Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Melanoma: HELP
Articles by Jonathan S. Zager
Based on 102 articles published since 2008
||||

Between 2008 and 2019, Jonathan Zager wrote the following 102 articles about Melanoma.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5
1 Guideline Sentinel Lymph Node Biopsy and Management of Regional Lymph Nodes in Melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Clinical Practice Guideline Update. 2018

Wong, Sandra L / Faries, Mark B / Kennedy, Erin B / Agarwala, Sanjiv S / Akhurst, Timothy J / Ariyan, Charlotte / Balch, Charles M / Berman, Barry S / Cochran, Alistair / Delman, Keith A / Gorman, Mark / Kirkwood, John M / Moncrieff, Marc D / Zager, Jonathan S / Lyman, Gary H. ·Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. · The Angeles Clinic and Research Institute, Santa Monica, CA, USA. · American Society of Clinical Oncology, Alexandria, VA, USA. guidelines@asco.org. · St Luke's Cancer Center, Easton, PA, USA. · Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. · Memorial Sloan Kettering Cancer Center, New York, NY, USA. · MD Anderson Cancer Center, Houston, TX, USA. · Broward Health, Fort Lauderdale, FL, USA. · Los Angeles Center for Health Services, University of California, Los Angeles, CA, USA. · Emory University, Atlanta, GA, USA. · , Silver Spring, MD, USA. · University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA. · Norfolk and Norwich University Hospital, Norwich, UK. · H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. · Fred Hutchinson Cancer Research Center, Seattle, WA, USA. ·Ann Surg Oncol · Pubmed #29236202.

ABSTRACT: PURPOSE: To update the American Society of Clinical Oncology (ASCO)-Society of Surgical Oncology (SSO) guideline for sentinel lymph node (SLN) biopsy in melanoma. METHODS: An ASCO-SSO panel was formed, and a systematic review of the literature was conducted regarding SLN biopsy and completion lymph node dissection (CLND) after a positive sentinel node in patients with melanoma. RESULTS: Nine new observational studies, two systematic reviews and an updated randomized controlled trial (RCT) of SLN biopsy, as well as two randomized controlled trials of CLND after positive SLN biopsy, were included. RECOMMENDATIONS: Routine SLN biopsy is not recommended for patients with thin melanomas that are T1a (non-ulcerated lesions < 0.8 mm in Breslow thickness). SLN biopsy may be considered for thin melanomas that are T1b (0.8 to 1.0 mm Breslow thickness or <0.8 mm Breslow thickness with ulceration) after a thorough discussion with the patient of the potential benefits and risk of harms associated with the procedure. SLN biopsy is recommended for patients with intermediate-thickness melanomas (T2 or T3; Breslow thickness of >1.0 to 4.0 mm). SLN biopsy may be recommended for patients with thick melanomas (T4; > 4.0 mm in Breslow thickness), after a discussion of the potential benefits and risks of harm. In the case of a positive SLN biopsy, CLND or careful observation are options for patients with low-risk micrometastatic disease, with due consideration of clinicopathological factors. For higher risk patients, careful observation may be considered only after a thorough discussion with patients about the potential risks and benefits of foregoing CLND. Important qualifying statements outlining relevant clinicopathological factors, and details of the reference patient populations are included within the guideline.

2 Editorial Improving clinical outcomes with pembrolizumab in patients with advanced melanoma. 2017

Kim, Dae Won / Zager, Jonathan S / Eroglu, Zeynep. ·Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA. · Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA. Zeynep.Eroglu@moffitt.org. ·Chin Clin Oncol · Pubmed #28285535.

ABSTRACT: -- No abstract --

3 Editorial Recent advances in the treatment of melanoma. 2013

Zager, Jonathan S / Sarnaik, Amod A / Gibney, Geoffrey T / Kudchadkar, Ragini R. ·Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA. Jonathan.Zager@Moffitt.org. ·Cancer Control · Pubmed #24077400.

ABSTRACT: -- No abstract --

4 Editorial What is the significance of the in transit or interval sentinel node in melanoma? 2011

Zager, Jonathan S / Puleo, Christopher A / Sondak, Vernon K. · ·Ann Surg Oncol · Pubmed #21837524.

