Kyaw thura zaw
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- 1. M.V. LOMONOSOV MOSCOW STATE UNIVERSITYFACULTY OF BASIC MEDICINE COMPARISON OFPOLY- CHEMOTHERAPY (CVD regimen) & THE SAME CHEMOTHERAPY (CT) PLUS INTERFERON-2a IN METASTATIC MELANOMA Student: Dr. Kyaw Thura ZawScientific Supervisor :Prof. Dr. Lev DemidovN.N. BLOKHIN CANCER RESEARCH CENTREMoscow ,2010
- Malignant melanoma is a neoplasm of melanocytesor of the cells that develop from melanocytes.
- Melanoma is showing a rapid worldwide rise in incidence, with a yearly increase of about 5% and a frequent occurrence in young adults . Even though surgery represents the cure in the early phase of disease, the prognosis in patients with metastatic melanoma remains very poor, with a median survival ofabout 69 months .
- Melanoma signaling cascades MAPK and PI3K. The MAPK pathway is hyperactivated in melanomas, mainly due to activating mutations in either the NRAS or BRAF genes .
- Frequency: Queensland, Australia, has the highest incidence of melanoma in the world, approximately 57 cases / 100,000 people / year. Israel also has one of the highest incidences,approximately 40 cases / 100,000 people annually.
- Incidence: Increasing rapidly worldwide, and faster rate than that of any other cancer except lung cancer in women. Melanoma is notorious for affecting young and middle-aged people.
5. Race Melanoma is more common in whites than in blacks and Asians. The rate of melanoma in blacks is estimated to be1/120that of whites.Sex Melanoma is slightly more common in men than women (1.2:1). Melanoma is the 5th most common malignancy in men and the 6th most common malignancy in women, accounting for 5% and 4% of all new cancer case. respectively. 6. Risk Factors
- Sun Exposure and Sun beds
- Skin Pigmentation
- Solar Elastosis and Solar Keratoses
- Gene Alterations
- Somatice Alterations
- Common Low Penetratace Genes
7. A=AsymmetryB=Border (irregular) C= Color D= Diameter ABCD Properties of Radial Melanomas 8. A 1.5-cm melanoma with characteristicasymmetry, irregular borders, and color variation. 9. Factors Predicting the Outcome of Response of Treatment
- Good performance status
- Soft tissue disease or only a few visceral metastases
- Age younger than 65 years
- No prior chemotherapy
- Normal hepatic and renal function
- Normal CBC count
- Absence of CNS metastases
10. AIM OF STUDY To Study and Compare thePoly-chemotherapy (CVD regimen) & the Same Chemotherapy(CT)plus Interferon - 2 a in Metastatic Melanoma. 11. Objectivesof Study
- To study the response rate of poly chemotherapy (CVD regimen) and the same chemotherapy (CT) plus interferon-2a in metastatic melanoma.
- To study the effect of combine Chemotherapy (CVD) in metastatic melanoma.
- To study Bio chemotherapy not more rather than Chemotherapy alone.
12. Materials and Methods 13. Patients Characteristics CVD PCVD+IFN P Age , median (min-max) 55 (35-65) P0.25 2 10 P>0.10 7 P>0.30 Metastatic sites Skin 4 P>0.25 6 P>0.10 Lymph node 10 P>0.70 9 P>0.25 Lungs 9 P=1.00 9 P=1.00 Liver 9 P>0.10 6 P>0.10 Other 3 P>0.10 0 P>0.20 Number of Metastases 1 1 P>0.10 4 P>0.10 2 8 P>0.70 7 P>0.70 3 6 P>0.25 4 P>0.25 14. Treatment Schedules
- The treatment regimen A consisted ofDacarbazine : 800mg/m2 IV day 1,Vinblastine : 1.6 mg/m2 IV days 1-5, andCisplatin :20 mg/m2 IV days 1-4(CVD) . The cycle was repeated on day 22.
- ThetreatmentregimenBconsistedofCVDchemotherapyplus IFN alpha-2a1.5x10 6IU/m2 days 1-10. The total number of cycles/day was 6atthemost .
15. Response of Therapy 16.
- CR: Complete Response, PR: Partial Response ,
- SD: Stable Disease
- PD: Progressive Disease.
COMPARISON BETWEEN THE RESULT OF CVD AND CVD+IFN 17. Overall survival. Heavy line represents CVD + IFN group; Fine line represents CVD group ; No. of death /Total No. Average survival Survival Median CVD+IFN 8/15 13.51(9.7;17.3) 12.0(9.9;14.1) CVD 7/15 10.75(9.1;12.4) 12.0(7.8;16.2) 18. CONCLUSIONS
- ResponseratewasthehighestbestinCVD+IFNgroup(6/15)compared to CVD (4/15) , but the difference was not significant.
- Combined Chemotherapy(CVD) and Biochemotherapy (CVD+IFN) in which, all showed some activity in Metastatic Melanoma.
- The best responding metastatic siteswere the lymph nodes all patients experienced mild adverse effects. No treatment-related deaths occurred. The median survival was 12monthsinCVD+IFN,CVDrespectively.