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Rozeman EA, Versluis JM, Sikorska K, Hoefsmit EP, Dimitriadis P, Rao D, Lacroix R, Grijpink-Ongering LG, Lopez-Yurda M, Heeres BC, van de Wiel BA, Flohil C, Sari A, Heijmink SWTPJ, van den Broek D, Broeks A, de Groot JWB, Vollebergh MA, Wilgenhof S, van Thienen JV, Haanen JBAG, Blank CU. IMPemBra: a phase 2 study comparing pembrolizumab with intermittent/short-term dual MAPK pathway inhibition plus pembrolizumab in patients with melanoma harboring the BRAFV600 mutation. J Immunother Cancer 2023; 11:e006821. [PMID: 37479483 PMCID: PMC10364170 DOI: 10.1136/jitc-2023-006821] [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] [Accepted: 06/18/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Continuous combination of MAPK pathway inhibition (MAPKi) and anti-programmed death-(ligand) 1 (PD-(L)1) showed high response rates, but only limited improvement in progression-free survival (PFS) at the cost of a high frequency of treatment-related adverse events (TRAE) in patients with BRAFV600-mutated melanoma. Short-term MAPKi induces T-cell infiltration in patients and is synergistic with anti-programmed death-1 (PD-1) in a preclinical melanoma mouse model. The aim of this phase 2b trial was to identify an optimal regimen of short-term MAPKi with dabrafenib plus trametinib in combination with pembrolizumab. METHODS Patients with treatment-naïve BRAFV600E/K-mutant advanced melanoma started pembrolizumab 200 mg every 3 weeks. In week 6, patients were randomized to continue pembrolizumab only (cohort 1), or to receive, in addition, intermittent dabrafenib 150 mg two times per day plus trametinib 2 mg one time per day for two cycles of 1 week (cohort 2), two cycles of 2 weeks (cohort 3), or continuously for 6 weeks (cohort 4). All cohorts continued pembrolizumab for up to 2 years. Primary endpoints were safety and treatment-adherence. Secondary endpoints were objective response rate (ORR) at week 6, 12, 18 and PFS. RESULTS Between June 2016 and August 2018, 33 patients with advanced melanoma have been included and 32 were randomized. Grade 3-4 TRAE were observed in 12%, 12%, 50%, and 63% of patients in cohort 1, 2, 3, and 4, respectively. All planned targeted therapy was given in 88%, 63%, and 38% of patients in cohort 2, 3, and 4. ORR at week 6, 12, and 18 were 38%, 63%, and 63% in cohort 1; 25%, 63%, and 75% in cohort 2; 25%, 50%, and 75% in cohort 3; and 0%, 63%, and 50% in cohort 4. After a median follow-up of 43.5 months, median PFS was 10.6 months for pembrolizumab monotherapy and not reached for patients treated with pembrolizumab and intermittent dabrafenib and trametinib (p=0.17). The 2-year and 3-year landmark PFS were both 25% for cohort 1, both 63% for cohort 2, 50% and 38% for cohort 3 and 75% and 60% for cohort 4. CONCLUSIONS The combination of pembrolizumab plus intermittent dabrafenib and trametinib seems more feasible and tolerable than continuous triple therapy. The efficacy is promising and appears to be favorable over pembrolizumab monotherapy. TRIAL REGISTRATION NUMBER NCT02625337.
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Affiliation(s)
- Elisa A Rozeman
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Judith M Versluis
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Karolina Sikorska
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Esmée P Hoefsmit
- Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Petros Dimitriadis
- Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Disha Rao
- Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ruben Lacroix
- Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Marta Lopez-Yurda
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Birthe C Heeres
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Bart A van de Wiel
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Claudie Flohil
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Aysegul Sari
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Daan van den Broek
- Department of Laboratory Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Annegien Broeks
- Core Facility and Biobanking, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Marieke A Vollebergh
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sofie Wilgenhof
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Johannes V van Thienen
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - John B A G Haanen
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Christian U Blank
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical Oncology, Leiden University Medical center, Leiden, The Netherlands
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Lucas MW, Versluis JM, Rozeman EA, Blank CU. Personalizing neoadjuvant immune-checkpoint inhibition in patients with melanoma. Nat Rev Clin Oncol 2023; 20:408-422. [PMID: 37147419 DOI: 10.1038/s41571-023-00760-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/07/2023]
Abstract
Neoadjuvant immune-checkpoint inhibition is a promising emerging treatment approach for patients with surgically resectable macroscopic stage III melanoma. The neoadjuvant setting provides an ideal platform for personalized therapy owing to the very homogeneous nature of the patient population and the opportunity for pathological response assessments within several weeks of starting treatment, thereby facilitating the efficient identification of novel biomarkers. A pathological response to immune-checkpoint inhibitors has been shown to be a strong surrogate marker of both recurrence-free survival and overall survival, enabling timely analyses of the efficacy of novel therapies in patients with early stage disease. Patients with a major pathological response (defined as the presence of ≤10% viable tumour cells) have a very low risk of recurrence, which offers an opportunity to adjust the extent of surgery and any subsequent adjuvant therapy and follow-up monitoring. Conversely, patients who have only a partial pathological response or who do not respond to neoadjuvant therapy still might benefit from therapy escalation and/or class switch during adjuvant therapy. In this Review, we outline the concept of a fully personalized neoadjuvant treatment approach exemplified by the current developments in neoadjuvant therapy for patients with resectable melanoma, which could provide a template for the development of similar approaches for patients with other immune-responsive cancers in the near future.
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Affiliation(s)
- Minke W Lucas
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Judith M Versluis
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Elisa A Rozeman
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Christian U Blank
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands.
- Department of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, Netherlands.
- Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands.
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Hoefsmit EP, Völlmy F, Rozeman EA, Reijers IL, Versluis JM, Hoekman L, van Akkooi AC, Long GV, Schadendorf D, Dummer R, Altelaar M, Blank CU. Systemic LRG1 expression in melanoma is associated with disease progression and recurrence. Cancer Research Communications 2023; 3:672-683. [PMID: 37089863 PMCID: PMC10117404 DOI: 10.1158/2767-9764.crc-23-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/07/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023]
Abstract
Abstract
The response rates upon neoadjuvant immune checkpoint blockade (ICB) in stage III melanoma are higher as compared to stage IV disease. Given that successful ICB depends on systemic immune response, we hypothesized that systemic immune suppression might be a mechanism responsible for lower response rates in late-stage disease, and also potentially with disease recurrence in early-stage disease. Plasma and serum samples of cohorts of melanoma patients were analyzed for circulating proteins using mass spectrometry proteomic profiling and Olink proteomic assay. A cohort of paired samples of patients with stage III that progressed to stage IV disease (n=64) was used to identify markers associated with higher tumor burden. Baseline patient samples from the OpACIN-neo study (n=83) and PRADO study (n=49; NCT02977052) were used as two independent cohorts to analyze whether the potential identified markers are also associated with disease recurrence after neoadjuvant ICB therapy. When comparing baseline proteins overlapping between patients with progressive disease and patients with recurrent disease, we found leucine-rich alpha-2-glycoprotein 1 (LRG1) to be associated with worse prognosis. Especially non-responder patients to neoadjuvant ICB (OpACIN-neo) with high LRG1 expression had a poor outcome with an estimated 36-month event-free survival of 14% as compared to 83% for non-responders with a low LRG1 expression (P = 0.014). This finding was validated in an independent cohort (P = 0.0021). LRG1 can be used as a biomarker to identify patients with high risk for disease progression and recurrence, and might be a target to be combined with neoadjuvant ICB.
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Affiliation(s)
- Esmee P. Hoefsmit
- Department of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Franziska Völlmy
- Biomolecular Mass Spectrometry and Proteomics, Center for Biomolecular Research and Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Elisa A. Rozeman
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Irene L.M. Reijers
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Judith M. Versluis
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Liesbeth Hoekman
- Proteomics Facility, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Alexander C.J. van Akkooi
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Georgina V. Long
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen and Germany Cancer Consortium, Partner Site Essen, Essen, Germany
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zürich, University Zürich, Zürich, Switzerland
| | - Maarten Altelaar
- Biomolecular Mass Spectrometry and Proteomics, Center for Biomolecular Research and Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
- Proteomics Facility, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Corresponding Authors: Christian U. Blank, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital (NKI-AVL), Plesmanlaan 121, Amsterdam 1066 CX, the Netherlands. Phone: +312-0512-2960; E-mail: ; and Maarten Altelaar,
| | - Christian U. Blank
- Department of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
- Corresponding Authors: Christian U. Blank, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital (NKI-AVL), Plesmanlaan 121, Amsterdam 1066 CX, the Netherlands. Phone: +312-0512-2960; E-mail: ; and Maarten Altelaar,
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Hoefsmit EP, van Royen PT, Rao D, Stunnenberg JA, Dimitriadis P, Lieftink C, Morris B, Rozeman EA, Reijers ILM, Lacroix R, Shehwana H, Ligtenberg MA, Beijersbergen RL, Peeper DS, Blank CU. Inhibitor of apoptosis proteins (IAP) antagonist induces T-cell proliferation after cross-presentation by dendritic cells. Cancer Immunol Res 2023; 11:450-465. [PMID: 36753604 DOI: 10.1158/2326-6066.cir-22-0494] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 11/28/2022] [Accepted: 02/01/2023] [Indexed: 02/10/2023]
Abstract
Cross-presentation of tumor antigens by dendritic cells (DCs) is crucial to prime, stimulate and restimulate CD8+ T cells. This process is important in initiating and maintaining an antitumor response. Here, we show that the presence of conventional type 1 DCs (cDC1), a DC subtype that excels in cross-presentation, in the tumor correlated with response to neoadjuvant immune checkpoint blockade (ICB) in melanoma. This led us to hypothesize that patients failing to respond to ICB could benefit from enhanced cross-presentation of tumor antigens. We therefore established a cross-presentation assay to screen over 5,500 compounds for enhancers of DC cross-presentation using induced T-cell proliferation as the readout. We identified 145 enhancers, including AZD5582, an antagonist of inhibitor of apoptosis proteins (IAPs) cIAP1, cIAP2 and XIAP. AZD5582 treatment led to DC activation of the non-canonical nuclear factor kappa B (NF-kB) pathway, enhanced antigen import from endolysosomes into the cytosol and increased expression of genes involved in cross-presentation. Furthermore, it upregulated expression of CD80, CD86, MHC class II, CD70 and secretion of TNF by DCs. This enhanced DC activation and maturation program was observed also in tumor-bearing mice upon AZD5582 treatment, culminating in an increased frequency of systemic tumor antigen-specific CD8+ T cells. Our results merit further exploration of AZD5582 to increase antigen cross-presentation for improving the clinical benefit of ICB in patients who are unlikely to respond to ICB.
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Affiliation(s)
- Esmee P Hoefsmit
- Netherlands Cancer Instiute, Amsterdam, Noord-Holland, Netherlands
| | | | - Disha Rao
- Netherlands Cancer Instiute, Amsterdam, Noord-Holland, Netherlands
| | | | - P Dimitriadis
- Netherlands Cancer Instiute, Amsterdam, Noord-Holland, Netherlands
| | - Cor Lieftink
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Ben Morris
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | - Ruben Lacroix
- Netherlands Cancer Instiute, Amsterdam, Noord-Holland, Netherlands
| | - Huma Shehwana
- Netherlands Cancer Instiute, Amsterdam, Noord-Holland, Netherlands
| | | | | | | | - Christian U Blank
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NKI-AVL), Amsterdam, Netherlands
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5
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Versluis JM, Menzies AM, Sikorska K, Rozeman EA, Saw RPM, van Houdt WJ, Eriksson H, Klop WMC, Ch'ng S, van Thienen JV, Mallo H, Gonzalez M, Torres Acosta A, Grijpink-Ongering LG, van der Wal A, Bruining A, van de Wiel BA, Scolyer RA, Haanen JBAG, Schumacher TN, van Akkooi ACJ, Long GV, Blank CU. Survival update of neoadjuvant ipilimumab plus nivolumab in macroscopic stage III melanoma in the OpACIN and OpACIN-neo trials. Ann Oncol 2023; 34:420-430. [PMID: 36681299 DOI: 10.1016/j.annonc.2023.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 11/04/2022] [Revised: 12/20/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Neoadjuvant ipilimumab plus nivolumab has yielded high response rates in patients with macroscopic stage III melanoma. These response rates translated to high short-term survival rates. However, data on long-term survival and disease recurrence are lacking. PATIENTS AND METHODS In OpACIN, 20 patients with macroscopic stage III melanoma were randomized to ipilimumab 3 mg/kg plus nivolumab 1 mg/kg q3w four cycles of adjuvant or split two cycles of neoadjuvant and two adjuvant. In OpACIN-neo, 86 patients with macroscopic stage III melanoma were randomized to arm A (2× ipilimumab 3 mg/kg plus nivolumab 1 mg/kg q3w; n = 30), arm B (2× ipilimumab 1 mg/kg plus nivolumab 3 mg/kg q3w; n = 30), or arm C (2× ipilimumab 3 mg/kg q3w plus 2× nivolumab 3 mg/kg q2w; n = 26) followed by surgery. RESULTS The median recurrence-free survival (RFS) and overall survival (OS) were not reached in either trial. After a median follow-up of 69 months for OpACIN, 1/7 patients with a pathologic response to neoadjuvant therapy had disease recurrence. The estimated 5-year RFS and OS rates for the neoadjuvant arm were 70% and 90% versus 60% and 70% for the adjuvant arm. After a median follow-up of 47 months for OpACIN-neo, the estimated 3-year RFS and OS rates were 82% and 92%, respectively. The estimated 3-year RFS rate for OpACIN-neo was 95% for patients with a pathologic response versus 37% for patients without a pathologic response (P < 0.001). In multiple regression analyses, pathologic response was the strongest predictor of disease recurrence. Of the 12 patients with distant disease recurrence after neoadjuvant therapy, 5 responded to subsequent anti-PD-1 and 8 to targeted therapy, although 7 patients showed progression after the initial response. CONCLUSIONS Updated data confirm the high survival rates after neoadjuvant combination checkpoint inhibition in macroscopic stage III melanoma, especially for patients with a pathologic response. Pathologic response is the strongest surrogate marker for long-term outcome.
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Affiliation(s)
- J M Versluis
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney; Faculty of Medicine and Health, The University of Sydney, Sydney; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, Australia
| | - K Sikorska
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E A Rozeman
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R P M Saw
- Melanoma Institute Australia, The University of Sydney, Sydney; Faculty of Medicine and Health, The University of Sydney, Sydney; Department of Surgery, Mater Hospital, Sydney; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - W J van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H Eriksson
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm; Department of Oncology/Skin Cancer Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - W M C Klop
- Departments of, Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - S Ch'ng
- Melanoma Institute Australia, The University of Sydney, Sydney; Department of Surgery, Mater Hospital, Sydney; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - J V van Thienen
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H Mallo
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M Gonzalez
- Melanoma Institute Australia, The University of Sydney, Sydney
| | - A Torres Acosta
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - A van der Wal
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Bruining
- Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - B A van de Wiel
- Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney; Faculty of Medicine and Health, The University of Sydney, Sydney; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney; Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - J B A G Haanen
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam
| | - T N Schumacher
- Department of Hematology, Leiden University Medical Center, Leiden; Division of Molecular Oncology and Immunology, Oncode Institute, Netherlands Cancer Institute, Amsterdam
| | - A C J van Akkooi
- Melanoma Institute Australia, The University of Sydney, Sydney; Faculty of Medicine and Health, The University of Sydney, Sydney; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - G V Long
- Melanoma Institute Australia, The University of Sydney, Sydney; Faculty of Medicine and Health, The University of Sydney, Sydney; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, Australia; Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - C U Blank
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam; Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands.
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Rozeman EA, Versluis JM, Moritz R, Wilgenhof S, van Thienen JV, Haanen JBAG, van de Heuvel MM, Blank CU, van Rossum HH. Diagnostic performance of early increase in S100B or LDH as outcome predictor for non-responsiveness to anti-PD-1 monotherapy in advanced melanoma. Clin Chim Acta 2022; 533:71-78. [PMID: 35709988 DOI: 10.1016/j.cca.2022.06.001] [Citation(s) in RCA: 2] [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: 04/08/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 11/03/2022]
Abstract
As a subset of advanced melanoma patients derive long-term benefit from anti-PD-1 therapy, early identification of non-responsiveness would enable an early switch to next line therapies. This study assessed if an early increase in S100B or lactate dehydrogenase (LDH) could be predictive for non-responsiveness to anti-PD-1. We retrospectively analysed advanced melanoma patients treated with anti-PD-1 monotherapy. Serum S100B and LDH levels were measured at baseline and before every infusion. Non-response was defined as progression or death at 6 months. Marker cut-offs were defined based on > 95% specificity and feasibility in clinical practice. For validation an independent cohort was analysed. In total, 313 patients were included (166 patients in training cohort, 147 patients in validation cohort). Increase of > 50% in LDH or > 100% in S100B above upper limit of normal at week 6 compared to baseline was determined as criterion to positively test for non-responsiveness. In the validation cohort, obtained specificity of the combination test was > 95% with a positive predictive value of 82%; obtained sensitivity was lower (21%), with a negative predictive value of 55%. Early increase in S100B or LDH is a strong parameter for non-responsiveness to anti-PD-1 in advanced melanoma. Prospective confirmation is needed before clinical implementation.
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Affiliation(s)
- Elisa A Rozeman
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Division of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Judith M Versluis
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Division of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ruben Moritz
- Department of Laboratory Medicine, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sofie Wilgenhof
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Johannes V van Thienen
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - John B A G Haanen
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Division of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Michel M van de Heuvel
- Division of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Respiratory Diseases, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Christian U Blank
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Division of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Huub H van Rossum
- Department of Laboratory Medicine, Netherlands Cancer Institute, Amsterdam, the Netherlands.
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Reijers IL, Dimitriadis P, Rozeman EA, Krijgsman O, Cornelissen S, Bosch LJ, Broeks A, Menzies AM, van de Wiel BA, Scolyer RA, Long GV, Blank CU. The interferon-gamma (IFN-y) signature from baseline tumor material predicts pathologic response after neoadjuvant ipilimumab (IPI) + nivolumab (NIVO) in stage III melanoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9539] [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: 11/20/2022] Open
Abstract
9539 Background: Neoadjuvant IPI + NIVO induces high pathologic response rates (pRR) of 74-78% in macroscopic stage III melanoma. Pathologic response ( < 50% viable tumor) is strongly associated with improved relapse-free survival (RFS); the previous OpACIN-neo study demonstrated a 2-year RFS of 96.9% in patients (pts) with pathologic response, whereas the 2-year RFS in non-responders was 35.5%. These data highlight the need for baseline biomarkers predictive for response and survival. Here, we present the predictive value of the 10-gene IFN-y expression signature algorithm (based on Ayers et al.) for pathologic response and relapse in a cohort of melanoma pts treated with neoadjuvant IPI + NIVO. Methods: Baseline tumor biopsies from lymph node metastases of stage III melanoma pts were used for IFN-y signature assessment. Pts were treated with a maximum of two cycles of neoadjuvant IPI 1mg/kg + NIVO 3mg/kg in the OpACIN-neo (arm B) and PRADO studies. RNA expression analysis was conducted using the nCounter® PanCancer Immune Profiling panel on the NanoString Flex machine (NanoString Technologies), which is clinically applicable due to its fast turn-around-time (two days). An IFN-y signature gene expression score (IFN-y score) was calculated using a NKI-developed algorithm. Association between IFN-y score and pathologic response or event-free survival (EFS) was examined by logistic regression and Cox analyses. The optimal cutoff between a high and low IFN-y score was defined based on a summary receiver operating characteristic (sROC) curve. Results: In total, 103 pts treated in the OpACIN-neo and PRADO studies had baseline tumor material available. Median age was 56 years, 62% was male, and 52% had a high baseline IFN-y score. The pRR of the total cohort was 70% (72/103 pts), including 56% (58/103) major pathologic response (MPR, 0-≤10% viable tumor) and 14% (14/103) partial responses (pPR, 10-≤50% viable tumor). 30% (31/103 pts) had no pathologic response. After a median follow-up of 25.2 months, 26 pts (25.2%) developed a melanoma relapse. The IFN-y score was significantly associated with response (OR 1.061, p < 0.001) and relapse (OR 0. 974, p = 0.029). The pRR was 89% (48/54) in pts with a high IFN-y score versus 49% (24/49) in those with a low IFN-y score (p < 0.001). Pts with a high IFN-y score were also less likely to develop a relapse (11% [6/54] versus 41% [20/49], p = 0.001). Conclusions: Pts with a high IFN-y score in pre-treatment biopsies are more likely to respond to neoadjuvant IPI + NIVO with favorable EFS. A rapid gene expression analysis enables the IFN-y score to be used in daily clinical practice to identify pts who might qualify for treatment escalation or de-escalation. The DONIMI study [NCT04133948] currently investigates different neoadjuvant treatment combinations in stage III melanoma pts based on their intratumoral IFN-y score.
