Clinical experience with adjuvant treatment of patients with Stage III melanoma of the trunk and extremities in a developing country
Keywords:
Adjuvant therapy, Melanoma, InterferonAbstract
Objectives: To describe the experience with the use of adjuvant high-dose interferon in patients with stage III melanoma of the trunk and extremities, establishing the causes why patients with an indication of adjuvant treatment did not receive it, as well as major toxicity and outcomes.
Materials and Methods: This is a retrospective study of a cohort of patients diagnosed with melanoma of the trunk and extremities, who were subjected to surgical treatment of the primary lesion and lymph node dissection in the INC over a ten-year period (1999-2009), and who had an indication for Interferon adjuvant treatment.
Results: Atotal88patientswerediagnosedwithStageIIImelanomaofthetrunkandextremities, of whom 50 (56.8%) were identified to have received adjuvant treatment with interferon. Among the main reasons why the remaining 38 patients did not receive it were, age and associated comorbidities (21), delayed oncology consultation (5), and decision of medical oncologist (5). Only 36% (18) patients received interferon for more than 10 months, and 62% of patients (N = 31) discontinued treatment. The main reason for suspending treatment was disease progression (N = 16, 51.6%), and 25 patients had grade III toxicity. A lower incidence of relapse was found in the group receiving the drug.
Conclusion: In this cohort it was found that patients with stage III melanoma receiving adjuvant interferon therapy had a lower relapse rate and better disease-free survival, which is in agreement with that reported in the literature.
Author Biographies
Mauricio García, Instituto Nacional de Cancerología
Clínica de Seno y Tumores de Tejidos Blandos, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
Sandra Díaz, Instituto Nacional de Cancerología
Clínica de Seno y Tumores de Tejidos Blandos, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
Angélica Gutiérrez, Instituto Nacional de Cancerología
Clínica de Seno y Tumores de Tejidos Blandos, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
Residente Mastología, Fundación Universitaria Ciencias de la Salud, Bogotá D.C., Colombia
Jesús Sánchez, Fundación Universitaria Ciencias de la Salud
Residente Mastología, Fundación Universitaria Ciencias de la Salud, Bogotá D.C., Colombia
Ricardo Sánchez, Instituto Nacional de Cancerología
Grupo de Investigación Clínica, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
References
Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. GLOBOCAN 2008 v2.0, Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 10 [Internet]. Lyon, Francia: International Agency for Research on Cancer; 2010. Disponible en: http://globocan.iarc.fr
Acosta AE, Fierro E, Velásquez VE, Rueda X. Melanoma: patogénesis, clínica e histopatología. Rev Asoc Col Dermatol. 2009;17(2):87-108.
República de Colombia, Ministerio de Salud y Protección Social, Instituto Nacional de, Cancerología., Anuario Estadístico 2010. Bogotá: Legis; 2010.
Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Troty Andy. AJCC Cancer Staging Manual. 7 ed. Chicago: Springer; 2010.
Tarhini AA, Kirkwood J. Clinical and Immunologic Basis of Interferon Therapy in Melanoma. Ann N Y Acad Sci. 2009;1182:47-57.
https://doi.org/10.1111/j.1749-6632.2009.05073.x
Lens M. Cutaneous melanoma: interferon alpha adjuvant therapy for patients at high risk for recurrent disease. Dermatol Ther. 2006;19(1):9-18.
https://doi.org/10.1111/j.1529-8019.2005.00051.x
Kirkwood JM, Strawderman MH, Ernstoff MS, Smith TJ, Borden EC, Blum RH. Interferon alfa-2b adjuvant therapy of high-risk resected cutaneous melanoma: the Eastern Cooperative Oncology Group Trial EST 1684. J Clin Oncol. 1996;14(1):7-17.
https://doi.org/10.1200/JCO.1996.14.1.7
Kirkwood JM, Manola J, Ibrahim J, Sondak V, Ernstoff MS, Rao U. A pooled analysis of Eastern Cooperative Oncology Group and intergroup trials of adjuvant high-dose interferon for melanoma. Clin Cancer Res. 2004;10(5):1670-7.
