Sign in to use this feature.

Years

Between: -

Subjects

remove_circle_outline
remove_circle_outline
remove_circle_outline
remove_circle_outline
remove_circle_outline
remove_circle_outline
remove_circle_outline

Journals

Article Types

Countries / Regions

Search Results (53)

Search Parameters:
Keywords = clinical stage IIB

Order results
Result details
Results per page
Select all
Export citation of selected articles as:
21 pages, 328 KiB  
Review
Adjuvant Immunotherapy in Stage IIB/IIC Melanoma: Current Evidence and Future Directions
by Ivana Prkačin, Ana Brkić, Nives Pondeljak, Mislav Mokos, Klara Gaćina and Mirna Šitum
Biomedicines 2025, 13(8), 1894; https://doi.org/10.3390/biomedicines13081894 - 4 Aug 2025
Viewed by 51
Abstract
Background: Patients with resected stage IIB and IIC melanoma are at high risk of recurrence and distant metastasis, despite surgical treatment. The recent emergence of immune checkpoint inhibitors (ICIs) has led to their evaluation in the adjuvant setting for early-stage disease. This [...] Read more.
Background: Patients with resected stage IIB and IIC melanoma are at high risk of recurrence and distant metastasis, despite surgical treatment. The recent emergence of immune checkpoint inhibitors (ICIs) has led to their evaluation in the adjuvant setting for early-stage disease. This review aims to synthesize current evidence regarding adjuvant immunotherapy for stage IIB/IIC melanoma, explore emerging strategies, and highlight key challenges and future directions. Methods: We conducted a comprehensive literature review of randomized clinical trials, observational studies, and relevant mechanistic and biomarker research on adjuvant therapy in stage IIB/IIC melanoma. Particular focus was placed on pivotal trials evaluating PD-1 inhibitors (KEYNOTE-716 and CheckMate 76K), novel vaccine and targeted therapy trials, mechanisms of resistance, immune-related toxicity, and biomarker development. Results: KEYNOTE-716 and CheckMate 76K demonstrated significant improvements in recurrence-free survival (RFS) and distant metastasis-free survival (DMFS) with pembrolizumab and nivolumab, respectively, compared to placebo. However, no definitive overall survival benefit has yet been shown. Adjuvant immunotherapy is linked to immune-related adverse events, including permanent endocrinopathies. Emerging personalized approaches, such as circulating tumor DNA monitoring and gene expression profiling, may enhance patient selection, but remain investigational. Conclusions: Adjuvant PD-1 blockade offers clear RFS benefits in high-risk stage II melanoma, but optimal patient selection remains challenging, due to uncertain overall survival benefit and toxicity concerns. Future trials should integrate biomarker-driven approaches to refine therapeutic decisions and minimize overtreatment. Full article
(This article belongs to the Section Gene and Cell Therapy)
10 pages, 450 KiB  
Article
The Role of Multidisciplinary Ocular and Periocular Cancers Meetings in Uveal Melanoma Management: A 2-Year Analysis
by Gustavo Savino, Monica Maria Pagliara, Maria Grazia Sammarco, Carmela Grazia Caputo, Maria Antonietta Blasi, Roberta Mattei, Sofia Marcelli, Luca Tagliaferri, Bruno Fionda, Giovanni Schinzari, Ernesto Rossi, Luca Zagaria, Tommaso Tartaglione, Luca Ausili Cefaro, Mattia Todaro, Alessandro Moro and Federico Giannuzzi
Cancers 2025, 17(14), 2274; https://doi.org/10.3390/cancers17142274 - 8 Jul 2025
Viewed by 287
Abstract
Purpose: The objective of this study was to evaluate the implementation of a Multidisciplinary Tumor Board (MDTB) strategy in the treatment of patients with uveal melanoma. Methods: A retrospective analysis was conducted on the implementation of MDTB meetings over a 24-month [...] Read more.
Purpose: The objective of this study was to evaluate the implementation of a Multidisciplinary Tumor Board (MDTB) strategy in the treatment of patients with uveal melanoma. Methods: A retrospective analysis was conducted on the implementation of MDTB meetings over a 24-month period. During this time, 72 intraocular tumors were discussed, including 59 confirmed cases of uveal melanoma. The MDTB involved a core group of specialists (e.g., ophthalmologists, oncologists, and radiologists), with other experts included when clinically appropriate. To assess patient satisfaction with the MDTB approach, a structured questionnaire was administered, including items on clarity of communication, perceived quality of care, and overall satisfaction, which were ranked on a 5-point scale. Results: A total of 319 patients with ocular, periocular, or orbital tumors were discussed during the study period, of which, 72 had intraocular tumors. A total of 13 (18%) were diagnosed to have choroidal metastases, whereas 59 (82%) had uveal melanomas. The average time between patient care and MDTB discussion was 15.9 days (IQR: 7.5–16.5). The mean time between the case discussion and the implementation of recommendations (diagnostic, therapeutic, or referral decisions) was 14.8 days (IQR: 6.0–23.75). Overall, 4 (7%) patients were classified as Stage I, 16 (27%) as Stage IIa, 18 (31%) as Stage IIb, 7 (12%) as Stage IIIa, 2 (3%) as Stage IIIb, and 12 (20%) as Stage IV. Regarding the satisfaction questionnaire, all patients (100%) agreed to have the clinical case discussed at the TB even though this could result in a delay in diagnostic/therapeutic implementation. However, only 60% of patients perceived they had been directly involved in the decision-making process. Conclusions: In selected cases of uveal melanoma and other types of cancer, MDTBs should be recognized as a gold standard in cancer care, allowing for comprehensive decision-making that draws on a wide range of highly specialized expertise. Full article
(This article belongs to the Section Cancer Therapy)
Show Figures

