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Bratova M, Skrickova J, Matusikova M, Hrabcova K, Havel L, Koubkova L, Hrnciarik M, Krejci J, Fischer O, Svaton M, Brat K. Effectiveness of first-line anticancer treatment may predict treatment response in further lines in stage III/IV patients with non-small cell lung cancer. J Cancer Res Clin Oncol 2023; 149:17123-17131. [PMID: 37768380 PMCID: PMC10657273 DOI: 10.1007/s00432-023-05431-5] [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: 07/11/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE The aim of our study was to evaluate if therapeutic success in the first-line of anticancer treatments in patients with NSCLC may predict treatment success in the following lines. METHODS We analyzed the data of patients with NSCLC stage III/IV from the TULUNG registry separately for chemotherapy, TKIs, ALK inhibitors, and immunotherapy in the first line during the years 2011-2019. "Succesful treatment " was defined as PFS ≥ 6 months, a "good responder " was a patient with ˃50% of "successful treatment " lines. Treatment responses were analyzed separately for each drug group. Descriptive statistics, Fisher exact test, Pearson Chi-Squared test, log-rank test, and univariate/multivariate logistic regression models were used. RESULTS The first-line TKI therapy was successful in 66.2%, while good responders accounted for 50.7% of the cohort and their rates were similar for all types of TKIs. First-line platinum-based chemotherapy was successful in 43.1% and 48.6% for combinations with pemetrexed and bevacizumab, respectively. Good responders accounted for 29.5% and 25.9%, respectively. In the group of ALK inhibitors, we observed treatment success in 52.3% of cases, while alectinib showed the highest effectiveness (up to 70%). Good responders constituted 50% of the group. In the first-line immunotherapy group, survival benefit was observed in 52.3%, and good responders constituted 52.3% of the cohort. CONCLUSION We concluded that the treatment success in first-line therapies in patients with NSCLC may predict survival benefits in the subsequent lines, particularly in EGFR- or ALK-positive disease and immunotherapy-treated patients.
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Affiliation(s)
- Monika Bratova
- Department of Respiratory Diseases, University Hospital Brno, Jihlavska Street 20, 625 00, Brno, EU, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jana Skrickova
- Department of Respiratory Diseases, University Hospital Brno, Jihlavska Street 20, 625 00, Brno, EU, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Magda Matusikova
- Institute of Biostatistics and Analyses, Ltd., Brno, Czech Republic
| | | | - Libor Havel
- Department of Respiratory Medicine, Thomayer Hospital, Prague, Czech Republic
| | - Leona Koubkova
- Department of Pneumology, University Hospital Motol, Prague, Czech Republic
- 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michal Hrnciarik
- Department of Pneumology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
- Faculty of Medicine, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Jana Krejci
- Department of Pneumology and Thoracic Surgery, Bulovka Hospital, Prague, Czech Republic
| | - Ondrej Fischer
- Department of Respiratory Medicine, University Hospital Olomouc, Olomouc, Czech Republic
- Faculty of Medicine, Palacky University, Olomouc, Czech Republic
| | - Martin Svaton
- Department of Pneumology, University Hospital Pilsen, Pilsen, Czech Republic
- Faculty of Medicine, Charles University in Prague, Pilsen, Czech Republic
| | - Kristian Brat
- Department of Respiratory Diseases, University Hospital Brno, Jihlavska Street 20, 625 00, Brno, EU, Czech Republic.
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic.
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Li N, Zheng X, Gan J, Zhuo T, Li X, Yang C, Wu Y, Qin S. Effects of glucocorticoid use on survival of advanced non-small-cell lung cancer patients treated with immune checkpoint inhibitors. Chin Med J (Engl) 2023; 136:2562-2572. [PMID: 37925595 PMCID: PMC10617908 DOI: 10.1097/cm9.0000000000002544] [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: 12/08/2022] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Lung cancer is the second most common cancer worldwide, with non-small-cell lung cancer (NSCLC) accounting for the majority of cases. Patients with NSCLC have achieved great survival benefits from immunotherapies targeting immune checkpoints. Glucocorticoids (GCs) are frequently used for palliation of cancer-associated symptoms, as supportive care for non-cancer-associated symptoms, and for management of immune-related adverse events (irAEs). The aim of this study was to clarify the safety and prognostic significance of glucocorticoid use in advanced patients with NSCLC treated with immune checkpoint inhibitors (ICIs). METHODS The study searched publications from PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine disc, Chinese National Knowledge Infrastructure, Wanfang Data, and Chinese Science and Technology Journal Database up to March 1st, 2022, and conducted a meta-analysis to assess the effects of glucocorticoid use on overall survival (OS) and progression-free survival (PFS) in NSCLC patients treated with ICIs through the available data. The study calculated the pooled hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS This study included data from 25 literatures that were mainly retrospective, with 8713 patients included. Patients taking GCs had a higher risk for tumor progression and death compared with those not taking GCs (PFS: HR = 1.57, 95% CI: 1.33-1.86, P <0.001; OS: HR = 1.63, 95% CI: 1.41-1.88, P <0.001). GCs used for cancer-associated symptoms caused an obviously negative effect on both PFS and OS (PFS: HR = 1.74, 95% CI: 1.32-2.29, P <0.001; OS: HR = 1.76, 95% CI: 1.52-2.04, P <0.001). However, GCs used for irAEs management did not negatively affect prognosis (PFS: HR = 0.68, 95% CI: 0.46-1.00, P = 0.050; OS: HR = 0.53, 95% CI: 0.34-0.83, P = 0.005), and GCs used for non-cancer-associated indications had no effect on prognosis (PFS: HR = 0.92, 95%CI: 0.63-1.32, P = 0.640; OS: HR = 0.91, 95% CI: 0.59-1.41, P = 0.680). CONCLUSIONS In advanced NSCLC patients treated with ICIs, the use of GCs for palliation of cancer-associated symptoms may result in a worse PFS and OS, indicating that they increase the risk of tumor progression and death. But, in NSCLC patients treated with ICIs, the use of GCs for the management of irAEs may be safe, and the use of GCs for the treatment of non-cancer-associated symptoms may not affect the ICIs' survival benefits. Therefore, it is necessary to be careful and evaluate indications rationally before administering GCs in individualized clinical management.
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Affiliation(s)
- Nijiao Li
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Xuliang Zheng
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Jinyan Gan
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Ting Zhuo
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Xiaohong Li
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Chuyi Yang
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Yanbin Wu
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Shouming Qin
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
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3
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Lee EM, Jiménez-Fonseca P, Galán-Moral R, Coca-Membribes S, Fernández-Montes A, Sorribes E, García-Torralba E, Puntí-Brun L, Gil-Raga M, Cano-Cano J, Calderon C. Toxicities and Quality of Life during Cancer Treatment in Advanced Solid Tumors. Curr Oncol 2023; 30:9205-9216. [PMID: 37887565 PMCID: PMC10605504 DOI: 10.3390/curroncol30100665] [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: 08/21/2023] [Revised: 10/04/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023] Open
Abstract
The purpose of the study was to identify subgroups of advanced cancer patients who experienced grade 3-4 toxicities as reported by their oncologists as well as identify the demographic, clinical, and treatment symptom characteristics as well as QoL outcomes associated with distinct profiles of each patient. A prospective, multicenter, observational study was conducted with advanced cancer patients of 15 different hospitals across Spain. After three months of systemic cancer treatment, participants completed questionnaires that evaluated psychological distress (BSI-18), quality of life (EORTC QLQ-C30) and fatigue (FAS). The most common tumor sites for the 557 cancer patients with a mean age of 65 years were bronchopulmonary, digestive, and pancreas. Overall, 19% of patients experienced high-grade toxicities (grade 3-4) during treatment. Patients with recurrent advanced cancer, with non-adenocarcinoma cancer, undergoing chemotherapy, and a showing deteriorated baseline status (ECOG > 1) were more likely to experience higher toxicity. Patients who experienced grade 3-4 toxicities during cancer treatment had their treatment suspended in 59% of the cases. Additionally, 87% of the patients had a dose adjustment or a cycle delayed in their treatment due to a high risk of dying during treatment. Future research should focus on identifying interventions to reduce high-grade toxicities and improve quality of life in cancer patients.
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Affiliation(s)
- Eun Mi Lee
- Faculty of Psychology, University of Barcelona, 08007 Barcelona, Spain
| | - Paula Jiménez-Fonseca
- Department of Medical Oncology, Hospital Universitario Central de Asturias, ISPA, 33011 Oviedo, Spain
| | - Rocio Galán-Moral
- Department of Medical Oncology, Hospital General Universitario de Ciudad Real, 13005 Madrid, Spain
| | - Sara Coca-Membribes
- Department of Medical Oncology, Hospital Universitario de Canarias, 38320 Tenerife, Spain
| | - Ana Fernández-Montes
- Department of Medical Oncology, Complejo Hospitalario Universitario de Ourense, 32005 Ourense, Spain
| | - Elena Sorribes
- Faculty of Psychology, University of Barcelona, 08007 Barcelona, Spain
| | | | - Laura Puntí-Brun
- Department of Medical Oncology, Consorcio Sanitario del Maresme, 08304 Mataró, Spain
| | - Mireia Gil-Raga
- Department of Medical Oncology, Hospital General Universitario de Valencia, 46014 Valencia, Spain
| | - Juana Cano-Cano
- Department of Medical Oncology, Hospital General Universitario de Ciudad Real, 13005 Madrid, Spain
| | - Caterina Calderon
- Faculty of Psychology, University of Barcelona, 08007 Barcelona, Spain
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Luján M, Lema M, Preciado B, Lema C, Egurrola J, Cardona A, González D, Mantilla W, Pino L, Rojas G, Gómez D, Munevar I, Manneh R, Manneh R, Lobatón J, Calle E, Borras M, Triana I, Londoño P, Aruachán S, Pineda M, Morán D. Real-world evidence of nivolumab for non-small-cell lung cancer in a developing country. J Investig Med 2023; 71:502-510. [PMID: 36760084 DOI: 10.1177/10815589221147897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Nivolumab is a human programmed death receptor-1 blocking antibody, used as treatment option in patients with advanced non-small-cell lung cancer (NSCLC). We assessed the nivolumab efficacy in terms of survival and response to treatment as second-line (2L) or third-line (3L) therapy in patients with advanced NSCLC. This is a multicentric observational study. Data of patients with advanced NSCLC who received nivolumab as 2L or 3L treatment were analyzed retrospectively. Information regarding patient demographics and clinical backgrounds, treatment patterns from diagnosis to post-nivolumab treatment, effectiveness, and safety of nivolumab treatment were collected. The outcomes evaluated were overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) to treatment. OS and PFS were estimated with the Kaplan-Meier method and the differences were evaluated through the log-rank test. Data of 178 patients were included. The median follow-up was 26.8 months (interquartile range (IQR): 20.3-40.4). Nivolumab was commonly used as a 2L treatment (77.5%). The outcomes in this setting (2L) were as follows: ORR was 21.0%, and the median PFS and OS were 5.5 months (95% confidence interval (CI): 4.5-6.5) and 12.4 months (95% CI: 10.8-14.0), respectively. In 3L, the ORR with nivolumab was 15.0%, the median PFS and OS were 4.1 months (95% CI: 3.1-5.1) and 10.1 months (95% CI: 9.4-10.6), respectively. Three patients (1.7%) required discontinuation due to toxicity. Nivolumab effectiveness and safety in this scenario was consistent with that reported by previous trials and other real-world data.
