1
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Mechanisms of Resistance and Strategies to Combat Resistance in PD-(L)1 Blockade. IMMUNO 2022. [DOI: 10.3390/immuno2040041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Prolonged survival and durable responses in several late-stage cancers such as melanoma and lung cancer have been made possible with the use of immune checkpoint inhibitors targeting the programmed cell-death protein 1 (PD-1) or its ligand PD-L1. While it is prudent to focus on the unprecedented and durable clinical responses, there are subsets of cancer patients that do not respond to immunotherapies or respond early and then relapse later. Many pathways of resistance have been characterized, and more continue to be uncovered. To overcome the development of resistance, an in-depth investigation is necessary to identify alternative immune receptors and signals with the overarching goal of expanding treatment options for those with demonstrated resistance to PD1 checkpoint immunotherapy. In this mini-review, we will discuss the mechanisms by which tumors exhibit resistance to anti-PD-1/PD-L1 immunotherapy and explore strategies to overcome such resistances.
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2
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Reyes RM, Zhang C, Deng Y, Ji N, Mukherjee N, Padron AS, Clark CA, Svatek RS, Curiel TJ. CD122-targeted interleukin-2 and αPD-L1 treat bladder cancer and melanoma via distinct mechanisms, including CD122-driven natural killer cell maturation. Oncoimmunology 2021; 10:2006529. [PMID: 34858732 PMCID: PMC8632314 DOI: 10.1080/2162402x.2021.2006529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Bladder cancer (BC) and melanoma are amenable to immune checkpoint blockade (ICB) therapy, yet most patients with advanced/metastatic disease do not respond. CD122-targeted interleukin (IL)-2 can improve ICB efficacy, but mechanisms are unclear. We tested αPD-L1 and CD122-directed immunotherapy with IL-2/αIL-2 complexes (IL-2c) in primary and metastatic bladder and melanoma tumors. IL-2c treatment of orthotopic MB49 and MBT-2 BC generated NK cell antitumor immunity through enhanced activation, reduced exhaustion, and promotion of a mature, effector NK cell phenotype. By comparison, subcutaneous B16-F10 melanoma, which is IL-2c sensitive, requires CD8+ T and not NK cells, yet we found αPD-L1 efficacy requires both CD8+ T and NK cells. We then explored αPD-L1 and IL-2c mechanisms at distinct metastatic sites and found intraperitoneal B16-F10 metastases were sensitive to αPD-L1 and IL-2c, with IL-2c but not αPD-L1, increasing CD122+ mature NK cell function, confirming conserved IL-2c effects in distinct cancer types and anatomic compartments. αPD-L1 failed to control tumor growth and prolong survival in B16-F10 lung metastases, yet IL-2c treated B16-F10 lung metastases effectively even in T cell and adaptive immunity deficient mice, which was abrogated by NK cell depletion in wild-type mice. Flow cytometric analyses of NK cells in B16-F10 lung metastases suggest that IL-2c directly boosts NK cell activation and effector function. Thus, αPD-L1 and IL-2c mediate nonredundant, immune microenvironment-specific treatment mechanisms involving CD8+ T and NK cells in primary and metastatic BC and melanoma. Mechanistic differences suggest effective treatment combinations including in other tumors or sites, warranting further studies.
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Affiliation(s)
- Ryan M Reyes
- South Texas Medical Scientist Training Program, University of Texas Health San Antonio, San Antonio, TX, USA.,Mays Cancer Center, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Chenghao Zhang
- Mays Cancer Center, University of Texas Health San Antonio, San Antonio, TX, USA.,Xiangya Medical School, Central South University, Changsha, Hunan, China
| | - Yilun Deng
- Mays Cancer Center, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Niannian Ji
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Neelam Mukherjee
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Alvaro S Padron
- Division of Hematology/Oncology, Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Curtis A Clark
- Mays Cancer Center, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Robert S Svatek
- Mays Cancer Center, University of Texas Health San Antonio, San Antonio, TX, USA.,Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Tyler J Curiel
- Mays Cancer Center, University of Texas Health San Antonio, San Antonio, TX, USA.,Division of Hematology/Oncology, Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
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3
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Gerard CL, Delyon J, Wicky A, Homicsko K, Cuendet MA, Michielin O. Turning tumors from cold to inflamed to improve immunotherapy response. Cancer Treat Rev 2021; 101:102227. [PMID: 34656019 DOI: 10.1016/j.ctrv.2021.102227] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/13/2021] [Accepted: 05/15/2021] [Indexed: 12/30/2022]
Abstract
Immune checkpoint inhibitors have revolutionized the treatment landscape for a number of cancers over the last few decades. Nevertheless, a majority of patients still do not benefit from these treatments. Such patient-specific lack of response can be predicted, in part, from the immune phenotypes present in the tumor microenvironment. We provide a perspective on options to reprogram the tumors and their microenvironment to increase the therapeutic efficacy of immunotherapies and expand their efficacy against cold tumors. Additionally, we review data from current preclinical and clinical trials aimed at testing the different therapeutic options in monotherapy or preferably in combination with checkpoint inhibitors.