Figure 1

17 pages, 1478 KiB  
Article
Impact of Bowel Resection on Operative Mortality and Overall Survival in Advanced Epithelial Ovarian Cancer
by Özgür Ozan Ceylan, İlyas Turan, Evrim Erdemoglu, Marina Santos González and Javier Magrina
Cancers 2025, 17(13), 2086; https://doi.org/10.3390/cancers17132086 - 22 Jun 2025
Viewed by 405
Abstract
Background/Objectives: Bowel resection may be necessary during cytoreductive surgery (CS) in advanced epithelial ovarian cancer to achieve complete tumor removal. However, concerns about increased perioperative risks and unclear survival benefits have led to ongoing debate. This study aimed to evaluate the impact [...] Read more.
Background/Objectives: Bowel resection may be necessary during cytoreductive surgery (CS) in advanced epithelial ovarian cancer to achieve complete tumor removal. However, concerns about increased perioperative risks and unclear survival benefits have led to ongoing debate. This study aimed to evaluate the impact of bowel resection on perioperative mortality and overall survival (OS) in patients undergoing CS. Methods: We retrospectively reviewed 127 patients with FIGO stage IIB–IV epithelial ovarian cancer who underwent primary or interval CS between 2007 and 2021. Patients were stratified based on the performance of bowel resection. Clinical, surgical, and survival data were analyzed using Kaplan–Meier survival analysis and Cox proportional hazards modeling. Primary outcomes were 90-day mortality and OS. Results: Bowel resection was performed in 58 patients (46%) with more extensive disease and poorer ECOG performance scores. Although the resection group had increased perioperative risks (e.g., higher transfusion rates and ICU use), OS was similar between groups (log-rank p = 0.122). Multivariate analysis identified that increasing age (HR = 1.042, p = 0.005) was independently associated with poorer OS, whereas lymph node dissection (HR = 0.450, p = 0.003) and undergoing primary CS (HR = 0.540, p = 0.047) were associated with improved survival. Bowel resection was not independently associated with OS. Conclusions: Bowel resection does not adversely affect OS when optimal cytoreduction is achieved. Although it increases perioperative complexity, it can be safely incorporated into CS in selected patients. These findings support its use as part of an individualized surgical strategy for advanced ovarian cancer. Full article
Show Figures

Figure 1

16 pages, 4017 KiB  
Article
Individualized Prediction of Postoperative Survival in Gallbladder Cancer: A Nomogram Based on SEER Data and External Validation
by Yayue Liu, Kangwei Zhu, Xindi Tian, Ping Chen, Qingqing Xiong, Guangtao Li, Xiaochen Ma, Ruyu Han, Liyu Sun, Yijian Shen, Fengyi Zhu, Yimeng Wang, Lu Chen and Tianqiang Song
Cancers 2025, 17(12), 1919; https://doi.org/10.3390/cancers17121919 - 9 Jun 2025
Viewed by 583
Abstract
Background: Gallbladder cancer (GBC) is a rare but aggressive malignancy. Prognostic tools are essential for optimizing postoperative treatment strategies. We aim to develop and validate a prognostic nomogram to estimate 1-, 3-, and 5-year overall survival (OS) in GBC patients and explore the [...] Read more.
Background: Gallbladder cancer (GBC) is a rare but aggressive malignancy. Prognostic tools are essential for optimizing postoperative treatment strategies. We aim to develop and validate a prognostic nomogram to estimate 1-, 3-, and 5-year overall survival (OS) in GBC patients and explore the role of adjuvant chemotherapy across different subgroups. Methods: A total of 1848 postoperative GBC patients from the SEER database (2000–2020 17 regions) were analyzed, with an additional external validation cohort of 108 patients from China (2010–2020). Prognostic factors were identified using LASSO regression and multivariable Cox analysis. A nomogram was constructed and validated using the concordance index (C-index), time-dependent ROC curves, calibration curves, and decision curve analysis (DCA). Subgroup analyses were performed to evaluate the impact of adjuvant chemotherapy. Results: The nomogram demonstrated strong predictive performance, with C-indices of 0.767 (training), 0.798 (internal validation), and 0.750 (external validation). Time-dependent ROC curves in the training cohort showed AUCs of 0.777, 0.769, and 0.800 for 1-, 3-, and 5-year OS, respectively. In the internal validation cohort, the corresponding AUCs were 0.763, 0.743, and 0.803. External validation using the independent Chinese cohort of 108 patients showed consistent results, with AUCs of 0.771, 0.835, and 0.810 for 1-, 3-, and 5-year OS. Subgroup analysis revealed that adjuvant chemotherapy significantly improved survival in patients with TNM stage >IIB. In contrast, patients with early-stage disease (TNM ≤ IIB) showed no significant survival benefit from chemotherapy. Conclusions: This study developed a validated prognostic nomogram for postoperative GBC patients, demonstrating strong discrimination and calibration. Subgroup analysis suggests that adjuvant chemotherapy benefits select high-risk patients, aiding personalized decision-making in clinical practice. Full article
Show Figures

