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van der Hiel B, Aalbersberg EA, van den Eertwegh AJM, de Wit-van der Veen LJ, Stokkel MPM, Lopez-Yurda M, Boellaard R, Kapiteijn EW, Hospers GAP, Aarts MJB, de Vos FYFL, Boers-Sonderen MJ, van der Veldt AAM, de Groot JWB, Haanen JBAG. The Predictive Value of FDG PET/CT for Determining Progression-Free Survival in Advanced Stage III-IV BRAF -Mutated Melanoma Patients Treated With Targeted Therapy-What Can Be Learned From Progression? Clin Nucl Med 2024; 49:138-145. [PMID: 38113329 DOI: 10.1097/rlu.0000000000004988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
PURPOSE The aims of this study were to investigate whether (early) PERCIST response monitoring with 18 F-FDG PET/CT is predictive for progression-free survival (PFS) in unresectable stage III or IV melanoma patients treated with BRAF/MEK inhibitor (MEKi) and to define dissemination patterns at progression with a lesion-based evaluation in direct comparison to baseline to improve our understanding of 18 F-FDG PET/CT during BRAF/MEKi. PATIENTS AND METHODS This prospective multicenter single-arm study included 70 patients with unresectable stage III/IV BRAF -mutated melanoma who underwent contrast-enhanced CT and 18 F-FDG PET/CT at baseline and 2 and 7 weeks during treatment with vemurafenib plus cobimetinib and at progression if possible. Tumor response assessment was done with RECIST1.1 and PERCIST. Follow-up PET/CT scans were visually compared with baseline to assess dissemination patterns. RESULTS Using RECIST1.1, PFS was not significantly different between the response groups ( P = 0.26). At 2 weeks, PERCIST median PFS was 15.7 months for patients with complete metabolic response (CMR) versus 8.3 months for non-CMR ( P = 0.035). The hazards ratio (HR) for progression/death in non-CMR versus CMR was 1.99 (95% confidence interval [CI], 1.03-3.84; P = 0.040) and 1.77 (95% CI, 0.91-3.43; P = 0.0935) when adjusting for lactate dehydrogenase (LDH). At 7 weeks, median PFS for PERCIST CMR was 16.7 months versus 8.5 months for non-CMR ( P = 0.0003). The HR for progression/death in the non-CMR group was significantly increased (HR, 2.94; 95% CI, 1.60-5.40; P = 0.0005), even when adjusting for LDH (HR, 2.65; 95% CI, 1.43-4.91; P = 0.0020). At week 7, 18 F-FDG PET/CT was false-positive in all 4 (6%) patients with new FDG-avid lesions but CMR of known metastases. When 18 F-FDG PET/CT was performed at progressive disease, 18/22 (82%) patients had progression of known metastases with or without new 18 F-FDG-avid lesions. CONCLUSIONS This study shows that PERCIST response assessment at week 7 is predictive for PFS, regardless of LDH. At 2 weeks, patients with CMR have longer PFS than patients with non-CMR, but different PET parameters should be investigated to further evaluate the added value of early 18 F-FDG PET/CT. Disease progression on PET/CT is predominated by progression of known metastases, and new 18 F-FDG-avid lesions during BRAF/MEKi are not automatically a sign of recurrent disease.
