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Fulton-Ward T, Middleton G. The impact of genomic context on outcomes of solid cancer patients treated with genotype-matched targeted therapies: a comprehensive review. Ann Oncol 2023; 34:1113-1130. [PMID: 37875224 DOI: 10.1016/j.annonc.2023.10.124] [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: 02/15/2023] [Revised: 08/18/2023] [Accepted: 10/08/2023] [Indexed: 10/26/2023] Open
Abstract
INTRODUCTION A critical need in the field of genotype-matched targeted therapy in cancer is to identify patients unlikely to respond to precision medicines. This will manage expectations of individualised therapies and avoid clinical progression to a point where institution of alternative treatments might not be possible. We examined the evidence base of the impact of genomic context on which targeted alterations are inscribed to identify baseline biomarkers distinguishing those obtaining the expected response from those with less benefit from targeted therapies. METHODS A comprehensive narrative review was conducted: scoping searches were undertaken in PubMed, Cochrane Database of Systematic Reviews, and PROSPERO. Outcomes included in meta-analysis were progression-free and overall survival. Data were extracted from Kaplan-Meier and used to calculate hazard ratios. Studies presenting data on two molecular subcohorts (e.g. co-mutation versus no co-mutation) were included in fixed meta-analysis. Other studies were used for descriptive purposes. RESULTS The presence of concomitant driver mutations, higher tumour mutational burden (TMB), greater copy number burden, and APOBEC signatures significantly reduces benefits of targeted therapy in lung cancers in never smokers (LCINS - less than 100 cigarettes per lifetime) and breast cancer, cancers with low TMB. LCINS have significantly poorer outcomes if their cancers harbour p53 co-mutations, an effect also seen in human epidermal growth factor receptor 2-positive (HER2+) breast cancer patients (trastuzumab) and head and neck cancer patients [phosphoinositide 3-kinase (PI3K) inhibition]. PI3K co-alterations have less impact when targeting epidermal growth factor receptor mutations and anaplastic lymphoma kinase fusions, but significantly reduce the impact of targeting HER2 and MET amplifications. SMARCA4 co-mutations predict for poor outcome in patients treated with osimertinib and sotorasib. In BRAF-mutant melanoma, whilst there are no genomic features distinguishing exceptional responders from primary progressors, there are clear transcriptomic features dichotomising these outcomes. CONCLUSION To our knowledge, this is the most comprehensive review to date of the impact of genomic context on outcomes with targeted therapy. It represents a valuable resource informing progress towards contextualised precision medicine.
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Affiliation(s)
- T Fulton-Ward
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - G Middleton
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; University Hospitals Birmingham, Birmingham, UK.
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Starkey T, Ionescu MC, Tilby M, Little M, Burke E, Fittall MW, Khan S, Liu JKH, Platt JR, Mew R, Tripathy AR, Watts I, Williams ST, Appanna N, Al-Hajji Y, Barnard M, Benny L, Burnett A, Bytyci J, Cattell EL, Cheng V, Clark JJ, Eastlake L, Gerrand K, Ghafoor Q, Grumett S, Harper-Wynne C, Kahn R, Lee AJX, Lomas O, Lydon A, Mckenzie H, Panneerselvam H, Pascoe JS, Patel G, Patel V, Potter VA, Randle A, Rigg AS, Robinson TM, Roylance R, Roques TW, Rozmanowski S, Roux RL, Shah K, Sheehan R, Sintler M, Swarup S, Taylor H, Tillett T, Tuthill M, Williams S, Ying Y, Beggs A, Iveson T, Lee SM, Middleton G, Middleton M, Protheroe A, Fowler T, Johnson P, Lee LYW. A population-scale temporal case-control evaluation of COVID-19 disease phenotype and related outcome rates in patients with cancer in England (UKCCP). Sci Rep 2023; 13:11327. [PMID: 37491478 PMCID: PMC10368624 DOI: 10.1038/s41598-023-36990-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/14/2023] [Indexed: 07/27/2023] Open
Abstract
Patients with cancer are at increased risk of hospitalisation and mortality following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, the SARS-CoV-2 phenotype evolution in patients with cancer since 2020 has not previously been described. We therefore evaluated SARS-CoV-2 on a UK populationscale from 01/11/2020-31/08/2022, assessing case-outcome rates of hospital assessment(s), intensive care admission and mortality. We observed that the SARS-CoV-2 disease phenotype has become less severe in patients with cancer and the non-cancer population. Case-hospitalisation rates for patients with cancer dropped from 30.58% in early 2021 to 7.45% in 2022 while case-mortality rates decreased from 20.53% to 3.25%. However, the risk of hospitalisation and mortality remains 2.10x and 2.54x higher in patients with cancer, respectively. Overall, the SARS-CoV-2 disease phenotype is less severe in 2022 compared to 2020 but patients with cancer remain at higher risk than the non-cancer population. Patients with cancer must therefore be empowered to live more normal lives, to see loved ones and families, while also being safeguarded with expanded measures to reduce the risk of transmission.
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Affiliation(s)
- Thomas Starkey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | - Michael Tilby
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Emma Burke
- Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Sam Khan
- University of Leicester, Leicester, UK
| | | | - James R Platt
- Leeds Institute of Medical Research at St James's, Leeds, UK
| | - Rosie Mew
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | | | | | | | | | - Youssra Al-Hajji
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | | | | | | | - Jola Bytyci
- Department of Oncology, University of Oxford, Oxford, UK
| | | | | | | | | | | | - Qamar Ghafoor
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Simon Grumett
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | | | - Oliver Lomas
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Anna Lydon
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - Hayley Mckenzie
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Jennifer S Pascoe
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - Vanessa A Potter
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Anne S Rigg
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Rebecca Roylance
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Tom W Roques
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | - René L Roux
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Ketan Shah
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Remarez Sheehan
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Martin Sintler
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | | | | | - Mark Tuthill
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Sarah Williams
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Yuxin Ying
- Department of Oncology, University of Oxford, Oxford, UK
| | - Andrew Beggs
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Tim Iveson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Siow Ming Lee
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Mark Middleton
- Department of Oncology, University of Oxford, Oxford, UK
| | - Andrew Protheroe
- Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tom Fowler
- UK Health Security Agency, London, UK
- William Harvey Research Institute, London, UK
| | | | - Lennard Y W Lee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
- Department of Oncology, University of Oxford, Oxford, UK.
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Croft W, Pearce H, Margielewska-Davies S, Lim L, Nicol SM, Zayou F, Blakeway D, Marcon F, Powell-Brett S, Mahon B, Merard R, Zuo J, Middleton G, Roberts K, Brown RM, Moss P. Spatial determination and prognostic impact of the fibroblast transcriptome in pancreatic ductal adenocarcinoma. eLife 2023; 12:e86125. [PMID: 37350578 PMCID: PMC10361717 DOI: 10.7554/elife.86125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/22/2023] [Indexed: 06/24/2023] Open
Abstract
Pancreatic ductal adenocarcinoma has a poor clinical outcome and responses to immunotherapy are suboptimal. Stromal fibroblasts are a dominant but heterogenous population within the tumor microenvironment and therapeutic targeting of stromal subsets may have therapeutic utility. Here, we combine spatial transcriptomics and scRNA-Seq datasets to define the transcriptome of tumor-proximal and tumor-distal cancer-associated fibroblasts (CAFs) and link this to clinical outcome. Tumor-proximal fibroblasts comprise large populations of myofibroblasts, strongly expressed podoplanin, and were enriched for Wnt ligand signaling. In contrast, inflammatory CAFs were dominant within tumor-distal subsets and expressed complement components and the Wnt-inhibitor SFRP2. Poor clinical outcome was correlated with elevated HIF-1α and podoplanin expression whilst expression of inflammatory and complement genes was predictive of extended survival. These findings demonstrate the extreme transcriptional heterogeneity of CAFs and its determination by apposition to tumor. Selective targeting of tumor-proximal subsets, potentially combined with HIF-1α inhibition and immune stimulation, may offer a multi-modal therapeutic approach for this disease.
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Affiliation(s)
- Wayne Croft
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of BirminghamBirminghamUnited Kingdom
- Centre for Computational Biology, University of BirminghamBirminghamUnited Kingdom
| | - Hayden Pearce
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of BirminghamBirminghamUnited Kingdom
| | - Sandra Margielewska-Davies
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of BirminghamBirminghamUnited Kingdom
| | - Lindsay Lim
- Cancer Research Horizons, The Francis Crick InstituteLondonUnited Kingdom
| | - Samantha M Nicol
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of BirminghamBirminghamUnited Kingdom
| | - Fouzia Zayou
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of BirminghamBirminghamUnited Kingdom
| | - Daniel Blakeway
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of BirminghamBirminghamUnited Kingdom
| | - Francesca Marcon
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital BirminghamBirminghamUnited Kingdom
| | - Sarah Powell-Brett
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital BirminghamBirminghamUnited Kingdom
| | - Brinder Mahon
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital BirminghamBirminghamUnited Kingdom
| | - Reena Merard
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital BirminghamBirminghamUnited Kingdom
| | - Jianmin Zuo
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of BirminghamBirminghamUnited Kingdom
| | - Gary Middleton
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of BirminghamBirminghamUnited Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital BirminghamBirminghamUnited Kingdom
| | - Keith Roberts
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital BirminghamBirminghamUnited Kingdom
| | - Rachel M Brown
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital BirminghamBirminghamUnited Kingdom
| | - Paul Moss
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of BirminghamBirminghamUnited Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital BirminghamBirminghamUnited Kingdom
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Pearce H, Croft W, Nicol SM, Margielewska-Davies S, Powell R, Cornall R, Davis SJ, Marcon F, Pugh MR, Fennell É, Powell-Brett S, Mahon BS, Brown RM, Middleton G, Roberts K, Moss P. Tissue-Resident Memory T Cells in Pancreatic Ductal Adenocarcinoma Coexpress PD-1 and TIGIT and Functional Inhibition Is Reversible by Dual Antibody Blockade. Cancer Immunol Res 2023; 11:435-449. [PMID: 36689623 PMCID: PMC10068448 DOI: 10.1158/2326-6066.cir-22-0121] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/02/2022] [Accepted: 01/19/2023] [Indexed: 01/24/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) has a poor clinical outlook. Responses to immune checkpoint blockade are suboptimal and a much more detailed understanding of the tumor immune microenvironment is needed if this situation is to be improved. Here, we characterized tumor-infiltrating T-cell populations in patients with PDAC using cytometry by time of flight (CyTOF) and single-cell RNA sequencing. T cells were the predominant immune cell subset observed within tumors. Over 30% of CD4+ T cells expressed a CCR6+CD161+ Th17 phenotype and 17% displayed an activated regulatory T-cell profile. Large populations of CD8+ tissue-resident memory (TRM) T cells were also present and expressed high levels of programmed cell death protein 1 (PD-1) and TIGIT. A population of putative tumor-reactive CD103+CD39+ T cells was also observed within the CD8+ tumor-infiltrating lymphocytes population. The expression of PD-1 ligands was limited largely to hemopoietic cells whilst TIGIT ligands were expressed widely within the tumor microenvironment. Programmed death-ligand 1 and CD155 were expressed within the T-cell area of ectopic lymphoid structures and colocalized with PD-1+TIGIT+ CD8+ T cells. Combinatorial anti-PD-1 and TIGIT blockade enhanced IFNγ secretion and proliferation of T cells in the presence of PD-1 and TIGIT ligands. As such, we showed that the PDAC microenvironment is characterized by the presence of substantial populations of TRM cells with an exhausted PD-1+TIGIT+ phenotype where dual checkpoint receptor blockade represents a promising avenue for future immunotherapy.
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Affiliation(s)
- Hayden Pearce
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Wayne Croft
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Computational Biology, University of Birmingham, Birmingham, United Kingdom
| | - Samantha M. Nicol
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Sandra Margielewska-Davies
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Richard Powell
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Richard Cornall
- Nuffield Department of Medicine and Medical Research Council Human Immunology Unit, University of Oxford, Oxford, United Kingdom
| | - Simon J. Davis
- Radcliffe Department of Medicine and Medical Research Council Human Immunology Unit, University of Oxford, Oxford, United Kingdom
| | - Francesca Marcon
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Matthew R. Pugh
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Éanna Fennell
- Health Research Institute, Bernal Institute and School of Medicine, University of Limerick, Limerick, Ireland
| | - Sarah Powell-Brett
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Brinder S. Mahon
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Rachel M. Brown
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Gary Middleton
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Keith Roberts
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Paul Moss
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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5
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Frankell AM, Dietzen M, Al Bakir M, Lim EL, Karasaki T, Ward S, Veeriah S, Colliver E, Huebner A, Bunkum A, Hill MS, Grigoriadis K, Moore DA, Black JRM, Liu WK, Thol K, Pich O, Watkins TBK, Naceur-Lombardelli C, Cook DE, Salgado R, Wilson GA, Bailey C, Angelova M, Bentham R, Martínez-Ruiz C, Abbosh C, Nicholson AG, Le Quesne J, Biswas D, Rosenthal R, Puttick C, Hessey S, Lee C, Prymas P, Toncheva A, Smith J, Xing W, Nicod J, Price G, Kerr KM, Naidu B, Middleton G, Blyth KG, Fennell DA, Forster MD, Lee SM, Falzon M, Hewish M, Shackcloth MJ, Lim E, Benafif S, Russell P, Boleti E, Krebs MG, Lester JF, Papadatos-Pastos D, Ahmad T, Thakrar RM, Lawrence D, Navani N, Janes SM, Dive C, Blackhall FH, Summers Y, Cave J, Marafioti T, Herrero J, Quezada SA, Peggs KS, Schwarz RF, Van Loo P, Miedema DM, Birkbak NJ, Hiley CT, Hackshaw A, Zaccaria S, Jamal-Hanjani M, McGranahan N, Swanton C. The evolution of lung cancer and impact of subclonal selection in TRACERx. Nature 2023; 616:525-533. [PMID: 37046096 PMCID: PMC10115649 DOI: 10.1038/s41586-023-05783-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/02/2023] [Indexed: 04/14/2023]
Abstract
Lung cancer is the leading cause of cancer-associated mortality worldwide1. Here we analysed 1,644 tumour regions sampled at surgery or during follow-up from the first 421 patients with non-small cell lung cancer prospectively enrolled into the TRACERx study. This project aims to decipher lung cancer evolution and address the primary study endpoint: determining the relationship between intratumour heterogeneity and clinical outcome. In lung adenocarcinoma, mutations in 22 out of 40 common cancer genes were under significant subclonal selection, including classical tumour initiators such as TP53 and KRAS. We defined evolutionary dependencies between drivers, mutational processes and whole genome doubling (WGD) events. Despite patients having a history of smoking, 8% of lung adenocarcinomas lacked evidence of tobacco-induced mutagenesis. These tumours also had similar detection rates for EGFR mutations and for RET, ROS1, ALK and MET oncogenic isoforms compared with tumours in never-smokers, which suggests that they have a similar aetiology and pathogenesis. Large subclonal expansions were associated with positive subclonal selection. Patients with tumours harbouring recent subclonal expansions, on the terminus of a phylogenetic branch, had significantly shorter disease-free survival. Subclonal WGD was detected in 19% of tumours, and 10% of tumours harboured multiple subclonal WGDs in parallel. Subclonal, but not truncal, WGD was associated with shorter disease-free survival. Copy number heterogeneity was associated with extrathoracic relapse within 1 year after surgery. These data demonstrate the importance of clonal expansion, WGD and copy number instability in determining the timing and patterns of relapse in non-small cell lung cancer and provide a comprehensive clinical cancer evolutionary data resource.