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Affiliation(s)
- Mauricio Luján
- Clínica de Oncología Astorga, Medellín, Colombia.,Universidad Pontificia Bolivariana, Medellín, Colombia.,Medicáncer, Medellín, Colombia
| | - Mauricio Lema
- Clínica de Oncología Astorga, Medellín, Colombia.,Clínica SOMA, Medellín, Colombia
| | | | - Camila Lema
- Clínica de Oncología Astorga, Medellín, Colombia
| | | | - Andrés Cardona
- Direction of Research and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Diego González
- Instituto de Cancerología Las Américas-AUNA, Medellín, Colombia.,Universidad de Antioquia, Medellín, Colombia
| | | | - Luis Pino
- Fundación Santafé de Bogotá, Bogotá, Colombia
| | | | - Diego Gómez
- Instituto de Cáncer del Hospital Internacional de Colombia (HIC), Piedecuesta, Colombia
| | | | - Raimundo Manneh
- Sociedad de Oncología y Hematología del Cesar SAS (SOHEC), Valledupar, Colombia
| | - Ray Manneh
- Sociedad de Oncología y Hematología del Cesar SAS (SOHEC), Valledupar, Colombia
| | - José Lobatón
- Instituto Médico de Alta Tecnología (IMAT) Oncomédica S.A, Montería, Colombia
| | | | | | - Iván Triana
- Fundación Santafé de Bogotá, Bogotá, Colombia
| | | | - Sandra Aruachán
- Instituto Médico de Alta Tecnología (IMAT) Oncomédica S.A, Montería, Colombia
| | - Mateo Pineda
- Clínica de Oncología Astorga, Medellín, Colombia
| | - Diego Morán
- Clínica de Oncología Astorga, Medellín, Colombia
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Identifying Patients at Risk of Acute Kidney Injury among Patients Receiving Immune Checkpoint Inhibitors: A Machine Learning Approach. Diagnostics (Basel) 2022; 12:diagnostics12123157. [PMID: 36553164 PMCID: PMC9776989 DOI: 10.3390/diagnostics12123157] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
Background: The benefits of immune checkpoint inhibitors (ICPis) in the treatment of patients with malignancies emerged recently, but immune-related adverse events (IRAEs), including acute kidney injury (AKI), cannot be ignored. The present study established and validated an ICPi-AKI prediction model based on machine learning algorithms to achieve early prediction of AKI events and timely intervention adjustment. Methods: We performed a retrospective study based on data from the First Medical Center of the PLA General Hospital. Patients with malignancy who received at least one dose of ICPi between January 2014 and December 2019 were included in the study. The characteristics of available variables were included after case review, and the baseline characteristics and clinical data of ICPi AKI and non-AKI patients were compared. After variable preprocessing, eight machine learning algorithms were used to construct a full variable availability model. Variable simplification models were constructed after screening important variables using the random forest recursive feature elimination method, and the performance of different machine learning methods and two types of modeling strategies were evaluated using multiple indicators. Results: Among the 1616 patients receiving checkpoint inhibitors, the overall incidence of AKI was 6.9% during the total follow-up time. Sixty-eight patients were associated with ICPi treatment after chart review, primarily in AKI stage 1 (70.5%), with a median time from first ICPi administration to AKI of 12.7 (IQR 2 to 56) weeks. The demographic characteristics, comorbidities, and proportions of malignancy types were similar between the ICPi-AKI and non-AKI groups, but there were significant differences in multiple characteristics, such as concomitant medications and laboratory test indicators. For model performance evaluation and comparison, the AUC values of all 38 variable availability models ranged from 0.7204−0.8241, and the AUC values of the simplicity model constructed using 16 significant variables ranged from 0.7528−0.8315. The neural networks model (NNs) and support vector machine (SVM) model had the best performance in the two types of modeling strategies, respectively; however, there was no significant difference in model performance comparison (p > 0.05). In addition, compared with the full variable availability model, the performance of the variable simplicity model was slightly improved. We also found that concomitant medications contributed more to the model prediction performance by screening the optimal feature combination. Conclusion: We successfully developed a machine learning-based ICPi-AKI prediction model and validated the best prediction performance of each machine model. It is reasonable to believe that clinical decision models driven by artificial intelligence can improve AKI prediction in patients with malignancies treated with ICPi. These models can be used to assist clinicians in the early identification of patients at high risk of AKI, support effective prevention and intervention, and ultimately improve the overall benefit of antitumor therapy in the target population.
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Liu K, Qin Z, Ge Y, Bian A, Xu X, Wu B, Xing C, Mao H. Acute kidney injury in advanced lung cancer patients treated with PD-1 inhibitors: a single center observational study. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04437-9. [DOI: 10.1007/s00432-022-04437-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
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7
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Kanabar SS, Tiwari A, Soran V, Balendran P, Price M, Turner AM. Impact of PD1 and PDL1 immunotherapy on non-small cell lung cancer outcomes: a systematic review. Thorax 2022; 77:1163-1174. [PMID: 35688624 DOI: 10.1136/thoraxjnl-2020-215614] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 05/11/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Despite comprising many cancer diagnoses, few treatments are suitable for patients with advanced non-small cell lung cancer (aNSCLC). Trials suggest blockade of programmed death 1 (PD1) or its ligand (PDL1) may be effective for these patients. However, this therapy's impact on outcomes other than survival, and outcomes of patients not in trials, remains largely unknown. Therefore, we compared the effectiveness of PD1 and PDL1 immunotherapy to chemotherapy and placebo across multiple clinical outcomes. METHODS Six databases were searched on 12-13 October 2019 for randomised controlled trials (RCTs) and observational studies investigating nivolumab, pembrolizumab, atezolizumab or durvalumab. Study selection was performed independently by two reviewers. Data for overall survival, progression-free survival, adverse effects (AEs) and quality of life (QoL) were descriptively and meta-analysed. Factors impacting treatment outcomes, including PDL1 expression, were explored. The similarity between RCT and observational data was assessed. RESULTS From 5423 search results, 139 full texts and abstracts were included. Immunotherapy was associated with a lower risk of death than both comparators. In RCTs, the incidence of treatment-related AEs was approximately 20% lower among patients using immunotherapy compared with chemotherapy. However, no other consistent benefits were observed. Progression-free survival results were inconsistent. Improvements to QoL varied according to the instrument used; however, QoL was not recorded widely. Survival results were similar between study designs; however, AEs incidence was lower in observational studies. DISCUSSION Among patients with aNSCLC, immunotherapy improved overall survival and incidence of treatment-related AEs compared with chemotherapy. Benefits to progression-free survival and QoL were less consistent. PROSPERO REGISTRATION NUMBER CRD42019153345.
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Affiliation(s)
- Shivani Setur Kanabar
- Medical School, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK .,Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Abhinav Tiwari
- Medical School, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Vina Soran
- Medical School, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Prashanthan Balendran
- Medical School, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Malcolm Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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8
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Brain metastases and immune checkpoint inhibitors in non-small cell lung cancer: a systematic review and meta-analysis. Cancer Immunol Immunother 2022; 71:3071-3085. [DOI: 10.1007/s00262-022-03224-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
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9
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Chu X, Niu L, Xiao G, Peng H, Deng F, Liu Z, Wu H, Yang L, Tan Z, Li Z, Zhou R. The Long-Term and Short-Term Efficacy of Immunotherapy in Non-Small Cell Lung Cancer Patients With Brain Metastases: A Systematic Review and Meta-Analysis. Front Immunol 2022; 13:875488. [PMID: 35693805 PMCID: PMC9175180 DOI: 10.3389/fimmu.2022.875488] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/20/2022] [Indexed: 12/12/2022] Open
Abstract
Background Although immunotherapy has been widely used, there is currently no research comparing immunotherapy for non-small cell lung cancer (NSCLC) patients with brain metastases (BMs). This meta-analysis addresses a gap in the comparison of immunotherapy efficacy, including immune checkpoint inhibitors (ICIs), chemotherapy (CT), radiotherapy (RT), and ICI combined CT or RT. Methods A search of Pubmed, Cochrane, EMBASE, and ClinicalTrial.gov was conducted to identify studies which enrolled NSCLC patients with BM treated with ICIs. The outcomes consisted of intracerebral overall response rate (iORR), intracerebral disease control rate (iDCR), extracranial overall response rate (EORR), distant brain failure (DBF), local control (LC), progression-free survival (PFS), and overall survival (OS). Results A total of 3160 participants from 46 trials were included in the final analysis. Patients treated with immunotherapy were associated with a longer PFS (0.48, 95%CI: 0.41-0.56), and a longer OS (0.64, 95%CI: 0.60-0.69) compared with immunotherapy-naive patients. In prospective studies, dual ICI combined CT and ICI combined CT achieved a better OS. The hazard ratio (HR) of dual ICI combined CT versus dual ICI was 0.61, and the HR of ICI combined CT versus ICI monotherapy was 0.58. Moreover, no statistical difference in PFS, OS, EORR, iORR, iDCR, and EDCR was found between patients with ICI monotherapy and ICI combined cranial radiotherapy. Concurrent ICI combined RT was shown to decrease the rate of DBF (OR = 0.15, 95% CI: 0.03-0.73) compared with RT after ICI. Patients treated with WBRT might have an inferior efficacy than those with SRS because the iORR of SRS was 0.75 (0.70, 0.80) and WBRT was 0. Furthermore, no obvious difference in PFS and OS was observed among the three different types of ICI, which targets PD-1, PD-L1, and CTLA-4, respectively. Conclusions Patients treated with ICI got superior efficacy to those without ICI. Furthermore, dual ICI combined CT and ICI combined CT seemed to be optimal for NSCLC patients with BM. In terms of response and survival, concurrent administration of SRS and ICI led to better outcomes for patients with BMs than non-concurrent or non-SRS. Importance of the Study In the new era of immunotherapy, our meta-analysis validated the importance of immunotherapy for non-small cell lung cancer (NSCLC) patients with brain metastases (BMs). By comparing the long-term and short-term impacts of various regimens, all immunotherapy treatments had superior efficacy to immunotherapy-naive. At the same time, through pairwise comparison in immunotherapy, our findings can help clinicians to make treatment decisions for NSCLC patients with BMs. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=269621, identifier CRD42021269621.
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Affiliation(s)
- Xianjing Chu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Lishui Niu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Gang Xiao
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Haiqin Peng
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Fuxing Deng
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiyuan Liu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Honghua Wu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Lei Yang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhuguilong Tan
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhanzhan Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Rongrong Zhou, ; Zhanzhan Li,
| | - Rongrong Zhou
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
- Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Rongrong Zhou, ; Zhanzhan Li,
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10
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Pierret T, Giaj-Levra N, Toffart AC, Alongi F, Moro-Sibilot D, Gobbini E. Immunotherapy in NSCLC Patients With Brain and Leptomeningeal Metastases. Front Oncol 2022; 12:787080. [PMID: 35494085 PMCID: PMC9039308 DOI: 10.3389/fonc.2022.787080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/07/2022] [Indexed: 11/24/2022] Open
Abstract
Immunotherapy has now been integrated as a treatment strategy for most patients with non-small cell lung cancer (NSCLC). However, the pivotal clinical trials that demonstrated its impressive efficacy often did not include patients with active, untreated brain metastases or leptomeningeal carcinomatosis. Nevertheless, NSCLC is the most common tumor to metastasize to the brain, and patients develop brain and meningeal involvement in approximately 40 and 10% of cases, respectively. Consequently, the appropriate care of these patients is a recurrent clinical concern. Although there are many aspects that would merit further investigation to explain the mechanism of intracranial response to immune checkpoint inhibitors (ICPs), some data suggest that they are able to cross the blood–brain barrier, resulting in local tumor microenvironment modification. This results in a similar clinical benefit in patients with stable, previously treated brain metastases compared to the general population. Despite important limitations, some real-life studies have described that the ICPs’ efficacy was maintained also in less selected patients with untreated or symptomatic brain metastases. In contrast, few data are available about patients with leptomeningeal carcinomatosis. Nevertheless, neurological complications due to ICP treatment in patients with brain metastases have to be evaluated and carefully monitored. Despite the fact that limited data are available in the literature, the purpose of this review is to show that the multimodal treatment of these patients with brain metastases and/or leptomeningeal disease should be discussed during tracing of the history of the disease, participating in the local and possibly systemic control of NSCLC.
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Affiliation(s)
- Thomas Pierret
- Thoracic Oncology Unit, Grenoble University Hospital, La Tronche, France
| | - Niccolò Giaj-Levra
- Department of Advanced Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | | | - Filippo Alongi
- Department of Advanced Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy.,University of Brescia, Brescia, Italy
| | - Denis Moro-Sibilot
- Thoracic Oncology Unit, Grenoble University Hospital, La Tronche, France
| | - Elisa Gobbini
- Thoracic Oncology Unit, Grenoble University Hospital, La Tronche, France.,Cancer Research Center Lyon, Center Léon Bérard, Lyon, France
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11
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Real-World Effectiveness of Immunotherapies in Pre-Treated, Advanced Non-Small Cell Lung Cancer Patients: A Systematic Literature Review. Lung Cancer 2022; 166:205-220. [DOI: 10.1016/j.lungcan.2022.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/03/2022] [Accepted: 03/05/2022] [Indexed: 12/26/2022]
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12
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From Anti-PD-1/PD-L1 to CTLA-4 and to MUC1-Is the Better Response to Treatment in Smokers of Cancer Patients Drug Specific? J Pers Med 2021; 11:jpm11090914. [PMID: 34575691 PMCID: PMC8471889 DOI: 10.3390/jpm11090914] [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] [Received: 07/07/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 11/17/2022] Open
Abstract
Whether smokers respond to anti-cancer drugs differently than non-smokers remains controversial. The objective of this study is to explore whether the better response of the smokers is specific to therapy of anti-PD-1/PD-L1, anti-checkpoint inhibitor, individual drugs on the cell surface, or lung cancer. Our results showed that among all non-small cell lung cancer (NSCLC) patients, when the data from anti-PD-1/PD-L1, anti-CTLA-4, and anti-MUC1 drugs are combined, the mean hazard ratios (HR) of smokers and non-smokers were 0.751 and 1.016, respectively. A meta-analysis with a fixed effect (FE) model indicated that the smokers have an HR value of 0.023 lower than that of the non-smokers. A stratified subgroup meta-analysis indicated that when treated with anti-CTLA-4 drugs, smokers had reduced HR values of 0.152 and 0.165 on average and FE model meta-analysis, respectively. When treated with an anti-MUC1 drug, smokers had reduced HR values of 1.563 and 0.645, on average and FE model meta-analysis, respectively. When treated with a combination of nivolumab and ipilimumab drugs, smokers had, on average, reduced HR and FE model meta-analysis values (0.257 and 0.141), respectively. Smoking is a clinical response predictor for anti-PD/PD-L1 monotherapy or first-line treatment in lung, urothelial carcinoma, and head and neck cancer. Smokers treated with other drugs have shown worse responses in comparison to non-smokers. These data suggest that, along with the progress in the development of new drugs for cancer, drugs acting on specific genotypes of smokers likely will arise.
