An Italian Retrospective Survey on Bone Metastasis in Melanoma: Impact of Immunotherapy and Radiotherapy on Survival.
SREs
bisphosphonates
bone metastases
denosumab
immunotherapy
melanoma
Journal
Frontiers in oncology
ISSN: 2234-943X
Titre abrégé: Front Oncol
Pays: Switzerland
ID NLM: 101568867
Informations de publication
Date de publication:
2020
2020
Historique:
received:
07
06
2020
accepted:
28
07
2020
entrez:
12
10
2020
pubmed:
13
10
2020
medline:
13
10
2020
Statut:
epublish
Résumé
We performed a multicenter retrospective observational study to investigate the impact of clinical-pathological features and therapeutic strategies on both the complications and survival of patients with bone metastases (BMs) from malignant melanoma. A total of 305 patients with melanoma and radiological evidence of BMs were retrospectively enrolled from 19 Italian centers. All patients received conventional treatments in accordance with each own treating physician's practice. Both univariate and multivariate models were used to explore the impact of melanoma features, including skeletal-related events (SREs), and different treatments on both overall survival (OS) and time-to-SREs. The chi-squared test evaluated the suitability of several parameters to predict the occurrence of SREs. Eighty-three percent of patients had metachronous BMs. The prevalent (90%) bone metastatic site was the spine, while 45% had involvement of the appendicular skeleton. Forty-seven percent experienced at least one SRE, including palliative radiotherapy (RT) in 37% of cases. No melanoma-associated factor was predictive of the development of SREs, although patients receiving early treatment with bone-targeted agents showed 62% lower risk and delayed time of SRE occurrence. Median OS from the diagnosis of bone metastasis was 10.7 months. The multivariate analysis revealed as independent prognostic factors the number of BMs, number of metastatic organs, baseline lactate dehydrogenase levels, and treatment with targeted therapy or immunotherapy. Subgroup analyses showed the best OS (median = 16.5 months) in the subset of patients receiving both immunotherapy and palliative RT. Based on our results, patients undergoing immunotherapy and palliative RT showed an OS benefit suggestive of a possible additive effect. The apparent protective role of bone targeting agent use on SREs observed in our analysis should deserve prospective evaluation.
Sections du résumé
BACKGROUND
BACKGROUND
We performed a multicenter retrospective observational study to investigate the impact of clinical-pathological features and therapeutic strategies on both the complications and survival of patients with bone metastases (BMs) from malignant melanoma.
PATIENTS AND METHODS
METHODS
A total of 305 patients with melanoma and radiological evidence of BMs were retrospectively enrolled from 19 Italian centers. All patients received conventional treatments in accordance with each own treating physician's practice. Both univariate and multivariate models were used to explore the impact of melanoma features, including skeletal-related events (SREs), and different treatments on both overall survival (OS) and time-to-SREs. The chi-squared test evaluated the suitability of several parameters to predict the occurrence of SREs.
RESULTS
RESULTS
Eighty-three percent of patients had metachronous BMs. The prevalent (90%) bone metastatic site was the spine, while 45% had involvement of the appendicular skeleton. Forty-seven percent experienced at least one SRE, including palliative radiotherapy (RT) in 37% of cases. No melanoma-associated factor was predictive of the development of SREs, although patients receiving early treatment with bone-targeted agents showed 62% lower risk and delayed time of SRE occurrence. Median OS from the diagnosis of bone metastasis was 10.7 months. The multivariate analysis revealed as independent prognostic factors the number of BMs, number of metastatic organs, baseline lactate dehydrogenase levels, and treatment with targeted therapy or immunotherapy. Subgroup analyses showed the best OS (median = 16.5 months) in the subset of patients receiving both immunotherapy and palliative RT.
CONCLUSION
CONCLUSIONS
Based on our results, patients undergoing immunotherapy and palliative RT showed an OS benefit suggestive of a possible additive effect. The apparent protective role of bone targeting agent use on SREs observed in our analysis should deserve prospective evaluation.
