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Niu C, Zhu K, Zhang J, Joshi U, Liu H, Zahid S, Jadhav N, Okolo PI. Analysis of immune-related adverse events in gastrointestinal malignancy patients treated with immune checkpoint inhibitors. Int J Cancer 2024; 154:1261-1271. [PMID: 38083969 DOI: 10.1002/ijc.34813] [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: 06/05/2023] [Revised: 10/22/2023] [Accepted: 11/06/2023] [Indexed: 02/07/2024]
Abstract
Immune checkpoint inhibitors are becoming an increasingly common treatment for advanced gastrointestinal cancer, but the possibility of immune-related adverse events has raised concerns. This study aimed to evaluate the risks of immune-related adverse events between patients who received immune checkpoint inhibitors and those who received chemotherapy among different types of gastrointestinal cancer. The study utilized data from the multicenter TriNetX database in the United States covering the period between 2015 and 2022. Hazard ratios and 95% confidence intervals were used to describe the relative hazard of immune-related adverse events based on comparing time-to-event rates. Our study revealed that the incidence of immune-related adverse events was significantly higher in patients who received immune checkpoint inhibitors and chemotherapy compared to those who received chemotherapy only in treating gastrointestinal cancer. CTLA-4 inhibitors tended to have a higher rate of immune-related adverse events compared to PD-1/PD-L1 inhibitors. Our study found a lower mortality rate among patients who developed immune-related adverse events compared to those who did not after propensity score matching (HR, 0.661; 95% CI 0.620-0.704; p < .01). We provide important real-world data on the incidence and impact of immune-related adverse events in patients with advanced gastrointestinal cancer treated with immune checkpoint inhibitors. Our study's results support clinicians in making informed decisions about the potential benefits and risks of immune checkpoint inhibitor therapy for patients with gastrointestinal cancer.
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Affiliation(s)
- Chengu Niu
- Internal Medicine Residency Program, Rochester General Hospital, Rochester, New York, USA
| | - Kaiwen Zhu
- Internal Medicine Residency Program, Rochester General Hospital, Rochester, New York, USA
| | - Jing Zhang
- Harbin Medical University, Harbin, China
| | - Utsav Joshi
- Internal Medicine Residency Program, Rochester General Hospital, Rochester, New York, USA
| | - Hongli Liu
- Internal Medicine Residency Program, Rochester General Hospital, Rochester, New York, USA
| | - Salman Zahid
- Internal Medicine Residency Program, Rochester General Hospital, Rochester, New York, USA
| | - Nagesh Jadhav
- Internal Medicine Residency Program, Rochester General Hospital, Rochester, New York, USA
| | - Patrick I Okolo
- Division of Gastroenterology, Rochester General Hospital, Rochester, New York, USA
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Anvari A, Sasanpour P, Rajabzadeh Kheradmardi M. Radiotherapy and immunotherapy in melanoma brain metastases. Hematol Oncol Stem Cell Ther 2021; 16:1-20. [PMID: 36634277 DOI: 10.1016/j.hemonc.2021.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 10/29/2021] [Accepted: 11/14/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Melanoma brain metastasis (MBM) generally portends a dismal prognosis. Simultaneous use of radiotherapy (RT) and immune checkpoint inhibitor (ICI) therapy demonstrated tremendous promise and emerged as the new standard. This meta-analysis was conducted to evaluate survival outcomes and toxicities of this combination in patients with MBM. Data analyses were performed using Comprehensive Meta-Analysis software (version 2) and IBM SPSS software (version 27). METHODS A systematic literature search of PubMed, EMBASE, and the Cochrane Library (via Wiley) was conducted using PICOS/PRISMA selection protocol and included studies to evaluate survival and safety-associated outcomes of ICI + RT for the treatment of MBM. RESULTS A total 44 studies involving 2498 patients were reviewed. The pooled effect size (ES) for overall survival (OS) to compare the ICI + RT arm and ICI alone arm (HR: 0.693 [0.526-0.913, p = .001]), and compare the ICI + RT arm and brain RT alone (HR: 0.595 [0.489-0.723, p < .001)] indicated better survival outcomes in ICI + RT versus RT alone and ICI alone arms. Comparing central nervous system toxicity in the ICI + RT arm and RT alone arm, the pooled ES Grade ≥ 3 neurologic adverse events (NAEs) risk ratio ([RR] = 1.425; 95% confidence interval [CI]: 0.485-4.183; p = .519) indicated that ICI + RT nonsignificantly increased Grade 3-4 NAEs. Comparing Grade ≥ 3 radiation necrosis in the ICI + RT arm and RT alone arm, the pooled ES RR (RR = 2.73; 95% CI: 0.59-12.59; p = .199) indicated that ICI + RT nonsignificantly increased Grade ≥ 3 radiation necrosis. CONCLUSION Concurrent administration of RT and ICI evinced favorable OS outcomes and acceptable safety profile in MBM patients. Planned prospective trials are required to demonstrate the issue.
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Affiliation(s)
- Amir Anvari
- Department of Radiation Oncology, Imam Hussein Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Pegah Sasanpour
- Department of Radiation Oncology, Imam Ali Hospital, Zahedan University of Medical Science, Zahedan, Iran
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Mineiro dos Santos Garrett NF, Carvalho da Costa AC, Barros Ferreira E, Damiani G, Diniz dos Reis PE, Inocêncio Vasques C. Prevalence of dermatological toxicities in patients with melanoma undergoing immunotherapy: Systematic review and meta-analysis. PLoS One 2021; 16:e0255716. [PMID: 34358260 PMCID: PMC8345892 DOI: 10.1371/journal.pone.0255716] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 07/22/2021] [Indexed: 12/18/2022] Open
Abstract
Background Checkpoint inhibitors have revolutionized advanced melanoma care; however, their cutaneous side effects have not been definitively elucidated. Objective To identify the prevalence of cutaneous toxicity in patients with melanoma treated with immune checkpoint inhibitors as monotherapy and/or in combination with chemotherapy and/or radiotherapy. Materials and methods We performed a systematic review and meta-analysis, which encompassed both clinical trials and observational studies describing the dermatological toxicities in patients treated with immune checkpoint inhibitors. The protocol was registered in the International Prospective Register of Systematic Review under the number CRD42018091915. The searches were performed using the CINAHL, Cochrane CENTRAL, LILACS, LIVIVO, PubMed, Scopus, and Web of Science databases. The methodological quality of the studies was evaluated with the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data Results A total of 9,802 articles were identified in the databases. The final sample comprised 39 studies. The evaluated drugs were ipilimumab, tremelimumab, pembrolizumab, and nivolumab. The results suggest that the most prevalent side effect was grade 1 and 2 pruritus (24%), followed by grade 1 and 2 rash (21%) and grade 1 and 2 vitiligo (10%). Conclusion The most prevalent side effects in patients treated with checkpoint inhibitors are pruritus, rash, and vitiligo, and they are rated mostly as grades 1 and 2 adverse events. Remarkably, vitiligo is most commonly found in patients treated with PD-1 inhibitors.
