1
|
Bai X, Shaheen A, Grieco C, d’Arienzo PD, Mina F, Czapla JA, Lawless AR, Bongiovanni E, Santaniello U, Zappi H, Dulak D, Williamson A, Lee R, Gupta A, Li C, Si L, Ubaldi M, Yamazaki N, Ogata D, Johnson R, Park BC, Jung S, Madonna G, Hochherz J, Umeda Y, Nakamura Y, Gebhardt C, Festino L, Capone M, Ascierto PA, Johnson DB, Lo SN, Long GV, Menzies AM, Namikawa K, Mandala M, Guo J, Lorigan P, Najjar YG, Haydon A, Quaglino P, Boland GM, Sullivan RJ, Furness AJ, Plummer R, Flaherty KT. Dabrafenib plus trametinib versus anti-PD-1 monotherapy as adjuvant therapy in BRAF V600-mutant stage III melanoma after definitive surgery: a multicenter, retrospective cohort study. EClinicalMedicine 2024; 71:102564. [PMID: 38572079 PMCID: PMC10990704 DOI: 10.1016/j.eclinm.2024.102564] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Affiliation(s)
- Xue Bai
- Department of Melanoma and Sarcoma, Peking University Cancer Hospital & Institute, China
- Massachusetts General Hospital, USA
| | | | | | | | - Florentia Mina
- Skin Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | - Eleonora Bongiovanni
- Dermatologic Clinic, Department of Medical Sciences, University of Turin Medical School, Italy
| | - Umberto Santaniello
- Dermatologic Clinic, Department of Medical Sciences, University of Turin Medical School, Italy
| | | | - Dominika Dulak
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Rebecca Lee
- Division of Cancer Sciences, University of Manchester and Christie NHS Foundation Trust, Manchester, UK
| | | | - Caili Li
- Department of Melanoma and Sarcoma, Peking University Cancer Hospital & Institute, China
| | - Lu Si
- Department of Melanoma and Sarcoma, Peking University Cancer Hospital & Institute, China
| | | | - Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Dai Ogata
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Rebecca Johnson
- Melanoma Institute Australia, The University of Sydney; Faculty of Medicine and Health, The University of Sydney; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, Australia
| | - Benjamin C. Park
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Seungyeon Jung
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gabriele Madonna
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics - Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Juliane Hochherz
- Department of Dermatology, University Medical Center Hamburg-Eppendorf (UKE), University Skin Cancer Center, Hamburg, Germany
| | - Yoshiyasu Umeda
- Department of Skin Oncology/Dermatology, Comprehensive Cancer Center, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yasuhiro Nakamura
- Department of Skin Oncology/Dermatology, Comprehensive Cancer Center, Saitama Medical University International Medical Center, Saitama, Japan
| | - Christoffer Gebhardt
- Department of Dermatology, University Medical Center Hamburg-Eppendorf (UKE), University Skin Cancer Center, Hamburg, Germany
| | - Lucia Festino
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics - Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Mariaelena Capone
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics - Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Paolo Antonio Ascierto
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics - Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Douglas B. Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Serigne N. Lo
- Melanoma Institute Australia, The University of Sydney; Faculty of Medicine and Health, The University of Sydney, North Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Georgina V. Long
- Melanoma Institute Australia, The University of Sydney; Faculty of Medicine and Health, The University of Sydney; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, Australia
| | - Alexander M. Menzies
- Melanoma Institute Australia, The University of Sydney; Faculty of Medicine and Health, The University of Sydney; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, Australia
| | - Kenjiro Namikawa
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Jun Guo
- Department of Melanoma and Sarcoma, Peking University Cancer Hospital & Institute, China
| | - Paul Lorigan
- Division of Cancer Sciences, University of Manchester and Christie NHS Foundation Trust, Manchester, UK
| | | | | | - Pietro Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Turin Medical School, Italy
| | | | | | | | | | | |
Collapse
|
2
|
Taylor AM, McKeown J, Dimitriou F, Jacques SK, Zimmer L, Allayous C, Yeoh HL, Haydon A, Ressler JM, Galea C, Woodford R, Kahler K, Hauschild A, Festino L, Hoeller C, Schwarze JK, Neyns B, Wicky A, Michielin O, Placzke J, Rutkowski P, Johnson DB, Lebbe C, Dummer R, Ascierto PA, Lo S, Long GV, Carlino MS, Menzies AM. Efficacy and safety of 'Second Adjuvant' therapy with BRAF/MEK inhibitors after local therapy for recurrent melanoma following adjuvant PD-1 based immunotherapy. Eur J Cancer 2024; 199:113561. [PMID: 38278009 DOI: 10.1016/j.ejca.2024.113561] [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: 11/20/2023] [Revised: 01/14/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Anti-PD-1 antibodies and BRAK/MEK inhibitors (BRAF/MEKi) reduce the risk of recurrence for patients with resected stage III melanoma. BRAFV600-mutated (BRAFmut) melanoma patients who recur with isolated disease following adjuvant therapy may be suitable for 'second adjuvant' treatment after local therapy. We sought to examine the efficacy and safety of 'second adjuvant' BRAF/MEKi. PATIENTS AND METHODS Patients with BRAFmut melanoma treated with adjuvant PD-1 based immunotherapy who recurred, underwent definitive local therapy and were then treated with adjuvant BRAF/MEKi were identified retrospectively from 13 centres (second adjuvant group). Demographics, disease and treatment characteristics and outcome data were examined. Outcomes were compared to BRAFmut patients who did not receive 'second adjuvant' therapy (no second adjuvant group). RESULTS 73 patients were included; 61 who received 'second adjuvant' therapy and 12 who did not. Most initially recurred on PD-1 therapy (66%). There were no differences in characteristics between groups. 92% of second adjuvant group received dabrafenib and trametinib and median duration of therapy was 11.8 months (0.4, 34.5). 72% required dose adjustments, 23% had grade 3 + toxicity and 38% permanently discontinued drug due to toxicity. After median 26.1 months (1.9, 56.3) follow-up, recurrence-free survival (RFS) was improved in second adjuvant group versus no second adjuvant group (median 30.8 vs 4 months, HR 0.35; p = 0.014), largely driven by a delay in early recurrence, with no difference in overall survival (p = 0.59). CONCLUSION This is the first study examining outcomes of 'second adjuvant' targeted therapy for melanoma, after failure of adjuvant PD-1 based immunotherapy. Data suggest a short-term improvement in RFS, but at the cost of toxicity. Alternative strategies and more data on sequencing adjuvant therapies are required to improve outcomes.
Collapse
Affiliation(s)
- Amelia M Taylor
- Melanoma Institute Australia, The University of Sydney, Australia
| | - Janet McKeown
- Melanoma Institute Australia, The University of Sydney, Australia
| | - Florentia Dimitriou
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Sarah K Jacques
- Crown Princess Mary Cancer Centre, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Clara Allayous
- Université Paris Cite,AP-HP Dermato-oncology, Cancer institute APHP.nord Paris cité, INSERM U976, Saint Louis Hospital, Paris, France
| | | | | | - Julia M Ressler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Claire Galea
- Melanoma Institute Australia, The University of Sydney, Australia
| | - Rachel Woodford
- Melanoma Institute Australia, The University of Sydney, Australia
| | - Katharina Kahler
- University Hospital (UKSH), Campus Kiel, Department of Dermatology, Kiel, Germany
| | - Axel Hauschild
- University Hospital (UKSH), Campus Kiel, Department of Dermatology, Kiel, Germany
| | - Lucia Festino
- Melanoma. Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Napoli, Italy
| | - Christoph Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Bart Neyns
- Department of Medical Oncology, Brussels, Belgium
| | - Alexandre Wicky
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Michielin
- Precision Oncology Center, Lausanne University Hospital, Switzerland
| | - Joanna Placzke
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Celeste Lebbe
- Université Paris Cite,AP-HP Dermato-oncology, Cancer institute APHP.nord Paris cité, INSERM U976, Saint Louis Hospital, Paris, France
| | - Reinhard Dummer
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Paolo A Ascierto
- Melanoma. Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Napoli, Italy
| | - Serigne Lo
- Melanoma Institute Australia, The University of Sydney, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| | - Matteo S Carlino
- Melanoma Institute Australia, The University of Sydney, Australia; Crown Princess Mary Cancer Centre, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia.
| |
Collapse
|
3
|
Herbison H, Davis S, Nickless D, Haydon A, Ameratunga M. Sustained Clinical Response to Immunotherapy Followed by BET Inhibitor in a Patient with Unresectable Sinonasal NUT Carcinoma. J Immunother Precis Oncol 2024; 7:67-72. [PMID: 38327754 PMCID: PMC10846633 DOI: 10.36401/jipo-23-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/24/2023] [Accepted: 09/13/2023] [Indexed: 02/09/2024]
Abstract
NUT carcinomas (NCs) are a group of rare tumors that can occur anywhere in the body and are defined by the fusion of the nuclear protein in testis (NUTM1) resulting in increased transcription of proto-oncogenes. NCs have a poor prognosis that varies according to the site of origin with an urgent need to develop new treatment strategies. Case reports on immunotherapy in pulmonary NC have been published, and bromodomain and extraterminal (BET) inhibitors have shown activity in NC in phase I/II trials. We present the case of a 27-year-old woman with an unresectable sinonasal NC who had a sustained clinical response to both immunotherapy and BET inhibitor therapy. This is the first reported case of immunotherapy in sinonasal NC, and it highlights the different responses to a range of treatments including BET inhibitor therapy. This case supports the theory that NCs arising from different primary sites have differing prognoses.
Collapse
Affiliation(s)
- Harriet Herbison
- Department of Medical Oncology, Monash Health, Clayton, Victoria, Australia
| | - Sidney Davis
- Department of Radiation Oncology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - David Nickless
- Department of Anatomical Pathology, Cabrini Pathology, Melbourne, Victoria, Australia
| | - Andrew Haydon
- Department of Medical Oncology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Malaka Ameratunga
- Department of Medical Oncology, The Alfred Hospital, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Hepner A, Versluis JM, Wallace R, Allayous C, Brown LJ, Trojaniello C, Gerard CL, Jansen YJ, Bhave P, Neyns B, Haydon A, Michielin O, Mangana J, Klein O, Shoushtari AN, Warner AB, Ascierto PA, McQuade JL, Carlino MS, Zimmer L, Lebbe C, Johnson DB, Sandhu S, Atkinson V, Blank CU, Lo SN, Long GV, Menzies AM. The features and management of acquired resistance to PD1-based therapy in metastatic melanoma. Eur J Cancer 2024; 196:113441. [PMID: 37988842 DOI: 10.1016/j.ejca.2023.113441] [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: 08/27/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Anti-PD-1 therapy (PD1) either alone or with anti-CTLA-4 (CTLA4), has high initial response rates, however 20% of patients (pts) with complete response (CR) and 30% with partial response (PR) within 12 months of treatment experience subsequent disease progression by 6 years. The nature and optimal management of this acquired resistance (AR) remains unknown. METHODS Pts from 16 centres who responded to PD1-based therapy and who later progressed were examined. Demographics, disease characteristics and subsequent treatments were evaluated. RESULTS 299 melanoma pts were identified, median age 64y, 44% BRAFV600m. 172 (58%) received PD1 alone, 114 (38%) PD1/CTLA4 and 13 (4%) PD1 and an investigational drug. 90 (30%) pts had CR, 209 (70%) PR. Median time to AR was 12.6 mo (95% CI, 11.3, 14.2). Most (N = 193, 65%) progressed in a single organ site, and in a solitary lesion (N = 151, 51%). The most frequent sites were lymph nodes (38%) and brain (25%). Management at AR included systemic therapy (ST, 45%), local therapy (LT) +ST (31%), LT alone (21%), or observation (3%). There was no statistical difference in PFS2 or OS based on management, however, PFS2 was numerically superior for pts treated with ST alone who progressed off PD1 therapy than those who progressed on PD1 (2-year PFS2 42% versus 25%, p = 0.249). mOS from AR was 38.0 months (95% CI, 29.5-NR); longer in single-site versus multi-site progression (2-year OS 70% vs 54%, p < 0·001). CONCLUSIONS Acquired resistance to PD1 therapy in melanoma is largely oligometastatic, and pts may have a favorable survival outcome following salvage treatment.
Collapse
Affiliation(s)
- Adriana Hepner
- Melanoma Institute Australia, The University of Sydney, NSW, Australia; Instituto do Cancer do Estado de Sao Paulo, SP, Brazil
| | | | - Roslyn Wallace
- Sir Peter MacCallum Cancer Centre Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Clara Allayous
- Université Paris Cite, Dermato-Oncology AP-HP Hôpital Saint Louis, INSERM U976, F-75010 Paris, France
| | - Lauren Julia Brown
- Crown Princess Mary Cancer Centre Westmead and Blacktown Hospitals, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Camille Lea Gerard
- Precision Oncology Center Oncology department, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Yanina Jl Jansen
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven 3000, Belgium
| | - Prachi Bhave
- Sir Peter MacCallum Cancer Centre Department of Oncology, The University of Melbourne, Melbourne, Australia; Department of Medical Oncology, Alfred Health, Melbourne, Australia
| | - Bart Neyns
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Andrew Haydon
- Department of Medical Oncology, Alfred Health, Melbourne, Australia; Monash University, Melbourne, Australia
| | - Olivier Michielin
- Precision Oncology Center Oncology department, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | | | - Oliver Klein
- Olivia Newton-John Cancer Centre and Austin Health, Melbourne, Australia
| | - Alexander N Shoushtari
- Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | | | | | | | | | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Celeste Lebbe
- Université Paris Cite, Dermato-Oncology AP-HP Hôpital Saint Louis, INSERM U976, F-75010 Paris, France
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville TN, USA
| | - Shahneen Sandhu
- Sir Peter MacCallum Cancer Centre Department of Oncology, The University of Melbourne, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Victoria Atkinson
- University of Queensland and Princess Alexandra and Greenslopes Private Hospital, Brisbane, Australia
| | - Christian U Blank
- Netherlands Cancer Institute (NKI), Amsterdam, the Netherlands; Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal North Shore and Mater Hospitals, NSW, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal North Shore and Mater Hospitals, NSW, Australia.
| |
Collapse
|
5
|
Soon JA, To YH, Alexander M, Trapani K, Ascierto PA, Athan S, Brown MP, Burge M, Haydon A, Hughes B, Itchins M, John T, Kao S, Koopman M, Li BT, Long GV, Loree JM, Markman B, Meniawy TM, Menzies AM, Nott L, Pavlakis N, Petrella TM, Popat S, Tie J, Xu W, Yip D, Zalcberg J, Solomon BJ, Gibbs P, McArthur GA, Franchini F, IJzerman M. A tailored approach to horizon scanning for cancer medicines. J Cancer Policy 2023; 38:100441. [PMID: 38008488 DOI: 10.1016/j.jcpo.2023.100441] [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: 04/26/2023] [Revised: 07/18/2023] [Accepted: 08/17/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Horizon scanning (HS) is the systematic identification of emerging therapies to inform policy and decision-makers. We developed an agile and tailored HS methodology that combined multi-criteria decision analysis weighting and Delphi rounds. As secondary objectives, we aimed to identify new medicines in melanoma, non-small cell lung cancer and colorectal cancer most likely to impact the Australian government's pharmaceutical budget by 2025 and to compare clinician and consumer priorities in cancer medicine reimbursement. METHOD Three cancer-specific clinician panels (total n = 27) and a consumer panel (n = 7) were formed. Six prioritisation criteria were developed with consumer input. Criteria weightings were elicited using the Analytic Hierarchy Process (AHP). Candidate medicines were identified and filtered from a primary database and validated against secondary and tertiary sources. Clinician panels participated in a three-round Delphi survey to identify and score the top five medicines in each cancer type. RESULTS The AHP and Delphi process was completed in eight weeks. Prioritisation criteria focused on toxicity, quality of life (QoL), cost savings, strength of evidence, survival, and unmet need. In both curative and non-curative settings, consumers prioritised toxicity and QoL over survival gains, whereas clinicians prioritised survival. HS results project the ongoing prevalence of high-cost medicines. Since completion in October 2021, the HS has identified 70 % of relevant medicines submitted for Pharmaceutical Benefit Advisory Committee assessment and 60% of the medicines that received a positive recommendation. CONCLUSION Tested in the Australian context, our method appears to be an efficient and flexible approach to HS that can be tailored to address specific disease types by using elicited weights to prioritise according to incremental value from both a consumer and clinical perspective. POLICY SUMMARY Since HS is of global interest, our example provides a reproducible blueprint for adaptation to other healthcare settings that integrates consumer input and priorities.
Collapse
Affiliation(s)
- Jennifer A Soon
- Centre for Health Policy, Cancer Health Services Research, University of Melbourne, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - Yat Hang To
- Gibbs Laboratory, Walter and Eliza Hall Institute of Research, Parkville, Australia
| | - Marliese Alexander
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Karen Trapani
- Centre for Health Policy, Cancer Health Services Research, University of Melbourne, Melbourne, Australia
| | - Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Sophy Athan
- Victorian Comprehensive Cancer Centre Alliance, Melbourne, Australia
| | - Michael P Brown
- Cancer Clinical Trials Unit, Royal Adelaide Hospital, Adelaide, Australia; School of Medicine, The University of Adelaide, Adelaide, Australia; Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, Australia
| | - Matthew Burge
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, Australia; Department of Medical Oncology, Prince Charles Hospital, Chermside, Australia
| | - Andrew Haydon
- Department of Medical Oncology, Alfred Health, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Brett Hughes
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, Australia; Department of Medical Oncology, Prince Charles Hospital, Chermside, Australia; The University of Queensland, Brisbane, Australia
| | - Malinda Itchins
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, Australia; Northern Clinical School, The University of Sydney, St Leonards, Australia
| | - Thomas John
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Steven Kao
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, Australia; School of Medicine, The University of Sydney, Sydney, Australia
| | - Miriam Koopman
- Medical Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Bob T Li
- Memorial Sloan Kettering Cancer Centre and Weill Cornell Medicine, New York, USA
| | - Georgina V Long
- School of Medicine, The University of Sydney, Sydney, Australia; Melanoma Institute Australia, Sydney, Australia; Royal North Shore and Mater Hospitals, Sydney, Australia
| | | | - Ben Markman
- Department of Medical Oncology, Alfred Health, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Tarek M Meniawy
- Sir Charles Gairdner Hospital and the University of Western Australia, Nedlands, Australia
| | - Alexander M Menzies
- School of Medicine, The University of Sydney, Sydney, Australia; Melanoma Institute Australia, Sydney, Australia
| | - Louise Nott
- Royal Hobart Hospital, Hobart, Australia; Icon Cancer Centre, Hobart, Australia
| | - Nick Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, Australia; School of Medicine, The University of Sydney, Sydney, Australia
| | | | - Sanjay Popat
- Lung Unit, The Royal Marsden NHS Foundation Trust, London, UK; Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Jeanne Tie
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Gibbs Laboratory, Walter and Eliza Hall Institute of Research, Parkville, Australia
| | - Wen Xu
- Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia
| | - Desmond Yip
- Department of Medical Oncology, The Canberra Hospital, Garran, Australia; School of Medicine and Psychology, Australian National University, Canberra, Australia
| | - John Zalcberg
- Department of Medical Oncology, Alfred Health, Melbourne, Australia; Erasmus School of Health Policy and Management, Rotterdam, the Netherlands
| | - Benjamin J Solomon
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Peter Gibbs
- Gibbs Laboratory, Walter and Eliza Hall Institute of Research, Parkville, Australia
| | - Grant A McArthur
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Victorian Comprehensive Cancer Centre Alliance, Melbourne, Australia
| | - Fanny Franchini
- Centre for Health Policy, Cancer Health Services Research, University of Melbourne, Melbourne, Australia
| | - Maarten IJzerman
- Erasmus School of Health Policy and Management, Rotterdam, the Netherlands
| |
Collapse
|
6
|
Bai X, Shaheen A, Grieco C, d’Arienzo PD, Mina F, Czapla JA, Lawless AR, Bongiovanni E, Santaniello U, Zappi H, Dulak D, Williamson A, Lee R, Gupta A, Li C, Si L, Ubaldi M, Yamazaki N, Ogata D, Johnson R, Park BC, Jung S, Madonna G, Hochherz J, Umeda Y, Nakamura Y, Gebhardt C, Festino L, Capone M, Ascierto PA, Johnson DB, Lo SN, Long GV, Menzies AM, Namikawa K, Mandala M, Guo J, Lorigan P, Najjar YG, Haydon A, Quaglino P, Boland GM, Sullivan RJ, Furness AJ, Plummer R, Flaherty KT. Dabrafenib plus trametinib versus anti-PD-1 monotherapy as adjuvant therapy in BRAF V600-mutant stage III melanoma after definitive surgery: a multicenter, retrospective cohort study. EClinicalMedicine 2023; 65:102290. [PMID: 37965433 PMCID: PMC10641479 DOI: 10.1016/j.eclinm.2023.102290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 11/16/2023] Open
Abstract
Background Both dabrafenib/trametinib (D/T) and anti-PD-1 monotherapy (PD-1) are approved adjuvant therapies for patients with stage III BRAF V600-mutant melanoma. However, there is still a lack of head-to-head comparative data. We aimed to describe efficacy and toxicity outcomes for these two standard therapies across melanoma centers. Methods This multicenter, retrospective cohort study was conducted in 15 melanoma centers in Australia, China, Germany, Italy, Japan, UK, and US. We included adult patients with resected stage III BRAF V600-mutant melanoma who received either adjuvant D/T or PD-1 between Jul 2015 and Oct 2022. The primary endpoint was relapse-free survival (RFS). Secondary endpoints included overall survival (OS), recurrence pattern and toxicity. Findings We included 598 patients with stage III BRAF V600-mutant melanoma who received either adjuvant D/T (n = 393 [66%]) or PD-1 (n = 205 [34%]) post definitive surgery between Jul 2015 and Oct 2022. At a median follow-up of 33 months (IQR 21-43), the median RFS was 51.0 months (95% CI 41.0-not reached [NR]) in the D/T group, significantly longer than PD-1 (44.8 months [95% CI 28.5-NR]) (univariate: HR 0.66, 95% CI 0.50-0.87, P = 0.003; multivariate: HR 0.58, 95% CI 0.39-0.86, P = 0.007), with comparable OS with PD-1 (multivariate, HR 0.90, 95% CI 0.48-1.70, P = 0.75). Similar findings were observed using a restricted-mean-survival-time model. Among those who experienced recurrence, the proportion of distant metastases was higher in the D/T cohort. D/T had a higher incidence of treatment modification due to adverse events (AEs) than PD-1, but fewer persistent AEs. Interpretation In patients with stage III BRAF V600-mutant melanoma post definitive surgery, D/T yielded better RFS than PD-1, with higher transient but lower persistent toxicity, and comparable OS. D/T seems to provide a better outcome compared with PD-1, but a longer follow-up and ideally a large prospective trial are needed. Funding Dr. Xue Bai was supported by the Beijing Hospitals Authority Youth Programme (QMS20211101) for her efforts devoted to this study. Dr. Keith T. Flaherty was funded by Adelson Medical Research Foundation for the efforts devoted to this study.
