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Kähler KC, Gutzmer R, Meier F, Zimmer L, Heppt M, Gesierich A, Thoms KM, Utikal J, Hassel JC, Loquai C, Pföhler C, Heinzerling L, Kaatz M, Göppner D, Pflugfelder A, Bohne AS, Satzger I, Reinhardt L, Placke JM, Schadendorf D, Ugurel S. Early Exanthema Upon Vemurafenib Plus Cobimetinib Is Associated With a Favorable Treatment Outcome in Metastatic Melanoma: A Retrospective Multicenter DeCOG Study. Front Oncol 2021; 11:672172. [PMID: 34109122 PMCID: PMC8183381 DOI: 10.3389/fonc.2021.672172] [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] [Received: 02/25/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background The combination of BRAF and MEK inhibitors has become standard of care in the treatment of metastatic BRAF V600-mutated melanoma. Clinical factors for an early prediction of tumor response are rare. The present study investigated the association between the development of an early exanthema induced by vemurafenib or vemurafenib plus cobimetinib and therapy outcome. Methods This multicenter retrospective study included patients with BRAF V600-mutated irresectable AJCC-v8 stage IIIC/D to IV metastatic melanoma who received treatment with vemurafenib (VEM) or vemurafenib plus cobimetinib (COBIVEM). The development of an early exanthema within six weeks after therapy start and its grading according to CTCAEv4.0 criteria was correlated to therapy outcome in terms of best overall response, progression-free (PFS), and overall survival (OS). Results A total of 422 patients from 16 centers were included (VEM, n=299; COBIVEM, n=123). 20.4% of VEM and 43.1% of COBIVEM patients developed an early exanthema. In the VEM cohort, objective responders (CR/PR) more frequently presented with an early exanthema than non-responders (SD/PD); 59.0% versus 38.7%; p=0.0027. However, median PFS and OS did not differ between VEM patients with or without an early exanthema (PFS, 6.9 versus 6.0 months, p=0.65; OS, 11.0 versus 12.4 months, p=0.69). In the COBIVEM cohort, 66.0% of objective responders had an early exanthema compared to 54.3% of non-responders (p=0.031). Median survival times were significantly longer for patients who developed an early exanthema compared to patients who did not (PFS, 9.7 versus 5.6 months, p=0.013; OS, not reached versus 11.6 months, p=0.0061). COBIVEM patients with a mild early exanthema (CTCAEv4.0 grade 1-2) had a superior survival outcome as compared to COBIVEM patients with a severe (CTCAEv4.0 grade 3-4) or non early exanthema, respectively (p=0.047). This might be caused by the fact that 23.6% of patients with severe exanthema underwent a dose reduction or discontinuation of COBIVEM compared to only 8.9% of patients with mild exanthema. Conclusions The development of an early exanthema within 6 weeks after treatment start indicates a favorable therapy outcome upon vemurafenib plus cobimetinib. Patients presenting with an early exanthema should therefore be treated with adequate supportive measures to provide that patients can stay on treatment.
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Affiliation(s)
- Katharina C Kähler
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Ralf Gutzmer
- Department of Dermatology, University Hospital Hannover, Hannover, Germany
| | - Friedegrund Meier
- Skin Cancer Center, National Center for Tumor Diseases, University Cancer Centre Dresden, Dresden, Germany.,Department of Dermatology, TU Dresden, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, German Cancer Consortium (DKTK), Essen, Germany
| | - Markus Heppt
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Anja Gesierich
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | - Kai-Martin Thoms
- Department of Dermatology, University Medical Center Göttingen, Göttingen, Germany
| | - Jochen Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - Jessica C Hassel
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Carmen Loquai
- Department of Dermatology, University Hospital Mainz, Mainz, Germany
| | - Claudia Pföhler
- Department of Dermatology, University Hospital Homburg, Homburg, Germany
| | - Lucie Heinzerling
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Department of Dermatology and Allergology, Ludwig-Maximilian University, München, Germany
| | - Martin Kaatz
- Department of Dermatology, SRH Waldklinikum, Gera, Germany
| | - Daniela Göppner
- Department of Dermatology, University Hospital Giessen, Gießen, Germany
| | | | - Ann-Sophie Bohne
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Imke Satzger
- Department of Dermatology, University Hospital Hannover, Hannover, Germany
| | - Lydia Reinhardt
- Skin Cancer Center, National Center for Tumor Diseases, University Cancer Centre Dresden, Dresden, Germany.,Department of Dermatology, TU Dresden, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jan-Malte Placke
- Department of Dermatology, University Hospital Essen, German Cancer Consortium (DKTK), Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, German Cancer Consortium (DKTK), Essen, Germany
| | - Selma Ugurel
- Department of Dermatology, University Hospital Essen, German Cancer Consortium (DKTK), Essen, Germany
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Lehner GM, Schacht V, Angela Y, Satzger I, Gutzmer R. Erfolgreiche Behandlung eines metastasierenden Melanoms mit Talimogen laherparepvec (T‐VEC) bei einer lebertransplantierten Patientin. J Dtsch Dermatol Ges 2020; 18:1495-1497. [PMID: 33373132 DOI: 10.1111/ddg.14284_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Gabriele M Lehner
- Klinik für Dermatologie, Allergologie und Venerologie, Hauttumorzentrum Hannover (HTZH), Medizinische Hochschule Hannover
| | - Vivien Schacht
- Klinik für Dermatologie, Allergologie und Venerologie, Hauttumorzentrum Hannover (HTZH), Medizinische Hochschule Hannover
| | - Yenny Angela
- Klinik für Dermatologie, Allergologie und Venerologie, Hauttumorzentrum Hannover (HTZH), Medizinische Hochschule Hannover
| | - Imke Satzger
- Klinik für Dermatologie, Allergologie und Venerologie, Hauttumorzentrum Hannover (HTZH), Medizinische Hochschule Hannover
| | - Ralf Gutzmer
- Klinik für Dermatologie, Allergologie und Venerologie, Hauttumorzentrum Hannover (HTZH), Medizinische Hochschule Hannover
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Lehner GM, Schacht V, Angela Y, Satzger I, Gutzmer R. Successful treatment of a metastatic melanoma with Talimogen laherparepvec (T-VEC) in a liver transplant patient. J Dtsch Dermatol Ges 2020; 18:1495-1497. [PMID: 32985132 DOI: 10.1111/ddg.14284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Gabriele M Lehner
- Klinik für Dermatologie, Allergologie und Venerologie, Hauttumorzentrum Hannover (HTZH), Medizinische Hochschule Hannover
| | - Vivien Schacht
- Klinik für Dermatologie, Allergologie und Venerologie, Hauttumorzentrum Hannover (HTZH), Medizinische Hochschule Hannover
| | - Yenny Angela
- Klinik für Dermatologie, Allergologie und Venerologie, Hauttumorzentrum Hannover (HTZH), Medizinische Hochschule Hannover
| | - Imke Satzger
- Klinik für Dermatologie, Allergologie und Venerologie, Hauttumorzentrum Hannover (HTZH), Medizinische Hochschule Hannover
| | - Ralf Gutzmer
- Klinik für Dermatologie, Allergologie und Venerologie, Hauttumorzentrum Hannover (HTZH), Medizinische Hochschule Hannover
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Gutzmer R, Eigentler T, Mohr P, Weichenthal M, Dücker P, Gebhardt C, Göppner D, Haferkamp S, Kähler K, Meier F, Pföhler C, Satzger I, Sickmann T, Sindrilaru A, Terheyden P, Ugurel S, Ulrich J, Utikal J, Weishaupt C, Schadendorf D. 1104P Nivolumab (NIVO) monotherapy or combination therapy with ipilimumab (NIVO+IPI) in advanced melanoma patients with brain metastases: Real-world evidence from the German non-interventional study NICO. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Satzger I, Leiter U, Gräger N, Keim U, Garbe C, Gutzmer R. Melanoma-specific survival in patients with positive sentinel lymph nodes: Relevance of sentinel tumor burden. Eur J Cancer 2019; 123:83-91. [DOI: 10.1016/j.ejca.2019.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/05/2019] [Accepted: 07/10/2019] [Indexed: 11/28/2022]
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Möhn N, Beutel G, Gutzmer R, Ivanyi P, Satzger I, Skripuletz T. Neurological Immune Related Adverse Events Associated with Nivolumab, Ipilimumab, and Pembrolizumab Therapy-Review of the Literature and Future Outlook. J Clin Med 2019; 8:jcm8111777. [PMID: 31653079 PMCID: PMC6912719 DOI: 10.3390/jcm8111777] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 12/11/2022] Open
Abstract
Immune checkpoint inhibitor (ICI) therapy has revolutionized the management of various cancers with previously poor prognosis. Despite its great efficacy, the therapy is associated with a wide spectrum of immune-related adverse events (irAE) including neurological symptoms which can affect all parts of the central and peripheral nervous system. Even though these events are rare, they are of high relevance as the rate of residual symptoms or even fatal outcomes is remarkable. To provide a detailed overview of neurological adverse events associated with immune checkpoint-inhibitor therapy we conducted a literature search. While focusing on ipilimumab, nivolumab, and pembrolizumab therapy, all available case reports as well as larger case series and clinical trials have been considered. Eighty-two case reports about checkpoint-inhibitor therapy induced symptoms of the peripheral nervous system have been published, while only 43 case reports addressed central nervous system abnormalities. The frequency of immune checkpoint-inhibitor therapy inducing neurological adverse events is about 1% in larger studies. Especially neuromuscular adverse events exhibit distinct clinical and diagnostic characteristics. Additionally, several affected patients presented with overlap-syndromes, which means that symptoms and diagnostic findings indicating myositis, myasthenia gravis, and neuropathy were present in one individual patient at the same time. Thus, neurological and particularly neuromuscular adverse events of immune checkpoint-inhibitor therapy may constitute a new disease entity.
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Affiliation(s)
- Nora Möhn
- Department of Neurology, Hannover Medical School, Hannover 30625, Germany;
- Center for Immuno-Oncology (IOZ) Hannover Medical School, Hannover 30625, Germany; (G.B.); (R.G.); (P.I.)
| | - Gernot Beutel
- Center for Immuno-Oncology (IOZ) Hannover Medical School, Hannover 30625, Germany; (G.B.); (R.G.); (P.I.)
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover 30625, Germany
| | - Ralf Gutzmer
- Center for Immuno-Oncology (IOZ) Hannover Medical School, Hannover 30625, Germany; (G.B.); (R.G.); (P.I.)
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hannover Medical School, Hannover 30625, German
| | - Philipp Ivanyi
- Center for Immuno-Oncology (IOZ) Hannover Medical School, Hannover 30625, Germany; (G.B.); (R.G.); (P.I.)
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover 30625, Germany
| | - Imke Satzger
- Center for Immuno-Oncology (IOZ) Hannover Medical School, Hannover 30625, Germany; (G.B.); (R.G.); (P.I.)
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hannover Medical School, Hannover 30625, German
| | - Thomas Skripuletz
- Department of Neurology, Hannover Medical School, Hannover 30625, Germany;
- Center for Immuno-Oncology (IOZ) Hannover Medical School, Hannover 30625, Germany; (G.B.); (R.G.); (P.I.)
