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Izumi K, Inoue M, Washino S, Shirotake S, Kagawa M, Takeshita H, Miura Y, Hyodo Y, Oyama M, Kawakami S, Miyagawa T, Saito K, Kageyama Y. Clinical outcomes of nivolumab plus ipilimumab in patients with metastatic non-clear cell renal cell carcinoma: Real-world data from a Japanese multicenter retrospective study. Int J Urol 2023; 30:714-721. [PMID: 36541136 DOI: 10.1111/iju.15128] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 06/30/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Although nivolumab plus ipilimumab has become a standard treatment regimen for metastatic clear cell renal cell carcinoma (ccRCC), its efficacy in non-clear cell carcinoma (nccRCC) has not been fully examined. In the current study, we evaluated the clinical outcomes of nivolumab plus ipilimumab in nccRCC compared with ccRCC. METHODS We retrospectively analyzed 22 patients with metastatic and/or locally advanced unresectable nccRCC who received nivolumab plus ipilimumab as a first-line therapy and compared them with 107 patients with ccRCC. Objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and toxicity were compared between the nccRCC and ccRCC groups. RESULTS The histology of nccRCC included eight papillary, six unclassified, three chromophobe, two collecting duct carcinoma, and three other subtypes. Best objective response in nccRCC patients included three complete responses and five partial responses, resulting in an ORR of 36%, while that in ccRCC patients was 50% (p = 0.22). With a median follow-up of 11.9 months, OS was significantly shorter in patients with nccRCC than in those with ccRCC (median 20.8 months vs. not reached, p = 0.04), while there was no significant difference in PFS (median 6.3 vs. 10.8 months, p = 0.21). Treatment-related adverse events occurred in 14 (64%) nccRCC patients and 81 (76%) ccRCC patients. CONCLUSIONS Combination treatment with nivolumab and ipilimumab demonstrated modest clinical efficacy in patients with nccRCC compared with patients with ccRCC, suggesting it could be a therapeutic option for metastatic nccRCC patients.
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Affiliation(s)
- Keita Izumi
- Department of Urology, Saitama Cancer Center, Kita-adachi-gun, Saitama, Japan
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
- Musashino Study Group, Saitama, Japan
| | - Masaharu Inoue
- Department of Urology, Saitama Cancer Center, Kita-adachi-gun, Saitama, Japan
- Musashino Study Group, Saitama, Japan
| | - Satoshi Washino
- Musashino Study Group, Saitama, Japan
- Department of Urology, Jichi Medical University Saitama Medical Center, Omiya-ku, Saitama, Japan
| | - Suguru Shirotake
- Musashino Study Group, Saitama, Japan
- Department of Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Makoto Kagawa
- Musashino Study Group, Saitama, Japan
- Department of Urology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Hideki Takeshita
- Musashino Study Group, Saitama, Japan
- Department of Urology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Yuji Miura
- Musashino Study Group, Saitama, Japan
- Department of Medical Oncology, Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - Yoji Hyodo
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
- Musashino Study Group, Saitama, Japan
| | - Masafumi Oyama
- Department of Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Satoru Kawakami
- Department of Urology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Tomoaki Miyagawa
- Department of Urology, Jichi Medical University Saitama Medical Center, Omiya-ku, Saitama, Japan
| | - Kazutaka Saito
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Yukio Kageyama
- Department of Urology, Saitama Cancer Center, Kita-adachi-gun, Saitama, Japan
