1
|
Ugurluer G, Schneiders FL, Corradini S, Boldrini L, Kotecha R, Kelly P, Portelance L, Camilleri P, Ben-David MA, Poiset S, Marschner SN, Panza G, Kutuk T, Palacios MA, Castelluccia A, Zoto Mustafayev T, Atalar B, Senan S, Ozyar E. Factors influencing local control after MR-guided stereotactic body radiotherapy (MRgSBRT) for adrenal metastases. Clin Transl Radiat Oncol 2024; 46:100756. [PMID: 38450219 PMCID: PMC10915494 DOI: 10.1016/j.ctro.2024.100756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/08/2024] Open
Abstract
Purpose Stereotactic body radiotherapy (SBRT) is an effective treatment for adrenal gland metastases, but it is technically challenging and there are concerns about toxicity. We performed a multi-institutional pooled retrospective analysis to study clinical outcomes and toxicities after MR-guided SBRT (MRgSBRT) using for adrenal gland metastases. Methods and Materials Clinical and dosimetric data of patients treated with MRgSBRT on a 0.35 T MR-Linac at 11 institutions between 2016 and 2022 were analyzed. Local control (LC), local progression-free survival (LPFS), distant progression-free survival (DPFS) and overall survival (OS) were estimated using Kaplan-Meier method and log-rank test. Results A total of 255 patients (269 adrenal metastases) were included. Metastatic pattern was solitary in 25.9 % and oligometastatic in 58.0 % of patients. Median total dose was 45 Gy (range, 16-60 Gy) in a median of 5 fractions, and the median BED10 was 100 Gy (range, 37.5-132.0 Gy). Adaptation was done in 87.4 % of delivered fractions based on the individual clinicians' judgement. The 1- and 2- year LPFS rates were 94.0 % (95 % CI: 90.7-97.3 %) and 88.3 % (95 % CI: 82.4-94.2 %), respectively and only 2 patients (0.8 %) experienced grade 3 + toxicity. No local recurrences were observed after treatment to a total dose of BED10 > 100 Gy, with single fraction or fractional dose of > 10 Gy. Conclusions This is a large retrospective multi-institutional study to evaluate the treatment outcomes and toxicities with MRgSBRT in over 250 patients, demonstrating the need for frequent adaptation in 87.4 % of delivered fractions to achieve a 1- year LPFS rate of 94 % and less than 1 % rate of grade 3 + toxicity. Outcomes analysis in 269 adrenal lesions revealed improved outcomes with delivery of a BED10 > 100 Gy, use of single fraction SBRT and with fraction doses > 10 Gy, providing benchmarks for future clinical trials.
Collapse
Affiliation(s)
- Gamze Ugurluer
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
| | - Famke L. Schneiders
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University Munich, Germany
| | - Luca Boldrini
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo Agostino Gemelli 8, Rome, Italy
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Patrick Kelly
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL, USA
| | | | | | - Merav A. Ben-David
- Department of Radiation Oncology, Assuta Medical Center, Tel Aviv, Israel
- Faculty of Health Science, Ben-Gurion University, Beer Sheva, Israel
| | - Spencer Poiset
- Department of Radiation Oncology, Sidney Kimmel Cancer Center of Thomas Jefferson University, Philadelphia, PA, USA
| | - Sebastian N. Marschner
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University Munich, Germany
| | - Giulia Panza
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo Agostino Gemelli 8, Rome, Italy
| | - Tugce Kutuk
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Miguel A. Palacios
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, Netherlands
| | | | | | - Banu Atalar
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
| |
Collapse
|
2
|
Senan S, Schneiders FL, Moghanaki D. Sub-lobar resections for peripheral non-small cell lung cancer measuring ≤ 2 cm: Insights from recent clinical trials. Radiother Oncol 2024; 192:110094. [PMID: 38224918 DOI: 10.1016/j.radonc.2024.110094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/02/2023] [Accepted: 01/11/2024] [Indexed: 01/17/2024]
Abstract
The findings of two well conducted trials that randomised 1803 patients with a peripheral non-small cell lung cancer measuring ≤ 2 cm to a lobar to sub-lobar resection have established the latter as a new standard of care. It is important for non-surgical oncologists to appreciate the details of study design and outcomes of both studies, given the possible impact they have for considerations of stereotactic ablative radiotherapy (SABR) for operable patients with early-stage NSCLC. Differences in overall survival between the study populations highlight the impact of confounding factors like smoking history and comorbidities on reported outcomes. For example, despite low post-operative mortality rates in both trials, the 5-year disease-free survival rate in the CALGB 140503 trial was only approximately 60 % with either surgical procedure. Both phase III trials required guideline recommended nodal staging, which does not reflect real world surgical practice, and which may limit the generalisability of the reported findings to local institutional outcomes. Furthermore, the emergence of other malignancies was recorded in 15-18 % of study patients during follow-up, and patients who underwent sub-lobar resections had a better long-term survival associated with a higher likelihood of undergoing additional curative treatments. These findings from the JCOG0802 and the CALGB 140503 will encourage more interest in enrolling patients into ongoing trials comparing surgical resection with SABR.
Collapse
Affiliation(s)
- Suresh Senan
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, De Boelelaan 1117, Postbus 7057 1007 MB, Amsterdam, the Netherlands.
| | - Famke L Schneiders
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, De Boelelaan 1117, Postbus 7057 1007 MB, Amsterdam, the Netherlands
| | - Drew Moghanaki
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite #B265, Los Angeles, CA 90095-6951 USA.
| |
Collapse
|
3
|
van der Pol Y, Tantyo NA, Evander N, Hentschel AE, Wever BM, Ramaker J, Bootsma S, Fransen MF, Lenos KJ, Vermeulen L, Schneiders FL, Bahce I, Nieuwenhuijzen JA, Steenbergen RD, Pegtel DM, Moldovan N, Mouliere F. Real-time analysis of the cancer genome and fragmentome from plasma and urine cell-free DNA using nanopore sequencing. EMBO Mol Med 2023; 15:e17282. [PMID: 37942753 DOI: 10.15252/emmm.202217282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023] Open
Abstract
Cell-free DNA (cfDNA) can be isolated and sequenced from blood and/or urine of cancer patients. Conventional short-read sequencing lacks deployability and speed and can be biased for short cfDNA fragments. Here, we demonstrate that with Oxford Nanopore Technologies (ONT) sequencing we can achieve delivery of genomic and fragmentomic data from liquid biopsies. Copy number aberrations and cfDNA fragmentation patterns can be determined in less than 24 h from sample collection. The tumor-derived cfDNA fraction calculated from plasma of lung cancer patients and urine of bladder cancer patients was highly correlated (R = 0.98) with the tumor fraction calculated from short-read sequencing of the same samples. cfDNA size profile, fragmentation patterns, fragment-end composition, and nucleosome profiling near transcription start sites in plasma and urine exhibited the typical cfDNA features. Additionally, a high proportion of long tumor-derived cfDNA fragments (> 300 bp) are recovered in plasma and urine using ONT sequencing. ONT sequencing is a cost-effective, fast, and deployable approach for obtaining genomic and fragmentomic results from liquid biopsies, allowing the analysis of previously understudied cfDNA populations.
Collapse
Affiliation(s)
- Ymke van der Pol
- Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Normastuti Adhini Tantyo
- Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Nils Evander
- Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Anouk E Hentschel
- Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Urology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Birgit Mm Wever
- Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Jip Ramaker
- Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Sanne Bootsma
- Amsterdam UMC Location University of Amsterdam, Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
- Oncode Institute, Amsterdam, The Netherlands
| | - Marieke F Fransen
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Pulmonology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kristiaan J Lenos
- Amsterdam UMC Location University of Amsterdam, Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
- Oncode Institute, Amsterdam, The Netherlands
| | - Louis Vermeulen
- Amsterdam UMC Location University of Amsterdam, Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
- Oncode Institute, Amsterdam, The Netherlands
| | - Famke L Schneiders
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Pulmonology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Idris Bahce
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Pulmonology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jakko A Nieuwenhuijzen
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Urology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Renske Dm Steenbergen
- Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - D Michiel Pegtel
- Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Norbert Moldovan
- Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Florent Mouliere
- Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Schneiders FL, van Vliet C, Giraud N, Bruynzeel AM, Slotman BJ, Palacios MA, Senan S. Clinical outcomes of MR-guided adrenal stereotactic ablative radiotherapy with preferential sparing of organs at risk. Clin Transl Radiat Oncol 2023; 43:100680. [PMID: 37808454 PMCID: PMC10551830 DOI: 10.1016/j.ctro.2023.100680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/15/2023] [Accepted: 09/21/2023] [Indexed: 10/10/2023] Open
Abstract
Background and purpose The optimal stereotactic ablative radiotherapy (SABR) doses for adrenal tumors are unknown. Some trials have specified that organ at risk (OAR) dose constraints should take priority over target coverage. We performed a retrospective review of the outcomes of MR-guided adrenal SABR (MRgRT) delivered with OAR sparing. Materials and methods Patients who underwent adrenal MRgRT between 2016 and 2023 were identified from our Ethics-approved institutional database. Dose ranged between 8 and 24 Gy per fraction, delivered in 1-5 fractions. A 3 mm margin was added to the breath-hold gross tumor volume (GTV) to derive a PTV. Plan were delivered to an 'optimized' PTV that was generated by excluding any overlap with OARs. Results Adrenal SABR was performed in 107 patients (114 metastases). The commonest scheme used 5 fractions of 10 Gy (53.5 %); 82 % of plans delivered a BED10 ≧ 80 Gy. Systemic therapy was administered within 3 months preceding or following SABR in 53.5 % of patients. Grade 3 acute toxicity (CTCAE v5.0) occurred in 0.9 % of patients, and 4.4 % reported late toxicity, consisting of adrenal insufficiency and a vertebral collapse. Median follow-up was 13.8 months (range, 0.0-73.4 months). Local progression occurred in 7.4 % of evaluable patients. PTV underdosage was frequent, with a coverage compromise index (D99/prescription dose) of < 0.90 in 52 % of all plans. Recurrences were independent of the prescription doses. Conclusion MRgRT for adrenal metastases is well tolerated with high local control rates despite prioritizing OAR sparing over PTV coverage. Studies using deformable dose accumulation may lead to a better understanding of dose-response relationship with adaptive SABR.