- Correspondence: ; Tel.: +49-511-532-3816; Fax: +49-511-532-3115
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7
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Kanaki T, Stang A, Gutzmer R, Zimmer L, Chorti E, Sucker A, Ugurel S, Hadaschik E, Gräger NS, Satzger I, Schadendorf D, Livingstone E. Impact of American Joint Committee on Cancer 8th edition classification on staging and survival of patients with melanoma. Eur J Cancer 2019; 119:18-29. [PMID: 31401470 DOI: 10.1016/j.ejca.2019.06.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 05/19/2019] [Revised: 06/17/2019] [Accepted: 06/21/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The American Joint Committee on Cancer (AJCC) 8th staging system introduced several revisions. To assess the impact of the 8th edition American Joint Committee on Cancer (AJCC8) staging system on subgrouping and survival, patients with melanoma from two tertiary skin cancer centres were classified according to both the 7th edition American Joint Committee on Cancer (AJCC7) and AJCC8. METHODS A total of 1948 patients aged ≥18 years with cutaneous melanoma stage II-IV were included. The impact of sex and age on reclassification was assessed by log binomial models. The inverse probability of censoring weighting method was used to compute ROC curves from time-to-event data to assess the discriminatory ability of AJCC7 and AJCC8. Melanoma-specific survival (MSS) and overall survival (OS) were calculated, and age- and sex-adjusted MSS hazard ratios were estimated using Cox proportional hazards models. RESULTS Of all, 23.5% of patients were assigned a different subgroup when classified according to AJCC8. Owing to upshifting to stage IIIC (AJCC7 24.8% vs. AJCC8 50.8%), patient numbers of stages IIIA and IIIB decreased from 28.7% to 16.2% and 46.5% to 28.3%. The prediction accuracy for AJCC7 and AJCC8 was comparable (integrated time-dependent area under the curve [AUC] of 0.75 and 0.74, respectively). Five-year MSS of IIB and IIC AJCC8 was poor and lower than that of IIIA AJCC8 (80%, 67% and 89%, respectively). Compared to results of the International Melanoma Database and Discovery Platform, 5-year MSS was 10-15% points lower for stages IIC, IIIB and IIIC. CONCLUSIONS Upshifting affects primarily stage III subgroups, while effects in stage II are minor. Stage IIB/C (AJCC8) patients have 67-80% MSS and should be considered for adjuvant treatment, while in stage IIIA, the indication of adjuvant treatment is questionable.
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Affiliation(s)
- Theodora Kanaki
- Department of Dermatology, University Hospital Essen, Essen, Germany and German Cancer Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreas Stang
- Center of Clinical Epidemiology, C/o Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Ralf Gutzmer
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hannover Medical School
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany and German Cancer Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eleftheria Chorti
- Department of Dermatology, University Hospital Essen, Essen, Germany and German Cancer Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Antje Sucker
- Department of Dermatology, University Hospital Essen, Essen, Germany and German Cancer Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Selma Ugurel
- Department of Dermatology, University Hospital Essen, Essen, Germany and German Cancer Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eva Hadaschik
- Department of Dermatology, University Hospital Essen, Essen, Germany and German Cancer Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nikolai S Gräger
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hannover Medical School
| | - Imke Satzger
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hannover Medical School
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, Essen, Germany and German Cancer Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elisabeth Livingstone
- Department of Dermatology, University Hospital Essen, Essen, Germany and German Cancer Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
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8
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Angela Y, Haferkamp S, Weishaupt C, Ugurel S, Becker JC, Oberndörfer F, Alar V, Satzger I, Gutzmer R. Combination of denosumab and immune checkpoint inhibition: experience in 29 patients with metastatic melanoma and bone metastases. Cancer Immunol Immunother 2019; 68:1187-1194. [PMID: 31187176 PMCID: PMC11028174 DOI: 10.1007/s00262-019-02353-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 06/03/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND PD-1 inhibition (PD-1i) is the standard of care in melanoma and other malignancies. In patients with bone metastases of solid tumors, the monoclonal antibody denosumab directed against RANKL is approved for the prevention of skeletal-related events. However, RANKL is not only relevant in osteoclastogenesis, but also has immunological effects. Hence, we aimed at investigating, whether the combination of PD-1i and denosumab produces synergistic effects in metastatic melanoma treatment. METHODS We retrospectively collected and analyzed clinical data of metastatic melanoma patients with bone metastases, who received PD-1i and denosumab therapy. RESULTS 29 patients were identified with a median age of 60.7 years: 20 were male and 9 were female. 20 patients (69%) were in stage IV M1c and 9 (31%) in stage IV M1d; 52% had an increased serum LDH. 24 patients (83%) received PD-1i as first-line therapy and five patients (17%) as second- or third-line therapy. 13 patients received the triple combination nivolumab, ipilimumab and denosumab (N + I+D), 16 patients received PD-1i and denosumab (PD-1i + D). Within a median follow-up time of 19.8 months, 17 patients progressed with a median time to progression of 6 months. The objective response rate was 54% in the N + I + D group and 50% in the PD-1i + D group. Recalcification of bone metastases was radiologically observed in 18 (62%) patients. No unexpected treatment-related adverse events emerged. CONCLUSIONS The combination therapy of metastatic melanoma with PD-1i and denosumab was feasible without unexpected safety issues and showed a promising efficacy signal. Further investigation in prospective studies is needed.
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Affiliation(s)
- Yenny Angela
- Department of Dermatology and Allergy, Skin Cancer Center Hannover, Medizinische Hochschule Hannover, Carl Neuberg Str. 1, 30625, Hannover, Germany.
| | | | | | - Selma Ugurel
- Department of Dermatology, University of Duisburg-Essen, Essen, Germany
| | - Jürgen C Becker
- Department of Dermatology, University of Duisburg-Essen, Essen, Germany
- Translational Skin Cancer Research (TSCR), German Cancer Consortium (DKTK), Essen/Düsseldorf, Germany
| | - Florian Oberndörfer
- Department of Dermatology and Allergy, Skin Cancer Center Hannover, Medizinische Hochschule Hannover, Carl Neuberg Str. 1, 30625, Hannover, Germany
| | - Vesna Alar
- Department of Dermatology and Allergy, Skin Cancer Center Hannover, Medizinische Hochschule Hannover, Carl Neuberg Str. 1, 30625, Hannover, Germany
| | - Imke Satzger
- Department of Dermatology and Allergy, Skin Cancer Center Hannover, Medizinische Hochschule Hannover, Carl Neuberg Str. 1, 30625, Hannover, Germany
| | - Ralf Gutzmer
- Department of Dermatology and Allergy, Skin Cancer Center Hannover, Medizinische Hochschule Hannover, Carl Neuberg Str. 1, 30625, Hannover, Germany
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Weichenthal M, Ugurel S, Leiter UM, Satzger I, Kähler KC, Welzel J, Pföhler C, Feldmann-Böddeker I, Meier FE, Terheyden P, Haferkamp S, Herbst R, Ulrich J, Utikal J, Kreuter A, Gutzmer R, Schadendorf D, Mohr P. Salvage therapy after failure from anti-PD-1 single agent treatment: A Study by the German ADOReg melanoma registry. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9505] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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
9505 Background: In melanoma, potential benefits of therapies after PD-1 inhibitor failure, including those BRAF positive patients who have already received combined BRAF-/MEK inhibitors before anti PD-1 are poorly defined. We therefore analyzed the treatment patterns and outcome of systemic therapies for patients after anti-PD-1 failure. Methods: From the ADOReg registry, patients fulfilling the following inclusion criteria were consecutively included until a number of 200 cases was reached. 1) Ipilimumab naive patients with unresectable metastatic cutaneous or mucosal melanoma. 2) Failure from treatment with a single agent anti PD-1 antibody. 3) Known BRAF status and, in case of BRAF-V600 mutation, BRAF-/MEK-inhibitor treatment prior to anti PD-1 treatment. 4) Consecutive systemic treatment started within a maximum of 6 months after anti PD-1 failure. Objectives: Rate of objective remissions (ORR), disease control (DCR), survival (OS), tolerability and disease patterns correlated to the use of different treatments after PD-1 treatment failure in real-life conditions in Germany. Results: In total 23.5 % of the patients received ipilimumab single agent, 38.5 % received the combination of ipilimumab and nivolumab (Ipi/Nivo), and the remaining various regimens. (Table) Ipi/Nivo resulted in an ORR significantly higher than for Ipi alone (p=0.02). In 18 patients receiving BRAF-/MEK inhibitor re-challenge, ORR was comparable to Ipi/Nivo. Conventional Chemotherapy was still in frequent use (dacarbazine n =33; other n=17), but response rates were low (ORR 6%). Some remission were also achieved by use of talimogene laherparepvec (n=2 out of 4). Conclusions: Treatment patterns of patients after anti-PD-1 failure differ remarkably. Although lower than reported in treatment naive patients, the combination of Ipilimumab and Nivolumab appeared favorable as compared to all other regimens, except for BRAF-/MEK inhibitor re-challenge which produced similar remission rates. Still, chemotherapies including dacarbazine are in clinical practice, though giving only poor outcome. [Table: see text]
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Affiliation(s)
| | - Selma Ugurel
- Department of Dermatology, University Hospital Erlangen and Department of Dermatology, University of Würzburg, Essen, Germany
| | - Ulrike M. Leiter
- Department of Dermatooncology, University of Tübingen, Tuebingen, Germany
| | | | | | | | - Claudia Pföhler
- Department of Dermatology, Saarland University Medical Center, Homburg/Saar, Germany
| | | | | | | | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | | | - Jens Ulrich
- Medical Center Quedlinburg, Quedlinburg, Germany
| | - Jochen Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), and Department of Dermatology, Venerology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - Alexander Kreuter
- HELIOS St. Elisabeth Hospital Oberhausen, University Witten/Herdecke, Oberhausen, Germany
| | - Ralf Gutzmer
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Dirk Schadendorf
- Universitaetsklinikum Essen & German Cancer Consortium, Essen, Germany
| | - Peter Mohr
- Elbe Kliniken Buxtehude, Buxtehude, Germany
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Schaper-Gerhardt K, Walter A, Schmitz-Rode C, Satzger I, Gutzmer R. The mTOR-inhibitor Sirolimus decreases the cyclosporine-induced expression of the oncogene ATF3 in human keratinocytes. J Dermatol Sci 2018; 92:172-180. [PMID: 30220530 DOI: 10.1016/j.jdermsci.2018.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 05/02/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Due to their immunosuppressive therapy, organtransplant recipients (OTRs) exhibit a high incidence for the development of cutaneous squamous cell carcinoma (cSCC). Randomized studies of kidney-transplanted patients indicate a significant lower susceptibility for cSCC among patients receiving the mTOR-inhibitor Sirolimus, compared to patients without mTOR-regimen. The exact mechanism, how mTOR inhibition affects keratinocyte carcinogenesis remains unclear. OBJECTIVE Our aim was to investigate the impact of Sirolimus on the expression level of the oncogene ATF3, which is involved in the development and progression of cSCC. METHODS We incubated human keratinocytes, cSSC cell lines and 3D skin equivalents with Sirolimus, exposed the cells to calcineurin inhibitors (CNI) and UVA-radiation and measured the expression level of ATF3 by real-time PCR and western blot. RESULTS We show that Sirolimus downregulates the expression of ATF3 induced by cyclosporine or cyclosporine plus UV-radiation in keratinocytes. In line with this we demonstrate a decrease in ATF3 expression, by incubating 3D skin equivalents with Sirolimus prior to cyclosporine and UV-light. However, Sirolimus has no significant impact on the ATF3 expression levels of cyclosporine stimulated cSCC cell lines. CONCLUSION Taken together, our study demonstrates that Sirolimus downregulates the CNI or UV-induced ATF3 expression in human keratinocytes, which could be a potential molecular mechanism how Sirolimus reduces cSCC in OTRs. The lack of ATF3 suppression by Sirolimus in cSCC cell lines fits to observations from clinical studies which demonstrated a clinical benefit from the switch to a mTOR-regimen in patients with low tumor burden in early stage of disease.