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Affiliation(s)
| | | | | | - Oscar Krijgsman
- Netherlands Cancer Institute (NKI-AVL), Amsterdam, Netherlands
| | | | - Linda J.W. Bosch
- Netherlands Cancer Institute, Department of Pathology, Amsterdam, Netherlands
| | - Annegien Broeks
- Core Facility Molecular Pathology and Biobanking, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Alexander M. Menzies
- Melanoma Institute Australia, The University of Sydney, and Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | | | - Richard A. Scolyer
- Melanoma Institute Australia, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, Australia
| | - Georgina V. Long
- Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
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Reijers ILM, Menzies AM, van Akkooi ACJ, Versluis JM, van den Heuvel NMJ, Saw RPM, Pennington TE, Kapiteijn E, van der Veldt AAM, Suijkerbuijk KPM, Hospers GAP, Rozeman EA, Klop WMC, van Houdt WJ, Sikorska K, van der Hage JA, Grünhagen DJ, Wouters MW, Witkamp AJ, Zuur CL, Lijnsvelt JM, Torres Acosta A, Grijpink-Ongering LG, Gonzalez M, Jóźwiak K, Bierman C, Shannon KF, Ch'ng S, Colebatch AJ, Spillane AJ, Haanen JBAG, Rawson RV, van de Wiel BA, van de Poll-Franse LV, Scolyer RA, Boekhout AH, Long GV, Blank CU. Personalized response-directed surgery and adjuvant therapy after neoadjuvant ipilimumab and nivolumab in high-risk stage III melanoma: the PRADO trial. Nat Med 2022; 28:1178-1188. [PMID: 35661157 DOI: 10.1038/s41591-022-01851-x] [Citation(s) in RCA: 105] [Impact Index Per Article: 52.5] [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: 04/11/2022] [Accepted: 04/29/2022] [Indexed: 02/06/2023]
Abstract
Neoadjuvant ipilimumab and nivolumab induces high pathologic response rates (pRRs) in clinical stage III nodal melanoma, and pathologic response is strongly associated with prolonged relapse-free survival (RFS). The PRADO extension cohort of the OpACIN-neo trial ( NCT02977052 ) addressed the feasibility and effect on clinical outcome of using pathologic response after neoadjuvant ipilimumab and nivolumab as a criterion for further treatment personalization. In total, 99 patients with clinical stage IIIb-d nodal melanoma were included and treated with 6 weeks of neoadjuvant ipilimumab 1 mg kg-1 and nivolumab 3 mg kg-1. In patients achieving major pathologic response (MPR, ≤10% viable tumor) in their index lymph node (ILN, the largest lymph node metastasis at baseline), therapeutic lymph node dissection (TLND) and adjuvant therapy were omitted. Patients with pathologic partial response (pPR; >10 to ≤50% viable tumor) underwent TLND only, whereas patients with pathologic non-response (pNR; >50% viable tumor) underwent TLND and adjuvant systemic therapy ± synchronous radiotherapy. Primary objectives were confirmation of pRR (ILN, at week 6) of the winner neoadjuvant combination scheme identified in OpACIN-neo; to investigate whether TLND can be safely omitted in patients achieving MPR; and to investigate whether RFS at 24 months can be improved for patients achieving pNR. ILN resection and ILN-response-tailored treatment were feasible. The pRR was 72%, including 61% MPR. Grade 3-4 toxicity within the first 12 weeks was observed in 22 (22%) patients. TLND was omitted in 59 of 60 patients with MPR, resulting in significantly lower surgical morbidity and better quality of life. The 24-month relapse-free survival and distant metastasis-free survival rates were 93% and 98% in patients with MPR, 64% and 64% in patients with pPR, and 71% and 76% in patients with pNR, respectively. These findings provide a strong rationale for randomized clinical trials testing response-directed treatment personalization after neoadjuvant ipilimumab and nivolumab.
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Affiliation(s)
- Irene L M Reijers
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Alexander M Menzies
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Alexander C J van Akkooi
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Judith M Versluis
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Noëlle M J van den Heuvel
- Department of Psychosocial research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Robyn P M Saw
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Thomas E Pennington
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Ellen Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Astrid A M van der Veldt
- Departments of Medical Oncology and Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Geke A P Hospers
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisa A Rozeman
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Willem M C Klop
- Department of Head and Neck Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Winan J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Karolina Sikorska
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jos A van der Hage
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Michel W Wouters
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Arjen J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Charlotte L Zuur
- Department of Head and Neck Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Otorhinolaryngology Head Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith M Lijnsvelt
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | - Maria Gonzalez
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Katarzyna Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Carolien Bierman
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Kerwin F Shannon
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Sydney Ch'ng
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J Colebatch
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
| | - Andrew J Spillane
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Breast and Melanoma Surgery, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - John B A G Haanen
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
- Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Robert V Rawson
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
| | - Bart A van de Wiel
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Psychosocial research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Richard A Scolyer
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Annelies H Boekhout
- Department of Psychosocial research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Georgina V Long
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Christian U Blank
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
- Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
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9
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Rozeman EA, Versluis JM, Hoefsmit EP, Dimitriadis P, Grijpink-Ongering LG, Sikorska K, van de Wiel BA, Heeres BC, Flohil C, Kvistborg P, van den Broek D, Broeks A, de Groot JW, Wilgenhof S, Vollebergh MA, van Thienen JV, Haanen JBAG, Blank CU. IMPemBra, a phase 2 study comparing pembrolizumab with intermittent/short‐term dual MAPK pathway inhibition plus pembrolizumab in patients with melanoma harboring the BRAFV600 mutation: Three-year survival data and translational analyses. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9552] [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: 11/20/2022] Open
Abstract
9552 Background: Continuous combination of MAPK pathway inhibition (MAPKi) and anti-PD-(L)1 showed high response rates, but also high frequency of treatment-related adverse events (TRAE) in BRAFV600-mutated melanoma patients (pts). Short‐time MAPKi already induces T cell infiltration in pts and was synergistic with anti-PD‐1 in a pre-clinical model. This phase 2b trial aimed to identify the optimal duration of MAPKi with dabrafenib + trametinib (D+T) in combination with pembrolizumab (PEM). We have previously shown that no SUSARs were observed, toxicity was related to duration of D+T, and response rates increased after addition of D+T. Here we present 3-year PFS and OS data and results of translational analyses. Methods: In IMPemBra, pts with treatment-naïve BRAFV600E/K mutant advanced melanoma started with PEM 200mg Q3W. After 2 cycles, pts were randomized to continue PEM only (cohort 1) or to receive in addition intermittent dabrafenib 150 mg BID + trametinib 2mg QD for 2 x 1 week (cohort 2), 2 x 2 weeks (cohort 3) or continuous for 6 weeks (cohort 4). All cohorts continued PEM for up to 2 years. Primary endpoints were safety, treatment adherence and immune-activating capacity of the different regimens. Secondary endpoints were objective response rate (ORR) and PFS, OS was an exploratory endpoint. For survival analyses, pts that received D+T (cohort 2-4) were pooled. Results: Thirty-two pts were randomized, 56% were male, 53% had M1c disease and 88% had a LDH level < ULN. No new grade 3-4 TRAE were observed; frequencies were 12%, 12%, 50% and 62% for pts in cohort 1, 2, 3 and 4, respectively. ORRs were 75% in cohort 1 and 2, and 88% in cohort 3 and 4. The frequency of PD1+CD8+ T cells in peripheral blood decreased slightly during treatment and there were no differences between cohorts. In cohort 1 and 2, an increase in IFNγ signature in tumor biopsies was already observed after 6 weeks of PEM, in cohort 3-4 an increase in IFNγ signature was observed in week 9, after addition of D+T. The same pattern was observed for CD8+ T cell infiltration and PD-L1 expression. After a median follow-up of 43.5 months, the median PFS of pts treated with PEM monotherapy was 10.6 months versus 32.3 months for pts treated with PEM plus D+T (p = 0.19). The 3-year PFS rates were 25.0% and 50.0% respectively. Median OS was 40.5 months in the PEM pts and not reached for pts treated with PEM plus D+T (p = 0.32); 3-year OS rates were 62.5% and 70.8% respectively. Conclusions: IMPemBra demonstrated that short-term addition of intermittent D+T to PEM seems a more feasible, tolerable and an effective alternative for the continuous triple combination. In addition, it gives the opportunity to treat with second line targeted therapy after disease progression. Therefore, this regimen should be considered for further investigation in a larger cohort. Clinical trial information: NCT02625337.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Claudi Flohil
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Pia Kvistborg
- The Netherlands Cancer Institute (NKI), Amsterdam, Netherlands
| | | | - Annegien Broeks
- Core Facility Molecular Pathology and Biobanking, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Sofie Wilgenhof
- Division of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
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10
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Versluis JM, Sikorska K, Rozeman EA, Menzies AM, Eriksson H, Klop WMC, Saw RP, van de Wiel BA, Scolyer RA, van Thienen JV, Mallo H, Gonzalez M, Torres Acosta A, Grijpink-Ongering LG, van der Wal A, Haanen JBAG, Van Akkooi ACJ, Long GV, Blank CU. Survival update of neoadjuvant ipilimumab + nivolumab in macroscopic stage III melanoma: The OpACIN and OpACIN-neo trials. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9572] [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: 11/20/2022] Open
Abstract
9572 Background: OpACIN was the first trial testing neoadjuvant ipilimumab (IPI) + nivolumab (NIVO) versus the same combination given adjuvant. An unexpected high pathologic responses of 78% was observed in the neoadjuvant arm with a 2-year relapse-free survival (RFS) rate of 80%. The subsequent OpACIN-neo trial tested 3 different dosing schedules of neoadjuvant IPI + NIVO and identified 2 cycles IPI 1 mg/kg + NIVO 3 mg/kg q3w as most favorable schedule with a pathologic response rate of 77% and 20% grade 3-4 immune-related adverse events. Long-term data on the durability of the pathologic (path) responses upon neoadjuvant checkpoint inhibition are lacking so far. Therefore, we present here the updated RFS and overall survival (OS) data of both trials. Methods: In OpACIN 20 macroscopic stage III melanoma pts were randomized to receive either IPI 3 mg/kg + NIVO 1 mg/kg q3w 4 cycles adjuvant after lymph node dissection or split 2 cycles neoadjuvant and 2 adjuvant. In OpACIN-neo 86 macroscopic stage III melanoma pts were randomized to arm A (2x IPI 3 mg/kg + NIVO 1 mg/kg q3w, n=30), arm B (2x IPI 1 mg/kg + NIVO 3 mg/kg q3w, n=30), or arm C (2x IPI 3 mg/kg q3w followed by 2x NIVO 3 mg/kg q2w, n=26) followed by lymph node dissection in week 6. RFS and OS were estimated using Kaplan Meier method. All comparative efficacy endpoints are descriptive for OpACIN, since the trial was not powered for comparison of the arms. Results: After a median follow-up (FU) of 68.6 months for OpACIN (minimum FU of 59.8 months), median RFS and OS were not reached. Only 1/7 patients (pts) with a pathologic response on neoadjuvant therapy has relapsed. Estimated 5-year RFS and OS rates for the neoadjuvant arm were 70.0% (95%CI: 46.7-100.0) and 90.0% (95%CI: 73.2-100.0) versus 60.0% (95%CI 36.2-99.5) and 70.0% (95%CI: 46.7-100.0) for the adjuvant arm. After a median FU of 46.8 months for OpACIN-neo (minimum FU of 38.2 months), median RFS and OS were not reached. Of pts with path response on neoadjuvant therapy, 3/64 (4.7%) had an event (2 pts relapsed, 1 pt died due to toxicity), versus 14/21 (66.7%) without path response. This resulted in a 3-year RFS rate of 95.3% (95%CI: 90.3-100.0) for responding versus 36.8% (95%CI: 20.4-66.4) for non-responding pts (p<0.001). Of the pts who relapsed after response, 1 had major path response (<10% vital tumor) and 1 a partial response (10-15% vital tumor). Estimated 3-year RFS and OS rates are presented in the Table. Conclusions: Updated data from OpACIN and OpaCIN-neo trials confirm the durability of responses upon neoadjuvant combination checkpoint inhibition in high risk stage III melanoma. Pathologic response remains a reliable surrogate marker for RFS and OS. Clinical trial information: NCT02437279, NCT02977052. [Table: see text]
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Affiliation(s)
| | | | | | - Alexander M. Menzies
- Melanoma Institute Australia, The University of Sydney, and Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | | | | | - Robyn P.M. Saw
- Melanoma Institute Australia, The University of Sydney, Royal Prince Alfred Hospital, The Mater Hospital Sydney, Sydney, NSW, Australia
| | | | - Richard A. Scolyer
- Melanoma Institute Australia, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, Australia
| | | | - Henk Mallo
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | | | | | | | | | - Georgina V. Long
- Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
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11
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Reijers ILM, Rawson RV, Colebatch AJ, Rozeman EA, Menzies AM, van Akkooi ACJ, Shannon KF, Wouters MW, Saw RPM, van Houdt WJ, Zuur CL, Nieweg OE, Ch’ng S, Klop WMC, Spillane AJ, Long GV, Scolyer RA, van de Wiel BA, Blank CU. Representativeness of the Index Lymph Node for Total Nodal Basin in Pathologic Response Assessment After Neoadjuvant Checkpoint Inhibitor Therapy in Patients With Stage III Melanoma. JAMA Surg 2022; 157:335-342. [PMID: 35138335 PMCID: PMC8829746 DOI: 10.1001/jamasurg.2021.7554] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 09/13/2021] [Accepted: 11/28/2021] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Neoadjuvant checkpoint inhibition in patients with high-risk stage III melanoma shows high pathologic response rates associated with a durable relapse-free survival. Whether a therapeutic lymph node dissection (TLND) can be safely omitted when a major pathologic response in the largest lymph node metastasis at baseline (index lymph node; ILN) is obtained is currently being investigated. A previous small pilot study (n = 12) showed that the response in the ILN may be representative of the pathologic response in the entire TLND specimen. OBJECTIVE To assess the concordance of response between the ILN and the total lymph node bed in a larger clinical trial population. DESIGN, SETTING, AND PARTICIPANTS Retrospective pathologic response analysis of a multicenter clinical trial population of patients from the randomized Study to Identify the Optimal Adjuvant Combination Scheme of Ipilimumab and Nivolumab in Melanoma Patients (OpACIN) and Optimal Neo-Adjuvant Combination Scheme of Ipilimumab and Nivolumab (OpACIN-neo) trials. Included patients were treated with 6 weeks neoadjuvant ipilimumab plus nivolumab. Patient inclusion into the trials was conducted from August 12, 2015, to October 24, 2016 (OpACIN), and November 24, 2016, and June 28, 2018 (OpACIN-neo). Data were analyzed from April 1, 2020, to August 31, 2021. MAIN OUTCOMES AND MEASURES Concordance of the pathologic response between the ILN and the TLND tumor bed. The pathologic response of the ILN was retrospectively assessed according to the International Neoadjuvant Melanoma Consortium criteria and compared with the pathologic response of the entire TLND specimen. RESULTS A total of 82 patients treated with neoadjuvant ipilimumab and nivolumab followed by TLND (48 [59%] were male; median age, 58.5 [range, 18-80] years) were included. The pathologic response in the ILN was concordant with the entire TLND specimen response in 81 of 82 patients (99%) and in 79 of 82 patients (96%) concordant when comparing the ILN response with the response in every individual lymph node. In the single patient with a discordant response, the ILN response (20% viable tumor, partial pathologic response) underestimated the entire TLND specimen response (5% viable, near-complete pathologic response). Two other patients each had 1 small nonindex node that contained 80% viable tumor (pathologic nonresponse) whereas all other lymph nodes (including the ILN) showed a partial pathologic response. In these 2 patients, the risk of regional relapse might potentially have been increased if TLND had been omitted. CONCLUSIONS AND RELEVANCE The results of this study suggest that the pathologic response of the ILN may be considered a reliable indicator of the entire TLND specimen response and may support the ILN response-directed omission of TLND in a prospective trial.
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Affiliation(s)
- Irene L. M. Reijers
- Department of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Robert V. Rawson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Tissue Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
| | - Andrew J. Colebatch
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Tissue Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
- Department of Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
| | - Elisa A. Rozeman
- Department of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Alex M. Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Oncology Department, Royal North Shore Hospital, Sydney, Australia
- Oncology Department, Mater Hospital, Sydney, New South Wales, Australia
| | | | - Kerwin F. Shannon
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Michel W. Wouters
- Department of Surgical Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Robyn P. M. Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Winan J. van Houdt
- Department of Surgical Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Charlotte L. Zuur
- Department of Head and Neck Surgery, the Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, the Netherlands
| | - Omgo E. Nieweg
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Sydney Ch’ng
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - W. Martin C. Klop
- Department of Head and Neck Surgery, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Andrew J. Spillane
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Oncology Department, Royal North Shore Hospital, Sydney, Australia
- Oncology Department, Mater Hospital, Sydney, New South Wales, Australia
| | - Georgina V. Long
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Oncology Department, Royal North Shore Hospital, Sydney, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Richard A. Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Tissue Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Bart A. van de Wiel
- Department of Pathology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Christian U. Blank
- Department of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
- Division of Molecular Oncology & Immunology, the Netherlands Cancer Institute, Amsterdam
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
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12
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Goldinger SM, Buder-Bakhaya K, Lo SN, Forschner A, McKean M, Zimmer L, Khoo C, Dummer R, Eroglu Z, Buchbinder EI, Ascierto PA, Gutzmer R, Rozeman EA, Hoeller C, Johnson DB, Gesierich A, Kölblinger P, Bennannoune N, Cohen JV, Kähler KC, Wilson MA, Cebon J, Atkinson V, Smith JL, Michielin O, Long GV, Hassel JC, Weide B, Haydu LE, Schadendorf D, McArthur G, Ott PA, Blank C, Robert C, Sullivan R, Hauschild A, Carlino MS, Garbe C, Davies MA, Menzies AM. Chemotherapy after immune checkpoint inhibitor failure in metastatic melanoma: a retrospective multicentre analysis. Eur J Cancer 2021; 162:22-33. [PMID: 34952480 DOI: 10.1016/j.ejca.2021.11.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 08/23/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Despite remarkably improved outcomes with immune checkpoint inhibition, many patients with metastatic melanoma will eventually require further therapy. Chemotherapy has limited activity when used first-line but can alter the tumour microenvironment and does improve efficacy when used in combination with immunotherapy in lung cancer. Whether chemotherapy after checkpoint inhibitor failure has relevant activity in patients with metastatic melanoma is unknown. METHODS Patients with metastatic melanoma treated with chemotherapy after progression on immunotherapy with checkpoint inhibitors were identified retrospectively from 24 melanoma centres. Objective response rate (ORR), progression-free survival (PFS), overall survival (OS) and safety were examined. RESULTS In total, 463 patients were treated between 2007 and 2017. Fifty-six per cent had received PD-1-based therapy before chemotherapy. Chemotherapy regimens included carboplatin + paclitaxel (32%), dacarbazine (25%), temozolomide (15%), taxanes (9%, nab-paclitaxel 4%), fotemustine (6%) and others (13%). Median duration of therapy was 7.9 weeks (0-108). Responses included 0.4% complete response (CR), 12% partial response (PR), 21% stable disease (SD) and 67% progressive disease (PD). Median PFS was 2.6 months (2.2, 3.0), and median PFS in responders was 8.7 months (6.3, 16.3), respectively. Twelve-month PFS was 12% (95% CI 2-15%). In patients who had received anti-PD-1 before chemotherapy, the ORR was 11%, and median PFS was 2.5 months (2.1, 2.8). The highest activity was achieved with single-agent taxanes (N = 40), with ORR 25% and median PFS 3.9 months (2.1, 6.2). Median OS from chemotherapy start was 7.1 months (6.5, 8.0). Subsequent treatment with checkpoint inhibitors achieved a response rate of 16% with a median PFS of 19.1 months (2.0-43.1 months). No unexpected toxicities were observed. CONCLUSION Chemotherapy has a low response rate and short PFS in patients with metastatic melanoma who have failed checkpoint inhibitor therapy, although activity varied between regimens. Chemotherapy has a limited role in the management of metastatic melanoma.
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Affiliation(s)
- Simone M Goldinger
- University of Zurich, Department of Dermatology, Gloriastrasse 31 Zurich, 8091, Switzerland; Melanoma Institute Australia, The University of Sydney, The Poche Centre, 40 Rocklands Road North Sydney NSW 2060, Australia.
| | - Kristina Buder-Bakhaya
- University Hospital Heidelberg, Department of Dermatology and National Center for Cancer (NCT), Im Neuenheimer Feld 460 Heidelberg, 69120, Germany.
