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Munhoz RR, Nader-Marta G, de Camargo VP, Queiroz MM, Cury-Martins J, Ricci H, de Mattos MR, de Menezes TAF, Machado GUC, Bertolli E, Barros M, de Souza CE, Franke F, Ferreira FO, Feher O, de Castro G. A phase 2 study of first-line nivolumab in patients with locally advanced or metastatic cutaneous squamous-cell carcinoma. Cancer 2022; 128:4223-4231. [PMID: 36274573 DOI: 10.1002/cncr.34463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/01/2022] [Accepted: 05/23/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cutaneous squamous-cell carcinoma (CSCC) is among the most frequent malignancies worldwide. For those not amenable to treatment with curative intent, immune checkpoint inhibition (ICI) with anti-programmed death receptor 1 (PD-1) antibodies has emerged as a novel therapeutic option. In this study, the authors sought to investigate the activity of the anti-PD-1 agent nivolumab in patients with advanced CSCC (aCSCC). METHODS CA209-9JC was an open-label, single-arm, phase 2 study to evaluate the safety and/or efficacy of nivolumab in systemic treatment-naive patients with aCSCC. Nivolumab (3 mg/kg) was administered every 2 weeks until disease progression, unacceptable toxicity, or 12 months of treatment. The primary end point was the best objective response rate (BORR) as per RECIST 1.1 criteria. Secondary end points included safety, progression-free survival (PFS), and overall survival (OS). RESULTS Twenty-four patients with aCSCC were enrolled with a median age of 74 years (range, 48-93). Among the 24 patients evaluable for response, the BORR was 58.3% (14/24); there were no complete responses. With a median follow-up of 17.6 months, median duration of response has not been reached, and the estimated median PFS and OS were 12.7 and 20.7 months, respectively. Prior exposure to radiotherapy was associated with worse outcomes (p = .035, univariate analysis). Treatment-related adverse events of any grade and grade ≥ 3 occurred in 21 (87.5%) and six (25%) patients, respectively, and one patient discontinued nivolumab due to toxicities. CONCLUSIONS Nivolumab resulted in robust antitumor activity, sustained responses, and good tolerability in systemic treatment-naive patients with aCSCC. These data provide further evidence to support the use of ICI as the standard treatment of aCSCC.
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Affiliation(s)
- Rodrigo R Munhoz
- Oncology Service, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Oncology Center, Hospital Sírio Libanês, São Paulo, Brazil
| | | | - Veridiana P de Camargo
- Centro de Oncologia e Hematologia, Beneficiência Portuguesa de São Paulo, São Paulo, Brazil
| | | | - Jade Cury-Martins
- Dermatology Department, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Hermínia Ricci
- Oncology Service, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcela R de Mattos
- Oncology Service, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Guilherme U C Machado
- Oncology Division, Hospital das Clínicas da Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Eduardo Bertolli
- Oncology Center, Hospital Sírio Libanês, São Paulo, Brazil.,Centro de Oncologia e Hematologia, Beneficiência Portuguesa de São Paulo, São Paulo, Brazil.,Skin Cancer Department, A.C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Milton Barros
- Skin Cancer Department, A.C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | | | - Fábio Franke
- Oncosite, Centro De Pesquisa Clínica Em Oncologia, Ijuí, Brazil
| | - Fabio O Ferreira
- Oncology Service, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Oncology Center, Hospital Sírio Libanês, São Paulo, Brazil
| | - Olavo Feher
- Oncology Service, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Oncology Center, Hospital Sírio Libanês, São Paulo, Brazil
| | - Gilberto de Castro
- Oncology Service, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Oncology Center, Hospital Sírio Libanês, São Paulo, Brazil
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Wall I, Boulat V, Shah A, Blenman KRM, Wu Y, Alberts E, Calado DP, Salgado R, Grigoriadis A. Leveraging the Dynamic Immune Environment Triad in Patients with Breast Cancer: Tumour, Lymph Node, and Peripheral Blood. Cancers (Basel) 2022; 14:4505. [PMID: 36139665 PMCID: PMC9496983 DOI: 10.3390/cancers14184505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022] Open
Abstract
During the anti-tumour response to breast cancer, the primary tumour, the peripheral blood, and the lymph nodes each play unique roles. Immunological features at each site reveal evidence of continuous immune cross-talk between them before, during and after treatment. As such, immune responses to breast cancer are found to be highly dynamic and truly systemic, integrating three distinct immune sites, complex cell-migration highways, as well as the temporal dimension of disease progression and treatment. In this review, we provide a connective summary of the dynamic immune environment triad of breast cancer. It is critical that future studies seek to establish dynamic immune profiles, constituting multiple sites, that capture the systemic immune response to breast cancer and define patient-selection parameters resulting in more significant overall responses and survival rates for breast cancer patients.
