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Schauer F, Rafei-Shamsabadi D, Mai S, Mai Y, Izumi K, Meiss F, Kiritsi D. Hemidesmosomal Reactivity and Treatment Recommendations in Immune Checkpoint Inhibitor-Induced Bullous Pemphigoid—A Retrospective, Monocentric Study. Front Immunol 2022; 13:953546. [PMID: 35936009 PMCID: PMC9355658 DOI: 10.3389/fimmu.2022.953546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Immune checkpoint inhibitors (ICI) induce T-cell-mediated antitumour responses. While ICI were initially successfully applied in metastasized melanoma, they are now approved for several tumour entities. Numerous autoimmune disorders have been reported to occur as adverse events of the treatment, among them bullous pemphigoid (BP), with less than 1% of the patients experiencing ICI-induced BP. This number is higher than the estimated prevalence of autoimmune bullous diseases in the general population of Germany, which lies around 0.05%. We here describe our cohort of eight patients, who developed a bullous pemphigoid under or shortly after ICI treatment. Half of them had a severe subtype (as shown by BPDAI >57) and showed a median onset of ICI-BP after 10 months of ICI initiation. Six patients had a palmar and/or plantar involvement, while oral involvement occurred in one case. All patients had linear epidermal IgG depositions in split skin in the indirect immunofluorescence. In four out of five biopsies available for direct immunofluorescence, linear IgG and C3 depositions were detected at the basement membrane, while one patient showed linear IgM staining. Moderate to high levels of FLBP180 autoantibodies were found in seven of eight cases. The disease can still be active after ICI discontinuation, while rituximab might be required for remission. Finally, four tumour samples were stained histochemically for collagen XVII (BP180), but no enhanced expression was found.
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Affiliation(s)
- Franziska Schauer
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
- *Correspondence: Franziska Schauer,
| | - David Rafei-Shamsabadi
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Shoko Mai
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yosuke Mai
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kentaro Izumi
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Frank Meiss
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Dimitra Kiritsi
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
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Ma VT, Lao CD, Fecher LA, Schiopu E. Successful use of secukinumab in two melanoma patients with immune checkpoint inhibitor-induced inflammatory arthropathy. Immunotherapy 2022; 14:593-598. [PMID: 35416067 DOI: 10.2217/imt-2021-0274] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Immune-related adverse events (irAEs) are a major concern when treating cancer patients with immune checkpoint inhibitor (ICI) therapy. Selecting the most appropriate management of irAEs remains an ongoing challenge because prolonged use of glucocorticoids come with their own side effects and may counteract the antineoplastic effects from immunotherapy. In this case report, we present two patients with metastatic melanoma who developed symptoms of inflammatory arthritis attributed to ICI therapy. We found that treatment with secukinumab, an anti-IL-17A inhibitor, effectively managed their symptoms and did not lead to tumor progression. Our study suggests that secukinumab can be a safe and effective treatment option for ICI-induced inflammatory arthropathy.