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Affiliation(s)
| | | | | | - Giovanni Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Department of Dermatology, Case Western Reserve University, Cleveland, OH, United States of America
- Department of Drug Sciences, University of Padua, Padua, Italy
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Brahm CG, van Linde ME, Enting RH, Schuur M, Otten RH, Heymans MW, Verheul HM, Walenkamp AM. The Current Status of Immune Checkpoint Inhibitors in Neuro-Oncology: A Systematic Review. Cancers (Basel) 2020; 12:cancers12030586. [PMID: 32143288 PMCID: PMC7139638 DOI: 10.3390/cancers12030586] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 12/14/2022] Open
Abstract
The introduction of immune checkpoint inhibitors (ICI), as a novel treatment modality, has transformed the field of oncology with unprecedented successes. However, the efficacy of ICI for patients with glioblastoma or brain metastases (BMs) from any tumor type is under debate. Therefore, we systematically reviewed current literature on the use of ICI in patients with glioblastoma and BMs. Prospective and retrospective studies evaluating the efficacy and survival outcomes of ICI in patients with glioblastoma or BMs, and published between 2006 and November 2019, were considered. A total of 88 studies were identified (n = 8 in glioblastoma and n = 80 in BMs). In glioblastoma, median progression-free (PFS) and overall survival (OS) of all studies were 2.1 and 7.3 months, respectively. In patients with BMs, intracranial responses have been reported in studies with melanoma and non-small-cell lung cancer (NSCLC). The median intracranial and total PFS in these studies were 2.7 and 3.0 months, respectively. The median OS in all studies for patients with brain BMs was 8.0 months. To date, ICI demonstrate limited efficacy in patients with glioblastoma or BMs. Future research should focus on increasing the local and systemic immunological responses in these patients.
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Affiliation(s)
- Cyrillo G. Brahm
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands;
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, location VUmc, 1007 MB Amsterdam, The Netherlands; (M.E.v.L.); (H.M.W.V.)
| | - Myra E. van Linde
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, location VUmc, 1007 MB Amsterdam, The Netherlands; (M.E.v.L.); (H.M.W.V.)
| | - Roelien H. Enting
- Department of Neurology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands;
| | - Maaike Schuur
- Department of Neurology, Cancer Center Amsterdam, Amsterdam University Medical Centers, location VUmc, 1007 MB Amsterdam, The Netherlands;
| | - René H.J. Otten
- University Library, Vrije Universiteit Amsterdam, 1007 MB Amsterdam, The Netherlands;
| | - Martijn W. Heymans
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, location VUmc, 1007 MB Amsterdam, The Netherlands;
| | - Henk M.W. Verheul
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, location VUmc, 1007 MB Amsterdam, The Netherlands; (M.E.v.L.); (H.M.W.V.)
- Department of Medical Oncology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Annemiek M.E. Walenkamp
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands;
- Correspondence: ; Tel.: +31-50-3612821; Fax: +31-50-3614862
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Danielli R, Cisternino F, Giannarelli D, Calabrò L, Camerini R, Savelli V, Bova G, Dragonetti R, Di Giacomo AM, Altomonte M, Maio M. Long-term follow up of metastatic melanoma patients treated with Thymosin alpha-1: investigating immune checkpoints synergy. Expert Opin Biol Ther 2019; 18:77-83. [PMID: 30063847 DOI: 10.1080/14712598.2018.1494717] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Immune checkpoint blockade antibodies (imAbs), such as the anti Cytotoxic T Lymphocyte Antigen-4 (CTLA-4) ipilimumab (IPI) raised overall survival (OS) in metastatic melanoma (MM). Further, long-term OS is a crucial endpoint in MM. Thymosin alpha-1 (Tα1) with dacarbazine (DTIC) showed activity in a phase II trial and a compassionate use program (EAP). We report on long-term follow-up of patients treated with Tα1 to investigate the preconditioning role of Tα1 in imAbs-treated patients. METHODS Records of patients with melanoma treated with Tα1 within a phase II trial and EAP program were reviewed comparing median OS among patients that sequentially received anti-CTLA-4 imAb and Tα1. Further, the effect of Tα1 on IPI long-term survivor patients was investigated. RESULTS Among patients treated with Tα1, 21/61 patients received sequentially even anti CTLA-4 imAbs. Median OS at the data cut-off was 57.8 and 7.4 months in patients treated sequentially with anti-CTLA-4 imAbs or not, respectively. Moreover, pretreatment with Tα1 in all (95) IPI-evaluable patients confirmed a significant increase in long-term OS. CONCLUSION This is the first report on long-term follow-up of Tα1-treated patients. Moreover, an advantage in OS in patients sequentially treated with Tα1 and IPI was seen that suggests a synergistic effect.