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Yamazaki N, Kiyohara Y, Uhara H, Tsuchida T, Yoshida A, Yamada T, Komoto A. Postmarketing surveillance of nivolumab plus ipilimumab combination therapy in Japanese patients with unresectable malignant melanoma. J Dermatol 2023; 50:1108-1120. [PMID: 37350027 DOI: 10.1111/1346-8138.16820] [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: 02/21/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 06/24/2023]
Abstract
Although malignant melanoma is relatively rare in Japan, it is often diagnosed at a later stage than in Western countries. Nivolumab and ipilimumab are immune checkpoint inhibitors targeting programmed death 1 and cytotoxic T-lymphocyte-associated protein 4, respectively. Owing to their complementary anticancer effects, nivolumab and ipilimumab combination therapy (N + I) has been studied and approved for treating malignant melanoma in various countries including Japan. Real-world postmarketing surveillance was implemented to record treatment-related adverse events (TRAEs) in patients treated with N + I following its approval in Japan. Patients were eligible for registration if they had unresectable malignant melanoma and started N + I between September 2018 and August 2019. The observation period was 13 weeks from starting N + I. Only safety information was collected and evaluated. The final case report form lock was March 2021. Overall, 173 patients (median age, 66.0 years; performance status 0-1, 88.4%; skin: 53.2%; mucosal: 32.4%) were eligible for the analyses. Overall, 34.1% of patients completed 4 doses of N + I. N + I was discontinued by 63.0% (due to adverse events in 67.9% and disease progression/death in 22.9%). Any grade and grade ≥3 TRAEs were reported in 73.41% and 52.02%, respectively. TRAEs in ≥10 patients were hepatic function abnormal (any grade/grade ≥3: 23.12%/13.29%), pyrexia (10.40%/0.58%), diarrhea (9.25%/2.89%), rash (8.67%/0.58%), hypophysitis (5.78%/5.20%), interstitial lung disease (5.78%/2.89%), and liver disorder (5.78%/4.62%). TRAEs were classified as recovered (36.99% of patients), recovering (44.51%), unrecovered (13.29%), recovered with sequelae (2.31%), and death (1.73%). Overall, 24 of 34 patients (70.59%) with gastrointestinal-related and 53 of 65 (81.54%) liver-related TRAEs received treatment, such as a steroid with/without an immunosuppressant; most patients recovered within 1 to 2 months. In conclusion, this postmarketing surveillance of N + I in patients with unresectable malignant melanoma revealed no new safety concerns compared with results of prior studies. Immune-related TRAEs were generally manageable by appropriate treatment including a steroid.
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Affiliation(s)
- Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshio Kiyohara
- Dermatology Division, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Hisashi Uhara
- Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tetsuya Tsuchida
- Department of Dermatology, Saitama Medical University, Saitama, Japan
| | - Ai Yoshida
- Patient Safety Japan, Bristol-Myers Squibb K.K., Tokyo, Japan
| | - Takako Yamada
- Patient Safety Japan, Bristol-Myers Squibb K.K., Tokyo, Japan
| | - Akira Komoto
- Patient Safety Japan, Bristol-Myers Squibb K.K., Tokyo, Japan
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Yuasa T. Editorial Comment on Clinical outcomes of nivolumab plus ipilimumab in patients with metastatic non-clear cell renal cell carcinoma: Real-world data from a Japanese multicenter retrospective study. Int J Urol 2023; 30:721-722. [PMID: 36653155 DOI: 10.1111/iju.15146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Takeshi Yuasa
