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Chang JH, Remulla D, Wehrle C, Woo KP, Dahdaleh FS, Joyce D, Naffouje SA. The Role of Neoadjuvant Immunotherapy in the Management of Merkel Cell Carcinoma with Clinically Detected Regional Lymph Node Metastasis. Ann Surg Oncol 2024:10.1245/s10434-024-15478-4. [PMID: 38824193 DOI: 10.1245/s10434-024-15478-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/06/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Immunotherapy is emerging as a promising option for certain locally advanced and metastatic cutaneous malignancies. However, the role of neoadjuvant immunotherapy (NIO) in Merkel cell carcinoma (MCC) with clinically detected regional lymph node metastasis (CDRLNM) has not been fully elucidated. METHODS For this study, MCC patients with CDRLNM who underwent surgical excision were selected from the National Cancer Database (NCDB). Those who received NIO were propensity-matched with those who did not, and Kaplan-Meier analysis was used to compare overall survival (OS). RESULTS Of the 1809 selected patients, 356 (19.7%) received NIO followed by wide excision (n = 352, 98.9%) or amputation (n = 4, 1.1%). The rate of complete pathologic response for the primary tumor (ypT0) was 45.2%. Only 223 patents (63.4%) also underwent lymph node dissection (LND). The complete pathologic nodal response (ypN0) rate for these patients was 17.9%. A pathologic complete response of both the primary tumor and the nodal basin (ypT0 ypN0) was seen in 16 of the 223 patients who underwent both primary tumor surgery and LND. Subsequently, 151 pairs were matched between the NIO and no-NIO groups (including only patients with LND). Kaplan-Meier analysis demonstrated a significant OS improvement with NIO (median not reached vs. 35.0 ± 8.0 months; p = 0.025). The 5-year OS was 57% in the NIO group versus 44% in no-NIO group (p = 0.021). CONCLUSION The study suggests that NIO in MCC with CDRLNM provides improved OS in addition to promising rates of primary complete response, which could change the profile of surgical resection. This supports ongoing clinical trials exploring the use of NIO in MCC.
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Affiliation(s)
- Jenny H Chang
- Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daphne Remulla
- Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Chase Wehrle
- Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Kimberly P Woo
- Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Fadi S Dahdaleh
- Department of Surgical Oncology, Edward-Elmhurst Health, Naperville, IL, USA
| | - Daniel Joyce
- Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Samer A Naffouje
- Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
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2
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Esser E, Grünewald I, Mihailovic N. [Periocular Merkel Cell Carcinoma - an overview of clinical aspects and current therapeutic options]. Laryngorhinootologie 2024; 103:404-412. [PMID: 38128577 DOI: 10.1055/a-2214-5209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Merkel cell carcinoma (MCC) is a rare but highly aggressive and rapidly expanding malignant skin tumor. It affects the periocular region in approximately 10% of cases. The current treatment recommendation for resectable non-metastatic MCC comprises total surgical excision; however, lymph node or distant metastases are often already present by the time of the diagnosis. Since an immune checkpoint inhibitor therapy with avelumab was first approved for MCC in 2016, there has been considerable improvement in mean survival compared to cytostatic therapy; at the same time, there has been a reduction in serious treatment-associated adverse events. Other immune checkpoint inhibitors are currently still in clinical trials, with very promising initial results. Because of the complexity of the diagnosis, treatment, and prognosis, it is essential that MCC patients receive interdisciplinary care in a specialized center including consultation with a tumor review board.
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Affiliation(s)
- Eliane Esser
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Munster, Germany
| | - Inga Grünewald
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Münster, Germany
| | - Natasa Mihailovic
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Münster, Germany
- Klinik für Augenheilkunde, Klinikum Fulda gAG, Fulda, Germany
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3
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Kakish H, Sun J, Ammori JB, Hoehn RS, Rothermel LD. First-line Immunotherapy for Metastatic Merkel Cell Carcinoma: Analysis of Real-world Survival Data and Practice Patterns. Am J Clin Oncol 2024:00000421-990000000-00184. [PMID: 38587336 DOI: 10.1097/coc.0000000000001098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND Immune checkpoint inhibitors are a promising new therapy for advanced Merkel Cell Carcinoma (MCC). We investigated real-world utilization and survival outcomes of first-line immunotherapies in a contemporary cohort. METHODS Using the National Cancer Database (NCDB), we identified 759 patients with MCC between 2015 and 2020 with stage IV disease and known status of first-line systemic therapy. Univariable and multivariable analyses were used to determine predictors of immunotherapy usage. Overall survival (OS) was compared for patients receiving immunotherapy, chemotherapy, or no systemic therapies. RESULTS We identified 759 patients meeting our inclusion criteria: 329 patients received immunotherapy, 161 received chemotherapy, and 269 received no systemic therapy. Adjusting for demographic, clinical, and facility factors, high facility volume significantly predicted first-line immunotherapy use (OR 1.99; P=0.017). Median OS was 16.2, 12.3, and 8.7 months, among patients who received immunotherapy, chemotherapy, or no systemic therapy, respectively (P<0.001). On Cox multivariable survival analysis, first-line immunotherapy treatment (HR=0.79, P=0.041) and treatment at high-volume centers (HR=0.58, P=0.004) were associated with improved OS. CONCLUSIONS Consistent with clinical trial results, first-line immunotherapy associated with improvement in median overall survival for patients with stage IV MCC, significantly outperforming chemotherapy in this real-world cohort. Treatment at high-volume centers associated with first-line immunotherapy utilization suggesting that familiarity with this rare disease is important to achieving optimal outcomes for metastatic MCC.
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Affiliation(s)
- Hanna Kakish
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - James Sun
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - John B Ammori
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Richard S Hoehn
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Luke D Rothermel
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH
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4
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Gikandi A, Chi SN, Yeo KK, O'Neill AF, Shulman DS, DuBois SG, Collins NB. Off-label prescribing of immune checkpoint inhibitor therapy at a single pediatric cancer center. Cancer Med 2024; 13:e7154. [PMID: 38629258 PMCID: PMC11022150 DOI: 10.1002/cam4.7154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/26/2024] [Accepted: 03/22/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) have improved outcomes in a variety of adult cancers and are prescribed with increasing frequency across oncology. However, patterns of off-label use of ICI in pediatrics remain unclear. METHODS This is a single-institution, retrospective cohort study evaluating off-label ICI use in pediatric and young adult patients with cancer treated at our institution from 2014 to 2022. Response was based on clinician assessment derived from clinical records. Immune-related adverse events (iRAEs) were classified according to CTCAE v5.0. RESULTS We identified 50 unique patients treated with off-label ICI (28 with solid tumors, 20 with central nervous system (CNS) tumors, 2 with hematologic malignancies). At time of ICI initiation, only five patients (10%) had localized disease, and all but one patient was treated in the relapsed/refractory setting. All patients were treated with the FDA-approved weight-based dosing recommendations. Overall, there was disease control in 21 patients (42%), with best response including one complete response (melanoma), two partial responses (high-grade glioma, CNS nongerminomatous germ cell tumor), and 18 patients with stable disease. Forty-four patients (88%) eventually experienced disease progression. Among 22 patients (44%) experiencing iRAEs, 10 (20%) had a grade ≥3 irAE, 12 (24%) required corticosteroids, and 14 (28%) required ICI discontinuation. irAE occurrence was associated with significantly improved progression-free survival (HR 0.35; 95% CI: 0.18 to 0.68; p = 0.002) and overall survival (HR 0.33; 95% CI: 0.17 to 0.66; p = 0.002). CONCLUSIONS At our institution, ICI was most commonly prescribed in the relapsed/refractory setting to patients with metastatic disease. The treatment was generally well-tolerated in the pediatric population. The overall response rate was low, and the majority of patients eventually experienced disease progression. A few patients, however, had durable treatment responses. Further studies are needed to identify which pediatric patients are most likely to benefit from ICI.
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Affiliation(s)
| | - Susan N Chi
- Harvard Medical School, Boston, Massachusetts, USA
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Kee Kiat Yeo
- Harvard Medical School, Boston, Massachusetts, USA
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Allison F O'Neill
- Harvard Medical School, Boston, Massachusetts, USA
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA
| | - David S Shulman
- Harvard Medical School, Boston, Massachusetts, USA
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven G DuBois
- Harvard Medical School, Boston, Massachusetts, USA
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalie B Collins
- Harvard Medical School, Boston, Massachusetts, USA
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA
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Seretis K, Sfaelos K, Boptsi E, Gaitanis G, Bassukas ID. The Neutrophil-to-Lymphocyte Ratio as a Biomarker in Cutaneous Oncology: A Systematic Review of Evidence beyond Malignant Melanoma. Cancers (Basel) 2024; 16:1044. [PMID: 38473401 DOI: 10.3390/cancers16051044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
With the ongoing progress of basic research along with the introduction of new pharmaceutical options spanning almost all therapeutic areas, the need for biomarkers that will be implemented into the personalized medical approach is higher than ever. Their use can be incorporated into clinical practice and can be applied to the classification of disorders and the evaluation of disease severity but also to the monitoring of the progress of therapeutic/pharmaceutical interventions. This systematic review collects the findings of hematologic biomarkers in various cutaneous malignancies, excluding malignant melanoma, to support their potential use in the prognosis but also in the assessment of therapeutic strategies for the specific category of skin disorders.
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Affiliation(s)
- Konstantinos Seretis
- Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, University of Ioannina, 451 10 Ioannina, Greece
| | - Konstantinos Sfaelos
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 451 10 Ioannina, Greece
| | - Elena Boptsi
- Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, University of Ioannina, 451 10 Ioannina, Greece
| | - Georgios Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 451 10 Ioannina, Greece
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 451 10 Ioannina, Greece
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Schoelles KJ, Auw-Haedrich C. Updates on eyelid cancers. Asia Pac J Ophthalmol (Phila) 2024; 13:100057. [PMID: 38615904 DOI: 10.1016/j.apjo.2024.100057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/16/2024] Open
Abstract
In this review, we aim to provide an overview of the five most common malignant eyelid tumors with current treatment recommendations based on international guidelines. Particular attention is paid to the clinicopathological correlation and the update with regard to adequate treatment. Newer systemic therapies enrich the existing treatment options, of which complete tumor excision remains the most important therapeutic measure.
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Cheraghlou S, Pahalyants V, Jairath NK, Doudican NA, Carucci JA. High-volume facilities are significantly more likely to use guideline-adherent systemic immunotherapy for metastatic Merkel cell carcinoma: implications for cancer care regionalization. Arch Dermatol Res 2024; 316:86. [PMID: 38349538 DOI: 10.1007/s00403-024-02817-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 12/17/2023] [Accepted: 01/11/2024] [Indexed: 02/15/2024]
Abstract
Merkel cell carcinoma (MCC) is a neuroendocrine skin cancer with a high rate of mortality. While still relatively rare, the incidence of MCC has been rapidly rising in the US and around the world. Since 2017, two immunotherapeutic drugs, avelumab and pembrolizumab, have been FDA-approved for the treatment of metastatic MCC and have revolutionized outcomes for MCC. However, real-world outcomes can differ from clinical trial data, and the adoption of novel therapeutics can be gradual. We aimed to characterize the treatment practices and outcomes of patients with metastatic MCC across the US. A retrospective cohort study of adult cases of MCC in the National Cancer Database diagnosed from 2004 to 2019 was performed. Multivariable logistic regressions to determine the association of a variety of patient, tumor, and system factors with likelihood of receipt of systemic therapies were performed. Univariate Kaplan-Meier and multivariable Cox survival regressions were performed. We identified 1017 cases of metastatic MCC. From 2017 to 2019, 54.2% of patients received immunotherapy. This increased from 45.1% in 2017 to 63.0% in 2019. High-volume centers were significantly more likely to use immunotherapy (odds ratio 3.235, p = 0.002). On univariate analysis, patients receiving systemic immunotherapy had significantly improved overall survival (p < 0.001). One-, 3-, and 5-year survival was 47.2% (standard error [SE] 1.8%), 21.8% (SE 1.5%), and 16.5% (SE 1.4%), respectively, for patients who did not receive immunotherapy versus 62.7% (SE 3.5%), 34.4% (SE 3.9%), and 23.6% (SE 4.4%), respectively, for those who did (Fig. 1). In our multivariable survival regression, receipt of immunotherapy was associated with an approximately 35% reduction in hazard of death (hazard ratio 0.665, p < 0.001; 95% CI 0.548-0.808). Our results demonstrate that the real-world survival advantage of immunotherapy for metastatic MCC is similar to clinical trial data. However, many patients with metastatic disease did not receive this guideline-recommended therapy in our most recent study year, and use of immunotherapy is higher at high-volume centers. This suggests that regionalization of care to high-volume centers or dissemination of their practices, may ultimately improve patient survival.
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Affiliation(s)
- Shayan Cheraghlou
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Vartan Pahalyants
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Neil K Jairath
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Nicole A Doudican
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - John A Carucci
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA.
- NYU Dermatologic Surgical Associates, 222 East 41st Street, New York, NY, 10017, USA.
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8
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Ríos-Viñuela E, García-Vázquez M, Juan MJ, Nagore E, Requena C, Sanmartín O, Llombart B. Avelumab to treat Merkel cell carcinoma: real-life experience in a dedicated oncology center. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00059-0. [PMID: 38423921 DOI: 10.1016/j.ad.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 03/02/2024] Open
Abstract
The arrival of immunotherapy has revolutioned the management of patients with metastatic Merkel cell carcinoma (MCC). We conducted an observational, retrospective study of 14 cases treated with avelumab. The response rate was 57%: complete response was reached in 29% of patients, and partial responses in 29%. The drug proved effective in 83% (5/6) of the patients with a single metastatic site. However, the disease progressed in 75% (3/4) of the patients with bone metastases. PD1-L expression, MCC polyomavirus (MCPyV) positivity, and an impaired neutrophil-to-lypmhocyte ratio (NLR) could not be associated with responses to the therapy. Avelumab is an effective and safe drug for the management of advanced MCC, and its effectiveness appears to be impacted by the number and location of metastases.
