151
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Shen X, Zhang L, Li J, Li Y, Wang Y, Xu ZX. Recent Findings in the Regulation of Programmed Death Ligand 1 Expression. Front Immunol 2019; 10:1337. [PMID: 31258527 PMCID: PMC6587331 DOI: 10.3389/fimmu.2019.01337] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/28/2019] [Indexed: 12/11/2022] Open
Abstract
With the recent approvals for the application of monoclonal antibodies that target the well-characterized immune checkpoints, immune therapy shows great potential against both solid and hematologic tumors. The use of these therapeutic monoclonal antibodies elicits inspiring clinical results with durable objective responses and improvements in overall survival. Agents targeting programmed cell death protein 1 (PD-1; also known as PDCD1) and its ligand (PD-L1) achieve a great success in immune checkpoints therapy. However, the majority of patients fail to respond to PD-1/PD-L1 axis inhibitors. Expression of PD-L1 on the membrane of tumor and immune cells has been shown to be associated with enhanced objective response rates to PD-1/PD-L1 inhibition. Thus, an improved understanding of how PD-L1 expression is regulated will enable us to better define its role as a predictive marker. In this review, we summarize recent findings in the regulation of PD-L1 expression.
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Affiliation(s)
- Xiangfeng Shen
- Key Laboratory of Pathobiology, Ministry of Education, Norman Bethune College of Medicine, Jilin University, Changchun, China
| | - Lihong Zhang
- Key Laboratory of Pathobiology, Ministry of Education, Norman Bethune College of Medicine, Jilin University, Changchun, China
| | - Jicheng Li
- Department of Physiology, College of Basic Medical Sciences, Jilin University, Changchun, China
| | - Yulin Li
- Key Laboratory of Pathobiology, Ministry of Education, Norman Bethune College of Medicine, Jilin University, Changchun, China
| | - Yishu Wang
- Key Laboratory of Pathobiology, Ministry of Education, Norman Bethune College of Medicine, Jilin University, Changchun, China
| | - Zhi-Xiang Xu
- Key Laboratory of Pathobiology, Ministry of Education, Norman Bethune College of Medicine, Jilin University, Changchun, China
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152
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Ghate K, Amir E, Kuksis M, Hernandez-Barajas D, Rodriguez-Romo L, Booth CM, Vera-Badillo FE. PD-L1 expression and clinical outcomes in patients with advanced urothelial carcinoma treated with checkpoint inhibitors: A meta-analysis. Cancer Treat Rev 2019; 76:51-56. [DOI: 10.1016/j.ctrv.2019.05.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 11/29/2022]
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153
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Inokuchi J, Eto M. Profile of pembrolizumab in the treatment of patients with unresectable or metastatic urothelial carcinoma. Cancer Manag Res 2019; 11:4519-4528. [PMID: 31191013 PMCID: PMC6526676 DOI: 10.2147/cmar.s167708] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/20/2019] [Indexed: 12/12/2022] Open
Abstract
The prognosis of patients with unresectable or metastatic urothelial carcinoma (UC) is poor. Platinum-based chemotherapy has been the standard first-line treatment in these patients for the past decade; however, the 5-year overall survival (OS) rate is only 13–22%. Recent advances in cancer immunology research have highlighted the pivotal role of the immune system in cancer development and progression, and new immune checkpoint inhibitors (ICIs) have demonstrated efficacy in a large variety of tumors including UC. Currently, five ICIs, including two anti-PD-1 antibodies (pembrolizumab and nivolumab) and three anti-PD-L1 antibodies (atezolizumab, avelumab, and durvalumab), have been granted approval by the US Food and Drug Administration (FDA) for patients with unresectable or metastatic UC who recurred or progressed after platinum-based chemotherapy. Among these agents, only pembrolizumab is supported by strong evidence from a large randomized Phase III trial (KEYNOTE-045). This trial demonstrated statistically significant improvements in OS for patients assigned to the pembrolizumab arm compared with the chemotherapy arm, both in the total population (HR 0.73; P=0.002) and in the population with high PD-L1 expression (HR 0.57; P=0.005). For patients with cisplatin-ineligible UC, pembrolizumab and atezolizumab were approved based on Phase II studies, with limitations on the use of these agents in patients with high tumor PD-L1 expression later imposed by the FDA. In conclusion, pembrolizumab may be a potential first-choice second-line therapy for unresectable or metastatic UC patients following platinum-based chemotherapy. Several Phase III trials are ongoing to evaluate the efficacy and toxicity of combination therapies of ICIs with chemotherapy, and ICIs with other ICIs with or without chemotherapy as first-line therapy. The results of these trials might redirect treatment strategies for patients with unresectable or metastatic UC.
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Affiliation(s)
- Junichi Inokuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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154
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Ding X, Chen Q, Yang Z, Li J, Zhan H, Lu N, Chen M, Yang Y, Wang J, Yang D. Clinicopathological and prognostic value of PD-L1 in urothelial carcinoma: a meta-analysis. Cancer Manag Res 2019; 11:4171-4184. [PMID: 31190987 PMCID: PMC6512637 DOI: 10.2147/cmar.s176937] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 03/07/2019] [Indexed: 12/31/2022] Open
Abstract
Objective: Our objective was to conduct a meta-analysis to investigate the clinicopathological features and prognostic value of programmed cell death ligand 1 (PD-L1) expression in patients with urothelial carcinoma (UC). Materials and methods: Twenty-seven studies with 4,032 patients were included in the meta-analysis. Pooled ORs and 95% CIs were used to examine the associations between clinical factors and PD-L1 expression. HRs and 95% CIs were extracted from eligible studies. Heterogeneity was evaluated using the chi-squared-based Q test and I2 statistic. Results: Expression of PD-L1 on tumor cells (TCs) was associated with muscle-invasive disease (OR=3.67, 95% CI: 2.53–5.33), and inversely associated with the history of intravesical bacilli Calmette-Guerin therapy (OR=0.39, 95% CI: 0.18–0.82) in bladder cancer patients. PD-L1 expression on TCs was associated with worse overall survival (HR=2.06, 95% CI: 1.38–3.06) in patients with organ-confined bladder cancer. PD-L1 expression in patients with UC was significantly related to better objective response rate after PD-1/PD-L1 antibody treatment. Conclusions: Expression of PD-L1 on TCs was associated with muscle-invasive disease in patients with bladder cancer. Patients with PD-L1-positive UC had a significantly better response to PD-1/PD-L1 targeted treatment.
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Affiliation(s)
- Xiangli Ding
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People's Republic of China
| | - Qiaochao Chen
- Department of Geriatrics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Zhao Yang
- Department of Biomedical Engineering, College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China
| | - Jun Li
- Department of Nephrology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People's Republic of China
| | - Hui Zhan
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People's Republic of China
| | - Nihong Lu
- Department of Respiration, The Third People's Hospital of Kunming, Kunming, Yunnan, People's Republic of China
| | - Min Chen
- Department of Cardiology, The First People's Hospital of Kunming, Kunming, Yunnan, People's Republic of China
| | - Yanlong Yang
- Department of Thoracic Surgery I, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Yunnan Cancer Center), Kunming, Yunnan, People's Republic of China
| | - Jiansong Wang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People's Republic of China
| | - Delin Yang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People's Republic of China
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Abstract
PURPOSE OF REVIEW Recent Food and Drug Administration (FDA) approval of five new immune checkpoint inhibitors for the treatment of metastatic urothelial cancer represents the first major treatment breakthrough for this disease since the introduction of combination chemotherapy over 30 years ago. This review examines the recent clinical trials leading to FDA approval of these agents, the current challenges facing immunotherapy and areas that require further research. RECENT FINDINGS The programmed death 1 receptor (PD-1) and its ligand programmed death ligand-1 (PD-L1) are important negative regulators of immune activity, preventing destruction of normal tissues and autoimmunity. Aggressive bladder cancer cells express aberrantly high levels of PD-L1, hijacking the normal immune-regulatory pathway to evade detection and destruction by the immune system. Blockade of the PD-1/PD-L1 axis with immune checkpoint inhibitors augments the immune system's ability to eradicate bladder cancer with impressive safety and tolerability profiles. SUMMARY Recent clinical trials demonstrate that patients with metastatic urothelial carcinoma are responsive to immune checkpoint inhibitor therapy. Optimal treatment regimens are still under development, but activity has been demonstrated in both the first and second-line setting for metastatic disease.
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156
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Eich ML, Chaux A, Guner G, Taheri D, Mendoza Rodriguez MA, Rodriguez Peña MDC, Baras AS, Hahn NM, Drake C, Sharma R, Bivalacqua TJ, Rezaei K, Netto GJ. Tumor immune microenvironment in non-muscle-invasive urothelial carcinoma of the bladder. Hum Pathol 2019; 89:24-32. [PMID: 31026471 DOI: 10.1016/j.humpath.2019.04.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/09/2019] [Accepted: 04/14/2019] [Indexed: 02/04/2023]
Abstract
Immunotherapy has gained significance in a variety of tumor types including advanced urothelial carcinoma. Noninvasive urothelial lesions have been treated with intravesical Bacillus-Calmette-Guerin (BCG) for decades. Given treatment failure in a subset of these tumors, ongoing clinical trials investigating the role of checkpoint inhibitors are actively pursued in this group of patients. The present study aims to delineate PD-L1, CD8, and FOXP3 expression in tumor microenvironment in non-muscle-invasive urothelial carcinoma samples obtained via sequential biopsies and to assess its potential role in predicting disease outcome. Cases with >1% and> 5% PD-L1 expression in tumor cells showed lower relative risk (RR) to recur at any subsequent biopsy compared with those with lower PD-L1 expression (RRs, 0.83 [P = .009] and 0.81 [P = .03], respectively). Cases with higher expression of FOXP3 in peritumoral lymphocytes were at lower risk for tumor grade progression at any biopsy (RR, 0.2; P = .02). Tumors with FOXP3/CD8 expression ratio of >1 in intratumoral lymphocytes had lower risk of grade progression (RR, 0.28; P = .04). Although higher number of FOXP3-, CD8-, and PD-L1-positive lymphocytes were encountered after BCG treatment, the findings did not reach statistical significance. In patients without BCG treatment, PD-L1 expression in tumor cells and peritumoral lymphocytes varied across serial biopsies, suggesting the need for additional approaches to assess eligibility for immunotherapy in non-muscle-invasive urothelial carcinoma patients.
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Affiliation(s)
- Marie-Lisa Eich
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Alcides Chaux
- Department of Scientific Research, School of Postgraduate Studies, Norte University, 1614 Asunción, Paraguay
| | - Gunes Guner
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Diana Taheri
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21231, USA
| | | | | | - Alexander S Baras
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Noah M Hahn
- Department of Urology, Johns Hopkins University, Baltimore, MD 21231, USA; Department of Oncology, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Charles Drake
- Department of Urology, Johns Hopkins University, Baltimore, MD 21231, USA; Department of Oncology, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Rajni Sharma
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Trinity J Bivalacqua
- Department of Urology, Johns Hopkins University, Baltimore, MD 21231, USA; Department of Oncology, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Katayoon Rezaei
- Department of Pathology, George Washington University, Washington, DC 20037, USA
| | - George J Netto
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL 35249, USA.
