4 research outputs found
Metasztatikus progresszió kezelése primer cutan és ocularis melanoma szinkrón előfordulását követően = Treatment of metastatic progression following the synchronous occurrence of cutaneous and ocular primary melanomas
Absztrakt:
A melanoma előfordulási gyakorisága az életkorral nő, legnagyobb arányban a nem
hispániai fehérekben fordul elő. Bár az ocularis melanoma gyakorisága a töredéke
a cutan melanomáénak – az összes melanomás eset mintegy 4%-a, éves incidenciája
0,6 : 100 000 –, a szemtumorok között a leggyakrabban előforduló malignitás. Az
ocularis Ă©s a cutan melanoma egyĂĽttes elĹ‘fordulása irodalmi ritkaságnak számĂt.
Közleményünkben egy 80 éves férfi esetét prezentáljuk, akinél 2008-ban cutan
nodularis melanomát excindáltak. Szemészeten 2013-ban fokozódó visuscsökkenés
miatt uvealis melanomát diagnosztizáltak, amelyet brachytherapiával kezeltek.
Képalkotó vizsgálatokkal és biopsziával 2015-ben melanoma hepaticus propagatiója
igazolĂłdott. A primer cutan laesio mutáciĂłanalĂzise BRAF V600 K tĂpusĂş
funkciĂłnyerĹ‘ mutáciĂłt igazolt, mĂg az áttĂ©tben a vad tĂpusĂş gĂ©n jelenlĂ©tĂ©t
mutattuk ki. Onkoteam javaslata alapján 2015 augusztusában intraarterialis
májkemoterápia kezdődött, melyből 11 ciklust kapott meg, 21 napos
időintervallumokkal. A beteg a kezelést jól tolerálta, mellékhatás nem
jelentkezett. A 2016. februári CT a májban lévő laesio parciális regresszióját
igazolta; a tizenegyedik ciklus intraarterialis májkemoterápiáját követően a
beteg komplett remisszióba került, amely több mint egy évig tartott. Az ocularis
és a cutan melanoma szinkrón előfordulása igen ritka, metasztatikus progresszió
esetĂ©n ugyanakkor az optimális onkoterápia kiválasztása komoly kihĂvást jelent.
A kĂ©t melanomatĂpus molekuláris patolĂłgiai háttere eltĂ©rĹ‘, amely segĂtheti a
metasztatikus laesiĂłk eredetĂ©nek azonosĂtását Ă©s az optimális, szemĂ©lyre szabott
kezelés megválasztását. Orv Hetil. 2018; 159(16): 642–647.
|
Abstract:
The incidence rates of cutaneous melanoma in non-Hispanic whites show an
increasing tendency with age. While uveal melanoma in general is a rare disease,
representing only 4% of all melanomas with an incidence rate of 0.6 per 100 000,
it is still the most frequent malignancy of the eye. Synchronous occurrence of
ocular and cutaneous melanoma is an exceptional rarity, due to the distinct
genetic background of the diseases. We report the case of a 80-year-old man who
underwent total excision of a cutaneous melanoma in 2008. In 2013, he was
diagnosed with uveal melanoma as part of a routine work-up for reduced vision.
The uveal melanoma was treated by brachytherapy. In 2015, liver metastases were
suspected by routine ultrasonography. Core biopsy was carried out, and the
histology confirmed melanoma metastases. The molecular analysis of the cutaneous
lesion showed gain of function mutation of the BRAF V600 K gene, while we found
a wild-type BRAF gene in the metastatic lesion. Based on the recommendation of
the oncoteam, hepatic intra-arterial Epirubicin-Platidiam therapy was
introduced. He received 11 doses of intra-arterial chemotherapy (IAC), in 21
cycles. IAC was well tolerated without any catheter-related complications or
toxicities. Partial regression of the hepatic metastases were documented in
February 2016. After completing the eleventh cycle of intrahepatic chemotherapy,
the disease remained in complete remission for over a year. The parallel
occurrence of cutaneous and ocular melanoma is rare, however, the metastatic
progression in such cases make the selection of optimal medical therapy
challenging. The distinct genetic background of two melanoma types may help the
identification of the source of the metastatic lesions, in order to guide the
treatment decisions. Orv Hetil. 2018; 159(16): 642–647
Metasztatikus progresszió kezelése primer cutan és ocularis melanoma szinkrón előfordulását követően
Biomarkers Associated with Clinical Outcome of Advanced Melanoma Patients Treated with Ipilimumab
Ipilimumab was the first immunotherapy approved for metastatic melanoma in decades and is currently registered as a second-line treatment. However, new immunotherapies, in combination with ipilimumab, offer even better clinical outcomes for patients compared with single-agent treatments, at the expense of improved toxicity. The aim of this study was to evaluate the feasibility of ipilimumab outside the clinical trials and to identify survival predictors for treatment benefit. Data were collected on 47 advanced melanoma patients treated with ipilimumab between 2010 and 2015 at a single center. Association of clinical characteristics (including primary tumor characteristics), serum lactate dehydrogenase (LDH), erythrocyte sedimentation rate, absolute eosinophil, lymphocyte, and neutrophil count, neutrophil/lymphocyte and eosinophil/lymphocyte ratio with toxicity and clinical outcome were assessed using univariate and multivariate analysis. Median progression-free survival at a median follow-up of 10 months was 2.7 months and median overall survival was 9.8 months. Objective response was observed in 17% of patients and the disease control rate at week 24 was 40%. The 1- and 2-year survival rates documented were 40 and 28%, respectively. Significant association between high LDH level (>1.5x upper limit of normal) and decreased overall survival was demonstrated in uni- and multivariate analysis (hazard ratio [HR]: 3.554, 95% CI: 1.225-10.306, p = 0.019). Neither biomarkers nor clinical outcome were associated with toxicity. Using baseline serum LDH to identify patients most likely to benefit from ipilimumab therapy could serve as a simple and inexpensive biomarker of clinical outcome