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13
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Mouri A, Kaira K, Yamaguchi O, Hashimoto K, Miura Y, Shiono A, Shinomiya S, Imai H, Kobayashi K, Kagamu H. Effect of Systemic Steroid Use for Immune-Related Adverse Events in Patients with Non-Small Cell Lung Cancer Receiving PD-1 Blockade Drugs. J Clin Med 2021; 10:jcm10163744. [PMID: 34442054 PMCID: PMC8397225 DOI: 10.3390/jcm10163744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 02/05/2023] Open
Abstract
Objectives: Programmed death-1(PD-1)/programmed death ligand-1 (PD-L1) antibodies have clinical benefits for cancer patients facing immune-related adverse events (irAEs). However, the effect of steroid use on the prognosis of patients with non-small cell lung cancer (NSCLC) receiving PD-1 blockade remains unclear. Methods: NSCLC patients with complete response (CR)/partial response (PR) or stable disease (SD)/not evaluable (NE) status plus progression-free survival (PFS) of 180 days after PD-1 blockade from December 2015 to December 2018 were retrospectively registered in our study and were divided into two groups: those with and without systemic steroid use for irAEs. Results: In total, 126 patients who had benefitted from PD-1 blockade were enrolled in our study; among them, 44 received systemic steroids for irAEs, and 82 had no adverse events or, if they did, did not receive systemic steroids. Among the 44 patients requiring steroids, interstitial lung disease (ILD), adrenal insufficiency, diarrhea, and liver dysfunction were observed in 19, 9, 4, and 4 patients, respectively. More side effects were observed in the group treated by steroids. The median PFS and overall survival (OS) in patients with and without systemic steroid use were 11.7 and 16.0 months (p < 0.037) and 35.0 and 41.0 months (p < 0.28), respectively. In univariate and multivariate analyses of survival, systemic steroid treatment for irAEs was significantly associated with PFS. The occurrence of ILD, adrenal insufficiency, and fever was significant in patients who used systemic steroids for irAEs. Conclusions: Patients administered systemic steroids for irAEs due to PD-1 blockade treatment exhibited shorter PFS than those who were not. Systemic steroids might affect survival after PD-1 blockade even for patients who once acquired its clinical benefit.
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Affiliation(s)
- Atsuto Mouri
- Correspondence: ; Tel.: +81-42-984-4111; Fax: +81-42-984-4741
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14
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Cruellas M, Yubero A, Zapata M, Galvez EM, Gascón M, Isla D, Lastra R, Martínez-Lostao L, Ocariz M, Pardo J, Ramírez A, Sesma A, Torres-Ramón I, Paño JR. How Could Antibiotics, Probiotics, and Corticoids Modify Microbiota and Its Influence in Cancer Immune Checkpoint Inhibitors: A Review. Infect Immun 2021; 89:e0066520. [PMID: 33526567 PMCID: PMC8370676 DOI: 10.1128/iai.00665-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Immunotherapy has become a new paradigm in oncology, improving outcomes for several types of cancer. However, there are some aspects about its management that remain uncertain. One of the key points that needs better understanding is the interaction between immunotherapy and gut microbiome and how modulation of the microbiome might modify the efficacy of immunotherapy. Consequently, the negative impact of systemic antibiotics and corticosteroids on the efficacy of immunotherapy needs to be clarified.
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Affiliation(s)
- Mara Cruellas
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Alfonso Yubero
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - María Zapata
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | | | - Marta Gascón
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Dolores Isla
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Rodrigo Lastra
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Luis Martínez-Lostao
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
- Immunology Department, University Hospital Lozano Blesa, Zaragoza, Spain
- Department of Microbiology, Pediatrics, Radiology and Public Health, University of Zaragoza, Zaragoza, Spain
- Aragon Nanoscience institute, Zaragoza, Spain
- Aragon Materials Science Institute, Zaragoza, Spain
| | - Maitane Ocariz
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Julián Pardo
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
- ARAID Foundation (IIS Aragón), Zaragoza, Spain
- Microbiology, Preventive Medicine and Public Health Department, Medicine, University of Zaragoza, Zaragoza, Spain
- Biomedical Research Center in Bioengineering, Biomaterials and Nanomedicine Network (CIBER-BBN), Madrid, Spain
| | - Ariel Ramírez
- Nanotoxicology and Immunotoxicology Unit (IIS Aragón), Zaragoza, Spain
| | - Andrea Sesma
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Irene Torres-Ramón
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - José Ramón Paño
- Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
- Infectious Disease Department, University Hospital Lozano Blesa, Zaragoza, Spain
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15
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Jessurun CAC, Hulsbergen AFC, de Wit AE, Tewarie IA, Snijders TJ, Verhoeff JJC, Phillips JG, Reardon DA, Mekary RA, Broekman MLD. The combined use of steroids and immune checkpoint inhibitors in brain metastasis patients: a systematic review and meta-analysis. Neuro Oncol 2021; 23:1261-1272. [PMID: 33631792 DOI: 10.1093/neuonc/noab046] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) have been a breakthrough for selected cancer patients, including those with brain metastases (BMs). Likewise, steroids have been an integral component of symptomatic management of BM patients. However, clinical evidence on the interaction between ICI and steroids in BM patients is conflicting and has not adequately been summarized thus far. Hence, the aim of this study was to perform a systematic literature review and meta-analysis on the association between steroid use and overall survival (OS) in BM patients receiving ICI. METHODS A systematic literature search was performed. Pooled effect estimates were calculated using random-effects models across included studies. RESULTS After screening 1145 abstracts, 15 observational studies were included. Fourteen studies reported sufficient data for meta-analysis, comprising 1102 BM patients of which 32.1% received steroids. In the steroid group, median OS ranged from 2.9 to 10.2 months. In the nonsteroid group, median OS ranged from 4.9 to 25.1 months. Pooled results demonstrated significantly worse OS (HR = 1.84, 95% CI 1.22-2.77) and systemic progression-free survival (PFS; HR = 2.00, 95% CI 1.37-2.91) in the steroid group. Stratified analysis showed a consistent effect across the melanoma subgroup; not in the lung cancer subgroup. No significant association was shown between steroid use and intracranial PFS (HR = 1.31, 95% CI 0.42-4.07). CONCLUSIONS Administration of steroids was associated with significantly worse OS and PFS in BM patients receiving ICI. Further research on dose, timing, and duration of steroids is needed to elucidate the cause of this association and optimize outcomes in BM patients receiving ICI.
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Affiliation(s)
- Charissa A C Jessurun
- Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Alexander F C Hulsbergen
- Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Anouk E de Wit
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ishaan A Tewarie
- Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Tom J Snijders
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joost J C Verhoeff
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - John G Phillips
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David A Reardon
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Rania A Mekary
- Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts, USA
| | - Marike L D Broekman
- Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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16
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Wang Y, Yang M, Tao M, Liu P, Kong C, Li H, Chen Y, Yin X, Yan X. Corticosteroid administration for cancer-related indications is an unfavorable prognostic factor in solid cancer patients receiving immune checkpoint inhibitor treatment. Int Immunopharmacol 2021; 99:108031. [PMID: 34358857 DOI: 10.1016/j.intimp.2021.108031] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/14/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Immunotherapies targeting immune checkpoints have achieved encouraging survival benefits in patients with various solid cancers. Corticosteroids are frequently administrated for cancer/non-cancer related indications and immune-related adverse events (irAEs). This study aimed to clarify the prognostic significance of corticosteroid administration in solid cancer patients receiving immune checkpoint inhibitor (ICI) treatment. METHOD First, a meta-analysis was performed using the literatures searched from PubMed, Cochrane Library, Web of Science, Embase, and Clinicaltrials.gov before January 2021. The Hazard ratios (HRs) coupled with 95% confidence intervals (CIs) were used to evaluate the correlation of corticosteroid administration with overall survival (OS) and progression-free survival (PFS). Then, a retrospective analysis enrolling 118 ICI-treated cancer patients was performed for validation, among which 26 patients received corticosteroids for cancer-related indications. RESULT In the meta-analysis, corticosteroid administration for cancer-related indications was significantly correlated with worse PFS (HR = 1.735(1.381-2.180)) and OS (HR = 1.936(1.587-2.361)) of the ICI-treated patients. However, corticosteroid administration for non-cancer-related indications and irAEs was unrelated with PFS (non-cancer-related indications: HR = 0.830(0.645-1.067); irAEs: HR = 1.302(0.628-2.696)) and OS (non-cancer-related indications: HR = 0.786(0.512-1.206); irAEs: HR = 1.107(0.832-1.474)) of the ICI-treated patients. The following retrospective analysis identified corticosteroid administration for cancer-related indications was an independent unfavorable predictor for PFS (P = 0.006) and OS (P = 0.044) of the ICI-treated patients. The subgroup analysis based on non-small cell lung cancer (NSCLC) demonstrated the similar results (P = 0.002 for PFS and P = 0.047 for OS). CONCLUSION Our study demonstrated corticosteroid administration for cancer-related indications is an unfavorable prognostic factor in solid cancer patients receiving ICI treatment. Therefore, careful selection of corticosteroid-treated patients for ICI therapy is quite necessary in individualized clinical management.
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Affiliation(s)
- Ying Wang
- Department of Oncology, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Mengxue Yang
- Department of Oncology, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Mingyang Tao
- Department of Oncology, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Peipei Liu
- Department of Oncology, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Cheng Kong
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Institute of Intestinal Diseases, Tongji University School of Medicine, Shanghai, China
| | - Hao Li
- Department of Biomedical Engineering, University of Houston, Houston, TX, USA; Institute of Intestinal Diseases, Tongji University School of Medicine, Shanghai, China
| | - Yingmei Chen
- Department of Oncology, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China.
| | - Xudong Yin
- Department of Oncology, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China.
| | - Xuebing Yan
- Department of Oncology, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China.
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17
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You Y, Jiang C, Peng K, He W, Wang L, Jin Y, Xia L. The predictive value of body mass index on prognosis and adverse events of cancers treated with immunotherapy: a systematic review and meta-analysis. Cancer Immunol Immunother 2021; 70:2323-2335. [PMID: 33512554 DOI: 10.1007/s00262-021-02858-y] [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: 11/12/2020] [Accepted: 01/06/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE High body mass index (BMI) greater than 25 kg/m2 has a complex relationship with cancers. The aim of this systematic review and meta-analysis is to explore controversy over whether BMI is correlated with outcomes including survival and immunotherapy-related adverse events (irAEs) in cancer patients treated with immunotherapy. METHODS We searched PubMed, Embase, Web of Science, and The Cochrane Library for relevant studies published up to June 2020. Title/abstract screening, full-text review, data extraction, and quality assessment were performed independently. Subgroup analysis was based on sex, treatment lines, the status of programmed death-ligand 1 (PD-L1), and tumor types. Sensitivity analysis was performed by synthesizing studies that adjusted for certain covariates or studies with good quality. Statistical heterogeneity was evaluated by the I2 value. Meta-analysis was performed with hazard ratio (HR) / odds ratio (OR) and 95% confidence intervals (CIs) as the effect measures. RESULTS Twenty studies were included for survival and irAEs analyses. Patients with high BMI who underwent immunotherapy had longer overall survival (OS) (pooled hazard ratio, pHR = 0.71 [95% CI: 0.59-0.85]) and progression-free survival (PFS) (pHR = 0.76 [95% CI: 0.65-0.88]) than those with low BMI; at the same time, high-BMI patients had increased irAEs (OR = 2.54 [95% CI: 1.12-5.79]). CONCLUSION In general, high BMI was correlated with improved OS and PFS in patients treated with immunotherapy along with a high risk of irAEs. However, discrepant findings from subgroup analyses urgently call for further analysis.
