologists. Oncol Res Treat 2023; 46:67-71. [PMID: 36473447 DOI: 10.1159/000528541] [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: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
Young oncologists around the globe face many challenges when it comes to their career and professional development. Aspects such as time management, work-life balance, career progression, and educational opportunities are only some of them. Professional societies have identified these challenges in this professional group and designed programs to tackle them specifically. The importance of this strategy cannot be overstated, as young oncologists, defined by most societies as oncologists under 40 years of age, compose almost 50% of the oncology workforce. On the other hand, recent surveys have shown that many young oncologists are considering alternative career paths due to burnout issues aggravated by the COVID-19 pandemic, on top of all other challenges. The virtual setting that has been forcedly introduced into our professional life has shortened distances between professionals and might have contributed to more accessible access to information and opportunities that some young oncologists could not profit from due to their traveling constraints. On the other hand, this virtual setting has shown us the asymmetries in opportunities for these professionals. Knowledgeable of all this, we summarize in this article some of the career and professional development offers available to all young oncologists, which we consider could help them deal with current and future challenges.
Collapse
Affiliation(s)
- Maximilian J Mair
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Claudia Cardone
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori- IRCCS-Fondazione G. Pascale, Naples, Italy
| | - Liz Connolly
- Department of Medical Oncology, Chris O Brien Lifehouse, Sydney, New South Wales, Australia
| | - Maria Kfoury
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy.,Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Jonathan Lim
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Elene Mariamidze
- Todua Clinic Department of Oncology and Haematology, Tbilisi, Georgia
| | - Alexios Matikas
- Breast Center, Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - Rille Pihlak
- Medical Oncology Department, St Bartholomew's Hospital, London, UK
| | - Kevin Punie
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute and University Hospitals Leuven, Leuven, Belgium
| | - Christoph Oing
- Translational and Clinical Research Institute, Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | | | - Pawel Sobczuk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Skłodowska-Curie National Research instutute of Oncology, Warsaw, Poland
| | - Hongcheng Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Anna S Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Teresa Amaral
- Skin Cancer Clinical Trials Center, Eberhard Karls University, Tuebingen, Germany
| |
Collapse
|
34
|
Perez-Gracia JL, Penel N, Calvo E, Awada A, Arkenau HT, Amaral T, Grünwald V, Sanmamed MF, Castelo-Branco L, Bodoky G, Lolkema MP, Di Nicola M, Casali P, Giuliani R, Pentheroudakis G. Streamlining clinical research: an ESMO awareness call to improve sponsoring and monitoring of clinical trials. Ann Oncol 2023; 34:70-77. [PMID: 36209982 DOI: 10.1016/j.annonc.2022.09.162] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND During recent years, the burden of bureaucracy in clinical research has increased dramatically, adversely impacting the activity of investigators and clinical research teams. Although compliance with the Declaration of Helsinki, the guidelines for Good Clinical Practice (GCP), and other applicable regulations remains unquestionable, their overinterpretation and substitution by the internal operating procedures of sponsors and Contract Research Organizations (CROs) have increased the administrative burden. A survey conducted by the European Society for Medical Oncology (ESMO) Clinical Research Observatory (ECRO) among 940 investigators confirmed that they considered that the administrative burden in clinical research is excessive; that administrative procedures could be reduced without affecting the safety and the rights of the patients and the quality of the data; and that bureaucracy represents an obstacle for clinical research. METHODS A panel of physicians with extensive experience in clinical research, composed by members of the ECRO and the ESMO Scientific Medical and Public Policy divisions, analyzed clinical trial procedures related to administrative workflow, pharmacovigilance, and medical care. RESULTS The panel identified situations that generate debate between investigators and sponsors/CROs and selected real clinical scenarios that exemplify such situations. The panel discussed and proposed specific recommendations for those situations, based on GCP. CONCLUSIONS This initiative aspires to streamline clinical research procedures and to become a platform for discussion among all clinical trial stakeholders, with the aim of promoting the sustainability of clinical research and the care of cancer patients.
Collapse
Affiliation(s)
- J L Perez-Gracia
- Department of Oncology, University Clinic of Navarra and Health Research Institute of Navarra (IdiSNA), Pamplona, Spain.
| | - N Penel
- Centre Oscar Lambret and Lille University, Lille, France
| | - E Calvo
- START Madrid-CIOCC, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - A Awada
- Institut Jules Bordet, Université Libre de Bruxelles (Head of the Oncology Medicine Department), Brussels, Belgium
| | | | - T Amaral
- Division of Dermato-Oncology, Department of Dermatology, University of Tuebingen, Tuebingen, Germany; Cluster of Excellence iFIT (EXC 2180) 'Image Guided and Functionally Instructed Tumor Therapies', Tuebingen, Germany
| | - V Grünwald
- University Hospital Essen, Clinic for Medical Oncology and Clinic for Urology, Essen, Germany
| | - M F Sanmamed
- Department of Oncology, University Clinic of Navarra and Health Research Institute of Navarra (IdiSNA), Pamplona, Spain
| | - L Castelo-Branco
- Scientific and Medical Division, ESMO - European Society for Medical Oncology, 6900 - Lugano, Switzerland; NOVA National School of Public Health, NOVA University, Lisbon, Portugal
| | | | - M P Lolkema
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M Di Nicola
- Immunotherapy and Innovative Therapeutics Unit, Oncology and Hematology Department Fondazione, IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - P Casali
- Fondazione IRCCS Istituto Nazionale Tumori and University of Milan, Milan, Italy
| | - R Giuliani
- The Clatterbridge Cancer Centre, Liverpool, UK
| | - G Pentheroudakis
- Scientific and Medical Division, European Society for Medical Oncology, Lugano, Switzerland
| |
Collapse
|
35
|
Schumann K, Mauch C, Klespe KC, Loquai C, Nikfarjam U, Schlaak M, Akçetin L, Kölblinger P, Hoellwerth M, Meissner M, Mengi G, Braun AD, Mengoni M, Dummer R, Mangana J, Sindrilaru MA, Radmann D, Hafner C, Freund J, Rappersberger K, Weihsengruber F, Meiss F, Reinhardt L, Meier F, Rainer B, Richtig E, Ressler JM, Höller C, Eigentler T, Amaral T, Peitsch WK, Hillen U, Harth W, Ziller F, Schatton K, Gambichler T, Susok L, Maul LV, Läubli H, Debus D, Weishaupt C, Börger S, Sievers K, Haferkamp S, Zenderowski V, Nguyen VA, Wanner M, Gutzmer R, Terheyden P, Kähler K, Emmert S, Thiem A, Sachse M, Gercken-Riedel S, Kaune KM, Thoms KM, Heinzerling L, Heppt MV, Tratzmiller S, Hoetzenecker W, Öllinger A, Steiner A, Peinhaupt T, Podda M, Schmid S, Wollina U, Biedermann T, Posch C. Real-world outcomes using PD-1 antibodies and BRAF + MEK inhibitors for adjuvant melanoma treatment from 39 skin cancer centers in Germany, Austria and Switzerland. J Eur Acad Dermatol Venereol 2022; 37:894-906. [PMID: 36433688 DOI: 10.1111/jdv.18779] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Programmed death-1 (PD-1) antibodies and BRAF + MEK inhibitors are widely used for adjuvant therapy of fully resected high-risk melanoma. Little is known about treatment efficacy outside of phase III trials. This real-world study reports on clinical outcomes of modern adjuvant melanoma treatment in specialized skin cancer centers in Germany, Austria and Switzerland. METHODS Multicenter, retrospective study investigating stage III-IV melanoma patients receiving adjuvant nivolumab (NIV), pembrolizumab (PEM) or dabrafenib + trametinib (D + T) between 1/2017 and 10/2021. The primary endpoint was 12-month recurrence-free survival (RFS). Further analyses included descriptive and correlative statistics, and a multivariate linear-regression machine learning model to assess the risk of early melanoma recurrence. RESULTS In total, 1198 patients from 39 skin cancer centers from Germany, Austria and Switzerland were analysed. The vast majority received anti PD-1 therapies (n = 1003). Twelve-month RFS for anti PD-1 and BRAF + MEK inhibitor-treated patients were 78.1% and 86.5%, respectively (hazard ratio [HR] 1.998 [95% CI 1.335-2.991]; p = 0.001). There was no statistically significant difference in overall survival (OS) in anti PD-1 (95.8%) and BRAF + MEK inhibitor (96.9%) treated patients (p > 0.05) during the median follow-up of 17 months. Data indicates that anti PD-1 treated patients who develop immune-related adverse events (irAEs) have lower recurrence rates compared to patients with no irAEs (HR 0.578 [95% CI 0.443-0.754], p = 0.001). BRAF mutation status did not affect overall efficacy of anti PD-1 treatment (p > 0.05). In both, anti PD-1 and BRAF + MEK inhibitor treated cohorts, data did not show any difference in 12-month RFS and 12-month OS comparing patients receiving total lymph node dissection (TLND) versus sentinel lymph node biopsy only (p > 0.05). The recurrence prediction model reached high specificity but only low sensitivity with an AUC = 0.65. No new safety signals were detected. Overall, recorded numbers and severity of adverse events were lower than reported in pivotal phase III trials. CONCLUSIONS Despite recent advances in adjuvant melanoma treatment, early recurrence remains a significant clinical challenge. This study shows that TLND does not reduce the risk of early melanoma recurrence and should only be considered in selected patients. Data further highlight that variables collected during clinical routine are unlikely to allow for a clinically relevant prediction of individual recurrence risk.