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Affiliation(s)
- Vincent T Ma
- Department of Internal Medicine, University of Wisconsin, Division of Hematology, Medical Oncology and Palliative Care, Madison, WI, USA.,Department of Internal Medicine, University of Michigan, Division of Hematology and Oncology, Ann Arbor, MI, USA
| | - Christopher D Lao
- Department of Internal Medicine, University of Michigan, Division of Hematology and Oncology, Ann Arbor, MI, USA
| | - Leslie A Fecher
- Department of Internal Medicine, University of Michigan, Division of Hematology and Oncology, Ann Arbor, MI, USA
| | - Elena Schiopu
- Department of Internal Medicine, University of Michigan, Division of Rheumatology, Ann Arbor, MI, USA
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Yennurajalingam S, Bruera E. Do Patients Benefit from a Trial of Corticosteroids at the End of Life? Curr Treat Options Oncol 2022; 23:796-805. [PMID: 35362799 DOI: 10.1007/s11864-022-00977-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 11/03/2022]
Abstract
OPINION STATEMENT Patients with advanced cancer in the last 6 months of their lives have a higher frequency of distressing and debilitating physical and psychosocial symptoms such as cancer pain, cancer-related fatigue (CRF), anorexia, shortness of breath, poor sleep, anxiety, and depression. Often these symptoms significantly impact the patients' quality of life, and therefore require prompt assessment and effective treatment. There are specific treatments for certain distressing cancer-related symptoms (e.g., opioids for pain), but for the other symptoms such as CRF, anorexia-cachexia, and shortness of breath, there are limited or no evidence-based treatments. Also, in the management of cancer pain in this population, many patients are refractory to opioids. Hence, corticosteroids are one of the most common adjuvant medications prescribed for the management of this distressing symptom. However, there is limited evidence in regard to the effectiveness of corticosteroids in the improvement of the symptoms, side-effect profile, most optimal duration of use, dose, type of steroid, and most recently, the use with immunotherapy in advanced cancer patients at the end of life. These factors significantly limit the use of this important medication in terminally ill cancer patients. Further research is therefore critical to provide the optimal prescription of corticosteroids in this highly distressed population.
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Affiliation(s)
- Sriram Yennurajalingam
- Department of Palliative Care Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. #1414, Houston, TX, 77030, USA.
| | - Eduardo Bruera
- Department of Palliative Care Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. #1414, Houston, TX, 77030, USA
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Nikita N, Banks J, Keith SW, Song A, Johnson JM, Wilson M, Sharma S, Lu-Yao G. Is Timing of Steroid Exposure Prior to Immune Checkpoint Inhibitor Initiation Associated with Treatment Outcomes in Melanoma? A Population-Based Study. Cancers (Basel) 2022; 14:1296. [PMID: 35267602 DOI: 10.3390/cancers14051296] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) harness the immune system and are the therapy of choice for multiple cancers. Although immunosuppressive agents such as steroids are also used in many cancers, it is unknown how their timing affects treatment outcomes. Thus, we investigated the relationship between the timing of steroid exposure preceding ICI administration and subsequent treatment outcomes in melanoma. This population-based study utilized the SEER-Medicare-linked database to identify patients diagnosed with melanoma between 1991 and 2015 and receiving ICIs between 2010 and 2016, examining last steroid exposure in the 12 months preceding ICI. The main outcome was all-cause mortality (ACM) after ICIs. Modifications of the Cox proportional hazards model were used to calculate time-dependent hazards. Of 1671 patients with melanoma receiving ICIs, 907 received steroids. Compared with no steroids, last steroid exposures ≤1 month and 1-3 months prior to ICIs were associated with a 126% and 51% higher ACM within 3 months post ICI initiation, respectively (hazard ratio (HR): 2.26, 95% CI: 1.65-3.08; and HR: 1.51, 95% CI: 1.01-2.27). Steroid exposure within 3 months of initiating ICIs was associated with increased mortality up to 6 months after ICI. Further investigation is warranted to elucidate mechanisms affecting outcomes due to steroids.
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Anastasopoulou A, Diamantopoulos PT, Skalioti C, Liapis G, Psychogiou E, Ziogas DC, Gogas H. The diagnosis and management of sarcoid-like reactions in patients with melanoma treated with BRAF and MEK inhibitors. A case series and review of the literature. Ther Adv Med Oncol 2021; 13:17588359211047349. [PMID: 34691245 PMCID: PMC8532252 DOI: 10.1177/17588359211047349] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/01/2021] [Indexed: 12/18/2022] Open
Abstract
Sarcoidosis and sarcoid-like reactions (SLR) have been repeatedly reported in patients with melanoma treated with BRAF and MEK inhibitors. In the current study we present three patients that developed SLR under treatment with BRAF and mitogen-activated protein kinase (MEK) inhibitors for melanoma. Two patients developed mediastinal lymphadenitis with histological features of an SLR while on targeted therapy in the adjuvant setting, whereas one patient with metastatic melanoma developed granulomatous nephritis while receiving combination treatment with BRAF/MEK inhibitors and atezolizumab. In addition, we review the published literature on the pathogenesis, clinical characteristics, histologic features, imaging findings, and other potential useful diagnostic tools. We also address the need for a common terminology for these cases and propose an algorithm for the accurate diagnosis of BRAF/MEK inhibitor-induced SLR. We also review the currently available data on the treatment of these patients and suggest a treatment approach for SLR in patients with melanoma, as well as for the management of melanoma when SLR emerges.