Collapse
Affiliation(s)
- Xue Bai
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
- Massachusetts General Hospital, USA
| | | | | | | | - Florentia Mina
- Skin Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | - Eleonora Bongiovanni
- Dermatologic Clinic, Department of Medical Sciences, University of Turin Medical School, Italy
| | - Umberto Santaniello
- Dermatologic Clinic, Department of Medical Sciences, University of Turin Medical School, Italy
| | | | - Dominika Dulak
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Rebecca Lee
- Division of Cancer Sciences, University of Manchester and Christie NHS Foundation Trust, Manchester, UK
| | | | - Caili Li
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Lu Si
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | | | - Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Dai Ogata
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Rebecca Johnson
- Melanoma Institute Australia, The University of Sydney; Faculty of Medicine and Health, The University of Sydney; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, Australia
| | - Benjamin C. Park
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Seungyeon Jung
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gabriele Madonna
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics - Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Juliane Hochherz
- Department of Dermatology, University Skin Cancer Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Yoshiyasu Umeda
- Department of Skin Oncology/Dermatology, Comprehensive Cancer Center, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yasuhiro Nakamura
- Department of Skin Oncology/Dermatology, Comprehensive Cancer Center, Saitama Medical University International Medical Center, Saitama, Japan
| | - Christoffer Gebhardt
- Department of Dermatology, University Skin Cancer Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Lucia Festino
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics - Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Mariaelena Capone
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics - Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Paolo Antonio Ascierto
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics - Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Douglas B. Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Serigne N. Lo
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
| | - Georgina V. Long
- Melanoma Institute Australia, The University of Sydney; Faculty of Medicine and Health, The University of Sydney; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, Australia
| | - Alexander M. Menzies
- Melanoma Institute Australia, The University of Sydney; Faculty of Medicine and Health, The University of Sydney; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, Australia
| | - Kenjiro Namikawa
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Jun Guo
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Paul Lorigan
- Division of Cancer Sciences, University of Manchester and Christie NHS Foundation Trust, Manchester, UK
| | | | | | - Pietro Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Turin Medical School, Italy
| | | | | | | | | | | |
Collapse
|
7
|
Haydon A, Avila S, Patino S, Callender B, Ortega P, Franco II, Ichikawa T, Golden DW. Communicating the External Beam Radiotherapy Experience (CEBRE) Discussion Guides: Real World Implementation and Evaluation. Int J Radiat Oncol Biol Phys 2023; 117:e107-e108. [PMID: 37784640 DOI: 10.1016/j.ijrobp.2023.06.883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Communicating about the radiotherapy treatment process can be difficult for patients and healthcare professionals. The "Communicating the External Beam Radiotherapy Experience" (CEBRE) and Communicating the Gynecologic Brachytherapy Experience (CoGBE) discussion guides use graphic narrative to explain external beam radiotherapy and gynecologic high-dose rate brachytherapy, respectively. The CEBRE, CoGBE, and CEBRE en Español guides have been available for free download since 10/2018, 6/2020, and 8/2021, respectively. This study aims to characterize how the guides are being implemented and used in practice. MATERIALS/METHODS Global downloads of the CEBRE, CoGBE, and CEBRE en Español guides were analyzed. Email addresses submitted at the time of download were used to contact study subjects. Duplicate emails, fake addresses, and expired emails were removed resulting in 500 individuals being invited to participate in the survey. A data collection web application survey was distributed on 1/27/23. Two reminders were sent prior to the survey closing on 2/13/23. The survey addressed how physicians or other radiotherapy team members use the CEBRE guides, where they are used, and how the guides can be improved. Likert-type data (1 = strongly disagree, 5 = strongly agree) are reported as median [interquartile range]. RESULTS As of 10/16/22, the CEBRE guides (English) had been downloaded 602 times, CoGBE 86 times, and CEBRE en Español 63 times. 42/500 individuals responded to the survey for an 8% response rate. 40/42 (95%) of participants were healthcare providers with 35/40 (87.5%) radiation oncologists. 16/40 (40%) have used the CEBRE guides in some way. 6/16 (37.5%) "always use," 2/16 (12.5%) "often use," and 3/16 (18.8%) "sometimes use" the guides during consultation. 8/16 (50%) report using the guides for education of medical students, residents, and fellows. The 16 respondents that use the guides felt the guides were useful overall (5[5-5]), felt "very confident" using the guides (4.5[4-5]), and felt the guides "help patients prepare for their treatment" (5[4-5]). 40 respondents provided suggestions on additional language translations with 19/40 (48%) recommending translation into Mandarin, 6/40 (15%) into Cantonese, Portuguese, French and Arabic, and 5/40 (12.5%) into Haitian, Hindi, and Vietnamese. CONCLUSION The majority of respondents did not use the CEBRE guides which may be due to difficulty with implementation. However, respondents who use the guides are confident using them and rate them as useful for patients. These data, although limited by the low response rate, suggest that the CEBRE guides have accomplished the goal of facilitating patient-physician conversations. Moreover, there is an interest in translating the guides into additional languages other than Spanish. Due to the low response rate, definitive conclusions cannot be made from these data. Therefore, further research such as interviews and focus groups may be beneficial.
Collapse
Affiliation(s)
- A Haydon
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - S Avila
- The University of Chicago Pritzker School of Medicine, Chicago, IL
| | - S Patino
- The University of Chicago, Chicago, IL
| | - B Callender
- Department of Medicine, University of Chicago Medical Center and Pritzker School of Medicine, Chicago, IL
| | - P Ortega
- Departments of Emergency Medicine and Medical Education, University of Illinois College of Medicine, Chicago, IL
| | - I I Franco
- Department of Radiation Oncology, Harvard Medical School, Boston, MA
| | - T Ichikawa
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - D W Golden
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| |
Collapse
|
8
|
Cass SH, Tobin JWD, Seo YD, Gener-Ricos G, Keung EZ, Burton EM, Davies MA, McQuade JL, Lazar AJ, Mason R, Millward M, Sandhu S, Khoo C, Warburton L, Guerra V, Haydon A, Dearden H, Menzies AM, Carlino MS, Smith JL, Mollee P, Burgess M, Mapp S, Keane C, Atkinson V, Parikh SA, Markovic SN, Ding W, Call TG, Hampel PJ, Long GV, Wargo JA, Ferrajoli A. Efficacy of immune checkpoint inhibitors for the treatment of advanced melanoma in patients with concomitant chronic lymphocytic leukemia. Ann Oncol 2023; 34:796-805. [PMID: 37414216 DOI: 10.1016/j.annonc.2023.06.007] [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: 03/20/2023] [Revised: 05/25/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have revolutionized the management of advanced melanoma (AM). However, data on ICI effectiveness have largely been restricted to clinical trials, thereby excluding patients with co-existing malignancies. Chronic lymphocytic leukemia (CLL) is the most prevalent adult leukemia and is associated with increased risk of melanoma. CLL alters systemic immunity and can induce T-cell exhaustion, which may limit the efficacy of ICIs in patients with CLL. We, therefore, sought to examine the efficacy of ICI in patients with these co-occurring diagnoses. PATIENTS AND METHODS In this international multicenter study, a retrospective review of clinical databases identified patients with concomitant diagnoses of CLL and AM treated with ICI (US-MD Anderson Cancer Center, N = 24; US-Mayo Clinic, N = 15; AUS, N = 19). Objective response rates (ORRs), assessed by RECIST v1.1, and survival outcomes [overall survival (OS) and progression-free survival (PFS)] among patients with CLL and AM were assessed. Clinical factors associated with improved ORR and survival were explored. Additionally, ORR and survival outcomes were compared between the Australian CLL/AM cohort and a control cohort of 148 Australian patients with AM alone. RESULTS Between 1997 and 2020, 58 patients with concomitant CLL and AM were treated with ICI. ORRs were comparable between AUS-CLL/AM and AM control cohorts (53% versus 48%, P = 0.81). PFS and OS from ICI initiation were also comparable between cohorts. Among CLL/AM patients, a majority were untreated for their CLL (64%) at the time of ICI. Patients with prior history of chemoimmunotherapy treatment for CLL (19%) had significantly reduced ORRs, PFS, and OS. CONCLUSIONS Our case series of patients with concomitant CLL and melanoma demonstrate frequent, durable clinical responses to ICI. However, those with prior chemoimmunotherapy treatment for CLL had significantly worse outcomes. We found that CLL disease course is largely unchanged by treatment with ICI.
Collapse
Affiliation(s)
- S H Cass
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - J W D Tobin
- Haematology Department, Princess Alexandra Hospital, Woolloongabba; University of Queensland, Brisbane, Australia
| | - Y D Seo
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - G Gener-Ricos
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston
| | - E Z Keung
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - E M Burton
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - M A Davies
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - J L McQuade
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - A J Lazar
- Departments of Pathology and Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, USA
| | - R Mason
- Gold Coast University Hospital, Southport
| | | | - S Sandhu
- Peter Macallum Cancer Centre, Melbourne
| | - C Khoo
- Peter Macallum Cancer Centre, Melbourne
| | - L Warburton
- Fiona Stanley Hospital, Perth; Edith Cowan University, Joondalup; Future Health Research and Innovation Fund/Raine Clinician Research Fellowship
| | - V Guerra
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston
| | | | - H Dearden
- Melanoma Institute Australia, The University of Sydney, Sydney
| | - A M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney; Faculty of Medicine and Health, The University of Sydney, Sydney; The University of Sydney Charles Perkins Centre, Sydney; The University of Sydney Royal North Shore and Mater Hospitals, Sydney
| | - M S Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney; Westmead Hospital, Sydney, Australia
| | - J L Smith
- Westmead Hospital, Sydney, Australia
| | - P Mollee
- Haematology Department, Princess Alexandra Hospital, Woolloongabba; University of Queensland, Brisbane, Australia
| | - M Burgess
- Haematology Department, Princess Alexandra Hospital, Woolloongabba; University of Queensland, Brisbane, Australia
| | - S Mapp
- Haematology Department, Princess Alexandra Hospital, Woolloongabba; University of Queensland, Brisbane, Australia
| | - C Keane
- Haematology Department, Princess Alexandra Hospital, Woolloongabba; University of Queensland, Brisbane, Australia
| | - V Atkinson
- Haematology Department, Princess Alexandra Hospital, Woolloongabba; University of Queensland, Brisbane, Australia
| | | | | | - W Ding
- Mayo Clinic, Rochester, USA
| | | | | | - G V Long
- Melanoma Institute Australia, The University of Sydney, Sydney; Faculty of Medicine and Health, The University of Sydney, Sydney; The University of Sydney Charles Perkins Centre, Sydney; The University of Sydney Royal North Shore and Mater Hospitals, Sydney
| | - J A Wargo
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA.
| | - A Ferrajoli
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston
| |
Collapse
|
9
|
Goodman RS, Lawless A, Woodford R, Fa’ak F, Tipirneni A, Patrinely JR, Yeoh HL, Rapisuwon S, Haydon A, Osman I, Mehnert JM, Long GV, Sullivan RJ, Carlino MS, Menzies AM, Johnson DB. Extended Follow-Up of Chronic Immune-Related Adverse Events Following Adjuvant Anti-PD-1 Therapy for High-Risk Resected Melanoma. JAMA Netw Open 2023; 6:e2327145. [PMID: 37535354 PMCID: PMC10401300 DOI: 10.1001/jamanetworkopen.2023.27145] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/21/2023] [Indexed: 08/04/2023] Open
Abstract
Importance Anti-programmable cell death-1 (anti-PD-1) improves relapse-free survival when used as adjuvant therapy for high-risk resected melanoma. However, it can lead to immune-related adverse events (irAEs), which become chronic in approximately 40% of patients with high-risk melanoma treated with adjuvant anti-PD-1. Objective To determine the incidence, characteristics, and long-term outcomes of chronic irAEs from adjuvant anti-PD-1 therapy. Design, Setting, and Participants This retrospective multicenter cohort study analyzed patients treated with adjuvant anti-PD-1 therapy for advanced and metastatic melanoma between 2015 and 2022 from 6 institutions in the US and Australia with at least 18 months of evaluable follow-up after treatment cessation (range, 18.2 to 70.4 months). Main Outcomes and Measures Incidence, spectrum, and ultimate resolution vs persistence of chronic irAEs (defined as those persisting at least 3 months after therapy cessation). Descriptive statistics were used to analyze categorical and continuous variables. Kaplan-Meier curves assessed survival, and Wilson score intervals were used to calculate CIs for proportions. Results Among 318 patients, 190 (59.7%) were male (median [IQR] age, 61 [52.3-72.0] years), 270 (84.9%) had a cutaneous primary, and 237 (74.5%) were stage IIIB or IIIC at presentation. Additionally, 226 patients (63.7%) developed acute irAEs arising during treatment, including 44 (13.8%) with grade 3 to 5 irAEs. Chronic irAEs, persisting at least 3 months after therapy cessation, developed in 147 patients (46.2%; 95% CI, 0.41-0.52), of which 74 (50.3%) were grade 2 or more, 6 (4.1%) were grade 3 to 5, and 100 (68.0%) were symptomatic. With long-term follow-up (median [IQR], 1057 [915-1321] days), 54 patients (36.7%) experienced resolution of chronic irAEs (median [IQR] time to resolution of 19.7 [14.4-31.5] months from anti-PD-1 start and 11.2 [8.1-20.7] months from anti-PD-1 cessation). Among patients with persistent irAEs present at last follow-up (93 [29.2%] of original cohort; 95% CI, 0.25-0.34); 55 (59.1%) were grade 2 or more; 41 (44.1%) were symptomatic; 24 (25.8%) were using therapeutic systemic steroids (16 [67%] of whom were on replacement steroids for hypophysitis (8 [50.0%]) and adrenal insufficiency (8 [50.0%]), and 42 (45.2%) were using other management. Among the 54 patients, the most common persistent chronic irAEs were hypothyroid (38 [70.4%]), arthritis (18 [33.3%]), dermatitis (9 [16.7%]), and adrenal insufficiency (8 [14.8%]). Furthermore, 54 [17.0%] patients experienced persistent endocrinopathies, 48 (15.1%) experienced nonendocrinopathies, and 9 (2.8%) experienced both. Of 37 patients with chronic irAEs who received additional immunotherapy, 25 (67.6%) experienced no effect on chronic irAEs whereas 12 (32.4%) experienced a flare in their chronic toxicity. Twenty patients (54.1%) experienced a distinct irAE. Conclusions and Relevance In this cohort study of 318 patients who received adjuvant anti-PD-1, chronic irAEs were common, affected diverse organ systems, and often persisted with long-term follow-up requiring steroids and additional management. These findings highlight the likelihood of persistent toxic effects when considering adjuvant therapies and need for long-term monitoring and management.
Collapse
Affiliation(s)
| | - Aleigha Lawless
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - Rachel Woodford
- Department of Medical Oncology, Melanoma Institute of Australia, Sydney, New South Wales, Australia
| | - Faisal Fa’ak
- Department of Hematology and Medical Oncology, Perlmutter Cancer Center, NYU Langone Health, New York University School of Medicine, New York
| | - Asha Tipirneni
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - J. Randall Patrinely
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hui Ling Yeoh
- Department of Medical Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - Suthee Rapisuwon
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Andrew Haydon
- Department of Medical Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - Iman Osman
- Division of Hematology and Medical Oncology, Perlmutter Cancer Center, NYU Langone Health, New York University School of Medicine, New York
| | - Janice M. Mehnert
- Division of Hematology and Medical Oncology, Perlmutter Cancer Center, NYU Langone Health, New York University School of Medicine, New York
| | - Georgina V. Long
- Department of Medical Oncology, Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
- Mater and Royal North Shore Hospitals, Sydney, New South Wales, Australia
| | - Ryan J. Sullivan
- Division of Hematology and Medical Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - Matteo S. Carlino
- Department of Medical Oncology, Blacktown and Westmead Hospitals, Melanoma Institute of Australia
- The University of Sydney, Sydney, New South Wales, Australia
| | - Alexander M. Menzies
- Department of Medical Oncology, Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia, Mater and Royal North Shore Hospitals, Sydney, New South Wales, Australia
| | - Douglas B. Johnson
- Department of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
10
|
Bhave P, Hong A, Lo SN, Johnson R, Mangana J, Johnson DB, Dulgar O, Eroglu Z, Yeoh HL, Haydon A, Lodde GC, Livingstone E, Khattak A, Kähler K, Hausschild A, McArthur GA, Menzies AM, Long G, Wang W, Carlino MS. Efficacy and toxicity of adjuvant radiotherapy in recurrent melanoma after adjuvant immunotherapy. J Immunother Cancer 2023; 11:jitc-2022-006629. [PMID: 36889810 PMCID: PMC10008434 DOI: 10.1136/jitc-2022-006629] [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] [Accepted: 02/17/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND In patients with stage III melanoma, despite surgical resection and adjuvant systemic therapy, locoregional recurrences still occur. The randomized, phase III Trans-Tasman Radiation Oncology Group (TROG) 02.01 trial demonstrated that adjuvant radiotherapy (RT) after complete lymphadenectomy (CLND) halves the incidence of melanoma recurrence within local nodal basins without improving overall survival or quality of life. However, the study was conducted prior to the current era of adjuvant systemic therapies and when CLND was the standard approach for microscopic nodal disease. As such, there is currently no data on the role of adjuvant RT in patients with melanoma who recur during or after adjuvant immunotherapy, including those that may or may not have undergone prior CLND. In this study, we aimed to answer this question. METHODS Patients with resected stage III melanoma who received adjuvant anti-programmed cell death protein-1 (PD-1) (±ipilimumab) immunotherapy with a subsequent locoregional (lymph node and/or in-transit metastases) recurrence were retrospectively identified. Multivariable logistic and Cox regression analyses were conducted. Primary outcome was rate of subsequent locoregional recurrence; secondary outcomes were locoregional recurrence-free survival (lr-RFS2) and overall RFS (RFS2) to second recurrence. RESULTS In total, 71 patients were identified: 42 (59%) men, 30 (42%) BRAF V600E mutant, 43 (61%) stage IIIC at diagnosis. Median time to first recurrence was 7 months (1-44), 24 (34%) received adjuvant RT and 47 (66%) did not. Thirty-three patients (46%) developed a second recurrence at a median of 5 months (1-22). The rate of locoregional relapse at second recurrence was lower in those who received adjuvant RT (8%, 2/24) compared with those who did not (36%, 17/47, p=0.01). Adjuvant RT at first recurrence was associated with an improved lr-RFS2 (HR 0.16, p=0.015), with a trend towards an improved RFS2 (HR 0.54, p=0.072) and no effect on risk of distant recurrence or overall survival. CONCLUSION This is the first study to investigate the role of adjuvant RT in patients with melanoma with locoregional disease recurrence during or after adjuvant anti-PD-1-based immunotherapy. Adjuvant RT was associated with improved lr-RFS2, but not risk of distant recurrence, demonstrating a likely benefit in locoregional disease control in the modern era. Further prospective studies are required to validate these results.
Collapse
Affiliation(s)
- Prachi Bhave
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia.,Sir Peter MacCallum Cancer Centre Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Angela Hong
- Melanoma Institute Australia, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, Sydney, New South Wales, Australia
| | - Rebecca Johnson
- Melanoma Institute Australia, Sydney, New South Wales, Australia
| | - Johanna Mangana
- Department of Dermatology, University Hospital Zürich, Zurich, Switzerland
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ozgecan Dulgar
- Department of Cutaneous Malignancy, Moffitt Cancer Center, Tampa, Florida, USA
| | - Zeynep Eroglu
- Department of Cutaneous Malignancy, Moffitt Cancer Center, Tampa, Florida, USA
| | - Hui-Ling Yeoh
- Department of Medical Oncology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Andrew Haydon
- Department of Medical Oncology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Georg C Lodde
- Department of Dermatology, University of Duisburg-Essen, Essen, Germany
| | | | - Adnan Khattak
- Department of Medical Oncology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Katharina Kähler
- Department of Dermatology, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - Axel Hausschild
- Department of Dermatology, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - Grant A McArthur
- Sir Peter MacCallum Cancer Centre Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alexander Maxwell Menzies
- Melanoma Institute Australia, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Georgina Long
- Melanoma Institute Australia, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Wei Wang
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia.,Melanoma Institute Australia, Sydney, New South Wales, Australia
| | - Matteo S Carlino
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia .,Melanoma Institute Australia, Sydney, New South Wales, Australia.,Department of Medical Oncology, Blacktown Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
11
|
Lai-Kwon J, Jacques S, Carlino M, Benannoune N, Robert C, Allayous C, Baroudjian B, Lebbe C, Zimmer L, Eroglu Z, Topcu TO, Dimitriou F, Haydon A, Lo SN, Menzies AM, Long GV. Efficacy of ipilimumab 3mg/kg following progression on low dose ipilimumab in metastatic melanoma. Eur J Cancer 2023; 186:12-21. [PMID: 37018924 DOI: 10.1016/j.ejca.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/15/2023] [Accepted: 03/04/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Differing doses of ipilimumab (IPI) are used in combination with an anti-PD1 antibody in advanced melanoma. There is no data on the outcomes of patients who progress following low-dose IPI (< 3 mg/kg) and are subsequently treated with IPI 3 mg/kg (IPI3). We conducted a multicentre retrospective survey to assess the efficacy of this strategy. METHODS Patients with resected stage III, unresectable stage III or IV melanoma who received low dose IPI (< 3 mg/kg) with an anti-PD1 antibody with recurrence (neo/adjuvant) or progressive disease (metastatic), who then received IPI3± anti-PD1 antibody were eligible. Best investigator-determined Response Evaluation Criteria in Solid Tumours response, progression-free survival (PFS) and overall survival (OS) were analysed. RESULTS Total 36 patients received low-dose IPI with an anti-PD1 antibody, 18 (50%) in the neo/adjuvant and 18 (50%) in the metastatic setting. Of which, 20 (56%) had primary resistance and 16 (44%) had acquired resistance. All patients received IPI3 for unresectable stage III or IV melanoma; median age 60 (29-78), 18 (50%) M1d disease, 32 (89%) Eastern Cooperative Oncology Group performance status 0-1. Around 35 (97%) received IPI3 with nivolumab and 1 received IPI3 alone. The response rate to IPI3 was 9/36 (25%). In patients with primary resistance, the response rate was 6/20 (30%). After a median follow-up of 22 months (95% CI: 15-27 months), the median PFS and OS were not reached in patients who responded; 1-year PFS and OS were 73% and 100%, respectively. CONCLUSIONS IPI3 following recurrence/progression on low dose IPI has clinical activity, including in primary resistance. IPI dosing is therefore critical in a subset of patients.
