Quality assurance and cost effectiveness of clinical pathways for melanoma and sarcoma care.

Clinical pathways, based on minimum standard of care, are essential to standardize the clinical approach to tumors and make a health care system sustainable.

In melanoma treatment the use of Quality Assurance (QA) measures is less established than for other tumors, and sustainability is now threaten by the rapid progress of systemic treatments burdened by high cost. In Europe, an international project to promote QA of care was  proposed (COST action). In Italy,  minimum standards and QA parameters for  surgical treatment have been established, and auditing is ongoing. In Veneto, cost-effectiveness evaluation of the clinical pathway is going to be undertaken, in order to improve sustainability.

Evaluation of diagnostic performance in soft tissue sarcomas (STS) shows an overall full concordance among pathologists around 50%. Moreover, adherence to clinical practice guidelines has a positive impact on patients’ survival. These findings were functional to set-up the  implementation of a clinical pathway for STS in Veneto. In perspective, a QA program, based on a pre-defined list of indicators, will be undertaken.

Locoregional treatments for locally advanced tumors.
Our group is actively involved in clinical and translational studies on locoregional therapies such as isolated limb perfusion (ILP, for the treatment of locally advanced melanoma and limb threatening soft tissue sarcomas), hyperthemic intraperitoneal intraoperative chemotherapy (HIPEC, which is used in combination with optinal cytoreductive surgery for the treatment of peritoneal tumors such as peritoneal mesothelioma, pseudomyxoma peritonei, and peritoneal carcinomatosis from colorectal and ovarian cancers), and electrochemotherapy (ECT, for the treatment of  patients with skin tumors [primary or metastatic], with particular reference to malignant melanoma, basal cell carcinoma, squamous cell carcinoma, breast cancer, and soft tissue sarcoma).

Predictive and prognostic biomarkers in oncology.
Somatic (primary or metastatic tumor) as well as germline (e.g. single nucleotide polymorphisms, SNP) molecular markers can be used to define the probability to develop cancer, to respond to treatment, to carry minimal residual disease and to survive after apparently radical surgery. We apply these key principles to patients with cutaneous melanoma, soft tissue sarcomas as well as peritoneal tumors (including peritoneal mesothelioma, pseudomyxoma peritonei, and peritoneal carcinomatosis from colorectal and ovarian carcinomas). The main laboratory methods are quantitative real time PCR and immunohistochemistry. The final aim is to create multivariable models predicting the risk of interest on an individual basis (which can be often implemented in the clinical setting in the form of nomograms) according to the principles of personalized oncology (currently also known as precision oncology).  

5 Publications

1) Clinical performance indicators for monitoring the management of cutaneous melanoma: a population-based perspective.
Buja A, Rugge M, De Luca G, Zorzi M, Cozzolino C, Vecchiato A, Del Fiore P, Tropea S, Bortolami A, Benini P, Rossi CR, Mocellin S. Melanoma Res. 2022 Oct 1;32(5):353-359. doi: 10.1097/CMR.0000000000000841. Epub 2022 Jul 19. PMID: 35855661

2) Direct Costs of Care for Adults with Soft Tissue Sarcomas: A Population-Based Study.
Rugge M, Buja A, Tropea S, Girardi G, Franzese LC, Cozzolino C, Zorzi M, Vecchiato A, Del Fiore P, Brunello A, Brazzale AR, Baldo V, Dei Tos AP, Rossi CR, Mocellin S. Cancers (Basel). 2022 Jun 24;14(13):3109. doi: 10.3390/cancers14133109. PMID: 35804880

3) The role of sentinel node tumor burden in modeling the prognosis of melanoma patients with positive sentinel node biopsy: an Italian melanoma intergroup study (N = 2,086).
Tropea S, Del Fiore P, Maurichi A, Patuzzo R, Santinami M, Ribero S, Quaglino P, Caliendo V, Borgognoni L, Sestini S, Giudice G, Nacchiero E, Caracò C, Cordova A, Solari N, Piazzalunga D, Tauceri F, Carcoforo P, Lombardo M, Cavallari S, Mocellin S; Italian Melanoma Intergroup (IMI). BMC Cancer. 2022 Jun 3;22(1):610. doi: 10.1186/s12885-022-09705-y. PMID: 35659273

4) Macrophage-Mediated Melanoma Reduction after HP-NAP Treatment in a Zebrafish Xenograft Model.
Codolo G, Facchinello N, Papa N, Bertocco A, Coletta S, Benna C, Dall'Olmo L, Mocellin S, Tiso N, de Bernard M. Int J Mol Sci. 2022 Jan 31;23(3):1644. doi: 10.3390/ijms23031644. PMID: 35163566

5) RIPK3 and AXL Expression Study in Primary Cutaneous Melanoma Unmasks AXL as Predictor of Sentinel Node Metastasis: A Pilot Study.
Nicolè L, Cappello F, Cappellesso R, Piccin L, Ventura L, Guzzardo V, Del Fiore P, Chiarion-Sileni V, Dei Tos AP, Mocellin S, Fassina A. Front Oncol. 2021 Oct 21;11:728319. doi: 10.3389/fonc.2021.728319. eCollection 2021. PMID: 34745951

Funding  (last five years)

People involved:
Simone Mocellin (full professor of surgery)
Marco Rastrelli (assistant professor)
Luigi Dall'olmo (assistant professor)

Group members:
Antonella Vecchiato (surgeon, IOV-IRCCS of Padova), Saveria Tropea (surgeon, IOV-IRCCS of Padova), Francesco Russano (surgeon, IOV-IRCCS of Padova), Marco Mazza (surgeon, IOV-IRCCS of Padova), Alessandra Buja (epidemiologist, University of Padova), Clara Benna (biologist, University of Padova), Romina Spina (case manager, IOV-IRCCS of Padova), Paolo del Fiore (data manager, IOV-IRCCS of Padova)