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Sun Y, Chen Y, Zhang X, Yi D, Kong F, Zhao L, Liao D, Chen L, Ma Q, Wang Z. ADCY4 promotes brain metastasis in small cell lung cancer and is associated with energy metabolism. Heliyon 2024; 10:e28162. [PMID: 38596032 PMCID: PMC11001775 DOI: 10.1016/j.heliyon.2024.e28162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/29/2024] [Accepted: 03/13/2024] [Indexed: 04/11/2024] Open
Abstract
Brain metastasis (BMs) in small cell lung cancer (SCLC) has a very poor prognosis. This study combined WGCNA with the mfuzz algorithm to identify potential biomarkers in the peripheral blood of patients with BMs. By comparing the significantly differentially expressed genes present in BMs samples, we identified ADCY4 as a target for further study. Expression of ADCY4 was used to cluster mfuzz expression pattern, and 28 hub genes for functional enrichment. PPI network analysis were obtained by comparing with differentially expressed genes in BMs. GABRE, NFE4 and LMOD2 are highly expressed in patients with BMs and have a good diagnostic effect. Immunoinfiltration analysis showed that SCLC patients with BMs may be associated with memory B cells, Tregs, NK cell activation, macrophage M0 and dendritic cell activation. prophytic was used to investigate the ADCY4-mediated anti-tumor drug response. In conclusion, ADCY4 can be used as a promising candidate biomarker for predicting BMs, molecular and immune features in SCLC. PCR showed that ADCY4 expression was increased in NCI-H209 and NCI-H526 SCLC cell lines. In vitro experiments confirmed that the expression of ADCY4 was significantly decreased after anti-PD1 antibody treatment, while the expression of energy metabolism factors were significantly different. This study reveals a potential mechanism by which ADCY4 mediates poor prognosis through energy metabolism -related pathways in SCLC.
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Affiliation(s)
- Yidan Sun
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300382, China
| | - Yixun Chen
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Xin Zhang
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300382, China
| | - Dan Yi
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300382, China
| | - Fanming Kong
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300382, China
| | - Linlin Zhao
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300382, China
| | - Dongying Liao
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300382, China
| | - Lei Chen
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300382, China
| | - Qianqian Ma
- Affiliated Women's Hospital of Jiangnan University Wuxi, Jiangsu, China
| | - Ziheng Wang
- Centre for Precision Medicine Research and Training, Faculty of Health Sciences, University of Macau, Macau SAR, China
- Department of Clinical Bio-bank, Affiliated Hospital of Nantong University, Jiangsu, China
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Holmberg CJ, Zijlker LP, Katsarelias D, Huibers AE, Wouters MWJM, Schrage Y, Reijers SJM, van Thienen JV, Grünhagen DJ, Martner A, Nilsson JA, van Akkooi ACJ, Ny L, van Houdt WJ, Olofsson Bagge R. The effect of a single dose of nivolumab prior to isolated limb perfusion for patients with in-transit melanoma metastases: An interim analysis of a phase Ib/II randomized double-blind placebo-controlled trial (NivoILP trial). Eur J Surg Oncol 2024; 50:108265. [PMID: 38493679 DOI: 10.1016/j.ejso.2024.108265] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE ILP has shown to achieve high response rates in patients with melanoma ITM. Possibly there is a synergistic mechanism of action of ILP and anti-PD1. The aim of this trial was to investigate the safety and efficacy of adding a single dose of systemic anti-PD1 to isolated limb perfusion (ILP) for patients with melanoma in-transit metastases (ITM). METHODS In this placebo controlled double-blind phase Ib/II trial, patients with melanoma ITM were randomized 1:1 to either a single systemic dose of nivolumab or placebo one day prior to ILP. The primary endpoint was complete response (CR) rate at three months, and safety in terms of incidence and severity of adverse events (AEs). RESULTS A total of 20 patients were included. AEs of any grade occurred in 90% of patients in the nivolumab arm and in 80% in the placebo arm within three months after ILP. Grade 3 AEs were reported in 40% and 30% respectively, most commonly related to wound infection, wound dehiscence, or skin necrosis. There were no grade 4 or 5 AEs reported. The CR rate was 75% in the nivolumab arm and 60% in the placebo arm. The 1-year local progression-free rate was 86% in the nivolumab arm and 67% in the placebo arm. The 1-year OS was 100% in both arms. CONCLUSION For patients with melanoma ITM, the addition of a single systemic dose of nivolumab the day before ILP is considered safe and feasible with promising efficacy. Accrual will continue in a phase 2 trial.
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Affiliation(s)
- Carl-Jacob Holmberg
- Sahlgrenska University Hospital, Department of Surgery, Gothenburg, Sweden; Sahlgrenska Center for Cancer Research, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Lisanne P Zijlker
- The Netherlands Cancer Institute, Department of Surgical Oncology, Amsterdam, the Netherlands; Melanoma Institute Australia, Sydney, New South Wales, Australia
| | - Dimitrios Katsarelias
- Sahlgrenska University Hospital, Department of Surgery, Gothenburg, Sweden; Sahlgrenska Center for Cancer Research, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anne E Huibers
- Sahlgrenska University Hospital, Department of Surgery, Gothenburg, Sweden; Sahlgrenska Center for Cancer Research, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michel W J M Wouters
- The Netherlands Cancer Institute, Department of Surgical Oncology, Amsterdam, the Netherlands
| | - Yvonne Schrage
- The Netherlands Cancer Institute, Department of Surgical Oncology, Amsterdam, the Netherlands
| | - Sophie J M Reijers
- The Netherlands Cancer Institute, Department of Surgical Oncology, Amsterdam, the Netherlands
| | - Johannes V van Thienen
- The Netherlands Cancer Institute, Department of Medical Oncology, Amsterdam, the Netherlands
| | - Dirk J Grünhagen
- Erasmus Medical Center, Department of Surgical Oncology, Rotterdam, the Netherlands
| | - Anna Martner
- TIMM Laboratory, Sahlgrenska Center for Cancer Research, Department of Microbiology and Immunology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jonas A Nilsson
- Sahlgrenska Center for Cancer Research, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Harry Perkins Institute of Medical Research, University of Western Australia, Perth, Western Australia, Australia
| | - Alexander C J van Akkooi
- Melanoma Institute Australia, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Lars Ny
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Winan J van Houdt
- The Netherlands Cancer Institute, Department of Surgical Oncology, Amsterdam, the Netherlands
| | - Roger Olofsson Bagge
- Sahlgrenska University Hospital, Department of Surgery, Gothenburg, Sweden; Sahlgrenska Center for Cancer Research, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.
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Zhang P, Shi S, Xu J, Chen Z, Song L, Zhang X, Cheng Y, Zhang Y, Ye F, Li Z, Yin F, Ji D, Gao H, Li Y, Chen W, Yang M, Weng D, Wu C, Ma Y, Sheng W, Zhao Y, Yin X, Shen W, Su W, Shi M, Fan S, Tan P, Xu Q, Lu M, Shen L. Surufatinib plus toripalimab in patients with advanced neuroendocrine tumours and neuroendocrine carcinomas: An open-label, single-arm, multi-cohort phase II trial. Eur J Cancer 2024; 199:113539. [PMID: 38237373 DOI: 10.1016/j.ejca.2024.113539] [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: 11/09/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND The programmed death 1 inhibitor toripalimab plus the angio-immuno kinase inhibitor surufatinib revealed a tolerable safety profile and preliminary efficacy in patients with advanced solid tumours in a phase I study. PATIENTS AND METHODS This was an open-label, single-arm, multi-cohort phase II study in China. Patients with advanced neuroendocrine tumours (NETs) or neuroendocrine carcinomas (NECs) or mixed neuroendocrine non-neuroendocrine neoplasms (MiNENs) who had failed or were intolerable of standard treatment were given surufatinib (250 mg orally, once daily) plus toripalimab (240 mg intravenously, once every 3 weeks). Primary end-point was investigator-assessed objective response rate (ORR) per Response Evaluation Criteria in Solid Tumors version 1.1. Secondary end-points included duration of response (DoR), disease control rate, progression-free survival (PFS), overall survival (OS), and safety. RESULTS Forty patients were enrolled into two cohorts by tumour types (NET, n = 19; NEC-MiNEN, n = 21). ORRs (95% CIs) were 21.1% (6.1-45.6) and 23.8% (8.2-47.2) in the NET and NEC-MiNEN cohorts, respectively. Median DoR was 7.1 months (6.9-not evaluable [NE]) and 4.1 months (3.0-NE), respectively. Median PFS was 9.6 months (4.1-NE) and 4.1 months (1.5-5.5); median OS was 27.3 (15.3-NE) and 10.9 months (9.1-14.6), respectively. Overall, grade ≥ 3 treatment-related adverse events occurred in 18 (45.0%) patients. CONCLUSIONS Surufatinib plus toripalimab showed antitumour activity and a tolerable safety profile in patients with previously treated NETs/NECs/MiNENs. Further study of this combination regimen is ongoing for advanced NECs, for which current therapeutic options remain limited. CLINICALTRIALS gov: NCT04169672.
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Affiliation(s)
- Panpan Zhang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Early Drug Development Centre, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Si Shi
- Department of Pancreatic Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, No.270 Dong'an Road, Xuhui district, Shanghai, China
| | - Jianming Xu
- Department of Gastrointestinal Oncology, The Fifth Medical Center of Chinese PLA General Hospital, No.8 East Avenue, Fengtai District, Beijing, China
| | - Zhendong Chen
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, No.678 Furong Road, Economic and Technological Development Zone, Hefei, Anhui, China
| | - Lijie Song
- First Department of Oncology, The First Affiliated Hospital of Zhengzhou University, No.1 East Jianshe Road, Erqi District, Zhengzhou, Henan, China
| | - Xing Zhang
- Biotherapy Center, Sun Yat-sen University Cancer Center, No.651 East Dongfeng Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Ying Cheng
- Department of Thoracic Oncology, Jilin Cancer Hospital, No.1066 Jinghu Avenue, Gaoxin District, Changchun, Jilin,China
| | - Yanqiao Zhang
- Second Department of Gastroenterology, Harbin Medical University Cancer Hospital, No.150 Haping Road, Nangang District, Harbin, Heilongjiang, China
| | - Feng Ye
- Department of Medical Oncology, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Siming District, Xiamen, Fujian, China
| | - Zhiping Li
- Department of Abdominal Oncology, West China Hospital of Sichuan University, No.37 Guoxue Lane, Wuhou District, Chengdu, Sichuan, China
| | - Fei Yin
- Department of Gastroenterology, The Fourth Hospital of Hebei Medical University, No.12 Jiankan Road, Shijiazhuang, Hebei, China
| | - Dongmei Ji
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, No.270 Dong'an Road, Xuhui district, Shanghai, China
| | - Heli Gao
- Department of Pancreatic Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, No.270 Dong'an Road, Xuhui district, Shanghai, China
| | - Yi Li
- Department of Gastrointestinal Oncology, The Fifth Medical Center of Chinese PLA General Hospital, No.8 East Avenue, Fengtai District, Beijing, China
| | - Wei Chen
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, No.678 Furong Road, Economic and Technological Development Zone, Hefei, Anhui, China
| | - Minjie Yang
- First Department of Oncology, The First Affiliated Hospital of Zhengzhou University, No.1 East Jianshe Road, Erqi District, Zhengzhou, Henan, China
| | - Desheng Weng
- Biotherapy Center, Sun Yat-sen University Cancer Center, No.651 East Dongfeng Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Chunjiao Wu
- Phase I Study Ward, Jilin Cancer Hospital, No.1066 Jinghu Avenue, Gaoxin District, Changchun, Jilin, China
| | - Yue Ma
- Second Department of Gastroenterology, Harbin Medical University Cancer Hospital, No.150 Haping Road, Nangang District, Harbin, Heilongjiang, China
| | - Wang Sheng
- Department of Medical Oncology, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Siming District, Xiamen, Fujian, China
| | - Yaqin Zhao
- Department of Abdominal Oncology, West China Hospital of Sichuan University, No.37 Guoxue Lane, Wuhou District, Chengdu, Sichuan, China
| | - Xiaolei Yin
- Department of Gastroenterology, The Fourth Hospital of Hebei Medical University, No.12 Jiankan Road, Shijiazhuang, Hebei, China
| | - Weina Shen
- Phase I Study Ward, Fudan University Shanghai Cancer Center, No.270 Dong'an Road, Xuhui district, Shanghai, China
| | - Weiguo Su
- HUTCHMED Limited, Building 4, 720 Cailun Road, Pilot Free Trade Zone, Shanghai, China
| | - Michael Shi
- Clinical & Regulatory Department, HUTCHMED Limited, Building 4, 720 Cailun Road, Pilot Free Trade Zone, Shanghai, China
| | - Songhua Fan
- Clinical & Regulatory Department, HUTCHMED Limited, Building 4, 720 Cailun Road, Pilot Free Trade Zone, Shanghai, China
| | - Panfeng Tan
- Clinical & Regulatory Department, HUTCHMED Limited, Building 4, 720 Cailun Road, Pilot Free Trade Zone, Shanghai, China
| | - Qian Xu
- Clinical & Regulatory Department, HUTCHMED Limited, Building 4, 720 Cailun Road, Pilot Free Trade Zone, Shanghai, China
| | - Ming Lu
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
| | - Lin Shen
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
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Jacques SK, McKeown J, Grover P, Johnson DB, Zaremba A, Dimitriou F, Weiser R, Farid M, Namikawa K, Sullivan RJ, Rutkowski P, Lebbe C, Hamid O, Zager JS, Michielin O, Neyns B, Nakamura Y, Robert C, Mehnert J, Ascierto PA, Bhave P, Park B, Zimmer L, Mangana J, Mooradian M, Placzke J, Allayous C, Glitza Oliva IC, Mehmi I, Depalo D, Wicky A, Schwarze JK, Roy S, Boatwright C, Vanella V, Long GV, Menzies AM, Lo SN, Carlino MS. Outcomes of patients with resected stage III/IV acral or mucosal melanoma, treated with adjuvant anti-PD-1 based therapy. Eur J Cancer 2024; 199:113563. [PMID: 38278007 DOI: 10.1016/j.ejca.2024.113563] [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: 10/22/2023] [Revised: 01/02/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024]
Abstract
IMPORTANCE Acral (AM) and mucosal melanomas (MM) are rare subtypes with a poor prognosis. In those with advanced disease, anti-PD-1 (PD1) therapy has reduced activity compared to that seen in non-acral cutaneous melanoma. OBJECTIVE To determine the efficacy of adjuvant PD1 in resected AM or MM. DESIGN An international, retrospective cohort study SETTING: Data up to November 2021 collected from 20 centres across 10 countries. PARTICIPANTS One hundred and ninety four patients with resected stage III or IV1 AM or MM who received adjuvant PD1 were included and compared to matched patients from the Melanoma Institute Australia (MIA) database using a propensity score matching analysis. MAIN OUTCOMES AND MEASURES Recurrence-free survival (RFS), distant metastasis-free survival (DMFS) and overall survival (OS) were investigated. RESULTS Forty five of 139 (32%) AM and 9 of 55 (16%) MM patients completed adjuvant therapy. The main reason for early treatment cessation in both groups was disease recurrence: 51 (37%) and 30 (55%) in the AM and MM groups, respectively. In the AM group adjuvant PD1 was associated with a longer RFS [HR-0.69 (0.52-0.92, p = 0.0127)], DMFS [HR0.58 (0.38-0.89, p = 0.0134)] and OS [HR of 0.59 (0.38-0.92, p-value 0.0196)] when compared to the historical cohort. In the MM group there was no statistical difference in RFS [HR1.36 (0.69-2.68,p-value 0.3799], DMFS or OS. CONCLUSION AND RELEVANCE After adjuvant PD1, both AM and MM have a high risk of recurrence. Our data suggests a benefit to using adjuvant PD1 therapy in resected AM but not in resected MM. Additional studies to investigate the efficacy of adjuvant PD1 for MM are needed.