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Affiliation(s)
- Isobelle Wall
- Cancer Bioinformatics, School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK
| | - Victoire Boulat
- Cancer Bioinformatics, School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK
- Immunity and Cancer Laboratory, The Francis Crick Institute, London NW1 1AT, UK
| | - Aekta Shah
- Cancer Bioinformatics, School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Kim R. M. Blenman
- Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, Yale University, New Haven, CT 06510, USA
- Department of Computer Science, School of Engineering and Applied Science, Yale University, New Haven, CT 06511, USA
| | - Yin Wu
- Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK
- Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King’s College London, London SE1 9RT, UK
- Centre for Inflammation Biology and Cancer Immunology, School of Immunology & Microbial Sciences, King’s College London, London SE1 9RT, UK
| | - Elena Alberts
- Cancer Bioinformatics, School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK
- Immunity and Cancer Laboratory, The Francis Crick Institute, London NW1 1AT, UK
| | - Dinis Pedro Calado
- Immunity and Cancer Laboratory, The Francis Crick Institute, London NW1 1AT, UK
| | - Roberto Salgado
- Department of Pathology, GZA-ZNA Hospitals, 2610 Antwerp, Belgium
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Anita Grigoriadis
- Cancer Bioinformatics, School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK
- Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Hospital, London SE1 9RT, UK
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Akama-Garren EH, Morris ZS, Sikora AG, Weichselbaum R, Schoenfeld JD. Prospective Clinical Investigation of the Efficacy of Combination Radiation Therapy With Immune Checkpoint Inhibition. Int J Radiat Oncol Biol Phys 2021; 111:1165-1175. [PMID: 34411638 PMCID: PMC10960630 DOI: 10.1016/j.ijrobp.2021.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 12/19/2022]
Abstract
Immune checkpoint inhibitors (ICIs) lead to durable responses in a subset of patients with cancer, but most patients do not respond to ICI, prompting interest in combining immunotherapy with other therapeutic regimens. Preclinical evidence supports the potential for therapeutic synergy between immunotherapy and radiation therapy through modulation of the tumor microenvironment and antitumor immune responses. Local therapy also has the potential to overcome localized sites of relative immune suppression and resistance. Prospective clinical trials have been initiated to test these hypotheses in the clinic as well as to investigate the toxicities and adverse events associated with combination immunotherapy and radiation therapy. In this review, we discuss the emerging results from prospective clinical trials of combination immunotherapy and radiation therapy, the safety and efficacy of their combination, concordance with preclinical and retrospective data, and some of the remaining open questions to be addressed by future clinical trials.
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Affiliation(s)
- Elliot H Akama-Garren
- Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Zachary S Morris
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Andrew G Sikora
- Department of Head and Neck Surgery, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ralph Weichselbaum
- Department of Radiation and Cellular Oncology, The University of Chicago Medical Center, Chicago, Illinois; The Ludwig Center for Metastasis Research, The University of Chicago Medical Center, Chicago, Illinois
| | - Jonathan D Schoenfeld
- Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts.