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Affiliation(s)
- Bernies van der Hiel
- From the Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek
| | - Else A Aalbersberg
- From the Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek
| | | | | | - Marcel P M Stokkel
- From the Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek
| | - Marta Lopez-Yurda
- Department of Biometrics, Netherlands Cancer Institute-Antoni van Leeuwenhoek
| | - Ronald Boellaard
- Department of Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam
| | - Ellen W Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Leiden
| | - Geke A P Hospers
- Department of Medical Oncology, University Medical Center Groningen, Groningen
| | - Maureen J B Aarts
- Department of Medical Oncology, GROW-School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht
| | - Filip Y F L de Vos
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht
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2
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de Meza MM, Blokx WAM, Bonenkamp HJ, Blank CU, Aarts MJB, van den Berkmortel FWPJ, Boers-Sonderen MJ, de Groot JWB, Haanen JB, Hospers GAP, Kapiteijn EW, van Not OJ, Piersma D, van Rijn RS, Stevense-Den Boer MA, van der Veldt AAM, Vreugdenhil G, van den Eertwegh AJM, Suijkerbuijk KPM, Wouters MWJM. Adjuvant treatment of in-transit melanoma: Narrowing the knowledge gap left by clinical trials. Int J Cancer 2023; 153:389-398. [PMID: 36843260 DOI: 10.1002/ijc.34485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 02/28/2023]
Abstract
Few clinical trials address efficacy of adjuvant systemic treatment in patients with in-transit melanoma (ITM). This study describes adjuvant systemic therapy of ITM patients beyond clinical trials. In this study, we included stage III adjuvant-treated melanoma patients registered in the nationwide Dutch Melanoma Treatment Registry between July 2018 and December 2020. Patients were divided into three groups: nodal disease only, ITM only and ITM and nodal disease. Recurrence patterns, recurrence-free survival (RFS) and overall survival (OS) at 12-months were analyzed. In our study population of 1037 patients, 66.8% had nodal disease only, 16.7% had ITM only and 16.2% had ITM with nodal disease. RFS at 12-months was comparable in the nodal only and ITM only group (72.2% vs70.1%, P = .97) but lower in ITM and nodal disease patients (57.8%; P = .01, P < .01). Locoregional metastases occurred as first recurrence in 38.9% nodal disease only, 71.9% of ITM-only and 44.0% of ITM and nodal disease patients. Distant recurrences occurred in 42.3%, 18.8% and 36.0%, respectively (P = .02). 12-months OS was not significantly different for nodal disease only patients compared with ITM-only (94.4% vs 97.6%, P = .06) but was significantly higher for ITM-only compared with ITM and nodal disease patients (97.6% vs 91.0%, P < .01). In conclusion, we showed that in the adjuvant setting, RFS rates in ITM-only patients are similar to non-ITM, though better than in ITM and nodal disease patients. Adjuvant-treated ITM-only patients less often experience distant recurrences and have a superior OS compared with ITM and nodal disease patients.
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Affiliation(s)
- Melissa M de Meza
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.,Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Willeke A M Blokx
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Han J Bonenkamp
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cristian U Blank
- Department of Medical Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maureen J B Aarts
- Department of Medical Oncology, GROW-School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Marye J Boers-Sonderen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - John B Haanen
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Geke A P Hospers
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ellen W Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Olivier J van Not
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Djura Piersma
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Rozemarijn S van Rijn
- Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | | | - Astrid A M van der Veldt
- Departments of Medical Oncology and Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gerard Vreugdenhil
- Department of Internal Medicine, Maxima Medical Center, Eindhoven, The Netherlands
| | - Alfons J M van den Eertwegh
- Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Michel W J M Wouters
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.,Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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3
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Blankenstein SA, Bonenkamp JJ, Aarts MJB, van den Berkmortel FWPJ, Blank CU, Blokx WAM, Boers-Sonderen MJ, van den Eertwegh AJM, Franken MG, de Groot JWB, Haanen JBAG, Hospers GAP, Kapiteijn EW, van Not OJ, Piersma D, van Rijn RS, Suijkerbuijk KPM, van der Veldt AAM, Vreugdenhil G, Westgeest HM, Wouters MWJM, van Akkooi ACJ. Is a History of Optimal Staging by Sentinel Lymph Node Biopsy in the Era Prior to Adjuvant Therapy Associated with Improved Outcome Once Melanoma Patients have Progressed to Advanced Disease? Ann Surg Oncol 2023; 30:573-586. [PMID: 36203067 DOI: 10.1245/s10434-022-12600-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 09/07/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Sentinel lymph node biopsy (SLNB) is important for staging in patients with primary cutaneous melanoma. Did having previously undergone SLNB also affect outcomes in patients once they have progressed to metastatic melanoma in the era prior to adjuvant therapy? METHODS Data were retrieved from the Dutch Melanoma Treatment Registry, a prospectively collected, nationwide database of patients with unresectable stage IIIC or IV (advanced) melanoma between 2012 and 2018. Melanoma-specific survival (MSS) was compared between patients with advanced cutaneous melanoma, previously treated with a wide local excision (WLE) or WLE combined with SLNB as initial treatment of their primary tumor. Cox regression analyses were used to analyze the influence of different variables on MSS. RESULTS In total, 2581 patients were included, of whom 1412 were treated with a WLE of the primary tumor alone and 1169 in whom this was combined with SLNB. At a median follow-up of 44 months from diagnosis of advanced melanoma, MSS was significantly longer in patients who had previously undergone SLNB {median 23 months (95% confidence interval [CI] 19-29) vs. 18 months (95% CI 15-20) for patients treated with WLE alone; p = 0.002}. However, multivariate Cox regression did not identify SLNB as an independent favorable prognostic factor for MSS after diagnosis of advanced melanoma. CONCLUSION Prior to the availability of adjuvant systemic therapy, once patients have unresectable stage IIIC or IV (advanced) melanoma, there was no difference in disease outcome for patients who were or were not previously staged with SLNB.
