Like a Rolling Stone: Sting-Cgas Pathway and Cell-Free DNA as Biomarkers for Combinatorial Immunotherapy

Harnessing tumor immunity with cytotoxics: T cells monitoring in mice bearing lung tumors treated with anti-VEGF and pemetrexed-cisplatin doublet

BACKGROUND

Successful immunotherapy is restricted to some cancers only, and combinatorial strategies with other drugs could help to improve their efficacy. Here, we monitor T cells in NSCLC model after treatment with cytotoxics (CT) and anti-VEGF drugs, to understand when immune checkpoint inhibitors should be best associated next.

METHODS

In vivo study was performed on BALB/c mice grafted with KLN205 cells. Eight treatments were tested including control, cisplatin and pemetrexed as low (LD CT) and full (MTD CT) dose as single agents, flat dose anti-VEGF and the association anti-VEGF + CT. Full immunomonitoring was performed by flow cytometry on tumor, spleen and blood over 3 weeks.

RESULTS

Immunomodulatory effect was dependent upon both treatments and time. In tumors, combination groups shown numerical lower Treg cells on Day 21. In spleen, anti-VEGF and LD CT group shown higher CD8/Treg ratio on Day 7; on Day 14, higher T CD4 were observed in both combination groups. Finally, in blood, Tregs were lower and CD8/Treg ratio higher, on Day 14 in both combination groups. On Day 21, CD4 and CD8 T cells were higher in the anti-VEGF + MTD CT group.

CONCLUSIONS

Anti-VEGF associated to CT triggers notable increase in CD8/Tregs ratio. Regarding the scheduling, a two-week delay after using anti-VEGF and CT could be the best sequence to optimize antitumor efficacy.

Immune Checkpoint Inhibitors in Triple Negative Breast Cancer: The Search for the Optimal Biomarker

Triple negative breast cancer (TNBC) is a high-risk and aggressive malignancy characterized by the absence of estrogen receptors (ER) and progesterone receptors (PR) on the surface of malignant cells, and by the lack of overexpression of human epidermal growth factor 2 (HER2). It has limited therapeutic options compared to other subtypes of breast cancer. There is now a growing body of evidence on the role of immunotherapy in TNBC, however much of the data from clinical trials is conflicting and thus, challenging for clinicians to integrate the data into clinical practice. Landmark phase III trials using immunotherapy in the early-stage neoadjuvant setting concluded that the addition of immunotherapy to chemotherapy improved the pathologic complete response (pCR) rate compared to chemotherapy with placebo while others found no significant improvement in pCR. Phase III trials have investigated the utility of immunotherapy in previously untreated metastatic TNBC, and these studies have similarly arrived at inconsistent conclusions. Some studies showed no benefit while others demonstrated a clinically significant improvement in overall survival in the PD-L1 positive population. It is not yet clear which biomarkers are most useful, and assays for these biomarkers have not been standardized. Given the often serious and severe side effects of immunotherapy, it is important and necessary to identify predictive biomarkers of response and resistance in order to enhance patient selection. In this review, we will discuss both the challenges of traditional biomarkers and the opportunities of emerging biomarkers for patient selection.

The Value of Population Screening in Advancing Personalized Medicine in the Field of Lung Cancer

During the past decade, progress has been made in the field of lung cancer molecular biology and onco-immunology, leading to prolonged survival of patients. The combination of increased fundamental knowledge and the pharmaceutical pipeline has allowed the development of various tyrosine kinase inhibitors, targeting numerous molecular alterations. These drugs are now available in daily practice and have transformed survival outcomes for patients harboring EGFR, ALK or ROS1 alterations. Multiple clinical trials are now ongoing in order to increase the number of approved drugs, thus overcoming the issues of rare mutations and tyrosine kinase inhibitors resistance. Immune checkpoint inhibitors development has also changed lung cancer outcomes, but underwhelming response rates highlight the need for immune biomarkers. While PD-L1 expression was the first approved immune biomarker, it has shown several limitations and new biomarkers have to be identified to predict response or resistance to immune checkpoint inhibitors. Testing methods, molecular results and targeted therapeutic schedules will be harmonized in the coming years, with the help of dedicated molecular multidisciplinary boards.

Changes of serum levels of tumor necrosis factor (TNF-α) and soluble interleukin-2 receptor (SIL 2R) in patients with cervical cancer and their clinical significance

OBJECTIVE

The goal of the current trial was to investigate the expression levels of tumor necrosis factor-α (TNF-α) and soluble interleukin-2 receptor (SIL-2R) in serum of patients with cervical cancer and analyze their clinical significance.

METHODS

We randomly selected 50 cases of cervical cancer patients who came to our hospital from March 2018 to March 2020 as the experimental group and 50 cases of healthy adult women during the same period as the control group. The experimental group received laparoscopic radical hysterectomy. We compared two groups of patients' serum level of TNF-α and SIL-2R expression. The receiver operating characteristic (ROC) curve was used to determine the diagnostic efficacy of serum TNF-α and SIL-2R in cervical cancer.

RESULTS

The expression levels of serum TNF-α and SIL-2R in the experimental group before radical hysterectomy were significantly higher than that one week after surgery; the preoperative serum TNF-α and SIL-2R expression levels of the experimental group were notably higher than those of the control group; and no marked difference in the expression levels of serum TNF-α and SIL-2R was observed between the control group and the experimental group one week after operation. The area under the curve of TNF-α was 0.846 (95% CI: 0.605~0.978), the diagnostic sensitivity was 81.54%, and the specificity was 70.12%; The area under the curve of SIL-2R is 0.813 (95% CI: 0.601~0.943), the diagnostic sensitivity was 80.13%, and the specificity was 69.97%.

CONCLUSION

Serum levels of TNF-α and SIL-2R expression in patients with cervical cancer are usually noticeably elevated. After surgical treatment, the serum levels of TNF-α and SIL-2R expression will gradually become normal. It is of significant clinical relevance to detect the serum levels of TNF-α and SIL-2R expression for early diagnosis of intervention of cervical cancer.

Cancer Immunotherapy Dosing: A Pharmacokinetic/Pharmacodynamic Perspective

Immune check-point inhibitors are drugs that are markedly different from other anticancer drugs because of their indirect mechanisms of antitumoral action and their apparently random effect in terms of efficacy and toxicity. This marked pharmacodynamics variability in patients calls for reconsidering to what extent approved dosing used in clinical practice are optimal or whether they should require efforts for customization in outlier patients. To better understand whether or not dosing could be an actionable item in oncology, in this review, preclinical and clinical development of immune checkpoint inhibitors are described, particularly from the angle of dose finding studies. Other issues in connection with dosing issues are developed, such as the flat dosing alternative, the putative role therapeutic drug monitoring could play, the rise of combinatorial strategies, and pharmaco-economic aspects.