Pub Date : 2025-01-01DOI: 10.1016/j.ejcskn.2025.100738
Clara Mayo de las Casas , Eloisa Jantus-Lewintre , Sebastian Ortiz Reina , Ana Drozdowskyj , Pablo Cerezuela-Fuentes , Jose Luis Manzano , Pablo Ayala de Miguel , Ana Arance Fernandez , Miguel Angel Berciano-Guerrero , Almudena Garcia-Castaño , Teresa Puertolas , Guillermo Crespo , Maria Quindos-Varela , Juan Francisco Rodriguez-Moreno , Alfonso Berrocal , Eva Muñoz-Couselo , Enrique Espinosa , Joselyn Valarezo , Susana Muñoz , Silvia Calabuig-Fariñas , Maria Gonzalez-Cao
Background
BRAF p.V600 mutation is the most frequent molecular driver alteration in melanoma. Detection of BRAF mutations in circulating-free DNA (cfDNA) reflects the shedding of tumor DNA and offers a potential non-invasive biomarker for disease monitoring and prognosis. However, the lack of standardized methodologies and inter-assay variability hinders its clinical implementation.
Methods
The sensitivity, agreement and concordance of seven BRAF mutation detection assays were assessed across four laboratories. BRAF p.V600 mutation in pretreatment plasma samples was analyzed in 51 patients diagnosed with advanced stage melanoma using two digital PCR-based assays (droplet digital PCR -ddPCR- Bio-Rad and microfluidic digital PCR -Absolute Q, ThermoFisher Scientific-), three RT-PCR based assays (Idylla®, Cobas®, PNA-Q-PCR) and two NGS based assays (Oncomine™ Pan-Cancer Cell-Free Assay and Illumina Platforms).
Results
digital PCR-based assays and Cobas® exhibited the highest sensitivity (51.0 %), followed by NGS Illumina® (45.1 %), Oncomine NGS / PNA-Q-PCR (43.1 %) and Idylla® (37.2 %). Results of different techniques showed a moderate to strong agreement, except for the comparison of Cobas with Idylla that was poor (Kappa=0.57). There was near-perfect agreement on detection of BRAF mutation between both NGS platforms and the NGS Illumina® with PNA-Q-PCR (Kappa = 0.92). Concordance of the quantitative results in terms of mutant allele frequency was near-perfect between NGS Illumina and ddPCR Bio-Rad assays (ICC = 0.99).
Conclusions
Our study demonstrates substantial agreement among multiple cfDNA BRAF mutation detection assays, particularly between NGS and digital PCR assays. These findings support the potential utility of different techniques for BRAF testing in cfDNA.
{"title":"Cross-method comparison for BRAF p.V600 mutation cfDNA testing in Melanoma: BRAFI study","authors":"Clara Mayo de las Casas , Eloisa Jantus-Lewintre , Sebastian Ortiz Reina , Ana Drozdowskyj , Pablo Cerezuela-Fuentes , Jose Luis Manzano , Pablo Ayala de Miguel , Ana Arance Fernandez , Miguel Angel Berciano-Guerrero , Almudena Garcia-Castaño , Teresa Puertolas , Guillermo Crespo , Maria Quindos-Varela , Juan Francisco Rodriguez-Moreno , Alfonso Berrocal , Eva Muñoz-Couselo , Enrique Espinosa , Joselyn Valarezo , Susana Muñoz , Silvia Calabuig-Fariñas , Maria Gonzalez-Cao","doi":"10.1016/j.ejcskn.2025.100738","DOIUrl":"10.1016/j.ejcskn.2025.100738","url":null,"abstract":"<div><h3>Background</h3><div>BRAF p.V600 mutation is the most frequent molecular driver alteration in melanoma. Detection of BRAF mutations in circulating-free DNA (cfDNA) reflects the shedding of tumor DNA and offers a potential non-invasive biomarker for disease monitoring and prognosis. However, the lack of standardized methodologies and inter-assay variability hinders its clinical implementation.