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Li L, Liu HT, Teng YX, Deng ZJ, Zhang GL, Su JY, Ma L, Zhong JH. Second-line treatment options for hepatocellular carcinoma: current state and challenges for the future. Expert Opin Investig Drugs 2022; 31:1151-1167. [PMID: 36437752 DOI: 10.1080/13543784.2022.2151891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Since the approval of sorafenib for systemic treatment of advanced hepatocellular carcinoma (HCC), many tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) have shown efficacy and tolerability as first-line treatments. On the other hand, these first-line therapies are associated with low objective response and drug resistance. Many drugs have been successfully tested for second-line treatment of advanced HCC. While the rapid proliferation of second-line treatments for advanced HCC brings hope to patients, it also complicates clinical decision-making. AREAS COVERED This review aims to facilitate decisions by summarizing the latest guidelines for second-line treatment of HCC in various countries or regions. We then review existing second-line treatment options and discuss challenges that should be addressed in the future. A literature search was conducted in April 2022 of PubMed/Medline, Cochrane library, and abstracts of international cancer meetings. EXPERT OPINION There is no standard second-line treatment, especially for the case of sequential treatment after atezolizumab plus bevacizumab (atezo+bev) and further studies focused on sequential treatment are warranted in this setting. The design of clinical trials, different etiologies, and complications or quality of life (QoL) are interesting issues in the second-line setting.
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Affiliation(s)
- Le Li
- Hepatobiliary Surgery Department, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Hao-Tian Liu
- Hepatobiliary Surgery Department, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Yu-Xian Teng
- Hepatobiliary Surgery Department, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Zhu-Jian Deng
- Hepatobiliary Surgery Department, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Guan-Lan Zhang
- Hepatobiliary Surgery Department, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Jia-Yong Su
- Hepatobiliary Surgery Department, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Liang Ma
- Hepatobiliary Surgery Department, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Jian-Hong Zhong
- Hepatobiliary Surgery Department, Guangxi Medical University Cancer Hospital, Nanning, China.,Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education; Guangxi Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Nanning, China
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Local Ablative Therapy Associated with Immunotherapy in Locally Advanced Pancreatic Cancer: A Solution to Overcome the Double Trouble?-A Comprehensive Review. J Clin Med 2022; 11:jcm11071948. [PMID: 35407555 PMCID: PMC8999652 DOI: 10.3390/jcm11071948] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/15/2022] [Accepted: 03/24/2022] [Indexed: 02/04/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) remains a major killer and is a challenging clinical research issue with abysmal survival due to unsatisfactory therapeutic efficacy. Two major issues thwart the treatment of locally advanced nonresectable pancreatic cancer (LAPC): high micrometastasis rate and surgical inaccessibility. Local ablative therapies induce a systemic antitumor response (i.e., abscopal effect) in addition to local effects. Thus, the incorporation of additional therapies could be key to improving immunotherapy's clinical efficacy. In this systematic review, we explore recent applications of local ablative therapies combined with immunotherapy to overcome immune resistance in PDAC and discuss future perspectives and challenges. Particularly, we describe four chemoradiation studies and nine reports on irreversible electroporation (IRE). Clinically, IRE is the ablative therapy of choice, utilized in all but two clinical trials, and may create a favorable microenvironment for immunotherapy. Various immunotherapies have been used in combination with IRE, such as NK cell- or γδ T cell-based therapy, as well as immune checkpoint inhibitors. The results of the clinical trials presented in this review and the advancement potential of these therapies to phase II/III trials remain unknown. A multiple treatment approach involving chemotherapy, local ablation, and immunotherapy holds promise in overcoming the double trouble of LAPC.
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Cattolico C, Bailey P, Barry ST. Modulation of Type I Interferon Responses to Influence Tumor-Immune Cross Talk in PDAC. Front Cell Dev Biol 2022; 10:816517. [PMID: 35273962 PMCID: PMC8902310 DOI: 10.3389/fcell.2022.816517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/31/2022] [Indexed: 12/13/2022] Open
Abstract
Immunotherapy has revolutionized the treatment of many cancer types. However, pancreatic ductal adenocarcinomas (PDACs) exhibit poor responses to immune checkpoint inhibitors with immunotherapy-based trials not generating convincing clinical activity. PDAC tumors often have low infiltration of tumor CD8+ T cells and a highly immunosuppressive microenvironment. These features classify PDAC as immunologically "cold." However, the presence of tumor T cells is a favorable prognostic feature in PDAC. Intrinsic tumor cell properties govern interactions with the immune system. Alterations in tumor DNA such as genomic instability, high tumor mutation burden, and/or defects in DNA damage repair are associated with responses to both immunotherapy and chemotherapy. Cytotoxic or metabolic stress produced by radiation and/or chemotherapy can act as potent immune triggers and prime immune responses. Damage- or stress-mediated activation of nucleic acid-sensing pathways triggers type I interferon (IFN-I) responses that activate innate immune cells and natural killer cells, promote maturation of dendritic cells, and stimulate adaptive immunity. While PDAC exhibits intrinsic features that have the potential to engage immune cells, particularly following chemotherapy, these immune-sensing mechanisms are ineffective. Understanding where defects in innate immune triggers render the PDAC tumor-immune interface less effective, or how T-cell function is suppressed will help develop more effective treatments and harness the immune system for durable outcomes. This review will focus on the pivotal role played by IFN-I in promoting tumor cell-immune cell cross talk in PDAC. We will discuss how PDAC tumor cells bypass IFN-I signaling pathways and explore how these pathways can be co-opted or re-engaged to enhance the therapeutic outcome.
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Affiliation(s)
- Carlotta Cattolico
- Bioscience, Early Oncology, AstraZeneca, Cambridge, United Kingdom
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Peter Bailey
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
- Section Surgical Research, University Clinic Heidelberg, Heidelberg, Germany
| | - Simon T. Barry
- Bioscience, Early Oncology, AstraZeneca, Cambridge, United Kingdom
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Optimized Dosing: The Next Step in Precision Medicine in Non-Small-Cell Lung Cancer. Drugs 2021; 82:15-32. [PMID: 34894338 DOI: 10.1007/s40265-021-01654-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 12/20/2022]
Abstract
In oncology, and especially in the treatment of non-small-cell lung cancer (NSCLC), dose optimization is often a neglected part of precision medicine. Many drugs are still being administered in "one dose fits all" regimens or based on parameters that are often only minor determinants for systemic exposure. These dosing approaches often introduce additional pharmacokinetic variability and do not add to treatment outcomes. Fortunately, pharmacological knowledge is increasing, providing valuable information regarding the potential of, for example, therapeutic drug monitoring. This article focuses on the evidence for the most promising and easily implemented optimized dosing approaches for the small-molecule inhibitors, chemotherapeutic agents, and monoclonal antibodies as treatment options currently approved for NSCLC. Despite limitations such as investigations having been conducted in oncological diseases other than NSCLC or the retrospective origin of many analyses, an alternative dosing regimen could be beneficial for treatment outcomes, prescriber convenience, or financial burden on healthcare systems. This review of the literature provides recommendations on the implementation of dose optimization and advice regarding promising strategies that deserve further research in NSCLC.
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Akhbariyoon H, Azizpour Y, Esfahani MF, Firoozabad MSM, Rad MR, Esfahani KS, Khoshavi N, Karimi N, Shirinisaz A, Abedi F, Rad MR, Sharifi P. Immune checkpoint inhibition for the treatment of cancers: An update and critical review of ongoing clinical trials. Clin Immunol 2021; 232:108873. [PMID: 34688855 DOI: 10.1016/j.clim.2021.108873] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/29/2021] [Accepted: 10/14/2021] [Indexed: 12/12/2022]
Abstract
Advances in Cancer immunotherapy in the past few years include the development of medications that modulate immune checkpoint proteins. Cytotoxic T-lymphocyte antigen 4 (CTLA4), programmed cell death protein 1 (PD1), and programmed cell death ligand 1 (PD-L1) are three co-inhibitory receptors that are expressed in the tumor microenvironment. Immune checkpoint inhibitors (ICI) that target these biomarkers unleash the properties of effector T cells that are licensed to kill cancer cells. Immune checkpoint blockade has dramatically changed the treatment landscape of many cancers. In this Review, we describe the current data regarding clinical trials of ICIs in six important cancers, including hepatocellular carcinoma (HCC), renal cell cancer (RCC), hodgkin lymphoma (HL), non-hodgkin lymphoma (NHL), non-small cell lung cancer (NSCLC), and head and neck cancer carcinoma (HNSCC).