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Affiliation(s)
- C L Gerard
- Precision Oncology Center, Lausanne University Hospital (CHUV), Switzerland
| | - J Delyon
- Precision Oncology Center, Lausanne University Hospital (CHUV), Switzerland
| | - A Wicky
- Precision Oncology Center, Lausanne University Hospital (CHUV), Switzerland
| | - K Homicsko
- Precision Oncology Center, Lausanne University Hospital (CHUV), Switzerland; Ludwig Institute for Cancer Research, University of Lausanne, Lausanne, Switzerland
| | - Michel A Cuendet
- Precision Oncology Center, Lausanne University Hospital (CHUV), Switzerland; Molecular Modelling Group, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Department of Physiology and Biophysics, Weill Cornell Medicine, NY, USA.
| | - O Michielin
- Precision Oncology Center, Lausanne University Hospital (CHUV), Switzerland; Molecular Modelling Group, Swiss Institute of Bioinformatics, Lausanne, Switzerland.
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4
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Tolba MF, Elghazaly H, Bousoik E, Elmazar MMA, Tolaney SM. Novel combinatorial strategies for boosting the efficacy of immune checkpoint inhibitors in advanced breast cancers. Clin Transl Oncol 2021; 23:1979-1994. [PMID: 33871826 DOI: 10.1007/s12094-021-02613-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/29/2021] [Indexed: 12/11/2022]
Abstract
The year 2019 witnessed the first approval of an immune checkpoint inhibitor (ICI) for the management of triple negative breast cancers (TNBC) that are metastatic and programmed death ligand (PD)-L1 positive. Extensive research has focused on testing ICI-based combinatorial strategies, with the ultimate goal of enhancing the response of breast tumors to immunotherapy to increase the number of breast cancer patients benefiting from this transformative treatment. The promising investigational strategies included immunotherapy combinations with monoclonal antibodies (mAbs) against human epidermal growth factor receptor (HER)-2 for the HER2 + tumors versus cyclin-dependent kinase (CDK)4/6 inhibitors in the estrogen receptor (ER) + disease. Multiple approaches are showing signals of success in advanced TNBC include employing Poly (ADP-ribose) polymerase (PARP) inhibitors, tyrosine kinase inhibitors, MEK inhibitors, phosphatidylinositol 3‑kinase (PI3K)/protein kinase B (AKT) signaling inhibitors or inhibitors of adenosine receptor, in combination with the classical PD-1/PD-L1 immune checkpoint inhibitors. Co-treatment with chemotherapy, high intensity focused ultrasound (HIFU) or interleukin-2-βɣ agonist have also produced promising outcomes. This review highlights the latest combinatorial strategies under development for overcoming cancer immune evasion and enhancing the percentage of immunotherapy responders in the different subsets of advanced breast cancers.
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Affiliation(s)
- M F Tolba
- Department of Pharmacology and Toxicology, Faculty of Pharmacy and Center of Drug Discovery Research and Development, Ain Shams University, Cairo, 11566, Egypt.
- School of Life and Medical Sciences, University of Hertfordshire-Hosted By Global Academic Foundation, New Capital City, Egypt.
| | - H Elghazaly
- Clinical Oncology Department, and Medical Research Center (MASRI), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - E Bousoik
- Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Chapman University, Irvine, CA, USA
- School of Pharmacy, Omar-Al-Mukhtar University, Derna, Libya
| | - M M A Elmazar
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, The British University in Egypt (BUE), 11837, El Sherouk City, Egypt
| | - S M Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
- Harvard Medical School, Boston, MA, USA
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5
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Wilson MA, Fecher LA. The Role of Systemic Therapy in Advanced Cutaneous Melanoma of the Head and Neck. Otolaryngol Clin North Am 2021; 54:329-342. [PMID: 33602512 DOI: 10.1016/j.otc.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The treatment of advanced melanoma has changed dramatically over the last decade. With the discovery of activating BRAF mutations and the development of targeted therapies and checkpoint inhibitors, the overall survival of patients with advanced melanoma has improved. This article provides an overview of systemic therapies, including the pivotal agents that have led to these advances.