Collapse
|
12
|
Weber JS, Schadendorf D, Del Vecchio M, Larkin J, Atkinson V, Schenker M, Pigozzo J, Gogas H, Dalle S, Meyer N, Ascierto PA, Sandhu S, Eigentler T, Gutzmer R, Hassel JC, Robert C, Carlino MS, Di Giacomo AM, Butler MO, Muñoz-Couselo E, Brown MP, Rutkowski P, Haydon A, Grob JJ, Schachter J, Queirolo P, de la Cruz-Merino L, van der Westhuizen A, Menzies AM, Re S, Bas T, de Pril V, Braverman J, Tenney DJ, Tang H, Long GV. Adjuvant Therapy of Nivolumab Combined With Ipilimumab Versus Nivolumab Alone in Patients With Resected Stage IIIB-D or Stage IV Melanoma (CheckMate 915). J Clin Oncol 2023; 41:517-527. [PMID: 36162037 PMCID: PMC9870220 DOI: 10.1200/jco.22.00533] [Citation(s) in RCA: 59] [Impact Index Per Article: 59.0] [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: 03/03/2022] [Revised: 07/08/2022] [Accepted: 08/01/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Ipilimumab and nivolumab have each shown treatment benefit for high-risk resected melanoma. The phase III CheckMate 915 trial evaluated adjuvant nivolumab plus ipilimumab versus nivolumab alone in patients with resected stage IIIB-D or IV melanoma. PATIENTS AND METHODS In this randomized, double-blind, phase III trial, 1,833 patients received nivolumab 240 mg once every 2 weeks plus ipilimumab 1 mg/kg once every 6 weeks (916 patients) or nivolumab 480 mg once every 4 weeks (917 patients) for ≤ 1 year. After random assignment, patients were stratified by tumor programmed death ligand 1 (PD-L1) expression and stage. Dual primary end points were recurrence-free survival (RFS) in randomly assigned patients and in the tumor PD-L1 expression-level < 1% subgroup. RESULTS At a minimum follow-up of approximately 23.7 months, there was no significant difference between treatment groups for RFS in the all-randomly assigned patient population (hazard ratio, 0.92; 95% CI, 0.77 to 1.09; P = .269) or in patients with PD-L1 expression < 1% (hazard ratio, 0.91; 95% CI, 0.73 to 1.14). In all patients, 24-month RFS rates were 64.6% (combination) and 63.2% (nivolumab). Treatment-related grade 3 or 4 adverse events were reported in 32.6% of patients in the combination group and 12.8% in the nivolumab group. Treatment-related deaths were reported in 0.4% of patients in the combination group and in no nivolumab-treated patients. CONCLUSION Nivolumab 240 mg once every 2 weeks plus ipilimumab 1 mg/kg once every 6 weeks did not improve RFS versus nivolumab 480 mg once every 4 weeks in patients with stage IIIB-D or stage IV melanoma. Nivolumab showed efficacy consistent with previous adjuvant studies in a population resembling current practice using American Joint Committee on Cancer eighth edition, reaffirming nivolumab as a standard of care for melanoma adjuvant treatment.
Collapse
Affiliation(s)
- Jeffrey S. Weber
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY
| | - Dirk Schadendorf
- Department of Dermatology, University of Essen and the German Cancer Consortium, Partner Site, Essen, Germany
| | | | - James Larkin
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Victoria Atkinson
- Division of Cancer Services, Gallipoli Medical Research Foundation and Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia
| | | | | | - Helen Gogas
- National and Kapodistrian University of Athens, Athens, Greece
| | | | - Nicolas Meyer
- Institut Universitaire du Cancer and CHU, Toulouse, France
| | | | - Shahneen Sandhu
- Peter MacCallum Cancer Centre and the University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas Eigentler
- Universitätsklinikum und Medizinische Fakultät Tübingen, Tübingen, and Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Dermatology, Venerology and Allergology, Berlin, Germany
| | - Ralf Gutzmer
- Medizinische Hochschule Hannover, Hannover, and Mühlenkreiskliniken Minden, Ruhr-Universität Bochum, Bochum, Germany
| | - Jessica C. Hassel
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Caroline Robert
- Gustave Roussy and Paris-Saclay University, Villejuif Cedex, France
| | - Matteo S. Carlino
- Westmead and Blacktown Hospitals, University of Sydney, Melanoma Institute Australia, Sydney, New South Wales, Australia
| | | | - Marcus O. Butler
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Michael P. Brown
- Cancer Trials Unit, Royal Adelaide Hospital, and School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Piotr Rutkowski
- Maria Sklodowska-Curie National Institute of Oncology, Warsaw, Poland
| | - Andrew Haydon
- The Alfred Hospital, Monash University, Melbourne, Australia
| | - Jean-Jacques Grob
- Department of Dermatology, Aix-Marseille University, Hôpital de la Timone, Marseille, France
| | - Jacob Schachter
- Sheba Medical Center, IEO European Institute of Oncology, Tel-Hashomer, Israel
| | - Paola Queirolo
- IEO European Institute of Oncology, IRCCS, Milan, Italy
- IRCCS San Martino, Genova, Italy
| | | | - Andre van der Westhuizen
- Calvary Mater Newcastle Hospital and University of Newcastle. Waratah, New South Wales, Australia
| | - Alexander M. Menzies
- Melanoma Institute Australia, University of Sydney, and Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Sandra Re
- Bristol Myers Squibb Company, Princeton, NJ
| | - Tuba Bas
- Bristol Myers Squibb Company, Princeton, NJ
| | | | | | | | - Hao Tang
- Bristol Myers Squibb Company, Princeton, NJ
| | - Georgina V. Long
- Melanoma Institute Australia, University of Sydney, and Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| |
Collapse
|
13
|
Chesney JA, Ribas A, Long GV, Kirkwood JM, Dummer R, Puzanov I, Hoeller C, Gajewski TF, Gutzmer R, Rutkowski P, Demidov L, Arenberger P, Shin SJ, Ferrucci PF, Haydon A, Hyngstrom J, van Thienen JV, Haferkamp S, Guilera JM, Rapoport BL, VanderWalde A, Diede SJ, Anderson JR, Treichel S, Chan EL, Bhatta S, Gansert J, Hodi FS, Gogas H. Randomized, Double-Blind, Placebo-Controlled, Global Phase III Trial of Talimogene Laherparepvec Combined With Pembrolizumab for Advanced Melanoma. J Clin Oncol 2023; 41:528-540. [PMID: 35998300 PMCID: PMC9870217 DOI: 10.1200/jco.22.00343] [Citation(s) in RCA: 53] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/09/2022] [Accepted: 07/25/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE The combination of talimogene laherparepvec (T-VEC) and pembrolizumab previously demonstrated an acceptable safety profile and an encouraging complete response rate (CRR) in patients with advanced melanoma in a phase Ib study. We report the efficacy and safety from a phase III, randomized, double-blind, multicenter, international study of T-VEC plus pembrolizumab (T-VEC-pembrolizumab) versus placebo plus pembrolizumab (placebo-pembrolizumab) in patients with advanced melanoma. METHODS Patients with stage IIIB-IVM1c unresectable melanoma, naïve to antiprogrammed cell death protein-1, were randomly assigned 1:1 to T-VEC-pembrolizumab or placebo-pembrolizumab. T-VEC was administered at ≤ 4 × 106 plaque-forming unit (PFU) followed by ≤ 4 × 108 PFU 3 weeks later and once every 2 weeks until dose 5 and once every 3 weeks thereafter. Pembrolizumab was administered intravenously 200 mg once every 3 weeks. The dual primary end points were progression-free survival (PFS) per modified RECIST 1.1 by blinded independent central review and overall survival (OS). Secondary end points included objective response rate per mRECIST, CRR, and safety. Here, we report the primary analysis for PFS, the second preplanned interim analysis for OS, and the final analysis. RESULTS Overall, 692 patients were randomly assigned (346 T-VEC-pembrolizumab and 346 placebo-pembrolizumab). T-VEC-pembrolizumab did not significantly improve PFS (hazard ratio, 0.86; 95% CI, 0.71 to 1.04; P = .13) or OS (hazard ratio, 0.96; 95% CI, 0.76 to 1.22; P = .74) compared with placebo-pembrolizumab. The objective response rate was 48.6% for T-VEC-pembrolizumab (CRR 17.9%) and 41.3% for placebo-pembrolizumab (CRR 11.6%); the durable response rate was 42.2% and 34.1% for the arms, respectively. Grade ≥ 3 treatment-related adverse events occurred in 20.7% of patients in the T-VEC-pembrolizumab arm and in 19.5% of patients in the placebo-pembrolizumab arm. CONCLUSION T-VEC-pembrolizumab did not significantly improve PFS or OS compared with placebo-pembrolizumab. Safety results of the T-VEC-pembrolizumab combination were consistent with the safety profiles of each agent alone.
Collapse
Affiliation(s)
- Jason A. Chesney
- UofL Health—Brown Cancer Center, University of Louisville, Louisville, KY
| | - Antoni Ribas
- Jonsson Comprehensive Cancer Center at the University of California Los Angeles, Los Angeles, CA
| | - Georgina V. Long
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | | | | | - Igor Puzanov
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Christoph Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Ralf Gutzmer
- Medizinische Hochschule Hannover, Hannover, Germany
- Mühlenkreiskliniken Minden, Ruhr University Bochum, Bochum, Germany
| | - Piotr Rutkowski
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Lev Demidov
- N.N. Blokhin Russian Cancer Research Center, Moscow, Russia
| | - Petr Arenberger
- University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Sang Joon Shin
- Division of Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Pier Francesco Ferrucci
- Biotherapy of Tumors Unit, Department of Experimental Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Andrew Haydon
- Department of Medical Oncology, Alfred Hospital, Melbourne, Australia
| | - John Hyngstrom
- Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT
| | | | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Josep Malvehy Guilera
- Department of Dermatology, Barcelona University, Barcelona, IDIBAPS, CIBER de Enfermedades Raras ISCIII, Madrid, Spain
| | - Bernardo Leon Rapoport
- The Medical Oncology Centre of Rosebank, Johannesburg, South Africa
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Ari VanderWalde
- Department of Hematology/Oncology, West Cancer Center & Research Institute, Memphis, TN
| | | | | | | | | | | | | | | | - Helen Gogas
- National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
14
|
Lemech C, Dredge K, Bampton D, Hammond E, Clouston A, Waterhouse NJ, Stanley AC, Leveque-El Mouttie L, Chojnowski GM, Haydon A, Pavlakis N, Burge M, Brown MP, Goldstein D. Phase Ib open-label, multicenter study of pixatimod, an activator of TLR9, in combination with nivolumab in subjects with microsatellite-stable metastatic colorectal cancer, metastatic pancreatic ductal adenocarcinoma and other solid tumors. J Immunother Cancer 2023; 11:jitc-2022-006136. [PMID: 36634920 PMCID: PMC9843174 DOI: 10.1136/jitc-2022-006136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Pixatimod is a unique activator of the Toll-like Receptor 9 pathway. This phase I trial evaluated safety, efficacy and pharmacodynamics of pixatimod and PD-1 inhibitor nivolumab in immunologically cold cancers. METHODS 3+3 dose escalation with microsatellite stable metastatic colorectal cancer (MSS mCRC) and metastatic pancreatic ductal adenocarcinoma (mPDAC) expansion cohorts. Participants received pixatimod once weekly as a 1-hour intravenous infusion plus nivolumab every 2 weeks. Objectives included assessment of safety, antitumor activity, pharmacodynamics, and pharmacokinetic profile. RESULTS Fifty-eight participants started treatment. The maximum tolerated dose of pixatimod was 25 mg in combination with 240 mg nivolumab, which was used in the expansion phases of the study. Twenty-one grade 3-5 treatment-related adverse events were reported in 12 participants (21%); one participant receiving 50 mg pixatimod/nivolumab had a treatment-related grade 5 AE. The grade 3/4 rate in the MSS mCRC cohort (n=33) was 12%. There were no responders in the mPDAC cohort (n=18). In the MSS mCRC cohort, 25 participants were evaluable (initial postbaseline assessment scans >6 weeks); of these, three participants had confirmed partial responses (PR) and eight had stable disease (SD) for at least 9 weeks. Clinical benefit (PR+SD) was associated with lower Pan-Immune-Inflammation Value and plasma IL-6 but increased IP-10 and IP-10/IL-8 ratio. In an MSS mCRC participant with PR as best response, increased infiltration of T cells, dendritic cells, and to a lesser extent NK cells, were evident 5 weeks post-treatment. CONCLUSIONS Pixatimod is well tolerated at 25 mg in combination with nivolumab. The efficacy signal and pharmacodynamic changes in MSS mCRC warrants further investigation. TRIAL REGISTRATION NUMBER NCT05061017.
Collapse
Affiliation(s)
- Charlotte Lemech
- Scientia Clinical Research Ltd, Sydney, New South Wales, Australia
| | - Keith Dredge
- Zucero Therapeutics Ltd, Brisbane, Queensland, Australia
| | - Darryn Bampton
- Zucero Therapeutics Ltd, Brisbane, Queensland, Australia
| | - Edward Hammond
- Zucero Therapeutics Ltd, Brisbane, Queensland, Australia
| | - Andrew Clouston
- Department of Pathology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Nigel J Waterhouse
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Amanda C Stanley
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | | | - Grace M Chojnowski
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Andrew Haydon
- Medical Oncology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Nick Pavlakis
- Medical Oncology, Genesis Care, North Shore Health Hub, St Leonards, New South Wales, Australia,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Matthew Burge
- Medical Oncology, The Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Michael P Brown
- Cancer Clinical Trials Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia,Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, South Australia, Australia
| | - David Goldstein
- Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
15
|
Yan MK, Adler NR, Wolfe R, Pan Y, Chamberlain A, Kelly J, Yap K, Voskoboynik M, Haydon A, Shackleton M, Mar VJ. The role of surveillance imaging for resected high‐risk melanoma. Asia Pac J Clin Oncol 2022. [DOI: 10.1111/ajco.13913] [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: 04/27/2022] [Revised: 11/25/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Mabel K. Yan
- Victorian Melanoma Service Alfred Health Melbourne Australia
- School of Public Health and Preventive Medicine Monash University Melbourne Australia
| | - Nikki R. Adler
- School of Public Health and Preventive Medicine Monash University Melbourne Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine Monash University Melbourne Australia
| | - Yan Pan
- Victorian Melanoma Service Alfred Health Melbourne Australia
- Central Clinical School Monash University Melbourne Australia
| | - Alexander Chamberlain
- Victorian Melanoma Service Alfred Health Melbourne Australia
- Central Clinical School Monash University Melbourne Australia
| | - John Kelly
- Victorian Melanoma Service Alfred Health Melbourne Australia
| | - Kenneth Yap
- Central Clinical School Monash University Melbourne Australia
- Department of Nuclear Medicine and PET Alfred Health Melbourne Australia
| | - Mark Voskoboynik
- Central Clinical School Monash University Melbourne Australia
- Department of Medical Oncology Alfred Health Melbourne Australia
| | - Andrew Haydon
- Central Clinical School Monash University Melbourne Australia
- Department of Medical Oncology Alfred Health Melbourne Australia
| | - Mark Shackleton
- Central Clinical School Monash University Melbourne Australia
- Department of Medical Oncology Alfred Health Melbourne Australia
| | - Victoria J. Mar
- Victorian Melanoma Service Alfred Health Melbourne Australia
- School of Public Health and Preventive Medicine Monash University Melbourne Australia
| |
Collapse
|
16
|
Wang C, Zoungas S, Yan M, Wolfe R, Haydon A, Shackleton M, Voskoboynik M, Moore M, Andrews MC, Nicholls SJ, Mar V. Immune checkpoint inhibitors and the risk of major atherosclerotic cardiovascular events in patients with high-risk or advanced melanoma: a retrospective cohort study. Cardiooncology 2022; 8:23. [PMID: 36461057 PMCID: PMC9716700 DOI: 10.1186/s40959-022-00149-8] [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] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) are associated with immune-mediated adverse effects, potentially involving any organ. ICI has also been associated with an increased risk of cardiovascular disease in cancer populations. OBJECTIVE To characterize the incidence and risk of major atherosclerotic cardiovascular events associated with ICI use in a high-risk and advanced melanoma population. METHODS We conducted a retrospective cohort study of patients with high-risk or advanced melanoma (AJCC stage II, III or IV) presenting to an academic tertiary hospital between 2015-2020. The main outcome was major atherosclerotic cardiovascular events (MACE) including acute myocardial infarction, ischemic stroke, acute limb ischemia and coronary revascularization. RESULTS The study cohort consisted of 646 patients, including 289 who had been treated with ICI. The incidence of MACE was higher in the ICI treated group (3.6 vs. 0.9 events per 100-person years). After adjusting for age, sex, smoking history and prior BRAF and/or MEK inhibitor use, ICI treatment was associated with an increased risk of MACE (HRadj 2.8, 95% CI 1.1-6.9, p = 0.03). Elevated risk was especially pronounced in patients with a past history of MACE (HR 14.4, 95% CI 1.9-112.3, p = 0.01). CONCLUSION Patients with high-risk or advanced melanoma are at an increased risk of atherosclerotic cardiovascular events following ICI treatment, particularly those with a history of cardiovascular disease.
Collapse
Affiliation(s)
- Charlie Wang
- grid.1623.60000 0004 0432 511XVictorian Melanoma Service, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004 Australia ,grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Sophia Zoungas
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Mabel Yan
- grid.1623.60000 0004 0432 511XVictorian Melanoma Service, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004 Australia ,grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Rory Wolfe
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Andrew Haydon
- grid.1623.60000 0004 0432 511XDepartment of Medical Oncology, The Alfred Hospital, Melbourne, Victoria Australia
| | - Mark Shackleton
- grid.1623.60000 0004 0432 511XDepartment of Medical Oncology, The Alfred Hospital, Melbourne, Victoria Australia
| | - Mark Voskoboynik
- grid.1623.60000 0004 0432 511XDepartment of Medical Oncology, The Alfred Hospital, Melbourne, Victoria Australia ,grid.1002.30000 0004 1936 7857Department of Medicine - Alfred, Monash University, Melbourne, Victoria Australia
| | - Maggie Moore
- grid.1623.60000 0004 0432 511XDepartment of Medical Oncology, The Alfred Hospital, Melbourne, Victoria Australia
| | - Miles C. Andrews
- grid.1623.60000 0004 0432 511XDepartment of Medical Oncology, The Alfred Hospital, Melbourne, Victoria Australia ,grid.1002.30000 0004 1936 7857Department of Medicine - Alfred, Monash University, Melbourne, Victoria Australia
| | - Stephen J. Nicholls
- grid.419789.a0000 0000 9295 3933MonashHeart, Monash Health, Clayton, Victoria Australia ,grid.1002.30000 0004 1936 7857Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Clayton, Victoria Australia
| | - Victoria Mar
- grid.1623.60000 0004 0432 511XVictorian Melanoma Service, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004 Australia ,grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| |
Collapse
|
17
|
Eggermont AMM, Kicinski M, Blank CU, Mandala M, Long GV, Atkinson V, Dalle S, Haydon A, Meshcheryakov A, Khattak A, Carlino MS, Sandhu S, Larkin J, Puig S, Ascierto PA, Rutkowski P, Schadendorf D, Boers-Sonderen M, Di Giacomo AM, van den Eertwegh AJM, Grob JJ, Gutzmer R, Jamal R, van Akkooi ACJ, Lorigan P, Grebennik D, Krepler C, Marreaud S, Suciu S, Robert C. Five-Year Analysis of Adjuvant Pembrolizumab or Placebo in Stage III Melanoma. NEJM Evidence 2022; 1:EVIDoa2200214. [PMID: 38319852 DOI: 10.1056/evidoa2200214] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Pembrolizumab or Placebo in Stage III MelanomaPatients with stage III melanoma randomly received adjuvant pembrolizumab or placebo. Five-year recurrence-free survival was 55.4% (95% CI, 50.8 to 59.8) versus 38.3% (33.9 to 42.7) and 5-year metastasis-free survival was 60.6% (56.0 to 64.9) versus 44.5% (39.9 to 48.9) for adjuvant pembrolizumab and placebo, respectively. No new safety signals were associated with adjuvant pembrolizumab.
