RESUMO
Purpose Transplant recipients who develop cutaneous squamous cell carcinomas are at high risk for multiple subsequent skin cancers. Sirolimus has been shown to reduce the occurrence of secondary skin cancers, but no study included a follow-up exceeding 2 years. We extended at 5 years the TUMORAPA randomized trial of sirolimus-based immunosuppressive regimen versus calcineurin inhibitor-based immunosuppression. Methods Kidney transplant recipients receiving calcineurin inhibitors who had at least one cutaneous squamous cell carcinoma were randomly assigned to receive sirolimus as a substitute for calcineurin inhibitors (n = 64) or to maintain their initial treatment (n = 56). The primary end point was survival free of squamous cell carcinoma at 5 years. Secondary end points included the occurrence of other skin cancers, renal function, patient and graft survival, and treatment tolerance. Results Survival free of cutaneous squamous cell carcinoma was significantly longer in the sirolimus group than in the calcineurin inhibitor group ( P = .007). In the sirolimus group, the number of patients with new skin cancers was significantly lower compared with the calcineurin inhibitor group: 22% versus 59% for squamous cell carcinomas ( P < .001), 34% versus 66% for other skin cancers ( P < .001), and 20% versus 37.5% for basal cell carcinomas ( P < .05). Kidney graft function, patients, and graft survival were similar in both groups. In the sirolimus group, the mean number of serious adverse effects per patient decreased from 1.16 during the first 2 years, to 0.83 between years 2 and 5. Conclusion In kidney transplant recipients with previous cutaneous squamous cell carcinomas, the antitumoral effect of conversion from calcineurin inhibitors to sirolimus was maintained at 5 years, and sirolimus tolerance was satisfactory.
Assuntos
Carcinoma de Células Escamosas/imunologia , Hospedeiro Imunocomprometido/efeitos dos fármacos , Imunossupressores/uso terapêutico , Sirolimo/uso terapêutico , Neoplasias Cutâneas/imunologia , Inibidores de Calcineurina/efeitos adversos , Carcinoma de Células Escamosas/prevenção & controle , Humanos , Transplante de Rim , Prevenção Secundária/métodos , Neoplasias Cutâneas/prevenção & controle , TransplantadosRESUMO
Immunotherapy for melanoma includes adoptive cell therapy with autologous tumor-infiltrating lymphocytes (TILs). This monocenter retrospective study was undertaken to evaluate the efficacy and safety of this treatment of patients with advanced melanoma. All advanced melanoma patients treated with TILs using the same TIL expansion methodology and same treatment interleukin-2 (IL-2) regimen between 2009 and 2012 were included. After sterile intralesional excision of a cutaneous or subcutaneous metastasis, TILs were produced according to a previously described method and then infused into the patient who also received a complementary subcutaneous IL-2 regimen. Nine women and 1 man were treated for unresectable stage IIIC (n = 4) or IV (n = 6) melanoma. All but 1 patient with unresectable stage III melanoma (1st line) had received at least 2 previous treatments, including anti-CTLA-4 antibody for 4. The number of TILs infused ranged from 0.23 × 109 to 22.9 × 109. Regarding safety, no serious adverse effect was reported. Therapeutic responses included a complete remission, a partial remission, 2 stabilizations, and 6 progressions. Among these 4 patients with clinical benefit, 1 is still alive with 9 years of follow-up and 1 died from another cause after 8 years of follow-up. Notably, patients treated with high percentages of CD4 + CD25 + CD127lowFoxp3+ T cells among their TILs had significantly shorter OS. The therapeutic effect of combining TILs with new immunotherapies needs further investigation.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Imunoterapia Adotiva/métodos , Linfócitos do Interstício Tumoral/imunologia , Melanoma/terapia , Linfócitos T Reguladores/imunologia , Células Cultivadas , Feminino , Seguimentos , Fatores de Transcrição Forkhead/metabolismo , Humanos , Interleucina-2/metabolismo , Linfócitos do Interstício Tumoral/transplante , Masculino , Melanoma/mortalidade , Melanoma/patologia , Estadiamento de Neoplasias , Indução de Remissão , Estudos Retrospectivos , Análise de Sobrevida , Linfócitos T Reguladores/transplanteRESUMO