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Affiliation(s)
- Stephanie A Blankenstein
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
| | - Johannes J Bonenkamp
- Department of Surgical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Maureen J B Aarts
- Department of Medical Oncology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Christian U Blank
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Willeke A M Blokx
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marye J Boers-Sonderen
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Alfons J M van den Eertwegh
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Location VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Margreet G Franken
- Institute for Medical Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | | | - John B A G Haanen
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Geke A P Hospers
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Ellen W Kapiteijn
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Olivier J van Not
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.,Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Djura Piersma
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Rozemarijn S van Rijn
- Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | | | - Astrid A M van der Veldt
- Departments of Medical Oncology and Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gerard Vreugdenhil
- Department of Internal Medicine, Maxima Medical Center, Veldhoven, The Netherlands
| | - Hans M Westgeest
- Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands
| | - Michel W J M Wouters
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexander C J van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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4
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Blankenstein SA, Bonenkamp JJ, Aarts MJB, van den Berkmortel FWPJ, Blank CU, Blokx WAM, Boers-Sonderen MJ, van den Eertwegh AJM, Franken MG, de Groot JWB, Haanen JBAG, Hospers GAP, Kapiteijn EW, van Not OJ, Piersma D, van Rijn RS, Suijkerbuijk KPM, van der Veldt AAM, Vreugdenhil G, Westgeest HM, Wouters MWJM, van Akkooi ACJ. ASO Visual Abstract: Is a History of Optimal Staging by SLNB in the Era Prior to Adjuvant Therapy Associated with Improved Outcome Once Melanoma Patients have Progressed to Advanced Disease? Ann Surg Oncol 2023; 30:587-588. [PMID: 36319872 DOI: 10.1245/s10434-022-12719-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Stephanie A Blankenstein
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Johannes J Bonenkamp
- Department of Surgical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Maureen J B Aarts
- Department of Medical Oncology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Christian U Blank
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Willeke A M Blokx
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marye J Boers-Sonderen
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Alfons J M van den Eertwegh
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Location VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Margreet G Franken
- Institute for Medical Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | | | - John B A G Haanen
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Geke A P Hospers
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Ellen W Kapiteijn
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Olivier J van Not
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Djura Piersma
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Rozemarijn S van Rijn
- Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | | | - Astrid A M van der Veldt
- Departments of Medical Oncology and Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gerard Vreugdenhil
- Department of Internal Medicine, Maxima Medical Center, Veldhoven, The Netherlands
| | - Hans M Westgeest
- Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands
| | - Michel W J M Wouters
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexander C J van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
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5
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de Meza MM, Ismail RK, Rauwerdink D, van Not OJ, van Breeschoten J, Blokx WAM, de Boer A, van Dartel M, Hilarius DL, Ellebaek E, Bonenkamp HJ, Blank CU, Aarts MJB, van Akkooi ACJ, van den Berkmortel FWPJ, Boers-Sonderen MJ, de Groot JWB, Haanen JB, Hospers GAP, Kapiteijn EW, Piersma D, van Rijn RS, van der Veldt AAM, Vreugdenhil A, Westgeest HM, van den Eertwegh AJM, Suijkerbuijk KPM, Wouters MWJM. Adjuvant treatment for melanoma in clinical practice - Trial versus reality. Eur J Cancer 2021; 158:234-245. [PMID: 34600790 DOI: 10.1016/j.ejca.2021.08.044] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/16/2021] [Accepted: 08/28/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Little is known about outcomes of adjuvant-treated melanoma patients beyond the clinical trial setting. Since 2019, adjuvant-treated melanoma patients have been registered in the DMTR, a population-based registry to monitor the quality and safety of melanoma care in the Netherlands. This study aims to describe treatment patterns, relapse, and toxicity rates of adjuvant-treated melanoma patients beyond the clinical trial setting. METHODS Analyses were performed on adjuvant-treated melanoma patients included in the DMTR. Descriptive statistics were used to analyse patient-, and treatment characteristics. A baseline registration completeness analysis was performed, and an analysis on trial eligibility in clinical practice patients. Recurrence-free survival (RFS) at 12-months was estimated with the Kaplan-Meier method. RESULTS A total of 641 patients were treated with adjuvant anti-PD-1 therapy. RFS at 12-months was 70.6% (95% CI, 66.9-74.6) with a median follow-up of 12.8 months. Sex, stage of disease and Breslow thickness were associated with a higher hazard for RFS. Eighteen per cent of the anti-PD-1-treated patients developed grade ≥3 toxicity. Sixty-one per cent of patients prematurely discontinued anti-PD-1 therapy. CONCLUSION Adjuvant anti-PD-1 treatment of resected stage III/IV melanoma in daily practice showed slightly higher toxicity rates and more frequent premature discontinuation but similar RFS rates compared to trials.