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Affiliation(s)
- Katrin Schaper-Gerhardt
- Skin Cancer Center Hannover, Department for Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
| | - Antje Walter
- Skin Cancer Center Hannover, Department for Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Christina Schmitz-Rode
- Skin Cancer Center Hannover, Department for Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Imke Satzger
- Skin Cancer Center Hannover, Department for Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Ralf Gutzmer
- Skin Cancer Center Hannover, Department for Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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11
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Satzger I, Ivanyi P, Länger F, Kreipe HH, Schaper-Gerhardt K, Beutel G, Cornberg M, Gutzmer R. Treatment-related hemophagocytic lymphohistiocytosis secondary to checkpoint inhibition with nivolumab plus ipilimumab. Eur J Cancer 2018; 93:150-153. [DOI: 10.1016/j.ejca.2018.01.063] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 01/03/2018] [Indexed: 11/29/2022]
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12
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DeTemple V, Satzger I, Walter A, Schaper K, Gutzmer R. Effects of mammalian target of rapamycin inhibitors on cytokine production and differentiation in keratinocytes. Exp Dermatol 2018; 25:775-82. [PMID: 27194247 DOI: 10.1111/exd.13079] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 05/05/2016] [Indexed: 12/15/2022]
Abstract
Risk factors for the development of cutaneous squamous cell carcinoma (cSCC) include ultraviolet radiation and immunosuppression. In particular, solid organ transplant recipients show a high incidence of cSCC, depending on the immunosuppressive regimen. While azathioprine or calcineurin inhibitors increase the risk of cSCC development, mammalian target of rapamycin (mTOR) inhibitors decreases this risk. At the moment, the mechanisms behind this protective effect of mTOR inhibitors are not fully understood. We evaluated effects of the mTOR inhibitors sirolimus and everolimus on keratinocytes, cSCC cell lines and an organotypic skin model in vitro in regard to proliferation, cytokine secretion and differentiation. We show that mTOR inhibitors block keratinocyte proliferation and alter cytokine and cytokeratin production: in particular, mTOR inhibition leads to upregulation of interleukin-6 and downregulation of cytokeratin 10. Therefore, mTOR inhibitors have effects on keratinocytes, which could play a role in the pathogenesis of cSCC.
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Affiliation(s)
- Viola DeTemple
- Department for Dermatology, Allergology and Venerology, Skin Cancer Center Hannover, Hannover Medical School, Hannover, Germany.
| | - Imke Satzger
- Department for Dermatology, Allergology and Venerology, Skin Cancer Center Hannover, Hannover Medical School, Hannover, Germany
| | - Antje Walter
- Department for Dermatology, Allergology and Venerology, Skin Cancer Center Hannover, Hannover Medical School, Hannover, Germany
| | - Katrin Schaper
- Department for Dermatology, Allergology and Venerology, Skin Cancer Center Hannover, Hannover Medical School, Hannover, Germany
| | - Ralf Gutzmer
- Department for Dermatology, Allergology and Venerology, Skin Cancer Center Hannover, Hannover Medical School, Hannover, Germany
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Schaper-Gerhardt K, Okoye S, Herbst R, Ulrich J, Terheyden P, Pföhler C, Utikal JS, Kreuter A, Mohr P, Dippel E, Satzger I, Sucker A, Schadendorf D, Ugurel S, Gutzmer R. PD-L1 status does not predict the outcome of BRAF inhibitor therapy in metastatic melanoma. Eur J Cancer 2017; 88:67-76. [PMID: 29195116 DOI: 10.1016/j.ejca.2017.10.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/20/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Targeted therapies with BRAF plus MEK inhibitors (BRAFi; MEKi) represent the major treatment strategy for patients with BRAF-mutated metastatic melanoma (MM). Previous analyses suggested a correlation between programmed death-ligand 1 (PD-L1) expression in tumour tissues and the outcome of targeted therapies. This study investigated PD-L1 as a potential predictive biomarker of BRAFi-based targeted therapies in MM patients. PATIENTS AND METHODS We analysed two independent cohorts of BRAF V600-mutated MM patients undergoing BRAFi-based therapies for PD-L1 expression in pre-treatment tumour tissues. The oligocentre cohort 1 included 83 patients whose tumour tissues were analysed retrospectively with the anti-PD-L1 antibody clone E1L3N. The multicentre cohort 2 included 58 patients whose tumour tissues were analysed prospectively within the framework of the "Registry of the Arbeitsgemeinschaft Dermatologische Onkologie" (ADOREG) and "Tissue Registry in Melanoma" (TRIM) project using the anti-PD-L1 antibody clone 28-8. RESULTS PD-L1 expression in pre-treatment tumour tissue did not correlate with response or survival to BRAFi-based therapies in both MM patient cohorts. This finding was not influenced by retrospective versus prospective immunohistochemistry analyses, oligocentre versus multicentre cohorts or the different anti-PD-L1 antibody clones used. In cohort 1, PD-L1 positivity was detected in tumour tissue of 41.0% and 18.1% of patients (cut-off 1% and 5%, respectively). In cohort 2, 58.6% and 39.7% of patients showed PD-L1 positivity (cut-off 1% and 5%, respectively). CONCLUSION In two independent cohorts including a total of 141 MM patients, PD-L1 expression in tumour tissue did not correlate with the outcome of BRAFi-based treatment. Therefore, PD-L1 cannot be recommended for the use as a predictive biomarker of BRAFi-based therapy in BRAF V600-mutated MM.
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Affiliation(s)
- Katrin Schaper-Gerhardt
- Skin Cancer Center Hannover, Dept. of Dermatology and Allergy, Hannover Medical School, Carl Neuberg Str. 1, 30625 Hannover, Germany.
| | - Steven Okoye
- Skin Cancer Center Hannover, Dept. of Dermatology and Allergy, Hannover Medical School, Carl Neuberg Str. 1, 30625 Hannover, Germany.
| | - Rudolf Herbst
- Department of Dermatology, Helios Clinic, Erfurt, Germany.
| | - Jens Ulrich
- Department of Dermatology, Quedlinburg, Germany.
| | | | - Claudia Pföhler
- Department of Dermatology, Saarland University Medical School, Homburg, Germany.
| | - Jochen S Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ) and Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, 68167 Mannheim, Germany.
| | - Alexander Kreuter
- Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University Witten-Herdecke, Germany.
| | - Peter Mohr
- Department of Dermatology, Elbe Clinic, Buxtehude, Germany.
| | - Edgar Dippel
- Department of Dermatology, Ludwigshafen Hospital, Ludwigshafen, Germany.
| | - Imke Satzger
- Skin Cancer Center Hannover, Dept. of Dermatology and Allergy, Hannover Medical School, Carl Neuberg Str. 1, 30625 Hannover, Germany.
| | - Antje Sucker
- Department of Dermatology, University of Duisburg-Essen, Essen, Germany.
| | - Dirk Schadendorf
- Department of Dermatology, University of Duisburg-Essen, Essen, Germany.
| | - Selma Ugurel
- Department of Dermatology, University of Duisburg-Essen, Essen, Germany.
| | - Ralf Gutzmer
- Skin Cancer Center Hannover, Dept. of Dermatology and Allergy, Hannover Medical School, Carl Neuberg Str. 1, 30625 Hannover, Germany.
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14
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Heppt MV, Roesch A, Weide B, Gutzmer R, Meier F, Loquai C, Kähler KC, Gesierich A, Meissner M, von Bubnoff D, Göppner D, Schlaak M, Pföhler C, Utikal J, Heinzerling L, Cosgarea I, Engel J, Eckel R, Martens A, Mirlach L, Satzger I, Schubert-Fritschle G, Tietze JK, Berking C. Prognostic factors and treatment outcomes in 444 patients with mucosal melanoma. Eur J Cancer 2017; 81:36-44. [PMID: 28600969 DOI: 10.1016/j.ejca.2017.05.014] [Citation(s) in RCA: 63] [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: 03/07/2017] [Revised: 04/28/2017] [Accepted: 05/06/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Mucosal melanoma (MM) is a rare but diverse cancer entity. Prognostic factors are not well established for Caucasians with MM. PATIENTS AND METHODS We analysed the disease course of 444 patients from 15 German skin cancer centres. Disease progression was determined with the cumulative incidence function. Survival times were estimated with the Kaplan-Meier method. Prognostic parameters were identified with multivariate Cox regression analysis. RESULTS Common anatomic sites of primary tumours were head and neck (MMHN, 37.2%), female genital tract (MMFG, 30.4%) and anorectal region (MMAN, 21.8%). MMAN patients showed the highest vertical tumour thickness (p = 0.001), had a more advanced nodal status (p = 0.014) and a higher percentage of metastatic disease (p = 0.001) at diagnosis. Mutations of NRAS (13.8%), KIT (8.6%) and BRAF (6.4%) were evenly distributed across all tumour site groups. Local relapses were observed in 32.4% and most commonly occurred in the MMHN group (p = 0.016). Male gender (p = 0.047), advanced tumour stage (p = 0.001), nodal disease (p = 0.001) and incomplete resection status (p = 0.001) were independent risk factors for disease progression. Overall survival (OS) was highest in the MMFG group (p = 0.030) and in patients without ulceration (p = 0.004). Multivariate risk factors for OS were M stage at diagnosis (p = 0.002) and incomplete resection of the primary tumour (p = 0.001). CONCLUSION In this large series of MM patients in a European population, anorectal MM was associated with the poorest prognosis.
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Affiliation(s)
- Markus V Heppt
- Department of Dermatology and Allergy, Munich University Hospital (LMU), Frauenlobstr. 9-11, 80337 Munich, Germany.
| | - Alexander Roesch
- Department of Dermatology, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany; German Cancer Consortium (DKTK), Germany.
| | - Benjamin Weide
- Department of Dermatology, Center for Dermatooncology, University Hospital Tübingen, Liebermeisterstr. 25, 72076 Tübingen, Germany.
| | - Ralf Gutzmer
- Department for Dermatology and Allergy, Skin Cancer Center Hannover (HTZH), Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Friedegund Meier
- Department of Dermatology, Skin Cancer Center, National Center for Tumor Diseases, Medical Faculty and University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Carmen Loquai
- Department of Dermatology, University Medical Center Mainz, Langenbeckstr. 1, 55131 Mainz, Germany.
| | - Katharina C Kähler
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Rosalind-Franklin-Str. 7, 24105 Kiel, Germany.
| | - Anja Gesierich
- Department of Dermatology, University Hospital Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany.
| | - Markus Meissner
- Department of Dermatology, Venereology and Allergology, Goethe University, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany.
| | - Dagmar von Bubnoff
- Department of Dermatology, Medical Center - University of Freiburg, Hauptstr. 7, 79104 Freiburg, Germany.
| | - Daniela Göppner
- Department of Dermatology and Allergology, Justus Liebig University, University Medical Center Gießen and Marburg, Gaffkystr. 14, 35392 Gießen, Germany.
| | - Max Schlaak
- Department of Dermatology and Venereology, Skin Cancer Center at the Center of Integrated Oncology (CIO) Köln Bonn, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
| | - Claudia Pföhler
- Saarland University Medical School, Department of Dermatology, Kirrberger Str. 100, 66421 Homburg, Saar, Germany.
| | - Jochen Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ) and Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | - Lucie Heinzerling
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany.
| | - Ioana Cosgarea
- Department of Dermatology, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany; German Cancer Consortium (DKTK), Germany.
| | - Jutta Engel
- Munich Cancer Registry (MCR) of the Munich Tumor Centre (TZM), Department of Medical Information Processing, Biometry and Epidemiology (IBE), University Hospital of Munich, Ludwig-Maximilian-University (LMU), Marchioninistr. 15, 81337 Munich, Germany.
| | - Renate Eckel
- Munich Cancer Registry (MCR) of the Munich Tumor Centre (TZM), Department of Medical Information Processing, Biometry and Epidemiology (IBE), University Hospital of Munich, Ludwig-Maximilian-University (LMU), Marchioninistr. 15, 81337 Munich, Germany.
| | - Alexander Martens
- Department of Dermatology, Center for Dermatooncology, University Hospital Tübingen, Liebermeisterstr. 25, 72076 Tübingen, Germany.
| | - Laura Mirlach
- Department of Dermatology and Allergy, Munich University Hospital (LMU), Frauenlobstr. 9-11, 80337 Munich, Germany.
| | - Imke Satzger
- Department for Dermatology and Allergy, Skin Cancer Center Hannover (HTZH), Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Gabriele Schubert-Fritschle
- Munich Cancer Registry (MCR) of the Munich Tumor Centre (TZM), Department of Medical Information Processing, Biometry and Epidemiology (IBE), University Hospital of Munich, Ludwig-Maximilian-University (LMU), Marchioninistr. 15, 81337 Munich, Germany.
| | - Julia K Tietze
- Department of Dermatology and Allergy, Munich University Hospital (LMU), Frauenlobstr. 9-11, 80337 Munich, Germany.
| | - Carola Berking
- Department of Dermatology and Allergy, Munich University Hospital (LMU), Frauenlobstr. 9-11, 80337 Munich, Germany.