https://doi.org/10.1158/1078-0432.CCR-1103-3
Petrella T, Verma S, Sipthoff K, Quirt I, McCready D. Adjuvant interferon therapy for patients at high risk for recurrent melanoma: an updated systematic review and practice guideline. Clin Oncol. 2012;24(6):413-23.
https://doi.org/10.1016/j.clon.2011.12.002
Eggermont AM, Suciu S, Testori A, Kruit WH, Mardsen J, Punt CJ, et al. Ulceration and stage are predictive of interferon efficacy in melanoma: Results of the phase III adjuvant trials EORTC 18952 and EORTC 18991. Eur J Cancer. 2012;48(2):218-25.
https://doi.org/10.1016/j.ejca.2011.09.028
Eggermont AM, Suciu S, Santinami M, Testori A, Kruit WH, Marsden J, et al. Adjuvant therapy with pegylated interferon alfa-2b versus observation alone in resected stage III melanoma: final results of EORTC 18991, a randomized phase III trial. Lancet. 2008;372(9633):117-26.
https://doi.org/10.1016/S0140-6736(08)61033-8
Eggermont AM, Suciu S, Mackie R, MacKie R, Ruka W, Testori A, et al. Post-surgery adjuvant therapy with intermediate doses of interferon alfa 2 b versus observation in patients with stage IIb/III melanoma (EORTC 18952): randomized controlled trial. Lancet. 2005;366(9492):1189-96.
https://doi.org/10.1016/S0140-6736(05)67482-X
Garbe C, Radny P, Linse R, Dummer R, Gutzmaer R, Ulrich J, et al. Adjuvant low-dose interferon {alpha}2a with or without dacarbazine compared with surgery alone: a prospectiverandomized phase III DeCOG trial in melanoma patients with regional lymph node metastasis. 2008;19(6):1195-201.
https://doi.org/10.1093/annonc/mdn001
Stadler R, Luger T, Bieber T, Köhler U, Linse R, Technau K, et al. Long-term survival benefit after adjuvant treatment of cutaneous melanoma with dacarbazine and low dose natural interferon alpha: a controlled, randomized multicenter trial. Acta Oncol. 2006;45(4):389-99.
https://doi.org/10.1080/02841860600630954
Mocellin S, Pasquali S, Rossi C, Nitti D. Interferon alpha adjuvant therapy in patients with high-risk melanoma: a systematic review and meta-analysis. J Natl Cancer Inst. 2010;102(7):493-501.
https://doi.org/10.1093/jnci/djq009
Pollitt RA, Clarke CA, Swetter SM, Peng DH, Zadnick J, Cockburn M. The expanding melanoma burden in Carlifornia hispanics: importance of socioeconomic distribution, histologic subtype, and anatomic location. Cancer. 2011;117(1):152-61.
https://doi.org/10.1002/cncr.25355
Linos E, Swetter SM, Cockburn MG, Colditz GA, Clarke CA. Incresing burden of melanoma in the United States. J Invest Dermatol. 2009;129(7):1666-74.
https://doi.org/10.1038/jid.2008.423
Shin S, Palis BE, Phillips JL, Stewart AK, Perry RR. Cutaneous melanoma in Asian-Americans. J Surg Oncol. 2009;99(2):114-8.
https://doi.org/10.1002/jso.21195
Pectasides D, Dafni U, Bafaloukos D, Skarlos D, Polyzos A, Tsoutsos D, et al. Randomized phase III study of 1 month versus 1 year of adjuvant high-dose interferon alfa-2b in patients with resected high-risk melanoma. J Clin Oncol. 2009;27(6):
https://doi.org/10.1200/JCO.2008.16.3121939-44.
Mao L, Si L, Chi Z, Cui C, Sheng X, Li S, et al. A randomised phase II trial of 1 month versus 1 year of adjuvant high-dose interferon -2b in high-risk acral melanoma patients. Eur J Cancer. 2011;47(10):1498-503.
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