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Harrington KJ, Ferris RL, Gillison M, Tahara M, Argiris A, Fayette J, Schenker M, Bratland Å, Walker JWT, Grell P, Even C, Chung CH, Redman R, Coutte A, Salas S, Grant C, de Azevedo S, Soulières D, Hansen AR, Wei L, Khan TA, Miller-Moslin K, Roberts M, Haddad R. Efficacy and Safety of Nivolumab Plus Ipilimumab vs Nivolumab Alone for Treatment of Recurrent or Metastatic Squamous Cell Carcinoma of the Head and Neck: The Phase 2 CheckMate 714 Randomized Clinical Trial. JAMA Oncol 2023; 9:779-789. [PMID: 37022706 PMCID: PMC10080406 DOI: 10.1001/jamaoncol.2023.0147] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/10/2022] [Indexed: 04/07/2023]
Abstract
Importance There remains an unmet need to improve clinical outcomes in patients with recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). Objective To evaluate clinical benefit of first-line nivolumab plus ipilimumab vs nivolumab alone in patients with R/M SCCHN. Design, Setting, and Participants The CheckMate 714, double-blind, phase 2 randomized clinical trial was conducted at 83 sites in 21 countries between October 20, 2016, and January 23, 2019. Eligible participants were aged 18 years or older and had platinum-refractory or platinum-eligible R/M SCCHN and no prior systemic therapy for R/M disease. Data were analyzed from October 20, 2016 (first patient, first visit), to March 8, 2019 (primary database lock), and April 6, 2020 (overall survival database lock). Interventions Patients were randomized 2:1 to receive nivolumab (3 mg/kg intravenously [IV] every 2 weeks) plus ipilimumab (1 mg/kg IV every 6 weeks) or nivolumab (3 mg/kg IV every 2 weeks) plus placebo for up to 2 years or until disease progression, unacceptable toxic effects, or consent withdrawal. Main Outcomes and Measures The primary end points were objective response rate (ORR) and duration of response between treatment arms by blinded independent central review in the population with platinum-refractory R/M SCCHN. Exploratory end points included safety. Results Of 425 included patients, 241 (56.7%; median age, 59 [range, 24-82] years; 194 males [80.5%]) had platinum-refractory disease (nivolumab plus ipilimumab, n = 159; nivolumab, n = 82) and 184 (43.3%; median age, 62 [range, 33-88] years; 152 males [82.6%]) had platinum-eligible disease (nivolumab plus ipilimumab, n = 123; nivolumab, n = 61). At primary database lock, the ORR in the population with platinum-refractory disease was 13.2% (95% CI, 8.4%-19.5%) with nivolumab plus ipilimumab vs 18.3% (95% CI, 10.6%-28.4%) with nivolumab (odds ratio [OR], 0.68; 95.5% CI, 0.33-1.43; P = .29). Median duration of response for nivolumab plus ipilimumab was not reached (NR) (95% CI, 11.0 months to NR) vs 11.1 months (95% CI, 4.1 months to NR) for nivolumab. In the population with platinum-eligible disease, the ORR was 20.3% (95% CI, 13.6%-28.5%) with nivolumab plus ipilimumab vs 29.5% (95% CI, 18.5%-42.6%) with nivolumab. The rates of grade 3 or 4 treatment-related adverse events with nivolumab plus ipilimumab vs nivolumab were 15.8% (25 of 158) vs 14.6% (12 of 82) in the population with platinum-refractory disease and 24.6% (30 of 122) vs 13.1% (8 of 61) in the population with platinum-eligible disease. Conclusions and Relevance The CheckMate 714 randomized clinical trial did not meet its primary end point of ORR benefit with first-line nivolumab plus ipilimumab vs nivolumab alone in platinum-refractory R/M SCCHN. Nivolumab plus ipilimumab was associated with an acceptable safety profile. Research to identify patient subpopulations in R/M SCCHN that would benefit from nivolumab plus ipilimumab over nivolumab monotherapy is warranted. Trial Registration ClinicalTrials.gov Identifier: NCT02823574.