Collapse
Affiliation(s)
- Famke L. Schneiders
- Department of Radiation Oncology, Amsterdam-UMC, Location VUmc, The Netherlands
- Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Claire van Vliet
- Department of Radiation Oncology, Amsterdam-UMC, Location VUmc, The Netherlands
| | - Nicolas Giraud
- Department of Radiation Oncology, Amsterdam-UMC, Location VUmc, The Netherlands
| | - Anna M.E. Bruynzeel
- Department of Radiation Oncology, Amsterdam-UMC, Location VUmc, The Netherlands
- Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Ben J. Slotman
- Department of Radiation Oncology, Amsterdam-UMC, Location VUmc, The Netherlands
- Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Miguel A. Palacios
- Department of Radiation Oncology, Amsterdam-UMC, Location VUmc, The Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam-UMC, Location VUmc, The Netherlands
- Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| |
Collapse
|
5
|
Giraud N, Schneiders FL, van Sornsen de Koste JR, Palacios MA, Senan S. Splenic Irradiation and Late Volume Changes Following Stereotactic Ablative Radiotherapy (SABR) for Adrenal Tumors. Int J Radiat Oncol Biol Phys 2023; 117:e385-e386. [PMID: 37785300 DOI: 10.1016/j.ijrobp.2023.06.2503] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Splenic irradiation may increase the risk of life-threatening infections. New guidelines recommend limiting mean spleen doses (MSD) to <10Gy, based on data derived after chemoradiotherapy and conventional radiotherapy. Splenic changes after abdominal SABR are not well characterized. We studied splenic doses during MR-guided SABR for adrenal tumors, and evaluated late changes in splenic volumes (SV). MATERIALS/METHODS AnEthics approved institutional database was accessed for details of patients treated using MR-SABR on a 0.35T unit for adrenal metastases between 2016-2023. No splenic planning constraints were routinely applied during this period. The spleen was delineated on treatment planning breath-hold CT and MR-scans and MSD, relative V5-10-20-30 values derived. On follow-up CT scans, SV was measured at 6, 12 and 24 months. Intergroup comparisons were performed with Wilcoxon rank-sum and Fisher exact tests; linear and logistic regression analyses computed to assess variables associated with the MSD and SV reduction >20% respectively. RESULTS Of 113 adrenal tumors treated, 56% were left-sided. MR-SABR was mostly delivered in 5 fractions to 50 Gy (53%), in 3 fractions to 45 Gy (13%) or 16-24 Gy single-fraction (14%). The median MSD and V10 were 9.7 Gy (range, 1.5-28.4) and 46.3% (range, 0-100%) for left-sided treatments, 1.5 Gy (range, 0.2-5.9) and 0% (range, 0-6.2%) for right-sided treatments. Systemic therapy was administered in 51% of patients, either during or after MR-SABR. Baseline SV, GTV and use of systemic treatment did not significantly differ between right and left-sided tumors. MSD>10Gy was only seen in 44% of left-sided tumors, accounting for 25% of all patients. Multivariable linear analysis revealed treatment laterality (p<0.001), PTV dose (p = 0.02) and larger GTV size (p<0.001) to be significantly associated with MSD. Repeat imaging was available at 6 months (n = 59, 56% left-sided), 12 months (n = 47, 57% left-sided) and 24 months (n = 31, 65% left-sided). In the overall population, MSD >10Gy correlated with greater decreases in SV at 6 months (-19.5% vs -1.7%, p = 0.003), 12 months (-17.0% vs -3.9%, p = 0.03) and 24 months (-24.6% vs -9.3%, p = 0.06). For patients with an MSD >10Gy, a >20% decrease in SV was observed in 46% at 6 months, and 40% at 12 months. SV reduction >20% was associated with the MSD, V5 and V10 in multivariable logistic regression analysis. CONCLUSION An MSD>10Gy was seen in 44% of all left adrenal SABR plans, with late SV reductions observed in 40% of them. The functional implications are unclear, but suggest a need to give more priority to splenic doses during abdominal SABR.
Collapse
Affiliation(s)
- N Giraud
- Amsterdam UMC, Amsterdam, The Netherlands
| | | | | | | | - S Senan
- Amsterdam UMC, Amsterdam, The Netherlands
| |
Collapse
|
6
|
Giraud N, Schneiders FL, Palacios MA, de Koste JRVS, Senan S. Central Lung Tumors Eligible for Stereotactic Ablative Radiotherapy (SABR) Trials: Analysis of a Cohort Treated Using MR-Guided SABR. Int J Radiat Oncol Biol Phys 2023; 117:e20. [PMID: 37784848 DOI: 10.1016/j.ijrobp.2023.06.690] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) SABR for central and ultracentral lung tumors results in increased toxicity. We implemented MR-guided SABR in patients meeting the IASLC classification for central tumors, namely a Gross Tumor Volume (GTV) ≤2cm from trachea, main bronchi, esophagus, heart, brachial plexus, main mediastinal vessels, phrenic or laryngeal nerves and spinal cord. As patient inclusion criteria for ongoing clinical trials varies, we studied the eligibility of MR-SABR patients for inclusion into 3 clinical trials for central tumors. MATERIALS/METHODS An Ethics approved institutional database was accessed for details of patients treated using multifractionated lung MR-SABR between 2016 and 2022. GTV and Planning Target Volumes (PTV) had been delineated on a breath-hold planning MRI and CT scans. For each tumor meeting the IASLC classification, patient eligibility for HILUS (NCT04917224), STRICT/STARLUNG (NCT05354596) and SUNSET (NCT03306680) trials were examined. RESULTS Multifraction MR-SABR was performed in 97 central lung lesions meeting IASLC criteria. Of these, 73 patients (75.3%) fulfilled inclusion criteria for at least 1 trial, but inclusion in all 3 trials was possible in just 18.6% of treated lesions. Inclusion in the HILUS, STRICT/STARLUNG and SUNSET trials were possible in 33.0%, 73.2% and 25.8% of MR-SABR patients, respectively. For HILUS-eligible patients, 11 met the HILUS group A classification (GTV ≤1cm from the trachea and main bronchi), and 21 in group B (GTV >1cm from the trachea and main bronchi but ≤1cm from the intermediate and lobar bronchi). Use of STRICT/STARLUNG trial criteria would have defined 13 tumors as ultracentral (GTV ≤0.5cm from the trachea, main bronchi or intermediary bronchus or esophagus), and 58 as central (GTV 0.5cm-2.5cm from previously described structures or ≤0.5cm from the heart, aorta, spinal cord or lobar bronchi). For the SUNSET study, 25 tumors fulfilled criteria for ultracentral location (PTV touching or overlapping the central bronchial tree, esophagus, pulmonary vein or pulmonary artery). CONCLUSION Ongoing clinical trials in central or ultracentral lung SABR enroll considerably different patient populations than those selected using the IASLC definition of central tumors. Due to steep dose-fall off in SABR plans, detailed descriptions of the location of tumor and organs-at-risk, as well as dose-distributions achieved, are necessary in order to allow study results to be uniformly extrapolated to clinical practice.
Collapse
Affiliation(s)
- N Giraud
- Amsterdam UMC, Amsterdam, The Netherlands
| | | | | | | | - S Senan
- Amsterdam UMC, Amsterdam, The Netherlands
| |
Collapse
|
7
|
Giraud N, Schneiders FL, Palacios MA, van Sornsen de Koste JR, Senan S. Volumes Changes in Adrenal Metastases during Delivery of 5-Fraction Stereotactic Magnetic Resonance-Guided Adaptive Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e386. [PMID: 37785301 DOI: 10.1016/j.ijrobp.2023.06.2504] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Stereotactic MR-guided adaptive radiotherapy (SMART) improves adrenal target coverage and reduces organ at risk doses. Changes in adrenal tumor volumes were observed during contouring for daily-adaptive planning. We hypothesized that such changes in GTV may correlate with long-term outcomes. MATERIALS/METHODS An Ethics approved institutional database was accessed for details of 5-fraction adrenal SABR treatments on a 0.35T MR-Linac between 2016-2023. Volumetric MR-scans were acquired at baseline, and prior to each of 5 fractions. Manually contoured GTVs were accessed. Volume changes between simulation and first fraction (ΔPF1), as well as between first and subsequent fractions (ΔF1F2 to ΔF1F5) were computed. Daily relative adrenal volume change (DRVC) and the absolute volume change (DAVC) before treatment, were calculated by dividing ΔPF1 by the number of days between simulation and F1. Paired Wilcoxon tests were used to compare volumes at different timepoints. Univariate linear regression (LinR) models were created to study per-treatment volume changes. A logistic regression (LogR) analysis explored associations between baseline characteristics and volumetric changes with radiological complete response (CR) at the date of last news. RESULTS Adrenal SMART in 5 fractions of either 8 or 10Gy was delivered to 70 patients. The median interval between simulation and F1 was 13 days (range, 2-35), and 13 days between F1-F5 (range, 9-31). Solitary metastasis comprised 44%; metastases were mainly from non-small cell lung (64%) or renal (9%) primaries. Concurrent systemic therapy (± 3 months) was delivered in 41% of patients. Mean baseline GTV at simulation and F1 were respectively 38.5 and 41.4cc (p<0.001). Mean ΔPF1 was +9.1% (-10.2% to +50.1%) or +2.9cc (-4.4 to +27.4cc). Mean DRVC was +0.8% per day (-1.0% to +8.4%), and did not correlate with histology, GTV or concurrent systemic treatment. Mean DAVC was +0.26cc per day (-0.31 to +2.4cc), and was associated with GTV size (p = 0.04). In total, 47% of adrenal GTVs decreased in volume at F5 compared to F1. A ≥10% increase in GTV was observed in 39% of patients during SMART. GTV variations of ≥20% occurred in 36% patients at some point during SMART. At a median follow-up of 20.3 months, radiological CR was seen in 23% of 64 evaluable patients. Radiological CR was significantly associated with baseline GTV (p = 0.03) and ΔF1F5 (p = 0.03), but not DRVC (p = 0.6) or ΔF1F3 (p = 0.3). Local relapses were seen in 6% of patients. CONCLUSION Changes in adrenal volumes during SMART were common, with variations ≥20% occurring in 36% patients. The probability of a radiological CR correlated with both baseline GTV size and median relative volume decline between fractions 1 and 5. These changes support use of daily SABR plan adaptation.