OBJECTIVE: Severe dermatophytosis is described in immunocompromised patients with defective cellular immunity. We report here a large series and a literature review of severe dermatophytosis in solid-organ transplant (SOT) recipients. METHOD: The data main source was a national French retrospective study of severe dermatophytosis in SOT recipients between 2010 and 2016. Inclusion criteria were the presence of dermatophytes in skin culture and 1 severity criteria: dermal invasion by dermatophytes (invasive dermatophytosis) or involvement of at least two body sites or >10% of body surface area (extensive dermatophytosis). RESULTS: A total of 12 patients were included (8 men, median age of 56 years [range: 33-71]). Of the 12 patients, 10 underwent kidney transplantation. The median time from transplantation to severe dermatophytosis diagnosis was 16 months [range: 2-94]. Clinical signs of superficial dermatophytosis were present in 8/12 patients before the emergence of severe dermatophytosis. Nine patients had invasive forms and three extensive ones, and nodules of the lower extremities were found in eight. Trichophyton rubrum was isolated in 11 cases. First-line treatment was terbinafine (7/12), posaconazole (3/12), or topical treatment alone (2/12). Immunosuppressive therapy was reduced in 3 patients because of associated infections. Complete response was obtained for 3/3 and 5/9 patients with extensive or invasive forms, respectively, after a median treatment's duration of 2.5 [range: 1.5-5] months and 7.5 months [range: 4-12]. Unrelated deaths (n = 2) and graft function impairment (n = 3) occurred. CONCLUSION: Severe dermatophytosis is a late complication in SOT recipients presenting with lower limb nodules, which might be prevented by prompt treatment of superficial dermatophytosis.
Assuntos
Transplante de Órgãos/efeitos adversos , Tinha/epidemiologia , Tinha/microbiologia , Transplantados , Trichophyton/isolamento & purificação , Adulto , Idoso , Feminino , França/epidemiologia , Humanos , Hospedeiro Imunocomprometido , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Tinha/etiologiaRESUMO
BACKGROUND: The course of skin cancer after retransplantation in organ-transplant recipients who have already developed posttransplant skin cancer has not been assessed. METHODS: This retrospective multicentric study included 53 patients with a history of cutaneous squamous cell carcinoma (SCC) after a first kidney transplantation who received a second kidney transplantation. The primary endpoint was the occurrence of aggressive cutaneous SCC after the second transplantation. Secondary endpoints included the course of skin cancers over 3 periods (first transplantation, return to dialysis, second transplantation), the time to occurrence, and risk factors for aggressive SCC after retransplantation. RESULTS: The first SCC developed in 47 patients with a functional graft and in 6 after return to dialysis. After the first transplantation, 17 (33.3%) patients developed SCC in dialysis and 39 (73.6%) after the second transplantation, respectively. Twenty aggressive SCC developed over the study period. They occurred in 14 (26.4%) patients after retransplantation vs 5 (9.4%) after the first transplantation with a median delay of 50 months and were responsible for 5 deaths. Fair skin type, multiple tumors before retransplantation, treatment with azathioprine, T cell-depleting antibodies, and delayed revision of immunosuppression were associated with an increased risk of aggressive cutaneous SCC after retransplantation. CONCLUSIONS: Candidates to retransplantation with a history of posttransplant SCC have a high risk of aggressive SCC. Our data suggest that the risk could be reduced by a tailored immunosuppression. A wait period may be required depending on the clinicopathological characteristics of the previous SCC and discussed on an individual patient basis.