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Affiliation(s)
- Amalia Anastasopoulou
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Greece
| | - Panagiotis T. Diamantopoulos
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma street, Athens, 11527, Greece
| | - Chrysanthi Skalioti
- Clinic of Nephrology and Renal Transplantation, Laikon General Hospital, Athens, Greece
| | - George Liapis
- First Department of Pathology, Laikon General Hospital, National and Kapodistrian University of Athens, Greece
| | - Eleni Psychogiou
- Pathology Department, Sotiria Regional Chest Disease Hospital of Athens, Greece
| | - Dimitrios C. Ziogas
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Greece
| | - Helen Gogas
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Greece
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Cruellas M, Yubero A, Zapata M, Galvez EM, Gascón M, Isla D, Lastra R, Martínez-Lostao L, Ocariz M, Pardo J, Ramírez A, Sesma A, Torres-Ramón I, Paño JR. How Could Antibiotics, Probiotics, and Corticoids Modify Microbiota and Its Influence in Cancer Immune Checkpoint Inhibitors: A Review. Infect Immun 2021; 89:e0066520. [PMID: 33526567 PMCID: PMC8370676 DOI: 10.1128/iai.00665-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Immunotherapy has become a new paradigm in oncology, improving outcomes for several types of cancer. However, there are some aspects about its management that remain uncertain. One of the key points that needs better understanding is the interaction between immunotherapy and gut microbiome and how modulation of the microbiome might modify the efficacy of immunotherapy. Consequently, the negative impact of systemic antibiotics and corticosteroids on the efficacy of immunotherapy needs to be clarified.
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Affiliation(s)
- Mara Cruellas
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Alfonso Yubero
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - María Zapata
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | | | - Marta Gascón
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Dolores Isla
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Rodrigo Lastra
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Luis Martínez-Lostao
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
- Immunology Department, University Hospital Lozano Blesa, Zaragoza, Spain
- Department of Microbiology, Pediatrics, Radiology and Public Health, University of Zaragoza, Zaragoza, Spain
- Aragon Nanoscience institute, Zaragoza, Spain
- Aragon Materials Science Institute, Zaragoza, Spain
| | - Maitane Ocariz
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Julián Pardo
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
- ARAID Foundation (IIS Aragón), Zaragoza, Spain
- Microbiology, Preventive Medicine and Public Health Department, Medicine, University of Zaragoza, Zaragoza, Spain
- Biomedical Research Center in Bioengineering, Biomaterials and Nanomedicine Network (CIBER-BBN), Madrid, Spain
| | - Ariel Ramírez
- Nanotoxicology and Immunotoxicology Unit (IIS Aragón), Zaragoza, Spain
| | - Andrea Sesma
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Irene Torres-Ramón
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - José Ramón Paño
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
- Infectious Disease Department, University Hospital Lozano Blesa, Zaragoza, Spain
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Angrish MD, Agha A, Pezo RC. Association of Antibiotics and Other Drugs with Clinical Outcomes in Metastatic Melanoma Patients Treated with Immunotherapy. J Skin Cancer 2021; 2021:9120162. [PMID: 34336290 DOI: 10.1155/2021/9120162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/13/2021] [Indexed: 12/13/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) targeting the programmed cell death protein-1 (PD-1) and programmed cell death ligand-1 (PD-L1) have improved survival in many advanced cancers including advanced melanoma, renal cell, urothelial, and non-small-cell lung cancers. However, not all patients respond, and immune-related adverse events (irAEs) are common. Commensal gut bacteria may serve as an immunoregulatory link-mediating ICI response and toxicity. Recent studies have shown that a lack of bacterial diversity, known as gut dysbiosis, can have an adverse impact on patients' response to ICIs and predispose to the development of irAEs. Data were collected from 167 patients with metastatic melanoma who received antibiotics within 30 days prior to and/or after initiation of ICI and patients who received NSAIDs, statins, steroids, or proton-pump inhibitors (PPI) within 30 days prior to ICI initiation. The primary outcome was time-to-discontinuation (TTD) of ICI therapy, measured from the date of ICI initiation to the last treatment date. The secondary outcome of interest was toxicity, with incidence of irAEs graded as per the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. Here, we demonstrate that individuals who received antibiotics had a significantly shorter time-to-discontinuation (TTD) of the ICI therapy as opposed those who were not administered antibiotics. Consistent with results from previous research, we propose that antibiotics have a negative effect on a patient's response to ICI therapy, most likely due to the result of gut dysbiosis, and should be critically assessed in terms of their use in patients undergoing ICI treatment.