ABSTRACT: -- No abstract --

5 Editorial Isolated limb infusion for melanoma: a less morbid alternative to hyperthermic isolated limb perfusion in the US. 2010

Santillan, Alfredo A / Zager, Jonathan S. · ·Expert Opin Drug Metab Toxicol · Pubmed #20078252.

ABSTRACT: -- No abstract --

6 Editorial Commentary on pharmacotherapy of regional melanoma therapy. 2010

Zager, Jonathan S / Delman, Keith A. · ·Expert Opin Pharmacother · Pubmed #20001424.

ABSTRACT: IMPORTANCE TO THE FIELD: Regional therapy continues to be the workhorse for the treatment of regional metastases and unresectable recurrences of melanoma limited to a limb. These approaches also offer an excellent opportunity for the study of disease biology and new drug delivery, pharmacokinetics and pharamacotherapeutics. AREAS COVERED IN THIS EDITORIAL: Utility of regional therapy as an area of study, benefits of both isolated limb infusion (ILI) and hyperthermic isolated limb perfusion (HILP) are discussed. The limitations of both approaches to regional therapy are also referenced. WHAT THE READER WILL GAIN: This editorial serves as a companion to the peer-reviewed paper which comprehensively reviews the subject of regional therapy by Tyler et al. It offers a brief commentary on the utility of regional therapies (ILI and HILP) for extremity in-transit melanoma and their role in investigating new therapeutic modalities. TAKE HOME MESSAGE: Regional therapy is an excellent therapeutic modality for disease limited to a limb and furthermore serves as an excellent model for scientific investigation, both clinical and translational.

7 Editorial Who is to blame for false-negative sentinel node biopsies in melanoma? 2010

Sondak, Vernon K / Zager, Jonathan S. · ·Ann Surg Oncol · Pubmed #19953329.

ABSTRACT: -- No abstract --

8 Editorial Melanoma: promising new discoveries and treatment modalities for difficult clinical scenarios - part II. 2009

Zager, Jonathan S / Weber, Jeffrey S. · ·Cancer Control · Pubmed #19556959.

ABSTRACT: -- No abstract --

9 Editorial Melanoma: promising new discoveries and treatment modalities for difficult clinical scenarios. 2008

Zager, Jonathan S / Daud, Adil I. · ·Cancer Control · Pubmed #18596670.

ABSTRACT: -- No abstract --

10 Review Update on BRAF and MEK inhibition for treatment of melanoma in metastatic, unresectable, and adjuvant settings. 2019

Broman, Kristy Kummerow / Dossett, Lesly A / Sun, James / Eroglu, Zeynep / Zager, Jonathan S. ·a Department of Cutaneous Oncology , Moffitt Cancer Center , Tampa , FL , USA. · b Division of Surgical Oncology , University of Michigan , Ann Arbor , MI , USA. ·Expert Opin Drug Saf · Pubmed #30977681.

ABSTRACT:

11 Review Engineered oncolytic viruses to treat melanoma: where are we now and what comes next? 2018

Rothermel, Luke D / Zager, Jonathan S. ·a Surgical Oncology , Moffitt Cancer Center , Tampa , FL , USA. · b Department of Cutaneous Oncology and Sarcoma , Moffitt Cancer Center , Tampa , FL , USA. ·Expert Opin Biol Ther · Pubmed #30392405.

ABSTRACT: INTRODUCTION: Melanoma treatments have evolved rapidly in the past decade and have included the use of intratumoral injections of engineered oncolytic viruses. One such oncolytic virus is talimogene laherparepvec (T-VEC), which is the first approved therapy of its kind for use in recurrent, unresectable stage IIIB-IVM1a melanoma. Additional oncolytic viruses and their uses in combination with other interventions are currently under investigation. Areas covered: Oncolytic viruses are being evaluated as immunotherapies for a variety of advanced malignancies. In this article, we review T-VEC, the only FDA-approved engineered oncolytic virus, in addition to ongoing research regarding other oncolytic viruses for the treatment of advanced melanomas. Finally, we discuss opportunities to improve these therapies through viral, host, and tumor-related modifications. Expert opinion: Engineered and naturally oncolytic viruses have demonstrable local and systemic efficacy as immunotherapies in cancer. T-VEC leads the way with improved survival outcomes for unresectable, stage IIIB-IVM1a melanoma as a monotherapy, and is demonstrating superior results in combination with systemic checkpoint inhibitors. Additional viral vectors show acceptable safety profiles and varying degrees of efficacy in targeting melanoma. The indications for use of oncolytic viruses will expand as their efficacy and appropriate usage is better understood in coming years.