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Affiliation(s)
| | - Yasaman Azizpour
- Department of Biochemistry, Tarbiat Modares University, 14115-175 Tehran, Iran
| | | | | | - Mehrdad Rabiee Rad
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Neda Khoshavi
- Department of Biology, Faculty of Science, Yazd University, Yazd, Iran
| | - Negin Karimi
- Department of Biology, Faculty of Science, Yazd University, Yazd, Iran
| | - Asal Shirinisaz
- Department of Biology, Faculty of Science, Yazd University, Yazd, Iran
| | - Fatemeh Abedi
- Department of Biology, Faculty of Science, Yazd University, Yazd, Iran
| | - Maryam Rabiee Rad
- Department of Biology, Faculty of Science, Yazd University, Yazd, Iran
| | - Parisa Sharifi
- Department of Biology, Faculty of Science, Yazd University, Yazd, Iran
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Liu HT, Jiang MJ, Deng ZJ, Li L, Huang JL, Liu ZX, Li LQ, Zhong JH. Immune Checkpoint Inhibitors in Hepatocellular Carcinoma: Current Progresses and Challenges. Front Oncol 2021; 11:737497. [PMID: 34745958 PMCID: PMC8570111 DOI: 10.3389/fonc.2021.737497] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/08/2021] [Indexed: 01/27/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignant tumor in the world and its incidence is increasing in many countries. In recent years, with the deepening understanding of the immune and pathological mechanisms of HCC, immunotherapy based on the regulation of tumor immune microenvironment has become a new treatment choice for patients with HCC. Immune checkpoint inhibitors (ICIs) targeting programmed death protein-1, programmed death protein-ligand-1, or cytotoxic T-lymphocyte-associated antigen 4 are the most widely used. Instead of general immune-enhancing therapies, ICIs can reactivate anti-tumor immune responses by disrupting co-inhibitory T cell signaling. In this review, the research progress and existing problems of ICIs in the treatment of HCC in recent years are reviewed.
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Affiliation(s)
| | | | | | | | | | | | | | - Jian-Hong Zhong
- Hepatobiliary Surgery Department, Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Guangxi Medical University Cancer Hospital, Nanning, China
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Alzhrani R, Alsaab HO, Vanamal K, Bhise K, Tatiparti K, Barari A, Sau S, Iyer AK. Overcoming the Tumor Microenvironmental Barriers of Pancreatic Ductal Adenocarcinomas for Achieving Better Treatment Outcomes. ADVANCED THERAPEUTICS 2021; 4:2000262. [PMID: 34212073 PMCID: PMC8240487 DOI: 10.1002/adtp.202000262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Indexed: 02/06/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive disease with the lowest survival rate among all solid tumors. The lethality of PDAC arises from late detection and propensity of the tumor to metastasize and develop resistance against chemo and radiation therapy. A highly complex tumor microenvironment composed of dense stroma, immune cells, fibroblast, and disorganized blood vessels, is the main obstacle to current PDAC therapy. Despite the tremendous success of immune checkpoint inhibitors (ICIs) in cancers, PDAC remains one of the poorest responders of ICIs therapy. The immunologically "cold" phenotype of PDAC is attributed to the low mutational burden, high infiltration of myeloid-derived suppressor cells and T-regs, contributing to a significant immunotherapy resistance mechanism. Thus, the development of innovative strategies for turning immunologically "cold" tumor into "hot" ones is an unmet need to improve the outcome of PDAC ICIs therapies. Other smart strategies, such as nanomedicines, sonic Hedgehog inhibitor, or smoothened inhibitor, are discussed to enhance chemotherapeutic agents' efficiency by disrupting the PDAC stroma. This review highlights the current challenges and various preclinical and clinical strategies to overcome current PDAC therapy difficulties, thus significantly advancing PDAC research knowledge.
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Affiliation(s)
- Rami Alzhrani
- Use-Inspired Biomaterials and Integrated Nano Delivery Systems Laboratory, Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit 48201, United States
- Department of Pharmaceutics and Pharmaceutical Technology, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia
| | - Hashem O. Alsaab
- Department of Pharmaceutics and Pharmaceutical Technology, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia
| | - Kushal Vanamal
- Use-Inspired Biomaterials and Integrated Nano Delivery Systems Laboratory, Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit 48201, United States
| | - Ketki Bhise
- Use-Inspired Biomaterials and Integrated Nano Delivery Systems Laboratory, Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit 48201, United States
| | - Katyayani Tatiparti
- Use-Inspired Biomaterials and Integrated Nano Delivery Systems Laboratory, Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit 48201, United States
| | - Ayatakshi Barari
- Use-Inspired Biomaterials and Integrated Nano Delivery Systems Laboratory, Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit 48201, United States
| | - Samaresh Sau
- Use-Inspired Biomaterials and Integrated Nano Delivery Systems Laboratory, Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit 48201, United States
| | - Arun K. Iyer
- Use-Inspired Biomaterials and Integrated Nano Delivery Systems Laboratory, Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit 48201, United States
- Molecular Therapeutics Program, Barbara Ann Karmanos Cancer Institute, Wayne State University, School of Medicine, Detroit, MI, United States
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Naito T, Shiraishi H, Fujiwara Y. Durvalumab for the treatment of PD-L1 non-small cell lung cancer. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2020. [DOI: 10.1080/23808993.2021.1855075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Tomoyuki Naito
- Department of Respiratory Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Hideaki Shiraishi
- Department of Respiratory Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yutaka Fujiwara
- Department of Respiratory Medicine, Mitsui Memorial Hospital, Tokyo, Japan
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9
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Kasi A, Al-Jumayli M, Park R, Baranda J, Sun W. Update on the Role of Poly (ADP-Ribose) Polymerase Inhibitors in the DNA Repair-Deficient Pancreatic Cancers: A Narrative Review. J Pancreat Cancer 2020; 6:107-115. [PMID: 33376937 PMCID: PMC7757687 DOI: 10.1089/pancan.2020.0010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose: Pancreatic ductal adenocarcinoma (PDAC) is the most common cancer found in the pancreas. It has a dismal prognosis and current therapeutic options, including surgical resection, provide only a temporary or limited response due to the development of treatment resistance. Methods: A narrative review of studies investigating poly (ADP-ribose) polymerase (PARP) pathway inhibitors in metastatic PDAC to highlight recent advances. Results: Mutations in BRCA genes confer a higher risk of PDAC, while germ line mutations are found in 4-7% of individuals harboring pancreatic cancer. Although solid tumors with defective DNA damage repair defect (DDR) genes such as BRCA show heightened sensitivity to platinum agents, tumors can exploit the PARP pathway as salvage pathways. Therefore, blocking this pathway will trigger cell death in vulnerable tumor cells with BRCA/DNA repair deficiency. Several drugs with inhibitory activity on the PARP pathway have been approved for breast and ovarian tumors harboring germ line or somatic BRCA mutations. Based on these results, the phase III POLO study showed a significant improvement in progression-free survival compared with placebo in BRCA mutant pancreatic tumors and highlighted the importance of germ line testing in everyone diagnosed with pancreatic cancer. In addition, expansion of the PARP inhibitor indication beyond BRCA mutations to other genes involved in DDR such as ATM and PALB2 merits attention. Conclusion: PARP inhibitors represent a safe and efficacious treatment for a subset of PDAC patients with BRCA mutations. Ongoing trials are evaluating PARP inhibitors in PDAC patients with non-BRCA DDR gene deficiencies as well as PARP inhibitors in combination with other agents, notably immune checkpoint inhibitors to expand the group of patients that derive benefit from this treatment.
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Affiliation(s)
- Anup Kasi
- Division of Medical Oncology, Department of Medicine, Kansas University Cancer Center, Kansas City, Kansas, USA
| | - Mohammed Al-Jumayli
- Division of Medical Oncology, Department of Medicine, Kansas University Cancer Center, Kansas City, Kansas, USA
| | - Robin Park
- Department of Medicine, MetroWest Medical Center/Tufts University School of Medicine, Framingham, Massachusetts, USA
| | - Joaquina Baranda
- Division of Medical Oncology, Department of Medicine, Kansas University Cancer Center, Kansas City, Kansas, USA
| | - Weijing Sun
- Division of Medical Oncology, Department of Medicine, Kansas University Cancer Center, Kansas City, Kansas, USA
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Abstract
This review summarizes completed and ongoing studies evaluating the activity of immune checkpoint inhibitors in esophagogastric cancer.
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Affiliation(s)
- Geoffrey Y Ku
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, Room 1035, New York, NY 10065, USA.
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Dika IE, Khalil DN, Abou-Alfa GK. Immune checkpoint inhibitors for hepatocellular carcinoma. Cancer 2019; 125:3312-3319. [PMID: 31290997 PMCID: PMC7944520 DOI: 10.1002/cncr.32076] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/12/2019] [Accepted: 01/18/2019] [Indexed: 12/20/2022]
Abstract
The position of immunotherapy as a pillar of systemic cancer treatment has been firmly established over the past decade. Immune checkpoint inhibitors are a welcome option for patients with different malignancies. This is in part because they offer the possibility of durable benefit, even for patients who have failed other treatment modalities. The recent demonstration that immunotherapy is effective for patients with hepatocellular carcinoma (HCC) is a milestone in the history of this recalcitrant disease. The treatment of HCC has been a challenge, and for many years was limited to the tyrosine kinase inhibitor sorafenib and to several novel tyrosine kinase inhibitors that have shown efficacy and have been approved. The current role of immune checkpoint inhibitors in the management of HCC, and how this role is likely to evolve in the years ahead, are key. Other than efforts evaluating single checkpoint inhibitors, potential combination strategies, including combinations with existing local and systemic approaches, including novel therapies are evolving. This is understandably of special interest considering the potential unique immune system of the liver, which may impact the use of immunotherapy in patients with HCC going forward, and how can it be enhanced further.