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Affiliation(s)
- Sarah K Jacques
- Department of Medical Oncology, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Janet McKeown
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Piyush Grover
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | | | - Anne Zaremba
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany
| | - Florentia Dimitriou
- Department of Dermatology, University Hospital of Zurich and Faculty of Medicine, University of Zürich, Zurich, Switzerland
| | - Roi Weiser
- MD Anderson Cancer Center, Houston, TX, USA
| | | | - Kenjiro Namikawa
- Department of Dermatologic Oncology, National Cancer Center, Tokyo, Japan
| | - Ryan J Sullivan
- Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Piotr Rutkowski
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Celeste Lebbe
- Université Paris Cite,AP-HP Dermato-oncology, Cancer institute APHP.nord Paris cité, INSERM U976, Saint Louis Hospital, Paris, France
| | - Omid Hamid
- The Angeles Clinic, A Cedars-Sinai Affiliate, Los Angeles, CA, USA
| | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffit Cancer Center, Tampa, FL, USA
| | - Olivier Michielin
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Bart Neyns
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Yasuhiro Nakamura
- Department of Skin Oncology/Dermatology, Comprehensive Cancer Center, Saitama Medical University International Medical Center, Saitama, Japan
| | - Caroline Robert
- Institute Gustave Roussy and Paris Saclay University, Villejuif Cedex, France
| | | | - Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Prachi Bhave
- Sir Peter MacCallum Cancer Centre Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Benjamin Park
- Vanderbilt University Medical Centre, Nashville, TN, USA
| | - Lisa Zimmer
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany
| | - Joanna Mangana
- Department of Dermatology, University Hospital of Zurich and Faculty of Medicine, University of Zürich, Zurich, Switzerland
| | - Megan Mooradian
- Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Joanna Placzke
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Clare Allayous
- Université Paris Cite,AP-HP Dermato-oncology, Cancer institute APHP.nord Paris cité, INSERM U976, Saint Louis Hospital, Paris, France
| | | | - Inderjit Mehmi
- The Angeles Clinic, A Cedars-Sinai Affiliate, Los Angeles, CA, USA
| | - Danielle Depalo
- Department of Cutaneous Oncology, Moffit Cancer Center, Tampa, FL, USA
| | - Alexandre Wicky
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Severine Roy
- Institute Gustave Roussy and Paris Saclay University, Villejuif Cedex, France
| | | | - Vito Vanella
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Matteo S Carlino
- Department of Medical Oncology, Westmead and Blacktown Hospitals, Sydney, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, Australia.
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Moreno-Ramírez D, Fernández-Orland A, Ferrándiz L. Immunotherapy and Targeted Therapy in Patients With Advanced Melanoma and the V600 BRAF Mutation: Which One First? Actas Dermosifiliogr 2024; 115:48-55. [PMID: 37321549 DOI: 10.1016/j.ad.2023.05.023] [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: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 06/17/2023] Open
Abstract
Systemic treatment with immunotherapy or targeted therapy can significantly improve survival in patients with advanced (metastatic or high-risk) melanoma. Fifty percent of patients with melanoma have a BRAF mutation. Decisions on optimal sequencing of systemic treatments should take into account drug- and tumor-related factors and patient characteristics. Although the combination of ipilimumab and nivolumab is associated with the best survival outcomes, it is associated with significant toxicity. Targeted therapy may be a more favorable option in certain clinical situations. We review the literature on immunotherapy and targeted therapy in melanoma and present an algorithm for guiding decision-making on their use as first-line systemic treatments for advanced BRAF-mutated melanoma.
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Affiliation(s)
- D Moreno-Ramírez
- Unidad de Melanoma, Servicio de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen Macarena, Sevilla, España.
| | - A Fernández-Orland
- Unidad de Melanoma, Servicio de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - L Ferrándiz
- Unidad de Melanoma, Servicio de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen Macarena, Sevilla, España
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6
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Moreno-Ramírez D, Fernández-Orland A, Ferrándiz L. [Translated article] Immunotherapy and Targeted Therapy in Patients With Advanced Melanoma and the V600 BRAF Mutation: Which One First? Actas Dermo-Sifiliográficas 2024; 115:T48-T55. [PMID: 37923078 DOI: 10.1016/j.ad.2023.10.036] [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: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 11/07/2023] Open
Abstract
Systemic treatment with immunotherapy or targeted therapy can significantly improve survival in patients with advanced (metastatic or high-risk) melanoma. Fifty percent of patients with melanoma have a BRAF mutation. Decisions on optimal sequencing of systemic treatments should take into account drug- and tumor-related factors and patient characteristics. Although the combination of ipilimumab and nivolumab is associated with the best survival outcomes, it is associated with significant toxicity. Targeted therapy may be a more favorable option in certain clinical situations. We review the literature on immunotherapy and targeted therapy in melanoma and present an algorithm for guiding decision-making on their use as first-line systemic treatments for advanced BRAF-mutated melanoma.
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Affiliation(s)
- D Moreno-Ramírez
- Unidad de Melanoma, Servicio de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen Macarena, Seville, Spain.
| | - A Fernández-Orland
- Unidad de Melanoma, Servicio de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen Macarena, Seville, Spain
| | - L Ferrándiz
- Unidad de Melanoma, Servicio de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen Macarena, Seville, Spain
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7
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Kang X, Wang J, Kang X, Bai L. Predictive value of prognostic nutritional index (PNI) in recurrent or unresectable hepatocellular carcinoma received anti-PD1 therapy. BMC Cancer 2023; 23:787. [PMID: 37612634 PMCID: PMC10463676 DOI: 10.1186/s12885-023-11166-w] [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: 12/10/2022] [Accepted: 07/09/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Clinical trials have shown that anti-PD1 therapy, either as a monotherapy or in combination, is effective and well-tolerated in patients with recurrent or unresectable hepatocellular carcinoma (HCC). In this study, we aimed to investigate the prognostic value of immune-nutritional biomarkers in measuring the effects of anti-PD1 therapy in these patients. METHODS We enrolled and followed up with 85 patients diagnosed with advanced HCC who underwent anti-PD1 therapy at the First Medical Centre of Chinese People's Liberation Army (PLA) General Hospital between January 2016 and January 2021. The retrospective analysis aimed to determine whether immune-nutritional biomarkers could serve as promising prognostic indices in these patients. RESULTS In this retrospective study, patients in the PNI-high group showed a better progression-free survival (PFS) compared to those in the PNI-low group (9.5 months vs. 4.2 months, P = 0.039). Similarly, the median overall survival (OS) was longer in the PNI-high group (23.9 months, 95%CI 17.45-30.35) than in the PNI-low group (11.7 months, 95%CI 9.27-14.13) (P = 0.002). These results were consistent with sub-analyses of the anti-PD1 therapy. Furthermore, both univariate and multivariate analyses indicated that a higher pre-treatment PNI ( > = 44.91) was a significant predictive factor for favorable outcomes in this patient cohort (HR = 0.411, P = 0.023). CONCLUSION Our study suggests that pre-treatment PNI is a critical predictive factor in patients with recurrent or unresectable HCC undergoing anti-PD1 therapy.
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Affiliation(s)
- Xindan Kang
- Department of Respiratory and Critical Care Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese People's Liberation Army General Hospital, Beijing, 100089, China
- Department of Oncology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100036, China
| | - Jing Wang
- Department of General Medicine, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100036, China
| | - Xue Kang
- Department of Oncology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100036, China
| | - Li Bai
- Department of Oncology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100036, China.
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Zhang RJ, Zhou HM, Lu HY, Yu HP, Tang WZ, Qiu MQ, Yan LY, Long MY, Su TS, Xiang BD, He ML, Wang XT, Liang SX, Li JX. Radiotherapy plus anti-PD1 versus radiotherapy for hepatic toxicity in patients with hepatocellular carcinoma. Radiat Oncol 2023; 18:129. [PMID: 37542246 PMCID: PMC10403970 DOI: 10.1186/s13014-023-02309-1] [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: 09/22/2022] [Accepted: 06/26/2023] [Indexed: 08/06/2023] Open
Abstract
PURPOSE In this study, we aimed to compare the radiation-induced hepatic toxicity (RIHT) outcomes of radiotherapy (RT) plus antibodies against programmed cell death protein 1 (anti-PD1) versus RT alone in patients with hepatocellular carcinoma (HCC), evaluate prognostic factors of non-classic radiation-induced liver disease (ncRILD), and establish a nomogram for predicting the probability of ncRILD. PATIENTS AND METHODS Patients with unresectable HCC treated with RT and anti-PD1 (RT + PD1, n = 30) or RT alone (n = 66) were enrolled retrospectively. Patients (n = 30) in each group were placed in a matched cohort using propensity score matching (PSM). Treatment-related hepatotoxicity was evaluated and analyzed before and after PSM. The prognostic factors affecting ncRILD were identified by univariable logistic analysis and Spearman's rank test in the matched cohort to generate a nomogram. RESULTS There were no differences in RIHT except for increased aspartate aminotransferase (AST) ≥ grade 1 and increased total bilirubin ≥ grade 1 between the two groups before PSM. After PSM, AST ≥ grade 1 occurred more frequently in the RT + PD1 group (p = 0.020), and there were no significant differences in other hepatotoxicity metrics between the two groups. In the matched cohort, V25, tumor number, age, and prothrombin time (PT) were the optimal prognostic factors for ncRILD modeling. A nomogram revealed a good predictive performance (area under the curve = 0.82). CONCLUSIONS The incidence of RIHT in patients with HCC treated with RT + PD1 was acceptable and similar to that of RT treatment. The nomogram based on V25, tumor number, age, and PT robustly predicted the probability of ncRILD.
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Affiliation(s)
- Rui-Jun Zhang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Hong-Mei Zhou
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Hai-Yan Lu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Hong-Ping Yu
- Department of Research, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
- School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Wei-Zhong Tang
- Division of Colorectal & Anal Surgery, Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Mo-Qin Qiu
- Department of Respiratory Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Liu-Ying Yan
- Department of General Affairs, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Mei-Ying Long
- School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Ting-Shi Su
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Bang-De Xiang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Mei-Ling He
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Xiao-Ting Wang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Shi-Xiong Liang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530021, China.
| | - Jian-Xu Li
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530021, China.
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Toulemonde E, Chevret S, Battistella M, Neidhardt EM, Nardin C, Le Du F, Meyer N, Véron M, Gambotti L, Lamrani-Ghaouti A, Jamme P, Chaffaut C, De Pontville M, Saada-Bouzid E, Beylot-Barry M, Simon C, Jouary T, Marabelle A, Mortier L. Safety and efficacy of the anti-PD1 immunotherapy with nivolumab in trichoblastic carcinomas. Cancer Immunol Immunother 2023:10.1007/s00262-023-03449-9. [PMID: 37067554 DOI: 10.1007/s00262-023-03449-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 04/06/2023] [Indexed: 04/18/2023]
Abstract
Trichoblastic carcinoma is a rare malignant cutaneous adnexal tumor with a risk of local invasion and distant metastasis. As of today, there is no consensus for the treatment of locally advanced or metastatic trichoblastic carcinoma. "AcSé Nivolumab" is a multi-center Phase II basket clinical trial (NCT03012581) evaluating the safety and efficacy of nivolumab in several cohorts of rare, advanced cancers. Here we report the results of nivolumab in patients with trichoblastic carcinoma. Of the eleven patients enrolled in the study, five patients had been previously treated by sonic hedgehog inhibitors. The primary endpoint 12-week objective response rate was 9.1% (N = 1/11) with 1 partial response. Six patients who progressed under previous lines of treatment showed stable disease at 12 weeks, reflecting a good control of the disease with nivolumab. Furthermore, 54.5% of the patients (N = 6/11) had their disease under control at 6 months. The 1-year overall survival was 80%, and the median progression-free survival was 8.4 months (95%CI, 5.7 to NA). With 2 responders (2 complete responses), the best response rate to nivolumab at any time was 18.2% (95%CI, 2.3-51.8%). No new safety signals were identified, and adverse events observed herein were previously described and well known with nivolumab monotherapy. These results are promising, suggesting that nivolumab might be an option for patients with advanced trichoblastic carcinomas. Further studies on larger cohorts are necessary to confirm these results and define the role of nivolumab in the treatment of trichoblastic carcinomas.
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Affiliation(s)
- E Toulemonde
- Department of Dermatology, Claude Huriez Hospital, CHU de Lille, Lille, France.
| | - S Chevret
- Department of Biostatistics, Saint Louis Hospital, AP-HP, Paris, France
| | - M Battistella
- Department of Pathology, Saint Louis Hospital, AP-HP, Université Paris Cité, INSERM U976, Paris, France
- CARADERM Network, Lille, France
| | - E M Neidhardt
- Department of Oncology, Centre Léon Berard, Lyon, France
| | - C Nardin
- Department of Dermatology, CHU Besançon and INSERM 1098, Besançon, France
| | - F Le Du
- Department of Oncology, CLCC Eugène Marquis, Rennes, France
| | - N Meyer
- Department of Oncodermatology, IUC and CHU Toulouse, Toulouse, France
| | - M Véron
- Department of Dermatology, Claude Huriez Hospital, CHU de Lille, Lille, France
| | - L Gambotti
- Department of Clinical Research, Institut National Contre Le Cancer (INCa), Paris, France
| | | | - P Jamme
- Department of Dermatology, Claude Huriez Hospital, CHU de Lille, Lille, France
| | - C Chaffaut
- Department of Biostatistics, Saint Louis Hospital, AP-HP, Paris, France
| | - M De Pontville
- Department of Dermatology, CHU Caen, Caen, France
- CARADERM Network, Lille, France
| | - E Saada-Bouzid
- Department of Medical Oncology, Centre Antoine Lacassagne, Côte d'Azur University, Nice, France
| | - M Beylot-Barry
- Department of Dermatology, CHU Bordeaux, INSERM U1312, Bordeaux, France
- CARADERM Network, Lille, France
| | - C Simon
- Département R&D Unicancer, Paris, France
| | - T Jouary
- Department of Dermatology, François Mitterrand Hospital, Pau, France
- CARADERM Network, Lille, France
| | - A Marabelle
- Department of Therapeutic Innovations and Early Clinical Trials, INSERM U1015 & CIC1428, University of Paris Saclay, Gustave Roussy, Villejuif, France
| | - L Mortier
- Department of Dermatology, Claude Huriez Hospital, CARADERM and University of Lille, U1189 Inserm, 59000, Lille, France
- CARADERM Network, Lille, France
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10
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Hu Z, Chen G, Zhao Y, Gao H, Li L, Yin Y, Jiang J, Wang L, Mang Y, Gao Y, Zhang S, Ran J, Li L. Exosome-derived circCCAR1 promotes CD8 + T-cell dysfunction and anti-PD1 resistance in hepatocellular carcinoma. Mol Cancer 2023; 22:55. [PMID: 36932387 PMCID: PMC10024440 DOI: 10.1186/s12943-023-01759-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [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: 09/28/2022] [Accepted: 03/10/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Circular RNAs (circRNAs) can be encapsulated into exosomes to participate in intercellular communication, affecting the malignant progression of a variety of tumors. Dysfunction of CD8 + T cells is the main factor in immune escape from hepatocellular carcinoma (HCC). Nevertheless, the effect of exosome-derived circRNAs on CD8 + T-cell dysfunction needs further exploration. METHODS The effect of circCCAR1 on the tumorigenesis and metastasis of HCC was assessed by in vitro and in vivo functional experiments. The function of circCCAR1 in CD8 + T-cell dysfunction was measured by enzyme-linked immunosorbent assay (ELISA), western blotting and flow cytometry. Chromatin immunoprecipitation, biotinylated RNA pull-down, RNA immunoprecipitation, and MS2 pull-down assays were used to the exploration of mechanism. A mouse model with reconstituted human immune system components (huNSG mice) was constructed to explore the role of exosomal circCCAR1 in the resistance to anti-PD1 therapy in HCC. RESULTS Increased circCCAR1 levels existed in tumor tissues and exosomes in the plasma of HCC patients, in the culture supernatant and HCC cells. CircCCAR1 accelerated the growth and metastasis of HCC in vitro and in vivo. E1A binding protein p300 (EP300) and eukaryotic translation initiation factor 4A3 (EIF4A3) promoted the biogenesis of circCCAR1, and Wilms tumor 1-associated protein (WTAP)-mediated m6A modification enhanced circCCAR1 stability by binding insulin-like growth factor 2 mRNA-binding protein 3 (IGF2BP3). CircCCAR1 acted as a sponge for miR-127-5p to upregulate its target WTAP and a feedback loop comprising circCCAR1/miR-127-5p/WTAP axis was formed. CircCCAR1 is secreted by HCC cells in a heterogeneous nuclear ribonucleoprotein A2/B1 (hnRNPA2B1)-dependent manner. Exosomal circCCAR1 was taken in by CD8 + T cells and caused dysfunction of CD8 + T cells by stabilizing the PD-1 protein. CircCCAR1 promoted resistance to anti-PD1 immunotherapy. Furthermore, increased cell division cycle and apoptosis regulator 1 (CCAR1) induced by EP300 promoted the binding of CCAR1 and β-catenin protein, which further enhanced the transcription of PD-L1. CONCLUSIONS The circCCAR1/miR-127-5p/WTAP feedback loop enhances the growth and metastasis of HCC. Exosomal circCCAR1 released by HCC cells contributes to immunosuppression by facilitating CD8 + T-cell dysfunction in HCC. CircCCAR1 induces resistance to anti-PD1 immunotherapy, providing a potential therapeutic strategy for HCC patients.