12 Review Regional therapies for locoregionally advanced and unresectable melanoma. 2018

Weitman, Evan S / Zager, Jonathan S. ·Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA. · Department of Cutaneous Oncology, Moffitt Cancer Center, 10920 McKinley Dr., MKC 4123, Tampa, FL, 33612, USA. jonathan.zager@moffitt.org. ·Clin Exp Metastasis · Pubmed #29736626.

ABSTRACT: Locoregionally advanced and unresectable disease can be seen in up to 10% of melanoma patients. Treatment options for these patients have been evolving most notably over the past few decades and have demonstrated efficacy through multiple intra-arterial as well as intralesional therapies. Isolated limb perfusions and isolated limb infusions have been utilized to treat locoregionally advanced melanoma of the extremity with overall response rates up to 90% in some reports. Intralesional therapies, for in transit metastatic melanoma, such as Bacille Calmette-Guerin, talimogene laherparepvec, and PV-10 (Rose Bengal) have all demonstrated efficacy in the treatment of unresectable cutaneous melanoma. The treatment effect due to intralesional injection has been identified in directly injected lesions as well as in distant uninjected "bystander lesions" with some injectables. This bystander effect is likely an immunologic reaction due to tumor antigen release, antigen-presenting cell uptake, T cell activation and subsequent bystander tumor destruction in uninjected lesions. Treatment options for unresectable melanoma metastases limited to the liver include isolated hepatic perfusion, which can now be performed through a minimally invasive approach known as percutaneous hepatic perfusion. These intra-arterial and intralesional regional therapies offer a variety of effective treatment modalities for unresectable disease and may potentially be combined with systemic treatments, such as immunotherapy, in the future treatment of locoregionally advanced melanoma.

13 Review Review of diagnostic, prognostic, and predictive biomarkers in melanoma. 2018

Ankeny, Jacob S / Labadie, Brian / Luke, Jason / Hsueh, Eddy / Messina, Jane / Zager, Jonathan S. ·Department of Cutaneous Oncology, Moffitt Cancer Center, 10920 McKinley Dr., MKC 4th 11.4123, Tampa, FL, 33612, USA. · Biological Sciences Division, University of Chicago, 5841 S. Maryland Ave., Chicago, IL, 60637, USA. · Department of Surgical Oncology, St. Louis University, 3655 Vista Ave., 1st Floor, St. Louis, MO, 63110, USA. · Department of Cutaneous Oncology, Moffitt Cancer Center, 10920 McKinley Dr., MKC 4th 11.4123, Tampa, FL, 33612, USA. jonathan.zager@moffitt.org. ·Clin Exp Metastasis · Pubmed #29722000.

ABSTRACT: Melanoma is an aggressive cutaneous malignancy with rapidly rising incidence. Diagnosis of controversial melanocytic lesions, correct prognostication of patients, selection of appropriate adjuvant and systemic therapies, and prediction of response to a given therapy remain very real challenges. Despite these challenges, multiple high throughput, nucleic-acid based biomarkers have been developed that can be assayed from histologic tissue specimens. FISH, CGH, Decision-Dx, and other multi-marker assays have been combined to improve overall predictability. This review discusses some of the most promising nucleic acid based assays that can be obtained from tissue specimens to assist with diagnosis, prognostication, and prediction of treatment response.