Collapse
Affiliation(s)
- Alexander M M Eggermont
- Comprehensive Cancer Center Munich, München, Germany
- Princess Máxima Center and University Medical Center Utrecht, Netherlands
| | - Michal Kicinski
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Christian U Blank
- Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Mario Mandala
- University of Perugia, Santa Maria della Misericordia Hospital, Italy
| | - Georgina V Long
- Melanoma Institute Australia, University of Sydney, Mater and Royal North Shore Hospitals, Sydney, VIC, Australia
| | - Victoria Atkinson
- Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Stéphane Dalle
- Lyon Civic Hospital Cancer Institute, Cancer Research Centre of Lyon, Lyon University, France
| | | | - Andrey Meshcheryakov
- Federal State Budgetary Institution "Russian Oncology Scientific Centre named after N.N. Blokhin RAMS," Moscow, Russian Federation
| | - Adnan Khattak
- Fiona Stanley Hospital/University of Western Australia, Perth, WA, Australia
| | - Matteo S Carlino
- Westmead and Blacktown Hospitals, Melanoma Institute Australia, and University of Sydney, Sydney, VIC, Australia
| | | | | | - Susana Puig
- Hospital Clínic de Barcelona, University of Barcelona and Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain
| | - Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale," Naples, Italy
| | - Piotr Rutkowski
- Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland
| | - Dirk Schadendorf
- University Hospital Essen, Essen, Germany
- German Cancer Consortium, Heidelberg, Germany
| | | | - Anna Maria Di Giacomo
- Center for Immuno-Oncology and Medical Oncology and Immunotherapy Unit, University Hospital of Siena, Italy
| | | | - Jean-Jacques Grob
- Aix-Marseille University, Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, France
| | - Ralf Gutzmer
- Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Germany
| | - Rahima Jamal
- Centre Hospitalier de l'Université de Montréal, Centre de Recherche du CHUM, Quebec, QC, Canada
| | | | - Paul Lorigan
- Division of Cancer Sciences, University of Manchester and Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | | | - Sandrine Marreaud
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Stefan Suciu
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Caroline Robert
- Gustave Roussy Cancer Campus Grand Paris and University Paris-Saclay, Villejuif, France
| |
Collapse
|
18
|
Muhandiramge J, Zalcberg JR, van Londen GJ, Warner ET, Carr PR, Haydon A, Orchard SG. Cardiovascular Disease in Adult Cancer Survivors: a Review of Current Evidence, Strategies for Prevention and Management, and Future Directions for Cardio-oncology. Curr Oncol Rep 2022; 24:1579-1592. [PMID: 35796941 PMCID: PMC9606033 DOI: 10.1007/s11912-022-01309-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Accepted: 06/14/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Cardiovascular disease is long-term complication of both cancer and anti-cancer treatment and can have significant ramifications for health-related quality of life and mortality. This narrative review explores the current evidence linking cardiovascular disease and cancer, as well as exploring strategies for the prevention and management of cardiovascular disease, and outlines future opportunities in the field of cardio-oncology. RECENT FINDINGS Cancer confers risk for various cardiovascular diseases including heart failure, cardiomyopathy, arrhythmia, coronary heart disease, stroke, venous thromboembolism, and valvular heart disease. Cancer treatment, in particular agents such as platinum-based chemotherapy, anthracyclines, hormonal treatments, and thoracic radiotherapy, further increases risk. While cardiovascular disease can be identified early and effectively managed in cancer survivors, cardiovascular screening and management does not typically feature in routine long-term cancer care of adult cancer survivors. Cancer and cancer treatment can accelerate the development of cardiovascular disease. Further research into screening and management strategies for cardiovascular disease, along with evidence-based guidelines, is required to ensure adult cancer survivors receive appropriate long-term care.
Collapse
Affiliation(s)
- Jaidyn Muhandiramge
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Austin Health, Heidelberg, VIC, Australia.
| | - John R Zalcberg
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Department of Medical Oncology, Alfred Hospital, Melbourne, VIC, Australia
| | - G J van Londen
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erica T Warner
- Clinical and Translational Epidemiology Unit, MGH Cancer Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Prudence R Carr
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Andrew Haydon
- Department of Medical Oncology, Alfred Hospital, Melbourne, VIC, Australia
| | - Suzanne G Orchard
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| |
Collapse
|
19
|
Pilgrim CHC, Maciejewska A, Ayres N, Ellis S, Goodwin M, Zalcberg JR, Haydon A. Synoptic CT scan reporting of pancreatic adenocarcinoma to align with international consensus guidelines on surgical resectability: a Victorian pilot. ANZ J Surg 2022; 92:2565-2570. [DOI: 10.1111/ans.17999] [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: 02/27/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Charles H. C. Pilgrim
- Hepatopancreaticobiliary Surgery The Alfred Hospital Melbourne Victoria Australia
- Department of Surgery, Central Clinical School Monash University Melbourne Victoria Australia
| | - Anna Maciejewska
- Southern Melbourne Integrated Cancer Service (funded by the Victorian Government) Melbourne Victoria Australia
| | - Nadia Ayres
- North Eastern Melbourne Integrated Cancer Service (funded by the Victorian Government) Melbourne Victoria Australia
| | - Sam Ellis
- Department of Surgery, Central Clinical School Monash University Melbourne Victoria Australia
- Department of Radiology The Alfred Hospital Melbourne Victoria Australia
| | - Mark Goodwin
- Department of Radiology Austin Health Melbourne Victoria Australia
- The University of Melbourne Melbourne Victoria Australia
| | - John R. Zalcberg
- School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Victoria Australia
- Department of Medical Oncology Alfred Health Melbourne Victoria Australia
| | - Andrew Haydon
- Southern Melbourne Integrated Cancer Service (funded by the Victorian Government) Melbourne Victoria Australia
- Department of Medical Oncology Alfred Health Melbourne Victoria Australia
| |
Collapse
|
20
|
Ratnayake G, Reinwald S, Edwards J, Wong N, Yu D, Ward R, Smith R, Haydon A, Au PM, van Zelm MC, Senthi S. Blood T-cell profiling in metastatic melanoma patients as a marker for response to immune checkpoint inhibitors combined with radiotherapy. Radiother Oncol 2022; 173:299-305. [PMID: 35772575 DOI: 10.1016/j.radonc.2022.06.016] [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: 01/27/2022] [Revised: 06/15/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND The addition of stereotactic ablative radiotherapy (SABR) to immune checkpoint inhibitors (ICIs) has the potential to significantly improve outcomes in the treatment of metastatic melanoma. We analysed peripheral blood immune cells of patients receiving combination SABR and ICI to detect the effect of treatment and identify potential biomarkers that predict outcome. METHODS 24 polymetastatic melanoma patients participated in the SABR IMPACT trial, receiving standard dose immunotherapy with anti-PD-1 and/or anti-CTLA-4 and stereotactic ablative radiotherapy to one site. Comprehensive immunophenotyping of T-cells was performed with flow cytometry on blood samples from 13 patients at baseline and following the first 4 cycles of treatment. RESULTS Following four cycles of immunotherapy and SABR, the proportion of naïve subsets were reduced within both the CD4 and CD8 T-cell lineages. Independently, SABR resulted in increased expression of PD-1 (p = 0.019) and ICOS (p = 0.046) on the CD8+ T-cells, accompanied by a reduction in regulatory T-cell frequencies (p = 0.048). A multivariate discriminant analysis revealed a baseline signature of lower levels of CD8+ naive T-cells and higher expression of TIM-3 on regulatory T-cells and memory T-cells better predicted response. CONCLUSION The combination of immunotherapy and SABR changed the immunophenotype of blood T cells, with some shifts attributable to SABR. Importantly, we identified a T-cell signature at baseline that best predicted response. Validation of these findings in an independent cohort could confirm these as biomarkers at baseline or early during treatment, and whether these can be utilised to stratify patients for high or low intensity treatment to reduce toxicity.
Collapse
Affiliation(s)
- Gishan Ratnayake
- Alfred Health Radiation Oncology, The Alfred Hospital, Melbourne, Australia; Radiation Oncology Princess Alexandra Hospital Raymond Terrace, Brisbane, Australia; Central Clinical School, Monash University, Melbourne, Australia.
| | - Simone Reinwald
- Alfred Health Radiation Oncology, The Alfred Hospital, Melbourne, Australia; Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Australia
| | - Jack Edwards
- Alfred Health Radiation Oncology, The Alfred Hospital, Melbourne, Australia; Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Australia
| | - Nicholas Wong
- Central Clinical School, Monash University, Melbourne, Australia; Monash Bioinformatic Platform, Monash University, Melbourne, Australia
| | - Di Yu
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Australia
| | - Rachel Ward
- Alfred Health Radiation Oncology, The Alfred Hospital, Melbourne, Australia
| | - Robin Smith
- Alfred Health Radiation Oncology, The Alfred Hospital, Melbourne, Australia
| | - Andrew Haydon
- Alfred Health Radiation Oncology, The Alfred Hospital, Melbourne, Australia
| | - Pei M Au
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Australia; Monash Bioinformatic Platform, Monash University, Melbourne, Australia
| | - Menno C van Zelm
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Australia; Department of Allergy, Immunology and Respiratory Medicine, Central Clinical School, Monash University and Alfred Hospital, Melbourne, Australia
| | - Sashendra Senthi
- Alfred Health Radiation Oncology, The Alfred Hospital, Melbourne, Australia; Radiation Oncology Princess Alexandra Hospital Raymond Terrace, Brisbane, Australia
| |
Collapse
|
21
|
Yan MK, Orchard SG, Adler NR, Wolfe R, McLean C, Rodríguez LM, Woods RL, Gibbs P, Chan AT, Haydon A, Mar VJ. Association between hypertension and cutaneous melanoma, and the effect of aspirin: extended follow-up of a large randomised controlled trial. Cancer Epidemiol 2022; 79:102173. [PMID: 35567859 PMCID: PMC10026004 DOI: 10.1016/j.canep.2022.102173] [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: 02/23/2022] [Revised: 04/24/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The association between hypertension and melanoma is unclear, and previous analyses of data from the ASPirin in Reducing Events in the Elderly (ASPREE) study demonstrated a reduced number of invasive melanoma events amongst aspirin-exposed hypertensive individuals. METHODS Data from the ASPREE study which included (1) the intervention period with a median follow-up of 4.7 years, and (2) the observational period with an additional 2 years follow-up, were combined for this analysis. Logistic regression analyses examined the association between baseline hypertension and treatment status and past melanoma history. Survival analyses examined the association between hypertension and melanoma risk, and the effect of aspirin across hypertension groups. Cox proportional hazards models were used to compare incidence across groups. RESULTS 19,114 participants (median age of 74 years) were randomised to daily 100 mg aspirin or placebo. At baseline, hypertension and past melanoma history were recorded in 14,195 and 685 individuals, respectively. After adjustment for confounders, hypertension was significantly associated with past melanoma history (OR=1.34, 95%CI: 1.11-1.62). In a prospective analysis, baseline hypertension was not associated with melanoma risk. However, aspirin was associated with a reduced risk of incident melanoma amongst individuals with uncontrolled hypertension (blood pressure ≥140/90 mmHg; HR=0.63, 95%CI 0.44-0.89), but not in those with controlled hypertension (HR=1.04, 95%CI 0.74-1.46). CONCLUSION Our results support a reduced melanoma incidence amongst individuals with uncontrolled hypertension exposed to aspirin. Additional studies are required to confirm these findings.
Collapse
Affiliation(s)
- Mabel K Yan
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia; Victorian Melanoma Service, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia.
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Nikki R Adler
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Catriona McLean
- Department of Anatomical Pathology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Luz María Rodríguez
- Gastrointestinal and Other Cancers Research Group, Division of Cancer Prevention, National Cancer Institute, NIH, Bethesda, MD, USA; Walter Reed National Military Medical Center (WRNMM) Uniformed Services University (USU) Department of Surgery, Bethesda, MD, USA
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Peter Gibbs
- The Walter & Eliza Hall Institute of Medical Research, University of Melbourne,1 G Royal Parade, Parkville, Victoria 3052, Australia
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Massachusetts, USA
| | - Andrew Haydon
- Department of Medical Oncology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Victoria J Mar
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia; Victorian Melanoma Service, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia
| |
Collapse
|
22
|
Zaman FY, Orchard SG, Haydon A, Zalcberg JR. Non-aspirin non-steroidal anti-inflammatory drugs in colorectal cancer: a review of clinical studies. Br J Cancer 2022; 127:1735-1743. [PMID: 35764787 DOI: 10.1038/s41416-022-01882-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/27/2022] [Accepted: 06/01/2022] [Indexed: 12/21/2022] Open
Abstract
Colorectal cancer (CRC) chemoprevention is an area of interest. Non-steroidal anti-inflammatory drugs (NSAIDs) are anti-inflammatory agents which have been identified as cancer chemoprevention agents given that inflammation is thought to contribute to tumorigenesis. Most studies have demonstrated that the NSAID, aspirin, plays a beneficial role in the prevention of CRC and colonic adenomas. Non-aspirin NSAIDs (NA-NSAIDs) have also been studied in CRC chemoprevention. There is increasing literature around their role in pre-cancerous polyp prevention and in decreasing CRC incidence and CRC-related outcomes in certain high-risk subgroups. However, the use of NA-NSAIDs may be accompanied by increased risks of toxicity. Further studies are required to establish the associations between concurrent aspirin and NA-NSAID use, and CRC-related outcomes.
Collapse
Affiliation(s)
- Farzana Y Zaman
- Department of Medical Oncology, The Alfred Hospital, Alfred Health, Melbourne, VIC, Australia.
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Andrew Haydon
- Department of Medical Oncology, The Alfred Hospital, Alfred Health, Melbourne, VIC, Australia
| | - John R Zalcberg
- Department of Medical Oncology, The Alfred Hospital, Alfred Health, Melbourne, VIC, Australia.,Head of Cancer Research Program, School of Public Health and Preventive Medicine, Faculty of Medicine, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
23
|
Dimitriou F, Namikawa K, Reijers ILM, Buchbinder EI, Soon JA, Zaremba A, Teterycz P, Mooradian MJ, Armstrong E, Nakamura Y, Vitale MG, Tran LE, Bai X, Allayous C, Provent-Roy S, Indini A, Bhave P, Farid M, Kähler KC, Mehmi I, Atkinson V, Klein O, Stonesifer CJ, Zaman F, Haydon A, Carvajal RD, Hamid O, Dummer R, Hauschild A, Carlino MS, Mandala M, Robert C, Lebbe C, Guo J, Johnson DB, Ascierto PA, Shoushtari AN, Sullivan RJ, Cybulska-Stopa B, Rutkowski P, Zimmer L, Sandhu S, Blank CU, Lo SN, Menzies AM, Long GV. Single-agent anti-PD-1 or combined with ipilimumab in patients with mucosal melanoma: an international, retrospective, cohort study. Ann Oncol 2022; 33:968-980. [PMID: 35716907 DOI: 10.1016/j.annonc.2022.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 03/09/2022] [Revised: 05/15/2022] [Accepted: 06/07/2022] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Mucosal melanoma (MM) is a rare melanoma subtype with distinct biology and poor prognosis. Data on the efficacy of immune checkpoint inhibitors (ICIs) is limited. We determined the efficacy of ICIs in MM, analysed by primary site and ethnicity/race. PATIENTS AND METHODS Retrospective cohort study from 25 cancer centres in Australia, Europe, USA and Asia. Patients with histologically confirmed MM were treated with anti-PD1+/-ipilimumab. Primary endpoints were response rate (RR), progression-free survival (PFS), overall survival (OS) by primary site (naso-oral, urogenital, anorectal, other), ethnicity/race (Caucasian, Asian, Other) and treatment. Univariate and multivariate Cox proportional hazard model analyses were conducted. RESULTS In total, 545 patients were included: 331 (63%) Caucasian, 176 (33%) Asian and 20 (4%) Other. Primary sites included 113 (21%) anorectal, 178 (32%) urogenital, 206 (38%) naso-oral and 45 (8%) other. 348 (64%) received anti-PD1 and 197 (36%) anti-PD1/ipilimumab. RR, PFS and OS did not differ by primary site, ethnicity/race or treatment. RR for naso-oral was numerically higher for anti-PD1/ipilimumab (40%, 95% CI 29-54%) compared with anti-PD1 (29%, 95% CI 21-37%). 35% of patients that initially responded progressed. Median duration of response (mDOR) was 26 months (95% CI 18-NR [Not Reached]). Factors associated with short PFS were ECOG PS ≥3 (p<0.01), LDH >ULN (p=0.01), lung metastases (p<0.01) and ≥1 previous treatments (p<0.01). Factors associated with short OS were ECOG PS ≥1 (p<0.01), LDH >ULN (p=0.03), lung metastases (p<0.01) and ≥1 previous treatments (p<0.01). CONCLUSIONS MM has poor prognosis. Treatment efficacy of anti-PD1+/-ipilimumab was similar and did not differ by ethnicity/race. Naso-oral primaries had numerically higher response to anti-PD1/ipilimumab, without difference in survival. The addition of ipilimumab did not show greater benefit over anti-PD1 for other primary sites. In responders, mDOR was short and acquired resistance was common. Other factors, including site and number of metastases were associated with survival.
Collapse
Affiliation(s)
- F Dimitriou
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Department of Dermatology, University Hospital Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - K Namikawa
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - I L M Reijers
- Department of Medical Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E I Buchbinder
- Melanoma Disease Center, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02481, USA
| | - J A Soon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - A Zaremba
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - P Teterycz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, 49585Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - M J Mooradian
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - E Armstrong
- Department of Medicine, Melanoma Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Y Nakamura
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
| | - M G Vitale
- Istituto Nazionale Tumori IRCCS Fondazione 'G. Pascale', Napoli, Italy
| | - L E Tran
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - X Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - C Allayous
- APHP Hôpital Saint-Louis, Dermatology Department, DMU ICARE, Paris, France
| | - S Provent-Roy
- Dermatology Service, Department of Medicine, Gustave Roussy and Paris-Saclay University, Villejuif, France
| | - A Indini
- Unit of Medical Oncology, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - P Bhave
- Westmead and Blacktown Hospitals, Sydney, New South Wales, Australia
| | - M Farid
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - K C Kähler
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - I Mehmi
- Department of Hematology/Oncology, The Angeles Clinic and Research Institute, a Cedars-Sinai Affiliate, 11800 Wilshire Blvd Suite 300, Los Angeles, CA, 90025, USA
| | - V Atkinson
- Princess Alexandra Hospital, Greenslopes Private Hospital, University of Queensland, Queensland, Australia
| | - O Klein
- Department of Medical Oncology, Austin Health, Melbourne, Australia; Olivia Newton-John Cancer Research Institute, Melbourne, Victoria
| | - C J Stonesifer
- Columbia University Irving Medical Center, New York City, New York, USA
| | - F Zaman
- Alfred Hospital, Melbourne, Victoria, Australia
| | - A Haydon
- Alfred Hospital, Melbourne, Victoria, Australia
| | - R D Carvajal
- Columbia University Irving Medical Center, New York City, New York, USA
| | - O Hamid
- Department of Hematology/Oncology, The Angeles Clinic and Research Institute, a Cedars-Sinai Affiliate, 11800 Wilshire Blvd Suite 300, Los Angeles, CA, 90025, USA
| | - R Dummer
- Department of Dermatology, University Hospital Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland
| | - A Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - M S Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Westmead and Blacktown Hospitals, Sydney, New South Wales, Australia
| | - M Mandala
- Unit of Medical Oncology, University of Perugia, Perugia, Italy
| | - C Robert
- Dermatology Service, Department of Medicine, Gustave Roussy and Paris-Saclay University, Villejuif, France
| | - C Lebbe
- Université de Paris, APHP Hôpital Saint-Louis, Dermatology Department, DMU ICARE, INSERM U-976, Paris, France
| | - J Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - D B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - P A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione 'G. Pascale', Napoli, Italy
| | - A N Shoushtari
- Department of Medicine, Melanoma Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - R J Sullivan
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - B Cybulska-Stopa
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Poland
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, 49585Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - L Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - S Sandhu
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - C U Blank
- Department of Medical Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - A M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - G V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia.
| |
Collapse
|
24
|
Yan MK, Orchard SG, Adler NR, Wolfe R, McLean C, Rodríguez LM, Woods RL, Gibbs P, Chan AT, Haydon A, Mar VJ. Effect of Aspirin on Melanoma Incidence in Older Persons: Extended Follow-up of a Large Randomized Double-blind Placebo-controlled Trial. Cancer Prev Res (Phila) 2022; 15:365-375. [PMID: 35395069 PMCID: PMC9167236 DOI: 10.1158/1940-6207.capr-21-0244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/09/2021] [Revised: 11/17/2021] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
Abstract
The effects of aspirin on melanoma are unclear, with studies reporting conflicting results. Data from two periods of the ASPirin in Reducing Events in the Elderly (ASPREE) study; the randomized placebo-controlled trial period examining daily 100 mg aspirin in older adults with a median follow-up of 4.7 years, and the second period, an additional 2 years of observational follow-up, were utilized in this secondary analysis to examine whether aspirin exposure is associated with a reduced cutaneous melanoma incidence. All melanoma cases were adjudicated and Cox proportional hazards models were used to compare incidence between randomized treatment groups. ASPREE recruited 19,114 participants with a median age of 74 years. During the trial period, 170 individuals (76 aspirin, 94 placebo) developed an invasive melanoma, and no significant effect of aspirin was observed on incident melanoma [HR = 0.81; 95% confidence interval (CI), 0.60-1.10]. Including the additional 2 years of observational follow-up (median follow-up of 6.3 years), 268 individuals (119 aspirin, 149 placebo) developed an invasive melanoma, and similar results were observed (HR = 0.81; 95% CI, 0.63-1.03). A reduced number of events was observed with aspirin among females in a subgroup analysis (HR = 0.65; 95% CI, 0.44-0.92); however, the interaction effect with males (HR = 0.92; 95% CI, 0.68-1.25) was nonsignificant (P = 0.17). Our findings from this randomized trial do not provide strong support that aspirin is associated with a reduced risk of invasive melanoma in older individuals. Additional studies are required to further explore this relationship. PREVENTION RELEVANCE Melanoma prevention is an important strategy to improve outcomes and while preventive efforts have largely focused on sun protection, the role of potential chemopreventive agents such as aspirin warrants investigation.