Collapse
Affiliation(s)
- N Giraud
- Amsterdam UMC, Amsterdam, The Netherlands
| | | | | | | | - S Senan
- Amsterdam UMC, Amsterdam, The Netherlands
| |
Collapse
|
8
|
Ugurluer G, Schneiders FL, Corradini S, Boldrini L, Kotecha R, Kelly P, Portelance L, Camilleri P, Ben-David MA, Poiset SJ, Marschner S, Panza G, Kutuk T, Palacios M, Mustafayev TZ, Atalar B, Senan S, Ozyar E. Outcomes of MR-Guided Stereotactic Body Radiotherapy (MRgSBRT) for Adrenal Metastases: A Multi-Institutional Pooled Analysis. Int J Radiat Oncol Biol Phys 2023; 117:S111-S112. [PMID: 37784293 DOI: 10.1016/j.ijrobp.2023.06.439] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Stereotactic body radiotherapy (SBRT) is an effective treatment for adrenal metastases, but it is technically challenging and there are concerns about toxicity due to the proximity of organs at risk. We hypothesized that MR-guided SBRT (MRgSBRT) using a 0.35 T MR-Linac for adrenal metastases can achieve durable local control (LC) with a low probability of toxicity. MATERIALS/METHODS In an ethics-approved study, we analyzed clinical and dosimetric data of patients treated with MRgSBRT at 10 institutions between 2016-2022. LC, local progression-free survival (LPFS), distant progression-free survival (DPFS) and overall survival (OS) were estimated using Kaplan-Meier method and log-rank test. Responses were evaluated using RECIST criteria. Toxicity was graded according to CTCAE (v4.0). OS and DPFS were calculated on a per-patient basis, while LC and LPFS were calculated on a per-lesion basis. RESULTS A total of 249 patients (260 adrenal lesions) were included; median age was 65 years (range 28-91), 65.5% were male, 83.9% had ECOG PS 0-1. The most common primary tumor was lung cancer (69.1%). Adrenal metastases were synchronous, metachronous, oligoprogressive or oligopersistent in 20%, 41.5%, 35.8% and 2.7% of patients, respectively. Metastatic pattern was solitary in 26.9%, oligometastatic in 57.3% and polymetastatic in 15.8% of patients. Right-sided metastases comprised 40%, left-sided 51.5% and lesions were bilateral in 8.5%. Chemotherapy and immunotherapy were administered in 67.1% and 60.6% of patients, respectively. Median gross tumor volume was 21.8 cc (range 1.1-383.2) and median planning target volume was 36.9 cc (range 3.6-516.9). Median total dose was 45 Gy (range 16-60), median fraction number was 5 (range 1-8) and median fraction dose used was 10 Gy (range 5-24). Median BED10 was 100 Gy (range 37.5-132); 87.8% of fractions used adapted plans. At a median follow-up was 17.7 months (IQR 5.5-21.7), local responses were scored as complete response (CR), partial response (PR), stable disease (SD) or progressive disease (PD) in 36.9%, 28.2%, 25.7%, and 9.1%, respectively. Median OS was 30.4 months, with 1- and 2- year OS rates of 75.3% and 57.1%, respectively. On multivariate analysis, significantly higher OS rates were seen in patients achieving a CR (p = 0.007, HR 0.50) and with ECOG scores of 0-1 (p = 0.001, HR 0.43). One- and 2- year LPFS rates were 94.5% and 88.8%, respectively. No local recurrences were observed after treatment to a BED10>100 or with single fraction (range 16-24 Gy). Only 2 patients (0.8%) had ≥grade 3 chronic toxicity. CONCLUSION This multi-institutional study of MRgSBRT outcomes for adrenal metastases revealed a 2-year LPFS of 89%, with a <1% risk of ≥grade 3 toxicity. Daily adaptation was performed in 90% of plans, indicating a beneficial role for MR guidance.
Collapse
Affiliation(s)
- G Ugurluer
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
| | - F L Schneiders
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - S Corradini
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - L Boldrini
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - R Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - P Kelly
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL
| | - L Portelance
- Department of Radiation Oncology, University of Miami, Miami, FL
| | - P Camilleri
- Radiation Oncology, GenesisCare, Oxford, United Kingdom
| | - M A Ben-David
- Department of Radiation Oncology, Assuta Medical Center, Tel Aviv, Israel
| | - S J Poiset
- Department of Radiation Oncology, Sidney Kimmel Cancer Center of Thomas Jefferson University, Philadelphia, PA
| | - S Marschner
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - G Panza
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - T Kutuk
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - M Palacios
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - T Zoto Mustafayev
- Department of Radiation Oncology, Acibadem Maslak Hospital, Istanbul, Turkey
| | - B Atalar
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
| | - S Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - E Ozyar
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
| |
Collapse
|
9
|
Tekatli H, Palacios MA, Schneiders FL, Haasbeek CJA, Slotman BJ, Lagerwaard FJ, Senan S. Local control and toxicity after magnetic resonance imaging (MR)-guided single fraction lung stereotactic ablative radiotherapy. Radiother Oncol 2023; 187:109823. [PMID: 37516364 DOI: 10.1016/j.radonc.2023.109823] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE Magnetic resonance imaging (MR)-guided radiotherapy permits continuous intrafraction visualization and use of automatic triggered beam delivery, with use of smaller planning target volumes (PTV). We report on long-term clinical outcomes following MR-guided single fraction (SF) lung SABR on a 0.35 T linac. MATERIALS AND METHODS Details of patients treated with SF-SABR for lung tumors were accessed from an ethics approved institutional database. A breath-hold 3D MR simulation scan was performed using a true FISP sequence, followed by a breath-hold 3D CT scan. The gross tumor volume (GTV) was first contoured on the breath-hold CT scan, which was then compared with contours on the 3D MR scan, before the GTV was finalized. SABR plans used step-and-shoot IMRT beams to a PTV derived by adding a 5 mm margin to the breath-hold GTV, and a 3 mm gating window was used. SABR was delivered during repeated breath-holds, using automatic beam gating with continuous visualization of the GTV in a sagittal MR plane. RESULTS Between 2018-2022, 50 consecutive patients were treated, and 69% had a primary non-small cell lung cancer. Median PTV was 11.2 cc (range 3.9-53.5); 80% of GTV's were located ≤2.5 cm from the chest wall. Prescribed doses were 34 Gy (in 58%), 30 Gy (32%), or between 20-28 Gy (10%). After a median follow-up of 18.1 months (95% CI 12.8-23.5), the 2-year survival was 82% (89% for primary NSCLC and 62% for metastases). After a median follow-up of 16.1 months (95% CI 11.2-21.1), local recurrences developed in 2 patients (4%). The 3-year local control rate was 97%, and just 1 patient developed grade ≥3 toxicity (chest wall pain). CONCLUSION MR-guided SF-SABR delivery to lung tumors on a 0.35 T linac, using repeated breath-holds with automatic beam gating, achieves good tumor control and low toxicity.