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Affiliation(s)
- E Ríos-Viñuela
- Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, Valencia, España; Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España.
| | - M García-Vázquez
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - M J Juan
- Servicio de Oncología Médica, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - E Nagore
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - C Requena
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - O Sanmartín
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - B Llombart
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
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9
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Haj-Yehia E, Mincu RI, Korste S, Lampe L, Margraf SM, Michel L, Mahabadi AA, Ferdinandy P, Rassaf T, Totzeck M. High neutrophil-to-lymphocyte ratio is associated with cancer therapy-related cardiovascular toxicity in high-risk cancer patients under immune checkpoint inhibitor therapy. Clin Res Cardiol 2024; 113:301-312. [PMID: 37955712 PMCID: PMC10850199 DOI: 10.1007/s00392-023-02327-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/17/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Cancer therapy-related cardiovascular toxicity (CTR-CVT) from immune checkpoint inhibitor (ICI) therapy is still incompletely characterized, and patients with pre-existing cardiovascular disease represent a particularly high-risk cohort. Valid parameters for risk stratification of these patients are missing. Neutrophil-to-lymphocyte ratio (NLR) has been shown to predict mortality and adverse events in other cardiovascular cohorts. The present study aims to examine the predictive capacity of NLR for risk stratification of patients particularly vulnerable for CTR-CVT under ICI therapy. METHODS We performed an analysis of 88 cancer patients (69 ± 11 years, 25% female) with pre-existing cardiovascular disease under ICI therapy from the prospective Essen Cardio-Oncology Registry (ECoR). NLR was assessed at patient enrollment and the population was divided through receiver operator characteristic (ROC) curve analysis in patients with low (< 4.57) and high (≥ 4.57) NLR. Endpoint was the whole spectrum of CTR-CVT, according to the European guidelines on cardio-oncology. The median follow-up was 357 days (interquartile range (IQR): 150-509 days). RESULTS We observed 4 cases of myocarditis, 17 cases of vascular toxicity, 3 cases of arterial hypertension, 22 cases of arrhythmia or QTc prolongation and 17 cases of cardiovascular dysfunction. NLR was associated with overall CTR-CVT by univariable Cox regression (hazard ratio (HR): 1.443; 95% confidence interval (CI) 1.082-1.925; p = 0.013). However, this association was attenuated after adjusting for further confounders. CONCLUSION NLR is moderately associated with CTR-CVT in cancer patients with pre-existing cardiovascular disease under ICI therapy. Surveillance of NLR during ICI therapy might be an effective and economically biomarker for risk stratification in these high-risk patients.
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Affiliation(s)
- Elias Haj-Yehia
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Raluca I Mincu
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Sebastian Korste
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Lena Lampe
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Simone M Margraf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Lars Michel
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Amir A Mahabadi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
- Pharmahungary Group, Szeged, Hungary
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Matthias Totzeck
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.
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Hansen UK, Church CD, Carnaz Simões AM, Frej MS, Bentzen AK, Tvingsholm SA, Becker JC, Fling SP, Ramchurren N, Topalian SL, Nghiem PT, Hadrup SR. T antigen-specific CD8+ T cells associate with PD-1 blockade response in virus-positive Merkel cell carcinoma. J Clin Invest 2024; 134:e177082. [PMID: 38618958 PMCID: PMC11014655 DOI: 10.1172/jci177082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/23/2024] [Indexed: 04/16/2024] Open
Abstract
Merkel cell carcinoma (MCC) is a highly immunogenic skin cancer primarily induced by Merkel cell polyomavirus, which is driven by the expression of the oncogenic T antigens (T-Ags). Blockade of the programmed cell death protein-1 (PD-1) pathway has shown remarkable response rates, but evidence for therapy-associated T-Ag-specific immune response and therapeutic strategies for the nonresponding fraction are both limited. We tracked T-Ag-reactive CD8+ T cells in peripheral blood of 26 MCC patients under anti-PD1 therapy, using DNA-barcoded pMHC multimers, displaying all peptides from the predicted HLA ligandome of the oncoproteins, covering 33 class I haplotypes. We observed a broad T cell recognition of T-Ags, including identification of 20 T-Ag-derived epitopes we believe to be novel. Broadening of the T-Ag recognition profile and increased T cell frequencies during therapy were strongly associated with clinical response and prolonged progression-free survival. T-Ag-specific T cells could be further boosted and expanded directly from peripheral blood using artificial antigen-presenting scaffolds, even in patients with no detectable T-Ag-specific T cells. These T cells provided strong tumor-rejection capacity while retaining a favorable phenotype for adoptive cell transfer. These findings demonstrate that T-Ag-specific T cells are associated with the clinical outcome to PD-1 blockade and that Ag-presenting scaffolds can be used to boost such responses.
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Affiliation(s)
- Ulla Kring Hansen
- Section of Experimental and Translational Immunology, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
- PokeAcell Aps, BioInnovation Institute, Copenhagen, Denmark
| | - Candice D. Church
- Department of Dermatology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Marcus Svensson Frej
- Section of Experimental and Translational Immunology, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
- PokeAcell Aps, BioInnovation Institute, Copenhagen, Denmark
| | - Amalie Kai Bentzen
- Section of Experimental and Translational Immunology, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Siri A. Tvingsholm
- Section of Experimental and Translational Immunology, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Jürgen C. Becker
- Department of Translational Skin Cancer Research, University Hospital Essen and German Cancer Consortium (DKTK), Essen, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | | | | | - Suzanne L. Topalian
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Bloomberg-Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Paul T. Nghiem
- Department of Dermatology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Sine Reker Hadrup
- Section of Experimental and Translational Immunology, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
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Weilandt J, Peitsch WK. Moderne Diagnostik und Therapie des Merkelzellkarzinoms. J Dtsch Dermatol Ges 2023; 21:1524-1548. [PMID: 38082520 DOI: 10.1111/ddg.15214_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/21/2023] [Indexed: 12/18/2023]
Abstract
ZusammenfassungDas Merkelzellkarzinom (MCC) ist ein seltener, aggressiver Hauttumor mit epithelialer und neuroendokriner Differenzierung, dessen Inzidenz in den letzten Jahrzehnten deutlich zugenommen hat. Risikofaktoren sind fortgeschrittenes Lebensalter, heller Hauttyp, UV‐Exposition und Immunsuppression. Pathogenetisch wird ein durch das Merkelzell‐Polyomavirus (MCPyV) hervorgerufener Typ von einem UV‐induzierten Typ mit hoher Tumormutationslast unterschieden.Klinisch präsentiert sich das MCC als meist schmerzloser, schnell wachsender, rötlich‐violetter Tumor mit glänzender Oberfläche, der bevorzugt im Kopf‐Hals‐Bereich und an den distalen Extremitäten lokalisiert ist. Eine sichere Diagnose kann nur anhand histologischer und immunhistochemischer Merkmale gestellt werden. Bei Erstdiagnose weisen 20%–26% der Patienten lokoregionäre Metastasen und 8%–14% Fernmetastasen auf, weshalb eine Ausbreitungsdiagnostik unabdingbar ist. Bei fehlenden klinischen Hinweisen auf Metastasen wird eine Sentinel‐Lymphknotenbiopsie empfohlen.Wesentliche Säulen der Therapie sind die Operation, die adjuvante oder palliative Strahlentherapie und in fortgeschrittenen inoperablen Stadien die medikamentöse Tumortherapie. Die Einführung von Immuncheckpoint‐Inhibitoren führte zu einem Paradigmenwechsel, da sich hiermit ein wesentlich langfristigeres Ansprechen und bessere Überlebensraten als mit Chemotherapie erreichen lassen. Zur Therapie des metastasierten MCC ist in Deutschland der PD‐L1‐Inhibitor Avelumab zugelassen, aber auch die PD‐1‐Antikörper Pembrolizumab und Nivolumab werden mit Erfolg eingesetzt. Adjuvante und neoadjuvante Therapiekonzepte, Immunkombinationstherapien und zielgerichtete Therapien als Monotherapie oder in Kombination mit Immuncheckpoint‐Inhibitoren befinden sich in klinischer Prüfung.
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Affiliation(s)
- Juliane Weilandt
- Klinik für Dermatologie und Phlebologie, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Wiebke K Peitsch
- Klinik für Dermatologie und Phlebologie, Vivantes Klinikum im Friedrichshain, Berlin, Germany
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Weilandt J, Peitsch WK. Modern diagnostics and treatment of Merkel cell carcinoma. J Dtsch Dermatol Ges 2023; 21:1524-1546. [PMID: 37875785 DOI: 10.1111/ddg.15214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/21/2023] [Indexed: 10/26/2023]
Abstract
Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer with epithelial and neuroendocrine differentiation, the incidence of which has increased substantially during the last decades. Risk factors include advanced age, fair skin type, UV exposure, and immunosuppression. Pathogenetically, a type caused by the Merkel cell polyomavirus is distinguished from a UV-induced type with a high tumor mutational burden. Clinically, MCC presents as a mostly painless, rapidly growing, reddish-violet tumor with a shiny surface, which is preferentially localized in the head-neck region and at the distal extremities. A reliable diagnosis can only be made based on histological and immunohistochemical features. At initial diagnosis, 20-26% of patients show locoregional metastases and 8-14% distant metastases, making staging examinations indispensable. If there is no clinical evidence of metastases, a sentinel lymph node biopsy is recommended. Essential columns of therapy are surgery, adjuvant or palliative radiotherapy and, in advanced inoperable stages, medicamentous tumor therapy. The introduction of immune checkpoint inhibitors has led to a paradigm shift, as they provide a considerably longer duration of response and better survival rates than chemotherapy. The PD-L1 inhibitor avelumab is approved for treatment of metastatic MCC in Germany, but the PD-1 antibodies pembrolizumab and nivolumab are also used with success. Adjuvant and neoadjuvant treatment concepts, immune combination therapies and targeted therapies as monotherapy or in combination with immune checkpoint inhibitors are in the clinical trial phase.
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Affiliation(s)
- Juliane Weilandt
- Department of Dermatology and Phlebology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Wiebke K Peitsch
- Department of Dermatology and Phlebology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
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Lohray R, Verma KK, Wang LL, Haynes D, Lewis DJ. Avelumab for Advanced Merkel Cell Carcinoma: Global Real-World Data on Patient Response and Survival. Pragmat Obs Res 2023; 14:149-154. [PMID: 38021416 PMCID: PMC10658947 DOI: 10.2147/por.s398151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Avelumab is a programmed cell death-ligand 1 (PD-L1) inhibitor approved by the Food and Drug Administration for advanced Merkel cell carcinoma (MCC). Studies conducted in real-world settings have shed light on its effectiveness and safety in clinical settings. Areas Covered Real-world studies on avelumab for MCC from North and South America, Europe, and Asia have been presented in this review. Most studies are on patients over age 70 and have a male-predominant sex ratio. Overall response rates range from 29.1% to 72.1%, (disease control rate: 60.0-72.7%; complete response rate: 15.8%-37.2%; partial rate: 18.2-42.1%; stable disease: 7.1-30.9%; progressive disease: 7.1-40.0%) and median progression free survival ranges from 8.1 to 24.1 months depending on the population studied. Immunosuppressed patients appear to benefit from avelumab as well, with response rates equivalent to the general population. Patients receiving avelumab as a first-line agent tend to have better outcomes than those using it as a second-line therapy. Fatigue, infusion-related reactions, and dyspnea were some of the most common adverse events identified in real-world studies. Autoimmune hepatitis and thyroiditis were also observed. Conclusion The use of avelumab as a safe and effective treatment option for advanced MCC is supported by real-world data, although additional study is required to assess long-term efficacy and safety outcomes.
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Affiliation(s)
| | - Kritin K Verma
- Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX, USA
| | - Leo L Wang
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Dylan Haynes
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel J Lewis
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
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Tachiki LML, Hippe DS, Williams Silva K, Hall ET, McCamy W, Fritzsche D, Perdue A, Majovski J, Pulliam T, Goldstein DA, Veatch J, Ho J, Nghiem PT, Thompson JA, Bhatia S. Extended duration of treatment using reduced-frequency dosing of anti-PD-1 therapy in patients with advanced melanoma and Merkel cell carcinoma. Cancer Immunol Immunother 2023; 72:3839-3850. [PMID: 37733060 PMCID: PMC10576731 DOI: 10.1007/s00262-023-03539-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/30/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Optimal duration of treatment (DoT) with immune checkpoint inhibitors (ICI) in metastatic cancers remains unclear. Many patients, especially those without radiologic complete remission, develop progressive disease after ICI discontinuation. Extending DoT with ICI may potentially improve efficacy outcomes but presents major logistical and cost challenges with standard frequency dosing (SFD). Receptor occupancy data supports reduced frequency dosing (RFD) of anti-PD-1 antibodies, which may represent a more practical and economically viable option to extend DoT. METHODS We conducted a retrospective study of patients with metastatic melanoma and Merkel cell carcinoma (MCC), who received ICI at RFD administered every 3 months, after initial disease control at SFD. We evaluated efficacy, safety, and cost-savings of the RFD approach in this cohort. RESULTS Between 2014 and 2021, 23 patients with advanced melanoma (N = 18) or MCC (N = 5) received anti-PD-1 therapy at RFD. Median DoT was 1.1 years at SFD and 1.2 years at RFD. The 3 year PFS after start of RFD was 73% in melanoma and 100% in MCC patients, which compare favorably to historical control rates. In the subset of 15 patients who received at least 2 years of therapy, total savings amounted to $1.1 million in drug costs and 384 h saved despite the extended DoT (median 3.4 years), as compared to the calculated cost of 2 years at SFD. CONCLUSIONS ICI administration at RFD can allow extension of treatment duration, while preserving efficacy and reducing logistical and financial burden. RFD approach deserves further exploration in prospective clinical trials.