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157
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Lenfant L, Rouprêt M. [Immunotherapy and bladder cancer]. Biol Aujourdhui 2019; 212:81-84. [PMID: 30973136 DOI: 10.1051/jbio/2018028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Indexed: 11/14/2022]
Abstract
Immunotherapy as a treatment of solid malignancy is based on the activation of the immune system against tumor cells. Since 1976, intravesical instillation of Bacillus Calmette-Guérin (BCG) has been used widely for the treatment of non muscle invasive bladder cancer and is nowadays recommended by all scientific guidelines. New targeted systemic immunotherapies and particularly checkpoints inhibitors are now widely used in several different cancers and notably in onco-urology. Immune checkpoint molecule inhibitors have opened the possibility of treatments for cancers and there are already phase 2 and 3 trials running with or without BCG in localized, muscle invasive and metastatic bladder cancer.
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Affiliation(s)
- Louis Lenfant
- Service d'Urologie, Sorbonne Université, GRC n° 5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, 83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Morgan Rouprêt
- Service d'Urologie, Sorbonne Université, GRC n° 5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, 83 Boulevard de l'Hôpital, 75013 Paris, France
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158
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Crist M, Iyer G, Hsu M, Huang WC, Balar AV. Pembrolizumab in the treatment of locally advanced or metastatic urothelial carcinoma: clinical trial evidence and experience. Ther Adv Urol 2019; 11:1756287219839285. [PMID: 31057668 PMCID: PMC6452591 DOI: 10.1177/1756287219839285] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/15/2019] [Indexed: 11/16/2022] Open
Abstract
The treatment of advanced urothelial carcinoma (UC) has dramatically changed with the advent of immune checkpoint inhibitors that disrupt the T-cell inhibitory interaction between the programmed cell death (PD)-1 receptor and its ligand (PD-L1). Pembrolizumab, a highly specific, monoclonal antibody directed against PD-1, has demonstrated clinical efficacy as well as a favorable toxicity profile, and has emerged as a new standard of care in the treatment of advanced UC. This review will summarize clinical efficacy from recent trials that led to the approval of pembrolizumab in treating platinum-refractory advanced UC as well as treating patients who are ineligible for first-line cisplatin-containing chemotherapy. While immune checkpoint inhibition has reinvigorated the treatment landscape of advanced UC and generated a great deal of optimism, only a minority of patients benefit. Combination strategies with the goal of increasing response rates are desperately needed as are biomarkers predictive of response.
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Affiliation(s)
| | - Gopa Iyer
- Memorial Sloan Kettering Cancer Center, New York, USA
| | | | | | - Arjun V Balar
- Associate Professor of Medicine, Director, Genitourinary Medical Oncology Program, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, 160 East 34th Street, 10th Floor, New York, NY 10016, USA
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159
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Mercier F, Consalvo N, Frey N, Phipps A, Ribba B. From waterfall plots to spaghetti plots in early oncology clinical development. Pharm Stat 2019; 18:526-532. [PMID: 30942559 DOI: 10.1002/pst.1944] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/06/2019] [Accepted: 02/27/2019] [Indexed: 12/24/2022]
Abstract
Waterfall plots are used to describe changes in tumor size observed in clinical studies. They are frequently used to illustrate the overall drug response in oncology clinical trials because of its simple representation of results. Unfortunately, this visual display suffers a number of limitations including (1) potential misguidance by masking the time dynamics of tumor size, (2) ambiguous labelling of the y-axis, and (3) low data-to-ink ratio. We offer some alternatives to address these shortcomings and recommend moving away from waterfall plots to the benefit of plots showing the individual time profiles of sum of lesion diameters (according to RECIST). The spider plot presents the individual changes in tumor measurements over time relative to baseline tumor burden. Baseline tumor size is a well-known confounding factor of drug effect which has to be accounted for when analyzing data in early clinical trials. While spider plots are conveniently correct for baseline tumor size, they cannot be presented in isolation. Indeed, percentage change from baseline has suboptimal statistical properties (including skewed distribution) and can be overly optimistic in favor of drug efficacy. We argued that plots of raw data (referred to as spaghetti plots) should always accompany spider plots to provide an equipoised illustration of the drug effect on lesion diameters.
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Affiliation(s)
- Francois Mercier
- Clinical Pharmacology, Roche Innovation Centre, Basel, Switzerland
| | | | - Nicolas Frey
- Clinical Pharmacology, Roche Innovation Centre, Basel, Switzerland
| | - Alex Phipps
- Clinical Pharmacology, Roche Innovation Centre, Welwyn, UK
| | - Benjamin Ribba
- Clinical Pharmacology, Roche Innovation Centre, Basel, Switzerland
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160
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Abstract
OPINION STATEMENT Upper tract urothelial carcinoma (UTUC) is a rare genitourinary entity of the renal pelvis and the ureter characterized by a more aggressive disease phenotype when compared with urothelial carcinoma of the bladder (UCB) with more than half of UTUC cases presenting with invasive disease at diagnosis compared to 20% for bladder tumors. There is growing evidence suggesting that its distinct natural history from that of bladder cancer can be related to several genetic and epigenetic differences. Treatment of low-risk disease consists of kidney-sparing surgeries such as ureteroscopic and percutaneous treatments, segmental ureterectomy, and adjuvant topical and intracavitary chemo-immunotherapies. The standard of care for high-risk non-metastatic disease remains radical nephroureterectomy and bladder cuff excision with increasing utilization rates of minimally invasive approaches leading to reduced morbidity without compromising outcomes while the role of lymphadenectomy is still being investigated. The prognosis of UTUC has been stagnant over the past decade highlighting the need for further studies on the role of multimodal therapy (neoadjuvant/adjuvant chemotherapy, immunotherapy, targeted therapy) to optimize management and improve outcomes.
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161
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Pattanaik S, Dey S, Jaiswal N, Rohilla R, Singh SK, Mandal AK, Mavuduru RS. Efficacy and safety of programmed cell death-1/programmed cell death ligand-1 inhibitors in advanced urothelial malignancy: A systematic review and meta-analysis. Indian J Urol 2019; 35:101-115. [PMID: 31000914 PMCID: PMC6458809 DOI: 10.4103/iju.iju_357_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/24/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Programmed cell death-1/programmed cell death ligand-1 (PD-1/PDL-1) inhibitors are the newest class of approved drugs for advanced urothelial cancer (AdUC). This review aims to collate the evidence for their efficacy and safety in various treatment settings. METHODS Extensive search of databases was performed (updated May 2018) and the protocol was registered on PROSPERO (CRD42017081568). The review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis statement. STATA (v 12) and Revman 5.3.5 were used for data analysis. RESULTS Ten nonrandomized, open-label clinical trials were included in this review. PD-1/PD-L1 inhibitors were used as second-line, stand-alone in eight trials and as first-line in cisplatin-ineligible in two trials. Heterogeneity was observed for study design, PDL-1 testing methods, cutoff criterias used and translational markers evaluated. The pooled objective response rate (ORR) was 18.2% (95% confidence interval [CI] 15.1-21.2, n = 1785) with PD-1/PDL-1 inhibitors in second-line settings as compared to 12.6% (95% CI 10.3-14.9, n = 736) with second-line chemotherapy and 23.7% (95% CI 19.9-27.4, n = 489) with PD-1/PDL-1 inhibitors as first-line therapy in cisplatin-ineligible patients. The median progression-free survival and overall survival was similar with PD-1/PD-L1 inhibitors in both second- and first-line treatment settings (1.5-2.9 vs. 2.0-2.7 months and 7.9-18.2 vs. 15.9 months) and second-line chemotherapy (3.3-4.0 months and 7.4-8 months). Odds of achieving ORR was 0.10 (95% CI 0.03-0.31, n = 229) in the second-line, stand-alone setting with a combined positive score (CPS) cutoff of 25% and was 0.34 (95% CI 0.19-0.62, n = 265) with a CPS cut-off of 10% in first-line setting in the cisplatin-ineligible. CONCLUSIONS PD-1/PDL-1 inhibitors appear to be promising in the treatment of AdUC and CPS may be a potentially reliable biomarker for predicting response but needs validation. Caution needs to be exercised until more data are available on imAEs and further studies are required to prove their worth as the standard of care.
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Affiliation(s)
- Smita Pattanaik
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sumit Dey
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nishant Jaiswal
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rachna Rohilla
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shrawan Kumar Singh
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arup Kumar Mandal
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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162
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Abstract
Genitourinary malignancies represent a diverse biologic and immunologic landscape. Recently, checkpoint blockade has transformed the treatment paradigms for bladder and kidney cancer. However, continued progress will be essential in bladder and kidney cancer, given response to inhibition of the PD-1/PD-L1 (PD-1/PD-L1) axis remains variable and only a minority of patients respond. In contrast with the clinical trial results in bladder and kidney cancer, studies of anti-PD-1/PD-L1 therapy in prostate cancer have generally been disappointing. Nevertheless, an exciting array of studies is underway that are translating lessons learned from tumor biology into promising clinical trials. Here we highlight important features of the immune tumor microenvironment of bladder, kidney, and prostate cancer and review key completed and ongoing clinical trials of anti-PD-1/PD-L1 therapy in these tumor types.
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163
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Fan Z, Liang Y, Yang X, Li B, Cui L, Luo L, Jia Y, Wang Y, Niu H. A meta-analysis of the efficacy and safety of PD-1/PD-L1 immune checkpoint inhibitors as treatments for metastatic bladder cancer. Onco Targets Ther 2019; 12:1791-1801. [PMID: 30881032 PMCID: PMC6404681 DOI: 10.2147/ott.s186271] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND This article is a meta-analysis aiming to systematically assess the efficacy and safety profiles of PD-1/PD-L1 inhibitors in patients with advanced or metastatic bladder cancer. METHODS We extracted and examined data from phase I, II, and III clinical trials from the Medline, Embase, and the Cochrane Library, which included patients with metastatic bladder cancer who were treated with PD-1/PD-L1 inhibitors. We performed a meta-analysis to investigate several indexes of efficacy and safety, including the objective response rate (ORR), 1-year overall survival (OS) rate, 1-year progression-free survival (PFS) rate, and adverse event (AE) rate of immune checkpoint inhibitors. The material data were calculated and pooled using The R Project for Statistical Computing and Review Manager 5.3. RESULTS After excluding ineligible records, 14 clinical trials were included in our analysis. The pooled frequencies of all-grade AEs and grade ≥3 AEs were 0.63 (95% CI 0.61-0.65, P=0.34) and 0.14 (95% CI 0.11-0.17, P=0.0072), respectively. The summary ORR was 0.21 (95% CI 0.18-0.24 P=0.07), and the 1-year OS and 1-year PFS rates were 0.48 (95% CI 0.42-0.54 P=0.0013) and 0.21 (95% CI 0.16-0.26 P=0.04), respectively. The OR of ORR between the PD-L1-positive and -negative groups was 3.09 (95% CI 2.01-4.75, P=0.08). CONCLUSION The PD-1/PD-L1 therapy showed appropriate efficacy and acceptable incidence of treatment-related AEs. In addition, the level of discrimination of PD-L1 expression might be related to the effect of the PD-1/PD-L1 inhibitors, and patients displaying positive expression might experience a better curative effect than patients displaying negative expression.
