BACKGROUND:The approval of adjuvant treatment with anti-PD-1 antibodies (anti-PD-1) and BRAF and MEK inhibitors (BRAFi/MEKi) for resected stage III/IV melanoma was based on randomized controlled trials demonstrating a benefit in recurrence-free survival (RFS). However, none showed a significant impact on overall survival (OS). We aimed to evaluate the OS impact of adjuvant therapies in real-world settings. METHODS:TAMARIS is a national multicenter retrospective study evaluating the efficacy of anti-PD-1 and BRAFi/MEKi for resected stage III melanoma in a French real-life prospective database (RIC-Mel). Patients with resectable stage III melanoma (AJCC 8th edition), who underwent complete surgical resection between 2018 and 2023 were included. OS in patients who received an adjuvant treatment (adjuvant group) was compared to those who did not receive systemic therapies (control group). Associations between the adjuvant strategy (adjuvant treatment versus observation) and OS were evaluated using a Cox regression model and inverse probability treatment weighting (IPTW) in order to limit potential biases. Subgroup analyses by baseline characteristics and treatment regimens were also conducted. RESULTS:Among the 1016 patients (median age: 60 years) included, 701 (69%) received adjuvant therapies with either anti-PD-1 (n = 588) or BRAFi/MEKi (n = 113). The median treatment duration was 10.9 months, and the median follow-up was 29.6 months. OS was significantly higher in the adjuvant group compared to the control group (HR: 0.62, [IC95%, 0.47-0.80], P = 0.003) confirmed in multivariate analysis and after IPTW-adjustment (HR: 0.68, [IC95%, 0.49-0.94], P = 0.020). In subgroup analyses, adjuvant treatment had a significant positive impact on OS across most subgroups, but not for stage IIIA. CONCLUSION:These real-world data indicate a significant OS benefit of adjuvant therapy in patients with AJCC8 stage III melanoma, but not in those with stage IIIA disease.
Toxoplasmosis has long been recognized as a serious complication in immunocompromised host, particularly those with advanced HIV/AIDS, hematopoietic stem-cell transplantation (HSCT), solid-organ transplant (SOT), and hematological malignancies. The rapid expansion of targeted immunomodulators, including chimeric antigen receptor T-cell (CAR-T) therapies, monoclonal antibodies, and small-molecule inhibitors, is creating new at-risk populations beyond traditional transplant settings. We present a 9-year-old boy with high-risk B-cell acute lymphoblastic leukemia (B-ALL), who developed prolonged fever and macrophage activation syndrome (MAS). After an extensive unrevealing workup, disseminated acute toxoplasmosis was identified incidentally on bone marrow aspirate via morphologic identification of tachyzoites and confirmed by Toxoplasma gondii PCR. This case exemplifies the emerging threat of toxoplasmosis in non-transplant immunomodulated hosts and supports three core mitigation strategies. First, baseline Toxoplasma IgG and IgM serology should be obtained in all patients initiating targeted immunotherapy, recognizing that B-cell depletion or hypogammaglobulinemia may render IgG unreliable, and that IgM may be falsely negative, delayed, or persistently positive in immunocompromised individuals. Second, targeted PCR from clinically relevant compartments or metagenomic next-generation sequencing when conventional diagnostics is unrevealing should be applied early. Third, prevention requires a bundled approach: baseline screening, patient education for seronegative individuals, and trimethoprim-sulfamethoxazole prophylaxis with or without serial qPCR monitoring for seropositive patients. Toxoplasmosis is no longer a transplant-exclusive concern. As targeted immunomodulators reshape practice across rheumatology, oncology, neurology, and autoimmune disease, infectious diseases specialists must lead efforts to raise cross-specialty awareness, establish guidelines, and build registries to define the true burden of toxoplasmosis in these growing populations.
The natural history of chronic pancreatitis (CP), aside from pain, is primarily marked by the risk of malnutrition and a poor quality of life. Addressing identifiable causes should be a priority whenever feasible, for instance, in cases of alcohol and/or tobacco dependence. The surveillance -including nutritional, anthropometric, biochemical, and bone assessments-should support a stepwise management approach, beginning with a balanced Mediterranean diet and extending to dietary counseling, oral nutritional supplements, and, if necessary, enteral and then parenteral nutrition.Beyond nutritional support, it is essential to evaluate for both exocrine and endocrine pancreatic insufficiency, with pancreatic enzyme replacement therapy considered when appropriate. Close monitoring is also needed for screening of other complications, such as diabetes, local or regional complications, and pancreatic cancer. Lastly, the psychological impact of the disease on the overall well-being must not be underestimated.