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Affiliation(s)
- Lisa May Ling Tachiki
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA.
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
| | - Daniel S Hippe
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Karly Williams Silva
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Evan Thomas Hall
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - William McCamy
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA
| | - Dane Fritzsche
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Andrea Perdue
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Julia Majovski
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Thomas Pulliam
- Department of Medicine, Division of Dermatology, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Joshua Veatch
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Joel Ho
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Paul T Nghiem
- Department of Medicine, Division of Dermatology, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - John A Thompson
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Shailender Bhatia
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA.
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
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Pokhrel A, Wu R, Wang JC. Review of Merkel cell carcinoma with solitary pancreatic metastases mimicking primary neuroendocrine tumor of the pancreas. Clin J Gastroenterol 2023; 16:641-662. [PMID: 37421584 DOI: 10.1007/s12328-023-01821-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/05/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE/BACKGROUND Merkel cell carcinoma (MCC) but metastases to the pancreas are very rare. There are only a few cases of isolated metastases of MCC to the pancreas. Because of this rarity, it can be wrongly diagnosed as a neuroendocrine tumor of the pancreas(pNET), especially the poorly differentiated neuroendocrine carcinoma (PNEC) subtype, in which the treatment is vastly different than that of MCC with isolated metastases of the pancreas. METHODS An electronic search of the PubMed and google scholar databases was performed to obtain the literature on MCC with pancreatic metastases, using the following search terms: Merkel cell carcinoma, pancreas, and metastases. Results are limited to the following available article types: case reports and case series. We identified 45 cases of MCC with pancreatic metastases from the PubMed and Google Scholar database search and examined their potential relevance. Only 22 cases with isolated pancreatic metastases were taken for review including one case that we encountered. RESULTS The results from our review of cases of isolated pancreatic metastases of MCC were compared to the characteristics of the poorly differentiated pancreatic neuroendocrine tumor (PNEC). We found the following: (a) MCC with isolated pancreatic metastases occurred at an older age than PNEC and with male gender predominance (b) Most of the metastases occurred within 2 years of initial diagnosis of MCC (c) Resection of pancreatic mass was the first line treatment in case of resectable PNECs whereas resection of metastases was infrequently performed in MCC with pancreatic metastases.
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Affiliation(s)
- Akriti Pokhrel
- Department of Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
- Department of Hematology and Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Richard Wu
- Department of Pathology, Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
- Department of Hematology and Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Jen Chin Wang
- Department of Pathology, Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA.
- Department of Hematology and Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA.
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Lee Boniao E, Allen RC, Sundar G. Targeted therapy and immunotherapy for orbital and periorbital tumors: a major review. Orbit 2023:1-18. [PMID: 37728602 DOI: 10.1080/01676830.2023.2256848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023]
Abstract
Traditionally, for patients who are poor candidates for surgery and/or radiotherapy, palliative chemotherapy is often offered but with significant toxic side effects. However, recent advancements in our understanding of tumor biology and molecular genetics have brought new understanding to the molecular pathways of certain tumors and cancers. This has ushered in a new era of precision medicine specific to a tumor or cancer treatment pathway (targeted therapy) or directed to host-tumor responses (immunotherapy). This article will focus on recent updates in the application of available targeted and immunotherapy for managing orbital and periorbital tumors and tumor-like conditions, which include cutaneous basal cell carcinoma, cutaneous squamous cell carcinoma, cutaneous melanoma, Merkel cell carcinoma, sebaceous gland carcinoma, solitary fibrous tumor, dermatofibrosarcoma protuberans, orbital meningioma, neurofibromatosis, Langerhans cell histiocytosis, ocular adnexal lymphoma, orbital lymphatic malformation, and adenoid cystic carcinoma.
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Affiliation(s)
- Emmanuel Lee Boniao
- Orbit & Oculofacial Surgery, Ophthalmic Oncology, Department of Ophthalmology, National University Hospital, National University of Singapore, Singapore, Singapore
- Department of Ophthalmology, Amai Pakpak Medical Center, Marawi City, Philippines
| | - Richard C Allen
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Gangadhara Sundar
- Orbit & Oculofacial Surgery, Ophthalmic Oncology, Department of Ophthalmology, National University Hospital, National University of Singapore, Singapore, Singapore
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Saiag P, Blom A. Should adjuvant nivolumab be used in surgically resected Merkel cell carcinoma patients? Lancet 2023; 402:751-753. [PMID: 37451294 DOI: 10.1016/s0140-6736(23)01041-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/11/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise Paré Hospital, Université de Versailles Saint-Quentin-en-Yvelines, Université Paris-Saclay, 92104 Paris, France.
| | - Astrid Blom
- Department of General and Oncologic Dermatology, Ambroise Paré Hospital, Université de Versailles Saint-Quentin-en-Yvelines, Université Paris-Saclay, 92104 Paris, France
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18
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Becker JC, Ugurel S, Leiter U, Meier F, Gutzmer R, Haferkamp S, Zimmer L, Livingstone E, Eigentler TK, Hauschild A, Kiecker F, Hassel JC, Mohr P, Fluck M, Thomas I, Garzarolli M, Grimmelmann I, Drexler K, Spillner AN, Eckhardt S, Schadendorf D. Adjuvant immunotherapy with nivolumab versus observation in completely resected Merkel cell carcinoma (ADMEC-O): disease-free survival results from a randomised, open-label, phase 2 trial. Lancet 2023; 402:798-808. [PMID: 37451295 DOI: 10.1016/s0140-6736(23)00769-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/02/2023] [Accepted: 04/06/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is an immunogenic but aggressive skin cancer. Even after complete resection and radiation, relapse rates are high. PD-1 and PD-L1 checkpoint inhibitors showed clinical benefit in advanced MCC. We aimed to assess efficacy and safety of adjuvant immune checkpoint inhibition in completely resected MCC (ie, a setting without an established systemic standard-of-care treatment). METHODS In this multicentre phase 2 trial, patients (any stage, Eastern Cooperative Oncology Group performance status 0-1) at 20 academic medical centres in Germany and the Netherlands with completely resected MCC lesions were randomly assigned 2:1 to receive nivolumab 480 mg every 4 weeks for 1 year, or observation, stratified by stage (American Joint Committee on Cancer stages 1-2 vs stages 3-4), age (<65 vs ≥65 years), and sex. Landmark disease-free survival (DFS) at 12 and 24 months was the primary endpoint, assessed in the intention-to-treat populations. Overall survival and safety were secondary endpoints. This planned interim analysis was triggered when the last-patient-in was followed up for more than 1 year. This study is registered with ClinicalTrials.gov (NCT02196961) and with the EU Clinical Trials Register (2013-000043-78). FINDINGS Between Oct 1, 2014, and Aug 31, 2020, 179 patients were enrolled (116 [65%] stage 3-4, 122 [68%] ≥65 years, 111 [62%] male). Stratification factors (stage, age, sex) were balanced across the nivolumab (n=118) and internal control group (observation, n=61); adjuvant radiotherapy was more common in the control group. At a median follow-up of 24·3 months (IQR 19·2-33·4), median DFS was not reached (between-groups hazard ratio 0·58, 95% CI 0·30-1·12); DFS rates in the nivolumab group were 85% at 12 months and 84% at 24 months, and in the observation group were 77% at 12 months and 73% at 24 months. Overall survival results were not yet mature. Grade 3-4 adverse events occurred in 48 [42%] of 115 patients who received at least one dose of nivolumab and seven [11%] of 61 patients in the observation group. No treatment-related deaths were reported. INTERPRETATION Adjuvant therapy with nivolumab resulted in an absolute risk reduction of 9% (1-year DFS) and 10% (2-year DFS). The present interim analysis of ADMEC-O might suggest clinical use of nivolumab in this area of unmet medical need. However, overall survival events rates, with ten events in the active treatment group and six events in the half-the-size observation group, are not mature enough to draw conclusions. The explorative data of our trial support the continuation of ongoing, randomised trials in this area. ADMEC-O suggests that adjuvant immunotherapy is clinically feasible in this area of unmet medical need. FUNDING Bristol Myers Squibb.
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Affiliation(s)
- Jürgen C Becker
- Department of Dermatology, University Hospital Essen, Essen, Germany; Translational Skin Cancer Research, Department of Dermatology and West German Cancer Center, University of Medicine Duisburg-Essen, Essen, Germany; German Cancer Consortium, Partner Site Essen, Essen, Germany
| | - Selma Ugurel
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site Essen, Essen, Germany
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, University Hospital Tübingen, Tübingen, Germany; German Cancer Consortium, Partner Site Tübingen, Tübingen, Germany
| | - Friedegund Meier
- Department of Dermatology, University Hospital Dresden, Dresden, Germany; German Cancer Consortium, Partner Site Dresden, Dresden, Germany
| | - Ralf Gutzmer
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany; Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site Essen, Essen, Germany
| | - Elisabeth Livingstone
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site Essen, Essen, Germany
| | - Thomas K Eigentler
- Centre for Dermatooncology, Department of Dermatology, University Hospital Tübingen, Tübingen, Germany; Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Felix Kiecker
- Department of Dermatology and Venereology, Vivantes Klinikum Berlin Neukölln, Berlin, Germany; Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jessica C Hassel
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany; German Cancer Consortium, Partner Site Heidelberg, Heidelberg, Germany
| | - Peter Mohr
- Department of Dermatology, Elbe-Kliniken, Buxtehude, Germany
| | - Michael Fluck
- Department of Oncology Hornheide, Fachklinik Hornheide, Münster, Germany
| | - Ioannis Thomas
- Centre for Dermatooncology, Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - Marlene Garzarolli
- Department of Dermatology, University Hospital Dresden, Dresden, Germany
| | - Imke Grimmelmann
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Konstantin Drexler
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | | | | | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site Essen, Essen, Germany.
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Gra M, Pham-Ledard A, Gerard E, Dutriaux C, Beylot-Barry M, Duval F, Carla L, Soulages A, Prey S. Brief Communication: Lambert-Eaton Myasthenic Paraneoplastic Syndrome Associated With Merkel Cell Carcinoma Successfully Treated by Immune Checkpoint Inhibitors: 2 Cases. J Immunother 2023; 46:276-278. [PMID: 37326491 DOI: 10.1097/cji.0000000000000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/19/2023] [Indexed: 06/17/2023]
Abstract
Merkel cell carcinoma (MCC) is an aggressive neuroendocrine cutaneous tumor with high metastatic potential. In rare cases, it can be associated with paraneoplastic syndromes (PNS), which result from an antitumor immunity against antigens produced by the tumor itself. Lambert-Eaton Myasthenic Syndrome (LEMS) is a neurological autoimmune PNS characterized by an impairment of the neuromuscular junction, leading to proximal muscle weakness and fatigability. Although the development of immune checkpoint inhibitors (ICI) is a breakthrough in the management of many cancers, onset or worsen of immune diseases has been described. Thereby, in patients with previous neurological PNS like LEMS, the ICI therapy for cancer may aggravate neurological symptoms and lead to irreversible impairment. We report here 2 cases of patients with metastatic MCC associated with a LEMS at the diagnosis. Both successfully received ICI therapies (anti-PDL1 avelumab and anti-PD1 pembrolizumab) without worsening of LEMS and any major immune-related adverse effects. Their neurological condition improved and disappeared concomitantly with the efficacy of immunotherapy, and we did not observe relapse of both MCC and LEMS after treatment discontinuation. Finally, we performed a complete review of the literature, which confirmed that ICI treatment could be discussed for patients with paraneoplastic LEMS, and emphasized the need for multidisciplinary management.
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Affiliation(s)
- Marion Gra
- CHU de Bordeaux, Service de Dermatologie, Bordeaux, France
| | - Anne Pham-Ledard
- CHU de Bordeaux, Service de Dermatologie, Bordeaux, France
- BRIC (BoRdeaux Institute of onCology), UMR1312, Team 5, INSERM, Univ, Bordeaux, Bordeaux, France
| | - Emilie Gerard
- CHU de Bordeaux, Service de Dermatologie, Bordeaux, France
| | - Caroline Dutriaux
- CHU de Bordeaux, Service de Dermatologie, Bordeaux, France
- BRIC (BoRdeaux Institute of onCology), UMR1312, Team 5, INSERM, Univ, Bordeaux, Bordeaux, France
| | - Marie Beylot-Barry
- CHU de Bordeaux, Service de Dermatologie, Bordeaux, France
- BRIC (BoRdeaux Institute of onCology), UMR1312, Team 5, INSERM, Univ, Bordeaux, Bordeaux, France
| | - Fanny Duval
- CHU de Bordeaux, Service de Neurologie, Bordeaux, France
| | - Louis Carla
- CHU de Bordeaux, Service de Neurologie, Bordeaux, France
| | | | - Sorilla Prey
- CHU de Bordeaux, Service de Dermatologie, Bordeaux, France
- BRIC (BoRdeaux Institute of onCology), UMR1312, Team 5, INSERM, Univ, Bordeaux, Bordeaux, France
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Celikdemir B, Houben R, Kervarrec T, Samimi M, Schrama D. Current and preclinical treatment options for Merkel cell carcinoma. Expert Opin Biol Ther 2023; 23:1015-1034. [PMID: 37691397 DOI: 10.1080/14712598.2023.2257603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Merkel cell carcinoma (MCC) is a rare, highly aggressive form of skin cancer with neuroendocrine features. The origin of this cancer is still unclear, but research in the last 15 years has demonstrated that MCC arises via two distinct etiologic pathways, i.e. virus and UV-induced. Considering the high mortality rate and the limited therapeutic options available, this review aims to highlight the significance of MCC research and the need for advancement in MCC treatment. AREAS COVERED With the advent of the immune checkpoint inhibitor therapies, we now have treatment options providing a survival benefit for patients with advanced MCC. However, the issue of primary and acquired resistance to these therapies remains a significant concern. Therefore, ongoing efforts seeking additional therapeutic targets and approaches for MCC therapy are a necessity. Through a comprehensive literature search, we provide an overview on recent preclinical and clinical studies with respect to MCC therapy. EXPERT OPINION Currently, the only evidence-based therapy for MCC is immune checkpoint blockade with anti-PD-1/PD-L1 for advanced patients. Neoadjuvant, adjuvant and combined immune checkpoint blockade are promising treatment options.