Collapse
Affiliation(s)
- Katharina Schumann
- Department of Dermatology and Allergy, School of Medicine, German Cancer Consortium (DKTK), Technical University of Munich, Munich, Germany
| | - Cornelia Mauch
- Department for Dermatology and Venereology and CIO ABCD, University Hospital Köln, Köln, Germany
| | - Kai-Christian Klespe
- Department for Dermatology and Venereology and CIO ABCD, University Hospital Köln, Köln, Germany
| | - Carmen Loquai
- Department for Dermatology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Ulrike Nikfarjam
- Department for Dermatology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Max Schlaak
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Larissa Akçetin
- Department for Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
| | - Peter Kölblinger
- Department for Dermatology and Allergology, Paracelsus Medical University, Salzburg, Austria
| | - Magdalena Hoellwerth
- Department for Dermatology and Allergology, Paracelsus Medical University, Salzburg, Austria
| | - Markus Meissner
- Department for Dermatology, University Clinic Frankfurt, Frankfurt, Germany
| | - Guelcin Mengi
- Department for Dermatology, University Clinic Frankfurt, Frankfurt, Germany
| | | | - Miriam Mengoni
- Department of Dermatology, University Hospital Magdeburg, Magdeburg, Germany
| | - Reinhard Dummer
- Dermatology Clinic, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Joanna Mangana
- Dermatology Clinic, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | - Dan Radmann
- Department for Dermatology and Allergy, University Clinic Ulm, Ulm, Germany
| | - Christine Hafner
- Department of Dermatology, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Johann Freund
- Department of Dermatology, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | | | | | - Frank Meiss
- Department for Dermatology and Venereology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Lydia Reinhardt
- Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Dresden, Germany.,Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Friedegund Meier
- Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Dresden, Germany.,Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Barbara Rainer
- Department of Dermatology and Venereology, Medical University Graz, Graz, Austria
| | - Erika Richtig
- Department of Dermatology and Venereology, Medical University Graz, Graz, Austria
| | | | - Christoph Höller
- Department of Dermatology, Medical University Vienna, Vienna, Austria
| | - Thomas Eigentler
- 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, Interdisciplinary Skin Cancer Center, University Medical Center Tuebingen, Tuebingen, Germany
| | - Teresa Amaral
- Department of Dermatology, Interdisciplinary Skin Cancer Center, University Medical Center Tuebingen, Tuebingen, Germany
| | - Wiebke K Peitsch
- Departments of Dermatology and Phlebology, Vivantes Skin Cancer Center, Vivantes Clinic Friedrichshain, Neukölln and Spandau, Berlin, Germany
| | - Uwe Hillen
- Department of Dermatology and Venereology, Vivantes Skin Cancer Center, Klinikum Neukölln, Berlin, Germany
| | - Wolfgang Harth
- Department of Dermatology and Allergology, Vivantes Skin Cancer Center, Klinikum Spandau, Berlin, Germany
| | - Fabian Ziller
- Department for Dermatology, DRK Hospital Chemnitz-Rabenstein, Chemnitz, Germany
| | - Kerstin Schatton
- Department for Dermatology, University Clinic Düsseldorf, Düsseldorf, Germany
| | - Thilo Gambichler
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Laura Susok
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Lara Valeska Maul
- Department for Dermatology, University Hospital Basel, Basel, Switzerland
| | - Heinz Läubli
- Department for Oncology, University Hospital Basel, Basel, Switzerland
| | - Dirk Debus
- Department of Dermatology, Nuremberg General Hospital - Paracelsus Medical University, Nuremberg, Germany
| | - Carsten Weishaupt
- Department for Dermatology and Venereology, University Clinic Münster, Münster, Germany
| | | | | | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | | | - Van Anh Nguyen
- Department for Dermatology, Venereology and Allergology, Medical University Innsbruck, Innsbruck, Austria
| | - Mariana Wanner
- Department for Dermatology, Venereology and Allergology, Medical University Innsbruck, Innsbruck, Austria
| | - Ralf Gutzmer
- Department of Dermatology, Mühlenkreiskliniken Minden und Ruhr University Bochum, Minden, Germany
| | - Patrick Terheyden
- Department for Dermatology and Venereology, University Clinic Schleswig-Holstein, Lübeck, Germany
| | - Katharina Kähler
- Department for Dermatology and Venereology, University Clinic Schleswig-Holstein, Kiel, Germany
| | - Steffen Emmert
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
| | - Alexander Thiem
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
| | - Michael Sachse
- Department for Dermatology, Clinic Bremerhaven Reinkenheide, Bremerhaven, Germany
| | - Silke Gercken-Riedel
- Department for Dermatology, Clinic Bremerhaven Reinkenheide, Bremerhaven, Germany
| | - Kjell Matthias Kaune
- Dermatology, Dermatosurgery and Allergology Clinic, Bremen-Mitte Hospital, Bremen, Germany
| | - Kai-Martin Thoms
- Department for Dermatology, University Hospital Göttingen, Georg-August-University, Göttingen, Germany
| | - Lucie Heinzerling
- Department for Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany.,Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg and Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg, Erlangen, Germany
| | - Markus Vincent Heppt
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg and Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg, Erlangen, Germany
| | - Sabine Tratzmiller
- Department for Dermatology, Municipal Hospital Karlsruhe, Karlsruhe, Germany
| | - Wolfram Hoetzenecker
- Department of Dermatology, University Hospital Linz, Johannes Kepler University, Linz, Austria
| | - Angela Öllinger
- Department of Dermatology, University Hospital Linz, Johannes Kepler University, Linz, Austria
| | | | | | - Maurizio Podda
- Department for Dermatology, Clinic Darmstadt, Darmstadt, Germany
| | - Sabine Schmid
- Department for Dermatology, Clinic Darmstadt, Darmstadt, Germany
| | - Uwe Wollina
- Department for Dermatology and Allergology, Municipal Hospital Dresden, Dresden, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy, School of Medicine, German Cancer Consortium (DKTK), Technical University of Munich, Munich, Germany
| | - Christian Posch
- Department of Dermatology and Allergy, School of Medicine, German Cancer Consortium (DKTK), Technical University of Munich, Munich, Germany.,Faculty of Medicine, Sigmund Freud University Vienna, Vienna, Austria.,Department for Dermatology, Clinic Hietzing, Vienna Healthcare Group, Vienna, Austria
| |
Collapse
|
36
|
Garbe C, Keim U, Amaral T, Berking C, Eigentler TK, Flatz L, Gesierich A, Leiter U, Stadler R, Sunderkötter C, Tüting T, Utikal J, Wollina U, Zimmer L, Zouboulis CC, Ascierto PA, Eggermont AM, Grob JJ, Hauschild A, Sekulovic LK, Long GV, Luke JJ, Michielin O, Peris K, Schadendorf D, Kirkwood JM, Lorigan PC. Prognosis of Patients With Primary Melanoma Stage I and II According to American Joint Committee on Cancer Version 8 Validated in Two Independent Cohorts: Implications for Adjuvant Treatment. J Clin Oncol 2022; 40:3741-3749. [PMID: 35709414 PMCID: PMC9649277 DOI: 10.1200/jco.22.00202] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [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: 01/27/2022] [Revised: 04/13/2022] [Accepted: 05/12/2022] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The first randomized trial of adjuvant treatment with checkpoint inhibitor in stage II melanoma reported a significant reduction in risk of tumor recurrence. This study evaluates two independent data sets to further document survival probabilities for patients with primary stage I and II melanoma. PATIENTS AND METHODS The Central Malignant Melanoma Registry (CMMR) in Germany evaluated 17,544 patients with a primary diagnosis of stage I and II melanoma from 2000 to 2015. The exploratory cohort consisted of 6,725 patients from the Center for Dermato-Oncology at the University of Tübingen, and the confirmatory cohort consisted of 10,819 patients from 11 other German centers. Survival outcomes were compared with published American Joint Committee on Cancer version 8 (AJCCv8) stage I and II survival data. RESULTS For the two CMMR cohorts in stage IA compared with the AJCCv8 cohort, melanoma-specific survival rates at 10 years were 95.1%-95.6% versus 98%; 89.7%-90.9% versus 94% in stage IB; 80.7%-83.1% versus 88% in stage IIA; 72.0%-79.9% versus 82% in stage IIB; and 57.6%-64.7% versus 75% in stage IIC, respectively. Recurrence rates were approximately twice as high as melanoma-specific mortality rates in stages IA-IIA. CONCLUSION The melanoma-specific survival rates in the two CMMR cohorts across stages I and II are less favorable than published in AJCCv8. This has important implications for the consideration of adjuvant treatment in this population.
