Lack of Association Between Autoimmune Antibodies and Improved Outcome in Melanoma Patients
Contrary to previous reports, the appearance of autoantibodies is not strongly associated with improved outcome in melanoma patients treated with interferon, according to a new study.
Adjuvant treatment of melanoma with interferon-α (IFN) has been shown to increase recurrence-free survival. In this study, Alexander M.M Eggermont, M.D., at Erasmus University MC in the Netherlands, and colleagues, looked at randomized controlled clinical trials in which patients with melanoma received or did not receive intermediate doses of IFN. Using statistical models accounting for guarantee-time bias--which is the additional time that patients with improved outcomes would have to become antibody-positive--they did not find a statistically significant association between autoantibodies after initiation of treatment and the length of time to recurrence.
Serum levels of antibodies were determined using enzyme-linked immunosorbent assays in over 500 patients in the European Organization for Research and Treatment of Cancer (EORTC18952) and Nordic IFN trials. Cox regression models were used to assess the association of seroconversion with recurrence-free survival.
When treated as a time-independent variable, appearance of autoantibodies was associated with improved relapse-free interval in both trials, but correction for guarantee-time bias found that the association was not statistically significant.
"The results of two similar randomized trials reported here do not suggest that the presence or appearance of autoantibodies is a strong prognostic factor in melanoma patients," the authors write. "The findings indicate that the assessment of autoimmune antibodies is not a useful tool in selecting patients who would benefit from treatment with intermediate doses of IFN-a2b."
Contact: Alexander Eggermont, a.eggermont@erasmusmc.nl, +31-10-7041506
Risk Assessment for Prostate Cancer Metastasis and Mortality
In this study, a risk assessment tool called the CAPRA--Cancer of the Prostate Risk Assessment--score was accurate in predicting bone metastasis, prostate cancer-specific mortality, and all-cause mortality at diagnosis of localized prostate cancer.
Although many systems designed to assess prostate cancer risk are available, most only predict biochemical recurrence, usually after a single type of treatment. For this study, Matthew R. Cooperberg, M.D., M.P.H., of the Department of Urology at the University of California, San Francisco, and colleagues used registry data to investigate whether the CAPRA score could predict bone metastasis, prostate cancer-specific mortality, and all-cause mortality.
The researchers studied 10,627 men with clinically localized prostate cancer from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry who underwent radical prostatectomy, radiation therapy (external-beam or interstitial), androgen deprivation therapy, or watchful waiting. CAPRA scores were calculated at diagnosis from the prostate-specific antigen level, Gleason score, percentage of biopsy cores that were positive for cancer, clinical tumor stage, and age at diagnosis.
Nearly 3% (311) of the men developed bone metastases; 2.4% (251) died of prostate cancer and 14.9% (1,582) died of other causes. Each single-point increase in the CAPRA score was associated with increased bone metastases and prostate cancer-specific and all-cause mortality, and the CAPR2A score was accurate for predicting all three outcomes.
"Given its high degree of accuracy and ease of calculation, the CAPRA score may prove an increasingly valuable tool for risk stratification in both the clinical practice and the research setting," the authors write.
Contact: Elizabeth Fernandez, efernandez@pubaff.ucsf.edu, 415-514-1592.
Journal
JNCI Journal of the National Cancer Institute