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Affiliation(s)
- Riccardo Danielli
- a Medical Oncology and Immunotherapy, Center for Immuno-Oncology , University Hospital of Siena , Siena , Italy
| | - Filomena Cisternino
- a Medical Oncology and Immunotherapy, Center for Immuno-Oncology , University Hospital of Siena , Siena , Italy
| | - Diana Giannarelli
- b Biostatistical Unit , Regina Elena National Cancer Institute , Rome , Italy
| | - Luana Calabrò
- a Medical Oncology and Immunotherapy, Center for Immuno-Oncology , University Hospital of Siena , Siena , Italy
| | | | - Vinno Savelli
- d Department of Medicine, Surgery and Neurosciences , University of Siena , Siena , Italy
| | - Giovanni Bova
- e Emergency Medicine Department , University Hospital of Siena , Siena , Italy
| | | | - Anna Maria Di Giacomo
- a Medical Oncology and Immunotherapy, Center for Immuno-Oncology , University Hospital of Siena , Siena , Italy
| | - Maresa Altomonte
- a Medical Oncology and Immunotherapy, Center for Immuno-Oncology , University Hospital of Siena , Siena , Italy
| | - Michele Maio
- a Medical Oncology and Immunotherapy, Center for Immuno-Oncology , University Hospital of Siena , Siena , Italy
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Not all immune-checkpoint inhibitors are created equal: Meta-analysis and systematic review of immune-related adverse events in cancer trials. Crit Rev Oncol Hematol 2017; 119:1-12. [DOI: 10.1016/j.critrevonc.2017.09.002] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/13/2017] [Accepted: 09/07/2017] [Indexed: 02/07/2023] Open
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Rapoport BL, Vorobiof DA, Dreosti LM, Nosworthy A, McAdam G, Jordaan JP, Miller-Jansön H, de Necker M, de Beer JC, Duvenhage H. Ipilimumab in Pretreated Patients With Advanced Malignant Melanoma: Results of the South African Expanded-Access Program. J Glob Oncol 2016; 3:515-523. [PMID: 29094091 PMCID: PMC5646890 DOI: 10.1200/jgo.2016.006544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose The primary objective of this study was to evaluate 1- and 2-year survival rates and durable remissions in pretreated patients with advanced (unresectable or metastatic) malignant melanoma treated with ipilimumab in a South African expanded-access program (SA-EAP). Patients and Methods This multicenter, retrospective study obtained data from pretreated patients with advanced malignant melanoma who were eligible for the ipilimumab SA-EAP. Ipilimumab was administered at a dose of 3 mg/kg intravenously every 3 weeks for four cycles to adults with advanced melanoma for whom at least one line of treatment for metastatic disease had failed. Data from the medical records of 108 patients treated within the SA-EAP were collected and statistically analyzed to determine overall (OS) and progression-free survival (PFS) at 1 and 2 years. Results In the population of 108 patients, a median OS of 8.98 months (95% CI, 7.47 to 10.79 months) was observed. One-year OS was 36% (95% CI, 26% to 45%), and 2-year survival was observed as 20% (95% CI, 12% to 27%). The median survival without progression (ie, PFS) was 3.44 months (95% CI, 2.98 to 4.16 months), and 1- and 2-year PFS were 22% (95% CI, 14% to 29%) and 14% (95% CI, 8% to 21%), respectively. The longest recorded survival was 3.4 years. No independent prognostic variables were identified to predict for OS by multivariate Cox proportional hazards model. Conclusion In this multicenter South African setting, ipilimumab at a dose of 3 mg/kg was an effective treatment with long-term OS in a subset of patients with pretreated advanced malignant melanoma.
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Affiliation(s)
- Bernardo L Rapoport
- , Medical Oncology Centre of Rosebank; , Sandton Oncology Center; , Wits Oncology Donald Gordon Medical Center; , Bristol-Myers Squibb South Africa, Johannesburg; , University of Pretoria, Pretoria; , Rondebosch Oncology Medical Center, Cape Town; , Westridge Oncology Center, Durban; and , , and , HEXOR, Midrand, South Africa
| | - Daniel A Vorobiof
- , Medical Oncology Centre of Rosebank; , Sandton Oncology Center; , Wits Oncology Donald Gordon Medical Center; , Bristol-Myers Squibb South Africa, Johannesburg; , University of Pretoria, Pretoria; , Rondebosch Oncology Medical Center, Cape Town; , Westridge Oncology Center, Durban; and , , and , HEXOR, Midrand, South Africa
| | - Lydia M Dreosti
- , Medical Oncology Centre of Rosebank; , Sandton Oncology Center; , Wits Oncology Donald Gordon Medical Center; , Bristol-Myers Squibb South Africa, Johannesburg; , University of Pretoria, Pretoria; , Rondebosch Oncology Medical Center, Cape Town; , Westridge Oncology Center, Durban; and , , and , HEXOR, Midrand, South Africa
| | - Adam Nosworthy
- , Medical Oncology Centre of Rosebank; , Sandton Oncology Center; , Wits Oncology Donald Gordon Medical Center; , Bristol-Myers Squibb South Africa, Johannesburg; , University of Pretoria, Pretoria; , Rondebosch Oncology Medical Center, Cape Town; , Westridge Oncology Center, Durban; and , , and , HEXOR, Midrand, South Africa
| | - Georgina McAdam
- , Medical Oncology Centre of Rosebank; , Sandton Oncology Center; , Wits Oncology Donald Gordon Medical Center; , Bristol-Myers Squibb South Africa, Johannesburg; , University of Pretoria, Pretoria; , Rondebosch Oncology Medical Center, Cape Town; , Westridge Oncology Center, Durban; and , , and , HEXOR, Midrand, South Africa
| | - Johan P Jordaan
- , Medical Oncology Centre of Rosebank; , Sandton Oncology Center; , Wits Oncology Donald Gordon Medical Center; , Bristol-Myers Squibb South Africa, Johannesburg; , University of Pretoria, Pretoria; , Rondebosch Oncology Medical Center, Cape Town; , Westridge Oncology Center, Durban; and , , and , HEXOR, Midrand, South Africa
| | - Helen Miller-Jansön
- , Medical Oncology Centre of Rosebank; , Sandton Oncology Center; , Wits Oncology Donald Gordon Medical Center; , Bristol-Myers Squibb South Africa, Johannesburg; , University of Pretoria, Pretoria; , Rondebosch Oncology Medical Center, Cape Town; , Westridge Oncology Center, Durban; and , , and , HEXOR, Midrand, South Africa