Collapse
Affiliation(s)
- Claus Garbe
- Department of Dermatology, Center for Dermatooncology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Ulrike Keim
- Department of Dermatology, Center for Dermatooncology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Teresa Amaral
- Department of Dermatology, Center for Dermatooncology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Carola Berking
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - Thomas K. Eigentler
- Department of Dermatology, Skin Cancer Center, Charité Berlin, Berlin, Germany
| | - Lukas Flatz
- Department of Dermatology, Center for Dermatooncology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Anja Gesierich
- Department of Dermatology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Ulrike Leiter
- Department of Dermatology, Center for Dermatooncology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Rudolf Stadler
- Department of Dermatology, Johannes Wesling Hospital Minden, Ruhr-University of Bochum, Minden, Germany
| | - Cord Sunderkötter
- Department of Dermatology and Venereology, University Hospital Halle, Halle, Germany
| | - Thomas Tüting
- Department of Dermatology, University Hospital Magdeburg, Magdeburg, Germany
| | - Jochen 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
| | - Uwe Wollina
- Department of Dermatology and Allergology, Municipal Hospital of Dresden, Dresden, Germany
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany
- German Cancer Consortium, Heidelberg Partner Site Essen, Essen, Germany
| | - Christos C. Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Paolo A. Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapy, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Alexander M.M. Eggermont
- Princess Máxima Center, Utrecht, the Netherlands
- University Medical Center Utrecht, Utrecht, the Netherlands
- Comprehensive Cancer Center Munich, Munich, Germany
| | - Jean-Jacques Grob
- Dermatology and Skin Cancer Department, APHM Timone, Aix-Marseille University, Marseille, France
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | | | - Georgina V. Long
- Melanoma Institute Australia, The University of Sydney, Mater Hospital, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jason J. Luke
- Cancer Immunotherapeutic Center of UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA
| | - Olivier Michielin
- Department of Medical Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Ketty Peris
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
- IRCCS, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, Essen, Germany
- German Cancer Consortium, Heidelberg Partner Site Essen, Essen, Germany
| | - John M. Kirkwood
- Melanoma and Skin Cancer Program, Hillman Cancer Research Pavilion Laboratory, University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Paul C. Lorigan
- Division of Cancer Sciences, The Christie NHS Foundation Trust, The University of Manchester, Manchester, United Kingdom
| |
Collapse
|
37
|
Aung TN, Shafi S, Wilmott JS, Nourmohammadi S, Vathiotis I, Gavrielatou N, Fernandez A, Yaghoobi V, Sinnberg T, Amaral T, Ikenberg K, Khosrotehrani K, Osman I, Acs B, Bai Y, Martinez-Morilla S, Moutafi M, Thompson JF, Scolyer RA, Rimm DL. Objective assessment of tumor infiltrating lymphocytes as a prognostic marker in melanoma using machine learning algorithms. EBioMedicine 2022; 82:104143. [PMID: 35810563 PMCID: PMC9272337 DOI: 10.1016/j.ebiom.2022.104143] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/12/2022] [Accepted: 06/21/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The prognostic value of tumor-infiltrating lymphocytes (TILs) assessed by machine learning algorithms in melanoma patients has been previously demonstrated but has not been widely adopted in the clinic. We evaluated the prognostic value of objective automated electronic TILs (eTILs) quantification to define a subset of melanoma patients with a low risk of relapse after surgical treatment. METHODS We analyzed data for 785 patients from 5 independent cohorts from multiple institutions to validate our previous finding that automated TIL score is prognostic in clinically-localized primary melanoma patients. Using serial tissue sections of the Yale TMA-76 melanoma cohort, both immunofluorescence and Hematoxylin-and-Eosin (H&E) staining were performed to understand the molecular characteristics of each TIL phenotype and their associations with survival outcomes. FINDINGS Five previously-described TIL variables were each significantly associated with overall survival (p<0.0001). Assessing the receiver operating characteristic (ROC) curves by comparing the clinical impact of two models suggests that etTILs (electronic total TILs) (AUC: 0.793, specificity: 0.627, sensitivity: 0.938) outperformed eTILs (AUC: 0.77, specificity: 0.51, sensitivity: 0.938). We also found that the specific molecular subtype of cells representing TILs includes predominantly cells that are CD3+ and CD8+ or CD4+ T cells. INTERPRETATION eTIL% and etTILs scores are robust prognostic markers in patients with primary melanoma and may identify a subgroup of stage II patients at high risk of recurrence who may benefit from adjuvant therapy. We also show the molecular correlates behind these scores. Our data support the need for prospective testing of this algorithm in a clinical trial. FUNDING This work was also supported by a sponsored research agreements from Navigate Biopharma and NextCure and by grants from the NIH including the Yale SPORE in in Skin Cancer, P50 CA121974, the Yale SPORE in Lung Cancer, P50 CA196530, NYU SPORE in Skin Cancer P50CA225450 and the Yale Cancer Center Support Grant, P30CA016359.
