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Kyaw thura zaw

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  • 1. M.V. LOMONOSOV MOSCOW STATE UNIVERSITY FACULTY OF BASIC MEDICINE   COMPARISON OF POLY- CHEMOTHERAPY (CVD regimen) & THE SAME CHEMOTHERAPY (CT) PLUS INTERFERON-α2a IN METASTATIC MELANOMA Student: Dr. Kyaw Thura Zaw Scientific Supervisor : Prof. Dr. Lev Demidov N.N. BLOKHIN CANCER RESEARCH CENTRE Moscow ,2010
  • 2. INTRODUCTION
    • Malignant melanoma is a neoplasm of melanocytes or of the cells that develop from melanocytes.
    • Melanoma is showing a rapid worldwide rise in incidence, with a yearly increase of about 5% and a frequent occurrence in young adults . Even though surgery represents the cure in the early phase of disease, the prognosis in patients with metastatic melanoma remains very poor, with a median survival of about 6–9 months .
  • 3.
    • Melanoma signaling cascades MAPK and PI3K. The MAPK pathway is hyperactivated in melanomas, mainly due to activating mutations in either the NRAS or BRAF genes .
  • 4. Epidemiology
    • Frequency : Queensland, Australia, has the highest incidence of melanoma in the world, approximately 57 cases / 100,000 people / year. Israel also has one of the highest incidences, approximately 40 cases / 100,000 people annually.
    • Incidence : Increasing rapidly worldwide, and faster rate than that of any other cancer except lung cancer in women. Melanoma is notorious for affecting young and middle-aged people.
  • 5. Race Melanoma is more common in whites than in blacks and Asians. The rate of melanoma in blacks is estimated to be 1/120 that of whites. Sex Melanoma is slightly more common in men than women (1.2:1). Melanoma is the 5th most common malignancy in men and the 6th most common malignancy in women, accounting for 5% and 4% of all new cancer case. respectively.
  • 6. Risk Factors
    • Sun Exposure and Sun beds
    • Nevi
    • Skin Pigmentation
    • Solar Elastosis and Solar Keratoses
    • Gene Alterations
    • Somatice Alterations
    • Common Low Penetratace Genes
  • 7. A=Asymmetry B=Border (irregular) C= Color D= Diameter ABCD Properties of Radial Melanomas
  • 8. A 1.5-cm melanoma with characteristic asymmetry, irregular borders, and color variation.
  • 9. Factors Predicting the Outcome of Response of Treatment
    • Good performance status
    • Soft tissue disease or only a few visceral metastases
    • Age younger than 65 years
    • No prior chemotherapy
    • Normal hepatic and renal function
    • Normal CBC count
    • Absence of CNS metastases
  • 10. AIM OF STUDY To Study and Compare the Poly-chemotherapy (CVD regimen) & the Same Chemotherapy(CT)plus Interferon α - 2 a in Metastatic Melanoma.
  • 11. Objectives of Study
    • To study the response rate of poly chemotherapy (CVD regimen) and the same chemotherapy (CT) plus interferon-α2a in metastatic melanoma.
    • To study the effect of combine Chemotherapy (CVD) in metastatic melanoma.
    • To study Bio chemotherapy not more rather than Chemotherapy alone.
  • 12. Materials and Methods
  • 13. Patient’s Characteristics CVD P CVD+IFN P Age , median (min-max) 55 (35-65) P<0.01 52(30-65) P<0.10 ECOG PS 0 2 P=1.00 2 P=1.00 1 3 P>0.10 6 P>0.25 2 10 P>0.10 7 P>0.30 Metastatic sites Skin 4 P>0.25 6 P>0.10 Lymph node 10 P>0.70 9 P>0.25 Lungs 9 P=1.00 9 P=1.00 Liver 9 P>0.10 6 P>0.10 Other 3 P>0.10 0 P>0.20 Number of Metastases 1 1 P>0.10 4 P>0.10 2 8 P>0.70 7 P>0.70 3 6 P>0.25 4 P>0.25
  • 14. Treatment Schedules
    • The treatment regimen A consisted of Dacarbazine : 800mg/m2 IV day 1, Vinblastine : 1.6 mg/m2 IV days 1-5, and Cisplatin : 20 mg/m2 IV days 1-4 (CVD) . The cycle was repeated on day 22.
    • The treatment regimen B consisted of CVD chemotherapy plus IFN alpha-2a 1.5x10 6 IU/m2 days 1-10. The total number of cycles/day was 6 at the most .
  • 15. Response of Therapy
  • 16.
    • CR: Complete Response, PR: Partial Response ,
    • SD: Stable Disease
    • PD: Progressive Disease.
    COMPARISON BETWEEN THE RESULT OF CVD AND CVD+IFN
  • 17. Overall survival. Heavy line represents CVD + IFN group; Fine line represents CVD group ; No. of death /Total No. Average survival Survival Median CVD+IFN 8/15 13.51(9.7;17.3) 12.0(9.9;14.1) CVD 7/15 10.75(9.1;12.4) 12.0(7.8;16.2)
  • 18. CONCLUSIONS
    • Response rate was the highest best in CVD+IFN group (6/15)compared to CVD (4/15) , but the difference was not significant.
    • Combined Chemotherapy(CVD) and Biochemotherapy (CVD+IFN) in which, all showed some activity in Metastatic Melanoma.
    • The best responding metastatic sites were the lymph nodes all patients experienced mild adverse effects. No treatment-related deaths occurred. The median survival was 12months in CVD+IFN, CVD respectively.
  • 19.