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Affiliation(s)
- Alexander M Frankell
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Michelle Dietzen
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Genome Evolution Research Group, Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Maise Al Bakir
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Emilia L Lim
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Takahiro Karasaki
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Metastasis Laboratory, University College London Cancer Institute, London, UK
| | - Sophia Ward
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Advanced Sequencing Facility, The Francis Crick Institute, London, UK
| | - Selvaraju Veeriah
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Emma Colliver
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Ariana Huebner
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Genome Evolution Research Group, Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Abigail Bunkum
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Metastasis Laboratory, University College London Cancer Institute, London, UK
- Computational Cancer Genomics Research Group, University College London Cancer Institute, London, UK
| | - Mark S Hill
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Kristiana Grigoriadis
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Genome Evolution Research Group, Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - David A Moore
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Department of Cellular Pathology, University College London Hospitals, London, UK
| | - James R M Black
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Genome Evolution Research Group, Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Wing Kin Liu
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Metastasis Laboratory, University College London Cancer Institute, London, UK
| | - Kerstin Thol
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Genome Evolution Research Group, Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Oriol Pich
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Thomas B K Watkins
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | | | - Daniel E Cook
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Roberto Salgado
- Department of Pathology, ZAS Hospitals, Antwerp, Belgium
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Gareth A Wilson
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Chris Bailey
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Mihaela Angelova
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Robert Bentham
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Genome Evolution Research Group, Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Carlos Martínez-Ruiz
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Genome Evolution Research Group, Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Christopher Abbosh
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - John Le Quesne
- Cancer Research UK Beatson Institute, Glasgow, UK
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
- Pathology Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Dhruva Biswas
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Bill Lyons Informatics Centre, University College London Cancer Institute, London, UK
| | - Rachel Rosenthal
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Clare Puttick
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Genome Evolution Research Group, Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Sonya Hessey
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Metastasis Laboratory, University College London Cancer Institute, London, UK
- Computational Cancer Genomics Research Group, University College London Cancer Institute, London, UK
| | - Claudia Lee
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Division of Medicine, University College London, London, UK
| | - Paulina Prymas
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Antonia Toncheva
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Jon Smith
- Scientific Computing, The Francis Crick Institute, London, UK
| | - Wei Xing
- Scientific Computing, The Francis Crick Institute, London, UK
| | - Jerome Nicod
- Advanced Sequencing Facility, The Francis Crick Institute, London, UK
| | - Gillian Price
- Department of Medical Oncology, Aberdeen Royal Infirmary NHS Grampian, Aberdeen, UK
- University of Aberdeen, Aberdeen, UK
| | - Keith M Kerr
- University of Aberdeen, Aberdeen, UK
- Department of Pathology, Aberdeen Royal Infirmary NHS Grampian, Aberdeen, UK
| | - Babu Naidu
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gary Middleton
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Kevin G Blyth
- Cancer Research UK Beatson Institute, Glasgow, UK
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK
| | - Dean A Fennell
- University of Leicester, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Martin D Forster
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Department of Oncology, University College London Hospitals, London, UK
| | - Siow Ming Lee
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Department of Oncology, University College London Hospitals, London, UK
| | - Mary Falzon
- Department of Cellular Pathology, University College London Hospitals, London, UK
| | - Madeleine Hewish
- Royal Surrey Hospital, Royal Surrey Hospitals NHS Foundation Trust, Guilford, UK
- University of Surrey, Guilford, UK
| | | | - Eric Lim
- Academic Division of Thoracic Surgery, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sarah Benafif
- Department of Oncology, University College London Hospitals, London, UK
| | - Peter Russell
- Princess Alexandra Hospital, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Ekaterini Boleti
- Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Matthew G Krebs
- Division of Cancer Sciences, The University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Jason F Lester
- Singleton Hospital, Swansea Bay University Health Board, Swansea, UK
| | | | - Tanya Ahmad
- Department of Oncology, University College London Hospitals, London, UK
| | - Ricky M Thakrar
- Department of Thoracic Medicine, University College London Hospitals, London, UK
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - David Lawrence
- Department of Thoracic Surgery, University College London Hospital NHS Trust, London, UK
| | - Neal Navani
- Department of Thoracic Medicine, University College London Hospitals, London, UK
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Caroline Dive
- Cancer Research UK Manchester Institute Cancer Biomarker Centre, University of Manchester, Manchester, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University of Manchester, Manchester, UK
| | - Fiona H Blackhall
- Division of Cancer Sciences, The University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Yvonne Summers
- Division of Cancer Sciences, The University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Judith Cave
- Department of Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Teresa Marafioti
- Department of Cellular Pathology, University College London Hospitals, London, UK
| | - Javier Herrero
- Bill Lyons Informatics Centre, University College London Cancer Institute, London, UK
| | - Sergio A Quezada
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Immune Regulation and Tumour Immunotherapy Group, Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
| | - Karl S Peggs
- Department of Haematology, University College London Hospitals, London, UK
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
| | - Roland F Schwarz
- Institute for Computational Cancer Biology, Center for Integrated Oncology (CIO), Cancer Research Center Cologne Essen (CCCE), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Berlin Institute for the Foundations of Learning and Data (BIFOLD), Berlin, Germany
| | - Peter Van Loo
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Cancer Genomics Laboratory, The Francis Crick Institute, London, UK
| | - Daniël M Miedema
- LEXOR, Center for Experimental and Molecular Medicine, Cancer Center Amsterdam and Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Oncode Institute, Amsterdam, The Netherlands
| | - Nicolai J Birkbak
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Crispin T Hiley
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, London, UK
| | - Simone Zaccaria
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Computational Cancer Genomics Research Group, University College London Cancer Institute, London, UK
| | - Mariam Jamal-Hanjani
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK.
- Cancer Metastasis Laboratory, University College London Cancer Institute, London, UK.
- Department of Oncology, University College London Hospitals, London, UK.
| | - Nicholas McGranahan
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK.
- Cancer Genome Evolution Research Group, Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK.
| | - Charles Swanton
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK.
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK.
- Department of Oncology, University College London Hospitals, London, UK.
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6
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Al Bakir M, Huebner A, Martínez-Ruiz C, Grigoriadis K, Watkins TBK, Pich O, Moore DA, Veeriah S, Ward S, Laycock J, Johnson D, Rowan A, Razaq M, Akther M, Naceur-Lombardelli C, Prymas P, Toncheva A, Hessey S, Dietzen M, Colliver E, Frankell AM, Bunkum A, Lim EL, Karasaki T, Abbosh C, Hiley CT, Hill MS, Cook DE, Wilson GA, Salgado R, Nye E, Stone RK, Fennell DA, Price G, Kerr KM, Naidu B, Middleton G, Summers Y, Lindsay CR, Blackhall FH, Cave J, Blyth KG, Nair A, Ahmed A, Taylor MN, Procter AJ, Falzon M, Lawrence D, Navani N, Thakrar RM, Janes SM, Papadatos-Pastos D, Forster MD, Lee SM, Ahmad T, Quezada SA, Peggs KS, Van Loo P, Dive C, Hackshaw A, Birkbak NJ, Zaccaria S, Jamal-Hanjani M, McGranahan N, Swanton C. The evolution of non-small cell lung cancer metastases in TRACERx. Nature 2023; 616:534-542. [PMID: 37046095 PMCID: PMC10115651 DOI: 10.1038/s41586-023-05729-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/12/2023] [Indexed: 04/14/2023]
Abstract
Metastatic disease is responsible for the majority of cancer-related deaths1. We report the longitudinal evolutionary analysis of 126 non-small cell lung cancer (NSCLC) tumours from 421 prospectively recruited patients in TRACERx who developed metastatic disease, compared with a control cohort of 144 non-metastatic tumours. In 25% of cases, metastases diverged early, before the last clonal sweep in the primary tumour, and early divergence was enriched for patients who were smokers at the time of initial diagnosis. Simulations suggested that early metastatic divergence more frequently occurred at smaller tumour diameters (less than 8 mm). Single-region primary tumour sampling resulted in 83% of late divergence cases being misclassified as early, highlighting the importance of extensive primary tumour sampling. Polyclonal dissemination, which was associated with extrathoracic disease recurrence, was found in 32% of cases. Primary lymph node disease contributed to metastatic relapse in less than 20% of cases, representing a hallmark of metastatic potential rather than a route to subsequent recurrences/disease progression. Metastasis-seeding subclones exhibited subclonal expansions within primary tumours, probably reflecting positive selection. Our findings highlight the importance of selection in metastatic clone evolution within untreated primary tumours, the distinction between monoclonal versus polyclonal seeding in dictating site of recurrence, the limitations of current radiological screening approaches for early diverging tumours and the need to develop strategies to target metastasis-seeding subclones before relapse.
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Affiliation(s)
- Maise Al Bakir
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Ariana Huebner
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Genome Evolution Research Group, Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Carlos Martínez-Ruiz
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Genome Evolution Research Group, Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Kristiana Grigoriadis
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Genome Evolution Research Group, Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Thomas B K Watkins
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Oriol Pich
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - David A Moore
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Department of Cellular Pathology, University College London Hospitals, London, UK
| | - Selvaraju Veeriah
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Sophia Ward
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Advanced Sequencing Facility, The Francis Crick Institute, London, UK
| | - Joanne Laycock
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Diana Johnson
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Andrew Rowan
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Maryam Razaq
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Mita Akther
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | | | - Paulina Prymas
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Antonia Toncheva
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Sonya Hessey
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Metastasis Laboratory, University College London Cancer Institute, London, UK
- Computational Cancer Genomics Research Group, University College London Cancer Institute, London, UK
| | - Michelle Dietzen
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Genome Evolution Research Group, Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Emma Colliver
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Alexander M Frankell
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Abigail Bunkum
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Metastasis Laboratory, University College London Cancer Institute, London, UK
- Computational Cancer Genomics Research Group, University College London Cancer Institute, London, UK
| | - Emilia L Lim
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Takahiro Karasaki
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Metastasis Laboratory, University College London Cancer Institute, London, UK
| | - Christopher Abbosh
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Crispin T Hiley
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Mark S Hill
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Daniel E Cook
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Gareth A Wilson
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Roberto Salgado
- Department of Pathology, ZAS Hospitals, Antwerp, Belgium
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Emma Nye
- Experimental Histopathology, The Francis Crick Institute, London, UK
| | | | - Dean A Fennell
- University of Leicester, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Gillian Price
- Department of Medical Oncology, Aberdeen Royal Infirmary NHS Grampian, Aberdeen, UK
- University of Aberdeen, Aberdeen, UK
| | - Keith M Kerr
- University of Aberdeen, Aberdeen, UK
- Department of Pathology, Aberdeen Royal Infirmary NHS Grampian, Aberdeen, UK
| | - Babu Naidu
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Gary Middleton
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Yvonne Summers
- Division of Cancer Sciences, The University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Colin R Lindsay
- Division of Cancer Sciences, The University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Fiona H Blackhall
- Division of Cancer Sciences, The University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Judith Cave
- Department of Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kevin G Blyth
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
- Cancer Research UK Beatson Institute, Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK
| | - Arjun Nair
- Department of Radiology, University College London Hospitals, London, UK
- UCL Respiratory, Department of Medicine, University College London, London, UK
| | - Asia Ahmed
- Department of Radiology, University College London Hospitals, London, UK
| | - Magali N Taylor
- Department of Radiology, University College London Hospitals, London, UK
| | | | - Mary Falzon
- Department of Cellular Pathology, University College London Hospitals, London, UK
| | - David Lawrence
- Department of Thoracic Surgery, University College London Hospital NHS Trust, London, UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
- Department of Thoracic Medicine, University College London Hospitals, London, UK
| | - Ricky M Thakrar
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
- Department of Thoracic Medicine, University College London Hospitals, London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | | | - Martin D Forster
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Department of Oncology, University College London Hospitals, London, UK
| | - Siow Ming Lee
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Department of Oncology, University College London Hospitals, London, UK
| | - Tanya Ahmad
- Department of Oncology, University College London Hospitals, London, UK
| | - Sergio A Quezada
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Immune Regulation and Tumour Immunotherapy Group, Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
| | - Karl S Peggs
- Department of Haematology, University College London Hospitals, London, UK
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
| | - Peter Van Loo
- Cancer Genomics Laboratory, The Francis Crick Institute, London, UK
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Caroline Dive
- Cancer Research UK Manchester Institute Cancer Biomarker Centre, University of Manchester, Manchester, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University of Manchester, Manchester, UK
| | - Allan Hackshaw
- Cancer Research UK & UCL Cancer Trials Centre, London, UK
| | - Nicolai J Birkbak
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Simone Zaccaria
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Computational Cancer Genomics Research Group, University College London Cancer Institute, London, UK
| | - Mariam Jamal-Hanjani
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK.
- Cancer Metastasis Laboratory, University College London Cancer Institute, London, UK.
- Department of Oncology, University College London Hospitals, London, UK.
| | - Nicholas McGranahan
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK.
- Cancer Genome Evolution Research Group, Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK.
| | - Charles Swanton
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK.
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK.
- Department of Oncology, University College London Hospitals, London, UK.
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7
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Sillo TO, Beggs AD, Middleton G, Akingboye A. The Gut Microbiome, Microsatellite Status and the Response to Immunotherapy in Colorectal Cancer. Int J Mol Sci 2023; 24:ijms24065767. [PMID: 36982838 PMCID: PMC10054450 DOI: 10.3390/ijms24065767] [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: 02/17/2023] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
There is increasing evidence in a range of cancer types that the microbiome plays a direct role in modulating the anti-cancer immune response both at the gut level and systemically. Differences in the gut microbiota have been shown to correlate with differences in immunotherapy responses in a range of non-gastrointestinal tract cancers. DNA mismatch repair-deficient (dMMR) colorectal cancer (CRC) is radically different to DNA mismatch repair-proficient (pMMR) CRC in clinical phenotype and in its very good responses to immunotherapy. While this has usually been thought to be due to the high mutational burden in dMMR CRC, the gut microbiome is radically different in dMMR and pMMR CRC in terms of both composition and diversity. It is probable that differences in the gut microbiota contribute to the varied responses to immunotherapy in dMMR versus pMMR CRC. Targeting the microbiome offers a way to boost the response and increase the selection of patients who might benefit from this therapy. This paper reviews the available literature on the role of the microbiome in the response to immunotherapy in dMMR and pMMR CRC, explores the potential causal relationship and discusses future directions for study in this exciting and rapidly changing field.
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Affiliation(s)
- Toritseju O Sillo
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Andrew D Beggs
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Gary Middleton
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
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8
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Lee LYW, Tilby M, Starkey T, Ionescu MC, Burnett A, Hattersley R, Khan S, Little M, Liu JKH, Platt JR, Tripathy A, Watts I, Williams ST, Appanna N, Al-Hajji Y, Barnard M, Benny L, Buckley A, Cattell E, Cheng V, Clark J, Eastlake L, Gerrand K, Ghafoor Q, Grumett S, Harper-Wynne C, Kahn R, Lee AJX, Lydon A, McKenzie H, Panneerselvam H, Pascoe J, Patel G, Patel V, Potter V, Randle A, Rigg AS, Robinson T, Roylance R, Roques T, Rozmanowski S, Roux RL, Shah K, Sintler M, Taylor H, Tillett T, Tuthill M, Williams S, Beggs A, Iveson T, Lee SM, Middleton G, Middleton M, Protheroe AS, Fittall MW, Fowler T, Johnson P. Association of SARS-CoV-2 Spike Protein Antibody Vaccine Response With Infection Severity in Patients With Cancer: A National COVID Cancer Cross-sectional Evaluation. JAMA Oncol 2023; 9:188-196. [PMID: 36547970 PMCID: PMC9936347 DOI: 10.1001/jamaoncol.2022.5974] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/01/2022] [Indexed: 12/24/2022]
Abstract
Importance Accurate identification of patient groups with the lowest level of protection following COVID-19 vaccination is important to better target resources and interventions for the most vulnerable populations. It is not known whether SARS-CoV-2 antibody testing has clinical utility for high-risk groups, such as people with cancer. Objective To evaluate whether spike protein antibody vaccine response (COV-S) following COVID-19 vaccination is associated with the risk of SARS-CoV-2 breakthrough infection or hospitalization among patients with cancer. Design, Setting, and Participants This was a population-based cross-sectional study of patients with cancer from the UK as part of the National COVID Cancer Antibody Survey. Adults with a known or reported cancer diagnosis who had completed their primary SARS-CoV-2 vaccination schedule were included. This analysis ran from September 1, 2021, to March 4, 2022, a period covering the expansion of the UK's third-dose vaccination booster program. Interventions Anti-SARS-CoV-2 COV-S antibody test (Elecsys; Roche). Main Outcomes and Measures Odds of SARS-CoV-2 breakthrough infection and COVID-19 hospitalization. Results The evaluation comprised 4249 antibody test results from 3555 patients with cancer and 294 230 test results from 225 272 individuals in the noncancer population. The overall cohort of 228 827 individuals (patients with cancer and the noncancer population) comprised 298 479 antibody tests. The median age of the cohort was in the age band of 40 and 49 years and included 182 741 test results (61.22%) from women and 115 737 (38.78%) from men. There were 279 721 tests (93.72%) taken by individuals identifying as White or White British. Patients with cancer were more likely to have undetectable anti-S antibody responses than the general population (199 of 4249 test results [4.68%] vs 376 of 294 230 [0.13%]; P < .001). Patients with leukemia or lymphoma had the lowest antibody titers. In the cancer cohort, following multivariable correction, patients who had an undetectable antibody response were at much greater risk for SARS-CoV-2 breakthrough infection (odds ratio [OR], 3.05; 95% CI, 1.96-4.72; P < .001) and SARS-CoV-2-related hospitalization (OR, 6.48; 95% CI, 3.31-12.67; P < .001) than individuals who had a positive antibody response. Conclusions and Relevance The findings of this cross-sectional study suggest that COV-S antibody testing allows the identification of patients with cancer who have the lowest level of antibody-derived protection from COVID-19. This study supports larger evaluations of SARS-CoV-2 antibody testing. Prevention of SARS-CoV-2 transmission to patients with cancer should be prioritized to minimize impact on cancer treatments and maximize quality of life for individuals with cancer during the ongoing pandemic.
