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Novak U, Fehr M, Schär S, Dreyling M, Schmidt C, Derenzini E, Zander T, Hess G, Mey U, Ferrero S, Mach N, Boccomini C, Böttcher S, Voegeli M, Cairoli A, Ivanova VS, Menter T, Dirnhofer S, Scheibe B, Gadient S, Eckhardt K, Zucca E, Driessen C, Renner C. Combined therapy with ibrutinib and bortezomib followed by ibrutinib maintenance in relapsed or refractory mantle cell lymphoma and high-risk features: a phase 1/2 trial of the European MCL network (SAKK 36/13). EClinicalMedicine 2023; 64:102221. [PMID: 37781158 PMCID: PMC10541470 DOI: 10.1016/j.eclinm.2023.102221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/15/2023] [Accepted: 09/01/2023] [Indexed: 10/03/2023] Open
Abstract
Background The Bruton's tyrosine kinase inhibitor ibrutinib and the proteasome inhibitor bortezomib have single-agent activity, non-overlapping toxicities, and regulatory approval in mantle cell lymphoma (MCL). In vitro, their combination provides synergistic cytotoxicity. In this investigator-initiated phase 1/2 trial, we established the recommended phase 2 dose of ibrutinib in combination with bortezomib, and assessed its efficacy in patients with relapsed or refractory MCL. Methods In this phase 1/2 study open in 15 sites in Switzerland, Germany and Italy, patients with relapsed or refractory MCL after ≤2 lines of chemotherapy and both ibrutinib-naïve and bortezomib-naïve received six cycles of ibrutinibb and bortezomib, followed by ibrutinib maintenance. For the phase 1 study, a standard 3 + 3 dose escalation design was used to determine the recommended phase 2 dose of ibrutinib in combination with bortezomib. The primary endpoint in phase 1 was the dose limiting toxicities in cycle 1. The phase 2 study was an open-label, single-arm trial with a Simon's two-stage min-max design, with a primary endpoint of overall response rate (ORR) assessed by CT/MRI. This study was registered with ClinicalTrials.gov, NCT02356458. Findings Between August 2015 and September 2016, nine patients were treated in the phase 1 study, and 49 patients were treated between November 2016 and March 2020 in the phase 2 of the trial. The ORR was 81.8% (90% CI 71.1, 89.8%, CR(u) 21.8%) which increased with continued ibrutinib (median 10.6 months) to 87.3%, (CR(u) 41.8%). 75.6% of patients had at least one high-risk feature (Ki-67 > 30%, blastoid or pleomorphic variant, p53 overexpression, TP53 mutations and/or deletions). In these patients, ibrutinib and bortezomib were also effective with an ORR of 74%, increasing to 82% during maintenance. With a median follow-up of 25.4 months, the median duration of response was 22.7, and the median PFS was 18.6 months. PFS reached 30.8 and 32.9 months for patients with a CR or Cru, respectively. Interpretation The combination of ibrutinib and bortezomib shows durable efficacy in patients with relapsed or refractory MCL, also in the presence of high-risk features. Funding SAKK (Hubacher Fund), Swiss State Secretariat for Education, Research and Innovation, Swiss Cancer Research Foundation, and Janssen.