14 Review Pharmacokinetic drug evaluation of talimogene laherparepvec for the treatment of advanced melanoma. 2018

Burke, Erin E / Zager, Jonathan S. ·a Moffitt Cancer Center , Tampa , FL , USA. · b Department of Cutaneous Oncology , Moffitt Cancer Center , Tampa , FL , USA. ·Expert Opin Drug Metab Toxicol · Pubmed #29557682.

ABSTRACT: INTRODUCTION: Current treatment of advanced melanoma is rapidly changing with the introduction of new and effective therapies including systemic as well as locoregional therapies. An example of one such locoregional therapy is intralesional injection with talimogene laherparepvec (T-VEC). Areas covered: T-VEC has been shown in a number of studies to be an effective treatment for patients with stage IIIB, IIIC and IVM1a melanoma. In this article the effectiveness, pharmacokinetics and safety profile of T-VEC is reviewed. Additionally, new research looking at combinations of T-VEC and systemic immunotherapies is reviewed. Expert opinion: Overall, T-VEC is an easily administered, safe, well tolerated and effective oncolytic viral therapy for the treatment of stage IIIB, IIIC, IVM1a unresectable and injectable metastatic melanoma. Recently published studies are showing promising results when T-VEC is combined with systemic therapy and this may be the way of the not too distant future in how we treat metastatic melanoma. Continued work regarding the use of T-VEC with other systemic agents will provide new and more effective treatment strategies for advanced melanoma.

15 Review Intralesional therapy as a treatment for locoregionally metastatic melanoma. 2018

Miura, John T / Zager, Jonathan S. ·a Departments of Cutaneous Oncology and Sarcoma, Moffitt Cancer Center , University of South Florida School of Medicine , Tampa , FL , USA. ·Expert Rev Anticancer Ther · Pubmed #29466885.

ABSTRACT: INTRODUCTION: The emergence of novel intralesional therapies have dramatically changed the treatment landscape for melanoma. The heterogeneous presentation of melanoma continues to pose challenges for clinicians, especially when dealing with advanced locoregional disease. Intralesional therapies have the benefit of causing local tumor destruction, while minimizing systemic toxicity. Moreover, the integration of immunotherapeutic agents into intralesional compounds has resulted in the additional benefit of a bystander effect, whereby untreated distant lesions also derive a benefit from treatment. Intralesional therapy has assumed an important role in the management of unresectable, locoregional disease for melanoma. Areas covered: Multiple intralesional agents have been studied over the years, with only a few demonstrating promising results. This review will provide an overview of the different intralesional agents for melanoma. Mechanisms of action, clinical efficacy, and side effects will be the primary focus. Expert commentary: Treatment options for advanced melanoma continue to evolve. Attractive new therapies delivered by an intralesional route has demonstrated promising results, with minimal side effects. The ideal treatment strategy for melanoma will remain a multimodal approach; intralesional therapy provides an additional tool in the treatment armamentarium for melanoma.

16 Review Current standards of surgical management in primary melanoma. 2018

Perez, Matthew C / Orcutt, Sonia T / Zager, Jonathan S. ·Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA. · Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA - Jonathan.zager@moffitt.org. ·G Ital Dermatol Venereol · Pubmed #28895666.

ABSTRACT: Melanoma accounts for the majority of skin cancer-related deaths, and its incidence continues to rise worldwide. While advanced disease has historically been associated with poor long-term survival, early-stage disease has a favorable prognosis and therefore, early diagnosis is paramount. Resection of primary melanoma requires a balance of maximizing oncological outcome while minimizing morbidity. Wide excision with 1-2 cm margins, depending on depth of the tumor, is the standard of care for surgical treatment of primary, invasive melanoma. Sentinel lymph node biopsy is indicated for patients with clinically node-negative, intermediate-thickness primary melanomas but should also be considered in selected patients with thin and thick primaries. In this article, historical perspectives and key clinical trials regarding the current guidelines for the surgical management of primary melanoma are discussed.

17 Review Chemosaturation With Percutaneous Hepatic Perfusion in Unresectable Hepatic Metastases. 2017

Glazer, Evan S / Zager, Jonathan S. ·Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Sciences Center, Memphis,TN. · Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL. Jonathan.Zager@Moffitt.org. ·Cancer Control · Pubmed #28178721.