Collapse
Affiliation(s)
- Hilâl Tekatli
- Amsterdam UMC, location VUmc, Department of Radiation Oncology, Amsterdam, the Netherlands.
| | - Miguel A Palacios
- Amsterdam UMC, location VUmc, Department of Radiation Oncology, Amsterdam, the Netherlands
| | - Famke L Schneiders
- Amsterdam UMC, location VUmc, Department of Radiation Oncology, Amsterdam, the Netherlands
| | - Cornelis J A Haasbeek
- Amsterdam UMC, location VUmc, Department of Radiation Oncology, Amsterdam, the Netherlands
| | - Ben J Slotman
- Amsterdam UMC, location VUmc, Department of Radiation Oncology, Amsterdam, the Netherlands
| | - Frank J Lagerwaard
- Amsterdam UMC, location VUmc, Department of Radiation Oncology, Amsterdam, the Netherlands
| | - Suresh Senan
- Amsterdam UMC, location VUmc, Department of Radiation Oncology, Amsterdam, the Netherlands
| |
Collapse
|
10
|
Giraud N, Schneiders FL, van Sornsen de Koste JR, Palacios MA, Senan S. Tumor volume changes during stereotactic ablative radiotherapy for adrenal gland metastases under MRI guidance. Radiother Oncol 2023; 186:109749. [PMID: 37330058 DOI: 10.1016/j.radonc.2023.109749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE Gross tumor volume (GTV) changes during stereotactic ablative radiotherapy (SABR) for adrenal tumors are not well characterized. We studied treatment-induced GTV changes during, and after, 5-fraction MR-guided SABR on a 0.35 T unit. METHODS AND MATERIALS Details of patients treated for adrenal metastases using 5-fraction adaptive MR-SABR were accessed. GTV changes between simulation and first fraction (ΔSF1) and all fractions were recorded. Wilcoxon paired tests were used for intrapatient comparisons. Logistic and linear regression models were used for features associated with dichotomous and continuous variables, respectively. RESULTS Once-daily fractions of 8 Gy or 10 Gy were delivered to 70 adrenal metastases. Median simulation-F1 interval was 13 days; F1-F5 interval was 13 days. Median baseline GTVs at simulation and F1 were 26.6 and 27.2 cc, respectively (p < 0.001). Mean ΔSF1 was + 9.1% (2.9 cc) relative to simulation; 47% of GTVs decreased in volume at F5 versus F1. GTV variations of ≥ 20% occurred in 59% treatments at some point between simulation to end SABR, and these did not correlate with baseline tumor characteristics. At a median follow-up of 20.3 months, a radiological complete response (CR) was seen in 23% of 64 evaluable patients. CR was associated with baseline GTV (p = 0.03) and ΔF1F5 (p = 0.03). Local relapses were seen in 6%. CONCLUSION Frequent changes in adrenal GTVs during 5-fraction SABR delivery support the use of on-couch adaptive replanning. The likelihood of a radiological CR correlates with the baseline GTV and intra-treatment GTV decline.
Collapse
Affiliation(s)
- Nicolas Giraud
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Radiation Oncology, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands.
| | - Famke L Schneiders
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Radiation Oncology, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - John R van Sornsen de Koste
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Radiation Oncology, Boelelaan 1117, Amsterdam, the Netherlands
| | - Miguel A Palacios
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Radiation Oncology, Boelelaan 1117, Amsterdam, the Netherlands
| | - Suresh Senan
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Radiation Oncology, Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
11
|
Palacios MA, Verheijen S, Schneiders FL, Bohoudi O, Slotman BJ, Lagerwaard FJ, Senan S. Same-day consultation, simulation and lung Stereotactic Ablative Radiotherapy delivery on a Magnetic Resonance-linac. Phys Imaging Radiat Oncol 2022; 24:76-81. [PMID: 36217429 PMCID: PMC9547277 DOI: 10.1016/j.phro.2022.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/09/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/09/2022] Open
Abstract
A same-day consultation and lung SABR workflow was introduced, and experience in 10 patients reported. A detailed simulation procedure and the use of real-time cine magnetic resonance imaging enabled accurate treatment delivery. All patients reported satisfaction with the procedure, which improved patient convenience. On average, at least 94.4% (5th percentile) of the GTV was always located inside the PTV during beam-on. System-latency for triggering a beam-off event comprised 5.3% of the delivery time.
Background and Purpose Magnetic resonance-guided radiotherapy (MRgRT) with real-time intra-fraction tumor motion monitoring allows for high precision Stereotactic Ablative Radiotherapy (SABR). This study aimed to investigate the clinical feasibility, patient satisfaction and delivery accuracy of single-fraction MR-guided SABR in a single day (one-stop-shop, OSS). Methods and Materials Ten patients with small lung tumors eligible for single fraction treatments were included. The OSS procedure consisted of consultation, treatment simulation, treatment planning and delivery. Following SABR delivery, patients completed a reported experience measure (PREM) questionnaire. Prescribed doses ranged 28–34 Gy. Median GTV was 2.2 cm3 (range 1.3–22.9 cm3). A gating boundary of 3 mm, and PTV margin of 5 mm around the GTV, were used with auto-beam delivery control. Accuracy of SABR delivery was studied by analyzing delivered MR-cines reconstructed from machine log files. Results All 10 patients completed the OSS procedure in a single day, and all reported satisfaction with the process. Median time for the treatment planning step and the whole procedure were 2.8 h and 6.6 h, respectively. With optimization of the procedure, treatment could be completed in half a day. During beam-on, the 3 mm tracking boundary encompassed between 78.0 and 100 % of the GTV across all patients, with corresponding PTV values being 94.4–100 % (5th-95th percentiles). On average, system-latency for triggering a beam-off event comprised 5.3 % of the delivery time. Latency reduced GTV coverage by an average of −0.3 %. Duty-cycles during treatment delivery ranged from 26.1 to 64.7 %. Conclusions An OSS procedure with MR-guided SABR for lung cancer led to good patient satisfaction. Gated treatment delivery was highly accurate with little impact of system-latency.
Collapse
|
12
|
Sanborn RE, Schneiders FL, Senan S, Gadgeel SM. Beyond Checkpoint Inhibitors: Enhancing Antitumor Immune Response in Lung Cancer. Am Soc Clin Oncol Educ Book 2022; 42:1-14. [PMID: 35671433 DOI: 10.1200/edbk_350967] [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]
Abstract
The introduction of immune checkpoint inhibitors has dramatically changed the treatment landscape and improved survival for many patients with thoracic malignancies. Although some patients may experience prolonged survival benefit with immune checkpoint inhibitors, a majority do not experience disease control or benefit, supporting the need for research and development of improved approaches for facilitating immune recognition. Additionally, many patients will experience toxicity with the current approaches to immunotherapy, supporting the need for developing treatment strategies with less risk of adverse events. An extensive array of different strategies are currently under investigation, including novel combinations of checkpoint inhibitors or immunotherapies; novel agents beyond checkpoint inhibitors (e.g., bispecific antibodies, vaccine strategies, cytokine therapies); and different approaches for use of radiation to augment systemic immunotherapy agents. With each strategy, researchers are evaluating the potential for augmenting antitumor responses and ensuring more sustained antitumor effects. This article highlights areas of active research, reviewing the rationale for different investigative strategies, as well as currently available clinical data.
Collapse
Affiliation(s)
- Rachel E Sanborn
- Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR
| | | | - Suresh Senan
- Amsterdam University Medical Centers, Amsterdam, Netherlands
| | | |
Collapse
|
13
|
van Sörnsen de Koste JR, van Vliet CC, Schneiders FL, Bruynzeel AME, Slotman BJ, Palacios MA, Senan S. Renal atrophy following gated delivery of stereotactic ablative radiotherapy to adrenal metastases. Phys Imaging Radiat Oncol 2021; 20:1-4. [PMID: 34604552 PMCID: PMC8473532 DOI: 10.1016/j.phro.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/22/2022]
Abstract
Stereotactic ablative radiotherapy (SABR) planning for adrenal metastases aims to minimize doses to the adjacent kidney. Renal dose constraints for SABR delivery are not well defined. In 20 patients who underwent MR-guided breath-hold SABR in five daily fractions of 8–10 Gy, ipsilateral renal volumes receiving ≥20 Gy best correlated with loss of renal volumes, with median renal volume reduction being 6% (range: 3%-11%, 10th-90th percentiles). Organ function did not deteriorate in 18 patients, who had post treatment renal function tests available. This suggests that the ipsilateral renal volume receiving 20 Gy can be used as partial organ dose constraint for SABR to targets in the upper abdomen.
Collapse
Affiliation(s)
- John R van Sörnsen de Koste
- Department of Radiation Oncology, Amsterdam University Medical Centers, location VUmc, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Claire C van Vliet
- Department of Radiation Oncology, Amsterdam University Medical Centers, location VUmc, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Famke L Schneiders
- Department of Radiation Oncology, Amsterdam University Medical Centers, location VUmc, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Anna M E Bruynzeel
- Department of Radiation Oncology, Amsterdam University Medical Centers, location VUmc, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Berend J Slotman
- Department of Radiation Oncology, Amsterdam University Medical Centers, location VUmc, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Miguel A Palacios
- Department of Radiation Oncology, Amsterdam University Medical Centers, location VUmc, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, location VUmc, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| |
Collapse
|
14
|
Ulas EB, Dickhoff C, Schneiders FL, Senan S, Bahce I. Neoadjuvant immune checkpoint inhibitors in resectable non-small-cell lung cancer: a systematic review. ESMO Open 2021; 6:100244. [PMID: 34479033 PMCID: PMC8414043 DOI: 10.1016/j.esmoop.2021.100244] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 12/25/2022] Open
Abstract
Background The neoadjuvant use of immune checkpoint inhibitors (ICIs) in resectable non-small-cell lung cancer (NSCLC) is currently an area of active ongoing research. The place of neoadjuvant ICIs in the treatment guidelines needs to be determined. We carried out a systematic review of published data on neoadjuvant ICIs in resectable NSCLC to study its efficacy and safety. Patients and methods A literature search was carried out using the MEDLINE (PubMed) and Embase databases to retrieve articles and conference abstracts of clinical trials measuring the efficacy [major pathological response (MPR) and pathological complete response (pCR)] and safety (failure to undergo resection, surgical delay, treatment-related adverse events (trAEs) grade ≥3) of neoadjuvant immunotherapy in resectable NSCLC until July 2021. Results Nineteen studies with a total of 1066 patients were included in this systematic review. Neoadjuvant immunotherapy was associated with improved pathological response rates, especially in combination with chemotherapy. Using mono ICI, dual therapy–ICI, chemoradiation–ICI, radiotherapy–ICI, and chemo–ICI, the MPR rates were 0%-45%, 50%, 73%, 53%, and 27%-86%, respectively. Regarding pCR, the rates were 7%-16%, 33%-38%, 27%, 27%, and 9%-63%, respectively. Safety endpoints using monotherapy–ICI, dual therapy–ICI, chemoradiation–ICI, radiotherapy–ICI, and chemo–ICI showed a failure to undergo resection in 0%-17%, 19%-33%, 8%, 13%, and 0%-46%, respectively. The trAEs grade ≥3 rates were 0%-20%, 10%-33%, 7%, 23%, and 0%-67%, respectively. Conclusion In patients with resectable NSCLC stage, neoadjuvant immunotherapy can improve pathological response rates with acceptable toxicity. Further research is needed to identify patients who may benefit most from this approach, and adequately powered trials to establish clinically meaningful benefits are awaited. Neoadjuvant strategies involving immunotherapy are currently being investigated in NSCLC. Neoadjuvant immunotherapy was associated with improvement in pathological response rates. Neoadjuvant immunotherapy can be safe and feasible with acceptable surgical delay and trAEs. Further research is needed to identify patients benefiting most from these approaches.