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Affiliation(s)
- Lennard Y. W. Lee
- Department of Oncology, University of Oxford, Oxford, United Kingdom
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Michael Tilby
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Thomas Starkey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | | | - Alex Burnett
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Rosie Hattersley
- Torbay and South Devon NHS Foundation Trust, Torquay, United Kingdom
| | - Sam Khan
- University of Leicester, Leicester, United Kingdom
| | - Martin Little
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - James R. Platt
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom
| | - Arvind Tripathy
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | | | | | | | - Youssra Al-Hajji
- Birmingham Medical School, University of Birmingham, Birmingham, United Kingdom
| | | | - Liza Benny
- UK Health Security Agency, London, United Kingdom
| | | | | | - Vinton Cheng
- University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - James Clark
- Imperial College London, London, United Kingdom
| | | | - Kate Gerrand
- UK Health Security Agency, London, United Kingdom
| | - Qamar Ghafoor
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Simon Grumett
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | | | | | - Anna Lydon
- Torbay and South Devon NHS Trust, Torquay, United Kingdom
| | - Hayley McKenzie
- University Hospital Southampton, Southampton, United Kingdom
| | | | - Jennifer Pascoe
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | | | - Vanessa Potter
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | | | - Anne S. Rigg
- Guy's and St Thomas' Hospitals NHS Trust, London, United Kingdom
| | | | - Rebecca Roylance
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Tom Roques
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, United Kingdom
| | | | - René L. Roux
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Ketan Shah
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Martin Sintler
- Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom
| | - Harriet Taylor
- Oxford Medical School, University of Oxford, Oxford, United Kingdom
| | | | - Mark Tuthill
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Sarah Williams
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Andrew Beggs
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Tim Iveson
- Department of Oncology, Southampton University Hospitals, Southampton, United Kingdom
| | - Siow Ming Lee
- UCLH/CRUK Lung Cancer Centre of Excellence, London, United Kingdom
| | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Mark Middleton
- Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Andrew S. Protheroe
- Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, United Kingdom
| | | | - Tom Fowler
- William Harvey Research Institute, London, United Kingdom
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9
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Cerone MA, Mills TC, Sharpe R, McBride D, MacDonald M, MacMahon S, Mugalaasi H, Rehal P, Rettino A, Roberts H, Ross M, White DE, Peden J, Rawlinson J, Ho SN, Hollingsworth S, Popat S, Middleton G, Johnson P, Swanton C. The Cancer Research UK Stratified Medicine Programme as a model for delivering personalised cancer care. Br J Cancer 2023; 128:161-164. [PMID: 36599918 PMCID: PMC9902467 DOI: 10.1038/s41416-022-02107-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 11/25/2022] [Accepted: 12/06/2022] [Indexed: 01/06/2023] Open
Abstract
Genomic screening is routinely used to guide the treatment of cancer patients in many countries. However, several multi-layered factors make this effort difficult to deliver within a clinically relevant timeframe. Here we share the learnings from the CRUK-funded Stratified Medicine Programme for advanced NSCLC patients, which could be useful to better plan future studies.
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Grants
- 25354 Cancer Research UK
- A22792 Cancer Research UK
- A22803 Cancer Research UK
- A26796 Cancer Research UK
- 22209 Cancer Research UK
- A22788 Cancer Research UK
- A22795 Cancer Research UK
- 19363 Cancer Research UK
- A26792 Cancer Research UK
- A22798 Cancer Research UK
- A22800 Cancer Research UK
- A22793 Cancer Research UK
- A22801 Cancer Research UK
- A22786 Cancer Research UK
- A22802 Cancer Research UK
- A26790 Cancer Research UK
- A26797 Cancer Research UK
- A22790 Cancer Research UK
- A22808 Cancer Research UK
- A22791 Cancer Research UK
- A22796 Cancer Research UK
- A22787 Cancer Research UK
- A26798 Cancer Research UK
- Each Principal Investigators at the hospitals involved in the study received a yearly grant from CRUK throughout the programme; all the reference numbers are listed here: CRUK - A26798, A22801, A22802, A22786, A22787, A26796, A22792, A22793, A22788, A22790, A26794, A22791, A26792, A22808, A26790, A22796, A22795, A22803, A26797, A22797, A22798, A22794, A22800, A31319, A31320, A31318
- Cancer Research UK (CRUK)
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Affiliation(s)
| | | | - Rowena Sharpe
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Moira MacDonald
- All Wales Medical Genomics Service, University Hospital of Wales, Cardiff, UK
| | - Suzanne MacMahon
- The Centre for Molecular Pathology, The Royal Marsden, Sutton, UK
| | - Hood Mugalaasi
- The Centre for Molecular Pathology, The Royal Marsden, Sutton, UK
| | - Pauline Rehal
- West Midlands Regional Genetics Laboratory, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Alessandro Rettino
- West Midlands Regional Genetics Laboratory, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Helen Roberts
- All Wales Medical Genomics Service, University Hospital of Wales, Cardiff, UK
| | - Mark Ross
- Illumina Cambridge, Great Abington, Cambridge, UK
| | | | | | | | - Steffan N Ho
- Pfizer, Global Product Development Oncology, San Diego, CA, USA
| | | | - Sanjay Popat
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Gary Middleton
- Institute of Immunology & Immunotherapy, University of Birmingham, Birmingham, UK
| | - Peter Johnson
- School of Cancer Sciences, University of Southampton, Southampton, UK
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Cerone MA, Mills TC, Sharpe R, McBride D, MacDonald M, MacMahon S, Mugalaasi H, Rehal P, Rettino A, Roberts H, Ross M, White DE, Peden J, Rawlinson J, Ho SN, Hollingsworth S, Popat S, Middleton G, Johnson P, Swanton C. Correction to: The Cancer Research UK Stratified Medicine Programme as a model for delivering personalised cancer care. Br J Cancer 2023; 128:399. [PMID: 36697967 PMCID: PMC9902544 DOI: 10.1038/s41416-023-02160-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
| | | | - Rowena Sharpe
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Moira MacDonald
- All Wales Medical Genomics Service, University Hospital of Wales, Cardiff, UK
| | - Suzanne MacMahon
- The Centre for Molecular Pathology, The Royal Marsden, Sutton, UK
| | - Hood Mugalaasi
- The Centre for Molecular Pathology, The Royal Marsden, Sutton, UK
| | - Pauline Rehal
- West Midlands Regional Genetics Laboratory, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Alessandro Rettino
- West Midlands Regional Genetics Laboratory, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Helen Roberts
- All Wales Medical Genomics Service, University Hospital of Wales, Cardiff, UK
| | - Mark Ross
- Illumina Cambridge, Great Abington, Cambridge, UK
| | | | | | | | - Steffan N Ho
- Pfizer, Global Product Development Oncology, San Diego, CA, USA
| | | | - Sanjay Popat
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Gary Middleton
- Institute of Immunology & Immunotherapy, University of Birmingham, Birmingham, UK
| | - Peter Johnson
- School of Cancer Sciences, University of Southampton, Southampton, UK
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Lee LYW, Ionescu MC, Starkey T, Little M, Tilby M, Tripathy AR, Mckenzie HS, Al-Hajji Y, Appanna N, Barnard M, Benny L, Burnett A, Cattell EL, Clark JJ, Khan S, Ghafoor Q, Panneerselvam H, Illsley G, Harper-Wynne C, Hattersley RJ, Lee AJ, Lomas O, Liu JK, McCauley A, Pang M, Pascoe JS, Platt JR, Patel G, Patel V, Potter VA, Randle A, Rigg AS, Robinson TM, Roques TW, Roux RL, Rozmanowski S, Taylor H, Tuthill MH, Watts I, Williams S, Beggs A, Iveson T, Lee SM, Middleton G, Middleton M, Protheroe A, Fittall MW, Fowler T, Johnson P. COVID-19: Third dose booster vaccine effectiveness against breakthrough coronavirus infection, hospitalisations and death in patients with cancer: A population-based study. Eur J Cancer 2022; 175:1-10. [PMID: 36084618 PMCID: PMC9276646 DOI: 10.1016/j.ejca.2022.06.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE People living with cancer and haematological malignancies are at an increased risk of hospitalisation and death following infection with acute respiratory syndrome coronavirus 2. Coronavirus third dose vaccine boosters are proposed to boost waning immune responses in immunocompromised individuals and increase coronavirus protection; however, their effectiveness has not yet been systematically evaluated. METHODS This study is a population-scale real-world evaluation of the United Kingdom's third dose vaccine booster programme for cancer patients from 8th December 2020 to 7th December 2021. The cancer cohort comprises individuals from Public Health England's national cancer dataset, excluding individuals less than 18 years. A test-negative case-control design was used to assess the third dose booster vaccine effectiveness. Multivariable logistic regression models were fitted to compare risk in the cancer cohort relative to the general population. RESULTS The cancer cohort comprised of 2,258,553 tests from 361,098 individuals. Third dose boosters were evaluated by reference to 87,039,743 polymerase chain reaction coronavirus tests. Vaccine effectiveness against breakthrough infections, symptomatic infections, coronavirus hospitalisation and death in cancer patients were 59.1%, 62.8%, 80.5% and 94.5%, respectively. Lower vaccine effectiveness was associated with a cancer diagnosis within 12 months, lymphoma, recent systemic anti-cancer therapy (SACT) or radiotherapy. Patients with lymphoma had low levels of protection from symptomatic disease. In spite of third dose boosters, following multivariable adjustment, individuals with cancer remain at an increased risk of coronavirus hospitalisation and death compared to the population control (OR 3.38, 3.01, respectively. p < 0.001 for both). CONCLUSIONS Third dose boosters are effective for most individuals with cancer, increasing protection from coronavirus. However, their effectiveness is heterogenous and lower than the general population. Many patients with cancer will remain at the increased risk of coronavirus infections even after 3 doses. In the case of patients with lymphoma, there is a particularly strong disparity of vaccine effectiveness against breakthrough infection and severe disease. Breakthrough infections will disrupt cancer care and treatment with potentially adverse consequences on survival outcomes. The data support the role of vaccine boosters in preventing severe disease, and further pharmacological intervention to prevent transmission and aid viral clearance to limit the disruption of cancer care as the delivery of care continues to evolve during the coronavirus pandemic.
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Affiliation(s)
- Lennard Y W Lee
- Department of Oncology, University of Oxford; Institute of Cancer and Genomic Sciences, University of Birmingham; Institute of Immunology and Immunotherapy, University of Birmingham.
| | | | - Thomas Starkey
- Institute of Cancer and Genomic Sciences, University of Birmingham
| | - Martin Little
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust
| | - Michael Tilby
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust
| | - Arvind R Tripathy
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust
| | - Hayley S Mckenzie
- Oncology Department, University Hospitals Southampton NHS Foundation Trust
| | | | | | | | | | | | - Emma L Cattell
- Department of Cancer, Taunton and Somerset NHS Foundation Trust
| | - James J Clark
- Department of Surgery and Cancer, Imperial College London
| | - Sam Khan
- Leicester Cancer Research Centre, University of Leicester
| | - Qamar Ghafoor
- University Hospitals Birmingham NHS Foundation Trust
| | | | | | | | | | - Alvin Jx Lee
- UCL Cancer Institute, University College London; University College London Hospitals NHS Trust
| | - Oliver Lomas
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust
| | - Justin Kh Liu
- Leeds Institute of Medical Research at St James's, University of Leeds
| | | | | | - Jennifer S Pascoe
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust
| | - James R Platt
- Leeds Institute of Medical Research at St James's, University of Leeds
| | - Grisma Patel
- Cancer Division, UCL Cancer Institute, University College London
| | | | - Vanessa A Potter
- Department of Oncology, University Hospital Coventry and Warwickshire
| | | | - Anne S Rigg
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust
| | | | - Tom W Roques
- Cancer Services, Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - René L Roux
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust
| | | | | | - Mark H Tuthill
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust
| | | | - Sarah Williams
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust
| | - Andrew Beggs
- Institute of Cancer and Genomic Sciences, University of Birmingham
| | - Tim Iveson
- Cancer Sciences, University of Southampton
| | - Siow M Lee
- UCL Cancer Institute, University College London; University College London Hospitals NHS Trust; CRUK Lung Cancer Centre of Excellence, University College London
| | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham; Department of Oncology, University Hospitals Birmingham NHS Foundation Trust
| | | | - Andrew Protheroe
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust
| | | | | | - Peter Johnson
- Department of Oncology, University Hospital Coventry and Warwickshire; Cancer Sciences, University of Southampton
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Middleton G, Liu W, Savage J, Bridgewater J, Ross P, Saunders M, Plummer R, Clive S, Coyle V, Thomas A, P. Taniere, Billingham L. 426P Assessing nivolumab in class II expressing microsatellite stable (pMMR) colorectal cancer (CRC): Results of the ANICCA-Class II trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Lee LYW, Starkey T, Ionescu MC, Little M, Tilby M, Tripathy AR, Mckenzie HS, Al-Hajji Y, Barnard M, Benny L, Burnett A, Cattell EL, Charman J, Clark JJ, Khan S, Ghafoor Q, Illsley G, Harper-Wynne C, Hattersley RJ, Lee AJX, Leonard PC, Liu JKH, Pang M, Pascoe JS, Platt JR, Potter VA, Randle A, Rigg AS, Robinson TM, Roques TW, Roux RL, Rozmanowski S, Tuthill MH, Watts I, Williams S, Iveson T, Lee SM, Middleton G, Middleton M, Protheroe A, Fittall MW, Fowler T, Johnson P. Vaccine effectiveness against COVID-19 breakthrough infections in patients with cancer (UKCCEP): a population-based test-negative case-control study. Lancet Oncol 2022; 23:748-757. [PMID: 35617989 PMCID: PMC9126559 DOI: 10.1016/s1470-2045(22)00202-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND People with cancer are at increased risk of hospitalisation and death following infection with SARS-CoV-2. Therefore, we aimed to conduct one of the first evaluations of vaccine effectiveness against breakthrough SARS-CoV-2 infections in patients with cancer at a population level. METHODS In this population-based test-negative case-control study of the UK Coronavirus Cancer Evaluation Project (UKCCEP), we extracted data from the UKCCEP registry on all SARS-CoV-2 PCR test results (from the Second Generation Surveillance System), vaccination records (from the National Immunisation Management Service), patient demographics, and cancer records from England, UK, from Dec 8, 2020, to Oct 15, 2021. Adults (aged ≥18 years) with cancer in the UKCCEP registry were identified via Public Health England's Rapid Cancer Registration Dataset between Jan 1, 2018, and April 30, 2021, and comprised the cancer cohort. We constructed a control population cohort from adults with PCR tests in the UKCCEP registry who were not contained within the Rapid Cancer Registration Dataset. The coprimary endpoints were overall vaccine effectiveness against breakthrough infections after the second dose (positive PCR COVID-19 test) and vaccine effectiveness against breakthrough infections at 3-6 months after the second dose in the cancer cohort and control population. FINDINGS The cancer cohort comprised 377 194 individuals, of whom 42 882 had breakthrough SARS-CoV-2 infections. The control population consisted of 28 010 955 individuals, of whom 5 748 708 had SARS-CoV-2 breakthrough infections. Overall vaccine effectiveness was 69·8% (95% CI 69·8-69·9) in the control population and 65·5% (65·1-65·9) in the cancer cohort. Vaccine effectiveness at 3-6 months was lower in the cancer cohort (47·0%, 46·3-47·6) than in the control population (61·4%, 61·4-61·5). INTERPRETATION COVID-19 vaccination is effective for individuals with cancer, conferring varying levels of protection against breakthrough infections. However, vaccine effectiveness is lower in patients with cancer than in the general population. COVID-19 vaccination for patients with cancer should be used in conjunction with non-pharmacological strategies and community-based antiviral treatment programmes to reduce the risk that COVID-19 poses to patients with cancer. FUNDING University of Oxford, University of Southampton, University of Birmingham, Department of Health and Social Care, and Blood Cancer UK.