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Affiliation(s)
- Büke Celikdemir
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Roland Houben
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Thibault Kervarrec
- Department of Pathology, Centre Hospitalier Universitaire De Tours, Tours, France
| | - Mahtab Samimi
- Department of Dermatology, University Hospital of Tours, Tours, France
| | - David Schrama
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
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21
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Jani S, Church CD, Nghiem P. Insights into anti-tumor immunity via the polyomavirus shared across human Merkel cell carcinomas. Front Immunol 2023; 14:1172913. [PMID: 37287968 PMCID: PMC10242112 DOI: 10.3389/fimmu.2023.1172913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/27/2023] [Indexed: 06/09/2023] Open
Abstract
Understanding and augmenting cancer-specific immunity is impeded by the fact that most tumors are driven by patient-specific mutations that encode unique antigenic epitopes. The shared antigens in virus-driven tumors can help overcome this limitation. Merkel cell carcinoma (MCC) is a particularly interesting tumor immunity model because (1) 80% of cases are driven by Merkel cell polyomavirus (MCPyV) oncoproteins that must be continually expressed for tumor survival; (2) MCPyV oncoproteins are only ~400 amino acids in length and are essentially invariant between tumors; (3) MCPyV-specific T cell responses are robust and strongly linked to patient outcomes; (4) anti-MCPyV antibodies reliably increase with MCC recurrence, forming the basis of a standard clinical surveillance test; and (5) MCC has one of the highest response rates to PD-1 pathway blockade among all solid cancers. Leveraging these well-defined viral oncoproteins, a set of tools that includes over 20 peptide-MHC class I tetramers has been developed to facilitate the study of anti-tumor immunity across MCC patients. Additionally, the highly immunogenic nature of MCPyV oncoproteins forces MCC tumors to develop robust immune evasion mechanisms to survive. Indeed, several immune evasion mechanisms are active in MCC, including transcriptional downregulation of MHC expression by tumor cells and upregulation of inhibitory molecules including PD-L1 and immunosuppressive cytokines. About half of patients with advanced MCC do not persistently benefit from PD-1 pathway blockade. Herein, we (1) summarize the lessons learned from studying the anti-tumor T cell response to virus-positive MCC; (2) review immune evasion mechanisms in MCC; (3) review mechanisms of resistance to immune-based therapies in MCC and other cancers; and (4) discuss how recently developed tools can be used to address open questions in cancer immunotherapy. We believe detailed investigation of this model cancer will provide insight into tumor immunity that will likely also be applicable to more common cancers without shared tumor antigens.
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Affiliation(s)
- Saumya Jani
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Candice D. Church
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Paul Nghiem
- Department of Medicine, University of Washington, Seattle, WA, United States
- Fred Hutchinson Cancer Center, Seattle, WA, United States
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22
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Houben R, Alimova P, Sarma B, Hesbacher S, Schulte C, Sarosi EM, Adam C, Kervarrec T, Schrama D. 4-[(5-Methyl-1H-pyrazol-3-yl)amino]-2H-phenyl-1-phthalazinone Inhibits MCPyV T Antigen Expression in Merkel Cell Carcinoma Independent of Aurora Kinase A. Cancers (Basel) 2023; 15:cancers15092542. [PMID: 37174007 PMCID: PMC10177447 DOI: 10.3390/cancers15092542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
Merkel cell carcinoma (MCC) is frequently caused by the Merkel cell polyomavirus (MCPyV), and MCPyV-positive tumor cells depend on expression of the virus-encoded T antigens (TA). Here, we identify 4-[(5-methyl-1H-pyrazol-3-yl)amino]-2H-phenyl-1-phthalazinone (PHT)-a reported inhibitor of Aurora kinase A-as a compound inhibiting growth of MCC cells by repressing noncoding control region (NCCR)-controlled TA transcription. Surprisingly, we find that TA repression is not caused by inhibition of Aurora kinase A. However, we demonstrate that β-catenin-a transcription factor repressed by active glycogen synthase kinase 3 (GSK3)-is activated by PHT, suggesting that PHT bears a hitherto unreported inhibitory activity against GSK3, a kinase known to function in promoting TA transcription. Indeed, applying an in vitro kinase assay, we demonstrate that PHT directly targets GSK3. Finally, we demonstrate that PHT exhibits in vivo antitumor activity in an MCC xenograft mouse model, suggesting a potential use in future therapeutic settings for MCC.
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Affiliation(s)
- Roland Houben
- Department of Dermatology, Venereology und Allergology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Pamela Alimova
- Department of Dermatology, Venereology und Allergology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Bhavishya Sarma
- Department of Dermatology, Venereology und Allergology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Sonja Hesbacher
- Department of Dermatology, Venereology und Allergology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Carolin Schulte
- Department of Dermatology, Venereology und Allergology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Eva-Maria Sarosi
- Department of Dermatology, Venereology und Allergology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Christian Adam
- Department of Dermatology, Venereology und Allergology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Thibault Kervarrec
- Department of Pathology, Centre Hospitalier Universitaire de Tours, INRA UMR 1282 BIP, 37200 Tours, France
| | - David Schrama
- Department of Dermatology, Venereology und Allergology, University Hospital Würzburg, 97080 Würzburg, Germany
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23
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Averbuch I, Stoff R, Miodovnik M, Fennig S, Bar-Sela G, Yakobson A, Daliot J, Asher N, Fenig E. Avelumab for the treatment of locally advanced or metastatic Merkel cell carcinoma-A multicenter real-world experience in Israel. Cancer Med 2023. [PMID: 37012213 DOI: 10.1002/cam4.5890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/24/2023] [Accepted: 03/12/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare and aggressive malignancy of the skin, affecting predominantly the fair-skinned older population exposed to high levels of ultraviolet light. Immune suppression is considered a significant risk factor. With the recent advances in the field of immunotherapy, the treatment paradigm for advanced MCC, traditionally based on chemotherapy, has largely shifted to anti-PD-L1 and PD-1 agents such as avelumab and pembrolizumab, respectively. However, real-world data remain sparse. The aim of this study was to assess real-world evidence of the effectiveness of avelumab in a diverse group of patients with MCC in Israel. METHODS The electronic databases of five university hospitals in Israel were searched for all consecutive patients with MCC treated with at least one dose of avelumab in 2018-2022. Data on baseline, disease-related, treatment-related, and outcome parameters were collected and analyzed. RESULTS The cohort included 62 patients of whom 22% were immune-suppressed. The overall response rate to avelumab was 59%. The median progression-free survival was 8.1 months, and the median overall survival, 23.5 months, with no differences between immune-competent and immune-suppressed patients. Treatment was well tolerated; any-grade toxicity developed in 34% of patients, and grade 3-4 toxicity, in 14%. CONCLUSIONS Avelumab was found to be effective and safe for the treatment of advanced MCC in a diverse group of patients, including some with immune suppression. Further studies are warranted to evaluate the optimal sequence and duration of treatment and to assess the potential role of avelumab for earlier stages of MCC.
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Affiliation(s)
- Itamar Averbuch
- Davidoff Cancer Center, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronen Stoff
- Ella Institute for Immuno-Oncology, Sheba Medical Center, Sackler, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mor Miodovnik
- Department of Dermatology, Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Fennig
- Institute of Oncology, Kaplan Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Gil Bar-Sela
- Cancer Center, Emek Medical Center, Rappaport Faculty of Medicine, Israel Institute of Technology-Technion, Haifa, Israel
| | - Alexander Yakobson
- The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center, School of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Jonathan Daliot
- Davidoff Cancer Center, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Natan Asher
- Ella Institute for Immuno-Oncology, Sheba Medical Center, Sackler, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Fenig
- Davidoff Cancer Center, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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24
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Weppler AM, Da Meda L, Pires da Silva I, Xu W, Grignani G, Menzies AM, Carlino MS, Long GV, Lo SN, Nordman I, Steer CB, Lyle M, Trojaniello C, Ascierto PA, Lebbe C, Sandhu S. Durability of response to immune checkpoint inhibitors in metastatic Merkel cell carcinoma after treatment cessation. Eur J Cancer 2023; 183:109-118. [PMID: 36842413 DOI: 10.1016/j.ejca.2023.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND Metastatic Merkel cell carcinoma (mMCC) is highly responsive to immune checkpoint inhibitors (ICIs); however, durability of response after treatment cessation and response to retreatment in the setting of progression is unknown. METHODS Patients (pts) having mMCC from 10 centres who discontinued ICI treatment for a reason other than progression were studied. RESULTS Forty patients were included. Median time on treatment was 13.5 months (range 1-35). Thirty-one patients (77.5%) stopped treatment electively while 9 patients (22.5%) stopped due to treatment-related toxicity. After median of 12.3 months from discontinuation, 14 pts (35%) have progressed (PD). Disease progression rate following ICI discontinuation was 26% (8 of 31) in patients who discontinued in complete response (CR), 57% (4 of 7) in patients in partial response and 100% (2 of 2) in those with stable disease. Median progression-free survival (PFS) after treatment cessation was 21 months (95% confidence interval [CI], 18- not reached [NR]), with a third of patients progressing during their first year off treatment. PFS was longer for patients who discontinued ICI electively (median PFS 29 months; 95% CI, 21-NR) compared to those who stopped due to toxicity (median PFS 11 months; 95% CI, 10-NR). ICI was restarted in 8 of 14 pts (57%) with PD, with response rate of 75% (4 CR, 2 partial response, 1 stable disease, 1 PD). CONCLUSION ICI responses in mMCC do not appear durable off treatment, including in patients who achieve a CR, though response to retreatment is promising. Extended duration of treatment needs to be investigated to optimise long-term outcomes.
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Affiliation(s)
| | - Laetitia Da Meda
- Institut du cancer AP-HP. Nord - Université Paris Cité Dermato-Oncology, Hôpital Saint Louis, Paris, France
| | - Ines Pires da Silva
- Melanoma Institute of Australia, The University of Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Australia; Westmead & Blacktown Hospital, Sydney, Australia
| | - Wen Xu
- Princess Alexandra Hospital, Brisbane, Australia; The University of Queensland, Brisbane, Australia
| | | | - Alexander M Menzies
- Melanoma Institute of Australia, The University of Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Australia; Royal North Shore and Mater Hospitals, Sydney, Australia
| | - Matteo S Carlino
- Melanoma Institute of Australia, The University of Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Australia; Westmead & Blacktown Hospital, Sydney, Australia
| | - Georgina V Long
- Melanoma Institute of Australia, The University of Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Australia
| | - Serigne N Lo
- Melanoma Institute of Australia, The University of Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Australia
| | - Ina Nordman
- Calvary Mater Newcastle, Waratah, Australia; University of Newcastle, Newcastle, Australia
| | - Christopher B Steer
- Border Medical Oncology, Albury Wodonga Regional Cancer Centre, Albury, Australia Cairns Hospital, Cairns, Australia; University of NSW, Rural Clinical Campus, Albury, Australia
| | - Megan Lyle
- Cairns Hospital, Cairns, Australia; James Cook University, Cairns, Australia
| | | | - Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Celeste Lebbe
- Institut du cancer AP-HP. Nord - Université Paris Cité Dermato-Oncology, Hôpital Saint Louis, Paris, France
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25
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Sergi MC, Lauricella E, Porta C, Tucci M, Cives M. An update on Merkel cell carcinoma. Biochim Biophys Acta Rev Cancer 2023; 1878:188880. [PMID: 36914034 DOI: 10.1016/j.bbcan.2023.188880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 03/13/2023]
Abstract
Merkel cell carcinoma (MCC) is a rare cancer of the skin characterized by a neuroendocrine phenotype and an aggressive clinical behavior. It frequently originates in sun-exposed body areas, and its incidence has steadily increased in the last three decades. Merkel cell polyomavirus (MCPyV) and ultraviolet (UV) radiation exposure are the main causative agents of MCC, and distinct molecular features have been documented in virus-positive and virus-negative malignancies. Surgery remains the cornerstone of treatment for localized tumors, but even when integrated with adjuvant radiotherapy is able to definitively cure only a fraction of MCC patients. While characterized by a high objective response rate, chemotherapy is associated with a short-lasting benefit of approximately 3 months. On the other hand, immune checkpoint inhibitors including avelumab and pembrolizumab have demonstrated durable antitumor activity in patients with stage IV MCC, and investigations on their use in the neoadjuvant or adjuvant setting are currently underway. Addressing the needs of those patients who do not persistently benefit from immunotherapy is currently one of the most compelling unmet needs in the field, and multiple clinical trials of new tyrosine kinase inhibitors (TKIs), peptide receptor radionuclide therapy (PRRT), therapeutic vaccines, immunocytokines as well as innovative forms of adoptive cellular immunotherapies are under clinical scrutiny at present.
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Affiliation(s)
- Maria Chiara Sergi
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Eleonora Lauricella
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Camillo Porta
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy; Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari, Italy
| | - Marco Tucci
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy; Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari, Italy
| | - Mauro Cives
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy; Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari, Italy.