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Affiliation(s)
- Zongqiang Hu
- Department of Hepato-Pancreato-Biliary Surgery, First People's Hospital of Kunming City & Calmette Affiliated Hospital of Kunming Medical University, 1228 Beijing Road, Panlong District, Kunming, 650032, Yunnan, China
| | - Gang Chen
- Department of Hepato-Pancreato-Biliary Surgery, First People's Hospital of Kunming City & Calmette Affiliated Hospital of Kunming Medical University, 1228 Beijing Road, Panlong District, Kunming, 650032, Yunnan, China
| | - Yingpeng Zhao
- Department of Hepato-Pancreato-Biliary Surgery, First People's Hospital of Kunming City & Calmette Affiliated Hospital of Kunming Medical University, 1228 Beijing Road, Panlong District, Kunming, 650032, Yunnan, China
| | - Hongqiang Gao
- Department of Hepato-Pancreato-Biliary Surgery, First People's Hospital of Kunming City & Calmette Affiliated Hospital of Kunming Medical University, 1228 Beijing Road, Panlong District, Kunming, 650032, Yunnan, China
| | - Laibang Li
- Department of Hepato-Pancreato-Biliary Surgery, First People's Hospital of Kunming City & Calmette Affiliated Hospital of Kunming Medical University, 1228 Beijing Road, Panlong District, Kunming, 650032, Yunnan, China
| | - Yanfeng Yin
- Department of Hepato-Pancreato-Biliary Surgery, First People's Hospital of Kunming City & Calmette Affiliated Hospital of Kunming Medical University, 1228 Beijing Road, Panlong District, Kunming, 650032, Yunnan, China
| | - Jie Jiang
- Department of Hepato-Pancreato-Biliary Surgery, First People's Hospital of Kunming City & Calmette Affiliated Hospital of Kunming Medical University, 1228 Beijing Road, Panlong District, Kunming, 650032, Yunnan, China
| | - Li Wang
- Department of Hepato-Pancreato-Biliary Surgery, First People's Hospital of Kunming City & Calmette Affiliated Hospital of Kunming Medical University, 1228 Beijing Road, Panlong District, Kunming, 650032, Yunnan, China
| | - Yuanyi Mang
- Department of Hepato-Pancreato-Biliary Surgery, First People's Hospital of Kunming City & Calmette Affiliated Hospital of Kunming Medical University, 1228 Beijing Road, Panlong District, Kunming, 650032, Yunnan, China
| | - Yang Gao
- Department of Hepato-Pancreato-Biliary Surgery, First People's Hospital of Kunming City & Calmette Affiliated Hospital of Kunming Medical University, 1228 Beijing Road, Panlong District, Kunming, 650032, Yunnan, China
| | - Shengning Zhang
- Department of Hepato-Pancreato-Biliary Surgery, First People's Hospital of Kunming City & Calmette Affiliated Hospital of Kunming Medical University, 1228 Beijing Road, Panlong District, Kunming, 650032, Yunnan, China.
| | - Jianghua Ran
- Department of Hepato-Pancreato-Biliary Surgery, First People's Hospital of Kunming City & Calmette Affiliated Hospital of Kunming Medical University, 1228 Beijing Road, Panlong District, Kunming, 650032, Yunnan, China.
| | - Li Li
- Department of Hepato-Pancreato-Biliary Surgery, First People's Hospital of Kunming City & Calmette Affiliated Hospital of Kunming Medical University, 1228 Beijing Road, Panlong District, Kunming, 650032, Yunnan, China.
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Gu GJ, Chung H, Park JY, Yoo R, Im HJ, Choi H, Lee YS, Seok SH. Mannosylated-serum albumin nanoparticle imaging to monitor tumor-associated macrophages under anti-PD1 treatment. J Nanobiotechnology 2023; 21:31. [PMID: 36707872 PMCID: PMC9881286 DOI: 10.1186/s12951-023-01791-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/21/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors such as anti-programmed cell death protein 1 (PD1) block tumor growth by reinvigorating the immune system; however, determining their efficacy only by the changes in tumor size may prove inaccurate. As the immune cells including macrophages in the tumor microenvironment (TME) are associated with the response to anti-PD1 therapy, tumor-associated macrophages (TAMs) imaging using nanoparticles can noninvasively provide the immune enrichment status of TME. Herein, the mannosylated-serum albumin (MSA) nanoparticle was labeled with radioactive isotope 68Ga to target the mannose receptors on macrophages for noninvasive monitoring of the TME according to anti-PD1 therapy. RESULTS B16F10-Luc and MC38-Luc tumor-bearing mice were treated with anti-PD1, and the response to anti-PD1 was determined by the tumor volume. According to the flow cytometry, the responders to anti-PD1 showed an increased proportion of TAMs, as well as lymphocytes, and the most enriched immune cell population in the TME was also TAMs. For noninvasive imaging of TAMs as a surrogate of immune cell augmentation in the TME via anti-PD1, we acquired [68Ga] Ga-MSA positron emission tomography. According to the imaging study, an increased number of TAMs in responders at the early phase of anti-PD1 treatment was observed in both B16F10-Luc and MC38-Luc tumor-bearing mice models. CONCLUSION As representative immune cells in the TME, non-invasive imaging of TAMs using MSA nanoparticles can reflect the immune cell enrichment status in the TME closely associated with the response to anti-PD1. As non-invasive imaging using MSA nanoparticles, this approach shows a potential to monitor and evaluate anti-tumor response to immune checkpoint inhibitors.
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Affiliation(s)
- Gyo Jeong Gu
- grid.31501.360000 0004 0470 5905Macrophage Laboratory, Department of Microbiology and Immunology, Institute of Endemic Disease, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyewon Chung
- grid.31501.360000 0004 0470 5905Macrophage Laboratory, Department of Microbiology and Immunology, Institute of Endemic Disease, Seoul National University College of Medicine, Seoul, Republic of Korea ,grid.31501.360000 0004 0470 5905Bio-MAX Institute, Seoul National University, Seoul, Republic of Korea
| | - Ji Yong Park
- grid.31501.360000 0004 0470 5905Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea ,grid.31501.360000 0004 0470 5905Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Ranji Yoo
- grid.31501.360000 0004 0470 5905Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea ,grid.412484.f0000 0001 0302 820X Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyung-Jun Im
- grid.31501.360000 0004 0470 5905Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea ,grid.31501.360000 0004 0470 5905Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hongyoon Choi
- grid.31501.360000 0004 0470 5905Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea ,grid.31501.360000 0004 0470 5905Radiation Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea ,grid.412484.f0000 0001 0302 820XDepartment of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yun-Sang Lee
- grid.31501.360000 0004 0470 5905Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea ,grid.31501.360000 0004 0470 5905Radiation Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea ,grid.31501.360000 0004 0470 5905Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea ,grid.31501.360000 0004 0470 5905Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyeok Seok
- grid.31501.360000 0004 0470 5905Macrophage Laboratory, Department of Microbiology and Immunology, Institute of Endemic Disease, Seoul National University College of Medicine, Seoul, Republic of Korea ,grid.31501.360000 0004 0470 5905Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea ,grid.31501.360000 0004 0470 5905Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
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Xu H, Luo H, Zhang J, Li K, Lee MH. Therapeutic potential of Clostridium butyricum anticancer effects in colorectal cancer. Gut Microbes 2023; 15:2186114. [PMID: 36941257 PMCID: PMC10038047 DOI: 10.1080/19490976.2023.2186114] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Probiotic roles of Clostridium butyricum (C.B) are involved in regulating disease and cancers, yet the mechanistic basis for these regulatory roles remains largely unknown. Here, we demonstrate that C.B reprograms the proliferation, migration, stemness, and tumor growth in CRC by regulating pivotal signal molecules including MYC. Destabilization of MYC by C.B supplementation suppresses cancer cell proliferation/metastasis, sensitizes 5-FU treatment, and boosts responsiveness of anti-PD1 therapy. MYC is a transcriptional regulator of Thymidylate synthase (TYMS), a key target of the 5-FU. Also MYC is known to impact on PD-1 expression. Mechanistically, C.B treatment of CRC cells results in MYC degradation by enhancing proteasome-mediated ubiquitination, thereby mitigating MYC-mediated 5-FU resistance and boosting anti-PD1 immunotherapeutic efficacy. Together, our findings uncover previously unappreciated links between C.B and CRC cell signaling, providing insight into the tumorigenesis modulating mechanisms of C.B in boosting chemo/immune therapies.
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Affiliation(s)
- Hui Xu
- Guangdong Research Institute of Gastroenterology, and Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haidan Luo
- Guangdong Research Institute of Gastroenterology, and Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiayu Zhang
- Guangdong Research Institute of Gastroenterology, and Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kai Li
- Guangdong Research Institute of Gastroenterology, and Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mong-Hong Lee
- Guangdong Research Institute of Gastroenterology, and Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Casari C, Novysedlak R, Vachtenheim J, Lischke R, Strizova Z. Novel Treatment Options in Metastatic Esophageal Carcinoma: Checkpoint Inhibitors in Combination Therapies. Pharmacology 2022; 108:37-46. [PMID: 36463853 DOI: 10.1159/000527697] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/16/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Metastatic esophageal carcinoma (EC) has a poor prognosis and only limited treatment options. While immune checkpoint inhibitors (ICIs) have improved the treatment of a broad spectrum of cancers, patients with EC mostly fail to respond to this treatment. For that reason, it is crucial to understand the immune phenotype of each cancer patient and moreover, to understand how different therapies modulate the cancer microenvironment and sensitize the tumors to the treatment with ICIs. SUMMARY We have conducted a systematic review of the literature to evaluate the potential of ICI therapy in combination with chemotherapy, radiotherapy, and/or biologic therapy in EC patients. In our review, we have discussed the effects of diverse treatment approaches on the tumor microenvironment of EC. In addition, we have reviewed the current phase II and III clinical trials in EC patients to provide a rationale for immunotherapy application in combination settings with chemotherapy, radiotherapy, and/or biologic therapy. KEY MESSAGES A great effort is already underway in clinical trials evaluating the combinatorial administration of ICIs and other treatment modalities in metastatic EC patients. PD-L1 expression status was shown to be higher in the squamous cell carcinoma (SCC) as compared to adenocarcinoma. Thus, ICIs plus chemotherapy are being discussed as a particularly feasible option for patients with SCC. Radiation was shown to induce the expression of immune checkpoint molecules and to promote the priming and activation of cytotoxic T cells which provides a rationale for ICI administration in a combination with radiotherapy. The combination of ICIs with biologic therapy was shown to be safe; however, the impact on the clinical outcomes of EC patients varied among studies.
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Affiliation(s)
- Capucine Casari
- Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Rene Novysedlak
- 3rd Department of Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Jiri Vachtenheim
- 3rd Department of Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Robert Lischke
- 3rd Department of Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Zuzana Strizova
- Department of Immunology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
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Abed A, Law N, Calapre L, Lo J, Bhat V, Bowyer S, Millward M, Gray ES. Human leucocyte antigen genotype association with the development of immune-related adverse events in patients with non-small cell lung cancer treated with single agent immunotherapy. Eur J Cancer 2022; 172:98-106. [PMID: 35759816 DOI: 10.1016/j.ejca.2022.05.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/23/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Biomarkers that predict the risk of immune-mediated adverse events (irAEs) among patients with non-small cell lung cancer (NSCLC) may reduce morbidity and mortality associated with these treatments. METHODS We carried out high resolution human leucocyte antigen (HLA)-I typing on 179 patients with NSCLC treated with anti-program death (PD)-1/program death ligand (PDL)-1. Toxicity data were collected and graded as per common terminology criteria for adverse event (CTCAE) v5.0. We used 14.8-week for landmark analysis to address lead-time bias to investigate the correlation between HLA-I/II zygosity, supertypes and alleles with irAE. Furthermore, we assessed the association for irAE with clinical benefit rate (CBR), progression-free survival (PFS) and overall survival (OS). RESULTS Homozygosity at one or more HLA-I loci, but not HLA-II, was associated with a reduced risk of irAE (relative risk (RR) = 0.61, 95% CI 0.33-0.95, P = 0.035) especially pneumonitis or any grade 3 toxicity. Patients with HLA-A03 supertype had a higher risk of developing irAE (RR = 1.42, 95% CI 1.02-2.01, P = 0.039). The occurrence of any irAE was significantly associated with improved CBR (RR = 1.48, P < 0.0001), PFS (HR = 0.45, P = 0.0003) and OS (HR = 0.34, P < 0.0001). CONCLUSIONS Homozygosity at one or more HLA-I loci may serve as biomarker to predict patients who are unlikely to experience severe irAEs among patients with NSCLC and treated with anti-PD1/PDL1, but less likely to derive clinical benefit. Patients with HLA-I homozygous might benefit from additional therapy.
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Affiliation(s)
- Afaf Abed
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia; Centre for Precision Health, Edith Cowan University, Joondalup, WA, Australia; Linear Clinical Research, Nedlands, WA, Australia; School of Medicine, University of Western Australia, Nedlands, Australia.
| | - Ngie Law
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
| | - Leslie Calapre
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia; Centre for Precision Health, Edith Cowan University, Joondalup, WA, Australia.
| | - Johnny Lo
- School of Sciences, Edith Cowan University, Joondalup, WA, Australia; Centre for Artificial Intelligence and Machine Learning, Edith Cowan University, Joondalup, WA, Australia.
| | - Vikas Bhat
- School of Medicine, University of Western Australia, Nedlands, Australia.
| | - Samantha Bowyer
- Linear Clinical Research, Nedlands, WA, Australia; School of Medicine, University of Western Australia, Nedlands, Australia; Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
| | - Michael Millward
- Linear Clinical Research, Nedlands, WA, Australia; School of Medicine, University of Western Australia, Nedlands, Australia.
| | - Elin S Gray
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia; Centre for Precision Health, Edith Cowan University, Joondalup, WA, Australia.