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Affiliation(s)
- Lennard Y W Lee
- Department of Oncology, University of Oxford, Oxford, UK; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Thomas Starkey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | - Martin Little
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Michael Tilby
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Arvind R Tripathy
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Hayley S Mckenzie
- Oncology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Youssra Al-Hajji
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | | | | | | | - Emma L Cattell
- Department of Cancer, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Jackie Charman
- National Disease Registration Service, NHS Digital, London, UK
| | - James J Clark
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sam Khan
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - Qamar Ghafoor
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Catherine Harper-Wynne
- Kent Oncology Centre, University of Kent and Kent and Medway Medical School, Maidstone, UK
| | - Rosie J Hattersley
- Department of Oncology, Torbay Hospital NHS Foundation Trust, Torquay, UK
| | - Alvin J X Lee
- UCL Cancer Institute, University College London Hospitals NHS Trust and University College London, London, UK
| | - Pauline C Leonard
- Cancer Services, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - Justin K H Liu
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Matthew Pang
- Department of Health and Social Care, London, UK
| | - Jennifer S Pascoe
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - James R Platt
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Vanessa A Potter
- Department of Oncology, University Hospital Coventry and Warwickshire, Coventry, UK
| | | | - Anne S Rigg
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tim M Robinson
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Tom W Roques
- Cancer Services, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - René L Roux
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Mark H Tuthill
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Isabella Watts
- Department of Academic Oncology, Royal Free Hospital, London, UK
| | - Sarah Williams
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Tim Iveson
- Cancer Sciences, University of Southampton, Southampton, UK
| | - Siow Ming Lee
- UCL Cancer Institute, University College London Hospitals NHS Trust and University College London, London, UK; CRUK Lung Cancer Centre of Excellence, University College London Hospitals NHS Trust and University College London, London, UK
| | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK; Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mark Middleton
- Department of Oncology, University of Oxford, Oxford, UK
| | - Andrew Protheroe
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - Peter Johnson
- NHS England, London, UK; Cancer Sciences, University of Southampton, Southampton, UK
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Brown LC, Graham J, Fisher D, Adams R, Seligmann J, Seymour M, Kaplan R, Yates E, Parmar M, Richman SD, Quirke P, Butler R, Shiu K, Middleton G, Samuel L, Wilson RH, Maughan TS. Experiences of running a stratified medicine adaptive platform trial: Challenges and lessons learned from 10 years of the FOCUS4 trial in metastatic colorectal cancer. Clin Trials 2022; 19:146-157. [PMID: 35083924 PMCID: PMC9036145 DOI: 10.1177/17407745211069879] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Complex innovative design trials are becoming increasingly common and offer potential for improving patient outcomes in a faster time frame. FOCUS4 was the first molecularly stratified trial in metastatic colorectal cancer and it remains one of the first umbrella trial designs to be launched globally. Here, we aim to describe lessons learned from delivery of the trial over the last 10 years. METHODS FOCUS4 was a Phase II/III molecularly stratified umbrella trial testing the safety and efficacy of targeted therapies in metastatic colorectal cancer. It used adaptive statistical methodology to decide which sub-trial should close early, and new therapies were added as protocol amendments. Patients with newly diagnosed metastatic colorectal cancer were registered, and central laboratory testing was used to stratify their tumour into molecular subtypes. Following 16 weeks of first-line therapy, patients with stable or responding disease were eligible for randomisation into either a molecularly stratified sub-trial (FOCUS4-B, C or D) or non-stratified FOCUS4-N. The primary outcome for all studies was progression-free survival comparing the intervention with active monitoring/placebo. At the close of the trial, feedback was elicited from all investigators through surveys and interviews and consolidated into a series of recommendations and lessons learned for the delivery of similar future trials. RESULTS Between January 2014 and October 2020, 1434 patients were registered from 88 UK hospitals. Of the 20 drug combinations that were explored for inclusion in the platform trial, three molecularly targeted sub-trials were activated: FOCUS4-D (February 2014-March 2016) evaluated AZD8931 in the BRAF-PIK3CA-RAS wildtype subgroup; FOCUS4-B (February 2016-July 2018) evaluated aspirin in the PIK3CA mutant subgroup and FOCUS4-C (June 2017-October 2020) evaluated adavosertib in the RAS+TP53 double mutant subgroup. FOCUS4-N was active throughout and evaluated capecitabine monotherapy versus a treatment break. A total of 361 (25%) registered patients were randomised into a sub-trial. Feedback on the experiences of delivery of FOCUS4 could be grouped into three main areas of challenge: funding/infrastructure, biomarker testing procedures and trial design efficiencies within which 20 recommendations are summarised. CONCLUSION Adaptive stratified medicine platform studies are feasible in common cancers but present challenges. Our stakeholder feedback has helped to inform how these trial designs can succeed and answer multiple questions efficiently, providing resource is adequate.
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Affiliation(s)
| | - Janet Graham
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | - Richard Adams
- Centre for Trials Research, Cardiff University and Velindre NHS Trust, Cardiff, UK
| | - Jenny Seligmann
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
| | - Matthew Seymour
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
| | | | - Emma Yates
- MRC Clinical Trials Unit at UCL, London, UK
| | | | - Susan D Richman
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
| | - Philip Quirke
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
| | | | | | | | | | - Richard H Wilson
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Timothy S Maughan
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
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Fisher BA, Veenith T, Slade D, Gaskell C, Rowland M, Whitehouse T, Scriven J, Parekh D, Balasubramaniam MS, Cooke G, Morley N, Gabriel Z, Wise MP, Porter J, McShane H, Ho LP, Newsome PN, Rowe A, Sharpe R, Thickett DR, Bion J, Gates S, Richards D, Kearns P, Turner R, Libri V, Mussai F, Middleton G, Bowden S, Bangash M, Gao-Smith F, Patel J, Sapey E, Thomas M, Coles M, Watkinson P, Rahman N, Angus B, Mentzer AJ, Novak A, Feldman M, Richter A, Faustini S, Bathurst C, Van de Wiel J, Mee S, James K, Rahman B, Turner K, Hill A, Gordon A, Yap C, Matthay M, McAuley D, Hall A, Dark P, McMichael A. Namilumab or infliximab compared with standard of care in hospitalised patients with COVID-19 (CATALYST): a randomised, multicentre, multi-arm, multistage, open-label, adaptive, phase 2, proof-of-concept trial. Lancet Respir Med 2022; 10:255-266. [PMID: 34922649 PMCID: PMC8676420 DOI: 10.1016/s2213-2600(21)00460-4] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Dysregulated inflammation is associated with poor outcomes in COVID-19. We aimed to assess the efficacy of namilumab (a granulocyte-macrophage colony stimulating factor inhibitor) and infliximab (a tumour necrosis factor inhibitor) in hospitalised patients with COVID-19, to prioritise agents for phase 3 trials. METHODS In this randomised, multicentre, multi-arm, multistage, parallel-group, open-label, adaptive, phase 2, proof-of-concept trial (CATALYST), we recruited patients (aged ≥16 years) admitted to hospital with COVID-19 pneumonia and C-reactive protein (CRP) concentrations of 40 mg/L or greater, at nine hospitals in the UK. Participants were randomly assigned with equal probability to usual care or usual care plus a single intravenous dose of namilumab (150 mg) or infliximab (5 mg/kg). Randomisation was stratified by care location within the hospital (ward vs intensive care unit [ICU]). Patients and investigators were not masked to treatment allocation. The primary endpoint was improvement in inflammation, measured by CRP concentration over time, analysed using Bayesian multilevel models. This trial is now complete and is registered with ISRCTN, 40580903. FINDINGS Between June 15, 2020, and Feb 18, 2021, we screened 299 patients and 146 were enrolled and randomly assigned to usual care (n=54), namilumab (n=57), or infliximab (n=35). For the primary outcome, 45 patients in the usual care group were compared with 52 in the namilumab group, and 29 in the usual care group were compared with 28 in the infliximab group. The probabilities that the interventions were superior to usual care alone in reducing CRP concentration over time were 97% for namilumab and 15% for infliximab; the point estimates for treatment-time interactions were -0·09 (95% CI -0·19 to 0·00) for namilumab and 0·06 (-0·05 to 0·17) for infliximab. 134 adverse events occurred in 30 (55%) of 55 patients in the namilumab group compared with 145 in 29 (54%) of 54 in the usual care group. 102 adverse events occurred in 20 (69%) of 29 patients in the infliximab group compared with 112 in 17 (50%) of 34 in the usual care group. Death occurred in six (11%) patients in the namilumab group compared with ten (19%) in the usual care group, and in four (14%) in the infliximab group compared with five (15%) in the usual care group. INTERPRETATION Namilumab, but not infliximab, showed proof-of-concept evidence for reduction in inflammation-as measured by CRP concentration-in hospitalised patients with COVID-19 pneumonia. Namilumab should be prioritised for further investigation in COVID-19. FUNDING Medical Research Council.
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Affiliation(s)
- Benjamin A Fisher
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK,Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK,National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK,Correspondence to: Dr Benjamin A Fisher, Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Tonny Veenith
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK,Department of Critical Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Daniel Slade
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Charlotte Gaskell
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Matthew Rowland
- Kadoorie Centre for Critical Care Research, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Tony Whitehouse
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK,Department of Critical Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - James Scriven
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK,Department of Infectious Diseases, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dhruv Parekh
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK,Department of Critical Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK,Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Graham Cooke
- Department of Infectious Disease, Imperial College London, London, UK
| | - Nick Morley
- Department of Haematology, Royal Hallamshire Hospital, Sheffield, UK
| | - Zoe Gabriel
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Matthew P Wise
- Department of Critical Care Medicine, University Hospital of Wales, Cardiff, UK
| | - Joanna Porter
- Department of Respiratory Medicine, University College Hospital, London, UK
| | | | - Ling-Pei Ho
- Medical Research Council Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK,Oxford Interstitial Lung Disease Service, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Philip N Newsome
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK,National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Anna Rowe
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK,National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rowena Sharpe
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - David R Thickett
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK,Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Julian Bion
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK,Department of Critical Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Simon Gates
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Duncan Richards
- Oxford Clinical Trials Research Unit, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Pamela Kearns
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK,National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Middleton G, Rose K. 129 A rare presentation of bilateral tubal ectopic pregnancy after spontaneous conception. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Booth S, Curley HM, Varnai C, Arnold R, Lee LYW, Campton NA, Cook G, Purshouse K, Aries J, Innes A, Cook LB, Tomkins O, Oram HS, Tilby M, Kulasekararaj A, Wrench D, Dolly S, Newsom‐Davies T, Pettengell R, Gault A, Moody S, Mittal S, Altohami M, Tillet T, Illingworth J, Mukherjee L, Apperly J, Ashcroft J, Rabin N, Carmichael J, Cazier J, Kerr R, Middleton G, Collins GP, Palles C. Key findings from the UKCCMP cohort of 877 patients with haematological malignancy and COVID-19: disease control as an important factor relative to recent chemotherapy or anti-CD20 therapy. Br J Haematol 2022; 196:892-901. [PMID: 34761389 PMCID: PMC8652610 DOI: 10.1111/bjh.17937] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 12/13/2022]
Abstract
Patients with haematological malignancies have a high risk of severe infection and death from SARS-CoV-2. In this prospective observational study, we investigated the impact of cancer type, disease activity, and treatment in 877 unvaccinated UK patients with SARS-CoV-2 infection and active haematological cancer. The primary end-point was all-cause mortality. In a multivariate analysis adjusted for age, sex and comorbidities, the highest mortality was in patients with acute leukaemia [odds ratio (OR) = 1·73, 95% confidence interval (CI) 1·1-2·72, P = 0·017] and myeloma (OR 1·3, 95% CI 0·96-1·76, P = 0·08). Having uncontrolled cancer (newly diagnosed awaiting treatment as well as relapsed or progressive disease) was associated with increased mortality risk (OR = 2·45, 95% CI 1·09-5·5, P = 0·03), as was receiving second or beyond line of treatment (OR = 1·7, 95% CI 1·08-2·67, P = 0·023). We found no association between recent cytotoxic chemotherapy or anti-CD19/anti-CD20 treatment and increased risk of death within the limitations of the cohort size. Therefore, disease control is an important factor predicting mortality in the context of SARS-CoV-2 infection alongside the possible risks of therapies such as cytotoxic treatment or anti-CD19/anti-CD20 treatments.
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Affiliation(s)
- Stephen Booth
- Oxford NIHR Biomedical Research CentreDepartment of HaematologyChurchill HospitalOxfordUK
| | - Helen M. Curley
- Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
| | - Csilla Varnai
- Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
- Centre for Computational BiologyUniversity of BirminghamBirminghamUK
| | - Roland Arnold
- Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
| | - Lennard Y. W. Lee
- Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
- Department of OncologyOxford UniversityOxfordUK
| | - Naomi A. Campton
- Institute of Translational MedicineBirmingham Health PartnersBirminghamUK
| | - Gordon Cook
- NIHR (Leeds) MIC, LeedsSt James's Teaching Hospital, University of LeedsLeedsUK
| | - Karin Purshouse
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | | | | | | | | | | | | | | | - David Wrench
- Guys and St Thomas' NHS Foundation TrustLondonUK
| | | | | | - Ruth Pettengell
- St Georges University Hospitals NHS Foundation TrustLondonUK
| | - Abigail Gault
- NCCC Northern Centre for Cancer CareThe Newcastle Upon Tyne NHS Foundation TrustNewcastleUK
| | - Sam Moody
- NCCC Northern Centre for Cancer CareThe Newcastle Upon Tyne NHS Foundation TrustNewcastleUK
| | | | | | | | - Jack Illingworth
- BarkingHavering and Redbridge University Hospitals NHS TrustEssexUK
| | | | | | - John Ashcroft
- NIHR (Leeds) MIC, LeedsSt James's Teaching Hospital, University of LeedsLeedsUK
- Mid Yorkshire Hospitals NHS TrustWakefieldUK
| | - Neil Rabin
- University College London HospitalsLondonUK
| | - Jonathan Carmichael
- NIHR (Leeds) MIC, LeedsSt James's Teaching Hospital, University of LeedsLeedsUK
| | - Jean‐Baptiste Cazier
- Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
- Centre for Computational BiologyUniversity of BirminghamBirminghamUK
| | - Rachel Kerr
- Department of OncologyOxford UniversityOxfordUK
| | - Gary Middleton
- Institute of Immunology and ImmunotherapyUniversity of BirminghamEdgbastonBirminghamUK
| | - Graham P. Collins
- Oxford NIHR Biomedical Research CentreDepartment of HaematologyChurchill HospitalOxfordUK
| | - Claire Palles
- Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
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Middleton G, Robbins H, Andre F, Swanton C. A state-of-the-art review of stratified medicine in cancer: towards a future precision medicine strategy in cancer. Ann Oncol 2022; 33:143-157. [PMID: 34808340 DOI: 10.1016/j.annonc.2021.11.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Building on the success of targeted therapy in certain well-defined cancer genotypes, three platform studies-NCI-MATCH, LUNG-MAP and The National Lung Matrix Trial (NLMT)-have attempted to discover new genotype-matched therapies for people with cancer. PATIENTS AND METHODS We review the outputs from these platform studies. This review led us to propose a series of recommendations and considerations that we hope will inform future precision medicine programmes in cancer. RESULTS The three studies collectively screened over 13 000 patients. Across 37 genotype-matched cohorts, there have been 66/875 responders, with an overall response rate of 7.5%. Targeting copy number gain yielded 5/199 responses across nine biomarker-drug matched cohorts, with a response rate of 2.5%. CONCLUSIONS The majority of these studies used single-agent targeted therapies. Whilst preclinical data can suggest rational combination treatment to reverse adaptive resistance or block parallel activated pathways, there is an essential need for accurate modelling of the toxicity-activity trade-off of combinations. Agent selection is often suboptimal; dose expansion should only be carried out with agents with clear clinical proof of mechanism and high target selectivity. Targeting copy number change has been disappointing; it is crucial to define the drivers on shared amplicons that include the targeted aberration. Maximising outcomes with currently available targeted therapies requires moving towards a more contextualised stratified medicine acknowledging the criticality of the genomic, transcriptional and immunological context on which the targeted aberration is inscribed. Genomic complexity and instability is likely to be a leading cause of targeted therapy failure in genomically complex cancers. Preclinical models must be developed that more accurately capture the genomic complexity of human disease. The degree of attrition of studies carried out after standard-of-care therapy suggests that serious efforts be made to develop a suite of precision medicine studies in the minimal residual disease setting.
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Affiliation(s)
- G Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
| | - H Robbins
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - F Andre
- Institut Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Villejuif, France; PRISM Center for Precision Medicine
| | - C Swanton
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK; Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
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Várnai C, Palles C, Arnold R, Curley HM, Purshouse K, Cheng VWT, Booth S, Campton NA, Collins GP, Hughes DJ, Kulasekararaj AG, Lee AJX, Olsson-Brown AC, Sharma-Oates A, Van Hemelrijck M, Lee LYW, Kerr R, Middleton G, Cazier JB. Mortality Among Adults With Cancer Undergoing Chemotherapy or Immunotherapy and Infected With COVID-19. JAMA Netw Open 2022; 5:e220130. [PMID: 35188551 PMCID: PMC8861846 DOI: 10.1001/jamanetworkopen.2022.0130] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/14/2021] [Indexed: 12/20/2022] Open
Abstract
Importance Large cohorts of patients with active cancers and COVID-19 infection are needed to provide evidence of the association of recent cancer treatment and cancer type with COVID-19 mortality. Objective To evaluate whether systemic anticancer treatments (SACTs), tumor subtypes, patient demographic characteristics (age and sex), and comorbidities are associated with COVID-19 mortality. Design, Setting, and Participants The UK Coronavirus Cancer Monitoring Project (UKCCMP) is a prospective cohort study conducted at 69 UK cancer hospitals among adult patients (≥18 years) with an active cancer and a clinical diagnosis of COVID-19. Patients registered from March 18 to August 1, 2020, were included in this analysis. Exposures SACT, tumor subtype, patient demographic characteristics (eg, age, sex, body mass index, race and ethnicity, smoking history), and comorbidities were investigated. Main Outcomes and Measures The primary end point was all-cause mortality within the primary hospitalization. Results Overall, 2515 of 2786 patients registered during the study period were included; 1464 (58%) were men; and the median (IQR) age was 72 (62-80) years. The mortality rate was 38% (966 patients). The data suggest an association between higher mortality in patients with hematological malignant neoplasms irrespective of recent SACT, particularly in those with acute leukemias or myelodysplastic syndrome (OR, 2.16; 95% CI, 1.30-3.60) and myeloma or plasmacytoma (OR, 1.53; 95% CI, 1.04-2.26). Lung cancer was also significantly associated with higher COVID-19-related mortality (OR, 1.58; 95% CI, 1.11-2.25). No association between higher mortality and receiving chemotherapy in the 4 weeks before COVID-19 diagnosis was observed after correcting for the crucial confounders of age, sex, and comorbidities. An association between lower mortality and receiving immunotherapy in the 4 weeks before COVID-19 diagnosis was observed (immunotherapy vs no cancer therapy: OR, 0.52; 95% CI, 0.31-0.86). Conclusions and Relevance The findings of this study of patients with active cancer suggest that recent SACT is not associated with inferior outcomes from COVID-19 infection. This has relevance for the care of patients with cancer requiring treatment, particularly in countries experiencing an increase in COVID-19 case numbers. Important differences in outcomes among patients with hematological and lung cancers were observed.
