NCCN Guidelines Insights: Melanoma, Version 3.2016

Coit, Daniel G.; Thompson, John A.; Algazi, Alain P.; Andtbacka, Robert H.I.; Bichakjian, Christopher K.; Carson, William E.; Daniels, Gregory A.; DiMaio, Dominick J.; Fields, Ryan C.; Fleming, Martin D.; Gastman, Brian; González, René; Guild, Valerie; Johnson, Douglas B.; Joseph, Richard W.; Lange, Julie R.; Martini, Mary C.; Materin, Miguel A.; Olszanski, Anthony J.; Ott, Patrick A.; Gupta, Aparna Priyanath; Ross, Merrick I.; Salama, April K.S.; Skitzki, Joseph J.; Swetter, Susan M.; Tanabe, Kenneth K.; Torres-Roca, Javier F.; Trisal, Vijay; Urist, Marshall M.; McMillian, Nicole R.; Engh, Anita M.

doi:10.6004/jnccn.2016.0101

Cited by 88 publications

(63 citation statements)

References 29 publications

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“…However, its widespread use is controversial at the current time, as the assay has not been validated in a prospective, multi-center cohort, and is not associated with benefit to a particular treatment, such as adjuvant immunotherapy with IFN or ipilimumab, the two FDA-approved adjuvant therapies for melanoma. In fact, the 2016 National Comprehensive Cancer Network guidelines indicate that currently available gene expression profiling tests should not be used to guide patient care, and not outside of a clinical trial (22). Our experience suggests that, despite the challenges of using tissues collected as part of cooperative group studies, such a validation is possible and indispensable for the further clinical development of any prognostic assay.…”

Section: Discussionmentioning

confidence: 99%

Prospective Validation of Molecular Prognostic Markers in Cutaneous Melanoma: A Correlative Analysis of E1690

Kashani‐Sabet

Nosrati

Miller

et al. 2017

Clinical Cancer Research

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Purpose To validate the prognostic impact of combined expression levels of three markers (SPP1, RGS1, and NCOA3) in melanoma specimens from patients enrolled in the E1690 clinical trial of high-dose or low-dose interferon alpha-2b (IFN) versus observation. Experimental Design Tissue was available from 248 patients. Marker expression was determined by digital imaging of immunohistochemically stained slides. The prognostic impact of each marker was first assessed by recording its expression value relative to the median. A multi-marker index was then developed to combine marker expression levels by counting for each patient the number of markers with high expression. The impact of the multi-marker index on relapse-free survival (RFS) and overall survival (OS) was assessed using Kaplan-Meier analysis, and both univariate and multivariate Cox regression analyses. Results By Kaplan-Meier analysis, high multi-marker expression scores were significantly predictive of RFS (P<0.001) and OS (P<0.001). Stepwise multivariate Cox regression analysis with backward elimination that included routine clinical and histological prognostic factors revealed high multi-marker expression scores and tumor thickness as the only factors significantly and independently predicting RFS and OS. Stepwise multivariate Cox regression analyses that also included treatment type and number of positive lymph nodes generated identical results for both RFS and OS. In the molecularly defined low-risk subgroup, patients treated with high-dose IFN had a significantly improved RFS compared with patients in the other two subgroups (P<0.05). Conclusions These results validate the independent impact of combined expression levels of SPP1, RGS1, and NCOA3 on survival of melanoma in a prospectively collected cohort.

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Section: Discussionmentioning

confidence: 99%

Prospective Validation of Molecular Prognostic Markers in Cutaneous Melanoma: A Correlative Analysis of E1690

Kashani‐Sabet

Nosrati

Miller

et al. 2017

Clinical Cancer Research

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“…The introduction of effective systemic therapies (e.g., BRAF/MEK, Anti-CTLA4, and PD-1 inhibitors) for patients with metastatic melanoma has altered the approach to management of patients with metastatic disease (39). Surgical metastasectomy plays a role in carefully selected patients who have limited sites of metastatic disease, either at first presentation of metastatic disease or if they have had a high-quality response to immunotherapy or potentially molecularly targeted therapy (40).…”

Section: Surgical Treatment Of Metastatic Melanomamentioning

confidence: 99%

Surgical Management of Melanoma

Joyce

2017

Cutaneous Melanoma: Etiology and Therapy

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This chapter discusses the surgical principles in the management of melanoma. Surgery remains the mainstay of treatment of primary melanoma, and in the majority of cases it is curative. Appropriate surgical management is critical for the diagnosis, staging, and optimal treatment of both in situ and invasive primary cutaneous melanoma. Surgical management is dependent on the stage of the disease, and therefore this chapter evaluates localized, regional, and metastatic disease. The concept of sentinel lymph node biopsy is discussed along with its benefits, pitfalls, and prognostic significance. Furthermore, several important surgical issues are discussed, including the extent of surgical margins, Mohs micrographic surgery for melanoma in situ, and the role of metastasectomy.

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“…These results provide support for the recommendation by several professional organizations that staging by means of sentinel-node biopsy should be performed when appropriate. 4–7 …”

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confidence: 99%

Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma

et al. 2017

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BACKGROUND Sentinel-lymph-node biopsy is associated with increased melanoma-specific survival (i.e., survival until death from melanoma) among patients with node-positive intermediate-thickness melanomas (1.2 to 3.5 mm). The value of completion lymph-node dissection for patients with sentinel-node metastases is not clear. METHODS In an international trial, we randomly assigned patients with sentinel-node metastases detected by means of standard pathological assessment or a multimarker molecular assay to immediate completion lymph-node dissection (dissection group) or nodal observation with ultrasonography (observation group). The primary end point was melanoma-specific survival. Secondary end points included disease-free survival and the cumulative rate of nonsentinel-node metastasis. RESULTS Immediate completion lymph-node dissection was not associated with increased melanoma-specific survival among 1934 patients with data that could be evaluated in an intention-to-treat analysis or among 1755 patients in the per-protocol analysis. In the per-protocol analysis, the mean (±SE) 3-year rate of melanoma-specific survival was similar in the dissection group and the observation group (86±1.3% and 86±1.2%, respectively; P=0.42 by the log-rank test) at a median follow-up of 43 months. The rate of disease-free survival was slightly higher in the dissection group than in the observation group (68±1.7% and 63±1.7%, respectively; P=0.05 by the log-rank test) at 3 years, based on an increased rate of disease control in the regional nodes at 3 years (92±1.0% vs. 77±1.5%; P<0.001 by the log-rank test); these results must be interpreted with caution. Nonsentinel-node metastases, identified in 11.5% of the patients in the dissection group, were a strong, independent prognostic factor for recurrence (hazard ratio, 1.78; P=0.005). Lymphedema was observed in 24.1% of the patients in the dissection group and in 6.3% of those in the observation group. CONCLUSIONS Immediate completion lymph-node dissection increased the rate of regional disease control and provided prognostic information but did not increase melanoma-specific survival among patients with melanoma and sentinel-node metastases. (Funded by the National Cancer Institute and others; MSLT-II ClinicalTrials.gov number, NCT00297895.)

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NCCN Guidelines Insights: Melanoma, Version 3.2016

Cited by 88 publications

References 29 publications

Prospective Validation of Molecular Prognostic Markers in Cutaneous Melanoma: A Correlative Analysis of E1690

Prospective Validation of Molecular Prognostic Markers in Cutaneous Melanoma: A Correlative Analysis of E1690

Surgical Management of Melanoma

Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma

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