Vitamin D deficiency in metastatic melanoma

reference

d. Timerman, M. Mcenery-Stonelake, C. Joyce et al. A vitamin D deficiency is associated with a poorer forecast in metastatic melanoma. oncotarget . 2017; 8 (4): 6873-6882.

Study goal

to determine whether vitamin D deficiency and saturation are associated with the melanoma result. Patients with 25-hydroxyvitamin D3 (25 [OH] D3) <21 ng/ml was recommended to take 50,000 IE vitamin D3 per week for 8 weeks and then continue with 4,000 IE per week.

draft

retrospective monocentric study of medical records from January 2007 to June 2013.

participant

records of 252 people with a 25 (OH) D3 mirror, which was recorded within 1 year after the histopathological diagnosis of a melanoma, were included in the study. Individual and melanous features such as age, gender, Breslow-thickness, ulceration, stage, mitoserates and lactate hydrogenase (LDH) mirror were taken from medical records. The subgroup analysis comprised 168 patients with a subsequent 25 (OH) D3 mirror who was recorded at any time (ie patients with more than 1 vitamin D level in their records).

study parameters evaluated

The vitamin D deficiency status was based on the current practice guidelines of the Endocrine Society. For comparison, the analysis included the effects of changes in the 25 (OH) D3 levels on survival.

primary result measurements

Vitamin D mirror, marker of melanoma growth (LDH level, mitosis growth, ulceration, stage) and survival/death.

important knowledge

patients who died had a greater probability of a vitamin D deficiency (<21 ng/ml; p = 0.012), LDH> 240 u/l ( p 50 years; p = 0.007), higher level ( p <0.001), ulceration ( p = 0.001) and higher mitoserates ( p = 0.001) compared to those who were alive at the end of the study or were lost for follow -up. Patients with vitamin D deficiency (<21 ng/ml) were more likely to have a higher level of disease ( p = 0.01) and a higher mortality ( p = 0.012). Patients with metastatic melanoma who had a defect and vitamin D income but did not increase serum levels by ≥ 20 ng/dl had a poorer prognosis (Hazard Ratio [HR]: 4.68; 95% confidence interval [CI]: 1.05-2088) than those that were over-saturated and one Vitamin D increase of> 20 ng/ml. Overall, these results indicate that an initial vitamin D deficiency and insufficient filling are associated with a poorer prognosis in patients with metastatic melanoma.

practice implications

melanoma diagnoses in the United States rose by 3.1 % per year from 1992 to 2004. ^{1 The lifetime risk for melanomas in the United States is 1 to 39 for Caucasian men and 1 to 58 for Caucasian women. Treatment promoted.}

The relationship between vitamin D and cancer, including melanoma. 3-5 , confirms earlier studies in which it was found that lower serum-25 (OH) D levels were found with an increased risk of melanoma, a larger Breslow-thickness and a worse overall survival. 25 (OH) D mirror during aftercare was an independent prognostic marker. ⁷ The connection between vitamin D and the risk of melanoma is falsified by other studies that show no connection between vitamin D levels and mortality, and through studies that show increased melanomial incidence in patients with high vitamin D levels. In this context, however, it is important to take into account that the risk of melanoma is more related to repeated overexposition to ultraviolet B-radiation (UVB) (bubble formation in sunburns) than with cumulative lifelong exposure.

Overall, these results indicate that an initial vitamin D deficiency and inadequate repletion are associated with a poorer prognosis in patients with metastatic melanoma.

In view of the fact that patients with melanoma are advised to avoid sunlight and taking additional vitamin D, this study provides an evidence base for such a recommendation. One of these experts (Traub) has published a study that shows that a repletion strategy of 10,000 IE vitamin D3 is safe and effective for 3 months

The authors of the study discussed here suggest that Serum-25 (OH) D, since it is associated with a robust immune response, could be seen as a marker for immunosufficiency in patients with metastatic melanoma. It is also known that UV radiation, especially the UVB area, has immunosuppressive effects on the skin. DNA damage caused by UVB are not only a carcinogen, but also a main trigger of UV-induced immunosuppression.

We could not check the sources and the dosage of vitamin D preparations taken by the participants in the study. We also recognize that large prospective clinical studies with patients with melanoma who receive a vitamin D supplement are necessary to prove a causal connection.

The most important finding is that we should receive 25 (OH) D3 mirrors for all patients with melanoma and for those who have a deficiency supplement with vitamin D3 to saturation. We should maintain the saturation of 2,000 to 4,000 IE every day. Use the same strategy in patients with melanoma in the history to prevent a recurrence.