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Affiliation(s)
- Yafei You
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Senen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, People's Republic of China.,Department of The VIP Region, Sun Yat-Senen University Cancer Center, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Chang Jiang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Senen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, People's Republic of China.,Department of The VIP Region, Sun Yat-Senen University Cancer Center, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Kunwei Peng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Senen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, People's Republic of China.,Department of The VIP Region, Sun Yat-Senen University Cancer Center, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Wenzhuo He
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Senen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, People's Republic of China.,Department of The VIP Region, Sun Yat-Senen University Cancer Center, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Lei Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Senen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, People's Republic of China.,Department of The VIP Region, Sun Yat-Senen University Cancer Center, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Yanan Jin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Senen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, People's Republic of China.,Department of The VIP Region, Sun Yat-Senen University Cancer Center, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Liangping Xia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Senen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, People's Republic of China. .,Department of The VIP Region, Sun Yat-Senen University Cancer Center, Guangzhou, 510060, Guangdong, People's Republic of China.
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18
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Okishio K, Morita R, Shimizu J, Saito H, Sakai H, Kim YH, Hataji O, Yomota M, Nishio M, Aoe K, Kanai O, Kumagai T, Kibata K, Tsukamoto H, Oizumi S, Fujimoto D, Tanaka H, Mizuno K, Masuda T, Kozuki T, Haku T, Suzuki H, Okamoto I, Hoshiyama H, Yada N, Ohe Y. Nivolumab treatment of elderly Japanese patients with non-small cell lung cancer: subanalysis of a real-world retrospective observational study (CA209-9CR). ESMO Open 2021; 5:S2059-7029(20)32635-1. [PMID: 32690620 PMCID: PMC7373314 DOI: 10.1136/esmoopen-2019-000656] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 12/23/2022] Open
Abstract
Objectives We conducted a subanalysis of data from the multicentre, retrospective observational Nivolumab Japan Real World (CA209-9CR) study to evaluate nivolumab effectiveness and safety in elderly patients (aged ≥75 years) with advanced/metastatic non-small cell lung cancer. Materials and methods Medical record data of patients initiating nivolumab treatment between April 2016 and December 2016 were collected using electronic data capture from 23 cancer hospitals in Japan between March 2017 and August 2018. Nivolumab treatment data were collected to investigate the treatment patterns by age group (<75 and ≥75 years), and the effectiveness and safety of nivolumab treatment. Results Of the 901 patients evaluated, 178 (19.8%) were aged ≥75 years. Overall, patients received a median of five nivolumab treatments regardless of age group. Comparable progression-free survival was observed, with a median of 2.1 months in patients aged <75 years and 2.1 months in patients aged ≥75 years (p=0.5441). No significant differences were found in duration of response, overall response rate or disease control rate between the two age groups. Median overall survival in patients aged <75 and ≥75 years was 14.7 months and 12.3 months, respectively. Grade ≥3 adverse events (AEs) occurred in 29.2% and 28.1% of patients aged <75 and ≥75 years, respectively. Immune-related AEs decreased slightly with increasing age; time to onset and rates of improvement were similar for patients aged <75 and ≥75 years. The most common grade 3–4 AEs were interstitial lung disease in both age groups (4.0% in patients aged <75 years and 2.8% in those aged ≥75 years). Poor performance status was associated with worse outcomes in both age groups. Conclusion Based on Japanese real-world data, the effectiveness and safety of nivolumab were confirmed regardless of age.
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Affiliation(s)
- Kyoichi Okishio
- Department of Thoracic Oncology, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan
| | - Ryo Morita
- Department of Thoracic Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Junichi Shimizu
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Haruhiro Saito
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Hiroshi Sakai
- Department of Thoracic Oncology, Saitama Cancer Center, Kitaadachi-gun, Saitama, Japan
| | - Young Hak Kim
- Department of Respiratory Medicine, Kyoto University Hospital, Kyoto, Kyoto, Japan
| | - Osamu Hataji
- Department of Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Mie, Japan
| | - Makiko Yomota
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Makoto Nishio
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
| | - Keisuke Aoe
- Department of Medical Oncology, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Yamaguchi, Japan
| | - Osamu Kanai
- Division of Respiratory Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto, Japan
| | - Toru Kumagai
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Osaka, Japan
| | - Kayoko Kibata
- Department of Thoracic Oncology, Kansai Medical University Hospital, Hirakata, Osaka, Japan
| | - Hiroaki Tsukamoto
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan
| | - Satoshi Oizumi
- Department of Respiratory Medicine, National Hospital Organization Hokkaido Cancer Center, Sapporo, Hokkaido, Japan
| | - Daichi Fujimoto
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Hiroshi Tanaka
- Department of Internal Medicine, Niigata Cancer Center Hospital, Niigata, Niigata, Japan
| | - Keiko Mizuno
- Department of Pulmonary Medicine, Kagoshima University Hospital, Kagoshima, Kagoshima, Japan
| | - Takeshi Masuda
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
| | - Toshiyuki Kozuki
- Department of Thoracic Oncology and Medicine, National Hospital Organization Shikoku Cancer Center, Matuyama, Ehime, Japan
| | - Takashi Haku
- Respiratory Medicine, Tokushima Prefectural Central Hospital, Tokushima, Tokushima, Japan
| | - Hiroyuki Suzuki
- Department of Chest Surgery, Fukushima Medical University, Fukushima, Fukushima, Japan
| | - Isamu Okamoto
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | | | | | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
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19
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Pathak R, Amini A, Hill A, Massarelli E, Salgia R. Immunotherapy in Non-Small Cell Lung Cancer Patients with Brain Metastases: Clinical Challenges and Future Directions. Cancers (Basel) 2021; 13:3407. [PMID: 34298620 PMCID: PMC8303291 DOI: 10.3390/cancers13143407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/28/2022] Open
Abstract
Immune checkpoint inhibitors have revolutionized the treatment landscape for patients with non-small cell lung cancers. Existing treatment paradigms for brain metastases in lung cancer patients leave patients with adverse neurocognitive function, poor quality of life, and dismal prognosis, thus highlighting the need to develop more effective systemic therapies. Although data are limited, emerging knowledge suggests promising activity and safety of immune checkpoint inhibitors in brain metastases in non-small cell lung cancer patients. This review aims to summarize the current data, highlight the challenges of incorporating immune checkpoint inhibitors in treating these patients, and identify areas for future research.
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Affiliation(s)
- Ranjan Pathak
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (A.H.); (E.M.); (R.S.)
| | - Arya Amini
- Department of Radiation Oncology, City of Hope, Duarte, CA 91010, USA;
| | - Addie Hill
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (A.H.); (E.M.); (R.S.)
| | - Erminia Massarelli
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (A.H.); (E.M.); (R.S.)
| | - Ravi Salgia
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (A.H.); (E.M.); (R.S.)
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20
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Zhang H, Li X, Huang X, Li J, Ma H, Zeng R. Impact of corticosteroid use on outcomes of non-small-cell lung cancer patients treated with immune checkpoint inhibitors: A systematic review and meta-analysis. J Clin Pharm Ther 2021; 46:927-935. [PMID: 34138497 DOI: 10.1111/jcpt.13469] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 01/04/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Administration of corticosteroids to immune checkpoint inhibitors (ICI)-treated patients has raised concerns due to doubts about ICIs' efficacy under those conditions. Hence, we reviewed studies comparing overall and progression-free survival (OS and PFS) outcomes in patients with non-small-cell lung carcinoma (NSCLC) treated with ICI and either with or without corticosteroids for any reason. METHODS We searched the PubMed Central, Cochrane library, EMBASE and MEDLINE databases from inception until February 2021 for relevant publications. We used the Newcastle-Ottawa scale to assess the quality of the identified studies. We used the published data to carry out a meta-analysis with a random-effects model and report pooled odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS We included data from 14 studies with 5461 participants in the meta-analysis. Most studies were retrospective in nature and of low quality, and most of them were conducted in the USA and in European countries. Nivolumab is the most common ICI used in the included studies followed by pembrolizumab. We found that patients using corticosteroids had reduced OSs (pooled HR, 1.82; 95% CI, 1.51-2.18) and PFSs (pooled HR, 1.69; 95% CI, 1.41-2.04) than the patients not using corticosteroids. We identified significant heterogeneity and publication bias for both the outcomes. However, the sensitivity analysis revealed that the estimates were robust to the individual study effects. WHAT IS NEW AND CONCLUSION Our findings suggest that corticosteroids significantly reduce the OS and PFS of patients with NSCLC under ICI therapy. Hence, clinicians and oncologists should consider this information when prescribing corticosteroids for this target population.
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Affiliation(s)
- Hongchuan Zhang
- Department of Oncology, Dianjiang People's Hospital of Chongqing, Chongqing, China
| | - Xuemei Li
- Department of Ultrasound, Dianjiang People's Hospital of Chongqing, Chongqing, China
| | - Xingliang Huang
- Department of Pharmacy, Dianjiang People's Hospital of Chongqing, Chongqing, China
| | - Junfeng Li
- Department of Oncology, Dianjiang People's Hospital of Chongqing, Chongqing, China
| | - Hong Ma
- Department of Oncology, Dianjiang People's Hospital of Chongqing, Chongqing, China
| | - Rui Zeng
- Department of Oncology and Hematology, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, China
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21
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Tomasik B, Bieńkowski M, Braun M, Popat S, Dziadziuszko R. Effectiveness and safety of immunotherapy in NSCLC patients with ECOG PS score ≥2 - Systematic review and meta-analysis. Lung Cancer 2021; 158:97-106. [PMID: 34144405 DOI: 10.1016/j.lungcan.2021.06.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/08/2021] [Accepted: 06/03/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) are standard of care in advanced non-small cell lung cancer (NSCLC), however their status in patients with poor performance status (PS) is poorly defined. We aimed to evaluate the efficacy and safety of ICIs in NSCLC patients with PS ≥ 2. METHODS We conducted a systematic review and meta-analysis of interventional and observational studies, which reported efficacy and safety data on ICIs in PS ≥ 2 comparing to PS ≤ 1 NSCLC patients. Efficacy endpoints included: Objective Response Rate (ORR), Disease-Control Rate (DCR), Overall Survival (OS), Progression-Free Survival (PFS). Safety endpoint was the incidence of severe (grade≥3) Adverse Events (AE). Random-effects model was applied for meta-analysis. Heterogeneity was assessed using I2. The review is registered on PROSPERO (CRD42020162668). FINDINGS Sixty-seven studies (n = 26,442 patients) were included. In PS ≥ 2 vs. PS ≤ 1 patients, the pooled odds ratios were: for ORR 0.46 (95 %CI: 0.39-0.54, I2:0 %); for DCR 0.39 (95 %CI: 0.33-0.48, I2:50 %) and for AEs 1.12 (95 %CI: 0.84-1.48, I2:39 %). The pooled hazard ratio for PFS was 2.17 (95 %CI: 1.96-2.39, I2:65 %) and for OS was 2.76 (95 %CI: 2.43-3.14, I2:76 %). The safety profile was comparable regardless of the PS status. INTERPRETATION Patients with impaired PS status are, on average, twice less likely to achieve a response when exposed to ICIs when compared with representative PS ≤ 1 population. For lung cancer patients treated with ICIs, the impaired PS is not only prognostic, but also predictive for response, while the safety profile is not affected. Prospective randomized studies are indispensable to determine whether poor PS patients derive benefit from ICIs.
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Affiliation(s)
- Bartłomiej Tomasik
- Department of Biostatistics and Translational Medicine, Medical University of Łódź, 15 Mazowiecka Street, 92-215 Łódź, Poland; Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Michał Bieńkowski
- Department of Pathomorphology, Medical University of Gdańsk, 17 Smoluchowskiego Street, 80-214 Gdańsk, Poland
| | - Marcin Braun
- Department of Pathology, Chair of Oncology, Medical University of Łódź, Pomorska 251 Street, 92-213 Łódź, Poland
| | - Sanjay Popat
- Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK; The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK; National Hearth and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, UK
| | - Rafał Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, 7 Debinki Street, 80-211 Gdańsk, Poland.
