Publications by authors named "J Stretch"
Background: Although most melanomas drain to the more common major lymph node basins (axilla, groin, neck), rarely they drain to deep SLN locations such as intra-abdominal and intra-thoracic (including intercostal and internal mammary) sites, which pose a higher surgical risk and complexity for procurement. Our study is aimed at determining the rate of positivity and likelihood of recurrence in these nodal sites to guide management decisions for patients with truncal melanomas which drain to these 'deep' SLN locations.
Methods: Retrospective data collected between May 2008 and May 2022 including all patients with truncal melanomas who underwent lymphoscintigraphy resulting in the identification of deep SLNs in intra-abdominal and intra-thoracic sites were included.
Heterogeneous resistance to immunotherapy remains a major challenge in cancer treatment, often leading to disease progression and death. Using CITE-seq and matched 40-plex PhenoCycler tissue imaging, we performed longitudinal multimodal single-cell analysis of tumors from metastatic melanoma patients with innate resistance, acquired resistance, or response to immunotherapy. We established the multimodal integration toolkit to align transcriptomic features, cellular epitopes, and spatial information to provide deeper insights into the tumors.
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- In a study comparing neoadjuvant (before surgery) and adjuvant (after surgery) immunotherapy for stage III melanoma, neoadjuvant treatment showed greater effectiveness.
- The trial involved random assignment of 423 patients to receive either two cycles of neoadjuvant ipilimumab plus nivolumab followed by surgery, or surgery followed by 12 cycles of adjuvant nivolumab.
- Results indicated a significantly higher 12-month event-free survival rate in the neoadjuvant group (83.7%) compared to the adjuvant group (57.2%), with neoadjuvant therapy leading to better patient outcomes and more major pathological responses despite a higher incidence of severe adverse events.
Article Synopsis
- This study examines the effectiveness of a risk calculator for predicting sentinel lymph node (SLN) positivity in patients with AJCC T1-T2 melanomas at the Melanoma Institute Australia.
- The analysis compared SLN biopsy rates and positivity between two time periods: before and after implementing the nomogram, with findings showing increased SLN biopsy rates in lower-risk melanoma patients post-nomogram.
- The results suggest that the SLN risk calculator significantly impacts clinical practice, particularly for T1a and higher-risk T1b melanomas, indicating a need for updated guidelines to improve patient selection for SLN biopsies.
Background: Neoadjuvant systemic therapy (NAST) for patients with stage III melanoma achieves high major pathologic response rates and high recurrence-free survival rates. This study aimed to determine how NAST with targeted therapies (TTs) and immune checkpoint inhibitors (ICIs) influences surgical outcomes after lymph node dissection in terms of complications, morbidity, and textbook outcomes.
Methods: Patients who underwent a lymph node dissection after either NAST in a clinical trial or upfront surgery for stage III melanoma between 2014 and 2022 were identified from an institutional research database.