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, The Poche Centre, 40 Rocklands Road North Sydney NSW 2060, Australia.
| | - Andrea Forschner
- University of Tuebingen, Department of Dermatology, Liebermeisterstrasse 25, Tübingen, 72076, Germany.
| | - Meredith McKean
- University of Texas MD Anderson Cancer Center, Department of Melanoma Medical Oncology and Department of Surgical Oncology, 1400 Pressler Street, Houston, TX 77006 USA.
| | - Lisa Zimmer
- University Hospital Essen, Department of Dermatology, Essen & German Cancer Consortium, Partner Site Essen, Germany.
| | - Chloe Khoo
- Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - Reinhard Dummer
- University of Zurich, Department of Dermatology, Gloriastrasse 31 Zurich, 8091, Switzerland.
| | - Zeynep Eroglu
- Moffitt Cancer Center, Department of Cutaneous Oncology, 12902 Magnolia Drive, Tampa, FL 33612, USA.
| | | | - Paolo A Ascierto
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Napoli, Italy.
| | - Ralf Gutzmer
- Skin Cancer Center, Department of Dermatology, Mühlenkreiskliniken, Ruhr University Bochum Campus Minden, Germany.
| | - Elisa A Rozeman
- Antoni van Leeuwenhoek Hospital - The Netherlands Cancer Institute, Department of Medical Oncology and Immunology, Plesmanlaan 121 Amsterdam, 1066 CX, the Netherlands.
| | - Christoph Hoeller
- Medical University of Vienna, Department of Dermatology, Waehringer Guertel 18-20, Vienna, 1090, Austria.
| | - Douglas B Johnson
- Vanderbilt University Medical Center, Department of Medicine, Nashville, TN, USA.
| | - Anja Gesierich
- University Hospital Wuerzburg, Department of Dermatology, Wuerzburg, Germany.
| | - Peter Kölblinger
- Department of Dermatology and Allergology, Paracelsus Medical University, Salzburg, Austria.
| | - Naima Bennannoune
- Gustave Roussy and Paris-Saclay University, 114 rue Edouard Vaillant Villejuif Cedex, 94805, France.
| | - Justine V Cohen
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
| | - Katharina C Kähler
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Strasse 3, Haus C, Kiel, 24105, Germany.
| | - Melissa A Wilson
- Perlmutter Cancer Center, NYU Langone Health, NYU School of Medicine, 160 E. 34th Street, New York, NY 10016, USA.
| | - Jonathan Cebon
- Olivia Newton-John Cancer Research Institute, Austin Health, School of Cancer Medicine, La Trobe University, 145 Studley Road, Heidelberg VIC, Melbourne, 3084, Australia.
| | - Victoria Atkinson
- University of QLD, Princess Alexandra Hospital, Greenslopes Private Hospital, 199 Ipswich Rd, Woolloongabba QLD 4102, Australia.
| | - Jessica L Smith
- Crown Princess Mary Cancer Centre Westmead, Sydney, NSW, Australia.
| | - Olivier Michielin
- Lausanne University Hospital, Department of Oncology, Precision Oncology Center, Rue du Bugnon 21, Lausanne, 1011, Switzerland.
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, The Poche Centre, 40 Rocklands Road North Sydney NSW 2060, Australia; Royal North Shore Hospital, Reserve Road St Leonards NSW 2065, Australia; Mater Hospital, 25 Rocklands Road, North Sydney NSW 2060, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Charles Perkins Centre, The University of Sydney, Australia.
| | - Jessica C Hassel
- University Hospital Heidelberg, Department of Dermatology and National Center for Cancer (NCT), Im Neuenheimer Feld 460 Heidelberg, 69120, Germany.
| | - Benjamin Weide
- University of Tuebingen, Department of Dermatology, Liebermeisterstrasse 25, Tübingen, 72076, Germany.
| | - Lauren E Haydu
- University of Texas MD Anderson Cancer Center, Department of Melanoma Medical Oncology and Department of Surgical Oncology, 1400 Pressler Street, Houston, TX 77006 USA.
| | - Dirk Schadendorf
- University Hospital Essen, Department of Dermatology, Essen & German Cancer Consortium, Partner Site Essen, Germany.
| | | | - Patrick A Ott
- Dana Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA.
| | - Christian Blank
- Antoni van Leeuwenhoek Hospital - The Netherlands Cancer Institute, Department of Medical Oncology and Immunology, Plesmanlaan 121 Amsterdam, 1066 CX, the Netherlands.
| | - Caroline Robert
- Gustave Roussy and Paris-Saclay University, 114 rue Edouard Vaillant Villejuif Cedex, 94805, France.
| | - Ryan Sullivan
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Strasse 3, Haus C, Kiel, 24105, Germany.
| | - Matteo S Carlino
- Crown Princess Mary Cancer Centre Westmead, Sydney, NSW, Australia.
| | - Claus Garbe
- University of Tuebingen, Department of Dermatology, Liebermeisterstrasse 25, Tübingen, 72076, Germany.
| | - Michael A Davies
- University of Texas MD Anderson Cancer Center, Department of Melanoma Medical Oncology and Department of Surgical Oncology, 1400 Pressler Street, Houston, TX 77006 USA.
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, The Poche Centre, 40 Rocklands Road North Sydney NSW 2060, Australia; Royal North Shore Hospital, Reserve Road St Leonards NSW 2065, Australia; Mater Hospital, 25 Rocklands Road, North Sydney NSW 2060, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
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13
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Krijgsman O, Kemper K, Boshuizen J, Vredevoogd DW, Rozeman EA, Ibanez Molero S, de Bruijn B, Cornelissen-Steijger P, Shahrabi A, Del Castillo Velasco-Herrera M, Song JY, Ligtenberg MA, Kluin RJC, Kuilman T, Ross-Macdonald P, Haanen JBAG, Adams DJ, Blank CU, Peeper DS. Predictive Immune-Checkpoint Blockade Classifiers Identify Tumors Responding to Inhibition of PD-1 and/or CTLA-4. Clin Cancer Res 2021; 27:5389-5400. [PMID: 34230026 DOI: 10.1158/1078-0432.ccr-20-4218] [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: 10/29/2020] [Revised: 12/01/2020] [Accepted: 06/25/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Combining anti-PD-1 + anti-CTLA-4 immune-checkpoint blockade (ICB) shows improved patient benefit, but it is associated with severe immune-related adverse events and exceedingly high cost. Therefore, there is a dire need to predict which patients respond to monotherapy and which require combination ICB treatment. EXPERIMENTAL DESIGN In patient-derived melanoma xenografts (PDX), human tumor microenvironment (TME) cells were swiftly replaced by murine cells upon transplantation. Using our XenofilteR deconvolution algorithm we curated human tumor cell RNA reads, which were subsequently subtracted in silico from bulk (tumor cell + TME) patients' melanoma RNA. This produced a purely tumor cell-intrinsic signature ("InTumor") and a signature comprising tumor cell-extrinsic RNA reads ("ExTumor"). RESULTS We show that whereas the InTumor signature predicts response to anti-PD-1, the ExTumor predicts anti-CTLA-4 benefit. In PDX, InTumorLO, but not InTumorHI, tumors are effectively eliminated by cytotoxic T cells. When used in conjunction, the InTumor and ExTumor signatures identify not only patients who have a substantially higher chance of responding to combination treatment than to either monotherapy, but also those who are likely to benefit little from anti-CTLA-4 on top of anti-PD-1. CONCLUSIONS These signatures may be exploited to distinguish melanoma patients who need combination ICB blockade from those who likely benefit from either monotherapy.
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Affiliation(s)
- Oscar Krijgsman
- Department of Molecular Oncology and Immunology, Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Kristel Kemper
- Department of Molecular Oncology and Immunology, Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Julia Boshuizen
- Department of Molecular Oncology and Immunology, Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - David W Vredevoogd
- Department of Molecular Oncology and Immunology, Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Elisa A Rozeman
- Medical Oncology Department, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sofia Ibanez Molero
- Department of Molecular Oncology and Immunology, Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Beaunelle de Bruijn
- Department of Molecular Oncology and Immunology, Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Paulien Cornelissen-Steijger
- Department of Molecular Oncology and Immunology, Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Aida Shahrabi
- Department of Molecular Oncology and Immunology, Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Ji-Ying Song
- Animal Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Maarten A Ligtenberg
- Department of Molecular Oncology and Immunology, Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Roelof J C Kluin
- Genomics Core Facility, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Thomas Kuilman
- Department of Molecular Oncology and Immunology, Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - John B A G Haanen
- Medical Oncology Department, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - David J Adams
- Experimental Cancer Genetics, The Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - Christian U Blank
- Medical Oncology Department, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Daniel S Peeper
- Department of Molecular Oncology and Immunology, Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
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14
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Rawson RV, Adhikari C, Bierman C, Lo SN, Shklovskaya E, Rozeman EA, Menzies AM, van Akkooi ACJ, Shannon KF, Gonzalez M, Guminski AD, Tetzlaff MT, Stretch JR, Eriksson H, van Thienen JV, Wouters MW, Haanen JBAG, Klop WMC, Zuur CL, van Houdt WJ, Nieweg OE, Ch'ng S, Rizos H, Saw RPM, Spillane AJ, Wilmott JS, Blank CU, Long GV, van de Wiel BA, Scolyer RA. Pathological response and tumour bed histopathological features correlate with survival following neoadjuvant immunotherapy in stage III melanoma. Ann Oncol 2021; 32:766-777. [PMID: 33744385 DOI: 10.1016/j.annonc.2021.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 12/06/2020] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Guidelines for pathological evaluation of neoadjuvant specimens and pathological response categories have been developed by the International Neoadjuvant Melanoma Consortium (INMC). As part of the Optimal Neo-adjuvant Combination Scheme of Ipilimumab and Nivolumab (OpACIN-neo) clinical trial of neoadjuvant combination anti-programmed cell death protein 1/anti-cytotoxic T-lymphocyte-associated protein 4 immunotherapy for stage III melanoma, we sought to determine interobserver reproducibility of INMC histopathological assessment principles, identify specific tumour bed histopathological features of immunotherapeutic response that correlated with recurrence and relapse-free survival (RFS) and evaluate proposed INMC pathological response categories for predicting recurrence and RFS. PATIENTS AND METHODS Clinicopathological characteristics of lymph node dissection specimens of 83 patients enrolled in the OpACIN-neo clinical trial were evaluated. Two methods of assessing histological features of immunotherapeutic response were evaluated: the previously described immune-related pathologic response (irPR) score and our novel immunotherapeutic response score (ITRS). For a subset of cases (n = 29), cellular composition of the tumour bed was analysed by flow cytometry. RESULTS There was strong interobserver reproducibility in assessment of pathological response (κ = 0.879) and percentage residual viable melanoma (intraclass correlation coefficient = 0.965). The immunotherapeutic response subtype with high fibrosis had the strongest association with lack of recurrence (P = 0.008) and prolonged RFS (P = 0.019). Amongst patients with criteria for pathological non-response (pNR, >50% viable tumour), all who recurred had ≥70% viable melanoma. Higher ITRS and irPR scores correlated with lack of recurrence in the entire cohort (P = 0.002 and P ≤ 0.0001). The number of B lymphocytes was significantly increased in patients with a high fibrosis subtype of treatment response (P = 0.046). CONCLUSIONS There is strong reproducibility for assessment of pathological response using INMC criteria. Immunotherapeutic response of fibrosis subtype correlated with improved RFS, and may represent a biomarker. Potential B-cell contribution to fibrosis development warrants further study. Reclassification of pNR to a threshold of ≥70% viable melanoma and incorporating additional criteria of <10% fibrosis subtype of response may identify those at highest risk of recurrence, but requires validation.
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Affiliation(s)
- R V Rawson
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Departments of Tissue Pathology and Diagnostic Oncology, Sydney, Australia; Department of Melanoma Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia; NSW Health Pathology, Sydney, Australia
| | - C Adhikari
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Departments of Tissue Pathology and Diagnostic Oncology, Sydney, Australia; Department of Melanoma Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia; NSW Health Pathology, Sydney, Australia
| | - C Bierman
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - E Shklovskaya
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - E A Rozeman
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| | | | - K F Shannon
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Departments of Tissue Pathology and Diagnostic Oncology, Sydney, Australia; Department of Melanoma Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - M Gonzalez
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - A D Guminski
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| | - M T Tetzlaff
- Department of Pathology, Dermatopathology and Oral Pathology Unit, The University of California, San Francisco, San Francisco, USA; Department of Dermatology, Dermatopathology and Oral Pathology Unit, The University of California, San Francisco, San Francisco, USA
| | - J R Stretch
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Departments of Tissue Pathology and Diagnostic Oncology, Sydney, Australia; Department of Melanoma Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| | - H Eriksson
- Theme Cancer, Skin Cancer Center/Department of Oncology, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - J V van Thienen
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M W Wouters
- The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - J B A G Haanen
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - W M C Klop
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C L Zuur
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - W J van Houdt
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - O E Nieweg
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Departments of Tissue Pathology and Diagnostic Oncology, Sydney, Australia; Department of Melanoma Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| | - S Ch'ng
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Departments of Tissue Pathology and Diagnostic Oncology, Sydney, Australia; Department of Melanoma Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| | - H Rizos
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - R P M Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Departments of Tissue Pathology and Diagnostic Oncology, Sydney, Australia; Department of Melanoma Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| | - A J Spillane
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| | - J S Wilmott
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - C U Blank
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - G V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| | - B A van de Wiel
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Departments of Tissue Pathology and Diagnostic Oncology, Sydney, Australia; Department of Melanoma Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia; NSW Health Pathology, Sydney, Australia.
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15
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Versluis JM, Reijers ILM, Rozeman EA, Menzies AM, van Akkooi ACJ, Wouters MW, Ch'ng S, Saw RPM, Scolyer RA, van de Wiel BA, Schilling B, Long GV, Blank CU. Neoadjuvant ipilimumab plus nivolumab in synchronous clinical stage III melanoma. Eur J Cancer 2021; 148:51-57. [PMID: 33735809 DOI: 10.1016/j.ejca.2021.02.012] [Citation(s) in RCA: 3] [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: 09/18/2020] [Revised: 12/18/2020] [Accepted: 02/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patients with synchronous clinical stage III melanoma can present with primary melanoma lesions, locally recurrent melanoma or in-transit metastases. Neoadjuvant ipilimumab plus nivolumab induces high pathologic response rates and an impressive relapse-free survival in patients with nodal macroscopic stage III melanoma. Whether primary site melanoma and in-transit metastases respond similarly to lymph node metastases with neoadjuvant immunotherapy is largely unknown. Such data would clarify whether surgical excision of these melanoma lesions should be performed before neoadjuvant therapy or whether it could be deferred and performed in conjunction with lymphadenectomy following neoadjuvant immunotherapy. PATIENTS Patients with synchronous clinical stage III melanoma were identified from the OpACIN, OpACIN-neo and PRADO neoadjuvant trials, where all patients were treated with ipilimumab plus nivolumab. An additional case treated outside those clinical trials was included. RESULTS Seven patients were identified; six patients had a concordant response in primary site melanoma lesions or in-transit metastasis and the lymph node metastases. One patient had concordant progression in both the primary and nodal tumour lesions and developed stage IV disease during neoadjuvant treatment, and thus, no resection was performed. CONCLUSION Pathologic response following neoadjuvant ipilimumab plus nivolumab in primary site melanoma lesions or in-transit metastasis is concordant with a response in the lymph node metastases, indicating that there may be no need to perform upfront surgery to these melanoma lesions prior to neoadjuvant treatment.
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Affiliation(s)
- Judith M Versluis
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Irene L M Reijers
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Elisa A Rozeman
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Rd, Wollstonecraft NSW 2065, Australia; Royal North Shore and Mater Hospitals, 25 Rocklands Rd, North Sydney NSW 2060, Australia
| | - Alexander C J van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Michel W Wouters
- Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Sydney Ch'ng
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Rd, Wollstonecraft NSW 2065, Australia; Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown NSW 2050, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Rd, Wollstonecraft NSW 2065, Australia; Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown NSW 2050, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Rd, Wollstonecraft NSW 2065, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney NSW 2006, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown NSW 2050, Australia
| | - Bart A van de Wiel
- Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Bastian Schilling
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Rd, Wollstonecraft NSW 2065, Australia; Royal North Shore and Mater Hospitals, 25 Rocklands Rd, North Sydney NSW 2060, Australia
| | - Christian U Blank
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 Leiden, the Netherlands.
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16
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Menzies AM, Amaria RN, Rozeman EA, Huang AC, Tetzlaff MT, van de Wiel BA, Lo S, Tarhini AA, Burton EM, Pennington TE, Saw RPM, Xu X, Karakousis GC, Ascierto PA, Spillane AJ, van Akkooi ACJ, Davies MA, Mitchell TC, Tawbi HA, Scolyer RA, Wargo JA, Blank CU, Long GV. Pathological response and survival with neoadjuvant therapy in melanoma: a pooled analysis from the International Neoadjuvant Melanoma Consortium (INMC). Nat Med 2021; 27:301-309. [PMID: 33558722 DOI: 10.1038/s41591-020-01188-3] [Citation(s) in RCA: 201] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/20/2020] [Indexed: 12/26/2022]
Abstract
The association among pathological response, recurrence-free survival (RFS) and overall survival (OS) with neoadjuvant therapy in melanoma remains unclear. In this study, we pooled data from six clinical trials of anti-PD-1-based immunotherapy or BRAF/MEK targeted therapy. In total, 192 patients were included; 141 received immunotherapy (104, combination of ipilimumab and nivolumab; 37, anti-PD-1 monotherapy), and 51 received targeted therapy. A pathological complete response (pCR) occurred in 40% of patients: 47% with targeted therapy and 33% with immunotherapy (43% combination and 20% monotherapy). pCR correlated with improved RFS (pCR 2-year 89% versus no pCR 50%, P < 0.001) and OS (pCR 2-year OS 95% versus no pCR 83%, P = 0.027). In patients with pCR, near pCR or partial pathological response with immunotherapy, very few relapses were seen (2-year RFS 96%), and, at this writing, no patient has died from melanoma, whereas, even with pCR from targeted therapy, the 2-year RFS was only 79%, and OS was only 91%. Pathological response should be an early surrogate endpoint for clinical trials and a new benchmark for development and approval in melanoma.
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Affiliation(s)
- Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Royal North Shore and Mater Hospitals, Sydney, Australia
| | - Rodabe N Amaria
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Alexander C Huang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Parker Institute for Cancer Immunotherapy at University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Serigne Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ahmad A Tarhini
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Thomas E Pennington
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Hospital, Sydney, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Hospital, Sydney, Australia
| | - Xiaowei Xu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione 'G. Pascale', Napoli, Italy
| | - Andrew J Spillane
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Royal North Shore and Mater Hospitals, Sydney, Australia
| | | | | | - Tara C Mitchell
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hussein A Tawbi
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and New Health Pathology, Sydney, Australia
| | | | | | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia. .,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. .,Royal North Shore and Mater Hospitals, Sydney, Australia.
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17
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Hoefsmit EP, Rozeman EA, Van TM, Dimitriadis P, Krijgsman O, Conway JW, Pires da Silva I, van der Wal JE, Ketelaars SLC, Bresser K, Broeks A, Kerkhoven RM, Reeves JW, Warren S, Kvistborg P, Scolyer RA, Kapiteijn EW, Peeper DS, Long GV, Schumacher TNM, Blank CU. Comprehensive analysis of cutaneous and uveal melanoma liver metastases. J Immunother Cancer 2020; 8:e001501. [PMID: 33262254 PMCID: PMC7713183 DOI: 10.1136/jitc-2020-001501] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The profound disparity in response to immune checkpoint blockade (ICB) by cutaneous melanoma (CM) and uveal melanoma (UM) patients is not well understood. Therefore, we characterized metastases of CM and UM from the same metastatic site (liver), in order to dissect the potential underlying mechanism in differential response on ICB. METHODS Tumor liver samples from CM (n=38) and UM (n=28) patients were analyzed at the genomic (whole exome sequencing), transcriptional (RNA sequencing) and protein (immunohistochemistry and GeoMx Digital Spatial Profiling) level. RESULTS Comparison of CM and UM metastases from the same metastatic site revealed that, although originating from the same melanocyte lineage, CM and UM differed in somatic mutation profile, copy number profile, tumor mutational burden (TMB) and consequently predicted neoantigens. A higher melanin content and higher expression of the melanoma differentiation antigen MelanA was observed in liver metastases of UM patients. No difference in B2M and human leukocyte antigen-DR (HLA-DR) expression was observed. A higher expression of programmed cell death ligand 1 (PD-L1) was found in CM compared with UM liver metastases, although the majority of CM and UM liver metastases lacked PD-L1 expression. There was no difference in the extent of immune infiltration observed between CM and UM metastases, with the exception of a higher expression of CD163 (p<0.0001) in CM liver samples. While the extent of immune infiltration was similar for CM and UM metastases, the ratio of exhausted CD8 T cells to cytotoxic T cells, to total CD8 T cells and to Th1 cells, was significantly higher in UM metastases. CONCLUSIONS While TMB was different between CM and UM metastases, tumor immune infiltration was similar. The greater dependency on PD-L1 as an immune checkpoint in CM and the identification of higher exhaustion ratios in UM may both serve as explanations for the difference in response to ICB. Consequently, in order to improve current treatment for metastatic UM, reversal of T cell exhaustion beyond programmed cell death 1 blockade should be considered.
