Fallen dogmas – recent advances in locoregionally advanced melanoma

Wysocki, Wojciech M.; Grela-Wojewoda, Aleksandra; Jankowski, Michał

doi:10.20452/pamw.15936

Cited by 4 publications

(4 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…When making decisions concerning CLND, all circumstances should be considered, especially the potential benefits for the patients and potential risks associated with surgery [14]. However, if a lymphadenectomy is not performed, the patient should be monitored using ultrasonography of regional lymph nodes every 3-4 months, which requires high level of compliance [35,43,44].…”

Section: Discussionmentioning

confidence: 99%

Does It Really Pay-Off? Comparison of Lymphadenectomy versus Observational Approach in Skin Melanoma with Positive Sentinel Node Biopsy: Systematic Review and Meta-Analysis

Richter

Stefura

Macheta

et al. 2022

JCM

Self Cite

View full text Add to dashboard Cite

The aim of this meta-analysis was to answer the question as to whether performing CLND (complete lymph node dissection) is necessary in every case of the melanoma patient after the positive SNB (sentinel node biopsy). To resolve doubts the authors reanalyzed previous articles and systematized the knowledge about the concerning medical problem. The databases such as PubMed, Scopus and Web of Science were screened to find articles that will be helpful to answer the controversial question if performing lymphadenectomy is crucial. The inclusion criteria consisted of randomized clinical trials, comparison of lymphadenectomy versus observation and positive sentinel node biopsy. After which, seven articles were examined. Authors analyzed parameters such as: recurrence, 3-year survival and 5-year survival. There was no relationship between the performance of CLND and melanoma recurrence (OR 1.04; 95% CI: 0.82–1.31; p = 0.75). However, no CLND group had higher 3-year survival (OR 1.22; 95% CI: 1.03–1.44; p = 0.02) and 5-year survival (OR 1.30; 95% CI: 1.19–1.85; p = 0.008). In conclusion, the observational approach to the melanoma patients with positive sentinel node biopsy is associated with comparable or slightly improved 3- and 5-year survival, then in case of routine lymphadenectomy. Although, in each melanoma patient a decision to perform or withhold lymphadenectomy should always be considered individually. Patients with low perioperative risk could be considered for surgical approach. The study was registered in PROSPERO and was assigned with the unique identifying number “CRD42021241272”.

show abstract

Section: Discussionmentioning

confidence: 99%

Does It Really Pay-Off? Comparison of Lymphadenectomy versus Observational Approach in Skin Melanoma with Positive Sentinel Node Biopsy: Systematic Review and Meta-Analysis

Richter

Stefura

Macheta

et al. 2022

JCM

Self Cite

View full text Add to dashboard Cite

show abstract

“…Despite this recent growth in the number of cases of melanoma, which prompted progress in melanoma management, the optimal post-treatment follow-up regimen has remained a controversial topic, with relatively low-quality studies behind current recommendations. This is a particularly significant issue for early melanoma patients, who constitute the majority of the treated population worldwide [ 3 , 4 ]. In this population, the conventional follow-up schedule group (CSG) encompasses frequent patient appointments (every three months through the first year and every four months in the second year, followed by every six months in years 3–5) whereas the reduced-frequency follow-up schedule (experimental follow-up schedule group, ESG) depends on the patient’s state and is individualized, with significantly less frequent clinical appointments compared to CSG [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Conventional versus Reduced-Frequency Follow-Up in Early-Stage Melanoma Survivors: A Systematic Review with Meta-Analysis