Assuntos
Carcinoma de Células Escamosas/etiologia , Transplante de Rim/efeitos adversos , Reoperação/efeitos adversos , Neoplasias Cutâneas/etiologia , Adulto , Carcinoma de Células Escamosas/induzido quimicamente , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Feminino , França , Humanos , Imunossupressores/efeitos adversos , Estimativa de Kaplan-Meier , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Países Baixos , Modelos de Riscos Proporcionais , Diálise Renal , Reoperação/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Neoplasias Cutâneas/induzido quimicamente , Neoplasias Cutâneas/mortalidade , Neoplasias Cutâneas/patologia , Fatores de Tempo , Resultado do TratamentoRESUMO
The aims of this study were to determine the clinical and histological characteristics of melanoma in transplant recipients, the mutation profile (BRAF, NRAS and c-KIT genes), and the immune tolerance of the tumour microenvironment by immunohistochemical study of the expression of indoleamine 2,3-dioxygenase (IDO), PD1, PD-L1, CD8 and FoxP3. The study population comprised patients who had undergone a renal transplant in Nantes University Hospital who developed post-transplantation melanoma. Twenty cases of melanoma out of 4,663 transplant recipients were studied. The results differed from the usual data with respect to melanoma site: 40% were located on the face and were of the malignant lentigo type. The mutation profile was concordant with that of the immunocompetent population. IDO was expressed in all the sections tested, while CD8, FoxP3, PD1 and PD-L1 were poorly expressed. This reflected a highly immunodepressed tumour environment, raising the question of the inductive role of IDO on tumour immune tolerance in patients presenting with long-term immunodepression.
Assuntos
Biomarcadores Tumorais/genética , Imunidade Inata , Transplante de Rim/efeitos adversos , Melanoma/genética , Melanoma/imunologia , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígeno B7-H1/análise , Biomarcadores Tumorais/análise , Linfócitos T CD8-Positivos/imunologia , Análise Mutacional de DNA , Feminino , Fatores de Transcrição Forkhead/análise , GTP Fosfo-Hidrolases/genética , Predisposição Genética para Doença , Humanos , Tolerância Imunológica , Imunidade Inata/efeitos dos fármacos , Hospedeiro Imunocomprometido , Imuno-Histoquímica , Imunossupressores/efeitos adversos , Indolamina-Pirrol 2,3,-Dioxigenase/análise , Linfócitos do Interstício Tumoral/imunologia , Masculino , Proteínas de Membrana/genética , Pessoa de Meia-Idade , Mutação , Fenótipo , Receptor de Morte Celular Programada 1/análise , Proteínas Proto-Oncogênicas B-raf/genética , Proteínas Proto-Oncogênicas c-kit/genética , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Evasão Tumoral , Microambiente Tumoral , Adulto JovemRESUMO
Few satisfactory treatment options are available for widespread areas affected by multiple actinic keratoses (AKs). Our primary objective was to assess the response rate to weekly 5-fluorouracil (5-FU) chemowraps on widespread AK lesions, and secondarily to assess tolerability, the percentage of patients with recurrence and time to recurrence, the response rate for patients with associated Bowen's disease (BD), and the percentage of squamous cell carcinomas (SCCs) identified after treatment. We conducted an open study which included all the patients who had been treated with weekly 5-FU chemowraps in our department over the course of five years for areas of widespread AKs. The response rate for AKs was 60%, with 20% complete responses among 25 patients after an average of 9.6 sessions (1 to 64). The treatment had to be discontinued because of toxicity in four patients; one case of contact dermatitis, one case of erosive pustular dermatosis, and two cases of Grade 2 irritations. Invasive SCCs were identified in five patients after treatment cessation. The median recurrence-free survival was five months. A 64% response rate was achieved for associated BD. The weekly application of 5-FU under occlusion seems to be an interesting, well-tolerated therapeutic option for the treatment of widespread AKs.