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Affiliation(s)
- Melissa A Wilson
- Sidney Kimmel Cancer Center, Thomas Jefferson University, 1025 Walnut Street, Suite 700, Philadelphia, PA 19107, USA
| | - Leslie A Fecher
- University of Michigan, Rogel Cancer Center, C343 MIB, 1500 East Medical Center Drive, SPC 5848, Ann Arbor, MI 48109-5848, USA.
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6
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Drerup JM, Deng Y, Pandeswara SL, Padrón ÁS, Reyes RM, Zhang X, Mendez J, Liu A, Clark CA, Chen W, Conejo-Garcia JR, Hurez V, Gupta H, Curiel TJ. CD122-Selective IL2 Complexes Reduce Immunosuppression, Promote Treg Fragility, and Sensitize Tumor Response to PD-L1 Blockade. Cancer Res 2020; 80:5063-5075. [PMID: 32948605 PMCID: PMC7669742 DOI: 10.1158/0008-5472.can-20-0002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 07/10/2020] [Accepted: 09/15/2020] [Indexed: 12/20/2022]
Abstract
The IL2 receptor (IL2R) is an attractive cancer immunotherapy target that controls immunosuppressive T regulatory cells (Treg) and antitumor T cells. Here we used IL2Rβ-selective IL2/anti-IL2 complexes (IL2c) to stimulate effector T cells preferentially in the orthotopic mouse ID8agg ovarian cancer model. Despite strong tumor rejection, IL2c unexpectedly lowered the tumor microenvironmental CD8+/Treg ratio. IL2c reduced tumor microenvironmental Treg suppression and induced a fragile Treg phenotype, helping explain improved efficacy despite numerically increased Tregs without affecting Treg in draining lymph nodes. IL2c also reduced Treg-mediated, high-affinity IL2R signaling needed for optimal Treg functions, a likely mechanism for reduced Treg suppression. Effector T-cell IL2R signaling was simultaneously improved, suggesting that IL2c inhibits Treg functions without hindering effector T cells, a limitation of most Treg depletion agents. Anti-PD-L1 antibody did not treat ID8agg, but adding IL2c generated complete tumor regressions and protective immune memory not achieved by either monotherapy. Similar anti-PD-L1 augmentation of IL2c and degradation of Treg functions were seen in subcutaneous B16 melanoma. Thus, IL2c is a multifunctional immunotherapy agent that stimulates immunity, reduces immunosuppression in a site-specific manner, and combines with other immunotherapies to treat distinct tumors in distinct anatomic compartments. SIGNIFICANCE: These findings present CD122-targeted IL2 complexes as an advancement in cancer immunotherapy, as they reduce Treg immunosuppression, improve anticancer immunity, and boost PD-L1 immune checkpoint blockade efficacy in distinct tumors and anatomic locations.
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Affiliation(s)
- Justin M Drerup
- Department of Cell Systems and Anatomy, The Graduate School of Biomedical Sciences, University of Texas Health San Antonio, Texas
- Department of Medicine, University of Texas Health San Antonio, Texas
| | - Yilun Deng
- Department of Medicine, University of Texas Health San Antonio, Texas
| | | | - Álvaro S Padrón
- Department of Medicine, University of Texas Health San Antonio, Texas
| | - Ryan M Reyes
- Department of Microbiology, Immunology and Molecular Genetics, The Graduate School of Biomedical Sciences, University of Texas Health San Antonio, Texas
| | - Xinyue Zhang
- Sun Yat-sen University, Guangzhou, Guangdong, P.R.China
| | - Jenny Mendez
- Department of Medicine, University of Texas Health San Antonio, Texas
| | - Aijie Liu
- Department of Medicine, University of Texas Health San Antonio, Texas
| | - Curtis A Clark
- Department of Medicine, University of Texas Health San Antonio, Texas
- Department of Microbiology, Immunology and Molecular Genetics, The Graduate School of Biomedical Sciences, University of Texas Health San Antonio, Texas
| | | | | | - Vincent Hurez
- Department of Medicine, University of Texas Health San Antonio, Texas
| | - Harshita Gupta
- Department of Medicine, University of Texas Health San Antonio, Texas
| | - Tyler J Curiel
- Department of Medicine, University of Texas Health San Antonio, Texas.
