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Wiegand S, Wichmann G, Vogt J, Vogel K, Franke A, Kuhnt T, Lordick F, Scheuble AM, Hambsch P, Brossart P, Bauernfeind FG, Kaftan H, Maschmeyer G, Paland M, Münter M, Lewitzki V, Rotter N, Stromberger C, Beck M, Dommerich S, Gauler TC, Hapke G, Guntinas-Lichius O, Schröder U, Görner M, Hautmann MG, Steger F, Tamaskovics B, Schmiedeknecht A, Dietz A. Postoperative adjuvant radiochemotherapy with cisplatin versus adjuvant radiochemotherapy with cisplatin and pembrolizumab in locally advanced head and neck squamous cell carcinoma- the study protocol of the Adrisk trial. Front Oncol 2023; 13:1128176. [PMID: 37025596 PMCID: PMC10071022 DOI: 10.3389/fonc.2023.1128176] [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: 12/20/2022] [Accepted: 03/07/2023] [Indexed: 04/08/2023] Open
Abstract
Most of the patients with head and neck squamous cell carcinoma (HNSCC) are diagnosed with locally advanced disease. Standards of care for curative-intent treatment of this patient group are either surgery and adjuvant radio(chemo)therapy (aRCT) or definitive chemoradiation. Despite these treatments, especially pathologically intermediate and high-risk HNSCC often recur. The ADRISK trial investigates in locally advanced HNSCC and intermediate and high risk after up-front surgery if the addition of pembrolizumab to aRCT with cisplatin improves event-free sur-vival compared to aRCT alone. ADRISK is a prospective, randomized controlled investiga-tor-initiated (IIT)-phase II multicenter trial within the German Interdisciplinary Study Group of German Cancer Society (IAG-KHT). Patients with primary resectable stage III and IV HNSCC of the oral cavity, oropharynx, hypopharynx and larynx with pathologic high (R1, extracapsular nodal extension) or intermediate risk (R0 <5 mm; N≥2) after surgery will be eligible. Two hun-dred forty patients will be randomly assigned (1:1) to either standard aRCT with cisplatin (standard arm) or aRCT with cisplatin + pembrolizumab (200 mg iv, in 3-week cycle, max. 12 months) (interventional arm). Endpoints are event-free and overall survival. Recruitment started in August 2018 and is ongoing.
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Affiliation(s)
- Susanne Wiegand
- Department of Otolaryngology, Head and Neck Surgery, Leipzig University Medical Center, Leipzig, Germany
- *Correspondence: Susanne Wiegand,
| | - Gunnar Wichmann
- Department of Otolaryngology, Head and Neck Surgery, Leipzig University Medical Center, Leipzig, Germany
| | - Jeannette Vogt
- Department of Otolaryngology, Head and Neck Surgery, Leipzig University Medical Center, Leipzig, Germany
| | - Kathrin Vogel
- Department of Otolaryngology, Head and Neck Surgery, Leipzig University Medical Center, Leipzig, Germany
| | - Annegret Franke
- Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - Thomas Kuhnt
- Department of Radiation Oncology, University Hospital Leipzig, Leipzig, Germany
| | - Florian Lordick
- University Cancer Center Leipzig, Leipzig University Medical Center, Leipzig, Germany
| | - Anne-Marie Scheuble
- University Cancer Center Leipzig, Leipzig University Medical Center, Leipzig, Germany
| | - Peter Hambsch
- Department of Radiation Oncology, University Hospital Leipzig, Leipzig, Germany
| | - Peter Brossart
- Department of Oncology, Hematology, Immuno-Oncology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| | - Franz Georg Bauernfeind
- Department of Oncology, Hematology, Immuno-Oncology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| | - Holger Kaftan
- Department of Otorhinolaryngology, Helios-Klinikum Erfurt, Erfurt, Germany
| | - Georg Maschmeyer
- Department of Haematology, Oncology, and Palliative Care, Ernst Von Bergmann Clinic, Potsdam, Germany
| | - Matthias Paland
- Department of Haematology, Oncology, and Palliative Care, Ernst Von Bergmann Clinic, Potsdam, Germany
| | - Marc Münter
- Institute of Radiotherapy, Klinikum Stuttgart, Stuttgart, Germany
| | - Victor Lewitzki
- Department of Radiation Oncology, University of Würzburg, Würzburg, Germany
| | - Nicole Rotter
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Mannheim, Mannheim, Germany
| | - Carmen Stromberger
- Department of Radiation Oncology, Charité, Berlin, Germany
- Vivantes Klinikum Neukölln, Department of Radiooncology and Radiotherapy, Berlin, Germany
| | - Marcus Beck
- Department of Radiation Oncology, Charité, Berlin, Germany
| | | | - Thomas Christoph Gauler
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Gunnar Hapke
- Department of Hematology and Oncology, Marienkrankenhaus Hamburg, Hamburg, Germany
| | | | - Ursula Schröder
- Department of Otorhinolaryngology, University of Lübeck, Lübeck, Germany
| | - Martin Görner
- Department of Hematology, Oncology and Palliative Medicine, Klinikum Bielefeld Mitte, Bielefeld, Germany
| | - Matthias G. Hautmann
- Department for Radiotherapy, University Hospital Regensburg, Regensburg, Germany
| | - Felix Steger
- Department for Radiotherapy, University Hospital Regensburg, Regensburg, Germany
| | - Bálint Tamaskovics
- Department of Radiation Oncology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | | | - Andreas Dietz
- Department of Otolaryngology, Head and Neck Surgery, Leipzig University Medical Center, Leipzig, Germany