Assuntos
Fármacos Dermatológicos/administração & dosagem , Fluoruracila/administração & dosagem , Ceratose Actínica/tratamento farmacológico , Administração Cutânea , Idoso , Idoso de 80 Anos ou mais , Esquema de Medicação , Feminino , Humanos , Ceratose Actínica/patologia , Masculino , Pessoa de Meia-Idade , Uso Off-Label , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Circulating tumor DNA is a promising non-invasive tool for cancer monitoring. The main objective of our work was to investigate the relationship between mutant BRAF DNA in plasma and clinical response. Thirty-eight stage IV patients with a V600 mutated BRAF melanoma were included prior to any treatment. DNA was extracted from plasma and mutant DNA was detected using the amplification-refractory mutation system method. Before the beginning of any treatment, the corresponding BRAF mutation was detected in 29 of the 38 tested plasma samples (76.3% positive per cent agreement). We observed a strong correlation between the presence of circulating mutated DNA and overall survival (OS; P=.02), and with the number of metastatic sites (P=.01). The presence of circulating mutated DNA was also strongly correlated with serum LDH activity (P<.01) and S100 protein concentration (P<.01). Finally, seven patients presented discordant BRAF status in different tumor sites. In all these patients, the test performed on ctDNA was positive, suggesting that ctDNA analysis might be less sensitive to tumor heterogeneity. Altogether, these results suggest that plasmatic mutant BRAF DNA is a prognostic factor of OS, correlated with tumor burden. In addition, it represents an interesting alternative source of DNA to detect BRAF mutations before treatment.
Assuntos
DNA Tumoral Circulante/química , Melanoma/genética , Proteínas Proto-Oncogênicas B-raf/genética , Adulto , Idoso , Feminino , França/epidemiologia , Humanos , L-Lactato Desidrogenase/sangue , Masculino , Melanoma/sangue , Melanoma/mortalidade , Pessoa de Meia-Idade , Metástase Neoplásica , Proteínas S100/sangueAssuntos
Glândulas Écrinas/patologia , Leucemia Linfocítica Crônica de Células B/complicações , Micose Fungoide/complicações , Neoplasias Cutâneas/complicações , Idoso , Biomarcadores Tumorais/análise , Biópsia , Glândulas Écrinas/virologia , Feminino , Herpesvirus Humano 4/isolamento & purificação , Humanos , Imuno-Histoquímica , Leucemia Linfocítica Crônica de Células B/patologia , Leucemia Linfocítica Crônica de Células B/virologia , Micose Fungoide/patologia , Micose Fungoide/virologia , Valor Preditivo dos Testes , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/virologiaRESUMO
PURPOSE: Whereas vismodegib is effective in the treatment of locally advanced/metastatic basal cell carcinoma, dysgeusia and weight loss are common side effects of such treatment. The main objective of this study was to monitor the nutritional status of vismodegib-treated patients. Secondary objective was to assess the incidence of dysgeusia and the benefit of early nutritional management. METHODS: This prospective study included all patients who started vismodegib between October 2011 and May 2013 at Nantes University Hospital. Prior to July 2012, patients treated with vismodegib had not received any specific nutritional management (Historical cohort). Body weight and presence of dysgeusia were recorded monthly. Patients treated after July 2012 (Nutrition cohort) were evaluated by a physician of the Nutrition Support Unit and received dietary counseling at vismodegib initiation. A standardized nutritional management protocol was initiated in case of significant weight loss. RESULTS: Forty-five patients (21 and 24 in the Nutrition and Historical cohort, respectively) were enrolled. In the Nutrition cohort, five patients (24 %) were undernourished at vismodegib initiation, and the 6-month cumulative incidence of dysgeusia was 71 %. Eight patients (38 %) and 13 patients (54 %) had a weight loss greater than 5 % in the Nutrition and Historical cohort, respectively (p = 0.3727). CONCLUSION: The results of this pilot study suggest the benefit of early nutritional screening. The potential benefit of nutritional support in this setting warrants further investigation.
