Nutritional status associates with immunotherapy clinical outcomes in recurrent or metastatic head and neck squamous cell carcinoma patients

BACKGROUND

Beyond programmed death-ligand 1 (PD-L1) assessed by the combined positive score (CPS) and tumor mutational burden (TMB), no other biomarkers are approved for immunotherapy interventions. Here, we investigated whether additional clinical and pathological variables may impact on immunotherapy outcomes in recurrent or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) patients.

METHODS

R/M HNSCC patients treated with immunotherapy were reviewed. Analyzed variables at baseline included: clinicopathological, laboratory, and variables reflecting the host nutritional status such as the prognostic nutritional index (PNI) and albumin. The primary endpoint was progression free survival (PFS). The secondary endpoints were overall survival (OS) and objective response rate (ORR). Univariable and multivariable Cox models were fitted and random forest algorithm was used to estimate the importance of each prognostic variable.

RESULTS

A total of 100 patients were treated with immunotherapy; 50% with single agent and 50% with experimental immunotherapy combinations. In the multivariable analysis, both ECOG performance status (HR: 1.73; 95%CI 1.07-2.82; p = 0.03) and PNI levels (10-point increments, HR: 0.66; 0.46-0.95; p = 0.03) were significantly associated with PFS. However, the derived neutrophil to lymphocyte ratio (dNLR) and lactate dehydrogenase (LDH) were not significantly associated with PFS (p-values > 0.15). In the OS analysis, albumin and PNI were the only statistically significant factors in the multivariable model (p < 0.001).

CONCLUSIONS

In our cohort, PNI and ECOG performance status were most strongly associated with PFS in R/M HNSCC patients treated with immunotherapy. These results suggest that parameters informative of nutritional status should be considered before immunotherapy.

Isatuximab plus atezolizumab in patients with advanced solid tumors: results from a phase I/II, open-label, multicenter study

BACKGROUND

The anti-CD38 antibody isatuximab is approved for the treatment of relapsed/refractory multiple myeloma, but there are no data on its efficacy in solid tumors. This phase I/II study (NCT03637764) assessed the safety and activity of isatuximab plus atezolizumab (Isa + Atezo), an anti-programmed death-ligand 1 (PD-L1) antibody, in patients with immunotherapy-naive solid tumors: epithelial ovarian cancer (EOC), glioblastoma (GBM), hepatocellular carcinoma (HCC), and squamous cell carcinoma of the head and neck (SCCHN).

PATIENTS AND METHODS

Phase I assessed safety, tolerability, pharmacokinetics, pharmacodynamics, and the recommended phase II dose (RP2D) of isatuximab 10 mg/kg intravenously (i.v.) every week for 3 weeks followed by once every 3 weeks + atezolizumab 1200 mg i.v. every 3 weeks. Phase II used a Simon's two-stage design to assess the overall response rate or progression-free survival rate at 6 months (GBM cohort). Interim analysis was carried out at 6 months following first dose of the last enrolled patient in each cohort. Pharmacodynamic biomarkers were tested for CD38, PD-L1, tumor-infiltrating immune cells, and FOXP3+ regulatory T cells (Tregs) in the tumor microenvironment (TME).

RESULTS

Overall, 107 patients were treated (EOC, n = 18; GBM, n = 33; HCC, n = 27; SCCHN, n = 29). In phase I, Isa + Atezo showed an acceptable safety profile, no dose-limiting toxicities were observed, and RP2D was confirmed. Most patients experienced ≥1 treatment-emergent adverse event (TEAE), with ≤48.5% being grade ≥3. The most frequent TEAE was infusion reactions. The study did not continue to stage 2 based on prespecified targets. Tumor-infiltrating CD38+ immune cells were reduced and almost cleared after treatment. Isa + Atezo did not significantly modulate Tregs or PD-L1 expression in the TME.

CONCLUSIONS

Isa + Atezo had acceptable safety and tolerability. Clinical pharmacodynamic evaluation revealed efficient target engagement of isatuximab via treatment-mediated reduction of CD38+ immune cells in the TME. Based on clinical data, CD38 inhibition does not improve responsiveness to PD-L1 blockade in these patients.

PL02.1.A EO2401, a novel microbiome-derived therapeutic vaccine for patients with recurrent glioblastoma: ROSALIE study

Background

EO2401 (EO) was designed to activate existing commensal memory T-cells cross-reacting with tumor associated antigens (TAAs). EO includes microbial-derived, synthetically produced peptides corresponding to HLA-A2 restricted epitopes with molecular mimicry to three TAAs upregulated in glioblastoma (GB), IL13Rα2, BIRC5 and FOXM1, with the CD4 helper peptide UCP2 and the adjuvant Montanide. Pre-clinically EO generated strong immune responses and cross-reactive CD8 cells recognizing the targeted TAAs.

Methods

This ongoing Ph 1/2 trial (NCT04116658) investigates the safety and tolerability (primary) of EO (300 µg/peptide, SC Q2W X 4, then Q4W), EO with nivolumab (3 mg/kg Q2W; EN), and EN with bevacizumab (10 mg/kg Q2W; ENB) among four Cohorts (Cs) of pts with GB at first progression/recurrence after radiotherapy/temozolomide. Treatment was delivered until progression, or 24 months. After the Ph 1 of EO followed by EN (C1), C2 investigated EN without (C2a) or with (C2b) surgery while C3 investigated ENB (population as C2a).

