1
|
Leonetti A, Perrone F, Puntoni M, Maglietta G, Bordi P, Bria E, Vita E, Gelsomino F, De Giglio A, Gelibter A, Siringo M, Mazzoni F, Caliman E, Genova C, Bertolini F, Guaitoli G, Passiglia F, Delcuratolo MD, Montrone M, Cerea G, Pasello G, Roca E, Belluomini L, Cecere FL, Guida A, Manzo A, Adamo V, Rastelli F, Bulotta A, Citarella F, Toschi L, Zoratto F, Cortinovis DL, Berardi R, Follador A, Carta A, Camerini A, Salerno F, Silva RR, Baldini E, Cortellini A, Brighenti M, Santoni M, Malorgio F, Caminiti C, Tiseo M. Real-world outcomes of Italian patients with advanced non-squamous lung cancer treated with first-line pembrolizumab plus platinum-pemetrexed. Eur J Cancer 2024; 202:114006. [PMID: 38489861 DOI: 10.1016/j.ejca.2024.114006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/03/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE The aim of this multi-center, retrospective/prospective cohort observational study was to evaluate outcomes in routine clinical practice of first-line chemo-immunotherapy with cis/carboplatin, pemetrexed and pembrolizumab in patients with advanced non-squamous non-small cell lung cancer (NSCLC) in 33 Italian centers. METHODS The outcome measure was to evaluate overall survival (OS) in a real-world patient population. Secondary endpoints were: progression-free survival (PFS), objective response rate (ORR), duration of response (DoR) and incidence of treatment-related adverse events (AEs). RESULTS 1068 patients were enrolled at the time of data cut-off (January 31st, 2023), and 812 (76.0%) belonged to the retrospective cohort. Median age was 66 years (27-85), ECOG PS was ≥ 2 in 91 (8.6%) patients; 254 (23.8%) patients had brain metastases at baseline; 38 (3.6%) patients had tumor with PD-L1 expression ≥ 50%. After a median follow-up of 17.0 months (95% CI, 16.1-17.9), median OS was 16.1 months (95% CI, 14.4-18.8) and PFS was 9.9 months (95% CI, 8.8-11.2). Median DoR (n = 493) was 14.7 months (95% CI, 13.6-17.1). ORR was 43.4% (95% CI, 40.4-46.4). Any-grade AEs occurred in 636 (59.6%) patients and grade ≥ 3 in 253 (23.7%) patients. Most common grade ≥ 3 AEs were neutropenia (6.3%) and anemia (6.3%). CONCLUSIONS First-line chemo-immunotherapy was effective and tolerable in this large, real-world Italian study of patients with advanced non-squamous NSCLC. Our results were in line with the KEYNOTE-189 registration study, also considering the low number of PD-L1 ≥ 50% patients included in our study.
Collapse
Affiliation(s)
| | - Fabiana Perrone
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy.
| | - Matteo Puntoni
- Clinical & Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
| | - Giuseppe Maglietta
- Clinical & Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
| | - Paola Bordi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Emilio Bria
- UOSD Oncologia Toraco-Polmonare, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Medical Oncology, Department of Traslational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuele Vita
- UOSD Oncologia Toraco-Polmonare, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Medical Oncology, Department of Traslational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Gelsomino
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea De Giglio
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alain Gelibter
- Medical Oncology (B), Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Marco Siringo
- Medical Oncology (B), Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | | | - Enrico Caliman
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Carlo Genova
- Academic Oncology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy
| | - Federica Bertolini
- Division of Medical Oncology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Giorgia Guaitoli
- Division of Medical Oncology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Francesco Passiglia
- Department of Oncology, University of Turin, AOU San Luigi Gonzaga, Orbassano, Turin, Italy
| | | | - Michele Montrone
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Giulio Cerea
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giulia Pasello
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Elisa Roca
- Thoracic Oncology - Lung Unit, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Lorenzo Belluomini
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | | | - Annalisa Guida
- Department of Medical Oncology, St. Mary's Hospital, Terni, Italy
| | - Anna Manzo
- Thoracic Medical Oncology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Vincenzo Adamo
- Medical Oncology Unit, Azienda Ospedaliera Papardo, Messina, Italy
| | - Francesca Rastelli
- Medical Oncology, AST (Azienda Sanitaria Territoriale) of Ascoli Piceno, Ascoli Piceno, Italy
| | - Alessandra Bulotta
- Department of Oncology, Istituto di Ricerca a Carattere Scientifico (IRCCS) San Raffaele Hospital, Milan, Italy
| | - Fabrizio Citarella
- Department of Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - Luca Toschi
- IRCCS Humanitas Clinical and Research Center - Humanitas Cancer Center, Rozzano, Milan, Italy
| | | | - Diego Luigi Cortinovis
- SC Medical Oncology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; Medicine and Surgery Department, University of Milano Bicocca, Milan, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Alessandro Follador
- Medical Oncology Unit San Daniele - Tolmezzo, ASUFC Azienda Sanitaria Universitaria Friuli Centrale, Italy
| | - Annamaria Carta
- Pathology and Oncology Unit, Businco Oncological Hospital, Cagliari, Italy
| | - Andrea Camerini
- Medical Oncology, Versilia Hospital, Azienda USL Toscana Nord Ovest, Lido di Camaiore, Italy
| | - Flavio Salerno
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - Rosa Rita Silva
- Department of Oncology, ASUR Marche, Area Vasta 2, Fabriano, Italy
| | | | - Alessio Cortellini
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Roma, Italy; Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
| | | | | | | | - Caterina Caminiti
- Clinical & Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| |
Collapse
|
2
|
Nassar AH, El Zarif T, Khalid AB, Rahme S, Zhong C, Kwak L, Salame M, Farhat EB, Freeman D, El-Am E, Ravishankar A, Ahmad B, Nana FA, Kaldas D, Naqash AR, Sharon E, LeBoeuf NR, Cortellini A, Malgeri A, Gupta S, Al-Hader A, Sparks JA, Linnoila J, Hamnvik OPR, Mouhieddine TH, Marron T, Parikh K, McKay RR, Dilling T, Choueiri TK, Adib E, Najem E, Kim SY, Sonpavde G. Clinical outcomes and safety of immune checkpoint inhibitors in patients with solid tumors and paraneoplastic syndromes. J Immunother Cancer 2024; 12:e008724. [PMID: 38448038 PMCID: PMC10916116 DOI: 10.1136/jitc-2023-008724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Patients with paraneoplastic syndromes (PNS) are excluded from clinical trials involving immune checkpoint inhibitors (ICIs) due to safety concerns. Moreover, real-world data on efficacy and safety is scarce. METHODS In this retrospective study, data were collected on patients with PNS and solid tumors receiving ICI between 2015 and 2022 at nine institutions. Patients were classified into: Cohort 1 (pre-existing PNS before ICI initiation), cohort 2 (PNS during ICI treatment), and cohort 3 (PNS after ICI discontinuation). Patients with metastatic non-small cell lung cancer (NSCLC) (mNSCLC) from cohort 1 were matched to patients who were PNS-free at each institution up to a 1:3 ratio for age, sex, type of ICI, use of concurrent chemotherapy, and number of lines of systemic therapy prior to ICI initiation. Kaplan-Meier method was used to assess overall survival (OS) and time-to-next treatment (TTNT). RESULTS Among 109 patients with PNS treated with ICIs, median age at ICI initiation was 67 years (IQR: 58-74). The most represented cancer type was NSCLC (n=39, 36%). In cohort 1 (n=55), PNS exacerbations occurred in 16 (29%) patients with median time to exacerbation after ICI of 1.1 months (IQR: 0.7-3.3). Exacerbation or de novo PNS prompted temporary/permanent interruption of ICIs in 14 (13%) patients. For cohort 2 (n=16), median time between ICI initiation and de novo PNS was 1.2 months (IQR: 0.4-3.5). Treatment-related adverse events (trAEs) occurred in 43 (39%) patients. Grade ≥3 trAEs occurred in 18 (17%) patients. PNS-directed immunosuppressive therapy was required in 55 (50%) patients. We matched 18 patients with mNSCLC and PNS (cohort 1) to 40 without PNS, treated with ICIs. There was no significant difference in OS or TTNT between patients with mNSCLC with and without PNS, although a trend was seen towards worse outcomes in patients with PNS. TrAEs occurred in 6/18 (33%) and 14/40 (35%), respectively. Grade ≥3 trAEs occurred in 4 (22%) patients with PNS and 7 (18%) patients without PNS. CONCLUSIONS Exacerbations of pre-existing PNS occurred in 29% of patients treated with ICIs and both exacerbations and de novo PNS occur early in the ICI course. TrAE from ICIs were similar between patients with and without PNS. Our data suggest that pre-existing PNS should not preclude consideration of ICI therapy although patients may not derive the same clinical benefit compared with patients without PNS.
Collapse
Affiliation(s)
| | - Talal El Zarif
- Yale University, New Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ahmed Bilal Khalid
- Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
| | - Serena Rahme
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, New York, USA
| | - Caiwei Zhong
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lucia Kwak
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Elias Bou Farhat
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Dory Freeman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Arjun Ravishankar
- Yale University, New Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Bachar Ahmad
- Yale University, New Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Frank Aboubakar Nana
- Division of Pneumology, CHU UCL Namur, Yvoir, Namur, Belgium
- Division of Pneumology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - David Kaldas
- Department of Internal Medicine, University of South Florida, Tampa, Florida, USA
- Department of Clinical Oncology, Cairo University, Giza, Egypt
| | - Abdul Rafeh Naqash
- Medical Oncology/TSET Phase 1 Program, The University of Oklahoma Stephenson Cancer Center, Oklahoma City, Oklahoma, USA
| | - Elad Sharon
- National Cancer Institute, Bethesda, Maryland, USA
| | | | - Alessio Cortellini
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Andrea Malgeri
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Shruti Gupta
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ahmad Al-Hader
- Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
| | | | - Jenny Linnoila
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - Thomas Marron
- Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Rana R McKay
- Division of Medical Oncology, University of California San Diego, La Jolla, California, USA
| | - Thomas Dilling
- Department of Internal Medicine, University of South Florida, Tampa, Florida, USA
| | - Toni K Choueiri
- Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, UK
| | - Elio Adib
- Harvard Medical School, Boston, Massachusetts, USA
| | - Elie Najem
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - So Yeon Kim
- Yale University, New Haven, Connecticut, USA
| | - Guru Sonpavde
- Medical Oncology, AdventHealth Central Florida, Orlando, Florida, USA
- AdventHealth Cancer Institute, AdventHealth, Altamonte Springs, Florida, USA
| |
Collapse
|
3
|
Pecci F, Cantini L, Cognigni V, Perrone F, Mazzaschi G, Agostinelli V, Mentrasti G, Favari E, Maffezzoli M, Cortellini A, Rossi F, Chiariotti R, Venanzi FM, Lo Russo G, Galli G, Proto C, Ganzinelli M, Tronconi F, Morgese F, Campolucci C, Moretti M, Vignini A, Tiseo M, Minari R, Rocchi MLB, Buti S, Berardi R. Prognostic Impact of Blood Lipid Profile in Patients With Advanced Solid Tumors Treated With Immune Checkpoint Inhibitors: A Multicenter Cohort Study. Oncologist 2024; 29:e372-e381. [PMID: 37796838 PMCID: PMC10911919 DOI: 10.1093/oncolo/oyad273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/07/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Specific components of lipid profile seem to differently impact on immune activity against cancer and unraveling their prognostic role in patients with solid cancer treated with immune checkpoint inhibitors (ICIs) is needed. MATERIALS AND METHODS We retrospectively collected baseline clinicopathological characteristics including circulating lipid profile (total cholesterol [TC], triglycerides [TG], low-density lipoproteins [LDL], high-density lipoproteins [HDL]) of patients with consecutive solid cancer treated with ICIs, and we investigated their role in predicting clinical outcomes. RESULTS At a median follow-up of 32.9 months, among 430 enrolled patients, those with TC ≥ 200 mg/dl showed longer median progression-free survival (mPFS; 6.6 vs. 4.7 months, P = .4), although not reaching statistical significance, and significantly longer median overall survival (mOS; 19.4 vs. 10.8 months, P = .02) compared to those with TC < 200 mg/dl. Conversely, patients with TG ≥150 mg/dl displayed shorter PFS (3.4 vs. 5.1 months, P = .02) and OS (7.1 vs. 12.9 months, P = .009) compared to those with TG <150 mg/dl. TC and TG were then combined in a "LIPID score" identifying three subgroups: good-risk (GR) (TC ≥200 mg/dl and TG <150 mg/dl), intermediate-risk (IR) (TC <200 mg/dl and TG <150 mg/dl or TC ≥200 mg/dl and TG ≥150 mg/dl) and poor-risk (PR) (TC <200 mg/dl and TG ≥150 mg/dl). The mPFS of GR, IR, and PR groups was 7.8, 4.3, and 2.5 months, respectively (P = .005); mOS of GR, IR, and PR was 20.4, 12.4, and 5.3 months, respectively (P < .001). At multivariable analysis, the PR profile represented an independent poor prognostic factor for both PFS and OS. CONCLUSIONS We developed a lipid score that defined subgroups of patients with cancer who differently benefit from ICIs. Further mechanistic insights are warranted to clarify the prognostic and predictive role of lipid profile components in patients treated with ICIs.
Collapse
Affiliation(s)
- Federica Pecci
- Department of Medical Oncology, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| | - Luca Cantini
- Department of Medical Oncology, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
- Fortrea, Inc., Durham, NC, USA
| | - Valeria Cognigni
- Department of Medical Oncology, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| | - Fabiana Perrone
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Giulia Mazzaschi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Veronica Agostinelli
- Department of Medical Oncology, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| | - Giulia Mentrasti
- Department of Medical Oncology, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| | - Elda Favari
- Department of Food and Drug, University of Parma, Parma, Italy
| | - Michele Maffezzoli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Alessio Cortellini
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Francesca Rossi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| | - Rebecca Chiariotti
- Department of Medical Oncology, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| | - Francesco Maria Venanzi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| | - Giuseppe Lo Russo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giulia Galli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Ganzinelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesca Tronconi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| | - Francesca Morgese
- Department of Medical Oncology, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| | - Carla Campolucci
- SOD Medicina di Laboratorio, Azienda Ospedaliera Universitaria delle Marche, Ancona, Italy
| | - Marco Moretti
- SOD Medicina di Laboratorio, Azienda Ospedaliera Universitaria delle Marche, Ancona, Italy
| | - Arianna Vignini
- Department of Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Marcello Tiseo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Roberta Minari
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Sebastiano Buti
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Rossana Berardi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| |
Collapse
|
4
|
Celsa C, Cabibbo G, Fulgenzi CAM, Scheiner B, D'Alessio A, Manfredi GF, Nishida N, Ang C, Marron TU, Saeed A, Wietharn B, Pinter M, Cheon J, Huang YH, Lee PC, Phen S, Gampa A, Pillai A, Vivaldi C, Salani F, Masi G, Roehlen N, Thimme R, Vogel A, Schönlein M, von Felden J, Schulze K, Wege H, Galle PR, Kudo M, Rimassa L, Singal AG, El Tomb P, Ulahannan S, Parisi A, Chon HJ, Hsu WF, Stefanini B, Verzoni E, Giusti R, Veccia A, Catino A, Aprile G, Guglielmini PF, Di Napoli M, Ermacora P, Antonuzzo L, Rossi E, Verderame F, Zustovich F, Ficorella C, Di Pietro FR, Battelli N, Negrini G, Grossi F, Bordonaro R, Pipitone S, Banzi M, Ricciardi S, Laera L, Russo A, De Giorgi U, Cavanna L, Sorarù M, Montesarchio V, Bordi P, Brunetti L, Pinto C, Bersanelli M, Cammà C, Cortellini A, Pinato DJ. Characteristics and outcomes of immunotherapy-related liver injury in patients with hepatocellular carcinoma versus other advanced solid tumours. J Hepatol 2024; 80:431-442. [PMID: 37972660 DOI: 10.1016/j.jhep.2023.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND & AIMS Immune-related liver injury (irLI) is commonly observed in patients with cancer treated with immune checkpoint inhibitors (ICIs). We aimed to compare the incidence, clinical characteristics, and outcomes of irLI between patients receiving ICIs for hepatocellular carcinoma (HCC) vs. other solid tumours. METHODS Two separate cohorts were included: 375 patients with advanced/unresectable HCC, Child-Pugh A class treated with first-line atezolizumab+bevacizumab from the AB-real study, and a non-HCC cohort including 459 patients treated with first-line ICI therapy from the INVIDIa-2 multicentre study. IrLI was defined as a treatment-related increase of aminotransferase levels after exclusion of alternative aetiologies of liver injury. The incidence of irLI was adjusted for the duration of treatment exposure. RESULTS In patients with HCC, the incidence of any grade irLI was 11.4% over a median treatment exposure of 4.4 months (95% CI 3.7-5.2) vs. 2.6% in the INVIDIa-2 cohort over a median treatment exposure of 12.4 months (95% CI 11.1-14.0). Exposure-adjusted-incidence of any grade irLI was 22.1 per 100-patient-years in patients with HCC and 2.1 per 100-patient-years in patients with other solid tumours (p <0.001), with median time-to-irLI of 1.4 and 4.7 months, respectively. Among patients who developed irLI, systemic corticosteroids were administered in 16.3% of patients with HCC and 75.0% of those without HCC (p <0.001), and irLI resolution was observed in 72.1% and 58.3%, respectively (p = 0.362). In patients with HCC, rates of hepatic decompensation and treatment discontinuation due to irLI were 7%. Grade 1-2 irLI was associated with improved overall survival only in patients with HCC (hazard ratio 0.53, 95% CI 0.29-0.96). CONCLUSIONS Despite higher incidence and earlier onset, irLI in patients with HCC is characterised by higher rates of remission and lower requirement for corticosteroid therapy (vs. irLI in other solid tumours), low risk of hepatic decompensation and treatment discontinuation, not negatively affecting oncological outcomes. IMPACT AND IMPLICATIONS Immune-related liver injury (irLI) is common in patients with cancer receiving immune checkpoint inhibitors (ICIs), but whether irLI is more frequent or it is associated with a worse clinical course in patients with hepatocellular carcinoma (HCC), compared to other tumours, is not known. Herein, we compared characteristics and outcomes of irLI in two prospective cohorts including patients treated with ICIs for HCC or for other oncological indications. irLI is significantly more common and it occurs earlier in patients with HCC, also after adjustment for duration of treatment exposure. However, outcomes of patients with HCC who developed irLI are not negatively affected in terms of requirement for corticosteroid therapy, hepatic decompensation, treatment discontinuation and overall survival.
Collapse
Affiliation(s)
- Ciro Celsa
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS London, UK; Gastroenterology and Hepatology Unit, Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, University of Palermo, Italy
| | - Giuseppe Cabibbo
- Gastroenterology and Hepatology Unit, Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, University of Palermo, Italy
| | - Claudia A M Fulgenzi
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS London, UK; Operative Research Unit of Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Bernhard Scheiner
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS London, UK; Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Antonio D'Alessio
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS London, UK; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Giulia F Manfredi
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS London, UK; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Naoshi Nishida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Celina Ang
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA
| | - Thomas U Marron
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA
| | - Anwaar Saeed
- Department of Medicine, Division of Hematology & Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brooke Wietharn
- Department of Medicine, Division of Medical Oncology, Kansas University Cancer Center, Kansas City, Kansas, USA
| | - Matthias Pinter
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Jaekyung Cheon
- Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Yi-Hsiang Huang
- Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Pei-Chang Lee
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Samuel Phen
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Anuhya Gampa
- Section of Gastroenterology, Hepatology & Nutrition, the University of Chicago Medicine 5841 S. Maryland Ave, 60637 Chicago, IL, USA
| | - Anjana Pillai
- Unit of Medical Oncology 2, Azienda Ospedaliero- Universitaria Pisana, Pisa, Italy
| | - Caterina Vivaldi
- Scuola Superiore Sant'Anna Pisa, interdisciplinary research center "Health Science", Pisa, Italy
| | - Francesca Salani
- Unit of Medical Oncology 2, Azienda Ospedaliero- Universitaria Pisana, Pisa, Italy; Scuola Superiore Sant'Anna Pisa, interdisciplinary research center "Health Science", Pisa, Italy
| | - Gianluca Masi
- Unit of Medical Oncology 2, Azienda Ospedaliero- Universitaria Pisana, Pisa, Italy
| | - Natascha Roehlen
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Robert Thimme
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Arndt Vogel
- Hannover Medical School, Hannover, Germany; Longo Family Chair in Liver Cancer Research, Division of Gastroenterology and Hepatology, Toronto General Hospital, Medical Oncology, Princess Margaret Cancer Centre, Schwartz Reisman Liver Research Centre, Toronto, Canada
| | - Martin Schönlein
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johann von Felden
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kornelius Schulze
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Henning Wege
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter R Galle
- University Medical Center Mainz, Department of Internal Medicine I, Mainz, Germany
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy; Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Amit G Singal
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Paul El Tomb
- Medical Oncology/TSET Phase 1 Program, Stephenson Cancer Center, University of Oklahoma, Oklahoma City
| | - Susanna Ulahannan
- Medical Oncology/TSET Phase 1 Program, Stephenson Cancer Center, University of Oklahoma, Oklahoma City
| | - Alessandro Parisi
- Department of Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
| | - Hong Jae Chon
- Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Wei-Fan Hsu
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Bernardo Stefanini
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Elena Verzoni
- SS. Oncologia Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | - Annamaria Catino
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | | | - Marilena Di Napoli
- UC Oncologia Medica Uro-Ginecologica, Istituto Nazionale Tumori "Fondazione G. Pascale", IRCCS, Napoli, Italy
| | - Paola Ermacora
- Dipartimento di Oncologia, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Azienda sanitaria universitaria Integrata Friuli Centrale, Udine, Italy
| | | | - Ernesto Rossi
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Fable Zustovich
- UOC Oncologia di Belluno, Dipartimento di Oncologia Clinica, AULSS 1 Dolomiti, Ospedale S.Martino, Belluno, Italy
| | - Corrado Ficorella
- Department of Biotechnological and Applied Clinical Sciences, St Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | | | - Nicola Battelli
- UOC Oncologia, Ospedale Generale Provinciale di Macerata, ASUR Marche Area Vasta 3, Macerata, Italy
| | - Giorgia Negrini
- Medical Oncology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Francesco Grossi
- Medical Oncology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Stefania Pipitone
- Medical Oncology Unit, University Hospital of Modena e Reggio Emilia, Italy
| | - Maria Banzi
- Medical Oncology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | - Letizia Laera
- Medical Oncology, Ospedale Generale Regionale F Miulli, Acquaviva delle Fonti, Puglia, Italy
| | - Antonio Russo
- Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo, Palermo, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Mariella Sorarù
- Medical Oncology, Camposampiero Hospital, AULSS 6 Euganea, Padova, Italy
| | - Vincenzo Montesarchio
- UOC Oncologia, Ospedale Monaldi, Azienda Ospedaliera Specialistica dei Colli, Napoli, Italy
| | - Paola Bordi
- Medical Oncology Unit, Medicine and Surgery Department, University of Parma, Parma, Italy
| | - Leonardo Brunetti
- Operative Research Unit of Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Carmine Pinto
- Medical Oncology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Melissa Bersanelli
- Medical Oncology Unit, Medicine and Surgery Department, University of Parma, Parma, Italy
| | - Calogero Cammà
- Gastroenterology and Hepatology Unit, Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, University of Palermo, Italy
| | - Alessio Cortellini
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS London, UK; Operative Research Unit of Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - David J Pinato
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS London, UK; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.
| |
Collapse
|
5
|
Fujiwara Y, Cortellini A, Naqash AR. Association of Survival With Immune-Related Adverse Events-Time to Consider the Duration of Treatment. JAMA Dermatol 2024; 160:368-369. [PMID: 38265810 DOI: 10.1001/jamadermatol.2023.5594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- Yu Fujiwara
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Alessio Cortellini
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Department of Surgery and Cancer, Imperial College London, London, England
| | - Abdul Rafeh Naqash
- Medical Oncology/TSET Phase 1 Program, Stephenson Cancer Center, University of Oklahoma, Oklahoma City
| |
Collapse
|
6
|
Prelaj A, Ganzinelli M, Provenzano L, Mazzeo L, Viscardi G, Metro G, Galli G, Agustoni F, Corte CMD, Spagnoletti A, Giani C, Ferrara R, Proto C, Brambilla M, Dumitrascu AD, Inno A, Signorelli D, Pizzutilo EG, Brighenti M, Biello F, Bennati C, Toschi L, Russano M, Cortellini A, Catania C, Bertolini F, Berardi R, Cantini L, Pecci F, Macerelli M, Emili R, Bareggi C, Verderame F, Lugini A, Pisconti S, Buzzacchino F, Aieta M, Tartarone A, Spinelli G, Vita E, Grisanti S, Trovò F, Auletta P, Lorenzini D, Agnelli L, Sangaletti S, Mazzoni F, Calareso G, Ruggirello M, Greco GF, Vigorito R, Occhipinti M, Manglaviti S, Beninato T, Leporati R, Ambrosini P, Serino R, Silvestri C, Zito E, Pedrocchi ACL, Miskovic V, de Braud F, Pruneri G, Lo Russo G, Genova C, Vingiani A. APOLLO 11 Project, Consortium in Advanced Lung Cancer Patients Treated With Innovative Therapies: Integration of Real-World Data and Translational Research. Clin Lung Cancer 2024; 25:190-195. [PMID: 38262770 DOI: 10.1016/j.cllc.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024]
Abstract
INTRODUCTION Despite several therapeutic efforts, lung cancer remains a highly lethal disease. Novel therapeutic approaches encompass immune-checkpoint inhibitors, targeted therapeutics and antibody-drug conjugates, with different results. Several studies have been aimed at identifying biomarkers able to predict benefit from these therapies and create a prediction model of response, despite this there is a lack of information to help clinicians in the choice of therapy for lung cancer patients with advanced disease. This is primarily due to the complexity of lung cancer biology, where a single or few biomarkers are not sufficient to provide enough predictive capability to explain biologic differences; other reasons include the paucity of data collected by single studies performed in heterogeneous unmatched cohorts and the methodology of analysis. In fact, classical statistical methods are unable to analyze and integrate the magnitude of information from multiple biological and clinical sources (eg, genomics, transcriptomics, and radiomics). METHODS AND OBJECTIVES APOLLO11 is an Italian multicentre, observational study involving patients with a diagnosis of advanced lung cancer (NSCLC and SCLC) treated with innovative therapies. Retrospective and prospective collection of multiomic data, such as tissue- (eg, for genomic, transcriptomic analysis) and blood-based biologic material (eg, ctDNA, PBMC), in addition to clinical and radiological data (eg, for radiomic analysis) will be collected. The overall aim of the project is to build a consortium integrating different datasets and a virtual biobank from participating Italian lung cancer centers. To face with the large amount of data provided, AI and ML techniques will be applied will be applied to manage this large dataset in an effort to build an R-Model, integrating retrospective and prospective population-based data. The ultimate goal is to create a tool able to help physicians and patients to make treatment decisions. CONCLUSION APOLLO11 aims to propose a breakthrough approach in lung cancer research, replacing the old, monocentric viewpoint towards a multicomprehensive, multiomic, multicenter model. Multicenter cancer datasets incorporating common virtual biobank and new methodologic approaches including artificial intelligence, machine learning up to deep learning is the road to the future in oncology launched by this project.
