Abstract Background and Objectives To describe the outcomes of lesional therapy of in‐transit melanoma (ITM) with interleukin‐2 (IL‐2), diphencyprone (DPCP), combination lesional therapy (IL‐2, retinoid, and imiquimod; CLT), and imiquimod. Methods Data was collected for consecutive patients with ITM receiving lesional therapies from 2008 to 2018 in a retrospective review. Included patients did not have metastatic disease at time of starting on lesional therapy and were not on systemic therapy. The primary outcome was complete pathologic response (pCR). Results Of 83 patients, 57 (69%) started treatment with IL‐2, 10 (12%) with DPCP, 12 (14%) with CLT, and 4 (5%) with imiquimod. pCR was achieved in 34 patients (41%) overall, including 44% starting on IL‐2, 20% on DPCP, 58% on CLT, and none on imiquimod ( P = .024). With a median follow‐up of 45 months, cumulative one‐year overall survival was 86%, with the best survival in the CLT group. Forty‐eight percent experienced common terminology criteria for adverse events grade 1 or 2 toxicity. A quarter of patients on DPCP discontinued therapy due to toxicity ( P = .002). Conclusions IL‐2 may be considered for the treatment of ITM with multiple or rapidly developing lesions where there would otherwise be significant morbidity with surgery, given pCR rates and toxicity.
Abstract Background Persistent pain is a common yet debilitating complication after breast cancer surgery. Given the pervasive effects of this pain disorder on the patient and healthcare system, post-mastectomy pain syndrome (PMPS) is becoming a larger population health problem, especially as the prognosis and survivorship of breast cancer increases. Interventions that prevent persistent pain after breast surgery are needed to improve the quality of life of breast cancer survivors. An intraoperative intravenous lidocaine infusion has emerged as a potential intervention to decrease the incidence of PMPS. We aim to determine the definitive effects of this intervention in patients undergoing breast cancer surgery. Methods PLAN will be a multicenter, parallel-group, blinded, 1:1 randomized, placebo-controlled trial of 1,602 patients undergoing breast cancer surgery. Adult patients scheduled for a lumpectomy or mastectomy will be randomized to receive an intravenous 2% lidocaine bolus of 1.5 mg/kg with induction of anesthesia, followed by a 2.0 mg/kg/h infusion until the end of surgery, or placebo solution (normal saline) at the same volume. The primary outcome will be the incidence of persistent pain at 3 months. Secondary outcomes include the incidence of pain and opioid consumption at 1 h, 1–3 days, and 12 months after surgery, as well as emotional, physical, and functional parameters, and cost-effectiveness. Discussion This trial aims to provide definitive evidence on an intervention that could potentially prevent persistent pain after breast cancer surgery. If this trial is successful, lidocaine infusion would be integrated as standard of care in breast cancer management. This inexpensive, widely available, and easily administered intervention has the potential to reduce pain and suffering in an already afflicted patient population, decrease the substantial costs of chronic pain management, potentially decrease opioid use, and improve the quality of life in patients. Trial registration This trial has been registered on clinicaltrials.gov (NCT04874038, Dr. James Khan. Date of registration: May 5, 2021).
No population-based study exists to demonstrate the full-spectrum impact of COVID-19 on hindering incident cancer detection in a large cancer system. Building upon our previous publication in JNCCN , we conducted an updated analysis using 12 months of new data accrued in the pandemic era (extending the study period from September 26, 2020, to October 2, 2021) to demonstrate how multiple COVID-19 waves affected the weekly cancer incidence volume in Ontario, Canada, and if we have fully cleared the backlog at the end of each wave.