Results

Among 40 treated pts (C1 n=3, C2a n=23, C2b n=3, C3 n=11), median age was 60 years, 53% were male, 40% had KPS 90-100%, 35% had O6-methylguanine DNA-methyltransferase promotor hypermethylated tumors, and 5% isocitrate dehydrogenase 1 mutated tumors. All evaluable pts demonstrated strong CD8 T-cell ELISPOT responses against the 3 vaccine peptides; response was shown with tetramer staining of specific CD8 in 24/25 investigated pts after in vitro stimulation and in 19/20 pts directly ex vivo. Cross-reactivity against targeted TAAs was confirmed in 20/21 pts. Majority of response were detected by week 4 after 1st dose and as early as 2 weeks in some pts. EO, EN, and ENB were well tolerated (max exposure EN 86 wks, ENB 47 wks) with EO associated toxicity limited to local administration site reactions (48%; all grade 1-2). The frequency and severity of nivolumab- or bevacizumab-associated AEs was consistent with historical single-agent profiles. With a median follow-up of 13.6 months, median progression-free survival (mPFS), and median survival for EN (C1+C2a+C2b) were 1.8 months (2 ongoing at 7.3, and 18.5 months), and 11.0 months (survival at 12 months 42%), respectively. With a median follow-up of 7.3 months (range, 3.0-10.5), pts on ENB (C3) have mPFS and survival at 6 months of 5.5 months (3 ongoing at 5.6, 7.3 and 9.1 months), and 82% (9/11 alive), respectively. ORR/DCR (ORR+SD) for EN and ENB were 10%/34% and 55%/82%, respectively.

Conclusion

EO2401 generated strong systemic immune responses and was well tolerated in combination with nivolumab ± bevacizumab. Preliminary ORR/DCR and mPFS for ENB, and survival for EN seem encouraging. Updated results from the current 40 patients and results from additional 35 patients who already started treatment with EN with the option for low-dose bevacizumab edema treatment at neurological symptoms will be presented.

A novel EGFRvIII-T cell bispecific antibody for the treatment of glioblastoma

T cell bispecific antibodies (TCBs) are engineered molecules that bind both the T cell receptor and tumor-specific antigens. Epidermal growth factor receptor variant III (EGFRvIII) mutation is a common event in glioblastoma (GBM) and is characterized by the deletion of exons 2-7, resulting in a constitutively active receptor that promotes cell proliferation, angiogenesis and invasion. EGFRvIII is expressed on the surface of tumor cells and is not expressed in normal tissues making EGFRvIII an ideal neoantigen target for TCBs. We designed and developed a novel 2+1 EGFRvIII-TCB with optimal pharmacological characteristics and potent anti-tumor activity. EGFRvIII-TCB showed specificity for EGFRvIII and promoted tumor cell killing as well as T cell activation and cytokine secretion only in patient-derived models expressing EGFRvIII. Moreover, EGFRvIII-TCB promoted T cell recruitment into intracranial tumors. EGFRvIII-TCB induced tumor regression in GBM animal models, including humanized orthotopic GBM patient-derived xenograft (PDX) models. Our results warrant the clinical testing of EGFRvIII-TCB for the treatment of EGFRvIII-expressing GBMs.

EO2401, a novel microbiome-derived therapeutic vaccine for patients with recurrent glioblastoma: ROSALIE study

2034

Background: EO2401 (EO) was designed to activate existing commensal memory T-cells cross-reacting with tumor associated antigens (TAAs). EO includes microbial-derived, synthetically produced peptides corresponding to HLA-A2 restricted epitopes with molecular mimicry to three TAAs upregulated in glioblastoma (GB), IL13Rα2, BIRC5 and FOXM1, with the CD4 helper peptide UCP2 and the adjuvant Montanide. Pre-clinically EO generates strong immune responses and cross-reactive CD8 cells recognizing the TAAs. Methods: This ongoing Ph 1/2 trial (NCT04116658) investigates EO (SC q2 wks X 4 then q4 wks), EO with nivolumab (3 mg/kg q2 wks; EN), and EN with bevacizumab (10 mg/kg q2 wks; ENB) among four Cohorts (Cs) of pts with GB at first progression after radiotherapy/temozolomide. After the Ph 1 of EO followed by EN (C1), C2 investigated EN without (C2a) or with (C2b) surgery while C3 investigated ENB (population as C2a). Results: Among 40 treated pts (C1 n = 3, C2a n = 23, C2b n = 3, C3 n = 11), median age was 60, 53% male, 40% had KPS 90-100% and 35% had O6-methylguanine DNA-methyltransferase promotor hypermethylated tumors. All evaluable pts demonstrated strong CD8 T-cell ELISPOT responses against the 3 vaccine peptides, with tetramer staining of specific CD8 detected in 24/25 investigated pts after in vitro stimulation and in 19/20 pts directly ex vivo. Cross-reactivity against targeted TAAs was confirmed in 20/21 pts. Majority of response were detected by week 4 after 1st dose and as early as 2 weeks for some pts. EO, EN, and ENB were well tolerated (max exposure EN 68 wks, ENB 30 wks) with EO associated toxicity limited to local administration site reactions (48%; grade 1-2). The frequency and severity of nivolumab- or bevacizumab-associated AEs was consistent with historical monocompound experience. With a median follow-up of 9.3 months (range, 2.8-15.6), median progression-free survival (PFS), survival at 6 months (OS-6) and at 12 months for EN (C1+C2a+C2b) were 1.8 months (3 ongoing at 5.9, 7.1, and 14.7 months), 85%, and 50.1% (19/29 alive), respectively. With a median follow-up of 3.7 months (range, 2.2-7.2), pts on ENB (C3) have median PFS and OS-6 of 5.5 months (7 ongoing), and 80% (10/11 alive), respectively. ORR for EN and ENB were 10% and 36%, respectively (5 of 7 ongoing). In C2a, 12/23 pts stopped treatment due to neurological symptoms and PD on first MRI (median 5 wks, range 2-8). In C3 (ENB), only 1/11 pts stopped early due to PD. Conclusions: EO2401 generated strong systemic immune responses and was well tolerated in combination with nivolumab +/- bevacizumab. The addition of bevacizumab to EN improved PFS while survival across treatment cohorts is pending ongoing follow-up. To prolong EN exposure that is likely required for therapeutic activity in recurrent GB, the trial has been expanded with additional pts to evaluate low-dose bevacizumab (5 mg/kg q2 wks up to x 6) for early progressive neurological symptoms. Clinical trial information: NCT04116658.