Collapse
Affiliation(s)
- Arsela Prelaj
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy; Electronic, Information e Bio-engeenering, Politecnico di Milano, Milan, Italy
| | - Monica Ganzinelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Leonardo Provenzano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy.
| | - Laura Mazzeo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Giuseppe Viscardi
- Oncology Department, Ospedale Monaldi, Azienda Ospedaliera Dei Colli, Napoli, Italy
| | - Giulio Metro
- Oncology Unit, Azienda Ospedaliera Santa Maria della Misercordia, Perugia, Italy
| | - Giulia Galli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Agustoni
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carminia Maria Della Corte
- Dipartimento di Medicina di Precisione, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Andrea Spagnoletti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Claudia Giani
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Roberto Ferrara
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Marta Brambilla
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Andra Diana Dumitrascu
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Alessandro Inno
- Oncology Department, IRCCS Ospedale Sacro Cuore don Calabria, Verona, Italy
| | - Diego Signorelli
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | | | - Federica Biello
- Medical Oncology Unit, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Chiara Bennati
- Oncology Unit, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Luca Toschi
- Oncology Department, Istituto Clinico Humanitas IRCCS, Milan, Italy
| | - Marco Russano
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy; Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom
| | - Alessio Cortellini
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
| | - Chiara Catania
- Oncology Department, Humanitas Gavazzeni, Bergamo, Italy
| | | | - Rossana Berardi
- Clinica Oncologica, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| | - Luca Cantini
- Clinica Oncologica, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| | - Federica Pecci
- Clinica Oncologica, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| | - Marianna Macerelli
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Santa Maria Della Misericordia, Udine, Italy
| | - Rita Emili
- Oncology Unit, Ospedale Santa Maria della Misericordia, Urbino, Italy
| | - Claudia Bareggi
- Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Antonio Lugini
- Oncology Unit, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | | | | | - Michele Aieta
- Oncology Unit, IRCCS CROB, Rionero in Vulture, Italy
| | | | | | - Emanuele Vita
- Oncology Department, Policlinico Universitario Fondazione "A.Gemelli" IRCCS, Rome, Italy
| | - Salvatore Grisanti
- Medical Oncology Unit, ASST Spedali Civili di Breascia, University of Brescia, Brescia, Italy
| | - Francesco Trovò
- Electronic, Information e Bio-engeenering, Politecnico di Milano, Milan, Italy
| | - Pietro Auletta
- IPOP onlus - Associazione Insieme per i Pazienti di Oncologia Polmonare, Milan, Italy
| | - Daniele Lorenzini
- Pathology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Luca Agnelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Sabina Sangaletti
- Sperimental Oncology and Molecular Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | | | - Giuseppina Calareso
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Margherita Ruggirello
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | | | - Raffaella Vigorito
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Mario Occhipinti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Sara Manglaviti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Teresa Beninato
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Rita Leporati
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Paolo Ambrosini
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Roberta Serino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Cecilia Silvestri
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Emanuela Zito
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | | | - Vanja Miskovic
- Electronic, Information e Bio-engeenering, Politecnico di Milano, Milan, Italy
| | - Filippo de Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Giancarlo Pruneri
- Pathology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Giuseppe Lo Russo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Carlo Genova
- Medical Oncology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Andrea Vingiani
- Pathology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| |
Collapse
|
7
|
Hedayat S, Cascione L, Cunningham D, Schirripa M, Lampis A, Hahne JC, Tunariu N, Hong SP, Marchetti S, Khan K, Fontana E, Angerilli V, Delrieux M, Nava Rodrigues D, Procaccio L, Rao S, Watkins D, Starling N, Chau I, Braconi C, Fotiadis N, Begum R, Guppy N, Howell L, Valenti M, Cribbes S, Kolozsvari B, Kirkin V, Lonardi S, Ghidini M, Passalacqua R, Elghadi R, Magnani L, Pinato DJ, Di Maggio F, Ghelardi F, Sottotetti E, Vetere G, Ciraci P, Vlachogiannis G, Pietrantonio F, Cremolini C, Cortellini A, Loupakis F, Fassan M, Valeri N. Circulating microRNA analysis in a prospective co-clinical trial identifies MIR652-3p as a response biomarker and driver of regorafenib resistance mechanisms in colorectal cancer. Clin Cancer Res 2024:734699. [PMID: 38376926 DOI: 10.1158/1078-0432.ccr-23-2748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND The multi-kinase inhibitor regorafenib has demonstrated efficacy in chemo-refractory metastatic colorectal cancer (mCRC) patients. However, lack of predictive biomarkers and concerns over significant toxicities hamper the use of regorafenib in clinical practice. METHODS Serial liquid biopsies were obtained at baseline and monthly until disease progression in chemo-refractory mCRC patients treated with regorafenib in a phase II clinical trial (PROSPECT-R n=40; NCT03010722) and in a multicentric validation cohort (n=241). Tissue biopsies collected at baseline, after 2 months and at progression in the PROSPECT-R trial were used to establish Patient-Derived Organoids (PDOs) and for molecular analyses. MicroRNA profiling was performed on baseline bloods using the NanoString nCounter platform and results were validated by digital droplet PCR and/or In Situ Hybridization in paired liquid and tissue biopsies. PDOs co-cultures and PDO-xenotransplants were generated for functional analyses. RESULTS Large-scale microRNA expression analysis in longitudinal matched liquid and tissue biopsies from the PROSPECT-R trial identified MIR652-3p as a biomarker of clinical benefit to regorafenib. These findings were confirmed in an independent validation cohort and in a "control" group of 100 patients treated with lonsurf. Using ex vivo co-culture assays paired with single-cell RNA-sequencing of PDO established pre- and post-treatment, we modelled regorafenib response observed in vivo and in patients, and showed that MIR652-3p controls resistance to regorafenib by impairing regorafenib-induced lethal autophagy and by orchestrating the switch from neo-angiogenesis to vessel co-option. CONCLUSIONS Our results identify MIR652-3p as potential biomarker and as a driver of cell and non-cell autonomous mechanisms of resistance to regorafenib.
Collapse
Affiliation(s)
| | - Luciano Cascione
- IOR - Institute of Oncology Research, Bellinzona, Ticino, Switzerland
| | | | - Marta Schirripa
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, United States
| | - Andrea Lampis
- Institute of Cancer Research, Sutton, United Kingdom
| | - Jens C Hahne
- Institute of Cancer Research, Sutton, United Kingdom
| | | | - Sung Pil Hong
- Yonsei University College of Medicine, Seoul, Korea (South), Republic of
| | | | - Khurum Khan
- Institute of Cancer Research, Sutton, United Kingdom
| | - Elisa Fontana
- Sarah Cannon Research Institute, London, London, United Kingdom
| | | | - Mia Delrieux
- Institute of Cancer Research, Sutton, United Kingdom
| | | | | | - Sheela Rao
- Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | | | | | - Ian Chau
- Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | | | | | - Ruwaida Begum
- Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Naomi Guppy
- Institute of Cancer Research, London, United Kingdom
| | - Louise Howell
- Institute of Cancer Research, Sutton, Surrey, United Kingdom
| | | | | | | | | | - Sara Lonardi
- Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | | | | | | | - Luca Magnani
- Institute of Cancer Research, London, United Kingdom
| | | | | | | | | | | | - Paolo Ciraci
- Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | | | | | | | | | | | - Nicola Valeri
- Institute of Cancer Research, Sutton, London, United Kingdom
| |
Collapse
|
8
|
Mostaghim A, Minkove S, Aguilar-Company J, Ruiz-Camps I, Eremiev-Eremiev S, Dettorre GM, Fox L, Tondini C, Brunet J, Carmona-García MC, Lambertini M, Bower M, Newsom-Davis T, Sharkey R, Pria AD, Rossi M, Plaja A, Salazar R, Sureda A, Prat A, Michalarea V, Van Hemelrijck M, Sita-Lumsden A, Bertuzzi A, Rimassa L, Rossi S, Rizzo G, Pedrazzoli P, Lee AJ, Murphy C, Belessiotis K, Diamantis N, Mukherjee U, Pommeret F, Stoclin A, Martinez-Vila C, Bruna R, Gaidano G, D'Avanzo F, Gennari A, Athale J, Eichacker P, Pinato DJ, Torabi-Parizi P, Cortellini A. Previous immune checkpoint inhibitor therapy is associated with decreased COVID-19-related hospitalizations and complications in patients with cancer: Results of a propensity-matched analysis of the OnCovid registry. Int J Infect Dis 2024; 139:13-20. [PMID: 38029831 DOI: 10.1016/j.ijid.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/06/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVES To date, studies have not provided definitive answers regarding whether previous immune checkpoint inhibitor (ICI) treatment alters outcomes for cancer patients with COVID-19. METHODS The OnCovid registry (NCT04393974) was searched from February 27, 2020, to January 31, 2022, for patients who received systemic anti-cancer therapy in the 4 weeks before laboratory-confirmed COVID-19 diagnosis. Propensity-score matching using country, vaccination status, primary tumor type, sex, age, comorbidity burden, tumor stage, and remission status investigated differences in predefined clinical outcomes comparing those who had or had not received ICIs. RESULTS Of 3523 patients screened, 137 ICI-only and 1378 non-ICI met inclusion criteria. Before matching, ICI patients were older, male, enrolled at centers in Italy, and had histories of smoking, thoracic cancers, advanced cancer stages, and active malignancies (P ≤0.02). After matching, there were 120 ICI and 322 non-ICI patients. ICI patients had no differences (odds ratio: 95% CI) in presenting COVID-19 symptoms (0.69: 0.37-1.28), receipt of COVID-specific therapy (0.88: 0.54-1.41), 14-day (0.95: 0.56-1.61), or 28-day (0.79: 0.48-1.29) mortalities. However, ICI patients required less COVID-19-related hospitalization (0.37: 0.21-0.67) and oxygen therapy (0.51: 0.31-0.83) and developed fewer complications (0.57: 0.36-0.92). CONCLUSION In this propensity-score matched analysis, previous ICI therapy did not worsen and potentially improved COVID-19 outcomes in patients with cancer.
Collapse
Affiliation(s)
- Anahita Mostaghim
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, USA; Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, USA
| | - Samuel Minkove
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, USA
| | - Juan Aguilar-Company
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain; Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Isabel Ruiz-Camps
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain; Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Simeon Eremiev-Eremiev
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain; Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Gino M Dettorre
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, USA
| | - Laura Fox
- Department of Hematology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Carlo Tondini
- Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Joan Brunet
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - MCarmen Carmona-García
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Matteo Lambertini
- Medical Oncology Department, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Thomas Newsom-Davis
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Rachel Sharkey
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Alessia Dalla Pria
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Maura Rossi
- Oncology Unit, Azienda Ospedaliera "SS Antonio e Biagio e Cesare Arrigo", Alessandria, Italy
| | - Andrea Plaja
- Medical Oncology Department, B-ARGO Group, IGTP, Catalan Institute of Oncology-Badalona, Spain
| | - Ramon Salazar
- Department of Medical Oncology, ICO L'Hospitalet, Oncobell Program (IDIBELL), CIBERONC, Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Sureda
- Haematology Department, ICO Hospitalet, Hospitalet de Llobregat, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain; Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - Vasiliki Michalarea
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Mieke Van Hemelrijck
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK; Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Ailsa Sita-Lumsden
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Alexia Bertuzzi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Milan, Italy
| | - Sabrina Rossi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Gianpiero Rizzo
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Alvin Jx Lee
- Cancer Division, University College London Hospital, London, UK
| | - Cian Murphy
- Cancer Division, University College London Hospital, London, UK
| | | | | | - Uma Mukherjee
- Medical Oncology, Barts Health NHS Trust, London, UK
| | - Fanny Pommeret
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, Villejuif, France
| | - Annabelle Stoclin
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, Villejuif, France
| | | | - Riccardo Bruna
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and Ospedale Maggiore della Carità Hospital, Novara, Italy
| | - Gianluca Gaidano
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and Ospedale Maggiore della Carità Hospital, Novara, Italy
| | - Francesca D'Avanzo
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Alessandra Gennari
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Janhavi Athale
- Critical Care Medicine, Mayo Clinic Arizona, Phoenix, USA
| | - Peter Eichacker
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, USA
| | - David J Pinato
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; Department of Surgery and Cancer, Imperial College of London, Hammersmith Hospital Campus, London, UK
| | - Parizad Torabi-Parizi
- Critical Care Medicine Department, Clinical Center and National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - Alessio Cortellini
- Department of Surgery and Cancer, Imperial College of London, Hammersmith Hospital Campus, London, UK; Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Roma, Italy.
| |
Collapse
|
9
|
Balcar L, Scheiner B, Fulgenzi CAM, D’Alessio A, Pomej K, Roig MB, Meyer EL, Che J, Nishida N, Lee PC, Wu L, Ang C, Krall A, Saeed A, Stefanini B, Cammarota A, Pressiani T, Abugabal YI, Chamseddine S, Wietharn B, Parisi A, Huang YH, Phen S, Vivaldi C, Salani F, Masi G, Bettinger D, Vogel A, von Felden J, Schulze K, Silletta M, Trauner M, Samson A, Wege H, Piscaglia F, Galle PR, Stauber R, Kudo M, Singal AG, Itani A, Ulahannan SV, Parikh ND, Cortellini A, Kaseb A, Rimassa L, Chon HJ, Pinato DJ, Pinter M. A meta-analysis and real-world cohort study on the sex-related differences in efficacy and safety of immunotherapy for hepatocellular carcinoma. JHEP Rep 2024; 6:100982. [PMID: 38274490 PMCID: PMC10809085 DOI: 10.1016/j.jhepr.2023.100982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/15/2023] [Accepted: 11/30/2023] [Indexed: 01/27/2024] Open
Abstract
Background & Aims Sex-related differences in the immune pathogenesis of hepatocellular carcinoma (HCC), particularly related to oestrogen-dependent secretion of pro-tumourigenic cytokines, are well-known. Whether sex influences the efficacy and safety of immunotherapy is not known. Methods We performed a restricted maximum likelihood random effects meta-analysis of five phase III trials that evaluated immune checkpoint inhibitors (ICIs) in advanced HCC and reported overall survival (OS) hazard ratios (HRs) stratified by sex to evaluate sex-related differences in OS. In a real-world cohort of 840 patients with HCC from 22 centres included between 2018 and 2023, we directly compared the efficacy and safety of atezolizumab + bevacizumab (A+B) between sexes. Radiological response was reported according to RECIST v1.1. Uni- and multivariable Cox regression analyses were performed for OS and progression-free survival (PFS). Results In the meta-analysis, immunotherapy was associated with a significant OS benefit only in male (pooled HR 0.79; 95% CI 0.73-0.86) but not in female (pooled HR 0.85; 95% CI 0.70-1.03) patients with HCC. When directly comparing model estimates, no differences in the treatment effect between sexes were observed. Among 840 patients, 677 (81%) were male (mean age 66 ± 11 years), and 163 (19%) were female (mean age 67 ± 12 years). Type and severity of adverse events were similar between the two groups. OS and PFS were comparable between males and females upon uni- and multivariable analyses (aHR for OS and PFS: 0.79, 95% CI 0.59-1.04; 1.02, 95% CI 0.80-1.30, respectively). Objective response rates (24%/22%) and disease control rates (59%/59%) were also similar between sexes. Conclusion Female phase III trial participants experienced smaller OS benefit following ICI therapy for advanced HCC, while outcomes following A+B treatment were comparable between sexes in a large real-world database. Based on the ambiguous sex-related differences in survival observed here, further investigation of sex-specific clinical and biologic determinants of responsiveness and survival following ICIs are warranted. Impact and implications While immune checkpoint inhibitors have emerged as standard of care for the treatment of hepatocellular carcinoma, there are conflicting reports on whether the efficacy of cancer immunotherapy differs between females and males. Our study suggests ambiguous sex-related differences in outcomes from immunotherapy in hepatocellular carcinoma. Further investigation of sex-specific clustering in clinicopathologic and immunologic determinants of responsiveness to immune checkpoint inhibitor therapy should be prioritised. Systematic review registration PROSPERO CRD42023429625.
Collapse
Affiliation(s)
- Lorenz Balcar
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Liver Cancer (HCC) Study Group Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Bernhard Scheiner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Liver Cancer (HCC) Study Group Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Claudia Angela Maria Fulgenzi
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Antonio D’Alessio
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Katharina Pomej
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Liver Cancer (HCC) Study Group Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Marta Bofill Roig
- Section for Medical Statistics, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Elias Laurin Meyer
- Section for Medical Statistics, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
- Berry Consultants, Vienna, Austria
| | - Jaekyung Che
- Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Centre, CHA University, Seongnam, Republic of Korea
| | - Naoshi Nishida
- Department of Gastroenterology and Hepatology, Kindai University, Faculty of Medicine, Osaka, Japan
| | - Pei-Chang Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Linda Wu
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA
| | - Celina Ang
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA
| | - Anja Krall
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Anwaar Saeed
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh (UPMC), Pittsburgh, PA, USA
| | - Bernardo Stefanini
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonella Cammarota
- Drug Development Unit, Sarah Cannon Research Institute UK, London, UK
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Yehia I. Abugabal
- Dept of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shadi Chamseddine
- Dept of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brooke Wietharn
- Division of Medical Oncology, Department of Medicine, University of Kansas Cancer Center, Westwood, KS, USA
| | - Alessandro Parisi
- Department of Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Yi-Hsiang Huang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan; Healthcare and Services Center, Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Samuel Phen
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Caterina Vivaldi
- Unit of Medical Oncology 2, University Hospital of Pisa, Pisa, Italy
| | - Francesca Salani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Gianluca Masi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Dominik Bettinger
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology, and Infectious Diseases), Freiburg University Medical Centre, Freiburg, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Johann von Felden
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Kornelius Schulze
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Marianna Silletta
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Adel Samson
- Leeds Institute of Medical Research at St. James's (LIMR), School of Medicine, Faculty of Medicine and Health, University of Leeds, St James's University Hospital, Leeds, UK
| | - Henning Wege
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Peter R. Galle
- I. Medical Department, University Medical Centre Mainz, Mainz, Germany
| | - Rudolf Stauber
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University, Faculty of Medicine, Osaka, Japan
| | - Amit G. Singal
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Aleena Itani
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Susanna V. Ulahannan
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Neehar D. Parikh
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Alessio Cortellini
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Ahmed Kaseb
- Dept of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Hong Jae Chon
- Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Centre, CHA University, Seongnam, Republic of Korea
| | - David J. Pinato
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Matthias Pinter
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Liver Cancer (HCC) Study Group Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
10
|
Vincenzi B, Cortellini A, Mazzocca A, Orlando S, Romandini D, Aguilar-Company J, Ruiz-Camps I, Valverde Morales C, Eremiev-Eremiev S, Tondini C, Brunet J, Bertulli R, Provenzano S, Bower M, Generali D, Salazar R, Sureda A, Prat A, Vasiliki M, Van Hemelrijck M, Sita-Lumsden A, Bertuzzi A, Rossi S, Jackson A, Grosso F, Lee AJX, Murphy C, Belessiotis K, Mukherjee U, Pommeret F, Loizidou A, Gaidano G, Dettorre GM, Grisanti S, Tucci M, Fulgenzi CAM, Gennari A, Napolitano A, Pinato DJ. Impact of SARS-CoV-2 vaccines and recent chemotherapy on COVID-19 morbidity and mortality in patients with soft tissue sarcoma: an analysis from the OnCovid registry. Ther Adv Med Oncol 2024; 16:17588359231225028. [PMID: 38249336 PMCID: PMC10798088 DOI: 10.1177/17588359231225028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
Background To date, limited evidence exists on the impact of COVID-19 in patients with soft tissue sarcoma (STS), nor about the impact of SARS-CoV-2 vaccines and recent chemotherapy on COVID-19 morbidity and mortality in this specific population. Methods We described COVID-19 morbidity and mortality among patients with STS across 'Omicron' (15 December 2021-31 January 2022), 'Pre-vaccination' (27 February 2020-30 November 2020), and 'Alpha-Delta' phase (01 December 2020-14 December 2021) using OnCovid registry participants (NCT04393974). Case fatality rate at 28 days (CFR28) and COVID-19 severity were also described according to the SARS-CoV-2 vaccination status, while the impact of the receipt of cytotoxic chemotherapy within 4 weeks prior to COVID-19 on clinical outcomes was assessed with Inverse Probability of Treatment Weighting (IPTW) models adjusted for possible confounders. Results Out of 3820 patients, 97 patients with STS were included. The median age at COVID-19 diagnosis was 56 years (range: 18-92), with 65 patients (67%) aged < 65 years and most patients had a low comorbidity burden (65, 67.0%). The most frequent primary tumor sites were the abdomen (56.7%) and the gynecological tract (12.4%). In total, 36 (37.1%) patients were on cytotoxic chemotherapy within 4 weeks prior to COVID-19. The overall CFR28 was 25.8%, with 38% oxygen therapy requirement, 34% rate of complications, and 32.3% of hospitalizations due to COVID-19. CFR28 (29.5%, 21.4%, and 12.5%) and all indicators of COVID-19 severity demonstrated a trend toward a numerical improvement across the pandemic phases. Similarly, vaccinated patients demonstrated numerically improved CFR28 (16.7% versus 27.7%) and COVID-19 morbidity compared with unvaccinated patients. Patients who were on chemotherapy experienced comparable CFR28 (19.4% versus 26.0%, p = 0.4803), hospitalizations (50.0% versus 44.4%, p = 0.6883), complication rates (30.6% versus 34.0%, p = 0.7381), and oxygen therapy requirement (28.1% versus 40.0%, p = 0.2755) compared to those who were not on anticancer therapy at COVID-19, findings further confirmed by the IPTW-fitted multivariable analysis. Conclusion In this study, we demonstrate an improvement in COVID-19 outcomes in patients with STS over time. Recent exposure to chemotherapy does not impact COVID-19 morbidity and mortality and SARS-CoV-2 vaccination confers protection against adverse outcomes from COVID-19 in this patient population.
Collapse
Affiliation(s)
- Bruno Vincenzi
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Alessio Cortellini
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Department of Surgery and Cancer, Imperial College of London, Hammersmith Hospital Campus, Du Cane Road, London, UK
| | - Alessandro Mazzocca
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Sarah Orlando
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Davide Romandini
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Juan Aguilar-Company
- Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
- Infectious Diseases, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Isabel Ruiz-Camps
- Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
- Infectious Diseases, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Claudia Valverde Morales
- Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), IOB-Quiron, UVic-UCC, Barcelona, Spain
| | - Simeon Eremiev-Eremiev
- Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
- Infectious Diseases, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Carlo Tondini
- Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Joan Brunet
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Rossella Bertulli
- Medical Oncology 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Provenzano
- Medical Oncology 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Daniele Generali
- Multidisciplinary Breast Pathology and Translational Research Unit, ASST Cremona, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
| | - Ramon Salazar
- Department of Medical Oncology, ICO L’Hospitalet, Oncobell Program (IDIBELL), CIBERONC, Hospitalet de Llobregat, Spain
| | - Anna Sureda
- Haematology Department, ICO Hospitalet, Hospitalet de Llobregat, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
- Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - Michalarea Vasiliki
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
| | - Mieke Van Hemelrijck
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - Ailsa Sita-Lumsden
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
| | - Alexia Bertuzzi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Sabrina Rossi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Federica Grosso
- Mesothelioma Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alvin J. X. Lee
- Cancer Division, University College London Hospital, London, UK
| | - Cian Murphy
- Cancer Division, University College London Hospital, London, UK
| | | | - Uma Mukherjee
- Medical Oncology, Barts Health NHS Trust, London, UK
| | - Fanny Pommeret
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, Villejuif, France
| | - Angela Loizidou
- Department of Infectious Diseases, Internal Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Gianluca Gaidano
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and Ospedale Maggiore della Carità Hospital, Novara, Italy
| | - Gino M. Dettorre
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Marco Tucci
- Section of Medical Oncology, Department of Interdisciplinary Medicine (DIM), University of Bari ‘Aldo Moro’, Bari, Italy
- IRCCS, Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Claudia A. M. Fulgenzi
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Department of Surgery and Cancer, Imperial College of London, Hammersmith Hospital Campus, London, UK
| | - Alessandra Gennari
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | | | - David J. Pinato
- Department of Surgery and Cancer, Imperial College of London, Hammersmith Hospital Campus, London, UK
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| |
Collapse
|
11
|
Fujiwara Y, Horita N, Adib E, Zhou S, Nassar AH, Asad ZUA, Cortellini A, Naqash AR. Treatment-related adverse events, including fatal toxicities, in patients with solid tumours receiving neoadjuvant and adjuvant immune checkpoint blockade: a systematic review and meta-analysis of randomised controlled trials. Lancet Oncol 2024; 25:62-75. [PMID: 38012893 DOI: 10.1016/s1470-2045(23)00524-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Incorporating immune checkpoint blockade into perioperative cancer therapy has improved clinical outcomes. However, the safety of immune checkpoint blockade needs better evaluation, given the chances of more prolonged disease-free survival. We aimed to assess how adding immune checkpoint blockade to perioperative therapy affects treatment-related adverse events. METHODS For this systematic review and meta-analysis, we searched PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library from database inception until Aug 8, 2023, for randomised controlled trials that assessed the addition of immune checkpoint blockade to neoadjuvant or adjuvant therapy for cancer, reported treatment-related deaths, and had a design in which the experimental group assessed immune checkpoint blockade in combination with the therapy used in the control group. Meta-analysis was done to pool odds ratios (ORs) of treatment-related deaths, any grade and grade 3-4 treatment-related adverse events, serious adverse events, and adverse events leading to treatment discontinuation. The protocol is registered with PROSPERO, CRD42022343741. FINDINGS 28 randomised controlled trials with 16 976 patients were included. The addition of immune checkpoint blockade was not significantly associated with increased treatment-related deaths (OR 1·76, 95% CI 0·95-3·25; p=0·073), consistent across immune checkpoint blockade subtype (I2=0%). 40 fatal toxicities were identified across 9864 patients treated with immune checkpoint blockade, with pneumonitis being the most common (six [15·0%]); 13 fatal toxicities occurred among 7112 patients who were not treated with immune checkpoint blockade. The addition of immune checkpoint blockade increased the incidence of grade 3-4 treatment-related adverse events (OR 2·73, 95% CI 1·98-3·76; p<0·0001), adverse events leading to treatment discontinuation (3·67, 2·45-5·51; p<0·0001), and treatment-related adverse events of any grade (2·60 [1·88-3·61], p<0·0001). The immune checkpoint blockade versus placebo design primarily used as adjuvant therapy was associated with increased incidence of treatment-related deaths (4·02, 1·04-15·63; p=0·044) and grade 3-4 adverse events (5·31, 3·08-9·15; p<0·0001), whereas the addition of immune checkpoint blockade in the neoadjuvant setting was not associated with increased incidence of treatment-related death (1·11, 95% CI 0·38-3·29; p=0·84) or grade 3-4 adverse events (1·17, 0·90-1·51; p=0·23). INTERPRETATION The addition of immune checkpoint blockade to perioperative therapy was associated with an increase in grade 3-4 treatment-related adverse events and adverse events leading to treatment discontinuation. These findings provide safety insights for further clinical trials assessing neoadjuvant or adjuvant immune checkpoint blockade therapy. Clinicians should closely monitor patients for treatment-related adverse events to prevent treatment discontinuations and morbidity from these therapies in earlier-stage settings. FUNDING None.