Figure 1

15 pages, 254 KiB  
Review
Beyond the Cure: Optimizing Follow-Up Care for Cervical Cancer Survivors
by Retika Mohan, Mena Abdalla, Anna-Lucia Koerling and Sahathevan Sathiyathasan
Reprod. Med. 2025, 6(2), 12; https://doi.org/10.3390/reprodmed6020012 - 14 May 2025
Viewed by 758
Abstract
Cervical cancer is a significant global health challenge, ranking as the fourth most common malignancy in women worldwide (age-standardized incidence: 13.3/100,000). In the UK, prevalence is markedly lower (7.6/100,000) compared to global averages, attributable to successful HPV vaccination and screening programs. post-treatment follow-up [...] Read more.
Cervical cancer is a significant global health challenge, ranking as the fourth most common malignancy in women worldwide (age-standardized incidence: 13.3/100,000). In the UK, prevalence is markedly lower (7.6/100,000) compared to global averages, attributable to successful HPV vaccination and screening programs. post-treatment follow-up is critical for monitoring recurrence, managing complications, and addressing survivors’ psychosocial needs. However, follow-up care lacks standardization, especially for advanced-stage cervical cancer. This narrative review critically assesses existing guidelines, practices, and innovative approaches to follow-up care post-cervical cancer treatment, identifying inconsistencies and offering recommendations for standardization. This review synthesizes recommendations from 12 guidelines (NCCN, ASTRO, ESGO, BSCCP, BGCS, and ESMO) to evaluate follow-up strategies for cervical cancer survivors. Emerging evidence supports risk-stratified approaches combining Patient-Initiated Follow-Up (PIFU) for low-risk patients with intensive imaging (PET/CT/MRI) for advanced stages. Psychosocial interventions, particularly for sexual health and return-to-work challenges, remain underutilized despite ESGO recommendations. Follow-up recommendations vary significantly, focusing on clinical examination and symptom-based imaging. Patient-Initiated Follow-Up (PIFU) is a growing trend, though concerns persist regarding its appropriateness for high-risk groups. Most recurrences are symptomatic, supporting less-intensive protocols for low-risk patients. Imaging methods like FDG PET/CT provide prognostic insights but are not universally adopted. Psychosocial and psychosexual care needs remain under addressed. Standardized, evidence-based follow-up protocols are essential to address disparities in survivorship care. Holistic strategies incorporating psychosocial support and tailored plans will ensure comprehensive care. This is the first review to integrate NCCN imaging standards with ESGO psychosocial care in a risk-stratified model. Future research should refine PIFU models and imaging strategies to balance resource use with quality care. Critical clinical implications emerge: (1) Risk-stratified follow-up reduces unnecessary imaging by 31% (95% CI 24–38%) in low-risk patients while maintaining 98% 5-year survival; (2) mandatory psycho-oncology referrals (per ESGO guidelines) lower depression rates by 58% (OR 0.59); (3) PET/CT should be reserved for stage IIB+ patients with symptoms, saving EUR 2300 per avoided scan. These evidence-based thresholds enable personalized survivorship care. Full article
25 pages, 4871 KiB  
Article
An MGRN1-Based Biomarker Combination Accurately Predicts Melanoma Patient Survival
by José Sánchez-Beltrán, Javier Soler Díaz, Cecilia Herraiz, Conchi Olivares, Sonia Cerdido, Pablo Cerezuela-Fuentes, José Carlos García-Borrón and Celia Jiménez-Cervantes
Int. J. Mol. Sci. 2025, 26(4), 1739; https://doi.org/10.3390/ijms26041739 - 18 Feb 2025
Viewed by 2671
Abstract
With ever-increasing incidence and high metastatic potential, cutaneous melanoma is the deadliest skin cancer. Risk prediction based on the Tumor-Node-Metastasis (TNM) staging system has medium accuracy with intermediate IIB-IIIB stages, as roughly 25% of patients with low-medium-grade TNM, and hence a favorable prognostic, [...] Read more.
With ever-increasing incidence and high metastatic potential, cutaneous melanoma is the deadliest skin cancer. Risk prediction based on the Tumor-Node-Metastasis (TNM) staging system has medium accuracy with intermediate IIB-IIIB stages, as roughly 25% of patients with low-medium-grade TNM, and hence a favorable prognostic, undergo an aggressive disease with short survival and around 15% of deaths arise from metastases of thin, low-risk lesions. Therefore, reliable prognostic biomarkers are required. We used genomic and clinical information of melanoma patients from the TCGA-SKCM cohort and two GEO studies for discovery and validation of potential biomarkers, respectively. Neither mutation nor overexpression of major melanoma driver genes provided significant prognostic information. Conversely, expression of MGRN1 and the melanocyte-specific genes MLANA, PMEL, and TYRP1 provided a simple 4-gene signature identifying with high-sensitivity (>80%), low-medium TNM patients with adverse outcomes. Transcriptomic analysis of tumors with this signature, or from low-medium-grade TNM patients with poor outcomes, revealed comparable dysregulation of an inflammatory response, cell cycle progression, and DNA damage/repair programs. A functional analysis of MGRN1-knockout cells confirmed these molecular features. Therefore, the simple MGRN1-MLANA-PMEL-TYRP1 combination of biomarkers complemented TNM staging prognostic accuracy and pointed to the dysregulation of immunological responses and genomic stability as determinants of a melanoma outcome. Full article
(This article belongs to the Section Molecular Oncology)
Show Figures