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Li JX, Deng WX, Huang ST, Lin XF, Long MY, Zhang J, Su TS, Li LQ, Pang YD, Liang CF, Zhou HM, Lu HY, Liang SX, Xiang BD. Efficacy and safety of radiotherapy plus anti-PD1 versus transcatheter arterial chemoembolization plus sorafenib for advanced hepatocellular carcinoma: a real-world study. Radiat Oncol 2022; 17:106. [PMID: 35690773 PMCID: PMC9188229 DOI: 10.1186/s13014-022-02075-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/27/2022] [Indexed: 02/08/2023] Open
Abstract
Background The combination of transcatheter arterial chemoembolization (TACE) plus sorafenib prolonged progression-free survival (PFS) and overall survival (OS) than sorafenib or TACE monotherapy for patients with hepatocellular carcinoma (HCC). This study assessed the efficacy and safety of radiotherapy (RT) plus monoclonal antibody against programmed cell death 1 (anti-PD1) versus TACE plus sorafenib for patients with advanced HCC. Methods Patients with advanced HCC who treated with RT plus anti-PD1 and TACE plus sorafenib were enrolled. Objective response rate (ORR), PFS, disease control rate (DCR) and OS were calculated to assess the antitumor response and the treatment-related adverse events to the safety. Results Between January 2018 to March 2021, 37 patients underwent RT plus anti-PD1 and 41 patients underwent TACE plus sorafenib. The baseline characteristics between the two groups were comparable. The ORR and DCR were significantly higher in the RT + PD1 group than the TACE plus sorafenib group according to RECIST 1.1 (54.05% vs. 12.20%, P < 0.001; 70.27% vs. 46.37%, P = 0.041; respectively) and according to mRECIST (56.76% vs. 31.71%, P = 0.039; 70.27% vs. 46.37%, P = 0.041; respectively). RT plus anti-PD1 provided significantly better PFS (HR, 0.51; 95% CI 0.30–0.86; P = 0.017) than TACE plus sorafenib. Moreover, patients with RT plus anti-PD1 had significantly higher 3-, 6-, and 9-month OS rates than those with TACE plus sorafenib(97.3% vs. 92.30%, P < 0.001; 91.89% vs. 68.60%, P < 0.001; 75.5% vs. 60.60%, P < 0.001; respectively). The median OS was more favorable 17.4 months for the RT + PD1 group and 11.9 months for the TACE plus sorafenib group. No treatment-related death was observed. Grade 3 or more treatment-related adverse events (TRAEs) occurred significantly less in patients in the RT + PD1 group than the TACE plus sorafenib group (29.7% vs. 75.6%, P < 0.001), and all TRAEs were manageable. Conclusions In this real-world study, RT plus anti-PD1 showed significantly promising efficacy and manageable safety than TACE plus sorafenib in patients with advanced HCC. Toxicities were manageable, with no unexpected safety signals. The study provides evidence on a new therapeutic method in the treatment of advanced HCC.
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Affiliation(s)
- Jian-Xu Li
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Wen-Xiang Deng
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Shi-Ting Huang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Xiao-Feng Lin
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Mei-Ying Long
- School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Jie Zhang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Ting-Shi Su
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Li-Qing Li
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Ya-Dan Pang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Chun-Feng Liang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Hong-Mei Zhou
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Hai-Yan Lu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Shi-Xiong Liang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530021, China
| | - Bang-De Xiang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, China.
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Aguado C, Chara L, Antoñanzas M, Matilla Gonzalez JM, Jiménez U, Hernanz R, Mielgo-Rubio X, Trujillo-Reyes JC, Couñago F. Neoadjuvant treatment in non-small cell lung cancer: New perspectives with the incorporation of immunotherapy. World J Clin Oncol 2022; 13:314-322. [PMID: 35662985 PMCID: PMC9153074 DOI: 10.5306/wjco.v13.i5.314] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/24/2021] [Accepted: 05/07/2022] [Indexed: 02/06/2023] Open
Abstract
The aim of neoadjuvant treatment in non-small cell lung cancer (NSCLC) is to eliminate micrometastatic disease to facilitate surgical resection. Neoadjuvant chemotherapy (ChT) in localised NSCLC has numerous advantages over other therapeutic modalities and is considered standard treatment in resectable disease. Treatment with immune checkpoint inhibitors (ICI) improves long-term survival in advanced disease and has a better toxicity profile than conventional therapies. These immunotherapy agents (anti-PD1/PD-L1), administered with or without ChT, are currently being evaluated in the preoperative setting, with initial results showing better pathological response rates and more long-term benefits. Importantly, these drugs do not appear to increase the rate of severe adverse effects and/or postoperative complications. However, several questions still need to be resolved, including the identification of predictive biomarkers; comparative studies of immunotherapy alone vs combined treatment with ChT and/or radiotherapy; the optimal duration of treatment; the timing of surgery; the need for adjuvant treatment; appropriate radiologic evaluation and mediastinal staging; and the correlation between pathological response and survival outcomes. Here we review the current evidence for immunotherapy from a multidisciplinary perspective and discuss current and future controversies.
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Affiliation(s)
- Carlos Aguado
- Department of Medical Oncology, Hospital Clínico Universitario San Carlos, Madrid 28040, Spain
| | - Luis Chara
- Department of Medical Oncology, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
| | - Mónica Antoñanzas
- Department of Medical Oncology, Hospital Clínico Universitario San Carlos, Madrid 28040, Spain
| | | | - Unai Jiménez
- Department of Thoracic Surgery, Hospital Universitario Cruces, Barakaldo, Bizkaia 48903, Basque Country, Spain
| | - Raul Hernanz
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - Xabier Mielgo-Rubio
- Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, Alcorcón 28922, Madrid, Spain
| | - Juan Carlos Trujillo-Reyes
- Department of Thoracic Surgery, Hospital de la Santa Creu I Sant Pau, Barcelona 08029, Catalonia, Spain
- Department of Surgery, Universitat Autonoma de Barcelona, Barcelona 08029, Catalonia, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón 28223, Madrid, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
- Medicine Department, School of Biomedical Sciences, Universidad Europea de Madrid, Villaviciosa de Odón 28670, Madrid, Spain
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Gómez-Llobell M, Peleteiro Raíndo A, Climent Medina J, Gómez Centurión I, Mosquera Orgueira A. Immune Checkpoint Inhibitors in Acute Myeloid Leukemia: A Meta-Analysis. Front Oncol 2022; 12:882531. [PMID: 35530329 PMCID: PMC9069679 DOI: 10.3389/fonc.2022.882531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background Experience with immune checkpoint inhibitors (ICIs) in the treatment of acute myeloid leukemia (AML) is still limited and based on early clinical trials, with no reported randomized clinical data. In this study, we reviewed the available evidence on the use of ICIs, either in monotherapy or in combination with other treatments, in different AML settings, including newly diagnosed AML, relapsed or refractory (R/R) AML and maintenance treatment after allogeneic-HSCT (allo-HSCT). Materials and Methods A systematic literature review was conducted using PubMed electronic database as primary source to identify the studies involving immune checkpoint inhibitors in first-line and R/R AML. We recorded Overall Response (ORR), Complete Response (CR) and Complete Response with incomplete count recovery (CRi) rates, overall survival (OS) and immune-related adverse events ≥ grade 3 (irAEs). Hereafter, we analyzed the overall profile of these ICIs by performing a meta-analysis of the reported outcomes. Results A total of 13 studies were identified where ICI was used in patients with AML. ORR across these studies was 42% (IC95%, 31% - 54%) and CR/CRi was 33% (IC95%, 22%-45%). Efficacy was also assessed considering the AML setting (first-line vs. relapsed/refractory) and results pointed to higher response rates in first-line, compared to R/R. Mean overall survival was 8.9 months [median 8 months, (IC95%, 3.9 - 15.5)]. Differences between first line and R/R settings were observed, since average overall survival in first line was 12.0 months, duplicating the OS in R/R which was 7.3 months. Additionally, the most specific adverse events (AEs) of these therapies are immune-related adverse events (irAEs), derived from their inflammatory effects. Grade ≥3 irAEs rate was low and similar among studies [12% (95%CI 8% - 16%)]. Conclusion ICIs in combination with intensive chemotherapy, hypomethylating agents or other targeted therapies are gaining interest in the management of hematological malignancies such as AML. However, results obtained from clinical trials are modest and limited by both, the type of design and the clinical trial phase. Hopefully, the prospective study of these therapies in late-stage development could help to identify patients who may benefit from ICI therapy.
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Affiliation(s)
- Marina Gómez-Llobell
- Hematology Department, Medical University General Hospital Gregorio Marañon, Madrid, Spain
| | - Andrés Peleteiro Raíndo
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Division of Hematology, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS) University Hospital of Santiago de Compostela (SERGAS), Department of Hematology, Santiago de Compostela, Spain
| | | | | | - Adrián Mosquera Orgueira
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Division of Hematology, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS) University Hospital of Santiago de Compostela (SERGAS), Department of Hematology, Santiago de Compostela, Spain
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Chen SW, Zhu SQ, Pei X, Qiu BQ, Xiong D, Long X, Lin K, Lu F, Xu JJ, Wu YB. Cancer cell-derived exosomal circUSP7 induces CD8 + T cell dysfunction and anti-PD1 resistance by regulating the miR-934/SHP2 axis in NSCLC. Mol Cancer 2021; 20:144. [PMID: 34753486 PMCID: PMC8576933 DOI: 10.1186/s12943-021-01448-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 10/22/2021] [Indexed: 02/07/2023] Open
Abstract
Background CD8+ T cells play a critical role in the innate antitumour immune response. Recently, CD8+ T cell dysfunction has been verified in various malignant cancers, including non-small cell lung cancer (NSCLC). However, the molecular biological mechanisms of CD8+ T cell dysfunction in human NSCLC are still unclear. Methods The expression of circular ubiquitin-specific protease-7 (circUSP7) in NSCLC tissues, exosomes, and cell lines was detected by quantitative real-time polymerase chain reaction (qRT-PCR). Exosomes were isolated from the culture medium of NSCLC cells and the plasma of NSCLC patients using an ultracentrifugation method and the ExoQuick Exosome Precipitation Solution kit. The exosomes were then characterized by transmission electronic microscopy (TEM), NanoSight and western blotting. The role of circUSP7 in CD8+ T cell dysfunction was assessed by enzyme-linked immunosorbent assay (ELISA). In vivo circular RNA (circRNA) precipitation (circRIP), RNA immunoprecipitation (RIP), and luciferase reporter assays were performed to explore the molecular mechanisms of circUSP7 in CD8+ T cells. In a retrospective study, the clinical characteristics and prognostic significance of circUSP7 in NSCLC tissues were determined. Results The expression levels of circUSP7 were higher in human NSCLC tissues than in matched adjacent nontumour tissues. Increased levels of circUSP7 indicate poor clinical prognosis and CD8+ T cell dysfunction in patients with NSCLC. The circUSP7 found in NSCLC patient plasma is predominantly secreted by NSCLC cells in an exosomal manner, and circUSP7 inhibits IFN-γ, TNF-α, Granzyme-B and Perforin secretion by CD8+ T cells. Furthermore, circUSP7 inhibits CD8+ T cell function by upregulating the expression of Src homology region 2 (SH2)-containing protein tyrosine phosphatase 2 (SHP2) via sponging miR-934. Finally, we show that circUSP7 may promote resistance to anti-PD1 immunotherapy in NSCLC patients. Conclusions Exosomal circUSP7 is predominantly secreted by NSCLC cells and contributes to immunosuppression by promoting CD8+ T cell dysfunction in NSCLC. CircUSP7 induces resistance to anti-PD1 immunotherapy, providing a potential therapeutic strategy for NSCLC patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12943-021-01448-x.
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Affiliation(s)
- Shi-Wei Chen
- Department of Cardiothoracic Surgery, the Second Affiliated Hospital of Nanchang University, 1 Ming de Road, Nanchang, 330000, People's Republic of China
| | - Shu-Qiang Zhu
- Department of Cardiothoracic Surgery, the Second Affiliated Hospital of Nanchang University, 1 Ming de Road, Nanchang, 330000, People's Republic of China
| | - Xu Pei
- Department of Cardiothoracic Surgery, the Second Affiliated Hospital of Nanchang University, 1 Ming de Road, Nanchang, 330000, People's Republic of China
| | - Bai-Quan Qiu
- Department of Cardiothoracic Surgery, the Second Affiliated Hospital of Nanchang University, 1 Ming de Road, Nanchang, 330000, People's Republic of China
| | - Dian Xiong
- Department of Cardiothoracic Surgery, the Second Affiliated Hospital of Nanchang University, 1 Ming de Road, Nanchang, 330000, People's Republic of China
| | - Xiang Long
- Department of Cardiothoracic Surgery, the Second Affiliated Hospital of Nanchang University, 1 Ming de Road, Nanchang, 330000, People's Republic of China
| | - Kun Lin
- Department of Cardiothoracic Surgery, the Second Affiliated Hospital of Nanchang University, 1 Ming de Road, Nanchang, 330000, People's Republic of China
| | - Feng Lu
- Department of Cardiothoracic Surgery, the Second Affiliated Hospital of Nanchang University, 1 Ming de Road, Nanchang, 330000, People's Republic of China
| | - Jian-Jun Xu
- Department of Cardiothoracic Surgery, the Second Affiliated Hospital of Nanchang University, 1 Ming de Road, Nanchang, 330000, People's Republic of China
| | - Yong-Bing Wu
- Department of Cardiothoracic Surgery, the Second Affiliated Hospital of Nanchang University, 1 Ming de Road, Nanchang, 330000, People's Republic of China.
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Cabezas-Camarero S, Alonso-Ovies A, Merino-Menéndez S, Cabrera-Martín MN, Plaza-Hernández JC, Pérez-Segura P. Major pathological response and durable locoregional control after neoadjuvant pembrolizumab-carboplatin-paclitaxel in head and neck cancer. Oral Oncol 2021; 123:105589. [PMID: 34742008 DOI: 10.1016/j.oraloncology.2021.105589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 10/17/2021] [Indexed: 11/24/2022]
Abstract
Head and neck cancers are increasingly being diagnosed in elderly patients, where standard curative-intent, therapeutic options are often too aggressive for frail, malnourished and heavily comorbid patients. Since the incorporation of immune checkpoint inhibitors (ICIs) a few small studies have reported promising safety and efficacy with ICIs in the neoadjuvant locally-advaced setting. We present the case of an elderly, frail and comorbid patient, with a high-PDL1 expressing and very locally-advanced unresectable oral cavity cancer, that was treated with the combination of pembrolizumab and weekly carboplatin and paclitaxel, achieving a major pathological response, that permitted to de-escalate adjuvant therapy after surgery and is free of locoregional relapse 7 months after surgery. This is, to our knowledge, the first patient treated with neoadjuvant chemo-immunotherapy outside a clinical trial in SCCHN.
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20
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Touati R, Cohen R. [Drug Approval: Nivolumab plus ipilimumab for patients with MSI -high metastatic colorectal cancer previously treated with 5-fluorouracilchemotherapy]. Bull Cancer 2021; 109:3-4. [PMID: 34756719 DOI: 10.1016/j.bulcan.2021.08.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/28/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Ruben Touati
- CHRU de Brest, Hôpital Morvan, Service d'oncologie-radiothérapie, 29200, Brest, France.
| | - Romain Cohen
- AP-HP, hôpital Saint-Antoine, Sorbonne Université, service d'oncologie médicale, 75012 Paris, France; Sorbonne Université, Inserm, Unité Mixte de Recherche Scientifique 938, Centre de recherche Saint-Antoine et SIRIC CURAMUS, Équipe Instabilité des Microsatellites et Cancer, Équipe labellisée par la Ligue nationale contre le Cancer, 75012 Paris, France
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21
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Naoun N, Vano YA. [New EMA approval: Nivolumab plus Cabozantinib for advanced renal clear cell carcinoma]. Bull Cancer 2021; 108:991-3. [PMID: 34538614 DOI: 10.1016/j.bulcan.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/03/2021] [Indexed: 01/02/2023]
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22
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Feng Y, Chen C, Zhao L, Zhu X, Zhu X, Li Q. A potential mechanism of the onset of immune-related pneumonitis triggered by anti-PD-1 treatment in a patient with advanced adenocarcinoma lung cancer: case report. BMC Pulm Med 2021; 21:291. [PMID: 34521373 PMCID: PMC8438889 DOI: 10.1186/s12890-021-01649-6] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022] Open
Abstract
Background In recent years, the application of immunotherapy combined with chemotherapy in the first-line lung cancer has showed significant benefit in improving long-term survival. Immunotherapy also has risks of immune-related pneumonitis (IRP) after long-term treatment. Despite the treatment strategy of the IRP has been very clear. However, the mechanism is unclear. Case presentation A 73-year-old male patient was diagnosed with left lung adenocarcinoma IVa, EGFR, ALK, ROS1 negative. The patient received anti-PD1 antibody combined with pemetrexed and cisplatin. After 5 cycles of treatment, partial response was obtained. Subsequently, the patient continued the treatment of anti-PD1 antibody combined with pemetrexed. Before the 7th cycle, the CT found a new lesion in the basal segment of the right lower lobe. It was diagnosed with IRP and pneumocystis jirovecii. The patient did not give trimethoprim–sulphamethoxazole (TMP–SMX) and corticosteroids, symptoms and radiological lesions had improved. We describe the report of immune-related pneumonitis trigged by anti PD-1 and monitored the dynamic changes of CD4+, CD8+ T lymphocytes, MDSC and Treg cells in the bilateral bronchoalveolar alveolar lavage fluid. From the point of view of immune cells, the mechanism of immune reconstitution inflammatory syndrome is confirmed. Based on the current case report and literature, this study proposes a potential mechanism of the onset. Conclusion Immune reconstitution inflammatory syndrome may be potential mechanism of IRP. This study may improve our understanding of the pathogenesis underlying IRP. We believe the detection and dynamic monitoring CD4+, CD8+ T lymphocytes, MDSC and Treg cells can provide more accurate procedures.
