Melanoma Management最新文献

Background: Adjuvant immunotherapy and targeted therapy are now the standard of care for patients with resected stage IIIA-IV melanoma. However, little is known regarding its efficacy in real-world patients who were not represented in these landmark trials.

Methods: This retrospective study included all patients with resected stage IIIA-IV melanoma who received adjuvant systemic therapy between January 1 2018 and December 31 2020, in two Canadian academic cancer. Primary outcome was the proportion of trial non-eligible patients in the real-world setting. Survival and safety analyses were also conducted.

Results: Of the total 113 patient, 99 (88%) were trial non-eligible patients. Most common reasons for trial non-eligible criteria was having no baseline CLND (72%), followed by outside of treatment window >12 weeks (30%), stage IIIA (14%), unknown primary (9%), stage IV (14%), and baseline AD on immunosuppressants (3%). There were no significant RFS (P = 0.731) or OS (P = 0.110) differences in the overall population of trial eligible vs. non-eligible. Safety profiles were similar between the trial eligible vs. non-eligible groups.

Conclusion: Our study suggested a high proportion of real-world patients would have been deemed non-eligible for clinical trials. Regardless, adjuvant systemic therapy delivered similar survival and toxicity outcomes in both groups.

Background: Vemurafenib (Zelboraf^®, Roche), approved by the FDA in 2011 for unresectable and metastatic melanoma and Erdheim-Chester Disease, has been explored in trials for other BRAF-mutated cancers. Despite 12 years of clinical use, the risk-benefit profile for off-label indications remain unclear.

Research design and methods: This study systematically reviewed clinical trials utilizing vemurafenib in adult malignancies, with responses assessed using RECIST or similar criteria. On May 25, 2023, we searched PubMed/MEDLINE, Embase, Cochrane CENTRAL, and ClinicalTrials.gov. Screening and data extraction were performed in a masked, duplicate fashion, collecting data on trial characteristics, adverse events, progression-free survival, overall survival, and objective response rates.

Results: Vemurafenib was tested in 15 cancers beyond its FDA-approved indications. A 0% complete response rate was observed in colorectal cancer, non-small cell lung cancer, and papillary thyroid cancer. Adverse events were more frequent in non-melanoma cancers, with 5,205 grade 3-5 events reported, equating to two severe events for every three participants. Only metastatic melanoma consistently demonstrated efficacy, aligning with its FDA approval.

Conclusions: Although vemurafenib showed efficacy in metastatic melanoma, off-label use resulted in limited benefit and increased adverse events. Unclear endpoints and underreported adverse events highlight the need for improved clinical trial design.

Aims: Skin biopsy remains the diagnostic gold standard for assessing melanocytic lesions, yet its use is influenced by provider experience and scope of practice. This study evaluated patient attitudes toward biopsy, barriers such as discomfort and needle phobia, and interest in noninvasive alternatives.

Patients and methods: A cross-sectional survey of 506 adults assessed prior biopsy experience, biopsy-related discomfort, recovery time, anesthesia pain, needle fear and willingness to pay for noninvasive tools.

Results: Twenty-eight percent of respondents had undergone biopsy. Of these, two-thirds reported discomfort and 28% rated it moderate to high. Recovery lasted ≥1 week for 59%, ≥2 weeks for 18%, and ≥1 month for 7%. Anesthesia was moderately to very painful for 33%. Common concerns included pain, scarring, infection risk and prolonged healing. Among those with biopsy experience, 53% expressed strong interest in noninvasive diagnostics, and 82% were willing to pay out-of-pocket.

Conclusions: Patient-reported pain, needle fear and prolonged recovery contribute to hesitancy toward biopsy. Strong interest in noninvasive methods underscores the need to advance alternatives such as reflective confocal microscopy, tape stripping and electrical impedance spectroscopy, while future studies should examine socioeconomic and access-related influences.

Primary dermal melanoma (PDM) is a rare subtype of cutaneous melanoma, with involvement of the dermis/subcutaneous tissue or both, but no involvement of the epidermis. PDM could not be distinguished histologically from metastasis of primary cutaneous melanoma. PDM has a longer life expectancy compared to cutaneous metastatic melanoma. Therefore, it is important to recognize PDM and make a correct diagnosis. We present a case of primary dermal melanoma on the left leg of a 38-year-old woman.

