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Al-Marrawi MY, Mackley HB, Ali S, Wagner H, Joshi M, Holder S, Kaag M, Mallon C, Talamo G, Drabick JJ. Consolidation With Radiation or Concurrent Chemo-Radiation After Chemotherapy Results in Durable Complete Remissions of Isolated Nodal Recurrences of Urothelial Cancer: A Case Series and Review. Clin Genitourin Cancer 2016; 14:e393-9. [PMID: 26877063 DOI: 10.1016/j.clgc.2016.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/13/2016] [Accepted: 01/16/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Mhd Yaser Al-Marrawi
- Division of Hematology and Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA.
| | - Heath B Mackley
- Division of Radiation Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA
| | - Suhail Ali
- Division of Hematology and Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA
| | - Henry Wagner
- Division of Radiation Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA
| | - Monika Joshi
- Division of Hematology and Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA
| | - Sheldon Holder
- Division of Hematology and Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA
| | - Mathew Kaag
- Division of Urological Surgery, Penn State University/Hershey Cancer Institute, Hershey, PA
| | - Carol Mallon
- Division of Hematology and Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA
| | - Giampaolo Talamo
- Division of Hematology and Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA
| | - Joseph J Drabick
- Division of Hematology and Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA
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Carosella ED, Ploussard G, LeMaoult J, Desgrandchamps F. A Systematic Review of Immunotherapy in Urologic Cancer: Evolving Roles for Targeting of CTLA-4, PD-1/PD-L1, and HLA-G. Eur Urol 2015; 68:267-79. [PMID: 25824720 DOI: 10.1016/j.eururo.2015.02.032] [Citation(s) in RCA: 166] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 02/25/2015] [Indexed: 02/06/2023]
Abstract
CONTEXT Overexpression of immune checkpoint molecules affects tumor-specific T-cell immunity in the cancer microenvironment, and can reshape tumor progression and metastasis. Antibodies targeting checkpoints could restore antitumor immunity by blocking the inhibitory receptor-ligand interaction. OBJECTIVE To analyze data and current trends in immune checkpoint targeting therapy for urologic cancers. EVIDENCE ACQUISITION Systematic literature search for clinical trials in the PubMed and Cochrane databases up to August 2014 according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Endpoints included oncologic results, tumor response rates, safety, and tolerability. EVIDENCE SYNTHESIS Anti-CTLA-4 monotherapy has demonstrated biochemical responses in prostate cancer. One phase 3 trial assessing ipilimumab efficacy in castration-resistant disease was negative overall. Nevertheless, ipilimumab may significantly improve overall survival compared with placebo in subgroups of patients with favorable prognostic features. In renal cancer, phase 1 trials showed interesting stabilization or long-lasting objective response rates approaching 50% using anti-PD-1/PD-L1 drugs in heavily pretreated metastatic patients. In bladder cancer, one phase 2 trial indicated a good safety profile for ipilimumab as a neoadjuvant drug before radical cystectomy. Overall, immune-related effects such as colitis and dermatitis were common and well tolerated. CONCLUSIONS Our systematic review shows that antibodies blocking immune checkpoints offer interesting and long-lasting response rates in heavily pretreated patients with advanced urologic cancers. More promising results are currently provided by anti-CTLA-4 antibodies in prostate cancer and by PD-1/PD-L1 inhibitors in renal cancer. These should encourage new clinical trials of immune therapy combinations and immunotherapy monotherapy combined with conventional anticancer drugs. In bladder cancer, the use of targeted immunotherapy still remains underevaluated; however, preliminary results reported at recent conferences seem encouraging. PATIENT SUMMARY Data from studies support the activity and safety of immune checkpoint inhibitors in urologic cancers, alone or in combination with conventional cancer therapies. Encouraging data in other oncologic fields could translate into interesting responses in urological cancers.
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Affiliation(s)
- Edgardo D Carosella
- CEA, Institute of Emerging Diseases and Innovative Therapies (iMETI), Research Division in Hematology and Immunology (SRHI), Saint-Louis Hospital, Paris, France; University Paris Diderot, Sorbonne Paris Cité, UMR E_5 Institut Universitaire d'Hematologie, Saint-Louis Hospital, Paris, France.