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15
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Schaper K, Köther B, Hesse K, Satzger I, Gutzmer R. The pattern and clinicopathological correlates of programmed death-ligand 1 expression in cutaneous squamous cell carcinoma. Br J Dermatol 2017; 176:1354-1356. [PMID: 27516151 DOI: 10.1111/bjd.14955] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- K Schaper
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - B Köther
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - K Hesse
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - I Satzger
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - R Gutzmer
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
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16
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Gutzmer R, Koop A, Meier F, Hassel JC, Terheyden P, Zimmer L, Heinzerling L, Ugurel S, Pföhler C, Gesierich A, Livingstone E, Satzger I, Kähler KC. Programmed cell death protein-1 (PD-1) inhibitor therapy in patients with advanced melanoma and preexisting autoimmunity or ipilimumab-triggered autoimmunity. Eur J Cancer 2017; 75:24-32. [PMID: 28214654 DOI: 10.1016/j.ejca.2016.12.038] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [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: 09/30/2016] [Revised: 11/27/2016] [Accepted: 12/10/2016] [Indexed: 12/15/2022]
Abstract
AIM Programmed cell death protein 1 (PD-1) inhibitors are a common treatment strategy for metastatic melanoma and other tumour entities. Clinical trials usually exclude patients with preexisting autoimmune diseases, thus experience with PD-1 inhibitor (PD-1i) in this patient population is limited. PATIENTS AND METHODS Metastatic melanoma patients with preexisting autoimmune disorders or previous ipilimumab-triggered immune-related adverse events (irAE) undergoing treatment with PD-1i from seven German skin cancer centres were evaluated retrospectively with regard to flare of the preexisting autoimmunity and development of new, not preexisting irAE as well as response to PD-1i therapy. RESULTS In total, 41 patients had either preexisting autoimmunity (n=19, group A, including two patients with additional ipilimumab-triggered autoimmune colitis) or ipilimumab-triggered irAE (n=22, group B). At PD-1i therapy initiation, six patients in group A and two patients in group B required immunosuppressive therapy. In group A, a flare of preexisting autoimmune disorders was seen in 42% of patients, new irAE in 16%. In group B, 4.5% of patients showed a flare of ipilimumab-triggered irAE and 23% new irAE. All flares of preexisting autoimmune disorders or irAE were managed by immunosuppressive and/or symptomatic therapy and did not require termination of PD-1i therapy. tumour responses (32% in group A and 45% in group B) were unrelated to occurrence of autoimmunity. CONCLUSION While preexisting autoimmunity commonly showed a flare during PD-1i therapy, a flare of ipilimumab-triggered irAE was rare. Response rates were above 30% and unrelated to irAE. PD-1i therapy can be considered in patients with autoimmune disorders depending on severity and activity of autoimmunity.
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Affiliation(s)
- Ralf Gutzmer
- Skin Cancer Center Hannover, Hannover Medical School, Carl Neuberg Str. 1, 30625 Hannover, Germany.
| | - Anika Koop
- Skin Cancer Center Hannover, Hannover Medical School, Carl Neuberg Str. 1, 30625 Hannover, Germany.
| | - Friedegund Meier
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Carl Gustav at the TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Jessica C Hassel
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
| | - Patrick Terheyden
- Department of Dermatology, University of Lübeck, Ratzeburger Allee 160, 23562 Luebeck, Germany.
| | - Lisa Zimmer
- Department of Dermatology, University of Duisburg-Essen, Essen, Germany.
| | - Lucie Heinzerling
- University Hospital Erlangen, Department of Dermatology, Erlangen, Germany.
| | - Selma Ugurel
- Department of Dermatology, University of Duisburg-Essen, Essen, Germany.
| | - Claudia Pföhler
- Saarland University Medical School, Department of Dermatology, Homburg, Germany.
| | - Anja Gesierich
- University Hospital Würzburg, Department of Dermatology, Würzburg, Germany.
| | | | - Imke Satzger
- Skin Cancer Center Hannover, Hannover Medical School, Carl Neuberg Str. 1, 30625 Hannover, Germany.
| | - Katharina C Kähler
- Department of Dermatology, Skin Cancer Center, Schleswig-Holstein University Hospital, Campus Kiel, Kiel, Germany.
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Abstract
Mucosal melanomas represent a rare entity with different risk factors and molecular features compared to cutaneous melanomas. They arise most commonly from mucosal surfaces in the head/neck region, the female genital tract (FGT) and the anorectal region. The aim of this study was to evaluate clinics, prognosis, and treatment options of patients with mucosal melanoma, in particular with regard to different primary sites.We retrospectively analyzed 75 patients with mucosal melanomas diagnosed in the years 1993 to 2015 in our department. The primary melanomas were located in the head/neck region (n = 32), the FGT (n = 24), and the anorectal region (n = 19).The median age of the patients was 66 years. At initial diagnosis the primary melanoma was not completely resectable in 11 (15%) patients, 18 (24%) patients had regional lymph node metastases, and 7 (9%) patients distant metastases. During follow-up, 22 (29%) patients suffered from a local recurrence, in particular patients with primary melanoma in the head/neck region without postoperative radiotherapy. By multivariate analysis location of the primary melanoma in the head/neck area or anorectal region and presence of metastases at time of diagnosis represented poor prognostic factors for recurrence-free survival. In 62 tested individuals 7 KIT mutations were found, 2 BRAF mutations in 57 tested patients. Four patients received targeted therapies, 14 checkpoint inhibitors, 4 (1/1 on vemurafenib, 1/7 on ipilimumab, and 2/7 on PD-1 inhibitors) patients showed responses of more than 100 days duration.Mucosal melanomas are often locally advanced or metastatic at initial diagnosis, thus they require extensive staging procedures. The high rate of local recurrences in the head/neck region can be significantly reduced by postoperative radiotherapy. For the potential use of medical treatment a mutation analysis for KIT and BRAF genes should be performed. The use of new immunologic and targeted therapies has to be further evaluated.
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Affiliation(s)
- Tim Schaefer
- Department for Dermatology and Allergy, Skin Cancer Center Hannover (HTZH), Hannover Medical School
- Office for Dermatology, Allergy and Venerology, Seelze, Germany
| | - Imke Satzger
- Department for Dermatology and Allergy, Skin Cancer Center Hannover (HTZH), Hannover Medical School
| | - Ralf Gutzmer
- Department for Dermatology and Allergy, Skin Cancer Center Hannover (HTZH), Hannover Medical School
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18
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Hesse K, Satzger I, Schacht V, Köther B, Hillen U, Klode J, Schaper K, Gutzmer R. Characterisation of Prognosis and Invasion of Cutaneous Squamous Cell Carcinoma by Podoplanin and E-Cadherin Expression. Dermatology 2016; 232:558-565. [PMID: 27875814 DOI: 10.1159/000450920] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 09/16/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Around 5% of all cutaneous squamous cell carcinoma (cSCC) metastasise. Metastases usually locate in regional skin and lymph nodes, suggesting collective cancer invasion. The cellular level of tumour invasion and prognostic parameters remain to be characterised. METHODS We performed immunohistochemical analyses of E-cadherin (marker for collective cancer invasion) and podoplanin (marker for epithelial-mesenchymal transition [EMT], single-cell invasion) expression in 102 samples of metastatic and non-metastatic cSCC and 18 corresponding skin and lymph node metastases to characterise the invasion of cSCC. Immunohistochemical results were retrospectively correlated with clinical data. RESULTS E-cadherin was highly expressed in metastatic and non-metastatic cSCC and skin metastases. This suggests collective cancer invasion. However, E-cadherin was downregulated in poorly differentiated cSCC and lymph node metastases, suggesting partial EMT. Podoplanin was significantly upregulated in metastatic (p = 0.002) and poorly differentiated (p = 0.003) cSCC. Overexpression of podoplanin represented a statistically independent prognostic factor for disease-free survival (p = 0.014). CONCLUSION Collective cancer invasion is likely in cSCC. In lymph node metastases and poorly differentiated cSCC, partial EMT is possible. Podoplanin is an independent prognostic parameter for metastasis.
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Affiliation(s)
- Kristina Hesse
- Skin Cancer Center Hannover, Department for Dermatology and Allergy, Hannover Medical School, Hannover, Germany
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19
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Satzger I, Marks L, Kerick M, Klages S, Berking C, Herbst R, Völker B, Schacht V, Timmermann B, Gutzmer R. Allele frequencies of BRAFV600 mutations in primary melanomas and matched metastases and their relevance for BRAF inhibitor therapy in metastatic melanoma. Oncotarget 2016; 6:37895-905. [PMID: 26498143 PMCID: PMC4741972 DOI: 10.18632/oncotarget.5634] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 03/26/2015] [Accepted: 10/06/2015] [Indexed: 01/03/2023] Open
Abstract
Background The detection of BRAFV600 mutations in patients with metastatic melanoma is important because of the availability of BRAF inhibitor therapy. However, the clinical relevance of the frequency of BRAFV600 mutant alleles is unclear. Patients and Methods Allele frequencies of BRAFV600 mutations were analyzed by ultra-deep next-generation sequencing in formalin-fixed, paraffin-embedded melanoma tissue (75 primary melanomas and 88 matched metastases). In a second study, pretreatment specimens from 76 patients who received BRAF inhibitors were retrospectively analyzed, and BRAFV600 allele frequencies were correlated with therapeutic results. Results Thirty-five patients had concordantly BRAF-positive and 36 (48%) patients had concordantly BRAF-negative primary melanomas and matched metastases, and four patients had discordant samples with low allele frequencies (3.4–5.2%). Twenty-six of 35 patients with concordant samples had BRAFV600E mutations, three of whom had additional mutations (V600K in two patients and V600R in one) and nine patients had exclusively non-V600E mutations (V600K in eight patients and V600E -c.1799_1800TG > AA- in one patient). The frequency of mutated BRAFV600 alleles was similar in the primary melanoma and matched metastasis in 27/35 patients, but differed by >3-fold in 8/35 of samples. BRAFV600E allele frequencies in pretreatment tumor specimens were not significantly correlated with treatment outcomes in 76 patients with metastatic melanoma who were treated with BRAF inhibitors. Conclusions BRAFV600 mutation status and allele frequency is consistent in the majority of primary melanomas and matched metastases. A small subgroup of patients has double mutations. BRAFV600 allele frequencies are not correlated with the response to BRAF inhibitors.
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Affiliation(s)
- Imke Satzger
- Department of Dermatology and Allergy, Skin Cancer Center Hannover, Hannover Medical School, Hannover, Germany
| | - Lena Marks
- Department of Dermatology and Allergy, Skin Cancer Center Hannover, Hannover Medical School, Hannover, Germany
| | - Martin Kerick
- Sequencing Core Facility, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Sven Klages
- Sequencing Core Facility, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Carola Berking
- Department of Dermatology, Ludwig-Maximilian University of Munich, Munich, Germany
| | - Rudolf Herbst
- Department of Dermatology and Allergology, HELIOS Skin Cancer Center, Erfurt, Germany
| | - Bernward Völker
- Institute of Pathology, Nordstadt Krankenhaus, Hannover, Germany
| | - Vivien Schacht
- Department of Dermatology and Allergy, Skin Cancer Center Hannover, Hannover Medical School, Hannover, Germany
| | - Bernd Timmermann
- Sequencing Core Facility, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Ralf Gutzmer
- Department of Dermatology and Allergy, Skin Cancer Center Hannover, Hannover Medical School, Hannover, Germany
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Kretschmer L, Bertsch HP, Zapf A, Mitteldorf C, Satzger I, Thoms KM, Völker B, Schön MP, Gutzmer R, Starz H. Nodal Basin Recurrence After Sentinel Lymph Node Biopsy for Melanoma: A Retrospective Multicenter Study in 2653 Patients. Medicine (Baltimore) 2015; 94:e1433. [PMID: 26356697 PMCID: PMC4616624 DOI: 10.1097/md.0000000000001433] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 11/25/2022] Open
Abstract
UNLABELLED The objective of this study was to analyze different types of nodal basin recurrence after sentinel lymph node biopsy (SLNB) for melanoma. PATIENTS AND METHODS Kaplan-Meier estimates and the Cox proportional hazards model were used to study 2653 patients from 3 German melanoma centers retrospectively.The estimated 5-year negative predictive value of SLNB was 96.4%. The estimated false-negative (FN) rates after 1, 2, 3, 5, and 10 years were 2.5%, 4.6%, 6.4%, 8.7%, and 12.6%, respectively. Independent factors associated with false negativity were older age, fewer SLNs excised, and head or neck location of the primary tumor. Compared with SLN-positive patients, the FNs had a significantly lower survival. In SLN-positive patients undergoing completion lymphadenectomy (CLND), the 5-year nodal basin recurrence rate was 18.3%. The recurrence rates for axilla, groin, and neck were 17.2%, 15.5%, and 44.1%, respectively. Significant factors predicting local relapse after CLND were older age, head, or neck location of the primary tumor, ulceration, deeper penetration of the metastasis into the SLN, tumor-positive CLND, and >2 lymph node metastases. All kinds of nodal relapse were associated with a higher prevalence of in-transit metastases.The FN rate after SLNB steadily increases over the observation period and should, therefore, be estimated by the Kaplan-Meier method. False-negativity is associated with fewer SLNs excised. The beneficial effect of CLND on nodal basin disease control varies considerably across different risk groups. This should be kept in mind about SLN-positive patients when individual decisions on prophylactic CLND are taken.