Figure 1

14 pages, 1438 KiB  
Article
Adjuvant Immunotherapy After Resected Melanoma: Survival Outcomes, Prognostic Factors and Patterns of Relapse
by Sergio Martinez-Recio, Maria Alejandra Molina-Pérez, Eva Muñoz-Couselo, Alberto R. Sevillano-Tripero, Francisco Aya, Ana Arance, Mayra Orrillo, Juan Martin-Liberal, Luis Fernandez-Morales, Rocio Lesta, María Quindós-Varela, Maria Nieva, Joana Vidal, Daniel Martinez-Perez, Andrés Barba and Margarita Majem
Cancers 2025, 17(1), 143; https://doi.org/10.3390/cancers17010143 - 5 Jan 2025
Cited by 1 | Viewed by 1328
Abstract
Background: Anti-PD-1-based immunotherapy has improved outcomes in stage IIB to IV resected melanoma patients in clinical trials. However, little is known about real-world outcomes, prognostic factors and patterns of relapse. Methods: This is a retrospective multicenter observational study including patients with resected melanoma [...] Read more.
Background: Anti-PD-1-based immunotherapy has improved outcomes in stage IIB to IV resected melanoma patients in clinical trials. However, little is known about real-world outcomes, prognostic factors and patterns of relapse. Methods: This is a retrospective multicenter observational study including patients with resected melanoma treated with subsequent anti-PD-1-based adjuvant immunotherapy. Data on clinical and demographic characteristics, delivered treatment, prognostic factors, time and pattern of relapse were collected. Results: We included 245 patients from eight centers; 4% of patients were at stage IIB-C, 80% at stage IIIA-D and 16% at stage IV. Recurrence-free survival (RFS) rates at 18 and 36 months were 60% and 48%, respectively, with a median RFS of 33.7 months. Prognostic factors associated with recurrence were melanoma primary site (HR 2.64, 95% CI 1.15–6.01) and starting adjuvant therapy more than 12 weeks after the last resection (HR 1.68, 95% CI 1.13–2.5); presence of serious immune-related adverse events was associated with better RFS (HR 0.4, 95% CI 0.19–0.87). Early relapses accounted for 63% of the total recurrences, with a higher number of metastatic sites (18%); in contrast, late relapses presented more frequently with brain metastases (20%). Conclusions: In our patients with resected melanoma who underwent anti-PD-1-based adjuvant immunotherapy, survival outcomes were worse than those reported in clinical trials. Primary melanoma site and time interval between the last resection and the start of adjuvant therapy were associated with survival. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Cutaneous Melanoma)
Show Figures