Collapse
Affiliation(s)
- Mabel K Yan
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004
- Victorian Melanoma Service, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004
| | - Nikki R Adler
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004
| | - Catriona McLean
- Department of Anatomical Pathology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004
| | - Luz María Rodríguez
- Gastrointestinal and Other Cancers Research Group, Division of Cancer Prevention, National Cancer Institute, NIH, Bethesda, MD, USA
- Walter Reed National Military Medical Center (WRNMM) Uniformed Services University (USU) Department of Surgery, Bethesda, MD, USA
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004
| | - Peter Gibbs
- The Walter & Eliza Hall Institute of Medical Research, University of Melbourne,1G Royal Parade, Parkville, Victoria 3052
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Massachusetts, United States of America
| | - Andrew Haydon
- Department of Medical Oncology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004
| | - Victoria J Mar
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004
- Victorian Melanoma Service, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004
| |
Collapse
|
25
|
Luke JJ, Rutkowski P, Queirolo P, Del Vecchio M, Mackiewicz J, Chiarion-Sileni V, de la Cruz Merino L, Khattak MA, Schadendorf D, Long GV, Ascierto PA, Mandala M, De Galitiis F, Haydon A, Dummer R, Grob JJ, Robert C, Carlino MS, Mohr P, Poklepovic A, Sondak VK, Scolyer RA, Kirkwood JM, Chen K, Diede SJ, Ahsan S, Ibrahim N, Eggermont AMM. Pembrolizumab versus placebo as adjuvant therapy in completely resected stage IIB or IIC melanoma (KEYNOTE-716): a randomised, double-blind, phase 3 trial. Lancet 2022; 399:1718-1729. [PMID: 35367007 DOI: 10.1016/s0140-6736(22)00562-1] [Citation(s) in RCA: 202] [Impact Index Per Article: 101.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pembrolizumab prolongs progression-free and overall survival among patients with advanced melanoma and recurrence-free survival in resected stage III disease. KEYNOTE-716 assessed pembrolizumab as adjuvant therapy in patients with completely resected, high-risk, stage II melanoma. We report results from the planned first and second interim analyses for recurrence-free survival. METHODS In this double-blind, randomised, placebo-controlled phase 3 study, involving 160 academic medical centres and hospitals in 16 countries (Australia, Belgium, Brazil, Canada, Chile, France, Germany, Israel, Italy, Japan, Poland, South Africa, Spain, Switzerland, the UK, and the USA), patients aged 12 years or older with newly diagnosed, completely resected stage IIB or IIC melanoma (TNM stage T3b or T4 with a negative sentinel lymph node biopsy) were recruited. Eligible patients were randomly assigned (1:1), in blocks of four and stratified by T-category (3b, 4a, and 4b) and paediatric status (age 12-17 years vs ≥18 years), using an interactive response technology system to intravenous pembrolizumab 200 mg (2 mg/kg in paediatric patients) or placebo every 3 weeks for 17 cycles or until disease recurrence or unacceptable toxicity. All patients, clinical investigators, and analysts were masked to treatment assignment. The primary endpoint was investigator-assessed recurrence-free survival (defined as time from randomisation to recurrence or death) in the intention-to-treat (ITT) population (ie, all patients randomly assigned to treatment). The primary endpoint was met if recurrence-free survival was significantly improved for pembrolizumab versus placebo at either the first interim analysis (after approximately 128 patients had events) or second interim analysis (after 179 patients had events) under multiplicity control. Safety was assessed in all patients randomly assigned to treatment who received at least one dose of study treatment. This study is registered with ClinicalTrials.gov, NCT03553836, and is closed to accrual. FINDINGS Between Sept 23, 2018, and Nov 4, 2020, 1182 patients were screened, of whom 976 were randomly assigned to pembrolizumab (n=487) or placebo (n=489; ITT population). The median age was 61 years (IQR 52-69) and 387 (40%) patients were female and 589 (60%) were male. 874 (90%) of 976 patients were White and 799 (82%) were not Hispanic or Latino. 483 (99%) of 487 patients in the pembrolizumab group and 486 (99%) of 489 in the placebo group received assigned treatment. At the first interim analysis (data cutoff on Dec 4, 2020; median follow-up of 14·4 months [IQR 10·2-18·7] in the pembrolizumab group and 14·3 months [10·1-18·7] in the placebo group), 54 (11%) of 487 patients in the pembrolizumab group and 82 (17%) of 489 in the placebo group had a first recurrence of disease or died (hazard ratio [HR] 0·65 [95% CI 0·46-0·92]; p=0·0066). At the second interim analysis (data cutoff on June 21, 2021; median follow-up of 20·9 months [16·7-25·3] in the pembrolizumab group and 20·9 months [16·6-25·3] in the placebo group), 72 (15%) patients in the pembrolizumab group and 115 (24%) in the placebo group had a first recurrence or died (HR 0·61 [95% CI 0·45-0·82]). Median recurrence-free survival was not reached in either group at either assessment timepoint. At the first interim analysis, grade 3-4 treatment-related adverse events occurred in 78 (16%) of 483 patients in the pembrolizumab groups versus 21 (4%) of 486 in the placebo group. At the first interim analysis, four patients died from an adverse event, all in the placebo group (one each due to pneumonia, COVID-19-related pneumonia, suicide, and recurrent cancer), and at the second interim analysis, one additional patient, who was in the pembrolizumab group, died from an adverse event (COVID-19-related pneumonia). No deaths due to study treatment occurred. INTERPRETATION Pembrolizumab as adjuvant therapy for up to approximately 1 year for stage IIB or IIC melanoma resulted in a significant reduction in the risk of disease recurrence or death versus placebo, with a manageable safety profile. FUNDING Merck Sharp & Dohme, a subsidiary of Merck & Co, Kenilworth, NJ, USA.
Collapse
Affiliation(s)
- Jason J Luke
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA.
| | - Piotr Rutkowski
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Paola Queirolo
- Istituto Europeo di Oncologia - IRCCS, Milano; Ospedale San Martino IRCCS, Genova, Italy
| | | | - Jacek Mackiewicz
- Poznan University of Medical Sciences, Poznan, Poland; Greater Poland Cancer Center, Poznan, Poland
| | | | - Luis de la Cruz Merino
- Clinical Oncology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain; Medicine Department, Universidad de Sevilla, Sevilla, Spain
| | | | - Dirk Schadendorf
- University Hospital Essen and German Cancer Consortium Partner Site, Essen, Germany
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Charles Perkins Center, The University of Sydney, Sydney, NSW, Australia; Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Mario Mandala
- University of Perugia, Perugia, Italy; Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Andrew Haydon
- Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | - Reinhard Dummer
- University Hospital Zürich, University of Zurich, Skin Cancer Center, Zurich, Switzerland
| | | | - Caroline Robert
- Institut Gustave Roussy, Villejuif, France; Paris-Saclay University, Villejuif, France
| | - Matteo S Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Westmead and Blacktown Hospitals, Sydney, NSW, Australia
| | - Peter Mohr
- Elbe Kliniken Buxtehude, Buxtehude, Germany
| | | | - Vernon K Sondak
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - 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; Charles Perkins Center, The University of Sydney, Sydney, NSW, Australia; Royal Prince Alfred Hospital Sydney, NSW, Australia; NSW Health Pathology, Sydney, NSW, Australia
| | | | - Ke Chen
- Merck & Co, Inc., Kenilworth, NJ, USA
| | | | | | | | - Alexander M M Eggermont
- University Medical Center Utrecht, Utrecht, Netherlands; Princess Máxima Center, Utrecht, Netherlands; Comprehensive Cancer Center Munich, Munich, Germany
| |
Collapse
|
26
|
Yan MK, Adler NR, Pan Y, Chamberlain A, Kelly J, Yap K, Voskoboynik M, Haydon A, Shackleton M, Mar VJ. Yield of baseline imaging for distant metastases in high-risk primary melanoma. J Surg Oncol 2022; 125:1312-1317. [PMID: 35262187 DOI: 10.1002/jso.26846] [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: 12/18/2021] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The yield of baseline imaging in patients presenting with higher risk primary tumours, at least American Joint Committee on Cancer 8th edition stage IIC or III melanoma, is unclear. METHODS This retrospective study included patients referred to the Victorian Melanoma Service from January 2017 to April 2020, diagnosed with at least stage IIC or stage III melanoma. Patients with a T4b tumour and no sentinel lymph node biopsy were included as 'T4bNX'. RESULTS One hundred and sixty-four patients (median age 65 years) with baseline imaging (T4bNX: 19, IIC: 30, IIIA: 21, IIIB: 43, IIIC: 50, IIID: 1) were included. The majority were male (73%), and those with T4bNX melanoma tended to be older (median age 79 years). Distant metastases were detected in 21% (4/19) of T4bNX, 3% (1/30) of stage IIC, 0% (0/21) of stage IIIA, and 6% (6/94) of stages IIIB-D melanoma patients. All stage III patients with distant metastases had palpable lymphadenopathy a presentation. Two patients had brain metastases, both of whom had T4bNX melanoma and synchronous extra-cranial metastases. CONCLUSIONS Compared to stage IIC, baseline imaging detects higher rates of extra-cranial distant disease in stages IIIB-D and T4bNX melanoma. Intracranial imaging has greater yield in patients with distant extra-cranial disease.
Collapse
Affiliation(s)
- Mabel K Yan
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nikki R Adler
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yan Pan
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Alexander Chamberlain
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - John Kelly
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia
| | - Kenneth Yap
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Nuclear Medicine and PET, Alfred Health, Melbourne, Victoria, Australia
| | - Mark Voskoboynik
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medical Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - Andrew Haydon
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medical Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - Mark Shackleton
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medical Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - Victoria J Mar
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
27
|
Cherk MH, Nadebaum DP, Barber TW, Beech P, Haydon A, Yap KS. 18 F-FDG PET/CT features of immune-related adverse events and pitfalls following immunotherapy. J Med Imaging Radiat Oncol 2022; 66:483-494. [PMID: 35191204 PMCID: PMC9303622 DOI: 10.1111/1754-9485.13390] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/03/2022] [Indexed: 12/17/2022]
Abstract
18F‐FDG PET/CT scanning is routinely performed to stage and evaluate the treatment response in many malignancies. Immunotherapy is a rapidly growing treatment option for many cancers, and both clinicians and imaging specialists need to be familiar with 18F‐FDG PET/CT imaging characteristics unique to patients on this type of treatment. In particular, many immune‐related adverse events (irAEs) can be detected on 18F‐FDG PET/CT and early accurate identification is critical to reduce treatment related morbidity and incorrect interpretation of malignant disease status. This pictorial essay reviews frequently encountered irAEs in clinical practice and their appearances on 18F‐FDG PET/CT along with a brief discussion on pseudoprogression and hyperprogression.
Collapse
Affiliation(s)
- Martin H Cherk
- Department of Nuclear Medicine & PET, Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - David P Nadebaum
- Department of Nuclear Medicine & PET, Alfred Hospital, Melbourne, Victoria, Australia
| | - Thomas W Barber
- Department of Nuclear Medicine & PET, Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Paul Beech
- Department of Nuclear Medicine & PET, Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Andrew Haydon
- Monash University, Melbourne, Victoria, Australia.,Department of Medical Oncology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Kenneth S Yap
- Department of Nuclear Medicine & PET, Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
28
|
Gunadasa I, Haydon A, Zalcberg JR, Khu YL, Burton P, Brown W. Locally advanced esophageal cancer: Evaluation of prognosis by assessment of the “yp” stage based on the neoadjuvant regimen received. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
356 Background: Neoadjuvant treatment in the form of chemoradiotherapy (nCRT) or chemotherapy (nCT) for resectable oesophageal cancer is the standard of care and improves R0 resection rates and overall survival (OS). The recently reported Neo-AEGIS study demonstrated ongoing equipoise between neoadjuvant chemoradiotherapy and peri-operative chemotherapy for oesophageal adenocarcinoma. There is limited data evaluating the prognostic outcomes by evaluation of the pathological stage after resection (yp stage) based on the neoadjuvant regimen received. The aim of this study was to look at the survival outcomes of patients with oesophageal cancer who received neoadjuvant therapy and to analyze the prognostic significance of pathological stage at surgery (“yp” stage) compared to the clinical stage based on the neoadjuvant therapy received. Methods: This was a single- centre, retrospective study over a fifteen-year period between 2005 and 2019. Consecutive patients with oesophageal and GOJ cancers that underwent resection post neoadjuvant treatment were included. The unit policy was to treat adenocarcinoma of the oesophagus and GOJ with perioperative chemotherapy until 2015 after which it was switched to neoadjuvant chemoradiotherapy in the form of the CROSS protocol. Results: Neoadjuvant treatment with either neoadjuvant chemoradiotherapy (nCRT) or neoadjuvant chemotherapy (nCT) prior to surgical resection was undertaken in 137 patients with resectable oesophageal and GOJ cancers between the years 2005 and 2019. The median age was 65 and 79% of the cohort was male. The majority of tumours were located in the lower oesophagus or GOJ and 96 patients in the cohort were clinical stage 3. 126 patients had adenocarcinoma and 11 patients had squamous cell carcinoma. 72 patients received nCT, and 65 patients received the nCRT. The “yp” stage showed 26 patients achieved a complete pathological response (CPR) and 47 patients were down-staged. The clinical stage was not a predictor of overall survival (p = 0.65). On the other hand, the “yp” stage was a significant predictor of survival (p < 1×10-8). In patients who received nCRT, 18 achieved a complete pathological response compared to 8 patients who had received nCT. Patients who received nCRT showed improved survival compared to patients who received nCT (p = 0.043). Patients who achieved a CPR with neoadjuvant chemotherapy had an OS of 100% compared to OS of 80% in patients who received nCRT (p = NS). Neoadjuvant chemoradiotherapy was associated with less loco-regional recurrences and distant recurrences compared to neoadjuvant chemotherapy. Conclusions: The “yp” stages, as well as down-staging with neoadjuvant therapy are strong predictors of survival. A greater proportion of patients achieved down-staging and CPR following neoadjuvant chemoradiotherapy compared to neoadjuvant chemotherapy.
Collapse
Affiliation(s)
| | | | - John Raymond Zalcberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Yin Li Khu
- Alfred Health, Melbourne, VIC, Australia
| | | | | |
Collapse
|
29
|
Fernandez-Penas P, Carlino M, Tsai K, Atkinson V, Shaheen M, Thomas S, Mihalcioiu C, Hagen TV, Roberts-Thomson R, Haydon A, Mant A, Butler M, Daniels G, Bunchbinder E, Hyngstrom J, Moller M, Puzanov I, Lance Cowey C, Whitman E, Ballesteros-Merino C, Jensen S, Fox B, Schmidt E, Diede S, Setta R, Sell J, Canton D, Aung S, Twitty C, Xie S, Lu Y, O’Keefe B, Algazi A, Daud A. 383 Durable responses with intratumoral electroporation of plasmid interleukin 12 plus pembrolizumab in patients with advanced melanoma progressing on an anti-PD-1 antibody: updated data from keynote 695. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BackgroundElectroporated plasmid interleukin-12 (pIL-12-EP; tavokinogene telseplasmid; TAVO) induces sustained intratumoral expression of IL-12, a cytokine that is integral for response to anti-PD-1 antibodies. Here, we present updated safety and response duration data from KEYNOTE 695, a Phase 2, multicenter, open-label trial of pIL-12-EP in combination with pembrolizumab in patients with stage III/IV melanoma immediately following confirmed progression on an anti-PD-1 antibody.MethodsPatients with confirmed disease progression after ≥12 weeks‘ treatment with an anti-PD-1 antibody alone or in combination were eligible. Patients received intratumoral pIL-12-EP on days 1, 5 and 8 every 6 weeks and pembrolizumab 200 mg every 3 weeks. Responses were assessed by the investigator at 12-week intervals using RECIST v1.1; overall survival (OS) and duration of response (DoR) assessments were conducted using the Kaplan-Meier method.ResultsOf the first 56 patients treated, 50% had visceral disease (M1b-d), 80% had received 1–2 and 20% ≥3 prior lines of therapy, 27% had prior ipilimumab and 21% prior BRAF/MEK inhibitors. 61% of patients were primary refractory to anti-PD-1. 54 patients were efficacy evaluable, defined as patients who had at least one post-treatment scan. The investigator-assessed objective response rate (ORR) per RECIST was 27.8% (4 CR, 11 PR); ORR per iRECIST was 29.6%. In patients with M1b-d staging, ORR was 33.3% (n=9/27), and in those receiving prior ipilimumab, ORR was 33.3% (n=5/15). Seven patients had 100% reduction in target lesions, and regression was observed in non-injected lesions. The median DoR had not been reached. With a median follow up of 19.3 months, the median OS (95% CI) was 24.5 (14.4, NR) months (figure 1). The study is now fully enrolled. In 105 patients with safety data, there were no Grade 4/5 treatment-related adverse events (TRAEs) reported. Grade 3 TRAEs occurred in 5.7% and comprised cellulitis in two patients and arthralgia, pneumonitis, enteritis, keratoacanthoma, lichen planus and musculoskeletal chest pain in one patient each. The Grade 1/2 TRAEs in ≥10% patients were fatigue (27.6%), procedural pain (20.0%), diarrhea (17.1%), nausea (10.5%) and pruritus (10.5%). ORR by blinded independent central review has commenced and a global phase 3 trial is planned.Abstract 383 Figure 1Overall survival in patients treated with pIL-12-EP in combination with pembrolizumab. Dark grey bars: time on study treatment, light grey bars: end of treatment to death or censoringConclusionsPatients with anti-PD-1 therapy refractory advanced melanoma can achieve deep, durable responses in both injected and non-injected lesions with pIL-12-EP plus pembrolizumab. Intratumoral pIL-12-EP in combination with pembrolizumab was generally well tolerated, with minimal Grade 3 and no Grade 4/5 TRAEs.Trial RegistrationNCT03132675Ethics ApprovalThe study was approved by a central IRB and/or local institutional IRB/Ethics Committee as required for each participating institution.ConsentWritten informed consent was obtained from the patients participating in the trial; the current abstract does not include information requiring additional consent
Collapse
|
30
|
Lemech C, Dredge K, Bampton D, Hammond E, Stanley A, Leveque-ElMouttie L, Chojnowski G, Haydon A, Pavlakis N, Burge M, Brown M, Goldstein D. 340 A phase Ib study of the safety and tolerability of pixatimod plus nivolumab in subjects with advanced solid tumors with an expansion cohort in metastatic pancreatic adenocarcinoma (mPDAC). J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundPixatimod is a novel immunomodulatory agent which stimulates dendritic cells (DC) via Toll-Like Receptor (TLR9) pathway to activate natural killer (NK) cells.1 In combination with PD1 inhibitors, it also enhances T cell infiltration in vivo.2 We report on safety, pharmacokinetics (PK) and pharmacodynamics (PD), and antitumor activity of pixatimod plus nivolumab in advanced cancer patients (stage 1) and in an expansion cohort of mPDAC (stage 2).MethodsIn the dose escalation stage (3+3 design), eligible patients (ECOG≤1) with advanced solid malignancies who failed standard therapies received pixatimod once weekly as a 1-hour i.v. infusion plus nivolumab (240 mg, every other week) until disease progression or discontinuation due to intolerability. The primary objective was determination of the maximum tolerated dose (MTD). Secondary objectives evaluated safety, antitumor activity per RECIST v1.1, PK of pixatimod, and PD (PBMC, plasma cytokines and chemokines). Stage 2 comprised mPDAC subjects who had received no more than one prior line of chemotherapy in the metastatic setting.ResultsThe dose-escalation stage recruited 16 subjects across two cohorts (25 & 50 mg pixatimod). Two dose limiting toxicities (DLTs) in 50 mg cohort were pulmonary edema and multi-organ failure. Of note, the subject with multi-organ failure had substantially higher CA19.9, Pan-immune-Inflammatory Value (PIV = Neutrophils x Platelets x Monocytes/Lymphocytes) and interleukins (IL) IL-1α and IL-23 at baseline compared with the cohort. One DLT occurred in the 25 mg cohort, pneumonitis, which was identified as the MTD. A further 14 mPDAC subjects were recruited to the expansion stage (25 mg). Seven SAEs were reported to be possibly or likely related to the combination. No objective responses were reported in the mPDAC stage, the best response was SD (n = 3). In another submitted abstract by Lemech et al, we report two subjects in the dose escalation stage with MSS mCRC were confirmed PR, and data from the amended study to include an MSS mCRC expansion cohort will also be presented. Time versus concentration data for pixatimod in advanced cancer patients was similar to that previously reported in monotherapy setting. In mPDAC subjects, there was minimal immune activation as evidenced by a lack of change in effector memory T cells or NK cells in PBMC, plasma cytokines and chemokines.ConclusionsPixatimod is well tolerated at 25 mg in combination with nivolumab but did not provide clear clinical benefit or evidence of immune activation in the mPDAC cohort.AcknowledgementsResearch funding was provided by Zucero Therapeutics Ltd and Bristol Myers Squibb (BMS), Australia.Trial RegistrationClinical trial informationACTRN12617001573347.ReferencesBrennan TV, Lin L, Brandstadter JD, Rendell VR, Dredge K, Huang X, et al. Heparan sulfate mimetic PG545-mediated antilymphoma effects require TLR9-dependent NK cell activation. J Clin Invest 2016;126(1):207–19.Hammond E, Haynes NM, Cullinane C, Brennan TV, Bampton D, Handley P, et al. Immunomodulatory activities of pixatimod: emerging nonclinical and clinical data, and its potential utility in combination with PD-1 inhibitors. J Immunother Cancer 2018;6(1):54.Ethics ApprovalThe clinical trial entitled “An open-label, multi-centre Phase Ib study of the safety and tolerability of IV infused PG545 in combination with nivolumab in patients with advanced solid tumours with an expansion cohort in patients with metastatic pancreatic cancer. Protocol ZU545102” obtained ethics approval from the Royal Adelaide Hospital (HREC Reference number, HREC/17/RAH/195 and the CALHN Reference number, R20170515) and Bellberry Limited (Application No: 2018-08-695). All participants in the study gave informed consent before taking part in ZU545102.