| | | | - Joel LeMaoult
- CEA, Institute of Emerging Diseases and Innovative Therapies (iMETI), Research Division in Hematology and Immunology (SRHI), Saint-Louis Hospital, Paris, France; University Paris Diderot, Sorbonne Paris Cité, UMR E_5 Institut Universitaire d'Hematologie, Saint-Louis Hospital, Paris, France
| | - Francois Desgrandchamps
- CEA, Institute of Emerging Diseases and Innovative Therapies (iMETI), Research Division in Hematology and Immunology (SRHI), Saint-Louis Hospital, Paris, France; University Paris Diderot, Sorbonne Paris Cité, UMR E_5 Institut Universitaire d'Hematologie, Saint-Louis Hospital, Paris, France; Urology Department, Saint-Louis Hospital, Paris, France
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Fay AP, Signoretti S, Callea M, Telό GH, McKay RR, Song J, Carvo I, Lampron ME, Kaymakcalan MD, Poli-de-Figueiredo CE, Bellmunt J, Hodi FS, Freeman GJ, Elfiky A, Choueiri TK. Programmed death ligand-1 expression in adrenocortical carcinoma: an exploratory biomarker study. J Immunother Cancer 2015; 3:3. [PMID: 25767716 PMCID: PMC4357210 DOI: 10.1186/s40425-015-0047-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 01/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adrenocortical carcinoma (ACC) is a rare tumor in which prognostic factors are still not well established. Programmed Death Ligand-1 (PD-L1) expression in ACC and its association with clinico-pathological features and survival outcomes are unknown. METHODS Formalin-fixed paraffin-embedded (FFPE) specimens were obtained from 28 patients with ACC. PD-L1 expression was evaluated by immunohistochemistry (IHC) in both tumor cell membrane and tumor infiltrating mononuclear cells (TIMC). PD-L1 positivity on tumor cells was defined as ≥5% tumor cell membrane staining. TIMC were evaluated by IHC using a CD45 monoclonal antibody. For PD-L1 expression in TIMC, a combined score based on the extent of infiltrates and percentage of positive cells was developed. Any score greater that zero was considered PD-L1 positive. Baseline clinico-pathological characteristics and follow up data were retrospectively collected. Comparisons between PD-L1 expression and clinico-pathological features were evaluated using unpaired t-test and Fisher's exact test. Kaplan-Meier method and log-rank test were used to assess association between PD-L1 expression and 5-year overall survival (OS). RESULTS Among 28 patients with surgically treated ACC, 3 (10.7%) were considered PD-L1 positive on tumor cell membrane. On the other hand, PD-L1 expression in TIMC was performed in 27 specimens and PD-L1 positive staining was observed in 19 (70.4%) patients. PD-L1 positivity in either tumor cell membrane or TIMC was not significantly associated with higher stage at diagnosis, higher tumor grade, excessive hormone secretion, or OS. CONCLUSIONS PD-L1 expression can exist in ACC in both tumor cell membrane and TIMC with no relationship to clinico-pathologic parameters or survival.
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Affiliation(s)
- André P Fay
- />Dana-Farber Cancer Institute, 450 Brookline Avenue (DANA 1230), Boston, MA 02215 USA
- />Programa de Pós-Graduação em Medicina e Ciências da Saúde, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga 6690, Porto Alegre, RS 90619-900 Brazil
| | - Sabina Signoretti
- />Brigham and Women’s Hospital, 75 Francis Street (Thorn Building 504A), Boston, MA 02215 USA
- />Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - Marcella Callea
- />Brigham and Women’s Hospital, 75 Francis Street (Thorn Building 504A), Boston, MA 02215 USA
| | - Gabriela H Telό
- />Joslin Diabetes Center, One Joslin Place, Boston, MA 02215 USA
| | - Rana R McKay
- />Dana-Farber Cancer Institute, 450 Brookline Avenue (DANA 1230), Boston, MA 02215 USA
- />Brigham and Women’s Hospital, 75 Francis Street (Thorn Building 504A), Boston, MA 02215 USA
- />Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - Jiaxi Song
- />Brigham and Women’s Hospital, 75 Francis Street (Thorn Building 504A), Boston, MA 02215 USA
| | - Ingrid Carvo
- />Brigham and Women’s Hospital, 75 Francis Street (Thorn Building 504A), Boston, MA 02215 USA
| | - Megan E Lampron
- />Dana-Farber Cancer Institute, 450 Brookline Avenue (DANA 1230), Boston, MA 02215 USA
| | - Marina D Kaymakcalan
- />Dana-Farber Cancer Institute, 450 Brookline Avenue (DANA 1230), Boston, MA 02215 USA
| | - Carlos E Poli-de-Figueiredo
- />Programa de Pós-Graduação em Medicina e Ciências da Saúde, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga 6690, Porto Alegre, RS 90619-900 Brazil
| | - Joaquim Bellmunt
- />Dana-Farber Cancer Institute, 450 Brookline Avenue (DANA 1230), Boston, MA 02215 USA
- />Brigham and Women’s Hospital, 75 Francis Street (Thorn Building 504A), Boston, MA 02215 USA
- />Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - F Stephen Hodi
- />Dana-Farber Cancer Institute, 450 Brookline Avenue (DANA 1230), Boston, MA 02215 USA
