Garrison Zachary, Clister Terri, Bleem Eric, Berry Elizabeth G, Kulkarni Rajan P
Department of Dermatology, Oregon Health & Science University, Portland, OR 97239, USA.
Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA.
Cancers (Basel). 2024 Mar 1;16(5):1027. doi: 10.3390/cancers16051027.
BRAF-mutant melanoma patients can be treated with targeted therapy or immunotherapies, and it is not clear which should be provided first. Targeted treatments do not work in up to one-third of cases, while immunotherapies may only be effective in up to 60% and come with a high risk of immune-related side effects. Determining which treatment to provide first is thus of critical importance. Recent studies suggest that chromosomal instability and aneuploidy and cyclic GMP-AMP synthase (cGAS) can act as biomarkers for cancer severity and patient outcome. Neither potential biomarker has been extensively studied in melanoma. We examined 20 BRAF-mutant melanomas treated with immunotherapy or targeted therapy and measured chromosomal aneuploidy and cGAS expression levels. Treatment type, aneuploidy, and cGAS expression were correlated with progression-free survival (PFS) in these patients. Those treated with immunotherapy first had significantly better outcomes than those treated with targeted therapy, suggesting immunotherapy should be strongly considered as the first-line therapy for patients bearing BRAF-mutant melanoma. We found that there was no correlation of aneuploidy with outcome while there was some positive correlation of cGAS levels with PFS. Further studies are needed to confirm these findings and to test other potential biomarkers.
BRAF 突变型黑色素瘤患者可接受靶向治疗或免疫治疗,但尚不清楚应首先采用哪种治疗方法。靶向治疗在多达三分之一的病例中无效,而免疫治疗可能仅在高达 60% 的病例中有效,并且存在高风险的免疫相关副作用。因此,确定首先提供哪种治疗至关重要。最近的研究表明,染色体不稳定性、非整倍体和环状 GMP-AMP 合酶 (cGAS) 可作为癌症严重程度和患者预后的生物标志物。这两种潜在的生物标志物在黑色素瘤中均未得到广泛研究。我们检查了 20 例接受免疫治疗或靶向治疗的 BRAF 突变型黑色素瘤,并测量了染色体非整倍体和 cGAS 表达水平。治疗类型、非整倍体和 cGAS 表达与这些患者的无进展生存期 (PFS) 相关。首先接受免疫治疗的患者的预后明显优于接受靶向治疗的患者,这表明免疫治疗应被强烈考虑作为 BRAF 突变型黑色素瘤患者的一线治疗方法。我们发现非整倍体与预后无关,而 cGAS 水平与 PFS 存在一些正相关。需要进一步研究以证实这些发现并测试其他潜在的生物标志物。