ABSTRACT: BACKGROUND: In patients with hepatic metastases from solid-organ malignancies, surgical resection may be a potentially curative option, but it is not possible in most cases. Chemosaturation with percutaneous hepatic perfusion was developed for the management of unresectable metastases to the liver. METHODS: Relevant medical literature was summarized with regard to the outcomes and limitations of chemosaturation with percutaneous hepatic perfusion. RESULTS: Six articles were identified that contained data on 91 individuals who received chemosaturation with percutaneous hepatic perfusion. More than 60% of these study patients were diagnosed with ocular melanoma. The overall response rate was 48% and the rate of disease control was 90%. Chemosaturation with percutaneous hepatic perfusion improved the rates of overall and hepatic progression-free survival (PFS). The data are limited but suggest that the rate of PFS was improved in study patients with isolated melanoma hepatic metastases who received chemosaturation with percutaneous hepatic perfusion compared with those assigned to standard care. CONCLUSIONS: Our results suggest that chemosaturation with percutaneous hepatic perfusion produces favorable tumor response rates in select individuals with unresectable hepatic metastases from multiple primary cancers, particularly ocular and cutaneous melanomas. Data from a single randomized clinical trial have also shown that chemosaturation with percutaneous hepatic perfusion can affect hepatic PFS in certain patients.

18 Review The safety of talimogene laherparepvec for the treatment of advanced melanoma. 2017

Gangi, Alexandra / Zager, Jonathan S. ·a Department of Cutaneous Oncology , Moffitt Cancer Center , Tampa , FL , USA. ·Expert Opin Drug Saf · Pubmed #27989216.

ABSTRACT: INTRODUCTION: Talimogene laherparepvec (T-VEC, IMLYGIC) is an oncolytic herpes virus type I used as intralesional therapy for the treatment of unresectable metastatic melanoma in a cutaneous, subcutaneous, or nodal location. Talimogene laherparepvec selectively replicates within and lyses tumor cells while producing granulocyte macrophage colony-stimulating factor (GM-CSF), which may promote an immune mediated antitumor response. Areas covered: The US Food and Drug Administration approved Talimogene laherparepvec in late 2015 following the completion of phase I, II and III trials that demonstrated safety and efficacy. Current NCCN practice guidelines have added Talimogene laherparepvec as a primary treatment for stage IIIB/C and stage IVM1a melanoma patients with evidence of good durable response rates, and this article sets out to review the use and safety and efficacy of T-VEC Expert opinion: Treatment options for locally advanced and metastatic melanoma are expanding with new developments in immunotherapy and immune checkpoint inhibitors. The ideal treatment of metastatic melanoma continues to be multimodal, combining systemic treatments, intralesional and regional therapies, surgery and radiotherapy to achieve optimal outcomes. Use of talimogene laherparepvec as intrelsional therapy has demonstrated promising effects in select patients with advanced melanoma. Future directions for Talimogene laherparepvec include combination therapies with other systemic immunotherapies such as anti-CTLA-4 antibody and anti-PD-1 drugs.

19 Review Intralesional and systemic immunotherapy for metastatic melanoma. 2016

Luu, Carrie / Khushalani, Nikhil I / Zager, Jonathan S. ·a Department of Cutaneous Oncology , H. Lee Moffitt Cancer Center , Tampa , FL , USA. · b Department of Cutaneous Oncology , Director of Regional Therapies Moffitt Cancer Center , Tampa , FL , USA. ·Expert Opin Biol Ther · Pubmed #27602429.