| | - Margreet de Necker
- , Medical Oncology Centre of Rosebank; , Sandton Oncology Center; , Wits Oncology Donald Gordon Medical Center; , Bristol-Myers Squibb South Africa, Johannesburg; , University of Pretoria, Pretoria; , Rondebosch Oncology Medical Center, Cape Town; , Westridge Oncology Center, Durban; and , , and , HEXOR, Midrand, South Africa
| | - Janetta C de Beer
- , Medical Oncology Centre of Rosebank; , Sandton Oncology Center; , Wits Oncology Donald Gordon Medical Center; , Bristol-Myers Squibb South Africa, Johannesburg; , University of Pretoria, Pretoria; , Rondebosch Oncology Medical Center, Cape Town; , Westridge Oncology Center, Durban; and , , and , HEXOR, Midrand, South Africa
| | - Hennie Duvenhage
- , Medical Oncology Centre of Rosebank; , Sandton Oncology Center; , Wits Oncology Donald Gordon Medical Center; , Bristol-Myers Squibb South Africa, Johannesburg; , University of Pretoria, Pretoria; , Rondebosch Oncology Medical Center, Cape Town; , Westridge Oncology Center, Durban; and , , and , HEXOR, Midrand, South Africa
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González-Rodríguez E, Rodríguez-Abreu D. Immune Checkpoint Inhibitors: Review and Management of Endocrine Adverse Events. Oncologist 2016; 21:804-16. [PMID: 27306911 PMCID: PMC4943391 DOI: 10.1634/theoncologist.2015-0509] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 02/19/2016] [Indexed: 12/11/2022] Open
Abstract
UNLABELLED : In recent years, immune checkpoint inhibitors have emerged as effective therapies for advanced neoplasias. As new checkpoint target blockers become available and additional tumor locations tested, their use is expected to increase within a short time. Immune-related adverse events (irAEs) affecting the endocrine system are among the most frequent and complex toxicities. Some may be life-threatening if not recognized; hence, appropriate guidance for oncologists is needed. Despite their high incidence, endocrine irAEs have not been fully described for all immunotherapy agents available. This article is a narrative review of endocrinopathies associated with cytotoxic T lymphocyte-associated antigen-4, blockade of programmed death receptor 1 and its ligand inhibitors, and their combination. Thyroid dysfunction is the most frequent irAE reported, and hypophysitis is characteristic of ipilimumab. Incidence, timing patterns, and clinical presentation are discussed, and practical recommendations for clinical management are suggested. Heterogeneous terminology and lack of appropriate resolution criteria in clinical trials make adequate evaluation of endocrine AEs difficult. It is necessary to standardize definitions to contrast incidences and characterize toxicity patterns. To provide optimal care, a multidisciplinary team that includes endocrinology specialists is recommended. IMPLICATIONS FOR PRACTICE Immune checkpoint inhibitors are already part of oncologists' therapeutic arsenal as effective therapies for otherwise untreatable neoplasias, such as metastatic melanoma or lung cancer. Their use is expected to increase exponentially in the near future as additional agents become available and their approval is extended to different tumor types. Adverse events affecting the endocrine system are among the most frequent and complex toxicities oncologists may face, and some may be life-threatening if not recognized. This study reviews endocrinopathies associated to immune checkpoint inhibitors available to date. Incidence, timing patterns, and clinical presentation are discussed, and practical recommendations for management are proposed.
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Affiliation(s)
- Elisa González-Rodríguez
- Section of Endocrinology and Nutrition, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Delvys Rodríguez-Abreu
- Section of Medical Oncology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Spagnolo F, Picasso V, Lambertini M, Ottaviano V, Dozin B, Queirolo P. Survival of patients with metastatic melanoma and brain metastases in the era of MAP-kinase inhibitors and immunologic checkpoint blockade antibodies: A systematic review. Cancer Treat Rev 2016; 45:38-45. [PMID: 26975020 DOI: 10.1016/j.ctrv.2016.03.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 03/01/2016] [Accepted: 03/02/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The incidence of brain metastases (BM) in melanoma patients is common and associated with poor prognosis. MAP-kinase inhibitors and immunologic checkpoint blockade antibodies led to improved survival of metastatic melanoma patients; however, patients with BM are under-represented or excluded from the majority of clinical trials and the impact of new drugs on their survival is less clear. With the present systematic review, we aimed to analyze outcomes of patients with melanoma BM treated with the new drugs, both in the setting of phase I-II-III clinical trials and in the "real world". METHODS An electronic search was performed to identify studies reporting survival outcomes of patients with melanoma BM treated with MAP-kinase inhibitors and/or immunologic checkpoint blockade antibodies, regardless of study design. RESULTS Twenty-two studies were included for a total of 2153 patients. Median OS was 7.9 months in phase I-II-III trials and 7.7 months in "real world" studies. In clinical trials, median OS was 7.0 months for patients treated with immunotherapy and 7.9 months for patients treated with BRAF inhibitors. In "real world" studies, median OS was 4.3 months and 7.7 months for patients treated with immunotherapy and BRAF inhibitors, respectively. Evidence of clinical activity exists for both immunotherapy and MAP-kinase inhibitors. CONCLUSIONS MAP-kinase inhibitors and immunologic checkpoint blockade antibodies have clinical activity and may achieve improved OS in patients with metastatic melanoma and BM. These results support the inclusion of patients with BM in investigations of new agents and new treatment regimens for metastatic melanoma.
