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Background  Primary vaginal melanomas are uncommon and aggressive tumors with poor prognosis, and the development of new targeted therapies is essential. This study aimed to identify the molecular markers occurring in these patients and potentially improve treatment strategies.    Materials and Methods  The clinicopathological characteristics of 36 patients with primary vaginal melanomas were reviewed. Oncogenic mutations in  BRAF ,  KIT ,  NRAS ,  GNAQ  and  GNA11  and the promoter region of telomerase reverse transcriptase ( TERT ) were investigated using the Sanger sequencing. The expression and copy number of programmed death‐ligand 1 ( PD‐L1 ) were also assessed.    Results  Mutations in  NRAS ,  KIT , and  TERT  promoter were identified in 13.9% (5/36), 2.9% (1/34), and 5.6% (2/36) of the primary vaginal melanomas, respectively.  PD‐L1  expression and amplification were observed in 27.8% (10/36) and 5.6% (2/36) of cases, respectively.  PD‐L1  positive expression and/or amplification was associated with older patients ( p  = .008). Patients who had  NRAS  mutations had a poorer overall survival compared with those with a wild‐type  NRAS  (33.5 vs. 14.0 months; hazard ratio [HR], 3.09; 95% CI, 1.08–8.83). Strikingly, two patients with/without  PD‐L1  expression receiving immune checkpoint inhibitors had a satisfying outcome. Multivariate analysis demonstrated that &gt;10 mitoses per mm 2  (HR, 2.96; 95% CI, 1.03–8.51) was an independent prognostic factor.    Conclusions   NRAS  mutations and  PD‐L1  expression were most prevalent in our cohort of primary vaginal melanomas and can be potentially considered as therapeutic targets.    Implications for Practice  This study used the Sanger sequencing, immunohistochemistry, and fluorescence in situ hybridization methods to detect common genetic mutations and  PD‐L1  expression and copy number in 36 primary vaginal melanomas.  NRAS  mutations and  PD‐L1  expression were the most prevalent, but  KIT  and  TERT  mutations occurred at a lower occurrence in this rare malignancy. Two patients receiving immune checkpoint inhibitors had a satisfying outcome, signifying that the  PD‐L1  expression and amplification can be a possible predictive marker of clinical response. This study highlights the possible prospects of biomarkers that can be used for patient selection in clinical trials involving treatments with novel targeted therapies based on these molecular aberrations.

Prevalence of NRAS Mutation, PD‐L1 Expression and Amplification, and Overall Survival Analysis in 36 Primary Vaginal Melanomas