OBJECTIVES: The aims of the study were to assess the clinical and histopathological characteristics of a comprehensive cohort of women with vulvovaginal melanoma (VVM) treated at our institution and to study the treatment response of checkpoint inhibitors in this patient cohort. MATERIALS AND METHODS: This is a retrospective study of women with invasive VVM treated at the Princess Margaret Cancer Centre in Toronto, Ontario, Canada, over a period of 15 years. Clinical and histopathological characteristics, treatment, as well as treatment-related outcome were analyzed in 32 women. Treatment response was evaluated retrospectively using the "response criteria for use in trials testing immunotherapeutics" (iRECIST). The objective response rate was defined as the proportion of patients with complete or partial response based on the best overall response. RESULTS: At a median follow-up of 37.8 months (5.8-110.4), 26 women (81.3%) had disease progression and 16 (50%) died. Thirteen patients with locally unresectable or metastatic melanoma were treated with immune checkpoint inhibitors. Ten additional cases were identified from previously published reports. The best objective response rate for immune checkpoint inhibitors was 30.4% (95% CI = 11.6%-49.2%) and the clinical benefit rate was 52.2% (95% CI = 31.8%-72.6%). The clinical benefit rate was significantly better for programmed cell death protein 1 inhibitors (or a combination) compared with ipilimumab alone (Fisher exact, p = .023). Grade 3/4 adverse events were observed in 3 (13.0%) of the 23 patients. CONCLUSIONS: Women with VVM constitute a high-risk group with poor overall prognosis. Immune checkpoint inhibitors are effective in the treatment of metastatic melanoma in this patient cohort.
OBJECTIVES: The aims of the study were to assess the clinical and histopathological characteristics of a comprehensive cohort of women with vulvovaginal melanoma (VVM) treated at our institution and to study the treatment response of checkpoint inhibitors in this patient cohort. MATERIALS AND METHODS: This is a retrospective study of women with invasive VVM treated at the Princess Margaret Cancer Centre in Toronto, Ontario, Canada, over a period of 15 years. Clinical and histopathological characteristics, treatment, as well as treatment-related outcome were analyzed in 32 women. Treatment response was evaluated retrospectively using the "response criteria for use in trials testing immunotherapeutics" (iRECIST). The objective response rate was defined as the proportion of patients with complete or partial response based on the best overall response. RESULTS: At a median follow-up of 37.8 months (5.8-110.4), 26 women (81.3%) had disease progression and 16 (50%) died. Thirteen patients with locally unresectable or metastatic melanoma were treated with immune checkpoint inhibitors. Ten additional cases were identified from previously published reports. The best objective response rate for immune checkpoint inhibitors was 30.4% (95% CI = 11.6%-49.2%) and the clinical benefit rate was 52.2% (95% CI = 31.8%-72.6%). The clinical benefit rate was significantly better for programmed cell death protein 1 inhibitors (or a combination) compared with ipilimumab alone (Fisher exact, p = .023). Grade 3/4 adverse events were observed in 3 (13.0%) of the 23 patients. CONCLUSIONS: Women with VVM constitute a high-risk group with poor overall prognosis. Immune checkpoint inhibitors are effective in the treatment of metastatic melanoma in this patient cohort.