Assuntos
Anilidas/efeitos adversos , Antineoplásicos/efeitos adversos , Carcinoma Basocelular/tratamento farmacológico , Disgeusia/induzido quimicamente , Piridinas/efeitos adversos , Neoplasias Cutâneas/tratamento farmacológico , Redução de Peso/efeitos dos fármacos , Idoso , Idoso de 80 Anos ou mais , Anilidas/administração & dosagem , Antineoplásicos/administração & dosagem , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Piridinas/administração & dosagemRESUMO
Vemurafenib is a BRAF inhibitor indicated in metastatic or unresectable melanoma in patients with BRAF mutations. Vemurafenib is frequently toxic, but the toxicity is often not serious. The third case of vemurafenib-induced drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is reported herein. The case is unusual in that the onset was early, with symptoms emerging as of day 8 of treatment. Treatment of DRESS syndrome is not currently based on precise recommendations, but systemic corticosteroid therapy is effective in serious cases. Severe toxidermias under vemurafenib are exceptional; immediate discontinuation of treatment upon diagnosis is imperative. Switching from vemurafenib to dabrafenib then seems to constitute an interesting therapeutic alternative, since its efficacy is the same but with fewer cutaneous adverse reactions. This case highlights the importance of awareness of the risk of DRESS syndrome associated with vemurafenib and monitoring for warning signs from treatment initiation.
Assuntos
Antineoplásicos/efeitos adversos , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Indóis/efeitos adversos , Sulfonamidas/efeitos adversos , Idoso , Síndrome de Hipersensibilidade a Medicamentos/terapia , Humanos , Masculino , Melanoma/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , VemurafenibRESUMO
BACKGROUND: New targeted melanoma therapies such as B-RAF inhibitors have shown high and promising clinical benefit but have cutaneous side-effects, including photosensitivity, which is triggered in the UVA radiation spectrum. However, visible spectrum implication has not yet been investigated. We conducted a study to determine whether visible light also contributes to the phototoxicity action spectrum of vemurafenib. The secondary end points were to determine the time to complete regression of the phototoxicity post-vemurafenib discontinuation and whether there was a significant difference between the UVA radiation immediate reactivity cut-offs, in patients treated with vemurafenib vs. those treated with dabrafenib. METHOD: This prospective, observational study included patients with B-RAF mutant metastatic melanoma: 34 patients treated with vemurafenib and 9 with dabrafenib. RESULTS: The visible-light phototest results in patients treated with vemurafenib were all negative before and after 2 months of treatment. The UVA radiation phototests conducted 1 or 2 weeks post-vemurafenib discontinuation in 4 patients showed a normalised UVA-radiation reactivity cut-off. UVA radiation phototests after 2 months of treatment were conducted for all patients. The UVA radiation reactivity cut-off had been lowered for 30 patients (88%) on vemurafenib and 3 patients (33%) on dabrafenib. The median UVA radiation reactivity cut-off was 12 J/cm(2) for the patients on vemurafenib and 20 J/cm(2) for the patients on dabrafenib. CONCLUSION: B-RAF inhibitor phototoxicity is exclusively triggered by UVA radiation and resolves rapidly post-treatment discontinuation. A significant difference between the UVA immediate reactivity cut-offs, vemurafenib vs. dabrafenib, explains the difference in the clinical photosensitivity rates reported in the clinical trials.