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Affiliation(s)
- Esmee P Hoefsmit
- Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Elisa A Rozeman
- Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Trieu My Van
- Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Petros Dimitriadis
- Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Oscar Krijgsman
- Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jordan W Conway
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
| | | | | | - Steven L C Ketelaars
- Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Kaspar Bresser
- Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Annegien Broeks
- Core Facility and Biobanking, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ron M Kerkhoven
- NKI Genomics Core Facility, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Sarah Warren
- NanoString Technologies Inc, Seattle, Washington, USA
| | - Pia Kvistborg
- Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Richard A Scolyer
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and New South Wales Health Pathology, Sydney, New South Wales, Australia
| | - Ellen W Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Daniel S Peeper
- Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Oncode Institute, Utrecht, The Netherlands
| | - Georgina V Long
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
- Royal North Shore Hospital, Melanoma Institute Australia, and The University of Sydney, Wollstonecraft, New South Wales, Australia
| | - Ton N M Schumacher
- Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Oncode Institute, Utrecht, The Netherlands
| | - Christian U Blank
- Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Versluis JM, Rozeman EA, Menzies AM, Reijers ILM, Krijgsman O, Hoefsmit EP, van de Wiel BA, Sikorska K, Bierman C, Dimitriadis P, Gonzalez M, Broeks A, Kerkhoven RM, Spillane AJ, Haanen JBAG, van Houdt WJ, Saw RPM, Eriksson H, van Akkooi ACJ, Scolyer RA, Schumacher TN, Long GV, Blank CU. L3 Update of the OpACIN and OpACIN-neo trials: 36-months and 24-months relapse-free survival after (neo)adjuvant ipilimumab plus nivolumab in macroscopic stage III melanoma patients. J Immunother Cancer 2020. [DOI: 10.1136/jitc-2020-itoc7.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundBefore adjuvant checkpoint inhibition the 5-year overall survival (OS) rate was poor (<50%) in high-risk stage III melanoma patients. Adjuvant CTLA-4 (ipilimumab, IPI) and PD-1 (nivolumab, NIVO, or pembrolizumab) blockade have been shown to improve relapse-free survival (RFS) and OS (latter only for IPI so far). Due to a broader immune activation neoadjuvant therapy with checkpoint inhibitors might be more effective than adjuvant, as suggested in preclinical experiments. The OpACIN trial compared neoadjuvant versus adjuvant IPI plus NIVO, while the subsequent OpACIN-neo trial tested three different dosing schedules of neoadjuvant IPI plus NIVO without adjuvant therapy. High pathologic response rates of 74–78% were induced by neoadjuvant IPI plus NIVO. Here, we present the 36- and 24-months RFS of the OpACIN and OpACIN-neo trial, respectively.Materials and MethodsThe phase 1b OpACIN trial included 20 stage IIIB/IIIC melanoma patients, which were randomized to receive IPI 3 mg/kg plus NIVO 1 mg/kg either adjuvant 4 cycles or split 2 cycles neoadjuvant and 2 adjuvant. In the phase 2 OpACIN-neo trial, 86 patients were randomized to 2 cycles neoadjuvant treatment, either in arm A: 2x IPI 3 mg/kg plus NIVO 1 mg/kg q3w (n=30), arm B: 2x IPI 1 mg/kg plus NIVO 3 mg/kg q3w (n=30), or arm C: 2x IPI 3 mg/kg q3w followed immediately by 2x NIVO 3 mg/kg q3w (n=26). Pathologic response was defined as <50% viable tumor cells and in both trials centrally reviewed by a blinded pathologist. RFS rates were estimated using the Kaplan-Meier method.ResultsOnly 1 of 71 (1.4%) patients with a pathologic response on neoadjuvant therapy had relapsed, versus 16 of 23 patients (69.6%) without a pathologic response, after a median follow-up of 36 months for the OpACIN and 24 months for the OpACIN-neo trial. In the OpACIN trial, the estimated 3-year RFS rate for the neoadjuvant arm was 80% (95% CI: 59%-100%) versus 60% (95% CI: 36%-100%) for the adjuvant arm. Median RFS was not reached for any of the arms within the OpACIN-neo trial. Estimated 24-months RFS rate was 84% for all patients (95% CI: 76%-92%); 90% for arm A (95% CI: 80%-100%), 78% for arm B (95% CI: 63%-96%) and 83% for arm C (95% CI: 70%-100%). Baseline interferon-γ gene expression score and tumor mutational burden predict response.ConclusionsOpACIN for the first time showed a potential benefit of neoadjuvant IPI plus NIVO versus adjuvant immunotherapy, whereas the OpACIN-neo trial confirmed the high pathologic response rates that can be achieved by neoadjuvant IPI plus NIVO. Both trials show that pathologic response can function as a surrogate markers for RFS.Clinical trial informationNCT02437279, NCT02977052Disclosure InformationJ.M. Versluis: None. E.A. Rozeman: None. A.M. Menzies: F. Consultant/Advisory Board; Modest; BMS, MSD, Novartis, Roche, Pierre-Fabre. I.L.M. Reijers: None. O. Krijgsman: B. Research Grant (principal investigator, collaborator or consultant and pending grants as well as grants already received); Modest; BMS. E.P. Hoefsmit: None. B.A. van de Wiel: None. K. Sikorska: None. C. Bierman: None. P. Dimitriadis: None. M. Gonzalez: None. A. Broeks: None. R.M. Kerkhoven: None. A.J. Spillane: None. J.B.A.G. Haanen: B. Research Grant (principal investigator, collaborator or consultant and pending grants as well as grants already received); Modest; BMS, MSD, Neon Therapeutics, Novartis. F. Consultant/Advisory Board; Modest; BMS, MSD, Novartis, Pfizer, AZ/MedImmune, Rocher/Genentech, Ipsen, Bayer, Immunocore, SeattleGenetics, Neon Therapeutics, Celsius Therapeutics, Gadet, GSK. W.J. van Houdt: None. R.P.M. Saw: None. H. Eriksson: None. A.C.J. van Akkooi: B. Research Grant (principal investigator, collaborator or consultant and pending grants as well as grants already received); Modest; Amgen, BMS, Novartis. F. Consultant/Advisory Board; Modest; Amgen, BMS, Novartis, MSD Merck, Merck-Pfizer, 4SC. R.A. Scolyer: F. Consultant/Advisory Board; Modest; MSD, Neracare, Myriad, Novartis. T.N. Schumacher: B. Research Grant (principal investigator, collaborator or consultant and pending grants as well as grants already received); Modest; MSD, BMS, Merck. E. Ownership Interest (stock, stock options, patent or other intellectual property); Modest; AIMM Therapeutics, Allogene Therapeutics, Amgen, Merus, Neogene Therapeutics, Neon Therapeutics. F. Consultant/Advisory Board; Modest; Adaptive Biotechnologies, AIMM Therapeutics, Allogene Therapeutics, Amgen, Merus, Neon Therapeutics, Scenic Biotech. Other; Modest; Third Rock Ventures. G.V. Long: F. Consultant/Advisory Board; Modest; Aduro, Amgen, BMS, Mass-Array, Pierre-Fabre, Novartis, Merck MSD, Roche. C.U. Blank: B. Research Grant (principal investigator, collaborator or consultant and pending grants as well as grants already received); Modest; BMS, Novartis, NanoString. E. Ownership Interest (stock, stock options, patent or other intellectual property); Modest; Uniti Cars, Neon Therapeutics, Forty Seven. F. Consultant/Advisory Board; Modest; BMS, MSD, Roche, Novartis, GSK, AZ, Pfizer, Lilly, GenMab, Pierre-Fabre.
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Renner K, Bruss C, Schnell A, Koehl G, Becker HM, Fante M, Menevse AN, Kauer N, Blazquez R, Hacker L, Decking SM, Bohn T, Faerber S, Evert K, Aigle L, Amslinger S, Landa M, Krijgsman O, Rozeman EA, Brummer C, Siska PJ, Singer K, Pektor S, Miederer M, Peter K, Gottfried E, Herr W, Marchiq I, Pouyssegur J, Roush WR, Ong S, Warren S, Pukrop T, Beckhove P, Lang SA, Bopp T, Blank CU, Cleveland JL, Oefner PJ, Dettmer K, Selby M, Kreutz M. Restricting Glycolysis Preserves T Cell Effector Functions and Augments Checkpoint Therapy. Cell Rep 2020; 29:135-150.e9. [PMID: 31577944 DOI: 10.1016/j.celrep.2019.08.068] [Citation(s) in RCA: 171] [Impact Index Per Article: 42.8] [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: 10/27/2018] [Revised: 08/05/2019] [Accepted: 08/22/2019] [Indexed: 12/20/2022] Open
Abstract
Tumor-derived lactic acid inhibits T and natural killer (NK) cell function and, thereby, tumor immunosurveillance. Here, we report that melanoma patients with high expression of glycolysis-related genes show a worse progression free survival upon anti-PD1 treatment. The non-steroidal anti-inflammatory drug (NSAID) diclofenac lowers lactate secretion of tumor cells and improves anti-PD1-induced T cell killing in vitro. Surprisingly, diclofenac, but not other NSAIDs, turns out to be a potent inhibitor of the lactate transporters monocarboxylate transporter 1 and 4 and diminishes lactate efflux. Notably, T cell activation, viability, and effector functions are preserved under diclofenac treatment and in a low glucose environment in vitro. Diclofenac, but not aspirin, delays tumor growth and improves the efficacy of checkpoint therapy in vivo. Moreover, genetic suppression of glycolysis in tumor cells strongly improves checkpoint therapy. These findings support the rationale for targeting glycolysis in patients with high glycolytic tumors together with checkpoint inhibitors in clinical trials.
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Affiliation(s)
- Kathrin Renner
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany; Regensburg Center for Interventional Immunology, Regensburg, Germany.
| | - Christina Bruss
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Annette Schnell
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Gudrun Koehl
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Holger M Becker
- Division of General Zoology, University of Kaiserslautern, Kaiserslautern, Germany
| | - Matthias Fante
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Ayse-Nur Menevse
- Regensburg Center for Interventional Immunology, Regensburg, Germany
| | - Nathalie Kauer
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Raquel Blazquez
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Lisa Hacker
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Sonja-Maria Decking
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Toszka Bohn
- Institute for Immunology, University Medical Center Johannes Gutenberg University (UMC) Mainz, Mainz, Germany
| | - Stephanie Faerber
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Katja Evert
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Lisa Aigle
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Sabine Amslinger
- Institute of Organic Chemistry, University of Regensburg, Regensburg, Germany
| | - Maria Landa
- Institute of Organic Chemistry, University of Regensburg, Regensburg, Germany
| | - Oscar Krijgsman
- Department Medical Oncology and Division of Molecular Oncology and Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Elisa A Rozeman
- Department Medical Oncology and Division of Molecular Oncology and Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Christina Brummer
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Peter J Siska
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Katrin Singer
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Stefanie Pektor
- Department of Nuclear Medicine, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Matthias Miederer
- Department of Nuclear Medicine, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Katrin Peter
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Eva Gottfried
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Wolfgang Herr
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Ibtisam Marchiq
- Institute of Research on Cancer and Aging (IRCAN), CNRS-INSERM-UNS UMR 7284, Nice, France
| | - Jacques Pouyssegur
- Institute of Research on Cancer and Aging (IRCAN), CNRS-INSERM-UNS UMR 7284, Nice, France; Department of Medical Biology, Scientific Centre of Monaco (CSM), Monaco
| | - William R Roush
- Department of Chemistry, The Scripps Research Institute, Scripps-Florida, Jupiter, FL, USA
| | - SuFey Ong
- NanoString Technologies, Seattle, WA, USA
| | | | - Tobias Pukrop
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Philipp Beckhove
- Regensburg Center for Interventional Immunology, Regensburg, Germany
| | - Sven A Lang
- Department of General and Visceral Surgery, Medical Center, Faculty of Medicine University of Freiburg, Freiburg, Germany
| | - Tobias Bopp
- Institute for Immunology, University Medical Center Johannes Gutenberg University (UMC) Mainz, Mainz, Germany; Research Center for Immunotherapy (FZI), UMC Mainz, Mainz, Germany; University Cancer Center Mainz, UMC Mainz, Mainz, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Christian U Blank
- Department Medical Oncology and Division of Molecular Oncology and Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - John L Cleveland
- Department of Tumor Biology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Peter J Oefner
- Institute of Functional Genomics, University of Regensburg, Regensburg, Germany
| | - Katja Dettmer
- Institute of Functional Genomics, University of Regensburg, Regensburg, Germany
| | - Mark Selby
- Bristol-Myers Squibb, Redwood City, CA, USA
| | - Marina Kreutz
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany; Regensburg Center for Interventional Immunology, Regensburg, Germany
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Reijers IL, Rozeman EA, Menzies AM, Versluis JM, van de Wiel BA, Sikorska K, Eriksson H, Shannon K, Bierman C, van Tinteren H, Gonzalez M, Spillane AJ, Saw RP, van Akkooi AC, Scolyer RA, Hansson J, Long GV, Blank CU. Abstract 3271: Different pathologic response rates between Australia and Europe in macroscopic stage III melanoma patients upon neoadjuvant ipilimumab plus nivolumab in the phase II OpACIN-neo trial. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-3271] [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: 11/16/2022]
Abstract
Abstract
Background In the multicenter investigator-initiated OpACIN-neo trial, patients (pts) with macroscopic stage III melanoma were randomized (stratified by center) to three different dosing schemes of neoadjuvant ipilimumab (IPI) + nivolumab (NIVO). Two cycles IPI 1 mg/kg + NIVO 3 mg/kg was identified as the most favorable regimen with 20% grade 3-4 adverse events and a pathologic response rate (pRR) of 77%. After a median follow-up of 17.7 months, relapses were observed in 1/64 (2%) of the pts with a pathologic response, and in 13/21 (62%) of the non-responders. Post-hoc analyses according to continent of study inclusion were conducted to investigate potential differences between pts treated in Europe (EU) and in Australia (AUS).
Methods We evaluated baseline patient characteristics, safety and efficacy in terms of pathologic response in pts treated in EU (n=48) and AUS (n=38). Mutational (mut) load of baseline biopsies was assessed using whole exome sequencing. Multivariate analyses were performed using the logistic regression method. Median follow-up was 18.2 months for EU pts and 16.6 months for AUS pts.
Results Baseline characteristics (AUS vs EU) differed in age (median 60 vs 53 year [yr], p=0.017). There were numerically more male pts in the Australian cohort (65.8 vs 50.0%, p=0.142) and more pts with unknown primary melanoma (36.8 vs 20.8%, p=0.100). A numerical higher pRR was observed in AUS pts vs EU pts (84.2% vs 64.7%, OR 2.50, p=0.092). The pRR was significantly higher for older pts (OR per yr 1.059, p=0.003), males (83.7% vs 63.9%, OR 2.90, p=0.041), and pts with higher mut load (OR per mutation 1.002, p=0.014). Mut load was higher in pts with pathologic response (p=0.0013) and in AUS pts (p=0.0003). There was a positive correlation between age and mut load (R=0.26, p=0.043). Multivariate analysis including continent, age, gender and mut load revealed that only mut load was significantly associated with response (OR 1.002, p=0.037).The frequency of grade 3-5 toxicities was the same in pts <60 compared to pts >60 yr (42.3% vs 32.4%, p=0.353).
Conclusion The numerical higher pRR in AUS vs EU melanoma pts upon neoadjuvant IPI + NIVO appears mostly driven by a higher mut load found in the melanomas of AUS pts. AUS pts were older and there was a positive correlation between age and mut load, indicating that the higher mut load in AUS pts might be explained by higher age. It remains to be elucidated if continental variance in sun exposure also contributed to the difference in mut load. The fact that older pts achieve a higher response rate in absence of increased toxicity rates indicates that older pts should not be withheld neoadjuvant IPI + NIVO.
Citation Format: Irene L. Reijers, Elisa A. Rozeman, Alexander M. Menzies, Judith M. Versluis, Bart A. van de Wiel, Karolina Sikorska, Hanna Eriksson, Kerwin Shannon, Carolien Bierman, Harm van Tinteren, Maria Gonzalez, Andrew J. Spillane, Robyn P. Saw, Alexander C. van Akkooi, Richard A. Scolyer, Johan Hansson, Georgina V. Long, Christian U. Blank. Different pathologic response rates between Australia and Europe in macroscopic stage III melanoma patients upon neoadjuvant ipilimumab plus nivolumab in the phase II OpACIN-neo trial [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3271.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Robyn P. Saw
- 2Melanoma Institute Australia, Sydney, Australia
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Blank CU, Versluis JM, Rozeman EA, Menzies AM, Reijers IL, Krijgsman O, Hoefsmit EP, van de Wiel BA, Sikorska K, Bierman C, Dimitriadis P, Gonzalez M, Broeks A, Kerkhoven RM, Spillane AJ, Haanen JB, van Houdt WJ, Saw RP, Eriksson H, van Akkooi AC, Scolyer RA, Schumacher TN, Long GV. Abstract 3412: 36-months and 18-months relapse-free survival after (neo)adjuvant ipilimumab plus nivolumab in macroscopic stage III melanoma patients - update of the OpACIN and OpACIN-neo trials. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-3412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction The outcome of high-risk stage III melanoma patients was poor with a 5-year overall survival (OS) rate of <50%. Adjuvant ipilimumab (IPI) improved the relapse-free survival (RFS) and OS, and adjuvant anti-PD-1 improved the RFS further. Preclinical data suggested that neoadjuvant therapy may be more effective than adjuvant therapy due to broader immune activation. The OpACIN trial compared neoadjuvant IPI plus nivolumab (NIVO) versus adjuvant IPI plus NIVO, while the subsequent OpACIN-neo trial tested three different dosing schedules of neoadjuvant IPI plus NIVO only. Neoadjuvant IPI plus NIVO induced high pathologic response rates of 74-78%. Here, we present the 36- and 18-months RFS update of the OpACIN and OpACIN-neo trial, respectively.
Methods The phase 1b OpACIN trial randomized 20 stage IIIB/IIIC melanoma patients to receive either 4 cycles of adjuvant IPI 3 mg/kg plus NIVO 1 mg/kg or 2 cycles of neoadjuvant IPI plus NIVO at the same dose followed by 2 cycles adjuvant IPI plus NIVO. In the OpACIN-neo trial, 86 patients were randomized to 2 cycles neoadjuvant in arm A: 2x IPI 3 mg/kg plus NIVO 1 mg/kg q3w (n=30), arm B: 2x IPI 1 mg/kg plus NIVO 3 mg/kg q3w (n=30), and arm C: 2x IPI 3 mg/kg q3w followed immediately by 2x NIVO 3 mg/kg q3w (n=26). Pathologic response was defined as <50% viable tumor cells and centrally reviewed by a blinded pathologist. RFS rates were estimated using the Kaplan-Meier method.
Results After a median follow-up of 36 months for the OpACIN and 18 months for the OpACIN-neo trial, only 1 of 71 patients (1.4%) with a pathologic response on neoadjuvant therapy had relapsed, versus 15 of 23 patients (65.2%) without a pathologic response. The estimated 3-year RFS rate for the neoadjuvant arm was 80% (95% CI: 59%-100%) versus 60% (95% CI: 36%-100%) for the adjuvant arm in the OpACIN trial. The median RFS was not reached in any of the arms within the OpACIN-neo trial. Estimated 18-months RFS rate was 85% (95% CI: 78%-93%) for all patients; for arm A 90% (95% CI: 80%-100%), for arm B 82% (95% CI: 70%-98%) and for arm C 83% (95% CI: 70%-100%). Translational analyses showed that tumor mutational burden and interferon-γ gene expression score at baseline, both separate and combined, can function as predictors of response.
Conclusions OpACIN showed for the first time a potential benefit of neoadjuvant versus adjuvant immunotherapy, while OpACIN-neo confirmed the high pathologic response rates which can be achieved by neoadjuvant IPI plus NIVO. Both trials argue for pathologic response as a surrogate markers for RFS.
Clinical trial information: NCT02437279, NCT02977052
Citation Format: Christian U. Blank, Judith M. Versluis, Elisa A. Rozeman, Alexander M. Menzies, Irene L. Reijers, Oscar Krijgsman, Esmée P. Hoefsmit, Bart A. van de Wiel, Karolina Sikorska, Carolien Bierman, Petros Dimitriadis, Maria Gonzalez, Annegien Broeks, Ron M. Kerkhoven, Andrew J. Spillane, John B. Haanen, Winan J. van Houdt, Robyn P. Saw, Hanna Eriksson, Alexander C. van Akkooi, Richard A. Scolyer, Ton N. Schumacher, Georgina V. Long. 36-months and 18-months relapse-free survival after (neo)adjuvant ipilimumab plus nivolumab in macroscopic stage III melanoma patients - update of the OpACIN and OpACIN-neo trials [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3412.