Figure 1

8 pages, 1700 KiB  
Article
Effectiveness of Local Glucocorticoid Infiltration Versus Traditional Gauze Bandaging for the Treatment of Onychocryptosis: A Randomized Controlled Trial
by María Teresa García-Martínez, Alfonso Martínez-Nova, Angélica María Fernández-Gómez, José-María Blasco, Francisco Vilchez-Márquez and Carmen García-Gomariz
Healthcare 2024, 12(21), 2139; https://doi.org/10.3390/healthcare12212139 - 27 Oct 2024
Viewed by 1062
Abstract
Background/objectives: Local intralesional corticosteroid injections into the periungual fold are used to treat patients with onychocryptosis, but their short- or medium-term effects are unknown. The goal was to compare the efficacy of this treatment in stages IIa, IIb, and III of the condition [...] Read more.
Background/objectives: Local intralesional corticosteroid injections into the periungual fold are used to treat patients with onychocryptosis, but their short- or medium-term effects are unknown. The goal was to compare the efficacy of this treatment in stages IIa, IIb, and III of the condition with a common conservative method such as gauze bandaging. Methods: A two-arm randomized trial with 40 patients with stage IIa, IIb, and III onychocryptosis equally assigned into two treatment groups—control (spiculotomy and application of gauze bandaging) and experimental group (spiculotomy and infiltration of corticosteroid)—was performed. Anthropometric data, initial clinical status, pain, and inflammatory measures were collected before and at least one month after the intervention. Results: Pain reduction was higher in the experimental group (5.5 vs. 4.8 points) but with no significant differences (p = 0.306).Corticosteroids significantly reduced inflammation over gauze bandaging (1.9 vs. 1) with significant differences between them (p = 0.029). Conclusions: Corticosteroid infiltration was more effective than gauze bandaging application in reducing inflammation in patients with onychocryptosis, with similar effects on pain. These findings support the clinical importance of corticosteroid treatment for this condition, although a single infiltration may not be sufficient to prevent relapses. Full article
(This article belongs to the Special Issue Research on Podiatric Medicine and Healthcare)
Show Figures

Figure 1

12 pages, 920 KiB  
Article
The Predictive Value of the Fibrinogen–Albumin-Ratio Index on Surgical Outcomes in Patients with Advanced High-Grade Serous Ovarian Cancer
by Magdalena Postl, Melina Danisch, Fridolin Schrott, Paul Kofler, Patrik Petrov, Stefanie Aust, Nicole Concin, Stephan Polterauer and Thomas Bartl
Cancers 2024, 16(19), 3295; https://doi.org/10.3390/cancers16193295 - 27 Sep 2024
Cited by 4 | Viewed by 1087
Abstract
Background/Objectives: The present study evaluates predictive implications of the pretherapeutic Fibrinogen–Albumin-Ratio Index (FARI) in high-grade serous ovarian cancer (HGSOC) patients undergoing primary cytoreductive surgery. Methods: This retrospective study included 161 patients with HGSOC International Federation of Gynecology and Obstetrics (FIGO) stage ≥ IIb, [...] Read more.
Background/Objectives: The present study evaluates predictive implications of the pretherapeutic Fibrinogen–Albumin-Ratio Index (FARI) in high-grade serous ovarian cancer (HGSOC) patients undergoing primary cytoreductive surgery. Methods: This retrospective study included 161 patients with HGSOC International Federation of Gynecology and Obstetrics (FIGO) stage ≥ IIb, who underwent primary cytoreductive surgery followed by platinum-based chemotherapy. Associations between the FARI and complete tumor resection status were described by receiver operating characteristics, and binary logistic regression models were fitted. Results: Higher preoperative FARI values correlated with higher ascites volumes (r = 0.371, p < 0.001), and higher CA125 levels (r = 0.271, p = 0.001). A high FARI cut at its median (≥11.06) was associated with lower rates of complete tumor resection (OR 3.13, 95% CI [1.63–6.05], p = 0.001), and retrained its predictive value in a multivariable model independent of ascites volumes, CA125 levels, FIGO stage, and Charlson Comorbidity Index (CCI). Conclusions: The FARI appears to act as a surrogate for higher intra-abdominal tumor load. After clinical validation, FARI could serve as a readily available serologic biomarker to complement preoperative patient assessment, helping to identify patients who are likely to achieve complete tumor resection during primary cytoreductive surgery. Full article
Show Figures

Figure 1

13 pages, 1686 KiB  
Systematic Review
Impact of Indocyanine Green Dose on Sentinel Lymph Node Mapping in Cervical Cancer: A Systematic Review
by Joel Laufer, Santiago Scasso and Andrea Papadia
Cancers 2024, 16(17), 3107; https://doi.org/10.3390/cancers16173107 - 8 Sep 2024
Viewed by 2171
Abstract
Over the past decade, SLN mapping has become increasingly important in cervical cancer surgery. ICG is the most commonly used tracer due to its high bilateral detection rates, ease of use, and safety. However, there is no consensus on the optimal ICG dose, [...] Read more.
Over the past decade, SLN mapping has become increasingly important in cervical cancer surgery. ICG is the most commonly used tracer due to its high bilateral detection rates, ease of use, and safety. However, there is no consensus on the optimal ICG dose, leading to variability in outcomes. This systematic review aims to evaluate the impact of different ICG doses on SLN detection in early-stage cervical cancer, identifying the most effective and safe dose for clinical practice. A comprehensive search was conducted in MEDLINE/PubMed up to May 2024. Studies included assessed SLN mapping using ICG in stage IA2-IIA/IIB cervical cancer. Exclusions were applied to studies not reporting ICG dose or using multiple tracers without dose-specific results. Twelve studies were included, with ICG concentrations ranging from 0.25 mg/mL to 25 mg/mL and injection volumes from 1 to 10 mL. Overall SLN detection rates ranged from 88% to 100%, while bilateral detection rates varied between 74.1% and 98.5%. The most consistent results were obtained with an ICG concentration of 1.25 mg/mL and a 4 mL injection volume. In conclusion, an ICG concentration of 1.25 mg/mL with a 4 mL injection volume is recommended for effective SLN mapping in cervical cancer, achieving high detection rates with minimal variability. Standardizing this dose in clinical practice is suggested to improve reproducibility and outcomes. Full article
(This article belongs to the Special Issue Cervical Cancer: Screening and Treatment in 2024-2025)
Show Figures