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Affiliation(s)
- Lutz Kretschmer
- From the Department of Dermatology, Venereology and Allergology, Georg August University of Göttingen, Robert-Koch-Str. 40, D-37075 Göttingen (LK, HPB, KMT, MPS); Department of Medical Statistics, Georg August University of Göttingen, Humboldtallee 32 37073 Göttingen (AZ); Department of Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany (IS, BV, RG); Department of Dermatology, Venereology and Allergology, Klinikum Hildesheim GmbH, Senator-Braun-Allee 33, 31135 Hildesheim, Germany (CM); and Department of Dermatology and Allergology, Klinikum Augsburg, Germany, Sauerbruchstr. 6, D-86179 Augsburg (HS)
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Tolk H, Satzger I, Mohr P, Zimmer L, Weide B, Schäd S, Gutzmer R. Complete remission of metastatic melanoma upon BRAF inhibitor treatment - what happens after discontinuation? Melanoma Res 2015; 25:362-6. [PMID: 26061438 DOI: 10.1097/cmr.0000000000000169] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 12/12/2022]
Abstract
Treatment with BRAF inhibitors (BRAFi) leads to complete remissions (CR) in 3-6% of patients with BRAF mutant metastatic melanoma. In cases of CR, it is unclear whether BRAFi therapy should be continued. We retrospectively analyzed the clinical course of patients with metastatic melanoma who discontinued BRAFi therapy after achieving a CR. In 12 patients, CR of metastatic melanoma was diagnosed after a median BRAFi treatment duration of 13 (range 0.3-32) months. Reasons for discontinuation were side effects in seven patients and patient demand in five patients. Six patients are still in CR after a median of 17 (range 2-26) months after discontinuation of BRAF inhibition. Six patients developed a melanoma recurrence after a median of 3 (range 2-17) months of discontinuation of BRAFi therapy. Subsequently, these patients were again treated with a BRAFi, which resulted in three CR, one stable disease, and one progressive disease; one patient could not be assessed. Melanoma patients achieving CR during BRAFi therapy represent a heterogeneous group. Discontinuation of BRAFi therapy after a CR has to be balanced carefully with the potential risk of nonresponding to BRAFi retreatment in the case of relapse.
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Affiliation(s)
- Henrike Tolk
- aDepartment of Dermatology and Allergy, Skin Cancer Center Hannover, Hannover Medical School, Hannover bCenter for Dermatology, Elbe-Klinikum Buxtehude, Buxtehude cDepartment of Dermatology, University Hospital, University of Duisburg-Essen, Essen dDepartment of Dermatology, University of Tuebingen, Tuebingen eDepartment of Dermatology, University of Rostock, Rostock, Germany
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Ugurel S, Loquai C, Kähler K, Hassel J, Berking C, Zimmer L, Haubitz I, Satzger I, Müller-Brenne T, Mikhaimer N, Becker J, Kilian K, Schadendorf D, Heinzerling L, Kaatz M, Utikal J, Göppner D, Pföhler C, Pflugfelder A, Mössner R, Gutzmer R. A multicenter DeCOG study on predictors of vemurafenib therapy outcome in melanoma: pretreatment impacts survival. Ann Oncol 2015; 26:573-82. [DOI: 10.1093/annonc/mdu573] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Niebuhr M, Mainardy J, Heratizadeh A, Satzger I, Werfel T. Staphylococcal exotoxins induce interleukin 22 in human th22 cells. Int Arch Allergy Immunol 2014; 165:35-9. [PMID: 25301279 DOI: 10.1159/000367923] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 08/27/2014] [Indexed: 12/16/2023] Open
Abstract
BACKGROUND We have shown previously that T cells from atopic dermatitis (AD) patients produce more IL-22 upon staphylococcal exotoxin stimulation compared to psoriasis patients and healthy controls. The role of staphylococcal exotoxins on polarized memory T helper (Th)22 cells which are enriched in inflamed AD skin remains elusive. Our aim was to investigate IL-22 production in response to staphylococcal enterotoxin B (SEB) and α-toxin stimulation in human memory T cells and polarized Th22 cells. METHODS IL-22 induction was investigated in human peripheral blood-derived CD4+CD45RO+CD45RA- T cells and polarized Th22 cells after SEB and sublytic α-toxin stimulation in a time-dependent manner at the mRNA and protein (ELISA) levels. RESULTS Th22 cells secreted more IL-22 compared to freshly isolated peripheral blood-derived memory T cells. SEB and α-toxin induced IL-22 in memory T cells as well as in Th22 cells. More IL-22 was induced by SEB and α-toxin in freshly isolated peripheral blood memory T cells compared to Th22 cells derived from memory T cells in long-term cell culture without polarization and Th22 cells under Th22-promoting conditions with IL-6 and TNF-α. No differences in IL-22 induction by staphylococcal exotoxins were observed between cells from AD compared to psoriasis patients and healthy controls. CONCLUSIONS Increased IL-22 secretion can promptly be induced by staphylococcal exotoxins in skin infiltrating CD4+CD45RO+CD45RA- memory T cells and can potentially amplify chronic skin inflammation in AD in the context of bacterial colonization and infection. This should be investigated further in detail in lesional skin of AD and psoriasis patients.
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Affiliation(s)
- Margarete Niebuhr
- Department of Dermatology and Allergy, Division of Immunodermatology and Allergy Research, Hannover Medical School, Hannover, Germany
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Niebuhr M, Baumert K, Heratizadeh A, Satzger I, Werfel T. Impaired NLRP3 inflammasome expression and function in atopic dermatitis due to Th2 milieu. Allergy 2014; 69:1058-67. [PMID: 24894535 DOI: 10.1111/all.12428] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [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: 04/18/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) and psoriasis patients are frequently colonized with Staphylococcus aureus (S. aureus) that produce the staphylococcal exotoxin α-toxin. However, only patients with AD suffer from bacterial superinfections with this pathogen, which implicates immunological differences in AD vs psoriasis in combating these bacteria. S. aureus recognition is partially mediated by intracellular nucleotide-binding oligomerization domain receptors (NLRs), which link α-toxin to caspase-1 activation through the formation of the NLRP3 inflammasome and to IL-1β secretion. OBJECTIVE To investigate (i) NLRP3 expression in the context of different T-helper cytokine milieus and (ii) its function in response to sublytic α-toxin stimulation in patients with AD and psoriasis compared with healthy controls. METHODS NLRP3 expression and function were investigated in lesional AD and psoriasis skin as well as in primary keratinocytes (HPKs) and monocytes upon stimulation with Th1, Th2, Th17 and Th22 cytokines or staphylococcal α-toxin, respectively, at the mRNA and protein (ELISA, immunohistochemistry and immunofluorescence) level. RESULTS NLRP3 and caspase-1 expressions were reduced in lesional AD skin compared to psoriatic and healthy skin. IL-4, IL-5 and IL-13 downregulated NLRP3 and ASC, whereas interferon-γ upregulated NLRP3 in HPKs. In monocytes, caspase-1 expression was reduced by Th2 cytokines and enhanced by a Th1 milieu. Caspase-1-dependent IL-1β secretion was impaired in monocytes from patients with AD compared to patients with psoriasis and healthy controls by α-toxin stimulation following priming with lipoteichoic acid. CONCLUSION Impaired NLRP3 expression and function may partially explain how skin colonization and infection with S. aureus can contribute to chronic skin inflammation in AD.
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Affiliation(s)
- M. Niebuhr
- Division of Immunodermatology and Allergy Research; Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - K. Baumert
- Division of Immunodermatology and Allergy Research; Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - A. Heratizadeh
- Division of Immunodermatology and Allergy Research; Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - I. Satzger
- Division of Immunodermatology and Allergy Research; Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - T. Werfel
- Division of Immunodermatology and Allergy Research; Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
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Alter M, Satzger I, Schrem H, Kaltenborn A, Kapp A, Gutzmer R. Rückgang nicht-melanozytärer Hauttumoren nach Umstellung der Immunsuppression auf mTOR-Inhibitoren bei organtransplantierten Patienten. J Dtsch Dermatol Ges 2014. [DOI: 10.1111/ddg.12355_suppl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mareike Alter
- Universitätsklinik für Dermatologie und Venerologie; Otto von Guericke Universität Magdeburg
| | - Imke Satzger
- Klinik für Dermatologie; Allergologie und Venerologie, Hauttumorzentrum Hannover, Medizinische Hochschule Hannover
| | - Harald Schrem
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie; Medizinische Hochschule Hannover
| | - Alexander Kaltenborn
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie; Medizinische Hochschule Hannover
| | - Alexander Kapp
- Klinik für Dermatologie; Allergologie und Venerologie, Hauttumorzentrum Hannover, Medizinische Hochschule Hannover
| | - Ralf Gutzmer
- Klinik für Dermatologie; Allergologie und Venerologie, Hauttumorzentrum Hannover, Medizinische Hochschule Hannover
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Alter M, Satzger I, Schrem H, Kaltenborn A, Kapp A, Gutzmer R. Non-melanoma skin cancer is reduced after switch of immunosuppression to mTOR-inhibitors in organ transplant recipients. J Dtsch Dermatol Ges 2014; 12:480-8. [PMID: 24813579 DOI: 10.1111/ddg.12355] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 03/20/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Organ transplant recipients are prone to the development of non-melanoma skin cancer. Organ transplant recipients often develop multiple non-melanoma skin cancers and the tumors show an aggressive growth pattern, therefore surgical therapy can be difficult. Switch of the immunosuppressive regimen to mTOR-inhibitors such as everolimus or sirolimus can have an antitumor effect. PATIENTS AND METHODS In a monocentric retrospective study we evaluated organ transplant recipients who presented with non-melanoma skin cancer in the years 2008-2010. Experience with patients who were switched to an mTOR-inhibitor due to non-melanoma skin cancer are reported in detail, and recent clinical studies are reviewed. RESULTS 60 organ transplant recipients with non-melanoma skin cancer were evaluated. Due to the development of multiple non-melanoma skin cancer within a few years, the immunosuppressive regimen was switched to everolimus in 7 patients and to sirolimus in 5 patients. Eight patients were evaluable for the effect of mTOR-inhibitors on the development of non-melanoma skin cancer; 4 patients had to discontinue the medication with mTOR-inhibitors early due to various side effects. In the year before the switch to mTOR-inhibitors, 8 patients developed 16 squamous cell carcinomas, 3 Basal cell carcinomas and 22 cases of Bowen's disease. All tumors were histologically confirmed. In the year after switch of immunosuppression, the rate of squamous cell carcinomas (n = 2) and Bowen's disease (n = 3), but not of basal cell carcinomas (n = 2) was significantly reduced. Moreover, 5 prospective randomized trials recently have demonstrated a reduced number of non-melanoma skin cancers in organ transplant recipients after switch of the immunosuppressive regimen to mTOR-inhibitors. CONCLUSION Switch of the immunosuppressive regimen to mTOR-inhibitors should be considered for organ transplant recipients suffering from multiple non-melanoma skin cancers.