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22
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Teixeira Loiola de Alencar V, Guedes Camandaroba MP, Pirolli R, Fogassa CAZ, Cordeiro de Lima VC. Immunotherapy as Single Treatment for Patients With NSCLC With Brain Metastases: A Systematic Review and Meta-Analysis-the META-L-BRAIN Study. J Thorac Oncol 2021; 16:1379-1391. [PMID: 33964398 DOI: 10.1016/j.jtho.2021.04.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Brain metastases (BMs) occur in 40% of patients with lung cancer. The activity of immunotherapy in these patients, however, remains controversial, as the cornerstone treatment is radiotherapy (RT). Because RT is associated with adverse events that may impair the quality of life, the possibility of substituting it with a single systemic approach is attractive. Therefore, we performed a systematic review and meta-analysis to evaluate the potential benefit of immune checkpoint inhibitors (ICIs) in patients with NSCLC with untreated BM (unBM). METHODS Studies that enrolled patients with NSCLC treated with ICIs and specifically allowed for unBM were identified by searching the EMBASE, PubMed, Cochrane, and other databases. The outcomes evaluated were intracerebral overall response rate (icORR) and intracerebral disease control rate (icDCR) for unBM, and grades 3 and 4 toxicity rate. RESULTS We included 12 studies with a total of 566 individuals in the final analysis. Anti-programmed cell death protein-1 therapy seems to be active in the central nervous system, with an icORR of 16.4% (95% confidence interval [CI]: 9.8%-24%; I2 = 33.17%) and an icDCR of 45% (95% CI: 33.4%-56.9%; I2 = 46.91%). In the meta-analysis for icORR (risk ratio = 1.26, 95% CI: 0.57-2.79) and icDCR (risk ratio = 0.88, 95% CI: 0.55-1.43) we did not observe any difference among patients with BM who were treated with RT before ICI start and those who were treated with ICI only. CONCLUSIONS ICI seems to be effective as a single treatment for active BM in selected patients with advanced NSCLC.
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Affiliation(s)
| | | | - Rafaela Pirolli
- Clinical Oncology Department, AC Camargo Cancer Center, São Paulo, Brazil
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23
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Jagieła J, Bartnicki P, Rysz J. Nephrotoxicity as a Complication of Chemotherapy and Immunotherapy in the Treatment of Colorectal Cancer, Melanoma and Non-Small Cell Lung Cancer. Int J Mol Sci 2021; 22:ijms22094618. [PMID: 33924827 PMCID: PMC8125622 DOI: 10.3390/ijms22094618] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 12/12/2022] Open
Abstract
Acute kidney injury is a common complication of many medical procedures, including those used in cancer treatment. Both chemotherapy and immunotherapy may result in deterioration of kidney function, which may lead to an increase in mortality among patients with cancer. Antineoplastic agents can affect any element of the nephron, leading to the appearance of clinical symptoms such as proteinuria, hypertension, electrolyte disorders, glomerulonephritis, acute and chronic interstitial nephritis and acute kidney injury. The medical literature describing renal complications occurring during chemotherapeutic and immunotherapeutic treatment in neoplasms, such as colorectal cancer, non-small cell lung cancer and melanoma, was analysed. The immune system plays an important role in controlling the development of neoplasms and fighting them. Oncological treatment algorithms include immunotherapy as monotherapy, combined with chemotherapy or chemotherapy as monotherapy. In the treatment of the above-mentioned neoplasms immunotherapeutics are used, such as checkpoint inhibitors (CPI) (i.e., ipilimumab, pembrolizumab, nivolumab, atezolizumab), vascular endothelial growth factor (VEGF) inhibitors (i.e., bevacizumab, ramucirumab) and a variety of chemotherapeutic agents (irinotecan, capecitabine, oxaliplatin, gefitinib, erlotinib, gemcitabine, cisplatin, paclitaxel, carboplatin, doclitaxel, vinorelbine, topotecan, etoposide). In our article, we focused on the number and type of renal complications as well as on the time of their manifestation when using specific treatment regimens. Our analysis also includes case reports. We discussed treatment of immunological complications and adjustments of the dose of chemotherapeutic agents depending on the creatinine clearance. Analysing the data from the literature, when two immunotherapeutic agents are used together, the number of recorded renal complications increases. Bevacizumab and ramucirumab are the cause of the largest number of renal complications among the immunotherapeutic agents described above. Cisplatin is the best-described substance with the greatest nephrotoxic potential among the chemotherapeutic agents. Crucial for renal complications are also cancer stage, previous chemotherapy and other risk factors of AKI such as age, comorbidities and medications used. Due to the described complications during oncological treatment, including kidney damage, it seems necessary to elaborate standards of cooperation between oncologists and nephrologists both during and after treatment of a patient with cancer. Therefore, it is necessary to conduct further research and develop algorithms for management of a cancer patient, especially during such an intensive progress in oncology.
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24
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Giustini N, Bazhenova L. Recognizing Prognostic and Predictive Biomarkers in the Treatment of Non-Small Cell Lung Cancer (NSCLC) with Immune Checkpoint Inhibitors (ICIs). LUNG CANCER-TARGETS AND THERAPY 2021; 12:21-34. [PMID: 33790679 PMCID: PMC8006757 DOI: 10.2147/lctt.s235102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/20/2021] [Indexed: 12/25/2022]
Abstract
Immunotherapy plays a central role in the treatment of NSCLC and biomarkers predicting response to ICIs are valuable therapeutic tools. Programmed death-ligand 1 (PD-L1) immunohistochemistry (IHC) is integral in therapy selection as its positive predictive nature to ICIs in the metastatic setting is well documented. Tumor mutational burden (TMB) has undergone much study and, while results are somewhat mixed, there is evidence for its positive predictive value with ICI use. Additional markers such as tumor-infiltrating lymphocytes (TILs), gene expression profiling (GEP), mismatch repair (MMR) and microsatellite instability (MSI), somatic mutations, neutrophil to leukocyte ratio (NLR), smoking history, medication history, and immune-related adverse event (irAE) development can further guide clinicians.
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Affiliation(s)
- Nicholas Giustini
- UCSD Moores Cancer Center, Department of Hematology and Oncology, 3855 Health Sciences Drive MC #0987, La Jolla, CA, 92093-0829, USA
| | - Lyudmila Bazhenova
- UCSD Moores Cancer Center, Department of Hematology and Oncology, 3855 Health Sciences Drive MC #0987, La Jolla, CA, 92093-0829, USA
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25
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Umehara K, Yama K, Goto K, Wakamoto A, Hatsuyama T, Honjo O, Saikai T, Fujita A, Sato H. Effect of Systemic Corticosteroid Therapy on the Efficacy and Safety of Nivolumab in the Treatment of Non-Small-Cell Lung Cancer. Cancer Control 2021; 28:1073274820985790. [PMID: 33733906 PMCID: PMC8204518 DOI: 10.1177/1073274820985790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Corticosteroids are used to treat immune-related adverse events (irAEs) associated with nivolumab. However, patients with non-small-cell lung cancer who are administered corticosteroids before the initiation of nivolumab treatment are commonly excluded from clinical trials. The appropriate timing for corticosteroid administration in relation to nivolumab treatment, effects of corticosteroids on the efficacy of nivolumab, and resulting adverse events are not clearly understood. In this study, the effects of differences in the timing of corticosteroid administration on nivolumab efficacy and the resulting adverse events were examined. METHODS A retrospective study was conducted with 109 patients who were treated with nivolumab at Sapporo Minami-Sanjo Hospital between December 2015 and March 2018. RESULTS Of the 109 patients treated with nivolumab, 12 patients were administered corticosteroids before the first cycle of nivolumab (pre-CS), and 33 patients were administered corticosteroids after the first cycle of nivolumab (post-CS). These 2 groups were compared with the control group comprising 64 patients who were not administered corticosteroids (non-CS). The objective response rate in the post-CS group was significantly higher than that in the non-CS group, and the disease control rate in the pre-CS group was significantly lower than that in the non-CS group. The overall survival time and progression-free survival time in the pre-CS group were significantly shorter than those observed in the non-CS group; however, these did not differ from those in the post-CS group. CONCLUSIONS These results suggest that corticosteroids administered to patients with non-small-cell lung cancer after initiation of nivolumab treatment did not affect the disease prognosis. Thus, corticosteroids can be administered immediately for rapid treatment of irAEs.
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Affiliation(s)
- Kengo Umehara
- Pharmaceutical Division, 73964Sapporo Minami-Sanjo Hospital (Hokkaido Keiaikai), Sapporo, Hokkaido, Japan
| | - Kaori Yama
- Division of Clinical Pharmacy, Department of Pharmacy, Faculty of Pharmaceutical Sciences, 88281Hokkaido University of Science, Sapporo, Hokkaido, Japan
| | - Keisuke Goto
- Pharmaceutical Division, 73964Sapporo Minami-Sanjo Hospital (Hokkaido Keiaikai), Sapporo, Hokkaido, Japan
| | - Azusa Wakamoto
- Pharmaceutical Division, 73964Sapporo Minami-Sanjo Hospital (Hokkaido Keiaikai), Sapporo, Hokkaido, Japan
| | - Tae Hatsuyama
- Pharmaceutical Division, 73964Sapporo Minami-Sanjo Hospital (Hokkaido Keiaikai), Sapporo, Hokkaido, Japan
| | - Osamu Honjo
- Respiratory Department, 73964Sapporo Minami-Sanjo Hospital (Hokkaido Keiaikai), Sapporo, Hokkaido, Japan
| | - Toyohiro Saikai
- Respiratory Department, 73964Sapporo Minami-Sanjo Hospital (Hokkaido Keiaikai), Sapporo, Hokkaido, Japan
| | - Akihisa Fujita
- Respiratory Department, 73964Sapporo Minami-Sanjo Hospital (Hokkaido Keiaikai), Sapporo, Hokkaido, Japan
| | - Hideki Sato
- Division of Clinical Pharmacy, Department of Pharmacy, Faculty of Pharmaceutical Sciences, 88281Hokkaido University of Science, Sapporo, Hokkaido, Japan
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Castello A, Rossi S, Toschi L, Lopci E. Impact of Antibiotic Therapy and Metabolic Parameters in Non-Small Cell Lung Cancer Patients Receiving Checkpoint Inhibitors. J Clin Med 2021; 10:jcm10061251. [PMID: 33803006 PMCID: PMC8002619 DOI: 10.3390/jcm10061251] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 01/05/2023] Open
Abstract
Introduction: In the current study, we aimed to assess the impact of antibiotics (ATB) and metabolic parameters on clinical outcome of non-small cell lung carcinoma (NSCLC) patients treated with immune checkpoint inhibitors (ICI). Methods: Data from fifty NSCLC patients referred for ICI between December 2015 and May 2019 were analyzed. All patients underwent 18F-fluorodeoxyglucose positron emission tomography computed tomography (18F-FDG PET/CT) and contrast-enhanced CT at baseline and for response assessment after 6–8 weeks. Patients who received ATB within 1 month before or after the first dose of ICI were compared with those who did not. Response assessment according to iRECIST and EORTC was evaluated, as well as progression-free survival (PFS) and overall survival (OS). For semi-quantitative parameters, we computed metabolic tumor volume (MTV), total lesion glycolysis (TLG) and their variations (∆). Results: Twenty NSCLC cases of 50 (40%) had received ATB. Patients receiving ATB had a higher number of metastases (p = 0.046), and were associated with an elevated tumor burden, expressed by TLG (687 vs. 235.3, p = 0.007) and MTV (125.6 vs. 40.6, p = 0.002), compared to no-ATB patients. According to iRECIST, progressive disease rate was significantly higher for ATB group (64.7% vs. 27.6%, p = 0.029). Likewise, PFS was shorter for ATB compared to no-ATB (median 4.1 vs. 12.4 months, p = 0.004), while no difference for OS was detected. On multivariate analysis, the effect of ATB remained significant for poor PFS along with performance status (ECOG ≥ 1), and ∆SUVmax. Conclusions: ATB therapy seems to be associated with a worse treatment response, PFS, and higher metabolic tumor burden in NSCLC patients treated with ICI.