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Affiliation(s)
- Yu Feng
- Department of Respiratory Medicine, Shanghai East Hospital, Affiliated to Tongji University, Shanghai, 200120, China
| | - Cuncun Chen
- Department of Clinical Laboratory, Shanghai East Hospital, Affiliated to Tongji University, Shanghai, 200120, China
| | - Liming Zhao
- Department of Respiratory Medicine, Shanghai East Hospital, Affiliated to Tongji University, Shanghai, 200120, China
| | - Xuyou Zhu
- Department of Pathology, Tongji Hospital, Affiliated to Tongji University, Shanghai, 200438, China
| | - Xiaoping Zhu
- Department of Respiratory Medicine, Shanghai East Hospital, Affiliated to Tongji University, Shanghai, 200120, China
| | - Qiang Li
- Department of Respiratory Medicine, Shanghai East Hospital, Affiliated to Tongji University, Shanghai, 200120, China.
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Vauchier C, Pluvy J, Theou-Anton N, Soussi G, Poté N, Brosseau S, Gounant V, Zalcman G. Poor performance status patient with long-lasting major response to pembrolizumab in advanced non-small-cell lung cancer with coexisting POLE mutation and deficient mismatch repair pathway. Lung Cancer 2021; 160:28-31. [PMID: 34371300 DOI: 10.1016/j.lungcan.2021.07.016] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/13/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
Immunotherapy with immune checkpoint inhibitors (ICIs) represents a major breakthrough in lung cancer treatment. For patients with advanced non-small-cell lung cancer (NSCLC) and poor performance status (PS), the availability of sensitivity markers to immune-checkpoint inhibitors (ICI) would be useful for attending physicians and assist them in their decision-making process. Deficient mismatch repair (dMMR) can lead to high microsatellite instability (MSI-H) and coexist with mutations in polymerase proofreading (DNA polymerase Epsilon POLE and delta 1 POLD1) with a specific mutational signature. This would result in high tumor mutational burden and programmed cell death protein ligand 1 (PD-L1) overexpression. We report herein on a NSCLC case with MSI-H and POLE mutation in a patient with inaugural poor general condition, who exhibited prolonged response to anti-programmed cell death protein (PD-1) therapy. Additionally, there was a marked improvement of the patient's performance status, from PS 3 before ICI administration to PS 1 upon ICI therapy.
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Affiliation(s)
- Charles Vauchier
- Department of Thoracic Oncology & CIC1425-CLIP2 Early Phase Cancer Clinical Trials Unit, University Hospital Bichat-Claude Bernard, Université de Paris, Paris, France
| | - Johan Pluvy
- Department of Thoracic Oncology & CIC1425-CLIP2 Early Phase Cancer Clinical Trials Unit, University Hospital Bichat-Claude Bernard, Université de Paris, Paris, France
| | - Nathalie Theou-Anton
- Department of Genetics, University Hospital Bichat-Claude Bernard, Université de Paris, Paris, France
| | - Ghassen Soussi
- Department of Thoracic Oncology & CIC1425-CLIP2 Early Phase Cancer Clinical Trials Unit, University Hospital Bichat-Claude Bernard, Université de Paris, Paris, France
| | - Nicolas Poté
- Department of Pathology, University Hospital Bichat-Claude Bernard, UMR INSERM 1152, Université de Paris, Paris, France
| | - Solenn Brosseau
- Department of Thoracic Oncology & CIC1425-CLIP2 Early Phase Cancer Clinical Trials Unit, University Hospital Bichat-Claude Bernard, Université de Paris, Paris, France; U830 INSERM "Cancer, Heterogeneity, Instability and Plasticity", Institut Curie Research Center, Paris, France
| | - Valérie Gounant
- Department of Thoracic Oncology & CIC1425-CLIP2 Early Phase Cancer Clinical Trials Unit, University Hospital Bichat-Claude Bernard, Université de Paris, Paris, France
| | - Gérard Zalcman
- Department of Thoracic Oncology & CIC1425-CLIP2 Early Phase Cancer Clinical Trials Unit, University Hospital Bichat-Claude Bernard, Université de Paris, Paris, France; U830 INSERM "Cancer, Heterogeneity, Instability and Plasticity", Institut Curie Research Center, Paris, France.
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Koumarianou A, Kaltsas GA, Chatzellis E, Kyriakopoulos G, Kolomodi D, Alexandraki KI. Immunotherapeutics at the spearhead: current status in targeting neuroendocrine neoplasms. Endocrine 2021; 73:232-239. [PMID: 33544352 DOI: 10.1007/s12020-021-02639-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/18/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE Recent advances in the field of immunotherapy have significantly prolonged the survival of patients with aggressive carcinomas, but the role of immunotherapy in neuroendocrine neoplasms (NENs) remains to be elucidated. METHODS AND RESULTS We report a patient diagnosed with a well-differentiated grade 3 pancreatic NEN (pNEN) and type 3 liver metastases who received compassionate nivolumab as a fifth line treatment and achieved a durable partial response of more than 34 months. We have performed a systematic review to the literature on tumor microenvironment and potential biomarkers in the field of NEN including the tumor mutational burden, the tumor infiltrating lymphocytes, the programmed cell death ligand 1, and the mismatch repair system. The potential role of the immune system modulation together with a critical assessment of the recent phase II clinical studies in NEN including monotherapy with anti-PD-1/PD-L1 monoclonal antibodies, and combination therapies including anti-PD-1 along with anti-CTLA-4 monoclonal antibodies are also provided. CONCLUSION Immunotherapeutics are gaining a post in the field of NENs in cases progressing during the course of the disease, dictating urgently the identification of biomarkers that will enable selection of NEN patients who may benefit from this treatment.
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Affiliation(s)
- Anna Koumarianou
- Hematology Oncology Unit, Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
- European Neuroendocrine Tumor Society, ENETS Center of Excellence, EKPA-LAIKO CENTER, Athens, Greece.
| | - Gregory A Kaltsas
- European Neuroendocrine Tumor Society, ENETS Center of Excellence, EKPA-LAIKO CENTER, Athens, Greece
- 1st Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Chatzellis
- European Neuroendocrine Tumor Society, ENETS Center of Excellence, EKPA-LAIKO CENTER, Athens, Greece
| | - Georgios Kyriakopoulos
- European Neuroendocrine Tumor Society, ENETS Center of Excellence, EKPA-LAIKO CENTER, Athens, Greece
| | - Denise Kolomodi
- European Neuroendocrine Tumor Society, ENETS Center of Excellence, EKPA-LAIKO CENTER, Athens, Greece
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Tsai HL, Yeh YC, Yu TY, Lee CY, Hung GY, Yeh YT, Liu CS, Yen HJ. Complete and durable response to immune checkpoint inhibitor in a patient with refractory and metastatic hepatoblastoma. Pediatr Hematol Oncol 2021; 38:385-390. [PMID: 33641599 DOI: 10.1080/08880018.2020.1853859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We herein report the case of a girl with PRETEXT III hepatoblastoma (HB) developing recurrent lung metastases despite multiple chemotherapy regimens, aggressive tumor excision, multiple lung metastasectomies, and autologous peripheral blood stem cell transplantation. High tumor mutation burden (TMB) was identified through targeted next-generation sequencing, and pembrolizumab was administered post-operatively as a last resort. A complete and sustained response to the immune checkpoint inhibitor was achieved for 22 months. Although the majority of HB have a low TMB, immune checkpoint inhibitor therapy may be useful for patients with refractory HBs with a high TMB.
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Affiliation(s)
- Hsin-Lien Tsai
- Department of Pediatrics, Taipei Veterans General Hospital, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yi-Chen Yeh
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Ting-Yen Yu
- Department of Pediatrics, Taipei Veterans General Hospital, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Department of Pediatrics, Far Eastern Memorial Hospital, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Chih-Ying Lee
- Department of Pediatrics, Taipei Veterans General Hospital, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
| | - Giun-Yi Hung
- Department of Pediatrics, Taipei Veterans General Hospital, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
| | - Yi-Ting Yeh
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Chin-Su Liu
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Hsiu-Ju Yen
- Department of Pediatrics, Taipei Veterans General Hospital, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
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Ma G, Kostevšek N, Monaco I, Ruiz A, Markelc B, Cheung CCL, Hudoklin S, Kreft ME, Hassan HAFM, Barker M, Conyard J, Hall C, Meech S, Mayes AG, Serša I, Čemažar M, Marković K, Ščančar J, Franchini MC, Al-Jamal WT. PD1 blockade potentiates the therapeutic efficacy of photothermally-activated and MRI-guided low temperature-sensitive magnetoliposomes. J Control Release 2021; 332:419-33. [PMID: 33677010 DOI: 10.1016/j.jconrel.2021.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/08/2021] [Accepted: 03/01/2021] [Indexed: 12/22/2022]
Abstract
This study investigates the effect of PD1 blockade on the therapeutic efficacy of novel doxorubicin-loaded temperature-sensitive liposomes. Herein, we report photothermally-activated, low temperature-sensitive magnetoliposomes (mLTSL) for efficient drug delivery and magnetic resonance imaging (MRI). The mLTSL were prepared by embedding small nitrodopamine palmitate (NDPM)-coated iron oxide nanoparticles (IO NPs) in the lipid bilayer of low temperature-sensitive liposomes (LTSL), using lipid film hydration and extrusion. Doxorubicin (DOX)-loaded mLTSL were characterized using dynamic light scattering, differential scanning calorimetry, electron microscopy, spectrofluorimetry, and atomic absorption spectroscopy. Photothermal experiments using 808 nm laser irradiation were conducted. In vitro photothermal DOX release studies and cytotoxicity was assessed using flow cytometry and resazurin viability assay, respectively. In vivo DOX release and tumor accumulation of mLTSL(DOX) were assessed using fluorescence and MR imaging, respectively. Finally, the therapeutic efficacy of PD1 blockade in combination with photothermally-activated mLTSL(DOX) in CT26-tumor model was evaluated by monitoring tumor growth, cytokine release and immune cell infiltration in the tumor tissue. Interestingly, efficient photothermal heating was obtained by varying the IO NPs content and the laser power, where on-demand burst DOX release was achievable in vitro and in vivo. Moreover, our mLTSL exhibited promising MR imaging properties with high transverse r2 relaxivity (333 mM-1 s-1), resulting in superior MR imaging in vivo. Furthermore, mLTSL(DOX) therapeutic efficacy was potentiated in combination with anti-PD1 mAb, resulting in a significant reduction in CT26 tumor growth via immune cell activation. Our study highlights the potential of combining PD1 blockade with mLTSL(DOX), where the latter could facilitate chemo/photothermal therapy and MRI-guided drug delivery.
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Valentin J, Gérard E, Ferte T, Prey S, Dousset L, Dutriaux C, Beylot-Barry M, Pham-Ledard A. Real world safety outcomes using cemiplimab for cutaneous squamous cell carcinoma. J Geriatr Oncol 2021; 12:1110-1113. [PMID: 33736973 DOI: 10.1016/j.jgo.2021.02.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/06/2021] [Accepted: 02/24/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Locally advanced or metastatic cutaneous squamous cell carcinoma (cSCC) mostly affects older and frail patients. Cemiplimab is an anti-PD1 antibody used in this indication since its approval by the FDA and the EMA in 2019 after encouraging results from phase II trials. We aimed to evaluate cemiplimab safety in patients from daily practice. METHODS Retrospective and monocentric study including all patients who received at least one infusion of cemiplimab between August 2018 and September 2019. Adverse effects (AEs), treatment interruption, and efficacy were recorded (data cut-off, November 1st 2020). RESULTS Twenty-two patients were included, median age was 83 [55-93], 73% were Eastern Cooperative Oncology Group (ECOG) 0 or 1, 36% were immune compromised. After a median time on treatment of six months [0.7-22], seventeen patients (77%) experienced 24 AEs, comprising 45% serious AEs (SAEs) grade ≥ 3 and one SAE grade 5 (myositis). Patients who presented SAEs were all >65 years old. Nine patients (41%) definitively discontinued treatment due to AEs. Seventeen patients were evaluable, after a median follow-up of eleven months [1-22], 32% had an objective response (2 complete and 5 partial responses), 47% had controlled disease and 35% experienced progression. CONCLUSIONS In our cohort, safety seemed to be worse than in phase II trial with more treatment discontinuations due to cemiplimab toxicity, probably reflecting the distinct demographic and medical characteristics of patients in daily care.
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Affiliation(s)
- Julie Valentin
- Dermatology Department, CHU Bordeaux, F-33000 Bordeaux, France
| | - Emilie Gérard
- Dermatology Department, CHU Bordeaux, F-33000 Bordeaux, France
| | - Thomas Ferte
- Pôle de Santé Publique, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique, CHU de Bordeaux, Bordeaux, France
| | - Sorilla Prey
- Dermatology Department, CHU Bordeaux, F-33000 Bordeaux, France; Univ. Bordeaux, INSERM U1035, F-33076 Bordeaux, France
| | - Léa Dousset
- Dermatology Department, CHU Bordeaux, F-33000 Bordeaux, France; Univ. Bordeaux, INSERM U1035, F-33076 Bordeaux, France
| | - Caroline Dutriaux
- Dermatology Department, CHU Bordeaux, F-33000 Bordeaux, France; Univ. Bordeaux, INSERM U1035, F-33076 Bordeaux, France
| | - Marie Beylot-Barry
- Dermatology Department, CHU Bordeaux, F-33000 Bordeaux, France; Univ. Bordeaux, INSERM U1053, Team 3 Oncogenesis of Cutaneous Lymphoma, F-33076 Bordeaux, France
| | - Anne Pham-Ledard
- Dermatology Department, CHU Bordeaux, F-33000 Bordeaux, France; Univ. Bordeaux, INSERM U1053, Team 3 Oncogenesis of Cutaneous Lymphoma, F-33076 Bordeaux, France.
