Background: Elevated lactate dehydrogenase (LDH) is a known predictive and prognostic factor for a poor outcome in patients with metastatic melanoma. It is unclear whether first-line targeted therapy (TT) or immune checkpoint inhibition (ICI) is more beneficial in melanoma patients with elevated LDH because prospective studies in this area are lacking. Methods: This multicentre retrospective cohort study was conducted at 25 melanoma centres worldwide to analyse progression-free survival (PFS) and overall survival (OS) among melanoma patients with elevated LDH. The role of confounders was addressed by using inverse probability of treatment weighting. Results: Among 173 BRAFV600-mutant patients, PFS at 12 months in the TT group was 22% compared with 52% in the combined anti-PD-1 and anti-CTLA-4 group (HR 0.6, 95% CI 0.4-1.0, p = 0.07) and 18% in the anti-PD-1 monotherapy group (HR 1.8, 95% CI 1.2-2.8, p = 0.003). Twelve months' OS was 48% in the TT group compared with 83% in the combined anti-PD-1 and anti-CTLA-4 group (HR 0.5, 95% CI 0.3-1.0, p = 0.03) and 50% in the anti-PD-1 monotherapy group (HR 1.2, 95% CI 0.8-2.0, p = 0.37). The ORR in the TT group was 63%, compared with 55% and 20% in the combined anti-PD-1 and anti-CTLA-4 and anti-PD-1 monotherapy group, respectively. Among 314 patients receiving ICI first-line, PFS at 12 months was 33% in the anti-PD-1 group versus 38% in the combined anti-PD-1 and anti-CTLA-4 group (HR 0.8, 95% CI 0.6-1.0; p = 0.07). OS at 12 months was 54% in the anti-PD-1 group versus 66% in the combined ICI group (HR 0.7, 95% CI 0.5-1.0; p = 0.03). The ORR was 30% in the anti-PD-1 monotherapy group and 43% in the combined anti-PD-1 and anti-CTLA-4 group. Results from multivariate analysis confirmed the absence of qualitative confounding. Conclusions: Among BRAF-mutant patients with elevated LDH, combined anti-PD-1 and anti-CTLA-4 blockade seems to be associated with prolonged OS compared with first-line TT. Among patients receiving ICI as a first-line treatment, OS appears to be longer for the combination of anti-PD-1 and anti-CTLA-4 than for anti-PD-1 alone. (C) 2021 Elsevier Ltd. All rights reserved.

In January 2013 a 72 year old women presented to our department with widespread, annular, erythematous plaques located on the trunk as well as livedo racemosa located on the lower extremities. In 1995 a diagnosis of breast cancer was made. At the time of in-patient care, new bone metastases were diagnosed. Additionally, treatment with the monoclonal antibody denusomab was initiated for bone metastases. Based on the clinical picture, histopathological analyses, and characteristic serological findings, a diagnosis of subacute cutaneous lupus erythematosus was made. Facing the clinical course of disease with concomitant occurrence of skin lesions and breast cancer metastases as well as beginning of denusomab therapy, the presence of a paraneoplastic or drug-induced subacute cutaneous lupus erythematosus might be discussed.

Nach Ausschöpfung von klassischen Behandlungsverfahren wie Chemo- und Strahlentherapie gibt es für Patienten mit ausgedehnten, inoperablen Hauttumoren oder Hautmetastasen nur wenige Möglichkeiten einer lokalen Tumorkontrolle. Die Elektrochemotherapie bietet in diesen Fällen eine hocheffektive, nebenwirkungsarme Behandlungsoption, die wiederholt auch in vorbehandelten Arealen und ohne wesentliche Einschränkungen im Hinblick auf Anzahl und Lage der Metastasen eingesetzt werden kann. Durch die Reduktion der Tumormasse sowie Minderung etwaiger Blutungen und Exsudation kann eine deutliche Verbesserung der Lebensqualität für die betroffenen Patienten erzielt werden. Der Erfolg der Elektrochemotherapie gibt aktuell Anlass zur Überprüfung der Indikationserweiterung auf viszerale Tumore, Knochenmetastasen und sogar Hirntumore.

Following classic treatment options for cancer patients such as chemotherapy or radiation, only few therapies remain for patients with widespread, inoperable skin tumours or metastases. Electrochemotherapy is a highly effective treatment approach in such cases with few side effects. Electrochemotherapy can be repeatedly performed even in pre-treated areas without substantial limitations concerning number and location of skin metastases. Reduction of tumor mass and decrease of bleeding and exudation might significantly improve patient's quality of live. The overall success of electrochemotherapy encourages expanding its indication to visceral tumours or bone and brain metastases.