Assuntos
Dermatite Fototóxica/etiologia , Indóis/efeitos adversos , Melanoma/tratamento farmacológico , Proteínas Proto-Oncogênicas B-raf/efeitos dos fármacos , Neoplasias Cutâneas/tratamento farmacológico , Sulfonamidas/efeitos adversos , Raios Ultravioleta/efeitos adversos , Adulto , Idoso , Estudos de Coortes , Dermatite Fototóxica/fisiopatologia , Feminino , Seguimentos , Humanos , Imidazóis/efeitos adversos , Imidazóis/uso terapêutico , Indóis/uso terapêutico , Masculino , Melanoma/genética , Melanoma/mortalidade , Melanoma/patologia , Pessoa de Meia-Idade , Terapia de Alvo Molecular/métodos , Invasividade Neoplásica/patologia , Oximas/efeitos adversos , Oximas/uso terapêutico , Cuidados Paliativos/métodos , Estudos Prospectivos , Proteínas Proto-Oncogênicas B-raf/genética , Medição de Risco , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/mortalidade , Neoplasias Cutâneas/patologia , Sulfonamidas/uso terapêutico , Análise de Sobrevida , Resultado do Tratamento , VemurafenibRESUMO
Tumor immune escape has recently been shown to be related to the development of an immune tolerance state of the microenvironment. Cytokines activating the immune system such as IFN-γ can be used to reverse the immune escape and thus to potentiate the efficacy of immunotherapy. A clinical study was conducted in 18 stage IIIc/IV melanoma patients treated with tumor-infiltrating lymphocytes (TILs) in combination with intratumoral TG1042 injection (adenovirus expressing IFN-γ). The primary objective was to investigate the safety of treatment. Secondary objectives were to study the clinical response and translational research. The treatment was well tolerated. Among the 13 patients evaluable for tumor response, 38.5% had an overall objective response (OOR = CR + PR) and disease control rate (DCR = CR + PR + S) of 46%. The clinical response of the 37 targeted lesions led to an OOR of 51% and a DCR of 75%. Translational research on predictive markers did not significantly differ between responder and non-responder patients. However, specifically regarding injected lesions, the clinical response correlated with CD3-/CD56+ NK cells which could be activated by TG1042. Further larger studies of this combined immunotherapy are needed to confirm our findings. Intralesional TG1042 combined with antigen-selected TILs should be discussed.
Assuntos
Interferon gama/uso terapêutico , Linfócitos do Interstício Tumoral/transplante , Melanoma/imunologia , Melanoma/terapia , Adenoviridae/genética , Adulto , Idoso , Linhagem Celular Tumoral , Terapia Baseada em Transplante de Células e Tecidos , Terapia Combinada/métodos , Feminino , GTP Fosfo-Hidrolases/genética , Terapia Genética/métodos , Humanos , Imunoterapia Adotiva/métodos , Interferon gama/genética , Linfócitos do Interstício Tumoral/imunologia , Masculino , Proteínas de Membrana/genética , Pessoa de Meia-Idade , Proteínas Proto-Oncogênicas B-raf/genética , Evasão Tumoral/imunologiaRESUMO
Since the approval of vorinostat for the treatment of refractory cutaneous epidermotropic T-cell lymphoma (CTCL) in 2006, very little data about this treatment have been published. The aim of this retrospective study was to assess the efficacy and safety of vorinostat in patients with CTCL treated between 2007 and 2013 in our department. Fifteen patients (median age 64 years) were included: 9 with Sézary syndrome and 6 with mycosis fungoides. They were all in progression and the median number of systemic treatments previously administered was 3 (range 1-7). With vorinostat treatment, the best response was partial remission in 5 patients (33%) and stabilization in 4 patients (27%). Six patients experienced disease progression. The mean time to response and response duration were 70 (range 31-140) and 300 days (range 157-663), respectively. The most frequent adverse events were asthenia, weight loss, nausea and anaemia. Vorinostat could be a therapeutic alternative for CTCL after treatment failure.