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Garon-Czmil J, Abs D, Granel-Brocard F, Gillet P, Yelehe-Okouma M. A flare-up of rheumatoid arthritis followed by adrenocorticotropic insufficiency induced by pembrolizumab: A case-report. Therapie 2020; 76:510-512. [PMID: 33288227 DOI: 10.1016/j.therap.2020.11.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Julie Garon-Czmil
- Centre Régional de Pharmacovigilance, CHRU de Nancy, Hôpital de Brabois, Bâtiment Biologie Biopathologie, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France; UMR 7365 CNRS-UL, IMoPA, Ingénierie Moléculaire et Physiopathologie Articulaire Biopôle de l'Université de Lorraine, campus Brabois-Santé, 54505 Vandœuvre-lès-Nancy, France; Département d'Endocrinologie, Diabétologie et Nutrition, CHRU de Nancy, Hôpital de Brabois, 54511 Vandœuvre-lès-Nancy, France
| | - Diane Abs
- Département de Dermatologie et Allergologie, CHRU de Nancy, Hôpital de Brabois, 54511 Vandœuvre-lès-Nancy, France
| | - Florence Granel-Brocard
- Département de Dermatologie et Allergologie, CHRU de Nancy, Hôpital de Brabois, 54511 Vandœuvre-lès-Nancy, France
| | - Pierre Gillet
- Centre Régional de Pharmacovigilance, CHRU de Nancy, Hôpital de Brabois, Bâtiment Biologie Biopathologie, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France; UMR 7365 CNRS-UL, IMoPA, Ingénierie Moléculaire et Physiopathologie Articulaire Biopôle de l'Université de Lorraine, campus Brabois-Santé, 54505 Vandœuvre-lès-Nancy, France.
| | - Mélissa Yelehe-Okouma
- Centre Régional de Pharmacovigilance, CHRU de Nancy, Hôpital de Brabois, Bâtiment Biologie Biopathologie, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
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Deutsch E, Besse B, Le Pavec J, Le Péchoux C, Botticella A, Ammari S, Even C, Robert C, Levy A. Can radiation-recall predict long lasting response to immune checkpoint inhibitors? Radiother Oncol 2020; 154:125-127. [PMID: 32976876 DOI: 10.1016/j.radonc.2020.09.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 12/19/2022]
Abstract
RR secondary to ICI (nivolumab in all patients) were observed in the lung (n = 1) or skin (n = 3). All patients had a long-term response to ICI and are currently alive with no active disease (Median FU from ICI discontinuation: 30 months). RR could reflect a beneficial immune activation and constitute a predictive clinical biomarker of ICI long-term efficacy.
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Affiliation(s)
- Eric Deutsch
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, France; Université Paris-Saclay, Le Kremlin-Bicêtre, France; INSERM U1030, Molecular Radiotherapy, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Benjamin Besse
- Université Paris-Saclay, Le Kremlin-Bicêtre, France; Department of Medical Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, Villejuif, France
| | - Jérôme Le Pavec
- Université Paris-Saclay, Le Kremlin-Bicêtre, France; Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Institut d'Oncologie Thoracique (IOT), Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Cécile Le Péchoux
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, France
| | - Angela Botticella
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, France
| | - Samy Ammari
- Department of Radiology, Gustave Roussy, Villejuif, France
| | - Caroline Even
- Department of Medical Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, Villejuif, France
| | - Caroline Robert
- Université Paris-Saclay, Le Kremlin-Bicêtre, France; Department of Medical Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, Villejuif, France
| | - Antonin Levy
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, France; Université Paris-Saclay, Le Kremlin-Bicêtre, France; INSERM U1030, Molecular Radiotherapy, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
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30
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Schardt J. [The use of immune checkpoint inhibitors in routine oncology]. Z Rheumatol 2020; 79:809-817. [PMID: 32936368 PMCID: PMC7653782 DOI: 10.1007/s00393-020-00876-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 11/12/2022]
Abstract
Hintergrund Die Einführung von Immuncheckpoint-Inhibitoren (ICI) hat die Behandlungskonzepte der Onkologie für eine Vielzahl von unterschiedlichen Krebsarten maßgeblich verändert. Dabei werden in der klinischen Routine v. a. humanisierte Antikörper gegen Immuncheckpoints wie „cytotoxic T‑lymphocyte associated protein 4“ (CTLA-4) oder „programmed cell death 1/programmed cell death ligand 1“ (PD1/PD-L1) eingesetzt. Fragestellung Übersicht zur Therapielandschaft mit Immuncheckpoint-Inhibitoren bei mehrheitlich soliden Tumoren in der Onkologie. Material und Methoden Darstellung und Diskussion aktueller Studienresultate, Einbezug aktueller Behandlungsempfehlungen und Zulassungsindikationen. Ergebnisse Sieben verschiedene Immuncheckpoint-Inhibitoren werden in der Onkologie therapeutisch eingesetzt: ein Anti-CTLA-4-Antikörper, 3 Anti-PD1-Antikörper und 3 Anti-PD-L1-Antiköper. FDA-Zulassung auf dem US-Markt für 17 verschiedene Tumorentitäten und einer agnostischen Indikation (Tumoren mit defizienter Mismatch-repair-Maschinerie/hohe Mikrosatelliteninstabilität). Langzeitremissionen sind in ca. zwei Drittel der Patienten mit Tumoransprechen möglich. Schlussfolgerungen Nutzen der Immuncheckpoint-Inhibitoren nur für einen Teil der behandelten Patienten. Primäre und sekundäre Resistenzmechanismen erst in Anfängen verstanden. Kombinationstherapien der Immuncheckpoint-Inhibitoren mit z. B. Chemotherapie, neuen Immuncheckpoint-Inhibitoren (z. B. Anti-LAG3-Antikörper) oder gezielten Therapien (z. B. CDK4/6, PARP-Inhibitoren) zur Verbesserung der Wirksamkeit werden in klinischen Studien untersucht. Verlässliche, prädiktive Marker sind dringend erforderlich.
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Affiliation(s)
- Julian Schardt
- Universitätsklinik für Medizinische Onkologie, Inselspital, Freiburgstr. 41G, 3010, Bern, Schweiz.
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Schuiveling M, Tonk EHJ, Verheijden RJ, Suijkerbuijk KPM. Hyperprogressive disease rarely occurs during checkpoint inhibitor treatment for advanced melanoma. Cancer Immunol Immunother 2020; 70:1491-1496. [PMID: 32929554 PMCID: PMC8053186 DOI: 10.1007/s00262-020-02716-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/31/2020] [Indexed: 01/01/2023]
Abstract
Introduction Hyperprogression, characterized by a rapid acceleration in tumor growth, is a novel pattern of progression recently described in patients treated with immune checkpoint inhibitors. This study aims to assess the incidence of hyperprogression in patients with advanced melanoma treated with checkpoint inhibitors. Methods Clinical and radiological findings of all advanced melanoma patients who started checkpoint inhibitors between January 2013 and March 2019 in a tertiary academic center in the Netherlands were analyzed. Change in tumor burden was calculated by assessing volumetric tumor growth using the criteria as defined by immune Response Evaluation Criteria in Solid Tumors version 1.1. Hyperprogression was defined as a time to treatment failure less than 2 months with doubling of tumor burden and a twofold increase in tumor growth rate during treatment. Possible hyperprogression was defined as the presence of the first two criteria in the absence of a pre-baseline scan. Results Out of 206 treatment episodes in 168 patients, 75 were evaluable for hyperprogression and 87 for possible hyperprogression. Hyperprogression was observed in one patient (1.3%) and possible hyperprogression was observed in one patient (1.1%). Conclusion Hyperprogression is rare in melanoma patients treated with immune checkpoint inhibitors. Our data question if hyperprogression really is a biological entity in metastatic melanoma.
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Affiliation(s)
- M Schuiveling
- Department of Medical Oncology, University Medical Center Utrecht Cancer Center, Utrecht, The Netherlands
| | - E H J Tonk
- Department of Medical Oncology, University Medical Center Utrecht Cancer Center, Utrecht, The Netherlands
| | - R J Verheijden
- Department of Medical Oncology, University Medical Center Utrecht Cancer Center, Utrecht, The Netherlands
| | - K P M Suijkerbuijk
- Department of Medical Oncology, University Medical Center Utrecht Cancer Center, Utrecht, The Netherlands.
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Abstract
PURPOSE OF REVIEW Neoadjuvant therapy in melanoma is an area of active investigation with numerous completed and ongoing trials studying a variety of therapeutic interventions utilizing diverse designs. Here, we review completed and ongoing neoadjuvant trials in melanoma, discuss endpoint assessment, and highlight biomarker development in this context. RECENT FINDINGS High-risk resectable melanoma with clinically detectable lymph node (LN) with or without in-transit and/or satellite metastases represent ~ 20% of melanoma patients and have a high risk of relapse despite definitive surgery. Adjuvant therapy with anti-PD-1 immunotherapy or BRAF/MEK-targeted therapy has improved relapse-free survival (RFS) and overall survival (OS) in large phase III trials and is approved for this indication. However, despite surgery and adjuvant therapy, many patients relapse and/or experience treatment-related toxicity, underscoring the need to identify and understand mechanisms of response and resistance. In melanoma, neoadjuvant therapy is an active area of research with numerous completed and ongoing trials utilizing FDA-approved and novel agents with intriguing results. Neoadjuvant therapy for regionally metastatic disease is an established standard in multiple cancers, where it has been shown to improve operability, facilitate biomarker development, and even is a registrational endpoint for drug development in breast cancer. Recently, a spate of neoadjuvant studies in melanoma has looked at a swathe of agents with promising clinical and biomarker results. Coordinated efforts are underway to translate these findings to earlier stage disease while prioritizing the evaluation of new strategies in unresectable disease.
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Hernando-Calvo A, García-Alvarez A, Villacampa G, Ortiz C, Bodet D, García-Patos V, Recio JA, Dienstmann R, Muñoz-Couselo E. Dynamics of clinical biomarkers as predictors of immunotherapy benefit in metastatic melanoma patients. Clin Transl Oncol 2020; 23:311-317. [PMID: 32562197 DOI: 10.1007/s12094-020-02420-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/04/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Baseline LDH, derived neutrophil-lymphocyte ratio (dNLR) and immune-related adverse events (irAEs) are associated with outcomes of patients with metastatic melanoma (MM). We hypothesized whether dynamic shifts in LDH, dNLR and incidence of irAEs may impact the prognosis of MM patients treated with anti-CTLA4 or anti-PD1 as single agents. METHODS Retrospective analysis of medical charts from MM patients with prospective monitoring of dNLR, LDH values and irAE incidence. Primary endpoint was overall survival (OS). RESULTS Patients switching from either high dNLR (≥2.5) to low dNLR (HR: 0.14; 0.03-0.74; p = 0.02) or high LDH (≥1.5 × ULN) to low LDH levels (HR: 0.08; 0.01-0.68; p = 0.02) had significantly better OS than those with high dNLR or LDH scores at the end of cycle 2. Longer OS was also observed in patients developing irAEs ≥ grade 2 as compared to no irAEs (HR: 0.2; 0.05-0.89; p = 0.03). CONCLUSIONS We found that major shifts in dNLR and LDH measures from baseline to cycle 2 measures and shifts from baseline to cycle 2 are significantly associated with OS in MM patients receiving single agent anti-PD1 therapy. Laboratory changes and clinical variables may help optimize prognostic estimates.
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Affiliation(s)
| | | | - G Villacampa
- Vall D'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - C Ortiz
- Vall D'Hebron University Hospital, Barcelona, Spain
| | - D Bodet
- Vall D'Hebron University Hospital, Barcelona, Spain
| | | | - J A Recio
- Vall D'Hebron University Hospital, Vall D'Hebron Research Institute (VHIR), Barcelona, Spain
| | - R Dienstmann
- Vall D'Hebron Institute of Oncology (VHIO), Barcelona, Spain
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Simonaggio A, Elaidi R, Fournier L, Fabre E, Ferrari V, Borchiellini D, Thouvenin J, Barthelemy P, Thibault C, Tartour E, Oudard S, Vano YA. Variation in neutrophil to lymphocyte ratio (NLR) as predictor of outcomes in metastatic renal cell carcinoma (mRCC) and non-small cell lung cancer (mNSCLC) patients treated with nivolumab. Cancer Immunol Immunother 2020; 69:2513-2522. [PMID: 32561968 DOI: 10.1007/s00262-020-02637-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 01/20/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND An elevated pre-treatment neutrophil to lymphocytes ratio (NLR) is associated with poor prognosis in various malignancies. Optimal cut-off is highly variable across studies and could not be determined individually for a patient to inform his prognosis. We hypothesize that NLR variations could be more useful than baseline NLR to predict progression-free survival (PFS) and overall survival (OS) in patients (pts) receiving anti-PD1 treatment. PATIENTS AND METHODS All pts with metastatic renal cell carcinoma (mRCC) and metastatic non-small cell lung cancer (mNSCLC) who received anti-PD1 nivolumab monotherapy in second-line setting or later were included in this French multicentric retrospective study. NLR values were prospectively collected prior to each nivolumab administration. Clinical characteristics were recorded. Associations between baseline NLR, NLR variations and survival outcomes were determined using Kaplan-Meier's method and multivariable Cox regression models. RESULTS 161 pts (86 mRCC and 75 mNSCLC) were included with a median follow-up of 18 months. On the whole cohort, any NLR increase at week 6 was significantly associated with worse outcomes compared to NLR decrease, with a median PFS of 11 months vs 3.7 months (p < 0.0001), and a median OS of 28.5 months vs. 18 months (p = 0.013), respectively. In multivariate analysis, NLR increase was significantly associated with worse PFS (HR 2.2; p = 6.10-5) and OS (HR 2.1; p = 0.005). Consistent results were observed in each cohort when analyzed separately. CONCLUSION Any NLR increase at week 6 was associated with worse PFS and OS outcomes. NLR variation is an inexpensive and dynamic marker easily obtained to monitor anti-PD1 efficacy.
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Affiliation(s)
- A Simonaggio
- Medical Oncology Department, Hôpital Européen Georges Pompidou, Paris, France
| | - R Elaidi
- Medical Oncology Department, Hôpital Européen Georges Pompidou, Paris, France
| | - L Fournier
- Department of Radiology, Hôpital Européen Georges Pompidou, Paris, France
| | - E Fabre
- Medical Thoracic Oncology Department, Hopital Européen Georges Pompidou, Paris, France
- U970, Université Paris Descartes Sorbonne Paris-Cité, 75006, Paris, France
| | - V Ferrari
- Department of Medical Oncology, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - D Borchiellini
- Department of Medical Oncology, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - J Thouvenin
- Department of Medical Oncology, University Hospital of Strasbourg, Strasbourg, France
| | - P Barthelemy
- Department of Medical Oncology, University Hospital of Strasbourg, Strasbourg, France
| | - C Thibault
- Medical Oncology Department, Hôpital Européen Georges Pompidou, Paris, France
| | - E Tartour
- Department of Immunology, Hôpital Européen Georges Pompidou, 75015, Paris, France
- U970, Université Paris Descartes Sorbonne Paris-Cité, 75006, Paris, France
| | - S Oudard
- Medical Oncology Department, Hôpital Européen Georges Pompidou, Paris, France
| | - Y A Vano
- Medical Oncology Department, Hôpital Européen Georges Pompidou, Paris, France.
- INSERM, UMR-S 1138, Centre de Recherche des Cordeliers, Team "Cancer, Immune Control and Escape", University Paris Descartes Sorbonne, 75006, Paris, France.
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Carron R, Gaudy-Marqueste C, Amatore F, Padovani L, Malissen N, Balossier A, Loundou A, Bonnet N, Muracciole X, Régis JM, Grob JJ. Stereotactic radiosurgery combined with anti-PD1 for the management of melanoma brain metastases: A retrospective study of safety and efficacy. Eur J Cancer 2020; 135:52-61. [PMID: 32535348 DOI: 10.1016/j.ejca.2020.04.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/07/2020] [Accepted: 04/07/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Brain metastases can be effectively treated with stereotactic radiosurgery (SRS). Immune checkpoint inhibitors are now pivotal in metastatic melanoma care, but some concerns have emerged regarding the safety of their combination with radiation therapy. METHODS We present a retrospective analysis of a cohort of patients treated by anti-PD1 and SRS as a sole modality of radiation therapy (no whole brain radiation therapy at any time) in a single institution. We included patients on anti-PD1 at the time of SRS or patients who started anti-PD1 within a maximum period of 3 months following SRS and were treated at least one year before the analysis. Clinical and serial imaging data were reviewed to determine the efficacy and the rate of adverse radiation effectss of the combination. RESULTS A total of 50 patients were included. SRS targeted 1, 2 to 3 and >3 brain metastases in 17, 16 and 17 patients, respectively. Two patients died before the first evaluation. Nine patients presented with an increase in peritumoral oedema, three with intracranial haemorrhage and one patient with both oedema and haemorrhage. Median follow-up was 38.89 months (interquartile range 24.43; 45.28). Median overall survival from SRS was 16.62 months with 1-, 2- and 3-year rates of 60%, 40% and 35%, respectively. Median brain-Progression Free Survival was 13.2 months with 1, 2 and 3-year rates of 62.1%, 49.7% and 49.7%, respectively. CONCLUSIONS This real-world cohort of patients treated with a homogeneous strategy combining upfront stereotactic radiosurgery and anti-PD1 shows remarkable survival rates and does not reveal unexpected toxicity.