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Affiliation(s)
- Melissa M de Meza
- Department of Biomedical Data Sciences, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333ZA, the Netherlands; Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066CX, the Netherlands; Scientific Bureau, Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, Leiden, 2333AA, the Netherlands.
| | - Rawa K Ismail
- Scientific Bureau, Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, Leiden, 2333AA, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Heidelberglaan 8, Utrecht, 3584CS, the Netherlands
| | - Daan Rauwerdink
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333ZA, the Netherlands
| | - Olivier J van Not
- Scientific Bureau, Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, Leiden, 2333AA, the Netherlands; Department of Medical Oncology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, the Netherlands
| | - Jesper van Breeschoten
- Scientific Bureau, Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, Leiden, 2333AA, the Netherlands; Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, De Boelelaan 1118, Amsterdam, 1081HZ, the Netherlands
| | - Willeke A M Blokx
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, the Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Heidelberglaan 8, Utrecht, 3584CS, the Netherlands; Medicines Evaluation Board, Graadt van Roggenweg 500, Utrecht, 3531AH, the Netherlands
| | - Maaike van Dartel
- Medicines Evaluation Board, Graadt van Roggenweg 500, Utrecht, 3531AH, the Netherlands
| | - Doranne L Hilarius
- Department of Pharmacy, Rode Kruis Ziekenhuis, Vondellaan 13, Beverwijk, 1942LE, the Netherlands
| | - Eva Ellebaek
- National Center for Cancer Immune Therapy, Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Borgmester Ib Juuls Vej 1, Herlev, 2730, Denmark
| | - Han J Bonenkamp
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, 6525GA, the Netherlands
| | - Christian U Blank
- Department of Medical Oncology and Immunology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066CX, the Netherlands
| | - Maureen J B Aarts
- Department of Medical Oncology, Maastricht University Medical Center, P. Debyelaan 25, Maastricht, 6229 HX, the Netherlands
| | - Alexander C J van Akkooi
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Heidelberglaan 8, Utrecht, 3584CS, the Netherlands
| | | | - Marye J Boers-Sonderen
- Department of Medical Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, 6525GA, the Netherlands
| | | | - John B Haanen
- Department of Medical Oncology and Immunology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066CX, the Netherlands
| | - Geke A P Hospers
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, 9713GZ, the Netherlands
| | - Ellen W Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333ZA, the Netherlands
| | - Djura Piersma
- Department of Internal Medicine, Medisch Spectrum Twente, Koningsplein 1, Enschede, 7512KZ, the Netherlands
| | - Roos S van Rijn
- Department of Internal Medicine, Medical Center Leeuwarden, Henri Dunantweg 2, Leeuwarden, 8934AD, the Netherlands
| | - Astrid A M van der Veldt
- Departments of Medical Oncology and Radiology and Nuclear Medicine, Erasmus Medical Center, 's-Gravendijkwal 230, Rotterdam, 3015CE, the Netherlands
| | - Art Vreugdenhil
- Department of Internal Medicine, Maxima Medical Center, De Run 4600, Eindhoven 5504DB, the Netherlands
| | - Hans M Westgeest
- Department of Internal Medicine, Amphia Hospital, Molengracht 21, Breda 4818CK, the Netherlands
| | - Alfons J M van den Eertwegh
- Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, De Boelelaan 1118, Amsterdam, 1081HZ, the Netherlands
| | - Karijn P M Suijkerbuijk
- Department of Medical Oncology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, the Netherlands
| | - Michel W J M Wouters
- Department of Biomedical Data Sciences, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333ZA, the Netherlands; Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066CX, the Netherlands; Scientific Bureau, Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, Leiden, 2333AA, the Netherlands
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6
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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.