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Affiliation(s)
- Zhongyuan Fan
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China, ;
| | - Ye Liang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China, ;
| | - Xuecheng Yang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China, ;
| | - Bin Li
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China, ;
| | - Lili Cui
- Department of Urology, Dongying Vocational Institute, Dongying, China
| | - Lei Luo
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China, ;
| | - Yuefeng Jia
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China, ;
| | - Yonghua Wang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China, ;
| | - Haitao Niu
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China, ;
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164
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Almeida FV, Douglass SM, Fane ME, Weeraratna AT. Bad company: Microenvironmentally mediated resistance to targeted therapy in melanoma. Pigment Cell Melanoma Res 2019; 32:237-247. [PMID: 30216694 PMCID: PMC6727967 DOI: 10.1111/pcmr.12736] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/18/2018] [Accepted: 09/10/2018] [Indexed: 12/21/2022]
Abstract
This review will focus on the role of the tumor microenvironment (TME) in the development of drug resistance in melanoma. Resistance to mitogen-activated protein kinase inhibitors (MAPKi) in melanoma is observed months after treatment, a phenomenon that is often attributed to the incredible plasticity of melanoma cells but may also depend on the TME. The TME is unique in its cellular composition-it contains fibroblasts, immune cells, endothelial cells, adipocytes, and among others. In addition, the TME provides "non-homeostatic" levels of oxygen, nutrients (hypoxia and metabolic stress), and extracellular matrix proteins, creating a pro-tumorigenic niche that drives resistance to MAPKi treatment. In this review, we will focus on how changes in the tumor microenvironment regulate MAPKi resistance.
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Affiliation(s)
- Filipe V Almeida
- Immunology, Microenvironment & Metastasis Program, Melanoma Research Center. Wistar Institute, 3601 Spruce Street, Philadelphia PA 19104, USA
| | - Stephen M. Douglass
- Immunology, Microenvironment & Metastasis Program, Melanoma Research Center. Wistar Institute, 3601 Spruce Street, Philadelphia PA 19104, USA
| | - Mitchell E. Fane
- Immunology, Microenvironment & Metastasis Program, Melanoma Research Center. Wistar Institute, 3601 Spruce Street, Philadelphia PA 19104, USA
| | - Ashani T. Weeraratna
- Immunology, Microenvironment & Metastasis Program, Melanoma Research Center. Wistar Institute, 3601 Spruce Street, Philadelphia PA 19104, USA
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165
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Lattanzi M, Balar AV. Current Status and Future Direction of Immunotherapy in Urothelial Carcinoma. Curr Oncol Rep 2019; 21:24. [PMID: 30806823 DOI: 10.1007/s11912-019-0775-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Since 2016, five new programmed cell death protein 1/ligand 1 (PD-1/L1) checkpoint inhibitors have been approved for metastatic urothelial carcinoma. This review will summarize the data supporting the widespread use of these agents and highlight areas of ongoing clinical development. RECENT FINDINGS PD-1/L1 axis inhibition has demonstrated clear superiority to chemotherapy for the treatment of metastatic urothelial cancer in the second-line setting. A multitude of ongoing studies are investigating the feasibility and efficacy of incorporating established and novel immunotherapies into earlier lines of therapy, including non-metastatic muscle-invasive bladder cancer and even non-muscle-invasive disease. Early-phase clinical trials have begun to explore the safety and activity of novel immune-oncology combinations across a range of clinical settings. Immunotherapy has a clearly defined role in the treatment of metastatic urothelial cancer both in the platinum-refractory setting and in the first-line cisplatin-ineligible setting. Ongoing clinical trials will dictate how to best incorporate immunotherapy into earlier lines of therapy and define the safety and activity of novel immunotherapy agents and combinations.
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Affiliation(s)
- Michael Lattanzi
- Department of Medicine, NYU School of Medicine, New York, NY, USA
| | - Arjun V Balar
- Department of Medicine, NYU School of Medicine, New York, NY, USA. .,Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA. .,NYU School of Medicine, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, 160 East 34th Street, 10th Floor, New York, NY, 10016, USA.
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166
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Mutational and Antigenic Landscape in Tumor Progression and Cancer Immunotherapy. Trends Cell Biol 2019; 29:396-416. [PMID: 30765144 DOI: 10.1016/j.tcb.2019.01.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/04/2019] [Accepted: 01/08/2019] [Indexed: 12/18/2022]
Abstract
Evolving neoplasms accumulate non-synonymous mutations at a high rate, potentially enabling the expression of antigenic epitopes that can be recognized by the immune system. Since they are not covered by central tolerance, such tumor neoantigens (TNAs) should be under robust immune control as they surge. However, genetic defects that impair cancer cell eradication by the immune system coupled with the establishment of local immunosuppression can enable TNA accumulation, which is generally associated with improved clinical sensitivity to various immunotherapies. Here, we explore how tumor-intrinsic factors and immunological processes shape the mutational and antigenic landscape of evolving neoplasms to influence clinical responses to immunotherapy, and propose strategies to achieve robust immunological control of the disease despite disabled immunosurveillance.
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167
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Metabolic and Molecular Basis of Sarcopenia: Implications in the Management of Urothelial Carcinoma. Int J Mol Sci 2019; 20:ijms20030760. [PMID: 30754663 PMCID: PMC6387186 DOI: 10.3390/ijms20030760] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/05/2019] [Accepted: 02/09/2019] [Indexed: 12/11/2022] Open
Abstract
Sarcopenia, which represents the degenerative and systemic loss of skeletal muscle mass, is a multifactorial syndrome caused by various clinical conditions. Sarcopenia reflects not only frailty and poor general health status, but also the possible presence of advanced or progressive cancer or cancer cachexia. Therefore, sarcopenia affects the management of cancer-bearing patients, including those with urothelial carcinoma. Recently, growing evidence has shown that sarcopenia is significantly associated with higher rates of treatment-related complications and worse prognosis in patients with urothelial carcinoma, including muscle-invasive bladder cancer, upper tract urothelial carcinoma, and advanced urothelial carcinoma. Moreover, several studies reported that a post-therapeutic increase in skeletal muscle mass predicts favorable prognosis in urothelial carcinoma patients. To further explore the role of sarcopenia in the management of urothelial carcinoma patients, comprehensive understanding of its pathophysiology is vital. In this article, we reviewed the metabolic and molecular basis of cancer cachexia and sarcopenia. From this viewpoint, we discussed the possible mechanism of changes in skeletal muscle mass during the course of treatment.
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168
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Hierro C, Matos I, Martin-Liberal J, Ochoa de Olza M, Garralda E. Agnostic-Histology Approval of New Drugs in Oncology: Are We Already There? Clin Cancer Res 2019; 25:3210-3219. [DOI: 10.1158/1078-0432.ccr-18-3694] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/23/2018] [Accepted: 01/18/2019] [Indexed: 11/16/2022]
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169
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Chen S, Zhang N, Shao J, Wang T, Wang X. Multi-omics Perspective on the Tumor Microenvironment based on PD-L1 and CD8 T-Cell Infiltration in Urothelial Cancer. J Cancer 2019; 10:697-707. [PMID: 30719168 PMCID: PMC6360411 DOI: 10.7150/jca.28494] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/07/2018] [Indexed: 12/31/2022] Open
Abstract
Objectives: We carried out an integrated analysis based on multiple-dimensional types of data from cohorts of bladder cancer patients to identify multi-omics perspective (genomics and transcriptomics) on the tumor microenvironment on the bases of the programmed cell death 1 ligand (PD-L1) and CD8 T-cell infiltration in urothelial carcinoma. Methods: Multiple-dimensional types of data, including clinical, genomic and transcriptomic data of 408 bladder cancer patients were retrieved from the Cancer Genome Atlas database. Based on the median values of PD-L1 and CD8A, the tumor samples were grouped into four tumor microenvironment immune types (TMIT). The RNA sequencing profiles, somatic mutation and PD-L1 amplification data of bladder cancer were analyzed by different TMITs. Results: Our research demonstrated that 36.8% of the evaluated bladder cancer belonged to TMIT I (high PD-L1/high CD8A). TIMT subtypes were not significantly associated with overall survival or disease free survival in urothelial cancer. TMIT I facilitates CD8+ T-cell infiltration and activates T-effector and interferon gamma (IFN-γ) associated gene signature. The number of somatic mutations, cytolytic activity, IFN-γ mRNA expression and TIGIT mRNA expression in TMIT I was remarkably higher than those in other TMIT groups. Our results showed a high rate of C>T transversion and a high rate of transition/transversion (Ti/Tv) in TMIT I bladder tumors. The RB1 mutation was significantly associated with TMIT I bladder cancer and be significantly co-occurring with the TP53 mutation. However, FGFR3 mutation and TP53 mutation were mutually exclusive in TMIT II bladder tumors. More importantly, different amino acid changes by FGFR3/RB1 mutations were also found between TMIT I and TMIT II bladder cancer, such as amino acid changes in “Immunoglobulin I-set domain (260-356)”and “Protein tyrosine kinase (472-748)”. We also detected 9 genes as significantly cancer-associated genes in TMIT I bladder cancer, of which, RAD51C has been reported to play an important role in DNA damage responses. Further analysis concentrated on the potential molecular mechanism found that TMIT I was significantly associated with anti-tumor immune-related signaling pathway, and kataegis was present on chromosome 21 in TMIT I bladder tumors. Conclusions: The classification of bladder cancer into four TMITs on the bases of the PD-L1 expression and the CD8+ CTLs statuses is an appropriate approach for bladder tumor immunotherapy. TMIT I (high PD-L1/high CD8A) is significantly correlated with more somatic mutation burden, and facilitates CD8+ T-cell infiltration and activates T-effector and IFN-γ associated gene signature. Alteration landscape for somatic variants was different between TMIT I and TMIT II (low PD-L1/low CD8A).