Collapse
Affiliation(s)
- Thazin Nwe Aung
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Saba Shafi
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - James S Wilmott
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Saeed Nourmohammadi
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Ioannis Vathiotis
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Niki Gavrielatou
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Aileen Fernandez
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Vesal Yaghoobi
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Tobias Sinnberg
- University Tübingen, Tübingen, Germany; Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies", 72076 Tübingen, Germany
| | - Teresa Amaral
- University Tübingen, Tübingen, Germany; Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies", 72076 Tübingen, Germany
| | - Kristian Ikenberg
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Kiarash Khosrotehrani
- University of Queensland, UQ Diamantina Institute, Brisbane, QLD, Australia; Department of Dermatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Iman Osman
- Department of Medicine, Grossman School of Medicine, New York University, USA
| | - Balazs Acs
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA; Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Pathology and Cytology, Karolinska University Laboratory, Stockholm, Sweden
| | - Yalai Bai
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | | | - Myrto Moutafi
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - David L Rimm
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA; Department of Internal Medicine (Medical Oncology), Yale University School of Medicine, New Haven, CT, USA.
| |
Collapse
|
38
|
Gaißler A, Meldgaard TS, Heeke C, Babaei S, Tvingsholm SA, Bochem J, Spreuer J, Amaral T, Wagner NB, Klein R, Meier F, Garbe C, Eigentler TK, Pawelec G, Claassen M, Weide B, Hadrup SR, Wistuba-Hamprecht K. Dynamics of Melanoma-Associated Epitope-Specific CD8+ T Cells in the Blood Correlate With Clinical Outcome Under PD-1 Blockade. Front Immunol 2022; 13:906352. [PMID: 35874702 PMCID: PMC9300827 DOI: 10.3389/fimmu.2022.906352] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022] Open
Abstract
Immune checkpoint blockade (ICB) is standard-of-care for patients with metastatic melanoma. It may re-invigorate T cells recognizing tumors, and several tumor antigens have been identified as potential targets. However, little is known about the dynamics of tumor antigen-specific T cells in the circulation, which might provide valuable information on ICB responses in a minimally invasive manner. Here, we investigated individual signatures composed of up to 167 different melanoma-associated epitope (MAE)-specific CD8+ T cells in the blood of stage IV melanoma patients before and during anti-PD-1 treatment, using a peptide-loaded multimer-based high-throughput approach. Additionally, checkpoint receptor expression patterns on T cell subsets and frequencies of myeloid-derived suppressor cells and regulatory T cells were quantified by flow cytometry. Regression analysis using the MAE-specific CD8+ T cell populations was applied to identify those that correlated with overall survival (OS). The abundance of MAE-specific CD8+ T cell populations, as well as their dynamics under therapy, varied between patients. Those with a dominant increase of these T cell populations during PD-1 ICB had a longer OS and progression-free survival than those with decreasing or balanced signatures. Patients with a dominantly increased MAE-specific CD8+ T cell signature also exhibited an increase in TIM-3+ and LAG-3+ T cells. From these results, we created a model predicting improved/reduced OS by combining data on dynamics of the three most informative MAE-specific CD8+ T cell populations. Our results provide insights into the dynamics of circulating MAE-specific CD8+ T cell populations during ICB, and should contribute to a better understanding of biomarkers of response and anti-cancer mechanisms.
Collapse
Affiliation(s)
- Andrea Gaißler
- Department of Dermatology, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Internal Medicine I, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Trine Sundebo Meldgaard
- Department of Health Technology, Danmarks Tekniske Universitet (DTU) HEALTH TECH, Copenhagen, Denmark
| | - Christina Heeke
- Department of Health Technology, Danmarks Tekniske Universitet (DTU) HEALTH TECH, Copenhagen, Denmark
| | - Sepideh Babaei
- Internal Medicine I, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Siri Amanda Tvingsholm
- Department of Health Technology, Danmarks Tekniske Universitet (DTU) HEALTH TECH, Copenhagen, Denmark
| | - Jonas Bochem
- Department of Dermatology, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Internal Medicine I, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Janine Spreuer
- Department of Dermatology, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Internal Medicine I, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Teresa Amaral
- Department of Dermatology, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Excellence Cluster (EXC) 2180, “Image Guided and Functionally Instructed Tumor Therapies” (iFIT), Tübingen, Germany
| | - Nikolaus Benjamin Wagner
- Department of Dermatology, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Department of Dermatology, Venereology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Reinhild Klein
- Internal Medicine II, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Friedegund Meier
- Skin Cancer Center at the University Cancer Centre and National Center for Tumor Diseases Dresden, Dresden, Germany
- Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Claus Garbe
- Department of Dermatology, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Thomas K. Eigentler
- Department of Dermatology, Venereology and Allergology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Graham Pawelec
- Department of Immunology, Interfaculty Institute for Cell Biology, Eberhard Karls University Tübingen, Tübingen, Germany
- Health Sciences North Research Institute, Sudbury, ON, Canada
| | - Manfred Claassen
- Internal Medicine I, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Department of Computer Science, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Benjamin Weide
- Department of Dermatology, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Sine Reker Hadrup
- Department of Health Technology, Danmarks Tekniske Universitet (DTU) HEALTH TECH, Copenhagen, Denmark
| | - Kilian Wistuba-Hamprecht
- Department of Dermatology, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Internal Medicine I, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Department of Immunology, Interfaculty Institute for Cell Biology, Eberhard Karls University Tübingen, Tübingen, Germany
- *Correspondence: Kilian Wistuba-Hamprecht,
| |
Collapse
|
39
|
Garbe C, Amaral T, Peris K, Hauschild A, Arenberger P, Basset-Seguin N, Bastholt L, Bataille V, Del Marmol V, Dréno B, Fargnoli MC, Forsea AM, Grob JJ, Höller C, Kaufmann R, Kelleners-Smeets N, Lallas A, Lebbé C, Lytvynenko B, Malvehy J, Moreno-Ramirez D, Nathan P, Pellacani G, Saiag P, Stratigos AJ, Van Akkooi ACJ, Vieira R, Zalaudek I, Lorigan P. European consensus-based interdisciplinary guideline for melanoma. Part 1: Diagnostics: Update 2022. Eur J Cancer 2022; 170:236-255. [PMID: 35570085 DOI: 10.1016/j.ejca.2022.03.008] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [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: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 01/02/2023]
Abstract
Cutaneous melanoma (CM) is potentially the most dangerous form of skin tumor and causes 90% of skin cancer mortality. A unique collaboration of multi-disciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization for Research and Treatment of Cancer (EORTC) was formed to make recommendations on CM diagnosis and treatment, based on systematic literature reviews and the experts' experience. The diagnosis of melanoma can be made clinically and shall always be confirmed with dermatoscopy. If a melanoma is suspected, a histopathological examination is always required. Sequential digital dermatoscopy and full body photography can be used in high-risk patients to improve the detection of early melanoma. Where available, confocal reflectance microscopy can also improve clinical diagnosis in special cases. Melanoma shall be classified according to the 8th version of the American Joint Committee on Cancer classification. Thin melanomas up to 0.8 mm tumor thickness do not require further imaging diagnostics. From stage IB onwards, examinations with lymph node sonography are recommended, but no further imaging examinations. From stage IIC onwards whole-body examinations with computed tomography (CT) or positron emission tomography CT (PET-CT) in combination with brain magnetic resonance imaging are recommended. From stage III and higher, mutation testing is recommended, particularly for BRAF V600 mutation. It is important to provide a structured follow-up to detect relapses and secondary primary melanomas as early as possible. There is no evidence to define the frequency and extent of examinations. A stage-based follow-up scheme is proposed which, according to the experience of the guideline group, covers the optimal requirements, but further studies may be considered. This guideline is valid until the end of 2024.
Collapse
Affiliation(s)
- Claus Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany.