Identifiants
pubmed: 33042809
doi: 10.3389/fonc.2020.01652
pmc: PMC7523509
doi:
Types de publication
Journal Article
Langues
eng
Pagination
1652Informations de copyright
Copyright © 2020 Mannavola, Mandala, Todisco, Sileni, Palla, Minisini, Pala, Morgese, Di Guardo, Stucci, Guida, Indini, Quaglino, Ferraresi, Marconcini, Tronconi, Rossi, Nigro, Occelli, Cortellini, Quadrini, Palmieri, Pigozzo, Ascierto, Vitale, Strippoli, Ferrucci, Berardi, Randon, Cardone, Schinzari, Silvestris and Tucci.
Références
J Dermatolog Treat. 2018 Mar;29(2):176-181
pubmed: 28745581
Prostate Cancer. 2019 Jul 9;2019:5971615
pubmed: 31360552
Cochrane Database Syst Rev. 2012 Feb 15;(2):CD003474
pubmed: 22336790
J Bone Miner Res. 2014 Jan;29(1):55-66
pubmed: 23787729
Cell. 2015 Jun 18;161(7):1681-96
pubmed: 26091043
J Hematol Oncol. 2018 Aug 16;11(1):104
pubmed: 30115069
Support Care Cancer. 2013 Dec;21(12):3279-86
pubmed: 23884473
Melanoma Res. 2019 Feb;29(1):77-84
pubmed: 30379726
Clin Cancer Res. 2013 Mar 1;19(5):1225-31
pubmed: 23307859
Nat Med. 2019 Jun;25(6):941-946
pubmed: 31171878
Cancer Treat Rev. 2015 Nov;41(9):798-808
pubmed: 26410578
Nat Rev Clin Oncol. 2019 Dec;16(12):729-745
pubmed: 31243334
JAMA Oncol. 2016 Apr;2(4):493-9
pubmed: 26794729
Tumour Biol. 2016 Jan;37(1):1131-40
pubmed: 26276360
Int J Cancer. 2011 May 15;128(10):2453-62
pubmed: 20648558
Eur J Cancer. 2017 Sep;82:45-55
pubmed: 28648698
Crit Rev Oncol Hematol. 2015 Oct;96(1):183-93
pubmed: 26126493
J Bone Oncol. 2017 Aug 18;8:13-17
pubmed: 28856087
Clin Cancer Res. 2012 Mar 1;18(5):1386-94
pubmed: 22156613
J Clin Oncol. 2016 Apr 20;34(12):e104-6
pubmed: 25311221
Cancer Immunol Immunother. 2019 Jul;68(7):1187-1194
pubmed: 31187176
Nat Rev Cancer. 2018 May;18(5):313-322
pubmed: 29449659
Melanoma Res. 2019 Feb;29(1):1-12
pubmed: 30308577
Cancer Metastasis Rev. 2014 Sep;33(2-3):497-509
pubmed: 24398859
Tumori. 2016 Mar-Apr;102(2):156-61
pubmed: 26166220
Oncologist. 2016 Apr;21(4):508-13
pubmed: 26975863
Nat Rev Drug Discov. 2018 Nov 28;17(12):854-855
pubmed: 30482962
J Bone Oncol. 2018 Nov 06;15:004-4
pubmed: 30937279
Radiology. 1956 Aug;67(2):224-8
pubmed: 13350518
Nat Rev Clin Oncol. 2018 Nov;15(11):676-693
pubmed: 30232468
J Transl Med. 2019 Jul 19;17(1):230
pubmed: 31324252
Front Oncol. 2019 Nov 05;9:1148
pubmed: 31750245
J Bone Oncol. 2015 Oct 29;4(4):107-9
pubmed: 26730358
J Oncol. 2012;2012:647684
pubmed: 22792102
Ann Oncol. 2014 Sep;25 Suppl 3:iii124-37
pubmed: 24782453
Lancet Oncol. 2014 Dec;15(13):e584-e585
pubmed: 25456376
Clin Cancer Res. 2017 Oct 1;23(19):5789-5801
pubmed: 28634284
Nat Med. 2019 Jun;25(6):929-935
pubmed: 31171876
Oncotarget. 2018 Apr 17;9(29):20826-20837
pubmed: 29755693