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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.
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7
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Hoefsmit EP, Rozeman EA, Van TM, Dimitriadis P, Krijgsman O, Conway JW, Pires da Silva I, van der Wal JE, Ketelaars SLC, Bresser K, Broeks A, Kerkhoven RM, Reeves JW, Warren S, Kvistborg P, Scolyer RA, Kapiteijn EW, Peeper DS, Long GV, Schumacher TNM, Blank CU. Comprehensive analysis of cutaneous and uveal melanoma liver metastases. J Immunother Cancer 2020; 8:e001501. [PMID: 33262254 PMCID: PMC7713183 DOI: 10.1136/jitc-2020-001501] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [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: 11/15/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The profound disparity in response to immune checkpoint blockade (ICB) by cutaneous melanoma (CM) and uveal melanoma (UM) patients is not well understood. Therefore, we characterized metastases of CM and UM from the same metastatic site (liver), in order to dissect the potential underlying mechanism in differential response on ICB. METHODS Tumor liver samples from CM (n=38) and UM (n=28) patients were analyzed at the genomic (whole exome sequencing), transcriptional (RNA sequencing) and protein (immunohistochemistry and GeoMx Digital Spatial Profiling) level. RESULTS Comparison of CM and UM metastases from the same metastatic site revealed that, although originating from the same melanocyte lineage, CM and UM differed in somatic mutation profile, copy number profile, tumor mutational burden (TMB) and consequently predicted neoantigens. A higher melanin content and higher expression of the melanoma differentiation antigen MelanA was observed in liver metastases of UM patients. No difference in B2M and human leukocyte antigen-DR (HLA-DR) expression was observed. A higher expression of programmed cell death ligand 1 (PD-L1) was found in CM compared with UM liver metastases, although the majority of CM and UM liver metastases lacked PD-L1 expression. There was no difference in the extent of immune infiltration observed between CM and UM metastases, with the exception of a higher expression of CD163 (p<0.0001) in CM liver samples. While the extent of immune infiltration was similar for CM and UM metastases, the ratio of exhausted CD8 T cells to cytotoxic T cells, to total CD8 T cells and to Th1 cells, was significantly higher in UM metastases. CONCLUSIONS While TMB was different between CM and UM metastases, tumor immune infiltration was similar. The greater dependency on PD-L1 as an immune checkpoint in CM and the identification of higher exhaustion ratios in UM may both serve as explanations for the difference in response to ICB. Consequently, in order to improve current treatment for metastatic UM, reversal of T cell exhaustion beyond programmed cell death 1 blockade should be considered.