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Affiliation(s)
- Francesco Spagnolo
- Department of Plastic and Reconstructive Surgery, IRCCS AOU San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
| | - Virginia Picasso
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Matteo Lambertini
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Vincenzo Ottaviano
- Department of Plastic and Reconstructive Surgery, St George's Hospital, London, UK
| | - Beatrice Dozin
- Clinical Epidemiology Unit, IRCCS AOU San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Paola Queirolo
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
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Guan X, Wang H, Ma F, Qian H, Yi Z, Xu B. The Efficacy and Safety of Programmed Cell Death 1 and Programmed Cell Death 1 Ligand Inhibitors for Advanced Melanoma: A Meta-Analysis of Clinical Trials Following the PRISMA Guidelines. Medicine (Baltimore) 2016; 95:e3134. [PMID: 26986169 PMCID: PMC4839950 DOI: 10.1097/md.0000000000003134] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The purpose of this study was to investigate the efficacy and safety of programmed cell death 1 (PD-1) and programmed cell death 1 ligand (PD-L1) inhibitors using a meta-analysis of present trials for advanced melanoma. A fully recursive literature search of the primary electronic databases for available trials was performed. The objective response rate (ORR) and the median progression-free survival (PFS) of clinical responses were considered the main endpoints to evaluate the efficacy, whereas Grade 3-4 adverse effects (AEs) were analyzed to evaluate safety. The ORR of PD-1 and PD-L1 inhibitors was 30% (95% CI: 25-35%). No significant difference in the ORR was observed after the comparisons of low-dose, median-dose, and high-dose cohorts. In addition, the rate of Grade 3-4 AEs was 9% (95% CI: 6-12%). According to the 3 randomized controlled trials that compared PD-1 inhibitors with chemotherapy, the difference between these 2 groups was found to be statistically significant with respect to the ORR, PFS and the incidence of Grade 3-4 AEs; that is, the relative risk (RR) of the ORR was 3.42 (95% CI: 2.49-4.69, P < 0.001), the hazard ratio (HR) of the PFS was 0.50 (95% CI: 0.44-0.58, P < 0.001), and the RR of Grade 3-4 AEs was 0.45 (95% CI: 0.31-0.65, P < 0.001). According to a meta-analysis of limited concurrent studies, PD-1 and PD-L1 inhibitors appear to be associated with improved response rates, superior response durability and tolerable toxicity in patients with advanced melanoma.
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Affiliation(s)
- Xiuwen Guan
- From the Department of Medical Oncology (XG, FM, ZY, BX), and State Key Laboratory of Molecular Oncology (HW, HQ), Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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S. Ahmad S, Qian W, Ellis S, Mason E, Khattak MA, Gupta A, Shaw H, Quinton A, Kovarikova J, Thillai K, Rao A, Board R, Nobes J, Dalgleish A, Grumett S, Maraveyas A, Danson S, Talbot T, Harries M, Marples M, Plummer R, Kumar S, Nathan P, Middleton MR, Larkin J, Lorigan P, Wheater M, Ottensmeier CH, Corrie PG. Ipilimumab in the real world: the UK expanded access programme experience in previously treated advanced melanoma patients. Melanoma Res 2015; 25:432-42. [PMID: 26225580 PMCID: PMC4560270 DOI: 10.1097/cmr.0000000000000185] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/29/2015] [Indexed: 11/26/2022]
Abstract
Before licensing, ipilimumab was first made available to previously treated advanced melanoma patients through an expanded access programme (EAP) across Europe. We interrogated data from UK EAP patients to inform future clinical practice. Clinicians registered in the UK EAP provided anonymized patient data using a prespecified variable fields datasheet. Data collected were baseline patient characteristics, treatment delivered, toxicity, response, progression-free survival and overall survival (OS). Data were received for 193 previously treated metastatic melanoma patients, whose primary sites were cutaneous (82%), uveal (8%), mucosal (2%), acral (3%) or unknown (5%). At baseline, 88% of patients had a performance status (PS) of 0-1 and 20% had brain metastases. Of the patients, 53% received all four planned cycles of ipilimumab; the most common reason for stopping early was disease progression, including death from melanoma. Toxicity was recorded for 171 patients, 30% of whom experienced an adverse event of grade 3 or higher, the most common being diarrhoea (13%) and fatigue (9%). At a median follow-up of 23 months, the median progression-free survival and OS were 2.8 and 6.1 months, respectively; the 1-year and 2-year OS rates were 31 and 14.8%, respectively. The 2-year OS was significantly lower for patients with poorer PS (P<0.0001), low albumin concentrations (P<0.0001), the presence of brain metastases (P=0.007) and lactate dehydrogenase levels more than two times the upper limit of normal (P<0.0001) at baseline. These baseline characteristics are negative predictors of benefit from ipilimumab and should be taken into consideration before prescription.
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Affiliation(s)
| | - Wendi Qian
- Cambridge Cancer Trials Centre, Cambridge Clinical Trials Unit – Cancer Theme, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - Sarah Ellis
- Southampton Experimental Cancer Medicine Center, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton
| | - Elaine Mason
- Department of Medical Oncology, The Christie, Manchester
| | | | | | - Heather Shaw
- Department of Medical Oncology, Mount Vernon Hospital, Northwood
| | - Amy Quinton
- Department of Medical Oncology, Velindre Cancer Centre, Cardiff
| | | | - Kiruthikah Thillai
- Directorate of Haematology and Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London
| | - Ankit Rao
- Department of Medical Oncology, Royal Wolverhampton Hospitals
| | - Ruth Board
- Department of Medical Oncology, Royal Preston Hospital
| | - Jenny Nobes
- Clinical Oncology, Norfolk and Norwich University Hospital
| | - Angus Dalgleish
- Division of Clinical Sciences, St George’s Hospital Medical School, London
| | - Simon Grumett
- Department of Medical Oncology, Royal Wolverhampton Hospitals
| | | | - Sarah Danson
- Sheffield Experimental Cancer Medicine Centre, University of Sheffield, Weston Park Hospital, Sheffield
| | - Toby Talbot
- Clinical Oncology Department, Royal Cornwall Hospitals
| | - Mark Harries
- Directorate of Haematology and Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London
| | - Maria Marples
- St. James’s Institute of Oncology, St. James's University Hospital, Leeds, UK
| | - Ruth Plummer
- Northern Centre for Cancer Care, Newcastle upon Tyne
| | - Satish Kumar
- Department of Medical Oncology, Velindre Cancer Centre, Cardiff
| | - Paul Nathan
- Department of Medical Oncology, Mount Vernon Hospital, Northwood
| | | | - James Larkin
- Department of Medicine, Royal Marsden NHS Foundation Trust, London
| | - Paul Lorigan
- Department of Medical Oncology, The Christie, Manchester
| | - Matthew Wheater
- Southampton Experimental Cancer Medicine Center, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton
| | - Christian H. Ottensmeier
- Southampton Experimental Cancer Medicine Center, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton
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12
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Conry RM, Sullivan JC, Nabors LB. Ipilimumab-induced encephalopathy with a reversible splenial lesion. Cancer Immunol Res 2015; 3:598-601. [PMID: 25922203 DOI: 10.1158/2326-6066.cir-15-0035] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 03/18/2015] [Indexed: 11/16/2022]
Abstract
Ipilimumab, an anticytotoxic T-lymphocyte antigen (CTLA)-4 monoclonal antibody, is a first-line therapy for stage IV melanoma. Although high-grade immune-related adverse events occur in 25% of patients receiving ipilimumab, serious neurologic toxicity, primarily consisting of transient sensory and motor neuropathies, affects less than 1% of patients. We present a case report of a patient with melanoma who received high-dose ipilimumab at 10 mg/kg as first-line therapy for metastatic disease. After the third dose, the patient developed "mild" encephalopathy with a reversible splenial lesion (MERS) of the corpus callosum by MRI and neurogenic bladder, two novel immune-related adverse events during checkpoint inhibition. In addition to headache, delirium, and altered consciousness commonly seen with MERS, the patient also developed tremor, gait instability, paresthesias, and neurogenic bladder. The latter two symptoms were thought to represent sensory and autonomic neuropathies, respectively. The syndrome gradually resolved following intravenous methylprednisolone at 2 mg/kg divided twice daily for 5 days and a slow taper of oral prednisone over 8 weeks.
