A prospective evaluation of the role of Vascular Endothelial Growth Factor (VEGF) and the immune system in stage III/IV melanoma.
BACKGROUND
The immune system and vascular endothelial growth factor (VEGF) may be influential in melanoma behavior. We performed a prospective, exploratory analysis in 10 stage III and 22 stage IV melanoma patients to observe factors influencing outcomes.


METHODS
Patients accrued during 2010 and 2011 were treated according to standard protocols for disease stage. We analyzed selected biomarkers for predictive patterns of clinical response. Survival outcomes were calculated using Kaplan-Meier curves.


RESULTS
Baseline LDH was negatively correlated with length of survival and positively correlated to baseline VEGF in stage IV melanoma patients. We found a positive correlation between peripheral blood Treg concentrations and baseline VEGF in stage IV patients. No stage III patients died during the study period; median survival for stage IV patients was 48 months using a Kaplan-Meier survival curve, which illustrates the enrichment for exceptional stage IV survivors. Six stage IV patients remain disease free, including 4 of the 10 patients who received IL-2 +/- metastatectomy.


CONCLUSIONS
Recent advances in immunotherapy have demonstrated durable therapeutic responses which may favorably impact survival. Examining T-cell characteristics of metastatic melanoma patients may gain further insight into underlying immunomodulation mechanisms to guide improved therapies.
Lehigh Valley Health Network, Department of Hematology Oncology, John and Dorothy Morgan Cancer Center, 1240 S. Cedar Crest Blvd, Suite 401, Allentown, PA 18103 USA.
Nicole Marie
NM
Agostino
Lehigh Valley Health Network, Department of Hematology Oncology, John and Dorothy Morgan Cancer Center, 1240 S. Cedar Crest Blvd, Suite 401, Allentown, PA 18103 USA.
Christine
C
Saraceni
Lehigh Valley Health Network, Department of Hematology Oncology, John and Dorothy Morgan Cancer Center, 1240 S. Cedar Crest Blvd, Suite 401, Allentown, PA 18103 USA.
Hope
H
Kincaid
Lehigh Valley Health Network, Department of Hematology Oncology, John and Dorothy Morgan Cancer Center, 1240 S. Cedar Crest Blvd, Suite 401, Allentown, PA 18103 USA.
Wenjing
W
Shi
Mayo Clinic, Rochester, MN USA.
Wendy Kay
WK
Nevala
Mayo Clinic, Rochester, MN USA.
Svetomir
S
Markovic
Lehigh Valley Health Network, Department of Hematology Oncology, John and Dorothy Morgan Cancer Center, 1240 S. Cedar Crest Blvd, Suite 401, Allentown, PA 18103 USA.
Suresh G
SG
Nair
Biomarkers; CD4+/CD8+ ratio; LDH; Melanoma; Stage IV; TH1/TH2 ratio; Tregs; VEGF