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The Role of Interferons in the Therapy of Melanoma
Published in Ronald H. Goldfarb, Theresa L. Whiteside, Tumor Immunology and Cancer Therapy, 2020
Dosages from 12 Mu/M2 to 50 Mu/M2, as well as 50 Mu/M2 plus Cimetidine, gave comparable results at the Mayo Clinic with recombinant interferon alfa-2a in 96 patients with metastatic melanoma (45). A large experience has been reported with recombinant interferon alfa-2b given at 10 Mu/M2 administered subcutaneously three times a week, with overall response rates and durable complete response rates comparable to higher dose IV, and IM experiences (42). These are summarized in Table 1.
Acquired Bleeding Disorders Associated with Disease and Medications
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
William A. Rock, Sue D. Walker
Interferon alfa-2a is associated with GI hemorrhage during therapy; infrequently, the GI hemorrhage is severe or fatal. In CML patients treated with interferon alfa-2a, a severe life-threatening leukopenia and thrombocytopenia were seen in 27% of patients. Retinal hemorrhages have been observed rarely in patients being treated with interferon alfa-2b after use of the drug for several months (134).
Basal Cell Nevus Syndrome
Published in Dongyou Liu, Handbook of Tumor Syndromes, 2020
Priyanka Chhadva, Pete Setabutr
Due to the multisystem presentation of BCNS, patients with this disorder must be treated by numerous specialists. Prevention of BCC includes decreased sun exposure, and wearing UV sunblock, sunglasses, and sun-protective clothing. Also, oral retinoids may thwart or delay the growth and recurrence of BCCs [46]. When BCCs do occur, the mainstay of treatment is surgical excision. For initial small and well-defined lesions, curettage and cautery/electrodessication is preferred, as well as cryosurgery [47–50]. For larger, thick, concave lesions, microscopic excision with ultrapulse CO2 laser therapy can be used [51,52]. Photodynamic therapy with topical application of delta-aminolaevulinic acid is an option for superficial and flat lesions [52–55]. For recurrent lesions in risky locations such as the periorbital, nasolabial, and nasal skin, a more aggressive approach must be taken, which includes Mohs micrographic surgery [48,56–58]. Local radiotherapy is not recommended due to the risk of tumor enlargement and recurrence [22,39]. Nonsurgical approaches also depend on tumor characteristics. For low-risk, superficial, non-hair follicle−involving BCC, topical 0.1% 5–fluorouracil can be used [59]. For small papular tumors, intralesional injection of interferon alfa-2b can be used [52]. Paclitaxel can be used to treat multiple aggressive BCCs [60]. Topical imiquimod may treat small, low-risk superficial or nodular BCC [61]. It acts as a Toll-like receptor-7 agonist and causes apoptosis of BCCs [62]. In addition, vismodegib (Erivedge) and sonidegib (Odomzo) targeting the “hedgehog pathway,” which is affected by the PTCH mutation, have been approved to treat people with basal cell cancers that have spread in the body or that cannot be treated with surgery or radiation.
Long-term Management of Panuveitis and Choroidal Mass Associated with Rosai Dorfman Disease with Pegylated Interferon
Published in Ocular Immunology and Inflammation, 2022
Lucas Kim, J. Clay Bavinger, Jessica G. Shantha, Anastasios Costarides, Hans E. Grossniklaus, Steven Yeh
However, given the lack of systemic RDD response to prednisone, options discussed with the patient included cladribine, vinblastine, and etoposide, and interferon. Pegylated interferon alfa-2b administered via weekly injections (Pegintron 1.5 mcg/kg/week) was initiated with good tolerance, and was continued for 14 months. At this time, regression of the subcutaneous lesions was observed along with stabilization of the ocular disease. Pegylated interferon was discontinued and the patient has been maintained on low dose oral prednisone (2.5–10 mg daily) without disease recurrence or recurrent intraocular pressure elevation after 6 years of follow-up. At last follow up, the patient’s visual acuity remained stable at counting fingers at 3 feet OD, and 20/40 OS. Fundus exam showed atrophic changes with the posterior pole with subretinal fibrosis nasally in the right eye (Figure 4a) and patchy, choroidal pigmentary changes in the left eye (Figure 4b). Horizontal B-scan of the right eye showed resolution of choroidal thickening but persistent echolucency posterior to the sclera in the peripapillary region (Figure 4c). An equatorial scan temporally (3E) right eye showed mild vitreous opacity and improved choroidal thickening (Figure 4d).
Chimeric antigen receptor T-cell therapy for melanoma
Published in Expert Review of Clinical Immunology, 2021
Azadehsadat Razavi, Mahsa Keshavarz-Fathi, John Pawelek, Nima Rezaei
Surgical excision of tumor is the treatment applied to all stages of melanoma [30,50]. However, surgical excision is ineffective in relapsed patients and those with stage III and IV melanoma [28,51,52]. For these patients, surgery is combined with other treatments. In addition, patients may be given other therapies either before or after removal of malignant lesions as neoadjuvant or adjuvant therapy, respectively [28]. Neoadjuvant therapy such as biochemotherapy (BCT), which is administered before surgery, is an efficient therapy to reduce local invasion [53]. As its name implies, adjuvant therapy is administered to the patient after surgery to maximize the overall survival and help prevent relapse. Studies have shown that radiotherapy, chemotherapy or immunotherapy combined with surgery can prolong survival of stage IV melanoma [54,55]. Interferon alfa-2b (IFNα-2b) was the first adjuvant therapy for patients who underwent surgical resection [28].
Safety of pembrolizumab for resected stage III melanoma
Published in Expert Opinion on Drug Safety, 2020
Overall, around 1500 patients with resected stage III melanoma have been treated with ipilimumab 10 mg/kg Q3W for 4 doses then every 12 weeks up to 4 additional doses in three phase III clinical trials to date: EORTC 18071, Checkmate-238 and E1609 comparing ipilimumab to placebo, nivolumab and high-dose interferon alfa-2b, respectively [14–16]. The overall incidence of treatment-related AEs was 90–98.8% with a rate of grade ≥3 AEs of 42.5–56.7%. The most frequently reported AEs were diarrhea/colitis (45.9–55.5%), fatigue/asthenia (41–44.6%), skin rash (29.4–58.6%) and alanine aminotransferase elevation (ALT, 14.6–32.4%). There was a total of 13 deaths related to ipilimumab (0–1.6%). Those AEs lead to discontinuation of ipilimumab in 42.6–54% of patients which is higher than has been observed in advanced melanoma [33]. In the phase III trial E1609, ipilimumab 3 mg/kg Q3W for 4 doses then every 12 weeks up to 4 additional doses has also been compared to high-dose interferon alfa-2b in 516 patients with a rate of grade ≥3 treatment-related AEs of 38.2% for an overall incidence of treatment-related AEs of 90% in the ipilimumab arm [15]. The most common AEs were diarrhea/colitis (50.6%), skin rash (46.7%) and ALT elevation (18.6%). There were 3 deaths related to ipilimumab (0.6%). The rate of discontinuation owing to AEs was 35%.