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Affiliation(s)
- Imane El Dika
- Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | - Danny N. Khalil
- Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
- Ludwig Collaborative and Swim Across America Laboratory, Memorial Sloan Kettering Cancer Center, New York, New York
- Parker Institute for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ghassan K. Abou-Alfa
- Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
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12
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Hobbs BP, Barata PC, Kanjanapan Y, Paller CJ, Perlmutter J, Pond GR, Prowell TM, Rubin EH, Seymour LK, Wages NA, Yap TA, Feltquate D, Garrett-Mayer E, Grossman W, Hong DS, Ivy SP, Siu LL, Reeves SA, Rosner GL. Seamless Designs: Current Practice and Considerations for Early-Phase Drug Development in Oncology. J Natl Cancer Inst 2019; 111:118-128. [PMID: 30561713 PMCID: PMC6376915 DOI: 10.1093/jnci/djy196] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/30/2018] [Accepted: 10/03/2018] [Indexed: 02/06/2023] Open
Abstract
Traditionally, drug development has evaluated dose, safety, activity, and comparative benefit in a sequence of phases using trial designs and endpoints specifically devised for each phase. Innovations in drug development seek to consolidate the phases and rapidly expand accrual with "seamless" trial designs. Although consolidation and rapid accrual may yield efficiencies, widespread use of seamless first-in-human (FiH) trials without careful consideration of objectives, statistical analysis plans, or trial oversight raises concerns. A working group formed by the National Cancer Institute convened to consider and discuss opportunities and challenges for such trials as well as encourage responsible use of these designs. We reviewed all abstracts presented at American Society of Clinical Oncology annual meetings from 2010 to 2017 for FiH trials enrolling at least 100 patients. We identified 1786 early-phase trials enrolling 57 559 adult patients. Fifty-one of the trials (2.9%) investigated 50 investigational new drugs, were seamless, and accounted for 14.6% of the total patients. The seamless trials included a median of 3 (range = 1-13) expansion cohorts. The overall risk of clinically significant treatment-related adverse events (grade 3-4) was 49.1% (range = 0.0-100%), and seven studies reported at least one toxic death. Rapid expansion of FiH trials may lead to earlier drug approval and corresponding widespread patient access to active therapeutics. Nevertheless, seamless designs must adhere to established ethical, scientific, and statistical standards. Protocols should include prospectively planned analyses of efficacy in disease- or biomarker-defined cohorts of sufficient rigor to support accelerated approval.
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Affiliation(s)
- Brian P Hobbs
- Quantitative Health Sciences and Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Pedro C Barata
- Division of Hematology and Medical Oncology, Taussig Cancer Institute Cleveland Clinic, Cleveland, OH
- Department of Internal Medicine, Division of Hematology and Medical Oncology, Tulane University Medical School, New Orleans, LA
| | - Yada Kanjanapan
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia
| | - Channing J Paller
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | | | - Gregory R Pond
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Tatiana M Prowell
- Office of Hematology & Oncology Products, Food and Drug Administration, Silver Spring, MD
- Breast Cancer Program, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Eric H Rubin
- Global Clinical Oncology, Merck Research Laboratories, Kenilworth, NJ
| | - Lesley K Seymour
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - Nolan A Wages
- Division of Translational Research & Applied Statistics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA
| | - Timothy A Yap
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David Feltquate
- Early Clinical Development, Bristol-Myers Squibb, Princeton, NJ
| | | | - William Grossman
- Cancer Immunotherapy- Global Product Development Oncology, Genentech, Inc., San Francisco, CA
- Bellicum Inc., Brisbane, CA
| | - David S Hong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - S Percy Ivy
- National Cancer Institute, Cancer Therapy Evaluation Program, Rockville, MD
| | - Lillian L Siu
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Steven A Reeves
- National Cancer Institute, Coordinating Center for Clinical Trials, Rockville, MD
| | - Gary L Rosner
- Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins, Baltimore, MD
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13
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Zandberg DP, Algazi AP, Jimeno A, Good JS, Fayette J, Bouganim N, Ready NE, Clement PM, Even C, Jang RW, Wong S, Keilholz U, Gilbert J, Fenton M, Braña I, Henry S, Remenar E, Papai Z, Siu LL, Jarkowski A, Armstrong JM, Asubonteng K, Fan J, Melillo G, Mesía R. Durvalumab for recurrent or metastatic head and neck squamous cell carcinoma: Results from a single-arm, phase II study in patients with ≥25% tumour cell PD-L1 expression who have progressed on platinum-based chemotherapy. Eur J Cancer 2018; 107:142-152. [PMID: 30576970 DOI: 10.1016/j.ejca.2018.11.015] [Citation(s) in RCA: 163] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/09/2018] [Accepted: 11/10/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Patients with recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) progressing on platinum-based chemotherapy have poor prognoses and limited therapeutic options. Programmed cell death-1 (PD-1) and its ligand 1 (PD-L1) are frequently upregulated in HNSCC. The international, multi-institutional, single-arm, phase II HAWK study (NCT02207530) evaluated durvalumab monotherapy, an anti-PD-L1 monoclonal antibody, in PD-L1-high patients with platinum-refractory R/M HNSCC. PATIENTS AND METHODS Immunotherapy-naïve patients with confirmed PD-L1-high tumour cell expression (defined as patients with ≥25% of tumour cells expressing PD-L1 [TC ≥ 25%] using the VENTANA PD-L1 [SP263] Assay) received durvalumab 10 mg/kg intravenously every 2 weeks for up to 12 months. The primary end-point was objective response rate; secondary end-points included progression-free survival (PFS) and overall survival (OS). RESULTS Among evaluable patients (n = 111), objective response rate was 16.2% (95% confidence interval [CI], 9.9-24.4); 29.4% (95% CI, 15.1-47.5) for human papillomavirus (HPV)-positive patients and 10.9% (95% CI, 4.5-21.3) for HPV-negative patients. Median PFS and OS for treated patients (n = 112) was 2.1 months (95% CI, 1.9-3.7) and 7.1 months (95% CI, 4.9-9.9); PFS and OS at 12 months were 14.6% (95% CI, 8.5-22.1) and 33.6% (95% CI, 24.8-42.7). Treatment-related adverse events were 57.1% (any grade) and 8.0% (grade ≥3); none led to death. At data cut-off, 24.1% of patients remained on treatment or in follow-up. CONCLUSION Durvalumab demonstrated antitumour activity with acceptable safety in PD-L1-high patients with R/M HNSCC, supporting its ongoing evaluation in phase III trials in first- and second-line settings. In an ad hoc analysis, HPV-positive patients had a numerically higher response rate and survival than HPV-negative patients.
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Affiliation(s)
- Dan P Zandberg
- University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, PA, USA.
| | - Alain P Algazi
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Antonio Jimeno
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - James S Good
- Institute of Head and Neck Studies and Education, Queen Elizabeth Hospital, Birmingham, UK
| | - Jérôme Fayette
- Clinical Oncology, Cancer Center Centre Léon Bérard, University of Lyon, Lyon, France
| | - Nathaniel Bouganim
- Department of Oncology, McGill University Health Centre, Montréal, QC, Canada
| | | | - Paul M Clement
- Department of Oncology, Leuven Cancer Institute, KU Leuven, Belgium
| | - Caroline Even
- Department of Head and Neck Oncology, Institut Gustave Roussy, Villejuif, France
| | - Raymond W Jang
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Stuart Wong
- Division of Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | - Moon Fenton
- The West Cancer Center, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Irene Braña
- Medical Oncology Department, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Stephanie Henry
- Department of Oncology-Hematology, Radiotherapy, and Nuclear Medicine, CHU UCL Namur, Namur, Belgium
| | - Eva Remenar
- National Institute of Oncology (Országos Onkológiai Intézet), Budapest, Hungary
| | - Zsuzsanna Papai
- State Health, Center Higatian Defanse Forses, Budapest, Hungary
| | - Lillian L Siu
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | | | | | - Jean Fan
- AstraZeneca, Gaithersburg, MD, USA
| | | | - Ricard Mesía
- Medical Oncology Department, Catalan Institute of Oncology, University of Barcelona, IDIBELL, Barcelona, Spain
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14
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Muñoz-Unceta N, Burgueño I, Jiménez E, Paz-Ares L. Durvalumab in NSCLC: latest evidence and clinical potential. Ther Adv Med Oncol 2018; 10:1758835918804151. [PMID: 30344651 PMCID: PMC6187424 DOI: 10.1177/1758835918804151] [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: 05/23/2018] [Accepted: 09/03/2018] [Indexed: 12/26/2022] Open
Abstract
Advances in immunotherapy have led to radical improvements in outcomes, including overall survival, such as in non-small cell lung cancer (NSCLC) patients with metastatic disease treated with immune checkpoint inhibitors. More recently, promising results have been obtained in earlier disease settings, and combinations with other therapies are being actively investigated. Durvalumab, a monoclonal antibody directed against the programmed death ligand 1, has demonstrated significant activity in NSCLC, including increased progression-free survival rates after chemoradiation for unresectable stage III disease, with a favourable safety profile. Clinical trials, including phase III studies, are ongoing as monotherapy and in combination with chemotherapy, radiotherapy and other immunotherapies, such as the anti-cytotoxic T-lymphocyte antigen 4 drug tremelimumab, in diverse stages of the disease.
