Prognostic Gene Expression Profiling in Melanoma: Necessary Steps to Incorporate into Clinical Practice

Abstract

Prognostic gene expression profiling (GEP) tests for cutaneous melanoma (CM) are not recommended in current guidelines outside of a clinical trial. However, their use is becoming more prevalent and some practitioners are using GEP tests to guide patient management. Thus, there is an urgent need to bridge this gap between test usage and clinical guideline recommendations by obtaining high-quality evidence to guide us toward best practice use of GEP testing in CM patients. We focus here on the opportunities and uncertainties associated with prognostic GEP testing in CM, review how GEP testing was incorporated into clinical care guidelines for uveal melanoma and breast cancer and discuss the role of clinical trials to determine best use in patients with CM.

The role of integrins in melanoma: a review

“…It is not surprising that integrin molecules are included in some of these test kits given their significant role in melanoma aggressiveness. Although it is not the standard of care to include molecular testing in melanoma risk stratification, awareness of molecular‐based testing among patients and clinicians is increasing 52 . However, in addition to the added cost of these tests, there continue to be questions about the clinical utility, especially if they are purely prognostic 53 .…”

“…There are no definite guidelines available to date to determine a treatment course on the basis of prognostic molecular testing, and gene expression profiling is not recommended by the National Comprehensive Cancer Network outside of clinical research. Given the multiple caveats associated with testing, 52,54 clinicians should educate themselves on the accuracy and validity of commercially available molecular tests before recommending them to patients.…”

β3 integrin immunohistochemistry as a method to predict sentinel lymph node status in patients with primary cutaneous melanoma

“…In contrast RT‐qPCR is highly sensitive, specific, easily multiplexed, and amendable to high‐throughput workflows. It is therefore not surprising that the recently introduced molecular‐based melanoma risk stratification tools are based on RT‐qPCR 5 , 20 , 21 . For example, β3 integrin is one of eight biomarkers used for melanoma risk stratification in a commercially available gene expression profile which identifies patients who are so low risk that they may safely forgo SLN biopsy 5 , 22…”

Cellular and Molecular Aspects of Anti-Melanoma Effect of Minocycline—A Study of Cytotoxicity and Apoptosis on Human Melanotic Melanoma Cells

“…With reference to the above, a lot of new information and clues have been recently published. They concern both genetic prognosis and profiling of melanoma [ 16 , 17 , 18 , 19 ], as well as various drugs, often well-known, which could be considered new anti-melanoma agents, e.g., everolimus [ 20 ], benserazide [ 21 ] or naturally occurring mangiferin [ 22 ].…”