Collapse
Affiliation(s)
- Yu Fujiwara
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA; Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Nobuyuki Horita
- Chemotherapy Center, Yokohama City University Hospital, Kanazawa-ku, Yokohama, Japan
| | - Elio Adib
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Susu Zhou
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Amin H Nassar
- Department of Hematology/Oncology, Yale New Haven Hospital, New Haven, CT, USA
| | - Zain Ul Abideen Asad
- Department of Cardiovascular Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Alessio Cortellini
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy; Department of Surgery and Cancer, Imperial College London, London, UK
| | - Abdul Rafeh Naqash
- Medical Oncology/TSET Phase 1 Program, Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA.
| |
Collapse
|
12
|
El Zarif T, Nassar AH, Pond GR, Zhuang TZ, Master V, Nazha B, Niglio S, Simon N, Hahn AW, Pettaway CA, Tu SM, Abdel-Wahab N, Velev M, Flippot R, Buti S, Maruzzo M, Mittra A, Gheeya J, Yang Y, Rodriguez PA, Castellano D, de Velasco G, Roviello G, Antonuzzo L, McKay RR, Vincenzi B, Cortellini A, Hui G, Drakaki A, Glover M, Khaki AR, El-Am E, Adra N, Mouhieddine TH, Patel V, Piedra A, Gernone A, Davis NB, Matthews H, Harrison MR, Kanesvaran R, Giudice GC, Barata P, Farolfi A, Lee JL, Milowsky MI, Stahlfeld C, Appleman L, Kim JW, Freeman D, Choueiri TK, Spiess PE, Necchi A, Apolo AB, Sonpavde GP. Safety and efficacy of immune checkpoint inhibitors in advanced penile cancer: report from the Global Society of Rare Genitourinary Tumors. J Natl Cancer Inst 2023; 115:1605-1615. [PMID: 37563779 DOI: 10.1093/jnci/djad155] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/26/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Treatment options for penile squamous cell carcinoma are limited. We sought to investigate clinical outcomes and safety profiles of patients with penile squamous cell carcinoma receiving immune checkpoint inhibitors. METHODS This retrospective study included patients with locally advanced or metastatic penile squamous cell carcinoma receiving immune checkpoint inhibitors between 2015 and 2022 across 24 centers in the United States, Europe, and Asia. Overall survival and progression-free survival were estimated using the Kaplan-Meier method. Objective response rates were determined per Response Evaluation Criteria in Solid Tumours 1.1 criteria. Treatment-related adverse events were graded per the Common Terminology Criteria for Adverse Events, version 5.0. Two-sided statistical tests were used for comparisons. RESULTS Among 92 patients, 8 (8.7%) were Asian, 6 (6.5%) were Black, and 24 (29%) were Hispanic and/or Latinx. Median (interquartile range) age was 62 (53-70) years. In all, 83 (90%) had metastatic penile squamous cell carcinoma, and 74 (80%) had received at least second-line treatment. Most patients received pembrolizumab monotherapy (n = 26 [28%]), combination nivolumab-ipilimumab with or without multitargeted tyrosine kinase inhibitors (n = 23 [25%]), or nivolumab (n = 16 [17%]) or cemiplimab (n = 15 [16%]) monotherapies. Median overall and progression-free survival were 9.8 months (95% confidence interval = 7.7 to 12.8 months) and 3.2 months (95% confidence interval = 2.5 to 4.2 months), respectively. The objective response rate was 13% (n = 11/85) in the overall cohort and 35% (n = 7/20) in patients with lymph node-only metastases. Visceral metastases, Eastern Cooperative Oncology Group (ECOG) performance status of 1 or higher, and a higher neutrophil/lymphocyte ratio were associated with worse overall survival. Treatment-related adverse events occurred in 27 (29%) patients, and 9.8% (n = 9) of the events were grade 3 or higher. CONCLUSIONS Immune checkpoint inhibitors are active in a subset of patients with penile squamous cell carcinoma. Future translational studies are warranted to identify patients more likely to derive clinical benefit from immune checkpoint inhibitors.
Collapse
Affiliation(s)
- Talal El Zarif
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
- Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Amin H Nassar
- Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Gregory R Pond
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Tony Zibo Zhuang
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Viraj Master
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Bassel Nazha
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Scot Niglio
- New York University Grossman School of Medicine, New York, NY, USA
| | - Nicholas Simon
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrew W Hahn
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Shi-Ming Tu
- Division of Hematology and Oncology, University of Arkansas for Medical Sciences, Winthrop P. Rockefeller Cancer Institute, Little Rock, AR, USA
| | - Noha Abdel-Wahab
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Assiut University Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt
| | - Maud Velev
- Département d'Innovation Thérapeutique et Essais Précoces, Gustave Roussy-Paris-Saclay University, Villejuif, France
| | - Ronan Flippot
- Medical Oncology Department, Institute Gustave Roussy, Villejuif, France
| | - Sebastiano Buti
- Department of Medicine and Surgery, Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Marco Maruzzo
- Oncology 1 Unit, Istituto Oncologico Veneto IOV-Istituto Di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Arjun Mittra
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Jinesh Gheeya
- Genitourinary Oncology Section, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center-James Cancer Hospital, Columbus, OH, USA
| | - Yuanquan Yang
- Genitourinary Oncology Section, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center-James Cancer Hospital, Columbus, OH, USA
| | | | - Daniel Castellano
- Department of Medical Oncology, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Guillermo de Velasco
- Department of Medical Oncology, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Giandomenico Roviello
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Rana R McKay
- University of California San Diego, San Diego, CA, USA
| | - Bruno Vincenzi
- Medical Oncology Department, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Alessio Cortellini
- Medical Oncology Department, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom
| | - Gavin Hui
- University of California Los Angeles, Los Angeles, CA, USA
| | | | - Michael Glover
- Division of Medical Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Ali Raza Khaki
- Division of Medical Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Edward El-Am
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nabil Adra
- Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Tarek H Mouhieddine
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vaibhav Patel
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aida Piedra
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Nancy B Davis
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harrison Matthews
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA
| | - Michael R Harrison
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA
| | | | - Giulia Claire Giudice
- Department of Medicine and Surgery, Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Pedro Barata
- University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Alberto Farolfi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," Meldola, Italy
| | - Jae Lyun Lee
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Matthew I Milowsky
- University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Charlotte Stahlfeld
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Leonard Appleman
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joseph W Kim
- Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Dory Freeman
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Toni K Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Andrea Necchi
- Department of Genitourinary Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea B Apolo
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Guru P Sonpavde
- Division of Medical Oncology, Advent Health Cancer Institute, Orlando, FL, USA
| |
Collapse
|
13
|
Anpalakhan S, Signori A, Cortellini A, Verzoni E, Giusti R, Aprile G, Ermacora P, Catino A, Pipitone S, Di Napoli M, Scotti V, Mazzoni F, Guglielmini PF, Veccia A, Maruzzo M, Schinzari G, Casadei C, Grossi F, Rizzo M, Montesarchio V, Verderame F, Mencoboni M, Zustovich F, Fratino L, Accettura C, Cinieri S, Tondini CA, Camerini A, Banzi MC, Sorarù M, Zucali PA, Vignani F, Ricciardi S, Russo A, Cosenza A, Di Maio M, De Giorgi U, Pignata S, Giannarelli D, Pinto C, Buti S, Fornarini G, Rebuzzi SE, Rescigno P, Addeo A, Banna GL, Bersanelli M. Using peripheral immune-inflammatory blood markers in tumors treated with immune checkpoint inhibitors: An INVIDIa-2 study sub-analysis. iScience 2023; 26:107970. [PMID: 37860695 PMCID: PMC10583024 DOI: 10.1016/j.isci.2023.107970] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/29/2023] [Accepted: 09/15/2023] [Indexed: 10/21/2023] Open
Abstract
The neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammatory index (SII) have been reported as prognosticators in non-small cell lung cancer (NSCLC), renal cell carcinoma (RCC), and melanoma. This analysis of the INVIDIa-2 study on influenza vaccination in patients with cancer treated with immune checkpoint inhibitors (ICIs) assessed NLR and SII on overall survival (OS) by literature-reported (LR), receiver operating characteristic curve (ROC)-derived (ROC) cutoffs or as continuous variable (CV). NLR and SII with ROC cutoffs of <3.4 (p < 0.001) and <831 (p < 0.001) were independent factors for OS in multivariate analysis. SII with LR, ROC, or CV significantly predicted OS in NSCLC (p = 0.002, p = 0.003, p = 0.003), RCC (p = 0.034, p = 0.014, p = 0.014), and melanoma (p = 0.038, p = 0.022, p = 0.019). NLR with LR and ROC cutoffs predicted OS in first line (p < 0.001 for both) and second line or beyond (p = 0.006 for both); likewise SII (p < 0.001; p = 0.002 and p < 0.001). NLR and SII are prognosticators in NSCLC, RCC, and melanoma treated with ICIs.
Collapse
Affiliation(s)
| | | | - Alessio Cortellini
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
| | - Elena Verzoni
- SS. Oncologia Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Raffaele Giusti
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Sant'Andrea, Roma, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Unità Locale Socio-Sanitaria (ULSS) 8 Berica-East District, Vicenza, Italy
| | - Paola Ermacora
- Department of Oncology, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Azienda Sanitaria Universitaria Integrata Friuli Centrale, Udine, Italy
| | - Annamaria Catino
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Stefania Pipitone
- Department of Oncology and Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Modena, Italy
| | - Marilena Di Napoli
- Oncologia Medica Uro-Ginecologica, Istituto Nazionale Tumori "Fondazione G. Pascale," IRCCS, Napoli, Italy
| | - Vieri Scotti
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Francesca Mazzoni
- Medical Oncology Unit, Oncology Department, Careggi University Hospital, Firenze, Italy
| | | | | | - Marco Maruzzo
- Oncologia Medica 1, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Giovanni Schinzari
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Chiara Casadei
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Italy
| | - Francesco Grossi
- Medical Oncology Division, University of Insubria, ASST dei Sette Laghi, Varese, Italy
| | - Mimma Rizzo
- Division of Translational Oncology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
- Medical Oncology Unit, Azienda Ospesaliera Universitaria Consorziale – Policlinico di Bari, Bari, Italy
| | - Vincenzo Montesarchio
- U.O.C. Oncologia, Azienda Ospedaliera Specialistica dei Colli, Ospedale Monaldi, Napoli, Italy
| | - Francesco Verderame
- Oncology Unit AO Azienda Ospedaliera Ospedali Riuniti "Villa Sofia - Cervello", Palermo, Italy
| | | | - Fable Zustovich
- UOC Oncologia di Belluno, Dipartimento di Oncologia Clinica, AULSS 1 Dolomiti, Ospedale S.Martino, Belluno, Italy
| | - Lucia Fratino
- Medical Oncology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Pordenone, Italy
| | | | - Saverio Cinieri
- Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | | | - Andrea Camerini
- Oncologia Medica, Ospedale della Versilia, Lido di Camaiore, Italy
| | - Maria Chiara Banzi
- Medical Oncology, Comprehensive Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mariella Sorarù
- Medical Oncology, Camposampiero Hospital, Camposampiero (Padua), Italy
| | - Paolo Andrea Zucali
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Oncology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesca Vignani
- Department of Oncology, University of Turin, Turin, Italy
- Medical Oncology, AO Ordine Mauriziano, Turin, Italy
| | - Serena Ricciardi
- Pulmonary Oncology Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - Antonio Russo
- Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo, Palermo, Italy
| | - Agnese Cosenza
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Turin, Italy
- Medical Oncology, AO Ordine Mauriziano, Turin, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Italy
| | - Sandro Pignata
- Oncologia Medica Uro-Ginecologica, Istituto Nazionale Tumori "Fondazione G. Pascale," IRCCS, Napoli, Italy
| | - Diana Giannarelli
- Facility of Epidemiology & Biostatistics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Carmine Pinto
- Medical Oncology, Comprehensive Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sara Elena Rebuzzi
- Medical Oncology Unit, Ospedale San Paolo, 17100 Savona, Italy
- Department of Internal Medicine and Medical Specialties (Di. M. I.), University of Genoa, Genoa, Italy
| | - Pasquale Rescigno
- Translational and Clinical Research Institute, Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | | | - Giuseppe L. Banna
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- Faculty of Science and Health, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Melissa Bersanelli
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
| |
Collapse
|
14
|
Dharmapuri S, Özbek U, Jethra H, Jun T, Marron TU, Saeed A, Huang YH, Muzaffar M, Pinter M, Balcar L, Fulgenzi C, Amara S, Weinmann A, Personeni N, Scheiner B, Pressiani T, Navaid M, Bengsch B, Paul S, Khan U, Bettinger D, Nishida N, Mohamed YI, Vogel A, Gampa A, Korolewicz J, Cammarota A, Kaseb A, Galle PR, Pillai A, Wang YH, Cortellini A, Kudo M, D’Alessio A, Rimassa L, Pinato DJ, Ang C. Baseline neutrophil-lymphocyte ratio and platelet-lymphocyte ratio appear predictive of immune treatment related toxicity in hepatocellular carcinoma. World J Gastrointest Oncol 2023; 15:1900-1912. [DOI: 10.4251/wjgo.v15.i11.1900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/14/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND A well-recognized class effect of immune checkpoint inhibitors (ICI) is immune-related adverse events (IrAEs) ranging from low grade toxicities to life-threatening end organ damage requiring permanent discontinuation of ICI. Deaths are reported in < 5% of patients treated with ICI. There are, however, no reliable markers to predict the onset and severity of IrAEs. We tested the association between neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) at baseline with development of clinically significant IrAEs (grade ≥ 2) in hepatocellular carcinoma (HCC) patients treated with ICI.
AIM To test the association between NLR and PLR at baseline with development of clinically significant IrAEs (grade ≥ 2) in HCC patients treated with ICI.
METHODS Data was extracted from an international database from a consortium of 11 tertiary-care referral centers. NLR = absolute neutrophil count/absolute lymphocyte count (ALC) and PLR = platelet count/ALC. Cutoff of 5 was used for NLR and 300 for PLR based on literature. We also tested the association between antibiotic and steroid exposure to IrAEs.
RESULTS Data was collected from 361 patients treated between 2016-2020 across the United States (67%), Asia (14%) and Europe (19%). Most patients received Nivolumab (n = 255, 71%). One hundred sixty-seven (46%) patients developed at least one IrAE, highest grade 1 in 80 (48%), grade ≥ 2 in 87 (52%) patients. In a univariable regression model PLR > 300 was significantly associated with a lower incidence of grade ≥ 2 IrAEs (OR = 0.40; P = 0.044). Similarly, a trend was observed between NLR > 5 and lower incidence of grade ≥ 2 IrAEs (OR = 0.58; P = 0.097). Multivariate analyses confirmed PLR > 300 as an independent predictive marker of grade ≥ 2 IrAEs (OR = 0.26; P = 0.011), in addition to treatment with programmed cell death ligand 1 (PD-1)/cytotoxic T lymphocyte-associated protein-4 (OR = 2.57; P = 0.037) and PD-1/tyrosine kinase inhibitor (OR = 3.39; P = 0.01) combinations. Antibiotic use was not associated with IrAE incidence (OR = 1.02; P = 0.954). Patients treated with steroids had a > 2-fold higher incidence of grade ≥ 2 IrAEs (OR = 2.74; P < 0.001), although 74% were prescribed steroids for the treatment of IrAEs.
CONCLUSION Given that high baseline NLR and PLR are associated with a decreased incidence of IrAEs, lower baseline NLR and PLR may be predictive biomarkers for the appearance of IrAEs in HCC treated with ICI. This finding is in keeping with several studies in solid tumors that have shown that baseline NLR and PLR appear predictive of IrAEs.
Collapse
Affiliation(s)
- Sirish Dharmapuri
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Umut Özbek
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Hiren Jethra
- Department of Data Analytics Harrisburg, Harrisburg University of Science and Technology, Harrisburd, PA 17101, United States
| | - Tomi Jun
- SEMA4, Stamford, CT 06902, United States
| | - Thomas U Marron
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Anwaar Saeed
- Division of Medical Oncology Kansas, University of Kansas Cancer Center, Kansas, MO 66160, United States
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Mahvish Muzaffar
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27858, United States
| | - Matthias Pinter
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna 1090, Austria
| | - Lorenz Balcar
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna 1090, Austria
| | - Claudia Fulgenzi
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital London, London W12 0HS, United Kingdom
| | - Suneetha Amara
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27858, United States
| | - Arndt Weinmann
- Department of Hepatology, Johannes Gutenberg-University Medical Centre, Niedersachsen 30625, Germany
| | - Nicola Personeni
- Medical Oncology Unit, ASST Garda, Via Lungomella Valsecchi, Brescia, Manerbio 25025, Italy
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Rozzano 20089, Italy
| | - Bernhard Scheiner
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna 1090, Austria
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Rozzano 20089, Italy
| | - Musharraf Navaid
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27858, United States
| | - Bertram Bengsch
- Department of Medicine II, Univ Med Ctr Freiburg, Hugstetter Str 55, University Hospital Freiburg, Freiburg D-79106, Germany
| | - Sonal Paul
- Department of Oncology Baltimore, LifeBridge Health, Baltimore, MD 21215, United States
| | - Uqba Khan
- Division of Hematology and Oncology, Weill Cornell Medical College, NY 10065, United States
| | - Dominik Bettinger
- Department of Medicine II, Univ Med Ctr Freiburg, Hugstetter Str 55, University Hospital Freiburg, Freiburg D-79106, Germany
| | - Naoshi Nishida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 577-8502, Japan
| | - Yehia Ibrahim Mohamed
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Arndt Vogel
- Department of Gastroenterology Hepatology and Endocrinology, HannoverArndt Vogel, Medical School Hannover, Carl-Neubergstr., Hannover 30659, Germany
| | - Anuhya Gampa
- Department of Hepatology, Rush University Medical Group 1725 W Harrison St Ste 158, Chicago, IL 60612, United States
| | - James Korolewicz
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital London, London W12 0HS, United Kingdom
| | - Antonella Cammarota
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Rozzano 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Milan, Pieve Emanuele 20072, Italy
| | - Ahmed Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Peter R Galle
- Department of Internal Medicine I and Cirrhosis Center Mainz, University Medical Center Mainz, Johannes Gutenberg Univ Mainz, Med Klin and Poliklin, Mainz D-55131, Germany
| | - Anjana Pillai
- Department of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medical Center, Chicago, IL 60637, United States
| | - Ying-Hong Wang
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital London, London W12 0HS, United Kingdom
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 577-8502, Japan
| | - Antonio D’Alessio
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital London, London W12 0HS, United Kingdom
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Rozzano 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Milan, Pieve Emanuele 20072, Italy
| | - David James Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital London, London W12 0HS, United Kingdom
| | - Celina Ang
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| |
Collapse
|
15
|
Bersanelli M, Cortellini A, Leonetti A, Parisi A, Tiseo M, Bordi P, Michiara M, Bui S, Cosenza A, Ferri L, Giudice GC, Testi I, Rapacchi E, Camisa R, Vincenzi B, Caruso G, Rauti AN, Arturi F, Tucci M, Santo V, Ricozzi V, Burtet V, Sgargi P, Todeschini R, Zustovich F, Stucci LS, Santini D, Buti S. Systematic vitamin D supplementation is associated with improved outcomes and reduced thyroid adverse events in patients with cancer treated with immune checkpoint inhibitors: results from the prospective PROVIDENCE study. Cancer Immunol Immunother 2023; 72:3707-3716. [PMID: 37638980 PMCID: PMC10576732 DOI: 10.1007/s00262-023-03522-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/10/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Hypovitaminosis D can have a negative prognostic impact in patients with cancer. Vitamin D has a demonstrated role in T-cell-mediated immune activation. We hypothesized that systematic vitamin D repletion could impact clinical outcomes in patients with cancer receiving immune-checkpoint inhibitors (ICIs). METHODS We planned a prospective observational study (PROVIDENCE) to assess serum vitamin D levels in patients with advanced cancer receiving ICIs (cohort 1 at treatment initiation, cohort 2 during treatment) and the impact of systematic repletion on survival and toxicity outcomes. In an exploratory analysis, we compared the clinical outcomes of cohort 1 with a control cohort of patients followed at the participating centers who did not receive systematic vitamin D repletion. RESULTS Overall, 164 patients were prospectively recruited in the PROVIDENCE study. In cohort 1, consisting of 101 patients with 94.1% hypovitaminosis (≤ 30 ng/ml) at baseline, adequate repletion with cholecalciferol was obtained in 70.1% at the three months re-assessment. Cohort 2 consisted of 63 patients assessed for vitamin D at a median time of 3.7 months since immunotherapy initiation, with no patients having adequate levels (> 30 ng/ml). Even in cohort 2, systematic supplementation led to adequate levels in 77.8% of patients at the three months re-assessment. Compared to a retrospective control group of 238 patients without systematic vitamin D repletion, PROVIDENCE cohort 1 showed longer overall survival (OS, p = 0.013), time to treatment failure (TTF, p = 0.017), and higher disease control rate (DCR, p = 0.016). The Inverse Probability of Treatment Weighing (IPTW) fitted multivariable Cox regression confirmed the significantly decreased risk of death (HR 0.55, 95%CI: 0.34-0.90) and treatment discontinuation (HR 0.61, 95%CI: 0.40-0.91) for patients from PROVIDENCE cohort 1 in comparison to the control cohort. In the context of longer treatment exposure, the cumulative incidence of any grade immune-related adverse events (irAEs) was higher in the PROVIDENCE cohort 1 compared to the control cohort. Nevertheless, patients from cohort 1 experienced a significantly decreased risk of all grade thyroid irAEs than the control cohort (OR 0.16, 95%CI: 0.03-0.85). CONCLUSION The PROVIDENCE study suggests the potential positive impact of early systematic vitamin D supplementation on outcomes of patients with advanced cancer receiving ICIs and support adequate repletion as a possible prophylaxis for thyroid irAEs.
Collapse
Affiliation(s)
- Melissa Bersanelli
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Gruppo Oncologico Italiano Di Ricerca Clinica (GOIRC), Parma, Italy
| | - Alessio Cortellini
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Alvaro del Portillo N° 200, 00128, Rome, Italy.
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK.
| | - Alessandro Leonetti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Gruppo Oncologico Italiano Di Ricerca Clinica (GOIRC), Parma, Italy
| | - Alessandro Parisi
- Department of Oncology, Università Politecnica Delle Marche-AOU Delle Marche, 60121, Ancona, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Gruppo Oncologico Italiano Di Ricerca Clinica (GOIRC), Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paola Bordi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Maria Michiara
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Simona Bui
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Agnese Cosenza
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Leonarda Ferri
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Giulia Claire Giudice
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Irene Testi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elena Rapacchi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Roberta Camisa
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Bruno Vincenzi
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Alvaro del Portillo N° 200, 00128, Rome, Italy
| | - Giuseppe Caruso
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Federica Arturi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marco Tucci
- Department of Interdisciplinary Medicine (DIM), University of Bari "Aldo Moro", Bari, Italy
| | - Valentina Santo
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Alvaro del Portillo N° 200, 00128, Rome, Italy
| | - Valentina Ricozzi
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Alvaro del Portillo N° 200, 00128, Rome, Italy
| | - Vanessa Burtet
- UOC Farmacia Ospedaliera, Aulss N.1 Dolomiti, Belluno Hospital, Belluno, Italy
| | - Paolo Sgargi
- Cancer Registry of Parma Province, University Hospital of Parma, Parma, Italy
| | | | - Fable Zustovich
- UOC Oncologia, Aulss N.1 Dolomiti, Belluno Hospital, Belluno, Italy
| | | | - Daniele Santini
- Oncologia Medica A, Policlinico Umberto 1, La Sapienza Università Di Roma, Rome, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Gruppo Oncologico Italiano Di Ricerca Clinica (GOIRC), Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| |
Collapse
|
16
|
Takada K, Takamori S, Brunetti L, Crucitti P, Cortellini A. Impact of Neoadjuvant Immune Checkpoint Inhibitors on Surgery and Perioperative Complications in Patients With Non-small-cell Lung Cancer: A Systematic Review. Clin Lung Cancer 2023; 24:581-590.e5. [PMID: 37741717 DOI: 10.1016/j.cllc.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/11/2023] [Accepted: 08/31/2023] [Indexed: 09/25/2023]
Abstract
Several clinical trials are currently underway to evaluate immune checkpoint inhibitors (ICIs) as neoadjuvant treatment for patients with early-stage non-small-cell lung cancer (NSCLC), and their use in clinical practice is expected to increase in the future. Therefore, a proper assessment of surgical outcomes and perioperative complications after neoadjuvant ICIs is essential to establish recommendations and guidelines. We performed a systematic literature review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA), searching the PubMed and Scopus databases from the January 1, 2017, to the July 27, 2023, to identify potentially relevant published trials of neoadjuvant ICIs in patients with reseactable NSCLC with available information on surgical outcomes and perioperative complications. A total of 18 studies were included in the review. The rates of surgery cancellation ranged from 0% to 45.8%. Importantly, adverse events (AEs) were the least reported underlying cause, while disease progression caused from 0% to 75% of cancellations. Surgery delays ranged from 0% to 31.3% with AEs as the most frequently reported underlying cause. However, 6 out of 13 trials (46.2%) reported no surgery delays. Conversion rates from minimally invasive to open chest surgery were available for 7 trials and ranged from 0% to 53.8%. Thirty-day mortality rates ranged from 0% to 5.4%, with 11 out of 16 trials reporting 0%. A few reports described perioperative complications in detail. Considering the limited evidence available, we can preliminarily confirm that preoperative ICIs are safe and well tolerated even from the surgical perspective. Additional details on intraoperative findings from prospective controlled trials are needed to establish and disseminate guidelines and recommendations for thoracic surgeons.
Collapse
Affiliation(s)
- Kazuki Takada
- Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Shinkichi Takamori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Leonardo Brunetti
- Medical Oncology Department, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Pierfilippo Crucitti
- Thoracic Surgery Department, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Alessio Cortellini
- Medical Oncology Department, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy; Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK.
| |
Collapse
|
17
|
Mallardo D, Woodford R, Menzies AM, Zimmer L, Williamson A, Ramelyte E, Dimitriou F, Wicky A, Wallace R, Mallardo M, Cortellini A, Budillon A, Atkinson V, Sandhu S, Olivier M, Dummer R, Lorigan P, Schadendorf D, Long GV, Simeone E, Ascierto PA. The role of diabetes in metastatic melanoma patients treated with nivolumab plus relatlimab. J Transl Med 2023; 21:753. [PMID: 37880788 PMCID: PMC10601323 DOI: 10.1186/s12967-023-04607-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/08/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND The combination of nivolumab + relatlimab is superior to nivolumab alone in the treatment of naive patients and has activity in PD-1 refractory melanoma. We had previously observed a reduced expression of LAG3 in melanoma tissue from patients with type 2 diabetes. METHOD To evaluate the impact of diabetes on oncological outcomes of patients with advanced melanoma treated with nivolumab plus the LAG3 inhibitor relatlimab we performed a retrospective multicenter study. RESULTS Overall, 129 patients were included: 88 without diabetes before the treatment, 37 who were diagnosed with type 2 diabetes before the start of treatment, and 4 without diabetes before treatment who developed immune checkpoint inhibitor-induced diabetes (ICI-DM). PFS was 21.71 months (95% CI: 15.61-27.81) in patients without diabetes, 10.23 months (95% CI: 5.81-14.66) in patients with type 2 diabetes, and 50.85 months (95% CI: 23.04-78.65) in patients who developed ICI-DM. OS was 37.94 months (95% CI: 31.02-44.85) in patients without diabetes, 22.12 months (95% CI: 14.41-29.85) in those with type 2 diabetes and 57.64 months (95% CI: 42.29-72.99) in those who developed ICI-DM. Multivariate analysis showed that the presence of diabetes and LDH was correlated with OS and PFS. The mean OS was 64.63 months in subjects with low levels of glucose (< 137 mg/dl) and 36.27 months in those with high levels (hazard ratio 0.16, 95% CI: 0.04-0.58; p = 0.005). The patients whose glucose blood level increased after 3 months of treatment with nivolumab + relatinib compared to baseline (ratio of blood level at baseline/after 3 months > 1.5) had a worse prognosis than those whose glucose level had not increased. This result was observed also in subgroups treated either in first line or further lines. Patients who developed ICI-DM during the study period had better outcomes than the overall population and patients without diabetes. CONCLUSIONS LAG3 inhibition for treating metastatic or unresectable melanoma has a reduced efficacy in patients with type 2 diabetes, possibly due to a low expression of LAG3 in tumor tissue. Higher level evidence should be obtained.
