Pregnancy associated melanoma (PAM) by definition appears during pregnancy or within 1 year after delivery. In this retrospective study we analysed the pathological characteristics and survival rate of PAM and matched the data with non-pregnant age- and stage-matched control patients. Between 2003 and 2014, 34 pregnant women (aged 32.5 ± 5.6 years) were diagnosed with melanoma at the Department of Dermatology, Venereology and Dermatooncology of the Semmelweis University. During the pathological process histologic subtype, Breslow thickness and Clark level, tumor cell type, mitotic rate, peritumoral inflammation, as well as ulceration, regression, necrosis, vascular invasion and presence of satellite were analyzed and related to clinical data. Primary tumor location and clinical staging, disease course, local recurrence and metastases, 5-year survival rate, other tumor development before or after the diagnosis of melanoma have also been documented. We found no difference in all parameters between pregnant and non-pregnant melanoma cases except peritumoral inflammation which was higher in PAM group, moreover the presence of mild inflammation was significantly higher in PAM group compared to non-pregnancy associated melanoma (NPAM) women group.

Real-world evidence plays an important role in the assessment of efficacy and safety of novel therapies. The increasing use of immune checkpoint inhibitors (ICIs) in patients with advanced melanoma has led to notably improved clinical outcomes, while they are also associated with immune-related adverse events (irAEs). The majority of the available data are based on clinical trials, where the investigated subjects often do not adequately represent the general patient population of the everyday practice. Although there is a niche of objective biomarkers for the future treatment response of ICIs, certain studies suggest that irAEs may be predictive. The aim of this study was to carry out a retrospective analysis of treatment data from patients with advanced melanoma, treated with a single anti-PD-1 agent (pembrolizumab or nivolumab) during a 77-month-long period. Treatment efficacy and occurrence of adverse events were analyzed to identify potential predictive markers. Primary and secondary endpoints were the overall survival (OS) and progression-free survival (PFS). In our cohort, we demonstrated that the occurrence of more than one irAE showed a correlation with response to PD-1 ICI therapy and improved the OS and PFS. Our study suggests, that the grade of toxicity of the irAE may affect the survival rate.

As the fifth pillar of antitumor treatment, immunotherapies have brought a significant breakthrough in oncology. Immune checkpoint inhibitors have been shown to be the most effective modality among immunotherapies by stimulating the antitumor activity of the patient’s immune system. Monoclonal antibodies such as inhibitors of cytotoxic T-lymphocyte-associated protein-4 (CTLA-4), programmed cell death protein-1 (PD-1), and programmed cell death protein ligand (PD-L1) as immune checkpoint blockers (ICIs) have been approved in many solid tumors. In addition to the introduction of immunotherapies, immunerelated side effects must also be expected. Skin reactions are one of the leading adverse immune-mediated adverse events. Below, we describe the typical immune-mediated adverse reactions affecting the skin during immunotherapy used in oncology.

Az utóbbi évek lényeges változást hoztak az áttétes, irreszekábilis melanoma malignum kezelésében. Az eddig egyedüli kemoterápia mellett megjelentek új modalitású onkológiai szerek, úgymint a BRAF V600E/BRAF V600K mutációt hordozó tumoros sejtekre ható célzott terápiák, illetve az immunterápiák. Ez utóbbiak az immunellenőrzési pontokban bekapcsolódó antitestek -CTLA4 gátló ipilimumab, majd a PD1 blokkoló szerek: nivolumab, pembrolizumabés egy onkolítikus vírus (T-VEC) jelentősen növelik a betegek túlélési esélyeit. Jelen közleményünk az előrehaladott áttétes melanoma kezelésére ma elérhető immunonkológiai szereket taglalja.

No abstract