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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
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.
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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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