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Affiliation(s)
- Siteng Chen
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ning Zhang
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jialiang Shao
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Wang
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiang Wang
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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170
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Guha A, Armanious M, Fradley MG. Update on cardio-oncology: Novel cancer therapeutics and associated cardiotoxicities. Trends Cardiovasc Med 2019; 29:29-39. [DOI: 10.1016/j.tcm.2018.06.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/22/2018] [Accepted: 06/03/2018] [Indexed: 02/08/2023]
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171
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Guo JC, Chen LH. Pembrolizumab-induced uveitis in a patient with metastatic urothelial carcinoma. JOURNAL OF CANCER RESEARCH AND PRACTICE 2019. [DOI: 10.4103/jcrp.jcrp_20_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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172
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Affiliation(s)
- Lorenzo Galluzzi
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, United States; Sandra and Edward Meyer Cancer Center, New York, NY, United States; Department of Dermatology, Yale University School of Medicine, New Haven, CT, United States; Université Paris Descartes/Paris V, Paris, France.
| | - Nils-Petter Rudqvist
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, United States.
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173
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Thibault C. Immunothérapie dans les carcinomes urothéliaux. Bull Cancer 2019; 105 Suppl 1:S43-S49. [PMID: 30595198 DOI: 10.1016/s0007-4551(18)30389-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
IMMUNOTHERAPIES FOR UROTHELIAL CARCINOMA Therapeutic advances in the last 3 decades in bladder cancer were very limited. The 21th century will be more promising with the advent of immunotherapies, with at the top of the list the immune-checkpoint inhibitors. The promising results of the early trials let us hope that these new therapies will soon enroll in the therapeutic landscape of urothelial carcinoma. This article reviews the clinical data of ongoing immunotherapeutic trials (checkpoint inhibitors, vaccine, cytokine) and also the association of the therapies with chemotherapy, antiangiogenics and radiotherapy.
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Affiliation(s)
- Constance Thibault
- Service d'oncologie médicale, Hôpital Européen Georges-Pompidou, Paris, France.
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174
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Jain RK, Snyders T, Nandgoapal L, Garje R, Zakharia Y, Gupta S. Immunotherapy Advances in Urothelial Carcinoma. Curr Treat Options Oncol 2018; 19:79. [DOI: 10.1007/s11864-018-0598-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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175
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Hwang C. Genitourinary Pathology Reporting Parameters Most Relevant to the Medical Oncologist. Surg Pathol Clin 2018; 11:877-891. [PMID: 30447846 DOI: 10.1016/j.path.2018.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Pathologic variables play an important role in prognostication in urologic malignancies. Histologic subtype, histologic grade, and anatomic extent of disease (pathologic tumor and nodal staging) influence treatment decisions in both the adjuvant and metastatic settings. This article discusses treatment paradigms for the most common urologic malignancies, followed by the evidence base to support the relationship between pathologic assessment and decision making by the medical oncologist.
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Affiliation(s)
- Clara Hwang
- Department of Internal Medicine, Division of Hematology and Oncology, Henry Ford Cancer Institute, Henry Ford Health System, 2799 West Grand Boulevard, CFP5, Detroit, MI 48202, USA.
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176
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Gómez De Liaño A, Duran I. The continuing role of chemotherapy in the management of advanced urothelial cancer. Ther Adv Urol 2018; 10:455-480. [PMID: 30574206 PMCID: PMC6295780 DOI: 10.1177/1756287218814100] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 10/17/2018] [Indexed: 01/12/2023] Open
Abstract
Despite intense drug development in the last decade in metastatic urothelial carcinoma and the incorporation of novel compounds to the treatment armamentarium, chemotherapy remains a key treatment strategy for this disease. Platinum-based combinations are still the backbone of first-line therapy in most cases. The role of chemotherapy in the second line has been more ill-defined due to the complexity of this setting, where patient selection remains critical. Nevertheless, two regimens, one in monotherapy (i.e. vinflunine) and one in combination with antiangiogenics (i.e. docetaxel + ramucirumab) have shown efficacy. Immunotherapy through checkpoint inhibition has revealed remarkably durable benefit in a small proportion of patients in the first and second line and is currently the preferred partner for combinations with chemotherapy. Difficult populations such as patients with liver metastases or those progressing to checkpoint inhibition represent a medical challenge and selective ways of delivering cytotoxics, like the antibody-drug conjugates, might represent a valid alternative. This article reviews the current role of chemotherapy in the management of advanced urothelial carcinoma and the ongoing and coming studies involving this treatment strategy.
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Affiliation(s)
- Alfonso Gómez De Liaño
- Medical Oncology Department, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Ignacio Duran
- Servicio de Oncologia Medica, Medical Oncology Department, Hospital Universitario Marques de Valdecilla, Edificio Sur, 2 Planta, Despacho 277, 39008 Santander, Spain
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177
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Abstract
Urothelial malignancies, including carcinomas of the bladder, ureters, and renal pelvis comprised ∼8% of new cancer cases in the USA in 2016. In the metastatic setting, 15% of patients exhibit long-term survival following cisplatin-based chemotherapy and in patients with recurrent disease, response rates to second-line chemotherapy are generally 15%-20% with a 3-month progression-free survival. However, recent advances in immunotherapy represent an opportunity to significantly improve patient outcomes. Moreover, the advent of next-generation sequencing has resulted in both an improved understanding of the fundamental genetic changes that characterize urothelial carcinoma (UC) and identification of several candidate biomarkers of response to various therapies. Incorporation of prospective genotyping into clinical trials will allow for the identification and enrichment of patients most likely to respond to specific targeted therapies and chemotherapy. Combining different therapeutic classes to enhance outcomes is also an area of active research in UC.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/pharmacology
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/antagonists & inhibitors
- Biomarkers, Tumor/genetics
- Carcinoma, Transitional Cell/drug therapy
- Carcinoma, Transitional Cell/genetics
- Carcinoma, Transitional Cell/mortality
- Carcinoma, Transitional Cell/pathology
- Clinical Trials as Topic
- Drug Resistance, Neoplasm/drug effects
- Drug Resistance, Neoplasm/genetics
- Gene Expression Profiling
- Gene Expression Regulation, Neoplastic/drug effects
- Gene Expression Regulation, Neoplastic/genetics
- Genotyping Techniques
- High-Throughput Nucleotide Sequencing
- Humans
- Molecular Targeted Therapy/methods
- Mutation Rate
- Progression-Free Survival
- Urologic Neoplasms/drug therapy
- Urologic Neoplasms/genetics
- Urologic Neoplasms/pathology
- Urothelium/pathology
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Affiliation(s)
- G Iyer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - J E Rosenberg
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA.
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178
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Zhang T, Armstrong AJ, George DJ, Huang J. The promise of immunotherapy in genitourinary malignancies. PRECISION CLINICAL MEDICINE 2018; 1:97-101. [PMID: 30687563 PMCID: PMC6333044 DOI: 10.1093/pcmedi/pby018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 11/22/2018] [Indexed: 12/24/2022] Open
Abstract
A broad understanding of the tumor immune landscape has led to a revolution of immune checkpoint inhibitors in the treatment of multiple cancer types. In genitourinary malignancies, immune checkpoint inhibitors have improved outcomes for patients with metastatic renal cell carcinoma and metastatic urothelial carcinoma; however, these treatments have not yet proven broadly beneficial for patients with metastatic prostate cancer. Numerous prospective trials are ongoing to further improve outcomes with immunotherapy combinations and for biomarker development to predict benefit from immune checkpoint inhibition. This perspective article highlights our current immunotherapy approaches in each of the genitourinary malignancies and the ongoing clinical trials that may inform our future treatments in renal, urothelial, and prostate cancers.
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Affiliation(s)
- Tian Zhang
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC
| | | | - Daniel J George
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC
| | - Jiaoti Huang
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC
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179
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Simsek M, Tekin SB, Bilici M. Immunological Agents Used in Cancer Treatment. Eurasian J Med 2018; 51:90-94. [PMID: 30911265 DOI: 10.5152/eurasianjmed.2018.18194] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/26/2018] [Indexed: 12/19/2022] Open
Abstract
Immune checkpoint inhibitors (ICI) are monoclonal antibodies targeting cytotoxic T lymphocyte antigen-4 (CTLA-4), programmed cell death protein-1 (PD-1), or PD-1 ligand (PD-L1). ICI are approved for the treatment of malign melanoma, non-small cell lung cancer, classical Hodgkin lymphoma, head and neck squamous cell carcinoma, urothelial carcinoma, and renal cell carcinoma. They can lead to long-term anti-tumor responses by deactivating the brake mechanism in the immune system. Ipilimumab, tremelimumab, pembrolizumab, nivolumab, atezolizumab, durvalumab, and avelumab are examples of ICI. CTLA-4 is a brake mechanism in immune response. Ipilimumab and tremelimumab are antibodies against CTLA-4. PD-1 is another important immune checkpoint co-inhibitor receptor that is expressed by activated T cells in the peripheral tissue. As a result of blockage of the PD-1/PD-L1 pathway, local tumor-specific immune response augments, and long-term tumor control can be achieved. In recent years, ICI are approved for the treatment of various malignities. They may be responsible for specific toxicities called immune-related adverse events (irAEs). irAEs are a consequence infiltration of normal tissues by activated T lymphocytes that are responsible for autoimmunity. Corticosteroids and anti-tumor necrosis factor agents, such as infliximab and mycophenolate mofetil, are effective in the treatment of irAEs. Immune checkpoint inhibition with monoclonal antibodies against CTLA-4 and/or PD-1/PD-L1 by single agent or combination treatments became a new option in various solid tumors. However, ICI have unique adverse events, and these adverse events should be considered in any new onset clinical situation and should be managed properly. Future prospective randomized clinical trials will clarify recent questions.
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Affiliation(s)
- Melih Simsek
- Department of Medical Oncology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Salim Basol Tekin
- Department of Medical Oncology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Mehmet Bilici
- Department of Medical Oncology, Atatürk University School of Medicine, Erzurum, Turkey
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180
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Kanesvaran R, Cordoba R, Maggiore R. Immunotherapy in Older Adults With Advanced Cancers: Implications for Clinical Decision-Making and Future Research. Am Soc Clin Oncol Educ Book 2018; 38:400-414. [PMID: 30231397 DOI: 10.1200/edbk_201435] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Immunotherapy has expanded the therapeutic landscape for advanced cancers, including solid tumors and lymphomas. For many patients with cancer, these agents have been shown to have substantial efficacy and favorable toxicity compared with cytotoxic agents, particularly in the second-line setting. With the advent of anti-PD-1 and anti-PD-L1 checkpoint inhibitors, combination immunotherapy- and chemoimmunotherapy-based strategies have emerged as promising novel regimens to improve cancer-related outcomes. Older adults age 65 or older represent the growing majority of patients diagnosed with cancer. However, older adults are under-represented in clinical trials in general, as well as in the landmark studies that led to approval of these immunotherapy agents. Because of increasing age and attendant multimorbidity and impaired functional status, many of these patients seen in the community-based oncology practices would not have been considered eligible for such studies. Thus, the results of these studies are difficult to generalize to a broader patient population with these competing risks. Furthermore, robust evaluation of toxicities, effect on quality of life and functional status, and aging-related (i.e., immunosenescence) and immunotherapy-related changes affecting the immune system remain underexplored research areas for older adults. This review examines the role of immunotherapy and its unique issues, specifically in older adults with lung cancer, bladder cancer, and lymphomas.