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Affiliation(s)
- Angelo Castello
- Nuclear Medicine Unit, IRCCS-Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy;
| | - Sabrina Rossi
- Department of Oncology and Hematology, IRCCS-Humanitas Research Center, 20089 Rozzano, Italy; (S.R.); (L.T.)
| | - Luca Toschi
- Department of Oncology and Hematology, IRCCS-Humanitas Research Center, 20089 Rozzano, Italy; (S.R.); (L.T.)
| | - Egesta Lopci
- Nuclear Medicine Unit, IRCCS-Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy;
- Correspondence: ; Tel.: +39-02-82247542; Fax: +39-02-82246693
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Xu H, Xu X, Ge W, Lei J, Cao D. The association between immune-related adverse events and the prognosis of solid cancer patients treated with immunotherapy: a systematic review and meta-analysis. Ther Adv Med Oncol 2021; 12:1758835920980546. [PMID: 33425028 PMCID: PMC7758867 DOI: 10.1177/1758835920980546] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 11/16/2020] [Indexed: 11/22/2022] Open
Abstract
Background: Immune-related adverse events (irAEs) are common during immune checkpoint inhibitor (ICI) treatment and reported to be associated with good survival. This study evaluated the association between onset timing of irAEs and survival of cancer patients treated with ICIs. Methods: Databases including PubMed, Embase, and the Cochrane library were systematically searched to retrieve clinical studies assessing the relationship between irAEs and survival in cancer patients with ICIs. The overall response rate for treatment response and hazard ratio (HR) for overall survival (OS) and progression-free survival (PFS) were calculated using RevMan 5.3. Subgroup analysis in terms of cancer type, ICIs type, region, specific irAEs, accordingly. Results: A total of 34 studies were included. The HRs for OS and PFS in cancer patients with versus without irAEs were 0.57 [95% confidence interval (CI): 0.44, 0.74; p < 0.0001], and 0.50 (95% CI: 0.37, 0.67; p < 0.00001), respectively. The odds ratio for overall response in cancer patients with irAEs was 4.72 (95% CI: 3.48, 6.40; p < 0.00001) compared with those without irAEs. Subgroup analyses suggested that the prognostic role of irAEs was associated with cancer types and region, but not irAEs types. The landmark analysis of OS revealed that there is a non-proportional (early) effect of irAEs on OS in ICI-treated cancer patients (landmark >12 weeks, HROS = 1.08; 95% CI: 0.89, 1.30; p = 0.46). Conclusion: Our findings suggest that the occurrence of irAEs could be a prognostic factor for cancer patients who were treated with ICIs.
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Affiliation(s)
- Huilin Xu
- Department of Oncology, The Fifth Hospital of WuHan, WuHan, Hubei, China
| | - Ximing Xu
- Department of Oncology, RenMin Hospital of Wuhan University, Wuhan, China
| | - Wei Ge
- Department of Oncology, RenMin Hospital of Wuhan University, Wuhan, China
| | - Jinju Lei
- Department of Oncology, RenMin Hospital of Wuhan University, Wuhan, China
| | - Dedong Cao
- Department of Oncology, RenMin Hospital of Wuhan University, Jiefang Road #238 Wuchang District, Wuhan, 430000, China
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Assié JB, Corre R, Levra MG, Calvet CY, Gaudin AF, Grumberg V, Jouaneton B, Cotté FE, Chouaïd C. Nivolumab treatment in advanced non-small cell lung cancer: real-world long-term outcomes within overall and special populations (the UNIVOC study). Ther Adv Med Oncol 2020; 12:1758835920967237. [PMID: 33403011 PMCID: PMC7745546 DOI: 10.1177/1758835920967237] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/23/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To describe long-term outcomes of patients treated with nivolumab for advanced non-small cell lung cancer (aNSCLC) in everyday clinical practice in France, with a focus on patients aged ⩾80 years, patients with renal impairment and patients with brain metastases. METHODS The study included all patients with aNSCLC recorded in the French national hospital database, starting nivolumab in 2015-2016 and followed until December 2018. Patients were stratified by age, the presence of renal impairment and brain metastasis, as documented in the hospital discharge summaries. Information was retrieved on demographics, comorbidities and treatment history at baseline. Time to discontinuation of nivolumab treatment and overall survival were estimated using Kaplan-Meier survival analysis. RESULTS Overall, 10,452 patients were included, of whom 514 were octogenarians, 479 had renal impairment and 1800 had brain metastases at baseline. Median duration of nivolumab treatment was 2.8 months in the overall population and in both the octogenarian and renally impaired subgroups, and 2.3 months in patients with brain metastases. Median overall survival in these patient groups was 11.7 months (95% confidence interval: 11.3-12.2), 11.7 months (11.3-12.1), 11.7 months (11.3-12.2) and 9.9 months (9.0-10.9) respectively. Three-year overall survival rates were 19.1% (18.1-20.2) in the overall population, 16.5% (11.6-23.4) in octogenarians, 15.9% (11.8-21.4) in patients with renal impairment and 21.7% (19.4-24.2) in those with brain metastases. CONCLUSION This large nationwide retrospective real-life cohort provided narrow estimates of long-term overall survival, which reached 19% at 3 years, consistent with data from phase III trials of nivolumab. Survival rates were comparable in the three special populations of interest and the overall population.
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Affiliation(s)
- Jean-Baptiste Assié
- Service de Pneumologie, CHI Créteil, UPEC, Créteil, France
- Centre de Recherche des Cordeliers, Inserm, Sorbonne Université, Université de Paris, Functional Genomics of Solid Tumours Laboratory, Paris, France
| | - Romain Corre
- Service de Pneumologie, Centre Hospitalier Intercommunal de Quimper, Quimper, France
| | - Matteo Giaj Levra
- Thoracic Oncology Unit, Centre Hospitalier Universitaire Grenoble Alpes (CHUGA), Grenoble, France
- Institute for Advanced Biosciences INSERM U1209 CNRS UMR5309 Université Grenoble Alpes, Grenoble, France
| | | | | | | | | | | | - Christos Chouaïd
- Service de Pneumologie, CHI Créteil, UPEC, Créteil, France
- Inserm U955, UPEC, IMRB, équipe CEpiA, Créteil, France
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Huang Y, Zhu L, Guo T, Chen W, Zhang Z, Li W, Pan X. Metastatic sites as predictors in advanced NSCLC treated with PD-1 inhibitors: a systematic review and meta-analysis. Hum Vaccin Immunother 2020; 17:1278-1287. [PMID: 33079622 DOI: 10.1080/21645515.2020.1823779] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Programmed cell death protein 1 (PD-1) inhibitors are the first-line treatment for advanced non-small-cell lung cancer (NSCLC) patients. However, their efficacy in metastatic NSCLC patients remains controversial. AIM OF THE STUDY The aim of our study was to evaluate the prognosis of advanced metastatic NSCLC patients treated with PD-1 inhibitors, and discuss the predictive effect of metastatic site on the long-term outcome. METHODS The Embase, Ovid Medline, Cochrane Central Register of Controlled Trials, and PubMed databases were systematically screened up to February 10, 2020. Twenty-five eligible studies, involving 8,067 patients that assessed the impact of metastatic sites on survival outcome were incorporated in our study. Overall survival (OS) and progression-free survival (PFS) were described as hazard ratio (HR) with 95% confidence interval (CI). RESULTS Among the advanced NSCLC patients, the median proportion of brain, liver, bone, and adrenal gland metastases were 21%, 17%, 35%, and 21%, respectively. Patients with metastases to the brain, liver, and bone had worse OS compared to patients without these metastases when treated with PD-1 inhibitors. Similarly, patients with metastasis to the brain and liver were more likely to progress when treated with PD-1 inhibitors. Besides, patients with multiple metastatic sites had worse PFS compared to patients with one metastatic site, while no significant difference was found in terms of OS. CONCLUSIONS Based on the findings of our systematic review and meta-analysis, metastatic sites were independent predictors of the survival outcome for advanced NSCLC patients treated with PD-1 inhibitors.
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Affiliation(s)
- Yangyun Huang
- Department of Thoracic Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, PR China
| | - Lihuan Zhu
- Department of Thoracic Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, PR China
| | - Tianxing Guo
- Department of Thoracic Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, PR China
| | - Wenshu Chen
- Department of Thoracic Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, PR China
| | - Zhenlong Zhang
- Department of Thoracic Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, PR China
| | - Wujin Li
- Department of Thoracic Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, PR China
| | - Xiaojie Pan
- Department of Thoracic Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, PR China
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Kim YJ, Oremus M, Chen HH, McFarlane T, Shah D, Horton S. Real-world effectiveness of nivolumab in patients with non-small-cell lung cancer: a systematic review and meta-analysis. Future Oncol 2020; 16:2045-2058. [DOI: 10.2217/fon-2020-0248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: The effectiveness of immunotherapies for non-small-cell lung cancer under real-world clinical settings remains uncertain. Materials & methods: Systematic searches of PubMed, EMBASE and Web of Science were conducted. Random-effects models were used to estimate pooled median overall survival and progression-free survival estimates. Results: 36 studies of nivolumab were included for narrative synthesis and 11 of these studies were included for meta-analysis. Age, sex, histology and prior lines of treatment did not affect survival outcomes, while Eastern Cooperative Oncology Group Performance Status and brain metastasis were inversely associated with survival. In the meta-analysis, nivolumab was associated with 9.6 months (95% CI: 8.4–10.9) of overall survival and 2.6 months (95% CI: 1.6–3.6) of progression-free survival. Conclusion: Very-low-certainty evidence suggested the real-world effectiveness of nivolumab was consistent with those observed in the clinical trials.
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Affiliation(s)
- Yong-Jin Kim
- University of Waterloo, School of Public Health & Health Systems, Waterloo, ON N2L 3G1, Canada
| | - Mark Oremus
- University of Waterloo, School of Public Health & Health Systems, Waterloo, ON N2L 3G1, Canada
| | - Helen H Chen
- University of Waterloo, School of Public Health & Health Systems, Waterloo, ON N2L 3G1, Canada
| | - Thomas McFarlane
- University of Waterloo, School of Pharmacy, Kitchener, ON N2G 1C5, Canada
| | - Devanshi Shah
- University of Waterloo, School of Public Health & Health Systems, Waterloo, ON N2L 3G1, Canada
| | - Susan Horton
- University of Waterloo, School of Public Health & Health Systems, Waterloo, ON N2L 3G1, Canada
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Chen H, Wang D, Zhong Q, Tao Y, Zhou Y, Shi Y. Pretreatment body mass index and clinical outcomes in cancer patients following immune checkpoint inhibitors: a systematic review and meta-analysis. Cancer Immunol Immunother 2020; 69:2413-2424. [PMID: 32749571 DOI: 10.1007/s00262-020-02680-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/21/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND This systematic review and meta-analysis aimed to evaluate the association between pretreatment body mass index (BMI) and clinical outcomes in cancer patients treated with immune checkpoint inhibitors (ICIs). METHODS Systematical searches of PubMed, Embase, and the Cochrane Library databases were carried out. Studies reporting on the association between BMI and outcomes of ICIs were included. The intended outcomes included overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and immune-related adverse events (irAEs). Quantitative analyses and dose-response meta-analyses were performed under random effect models. RESULTS Twenty-two eligible studies involving 5686 cancer patients treated with ICIs were identified. Compared to those with lower BMI, patients with higher BMI obtained a significant benefit on OS (HR = 0.698, 95% CI 0.614-0.794, P < 0.001; I2 = 45.9%) and PFS (HR = 0.760, 95% CI 0.672-0.861, P < 0.001; I2 = 37.9%). Most stratified analyses for OS and PFS also showed similar pooled risk estimates. For an increment of every 5 kg/m2 in BMI, the risk for death reduced by approximately 15.6% (HR = 0.844, 95% CI 0.752-0.945, P = 0.003). Moreover, patients with higher BMI had a remarkably better ORR (OR = 0.468, 95% CI 0.263-0.833, P = 0.010; I2 = 73.6%) than that of those with lower BMI. However, no statistically significant differences were found in the incidence of any grade irAEs (P = 0.073) and ≥ 3 grade irAEs (P = 0.105) between higher and lower BMI. CONCLUSION Higher BMI is significantly associated with improved outcomes in patients treated with ICIs. Further large-scale prospective research is warranted to better illuminate the association between BMI and outcomes from ICIs.
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Affiliation(s)
- Haizhu Chen
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Beijing Key Laboratory of Clinical Study On Anticancer Molecular Targeted Drugs, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Daquan Wang
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Qiaofeng Zhong
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Beijing Key Laboratory of Clinical Study On Anticancer Molecular Targeted Drugs, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yunxia Tao
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Beijing Key Laboratory of Clinical Study On Anticancer Molecular Targeted Drugs, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yu Zhou
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Beijing Key Laboratory of Clinical Study On Anticancer Molecular Targeted Drugs, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yuankai Shi
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Beijing Key Laboratory of Clinical Study On Anticancer Molecular Targeted Drugs, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
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Oki R, Hirakawa Y, Kimura H, Honda K, Hinata M, Abe H, Domoto Y, Tanaka G, Nagase T, Nangaku M. Renal Effects after Pembrolizumab Treatment for Non-small Cell Lung Carcinoma. Intern Med 2020; 59:977-981. [PMID: 31813918 PMCID: PMC7184094 DOI: 10.2169/internalmedicine.3928-19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Immune checkpoint inhibitors (CPIs), including pembrolizumab, are becoming common oncological treatments. CPIs have been associated with a significant risk of developing immune-related adverse events (irAEs), such as nephritis and interstitial nephritis. However, the occurrence of glomerulonephritis has only rarely been reported. We herein present the case of a 75-year-old woman with non-small cell lung carcinoma (NSCLC) who developed proteinuria and microscopic hematuria during treatment with pembrolizumab. Renal biopsy revealed tubulointerstitial nephritis and IgA nephropathy. Considering that a urinalysis showed no abnormality before treatment, the condition might have been induced by pembrolizumab. In this report, we focus on the correct diagnosis and management of renal irAEs, which remain controversial.
