Melanoma Management最新文献

{"title":"Combination therapy for metastatic melanoma: a pharmacist's role, drug interactions & complementary alternative therapies.","authors":"Gabriel Gazzé","doi":"10.2217/mmt-2017-0026","DOIUrl":"10.2217/mmt-2017-0026","url":null,"abstract":"<p><p>The incidence of metastatic melanoma has been increasing dramatically over the last decades. Yet, there have been many new innovative therapies, such as targeted therapies and checkpoint inhibitors, which have made progress in survival for these patients. The oncology pharmacist is part of the healthcare team and can help in optimizing these newer therapies. There will be discussion about combination therapies, the oncology pharmacist's role, and issues at the core of his interest, such as drug interactions and complementary and alternative therapies.</p>","PeriodicalId":44562,"journal":{"name":"Melanoma Management","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2018-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8b/70/mmt-05-07.PMC6240885.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36703201","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}

{"title":"Preoperative <i>BRAF</i> inhibition in patients with irresectable locally advanced stage III melanoma.","authors":"Marloes Faut,&nbsp;Mathilde Jalving,&nbsp;Gilles F Diercks,&nbsp;Geke A Hospers,&nbsp;Barbara L van Leeuwen,&nbsp;Lukas B Been","doi":"10.2217/mmt-2018-0002","DOIUrl":"https://doi.org/10.2217/mmt-2018-0002","url":null,"abstract":"<p><strong>Aim: </strong>Neoadjuvant treatment of locally advanced disease with <i>BRAF</i> inhibitors is expected to increase the likelihood of a R0 resection. We present six patients with stage III unresectable melanoma, neoadjuvantly treated with <i>BRAF</i> inhibitors.</p><p><strong>Methods: </strong>Patients with unresectable, <i>BRAF</i>-mutated, stage III melanoma, were treated with <i>BRAF</i> inhibitors between 2012 and 2015. Unresectability was determined based on clinical and/or radiological findings. At maximal response, resection was performed. The specimen was reviewed to determine the degree of response.</p><p><strong>Results: </strong>In five of six patients a radical resection was achieved. Postoperative complications were unremarkable. In five of six resected specimens, vital tumor tissue was found.</p><p><strong>Conclusion: </strong>Neoadjuvant <i>BRAF</i> inhibitor treatment of locally advanced melanoma is feasible and has the potential to facilitate an R0 resection.</p>","PeriodicalId":44562,"journal":{"name":"Melanoma Management","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2018-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/mmt-2018-0002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36703202","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}

{"title":"Advances in the use of reflectance confocal microscopy in melanoma.","authors":"Andréanne Waddell,&nbsp;Phoebe Star,&nbsp;Pascale Guitera","doi":"10.2217/mmt-2018-0001","DOIUrl":"https://doi.org/10.2217/mmt-2018-0001","url":null,"abstract":"<p><p><i>In vivo</i> reflectance confocal microscopy (RCM) is a noninvasive high-resolution skin imaging tool that has become an important adjunct to clinical exam, dermoscopy and histopathology assessment, in the diagnosis and management of melanoma. RCM generates a horizontal view of the skin, whereby cellular and subcellular (e.g., nuclei, melanophages, collagen) structures, to the level of the upper dermis, are projected onto a screen at near-histological resolution. Morphologic descriptors, standardized terminology, and diagnostic algorithms are well established for the RCM assessment of melanoma, melanocytic, and nonmelanocytic lesions. Clinical applications of RCM in melanoma are broad and include diagnosis, assessment of large lesions on cosmetically sensitive areas, directing areas to biopsy, delineating margins prior to surgery, detecting response to treatment and assessing recurrence. This review will provide an overview of RCM technology, findings by melanoma subtype, clinical applications, as well as explore the accuracy of RCM for melanoma diagnosis, pitfalls and emerging uses of this technology <i>ex vivo</i>.</p>","PeriodicalId":44562,"journal":{"name":"Melanoma Management","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2018-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/mmt-2018-0001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36471137","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}

