TY - JOUR A1 - Koch, Elias A. T. A1 - Petzold, Anne A1 - Wessely, Anja A1 - Dippel, Edgar A1 - Gesierich, Anja A1 - Gutzmer, Ralf A1 - Hassel, Jessica C. A1 - Haferkamp, Sebastian A1 - Hohberger, Bettina A1 - Kähler, Katharina C. A1 - Knorr, Harald A1 - Kreuzberg, Nicole A1 - Leiter, Ulrike A1 - Loquai, Carmen A1 - Meier, Friedegund A1 - Meissner, Markus A1 - Mohr, Peter A1 - Pföhler, Claudia A1 - Rahimi, Farnaz A1 - Schadendorf, Dirk A1 - Schell, Beatrice A1 - Schlaak, Max A1 - Terheyden, Patrick A1 - Thoms, Kai-Martin A1 - Schuler-Thurner, Beatrice A1 - Ugurel, Selma A1 - Ulrich, Jens A1 - Utikal, Jochen A1 - Weichenthal, Michael A1 - Ziller, Fabian A1 - Berking, Carola A1 - Heppt, Markus T1 - Immune checkpoint blockade for metastatic uveal melanoma: patterns of response and survival according to the presence of hepatic and extrahepatic metastasis JF - Cancers N2 - Background: Since there is no standardized and effective treatment for advanced uveal melanoma (UM), the prognosis is dismal once metastases develop. Due to the availability of immune checkpoint blockade (ICB) in the real-world setting, the prognosis of metastatic UM has improved. However, it is unclear how the presence of hepatic and extrahepatic metastasis impacts the response and survival after ICB. Methods: A total of 178 patients with metastatic UM treated with ICB were included in this analysis. Patients were recruited from German skin cancer centers and the German national skin cancer registry (ADOReg). To investigate the impact of hepatic metastasis, two cohorts were compared: patients with liver metastasis only (cohort A, n = 55) versus those with both liver and extra-hepatic metastasis (cohort B, n = 123). Data were analyzed in both cohorts for response to treatment, progression-free survival (PFS), and overall survival (OS). The survival and progression probabilities were calculated with the Kaplan–Meier method. Log-rank tests, χ\(^2\) tests, and t-tests were performed to detect significant differences between both cohorts. Results: The median OS of the overall population was 16 months (95% CI 13.4–23.7) and the median PFS, 2.8 months (95% CI 2.5–3.0). The median OS was longer in cohort B than in cohort A (18.2 vs. 6.1 months; p = 0.071). The best objective response rate to dual ICB was 13.8% and to anti-PD-1 monotherapy 8.9% in the entire population. Patients with liver metastases only had a lower response to dual ICB, yet without significance (cohort A 8.7% vs. cohort B 16.7%; p = 0.45). Adverse events (AE) occurred in 41.6%. Severe AE were observed in 26.3% and evenly distributed between both cohorts. Conclusion: The survival of this large cohort of patients with advanced UM was more favorable than reported in previous benchmark studies. Patients with both hepatic and extrahepatic metastasis showed more favorable survival and higher response to dual ICB than those with hepatic metastasis only. KW - uveal melanoma KW - immune checkpoint blockade KW - PD-1 KW - CTLA-4 KW - liver metastasis KW - treatment resistance Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-242603 SN - 2072-6694 VL - 13 IS - 13 ER - TY - THES A1 - Hassel, Jessica C. T1 - Untersuchungen zur Apoptoseregulation durch die Melanom induzierende Rezeptortyrosinkinase Xmrk T1 - Investigations on apoptosis regulation by the melanoma inducing receptor tyrosine kinase Xmrk N2 - Überexpression der konstitutiv aktiven Rezeptortyrosinkinase Xmrk im Zahnkarpfen Xiphophorus führt zur Ausbildung maligner Melanome. Expressionsstudien in transgenen Medaka-Fischen haben gezeigt, daß Xmrk allerdings nur in bestimmten Geweben wie Hirn, Epithelien, Auge und Pigmentzellen zur Tumorbildung führt. Zellen, die durch Xmrk transformiert werden können, scheinen somit über entsprechende Komponenten der durch Xmrk induzierten intrazellulären Signaltransduktion verfügen zu müssen. Bisher wurde eine Reihe von Signalproteinen identifiziert, die von Xmrk rekrutiert und aktiviert werden. Dazu gehören die PLC-g, die Adapterproteine Shc und Grb2, die PI3K, die Fyn-Kinase aus der Familie der Src-Kinasen und der Transkriptionsfaktor STAT5. Um die Signaltransduktion von Xmrk in induzierbarer Form untersuchen zu können, wurde eine mit EGF stimulierbare Rezeptorchimäre HER-mrk, deren extrazellulärer Anteil vom humanen EGF-R und deren intrazellulärer Anteil von Xmrk stammt, in der IL-3 abhängigen