title: In vivoprofiling reveals immunomodulatory effects of sorafenib and dacarbazine on melanoma.
abstract: Sorafenib is a multi-kinase inhibitor used alone or in combination with dacarbazine to treat metastasized melanoma. Our study investigated the relationship between metabolic response assessed by PET-CT and global transcriptome changes during sorafenib and dacarbazine therapy in patients with advanced melanoma. We conducted an open-label, investigator-initiated study that enrolled 13 sorafenib-naïve Stage IV melanoma patients, whose metastases were accessible for repeated biopsies. Treatment regimen included orally administered sorafenib and intravenous dacarbazine. Biopsies of skin or superficial lymph node metastases were taken before treatment (baseline), during sorafenib and after dacarbazine therapy and used for transcriptional profiling and validation experiments. Serum samples were evaluated for cytokine production. Metabolic response to therapy was observed in 45.5% of patients. The study drugs were well tolerated. We observed a clear upregulation of interferon (IFN)-stimulated immune response genes in profiled metastases. The IFNγ-induced gene signature seemed to be enhanced after addition of dacarbazine to sorafenib. Serum IFNγ also increased during therapy, particularly after addition of dacarbazine. Induction of IFNγ stimulated genes correlating with increased serum IFNγ was predictive of better clinical outcome and responders who had significantly higher serum IFNγ levels lived longer. Our data revealin situchanges in melanoma metastases during treatment with sorafenib and dacarbazine and suggest an additional mechanism of action through immunomodulation.
authors.affiliation: Department of Dermatology; University Hospital Zurich ; Zurich, Switzerland.
authors.forename: Mirjana
authors.initials: M
authors.lastname: Urosevic-Maiwald
authors.affiliation: Department of Dermatology; University Hospital Zurich ; Zurich, Switzerland.
authors.forename: Marjam J
authors.initials: MJ
authors.lastname: Barysch
authors.affiliation: Department of Dermatology; University Hospital Zurich ; Zurich, Switzerland.
authors.forename: Phil F
authors.initials: PF
authors.lastname: Cheng
authors.affiliation: Department of Dermatology; University Hospital Zurich ; Zurich, Switzerland.
authors.forename: Maria B
authors.initials: MB
authors.lastname: Karpova
authors.affiliation: Department of Nuclear Medicine; University Hospital Zurich ; Zurich, Switzerland.
authors.forename: Hans
authors.initials: H
authors.lastname: Steinert
authors.affiliation: Functional Genomics Center; ETH Zurich ; Zurich, Switzerland.
authors.forename: Michal J
authors.initials: MJ
authors.lastname: Okoniewski
authors.affiliation: Department of Dermatology; University Hospital Zurich ; Zurich, Switzerland.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Dummer
keywords: AE, adverse events CMR, complete metabolic response; ISG, IFN-stimulated gene; PMD, progressive metabolic disease; PMR, partial metabolic response; SAE, serious adverse events SMD; dacarbazine; gene expression profiling; interferon-γ; melanoma; sorafenib; stable metabolic disease