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de La Rochefoucauld J, Noël N, Lambotte O. Management of immune-related adverse events associated with immune checkpoint inhibitors in cancer patients: a patient-centred approach. Intern Emerg Med 2020; 15:587-598. [PMID: 32144552 DOI: 10.1007/s11739-020-02295-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Received: 11/02/2019] [Accepted: 02/13/2020] [Indexed: 02/06/2023]
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment. The number of indications is increasing and antibodies targeting the CTLA-4 and PD-1/PD-L1 pathways are now also prescribed in adjuvant settings and for metastatic cancer. However, ICIs reactivate autoreactive immune cells as well as tumour-specific T cells, which lead to immune-related adverse events (irAEs) in around 70% of treated patients. Although all organs can potentially be involved, the skin, gut, thyroid, lungs, liver, and joints are most frequently affected. Most irAEs occur in the first few months of treatment but late-onset toxicity-even after the ICI has been discontinued-is also possible. In terms of severity, most irAEs are grade 1-2. Some irAEs (especially myocarditis, pneumonitis, and encephalitis) are potentially fatal; in patients with highly suggestive clinical signs, treatment should be initiated before the diagnostic work-up has been completed. When confronted with an unexpected clinical sign, the physician must differentiate rapidly between an irAE, cancer progression, and another (unrelated) cause. The management of irAEs is based on the temporary or permanent discontinuation of the ICI and (for grade ≥ 2 events) the administration of steroids.
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Affiliation(s)
- Jeanne de La Rochefoucauld
- Department of Internal Medicine and Clinical Immunology, APHP-Université-Paris-Saclay, Hôpital Universitaire Bicêtre, CHU Bicêtre, APHP, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France
| | - Nicolas Noël
- Department of Internal Medicine and Clinical Immunology, APHP-Université-Paris-Saclay, Hôpital Universitaire Bicêtre, CHU Bicêtre, APHP, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France
- INSERM U1184, Immunology of Viral Infections and Autoimmune Diseases, 94276, Le Kremlin Bicêtre, France
- Université Paris Saclay, UMR 1184, 94276, Le Kremlin Bicêtre, France
- CEA, DSV/iMETI, IDMIT, 92265, Fontenay-aux-Roses, France
| | - Olivier Lambotte
- Department of Internal Medicine and Clinical Immunology, APHP-Université-Paris-Saclay, Hôpital Universitaire Bicêtre, CHU Bicêtre, APHP, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.
- INSERM U1184, Immunology of Viral Infections and Autoimmune Diseases, 94276, Le Kremlin Bicêtre, France.
- Université Paris Saclay, UMR 1184, 94276, Le Kremlin Bicêtre, France.
- CEA, DSV/iMETI, IDMIT, 92265, Fontenay-aux-Roses, France.
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Kasanen H, Hernberg M, Mäkelä S, Brück O, Juteau S, Kohtamäki L, Ilander M, Mustjoki S, Kreutzman A. Age-associated changes in the immune system may influence the response to anti-PD1 therapy in metastatic melanoma patients. Cancer Immunol Immunother 2020; 69:717-30. [PMID: 32036449 DOI: 10.1007/s00262-020-02497-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/20/2020] [Indexed: 12/12/2022]
Abstract
Anti-PD1 treatment has improved the survival of metastatic melanoma patients, yet it is unknown which patients benefit from the treatment. In this exploratory study, we aimed to understand the effects of anti-PD1 therapy on the patients’ immune system and discover the characteristics that would result in successful treatment. We collected peripheral blood (PB) samples from 17 immuno-oncology-naïve metastatic melanoma patients before and after 1 and 3 months of anti-PD1 therapy. In addition, matching tumor biopsies at the time of diagnosis were collected for tissue microarray. The complete blood counts, PB immunophenotype, serum cytokine profiles, and tumor-infiltrating lymphocytes were analyzed and correlated with the clinical data. Patients were categorized based on their disease control into responders (complete response, partial response, stable disease > 6 months, N = 11) and non-responders (progressive disease, stable disease ≤ 6 months, N = 6). During therapy, the PB natural killer T (NKT) cell frequency, expression of CD25 and CD45RO on cytotoxic natural killer (NK) cells, and serum CXC chemokine levels were significantly increased in responders. Furthermore, higher age together with age-associated characteristics from PB, lower frequency of PB-naïve CD8+ T cells, and elevated levels of serum MCP-4 and OPG were discovered as baseline predictors of treatment response. We therefore propose that in addition to T cells, anti-PD1 treatment is associated with NK- and NKT-cell population dynamics, and that the age-associated characteristics from PB together with older age may contribute to prolonged PFS in anti-PD1-treated melanoma patients.
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Hsu SPC, Chen YC, Chiang HC, Huang YC, Huang CC, Wang HE, Wang YS, Chi KH. Rapamycin and hydroxychloroquine combination alters macrophage polarization and sensitizes glioblastoma to immune checkpoint inhibitors. J Neurooncol 2020; 146:417-426. [PMID: 32020472 PMCID: PMC7000510 DOI: 10.1007/s11060-019-03360-3] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/03/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The failure of immune checkpoint inhibitor (ICPi) on glioblastoma (GBM) treatment underscores the need for improving therapeutic strategy. We aimed to change tumor associated macrophage (TAM) from M2 type (anti-inflammatory) to M1 (pro-inflammatory) type to increase the therapeutic response of ICPi. We proposed that combined rapamycin (R) and hydroxychloroquine (Q) preferentially induce M2 cells death, as fatty acid oxidation was their major source of energy. METHODS Macrophage polarization was characterized on mice and human macrophage cell lines by specific cytokines stimulation with or without RQ treatment under single culture or co-culture with GBM cell lines. Tumor sizes were evaluated on subcutaneous and intracranial GL261 mice models with or without RQ, anti-PD1 mAb treatment. Tumor volumes assessed by MRI scan and proportions of tumor infiltrating immune cells analyzed by flow cytometry were compared. RESULTS In vitro RQ treatment decreased the macrophages polarization of M2, increased the phagocytic ability, and increased the lipid droplets accumulation. RQ treatment decreased the expression levels of CD47 and SIRPα on tumor cells and macrophage cells in co-culture experiments. The combination of RQ and anti-PD1 treatment was synergistic in action. Enhanced the intra-tumoral M1/M2 ratio, the CD8/CD4 ratio in the intracranial GL261 tumor model after RQ treatment were evident. CONCLUSION We provide a rationale for manipulating the macrophage phenotype and increased the therapeutic effect of ICPi. To re-educate and re-empower the TAM/microglia opens an interesting avenue for GBM treatment.
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Affiliation(s)
- Sanford P C Hsu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming University, Taipei, Taiwan
| | | | | | | | | | - Hsin-Ell Wang
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Shang Wang
- JohnPro Biotech Inc., Taipei, Taiwan.,Department of Radiation Therapy and Oncology, Shin Kong Wu Ho-Su Memorial Hospital, #95, Wen-Chang Rd., Shi-Lin, Taipei, 11101, Taiwan (ROC)
| | - Kwan-Hwa Chi
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan. .,Department of Radiation Therapy and Oncology, Shin Kong Wu Ho-Su Memorial Hospital, #95, Wen-Chang Rd., Shi-Lin, Taipei, 11101, Taiwan (ROC).
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Zarifa A, Lopez-Mattei J, Palaskas N, Iliescu C, Durand JB, Kim PY. Immune Checkpoint Inhibitors (ICIs)-Related Cardiotoxicity. Adv Exp Med Biol 2020; 1244:277-85. [PMID: 32301022 DOI: 10.1007/978-3-030-41008-7_15] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The growing success of immune checkpoint inhibitors (ICIs) has led to effectively treating several types of cancers. Even though their use has been associated with the development of cardiac adverse effects, which may decrease the overall survival in cancer patients. These cardiac toxicities are thought to be the result of targeting specific checkpoint proteins on normal myocardial cells leading to over stimulation of the immune system as well as secondary downstream off-target effects on normal tissue.Although cardiotoxicities related to immunotherapy are reportedly rare, they can be severe and associated with life-threatening conditions such as fulminant myocarditis, hemodynamic instability, and cardiac arrest.We will review the most commonly reported cardiovascular toxicities associated with ICIs and their management.
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Delaitre L, Martins-Héricher J, Truchot E, Denis D, Prophette B, Maillard H, Bénéton-Benhard N. [Regression of cutaneous basal cell and squamous cell carcinoma under pembrolizumab]. Ann Dermatol Venereol 2019; 147:279-284. [PMID: 31879092 DOI: 10.1016/j.annder.2019.10.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 06/03/2019] [Accepted: 10/02/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The recommended treatments for advanced squamous cell carcinoma (SCC) (chemotherapy, radiotherapy, anti-EGFR) and advanced basal cell carcinoma (BCC) (vismodegib and sonidegib) have many side effects. Nivolumab (anti-PD1 antibody) may be used as second-line therapy in SCC of the head and neck. We report the case of a patient with advanced SCC and BCC which regressed under pembrolizumab. PATIENTS AND METHODS A 69-year-old man consulted for a large vertex SCC measuring 15cm in diameter. He also had BCC on the left nostril and sternal Bowen disease. Radiological assessment revealed cervical and parotid lymph node involvement. Treatment with pembrolizumab 2mg/kg every 3 weeks was decided at a Multidisciplinary Concertation Meeting. Tumor regression of the vertex SCC was noted at the third course of treatment, as well as regression of the nasal BCC and the sternal Bowen disease. A complete response was observed after 11 courses of treatment for SCC, 7 courses for BCC, and 10 courses for Bowen disease. CONCLUSION We report an original case of cure of BCC with anti-PD1 (pembrolizumab) prescribed for locally advanced inoperable SCC. The place of this treatment in the therapeutic arsenal remains to be defined. Clinical trials are in progress concerning use of this treatment in advanced cutaneous SCC and inoperable BCC.
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Affiliation(s)
- L Delaitre
- Service de dermatologie, centre hospitalier du Mans, 72000 Le Mans, France.
| | - J Martins-Héricher
- Service de dermatologie, centre hospitalier du Mans, 72000 Le Mans, France
| | - E Truchot
- Service d'ORL, centre hospitalier du Mans, 72000 Le Mans, France
| | - D Denis
- Service de dermatologie, centre hospitalier du Mans, 72000 Le Mans, France
| | - B Prophette
- Service d'anatomo-pathologie, centre hospitalier du Mans, 72000 Le Mans, France
| | - H Maillard
- Service de dermatologie, centre hospitalier du Mans, 72000 Le Mans, France
| | - N Bénéton-Benhard
- Service de dermatologie, centre hospitalier du Mans, 72000 Le Mans, France
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Abstract
PURPOSE OF REVIEW This review highlights the spectrum of neurologic adverse events seen with use of immune checkpoint inhibitors (ICIs), their potential mechanisms, the treatments undertaken, and the clinical outcomes. RECENT FINDINGS The advent of ICIs has revolutionized cancer therapy. Neurologic adverse events (NAEs) are rare but clinically significant complication of ICIs. They can involve both the central and peripheral nervous system. Examples include myositis, neuropathy, encephalopathy, and myasthenia gravis. Treatment consists of holding the ICI, administration of corticosteroids, and other immunomodulatory agents as needed. The outcomes are generally favorable; however, rarely severe events can lead to significant morbidity and even mortality. Identifying and treating the range of neurologic adverse events that may potentially arise with ICIs is very important as the oncologic indications for their use continues to expand.
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Lemasson J, Cuzzubbo S, Doucet L, Gounant V, Baroudjian B, Herms F, Carpentier AF, Lebbé C, Vitaux H, Hautefort C, Delyon J. Cochleovestibular toxicity induced by immune checkpoint inhibition: a case series. Eur J Cancer 2019; 117:116-118. [PMID: 31279302 DOI: 10.1016/j.ejca.2019.05.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
Affiliation(s)
| | - Stefania Cuzzubbo
- Neuro-Oncology, AP-HP Hopital Saint-Louis, Paris, France; Université de Paris, France
| | - Ludovic Doucet
- Medical Oncology, AP-HP Hopital Saint-Louis, Paris, France
| | | | | | - Florian Herms
- Dermatology, AP-HP Hopital Saint-Louis, Paris, France
| | - Antoine F Carpentier
- Neuro-Oncology, AP-HP Hopital Saint-Louis, Paris, France; Université de Paris, France
| | - Céleste Lebbé
- Dermatology, AP-HP Hopital Saint-Louis, Paris, France; Université de Paris, INSERM HIPI, France
| | - Hélène Vitaux
- Department of Otorhinolaryngology, Head & Neck Surgery, Hopital Lariboisière, Paris, France
| | - Charlotte Hautefort
- Department of Otorhinolaryngology, Head & Neck Surgery, Hopital Lariboisière, Paris, France
| | - Julie Delyon
- Dermatology, AP-HP Hopital Saint-Louis, Paris, France; Université de Paris, INSERM HIPI, France.
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Moya-Plana A, Herrera Gómez RG, Rossoni C, Dercle L, Ammari S, Girault I, Roy S, Scoazec JY, Vagner S, Janot F, Eggermont AMM, Robert C. Evaluation of the efficacy of immunotherapy for non-resectable mucosal melanoma. Cancer Immunol Immunother 2019; 68:1171-1178. [PMID: 31172258 PMCID: PMC11028088 DOI: 10.1007/s00262-019-02351-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [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: 10/11/2018] [Accepted: 05/28/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors are now standard-of-care treatments for metastatic cutaneous melanoma. However, for rare sub-groups, such as mucosal melanomas, few published data are available, and with no established therapeutic guidelines. Our objective was to assess the response to anti-CTLA4 and anti-PD1 immunotherapy in patients with mucosal melanomas. METHODS We performed a single-center, prospective cohort analysis of patients with non-surgical locally advanced and/or metastatic mucosal melanoma receiving anti-CTLA4 and/or anti-PD1 immunotherapy from 2010 to 2016. RESULTS Forty-four patients were enrolled, including 18 (40.9%) with head and neck, 12 (27.3%) with vulvo-vaginal and 14 (31.8%) with ano-rectal primary tumours. Eleven (25%) patients had stage 3 disease, and 11 (25%) had distant metastases. The first-line immunotherapy was ipilimumab in 24 patients and pembrolizumab in 20. The objective response rate (ORR) was 8.2% (one complete response) for ipilimumab and 35% (four complete responses) for pembrolizumab. No significant difference was observed for primary tumour location. The median follow-up was 24 months (range 4-73). The median progression-free survival (PFS) in the first-line ipilimumab and pembrolizumab groups was 3 months [95% confidence interval (CI) 2.5-4.6] and 5 months (95% CI 2.6-33.1), respectively (p = 0.0147). CONCLUSION In the patients with unresectable and/or metastatic mucosal melanoma, we found ORR and PFS rates comparable to those in patients with cutaneous melanoma, with no significant differences in the types of mucosal surfaces involved. Anti-PD1 therapy has a more favorable benefit-risk ratio than ipilimumab and should be used preferentially.
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Affiliation(s)
- Antoine Moya-Plana
- Head and Neck Surgery Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France.