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Affiliation(s)
- Robert M Conry
- Division of Hematology Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Joseph C Sullivan
- Neuroradiology Section, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Louis B Nabors
- Neuro-Oncology Program, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
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13
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Yu S, Wang F, Fan L, Wei Y, Li H, Sun Y, Yang A, Jin B, Song C, Yang K. BAP31, a promising target for the immunotherapy of malignant melanomas. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2015; 34:36. [PMID: 25903101 PMCID: PMC4405826 DOI: 10.1186/s13046-015-0153-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/01/2015] [Indexed: 01/09/2023]
Abstract
PURPOSE Malignant melanoma's (MM) incidence is rising faster than that of any other cancer in the US and the overall survival at 5 years is less than 10%. B cell associated protein 31 (BAP31) is overexpressed in most MMs and might be a promising target for immunotherapy of this disease. EXPERIMENTAL DESIGN Firstly, we investigated the expression profiles of human BAP31 (hBAP31) and mouse BAP31 (mBAP31) in human and mouse normal tissues, respectively. The expression level of hBAP31 in human MMs and mBAP31 in B16 melanoma cells was also analyzed. Then we constructed novel mBAP31 DNA vaccines and tested there ability to stimulate mBAP31-specific immune responses and antitumor immunity in B16 melanoma-bearing mice. RESULTS For the first time, we found that protein expression of hBAP31 were dramatically upregulated in human MMs when compared with human normal tissues. Predominant protein expression of mBAP31 was found in mouse B16 melanoma cells but not in mouse important organs. When mice were immunized with mBAP31 DNA vaccines, strong cellular response to mBAP31 was observed in the vaccinated mice. CTLs isolated from immunized mice could effectively kill mBAP31-positive target mouse B16 melanoma tumor cells in vitro and vaccination with mBAP31 DNA vaccines had potent anti-tumor activity in therapeutic model using B16 melanoma cells. CONCLUSIONS These are the first data supporting a vaccine targeting BAP31 that is capable of inducing effective immunity against BAP31-expressing MMs and will be applicable to human MMs and hBAP31 DNA vaccine warrants investigation in human clinical trials.
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Affiliation(s)
- Shaojuan Yu
- Department of Immunology, Fourth Military Medical University, 169 Changle West Road, Xi'an, 710032, People Republic of China. .,Department of Cardiology, First Hospital of Xi,an, 30 Fenxiang, Xi'an, 710003, People Republic of China.
| | - Fuli Wang
- Department of Urology, Xijing Hospital, 125 Changle West Road, Xi'an, 710032, People Republic of China.
| | - Li Fan
- Department of Immunology, Fourth Military Medical University, 169 Changle West Road, Xi'an, 710032, People Republic of China. .,Department of Pharmaceutical Analysis, Fourth Military Medical University, 169 Changle West Road, Xi'an, 710032, People Republic of China.
| | - Yuying Wei
- Department of Immunology, Fourth Military Medical University, 169 Changle West Road, Xi'an, 710032, People Republic of China.
| | - Haitao Li
- Department of Immunology, Fourth Military Medical University, 169 Changle West Road, Xi'an, 710032, People Republic of China.
| | - Yuanjie Sun
- Department of Immunology, Fourth Military Medical University, 169 Changle West Road, Xi'an, 710032, People Republic of China.
| | - Angang Yang
- Department of Immunology, Fourth Military Medical University, 169 Changle West Road, Xi'an, 710032, People Republic of China.
| | - Boquan Jin
- Department of Immunology, Fourth Military Medical University, 169 Changle West Road, Xi'an, 710032, People Republic of China.
| | - Chaojun Song
- Department of Immunology, Fourth Military Medical University, 169 Changle West Road, Xi'an, 710032, People Republic of China.
| | - Kun Yang
- Department of Immunology, Fourth Military Medical University, 169 Changle West Road, Xi'an, 710032, People Republic of China.
