A Prospective Evaluation of the Role of Vascular Endothelial Growth Factor (VEGF) and the Immune System in Stage III/IV Melanoma.

Nicole M. Agostino DO, Lehigh Valley Health Network
Christine Saraceni, Lehigh Valley Health Network
Hope Kincaid MPH, CPH, Lehigh Valley Health Network
Wenjing Shi, Lehigh Valley Health Network
Wendy Kay Nevala
Svetomir Markovic
Suresh G. Nair MD, Lehigh Valley Health Network


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.

PATIENTS AND 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.