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Affiliation(s)
- Ravindran Kanesvaran
- From the National Cancer Centre Singapore, Singapore; Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain; University of Rochester, Rochester, NY
| | - Raul Cordoba
- From the National Cancer Centre Singapore, Singapore; Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain; University of Rochester, Rochester, NY
| | - Ronald Maggiore
- From the National Cancer Centre Singapore, Singapore; Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain; University of Rochester, Rochester, NY
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181
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Santoni M, Conti A, Buti S, Bersanelli M, Foghini L, Piva F, Giulietti M, Lusuardi L, Battelli N. Risk of fatigue in cancer patients treated with anti programmed cell death-1/anti programmed cell death ligand-1 agents: a systematic review and meta-analysis. Immunotherapy 2018; 10:1303-1313. [PMID: 30474475 DOI: 10.2217/imt-2018-0067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM We aimed to assess the incidence and relative risk (RR) of fatigue in cancer patients treated with anti programmed cell death-1 (PD-1) and anti programmed cell death ligand-1 (PD-L1) agents. PATIENTS & METHODS Eligible studies were selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Incidence, RR and 95% CIs were calculated using random or fixed-effects models. RESULTS Thirty-eight studies were included in this analysis, with a total of 11,719 patients. The incidences were 23.4 and 2.1% for all- and high-grade fatigue, respectively. The highest incidence of high-grade fatigue was reported by the combination of nivolumab and ipilimumab. Overall RR of high-grade fatigue with anti-PD-1/PD-L1 compared with chemotherapy or targeted therapy was 0.48. CONCLUSION Treatment with anti-PD-1/PD-L1 agents correlates with lower incidence and RR of fatigue compared with standard therapies.
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Affiliation(s)
- Matteo Santoni
- Oncology Unit, Macerata Hospital, via Santa Lucia 2, 62100, Macerata, Italy
| | - Alessandro Conti
- Azienda Ospedaliera dell'Alto Adige, Bressanone/Brixen Hospital, Via Dante, 51, 39042, Italy
| | - Sebastiano Buti
- University Hospital of Parma, Via Gramsci 14 - 43126, Parma, Italy
| | | | - Laura Foghini
- Oncology Unit, Macerata Hospital, via Santa Lucia 2, 62100, Macerata, Italy
| | - Francesco Piva
- Department of Specialistic Clinical & Odontostomatological Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Matteo Giulietti
- Department of Specialistic Clinical & Odontostomatological Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Lukas Lusuardi
- Department of Urology & Andrology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Nicola Battelli
- Oncology Unit, Macerata Hospital, via Santa Lucia 2, 62100, Macerata, Italy
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182
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de Malet A, Antoni G, Collins M, Soularue E, Marthey L, Vaysse T, Coutzac C, Chaput N, Mateus C, Robert C, Carbonnel F. Evolution and recurrence of gastrointestinal immune-related adverse events induced by immune checkpoint inhibitors. Eur J Cancer 2018; 106:106-114. [PMID: 30476730 DOI: 10.1016/j.ejca.2018.10.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/09/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs), such as anti-CTLA-4 and anti-PD-1 antibodies, are effective against several malignancies. They are associated with gastrointestinal immune-related adverse events (GI-IrAEs), which may be severe and lead to ICI discontinuation. We assessed the risk of evolution of GI-IrAEs to chronic GI inflammation and the risk of recurrence after a second line of ICI. PATIENTS AND METHODS This was a single-centre study. Included patients had a GI-IrAE due to ICIs between September 2010 and July 2017. We assessed the persistence of symptoms, endoscopic and/or histological inflammation, and the risk of recurrent GI-IrAEs after the second line of ICIs. RESULTS Eighty patients were included. The median follow-up was 8.4 months (0.36-72.3). The median duration of GI symptoms was 1.5 months (5 days-10.3 months): 1.4 months (7 days-4.9 months) with anti-CTLA-4, 2.0 months (5 days-10.3 months) with anti-PD-1 and 1.0 month (8 days-3.4 months) with combination therapy (log-rank test: p = 0.02). Three and 6 months after the beginning of GI-IrAEs, 22% (95% confidence interval: 14%-33%) and 5.4% (2.0%-14.7%) of patients had persistent symptoms, respectively. After a median of 6 months, 20/27 patients had endoscopic and/or histological inflammation, of whom, seven were symptom free. After the first episode, 6/26 patients relapsed after receiving another course of ICIs. Among these 26, 89% (77%-100%) had no recurrence after 3 months, 71% or 95% if the second line was anti-CTLA-4 or anti-PD-1, respectively. CONCLUSION GI-IrAEs seem to be acute or subacute, not chronic. Reintroduction of ICIs is possible in patients who had GI-IrAE.
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Affiliation(s)
- Alice de Malet
- Department of Gastroenterology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 94270, Le Kremlin-Bicêtre, France
| | | | - Michael Collins
- Department of Gastroenterology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 94270, Le Kremlin-Bicêtre, France; University Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, 94276, France
| | - Emilie Soularue
- Department of Gastroenterology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 94270, Le Kremlin-Bicêtre, France; University Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, 94276, France
| | - Lysiane Marthey
- Department of Gastroenterology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 94270, Le Kremlin-Bicêtre, France
| | - Thibaut Vaysse
- Department of Gastroenterology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 94270, Le Kremlin-Bicêtre, France
| | - Clelia Coutzac
- Laboratory of Immunomonitoring in Oncology, CNRS-UMS 3655 and INSERM-US23, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, Villejuif, F-94805, France
| | - Nathalie Chaput
- Laboratory of Immunomonitoring in Oncology, CNRS-UMS 3655 and INSERM-US23, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, Villejuif, F-94805, France; University Paris-Saclay, Faculté de Pharmacie, Chatenay-Malabry, F-92296, France
| | - Christine Mateus
- Départment of Medecine, Dermatology Unit, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, Villejuif, F-94805, France
| | - Caroline Robert
- Départment of Medecine, Dermatology Unit, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, Villejuif, F-94805, France
| | - Franck Carbonnel
- Department of Gastroenterology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 94270, Le Kremlin-Bicêtre, France; University Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, 94276, France.
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Togasaki K, Sukawa Y, Kanai T, Takaishi H. Clinical efficacy of immune checkpoint inhibitors in the treatment of unresectable advanced or recurrent gastric cancer: an evidence-based review of therapies. Onco Targets Ther 2018; 11:8239-8250. [PMID: 30538493 PMCID: PMC6254591 DOI: 10.2147/ott.s152514] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Standard treatment options for patients with advanced gastric cancer (GC) offer limited efficacy and are associated with some toxicity, which necessitates the development of more effective therapies for improving the treatment outcomes for this disease. Immunotherapy involving immune checkpoint inhibitors (ICIs) which inhibit the programmed death 1 (PD-1)/programmed death ligand 1 interaction has emerged as a new treatment option. Nivolumab, a human IgG4 monoclonal antibody inhibitor of PD-1, has demonstrated promising clinical activity and induced durable responses in patients with advanced GC. Nivolumab has recently been approved for treating patients with pretreated advanced GC in Japan. In the present review, we summarized current evidence of the clinical efficacy of ICIs in a variety of solid tumors and reported our experience in patients with GC who were treated with nivolumab and the interesting features that were observed in these cases. Certain ICI-specific clinical features such as pseudo- and hyper-progression of tumor and hyper-response to subsequent chemotherapy have been reported in several cancer types. Lastly, we discussed the present scenario regarding research on biomarkers for assessing the clinical benefits of ICI therapies.
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Affiliation(s)
- Kazuhiro Togasaki
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Keio University School of Medicine, Shinjuku-ku, Tokyo 160-8582, Japan,
| | - Yasutaka Sukawa
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Keio University School of Medicine, Shinjuku-ku, Tokyo 160-8582, Japan,
| | - Takanori Kanai
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Keio University School of Medicine, Shinjuku-ku, Tokyo 160-8582, Japan,
| | - Hiromasa Takaishi
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Keio University School of Medicine, Shinjuku-ku, Tokyo 160-8582, Japan,
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Zajac M, Boothman AM, Ben Y, Gupta A, Jin X, Mistry A, Sabalos C, Nielsen A, Manriquez G, Barker C, Antal J, Wang P, Patil P, Schechter N, Rebelatto MC, Walker J. Analytical Validation and Clinical Utility of an Immunohistochemical Programmed Death Ligand-1 Diagnostic Assay and Combined Tumor and Immune Cell Scoring Algorithm for Durvalumab in Urothelial Carcinoma. Arch Pathol Lab Med 2018; 143:722-731. [DOI: 10.5858/arpa.2017-0555-oa] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Clinical responses to anti–programmed death receptor-1 and anti–programmed death ligand-1 (PD-L1) agents are generally improved in patients with high PD-L1 expression compared with those with low/negative expression across several tumor types, including urothelial carcinoma.
Objective.—
To validate a PD-L1 immunohistochemical diagnostic test in urothelial carcinoma patients treated with the anti–PD-L1 monoclonal antibody durvalumab.
Design.—
The Ventana PD-L1 (SP263) assay was validated for intended use in urothelial carcinoma formalin-fixed, paraffin-embedded samples in studies addressing sensitivity, specificity, robustness, and precision, and implemented in study CD-ON-MEDI4736-1108 (NCT01693562). Efficacy was analyzed in patients classified according to prespecified PD-L1 expression cutoffs: PD-L1 high (if >1% of the tumor area contained tumor-associated immune cells, ≥25% of tumor cells or ≥25% of immune cells stained for PD-L1; if ≤1% of the tumor area contained immune cells, ≥25% of tumor cells or 100% of immune cells stained for PD-L1) and PD-L1 low/negative (did not meet criteria for PD-L1 high).
Results.—
The assay met all predefined acceptance criteria for sensitivity, specificity, and precision. Interreader and intrareader precision overall agreement were 93.0% and 92.4%, respectively. For intraday reproducibility and interday precision, overall agreement was 99.2% and 100%, respectively. Interlaboratory overall agreement was 92.6%. In study CD-ON-MEDI4736-1108, durvalumab demonstrated clinical activity and durable responses in both PD-L1–high and PD-L1–low/negative subgroups, although objective response rates tended to be higher in the PD-L1–high subgroup than in the PD-L1–low/negative subgroup.
Conclusions.—
Determination of PD-L1 expression in urothelial carcinoma patients using the Ventana PD-L1 (SP263) assay was precise, highly reproducible, and clinically relevant.