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Affiliation(s)
- Christian U. Blank
- 1Netherlands Cancer Institute/Antoni van Leeuwenhoek (NKI-AvL), Amsterdam, Netherlands
| | - Judith M. Versluis
- 1Netherlands Cancer Institute/Antoni van Leeuwenhoek (NKI-AvL), Amsterdam, Netherlands
| | - Elisa A. Rozeman
- 1Netherlands Cancer Institute/Antoni van Leeuwenhoek (NKI-AvL), Amsterdam, Netherlands
| | | | - Irene L. Reijers
- 1Netherlands Cancer Institute/Antoni van Leeuwenhoek (NKI-AvL), Amsterdam, Netherlands
| | - Oscar Krijgsman
- 1Netherlands Cancer Institute/Antoni van Leeuwenhoek (NKI-AvL), Amsterdam, Netherlands
| | - Esmée P. Hoefsmit
- 1Netherlands Cancer Institute/Antoni van Leeuwenhoek (NKI-AvL), Amsterdam, Netherlands
| | - Bart A. van de Wiel
- 1Netherlands Cancer Institute/Antoni van Leeuwenhoek (NKI-AvL), Amsterdam, Netherlands
| | - Karolina Sikorska
- 1Netherlands Cancer Institute/Antoni van Leeuwenhoek (NKI-AvL), Amsterdam, Netherlands
| | - Carolien Bierman
- 1Netherlands Cancer Institute/Antoni van Leeuwenhoek (NKI-AvL), Amsterdam, Netherlands
| | - Petros Dimitriadis
- 1Netherlands Cancer Institute/Antoni van Leeuwenhoek (NKI-AvL), Amsterdam, Netherlands
| | | | - Annegien Broeks
- 1Netherlands Cancer Institute/Antoni van Leeuwenhoek (NKI-AvL), Amsterdam, Netherlands
| | - Ron M. Kerkhoven
- 1Netherlands Cancer Institute/Antoni van Leeuwenhoek (NKI-AvL), Amsterdam, Netherlands
| | | | - John B. Haanen
- 1Netherlands Cancer Institute/Antoni van Leeuwenhoek (NKI-AvL), Amsterdam, Netherlands
| | - Winan J. van Houdt
- 1Netherlands Cancer Institute/Antoni van Leeuwenhoek (NKI-AvL), Amsterdam, Netherlands
| | - Robyn P. Saw
- 3Melanoma Institute Australia, Syndey, Australia
| | | | | | | | - Ton N. Schumacher
- 1Netherlands Cancer Institute/Antoni van Leeuwenhoek (NKI-AvL), Amsterdam, Netherlands
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Trebeschi S, Drago SG, Birkbak NJ, Kurilova I, Cǎlin AM, Delli Pizzi A, Lalezari F, Lambregts DMJ, Rohaan MW, Parmar C, Rozeman EA, Hartemink KJ, Swanton C, Haanen JBAG, Blank CU, Smit EF, Beets-Tan RGH, Aerts HJWL. Predicting response to cancer immunotherapy using noninvasive radiomic biomarkers. Ann Oncol 2020; 30:998-1004. [PMID: 30895304 PMCID: PMC6594459 DOI: 10.1093/annonc/mdz108] [Citation(s) in RCA: 305] [Impact Index Per Article: 76.3] [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] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Immunotherapy is regarded as one of the major breakthroughs in cancer treatment. Despite its success, only a subset of patients responds-urging the quest for predictive biomarkers. We hypothesize that artificial intelligence (AI) algorithms can automatically quantify radiographic characteristics that are related to and may therefore act as noninvasive radiomic biomarkers for immunotherapy response. PATIENTS AND METHODS In this study, we analyzed 1055 primary and metastatic lesions from 203 patients with advanced melanoma and non-small-cell lung cancer (NSCLC) undergoing anti-PD1 therapy. We carried out an AI-based characterization of each lesion on the pretreatment contrast-enhanced CT imaging data to develop and validate a noninvasive machine learning biomarker capable of distinguishing between immunotherapy responding and nonresponding. To define the biological basis of the radiographic biomarker, we carried out gene set enrichment analysis in an independent dataset of 262 NSCLC patients. RESULTS The biomarker reached significant performance on NSCLC lesions (up to 0.83 AUC, P < 0.001) and borderline significant for melanoma lymph nodes (0.64 AUC, P = 0.05). Combining these lesion-wide predictions on a patient level, immunotherapy response could be predicted with an AUC of up to 0.76 for both cancer types (P < 0.001), resulting in a 1-year survival difference of 24% (P = 0.02). We found highly significant associations with pathways involved in mitosis, indicating a relationship between increased proliferative potential and preferential response to immunotherapy. CONCLUSIONS These results indicate that radiographic characteristics of lesions on standard-of-care imaging may function as noninvasive biomarkers for response to immunotherapy, and may show utility for improved patient stratification in both neoadjuvant and palliative settings.
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Affiliation(s)
- S Trebeschi
- Department of Radiology, Netherlands Cancer Institute, Amsterdam; GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands; Departments of Radiation Oncology; Radiology, Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - S G Drago
- Department of Radiology, Netherlands Cancer Institute, Amsterdam; Department of Radiology, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy
| | - N J Birkbak
- The Francis Crick Institute, London; University College London, London, UK; Department of Molecular Medicine, Aarhus University, Aarhus, Denmark
| | - I Kurilova
- Department of Radiology, Netherlands Cancer Institute, Amsterdam; GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands
| | - A M Cǎlin
- Department of Radiology, Netherlands Cancer Institute, Amsterdam; Affidea Romania, Cluj-Napoca, Romania
| | - A Delli Pizzi
- Department of Radiology, Netherlands Cancer Institute, Amsterdam; ITAB Institute for Advanced Biomedical Technologies, University G. d'Annunzio, Chieti, Italy
| | - F Lalezari
- Department of Radiology, Netherlands Cancer Institute, Amsterdam
| | - D M J Lambregts
- Department of Radiology, Netherlands Cancer Institute, Amsterdam
| | | | - C Parmar
- Departments of Radiation Oncology; Radiology, Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | | | | | - C Swanton
- The Francis Crick Institute, London; University College London, London, UK
| | | | | | - E F Smit
- Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Amsterdam; GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands
| | - H J W L Aerts
- Department of Radiology, Netherlands Cancer Institute, Amsterdam; Departments of Radiation Oncology; Radiology, Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
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23
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Nejman D, Livyatan I, Fuks G, Gavert N, Zwang Y, Geller LT, Rotter-Maskowitz A, Weiser R, Mallel G, Gigi E, Meltser A, Douglas GM, Kamer I, Gopalakrishnan V, Dadosh T, Levin-Zaidman S, Avnet S, Atlan T, Cooper ZA, Arora R, Cogdill AP, Khan MAW, Ologun G, Bussi Y, Weinberger A, Lotan-Pompan M, Golani O, Perry G, Rokah M, Bahar-Shany K, Rozeman EA, Blank CU, Ronai A, Shaoul R, Amit A, Dorfman T, Kremer R, Cohen ZR, Harnof S, Siegal T, Yehuda-Shnaidman E, Gal-Yam EN, Shapira H, Baldini N, Langille MGI, Ben-Nun A, Kaufman B, Nissan A, Golan T, Dadiani M, Levanon K, Bar J, Yust-Katz S, Barshack I, Peeper DS, Raz DJ, Segal E, Wargo JA, Sandbank J, Shental N, Straussman R. The human tumor microbiome is composed of tumor type-specific intracellular bacteria. Science 2020; 368:973-980. [PMID: 32467386 DOI: 10.1126/science.aay9189] [Citation(s) in RCA: 957] [Impact Index Per Article: 239.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 01/22/2020] [Accepted: 04/14/2020] [Indexed: 12/15/2022]
Abstract
Bacteria were first detected in human tumors more than 100 years ago, but the characterization of the tumor microbiome has remained challenging because of its low biomass. We undertook a comprehensive analysis of the tumor microbiome, studying 1526 tumors and their adjacent normal tissues across seven cancer types, including breast, lung, ovary, pancreas, melanoma, bone, and brain tumors. We found that each tumor type has a distinct microbiome composition and that breast cancer has a particularly rich and diverse microbiome. The intratumor bacteria are mostly intracellular and are present in both cancer and immune cells. We also noted correlations between intratumor bacteria or their predicted functions with tumor types and subtypes, patients' smoking status, and the response to immunotherapy.
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Affiliation(s)
- Deborah Nejman
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Ilana Livyatan
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel.,Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
| | - Garold Fuks
- Department of Physics of Complex Systems, Weizmann Institute of Science, Rehovot, Israel
| | - Nancy Gavert
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Yaara Zwang
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Leore T Geller
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | | | - Roi Weiser
- Division of Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Giuseppe Mallel
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Elinor Gigi
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Arnon Meltser
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Gavin M Douglas
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada
| | - Iris Kamer
- Institute of Oncology, Sheba Medical Center, Ramat Gan, Israel
| | | | - Tali Dadosh
- Department of Chemical Research Support, Weizmann Institute of Science, Rehovot, Israel
| | - Smadar Levin-Zaidman
- Department of Chemical Research Support, Weizmann Institute of Science, Rehovot, Israel
| | - Sofia Avnet
- Orthopaedic Pathophysiology and Regenerative Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Tehila Atlan
- Department of Bioinformatics, Jerusalem College of Technology, Jerusalem, Israel
| | - Zachary A Cooper
- Translational Medicine, Oncology R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Reetakshi Arora
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexandria P Cogdill
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Md Abdul Wadud Khan
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gabriel Ologun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yuval Bussi
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel.,Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel.,Department of Biomolecular Sciences, Weizmann Institute of Science, Rehovot, Israel
| | - Adina Weinberger
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel.,Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
| | - Maya Lotan-Pompan
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel.,Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
| | - Ofra Golani
- Department of Life Sciences Core Facilities, Weizmann Institute of Science, Rehovot, Israel
| | - Gili Perry
- Cancer Research Center, Sheba Medical Center, Ramat Gan, Israel
| | - Merav Rokah
- Department of Thoracic Surgery, Sheba Medical Center, Ramat Gan, Israel
| | | | - Elisa A Rozeman
- Department of Medical Oncology and Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Christian U Blank
- Department of Medical Oncology and Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Anat Ronai
- Pediatric Gastroenterology Institute, Rambam Medical Center, Haifa, Israel
| | - Ron Shaoul
- Pediatric Gastroenterology Institute, Rambam Medical Center, Haifa, Israel
| | - Amnon Amit
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Tatiana Dorfman
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel.,Ambulatory and Breast Surgery Service, Rambam Health Care Campus, Haifa, Israel
| | - Ran Kremer
- Department of Thoracic Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Zvi R Cohen
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel
| | - Sagi Harnof
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Neurosurgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Tali Siegal
- Neuro-Oncology Unit, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | | | | | - Hagit Shapira
- Institute of Pathology, Megalab, Maccabi Healthcare Services, Rehovot, Israel
| | - Nicola Baldini
- Orthopaedic Pathophysiology and Regenerative Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Morgan G I Langille
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Alon Ben-Nun
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Thoracic Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Bella Kaufman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Institute of Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Aviram Nissan
- Department of Surgical Oncology (Surgery C), Sheba Medical Center, Ramat Gan, Israel
| | - Talia Golan
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Institute of Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Maya Dadiani
- Cancer Research Center, Sheba Medical Center, Ramat Gan, Israel
| | - Keren Levanon
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Cancer Research Center, Sheba Medical Center, Ramat Gan, Israel
| | - Jair Bar
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Institute of Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Shlomit Yust-Katz
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Neuro-Oncology Unit, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Iris Barshack
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Pathology, Sheba Medical Center, Ramat Gan, Israel
| | - Daniel S Peeper
- Division of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Dan J Raz
- Division of Thoracic Surgery, City of Hope Medical Center, Duarte, CA, USA
| | - Eran Segal
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel.,Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
| | - Jennifer A Wargo
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Judith Sandbank
- Institute of Pathology, Megalab, Maccabi Healthcare Services, Rehovot, Israel
| | - Noam Shental
- Department of Mathematics and Computer Science, The Open University of Israel, Ra'anana, Israel
| | - Ravid Straussman
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel.
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24
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Reijers IL, Dimitriadis P, Rozeman EA, Versluis JM, Broeks A, Bosch LJ, Bouwman J, Cornelissen S, Krijgsman O, Gonzalez M, Rao D, Grijpink-Ongering LG, van Dijk M, Spillane A, Scolyer RA, Van De Wiel BA, Menzies AM, Van Akkooi ACJ, Long GV, Blank CU. Personalized combination of neoadjuvant domatinostat, nivolumab and ipilimumab in macroscopic stage III melanoma patients stratified according to the interferon-gamma signature: The DONIMI study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.tps10087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS10087 Background: Previous OpACIN and OpACIN-neo studies, investigating neoadjuvant ipilimumab (IPI) plus nivolumab (NIVO), demonstrated high pathologic response rates (74-78%) and favorable long-term outcomes in patients (pts) achieving pathologic response; at 36 and 18 months follow-up, respectively, only 1/71 (1.4%) pts with response has relapsed. In contrast, pts without pathologic response (pNR) have a poor prognosis; 15/23 (65.2%) have relapsed so far. This emphasizes the need for baseline biomarkers predictive of non-response and new neoadjuvant treatment combinations for these pts. In our previous studies, baseline interferon-gamma (IFN-γ) signature low pts were less likely to respond to neoadjuvant IPI plus NIVO. The DONIMI study tests the combination of NIVO +/- IPI with domatinostat (DOM), a class 1 histone deacetylase inhibitor, according to the IFN-γ signature in the tumor. Based on the signature previously described by Ayers et al. we have developed a neoadjuvant IFN-γ signature algorithm that will be used for the first time to classify pts in this prospective trial. Methods: The aim of this two-center investigator-initiated phase 1b study is to assess the safety and feasibility of neoadjuvant NIVO +/- DOM +/- IPI in 45 stage III melanoma pts with RECIST 1.1 measurable de-novo or recurrent disease. IFN-γ signature high pts (n = 20) will be randomized (stratified by center) to Arm A (2 cycles NIVO 240mg q3wk) or Arm B (2 cycles NIVO 240mg q3wk + DOM 200mg twice daily (BID), d1-14, q3wk). IFN-γ signature low pts (n = 25) will be randomized to Arm C (2 cycles NIVO 240mg q3wk + DOM 200mg BID, d1-14, q3wk) or Arm D (2 cycles NIVO 240mg q3wk + IPI 80mg q3wk + DOM 200mg once daily (OD), d1-14, q3wk). Based on safety data of the first 5 pts in arm D, the remaining pts will be treated with either a higher dosing scheme (200mg BID, d1-14, q3wks), a lower dosing scheme (100mg OD, d1-14, q3wks) or the same dosing scheme (200mg OD, d1-14, q3wks). The primary endpoint is safety and feasibility. A treatment arm will be declared as not feasible if 2/5 or 3/10 pts cannot adhere to the preplanned time of surgery (week 6 +/- 1week) due to treatment-related adverse events. Biopsies (week 0, 3), blood samples (week 0, 3, 6, 12) and feces (week 0, 3, 6) will be collected for translational research. The first patient was enrolled on January 23th, 2020. Clinical trial information: NCT04133948.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Oscar Krijgsman
- Netherlands Cancer Institute (NKI-AVL), Amsterdam, Netherlands
| | | | - Disha Rao
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | | | - Richard A. Scolyer
- Melanoma Institute Australia, The University of Sydney, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Bart A. Van De Wiel
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Alexander M. Menzies
- Melanoma Institute Australia, University of Sydney, Royal North Shore Hospital, Sydney, Australia
| | | | - Georgina V. Long
- Melanoma Institute Australia, The University of Sydney, Royal North Shore Hospital, Mater Hospital, Sydney, Australia
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25
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Slagter M, Rozeman EA, Ding H, Versluis JM, Valenti M, Peters D, Broeks A, Rooijen CV, Horlings H, Haanen JBAG, Hooijberg E, Wessels LFA, Blank CU, Schumacher TN. Spatial proximity of CD8 T cells to tumor cells as an independent biomarker for response to anti-PD-1 therapy. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.10038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10038 Background: Only a subset of advanced melanoma patients respond to anti-PD-1 (aPD1) monotherapy. Upfront identification of (non-)responsiveness would help guide first-line treatment decisions, prevent overtreatment and unnecessary risk for toxicities. T cell density and expression of T cell related genes have been associated with response to aPD1, but are imperfect predictors. We investigated whether spatial proximity of CD8 T cells to tumor cells improves upon the predictive value of T cell density alone. Methods: Pretreatment tumor specimens from melanoma patients treated with aPD1 in the Netherlands Cancer Institute were stained for DAPI, SOX10/Melan-A, CD4, CD8, FOXP3 and PD-1 by multiplex immunofluorescence. Sections were imaged on Vectra and analyzed using HALO to optimize marker thresholds and demarcate tumor and stroma. T cell proximity to tumor cells was evaluated as difference in area under the curve between i) a spatial G-function quantifying T cell density around tumor cells in tumor areas and ii) analogous null distributions obtained by random permutation of cell labels. This assessment of co-clustering is independent of cell density and heterogeneity therein and does not reflect repulsion of T cells to stromal/marginal areas. Clinical characteristics, RECIST response and survival were collected from patient records. Associations between T cell density, T cell proximity to Sox10/Melan-A+ tumor cells, other clinical biomarkers (LDH, M stage and WHO performance status) and response were examined in a Bayesian hierarchical logistic regression. Results: Tumor specimens of 98 patients were included, of whom 45 were treated with aPD1 as first-line therapy and 33 had an objective response. CD8 T cell proximity to tumor cells was associated with response in an independent, comparatively strong, and tissue dependent manner (cutaneous tissue: 2.78 [2.45, 3.17], visceral: 2.30 [1.95, 2.72], lymphoid: 2.12 [1.88, 2.40], format: maximal posteriori odds ratio [89% equal-tailed credibility interval]), in a multivariate model correcting for CD8 T cell density (1.74 [1.62, 1.88]), LDH (1.93 [1.72, 2.16]), M stage (0.92 [0.87, 0.98]) and WHO performance status (0.79 [0.72, 0.88]). Our model achieved an area under the ROC curve of 77.7%, whereas an analogous model omitting the proximity variable achieved 73.1%. Conclusions: Our analyses show that spatial proximity of CD8 T cells to tumor cells functions as an independent biomarker for response to aPD1 and suggests that preexisting CD8 T cell tumor reactivity is reflected by this spatial proximity.
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Affiliation(s)
| | | | - Huiwen Ding
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | - Dennis Peters
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | - Hugo Horlings
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | - Lodewyk F. A. Wessels
- Department of Molecular Carcinogenesis, Netherlands Cancer Institute, Amsterdam, Netherlands
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26
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Rozeman EA, Versluis JM, Sikorska K, Lacroix R, Grijpink-Ongering LG, Heeres B, Van De Wiel BA, Dimitriadis P, Sari A, Heijmink S, Kvistborg P, van den Broek D, Broeks A, de Groot JW, Wilgenhof S, Vollebergh MA, Van Thienen JV, Haanen JBAG, Blank CU. The IMPemBra trial, a phase II study comparing pembrolizumab with intermittent/short‐term dual MAPK pathway inhibition plus pembrolizumab in melanoma patients harboring the BRAFV600 mutation. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.10021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10021 Background: Continuous combination of MAPK inhibition (MAPKi) and anti-PD-(L)1 has been investigated by several trials to improve outcome of BRAFV600 mutated melanoma patients. A major obstacle for continuous combination is the high frequency (~60%) of grade 3-4 treatment-related adverse events (TRAE) for which many patients need to discontinue (~40%). In a preclinical model we showed that short‐time MAPKi induces T cell infiltration and is synergistic with anti-PD‐1. In patients T cell infiltration increased after short-term MAPKi, while after > 2 weeks this was often diminished. The aim of this phase 2b study was to identify the optimal duration of MAPKi with dabrafenib (BRAFi) + trametinib (MEKi) in combination with pembrolizumab (anti-PD-1) in terms of safety, feasibility and immune-activating capacity. Methods: Treatment-naïve BRAFV600E/K mutant advanced melanoma patients started pembrolizumab (PEM) 200mg Q3W and were randomized in week 6 to continue PEM only (cohort 1) or to receive in addition intermittent dabrafenib (D) 150 mg BID + trametinib (T) 2mg QD for 2 x 1 week (cohort 2), 2 x 2 weeks (cohort 3), or continuous for 6 weeks (cohort 4). All cohorts continued PEM for up to 2 years. Primary endpoints were safety and treatment-adherence. Secondary endpoints were objective response rate (ORR, RECIST 1.1) at week 6, 12, 18 compared to baseline and PFS. Results: Between June 2016 and August 2018, 32 patients have been included; 56% were male, 50% had M1c disease and the majority had a BRAFV600E mutation (81%) and a baseline LDH level > ULN (87%). Grade 3-4 TRAE were observed in 12%, 12%, 50%, and 62% of patients in cohort 1, 2, 3, and 4, respectively. All planned D+T was given in 88%, 63%, and 38% of patients in cohort 2, 3, and 4. Most patients needed to interrupt or discontinue D+T due to fever or elevated liver enzymes. ORR at week 6, week 12, and week 18 were 38%, 62%, and 62% in cohort 1, 25%, 62%, and 75% in cohort 2, 25%, 50%, and 75% in cohort 3 and 0%, 62%, and 50% in cohort 4. After a median follow-up of 17.4 months, the median PFS of patients treated with PEM monotherapy was 10.6 months compared to 27.0 months for patients treated with PEM and short-term/intermittent D+T (p = 0.13). Conclusions: Combination of PEM plus intermittent D+T seems more feasible and tolerable than continuous triple therapy. Intermittent short-time combination therapy might be equally effective, enables therapy with MAPKi as a second line, and therefore warrants further investigation in a larger patient cohort. Clinical trial information: NCT02625337.