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Affiliation(s)
- Nerea Muñoz-Unceta
- Medical Oncology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación i+12, Madrid, Spain
| | - Isabel Burgueño
- Medical Oncology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación i+12, Madrid, Spain
| | - Elizabeth Jiménez
- Medical Oncology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación i+12, Madrid, Spain
| | - Luis Paz-Ares
- Servicio de Oncología Médica, Hospital Universitario 12 de Octubre, Av. de Córdoba km 5,4, 28041 Madrid, Spain
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15
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Ochoa de Olza M, Oliva M, Hierro C, Matos I, Martin-Liberal J, Garralda E. Early-drug development in the era of immuno-oncology: are we ready to face the challenges? Ann Oncol 2018; 29:1727-1740. [PMID: 29945232 DOI: 10.1093/annonc/mdy225] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The classical development of drugs has progressively faded away, and we are currently in an era of seamless drug-development, where first-in-human trials include unusually big expansion cohorts in the search for early signs of activity and rapid regulatory approval. The fierce competition between different pharmaceutical companies and the hype for immune combinations obliges us to question the current way in which we are evaluating these drugs. In this review, we discuss critical issues and caveats in immunotherapy development. A particular emphasis is put on the limitations of pre-clinical toxicology studies, where both murine models and cynomolgus monkeys have underpredicted toxicity in humans. Moreover, relevant issues surrounding dose determination during phase I trials, such as dose-escalation methods or flat versus body-weight dosing, are discussed. A proposal of how to face these different challenges is offered, in order to achieve maximum efficacy with minimum toxicity for our patients.
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Affiliation(s)
- M Ochoa de Olza
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Molecular Therapeutics Research Unit, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.
| | - M Oliva
- Drug Development Program, Department of Medical Oncology and Haematology, Princess Margaret Hospital, University of Toronto, Toronto, Canada
| | - C Hierro
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Molecular Therapeutics Research Unit, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - I Matos
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Molecular Therapeutics Research Unit, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - J Martin-Liberal
- Molecular Therapeutics Research Unit, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Medical Oncology Department, Catalan Institute of Oncology (ICO), l'Hospitalet de Llobregat, Barcelona, Spain
| | - E Garralda
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Molecular Therapeutics Research Unit, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
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16
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Fuchs CS, Doi T, Jang RW, Muro K, Satoh T, Machado M, Sun W, Jalal SI, Shah MA, Metges JP, Garrido M, Golan T, Mandala M, Wainberg ZA, Catenacci DV, Ohtsu A, Shitara K, Geva R, Bleeker J, Ko AH, Ku G, Philip P, Enzinger PC, Bang YJ, Levitan D, Wang J, Rosales M, Dalal RP, Yoon HH. Safety and Efficacy of Pembrolizumab Monotherapy in Patients With Previously Treated Advanced Gastric and Gastroesophageal Junction Cancer: Phase 2 Clinical KEYNOTE-059 Trial. JAMA Oncol 2018; 4:e180013. [PMID: 29543932 DOI: 10.1001/jamaoncol.2018.0013] [Citation(s) in RCA: 1261] [Impact Index Per Article: 210.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Therapeutic options are needed for patients with advanced gastric cancer whose disease has progressed after 2 or more lines of therapy. Objective To evaluate the safety and efficacy of pembrolizumab in a cohort of patients with previously treated gastric or gastroesophageal junction cancer. Design, Setting, and Participants In the phase 2, global, open-label, single-arm, multicohort KEYNOTE-059 study, 259 patients in 16 countries were enrolled in a cohort between March 2, 2015, and May 26, 2016. Median (range) follow-up was 5.8 (0.5-21.6) months. Intervention Patients received pembrolizumab, 200 mg, intravenously every 3 weeks until disease progression, investigator or patient decision to withdraw, or unacceptable toxic effects. Main Outcomes and Measures Primary end points were objective response rate and safety. Objective response rate was assessed by central radiologic review per Response Evaluation Criteria in Solid Tumors, version 1.1, in all patients and those with programmed cell death 1 ligand 1 (PD-L1)-positive tumors. Expression of PD-L1 was assessed by immunohistochemistry. Secondary end points included response duration. Results Of 259 patients enrolled, most were male (198 [76.4%]) and white (200 [77.2%]); median (range) age was 62 (24-89) years. Objective response rate was 11.6% (95% CI, 8.0%-16.1%; 30 of 259 patients), with complete response in 2.3% (95% CI, 0.9%-5.0%; 6 of 259 patients). Median (range) response duration was 8.4 (1.6+ to 17.3+) months (+ indicates that patients had no progressive disease at their last assessment). Objective response rate and median (range) response duration were 15.5% (95% CI, 10.1%-22.4%; 23 of 148 patients) and 16.3 (1.6+ to 17.3+) months and 6.4% (95% CI, 2.6%-12.8%; 7 of 109 patients) and 6.9 (2.4 to 7.0+) months in patients with PD-L1-positive and PD-L1-negative tumors, respectively. Forty-six patients (17.8%) experienced 1 or more grade 3 to 5 treatment-related adverse events. Two patients (0.8%) discontinued because of treatment-related adverse events, and 2 deaths were considered related to treatment. Conclusions and Relevance Pembrolizumab monotherapy demonstrated promising activity and manageable safety in patients with advanced gastric or gastroesophageal junction cancer who had previously received at least 2 lines of treatment. Durable responses were observed in patients with PD-L1-positive and PD-L1-negative tumors. Further study of pembrolizumab for this group of patients is warranted. Trial Registration clinicaltrials.gov Identifier: NCT02335411.
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Affiliation(s)
| | | | - Raymond W Jang
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Kei Muro
- Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Taroh Satoh
- Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | | | - Weijing Sun
- University of Pittsburgh, Pittsburgh, Pennsylvania.,Now with the University of Kansas, Kansas City
| | | | - Manish A Shah
- Weill Cornell Medicine, New York Presbyterian Hospital, New York
| | - Jean-Phillipe Metges
- Centre Hospitalier Regional Universitaire (CHRU) de Brest-Hopital Morvan, Brest, France
| | | | - Talia Golan
- The Oncology Institute at the Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mario Mandala
- ASST Papa Giovanni XXIII, Cancer Center, Bergamo, Italy
| | - Zev A Wainberg
- David Geffen School of Medicine at University of California, Los Angeles
| | | | | | | | - Ravit Geva
- Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | | | - Andrew H Ko
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
| | - Geoffrey Ku
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Peter C Enzinger
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Yung-Jue Bang
- Seoul National University College of Medicine, Seoul, Republic of Korea
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17
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Cho JH, Lee J. Anti-programmed death ligand 1 (PD-L1) inhibitors in metastatic gastric cancer. PRECISION AND FUTURE MEDICINE 2017. [DOI: 10.23838/pfm.2017.00177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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18
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Dika IE, Abou-Alfa GK. Treatment options after sorafenib failure in patients with hepatocellular carcinoma. Clin Mol Hepatol 2017; 23:273-279. [PMID: 29151326 PMCID: PMC5760005 DOI: 10.3350/cmh.2017.0108] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/19/2017] [Indexed: 12/20/2022] Open
Abstract
Second line therapy after failure of sorafenib continues to be under study. Prognosis of hepatocellular carcinoma is measured in months, with median overall survival reaching 10.7 months with sorafenib. Because of the modest net benefit sorafenib has contributed, and rising incidence of hepatocellular carcinoma in the world, continued efforts are ongoing to look for efficient upfront, second line, or combination therapies. Herein we review the most relevant to date published literature on treatment options beyond sorafenib, reported studies, ongoing investigational efforts, and possibilities for future studies in advanced hepatocellular carcinoma.