Collapse
Affiliation(s)
- Domenico Mallardo
- Melanoma, Cancer Immunotherapy, and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Via Mariano Semmola, 53, 80131, Naples, Italy
| | - Rachel Woodford
- Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, NCT-West, German Cancer Consortium, Partner Site Essen and University Alliance Ruhr, Research Center One Health, Essen, Germany
| | - Andrew Williamson
- Christie NHS Foundation Trust and Division of Cancer Services, University of Manchester, Manchester, UK
| | - Egle Ramelyte
- Department of Dermatology, University of Zurich, Zurich, Switzerland
| | | | - Alexandre Wicky
- Department of Oncology, Precision Oncology Center, Lausanne University Hospital, Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | | | - Mario Mallardo
- Melanoma, Cancer Immunotherapy, and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Via Mariano Semmola, 53, 80131, Naples, Italy
| | - Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W120HS, UK
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Biomedico, Rome, Italy
| | - Alfredo Budillon
- Scientific Director, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Victoria Atkinson
- Greenslopes Private Hospital, University of Queensland QLD, Greenslopes, Australia
| | | | - Michielin Olivier
- Department of Oncology, Precision Oncology Center, Lausanne University Hospital, Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University of Zurich, Zurich, Switzerland
| | - Paul Lorigan
- Christie NHS Foundation Trust and Division of Cancer Services, University of Manchester, Manchester, UK
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, NCT-West, German Cancer Consortium, Partner Site Essen and University Alliance Ruhr, Research Center One Health, Essen, Germany
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Ester Simeone
- Melanoma, Cancer Immunotherapy, and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Via Mariano Semmola, 53, 80131, Naples, Italy
| | - Paolo A Ascierto
- Melanoma, Cancer Immunotherapy, and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Via Mariano Semmola, 53, 80131, Naples, Italy.
| |
Collapse
|
18
|
Choucair K, Nebhan C, Cortellini A, Hentzen S, Wang Y, Liu C, Giusti R, Filetti M, Ascierto PA, Vanella V, Galetta D, Catino A, Al-Bzour N, Saeed A, Cavalcante L, Pizzutilo P, Genova C, Bersanelli M, Buti S, Johnson DB, Fulgenzi CAM, Pinato DJ, Radford M, Kim C, Naqash AR, Saeed A. Characterization of Age-Associated, Neutrophil-to-Lymphocyte Ratio (NLR) and Systemic Immune-Inflammatory Index (SII) as Biomarkers of Inflammation in Geriatric Patients with Cancer Treated with Immune Checkpoint Inhibitors: Impact on Efficacy and Survival. Cancers (Basel) 2023; 15:5052. [PMID: 37894419 PMCID: PMC10605297 DOI: 10.3390/cancers15205052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Geriatric patients (≥80 years) are underrepresented in immune checkpoint inhibitor (ICIs) clinical trials. However, their unique biology may affect their response to ICIs. There are currently no established biomarkers of the response to ICIs in adult patients with cancer that can help with patient selection. METHODS We built a multicenter, international retrospective study of 885 patients (<80 years: n = 417, 47.12%; ≥80 years: n = 468, 52.88%) with different tumor types treated with ICIs between 2011 and 2021 from 11 academic centers in the U.S. and Europe. The main outcome measures were objective response rates (ORR), progression-free survival (PFS) and overall survival (OS) stratified by age and circulating inflammatory levels (neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammatory index (SII)). RESULTS Patients ≥80 years with low NLR (NLR-L) and SII (SII-L) had significantly higher ORR (vs. high NLR [NLR-H], p < 0.01 and SII-H, p < 0.05, respectively). At median follow-ups (13.03 months), and compared to SII-H, patients with SII-L had significantly longer median PFS and OS in patients <80 (p < 0.001), and ≥80 years (p < 0.001). SII-L was independently associated with longer PFS and OS (HR: 0.61 and 0.62, respectively, p < 0.01). CONCLUSION Lower inflammation pre-ICI initiation may predict an improved response and survival in geriatric patients with cancer.
Collapse
Affiliation(s)
- Khalil Choucair
- Barbara Ann Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, USA;
| | - Caroline Nebhan
- Vanderbilt-Ingram Cancer Center, Nashville, TN 37232, USA; (C.N.); (D.B.J.)
| | - Alessio Cortellini
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London SW7 2BX, UK; (A.C.); (C.A.M.F.); (D.J.P.)
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Stijn Hentzen
- Department of Medicine, Kansas University Medical Center, Kansas City, KS 66211, USA; (S.H.); (M.R.)
| | - Yinghong Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Cynthia Liu
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Raffaele Giusti
- Medical Oncology Unit, Azienda Ospedaliero Universitaria Sant’Andrea, 00189 Rome, Italy;
| | - Marco Filetti
- Phase 1 Unit, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 71013 Rome, Italy;
| | - Paolo Antonio Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, 80131 Napoli, Italy; (P.A.A.); (V.V.)
| | - Vito Vanella
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, 80131 Napoli, Italy; (P.A.A.); (V.V.)
| | - Domenico Galetta
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori Giovanni Paolo II, 70124 Bari, Italy; (D.G.); (A.C.); (P.P.)
| | - Annamaria Catino
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori Giovanni Paolo II, 70124 Bari, Italy; (D.G.); (A.C.); (P.P.)
| | - Nour Al-Bzour
- UPMC Hillman Cancer Center, Department of Medicine, Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA 15232, USA;
| | - Azhar Saeed
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT 05401, USA;
| | | | - Pamela Pizzutilo
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori Giovanni Paolo II, 70124 Bari, Italy; (D.G.); (A.C.); (P.P.)
| | - Carlo Genova
- UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
- Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova, 16126 Genova, Italy
| | | | - Sebastiano Buti
- Medicine and Surgery Department, University of Parma, 43121 Parma, Italy;
| | - Douglas B. Johnson
- Vanderbilt-Ingram Cancer Center, Nashville, TN 37232, USA; (C.N.); (D.B.J.)
| | - Claudia Angela Maria Fulgenzi
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London SW7 2BX, UK; (A.C.); (C.A.M.F.); (D.J.P.)
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - David J. Pinato
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London SW7 2BX, UK; (A.C.); (C.A.M.F.); (D.J.P.)
| | - Maluki Radford
- Department of Medicine, Kansas University Medical Center, Kansas City, KS 66211, USA; (S.H.); (M.R.)
| | - Chul Kim
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA;
| | - Abdul Rafeh Naqash
- Medical Oncology/Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73019, USA;
| | - Anwaar Saeed
- UPMC Hillman Cancer Center, Department of Medicine, Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA 15232, USA;
| |
Collapse
|
19
|
Cortellini A, D'Alessio A, Pinato DJ. Diabetes and Immune Checkpoint Inhibitors-Response. Clin Cancer Res 2023; 29:4017-4018. [PMID: 37779446 DOI: 10.1158/1078-0432.ccr-23-2097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Alessio Cortellini
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, Italy
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
| | - Antonio D'Alessio
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| |
Collapse
|
20
|
Di Nardo L, Del Regno L, Di Stefani A, Mannino M, Fossati B, Catapano S, Quattrini L, Pellegrini C, Cortellini A, Parisi A, Capoluongo E, Autilio C, Fargnoli MC, Peris K. The dynamics of circulating tumour DNA (ctDNA) during treatment reflects tumour response in advanced melanoma patients. Exp Dermatol 2023; 32:1785-1793. [PMID: 37533342 DOI: 10.1111/exd.14901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/04/2023]
Abstract
Despite the introduction of targeted (BRAFi/MEKi) and immune checkpoint inhibitors (ICIs) has significantly reduced the recurrence rate and improved the overall survival (OS) of patients with Stage III and IV melanoma, only a percentage will benefit of durable disease control. The aim of this study was to examine whether the levels of circulating tumour DNA (ctDNA) in plasma of advanced melanoma patients undergoing BRAFi/MEKi or ICIs vary according to the patients' survival outcomes (i.e. progression-free survival (PFS) and OS) and disease progression. Plasma samples of Stage III-IV melanoma patients were collected at baseline (treatment initiation) and thereafter every 3 months. Circulating BRAFV600E/K and NRASQ61R/K mutations were analysed through droplet digital PCR (ddPCR, Bio-Rad) in a total of 177 plasma samples from 48 melanoma patients (19 Stage III, 29 Stage IV). Baseline ctDNA concentration was significantly associated with OS (HR = 1.003, 95% CI = 1.000-1.006, p = 0.043) and PFS (HR = 1.004, 95% CI = 1.000-1.007, p = 0.029) independent of clinical-prognostic confounders. For each unit increase in the ∆ctDNA (concentration difference between the last follow-up and baseline) there was a 24% increased risk of disease progression, irrespective of treatment type and stage at diagnosis (OR = 1.24, 95% CI = 1.03-1.49, p = 0.020, AUC = 0.93). Patients with reduction of ctDNA level from baseline to the last follow-up had longer OS (HR = 0.14; 95% CI = 0.05-0.44, p = 0.001) and PFS (HR = 0.08; 95% CI = 0.03-0.27, p < 0.0001) compared to patients with increased ctDNA, including adjustment for confounding factors. Our findings suggest that variation of ctDNA over time during melanoma treatment reflects the clinical outcome and tumour response to therapy and might be helpful in clinical monitoring.
Collapse
Affiliation(s)
- Lucia Di Nardo
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Del Regno
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A, Gemelli - IRCCS, Rome, Italy
| | - Alessandro Di Stefani
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A, Gemelli - IRCCS, Rome, Italy
| | - Maria Mannino
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A, Gemelli - IRCCS, Rome, Italy
| | - Barbara Fossati
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A, Gemelli - IRCCS, Rome, Italy
| | - Silvia Catapano
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A, Gemelli - IRCCS, Rome, Italy
| | - Laura Quattrini
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A, Gemelli - IRCCS, Rome, Italy
| | - Cristina Pellegrini
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessio Cortellini
- Medical Oncology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Alessandro Parisi
- Department of Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ettore Capoluongo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università Federico II, Naples, Italy
- CEINGE, Advanced Biotechnology, Naples, Italy
- Department of Clinical Pathology and Genomics, Ospedale Cannizzaro, Catania, Italy
| | - Chiara Autilio
- Department of Biochemistry and Molecular Biology and Research Institute Hospital, Complutense University, Madrid, Spain
| | - Maria Concetta Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Dermatology Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Ketty Peris
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A, Gemelli - IRCCS, Rome, Italy
| |
Collapse
|
21
|
Naqash AR, McCallen JD, Mi E, Iivanainen S, Marie MA, Gramenitskaya D, Clark J, Koivunen JP, Macherla S, Jonnalagadda S, Polsani S, Jiwani RA, Hafiz M, Muzaffar M, Brunetti L, Stroud CRG, Walker PR, Wang K, Chung Y, Ruppin E, Lee SH, Yang LV, Pinato DJ, Lee JS, Cortellini A. Increased interleukin-6/C-reactive protein levels are associated with the upregulation of the adenosine pathway and serve as potential markers of therapeutic resistance to immune checkpoint inhibitor-based therapies in non-small cell lung cancer. J Immunother Cancer 2023; 11:e007310. [PMID: 37852738 PMCID: PMC10603340 DOI: 10.1136/jitc-2023-007310] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Systemic immune activation, hallmarked by C-reactive protein (CRP) and interleukin-6 (IL-6), can modulate antitumor immune responses. In this study, we evaluated the role of IL-6 and CRP in the stratification of patients with non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs). We also interrogated the underlying immunosuppressive mechanisms driven by the IL-6/CRP axis. METHODS In cohort A (n=308), we estimated the association of baseline CRP with objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) in patients with NSCLC treated with ICIs alone or with chemo-immunotherapy (Chemo-ICI). Baseline tumor bulk RNA sequencing (RNA-seq) of lung adenocarcinomas (LUADs) treated with pembrolizumab (cohort B, n=59) was used to evaluate differential expression of purine metabolism, as well as correlate IL-6 expression with PFS. CODEFACS approach was applied to deconvolve cohort B to characterize the tumor microenvironment by reconstructing the cell-type-specific transcriptome from bulk expression. Using the LUAD cohort from The Cancer Genome Atlas (TCGA) we explored the correlation between IL-6 expression and adenosine gene signatures. In a third cohort (cohort C, n=18), plasma concentrations of CRP, adenosine 2a receptor (A2aR), and IL-6 were measured using ELISA. RESULTS In cohort A, 67.2% of patients had a baseline CRP≥10 mg/L (CRP-H). Patients with CRP-H achieved shorter OS (8.6 vs 14.8 months; p=0.006), shorter PFS (3.3 vs 6.6 months; p=0.013), and lower ORR (24.7% vs 46.3%; p=0.015). After adjusting for relevant clinical variables, CRP-H was confirmed as an independent predictor of increased risk of death (HR 1.51, 95% CI: 1.09 to 2.11) and lower probability of achieving disease response (OR 0.34, 95% CI: 0.13 to 0.89). In cohort B, RNA-seq analysis demonstrated higher IL-6 expression on tumor cells of non-responders, along with a shorter PFS (p<0.05) and enrichment of the purinergic pathway. Within the TCGA LUAD cohort, tumor IL-6 expression strongly correlated with the adenosine signature (R=0.65; p<2.2e-16). Plasma analysis in cohort C demonstrated that CRP-H patients had a greater median baseline level of A2aR (6.0 ng/mL vs 1.3 ng/mL; p=0.01). CONCLUSIONS This study demonstrates CRP as a readily available blood-based prognostic biomarker in ICI-treated NSCLC. Additionally, we elucidate a potential link of the CRP/IL-6 axis with the immunosuppressive adenosine signature pathway that could drive inferior outcomes to ICIs in NSCLC and also offer novel therapeutic avenues.
Collapse
Affiliation(s)
- Abdul Rafeh Naqash
- Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Hematology / Oncology Division, East Carolina University, Greenville, South Carolina, USA
| | - Justin D McCallen
- Department of Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Emma Mi
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
| | - Sanna Iivanainen
- Oncology and Radiation Department, Oulu University Hospital, University of Oulu, MRC Oulu, Oulu, Finland
| | - Mona A Marie
- Hematology / Oncology Division, East Carolina University, Greenville, South Carolina, USA
| | - Daria Gramenitskaya
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
| | - James Clark
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
| | - Jussi Pekka Koivunen
- Oncology and Radiation Department, Oulu University Hospital, University of Oulu, MRC Oulu, Oulu, Finland
| | - Shravanti Macherla
- Hematology / Oncology Division, East Carolina University, Greenville, South Carolina, USA
| | - Sweta Jonnalagadda
- Hematology / Oncology Division, East Carolina University, Greenville, South Carolina, USA
| | - Shanker Polsani
- Hematology / Oncology Division, East Carolina University, Greenville, South Carolina, USA
| | - Rahim Ali Jiwani
- Department of Internal Medicine, East Carolina University, Greenville, NC, USA
| | - Maida Hafiz
- Division of Pulmonary Critical Care, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Division of Pulmonary and Critical Care, East Carolina University, Greenville, NC, USA
| | - Mahvish Muzaffar
- Hematology / Oncology Division, East Carolina University, Greenville, South Carolina, USA
| | - Leonardo Brunetti
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Roma, Italy, Italy
| | | | - Paul R Walker
- Hematology / Oncology Division, East Carolina University, Greenville, South Carolina, USA
- Circulogene, Birmingham, Alabama, USA
| | - Kun Wang
- Cancer Data Science Lab, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - Youngmin Chung
- Department of Artificial Intelligence, Sungkyunkwan University, Suwon, Reuplic of Korea
| | - Eytan Ruppin
- Cancer Data Science Lab, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - Se-Hoon Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Li V Yang
- Hematology / Oncology Division, East Carolina University, Greenville, South Carolina, USA
| | - David J Pinato
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Joo Sang Lee
- Department of Artificial Intelligence, Sungkyunkwan University, Suwon, Reuplic of Korea
- Department of Precision Medicine, School of Medicine, Sungkyunkwan University, Suwon, Republic of Korea
- Department of Digital Health, Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Alessio Cortellini
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Roma, Italy, Italy
| |
Collapse
|
22
|
Vithayathil M, D'Alessio A, Fulgenzi CAM, Nishida N, Schönlein M, von Felden J, Schulze K, Wege H, Saeed A, Wietharn B, Hildebrand H, Wu L, Ang C, Marron TU, Weinmann A, Galle PR, Bettinger D, Bengsch B, Vogel A, Balcar L, Scheiner B, Lee PC, Huang YH, Amara S, Muzaffar M, Naqash AR, Cammarota A, Zanuso V, Pressiani T, Pinter M, Cortellini A, Kudo M, Rimassa L, Pinato DJ, Sharma R. Impact of body mass index in patients receiving atezolizumab plus bevacizumab for hepatocellular carcinoma. Hepatol Int 2023; 17:904-914. [PMID: 37005953 PMCID: PMC10386929 DOI: 10.1007/s12072-023-10491-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/16/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Atezolizumab plus bevacizumab (Atezo/Bev) is first line-treatment for unresectable hepatocellular carcinoma (HCC). Body mass index (BMI) has demonstrated predictive value for response to immunotherapy in non-HCC cancer types. Our study investigated the effect of BMI on safety and efficacy of real-life use of Atezo/Bev for unresectable HCC. METHODS 191 consecutive patients from seven centres receiving Atezo/Bev were included in the retrospective study. Overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and disease control rate (DCR) defined by RECIST v1.1 were measured in overweight (BMI ≥ 25) and non-overweight (BMI < 25) patients. Treatment-related adverse events (trAEs) were evaluated. RESULTS Patients in the overweight cohort (n = 94) had higher rates of non-alcoholic fatty liver disease (NAFLD) and lower rates of Hepatitis B compared to non-overweight cohort (n = 97). Baseline Child-Pugh class and Barcelona Clinic Liver Cancer stage were similar between cohorts, with lower rates of extrahepatic spread in the overweight group. Overweight patients had similar OS compared to non-overweight (median OS 15.1 vs. 14.9 months; p = 0.99). BMI did not influence median PFS (7.1 vs. 6.1 months; p = 0.42), ORR (27.2% vs. 22.0%; p = 0.44) and DCR (74.1% vs. 71.9%; p = 0.46). There were higher rates of atezolizumab-related fatigue (22.3% vs. 10.3%; p = 0.02) and bevacizumab-related thrombosis (8.5% vs. 2.1%; p = 0.045) in the overweight patients, but overall trAEs and treatment discontinuation were comparable between cohorts. CONCLUSION Atezo/Bev has comparable efficacy in overweight HCC patients, with an increase in treatment-related fatigue and thrombosis. Combination therapy is safe and efficacious to use in overweight patients, including those with underlying NAFLD.
Collapse
Affiliation(s)
- Mathew Vithayathil
- Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK
| | - Antonio D'Alessio
- Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Claudia Angela Maria Fulgenzi
- Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK
- Division of Medical Oncology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Naoshi Nishida
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Martin Schönlein
- Department of Oncology, Hematology and Bone Marrow Transplantation With Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johann von Felden
- Department of Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kornelius Schulze
- Department of Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Henning Wege
- Department of Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anwaar Saeed
- Division of Medical Oncology, Department of Medicine, Kansas University Cancer Center, Kansas City, KS, USA
| | - Brooke Wietharn
- Division of Medical Oncology, Department of Medicine, Kansas University Cancer Center, Kansas City, KS, USA
| | - Hannah Hildebrand
- Division of Medical Oncology, Department of Medicine, Kansas University Cancer Center, Kansas City, KS, USA
| | - Linda Wu
- Division of Hematology/Oncology, Department of Medicine, Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA
| | - Celina Ang
- Division of Hematology/Oncology, Department of Medicine, Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA
| | - Thomas U Marron
- Division of Hematology/Oncology, Department of Medicine, Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA
| | - Arndt Weinmann
- I. Medical Department, University Medical Center Mainz, Mainz, Germany
| | - Peter R Galle
- I. Medical Department, University Medical Center Mainz, Mainz, Germany
| | - Dominik Bettinger
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Faculty of Medicine, Freiburg University Medical Center, University of Freiburg, Freiburg, Germany
| | - Bertram Bengsch
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Faculty of Medicine, Freiburg University Medical Center, University of Freiburg, Freiburg, Germany
- University of Freiburg, Signalling Research Centers BIOSS and CIBSS, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site, Freiburg, Germany
| | | | - Lorenz Balcar
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Bernhard Scheiner
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Pei-Chang Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Suneetha Amara
- Division of Hematology/Oncology, East Carolina University, Greenville, NC, USA
| | - Mahvish Muzaffar
- Division of Hematology/Oncology, East Carolina University, Greenville, NC, USA
| | - Abdul Rafeh Naqash
- Division of Hematology/Oncology, East Carolina University, Greenville, NC, USA
- Medical Oncology/TSET Phase 1 Program, Stephenson Cancer Center, University of Oklahoma, Norman, OK, USA
| | - Antonella Cammarota
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Valentina Zanuso
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Matthias Pinter
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Alessio Cortellini
- Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - David J Pinato
- Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Rohini Sharma
- Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK.
| |
Collapse
|
23
|
Castelo-Branco L, Lee R, Brandão M, Cortellini A, Freitas A, Garassino M, Geukens T, Grivas P, Halabi S, Oliveira J, Pinato DJ, Ribeiro J, Peters S, Pentheroudakis G, Warner JL, Romano E. Learning lessons from the COVID-19 pandemic for real-world evidence research in oncology-shared perspectives from international consortia. ESMO Open 2023; 8:101596. [PMID: 37418836 PMCID: PMC10277850 DOI: 10.1016/j.esmoop.2023.101596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 07/09/2023] Open
Affiliation(s)
- L Castelo-Branco
- Scientific and Medical Division, ESMO (European Society for Medical Oncology), Lugano, Switzerland; NOVA National School of Public Health, NOVA University, Lisbon, Portugal.
| | - R Lee
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester; Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK
| | - M Brandão
- Medical Oncology Department, Institut Jules Bordet, Brussels, Belgium
| | - A Cortellini
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy; Department of Surgery and Cancer, Hammersmight Hospital Campus, Imperial College London, London
| | - A Freitas
- Department of Computer Science/CRUK Manchester Institute, The University of Manchester, Manchester, UK; IDIAP Research Institute, Martigny, Switzerland
| | - M Garassino
- Department of medicine, Hematology Oncology section, The University of Chicago, Chicago, USA
| | - T Geukens
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - P Grivas
- Department of Medicine, Division of Oncology, University of Washington, Seattle; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle
| | - S Halabi
- Department of Biostatistics and Bioinformatics, Duke University, Durham, USA
| | - J Oliveira
- Department of Medicine, Instituto Português de Oncologia, Porto, Portugal
| | - D J Pinato
- Department of Surgery and Cancer, Imperial College London, London, UK; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - J Ribeiro
- Gustave Roussy, Department of Cancer Medicine, Villejuif, France
| | - S Peters
- Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - G Pentheroudakis
- Scientific and Medical Division, ESMO (European Society for Medical Oncology), Lugano, Switzerland
| | - J L Warner
- Center for Clinical Cancer Informatics and Data Science, Division of Hematology/Oncology, Department of Medicine, Brown University, Providence, USA
| | - E Romano
- Emanuela Romano Center of Cancer Immunotherapy, Department of Oncology, Institut Curie, Paris, France
| |
Collapse
|
24
|
El Zarif T, Nassar AH, Adib E, Fitzgerald BG, Huang J, Mouhieddine TH, Rubinstein PG, Nonato T, McKay RR, Li M, Mittra A, Owen DH, Baiocchi RA, Lorentsen M, Dittus C, Dizman N, Falohun A, Abdel-Wahab N, Diab A, Bankapur A, Reed A, Kim C, Arora A, Shah NJ, El-Am E, Kozaily E, Abdallah W, Al-Hader A, Abu Ghazal B, Saeed A, Drolen C, Lechner MG, Drakaki A, Baena J, Nebhan CA, Haykal T, Morse MA, Cortellini A, Pinato DJ, Dalla Pria A, Hall E, Bakalov V, Bahary N, Rajkumar A, Mangla A, Shah V, Singh P, Aboubakar Nana F, Lopetegui-Lia N, Dima D, Dobbs RW, Funchain P, Saleem R, Woodford R, Long GV, Menzies AM, Genova C, Barletta G, Puri S, Florou V, Idossa D, Saponara M, Queirolo P, Lamberti G, Addeo A, Bersanelli M, Freeman D, Xie W, Reid EG, Chiao EY, Sharon E, Johnson DB, Ramaswami R, Bower M, Emu B, Marron TU, Choueiri TK, Baden LR, Lurain K, Sonpavde GP, Naqash AR. Safety and Activity of Immune Checkpoint Inhibitors in People Living With HIV and Cancer: A Real-World Report From the Cancer Therapy Using Checkpoint Inhibitors in People Living With HIV-International (CATCH-IT) Consortium. J Clin Oncol 2023; 41:3712-3723. [PMID: 37192435 PMCID: PMC10351941 DOI: 10.1200/jco.22.02459] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/01/2023] [Accepted: 03/29/2023] [Indexed: 05/18/2023] Open
Abstract
PURPOSE Compared with people living without HIV (PWOH), people living with HIV (PWH) and cancer have traditionally been excluded from immune checkpoint inhibitor (ICI) trials. Furthermore, there is a paucity of real-world data on the use of ICIs in PWH and cancer. METHODS This retrospective study included PWH treated with anti-PD-1- or anti-PD-L1-based therapies for advanced cancers. Kaplan-Meier method was used to estimate overall survival (OS) and progression-free survival (PFS). Objective response rates (ORRs) were measured per RECIST 1.1 or other tumor-specific criteria, whenever feasible. Restricted mean survival time (RMST) was used to compare OS and PFS between matched PWH and PWOH with metastatic NSCLC (mNSCLC). RESULTS Among 390 PWH, median age was 58 years, 85% (n = 331) were males, 36% (n = 138) were Black; 70% (n = 274) received anti-PD-1/anti-PD-L1 monotherapy. Most common cancers were NSCLC (28%, n = 111), hepatocellular carcinoma ([HCC]; 11%, n = 44), and head and neck squamous cell carcinoma (HNSCC; 10%, n = 39). Seventy percent (152/216) had CD4+ T cell counts ≥200 cells/µL, and 94% (179/190) had HIV viral load <400 copies/mL. Twenty percent (79/390) had any grade immune-related adverse events (irAEs) and 7.7% (30/390) had grade ≥3 irAEs. ORRs were 69% (nonmelanoma skin cancer), 31% (NSCLC), 16% (HCC), and 11% (HNSCC). In the matched mNSCLC cohort (61 PWH v 110 PWOH), 20% (12/61) PWH and 22% (24/110) PWOH had irAEs. Adjusted 42-month RMST difference was -0.06 months (95% CI, -5.49 to 5.37; P = .98) for PFS and 2.23 months (95% CI, -4.02 to 8.48; P = .48) for OS. CONCLUSION Among PWH, ICIs demonstrated differential activity across cancer types with no excess toxicity. Safety and activity of ICIs were similar between matched cohorts of PWH and PWOH with mNSCLC.