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Affiliation(s)
- Kevin J. Harrington
- Royal Marsden Hospital/The Institute of Cancer Research National Institute for Health and Care Research Biomedical Research Centre, London, United Kingdom
| | | | - Maura Gillison
- The University of Texas MD Anderson Cancer Center, Houston
| | | | - Athanasios Argiris
- Hygeia Hospital, Marousi, Greece
- Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jérôme Fayette
- Centre Léon Bérard, Lyon, France
- Hôpital Saint-André, Bordeaux, France
| | | | | | | | - Peter Grell
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | | | | | - Rebecca Redman
- University of Louisville, Brown Cancer Center, Louisville, Kentucky
| | | | - Sébastien Salas
- Assistance Publique–Hôpitaux de Marseille, Marseille, France
| | | | | | | | - Aaron R. Hansen
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Li Wei
- Bristol Myers Squibb, Princeton, New Jersey
| | | | | | | | - Robert Haddad
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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Choueiri TK, Powles T, Albiges L, Burotto M, Szczylik C, Zurawski B, Yanez Ruiz E, Maruzzo M, Suarez Zaizar A, Fein LE, Schutz FA, Heng DYC, Wang F, Mataveli F, Chang YL, van Kooten Losio M, Suarez C, Motzer RJ. Cabozantinib plus Nivolumab and Ipilimumab in Renal-Cell Carcinoma. N Engl J Med 2023; 388:1767-1778. [PMID: 37163623 PMCID: PMC10257898 DOI: 10.1056/nejmoa2212851] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND The efficacy and safety of treatment with cabozantinib in combination with nivolumab and ipilimumab in patients with previously untreated advanced renal-cell carcinoma are unknown. METHODS In this phase 3, double-blind trial, we enrolled patients with advanced clear-cell renal-cell carcinoma who had not previously received treatment and had intermediate or poor prognostic risk according to the International Metastatic Renal-Cell Carcinoma Database Consortium categories. Patients were randomly assigned to receive 40 mg of cabozantinib daily in addition to nivolumab and ipilimumab (experimental group) or matched placebo in addition to nivolumab and ipilimumab (control group). Nivolumab (3 mg per kilogram of body weight) and ipilimumab (1 mg per kilogram) were administered once every 3 weeks for four cycles. Patients then received nivolumab maintenance therapy (480 mg once every 4 weeks) for up to 2 years. The primary end point was progression-free survival, as determined by blinded independent review according to Response Evaluation Criteria in Solid Tumors, version 1.1, and was assessed in the first 550 patients who had undergone randomization. The secondary end point was overall survival, assessed in all patients who had undergone randomization. RESULTS Overall, 855 patients underwent randomization: 428 were assigned to the experimental group and 427 to the control group. Among the first 550 patients who had undergone randomization (276 in the experimental group and 274 in the control group), the probability of progression-free survival at 12 months was 0.57 in the experimental group and 0.49 in the control group (hazard ratio for disease progression or death, 0.73; 95% confidence interval, 0.57 to 0.94; P = 0.01); 43% of the patients in the experimental group and 36% in the control group had a response. Grade 3 or 4 adverse events occurred in 79% of the patients in the experimental group and in 56% in the control group. Follow-up for overall survival is ongoing. CONCLUSIONS Among patients with previously untreated, advanced renal-cell carcinoma who had intermediate or poor prognostic risk, treatment with cabozantinib plus nivolumab and ipilimumab resulted in significantly longer progression-free survival than treatment with nivolumab and ipilimumab alone. Grade 3 or 4 adverse events were more common in the experimental group than in the control group. (Funded by Exelixis; COSMIC-313 ClinicalTrials.gov number, NCT03937219.).