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Affiliation(s)
- Imane El Dika
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ghassan K. Abou-Alfa
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
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19
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Connell LC, Harding JJ, Abou-Alfa GK. Advanced Hepatocellular Cancer: the Current State of Future Research. Curr Treat Options Oncol 2017; 17:43. [PMID: 27344158 DOI: 10.1007/s11864-016-0415-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OPINION STATEMENT Hepatocellular carcinoma is a common malignancy worldwide, rapidly rising in incidence. While there have been some developments in advancing therapeutic options in this disease, these have admittedly been modest to date, and as a result, this is a patient population with an inherently poor prognosis. Currently, sorafenib remains the only established systemic therapy proven to increase the overall survival of patients with advanced disease. The approval of sorafenib in 2007 ushered in the era of targeted therapies. Several phase 2 and 3 clinical trials have failed however to improve on sorafenib in the first-line setting, and no single agent has been demonstrated to impact outcomes after sorafenib failure. Having reached somewhat of an impasse in terms of drug development in hepatocellular carcinoma, enthusiasm in the field has moved toward innovative approaches such as molecular characterization and immunotherapy in an attempt to impact survival. This review highlights the current endeavors in terms of experimental research for patients with advanced hepatocellular carcinoma.
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Affiliation(s)
- Louise C Connell
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA
| | - James J Harding
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, 10065, USA
| | - Ghassan K Abou-Alfa
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA.
- Department of Medicine, Weill Cornell Medical College, New York, NY, 10065, USA.
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20
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Procaccio L, Schirripa M, Fassan M, Vecchione L, Bergamo F, Prete AA, Intini R, Manai C, Dadduzio V, Boscolo A, Zagonel V, Lonardi S. Immunotherapy in Gastrointestinal Cancers. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4346576. [PMID: 28758114 PMCID: PMC5512095 DOI: 10.1155/2017/4346576] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 05/18/2017] [Indexed: 12/29/2022]
Abstract
Gastrointestinal cancers represent a major public health problem worldwide. Immunotherapeutic strategies are currently under investigation in this setting and preliminary results of ongoing trials adopting checkpoint inhibitors are striking. Indeed, although a poor immunogenicity for GI has been reported, a strong biological rationale supports the development of immunotherapy in this field. The clinical and translational research on immunotherapy for the treatment of GI cancers started firstly with the identification of immune-related mechanisms possibly relevant to GI tumours and secondly with the development of immunotherapy-based agents in clinical trials. In the present review a general overview is firstly provided followed by a focus on major findings on gastric, colorectal, and hepatocellular carcinomas. Finally, pathological and molecular perspectives are provided since many efforts are ongoing in order to identify possible predictive biomarkers and to improve patients' selection. Many issues are still unsolved in this field; however, we strongly believe that immunotherapy might positively affect the natural history of a subgroup of GI cancer patients improving outcome and the overall quality of life.
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Affiliation(s)
- Letizia Procaccio
- Division of Medical Oncology 1, Istituto Oncologico Veneto, IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Marta Schirripa
- Division of Medical Oncology 1, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Matteo Fassan
- Department of Medicine, Surgical Pathology & Cytopathology Unit, University of Padova, Padova, Italy
| | - Loredana Vecchione
- Division of Molecular Carcinogenesis, Cancer Genomics Center Netherlands, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Francesca Bergamo
- Division of Medical Oncology 1, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Alessandra Anna Prete
- Division of Medical Oncology 1, Istituto Oncologico Veneto, IRCCS, Padova, Italy
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I University Hospital, Rome, Italy
| | - Rossana Intini
- Division of Medical Oncology 1, Istituto Oncologico Veneto, IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Chiara Manai
- Division of Medical Oncology 1, Istituto Oncologico Veneto, IRCCS, Padova, Italy
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I University Hospital, Rome, Italy
| | - Vincenzo Dadduzio
- Division of Medical Oncology 1, Istituto Oncologico Veneto, IRCCS, Padova, Italy
- Department of Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alice Boscolo
- Division of Medical Oncology 1, Istituto Oncologico Veneto, IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Vittorina Zagonel
- Division of Medical Oncology 1, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Sara Lonardi
- Division of Medical Oncology 1, Istituto Oncologico Veneto, IRCCS, Padova, Italy
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21
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Abstract
Gastric cancers, with gastric adenocarcinoma (GAC) as the most common histological type, impose a considerable global health burden. Although the screening strategies for early detection have been shown to be successful in Japan and South Korea, they are either not implemented or not feasible in most of the world, leading to late diagnosis in most patients. Helicobacter pylori infection contributes to the development of many endemic GACs, and pre-emptive eradication or early treatment of this bacterial infection might provide effective primary prevention. GACs are phenotypically and genotypically heterogeneous. Localized (clinical stage I) GAC is best treated either endoscopically or with limited surgical resection, but clinical stage II or stage III tumours require multidisciplinary adjunctive approaches in addition to surgery. Although GAC is highly treatable in its early stages, advanced (clinical stage IV) GAC has a median survival of just ∼9-10 months. However, detailed molecular and immune profiling of GAC is yielding promise; early studies with immune checkpoint inhibitors suggest that GAC is amenable to immune modulation. Molecular studies have yielded a vast quantity of new information for potential exploitation. Nevertheless, advances against GACs have lagged compared with other tumours of similar incidence, and more research is necessary to overcome the obstacles to prolong survival.
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Affiliation(s)
- Jaffer A Ajani
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas 77030, USA
| | - Jeeyun Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Takeshi Sano
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - Yelena Y Janjigian
- Department of Solid Tumor Gastrointestinal Service (Medical Oncology), Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Daiming Fan
- State Key Laboratory of Cancer Biology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Shumei Song
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas 77030, USA
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22
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Abstract
INTRODUCTION Esophageal cancer (EC) is the eighth most common cancer in the world, and the prognosis of EC is still poor. Although immunotherapy has been developed in melanoma and lung cancer, it is also expected to show efficacy in EC. Currently, several clinical trials are ongoing to evaluate the safety and efficacy of immunotherapies, immune checkpoint inhibitors, adoptive T cell transfer, and therapeutic cancer vaccines in EC. Areas covered: This review provides an overview and the status of immunotherapy in EC. Clinical significance of molecules related immune checkpoints, especially PD-1 and PD-L1 is presented and the designs, results and future directions of clinical trials using immunotherapy in EC are provided. Expert opinion: To bring immunotherapy to the forefront of treatment for EC, it is necessary to select patients who can obtain a high efficacy of immunotherapy and to also elucidate the correct timing for administration. Moreover, combination therapies of immunotherapy with existing chemotherapy or radiation or other immunotherapy with different mechanisms of action must be evaluated to achieve excellent outcomes in patients with EC.
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Affiliation(s)
- Tomokazu Tanaka
- a Department of Surgery , Saga University Faculty of Medicine , Saga , Japan
| | - Jun Nakamura
- a Department of Surgery , Saga University Faculty of Medicine , Saga , Japan
| | - Hirokazu Noshiro
- a Department of Surgery , Saga University Faculty of Medicine , Saga , Japan
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23
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Bilgin B, Sendur MAN, Bülent Akıncı M, Şener Dede D, Yalçın B. Targeting the PD-1 pathway: a new hope for gastrointestinal cancers. Curr Med Res Opin 2017; 33:749-759. [PMID: 28055269 DOI: 10.1080/03007995.2017.1279132] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND VEGF, HER2 and EGFR targeted agents are currently used in gastric, esophageal and colorectal cancers. However, treatment outcomes are still poor in most gastrointestinal (GI) cancers. Immune checkpoints are one of the most promising immunotherapy approaches. In this review article, we aim to discuss the efficacy and safety of anti-PD-1/PD-L1 therapies in GI cancers, including gastric, esophageal and colorectal cancer in published or reported recent studies. SCOPE A literature search was made from PubMed and ASCO Annual Meeting abstracts by using the following search keywords: "nivolumab", "pembrolizumab", "avelumab", "GI cancers" "anti-PD1 therapy" and "anti-PD-L1 therapy". The last search was on 2 November 2016. The most important limitation of our review is that most of the data on anti-PD-1/PD-L1 therapies in GI cancers relies on phase 1 and 2 trials. FINDINGS Currently, there are two anti-PD-1 (nivolumab and pembrolizumab) and one anti-PDL1 (atezolizumab) agents approved by FDA. After the treatment efficacy of immune checkpoint blockade was shown in melanoma, renal cell cancer and non-squamous lung cancer, trials which evaluate immune checkpoint blockade in GI cancers are ongoing. Early results of trials have been promising and encouraging for patients with advanced stage gastroesophageal cancer. According to early results of published trials, response to anti-PD1/PD-L1 agents appears to be associated with tumor PD-L1 levels. According to two recently published phase 2 trials, the clinical benefits of immune checkpoint blockade with both nivolumab and pembrolizumab were limited in patients with microsatellite instability (MSI) positive advanced colorectal cancer. However, several phase 2/3 trials are still ongoing. CONCLUSION Both pembrolizumab and nivolumab show promising efficacy with acceptable safety data in published trials in GI cancers, especially in refractory MSI positive metastatic colorectal cancer.