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Affiliation(s)
- Esmee P Hoefsmit
- Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Elisa A Rozeman
- Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Trieu My Van
- Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Petros Dimitriadis
- Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Oscar Krijgsman
- Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jordan W Conway
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
| | | | | | - Steven L C Ketelaars
- Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Kaspar Bresser
- Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Annegien Broeks
- Core Facility and Biobanking, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ron M Kerkhoven
- NKI Genomics Core Facility, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Sarah Warren
- NanoString Technologies Inc, Seattle, Washington, USA
| | - Pia Kvistborg
- Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Richard A Scolyer
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and New South Wales Health Pathology, Sydney, New South Wales, Australia
| | - Ellen W Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Daniel S Peeper
- Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Oncode Institute, Utrecht, The Netherlands
| | - Georgina V Long
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
- Royal North Shore Hospital, Melanoma Institute Australia, and The University of Sydney, Wollstonecraft, New South Wales, Australia
| | - Ton N M Schumacher
- Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Oncode Institute, Utrecht, The Netherlands
| | - Christian U Blank
- Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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8
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Berends AMA, van der Horst-Schrivers ANA, Oosting SF, Kapiteijn EW, de Groot JWB, Links TP. Hypocalcemia induced by tyrosine kinase inhibitors: targeted treatment with 'untargeted' side effects. Acta Oncol 2020; 59:726-729. [PMID: 32056474 DOI: 10.1080/0284186x.2020.1726455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Annika M. A. Berends
- Department of Endocrinology, Division of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Sjoukje F. Oosting
- Department of Medical Oncology, Division of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Ellen W. Kapiteijn
- Department of Medical Oncology, Division of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Thera P. Links
- Department of Endocrinology, Division of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
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9
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Brouwer NJ, Marinkovic M, Jochems A, Kapiteijn EW, van Duinen SG, Haeseker BI, Jager MJ, Luyten GPM. Conjunctival Metastasis of a Cutaneous Melanoma. Ocul Oncol Pathol 2017; 4:107-111. [PMID: 30320090 DOI: 10.1159/000479114] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 06/30/2017] [Indexed: 02/03/2023] Open
Abstract
Purpose To report a patient who presented with a conjunctival tumour as a first sign of distant metastasis of cutaneous melanoma. The patient was treated successfully with BRAF/MEK-inhibitors and anti-PD-1 antibodies. Methods Clinical and histopathological examination of the conjunctival lesion. Results A 74-year-old man was referred to our hospital with a pigmented conjunctival tumour, 5 months after having been diagnosed with cutaneous melanoma on his right scapula with loco-regional axillary lymph node metastases. The conjunctival lesion was excised and showed a BRAF V600E mutation. Histopathology showed a melanoma with characteristics suspicious for metastasis, as the lesion did not have a relation with the overlying epithelium. Systemic screening showed multiple distant metastases of the cutaneous melanoma in spleen, liver, and bone. Systemic treatment with the combination of a BRAF-inhibitor (dabrafenib) and MEK-inhibitor (trametinib) was started and followed by a switch to an anti-PD-1 antibody (pembrolizumab). Twenty-two months later, the patient is alive and in good clinical health. Conclusion Conjunctival metastases of cutaneous melanoma may mimic primary conjunctival melanoma. A good medical history and systemic work-up are required to differentiate these diseases. Identification of the proper diagnosis including mutation analysis is crucial, allowing patients to benefit from newly introduced treatment strategies for metastatic cutaneous melanoma.
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Affiliation(s)
- Niels J Brouwer
- Department of Ophthalmology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Marina Marinkovic
- Department of Ophthalmology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Anouk Jochems
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ellen W Kapiteijn
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sjoerd G van Duinen
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Barbara I Haeseker
- Department of Department of Ophthalmology, Alrijne Hospital, Leiden, The Netherlands
| | - Martine J Jager
- Department of Ophthalmology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Gregorius P M Luyten
- Department of Ophthalmology, Leiden University Medical Centre, Leiden, The Netherlands
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10
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van Dijk EHC, Duits DEM, Versluis M, Luyten GPM, Bergen AAB, Kapiteijn EW, de Lange MJ, Boon CJF, van der Velden PA. Loss of MAPK Pathway Activation in Post-Mitotic Retinal Cells as Mechanism in MEK Inhibition-Related Retinopathy in Cancer Patients. Medicine (Baltimore) 2016; 95:e3457. [PMID: 27149444 PMCID: PMC4863761 DOI: 10.1097/md.0000000000003457] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Recently, treatment with MEK inhibitors has been shown to be an effective treatment option for metastatic melanoma. Treatment efficacy is dependent on inhibition of MAPK-related melanoma proliferation. However, targeting of MEK can be accompanied by a time-dependent and reversible serous retinopathy of unknown origin.We analyzed the molecular mechanism by which the MEK inhibitor binimetinib may lead to retinopathy, using neuroretina and cell models of retinal pigment epithelium (RPE).Binimetinib inhibited the MAPK pathway while discontinuation of treatment resulted in reactivation. However, cell proliferation was not inhibited correspondingly during binimetinib treatment of ARPE19 cells. Remarkably, post-mitotic neuroretinal tissue displayed a strong MAPK activation that was lost after binimetinib treatment.We propose that binimetinib-associated retinopathy is correlated with inhibition of the MAPK pathway in multiple retinal components. Retinal cells are able to regain the activation after binimetinib treatment, mimicking the reversibility of the retinopathy. As most retinal cells are nonregenerating, other mechanisms than stimulation of proliferation must be involved.