Collapse
|
31
|
Lemech C, Dredge K, Bampton D, Hammond E, Clouson A, Waterhouse N, Stanley A, Leveque-ElMouttie L, Chojnowski G, Haydon A, Pavlakis N, Burge M, Brown M, Goldstein D. 341 A phase Ib expansion cohort of pixatimod plus nivolumab in previously treated, microsatellite stable metastatic colorectal cancer (MSS mCRC). J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundPixatimod is a novel immunomodulatory agent which stimulates dendritic cells (DC) via Toll-Like Receptor 9 (TLR9) pathway to activate natural killer (NK) cells.1 It also enhances T cell infiltration into tumors when combined with PD1 inhibitors in vivo.2 We report on safety, pharmacodynamics (PD), and antitumor activity of pixatimod plus nivolumab in a cohort of previously treated MSS mCRC subjects.MethodsEligible MSS mCRC patients (ECOG≤1) with a median of 3 lines of previous treatment received 25 mg pixatimod once weekly as a 1-hour i.v. infusion plus nivolumab (240 mg, every other week) until disease progression or discontinuation due to intolerability. Primary and secondary objectives included the assessment of safety and antitumor activity per RECIST v1.1 at the recommended dose, and evidence of immune activation in peripheral blood mononuclear cells (PBMC), plasma cytokines/chemokines, and paired tumor tissue biopsies, where available.ResultsThirty-three subjects with MSS mCRC (42% male) started treatment. Median age was 58 (range 35–80), median number of previous lines of chemotherapy was 3 (range 1–6), ECOG PS 0/1 was 67%/33%, 64% had target liver metastases, and primary tumor site was right-sided/transverse colon in 21% and left-sided colon/rectum 79%. Median number of cycles completed was 2 (range 0–13). Treatment-related AEs led to treatment discontinuation in 2 patients (autoimmune hepatitis and pneumonitis). Ten Grade 3 treatment-related AEs were reported in 4 subjects (12%). Thirty subjects received at least one cycle of treatment (1-month), with 25 subjects having initial post-baseline assessment scans > 6 weeks (as per RECIST v1.1). Of these, 3 subjects had confirmed partial responses and 8 had stable disease. Lower Pan-immune-Inflammatory Value (PIV = Neutrophils x Platelets x Monocytes/Lymphocytes) at screening were associated with clinical benefit (PR/SD). Post-treatment increases in plasma IP-10 and IP-10/IL-8 ratio, effector memory (CD45RA-CCR7-) CD4+ and CD8+ T cells, and Ki-67 expression in CD4+ and CD8+ T cells from PBMC were also detected in the clinical benefit cohort compared to subjects with progressive disease. Conversely, plasma levels of IL-6 were significantly lower in patients with clinical benefit. Analyses of pre- & on-treatment biopsies from the only PR patient with available paired biopsies demonstrated an increase in T cell infiltration.ConclusionsPixatimod is well tolerated at 25 mg in combination with a standard dose of nivolumab. The efficacy signal and pharmacodynamic changes in MSS mCRC warrants further investigation of pixatimod plus nivolumab for this patient population.AcknowledgementsResearch Funding provided by Zucero Therapeutics Ltd and Bristol Myers Squibb (BMS), Australia.Trial RegistrationClinical trial informationACTRN12617001573347ReferencesBrennan TV, Lin L, Brandstadter JD, Rendell VR, Dredge K, Huang X, et al. Heparan sulfate mimetic PG545-mediated antilymphoma effects require TLR9-dependent NK cell activation. J Clin Invest 2016;126(1):207–19.Hammond E, Haynes NM, Cullinane C, Brennan TV, Bampton D, Handley P, et al. Immunomodulatory activities of pixatimod: emerging nonclinical and clinical data, and its potential utility in combination with PD-1 inhibitors. J Immunother Cancer 2018;6(1):54.Ethics ApprovalThe clinical trial entitled “An open-label, multi-centre Phase Ib study of the safety and tolerability of IV infused PG545 in combination with nivolumab in patients with advanced solid tumours with an expansion cohort in patients with metastatic pancreatic cancer. Protocol ZU545102” obtained ethics approval from the Royal Adelaide Hospital (HREC Reference number, HREC/17/RAH/195 and the CALHN Reference number, R20170515) and Bellberry Limited (Application No: 2018-08-695). All participants in the study gave informed consent before taking part in ZU545102.
Collapse
|
32
|
Haydon A, Alamgeer M, Brungs D, Collichio F, Khushalani N, Colevas D, Rischin D, Kudchadkar R, Chai-Ho W, Daniels G, Lutzky J, Lee J, Bowyer S, Migden M, Silk A, Lebbe C, Grob JJ, Melero I, Sheladia P, Bommareddy P, He S, Andreu-Vieyra C, Fury M, Hill A. 547 CERPASS: A randomized, controlled, open-label, phase 2 study of cemiplimab ± RP1 in patients with advanced cutaneous squamous cell carcinoma. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BackgroundThe prognosis for advanced and metastatic cutaneous squamous cell carcinoma (CSCC) remains poor for many patients with the disease despite approval of the anti-PD1 antibodies cemiplimab and pembrolizumab.1 2 RP1 is an oncolytic virus (HSV-1) that expresses a fusogenic glycoprotein (GALV-GP R-) and granulocyte macrophage colony stimulating factor (GM-CSF). In preclinical studies, RP1 induced immunogenic tumor cell death and provided potent systemic anti-tumor activity, which is further improved by combining anti-PD-1 therapy.3 Preliminary results from IGNYTE, a phase I/II clinical study of RP1 in combination with nivolumab showed a high rate of deep and durable responses in patients (pts) with CSCC.4 The objective of this trial is to evaluate the safety and efficacy of cemiplimab + RP1 versus cemiplimab alone in advanced CSCC.MethodsThis global, multicenter, randomized phase 2 study is enrolling pts with metastatic or unresectable, locally advanced CSCC who are not candidates for/refuse surgery and/or radiotherapy. Key eligibility criteria include no prior treatment with anti-PD1/PD-L1 antibodies or oncolytic viruses. The clinical trial will enroll approximately 180 pts from centers in the EU, Australia, Canada and USA. Pts will be randomized in a 2:1 ratio favoring the RP1 + cemiplimab arm. Pts will receive 350 mg of cemiplimab intravenously (IV) Q3W for up to 108 weeks. In the RP1 + cemiplimab arm, RP1 will be injected intratumorally at a starting RP1 dose of 1 × 10^6 plaque forming units (PFU)/mL alone, followed by up to 7 doses of RP1 at 1 × 10^7 PFU/mL Q3W together with cemiplimab. Pts in the combination arm may receive up to 8 additional RP1 doses. No crossover will be allowed. Pts will be stratified by disease status and prior systemic therapy. Tumor assessments will be performed every 9 weeks. Primary endpoints are overall response rate and complete response rate by blinded independent review. Secondary endpoints include safety, progression free survival, duration of response and overall survival. Exploratory endpoints include viral shedding and biodistribution, and immune biomarker analyses. This trial is currently enrolling pts.Trial RegistrationNCT04050436ReferencesMigden MR, Rischin D, Schmults CD, Guminski A, Hauschild A, Lewis KD, Chung CH, Hernandez-Aya L, Lim AM, Chang ALS, Rabinowits G, Thai AA, Dunn LA, Hughes BGM, Khushalani NI, Modi B, Schadendorf D, Gao B, Seebach F, Li S, Li J, Mathias M, Booth J, Mohan K, Stankevich E, Babiker HM, Brana I, Gil-Martin M, Homsi J, Johnson ML, Moreno V, Niu J, Owonikoko TK, Papadopoulos KP, Yancopoulos GD, Lowy I, Fury MG. PD-1 blockade with cemiplimab in advanced cutaneous squamous-cell carcinoma. N Engl J Med 2018;379(4):341–351.Grob JJ, Gonzalez R, Basset-Seguin N, Vornicova O, Schachter J, Joshi A, Meyer N, Grange F, Piulats JM, Bauman JR, Zhang P, Gumuscu B, Swaby RF, Hughes BGM. Pembrolizumab monotherapy for recurrent or metastatic cutaneous squamous cell carcinoma: a single-arm phase II trial (KEYNOTE-629). J Clin Oncol 2020;38(25):2916–2925.Thomas S, Kuncheria L, Roulstone V, Kyula JN, Mansfield D, Bommareddy PK, Smith H, Kaufman HL, Harrington KJ, Coffin RS. Development of a new fusion-enhanced oncolytic immunotherapy platform based on herpes simplex virus type 1. J Immunother Cancer 2019;7(1):214.Middleton M, Aroldi F, Sacco J, Milhem M, Curti B, VanderWalde A, Baum S, Samson A, Pavlick A, Chesney J, Niu J, Rhodes T, Bowles T, Conry R, Olsson-Brown A, Earl Laux D, Kaufman H, Bommareddy P, Deterding A, Samakoglu S, Coffin R, Harrington K. 422 An open-label, multicenter, phase 1/2 clinical trial of RP1, an enhanced potency oncolytic HSV, combined with nivolumab: updated results from the skin cancer cohorts. J Immunother Cancer 2020; 8 (3).Ethics ApprovalThe study was approved by institutional review board or the local ethics committee at each site. Informed consent was obtained from patients before participating into the trial.
Collapse
|
33
|
Halle BR, Betof Warner A, Zaman FY, Haydon A, Bhave P, Dewan AK, Ye F, Irlmeier R, Mehta P, Kurtansky NR, Lacouture ME, Hassel JC, Choi JS, Sosman JA, Chandra S, Otto TS, Sullivan R, Mooradian MJ, Chen ST, Dimitriou F, Long G, Carlino M, Menzies A, Johnson DB, Rotemberg VM. Immune checkpoint inhibitors in patients with pre-existing psoriasis: safety and efficacy. J Immunother Cancer 2021; 9:jitc-2021-003066. [PMID: 34635495 PMCID: PMC8506877 DOI: 10.1136/jitc-2021-003066] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 08/31/2021] [Indexed: 12/14/2022] Open
Abstract
Background Immune checkpoint inhibitors (ICIs) are approved to treat multiple cancers. Retrospective analyses demonstrate acceptable safety of ICIs in most patients with autoimmune disease, although disease exacerbation may occur. Psoriasis vulgaris is a common, immune-mediated disease, and outcomes of ICI treatment in patients with psoriasis are not well described. Thus we sought to define the safety profile and effectiveness of ICIs in patients with pre-existing psoriasis. Methods In this retrospective cohort study, patients from eight academic centers with pre-existing psoriasis who received ICI treatment for cancer were evaluated. Main safety outcomes were psoriasis exacerbation and immune-related adverse events (irAEs). We also assessed progression-free survival (PFS) and overall survival. Results Of 76 patients studied (50 (66%) male; median age 67 years; 62 (82%) with melanoma, 5 (7%) with lung cancer, 2 (3%) with head and neck cancer, and 7 (9%) with other cancers; median follow-up 25.1 months (range=0.2–99 months)), 51 (67%) received anti-PD-1 antibodies, 8 (11%) anti-CTLA-4, and 17 (22%) combination of anti-PD-1/CTLA-4. All patients had pre-existing psoriasis, most frequently plaque psoriasis (46 patients (61%)) and 15 (20%) with psoriatic arthritis. Forty-one patients (54%) had received any prior therapy for psoriasis although only two (3%) were on systemic immunosuppression at ICI initiation. With ICI treatment, 43 patients (57%) experienced a psoriasis flare of cutaneous and/or extracutaneous disease after a median of 44 days of receiving ICI. Of those who experienced a flare, 23 patients (53%) were managed with topical therapy only; 16 (21%) needed systemic therapy. Only five patients (7%) required immunotherapy discontinuation for psoriasis flare. Forty-five patients (59%) experienced other irAEs, 17 (22%) of which were grade 3/4. PFS with landmark analysis was significantly longer in patients with a psoriasis flare versus those without (39 vs 8.7 months, p=0.049). Conclusions In this multicenter study, ICI therapy was associated with frequent psoriasis exacerbation, although flares were manageable with standard psoriasis treatments and few required ICI discontinuation. Patients who experienced disease exacerbation performed at least as well as those who did not. Thus, pre-existing psoriasis should not prevent patients from receiving ICIs for treatment of malignancy.
Collapse
Affiliation(s)
| | | | | | - Andrew Haydon
- Department of Medical Oncology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Prachi Bhave
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Anna K Dewan
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Fei Ye
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rebecca Irlmeier
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paras Mehta
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | - Jessica C Hassel
- Department of Dermatology, NCT, University Hospital Heidelberg, Heidelberg, Germany
| | - Jacob S Choi
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jeffrey A Sosman
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sunandana Chandra
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tracey S Otto
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA.,Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Ryan Sullivan
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Meghan J Mooradian
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Steven T Chen
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Florentia Dimitriou
- Melanoma Institute Australia, North Sydney, New South Wales, Australia.,Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Georgina Long
- Melanoma Institute Australia, North Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Matteo Carlino
- Melanoma Institute Australia, North Sydney, New South Wales, Australia.,Westmead Hospital, Westmead, New South Wales, Australia
| | - Alexander Menzies
- Melanoma Institute Australia, North Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Douglas B Johnson
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | |
Collapse
|
34
|
Orchard S, Lockery J, Gibbs P, Polehkina G, Wolfe R, Zalcberg J, Haydon A, McNeil J, Nelson M, Reid C, Kirpach B, Murray A, Woods R. 602Prevalence of cancer history and association with risk factors in a healthy older population. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The ASPirin in Reducing Events in the Elderly (ASPREE) study randomised healthy older individuals to 100mg aspirin or placebo, with clinical outcomes and disability-free survival endpoints. Detailed baseline data provides a rare opportunity to explore cancer burden and association with known cancer risk factors in this population.
Methods
At enrolment (2010-2014), self-reported personal cancer history, cancer type and cancer risk factor data were sought from 19,114 participants (Australia, n = 16,703; U.S., n = 2,411). Participants were healthy and expected to survive 5 years.
Results
Of those reporting a prior cancer diagnosis (18% women, 22% men), women were diagnosed younger (16% vs 6% of diagnoses <50 years). Cancer prevalence increased with age. Prostate and breast cancer history were higher in U.S. participants; melanoma and colorectal cancer were higher in Australian participants. Cancer history prevalence was not associated with any common risk factors, but was associated with poor health ratings in men. Blood and breast cancer history was more common with past aspirin use.
Conclusions
Personal cancer history in healthy older ASPREE participants was as expected for the most common cancer types in the respective populations. The lack of alignment with known risk factors is attributable to survivor bias, driven by entry criteria, and to possible molecular differences in cancer between elderly and younger people.
Key messages
As the prevalence of cancer increases with age, the lack of alignment with known risk factors implies other factors play a significant role.
Collapse
Affiliation(s)
| | | | - Peter Gibbs
- Peter Macallum Cancer Foundation, Melbourne, Australia
| | | | | | | | | | | | - Mark Nelson
- Menzies Institute For Medical Research, University of Tasmania, Hobart, Australia
| | | | | | | | | |
Collapse
|
35
|
Jayasekara H, MacInnis R, Yang Y, Hodge A, Mitchell H, Haydon A, Room R, Hopper J, Gunter M, Riboli E, Giles G, Milne R, English D, Ferrari P. 783Lifetime alcohol intake and stomach cancer risk: a pooled analysis of two prospective cohort studies. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Alcohol consumption is causally linked to several cancer sites but the evidence for stomach cancer is still inconclusive. We aimed to quantify the association between alcohol intake and risk of stomach cancer, including subtypes.
Methods
We pooled data from two cohort studies including 452,958 individuals enrolled in the European Prospective Investigation into Cancer in 1992-98 and 38,756 Australians enrolled in the Melbourne Collaborative Cohort Study in 1990-94. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) for incident stomach cancer were estimated using Cox regression.
Results
1,225 incident stomach cancers were diagnosed over 7,094,637 person-years. Alcohol intake was not associated with overall stomach cancer risk. We observed a weak positive dose-response association for lifetime intake with non-cardia stomach cancer (HR = 1.03, 95% CI: 1.00-1.06/per 10 g/day increment), which is the more common type (77.6% of cases), and a weak inverse association with cardia cancer (HR = 0.93, 95% CI: 0.87-1.00) (phomogeneity=0.006). These associations did not differ appreciably by smoking or Helicobacter pylori infection status. Differences in HRs between diffuse-type and intestinal-type cancer were minimal (phomogeneity=0.97). HRs of 1.50 (95% CI: 1.12-2.01) for non-cardia and 0.53 (95% CI: 0.27-1.02) for cardia cancer were observed for a life course trajectory characterised by sustained heavy drinking compared with light drinking (phomogeneity=0.01).
Conclusions
Lifetime alcohol intake was associated with increased risk of non-cardia stomach cancer. The inverse association for cardia cancer indicates aetiologic differences between subsites.
Key messages
Limiting long-term alcohol consumption, and avoiding heavy use in particular, might be beneficial in preventing non-cardia stomach cancer.
Collapse
Affiliation(s)
| | - Robert MacInnis
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Yi Yang
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Allison Hodge
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Hazel Mitchell
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Kensington, Australia
| | - Andrew Haydon
- Department of Medical Oncology, Alfred Hospital, Melbourne, Australia
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Australia
| | - John Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Marc Gunter
- on behalf of EPIC PIs and collaborators, International Agency for Research On Cancer, Lyon, France
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Graham Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Roger Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Dallas English
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Pietro Ferrari
- on behalf of EPIC PIs and collaborators, International Agency for Research On Cancer, Lyon, France
| |
Collapse
|
36
|
Smithers BM, Saw RPM, Gyorki DE, Martin RCW, Atkinson V, Haydon A, Roberts-Thomson R, Thompson JF. Contemporary management of locoregionally advanced melanoma in Australia and New Zealand and the role of adjuvant systemic therapy. ANZ J Surg 2021; 91 Suppl 2:3-13. [PMID: 34288329 DOI: 10.1111/ans.17051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/17/2021] [Accepted: 06/22/2021] [Indexed: 12/19/2022]
Abstract
Australia and New Zealand have the highest incidence and mortality rates for melanoma in the world. Local surgery is still the standard treatment of primary cutaneous melanoma, and it is therefore important that surgeons understand the optimal care pathways for patients with melanoma. Accurate staging is critical to ensure a reliable assessment of prognosis and to guide treatment selection. Sentinel node biopsy (SNB) plays an important role in staging and the provision of reliable prognostic estimates for patients with cutaneous melanoma. Patients with stage III melanoma have a substantial risk of disease recurrence following surgery, leading to poor long-term outcomes. Systemic immunotherapies and targeted therapies, known to be effective for stage IV melanoma, have now also been shown to be effective as adjuvant post-surgical treatments for resected stage III melanoma. These patients should be made aware of this and preferably managed in an integrated multidisciplinary model of care, involving the surgeon, medical oncologists and radiation oncologists. This review considers the impact of a recent update to the American Joint Committee on Cancer (AJCC) staging system, the role of SNB for patients with high-risk primary melanoma and recent advances in adjuvant systemic therapies for high-risk patients.
Collapse
Affiliation(s)
- B Mark Smithers
- Queensland Melanoma Project, Faculty of Medicine, University of Queensland and Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - David E Gyorki
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Victoria Atkinson
- Queensland Melanoma Project, Faculty of Medicine, University of Queensland and Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | | | - John F Thompson
- Melanoma Institute Australia, The University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
37
|
da Silva IP, Ahmed T, Reijers ILM, Warner AB, Patrinely JR, Serra-Bellver P, Allayous C, Mangana J, Zimmer L, Trojaniello C, Klein O, Gerard CL, Michielin O, Haydon A, Ascierto PA, Carlino MS, Lebbe C, Lorigan P, Johnson DB, Sandhu S, Lo SN, Menzies AM, Long GV. Ipilimumab versus ipilimumab plus anti-PD-1 for metastatic melanoma - Authors' reply. Lancet Oncol 2021; 22:e343-e344. [PMID: 34339647 DOI: 10.1016/s1470-2045(21)00419-8] [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: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Ines Pires da Silva
- Melanoma Institute Australia, University of Sydney, Sydney, NSW, Australia; Department of Medical Oncology, Westmead and Blacktown Hospitals, Sydney, NSW, Australia
| | - Tasnia Ahmed
- Melanoma Institute Australia, University of Sydney, Sydney, NSW, Australia
| | | | | | | | | | - Clara Allayous
- AP-HP Dermatology, INSERM U976, Université de Paris, Saint Louis Hospital, Paris, France
| | - Joanna Mangana
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Claudia Trojaniello
- Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G Pascale, Napoli, Italy
| | - Oliver Klein
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia
| | - Camille L Gerard
- Oncology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Michielin
- Oncology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Andrew Haydon
- Department of Medical Oncology, Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | - Paolo A Ascierto
- Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G Pascale, Napoli, Italy
| | - Matteo S Carlino
- Melanoma Institute Australia, University of Sydney, Sydney, NSW, Australia; Department of Medical Oncology, Westmead and Blacktown Hospitals, Sydney, NSW, Australia
| | - Celeste Lebbe
- AP-HP Dermatology, INSERM U976, Université de Paris, Saint Louis Hospital, Paris, France
| | - Paul Lorigan
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Services, The University of Manchester, Manchester, UK
| | | | | | - Serigne N Lo
- Melanoma Institute Australia, University of Sydney, Sydney, NSW, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, University of Sydney, Sydney, NSW, Australia; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Georgina V Long
- Melanoma Institute Australia, University of Sydney, Sydney, NSW, Australia; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia.
| |
Collapse
|
38
|
Afshar N, Dashti SG, Te Marvelde L, Blakely T, Haydon A, White VM, Emery JD, Bergin RJ, Whitfield K, Thomas RJS, Giles GG, Milne RL, English DR. Factors Explaining Socio-Economic Inequalities in Survival from Colon Cancer: A Causal Mediation Analysis. Cancer Epidemiol Biomarkers Prev 2021; 30:1807-1815. [PMID: 34272266 DOI: 10.1158/1055-9965.epi-21-0222] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/09/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Socio-economic inequalities in colon cancer survival exist in high-income countries, but the reasons are unclear. We assessed the mediating effects of stage at diagnosis, comorbidities, and treatment (surgery and intravenous chemotherapy) on survival from colon cancer. METHODS We identified 2,203 people aged 15 to 79 years with first primary colon cancer diagnosed in Victoria, Australia, between 2008 and 2011. Colon cancer cases were identified through the Victorian Cancer Registry (VCR), and clinical information was obtained from hospital records. Deaths till December 31, 2016 (n = 807), were identified from Victorian and national death registries. Socio-economic disadvantage was based on residential address at diagnosis. For stage III disease, we decomposed its total effect into direct and indirect effects using interventional mediation analysis. RESULTS Socio-economic inequalities in colon cancer survival were not explained by stage and were greater for men than women. For men with stage III disease, there were 161 [95% confidence interval (CI), 67-256] additional deaths per 1,000 cases in the 5 years following diagnosis for the most disadvantaged compared with the least disadvantaged. The indirect effects through comorbidities and intravenous chemotherapy explained 6 (95% CI, -10-21) and 15 (95% CI, -14-44) per 1,000 of these additional deaths, respectively. Surgery did not explain the observed gap in survival. CONCLUSIONS Disadvantaged men have lower survival from stage III colon cancer that is only modestly explained by having comorbidities or not receiving chemotherapy after surgery. IMPACT Future studies should investigate the potential mediating role of factors occurring beyond the first year following diagnosis, such as compliance with surveillance for recurrence and supportive care services.
Collapse
Affiliation(s)
- Nina Afshar
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.