Assuntos
Antineoplásicos/uso terapêutico , Inibidores de Histona Desacetilases/uso terapêutico , Ácidos Hidroxâmicos/uso terapêutico , Micose Fungoide/tratamento farmacológico , Recidiva Local de Neoplasia , Síndrome de Sézary/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Adulto , Idoso , Antineoplásicos/efeitos adversos , Progressão da Doença , Resistencia a Medicamentos Antineoplásicos , Feminino , Inibidores de Histona Desacetilases/efeitos adversos , Humanos , Ácidos Hidroxâmicos/efeitos adversos , Masculino , Pessoa de Meia-Idade , Micose Fungoide/patologia , Indução de Remissão , Estudos Retrospectivos , Síndrome de Sézary/patologia , Neoplasias Cutâneas/patologia , Fatores de Tempo , Resultado do Tratamento , VorinostatRESUMO
The relationship between BRAF mutations and the patient clinical profile is still under question. The objective of the present study was to correlate the BRAF mutation status in primary and metastatic melanomas with the clinicopathological profile, disease-free (DFS) and overall survival (OS). A total of 367 melanoma samples from 278 patients were screened for their BRAF status using a combination of allele-specific amplification and DNA sequencing. Two or three tissue samples from the same patient were available for 74 patients. The clinicopathological characteristics were tested for their association with the BRAF mutation using the Fisher's or Pearson's χ2 test. Log-rank tests and Cox models were used for survival analyses. BRAF mutation was found in 152 samples (41.4%). Ten of the 74 patients with several tissue samples (13.5%) had discordant BRAF mutation results. BRAF-mutated patients were significantly younger at the time of primary melanoma and first diagnosis of metastasis than BRAF wild-type patients but with no difference in DFS and OS. According to our results, a primary melanoma with BRAF mutation is not associated with a more aggressive illness.
Assuntos
Melanoma/genética , Melanoma/patologia , Metástase Neoplásica/genética , Proteínas Proto-Oncogênicas B-raf/genética , Idade de Início , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica/patologia , Proteínas Proto-Oncogênicas B-raf/metabolismo , Análise de SobrevidaRESUMO
A 77-year-old patient treated with ipilimumab (anti-CTLA-4 antibody) for metastatic melanoma developed autoimmune pancytopenia (anemia, thrombocytopenia, and neutropenia) 8 days after the fourth infusion. This pancytopenia was resistant to high-dose oral corticosteroids (1 mg/kg) and to hematopoietic growth factors. It resolved after intravenous immunoglobulins injection. To date, only 1 case of autoimmune pancytopenia has been reported after this treatment. According to the case that we report, it seems essential to control the leukocyte count before any injection of ipilimumab.
Assuntos
Anticorpos Monoclonais/administração & dosagem , Doenças Autoimunes/etiologia , Imunoterapia/efeitos adversos , Melanoma/terapia , Pancitopenia/etiologia , Neoplasias Cutâneas/terapia , Idoso , Anticorpos Monoclonais/efeitos adversos , Antígeno CTLA-4/imunologia , Feminino , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Ipilimumab , Contagem de Leucócitos , Melanoma/complicações , Melanoma/imunologia , Monitorização Fisiológica , Metástase Neoplásica , Recuperação de Função Fisiológica , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/imunologiaRESUMO
BACKGROUND: Cutaneous squamous cell carcinomas (CSCC) are very common. Localized CSCC are cured by surgery and/or radiotherapy and have a better prognosis than locally inoperable advanced CSCC. Cetuximab has recently been proposed to treat locally advanced CSCC when surgery or radiotherapy cannot be offered. OBJECTIVE: The authors report results of a pilot study conducted in inoperable CSCC patients treated with cetuximab alone or combined with chemotherapy or radiotherapy. MATERIAL AND METHODS: This study was conducted in 20 CSCC patients. RECIST criteria were used to evaluate clinical and radiological responses. RESULTS: Five patients received cetuximab associated with radiotherapy (CR), nine with carboplatin (CC) and six as monotherapy (CM) over 1-month cycle treatment. Response to treatment was evaluated every two cycles. After 2 months of treatment, the authors observed nine partial responses, six stabilizations and four progressions. Disease control rate was of 78% (100% for CR, 87.5% for CC and 50% for CM) with a 47% response rate (80% for CR, 37.5% for CC and 33% for CM). CONCLUSION: The authors confirm the potential interest of cetuximab to treat unresectable advanced CSCC alone or combined with CC and CM. These results justify discussing a further randomized study combining radiotherapy and cetuximab.
Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos/uso terapêutico , Carcinoma de Células Escamosas/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Carboplatina/uso terapêutico , Carcinoma de Células Escamosas/radioterapia , Cetuximab , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Prognóstico , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/radioterapia , Taxa de SobrevidaAssuntos
Indóis/uso terapêutico , Melanoma/tratamento farmacológico , Melanoma/genética , Proteínas Proto-Oncogênicas B-raf/genética , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/genética , Sulfonamidas/uso terapêutico , Humanos , Inibidores de Proteínas Quinases/uso terapêutico , Estudos Retrospectivos , VemurafenibRESUMO
BACKGROUND: Vemurafenib is a BRAF inhibitor indicated for the treatment of metastatic melanoma. We report the two first cases of severe and prolonged radiotherapy-induced visceral toxicity in patients treated concomitantly with vemurafenib: a brain radionecrosis and an anorectitis. It raises the question of both the risks of this association and its benefit in melanoma. OBSERVATIONS: The first patient, a female aged 32, treated with vemurafenib for three months, presented a steroid-dependent radionecrosis after brain stereotactic radiosurgery. Symptoms persisted until her death six months later. The second patient, a male aged 64 and treated with vemurafenib for nineteen days, presented a radiation-induced anorectitis complicated by diarrhoea, anorexia and weight loss following the concomitant radiation of a primary rectal tumour. A colostomy was needed after ten months in order to improve local status and general health. CONCLUSIONS: In our patients, the radiotherapy-induced toxicity under vemurafenib was unusual in its intensity and duration, suggesting a radiosensitization phenomenon. This hypothesis is reinforced by the publication of six cases of severe radiodermatitis under vemurafenib and by in vitro data. The combination of vemurafenib and radiotherapy should thus lead to discussion of a transient cessation of vemurafenib, given the severity of the adverse events experienced. Meanwhile, further studies are needed to determine the potential benefit of this combined treatment in metastatic melanoma.
Assuntos
Antineoplásicos/efeitos adversos , Neoplasias Encefálicas/cirurgia , Encéfalo/patologia , Indóis/efeitos adversos , Melanoma/terapia , Segunda Neoplasia Primária/radioterapia , Lesões por Radiação/patologia , Radiocirurgia/efeitos adversos , Neoplasias Retais/radioterapia , Sulfonamidas/efeitos adversos , Adulto , Canal Anal/efeitos da radiação , Encéfalo/efeitos da radiação , Neoplasias Encefálicas/secundário , Quimiorradioterapia/efeitos adversos , Feminino , Humanos , Masculino , Melanoma/secundário , Pessoa de Meia-Idade , Necrose/etiologia , Proctite/etiologia , Lesões por Radiação/etiologia , Reto/efeitos da radiação , VemurafenibRESUMO
BACKGROUND: Publications reporting photodynamic therapy (PDT) in mycosis fungoides (MF) are rare, involve small samples, and are difficult to compare because of a lack of technical standardization. OBJECTIVE: We sought to assess PDT effectiveness and tolerability in early-stage MF using a strict reproducible procedure. METHODS: This was a prospective study conducted in Nantes University Hospital, France, including patients older than 18 years with histologically proven MF (stage IA or IB). Methyl-aminolevulinic acid-PDT sessions were repeated monthly for 6 months. Clinical and histologic responses were assessed 1 month after the last session. Patient satisfaction was assessed by telephone survey. RESULTS: Twelve patients (with 29 lesions) were treated with PDT. An objective response in target lesions was obtained in 75% of patients. Response rates were similar between plaques and patches but higher in sun-protected compared with sun-exposed areas (trend without reaching significance). During PDT, new lesions appeared in 5 of 12 patients in untreated areas. Most patients were highly satisfied and preferred PDT to the topical chemotherapy previously used. LIMITATIONS: PDT procedure criteria selection was partially arbitrary. CONCLUSIONS: In early-stage MF, PDT is effective and appreciated (especially when compared with conventional topical chemotherapy). Unilesional and paucilesional forms and lesions in sun-protected areas are to be preferred.