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Daniello L, Elshiaty M, Bozorgmehr F, Kuon J, Kazdal D, Schindler H, Shah R, Volckmar AL, Lusky F, Diekmann L, Liersch S, Faehling M, Muley T, Kriegsmann M, Benesova K, Stenzinger A, Thomas M, Christopoulos P. Therapeutic and Prognostic Implications of Immune-Related Adverse Events in Advanced Non-Small-Cell Lung Cancer. Front Oncol 2021; 11:703893. [PMID: 34268127 PMCID: PMC8277237 DOI: 10.3389/fonc.2021.703893] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/09/2021] [Indexed: 01/14/2023] Open
Abstract
Introduction PD-(L)1 inhibitors have improved prognosis of non-small-cell lung cancer (NSCLC), but can also cause immune-related adverse events (irAEs) that complicate management. Methods We analyzed NSCLC patients receiving PD-(L)1 inhibitors from 2012 to 2020 in a German academic center. Results IrAE showed comparable frequencies in stage IV (198/894 or 22%) vs. III (14/45 or 31%, p = 0.15), after anti-PD-(L)1 monotherapy vs. chemoimmunotherapy (139/483 vs. 58/213, p = 0.75), and across treatment lines. In stage IV, irAE occurred after 3.1 months in median, affected multiple organs (median 2) in 27/894 patients and were associated with PD-L1 positivity (25 vs. 14%, p = 0.003), lower neutrophil-to-lymphocyte ratios (29 vs. 17%, p < 0.001 for NLR dichotomized at 5), better ECOG status (26 vs. 18% for 0 vs. 1, p = 0.004), but not related to age, sex, smoking and palliative radiotherapy. Two hundred thirty two irAEs occurred mostly in endocrine glands (4.9%), lungs (4.4%), the musculoskeletal system (4.2%), colon (4.1%), liver (3.7%), and skin (2.6%), while pneumonitis was most frequent with durvalumab following definitive chemoradiation (16% or 7/45, p < 0.01). IrAE severity was grade 1 in 11%, 2 in 41%, 3 in 36%, and 4 in 11% events, while two were lethal (<1%, myocarditis and pneumonitis). Therapy was suspended in 72%, while steroids were initiated in 66% and complemented by other immunosuppressants in 6%, with longest treatment duration for rheumatic events (mean >3 months), and average cumulative prednisone doses >700 mg for all organs, except for skin. Patients developing irAE had longer progression-free (PFS) and overall survival (OS) in multivariable 12/14-week landmark analyses including ECOG status, treatment line, treatment type, PD-L1 TPS, and NLR (median PFS 17 vs. 10 months, HR = 0.68, p = 0.009; median OS 37 vs. 15 months, HR = 0.40, p < 0.001), regardless of grade. OS was longest with skin (95% at 2 years) and shortest with pneumonitis, hepatitis, neurologic, and cardiologic irAE (38, 37, 28, and 0% at 2 years, p < 0.001). Conclusions Approximately one-fourth of immunotherapy-treated NSCLC patients develop irAEs, most of which necessitate treatment suspension and steroids. Despite more frequent occurrence with PD-L1 positive tumors, lower NLR, and better ECOG PS, irAEs are independently associated with longer survival, especially when affecting the skin. Lethality is below 1%.