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Affiliation(s)
- Csilla Várnai
- Centre for Computational Biology, University of Birmingham, Birmingham, United Kingdom
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
- Cancer Research UK Birmingham Centre, University of Birmingham, United Kingdom
| | - Claire Palles
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Roland Arnold
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Helen M. Curley
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Karin Purshouse
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Vinton W. T. Cheng
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Stephen Booth
- Oxford NIHR Biomedical Research Centre, Department of Haematology, Churchill Hospital, Oxford, United Kingdom
| | - Naomi A. Campton
- Institute of Translational Medicine, Birmingham Health Partners, Birmingham, United Kingdom
| | - Graham P. Collins
- Oxford NIHR Biomedical Research Centre, Department of Haematology, Churchill Hospital, Oxford, United Kingdom
| | - Daniel J. Hughes
- Department of Cancer Imaging, King’s College London, London, United Kingdom
| | | | - Alvin J. X. Lee
- UCL Cancer Institute, University College London, London, United Kingdom
| | - Anna C. Olsson-Brown
- The Clatterbridge Cancer Centre, Wirral, United Kingdom
- The University of Liverpool, Liverpool, United Kingdom
| | - Archana Sharma-Oates
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Lennard Y. W. Lee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
- Department of Oncology, Oxford University, Oxford, United Kingdom
| | - Rachel Kerr
- Department of Oncology, Oxford University, Oxford, United Kingdom
| | - Gary Middleton
- Cancer Research UK Birmingham Centre, University of Birmingham, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Jean-Baptiste Cazier
- Centre for Computational Biology, University of Birmingham, Birmingham, United Kingdom
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
- Cancer Research UK Birmingham Centre, University of Birmingham, United Kingdom
- Queen Elizabeth Hospital, Birmingham, United Kingdom
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20
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Adams RA, Fisher DJ, Graham J, Seligmann JF, Seymour M, Kaplan R, Yates E, Parmar M, Richman SD, Quirke P, Butler R, Brown E, Collinson F, Falk S, Wasan H, Shiu KK, Middleton G, Samuel L, Wilson RH, Brown LC, Maughan TS. Capecitabine Versus Active Monitoring in Stable or Responding Metastatic Colorectal Cancer After 16 Weeks of First-Line Therapy: Results of the Randomized FOCUS4-N Trial. J Clin Oncol 2021; 39:3693-3704. [PMID: 34516759 PMCID: PMC8601309 DOI: 10.1200/jco.21.01436] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/04/2021] [Accepted: 08/16/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Despite extensive randomized evidence supporting the use of treatment breaks in metastatic colorectal cancer (mCRC), they are not universally offered to patients despite improvements in quality of life without detriment to overall survival (OS). FOCUS4-N was set up to explore the impact of oral maintenance therapy in patients who are responding to first-line therapy. METHODS FOCUS4 was a molecularly stratified trial program that registered patients with newly diagnosed mCRC. The FOCUS4-N trial was offered to patients in whom a targeted subtrial was unavailable or biomarker tests failed. Patients were randomly assigned using a 1:1 ratio between maintenance capecitabine and active monitoring (AM). The primary outcome was progression-free survival (PFS) with secondary outcomes including OS toxicity and tolerability. RESULTS Between March 2014 and March 2020, 254 patients were randomly assigned (127 to capecitabine and 127 to AM) across 88 UK sites. Baseline characteristics were balanced. There was strong evidence of efficacy for PFS (hazard ratio = 0.40; 95% CI, 0.21 to 0.75; P < .0001), but no significant improvement in OS (hazard ratio, 0.93; 95% CI, 0.69 to 1.27; P = .66) was observed. Compliance with treatment was good, and toxicity from capecitabine versus AM was as expected with grade ≥ 2 fatigue (25% v 12%), diarrhea (23% v 13%), and hand-foot syndrome (26% v 3%). Quality of life showed little difference between the groups. CONCLUSION Despite strong evidence of disease control with maintenance therapy, OS remains unaffected and FOCUS4-N provides additional evidence to support the use of treatment breaks as safe management alternatives for patients who are stable or responding to first-line treatment for mCRC. Capecitabine without bevacizumab may be used to extend PFS in the interval after 16 weeks of first-line therapy.
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Affiliation(s)
- Richard A. Adams
- Centre for Trials Research Cardiff University and Velindre NHS Trust, Cardiff, United Kingdom
| | | | - Janet Graham
- University of Glasgow and Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Jenny F. Seligmann
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Matthew Seymour
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | | | - Emma Yates
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | - Mahesh Parmar
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | - Susan D. Richman
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Philip Quirke
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Rachel Butler
- Bristol Genetics Laboratory, Bristol, United Kingdom
| | - Ewan Brown
- Western General Hospital, Edinburgh, United Kingdom
| | - Fiona Collinson
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Stephen Falk
- Bristol Cancer Institute, Bristol, United Kingdom
| | | | - Kai-Keen Shiu
- University College Hospital London, London, United Kingdom
| | | | | | - Richard H. Wilson
- University of Glasgow and Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | - Timothy S. Maughan
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
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21
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Smyth EC, Vlachogiannis G, Hedayat S, Harbery A, Hulkki-Wilson S, Salati M, Kouvelakis K, Fernandez-Mateos J, Cresswell GD, Fontana E, Seidlitz T, Peckitt C, Hahne JC, Lampis A, Begum R, Watkins D, Rao S, Starling N, Waddell T, Okines A, Crosby T, Mansoor W, Wadsley J, Middleton G, Fassan M, Wotherspoon A, Braconi C, Chau I, Vivanco I, Sottoriva A, Stange DE, Cunningham D, Valeri N. EGFR amplification and outcome in a randomised phase III trial of chemotherapy alone or chemotherapy plus panitumumab for advanced gastro-oesophageal cancers. Gut 2021; 70:1632-1641. [PMID: 33199443 PMCID: PMC8355876 DOI: 10.1136/gutjnl-2020-322658] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Epidermal growth factor receptor (EGFR) inhibition may be effective in biomarker-selected populations of advanced gastro-oesophageal adenocarcinoma (aGEA) patients. Here, we tested the association between outcome and EGFR copy number (CN) in pretreatment tissue and plasma cell-free DNA (cfDNA) of patients enrolled in a randomised first-line phase III clinical trial of chemotherapy or chemotherapy plus the anti-EGFR monoclonal antibody panitumumab in aGEA (NCT00824785). DESIGN EGFR CN by either fluorescence in situ hybridisation (n=114) or digital-droplet PCR in tissues (n=250) and plasma cfDNAs (n=354) was available for 474 (86%) patients in the intention-to-treat (ITT) population. Tissue and plasma low-pass whole-genome sequencing was used to screen for coamplifications in receptor tyrosine kinases. Interaction between chemotherapy and EGFR inhibitors was modelled in patient-derived organoids (PDOs) from aGEA patients. RESULTS EGFR amplification in cfDNA correlated with poor survival in the ITT population and similar trends were observed when the analysis was conducted in tissue and plasma by treatment arm. EGFR inhibition in combination with chemotherapy did not correlate with improved survival, even in patients with significant EGFR CN gains. Addition of anti-EGFR inhibitors to the chemotherapy agent epirubicin in PDOs, resulted in a paradoxical increase in viability and accelerated progression through the cell cycle, associated with p21 and cyclin B1 downregulation and cyclin E1 upregulation, selectively in organoids from EGFR-amplified aGEA. CONCLUSION EGFR CN can be accurately measured in tissue and liquid biopsies and may be used for the selection of aGEA patients. EGFR inhibitors may antagonise the antitumour effect of anthracyclines with important implications for the design of future combinatorial trials.
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Affiliation(s)
- Elizabeth C Smyth
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Medicine, Royal Marsden Hospital NHS Trust, London, UK
| | - Georgios Vlachogiannis
- Molecular Pathology, The Institute of Cancer Research, Sutton, UK
- Centre for Evolution and Cancer, The Institute of Cancer Research, Sutton, UK
| | - Somaieh Hedayat
- Molecular Pathology, The Institute of Cancer Research, Sutton, UK
- Centre for Evolution and Cancer, The Institute of Cancer Research, Sutton, UK
| | - Alice Harbery
- Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK
| | | | - Massimiliano Salati
- Molecular Pathology, The Institute of Cancer Research, Sutton, UK
- Centre for Evolution and Cancer, The Institute of Cancer Research, Sutton, UK
| | - Kyriakos Kouvelakis
- Clinical Research & Development, Royal Marsden Hospital NHS Trust, London, UK
| | | | - George D Cresswell
- Centre for Evolution and Cancer, The Institute of Cancer Research, Sutton, UK
| | - Elisa Fontana
- Molecular Pathology, The Institute of Cancer Research, Sutton, UK
| | - Therese Seidlitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Clare Peckitt
- Clinical Research & Development, Royal Marsden Hospital NHS Trust, London, UK
| | - Jens C Hahne
- Molecular Pathology, The Institute of Cancer Research, Sutton, UK
- Centre for Evolution and Cancer, The Institute of Cancer Research, Sutton, UK
| | - Andrea Lampis
- Molecular Pathology, The Institute of Cancer Research, Sutton, UK
- Centre for Evolution and Cancer, The Institute of Cancer Research, Sutton, UK
| | - Ruwaida Begum
- Department of Medicine, Royal Marsden Hospital NHS Trust, London, UK
| | - David Watkins
- Department of Medicine, Royal Marsden Hospital NHS Trust, London, UK
| | - Sheela Rao
- Department of Medicine, Royal Marsden Hospital NHS Trust, London, UK
| | - Naureen Starling
- Department of Medicine, Royal Marsden Hospital NHS Trust, London, UK
| | - Tom Waddell
- Department of Medicine, Royal Marsden Hospital NHS Trust, London, UK
- Department of Medical Oncology, Christie Hospital, Manchester, UK
| | - Alicia Okines
- Department of Medicine, Royal Marsden Hospital NHS Trust, London, UK
| | - Tom Crosby
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, UK
| | - Was Mansoor
- Department of Medical Oncology, Christie Hospital, Manchester, UK
| | - Jonathan Wadsley
- Cancer Clinical Trials Centre, Weston Park Cancer Centre, Sheffield, UK
| | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Matteo Fassan
- Department of Medicine (DIMED), University of Padua, Padova, Italy
| | | | - Chiara Braconi
- Department of Medicine, Royal Marsden Hospital NHS Trust, London, UK
- Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Ian Chau
- Department of Medicine, Royal Marsden Hospital NHS Trust, London, UK
| | - Igor Vivanco
- Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK
| | - Andrea Sottoriva
- Centre for Evolution and Cancer, The Institute of Cancer Research, Sutton, UK
| | - Daniel E Stange
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, Heidelberg, Germany
- National Center for Tumor Diseases, Partner Site Dresden, Heidelberg, Germany
| | - David Cunningham
- Department of Medicine, Royal Marsden Hospital NHS Trust, London, UK
| | - Nicola Valeri
- Department of Medicine, Royal Marsden Hospital NHS Trust, London, UK
- Molecular Pathology, The Institute of Cancer Research, Sutton, UK
- Centre for Evolution and Cancer, The Institute of Cancer Research, Sutton, UK
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23
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Jamal-Hanjani M, Greystoke A, Thistlethwaite F, Summers YJ, Allison J, Cave J, Orchard K, Ottensmeier C, Middleton G, Khoja L, Grant M, Patel S, Robertson J, Peggs K, Forster M. An open-label, multicenter phase I/IIa study evaluating the safety and clinical activity of clonal neoantigen reactive T cells in patients with advanced non-small cell lung cancer (CHIRON). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps9138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS9138 Background: Lung cancer is the most common cause of cancer-related death worldwide with over 1.6 million deaths per year. Non-small cell lung cancer (NSCLC) accounts for 80% of cases, the majority of which are adenocarcinomas. 75% of patients present with inoperable tumours and/or with distant metastatic spread, with 5-year survival for stage IV disease as low as 5%. Treatment options include chemotherapy, targeted therapies for specific mutations, and - increasingly - immune checkpoint inhibitors (CPI). Adoptive cell therapies (ACT) can produce durable responses in pre-treated NSCLC. Evidence also suggests potential benefit of combining ACT with CPIs, even after acquired resistance. Efforts to improve efficacy include the expansion of T cells able to recognise patient-specific clonal tumour neoantigens. Clonal tumour neoantigens arise early in cancer evolution and represent a subset of patient-specific mutations present in all cancer cells. Developing ACTs that target clonal neoantigens represents a personalised approach to treating all cancer cells concurrently, minimising the risk of tumour escape and reducing potential for off-target toxicities. Insights gained from applying the PELEUS bioinformatic platform (developed using UK TRACERx study data) to matched tumour and blood samples from NSCLC patients – as part of a tissue acquisition study (NCT03517917) – has enabled the manufacture of a personalized clonal neoantigen-reactive T cell (cNeT) product (ATL001), which is now in clinical development. Methods: The CHIRON Study (NCT04032847), is a first-in-human, open-label, multi-centre, phase I/IIa study to characterise the safety and clinical activity of ATL001 administered intravenously in up to 40 adults with advanced unresectable or metastatic NSCLC. Following consent and screening, patients enter the study for procurement of tumor tissue and blood to manufacture ATL001. Tissue may be procured during treatment with standard systemic therapies. Patients in Cohort A receive cyclophosphamide/fludarabine on days -6 to -4, followed by a single dose of ATL001 and 10 daily doses of subcutaneous IL-2; Patients in Cohort B will additionally receive one dose of pembrolizumab between days -13 and -6 before receiving ATL001, then restart pembrolizumab 2 weeks after receiving ATL001 and continue for up to 12 months. Key eligibility criteria include treatment with at least one prior systemic therapy (including a PD-1 inhibitor). Primary endpoints are the safety and tolerability of ATL001 as a monotherapy and in combination with pembrolizumab. Secondary endpoints include change in tumor size and response rate by RECIST 1.1 and imRECIST. Correlative studies will investigate the effects of cNeT dose and engraftment kinetics on clinical activity. The study began enrolling patients in Cohort A in August 2019. Clinical trial information: NCT04032847.
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Affiliation(s)
| | | | - Fiona Thistlethwaite
- The Christie NHS Foundation Trust and University of Manchester, Manchester, United Kingdom
| | - Yvonne J. Summers
- The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | | | - Judith Cave
- Southampton University Hospitals NHS Trust, Brockenhurst, United Kingdom
| | - Kim Orchard
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | - Gary Middleton
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Leila Khoja
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | - Karl Peggs
- Achilles Therapeutics Ltd, London, United Kingdom
| | - Martin Forster
- University College London Hospitals NHS Foundation, London, United Kingdom
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24
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Sobrero A, Lenz H, Eng C, Scheithauer W, Middleton G, Chen W, Esser R, Nippgen J, Burris H. Extended RAS Analysis of the Phase III EPIC Trial: Irinotecan + Cetuximab Versus Irinotecan as Second-Line Treatment for Patients with Metastatic Colorectal Cancer. Oncologist 2021; 26:e261-e269. [PMID: 33191588 PMCID: PMC7873334 DOI: 10.1002/onco.13591] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/23/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The multicenter, open-label, randomized, phase III EPIC study (EMR 062202-025) investigated cetuximab plus irinotecan versus irinotecan in patients with epidermal growth factor receptor-detectable metastatic colorectal cancer (mCRC) that progressed on first-line fluoropyrimidine- and oxaliplatin-based chemotherapy; we report the outcomes of patients with RAS-wild-type (wt) disease. MATERIALS AND METHODS Available DNA samples from RAS-unselected patients (n = 1,164 of 1,298 [89.7%]) were reanalyzed for RAS mutations using beads, emulsion, amplification, and magnetics. Baseline characteristics, efficacy, safety, and poststudy therapy were assessed. RAS-wt status was defined as a mutated RAS allele frequency of ≤5%, with all relevant alleles being analyzable. RESULTS Baseline characteristics were comparable between the groups (n = 452 patients with RAS-wt mCRC; cetuximab plus irinotecan n = 231, irinotecan n = 221) and between the RAS-wt and RAS-unselected populations. In the cetuximab plus irinotecan versus irinotecan arms, median overall survival was 12.3 versus 12.0 months, median progression-free survival (PFS) was 5.4 versus 2.6 months, and objective response rate (ORR) was 29.4% versus 5.0%, respectively. Quality of life (QoL) was improved in the cetuximab plus irinotecan arm. Serious adverse events occurred in 45.4% (cetuximab plus irinotecan) and 42.4% (irinotecan) of patients. In total, 47.1% of patients in the irinotecan arm received subsequent cetuximab therapy. CONCLUSION PFS, ORR, and QoL were improved with cetuximab plus irinotecan as a second-line treatment in patients with RAS-wt mCRC, confirming that cetuximab-based therapy is suitable in this population. Almost half of patients in the irinotecan arm received poststudy cetuximab, masking a potential overall survival benefit of cetuximab addition. IMPLICATIONS FOR PRACTICE Cetuximab is approved for the treatment of RAS-wild-type metastatic colorectal cancer (mCRC). In this retrospective analysis of the phase III EPIC study (cetuximab plus irinotecan vs. irinotecan alone as second-line treatment in patients with RAS-unselected mCRC), the subgroup of patients with RAS-wild-type mCRC who received cetuximab plus irinotecan had improved progression-free survival, objective response rate, and quality of life compared with the RAS-unselected population. These findings suggest that cetuximab-based therapy is a suitable second-line treatment for patients with RAS-wild-type mCRC.
