Real-life use of trametinib after immunotherapy failure in BRAF wild-type advanced melanoma.

BRAF V600 wild-type advanced melanomas quickly reach a therapeutic dead-end, after immunotherapy failure. Even if preclinical studies have suggested sensitivity to MEK inhibitors such as trametinib in NRAS, NF1 or GNA mutated melanoma, therapeutic options are limited for these patients. We present a retrospective monocentric study of 22 patients with advanced melanoma treated by trametinib after immunotherapy resistance. Melanomas harboured NRAS (20), NF1 (1) or GNA 11 (1) mutations. For most of them (18), anti-PD1 was associated with trametinib. A disease-control was reported in 36% of patients (8/22), with six stable diseases and two partial responses according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria. Median progression-free survival was 2 months (1-14) and median overall survival was 6.5 months (2-24). In patients with progressive disease (14/22), dissociated radiologic responses and clinical benefits such as pain reduction were seen in five patients. High blood level of lactate dehydrogenase (LDH) seemed associated with trametinib failure, without significance ( P = 0.06). Adverse events (grade 1-3) occurred in 91% of patients during the first weeks of treatment, mainly papulo-pustular rashes (77%), leg oedemas (36%), asthenia (18%) and diarrhoea (14%). This real-life study showed that trametinib may benefit some metastatic melanoma that progressed after chemotherapy and immune checkpoint inhibitors. Objective disease control (partial response or stable disease) using RECIST criteria was observed in 36% of patients. Because of frequent side-effects which can alter the quality of life and the short response duration, this off-label option has to be discussed with the patient. Studies with combination therapy with trametinib to improve relapse-free survival and lower side-effects are ongoing.

Coating alginate microspheres with a serum albumin-alginate membrane: application to the encapsulation of a peptide.

Calcium alginate gel microspheres coated with a human serum albumin (HSA)-alginate membrane were prepared adapting a transacylation method previously applied to large beads. The procedure involved emulsification of an aqueous solution of sodium alginate and propylene glycol alginate (PGA) in an oily phase, followed by addition of CaCl(2). The resulting gel microspheres were transferred in an aqueous solution of HSA. The addition of 0.5 M NaOH started the reaction between PGA and HSA, producing amide bonds and forming a membrane around the particles. An optimization study was conducted, notably exploring the addition of HSA to the internal phase. The microcapsules were studied with respect to morphology (optical and scanning electron microscopy) and size (laser granulometry), in comparison with uncoated gel microspheres. Biocompatibility was checked in osteoblast cultures. Lysine-arginine-phenylalanine-lysine (KRFK) was encapsulated and the release kinetics was studied in vitro. The method provided stable microspheres (size around 60 microm), with a membrane surviving a treatment with citrate and resisting lyophilization. The microcapsules were shown biocompatible. The release of KRFK was slower (release time>8 days) than that of uncoated microspheres. These microcapsules might be useful as peptide containers to be combined with prosthetic materials for improving osteointegration.