Collapse
Affiliation(s)
- E B Ulas
- Department of Pulmonology, Amsterdam University Medical Center, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, the Netherlands.
| | - C Dickhoff
- Department of Surgery and Cardiothoracic Surgery, Amsterdam University Medical Center, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - F L Schneiders
- Department of Radiation Oncology, Amsterdam University Medical Center, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - S Senan
- Department of Radiation Oncology, Amsterdam University Medical Center, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - I Bahce
- Department of Pulmonology, Amsterdam University Medical Center, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
15
|
Affiliation(s)
- Famke L Schneiders
- Department of Radiation Oncology, Amsterdam University Medical Centers, location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, Netherlands.
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
16
|
Chen H, Schneiders FL, Bruynzeel AME, Lagerwaard FJ, van Sörnsen de Koste JR, Cobussen P, Bohoudi O, Slotman BJ, Louie AV, Senan S. Impact of daily plan adaptation on organ-at-risk normal tissue complication probability for adrenal lesions undergoing stereotactic ablative radiation therapy. Radiother Oncol 2021; 163:14-20. [PMID: 34343546 DOI: 10.1016/j.radonc.2021.07.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/12/2021] [Accepted: 07/25/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Stereotactic ablative radiotherapy (SABR) can achieve good local control for metastatic adrenal lesions. Magnetic resonance (MR)-guidance with daily on-table plan adaptation can augment the delivery of SABR with greater dose certainty. The goal of this study was to quantify the potential clinical benefit MR-guided daily-adaptive adrenal SABR using the normal tissue complication probability (NTCP) framework. METHODS Patients treated with adrenal MR-guided SABR at a single institution were retrospectively reviewed. Lyman-Kutcher-Burman NTCP models were used to calculate the NTCP of upper abdominal organs-at-risk (OARs) at simulation and both before and after daily on-table plan adaptation. Differences in OAR NTCPs were assessed using signed-rank tests. Potential predictors of the benefits of adaptation were assessed by linear regression. RESULTS Fifty-two adrenal MR-guided SABR courses were analyzed. The baseline simulation plan underestimated the absolute stomach NTCP by 10.0% on average (95% confidence interval: 4.7-15.2%, p < 0.001). Daily on-table adaptation lowered absolute NTCP by 8.7% (4.2-13.2%, p < 0.001). The most significant predictor of the benefits of adaptation was lesion laterality (p = 0.018), with left-sided lesions benefitting more (13.3% [6.3-20.4%], p < 0.001) than right-sided lesions (2.1% [-1.6-5.7%], p = 0.25). Sensitivity analyses did not change the statistical significance of the findings. CONCLUSION NTCP analysis revealed that patients with left adrenal tumors were more likely to benefit from MR-guided daily on-table adaptive SABR using current dose/fractionation regimens due to reductions in predicted gastric toxicity. Right-sided adrenal lesions may be considered for dose escalation due to low predicted NTCP.
Collapse
Affiliation(s)
- Hanbo Chen
- Department of Radiation Oncology, Amsterdam University Medical Centers - Location VUmc, Amsterdam, The Netherlands.
| | - Famke L Schneiders
- Department of Radiation Oncology, Amsterdam University Medical Centers - Location VUmc, Amsterdam, The Netherlands
| | - Anna M E Bruynzeel
- Department of Radiation Oncology, Amsterdam University Medical Centers - Location VUmc, Amsterdam, The Netherlands
| | - Frank J Lagerwaard
- Department of Radiation Oncology, Amsterdam University Medical Centers - Location VUmc, Amsterdam, The Netherlands
| | - John R van Sörnsen de Koste
- Department of Radiation Oncology, Amsterdam University Medical Centers - Location VUmc, Amsterdam, The Netherlands
| | - Paul Cobussen
- Department of Radiation Oncology, Amsterdam University Medical Centers - Location VUmc, Amsterdam, The Netherlands
| | - Omar Bohoudi
- Department of Radiation Oncology, Amsterdam University Medical Centers - Location VUmc, Amsterdam, The Netherlands
| | - Berend J Slotman
- Department of Radiation Oncology, Amsterdam University Medical Centers - Location VUmc, Amsterdam, The Netherlands
| | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, Toronto, Canada
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers - Location VUmc, Amsterdam, The Netherlands
| |
Collapse
|
17
|
Finazzi T, Schneiders FL, Senan S. Developments in radiation techniques for thoracic malignancies. Eur Respir Rev 2021; 30:30/160/200224. [PMID: 33952599 DOI: 10.1183/16000617.0224-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/27/2020] [Indexed: 12/25/2022] Open
Abstract
Radiation therapy is a cornerstone of modern lung cancer treatment alongside surgery, chemotherapy, immunotherapy and targeted therapies. Advances in radiotherapy techniques have enhanced the accuracy of radiation delivery, which has contributed to the evolution of radiation therapy into a guideline-recommended treatment in both early-stage and locally advanced nonsmall cell lung cancer. Furthermore, although radiotherapy has long been used for palliation of disease in advanced lung cancer, it is increasingly having a role as a locally ablative treatment in patients with oligometastatic disease.This review provides an overview of recent developments in radiation techniques, particularly for non-radiation oncologists who are involved in the care of lung cancer patients. Technical advances are discussed, and findings of recent clinical trials are highlighted, all of which have led to a changing perception of the role of radiation therapy in multidisciplinary care.
Collapse
Affiliation(s)
- Tobias Finazzi
- Clinic of Radiotherapy and Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - Famke L Schneiders
- Dept of Radiation Oncology, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
| | - Suresh Senan
- Dept of Radiation Oncology, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
| |
Collapse
|
18
|
Dickhoff C, Senan S, Schneiders FL, Veltman J, Hashemi S, Daniels JMA, Fransen M, Heineman DJ, Radonic T, van de Ven PM, Bartelink IH, Meijboom LJ, Garcia-Vallejo JJ, Oprea-Lager DE, de Gruijl TD, Bahce I. Ipilimumab plus nivolumab and chemoradiotherapy followed by surgery in patients with resectable and borderline resectable T3-4N0-1 non-small cell lung cancer: the INCREASE trial. BMC Cancer 2020; 20:764. [PMID: 32795284 PMCID: PMC7427738 DOI: 10.1186/s12885-020-07263-9] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/05/2020] [Indexed: 12/22/2022] Open
Abstract
Background The likelihood of a tumor recurrence in patients with T3-4N0–1 non-small cell lung cancer following multimodality treatment remains substantial, mainly due distant metastases. As pathological complete responses (pCR) in resected specimens are seen in only a minority (28–38%) of patients following chemoradiotherapy, we designed the INCREASE trial (EudraCT-Number: 2019–003454-83; Netherlands Trial Register number: NL8435) to assess if pCR rates could be further improved by adding short course immunotherapy to induction chemoradiotherapy. Translational studies will correlate changes in loco-regional and systemic immune status with patterns of recurrence. Methods/design This single-arm, prospective phase II trial will enroll 29 patients with either resectable, or borderline resectable, T3-4N0–1 NSCLC. The protocol was approved by the institutional ethics committee. Study enrollment commenced in February 2020. On day 1 of guideline-recommended concurrent chemoradiotherapy (CRT), ipilimumab (IPI, 1 mg/kg IV) and nivolumab (NIVO, 360 mg flat dose IV) will be administered, followed by nivolumab (360 mg flat dose IV) after 3 weeks. Radiotherapy consists of once-daily doses of 2 Gy to a total of 50 Gy, and chemotherapy will consist of a platinum-doublet. An anatomical pulmonary resection is planned 6 weeks after the last day of radiotherapy. The primary study objective is to establish the safety of adding IPI/NIVO to pre-operative CRT, and its impact on pathological tumor response. Secondary objectives are to assess the impact of adding IPI/NIVO to CRT on disease free and overall survival. Exploratory objectives are to characterize tumor inflammation and the immune contexture in the tumor and tumor-draining lymph nodes (TDLN), and to explore the effects of IPI/NIVO and CRT and surgery on distribution and phenotype of peripheral blood immune subsets. Discussion The INCREASE trial will evaluate the safety and local efficacy of a combination of 4 modalities in patients with resectable, T3-4N0–1 NSCLC. Translational research will investigate the mechanisms of action and drug related adverse events. Trial registration Netherlands Trial Registration (NTR): NL8435, Registered 03 March 2020.
Collapse
Affiliation(s)
- Chris Dickhoff
- Department of Surgery and Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands.