- Cancer Health Services Research Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - S Ghazaleh Dashti
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Luc Te Marvelde
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Tony Blakely
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Haydon
- Department of Medical Oncology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Victoria M White
- School of Psychology, Deakin University, Burwood, Victoria, Australia
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Jon D Emery
- Cancer in Primary Care Research Group, Department of General Practice, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Rebecca J Bergin
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Cancer in Primary Care Research Group, Department of General Practice, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Kathryn Whitfield
- Cancer Strategy and Development, Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Robert J S Thomas
- Cancer Strategy and Development, Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Dallas R English
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
39
|
Long GV, Schadendorf D, Vecchio MD, Larkin J, Atkinson V, Schenker M, Pigozzo J, Gogas HJ, Dalle S, Meyer N, Ascierto PA, Sandhu S, Eigentler T, Gutzmer R, Hassel JC, Robert C, Carlino M, Giacomo AMD, Butler MO, Muñoz-Couselo E, Brown MP, Rutkowski P, Haydon A, Grob JJ, Schachter J, Queirolo P, Menzies A, Re S, Bas TO, de Pril V, Tenney D, Tang H, Weber JS. Abstract CT004: Adjuvant therapy with nivolumab (NIVO) combined with ipilimumab (IPI) vs NIVO alone in patients (pts) with resected stage IIIB-D/IV melanoma (CheckMate 915). Clin Trials 2021. [DOI: 10.1158/1538-7445.am2021-ct004] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
40
|
Hepner A, Atkinson VG, Larkin J, Burrell RA, Carlino MS, Johnson DB, Zimmer L, Tsai KK, Klein O, Lo SN, Haydon A, Bhave P, Lyle M, Pallan L, Pires da Silva I, Gerard C, Michielin O, Long GV, Menzies AM. Re-induction ipilimumab following acquired resistance to combination ipilimumab and anti-PD-1 therapy. Eur J Cancer 2021; 153:213-222. [PMID: 34214936 DOI: 10.1016/j.ejca.2021.04.021] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/24/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Combination immunotherapy with nivolumab and ipilimumab has a high initial response rate in advanced melanoma; however, up to 55% of patients later progress. The efficacy and safety of ipilimumab re-induction in the setting of acquired resistance (AR) to combination immunotherapy is unknown. METHODS Patients with advanced melanoma who initially achieved a complete response, partial response or sustained stable disease to induction combination immunotherapy then progressed and were reinduced with ipilimumab (alone or in combination with anti-PD-1) and were analysed retrospectively. Demographics, disease characteristics, efficacy and toxicity were examined. RESULTS Forty-seven patients were identified from 12 centres. The response rate to reinduction therapy was 12/47 (26%), and disease control rate was 21/47 (45%). Responses appeared more frequent in patients who developed AR after ceasing induction immunotherapy (30% vs. 18%, P = 0.655). Time to AR was 11 months (95% confidence interval [CI], 8-15 months). After a median follow-up of 16 months (95% CI, 10-25 months), responders to reinduction had a median progression-free survival of 14 months (95% CI, 13, NR months), and in the whole cohort, the median overall survival from reinduction was 17 months (95% CI, 12-NR months). Twenty-seven (58%) immune-related adverse events (irAEs) were reported; 18 (38%) were grade 3/4, and in 11 of 27 (40%), the same irAE observed during induction therapy recurred. CONCLUSIONS Reinduction with ipilimumab ± anti-PD-1 has modest clinical activity. Clinicians should be attentive to the risk of irAEs, including recurrence of irAEs that occurred during induction therapy. Future studies are necessary to determine best management after resistance to combination immunotherapy.
Collapse
Affiliation(s)
- Adriana Hepner
- Melanoma Institute Australia, The University of Sydney, NSW, Australia; Instituto do Cancer do Estado de Sao Paulo, SP, Brazil
| | - Victoria G Atkinson
- University of QLD and Princess Alexandra and Greenslopes Private Hospital, Brisbane, Australia
| | - James Larkin
- The Royal Marsden, NHS Foundation Trust, London, UK
| | | | - Matteo S Carlino
- Melanoma Institute Australia, The University of Sydney, NSW, Australia; Crown Princess Mary Cancer Centre Westmead and Blacktown Hospitals, Australia
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Katy K Tsai
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, CA, USA
| | - Oliver Klein
- Olivia Newton-John Cancer Centre and Austin Health, Melbourne, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, NSW, Australia
| | - Andrew Haydon
- Alfred Health, Melbourne, Australia; Monash University, Melbourne, Australia
| | | | - Megan Lyle
- Cairns Private Hospital, Cairns, Australia
| | - Lalit Pallan
- Melanoma Institute Australia, The University of Sydney, NSW, Australia
| | | | - Camille Gerard
- Department of Oncology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Olivier Michielin
- Department of Oncology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal North Shore and Mater Hospitals, NSW, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal North Shore and Mater Hospitals, NSW, Australia.
| |
Collapse
|
41
|
Jayasekara H, MacInnis RJ, Lujan‐Barroso L, Mayen‐Chacon A, Cross AJ, Wallner B, Palli D, Ricceri F, Pala V, Panico S, Tumino R, Kühn T, Kaaks R, Tsilidis K, Sánchez M, Amiano P, Ardanaz E, Chirlaque López MD, Merino S, Rothwell JA, Boutron‐Ruault M, Severi G, Sternby H, Sonestedt E, Bueno‐de‐Mesquita B, Boeing H, Travis R, Sandanger TM, Trichopoulou A, Karakatsani A, Peppa E, Tjønneland A, Yang Y, Hodge AM, Mitchell H, Haydon A, Room R, Hopper JL, Weiderpass E, Gunter MJ, Riboli E, Giles GG, Milne RL, Agudo A, English DR, Ferrari P. Lifetime alcohol intake, drinking patterns over time and risk of stomach cancer: A pooled analysis of data from two prospective cohort studies. Int J Cancer 2021; 148:2759-2773. [PMID: 33554339 PMCID: PMC9290950 DOI: 10.1002/ijc.33504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/08/2020] [Revised: 12/22/2020] [Accepted: 01/04/2021] [Indexed: 02/03/2023]
Abstract
Alcohol consumption is causally linked to several cancers but the evidence for stomach cancer is inconclusive. In our study, the association between long-term alcohol intake and risk of stomach cancer and its subtypes was evaluated. We performed a pooled analysis of data collected at baseline from 491 714 participants in the European Prospective Investigation into Cancer and Nutrition and the Melbourne Collaborative Cohort Study. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for incident stomach cancer in relation to lifetime alcohol intake and group-based life course intake trajectories, adjusted for potential confounders including Helicobacter pylori infection. In all, 1225 incident stomach cancers (78% noncardia) were diagnosed over 7 094 637 person-years; 984 in 382 957 study participants with lifetime alcohol intake data (5 455 507 person-years). Although lifetime alcohol intake was not associated with overall stomach cancer risk, we observed a weak positive association with noncardia cancer (HR = 1.03, 95% CI: 1.00-1.06 per 10 g/d increment), with a HR of 1.50 (95% CI: 1.08-2.09) for ≥60 g/d compared to 0.1 to 4.9 g/d. A weak inverse association with cardia cancer (HR = 0.93, 95% CI: 0.87-1.00) was also observed. HRs of 1.48 (95% CI: 1.10-1.99) for noncardia and 0.51 (95% CI: 0.26-1.03) for cardia cancer were observed for a life course trajectory characterized by heavy decreasing intake compared to light stable intake (Phomogeneity = .02). These associations did not differ appreciably by smoking or H pylori infection status. Limiting alcohol use during lifetime, particularly avoiding heavy use during early adulthood, might help prevent noncardia stomach cancer. Heterogeneous associations observed for cardia and noncardia cancers may indicate etiologic differences.
Collapse
Affiliation(s)
- Harindra Jayasekara
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVictoriaAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, The University of MelbourneMelbourneVictoriaAustralia
- Centre for Alcohol Policy ResearchLa Trobe UniversityBundooraVictoriaAustralia
| | - Robert J. MacInnis
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVictoriaAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, The University of MelbourneMelbourneVictoriaAustralia
| | - Leila Lujan‐Barroso
- Unit of Nutrition and Cancer, Catalan Institute of Oncology ‐ ICO, Nutrition and Cancer Group, Bellvitge Biomedical Research Institute ‐ IDIBELL, L'Hospitalet de LlobregatBarcelonaSpain
- Department of Nursing of Public HealthMental Health and Maternity and Child Health School of Nursing Universitat de BarcelonaBarcelonaSpain
| | - Ana‐Lucia Mayen‐Chacon
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, World Health OrganizationLyonFrance
| | - Amanda J. Cross
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Bengt Wallner
- Department of Surgical and Perioperatve Sciences, SurgeryUmeå University HospitalUmeåSweden
| | - Domenico Palli
- Cancer Risk Factors and Life‐Style Epidemiology UnitInstitute for Cancer Research, Prevention and Clinical Network – ISPROFlorenceItaly
| | - Fulvio Ricceri
- Department of Clinical and Biological SciencesUniversity of TurinTurinItaly
- Unit of Epidemiology, Regional Health Service ASL TO3GrugliascoItaly
| | - Valeria Pala
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di MilanoMilanItaly
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e ChirurgiaFederico II UniversityNaplesItaly
| | - Rosario Tumino
- Cancer Registry and Histopathology DepartmentProvincial Health Authority (ASP)RagusaItaly
| | - Tilman Kühn
- Division of Cancer EpidemiologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
| | - Rudolf Kaaks
- Division of Cancer EpidemiologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
| | - Kostas Tsilidis
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Maria‐Jose Sánchez
- Escuela Andaluza de Salud Pública (EASP)GranadaSpain
- Instituto de Investigación Biosanitaria ibs.GRANADAGranadaSpain
- CIBER in Epidemiology and Public Health (CIBERESP)MadridSpain
- Universidad de GranadaGranadaSpain
| | - Pilar Amiano
- CIBER in Epidemiology and Public Health (CIBERESP)MadridSpain
- Public Health Division of Gipuzkoa, BioDonostia Research InstituteDonostia‐San SebastianSpain
| | - Eva Ardanaz
- CIBER in Epidemiology and Public Health (CIBERESP)MadridSpain
- Navarra Public Health InstitutePamplonaSpain
- IdiSNA, Navarra Institute for Health ResearchPamplonaSpain
| | - María Dolores Chirlaque López
- CIBER in Epidemiology and Public Health (CIBERESP)MadridSpain
- Department of EpidemiologyRegional Health Council, IMIB‐Arrixaca, Murcia UniversityMurciaSpain
| | - Susana Merino
- Public Health Directorate, Regional Government of AsturiasOviedoSpain
| | - Joseph A. Rothwell
- CESP (U1018), Faculté de médecineUniversité Paris‐Saclay, UVSQ, INSERMVillejuifFrance
- Gustave RoussyVillejuifFrance
| | | | - Gianluca Severi
- CESP (U1018), Faculté de médecineUniversité Paris‐Saclay, UVSQ, INSERMVillejuifFrance
- Gustave RoussyVillejuifFrance
- Department of StatisticsComputer Science and Applications “G. Parenti” (DISIA), University of FlorenceFlorenceItaly
| | - Hanna Sternby
- Department of SurgeryInstitution of Clinical Sciences Malmö, Lund UniversityLundSweden
| | - Emily Sonestedt
- Nutritional Epidemiology, Department of Clinical Sciences MalmöLund UniversityMalmöSweden
| | - Bas Bueno‐de‐Mesquita
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | - Heiner Boeing
- Institute of Nutrition Science, University of PotsdamNuthetalGermany
| | - Ruth Travis
- Cancer Epidemiology Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Torkjel M. Sandanger
- Department of Community Medicine, Faculty of Health SciencesUiT‐the Arctic University of NorwayTromsøNorway
| | | | - Anna Karakatsani
- Hellenic Health FoundationAthensGreece
- 2nd Pulmonary Medicine DepartmentSchool of Medicine, National Kapodistrian University of Athens, “ATTIKON” University HospitalHaidariGreece
| | | | - Anne Tjønneland
- Danish Cancer Society Research CenterCopenhagenDenmark
- Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
| | - Yi Yang
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVictoriaAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, The University of MelbourneMelbourneVictoriaAustralia
| | - Allison M. Hodge
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVictoriaAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, The University of MelbourneMelbourneVictoriaAustralia
| | - Hazel Mitchell
- School of Biotechnology and Biomolecular Sciences, University of New South WalesKensingtonNew South WalesAustralia
| | - Andrew Haydon
- Department of Medical OncologyAlfred HospitalMelbourneVictoriaAustralia
| | - Robin Room
- Centre for Alcohol Policy ResearchLa Trobe UniversityBundooraVictoriaAustralia
- Centre for Social Research on Alcohol and Drugs, Department of Public Health SciencesStockholm UniversityStockholmSweden
| | - John L. Hopper
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, The University of MelbourneMelbourneVictoriaAustralia
| | - Elisabete Weiderpass
- Office of the Director, International Agency for Research on Cancer, World Health OrganizationLyonFrance
| | - Marc J. Gunter
- Nutritional Epidemiology Group, International Agency for Research on Cancer, World Health OrganizationLyonFrance
| | - Elio Riboli
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Graham G. Giles
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVictoriaAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, The University of MelbourneMelbourneVictoriaAustralia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash UniversityClaytonVictoriaAustralia
| | - Roger L. Milne
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVictoriaAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, The University of MelbourneMelbourneVictoriaAustralia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash UniversityClaytonVictoriaAustralia
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology ‐ ICO, Nutrition and Cancer Group, Bellvitge Biomedical Research Institute ‐ IDIBELL, L'Hospitalet de LlobregatBarcelonaSpain
| | - Dallas R. English
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVictoriaAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, The University of MelbourneMelbourneVictoriaAustralia
| | - Pietro Ferrari
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, World Health OrganizationLyonFrance
| |
Collapse
|
42
|
Nguyen J, Barber TW, Cameron R, Haydon A, Mar V. Findings and Resolution of Melanoma Perineural Spread Along the Greater Auricular Nerve on FDG PET/CT and MRI. Clin Nucl Med 2021; 46:e329-e331. [PMID: 33591024 DOI: 10.1097/rlu.0000000000003534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT We report an unusual case of a 59-year-old man with recurrent right ear melanoma resulting in perineural spread to the right greater auricular nerve. Direct perineural spread to the greater auricular nerve is not commonly reported in melanoma. Our case demonstrates perineural spread along the greater auricular nerve on 18F-FDG PET/CT and MRI. This finding was supported by intraneural invasion noted at the surgical margin of the wide local excision of the right helix melanoma. Resolution of FDG activity and improved MRI appearances of the right greater auricular nerve were seen after immunotherapy treatment.
Collapse
Affiliation(s)
| | | | | | - Andrew Haydon
- Medical Oncology, Alfred Health, Melbourne, Victoria, Australia
| | | |
Collapse
|
43
|
Pires da Silva I, Ahmed T, Reijers ILM, Weppler AM, Betof Warner A, Patrinely JR, Serra-Bellver P, Allayous C, Mangana J, Nguyen K, Zimmer L, Trojaniello C, Stout D, Lyle M, Klein O, Gerard CL, Michielin O, Haydon A, Ascierto PA, Carlino MS, Lebbe C, Lorigan P, Johnson DB, Sandhu S, Lo SN, Blank CU, Menzies AM, Long GV. Ipilimumab alone or ipilimumab plus anti-PD-1 therapy in patients with metastatic melanoma resistant to anti-PD-(L)1 monotherapy: a multicentre, retrospective, cohort study. Lancet Oncol 2021; 22:836-847. [PMID: 33989557 DOI: 10.1016/s1470-2045(21)00097-8] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Anti-PD-1 therapy (hereafter referred to as anti-PD-1) induces long-term disease control in approximately 30% of patients with metastatic melanoma; however, two-thirds of patients are resistant and will require further treatment. We aimed to determine the efficacy and safety of ipilimumab plus anti-PD-1 (pembrolizumab or nivolumab) compared with ipilimumab monotherapy in patients who are resistant to anti-PD-(L)1 therapy (hereafter referred to as anti-PD-[L]1). METHODS This multicentre, retrospective, cohort study, was done at 15 melanoma centres in Australia, Europe, and the USA. We included adult patients (aged ≥18 years) with metastatic melanoma (unresectable stage III and IV), who were resistant to anti-PD-(L)1 (innate or acquired resistance) and who then received either ipilimumab monotherapy or ipilimumab plus anti-PD-1 (pembrolizumab or nivolumab), based on availability of therapies or clinical factors determined by the physician, or both. Tumour response was assessed as per standard of care (CT or PET-CT scans every 3 months). The study endpoints were objective response rate, progression-free survival, overall survival, and safety of ipilimumab compared with ipilimumab plus anti-PD-1. FINDINGS We included 355 patients with metastatic melanoma, resistant to anti-PD-(L)1 (nivolumab, pembrolizumab, or atezolizumab), who had been treated with ipilimumab monotherapy (n=162 [46%]) or ipilimumab plus anti-PD-1 (n=193 [54%]) between Feb 1, 2011, and Feb 6, 2020. At a median follow-up of 22·1 months (IQR 9·5-30·9), the objective response rate was higher with ipilimumab plus anti-PD-1 (60 [31%] of 193 patients) than with ipilimumab monotherapy (21 [13%] of 162 patients; p<0·0001). Overall survival was longer in the ipilimumab plus anti-PD-1 group (median overall survival 20·4 months [95% CI 12·7-34·8]) than with ipilimumab monotherapy (8·8 months [6·1-11·3]; hazard ratio [HR] 0·50, 95% CI 0·38-0·66; p<0·0001). Progression-free survival was also longer with ipilimumab plus anti-PD-1 (median 3·0 months [95% CI 2·6-3·6]) than with ipilimumab (2·6 months [2·4-2·9]; HR 0·69, 95% CI 0·55-0·87; p=0·0019). Similar proportions of patients reported grade 3-5 adverse events in both groups (59 [31%] of 193 patients in the ipilimumab plus anti-PD-1 group vs 54 [33%] of 162 patients in the ipilimumab group). The most common grade 3-5 adverse events were diarrhoea or colitis (23 [12%] of 193 patients in the ipilimumab plus anti-PD-1 group vs 33 [20%] of 162 patients in the ipilimumab group) and increased alanine aminotransferase or aspartate aminotransferase (24 [12%] vs 15 [9%]). One death occurred with ipilimumab 26 days after the last treatment: a colon perforation due to immune-related pancolitis. INTERPRETATION In patients who are resistant to anti-PD-(L)1, ipilimumab plus anti-PD-1 seemed to yield higher efficacy than ipilimumab with a higher objective response rate, longer progression-free, and longer overall survival, with a similar rate of grade 3-5 toxicity. Ipilimumab plus anti-PD-1 should be favoured over ipilimumab alone as a second-line immunotherapy for these patients with advanced melanoma. FUNDING None.
Collapse
Affiliation(s)
- Ines Pires da Silva
- Melanoma Institute Australia, University of Sydney, Sydney, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia; Blacktown Hospital, Sydney, NSW, Australia
| | - Tasnia Ahmed
- Melanoma Institute Australia, University of Sydney, Sydney, NSW, Australia
| | | | - Alison M Weppler
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | | | | | | | - Clara Allayous
- AP-HP Dermatology, INSERM U976, Université de Paris, Saint Louis Hospital, Paris, France
| | - Joanna Mangana
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Khang Nguyen
- Westmead Hospital, Sydney, NSW, Australia; Blacktown Hospital, Sydney, NSW, Australia
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Claudia Trojaniello
- Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G Pascale, Napoli, Italy
| | - Dan Stout
- Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | - Megan Lyle
- Cairns Hospital, James Cook University, Cairns, QLD, Australia
| | - Oliver Klein
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia
| | - Camille L Gerard
- Oncology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Michielin
- Oncology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Andrew Haydon
- Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | - Paolo A Ascierto
- Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G Pascale, Napoli, Italy
| | - Matteo S Carlino
- Melanoma Institute Australia, University of Sydney, Sydney, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia; Blacktown Hospital, Sydney, NSW, Australia
| | - Celeste Lebbe
- AP-HP Dermatology, INSERM U976, Université de Paris, Saint Louis Hospital, Paris, France
| | - Paul Lorigan
- The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK
| | | | - Shahneen Sandhu
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, University of Sydney, Sydney, NSW, Australia
| | | | - Alexander M Menzies
- Melanoma Institute Australia, University of Sydney, Sydney, NSW, Australia; Royal North Shore Hospital, Sydney, NSW, Australia; Mater Hospital, Sydney, NSW, Australia
| | - Georgina V Long
- Melanoma Institute Australia, University of Sydney, Sydney, NSW, Australia; Royal North Shore Hospital, Sydney, NSW, Australia; Mater Hospital, Sydney, NSW, Australia.
| |
Collapse
|
44
|
Brown LJ, Weppler A, Bhave P, Allayous C, Patrinely JR, Ott P, Sandhu S, Haydon A, Lebbe C, Johnson DB, Long GV, Menzies AA, Carlino MS. Combination anti-PD1 and ipilimumab therapy in patients with advanced melanoma and pre-existing autoimmune disorders. J Immunother Cancer 2021; 9:jitc-2020-002121. [PMID: 33963010 PMCID: PMC8108669 DOI: 10.1136/jitc-2020-002121] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2021] [Indexed: 12/13/2022] Open
Abstract
Background Clinical trials of immunotherapy have excluded patients with pre-existing autoimmune disease. While the safety and efficacy of single agent ipilimumab and anti-PD1 antibodies in patients with autoimmune disease has been examined in retrospective studies, no data are available for combination therapy which has significantly higher toxicity risk. We sought to establish the safety and efficacy of combination immunotherapy for patients with advanced melanoma and pre-existing autoimmune diseases. Methods We performed a retrospective study of patients with advanced melanoma and pre-existing autoimmune disease who received combination ipilimumab and anti-PD1 at 10 international centers from March 2015 to February 2020. Data regarding the autoimmune disease, treatment, toxicity and outcomes were examined in patients. Results Of the 55 patients who received ipilimumab and anti-PD1, the median age was 63 years (range 23–83). Forty-six were treated with ipilimumab and nivolumab and nine with ipilimumab and pembrolizumab. Eighteen patients (33%) had a flare of their autoimmune disease including 4 of 7 with rheumatoid arthritis, 3 of 6 with psoriasis, 5 of 10 with inflammatory bowel disease, 3 of 19 with thyroiditis, 1 of 1 with Sjogren’s syndrome, 1 of 1 with polymyalgia and 1 of 1 with Behcet’s syndrome and psoriasis. Eight (44%) patients ceased combination therapy due to flare. Thirty-seven patients (67%) had an unrelated immune-related adverse event (irAE), and 20 (36%) ceased combination immunotherapy due to irAEs. There were no treatment-related deaths. Patients on immunosuppression (OR 4.59; p=0.03) had a higher risk of flare. The overall response rate was 55%, with 77% of responses ongoing. Median progression free survival and overall survival were 10 and 24 months, respectively. Patients on baseline immunosuppression had an overall survival of 11 months (95% CI 3.42 to 18.58) compared with 31 months without (95% CI 20.89 to 41.11, p=0.005). Conclusions In patients with pre-existing autoimmune disease, not on immunosuppression and advanced melanoma, combination ipilimumab and anti-PD1 has similar efficacy compared with previously reported trials. There is a risk of flare of pre-existing autoimmune disorders, particularly in patients with inflammatory bowel disease and rheumatologic conditions, and patients on baseline immunosuppression.