- Inserm U981, Melanoma Group, Gustave Roussy Cancer Campus, Villejuif, France.
| | | | - Caroline Rossoni
- Biostatistics Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Laurent Dercle
- Radiology Department, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Samy Ammari
- Radiology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Isabelle Girault
- Inserm U981, Melanoma Group, Gustave Roussy Cancer Campus, Villejuif, France
| | - Séverine Roy
- Inserm U981, Melanoma Group, Gustave Roussy Cancer Campus, Villejuif, France
| | - Jean-Yves Scoazec
- Inserm U981, Melanoma Group, Gustave Roussy Cancer Campus, Villejuif, France
- Pathology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Stephan Vagner
- Inserm U981, Melanoma Group, Gustave Roussy Cancer Campus, Villejuif, France
| | - François Janot
- Head and Neck Surgery Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | | | - Caroline Robert
- Inserm U981, Melanoma Group, Gustave Roussy Cancer Campus, Villejuif, France
- Université Paris-Saclay, Villejuif, France
- Onco-dermatology Department, Gustave Roussy Cancer Campus, Grand Paris, France
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Manson G, Mear JB, Herbaux C, Schiano JM, Casasnovas O, Stamatoullas A, Deau B, Schmitt A, Garnier G, Regny C, Bouabdallah K, Moles-Moreau MP, Ghesquieres H, Tempescul A, Dulery R, Nicolas-Virelizier E, Delmer A, Borel C, Chauchet A, Damotte D, Dercle L, Brice P, Houot R; LYSA. Long-term efficacy of anti-PD1 therapy in Hodgkin lymphoma with and without allogenic stem cell transplantation. Eur J Cancer 2019; 115:47-56. [PMID: 31082693 DOI: 10.1016/j.ejca.2019.04.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Long-term efficacy of anti-PD1 therapy and the need for a consolidation with allogenic haematopoietic stem cell transplantation (allo-HSCT) remain unclear in patients with relapsed/refractory (R/R) Hodgkin lymphoma (HL). METHODS We retrospectively analysed 78 patients with R/R HL treated with nivolumab in the French Early Access Program and compared their outcomes according to subsequent allo-HSCT. RESULTS After a median follow-up of 34.3 months, the best overall response rate was 65.8%, including 38.2% complete responses (CRs). The median progression-free survival (PFS) was 12.1 months. Patients reaching a CR upon nivolumab had a significantly longer PFS than those reaching a partial response (PR) (median = not reached vs 9.3 months, p < 0.001). In our cohort, 13 patients who responded (i.e. in CR or PR) to nivolumab monotherapy underwent consolidation with allo-HSCT. Among responding patients, none of those who underwent subsequent allo-HSCT (N = 13) relapsed, whereas 62.2% of those who were not consolidated with allo-HSCT (N = 37) relapsed (p < 0.001). There was no difference in overall survival (OS) between the two groups. Five of 6 patients who were not in CR at the time of transplantation (4 PRs and 1 progressive disease) converted into a CR after allo-HSCT. CONCLUSION Most patients with R/R HL treated with anti-PD1 monotherapy eventually progressed, notably those who did not achieve a CR. Patients undergoing consolidation with allo-HSCT after anti-PD1 therapy experienced prolonged disease-free survival compared with non-transplanted patients, but this difference did not translate into a benefit in OS. This information should be considered when evaluating the risk/benefit ratio of allo-HSCT after anti-PD1 therapy.
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Indini A, Di Guardo L, Cimminiello C, Prisciandaro M, Randon G, De Braud F, Del Vecchio M. Immune-related adverse events correlate with improved survival in patients undergoing anti-PD1 immunotherapy for metastatic melanoma. J Cancer Res Clin Oncol 2018; 145:511-521. [PMID: 30539281 DOI: 10.1007/s00432-018-2819-x] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/06/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Therapeutic chances for metastatic melanoma have consistently changed over the last years with the advent of antibodies targeting the programmed cell death protein-1 (PD-1). Onset of immune-related adverse events (irAEs) during treatment can be a source of concern, and the association with survival outcome is yet to be defined. PATIENTS AND METHODS Data of consecutive patients treated with anti-PD1 (nivolumab or pembrolizumab) for metastatic melanoma between July 2013 and January 2018 were retrospectively reviewed. Baseline factors, together with onset of irAEs and vitiligo during treatment, were evaluated to identify predictors of progression-free (PFS) and overall (OS) survival. PFS and OS were assessed using Kaplan-Meier and Cox models. RESULTS Overall, 173 patients were included in the present analysis, and 102 patients (59%) experienced irAEs. Disease control rate was 51%. Median (interquartile range) PFS and OS were 4.9 (2.6-13.3) and 8.6 (3.5-18.3) months, respectively. At multivariate analysis, irAEs occurrence was independently associated with improved PFS [HR 0.47 (95% CI 0.26, 0.86); p = 0.016], and correlated with better OS [HR 0.39 (95% CI 0.18, 0.81); p = 0.007]. Among various irAEs, the occurrence of vitiligo was associated with a trend toward a non-significant improved OS in comparison with other irAEs (p = 0.061). Median OS was undefined for patients experiencing vitiligo vs. 21.9 months for patients with other irAEs vs. 9.7 months for patients who had no irAEs (p = 0.003). CONCLUSIONS Our study underlines the association between irAEs and survival outcomes from anti-PD1 therapy. Careful management of treatment-related toxicity can lead to achieve maximum clinical benefit from this therapy.
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Affiliation(s)
- Alice Indini
- Melanoma Medical Oncology Unit, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133, Milan, Italy.
| | - Lorenza Di Guardo
- Melanoma Medical Oncology Unit, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133, Milan, Italy
| | - Carolina Cimminiello
- Melanoma Medical Oncology Unit, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133, Milan, Italy
| | - Michele Prisciandaro
- Melanoma Medical Oncology Unit, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133, Milan, Italy
| | - Giovanni Randon
- Melanoma Medical Oncology Unit, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133, Milan, Italy
| | - Filippo De Braud
- Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.,Università degli studi di Milano, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Michele Del Vecchio
- Melanoma Medical Oncology Unit, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133, Milan, Italy
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Shi X, Li X, Wang H, Yu Z, Zhu Y, Gao Y. Specific inhibition of PI3Kδ/γ enhances the efficacy of anti-PD1 against osteosarcoma cancer. J Bone Oncol 2019; 16:100206. [PMID: 31334002 DOI: 10.1016/j.jbo.2018.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/03/2018] [Accepted: 11/05/2018] [Indexed: 02/06/2023] Open
Abstract
Impressive responses have been observed in patients with cancer treated with checkpoint inhibitory anti-programmed cell death-1 (PD-1) or anti-cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) antibodies through disinhibiting the immune system. However, tumors possess complex immunosuppressive tumor microenvironment to present therapeutic obstacles and the response rates to immune checkpoint inhibition remain low. One significant barrier to the efficacy of anti-PD1 treatment is the recruitment of myeloid-derived suppressor cells (MDSCs) into the tumor. MDSCs dramatically increased in peripheral blood of patients with osteosarcoma and prohibited both T-cell activation and infiltration. Here we demonstrated functional inhibition of G-MDSCs with (S)-(-)-N-[2-(3-Hydroxy-1H-indol-3-yl)-methyl]-acetamide (SNA), a specific inhibitor of PI3Kδ/γ, could prime tumor microenvironment, resultantly enhancing the therapeutic efficacy of anti-PD1 treatment in a syngeneic osteosarcoma tumor model. Combining SNA with anti-PD1 dramatically slowed osteosarcoma tumor growth and prolonged survival time of tumor-bearing mice, at least in part mediated through CD8+ T cells. Our results demonstrated that addition of SNA to anti-PD1 significantly altered infiltration and function of innate immune cells, providing the rationale for combination therapy in patients with osteosarcoma through inhibiting the function of MDSCs with a selective PI3Kδ/γ inhibitor to enhance responses to immune checkpoint blockade.
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Ibrahim T, Mateus C, Baz M, Robert C. Older melanoma patients aged 75 and above retain responsiveness to anti-PD1 therapy: results of a retrospective single-institution cohort study. Cancer Immunol Immunother 2018; 67:1571-1578. [PMID: 30056599 PMCID: PMC11028036 DOI: 10.1007/s00262-018-2219-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 12/28/2017] [Accepted: 07/25/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The utility of immunotherapy in elderly melanoma patients is debated. We aimed in this study to evaluate the efficacy and tolerability of immunotherapy among elderly patients. METHOD This is a retrospective single-institution cohort study. Patients aged 75 years and above who had been treated with nivolumab, pembrolizumab or ipilimumab for advanced or metastatic melanoma, were included. Patients and disease characteristics were collected using electronic medical records. Objective response was determined according to the immune-related response criteria. Drug-related toxicities (DRT) were graded according to the CTCAE v4.03. RESULTS 99 patients were included with a mean age of 80 years (SD = 4). One patient received nivolumab and ipilimumab combination, but died because of drug-related diverticulitis. Median PFS on pembrolizumab, nivolumab or ipilimumab were equal to 11.9 (95% CI 5.4-18.4), 1.4 (95% CI 0.01-2.8), and 2.8 months (95% CI 2.6-3), respectively, while objective response rates were equal to 51.6, 12.5, and 17.3%, respectively. Median OS was not reached in patients who received only pembrolizumab, 8.7 months in the ipilimumab only group, and 23 months in patients receiving several immune therapies sequentially. Pembrolizumab, nivolumab, and ipilimumab grade 3-4 DRT rates were equal to 24.2, 62.5, and 32.7% respectively, while discontinuation rates were equal to 43.5, 62.5, and 28.8%, respectively. CONCLUSIONS Our study suggests that immunotherapy is effective and well tolerated in the elderly. The PFS on pembrolizumab was greater than expected, a finding that needs to be investigated further.
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Affiliation(s)
- Tony Ibrahim
- Department of Medical Oncology, Gustave Roussy Institut, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
| | - Christine Mateus
- Dermatology Department, Gustave Roussy Institut, Villejuif, France
| | - Maria Baz
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Caroline Robert
- Dermatology Department, Gustave Roussy Institut, Villejuif, France
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Taquin H, Fontas E, Massol O, Chevallier P, Balloti R, Beranger G, Lacour JP, Passeron T, Montaudié H. Efficacy and safety data for checkpoint inhibitors in advanced melanoma under real-life conditions: A monocentric study conducted in Nice from 2010 to 2016. Ann Dermatol Venereol 2018; 145:649-658. [PMID: 30098818 DOI: 10.1016/j.annder.2018.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 02/10/2018] [Accepted: 06/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Immunotherapies using anti-CTLA4 and anti-PD1 antibodies have revolutionised the management of patients with advanced melanoma. The aim of our study was to analyse the efficacy and safety of immunotherapies in patients with advanced melanoma under real-life conditions. METHODS We conducted a monocentric, retrospective, observational study that included all patients treated with immunotherapies (ipilimumab, i.e. ipi; nivolumab, i.e. niv and pembrolizumab, i.e. pbr) for advanced melanoma with exclusion of primary mucosal or ocular melanoma. The primary endpoint was progression-free survival (PFS). RESULTS A total of 110 patients were included. Median PFS was better in the anti-PD1 group than in the anti-CTLA4 group (3.9 months vs. 2.9 months, P=0.025). The frequency of adverse events of any grade was 53.4% with ipi, 66.7% with niv and 75% with pbr. DISCUSSION Our study shows slightly inferior efficacy data vs. clinical trials of ipi and niv because patients were presenting more severe illness at inclusion. Nevertheless, the study argues in favour of the superiority of anti-PD1 antibodies vs. anti-CTLA4 antibodies in terms of PFS and best overall response. Moreover, our study exhibits safety data comparable to those from clinical trials except for a lower frequency with ipi. CONCLUSION Our efficacy and safety data obtained under real-life conditions are reassuring since they are consistent with data already published.
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Affiliation(s)
- H Taquin
- Dermatology department, CHU de Nice, 06200 Nice, France
| | - E Fontas
- Biostatistics department, CHU de Nice, 06200 Nice, France
| | - O Massol
- Biostatistics department, CHU de Nice, 06200 Nice, France
| | - P Chevallier
- Radiology department, CHU de Nice, 06200 Nice, France
| | - R Balloti
- U1065, Inserm, centre méditerranéen de médecine moléculaire, équipe 1, 06200 Nice, France
| | - G Beranger
- U1065, Inserm, centre méditerranéen de médecine moléculaire, équipe 1, 06200 Nice, France
| | - J-P Lacour
- Dermatology department, CHU de Nice, 06200 Nice, France
| | - T Passeron
- Dermatology department, CHU de Nice, 06200 Nice, France; U1065, Inserm, centre méditerranéen de médecine moléculaire, équipe 12, 06200 Nice, France
| | - H Montaudié
- Dermatology department, CHU de Nice, 06200 Nice, France; U1065, Inserm, centre méditerranéen de médecine moléculaire, équipe 12, 06200 Nice, France.
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Abstract
Thyroid pathologies are the most common forms of endocrinopathy under anticancer immunotherapy. Frequency ranges from 3% to 22% for hypothyroidism and 1% to 11% for thyrotoxicosis. Risk is higher with anti-PD-1 than anti-CTLA-4 treatment and higher again with associated treatment. Pathophysiology mainly consists in silent inflammatory thyroiditis, which accounts for the usual presentation of transient thyrotoxicosis followed by hypothyroidism. Therapeutic strategy usually consists in monitoring with or without symptomatic treatment in case of thyrotoxicosis, and levothyroxine replacement therapy in case of symptomatic hypothyroidism or TSH>10 mIU/L. Screening for dysthyroidism should be systematic ahead of treatment and before each immunotherapy injection for the first 6 months, then at a lower rhythm. It comprises clinical assessment and TSH assay. Onset of thyroid dysfunction should not interrupt immunotherapy, being mainly transient, easy to treat and mild. Teamwork between oncologists and endocrinologists improves screening and management, so as better to accompany the patient during treatment.
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Affiliation(s)
- Frederic Illouz
- Department of Endocrinology, Diabetes and Nutrition, Reference Centre of Rare Thyroid and Hormonal Receptors Disease, Hospital of Angers, 49933 Angers cedex 09, France.
| | - Delphine Drui
- Department of Endocrinology, Institut du Thorax, CHU de Nantes, 44000 Nantes, France
| | - Philippe Caron
- Service d'Endocrinologie, Maladies Métaboliques, Nutrition, CHU de Toulouse, Hôpital Larrey, TSA 30030, 31059 Toulouse cedex 9, France
| | - Christine Do Cao
- Service d'Endocrinologie, CHRU de Lille, Hôpital Huriez, 59037 Lille cedex, France
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Abstract
BACKGROUND Oncologic immunotherapy is a form of therapy intended to reactivate the immune response to tumor cells using agents that modulate immune checkpoints, such as programmed cell death protein 1 and its ligand (PD-1/PD-L), and cytotoxic T-lymphocyte-associated antigen 4. Along with activation of the immune system to tumors, immune-mediated kidney side effects have been reported, most of which are cases of interstitial nephritis. Glomerular disease, however, appears rare. CASE PRESENTATION Herein, we describe a patient with nephrotic syndrome related to treatment with an anti-PD1 antibody for Hodgkin lymphoma. Following the third dose of anti-PD1 antibody, the patient developed massive proteinuria and nephrotic syndrome. Kidney biopsy showed diffuse podocyte foot process effacement upon electron microscopy, which was consistent with minimal change disease. Corticosteroid treatment yielded full and rapid remission of nephrotic syndrome in 1 month. CONCLUSION The present case suggests an association between anti-PD1 therapeutic immune activation and the development of nephrotic syndrome. Given the increasing prevalence of oncologic immunotherapy, patients should be routinely monitored for kidney side effects associated with these agents.
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Affiliation(s)
- Bixia Gao
- Renal Division, Department of Medicine, Peking University First Hospital and Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Beijing, 100034, China
| | - Ningjing Lin
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Suxia Wang
- Laboratory of Electron Microscopy, Pathological Centre, Peking University First Hospital, Beijing, 100034, China
| | - Yu Wang
- Renal Division, Department of Medicine, Peking University First Hospital and Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Beijing, 100034, China.
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