</div></div><div><h3>Methods</h3><div>The sensitivity, agreement and concordance of seven <em>BRAF</em> mutation detection assays were assessed across four laboratories. <em>BRAF</em> p.V600 mutation in pretreatment plasma samples was analyzed in 51 patients diagnosed with advanced stage melanoma using two digital PCR-based assays (droplet digital PCR -ddPCR- Bio-Rad and microfluidic digital PCR -Absolute Q, ThermoFisher Scientific-), three RT-PCR based assays (Idylla®, Cobas®, PNA-Q-PCR) and two NGS based assays (Oncomine™ Pan-Cancer Cell-Free Assay and Illumina Platforms).</div></div><div><h3>Results</h3><div>digital PCR-based assays and Cobas® exhibited the highest sensitivity (51.0 %), followed by NGS Illumina® (45.1 %), Oncomine NGS / PNA-Q-PCR (43.1 %) and Idylla® (37.2 %). Results of different techniques showed a moderate to strong agreement, except for the comparison of Cobas with Idylla that was poor (Kappa=0.57). There was near-perfect agreement on detection of <em>BRAF</em> mutation between both NGS platforms and the NGS Illumina® with PNA-Q-PCR (Kappa = 0.92). Concordance of the quantitative results in terms of mutant allele frequency was near-perfect between NGS Illumina and ddPCR Bio-Rad assays (ICC = 0.99).</div></div><div><h3>Conclusions</h3><div>Our study demonstrates substantial agreement among multiple cfDNA <em>BRAF</em> mutation detection assays, particularly between NGS and digital PCR assays. These findings support the potential utility of different techniques for BRAF testing in cfDNA.</div></div>","PeriodicalId":100396,"journal":{"name":"EJC Skin Cancer","volume":"3 ","pages":"Article 100738"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144739604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.ejcskn.2025.100743
Filippo Nozzoli , Silvia Mancini , Andrea Ambrosini-Spaltro , Emilia Crisanti , Luca Riccioni , Giovanni De Luca , Annarita Lombardi , Fabio Falcini , Rosa Vattiato , Federica Zamagni , Lorenzo Borgognoni , Serena Sestini , Vincenzo De Giorgi , Laura Doni , Ismaela Vascotto , Angelo Cassisa , Chiara Anichini , Romina Nassini , Pierangelo Geppetti , Emanuele Crocetti , Daniela Massi
Aims
Perineural invasion (PNI) is a well-recognized risk factor for head and neck cutaneous squamous cell carcinoma (HNCSCC). This study investigates whether a detailed scoring system for PNI can improve prognostic accuracy in HNCSCC, beyond the traditional PNI binary assessment.
Methods
Among the Emilia-Romagna Cancer Registry, we analysed 61 patients with tumour progression and 61 without, using six histological PNI features: number of nerves involved, nerve diameter and depth, intra- vs. extratumoral location, nerve sheath involvement, and presence of mitotic figures within PNI. These parameters were compiled into a cumulative PNI score, categorizing patients as high- or low-risk based on the median score. An additional 20 patients treated with immunotherapy and 25 external PNI-positive cases were included for validation. Prognostic correlations were then analyzed by Cox proportional hazards regression model.
Results
Twenty-one patients (17.2 %) had PNI and 81 % of them were cases with recurrence. A significantly higher proportion of cases (81.0 %) exhibited perineural invasion compared to controls (19.0 %) (p = 0.005). High-risk PNI scores were significantly associated with worse outcomes: five-year overall survival was lower in high-risk patients (10.1 % vs. 23.3 %), and disease-specific survival was also reduced (75.0 % vs. 88.9 %). High-risk PNI scores conferred a four-fold increased risk of recurrence and nearly eight-fold higher risk of death. Among immunotherapy-treated patients, the risk of death was nineteen times higher for those in the high-risk PNI group.
Conclusions
Our findings suggest that a multi-parameter PNI scoring system can refine prognostic stratification, potentially guiding more personalized treatment decisions and informing updates to the current staging guidelines.