et al. 2023

View full text Add to dashboard Cite

To date, there have been multiple studies and clinical guidelines or recommendations for complex management of melanoma patients. The most controversial subjects included the frequency of follow-up. This study provides a coherent and comprehensive comparison of conventional vs. reduced-frequency follow-up strategies for early-stage melanoma patients. The value of our study consists in the precise analysis of a large collection of articles and the selection of the most valuable works in relation to the topic according to rigorous criteria, which allowed for a thorough study of the topic. The search strategy was implemented using multiple databases. The inclusion criteria were randomized clinical trial or cohort studies that compared the outcomes of a conventional follow-up schedule versus a reduced-frequency follow-up schedule for patients diagnosed with melanoma. In this study, authors analyzed recurrence and 3-year survival. Meta-analysis of outcomes presented by Deckers et al. and Moncrieff et. al. did not reveal a significant difference favoring one of the groups (OR 1.14; 95%CI: 0.65–2.00; p = 0.64). The meta-analysis of 3-year overall survival included two studies. The statistical analysis showed no significant difference in favor of the conventional follow-up group. (OR 1.10; 95%CI: 0.57–2.11; p = 0.79). Our meta-analysis shows that there is no advantage in a conventional follow-up regimen over a reduced-frequency regimen in early-stage melanoma patients.

show abstract

“…After 6.5 months of observation, the median OS (primary endpoint) for the combination was 72.1 months versus 36.9 months and 19.9 months for nivolumab and ipilimumab alone, however with a cost of more frequent G3/G4 adverse events (59% vs. 24% vs. 28% of patients on nivolumab + ipilimumab, nivolumab, or ipilimumab, respectively) according to Common Terminology Criteria for Adverse Events (CTCAE) [ 14 ]. Therefore, Polish and European guidelines recommend that combination as a preferred first-line treatment in advanced melanoma regardless of BRAF mutation status and especially in patients previously exposed to immunotherapy in the adjuvant setting [ 2 , 3 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Early Effects of Nivolumab and Ipilimumab Combined Immunotherapy in the Treatment of Metastatic Melanoma in Poland: A Multicenter Experience

et al. 2022

View full text Add to dashboard Cite

Nivolumab and ipilimumab combination became the first-line standard in advanced melanoma. We assessed its efficacy in a real-life study in Poland. In a one-year follow-up, we evaluated the medical records of 50 melanoma patients treated with that modality in five oncology centers. We recorded therapy outcomes and adverse events (AEs) after 3 and 12 months of therapy. At the first checkpoint, the disease control rate (DCR) was recorded in 58% (n = 29) of patients, but the same number of patients (n = 29, 58%) stopped immunotherapy due to disease progression (PD, n = 14, 48.3%), toxicity (n = 11, 37.9%) or death (n = 4, 13.8%). Among patients with DCR after the induction phase, 8 (27.6%) terminated due to toxicity, and 21 (72.4%) continued. However, at the 12-month checkpoint, only 14 patients (27% of all) were still receiving immunotherapy. In 7 (33.3%) it was discontinued due to PD (n = 2), toxicity (n = 2, 28.6% each), or death (n = 3, 42.9%). AEs occurred in 66.7% (n = 34) of patients; severe (grade 3 or 4) in half of them. Interestingly, those with AEs had an 80% lower risk of death (hazard ratio [HR] 0.2, 95% confidence interval [CI] 0.07–0.57, p = 0.001) and PD (HR 0.2, 95%CI 0.09–0.47, p < 0.0001). In the entire group of patients, after a 12-month follow-up, the median overall survival was not reached (NR, range: 6.8 months-NR) and progression-free survival was 6.3 (range: 3-NR) months. Our results demonstrate that combined immunotherapy is less effective in real-life than in pivotal trials. However, early responders will likely continue the therapy after a one-year follow-up. AEs occurrence might be a predictor of clinical effectiveness.

show abstract

Fallen dogmas – recent advances in locoregionally advanced melanoma

Cited by 4 publications

References 12 publications

Does It Really Pay-Off? Comparison of Lymphadenectomy versus Observational Approach in Skin Melanoma with Positive Sentinel Node Biopsy: Systematic Review and Meta-Analysis

Does It Really Pay-Off? Comparison of Lymphadenectomy versus Observational Approach in Skin Melanoma with Positive Sentinel Node Biopsy: Systematic Review and Meta-Analysis

Conventional versus Reduced-Frequency Follow-Up in Early-Stage Melanoma Survivors: A Systematic Review with Meta-Analysis

Early Effects of Nivolumab and Ipilimumab Combined Immunotherapy in the Treatment of Metastatic Melanoma in Poland: A Multicenter Experience

Contact Info

Product

Resources

About