Molecular risk prediction in cutaneous melanoma: A meta-analysis of the 31-gene expression profile prognostic test in 1,479 patients

Greenhaw, Bradley N.; Covington, Kyle R.; Kurley, Sarah J.; Yeniay, Yıldıray; Cao, Nhat Anh; Plasseraud, Kristen M; Cook, Robert W.; Hsueh, Eddy C.; Gastman, Brian; Wei, Maria L.

doi:10.1016/j.jaad.2020.03.053

Cited by 54 publications

(48 citation statements)

References 30 publications

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“…The primary utility of the 31-GEP test is to add objective prognostic information, based on intrinsic tumor biology, which may be missed by traditional staging factors, to develop appropriate risk-tailored management strategies. With a median time to recurrence for patients with class 2 tumors at less than 2 years [34], the most intensive surveillance can be focused during this period. Because all patients were recommended for an SLNB, this patient cohort is at a perceived higher risk for adverse events, based on clinicopathological features, than patients who do not receive SLNB recommendations.…”

Section: Discussionmentioning

confidence: 99%

“…Evaluation of these end points was limited by the relatively short follow-up of this cohort. However, the clinical accuracy of the 31-GEP test to predict patient outcomes has been extensively reported, including two recent systematic reviews and meta-analyses [23,24,34,37,38], including in prospective cohorts [26,27]. Longer follow-up of our cohort will permit an evaluation of the combination of the test result and completed management plans to identify recurrence.…”

Section: Discussionmentioning

confidence: 99%

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Integrating the Melanoma 31-Gene Expression Profile Test with Surgical Oncology Practice Within National Guideline and Staging Recommendations

Hyams¹,

Covington²,

Johnson³

et al. 2020

Future Oncol.

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Aim: Define changes in clinical management resulting from use of the prognostic 31-gene expression profile (31-GEP) test for cutaneous melanoma in a surgical oncology practice. Patients & methods: Management plans for 112 consecutively tested patients with stage I–III melanoma were evaluated for duration and number of clinical visits, blood work and imaging. Results: 31-GEP high-risk (class 2; n = 46) patients received increased management compared with low-risk (class 1; n = 66) patients. Test results were most closely associated with follow-up and imaging. Of class 1 patients, 65% received surveillance intensity within guidelines for stage I–IIA patients; 98% of class 2 patients received surveillance intensity equal to stage IIB–IV patients. Conclusion: We suggest clinical follow-up and metastatic screening be adjusted according to 31-GEP test results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Integrating the Melanoma 31-Gene Expression Profile Test with Surgical Oncology Practice Within National Guideline and Staging Recommendations

Hyams¹,

Covington²,

Johnson³

et al. 2020

Future Oncol.

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“…Validation studies of the 31-GEP, which categorizes risk as low or high by class, has indicated the 31-GEP test as an accurate predictor of metastasis of cutaneous melanoma [188][189][190] . Systematic meta-analysis demonstrated the 31-GEP test consistently identifies melanoma patients at increased risk of metastasis independent of clinicopathologic factors and improves on current staging [191] . The identification of early stage low-risk patients vs. late stage high-risk stage patients would significantly help in determining life-saving adjuvant therapies or avoiding unnecessary treatments and costs.…”

Section: Future Directionsmentioning

confidence: 99%

Overview of genetic signaling pathway interactions within cutaneous malignancies

Maner¹,

Dupuis²,

Su³

et al. 2020

JCMT

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Melanoma and non-melanoma cutaneous malignancies are some of the leading causes of cancer-related death in the United States. Though melanoma is more known to have a high mortality rate, the total mortality per year is nearly equal for between melanoma and non-melanoma skin cancer. Moreover, the non-melanoma types of cutaneous malignancies have potential to become locally invasive and even metastasize with very little to no treatment options when advanced. The development of these malignancies involves various genetic pathways through the four hallmarks of cancer development: malignant cell growth, apoptosis evasion, the use of supporting stroma and vascularization, and modulating and promoting an inadequate immune response. The genetic signaling pathways of basal cell carcinoma, squamous cell carcinoma, verrucous carcinoma, basosquamous cell carcinoma, melanoma, and cutaneous T-cell lymphoma interact with each other through genetic predisposition as well as with environmental exposures. Furthermore, solar ultraviolet radiation and chronic inflammatory states are found to initiate the progression of many of these cutaneous malignancies. This paper includes validated models of genetic pathways, emerging pathways, and crosstalk between genetic pathways through the four hallmarks of cancer development. Moreover, unlike most reviews addressing oncogenetics of the well-recognized, as well as newly dynamic, interrelated, interactive, complex, and adaptive flux states.

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“…At the same time, most will recognize the fact that classic staging with histopathological and clinical factors will become obsolete once high-level molecular biomarkers are able to reliably predict prognosis. For instance, there are already a few panels of gene expression profiles (GEP) being tested for this purpose [29][30][31].…”

Section: What Is the Problem? How Big Is The Risk? What Is The Appropmentioning

confidence: 99%

Adjuvant Therapy for Melanoma: Past, Current, and Future Developments

Testori

Chiellino

Akkooi

2020

Cancers

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This review describes the progress that the concept of adjuvant therapies has undergone in the last 50 years and focuses on the most recent development where an adjuvant approach has been scientifically evaluated in melanoma clinical trials. Over the past decade the development of immunotherapies and targeted therapies has drastically changed the treatment of stage IV melanoma patients. These successes led to trials studying the same therapies in the adjuvant setting, in high risk resected stage III and IV melanoma patients. Adjuvant immune checkpoint blockade with anti-CTLA-4 antibody ipilimumab was the first drug to show an improvement in recurrence-free and overall survival but this was accompanied by high severe toxicity rates. Therefore, these results were bypassed by adjuvant treatment with anti-PD-1 agents nivolumab and pembrolizumab and BRAF-directed target therapy, which showed even better recurrence-free survival rates with more favorable toxicity rates. The whole concept of adjuvant therapy may be integrated with the new neoadjuvant approaches that are under investigation through several clinical trials. However, there is still no data available on whether the effective adjuvant therapy that patients finally have at their disposal could be offered to them while waiting for recurrence, sparing at least 50% of them a potentially long-term toxic side effect but with the same rate of overall survival (OS). Adjuvant therapy for melanoma has radically changed over the past few years—anti-PD-1 or BRAF-directed therapy is the new standard of care.

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Molecular risk prediction in cutaneous melanoma: A meta-analysis of the 31-gene expression profile prognostic test in 1,479 patients

Cited by 54 publications

References 30 publications

Integrating the Melanoma 31-Gene Expression Profile Test with Surgical Oncology Practice Within National Guideline and Staging Recommendations

Integrating the Melanoma 31-Gene Expression Profile Test with Surgical Oncology Practice Within National Guideline and Staging Recommendations

Overview of genetic signaling pathway interactions within cutaneous malignancies

Adjuvant Therapy for Melanoma: Past, Current, and Future Developments

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