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MESH Headings
- Aged
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/therapeutic use
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/physiopathology
- Clinical Protocols
- Female
- Glomerulonephritis, IGA/chemically induced
- Glomerulonephritis, IGA/physiopathology
- Humans
- Lung Neoplasms/drug therapy
- Lung Neoplasms/physiopathology
- Nephritis, Interstitial/chemically induced
- Nephritis, Interstitial/physiopathology
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Affiliation(s)
- Rikako Oki
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Japan
| | - Yosuke Hirakawa
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Japan
| | - Hitomi Kimura
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Japan
| | - Kenjiro Honda
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Japan
| | - Munetoshi Hinata
- Department of Pathology, The University of Tokyo Hospital, Japan
| | - Hiroyuki Abe
- Department of Pathology, The University of Tokyo Hospital, Japan
| | - Yukako Domoto
- Department of Pathology, The University of Tokyo Hospital, Japan
| | - Goh Tanaka
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | - Takahide Nagase
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Japan
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Haanen J, Ernstoff MS, Wang Y, Menzies AM, Puzanov I, Grivas P, Larkin J, Peters S, Thompson JA, Obeid M. Autoimmune diseases and immune-checkpoint inhibitors for cancer therapy: review of the literature and personalized risk-based prevention strategy. Ann Oncol 2020; 31:724-744. [PMID: 32194150 DOI: 10.1016/j.annonc.2020.03.285] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/03/2020] [Accepted: 03/07/2020] [Indexed: 02/08/2023] Open
Abstract
Patients with cancer and with preexisting active autoimmune diseases (ADs) have been excluded from immunotherapy clinical trials because of concerns for high susceptibility to the development of severe adverse events resulting from exacerbation of their preexisting ADs. However, a growing body of evidence indicates that immune-checkpoint inhibitors (ICIs) may be safe and effective in this patient population. However, baseline corticosteroids and other nonselective immunosuppressants appear to negatively impact drug efficacy, whereas retrospective and case report data suggest that use of specific immunosuppressants may not have the same consequences. Therefore, we propose here a two-step strategy. First, to lower the risk of compromising ICI efficacy before their initiation, nonselective immunosuppressants could be replaced by specific selective immunosuppressant drugs following a short rotation phase. Subsequently, combining ICI with the selective immunosuppressant could prevent exacerbation of the AD. For the most common active ADs encountered in the context of cancer, we propose specific algorithms to optimize ICI therapy. These preventive strategies go beyond current practices and recommendations, and should be practiced in ICI-specialized clinics, as these require multidisciplinary teams with extensive knowledge in the field of clinical immunology and oncology. In addition, we challenge the exclusion from ICI therapy for patients with cancer and active ADs and propose the implementation of an international registry to study such novel strategies in a prospective fashion.
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Affiliation(s)
- J Haanen
- Netherlands Cancer Institute, Division of Medical Oncology, Amsterdam, The Netherlands
| | - M S Ernstoff
- Roswell Park Comprehensive Cancer Center, Buffalo, USA
| | - Y Wang
- Department of Gastroenterology, Hepatology & Nutrition, University of Texas MD Anderson Cancer Center, Houston, USA
| | - A M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Royal North Shore and Mater Hospitals, Sydney, Australia
| | - I Puzanov
- Roswell Park Comprehensive Cancer Center, Buffalo, USA
| | - P Grivas
- University of Washington, Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - J Larkin
- Royal Marsden NHS Foundation Trust, London, UK
| | - S Peters
- Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV) and Lausanne University, Lausanne, Switzerland
| | - J A Thompson
- University of Washington, Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, USA; National Cancer Institute/NIH, Bethesda, USA
| | - M Obeid
- Department of Medicine, Service of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Vaccine and Immunotherapy Center, Centre Hospitalier Universitaire Vaudois (CHUV), Centre d'Immunothérapie et de Vaccinologie, Lausanne, Switzerland.
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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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35
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Petrelli F, Signorelli D, Ghidini M, Ghidini A, Pizzutilo EG, Ruggieri L, Cabiddu M, Borgonovo K, Dognini G, Brighenti M, De Toma A, Rijavec E, Garassino MC, Grossi F, Tomasello G. Association of Steroids use with Survival in Patients Treated with Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis. Cancers (Basel) 2020; 12:cancers12030546. [PMID: 32120803 PMCID: PMC7139305 DOI: 10.3390/cancers12030546] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/23/2020] [Accepted: 02/25/2020] [Indexed: 12/21/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) can elicit toxicities by inhibiting negative regulators of adaptive immunity. Sometimes, management of toxicities may require systemic glucocorticoids. We performed a systematic review and meta-analysis of published studies to evaluate the correlation between steroids use, overall survival (OS), and progression-free survival (PFS) in cancer patients treated with ICIs. Publications that compared steroids with non-steroid users in cancer patients treated with ICIs from inception to June 2019 were identified by searching the EMBASE, PubMed, SCOPUS, Web of Science, and Cochrane Library databases. The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Patients (studies, n = 16; patients, n = 4045) taking steroids were at increased risk of death and progression compared to those not taking steroids (HR = 1.54, 95% CI: 1.24-1.91; p = 0.01 and HR = 1.34, 95% CI: 1.02-1.76; p = 0.03, respectively). The main negative effect on OS was associated with patients taking steroids for supportive care (HR = 2.5, 95% CI 1.41-4.43; p < 0.01) or brain metastases (HR = 1.51, 95% CI 1.22-1.87; p < 0.01). In contrast, steroids used to mitigate adverse events did not negatively affect OS. In conclusion, caution is needed when steroids are used for symptom control. In these patients, a negative impact of steroid use was observed for both OS and PFS.
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Affiliation(s)
- Fausto Petrelli
- Medical Oncology Unit, ASST Bergamo Ovest, 24047 Treviglio (BG), Italy; (M.C.); (K.B.)
- Correspondence: ; Tel.: +39-036-3424-420; Fax: +39-036-3424-380
| | - Diego Signorelli
- Thoracic Oncology, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (D.S.); (A.D.T.); (M.C.G.)
| | - Michele Ghidini
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy; (M.G.); (E.R.); (F.G.)
| | - Antonio Ghidini
- Medical Oncology Unit, Casa di Cura Igea, 20126 Milano, Italy;
| | - Elio Gregory Pizzutilo
- Medical Oncology Unit, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy; (E.G.P.); (L.R.); (G.T.)
| | - Lorenzo Ruggieri
- Medical Oncology Unit, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy; (E.G.P.); (L.R.); (G.T.)
| | - Mary Cabiddu
- Medical Oncology Unit, ASST Bergamo Ovest, 24047 Treviglio (BG), Italy; (M.C.); (K.B.)
| | - Karen Borgonovo
- Medical Oncology Unit, ASST Bergamo Ovest, 24047 Treviglio (BG), Italy; (M.C.); (K.B.)
| | | | | | - Alessandro De Toma
- Thoracic Oncology, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (D.S.); (A.D.T.); (M.C.G.)
| | - Erika Rijavec
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy; (M.G.); (E.R.); (F.G.)
| | - Marina Chiara Garassino
- Thoracic Oncology, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (D.S.); (A.D.T.); (M.C.G.)
| | - Francesco Grossi
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy; (M.G.); (E.R.); (F.G.)
| | - Gianluca Tomasello
- Medical Oncology Unit, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy; (E.G.P.); (L.R.); (G.T.)
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Urwyler P, Earnshaw I, Bermudez M, Perucha E, Wu W, Ryan S, Mcdonald L, Karagiannis SN, Taams LS, Powell N, Cope A, Papa S. Mechanisms of checkpoint inhibition-induced adverse events. Clin Exp Immunol 2020; 200:141-154. [PMID: 31989585 DOI: 10.1111/cei.13421] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2019] [Indexed: 12/14/2022] Open
Abstract
Immune checkpoint inhibition has revolutionized the treatment of several solid cancers, most notably melanoma and non-small-cell lung cancer (NSCLC). Drugs targeting cytotoxic T lymphocyte antigen (CTLA)-4 and programmed cell death 1 (PD-1) have made their way into routine clinical use; however, this has not been without difficulties. Stimulation of the immune system to target cancer has been found to result in a reduction of self-tolerance, leading to the development of adverse effects that resemble autoimmunity. These adverse effects are erratic in their onset and severity and can theoretically affect any organ type. Several mechanisms for immune-related toxicity have been investigated over recent years; however, no consensus on the cause or prediction of toxicity has been reached. This review seeks to examine reported evidence for possible mechanisms of toxicity, methods for prediction of those at risk and a discussion of future prospects within the field.
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Affiliation(s)
- P Urwyler
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - I Earnshaw
- Centre for Inflammation Biology and Cancer Immunology, Department of Inflammatory Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - M Bermudez
- Centre for Inflammation Biology and Cancer Immunology, Department of Inflammatory Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - E Perucha
- Centre for Inflammation Biology and Cancer Immunology, Department of Inflammatory Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - W Wu
- Centre for Inflammation Biology and Cancer Immunology, Department of Inflammatory Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - S Ryan
- Centre for Inflammation Biology and Cancer Immunology, Department of Inflammatory Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - L Mcdonald
- Oncology and Haematology Clinical Trials, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S N Karagiannis
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - L S Taams
- Centre for Inflammation Biology and Cancer Immunology, Department of Inflammatory Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - N Powell
- Centre for Inflammation Biology and Cancer Immunology, Department of Inflammatory Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - A Cope
- Centre for Inflammation Biology and Cancer Immunology, Department of Inflammatory Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - S Papa
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,ImmunoEngineering, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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37
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Adachi Y, Tamiya A, Taniguchi Y, Enomoto T, Azuma K, Kouno S, Inagaki Y, Saijo N, Okishio K, Atagi S. Predictive factors for progression-free survival in non-small cell lung cancer patients receiving nivolumab based on performance status. Cancer Med 2019; 9:1383-1391. [PMID: 31880861 PMCID: PMC7013052 DOI: 10.1002/cam4.2807] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/13/2019] [Accepted: 12/14/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Nivolumab has promising efficacy for the treatment of non-small cell lung cancer (NSCLC). Various predictive factors for nivolumab response in those with NSCLC have been reported, including performance status (PS). The objective of this retrospective study was to determine the predictive factors for nivolumab response in those with NSCLC with good PS and those with poor PS. METHODS We retrospectively collected pretreatment clinical data of 296 consecutive patients with NSCLC treated with nivolumab. We investigated the relationship between progression-free survival (PFS) and patient characteristics and analyzed predictive factors associated with good PS (PS 0-1) or poor PS (PS 2-4). RESULTS The median age of patients was 70 years; 206 patients were male, and 224 were classified as having good PS (PS 0-1). The median PFS was 3.0 months, 3.7 months, and 1.2 months for all patients, patients with good PS, and patients with poor PS respectively. Multivariate analysis showed that never smoking (hazard ratio [HR], 1.77; 95% confidence interval [CI], 1.15-2.75), high C-reactive protein (CRP) (HR, 1.39; 95% CI, 1.00-1.93), liver metastasis (HR, 1.95; 95% CI, 1.24-3.07), pleural effusion (HR, 1.45; 95% CI, 1.06-2.00), and steroid use (HR, 2.85; 95% CI, 1.65-4.94) were associated with significantly shorter PFS in patients with good PS. A high advanced lung cancer inflammation index (ALI) was significantly associated with longer PFS in patients with poor PS (HR, 0.24; 95% CI, 0.08-0.79). CONCLUSIONS In patients with NSCLC treated with nivolumab, the factors found to be predictive of shorter PFS in patients with good PS were never smoking, high CRP, liver metastasis, pleural effusion, and steroid administration, whereas high ALI was predictive of longer PFS in patients with poor PS.
