Sclerosus Associated With Immune Checkpoint Inhibitor Therapy: A Case Series of 11 Patients
Abstract There have only been a limited number of case reports that have described vulval lichen sclerosus in patients receiving immune checkpoint inhibitor (ICI) therapy. We describe 11 cases of vulval lichen sclerosus in patients with melanoma treated with ICIs, and in nine of these cases, the lichen sclerosus symptoms began after ICI commencement. This represents the largest reported series to date and highlights the need for clinician awareness of this potential immune-related adverse effect. Read Full Paper
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 [...]
Updated pan-tumor guidelines for neoadjuvant scoring of pathologic response: a joint SITC and INMC effort
Abstract Background: Practice-changing clinical trials for novel therapeutic regimens administered in the neoadjuvant setting have been reported for multiple cancer types, bringing this treatment strategy to the forefront for patients with high-risk surgically resectable disease. Previously, tumor-type- or therapy-type-specific scoring systems were used for pathologic response assessment. The goal of this effort is to update, harmonize, and standardize the emerging system(s) for pathologic response assessment and data capture. Materials and methods: Leaders in pathology, oncology, and surgery, including those from the Society for Immunotherapy of Cancer's Pan-tumor Harmonization of Pathologic Response Assessment (PATHdata) efforts and the International Neoadjuvant Melanoma Consortium (INMC), [...]
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 [...]
CP-GEP identifies high-risk T1a melanoma patients beyond established adverse features
No abstract available. Read Full Paper
Healthcare Costs and Carbon Emissions of Stage III Melanoma Surveillance Imaging
Abstract Objectives: The aim of this study was to estimate the health system cost and carbon emissions of diagnostic imaging tests undertaken by patients on different surveillance schedules for follow-up of stage III melanoma. We also aimed to demonstrate how different monetary valuations of carbon emissions affect overall cost. Methods: We conducted a retrospective analysis of administrative data from the Melanoma Institute Australia's Melanoma Research Database for patients diagnosed with stage III melanoma between 2000 and 2014 and followed them until 2023. Imaging tests (computed tomography [CT], positron emission tomography [PET], PET-CT, ultrasound, X-ray, and magnetic resonance imaging [MRI]) undertaken during [...]
GLUT1 expression, lymphocyte distribution and CD3+ T-cell metabolic subsets as predictive markers of response to immunotherapy in advanced melanoma
Abstract Background: Glycolysis, commonly used by malignant tumors for energy production, results in acidification of the tumor microenvironment (TME) through the secretion and accumulation of lactic acid. Acidosis is a potent inhibitor of immune cell function and may therefore affect T-cell infiltration and the efficacy of immunotherapy. This study aimed to characterize the metabolic tumor microenvironment and its association with lymphocyte distribution in patients with advanced melanoma treated with immune checkpoint blockade (ICB) therapies. Methods: Pre-treatment formalin-fixed, paraffin-embedded metastatic melanoma specimens from 45 patients treated with anti-PD-1 ± anti-CTLA-4 ICB were included in this study. Patients with progression-free survival (PFS) ≥ [...]
Immune signature-based uncoupling of checkpoint inhibitor efficacy and toxicity
Abstract Personalized escalation and de-escalation of immune checkpoint inhibitor (ICI) regimens may help to overcome upfront resistance and mitigate the risk for immune-related adverse events (irAEs). Here, we examined the association between pathological response and irAEs per ICI regimen. Meta-analysis of neoadjuvant ICI trials in melanoma illustrated a pattern of increased toxicity and efficacy with the addition and/or higher dosing of anti-CTLA-4 to anti-PD-1. We subgrouped anti-PD-1, low-dose anti-CTLA-4 + anti-PD-1, high-dose anti-CTLA-4 + anti-PD-1, and anti-PD-1 + anti-LAG-3 cohorts according to the baseline interferon-gamma (IFN-γ) signature and analyzed these for response and toxicity rates. Whereas in IFN-γ high [...]
The Effect of Prior Radiotherapy on Postoperative Complications in Patients Undergoing Free Flap Reconstruction of the Head and Neck
Abstract Background: Free tissue transfer is standard of care in the reconstruction of large defects in the head and neck. Many patients who undergo free flap reconstruction have had prior head and neck radiotherapy (HNRT). The aim of this study is to compare the surgical outcomes of HNRT versus HNRT naïve patients undergoing free flap reconstruction in a large Australian cohort. Methods: Data from patients who underwent free flap reconstruction of head and neck defects between January 2017 and December 2020 were extracted from a prospectively collated database at Chris O'Brien Lifehouse (Sydney, Australia). Participants were divided into two groups based [...]
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 [...]