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Affiliation(s)
- Lea Daniello
- Department of Thoracic Oncology, Thoraxklinik and National Center for Tumor Diseases (NCT) at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center of Lung Research (DZL), Heidelberg, Germany
| | - Mariam Elshiaty
- Department of Thoracic Oncology, Thoraxklinik and National Center for Tumor Diseases (NCT) at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center of Lung Research (DZL), Heidelberg, Germany
| | - Farastuk Bozorgmehr
- Department of Thoracic Oncology, Thoraxklinik and National Center for Tumor Diseases (NCT) at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center of Lung Research (DZL), Heidelberg, Germany
| | - Jonas Kuon
- Department of Thoracic Oncology, Thoraxklinik and National Center for Tumor Diseases (NCT) at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center of Lung Research (DZL), Heidelberg, Germany
| | - Daniel Kazdal
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center of Lung Research (DZL), Heidelberg, Germany.,Institute of Pathology Heidelberg, Heidelberg, Germany
| | - Hannah Schindler
- Department of Thoracic Oncology, Thoraxklinik and National Center for Tumor Diseases (NCT) at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center of Lung Research (DZL), Heidelberg, Germany
| | - Rajiv Shah
- Department of Thoracic Oncology, Thoraxklinik and National Center for Tumor Diseases (NCT) at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center of Lung Research (DZL), Heidelberg, Germany
| | | | - Fabienne Lusky
- Department of Thoracic Oncology, Thoraxklinik and National Center for Tumor Diseases (NCT) at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center of Lung Research (DZL), Heidelberg, Germany
| | - Leonore Diekmann
- Department of Internal Medicine V, Hematology, Oncology und Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stephan Liersch
- Department of Pharmacy, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Faehling
- Department of Cardiology, Angiology and Pneumology, Esslingen Hospital, Esslingen, Germany
| | - Thomas Muley
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center of Lung Research (DZL), Heidelberg, Germany.,Translational Research Unit, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Mark Kriegsmann
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center of Lung Research (DZL), Heidelberg, Germany.,Institute of Pathology Heidelberg, Heidelberg, Germany
| | - Karolina Benesova
- Department of Internal Medicine V, Hematology, Oncology und Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Albrecht Stenzinger
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center of Lung Research (DZL), Heidelberg, Germany.,Institute of Pathology Heidelberg, Heidelberg, Germany
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik and National Center for Tumor Diseases (NCT) at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center of Lung Research (DZL), Heidelberg, Germany
| | - Petros Christopoulos
- Department of Thoracic Oncology, Thoraxklinik and National Center for Tumor Diseases (NCT) at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center of Lung Research (DZL), Heidelberg, Germany
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Meriggi F, Zaniboni A. Antibiotics and steroids, the double enemies of anticancer immunotherapy: a review of the literature. Cancer Immunol Immunother 2021; 70:1511-7. [PMID: 33165628 DOI: 10.1007/s00262-020-02786-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2023]
Abstract
The advent of immunotherapy in onco-haematology has represented a kind of revolution that has been able to modify the prognosis of numerous tumours that until recently would have been rapidly lethal. While much is known about the mechanism of action of these drugs, relatively little is known about the factors that represent potential predictors of response and toxicity. Among these factors, the simultaneous administration of antibiotics and/or steroids seems to have a negative impact. Furthermore, several retrospective studies have highlighted the strong link between cancer and gut microbiota, regardless of the tumour site, and how microbiota, playing a key role in the prevention of systemic inflammation at various levels and in the intestinal homeostasis, can be negatively influenced by the dysbiosis caused by antibiotic therapy administered during or in the weeks immediately preceding the start of immunotherapy. Moreover, we assume that the concurrent administration of steroids, which is often necessary in cancer patients, likely results in a deleterious effect on the therapeutic outcomes of immunotherapy. In this review, we will try to clarify the evidence on the possible detrimental effects of antibiotics and steroids, which are currently considered the double enemies of anticancer immunotherapy.