{"title":"Evaluating perineural invasion severity in head and neck cutaneous squamous cell carcinomas to refine prognostic accuracy: A retrospective case-control study","authors":"Filippo Nozzoli , Silvia Mancini , Andrea Ambrosini-Spaltro , Emilia Crisanti , Luca Riccioni , Giovanni De Luca , Annarita Lombardi , Fabio Falcini , Rosa Vattiato , Federica Zamagni , Lorenzo Borgognoni , Serena Sestini , Vincenzo De Giorgi , Laura Doni , Ismaela Vascotto , Angelo Cassisa , Chiara Anichini , Romina Nassini , Pierangelo Geppetti , Emanuele Crocetti , Daniela Massi","doi":"10.1016/j.ejcskn.2025.100743","DOIUrl":"10.1016/j.ejcskn.2025.100743","url":null,"abstract":"<div><h3>Aims</h3><div>Perineural invasion (PNI) is a well-recognized risk factor for head and neck cutaneous squamous cell carcinoma (HNCSCC). This study investigates whether a detailed scoring system for PNI can improve prognostic accuracy in HNCSCC, beyond the traditional PNI binary assessment.</div></div><div><h3>Methods</h3><div>Among the Emilia-Romagna Cancer Registry, we analysed 61 patients with tumour progression and 61 without, using six histological PNI features: number of nerves involved, nerve diameter and depth, intra- <em>vs</em>. extratumoral location, nerve sheath involvement, and presence of mitotic figures within PNI. These parameters were compiled into a cumulative PNI score, categorizing patients as high- or low-risk based on the median score. An additional 20 patients treated with immunotherapy and 25 external PNI-positive cases were included for validation. Prognostic correlations were then analyzed by Cox proportional hazards regression model.</div></div><div><h3>Results</h3><div>Twenty-one patients (17.2 %) had PNI and 81 % of them were cases with recurrence. A significantly higher proportion of cases (81.0 %) exhibited perineural invasion compared to controls (19.0 %) (<em>p</em> = 0.005). High-risk PNI scores were significantly associated with worse outcomes: five-year overall survival was lower in high-risk patients (10.1 % vs. 23.3 %), and disease-specific survival was also reduced (75.0 % vs. 88.9 %). High-risk PNI scores conferred a four-fold increased risk of recurrence and nearly eight-fold higher risk of death. Among immunotherapy-treated patients, the risk of death was nineteen times higher for those in the high-risk PNI group.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that a multi-parameter PNI scoring system can refine prognostic stratification, potentially guiding more personalized treatment decisions and informing updates to the current staging guidelines.</div></div>","PeriodicalId":100396,"journal":{"name":"EJC Skin Cancer","volume":"3 ","pages":"Article 100743"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Corrigendum to: Line-field confocal optical coherence tomography (LC-OCT) features of a melanotic macule of the lip [EJC Skin Cancer, vol. 2, December (2024), 100016]","authors":"Barouyr Baroudjian , Clothilde Raoux , Perla El Zeinaty , Camille Gandon , Celeste Lebbé","doi":"10.1016/j.ejcskn.2025.100765","DOIUrl":"10.1016/j.ejcskn.2025.100765","url":null,"abstract":"","PeriodicalId":100396,"journal":{"name":"EJC Skin Cancer","volume":"3 ","pages":"Article 100765"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145750076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.ejcskn.2025.100769
William Liakos , Kevin Varghese , Kennedy Sun , Vishal A. Patel
Neoadjuvant and adjuvant treatment strategies are promising approaches to enhance outcomes in locally advanced, resectable cutaneous squamous cell carcinoma (LACSCC). This review summarizes key studies of neoadjuvant, adjuvant, and combination therapies to guide clinical practice in treatment of LACSCC. The clinical trials and real-world studies reviewed in this study collectively demonstrate that neoadjuvant strategies for LACSCC, especially with immune checkpoint inhibitors, yielded high pathological response rates, improved survival, reduced treatment side effects, and decreased surgical morbidity. Adjuvant immunotherapy also has recently been shown to also provide a substantial benefit in specific LACSCC tumors, often in combination with radiation therapy. Moreover, adaptive neoadjuvant therapies could enable treatment de-escalation and even avoidance of surgery altogether, while achieving high durable response rates.