P14.58 Efficacy and safety of lomustine versus fotemustine as first and second line treament in relapsed glioblastoma patients

BACKGROUND

Glioblastoma (GB) is the most aggressive primary brain tumour. Despite the survival benefit associated with adjuvant therapy, most of patients (pts) relapse after initial therapy. Nitrosoureas (NU) are the standard treatment at relapse in Europe. Both fotemustine (FM) (Addeo schema) and lomustine (LM) (administered orally every 6 weeks) are used in this context.

MATERIAL AND METHODS

This retrospective cohort study included pts diagnosed with GB treated with NU at relapse in four Catalonia hospitals from 2010 to 2020. Clinical and pathological data were collected from medical records. We analysed 6months-progression-free survival (6m-PFS), progression-free survival (PFS) and overall survival (OS) from the start of NU to progression or death respectively. Differences in toxicity grade using CTCAE v5.0 were analysed globally as ‘non-toxicity’, ‘mild toxicity (grade 1 or 2)’ and ‘high toxicity (grade 3 or 4)’.

RESULTS

We identified 236 GB pts with a median age of 58 years old. 29% of the pts presented MGMT promotor methylation and only 3%(n=7) had IDH mutation. After a median follow-up of 20 months, 94% of the pts were dead at the time of the analyses. At first line, 83 pts were treated with FM and 18 with LM. Pts treated with FM had better performance status (PS) than those treated with LM (p=.010). Median PFS was 2 months and 6m-PFS was 12% vs 6% in FM and LM group respectively (p=.87). Median OS was 3 months with LM vs 6 months with FM, with no statistically significant differences even adjusted for prognostic factors (p=.79 HR:0.9 CI 95% 0.41–1.96).At second line, 78 were treated with FM and 24 with LM, no differences between groups. Median PFS was 2 months in both groups and median OS was 3 vs 5 months for pts treated with LM vs FM respectively, with no significant differences. 6m-PFS was 13% for LM vs 0% for the FM group (p=.39).Pts received a mean of 1.7 cycles (every 6 weeks) and 4.1 cycles (every 2 weeks) in LM and FM group, respectively. Thrombocytopenia was the most common serious side-effect, with a higher proportion of grade 1–2 toxicity in the FM group (p=.03) that also required more treatment delays (p=.01).

CONCLUSION

Despite being retrospective study and a few pts were treated with LM, there were no differences neither in PFS nor in OS in pts treated with LM vs FM at first or second line. Higher G1-2 thrombocytopenia was shown in the FM group probably due to a higher number of hematology samples collected.

SEOM clinical guideline for management of adult medulloblastoma (2020)

Recent advances in molecular profiling, have reclassified medulloblastoma, an undifferentiated tumor of the posterior fossa, in at least four diseases, each one with differences in prognosis, epidemiology and sensibility to different treatments. The recommended management of a lesion with radiological characteristics suggestive of MB includes maximum safe resection followed by a post-surgical MR < 48 h, LCR cytology and MR of the neuroaxis. Prognostic factors, such as presence of a residual tumor volume > 1.5 cm2, presence of micro- or macroscopic dissemination, and age > 3 years as well as pathological (presence of anaplastic or large cell features) and molecular findings (group, 4, 3 or p53 SHH mutated subgroup) determine the risk of relapse and should guide adjuvant management. Although there is evidence that both high-risk patients and to a lesser degree, standard-risk patients benefit from adjuvant craneoespinal radiation followed by consolidation chemotherapy, tolerability is a concern in adult patients, leading invariably to dose reductions. Treatment after relapse is to be considered palliative and inclusion on clinical trials, focusing on the molecular alterations that define each subgroup, should be encouraged. Selected patients can benefit from surgical rescue or targeted radiation or high-dose chemotherapy followed by autologous self-transplant. Even in patients that are cured by chemorradiation presence of significant sequelae is common and patients must undergo lifelong follow-up.