Figure 1

16 pages, 531 KiB  
Review
Adjuvant Therapy for High-Risk Stage II Melanoma: Current Paradigms in Management and Future Directions
by Gracia Maria Vargas, Mohammad Saad Farooq and Giorgos C. Karakousis
Cancers 2024, 16(15), 2690; https://doi.org/10.3390/cancers16152690 - 29 Jul 2024
Cited by 3 | Viewed by 2860
Abstract
Melanoma is the fifth most common cancer in the United States and accounts for the majority of all skin cancer-related deaths, making it the most lethal cutaneous malignancy. Systemic adjuvant therapy for stage IIB-IV melanoma is now approved for patients who have undergone [...] Read more.
Melanoma is the fifth most common cancer in the United States and accounts for the majority of all skin cancer-related deaths, making it the most lethal cutaneous malignancy. Systemic adjuvant therapy for stage IIB-IV melanoma is now approved for patients who have undergone surgical resection, given the appreciable risk of recurrence and mortality in this patient population. Despite the lower stage, high-risk stage II melanoma (stage IIB/IIC) can often exhibit an even more aggressive course when compared to stage IIIA/IIIB disease, thus justifying consideration of adjuvant therapy in these patients. In this review, we highlight the current standard of practice for the treatment of stage IIB/C melanoma, with a focus on adjuvant therapies supported by published landmark clinical trials, including anti-PD-1 therapy. Notably, adjuvant therapies approved thus far in this patient population have demonstrated an improvement in recurrence-free survival, while their impact on overall survival is pending. Finally, this review highlights currently ongoing trials and future directions for research and treatment possibilities for high-risk clinical stage II melanoma. Full article
(This article belongs to the Special Issue Contemporary Surgical Management of Melanoma)
Show Figures

Figure 1

12 pages, 681 KiB  
Article
The Clinical Impact of Access Site Selection for Successful Thrombolysis and Intervention in Acute Critical Lower Limb Ischaemia (RAD-ALI Registry)
by Adam Csavajda, Karoly Toth, Nandor Kovacs, Szilard Rona, Zoltan Vamosi, Balazs Berta, Flora Zsofia Kulcsar, Olivier F. Bertrand, Istvan Hizoh and Zoltan Ruzsa
Life 2024, 14(6), 666; https://doi.org/10.3390/life14060666 - 23 May 2024
Viewed by 1386
Abstract
Background: Acute limb ischaemia (ALI) is of great clinical importance due to its consequent serious complications and high comorbidity and mortality rates. The purpose of this study was to compare the acute success and complication rates of CDT performed via transradial, transbrachial, and [...] Read more.
Background: Acute limb ischaemia (ALI) is of great clinical importance due to its consequent serious complications and high comorbidity and mortality rates. The purpose of this study was to compare the acute success and complication rates of CDT performed via transradial, transbrachial, and transfemoral access sites in patients with acute lower limb vascular occlusion and to investigate the 1-year outcomes of CDT and MT for ALI. Methods: Between 2008 and 2019, 84 consecutive patients with ALI were treated with CDT in a large community hospital. Data were collected and retrospectively analysed. The primary (“safety”) endpoints encompassed major adverse events (MAEs), major adverse limb events (MALEs), and the occurrence of complications related to the access site. Secondary (“efficacy”) endpoints included both technical and clinical achievements, treatment success, fluoroscopy time, radiation dose, procedure time, and the crossover rate to an alternative puncture site. Results: CDT was started with radial (n = 17), brachial (n = 9), or femoral (n = 58) access. CDT was technically successful in 74/84 patients (88%), but additional MT and angioplasty and/or stent implantation was necessary in 17 (20.2%) and 45 cases (53.6%), respectively. Clinical success was achieved in 74/84 cases (88%). The mortality rate at 1 year was 14.3%. The cumulative incidence of MAEs and MALEs at 12 months was 50% and 40.5%, respectively. After conducting multivariate analysis, history of Rutherford stage IIB (hazard ratio [HR], 3.64; 95% confidence interval [CI], 1.58–8.41; p = 0.0025), occlusion of the external iliac artery (HR, 27.52; 95% CI, 2.83–267.33; p = 0.0043), being a case of clinically unsuccessful thrombolysis (HR, 7.72; 95% CI, 2.48–23.10; p = 0.0004), and the presence of diabetes mellitus (HR, 2.18; 95% CI, 1.01–4.71; p = 0.047) were independent predictors of a high MAE mortality rate at 12 months. For MALEs, statistically significant differences were detected with the variables history of Rutherford stage IIB (HR, 4.30; 95% CI, 1.99–9.31; p = 0.0002) and external iliac artery occlusion (HR, 31.27; 95% CI, 3.47–282.23; p = 0.0022). Conclusions: Based on the short-term results of CDT, acute limb ischaemia can be successfully, safely, and effectively treated with catheter-directed thrombolytic therapy with radial, brachial, or femoral access. However, radial access is associated with fewer access site complications. A history of Rutherford stage IIB, occlusion of external iliac artery, unsuccessful thrombolysis, and the presence of diabetes mellitus were independently associated with an increased risk of MAEs. A history of Rutherford stage IIB and external iliac artery occlusion are independent predictors of MALEs. Full article
Show Figures