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Affiliation(s)
- Burak Bilgin
- a Yıldırım Beyazıt University , Faculty of Medicine, Department of Medical Oncology , Ankara , Turkey
| | - Mehmet A N Sendur
- a Yıldırım Beyazıt University , Faculty of Medicine, Department of Medical Oncology , Ankara , Turkey
| | - Muhammed Bülent Akıncı
- a Yıldırım Beyazıt University , Faculty of Medicine, Department of Medical Oncology , Ankara , Turkey
| | - Didem Şener Dede
- a Yıldırım Beyazıt University , Faculty of Medicine, Department of Medical Oncology , Ankara , Turkey
| | - Bülent Yalçın
- a Yıldırım Beyazıt University , Faculty of Medicine, Department of Medical Oncology , Ankara , Turkey
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24
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Abstract
This review summarizes completed and ongoing studies evaluating the activity of immune checkpoint inhibitors in esophagogastric cancer.
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Affiliation(s)
- Geoffrey Y Ku
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, Room 1035, New York, NY 10065, USA.
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25
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Massard C, Gordon MS, Sharma S, Rafii S, Wainberg ZA, Luke J, Curiel TJ, Colon-Otero G, Hamid O, Sanborn RE, O'Donnell PH, Drakaki A, Tan W, Kurland JF, Rebelatto MC, Jin X, Blake-Haskins JA, Gupta A, Segal NH. Safety and Efficacy of Durvalumab (MEDI4736), an Anti-Programmed Cell Death Ligand-1 Immune Checkpoint Inhibitor, in Patients With Advanced Urothelial Bladder Cancer. J Clin Oncol 2016; 34:3119-25. [PMID: 27269937 PMCID: PMC5569690 DOI: 10.1200/jco.2016.67.9761] [Citation(s) in RCA: 649] [Impact Index Per Article: 81.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To investigate the safety and efficacy of durvalumab, a human monoclonal antibody that binds programmed cell death ligand-1 (PD-L1), and the role of PD-L1 expression on clinical response in patients with advanced urothelial bladder cancer (UBC). METHODS A phase 1/2 multicenter, open-label study is being conducted in patients with inoperable or metastatic solid tumors. We report here the results from the UBC expansion cohort. Durvalumab (MEDI4736, 10 mg/kg every 2 weeks) was administered intravenously for up to 12 months. The primary end point was safety, and objective response rate (ORR, confirmed) was a key secondary end point. An exploratory analysis of pretreatment tumor biopsies led to defining PD-L1-positive as ≥ 25% of tumor cells or tumor-infiltrating immune cells expressing membrane PD-L1. RESULTS A total of 61 patients (40 PD-L1-positive, 21 PD-L1-negative), 93.4% of whom received one or more prior therapies for advanced disease, were treated (median duration of follow-up, 4.3 months). The most common treatment-related adverse events (AEs) of any grade were fatigue (13.1%), diarrhea (9.8%), and decreased appetite (8.2%). Grade 3 treatment-related AEs occurred in three patients (4.9%); there were no treatment-related grade 4 or 5 AEs. One treatment-related AE (acute kidney injury) resulted in treatment discontinuation. The ORR was 31.0% (95% CI, 17.6 to 47.1) in 42 response-evaluable patients, 46.4% (95% CI, 27.5 to 66.1) in the PD-L1-positive subgroup, and 0% (95% CI, 0.0 to 23.2) in the PD-L1-negative subgroup. Responses are ongoing in 12 of 13 responding patients, with median duration of response not yet reached (range, 4.1+ to 49.3+ weeks). CONCLUSION Durvalumab demonstrated a manageable safety profile and evidence of meaningful clinical activity in PD-L1-positive patients with UBC, many of whom were heavily pretreated.
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Affiliation(s)
- Christophe Massard
- Christophe Massard, Institut Gustave Roussy Cancer Centre, Villejuif, France; Michael S. Gordon, Pinnacle Oncology Hematology, Scottsdale, AZ; Sunil Sharma, Huntsman Cancer Institute, Salt Lake City, UT; Saeed Rafii, Sarah Cannon Research Institute, London, UK; Zev A. Wainberg and Alexandra Drakaki, University of California, Los Angeles; and Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Jason Luke and Peter H. O'Donnell, University of Chicago Comprehensive Cancer Center, Chicago, IL; Tyler J. Curiel, The University of Texas Health Science Center, San Antonio, TX; Gerardo Colon-Otero and Winston Tan, Mayo Clinic, Jacksonville, FL; Rachel E. Sanborn, Providence Cancer Center, Portland, OR; John F. Kurland, Marlon C. Rebelatto, Xiaoping Jin, John A. Blake-Haskins, and Ashok Gupta, MedImmune, Gaithersburg, MD; and Neil H. Segal, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael S Gordon
- Christophe Massard, Institut Gustave Roussy Cancer Centre, Villejuif, France; Michael S. Gordon, Pinnacle Oncology Hematology, Scottsdale, AZ; Sunil Sharma, Huntsman Cancer Institute, Salt Lake City, UT; Saeed Rafii, Sarah Cannon Research Institute, London, UK; Zev A. Wainberg and Alexandra Drakaki, University of California, Los Angeles; and Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Jason Luke and Peter H. O'Donnell, University of Chicago Comprehensive Cancer Center, Chicago, IL; Tyler J. Curiel, The University of Texas Health Science Center, San Antonio, TX; Gerardo Colon-Otero and Winston Tan, Mayo Clinic, Jacksonville, FL; Rachel E. Sanborn, Providence Cancer Center, Portland, OR; John F. Kurland, Marlon C. Rebelatto, Xiaoping Jin, John A. Blake-Haskins, and Ashok Gupta, MedImmune, Gaithersburg, MD; and Neil H. Segal, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sunil Sharma
- Christophe Massard, Institut Gustave Roussy Cancer Centre, Villejuif, France; Michael S. Gordon, Pinnacle Oncology Hematology, Scottsdale, AZ; Sunil Sharma, Huntsman Cancer Institute, Salt Lake City, UT; Saeed Rafii, Sarah Cannon Research Institute, London, UK; Zev A. Wainberg and Alexandra Drakaki, University of California, Los Angeles; and Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Jason Luke and Peter H. O'Donnell, University of Chicago Comprehensive Cancer Center, Chicago, IL; Tyler J. Curiel, The University of Texas Health Science Center, San Antonio, TX; Gerardo Colon-Otero and Winston Tan, Mayo Clinic, Jacksonville, FL; Rachel E. Sanborn, Providence Cancer Center, Portland, OR; John F. Kurland, Marlon C. Rebelatto, Xiaoping Jin, John A. Blake-Haskins, and Ashok Gupta, MedImmune, Gaithersburg, MD; and Neil H. Segal, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Saeed Rafii
- Christophe Massard, Institut Gustave Roussy Cancer Centre, Villejuif, France; Michael S. Gordon, Pinnacle Oncology Hematology, Scottsdale, AZ; Sunil Sharma, Huntsman Cancer Institute, Salt Lake City, UT; Saeed Rafii, Sarah Cannon Research Institute, London, UK; Zev A. Wainberg and Alexandra Drakaki, University of California, Los Angeles; and Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Jason Luke and Peter H. O'Donnell, University of Chicago Comprehensive Cancer Center, Chicago, IL; Tyler J. Curiel, The University of Texas Health Science Center, San Antonio, TX; Gerardo Colon-Otero and Winston Tan, Mayo Clinic, Jacksonville, FL; Rachel E. Sanborn, Providence Cancer Center, Portland, OR; John F. Kurland, Marlon C. Rebelatto, Xiaoping Jin, John A. Blake-Haskins, and Ashok Gupta, MedImmune, Gaithersburg, MD; and Neil H. Segal, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Zev A Wainberg
- Christophe Massard, Institut Gustave Roussy Cancer Centre, Villejuif, France; Michael S. Gordon, Pinnacle Oncology Hematology, Scottsdale, AZ; Sunil Sharma, Huntsman Cancer Institute, Salt Lake City, UT; Saeed Rafii, Sarah Cannon Research Institute, London, UK; Zev A. Wainberg and Alexandra Drakaki, University of California, Los Angeles; and Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Jason Luke and Peter H. O'Donnell, University of Chicago Comprehensive Cancer Center, Chicago, IL; Tyler J. Curiel, The University of Texas Health Science Center, San Antonio, TX; Gerardo Colon-Otero and Winston Tan, Mayo Clinic, Jacksonville, FL; Rachel E. Sanborn, Providence Cancer Center, Portland, OR; John F. Kurland, Marlon C. Rebelatto, Xiaoping Jin, John A. Blake-Haskins, and Ashok Gupta, MedImmune, Gaithersburg, MD; and Neil H. Segal, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jason Luke
- Christophe Massard, Institut Gustave Roussy Cancer Centre, Villejuif, France; Michael S. Gordon, Pinnacle Oncology Hematology, Scottsdale, AZ; Sunil Sharma, Huntsman Cancer Institute, Salt Lake City, UT; Saeed Rafii, Sarah Cannon Research Institute, London, UK; Zev A. Wainberg and Alexandra Drakaki, University of California, Los Angeles; and Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Jason Luke and Peter H. O'Donnell, University of Chicago Comprehensive Cancer Center, Chicago, IL; Tyler J. Curiel, The University of Texas Health Science Center, San Antonio, TX; Gerardo Colon-Otero and Winston Tan, Mayo Clinic, Jacksonville, FL; Rachel E. Sanborn, Providence Cancer Center, Portland, OR; John F. Kurland, Marlon C. Rebelatto, Xiaoping Jin, John A. Blake-Haskins, and Ashok Gupta, MedImmune, Gaithersburg, MD; and Neil H. Segal, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tyler J Curiel