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Affiliation(s)
- Magdalena Zajac
- From Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (Drs Zajac, Boothman, and Walker and Mr Barker); Global Medicines Development, AstraZeneca, Gaithersburg, Maryland (Dr Ben); Clinical Development (Dr Gupta and Ms Antal), Biostatistics (Dr Jin), and Translational Sciences and Pathology (Dr Rebelatto), MedImmune, Gaithersburg, Maryland; and Roche Tissue
| | - Anne-Marie Boothman
- From Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (Drs Zajac, Boothman, and Walker and Mr Barker); Global Medicines Development, AstraZeneca, Gaithersburg, Maryland (Dr Ben); Clinical Development (Dr Gupta and Ms Antal), Biostatistics (Dr Jin), and Translational Sciences and Pathology (Dr Rebelatto), MedImmune, Gaithersburg, Maryland; and Roche Tissue
| | - Yong Ben
- From Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (Drs Zajac, Boothman, and Walker and Mr Barker); Global Medicines Development, AstraZeneca, Gaithersburg, Maryland (Dr Ben); Clinical Development (Dr Gupta and Ms Antal), Biostatistics (Dr Jin), and Translational Sciences and Pathology (Dr Rebelatto), MedImmune, Gaithersburg, Maryland; and Roche Tissue
| | - Ashok Gupta
- From Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (Drs Zajac, Boothman, and Walker and Mr Barker); Global Medicines Development, AstraZeneca, Gaithersburg, Maryland (Dr Ben); Clinical Development (Dr Gupta and Ms Antal), Biostatistics (Dr Jin), and Translational Sciences and Pathology (Dr Rebelatto), MedImmune, Gaithersburg, Maryland; and Roche Tissue
| | - Xiaoping Jin
- From Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (Drs Zajac, Boothman, and Walker and Mr Barker); Global Medicines Development, AstraZeneca, Gaithersburg, Maryland (Dr Ben); Clinical Development (Dr Gupta and Ms Antal), Biostatistics (Dr Jin), and Translational Sciences and Pathology (Dr Rebelatto), MedImmune, Gaithersburg, Maryland; and Roche Tissue
| | - Amita Mistry
- From Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (Drs Zajac, Boothman, and Walker and Mr Barker); Global Medicines Development, AstraZeneca, Gaithersburg, Maryland (Dr Ben); Clinical Development (Dr Gupta and Ms Antal), Biostatistics (Dr Jin), and Translational Sciences and Pathology (Dr Rebelatto), MedImmune, Gaithersburg, Maryland; and Roche Tissue
| | - Constantine Sabalos
- From Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (Drs Zajac, Boothman, and Walker and Mr Barker); Global Medicines Development, AstraZeneca, Gaithersburg, Maryland (Dr Ben); Clinical Development (Dr Gupta and Ms Antal), Biostatistics (Dr Jin), and Translational Sciences and Pathology (Dr Rebelatto), MedImmune, Gaithersburg, Maryland; and Roche Tissue
| | - Alma Nielsen
- From Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (Drs Zajac, Boothman, and Walker and Mr Barker); Global Medicines Development, AstraZeneca, Gaithersburg, Maryland (Dr Ben); Clinical Development (Dr Gupta and Ms Antal), Biostatistics (Dr Jin), and Translational Sciences and Pathology (Dr Rebelatto), MedImmune, Gaithersburg, Maryland; and Roche Tissue
| | - Guadalupe Manriquez
- From Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (Drs Zajac, Boothman, and Walker and Mr Barker); Global Medicines Development, AstraZeneca, Gaithersburg, Maryland (Dr Ben); Clinical Development (Dr Gupta and Ms Antal), Biostatistics (Dr Jin), and Translational Sciences and Pathology (Dr Rebelatto), MedImmune, Gaithersburg, Maryland; and Roche Tissue
| | - Craig Barker
- From Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (Drs Zajac, Boothman, and Walker and Mr Barker); Global Medicines Development, AstraZeneca, Gaithersburg, Maryland (Dr Ben); Clinical Development (Dr Gupta and Ms Antal), Biostatistics (Dr Jin), and Translational Sciences and Pathology (Dr Rebelatto), MedImmune, Gaithersburg, Maryland; and Roche Tissue
| | - Joyce Antal
- From Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (Drs Zajac, Boothman, and Walker and Mr Barker); Global Medicines Development, AstraZeneca, Gaithersburg, Maryland (Dr Ben); Clinical Development (Dr Gupta and Ms Antal), Biostatistics (Dr Jin), and Translational Sciences and Pathology (Dr Rebelatto), MedImmune, Gaithersburg, Maryland; and Roche Tissue
| | - Peiyi Wang
- From Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (Drs Zajac, Boothman, and Walker and Mr Barker); Global Medicines Development, AstraZeneca, Gaithersburg, Maryland (Dr Ben); Clinical Development (Dr Gupta and Ms Antal), Biostatistics (Dr Jin), and Translational Sciences and Pathology (Dr Rebelatto), MedImmune, Gaithersburg, Maryland; and Roche Tissue
| | - Pallavi Patil
- From Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (Drs Zajac, Boothman, and Walker and Mr Barker); Global Medicines Development, AstraZeneca, Gaithersburg, Maryland (Dr Ben); Clinical Development (Dr Gupta and Ms Antal), Biostatistics (Dr Jin), and Translational Sciences and Pathology (Dr Rebelatto), MedImmune, Gaithersburg, Maryland; and Roche Tissue
| | - Nicole Schechter
- From Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (Drs Zajac, Boothman, and Walker and Mr Barker); Global Medicines Development, AstraZeneca, Gaithersburg, Maryland (Dr Ben); Clinical Development (Dr Gupta and Ms Antal), Biostatistics (Dr Jin), and Translational Sciences and Pathology (Dr Rebelatto), MedImmune, Gaithersburg, Maryland; and Roche Tissue
| | - Marlon C. Rebelatto
- From Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (Drs Zajac, Boothman, and Walker and Mr Barker); Global Medicines Development, AstraZeneca, Gaithersburg, Maryland (Dr Ben); Clinical Development (Dr Gupta and Ms Antal), Biostatistics (Dr Jin), and Translational Sciences and Pathology (Dr Rebelatto), MedImmune, Gaithersburg, Maryland; and Roche Tissue
| | - Jill Walker
- From Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (Drs Zajac, Boothman, and Walker and Mr Barker); Global Medicines Development, AstraZeneca, Gaithersburg, Maryland (Dr Ben); Clinical Development (Dr Gupta and Ms Antal), Biostatistics (Dr Jin), and Translational Sciences and Pathology (Dr Rebelatto), MedImmune, Gaithersburg, Maryland; and Roche Tissue
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Ayers M, Nebozhyn M, Cristescu R, McClanahan TK, Perini R, Rubin E, Cheng JD, Kaufman DR, Loboda A. Molecular Profiling of Cohorts of Tumor Samples to Guide Clinical Development of Pembrolizumab as Monotherapy. Clin Cancer Res 2018; 25:1564-1573. [PMID: 30442684 DOI: 10.1158/1078-0432.ccr-18-1316] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/29/2018] [Accepted: 08/16/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE Molecular profiling of large databases of human tumor gene expression profiles offers novel opportunities for informing decisions in clinical development programs. EXPERIMENTAL DESIGN Gene expression profile of programmed death ligand 1 (PD-L1) was explored in a dataset of 16,000 samples, including approximately 4,000 metastatic tumors, across >25 tumor types prevalent in the United States, looking for new indications for the programmed death 1 (PD-1) inhibitor pembrolizumab. PD-L1 expression was highly concordant with several genomic signatures indicative of immune-inflamed tumor microenvironment. Prevalence of activated immune-inflamed tumors across all tumor types was explored and used to rank tumor types for potential response to pembrolizumab monotherapy. RESULTS The analysis yielded 3 tiers of indications in which high levels of PD-L1 and immune-inflamed signatures were found in up to 40% to 60%, 20% to 40%, and 0% to 20% of tumors. Tier 1 contained novel indications known at the time of analysis to be responsive to PD-1 checkpoint blockade in the clinic (such as melanoma and non-small cell lung cancer), as well as indications not studied in the clinic previously, including microsatellite instability-high colorectal, head and neck, bladder, and triple-negative breast cancers. Complementary analysis of an Asian/Pacific cancer dataset (gastric cancer) revealed high prevalence of immune-inflamed tumors in gastric cancer. These data contributed to prioritization of these indications for clinical development of pembrolizumab as monotherapy. CONCLUSIONS Data highlight the value of molecular profiling in identifying populations with high unmet needs with potentially favorable response characteristics and accelerating development of novel therapies for these patients.See related commentary by Mansfield and Jen, p. 1443.
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Affiliation(s)
- Mark Ayers
- Merck & Co., Inc., Kenilworth, New Jersey
| | | | | | | | | | - Eric Rubin
- Merck & Co., Inc., Kenilworth, New Jersey
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Abstract
INTRODUCTION Urothelial carcinoma is one of the most common cancers in the western world and, until recently, had limited therapeutic options. The contemporary advancement of immune checkpoint inhibitors (ICI) has heralded a new era for these patients and represents a major shift in the evolving treatment landscape. AREAS COVERED This article provides a comprehensive summary of the currently available treatments for metastatic urothelial carcinoma (mUC). The authors also review ongoing, phase-III studies with novel therapeutic targets and highlight recent insights into tumor biology that may help better understand the disease. EXPERT OPINION The treatment landscape for first-line therapy of mUC continues to include platinum-based chemotherapy for patients who are eligible. While the approval of ICI has changed the management in those who are post-platinum or platinum-ineligible, the wider use of ICI in the first-line setting requires further clarity given recent FDA announcements. Maintaining the remarkable progress in mUC may depend upon ongoing phase-III studies evaluating treatment options beyond ICI. Better prognostication and identification of those unlikely to respond to ICI remain important unanswered questions, particularly as this class of agents moves further along the disease spectrum of non-metastatic UC.
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Affiliation(s)
- Aly-Khan A Lalani
- a Juravinski Cancer Center , McMaster University , Hamilton , ON , Canada
| | - Guru P Sonpavde
- b Lank Center for Genitourinary Oncology , Dana-Farber Cancer Institute , Boston , MA , USA
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187
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Rouprêt M, Neuzillet Y, Pignot G, Compérat E, Audenet F, Houédé N, Larré S, Masson-Lecomte A, Colin P, Brunelle S, Xylinas E, Roumiguié M, Méjean A. RETRACTED: Recommandations françaises du Comité de Cancérologie de l’AFU — Actualisation 2018—2020 : tumeurs de la vessie French ccAFU guidelines — Update 2018—2020: Bladder cancer. Prog Urol 2018; 28:S46-S78. [PMID: 30366708 DOI: 10.1016/j.purol.2018.07.283] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 12/24/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations. Le nouvel article est disponible à cette adresse: doi:10.1016/j.purol.2019.01.006. C’est cette nouvelle version qui doit être utilisée pour citer l’article. This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published. The replacement has been published at the doi:10.1016/j.purol.2019.01.006. That newer version of the text should be used when citing the article.
