Pathological assessment of resection specimens after neoadjuvant therapy for metastatic melanoma
Pathological assessment of resection specimens after neoadjuvant therapy for metastatic melanoma
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DOI：
10.1093/annonc/mdy226
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发表时间：
2018-08-01
影响因子：
50.5
通讯作者：
Scolyer, R. A.
中科院分区：
文献类型：
--
作者：
Tetzlaff, M. T.;Messina, J. L.;Scolyer, R. A.
背景：临床试验最近评估了手术切除的局部黑色素瘤转移患者新辅助治疗的安全性和有效性。为了在此类试验中获取与病理反应相关的信息丰富的预后数据，标准化这种治疗后的病理评估和肿瘤反应报告是至关重要的。方法：2016年和2017年的国际新辅助黑色素瘤联盟会议汇集了来自学术中心的病理学家，制定了AJCC（第8版）IIIB/C/D期或寡转移期IV期黑色素瘤患者接受新辅助靶向或免疫治疗的病理检查和手术标本报告的共识指南。病理反应的模式提供了背景，以告知这些指南。结果：基于我们的集体经验，并以建立良好的新辅助治疗环境（如乳腺癌）的努力为指导，提供了指导处理新辅助治疗前后黑色素瘤标本的程序，以促进不同试验和中心的结果比较。病理反应的定义与病理反应程度的报告和量化指南一起提供。最后，描述和说明了新佐剂靶向和免疫检查点治疗后观察到的组织病理反应谱。结论：在新佐剂靶向或免疫检查点治疗后，对切除的黑色素瘤转移瘤进行标准化的病理评估，可以对患者的预后进行更有力的分层。这包括认识到新辅助治疗的组织病理反应模式的频谱和病理反应分级的标准方法。这种方法将促进临床试验结果的比较，并为正在进行的相关研究提供信息，以了解在新辅助治疗环境中对药物的反应和耐药机制。
Background: Clinical trials have recently evaluated safety and efficacy of neoadjuvant therapy among patients with surgically resectable regional melanoma metastases. To capture informative prognostic data connected to pathological response in such trials, it is critical to standardize pathologic assessment and reporting of tumor response after this treatment.Methods: The International Neoadjuvant Melanoma Consortium meetings in 2016 and 2017 assembled pathologists from academic centers to develop consensus guidelines for pathologic examination and reporting of surgical specimens from AJCC (8th edition) stage IIIB/C/D or oligometastatic stage IV melanoma patients treated with neoadjuvant-targeted or immune therapy. Patterns of pathologic response are provided context to inform these guidelines.Results: Based on our collective experience and guided by efforts in well-established neoadjuvant settings like breast cancer, procedures directing handling of pre- and post-neoadjuvant therapy-treated melanoma specimens are provided to facilitate comparison of findings across different trials and centers. Definitions of pathologic response are provided together with guidelines for reporting and quantifying the extent of pathologic response. Finally, the spectrum of histopathologic responses observed following neoadjuvant-targeted and immune-checkpoint therapy is described and illustrated.Conclusions: Standardizing pathologic evaluation of resected melanoma metastases following neoadjuvant-targeted or immune-checkpoint therapy allows more robust stratification of patient outcomes. This includes recognizing the spectrum of histopathologic response patterns to neoadjuvant therapy and a standard approach to grading pathologic responses. Such an approach will facilitate comparison of results across clinical trials and inform ongoing correlative studies into the mechanisms of response and resistance to agents applied in the neoadjuvant setting.