Zager, Jonathan S
Mayo Clinic
Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
Citations 2
A comparison of isolated limb infusion/perfusion, immune checkpoint inhibitors, and intralesional therapy as first‐line treatment for patients with melanoma in‐transit metastases
DePalo, Danielle K. , Dugan, Michelle M. , Naqvi, Syeda Mahrukh Hussnain , Ollila, David W. , Hieken, Tina J. , Block, Matthew S. , Houdt, Winan J. van , Reijers, Sophie J. M. , Asher, Nethanel , Duncan, Zoey , Anderson, Matilda, Snow, Hayden , Held, Jenny M., Farma, Jeffrey M. , Vetto, John T. , Hui, Jane Yuet Ching , Kolbow, Madison , Saw, Robyn P.M. , Lo, Serigne , Long, Georgina V. , Karapetyan, Lilit , Akkooi, Alexander C. J. van , van Houdt, Winan J , Asher, Nethanel , Hui, Jane Yuet Ching , Kolbow, Madison , Lo, Serigne N , Thompson, John F , Zager, Jonathan S , Hieken, Tina J , Long, Georgina V , Wouters, Michel W.J.M. , Broman, Kristy K. , Gyorki, David E. , Held, Jenny, Thompson, John F. , Kim, Youngchul , Ny, Lars , Bagge, Roger Olofsson , Zager, Jonathan S.
Cancer | November 10, 2024 | Volume: 131 | Issue: 1 | Pages: No page available
AbstractBackgroundIsolated limb infusion and perfusion (ILI/ILP) has been a mainstay treatment for unresectable melanoma in‐transit metastases (ITM), but increased use of immune checkpoint inhibitors (ICI) and intralesional therapy (talimogene laherparepvec [TVEC]) introduced several different management options. This study compares first‐line ILI/ILP, ICI, and TVEC.MethodsRetrospective review from 12 international institutions included patients treated from 1990 to 2022 with first‐line ILI/ILP, ICI, or TVEC for unresectable melanoma ITM.ResultsA total of 551 patients were treated, with ILI/ILP (n = 356), ICI (n = 125), and TVEC (n = 70) with median follow‐up of 5.5 years. Tumor burden was highest with ILI/ILP and lowest with TVEC (p = .002). Breslow thickness was lowest with TVEC (p = .007). TVEC was mostly used in stage IIIB disease versus IIIC for ILI/ILP and ICI (p = .01). Using ICI as the reference category, TVEC had the highest odds of a complete response (CR) (odds ratio, 1.96; p = .029) and a longer local progression‐free survival (PFS) (hazard ratio [HR], 0.40; p = .003). ILI/ILP had shorter local PFS (HR, 1.72; p = .012), PFS (HR, 1.79; p < .001), distant metastasis‐free survival (DMFS) (HR, 1.75; p = .014), overall survival (HR, 1.82; p = .009), and melanoma‐specific survival (HR, 2.29; p = .004). Stage IIIB disease had longer DMFS (HR, 0.24; p < .001) compared to IIIC/D.ConclusionsTVEC as first‐line therapy for unresectable melanoma ITM was associated with superior CR rates and local PFS. Notably, TVEC was used in patients with a lower Breslow thickness, disease stage, and tumor burden. Therefore, when compared to ILI/ILP and ICI, TVEC should be considered as first‐line therapy for unresectable stage IIIB melanoma ITM with minimal tumor burden and lower Breslow thickness.
Regression in melanoma is significantly associated with a lower regional recurrence rate and better recurrence‐free survival
Subramanian, Sarayu , Olson, Natalie , Leong, Stanley P. L. , Kashani‐Sabet, Mohammed, White, Richard L. , Zager, Jonathan S. , Sondak, Vernon K. , Messina, Jane L. , Pockaj, Barbara A. , Vetto, John T. , Fowler, Graham, Schneebaum, Schlomo , Han, Dale , White, Richard , Zager, Jonathan S , Pockaj, Barbara, Han, Dale , Han, Gang , Kosiorek, Heidi
Journal of Surgical Oncology | September 18, 2021 | Volume: 125 | Issue: 2 | Pages: 229-238
AbstractBackground and ObjectivesThe prognostic significance of regression in predicting melanoma recurrences is unknown. We present a large multicenter study correlating regression with recurrence.MethodsThe Sentinel Lymph Node Working Group database was queried from 1993 to 2018 for cases with regression data. Clinicopathologic factors were correlated with overall and first‐site of recurrence and with recurrence‐free survival (RFS).ResultsThere were 4790 patients and the median follow‐up was 39.6 months. Regression and recurrences were seen in 1081 (22.6%) and 773 (16.1%) cases, respectively. First‐site locoregional and distant recurrences were seen in 412 (8.6%) and 352 (7.3%) patients, respectively. Regression was seen in 15.8% and 24.7% of all cases with and without recurrences (p < 0.0001), respectively, while regression was seen in 14.3% and 17.9% of first‐site locoregional and distant recurrent cases, respectively, compared with 23.3% and 22.9% of patients with regression and without first‐site locoregional and distant recurrences, respectively (p = 0.29). On multivariable analysis, after controlling for age, gender, thickness, ulceration, lymphovascular invasion, and sentinel lymph node status, regression significantly predicted improved RFS (p = 0.004) and fewer first‐site regional recurrences (p = 0.017).ConclusionOur data suggest that regression is a favorable prognostic marker in melanoma and predicts significantly better RFS and decreased first‐site regional recurrences.