{"title":"Neoadjuvant and adjuvant therapy for locally advanced cutaneous squamous cell carcinoma","authors":"William Liakos , Kevin Varghese , Kennedy Sun , Vishal A. Patel","doi":"10.1016/j.ejcskn.2025.100769","DOIUrl":"10.1016/j.ejcskn.2025.100769","url":null,"abstract":"<div><div>Neoadjuvant and adjuvant treatment strategies are promising approaches to enhance outcomes in locally advanced, resectable cutaneous squamous cell carcinoma (LACSCC). This review summarizes key studies of neoadjuvant, adjuvant, and combination therapies to guide clinical practice in treatment of LACSCC. The clinical trials and real-world studies reviewed in this study collectively demonstrate that neoadjuvant strategies for LACSCC, especially with immune checkpoint inhibitors, yielded high pathological response rates, improved survival, reduced treatment side effects, and decreased surgical morbidity. Adjuvant immunotherapy also has recently been shown to also provide a substantial benefit in specific LACSCC tumors, often in combination with radiation therapy. Moreover, adaptive neoadjuvant therapies could enable treatment de-escalation and even avoidance of surgery altogether, while achieving high durable response rates.</div></div>","PeriodicalId":100396,"journal":{"name":"EJC Skin Cancer","volume":"3 ","pages":"Article 100769"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145527980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.ejcskn.2025.100763
Lauren Souverijns , Rob Somers , Hanne Boon , Annemiek Leeman , Isabelle Vanden Bempt , Francesca Maria Bosisio
Melanocytomas have been defined as a category of intermediate melanocytic tumors that are situated biologically and genetically between benign nevi and malignant melanomas. Although melanocytomas typically display low-grade clinical behavior, their exact risk of malignant progression remains uncertain. Since the WHO introduced this concept in 2018, there have been substantial advances in understanding their genetic complexity and diagnostic challenges. Reduced inter-observer variability and advanced molecular diagnostics, including next-generation sequencing and copy number variation analysis, can support clinical decisions for management of melanocytomas. This literature review summarizes advances in understanding melanocytoma biology, focusing specifically on WHO pathways 1, 4, 7 and 8, which encompass clinically relevant entities such as Wnt-activated melanocytomas, BAP1-inactivated lesions, pigmented epithelioid melanocytomas, Spitz tumors, congenital nevi and “blue pathway” melanocytic tumors. In particular, we highlight key molecular features that have been linked with the presence of risk of progression to metastatic disease, including gene mutations (e.g., TERT promoter mutations, homozygous CDKN2A deletions, SF3B1 mutation and secondary mutations in BAP1 outside of pathway I) and copy number variations involving parts of the genomes pivotal for melanoma biology. Despite recent progress, further studies are still required to fully characterize the molecular landscape of melanocytomas, aiming to optimize clinical guidelines, reduce diagnostic uncertainty and facilitate appropriate treatment strategies.