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14
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Buqué A, Bloy N, Aranda F, Castoldi F, Eggermont A, Cremer I, Fridman WH, Fucikova J, Galon J, Marabelle A, Spisek R, Tartour E, Zitvogel L, Kroemer G, Galluzzi L. Trial Watch: Immunomodulatory monoclonal antibodies for oncological indications. Oncoimmunology 2015; 4:e1008814. [PMID: 26137403 PMCID: PMC4485728 DOI: 10.1080/2162402x.2015.1008814] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 01/12/2015] [Indexed: 12/14/2022] Open
Abstract
Immunomodulatory monoclonal antibodies (mAbs) differ from their tumor-targeting counterparts because they exert therapeutic effects by directly interacting with soluble or (most often) cellular components of the immune system. Besides holding promise for the treatment of autoimmune and inflammatory disorders, immunomodulatory mAbs have recently been shown to constitute a potent therapeutic weapon against neoplastic conditions. One class of immunomodulatory mAbs operates by inhibiting safeguard systems that are frequently harnessed by cancer cells to establish immunological tolerance, the so-called "immune checkpoints." No less than 3 checkpoint-blocking mAbs have been approved worldwide for use in oncological indications, 2 of which during the past 12 months. These molecules not only mediate single-agent clinical activity in patients affected by specific neoplasms, but also significantly boost the efficacy of several anticancer chemo-, radio- or immunotherapies. Here, we summarize recent advances in the development of checkpoint-blocking mAbs, as well as of immunomodulatory mAbs with distinct mechanisms of action.
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Key Words
- CRC, colorectal carcinoma
- CTLA4, cytotoxic T lymphocyte-associated protein 4
- FDA, Food and Drug Administration
- IL, interleukin
- KIR, killer cell immunoglobulin-like receptor
- MEDI4736
- MPDL3280A
- NK, natural killer
- NSCLC, non-small cell lung carcinoma
- PD-1, programmed cell death 1
- RCC, renal cell carcinoma
- TGFβ1, transforming growth factor β1
- TLR, Toll-like receptor
- TNFRSF, tumor necrosis factor receptor superfamily
- Treg, regulatory T cell
- ipilimumab
- mAb, monoclonal antibody
- nivolumab
- pembrolizumab
- urelumab
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Affiliation(s)
- Aitziber Buqué
- Gustave Roussy Cancer Campus; Villejuif, France
- INSERM, U1138; Paris, France
- Equipe 11 labellisée par la Ligue Nationale contre le Cancer, Center de Recherche des Cordeliers; Paris, France
| | - Norma Bloy
- Gustave Roussy Cancer Campus; Villejuif, France
- INSERM, U1138; Paris, France
- Equipe 11 labellisée par la Ligue Nationale contre le Cancer, Center de Recherche des Cordeliers; Paris, France
- Faculté de Medicine, Université Paris Sud/Paris XI; Le Kremlin-Bicêtre, France
| | - Fernando Aranda
- Group of Immune receptors of the Innate and Adaptive System, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS); Barcelona, Spain
| | - Francesca Castoldi
- Gustave Roussy Cancer Campus; Villejuif, France
- INSERM, U1138; Paris, France
- Equipe 11 labellisée par la Ligue Nationale contre le Cancer, Center de Recherche des Cordeliers; Paris, France
- Faculté de Medicine, Université Paris Sud/Paris XI; Le Kremlin-Bicêtre, France
- Sotio a.c.; Prague, Czech Republic
| | | | - Isabelle Cremer
- INSERM, U1138; Paris, France
- Equipe 13, Center de Recherche des Cordeliers; Paris, France
- Université Pierre et Marie Curie/Paris VI; Paris, France
| | - Wolf Hervé Fridman
- INSERM, U1138; Paris, France
- Université Pierre et Marie Curie/Paris VI; Paris, France
- Dept. of Immunology, 2nd Faculty of Medicine and University Hospital Motol, Charles University; Prague, Czech Republic
| | - Jitka Fucikova
- Sotio a.c.; Prague, Czech Republic
- Dept. of Immunology, 2nd Faculty of Medicine and University Hospital Motol, Charles University; Prague, Czech Republic
| | - Jérôme Galon
- INSERM, U1138; Paris, France
- Université Pierre et Marie Curie/Paris VI; Paris, France
- Laboratory of Integrative Cancer Immunology, Center de Recherche des Cordeliers; Paris, France
- Université Paris Descartes/Paris V; Sorbonne Paris Cité; Paris, France
| | - Aurélien Marabelle
- Gustave Roussy Cancer Campus; Villejuif, France
- INSERM, U1015, CICBT507; Villejuif, France
| | - Radek Spisek
- Sotio a.c.; Prague, Czech Republic
- Equipe 13, Center de Recherche des Cordeliers; Paris, France
| | - Eric Tartour
- Université Paris Descartes/Paris V; Sorbonne Paris Cité; Paris, France
- INSERM, U970; Paris, France
- Paris-Cardiovascular Research Center (PARCC); Paris, France
- Service d'Immunologie Biologique, Hôpital Européen Georges Pompidou (HEGP); AP-HP; Paris, France
| | - Laurence Zitvogel
- Gustave Roussy Cancer Campus; Villejuif, France
- INSERM, U1015, CICBT507; Villejuif, France
| | - Guido Kroemer
- INSERM, U1138; Paris, France
- Equipe 11 labellisée par la Ligue Nationale contre le Cancer, Center de Recherche des Cordeliers; Paris, France
- Université Paris Descartes/Paris V; Sorbonne Paris Cité; Paris, France
- Pôle de Biologie, Hôpital Européen Georges Pompidou; AP-HP; Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Campus; Villejuif, France
| | - Lorenzo Galluzzi
- Gustave Roussy Cancer Campus; Villejuif, France
- INSERM, U1138; Paris, France
- Equipe 11 labellisée par la Ligue Nationale contre le Cancer, Center de Recherche des Cordeliers; Paris, France
- Université Paris Descartes/Paris V; Sorbonne Paris Cité; Paris, France
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15
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Abstract
The anti-cytotoxic T-lymphocyte antigen-4 (anti-CTLA-4) antibody ipilimumab is the first treatment that significantly improved the survival rates of metastatic melanoma patients, marking a new era in the treatment of melanoma. During its development, a hallmark of ipilimumab therapy was the extended duration of response, achieved in 20% of patients. The follow-up of patients included in phase II and phase III trials and in expanded access programs revealed that the survival rates remained stable after 3 years. These results demonstrated that ipilimumab induces an effective anti-tumor immune response persisting after the completion of treatment, and suggested a potential remission in a subset of patients. In this article we review the development of ipilimumab and highlight the long-term results. This approach emphasizes the need to optimize the use of ipilimumab in the future, by identifying the patients most likely to achieve long term survival after ipilimumab therapy, and by developing combined therapeutic approaches involving cytotoxic agents, targeted therapies or other immunotherapies to achieve durable control in a larger proportion of patients.