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Affiliation(s)
- Urban Novak
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Martin Fehr
- Department of Medical Oncology and Haematology, Kantonsspital Sankt Gallen, Switzerland
| | - Sämi Schär
- SAKK Competence Centre, Bern, Switzerland
| | - Martin Dreyling
- Department of Medicine III, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Christian Schmidt
- Department of Medicine III, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Enrico Derenzini
- Onco-Haematology Division, IEO European Institute of Oncology IRCCS, Department of Health Sciences, University of Milan, Italy
| | - Thilo Zander
- Division of Medical Oncology, Luzerner Kantonsspital, Switzerland
| | - Georg Hess
- University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - Ulrich Mey
- Department of Oncology and Haematology, Kantonsspital Graubünden, Switzerland
| | - Simone Ferrero
- Haematology Department of Molecular Biotechnologies and Health Sciences, University of Torino, and Haematology 1, AOU “Città della Salute e della Scienza di Torino”, Italy
| | - Nicolas Mach
- Department of Oncology, University Hospital of Geneva, Switzerland
| | | | - Sebastian Böttcher
- Department of Medicine, Clinic III, Rostock University Medical Centre, Germany
| | - Michèle Voegeli
- Department of Haematology and Oncology, Kantonsspital Baselland, Liestal, Switzerland
| | - Anne Cairoli
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Vanesa-Sindi Ivanova
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Switzerland
| | - Thomas Menter
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Switzerland
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Switzerland
| | | | | | | | - Emanuele Zucca
- Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Christoph Driessen
- Department of Medical Oncology and Haematology, Kantonsspital Sankt Gallen, Switzerland
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Novak U, Fehr M, Schär S, Dreyling M, Scheubeck G, Ramadan S, Zucca E, Zander T, Hess G, Mey U, Ferrero S, Mach N, Boccomini C, Böttcher S, Voegeli M, Cairoli A, Menter T, Dirnhofer S, Gadient S, Eckhardt K, Driessen C, Renner C. SAKK 36/13 ‐ IBRUTINIB PLUS BORTEZOMIB AND IBRUTINIB MAINTENANCE FOR RELAPSED AND REFRACTORY MANTLE CELL LYMPHOMA: FINAL REPORT OF A PHASE I/II TRIAL OF THE EUROPEAN MCL NETWORK. Hematol Oncol 2021. [DOI: 10.1002/hon.62_2879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- U. Novak
- Inselspital, Bern University Hospital Medical Oncology Bern Switzerland
| | - M. Fehr
- Kantonsspital St. Gallen Department of Medical Oncology and Hematology St. Gallen Switzerland
| | - S. Schär
- SAKK Coordinating Center Bern Switzerland
| | - M. Dreyling
- Universität München‐Grossadern Medizinische Klinik III München Germany
| | - G. Scheubeck
- Universität München‐Grossadern Medizinische Klinik III München Germany
| | - S. Ramadan
- IEO, European Institute of Oncology IRCCS Onco‐Hematology Division Milano Italy
| | - E. Zucca
- Oncology Institute of Southern Switzerland Ospedale San Giovanni Bellinzona Switzerland
| | - T. Zander
- Kantonsspital Luzern Department Oncology Luzern Switzerland
| | - G. Hess
- Johannes Gutenberg Universität Mainz Universitätsmedizin Mainz Germany
| | - U. Mey
- Kantonsspital Graubünden Department of Oncology and Hematology Chur Switzerland
| | - S. Ferrero
- AOU "Città della Salute e della Scienza di Torino" Hematology 1 Torino Italy
| | - N. Mach
- University Hospital of Geneva Department of Oncology Genève Switzerland
| | - C. Boccomini
- AOU "Città della Salute e della Scienza di Torino" Hematology 1 Torino Italy
| | - S. Böttcher
- Rostock University Medical Center Department of Medicine, Clinic III ‐ Hematology, Oncology Palliative Medicine Rostock Germany
| | - M. Voegeli
- Kantonsspital Baselland Oncology Liestal Switzerland
| | - A. Cairoli
- CHUV University Hospital and University of Lausanne Service et Laboratoire Central d'Hématologie Département d'Oncologie Lausanne Switzerland
| | - T. Menter
- University Hospital Basel Institute of Pathology and Medical Genetics Basel Switzerland
| | - S. Dirnhofer
- University Hospital Basel Institute of Pathology and Medical Genetics Basel Switzerland
| | - S. Gadient
- SAKK Coordinating Center Bern Switzerland
| | | | - C. Driessen
- Kantonsspital St. Gallen Department of Medical Oncology and Hematology St. Gallen Switzerland
| | - C. Renner
- Onkozentrum, Hirslanden & Zürich Zürich Switzerland
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Vrbova L, Sciberras J, demarsh A, ahmad R, Todoric D, fazil A, Shane A, Gadient S, Ng V, Buck P, Thomas-Reilly G. Risk Assessment across the Event Continuum: a Canadian Approach for Emerging and Endemic Zoonotic Diseases. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.3670] [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: 10/28/2022] Open