{"title":"Molecular analyses in melanocytoma diagnosis and risk progression assessment","authors":"Lauren Souverijns , Rob Somers , Hanne Boon , Annemiek Leeman , Isabelle Vanden Bempt , Francesca Maria Bosisio","doi":"10.1016/j.ejcskn.2025.100763","DOIUrl":"10.1016/j.ejcskn.2025.100763","url":null,"abstract":"<div><div>Melanocytomas have been defined as a category of intermediate melanocytic tumors that are situated biologically and genetically between benign nevi and malignant melanomas. Although melanocytomas typically display low-grade clinical behavior, their exact risk of malignant progression remains uncertain. Since the WHO introduced this concept in 2018, there have been substantial advances in understanding their genetic complexity and diagnostic challenges. Reduced inter-observer variability and advanced molecular diagnostics, including next-generation sequencing and copy number variation analysis, can support clinical decisions for management of melanocytomas. This literature review summarizes advances in understanding melanocytoma biology, focusing specifically on WHO pathways 1, 4, 7 and 8, which encompass clinically relevant entities such as Wnt-activated melanocytomas, BAP1-inactivated lesions, pigmented epithelioid melanocytomas, Spitz tumors, congenital nevi and “blue pathway” melanocytic tumors. In particular, we highlight key molecular features that have been linked with the presence of risk of progression to metastatic disease, including gene mutations (e.g., <em>TERT</em> promoter mutations, homozygous <em>CDKN2A</em> deletions, <em>SF3B1</em> mutation and secondary mutations in <em>BAP1</em> outside of pathway I) and copy number variations involving parts of the genomes pivotal for melanoma biology. Despite recent progress, further studies are still required to fully characterize the molecular landscape of melanocytomas, aiming to optimize clinical guidelines, reduce diagnostic uncertainty and facilitate appropriate treatment strategies.</div></div>","PeriodicalId":100396,"journal":{"name":"EJC Skin Cancer","volume":"3 ","pages":"Article 100763"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145424551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Significant advancements have been made in the treatment of cutaneous melanoma over the past decade, particularly with the effectiveness of immune checkpoint inhibitors (ICIs) in advanced and adjuvant stages. However, the efficacy of ICIs for non-Caucasian populations and the rare clinical subtypes acral melanoma (AM) and mucosal melanoma (MM), has gradually been recognized to be lower in the advanced setting than cutaneous melanoma, suggesting that the use of ICIs in treating AM and MM need careful consideration in terms of ethnic and disease-specific factors to optimize outcomes in the adjuvant and neoadjuvant setting. However, the efficacy of adjuvant and neoadjuvant ICIs for AM and MM remains unclear. Therefore, in this review, we discussed the latest study updates on adjuvant and neoadjuvant therapies for AM and MM, focusing on anti-PD-1 antibody-based therapies. Our findings revealed that the efficacy of adjuvant and neoadjuvant therapy with anti-programmed death-1 receptor (anti-PD-1) antibody-based therapies for cutaneous melanoma is promising; however, their effectiveness varies according to ethnicity and melanoma subtype. There are several ongoing clinical trials on adjuvant and neoadjuvant therapies targeting AM or MM, which will provide the future perspectives of the strategy in the adjuvant and neoadjuvant settings for these rare melanoma subtypes.
