Improved survival in patients with poor-prognosis malignant melanoma treated with adjuvant levamisole: a phase III study by the National Cancer Institute of Canada Clinical Trials Group.

Quirt, Ian; Shelley, W; Pater, Joe; Bodurtha, A.; McCulloch, P B; McPherson, Thomas; Paterson, Alexander; Prentice, Ross L.; Silver, Hulbert K. B.; Willan, AR

doi:10.1200/jco.1991.9.5.729

Cited by 77 publications

(25 citation statements)

References 6 publications

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“…A fourth, non-placebo-controlled, trial by the NCIC (National Cancer Institute of Canada Clinical Trials Group) compared levamisole vs. levamisole + BCG vs. BCG vs. observation. After 5 years, there was a significant benefit for the 135 patients in the levamisole arm with respect to overall survival (74 % vs. 62 %; p = 0.0268) [373]. Meta-analysis of 5-year survival data from all 4 trials yielded no significant benefit for levamisole in terms of mortality risk (RR 0.94 [95 % CI 0.75-1.20; p = 0.6]) [348].…”

Section: A Pflugfeldermentioning

confidence: 99%

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

Pflugfelder

Kochs

Blum

et al. 2013

J Deutsche Derma Gesell

181

148

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Section: A Pflugfeldermentioning

confidence: 99%

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

Pflugfelder

Kochs

Blum

et al. 2013

J Deutsche Derma Gesell

181

148

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“…Although the most signif icant prognostic factor if the number of nodal metastases, ulceration and tumor thickness are also significant in most studies. To date, there is no standardized adjuvant treatment after radical surgery [14][15][16], even if the WHO melanoma program has recently published preliminary results of a ran domized adjuvant IFN trial, showing a higher 2-year disease-free interval in patients who were given IFN-a [17].…”

Section: Introductionmentioning

confidence: 99%

Adjuvant Therapy of Stage IIIb Melanoma with Interferon Alfa-2b: Clinical and Immunological Relevance

Doveil¹,

Fierro²,

Novelli³

et al. 1995

Dermatology

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Background: The poor prognosis of stage IIIb melanoma (5-year survival: 36%) shows the need for effective adjuvant therapy to prolong disease-free survival. Objective: The feasibility and efficacy of interferon alfa-2b (IFN-α) therapy in stage IIIb melanoma patients was investigated. Methods: alpha-IFN was given at a dose of 3 MU i.m. three times a week to 50 patients. Clinical and immunological controls were carried out. Results: The median follow-up was 43 months (range 5-84). Median survival was 43 months and median disease-free survival 39 months. Overall 5-year survival (62%) was higher than that reported in the literature to date. A significant increase of circulating CD56+ and DR+ lymphocytes after therapy was more evident in disease-free patients than in those with progressing disease. Conclusion: Adjuvant IFN-α therapy in stage IIIb melanoma patients is well tolerated and seems to increase survival. However, multicenter randomized trials are needed to confirm these preliminary findings.

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“…2 By 1990, 3 major studies supported levamisole as an adjunctive therapy in melanoma 3 and colon cancer. 4 Although levamisole appeared to be nontoxic at single or low doses, long-term use in clinical trials demonstrated that 2.5%-13% of patients developed life-threatening agranulocytosis, and up to 10% of those instances resulted in death.…”

Section: Discussionmentioning

confidence: 99%

“…She was found to have positive perinuclear antineutrophil cytoplasmic antibodies (p-ANCA), antimyeloperoxidase (MPO) antibodies, anticardiolipin (ACL) antibodies, and lupus anticoagulant (LAC). By hospital day 3, her lesions had significantly improved without any intervention, and her absolute neutrophil count increased to 1080/mm 3 .…”

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confidence: 99%

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Cracking the case

Kneeland

Dhaliwal

2011

Journal of Hospital Medicine

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The approach to clinical conundrums by an expert clinician is revealed through presentation of an actual patient's case in an approach typical of morning report. Similar to patient care, sequential pieces of information are provided to the clinician who is unfamiliar with the case. The focus is on the thought processes of both the clinical team caring for the patient and the discussant. A 43-year-old woman presented to an outside hospital with painful plaques and patches on her bilateral lower extremities. Two weeks prior to presentation, she had noticed a single red lesion on her left ankle. Over the next two weeks, the lesion enlarged to involve the lower half of her posterior calf and subsequently turned purple and became exquisitely tender. Similar but smaller purple, tender lesions simultaneously appeared, first over her right shin and then on her bilateral thighs and hips. She also reported fatigue as well as diffuse joint pains in her hands and wrists bilaterally for the past month. She denied any swelling of these joints or functional impairment. She denied fevers, weight loss, headache, sinus symptoms, difficulty breathing, or abdominal pain.Although we do not yet have a physical exam, the tempo, pattern of spread, and accompanying features allow some early hypotheses to be considered. Distal lower extremity lesions which darkened and spread could be erythema nodosum or erythema induratum. Malignancies rarely have such prominent skin manifestations, although leukemia cutis or an aggressive cutaneous T cell lymphoma might present with disseminated and darkened plaques, and Kaposi's sarcoma is characteristically purple and multifocal. Autoimmune disorders such as sarcoidosis, cutaneous lupus, and psoriasis may similarly present with widespread plaques. Most disseminated infections that start with patches evolve to pustules, ulcers, bullae, or other forms that reflect the invasive nature of the infection; syphilis warrants consideration for any widespread eruption of unknown etiology. Antecedent arthralgias with fatigue suggest an autoimmune condition, although infections such as hepatitis or parvovirus can do the same. Systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA) would be favored initially on account of her demographics and the hand and wrist involvement, and each can be associated with vasculitis. The significant pain as described is not compatible with most of the aforementioned diagnoses. Its presence, coupled with potential autoimmune symptoms, suggests a vasculitis such as polyarteritis nodosa (which can have prominent diffuse skin involvement), Henoch Schonlein purpura (with its predilection for the lower extremities, including extension to the hips and buttocks), cryoglobulinemia, or SLE-or RA-associated vasculitis. Calciphylaxis is another ischemic vascular disorder that can cause diffuse dark painful lesions, but this only warrants consideration if advanced renal disease is present.A skin biopsy of her right hip was taken at the outside hospital. She was discharged on a two-wee...

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Improved survival in patients with poor-prognosis malignant melanoma treated with adjuvant levamisole: a phase III study by the National Cancer Institute of Canada Clinical Trials Group.

Cited by 77 publications

References 6 publications

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

Adjuvant Therapy of Stage IIIb Melanoma with Interferon Alfa-2b: Clinical and Immunological Relevance

Cracking the case

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