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Affiliation(s)
| | | | - Karolina Sikorska
- Department of Statistics, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Ruben Lacroix
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Birthe Heeres
- Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Bart A. Van De Wiel
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | | | - Ayşegül Sari
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | | | - Pia Kvistborg
- The Netherlands Cancer Institute (NKI), Amsterdam, Netherlands
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27
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Rozeman EA, Reijers IL, Hoefsmit EP, Sikorska K, Krijgsman O, Van De Wiel BA, Dimitriadis P, Eriksson H, Gonzalez M, Grijpink-Ongering LG, Kerkhoven RM, Broeks A, Klop WM, Spillane A, Saw RPM, Van Akkooi ACJ, Scolyer RA, Menzies AM, Long GV, Blank CU. Twenty-four months RFS and updated toxicity data from OpACIN-neo: A study to identify the optimal dosing schedule of neoadjuvant ipilimumab (IPI) and nivolumab (NIVO) in stage III melanoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.10015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10015 Background: Early results of the OpACIN-neo study testing 3 different dosing schedules of neoadjuvant IPI + NIVO demonstrated that 2 cycles IPI 1mg/kg + NIVO 3mg/kg (IPI1NIVO3, arm B) was the most favorable schedule with 20% grade 3-4 immunotherapy-related adverse events (irAEs) and a pathologic response rate (pRR) of 77%. After a median follow-up (FU) of 8.3 months, none of the 64 patients (pts) with a pathologic (path) response ( < 50% viable tumor cells) versus 9/21 (43%) without a path response had relapsed. Here, we present the updated 2-year RFS, EFS and long-term toxicity data. Methods: In the phase 2 multi-center OpACIN-neo trial, 86 stage III melanoma pts with resectable and RECIST 1.1 measurable lymph node metastasis were randomized between 3 different dosing schedules of neoadjuvant IPI + NIVO: arm A: 2x IPI3+NIVO1 Q3W (n = 30), arm B: 2x IPI1+NIVO3 Q3W (n = 30), and arm C: 2x IPI3 Q3W followed by 2x NIVO3 Q2W (n = 26). Lymph node dissection was scheduled at week 6. Primary endpoints were toxicity, radiologic RR and pRR; RFS and EFS were secondary endpoints. Results: After a median FU of 24.6 months, the median RFS and EFS was not reached in any of the 3 arms. In total, 2 pts progressed before surgery, 12 pts relapsed (11 pts without path response and 1 pt with pCR) and 5 pts died (4 due to melanoma and one pt due to toxicity). Estimated 24-months RFS was 84% (95% CI 76-92%) for the total population, 97% (95% CI 93-100%) for pts with a path response and 36% (95% CI 17-74%) for pts without a path response. Estimated 24-months EFS for the total population was 82% (95% CI 74-91%). RFS and EFS did not differ between the arms. Of the 81 pts alive, 55 (68%) have ongoing irAEs; only 2 (3%) pts have ≥ grade 3 irAEs. Most frequent ongoing irAEs were vitiligo (35%), fatigue (14%), sicca syndrome (11%), rash (10%), arthralgia (7%) and endocrine toxicities (20%). 17 pts need hormone replacement therapy: 11 (14%) thyroid hormone and 7 (9%) hydrocortisone. No difference between treatment arms was observed. Ongoing surgery-related AEs were observed in 31 (38%) pts of which lymphedema was seen most frequently (17 pts; 21%). Conclusions: Extended follow-up data shows that 2 cycles of neoadjuvant IPI + NIVO without adjuvant therapy induces durable RFS. While almost no ongoing high-grade irAEs were observed, the majority of pts have low-grade ongoing toxicities. These outcomes strongly support the need to test 2 cycles of neoadjuvant IPI1+NIVO3 versus adjuvant anti-PD-1 in a randomized phase 3 trial. Clinical trial information: NCT02977052.
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Affiliation(s)
| | | | | | - Karolina Sikorska
- Department of Statistics, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Oscar Krijgsman
- Netherlands Cancer Institute (NKI-AVL), Amsterdam, Netherlands
| | - Bart A. Van De Wiel
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | | | | | | | | | | | | | | | | | - Robyn PM Saw
- Melanoma Institute Australia, The University of Sydney, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | - Richard A. Scolyer
- The University of Sydney, Melanoma Institute Australia and Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Alexander M. Menzies
- Melanoma Institute Australia, University of Sydney, Royal North Shore Hospital, Sydney, Australia
| | - Georgina V. Long
- Melanoma Institute Australia, The University of Sydney, Royal North Shore Hospital, Mater Hospital, Sydney, Australia
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Van den Heuvel NMJ, Reijers IL, Rozeman EA, Versluis JM, Józwiak K, Spillane A, Scolyer RA, Pennington T, Saw RPM, Gonzalez M, van Houdt WJ, Klop WM, Wouters MW, Menzies AM, Van Akkooi ACJ, van de Poll-Franse LV, Long GV, Blank CU, Boekhout AH. Health-related quality of life in stage III melanoma patients treated with neoadjuvant ipilimumab and nivolumab followed by index lymph node excision only, compared to therapeutic lymph node dissection: First results of the PRADO trial. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.10064] [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: 11/20/2022] Open
Abstract
10064 Background: Neoadjuvant ipilimumab and nivolumab induces high pathologic response rates of 74-78% (OpACIN and OpACIN-neo trial), thus the role of Therapeutic Lymph Node Dissections (TLND) in patients with major pathologic responses (MPR: pathological (near) complete response) is now unclear. In the PRADO trial, TLND was omitted in patients with MPR in their index lymph node ((ILN), the largest LN marked prior to neoadjuvant therapy). We sought to determine if less extensive surgery is associated with better Health Related Quality of Life (HRQoL). These are the first results of the comparison of HRQoL between patients undergoing a TLND or less extensive ILN excision. Methods: HRQoL was assessed with the European Organisation for Research and Treatment of Cancer QoL questionnaire-C30 (QLQ-C30). A generalized estimation equation was used to assess the difference in HRQoL outcomes between patients who underwent TLND (pathological non- and partial-responders, pNR/pPR) versus those who did not (pathological (near)complete responders, pNCR/pCR). Differences were adjusted for age, gender and follow-up (FU, in weeks), but not for pathological responses (pNR, pPR, pNCR & pCR). Differences in QLQ-C30 scores were classified as clinically important according to published guidelines. Results: A total of 49 patients from the PRADO study had reached at least 24 weeks FU, and were included in the first explorative analysis. The median age of this study population was 58 years (range, 22-84). Questionnaire completion rates were high: 94% at baseline, 100%, 90%, 88% at week 6, 12 and 24, respectively. Sixteen (33%) patients underwent TLND versus 33 (67%) who had ILN excision only. Over a FU period of 24 weeks, patients who underwent TLND scored significantly lower on global (68 vs 78, adjusted difference (diff) = -9.53, p = .005), physical (84 vs 94 diff = -11.1, p = < .001), emotional (69 vs 83, diff = -11.7, p = .001), role (70 vs 85, diff = -13, p = .004), and social functioning (81 vs 91, diff = -8.9, p = .016) and had a higher symptom burden of fatigue (35 vs 23, diff = 11.1, p = .004), insomnia (38 vs 18, diff = 16.6, p = .002) and financial impact (12 vs 4, diff = 7.9, p = .027) than patients undergoing ILN excision only. These differences were indicated as clinically relevant. Conclusions: First results from PRADO suggest that reducing the extent of surgery following neoadjuvant immunotherapy might result in better HRQoL of high-risk stage III melanoma patients. Clinical trial information: NCT02977052.
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Affiliation(s)
| | | | | | | | - Katarzyna Józwiak
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | | | - Richard A. Scolyer
- The University of Sydney, Melanoma Institute Australia and Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | - Robyn PM Saw
- Melanoma Institute Australia, The University of Sydney, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | | | | | - Michel W.J.M. Wouters
- The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Alexander M. Menzies
- Melanoma Institute Australia, University of Sydney, Royal North Shore Hospital, Sydney, Australia
| | | | | | - Georgina V. Long
- Melanoma Institute Australia, The University of Sydney, Royal North Shore Hospital, Mater Hospital, Sydney, Australia
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29
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Blank CU, Reijers IL, Pennington T, Versluis JM, Saw RPM, Rozeman EA, Kapiteijn E, Van Der Veldt AAM, Suijkerbuijk K, Hospers G, Klop WMC, Sikorska K, Van Der Hage JA, Grunhagen DJ, Spillane A, Rawson RV, Van De Wiel BA, Menzies AM, Van Akkooi ACJ, Long GV. First safety and efficacy results of PRADO: A phase II study of personalized response-driven surgery and adjuvant therapy after neoadjuvant ipilimumab (IPI) and nivolumab (NIVO) in resectable stage III melanoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.10002] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10002 Background: OpACIN-neo tested 3 dosing schemes of neoadjuvant (neoadj) IPI+NIVO and identified 2 cycles of IPI 1mg/kg + NIVO 3mg/kg (I1N3) as the most favorable with a pathologic (path) response rate (pRR) of 77% and 20% grade 3-4 irAEs. After 17.6 months median FU, 1/64 (2%) patients (pts) with path response vs 13/21 (62%) of the non-responders ( > 50% viable tumor cells; pNR) had relapsed. We hypothesized that therapeutic lymph node dissection (TLND) could be omitted in pts achieving a complete or near-complete path response (≤10% viable tumor cells; major path response, MPR) in the index node (largest LN metastasis: ILN), whereas additional adjuvant (adj) therapy might improve the outcome of pNR pts. Methods: PRADO is an extension cohort of the multi-center phase 2 OpACIN-neo study that aims to confirm the pRR and safety of neoadj I1N3 and to test response-driven subsequent therapy. Pts with RECIST 1.1 measurable clinical stage III melanoma were included to receive 2 cycles of neoadj I1N3 after marker placement in the ILN. ILN resection was planned at wk 6. Pts that achieved MPR in the ILN did not undergo TLND; pts with pPR ( > 10 – ≤50% viable tumor cells) underwent TLND; and pts with pNR underwent TLND and received adj NIVO or targeted therapy (TT) for 52 wks +/- radiotherapy (RT). Primary endpoints were pRR in the ILN and 24-month RFS. Estimated toxicity rates at wk 12 were calculated using a Kaplan Meier based method. Results: Between Nov 16, 2018 and Jan 3, 2020, 99 of 114 screened pts were eligible and enrolled. So far, 86 pts had ≥12 wks FU. 70/99 pts achieved a path response in the ILN (pRR 71%, 95% CI 61% - 79%); 60 (61%) had MPR. TLND was omitted in 58 (97%) of the MPR pts. There were 28 non-responders; 7 developed distant metastasis before ILN resection. To date, 8 of the 21 pNR pts had adj NIVO, 7 had adj TT and 7 had adj RT. The estimated grade 3-4 irAE rate at wk 12 was 24%. Due to toxicity, 10 pts (10%) received only 1 cycle I1N3 and in 3 pts ILN resection was not performed: 2 of these pts underwent TLND at wk 9 and one pt was not evaluated for path response. At data cutoff, the surgery-related grade 1,2 and 3 AE rates were 29%, 10% and 0% in pts who underwent ILN resection only vs 21%, 30% and 9% in pts who underwent subsequent TLND (p = 0.004). At ASCO 2020 all pts will have reached ≥12 wks FU. Conclusions: Neoadj I1N3 treatment induced a high pRR with tolerable toxicity. TLND was omitted in a major subset of pts, reducing surgical morbidity. Longer FU is needed to report safety and RFS when TLND is omitted in MPR pts. Clinical trial information: NCT02977052.
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Affiliation(s)
| | | | | | | | - Robyn PM Saw
- Melanoma Institute Australia, The University of Sydney, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | | | | | | | - Geke Hospers
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, Netherlands
| | - W. Martin. C. Klop
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Karolina Sikorska
- Department of Statistics, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Jos A. Van Der Hage
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Dirk J. Grunhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | - Robert V Rawson
- Melanoma Institute Australia, Royal Prince Alfred Hospital, Sydney, Australia
| | - Bart A. Van De Wiel
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Alexander M. Menzies
- Melanoma Institute Australia, University of Sydney, Royal North Shore Hospital, Sydney, Australia
| | | | - Georgina V. Long
- Melanoma Institute Australia, The University of Sydney, Royal North Shore Hospital, Mater Hospital, Sydney, Australia
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30
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Li H, van der Leun AM, Yofe I, Lubling Y, Gelbard-Solodkin D, van Akkooi ACJ, van den Braber M, Rozeman EA, Haanen JBAG, Blank CU, Horlings HM, David E, Baran Y, Bercovich A, Lifshitz A, Schumacher TN, Tanay A, Amit I. Dysfunctional CD8 T Cells Form a Proliferative, Dynamically Regulated Compartment within Human Melanoma. Cell 2020; 181:747. [PMID: 32359441 DOI: 10.1016/j.cell.2020.04.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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31
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Helmink BA, Reddy SM, Gao J, Zhang S, Basar R, Thakur R, Yizhak K, Sade-Feldman M, Blando J, Han G, Gopalakrishnan V, Xi Y, Zhao H, Amaria RN, Tawbi HA, Cogdill AP, Liu W, LeBleu VS, Kugeratski FG, Patel S, Davies MA, Hwu P, Lee JE, Gershenwald JE, Lucci A, Arora R, Woodman S, Keung EZ, Gaudreau PO, Reuben A, Spencer CN, Burton EM, Haydu LE, Lazar AJ, Zapassodi R, Hudgens CW, Ledesma DA, Ong S, Bailey M, Warren S, Rao D, Krijgsman O, Rozeman EA, Peeper D, Blank CU, Schumacher TN, Butterfield LH, Zelazowska MA, McBride KM, Kalluri R, Allison J, Petitprez F, Fridman WH, Sautès-Fridman C, Hacohen N, Rezvani K, Sharma P, Tetzlaff MT, Wang L, Wargo JA. B cells and tertiary lymphoid structures promote immunotherapy response. Nature 2020; 577:549-555. [DOI: 10.1038/s41586-019-1922-8] [Citation(s) in RCA: 863] [Impact Index Per Article: 215.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 12/04/2019] [Indexed: 12/28/2022]
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Reijers ILM, Rozeman EA, Wilgenhof S, van Thienen JV, Haanen JBAG, Blank CU. Switch to checkpoint inhibition after targeted therapy at time of progression or during ongoing response: A retrospective single-centre experience in patients with BRAF-mutated melanoma. Pigment Cell Melanoma Res 2019; 33:498-506. [PMID: 31646741 DOI: 10.1111/pcmr.12835] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 04/10/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 11/29/2022]
Abstract
BRAF + MEK inhibition is preferentially applied as first-line therapy in BRAF V600-mutated melanoma patients with unfavourable prognostic features, due to the ability of targeted therapy (TT) to induce rapid symptom control, decrease tumour burden and normalize lactate dehydrogenase (LDH) levels. In addition, short-term TT transiently increases tumour antigen presentation and tumour influx of T cells. Therefore, it might be favourable to switch TT to checkpoint inhibition (CPI) before progression (PD). We retrospectively analysed melanoma patients treated first line with TT (TT1) and who subsequently switched to CPI during response to TT (sDR group) or at progression upon TT (sPD group). We identified 74 patients (n = 37 sDR group and n = 37 sPD group). ORR to CPI was 27.0% in the sDR group versus 24.3% in the sPD group (p = .790). Median was PFS 2.5 months versus 1.2 months (p = .145), and median OS was 30.6 versus 14.1 months (p = .007). After adjusting for baseline differences and known prognostic factors, hazard ratios (HRs) favouring sDR were 0.89 for PFS upon CPI (p = .956) and 0.48 for OS (p = .055). Thus, patients switching to CPI during ongoing clinical benefit from TT do not have an inferior outcome. Due to baseline imbalances and small patient population, a favourable trend for the sDR group can be hypothesized only.
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Affiliation(s)
- Irene L M Reijers
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Elisa A Rozeman
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sofie Wilgenhof
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Johannes V van Thienen
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - John B A G Haanen
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Christian U Blank
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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33
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Hoefsmit EP, Rozeman EA, Haanen JBAG, Blank CU. Susceptible loci associated with autoimmune disease as potential biomarkers for checkpoint inhibitor-induced immune-related adverse events. ESMO Open 2019; 4:e000472. [PMID: 31423333 PMCID: PMC6677983 DOI: 10.1136/esmoopen-2018-000472] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/01/2019] [Accepted: 03/19/2019] [Indexed: 12/13/2022] Open
Abstract
Unprecedented successes regarding cancer immunotherapy have been achieved, in which therapeutic agents are used to target immune cells rather than cancer cells. The most effective immunotherapy to date is the group of immune checkpoint inhibitors (CPI), targeting, for example, cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) or programmed cell death protein (PD-1). TThe combination of these therapies (anti-PD-1 with anti-CTLA-4) induces high response rates, and seem to be increased further when applied in early-stage disease. However, combined CTLA-4 plus PD-1 blockade causes frequent high-grade immune-related adverse events (irAE). To date, research on biological mechanism of irAEs is scarce and no widely accepted biomarkers predicting onset of severe irAEs have been identified. The similarity of irAEs to autoimmune disorders fuels the hypothesis that irAEs may be linked to susceptible genetic loci related to various autoimmune diseases. In this review, we extensively searched for susceptible loci associated with various autoimmune diseases, and pooled them in groups most likely to be associated with CPI-induced irAEs. These sets could be used in future research on predicting irAEs and guide physicians in a more refined and personal manner.
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Affiliation(s)
- Esmée P Hoefsmit
- Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Elisa A Rozeman
- Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Medical Oncology Department, Netherlands Cancer Institute-Antoni van Leeuwenhoek Ziekenhuis, Amsterdam, The Netherlands
| | - John B A G Haanen
- Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Medical Oncology Department, Netherlands Cancer Institute-Antoni van Leeuwenhoek Ziekenhuis, Amsterdam, The Netherlands
| | - Christian U Blank
- Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Medical Oncology Department, Netherlands Cancer Institute-Antoni van Leeuwenhoek Ziekenhuis, Amsterdam, The Netherlands
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34
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Jansen YJL, Rozeman EA, Mason R, Goldinger SM, Geukes Foppen MH, Hoejberg L, Schmidt H, van Thienen JV, Haanen JBAG, Tiainen L, Svane IM, Mäkelä S, Seremet T, Arance A, Dummer R, Bastholt L, Nyakas M, Straume O, Menzies AM, Long GV, Atkinson V, Blank CU, Neyns B. Discontinuation of anti-PD-1 antibody therapy in the absence of disease progression or treatment limiting toxicity: clinical outcomes in advanced melanoma. Ann Oncol 2019; 30:1154-1161. [PMID: 30923820 DOI: 10.1093/annonc/mdz110] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [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] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Programmed cell death protein 1 (PD-1) blocking monoclonal antibodies improve the overall survival of patients with advanced melanoma but the optimal duration of treatment has not been established. PATIENTS AND METHODS This academic real-world cohort study investigated the outcome of 185 advanced melanoma patients who electively discontinued anti-PD-1 therapy with pembrolizumab (N = 167) or nivolumab (N = 18) in the absence of disease progression (PD) or treatment limiting toxicity (TLT) at 14 medical centres across Europe and Australia. RESULTS Median time on treatment was 12 months (range 0.7-43). The best objective tumour response at the time of treatment discontinuation was complete response (CR) in 117 (63%) patients, partial response (PR) in 44 (24%) patients and stable disease (SD) in 16 (9%) patients; 8 (4%) patients had no evaluable disease (NE). After a median follow-up of 18 months (range 0.7-48) after treatment discontinuation, 78% of patients remained free of progression. Median time to progression was 12 months (range 2-23). PD was less frequent in patients with CR (14%) compared with patients with PR (32%) and SD (50%). Six out of 19 (32%) patients who were retreated with an anti-PD-1 at the time of PD obtained a new antitumour response. CONCLUSIONS In this real-world cohort of advanced melanoma patients discontinuing anti-PD-1 therapy in the absence of TLT or PD, the duration of anti-PD-1 therapy was shorter when compared with clinical trials. In patients obtaining a CR, and being treated for >6 months, the risk of relapse after treatment discontinuation was low. Patients achieving a PR or SD as best tumour response were at higher risk for progression after discontinuing therapy, and defining optimal treatment duration in such patients deserves further study. Retreatment with an anti-PD-1 at the time of progression may lead to renewed antitumour activity in some patients. CLINICAL TRIAL REGISTRATION NCT02673970 (https://clinicaltrials.gov/ct2/show/NCT02673970?cond=melanoma&cntry=BE&city=Jette&rank=3).