- Department of Microbiology, Immunology and Molecular Genetics, The Graduate School of Biomedical Sciences, University of Texas Health San Antonio, Texas
- Mays Family Cancer Center, University of Texas Health San Antonio, Texas
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7
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A novel format for recombinant antibody-interleukin-2 fusion proteins exhibits superior tumor-targeting properties in vivo. Oncotarget 2020; 11:3698-3711. [PMID: 33110477 PMCID: PMC7566808 DOI: 10.18632/oncotarget.27726] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/17/2020] [Indexed: 01/13/2023] Open
Abstract
The targeted delivery of interleukin-2 to the tumor is gaining attention as an avenue to potentiate the action of T and NK cells at the site of disease. We have previously described the fusion of the L19 antibody, specific to the EDB domain of fibronectin, with human interleukin-2, using a non-covalent homodimeric diabody format. Here, we describe four novel formats for the L19-IL2 fusion, featuring different arrangements of antibody and IL2. A comparative quantitative biodistribution analysis in tumor-bearing mice using radioiodinated proteins revealed that the novel format (L19L19-IL2, with the antibody in single-chain diabody format) exhibited the best biodistribution results. In vitro assays on peripheral blood mononuclear cells showed a decrease activation of regulatory T cells when single IL2 domain was used. In vivo, both L19-IL2 and L19L19-IL2 inhibited tumor growth in immunocompetent mouse models of cancer. T-cell analysis revealed similar levels of CD4+ and FoxP3+ cells, with an expansion of the CD8+ T cell in mice treated with L19-IL2 and L19L19-IL2. The percentage of CD4+ regulatory T cells was markedly decreased with L19L19-IL2 combined with a mouse-specific PD-1 blocker. Collectively, these data indicate that the new L19L19-IL2 format exhibits favorable tumor-homing properties and mediates a potent anti-cancer activity in vivo.
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8
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Immune Checkpoint Inhibition-Does It Cause Rheumatic Diseases? Mechanisms of Cancer-Associated Loss of Tolerance and Pathogenesis of Autoimmunity. Rheum Dis Clin North Am 2020; 46:587-603. [PMID: 32631606 DOI: 10.1016/j.rdc.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Mechanisms of immune checkpoints and their role in autoimmunity are discussed in the context of immune checkpoint inhibitor (ICI) therapy for cancer. The updated clinical spectrum of immune-related adverse events (irAEs), with an in-depth discussion of rheumatic irAEs, is presented. The relationship between ICI-induced loss of self-tolerance in cancer and the implications for understanding of irAEs, rheumatic irAEs in particular, is overviewed.
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9
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Torrejon DY, Abril-Rodriguez G, Champhekar AS, Tsoi J, Campbell KM, Kalbasi A, Parisi G, Zaretsky JM, Garcia-Diaz A, Puig-Saus C, Cheung-Lau G, Wohlwender T, Krystofinski P, Vega-Crespo A, Lee CM, Mascaro P, Grasso CS, Berent-Maoz B, Comin-Anduix B, Hu-Lieskovan S, Ribas A. Overcoming Genetically Based Resistance Mechanisms to PD-1 Blockade. Cancer Discov 2020; 10:1140-1157. [PMID: 32467343 DOI: 10.1158/2159-8290.cd-19-1409] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/23/2020] [Accepted: 05/07/2020] [Indexed: 11/16/2022]
Abstract
Mechanism-based strategies to overcome resistance to PD-1 blockade therapy are urgently needed. We developed genetic acquired resistant models of JAK1, JAK2, and B2M loss-of-function mutations by gene knockout in human and murine cell lines. Human melanoma cell lines with JAK1/2 knockout became insensitive to IFN-induced antitumor effects, while B2M knockout was no longer recognized by antigen-specific T cells and hence was resistant to cytotoxicity. All of these mutations led to resistance to anti-PD-1 therapy in vivo. JAK1/2-knockout resistance could be overcome with the activation of innate and adaptive immunity by intratumoral Toll-like receptor 9 agonist administration together with anti-PD-1, mediated by natural killer (NK) and CD8 T cells. B2M-knockout resistance could be overcome by NK-cell and CD4 T-cell activation using the CD122 preferential IL2 agonist bempegaldesleukin. Therefore, mechanistically designed combination therapies can overcome genetic resistance to PD-1 blockade therapy. SIGNIFICANCE: The activation of IFN signaling through pattern recognition receptors and the stimulation of NK cells overcome genetic mechanisms of resistance to PD-1 blockade therapy mediated through deficient IFN receptor and antigen presentation pathways. These approaches are being tested in the clinic to improve the antitumor activity of PD-1 blockade therapy.This article is highlighted in the In This Issue feature, p. 1079.