{"title":"Real-world experience with pembrolizumab toxicities in advanced melanoma patients: a single-center experience in the UK.","authors":"Alfred Cp So,&nbsp;Ruth E Board","doi":"10.2217/mmt-2017-0028","DOIUrl":"https://doi.org/10.2217/mmt-2017-0028","url":null,"abstract":"<p><strong>Aim: </strong>We aimed to characterize the safety profile of pembrolizumab in advanced melanoma patients at our center to better reflect 'real-world' data on anti-PD-1 inhibitors.</p><p><strong>Materials & methods: </strong>At our institution, 58 ipilimumab-naive and 30 ipilimumab-treated patients with advanced melanoma who have received pembrolizumab between June 2014 and June 2017 were included for analysis.</p><p><strong>Results: </strong>Incidence of any-grade and grade 3/4 toxicities were 81.8% (n = 72) and 12.5% (n = 11), respectively. The most common side effects were skin-related (61.4%, n = 54) and gastrointestinal-related (51.1%, n = 45) events. In total, 25% of patients required oral steroids to manage immune-related adverse events with a median cumulative prednisolone dose of 683 mg (range: 40-3745 mg).</p><p><strong>Conclusion: </strong>Pembrolizumab is well tolerated in 'real-world' patients and severe toxicities can be effectively managed with systemic steroids.</p>","PeriodicalId":44562,"journal":{"name":"Melanoma Management","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2018-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/mmt-2017-0028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36471070","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}

{"title":"Continuing and new roles for surgery in the management of patients with stage IV melanoma.","authors":"Erica B Friedman,&nbsp;John F Thompson","doi":"10.2217/mmt-2017-0024","DOIUrl":"https://doi.org/10.2217/mmt-2017-0024","url":null,"abstract":"Until a few years ago, it was generally agreed that the best treatment option for melanoma patients with distant metastases (stage IV disease) was complete surgical resection, whenever possible. Those with more widespread disease or who were deemed unfit for surgery were referred to medical oncologists, but they had little to offer in the way of effective systemic therapy, and often simply recommended palliative end-of-life care. In the second decade of the 21st century, however, we have witnessed a dramatic change in the management of metastatic melanoma, with the introduction of two novel therapeutic drug classes – targeted small molecule inhibitors of the oncogenic BRAF V600 mutation or a downstream signaling target (MEK), and immune checkpoint inhibitors consisting of monoclonal antibodies against CTLA-4 and PD-1. Accordingly, clinical decision making for patients with stage IV melanoma has become increasingly complex, and multiple clinical trials are in progress to determine the best strategies to combine or sequence systemic treatment and surgery. Some believe that a complete paradigm shift in the approach to patients with metastatic melanoma has occurred, with surgeons no longer playing any useful role. A more enlightened view is that we have entered an era of truly integrated and carefully coordinated multidisciplinary care of these patients. The reality is that surgery remains an excellent treatment option for patients with just one or a small number of distant metastases. Complete surgical resection offers a rapid, cost-effective means of rendering them clinically disease free and should be the first-line treatment in appropriately screened patients. This strategy is supported by the results of several clinical trials. Good survival outcomes were achieved in the CanvaxinTM stage IV trial, which compared patients who received adjuvant treatment with Bacillus Calmette–Guérin (BCG) and an allogenic melanoma vaccine after complete resection of metastatic disease to patients who received only BCG with placebo after resection [1]. While the study did not show any benefit in the vaccine-treated arm, 5-year overall survival (OS) rates following complete surgical resection were approximately 40% in both groups, substantially higher than would have been expected if the patients had been treated with the systemic therapies that were available at the time. The Southwestern Oncology Group’s prospective multicenter trial of patients with surgically resectable metastatic melanoma also found that prolonged OS can be achieved by complete resection. While median relapse-free survival (RFS) was short (5 months), median OS was 21 months and 4-year survival was 31% [2]. In the first Multicenter Lymphadenectomy Trial, retrospective analysis of patients who developed distant metastases found that inclusion of surgery as part of the treatment plan conferred a survival advantage, even in patients who developed high-risk visceral metastases. If surgery was perfo","PeriodicalId":44562,"journal":{"name":"Melanoma Management","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2018-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/mmt-2017-0024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36471136","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}