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Immune biological rationales for the design of combined radio- and immunotherapies. Cancer Immunol Immunother 2020; 69:293-306. [PMID: 31953578 PMCID: PMC7000501 DOI: 10.1007/s00262-019-02460-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 12/22/2019] [Indexed: 02/07/2023]
Abstract
Cancer immunotherapies are promising treatments for many forms of cancer. Nevertheless, the response rates to, e.g., immune checkpoint inhibitors (ICI), are still in low double-digit percentage. This calls for further therapy optimization that should take into account combination of immunotherapies with classical tumor therapies such as radiotherapy. By designing multimodal approaches, immune modulatory properties of certain radiation schemes, additional immune modulation by immunotherapy with ICI and hyperthermia, as well as patient stratification based on genetic and immune constitutions have to be considered. In this context, both the tumor and its microenvironment including cells of the innate and adaptive immune system have to be viewed in synopsis. Knowledge of immune activation and immune suppression by radiation is the basis for well-elaborated addition of certain immunotherapies. In this review, the focus is set on additional immune stimulation by hyperthermia and restoration of an immune response by ICI. The impact of radiation dose and fractionation on immune modulation in multimodal settings has to be considered, as the dynamics of the immune response and the timing between radiotherapy and immunotherapy. Another big challenge is the patient stratification that should be based on matrices of biomarkers, taking into account genetics, proteomics, radiomics, and “immunomics”. One key aim is to turn immunological “cold” tumors into “hot” tumors, and to eliminate barriers of immune-suppressed or immune-excluded tumors. Comprehensive knowledge of immune alterations induced by radiation and immunotherapy when being applied together should be utilized for patient-adapted treatment planning and testing of innovative tumor therapies within clinical trials.
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Sridharan V, Schoenfeld JD. Immunotherapy and Radiation: Charting a Path Forward Together. Hematol Oncol Clin North Am 2019; 33:1057-1069. [PMID: 31668206 DOI: 10.1016/j.hoc.2019.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Preclinical studies combining immunotherapy and radiation therapy have suggested promising synergy, prompting translation into clinical trials. Radiation has been shown to significantly alter the tumor microenvironment, cause immunogenic cell death, and potentiate anti-tumor immune responses. Several radiation parameters may modulate these effects. Clinical data to date have suggested that combination therapy is largely well tolerated, but additional study is warranted to better estimate both short-term and long-term risks of combination treatment and extend these data to new immunotherapy agents. Ensuring proper radiation access and quality is critical to the success of future trials.
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Affiliation(s)
- Vishwajith Sridharan
- Department of Medicine, Massachusetts General Hospital, 75 Fruit Street, Boston, MA 02114, USA
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, 75 Francis Street, L2, Boston, MA 02115, USA.
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Wang Y, Deng W, Li N, Neri S, Sharma A, Jiang W, Lin SH. Combining Immunotherapy and Radiotherapy for Cancer Treatment: Current Challenges and Future Directions. Front Pharmacol 2018; 9:185. [PMID: 29556198 PMCID: PMC5844965 DOI: 10.3389/fphar.2018.00185] [Citation(s) in RCA: 241] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/19/2018] [Indexed: 12/17/2022] Open
Abstract
Since the approval of anti-CTLA4 therapy (ipilimumab) for late-stage melanoma in 2011, the development of anticancer immunotherapy agents has thrived. The success of many immune-checkpoint inhibitors has drastically changed the landscape of cancer treatment. For some types of cancer, monotherapy for targeting immune checkpoint pathways has proven more effective than traditional therapies, and combining immunotherapy with current treatment strategies may yield even better outcomes. Numerous preclinical studies have suggested that combining immunotherapy with radiotherapy could be a promising strategy for synergistic enhancement of treatment efficacy. Radiation delivered to the tumor site affects both tumor cells and surrounding stromal cells. Radiation-induced cancer cell damage exposes tumor-specific antigens that make them visible to immune surveillance and promotes the priming and activation of cytotoxic T cells. Radiation-induced modulation of the tumor microenvironment may also facilitate the recruitment and infiltration of immune cells. This unique relationship is the rationale for combining radiation with immune checkpoint blockade. Enhanced tumor recognition and immune cell targeting with checkpoint blockade may unleash the immune system to eliminate the cancer cells. However, challenges remain to be addressed to maximize the efficacy of this promising combination. Here we summarize the mechanisms of radiation and immune system interaction, and we discuss current challenges in radiation and immune checkpoint blockade therapy and possible future approaches to boost this combination.
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Affiliation(s)
- Yifan Wang
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, United States
| | - Weiye Deng
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Nan Li
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Shinya Neri
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Amrish Sharma
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Wen Jiang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Steven H Lin
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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