Collapse
Affiliation(s)
| | | | - Elio Adib
- Dana-Farber Cancer Institute, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | | | | | | | - Paul G. Rubinstein
- Division of Hematology/Oncology, Ruth M. Rothstein CORE Center, Cook County Health and Hospital Systems (Cook County Hospital), University of Illinois Chicago Cancer Center, Chicago, IL
| | - Taylor Nonato
- Moores Cancer Center, The University of California San Diego, La Jolla, CA
| | - Rana R. McKay
- Moores Cancer Center, The University of California San Diego, La Jolla, CA
| | - Mingjia Li
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Arjun Mittra
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Dwight H. Owen
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Robert A. Baiocchi
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Michael Lorentsen
- Division of Hematology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Christopher Dittus
- Division of Hematology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Nazli Dizman
- Yale University School of Medicine, New Haven, CT
| | | | - Noha Abdel-Wahab
- University of Texas MD Anderson Cancer Center, Houston, TX
- Assiut University Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt
| | - Adi Diab
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anand Bankapur
- Department of Surgery, Division of Urology, Cook County Health, Chicago, IL
| | - Alexandra Reed
- Department of Surgery, Division of Urology, Cook County Health, Chicago, IL
| | - Chul Kim
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Aakriti Arora
- Medstar/Georgetown-Washington Hospital Center, Washington, DC
| | - Neil J. Shah
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Edward El-Am
- Indiana University School of Medicine, Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Elie Kozaily
- Indiana University School of Medicine, Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Wassim Abdallah
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Ahmad Al-Hader
- Indiana University School of Medicine, Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | | | - Anwaar Saeed
- Kansas University Cancer Center, Kansas City, KS
- University of Pittsburgh Hillman Cancer Center, Pittsburgh, PA
| | - Claire Drolen
- University of California Los Angeles, Los Angeles, CA
| | | | | | - Javier Baena
- 12 de Octubre University Hospital, Madrid, Spain
| | - Caroline A. Nebhan
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Tarek Haykal
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC
| | - Michael A. Morse
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC
| | - Alessio Cortellini
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - David J. Pinato
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom
- Department of Translational Medicine, Università Del Piemonte Orientale “A. Avogadro”, Novara, Italy
| | - Alessia Dalla Pria
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom
- Chelsea and Westminster Hospital, London, United Kingdom
| | - Evan Hall
- University of Washington, Seattle, WA
| | | | | | | | - Ankit Mangla
- Seidman Cancer Center, University Hospitals, Cleveland, OH
| | | | | | | | | | - Danai Dima
- Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Ryan W. Dobbs
- Division of Hematology/Oncology, Ruth M. Rothstein CORE Center, Cook County Health and Hospital Systems (Cook County Hospital), University of Illinois Chicago Cancer Center, Chicago, IL
| | - Pauline Funchain
- Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Rabia Saleem
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK
| | - Rachel Woodford
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Georgina V. Long
- Melanoma Institute Australia, Faculty of Medicine & Health, Charles Perkins Centre, The University of Sydney, and Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | | | - Carlo Genova
- UO Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Dipartimento di Medicina Interna e Specialità Mediche (DiMI), Università degli Studi di Genova, Genova, Italy
| | - Giulia Barletta
- UO Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Sonam Puri
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Vaia Florou
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Dame Idossa
- University of California San Francisco, San Francisco, CA
| | - Maristella Saponara
- Division of Melanoma and Sarcoma Medical Treatment, IEO European Institute of Oncology IRCCS Milan, Milan, Italy
| | - Paola Queirolo
- Division of Melanoma and Sarcoma Medical Treatment, IEO European Institute of Oncology IRCCS Milan, Milan, Italy
| | - Giuseppe Lamberti
- Department of Experimental, Diagnostic and Specialty Medicine, Università di Bologna, Bologna, Italy
| | - Alfredo Addeo
- Swiss Cancer Center Leman, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | | | | | | | - Erin G. Reid
- Moores Cancer Center, The University of California San Diego, La Jolla, CA
| | | | - Elad Sharon
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Douglas B. Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Ramya Ramaswami
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Mark Bower
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom
- Chelsea and Westminster Hospital, London, United Kingdom
| | - Brinda Emu
- Yale University School of Medicine, New Haven, CT
| | - Thomas U. Marron
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Kathryn Lurain
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | | |
Collapse
|
25
|
Cortellini A, D'Alessio A, Cleary S, Buti S, Bersanelli M, Bordi P, Tonini G, Vincenzi B, Tucci M, Russo A, Pantano F, Russano M, Stucci LS, Sergi MC, Falconi M, Zarzana MA, Santini D, Spagnolo F, Tanda ET, Rastelli F, Giorgi FC, Pergolesi F, Giusti R, Filetti M, Lo Bianco F, Marchetti P, Botticelli A, Gelibter A, Siringo M, Ferrari M, Marconcini R, Vitale MG, Nicolardi L, Chiari R, Ghidini M, Nigro O, Grossi F, De Tursi M, Di Marino P, Queirolo P, Bracarda S, Macrini S, Inno A, Zoratto F, Veltri E, Spoto C, Vitale MG, Cannita K, Gennari A, Morganstein DL, Mallardo D, Nibid L, Sabarese G, Brunetti L, Perrone G, Ascierto PA, Ficorella C, Pinato DJ. Type 2 Diabetes Mellitus and Efficacy Outcomes from Immune Checkpoint Blockade in Patients with Cancer. Clin Cancer Res 2023; 29:2714-2724. [PMID: 37125965 DOI: 10.1158/1078-0432.ccr-22-3116] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/14/2023] [Accepted: 04/25/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE No evidence exists as to whether type 2 diabetes mellitus (T2DM) impairs clinical outcome from immune checkpoint inhibitors (ICI) in patients with solid tumors. EXPERIMENTAL DESIGN In a large cohort of ICI recipients treated at 21 institutions from June 2014 to June 2020, we studied whether patients on glucose-lowering medications (GLM) for T2DM had shorter overall survival (OS) and progression-free survival (PFS). We used targeted transcriptomics in a subset of patients to explore differences in the tumor microenvironment (TME) of patients with or without diabetes. RESULTS A total of 1,395 patients were included. Primary tumors included non-small cell lung cancer (NSCLC; 54.7%), melanoma (24.7%), renal cell (15.0%), and other carcinomas (5.6%). After multivariable analysis, patients on GLM (n = 226, 16.2%) displayed an increased risk of death [HR, 1.29; 95% confidence interval (CI),1.07-1.56] and disease progression/death (HR, 1.21; 95% CI, 1.03-1.43) independent of number of GLM received. We matched 92 metformin-exposed patients with 363 controls and 78 patients on other oral GLM or insulin with 299 control patients. Exposure to metformin, but not other GLM, was associated with an increased risk of death (HR, 1.53; 95% CI, 1.16-2.03) and disease progression/death (HR, 1.34; 95% CI, 1.04-1.72). Patients with T2DM with higher pretreatment glycemia had higher neutrophil-to-lymphocyte ratio (P = 0.04), while exploratory tumoral transcriptomic profiling in a subset of patients (n = 22) revealed differential regulation of innate and adaptive immune pathways in patients with T2DM. CONCLUSIONS In this study, patients on GLM experienced worse outcomes from immunotherapy, independent of baseline features. Prospective studies are warranted to clarify the relative impact of metformin over a preexisting diagnosis of T2DM in influencing poorer outcomes in this population.
Collapse
Affiliation(s)
- Alessio Cortellini
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
| | - Antonio D'Alessio
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Siobhan Cleary
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
| | - Sebastiano Buti
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Paola Bordi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Giuseppe Tonini
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Bruno Vincenzi
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Marco Tucci
- Department of Interdisciplinary Medicine (DIM), University of Bari "Aldo Moro", Italy
- Medical Oncology Unit, Policlinico Hospital of Bari, Bari, Italy
| | - Alessandro Russo
- Medical Oncology, A.O. Papardo & Department of Human Pathology, University of Messina, Messina, Italy
| | - Francesco Pantano
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Marco Russano
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | | | | | - Martina Falconi
- Medical Oncology, A.O. Papardo & Department of Human Pathology, University of Messina, Messina, Italy
| | - Maria Antonietta Zarzana
- Medical Oncology, A.O. Papardo & Department of Human Pathology, University of Messina, Messina, Italy
| | - Daniele Santini
- UOC Oncologia Medica territoriale, La Sapienza University, Polo Pontino, Rome, Italy
| | | | - Enrica T Tanda
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Genetics of Rare Cancers, Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy
| | - Francesca Rastelli
- UOC Oncologia Ascoli Piceno - San Benedetto del Tronto, Ascoli Piceno, Italy
| | | | - Federica Pergolesi
- UOC Oncologia Ascoli Piceno - San Benedetto del Tronto, Ascoli Piceno, Italy
| | - Raffaele Giusti
- Azienda Ospedaliera Sant'Andrea, Sapienza University of Rome, Rome, Italy
| | - Marco Filetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
- Early Phase Trials, Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | | | - Paolo Marchetti
- Istituto Dermopatico dell'Immacolata: IDI IRCCS, Rome, Italy
| | - Andrea Botticelli
- Department of Clinical and Molecular Oncology, "Sapienza" University of Rome, Rome, Italy
| | - Alain Gelibter
- Department of Clinical and Molecular Oncology, "Sapienza" University of Rome, Rome, Italy
| | - Marco Siringo
- Department of Clinical and Molecular Oncology, "Sapienza" University of Rome, Rome, Italy
| | - Marco Ferrari
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | | | | | - Rita Chiari
- UOC Oncologia, Azienda Ospedaliera Marche Nord, Pesaro, Italy
| | - Michele Ghidini
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Olga Nigro
- Medical Oncology, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Francesco Grossi
- Medical Oncology, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
- Division of Medical Oncology, University of Insubria, Varese, Italy
| | - Michele De Tursi
- Department of Innovative Technologies in Medicine & Dentistry, University G. D'Annunzio, Chieti-Pescara, Italy
| | | | - Paola Queirolo
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sergio Bracarda
- S.C. Medical Oncology, Azienda Ospedaliera S. Maria, Terni, Italy
| | - Serena Macrini
- S.C. Medical Oncology, Azienda Ospedaliera S. Maria, Terni, Italy
| | - Alessandro Inno
- Oncology Unit, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | | | - Enzo Veltri
- Medical Oncology, Santa Maria Goretti Hospital, Latina, Italy
| | - Chiara Spoto
- Medical Oncology, Santa Maria Goretti Hospital, Latina, Italy
| | - Maria Grazia Vitale
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Katia Cannita
- Medical Oncology Unit, Department of Oncology, Teramo, Italy
| | - Alessandra Gennari
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Daniel L Morganstein
- Skin Unit, Royal Marsden Hospital, London, United Kingdom
- Department of Endocrinology, Chelsea and Westminster Hospital, London, United Kingdom
| | - Domenico Mallardo
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Lorenzo Nibid
- Pathology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Giovanna Sabarese
- Pathology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Leonardo Brunetti
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Giuseppe Perrone
- Pathology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Paolo A Ascierto
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Corrado Ficorella
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| |
Collapse
|
26
|
Bersanelli M, Verzoni E, Cortellini A, Giusti R, Calvetti L, Ermacora P, Di Napoli M, Catino A, Guadalupi V, Guaitoli G, Scotti V, Mazzoni F, Veccia A, Guglielmini PF, Perrone F, Maruzzo M, Rossi E, Casadei C, Montesarchio V, Grossi F, Rizzo M, Travagliato Liboria MG, Mencoboni M, Zustovich F, Fratino L, Accettura C, Cinieri S, Camerini A, Sorarù M, Zucali PA, Ricciardi S, Russo A, Negrini G, Banzi MC, Lacidogna G, Fornarini G, Laera L, Mucciarini C, Santoni M, Mosillo C, Bonetti A, Longo L, Sartori D, Baldini E, Guida M, Iannopollo M, Bordonaro R, Morelli MF, Tagliaferri P, Spada M, Ceribelli A, Silva RR, Nolè F, Beretta G, Giovanis P, Santini D, Luzi Fedeli S, Nanni O, Maiello E, Labianca R, Pinto C, Clemente A, Tognetto M, De Giorgi U, Pignata S, Di Maio M, Buti S, Giannarelli D. Impact of influenza vaccination on survival of patients with advanced cancer receiving immune checkpoint inhibitors (INVIDIa-2): final results of the multicentre, prospective, observational study. EClinicalMedicine 2023; 61:102044. [PMID: 37434748 PMCID: PMC10331809 DOI: 10.1016/j.eclinm.2023.102044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 07/13/2023] Open
Abstract
Background The prospective multicentre observational INVIDIa-2 study investigated the clinical effectiveness of influenza vaccination in patients with advanced cancer receiving immune checkpoint inhibitors (ICI). In this secondary analysis of the original trial, we aimed to assess the outcomes of patients to immunotherapy based on vaccine administration. Methods The original study enrolled patients with advanced solid tumours receiving ICI at 82 Italian Oncology Units from Oct 1, 2019, to Jan 31, 2020. The trial's primary endpoint was the time-adjusted incidence of influenza-like illness (ILI) until April 30, 2020, the results of which were reported previously. Secondary endpoints (data cut-off Jan 31, 2022) included the outcomes of patients to immunotherapy based on vaccine administration, for which the final results are reported herein. A propensity score matching by age, sex, performance status, primary tumour site, comorbidities, and smoking habits was planned for the present analysis. Only patients with available data for these variables were included. The outcomes of interest were overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease-control rate (DCR). Findings The original study population consisted of 1188 evaluable patients. After a propensity score matching, 1004 patients were considered (502 vaccinated and 502 unvaccinated), and 986 of them were evaluable for overall survival (OS). At the median follow-up of 20 months, the influenza vaccination demonstrated a favourable impact on the outcome receiving ICI in terms of median OS [27.0 months (CI 19.5-34.6) in vaccinated vs. 20.9 months (16.6-25.2) in unvaccinated, p = 0.003], median progression-free survival [12.5 months (CI 10.4-14.6) vs. 9.6 months (CI 7.9-11.4), p = 0.049], and disease-control rate (74.7% vs. 66.5%, p = 0.005). The multivariable analyses confirmed the favourable impact of influenza vaccination in terms of OS (HR 0.75, 95% C.I. 0.62-0.92; p = 0.005) and DCR (OR 1.47, 95% C.I. 1.11-1.96; p = 0.007). Interpretation The INVIDIa-2 study results suggest a favourable immunological impact of influenza vaccination on the outcome of cancer patients receiving ICI immunotherapy, further encouraging the vaccine recommendation in this population and supporting translational investigations about the possible synergy between antiviral and antitumour immunity. Funding The Federation of Italian Cooperative Oncology Groups (FICOG), Roche S.p.A., and Seqirus.
Collapse
Affiliation(s)
| | - Elena Verzoni
- SS.Oncologia Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alessio Cortellini
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
| | - Raffaele Giusti
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Sant’Andrea, Roma, Italy
| | - Lorenzo Calvetti
- Department of Oncology, San Bortolo General Hospital, Unità Locale Socio-Sanitaria (ULSS)8 Berica, Vicenza, Italy
| | - Paola Ermacora
- Dipartimento di Oncologia, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Azienda Sanitaria Universitaria Integrata Friuli Centrale, Udine, Italy
| | - Marilena Di Napoli
- Department of Uro Gynecological Oncology, Istituto Nazionale dei Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Annamaria Catino
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Valentina Guadalupi
- SS.Oncologia Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giorgia Guaitoli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Vieri Scotti
- SODc Radioterapia Oncologica, DAI Oncologia, AOU Careggi, Firenze, Italy
| | | | | | | | - Fabiana Perrone
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Marco Maruzzo
- Oncologia Medica 1, Dipartimento di Oncologia, Istituto Oncologico Veneto IOV–IRCCS, Padova, Italy
| | - Ernesto Rossi
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Chiara Casadei
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Vincenzo Montesarchio
- U.O.C. Oncologia, Azienda Ospedaliera Specialistica dei Colli, Ospedale Monaldi, Napoli, Italy
| | - Francesco Grossi
- Università degli Studi dell’Insubria, ASST dei Sette Laghi, Varese, Italy
| | - Mimma Rizzo
- Oncologia Traslazionale, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | - Manlio Mencoboni
- SSD Oncologia, Villa Scassi Hospital, ASL3 Regione Liguria, Genova, Italy
| | | | | | | | - Saverio Cinieri
- Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | - Andrea Camerini
- Medical Oncology, Versilia Hospital - Azienda USL Toscana Nord Ovest, Lido di Camaiore, Italy
| | - Mariella Sorarù
- Medical Oncology, Camposampiero Hospital, ULSS 6 Euganea, Padova, Italy
| | - Paolo Andrea Zucali
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Oncology, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Serena Ricciardi
- UOSD Pneumologia Oncologica, Az. Ospedal. San Camillo Forlanini, Roma, Italy
| | - Antonio Russo
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giorgia Negrini
- Oncologia Medica, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Chiara Banzi
- Medical Oncology, Comprehensive Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gaetano Lacidogna
- Department of Oncology, University of Turin, Turin, Italy
- Medical Oncology, AO Ordine Mauriziano, Turin, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Letizia Laera
- UOC di Oncologia e Oncoematologia Ente Ecclesiastico Ospedale Generale Regionale “Miulli” Acquaviva delle Fonti (BA), Italy
| | | | - Matteo Santoni
- UOC Oncologia, Ospedale Generale Provinciale di Macerata, ASUR Marche Area Vasta 3, Macerata, Italy
| | - Claudia Mosillo
- Department of Oncology, Medical & Translational Oncology, Azienda Ospedaliera Santa Maria, Terni, Italy
| | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital, Verona, Legnago, Italy
| | - Lucia Longo
- UOSD Oncologia Area Sud Azienda AUSL Modena, Sassuolo (MO), Italy
| | | | | | - Michele Guida
- Rare Tumors and Melanoma Unit, IRCCS Istituto dei Tumori “Giovanni Paolo II”, Bari, Italy
| | - Mauro Iannopollo
- SOC Oncologia, Dipartimento di Oncologia, Azienda Usl Toscana Centro, Presidio Ospedaliero SS. Cosma e Damiano - Pescia e San Jacopo, Pistoia, Italy
| | | | | | | | - Massimiliano Spada
- UOC Oncologia, Fondazione Istituto G. Giglio - C.da Pietrapollastra-Pisciotto SNC, Cefalù (PA), Italy
| | - Anna Ceribelli
- Department of Oncology, San Camillo De Lellis Hospital, Rieti, Italy
| | - Rosa Rita Silva
- Medical Oncology, ASUR Marche, Area Vasta 2, Fabriano, Italy
| | - Franco Nolè
- Medical Oncology Division of Urogenital and Head & Neck Tumours IEO, European Institute of Oncology IRCCS, Milano, Italy
| | | | - Petros Giovanis
- UOC Oncologia, Ospedale Santa Maria del Prato, Feltre, AULSS1 Dolomiti, Feltre, Italy
| | - Daniele Santini
- Oncologia Medica A, Policlinico Umberto 1, La Sapienza Università di Roma, Romaa, Italy
| | - Stefano Luzi Fedeli
- Department of Medical Oncology, AOU Ospedali Riuniti, Presidio San Salvatore, Pesaro, Italy
| | - Oriana Nanni
- Biostatistics and Clinical Research Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Evaristo Maiello
- Department of Oncology, Fondazione “Casa Sollievo della Sofferenza” IRCCS Hospital, San Giovanni Rotondo, Italy
- Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
| | - Roberto Labianca
- Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
- Medical Oncology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Carmine Pinto
- Medical Oncology, Comprehensive Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
| | - Alberto Clemente
- Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
| | - Michele Tognetto
- Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
- Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
| | - Sandro Pignata
- Department of Uro Gynecological Oncology, Istituto Nazionale dei Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
- Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Turin, Italy
- Medical Oncology, AO Ordine Mauriziano, Turin, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Medicine and Surgery Department, University of Parma, Parma, Italy
| | - Diana Giannarelli
- Facility of Epidemiology & Biostatistics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | |
Collapse
|
27
|
Pinato DJ, Li X, Mishra-Kalyani P, D’Alessio A, Fulgenzi CA, Scheiner B, Pinter M, Wei G, Schneider J, Rivera DR, Pazdur R, Theoret MR, Casak S, Lemery S, Fashoyin-Aje L, Cortellini A, Pelosof L. Association between antibiotics and adverse oncological outcomes in patients receiving targeted or immune-based therapy for hepatocellular carcinoma. JHEP Rep 2023; 5:100747. [PMID: 37197442 PMCID: PMC10183666 DOI: 10.1016/j.jhepr.2023.100747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 05/19/2023] Open
Abstract
Background & Aims Immune checkpoint inhibitors (ICIs) alone or in combination with other ICIs or vascular endothelial growth factor pathway inhibitors are therapeutic options in unresectable/metastatic hepatocellular carcinoma (HCC). Whether antibiotic (ATB) exposure affects outcome remains unclear. Methods This study retrospectively analysed an FDA database including 4,098 patients receiving ICI (n = 842) either as monotherapy (n = 258) or in combination (n = 584), tyrosine kinase inhibitor (TKI) (n = 1,968), vascular endothelial growth factor pathway inhibitors (n = 480), or placebo (n = 808) as part of nine international clinical trials. Exposure to ATB within 30 days before or after treatment initiation was correlated with overall survival (OS) and progression-free survival (PFS) across therapeutic modality before and after inverse probability of treatment weighting (IPTW). Results Of 4,098 patients with unresectable/metastatic HCC, of which 39% were of hepatitis B aetiology and 21% were of hepatitis C aetiology, 83% were males with a median age of 64 years (range 18-88), a European Collaborative Oncology Group performance status of 0 (60%), and Child-Pugh A class (98%). Overall, ATB exposure (n = 620, 15%) was associated with shorter median PFS (3.6 months in ATB-exposed vs. 4.2 months; hazard ratio [HR] 1.29; 95% CI 1.22, 1.36) and OS (8.7 months in ATB-exposed vs. 10.6 months; HR 1.36; 95% CI 1.29, 1.43). In IPTW analyses, ATB was associated with shorter PFS in patients treated with ICI (HR 1.52; 95% CI 1.34, 1.73), TKI (HR 1.29; 95% CI 1.19, 1.39), and placebo (HR 1.23; 95% CI 1.11, 1.37). Similar results were observed in IPTW analyses of OS in patients treated with ICI (HR 1.22; 95% CI 1.08, 1.38), TKI (HR 1.40; 95% CI 1.30, 1.52), and placebo (HR 1.40; 95% CI 1.25, 1.57). Conclusions Unlike other malignancies where the detrimental effect of ATB may be more prominent in ICI recipients, ATB is associated with worse outcomes in this study across different therapies for HCC including placebo. Whether ATB is causally linked to worse outcomes through disruption of the gut-liver axis remains to be demonstrated in translational studies. Impact and Implications A growing body of evidence suggests the host microbiome, frequently altered by antibiotic treatment, as an important outcome predictor in the context of immune checkpoint inhibitor therapy. In this study, we analysed the effects of early antibiotic exposure on outcomes in almost 4,100 patients with hepatocellular carcinoma treated within nine multicentre clinical trials. Interestingly, early exposure to antibiotic treatment was associated with worse outcomes not only in patients treated with immune checkpoint inhibitors but also in those treated with tyrosine kinase inhibitors and placebo. This is in contrast to data published in other malignancies, where the detrimental effect of antibiotic treatment may be more prominent in immune checkpoint inhibitor recipients, highlighting the uniqueness of hepatocellular carcinoma given the complex interplay between cirrhosis, cancer, risk of infection, and the pleiotropic effect of molecular therapies for this disease.
Collapse
Affiliation(s)
- David J. Pinato
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- Corresponding authors. Addresses: Imperial College London Hammersmith Campus, Du Cane Road, W12 0HS, London, UK. Tel.: +44-20-83833720.
| | - Xiaoxue Li
- Office of Biostatistics, Center for Drug Evaluation and Research (CDER), US FDA, Silver Spring, MD, USA
| | - Pallavi Mishra-Kalyani
- Office of Biostatistics, Center for Drug Evaluation and Research (CDER), US FDA, Silver Spring, MD, USA
| | - Antonio D’Alessio
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Claudia A.M. Fulgenzi
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
- Department of Medical Oncology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Bernhard Scheiner
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Matthias Pinter
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Guo Wei
- Oncology Center of Excellence, US FDA, Silver Spring, MD, USA
| | - Julie Schneider
- Oncology Center of Excellence, US FDA, Silver Spring, MD, USA
| | - Donna R. Rivera
- Oncology Center of Excellence, US FDA, Silver Spring, MD, USA
| | - Richard Pazdur
- Oncology Center of Excellence, US FDA, Silver Spring, MD, USA
- Office of Oncologic Diseases, Center for Drug Evaluation and Research (CDER), US FDA, Silver Spring, MD, USA
| | - Marc R. Theoret
- Oncology Center of Excellence, US FDA, Silver Spring, MD, USA
- Office of Oncologic Diseases, Center for Drug Evaluation and Research (CDER), US FDA, Silver Spring, MD, USA
| | - Sandra Casak
- Office of Oncologic Diseases, Center for Drug Evaluation and Research (CDER), US FDA, Silver Spring, MD, USA
| | - Steven Lemery
- Office of Oncologic Diseases, Center for Drug Evaluation and Research (CDER), US FDA, Silver Spring, MD, USA
| | - Lola Fashoyin-Aje
- Office of Oncologic Diseases, Center for Drug Evaluation and Research (CDER), US FDA, Silver Spring, MD, USA
| | - Alessio Cortellini
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
| | - Lorraine Pelosof
- Office of Oncologic Diseases, Center for Drug Evaluation and Research (CDER), US FDA, Silver Spring, MD, USA
- Office of Oncologic Diseases, Center for Drug Evaluation and Research (CDER), US Food and Drug Administration (FDA), 10903 New Hampshire Avenue, White Oak Building 22, Silver Spring, MD 20993, USA. Tel.: +1-240-402-6469.
| |
Collapse
|
28
|
Alessi JV, Elkrief A, Ricciuti B, Wang X, Cortellini A, Vaz VR, Lamberti G, Frias RL, Venkatraman D, Fulgenzi CAM, Pecci F, Recondo G, Di Federico A, Barrichello A, Park H, Nishino M, Hambelton GM, Egger JV, Ladanyi M, Digumarthy S, Johnson BE, Christiani DC, Lin X, Gainor JF, Lin JJ, Pinato DJ, Schoenfeld AJ, Awad MM. Clinicopathologic and Genomic Factors Impacting Efficacy of First-Line Chemoimmunotherapy in Advanced NSCLC. J Thorac Oncol 2023; 18:731-743. [PMID: 36775193 PMCID: PMC10500613 DOI: 10.1016/j.jtho.2023.01.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/17/2023] [Accepted: 01/29/2023] [Indexed: 02/12/2023]
Abstract
INTRODUCTION Although programmed cell death protein 1 and programmed death-ligand 1 (PD-L1) blockade in combination with platinum-doublet chemotherapy has become a mainstay of first-line treatment for advanced NSCLC, factors associated with efficacy of chemoimmunotherapy (CIT) are not well characterized. METHODS In this multicenter retrospective analysis, clinicopathologic and genomic data were collected from patients with advanced NSCLC (lacking sensitizing genomic alterations in EGFR and ALK) and evaluated with clinical outcomes to first-line CIT. RESULTS Among 1285 patients treated with CIT, a worsening performance status and increasing derived neutrophil-to-lymphocyte ratio in the blood were associated with a significantly reduced objective response rate (ORR), median progression-free survival (mPFS), and median overall survival (mOS). With increasing PD-L1 tumor proportion scores of less than 1%, 1% to 49%, 50% to 89%, and greater than or equal to 90%, there was a progressive improvement in ORR (32.7% versus 37.5% versus 51.6% versus 61.7%, p < 0.001), mPFS (5.0 versus 6.1 versus 6.8 versus 13.0 mo, p < 0.001), and generally mOS (12.9 versus 14.6 versus 34.7 versus 23.1 mo, p = 0.009), respectively. Of 789 NSCLCs with comprehensive genomic data, NSCLCs with a tumor mutational burden (TMB) greater than or equal to the 90th percentile had an improved ORR (53.5% versus 36.4%, p = 0.004), mPFS (10.8 versus 5.5 mo, p < 0.001), and mOS (29.2 versus 13.1 mo, p < 0.001), compared with those with a TMB less than the 90th percentile. In all-comers with nonsquamous NSCLC, the presence of an STK11, KEAP1, or SMARCA4 mutation was associated with significantly worse ORR, mPFS, and mOS to CIT (all p < 0.05); this was also observed in the KRAS-mutant subgroup of NSCLCs with co-occurring mutations in STK11, KEAP1, or SMARCA4 (all p < 0.05). In KRAS wild-type NSCLC, KEAP1 and SMARCA4 mutations were associated with a significantly shorter mPFS and mOS to CIT (all p < 0.05), but STK11 mutation status had no significant impact on mPFS (p = 0.16) or mOS (p = 0.38). CONCLUSIONS In advanced NSCLC, better patient performance status, low derived neutrophil-to-lymphocyte ratio, increasing PD-L1 expression, a very high TMB, and STK11/KEAP1/SMARCA4 wild-type status are associated with improved clinical outcomes to first-line CIT.