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Klümper N, Saal J, Berner F, Lichtensteiger C, Wyss N, Heine A, Bauernfeind FG, Ellinger J, Brossart P, Diem S, Schmid S, Joerger M, Frueh M, Ritter M, Hölzel M, Flatz L, Bald T. C reactive protein flare predicts response to checkpoint inhibitor treatment in non-small cell lung cancer. J Immunother Cancer 2022; 10:jitc-2021-004024. [PMID: 35292517 PMCID: PMC8928397 DOI: 10.1136/jitc-2021-004024] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [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] [Accepted: 02/14/2022] [Indexed: 12/28/2022] Open
Abstract
Biomarkers for predicting response to anti-programmed death-1 (PD-1) immune checkpoint blockade (ICB) in non-small cell lung cancer (NSCLC) remain in demand. Since anti-tumor immune activation is a process, early dynamic changes of the acute-phase reactant C reactive protein (CRP) may serve as a predictive on-treatment biomarker. In a retrospective (N=105) and prospective (N=108) ICB-treated NSCLC cohort, early CRP kinetics were stratified after the start of immunotherapy until weeks 4, 6, and 12 as follows: an early doubling of baseline CRP followed by a drop below baseline (CRP flare-responder), a drop of at least 30% below baseline without prior flare (CRP responders), or those who remained as CRP non-responders. In our study, we observed characteristic longitudinal changes of serum CRP concentration after the initiation of ICB. In the prospective cohort, N=40 patients were defined as CRP non-responders, N=39 as CRP responders, and N=29 as CRP flare-responders with a median progression-free survival (PFS) of 2.4, 8.1, and 14.3 months, respectively, and overall survival (OS) of 6.6, 18.6, and 32.9 months (both log-rank p<0.001). Of note, CRP flare-responses, characterized by a sharp on-treatment CRP increase in the first weeks after therapy initiation, followed by a decrease of CRP serum level below baseline, predict ICB response as early as 4 weeks after therapy initiation. Of note, early CRP kinetics showed no predictive value for chemoimmunotherapy or when steroids were administered concurrently. On-treatment CRP kinetics had a predictive value for both major histological NSCLC subtypes, adenocarcinoma and squamous cell carcinoma. The results were verified in an independent retrospective cohort of 105 patients. In conclusion, CRP flare predicted anti-PD-1 monotherapy response and survival in two independent cohorts including a total of 213 patients with NSCLC, regardless of histology. Due to its wide clinical availability, early CRP kinetics could become an easily determined, cost-efficient, and non-invasive biomarker to predict response to checkpoint inhibitors in NSCLC within the first month.
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Affiliation(s)
- Niklas Klümper
- Institute for Experimental Oncology, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Cologne/Bonn, University Hospital Bonn, Bonn, Germany.,Department of Urology, University Hospital Bonn, Bonn, Germany
| | - Jonas Saal
- Center for Integrated Oncology Cologne/Bonn, University Hospital Bonn, Bonn, Germany.,Medical Clinic III for Oncology, Hematology, Immune-Oncology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Fiamma Berner
- Institute of Immunobiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | | | - Nina Wyss
- Institute of Immunobiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Annkristin Heine
- Center for Integrated Oncology Cologne/Bonn, University Hospital Bonn, Bonn, Germany.,Medical Clinic III for Oncology, Hematology, Immune-Oncology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Franz Georg Bauernfeind
- Center for Integrated Oncology Cologne/Bonn, University Hospital Bonn, Bonn, Germany.,Medical Clinic III for Oncology, Hematology, Immune-Oncology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Jörg Ellinger
- Center for Integrated Oncology Cologne/Bonn, University Hospital Bonn, Bonn, Germany.,Department of Urology, University Hospital Bonn, Bonn, Germany
| | - Peter Brossart
- Center for Integrated Oncology Cologne/Bonn, University Hospital Bonn, Bonn, Germany.,Department of Oncology, Hematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Stefan Diem
- Department of Oncology and Hematology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Sabine Schmid
- Department of Oncology and Hematology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Markus Joerger
- Department of Oncology and Hematology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Martin Frueh
- Department of Oncology and Hematology, Kantonsspital St Gallen, St Gallen, Switzerland.,Department of Medical Oncology, University Hospital Bern, Bern, Switzerland
| | - Manuel Ritter
- Center for Integrated Oncology Cologne/Bonn, University Hospital Bonn, Bonn, Germany.,Department of Urology, University Hospital Bonn, Bonn, Germany
| | - Michael Hölzel
- Institute for Experimental Oncology, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Cologne/Bonn, University Hospital Bonn, Bonn, Germany
| | - Lukas Flatz
- Institute of Immunobiology, Kantonsspital St Gallen, St Gallen, Switzerland.,Department of Dermatology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Tobias Bald
- Institute for Experimental Oncology, University Hospital Bonn, Bonn, Germany .,Center for Integrated Oncology Cologne/Bonn, University Hospital Bonn, Bonn, Germany
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