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West J, Robertson-Tessi M, Luddy K, Park DS, Williamson DFK, Harmon C, Khong HT, Brown J, Anderson ARA. The Immune Checkpoint Kick Start: Optimization of Neoadjuvant Combination Therapy Using Game Theory. JCO Clin Cancer Inform 2020; 3:1-12. [PMID: 30742484 DOI: 10.1200/cci.18.00078] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE In an upcoming clinical trial at the Moffitt Cancer Center for women with stage 2/3 estrogen receptor-positive breast cancer, treatment with an aromatase inhibitor and a PD-L1 checkpoint inhibitor combination will be investigated to lower a preoperative endocrine prognostic index (PEPI) that correlates with relapse-free survival. PEPI is fundamentally a static index, measured at the end of neoadjuvant therapy before surgery. We have developed a mathematical model of the essential components of the PEPI score to identify successful combination therapy regimens that minimize tumor burden and metastatic potential, on the basis of time-dependent trade-offs in the system. METHODS We considered two molecular traits, CCR7 and PD-L1, which correlate with treatment response and increased metastatic risk. We used a matrix game model with the four phenotypic strategies to examine the frequency-dependent interactions of cancer cells. This game was embedded in an ecological model of tumor population-growth dynamics. The resulting model predicts evolutionary and ecological dynamics that track with changes in the PEPI score. RESULTS We considered various treatment regimens on the basis of combinations of the two therapies with drug holidays. By considering the trade off between tumor burden and metastatic potential, the optimal therapy plan was a 1-month kick start of the immune checkpoint inhibitor followed by 5 months of continuous combination therapy. Relative to a protocol giving both therapeutics together from the start, this delayed regimen resulted in transient suboptimal tumor regression while maintaining a phenotypic constitution that is more amenable to fast tumor regression for the final 5 months of therapy. CONCLUSION The mathematical model provides a useful abstraction of clinical intuition, enabling hypothesis generation and testing of clinical assumptions.
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Affiliation(s)
- Jeffrey West
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - Kimberly Luddy
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.,Trinity College Dublin, Dublin, Ireland
| | - Derek S Park
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | - Hung T Khong
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Joel Brown
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.,University of Illinois at Chicago, Chicago, IL
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Besse B, Barlesi F, Demedts I, Fuentes Pradera J, Robinet G, Gazzah A, Soldatenkova V, Frimodt-Moller B, Kim JS, Vansteenkiste J. A phase 1b study of necitumumab in combination with abemaciclib in patients with stage IV non-small cell lung cancer. Lung Cancer 2019; 137:136-143. [PMID: 31586771 DOI: 10.1016/j.lungcan.2019.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/26/2019] [Accepted: 09/02/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Necitumumab, an anti-EGFR antibody, and abemaciclib, a CDK4/6 inhibitor, have shown activity in patients with non-small cell lung cancer (NSCLC) and have non-overlapping toxicities. A 2-part, single-arm, multicenter, phase 1b trial was conducted to test the safety and efficacy of necitumumab plus abemaciclib in patients with advanced NSCLC who had received ≤2 lines of chemotherapy, including a platinum-based one. MATERIALS AND METHODS Part A was a dose-escalation phase for abemaciclib (100, 150, 200 mg, Q12 H) in combination with necitumumab 800 mg D1D8 Q3W to determine the recommended dose for the expansion cohort, Part B. The primary endpoint was progression-free survival (PFS) rate at 3 months. RESULTS Sixty-six patients entered the study: 71% male, 41% squamous histology, 15% never-smokers. In Part A (n = 15), the maximum tolerated dose of abemaciclib was 150 mg Q12H in combination with necitumumab 800 mg. In 57 patients treated at this dose level, the 3-month PFS rate was 32.3% (95% CI: 20.4-44.8); median PFS was 2.14 months (1.41-2.76). The overall response rate (ORR) was 5.3% (1.1-14.6). The median OS was 6.93 months (4.96-12.85). In the exploratory subgroup analysis of EGFR expression-negative patients (n = 10), both the 3-month PFS and ORR were 0.0%. The most common grade 3 treatment-emergent adverse events were fatigue (14%), dyspnea (9%), diarrhea (7%), vomiting (7%), and hypokalemia (7%). CONCLUSIONS Abemaciclib 150 mg Q12H with necitumumab 800 mg did not produce an additive effect over single-agent activity in patients with Stage IV NSCLC. The safety profile was consistent with the individual study drugs.