Abstract 2953: Adapting a molecular prescreening program to detect notch pathway alterations in the context of early drug development

Introduction: Gene alterations in NOTCH signaling pathway have a prevalence ranging from &lt;1% to 13% across tumor types. Efforts in adapting molecular prescreening programs to emerging biomarkers are critical in the context of early clinical trials. The aim of this retrospective study is to assess the prevalence of NOTCH pathway alterations and compare the results of our two institutional panels with public databases (AACR Project GENIE) in order to guide drug development efforts and basket trials.

Methods: From Jan/2017 to Dec/2018, 1,697 patients (pts) had their FFPE tumor samples (either primary or metastasis) analyzed for mutations (mut) using a custom developed Amplicon-Seq panel of 59 cancer-related genes (including NOTCH1 [hotspots 5% exon coverage] and NOTCH4 [hotspots 3% exon coverage]) that was run in Illumina MiSeq (v1). Additionally, 502 samples were analyzed for Copy Number Alterations (CNA) using a panel of 44 genes (including NOTCH1-4) using NanoString nCounter (copy number between 4-6 copies were validated by FISH). From Jun/2018 to Jun/2019 an expanded NOTCH Amplicon-Seq panel v2 (including additional exons in NOTCH1 plus NOTCH2 and NOTCH3 hotspots regions) replaced the prior v1 panel and 618 samples were sequenced.

Results: Colorectal cancer (CRC) (n= 404 [24%]; n=241 [39 %]) and breast cancer (BC) (n=283 [17%]; n= 194 [31%]) were the most frequent tumor types for v1 and v2 panel cohorts, respectively. NOTCH1-4 mut were detected in 11 cases (0.64%). The highest rate of NOTCH pathway alterations (NOTCH1-4 mut plus CN gain or loss) was detected in BC (n=14 [7.7%]) with a clear enrichment in triple negative subtype. Higher prevalence of NOTCH1-4 mut was detected using expanded v2 panel, with 17 NOTCH1-4 mut cases (2.75%). Head & neck (H&N) (n=3 [5%]); BC (n=6 [3%]); and CRC (n=6 [2.5%]) were most common tumors. From all NOTCH1-4 gene mut detected, 8 were known actionable oncogenic driver mut and 9 were variants of unknown significance. When comparing our latest v2 results with GENIE database (mostly large NGS panels with exon capture), we found a similar prevalence in NOTCH1-4 mut in BC and CRC, but lower prevalence was seen in H&N, biliary and gastric tumors. We enrolled 4 pt in clinical trials with NOTCH inhibitors (3 NOTCH1 actionable mut pt (0.48%), 1 NOTCH3 actionable mut pt (0.16%).

Conclusion: Institutional efforts to increase coverage of NOTCH pathway genes improved the detection of actionable NOTCH1-4 mut. Differences in prevalence as compared to GENIE dataset may be attributed to the small number of samples tested with our v2 panel and larger panels covering all exons of NOTCH1-4 genes in GENIE cohort. Therefore, we keep evolving our NOTCH prescreening program for clinical trial enrichment.

Citation Format: Analía Azaro, Susana Aguilar, Zighereda Ogbah, Omar Saavedra, María Vieito, Ignacio Matos, Irene Braña, Enriqueta Felip, Joan Carles, Lorena Fariñas, Elena Elez, Teresa Macarulla, Cristina Saura, Rodrigo Dienstmann, Elena Garralda, Ana Vivancos. Adapting a molecular prescreening program to detect notch pathway alterations in the context of early drug development [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2953.

Global Gene Expression Characterization of Circulating Tumor Cells in Metastasic Castration-Resistant Prostate Cancer Patients

Background: Current therapeutic options in the course of metastatic castration-resistant prostate cancers (mCRPC) reinforce the need for reliable tools to characterize the tumor in a dynamic way. Circulating tumor cells (CTCs) have emerged as a viable solution to the problem, whereby patients with a variety of solid tumors, including PC, often do not have recent tumor tissue available for analysis. The biomarker characterization in CTCs could provide insights into the current state of the disease and an overall picture of the intra-tumor heterogeneity. Methods: in the present study, we applied a global gene expression characterization of the CTC population from mCRPC (n = 9), with the goal to better understand the biology of these cells and identify the relevant molecules favoring this tumor progression. Results: This analysis allowed the identification of 50 genes specifically expressed in CTCs from patients. Six of these markers (HOXB13, QKI, MAOA, MOSPD1, SDK1, and FGD4), were validated in a cohort of 28 mCRPC, showing clinical interest for the management of these patients. Of note, the activity of this CTC signature was related to the regulation of MYC, a gene strongly implicated in the biology of mCRPC. Conclusions: Overall, our results represent new evidence on the great value of CTCs as a non-invasive biopsy to characterize PC.

Phase I study of CC-90010, a reversible, oral BET inhibitor in patients with advanced solid tumors and relapsed/refractory non-Hodgkin's lymphoma

BACKGROUND

Bromodomain and extra-terminal (BET) proteins are epigenetic readers that regulate expression of genes involved in oncogenesis. CC-90010 is a novel, oral, reversible, small-molecule BET inhibitor.

PATIENTS AND METHODS

CC-90010-ST-001 (NCT03220347; 2015-004371-79) is a phase I dose-escalation and expansion study of CC-90010 in patients with advanced or unresectable solid tumors and relapsed/refractory (R/R) non-Hodgkin's lymphoma (NHL). We report results from the dose escalation phase, which explored 11 dose levels and four dosing schedules, two weekly (2 days on/5 days off; 3 days on/4 days off), one biweekly (3 days on/11 days off), and one monthly (4 days on/24 days off). The primary objectives were to determine the safety, maximum tolerated dose (MTD) and/or recommended phase II dose (RP2D) and schedule. Secondary objectives were to evaluate signals of early antitumor activity, pharmacokinetics, and pharmacodynamics.