| | - Teresa Amaral
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Ketty Peris
- Institute of Dermatology, Università Cattolica, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Nicole Basset-Seguin
- Université Paris Cite, AP-HP Department of Dermatology INSERM U 976 Hôpital Saint Louis Paris France
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Denmark
| | - Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London, SE1 7EH, UK
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Brigitte Dréno
- Dermatology Department, CHU Nantes, CIC 1413, CRCINA, University Nantes, Nantes, France
| | - Maria C Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ana-Maria Forsea
- Dermatology Department, Elias University Hospital, Carol Davila University of Medicine and Pharmacy Bucharest, Romania
| | | | - Christoph Höller
- Department of Dermatology, Medical University of Vienna, Austria
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Celeste Lebbé
- Université Paris Cite, AP-HP Department of Dermatology INSERM U 976 Hôpital Saint Louis Paris France
| | - Bohdan Lytvynenko
- Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Josep Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - David Moreno-Ramirez
- Medical-&-Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Paul Nathan
- Mount-Vernon Cancer Centre, Northwood United Kingdom
| | | | - Philippe Saiag
- University Department of Dermatology, Université de Versailles-Saint Quentin en Yvelines, APHP, Boulogne, France
| | - Alexander J Stratigos
- 1st Department of Dermatology, University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Alexander C J Van Akkooi
- Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Ricardo Vieira
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Paul Lorigan
- The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| |
Collapse
|
40
|
Garbe C, Amaral T, Peris K, Hauschild A, Arenberger P, Basset-Seguin N, Bastholt L, Bataille V, Del Marmol V, Dréno B, Fargnoli MC, Forsea AM, Grob JJ, Hoeller C, Kaufmann R, Kelleners-Smeets N, Lallas A, Lebbé C, Lytvynenko B, Malvehy J, Moreno-Ramirez D, Nathan P, Pellacani G, Saiag P, Stratigos AJ, Van Akkooi ACJ, Vieira R, Zalaudek I, Lorigan P. European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment - Update 2022. Eur J Cancer 2022; 170:256-284. [PMID: 35623961 DOI: 10.1016/j.ejca.2022.04.018] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [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] [Indexed: 11/26/2022]
Abstract
A unique collaboration of multidisciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO), and the European Organization of Research and Treatment of Cancer (EORTC) was formed to make recommendations on cutaneous melanoma diagnosis and treatment, based on the systematic literature reviews and the experts' experience. Cutaneous melanomas are excised with one to 2-cm safety margins. Sentinel lymph node dissection shall be performed as a staging procedure in patients with tumor thickness ≥1.0 mm or ≥0.8 mm with additional histological risk factors, although there is as yet no clear survival benefit for this approach. Therapeutic decisions in stage III/IV patients should be primarily made by an interdisciplinary oncology team ("tumor board"). Adjuvant therapies can be proposed in stage III/completely resected stage IV patients and are primarily anti-PD-1, independent of mutational status, or alternatively dabrafenib plus trametinib for BRAF mutant patients. In distant metastases (stage IV), either resected or not, systemic treatment is always indicated. For first-line treatment particularly in BRAF wild-type patients, immunotherapy with PD-1 antibodies alone or in combination with CTLA-4 antibodies shall be considered. In stage IV melanoma with a BRAF-V600 E/K mutation, first-line therapy with BRAF/MEK inhibitors can be offered as an alternative to immunotherapy. In patients with primary resistance to immunotherapy and harboring a BRAF-V600 E/K mutation, this therapy shall be offered as second-line therapy. Systemic therapy in stage III/IV melanoma is a rapidly changing landscape, and it is likely that these recommendations may change in the near future.
Collapse
Affiliation(s)
- Claus Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany.
| | - Teresa Amaral
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Ketty Peris
- Institute of Dermatology, Università Cattolica, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Nicole Basset-Seguin
- Université Paris Cite, AP-HP, Department of Dermatology INSERM U 976 Hôpital, Saint Louis Paris France
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London, SE1 7EH, United Kingdom
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Brigitte Dréno
- Dermatology Department, CHU Nantes, CIC 1413, CRCINA, University Nantes, Nantes, France
| | - Maria C Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ana-Maria Forsea
- Dermatology Department, Elias University Hospital, Carol Davila University of Medicine and Pharmacy Bucharest, Romania
| | | | | | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | | | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Celeste Lebbé
- Université Paris Cite, AP-HP, Department of Dermatology INSERM U 976 Hôpital, Saint Louis Paris France
| | - Bodhan Lytvynenko
- Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Josep Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - David Moreno-Ramirez
- Medical-&-Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Paul Nathan
- Mount-Vernon Cancer Centre, Northwood United Kingdom
| | | | - Philippe Saiag
- University Department of Dermatology, Université de Versailles-Saint Quentin en Yvelines, APHP, Boulogne, France
| | - Alexander J Stratigos
- First Department of Dermatology, University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Alexander C J Van Akkooi
- Melanoma Institute Australia, The University of Sydney, and Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Ricardo Vieira
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Paul Lorigan
- The University of Manchester, Oxford Rd, Manchester, M13 9PL, United Kingdom
| |
Collapse
|
41
|
Forschner A, Niessner H, Sinnberg T, Eigentler T, Amaral T, Seith F, Garbe C, Biskup S, Battke F. Zirkulierende Tumor-DNA (ctDNA) bei der Entdeckung von Rezidiven bei Melanompatienten mit adjuvanter Anti-PD-1-Therapie. J Dtsch Dermatol Ges 2022; 20:867-871. [PMID: 35711040 DOI: 10.1111/ddg.14766_g] [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: 11/29/2022]
Affiliation(s)
| | | | - Tobias Sinnberg
- Dermatoonkologie, Universitäts-Hautklinik Tübingen.,iFIT Exzellenzcluster (EXC 2180), Universität Tübingen
| | | | - Teresa Amaral
- Dermatoonkologie, Universitäts-Hautklinik Tübingen.,Portuguese Air Force Health Care Direction, Lissabon, Portugal
| | - Ferdinand Seith
- Abteilung für diagnostische und interventionelle Radiologie, Universitäts-Klinikum Tübingen
| | - Claus Garbe
- Dermatoonkologie, Universitäts-Hautklinik Tübingen
| | - Saskia Biskup
- Center for Genomics and Transcriptomics (CeGaT) GmbH, Tübingen
| | - Florian Battke
- Center for Genomics and Transcriptomics (CeGaT) GmbH, Tübingen
| |
Collapse
|
42
|
Pinto D, Rato ND, Garcia C, Teixeira M, Marques MJ, Amaral T, Amaral L, Ruivo P, Abreu R, Oliveira AP, Carneiro C, Figueiredo D, Polónia J, Mesquita-Bastos J, Viana JL, Pescatello LS, Ribeiro F, Alves AJ. EFFECTS OF HOME-BASED ISOMETRIC HANDGRIP OR AEROBIC EXERCISE TRAINING IN OLDER ADULTS WITH PRE-HYPERTENSION AND HYPERTENSION. J Hypertens 2022. [DOI: 10.1097/01.hjh.0000838220.85703.0f] [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: 11/25/2022]
|
43
|
Forschner A, Niessner H, Sinnberg T, Eigentler T, Amaral T, Seith F, Garbe C, Biskup S, Battke F. Circulating tumor DNA (ctDNA) in the detection of relapse in melanoma patients with adjuvant anti-PD-1 therapy. J Dtsch Dermatol Ges 2022; 20:867-871. [PMID: 35555861 DOI: 10.1111/ddg.14766] [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: 11/28/2022]
Affiliation(s)
- Andrea Forschner
- Department of Dermatology, University Hospital Tuebingen, Tübingen, Germany
| | - Heike Niessner
- Department of Dermatology, University Hospital Tuebingen, Tübingen, Germany
| | - Tobias Sinnberg
- Department of Dermatology, University Hospital Tuebingen, Tübingen, Germany.,iFIT cluster of excellence (EXC 2180), University of Tuebingen, Germany
| | - Thomas Eigentler
- Department of Dermatology, University Hospital Tuebingen, Tübingen, Germany
| | - Teresa Amaral
- Department of Dermatology, University Hospital Tuebingen, Tübingen, Germany.,Portuguese Air Force Health Care Direction, Lisbon, Portugal
| | - Ferdinand Seith
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Claus Garbe
- Department of Dermatology, University Hospital Tuebingen, Tübingen, Germany
| | - Saskia Biskup
- Center for Genomics and Transcriptomics (CeGaT) GmbH, Tuebingen, Germany
| | - Florian Battke
- Center for Genomics and Transcriptomics (CeGaT) GmbH, Tuebingen, Germany
| |
Collapse
|
44
|
Almansour H, Afat S, Serna-Higuita LM, Amaral T, Schraag A, Peisen F, Brendlin A, Seith F, Klumpp B, Eigentler TK, Othman AE. Early Tumor Size Reduction of at least 10% at the First Follow-Up Computed Tomography Can Predict Survival in the Setting of Advanced Melanoma and Immunotherapy. Acad Radiol 2022; 29:514-522. [PMID: 34130924 DOI: 10.1016/j.acra.2021.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/01/2022]
Abstract
RATIONALE AND OBJECTIVES Early tumor size reduction (TSR) has been explored as a prognostic factor for survival in patients with advanced melanoma in clinical trials. The purpose of this analysis is to validate, in a routine clinical milieu, the predictive capacity of TSR by 10% for overall survival (OS) and progression-free survival (PFS) and to compare its predictive performance with the RECIST 1.1 criteria. MATERIALS AND METHODS This retrospective study was approved by the local ethics committee. A total of 152 patients with both CT before immunotherapy initiation and at first response evaluation after immunotherapy initiation were included. Prior to statistical analysis, treatment response was trichotomized as follows: Complete response and/or partial response, stable disease and progressive disease. Furthermore, response was dichotomized regarding TSR (TSR ≥ 10% and TSR < 10%). Kaplan-Meier survival estimates, Cox regression and Harrel's concordance index (C-index) were computed for prediction of overall survival and progression-free survival. RESULTS Tumor size reduction by at least 10% significantly differentiated between patients with increased survival from the ones with decreased survival (median OS: TSR ≥ 10%: 2137 days vs. TSR < 10%: 263 days) (p < 0.001) (median PFS: TSR ≥ 10%: 590 days vs. TSR < 10%: 11 days) (p < 0.001). RECIST 1.1. criteria had a slightly higher C-index for overall survival reflecting a slight superior predictive capacity (RECIST: 0.69 vs TSR: 0.64) but a similar predictive capacity regarding progression-free survival (both: 0. 63). CONCLUSION Early tumor size reduction serves as a simple-to-use metric which can be implemented on the first follow-up CT. Tumor size reduction by at least 10% can be considered an additional biomarker predictive of overall survival and progression-free survival in routine clinical care and not only in the context of clinical trials in patients with advanced melanoma undergoing immunotherapy. Nevertheless, RECIST-based criteria should remain the main tool of treatment response assessment until results of prospective studies validating the TSR method are available.