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Affiliation(s)
- Y J L Jansen
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussel, Belgium.
| | - E A Rozeman
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R Mason
- Department of Medical Oncology, Princess Alexandra Hospital, Brisbane; Greenslope Oncology, Greenslope Private Hospital, Brisbrane
| | - S M Goldinger
- Melanoma Institute Australia and The University of Syndey, Sydney, Australia; Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - M H Geukes Foppen
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L Hoejberg
- Department of Oncology, Odense University Hospital, Odense
| | - H Schmidt
- Department of Oncology, Aarhus Universitet, Aarhus, Denmark
| | - J V van Thienen
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J B A G Haanen
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L Tiainen
- Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - I M Svane
- Department of Oncology, Copenhagen University Hospital, Herlev, Denmark
| | - S Mäkelä
- Department of Oncology, University of Helsinki, Helsinki, Finland
| | - T Seremet
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - A Arance
- Department of Medical Oncology, Hospital Clínic Barcelona, Barcelona, Spain
| | - R Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - L Bastholt
- Department of Oncology, Odense University Hospital, Odense
| | - M Nyakas
- Department of Clinical Cancer Research, Oslo University Hospital, Oslo
| | - O Straume
- Department of Oncology, Universitetet Bergen, Bergen, Norway
| | - A M Menzies
- Melanoma Institute Australia and The University of Syndey, Sydney, Australia; Department of Medical Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney; Department of Medical Oncology, Mater Hospital, Sydney, Australia
| | - G V Long
- Melanoma Institute Australia and The University of Syndey, Sydney, Australia; Department of Medical Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney; Department of Medical Oncology, Mater Hospital, Sydney, Australia
| | - V Atkinson
- Greenslope Oncology, Greenslope Private Hospital, Brisbrane; Department of Medical Oncology, Princess Alexandra Hospital, Brisbane
| | - C U Blank
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - B Neyns
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussel, Belgium
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35
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Rozeman EA, Menzies AM, van Akkooi ACJ, Adhikari C, Bierman C, van de Wiel BA, Scolyer RA, Krijgsman O, Sikorska K, Eriksson H, Broeks A, van Thienen JV, Guminski AD, Acosta AT, Ter Meulen S, Koenen AM, Bosch LJW, Shannon K, Pronk LM, Gonzalez M, Ch'ng S, Grijpink-Ongering LG, Stretch J, Heijmink S, van Tinteren H, Haanen JBAG, Nieweg OE, Klop WMC, Zuur CL, Saw RPM, van Houdt WJ, Peeper DS, Spillane AJ, Hansson J, Schumacher TN, Long GV, Blank CU. Identification of the optimal combination dosing schedule of neoadjuvant ipilimumab plus nivolumab in macroscopic stage III melanoma (OpACIN-neo): a multicentre, phase 2, randomised, controlled trial. Lancet Oncol 2019; 20:948-960. [PMID: 31160251 DOI: 10.1016/s1470-2045(19)30151-2] [Citation(s) in RCA: 298] [Impact Index Per Article: 59.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/08/2019] [Accepted: 03/14/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND The outcome of patients with macroscopic stage III melanoma is poor. Neoadjuvant treatment with ipilimumab plus nivolumab at the standard dosing schedule induced pathological responses in a high proportion of patients in two small independent early-phase trials, and no patients with a pathological response have relapsed after a median follow up of 32 months. However, toxicity of the standard ipilimumab plus nivolumab dosing schedule was high, preventing its broader clinical use. The aim of the OpACIN-neo trial was to identify a dosing schedule of ipilimumab plus nivolumab that is less toxic but equally effective. METHODS OpACIN-neo is a multicentre, open-label, phase 2, randomised, controlled trial. Eligible patients were aged at least 18 years, had a WHO performance status of 0-1, had resectable stage III melanoma involving lymph nodes only, and measurable disease according to the Response Evaluation Criteria in Solid Tumors version 1.1. Patients were enrolled from three medical centres in Australia, Sweden, and the Netherlands, and were randomly assigned (1:1:1), stratified by site, to one of three neoadjuvant dosing schedules: group A, two cycles of ipilimumab 3 mg/kg plus nivolumab 1 mg/kg once every 3 weeks intravenously; group B, two cycles of ipilimumab 1 mg/kg plus nivolumab 3 mg/kg once every 3 weeks intravenously; or group C, two cycles of ipilimumab 3 mg/kg once every 3 weeks directly followed by two cycles of nivolumab 3 mg/kg once every 2 weeks intravenously. The investigators, site staff, and patients were aware of the treatment assignment during the study participation. Pathologists were masked to treatment allocation and all other data. The primary endpoints were the proportion of patients with grade 3-4 immune-related toxicity within the first 12 weeks and the proportion of patients achieving a radiological objective response and pathological response at 6 weeks. Analyses were done in all patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, number NCT02977052, and is ongoing with an additional extension cohort and to complete survival analysis. FINDINGS Between Nov 24, 2016 and June 28, 2018, 105 patients were screened for eligibility, of whom 89 (85%) eligible patients were enrolled and randomly assigned to one of the three groups. Three patients were excluded after randomisation because they were found to be ineligible, and 86 received at least one dose of study drug; 30 patients in group A, 30 in group B, and 26 in group C (accrual to this group was closed early upon advice of the Data Safety Monitoring Board on June 4, 2018 because of severe adverse events). Within the first 12 weeks, grade 3-4 immune-related adverse events were observed in 12 (40%) of 30 patients in group A, six (20%) of 30 in group B, and 13 (50%) of 26 in group C. The difference in grade 3-4 toxicity between group B and A was -20% (95% CI -46 to 6; p=0·158) and between group C and group A was 10% (-20 to 40; p=0·591). The most common grade 3-4 adverse events were elevated liver enzymes in group A (six [20%)]) and colitis in group C (five [19%]); in group B, none of the grade 3-4 adverse events were seen in more than one patient. One patient (in group A) died 9·5 months after the start of treatment due to the consequences of late-onset immune-related encephalitis, which was possibly treatment-related. 19 (63% [95% CI 44-80]) of 30 patients in group A, 17 (57% [37-75]) of 30 in group B, and nine (35% [17-56]) of 26 in group C achieved a radiological objective response, while pathological responses occurred in 24 (80% [61-92]) patients in group A, 23 (77% [58-90]) in group B, and 17 (65% [44-83]) in group C. INTERPRETATION OpACIN-neo identified a tolerable neoadjuvant dosing schedule (group B: two cycles of ipilimumab 1 mg/kg plus nivolumab 3 mg/kg) that induces a pathological response in a high proportion of patients and might be suitable for broader clinical use. When more mature data confirm these early observations, this schedule should be tested in randomised phase 3 studies versus adjuvant therapies, which are the current standard-of-care systemic therapy for patients with stage III melanoma. FUNDING Bristol-Myers Squibb.
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Affiliation(s)
| | - Alexander M Menzies
- Melanoma Institute of Australia, The University of Sydney, Sydney, NSW, Australia; Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | | | - Chandra Adhikari
- Melanoma Institute of Australia, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Richard A Scolyer
- Melanoma Institute of Australia, The University of Sydney, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | | | - Hanna Eriksson
- Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | | | | | - Alexander D Guminski
- Melanoma Institute of Australia, The University of Sydney, Sydney, NSW, Australia; Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | | | | | | | | | - Kerwin Shannon
- Melanoma Institute of Australia, The University of Sydney, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Loes M Pronk
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Maria Gonzalez
- Melanoma Institute of Australia, The University of Sydney, Sydney, NSW, Australia
| | - Sydney Ch'ng
- Melanoma Institute of Australia, The University of Sydney, Sydney, NSW, Australia; Royal North Shore and Mater Hospitals, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | - Jonathan Stretch
- Melanoma Institute of Australia, The University of Sydney, Sydney, NSW, Australia; Royal North Shore and Mater Hospitals, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Stijn Heijmink
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | - Omgo E Nieweg
- Melanoma Institute of Australia, The University of Sydney, Sydney, NSW, Australia; Royal North Shore and Mater Hospitals, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | | | - Robyn P M Saw
- Melanoma Institute of Australia, The University of Sydney, Sydney, NSW, Australia; Royal North Shore and Mater Hospitals, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | | | - Andrew J Spillane
- Melanoma Institute of Australia, The University of Sydney, Sydney, NSW, Australia; Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Johan Hansson
- Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | | | - Georgina V Long
- Melanoma Institute of Australia, The University of Sydney, Sydney, NSW, Australia
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36
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Boekhout AH, Józwiak K, Rozeman EA, Janssen SHM, van de Poll-Franse LV, Blank CU. Patient-reported outcomes of patients treated with (neo)adjuvant immune checkpoint combination therapy in high-risk stage III macroscopic melanoma: A matched cohort study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9588] [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: 11/20/2022] Open
Abstract
9588 Background: Results from the phase 1b (OpACIN) study comparing neoadjuvant to adjuvant ipilimumab (3mg/kg) plus nivolumab (1mg/kg) demonstrated a high clinical activity of neoadjuvant treatment in high-risk melanoma. However, the toxicity was high, with 90% grade 3 to 4 toxicity. These findings raise questions about long-term quality of life (QoL) in these patients (pts) who were treated with curative intent. Here we present the first analysis of patient-reported outcomes of patients treated with (neo)adjuvant immune checkpoint combination therapy. Methods: Sixteen of 20 pts had completed study treatment and were currently in follow-up (FU). Pts were asked to fill in The European Organisation for Research and Treatment of Cancer QoL questionnaire-C30 (QLQ-C30). The QLQ-C30 was used to assess health-related QoL and is composed of functional, symptomatic dimensions and a dimension of global health/QoL. A reference population (controls without a diagnosis of cancer) was obtained from the ‘Patient Reported Outcomes Following Initial treatment and Long term Evaluation of Survivorship’ registry. Pts were individually matched on age, gender, education and marital status with up to 9 controls. Pts and controls were compared on QLQ-30 scores using univariable linear regression analyses. Results: Thirteen out of 16 invited pts (81% response) returned a completed questionnaire. Median FU was 30 months after randomization. Pts scored significantly lower in emotional (std coeff. = -1.0, p = .007), role (std coeff. = -0.7, p = .08), cognitive (std coeff. = -0.8, p = .018) and social (std coeff. = -1.0, p = .014) functioning and higher in symptom burden of fatigue (std coeff. = .9, p = .024) compared to controls, which were all clinically relevant. The physical functioning and global QoL score did not differ between pts and controls. Conclusions: High risk stage III melanoma pts treated with (neo)adjuvant immune checkpoint combination therapy showed significantly lower emotional, role, cognitive and social functioning scores than controls. Pts reported higher levels of fatigue, however, there was no difference on physical functioning and global QoL between pts and controls.
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Affiliation(s)
| | - Katarzyna Józwiak
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
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37
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Menzies AM, Rozeman EA, Amaria RN, Huang ACC, Scolyer RA, Tetzlaff MT, Van De Wiel BA, Lo S, Tarhini AA, Tawbi HAH, Burton EM, Karakousis G, Ascierto PA, Spillane A, Davies MA, Van Akkooi ACJ, Mitchell TC, Long GV, Wargo JA, Blank CU. Pathological response and survival with neoadjuvant therapy in melanoma: A pooled analysis from the International Neoadjuvant Melanoma Consortium (INMC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9503] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9503 Background: Pathological complete response (pCR) to neoadjuvant systemic therapy (NST) correlates with survival, and is recognized as a path to regulatory approval in several cancers. Recent trials have reported that neoadjuvant immunotherapy (IT) and targeted therapy (TT) regimens achieve high pCR rates and impressive recurrence-free survival in stage III melanoma, however, the relationship between pCR, relapse-free (RFS) and overall survival (OS) in larger datasets of melanoma patients (pts) remains unknown. Methods: We pooled data from 6 modern NST clinical trials of anti-PD-1 based immunotherapy or BRAF/MEK targeted therapy conducted across institutions participating in the INMC. Pts with RECIST measurable, surgically resectable clinical stage III melanoma who underwent surgery were included. NST regimens included nivolumab (as monotherapy or in combination with ipilimumab), pembrolizumab or dabrafenib+trametinib. Baseline disease characteristics, treatment regimen, pCR and RFS were examined. Results: 184 pts with clinical stage III melanoma (AJCCv7: 100 IIIB, 84 IIIC) completed NST (133 IT, 51 TT) and underwent surgery. Median age was 57y (range 18-87). A pCR was observed in 41% of patients; 51 (38%) with IT and 24 (47%) with TT. Median follow-up post-surgery is 13 mo (95% CI 12-16); 10 mo with IT and 22 mo with TT. 44 (24%) pts have recurred (17 loco-regional, 21 distant, 6 both sites at first recurrence), 18 (14%) after IT and 26 (51%) after TT. 12-month RFS was improved with IT vs TT (83% vs 65%, p < 0.001). For those with pCR, 7% have recurred, 0/51 (0%) after IT, 7/17 (41%) after TT. For those without pCR, 34% have recurred, 18/82 (22%) after IT and 19/27 (70%) after TT. 12-month RFS was improved in those with pCR vs without pCR (95% vs 62%, p < 0.001), including in those with IT (100% vs 72%, p < 0.001) and TT (88% vs 43%, p < 0.001). 16 (9%) patients have died including two who had a pCR, both from TT. Conclusions: Neoadjuvant IT and TT are active regimens in resectable clinical stage III melanoma patients and are associated with high pCR rate. The ability to achieve pCR correlates with improved RFS and remarkably no patient with pCR from immunotherapy has recurred to date.
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Affiliation(s)
- Alexander M. Menzies
- Melanoma Institute Australia, University of Sydney, Royal North Shore Hospital, Sydney, Australia
| | | | | | | | - Richard A. Scolyer
- The University of Sydney, Melanoma Institute Australia and Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | | | - Serigne Lo
- Melanoma Institute Australia, University of Sydney, Sydney, NSW, Australia
| | - Ahmad A. Tarhini
- Case Comprehensive Cancer Center/Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | | | | | - Giorgos Karakousis
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | - Tara C. Mitchell
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Georgina V. Long
- Melanoma Institute Australia, The University of Sydney, and Royal North Shore and Mater Hospitals, Sydney, Australia
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38
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Reijers I, Rozeman EA, Menzies AM, Van De Wiel BA, Eriksson H, Suijkerbuijk K, Van Der Veldt AAM, Kapiteijn E, Hospers G, Klop WM, Spillane A, Scolyer RA, Svane IM, Bastholt L, Schmidt H, Larkin JM, Van Akkooi ACJ, Long GV, Blank CU. Personalized response-driven adjuvant therapy after combination ipilimumab and nivolumab in high-risk resectable stage III melanoma: PRADO trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.tps9605] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS9605 Background: Adjuvant (adj) immune checkpoint inhibition (ICI) improves relapse free survival (RFS) in stage III melanoma patients (pts). However, preclinical and translational data suggest that neo-adjuvant (neoadj) treatment might be favorable due to broader immune activation. The phase 1b OpACIN study comparing neoadj to adj IPI plus NIVO demonstrated a high pathological response rate (pRR) of 78% complicated by 90% gr 3-4 immune-related adverse events (irAEs). The phase 2 OpACIN-neo trial tested safety and efficacy of three different schemes of neoadj IPI+NIVO and identified two cycles of IPI 1mg/kg + NIVO 3mg/kg as well tolerated (20% gr 3-4 irAEs), with a high pRR of 77%. In both trials, none of the pts with a pathologic response have relapsed after a median follow-up of 30 and 8.3 months. In stage IV melanoma, long-term benefit is observed in patients achieving CR with ICI, even after cessation of therapy. This raises the question of whether a therapeutic lymph node dissection (TLND) can be omitted when a deep pathologic response with neoadj IPI+NIVO is achieved. Methods: The aim of this international multi-center investigator-initiated phase 2 PRADO extension study is to confirm the pRR and toxicity of 2 cycles of neoadjuvant IPI 1mg/kg + NIVO 3mg/kg (the preferred OPACIN-neo regimen) and to test response-driven subsequent therapy i.e. omitting surgery and adjuvant ICI based on the pathological response. 100-110 pts with stage IIIB/C melanoma and a measurable lymph node (≥15mm according to RECIST 1.1) will receive two cycles of IPI 1mg/kg + NIVO 3mg/kg after marker placement into the largest lymph node metastasis. After six weeks, pts will undergo resection of the index lymph node. For pCR/near pCR, pts will not undergo TLND; For pPR, pts will undergo TLND; and for pNR, pts will undergo TLND and start adjuvant NIVO or targeted therapy +/- radiotherapy for 52 weeks. Primary endpoints are pRR of marked lymph node and RFS at 24 months. Baseline biopsies, blood samples (week 0, 6, 12) and faeces (week 0, 6) will be collected for translational research analyses. The first patient in this trial was included in October 2018; 22 patients have been enrolled. Clinical trial information: NCT02977052.
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Affiliation(s)
- Irene Reijers
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Alexander M. Menzies
- Melanoma Institute Australia, University of Sydney, Royal North Shore Hospital, Sydney, Australia
| | | | | | | | | | | | - Geke Hospers
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, Netherlands
| | | | | | - Richard A. Scolyer
- Melanoma Institute Australia, The University of Sydney, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Inge Marie Svane
- Department of Haematology and Department of Oncology, Herlev University Hospital, Herlev, Denmark
| | | | | | | | | | - Georgina V. Long
- Melanoma Institute Australia, The University of Sydney, and Royal North Shore and Mater Hospitals, Sydney, Australia
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39
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Schilling B, Martens A, Geukes Foppen MH, Gebhardt C, Hassel JC, Rozeman EA, Gesierich A, Gutzmer R, Kähler KC, Livingstone E, Diamantopoulos PT, Gogas H, Madonna G, Ascierto PA, Goldinger SM, Mangana J, Garbe C, Schadendorf D, Blank C, Weide B. First-line therapy-stratified survival in BRAF-mutant melanoma: a retrospective multicenter analysis. Cancer Immunol Immunother 2019; 68:765-772. [PMID: 30806748 PMCID: PMC11028062 DOI: 10.1007/s00262-019-02311-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 08/09/2018] [Accepted: 01/31/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Inhibition of the mitogen-activated protein kinase (MAPK) pathway as well as programmed death 1 receptor (PD-1) blockade was shown to prolong overall survival (OS) in patients with advanced B-Raf proto-oncogene (BRAF)-mutant melanoma. However, due to the lack of head-to-head trials, it remains unclear if one of these therapeutic approaches should be preferred in first-line therapy. Here, we present a retrospective analysis comparing anti-PD-1 monotherapy with BRAF/MAPK/ERK kinase (MEK) combined inhibition used as first-line agents in a real-world clinical setting. PATIENTS AND METHODS Clinical data, routine blood counts and lactate dehydrogenase (LDH) levels of 301 patients with unresectable or metastatic melanoma harboring an activating mutation in BRAF (V600E/K) were included. Of these, 106 received anti-PD-1 antibodies, while 195 patients were treated with a selective BRAF inhibitor combined with an MEK inhibitor as palliative first-line therapy. Patients were sub-grouped according to previously described predictive and prognostic markers. RESULTS OS was significantly longer in patients receiving anti-PD-1 monotherapy compared to patients receiving combined MAPK inhibitors. Subsequent therapies were comparable among these groups. The difference in OS was less pronounced in patients with high LDH levels and visceral metastatic spread. CONCLUSION First-line treatment with a PD-1 blocking antibody might be associated with longer OS than first-line inhibition of the MAPK pathway in patients with advanced melanoma harboring mutant BRAF. These hypothesis-generating data need to be confirmed or rejected in prospective, randomized trials.
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Affiliation(s)
- Bastian Schilling
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | - Alexander Martens
- Department of Dermatology, University Medical Center Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Germany
| | - Marnix H Geukes Foppen
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Christoffer Gebhardt
- Department of Dermatology, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Dermatology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jessica C Hassel
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Elisa A Rozeman
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Anja Gesierich
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | - Ralf Gutzmer
- Department of Dermatology, Skin Cancer Center, Hannover Medical School, Hannover, Germany
| | - Katharina C Kähler
- Department of Dermatology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Elisabeth Livingstone
- Department of Dermatology, West German Cancer Center, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Panagiotis T Diamantopoulos
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Helen Gogas
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Simone M Goldinger
- Department of Dermatology, University Hospital of Zürich, Zurich, Switzerland
| | - Johanna Mangana
- Department of Dermatology, University Hospital of Zürich, Zurich, Switzerland
| | - Claus Garbe
- Department of Dermatology, University Medical Center Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, West German Cancer Center, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Christian Blank
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Benjamin Weide
- Department of Dermatology, University Medical Center Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Germany.
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40
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Schermers B, Franke V, Rozeman EA, van de Wiel BA, Bruining A, Wouters MW, van Houdt WJ, Ten Haken B, Muller SH, Bierman C, Ruers TJM, Blank CU, van Akkooi ACJ. Surgical removal of the index node marked using magnetic seed localization to assess response to neoadjuvant immunotherapy in patients with stage III melanoma. Br J Surg 2019; 106:519-522. [PMID: 30882901 PMCID: PMC6593699 DOI: 10.1002/bjs.11168] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/16/2019] [Accepted: 02/12/2019] [Indexed: 12/11/2022]
Abstract
This pilot study explored the value of localized index node removal after neoadjuvant immunotherapy in patients with stage III melanoma, for use as a response indicator to guide the extent of completion lymph node dissection. Promising technology.