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Affiliation(s)
- Elon H C van Dijk
- From the Department of Ophthalmology (EHCVD, DEMD, MV, GPML, MJDL, CJFB, PAVDV), Leiden University Medical Center, Leiden; Department of Ophthalmology (AABB); Department of Clinical Genetics (AABB), Academic Medical Center; Department of Clinical and Molecular Ophthalmogenetics (AABB), The Netherlands Institute for Neurosciences/Royal Netherlands Academy of Arts and Sciences, Amsterdam; and Department of Medical Oncology (EWK), Leiden University Medical Center, Leiden, the Netherlands
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Kelderman S, Heemskerk B, van Tinteren H, van den Brom RRH, Hospers GAP, van den Eertwegh AJM, Kapiteijn EW, de Groot JWB, Soetekouw P, Jansen RL, Fiets E, Furness AJS, Renn A, Krzystanek M, Szallasi Z, Lorigan P, Gore ME, Schumacher TNM, Haanen JBAG, Larkin JMG, Blank CU. Lactate dehydrogenase as a selection criterion for ipilimumab treatment in metastatic melanoma. Cancer Immunol Immunother 2014; 63:449-58. [PMID: 24609989 PMCID: PMC11029318 DOI: 10.1007/s00262-014-1528-9] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 02/22/2014] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Ipilimumab, a cytotoxic T lymphocyte-associated antigen-4 blocking antibody, has improved overall survival (OS) in metastatic melanoma in phase III trials. However, about 80 % of patients fail to respond, and no predictive markers for benefit from therapy have been identified. We analysed a 'real world' population of patients treated with ipilimumab to identify markers for treatment benefit. METHODS Patients with advanced cutaneous melanoma were treated in the Netherlands (NL) and the United Kingdom (UK) with ipilimumab at 3 mg/kg. Baseline characteristics and peripheral blood parameters were assessed, and patients were monitored for the occurrence of adverse events and outcomes. RESULTS A total of 166 patients were treated in the Netherlands. Best overall response and disease control rates were 17 and 35 %, respectively. Median follow-up was 17.9 months, with a median progression-free survival of 2.9 months. Median OS was 7.5 months, and OS at 1 year was 37.8 % and at 2 years was 22.9 %. In a multivariate model, baseline serum lactate dehydrogenase (LDH) was demonstrated to be the strongest predictive factor for OS. These findings were validated in an independent cohort of 64 patients from the UK. CONCLUSION In both the NL and UK cohorts, long-term benefit of ipilimumab treatment was unlikely for patients with baseline serum LDH greater than twice the upper limit of normal. In the absence of prospective data, clinicians treating melanoma may wish to consider the data presented here to guide patient selection for ipilimumab therapy.
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Affiliation(s)
- Sander Kelderman
- Netherlands Cancer Institute NKI-AVL, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Bianca Heemskerk
- Netherlands Cancer Institute NKI-AVL, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Harm van Tinteren
- Netherlands Cancer Institute NKI-AVL, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | | | - Geke A. P. Hospers
- University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | | | - Ellen W. Kapiteijn
- Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | | | - Patricia Soetekouw
- Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Rob L. Jansen
- Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Edward Fiets
- Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, The Netherlands
| | | | - Alexandra Renn
- Royal Marsden Hospital, 197 Fulham Road, London, SW3 6JJ UK
| | - Marcin Krzystanek
- Technical University of Denmark, Anker Engelunds Vej 1, 2800 Kongens Lyngby, Denmark
| | - Zoltan Szallasi
- Technical University of Denmark, Anker Engelunds Vej 1, 2800 Kongens Lyngby, Denmark
| | - Paul Lorigan
- Christie Hospital, 550 Wilmslow Road, Manchester, M20 4BX UK
| | - Martin E. Gore
- Royal Marsden Hospital, 197 Fulham Road, London, SW3 6JJ UK
| | - Ton N. M. Schumacher
- Netherlands Cancer Institute NKI-AVL, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - John B. A. G. Haanen
- Netherlands Cancer Institute NKI-AVL, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | | | - Christian U. Blank
- Netherlands Cancer Institute NKI-AVL, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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