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Affiliation(s)
- Davis Y Torrejon
- Division of Hematology-Oncology, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Gabriel Abril-Rodriguez
- Division of Hematology-Oncology, Department of Medicine, University of California, Los Angeles, Los Angeles, California.,Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California
| | - Ameya S Champhekar
- Division of Hematology-Oncology, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Jennifer Tsoi
- Division of Hematology-Oncology, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Katie M Campbell
- Division of Hematology-Oncology, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Anusha Kalbasi
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
| | - Giulia Parisi
- Division of Hematology-Oncology, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Jesse M Zaretsky
- Division of Hematology-Oncology, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Angel Garcia-Diaz
- Division of Hematology-Oncology, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Cristina Puig-Saus
- Division of Hematology-Oncology, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Gardenia Cheung-Lau
- Division of Surgical Oncology, Department of Surgery, University of California, Los Angeles, Los Angeles, California
| | - Thomas Wohlwender
- Division of Surgical Oncology, Department of Surgery, University of California, Los Angeles, Los Angeles, California
| | - Paige Krystofinski
- Division of Hematology-Oncology, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Agustin Vega-Crespo
- Division of Hematology-Oncology, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Christopher M Lee
- Division of Hematology-Oncology, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Pau Mascaro
- Division of Hematology-Oncology, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Catherine S Grasso
- Division of Hematology-Oncology, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Beata Berent-Maoz
- Division of Hematology-Oncology, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Begoña Comin-Anduix
- Division of Surgical Oncology, Department of Surgery, University of California, Los Angeles, Los Angeles, California.,Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Siwen Hu-Lieskovan
- Division of Hematology-Oncology, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Antoni Ribas
- Division of Hematology-Oncology, Department of Medicine, University of California, Los Angeles, Los Angeles, California. .,Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California.,Division of Surgical Oncology, Department of Surgery, University of California, Los Angeles, Los Angeles, California.,Jonsson Comprehensive Cancer Center, Los Angeles, California.,Parker Institute for Cancer Immunotherapy, San Francisco, California
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10
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Modern Aspects of Immunotherapy with Checkpoint Inhibitors in Melanoma. Int J Mol Sci 2020; 21:ijms21072367. [PMID: 32235439 PMCID: PMC7178114 DOI: 10.3390/ijms21072367] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 12/15/2022] Open
Abstract
Although melanoma is one of the most immunogenic tumors, it has an ability to evade anti-tumor immune responses by exploiting tolerance mechanisms, including negative immune checkpoint molecules. The most extensively studied checkpoints represent cytotoxic T lymphocyte-associated protein-4 (CTLA-4) and programmed cell death protein 1 (PD-1). Immune checkpoint inhibitors (ICI), which were broadly applied for melanoma treatment in the past decade, can unleash anti-tumor immune responses and result in melanoma regression. Patients responding to the ICI treatment showed long-lasting remission or disease control status. However, a large group of patients failed to respond to this therapy, indicating the development of resistance mechanisms. Among them are intrinsic tumor properties, the dysfunction of effector cells, and the generation of immunosuppressive tumor microenvironment (TME). This review discusses achievements of ICI treatment in melanoma, reasons for its failure, and promising approaches for overcoming the resistance. These methods include combinations of different ICI with each other, strategies for neutralizing the immunosuppressive TME and combining ICI with other anti-cancer therapies such as radiation, oncolytic viral, or targeted therapy. New therapeutic approaches targeting other immune checkpoint molecules are also discussed.
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11
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Beiu C, Giurcaneanu C, Grumezescu AM, Holban AM, Popa LG, Mihai MM. Nanosystems for Improved Targeted Therapies in Melanoma. J Clin Med 2020; 9:jcm9020318. [PMID: 31979325 PMCID: PMC7073828 DOI: 10.3390/jcm9020318] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/11/2020] [Accepted: 01/20/2020] [Indexed: 02/06/2023] Open
Abstract
Melanoma is one of the most aggressive forms of skin cancer, with limited therapeutic options. Since its incidence has been rapidly rising in recent years, the study of new targeted therapeutic strategies has increased. The implication of nanoscience in the development of alternative targeted therapies for melanoma has multiple benefits and could significantly improve the outcome of melanoma patients. In this paper, we review the most recent progress in the field of targeted therapies, emphasizing the impact of nanoscale materials on the targeting and controlled release of anti-tumor drugs. The applications of nanomedicine in the management of melanoma are extensive and refer to sentinel lymph node mapping, chemotherapy, and RNA interference; each of these applications harboring the potential to develop efficient and personalized diagnostic techniques and therapies. Further research, especially in clinical trials, is needed to establish whether fighting melanoma on the nanoscale level represents the key to reaching a critical inflection point in mankind’s battle with metastatic melanoma.