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Affiliation(s)
| | - Heinz‐Josef Lenz
- Keck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Cathy Eng
- University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | | | - Gary Middleton
- College of Medical and Dental Sciences, University of BirminghamBirminghamUnited Kingdom
| | - Wenfeng Chen
- Merck Serono Co., Ltd., China, an affiliate of Merck KGaADarmstadtGermany
| | | | - Johannes Nippgen
- Merck Serono Co., Ltd., China, an affiliate of Merck KGaADarmstadtGermany
| | - Howard Burris
- Tennessee Oncology Sarah Cannon Research InstituteNashvilleTennesseeUSA
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Middleton G. Beyond Ipilimumab: a review of immunotherapeutic approaches in clinical trials in melanoma. Immunotherapy Advances 2020; 1:ltaa010. [PMID: 36284898 PMCID: PMC9585671 DOI: 10.1093/immadv/ltaa010] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/17/2020] [Accepted: 12/16/2020] [Indexed: 02/07/2023] Open
Abstract
In this first in a series of ‘Trials Watch’ articles, we briefly review a highly selected set of clinical trials that are currently recruiting or about to open to recruitment in melanoma, the disease first transformed by the introduction of immune checkpoint blockade inhibitors (ICI). We place equal emphasis on phase I/II studies investigating the activity of biologically compelling novel immunotherapeutics, and on randomised trials of ICI with and without novel agents, as these latter studies optimise the standard-of-care use of ICI, and determine whether novel agents become part of the approved therapeutic armamentarium. We do not consider here combination therapy with other checkpoint antagonists or agonists besides combination of anti-PD-1/PD-L1 monoclonal antibodies (mAbs) with anti-CTLA4 mAbs, as these will be reviewed in a subsequent article in this series. A glossary of agents to be discussed is found at the end of this article.
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Affiliation(s)
- Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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26
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Marcon F, Zuo J, Pearce H, Nicol S, Margielewska-Davies S, Farhat M, Mahon B, Middleton G, Brown R, Roberts KJ, Moss P. NK cells in pancreatic cancer demonstrate impaired cytotoxicity and a regulatory IL-10 phenotype. Oncoimmunology 2020; 9:1845424. [PMID: 33299656 PMCID: PMC7714501 DOI: 10.1080/2162402x.2020.1845424] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the most common tumor subtypes and remains associated with very poor survival. T cell infiltration into tumor tissue is associated with improved clinical outcome but little is known regarding the potential role of NK cells in disease control. Here we analyze the phenotype and function of NK cells in the blood and tumor tissue from patients with PDAC. Peripheral NK cells are present in normal numbers but display a CD16hiCD57hi phenotype with marked downregulation of NKG2D. Importantly, these cells demonstrate reduced cytotoxic activity and low levels of IFN-γ expression but instead produce high levels of intracellular IL-10, an immunoregulatory cytokine found at increased levels in the blood of PDAC patients. In contrast, NK cells are largely excluded from tumor tissue where they display strong downregulation of both CD16 and CD57, a phenotype that was recapitulated in primary NK cells following co-culture with PDAC organoids. Moreover, expression of activatory proteins, including DNAM-1 and NKP30, was markedly suppressed and the DNAM-1 ligand PVR was strongly expressed on tumor cells. As such, in situ and peripheral NK cells display differential features in patients with PDAC and indicate local and systemic mechanisms by which the tumor can evade immune control. These findings offer a number of potential options for NK-based immunotherapy in the management of patients with PDAC.
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Affiliation(s)
- Francesca Marcon
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham;UK
| | - Jianmin Zuo
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Hayden Pearce
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Samantha Nicol
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sandra Margielewska-Davies
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Mustafa Farhat
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Brinder Mahon
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham;UK
| | - Gary Middleton
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Rachel Brown
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham;UK
| | - Keith J. Roberts
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham;UK
| | - Paul Moss
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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27
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Lee LYW, Cazier JB, Starkey T, Briggs SEW, Arnold R, Bisht V, Booth S, Campton NA, Cheng VWT, Collins G, Curley HM, Earwaker P, Fittall MW, Gennatas S, Goel A, Hartley S, Hughes DJ, Kerr D, Lee AJX, Lee RJ, Lee SM, Mckenzie H, Middleton CP, Murugaesu N, Newsom-Davis T, Olsson-Brown AC, Palles C, Powles T, Protheroe EA, Purshouse K, Sharma-Oates A, Sivakumar S, Smith AJ, Topping O, Turnbull CD, Várnai C, Briggs ADM, Middleton G, Kerr R. COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study. Lancet Oncol 2020; 21:1309-1316. [PMID: 32853557 PMCID: PMC7444972 DOI: 10.1016/s1470-2045(20)30442-3] [Citation(s) in RCA: 399] [Impact Index Per Article: 99.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with cancer are purported to have poor COVID-19 outcomes. However, cancer is a heterogeneous group of diseases, encompassing a spectrum of tumour subtypes. The aim of this study was to investigate COVID-19 risk according to tumour subtype and patient demographics in patients with cancer in the UK. METHODS We compared adult patients with cancer enrolled in the UK Coronavirus Cancer Monitoring Project (UKCCMP) cohort between March 18 and May 8, 2020, with a parallel non-COVID-19 UK cancer control population from the UK Office for National Statistics (2017 data). The primary outcome of the study was the effect of primary tumour subtype, age, and sex and on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) prevalence and the case-fatality rate during hospital admission. We analysed the effect of tumour subtype and patient demographics (age and sex) on prevalence and mortality from COVID-19 using univariable and multivariable models. FINDINGS 319 (30·6%) of 1044 patients in the UKCCMP cohort died, 295 (92·5%) of whom had a cause of death recorded as due to COVID-19. The all-cause case-fatality rate in patients with cancer after SARS-CoV-2 infection was significantly associated with increasing age, rising from 0·10 in patients aged 40-49 years to 0·48 in those aged 80 years and older. Patients with haematological malignancies (leukaemia, lymphoma, and myeloma) had a more severe COVID-19 trajectory compared with patients with solid organ tumours (odds ratio [OR] 1·57, 95% CI 1·15-2·15; p<0·0043). Compared with the rest of the UKCCMP cohort, patients with leukaemia showed a significantly increased case-fatality rate (2·25, 1·13-4·57; p=0·023). After correction for age and sex, patients with haematological malignancies who had recent chemotherapy had an increased risk of death during COVID-19-associated hospital admission (OR 2·09, 95% CI 1·09-4·08; p=0·028). INTERPRETATION Patients with cancer with different tumour types have differing susceptibility to SARS-CoV-2 infection and COVID-19 phenotypes. We generated individualised risk tables for patients with cancer, considering age, sex, and tumour subtype. Our results could be useful to assist physicians in informed risk-benefit discussions to explain COVID-19 risk and enable an evidenced-based approach to national social isolation policies. FUNDING University of Birmingham and University of Oxford.
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Affiliation(s)
- Lennard Y W Lee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Department of Oncology, University of Oxford, Oxford, UK; University Hospitals Birmingham, Birmingham, UK
| | - Jean-Baptiste Cazier
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Computational Biology, University of Birmingham, Birmingham, UK
| | - Thomas Starkey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Sarah E W Briggs
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Roland Arnold
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Vartika Bisht
- Centre for Computational Biology, University of Birmingham, Birmingham, UK
| | - Stephen Booth
- Department of Haematology, University of Oxford, Oxford, UK
| | - Naomi A Campton
- Institute of Translational Medicine, Birmingham Health Partners, Birmingham, UK
| | - Vinton W T Cheng
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Graham Collins
- Department of Haematology, University of Oxford, Oxford, UK
| | - Helen M Curley
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | | | | | - Anshita Goel
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Simon Hartley
- Centre for Computational Biology, University of Birmingham, Birmingham, UK; Advanced Research Computing, University of Birmingham, Birmingham, UK
| | - Daniel J Hughes
- Department of Cancer Imaging, King's College London, London, UK
| | - David Kerr
- Nuffield Division of Clinical and Laboratory Services, University of Oxford, Oxford, UK
| | - Alvin J X Lee
- UCL Cancer Institute, University College London, London, UK
| | - Rebecca J Lee
- The University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | | | | | - Chris P Middleton
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Computational Biology, University of Birmingham, Birmingham, UK
| | - Nirupa Murugaesu
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Tom Newsom-Davis
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Claire Palles
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | - Emily A Protheroe
- University of Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Karin Purshouse
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
| | | | | | | | | | - Chris D Turnbull
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Csilla Várnai
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Computational Biology, University of Birmingham, Birmingham, UK
| | | | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK; University Hospitals Birmingham, Birmingham, UK.
| | - Rachel Kerr
- Department of Oncology, University of Oxford, Oxford, UK
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28
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Lee LYW, Hill T, Topping O, Tilby M, Baker M, Greig J, Isherwood L, Miller R, Petrenko Y, Desai R, Field A, Kennedy B, Khan S, Kountourou A, Ndlovu S, Starkey T, Storey F, Turner L, Vaughan-Williams W, Moyler S, Preston H, Latty B, Walker S, Henderson DR, Thompson J, Jones N, Ghafoor Q, Pascoe J, Williams S, Middleton G. Utility of COVID-19 Screening in Cancer Patients. Cancer Cell 2020; 38:306-307. [PMID: 32730750 PMCID: PMC7380207 DOI: 10.1016/j.ccell.2020.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Lennard Y W Lee
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Cancer and Genomic Sciences, University of Birmingham, UK.
| | - Thomas Hill
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Oliver Topping
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Michael Tilby
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mark Baker
- University of Birmingham Medical School, University of Birmingham, UK
| | - Julian Greig
- University of Birmingham Medical School, University of Birmingham, UK
| | | | - Robert Miller
- University of Birmingham Medical School, University of Birmingham, UK
| | - Yuriy Petrenko
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ruchi Desai
- University of Birmingham Medical School, University of Birmingham, UK
| | - Alice Field
- University of Birmingham Medical School, University of Birmingham, UK
| | - Bethany Kennedy
- University of Birmingham Medical School, University of Birmingham, UK
| | - Shahbano Khan
- University of Birmingham Medical School, University of Birmingham, UK
| | | | - Sandisile Ndlovu
- University of Birmingham Medical School, University of Birmingham, UK
| | - Thomas Starkey
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Cancer and Genomic Sciences, University of Birmingham, UK
| | - Francesca Storey
- University of Birmingham Medical School, University of Birmingham, UK
| | - Lucy Turner
- University of Birmingham Medical School, University of Birmingham, UK
| | | | - Surrinder Moyler
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Helen Preston
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Beverley Latty
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sharon Walker
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Daniel R Henderson
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Joyce Thompson
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nicola Jones
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Qamar Ghafoor
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jenny Pascoe
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sarah Williams
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gary Middleton
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Immunology and Immunotherapy, University of Birmingham, UK.
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Middleton G, Fletcher P, Popat S, Savage J, Summers Y, Greystoke A, Gilligan D, Cave J, O'Rourke N, Brewster A, Toy E, Spicer J, Jain P, Dangoor A, Mackean M, Forster M, Farley A, Wherton D, Mehmi M, Sharpe R, Mills TC, Cerone MA, Yap TA, Watkins TBK, Lim E, Swanton C, Billingham L. Publisher Correction: The National Lung Matrix Trial of personalized therapy in lung cancer. Nature 2020; 585:E21. [PMID: 32887973 DOI: 10.1038/s41586-020-2656-3] [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] [Indexed: 11/09/2022]
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Affiliation(s)
- Gary Middleton
- Institute of Immunology & Immunotherapy, University of Birmingham, Birmingham, UK. .,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Peter Fletcher
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Joshua Savage
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | | | | | - Judith Cave
- Southampton University Hospitals NHS Trust, Southampton, UK
| | | | | | - Elizabeth Toy
- Royal Devon and Exeter Foundation NHS Trust, Exeter, UK
| | - James Spicer
- King's College London, Guy's Hospital, London, UK
| | - Pooja Jain
- St James's University Hospital, Leeds, UK
| | - Adam Dangoor
- Bristol Haematology and Oncology Centre, Bristol, UK
| | | | | | - Amanda Farley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Dee Wherton
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Manita Mehmi
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Rowena Sharpe
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | | | - Timothy A Yap
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Charles Swanton
- The Francis Crick Institute, London, UK.,Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, University College London, London, UK
| | - Lucinda Billingham
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
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30
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Olsson-Brown A, Hughes D, Purshouse K, Lee L, Cheng V, Lee A, Protheroe E, Smith A, Curley H, Arnold R, Cazier JB, D'Costa J, Palles C, Campton N, Varnai C, Sivakumar S, Kerr R, Middleton G. 1703P UK Coronavirus Cancer Monitoring Project (UKCCMP): A national reporting network for real time data of the COVID-19 pandemic. Ann Oncol 2020. [PMCID: PMC7506390 DOI: 10.1016/j.annonc.2020.08.1767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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31
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Lee L, Starkey T, Cazier JB, Kerr R, Middleton G. 1677MO COVID-19 mortality in hospitalized cancer patients is not significantly affected by chemotherapy or other anti-cancer treatments. Ann Oncol 2020. [PMCID: PMC7506400 DOI: 10.1016/j.annonc.2020.08.1742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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32
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Pickles OJ, Lee LYW, Starkey T, Freeman-Mills L, Olsson-Brown A, Cheng V, Hughes DJ, Lee A, Purshouse K, Middleton G. Immune checkpoint blockade: releasing the breaks or a protective barrier to COVID-19 severe acute respiratory syndrome? Br J Cancer 2020; 123:691-693. [PMID: 32546835 PMCID: PMC7296191 DOI: 10.1038/s41416-020-0930-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/12/2020] [Accepted: 05/21/2020] [Indexed: 01/04/2023] Open
Abstract
The rapid emergence of COVID-19 has sent shockwaves through healthcare systems globally, with cancer patients at increased risk. The interplay of the virus and host immune system has been implicated in the development of ARDS. Immunotherapy agents have the potential to adversely potentiate this phenomenon, requiring careful real-world observation.
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Affiliation(s)
- Oliver J Pickles
- Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Lennard Y W Lee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Thomas Starkey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Luke Freeman-Mills
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | - Anna Olsson-Brown
- Clatterbridge Cancer Centre, Bebington, Wirral, CH63 4JY, UK
- Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3GL, UK
| | - Vinton Cheng
- Leeds Cancer Centre, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Daniel J Hughes
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Alvin Lee
- UCL Cancer Institute, University College London, London, WC1E 6BT, UK
| | - Karin Purshouse
- Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, EH4 2XR, UK
| | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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33
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Middleton G, Brock K, Savage J, Mant R, Summers Y, Connibear J, Shah R, Ottensmeier C, Shaw P, Lee SM, Popat S, Barrie C, Barone G, Billingham L. Pembrolizumab in patients with non-small-cell lung cancer of performance status 2 (PePS2): a single arm, phase 2 trial. Lancet Respir Med 2020; 8:895-904. [PMID: 32199466 DOI: 10.1016/s2213-2600(20)30033-3] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Therapeutic blockade of the axis of programmed cell death 1 (PD-1) and its ligand (PD-L1) has transformed the management of non-small-cell lung cancer (NSCLC). Clinical trials with pembrolizumab have enrolled patients with performance status (PS) 0-1. However, around 18% of patients with NSCLC are PS2, and the activity and safety of pembrolizumab in these patients is unclear. We aimed to evaluate the safety and efficacy of pembrolizumab in these patients. METHODS We did a multicentre, single-arm, open-label, phase 2 trial (PePS2) in ten hospitals in the UK, in which patients with NSCLC and a rigorous ascription of PS2 were given pembrolizumab 200 mg every 3 weeks. No masking was used in this trial. We stratified the treatment evaluation by tumour proportion score (TPS) and line of therapy. Co-primary outcomes were: (1) durable clinical benefit (DCB), defined as the occurrence of complete response, partial response, or stable disease that continues until at least the second CT scan scheduled at 18 weeks; and (2) toxicity, defined as the occurrence at any time of treatment-related dose delay or treatment discontinuation due to an adverse event. Analysis included all patients who received any pembrolizumab. As well as reporting simple observed incidence for the co-primary outcomes, DCB and toxicity, we also estimated incidence using a model-based method for correlated binary outcomes. This study is registered with ClinicalTrials.gov, NCT02733159; EudraCT, 2015-002241-55; and ISRCTN, 10047797. FINDINGS Between Jan 4, 2017, and Feb 13, 2018, of 112 patients assessed for eligibility, we recruited 62 patients. 60 patients were evaluable for the co-primary outcomes. Median age was 72 years (IQR 65-75); 33 (55%) of participants were male and 27 (45%) were female. The observed incidence for DCB was 38% (95% CI 21-57) in first-line patients (n=24) and 36% (22-52) in subsequent-line patients (n=36); DCB was 22% (11-41) in patients with a TPS less than 1% (n=27), 47% (25-70) in patients with a TPS of 1-49% (n=15), and 53% (30-75) in patients with a TPS of 50% or greater (n=15). An increase in DCB incidences with TPS was also shown in model-based estimates. Toxicity was observed in 28% (95% CI 19-41) of patients, 11 (18%) of 60 due to dose delay and 6 (10%) of 60 due to drug discontinuation. No grade 5 treatment-related adverse events were observed and no early deaths were attributed to hyperprogression. The most common grade 3-4 adverse events were dyspnoea (n=9), hyponatraemia (n=5), and anorexia (n=4). There were ten serious adverse events considered to be related to treatment, comprising diarrhoea (n=3) and acute kidney injury, adrenal insufficiency, hyperbilirubinaemia, oral mucositis, rash, urinary tract infection, and vomiting (n=1 each). INTERPRETATION Patients with NSCLC of PS2 are a group of patients of unmet therapeutic need. The PePS2 trial shows that pembrolizumab can be safely administered to these patients, with no increase in the risk of immune-related or other toxicities. Efficacy outcomes are at least as good as those in patients with PS0-1 and the data provides clinicians with the confidence to incorporate pembrolizumab into the treatment pathway of patients with NSCLC of PS2. FUNDING Merck, Sharp & Dohme.