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Affiliation(s)
- Benjamin Besse
- Gustave Roussy Cancer Center, Villejuif, France and Paris-Sud University, Orsay, France.
| | - Fabrice Barlesi
- Aix Marseille University, CNRS, INSERM, CRCM, Assistance Publique Hôpitaux de Marseille, Centre Essais Précoces en Cancérologie de Marseille CLIP², Marseille, France
| | - Ingel Demedts
- AZ Delta, Wilgenstraat 2, Department of Pulmonary Diseases, Roeselare, 8800, Belgium
| | - Jose Fuentes Pradera
- Hospital Universitario Nuestra Señora de Valme, Autovia Sevilla-Cadiz, s/n ONCOLOGY, Sevilla, 46014, Spain
| | - Gilles Robinet
- CHU de Brest - Hôpital Morvan, 5 Avenue Foch, Brest, 29200, France
| | - Anas Gazzah
- Gustave Roussy Cancer Center, Villejuif, France and Paris-Sud University, Orsay, France
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Soyano AE, Dholaria B, Marin-Acevedo JA, Diehl N, Hodge D, Luo Y, Manochakian R, Chumsri S, Adjei A, Knutson KL, Lou Y. Peripheral blood biomarkers correlate with outcomes in advanced non-small cell lung Cancer patients treated with anti-PD-1 antibodies. J Immunother Cancer 2018; 6:129. [PMID: 30470260 PMCID: PMC6251165 DOI: 10.1186/s40425-018-0447-2] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 11/08/2018] [Indexed: 01/15/2023] Open
Abstract
Background Anti-programmed cell death 1 (PD-1) antibodies have demonstrated improved overall survival (OS) and progression-free survival (PFS) in a subset of patients with metastatic or locally advanced non-small cell lung cancer (NSCLC). To date, no blood biomarkers have been identified in NSCLC to predict clinical outcomes of treatment with anti-PD-1 antibodies. Patient and methods We performed an analysis of retrospectively registered data of 157 patients with advanced NSCLC treated with anti-PD-1 antibodies at Mayo Clinic in Florida and Rochester. White blood cell count, absolute neutrophil count (ANC), absolute lymphocyte count (ALC), ANC to ALC (ANC: ALC) ratio, absolute eosinophil count, absolute monocyte count (AMC), platelet counts, and myeloid to lymphoid (M:L) ratio at baseline and throughout treatment were assessed. Kaplan-Meier method and Cox proportional hazards model were performed. Results We treated 146 patients with nivolumab and 11 with pembrolizumab between January 1, 2015 and April 15, 2017. At median follow-up of 20 months, median OS and PFS were 6.0 and 2.6 months, respectively. Higher baseline ANC, AMC, ANC: ALC ratio and M: L ratio correlated with worse clinical outcomes in patients who underwent anti-PD-1 treatment. A baseline ANC: ALC ratio of 5.9 or higher had a significantly increased risk of death (hazard ratio [HR] =1.94; 95% confidence interval [CI], 1.24–3.03; P = 0.004) and disease progression (HR, 1.65; 95% CI, 1.17–2.34; P = 0.005) compared with patients with lower ratio. Similarly, a baseline M: L ratio of 11.3 or higher had significantly increased risk of death (HR, 2.5; 95% CI, 1.54–4.05; P < 0.001), even after a multivariate analysis (HR, 2.31; P = 0.002), compared to those with lower ratio. Conclusions Increased baseline ANC: ALC ratio and M: L ratio before initiation of anti-PD1 antibodies were associated with poor PFS and OS in advanced NSCLC patients. The potential predictive value of these readily available biomarkers might help with risk stratification and treatment strategies. These findings warrant further investigation in a larger, prospective study. Electronic supplementary material The online version of this article (10.1186/s40425-018-0447-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aixa E Soyano
- Department of Hematology and Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Bhagirathbhai Dholaria
- Department of Hematology and Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.,Department of Blood and Marrow Transplantation and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Nancy Diehl
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - David Hodge
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Yan Luo
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | - Rami Manochakian
- Department of Hematology and Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Saranya Chumsri
- Robert and Monica Jacoby Center for Breast Health, Mayo Clinic, Jacksonville, FL, USA
| | - Alex Adjei
- Department of Medical Oncology, Mayo Clinic, Rochester, MI, USA
| | - Keith L Knutson
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | - Yanyan Lou
- Department of Hematology and Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Kim ES, Kelly K, Paz-Ares LG, Garrido P, Jalal S, Mahadevan D, Gutierrez M, Provencio M, Schaefer E, Shaheen M, Johnston EL, Turner PK, Kambhampati SRP, Beckmann R, Hossain A, John WJ, Goldman JW. Abemaciclib in Combination with Single-Agent Options in Patients with Stage IV Non-Small Cell Lung Cancer: A Phase Ib Study. Clin Cancer Res 2018; 24:5543-5551. [PMID: 30082474 DOI: 10.1158/1078-0432.ccr-18-0651] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/18/2018] [Accepted: 07/30/2018] [Indexed: 11/16/2022]
Abstract