{"title":"Adjuvant and neoadjuvant immunotherapy for acral and mucosal melanoma","authors":"Takaya Komori , Shigeru Koizumi , Sadao Inoue , Maiko Yamaura , Yuri Murayama , Atsushi Otsuka , Yasuhiro Nakamura","doi":"10.1016/j.ejcskn.2024.100277","DOIUrl":"10.1016/j.ejcskn.2024.100277","url":null,"abstract":"<div><div>Significant advancements have been made in the treatment of cutaneous melanoma over the past decade, particularly with the effectiveness of immune checkpoint inhibitors (ICIs) in advanced and adjuvant stages. However, the efficacy of ICIs for non-Caucasian populations and the rare clinical subtypes acral melanoma (AM) and mucosal melanoma (MM), has gradually been recognized to be lower in the advanced setting than cutaneous melanoma, suggesting that the use of ICIs in treating AM and MM need careful consideration in terms of ethnic and disease-specific factors to optimize outcomes in the adjuvant and neoadjuvant setting. However, the efficacy of adjuvant and neoadjuvant ICIs for AM and MM remains unclear. Therefore, in this review, we discussed the latest study updates on adjuvant and neoadjuvant therapies for AM and MM, focusing on anti-PD-1 antibody-based therapies. Our findings revealed that the efficacy of adjuvant and neoadjuvant therapy with anti-programmed death-1 receptor (anti-PD-1) antibody-based therapies for cutaneous melanoma is promising; however, their effectiveness varies according to ethnicity and melanoma subtype. There are several ongoing clinical trials on adjuvant and neoadjuvant therapies targeting AM or MM, which will provide the future perspectives of the strategy in the adjuvant and neoadjuvant settings for these rare melanoma subtypes.</div></div>","PeriodicalId":100396,"journal":{"name":"EJC Skin Cancer","volume":"3 ","pages":"Article 100277"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143183584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.ejcskn.2025.100284
Oliver John Kennedy , Nina Glassee , Michal Kicinski , Emanuel Bührer , Sara Valpione , Sara Gandini , Stefan Suciu , Christian U. Blank , Georgina V. Long , Victoria G. Atkinson , Stéphane Dalle , Andrew M. Haydon , Andrey Meshcheryakov , Adnan Khattak , Matteo S. Carlino , Shahneen Sandhu , James Larkin , Susana Puig , Paolo A. Ascierto , Piotr Rutkowski , Mario Mandala
Background
Metabolic conditions, such as obesity and type 2 diabetes mellitus (T2DM), cause changes in immune function that may influence immunotherapy effectiveness and immune-related adverse events (irAEs).
Objectives
To investigate the prognostic and predictive effects of BMI and T2DM and investigate the effect of BMI on toxicity using data from the EORTC 1325/KEYNOTE-054 randomised controlled trial.
Methods
Pembrolizumab (n = 514) was administered every three weeks for 1 year and prolonged recurrence-free survival (RFS) compared to placebo (n = 505) among patients with resected high-risk stage III melanoma. Here, we used multivariate Cox regression to investigate associations of BMI and T2DM with RFS, and Fine and Gray regression to investigate the association of BMI with the cumulative incidence of irAEs.
Results
BMI had an approximately U-shaped association with RFS (p = 0.004) in both treatment arms combined. The RFS hazard ratios (HR)s for BMIs of 20, 30 and 35 kg/m2 (compared to 25 kg/m2) were 1.28 (95 % CI 1.05–1.56), 0.96 (95 % CI 0.88–1.06) and 1.14 (95 % CI 0.98–1.34), respectively. There was no evidence that BMI was associated with pembrolizumab effectiveness (p = 0.20) or the cumulative incidence of irAEs (p = 0.74). T2DM was not associated with RFS (HR 1.01, 95 % CI 0.73–1.40) in both arms combined and there was no evidence of an association between T2DM and pembrolizumab effectiveness (p = 0.83). In summary, in patients with resected high-risk stage III melanoma, BMI was associated with RFS in patients overall and within each treatment group.
Conclusions
BMI appeared to confer a prognostic effect but was not predictive of pembrolizumab effectiveness regarding RFS. BMI was not related to irAEs among patients receiving pembrolizumab, while T2DM was not associated with RFS irrespective of treatment.
