E. Desmedt

Modalités de diagnostic des récidives de mélanome : étude rétrospective chez 100 malades

BACKGROUND There is no international consensus on practical methods of monitoring melanoma following surgical removal of a primary tumour. The chief aim of such monitoring is to ensure detection of relapse where early diagnosis is crucial for survival (i.e. in-transit and lymph node metastases amenable to surgical removal) and the emergence of any first recurrence of primary melanoma. AIM The aim of our study was to identify the role of various agents and diagnostic tools both in first recurrence of primary melanoma and in clinical relapse of melanoma. PATIENTS AND METHODS This was a retrospective study covering all patients with in-transit or regional lymph node metastasis seen between January 2005 and December 2007. The type of recurrence and method of detection were studied. RESULTS Ninety-four patients presented recurrence, with 66% of relapses comprising regional lymph node metastasis and 34% consisting of in-transit metastases. Thirty-three percent of cases of recurrence were detected by patients themselves, 21% by our department, 22% by a private dermatologist, 18% by a radiologist and 6% by a general practitioner. Fifty-four percent of recurrences among patients aged under 50 years were self-detected compared to 18% among patients aged over 70 years. A second melanoma was detected in six patients. DISCUSSION This study underscores the great importance of self-examination in melanoma follow-up with over one third of recurrences being self-detected by patients. Self-examination was more effective for younger patients, emphasizing the need to increase awareness among older patients. This study also demonstrates the essential part played by dermatologists in terms of regular follow-up of melanoma.

BRAF inhibitor discontinuation and rechallenge in advanced melanoma patients with a complete initial treatment response

BRAF inhibitors (BRAFi), a targeted therapy, are used to treat metastatic late-stage melanomas harbouring the BRAF-V600 mutation (found in about 50% of melanomas). The targeted therapy is generally maintained until tumour progression or major toxicity occurs, although responses are often limited in time. It is unknown whether melanoma patients achieving a complete response with targeted therapy can safely discontinue treatment. We retrospectively observed the clinical course of patients with metastatic melanoma who discontinued BRAFi therapy after achieving a complete response and those with an incomplete response combined with surgical removal of the remaining tumours. We also evaluated the effectiveness of BRAFi in these patients after recurrence. In 11 patients, the best response was diagnosed after a median BRAFi treatment duration of 105 (29–341) days. The median follow-up after BRAFi initiation was 769 (435–1765) days. Recurrence was observed in all 11 patients (100%), median: 82 (27–322) days. Five patients achieved a complete response, with a median progression-free survival after cessation of 136.5 (34–322) days versus 82 (27–144) days for six patients with an incomplete response combined with surgical removal of remaining tumours. Baseline characteristics and time to best response and to discontinuation did not influence the rate of relapse. Subsequently, eight patients were rechallenged with a BRAFi. The median progression-free survival time after BRAFi rechallenge was 222.5 (15–425) days. The three remaining patients received treatments other than BRAFi. Our findings may be valuable with respect to ongoing clinical trials of combinations of targeted therapies and immunomodulatory antibodies.

Occurrence of vismodegib-induced cramps in the treatment of basal cell carcinoma: a prospective study in 30 patients

REFERENCES 1. Zhao ZT, Ji CM, Yu WJ, et al. Omalizumab for the treatment of chronic spontaneous urticaria: a meta-analysis of randomized clinical trials. J Allergy Clin Immunol. 2016;137:1742-1750. 2. Metz M, Ohanyan T, Church MK, Maurer M. Omalizumab is an effective and rapidly acting therapy in difficult-to-treat chronic urticaria: a retrospective clinical analysis. J Dermatol Sci. 2014; 73:57-62. 3. Metz M, Ohanyan T, Church MK, Maurer M. Retreatment with omalizumab results in rapid remission in chronic spontaneous and inducible urticaria. JAMA Dermatol. 2014;150:288-290. 4. T€ urk M, Yılmaz _I, Bahçecio glu SN. Treatment and retreatment with omalizumab in chronic spontaneous urticaria: real life experience with twenty-five patients. Allergol Int. 2018;67: 85-89 [Epub ahead of print]. 5. L’Agenzia Italiana del Farmaco. Piano terapeutico (PT) AIFA per la prescrizione di Xolair (omalizumab) (orticaria cronica spontanea). Available at: http://www.gazzettaufficiale.it/do/ atto/serie_generale/caricaPdf?cdimg1⁄415A062540010001011 0001&dgu1⁄42015-08-21&art.dataPubblicazioneGazzetta1⁄4201508-21&art.codiceRedazionale1⁄415A06254&art.num1⁄41&art. tiposerie1⁄4SG.