Collapse
|
45
|
Pinto D, Dias N, Garcia C, Teixeira M, Marques EA, Marques MJ, Amaral T, Amaral L, Ruivo P, Abreu R, Carneiro C, Oliveira AP, Figueiredo D, Polónia J, Mesquita-Bastos J, Viana JL, Pescatello LS, Ribeiro F, Alves AJ. EFFECTS OF HOME-BASED ISOMETRIC HANDGRIP TRAINING OR AEROBIC TRAINING ON OFFICE BLOOD PRESSURE AMONG OLDER ADULTS WITH HIGH NORMAL BP TO ESTABLISHED HYPERTENSION -PRELIMINARY RESULTS OF THE HOLDAGE TRIAL. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02560-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
46
|
Bochem J, Zelba H, Spreuer J, Amaral T, Wagner NB, Gaissler A, Pop OT, Thiel K, Yurttas C, Soffel D, Forchhammer S, Sinnberg T, Niessner H, Meier F, Terheyden P, Königsrainer A, Garbe C, Flatz L, Pawelec G, Eigentler TK, Löffler MW, Weide B, Wistuba-Hamprecht K. Early disappearance of tumor antigen-reactive T cells from peripheral blood correlates with superior clinical outcomes in melanoma under anti-PD-1 therapy. J Immunother Cancer 2021; 9:jitc-2021-003439. [PMID: 34933966 PMCID: PMC8693089 DOI: 10.1136/jitc-2021-003439] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 01/03/2023] Open
Abstract
Background Anti-programmed cell death protein 1 (PD-1) antibodies are now routinely administered for metastatic melanoma and for increasing numbers of other cancers, but still only a fraction of patients respond. Better understanding of the modes of action and predictive biomarkers for clinical outcome is urgently required. Cancer rejection is mostly T cell-mediated. We previously showed that the presence of NY-ESO-1-reactive and/or Melan-A-reactive T cells in the blood correlated with prolonged overall survival (OS) of patients with melanoma with a heterogeneous treatment background. Here, we investigated whether such reactive T cells can also be informative for clinical outcomes in metastatic melanoma under PD-1 immune-checkpoint blockade (ICB). Methods Peripheral blood T cell stimulation by NY-ESO-1 and Melan-A overlapping peptide libraries was assessed before and during ICB in two independent cohorts of a total of 111 patients with stage IV melanoma. In certain cases, tumor-infiltrating lymphocytes could also be assessed for such responses. These were characterized using intracellular cytokine staining for interferon gamma (IFN-γ), tumor negrosis factor (TNF) and CD107a. Digital pathology analysis was performed to quantify NY-ESO-1 and Melan-A expression by tumors. Endpoints were OS and progression-free survival (PFS). Results The initial presence in the circulation of NY-ESO-1- or Melan-A-reactive T cells which became no longer detectable during ICB correlated with validated, prolonged PFS (HR:0.1; p>0.0001) and OS (HR:0.2; p=0.021). An evaluation of melanoma tissue from selected cases suggested a correlation between tumor-resident NY-ESO-1- and Melan-A-reactive T cells and disease control, supporting the notion of a therapy-associated sequestration of cells from the periphery to the tumor predominantly in those patients benefitting from ICB. Conclusions Our findings suggest a PD-1 blockade-dependent infiltration of melanoma-reactive T cells from the periphery into the tumor and imply that this seminally contributes to effective treatment.
Collapse
MESH Headings
- Aged
- Aged, 80 and over
- Antigens, Neoplasm/immunology
- Antigens, Neoplasm/metabolism
- Biomarkers, Tumor/immunology
- Biomarkers, Tumor/metabolism
- CD8-Positive T-Lymphocytes/immunology
- Female
- Follow-Up Studies
- Humans
- Immune Checkpoint Inhibitors/therapeutic use
- Leukocytes, Mononuclear/drug effects
- Leukocytes, Mononuclear/immunology
- Leukocytes, Mononuclear/metabolism
- Leukocytes, Mononuclear/pathology
- Lymphocytes, Tumor-Infiltrating/immunology
- MART-1 Antigen/immunology
- MART-1 Antigen/metabolism
- Male
- Melanoma/drug therapy
- Melanoma/immunology
- Melanoma/mortality
- Melanoma/pathology
- Membrane Proteins/immunology
- Membrane Proteins/metabolism
- Middle Aged
- Prognosis
- Programmed Cell Death 1 Receptor/antagonists & inhibitors
- Survival Rate
Collapse
Affiliation(s)
- Jonas Bochem
- Department of Dermatology, University Medical Center, Tübingen, Germany
| | - Henning Zelba
- Department of Dermatology, University Medical Center, Tübingen, Germany
| | - Janine Spreuer
- Department of Dermatology, University Medical Center, Tübingen, Germany
| | - Teresa Amaral
- Department of Dermatology, University Medical Center, Tübingen, Germany
| | - Nikolaus B Wagner
- Department of Dermatology, Venereology, Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Andrea Gaissler
- Department of Dermatology, University Medical Center, Tübingen, Germany
| | - Oltin T Pop
- Institute for Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Karolin Thiel
- Department of General, Visceral and Transplant Surgery, University Hospital, Tübingen, Germany
| | - Can Yurttas
- Department of General, Visceral and Transplant Surgery, University Hospital, Tübingen, Germany
| | - Daniel Soffel
- Department of Dermatology, University Medical Center, Tübingen, Germany
| | | | - Tobias Sinnberg
- Department of Dermatology, University Medical Center, Tübingen, Germany
| | - Heike Niessner
- Department of Dermatology, University Medical Center, Tübingen, Germany
| | - Friedegund Meier
- Skin Cancer Center at the University Cancer Centre and National Center for Tumor Diseases Dresden; Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | | | - Alfred Königsrainer
- Department of General, Visceral and Transplant Surgery, University Hospital, Tübingen, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ) Partner Site Tübingen, Tübingen, Germany
- Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
| | - Claus Garbe
- Department of Dermatology, University Medical Center, Tübingen, Germany
| | - Lukas Flatz
- Department of Dermatology, University Medical Center, Tübingen, Germany
| | - Graham Pawelec
- Health Sciences North Research Institute of Canada, Sudbury, Ontario, Canada
- Department of Immunology, University of Tübingen, Tübingen, Germany
| | | | - Markus W Löffler
- Department of General, Visceral and Transplant Surgery, University Hospital, Tübingen, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ) Partner Site Tübingen, Tübingen, Germany
- Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
- Department of Immunology, University of Tübingen, Tübingen, Germany
- Department of Clinical Pharmacology, University Hospital Tübingen, Tübingen, Germany
| | - Benjamin Weide
- Department of Dermatology, University Medical Center, Tübingen, Germany
| | - Kilian Wistuba-Hamprecht
- Department of Dermatology, University Medical Center, Tübingen, Germany