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Kartolo A, Deluce J, Holstead R, Hopman W, Lenehan J, Baetz T. Impact of Baseline Corticosteroids on Immunotherapy Efficacy in Patients With Advanced Melanoma. J Immunother 2021; 44:167-74. [DOI: 10.1097/cji.0000000000000360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/16/2020] [Indexed: 11/25/2022]
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11
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Kartolo A, Holstead R, Hopman W, Young L, Baetz T. Safety and efficacy analysis of pembrolizumab dosing patterns in patients with advanced melanoma and non-small cell lung cancer. J Oncol Pharm Pract 2021; 28:87-95. [PMID: 33509058 DOI: 10.1177/1078155220984252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To evaluate the impact of discrepancy between prescribed and recommended fixed 200 mg dose (P-F discrepancy) on immune-related adverse events (irAEs) and treatment efficacy in patients with advanced melanoma and NSCLC. METHODS This retrospective study included 177 patients with advanced melanoma or non-small cell lung cancer (NSCLC) who received at least one cycle of single-agent pembrolizumab. We defined P-F discrepancy as the differences between prescribed pembrolizumab dose and 200 mg recommended dose, expressed in percentages. Our primary outcome was immune-related adverse events (irAEs), and our secondary outcomes included overall survival (OS) and progression free survival (PFS). RESULTS The median P-F discrepancy was -21.5%, with the 25th and 75th percentile at -32% and -5.0% respectively. ROC curve analyses did not show any optimal cutoffs to prognosticate irAEs (AUC = 0.558 for all patients) or cancer mortality (AUC = 0.583 for melanoma; AUC = 0.539 for NSCLC) in either cancer type. Separate multivariable Cox analyses suggested no statistically significant association between P-F discrepancy and overall survival in patients with melanoma (HR 1.012, 95%CI 0.987-1.038, P = 0.362) or NSCLC (HR 0.998, 95%CI 0.978-1.019, P = 0.876). CONCLUSION There was no optimal pembrolizumab cut-off point to predict irAEs or treatment efficacy. We supported the use of weight-based pembrolizumab dosing, given the potential cost-saving and no differences in terms of irAEs or treatment efficacy in patients with advanced melanoma or NSCLC. Future studies on province- or national-level would be important to validate our findings.
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Affiliation(s)
- A Kartolo
- Cancer Centre of Southeastern Ontario, Kingston, ON, Canada.,Queen's University, Kingston, ON, Canada
| | - R Holstead
- Cancer Centre of Southeastern Ontario, Kingston, ON, Canada.,Queen's University, Kingston, ON, Canada
| | - W Hopman
- Queen's University, Kingston, ON, Canada
| | - L Young
- Cancer Centre of Southeastern Ontario, Kingston, ON, Canada
| | - T Baetz
- Cancer Centre of Southeastern Ontario, Kingston, ON, Canada.,Queen's University, Kingston, ON, Canada
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Shah N, Cohen L, Seminario-vidal L. Management of oral reactions from immune checkpoint inhibitor therapy: A systematic review. J Am Acad Dermatol 2020; 83:1493-1498. [DOI: 10.1016/j.jaad.2020.05.133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 11/22/2022]
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De Giglio A, Mezquita L, Auclin E, Blanc-Durand F, Riudavets M, Caramella C, Martinez G, Benitez JC, Martín-Romano P, El-Amarti L, Hendriks L, Ferrara R, Naltet C, Lavaud P, Gazzah A, Adam J, Planchard D, Chaput N, Besse B. Impact of Intercurrent Introduction of Steroids on Clinical Outcomes in Advanced Non-Small-Cell Lung Cancer (NSCLC) Patients under Immune-Checkpoint Inhibitors (ICI). Cancers (Basel) 2020; 12:E2827. [PMID: 33007977 PMCID: PMC7599488 DOI: 10.3390/cancers12102827] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Baseline steroids before ICI have