We report a new immunological treatment for advanced cutaneous melanoma which combines laser stimulation with topical application of a toll-like receptor agonist. This treatment, in situ photoimmunotherapy (ISPI), provides an alternative to traditional therapies for melanoma patients with cutaneous metastases. A 6-week cycle of ISPI is carried out on cutaneous metastases located in a designated 20 x 20 cm treatment area: 2 weeks of pretreatment with twice-daily topical applications of imiquimod (5% cream under plastic occlusion), with a laser treatment session at week 2 and again at week 4. Topical imiquimod is continued for the entire 6-week cycle. Two patients with late-stage melanoma were treated with ISPI. Patient 1 had the primary tumour and local metastases on the left arm, as well as metastatic tumours in the lungs [American Joint Committee on Cancer (AJCC) stage IV]. Patient 2 had a head and neck melanoma with multiple local metastases (AJCC stage IIIC), which had failed repeated attempts at surgical resection and high-dose radiation therapy. Patient 1 is now free of all clinically detectable tumours (including the lung metastases) >20 months after the first treatment cycle. Patient 2 has been free of any clinical evidence of the tumour for over 6 months. These two cases demonstrate that ISPI can clear local tumour and trigger beneficial systemic responses, with a side-effect profile that compares favourably with other treatments for advanced melanoma.
Technically, the surgery is feasible and could be performed by any gynecologic oncologist who is skilled in radical pelvic surgery and the robotic system. The long-term obstetric and oncologic outcome of this technique would be expected to match the outcome of the other radical trachelectomy techniques in the published literature, but is yet to be fully elucidated.
More than 10% of cancer patients have venous thromboembolism (VTE). There is a clear relationship between VTE and several types of solid tumors; VTE negatively impacts survival. This disorder is the second leading cause of death in cancer patients. Some studies have reported that the solid tumor with the highest rate of VTE is ovarian cancer. Few studies have evaluated the contribution of VTE timing to survival in patients with solid tumors. A substantial proportion of deaths in cancer patients may be preventable with improved and tailored thromboprophylaxis.The aim of this retrospective study was to evaluate the effect of VTE on survival in patients with epithelial ovarian cancer (EOC) and to determine how the chronology of VTE events with respect to surgery impacts survival. A chart review was performed for data from patients treated for EOC [at a single medical center between 1996 and 2011]. Associations between VTE and the primary outcomes of progression-free survival (PFS) and overall survival (OS) were assessed using a Cox proportional hazards model. Data were adjusted for diagnosis, age, stage, histology, performance status, and residual disease.A total of 586 patients were treated for EOC met study criteria. Median patient age was 63 years (range, 17-94 years), and median body mass index was 27.1 kg/m 2 (range, 13.7-67.0 kg/m 2 ). Most patients (75.4%) had advanced stage (III/IV) disease; 68.3% had high-grade serous histology. Twenty-one patients (3.7%) had preoperative VTE, and 74 (13.2%) had postoperative VTE. Preoperative VTE was predictive of OS (adjusted hazard ratio [aHR], 3.1; 95% confidence interval [CI], 1.6-6.1; P = 0.001) but not PFS (P = 0.55). Postoperative VTE was predictive of both PFS (aHR, 1.45; 95% CI, 1.04-2.02; P = 0.03) and OS (aHR, 1.8; 95% CI, 1.3-2.6; P = 0.001). When VTE timing was modeled, preoperative VTE was predictive of OS (aHR, 3.5; 95% CI, 1.8-6.9; P < 0.001).but postoperative VTE was predictive of OS only when occurring after completion of primary therapy (aHR, 2.3; 95% CI, 1.4-3.6; P = 0.001).These findings demonstrate that both preoperative and postoperative VTE are independent predictors of poor survival in women with EOC. Postoperative VTE attenuates PFS when modeled as a binary variable but is not associated with PFS when VTE timing is modeled. Venous thromboembolism is potentially preventable. Further studies are needed to determine whether improved VTE prophylaxis and treatment can increase survival.
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