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Affiliation(s)
- Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
| | - Kristian Brock
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Joshua Savage
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Rhys Mant
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | | | - Riyaz Shah
- Kent Oncology Centre, Maidstone Hospital, Maidstone, UK
| | - Christian Ottensmeier
- Southampton Cancer Research UK Experimental Cancer Medicine Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Siow-Ming Lee
- University College London Hospital/Cancer Research UK Lung Cancer Centre of Excellence, London, UK
| | | | | | | | - Lucinda Billingham
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
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Middleton G, Fletcher P, Popat S, Savage J, Summers Y, Greystoke A, Gilligan D, Cave J, O'Rourke N, Brewster A, Toy E, Spicer J, Jain P, Dangoor A, Mackean M, Forster M, Farley A, Wherton D, Mehmi M, Sharpe R, Mills TC, Cerone MA, Yap TA, Watkins TBK, Lim E, Swanton C, Billingham L. The National Lung Matrix Trial of personalized therapy in lung cancer. Nature 2020; 583:807-812. [PMID: 32669708 PMCID: PMC7116732 DOI: 10.1038/s41586-020-2481-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/08/2020] [Indexed: 02/06/2023]
Abstract
The majority of targeted therapies for non-small-cell lung cancer (NSCLC) are directed against oncogenic drivers that are more prevalent in patients with light exposure to tobacco smoke1-3. As this group represents around 20% of all patients with lung cancer, the discovery of stratified medicine options for tobacco-associated NSCLC is a high priority. Umbrella trials seek to streamline the investigation of genotype-based treatments by screening tumours for multiple genomic alterations and triaging patients to one of several genotype-matched therapeutic agents. Here we report the current outcomes of 19 drug-biomarker cohorts from the ongoing National Lung Matrix Trial, the largest umbrella trial in NSCLC. We use next-generation sequencing to match patients to appropriate targeted therapies on the basis of their tumour genotype. The Bayesian trial design enables outcome data from open cohorts that are still recruiting to be reported alongside data from closed cohorts. Of the 5,467 patients that were screened, 2,007 were molecularly eligible for entry into the trial, and 302 entered the trial to receive genotype-matched therapy-including 14 that re-registered to the trial for a sequential trial drug. Despite pre-clinical data supporting the drug-biomarker combinations, current evidence shows that a limited number of combinations demonstrate clinically relevant benefits, which remain concentrated in patients with lung cancers that are associated with minimal exposure to tobacco smoke.
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Affiliation(s)
- Gary Middleton
- Institute of Immunology & Immunotherapy, University of Birmingham, Birmingham, UK.
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Peter Fletcher
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Joshua Savage
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | | | | | - Judith Cave
- Southampton University Hospitals NHS Trust, Southampton, UK
| | | | | | - Elizabeth Toy
- Royal Devon and Exeter Foundation NHS Trust, Exeter, UK
| | - James Spicer
- King's College London, Guy's Hospital, London, UK
| | - Pooja Jain
- St James's University Hospital, Leeds, UK
| | - Adam Dangoor
- Bristol Haematology and Oncology Centre, Bristol, UK
| | | | | | - Amanda Farley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Dee Wherton
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Manita Mehmi
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Rowena Sharpe
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | | | - Timothy A Yap
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Charles Swanton
- The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, University College London, London, UK
| | - Lucinda Billingham
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
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Lee LY, Cazier JB, Angelis V, Arnold R, Bisht V, Campton NA, Chackathayil J, Cheng VW, Curley HM, Fittall MW, Freeman-Mills L, Gennatas S, Goel A, Hartley S, Hughes DJ, Kerr D, Lee AJ, Lee RJ, McGrath SE, Middleton CP, Murugaesu N, Newsom-Davis T, Okines AF, Olsson-Brown AC, Palles C, Pan Y, Pettengell R, Powles T, Protheroe EA, Purshouse K, Sharma-Oates A, Sivakumar S, Smith AJ, Starkey T, Turnbull CD, Várnai C, Yousaf N, Kerr R, Middleton G. COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study. Lancet 2020; 395:1919-1926. [PMID: 32473682 PMCID: PMC7255715 DOI: 10.1016/s0140-6736(20)31173-9] [Citation(s) in RCA: 781] [Impact Index Per Article: 195.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Individuals with cancer, particularly those who are receiving systemic anticancer treatments, have been postulated to be at increased risk of mortality from COVID-19. This conjecture has considerable effect on the treatment of patients with cancer and data from large, multicentre studies to support this assumption are scarce because of the contingencies of the pandemic. We aimed to describe the clinical and demographic characteristics and COVID-19 outcomes in patients with cancer. METHODS In this prospective observational study, all patients with active cancer and presenting to our network of cancer centres were eligible for enrolment into the UK Coronavirus Cancer Monitoring Project (UKCCMP). The UKCCMP is the first COVID-19 clinical registry that enables near real-time reports to frontline doctors about the effects of COVID-19 on patients with cancer. Eligible patients tested positive for severe acute respiratory syndrome coronavirus 2 on RT-PCR assay from a nose or throat swab. We excluded patients with a radiological or clinical diagnosis of COVID-19, without a positive RT-PCR test. The primary endpoint was all-cause mortality, or discharge from hospital, as assessed by the reporting sites during the patient hospital admission. FINDINGS From March 18, to April 26, 2020, we analysed 800 patients with a diagnosis of cancer and symptomatic COVID-19. 412 (52%) patients had a mild COVID-19 disease course. 226 (28%) patients died and risk of death was significantly associated with advancing patient age (odds ratio 9·42 [95% CI 6·56-10·02]; p<0·0001), being male (1·67 [1·19-2·34]; p=0·003), and the presence of other comorbidities such as hypertension (1·95 [1·36-2·80]; p<0·001) and cardiovascular disease (2·32 [1·47-3·64]). 281 (35%) patients had received cytotoxic chemotherapy within 4 weeks before testing positive for COVID-19. After adjusting for age, gender, and comorbidities, chemotherapy in the past 4 weeks had no significant effect on mortality from COVID-19 disease, when compared with patients with cancer who had not received recent chemotherapy (1·18 [0·81-1·72]; p=0·380). We found no significant effect on mortality for patients with immunotherapy, hormonal therapy, targeted therapy, radiotherapy use within the past 4 weeks. INTERPRETATION Mortality from COVID-19 in cancer patients appears to be principally driven by age, gender, and comorbidities. We are not able to identify evidence that cancer patients on cytotoxic chemotherapy or other anticancer treatment are at an increased risk of mortality from COVID-19 disease compared with those not on active treatment. FUNDING University of Birmingham, University of Oxford.
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Affiliation(s)
- Lennard Yw Lee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Computational Biology, University of Birmingham, Birmingham, UK; University of Birmingham, Birmingham, UK; University Hospitals Birmingham, Birmingham, UK.
| | - Jean-Baptiste Cazier
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Computational Biology, University of Birmingham, Birmingham, UK; University of Birmingham, Birmingham, UK
| | | | - Roland Arnold
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Vartika Bisht
- Centre for Computational Biology, University of Birmingham, Birmingham, UK; University of Birmingham, Birmingham, UK
| | - Naomi A Campton
- Institute of Translational Medicine, Birmingham Health Partners, Birmingham, UK
| | - Julia Chackathayil
- Cancer Research Clinical Research Facility, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Vinton Wt Cheng
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Helen M Curley
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | | | | | - Anshita Goel
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Simon Hartley
- Centre for Computational Biology, University of Birmingham, Birmingham, UK; Advanced Research Computing, University of Birmingham, Birmingham, UK
| | - Daniel J Hughes
- Department of Cancer Imaging, King's College London, London, UK
| | - David Kerr
- Nuffield Division of Clinical and Laboratory Services, Oxford University, Oxford, UK
| | - Alvin Jx Lee
- UCL Cancer Institute, University College London, London, UK
| | - Rebecca J Lee
- University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | | | - Christopher P Middleton
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Computational Biology, University of Birmingham, Birmingham, UK
| | - Nirupa Murugaesu
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Thomas Newsom-Davis
- Department of Oncology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | | | - Claire Palles
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Yi Pan
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Computational Biology, University of Birmingham, Birmingham, UK
| | | | | | - Emily A Protheroe
- University of Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Karin Purshouse
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
| | | | | | | | - Thomas Starkey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | - Csilla Várnai
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Computational Biology, University of Birmingham, Birmingham, UK
| | - Nadia Yousaf
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Rachel Kerr
- Department of Oncology, Oxford University, Oxford, UK
| | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK; University Hospitals Birmingham, Birmingham, UK
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Middleton G, Yang Y, Campbell CD, André T, Atreya CE, Schellens JHM, Yoshino T, Bendell JC, Hollebecque A, McRee AJ, Siena S, Gordon MS, Tabernero J, Yaeger R, O'Dwyer PJ, De Vos F, Van Cutsem E, Millholland JM, Brase JC, Rangwala F, Gasal E, Corcoran RB. BRAF-Mutant Transcriptional Subtypes Predict Outcome of Combined BRAF, MEK, and EGFR Blockade with Dabrafenib, Trametinib, and Panitumumab in Patients with Colorectal Cancer. Clin Cancer Res 2020; 26:2466-2476. [PMID: 32047001 PMCID: PMC8194012 DOI: 10.1158/1078-0432.ccr-19-3579] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/20/2019] [Accepted: 02/07/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE The influence of the transcriptional and immunologic context of mutations on therapeutic outcomes with targeted therapy in cancer has not been well defined. BRAF V600E-mutant (BM) colorectal cancer comprises two main transcriptional subtypes, BM1 and BM2. We sought to determine the impact of BM subtype, as well as distinct biological features of those subtypes, on response to BRAF/MEK/EGFR inhibition in patients with colorectal cancer. PATIENTS AND METHODS Paired fresh tumor biopsies were acquired at baseline and on day 15 of treatment from all consenting patients with BM colorectal cancer enrolled in a phase II clinical trial of dabrafenib, trametinib, and panitumumab. For each sample, BM subtype, cell cycle, and immune gene signature expression were determined using RNA-sequencing (RNA-seq), and a Cox proportional hazards model was applied to determine association with progression-free survival (PFS). RESULTS Confirmed response rates, median PFS, and median overall survival (OS) were higher in BM1 subtype patients compared with BM2 subtype patients. Evaluation of immune contexture identified greater immune reactivity in BM1, whereas cell-cycle signatures were more highly expressed in BM2. A multivariate model of PFS incorporating BM subtype plus immune and cell-cycle signatures revealed that BM subtype encompasses the majority of the effect. CONCLUSIONS BM subtype is significantly associated with the outcome of combination dabrafenib, trametinib, and panitumumab therapy and may serve as a standalone predictive biomarker beyond mutational status. Our findings support a more nuanced approach to targeted therapeutic decisions that incorporates assessment of transcriptional context.
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Affiliation(s)
- Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom.
| | - Yiqun Yang
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | | | - Thierry André
- Hôpital Saint-Antoine and Sorbonne Universités, UPMC Paris 06, Paris, France
| | - Chloe E Atreya
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
| | | | | | - Johanna C Bendell
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee
| | | | - Autumn J McRee
- University of North Carolina, Chapel Hill, North Carolina
| | - Salvatore Siena
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | | | - Rona Yaeger
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter J O'Dwyer
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Filip De Vos
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | | | | | - Fatima Rangwala
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Eduard Gasal
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Ryan B Corcoran
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
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Pestinger V, Smith M, Sillo T, Findlay JM, Laes JF, Martin G, Middleton G, Taniere P, Beggs AD. Use of an Integrated Pan-Cancer Oncology Enrichment Next-Generation Sequencing Assay to Measure Tumour Mutational Burden and Detect Clinically Actionable Variants. Mol Diagn Ther 2020; 24:339-349. [PMID: 32306292 PMCID: PMC7264086 DOI: 10.1007/s40291-020-00462-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The identification of tumour mutational burden (TMB) as a biomarker of response to programmed cell death protein 1 (PD-1) immunotherapy has necessitated the development of genomic assays to measure this. We carried out comprehensive molecular profiling of cancers using the Illumina TruSight Oncology 500 (TSO500) panel and compared these to whole-genome sequencing (WGS). METHODS Cancer samples derived from formalin-fixed material were profiled on the TSO500 panel, sequenced on an Illumina NextSeq 500 instrument and processed through the TSO500 Docker pipeline. Either FASTQ files (PierianDx) or vcf files (OncoKDM) were processed to understand clinical actionability. RESULTS In total, 108 samples (a mixture of colorectal, lung, oesophageal and control samples) were processed via the DNA panel. There was good correlation between TMB, single-nucleotide variants (SNVs), indels and copy-number variations as predicted by TSO500 and WGS (R2 > 0.9) and good reproducibility, with less than 5% variability between repeated controls. For the RNA panel, 13 samples were processed, with all known fusions observed via orthogonal techniques. For clinical actionability, 72 tier 1 variants and 297 tier 2 variants were detected, with clinical trials identified for all patients. CONCLUSIONS The TSO500 assay accurately measures TMB, microsatellite instability, SNVs, indels, copy-number/structural variation and gene fusions when compared to WGS and orthogonal technologies. Coupled with a clinical annotation pipeline, this provides a powerful methodology for identification of clinically actionable variants.
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Affiliation(s)
- Valerie Pestinger
- Surgical Research Laboratory, Institute of Cancer and Genomic Sciences, University of Birmingham, Vincent Drive, Birmingham, B15 2TT, UK
| | | | - Toju Sillo
- Surgical Research Laboratory, Institute of Cancer and Genomic Sciences, University of Birmingham, Vincent Drive, Birmingham, B15 2TT, UK
| | | | | | | | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Andrew D Beggs
- Surgical Research Laboratory, Institute of Cancer and Genomic Sciences, University of Birmingham, Vincent Drive, Birmingham, B15 2TT, UK.
- Queen Elizabeth Hospital Birmingham, Birmingham, UK.
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Anil I, Arnold R, Benkwitz-Beford S, Branford S, Campton N, Cazier JB, Cheng V, Curley H, D'Costa J, Edmondson A, Goel A, Hartley S, Hughes DJ, Kerr R, Lee A, Lee LYW, Longworth N, Middleton C, Middleton G, Naksukpaiboon P, Olsson-Brown A, Palles C, Purshouse K, Sandys C, Sharma-Oates A, Sivakumar S, Smith A, Starkey T, Thompson S, Varnai C. The UK Coronavirus Cancer Monitoring Project: protecting patients with cancer in the era of COVID-19. Lancet Oncol 2020; 21:622-624. [PMID: 32304634 PMCID: PMC7159870 DOI: 10.1016/s1470-2045(20)30230-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/06/2020] [Indexed: 01/08/2023]
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Kong A, Good J, Kirkham A, Savage J, Mant R, Llewellyn L, Parish J, Spruce R, Forster M, Schipani S, Harrington K, Sacco J, Murray P, Middleton G, Yap C, Mehanna H. Phase I trial of WEE1 inhibition with chemotherapy and radiotherapy as adjuvant treatment, and a window of opportunity trial with cisplatin in patients with head and neck cancer: the WISTERIA trial protocol. BMJ Open 2020; 10:e033009. [PMID: 32184305 PMCID: PMC7076237 DOI: 10.1136/bmjopen-2019-033009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 01/15/2020] [Accepted: 01/30/2020] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Patients with head and neck squamous cell carcinoma with locally advanced disease often require multimodality treatment with surgery, radiotherapy and/or chemotherapy. Adjuvant radiotherapy with concurrent chemotherapy is offered to patients with high-risk pathological features postsurgery. While cure rates are improved, overall survival remains suboptimal and treatment has a significant negative impact on quality of life.Cell cycle checkpoint kinase inhibition is a promising method to selectively potentiate the therapeutic effects of chemoradiation. Our hypothesis is that combining chemoradiation with a WEE1 inhibitor will affect the biological response to DNA damage caused by cisplatin and radiation, thereby enhancing clinical outcomes, without increased toxicity. This trial explores the associated effect of WEE1 kinase inhibitor adavosertib (AZD1775). METHODS AND ANALYSIS This phase I dose-finding, open-label, multicentre trial aims to determine the highest safe dose of AZD1775 in combination with cisplatin chemotherapy preoperatively (group A) as a window of opportunity trial, and in combination with postoperative cisplatin-based chemoradiation (group B).Modified time-to-event continual reassessment method will determine the recommended dose, recruiting up to 21 patients per group. Primary outcomes are recommended doses with predefined target dose-limiting toxicity probabilities of 25% monitored up to 42 days (group A), and 30% monitored up to 12 weeks (group B). Secondary outcomes are disease-free survival times (groups A and B). Exploratory objectives are evaluation of pharmacodynamic (PD) effects, identification and correlation of potential biomarkers with PD markers of DNA damage, determine rate of resection status and surgical complications for group A; and quality of life in group B. ETHICS AND DISSEMINATION Research Ethics Committee, Edgbaston, West Midlands (REC reference 16/WM/0501) initial approval received on 18/01/2017. Results will be disseminated via peer-reviewed publication and presentation at international conferences. TRIAL REGISTRATION NUMBER ISRCTN76291951 and NCT03028766.