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Famke L Schneiders
- Department of Radiation Oncology, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Joris Veltman
- Department of Pulmonary Diseases, Amsterdam University Medical Center, location VUmcCancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Sayed Hashemi
- Department of Pulmonary Diseases, Amsterdam University Medical Center, location VUmcCancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, Amsterdam University Medical Center, location VUmcCancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Marieke Fransen
- Department of Pulmonary Diseases, Amsterdam University Medical Center, location VUmcCancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - David J Heineman
- Department of Surgery and Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Imke H Bartelink
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Lilian J Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Juan J Garcia-Vallejo
- Department of Molecular Cell Biology & Immunology, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Daniela E Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Tanja D de Gruijl
- Department of Medical Oncology, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Idris Bahce
- Department of Pulmonary Diseases, Amsterdam University Medical Center, location VUmcCancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| |
Collapse
|
19
|
Schneiders FL, Huijts CM, Reijm M, Bontkes HJ, Verheul HM, de Gruijl TD, van der Vliet HJ. The effects of systemic treatment with aminobisphosphonates and statins on circulating Vγ9Vδ2-T cells in patients with advanced cancer. Immunobiology 2018; 223:171-177. [DOI: 10.1016/j.imbio.2017.10.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
|
20
|
de Bruin RCG, Veluchamy JP, Lougheed SM, Schneiders FL, Lopez-Lastra S, Lameris R, Stam AG, Sebestyen Z, Kuball J, Molthoff CFM, Hooijberg E, Roovers RC, Santo JPD, van Bergen En Henegouwen PMP, Verheul HMW, de Gruijl TD, van der Vliet HJ. A bispecific nanobody approach to leverage the potent and widely applicable tumor cytolytic capacity of Vγ9Vδ2-T cells. Oncoimmunology 2017; 7:e1375641. [PMID: 29296532 DOI: 10.1080/2162402x.2017.1375641] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [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: 05/03/2017] [Revised: 08/11/2017] [Accepted: 08/31/2017] [Indexed: 12/23/2022] Open
Abstract
Though Vγ9Vδ2-T cells constitute only a small fraction of the total T cell population in human peripheral blood, they play a vital role in tumor defense and are therefore of major interest to explore for cancer immunotherapy. Vγ9Vδ2-T cell-based cancer immunotherapeutic approaches developed so far have been generally well tolerated and were able to induce significant clinical responses. However, overall results were inconsistent, possibly due to the fact that these strategies induced systemic activation of Vγ9Vδ2-T cells without preferential accumulation and targeted activation in the tumor. Here we show that a novel bispecific nanobody-based construct targeting both Vγ9Vδ2-T cells and EGFR induced potent Vγ9Vδ2-T cell activation and subsequent tumor cell lysis both in vitro and in an in vivo mouse xenograft model. Tumor cell lysis was independent of KRAS and BRAF tumor mutation status and common Vγ9Vδ2-T cell receptor sequence variations. In combination with the conserved monomorphic nature of the Vγ9Vδ2-TCR and the facile replacement of the tumor-specific nanobody, this immunotherapeutic approach can be applied to a large group of cancer patients.
Collapse
Affiliation(s)
- Renée C G de Bruin
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - John P Veluchamy
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Sinéad M Lougheed
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Famke L Schneiders
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Silvia Lopez-Lastra
- Innate Immunity Unit, Institut Pasteur, Paris, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U1223, Paris, France.,Université Paris-Sud, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Roeland Lameris
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Anita G Stam
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Zsolt Sebestyen
- Department of Hematology and Laboratory of Translational Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jürgen Kuball
- Department of Hematology and Laboratory of Translational Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Carla F M Molthoff
- Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Erik Hooijberg
- Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Rob C Roovers
- Department of Cell Biology, Faculty of Science, Utrecht University, Padualaan 8, 3584 CH, Utrecht, The Netherlands
| | - James P Di Santo
- Innate Immunity Unit, Institut Pasteur, Paris, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U1223, Paris, France
| | | | - Henk M W Verheul
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Tanja D de Gruijl
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Hans J van der Vliet
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| |
Collapse
|
21
|
Huijts CM, Schneiders FL, Garcia-Vallejo JJ, Verheul HM, de Gruijl TD, van der Vliet HJ. mTOR Inhibition Per Se Induces Nuclear Localization of FOXP3 and Conversion of Invariant NKT (iNKT) Cells into Immunosuppressive Regulatory iNKT Cells. J Immunol 2015; 195:2038-45. [PMID: 26238486 DOI: 10.4049/jimmunol.1402710] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 07/04/2015] [Indexed: 12/17/2022]
Abstract
CD1d-restricted activation of invariant NKT (iNKT) cells results in the abundant production of various types of cytokines and the subsequent modulation of immune responses. This has been shown to be relevant in several clinical disorders, including cancer, autoimmunity, and graft tolerance. Although it is well known that the suppressive function of regulatory T cells is critically dependent on the FOXP3 gene, FOXP3 can also be expressed by conventional human T cells upon activation, indicating the lack of specificity of FOXP3 as a marker for suppressive cells. In this study, we report that the mammalian target of rapamycin (mTOR) inhibitor rapamycin and IL-10, but not TGF-β, can induce FOXP3 expression in iNKT cell lines. Importantly, however, FOXP3(+) iNKT cells only acquired suppressive abilities when cultured in the presence of the mTOR inhibitor rapamycin. Suppression of responder T cell proliferation by FOXP3(+) iNKT cells was found to be cell contact-dependent and was accompanied by a reduced capacity of iNKT cells to secrete IFN-γ. Notably, imaging flow cytometry analysis demonstrated predominant nuclear localization of FOXP3 in suppressive FOXP3(+) iNKT cells, whereas nonsuppressive FOXP3(+) iNKT cells showed a predominance of cytoplasmically localized FOXP3. In conclusion, whereas IL-10 can enhance FOXP3 expression in iNKT cells, mTOR inhibition is solely required for promoting nuclear localization of FOXP3 and the induction of suppressive FOXP3(+) iNKT cells.
Collapse
Affiliation(s)
- Charlotte M Huijts
- Department of Medical Oncology, VU University Medical Center, 1081 HV Amsterdam, the Netherlands; and
| | - Famke L Schneiders
- Department of Medical Oncology, VU University Medical Center, 1081 HV Amsterdam, the Netherlands; and
| | - Juan J Garcia-Vallejo
- Department of Molecular Cell Biology and Immunology, VU University Medical Center, 1081 HV Amsterdam, the Netherlands
| | - Henk M Verheul
- Department of Medical Oncology, VU University Medical Center, 1081 HV Amsterdam, the Netherlands; and
| | - Tanja D de Gruijl
- Department of Medical Oncology, VU University Medical Center, 1081 HV Amsterdam, the Netherlands; and
| | - Hans J van der Vliet
- Department of Medical Oncology, VU University Medical Center, 1081 HV Amsterdam, the Netherlands; and
| |
Collapse
|
22
|
Werter IM, Schneiders FL, Scotet E, Verheul HMW, de Gruijl TD, van der Vliet HJ. Vγ9Vδ2-T cells as antigen presenting cells for iNKT cell based cancer immunotherapy. Oncoimmunology 2015; 3:e955343. [PMID: 25941612 DOI: 10.4161/21624011.2014.955343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 07/23/2014] [Accepted: 07/28/2014] [Indexed: 11/19/2022] Open
Abstract
CD1d-restricted invariant natural killer T cells (iNKT) constitute an important immunoregulatory T-cell subset involved in the induction of antitumor immune responses. Here, we provide a view on the recent observation that Vγ9Vδ2-T cells, through trogocytosis of CD1d-containing membrane fragments, have the capacity to act as antigen presenting cells for iNKT.
Collapse
Key Words
- APC
- APC, antigen presenting cells
- Ag, antigens
- BTN, butyrophilin
- BrHPP, bromohydrin pyrophosphate
- CD, Cluster of differentiation
- CD1d
- DN, double negative
- GM-CSF, granulocyte-macrophage colony-stimulating factor
- IFNγ, interferon γ
- IL, interleukine
- IPP, isopentenyl pyrophosphate
- MHC, major histocompatibility complex
- NK, natural killer cells
- PBMC, peripheral blood mononuclear cells
- TNFα, tumor necrosis factor α
- Th1, Type 1 T helper
- Th2, Type 2 T helper
- Vγ9Vδ2-T cells
- i.v., intravenous
- iNKT
- iNKT, invariant natural killer T cells
- moDC, monocyte derived dendritic cells
- pAg, phosphoantigens
- trogocytosis
- α-GalCer, α-galactosylceramide
Collapse
Affiliation(s)
- Inge M Werter
- Department of Medical Oncology; VU University Medical Center ; Amsterdam, The Netherlands
| | - Famke L Schneiders
- Department of Medical Oncology; VU University Medical Center ; Amsterdam, The Netherlands
| | - Emmanuel Scotet
- Institut National de la Santé et de la Recherche Médicale; UMR892; Center de Recherche en Cancérologie Nantes-Angers ; Nantes Cedex, France
| | - Henk M W Verheul
- Department of Medical Oncology; VU University Medical Center ; Amsterdam, The Netherlands
| | - Tanja D de Gruijl
- Department of Medical Oncology; VU University Medical Center ; Amsterdam, The Netherlands
| | - Hans J van der Vliet
- Department of Medical Oncology; VU University Medical Center ; Amsterdam, The Netherlands
| |
Collapse
|
23
|
Schneiders FL, Huijts CM, Mantici A, Menks MAC, Scotet E, Veerhuis R, Verheul HMW, de Gruijl TD, van der Vliet HJ. Aminobisphosphonates inhibit dendritic cell-mediated antigen-specific activation of CD1d-restricted iNKT cells. Clin Immunol 2015; 158:92-9. [PMID: 25796193 DOI: 10.1016/j.clim.2015.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 09/15/2014] [Revised: 03/08/2015] [Accepted: 03/10/2015] [Indexed: 11/16/2022]
Abstract
CD1d-restricted invariant natural killer T (iNKT) cells constitute an important immunoregulatory T cell subset that can be activated by the synthetic glycolipid α-galactosylceramide (α-GalCer) and initiate antitumor immune responses. As cancer patients are frequently treated with aminobisphosphonates (NBP), it is relevant to determine possible effects of NBP on CD1d-restricted glycolipid Ag-presentation to iNKT cells. We report a striking reduction of α-GalCer-induced iNKT cell activation by monocyte derived dendritic cells (moDC) upon their exposure to NBP during maturation. We found that production of apolipoprotein E (apoE), which is a known facilitator of trans-membrane transport of exogenously derived glycolipids, was significantly diminished in moDC exposed to NBP. As the inhibitory effect of NBP on iNKT cell activation was alleviated by exogenous apoE, our data indicate that reduced apoE production by antigen presenting cells (APC) through NBP limits glycolipid-induced iNKT cell activation. This should be taken into account in the design of iNKT cell-based anti-cancer therapies.