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Affiliation(s)
- M Rouprêt
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sorbonne université, GRC no5, ONCOTYPE-URO, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
| | - Y Neuzillet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Foch, université de Versailles-Saint-Quentin-en-Yvelines, 92150 Suresnes, France
| | - G Pignot
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie oncologique 2, institut Paoli-Calmettes, 13008 Marseille, France
| | - E Compérat
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'anatomie pathologique, hôpital Tenon, HUEP, Sorbonne université, GRC no5, ONCOTYPE-URO, 75020 Paris, France
| | - F Audenet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP-HP, 75015 Paris, France
| | - N Houédé
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'oncologie médicale, CHU Caremaux, Montpellier université, 30000 Nîmes, France
| | - S Larré
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Reims, Reims, 51100 France
| | - A Masson-Lecomte
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Saint-Louis, université Paris-Diderot, 75010 Paris, France
| | - P Colin
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital privé de la Louvière, 59800 Lille, France
| | - S Brunelle
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, institut Paoli-Calmettes, 13008 Marseille, France
| | - E Xylinas
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie de l'hôpital Bichat-Claude-Bernard, université Paris-Descartes, Assistance publique-Hôpitaux de Paris, 75018 Paris, France
| | - M Roumiguié
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'urologie, CHU Rangueil, Toulouse, 31000 France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP-HP, 75015 Paris, France
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188
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Shao IH, Chang YH, Pang ST. Recent advances in upper tract urothelial carcinomas: From bench to clinics. Int J Urol 2018; 26:148-159. [PMID: 30372791 DOI: 10.1111/iju.13826] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/10/2018] [Indexed: 12/16/2022]
Abstract
Urothelial carcinoma in the upper tract is rare and often discussed separately. Many established risk factors were identified for the disease, including genetic and external risk factors. Radiographic survey, endoscopic examination and urine cytology remained the most important diagnostic modalities. In localized upper tract urothelial carcinomas, radical nephroureterectomy with bladder cuff excision are the gold standard for large, high-grade and suspected invasive tumors of the renal pelvis and proximal ureter, whereas kidney-sparing surgeries should be considered in patients with low-risk disease. Advances in technology have given endoscopic surgery an important role, not only in diagnosis, but also in treatment. Although platinum-based combination chemotherapy is efficacious in advanced or metastatic disease, current established chemotherapy regimens are toxic and lack a sustained response. Immune checkpoint inhibitors have led to a new era of treatment for advanced or metastatic urothelial carcinomas. The remarkable results achieved thus far show that immunotherapy will likely be the future treatment paradigm. The combination of immune checkpoint inhibitors and other agents is another inspiring avenue to explore that could benefit even more patients. With respect to the high incidence rate and different clinical appearance of upper tract urothelial carcinomas in Taiwan, a possible correlation exists between exposure to certain external risk factors, such as arsenic in drinking water and aristolochic acid in Chinese herbal medicine. As more gene sequencing differences between upper tract urothelial carcinomas and various disease causes are detailed, this has warranted the era of individualized screening and treatment for the disease.
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Affiliation(s)
- I-Hung Shao
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Hsu Chang
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - See-Tong Pang
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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189
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Molecular predictors of response to PD-1/PD-L1 inhibition in urothelial cancer. World J Urol 2018; 37:1773-1784. [PMID: 30374610 DOI: 10.1007/s00345-018-2538-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 10/19/2018] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION The survival of patients with metastatic urothelial cancer (mUC) is poor. During the last 40 years, chemotherapy was the predominant treatment modality for mUC. The discovery of the immune checkpoint inhibitors (ICI), especially the inhibitors of the programmed cell death 1 and its ligand (PD-1/PD-L1), has revolutionized cancer immunotherapy. The PD-1 and PD-L1 inhibitors provide a new and effective treatment option for patients with UC, particularly for patients with recurrence after platinum-based therapy and those who are ineligible for cisplatin. METHODS A literature search on PubMed, ClinicalTrials.gov and selected annual congress abstracts was conducted in May 2018, using a combination of keywords, medical subject headings (MeSH) terms and free text incorporating urothelial bladder cancer; immunotherapy; immune checkpoint inhibition, biomarkers, PD1/PD-L1. RESULTS Although some patients demonstrate complete and/or durable responses under ICI, the reliable prediction of response to ICI is not possible. In the clinical setting, physicians are not able to predict response to ICI in mUC and to adequately select patients who will benefit. Exploratory analysis of clinical trial data revealed that PD-L1 expression, tumor mutation burden, tumor-infiltrating lymphocytes and gene expression profiles might have some predictive and/or prognostic value in different patient populations. CONCLUSION Validated robust biomarkers are still needed to overcome this hurdle to forecast response of ICI in UC patients.
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190
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Dhariwal R, Pindoria N, Dasgupta P, Khan MS. #Checkmate: could checkpoint inhibitors be the game changer in the fight against metastatic urothelial carcinoma? BJU Int 2018; 123:203-207. [DOI: 10.1111/bju.14463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Randeep Dhariwal
- Guy's and St. Thomas NHS Foundation Trust; Guy's Hospital; Kings College London - Urology; UK
| | - Nisha Pindoria
- Guy's and St. Thomas NHS Foundation Trust; Guy's Hospital; Kings College London - Urology; UK
| | - Prokar Dasgupta
- Guy's and St. Thomas NHS Foundation Trust; Guy's Hospital; Kings College London - Urology; UK
| | - Muhammad S. Khan
- Guy's and St. Thomas NHS Foundation Trust; Guy's Hospital; Kings College London - Urology; UK
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191
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Hyperprogressive disease: recognizing a novel pattern to improve patient management. Nat Rev Clin Oncol 2018; 15:748-762. [DOI: 10.1038/s41571-018-0111-2] [Citation(s) in RCA: 237] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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192
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Ramos JD, Yu EY. Immuno-oncology in urothelial carcinoma: who or what will ultimately sit on the iron throne? Immunotherapy 2018; 9:951-954. [PMID: 28971748 DOI: 10.2217/imt-2017-0109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Jorge D Ramos
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, Division of Oncology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 825 Eastlake Ave E - G4-800, Seattle, WA 98109-1024, USA
| | - Evan Y Yu
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, Division of Oncology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 825 Eastlake Ave E - G4-800, Seattle, WA 98109-1024, USA
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193
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Differential regulation of PD-L1 expression by immune and tumor cells in NSCLC and the response to treatment with atezolizumab (anti-PD-L1). Proc Natl Acad Sci U S A 2018; 115:E10119-E10126. [PMID: 30297397 PMCID: PMC6205493 DOI: 10.1073/pnas.1802166115] [Citation(s) in RCA: 177] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Programmed death-ligand 1 (PD-L1) expression on tumor cells and tumor-infiltrating immune cells is regulated by distinct mechanisms and has nonredundant roles in regulating anticancer immunity, and PD-L1 on both cell types is important for predicting best response to atezolizumab in non-small cell lung cancer. Programmed death-ligand 1 (PD-L1) expression on tumor cells (TCs) by immunohistochemistry is rapidly gaining importance as a diagnostic for the selection or stratification of patients with non-small cell lung cancer (NSCLC) most likely to respond to single-agent checkpoint inhibitors. However, at least two distinct patterns of PD-L1 expression have been observed with potential biological and clinical relevance in NSCLC: expression on TC or on tumor-infiltrating immune cells (ICs). We investigated the molecular and cellular characteristics associated with PD-L1 expression in these distinct cell compartments in 4,549 cases of NSCLC. PD-L1 expression on IC was more prevalent and likely reflected IFN-γ–induced adaptive regulation accompanied by increased tumor-infiltrating lymphocytes and effector T cells. High PD-L1 expression on TC, however, reflected an epigenetic dysregulation of the PD-L1 gene and was associated with a distinct histology described by poor immune infiltration, sclerotic/desmoplastic stroma, and mesenchymal molecular features. Importantly, durable clinical responses to atezolizumab (anti–PD-L1) were observed in patients with tumors expressing high PD-L1 levels on either TC alone [40% objective response rate (ORR)] or IC alone (22% ORR). Thus, PD-L1 expression on TC or IC can independently attenuate anticancer immunity and emphasizes the functional importance of IC in regulating the antitumor T cell response.
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Joseph JV, Brasacchio R, Fung C, Reeder J, Bylund K, Sahasrabudhe D, Yeh SY, Ghazi A, Fultz P, Rubens D, Wu G, Singer E, Schwarz E, Mohile S, Mohler J, Theodorescu D, Lee YF, Okunieff P, McConkey D, Rashid H, Chang C, Fradet Y, Guru K, Kukreja J, Sufrin G, Lotan Y, Bailey H, Noyes K, Schwartz S, Rideout K, Bratslavsky G, Campbell SC, Derweesh I, Abrahamsson PA, Soloway M, Gomella L, Golijanin D, Svatek R, Frye T, Lerner S, Palapattu G, Wilding G, Droller M, Trump D. A Festschrift in Honor of Edward M. Messing, MD, FACS. Bladder Cancer 2018; 4:S1-S43. [PMID: 30443561 PMCID: PMC6226303 DOI: 10.3233/blc-189037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/28/2018] [Indexed: 12/02/2022]
Affiliation(s)
- Jean V. Joseph
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Chunkit Fung
- University of Rochester Medical Center, Rochester, NY, USA
| | - Jay Reeder
- University of Rochester Medical Center, Rochester, NY, USA
| | - Kevin Bylund
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Shu Yuan Yeh
- University of Rochester Medical Center, Rochester, NY, USA
| | - Ahmed Ghazi
- University of Rochester Medical Center, Rochester, NY, USA
| | - Patrick Fultz
- University of Rochester Medical Center, Rochester, NY, USA
| | - Deborah Rubens
- University of Rochester Medical Center, Rochester, NY, USA
| | - Guan Wu
- University of Rochester Medical Center, Rochester, NY, USA
| | - Eric Singer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Edward Schwarz
- University of Rochester Medical Center, Rochester, NY, USA
| | - Supriya Mohile
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | | - Yi Fen Lee
- University of Rochester Medical Center, Rochester, NY, USA
| | - Paul Okunieff
- UF Health Proton Therapy Institute, Gainesville, FL, USA
| | - David McConkey
- Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA
| | - Hani Rashid
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Yves Fradet
- CHU de Quebec-Hotel-Dieu de Quebec, Quebec, QC, Canada
| | | | | | - Gerald Sufrin
- State University of New York at Buffalo, Buffalo, NY, USA
| | - Yair Lotan
- UT Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Howard Bailey
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | | | - Kathy Rideout
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Steven C. Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | | | - Leonard Gomella
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Robert Svatek
- UT Health Science Center San Antonio, San Antonio, TX, USA
| | - Thomas Frye
- University of Rochester Medical Center, Rochester, NY, USA
| | - Seth Lerner
- Baylor College of Medicine Medical Center, Houston, TX, USA
| | | | | | | | - Donald Trump
- Virginia Commonwealth University, Fairfax, VA, USA
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195
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Liang F, Zhang S, Wang Q, Li W. Evolution of randomized controlled trials and surrogacy of progression-free survival in advanced/metastatic urothelial cancer. Crit Rev Oncol Hematol 2018; 130:36-43. [PMID: 30196910 DOI: 10.1016/j.critrevonc.2018.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/22/2018] [Accepted: 07/30/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Clinical trials in advanced/metastatic urothelial cancer have been difficult to perform. We review the current characteristics of randomized controlled trials (RCTs) and evaluate whether PFS could be a potential surrogate endpoint for overall survival (OS) in advanced/metastatic urothelial cancer. METHODS We identified trials by a systematic review of Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception to April 2017. We included RCTs of patients with locally advanced/metastatic urothelial cancer that involved systemic therapy as an intervention, and those with reported hazards ratios (HRs) and corresponding 95% confidence intervals (CIs) for both OS and PFS, or provided Kaplan-Meier curves from which HRs and 95% CI could be calculated. The correlation coefficient between log of HRs for OS and PFS was calculated using linear regression weighted by sample size. RESULTS Forty eight trials that enrolled 7019 patients were included in the review and 24 RCTs were included in the surrogacy analysis. 27(56.3%) of identified 48 RCTs were phase II trials, and the median sample size was 107(range, 30-626) for all RCTs. The correlation coefficient between log HR for PFS and log HR for OS was 0.79 (95% CI, 0.58-0.91). The correlation coefficient increased to 0.87 (95% CI, 0.72-0.94) after excluding the only trial with immune checkpoint inhibitor. Multiple sensitivity analyses did not change the results..aph."/> CONCLUSIONS: PFS is strongly correlated with OS in trials of advanced/metastatic urothelial cancer assessing the treatment benefit of new drugs And PFS warrants further exploration as a surrogate endpoint in clinical trial datasets.
