Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A total of 65 patients with advanced cutaneous malignant melanoma (MM) have now been treated with interferon alpha-2b (Intron A) at a dose of 10 million IU/m2 administered subcutaneously thrice weekly. Fifty-one patients were evaluable for response, and 4 of these (7.8%) achieved complete remission; 2 of these 4 remain so at 37 + and 54 + months. Six additional patients achieved a partial remission. All responders had subcutaneous, lymph node and/or pulmonary metastases only. In all responders, therapy was continued for a total of 12 months. The vast majority of patients experienced side effects, largely flu-like symptoms, mild leukopenia and mild hepatocellular dysfunction. No evidence of cumulative toxicity was observed. Our experience indicates that interferon alpha-2b is active in patients with advanced cutaneous MM.
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PMID:Role of recombinant alpha-interferon in the treatment of advanced cutaneous malignant melanoma. 174 82

Interferon alfa-2b has recently been approved by the FDA as the first effective adjuvant therapy for the treatment of the "high risk for recurrence" melanoma patient. In a landmark study (ECOG 1684), the use of high dose Interferon alfa-2b for one year in melanoma patients with either deep primary melanomas or resected nodal metastases resulted in significant increases in overall survival (p = 0.04) and disease-free survival (p < 0.01) compared to the control, observation arm. If one considers only those patients with nodal metastases (89% of the study population) the survival benefit associated with adjuvant Interferon alfa-2b had a p value of 0.008. This survival benefit is on par with the survival benefit experienced with the adjuvant therapy of either breast or colon cancer. Because of the survival benefit associated with the adjuvant therapy, one could argue that any melanoma patient with a significant risk of nodal metastases (tumor thickness greater than 1.0 mm) should have a nodal staging procedure. Lymphatic mapping and sentinel node biopsy techniques are the least morbid and costly method to obtain this information. By performing nodal staging on patients with melanomas greater than 1.0 mm in thickness, effective adjuvant therapy can be applied in a selective fashion, exposing only those patients who have the most to benefit to the toxicities of the therapy.
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PMID:The adjuvant treatment of malignant melanoma. 914 64

Intra-operative sentinel lymph node (SLN) mapping and biopsy is a procedure that accurately stages the regional lymph node basin. Defined patterns of lymphatic drainage allow intra-operative determination of the first (sentinel) lymph node in the regional basin, and the absence of metastatic disease in the SLN accurately reflects the absence of melanoma in the remaining regional nodes. The use of a radiocolloid and a handheld gamma probe together with a vital blue dye provides optimal results, and allows for the successful identification of the SLN(s) in over 98 percent of the procedures. Close collaboration between surgeons, nuclear radiologists and pathologists is required to ensure optimal results. Surgical excision of the SLN allows for a more thorough and focused pathological examination of one or two nodes. Examination of serially sectioned SLNs by H&E staining, immunohistochemical staining and perhaps RT-PCR should reduce the number of patients with missed microscopic melanoma in the regional lymph nodes. Recently reported survival data from the Intergroup Melanoma Trial suggest that patients may benefit from identification and removal of regional lymph nodes that contain metastatic melanoma. Furthermore, the survival benefit recently reported in patients with melanoma metastatic to regional nodes prospectively randomized to receive high dose Interferon alfa-2b signals that the surgeons should aggressively examine patients for the presence of occult regional melanoma metastases. Intra-operative SLN mapping and SLN biopsy is a cost-effective procedure that allows accurate identification of regional lymph nodes that contain metastatic melanoma.
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PMID:Lymphatic mapping and sentinel node biopsy in patients with malignant melanoma. 914 71

Surgical resection remains the cornerstone of management for localized renal cell carcinoma. No effective postsurgical adjuvant therapy has been established for patients with locally advanced disease who are at high risk for recurrence. The effective treatment of metastatic kidney cancer remains a challenge. Immunologic therapy with cytokines, such as interferon-alfa (Intron A, Roferon-A) and interleukin-2 (IL-2 [Proleukin]), benefit relatively small numbers of patients. Preclinical research and clinical investigations aimed at identifying new agents and treatment programs with improved antitumor activity against metastases remain the highest priorities in this refractory disease. New immunologic approaches to the treatment of both advanced and high-risk postsurgical disease are focusing on novel vaccine therapies to target both renal epithelial and vascular antigens.
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PMID:Management of renal cell carcinoma. 1068 Jan 48

Controversy still surrounds the recommendation for performing sentinel node biopsy (SLNB) in patients with primary melanoma 1mm or greater in thickness, but why? In the absence of widespread, metastatic disease, nodal status is the single most important prognostic factor which determines likelihood of survival. It allows early therapeutic removal of micrometastatic lymph node disease and identifies patients who are eligible for Interferon alfa-2b adjuvant therapy. SLNB is a requirement for current clinical trials.
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PMID:Still debating sentinel lymph node biopsy? 1216 17

We describe the case of a 56 years old man, who was operated on with abdominal wall skin malignant melanoma 5 years ago. He received postoperative DTIC + Intron A treatment. Five years later he presented with complaints of epigastric pain, melena, hematochezia, anorexia and fatigue. Upper gastrointestinal tract endoscopy showed a tumour mass in the duodeno-jejunal flexure and colonoscopy showed a tumour in the large bowel. Histology verified anaplastic carcinoma. The patient was operated on. We found metastases in the small and the large bowel The patient underwent resection of the jejunum and right hemicolectomy. We describe the different types of metastases of malignant melanomas symptoms, therapies and prognosis.
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PMID:[Late metastases of cutaneous malignant melanoma on the abdominal wall to the small and large bowel]. 1626 71

Minimally invasive intraoperative lymphatic mapping and sentinel node biopsy has become the standard approach for staging the regional lymph nodes for early-stage melanoma. The procedure requires close collaboration of surgeon, pathologist, and nuclear medicine physician. The strength of lymphatic mapping and sentinel node biopsy is its accuracy of detecting occult lymph node metastases. Reverse transcriptase-PCR (RT-PCR) analyses of either fresh-frozen or paraffin-embedded sections of the sentinel lymph nodes have been found to be more sensitive than H&E staining or immunohistochemistry techniques, but lack of specificity and limits in the availability of tissue specimens make this technique impractical for routine use. Three randomized clinical trials are examining the therapeutic value of lymphatic mapping and sentinel node biopsy for melanoma. Preliminary results of the Multicenter Lymphadenectomy Trial I show the high level of accuracy and low morbidity of lymphatic mapping and sentinel node biopsy done through an international working group. The therapeutic value of lymphatic mapping and sentinel node biopsy is still unclear. Multicenter Lymphadenectomy Trial II will test the clinical significance of lymph nodes evaluated by RT-PCR and the value of completion lymph node dissection for patients found to have tumor-positive sentinel lymph nodes by H&E, immunohistochemistry, or RT-PCR. The Sunbelt Melanoma Trial examines the therapeutic value of completion dissection and benefits of Intron A. The ability to detect occult nodal metastases and evaluate the interaction of primary tumor with the regional lymph nodes may provide for better understanding of the metastatic process in patients with melanoma and help to determine the function of the regional lymph nodes as markers of metastases or incubators of tumor cells in the metastatic cascade.
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PMID:Sentinel lymph node biopsy and melanoma biology. 1660 52