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26
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Becker JC, Beer AJ, DeTemple VK, Eigentler T, Flaig MJ, Gambichler T, Grabbe S, Höller U, Klumpp B, Lang S, Pföhler C, Posch C, Prasad V, Schlattmann P, Schneider-Burrus S, Ter-Nedden J, Terheyden P, Thoms K, Vordermark D, Ugurel S. S2k-Leitlinie - Merkelzellkarzinom - Update 2022. J Dtsch Dermatol Ges 2023; 21:305-317. [PMID: 36929546 DOI: 10.1111/ddg.14930_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/09/2022] [Indexed: 03/18/2023]
Affiliation(s)
- Jürgen C Becker
- Translational Skin Cancer Research (TSCR), Deutsches Konsortium für translationale Krebsforschung (DKTK), Partnerstandort Essen, Klinik für Dermatologie, Universitätsmedizin Essen, Deutsches Krebsforschungszentrum, Heidelberg
| | | | - Viola K DeTemple
- Universitätsklinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Johannes Wesling Klinikum Minden
| | - Thomas Eigentler
- Klinik für Dermatologie, Venerologie und Allergologie, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin
| | - Michael J Flaig
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München
| | - Thilo Gambichler
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum
| | | | | | | | - Stephan Lang
- Hals-Nasen-Ohren-Klinik am Universitätsklinikum Essen
| | - Claudia Pföhler
- Klinik für Dermatologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Christian Posch
- Hautklinik Campus Biederstein, Technische Universität München
| | - Vikas Prasad
- Klinik für Nuklearmedizin, Universitätsklinikum Ulm
| | | | | | | | - Patrick Terheyden
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - Kai Thoms
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, Göttingen
| | - Dirk Vordermark
- Universitätsklinik und Poliklinik für Strahlentherapie, Halle
| | - Selma Ugurel
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
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27
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Becker JC, Beer AJ, DeTemple VK, Eigentler T, Flaig M, Gambichler T, Grabbe S, Höller U, Klumpp B, Lang S, Pföhler C, Posch C, Prasad V, Schlattmann P, Schneider-Burrus S, Ter-Nedden J, Terheyden P, Thoms K, Vordermark D, Ugurel S. S2k Guideline - Merkel cell carcinoma (MCC, neuroendocrine carcinoma of the skin) - Update 2022. J Dtsch Dermatol Ges 2023; 21:305-320. [PMID: 36929552 DOI: 10.1111/ddg.14930] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/09/2022] [Indexed: 03/18/2023]
Abstract
Merkel cell carcinoma (MCC, ICD-O M8247/3) is a rare, malignant, primary skin tumor with epithelial and neuroendocrine differentiation. The tumor cells share many morphologic, immunohistochemical, and ultrastructural features with cutaneous Merkel cells. Nevertheless, the cell of origin of MCC is unclear. MCC appears clinically as a reddish to purple spherical tumor with a smooth, shiny surface and a soft to turgid, elastic consistency, usually showing rapid growth. Spontaneous and often complete regressions of the tumor are observed. These likely immunologically-mediated regressions explain the cases in which only lymph node or distant metastases are found at the time of initial diagnosis and why the tumor responds very well to immunomodulatory therapies even at advanced stages. Due to its aggressiveness, the usually given indication for sentinel lymph node biopsy, the indication of adjuvant therapies to be evaluated, as well as the complexity of the necessary diagnostics, clinical management should already be determined by an interdisciplinary tumor board at the time of initial diagnosis.
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Affiliation(s)
- Jürgen C Becker
- Translational Skin Cancer Research (TSCR), Deutsches Konsortium für translationale Krebsforschung (DKTK), Partnerstandort Essen, Department of Dermatology, University Hospital Essen, German Cancer Research Center (DKFZ), Heidelberg
| | - Ambros J Beer
- Department of Nuclear Medicine, University Hospital Ulm
| | - Viola K DeTemple
- Department of Dermatology, Venereology, Allergology and Phlebology, Johannes Wesling Klinikum, Minden
| | - Thomas Eigentler
- Department of Dermatology, Venereology and Allergology, University Hospital Berlin
| | - Michael Flaig
- Department and Clinic for Dermatology and Allergology, LMU Klinikum Munich
| | - Thilo Gambichler
- Department of Dermatology, Venereology and Allergology, Ruhr University Bochum
| | | | | | | | - Stephan Lang
- Department of Ear, Nose and Throat Medicine, University Hospital Essen
| | - Claudia Pföhler
- Department of Dermatology, University Hospital Saarland, Homburg/Saar
| | - Christian Posch
- Department of Dermatology Campus Biederstein, Technical University Munich
| | - Vikas Prasad
- Department of Nuclear Medicine, University Hospital Ulm
| | | | | | - Jan Ter-Nedden
- Professional Association of German Dermatologists, Hamburg
| | - Patrick Terheyden
- Department of Dermatology, Venereology and Allergology, University Hospital Schleswig-Holstein, Campus Lübeck
| | - Kai Thoms
- Department of Dermatology, Venereology and Allergology, University Hospital Göttingen, Göttingen
| | | | - Selma Ugurel
- Department of Dermatology, Venereology and Allergology, University Hospital Essen
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28
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Bartley BR, Moore SA, Doan HQ, Rady PL, Tyring SK. Current treatments and emerging therapies of human polyomavirus-associated skin diseases: a comprehensive review. Int J Dermatol 2023; 62:387-396. [PMID: 36577746 DOI: 10.1111/ijd.16534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/04/2022] [Accepted: 11/18/2022] [Indexed: 12/30/2022]
Abstract
Since Merkel cell polyomavirus (MCPyV) was linked as the predominant etiology of Merkel cell carcinoma (MCC) in 2008, three additional human polyomaviruses (HPyV) have been definitively linked to cutaneous diseases-trichodysplasia spinulosa virus (TSPyV) and human polyomavirus 6 and 7 (HPyV6, HPyV7). TSPyV contributes to the development of trichodysplasia spinulosa (TS), and HPyV6/7 is associated closely with the eruption of pruritic and dyskeratotic dermatoses (PDD). Clinically, MCC is treated with surgical excision and radiation with adjuvant chemotherapy, although newer treatment options include immune checkpoint inhibition. These novel immunotherapies hold promise for the treatment of metastatic MCC, but resistance and side effects prevent a significant proportion of patients from realizing their benefits. Based on previous case reports, the standard of care for the less deadly but disfiguring cutaneous disease TS include immunosuppressant (IS) reduction, the use of antivirals such as cidofovir (CDV) or valganciclovir (VGCV), or a combination of these treatments. Similar treatments were attempted for PDD, but oral acitretin was found to be most effective. As MCC, TS, and PDD are rare diseases, further research is required for effective treatments. In this review, we summarize clinical trials, preclinical studies, and case reports that present outcomes and side effects of current and emerging treatments for HPyV-associated cutaneous diseases, offering a comprehensive resource for clinical application and prospective clinical trials.
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Affiliation(s)
- Brooke R Bartley
- Department of Dermatology, The University of Texas McGovern Medical School, Houston, TX, USA
| | - Stephen A Moore
- Department of Dermatology, The University of Texas McGovern Medical School, Houston, TX, USA
| | - Hung Q Doan
- Department of Dermatology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter L Rady
- Department of Dermatology, The University of Texas McGovern Medical School, Houston, TX, USA
| | - Stephen K Tyring
- Department of Dermatology, The University of Texas McGovern Medical School, Houston, TX, USA
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29
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Spiliopoulou P, Vornicova O, Genta S, Spreafico A. Shaping the Future of Immunotherapy Targets and Biomarkers in Melanoma and Non-Melanoma Cutaneous Cancers. Int J Mol Sci 2023; 24:ijms24021294. [PMID: 36674809 PMCID: PMC9862040 DOI: 10.3390/ijms24021294] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Recent advances in treating cutaneous melanoma have resulted in impressive patient survival gains. Refinement of disease staging and accurate patient risk classification have significantly improved our prognostic knowledge and ability to accurately stratify treatment. Undoubtedly, the most important step towards optimizing patient outcomes has been the advent of cancer immunotherapy, in the form of immune checkpoint inhibition (ICI). Immunotherapy has established its cardinal role in the management of both early and late-stage melanoma. Through leveraging outcomes in melanoma, immunotherapy has also extended its benefit to other types of skin cancers. In this review, we endeavor to summarize the current role of immunotherapy in melanoma and non-melanoma skin cancers, highlight the most pertinent immunotherapy-related molecular biomarkers, and lastly, shed light on future research directions.
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Affiliation(s)
- Pavlina Spiliopoulou
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada
| | - Olga Vornicova
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada
- Mount Sinai Hospital, University Health Network, Toronto, ON M5G 1X5, Canada
| | - Sofia Genta
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada
| | - Anna Spreafico
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada
- Correspondence: ; Tel.: +1-416-946-4501 (ext. 5083)
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30
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Wang AJ, McCann B, Soon WCL, De Ieso PB, Bressel M, Hui A, Chua M, Kok DL. Merkel cell carcinoma: a forty-year experience at the Peter MacCallum Cancer Centre. BMC Cancer 2023; 23:30. [PMID: 36611133 PMCID: PMC9826569 DOI: 10.1186/s12885-022-10349-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/22/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare but highly aggressive neuroendocrine skin malignancy, with Australia having the highest reported incidence in the world. There is currently a lack of consensus regarding optimal management of this disease. METHODS This was a retrospective audit conducted by reviewing existing medical records of MCC patients presenting to the Peter MacCallum Cancer Centre (PMCC) between 1980 and 2018. The primary endpoint was locoregional recurrence. The secondary endpoints were distant recurrence, disease-free survival (DFS) and overall survival (OS). RESULTS A total of 533 patients were identified. Locoregional recurrence occurring at one, two and 5 years was 24, 31 and 32%, respectively. The estimated 5-year OS and DFS were 46% (95% Confidence Interval [CI] 41-51%) and 34% (95% CI 30-39%) respectively. Older age at diagnosis (hazard ratio [HR] per year = 1.07, 95% CI 1.06-1.07, p < 0.001), and larger primary tumour diameter (HR =1.16, 95% CI 1.03-1.31, p = 0.019) were associated with worse OS on multivariable analysis. Positive or negative histopathological margin status was not associated with OS or DFS differences in patients treated with post-operative radiotherapy. CONCLUSIONS In our study, about a third of patients developed locoregional recurrence, distal recurrence or both, and there appears to be no change over the last four decades. If treated with adjuvant radiotherapy, there is no difference in OS or DFS with positive surgical margins. Findings should influence future guidelines.
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Affiliation(s)
- Annie J Wang
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia
| | - Brendan McCann
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia.
| | - William C L Soon
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia
| | - Paolo B De Ieso
- Icon Cancer Centre Moreland John Fawkner Private Hospital, Coburg, Australia
| | - Mathias Bressel
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Andrew Hui
- Andrew Love Cancer Centre, Geelong, Victoria, Australia
| | - Margaret Chua
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia
| | - David L Kok
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia.
- Department of Clinical Pathology, The University of Melbourne, Melbourne, Victoria, Australia.
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Esser E, Grünewald I, Mihailovic N. Periocular Merkel Cell Carcinoma - An Overview of Clinical Aspects and Current Treatment Options. Klin Monbl Augenheilkd 2023; 240:24-32. [PMID: 36368663 DOI: 10.1055/a-1925-7703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Merkel cell carcinoma (MCC) is a rare but highly aggressive and rapidly expanding malignant skin tumor. It affects the periocular region in approximately 10% of cases. The current treatment recommendation for resectable non-metastatic MCC comprises total surgical excision; however, lymph node or distant metastases are often already present by the time of the diagnosis. Since an immune checkpoint inhibitor therapy with avelumab was first approved for MCC in 2016, there has been considerable improvement in mean survival compared to cytostatic therapy; at the same time, there has been a reduction in serious treatment-associated adverse events. Other immune checkpoint inhibitors are currently still in clinical trials, with very promising initial results. Because of the complexity of the diagnosis, treatment, and prognosis, it is essential that MCC patients receive interdisciplinary care in a specialized center including consultation with a tumor review board.
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Affiliation(s)
- Eliane Esser
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Deutschland
| | - Inga Grünewald
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Deutschland
| | - Natasa Mihailovic
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Deutschland.,Klinik für Augenheilkunde, Klinikum Fulda gAG, Deutschland
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Glover A, Zhang Z, Shannon-Lowe C. Deciphering the roles of myeloid derived suppressor cells in viral oncogenesis. Front Immunol 2023; 14:1161848. [PMID: 37033972 PMCID: PMC10076641 DOI: 10.3389/fimmu.2023.1161848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/10/2023] [Indexed: 04/11/2023] Open
Abstract
Myeloid derived suppressor cells (MDSCs) are a heterogenous population of myeloid cells derived from monocyte and granulocyte precursors. They are pathologically expanded in conditions of ongoing inflammation where they function to suppress both innate and adaptive immunity. They are subdivided into three distinct subsets: monocytic (M-) MDSC, polymorphonuclear (or neutrophilic) (PMN-) MDSC and early-stage (e-) MDSC that may exhibit differential function in different pathological scenarios. However, in cancer they are associated with inhibition of the anti-tumour immune response and are universally associated with a poor prognosis. Seven human viruses classified as Group I carcinogenic agents are jointly responsible for nearly one fifth of all human cancers. These viruses represent a large diversity of species, including DNA, RNA and retroviridae. They include the human gammaherpesviruses (Epstein Barr virus (EBV) and Kaposi's Sarcoma-Associated Herpesvirus (KSHV), members of the high-risk human papillomaviruses (HPVs), hepatitis B and C (HBV, HCV), Human T cell leukaemia virus (HTLV-1) and Merkel cell polyomavirus (MCPyV). Each of these viruses encode an array of different oncogenes that perturb numerous cellular pathways that ultimately, over time, lead to cancer. A prerequisite for oncogenesis is therefore establishment of chronic infection whereby the virus persists in the host cells without being eradicated by the antiviral immune response. Although some of the viruses can directly modulate the immune response to enable persistence, a growing body of evidence suggests the immune microenvironment is modulated by expansions of MDSCs, driven by viral persistence and oncogenesis. It is likely these MDSCs play a role in loss of immune recognition and function and it is therefore essential to understand their phenotype and function, particularly given the increasing importance of immunotherapy in the modern arsenal of anti-cancer therapies. This review will discuss the role of MDSCs in viral oncogenesis. In particular we will focus upon the mechanisms thought to drive the MDSC expansions, the subsets expanded and their impact upon the immune microenvironment. Importantly we will explore how MDSCs may modulate current immunotherapies and their impact upon the success of future immune-based therapies.