ABSTRACT: INTRODUCTION: Immunotherapy has revolutionized the treatment of metastatic melanoma and dramatically improved patient outcomes. Ipilimumab, an inhibitor of cytotoxic T-lymphocyte antigen-4 (CTLA-4), was the first immunotherapeutic agent to demonstrate improved survival in advanced melanoma. More recently, other immune checkpoint inhibitors, including the programmed death-1 (PD-1) inhibitors pembrolizumab and nivolumab, have demonstrated efficacy in locally advanced unresectable and metastatic melanoma. In addition to systemically delivered immunotherapies, intralesional therapies such as talimogene laherparepvec (TVEC) play an important role in the treatment of locoregionally advanced and metastatic melanoma. Areas covered: This review provides an overview of the mechanisms behind immune checkpoint inhibitors. Clinical evidence of their efficacy is presented and discussion of new patterns of response and associated immune related adverse events associated with immunotherapy are provided. Expert opinion: Treatment options for locally advanced and metastatic melanoma are expanding with new developments in immunotherapy and immune checkpoint inhibitors. The utility of these novel therapies in the adjuvant setting is currently being explored. The ideal treatment of metastatic melanoma continues to be multimodal, combining systemic treatments, intralesional and regional therapies, surgery and radiotherapy to achieve optimal outcomes.

20 Review Developments in Intralesional Therapy for Metastatic Melanoma. 2016

Sloot, Sarah / Rashid, Omar M / Sarnaik, Arnod A / Zager, Jonathan S. ·Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA. Jonathan.Zager@Moffitt.org. ·Cancer Control · Pubmed #27009452.

ABSTRACT: BACKGROUND: Locoregional advanced melanoma poses a complex clinical challenge that requires a multidisciplinary, patient-centered approach. Numerous agents have been studied for their suitability as intralesional therapy in the past decades, but few have successfully completed phase 3 clinical trial testing. METHODS: The relevant medical literature was searched for articles regarding use of intralesional therapies in metastatic melanoma. Therapies with data from phase 2 or higher studies were selected for review. This review also summarizes the mechanisms of action, adverse-event profiles, and clinical data for these agents. RESULTS: Intralesional therapies demonstrate promising effects in select patients with advanced melanoma. The optimal approach should be individually tailored and consist of a combination of intralesional therapies, regional perfusions, systemic immunotherapies, targeted therapies, and surgery, if necessary. CONCLUSIONS: Due to its relatively good local response rates and tolerable adverse-event profile, intralesional therapy may be a treatment option for select patients with unresectable, locally advanced or metastatic melanoma.

21 Review Genetic Testing in the Multidisciplinary Management of Melanoma. 2015

Rashid, Omar M / Zager, Jonathan S. ·Department of Cutaneous Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, SRB 4.24012, Tampa, FL 33612, USA; Bienes Comprehensive Cancer Center, Holy Cross Hospital, 4725 N Federal Highway, Fort Lauderdale, FL 33308, USA. · Department of Cutaneous Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, SRB 4.24012, Tampa, FL 33612, USA. Electronic address: jonathan.zager@moffitt.org. ·Surg Oncol Clin N Am · Pubmed #26363541.

ABSTRACT: Melanoma is increasing in incidence and represents an aggressive type of cancer. Efforts have focused on identifying genetic factors in melanoma carcinogenesis to guide prevention, screening, early detection, and targeted therapy. This article reviews the hereditary risk factors associated with melanoma and the known molecular pathways and genetic mutations associated with this disease. This article also explores the controversies associated with genetic testing and the latest advances in identifying genetic targets in melanoma, which offer promise for future application in the multidisciplinary management of melanoma.

22 Review Sentinel lymph node mapping in melanoma in the twenty-first century. 2015

Doepker, Matthew P / Zager, Jonathan S. ·Department of Cutaneous Oncology, Moffitt Cancer Center, 12902 Magnolia Drive SRB-4, Tampa, FL 33612, USA. · Department of Cutaneous Oncology, Moffitt Cancer Center, 12902 Magnolia Drive SRB-4, Tampa, FL 33612, USA. Electronic address: jonathan.zager@moffitt.org. ·Surg Oncol Clin N Am · Pubmed #25769710.

ABSTRACT: The incidence of melanoma is increasing faster than any other cancer. The status of the regional nodal basin remains the most important prognostic factor. Sentinel lymph node biopsy (SLNB) is recommended for staging in patients diagnosed with intermediate-thickness melanoma (1.01-4.0 mm). SLNB is considered somewhat controversial, especially when used to stage thin (1 mm), thick (>4 mm), or desmoplastic melanoma. This article reviews the current literature regarding SLNB in thin, intermediate, thick, and desmoplastic melanoma. Data supporting the use of newer radiopharmaceuticals in sentinel lymph node mapping along with newer imaging modalities are also reviewed.