{"title":"Interferon is associated with improved survival for node-positive cutaneous melanoma: a single-institution experience.","authors":"Daniel E Oliver,&nbsp;Vernon K Sondak,&nbsp;Tobin Strom,&nbsp;Jonathan S Zager,&nbsp;Arash O Naghavi,&nbsp;Amod Sarnaik,&nbsp;Jane L Messina,&nbsp;Jimmy J Caudell,&nbsp;Andy M Trotti,&nbsp;Javier F Torres-Roca,&nbsp;Nikhil I Khushalani,&nbsp;Louis B Harrison","doi":"10.2217/mmt-2017-0025","DOIUrl":"https://doi.org/10.2217/mmt-2017-0025","url":null,"abstract":"<p><strong>Aim: </strong>We assessed the role of adjuvant interferon on relapse-free survival (RFS), distant metastasis-free survival (DMFS) and overall survival (OS) in node-positive melanoma patients.</p><p><strong>Methods: </strong>We retrospectively reviewed 385 node-positive patients without distant metastatic disease treated from 1998 to 2015. The surgery was therapeutic lymph node dissection (LND, n = 86) or sentinel lymph node biopsy ± completion LND (n = 270). 128 patients (33.2%) received adjuvant interferon.</p><p><strong>Results: </strong>After a median follow-up of 70 months, interferon was associated with improved RFS (hazard ratio [HR]: 0.55; p < 0.001), DMFS (HR: 0.59; p < 0.001) and OS (HR: 0.61; p = 0.003), controlling for tumor and nodal stage, node size, sex, primary site, adjuvant therapy and extracapsular extension. In an exploratory age-matched comparison of patients treated with (n = 67) and without (n = 233) adjuvant immunotherapy, interferon still showed improved RFS, DMFS and OS.</p><p><strong>Conclusion: </strong>Adjuvant interferon appears to improve OS among node-positive melanoma patients in a modern experience, providing context for comparison in the adjuvant therapy landscape.</p>","PeriodicalId":44562,"journal":{"name":"Melanoma Management","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2018-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/mmt-2017-0025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36471135","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}

{"title":"Gastrointestinal adverse events with combination of checkpoint inhibitors in advanced melanoma: a systematic review.","authors":"Elizabeth S Mearns,&nbsp;Jill A Bell,&nbsp;Aaron Galaznik,&nbsp;Stefanie M Puglielli,&nbsp;Allie B Cichewicz,&nbsp;Talia Boulanger,&nbsp;Ignacio Garcia-Ribas","doi":"10.2217/mmt-2017-0027","DOIUrl":"10.2217/mmt-2017-0027","url":null,"abstract":"<p><strong>Introduction: </strong>Immunotherapies, including checkpoint inhibitors (CIs) such as cytotoxic T-lymphocyte antigen-4 (CTLA-4) and programmed death-1 (PD-1) inhibitors, are revolutionizing the treatment of advanced melanoma. Combining CTLA-4 and PD-1 inhibitors provides additional clinical benefit compared with single agents alone. However, combination therapy can increase the incidence of gastrointestinal adverse events (GI AEs). This systematic review assessed the epidemiological, clinical, economic, and humanistic burden of GI AEs due to combination CIs in advanced melanoma.</p><p><strong>Methods: </strong>MEDLINE, EMBASE, and the Cochrane Library were systematically searched (December 2011 to December 2016) to identify primary studies, systematic reviews, meta-analyses, and conference proceedings (2014-2016) evaluating adults treated with ≥2 CIs for advanced melanoma.</p><p><strong>Results: </strong>Of the 3391 identified articles, 14 were included. Most studies examined the ipilimumab plus nivolumab combination. Any grade and grade 3-4 GI AEs occurred in more patients receiving ipilimumab plus nivolumab versus ipilimumab or nivolumab alone. The most common grade 3-4 GI AEs were diarrhea and colitis. Grade 3-4 colitis occurred in more patients receiving ipilimumab plus nivolumab. However, grade 3-4 diarrhea occurred at the same rate as ipilimumab alone. GI AEs developed with ipilimumab plus nivolumab approximately 6.6 weeks after initiating treatment. No studies assessing the economic or humanistic burden of GI AEs were identified.</p><p><strong>Conclusion: </strong>GI AEs occurred at a higher rate and greater severity in patients treated with ipilimumab plus nivolumab versus ipilimumab or nivolumab monotherapy. The lack of research on economic and humanistic burden of GI AEs with combination CIs for advanced melanoma represents an unmet need in the literature and should be explored in future studies.</p>","PeriodicalId":44562,"journal":{"name":"Melanoma Management","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2018-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/mmt-2017-0027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36471134","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}