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Affiliation(s)
- Fei Liang
- Shanghai Cancer Center and Shanghai Medical College, Fudan University, Shanghai, China
| | - Sheng Zhang
- Shanghai Cancer Center and Shanghai Medical College, Fudan University, Shanghai, China.
| | - Qing Wang
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenfeng Li
- The Affiliated Hospital of Qingdao University, Qingdao, China
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196
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Pichler R, Fritz J, Lackner F, Sprung S, Brunner A, Horninger W, Loidl W, Pircher A, Heidegger I. Prognostic Value of Testing PD-L1 Expression After Radical Cystectomy in High-risk Patients. Clin Genitourin Cancer 2018; 16:e1015-e1024. [DOI: 10.1016/j.clgc.2018.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 01/08/2023]
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197
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Stenehjem DD, Tran D, Nkrumah MA, Gupta S. PD1/PDL1 inhibitors for the treatment of advanced urothelial bladder cancer. Onco Targets Ther 2018; 11:5973-5989. [PMID: 30275703 PMCID: PMC6157986 DOI: 10.2147/ott.s135157] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction Until recently, systemic chemotherapy was the only option for treating bladder cancer and outcomes remained dismal. After a long gap of no progress for 40 years, immuno-therapy with checkpoint inhibitors (PDL1 and PD1) has revolutionized the treatment paradigm of bladder cancer, with five approved agents to treat platinum-refractory bladder cancer since the first approval of atezolizumab in May 2016. Methods This review summarizes the most recent data on approved checkpoint inhibitors currently used in management of advanced bladder cancer. Early- and late-phase trials of the five checkpoint inhibitors (pembrolizumab, nivolumab, atezolizumab, durvalumab, and avelumab) in advanced bladder cancer are reviewed in detail. This review also describes the potential application of PD1/PDL1 inhibitors in adjuvant and neoadjuvant settings and non-muscle-invasive bladder cancer, as well as with radiation in muscle-invasive bladder cancer treatment. The role of PDL1 and tumor-mutation burden and clinical considerations in choosing a particular immunotherapy are also discussed. Results The approved checkpoint inhibitors (PD1 and PDL1 inhibitors) have similar efficacy and safety profiles in metastatic platinum-refractory bladder cancer, but they vary in dose and frequency and cost burden. However, only pembrolizumab has shown superiority over standard chemotherapy in a randomized Phase III setting so far. In addition, in the first-line setting for cisplatin-ineligible patients, both pembrolizumab and atezolizumab are US Food and Drug Administration-approved and well tolerated. There is a lack of consensus on the utility of testing for PDL1 as a predictive biomarker, as patients with no PDL1 expression also derive some clinical benefit. Tumor-mutation burden is another predictive biomarker, but needs further validation. Conclusion Immunotherapy has offered a glimmer of hope to patients with bladder cancer. The current landscape is rapidly evolving, with novel immunotherapy-combination trials to improve outcomes further and evaluate predictive biomarkers to help identify patients most likely to benefit from such therapies.
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Affiliation(s)
- David D Stenehjem
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota.,Masonic Cancer Center, University of Minnesota,
| | - Dao Tran
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota
| | - Michael A Nkrumah
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota
| | - Shilpa Gupta
- Masonic Cancer Center, University of Minnesota, .,Division of Hematology, Oncology and Transplantation, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA,
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Interaction of PVR/PVRL2 with TIGIT/DNAM-1 as a novel immune checkpoint axis and therapeutic target in cancer. Mamm Genome 2018; 29:694-702. [PMID: 30132062 DOI: 10.1007/s00335-018-9770-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/04/2018] [Indexed: 02/08/2023]
Abstract
Avoiding immune surveillance and inducing a tumor-promoting inflammatory milieu found entry into the new generation of the hallmarks of cancer. Cancer cells hijack immune mechanisms which physiologically protect the body from the development of autoimmune diseases and excessive tissue damage during inflammation by downregulating immune responses. This is frequently achieved by upregulation of immune checkpoints. Therefore, the blocking of immune checkpoint ligand-receptor interactions can reinstall the immune systems capability to fight cancer cells as shown for CTLA4 and PD-1 inhibitors in a clinical setting. Newly described checkpoint antigens are currently under investigation in cancer immunotherapy. Preclinical data emphasize the immune checkpoint axis TIGIT-PVR/PVRL2 as very promising target. This axis includes additional receptors such as DNAM-1, CD96, and CD112R. In this review, we discuss the recent findings of the relevance of this complex receptor ligand system in hematologic and solid cancers. Emphasis is also laid on the discussion of potential combinations with other immunotherapeutic approaches.
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199
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Yao H, Wang H, Li C, Fang JY, Xu J. Cancer Cell-Intrinsic PD-1 and Implications in Combinatorial Immunotherapy. Front Immunol 2018; 9:1774. [PMID: 30105035 PMCID: PMC6077319 DOI: 10.3389/fimmu.2018.01774] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 07/18/2018] [Indexed: 12/14/2022] Open
Abstract
Programmed death 1 (PD-1) and its two natural ligands PD-L1 and PD-L2 are responsible for delivering inhibitory signals that regulate the balance between T cell activation, tolerance, and immunopathology. In previous studies, PD-1 was found only expressed on the surface of immune cells, such as T cells and B cells while PD-1’s ligands PD-L1 and PD-L2 were found expressed in some tumor cells. However, recent studies revealed intrinsic expression of PD-1 in melanoma and some other cancers. In melanoma cells, PD-1 can be activated by its ligand PD-L1 expressed by tumor cells, modulating downstream mammalian target of rapamycin signaling and promoting tumor growth independent of adaptive immunity. In addition to melanoma, PD-1 was also detected in liver cancer cells as well as in non-small lung cancer cells. Unlike its oncogenic functions in melanoma and hepatic carcinoma cells, PD-1 seemed to play a distinct role in lung cancer, as blockade of PD-1 instead promoted tumor cells proliferation. Tumor-intrinsic PD-1 expression seems to be widespread in many tumor types, according to our reanalysis on cancer transcriptomic and proteomic data. The multifaceted roles of PD-1 in tumor cells beyond immune checkpoint signaling may explain the differential therapeutic effects of anti-PD-1 and anti-PD-L1 drugs and provide crucial information when developing combinatorial approaches to enhance antitumor immunity.
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Affiliation(s)
- Han Yao
- State Key Laboratory for Oncogenes and Related Genes, Division of Gastroenterology and Hepatology, MOH Key Laboratory of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Huanbin Wang
- State Key Laboratory for Oncogenes and Related Genes, Division of Gastroenterology and Hepatology, MOH Key Laboratory of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Chushu Li
- State Key Laboratory for Oncogenes and Related Genes, Division of Gastroenterology and Hepatology, MOH Key Laboratory of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Jing-Yuan Fang
- State Key Laboratory for Oncogenes and Related Genes, Division of Gastroenterology and Hepatology, MOH Key Laboratory of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Jie Xu
- State Key Laboratory for Oncogenes and Related Genes, Division of Gastroenterology and Hepatology, MOH Key Laboratory of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
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200
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Ghatalia P, Zibelman M, Geynisman DM, Plimack E. Approved checkpoint inhibitors in bladder cancer: which drug should be used when? Ther Adv Med Oncol 2018; 10:1758835918788310. [PMID: 30083254 PMCID: PMC6066800 DOI: 10.1177/1758835918788310] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 06/12/2018] [Indexed: 02/06/2023] Open
Abstract
The treatment of advanced metastatic urothelial carcinoma has recently evolved
with the approval of five checkpoint inhibitors. In the second-line setting, in
patients who have progressed on cisplatin-based chemotherapy, pembrolizumab,
atezolizumab, durvalumab, nivolumab and avelumab are United States Food and Drug
Administration (FDA) approved. In cisplatin-ineligible patients, atezolizumab
and pembrolizumab are the FDA-approved checkpoint inhibitors. Here we describe
the updated clinical efficacy of these checkpoint inhibitors in the treatment of
advanced urothelial carcinoma and then suggest how they can be sequenced in the
context of available chemotherapeutic options. For cisplatin-eligible patients,
platinum-based chemotherapy remains the standard first-line treatment. For
patients progressing on platinum-based therapy, phase III trials have been
performed comparing pembrolizumab and atezolizumab separately with standard
chemotherapy, and results favor the use of pembrolizumab.
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Affiliation(s)
- Pooja Ghatalia
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia PA, USA
| | - Matthew Zibelman
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia PA, USA
| | - Daniel M Geynisman
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia PA, USA
| | - Elizabeth Plimack
- Department of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA
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