Highlights
- •Minimally invasive adrenalectomy is indicated for resistant to therapy melanoma.
- •There can be site-specific resistance in isolated areas like the adrenal.
- •The adrenal gland may function as a sanctuary site for metastatic growth.
Abstract
Background
Minimally invasive adrenalectomy has facilitated resection of resistant adrenal metastases.
The adrenal gland may function as a sanctuary site for metastatic growth despite systemic
therapy. The objective of the study was to assess the outcomes of selective minimally
invasive adrenalectomy during immunotherapy.
Methods
Candidates included patients with adrenal metastases resistant to systemic therapy
who underwent minimally invasive adrenalectomy.
Results
There were 15 patients undergoing 16 minimally invasive adrenalectomies. Patients
received either immunotherapy or BRAF inhibition prior to surgery. The mean operative
time was 130 min with a median length of hospital stay of 2 days. At a median follow
up of 24 months, 7 patients have no evidence of disease, 6 patients had progression
with eventual mortality, while another patients has stable disease with maintenance
therapy. One was lost to follow up.
Conclusion
Despite an increase in objective durable responses in metastatic melanoma, there is
still some site-specific resistance in isolated areas like the adrenal where early
minimally invasive adrenalectomy remains indicated.
Keywords
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References
- Cutaneous melanoma: available therapy for metastatic disease.Dermatol Ther. 2006; 19: 19-25
- Management of metastatic cutaneous melanoma: updates in clinical practice.Ther Adv Med Onc. 2019; 11: 1-16
- CTLA-4 and PD-1 receptors inhibit T-cell activation by distinct mechanisms.Mol Cell Biol. 2005; 25: 9543-9553
- Immunomodulatory effects of BRAF and MEK inhibitors: implications for melanoma therapy.Pharm Res (N Y). 2018; 136: 151-159
- Improved survival with ipilimumab in patients with metastatic melanoma.N Engl J Med. 2010; 368: 711-723
- Survival, durable tumor remission and long term safety in patients with advanced melanoma receiving nivolumab.J Clin Oncol. 2014; 32: 1020-1030
- Safety and efficacy of vemurafenib in BRAF V600E and BRAF V600K mutation-positive melanoma (BRIM-3): extended follow-up of a phase 3, randomised, open-label study.Lancet Oncol. 2014; 15: 323-332
- Metastasis-specific patterns of response and progression with anti-PD-1 treatment in metastatic melanoma.Pigment Cell Metabol Res. 2018; 31: 404-410
- The impact of melanoma genetics on treatment response and resistance in clinical and experimental studies.Cancer Metastasis Rev. 2017; 36: 53-75
- Metastatic pattern of malignant melanoma. A study of 216 autopsy cases.Am J Surg. 1978; 135: 807-810
- Metastatic patterns in autopsy cases of cutaneous melanoma.Invasion Metastasis. 1988; 8: 193-204
- Adrenal metastases of malignant melanoma: characteristic computed tomography appearances.Australas Radiol. 2005; 49: 325-329
- The role of resection in the management of melanoma metastatic to the adrenal gland.Surgery. 1991; 109: 127-131
- Long-term survival after complete resection of melanoma metastatic to the adrenal gland.Ann Surg Oncol. 1999; 6: 633-639
- Adrenalectomy for metastatic disease to the adrenal glands.Br J Surg. 1996; 83: 528-531
- Does complete resection of melanoma metastatic to solid intra-abdominal organs improve survival?.Ann Surg Oncol. 2001; 8: 658-662
- Adrenalectomy may increase survival of patients with adrenal metastases.Oncol Lett. 2012; 3: 917-920
- Laparoscopic transperitoneal lateral adrenalectomy for malignant and potentially malignant adrenal tumours.BMC Surg. 2015; 15: 101https://doi.org/10.11186/s12893-015-0088-z
- Surgical approaches to the adrenal gland.Surg Clin N Am. 2019; 99: 773-791