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Affiliation(s)
- Cristina Beiu
- Department of Oncologic Dermatology-“Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.B.); (C.G.); (L.G.P.)
| | - Calin Giurcaneanu
- Department of Oncologic Dermatology-“Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.B.); (C.G.); (L.G.P.)
| | - Alexandru Mihai Grumezescu
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 1–7 Polizu Street, 011061 Bucharest, Romania;
| | - Alina Maria Holban
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 1–7 Polizu Street, 011061 Bucharest, Romania;
- Department of Microbiology and Immunology, Faculty of Biology, University of Bucharest, 030018 Bucharest, Romania
- Correspondence: ; Tel.: +40-721-600-737
| | - Liliana Gabriela Popa
- Department of Oncologic Dermatology-“Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.B.); (C.G.); (L.G.P.)
| | - Mara Mădălina Mihai
- Department of Oncologic Dermatology-“Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.B.); (C.G.); (L.G.P.)
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12
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Gellrich FF, Schmitz M, Beissert S, Meier F. Anti-PD-1 and Novel Combinations in the Treatment of Melanoma-An Update. J Clin Med 2020; 9:E223. [PMID: 31947592 PMCID: PMC7019511 DOI: 10.3390/jcm9010223] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 12/15/2022] Open
Abstract
Until recently, distant metastatic melanoma was considered refractory to systemic therapy. A better understanding of the interactions between tumors and the immune system and the mechanisms of regulation of T-cells led to the development of immune checkpoint inhibitors. This review summarizes the current novel data on the treatment of metastatic melanoma with anti-programmed cell death protein 1 (PD-1) antibodies and anti-PD-1-based combination regimens, including clinical trials presented at major conference meetings. Immune checkpoint inhibitors, in particular anti-PD-1 antibodies such as pembrolizumab and nivolumab and the combination of nivolumab with the anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) antibody ipilimumab can achieve long-term survival for patients with metastatic melanoma. The anti-PD-1 antibodies nivolumab and pembrolizumab were also approved for adjuvant treatment of patients with resected metastatic melanoma. Anti-PD-1 antibodies appear to be well tolerated, and toxicity is manageable. Nivolumab combined with ipilimumab achieves a 5 year survival rate of more than 50% but at a cost of high toxicity. Ongoing clinical trials investigate novel immunotherapy combinations and strategies (e.g., Talimogene laherparepvec (T-VEC), Bempegaldesleukin (BEMPEG), incorporation or sequencing of targeted therapy, incorporation or sequencing of radiotherapy), and focus on poor prognosis groups (e.g., high tumor burden/LDH levels, anti-PD-1 refractory melanoma, and brain metastases).
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Affiliation(s)
- Frank Friedrich Gellrich
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany; (S.B.)
- Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, 01307 Dresden, Germany
| | - Marc Schmitz
- Institute of Immunology, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany;
- National Centre for Tumor Diseases, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Stefan Beissert
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany; (S.B.)
- Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, 01307 Dresden, Germany
| | - Friedegund Meier
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany; (S.B.)
- Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, 01307 Dresden, Germany
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Human Anti-tumor Immunity: Insights from Immunotherapy Clinical Trials. Immunity 2020; 52:36-54. [DOI: 10.1016/j.immuni.2019.12.010] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/08/2019] [Accepted: 12/14/2019] [Indexed: 12/15/2022]
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Abstract
New therapies that promote antitumour immunity have been recently developed. Most of these immunomodulatory approaches have focused on enhancing T-cell responses, either by targeting inhibitory pathways with immune checkpoint inhibitors, or by targeting activating pathways, as with chimeric antigen receptor T cells or bispecific antibodies. Although these therapies have led to unprecedented successes, only a minority of patients with cancer benefit from these treatments, highlighting the need to identify new cells and molecules that could be exploited in the next generation of immunotherapy. Given the crucial role of innate immune responses in immunity, harnessing these responses opens up new possibilities for long-lasting, multilayered tumour control.
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