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Affiliation(s)
- Mareike Alter
- Department of Dermatology and Venerology, Otto von Guericke University, Magdeburg, Germany
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Pflugfelder A, Kochs C, Blum A, Capellaro M, Czeschik C, Dettenborn T, Dill D, Dippel E, Eigentler T, Feyer P, Follmann M, Frerich B, Ganten MK, Gärtner J, Gutzmer R, Hassel J, Hauschild A, Hohenberger P, Hübner J, Kaatz M, Kleeberg UR, Kölbl O, Kortmann RD, Krause-Bergmann A, Kurschat P, Leiter U, Link H, Loquai C, Löser C, Mackensen A, Meier F, Mohr P, Möhrle M, Nashan D, Reske S, Rose C, Sander C, Satzger I, Schiller M, Schlemmer HP, Strittmatter G, Sunderkötter C, Swoboda L, Trefzer U, Voltz R, Vordermark D, Weichenthal M, Werner A, Wesselmann S, Weyergraf AJ, Wick W, Garbe C, Schadendorf D. Malignant melanoma S3-guideline "diagnosis, therapy and follow-up of melanoma". J Dtsch Dermatol Ges 2014; 11 Suppl 6:1-116, 1-126. [PMID: 24028775 DOI: 10.1111/ddg.12113_suppl] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This first German evidence-based guideline for cutaneous melanoma was developed under the auspices of the German Dermatological Society (DDG) and the Dermatologic Cooperative Oncology Group (DeCOG) and funded by the German Guideline Program in Oncology. The recommendations are based on a systematic literature search, and on the consensus of 32 medical societies, working groups and patient representatives. This guideline contains recommendations concerning diagnosis, therapy and follow-up of melanoma. The diagnosis of primary melanoma based on clinical features and dermoscopic criteria. It is confirmed by histopathologic examination after complete excision with a small margin. For the staging of melanoma, the AJCC classification of 2009 is used. The definitive excision margins are 0.5 cm for in situ melanomas, 1 cm for melanomas with up to 2 mm tumor thickness and 2 cm for thicker melanomas, they are reached in a secondary excision. From 1 mm tumor thickness, sentinel lymph node biopsy is recommended. For stages II and III, adjuvant therapy with interferon-alpha should be considered after careful analysis of the benefits and possible risks. In the stage of locoregional metastasis surgical treatment with complete lymphadenectomy is the treatment of choice. In the presence of distant metastasis mutational screening should be performed for BRAF mutation, and eventually for CKIT and NRAS mutations. In the presence of mutations in case of inoperable metastases targeted therapies should be applied. Furthermore, in addition to standard chemotherapies, new immunotherapies such as the CTLA-4 antibody ipilimumab are available. Regular follow-up examinations are recommended for a period of 10 years, with an intensified schedule for the first three years.
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Al Ghazal P, Gutzmer R, Satzger I, Starz H, Bader C, Thoms KM, Mitteldorf C, Schön MP, Kapp A, Bertsch HP, Kretschmer L. Lower prevalence of lymphatic metastasis and poorer survival of the sentinel node-negative patients limit the prognostic value of sentinel node biopsy for head or neck melanomas. Melanoma Res 2014; 24:158-64. [PMID: 24346168 DOI: 10.1097/cmr.0000000000000042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Head or neck location of primary cutaneous melanomas has been described as an adverse prognostic factor, but this has to be reassessed after the introduction of sentinel lymph node (SLN) excision (SLNE). Descriptive statistics, Kaplan-Meier estimates and Cox proportional hazard models were used to study retrospectively a population of 2302 consecutive melanoma patients from three German melanoma centres undergoing SLNE. Approximately 10% of the patients (N=237) had a primary melanoma located at the head or neck (HNM). In both the SLN-positive and SLN-negative subpopulation, patients with HNM were significantly older, more frequently men and had thicker primaries compared with patients with tumours in other locations. The proportion of positive SLNs was lower in HNM compared with other locations of the primary (20 vs. 26%, P=0.048). The false-negative rate was higher in HNM (17.5 vs. 8.4%, P=0.05). In patients with HNM, the SLN status was a significant factor for recurrence-free survival but not for overall survival. SLN-negative HNM patients had a significantly worse overall survival than the SLN negatives with primaries at other sites, whereas the prognosis of the SLN-positive patients was similar in both groups. The prevalence of lymph node metastases after SLNE is lower in patients with HNM compared with other melanoma locations. As a result, the prognostic information provided by the SLN for HNM seems less important. Decision making for SLNE in HNM should be carefully balanced considering the potential morbidity of the procedure.
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Affiliation(s)
- Philipp Al Ghazal
- aDepartment of Dermatology and Allergy, Hannover Medical School, Skin Cancer Center Hannover, Hannove bDepartment of Dermatology and Allergology, Klinikum Augsburg, Augsburg cDepartment of Dermatology, Venereology and Allergology, Georg August University, Göttingen dDepartment of Dermatology, Venereology and Allergology, Klinikum Hildesheim GmbH, Hildesheim, Germany
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Koop A, Satzger I, Alter M, Kapp A, Hauschild A, Gutzmer R. Intermittent BRAF-inhibitor therapy is a feasible option: report of a patient with metastatic melanoma. Br J Dermatol 2014; 170:220-2. [DOI: 10.1111/bjd.12615] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- A. Koop
- Department of Dermatology and Allergy; Skin Cancer Center Hannover; Hannover Medical School; Ricklinger Str. 5 30449 Hannover Germany
| | - I. Satzger
- Department of Dermatology and Allergy; Skin Cancer Center Hannover; Hannover Medical School; Ricklinger Str. 5 30449 Hannover Germany
| | - M. Alter
- Department of Dermatology and Allergy; Skin Cancer Center Hannover; Hannover Medical School; Ricklinger Str. 5 30449 Hannover Germany
| | - A. Kapp
- Department of Dermatology and Allergy; Skin Cancer Center Hannover; Hannover Medical School; Ricklinger Str. 5 30449 Hannover Germany
| | - A. Hauschild
- Department of Dermatology; University Hospital Schleswig-Holstein (UKSH); Campus Kiel Arnold-Heller-Straße 324105 Kiel Germany
| | - R. Gutzmer
- Department of Dermatology and Allergy; Skin Cancer Center Hannover; Hannover Medical School; Ricklinger Str. 5 30449 Hannover Germany
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Pflugfelder A, Kochs C, Blum A, Capellaro M, Czeschik C, Dettenborn T, Dill D, Dippel E, Eigentler T, Feyer P, Follmann M, Frerich B, Ganten MK, Gärtner J, Gutzmer R, Hassel J, Hauschild A, Hohenberger P, Hübner J, Kaatz M, Kleeberg UR, Kölbl O, Kortmann RD, Krause-Bergmann A, Kurschat P, Leiter U, Link H, Loquai C, Löser C, Mackensen A, Meier F, Mohr P, Möhrle M, Nashan D, Reske S, Rose C, Sander C, Satzger I, Schiller M, Schlemmer HP, Strittmatter G, Sunderkötter C, Swoboda L, Trefzer U, Voltz R, Vordermark D, Weichenthal M, Werner A, Wesselmann S, Weyergraf AJ, Wick W, Garbe C, Schadendorf D. S3-guideline "diagnosis, therapy and follow-up of melanoma" -- short version. J Dtsch Dermatol Ges 2014; 11:563-602. [PMID: 23721604 DOI: 10.1111/ddg.12044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Alter M, Satzger I, Mattern A, Kapp A, Gutzmer R. Treatment of advanced cutaneous squamous cell carcinomas with epidermal growth factor receptor inhibitors. Dermatology 2013; 227:289-94. [PMID: 24217470 DOI: 10.1159/000355181] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 08/03/2013] [Indexed: 11/19/2022] Open
Abstract
In advanced cutaneous squamous cell carcinoma (cSCC), efficient medical treatment options are limited in case surgery and radiotherapy failed, particularly since most patients are of higher age and suffer from comorbidities. In many tumor entities, the epidermal growth factor receptor (EGFR) has been established as an important therapeutic target, and blockade of EGFR signaling by monoclonal antibodies or small molecules achieves a therapeutic benefit. EGFR expression is also often dysregulated in cSCC. We report here two patients with advanced cSCC treated with the EGFR inhibitor cetuximab and summarize the current published experience with the use of EGFR inhibitors in cSCC.
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Affiliation(s)
- M Alter
- Department of Dermatology and Allergy, Hannover Medical School, Skin Cancer Center Hannover, Hannover, Germany
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Affiliation(s)
- Imke Satzger
- Skin Cancer Center Hannover, Hannover Medical School, Hannover, Germany
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Pflugfelder A, Kochs C, Blum A, Capellaro M, Czeschik C, Dettenborn T, Dill D, Dippel E, Eigentler T, Feyer P, Follmann M, Frerich B, Ganten MK, Gärtner J, Gutzmer R, Hassel J, Hauschild A, Hohenberger P, Hübner J, Kaatz M, Kleeberg UR, Kölbl O, Kortmann RD, Krause-Bergmann A, Kurschat P, Leiter U, Link H, Loquai C, Löser C, Mackensen A, Meier F, Mohr P, Möhrle M, Nashan D, Reske S, Rose C, Sander C, Satzger I, Schiller M, Schlemmer HP, Strittmatter G, Sunderkötter C, Swoboda L, Trefzer U, Voltz R, Vordermark D, Weichenthal M, Werner A, Wesselmann S, Weyergraf AJ, Wick W, Garbe C, Schadendorf D. Malignes Melanom S3-Leitlinie “Diagnostik, Therapie und Nachsorge des Melanoms”. J Dtsch Dermatol Ges 2013. [DOI: 10.1111/ddg.12113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Marcus Capellaro
- Arbeitsgemeinschaft Dermatologische Prävention (ADP) e.V.; Buxtehude
| | | | | | | | - Edgar Dippel
- Hautklinik, Hauttumorzentrum; Klinikum Ludwigshafen
| | | | - Petra Feyer
- Klinik für Strahlentherapie und Radioonkologie; Vivantes Klinikum Neukölln - Berlin
| | | | - Bernhard Frerich
- Klinik und Poliklinik für Mund- Kiefer- und Plastische Gesichtschirurgie; Universitätsmedizin Rostock
| | | | - Jan Gärtner
- Klinik und Poliklinik für Palliativmedizin; Universitätsklinikum Köln
| | - Ralf Gutzmer
- Klinik für Dermatologie; Allergologie und Venerologie, Medizinische Hochschule Hannover
| | | | - Axel Hauschild
- Klinik für Dermatologie, Venerologie, Allergologie; Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Peter Hohenberger
- Sektion Spezielle Chirurgische Onkologie & Thoraxchirurgie; UniversitätsMedizin Mannheim
| | - Jutta Hübner
- Johann Wolfgang Goethe-Universität; Frankfurt am Main
| | - Martin Kaatz
- Klinik für Hautkrankheiten und Allergologie; Wald-Klinikum Gera
| | - Ulrich R. Kleeberg
- Hämatologisch-onkologische Praxis Altona (HOPA); Struensee-Haus; Hamburg
| | - Oliver Kölbl
- Klinik und Poliklinik für Strahlentherapie; Universitätsklinikum Regensburg
| | | | | | - Peter Kurschat
- Klinik u. Poliklinik für Dermatologie und Venerologie; Universitätsklinikum Köln
| | | | - Hartmut Link
- Medizinische Klinik; Westpfalz-Klinikum Kaiserslautern
| | | | | | - Andreas Mackensen
- Medizinische Klinik 5 - Hämatologie/Onkologie; Universitätsklinikum Erlangen
| | | | - Peter Mohr
- Arbeitsgemeinschaft Dermatologische Prävention (ADP) e.V.; Buxtehude
| | | | | | - Sven Reske
- Klinik für Nuklearmedizin; Universitätsklinikum Ulm
| | | | - Christian Sander
- Klinik für Dermatologie und Allergologie; Asklepios Klinik St. Georg
| | - Imke Satzger
- Klinik für Dermatologie; Allergologie und Venerologie, Medizinische Hochschule Hannover
| | | | | | | | | | | | - Uwe Trefzer
- Klinik für Dermatologie Venerologie und Allergologie; Charité - Universitätsmedizin Berlin
| | - Raymond Voltz
- Klinik und Poliklinik für Palliativmedizin; Universitätsklinikum Köln
| | - Dirk Vordermark