Collapse
Affiliation(s)
- Lauren J Brown
- Department of Medical Oncology, Westmead and Blacktown Hospital, New South Wales, New South Wales, Australia
| | - Alison Weppler
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Prachi Bhave
- Department of Medical Oncology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Clara Allayous
- Department of Dermatology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
| | | | - Patrick Ott
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Shahneen Sandhu
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Andrew Haydon
- Department of Medical Oncology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Celeste Lebbe
- Department of Dermatology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Mater and Royal North Shore Hospitals, Sydney, New South Wales, Australia
| | - Alexander A Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Mater and Royal North Shore Hospitals, Sydney, New South Wales, Australia
| | - Matteo S Carlino
- Department of Medical Oncology, Westmead and Blacktown Hospital, New South Wales, New South Wales, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
45
|
Versluis JM, Hendriks AM, Weppler AM, Brown LJ, de Joode K, Suijkerbuijk KPM, Zimmer L, Kapiteijn EW, Allayous C, Johnson DB, Hepner A, Mangana J, Bhave P, Jansen YJL, Trojaniello C, Atkinson V, Storey L, Lorigan P, Ascierto PA, Neyns B, Haydon A, Menzies AM, Long GV, Lebbe C, van der Veldt AAM, Carlino MS, Sandhu S, van Tinteren H, de Vries EGE, Blank CU, Jalving M. The role of local therapy in the treatment of solitary melanoma progression on immune checkpoint inhibition: A multicentre retrospective analysis. Eur J Cancer 2021; 151:72-83. [PMID: 33971447 DOI: 10.1016/j.ejca.2021.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/08/2021] [Revised: 03/15/2021] [Accepted: 04/05/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In patients with metastatic melanoma, progression of a single tumour lesion (solitary progression) after response to immune checkpoint inhibition (ICI) is increasingly treated with local therapy. We evaluated the role of local therapy for solitary progression in melanoma. PATIENTS AND METHODS Patients with metastatic melanoma treated with ICI between 2010 and 2019 with solitary progression as first progressive event were included from 17 centres in 9 countries. Follow-up and survival are reported from ICI initiation. RESULTS We identified 294 patients with solitary progression after stable disease in 15%, partial response in 55% and complete response in 30%. The median follow-up was 43 months; the median time to solitary progression was 13 months, and the median time to subsequent progression after treatment of solitary progression (TTSP) was 33 months. The estimated 3-year overall survival (OS) was 79%; median OS was not reached. Treatment consisted of systemic therapy (18%), local therapy (36%), both combined (42%) or active surveillance (4%). In 44% of patients treated for solitary progression, no subsequent progression occurred. For solitary progression during ICI (n = 143), the median TTSP was 29 months. Both TTSP and OS were similar for local therapy, ICI continuation and both combined. For solitary progression post ICI (n = 151), the median TTSP was 35 months. TTSP was higher for ICI recommencement plus local therapy than local therapy or ICI recommencement alone (p = 0.006), without OS differences. CONCLUSION Almost half of patients with melanoma treated for solitary progression after initial response to ICI had no subsequent progression. This study suggests that local therapy can benefit patients and is associated with favourable long-term outcomes.
Collapse
Affiliation(s)
- Judith M Versluis
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Anne M Hendriks
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Alison M Weppler
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia
| | - Lauren J Brown
- Department of Medical Oncology, Westmead and Blacktown Hospitals, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW 2145, Australia
| | - Karlijn de Joode
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Karijn P M Suijkerbuijk
- Department of Medical Oncology, University Medical Center Utrecht Cancer Center, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Ellen W Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 AZ, Leiden, the Netherlands
| | - Clara Allayous
- AP-HP Dermatology Department, Saint-Louis Hospital, Université de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Douglas B Johnson
- Department of Medical Oncology, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, United States
| | - Adriana Hepner
- Melanoma Institute Australia, 40 Rocklands Rds, Wollstonecraft, NSW 2065, Australia; Medical Oncology Service, Instituto Do Cancer Do Estado de Sao Paulo, Av Dr Amaldo, 251 Cerqueira César, Sao Paulo 01246-000, Brazil
| | - Joanna Mangana
- Department of Dermatology, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Prachi Bhave
- Department of Medical Oncology, Alfred Hospital, 55 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Yanina J L Jansen
- Department of Surgical Oncology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium
| | - Claudia Trojaniello
- Department of Medical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Via Mariano Semmola, 80131 Napoli, NA, Italy
| | - Victoria Atkinson
- Department of Medical Oncology, Princess Alexandra Hospital, University of Queensland, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia
| | - Lucy Storey
- University of Manchester and Christie NHS Foundation Trust, Wimslow Rd, Manchester M20 4BX, United Kingdom
| | - Paul Lorigan
- University of Manchester and Christie NHS Foundation Trust, Wimslow Rd, Manchester M20 4BX, United Kingdom
| | - Paolo A Ascierto
- Department of Medical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Via Mariano Semmola, 80131 Napoli, NA, Italy
| | - Bart Neyns
- Department of Surgical Oncology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium
| | - Andrew Haydon
- Department of Medical Oncology, Alfred Hospital, 55 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, 40 Rocklands Rds, Wollstonecraft, NSW 2065, Australia; University of Sydney, Camperdown, NSW 2006, Australia; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Reserve Rd, St Leonards, NSW 2065, Australia
| | - Georgina V Long
- Melanoma Institute Australia, 40 Rocklands Rds, Wollstonecraft, NSW 2065, Australia; University of Sydney, Camperdown, NSW 2006, Australia; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Reserve Rd, St Leonards, NSW 2065, Australia
| | - Celeste Lebbe
- AP-HP Dermatology Department, Saint-Louis Hospital, Université de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Astrid A M van der Veldt
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands; Department of Radiology & Nuclear Medicine Erasmus MC Cancer Institute, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Matteo S Carlino
- Department of Medical Oncology, Westmead and Blacktown Hospitals, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW 2145, Australia; Melanoma Institute Australia, 40 Rocklands Rds, Wollstonecraft, NSW 2065, Australia; University of Sydney, Camperdown, NSW 2006, Australia
| | - Shahneen Sandhu
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia
| | - Harm van Tinteren
- Department of Biometrics, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Christian U Blank
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 AZ Leiden, the Netherlands
| | - Mathilde Jalving
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
| |
Collapse
|
46
|
Law E, Scott MC, Moon YSK, Lee AJ, Bandy VT, Haydon A, Shek A, Kang-Birken SL. Adapting pharmacy experiential education during COVID-19: Innovating remote preceptor resources, tools, and patient care delivery beyond virtual meetings. Am J Health Syst Pharm 2021; 78:1732-1738. [PMID: 33948622 PMCID: PMC8135914 DOI: 10.1093/ajhp/zxab192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose To describe the innovative teaching practices, tools, and resources for remote learning developed by a school of pharmacy with a decentralized experiential program to empower and support preceptors in response to the coronavirus disease 2019 (COVID-19) pandemic. Summary As the pandemic has continued, there have been significant shifts in pharmacy workflow, staffing, and patient care delivery. Pharmacy students are slowly being reintegrated into these learning environments. Although preceptors are willing and eager to teach, many lack the resources, tools, and support to create remote learning experiences at their facilities. The University of the Pacific Thomas J. Long School of Pharmacy has a decentralized experiential education model in which faculty regional coordinators with clinical practices and diverse expertise are disseminated throughout California. This model allowed us to collaborate and understand preceptor needs from a local level. We created a preceptor COVID-19 guidance document, introduced innovative virtual playbooks to pivot up to 100% remote rotations, and promoted the layered learning model to integrate pharmacy residents into the remote teaching space. Communication and flexibility are key to ensure student and preceptor safety while maintaining high-quality advanced pharmacy practice experiences and preserving patient-student relationships in telehealth. Conclusion Overall, we successfully created innovative solutions and leveraged our decentralized experiential model to meet the teaching and learning demands during an unanticipated crisis. We continue to adapt and plan to assess the effectiveness of the tools by administering surveys of preceptors and pharmacy students.
Collapse
Affiliation(s)
- Elaine Law
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, USA
| | - Marie C Scott
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, USA
| | - Yong S K Moon
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, USA
| | - Audrey J Lee
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, USA
| | - Veronica T Bandy
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, USA
| | - Andrew Haydon
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, USA
| | - Allen Shek
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, USA
| | - S Lena Kang-Birken
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, USA
| |
Collapse
|
47
|
Klein O, Brown WA, Saxon S, Haydon A. Salvage Treatment Using Anti-PD-1/CTLA-4 Immunotherapy After Failure of Neoadjuvant Chemotherapy in Microsatellite Instable Gastroesophageal Carcinoma. Oncologist 2021; 26:461-464. [PMID: 33856094 DOI: 10.1002/onco.13793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 04/07/2021] [Indexed: 12/30/2022] Open
Abstract
Perioperative chemotherapy is standard treatment for patients with early high-risk gastroesophageal adenocarcinoma independent of molecular subtype. Approximately 8% of gastroesophageal cancers have a microsatellite instable phenotype (MSI-H), and retrospective analyses of neoadjuvant/adjuvant chemotherapy trials suggests no survival benefit in this patient population compared with surgery alone. Patients with advanced MSI-H malignancies obtain durable responses with immunotherapy using anti-programmed cell death protein 1 (PD-1) checkpoint blockade. We describe a case of a patient with an early MSI-H gastroesophageal adenocarcinoma who progressed on neoadjuvant chemotherapy precluding subsequent surgical resection. The patient was subsequently treated with immunotherapy using the anti-PD-1 antibody nivolumab and the anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) antibody ipilimumab leading to a complete remission with biopsies of the residual tumor mass and regional lymph nodes revealing no residual tumor. This case highlights the lack of benefit from neoadjuvant chemotherapy in patients with MSI-H gastroesophageal cancers and suggests that perioperative anti-PD-1-based immunotherapy should be further investigated in this patient population. KEY POINTS: This report describes the successful salvage treatment of a patient with an early high-risk MSI-H gastroesophageal carcinoma who progressed through neoadjuvant chemotherapy using combination immunotherapy of the anti-programmed cell death protein 1 (PD-1) antibody nivolumab and the anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) antibody ipilimumab, leading to an ongoing complete remission. The case is in keeping with retrospective analyses of perioperative treatment trials demonstrating a lack of chemotherapy benefit in patients with MSI-H gastroesophageal carcinoma and supports the further investigation of anti-PD-1-based immunotherapy as a treatment modality in this patient population. The case highlights the potential difficulties that may be encountered in the surgical management of patients treated with neoadjuvant immunotherapy with reactive dense fibrotic changes precluding surgical resection.
Collapse
Affiliation(s)
- Oliver Klein
- Olivia Newton-John Cancer Research Institute, Melbourne, Australia
| | - Wendy A Brown
- Department of Surgery, Alfred Health, Melbourne, Australia
| | - Sarah Saxon
- Department of Anatomical Pathology, Alfred Health, Melbourne, Australia
| | - Andrew Haydon
- Department of Medical Oncology, Alfred Health, Melbourne, Australia
| |
Collapse
|
48
|
Patrinely JR, Johnson R, Lawless AR, Bhave P, Sawyers A, Dimitrova M, Yeoh HL, Palmeri M, Ye F, Fan R, Davis EJ, Rapisuwon S, Long GV, Haydon A, Osman I, Mehnert JM, Carlino MS, Sullivan RJ, Menzies AM, Johnson DB. Chronic Immune-Related Adverse Events Following Adjuvant Anti-PD-1 Therapy for High-risk Resected Melanoma. JAMA Oncol 2021; 7:744-748. [PMID: 33764387 DOI: 10.1001/jamaoncol.2021.0051] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Importance Agents targeting programmed cell death 1 (PD-1)/PD ligand 1 (PD-L1) improve long-term survival across many advanced cancers and are now used as adjuvant therapy for resected stage III and IV melanomas. The incidence and spectrum of chronic immune-related adverse events (irAEs) have not been well defined. Objective To determine the incidence, time course, spectrum, and associations of chronic irAEs arising from adjuvant anti-PD-1 therapy. Design, Setting, and Participants This retrospective multicenter cohort study was conducted between 2015 and 2020 across 8 academic medical centers in the United States and Australia. Patients with stage III to IV melanomas treated with anti-PD-1 in the adjuvant setting were included. Main Outcomes and Measures Incidence, types, and time course of chronic irAEs (defined as irAEs persisting at least 12 weeks after therapy cessation). Results Among 387 patients, the median (range) age was 63 (17-88) years, and 235 (60.7%) were male. Of these patients, 267 (69.0%) had any acute irAE, defined as those arising during treatment with anti-PD-1, including 52 (19.5%) with grades 3 through 5 events; 1 patient each had fatal myocarditis and neurotoxicity. Chronic irAEs, defined as those that persisted beyond 12 weeks of anti-PD-1 discontinuation, developed in 167 (43.2%) patients, of which most (n = 161; 96.4%) were mild (grade 1 or 2) and most persisted until last available follow-up (n = 143; 85.6%). Endocrinopathies (73 of 88; 83.0%), arthritis (22 of 45; 48.9%), xerostomia (9 of 17; 52.9%), neurotoxicities (11 of 15; 73.3%), and ocular events (5 of 8; 62.5%) were particularly likely to become chronic. In contrast, irAEs affecting visceral organs (liver, colon, lungs, kidneys) had much lower rates of becoming chronic irAEs; for example, colitis became chronic in 6 of 44 (13.6%) cases, of which 4 of 6 (66.7%) resolved with prolonged follow-up. Age, gender, time of onset, and need for steroids were not associated with the likelihood of chronicity of irAEs. Conclusion and Relevance In this multicenter cohort study, chronic irAEs associated with anti-PD-1 therapy appear to be more common than previously recognized and frequently persisted even with prolonged follow-up, although most were low grade. The risks of chronic irAEs should be integrated into treatment decision-making.
Collapse
Affiliation(s)
| | - Rebecca Johnson
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia.,Mater and Royal North Shore Hospitals, Sydney, New South Wales, Australia
| | - Aleigha R Lawless
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - Prachi Bhave
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia.,Department of Medical Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Amelia Sawyers
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York University School of Medicine, New York, New York
| | - Maya Dimitrova
- Division of Hematology and Medical Oncology, Perlmutter Cancer Center, NYU Langone Health, New York University School of Medicine, New York, New York
| | - Hui Ling Yeoh
- Department of Medical Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - Marisa Palmeri
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Fei Ye
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Run Fan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth J Davis
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Suthee Rapisuwon
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Georgina V Long
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia.,Mater and Royal North Shore Hospitals, Sydney, New South Wales, Australia
| | - Andrew Haydon
- Department of Medical Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - Iman Osman
- Division of Hematology and Medical Oncology, Perlmutter Cancer Center, NYU Langone Health, New York University School of Medicine, New York, New York
| | - Janice M Mehnert
- Division of Hematology and Medical Oncology, Perlmutter Cancer Center, NYU Langone Health, New York University School of Medicine, New York, New York.,Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Matteo S Carlino
- Department of Medical Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Ryan J Sullivan
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - Alexander M Menzies
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia.,Mater and Royal North Shore Hospitals, Sydney, New South Wales, Australia
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
49
|
Jayasekara H, Hodge AM, Haydon A, Room R, Hopper JL, English DR, Smith-Warner SA, Giles GG, Milne RL, MacInnis RJ. Prediagnosis alcohol intake and metachronous cancer risk in cancer survivors: A prospective cohort study. Int J Cancer 2021; 149:827-838. [PMID: 33872391 DOI: 10.1002/ijc.33603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/28/2020] [Revised: 03/21/2021] [Accepted: 04/07/2021] [Indexed: 12/24/2022]
Abstract
Alcohol consumption is a known cause of cancer, but its role in the etiology of second primary (metachronous) cancer is uncertain. Associations between alcohol intake up until study enrollment (prediagnosis) and risk of metachronous cancer were estimated using 9435 participants in the Melbourne Collaborative Cohort Study who were diagnosed with their first invasive cancer after enrollment (1990-1994). Follow-up was from date of first invasive cancer until diagnosis of metachronous cancer, death or censor date (February 2018), whichever came first. Alcohol intake for 10-year periods from age 20 until decade encompassing baseline using recalled beverage-specific frequency and quantity was used to calculate baseline and lifetime intakes, and group-based intake trajectories. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for potential confounders. After a mean follow-up of 7 years, 1512 metachronous cancers were identified. A 10 g/d increment in prediagnosis lifetime alcohol intake (HR = 1.03, 95% CI = 1.00-1.06; Pvalue = .02) and an intake of ≥60 g/d (HR = 1.32, 95% CI = 1.01-1.73) were associated with increased metachronous cancer risk. We observed positive associations (per 10 g/d increment) for metachronous colorectal (HR = 1.07, 95% CI = 1.00-1.14), upper aero-digestive tract (UADT) (HR = 1.16, 95% CI = 1.00-1.34) and kidney cancer (HR = 1.24, 95% CI = 1.10-1.39). Although these findings were partly explained by effects of smoking, the association for kidney cancer remained unchanged when current smokers or obese individuals were excluded. Alcohol intake trajectories over the life course confirmed associations with metachronous cancer risk. Prediagnosis long-term alcohol intake, and particularly heavy drinking, may increase the risk of metachronous cancer, particularly of the colorectum, UADT and kidney.
Collapse
Affiliation(s)
- Harindra Jayasekara
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Victoria, Australia
| | - Allison M Hodge
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Haydon
- Department of Medical Oncology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Victoria, Australia
- Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dallas R English
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stephanie A Smith-Warner
- Departments of Nutrition and Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Robert J MacInnis
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
50
|
Owen CN, Bai X, Quah T, Lo SN, Allayous C, Callaghan S, Martínez-Vila C, Wallace R, Bhave P, Reijers ILM, Thompson N, Vanella V, Gerard CL, Aspeslagh S, Labianca A, Khattak A, Mandala M, Xu W, Neyns B, Michielin O, Blank CU, Welsh SJ, Haydon A, Sandhu S, Mangana J, McQuade JL, Ascierto PA, Zimmer L, Johnson DB, Arance A, Lorigan P, Lebbé C, Carlino MS, Sullivan RJ, Long GV, Menzies AM. Delayed immune-related adverse events with anti-PD-1-based immunotherapy in melanoma. Ann Oncol 2021; 32:917-925. [PMID: 33798657 DOI: 10.1016/j.annonc.2021.03.204] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [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: 11/01/2020] [Revised: 03/09/2021] [Accepted: 03/28/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Immune-related adverse events (irAEs) typically occur within 4 months of starting anti-programmed cell death protein 1 (PD-1)-based therapy [anti-PD-1 ± anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA4)], but delayed irAEs (onset >12 months after commencement) can also occur. This study describes the incidence, nature and management of delayed irAEs in patients receiving anti-PD-1-based immunotherapy. PATIENTS AND METHODS Patients with delayed irAEs from 20 centres were studied. The incidence of delayed irAEs was estimated as a proportion of melanoma patients treated with anti-PD-1-based therapy and surviving >1 year. Onset, clinical features, management and outcomes of irAEs were examined. RESULTS One hundred and eighteen patients developed a total of 140 delayed irAEs (20 after initial combination with anti-CTLA4), with an estimated incidence of 5.3% (95% confidence interval 4.0-6.9, 53/999 patients at sites with available data). The median onset of delayed irAE was 16 months (range 12-53 months). Eighty-seven patients (74%) were on anti-PD-1 at irAE onset, 15 patients (12%) were <3 months from the last dose and 16 patients (14%) were >3 months from the last dose of anti-PD-1. The most common delayed irAEs were colitis, rash and pneumonitis; 55 of all irAEs (39%) were ≥grade 3. Steroids were required in 80 patients (68%), as well as an additional immunosuppressive agent in 27 patients (23%). There were two irAE-related deaths: encephalitis with onset during anti-PD-1 and a multiple-organ irAE with onset 11 months after ceasing anti-PD-1. Early irAEs (<12 months) had also occurred in 69 patients (58%), affecting a different organ from the delayed irAE in 59 patients (86%). CONCLUSIONS Delayed irAEs occur in a small but relevant subset of patients. Delayed irAEs are often different from previous irAEs, may be high grade and can lead to death. They mostly occur in patients still receiving anti-PD-1. The risk of delayed irAE should be considered when deciding the duration of treatment in responding patients. However, patients who stop treatment may also rarely develop delayed irAE.
Collapse
Affiliation(s)
- C N Owen
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - X Bai
- Massachusetts General Hospital, Boston, USA; Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - T Quah
- Westmead and Blacktown Hospitals, Sydney, Australia
| | - S N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - C Allayous
- Dermatology Department, Université de Paris, AP-HP Saint-Louis Hospital, INSERM, Paris, France
| | - S Callaghan
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - R Wallace
- Peter MacCallum Cancer Centre and the University of Melbourne, Melbourne, Australia
| | - P Bhave
- The Alfred Hospital, Melbourne, Australia
| | - I L M Reijers
- Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - N Thompson
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - V Vanella
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - C L Gerard
- Lausanne University Hospital, Lausanne, Switzerland
| | - S Aspeslagh
- University Hospital Brussels, Brussels, Belgium
| | - A Labianca
- Papa Giovanni XXIII Cancer Center Hospital, Bergamo, Italy
| | - A Khattak
- Fiona Stanley Hospital and Edith Cowan University, Perth, Australia
| | - M Mandala
- University of Perugia, Unit of Medical Oncology, Santa Maria misericordia hospital, Perugia, Italy
| | - W Xu
- Princess Alexandra Hospital and The University of Queensland, Brisbane, Australia
| | - B Neyns
- University Hospital Brussels, Brussels, Belgium
| | - O Michielin
- Lausanne University Hospital, Lausanne, Switzerland
| | - C U Blank
- Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S J Welsh
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Haydon
- The Alfred Hospital, Melbourne, Australia
| | - S Sandhu
- Peter MacCallum Cancer Centre and the University of Melbourne, Melbourne, Australia
| | - J Mangana
- Dermatology, Department of Dermato-Oncology, University Hospital Zurich, Zürich, Switzerland
| | - J L McQuade
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - P A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - L Zimmer
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - D B Johnson
- Vanderbilt University Medical Center, Nashville, USA
| | - A Arance
- Hospital Clinic Barcelona, Barcelona, Spain
| | - P Lorigan
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
| | - C Lebbé
- Dermatology Department, Université de Paris, AP-HP Saint-Louis Hospital, INSERM, Paris, France
| | - M S Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Westmead and Blacktown Hospitals, Sydney, Australia
| | | | - G V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia.
| | - A M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| |
Collapse
|