RESULTS

This study enrolled 69 patients, 67 with solid tumors and two with diffuse large B-cell lymphoma (DLBCL). The median age was 57 years (range, 21-80) and the median number of prior regimens was four (range, 1-9). Treatment-related adverse events (TRAEs) were mostly mild and manageable; grade 3/4 TRAEs reported in more than two patients were thrombocytopenia (13%), anemia, and fatigue (4% each). Six patients had dose-limiting toxicities. MTDs were 15 mg (2 days on/5 days off), 30 mg (3 days on/11 days off), and 45 mg (4 days on/24 days off). The RP2D and schedule selected for expansion was 45 mg (4 days on/24 days off). As of 8 October 2019, one patient with grade 2 astrocytoma achieved a complete response, one patient with endometrial carcinoma had a partial response, and six patients had prolonged stable disease ≥11 months.

CONCLUSIONS

CC-90010 is well tolerated, with single-agent activity in patients with heavily pretreated, advanced solid tumors.

Abstract B050: Validation of body mass index (BMI) as a prognostic factor in patients (pts) treated with immune checkpoint inhibitors (ICI) across multiple cancer types (CT) and the impact of confounding factors (CF)

Introduction: Obesity results in PD1-mediated T-cell dysfunction in preclinical models and improved outcomes from ICI. We wanted to validate this clinical association in a prospective cohort of pts receiving PD1/L1 inhibitors across multiple CT and investigate the potential impact of CF, such as age and concomitant medications (CM) that may interact with obesity. Methods: Clinicopathological data from 310 pts treated with ICI at VHIO phase 1 Unit from Aug'12 to Jul'18 were investigated. Frequent CM included metformin (M), statins (S) and others. Associations between different variables and progression-free survival (PFS) were assessed with univariable and multivariate Cox regression models and survival data were calculated by the Kaplan-Meier method. Tumor types were stratified by proven PD1/L1 inhibitor efficacy versus unknown PD1/L1 sensitivity. Results: Out of 310 pts, median age was 59.8 years (y), 54.2% were male and most frequent tumor type was melanoma (19.4%) and lung (13.2%). In univariate models, pts with BMI&gt;25 kg/m2 (n=147, 47%) had increased PFS (3.5 months [m], CI95% 2.8-5.5) as compared to those with BMI&lt;25 kg/m2 (2.3m, CI95% 1.9-3.7, HR=0.73, p=0.02). Overweight and obese pts were older and more often received S and M than those with normal BMI or underweight. Pts exposed to S (n=50, 16%) had increased PFS (6.3 m, CI95% 3.7-9.5) as compared to those without S use (2.7m, CI95% 2.1-3.5, HR=0.63, p=0.03). Other CM had no impact on pts outcomes. In a multivariable model adjusting for age, tumor type, S and M use, increased BMI had no longer a significant impact on PFS (HR=0.83 [CI95% 0.63-1.11], p=0.21), and only age remained a signficant prognostic fator (10-y increase in age, HR=0.86 [CI95% 0.77-0.95], p=0.005). Conclusion: In univariate models, increased BMI is associated with prolonged PFS in pts receiving ICI. However, after adjustment for CF such as age and CM, the association loses statistical significance. Larger randomized cohorts need to be investigated before conclusive statements on obesity as a determinant of benefit with ICI.

Citation Format: Analía Azaro, Alejandra Ivars, Ignacio Matos, Omar Saavedra, Itziar Gardeazabal, Juan Martin-Liberal, Cinta Hierro, María Vieito, Irene Braña, Cristina Viaplana, Guillermo Villacampa, Gemma Sala, María Alsina, Ana Callejo, Helena Verdaguer, Guillem Aegiles, Ana Oaknin, Eva Muñoz, Rodrigo Dienstmann, Elena Garralda. Validation of body mass index (BMI) as a prognostic factor in patients (pts) treated with immune checkpoint inhibitors (ICI) across multiple cancer types (CT) and the impact of confounding factors (CF) [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2019 Oct 26-30; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2019;18(12 Suppl):Abstract nr B050. doi:10.1158/1535-7163.TARG-19-B050

Molecular Diagnosis of Diffuse Gliomas through Sequencing of Cell-Free Circulating Tumor DNA from Cerebrospinal Fluid