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Affiliation(s)
- B Schermers
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,MIRA Institute, University of Twente, Enschede, the Netherlands
| | - V Franke
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - E A Rozeman
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - B A van de Wiel
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - A Bruining
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M W Wouters
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - W J van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - B Ten Haken
- MIRA Institute, University of Twente, Enschede, the Netherlands
| | - S H Muller
- Department of Clinical Physics, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - C Bierman
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - T J M Ruers
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,MIRA Institute, University of Twente, Enschede, the Netherlands
| | - C U Blank
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - A C J van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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41
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Li H, van der Leun AM, Yofe I, Lubling Y, Gelbard-Solodkin D, van Akkooi ACJ, van den Braber M, Rozeman EA, Haanen JBAG, Blank CU, Horlings HM, David E, Baran Y, Bercovich A, Lifshitz A, Schumacher TN, Tanay A, Amit I. Dysfunctional CD8 T Cells Form a Proliferative, Dynamically Regulated Compartment within Human Melanoma. Cell 2018; 176:775-789.e18. [PMID: 30595452 DOI: 10.1016/j.cell.2018.11.043] [Citation(s) in RCA: 616] [Impact Index Per Article: 102.7] [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: 09/18/2018] [Revised: 11/08/2018] [Accepted: 11/28/2018] [Indexed: 12/29/2022]
Abstract
Tumor immune cell compositions play a major role in response to immunotherapy, but the heterogeneity and dynamics of immune infiltrates in human cancer lesions remain poorly characterized. Here, we identify conserved intratumoral CD4 and CD8 T cell behaviors in scRNA-seq data from 25 melanoma patients. We discover a large population of CD8 T cells showing continuous progression from an early effector "transitional" into a dysfunctional T cell state. CD8 T cells that express a complete cytotoxic gene set are rare, and TCR sharing data suggest their independence from the transitional and dysfunctional cell states. Notably, we demonstrate that dysfunctional T cells are the major intratumoral proliferating immune cell compartment and that the intensity of the dysfunctional signature is associated with tumor reactivity. Our data demonstrate that CD8 T cells previously defined as exhausted are in fact a highly proliferating, clonal, and dynamically differentiating cell population within the human tumor microenvironment.
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Affiliation(s)
- Hanjie Li
- Department of Immunology, Weizmann Institute, Rehovot, Israel
| | - Anne M van der Leun
- Department of Molecular Oncology and Immunology, Oncode Institute, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ido Yofe
- Department of Immunology, Weizmann Institute, Rehovot, Israel
| | - Yaniv Lubling
- Department of Computer Science and Applied Mathematics and Department of Biological Regulation, Weizmann Institute, Rehovot, Israel
| | | | - Alexander C J van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Marlous van den Braber
- Department of Molecular Oncology and Immunology, Oncode Institute, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Elisa A Rozeman
- Department of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Medical Oncology Department, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - John B A G Haanen
- Department of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Medical Oncology Department, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Christian U Blank
- Department of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Medical Oncology Department, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Hugo M Horlings
- Department of Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Eyal David
- Department of Immunology, Weizmann Institute, Rehovot, Israel
| | - Yael Baran
- Department of Computer Science and Applied Mathematics and Department of Biological Regulation, Weizmann Institute, Rehovot, Israel
| | - Akhiad Bercovich
- Department of Computer Science and Applied Mathematics and Department of Biological Regulation, Weizmann Institute, Rehovot, Israel
| | - Aviezer Lifshitz
- Department of Computer Science and Applied Mathematics and Department of Biological Regulation, Weizmann Institute, Rehovot, Israel
| | - Ton N Schumacher
- Department of Molecular Oncology and Immunology, Oncode Institute, Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Amos Tanay
- Department of Computer Science and Applied Mathematics and Department of Biological Regulation, Weizmann Institute, Rehovot, Israel.
| | - Ido Amit
- Department of Immunology, Weizmann Institute, Rehovot, Israel.
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42
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Liu J, Rozeman EA, O'Donnell JS, Allen S, Fanchi L, Smyth MJ, Blank CU, Teng MWL. Batf3 + DCs and type I IFN are critical for the efficacy of neoadjuvant cancer immunotherapy. Oncoimmunology 2018; 8:e1546068. [PMID: 30713806 DOI: 10.1080/2162402x.2018.1546068] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [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: 06/12/2018] [Revised: 10/28/2018] [Accepted: 11/02/2018] [Indexed: 12/31/2022] Open
Abstract
New clinical trials are now evaluating the efficacy of neoadjuvant immunotherapy in the context of primary tumor surgery. Using the orthotopic 4T1.2 mouse model of spontaneously metastatic mammary cancer, we have shown that neoadjuvant immunotherapy and surgery was superior in the generation of tumor-specific CD8+ T cells and eradication of lethal metastases compared to surgery followed by adjuvant immunotherapy. However, the importance of host Batf3 and type I interferon (IFN) for long-term survival of mice following neoadjuvant immunotherapy is unknown. Here we demonstrated that loss of Batf3+ DCs or type I IFN receptor blockade in 4T1.2 tumor-bearing mice treated with neoadjuvant anti-PD-1+anti-CD137 immunotherapy reduced long-term survival with a corresponding reduction in tumor-specific CD8+ T cells producing effector cytokines in the primary tumor and in the periphery. Interestingly, we found all high-risk stage III melanoma patients relapsing after adjuvant or neoadjuvant ipilimumab+nivolumab within the OpACIN trial (NCT02437279) displayed low expression of Batf3+ DC-associated genes in pre-treatment tumor biopsies. Further focus should now be placed on validating the requirement of an intratumoral Batf3+ DC gene signature for response to neoadjuvant immunotherapy.
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Affiliation(s)
- Jing Liu
- Cancer Immunoregulation and Immunotherapy Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Elisa A Rozeman
- Division of Molecular Oncology & Immunology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Jake S O'Donnell
- Cancer Immunoregulation and Immunotherapy Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Immunology in Cancer and Infection Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Stacey Allen
- Cancer Immunoregulation and Immunotherapy Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Lorenzo Fanchi
- Division of Molecular Oncology & Immunology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Mark J Smyth
- Immunology in Cancer and Infection Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Christian U Blank
- Division of Molecular Oncology & Immunology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Michele W L Teng
- Cancer Immunoregulation and Immunotherapy Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,School of Medicine, University of Queensland, Herston, Queensland, Australia
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43
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de Moel EC, Rozeman EA, Kapiteijn EH, Verdegaal EME, Grummels A, Bakker JA, Huizinga TWJ, Haanen JB, Toes REM, van der Woude D. Autoantibody Development under Treatment with Immune-Checkpoint Inhibitors. Cancer Immunol Res 2018; 7:6-11. [PMID: 30425107 DOI: 10.1158/2326-6066.cir-18-0245] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/03/2018] [Accepted: 11/08/2018] [Indexed: 11/16/2022]
Abstract
Immune-checkpoint inhibitors (ICIs) activate the immune system to assault cancer cells in a manner that is not antigen specific. We hypothesized that tolerance may also be broken to autoantigens, resulting in autoantibody formation, which could be associated with immune-related adverse events (irAEs) and antitumor efficacy. Twenty-three common clinical autoantibodies in pre- and posttreatment sera from 133 ipilimumab-treated melanoma patients were determined, and their development linked to the occurrence of irAEs, best overall response, and survival. Autoantibodies developed in 19.2% (19/99) of patients who were autoantibody-negative pretreatment. A nonsignificant association was observed between development of any autoantibodies and any irAEs [OR, 2.92; 95% confidence interval (CI) 0.85-10.01]. Patients with antithyroid antibodies after ipilimumab had significantly more thyroid dysfunction under subsequent anti-PD-1 therapy: 7/11 (54.6%) patients with antithyroid antibodies after ipilimumab developed thyroid dysfunction under anti-PD1 versus 7/49 (14.3%) patients without antibodies (OR, 9.96; 95% CI, 1.94-51.1). Patients who developed autoantibodies showed a trend for better survival (HR for all-cause death: 0.66; 95% CI, 0.34-1.26) and therapy response (OR, 2.64; 95% CI, 0.85-8.16). We conclude that autoantibodies develop under ipilimumab treatment and could be a potential marker of ICI toxicity and efficacy.
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Affiliation(s)
- Emma C de Moel
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.
| | | | - Ellen H Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Els M E Verdegaal
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Annette Grummels
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Jaap A Bakker
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - John B Haanen
- Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - René E M Toes
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Diane van der Woude
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
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Lacroix R, Rozeman EA, Kreutz M, Renner K, Blank CU. Targeting tumor-associated acidity in cancer immunotherapy. Cancer Immunol Immunother 2018; 67:1331-1348. [PMID: 29974196 PMCID: PMC11028141 DOI: 10.1007/s00262-018-2195-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [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: 01/16/2018] [Accepted: 06/29/2018] [Indexed: 12/21/2022]
Abstract
Checkpoint inhibitors, such as cytotoxic T-lymphocyte-associated protein-4 (CTLA-4) and programmed cell death-1 (PD-1) monoclonal antibodies have changed profoundly the treatment of melanoma, renal cell carcinoma, non-small cell lung cancer, Hodgkin lymphoma, and bladder cancer. Currently, they are tested in various tumor entities as monotherapy or in combination with chemotherapies or targeted therapies. However, only a subgroup of patients benefit from checkpoint blockade (combinations). This raises the question, which all mechanisms inhibit T cell function in the tumor environment, restricting the efficacy of these immunotherapeutic approaches. Serum activity of lactate dehydrogenase, likely reflecting the glycolytic activity of the tumor cells and thus acidity within the tumor microenvironment, turned out to be one of the strongest markers predicting response to checkpoint inhibition. In this review, we discuss the impact of tumor-associated acidity on the efficacy of T cell-mediated cancer immunotherapy and possible approaches to break this barrier.
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Affiliation(s)
- Ruben Lacroix
- Department of Molecular Oncology and Immunology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - Elisa A Rozeman
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marina Kreutz
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Kathrin Renner
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Christian U Blank
- Department of Molecular Oncology and Immunology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands.
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Rozeman EA, Van Akkooi ACJ, Menzies AM, Smith M, Scolyer RA, Pronk LM, Gonzales M, Hoeller C, Hansson J, Larkin JMG, Long GV, Blank CU. Multicenter phase 2 study to identify the optimal neo-adjuvant combination scheme of ipilimumab (IPI) and nivolumab (NIVO) (OpACIN-neo). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps9606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Myles Smith
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Richard A. Scolyer
- Royal Prince Alfred Hospital/Melanoma Institute Australia/University of Sydney, Sydney, Australia
| | - Loes M. Pronk
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | - Johan Hansson
- Department of Oncology-Pathology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | | | - Georgina V. Long
- Melanoma Institute Australia, The University of Sydney, Mater Hospital, and Royal North Shore Hospital, Sydney, Australia
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Rozeman EA, Geukes Foppen MH, Ong S, Lacroix R, Danaher P, Broeks A, Cesano A, Wilgenhof S, Van Thienen JV, Haanen JBAG, Warren S, Blank CU. Immune gene profiling of pretreatment tumor samples in "real-world" advanced melanoma patients treated with anti-PD-1 and/or anti-CTLA-4. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.9585] [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: 11/20/2022] Open
Affiliation(s)
| | | | | | - Ruben Lacroix
- Netherlands Cancer Institute, Amsterdam, Netherlands
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Goldinger SM, Lo S, Hassel JC, Forschner A, McKean MA, Zimmer L, Khoo CCH, Dummer R, Eroglu Z, Buchbinder EI, Ascierto PA, Gutzmer R, Rozeman EA, Hoeller C, Johnson DB, Gesierich A, Kolblinger P, Benannoune N, Cohen JV, Menzies AM. The utility of chemotherapy after immunotherapy failure in metastatic melanoma: A multicenter case series. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e21588] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Serigne Lo
- Melanoma Institute Australia, Sydney, Australia
| | - Jessica Cecile Hassel
- University Hospital Heidelberg, Universitaets-Hautklinik, Hauttumorzentrum, Heidelberg, Germany
| | - Andrea Forschner
- Department of Dermatology Eberhard-Karls University of Tuebingen, Tuebingen, Germany
| | | | - Lisa Zimmer
- Department of Dermatology, University Hospital, University Duisburg-Essen, Essen, Germany
| | | | - Reinhard Dummer
- University of Zurich Hospital, Department of Dermatology, Zurich, Switzerland
| | | | | | | | - Ralf Gutzmer
- Skin Cancer Center Hannover, Hannover Medical School, Hannover, Germany
| | | | | | | | | | - Peter Kolblinger
- Paracelsus Medical University, Department of Dermatology, Salzburg, AT
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Geukes Foppen MH, Rozeman EA, van Wilpe S, Postma C, Snaebjornsson P, van Thienen JV, van Leerdam ME, van den Heuvel M, Blank CU, van Dieren J, Haanen JBAG. Immune checkpoint inhibition-related colitis: symptoms, endoscopic features, histology and response to management. ESMO Open 2018; 3:e000278. [PMID: 29387476 PMCID: PMC5786923 DOI: 10.1136/esmoopen-2017-000278] [Citation(s) in RCA: 175] [Impact Index Per Article: 29.2] [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: 09/19/2017] [Revised: 11/06/2017] [Accepted: 11/08/2017] [Indexed: 12/15/2022] Open
Abstract
Background Immune checkpoint inhibitors are successfully introduced as anticancer treatment. However, they may induce severe immune-related adverse events (irAEs). One of the most frequent irAEs is diarrhoea. The main objective of this study was to analyse symptoms (ie, grade of diarrhoea), endoscopic and histological features and response to management in immune checkpoint inhibition-related colitis (IRC). Patients and methods We retrospectively analysed patients who developed diarrhoea on checkpoint inhibition and therefore underwent an endoscopy and/or were treated with corticosteroids. Patients were treated between August 2010 and March 2016 for metastatic melanoma or non-small cell lung cancer. Severity of IRC was scored using the endoscopic Mayo score and the van der Heide score. Results Out of a cohort of 781 patients, 92 patients were identified who developed diarrhoea and therefore underwent an endoscopy and/or were treated with corticosteroids. Patients were treated with monotherapy anticytotoxic T-lymphocyte antigen-4, antiprogrammed death receptor-1 or a combination of both. All patients had symptoms of diarrhoea (grade 1: 16%; grade 2: 39% and grade 3: 44%). A complete colonoscopy was performed in 62 (67%) patients, of whom 42 (68%) had a pancolitis (≥3 affected segments). Ulcers were seen in 32% of endoscopies. There was no significant correlation between the grade of diarrhoea at presentation and endoscopic severity scores, the presence of ulcers or histological features. In 54 episodes of diarrhoea (56%), patients received one or more cycles infliximab for steroid-refractory colitis. Patients with higher endoscopic severity scores, ulcers and/or a pancolitis needed infliximab more often. Conclusions The correlation between grade of diarrhoea and endoscopic or histological features for severity of colitis is poor. Patients with higher endoscopic severity scores, ulcers or a pancolitis needed the addition of infliximab more often. Therefore, endoscopy may have value in the evaluation of the severity of IRC and may help in decision making for optimal management.
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Affiliation(s)
- Marnix H Geukes Foppen
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Elisa A Rozeman
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sandra van Wilpe
- Department of Gastroenterology and Hepatology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Cindy Postma
- Department of Gastroenterology and Hepatology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Petur Snaebjornsson
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Johannes V van Thienen
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michel van den Heuvel
- Department of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Christian U Blank
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jolanda van Dieren
- Department of Gastroenterology and Hepatology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - John B A G Haanen
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Kong X, Kuilman T, Shahrabi A, Boshuizen J, Kemper K, Song JY, Niessen HWM, Rozeman EA, Geukes Foppen MH, Blank CU, Peeper DS. Cancer drug addiction is relayed by an ERK2-dependent phenotype switch. Nature 2017; 550:270-274. [PMID: 28976960 PMCID: PMC5640985 DOI: 10.1038/nature24037] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 08/25/2017] [Indexed: 12/29/2022]
Abstract
Drug addiction denotes the dependency of tumors on the same therapeutic
drugs to which they have acquired resistance. Observations from cultured
cells1–3, animal models4 and
patients5–7 raise the possibility that cancer drug addiction can
instigate a potential cancer vulnerability, which may be used therapeutically.
However, for this trait to become of clinical interest, it is imperative to
first define the underlying mechanism. Therefore, we performed an unbiased
CRISPR-Cas9 knockout screen to functionally mine the genome of melanoma cells
that are both resistant and addicted to BRAF inhibition for “addiction
genes”. Here, we describe a signaling pathway comprising ERK2, JUNB and
FRA1, disruption of which allows tumor cells to reverse addiction and survive
upon treatment discontinuation. This occurred both in culture and mice, and was
irrespective of the acquired drug resistance mechanism. In melanoma and lung
cancer cells, death induced by drug withdrawal was preceded by a specific
ERK2-dependent phenotype switch, alongside transcriptional reprogramming
reminiscent of EMT. In melanoma, this caused shutdown of the lineage survival
oncoprotein MITF, restoration of which reversed both phenotype switching and
drug addiction-associated lethality. In melanoma patients who had progressed on
BRAF inhibition, treatment cessation was followed by increased expression of the
phenotype switch-associated receptor tyrosine kinase AXL. Drug discontinuation
synergized with the melanoma chemotherapeutic dacarbazine by further suppressing
MITF and its prosurvival target BCL2 while inducing DNA damage. Our results
uncover a pathway driving cancer drug addiction, which may guide alternating
therapeutic strategies for enhanced clinical responses of drug-resistant
cancers.
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Affiliation(s)
- Xiangjun Kong
- Division of Molecular Oncology and Immunology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Thomas Kuilman
- Division of Molecular Oncology and Immunology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Aida Shahrabi
- Division of Molecular Oncology and Immunology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Julia Boshuizen
- Division of Molecular Oncology and Immunology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Kristel Kemper
- Division of Molecular Oncology and Immunology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Ji-Ying Song
- Division of Experimental Animal Pathology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Hans W M Niessen
- Department of Pathology and Cardiac Surgery, VU University Medical Center, ACS, 1007 MB Amsterdam, The Netherlands
| | - Elisa A Rozeman
- Division of Molecular Oncology and Immunology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Marnix H Geukes Foppen
- Division of Molecular Oncology and Immunology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Christian U Blank
- Division of Molecular Oncology and Immunology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Daniel S Peeper
- Division of Molecular Oncology and Immunology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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Rozeman EA, Van Akkooi ACJ, Routier E, Menzies AM, Eriksson H, Smith M, Scolyer RA, Hoeller C, Hansson J, Robert C, Larkin JMG, Long GV, Blank CU. Multicenter phase 2 study to identify the optimal neo-adjuvant combination scheme of ipilimumab (IPI) and nivolumab (NIVO) (OpACIN-neo). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps9600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS9600 Background: The outcome of high risk stage IIIb and IIIc melanoma patients is poor, with a 5 year overall survival (OS) rate of < 50%. Adjuvant high dose IPI significantly improves 5 year progression free survival (PFS) and OS. In stage IV patients the combination of IPI and NIVO improves response rates (RR) and PFS compared to monotherapy, but at cost of higher toxicity. Neo-adjuvant treatment may be a favorable approach as immune checkpoint inhibition (ICI) is of greatest value at the moment of TCR triggering and therefore dependent on the amount of antigen present. The phase Ib OpACIN study comparing neo-adjuvant and adjuvant IPI and NIVO showed that neo-adjuvant treatment is feasible as all patients underwent surgery on time. The neo-adjuvant pathological RR was 80%, although 18/20 patients (90%) stopped early due to ≥1 grade 3 or 4 immune-related adverse events (irAEs). To date (median follow-up 45 wks), none of the 8 responders in the neo-adjuvant arm have relapsed. This raises the question whether the neo-adjuvant IPI and NIVO schedule can be adjusted to reduce toxicity but preserve efficacy. Methods: The aim of the multi-center phase 2 OpACIN-neo trial is to identify an optimal neo-adjuvant combination scheme of IPI and NIVO. 90 patients with resectable stage III melanoma will be randomized 1:1:1 between three combination schemes of IPI and NIVO. Patients in arm A will receive 2 courses standard regimen IPI 3mg/kg + NIVO 1mg/kg q3wks, in arm B IPI 1mg/kg + NIVO 3mg/kg q3wks, and in arm C 2 courses of IPI 3mg/kg q3wks directly followed (2-24hr) by 2 courses NIVO 3mg/kg q2wks. All patients will undergo surgery at week 6. The primary endpoints are rate of grade 3/4 irAEs, pathological RR, and radiologic RECIST 1.1. An interim analysis is planned after 13 patients have been accrued to each arm (according to the Simon 2-stage design). Major inclusion criteria are: ≥1 measurable lymph node metastases (according to RECIST 1.1) that can be biopsied, no history of in-transit metastases in the last 6 months, and naïve for ICI. Baseline biopsies and blood samples (week 0, 6, 12) will be taken for translational research. The first center started inclusion in December 2016, until now 2 patients have been enrolled. Clinical trial information: NCT02977052.
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Affiliation(s)
| | | | | | - Alexander M. Menzies
- Melanoma Institute Australia, Royal North Shore Hospital, The University of Sydney, Sydney, Australia
| | | | - Myles Smith
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Richard A. Scolyer
- Royal Prince Alfred Hospital/Melanoma Institute Australia/University of Sydney, Sydney, Australia
| | | | | | - Caroline Robert
- Gustave Roussy Comprehensive Cancer Center, Villejuif, France
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