Authors: Caroline Robert; Georgina V Long; Benjamin Brady; Caroline Dutriaux; Michele Maio; Laurent Mortier; Jessica C Hassel; Piotr Rutkowski; Catriona McNeil; Ewa Kalinka-Warzocha; Kerry J Savage; Micaela M Hernberg; Celeste Lebbé; Julie Charles; Catalin Mihalcioiu; Vanna Chiarion-Sileni; Cornelia Mauch; Francesco Cognetti; Ana Arance; Henrik Schmidt; Dirk Schadendorf; Helen Gogas; Lotta Lundgren-Eriksson; Christine Horak; Brian Sharkey; Ian M Waxman; Victoria Atkinson; Paolo A Ascierto Journal: N Engl J Med Date: 2014-11-16 Impact factor: 91.245
Authors: F Stephen Hodi; Steven J O'Day; David F McDermott; Robert W Weber; Jeffrey A Sosman; John B Haanen; Rene Gonzalez; Caroline Robert; Dirk Schadendorf; Jessica C Hassel; Wallace Akerley; Alfons J M van den Eertwegh; Jose Lutzky; Paul Lorigan; Julia M Vaubel; Gerald P Linette; David Hogg; Christian H Ottensmeier; Celeste Lebbé; Christian Peschel; Ian Quirt; Joseph I Clark; Jedd D Wolchok; Jeffrey S Weber; Jason Tian; Michael J Yellin; Geoffrey M Nichol; Axel Hoos; Walter J Urba Journal: N Engl J Med Date: 2010-06-05 Impact factor: 91.245
Authors: Jeffrey S Weber; Sandra P D'Angelo; David Minor; F Stephen Hodi; Ralf Gutzmer; Bart Neyns; Christoph Hoeller; Nikhil I Khushalani; Wilson H Miller; Christopher D Lao; Gerald P Linette; Luc Thomas; Paul Lorigan; Kenneth F Grossmann; Jessica C Hassel; Michele Maio; Mario Sznol; Paolo A Ascierto; Peter Mohr; Bartosz Chmielowski; Alan Bryce; Inge M Svane; Jean-Jacques Grob; Angela M Krackhardt; Christine Horak; Alexandre Lambert; Arvin S Yang; James Larkin Journal: Lancet Oncol Date: 2015-03-18 Impact factor: 41.316
Authors: Antoni Ribas; Omid Hamid; Adil Daud; F Stephen Hodi; Jedd D Wolchok; Richard Kefford; Anthony M Joshua; Amita Patnaik; Wen-Jen Hwu; Jeffrey S Weber; Tara C Gangadhar; Peter Hersey; Roxana Dronca; Richard W Joseph; Hassane Zarour; Bartosz Chmielowski; Donald P Lawrence; Alain Algazi; Naiyer A Rizvi; Brianna Hoffner; Christine Mateus; Kevin Gergich; Jill A Lindia; Maxine Giannotti; Xiaoyun Nicole Li; Scot Ebbinghaus; S Peter Kang; Caroline Robert Journal: JAMA Date: 2016-04-19 Impact factor: 56.272
Authors: Suzanne L Topalian; Mario Sznol; David F McDermott; Harriet M Kluger; Richard D Carvajal; William H Sharfman; Julie R Brahmer; Donald P Lawrence; Michael B Atkins; John D Powderly; Philip D Leming; Evan J Lipson; Igor Puzanov; David C Smith; Janis M Taube; Jon M Wigginton; Georgia D Kollia; Ashok Gupta; Drew M Pardoll; Jeffrey A Sosman; F Stephen Hodi Journal: J Clin Oncol Date: 2014-03-03 Impact factor: 44.544
Authors: Antoni Ribas; Igor Puzanov; Reinhard Dummer; Dirk Schadendorf; Omid Hamid; Caroline Robert; F Stephen Hodi; Jacob Schachter; Anna C Pavlick; Karl D Lewis; Lee D Cranmer; Christian U Blank; Steven J O'Day; Paolo A Ascierto; April K S Salama; Kim A Margolin; Carmen Loquai; Thomas K Eigentler; Tara C Gangadhar; Matteo S Carlino; Sanjiv S Agarwala; Stergios J Moschos; Jeffrey A Sosman; Simone M Goldinger; Ronnie Shapira-Frommer; Rene Gonzalez; John M Kirkwood; Jedd D Wolchok; Alexander Eggermont; Xiaoyun Nicole Li; Wei Zhou; Adriane M Zernhelt; Joy Lis; Scot Ebbinghaus; S Peter Kang; Adil Daud Journal: Lancet Oncol Date: 2015-06-23 Impact factor: 41.316
Authors: Maria B Schiavone; Vance Broach; Alexander N Shoushtari; Richard D Carvajal; Kaled Alektiar; Marisa A Kollmeier; Nadeem R Abu-Rustum; Mario M Leitao Journal: Gynecol Oncol Rep Date: 2016-04-14