Purpose: Diffuse gliomas are the most common primary tumor of the brain and include different subtypes with diverse prognosis. The genomic characterization of diffuse gliomas facilitates their molecular diagnosis. The anatomical localization of diffuse gliomas complicates access to tumor specimens for diagnosis, in some cases incurring high-risk surgical procedures and stereotactic biopsies. Recently, cell-free circulating tumor DNA (ctDNA) has been identified in the cerebrospinal fluid (CSF) of patients with brain malignancies.Experimental Design: We performed an analysis of IDH1, IDH2, TP53, TERT, ATRX, H3F3A, and HIST1H3B gene mutations in two tumor cohorts from The Cancer Genome Atlas (TCGA) including 648 diffuse gliomas. We also performed targeted exome sequencing and droplet digital PCR (ddPCR) analysis of these seven genes in 20 clinical tumor specimens and CSF from glioma patients and performed a histopathologic characterization of the tumors.Results: Analysis of the mutational status of the IDH1, IDH2, TP53, TERT, ATRX, H3F3A, and HIST1H3B genes allowed the classification of 79% of the 648 diffuse gliomas analyzed, into IDH-wild-type glioblastoma, IDH-mutant glioblastoma/diffuse astrocytoma and oligodendroglioma, each subtype exhibiting diverse median overall survival (1.1, 6.7, and 11.2 years, respectively). We developed a sequencing platform to simultaneously and rapidly genotype these seven genes in CSF ctDNA allowing the subclassification of diffuse gliomas.Conclusions: The genomic analysis of IDH1, IDH2, TP53, ATRX, TERT, H3F3A, and HIST1H3B gene mutations in CSF ctDNA facilitates the diagnosis of diffuse gliomas in a timely manner to support the surgical and clinical management of these patients. Clin Cancer Res; 24(12); 2812-9. ©2018 AACR.

Abstract B075: Evolving molecular prescreening program to identify genomic alterations in the NOTCH pathway

Introduction: Over 2 years we have adapted our VHIO molecular prescreening program (PreScr) to identify genomic alterations in tumors of patients (pt) eligible for phase 1 clinical trials (Ph1) testing NOTCH inhibitors. This retrospective study aims to assess the prevalence of NOTCH pathway alterations in tumors and how this information was used to select therapies and to develop the PreScr. Methods: From Jan/2015 to Dec/2016, 1,832 pt had formalin-fixed, paraffin-embedded tumor samples (TS) analyzed for mutations (mut) using a customized developed Amplicon-Seq panel of 61 cancer-related genes (including FBXW7 [50% exon coverage], NOTCH1 [hotspots 5% exon coverage], NOTCH4 [hotspots 3% exon coverage]) run in Illumina MiSeq; 191 (TS) for Copy Number Alterations (CNAs) using a panel of 59 genes (including NOTCH1-4) run in NanoString NCounter; and 481 (TS) for gene expression using a panel of 26 genes (including NOTCH 1-4) run in Nanostring NCounter. NOTCH1-2 gene amplifications (ampl) were validated by FISH. Results: Tumor types samples were colorectal (CRC) n=468 (25%), lung (LC) n=273 (15%), breast (BC) n=176 (10%), gynecologic (GYNC) n= 111 (6%), head and neck (H&N) n=95 (5%), urinary (UC) n=91 (5%), brain primary tumors n= 34 (2%), and others n=513 (28%). Overall, FBXW7 mut were detected in 28 cases (GYNC 4.5%, CRC 3.7%, UC 2.2%, H&N 1%, others 0.6%). Most frequent co-occurring mut were TP53 (n=15) and APC (n=11). We found no mutations in NOTCH1 or NOTCH4. NOTCH2ampl (≥ 6 copies) were found in 3 cases (biliary tract 20%, BC 4.3%). We found no CNAs in NOTCH1/3/4. Outlier high expression (normalized z-score &gt; 4) of NOTCH family genes was detected in a variety of tumor types, including LC (NOTCH2/3), CRC (NOTCH1/2), BC (NOTCH3/4), UC (NOTCH3/4), and salivary gland (NOTCH1). Five pt were treated with Notch Gamma-secretase inhibitors in clinical trials (4 pt with FBXW7 mut and 1 pt with NOTCH2 ampl). Conclusion: We found a low prevalence of NOTCH pathway alterations in metastatic pt for Ph1 clinical trials. In order to increase the sensitivity for NOTCH mut detection, we will increase exon coverage of NOTCH genes. In parallel, outlier high expression data will be used to guide enrichment in future clinical trials. Our results reveal the challenges faced in an evolving PreScr to the NOTCH targeted therapy development.

Citation Format: Analia Azaro, Susana Aguilar, Rodrigo Dienstmann, Irene Braña, Cinta Hierro, María Ochoa de Olza, Juan Martin-Liberal, María Vieito, Ignacio Matos, Paolo Nuciforo, Josep Tabernero, Jordi Rodon, Ana Vivancos, Elena Garralda. Evolving molecular prescreening program to identify genomic alterations in the NOTCH pathway [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2017 Oct 26-30; Philadelphia, PA. Philadelphia (PA): AACR; Mol Cancer Ther 2018;17(1 Suppl):Abstract nr B075.

Improving circulating tumor cells enumeration and characterization to predict outcome in first line chemotherapy mCRPC patients

Introduction

There is a critical need of new surrogate markers for improving the therapeutic selection and monitoring of metastatic prostate cancer patients. Nowadays clinical management of these patients is been driven by biochemical and clinical parameters without enough accuracy to allow a real personalized medicine. The present study was conducted to go insight the molecular profile of circulating tumor cells (CTCs) isolated from advanced metastatic castration-resistant prostate cancer (mCRPC) with the aim of identifying prognostic marker with potential utility for therapy selection and monitoring.

Materials and Methods

CTCs isolation was carried out in peripheral blood samples from 29 mCRPC patients that undergo systemic chemotherapy based on taxanes (docetaxel/cabazitaxel) and 19 healthy controls using in parallel CellSearch and an alternative EpCAM-based immunoisolation followed by RT-qPCR analysis to characterize the CTC population. A panel of 17 genes related with prostate biology, hormone regulation, stem properties, tumor aggressiveness and taxanes responsiveness was analysed to identify an expression signature characterizing the CTCs.