23 Review BRAF and MEK inhibition in melanoma. 2015

Dossett, Lesly A / Kudchadkar, Ragini R / Zager, Jonathan S. ·Moffitt Cancer Center, Complex General Surgical Oncology , 12902 Magnolia Drive, Tampa, FL 33612 , USA. ·Expert Opin Drug Saf · Pubmed #25648338.

ABSTRACT: INTRODUCTION: Selective inhibition of the MAPK pathway with either BRAF or MEK inhibition has emerged as a key component for the treatment of BRAF-mutant metastatic melanoma. New evidence suggests that the combination of BRAF and MEK inhibitors improves tumor response rate and progression-free survival, while potentially attenuating some of the serious adverse events observed with monotherapy. AREAS COVERED: This review covers the current data on the efficacy and safety of the selective BRAF (vemurafenib and dabrafenib) and MEK (trametinib) inhibitors as well as the available data on BRAF inhibitor + MEK inhibitor combination therapy (dabrafenib + trametinib and vemurafenib + cobimetinib). The efficacy, safety and toxicity data are discussed from Phase I, Phase II and Phase III trials of these drugs. EXPERT OPINION: Combination therapy with the BRAF and MEK inhibitors improves response rates and progression-free survival in patients with BRAF-mutant metastatic melanoma. Some of the serious adverse events, in particular, the incidence of cutaneous squamous cell carcinoma, are attenuated with combination therapy, whereas milder side effects such as pyrexia can be more common with combination therapy. Although dose reductions and dose interruptions are slightly more common with combination therapy, overall data supports the notion that combination therapy is safe and improves the outcomes for patients compared to single agent BRAF inhibitors.

24 Review Intralesional therapy for metastatic melanoma. 2014

Sloot, Sarah / Rashid, Omar M / Zager, Jonathan S. ·University Medical Center Groningen , Groningen , Netherlands. ·Expert Opin Pharmacother · Pubmed #25381015.

ABSTRACT: INTRODUCTION: Intralesional therapy for metastatic melanoma has some advantages over systemic therapy. Local drug administration allows for delivery of an increased concentration of the agent and reduced systemic exposure, thereby increasing local efficacy and limiting toxicity. Moreover, since in vivo tumor nodules contain the tumor antigens, this tumor tissue may serve as an autologous vaccine to induce systemic immunity. This so-called 'bystander effect', where uninjected distant lesions exhibit a response, has been reported in select intralesional therapy trials. AREAS COVERED: This review will give an overview of the working mechanisms, clinical evidence and side effects for available intralesional and topical therapies and summarize the most recent developments in this field. EXPERT OPINION: The ideal treatment approach for locoregionally advanced melanoma should be multidisciplinary and tailored to the patient, taking into consideration patient-related, tumor-related factors (such as location, tumor burden, mutation status) and previous treatments received. It will likely not be a single therapy, but rather a combination of injectable treatments, regional perfusions and systemic therapies.

25 Review Locoregional therapies in melanoma. 2014

Abbott, Andrea M / Zager, Jonathan S. ·Department of Cutaneous Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, SRB 4.24012, Tampa, FL 33612, USA. · Department of Cutaneous Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, SRB 4.24012, Tampa, FL 33612, USA. Electronic address: jonathan.zager@moffitt.org. ·Surg Clin North Am · Pubmed #25245964.

ABSTRACT: In-transit disease is defined as any dermal or subcutaneous metastases that arise between the primary melanoma but not beyond the draining regional nodal basin. Patients who develop in-transit disease are at further risk to develop additional locoregional and distant disease. Treatment must be individualized and take into consideration the extent of disease, tumor characteristics, and patient characteristics including age, comorbidities, previous therapies, and site of recurrence. Surgery, regional perfusions and intralesional injections all play a role in management options. These patients should be discussed and managed by a multidisciplinary team whenever possible.

Next