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Affiliation(s)
- Julie Delyon
- AP-HP, Hôpital Saint-Louis, Département de Dermatologie, Paris, France; INSERM U976, Paris 7 University, Paris, France
| | - Michele Maio
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Celeste Lebbé
- AP-HP, Hôpital Saint-Louis, Département de Dermatologie, Paris, France; INSERM U976, Paris 7 University, Paris, France; Université Paris-Diderot, Sorbonne Paris Cité, Paris, France.
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16
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Ilieva KM, Correa I, Josephs DH, Karagiannis P, Egbuniwe IU, Cafferkey MJ, Spicer JF, Harries M, Nestle FO, Lacy KE, Karagiannis SN. Effects of BRAF mutations and BRAF inhibition on immune responses to melanoma. Mol Cancer Ther 2014; 13:2769-83. [PMID: 25385327 DOI: 10.1158/1535-7163.mct-14-0290] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Malignant melanoma is associated with poor clinical prognosis; however, novel molecular and immune therapies are now improving patient outcomes. Almost 50% of melanomas harbor targetable activating mutations of BRAF that promote RAS-RAF-MEK-ERK pathway activation and melanoma proliferation. Recent evidence also indicates that melanomas bearing mutant BRAF may also have altered immune responses, suggesting additional avenues for treatment of this patient group. The small molecule inhibitors selective for mutant BRAF induce significant but short-lived clinical responses in a proportion of patients, but also lead to immune stimulatory bystander events, which then subside with the emergence of resistance to inhibition. Simultaneous BRAF and MEK inhibition, and especially combination of BRAF inhibitors with new immunotherapies such as checkpoint blockade antibodies, may further enhance immune activation, or counteract immunosuppressive signals. Preclinical evaluation and ongoing clinical trials should provide novel insights into the role of immunity in the therapy of BRAF-mutant melanoma.
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Affiliation(s)
- Kristina M Ilieva
- St. John's Institute of Dermatology, Division of Genetics and Molecular Medicine and NIHR Biomedical Research Centre at Guy's and St. Thomas's Hospitals and King's College London, London, United Kingdom
| | - Isabel Correa
- St. John's Institute of Dermatology, Division of Genetics and Molecular Medicine and NIHR Biomedical Research Centre at Guy's and St. Thomas's Hospitals and King's College London, London, United Kingdom
| | - Debra H Josephs
- St. John's Institute of Dermatology, Division of Genetics and Molecular Medicine and NIHR Biomedical Research Centre at Guy's and St. Thomas's Hospitals and King's College London, London, United Kingdom. Department of Research Oncology, Division of Cancer Studies, King's College London, Guy's Hospital, London, United Kingdom
| | - Panagiotis Karagiannis
- St. John's Institute of Dermatology, Division of Genetics and Molecular Medicine and NIHR Biomedical Research Centre at Guy's and St. Thomas's Hospitals and King's College London, London, United Kingdom
| | - Isioma U Egbuniwe
- St. John's Institute of Dermatology, Division of Genetics and Molecular Medicine and NIHR Biomedical Research Centre at Guy's and St. Thomas's Hospitals and King's College London, London, United Kingdom
| | - Michiala J Cafferkey
- St. John's Institute of Dermatology, Division of Genetics and Molecular Medicine and NIHR Biomedical Research Centre at Guy's and St. Thomas's Hospitals and King's College London, London, United Kingdom
| | - James F Spicer
- Department of Research Oncology, Division of Cancer Studies, King's College London, Guy's Hospital, London, United Kingdom
| | - Mark Harries
- Clinical Oncology, Guy's and St. Thomas's NHS Foundation Trust, Guy's Hospital, London, United Kingdom
| | - Frank O Nestle
- St. John's Institute of Dermatology, Division of Genetics and Molecular Medicine and NIHR Biomedical Research Centre at Guy's and St. Thomas's Hospitals and King's College London, London, United Kingdom
| | - Katie E Lacy
- St. John's Institute of Dermatology, Division of Genetics and Molecular Medicine and NIHR Biomedical Research Centre at Guy's and St. Thomas's Hospitals and King's College London, London, United Kingdom
| | - Sophia N Karagiannis
- St. John's Institute of Dermatology, Division of Genetics and Molecular Medicine and NIHR Biomedical Research Centre at Guy's and St. Thomas's Hospitals and King's College London, London, United Kingdom.
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17
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Durable benefit and the potential for long-term survival with immunotherapy in advanced melanoma. Cancer Treat Rev 2014; 40:1056-64. [PMID: 25060490 DOI: 10.1016/j.ctrv.2014.06.012] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/24/2014] [Accepted: 06/30/2014] [Indexed: 12/15/2022]
Abstract
Historically, the median overall survival for patients with stage IV melanoma was less than 1 year and the 5-year survival rate was ∼10%. Recent advances in therapy have raised 5-year survival expectations to ∼20%. Notably, a subset of melanoma patients who receive immunotherapy with high-dose interleukin-2, and now ipilimumab, can achieve long-term survival of at least 5 years. A major goal in melanoma research is to increase the number of patients who experience this overall survival benefit. In this review, we discuss the attributes of immunotherapy and newer targeted agents, and consider how combination strategies might improve the chances of achieving durable benefit and long-term survival. We also discuss three areas that we believe will be critical to making further advances in melanoma treatment. To better understand the clinical profile of patients who achieve long-term survival with immunotherapy, we first present data from ipilimumab clinical trials in which a subset of patients experienced durable responses. Second, we discuss the limitations of traditional metrics used to evaluate the benefits of immunotherapies. Third, we consider emerging issues that clinicians are currently facing when making treatment decisions regarding immunotherapy. A better understanding of these novel treatments may improve survival outcomes in melanoma, increase the number of patients who experience this overall survival benefit, and inform the future use of these agents in the treatment of other cancer types.
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