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The Management of Oligoprogression in the Landscape of New Therapies for Metastatic Melanoma
Background: A limited degree of progression after a response to treatment is labelled as oligoprogression and is a hot topic of metastatic melanoma (MM) management. Rogue progressive metastases could benefit from local treatment, which could allow the continuation of ongoing systemic therapy, also k...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826412/ https://www.ncbi.nlm.nih.gov/pubmed/31615127 http://dx.doi.org/10.3390/cancers11101559 |
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author | Guida, Michele Bartolomeo, Nicola De Risi, Ivana Fucci, Livia Armenio, Andrea Filannino, Ruggero Ruggieri, Eustachio Macina, Francesco Traversa, Michele Nardone, Annalisa Figliuolo, Francesco De Luca, Federica Mele, Fabio Tommasi, Stefania Strippoli, Sabino |
author_facet | Guida, Michele Bartolomeo, Nicola De Risi, Ivana Fucci, Livia Armenio, Andrea Filannino, Ruggero Ruggieri, Eustachio Macina, Francesco Traversa, Michele Nardone, Annalisa Figliuolo, Francesco De Luca, Federica Mele, Fabio Tommasi, Stefania Strippoli, Sabino |
author_sort | Guida, Michele |
collection | PubMed |
description | Background: A limited degree of progression after a response to treatment is labelled as oligoprogression and is a hot topic of metastatic melanoma (MM) management. Rogue progressive metastases could benefit from local treatment, which could allow the continuation of ongoing systemic therapy, also known as treatment beyond progression (TBP). Methods: We retrospectively reviewed 214 selected MM patients who were treated with v-Raf murine sarcoma viral oncogene homolog B (BRAF)/mitogen-activated-extracellular signal-regulated kinase (MEK) or programmed cell death protein 1 (PD-1) inhibitors and received a local treatment continuing TBP. We performed univariate and multivariable analyses to assess the association between therapy outcomes and a series of clinical and biological features. Results: We identified 27 (10%) oligoprogressed patients treated locally with surgery (14), radiosurgery (11), and electrochemotherapy (2). TBP included PD-1 inhibitors (13) and BRAF/MEK inhibitors (14). The median progression-free survival post oligoprogression (PFSPO) was 14 months (5–19 95% confidence interval (C.I.)). In the univariate analysis, a significantly longer PFSPO was associated with complete response (CR), Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0, neutrophils/lymphocytes ratio (N/L) <2, and progression-free survival (PFS) at oligoprogression >11 months. Nevertheless, in the multivariable analysis, only CR and N/L <2 were found to be associated with longer PFSPO. Conclusions: In selected patients, local treatments contribute to controlling oligoprogression for a long time, allowing the continuation of systemic treatment and prolongation of overall survival (OS). Increasing biological and clinical knowledge is improving the accuracy in identifying patients to apply for local ablative therapies. |
format | Online Article Text |
id | pubmed-6826412 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-68264122019-11-18 The Management of Oligoprogression in the Landscape of New Therapies for Metastatic Melanoma Guida, Michele Bartolomeo, Nicola De Risi, Ivana Fucci, Livia Armenio, Andrea Filannino, Ruggero Ruggieri, Eustachio Macina, Francesco Traversa, Michele Nardone, Annalisa Figliuolo, Francesco De Luca, Federica Mele, Fabio Tommasi, Stefania Strippoli, Sabino Cancers (Basel) Communication Background: A limited degree of progression after a response to treatment is labelled as oligoprogression and is a hot topic of metastatic melanoma (MM) management. Rogue progressive metastases could benefit from local treatment, which could allow the continuation of ongoing systemic therapy, also known as treatment beyond progression (TBP). Methods: We retrospectively reviewed 214 selected MM patients who were treated with v-Raf murine sarcoma viral oncogene homolog B (BRAF)/mitogen-activated-extracellular signal-regulated kinase (MEK) or programmed cell death protein 1 (PD-1) inhibitors and received a local treatment continuing TBP. We performed univariate and multivariable analyses to assess the association between therapy outcomes and a series of clinical and biological features. Results: We identified 27 (10%) oligoprogressed patients treated locally with surgery (14), radiosurgery (11), and electrochemotherapy (2). TBP included PD-1 inhibitors (13) and BRAF/MEK inhibitors (14). The median progression-free survival post oligoprogression (PFSPO) was 14 months (5–19 95% confidence interval (C.I.)). In the univariate analysis, a significantly longer PFSPO was associated with complete response (CR), Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0, neutrophils/lymphocytes ratio (N/L) <2, and progression-free survival (PFS) at oligoprogression >11 months. Nevertheless, in the multivariable analysis, only CR and N/L <2 were found to be associated with longer PFSPO. Conclusions: In selected patients, local treatments contribute to controlling oligoprogression for a long time, allowing the continuation of systemic treatment and prolongation of overall survival (OS). Increasing biological and clinical knowledge is improving the accuracy in identifying patients to apply for local ablative therapies. MDPI 2019-10-14 /pmc/articles/PMC6826412/ /pubmed/31615127 http://dx.doi.org/10.3390/cancers11101559 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Communication Guida, Michele Bartolomeo, Nicola De Risi, Ivana Fucci, Livia Armenio, Andrea Filannino, Ruggero Ruggieri, Eustachio Macina, Francesco Traversa, Michele Nardone, Annalisa Figliuolo, Francesco De Luca, Federica Mele, Fabio Tommasi, Stefania Strippoli, Sabino The Management of Oligoprogression in the Landscape of New Therapies for Metastatic Melanoma |
title | The Management of Oligoprogression in the Landscape of New Therapies for Metastatic Melanoma |
title_full | The Management of Oligoprogression in the Landscape of New Therapies for Metastatic Melanoma |
title_fullStr | The Management of Oligoprogression in the Landscape of New Therapies for Metastatic Melanoma |
title_full_unstemmed | The Management of Oligoprogression in the Landscape of New Therapies for Metastatic Melanoma |
title_short | The Management of Oligoprogression in the Landscape of New Therapies for Metastatic Melanoma |
title_sort | management of oligoprogression in the landscape of new therapies for metastatic melanoma |
topic | Communication |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826412/ https://www.ncbi.nlm.nih.gov/pubmed/31615127 http://dx.doi.org/10.3390/cancers11101559 |
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