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33
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Hooiveld-Noeken JS, Eggen AC, Rácz E, de Vries EG, Reyners AK, Jalving M. Towards less mutilating treatments in patients with advanced non-melanoma skin cancers by earlier use of immune checkpoint inhibitors. Crit Rev Oncol Hematol 2022; 180:103855. [DOI: 10.1016/j.critrevonc.2022.103855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/28/2022] [Accepted: 10/12/2022] [Indexed: 11/24/2022] Open
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Akaike T, Cahill K, Akaike G, Huynh ET, Hippe DS, Shinohara MM, Liao J, Apisarnthanarax S, Parvathaneni U, Hall E, Bhatia S, Cheng RK, Nghiem P, Tseng YD. Management and Prognosis of Cardiac Metastatic Merkel Cell Carcinoma: A Case-Control Study and Literature Review. Cancers (Basel) 2022; 14:cancers14235914. [PMID: 36497395 PMCID: PMC9741306 DOI: 10.3390/cancers14235914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022] Open
Abstract
Merkel cell carcinoma (MCC), an aggressive neuroendocrine skin cancer, has a high rate (20%) of distant metastasis. Within a prospective registry of 582 patients with metastatic MCC (mMCC) diagnosed between 2003-2021, we identified 9 (1.5%) patients who developed cardiac metastatic MCC (mMCC). We compared overall survival (OS) between patients with cardiac and non-cardiac metastases in a matched case-control study. Cardiac metastasis was a late event (median 925 days from initial MCC diagnosis). The right heart was predominantly involved (8 of 9; 89%). Among 7 patients treated with immunotherapy, 6 achieved a complete or partial response of the cardiac lesion. Among these 6 responders, 5 received concurrent cardiac radiotherapy (median 20 Gray) with immunotherapy; 4 of 5 did not have local disease progression or recurrence in the treated cardiac lesion. One-year OS was 44%, which was not significantly different from non-cardiac mMCC patients (45%, p = 0.96). Though it occurs relatively late in the disease course, cardiac mMCC responded to immunotherapy and/or radiotherapy and was not associated with worse prognosis compared to mMCC at other anatomic sites. These results are timely as cardiac mMCC may be increasingly encountered in the era of immunotherapy as patients with metastatic MCC live longer.
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Affiliation(s)
- Tomoko Akaike
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
- Correspondence: ; Tel.: +1-206-221-4594
| | - Kelsey Cahill
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Gensuke Akaike
- Department of Radiology, University of Washington, Seattle, WA 98195, USA
- TRA Medical Imaging, Tacoma, WA 98402, USA
| | - Emily T. Huynh
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Daniel S. Hippe
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Michi M. Shinohara
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Jay Liao
- Department of Radiation Oncology, University of Washington, Seattle, WA 91895, USA
| | | | - Upendra Parvathaneni
- Department of Radiation Oncology, University of Washington, Seattle, WA 91895, USA
| | - Evan Hall
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Shailender Bhatia
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Richard K. Cheng
- Division of Cardiology, University of Washington Medical Center, Seattle, WA 98195, USA
| | - Paul Nghiem
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Yolanda D. Tseng
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
- Department of Radiation Oncology, University of Washington, Seattle, WA 91895, USA
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35
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Lipid Nanoparticles Delivering Constitutively Active STING mRNA to Stimulate Antitumor Immunity. Int J Mol Sci 2022; 23:ijms232314504. [PMID: 36498833 PMCID: PMC9739380 DOI: 10.3390/ijms232314504] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022] Open
Abstract
Treating immunosuppressive tumors represents a major challenge in cancer therapies. Activation of STING signaling has shown remarkable potential to invigorate the immunologically "cold" tumor microenvironment (TME). However, we have shown that STING is silenced in many human cancers, including pancreatic ductal adenocarcinoma (PDAC) and Merkel cell carcinoma (MCC). In this study, we demonstrated that mRNA-lipid nanoparticle (LNP) technology could be used to efficiently deliver naturally occurring constitutively active STING mutant STINGR284S into these cancer cells to reactivate STING antitumor immunity and trigger robust killing of tumor cells. STING agonists are being actively pursued as cancer immunotherapies. However, traditional STING agonists can induce T cell cytotoxicity, counteracting the desired antitumor immune response. In addition, the antitumor efficacy of traditional STING agonists obligatorily depends on STING expression and does not work in STING-silenced cancers. Importantly, we found that STINGR284S mRNA-LNP does not introduce T cell cytotoxicity. Our studies demonstrated that mRNA-LNP delivery of STINGR284S can reactivate the antitumor response without introducing antiproliferative effects in lymphocytic immune cells, overcoming the toxicity and limitations of conventional STING agonists. Our work therefore identifies a novel therapeutic tool for reactivating antitumor immunity in an array of STING-silenced immunologically "cold" tumors that are refractory to current therapies.
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36
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Dimitraki MG, Sourvinos G. Merkel Cell Polyomavirus (MCPyV) and Cancers: Emergency Bell or False Alarm? Cancers (Basel) 2022; 14:cancers14225548. [PMID: 36428641 PMCID: PMC9688650 DOI: 10.3390/cancers14225548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 11/15/2022] Open
Abstract
Merkel cell polyomavirus (MCPyV), the sole member of Polyomavirus associated with oncogenesis in humans, is the major causative factor of Merkel cell carcinoma (MCC), a rare, neuroendocrine neoplasia of the skin. Many aspects of MCPyV biology and oncogenic mechanisms remain poorly understood. However, it has been established that oncogenic transformation is the outcome of the integration of the viral genome into the host DNA. The high prevalence of MCPyV in the population, along with the detection of the virus in various human tissue samples and the strong association of MCPyV with the emergence of MCC, have prompted researchers to further investigate the role of MCPyV in malignancies other than MCC. MCPyV DNA has been detected in several different non-MCC tumour tissues but with significantly lower prevalence, viral load and protein expression. Moreover, the two hallmarks of MCPyV MCC have rarely been investigated and the studies have produced generally inconsistent results. Therefore, the outcomes of the studies are inadequate and unable to clearly demonstrate a direct correlation between cellular transformation and MCPyV. This review aims to present a comprehensive recapitulation of the available literature regarding the association of MCPyV with oncogenesis (MCC and non-MCC tumours).
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37
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Park SJ, Kannan A, Harris JP, Lacy C, Daniels GA, Lee SP, Lambrecht N, Hook N, Olshan P, Billings PR, Aleshin A, Gao L. Circulating tumor DNA as a predictive biomarker in Merkel cell carcinoma. J Am Acad Dermatol 2022; 87:1209-1211. [PMID: 35318107 DOI: 10.1016/j.jaad.2022.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/11/2022] [Accepted: 03/13/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Soo J Park
- Division of Hematology and Oncology, University of California - San Diego, San Diego, California
| | - Aarthi Kannan
- Department of Dermatology, University of California - Irvine, Irvine, California
| | - Jeremy P Harris
- Radiation Oncology, University of California - Irvine, Irvine, California
| | - Curtis Lacy
- Department of Oncology, Loma Linda University, Loma Linda, California
| | - Gregory A Daniels
- Division of Hematology and Oncology, University of California - San Diego, San Diego, California
| | - Steve P Lee
- Radiation Oncology Section, Veterans Affairs Long Beach Healthcare System, Long Beach, California
| | - Nils Lambrecht
- Pathology Section, Veterans Affairs Long Beach Healthcare System, Long Beach, California
| | | | | | | | | | - Ling Gao
- Department of Dermatology, University of California - Irvine, Irvine, California; Dermatology Section, Veterans Affairs Long Beach Healthcare System, Long Beach, California; Southern California Institute for Research and Education, Long Beach, California.
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38
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Lewis DJ, Sobanko JF, Etzkorn JR, Shin TM, Giordano CN, McMurray SL, Walker JL, Zhang J, Miller CJ, Higgins HW. Merkel Cell Carcinoma. Dermatol Clin 2022; 41:101-115. [DOI: 10.1016/j.det.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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39
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Fronek L, Giansiracusa D, Nourmohammadi N, Johnson C, Yelich A, Hogan D. A Review of Cutaneous Diseases Observed in Solid Organ Transplant Recipients. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2022; 15:21-31. [PMID: 36312823 PMCID: PMC9586525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Solid organ transplant recipients are at increased risk for numerous cutaneous conditions that fall within four categories: pre-neoplastic, neoplastic, infectious, or idiopathic. Many of these diseases can be attributed to immunosuppressive medications, including mycophenolate mofetil, cyclosporine, azathioprine, tacrolimus, or glucocorticoids. Iatrogenic lessening of the immune system places the patient at risk of malignancies, opportunistic infections, immune-mediated dermatoses, and adverse effects of medications. As the life expectancy of patients with solid organ transplants continues to increase, dermatologists and transplant physicians must stay abreast of this spectrum of dermatologic conditions, their respective prognoses, prevention, mitigation, and treatment.
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Affiliation(s)
- Lisa Fronek
- Dr. Fronek is with Bighorn Mohs Surgery and Dermatology Center, Scripps Clinic, La Jolla, California
| | - Derrek Giansiracusa
- Mr. Giansiracusa and Ms. Nourmohammadi are with Lake Erie College of Osteopathic Medicine in Bradenton, Florida
| | - Niki Nourmohammadi
- Mr. Giansiracusa and Ms. Nourmohammadi are with Lake Erie College of Osteopathic Medicine in Bradenton, Florida
| | - Cassandra Johnson
- Drs. Johnson, Yelich, and Hogan are with HCA Healthcare and USF Morsani College of Medicine at Largo Medical Center in Largo, Florida
| | - Allyson Yelich
- Drs. Johnson, Yelich, and Hogan are with HCA Healthcare and USF Morsani College of Medicine at Largo Medical Center in Largo, Florida
| | - Daniel Hogan
- Drs. Johnson, Yelich, and Hogan are with HCA Healthcare and USF Morsani College of Medicine at Largo Medical Center in Largo, Florida
- Dr. Hogan is additionally with the Department of Dermatology at Bay Pines Veterans Affairs Healthcare System in Bay Pines, Florida
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40
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Aboul-Fettouh N, Kubicki SL, Chen L, Silapunt S, Migden MR. Targeted Therapy and Immunotherapy in Nonmelanoma Skin Cancer. Dermatol Clin 2022; 41:23-37. [DOI: 10.1016/j.det.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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41
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Saiag P, Blom A. Combined nivolumab and ipilimumab in non-resectable Merkel cell carcinoma. Lancet 2022; 400:976-977. [PMID: 36108656 DOI: 10.1016/s0140-6736(22)01749-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University UVSQ, EA 4340 Biomarkers in Cancerology and Hemato-Oncology, 92104 Boulogne-Billancourt, France.