- />Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- />Center of Immuno-Oncology, 450 Brookline Avenue, Boston, MA 02215 USA
| | - Gordon J Freeman
- />Dana-Farber Cancer Institute, 450 Brookline Avenue (DANA 1230), Boston, MA 02215 USA
- />Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - Aymen Elfiky
- />Dana-Farber Cancer Institute, 450 Brookline Avenue (DANA 1230), Boston, MA 02215 USA
- />Brigham and Women’s Hospital, 75 Francis Street (Thorn Building 504A), Boston, MA 02215 USA
- />Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - Toni K Choueiri
- />Dana-Farber Cancer Institute, 450 Brookline Avenue (DANA 1230), Boston, MA 02215 USA
- />Brigham and Women’s Hospital, 75 Francis Street (Thorn Building 504A), Boston, MA 02215 USA
- />Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
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Bellmunt J, Mullane SA, Werner L, Fay AP, Callea M, Leow JJ, Taplin ME, Choueiri TK, Hodi FS, Freeman GJ, Signoretti S. Association of PD-L1 expression on tumor-infiltrating mononuclear cells and overall survival in patients with urothelial carcinoma. Ann Oncol 2015; 26:812-817. [PMID: 25600565 DOI: 10.1093/annonc/mdv009] [Citation(s) in RCA: 225] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Programmed death-1 (PD-1) receptor/PD-1 ligand (PD-L1) pathway negatively regulates T-cell-mediated responses. The prognostic impact of PD-L1 expression needs to be defined in urothelial carcinoma (UC). PATIENTS AND METHODS Formalin-fixed paraffin-embedded tumor samples from 160 patients with UC were retrieved. PD-L1 expression was evaluated by immunohistochemistry using a mouse monoclonal anti-PD-L1 antibody (405.9A11). PD-L1 positivity on tumor cell membrane was defined as ≥5% of tumor cell membrane staining. The extent of tumor-infiltrating mononuclear cells (TIMCs) as well as PD-L1 expression on TIMCs was scored from 0 to 4. A score of 2, 3, or 4 was considered PD-L1-positive. Clinico-pathological variables were documented. The Cox regression model was used to assess the association of PD-L1 expression with overall survival (OS) in patients who developed metastases. RESULTS TIMCs were present in 143 of the 160 patient samples. Out of 160 samples, 32 (20%) had positive PD-L1 expression in tumor cell membrane. Out of 143 samples with TIMCs, 58 (40%) had positive PD-L1 expression in TIMCs. Smoking history, prior BCG use and chromosome 9 loss did not correlate with PD-L1 expression in either tumor cell membrane or TIMCs. PD-L1 positivity was not different between non-invasive or invasive UC. In patients who developed metastases (M1) and were treated with systemic therapy (n = 100), PD-L1 positivity on tumor cell membrane was seen in 14% of patients and did not correlate with OS (P = 0.45). Out of 89 M1 patients who had evaluable PD-L1 on TIMCs, PD-L1 expression was seen in 33% of patients and was significantly associated with longer OS on multivariate analysis (P = 0.0007). CONCLUSION PD-L1 is widely expressed in tumor cell membrane and TIMCs in UC. PD-L1 in tumor cells was not predictive of OS. However, positive PD-L1 expression in TIMCs was significantly associated with longer survival in those patients who developed metastases.
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Affiliation(s)
- J Bellmunt
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston; Medical Oncology Department, Brigham and Women's Hospital, Boston; Medical Oncology Department, Harvard Medical School, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston.
| | - S A Mullane
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston
| | - L Werner
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston
| | - A P Fay
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston
| | - M Callea
- Department of Pathology, Brigham and Women's Hospital, Boston
| | - J J Leow
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston
| | - M E Taplin
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston; Medical Oncology Department, Brigham and Women's Hospital, Boston; Medical Oncology Department, Harvard Medical School, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston
| | - T K Choueiri
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston; Medical Oncology Department, Brigham and Women's Hospital, Boston; Medical Oncology Department, Harvard Medical School, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston
| | - F S Hodi
- Medical Oncology Department, Harvard Medical School, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston; Center for Immuno-oncology, Dana-Farber Cancer Institute, Boston, USA
| | - G J Freeman
- Medical Oncology Department, Harvard Medical School, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston
| | - S Signoretti
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston; Medical Oncology Department, Harvard Medical School, Boston; Department of Pathology, Brigham and Women's Hospital, Boston
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