代谢条件,如肥胖和2型糖尿病(T2DM),引起免疫功能的改变,可能影响免疫治疗的有效性和免疫相关不良事件(irAEs)。目的利用EORTC 1325/KEYNOTE-054随机对照试验的数据,研究BMI和T2DM的预后和预测作用,并研究BMI对毒性的影响。方法spembrolizumab (n = 514)在切除的高风险III期黑色素瘤患者中每3周给予一次,与安慰剂(n = 505)相比,延长了1年无复发生存期(RFS)。在这里,我们使用多变量Cox回归来研究BMI和T2DM与RFS的关系,并使用Fine和Gray回归来研究BMI与irAEs累积发病率的关系。结果两个治疗组的bmi与RFS呈近似u型相关(p = 0.004)。bmi为20、30和35 kg/m2(与25 kg/m2相比)的RFS风险比分别为1.28(95 % CI 1.05-1.56)、0.96(95 % CI 0.88-1.06)和1.14(95 % CI 0.98-1.34)。没有证据表明BMI与派姆单抗的有效性(p = 0.20)或irAEs的累积发生率(p = 0.74)相关。两组合并T2DM与RFS无关(HR 1.01, 95 % CI 0.73-1.40),并且没有证据表明T2DM与派姆单抗有效性之间存在关联(p = 0.83)。总之,在切除的高风险III期黑色素瘤患者中,BMI与患者总体和每个治疗组的RFS相关。结论:bmi似乎具有预后作用,但不能预测派姆单抗对RFS的有效性。在接受派姆单抗治疗的患者中,BMI与irae无关,而T2DM与RFS无关,无论治疗方式如何。
{"title":"Prognostic and predictive importance of body mass index and type 2 diabetes in the European Organisation for Research and Treatment of Cancer 1325/KEYNOTE-054 phase III trial of pembrolizumab versus placebo in resected high-risk stage III melanoma","authors":"Oliver John Kennedy , Nina Glassee , Michal Kicinski , Emanuel Bührer , Sara Valpione , Sara Gandini , Stefan Suciu , Christian U. Blank , Georgina V. Long , Victoria G. Atkinson , Stéphane Dalle , Andrew M. Haydon , Andrey Meshcheryakov , Adnan Khattak , Matteo S. Carlino , Shahneen Sandhu , James Larkin , Susana Puig , Paolo A. Ascierto , Piotr Rutkowski , Mario Mandala","doi":"10.1016/j.ejcskn.2025.100284","DOIUrl":"10.1016/j.ejcskn.2025.100284","url":null,"abstract":"<div><h3>Background</h3><div>Metabolic conditions, such as obesity and type 2 diabetes mellitus (T2DM), cause changes in immune function that may influence immunotherapy effectiveness and immune-related adverse events (irAEs).</div></div><div><h3>Objectives</h3><div>To investigate the prognostic and predictive effects of BMI and T2DM and investigate the effect of BMI on toxicity using data from the EORTC 1325/KEYNOTE-054 randomised controlled trial.</div></div><div><h3>Methods</h3><div>Pembrolizumab (n = 514) was administered every three weeks for 1 year and prolonged recurrence-free survival (RFS) compared to placebo (n = 505) among patients with resected high-risk stage III melanoma. Here, we used multivariate Cox regression to investigate associations of BMI and T2DM with RFS, and Fine and Gray regression to investigate the association of BMI with the cumulative incidence of irAEs.</div></div><div><h3>Results</h3><div>BMI had an approximately U-shaped association with RFS (p = 0.004) in both treatment arms combined. The RFS hazard ratios (HR)s for BMIs of 20, 30 and 35 kg/m<sup>2</sup> (compared to 25 kg/m<sup>2</sup>) were 1.28 (95 % CI 1.05–1.56), 0.96 (95 % CI 0.88–1.06) and 1.14 (95 % CI 0.98–1.34), respectively. There was no evidence that BMI was associated with pembrolizumab effectiveness (p = 0.20) or the cumulative incidence of irAEs (p = 0.74). T2DM was not associated with RFS (HR 1.01, 95 % CI 0.73–1.40) in both arms combined and there was no evidence of an association between T2DM and pembrolizumab effectiveness (p = 0.83). In summary, in patients with resected high-risk stage III melanoma, BMI was associated with RFS in patients overall and within each treatment group.</div></div><div><h3>Conclusions</h3><div>BMI appeared to confer a prognostic effect but was not predictive of pembrolizumab effectiveness regarding RFS. BMI was not related to irAEs among patients receiving pembrolizumab, while T2DM was not associated with RFS irrespective of treatment.</div></div>","PeriodicalId":100396,"journal":{"name":"EJC Skin Cancer","volume":"3 ","pages":"Article 100284"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143436895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.ejcskn.2025.100286
Jean F. Séi , Véronique Chaussade , Leire Gonzalez-Lara , Iman Aouidad , Arnold Tchakérian , Marc Serra , Ute Zimmermann , Thierry Clerici , Astrid Blom , Elisa Funck-Brentano , Philippe Saiag
Background
Dermatofibrosarcoma protuberans (DFSP) presents a high recurrence rate after conventional excision. Mohs' micrographic surgery (MMS) ensures complete excision and minimal normal tissue loss. However, discriminating between residual tumor and normal skin can be difficult on frozen sections compared with fixed paraffin sections.