- Christophe Massard, Institut Gustave Roussy Cancer Centre, Villejuif, France; Michael S. Gordon, Pinnacle Oncology Hematology, Scottsdale, AZ; Sunil Sharma, Huntsman Cancer Institute, Salt Lake City, UT; Saeed Rafii, Sarah Cannon Research Institute, London, UK; Zev A. Wainberg and Alexandra Drakaki, University of California, Los Angeles; and Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Jason Luke and Peter H. O'Donnell, University of Chicago Comprehensive Cancer Center, Chicago, IL; Tyler J. Curiel, The University of Texas Health Science Center, San Antonio, TX; Gerardo Colon-Otero and Winston Tan, Mayo Clinic, Jacksonville, FL; Rachel E. Sanborn, Providence Cancer Center, Portland, OR; John F. Kurland, Marlon C. Rebelatto, Xiaoping Jin, John A. Blake-Haskins, and Ashok Gupta, MedImmune, Gaithersburg, MD; and Neil H. Segal, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gerardo Colon-Otero
- Christophe Massard, Institut Gustave Roussy Cancer Centre, Villejuif, France; Michael S. Gordon, Pinnacle Oncology Hematology, Scottsdale, AZ; Sunil Sharma, Huntsman Cancer Institute, Salt Lake City, UT; Saeed Rafii, Sarah Cannon Research Institute, London, UK; Zev A. Wainberg and Alexandra Drakaki, University of California, Los Angeles; and Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Jason Luke and Peter H. O'Donnell, University of Chicago Comprehensive Cancer Center, Chicago, IL; Tyler J. Curiel, The University of Texas Health Science Center, San Antonio, TX; Gerardo Colon-Otero and Winston Tan, Mayo Clinic, Jacksonville, FL; Rachel E. Sanborn, Providence Cancer Center, Portland, OR; John F. Kurland, Marlon C. Rebelatto, Xiaoping Jin, John A. Blake-Haskins, and Ashok Gupta, MedImmune, Gaithersburg, MD; and Neil H. Segal, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Omid Hamid
- Christophe Massard, Institut Gustave Roussy Cancer Centre, Villejuif, France; Michael S. Gordon, Pinnacle Oncology Hematology, Scottsdale, AZ; Sunil Sharma, Huntsman Cancer Institute, Salt Lake City, UT; Saeed Rafii, Sarah Cannon Research Institute, London, UK; Zev A. Wainberg and Alexandra Drakaki, University of California, Los Angeles; and Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Jason Luke and Peter H. O'Donnell, University of Chicago Comprehensive Cancer Center, Chicago, IL; Tyler J. Curiel, The University of Texas Health Science Center, San Antonio, TX; Gerardo Colon-Otero and Winston Tan, Mayo Clinic, Jacksonville, FL; Rachel E. Sanborn, Providence Cancer Center, Portland, OR; John F. Kurland, Marlon C. Rebelatto, Xiaoping Jin, John A. Blake-Haskins, and Ashok Gupta, MedImmune, Gaithersburg, MD; and Neil H. Segal, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rachel E Sanborn
- Christophe Massard, Institut Gustave Roussy Cancer Centre, Villejuif, France; Michael S. Gordon, Pinnacle Oncology Hematology, Scottsdale, AZ; Sunil Sharma, Huntsman Cancer Institute, Salt Lake City, UT; Saeed Rafii, Sarah Cannon Research Institute, London, UK; Zev A. Wainberg and Alexandra Drakaki, University of California, Los Angeles; and Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Jason Luke and Peter H. O'Donnell, University of Chicago Comprehensive Cancer Center, Chicago, IL; Tyler J. Curiel, The University of Texas Health Science Center, San Antonio, TX; Gerardo Colon-Otero and Winston Tan, Mayo Clinic, Jacksonville, FL; Rachel E. Sanborn, Providence Cancer Center, Portland, OR; John F. Kurland, Marlon C. Rebelatto, Xiaoping Jin, John A. Blake-Haskins, and Ashok Gupta, MedImmune, Gaithersburg, MD; and Neil H. Segal, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Peter H O'Donnell
- Christophe Massard, Institut Gustave Roussy Cancer Centre, Villejuif, France; Michael S. Gordon, Pinnacle Oncology Hematology, Scottsdale, AZ; Sunil Sharma, Huntsman Cancer Institute, Salt Lake City, UT; Saeed Rafii, Sarah Cannon Research Institute, London, UK; Zev A. Wainberg and Alexandra Drakaki, University of California, Los Angeles; and Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Jason Luke and Peter H. O'Donnell, University of Chicago Comprehensive Cancer Center, Chicago, IL; Tyler J. Curiel, The University of Texas Health Science Center, San Antonio, TX; Gerardo Colon-Otero and Winston Tan, Mayo Clinic, Jacksonville, FL; Rachel E. Sanborn, Providence Cancer Center, Portland, OR; John F. Kurland, Marlon C. Rebelatto, Xiaoping Jin, John A. Blake-Haskins, and Ashok Gupta, MedImmune, Gaithersburg, MD; and Neil H. Segal, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alexandra Drakaki
- Christophe Massard, Institut Gustave Roussy Cancer Centre, Villejuif, France; Michael S. Gordon, Pinnacle Oncology Hematology, Scottsdale, AZ; Sunil Sharma, Huntsman Cancer Institute, Salt Lake City, UT; Saeed Rafii, Sarah Cannon Research Institute, London, UK; Zev A. Wainberg and Alexandra Drakaki, University of California, Los Angeles; and Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Jason Luke and Peter H. O'Donnell, University of Chicago Comprehensive Cancer Center, Chicago, IL; Tyler J. Curiel, The University of Texas Health Science Center, San Antonio, TX; Gerardo Colon-Otero and Winston Tan, Mayo Clinic, Jacksonville, FL; Rachel E. Sanborn, Providence Cancer Center, Portland, OR; John F. Kurland, Marlon C. Rebelatto, Xiaoping Jin, John A. Blake-Haskins, and Ashok Gupta, MedImmune, Gaithersburg, MD; and Neil H. Segal, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Winston Tan
- Christophe Massard, Institut Gustave Roussy Cancer Centre, Villejuif, France; Michael S. Gordon, Pinnacle Oncology Hematology, Scottsdale, AZ; Sunil Sharma, Huntsman Cancer Institute, Salt Lake City, UT; Saeed Rafii, Sarah Cannon Research Institute, London, UK; Zev A. Wainberg and Alexandra Drakaki, University of California, Los Angeles; and Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Jason Luke and Peter H. O'Donnell, University of Chicago Comprehensive Cancer Center, Chicago, IL; Tyler J. Curiel, The University of Texas Health Science Center, San Antonio, TX; Gerardo Colon-Otero and Winston Tan, Mayo Clinic, Jacksonville, FL; Rachel E. Sanborn, Providence Cancer Center, Portland, OR; John F. Kurland, Marlon C. Rebelatto, Xiaoping Jin, John A. Blake-Haskins, and Ashok Gupta, MedImmune, Gaithersburg, MD; and Neil H. Segal, Memorial Sloan Kettering Cancer Center, New York, NY
| | - John F Kurland
- Christophe Massard, Institut Gustave Roussy Cancer Centre, Villejuif, France; Michael S. Gordon, Pinnacle Oncology Hematology, Scottsdale, AZ; Sunil Sharma, Huntsman Cancer Institute, Salt Lake City, UT; Saeed Rafii, Sarah Cannon Research Institute, London, UK; Zev A. Wainberg and Alexandra Drakaki, University of California, Los Angeles; and Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Jason Luke and Peter H. O'Donnell, University of Chicago Comprehensive Cancer Center, Chicago, IL; Tyler J. Curiel, The University of Texas Health Science Center, San Antonio, TX; Gerardo Colon-Otero and Winston Tan, Mayo Clinic, Jacksonville, FL; Rachel E. Sanborn, Providence Cancer Center, Portland, OR; John F. Kurland, Marlon C. Rebelatto, Xiaoping Jin, John A. Blake-Haskins, and Ashok Gupta, MedImmune, Gaithersburg, MD; and Neil H. Segal, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marlon C Rebelatto
- Christophe Massard, Institut Gustave Roussy Cancer Centre, Villejuif, France; Michael S. Gordon, Pinnacle Oncology Hematology, Scottsdale, AZ; Sunil Sharma, Huntsman Cancer Institute, Salt Lake City, UT; Saeed Rafii, Sarah Cannon Research Institute, London, UK; Zev A. Wainberg and Alexandra Drakaki, University of California, Los Angeles; and Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Jason Luke and Peter H. O'Donnell, University of Chicago Comprehensive Cancer Center, Chicago, IL; Tyler J. Curiel, The University of Texas Health Science Center, San Antonio, TX; Gerardo Colon-Otero and Winston Tan, Mayo Clinic, Jacksonville, FL; Rachel E. Sanborn, Providence Cancer Center, Portland, OR; John F. Kurland, Marlon C. Rebelatto, Xiaoping Jin, John A. Blake-Haskins, and Ashok Gupta, MedImmune, Gaithersburg, MD; and Neil H. Segal, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Xiaoping Jin