- Inter- and intra-patient heterogeneity of response and progression to targeted therapy in metastatic melanoma.PLoS One. 2014; 9e85004https://doi.org/10.1371/journal.pone.0085004
- Current landscape and future directions of biomarkers for predicting responses to immune checkpoint inhibitors.Cancer Manag Res. 2018; 10: 2475-2488
- The adrenal gland as a sanctuary site of metastases after Pembrolizumab treatment: a case series.J Natl Compr Cancer Netw. 2018; 16: 1279-1283
- Adrenalectomy for metastatic melanoma: current role in the age of nonsurgical treatments.Am Surg. 2015; 81: 1005-1009
- Immunological insights from patients undergoing surgery on ipilimumab from metastatic melanoma.Ann Surg Oncol. 2013; 203: 3106-3111
- Patterns of failure after immunotherapy with checkpoint inhibitors predict durable progression-free survival after local therapy for metastatic melanoma.J Immunother Cancer. 2019; 7 (doi: 10/1186/s40425-109-0672-3): 196
- Laparoscopic adrenalectomy in Cushing’s Syndrome and phaeochromocytoma.N Engl J Med. 1992; 37: 1033
- The role of laparoscopic adrenalectomy for adrenal tumours of 6 cm or greater.Surg Endosc. 2008; 22: 617-621
- Laparoscopic adrenalectomy for large adrenal masses: single team experience.Int J Surg. 2014; 12: 572-574
- Techniques to perform a laparoscopic right adrenalectomy for metastases abutting the liver, renal vein and posterior vena cava.Surg Endosc. 2016; 30: 1226https://doi.org/10.1007/s00464-015-4311-x
- Minimally invasive approach for adrenal lesions: systematic review of laparoscopic versus retroperitoneoscopic adrenalectomy and assessment of risk factors for complications.Int J Surg. 2016; 28: S118-S123
- Robotic assisted versus pure laparoscopic surgery of the adrenal glands: a case-control study comparing surgical techniques.Langenbeck’s Arch Surg. 2016; 401: 999-1006
- The impact of the ultrasonic, bipolar and integrated energy devices in the adrenal gland surgery: literature review and our experience.BMC Surg. 2019; 18: 123https://doi.org/10.1186/s12893-018-0457-5
- Single-port robotic-assisted adrenalectomy: feasibility, safety and cost-effectiveness.J Soc Laparoendosc Surg. 2015; 19 (e2014.00218)https://doi.org/10.4923/JSLS.2014/00218
- Risk factors for conversion and complications after unilateral laparoscopic adrenalectomy.Br J Surg. 2011; 98: 1392-1399
- Predictors of complication after adrenalectomy.Int Braz J Urol. 2019; 45: 514-522
- Patterns of acquired resistance to anti-PD-1 antibodies in patients with metastatic melanoma (MM).J Clin Oncol. 2015; 33 (abstr e20005)
- Indicators of responsiveness to immune checkpoint inhibitors.Sci Rep. 2017; 7: 807https://doi.org/10.1038/s41598-017-01000-2
- BRAF inhibition is associated with enhanced melanoma antigen expression and a more favourable tumor microenvironment in patients with metastatic melanoma.Clin Cancer Res. 2013; 19: 1225-1231
- Influence of tumor micro-environment heteroegeneity on therapeutic response.Nature. 2013; 501: 346-354
- The role of tumor-infiltrating lymphocytes (TILs) as a predictive biomarker of response to anti-PD1 therapy in patients with metastatic non-small cell lung cancer or metastatic melanoma.Med Oncol. 2018; 31: 25https://doi.org/10.1007/s12032-018-1080-0
- The risk of immune-related endocrine disorders associated with anti-PD-1 inhibitors therapy for solid tumors: a systematic review and meta-analysis.Int Immunopharmacol. 2018; 59: 328-338
- Guidelines for the evaluation of immune therapy activity in solid tumors: immune-related response criteria.Clin Cancer Res. 2009; 15: 7412-7420
Article info
Publication history
Published online: November 26, 2019
Accepted:
November 18,
2019
Received in revised form:
November 18,
2019
Received:
August 25,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