Results

Patients with ≥ 5 CTCs/7.5ml of peripheral blood at baseline and during the treatment showed lower progression free survival (PFS) and overall survival (OS). Changes of CTCs levels during the treatment were also associated with the patient's outcome. These results confirmed previous data obtained using CellSearch in mCRPC. In addition, we found a CTC profile mainly characterized by the expression of relevant genes for the hormone dependent regulation of PCa such as AR and CYP19 together with genes strongly implicated in PCa progression and resistance development such as BIRC5, TUB1A, GDF15, RAB7 and SPINK1. Our gene-expression profiling also permitted the identification of valuable prognostic biomarkers. Thus, high levels of AR, CYP19 and GDF15 were associated with poor PFS rates while AR, GDF15 and BIRC5 were also found as reliable predictors of OS. Besides, a logistic model using KLK3 and BIRC5 showed a high specificity and sensitivity compared to CellSearch to discriminate patients with a more aggressive evolution.

Conclusions

The molecular characterization of CTCs from advanced mCRPC patients provided with a panel of specific biomarkers, including genes related to taxanes resistance, with a promising applicability as “liquid biopsy” for the management of these patients.

Clinical Application of Circulating Tumour Cells in Prostate Cancer: From Bench to Bedside and Back

Prostate cancer is the most common cancer in men worldwide. To improve future drug development and patient management, surrogate biomarkers associated with relevant outcomes are required. Circulating tumour cells (CTCs) are tumour cells that can enter the circulatory system, and are principally responsible for the development of metastasis at distant sites. In recent years, interest in detecting CTCs as a surrogate biomarker has ghiiukjrown. Clinical studies have revealed that high levels of CTCs in the blood correlate with disease progression in patients with prostate cancer; however, their predictive value for monitoring therapeutic response is less clear. Despite the important progress in CTC clinical development, there are critical requirements for the implementation of their analysis as a routine oncology tool. The goal of the present review is to provide an update on the advances in the clinical validation of CTCs as a surrogate biomarker and to discuss the principal obstacles and main challenges to their inclusion in clinical practice.

A multimarker panel for circulating tumor cells detection predicts patient outcome and therapy response in metastatic colorectal cancer

Circulating tumor cells (CTCs), proposed as major players in cancer dissemination, have demonstrated clinical prognostic significance in several cancer types. However, their predictive value remains unclear. Here we evaluated the clinical utility of six CTC markers (tissue specific and epithelial to mesenchymal transition transcripts) both as prognostic and predictive tools in metastatic colorectal cancer (mCRC) patients. CTCs were immunoisolated from blood in 50 mCRC patients at baseline and at 4 and 16 weeks after treatment onset. Expression levels of GAPDH, VIL1, CLU, TIMP1, LOXL3 and ZEB2 were determined by qualitative polymerase chain reaction and normalized to the unspecific cell isolation marker CD45. At baseline, median progression-free survival (PFS) and overall survival (OS) for patients with high CTC markers were 6.3 and 12.7 months, respectively, versus 12.7 and 24.2 for patients with low CTC markers (PFS; p = 0.0003; OS; p = 0.044). Concerning response to therapy, PFS and OS for patients with increased CTC markers along treatment were, respectively, 6.6 and 13.1 months, compared with 12.7 and 24.3 for patients presenting CTC markers reduction (PFS; p = 0.004; OS; p = 0.007). Of note, CTC markers identified therapy-refractory patients not detected by standard image techniques. Patients with increased CTC markers along treatment, but classified as responders by computed tomography, showed significantly shorter survival times (PFS: 7.8 vs. 13.2; OS: 14.4 vs. 24.4; months). In conclusion, we have generated a CTC marker panel for prognosis evaluation and the identification of patients benefiting or not from therapy in mCRC. Our methodology efficiently classified patients earlier than routine computed tomography and from a minimally invasive liquid biopsy.

Zoledronic acid as an antimetastatic agent for different human tumor cell lines

BACKGROUND

Zoledronic acid effectively reduces skeletal events in patients with metastatic disease. The results of pre-clinical and emerging clinical data suggest an additional activity of zoledronic acid as an antitumor agent, interfering with the growth and dissemination of malignant cells. However, the mechanisms by which zoledronic acid impairs tumor progression are practically unknown. In the present study, we aimed to investigate the impact of zoledronic acid on invasion and colony formation ability of different human tumour cell lines.

MATERIALS AND METHODS

Human ovarian (SKOV3), colonic (HCT116), endometrial (HEC1A and Ishikawa) and breast cancer (MCF-7, MDA-MB-231, HCC1937, SKBR3 and T47D) cell lines were treated with different concentrations (10-100 μM) of zoledronic acid and analyzed using 3D assays to test their invasiveness and their ability to grow anchorage-independently, both hallmarks of aggressive tumor cell behavior.

RESULTS

The most intense effect of the drug on tumor invasion was observed on MDA-MB-231 cells, but at high concentrations HEC1A, SKOV3 and SKBR3 cells also exhibited reduced invasion capacity. We also found a significant reduction of colony formation under zoledronic acid treatment in MCF-7, T47-D, HCT116, Ishikawa, HEC1A and SKOV3 cells.

