Prospective tumour mutation burden and neoantigen profiling predicts immunotherapy response in metastatic melanoma
Abstract Tumour mutation burden (TMB) is a promising biomarker in predicting immunotherapy response, yet its reproducibility across target panels needs to be established. This study assessed the reproducibility of TMB estimates in melanoma using TruSight Oncology 500 across two laboratories and compared these results with the FoundationOne CDx and QIAseq TMB IO panels. High concordances in TMB estimation, mutation calls, and BRAF and N/K/HRAS hotspot variants were observed between platforms. In a cohort of 198 pre-treatment biopsies from patients treated with immune checkpoint inhibitors, high TMB (≥10 mut/Mb) was associated with significantly improved response and progression-free survival (PFS), while [...]
Real-world evaluation of the use of melanoma risk prediction tools by clinicians in Australia: a mixed methods study
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A cost comparison of radiotherapy and topical imiquimod for lentigo maligna treatment: Considerations for clinical decision-making
Abstract Background: Lentigo maligna (LM) is an in situ melanoma occurring on sun-damaged skin. Radiotherapy or topical imiquimod are potential alternatives to surgery; a recent randomized trial showed no difference in treatment failure between those approaches (underpowered because of pandemic disruption). Objective: To conduct an economic evaluation comparing radiotherapy versus topical imiquimod for treating LM. Methods: Based on no difference in clinical outcomes, a cost analysis was performed alongside the RADICAL trial, a multi-institutional randomized (1:1) phase 3 study (118/126 patients randomized completed treatment; 60 imiquimod and 58 radiotherapy) conducted in Australia, New Zealand, and Brazil. Direct medical costs and indirect costs [...]
Mobile Dermatoscope Type in Patient-Performed Teledermoscopy: A Study Within A Trial
Abstract Importance: Patient-performed teledermoscopy may improve access to dermatologic care, but evidence to guide dermatoscope selection for patient use is limited. Objective: To compare a lower-cost, ambient-light, nonpolarized dermatoscope with a higher-cost, illuminated, polarized dermatoscope for patient-performed teledermoscopy following treatment for early-stage melanoma. Design, setting, and participants: This randomized study within a trial was embedded within the MEL-SELF trial and recruited adults previously treated for early-stage melanoma (American Joint Committee on Cancer stages 0-II) in the patient-led surveillance arm of MEL-SELF from specialist and general practitioner-led skin cancer clinics in Australia from December 2021 to June 2024 with 12-month follow-up. Data were [...]
Pathological response calculation assessment remains accurate with reduced tumor bed examination after neoadjuvant immunotherapy in clinically detectable stage III melanoma.
Abstract Background: Neoadjuvant immunotherapy produces event-free survival advantage over adjuvant therapy for patients with surgically resectable macroscopic stage IIIB/C/D melanoma. Pathological response, determined as percentage residual viable tumor (% RVT), provides critical prognostic information and informs management decisions. Here, we assessed accuracy of %RVT calculation when reduced tumor bed (TB) was examined and leverage these results proposing streamlined protocols for pathological examination. Patients and methods: Comprehensive histopathological examination was carried out on 134 patient specimens after neoadjuvant immunotherapy with ipilimumab and nivolumab. Impact on %RVT when evaluating less TB than recommended by the initial International Neoadjuvant Melanoma Consortium (INMC) protocol was [...]
Preoperative predictors of priority outcomes of pelvic exenteration for locally recurrent rectal cancer: Results of the mixed-methods EviSurg study
Abstract Background: For patients with locally recurrent rectal cancer (LRRC), the potential benefit of exenteration (long-term disease control or cure) must be weighed against the morbidity and functional consequences of surgery. Consensus-derived priority outcomes of exenteration were recently established through a comprehensive series of studies, and represent shared priorities of patients, carers, and clinicians. This study aimed to identify preoperative predictors of priority outcomes following pelvic exenteration for LRRC, specifically R0 resection, overall survival, and quality of life (QOL). Methods: Prospectively collected data for 300 patients who underwent pelvic exenteration for LRRC between 1994 and 2023 were extracted from an institutional [...]
Intra-tumoural manganese is associated with radioresistance and overall survival in glioblastoma
Abstract Background: Glioblastoma (GBM) is relatively radioresistant compared to other malignancies. Like other tumours undergoing radiotherapy, there is a variable response in similar patients having identical treatments. Methods: Our objective was to identify a predictive biomarker of radioresistance in GBM, that we contend will apply to all solid cancers. Results: This retrospective study includes a homogenous cohort of 13 GBM patients (9 males, 4 females), carefully selected to minimise the influence of many known prognostic factors. Histopathology slides were analysed using laser ablation - inductively coupled plasma - mass spectrometry (LA-ICP-MS), measuring intra-tumoural manganese (Mn), iron (Fe), copper (Cu) and zinc (Zn). [...]
Letter Re: Critical evaluation of sentinel lymph node biopsy in pT1b and pT2a melanoma patients: A nationwide population-based study
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The Prognostic Significance of Tumoral Melanosis
Abstract Background: Tumoral melanosis (TM) is a histological term to describe a nodular aggregation of macrophages containing melanin pigment (melanophages) that is devoid of viable melanocytes. It is most often identified in skin, where it may be appreciated clinically as a pigmented lesion; however, it can also be found in other organs such as lymph nodes. The presence of TM is usually thought to signify the presence of a regressed melanoma or other pigmented tumor. Until recently, it was a relatively uncommon finding; however, with the use of effective systemic therapies against melanoma, its occurrence in histological specimens is more [...]
Effectiveness of a stepped-care model to address fear of cancer recurrence in patients with early-stage melanoma: results at 6- and 12-month follow-up
Abstract Purpose: To investigate the effectiveness of the Melanoma Care Program, an evidence-based, psychological intervention delivered through a stepped-care model, to address fear of cancer recurrence (FCR) in patients with early-stage melanoma at 6- and 12-month follow-up, when implemented into routine practice. Methods: Individuals with stage 0-II melanoma participated in FCR severity screening using the Fear of Cancer Recurrence Inventory. Participants with an FCR severity score of ≤ 12 were offered usual care. Participants with an FCR severity score of ≥ 13 were offered a psychoeducational booklet and a stepped-care model offering participants up to 5 psychotherapeutic telehealth sessions with a [...]