{"title":"An update on the relevance of vaccine research for the treatment of metastatic melanoma.","authors":"Robert O Dillman","doi":"10.2217/mmt-2017-0021","DOIUrl":"10.2217/mmt-2017-0021","url":null,"abstract":"<p><p>Signal transduction inhibitors and anticheckpoint antibodies have significantly improved survival for metastatic melanoma patients, but most still die within 5 years. Vaccine approaches to induce immunity to well-characterized melanoma-associated antigens, or to antigens expressed on allogeneic tumor cell lines, have not resulted in approved agents. Despite the limitations associated with the immunosuppressive tumor microenvironment, there now is one intralesional autologous vaccine approved for patients who have primarily soft-tissue metastases. There is continued interest in patient-specific vaccines, especially dendritic cell vaccines that utilize <i>ex vivo</i> loading of autologous antigen, thus bypassing certain <i>in vivo</i> immunosuppressive cells and cytokines. Because of their mechanism of action and limited toxicity, they are potentially synergistic or additive to other antimelanoma therapies.</p>","PeriodicalId":44562,"journal":{"name":"Melanoma Management","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/mmt-2017-0021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36471133","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}

{"title":"Has the melanoma information tsunami become a maelstrom?","authors":"John F Thompson, Alexander M Menzies","doi":"10.2217/mmt-2017-0020","DOIUrl":"10.2217/mmt-2017-0020","url":null,"abstract":"","PeriodicalId":44562,"journal":{"name":"Melanoma Management","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6094604/pdf/mmt-04-179.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36471131","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}

{"title":"Management of the cutaneous adverse effects of antimelanoma therapy.","authors":"Rose Congwei Liu,&nbsp;Germana Consuegra,&nbsp;Pablo Fernández-Peñas","doi":"10.2217/mmt-2017-0015","DOIUrl":"https://doi.org/10.2217/mmt-2017-0015","url":null,"abstract":"The advent of targeted therapy and immunotherapy has revolutionized the management of advanced melanoma. However, these novel therapies are associated with adverse effects (AEs), of which cutaneous toxicities are the most frequently observed. These cutaneous AEs can exert significant morbidity and impact on patient quality of life, hence the recognition and management of AEs is fundamental in preventing interruption or cessation of survival-prolonging treatments. Additionally, knowledge of these AEs are necessary in order for healthcare professionals to counsel patients when starting treatment and in the initiation of AE prophylaxis. The incidence and clinical presentation of the cutaneous toxicities of novel melanoma therapies will be discussed, and treatment guidelines provided.","PeriodicalId":44562,"journal":{"name":"Melanoma Management","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/mmt-2017-0015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36471132","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}