- Klinik und Poliklinik für Strahlentherapie; Universitätsklinikum Halle (Saale)
| | - Michael Weichenthal
- Klinik für Dermatologie, Venerologie, Allergologie; Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | | | | | | | - Wolfgang Wick
- Abteilung für Neuroonkologie; Universitätsklinik Heidelberg
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Pflugfelder A, Kochs C, Blum A, Capellaro M, Czeschik C, Dettenborn T, Dill D, Dippel E, Eigentler T, Feyer P, Follmann M, Frerich B, Ganten MK, Gärtner J, Gutzmer R, Hassel J, Hauschild A, Hohenberger P, Hübner J, Kaatz M, Kleeberg UR, Kölbl O, Kortmann RD, Krause-Bergmann A, Kurschat P, Leiter U, Link H, Loquai C, Löser C, Mackensen A, Meier F, Mohr P, Möhrle M, Nashan D, Reske S, Rose C, Sander C, Satzger I, Schiller M, Schlemmer HP, Strittmatter G, Sunderkötter C, Swoboda L, Trefzer U, Voltz R, Vordermark D, Weichenthal M, Werner A, Wesselmann S, Weyergraf AJ, Wick W, Garbe C, Schadendorf D. S3-Leitlinie ,,Diagnostik, Therapie und Nachsorge des Melanoms” - Kurzfassung. J Dtsch Dermatol Ges 2013. [DOI: 10.1111/ddg.12044_suppl] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Marcus Capellaro
- Arbeitsgemeinschaft Dermatologische Prävention (ADP) e.V.; Buxtehude
| | | | | | | | - Edgar Dippel
- Hautklinik, Hauttumorzentrum; Klinikum Ludwigshafen
| | | | - Petra Feyer
- Klinik für Strahlentherapie und Radioonkologie; Vivantes Klinikum Neukölln - Berlin
| | | | - Bernhard Frerich
- Klinik und Poliklinik für Mund- Kiefer- und Plastische Gesichtschirurgie; Universitätsmedizin Rostock
| | | | - Jan Gärtner
- Klinik und Poliklinik für Palliativmedizin; Universitätsklinikum Köln
| | - Ralf Gutzmer
- Klinik für Dermatologie, Allergologie und Venerologie; Medizinische Hochschule Hannover
| | | | - Axel Hauschild
- Klinik für Dermatologie, Venerologie, Allergologie; Universitätsklinikum Schleswig-Holstein; Campus Kiel
| | - Peter Hohenberger
- Sektion Spezielle Chirurgische Onkologie & Thoraxchirurgie; UniversitätsMedizin Mannheim
| | - Jutta Hübner
- Johann Wolfgang Goethe-Universität; Frankfurt am Main
| | - Martin Kaatz
- Klinik für Hautkrankheiten und Allergologie; Wald-Klinikum Gera
| | - Ulrich R. Kleeberg
- Hämatologisch-onkologische Praxis Altona (HOPA); Struensee-Haus; Hamburg
| | - Oliver Kölbl
- Klinik und Poliklinik für Strahlentherapie; Universitätsklinikum Regensburg
| | | | | | - Peter Kurschat
- Klinik u. Poliklinik für Dermatologie und Venerologie; Universitätsklinikum Köln
| | | | - Hartmut Link
- Medizinische Klinik, Westpfalz-Klinikum Kaiserslautern
| | | | | | - Andreas Mackensen
- Medizinische Klinik 5 - Hämatologie/Onkologie; Universitätsklinikum Erlangen
| | | | - Peter Mohr
- Arbeitsgemeinschaft Dermatologische Prävention (ADP) e.V.; Buxtehude
| | | | | | - Sven Reske
- Klinik für Nuklearmedizin; Universitätsklinikum Ulm
| | | | - Christian Sander
- Klinik für Dermatologie und Allergologie; Asklepios Klinik St. Georg
| | - Imke Satzger
- Klinik für Dermatologie, Allergologie und Venerologie; Medizinische Hochschule Hannover
| | | | | | | | | | | | - Uwe Trefzer
- Klinik für Dermatologie Venerologie und Allergologie; Charité - Universitätsmedizin Berlin
| | - Raymond Voltz
- Klinik und Poliklinik für Palliativmedizin; Universitätsklinikum Köln
| | - Dirk Vordermark
- Klinik und Poliklinik für Strahlentherapie; Universitätsklinikum Halle (Saale)
| | - Michael Weichenthal
- Klinik für Dermatologie, Venerologie, Allergologie; Universitätsklinikum Schleswig-Holstein; Campus Kiel
| | | | | | | | - Wolfgang Wick
- Abteilung für Neuroonkologie; Universitätsklinik Heidelberg
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Satzger I, Degen A, Asper H, Kapp A, Hauschild A, Gutzmer R. Serious Skin Toxicity With the Combination of BRAF Inhibitors and Radiotherapy. J Clin Oncol 2013; 31:e220-2. [DOI: 10.1200/jco.2012.44.4265] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Imke Satzger
- Hannover Medical School, Skin Cancer Center Hannover, Hannover, Germany
| | - Annette Degen
- Hannover Medical School, Skin Cancer Center Hannover, Hannover, Germany
| | - Hiba Asper
- Hannover Medical School, Skin Cancer Center Hannover, Hannover, Germany
| | - Alexander Kapp
- Hannover Medical School, Skin Cancer Center Hannover, Hannover, Germany
| | | | - Ralf Gutzmer
- Hannover Medical School, Skin Cancer Center Hannover, Hannover, Germany
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Voskens CJ, Goldinger SM, Loquai C, Robert C, Kaehler KC, Berking C, Bergmann T, Bockmeyer CL, Eigentler T, Fluck M, Garbe C, Gutzmer R, Grabbe S, Hauschild A, Hein R, Hundorfean G, Justich A, Keller U, Klein C, Mateus C, Mohr P, Paetzold S, Satzger I, Schadendorf D, Schlaeppi M, Schuler G, Schuler-Thurner B, Trefzer U, Ulrich J, Vaubel J, von Moos R, Weder P, Wilhelm T, Göppner D, Dummer R, Heinzerling LM. The price of tumor control: an analysis of rare side effects of anti-CTLA-4 therapy in metastatic melanoma from the ipilimumab network. PLoS One 2013; 8:e53745. [PMID: 23341990 PMCID: PMC3544906 DOI: 10.1371/journal.pone.0053745] [Citation(s) in RCA: 358] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 12/03/2012] [Indexed: 01/17/2023] Open
Abstract
Background Ipilimumab, a cytotoxic T-lymphocyte antigen-4 (CTLA-4) blocking antibody, has been approved for the treatment of metastatic melanoma and induces adverse events (AE) in up to 64% of patients. Treatment algorithms for the management of common ipilimumab-induced AEs have lead to a reduction of morbidity, e.g. due to bowel perforations. However, the spectrum of less common AEs is expanding as ipilimumab is increasingly applied. Stringent recognition and management of AEs will reduce drug-induced morbidity and costs, and thus, positively impact the cost-benefit ratio of the drug. To facilitate timely identification and adequate management data on rare AEs were analyzed at 19 skin cancer centers. Methods and Findings Patient files (n = 752) were screened for rare ipilimumab-associated AEs. A total of 120 AEs, some of which were life-threatening or even fatal, were reported and summarized by organ system describing the most instructive cases in detail. Previously unreported AEs like drug rash with eosinophilia and systemic symptoms (DRESS), granulomatous inflammation of the central nervous system, and aseptic meningitis, were documented. Obstacles included patientś delay in reporting symptoms and the differentiation of steroid-induced from ipilimumab-induced AEs under steroid treatment. Importantly, response rate was high in this patient population with tumor regression in 30.9% and a tumor control rate of 61.8% in stage IV melanoma patients despite the fact that some patients received only two of four recommended ipilimumab infusions. This suggests that ipilimumab-induced antitumor responses can have an early onset and that severe autoimmune reactions may reflect overtreatment. Conclusion The wide spectrum of ipilimumab-induced AEs demands doctor and patient awareness to reduce morbidity and treatment costs and true ipilimumab success is dictated by both objective tumor responses and controlling severe side effects.
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Affiliation(s)
| | | | - Carmen Loquai
- Department of Dermatology, University Hospital Mainz, Mainz, Germany
| | - Caroline Robert
- Institute Gustave Roussy, Department of Dermatology, Villejuif, France
| | | | - Carola Berking
- Department of Dermatology and Allergology, University of Munich LMU, Munich, Germany
| | - Tanja Bergmann
- Department of Internal Medicine (Gastroenterology, Endocrinology, and Pneumology), University Hospital Erlangen, Erlangen, Germany
| | - Clemens L. Bockmeyer
- Department of Dermatology and Allergy/Department of Pathology, Skin Cancer Center Hannover/Hannover Medical School, Hannover, Germany
| | - Thomas Eigentler
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - Michael Fluck
- Department of Dermatology, Hospital Hornheide, Münster, Germany
| | - Claus Garbe
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - Ralf Gutzmer
- Department of Dermatology and Allergy/Department of Pathology, Skin Cancer Center Hannover/Hannover Medical School, Hannover, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Hospital Mainz, Mainz, Germany
| | - Axel Hauschild
- Department of Dermatology, University Hospital Kiel, Kiel, Germany
| | - Rüdiger Hein
- Department of Dermatology/III. Medical Department, Technische Universität München, München, Germany
| | - Gheorghe Hundorfean
- Department of Internal Medicine (Gastroenterology, Endocrinology, and Pneumology), University Hospital Erlangen, Erlangen, Germany
| | - Armin Justich
- Department of Dermatology, University Hospital Graz, Graz, Austria
| | - Ullrich Keller
- Department of Dermatology/III. Medical Department, Technische Universität München, München, Germany
| | - Christina Klein
- Department of Dermatology, University Hospital Mainz, Mainz, Germany
| | - Christine Mateus
- Institute Gustave Roussy, Department of Dermatology, Villejuif, France
| | - Peter Mohr
- Department of Dermatology, Elbe Kliniken Buxtehude, Buxtehude, Germany
| | - Sylvie Paetzold
- Department of Dermatology, University Hospital Frankfurt, Frankfurt, Germany
| | - Imke Satzger
- Department of Dermatology and Allergy/Department of Pathology, Skin Cancer Center Hannover/Hannover Medical School, Hannover, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Marc Schlaeppi
- Department of Oncology/Hematology and Dermatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Gerold Schuler
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | | | - Uwe Trefzer
- Department of Dermatology, University Hospital Charité Berlin, Berlin, Germany
| | - Jens Ulrich
- Department of Dermatology, Hospital Quedlinburg, Quedlinburg, Germany
| | - Julia Vaubel
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Roger von Moos
- Department of Dermatology, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Patrik Weder
- Department of Oncology/Hematology and Dermatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Tabea Wilhelm
- Department of Dermatology, University Hospital Charité Berlin, Berlin, Germany
| | - Daniela Göppner
- Department of Dermatology, University Hospital Magdeburg, Magdeburg, Germany
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Lucie M. Heinzerling
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
- Department of Oncology/Hematology and Dermatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- * E-mail:
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Krengel S, Satzger I, Alter M, Kapp A, Gutzmer R. [Remission of an iatrogenic Kaposi sarcoma in a patient with myasthenia gravis after switching immunosuppressive therapy to the mTOR inhibitor everolimus]. Hautarzt 2012; 63:573-6. [PMID: 22751858 DOI: 10.1007/s00105-011-2274-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Iatrogenic Kaposi sarcomas (KS) in organ transplant recipients are often treated by switching immunosuppressive therapy to an mTOR inhibitor, such as sirolimus or everolimus, as these have immunosuppressive as well as anti-tumor effects. We report on an 80-year-old male patient who developed a disseminated cutaneous KS during therapy with prednisone and azathioprine for myasthenia gravis. After discontinuation of azathioprine therapy and despite continuing therapy with cortisone, the KS progressed and autoantibody levels against the nicotinic acetylcholine receptor increased. During the administration of everolimus, a long-term near-complete remission of KS and a decrease in autoantibodies took place. This case study illustrates that even in non-organ transplant patients with iatrogenic KS, switching to immunosuppressive therapy using an mTOR inhibitor can be beneficial.