Purpose: Abemaciclib, a dual inhibitor of cyclin-dependent kinases 4 and 6, has demonstrated preclinical activity in non-small cell lung cancer (NSCLC). A multicenter, nonrandomized, open-label phase Ib study was conducted to test safety, MTD, pharmacokinetics, and preliminary antitumor activity of abemaciclib in combination with other therapies for treatment in patients with metastatic NSCLC.Patients and Methods: An initial dose escalation phase was used to determine the MTD of twice-daily oral abemaciclib (150, 200 mg) plus pemetrexed, gemcitabine, or ramucirumab, followed by an expansion phase for each drug combination. Pemetrexed and gemcitabine were administered according to label. The abemaciclib plus ramucirumab study examined two dosing schedules.Results: The three study parts enrolled 86 patients; all received ≥1 dose of combination therapy. Across arms, the most common treatment-emergent adverse events were fatigue, diarrhea, neutropenia, decreased appetite, and nausea. The trial did not identify an abemaciclib MTD for the combination with pemetrexed or gemcitabine but did so for the combination of abemaciclib with days 1 and 8 ramucirumab (8 mg/kg). Plasma sample analysis showed that abemaciclib did not influence the pharmacokinetics of the combination agents and the combination agents did not affect abemaciclib exposure. The disease control rate was 57% for patients treated with abemaciclib-pemetrexed, 25% for abemaciclib-gemcitabine, and 54% for abemaciclib-ramucirumab. Median progression-free survival was 5.55, 1.58, and 4.83 months, respectively.Conclusions: Abemaciclib demonstrated an acceptable safety profile when dosed on a continuous twice-daily schedule in combination with pemetrexed, gemcitabine, or ramucirumab. Abemaciclib exposures remained consistent with those observed in single-agent studies. Clin Cancer Res; 24(22); 5543-51. ©2018 AACR.
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Affiliation(s)
- Edward S Kim
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina.
| | - Karen Kelly
- University of California, Davis, Comprehensive Cancer Center, Sacramento, California
| | - Luis G Paz-Ares
- Servicio de Oncología Médica, University Hospital Doce de Octubre, CNIO, Complutense University and CiberOnc, Madrid, Spain
| | - Pilar Garrido
- Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcalá, CiberOnc, Madrid, Spain
| | - Shadia Jalal
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | - Mariano Provencio
- Servicio de Oncología Médica, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - Monte Shaheen
- University of Arizona, Department of Medicine and Cancer Center, Tucson, Arizona
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Dhanak D, Edwards JP, Nguyen A, Tummino PJ. Small-Molecule Targets in Immuno-Oncology. Cell Chem Biol 2017; 24:1148-1160. [PMID: 28938090 DOI: 10.1016/j.chembiol.2017.08.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/04/2017] [Accepted: 08/23/2017] [Indexed: 01/12/2023]
Abstract
Advances in understanding the role and molecular mechanisms underlying immune surveillance and control of (pre)malignancies is revolutionizing clinical practice in the treatment of cancer. Presently, multiple biologic drugs targeting the immune checkpoint proteins PD(L)1 or CTLA4 have been approved and/or are in advanced stages of clinical development for many cancers. In addition, combination therapy with these agents and other immunomodulators is being intensively explored with the aim of improving primary response rates or prolonging overall survival. The effectiveness of cancer immunotherapy with biologics is spurring research in alternate approaches including small-molecule-mediated targeting of intracellular pathways modulating the innate and adaptive immune response. This focus of this review is on some of the key intracellular pathways where the development of a small-molecule therapeutic is attractive, tractable, and potentially synergistic with extracellular biologic-mediated immune checkpoint blockade.
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Affiliation(s)
- Dashyant Dhanak
- Discovery Sciences, Janssen Research & Development, 1400 McKean Road, P O Box 776, Spring House, PA 19477, USA.
| | - James P Edwards
- Discovery Sciences, Janssen Research & Development, 1400 McKean Road, P O Box 776, Spring House, PA 19477, USA
| | - Ancho Nguyen
- Immuno Oncology Discovery, Janssen Research & Development, 1400 McKean Road, P O Box 776, Spring House, PA 19477, USA
| | - Peter J Tummino
- Discovery Sciences, Janssen Research & Development, 1400 McKean Road, P O Box 776, Spring House, PA 19477, USA
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Checkpoint inhibitors for the treatment of non-small-cell lung cancer: news from the 2016 European Society for Medical Oncology Annual Congress. DRUGS & THERAPY PERSPECTIVES 2016. [DOI: 10.1007/s40267-016-0369-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Chopra M. Annual Congress of the European Society for Medical Oncology (ESMO): Copenhagen, Denmark; 7-11 October 2016. Target Oncol 2016; 11:705-709. [PMID: 27812901 DOI: 10.1007/s11523-016-0464-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Martin Chopra
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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