The management of advanced, unresectable, or metastatic BRAFV600-mutated melanoma is complex, particularly regarding therapy sequencing with targeted therapies (TT) and immune checkpoint inhibitors (ICI). The REMINISCENCE project aimed to enhance individualized therapy approaches by analyzing case reports of patients undergoing encorafenib and binimetinib (EB) therapy. This report discusses three melanoma patients with brain metastases treated in Germany and Austria, emphasizing personalized treatment strategies in BRAFV600-mutated melanoma, particularly when both ICI and TT are available. The timing for transitioning between therapies remains contentious, with many patients experiencing disease progression during or after adjuvant therapy. Findings from clinical trials like DREAMseq, SECOMBIT, EBIN, and ImmunoCobiVem may not directly apply to this evolving clinical landscape due to the impact of prior therapies on the tumor microenvironment. The variations in trial designs further complicate sequencing strategies. Emerging methods, such as early circulating tumor DNA (ctDNA)-guided approaches, present potential pathways for personalized treatment. Ongoing research into sequencing therapy is crucial for improving clinical outcomes. To determine the most effective treatment sequences based on individual medical histories, genetic profiles, and treatment goals, there is an urgent need for prospective biomarker-driven clinical trials.

Aim: The collaborative ocular melanoma study (COMS) reported similar survival between plaque brachytherapy (a type of interventional radiotherapy) and enucleation for medium-sized choroidal melanomas. We aimed to quantify the mortality differences required to achieve statistical significance and assess the robustness of these thresholds.

Methods: We reanalyzed 12-year mortality data from COMS using threshold analysis to determine how many additional or fewer deaths in either treatment arm would shift the lower bound of the 95% confidence interval (CI) for the risk ratio above 1.

Results: At 12 years, there were 105 melanoma-related deaths in the brachytherapy arm and 98 in the enucleation arm (risk ratio 1.08, 95% CI 0.82-1.42). Achieving statistical significance would have required 31 additional deaths in the brachytherapy arm or 23 fewer in the enucleation arm; conversely, favoring brachytherapy would have necessitated 34 additional deaths in the enucleation arm or 27 fewer in the brachytherapy arm. These thresholds remained consistent across power levels and sensitivity scenarios.

Conclusions: The COMS trial did not reveal a clinically meaningful survival difference. Our findings underscore the substantial mortality shifts required for statistical significance and highlight the challenges in detecting modest treatment effects in uveal melanoma trials.

Background: This bibliometric analysis aims to describe research trends and assess the methodological quality of the highest-impact SLNB research in melanoma.

Methods: We identified the 90 most cited publications on SLNB in melanoma using Web of Science, covering all available journal years (from 2005 to date). The Oxford Center for Evidence-Based Medicine (OCEBM) Levels of Evidence (LOE) were used to assess the methodological quality of each study.

Results: The 90 most cited publications on SLNB in melanoma collectively garnered 10,314 citations. Citation counts per publication ranged from 44 to 1,405 (mean 114.6 ± 185.2), with the highest-cited study authored by Professor Donald Morton et al. The majority of publications was classified as LOE 3 (n = 36). The United States of America (USA) led in publication output with 43 articles. Professors Merrick Ross (USA) and John Thompson (Australia) were the leading authors by publication count. The University of Sydney (Australia), University of Texas System, and Anderson Cancer Center (USA) were the top contributing institutions. Annals of Surgical Oncology published most articles.

Conclusions: This bibliometric analysis provides a comprehensive overview and valuable reference for future researchers in the field of SLNB in melanoma.

Background: Advances in cancer therapy have improved patient outcomes, but cardiotoxicity remains a significant risk. In melanoma patients treated with BRAF and MEK inhibitors, monitoring left ventricular ejection fraction (LVEF) during treatment is recommended to detect cardiac dysfunction. Despite the widespread use of FDG-PET in oncology, its potential for concurrent cardiac assessment remains underexplored.

Methods: A 42-year-old male undergoing treatment for disseminated melanoma underwent measurements of LVEF using four modalities: 3D-MUGA, 3D echocardiography, Rb-PET, and gated FDG-PET.

Results: LVEF was within the normal range across all modalities: 60% (3D-MUGA), 61% (3D echocardiography), 63% (Rb-PET), and 65% (FDG-PET).

Conclusion: This case presents an estimation of LVEF derived from a clinically indicated, FDG-PET scan, performed alongside three conventional modalities on the same day. This approach may be particularly useful in melanoma patients who undergo frequent FDG-PET scans. While the findings are promising, broader validation is needed.