| | - Astrid Blom
- Department of General and Oncologic Dermatology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University UVSQ, EA 4340 Biomarkers in Cancerology and Hemato-Oncology, 92104 Boulogne-Billancourt, France
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42
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Kim S, Wuthrick E, Blakaj D, Eroglu Z, Verschraegen C, Thapa R, Mills M, Dibs K, Liveringhouse C, Russell J, Caudell JJ, Tarhini A, Markowitz J, Kendra K, Wu R, Chen DT, Berglund A, Michael L, Aoki M, Wang MH, Hamaidi I, Cheng P, de la Iglesia J, Slebos RJ, Chung CH, Knepper TC, Moran-Segura CM, Nguyen JV, Perez BA, Rose T, Harrison L, Messina JL, Sondak VK, Tsai KY, Khushalani NI, Brohl AS. Combined nivolumab and ipilimumab with or without stereotactic body radiation therapy for advanced Merkel cell carcinoma: a randomised, open label, phase 2 trial. Lancet 2022; 400:1008-1019. [PMID: 36108657 PMCID: PMC9533323 DOI: 10.1016/s0140-6736(22)01659-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Merkel cell carcinoma is among the most aggressive and lethal of primary skin cancers, with a high rate of distant metastasis. Anti-programmed death receptor 1 (anti-PD-1) and programmed death ligand 1 (PD-L1) monotherapy is currently standard of care for unresectable, recurrent, or metastatic Merkel cell carcinoma. We assessed treatment with combined nivolumab plus ipilimumab, with or without stereotactic body radiotherapy (SBRT) in patients with advanced Merkel cell carcinoma as a first-line therapy or following previous treatment with anti-PD-1 and PD-L1 monotherapy. METHODS In this randomised, open label, phase 2 trial, we randomly assigned adults from two cancer sites in the USA (one in Florida and one in Ohio) to group A (combined nivolumab and ipilimumab) or group B (combined nivolumab and ipilimumab plus SBRT) in a 1:1 ratio. Eligible patients were aged at least 18 years with histologically proven advanced stage (unresectable, recurrent, or stage IV) Merkel cell carcinoma, a minimum of two tumour lesions measureable by CT, MRI or clinical exam, and tumour tissue available for exploratory biomarker analysis. Patients were stratified by previous immune-checkpoint inhibitor (ICI) status to receive nivolumab 240 mg intravenously every 2 weeks plus ipilimumab 1 mg/kg intravenously every 6 weeks (group A) or the same schedule of combined nivolumab and ipilimumab with the addition of SBRT to at least one tumour site (24 Gy in three fractions at week 2; group B). Patients had to have at least two measurable sites of disease so one non-irradiated site could be followed for response. The primary endpoint was objective response rate (ORR) in all randomly assigned patients who received at least one dose of combined nivolumab and ipilimumab. ORR was defined as the proportion of patients with a complete response or partial response per immune-related Response Evaluation Criteria in Solid Tumours. Response was assessed every 12 weeks. Safety was assessed in all patients. This trial is registered with ClinicalTrials.gov, NCT03071406. FINDINGS 50 patients (25 in both group A and group B) were enrolled between March 14, 2017, and Dec 21, 2021, including 24 ICI-naive patients (13 [52%] of 25 group A patients and 11 [44%] of 25 group B patients]) and 26 patients with previous ICI (12 [48%] of 25 group A patients and 14 [56%] of 25 group B patients]). One patient in group B did not receive SBRT due to concerns about excess toxicity. Median follow-up was 14·6 months (IQR 9·1-26·5). Two patients in group B were excluded from the analysis of the primary endpoint because the target lesions were irradiated and so the patients were deemed non-evaluable. Of the ICI-naive patients, 22 (100%) of 22 (95% CI 82-100) had an objective response, including nine (41% [95% CI 21-63]) with complete response. Of the patients who had previously had ICI exposure, eight (31%) of 26 patients (95% CI 15-52) had an objective response and four (15% [5-36]) had a complete response. No significant differences in ORR were observed between groups A (18 [72%] of 25 patients) and B (12 [52%] of 23 patients; p=0·26). Grade 3 or 4 treatment-related adverse events were observed in 10 (40%) of 25 patients in group A and 8 (32%) of 25 patients in group B. INTERPRETATION First-line combined nivolumab and ipilimumab in patients with advanced Merkel cell carcinoma showed a high ORR with durable responses and an expected safety profile. Combined nivolumab and ipilimumab also showed clinical benefit in patients with previous anti-PD-1 and PD-L1 treatment. Addition of SBRT did not improve efficacy of combined nivolumab and ipilimumab. The combination of nivolumab and ipilimumab represents a new first-line and salvage therapeutic option for advanced Merkel cell carcinoma. FUNDING Bristol Myers Squibb Rare Population Malignancy Program.
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Affiliation(s)
- Sungjune Kim
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA; Department of Immunology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
| | - Evan Wuthrick
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Dukagjin Blakaj
- Department of Radiation Oncology, Ohio State University James Cancer Hospital Solove Research Institute, Columbus, OH, USA
| | - Zeynep Eroglu
- Department of Cutaneous Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Claire Verschraegen
- Department of Medical Oncology, Ohio State University James Cancer Hospital Solove Research Institute, Columbus, OH, USA
| | - Ram Thapa
- Department of Biostatistics and Bioinformatics, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Matthew Mills
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Khaled Dibs
- Department of Radiation Oncology, Ohio State University James Cancer Hospital Solove Research Institute, Columbus, OH, USA
| | - Casey Liveringhouse
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Jeffery Russell
- Department of Head and Neck and Cutaneous Oncology, University of Utah Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Jimmy J Caudell
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Ahmad Tarhini
- Department of Cutaneous Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Joseph Markowitz
- Department of Cutaneous Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Kari Kendra
- Department of Medical Oncology, Ohio State University James Cancer Hospital Solove Research Institute, Columbus, OH, USA
| | - Richard Wu
- Department of Medical Oncology, Ohio State University James Cancer Hospital Solove Research Institute, Columbus, OH, USA
| | - Dung-Tsa Chen
- Department of Biostatistics and Bioinformatics, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Anders Berglund
- Department of Biostatistics and Bioinformatics, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Lauren Michael
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Mia Aoki
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Min-Hsuan Wang
- Department of Immunology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Imene Hamaidi
- Department of Immunology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Pingyan Cheng
- Department of Immunology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Janis de la Iglesia
- Department of Pathology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Robbert J Slebos
- Department of Head and Neck Endocrine Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Christine H Chung
- Department of Head and Neck Endocrine Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Todd C Knepper
- Department of Precision Medicine, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Carlos M Moran-Segura
- Department of Pathology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Jonathan V Nguyen
- Department of Pathology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Bradford A Perez
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Trevor Rose
- Department of Radiology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Louis Harrison
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Jane L Messina
- Department of Pathology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Vernon K Sondak
- Department of Cutaneous Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Kenneth Y Tsai
- Department of Pathology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Nikhil I Khushalani
- Department of Cutaneous Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Andrew S Brohl
- Department of Cutaneous Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
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Church C, Pulliam T, Longino N, Park SY, Smythe KS, Makarov V, Riaz N, Jing L, Amezquita R, Campbell JS, Gottardo R, Pierce RH, Choi J, Chan TA, Koelle DM, Nghiem P. Transcriptional and functional analyses of neoantigen-specific CD4 T cells during a profound response to anti-PD-L1 in metastatic Merkel cell carcinoma. J Immunother Cancer 2022; 10:e005328. [PMID: 36252564 PMCID: PMC9472219 DOI: 10.1136/jitc-2022-005328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Merkel cell carcinoma (MCC) often responds to PD-1 pathway blockade, regardless of tumor-viral status (~80% of cases driven by the Merkel cell polyomavirus (MCPyV)). Prior studies have characterized tumor-specific T cell responses to MCPyV, which have typically been CD8, but little is known about the T cell response to UV-induced neoantigens. METHODS A patient in her mid-50s with virus-negative (VN) MCC developed large liver metastases after a brief initial response to chemotherapy. She received anti-PD-L1 (avelumab) and had a partial response within 4 weeks. Whole exome sequencing (WES) was performed to determine potential neoantigen peptides. Characterization of peripheral blood neoantigen T cell responses was evaluated via interferon-gamma (IFNγ) ELISpot, flow cytometry and single-cell RNA sequencing. Tumor-resident T cells were characterized by multiplexed immunohistochemistry. RESULTS WES identified 1027 tumor-specific somatic mutations, similar to the published average of 1121 for VN-MCCs. Peptide prediction with a binding cut-off of ≤100 nM resulted in 77 peptides that were synthesized for T cell assays. Although peptides were predicted based on class I HLAs, we identified circulating CD4 T cells targeting 5 of 77 neoantigens. In contrast, no neoantigen-specific CD8 T cell responses were detected. Neoantigen-specific CD4 T cells were undetectable in blood before anti-PD-L1 therapy but became readily detectible shortly after starting therapy. T cells produced robust IFNγ when stimulated by neoantigen (mutant) peptides but not by the normal (wild-type) peptides. Single cell RNAseq showed neoantigen-reactive T cells expressed the Th1-associated transcription factor (T-bet) and associated cytokines. These CD4 T cells did not significantly exhibit cytotoxicity or non-Th1 markers. Within the pretreatment tumor, resident CD4 T cells were also Th1-skewed and expressed T-bet. CONCLUSIONS We identified and characterized tumor-specific Th1-skewed CD4 T cells targeting multiple neoantigens in a patient who experienced a profound and durable partial response to anti-PD-L1 therapy. To our knowledge, this is the first report of neoantigen-specific T cell responses in MCC. Although CD4 and CD8 T cells recognizing viral tumor antigens are often detectible in virus-positive MCC, only CD4 T cells recognizing neoantigens were detected in this patient. These findings suggest that CD4 T cells can play an important role in the response to anti-PD-(L)1 therapy.
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Affiliation(s)
- Candice Church
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Thomas Pulliam
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Natalie Longino
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Song Y Park
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kimberly S Smythe
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Vladimir Makarov
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Center for Immunotherapy and Precision Immuno-oncology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nadeem Riaz
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lichen Jing
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Robert Amezquita
- Biostatistics Bioinformatics and Epidemiology Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Jean S Campbell
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Raphael Gottardo
- Biostatistics Bioinformatics and Epidemiology Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Lausanne University Hospital, Lausanne, Vaud, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Robert H Pierce
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jaehyuk Choi
- Department of Dermatology, Biochemistry & Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Timothy A Chan
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Center for Immunotherapy and Precision Immuno-oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - David M Koelle
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
- Benaroya Research Institute, Seattle, WA, USA
| | - Paul Nghiem
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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Silk AW, Barker CA, Bhatia S, Bollin KB, Chandra S, Eroglu Z, Gastman BR, Kendra KL, Kluger H, Lipson EJ, Madden K, Miller DM, Nghiem P, Pavlick AC, Puzanov I, Rabinowits G, Ruiz ES, Sondak VK, Tavss EA, Tetzlaff MT, Brownell I. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of nonmelanoma skin cancer. J Immunother Cancer 2022; 10:jitc-2021-004434. [PMID: 35902131 PMCID: PMC9341183 DOI: 10.1136/jitc-2021-004434] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 12/21/2022] Open
Abstract
Nonmelanoma skin cancers (NMSCs) are some of the most commonly diagnosed malignancies. In general, early-stage NMSCs have favorable outcomes; however, a small subset of patients develop resistant, advanced, or metastatic disease, or aggressive subtypes that are more challenging to treat successfully. Recently, immune checkpoint inhibitors (ICIs) have been approved by the US Food and Drug Administration (FDA) for the treatment of Merkel cell carcinoma (MCC), cutaneous squamous cell carcinoma (CSCC), and basal cell carcinoma (BCC). Although ICIs have demonstrated activity against NMSCs, the routine clinical use of these agents may be more challenging due to a number of factors including the lack of predictive biomarkers, the need to consider special patient populations, the management of toxicity, and the assessment of atypical responses. With the goal of improving patient care by providing expert guidance to the oncology community, the Society for Immunotherapy of Cancer (SITC) convened a multidisciplinary panel of experts to develop a clinical practice guideline (CPG). The expert panel drew on the published literature as well as their own clinical experience to develop recommendations for healthcare professionals on important aspects of immunotherapeutic treatment for NMSCs, including staging, biomarker testing, patient selection, therapy selection, post-treatment response evaluation and surveillance, and patient quality of life (QOL) considerations, among others. The evidence- and consensus-based recommendations in this CPG are intended to provide guidance to cancer care professionals treating patients with NMSCs.
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Affiliation(s)
- Ann W Silk
- Merkel Cell Carcinoma Center of Excellence, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Shailender Bhatia
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Kathryn B Bollin
- Hematology and Medical Oncology, Scripps MD Anderson Cancer Center, San Diego, California, USA
| | - Sunandana Chandra
- Hematology Oncology Division, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Zeynep Eroglu
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Brian R Gastman
- Melanoma and High-Risk Skin Cancer Program, Cleveland Clinic Cancer Center, Cleveland, Ohio, USA
| | - Kari L Kendra
- Division Of Medical Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Harriet Kluger
- Yale Cancer Center, Yale University, New Haven, Connecticut, USA
| | - Evan J Lipson
- Bloomberg Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kathleen Madden
- Melanoma/Cutaneous Oncology Program, New York University Langone Perlmutter Cancer Center, New York, New York, USA
| | - David M Miller
- Department of Medicine and Department of Dermatology, Massachusetts General Cancer Center, Boston, Massachusetts, USA
| | - Paul Nghiem
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Anna C Pavlick
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Igor Puzanov
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Guilherme Rabinowits
- Department of Hematology/Oncology, Miami Cancer Institute/Baptist Health South Florida, Miami, Florida, USA
| | - Emily S Ruiz
- Mohs and Dermatologic Surgery Center, Dana-Farber/Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Vernon K Sondak
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | | | - Michael T Tetzlaff
- Dermopathology Division, University of California San Francisco, San Francisco, California, USA
| | - Isaac Brownell
- Dermatology Branch, National Institutes of Health, Bethesda, Maryland, USA
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Zelin E, Maronese CA, Dri A, Toffoli L, Di Meo N, Nazzaro G, Zalaudek I. Identifying Candidates for Immunotherapy among Patients with Non-Melanoma Skin Cancer: A Review of the Potential Predictors of Response. J Clin Med 2022; 11:3364. [PMID: 35743435 PMCID: PMC9225110 DOI: 10.3390/jcm11123364] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Non-melanoma skin cancer (NMSC) stands as an umbrella term for common cutaneous malignancies, including basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC), together with rarer cutaneous cancers, such as Merkel cell carcinoma (MCC) and other forms of adnexal cancers. The majority of NMSCs can be successfully treated with surgery or radiotherapy, but advanced and metastatic stages may require systemic approaches such as immunotherapy with immune checkpoint inhibitors (ICIs). SUMMARY Since immunotherapy is not effective in all patients and can potentially lead to severe adverse effects, an important clinical question is how to properly identify those who could be suitable candidates for this therapeutic choice. In this paper, we review the potential features and biomarkers used to predict the outcome of ICIs therapy for NMSCs. Moreover, we analyze the role of immunotherapy in special populations, such as the elderly, immunocompromised patients, organ transplant recipients, and subjects suffering from autoimmune conditions. KEY MESSAGES Many clinical, serum, histopathological, and genetic features have been investigated as potential predictors of response in NMSCs treated with ICIs. Although this field of research is very promising, definitive, cost-effective, and reproducible biomarkers are still lacking and further efforts are needed to validate the suggested predictors in larger cohorts.
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Affiliation(s)
- Enrico Zelin
- Dermatology Clinic, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy; (E.Z.); (L.T.); (N.D.M.); (I.Z.)
| | - Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Arianna Dri
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy;
- Department of Medical Oncology, Azienda Sanitaria Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Ludovica Toffoli
- Dermatology Clinic, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy; (E.Z.); (L.T.); (N.D.M.); (I.Z.)
| | - Nicola Di Meo
- Dermatology Clinic, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy; (E.Z.); (L.T.); (N.D.M.); (I.Z.)
| | - Gianluca Nazzaro
- Dermatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy; (E.Z.); (L.T.); (N.D.M.); (I.Z.)