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Müller AA, Dolowschiak T, Sellin ME, Felmy B, Verbree C, Gadient S, Westermann AJ, Vogel J, LeibundGut-Landmann S, Hardt WD. An NK Cell Perforin Response Elicited via IL-18 Controls Mucosal Inflammation Kinetics during Salmonella Gut Infection. PLoS Pathog 2016; 12:e1005723. [PMID: 27341123 PMCID: PMC4920399 DOI: 10.1371/journal.ppat.1005723] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [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] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/03/2016] [Indexed: 01/26/2023] Open
Abstract
Salmonella Typhimurium (S.Tm) is a common cause of self-limiting diarrhea. The mucosal inflammation is thought to arise from a standoff between the pathogen's virulence factors and the host's mucosal innate immune defenses, particularly the mucosal NAIP/NLRC4 inflammasome. However, it had remained unclear how this switches the gut from homeostasis to inflammation. This was studied using the streptomycin mouse model. S.Tm infections in knockout mice, cytokine inhibition and –injection experiments revealed that caspase-1 (not -11) dependent IL-18 is pivotal for inducing acute inflammation. IL-18 boosted NK cell chemoattractants and enhanced the NK cells' migratory capacity, thus promoting mucosal accumulation of mature, activated NK cells. NK cell depletion and Prf-/- ablation (but not granulocyte-depletion or T-cell deficiency) delayed tissue inflammation. Our data suggest an NK cell perforin response as one limiting factor in mounting gut mucosal inflammation. Thus, IL-18-elicited NK cell perforin responses seem to be critical for coordinating mucosal inflammation during early infection, when S.Tm strongly relies on virulence factors detectable by the inflammasome. This may have broad relevance for mucosal defense against microbial pathogens. Salmonella Typhimurium is a common cause of foodborne diarrhea. The disease symptoms arise already a few hours after infection. However, it had remained unclear how the immune system can mount the responses eliciting the disease symptoms so quickly. Earlier work in a mouse model had shown that the gut epithelium expresses a sensor, called NAIP/NLRC4/caspase-1 inflammasome that can detect the pathogen and mount a defense by 12-18h p.i. However, it has remained uncharacterized how inflammasome sensing drives the initial gut inflammation. Here, we found that the caspase-1 inflammasome triggers the production of IL-18, a pro-inflammatory cytokine that appears essential for the early onset of inflammation. IL-18 is driving the accumulation of NK cells into the infected mucosa, via the upregulation of NK cell chemoattractants and by the stimulation of their migratory capacity. Mature NK cells seem to induce mucosal inflammation via a perforin-mediated cytotoxic response. These data suggest that the inflammasome/IL-18/NK cell axis is a driver of early mucosal inflammation via a perforin-dependent cytotoxic NK cell response. Future work will have to address, if this mechanism is equally potent in the human gut and may contribute to ramping up the host's response during the first hours of infection. This may have implications for other gut infections and might provide leads for developing therapies.
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Affiliation(s)
- Anna A. Müller
- Institute of Microbiology, ETH Zürich, Zürich, Switzerland
| | | | - Mikael E. Sellin
- Institute of Microbiology, ETH Zürich, Zürich, Switzerland
- Department of Cell and Molecular Biology, Microbiology, Uppsala University, Uppsala, Sweden
| | - Boas Felmy
- Institute of Microbiology, ETH Zürich, Zürich, Switzerland
| | | | - Sandra Gadient
- Institute of Microbiology, ETH Zürich, Zürich, Switzerland
| | | | - Jörg Vogel
- Institute for Molecular Infection Biology, University of Würzburg, Würzburg, Germany
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Abstract
Due to the success of immunization and timely surveillance, Canada has not reported any cases of endemic measles since 1998. However, recent large outbreaks of imported-related measles have highlighted the risks of reintroduction of disease through travel and immunization coverage gaps in sub-populations. Building on its 2011 Elimination Report and in collaboration with provincial and territorial partners, the Public Health Agency of Canada has been promoting immunization, expanding the information gathered in immunization coverage surveys, piloting enhanced surveillance with real-time notifications of suspected and confirmed cases to enable early detection of outbreaks and strengthening its laboratory capacity. As these efforts are consolidated, this approach may become a model for other countries around the world as they seek to achieve measles elimination goals.
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Affiliation(s)
- P Lam
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - L Williams
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - S Gadient
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - S Squires
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - M St-Laurent
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
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