murinen pro-B-Zellinie Ba/F3 exprimiert. EGF-Stimulation dieser als BaF Hm bezeichneten Zellen führt zu IL-3 unabhängigem Wachstum und zu Langzeitüberleben. Stimulation des aus der gleichen Genfamilie stammenden EGF-Rezeptors hingegen, wird er in Ba/F3 Zellen exprimiert, kann kein Langzeitüberleben vermitteln. Erste Untersuchungen zeigten, daß das durch HER-mrk vermittelte Langzeitüberleben in Ba/F3 Zellen nicht auf einer höheren Rezeptorexpression verglichen mit den EGF-R exprimierenden Zellen beruht. Allerdings korreliert die Rezeptordichte mit der DNA-Syntheseleistung der Ba/F3 Zellen. Durch verschiedene carboxyterminal verkürzte HER-mrk Rezeptormutanten wurde eine unterschiedliche Anzahl von Substratbindungsstellen von Xmrk deletiert. Expression dieser HER-mrk Rezeptormutanten in Ba/F3 Zellen zeigte, daß für die Auslösung der Replikation der DNA keine C-terminale Substratbindungsstelle notwendig ist, während für eine Vollendung der Zellteilung mit Zellvermehrung und für Langzeitüberleben zwei membrannahe Substratbindungsstellen ausreichend sind. Der Vergleich der durch die verschiedenen Rezeptoren induzierten Signalwege bzw. der Substratinteraktionen von HER-mrk, seinen Mutanten und dem EGF-R gab Hinweise auf für die Antiapoptose entscheidende Signalwege. Untersuchungen zur Aktivierung von STAT1, 3 und 5 zeigten, daß HER-mrk zu einer Aktivierung aller drei STAT-Proteine führt, während der EGF-R in Ba/F3 Zellen nur STAT1 und 3, nicht aber STAT5 aktivieren kann. Die HER-mrk Rezeptormutanten zeigten, daß für die Aktivierung von STAT5 durch HER-mrk keine carboxyterminale Substratbindungsstelle notwendig ist, diese aber möglicherweise durch Stabilisierung der Rezeptorbindung seine Aktivierung verstärken. Für die Aktivierung von STAT1 und 3 hingegen sind carboxyterminale Substratbindungsstellen entscheidend. Das für ein antiapoptotisches Protein kodierende STAT5-Zielgen bcl-X wurde als HER-mrk Zielgen identifiziert. Auch die schwächere STAT5 Aktivierung durch die trunkierte HER-mrk Rezeptormutante Hm delta1006 hatte eine bcl-X Transkription zur Folge, während der EGF-R bcl-X nicht induzierte. Untersuchungen weiterer antiapoptotischer Signalwege zeigten, daß die mrk-Kinase sowie ihre Rezeptormutante Hm delta1006 im Gegensatz zum EGF-R auch zu einer Induktion von bcl-2 führen. Da diese Mutante kein Langzeitüberleben vermittelt, ist somit die Induktion der Genexpression antiapoptotischer Proteine wie Bcl-XL und Bcl-2 nicht ausreichend für Antiapoptose. Es bedarf somit der Kombination mehrerer antiapoptotischer Signalwege, um Langzeitüberleben zu sichern. Expression der Rezeptorchimäre HER-mrk in murinen Melanozyten führt bei Stimulation der mrk-Kinase zur Transformation der Zellen. Im Rahmen dieser Arbeit konnte eine starke Induktion von bcl-X nach HER-mrk Stimulation in den Melanozyten nachgewiesen werden. Bei der Untersuchung humaner Melanomzellinien, die in der Expression verschiedener Rezeptortyrosinkinasen oft ein sehr unterschiedliches Muster zeigen, konnte eine konstitutive Aktivität von STAT5 in allen untersuchten Zellinien nachgewiesen werden, während STAT1 und 3 nur eine schwache und inhomogene Basalaktivität aufwiesen. Es zeigt sich folglich ein ähnliches Bild wie im Xiphophorus-Melanom, in dem ausschließlich STAT5 konstitutiv aktiv ist. Die untersuchten humanen Melanomzellinien zeigten durchweg eine Expression von Bcl-XL. Andere Signalwege wie z.B. die Aktivierung der MAPK hingegen zeigten ein heterogenes Muster bei den verschiedenen Zellinien. Erste Experimente in A375 Zellen deuten darauf hin, daß die Expression von dominant negativem STAT5 zur Reduktion der bcl-X Transkription und zur Apoptose der Zellen führt (Wellbrock, unveröffentlicht). Der STAT5/Bcl-XL Signalweg scheint folglich ganz entscheidend für die Antiapoptose von Melanomen zu sein. N2 - Overexpression of the constitutively active receptor tyrosine kinase Xmrk, a member of the EGF-R family, in the fish Xiphophorus leads to the formation of malignant melanoma. Studies in transgenic Medaka fish showed that Xmrk only induced tumour formation in distinct tissues like brain, epithelia, eye and pigment cells. This showed that cells, which can be transformed by Xmrk need to have the appropriate components of the Xmrk signal transduction pathways. Until now PLC-g, the adaptor proteins Shc and Grb2, PI3K, the Src kinase Fyn and the transcription