Yep. It's me again, Margaret. I'm still yelling about simple blood draws that can provide critical information related to the diagnosis of, feasibility of treatment for, response to treatment, and prognosis generally in melanoma patients! Just last week I posted this: More blood tests to determine prognosis as well as response to therapy in melanoma patients!!!
Now, there's this....
Clinical response to PD-1 blockade correlates with a sub-fraction of peripheral central memory CD4+ T cells in patients with malignant melanoma. Takeuchi, Tanemura, Tada, et al. Int Immunol. 2017 Dec 23.
That seems pretty straight forward to me! But, there's more....
A high neutrophil to lymphocyte ratio prior to BRAF inhibitor treatment is a predictor of poor progression-free survival in patients with metastatic melanoma. Finon, Zaragoza, Maillard, et al. Eur J Dermatol. 2018 Jan 16.
Some studies have shown that a high neutrophil/lymphocyte ratio (NLR) greater than or = to 4 before initiating ipilimumab treatment is an independent prognostic indicator of poor survival in patients with metastatic melanoma (MM). To determine whether the NLR before starting BRAF inhibitor (BRAFi) treatment in patients with (MM) is associated with progression-free survival (PFS). This retrospective study included 49 patients consecutively receiving BRAFi for MM between July 2012 and December 2014. Cox proportional hazards regression was used to analyse the relationship between NLR and other factors, such as lactate dehydrogenase (LDH), performance status, BRAFi as first- or second-line therapy, and corticosteroid intake with PFS. The NLR before starting BRAFi was significantly associated with PFS based on univariate analysis and multivariate analysis adjusted for potential confounding factors, such as LDH activity, ulceration, performance status, first-line therapy, and corticosteroid intake. A high NLR (continuous variable) was associated with short PFS, and NLR greater than or = to 4 was associated with shorter PFS . Corticosteroid intake was not associated with short PFS based on multivariate analysis. An NLR greater than 4, before starting BRAFi treatment, is an independent prognostic indicator of poor progression-free survival.
SO.....again ~ folks with a high NLR (greater than or = to 4) did worse!!! This is NOT news people. I've been yelling about this since 2015!!!
That fact was valid when the NLR was tested in folks without metastatic disease ~ Neutrophil-to-lymphocyte ratios as a predictor of death from melanoma in patients with NONmetastatic disease
That fact was valid when the NLR was examined in regard to ipi (as noted in the above article) ~ Neutrophils as a prognostic predictor in patients trated with ipi/Yervoy
That fact was valid when first postulated in 2015 ~ Lab values that may predict response to Ipi/Yervoy????
Do we really need to examine that any further??? There is also this...
Development and validation of a plasma-based melanoma biomarker suitable for clinical use. Van, Lincoln, Van Laar. Br J Cancer. 2018 Jan 23.
Here folks looked at blood samples for microRNA whose presence helped define the difference between melanoma and normal plasma.
I have endless posts regarding the examination of tumor DNA in the blood of melanoma patients, allowing for the identification of disease, BRAF status, progression, response, etc. Earlier this month, I posted this: Circulating tumor DNA to help differentiate true progression of melanoma vs pseudoprogression in patients treated with anti-PD-1 Here are about a zillion additional posts: Circulating melanoma DNA
Really people! Can someone not do a definitive study on a larger scale...rather than piecemeal this and that....without sharing data...to come up with a valid and specific melanoma panel??? We have simple lipid panels that help guide heart health. We have lab draws and tests that help diagnosis and monitor diabetes. No set of labs is an absolute for ANYTHING. BUT!!!! They are incredibly important tools in diagnosing, treating and managing a wide variety of disease processes. They can do that for melanoma, too!!! We have learned that we can look at T cells, other basic blood cells, tumor DNA, RNA, all sorts of bits and bobs....floating in the blood of patients with melanoma, to provide meaningful information that could allow melanoma patients and their doctors a mechanism for making better choices in their treatment and care.
Radiologic scans expose us to radiation, "find" lots of red herrings, and are a huge financial burden. They also have limits regarding what they can see. Sub-centimeter tumors, not to mention little demon melanoma cells floating about, are not visualized. Additionally, imaging studies are cumbersome and have a built in time lag that can delay needed therapy or a change in current therapy as patients wait for "their next scan" to be compared to a prior one in order to define disease status. Determining pathology from tumor samples is often confusing. I had to have my initial slides examined by 3 pathologists to gain consensus that I was in fact dealing with melanoma. Folks need and deserve answers. A basic algorithim that incorporates all forms of investigation including blood markers, nuclear, radiographic, and tissue examination needs to be established for melanoma. NOW!!!
Seriously..NOW!!! - c