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Affiliation(s)
- Yuichi Adachi
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Akihiro Tamiya
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Yoshihiko Taniguchi
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Takatoshi Enomoto
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Kouji Azuma
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Shunichi Kouno
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Yuji Inagaki
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Nobuhiko Saijo
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Kyoichi Okishio
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Shinji Atagi
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
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Xu H, Cao D, He A, Ge W. The prognostic role of obesity is independent of sex in cancer patients treated with immune checkpoint inhibitors: A pooled analysis of 4090 cancer patients. Int Immunopharmacol 2019; 74:105745. [PMID: 31302449 DOI: 10.1016/j.intimp.2019.105745] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/24/2019] [Accepted: 07/05/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Recent studies suggest obesity is associated with improved survival of cancer patients treated with immune checkpoint inhibitors (ICIs). We performed this meta-analysis to evaluate the impact of obesity on survival of these patients with regard to the cutoff value of body mass index (BMI) as well as sex. METHODS Electronic databases including Pubmed, Emabse, and the Cochrane library were systematically searched until April 2019, without language limitation. Clinical studies evaluating the association between BMI and survival of cancer patients treated with ICIs were included. The main endpoints were overall survival (OS) and progression-free survival (PFS). Data from individual studies were extracted by two researchers, independently. RevMan 5.3 and Stata 11 software were used to perform the analysis. RESULTS 16 retrospective studies met the inclusion criteria, with a total of 4090 patients. The OS (HR = 0.72, 95% CI: 0.51-1.02; P = 0.06) and PFS (HR = 0.67, 95% CI: 0.48-0.95; P = 0.02) of the high BMI group were improved compared with the low BMI group. Dose-response analysis showed that the risk of death decreased by 3.6% when the BMI increased every 1 kg/m2. Subgroup analysis revealed that BMI > 30 was a reliable value for determining significantly better OS (HR = 0.64; 95%CI: 0.43-0.96; P = 0.03). The prognostic effect of BMI on OS was significant regardless of gender (For male, HR = 0.73, 95% CI: 0.61-0.86; P < 0.01. For female, HR = 0.63, 95% CI: 0.43-0.92; P = 0.02). CONCLUSIONS Obesity is associated with better outcomes in cancer patients treated with ICIs, and this clinical benefit may be independent of sex.
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Affiliation(s)
- Huilin Xu
- Department of Oncology, The Fifth Hospital of Wuhan, Xianzheng Road, Hanyang District, Wuhan, Hubei 430000, China.
| | - Dedong Cao
- Department of Oncology, RenMin Hospital of Wuhan University, Jiefang Road #238 Wuchang District, Wuhan 430000, China.
| | - Anbing He
- Department of Oncology, The Fifth Hospital of Wuhan, Xianzheng Road, Hanyang District, Wuhan, Hubei 430000, China
| | - Wei Ge
- Department of Oncology, RenMin Hospital of Wuhan University, Jiefang Road #238 Wuchang District, Wuhan 430000, China
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Ouaknine Krief J, Helly de Tauriers P, Dumenil C, Neveux N, Dumoulin J, Giraud V, Labrune S, Tisserand J, Julie C, Emile JF, Chinet T, Giroux Leprieur E. Role of antibiotic use, plasma citrulline and blood microbiome in advanced non-small cell lung cancer patients treated with nivolumab. J Immunother Cancer 2019; 7:176. [PMID: 31292005 PMCID: PMC6621972 DOI: 10.1186/s40425-019-0658-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 06/27/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Recent data suggested a role of gut microbiota and antibiotic use on immune checkpoint inhibitors efficacy. We aimed to evaluate the impact of early use of antibiotic (EUA), blood microbiome and plasmatic citrulline (marker of the intestinal barrier) on nivolumab efficacy in non-small cell lung cancer (NSCLC). METHODS We included all consecutive patients with advanced NSCLC treated with nivolumab in our Department between 2014 and 2017. Blood microbiome was analyzed at month (M) M0 and M2. Citrulline rates were evaluated at M0, M2, M4 and M6. RESULTS Seventy-two patients were included (EUA in 42%). Overall survival (OS) was longer without EUA (median 13.4 months) than with EUA (5.1 months, p = 0.03). Thirty-five patients (49%) had plasma samples available. High citrulline rate (≥20 μM) at M0 was associated with tumor response (p = 0.084) and clinical benefit (nivolumab > 6 months) (p = 0.002). Median progression-free survival (PFS) was 7.9 months (high citrulline) vs 1.6 months (low citrulline) (p < 0.0001), and median OS were respectively non reached vs 2.2 months (p < 0.0001). Patients with EUA had lower median citrulline rates at M0: 21 μM (IQR 15.0-30.8) vs 32 μM (IQR 24.0-42.0) without EUA (p = 0.044). The presence of specific bacterial DNA in blood at M0 was associated with response and clinical benefit (Peptostreptococcae, Paludibaculum, Lewinella) or with tumor progression (Gemmatimonadaceae). Multivariate analyses on PFS and OS confirmed the prognostic role of citrulline and blood microbiome. CONCLUSIONS EUA is associated with shorter OS with nivolumab and lower citrulline rates. Plasma citrulline and blood microbiome appear to be promising predictive factors of nivolumab efficacy.
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Affiliation(s)
- Julia Ouaknine Krief
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Pierre Helly de Tauriers
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Coraline Dumenil
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Nathalie Neveux
- Department of Biochemistry, APHP – Hopital Cochin, Paris, France
| | - Jennifer Dumoulin
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Violaine Giraud
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Sylvie Labrune
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Julie Tisserand
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Catherine Julie
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
- Department of Pathology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Jean-François Emile
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
- Department of Pathology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Thierry Chinet
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
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40
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Elias R, Odejide O. Immunotherapy in Older Adults: A Checkpoint to Palliation? Am Soc Clin Oncol Educ Book 2019; 39:e110-e120. [PMID: 31099630 DOI: 10.1200/edbk_238795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The excitement about immunotherapy is justified. Patients with advanced disease and limited life expectancy before immune checkpoint inhibitors are now having prolonged and sometimes complete responses to treatment; however, most patients do not respond to checkpoint inhibitors. The hope for a meaningful response with only a limited risk of high-grade toxicity generated a prognostic dilemma for patients with advanced cancers and their treating oncologists. Older adults with advanced cancers are at the intersection of multiple biologic and clinical factors that can influence the efficacy of immunotherapy. Treating physicians should take all of these elements into account when considering treatment options for an older adult with advanced disease. Oncologists should have an honest conversation with their patients regarding the uncertainty around the clinical profile of checkpoint inhibitors. Early high-quality goals of care discussions can help manage expectations of older adults with advanced cancer treated with immunotherapy. We review in this paper select clinical characteristics that are important to consider when evaluating an older adult for checkpoint inhibitor therapy. In addition, we discuss strategies to optimize goals of care discussion given the increasing complexity of prognostication in the immunotherapy era.
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Affiliation(s)
- Rawad Elias
- 1 Hartford HealthCare Cancer Institute, Hartford Hospital, Hartford, CT
| | - Oreofe Odejide
- 2 Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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Duma N, Abdel-Ghani A, Yadav S, Hoversten KP, Reed CT, Sitek AN, Enninga EAL, Paludo J, Aguilera JV, Leventakos K, Lou Y, Kottschade LA, Dong H, Mansfield AS, Manochakian R, Adjei AA, Dronca RS. Sex Differences in Tolerability to Anti-Programmed Cell Death Protein 1 Therapy in Patients with Metastatic Melanoma and Non-Small Cell Lung Cancer: Are We All Equal? Oncologist 2019; 24:e1148-e1155. [PMID: 31036771 DOI: 10.1634/theoncologist.2019-0094] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Immune-related adverse events (irAEs) have emerged as a serious clinical issue in the use of immune checkpoint inhibitors (ICIs). Risk factors for irAEs remain controversial. Therefore, we studied sex differences in irAEs in patients treated with anti-programmed cell death protein 1 (PD-1) therapy. MATERIALS AND METHODS All patients with metastatic melanoma and non-small cell lung cancer (NSCLC) treated with anti-PD-1 therapy at Mayo Clinic Rochester and Florida from 2015 to 2018 were reviewed. Kaplan-Meier method and log-rank test was used for time-to-event analysis. RESULTS In 245 patients with metastatic melanoma, premenopausal women were more likely to experience irAEs (all grades) compared with postmenopausal women and men (67% vs. 60% vs. 46%), primarily because of an increase in endocrinopathies (33% vs. 12% vs. 10%, respectively). In patients with NSCLC (231 patients), women (all ages) were also more likely to develop irAEs of all grades (48% vs. 31%). Women with NSCLC were more likely to develop pneumonitis (11% vs. 4%) and endocrinopathies (14% vs. 5%). No differences in grade ≥3 toxicities were seen across sexes in both cohorts, but women were more likely to receive systemic steroids for the treatment of irAEs compared with men. Better progression-free-survival was observed in women with NSCLC and irAEs (10 months vs. 3.3 months) compared with women without irAEs. CONCLUSION Women with metastatic melanoma and NSCLC are more likely to experience irAEs compared with men. We also observed differences between sexes in the frequency of certain irAEs. Larger studies are needed to investigate the mechanisms underlying these associations. IMPLICATIONS FOR PRACTICE The results of this study suggest that women may be at a higher risk for immune-related adverse events (irAEs) compared with men when treated with anti-programmed cell death protein 1 therapy. In addition, women were more likely to develop certain irAEs, including endocrinopathies and pneumonitis. Close follow-up of women undergoing treatment with immune checkpoint inhibitors will allow clinicians to diagnose these treatment-related complications early, potentially reducing their associated morbidity and mortality. In addition, a possible association between irAEs and response to therapy was observed.
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Affiliation(s)
- Narjust Duma
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Azzouqa Abdel-Ghani
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Siddhartha Yadav
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Clay T Reed
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrea N Sitek
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Jonas Paludo
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Yanyan Lou
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Lisa A Kottschade
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Haidong Dong
- Department of Immunology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Aaron S Mansfield
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rami Manochakian
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Alex A Adjei
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Roxana S Dronca
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida, USA
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42
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Fucà G, Galli G, Poggi M, Lo Russo G, Proto C, Imbimbo M, Ferrara R, Zilembo N, Ganzinelli M, Sica A, Torri V, Colombo MP, Vernieri C, Balsari A, de Braud F, Garassino MC, Signorelli D. Modulation of peripheral blood immune cells by early use of steroids and its association with clinical outcomes in patients with metastatic non-small cell lung cancer treated with immune checkpoint inhibitors. ESMO Open 2019; 4:e000457. [PMID: 30964126 PMCID: PMC6435242 DOI: 10.1136/esmoopen-2018-000457] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/09/2018] [Accepted: 12/26/2018] [Indexed: 12/26/2022] Open
Abstract
Background Steroids are frequently used in patients with metastatic non-small cell lung cancer (mNSCLC), but they could be detrimental for patients treated with immune checkpoint inhibitors (ICIs). Here, we assessed the association between early use of steroids, clinical outcomes and peripheral immune blood cells modulation in patients with mNSCLC treated with ICIs. Methods We reviewed patients with mNSCLC treated at our institution between April 2013 and December 2017. Early use of steroids was defined as the use of a daily prednisone-equivalent dose ≥10 mg for at least 1 day within 28 days after ICI initiation. Peripheral immune blood cell counts were retrieved at baseline and at 4 and 6 weeks after ICI initiation. Results Out of 151 patients included, 35 (23%) made early use of steroids that was associated with poor disease control (OR 0.32, p=0.006), progression-free survival (HR 1.80, p=0.003) and overall survival (HR 2.60, p<0.001). Early use of steroids significantly correlated with higher median absolute neutrophil count, neutrophil to lymphocyte ratio (NLR) and derived NLR, and lower median absolute and relative eosinophil count, both at 4 and 6 weeks after ICI initiation. Conclusions In patients with mNSCLC treated with ICIs, early use of steroids was associated with worse clinical outcomes and remarkable modulation of peripheral blood immune cells, which could contribute to restraining the activation of antitumour immunity. If confirmed in prospective studies, these findings would highlight the importance of carefully evaluating and, whenever possible, avoiding steroids during early phases of ICI treatment.
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Affiliation(s)
- Giovanni Fucà
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Giulia Galli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Marta Poggi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Giuseppe Lo Russo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Claudia Proto
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Martina Imbimbo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Roberto Ferrara
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Nicoletta Zilembo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Monica Ganzinelli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Antonio Sica
- Department of Pharmaceutical Sciences, Università degli Studi del Piemonte Orientale 'Amedeo Avogadro', Novara, Italy.,Department of Oncology and Hematology, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Valter Torri
- Laboratory of Methodology for Biomedical Research, IRCCS Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Mario Paolo Colombo
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Claudio Vernieri
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.,Fondazione Istituto FIRC di Oncologia Molecolare (IFOM), Milan, Italy
| | - Andrea Balsari
- Dipartimento di Scienze Biomediche per la Salute, University of Milan, Milan, Italy
| | - Filippo de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Marina Chiara Garassino
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Diego Signorelli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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