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Affiliation(s)
- Toni K Choueiri
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Thomas Powles
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Laurence Albiges
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Mauricio Burotto
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Cezary Szczylik
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Bogdan Zurawski
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Eduardo Yanez Ruiz
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Marco Maruzzo
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Alberto Suarez Zaizar
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Luis E Fein
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Fabio A Schutz
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Daniel Y C Heng
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Fong Wang
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Fabio Mataveli
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Yu-Lin Chang
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Maximiliano van Kooten Losio
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Cristina Suarez
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Robert J Motzer
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
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Kaseb AO, Hasanov E, Cao HST, Xiao L, Vauthey JN, Lee SS, Yavuz BG, Mohamed YI, Qayyum A, Jindal S, Duan F, Basu S, Yadav SS, Nicholas C, Sun JJ, Singh Raghav KP, Rashid A, Carter K, Chun YS, Tzeng CWD, Sakamuri D, Xu L, Sun R, Cristini V, Beretta L, Yao JC, Wolff RA, Allison JP, Sharma P. Perioperative nivolumab monotherapy versus nivolumab plus ipilimumab in resectable hepatocellular carcinoma: a randomised, open-label, phase 2 trial. Lancet Gastroenterol Hepatol 2022; 7:208-218. [PMID: 35065057 PMCID: PMC8840977 DOI: 10.1016/s2468-1253(21)00427-1] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/29/2021] [Accepted: 11/04/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hepatocellular carcinoma has high recurrence rates after surgery; however, there are no approved standard-of-care neoadjuvant or adjuvant therapies. Immunotherapy has been shown to improve survival in advanced hepatocellular carcinoma; we therefore aimed to evaluate the safety and tolerability of perioperative immunotherapy in resectable hepatocellular carcinoma. METHODS In this single-centre, randomised, open-label, phase 2 trial, patients with resectable hepatocellular carcinoma were randomly assigned (1:1) to receive 240 mg of nivolumab intravenously every 2 weeks (for up to three doses before surgery at 6 weeks) followed in the adjuvant phase by 480 mg of nivolumab intravenously every 4 weeks for 2 years, or 240 mg of nivolumab intravenously every 2 weeks (for up to three doses before surgery) plus one dose of 1 mg/kg of ipilimumab intravenously concurrently with the first preoperative dose of nivolumab, followed in the adjuvant phase by 480 mg of nivolumab intravenously every 4 weeks for up to 2 years plus 1 mg/kg of ipilimumab intravenously every 6 weeks for up to four cycles. Patients were randomly assigned to the treatment groups by use of block randomisation with a random block size. The primary endpoint was the safety and tolerability of nivolumab with or without ipilimumab. Secondary endpoints were the proportion of patients with an overall response, time to progression, and progression-free survival. This trial is registered with ClinicalTrials.gov (NCT03222076) and is completed. FINDINGS Between Oct 30, 2017, and Dec 3, 2019, 30 patients were enrolled and 27 were randomly assigned: 13 to nivolumab and 14 to nivolumab plus ipilimumab. Grade 3-4 adverse events were higher with nivolumab plus ipilimumab (six [43%] of 14 patients) than with nivolumab alone (three [23%] of 13). The most common treatment-related adverse events of any grade were increased alanine aminotransferase (three [23%] of 13 patients on nivolumab vs seven [50%] of 14 patients on nivolumab plus ipilimumab) and increased aspartate aminotransferase (three [23%] vs seven [50%]). No patients in either group had their surgery delayed due to grade 3 or worse adverse events. Seven of 27 patients had surgical cancellations, but none was due to treatment-related adverse events. Estimated median progression-free survival was 9·4 months (95% CI 1·47-not estimable [NE]) with nivolumab and 19·53 months (2·33-NE) with nivolumab plus ipilimumab (hazard ratio [HR] 0·99, 95% CI 0·31-2·54); median time to progression was 9·4 months (95% CI 1·47-NE) in the nivolumab group and 19·53 months (2·33-NE) in the nivolumab plus ipilimumab group (HR 0·89, 95% CI 0·31-2·54). In an exploratory analysis, three (23%) of 13 patients had an overall response with nivolumab monotherapy, versus none with nivolumab plus ipilimumab. Three (33%) of nine patients had a major pathological response (ie, ≥70% necrosis in the resected tumour area) with nivolumab monotherapy compared with three (27%) of 11 with nivolumab plus ipilimumab. INTERPRETATION Perioperative nivolumab alone and nivolumab plus ipilimumab appears to be safe and feasible in patients with resectable hepatocellular carcinoma. Our findings support further studies of immunotherapy in the perioperative setting in hepatocellular carcinoma. FUNDING Bristol Myers Squibb and the US National Institutes of Health.