- Department of Immunology, University of Tübingen, Tübingen, Germany
- Department for Internal Medicine I, University Medical Center, Tübingen, Germany
| |
Collapse
|
47
|
Serna-Higuita LM, Amaral T, Forschner A, Leiter U, Flatz L, Seeber O, Thomas I, Garbe C, Eigentler TK, Martus P. Association between Immune-Related Adverse Events and Survival in 319 Stage IV Melanoma Patients Treated with PD-1-Based Immunotherapy: An Approach Based on Clinical Chemistry. Cancers (Basel) 2021; 13:cancers13236141. [PMID: 34885249 PMCID: PMC8657404 DOI: 10.3390/cancers13236141] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 10/30/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 02/08/2023] Open
Abstract
Simple Summary Nivolumab combined with ipilimumab has improved the prognosis of patients with advanced melanoma. However, this therapy is frequently associated with immune-related adverse events. Published data suggested that objective responses rates appear to be superior in patients who developed immune-related adverse events. The primary aim of this study was to evaluate the association between immune-related adverse events and disease control rate, progressive-free survival, and overall survival in patients with stage IV melanoma treated with first-line PD-1-based immunotherapy. In this manuscript, we show that the presence of immune related side effects is related to better overall response and longer survival in patients with advance stage melanoma treated immuno-therapy, suggesting that immune-related adverse events might be a predictive factor of response in those patients. Abstract (1) Background: Immune checkpoint inhibitors have improved the prognosis of patients with advanced melanoma. Published data suggested that the objective response rates appear to be superior in patients who developed immune-related adverse events (irAEs). (2) The primary aim of this cohort study was to evaluate the association between irAEs and disease control rate in patients with stage IV melanoma treated with first-line PD-1-based immunotherapy. (3) Among 319 patients, 53% experienced at least one irAE. A higher percentage of patients with irAEs had disease control compared to those without irAEs (69.8% vs. 49.3%). In multivariate analysis, development of grade 3 and 4 irAEs was significantly associated with a protective effect for the outcome primary resistance (OR: 0.40 95% CI 0.23–0.70, p = 0.001). The presence of any grade irAEs was significantly associated with longer OS (irAEs grade 1–2 HRadj: 0.61 95% CI: 0.4–0.93, p = 0.02, irAEs grade 3–4 HRadj: 0.55 95% CI 0.31–0.99, p = 0.04), but not with PFS (irAEs grade 1–2 HRadj: 1.21 95% CI: 0.91–1.79, p = 0.16, irAEs grade 3–4 HRadj: 1.14 95% CI 0.83–2.02, p = 0.24). (4) The presence of irAEs with laboratorial expression is positively associated with response and OS, suggesting that irAEs might be a predictive factor in this setting.
Collapse
Affiliation(s)
- Lina María Serna-Higuita
- Department of Clinical Epidemiology and Applied Biostatistics, Eberhard Karls University of Tuebingen, 72076 Tuebingen, Germany;
- Correspondence: ; Tel.: +49-7071-29-85902
| | - Teresa Amaral
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, 72076 Tuebingen, Germany; (T.A.); (A.F.); (U.L.); (L.F.); (O.S.); (I.T.); (C.G.); (T.K.E.)
| | - Andrea Forschner
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, 72076 Tuebingen, Germany; (T.A.); (A.F.); (U.L.); (L.F.); (O.S.); (I.T.); (C.G.); (T.K.E.)
| | - Ulrike Leiter
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, 72076 Tuebingen, Germany; (T.A.); (A.F.); (U.L.); (L.F.); (O.S.); (I.T.); (C.G.); (T.K.E.)
| | - Lukas Flatz
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, 72076 Tuebingen, Germany; (T.A.); (A.F.); (U.L.); (L.F.); (O.S.); (I.T.); (C.G.); (T.K.E.)
| | - Olivia Seeber
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, 72076 Tuebingen, Germany; (T.A.); (A.F.); (U.L.); (L.F.); (O.S.); (I.T.); (C.G.); (T.K.E.)
| | - Ioannis Thomas
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, 72076 Tuebingen, Germany; (T.A.); (A.F.); (U.L.); (L.F.); (O.S.); (I.T.); (C.G.); (T.K.E.)
| | - Claus Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, 72076 Tuebingen, Germany; (T.A.); (A.F.); (U.L.); (L.F.); (O.S.); (I.T.); (C.G.); (T.K.E.)
| | - Thomas Kurt Eigentler
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, 72076 Tuebingen, Germany; (T.A.); (A.F.); (U.L.); (L.F.); (O.S.); (I.T.); (C.G.); (T.K.E.)
- Department of Dermatology, Venereology and Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Peter Martus
- Department of Clinical Epidemiology and Applied Biostatistics, Eberhard Karls University of Tuebingen, 72076 Tuebingen, Germany;
| |
Collapse
|
48
|
Keim U, Gandini S, Amaral T, Katalinic A, Holleczek B, Flatz L, Leiter U, Whiteman D, Garbe C. Cutaneous melanoma attributable to UVR exposure in Denmark and Germany. Eur J Cancer 2021; 159:98-104. [PMID: 34742161 DOI: 10.1016/j.ejca.2021.09.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/27/2021] [Revised: 09/07/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Increasing incidence rates of cutaneous melanoma (CM) observed during the last five decades in white populations are largely attributed to increased exposure to solar ultraviolet radiation (UVR), often expressed as population attributable fraction (PAF). Thus, many CMs could be prevented by reducing UVR exposure. The aim of this study was to estimate the PAF of CM attributable to UVR exposure and demographic changes in Denmark and Saarland/Germany for the period 1943 to 2036. MATERIAL AND METHODS CM incidence data (ICD-10, C43) for Denmark (1943-2016) and the German Federal State of Saarland (1972-2016) were retrieved from the NORDCAN database and from the Saarland Cancer Registry. The number of CMs attributable to UVR exposure was calculated by comparing contemporary or predicted CM incidence rates with CM rates in Denmark during the years 1943-1946. RESULTS In Denmark, the proportion of CM cases attributable to UVR exposure increased from around 20% in 1947-1951 to 96% in 2012-2016; in the Federal State of Saarland, it increased from 50% in 1972-1976 to 90% in 2012-2016. Until 2032-2036, the PAF is expected to rise in Denmark to 97% and in the Saarland to 92%. The demographic influence, on the other hand, is rather small. CONCLUSIONS More than 90% of all CM in Germany and Denmark are attributable to UVR exposure, and in principle, preventable. These findings underline the need for primary prevention strategies, aiming to increase the awareness of melanoma and its risk factors and to promote behavioural changes that decrease sun exposure.