- Christophe Massard, Institut Gustave Roussy Cancer Centre, Villejuif, France; Michael S. Gordon, Pinnacle Oncology Hematology, Scottsdale, AZ; Sunil Sharma, Huntsman Cancer Institute, Salt Lake City, UT; Saeed Rafii, Sarah Cannon Research Institute, London, UK; Zev A. Wainberg and Alexandra Drakaki, University of California, Los Angeles; and Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Jason Luke and Peter H. O'Donnell, University of Chicago Comprehensive Cancer Center, Chicago, IL; Tyler J. Curiel, The University of Texas Health Science Center, San Antonio, TX; Gerardo Colon-Otero and Winston Tan, Mayo Clinic, Jacksonville, FL; Rachel E. Sanborn, Providence Cancer Center, Portland, OR; John F. Kurland, Marlon C. Rebelatto, Xiaoping Jin, John A. Blake-Haskins, and Ashok Gupta, MedImmune, Gaithersburg, MD; and Neil H. Segal, Memorial Sloan Kettering Cancer Center, New York, NY
| | - John A Blake-Haskins
- Christophe Massard, Institut Gustave Roussy Cancer Centre, Villejuif, France; Michael S. Gordon, Pinnacle Oncology Hematology, Scottsdale, AZ; Sunil Sharma, Huntsman Cancer Institute, Salt Lake City, UT; Saeed Rafii, Sarah Cannon Research Institute, London, UK; Zev A. Wainberg and Alexandra Drakaki, University of California, Los Angeles; and Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Jason Luke and Peter H. O'Donnell, University of Chicago Comprehensive Cancer Center, Chicago, IL; Tyler J. Curiel, The University of Texas Health Science Center, San Antonio, TX; Gerardo Colon-Otero and Winston Tan, Mayo Clinic, Jacksonville, FL; Rachel E. Sanborn, Providence Cancer Center, Portland, OR; John F. Kurland, Marlon C. Rebelatto, Xiaoping Jin, John A. Blake-Haskins, and Ashok Gupta, MedImmune, Gaithersburg, MD; and Neil H. Segal, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ashok Gupta
- Christophe Massard, Institut Gustave Roussy Cancer Centre, Villejuif, France; Michael S. Gordon, Pinnacle Oncology Hematology, Scottsdale, AZ; Sunil Sharma, Huntsman Cancer Institute, Salt Lake City, UT; Saeed Rafii, Sarah Cannon Research Institute, London, UK; Zev A. Wainberg and Alexandra Drakaki, University of California, Los Angeles; and Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Jason Luke and Peter H. O'Donnell, University of Chicago Comprehensive Cancer Center, Chicago, IL; Tyler J. Curiel, The University of Texas Health Science Center, San Antonio, TX; Gerardo Colon-Otero and Winston Tan, Mayo Clinic, Jacksonville, FL; Rachel E. Sanborn, Providence Cancer Center, Portland, OR; John F. Kurland, Marlon C. Rebelatto, Xiaoping Jin, John A. Blake-Haskins, and Ashok Gupta, MedImmune, Gaithersburg, MD; and Neil H. Segal, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neil H Segal
- Christophe Massard, Institut Gustave Roussy Cancer Centre, Villejuif, France; Michael S. Gordon, Pinnacle Oncology Hematology, Scottsdale, AZ; Sunil Sharma, Huntsman Cancer Institute, Salt Lake City, UT; Saeed Rafii, Sarah Cannon Research Institute, London, UK; Zev A. Wainberg and Alexandra Drakaki, University of California, Los Angeles; and Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, CA; Jason Luke and Peter H. O'Donnell, University of Chicago Comprehensive Cancer Center, Chicago, IL; Tyler J. Curiel, The University of Texas Health Science Center, San Antonio, TX; Gerardo Colon-Otero and Winston Tan, Mayo Clinic, Jacksonville, FL; Rachel E. Sanborn, Providence Cancer Center, Portland, OR; John F. Kurland, Marlon C. Rebelatto, Xiaoping Jin, John A. Blake-Haskins, and Ashok Gupta, MedImmune, Gaithersburg, MD; and Neil H. Segal, Memorial Sloan Kettering Cancer Center, New York, NY.
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Serre R, Benzekry S, Padovani L, Meille C, André N, Ciccolini J, Barlesi F, Muracciole X, Barbolosi D. Mathematical Modeling of Cancer Immunotherapy and Its Synergy with Radiotherapy. Cancer Res 2016; 76:4931-40. [DOI: 10.1158/0008-5472.can-15-3567] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/25/2016] [Indexed: 11/16/2022]
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Yegin EG, Oymaci E, Karatay E, Coker A. Progress in surgical and nonsurgical approaches for hepatocellular carcinoma treatment. Hepatobiliary Pancreat Dis Int 2016; 15:234-56. [PMID: 27298100 DOI: 10.1016/s1499-3872(16)60097-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a complex and heterogeneous malignancy, frequently occurs in the setting of a chronically diseased organ, with multiple confounding factors making its management challenging. HCC represents one of the leading causes of cancer-related mortality globally with a rising trend of incidence in some of the developed countries, which indicates the need for better surgical and nonsurgical management strategies. DATA SOURCES PubMed database was searched for relevant articles in English on the issue of HCC management. RESULTS Surgical resection represents a potentially curative option for appropriate candidates with tumors detected at earlier stages and with well-preserved liver function. The long-term outcome of surgery is impaired by a high rate of recurrence. Surgical approaches are being challenged by local ablative therapies such as radiofrequency ablation and microwave ablation in selected patients. Liver transplantation offers potential cure for HCC and also correction of underlying liver disease, and minimizes the risk of recurrence, but is reserved for patients within a set of criteria proposed for a prudent allocation in the shortage of donor organs. Transcatheter locoregional therapies have become the palliative standard allowing local control for intermediate stage patients with noninvasive multinodular or large HCC who are beyond the potentially curative options. The significant survival benefit with the multikinase inhibitor sorafenib for advanced HCC has shifted the direction of research regarding systemic treatment toward molecular therapies targeting the disregulated pathways of hepatocarcinogenesis. Potential benefit is suggested from simultaneous or sequential multimodal therapies, and optimal combinations are being investigated. Despite the striking progress in preclinical studies of HCC immunotherapy and gene therapy, extensive clinical trials are required to achieve successful clinical applications of these innovative approaches. CONCLUSION Treatment decisions have become increasingly complex for HCC with the availability of multiple surgical and nonsurgical therapeutic options and require a comprehensive, multidisciplinary approach.
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Affiliation(s)
- Ender Gunes Yegin
- Department of Gastroenterology, Bozyaka Training and Research Hospital, Izmir 35170, Turkey.
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28
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Harding JJ, El Dika I, Abou-Alfa GK. Immunotherapy in hepatocellular carcinoma: Primed to make a difference? Cancer 2015; 122:367-77. [PMID: 26540029 DOI: 10.1002/cncr.29769] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/04/2015] [Accepted: 09/17/2015] [Indexed: 12/14/2022]
Abstract
Advanced hepatocellular carcinoma (HCC) carries a dismal prognosis and the current treatment is limited to sorafenib, an agent with modest benefit. Preclinical data have indicated that several immunologic mechanisms are at play to promote HCC development and growth while impairing effective antitumor immune surveillance. Several novel approaches geared toward manipulating the immune response to HCC have suggested a therapeutic benefit in early-stage clinical trials, indicating a real potential to augment tumor-specific immunity and improve outcomes in patients with this disease. In the current study, the authors reviewed the barriers to an effective immune response against HCC and contemporary clinical investigations that may be "primed" to alter the natural history of HCC.
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Affiliation(s)
- James J Harding
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Imane El Dika
- Internal Medicine/Hematology and Oncology, American University of Beirut, Beirut, Lebanon
| | - Ghassan K Abou-Alfa
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
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Loirat D, Le Tourneau C. Immunothérapie anticancer : les molécules immunomodulatrices en développement clinique. ONCOLOGIE 2015. [DOI: 10.1007/s10269-015-2546-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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30
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Translational Considerations on the Outlook of Immunotherapy for Colorectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2015. [DOI: 10.1007/s11888-015-0258-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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