Collapse
Affiliation(s)
- Joao V Alessi
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Arielle Elkrief
- Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Biagio Ricciuti
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Xinan Wang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Alessio Cortellini
- Division of Cancer, Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom; Department of Medical Oncology, University Campus Bio-Medico of Rome, Italy
| | - Victor R Vaz
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Giuseppe Lamberti
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rosa L Frias
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Deepti Venkatraman
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Claudia A M Fulgenzi
- Division of Cancer, Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom; Department of Medical Oncology, University Campus Bio-Medico of Rome, Italy
| | - Federica Pecci
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gonzalo Recondo
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Adriana Barrichello
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Hyesun Park
- Department of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts; Department of Radiology, Brigham and Women's Hospital and Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Mizuki Nishino
- Department of Radiology, Brigham and Women's Hospital and Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Grace M Hambelton
- Center for Thoracic Cancers, Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Jacklynn V Egger
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marc Ladanyi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Subba Digumarthy
- Department of Radiology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Bruce E Johnson
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - David C Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Xihong Lin
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Justin F Gainor
- Center for Thoracic Cancers, Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Jessica J Lin
- Center for Thoracic Cancers, Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - David J Pinato
- Division of Cancer, Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom
| | - Adam J Schoenfeld
- Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark M Awad
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
| |
Collapse
|
29
|
Chen M, Lu H, Copley SJ, Han Y, Logan A, Viola P, Cortellini A, Pinato DJ, Power D, Aboagye EO. A Novel Radiogenomics Biomarker for Predicting Treatment Response and Pneumotoxicity From Programmed Cell Death Protein or Ligand-1 Inhibition Immunotherapy in NSCLC. J Thorac Oncol 2023; 18:718-730. [PMID: 36773776 DOI: 10.1016/j.jtho.2023.01.089] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 11/23/2022] [Accepted: 01/17/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Patient selection for checkpoint inhibitor immunotherapy is currently guided by programmed death-ligand 1 (PD-L1) expression obtained from immunohistochemical staining of tumor tissue samples. This approach is susceptible to limitations resulting from the dynamic and heterogeneous nature of cancer cells and the invasiveness of the tissue sampling procedure. To address these challenges, we developed a novel computed tomography (CT) radiomic-based signature for predicting disease response in patients with NSCLC undergoing programmed cell death protein 1 (PD-1) or PD-L1 checkpoint inhibitor immunotherapy. METHODS This retrospective study comprises a total of 194 patients with suitable CT scans out of 340. Using the radiomic features computed from segmented tumors on a discovery set of 85 contrast-enhanced chest CTs of patients diagnosed with having NSCLC and their CD274 count, RNA expression of the protein-encoding gene for PD-L1, as the response vector, we developed a composite radiomic signature, lung cancer immunotherapy-radiomics prediction vector (LCI-RPV). This was validated in two independent testing cohorts of 66 and 43 patients with NSCLC treated with PD-1 or PD-L1 inhibition immunotherapy, respectively. RESULTS LCI-RPV predicted PD-L1 positivity in both NSCLC testing cohorts (area under the curve [AUC] = 0.70, 95% confidence interval [CI]: 0.57-0.84 and AUC = 0.70, 95% CI: 0.46-0.94). In one cohort, it also demonstrated good prediction of cases with high PD-L1 expression exceeding key treatment thresholds (>50%: AUC = 0.72, 95% CI: 0.59-0.85 and >90%: AUC = 0.66, 95% CI: 0.45-0.88), the tumor's objective response to treatment at 3 months (AUC = 0.68, 95% CI: 0.52-0.85), and pneumonitis occurrence (AUC = 0.64, 95% CI: 0.48-0.80). LCI-RPV achieved statistically significant stratification of the patients into a high- and low-risk survival group (hazard ratio = 2.26, 95% CI: 1.21-4.24, p = 0.011 and hazard ratio = 2.45, 95% CI: 1.07-5.65, p = 0.035). CONCLUSIONS A CT radiomics-based signature developed from response vector CD274 can aid in evaluating patients' suitability for PD-1 or PD-L1 checkpoint inhibitor immunotherapy in NSCLC.
Collapse
Affiliation(s)
- Mitchell Chen
- Department of Surgery and Cancer, Imperial College, London, United Kingdom; Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Haonan Lu
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - Susan J Copley
- Department of Surgery and Cancer, Imperial College, London, United Kingdom; Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Yidong Han
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Andrew Logan
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Patrizia Viola
- North West London Pathology, Charing Cross Hospital, London, United Kingdom
| | - Alessio Cortellini
- Department of Surgery and Cancer, Imperial College, London, United Kingdom; Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College, London, United Kingdom; Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Danielle Power
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Eric O Aboagye
- Department of Surgery and Cancer, Imperial College, London, United Kingdom.
| |
Collapse
|
30
|
Anpalakhan S, Huddar P, Behrouzi R, Signori A, Cave J, Comins C, Cortellini A, Addeo A, Escriu C, McKenzie H, Barone G, Murray L, Pinato DJ, Ottensmeier C, Campos S, Muthuramalingam S, Chan S, Gomes F, Banna GL. Immunotherapy-related adverse events in real-world patients with advanced non-small cell lung cancer on chemoimmunotherapy: a Spinnaker study sub-analysis. Front Oncol 2023; 13:1163768. [PMID: 37324003 PMCID: PMC10265987 DOI: 10.3389/fonc.2023.1163768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Background The Spinnaker study evaluated survival outcomes and prognostic factors in patients with advanced non-small-cell lung cancer receiving first-line chemoimmunotherapy in the real world. This sub-analysis assessed the immunotherapy-related adverse effects (irAEs) seen in this cohort, their impact on overall survival (OS) and progression-free survival (PFS), and related clinical factors. Methods The Spinnaker study was a retrospective multicentre observational cohort study of patients treated with first-line pembrolizumab plus platinum-based chemotherapy in six United Kingdom and one Swiss oncology centres. Data were collected on patient characteristics, survival outcomes, frequency and severity of irAEs, and peripheral immune-inflammatory blood markers, including the neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII). Results A total of 308 patients were included; 132 (43%) experienced any grade irAE, 100 (32%) Grade 1-2, and 49 (16%) Grade 3-4 irAEs. The median OS in patients with any grade irAES was significantly longer (17.5 months [95% CI, 13.4-21.6 months]) than those without (10.1 months [95% CI, 8.3-12.0 months]) (p<0.001), either if Grade 1-2 (p=0.003) or Grade 3-4 irAEs (p=0.042). The median PFS in patients with any grade irAEs was significantly longer (10.1 months [95% CI, 9.0-11.2 months]) than those without (6.1 months [95% CI, 5.2-7.1 months]) (p<0.001), either if Grade 1-2 (p=0.011) or Grade 3-4 irAEs (p=0.036). A higher rate of irAEs of any grade and specifically Grade 1-2 irAEs correlated with NLR <4 (p=0.013 and p=0.018), SII <1,440 (p=0.029 ad p=0.039), response to treatment (p=0.001 and p=0.034), a higher rate of treatment discontinuation (p<0.00001 and p=0.041), and the NHS-Lung prognostic classes (p=0.002 and p=0.008). Conclusions These results confirm survival outcome benefits in patients with irAEs and suggest a higher likelihood of Grade 1-2 irAEs in patients with lower NLR or SII values or according to the NHS-Lung score.
Collapse
Affiliation(s)
| | - Prerana Huddar
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Roya Behrouzi
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Judith Cave
- University of Southampton, Southampton, United Kingdom
| | | | - Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | | | - Carles Escriu
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Gloria Barone
- University Hospitals of Northamptonshire, Northampton, United Kingdom
| | - Lisa Murray
- Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - David J. Pinato
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Christian Ottensmeier
- The Clatterbridge Cancer Centre NHS Foundation Trust, University of Liverpool, Liverpool, United Kingdom
| | - Sara Campos
- Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | | | - Samuel Chan
- Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Fabio Gomes
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Giuseppe L. Banna
- Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| |
Collapse
|
31
|
Tagliamento M, Gennari A, Lambertini M, Salazar R, Harbeck N, Del Mastro L, Aguilar-Company J, Bower M, Sharkey R, Dalla Pria A, Plaja A, Jackson A, Handford J, Sita-Lumsden A, Martinez-Vila C, Matas M, Miguel Rodriguez A, Vincenzi B, Tonini G, Bertuzzi A, Brunet J, Pedrazzoli P, D'Avanzo F, Biello F, Sinclair A, Lee AJ, Rossi S, Rizzo G, Mirallas O, Pimentel I, Iglesias M, Sanchez de Torre A, Guida A, Berardi R, Zambelli A, Tondini C, Filetti M, Mazzoni F, Mukherjee U, Diamantis N, Parisi A, Aujayeb A, Prat A, Libertini M, Grisanti S, Rossi M, Zoratto F, Generali D, Saura C, Lyman GH, Kuderer NM, Pinato DJ, Cortellini A. Pandemic Phase-Adjusted Analysis of COVID-19 Outcomes Reveals Reduced Intrinsic Vulnerability and Substantial Vaccine Protection From Severe Acute Respiratory Syndrome Coronavirus 2 in Patients With Breast Cancer. J Clin Oncol 2023; 41:2800-2814. [PMID: 36720089 PMCID: PMC10414724 DOI: 10.1200/jco.22.01667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/07/2022] [Accepted: 12/12/2022] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Although representing the majority of newly diagnosed cancers, patients with breast cancer appear less vulnerable to COVID-19 mortality compared with other malignancies. In the absence of patients on active cancer therapy included in vaccination trials, a contemporary real-world evaluation of outcomes during the various pandemic phases, as well as of the impact of vaccination, is needed to better inform clinical practice. METHODS We compared COVID-19 morbidity and mortality among patients with breast cancer across prevaccination (February 27, 2020-November 30, 2020), Alpha-Delta (December 1, 2020-December 14, 2021), and Omicron (December 15, 2021-January 31, 2022) phases using OnCovid registry participants (ClinicalTrials.gov identifier: NCT04393974). Twenty-eight-day case fatality rate (CFR28) and COVID-19 severity were compared in unvaccinated versus double-dosed/boosted patients (vaccinated) with inverse probability of treatment weighting models adjusted for country of origin, age, number of comorbidities, tumor stage, and receipt of systemic anticancer therapy within 1 month of COVID-19 diagnosis. RESULTS By the data lock of February 4, 2022, the registry counted 613 eligible patients with breast cancer: 60.1% (n = 312) hormone receptor-positive, 25.2% (n = 131) human epidermal growth factor receptor 2-positive, and 14.6% (n = 76) triple-negative. The majority (61%; n = 374) had localized/locally advanced disease. Median age was 62 years (interquartile range, 51-74 years). A total of 193 patients (31.5%) presented ≥ 2 comorbidities and 69% (n = 330) were never smokers. In total, 392 (63.9%), 164 (26.8%), and 57 (9.3%) were diagnosed during the prevaccination, Alpha-Delta, and Omicron phases, respectively. Analysis of CFR28 demonstrates comparable estimates of mortality across the three pandemic phases (13.9%, 12.2%, 5.3%, respectively; P = .182). Nevertheless, a significant improvement in outcome measures of COVID-19 severity across the three pandemic time periods was observed. Importantly, when reported separately, unvaccinated patients from the Alpha-Delta and Omicron phases achieved comparable outcomes to those from the prevaccination phase. Of 566 patients eligible for the vaccination analysis, 72 (12.7%) were fully vaccinated and 494 (87.3%) were unvaccinated. We confirmed with inverse probability of treatment weighting multivariable analysis and following a clustered robust correction for participating center that vaccinated patients achieved improved CFR28 (odds ratio [OR], 0.19; 95% CI, 0.09 to 0.40), hospitalization (OR, 0.28; 95% CI, 0.11 to 0.69), COVID-19 complications (OR, 0.16; 95% CI, 0.06 to 0.45), and reduced requirement of COVID-19-specific therapy (OR, 0.24; 95% CI, 0.09 to 0.63) and oxygen therapy (OR, 0.24; 95% CI, 0.09 to 0.67) compared with unvaccinated controls. CONCLUSION Our findings highlight a consistent reduction of COVID-19 severity in patients with breast cancer during the Omicron outbreak in Europe. We also demonstrate that even in this population, a complete severe acute respiratory syndrome coronavirus 2 vaccination course is a strong determinant of improved morbidity and mortality from COVID-19.
Collapse
Affiliation(s)
- Marco Tagliamento
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Alessandra Gennari
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
- Medical Oncology Department, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Ramon Salazar
- Department of Medical Oncology, ICO L'Hospitalet, Oncobell Program (IDIBELL), CIBERONC, Hospitalet de Llobregat, Barcelona, Spain
| | - Nadia Harbeck
- Department of Gynecology and Obstetrics, Breast Center and Gynecological Cancer Center and CCC Munich, University Hospital Munich, Munich, Germany
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
- Medical Oncology Department, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Juan Aguilar-Company
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
- Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, United Kingdom
| | - Rachel Sharkey
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, United Kingdom
| | - Alessia Dalla Pria
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, United Kingdom
| | - Andrea Plaja
- Medical Oncology Department, B-ARGO Group, IGTP, Catalan Institute of Oncology-Badalona, Badalona, Spain
| | | | - Jasmine Handford
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Ailsa Sita-Lumsden
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | | | | | | | - Bruno Vincenzi
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Giuseppe Tonini
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Alexia Bertuzzi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Joan Brunet
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Francesca D'Avanzo
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Federica Biello
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Alasdair Sinclair
- Cancer Division, University College London Hospitals, London, United Kingdom
| | - Alvin J.X. Lee
- Cancer Division, University College London Hospitals, London, United Kingdom
| | - Sabrina Rossi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Gianpiero Rizzo
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Oriol Mirallas
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Isabel Pimentel
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | - Annalisa Guida
- Department of Oncology, Azienda Ospedaliera Santa Maria, Terni, Italy
| | - Rossana Berardi
- Medical Oncology, AOU Ospedali Riuniti, Polytechnic University of the Marche Region, Ancona, Italy
| | | | - Carlo Tondini
- Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Uma Mukherjee
- Medical Oncology, Barts Health NHS Trust, London, United Kingdom
| | | | - Alessandro Parisi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Healthcare NHS Foundation Trust, North Shields, United Kingdom
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
- Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - Michela Libertini
- Medical Oncology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | | | - Maura Rossi
- Oncology Unit, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo,” Alessandria, Italy
| | | | - Daniele Generali
- Multidisciplinary Breast Pathology and Translational Research Unit, ASST Cremona, Cremona, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Cristina Saura
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), IOB-Quiron, UVic-UCC, Barcelona, Spain
| | - Gary H. Lyman
- Public Health Sciences Division and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
- Divisions of Public Health Science and Clinical Research, Fred Hutchinson Cancer Center, Seattle, WA
| | | | - David J. Pinato
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Alessio Cortellini
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| |
Collapse
|
32
|
Fulgenzi CAM, Scheiner B, Korolewicz J, Stikas CV, Gennari A, Vincenzi B, Openshaw MR, Silletta M, Pinter M, Cortellini A, Scotti L, D’Alessio A, Pinato DJ. Efficacy and safety of frontline systemic therapy for advanced HCC: A network meta-analysis of landmark phase III trials. JHEP Rep 2023; 5:100702. [PMID: 37025943 PMCID: PMC10070142 DOI: 10.1016/j.jhepr.2023.100702] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/11/2023] [Accepted: 02/02/2023] [Indexed: 04/08/2023] Open
Abstract
Background & Aims Direct comparisons across first-line regimens for advanced hepatocellular carcinoma are not available. We performed a network metanalysis of phase III of trials to compare first-line systemic treatments for hepatocellular carcinoma in terms of overall survival (OS), progression-free survival (PFS), objective response rate, disease control rate, and incidence of adverse events (AEs). Methods After performing a literature review from January 2008 to September 2022, we screened 6,329 studies and reviewed 3,009 studies, leading to identification of 15 phase III trials for analysis. We extracted odds ratios for objective response rate and disease control rate, relative risks for AEs, and hazard ratios (HRs) with 95% CIs for OS and PFS, and used a frequentist network metanalysis, with fixed-effect multivariable meta-regression models to estimate the indirect pooled HRs, odds ratios, relative risks, and corresponding 95% CIs, considering sorafenib as reference. Results Of 10,820 included patients, 10,444 received active treatment and 376 placebo. Sintilimab + IBI350, camrelizumab + rivoceranib, and atezolizumab + bevacizumab provided the greatest reduction in the risk of death compared with sorafenib, with HRs of 0.57 (95% CI 0.43-0.75), 0.62 (95% CI 0.49-0.79), and 0.66 (95% CI 0.52-0.84), respectively. Considering PFS, camrelizumab + rivoceranib and pembrolizumab + lenvatinib were associated with the greatest reduction in the risk of PFS events compared with sorafenib, with HRs of 0.52 (95% CI 0.41-0.65) and 0.52 (95% CI 0.35-0.77), respectively. Immune checkpoint inhibitor (ICI) monotherapies carried the lowest risk for all-grade and grade ≥3 AEs. Conclusions The combinations of ICI + anti-vascular endothelial growth factor, and double ICIs lead to the greatest OS benefit compared with sorafenib, whereas ICI + kinase inhibitor regimens are associated with greater PFS benefit at the cost of higher toxicity rates. Impact and Implications In the last few years, many different therapies have been studied for patients with primary liver cancer that cannot be treated with surgery. In these cases, anticancer drugs (alone or in combination) are given with the intent to keep the cancer at bay and, ultimately, to prolong survival. Among all the therapies that have been investigated, the combination of immunotherapy (drugs that boost the immune system against the cancer) and anti-angiogenic agents (drugs that act on tumoural vessels) has appeared the best to improve survival. Similarly, the combination of two types of immunotherapies that activate the immune system at different levels has also shown positive results. Systematic Review Registration PROSPERO CRD42022366330.
Collapse
Affiliation(s)
- Claudia Angela Maria Fulgenzi
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
- Medical Oncology Department, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Bernhard Scheiner
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - James Korolewicz
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | | | - Alessandra Gennari
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Bruno Vincenzi
- Medical Oncology Department, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | | | - Marianna Silletta
- Medical Oncology Department, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Matthias Pinter
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
- Medical Oncology Department, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Lorenza Scotti
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy
| | - Antonio D’Alessio
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - David J. Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy
- Corresponding author. Address: Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, W12 0HS, London, UK. Tel.: +44-020-83833720
| |
Collapse
|
33
|
Cantini L, Paoloni F, Pecci F, Spagnolo F, Genova C, Tanda ET, Aerts S, Rebuzzi SE, Fornarini G, Zoratto F, Fancelli S, Lupi A, Della Corte CM, Parisi A, Bennati C, Ortega C, Atzori F, Piovano PL, Orciuolo C, De Tursi M, Ghidini M, Botticelli A, Scagnoli S, Belluomini L, Leporati R, Veccia A, Di Giacomo AM, Festino L, Cortinovis D, Acquati M, Filetti M, Giusti R, Tucci M, Sergi MC, Garutti M, Puglisi F, Manglaviti S, Citarella F, Santoni M, Rijavec E, Lo Russo G, Santini D, Addeo A, Antonuzzo L, Indini A, Rocchi MBL, Cortellini A, Grossi F, Ascierto PA, Aerts JGJV, Berardi R. Safety of Extended interval Dosing Immune Checkpoint Inhibitors: a multicentre cohort study. J Natl Cancer Inst 2023:7115841. [PMID: 37042716 DOI: 10.1093/jnci/djad061] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/10/2023] [Accepted: 03/24/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Real-life spectrum and survival implications of immune-related adverse events (irAEs) in patients treated with extended interval dosing (ED) immune checkpoint inhibitors (ICIs) are unknown. METHODS Characteristics of 812 consecutive solid cancer patients who received at least one cycle of ED monotherapy (pembrolizumab 400 mg Q6W or nivolumab 480 mg Q4W) after switching from canonical interval dosing (CD, pembrolizumab 200 mg Q3W or nivolumab 240 mg Q2W) or upfront were retrieved. Primary objective was to compare irAEs patterns within the same population (before and after switch to ED). irAEs spectrum in patients treated upfront with ED and association between irAEs and overall survival (OS) were also described. RESULTS 550 (68%) patients started ICIs with CD and switched to ED. During CD, 225 pts (41%) developed any grade and 17 (3%) G3/G4 irAEs; after switching to ED, any grade and G3/G4 irAEs were experienced by 155 (36%) and 20 (5%) patients. Switching to ED was associated with a lower probability of any grade irAEs (adjusted odds ratio [aOR]: 0.83; 95% CI: 0.64-0.99; p=.047), while no difference for G3/G4 events was noted (aOR: 1.55; 95% CI: 0.81-2.94; p=.18). Among patients who started upfront with ED (n = 232, 32%), 107 (41%) developed any grade and 14 (5%) G3/G4 irAEs during ED. Patients with irAEs during ED had improved OS (aHR: 0.53; 95% CI 0.34-0.82; p=.004 after switching; aHR: 0.57; 95% CI 0.35-0.93; p=.025 upfront). CONCLUSIONS Switching ICI treatment from CD and ED did not increase the incidence of irAEs and represents a safe option also outside clinical trials.
Collapse
Affiliation(s)
- Luca Cantini
- Clinical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
- Labcorp Drug Development Inc., Princeton, NJ, USA
| | - Francesco Paoloni
- Clinical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Federica Pecci
- Clinical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Francesco Spagnolo
- Medical Oncology Unit 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Carlo Genova
- Academic Medical Oncology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genoa, Italy
| | - Enrica Teresa Tanda
- Medical Oncology Unit 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Sophie Aerts
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Sara Elena Rebuzzi
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genoa, Italy
- Medical Oncology Unit, Ospedale San Paolo, Savona, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Sara Fancelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Alessio Lupi
- Clinical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | | | - Alessandro Parisi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Chiara Bennati
- S Maria delle Croci Hospital, AUSL della Romagna, Ravenna, Italy
| | - Cinzia Ortega
- Oncology, Asl Cn2, Ospedale Michele e Pietro Ferrero, Verduno, Italy
| | - Francesco Atzori
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Pier Luigi Piovano
- Oncology Unit, Azienda Ospedaliera "SS. Antonio e Biagio e C. Arrigo", Alessandria, Italy
| | | | - Michele De Tursi
- Department of Innovative Technologies in Medicine and Dentistry, University G. D'Annunzio, Chieti-Pescara, Italy
| | - Michele Ghidini
- Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Andrea Botticelli
- Medical Oncology Unit A, Policlinico Umberto I, Radiological, Oncological, Pathological Sciences Department Sapienza University of Rome, Italy
| | | | - Lorenzo Belluomini
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Rita Leporati
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Antonello Veccia
- Medical Oncology, Santa Chiara Hospital, Largo Medaglie d'Oro 1, Trento, Italy
| | - Anna Maria Di Giacomo
- University of Siena, Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - Lucia Festino
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | | | | | - Marco Filetti
- Phase 1 Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Marco Tucci
- Medical Oncology Unit, Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Italy
| | - Maria Chiara Sergi
- Medical Oncology Unit, Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Italy
| | - Mattia Garutti
- CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - Fabio Puglisi
- CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Sara Manglaviti
- Thoracic Unit, Medical Oncology Department 1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - Fabrizio Citarella
- Department of Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | | | - Erika Rijavec
- Medical Oncology Unit, Ospedale di Circolo e Fondazione Macchi, asst Settelaghi, Varese, Italy
| | - Giuseppe Lo Russo
- Thoracic Unit, Medical Oncology Department 1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - Daniele Santini
- UOC Oncologia Medica Territoriale, Sapienza Università, Polo Pontino, Rome, Italy
| | - Alfredo Addeo
- Oncology department, University Hospital Geneva, Switzerland
| | - Lorenzo Antonuzzo
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Clinical Oncology Unit, and Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Alice Indini
- Medical Oncology Unit, Ospedale di Circolo e Fondazione Macchi, asst Settelaghi, Varese, Italy
| | | | - Alessio Cortellini
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Francesco Grossi
- Medical oncology Unit, Ospedale di Circolo e Fondazione Macchi, asst Settelaghi, University of insubria, Varese, Italy
| | - Paolo Antonio Ascierto
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Joachim G J V Aerts
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Rossana Berardi
- Clinical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| |
Collapse
|
34
|
Makrakis D, Bakaloudi DR, Talukder R, Lin GI, Diamantopoulos LN, Jindal T, Vather-Wu N, Zakharia Y, Tripathi N, Agarwal N, Dawsey S, Gupta S, Lu E, Drakaki A, Liu S, Zakopoulou R, Bamias A, Fulgenzi CM, Cortellini A, Pinato D, Barata P, Grivas P, Khaki AR, Koshkin VS. Treatment Rechallenge With Immune Checkpoint Inhibitors in Advanced Urothelial Carcinoma. Clin Genitourin Cancer 2023; 21:286-294. [PMID: 36481176 DOI: 10.1016/j.clgc.2022.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/30/2022] [Accepted: 11/07/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To examine patient and disease characteristics, toxicity, and clinical outcomes for patients with advanced urothelial carcinoma (aUC) who are rechallenged with immune checkpoint inhibitor (ICI)-based therapy. PATIENTS AND METHODS In this retrospective cohort, we included patients treated with ICI for aUC after having prior ICI treatment. Endpoints included the evaluation of radiographic response and disease control rates with first and second ICI courses, outcomes based on whether there was a change in ICI class (anti-PD-1 vs. anti-PD-L1), and assessment of the reasons for ICI discontinuation. RESULTS We identified 25 patients with aUC from 9 institutions who received 2 separate ICI courses. ORR with first ICI and second ICI were 39% and 13%, respectively. Most patients discontinued first ICI due to progression (n = 19) or treatment-related toxicity (n = 4). Thirteen patients received non-ICI treatment between the first and second ICI, and 12 patients changed ICI class (anti-PD-1 vs. anti-PD-L1) at rechallenge. Among 10 patients who changed ICI class, 8 (80%) had progressive disease as best response with second ICI, while among 12 patients re-treated with the same ICI class, only 3 (25%) had progressive disease as best response at the time of rechallenge. With second ICI, most patients discontinued treatment due to progression (n = 18) or patient preference (n = 2). CONCLUSIONS A proportion of patients with aUC rechallenged with ICI-based regimens may achieve disease control, supporting clinical trials in that setting, especially with ICI-based combinations. Future studies are needed to validate our results and should also focus on identifying biomarkers predictive of benefit with ICI rechallenge.
Collapse
Affiliation(s)
- Dimitrios Makrakis
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | | | - Rafee Talukder
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | | | | | - Tanya Jindal
- Helen Diller Family Cancer Center, University of California, San Francisco, San Francisco, CA
| | | | - Yousef Zakharia
- Division of Oncology, Department of Medicine, University of Iowa, Iowa City, IA
| | - Nishita Tripathi
- Division of Oncology, Department of Medicine, University of Utah, Salt Lake City, UT
| | - Neeraj Agarwal
- Division of Oncology, Department of Medicine, University of Utah, Salt Lake City, UT
| | - Scott Dawsey
- Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Shilpa Gupta
- Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Eric Lu
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Alexandra Drakaki
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Sandy Liu
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Roubini Zakopoulou
- 2nd Propaedeutic Department of Internal Medicine, ATTIKON University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Aristotelis Bamias
- 2nd Propaedeutic Department of Internal Medicine, ATTIKON University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Claudia-Maria Fulgenzi
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London; Department of Medical Oncology, University Campus Bio-Medico of Rome, Italy
| | - Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London; Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - David Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Pedro Barata
- Tulane Medical School, New Orleans, LA; University Hospitals Seidman Cancer Center, Cleveland, OH
| | - Petros Grivas
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Ali Raza Khaki
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA
| | - Vadim S Koshkin
- Division of Hematology/Oncology, Department of Medicine, Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA.
| |
Collapse
|
35
|
Cortellini A, Tabernero J, Mukherjee U, Salazar R, Sureda A, Maluquer C, Ferrante D, Bower M, Sharkey R, Mirallas O, Plaja A, Cucurull M, Mesia R, Dalla Pria A, Newsom-Davis T, Van Hemelrijck M, Sita-Lumsden A, Apthorp E, Vincenzi B, Di Fazio GR, Tonini G, Pantano F, Bertuzzi A, Rossi S, Brunet J, Lambertini M, Pedrazzoli P, Biello F, D'Avanzo F, Lee AJX, Shawe-Taylor M, Rogers L, Murphy C, Cooper L, Andaleeb R, Khalique S, Bawany S, Ahmed S, Carmona-García MC, Fort-Culillas R, Liñan R, Zoratto F, Rizzo G, Perachino M, Doonga K, Gaidano G, Bruna R, Patriarca A, Martinez-Vila C, Pérez Criado I, Giusti R, Mazzoni F, Antonuzzo L, Santoro A, Parisi A, Queirolo P, Aujayeb A, Rimassa L, Diamantis N, Bertulli R, Fulgenzi CAM, D'Alessio A, Ruiz-Camps I, Saoudi-Gonzalez N, Garcia Illescas D, Medina I, Fox L, Gennari A, Aguilar-Company J, Pinato DJ. SARS-CoV-2 omicron (B.1.1.529)-related COVID-19 sequelae in vaccinated and unvaccinated patients with cancer: results from the OnCovid registry. Lancet Oncol 2023; 24:335-346. [PMID: 36898391 PMCID: PMC9991062 DOI: 10.1016/s1470-2045(23)00056-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND COVID-19 sequelae can affect about 15% of patients with cancer who survive the acute phase of SARS-CoV-2 infection and can substantially impair their survival and continuity of oncological care. We aimed to investigate whether previous immunisation affects long-term sequelae in the context of evolving variants of concern of SARS-CoV-2. METHODS OnCovid is an active registry that includes patients aged 18 years or older from 37 institutions across Belgium, France, Germany, Italy, Spain, and the UK with a laboratory-confirmed diagnosis of COVID-19 and a history of solid or haematological malignancy, either active or in remission, followed up from COVID-19 diagnosis until death. We evaluated the prevalence of COVID-19 sequelae in patients who survived COVID-19 and underwent a formal clinical reassessment, categorising infection according to the date of diagnosis as the omicron (B.1.1.529) phase from Dec 15, 2021, to Jan 31, 2022; the alpha (B.1.1.7)-delta (B.1.617.2) phase from Dec 1, 2020, to Dec 14, 2021; and the pre-vaccination phase from Feb 27 to Nov 30, 2020. The prevalence of overall COVID-19 sequelae was compared according to SARS-CoV-2 immunisation status and in relation to post-COVID-19 survival and resumption of systemic anticancer therapy. This study is registered with ClinicalTrials.gov, NCT04393974. FINDINGS At the follow-up update on June 20, 2022, 1909 eligible patients, evaluated after a median of 39 days (IQR 24-68) from COVID-19 diagnosis, were included (964 [50·7%] of 1902 patients with sex data were female and 938 [49·3%] were male). Overall, 317 (16·6%; 95% CI 14·8-18·5) of 1909 patients had at least one sequela from COVID-19 at the first oncological reassessment. The prevalence of COVID-19 sequelae was highest in the pre-vaccination phase (191 [19·1%; 95% CI 16·4-22·0] of 1000 patients). The prevalence was similar in the alpha-delta phase (110 [16·8%; 13·8-20·3] of 653 patients, p=0·24), but significantly lower in the omicron phase (16 [6·2%; 3·5-10·2] of 256 patients, p<0·0001). In the alpha-delta phase, 84 (18·3%; 95% CI 14·6-22·7) of 458 unvaccinated patients and three (9·4%; 1·9-27·3) of 32 unvaccinated patients in the omicron phase had sequelae. Patients who received a booster and those who received two vaccine doses had a significantly lower prevalence of overall COVID-19 sequelae than unvaccinated or partially vaccinated patients (ten [7·4%; 95% CI 3·5-13·5] of 136 boosted patients, 18 [9·8%; 5·8-15·5] of 183 patients who had two vaccine doses vs 277 [18·5%; 16·5-20·9] of 1489 unvaccinated patients, p=0·0001), respiratory sequelae (six [4·4%; 1·6-9·6], 11 [6·0%; 3·0-10·7] vs 148 [9·9%; 8·4-11·6], p=0·030), and prolonged fatigue (three [2·2%; 0·1-6·4], ten [5·4%; 2·6-10·0] vs 115 [7·7%; 6·3-9·3], p=0·037). INTERPRETATION Unvaccinated patients with cancer remain highly vulnerable to COVID-19 sequelae irrespective of viral strain. This study confirms the role of previous SARS-CoV-2 immunisation as an effective measure to protect patients from COVID-19 sequelae, disruption of therapy, and ensuing mortality. FUNDING UK National Institute for Health and Care Research Imperial Biomedical Research Centre and the Cancer Treatment and Research Trust.