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Affiliation(s)
- Ahmed Omar Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Elshad Hasanov
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hop Sanderson Tran Cao
- Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lianchun Xiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sunyoung S Lee
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Betul Gok Yavuz
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yehia I Mohamed
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aliya Qayyum
- Department of Abdominal Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sonali Jindal
- Immunotherapy Platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fei Duan
- Immunotherapy Platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sreyashi Basu
- Immunotherapy Platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shalini S Yadav
- Immunotherapy Platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Courtney Nicholas
- Immunotherapy Platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jing Jing Sun
- Immunotherapy Platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kanwal Pratap Singh Raghav
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Asif Rashid
- Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kristen Carter
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yun Shin Chun
- Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ching-Wei David Tzeng
- Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Divya Sakamuri
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Li Xu
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ryan Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vittorio Cristini
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX, USA
| | - Laura Beretta
- Department of Molecular and Cellular Oncology, Division of Basic Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James C Yao
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Robert A Wolff
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James Patrick Allison
- Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Padmanee Sharma
- Immunotherapy Platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Doki Y, Ajani JA, Kato K, Xu J, Wyrwicz L, Motoyama S, Ogata T, Kawakami H, Hsu CH, Adenis A, El Hajbi F, Di Bartolomeo M, Braghiroli MI, Holtved E, Ostoich SA, Kim HR, Ueno M, Mansoor W, Yang WC, Liu T, Bridgewater J, Makino T, Xynos I, Liu X, Lei M, Kondo K, Patel A, Gricar J, Chau I, Kitagawa Y. Nivolumab Combination Therapy in Advanced Esophageal Squamous-Cell Carcinoma. N Engl J Med 2022; 386:449-462. [PMID: 35108470 DOI: 10.1056/nejmoa2111380] [Citation(s) in RCA: 344] [Impact Index Per Article: 172.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND First-line chemotherapy for advanced esophageal squamous-cell carcinoma results in poor outcomes. The monoclonal antibody nivolumab has shown an overall survival benefit over chemotherapy in previously treated patients with advanced esophageal squamous-cell carcinoma. METHODS In this open-label, phase 3 trial, we randomly assigned adults with previously untreated, unresectable advanced, recurrent, or metastatic esophageal squamous-cell carcinoma in a 1:1:1 ratio to receive nivolumab plus chemotherapy, nivolumab plus the monoclonal antibody ipilimumab, or chemotherapy. The primary end points were overall survival and progression-free survival, as determined by blinded independent central review. Hierarchical testing was performed first in patients with tumor-cell programmed death ligand 1 (PD-L1) expression of 1% or greater and then in the overall population (all randomly assigned patients). RESULTS A total of 970 patients underwent randomization. At a 13-month minimum follow-up, overall survival was significantly longer with nivolumab plus chemotherapy than with chemotherapy alone, both among patients with tumor-cell PD-L1 expression of 1% or greater (median, 15.4 vs. 9.1 months; hazard ratio, 0.54; 99.5% confidence interval [CI], 0.37 to 0.80; P<0.001) and in the overall population (median, 13.2 vs. 10.7 months; hazard ratio, 0.74; 99.1% CI, 0.58 to 0.96; P = 0.002). Overall survival was also significantly longer with nivolumab plus ipilimumab than with chemotherapy among patients with tumor-cell PD-L1 expression of 1% or greater (median, 13.7 vs. 9.1 months; hazard ratio, 0.64; 98.6% CI, 0.46 to 0.90; P = 0.001) and in the overall population (median, 12.7 vs. 10.7 months; hazard ratio, 0.78; 98.2% CI, 0.62 to 0.98; P = 0.01). Among patients with tumor-cell PD-L1 expression of 1% or greater, a significant progression-free survival benefit was also seen with nivolumab plus chemotherapy over chemotherapy alone (hazard ratio for disease progression or death, 0.65; 98.5% CI, 0.46 to 0.92; P = 0.002) but not with nivolumab plus ipilimumab as compared with chemotherapy. The incidence of treatment-related adverse events of grade 3 or 4 was 47% with nivolumab plus chemotherapy, 32% with nivolumab plus ipilimumab, and 36% with chemotherapy alone. CONCLUSIONS Both first-line treatment with nivolumab plus chemotherapy and first-line treatment with nivolumab plus ipilimumab resulted in significantly longer overall survival than chemotherapy alone in patients with advanced esophageal squamous-cell carcinoma, with no new safety signals identified. (Funded by Bristol Myers Squibb and Ono Pharmaceutical; CheckMate 648 ClinicalTrials.gov number, NCT03143153.).
