Efficacy of combined hypo-fractionated radiotherapy and anti-PD-1 monotherapy in difficult-to-treat advanced melanoma patients.

Information on the role of radiotherapy in anti-PD-1 monoclonal antibody-treated melanoma patients is limited. We report on a prospective cohort of advanced melanoma patients treated simultaneously with radiotherapy and anti-PD-1 therapy between 01/01/15 and 30/06/16. Tumor evaluations (RECIST 1.1) were performed every 3 months on radiated and non-radiated lesions. Twenty-five advanced melanoma patients (64% AJCC stage IV M1c, 64% on second-line treatment or more, 60% with elevated LDH serum levels) were included. Radiotherapy was performed early (median: 24 days) after the first anti-PD-1 dose in 15 patients with rapidly progressing symptomatic lesion(s) or later (median: 5.4 months) in 10 patients with progressive disease (PD) despite PD-1 blockade. Radiotherapy was limited to one organ in 24 patients and consisted mainly of hypo-fractioned radiotherapy (median dose 26 Gy in 3-5 fractions, 17 patients) or brain radiosurgery (5 patients). Median follow-up after first anti-PD-1 dose was 16.9 m (range 2.7-27.4), with 44% of patients alive at last follow-up. For radiated lesions, rates of complete (CR), partial (PR) responses, stable disease (SD) or PD were 24%, 12%, 24%, and 32%, respectively. For non-radiated lesions, rates of CR, PR, SD, and PD were 20%, 19%, 12%, and 40%, respectively. Responses achieved after radiotherapy for radiated and non-radiated areas were correlated (Pearson correlation r: 0.89, P<0.0001) suggesting an abscopal effect. Five patients with CR remained disease-free after discontinuation of anti-PD-1 for a median of 9.5 months. No unusual adverse event was recorded. Hypo-fractionated radiotherapy may enhance efficacy of anti-PD1 therapy in difficult-to-treat patients. Controlled studies are needed.

Sunscreen use and melanocytic nevi in children: a systematic review.

We conducted a systematic review of the association between melanocytic nevi (MN) in childhood and sunscreen use. A bibliographic search was conducted between November 2008 and January 2009 using the following key words on MEDLINE and EMBASE: child*, in combination with naevi, nevi, naevus, nevus and sunscreen, sun protection. We also used Medical Subject Headings [sunscreening agents], or [radiation protection] with [nevus, pigmented]. A first screening was done on title and abstract reading. Randomized trials and cohort and cross-sectional studies analyzing the relationship between the use of sunscreen and MN in children were selected. Three reviewers abstracted data from each article. The three sets of results were compared for concordance and rereviewed if necessary. Fifteen articles were included (20,743 children). The studies were not consistent in terms of the ages of the children, MN count methods, or sunscreen use assessment. Owing to this heterogeneity, we were unable to pool the studies and conduct a meta-analysis. Twelve studies did not report that the use of sunscreen had a protective effect against MN development. Three studies reported a lower MN count when sunscreen was applied. This systematic review underlines the methodologic differences between studies. Eight of 15 studies reported a positive association between sunscreen application and MN count. Differences in MN counts, overexposure to sun, and inadequate sunscreen application on fair-skinned children could explain the disparity in the results. There is still no evidence of a protective effect of sunscreen against MN development in children.

Are sunscreens luxury products?

BACKGROUND: The incidence of skin cancers is rapidly increasing in Western countries. One of the main sun-protection measures advocated is application of sunscreen. Some studies report a failure to comply with sunscreen application guidance. One explanation is their cost. OBJECTIVE: To evaluate the true cost of sunscreen in two situations: a 4-member family spending 1 week at the beach and a transplant patient respecting all the sun protection recommendations. METHODS: We performed an analysis of prices of sunscreens sold via Internet drugstores in Europe and North America. Standard sunscreen application recommendations were followed. We tested the recommended amount of sunscreen to be applied (ie, 2 mg/cm(2)). RESULTS: Six hundred seven sunscreens from 17 drugstores in 7 countries were evaluated. Median price of sunscreen was $1.7 US per 10 grams. The price decreased with the size of the bottle. The median price for a family varied from $178.2 per week to $238.4 per week. The price decreased by 33% if the family wore UV-protective T-shirts and by 41% if large-volume bottles were used. The median price for a transplant patient varied from $245.3 per year to $292.3 per year. LIMITATIONS: Anti-UVA activity and topical properties were not evaluated. We tested the recommended amount (2 mg/cm(2)) rather than the amount actually used (1 mg/cm(2)). CONCLUSION: Under acute sun exposure conditions (a week at the beach), the cost of sun protection appears acceptable if sun protective clothing is worn and large-format bottles and low-cost sunscreens are used. Conversely, in a sun-sensitive population requiring year-round protection, the annual budget is relatively high and patients may require financial assistance to be compliant with sun protection guidelines.

Parents' attitudes related to melanocytic nevus count in children.

Sun exposure, fair phototype, and a high common melanocytic nevus (MN) count have been identified as the most important risk factors for melanoma. MN are mainly acquired during childhood, and their relationship to sun exposure, sunburn, and light skin complexion is well documented. The purpose of this study was to investigate how the sun protection attitudes of parents and their offspring affect MN development in children. We designed a cross-sectional study in 828 9-year-old school children. Trained nurses counted the MN on each child's back and arms, depending on their size. Questionnaires filled by children and parents provided information about sun exposure, attitude towards the sun, and sun-protection behaviors. Multivariate analysis showed that the childhood MN count was linked to fair phenotype--fair skin: rate ratio (RR)=3.80, 95% confidence interval (CI)=2.25-6.41; blue/green eyes: RR=1.2, 95% CI=1.11-1.34; blond hair: RR=1.25, 95% CI=1.10-1.41; history of sunburn: RR=1.13, 95% CI=1.03-1.23, seaside sun exposure--RR=1.14, 95% CI=1.01-1.28, and to their parents' behaviors during exposure to the sun--increase in the number of MN when parents used sunscreen: RR=1.23, 95% CI=1.08-1.40; decrease in MN count when parents wore a tee-shirt: RR=0.86, 95% CI=0.79-0.93. In conclusion, fair phenotype and sun exposure are known major risk factors for MN. Parents' behaviors influence their children and appeared in our analysis as another determinant predictor of MN count, being protective against (wearing a tee-shirt when exposed to sun) or increasing the risk (sunscreen use, reflecting higher sun exposure) for childhood MN development.