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Affiliation(s)
- S Krengel
- Klinik für Dermatologie, Allergologie und Venerologie, Hauttumorzentrum Hannover, Medizinische Hochschule Hannover, Deutschland.
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Satzger I, Mattern A, Kuettler U, Weinspach D, Niebuhr M, Kapp A, Gutzmer R. microRNA-21 is upregulated in malignant melanoma and influences apoptosis of melanocytic cells. Exp Dermatol 2012; 21:509-14. [DOI: 10.1111/j.1600-0625.2012.01510.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Imke Satzger
- Department of Dermatology and Allergy; Skin Cancer Center Hannover, Hannover Medical School; Hannover; Germany
| | - Anika Mattern
- Department of Dermatology and Allergy; Skin Cancer Center Hannover, Hannover Medical School; Hannover; Germany
| | - Uta Kuettler
- Department of Dermatology and Allergy; Skin Cancer Center Hannover, Hannover Medical School; Hannover; Germany
| | - Dirk Weinspach
- Department of Dermatology and Allergy; Skin Cancer Center Hannover, Hannover Medical School; Hannover; Germany
| | - Margarete Niebuhr
- Department of Dermatology and Allergy; Skin Cancer Center Hannover, Hannover Medical School; Hannover; Germany
| | - Alexander Kapp
- Department of Dermatology and Allergy; Skin Cancer Center Hannover, Hannover Medical School; Hannover; Germany
| | - Ralf Gutzmer
- Department of Dermatology and Allergy; Skin Cancer Center Hannover, Hannover Medical School; Hannover; Germany
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Affiliation(s)
- Imke Satzger
- Klinik für Dermatologie, Allergologie und Venerologie, Hauttumorzentrum Hannover (HTZH), Medizinische Hochschule Hannover, Hannover
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Niebuhr M, Mamerow D, Heratizadeh A, Satzger I, Werfel T. Staphylococcal α-toxin induces a higher T cell proliferation and interleukin-31 in atopic dermatitis. Int Arch Allergy Immunol 2011; 156:412-5. [PMID: 21832830 DOI: 10.1159/000323905] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 12/22/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with atopic dermatitis (AD) are frequently colonized with α-toxin-producing Staphylococcus aureus which is in turn positively correlated with the severity of eczema. METHODS IN this study we addressed T cell proliferation and T cell as well as monocyte cytokine secretion upon α-toxin stimulation in peripheral blood mononuclear cells (PBMCs) from AD patients compared to healthy controls. RESULTS We found that α-toxin stimulation of PBMCs markedly enhanced T cell proliferation both in patients with AD and healthy controls and was significantly increased in AD patients compared to healthy controls. PBMCs of AD patients secreted significantly more IL-31 compared to those of healthy controls upon α-toxin and SEB stimulation. Moreover, α-toxin stimulation yielded an increase in T cell (IL-2, IL-9, IL-10 and IFN-γ) as well as monocyte (IL-1β and TNF-α) cytokine secretion. CONCLUSION Our results could partly explain how skin colonization and infection with S. aureus can contribute to chronic skin inflammation and pruritus in AD.
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Affiliation(s)
- Margarete Niebuhr
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany.
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Satzger I, Meier A, Alter M, Kapp A, Gutzmer R. Parameters predicting prognosis in melanoma sentinel nodes. J Clin Oncol 2011; 29:3588-90; author reply 3590-1. [PMID: 21810683 DOI: 10.1200/jco.2011.37.1112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Meier A, Satzger I, Völker B, Kapp A, Gutzmer R. Reply to assessment of capsular melanoma cell deposits in sentinel lymph nodes. Cancer 2011. [DOI: 10.1002/cncr.25789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Satzger I, Meier A, Alter M, Kapp A, Gutzmer R. Which Parameters to Choose for Prediction of Non-Sentinel Lymph Node Positivity in Melanoma? J Clin Oncol 2011; 29:e315; author reply e316-7. [DOI: 10.1200/jco.2010.33.8210] [Citation(s) in RCA: 4] [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: 11/20/2022] Open
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Niebuhr M, Heratizadeh A, Wichmann K, Satzger I, Werfel T. Intrinsic alterations of pro-inflammatory mediators in unstimulated and TLR-2 stimulated keratinocytes from atopic dermatitis patients. Exp Dermatol 2011; 20:468-72. [DOI: 10.1111/j.1600-0625.2011.01277.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kretschmer L, Starz H, Thoms KM, Satzger I, Völker B, Jung K, Mitteldorf C, Bader C, Siedlecki K, Kapp A, Bertsch HP, Gutzmer R. Age as a key factor influencing metastasizing patterns and disease-specific survival after sentinel lymph node biopsy for cutaneous melanoma. Int J Cancer 2011; 129:1435-42. [PMID: 21064111 DOI: 10.1002/ijc.25747] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 09/08/2010] [Indexed: 11/07/2022]
Abstract
In our study, we investigated the impact of the constitutional factor age on the clinical courses of melanoma patients with sentinel lymph node (SLN) biopsy. Descriptive statistics, Kaplan-Meier estimates, logistic regression analysis and the Cox proportional hazards model were used to study a population of 2,268 consecutive patients from three German melanoma centers. Younger age was significantly related to less advanced primary tumors. Nevertheless, patients younger than 40 years of age had a twofold risk of being SLN-positive (p < 0.000001). Of the young patients with primary melanomas with a thickness of 0.76 mm to 1.0 mm, 19.7% were SLN-positive. Using multivariate analysis, younger age, increasing Breslow thickness, ulceration and male sex were significantly related to a higher probability of SLN-metastasis. During follow-up, older patients displayed a significantly increased risk of in-transit recurrences (p = 0.000002) and lymph node recurrences (p = 0.0004). With respect to melanoma specific overall survival the patient's age was highly significant in the multivariate analysis. The unfavorable effect of being older was significant in the subgroups with positive and negative SLNs. Age remained also significant for the survival after the onset of distant metastases (p = 0.002). In conclusion, the patient's age is a strong and independent predictor of melanoma-specific survival in patients with localized melanomas, in patients with positive SLNs and after the onset of distant metastases. Younger patients have a better prognosis despite their higher probability of SLN metastasis. Older patients are less frequently SLN-positive but have a higher risk of loco-regional recurrence.
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Affiliation(s)
- Lutz Kretschmer
- Department of Dermatology, Venereology and Allergology, Georg August University of Goettingen, Göttingen, Germany.
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Satzger I, Meier A, Hoy L, Völker B, Kapp A, Hauschild A, Gutzmer R. Sentinel Node Dissection Delays Recurrence and Prolongs Melanoma-Related Survival: An Analysis of 673 Patients from a Single Center with Long-Term Follow-Up. Ann Surg Oncol 2010; 18:514-20. [DOI: 10.1245/s10434-010-1318-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Indexed: 11/18/2022]
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Degen A, Alter M, Schenck F, Satzger I, Völker B, Kapp A, Gutzmer R. Das Hand-Fuß-Syndrom als Nebenwirkung der medikamentösen Tumortherapie - Klassifikation und Management. J Dtsch Dermatol Ges 2010. [DOI: 10.1111/j.1610-0387.2010.07449_supp.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gutzmer R, Schenck F, Satzger I. Comparison of classification systems in melanoma sentinel nodes: An analysis of 697 patients from a single center. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Waldkirch ES, Ückert S, Sigl K, Satzger I, Geismar U, Langnäse K, Richter K, Sohn M, Kuczyk MA, Hedlund P. Expression of cyclic AMP-dependent protein kinase isoforms in human cavernous arteries: functional significance and relation to phosphodiesterase type 4. J Sex Med 2010; 7:2104-2111. [PMID: 20487244 DOI: 10.1111/j.1743-6109.2010.01808.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The cyclic adenosine monophosphate-dependent protein kinase (cAK) is considered a key protein in the control of smooth muscle tone in the cardiovascular system. There is evidence that erectile dysfunction might be linked to systemic vascular disorders and arterial insufficiency, subsequently resulting in structural changes in the penile tissue. The expression and significance of cAK in human cavernous arteries (HCA) have not been evaluated. AIMS To evaluate the expression of cAK isoforms in HCA and examine the role of cAK in the cyclic adenosine monophosphate (cAMP)- and cyclic guanosine monophosphate (cGMP)-mediated control of penile vascular smooth muscle. METHODS The expression and distribution of phosphodiesterase type 4 (PDE4) and cAK isoforms in sections of HCA were investigated by means of immunohistochemistry and Western blot analysis. The effects of the cAK inhibitor Rp-8-CPT-cAMPS on the relaxation of isolated preparations of HCA (diameter > 100 µm) induced by rolipram, sildenafil, tadalafil, and vardenafil were studied using the organ bath technique. MAIN OUTCOME MEASURES Investigate the expression of cAK in relation to α-actin and PDE4 in HCA and evaluate the effects of an inhibition of cAK on the relaxation induced by inhibitors of PDE4 and PDE5 of isolated penile arteries. RESULTS Immunosignals specific for cAKIα, IIα, and IIβ were observed within the wall of HCA. Double stainings revealed colocalization of cAK with α-actin and PDE4. The expression of cAK isoforms was confirmed by Western blot analysis. The reversion of tension induced by inhibitors of PDE4 and PDE5 of isolated penile vascular tissue were attenuated significantly by Rp-8-CPT-cAMPS. CONCLUSIONS Our results demonstrate the expression of cAK isoforms in the smooth musculature of HCA and its colocalization with PDE4. A significant role for cAK in the regulation mediated by cAMP and cGMP of vascular smooth muscle tone in HCA can also be assumed.
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Affiliation(s)
- Eginhard S Waldkirch
- Hannover Medical School-Division of Surgery, Department of Urology and Urological Oncology, Hannover, Germany
| | - Stefan Ückert
- Hannover Medical School-Division of Surgery, Department of Urology and Urological Oncology, Hannover, Germany.
| | | | - Imke Satzger
- Hannover Medical School-Department of Dermatology and Allergology, Hannover, Germany
| | | | - Kristina Langnäse
- Otto-von-Guericke-University, Faculty of Medicine-Institute for Biochemistry and Cell Biology, Magdeburg, Germany
| | - Karin Richter
- Otto-von-Guericke-University, Faculty of Medicine-Institute for Biochemistry and Cell Biology, Magdeburg, Germany
| | - Michael Sohn
- Frankfurter Diakonie-Kliniken, St. Markus Academic Hospital-Department of Urology, Frankfurt am Main, Germany
| | - Markus A Kuczyk
- Hannover Medical School-Division of Surgery, Department of Urology and Urological Oncology, Hannover, Germany
| | - Petter Hedlund
- University Vita Salute, Faculty of Medicine, San Raffaele Hospital-Department of Urology, Urological Research Institute, Milan, Italy
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Degen A, Alter M, Schenck F, Satzger I, Völker B, Kapp A, Gutzmer R. The hand-foot-syndrome associated with medical tumor therapy - classification and management. J Dtsch Dermatol Ges 2010; 8:652-61. [PMID: 20482685 DOI: 10.1111/j.1610-0387.2010.07449.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The hand-foot-syndrome (HFS, palmoplantar erythrodysesthesia, chemotherapy-associated acral erythema) is characterized by painful predominantly palmo-plantar lesions. The association with different chemotherapeutic agents has been known for over 20 years. More recently, HFS has been reported in association with regimens using targeted agents, in particular the multikinase inhibitors (MKI) sorafenib and sunitinib. The HFS associated with MKI has a different distribution and clinical appearance than the traditional disorder. In this review, similarities and differences between chemotherapy- and MKI-associated HFS are discussed and current recommendations for their prophylaxis and management are summarized.
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Affiliation(s)
- Annette Degen
- Clinic and Polyclinic for Dermatology, and Allergy, Skin Cancer Center Hannover (HTZH), Hannover Medical School, Germany
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