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Affiliation(s)
- Yuichiro Doki
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Jaffer A Ajani
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Ken Kato
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Jianming Xu
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Lucjan Wyrwicz
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Satoru Motoyama
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Takashi Ogata
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Hisato Kawakami
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Chih-Hung Hsu
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Antoine Adenis
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Farid El Hajbi
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Maria Di Bartolomeo
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Maria I Braghiroli
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Eva Holtved
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Sandra A Ostoich
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Hye R Kim
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Masaki Ueno
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Wasat Mansoor
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Wen-Chi Yang
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Tianshu Liu
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - John Bridgewater
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Tomoki Makino
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Ioannis Xynos
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Xuan Liu
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Ming Lei
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Kaoru Kondo
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Apurva Patel
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Joseph Gricar
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Ian Chau
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
| | - Yuko Kitagawa
- From Osaka University Graduate School of Medicine, Osaka (Y.D., T.M.), National Cancer Center Hospital (K. Kato), Toranomon Hospital (M.U.), and Keio University School of Medicine (Y.K.), Tokyo, Akita University Hospital, Akita (S.M.), Kanagawa Cancer Center, Kanagawa (T.O.), and Kindai University Faculty of Medicine, Osakasayama (H.K.) - all in Japan; University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Fifth Medical Center, Chinese PLA General Hospital, Beijing (J.X.), and Zhongshan Hospital, Fudan University, Shanghai (T.L.); Klinika Onkologii i Radioterapii, Narodowy Instytut Onkologii, Warsaw, Poland (L.W.); National Taiwan University Hospital, Taipei (C.-H.H.), and E-Da Hospital and I-Shou University, Kaohsiung (W.-C.Y.) - both in Taiwan; Institut de Recherche en Cancérologie de Montpellier, INSERM, Université Montpellier, Institut du Cancer de Montpellier, Montpellier (A.A.), and Centre Oscar Lambret, Lille (F.E.H.) - both in France; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.D.B.); Institute of Cancer of São Paulo, University of São Paulo, São Paulo (M.I.B.); Odense University Hospital, Odense, Denmark (E.H.); Hospital Provincial del Centenario, Rosario, Argentina (S.A.O.); the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea (H.R.K.); the Christie NHS Foundation Trust, Manchester (W.M.), the UCL Cancer Institute, University College London, London (J.B.), and the Royal Marsden Hospital (Surrey), Sutton (I.C.) - all in the United Kingdom; and Bristol Myers Squibb, Princeton, NJ (I.X., X.L., M.L., K. Kondo, A.P., J.G.)