Collapse
Affiliation(s)
- Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, London, UK; Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy.
| | - Josep Tabernero
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology, IOB-Quiron, UVic-UCC, Barcelona, Spain
| | - Uma Mukherjee
- Medical Oncology, Barts Health NHS Trust, London, UK
| | - Ramon Salazar
- Catalan Institute of Oncology (ICO), University of Barcelona, Bellvitge Biomedical Research Institute (IDIBELL), CIBERONC, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Sureda
- Haematology Department, ICO Hospitalet, Hospitalet de Llobregat, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Clara Maluquer
- Haematology Department, ICO Hospitalet, Hospitalet de Llobregat, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Daniela Ferrante
- Unit of Medical Statistics, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Rachel Sharkey
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Oriol Mirallas
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology, IOB-Quiron, UVic-UCC, Barcelona, Spain
| | - Andrea Plaja
- Medical Oncology Department, B-ARGO Group, IGTP, Catalan Institute of Oncology, Badalona, Spain
| | - Marc Cucurull
- Medical Oncology Department, B-ARGO Group, IGTP, Catalan Institute of Oncology, Badalona, Spain
| | - Ricard Mesia
- Medical Oncology Department, B-ARGO Group, IGTP, Catalan Institute of Oncology, Badalona, Spain
| | - Alessia Dalla Pria
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Thomas Newsom-Davis
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Mieke Van Hemelrijck
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK; Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | | | | | - Bruno Vincenzi
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Giuseppina Rita Di Fazio
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Giuseppe Tonini
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Francesco Pantano
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Alexia Bertuzzi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Sabrina Rossi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Joan Brunet
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Matteo Lambertini
- Medical Oncology Department, UO Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, Genova, Italy
| | - Paolo Pedrazzoli
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy; Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Biello
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; Ospedale Maggiore della Caritá, Novara, Italy
| | - Francesca D'Avanzo
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; Ospedale Maggiore della Caritá, Novara, Italy
| | - Alvin J X Lee
- Cancer Division, University College London Hospitals, London, UK
| | | | - Lucy Rogers
- Cancer Division, University College London Hospitals, London, UK
| | - Cian Murphy
- Cancer Division, University College London Hospitals, London, UK
| | - Lee Cooper
- Cancer Division, University College London Hospitals, London, UK
| | - Ramis Andaleeb
- Cancer Division, University College London Hospitals, London, UK
| | - Saira Khalique
- Cancer Division, University College London Hospitals, London, UK
| | - Samira Bawany
- Cancer Division, University College London Hospitals, London, UK
| | - Sarah Ahmed
- Cancer Division, University College London Hospitals, London, UK
| | - M Carmen Carmona-García
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Roser Fort-Culillas
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Raquel Liñan
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | | | - Gianpiero Rizzo
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marta Perachino
- Medical Oncology Department, UO Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, Genova, Italy
| | - Kris Doonga
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Gianluca Gaidano
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; Ospedale Maggiore della Caritá, Novara, Italy
| | - Riccardo Bruna
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; Ospedale Maggiore della Caritá, Novara, Italy
| | - Andrea Patriarca
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; Ospedale Maggiore della Caritá, Novara, Italy
| | | | | | | | | | | | - Armando Santoro
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alessandro Parisi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Paola Queirolo
- Melanoma and Sarcoma Medical Treatment Unit, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Rossella Bertulli
- Medical Oncology 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia A M Fulgenzi
- Department of Surgery and Cancer, Imperial College London, London, UK; Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Antonio D'Alessio
- Department of Surgery and Cancer, Imperial College London, London, UK; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Isabel Ruiz-Camps
- Department of Infectious Diseases, Vall d'Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - Nadia Saoudi-Gonzalez
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology, IOB-Quiron, UVic-UCC, Barcelona, Spain
| | - David Garcia Illescas
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology, IOB-Quiron, UVic-UCC, Barcelona, Spain
| | - Irene Medina
- Department of Hematology, Vall d'Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - Laura Fox
- Department of Hematology, Vall d'Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - Alessandra Gennari
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; Ospedale Maggiore della Caritá, Novara, Italy
| | - Juan Aguilar-Company
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology, IOB-Quiron, UVic-UCC, Barcelona, Spain; Department of Infectious Diseases, Vall d'Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, London, UK; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| |
Collapse
|
36
|
Alaiwi SA, Nassar A, Zarif T, El-Am E, Denu R, Macaron W, Malvar C, Cortellini A, Korolewicz J, Sackstein P, Nana FA, Woodford R, Long GV, Kwan J, Grynberg S, Shapira R, Herrera-Juárez M, Foderaro S, Vasbinder A, Asnani A, Tandon A, Hayek S, Neilan TG, Choueiri T, Naqash AR. CLINICAL FEATURES AND OUTCOMES OF CARDIAC INVOLVEMENT IN PATIENTS WITH CANCER TREATED WITH IMMUNE CHECKPOINT INHIBITORS <ICI>. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02782-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
|
37
|
Talbot T, D'Alessio A, Pinter M, Balcar L, Scheiner B, Marron TU, Jun T, Dharmapuri S, Ang C, Saeed A, Hildebrand H, Muzaffar M, Fulgenzi CAM, Amara S, Naqash AR, Gampa A, Pillai A, Wang Y, Khan U, Lee P, Huang Y, Bengsch B, Bettinger D, Mohamed YI, Kaseb A, Pressiani T, Personeni N, Rimassa L, Nishida N, Kudo M, Weinmann A, Galle PR, Muhammed A, Cortellini A, Vogel A, Pinato DJ. Progression patterns and therapeutic sequencing following immune checkpoint inhibition for hepatocellular carcinoma: An international observational study. Liver Int 2023; 43:695-707. [PMID: 36577703 PMCID: PMC10947007 DOI: 10.1111/liv.15502] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/11/2022] [Accepted: 12/18/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Different approaches are available after the progression of disease (PD) to immune checkpoint inhibitors (ICIs) for hepatocellular carcinoma (HCC), including the continuation of ICI, treatment switching to tyrosine kinase inhibitors (TKIs) and cessation of anticancer therapy. We sought to characterise the relationship between radiological patterns of progression and survival post-ICI, also appraising treatment strategies. METHODS We screened 604 HCC patients treated with ICIs, including only those who experienced PD by data cut-off. We evaluated post-progression survival (PPS) according to the treatment strategy at PD and verified its relationship with radiological patterns of progression: intrahepatic growth (IHG), new intrahepatic lesion (NIH), extrahepatic growth (EHG), new extrahepatic lesion (NEH) and new vascular invasion (nVI). RESULTS Of 604 patients, 364 (60.3%) experienced PD during observation. Median PPS was 5.3 months (95% CI: 4.4-6.9; 271 events). At the data cut-off, 165 patients (45%) received no post-progression anticancer therapy; 64 patients (17.6%) continued ICI beyond PD. IHG (HR 1.64 [95% CI: 1.21-2.22]; p = .0013) and nVI (HR 2.15 [95% CI: 1.38-3.35]; p = .0007) were associated with shorter PPS. Multivariate models adjusted for progression patterns, treatment line and albumin-bilirubin grade and Eastern Cooperative Oncology Group performance status at PD confirmed receipt of ICI beyond PD with (HR 0.17, 95% CI: 0.09-0.32; p < .0001) or without subsequent TKI (HR 0.39, 95% CI: 0.26-0.58; p < .0001) as predictors of prolonged PPS versus no anticancer therapy. CONCLUSIONS ICI-TKI sequencing is a consolidated option in advanced HCC. nVI and IHG predict a poorer prognosis. Despite lack of recommendation, the continuation of ICI beyond progression in HCC is adopted clinically: future efforts should appraise which patients benefit from this approach.
Collapse
Affiliation(s)
- Thomas Talbot
- Department of Surgery & Cancer, Imperial College LondonHammersmith HospitalLondonUK
| | - Antonio D'Alessio
- Department of Surgery & Cancer, Imperial College LondonHammersmith HospitalLondonUK
- Department of Biomedical SciencesHumanitas UniversityMilanItaly
| | - Matthias Pinter
- Division of Gastroenterology & Hepatology, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Lorenz Balcar
- Division of Gastroenterology & Hepatology, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Bernhard Scheiner
- Division of Gastroenterology & Hepatology, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Thomas U. Marron
- Division of Hematology/Oncology, Department of Medicine, Tisch Cancer InstituteMount Sinai HospitalNew YorkNew YorkUSA
| | | | - Sirish Dharmapuri
- Division of Hematology/Oncology, Department of Medicine, Tisch Cancer InstituteMount Sinai HospitalNew YorkNew YorkUSA
| | - Celina Ang
- Division of Hematology/Oncology, Department of Medicine, Tisch Cancer InstituteMount Sinai HospitalNew YorkNew YorkUSA
| | - Anwaar Saeed
- Division of Medical Oncology, Department of MedicineKansas University Cancer CenterWestwoodKansasUSA
| | - Hannah Hildebrand
- Division of Medical Oncology, Department of MedicineKansas University Cancer CenterWestwoodKansasUSA
| | - Mahvish Muzaffar
- Division of Hematology/OncologyEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Claudia A. M. Fulgenzi
- Department of Surgery & Cancer, Imperial College LondonHammersmith HospitalLondonUK
- Department of Medical OncologyUniversity Campus Bio‐MedicoRomeItaly
| | - Suneetha Amara
- Division of Hematology/OncologyEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Abdul Rafeh Naqash
- Division of Hematology/OncologyEast Carolina UniversityGreenvilleNorth CarolinaUSA
- Division of Cancer Treatment and DiagnosisNational Cancer InstituteBethesdaMarylandUSA
| | - Anuhya Gampa
- Section of GastroenterologyHepatology & Nutrition, the University of Chicago MedicineChicagoIllinoisUSA
| | - Anjana Pillai
- Section of GastroenterologyHepatology & Nutrition, the University of Chicago MedicineChicagoIllinoisUSA
| | - Yinghong Wang
- Department of Gastroenterology, Hepatology & NutritionThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Uqba Khan
- Division of Hematology and OncologyWeill Cornell Medicine/New York Presbyterian HospitalNew YorkNew YorkUSA
| | - Pei‐Chang Lee
- Division of Gastroenterology and Hepatology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan
| | - Yi‐Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan
- Institute of Clinical MedicineNational Yang Ming Chiao Tung University School of MedicineTaipeiTaiwan
| | - Bertram Bengsch
- Department of Medicine II, Faculty of MedicineMedical Center University of Freiburg, University of FreiburgFreiburgGermany
| | - Dominik Bettinger
- Department of Medicine II, Faculty of MedicineMedical Center University of Freiburg, University of FreiburgFreiburgGermany
| | - Yehia I. Mohamed
- Department of Gastrointestinal Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Ahmed Kaseb
- Department of Gastrointestinal Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer CenterIRCCS Humanitas Research HospitalMilanItaly
| | - Nicola Personeni
- Department of Biomedical SciencesHumanitas UniversityMilanItaly
- Medical Oncology and Hematology Unit, Humanitas Cancer CenterIRCCS Humanitas Research HospitalMilanItaly
| | - Lorenza Rimassa
- Department of Biomedical SciencesHumanitas UniversityMilanItaly
- Medical Oncology and Hematology Unit, Humanitas Cancer CenterIRCCS Humanitas Research HospitalMilanItaly
| | - Naoshi Nishida
- Department of Gastroenterology and HepatologyKindai University Faculty of MedicineOsaka‐SayamaJapan
| | - Masatoshi Kudo
- Department of Gastroenterology and HepatologyKindai University Faculty of MedicineOsaka‐SayamaJapan
| | - Arndt Weinmann
- 1st Department of Internal Medicine, Gastroenterology and HepatologyUniversity Medical Center of the Johannes Gutenberg‐University MainzMainzGermany
| | - Peter R. Galle
- 1st Department of Internal Medicine, Gastroenterology and HepatologyUniversity Medical Center of the Johannes Gutenberg‐University MainzMainzGermany
| | - Ambreen Muhammed
- Department of Surgery & Cancer, Imperial College LondonHammersmith HospitalLondonUK
| | - Alessio Cortellini
- Department of Surgery & Cancer, Imperial College LondonHammersmith HospitalLondonUK
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and EndocrinologyHannover Medical SchoolHannoverGermany
| | - David J. Pinato
- Department of Surgery & Cancer, Imperial College LondonHammersmith HospitalLondonUK
- Division of Oncology, Department of Translational MedicineUniversity of Piemonte Orientale “A. Avogadro”NovaraItaly
| |
Collapse
|
38
|
Alaiwi SA, Nassar A, Zarif T, El-Am E, Denu R, Macaron W, Malvar C, Cortellini A, Korolewicz J, Sackstein P, Nana FA, Woodford R, Long GV, Kwan J, Grynberg S, Shapira R, Herrera-Juárez M, Foderaro S, Vasbinder A, Asnani A, Tandon A, Hayek S, Neilan TG, Choueiri T, Naqash AR. CLINICAL FEATURES AND OUTCOMES OF CARDIAC INVOLVEMENT IN PATIENTS WITH CANCER TREATED WITH IMMUNE CHECKPOINT INHIBITORS <ICI>. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02797-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
|
39
|
Fessas P, Scheiner B, D'Alessio A, M Fulgenzi CA, Korolewicz J, Ward C, Tait P, Thomas R, Cortellini A, Sharma R, Pinato DJ. PETAL protocol: a phase Ib study of pembrolizumab after transarterial chemoembolization in hepatocellular carcinoma. Future Oncol 2023; 19:499-507. [PMID: 37097715 DOI: 10.2217/fon-2022-0916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
Transarterial chemoembolization (TACE) is the treatment of choice for intermediate-stage hepatocellular carcinoma (HCC). Recent data suggest that TACE may boost the efficacy of anti-PD-1 immunotherapy. The authors present the trial protocol for PETAL, a phase Ib study, which will assess the safety and bioactivity of pembrolizumab, an anti-PD-1 antibody, following TACE in HCC. After a run-in phase evaluating six patients to establish preliminary safety, up to 26 additional participants will be enrolled. Pembrolizumab will be administered three-times weekly for 1 year or until progression, starting 30-45 days after TACE. The primary objective is to determine safety and the secondary objective is to preliminarily evaluate efficacy. Radiological responses will be evaluated every four cycles. Clinical Trial Registration: NCT03397654 (ClinicalTrials.gov).
Collapse
Affiliation(s)
- Petros Fessas
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Bernhard Scheiner
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
- Department of Radiology, Imperial College NHS Trust, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Antonio D'Alessio
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
- Liver Cancer (HCC) Study Group, Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Claudia A M Fulgenzi
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
| | - James Korolewicz
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Caroline Ward
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Paul Tait
- Department of Medical Oncology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Robert Thomas
- Department of Medical Oncology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Alessio Cortellini
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Rohini Sharma
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - David J Pinato
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| |
Collapse
|
40
|
van de Haar J, Ma X, Ooft SN, van der Helm PW, Hoes LR, Mainardi S, Pinato DJ, Sun K, Salvatore L, Tortora G, Zurlo IV, Leo S, Giampieri R, Berardi R, Gelsomino F, Merz V, Mazzuca F, Antonuzzo L, Rosati G, Stavraka C, Ross P, Rodriquenz MG, Pavarana M, Messina C, Iveson T, Zoratto F, Thomas A, Fenocchio E, Ratti M, Depetris I, Cergnul M, Morelli C, Libertini M, Parisi A, De Tursi M, Zanaletti N, Garrone O, Graham J, Longarini R, Gobba SM, Petrillo A, Tamburini E, La Verde N, Petrelli F, Ricci V, Wessels LFA, Ghidini M, Cortellini A, Voest EE, Valeri N. Codon-specific KRAS mutations predict survival benefit of trifluridine/tipiracil in metastatic colorectal cancer. Nat Med 2023; 29:605-614. [PMID: 36864254 PMCID: PMC10033412 DOI: 10.1038/s41591-023-02240-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/26/2023] [Indexed: 03/04/2023]
Abstract
Genomics has greatly improved how patients with cancer are being treated; however, clinical-grade genomic biomarkers for chemotherapies are currently lacking. Using whole-genome analysis of 37 patients with metastatic colorectal cancer (mCRC) treated with the chemotherapy trifluridine/tipiracil (FTD/TPI), we identified KRAS codon G12 (KRASG12) mutations as a potential biomarker of resistance. Next, we collected real-world data of 960 patients with mCRC receiving FTD/TPI and validated that KRASG12 mutations were significantly associated with poor survival, also in analyses restricted to the RAS/RAF mutant subgroup. We next analyzed the data of the global, double-blind, placebo-controlled, phase 3 RECOURSE trial (n = 800 patients) and found that KRASG12 mutations (n = 279) were predictive biomarkers for reduced overall survival (OS) benefit of FTD/TPI versus placebo (unadjusted interaction P = 0.0031, adjusted interaction P = 0.015). For patients with KRASG12 mutations in the RECOURSE trial, OS was not prolonged with FTD/TPI versus placebo (n = 279; hazard ratio (HR) = 0.97; 95% confidence interval (CI) = 0.73-1.20; P = 0.85). In contrast, patients with KRASG13 mutant tumors showed significantly improved OS with FTD/TPI versus placebo (n = 60; HR = 0.29; 95% CI = 0.15-0.55; P < 0.001). In isogenic cell lines and patient-derived organoids, KRASG12 mutations were associated with increased resistance to FTD-based genotoxicity. In conclusion, these data show that KRASG12 mutations are biomarkers for reduced OS benefit of FTD/TPI treatment, with potential implications for approximately 28% of patients with mCRC under consideration for treatment with FTD/TPI. Furthermore, our data suggest that genomics-based precision medicine may be possible for a subset of chemotherapies.
Collapse
Affiliation(s)
- Joris van de Haar
- Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Xuhui Ma
- Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Salo N Ooft
- Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Pim W van der Helm
- Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Louisa R Hoes
- Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sara Mainardi
- Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- Imperial College Healthcare NHS Trust, London, UK
| | - Kristi Sun
- Imperial College Healthcare NHS Trust, London, UK
| | - Lisa Salvatore
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Roma, Italy
- Oncologia Medica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giampaolo Tortora
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Roma, Italy
- Oncologia Medica, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Silvana Leo
- Medical Oncology, 'Vito Fazzi' Hospital, Lecce, Italy
| | - Riccardo Giampieri
- Department of Oncology, Università Politecnica delle Marche, Azienda Ospedialiera Universitaria delle Marche, Ancona, Italy
| | - Rossana Berardi
- Department of Oncology, Università Politecnica delle Marche, Azienda Ospedialiera Universitaria delle Marche, Ancona, Italy
| | | | - Valeria Merz
- Medical Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - Federica Mazzuca
- Department of Clinical and Molecular Medicine, Sapienza University, Oncology Unit, Azienda Ospedialiera Universitaria Sant'Andrea, Rome, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gerardo Rosati
- Medical Oncology Unit, S. Carlo Hospital, Potenza, Italy
| | - Chara Stavraka
- School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul Ross
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Maria Grazia Rodriquenz
- Istituto di Ricovero e Cura a Carattere Scientifico Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Michele Pavarana
- Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Carlo Messina
- Oncology Unit, ARNAS Civico Di Cristina Benfratelli Hospital, Palermo, Italy
| | | | - Federica Zoratto
- Unità Operativa Complessa Oncologia, Ospedale Santa Maria Goretti Latina, Latina, Italy
| | - Anne Thomas
- Leicester Cancer Research Centre, University of Leicester, Leicester Royal Infirmary, Leicester, UK
| | - Elisabetta Fenocchio
- Candiolo Cancer Institute FPO Istituto di Ricovero e Cura a Carattere Scientifico Candiolo, Candiolo, Italy
| | | | - Ilaria Depetris
- Division of Medical Oncology, ASL TO4, Ospedale Civile di Ivrea, Ivrea, Italy
| | - Massimiliano Cergnul
- Unità Operativa Oncologia Medica, Ospedale Civile di Legnano, Azienda Socio-Sanitaria Territoriale Ovest Milanese, Legnano, Italy
| | - Cristina Morelli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | | | - Alessandro Parisi
- Department of Oncology, Università Politecnica delle Marche, Azienda Ospedialiera Universitaria delle Marche, Ancona, Italy
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michele De Tursi
- Dipartimento di Tecnologie Innovative in Medicina & Odontoiatria, Università G. D'Annunzio, Chieti-Pescara, Chieti, Italy
| | - Nicoletta Zanaletti
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione G. Pascale, Naples, Italy
| | - Ornella Garrone
- Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Janet Graham
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Stefania Maria Gobba
- Division of Clinical Oncology, Azienda Socio-Sanitaria Territoriale dei Sette Laghi Varese, Varese, Italy
| | | | | | - Nicla La Verde
- Luigi Sacco Hospital-Polo Universitario, Azienda Socio-Sanitaria Territoriale Fatebenefratelli Sacco, Milan, Italy
| | - Fausto Petrelli
- Oncology Unit, Azienda Socio-Sanitaria Territoriale Bergamo Ovest, Treviglio, Italy
| | - Vincenzo Ricci
- Medical Oncology Unit, Azienda Ospedaliera di Rilievo Nazionale 'San Pio', Benevento, Italy
| | - Lodewyk F A Wessels
- Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Faculty of Electrical Engineering, Mathematics and Computer Science, Delft University of Technology, Delft, the Netherlands
| | - Michele Ghidini
- Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Emile E Voest
- Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Nicola Valeri
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK.
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK.
| |
Collapse
|
41
|
Perrone F, Favari E, Maglietta G, Verzè M, Pluchino M, Minari R, Sabato R, Mazzaschi G, Ronca A, Rossi A, Cortellini A, Pecci F, Cantini L, Bersanelli M, Quaini F, Tiseo M, Buti S. The role of blood cholesterol quality in patients with advanced cancer receiving immune checkpoint inhibitors. Cancer Immunol Immunother 2023:10.1007/s00262-023-03398-3. [PMID: 36828963 DOI: 10.1007/s00262-023-03398-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 02/04/2023] [Indexed: 02/26/2023]
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICIs) became the standard of care for several solid tumors. A limited fraction of patients (pts) achieves a long-term benefit. Plasmatic and intracellular cholesterol levels have emerged as promising biomarkers. The aim of the present study was to determine whether cholesterol efflux capacity (CEC), mediated by serum transporters (ABCA1 and ABCG1) and passive diffusion (PD), impacts on clinical outcome of advanced non-small cell lung cancer (NSCLC) and metastatic renal cell carcinoma (mRCC) pts treated with ICIs. MATERIAL AND METHODS We retrospectively enrolled advanced NSCLC and mRCC pts consecutively treated with ICIs between October 2013 and October 2018. CEC and cholesterol loading capacity (CLC) were assessed by well-established specific cell models. As primary endpoint, CEC, PD and CLC were correlated with overall survival (OS) while the effects of these parameters on progression-free survival (PFS) and clinical benefit (CB), defined as complete/partial response or stable disease, represented secondary endpoints. RESULTS NSCLC accounted for 94.2% of 70 enrolled cases, and serum sample suitable for CEC and PD determination was available in 68. Blood cholesterol and serum ABCA1, ABCG1, PD and CLC were associated with outcomes (OS, PFS and CB) at univariate analysis. At the multivariate analysis, only PD confirmed its positive prognostic value in terms of OS, PFS and CB. CONCLUSION The favorable impact of cholesterol PD on clinical outcome might reflect its main conformation in mature HDL particles which potentially shape an inflamed context, ultimately promoting ICI efficacy. Further prospective studies are needed to support our findings and uncover targetable pathways.
Collapse
Affiliation(s)
- Fabiana Perrone
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy.
| | - Elda Favari
- Food and Drug Department, University of Parma, Parma, Italy
| | - Giuseppe Maglietta
- Clinical & Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
| | - Michela Verzè
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Monica Pluchino
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Roberta Minari
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Roberto Sabato
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Giulia Mazzaschi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Annalisa Ronca
- Food and Drug Department, University of Parma, Parma, Italy
| | | | - Alessio Cortellini
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Federica Pecci
- Clinical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Luca Cantini
- Clinical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy.,Department of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Federico Quaini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| |
Collapse
|
42
|
Pinato DJ, Cortellini A. Antibiotic Therapy: The Cornerstone of Iatrogenic Resistance to Immune Checkpoint Inhibitors. J Clin Oncol 2023:JCO2300049. [PMID: 36827618 DOI: 10.1200/jco.23.00049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Affiliation(s)
- David J Pinato
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom.,Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Alessio Cortellini
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom.,Medical Oncology, Fondazione Policlinico Universitario Campus BioMedico, Rome, Italy
| |
Collapse
|
43
|
Russano M, La Cava G, Cortellini A, Citarella F, Galletti A, Di Fazio GR, Santo V, Brunetti L, Vendittelli A, Fioroni I, Pantano F, Tonini G, Vincenzi B. Immunotherapy for Metastatic Non-Small Cell Lung Cancer: Therapeutic Advances and Biomarkers. Curr Oncol 2023; 30:2366-2387. [PMID: 36826142 PMCID: PMC9955173 DOI: 10.3390/curroncol30020181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Immunotherapy has revolutionized the treatment paradigm of non-small cell lung cancer and improved patients' prognosis. Immune checkpoint inhibitors have quickly become standard frontline treatment for metastatic non-oncogene addicted disease, either as a single agent or in combination strategies. However, only a few patients have long-term benefits, and most of them do not respond or develop progressive disease during treatment. Thus, the identification of reliable predictive and prognostic biomarkers remains crucial for patient selection and guiding therapeutic choices. In this review, we provide an overview of the current strategies, highlighting the main clinical challenges and novel potential biomarkers.