Objectives
To develop a MMS procedure in conjunction with fixed paraffin sections to treat DFSP with reduced lateral margins and to evaluate the long-term recurrence rate in a consecutive series of DFSP patients.
Methods
We prospectively collected 223 consecutive cases of DFSP (206 primary and 17 recurrent) treated with fixed-MMS between October 1998 and December 2014 in our skin cancer referral center. Follow-up was provided until October 2020. The fixed-MMS was favored to treat DFSP due to the frequent large size of MMS layer, which made analysis of frozen sections difficult. Determined on the basis of publications on MMS in DFSP, we decided to proceed with a first stage of fixed MMS including a 13 mm lateral margin and a deep margin extending to the underlying muscle fascia.
Results
Most patients (N = 196; 87.9 %) had a complete resection after the first stage. In cases with incomplete resection (N = 27; 12.1 %), only the deep margin was involved in most cases (N = 21/27; 77.8 %). Complete resection was always achieved with a second (N = 23) or third or more stages (N = 3). Only one local recurrence was observed (after 85.3 months) with a median follow-up of 63.9 months [4.4–243.9].
Conclusions
We report the largest cohort of DFSP treated with fixed-MMS. Only one tumor recurred (0.4 % recurrence rate).
{"title":"Treatment of dermatofibrosarcoma protuberans with fixed Mohs' micrographic surgery: A French cohort prospective study","authors":"Jean F. Séi , Véronique Chaussade , Leire Gonzalez-Lara , Iman Aouidad , Arnold Tchakérian , Marc Serra , Ute Zimmermann , Thierry Clerici , Astrid Blom , Elisa Funck-Brentano , Philippe Saiag","doi":"10.1016/j.ejcskn.2025.100286","DOIUrl":"10.1016/j.ejcskn.2025.100286","url":null,"abstract":"<div><h3>Background</h3><div>Dermatofibrosarcoma protuberans (DFSP) presents a high recurrence rate after conventional excision. Mohs' micrographic surgery (MMS) ensures complete excision and minimal normal tissue loss. However, discriminating between residual tumor and normal skin can be difficult on frozen sections compared with fixed paraffin sections.</div></div><div><h3>Objectives</h3><div>To develop a MMS procedure in conjunction with fixed paraffin sections to treat DFSP with reduced lateral margins and to evaluate the long-term recurrence rate in a consecutive series of DFSP patients.</div></div><div><h3>Methods</h3><div>We prospectively collected 223 consecutive cases of DFSP (206 primary and 17 recurrent) treated with fixed-MMS between October 1998 and December 2014 in our skin cancer referral center. Follow-up was provided until October 2020. The fixed-MMS was favored to treat DFSP due to the frequent large size of MMS layer, which made analysis of frozen sections difficult. Determined on the basis of publications on MMS in DFSP, we decided to proceed with a first stage of fixed MMS including a 13 mm lateral margin and a deep margin extending to the underlying muscle fascia.</div></div><div><h3>Results</h3><div>Most patients (N = 196; 87.9 %) had a complete resection after the first stage. In cases with incomplete resection (N = 27; 12.1 %), only the deep margin was involved in most cases (N = 21/27; 77.8 %). Complete resection was always achieved with a second (N = 23) or third or more stages (N = 3). Only one local recurrence was observed (after 85.3 months) with a median follow-up of 63.9 months [4.4–243.9].</div></div><div><h3>Conclusions</h3><div>We report the largest cohort of DFSP treated with fixed-MMS. Only one tumor recurred (0.4 % recurrence rate).</div></div>","PeriodicalId":100396,"journal":{"name":"EJC Skin Cancer","volume":"3 ","pages":"Article 100286"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143471294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}