e21071 Background: In-transit melanoma metastases can have severe morbidity and poor survival. Preferred treatment is surgical resection but is limited by site and extent of disease. Diphencycprone (DPCP) cream is a cost effective and accessible immune contact sensitizer that can be directly applied to in-transit lesions. Studies show favorable, and durable, clinical efficacy and toxicity. Mean time to complete response is 8 months. We present the first North American series of patients with in-transit and other melanoma cutaneous lesions treated with DPCP. Methods: From a prospective database with demographic and clinical data at a tertiary care cancer center, a single center retrospective study of 15 consecutive patients with in-transit, unresectable, or other cutaneous melanoma lesions treated with DPCP for ≥ 1 month from December 1, 2014 to December 31, 2015 was done. Primary objectives were response rate and toxicity. Patients were sensitized with 2% DPCP followed by initial applications of 0.1% - 0.01% DPCP to the lesions. Concentration and duration were titrated weekly for optimal contact hypersensitivity response. Toxicity was graded with CTCAE v.4.03. Descriptive statistics were performed. Results: Mean patient age was 75 (range 43-92). 73% of patients had prior treatment, mainly surgery and intralesional Interleukin-2. 67% of treated lesions were on the lower limb. 2 patients (13%) had a complete response after 25 and 27 weeks on 0.05% and 0.01% DPCP. 4 patients (27%) had a partial response with a mean treatment time of 30 weeks (6-51 weeks). 6 (40%) had stable disease. 6 patients stopped DPCP: 3 from systemic progression and 3 from toxicity. 1 had CTACE 3/4 skin ulceration but resolved on stopping DPCP. The most common toxicity was blisters. Most blisters resolved with dose reduction and topical steroid. Conclusions: 80% of patients had either complete, partial response or stable disease and tolerable toxicity. DPCP is a simple, feasible, and low-cost option for in-transit and other melanoma cutaneous lesions ineligible/refractory to surgery. Future study should refine response rates, limit toxicity and create a sequential treatment map for locoregional disease.
ObjectiveThis study aims to determine an appropriate timeline to monitor indeterminate pulmonary nodules (IPN) in melanoma patients to confirm metastatic origin.Materials and Methods588 clinically non-metastatic melanoma patients underwent curative intent surgery during 3 years. Patients with baseline chest CT and at least one follow-up (FU) CT were retrospectively analyzed to assess for IPN. Patients with definitely benign nodules, metastases and non-melanoma malignancies were excluded. Change in volume from first to FU CT, initial diameter (D1) and volume (V1), distance from pleura, peripheral and perifissural location, density and clinical stage were evaluated. Nodules were volumetrically measured on CTs and were considered metastases if they increased in size between two CTs or if increase was accompanied by multiple new nodules or extrapulmonary metastases.Results148 patients were included. Two out of 243 baseline IPN detected in 70 patients, increased significantly in volume in 3 and 5 months and were proven metastases. During FU, 86% of 40 interval IPN detected in 28 patients, were proven metastases. Interval nodule (p < 0.0001, HR:243,CI:[57.32,1033.74]), 3-month volume change (OR:1.023,CI:[1.014,1.033]), V1 (OR:1.006,CI:[1.003,1.009]), D1 (OR:1.424,CI:[1.23,1.648]), distance from pleura (OR:1.03,CI:[1.003,1.059]), and combined stage IIC + III (OR:11.29,CI:[1.514,84.174]), were associated with increased risk for metastasis. 43%, 72% and 94% of patients with IPN were confirmed with metastases in the first FU CT at 3, 6 and 12 months respectively.ConclusionBaseline IPN are most likely benign, while interval IPN are high risk for metastasis. Absence of volume increase of IPN within 6 months excluded metastasis in most patients.
Purpose: This study is aimed at generating consensus among women who had ductal carcinoma in situ (DCIS) and healthcare professionals on how to improve communication about low-risk forms of DCIS and reduce affected women's diagnosis-related confusion and anxiety. Methods: We conducted a two-round online Delphi survey with affected women and professionals from across Canada. They rated items sourced from prior research and key informant interviews on a 7-point Likert scale. We retained items rated 6 or 7 by ≥ 80% of panelists. Results: Thirty-seven panelists (17 women, 20 professionals) completed Round 1 and 94.6% of those completed Round 2. Of 42 items rated, 18 were retained, 13 discarded, and 11 did not achieve consensus to retain or discard. Women and professionals agreed on 3 language approaches (use plain language, distinguish DCIS from invasive breast cancer, specify the risk of recurrence and spread) and 9 other strategies to help discuss DCIS (e.g., use visual aids, provide or refer women to culturally tailored DCIS-specific information, ensure physicians can access interpreters). Based on rating and comments, women were more enthusiastic than professionals about referring to abnormal cells rather than DCIS and scheduling longer or follow-up visits to address concerns. To disseminate these findings, panelists recommended public awareness campaigns for women and continuing education and professional society endorsement for physicians. Conclusion: These findings address gaps in prior research that recommended changing the DCIS label, but had not fully explored label preferences, or identified other ways to improve and support communication about DCIS.