Collapse
Affiliation(s)
- Ulrike Keim
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Teresa Amaral
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany; Portuguese Air Force Health Care Direction, Lisbon, Portugal
| | | | | | - Lukas Flatz
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - David Whiteman
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD 4006, Australia; The University of Queensland, School of Public Health, Herston Road, Herston, QLD 4006, Australia
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany.
| |
Collapse
|
49
|
Brendlin AS, Peisen F, Almansour H, Afat S, Eigentler T, Amaral T, Faby S, Calvarons AF, Nikolaou K, Othman AE. A Machine learning model trained on dual-energy CT radiomics significantly improves immunotherapy response prediction for patients with stage IV melanoma. J Immunother Cancer 2021; 9:jitc-2021-003261. [PMID: 34795006 PMCID: PMC8603266 DOI: 10.1136/jitc-2021-003261] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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] [Accepted: 10/13/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND To assess the additive value of dual-energy CT (DECT) over single-energy CT (SECT) to radiomics-based response prediction in patients with metastatic melanoma preceding immunotherapy. MATERIAL AND METHODS A total of 140 consecutive patients with melanoma (58 female, 63±16 years) for whom baseline DECT tumor load assessment revealed stage IV and who were subsequently treated with immunotherapy were included. Best response was determined using the clinical reports (81 responders: 27 complete response, 45 partial response, 9 stable disease). Individual lesion response was classified manually analogous to RECIST 1.1 through 1291 follow-up examinations on a total of 776 lesions (6.7±7.2 per patient). The patients were sorted chronologically into a study and a validation cohort (each n=70). The baseline DECT was examined using specialized tumor segmentation prototype software, and radiomic features were analyzed for response predictors. Significant features were selected using univariate statistics with Bonferroni correction and multiple logistic regression. The area under the receiver operating characteristic curve of the best subset was computed (AUROC). For each combination (SECT/DECT and patient response/lesion response), an individual random forest classifier with 10-fold internal cross-validation was trained on the study cohort and tested on the validation cohort to confirm the predictive performance. RESULTS We performed manual RECIST 1.1 response analysis on a total of 6533 lesions. Multivariate statistics selected significant features for patient response in SECT (min. brightness, R²=0.112, padj. ≤0.001) and DECT (textural coarseness, R²=0.121, padj. ≤0.001), as well as lesion response in SECT (mean absolute voxel intensity deviation, R²=0.115, padj. ≤0.001) and DECT (iodine uptake metrics, R²≥0.12, padj. ≤0.001). Applying the machine learning models to the validation cohort confirmed the additive predictive power of DECT (patient response AUROC SECT=0.5, DECT=0.75; lesion response AUROC SECT=0.61, DECT=0.85; p<0.001). CONCLUSION The new method of DECT-specific radiomic analysis provides a significant additive value over SECT radiomics approaches for response prediction in patients with metastatic melanoma preceding immunotherapy, especially on a lesion-based level. As mixed tumor response is not uncommon in metastatic melanoma, this lends a powerful tool for clinical decision-making and may potentially be an essential step toward individualized medicine.
Collapse
Affiliation(s)
- Andreas Stefan Brendlin
- Department of Diagnostic and Interventional Radiology, Universitätsklinikum Tübingen, Tubingen, Germany
| | - Felix Peisen
- Department of Diagnostic and Interventional Radiology, Universitätsklinikum Tübingen, Tubingen, Germany
| | - Haidara Almansour
- Department of Diagnostic and Interventional Radiology, Universitätsklinikum Tübingen, Tubingen, Germany
| | - Saif Afat
- Department of Diagnostic and Interventional Radiology, Universitätsklinikum Tübingen, Tubingen, Germany
| | - Thomas Eigentler
- Center of Dermatooncology, Department of Dermatology, Eberhard Karls Universitat Tubingen, Tubingen, Germany.,Department of Dermatology, Venereology and Allergology, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Teresa Amaral
- Center of Dermatooncology, Department of Dermatology, Eberhard Karls Universitat Tubingen, Tubingen, Germany
| | - Sebastian Faby
- Computed Tomography, Siemens Healthcare GmbH, Erlangen, Germany
| | | | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Universitätsklinikum Tübingen, Tubingen, Germany.,Image-guided and Functionally Instructed Tumor Therapies (iFIT), The Cluster of Excellence 2180, Tuebingen, Germany
| | - Ahmed E Othman
- Department of Diagnostic and Interventional Radiology, Universitätsklinikum Tübingen, Tubingen, Germany .,Institute of Neuroradiology, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| |
Collapse
|
50
|
van der Hage J, Sandrucci S, Audisio R, Wyld L, Søreide K, Amaral T, Audisio R, Bahadoer V, Beets G, Benstead K, Berge Nilsen E, Bol K, Brandl A, Braun J, Cufer T, Dopazo C, Edhemovic I, Eriksen JG, Fiore M, van Ginhoven T, Gonzalez-Moreno S, van der Hage J, Hutteman M, Masannat Y, Onesti EC, Rau B, De Reijke T, Rubio I, Ruurda J, Sandrucci S, Soreide K, Stattner S, Trapani D, D'Ugo D, Vriens M, Wyld L, Zahl Eriksson AG. The ESSO core curriculum committee update on surgical oncology. Eur J Surg Oncol 2021; 47:e1-e30. [PMID: 34657781 DOI: 10.1016/j.ejso.2021.10.003] [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: 09/23/2021] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Surgical oncology is a defined specialty within the European Board of Surgery within the European Union of Medical Specialists (UEMS). Variation in training and specialization still occurs across Europe. There is a need to align the core knowledge needed to fulfil the criteria across subspecialities in surgical oncology. MATERIAL AND METHODS The core curriculum, established in 2013, was developed with contributions from expert advisors from within the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy and Oncology (ESTRO) and European Society of Medical Oncology (ESMO) and related subspeciality experts. RESULTS The current version reiterates and updates the core curriculum structure needed for current and future candidates who plans to train for and eventually sit the European fellowship exam for the European Board of Surgery in Surgical Oncology. The content included is not intended to be exhaustive but, rather to give the candidate an idea of expectations and areas for in depth study, in addition to the practical requirements. The five elements included are: Basic principles of oncology; Disease site specific oncology; Generic clinical skills; Training recommendations, and, lastly; Eligibility for the EBSQ exam in Surgical Oncology. CONCLUSIONS As evidence-based care for cancer patients evolves through research into basic science, translational research and clinical trials, the core curriculum will evolve, mature and adapt to deliver continual improvements in cancer outcomes for patients.
Collapse
Affiliation(s)
- Jos van der Hage
- Department of Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
| | - Sergio Sandrucci
- Surgical Oncology Unit, City of Health and Science, University of Turin, Turin, Italy
| | - Riccardo Audisio
- Department of Surgery, Sahlgrenska University Hospital, University of Gothenburg, Sweden
| | - Lynda Wyld
- Department of Oncology and Metabolism, Sheffield University, Sheffield, United Kingdom
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, HPB unit, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | | | - Teresa Amaral
- Dermatology, Eberhard Karls Universitat Tubingen, Tubingen, Germany
| | | | - Viren Bahadoer
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Geerard Beets
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Kim Benstead
- Gloucestershire Oncology Centre, Cheltenham General Hospital, United Kingdom
| | - Elisabeth Berge Nilsen
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - Kalijn Bol
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Andreas Brandl
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany; Digestive Unit, Champalimaud Foundation, Lisbon, Portugal
| | - Jerry Braun
- Department of Thoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Tanja Cufer
- University Clinic Golnik, University of Ljubljana, 4204 Ljubljana, Slovenia
| | - Cristina Dopazo
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ibrahim Edhemovic
- Department of Surgery, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tessa van Ginhoven
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | - Jos van der Hage
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Merlijn Hutteman
- Department of Thoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Yazan Masannat
- University of Aberdeen, School of Medicine, Medical Science and Nutrition, Aberdeen, UK
| | - Elisa Concetta Onesti
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Beate Rau
- Department of General Surgery, Charité University of Berlin, Berlin, Germany
| | - Theo De Reijke
- Department of Urology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Isabel Rubio
- Breast Surgical Oncology, Clínica Universidad de Navarra, Madrid, Universidad de Navarra, Spain
| | - Jelle Ruurda
- Visceral Sarcoma Surgery Unit, Città della Salute e della Scienza, Turin, Italy
| | - Sergio Sandrucci
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Kjetil Soreide
- Department of Surgery, Salzkammergutklinikum, Standort Vöcklabruck, Oberösterreich, Austria
| | - Stefan Stattner
- Department of Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria; New drugs development for innovative therapies, European Institute of Oncology, IRCCS, Milano, Italy
| | - Dario Trapani
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, 00168 Rome, Italy
| | - Domenico D'Ugo
- Department of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Menno Vriens
- Department of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | |
Collapse
|