CONCLUSION

Zoledronic acid presents an interesting potential for use as anti-metastatic agent for different solid tumor types, affecting relevant steps of tumor dissemination.

A logistic model for the detection of circulating tumour cells in human metastatic colorectal cancer

The accuracy in the diagnosis of metastatic colorectal cancer (mCRC) represents one of the challenges in the clinical management of patients. The detection of circulating tumour cells (CTC) is becoming a promising alternative to current detection techniques, as it focuses on one of the players of the metastatic disease and it should provide with more specific and sensitive detection rates. Here, we describe an improved method of detection of CTC from mCRC patients by combining immune-enrichment, optimal purification of RNA from very low cell numbers, and the selection of accurate PCR probes. As a result, we obtained a logistic model that combines GAPDH and VIL1 normalized to CD45 rendering powerful results in the detection of CTC from mCRC patients (AUROC value 0.8599). We further demonstrated the utility of this model at the clinical setting, as a reliable prognosis tool to determine progression-free survival in mCRC patients. Overall, we developed a strategy that ameliorates the specificity and sensitivity in the detection of CTC, resulting in a robust and promising logistic model for the clinical management of metastatic colorectal cancer patients.

Molecular characterization of circulating tumor cells in human metastatic colorectal cancer

Metastatic colorectal cancer (mCRC) relies on the detachment of aggressive malignant cells from the primary tumor into the bloodstream and, concordantly, the presence of these Circulating Tumor Cells (CTC) is associated with a poor prognosis. In this work, the molecular characterization of CTC from mCRC patients was approached, with the aim of understanding their biology and improving their clinical utility in the management of colorectal cancer patients. For this, EpCAM-based immunoisolation of CTC was combined with whole transcriptome amplification and hybridization onto cDNA microarrays. Gene expression data from mCRC patients, once the background of unspecific immunoisolation from a group of controls had been subtracted, resulted in 410 genes that characterized the CTC population. Bioinformatics were used for the biological interpretation of the data, revealing that CTC are characterized by genes related to cell movement and adhesion, cell death and proliferation, and cell signalling and interaction. RTqPCR on an independent series of mCRC patients and controls was used for the validation of a number of genes related to the main cellular functions characterizing the CTC population. Comparison between primary carcinomas and lung and liver metastases further involved the CTC-genes in the promotion of metastasis. Moreover, the correlation of CTC-gene expression with clinical parameters demonstrated detection and prognosis significance. In conclusion, the molecular characterization of CTC from mCRC patients and the identification of diagnostic and prognostic biomarkers represent an innovative and promising approach in the clinical management of this type of patients.

Association of breast cancer and obesity in a homogeneous population from Spain

OBJECTIVE

To evaluate for the first time in Spain if the association between obesity and breast cancer prognosis is similar to that reported in other countries with non Mediterranean dietary patterns.

METHODS

Weight and height and other variables of interest, tumor characteristics and current clinical status 3 yr after diagnosis were retrieved from medical files of breast cancer women diagnosed during 2006. A total of 159 cases with complete information were studied and categorized according to the World Health Organization criteria in normal-/under-weight, overweight, and obese.

RESULTS

Among breast cancer patients, 70.4% were classified as overweight/ obese and 29.6% as normal weight. Prevalence of obesity was high (38.4%) in comparison with information reported for healthy women of the same region (27.11%) and was higher among post-menopausal patients and in women with low level of alcohol and tobacco consumption. Moreover, overweight/ obese cases (79.5%) tended to have more often human epidermal growth factor receptor 2 status negative when compared with those with normal weight (70.2%; p=0.097) and the survival curves tended to be influenced by body mass index although without statistical significance.

CONCLUSIONS

Overweight/obesity in a Mediterranean country is highly prevalent among breast cancer patients. Our results support a putative influence of obesity per se and not the alimentary patterns as a prognostic factor in breast cancer patients justifying the need to perform larger prospective studies.

[Anesthesia with sevoflurane for tonsillectomy in a boy with Duchenne muscular dystrophy]

A 6-year-old boy with Duchenne muscular dystrophy (DMD) and foreseen difficult tracheal intubation underwent tonsillectomy under general inhaled anesthesia with sevoflurane. No neuromuscular blockers were administered and no perioperative complications emerged. In spite of advances in genetic diagnosis there continue to be patients with DMD because of spontaneous mutation of the dystrophin gene. Late detection leaves them vulnerable to administration of drugs like succinylcholine that can trigger fatal reactions involving hyperpotassemia, rhabdomyolysis, and malignant hyperthermia. Total intravenous anesthesia seems the best way to provide general anesthesia for a patient with DMD. Inhaled anesthesia is an alternative. Although halogenated agents can lead to rhabdomyolysis and malignant hyperthermia, the frequency seems low if we bear in mind that the use of sevoflurane is widespread in pediatrics. In this case sevoflurane induction facilitated safe tracheal intubation.

The diagnosis and treatment of a patient with puerperal infection and subdural hygromas

We describe a patient readmitted after developing a persistent postural headache resulting from an accidental lumbar puncture during labor 10 days earlier. Magnetic resonance imaging demonstrated bifrontal subdural hygromas and diffuse pachymeningeal enhancement. The patient had signs of a puerperal infection, and an epidural patch was performed with dextran 40 instead of blood, after which gradual improvement was noted. The patient was discharged totally asymptomatic 3 days later.