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Spada F, Bossi P, Caracò C, Sileni VC, Dei Tos AP, Fazio N, Grignani G, Maio M, Quaglino P, Queirolo P, Ascierto PA. Nationwide multidisciplinary consensus on the clinical management of Merkel cell carcinoma: a Delphi panel. J Immunother Cancer 2022; 10:jitc-2022-004742. [PMID: 35701070 PMCID: PMC9198700 DOI: 10.1136/jitc-2022-004742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/04/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and highly aggressive cutaneous neuroendocrine carcinoma. The MCC incidence rate has rapidly grown over the last years, with Italy showing the highest increase among European countries. This malignancy has been the focus of active scientific research over the last years, focusing mainly on pathogenesis, new therapeutic trials and diagnosis. A national expert board developed 28 consensus statements that delineated the evolution of disease management and highlighted the paradigm shift towards the use of immunological strategies, which were then presented to a national MCC specialists panel for review. Sixty-five panelists answered both rounds of the questionnaire. The statements were divided into five areas: a high level of agreement was reached in the area of guidelines and multidisciplinary management, even if in real life the multidisciplinary team was not always represented by all the specialists. In the diagnostic pathway area, imaging played a crucial role in diagnosis and initial staging, planning for surgery or radiation therapy, assessment of treatment response and surveillance of recurrence and metastases. Concerning diagnosis, the usefulness of Merkel cell polyomavirus is recognized, but the agreement and consensus regarding the need for cytokeratin evaluation appears greater. Regarding the areas of clinical management and follow-up, patients with MCC require customized treatment. There was a wide dispersion of results and the suggestion to increase awareness about the adjuvant radiation therapy. The panelists unanimously agreed that the information concerning avelumab provided by the JAVELIN Merkel 200 study is adequate and reliable and that the expanded access program data could have concrete clinical implications. An immunocompromised patient with advanced MCC can be treated with immunotherapy after multidisciplinary risk/benefit assessment, as evidenced by real-world analysis and highlighted in the guidelines. A very high consensus regarding the addition of radiotherapy to treat the ongoing focal progression of immunotherapy was observed. This paper emphasizes the importance of collaboration and communication among the interprofessional team members and encourages managing patients with MCC within dedicated multidisciplinary teams. New insights in the treatment of this challenging cancer needs the contribution of many and different experts.
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Affiliation(s)
- Francesca Spada
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, Milano, Italy
| | - Paolo Bossi
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health-Medical Oncology, University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - Corrado Caracò
- Melanoma and Skin Cancers Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Napoli, Italy
| | | | | | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, Milano, Italy
| | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute FPO IRCCS, Candiolo, Italy
| | - Michele Maio
- Center for Immuno-Oncology, Department of Oncology, University Hospital of Siena, Siena, Italy
| | - Pietro Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Torino, Italy
| | - Paola Queirolo
- Melanoma and Sarcoma Medical Treatment, European Institute of Oncology (IEO), Milano, Italy
| | - Paolo Antonio Ascierto
- Melanoma Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione "G.Pascale", Napoli, Italy
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Ursu RG, Damian C, Porumb-Andrese E, Ghetu N, Cobzaru RG, Lunca C, Ripa C, Costin D, Jelihovschi I, Petrariu FD, Iancu LS. Merkel Cell Polyoma Virus and Cutaneous Human Papillomavirus Types in Skin Cancers: Optimal Detection Assays, Pathogenic Mechanisms, and Therapeutic Vaccination. Pathogens 2022; 11:pathogens11040479. [PMID: 35456154 PMCID: PMC9032856 DOI: 10.3390/pathogens11040479] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 02/06/2023] Open
Abstract
Oncogenic viruses are recognized to be involved in some cancers, based on very well-established criteria of carcinogenicity. For cervical cancer and liver cancer, the responsible viruses are well-known (e.g., HPV, HBV); in the case of skin cancer, there are still many studies which are trying to identify the possible viral etiologic agents as principal co-factors in the oncogenic process. We analysed scientific literature published in the last 5 years regarding mechanisms of carcinogenicity, methods of detection, available targeted therapy, and vaccination for Merkel cell polyomavirus, and beta human papillomavirus types, in relation to skin cancer. This review is targeted at presenting the recent findings which support the involvement of these viruses in the development of some types of skin cancers. In order to optimize the management of skin cancer, a health condition of very high importance, it would be ideal that the screening of skin cancer for these two analysed viruses (MCPyV and beta HPV types) to be implemented in each region's/country's cancer centres' molecular detection diagnostic platforms, with multiplex viral capability, optimal sensitivity, and specificity; clinically validated, and if possible, at acceptable costs. For confirmatory diagnosis of skin cancer, another method should be used, with a different principle, such as immunohistochemistry, with specific antibodies for each virus.
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Affiliation(s)
- Ramona Gabriela Ursu
- Department of Preventive Medicine and Interdisciplinarity (IX)—Microbiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (R.G.U.); (C.D.); (R.G.C.); (C.L.); (C.R.); (D.C.); (I.J.); (F.D.P.); (L.S.I.)
| | - Costin Damian
- Department of Preventive Medicine and Interdisciplinarity (IX)—Microbiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (R.G.U.); (C.D.); (R.G.C.); (C.L.); (C.R.); (D.C.); (I.J.); (F.D.P.); (L.S.I.)
| | - Elena Porumb-Andrese
- Department of Medical Specialties (III)—Dermatology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Nicolae Ghetu
- Department of Plastic Surgery, Regional Oncology Institute, 700483 Iasi, Romania
- Correspondence:
| | - Roxana Gabriela Cobzaru
- Department of Preventive Medicine and Interdisciplinarity (IX)—Microbiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (R.G.U.); (C.D.); (R.G.C.); (C.L.); (C.R.); (D.C.); (I.J.); (F.D.P.); (L.S.I.)
| | - Catalina Lunca
- Department of Preventive Medicine and Interdisciplinarity (IX)—Microbiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (R.G.U.); (C.D.); (R.G.C.); (C.L.); (C.R.); (D.C.); (I.J.); (F.D.P.); (L.S.I.)
| | - Carmen Ripa
- Department of Preventive Medicine and Interdisciplinarity (IX)—Microbiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (R.G.U.); (C.D.); (R.G.C.); (C.L.); (C.R.); (D.C.); (I.J.); (F.D.P.); (L.S.I.)
| | - Diana Costin
- Department of Preventive Medicine and Interdisciplinarity (IX)—Microbiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (R.G.U.); (C.D.); (R.G.C.); (C.L.); (C.R.); (D.C.); (I.J.); (F.D.P.); (L.S.I.)
| | - Igor Jelihovschi
- Department of Preventive Medicine and Interdisciplinarity (IX)—Microbiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (R.G.U.); (C.D.); (R.G.C.); (C.L.); (C.R.); (D.C.); (I.J.); (F.D.P.); (L.S.I.)
| | - Florin Dumitru Petrariu
- Department of Preventive Medicine and Interdisciplinarity (IX)—Microbiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (R.G.U.); (C.D.); (R.G.C.); (C.L.); (C.R.); (D.C.); (I.J.); (F.D.P.); (L.S.I.)
| | - Luminita Smaranda Iancu
- Department of Preventive Medicine and Interdisciplinarity (IX)—Microbiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (R.G.U.); (C.D.); (R.G.C.); (C.L.); (C.R.); (D.C.); (I.J.); (F.D.P.); (L.S.I.)
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Mazziotta C, Lanzillotti C, Gafà R, Touzé A, Durand MA, Martini F, Rotondo JC. The Role of Histone Post-Translational Modifications in Merkel Cell Carcinoma. Front Oncol 2022; 12:832047. [PMID: 35350569 PMCID: PMC8957841 DOI: 10.3389/fonc.2022.832047] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/01/2022] [Indexed: 12/12/2022] Open
Abstract
Merkel Cell Carcinoma (MCC) is a rare but highly aggressive form of non–melanoma skin cancer whose 5-year survival rate is 63%. Merkel cell polyomavirus (MCPyV), a small DNA tumor virus, is the etiological agent of MCC. Although representing a small proportion of MCC cases, MCPyV-negative MCCs have also been identified. The role of epigenetic mechanisms, including histone post-translational modifications (PTMs) in MCC, have been only partially determined. This review aims to describe the most recent progress on PTMs and their regulative factors in the context of MCC onset/development, providing an overview of current findings on both MCC subtypes. An outline of current knowledge on the potential employment of PTMs and related factors as diagnostic and prognostic markers, as well as novel treatment strategies targeting the reversibility of PTMs for MCC therapy is provided. Recent research shows that PTMs are emerging as important epigenetic players involved in MCC onset/development, and therefore may show a potential clinical significance. Deeper and integrated knowledge of currently known PTM dysregulations is of paramount importance in order to understand the molecular basis of MCC and improve the diagnosis, prognosis, and therapeutic options for this deadly tumor.
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Affiliation(s)
- Chiara Mazziotta
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Center for Studies on Gender Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Carmen Lanzillotti
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Center for Studies on Gender Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Roberta Gafà
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Antoine Touzé
- ISP "Biologie des infections à polyomavirus" Team, UMR INRA 1282, University of Tours, Tours, France
| | - Marie-Alice Durand
- ISP "Biologie des infections à polyomavirus" Team, UMR INRA 1282, University of Tours, Tours, France
| | - Fernanda Martini
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Center for Studies on Gender Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, Ferrara, Italy
| | - John Charles Rotondo
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Center for Studies on Gender Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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Gambichler T, Said S, Abu Rached N, Scheel CH, Susok L, Stranzenbach R, Becker JC. Pan-immune-inflammation value independently predicts disease recurrence in patients with Merkel cell carcinoma. J Cancer Res Clin Oncol 2022; 148:3183-3189. [PMID: 35098389 PMCID: PMC9508022 DOI: 10.1007/s00432-022-03929-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/17/2022] [Indexed: 12/25/2022]
Abstract
Purpose We aimed to determine whether the pan-immune-inflammation value (PIV) of patients with Merkel cell carcinoma (MCC) at primary diagnosis differs from controls and whether it is associated with disease stage and outcome. Methods In this retrospective study, we recruited MCC patients with stage I–III. PIV was calculated from absolute complete blood cell counts obtained within one week at MCC diagnosis as follows: [neutrophils (103/mm3) × platelets (103/mm3) × monocytes (103/mm3)]/lymphocytes (103/mm3). As controls, we studied age–gender-matched cutaneous melanoma (CM, stage I–III) patients and healthy controls (HC). Univariate and multivariate statistics were used. Results The median PIV in MCC patients was significantly increased compared to both CM patients as well as healthy controls. PIV of MCC patients in stage II and III was significantly higher compared to stage I patients. ROC analysis revealed that MCC recurrence was significantly associated with a PIV greater than 372 [p < 0.0001, Youden index 0.58; hazard ratio: 4 (95% confidence interval: 1.7 to 9.2)]. In multivariate analysis, only a PIV greater than 372 and higher MCC stage were determined as independent predictors for disease recurrence. Conclusion We determined, for the first time, the prognostic ability of the promising blood-based biomarker PIV in MCC patients and observed that PIV is increased in MCC patients in dependence on disease stage and independently predicts MCC recurrence.
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Affiliation(s)
- T Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany.
| | - S Said
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - N Abu Rached
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - C H Scheel
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - L Susok
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - R Stranzenbach
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - J C Becker
- Translational Skin Cancer Research, DKTK Partner Site Essen/Düsseldorf, West German Cancer Center, Dermatology, University Duisburg-Essen, Essen, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
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Russomanno K, Raiker R, Pakhchanian H, Deng M. Merkel Cell Carcinoma: A Bibliometric Analysis of the Top 100 Cited Publications. Dermatol Surg 2022; 48:22-27. [PMID: 34608096 DOI: 10.1097/dss.0000000000003251] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bibliometric studies provide a quantitative statistical analysis of the published literature within a field of interest and allow for easy identification of the major contributing authors, funding sources, and publication trends within the field. To date, no bibliometric studies have been performed pertaining to Merkel cell carcinoma (MCC). OBJECTIVE To identify the 100 most frequently cited articles in MCC through a bibliometric analysis of the literature. METHODS Web of science was queried to determine the 100 most frequently cited MCC publications published between the years 1970 and 2019. Articles were listed by title, authors and their affiliated institutions, journal title and type, year of publication, country of origin, funding sources, and citation frequency. RESULTS Among the 100 most frequently cited MCC publications, articles were cited between 67 and 589 times with a mean of 136.3 times. Articles were cited between 2.0 and 98.2 times per year since publication with a mean of 11.3 times per year. 67% of the articles were published in oncology journals; 33% and 10% of the articles in dermatology and surgery journals, respectively. The most represented journal was Cancer (12%). Paul Nghiem was the most frequently identified author (18%). 36% of the top 100 articles were published out of the University of Washington. The most frequent funding agency was the National Institutes of Health (77%). CONCLUSION Through this bibliometric analysis, researchers can easily identify key publications pertaining to MCC, which may in turn enhance their approach to understanding and practicing evidence-based medicine regarding MCC.
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Affiliation(s)
- Kristen Russomanno
- Department of Dermatology, Medstar Georgetown University Hospital/Medstar Washington Hospital Center, Washington, District of Columbia
- Department of Internal Medicine, Medstar Washington Hospital Center, Washington, District of Columbia
| | - Rahul Raiker
- Department of Dermatology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Haig Pakhchanian
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Min Deng
- Department of Dermatology, Medstar Georgetown University Hospital/Medstar Washington Hospital Center, Washington, District of Columbia
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