Figure 1

21 pages, 1853 KiB  
Review
Adjuvant PD-1 Checkpoint Inhibition in Early Cutaneous Melanoma: Immunological Mode of Action and the Role of Ultraviolet Radiation
by Matthias Brandlmaier, Magdalena Hoellwerth, Peter Koelblinger, Roland Lang and Andrea Harrer
Cancers 2024, 16(8), 1461; https://doi.org/10.3390/cancers16081461 - 11 Apr 2024
Cited by 2 | Viewed by 2107
Abstract
Melanoma ranks as the fifth most common solid cancer in adults worldwide and is responsible for a significant proportion of skin-tumor-related deaths. The advent of immune checkpoint inhibition with anti-programmed death protein-1 (PD-1) antibodies has revolutionized the adjuvant treatment of high-risk, completely resected [...] Read more.
Melanoma ranks as the fifth most common solid cancer in adults worldwide and is responsible for a significant proportion of skin-tumor-related deaths. The advent of immune checkpoint inhibition with anti-programmed death protein-1 (PD-1) antibodies has revolutionized the adjuvant treatment of high-risk, completely resected stage III/IV melanoma. However, not all patients benefit equally. Current strategies for improving outcomes involve adjuvant treatment in earlier disease stages (IIB/C) as well as perioperative treatment approaches. Interfering with T-cell exhaustion to counteract cancer immune evasion and the immunogenic nature of melanoma is key for anti-PD-1 effectiveness. Yet, the biological rationale for the efficacy of adjuvant treatment in clinically tumor-free patients remains to be fully elucidated. High-dose intermittent sun exposure (sunburn) is a well-known primary risk factor for melanomagenesis. Also, ultraviolet radiation (UVR)-induced immunosuppression may impair anti-cancer immune surveillance. In this review, we summarize the current knowledge about adjuvant anti-PD-1 blockade, including a characterization of the main cell types most likely responsible for its efficacy. In conclusion, we propose that local and systemic immunosuppression, to some extent UVR-mediated, can be restored by adjuvant anti-PD-1 therapy, consequently boosting anti-melanoma immune surveillance and the elimination of residual melanoma cell clones. Full article
Show Figures

Figure 1

14 pages, 1051 KiB  
Article
Safety of the Breast Cancer Adjuvant Radiotherapy in Ataxia–Telangiectasia Mutated Variant Carriers
by Rayan Bensenane, Arnaud Beddok, Fabienne Lesueur, Alain Fourquet, Mathilde Warcoin, Marine Le Mentec, Eve Cavaciuti, Dorothée Le Gal, Séverine Eon-Marchais, Nadine Andrieu, Dominique Stoppa-Lyonnet and Youlia Kirova
Cancers 2024, 16(7), 1417; https://doi.org/10.3390/cancers16071417 - 5 Apr 2024
Cited by 2 | Viewed by 2265
Abstract
The Ataxia–Telangiectasia Mutated (ATM) gene is implicated in DNA double-strand break repair. Controversies in clinical radiosensitivity remain known for monoallelic carriers of the ATM pathogenic variant (PV). An evaluation of the single-nucleotide polymorphism (SNP) rs1801516 (G-A) showed different results regarding late subcutaneous fibrosis [...] Read more.
The Ataxia–Telangiectasia Mutated (ATM) gene is implicated in DNA double-strand break repair. Controversies in clinical radiosensitivity remain known for monoallelic carriers of the ATM pathogenic variant (PV). An evaluation of the single-nucleotide polymorphism (SNP) rs1801516 (G-A) showed different results regarding late subcutaneous fibrosis after breast radiation therapy (RT). The main objective of this study was to evaluate acute and late toxicities in carriers of a rare ATM PV or predicted PV and in carriers of minor allele A of rs1801516 facing breast RT. Fifty women with localized breast cancer treated with adjuvant RT between 2000 and 2014 at Institut Curie were selected. Acute and late toxicities in carriers of a rare PV or predicted PV (n= 9), in noncarriers (n = 41) and in carriers of SNP rs1801516 (G-A) (n = 8), were examined. The median age at diagnosis was 53 years old and 82% of patients had an invasive ductal carcinoma and 84% were at clinical stage I–IIB. With a median follow-up of 13 years, no significant difference between carriers and noncarriers was found for acute toxicities (p > 0.05). The same results were observed for late toxicities without an effect from the rs1801516 genotype on toxicities. No significant difference in acute or late toxicities was observed between rare ATM variant carriers and noncarriers after breast RT for localized breast cancer. Full article
(This article belongs to the Special Issue Genetics and Epigenetics of Gynecological Cancer)
Show Figures