Collapse
Affiliation(s)
- Marco Russano
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo, 21, 00128 Rome, Italy
- Correspondence: ; Tel.: +39-06225411252
| | - Giulia La Cava
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Alessio Cortellini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Fabrizio Citarella
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Alessandro Galletti
- Division of Medical Oncology, San Camillo Forlanini Hospital, 00152 Roma, Italy
| | - Giuseppina Rita Di Fazio
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Valentina Santo
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Leonardo Brunetti
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Alessia Vendittelli
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Iacopo Fioroni
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Francesco Pantano
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Giuseppe Tonini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Bruno Vincenzi
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| |
Collapse
|
44
|
Ghidini M, Hahne JC, Senti C, Tomasello G, Ratti M, Heide T, Garrone O, Cortellini A, Passalacqua R, Valeri N. Circulating tumor DNA (ctDNA) dynamics and clinical outcome in metastatic colorectal cancer (mCRC) patients (pts) undergoing front-line chemotherapy. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
175 Background: The potential of monitoring circulating tumor DNA (ctDNA) dynamics to guide clinical decisions in metastatic colorectal cancer (mCRC) patients (pts) treated with I and II line systemic anti-cancer therapy (SACT) has not been widely tested. Methods: 862 serial plasmas were collected 4-weekly from baseline (BL) until disease progression in 75 mCRC pts undergoing SACT. ctDNA was tested using a custom (RMH GI; 20 genes) or a commercial (Roche Avenio; 77 genes) ctDNA next generation sequencing (NGS) panel. White blood cells were sequenced to rule out clonal hematopoiesis. Whole exome sequencing (WES) was performed on tissue biopsies. ctDNA normalization was defined as ≥99% clearance after 1 month of therapy (Mo1) in the 3 variants with the highest allele frequency in BL ctDNA. Results: 83 paired samples from 75 pts were available for analysis (for 8 pts, I and II line bloods were available). 12 pairs (14.4%) showed no variants in either BL or Mo1. In the remaining 71 comparisons (65 pts), 37 (52.1%) showed ctDNA normalization at Mo1. Among normalized pts there was a higher proportion of cases with a baseline ECOG performance status (PS) 0-1 (97.3% vs 82.4%, p = 0.0362) in comparison to non-normalized pts, whilst no other clinic-pathologic characteristics, including age, sex, prior primary tumor resection, sidedness, RAS/RAF genotype, type of regimen and number of metastatic sites were significantly associated with ctDNA dynamics. Pts with normalized ctDNA had significantly longer overall survival (OS), 45.6 months (95% confidence interval [CI]: 30.0 - not reached, 14 events) and progression-free survival (PFS), 13.9 months (95%CI: 11.2-18.3; 30 events) compared to non-normalized pts [OS = 22.6 months (95%CI: 16.6-31.2, 24 events) (Log-rank p = 0.01) and PFS = 10.7 months (95%CI: 7.53-13.8; 32 events) (Log-rank p = 0.036) respectively]. In addition, pts with normalized ctDNA had higher overall response rate (ORR) of 72.9% (27/37 responses; 95%CI: 53.0-84.1) compared to 38.2% (13/34 responses; 95%CI: 22.1 – 56.4) in non-normalized pts. In a multivariate model, ctDNA normalization was confirmed as an independent predictor of decreased risk of death (hazard ratio [HR] 0.47, 95%CI: 0.23-0.96; p = 0.04) and higher probability of achieving an objective response from front-line treatment (odds ratio [OR] 3.03, 95%CI: 1.08-8.49; p = 0.0351). Only 23/50 (46%) of variants detected in ctDNA were detected by WES in paired tissues in 12 pts for whom liquid/solid biopsy was available. Conclusions: ctDNA monitoring represents an early indicator of benefit from systemic therapy in mCRC pts. A significant fraction of variants detected in ctDNA was not detected in paired tissues.
Collapse
Affiliation(s)
- Michele Ghidini
- Division of Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Chiara Senti
- Division of Medical Oncology, ASST of Cremona, Hospital of Cremona, Cremona, Italy
| | - Gianluca Tomasello
- Division of Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Margherita Ratti
- Division of Medical Oncology, ASST of Cremona, Hospital of Cremona, Cremona, Italy
| | | | - Ornella Garrone
- Division of Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessio Cortellini
- Division of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Rodolfo Passalacqua
- Division of Medical Oncology, ASST of Cremona, Hospital of Cremona, Cremona, Italy
| | - Nicola Valeri
- Division of Surgery and Cancer, Imperial College London, London, United Kingdom
| |
Collapse
|
45
|
Fulgenzi CA, Korolewicz J, D'Alessio A, Scheiner B, Stikas CV, Gennari A, Cortellini A, Scotti L, Pinato DJJ. Efficacy and safety of frontline systemic therapy for advanced hepatocellular carcinoma (aHCC): A network meta-analysis of landmark phase III trials. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
549 Background: First line systemic therapy for advanced aHCC is rapidly expanding with new treatment options. However, direct comparisons across regimens are not available. We performed a network meta-analysis of phase III of trials to compare first line systemic treatments for aHCC in terms of overall survival (OS), progression free survival (PFS) and incidence of grade >3 adverse events (AEs). Methods: After performing a literature review from January 2008 to September 2022, we identified 6329 studies for screening, 3009 for revision, leading to identification of 15 phase III trials for the analysis: SHARP, Asia Pacific, Cheng 2013, Johnson 2013, Cainap 2015, REFLECT, CheckMate459, IMbrave150, ORIENT-32, HIMALAYA, COSMIC-312 and Qin 2021, Qin 2022, LEAP-002 and RATIONALE-301. These tested respectively: sorafenib (S) vs placebo (SHARP and Asia Pacific), sunitinib (Sun) vs S, brivanib (Bri) vs S, linifanib (Lin) vs S, lenvatinib (L) vs S, nivolumab (Nivo) vs S, atezolizumab+bevacizumab (A+B) vs S, sintilimab+IBI-305 vs S, durvalumab+tremelimumab (D+T) vs S, atezolizumab+cabozantinib (A+C) vs S, donafenib vs S, camrelizumab plus rivoceranib (C+R) vs S, pembrolizumab plus lenvatinib (P+L) vs L, and tislelizumab (TS) vs S as first line treatments for aHCC. Relative risks (RR) for grade >3 adverse events (AEs), and hazard ratios (HR) with 95% confidence intervals (95%CI) for overall (OS) and progression free survival (PFS) were extracted for each study. A frequentist network meta-analysis, with fixed effect multivariable meta-regression models to estimate the indirect pooled HRs, RRs and corresponding 95%CI, was performed considering S as reference. Results: In total, 10820 patients were included in the analysis, among them, 10444 received active treatment and 376 placebo. Sintilimab plus IBI-350 and A+B provided the greatest reduction in the risk of death compared to S, with a HR of 0.57 (95%CI:0.43-0.75), and 0.58 (95%CI:0.42-0.82), respectively; followed by C+R (HR:0.62; 95%CI:0.49-0-79), P+L (HR:0.77; 95%CI:0.62-0.97) and D+T (HR:0.78; 95%CI:0.66-0.93). Considering PFS, C+R and P+L were associated with the greatest reduction in the risk of PFS events compared to S, with HR of 0.52 (95%CI:0.41-0.65; 0.35-0.77, respectively). When looking at the risk of AEs, the combination of A+C (RR: 1.55;95%CI:0.80-3.02), C+R (RR:1.54;95%CI:0.95-2.50) and P+L (RR:1.23;95%CI:0.72-2.11) were associated with the highest risk of grade >3 AEs; whereas immune-checkpoint inhibitors (ICI) monotherapy (Nivo and TS) had the lowest risk (RR:0.46; 95%CI:0.20-1.05 and RR: 0.74; 95%CI:0.45-1.21). Conclusions: Combination of ICI + anti-VEGF antibodies leads to the greatest OS benefit compared to sorafenib, whereas ICI + kinase inhibitor regimens are associated with greater PFS benefit at the cost of higher toxicity rates.
Collapse
Affiliation(s)
| | | | | | - Bernhard Scheiner
- Divison of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | | | - Alessandra Gennari
- Università del Piemonte Orientale - Dipartimento di Medicina Traslazionale - DIMET, Novara, Italy
| | - Alessio Cortellini
- Division of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | | |
Collapse
|
46
|
Fulgenzi CA, Murphy C, D'Alessio A, Scheiner B, Pinter M, Cortellini A, Pinato DJJ. Effect of early antibiotic exposure on survival of patients receiving atezolizumab plus bevacizumab but not sorafenib for unresectable HCC: A sub-analysis of the phase III IMbrave150 study. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
597 Background: The combination of atezolizumab plus bevacizumab (A+B) is the standard of care for patients (pts) with unresectable/advanced hepatocellular carcinoma (HCC). Emerging evidence suggest a detrimental role of early antibiotics (ATB) exposure in immunotherapy recipients. However, it is unclear whether ATB affect outcomes of pts receiving A+B. Methods: We conducted a patient-level analysis of subjects receiving either A+B or Sorafenib (Sor) within the IMbrave150 trial to assess the impact of early ATB exposure (ATB+, i.e. +/-30 from treatment initiation) on overall (OS) and progression-free survival (PFS). Differences in median (m) OS and mPFS were estimated by the Kaplan-Meier method. Cox proportional regression models were used to assess the prognostic impact of ATB+ adjusting for race, age, baseline AFP, baseline ALBI grade, continent of origin and neutrophil-to-lymphocyte ratio, a measure of systemic inflammation. Results: Data of 420 IMbrave150 participants were made available by Vivli. Among them, 278 received A+B and 142 Sor. Most pts were of ECOG performance status 0 (65%); 47% had extrahepatic spread, 40% had macrovascular invasion and 35% had AFP>400 ng/mL. Viral aetiology (39% HBV and 24% HCV) was the most common risk factor for HCC. Overall, 60 pts in the A+B arm (21.5%) and 31 (21.8%) in the Sor group were ATB+. Baseline characteristics were well balanced across ATB groups, except for region of origin, with a higher proportion of Asian pts in ATB+ (60% vs 45%; p=0.01). After a median follow-up of 10.38 months (95%CI:8.6-12.5), OS and PFS rates at 12 months were 72.3% and 9.7% in A+B; 64.8%, and 1.4% in Sor, respectively. ATB+ exposure was associated with increased risk of death both in univariate (HR 1.67; 95%CI 1.04-2.69) and multivariate models (HR 1.62; 95%CI 1.40-1.89) in the A+B (p for interaction <0.001), but not in the Sor arm (univariate HR 0.63; 95%CI 0.32-1.25; multivariate HR 0.70; 95%CI 0.31-1.60). Similarly, the risk of progression was increased for ATB+ pts in the A+B arm (univariate HR 1.68; 95%CI 1.03-2.71; multivariate HR 1.59; 95%CI 1.40-1.81), but not in the Sor arm (univariate HR 0.51;95%CI 0.26-1.01; multivariate HR 0.53; 95%CI 0.21-1.30) with positive p for interaction (p=0.002). Objective response rate (ORR) according to RECIST v.1.1 did not differ between ATB+ (28.0%) and ATB- (30.0%) in A+B (p=0.68). Conclusions: In a post-hoc sub-analysis of IMbrave150 we demonstrate for the first time the negative impact of early antibiotics exposure on outcomes of patients receiving A+B but not in those treated with Sor. Prospective translational studies should evaluate the role of ATB-mediated gut dysbiosis as a proposed mechanism underlying the adverse outcome in immunotherapy-recipients.
Collapse
Affiliation(s)
- Claudia A.M. Fulgenzi
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | | | | | - Bernhard Scheiner
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | | | - Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | |
Collapse
|
47
|
Korolewicz J, Scheiner B, Fulgenzi C, D'Alessio A, Cortellini A, Pascual C, Mehan A, Partridge S, Mohammed O, Gupta A, Booker L, Cleator S, Rackie J, Needham Y, Krell J, Tookman L, Park WH, Asif M, Evans J, Pinato D. 96P The Hammersmith score optimises patient selection and predicts for overall survival in early-phase cancer trial participants independent of tumour burden. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
|
48
|
Aldea M, Marinello A, Duruisseaux M, Zrafi W, Conci N, Massa G, Metro G, Monnet I, Gomez Iranzo P, Tabbo F, Bria E, Guisier F, Vasseur D, Lindsay CR, Ponce-Aix S, Cousin S, Citarella F, Fallet V, Minatta JN, Eisert A, de Saint Basile H, Audigier-Valette C, Mezquita L, Calles A, Mountzios G, Tagliamento M, Remon Masip J, Raimbourg J, Terrisse S, Russo A, Cortinovis D, Rochigneux P, Pinato DJ, Cortellini A, Leonce C, Gazzah A, Ghigna MR, Ferrara R, Dall'Olio FG, Passiglia F, Ludovini V, Barlesi F, Felip E, Planchard D, Besse B. RET-MAP: An International Multicenter Study on Clinicobiologic Features and Treatment Response in Patients With Lung Cancer Harboring a RET Fusion. J Thorac Oncol 2023; 18:576-586. [PMID: 36646211 DOI: 10.1016/j.jtho.2022.12.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/05/2022] [Accepted: 12/22/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Nearly 1% to 2% of NSCLCs harbor RET fusions. Characterization of this rare population is still incomplete. METHODS This retrospective multicenter study included patients with any-stage RET positive (RET+) NSCLC from 31 cancer centers. Molecular profiling included DNA/RNA sequencing or fluorescence in situ hybridization analyses. Clinicobiological features and treatment outcomes (per investigator) with surgery, chemotherapy (CT), immune checkpoint blockers (ICBs), CT-ICB, multityrosine kinase inhibitors, and RET inhibitors (RETis) were evaluated. RESULTS For 218 patients included between February 2012 and April 2022, median age was 63 years, 56% were females, 93% had adenocarcinoma, and 41% were smokers. The most frequent fusion partner was KIF5B (72%). Median tumor mutational burden was 2.5 (range: 1-4) mutations per megabase, and median programmed death-ligand 1 expression was 10% (range: 0%-55%). The most common metastatic sites were the lung (50%), bone (43%), and pleura (40%). Central nervous system metastases were found at diagnosis of advanced NSCLC in 21% of the patients and at last follow-up or death in 31%. Overall response rate and median progression-free survival were 55% and 8.7 months with platinum doublet, 26% and 3.6 months with single-agent CT, 46% and 9.6 months with CT-ICB, 23% and 3.1 months with ICB, 37% and 3 months with multityrosine kinase inhibitor, and 76% and 16.2 months with RETi, respectively. Median overall survival was longer in patients treated with RETi versus no RETi (50.6 mo [37.7-72.1] versus 16.3 mo [12.7-28.8], p < 0.0001). CONCLUSIONS Patients with RET+ NSCLC have mainly thoracic and bone disease and low tumor mutational burden and programmed death-ligand 1 expression. RETi markedly improved survival, whereas ICB may be active in selected patients.
Collapse
Affiliation(s)
- Mihaela Aldea
- Department of Medical Oncology, International Center for Thoracic Cancers (CICT), Gustave Roussy, Villejuif, France; Paris-Saclay University, Kremlin-Bicêtre, France
| | - Arianna Marinello
- Department of Medical Oncology, International Center for Thoracic Cancers (CICT), Gustave Roussy, Villejuif, France; Department of Medical Oncology, Humanitas Research Hospital, Milan, Italy
| | - Michael Duruisseaux
- Respiratory Department and Early Phase, Louis Pradel Hospital, Hospices Civils de Lyon; Cancer Research Center of Lyon (CRCL), INSERM 1052, CNRS 5286; Univ Lyon, Claude Bernard Lyon 1 University, Lyon, France
| | - Wael Zrafi
- Department of Biostatistics and Bioinformatics, Gustave Roussy, Villejuif, France
| | - Nicole Conci
- Department of Medical Oncology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) University Hospital of Bologna, Bologna, Italy
| | - Giacomo Massa
- Department of Medical Oncology, National Cancer Institut, Milan, Italy
| | - Giulio Metro
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Isabelle Monnet
- Pneumology and Thoracic Oncology Department, Intercommunal Hospital of Creteil (CHI), Creteil, France
| | | | - Fabrizio Tabbo
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Emilio Bria
- Department of Medical Oncology, Comprehensive Cancer Center, IRCCS Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Florian Guisier
- Department of Medical Oncology, Rouen University Hospital, Rouen, France
| | - Damien Vasseur
- Department of Medical Biology and Pathology, Gustave Roussy, Villejuif, France
| | - Colin R Lindsay
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Santiago Ponce-Aix
- Department of Medical Oncology, University Hospital October 12, Madrid, Spain
| | - Sophie Cousin
- Department of Medical Oncology, Bergonié Institut, Bordeaux, France
| | | | - Vincent Fallet
- Department of Pneumology and Thoracic Oncology, Tenon Hospital, Assistance Publique Hôpitaux de Paris and GRC 4, Theranoscan, Sorbonne Université, Paris, France
| | | | - Anna Eisert
- Department of Medical Oncology, University Hospital of Cologne, Cologne, Germany
| | | | | | - Laura Mezquita
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain; Laboratory of Translational Genomics and Targeted Therapies in Solid Tumors, Institut D'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Antonio Calles
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Giannis Mountzios
- 4th Oncology Department and Clinical Trials Unit, Henry Dunant Hospital Center, Athens, Greece
| | - Marco Tagliamento
- Department of Internal Medicine and Medical Specialties, University of Genova, Genova, Italy
| | - Jordi Remon Masip
- Department of Medical Oncology, Centro Integral Oncológico Clara Campal (HM-CIOCC), Hospital HM Delfos, HM Hospitales, Barcelona, Spain
| | - Judith Raimbourg
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, St Herblain, France
| | - Safae Terrisse
- Department of Medical Oncology, Saint Louis Hospital, Paris, France
| | - Alessandro Russo
- Department of Medical Oncology, Papardo Hospital, Messina, Italy
| | - Diego Cortinovis
- Department of Medical Oncology, San Gerardo Hospital, Monza, Italy
| | - Philippe Rochigneux
- Department of Medical Oncology, Paoli-Calmettes Institute, Marseille, France
| | - David James Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, United Kingdom; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | | | - Camille Leonce
- Department of Molecular Pathology, Louis-Pradel Hospital, Lyon, France
| | - Anas Gazzah
- Department of Drug Development Department, International Center for Thoracic Cancers (CICT), Gustave Roussy, Villejuif, France
| | - Maria-Rosa Ghigna
- Department of Pathology, International Center for Thoracic Cancers (CICT), Gustave Roussy, Villejuif, France
| | - Roberto Ferrara
- Department of Medical Oncology, National Cancer Institut, Milan, Italy
| | | | - Francesco Passiglia
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Vienna Ludovini
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Fabrice Barlesi
- Department of Medical Oncology, International Center for Thoracic Cancers (CICT), Gustave Roussy, Villejuif, France; Paris-Saclay University, Kremlin-Bicêtre, France
| | - Enriqueta Felip
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - David Planchard
- Department of Medical Oncology, International Center for Thoracic Cancers (CICT), Gustave Roussy, Villejuif, France
| | - Benjamin Besse
- Department of Medical Oncology, International Center for Thoracic Cancers (CICT), Gustave Roussy, Villejuif, France; Paris-Saclay University, Kremlin-Bicêtre, France.
| |
Collapse
|
49
|
Buti S, Tommasi C, Scartabellati G, De Giorgi U, Brighi N, Rebuzzi SE, Puglisi S, Caffo O, Kinspergher S, Mennitto A, Cattrini C, Santoni M, Verzoni E, Rametta A, Stellato M, Malgeri A, Roviello G, de Filippo M, Cortellini A, Bersanelli M. The impact of proton-pump inhibitors administered with tyrosine kinase inhibitors in patients with metastatic renal cell carcinoma. Anticancer Drugs 2023; 34:178-186. [PMID: 36539370 PMCID: PMC9760470 DOI: 10.1097/cad.0000000000001356] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 12/24/2022]
Abstract
Tyrosine kinase inhibitors (TKIs) are the backbone of the systemic treatment for patients with metastatic renal cell carcinoma (mRCC). TKIs such as pazopanib and cabozantinib can interact with other drugs concomitantly administered, particularly with proton-pump inhibitors (PPIs), possibly impacting the effectiveness of the anticancer treatment and patients outcome. Few data are available about this interaction. We conducted a multicenter retrospective observational data collection of patients with mRCC treated with pazopanib or cabozantinib between January 2012 and December 2020 in nine Italian centers. Univariate and multivariate analyses were performed. The aim was to describe the impact of baseline concomitant PPIs on the outcome of patients to pazopanib and cabozantinib in terms of response, progression-free survival (PFS) and overall survival (OS), toxicity, and treatment compliance. The use of PPI in our study population (301 patients) significantly influenced the effectiveness of TKIs with worse PFS (16.3 vs. 9.9 months; P < 0.001) and OS (30.6 vs. 18.4 months; P = 0.013) in patients taking PPI at TKI initiation. This detrimental effect was maintained both in the pazopanib and cabozantinib groups. The use of PPI influenced the toxicity and TKI treatment compliance with a reduction of dose or schedule modifications, and treatment interruptions in the population taking PPIs. Our study demonstrates that the use of PPIs can significantly influence the outcome and compliance of patients with mRCC to TKI treatment, suggesting the importance of a more careful selection of patients who need a gastroprotective therapy, avoiding indiscriminate use of PPIs.
Collapse
Affiliation(s)
- Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma
- Department of Medicine and Surgery, University of Parma
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma
| | - Chiara Tommasi
- Medical Oncology Unit, University Hospital of Parma
- Department of Medicine and Surgery, University of Parma
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma
| | | | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | - Nicole Brighi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | - Sara Elena Rebuzzi
- Medical Oncology Unit, Ospedale San Paolo, Savona
- Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genova
| | - Silvia Puglisi
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova
| | - Orazio Caffo
- Department of Medical Oncology, Santa Chiara Hospital, Trento
| | | | - Alessia Mennitto
- Division of Oncology, University Hospital ‘Maggiore della Carità’, Novara
| | - Carlo Cattrini
- Division of Oncology, University Hospital ‘Maggiore della Carità’, Novara
| | - Matteo Santoni
- Department of Medical Oncology, University of Marche, University Hospital Ospedali Riuniti, Ancona
| | - Elena Verzoni
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - Alessandro Rametta
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - Marco Stellato
- Department of Medical Oncology, Università Campus Bio-Medico di Roma, Rome
| | - Andrea Malgeri
- Department of Medical Oncology, Università Campus Bio-Medico di Roma, Rome
| | | | - Massimo de Filippo
- Department of Medicine and Surgery, University of Parma
- Radiology Unit, University Hospital of Parma, Parma, Italy
| | | | - Melissa Bersanelli
- Medical Oncology Unit, University Hospital of Parma
- Department of Medicine and Surgery, University of Parma
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma
| |
Collapse
|
50
|
Buti S, Basso U, Giannarelli D, De Giorgi U, Maruzzo M, Iacovelli R, Galli L, Porta C, Carrozza F, Procopio G, Fonarini G, Lo Re G, Santoni M, Sabbatini R, Cusmai A, Zucali PA, Aschele C, Baldini E, Zafarana E, Favaretto A, Leo S, Hamzaj A, Mirabelli R, Nole’ F, Zai S, Chini C, Masini C, Fatigoni S, Rocchi A, Tamburini E, Cortellini A, Bersanelli M. Concomitant Drugs Prognostic Score in Patients With Metastatic Renal Cell Carcinoma Receiving Ipilimumab and Nivolumab in the Compassionate Use Program in Italy: Brief Communication. J Immunother 2023; 46:22-26. [PMID: 36472582 PMCID: PMC10561686 DOI: 10.1097/cji.0000000000000446] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 10/04/2022] [Indexed: 12/12/2022]
Abstract
A concomitant drug-based score was developed by our group and externally validated for prognostic and predictive purposes in patients with advanced cancer treated with immune checkpoint inhibitors (ICIs). The model considers the use of three classes of drugs within a month before initiating ICI, assigning score 1 for each between proton pump inhibitor and antibiotic administration until a month before immunotherapy initiation and score 2 in case of corticosteroid intake. In the present analysis, the drug score was validated in a prospective population of 305 patients with metastatic renal cell carcinoma treated with ipilimumab plus nivolumab in the first-line setting. The value of the model in predicting overall survival and progression-free survival was statistically significant and clinically meaningful, with an overall survival rate at 12 months of 73% vs. 44% (P<0.0001), and median progression-free survival of 11.6 (95% CI: 9.1-14.1) months versus 4.8 (95% CI: 2.7-7.0) months (P=0.002), respectively, for patients belonging to the favorable group (score 0-1) versus the unfavorable (score 2-4). Further development will be represented by the gut microbiome analysis according to the drug-based model classification and to the outcome of patients to ICI therapy to demonstrate the link between drug exposure and immune sensitivity.
Collapse
Affiliation(s)
- Sebastiano Buti
- Department of Medicine and Surgery, University of Parma, Parma
- Medical Oncology Unit, University Hospital of Parma, Parma
| | - Umberto Basso
- Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV-IRCCS, Padua
| | - Diana Giannarelli
- Department of Biostatistical, Regina Elena National Cancer Institute, IRCCS, Rome
| | - Ugo De Giorgi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola
| | - Marco Maruzzo
- Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV-IRCCS, Padua
| | - Roberto Iacovelli
- Department of Medical and Surgical Sciences, Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma
| | - Luca Galli
- Unit of Medical Oncology 2, Department of Translational Research and New Technologies in Medicine and Surgery, Azienda Ospedaliera Universitaria Pisana, Pisa
| | - Camillo Porta
- Department of Biomedical Sciences and Human Oncology, University of Bari ‘A. Moro’ and Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari
| | - Francesco Carrozza
- Oncology Unit" Santa Maria delle Croci Hospital", Department Oncology and Haematology AUSL, Romagna, Ravenna
| | - Giuseppe Procopio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori
| | - Giuseppe Fonarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova
| | - Giovanni Lo Re
- Division of Medical Oncology and Immune-Related Tumors, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano
| | | | - Roberto Sabbatini
- Oncological Medicine Unit and Medical Oncology Unit, Department of Oncology and Haematology, University Hospital of Modena, University of Modena and Reggio Emilia, Modena
| | - Antonio Cusmai
- Interventional and Medical Oncology Unit, National Cancer Research Center, Istituto Tumori Giovanni Paolo II, Viale Orazio Flacco, Bari
| | - Paolo Andrea Zucali
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele
- Department of Oncology, IRCCS Humanitas Research Hospital, Rozzano
| | - Carlo Aschele
- Department of Oncology, Ospedale S. Andrea, La Spezia
| | - Editta Baldini
- Department of Medical Oncology, San Luca Hospital, Lucca
| | - Elena Zafarana
- Department of Medical Oncology, Hospital of Prato, Prato
| | - Adolfo Favaretto
- Department of Medical Oncology, AULSS 2 Marca Trevigiana, Ca'Foncello Hospital, Treviso
| | - Silvana Leo
- Medical Oncology Unit, Vito Fazzi Hospital, Lecce
| | | | - Rosanna Mirabelli
- Department of Ematology and Oncology, Pugliese-Ciaccio Hospital, Catanzaro
| | - Franco Nole’
- Medical Oncology Division of Urogenital and Head and Neck Tumours IEO, European Institute of Oncology IRCCS, Milan
| | - Silvia Zai
- Medical Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria
| | - Claudio Chini
- Department of Medical Oncology, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese
| | - Cristina Masini
- Medical Oncology Unit, Clinical Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia
| | - Sonia Fatigoni
- Medical Oncology, Santa Maria della Misericordia Hospital, University of Perugia, Perugia
| | - Andrea Rocchi
- Hematology and Oncology Unit, San Giovanni Battista Hospital, Foligno
| | - Emiliano Tamburini
- Department of Oncology and Palliative Care, Cardinale G. Panico, Tricase City Hospital, Tricase, Italy
| | | | - Melissa Bersanelli
- Department of Medicine and Surgery, University of Parma, Parma
- Medical Oncology Unit, University Hospital of Parma, Parma
| |
Collapse
|