A new report weighs the pros and cons of a sentinel node biopsy for melanoma patients.
- BRAF mutation
The Annual Report on the status of cancer shows a decline in cancer deaths from major cancers including lung, colorectal, prostate, and breast, but some cancer deaths continue to increase specifically for men with melanoma as well as for those with liver, uterine, and pancreatic cancers.
Sorafenib plus chemotherapy did not improve the overall survival of metastatic melanoma patients not previously treated with chemotherapy. The trial results are published in the Journal of Clinical Oncology.
Of 281 cutaneous melanoma patients undergoing inguinal lymph node (ILND) dissection, 14% had wound complications, a rate much lower than those reported in previous single institution studies. In a multivariable model, obesity, and diabetes were significantly associated with wound complications. There was no difference in the rate of reoperation in patients with and without wound complications. The study concludes that the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) appears to underreport the actual incidence of wound complications after ILND.
According to a Kaiser Permanente study, HIV-positive subjects had a 2.1-fold higher risk for basal cell carcinomas and a 2.6-fold higher risk for squamous cell carcinomas, compared to HIV-negative subjects. Squamous cell carcinomas were associated with lower CD4 counts, a measure of immunodeficiency. Prior antiretroviral therapy was not found to be associated with the incidence of either squamous cell carcinomas or basal cell carcinomas
A 2nd publication from a German group also find mutations in TERT, in 74% of non-inherited melanoma cases. Together with the publication from the Harvard group in the same journal, these results are likely a starting point for targeting TERT, the enzyme responsible for adding extra ends onto chromosomes.
GSK has started its COMBI-AD phase III study evaluating its BRAF inhibitor, dabrafenib with trametinib, its MEK inhibitor as adjuvant therapy for melanoma. The global study will investigate whether the combo can delay or prevent the recurrence of melanoma in patients with Stage IIIa, IIIb, or IIIc BRAF V600E or V600K mutation-positive melanoma that has been completely removed by surgery.
Review of genetics of melanoma including analysis of the mutational signatures of melanoma tumors continues to cement the causative role of UV exposure in melanoma pathogenesis. Melanomas from sun-exposed skin areas have distinct mutational signatures including C to T transitions indicative of UV-induced damage. It is thus necessary to continue spreading awareness on how to decrease the risk factors of developing the disease while at the same time working for a cure.
Two University of Colorado Cancer Center studies show that silibinin protects against UVB damage and kills cells damaged by UVA — but is not at all toxic in healthy cells. Sibinin is a milk thistle extract now shown to kill skin cells mutated by UVA radiation and protects against damage by UVB radiation, potentially protecting against UV-induced skin cancer and photo-aging.