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Affiliation(s)
- Anthony Kong
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - James Good
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Amanda Kirkham
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Joshua Savage
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Rhys Mant
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | - Joanna Parish
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Rachel Spruce
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | - Stefano Schipani
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, Glasgow, UK
| | | | - Joseph Sacco
- Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral, UK
| | | | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Christina Yap
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Hisham Mehanna
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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Middleton G, Popat S, Fletcher P, Summers Y, Greystoke A, Gilligan D, Cave J, O'Rourke N, Brewster A, Toy E, Spicer J, Savage J, Sharpe R, Yap T, Swanton C, Billingham L. PL02.09 National Lung Matrix Trial (NLMT): First Results from an Umbrella Phase II Trial in Advanced Non-Small Cell Lung Cancer (NSCLC). J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Fultang L, Panetti S, Ng M, Collins P, Graef S, Rizkalla N, Booth S, Lenton R, Noyvert B, Shannon-Lowe C, Middleton G, Mussai F, De Santo C. MDSC targeting with Gemtuzumab ozogamicin restores T cell immunity and immunotherapy against cancers. EBioMedicine 2019; 47:235-246. [PMID: 31462392 PMCID: PMC6796554 DOI: 10.1016/j.ebiom.2019.08.025] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Targeting of MDSCs is a major clinical challenge in the era of immunotherapy. Antibodies which deplete MDSCs in murine models can reactivate T cell responses. In humans such approaches have not developed due to difficulties in identifying targets amenable to clinical translation. METHODS RNA-sequencing of M-MDSCs and G-MDSCs from cancer patients was undertaken. Flow cytometry and immunohistochemistry of blood and tumours determined MDSC CD33 expression. MDSCs were treated with Gemtuzumab ozogamicin and internalisation kinetics, and cell death mechanisms determined by flow cytometry, confocal microscopy and electron microscopy. Effects on T cell proliferation and CAR-T cell anti-tumour cytotoxicity were identified in the presence of Gemtuzumab ozogamicin. FINDINGS RNA-sequencing of human M-MDSCs and G-MDSCs identified transcriptomic differences, but that CD33 is a common surface marker. Flow cytometry indicated CD33 expression is higher on M-MDSCs, and CD33+ MDSCs are found in the blood and tumours regardless of cancer subtype. Treatment of human MDSCs leads to Gemtuzumab ozogamicin internalisation, increased p-ATM, and cell death; restoring T cell proliferation. Anti-GD2-/mesothelin-/EGFRvIII-CAR-T cell activity is enhanced in combination with the anti-MDSC effects of Gemtuzumab ozogamicin. INTERPRETATION The study identifies that M-MDSCs and G-MDSCs are transcriptomically different but CD33 is a therapeutic target on peripheral and infiltrating MDSCs across cancer subtypes. The immunotoxin Gemtuzumab ozogamicin can deplete MDSCs providing a translational approach to reactivate T cell and CAR-T cell responses against multiple cancers. In the rare conditions of HLH/MAS gemtuzumab ozogamicin provides a novel anti-myeloid strategy. FUND: This work was supported by Cancer Research UK, CCLG, Treating Children with Cancer, and the alumni and donors to the University of Birmingham.
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Affiliation(s)
- Livingstone Fultang
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Silvia Panetti
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Margaret Ng
- Department of Anatomic Pathology, The Chinese University of Hong Kong, Hong Kong
| | - Paul Collins
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Suzanne Graef
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Nagy Rizkalla
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Sarah Booth
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Richard Lenton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Boris Noyvert
- CRUK Birmingham Centre and Centre for Computational Biology, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Claire Shannon-Lowe
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Francis Mussai
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
| | - Carmela De Santo
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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Brooks JM, Menezes AN, Ibrahim M, Archer L, Lal N, Bagnall CJ, von Zeidler SV, Valentine HR, Spruce RJ, Batis N, Bryant JL, Hartley M, Kaul B, Ryan GB, Bao R, Khattri A, Lee SP, Ogbureke KUE, Middleton G, Tennant DA, Beggs AD, Deeks J, West CML, Cazier JB, Willcox BE, Seiwert TY, Mehanna H. Development and Validation of a Combined Hypoxia and Immune Prognostic Classifier for Head and Neck Cancer. Clin Cancer Res 2019; 25:5315-5328. [PMID: 31182433 DOI: 10.1158/1078-0432.ccr-18-3314] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/22/2019] [Accepted: 06/06/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Intratumoral hypoxia and immunity have been correlated with patient outcome in various tumor settings. However, these factors are not currently considered for treatment selection in head and neck cancer (HNC) due to lack of validated biomarkers. Here we sought to develop a hypoxia-immune classifier with potential application in patient prognostication and prediction of response to targeted therapy. EXPERIMENTAL DESIGN A 54-gene hypoxia-immune signature was constructed on the basis of literature review. Gene expression was analyzed in silico using the The Cancer Genome Atlas (TCGA) HNC dataset (n = 275) and validated using two independent cohorts (n = 130 and 123). IHC was used to investigate the utility of a simplified protein signature. The spatial distribution of hypoxia and immune markers was examined using multiplex immunofluorescence staining. RESULTS Unsupervised hierarchical clustering of TCGA dataset (development cohort) identified three patient subgroups with distinct hypoxia-immune phenotypes and survival profiles: hypoxialow/immunehigh, hypoxiahigh/immunelow, and mixed, with 5-year overall survival (OS) rates of 71%, 51%, and 49%, respectively (P = 0.0015). The prognostic relevance of the hypoxia-immune gene signature was replicated in two independent validation cohorts. Only PD-L1 and intratumoral CD3 protein expression were associated with improved OS on multivariate analysis. Hypoxialow/immunehigh and hypoxiahigh/immunelow tumors were overrepresented in "inflamed" and "immune-desert" microenvironmental profiles, respectively. Multiplex staining demonstrated an inverse correlation between CA-IX expression and prevalence of intratumoral CD3+ T cells (r = -0.5464; P = 0.0377), further corroborating the transcription-based classification. CONCLUSIONS We developed and validated a hypoxia-immune prognostic transcriptional classifier, which may have clinical application to guide the use of hypoxia modification and targeted immunotherapies for the treatment of HNC.
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Affiliation(s)
- Jill M Brooks
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, United Kingdom
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Albert N Menezes
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Maha Ibrahim
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
- South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Lucinda Archer
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Neeraj Lal
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Christopher J Bagnall
- Human Biomaterials Resource Centre, University of Birmingham, Birmingham, United Kingdom
| | - Sandra V von Zeidler
- Department of Pathology, Federal University of Espírito Santo, Espírito Santo, Brazil
| | - Helen R Valentine
- Division of Cancer Sciences, University of Manchester, Christie Hospital, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Rachel J Spruce
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, United Kingdom
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Nikolaos Batis
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, United Kingdom
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jennifer L Bryant
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, United Kingdom
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Margaret Hartley
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, United Kingdom
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Baksho Kaul
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Gordon B Ryan
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, United Kingdom
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Riyue Bao
- The University of Chicago Medicine, Chicago, Illinois
| | - Arun Khattri
- The University of Chicago Medicine, Chicago, Illinois
| | - Steven P Lee
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Kalu U E Ogbureke
- Department of Diagnostic and Biomedical Sciences, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Daniel A Tennant
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Andrew D Beggs
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jonathan Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Catharine M L West
- Division of Cancer Sciences, University of Manchester, Christie Hospital, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Jean-Baptiste Cazier
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Benjamin E Willcox
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | | | - Hisham Mehanna
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, United Kingdom.
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
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Sillo TO, Beggs AD, Morton DG, Middleton G. Mechanisms of immunogenicity in colorectal cancer. Br J Surg 2019; 106:1283-1297. [PMID: 31216061 PMCID: PMC6772007 DOI: 10.1002/bjs.11204] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/06/2019] [Accepted: 03/12/2019] [Indexed: 12/24/2022]
Abstract
Background The immune response in cancer is increasingly understood to be important in determining clinical outcomes, including responses to cancer therapies. New insights into the mechanisms underpinning the immune microenvironment in colorectal cancer are helping to develop the role of immunotherapy and suggest targeted approaches to the management of colorectal cancer at all disease stages. Method A literature search was performed in PubMed, MEDLINE and Cochrane Library databases to identify relevant articles. This narrative review discusses the current understanding of the contributors to immunogenicity in colorectal cancer and potential applications for targeted therapies. Results Responsiveness to immunotherapy in colorectal cancer is non-uniform. Several factors, both germline and tumour-related, are potential determinants of immunogenicity in colorectal cancer. Current approaches target tumours with high immunogenicity driven by mutations in DNA mismatch repair genes. Recent work suggests a role for therapies that boost the immune response in tumours with low immunogenicity. Conclusion With the development of promising therapies to boost the innate immune response, there is significant potential for the expansion of the role of immunotherapy as an adjuvant to surgical treatment in colorectal cancer.
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Affiliation(s)
- T O Sillo
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - A D Beggs
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - D G Morton
- Academic Department of Surgery, College of Medical and Dental Sciences, Queen Elizabeth Hospital, Birmingham, UK
| | - G Middleton
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Chin I, Yip K, Middleton G. Clinical presentation and prognosis of high PD-L1 expressors in non-small cell lung cancer. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30202-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Smyth E, Kouvelakis K, Cunningham D, Hahne J, Peckitt C, Vlachogiannis G, Watkins D, Rao S, Starling N, Wilson S, Waddell T, Okines A, Crosby T, Mansoor W, Wadsley J, Middleton G, Wotherspoon A, Chau I, Valeri N. EGFR amplification (amp) and survival in the REAL-3 trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sobrero A, Lenz HJ, Eng C, Scheithauer W, Middleton G, Chen W, Esser R, Nippgen J, Burris H. Retrospective RAS analysis of the EPIC trial: Cetuximab plus irinotecan vs irinotecan in patients (pts) with second-line metastatic colorectal cancer (mCRC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Middleton G, Brock K, Summers Y, Connibear J, Shah R, Ottensmeier C, Shaw P, Ming-Lee S, Popat S, Barrie C, Barone G, Mant R, Savage J, Billingham L. Pembrolizumab in performance status 2 patients with non-small cell lung cancer (NSCLC): Results of the PePS2 trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Khanna S, Graef S, Mussai F, Thomas A, Wali N, Yenidunya BG, Yuan C, Morrow B, Zhang J, Korangy F, Greten TF, Steinberg SM, Stetler-Stevenson M, Middleton G, De Santo C, Hassan R. Tumor-Derived GM-CSF Promotes Granulocyte Immunosuppression in Mesothelioma Patients. Clin Cancer Res 2018; 24:2859-2872. [PMID: 29602801 PMCID: PMC6601632 DOI: 10.1158/1078-0432.ccr-17-3757] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/09/2018] [Accepted: 03/23/2018] [Indexed: 12/12/2022]
Abstract
Purpose: The cross-talk between tumor cells, myeloid cells, and T cells can play a critical role in tumor pathogenesis and response to immunotherapies. Although the etiology of mesothelioma is well understood, the impact of mesothelioma tumor cells on the surrounding immune microenvironment is less well studied. In this study, the effect of the mesothelioma tumor microenvironment on circulating and infiltrating granulocytes and T cells is investigated.Experimental Design: Tumor tissues and peripheral blood from mesothelioma patients were evaluated for presence of granulocytes, which were then tested for their T-cell suppression potential. Different cocultures of granulocytes and/or mesothelioma tumor cells and/or T cells were set up to identify the mechanism of T-cell inhibition.Results: Analysis of human tumors showed that the mesothelioma microenvironment is enriched in infiltrating granulocytes, which inhibit T-cell proliferation and activation. Characterization of the whole blood at diagnosis identified similar, circulating, immunosuppressive CD11b+CD15+HLADR- granulocytes at increased frequency compared with healthy controls. Culture of healthy-donor granulocytes with human mesothelioma cells showed that GM-CSF upregulates NOX2 expression and the release of reactive oxygen species (ROS) from granulocytes, resulting in T-cell suppression. Immunohistochemistry and transcriptomic analysis revealed that a majority of mesothelioma tumors express GM-CSF and that higher GM-CSF expression correlated with clinical progression. Blockade of GM-CSF with neutralizing antibody, or ROS inhibition, restored T-cell proliferation, suggesting that targeting of GM-CSF could be of therapeutic benefit in these patients.Conclusions: Our study presents the mechanism behind the cross-talk between mesothelioma tumors and the immune microenvironment and indicates that targeting GM-CSF could be a novel treatment strategy to augment immunotherapy in patients with mesothelioma. Clin Cancer Res; 24(12); 2859-72. ©2018 AACR.
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Affiliation(s)
- Swati Khanna
- Thoracic and GI Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Suzanne Graef
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Francis Mussai
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Anish Thomas
- Thoracic and GI Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Neha Wali
- University of Maryland Baltimore County, Baltimore, Maryland
| | | | - Constance Yuan
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Betsy Morrow
- Thoracic and GI Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jingli Zhang
- Thoracic and GI Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Firouzeh Korangy
- Thoracic and GI Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Tim F Greten
- Thoracic and GI Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Office of the Clinical Director, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Maryalice Stetler-Stevenson
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Carmela De Santo
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Raffit Hassan
- Thoracic and GI Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
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Klonizakis M, Tew G, Gumber A, Crank H, King B, Middleton G, Michaels J. Supervised exercise training as an adjunct therapy for venous leg ulcers: a randomized controlled feasibility trial. Br J Dermatol 2018. [DOI: 10.1111/bjd.16618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Middleton G, Gridelli C, De Marinis F, Pujol JL, Reck M, Ramlau R, Parente B, Pieters T, Visseren-Grul CM, San Antonio B, John WJ, Zimmermann AH, Chouaki N, Paz-Ares L. Evaluation of changes in renal function in PARAMOUNT: a phase III study of maintenance pemetrexed plus best supportive care versus placebo plus best supportive care after induction treatment with pemetrexed plus cisplatin for advanced nonsquamous non-small-cell lung cancer. Curr Med Res Opin 2018; 34:865-871. [PMID: 29424248 DOI: 10.1080/03007995.2018.1439462] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To assess the effect of long-term pemetrexed maintenance therapy on patients' renal function. METHODS In the PARAMOUNT phase III trial (NCT 00789373), pemetrexed was compared with placebo as maintenance treatment in advanced nonsquamous non-small-cell lung cancer patients who completed 4 cycles of pemetrexed plus cisplatin induction therapy. To evaluate changes in renal function during pemetrexed continuation maintenance treatment, we retrospectively analyzed changes in serum creatinine (sCr), treatment-emergent adverse events, dose delays and treatment discontinuations associated with impaired renal function. RESULTS Creatinine clearance ≥45 mL/min was required before the start of any cycle. Patients on pemetrexed maintenance had a significantly higher percentage maximum increase in sCr over baseline versus placebo for the range of ≥10% to ≥90% increase (p < .05). The risk of experiencing renal events leading to dose delays and discontinuations was higher with higher increases in sCr but reversible in most patients. sCr increases of ≥30% and ≥40% were associated with gender (female), age (<70 years) and longer exposure to pemetrexed compared with placebo. Sixteen (4%) pemetrexed patients and 1 (1%) placebo patient discontinued treatment due to drug-related renal events; 13/16 (81%) of those pemetrexed patients had sCr increases ≥30% and 7/13 (54%) had pre-existing conditions and/or were receiving nephrotoxic drugs. CONCLUSIONS The appearance of renal events leading to dose delays and/or treatment discontinuations was associated with sCr increase of at least 30%. However, it was difficult to identify patients at a higher risk of treatment discontinuation due to a drug-related renal event based only on changes in pre-maintenance laboratory values.
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Affiliation(s)
- Gary Middleton
- a University of Birmingham , Birmingham , United Kingdom
| | | | | | - Jean-Louis Pujol
- d Centre Hospitalier Régional Universitaire de Montpellier , Montpellier , France
| | - Martin Reck
- e Department of Thoracic Oncology , LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL) , Grosshansdorf , Germany
| | - Rodryg Ramlau
- f Poznan University of Medical Sciences , Poznan , Poland
| | | | - Thierry Pieters
- h Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium
| | | | | | | | | | | | - Luis Paz-Ares
- m IBIS (University Hospital Virgen del Rocío, Seville University and CSIC), Seville & Doce de Octubre University Hospital , Madrid , Spain
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