An 88-year-old man with a history of MI for which he had required quadruple coronary-artery bypass grafting presented with mottled purple discoloration of the toes. One month earlier, he had ...undergone transapical transcatheter aortic-valve replacement.
An 88-year-old man with a history of myocardial infarction for which he had required quadruple coronary-artery bypass grafting presented with mottled-appearing purple discoloration of the skin on his toes. One month earlier, he had undergone transapical transcatheter aortic-valve replacement (TAVR). The discoloration of the skin on his toes (Panels A and B) was consistent with livedo reticularis. Laboratory findings were notable for a serum creatinine level of 2.8 mg per deciliter (248 μmol per liter), which had increased from a baseline level of 1.4 mg per deciliter (124 μmol per liter), and a white-cell count of 10,200 per microliter with . . .
Abstract Background Cutaneous adnexal carcinomas are a heterogeneous group of rare neoplasms. Surgical excision is the first‐line treatment in localized stage. The use and effectiveness of ...radiotherapy have not been thoroughly evaluated in these neoplasms. Objectives The present work analyses prognostic factors on outcomes in skin adnexal carcinomas, based on data from the CARADERM (CAncers RAres DERMatologiques) database. Methods Data were collected retrospectively including demographic data, tumour types and therapeutic characteristics of all patients included in the CARADERM database, with at least one informative follow‐up visit. Analyses were performed on three populations: patients with complete resection of the primary tumour (ADJ/primary population), patients achieving complete remission after complete resection of a recurrent tumour (ADJ/recurrent population) and patients with unresectable locally advanced or metastatic tumours (ADV/MET population). Overall and recurrence/progression‐free survivals at 3‐year were analysed using Cox regression models. Results Radiotherapy did not affect overall survival (OS) in the ADJ/primary population. Adjusted recurrence‐free survival (RFS) was significantly lower in the radiotherapy group in ADJ/primary group. Older patients had significantly poorer OS and RFS. Tumour size and immunosuppression were significantly associated with poorer RFS only. Radiotherapy had no effect on OS and RFS in the ADJ/recurrent population. Age was the only factor associated with a poorer OS. Radiotherapy was significantly associated with longer progression‐free survival (PFS) in age‐sex adjusted analysis in the ADV/MET population, without effect on OS. Conclusions Our study shows that age, tumour size and immunosuppression are significantly associated with survival in localized adnexal carcinomas. Radiotherapy may improve PFS in the ADV/MET population but not in localized and recurrent carcinomas after complete excision.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Melanoma brain metastases (MBMs) are historically associated with poor prognosis. Radiation therapy is conventionally associated with a high local control rate. Development of targeted therapy and ...immunotherapy has improved overall survival (OS) and intracranial response rate, but about 50% of patients failed to respond to these novel therapies. The objective of this study was to assess the impact of combined radiotherapy (cRT) on overall survival in a large multicenter real-life prospective cohort of patients with MBM treated with immunotherapy or targeted therapy.
Clinical data from 262 patients with MBM were collected via MelBase, a French multicentric biobank prospectively enrolling unresectable stage III or IV melanoma. Two groups were defined: patients receiving cRT (cRT group) or not receiving cRT (no-cRT group). Primary end-point was OS. Propensity score weighting was used to correct for indication bias.
Among the 262 patients, 93 (35%) received cRT (cRT group). The patients were treated with immunotherapy in 69% and 60% and with targeted therapy in 31% and 40% of the cRT and no-cRT groups, respectively. With a median follow-up of 6.9 months, median OS was 16.8 months and 6.9 months in the cRT and no-cRT groups, respectively. After propensity score weighting, cRT was associated with longer OS (hazard ratio = 0.6, 95% confidence interval: 0.4–0.8; p=0.007). Median OS after ponderation was 15.3 months and 6.2 months in the cRT and no-cRT groups, respectively.
This study shows that cRT may be associated with a significant decrease of 40% in the risk of death in patients with MBM treated with systemic therapy.
•This is a prospective multicenter observational cohort of advanced melanoma.•Propensity scores are used to limit confusion and selection bias.•Combined radiotherapy (cRT) increased overall survival in patients with brain metastases.•cRT and systemic therapy decreased the risk of death by 40%.•cRT and new systemic therapies may be synergistic.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background
Significant progress was recently observed in the treatment of metastatic melanoma (MM). With >50% of patients now reaching a second line of treatment and a significant improvement in the ...survival rate, an assessment of quality of life (QoL) during the whole course of the disease becomes necessary. The objective of this study was to describe the QoL of patients with MM in France, from their diagnosis of advanced disease to their death, in real life.
Methods
QoL data were collected through MelBase, a prospective, French, multicentric cohort dedicated to the follow‐up of adults with MM. QoL was assessed using the EuroQoL‐5D questionnaire and the Functional Assessment of Cancer Treatment (FACT)‐Melanoma questionnaire at the time of study inclusion, every 3 months, and at the time of each treatment change until death. To assess longitudinal changes from baseline to death, mixed‐effect models for repeated‐measures analyses were used to control for baseline covariates.
Results
QoL was assessed in 1435 patients who were included in the study between 2013 and 2018. The median follow‐up was 9.4 months, and 47% of patients died during follow‐up. During first‐line treatment, the model‐based, mean utility score was 0.830 (95% CI, 0.818‐0.843), the mean FACT‐General score was 77.22 (95% CI, 76.23‐78.22), and the mean FACT‐Melanoma score was 129.46 (95% CI, 128.02‐130.90). At the time of a change in treatment line, there was a decrease of −0.027 (95% CI, −0.03, −0.02) in the utility score, −1.82 (95% CI, −1.88, −1.76) in the FACT‐General score, and −2.98 (95% CI, −3.05, −2.91) in the FACT‐Melanoma score compared with first‐line treatment.
Conclusions
In the MelBase cohort, the QoL among patients with MM seems to be fairly stable over the whole disease course, although a small but significant decrease at time therapy is changed is observed.
With greater than 50% of patients who have metastatic melanoma reaching a second line of treatment, an assessment of their quality of life during the whole course disease becomes crucial. In the French MelBase cohort, the quality of life for patients who have metastatic melanoma is fairly stable over time.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Despite significant progress in melanoma survival, therapeutic options are still needed in case of progression under immune checkpoint inhibitors (ICI), and resistance to targeted therapies (TT) in ...BRAF-mutated melanomas. This study aimed to assess the safety of combined ICI and TT as a rescue line in real-life clinical practice. We conducted a study within the prospective French multicentric MelBase cohort, including patients treated with a combination of anti-PD1 (pembrolizumab/nivolumab) and BRAF inhibitor (BRAFi: dabrafenib/vemurafenib) and/or MEK inhibitors (MEKi: trametinib/cobimetinib) for BRAF mutated or wild-type advanced melanoma. Fifty-nine patients were included: 30% received the triple combination, 34% an anti-PD1 and BRAFi, and 36% an anti-PD1 and MEKi. Grade 3–4 adverse events occurred in 12% of patients. Permanent discontinuation or dose reduction of one of the treatments for toxicity was reported in 14% and 7% of patients, respectively. In the BRAF wild-type subgroup, treatment with MEKi and anti-PD1 induced a tumor control rate of 83% and median progression-free survival of 7.1 months. The combination of anti-PD1 and BRAFi and/or MEKi was a safe rescue line for advanced melanoma patients previously treated with ICI/TT. The benefit of these combinations, specifically anti-PD1 and MEKi in BRAF wild-type melanoma patients, needs to be prospectively studied.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
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