been associated with poor outcomes, particularly when introduced due to cancer symptoms. METHODS Retrospective analysis of advanced NSCLC patients treated with ICI. We collected the use of intercurrent steroids (≥10 mg of prednisone-equivalent) within the first eight weeks of ICI. We correlated steroid use with patient outcomes according to the indications. RESULTS 413 patients received ICI, 299 were steroids-naïve at baseline. A total of 49 patients received intercurrent steroids (16%), of whom 38 for cancer-related symptoms and 11 for other indications, such as immune-related events. Overall, median (m) progression-free survival (PFS) was 1.9 months (mo.) [95% CI, 1.8-2.4] and overall survival (OS) 10 mo. [95% CI, 8.1-12.9]. Intercurrent steroids under ICI correlated with a shorter PFS/OS (1.3 and 2.3 mo. respectively, both p < 0.0001). Intercurrent steroids for cancer-related symptoms correlated with poorest mPFS [1.1 mo.; 95% CI, 0.9-1.5] and mOS [1.9 mo.; 95%CI, 1.5-2.4; p < 0.0001)]. No mOS and mPFS differences were found between cancer-unrelated-steroid group and no-steroid group. Steroid use for cancer-related symptoms was an independent prognostic factor for poor PFS [HR 2.64; 95% CI, 1.2-5.6] and OS [HR 4.53; 95% CI, 1.8-11.1], both p < 0.0001. CONCLUSION Intercurrent steroids during ICI had no detrimental prognostic impact if the indication was unrelated to cancer symptoms.
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Affiliation(s)
- Andrea De Giglio
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
- Department of Specialized, Experimental and Diagnostic Medicine, S.Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Laura Mezquita
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
- Medical Oncology Department, Hospital Clinic, 08036 Barcelona, Spain
- Laboratory of Translational Genomics and Targeted therapies in Solid Tumors, IDIBAPS, 08036 Barcelona, Spain
| | - Edouard Auclin
- Medical and Thoracic Oncology Department, Georges Pompidou Hospital, 75015 Paris, France;
| | - Félix Blanc-Durand
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
| | - Mariona Riudavets
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
| | | | - Gala Martinez
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
| | - Jose Carlos Benitez
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
| | - Patricia Martín-Romano
- Early Drug Development Department, Gustave Roussy, 94805 Villejuif, France; (P.M.-R.); (A.G.)
| | - Lamiae El-Amarti
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
| | - Lizza Hendriks
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
- Department of pulmonary diseases, GROW- School for Oncology and developmental biology, Maastricht UMC+, 6229 Maastricht, The Netherlands
| | - Roberto Ferrara
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
- Thoracic Oncology Unit, Medical Oncology Department Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy
| | - Charles Naltet
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
| | - Pernelle Lavaud
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
| | - Anas Gazzah
- Early Drug Development Department, Gustave Roussy, 94805 Villejuif, France; (P.M.-R.); (A.G.)
| | - Julien Adam
- Department of Pathology, Gustave Roussy, 94805 Villejuif, France;
| | - David Planchard
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
| | - Nathalie Chaput
- Laboratory of Immunomonitoring in Oncology and CNRS-UMS 3655 and INSERM-US23, Gustave Roussy, 94805 Villejuif, France;
- Université Paris-Saclay, Faculté de Pharmacie, 92296 Chatenay-Malabry, France
| | - Benjamin Besse
- Cancer Medicine Department, Gustave Roussy, 94805 Villejuif, France; (A.D.G.); (L.M.); (F.B.-D.); (M.R.); (G.M.); (J.C.B.); (L.E.-A.); (L.H.); (R.F.); (C.N.); (P.L.); (D.P.)
- Université Paris-Saclay, Faculté de Médicine, 94276 Le Kremlin Bicêtre, France
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