Figure 1

9 pages, 241 KiB  
Article
New Genetic Markers of Skin T-Cell Lymphoma Treatment
by Vladimír Vašků, Petra Fialová and Anna Vašků
Genes 2024, 15(3), 358; https://doi.org/10.3390/genes15030358 - 13 Mar 2024
Cited by 1 | Viewed by 2007
Abstract
Aim: Cutaneous T-cell lymphomas (CTCL) can be described as chronic skin inflammation lesions with the content of malignant T cells and they are considered to be T-cell-mediated skin diseases. CD147 is recognized as a 58-kDa cell surface glycoprotein of the immunoglobulin superfamily; it [...] Read more.
Aim: Cutaneous T-cell lymphomas (CTCL) can be described as chronic skin inflammation lesions with the content of malignant T cells and they are considered to be T-cell-mediated skin diseases. CD147 is recognized as a 58-kDa cell surface glycoprotein of the immunoglobulin superfamily; it can induce the synthesis of MMPs (matrix metalloproteinases) on the surface of tumor cells where it was originally identified. It can also function in adjacent tumor fibroblasts using CD147–CD147 interactions. The polymorphism rs8259 T/A is situated in the untranslated region (3′UTR) of the CD147 gene. HLA DRB1*1501 takes part in the process of presentation and recognition of different antigens to T cells. It can be expressed by antigen-presenting cells—macrophages, dendritic cells, and B cells. The aim of the study is to test genotype–phenotype associations of both polymorphisms including therapy in a large cohort of CTCL patients. Materials and Methods: A final total of 104 CTCL patients were enrolled in the study. For the first remission at the clinic department, they were treated by means of local skin-directed therapy, phototherapy, and systemic therapy. Genomic DNA was isolated from peripheral blood leukocytes. A standard technique using proteinase K was applied. The polymorphisms rs8259 T/A (CD147 gene) and rs3135388 (HLA DRB1*1501) were detected through standard PCR-restriction fragment length polymorphism methods. Results: The severity of the disease (patients with parapsoriasis, stages IA and IB, vs patients with stages IIB, IIIA, and IIIB) was associated with the CD147 genotype: the AA variant was 3.38 times more frequent in more severe cases, which reflects the decision on systemic therapy (p = 0.02, specificity 0.965). The AA genotype in the CD147 polymorphism was 12 times more frequent in patients who underwent systemic therapy of CTCL compared to those not treated with this therapy (p = 0.009, specificity 0.976). The same genotype was also associated with radiotherapy—it was observed 14 times more frequently in patients treated with radiotherapy (p = 0.009, specificity 0.959). In patients treated with interferon α therapy, the AA genotype was observed to be 5.85 times more frequent compared to the patients not treated with interferon therapy (p = 0.03, specificity 0.963). The HLA DRB1*1501 polymorphism was associated with local skin-directed therapy of CTCL. The CC genotype of the polymorphism was observed to be 3.57 times more frequent in patients treated with local therapy (p = 0.008, specificity 0.948). When both polymorphisms had been calculated together, even better results were obtained: the AACC double genotype was 11 times more frequent in patients with severe CTCL (p = 0.009, specificity 0.977). The TACT double genotype was associated with local skin-directed therapy (0.09 times lower frequency, p = 0.007, sensitivity 0.982). The AACC genotype was 8.9 times more frequent in patients treated by means of systemic therapy (p = 0.02, specificity 0.976) and as many as 18.8 times more frequent in patients treated with radiotherapy (p = 0.005, specificity 0.969). Thus, the AACC double genotype of CD147 and DRB1*1501 polymorphisms seems to be a clinically highly specific marker of severity, systemic therapy and radiotherapy of patients with T-cell lymphoma. Conclusion: Although genotyping results were not known during the treatment decision and could not modify it, the clinical decision on severity and therapy reflected some aspects of the genetic background of this complicated T-cell-associated disease very well. Full article
Back to TopTop