Collapse
Affiliation(s)
- Famke L Schneiders
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Charlotte M Huijts
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Aslihan Mantici
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Mica A C Menks
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Emmanuel Scotet
- Institut National de la Santé et de la Recherche Médicale, UMR892, Centre de Recherche en Cancérologie Nantes-Angers, Nantes, France
| | - Rob Veerhuis
- Department of Clinical Chemistry, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Henk M W Verheul
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Tanja D de Gruijl
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Hans J van der Vliet
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| |
Collapse
|
24
|
Sluijter BJR, van den Hout MFCM, Koster BD, van Leeuwen PAM, Schneiders FL, van de Ven R, Molenkamp BG, Vosslamber S, Verweij CL, van den Tol MP, van den Eertwegh AJM, Scheper RJ, de Gruijl TD. Arming the Melanoma Sentinel Lymph Node through Local Administration of CpG-B and GM-CSF: Recruitment and Activation of BDCA3/CD141(+) Dendritic Cells and Enhanced Cross-Presentation. Cancer Immunol Res 2015; 3:495-505. [PMID: 25633713 DOI: 10.1158/2326-6066.cir-14-0165] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 01/22/2015] [Indexed: 11/16/2022]
Abstract
Melanoma-induced suppression of dendritic cells (DC) in the sentinel lymph node (SLN) interferes with the generation of protective antitumor immunity. In an effort to strengthen immune defense against metastatic spread, we performed a three-arm phase II study comprising 28 patients with stage I-II melanoma randomized to receive intradermal injections around the primary tumor excision site of saline or low-dose CpG-B, alone or combined with GM-CSF, before excision of the SLNs. After pathologic examination, 5 patients were diagnosed with stage III melanoma based on the presence of tumor cells in the SLNs. Combined CpG/GM-CSF administration resulted in enhanced maturation of all identifiable conventional (cDC) and plasmacytoid (pDC) DC subsets and selectively induced increased frequencies of SLN-resident BDCA3/CD141(+) cDC subsets that also expressed the C-type lectin receptor CLEC9A. Correlative in vivo analyses and in vitro studies provided evidence that these subsets were derived from BDCA3(+) cDC precursors in the blood that were recruited to the SLNs in a type I IFN-dependent manner and subsequently matured under the combined influence of CpG and GM-CSF. In line with their reported functional abilities, frequencies of in vivo CpG/GM-CSF-induced BDCA3/CD141(+) DCs correlated with increased ex vivo cross-presenting capacity of SLN suspensions. Combined local CpG/GM-CSF delivery thus supports protective antimelanoma immunity through concerted activation of pDC and cDC subsets and recruitment of BDCA3(+) cDC subsets with T cell-stimulatory and cross-priming abilities.
Collapse
Affiliation(s)
- Berbel J R Sluijter
- Department of Surgical Oncology, VU University Medical Center, Amsterdam, the Netherlands
| | | | - Bas D Koster
- Department of Medical Oncology, VU University Medical Center, Amsterdam, the Netherlands
| | - Paul A M van Leeuwen
- Department of Surgical Oncology, VU University Medical Center, Amsterdam, the Netherlands
| | - Famke L Schneiders
- Department of Medical Oncology, VU University Medical Center, Amsterdam, the Netherlands
| | - Rieneke van de Ven
- Department of Medical Oncology, VU University Medical Center, Amsterdam, the Netherlands
| | - Barbara G Molenkamp
- Department of Surgical Oncology, VU University Medical Center, Amsterdam, the Netherlands
| | - Saskia Vosslamber
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Cornelis L Verweij
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | | | | | - Rik J Scheper
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Tanja D de Gruijl
- Department of Medical Oncology, VU University Medical Center, Amsterdam, the Netherlands.
| |
Collapse
|
25
|
Lameris R, de Bruin RC, Schneiders FL, van Bergen en Henegouwen PM, Verheul HM, de Gruijl TD, van der Vliet HJ. Bispecific antibody platforms for cancer immunotherapy. Crit Rev Oncol Hematol 2014; 92:153-65. [DOI: 10.1016/j.critrevonc.2014.08.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 06/11/2014] [Accepted: 08/08/2014] [Indexed: 01/10/2023] Open
|
26
|
Schneiders FL, Prodöhl J, Ruben JM, O'Toole T, Scheper RJ, Bonneville M, Scotet E, Verheul HMW, de Gruijl TD, van der Vliet HJ. CD1d-restricted antigen presentation by Vγ9Vδ2-T cells requires trogocytosis. Cancer Immunol Res 2014; 2:732-40. [PMID: 24934445 DOI: 10.1158/2326-6066.cir-13-0167] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CD1d-restricted invariant natural killer T cells (iNKT) constitute an important immunoregulatory T-cell subset that can be activated by the synthetic glycolipid α-galactosylceramide (α-GalCer) and play a dominant role in antitumor immunity. Clinical trials with α-GalCer-pulsed monocyte-derived dendritic cells (moDC) have shown anecdotal antitumor activity in advanced cancer. It was reported that phosphoantigen (pAg)-activated Vγ9Vδ2-T cells can acquire characteristics of professional antigen-presenting cells (APC). Considering the clinical immunotherapeutic applications, Vγ9Vδ2-T APC can offer important advantages over moDC, potentially constituting an attractive novel APC platform. Here, we demonstrate that Vγ9Vδ2-T APC can present antigens to iNKT. However, this does not result from de novo synthesis of CD1d by Vγ9Vδ2-T, but critically depends on trogocytosis of CD1d-containing membrane fragments from pAg-expressing cells. CD1d-expressing Vγ9Vδ2-T cells were able to activate iNKT in a CD1d-restricted and α-GalCer-dependent fashion. Although α-GalCer-loaded moDC outperformed Vγ9Vδ2-T APC on a per cell basis, Vγ9Vδ2-T APC possess unique features with respect to clinical immunotherapeutic application that make them an interesting platform for consideration in future clinical trials.
Collapse
Affiliation(s)
| | | | | | | | - Rik J Scheper
- Pathology, VU University Medical Center, Amsterdam, the Netherlands; and
| | - Marc Bonneville
- Institut National de la Santé et de la Recherche Médicale, U892, Centre de Recherche en Cancérologie Nantes-Angers, Nantes, France
| | - Emmanuel Scotet
- Institut National de la Santé et de la Recherche Médicale, U892, Centre de Recherche en Cancérologie Nantes-Angers, Nantes, France
| | | | | | | |
Collapse
|
27
|
Abstract
Invariant natural killer T cells (iNKT) and dendritic cells (DC) play a central role in tumor immunity through downstream activation of immune effector cells by pro-inflammatory cytokines. Evidence is accumulating that the CD1d-iNKT cell axis can be effectively used to potentiate DC-based cancer vaccines. Here, we provide a detailed methodology for the generation of (CD1d-expressing) monocyte-derived DC (moDC) and their subsequent loading with the iNKT cell agonist α-galactosylceramide (α-GalCer) or their direct ligation by agonistic anti-CD1d monoclonal antibodies.
Collapse
Affiliation(s)
- Roeland Lameris
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | | | | | | |
Collapse
|
28
|
Huijts CM, Schneiders FL, Verheul HM, de Gruijl TD, van der Vliet HJ. Abstract 4720: mTOR inhibition is required for conversion of invariant NKT cells into immunosuppressive regulatory cells. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-4720] [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
Invariant Natural Killer T (iNKT) cells recognize glycolipid antigens presented by the CD1d antigen-presenting molecule. They have been shown to play an important role in various types of immune responses, including antitumor immune responses. Upon activation with α-galactosylceramide (α-GalCer) iNKT cells can produce different kinds of cytokines, like IFN-γ, resulting in activation of other T cell subsets. However, production of IL-2 by iNKT cells has been shown to contribute to the expansion of immunosuppressive regulatory T cells (Tregs). Although Tregs are critically dependent on the X-chromosome encoded FoxP3 gene, it is also known that FoxP3 is expressed in conventional T cells upon activation. Recently it was reported that freshly isolated iNKT cells can express FoxP3 upon stimulation with TGF-β and acquire suppressive capacities in the presence of rapamycin. In addition, IL-10 has been reported to stimulate iNKT cells resulting in CD25 upregulation and proliferation.
In order to assess whether it is possible to induce FoxP3 expression and suppressive capacities in iNKT cell lines, iNKT cell lines were cultured with IL-10, TGF-β and/ or rapamycin. Phenotypic analysis was performed and upregulation of FoxP3 was seen in all conditions cultured with IL-10 and rapamycin while, in contrast to a previous report, TGF-β was found to inhibit iNKT cell FoxP3 expression. To investigate whether these FoxP3+ iNKT cells acquired suppressive abilities, they were co-cultured with CFSE labeled responder cells. These assays showed that while IL10 resulted in a moderate increase in FoxP3 expressing iNKT cells, only iNKT cultured in the presence of rapamycin were able to suppress responder cells. Therefore, while IL-10 can enhance FoxP3 expression in proliferating iNKT cells, rapamycin is required and responsible for the induction of suppressive function of iNKT cells. As recent evidence indicates that FoxP3 is differentially localized in subcellular compartments in suppressive T cells versus activated T cells, we are currently performing FoxP3 localization experiments to identify different localization patterns in suppressive vs. non-suppressive FoxP3+ iNKT cells.