factor STAT5 have been identified as signalling proteins recruited and activated by Xmrk. To further investigate the mrk kinase induced signal transduction the receptor chimera HER-mrk was expressed in the IL-3 dependent pro-B cell line Ba/F3. This receptor chimera consists of the extracellular part of the human EGF receptor and the intracellular part of Xmrk. EGF stimulation, therefore, leads to mrk specific signalling in Ba/F3 cells. In HER-mrk expressing Ba/F3 cells EGF can replace the physiological growth factor IL-3 for proliferation and long term survival. In contrast stimulation of the EGF receptor if expressed in Ba/F3 cells does not have this effect. The long term survival triggered by HER-mrk was not based on higher receptor densities of HER-mrk expressing Ba/F3 cells compared to EGF-R expressing ones. Even a strong EGF-R expression could not mediate long term survival whereas even a low HER-mrk receptor expression was sufficient. Expression of C-terminal truncated HER-mrk receptor mutants in Ba/F3 cells showed that for induction of DNA synthesis no C-terminal substrate binding site is needed and that to complete cell division and for long term survival the two membrane proximal binding sites are important. This made it possible to define the crucial pathways for antiapoptotic signalling. Further analysis revealed that Her-mrk activates STAT1, 3 and 5 proteins, whereas the EGF-R could only activate STAT1 and 3, but not STAT5 in Ba/F3 cells. Strikingly, the HER-mrk receptor mutants showed that STAT5 activation by HER-mrk is not dependent on one of the known substrate binding sites but that C-terminal phosphotyrosines enhance the activation of STAT5, possibly by stabilizing the binding to the receptor. For the activation of STAT1 and 3, however, C-terminal substrate binding sites are needed. With regard to antiapoptotic signalling pathways a possible induction of the STAT5 target gene bcl-X has been investigated. Indeed, HER-mrk leads in contrast to the EGF-R to an induction of bcl-X transcription. Even the weaker STAT5 activation by the HER-mrk receptor mutant Hm delta1006 is followed by bcl-XL expression. Investigation of other antiapoptotic singalling pathways showed that the mrk kinse also leads to an induction of bcl-2 expression in contrast to the EGF-R. Strinkingly this was also seen for the receptor mutant Hm delta1006, which is not able to mediate long term growth in Ba/F3 cells. Therefore induction of the expression of the antiapoptotic proteins bcl-XL and bcl-2 seems not to be sufficient for long term survival. This suggests that a combination of different pathways is needed. Expression of the receptor chimera HER-mrk in murine melanocytes induces transformation of the cells under treatment with EGF. With this study it could be shown that mrk stimulation in these melanocytes leads to a strong induction of bcl-X which seems to be based on the activation of STAT5. Investigation of different human melanoma cell lines which often show varying expression of different receptor tyrosine kinases revealed constitutive activation of STAT5 in all of the tested cell lines. STAT1 and 3 however were only weakly activated and showed different activation patterns in the melanoma cell lines. Therefore in human melanoma cell lines a similar picture as for the Xiphophorus melanoma was found. While bcl-XL could not be investigated in the fish melanoma due to lacking cross reactivity of the antibody, northern probes and RT-PCR primers, the human melanoma cell lines showed expression of bcl-XL. Other pathways like the activation of MAPK, however, displayed a heterogenous activation pattern in the different cell lines. First experiments in A375 cells gave evidence that expression of dominant negative STAT5 is followed by reduction of bcl-X transcription and apoptosis of the cells (Wellbrock, unpublished). The STAT5/bcl-XL pathway therefore seems to be crucial for antiapoptosis in melanomas. KW - Apoptose KW - Rezeptortyrosinkinase KW - Melanom KW - STAT KW - Bcl-X KW - apoptosis KW - receptor tyrosine kinase KW - melanoma KW - STAT KW - bcl-X Y1 - 2003 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-11319 ER - TY - JOUR A1 - Lodde, Georg A1 - Forschner, Andrea A1 - Hassel, Jessica A1 - Wulfken, Lena M. A1 - Meier, Friedegund A1 - Mohr, Peter A1 - Kähler, Katharina A1 - Schilling, Bastian A1 - Loquai, Carmen A1 - Berking, Carola A1 - Hüning, Svea A1 - Schatton, Kerstin A1 - Gebhardt, Christoffer A1 - Eckardt, Julia A1 - Gutzmer, Ralf A1 - Reinhardt, Lydia A1 - Glutsch, Valerie A1 - Nikfarjam, Ulrike A1 - Erdmann, Michael A1 - Stang, Andreas A1 - Kowall, Bernd A1 - Roesch, Alexander A1 - Ugurel, Selma A1 - Zimmer, Lisa A1 - Schadendorf, Dirk A1 - Livingstone, Elisabeth T1 - Factors influencing the adjuvant therapy decision: results of a real-world multicenter data analysis of 904 melanoma patients JF - Cancers N2 - Adjuvant treatment of melanoma patients with immune-checkpoint inhibition (ICI) and targeted therapy (TT) significantly improved recurrence-free survival. This study investigates the real-world situation of 904 patients from 13 German skin cancer centers with an indication for adjuvant treatment since the approval of adjuvant ICI and TT. From adjusted log-binomial regression models, we estimated relative risks for associations between various influence factors and treatment decisions (adjuvant therapy yes/no, TT vs. ICI in BRAF mutant patients). Of these patients, 76.9% (95% CI 74–80) opted for a systemic adjuvant treatment. The probability of starting an adjuvant treatment was 26% lower in patients >65 years (RR 0.74, 95% CI 68–80). The most common reasons against adjuvant treatment given by patients were age (29.4%, 95% CI 24–38), and fear of adverse events (21.1%, 95% CI 16–28) and impaired quality of life (11.9%, 95% CI 7–16). Of all BRAF-mutated patients who opted for adjuvant treatment, 52.9% (95% CI 47–59) decided for ICI. Treatment decision for TT or ICI was barely associated with age, gender and tumor stage, but with comorbidities and affiliated center. Shortly after their approval, adjuvant treatments have been well accepted by physicians and patients. Age plays a decisive role in the decision for adjuvant treatment, while pre-existing autoimmune disease and regional differences influence the choice between TT or ICI. KW - melanoma KW - adjuvant treatment KW - checkpoint blocker KW - targeted therapy KW - BRAF KW - PD-1 Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-239583 SN - 2072-6694 VL - 13 IS - 10 ER - TY - JOUR A1 - Koch, Elias A. T. A1 - Petzold, Anne A1 - Wessely, Anja A1 - Dippel, Edgar A1 - Gesierich, Anja A1 - Gutzmer, Ralf A1 - Hassel, Jessica C. A1 - Haferkamp, Sebastian A1 - Kähler, Katharina C. A1 - Knorr, Harald A1 - Kreuzberg, Nicole A1 - Leiter, Ulrike A1 - Loquai, Carmen A1 - Meier, Friedegund A1 - Meissner, Markus A1 - Mohr, Peter A1 - Pföhler, Claudia A1 - Rahimi, Farnaz A1 - Schadendorf, Dirk A1 - Schell, Beatrice A1 - Schlaak, Max A1 - Terheyden, Patrick A1 - Thoms, Kai-Martin A1 - Schuler-Thurner, Beatrice A1 - Ugurel, Selma A1 - Ulrich, Jens A1 - Utikal, Jochen A1 - Weichenthal, Michael A1 - Ziller, Fabian A1 - Berking, Carola A1 - Heppt, Markus V. T1 - Immune checkpoint blockade for metastatic uveal melanoma: re-induction following resistance or toxicity JF - Cancers N2 - Re-induction with immune checkpoint blockade (ICB) needs to be considered in many patients with uveal melanoma (UM) due to limited systemic treatment options. Here, we provide hitherto the first analysis of ICB re-induction in UM. A total of 177 patients with metastatic UM treated with ICB were included from German skin cancer centers and the German national skin cancer registry (ADOReg). To investigate the impact of ICB re-induction, two cohorts were compared: patients who received at least one ICB re-induction (cohort A, n = 52) versus those who received only one treatment line of ICB (cohort B, n = 125). In cohort A, a transient benefit of overall survival (OS) was observed at 6 and 12 months after the treatment start of ICB. There was no significant difference in OS between both groups (p = 0.1) with a median OS of 16.2 months (cohort A, 95% CI: 11.1–23.8) versus 9.4 months (cohort B, 95% CI: 6.1–14.9). Patients receiving re-induction of ICB (cohort A) had similar response rates compared to those receiving ICB once. Re-induction of ICB may yield a clinical benefit for a small subgroup of patients even after resistance or development of toxicities. KW - uveal melanoma KW - immune checkpoint blockade KW - PD-1 KW - CTLA-4 KW - re-induction KW - treatment resistance KW - toxicity Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-254814 SN - 2072-6694 VL - 14 IS - 3 ER -