With these experiments we show that rapamycin is required for the induction of suppressive capacities in iNKT cells. Further studies are required to evaluate the clinical relevance of this modulating effect of mTOR inhibitors on iNKT cells in the field of transplantation medicine and anticancer therapies in renal cell carcinoma, breast cancer, and pancreatic neuroendocrine carcinomas.
Citation Format: Charlotte M. Huijts, Famke L. Schneiders, Henk M. Verheul, Tanja D. de Gruijl, Hans J. van der Vliet. mTOR inhibition is required for conversion of invariant NKT cells into immunosuppressive regulatory cells. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4720. doi:10.1158/1538-7445.AM2013-4720
Collapse
|
29
|
Schneiders FL, Santegoets SJ, Scheper RJ, Verheul HM, Bonneville M, Scotet E, de Gruijl TD, van der Vliet HJ. Abstract 3533: Acquisition of antigen presenting cell functions by Vγ9Vα2-T cells requires trogocytosis. Cancer Res 2012. [DOI: 10.1158/1538-7445.am2012-3533] [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
Invariant Natural Killer T (iNKT) cells are an important immunoregulatory T cell subset that is restricted by the CD1d Ag-presenting molecule. When activated by the glycolipid α-galactosylceramide (α-GalCer) iNKT produce large amounts of cytokines that play an important role in initiating and orchestrating antitumor immune responses. Early clinical trials with α-GalCer-pulsed monocyte derived dendritic cells (DC) have shown anecdotal antitumor activity in advanced cancer. It has been reported that phosphoantigen-responsive Vγ9Vα2-T cells could provide important advantages over DC with respect to clinical immunotherapeutic application, as Vγ9Vα2-T cells are more numerous compared to DC precursors, mature quickly (< 24 hr vs. 7-10 days for moDC) into professional APC, have better lymph node homing characteristics and a more uniform and consistent proinflammatory functional status. In order to assess whether Vγ9Vα2-T cells could be used as a novel Ag presenting platform for iNKT, we performed a phenotypic analysis of resting and phosphoAg-activated Vγ9Vα2-T cells and found that activation indeed resulted in an upregulation of Ag-presenting, co-stimulatory molecules and APC maturation markers. Importantly however, we found that the capacity of Vγ9Vα2-T to act as APC for iNKT cells did not result from de novo synthesis of relevant Ag presenting molecules by Vγ9Vα2-T cells, but was critically dependent on the presence of CD1d on phosphoantigen-expressing cells used for activation of Vγ9Vα2-T cells. Using lipophilic fluorochromes that are stably inserted into cellular membranes we could demonstrate a time-dependent and phosphoantigen-specific exchange of membrane patches between Vγ9Vα2-T cells and phosphoAg expressing cells with which the Vγ9Vα2-T cells interacted. This exchange of CD1d-containing membrane-fragments (termed trogocytosis) resulted in CD1d-expressing Vγ9Vα2-T cells that were subsequently able to activate iNKT cells in a CD1d-restricted and α-GalCer dependent fashion. We are currently performing fluorescent life-imaging techniques to provide direct evidence for trogocytosis. Furthermore, in preliminary experiments we have found that the acquisition of MHC-I restricted APC-functions by Vγ9Vα2-T cells also requires trogocytosis in order to stimulate CD8+ T cells. These findings provide evidence that apart from their known pro-inflammatory and cytolytic antitumor effector functions, Vγ9Vα2-T cells have a thus far unexplored important additional role within the tumor microenvironment by acting as APC propagating the presentation of tumor associated Ag to the immune system.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3533. doi:1538-7445.AM2012-3533
Collapse
Affiliation(s)
| | | | | | | | - Marc Bonneville
- 2Institut National de la Santé et de la Recherche Médicale, U892, Centre de Recherche en Cancérologie Nantes-Angers, Nantes, France
| | - Emmanuel Scotet
- 2Institut National de la Santé et de la Recherche Médicale, U892, Centre de Recherche en Cancérologie Nantes-Angers, Nantes, France
| | | | | |
Collapse
|
30
|
Schneiders FL, de Bruin RCG, van den Eertwegh AJM, Scheper RJ, Leemans CR, Brakenhoff RH, Langendijk JA, Verheul HMW, de Gruijl TD, Molling JW, van der Vliet HJ. Circulating invariant natural killer T-cell numbers predict outcome in head and neck squamous cell carcinoma: updated analysis with 10-year follow-up. J Clin Oncol 2012; 30:567-70. [PMID: 22253469 DOI: 10.1200/jco.2011.38.8819] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
31
|
de Bruin RCG, Schneiders FL, Santegoets SJAM, Verheul HMW, de Gruijl TD, van der Vliet HJ. Bulldozing β-linked glycolipids for recognition by invariant NKT cells. Immunotherapy 2012; 4:20. [PMID: 22263253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Affiliation(s)
- Renée C G de Bruin
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|
32
|
de Bruin RCG, Schneiders FL, Santegoets SJAM, Verheul HMW, de Gruijl TD, van der Vliet HJ. An α-galactosylceramide nose job shapes up iNKT cells. Immunotherapy 2012; 4:20-21. [PMID: 22263254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Affiliation(s)
- Renée C G de Bruin
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|
33
|
de Bruin RCG, Schneiders FL, Santegoets SJAM, Verheul HMW, de Gruijl TD, van der Vliet HJ. Gram-positive bacteria: a major microbial ‘turn-on’ for invariant NKT cells. Immunotherapy 2011; 4:19. [PMID: 22149997 DOI: 10.2217/imt.11.152] [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: 11/21/2022] Open
Affiliation(s)
- Renée C G de Bruin
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|
34
|
Schneiders FL, de Bruin RCG, Santegoets SJAM, Bonneville M, Scotet E, Scheper RJ, Verheul HMW, de Gruijl TD, van der Vliet HJ. Activated iNKT cells promote Vγ9Vδ2-T cell anti-tumor effector functions through the production of TNF-α. Clin Immunol 2011; 142:194-200. [PMID: 22122798 DOI: 10.1016/j.clim.2011.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 10/19/2011] [Accepted: 10/22/2011] [Indexed: 10/15/2022]
Abstract
Vγ9Vδ2-T cells constitute a proinflammatory lymphocyte subpopulation with established antitumor activity. Phosphoantigens activate Vγ9Vδ2-T cells in vivo and in vitro. We studied whether the antitumor activity of Vγ9Vδ2-T cells can be potentiated by invariant NKT cells (iNKT), an important immunoregulatory T cell subset. When activated by the glycolipid α-galactosylceramide (α-GalCer), iNKT produce large amounts of cytokines involved in antitumor immune responses. Monocyte-derived dendritic cells were loaded with both phosphoantigens (using aminobisphosphonates) and α-GalCer during maturation and subsequently co-cultured with Vγ9Vδ2-T and iNKT cells. Aminobisphosphonates dose-dependently enhanced Vγ9Vδ2-T cell activation, and this was potentiated by α-GalCer-induced iNKT co-activation. iNKT co-activation also enhanced the IFN-γ production and cytolytic potential of Vγ9Vδ2-T cells against tumor cells. Using transwell experiments and neutralizing antibodies cross-talk between iNKT and Vγ9Vδ2-T cells was found to be mediated by TNF-α. Our data provide a rationale for combining both activating ligands to improve Vγ9Vδ2-T cell based approaches in cancer-immunotherapy.
Collapse
Affiliation(s)
- Famke L Schneiders
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Schneiders FL, de Bruin R, Exley MA, van der Vliet HJ. Nuancing the proposed role of NKT cells in aging. Virulence 2011; 2:170; author reply 171. [PMID: 21304268 DOI: 10.4161/viru.2.2.15028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
36
|
Schneiders FL, Scheper RJ, von Blomberg BME, Woltman AM, Janssen HLA, van den Eertwegh AJM, Verheul HMW, de Gruijl TD, van der Vliet HJ. Clinical experience with α-galactosylceramide (KRN7000) in patients with advanced cancer and chronic hepatitis B/C infection. Clin Immunol 2010; 140:130-41. [PMID: 21169066 DOI: 10.1016/j.clim.2010.11.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 11/12/2010] [Accepted: 11/16/2010] [Indexed: 01/12/2023]
Abstract
For over a century, research has sought ways to boost the immune system in order to eradicate tumors and viruses that exist after escaping immunosurveillance. For the treatment of cancer and hepatitis immunotherapeutic strategies have overall had limited clinical success. An urgent need exists therefore to introduce more effective therapeutic approaches. Invariant (i)NKT cells constitute a conserved T lymphocyte lineage with dominant immunoregulatory, antitumor and antiviral effector cell properties. iNKT specifically recognize the glycolipid α-galactosylceramide in the context of CD1d resulting in their activation. Activated iNKT can promote the development of a long-lasting Th1 biased proinflammatory immune response as demonstrated in multiple tumor-metastasis and viral infection models. Here, we will provide a brief overview of the preclinical data of α-galactosylceramide that formed the basis for subsequent clinical trials in patients with advanced cancer and chronic hepatitis B/C, and elaborate on our own clinical experience with α-galactosylceramide in these patient groups.
Collapse
Affiliation(s)
- Famke L Schneiders
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|