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8
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Chan A, Dang C, Wisniewski J, Weng X, Hynson E, Zhong L, Wilson L. A Cost-effectiveness Analysis Comparing Pembrolizumab-Axitinib, Nivolumab-Ipilimumab, and Sunitinib for Treatment of Advanced Renal Cell Carcinoma. Am J Clin Oncol 2022; 45:66-73. [PMID: 34991104 DOI: 10.1097/coc.0000000000000884] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The US Food and Drug Administration (FDA) approved nivolumab-ipilimumab and pembrolizumab-axitinib as first-line treatments for metastatic, clear-cell, renal cell carcinoma (mRCC) based on results from CheckMate 214 and KEYNOTE-426. Our objective was to compare the adjusted, lifetime cost-effectiveness between nivolumab-ipilimumab, pembrolizumab-axitinib, and sunitinib for patients with mRCC. MATERIALS AND METHODS A 3-state Markov model was developed comparing nivolumab-ipilimumab and pembrolizumab-axitinib to each other and sunitinib, over a 20-year lifetime horizon from a US medical center perspective. The clinical outcomes of nivolumab-ipilimumab and pembrolizumab-axitinib were compared using matching-adjusted indirect comparison. Costs of drug treatment, adverse events, and utilities associated with different health states and adverse events were determined using national sources and published literature. Our outcome was incremental cost-effectiveness ratio (ICER) using quality-adjusted life years (QALY). One-way and probabilistic sensitivity analyses were conducted. RESULTS Nivolumab-ipilimumab was the most cost-effective option in the base case analysis with an ICER of $34,190/QALY compared with sunitinib, while the pembrolizumab-axitinib ICER was dominated by nivolumab-ipilimumab and was not cost-effective (ICER=$12,630,828/QALY) compared with sunitinib. The mean total costs per patient for the nivolumab-ipilimumab and pembrolizumab-axitinib arms were $284,683 and $457,769, respectively, compared with sunitinib at $241,656. QALY was longer for nivolumab-ipilimumab (3.23 QALY) than for adjusted pembrolizumab-axitinib (1.99 QALY), which was longer than sunitinib's (1.98 QALY). These results were most sensitive to treatment cost in both groups, but plausible changes did not alter the conclusions. CONCLUSIONS The base case scenario indicated that nivolumab-ipilimumab was the most cost-effective treatment option for mRCC compared with pembrolizumab-axitinib and sunitinib.
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9
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Friedman CF, Spencer C, Cabanski CR, Panageas KS, Wells DK, Ribas A, Tawbi H, Tsai K, Postow M, Shoushtari A, Chapman P, Karakunnel J, Bucktrout S, Gherardini P, Hollmann TJ, Chen RO, Callahan M, LaVallee T, Ibrahim R, Wolchok J. Ipilimumab alone or in combination with nivolumab in patients with advanced melanoma who have progressed or relapsed on PD-1 blockade: clinical outcomes and translational biomarker analyses. J Immunother Cancer 2022; 10:e003853. [PMID: 35074903 PMCID: PMC8788323 DOI: 10.1136/jitc-2021-003853] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There are no validated biomarkers that can aid clinicians in selecting who would best benefit from anticytotoxic T lymphocyte-associated antigen 4 monotherapy versus combination checkpoint blockade in patients with advanced melanoma who have progressive disease after programmed death 1 (PD-1) blockade. METHODS We conducted a randomized multicenter phase II trial in patients with advanced melanoma. Patients were randomly assigned to receive either 1 mg/kg of nivolumab plus 3 mg/kg of ipilimumab or 3 mg/kg of ipilimumab every 3 weeks for up to four doses. Patients were stratified by histological subtype and prior response to PD-1 therapy. The primary clinical objective was overall response rate by week 18. Translational biomarker analyses were conducted in patients with blood and tissue samples. RESULTS Objective responses were seen in 5 of 9 patients in the ipilimumab arm and 2 of 10 patients in the ipilimumab+nivolumab arm; disease control rates (DCRs) (66.7% vs 60.0%) and rates of grade 3-4 adverse events (56% vs 50%) were comparable between arms. In a pooled analysis, patients with clinical benefit (CB), defined as Response Evaluation Criteria in Solid Tumors response or progression-free for 6 months, showed increased circulating CD4+ T cells with higher polyfunctionality and interferon gamma production following treatment. Tumor profiling revealed enrichment of NRAS mutations and activation of transcriptional programs associated with innate and adaptive immunity in patients with CB. CONCLUSIONS In patients with advanced melanoma that previously progressed on PD-1 blockade, objective responses were seen in both arms, with comparable DCRs. Findings from biomarker analyses provided hypothesis-generating signals for validation in future studies of larger patient cohorts. TRIAL REGISTRATION NUMBER NCT02731729.
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Affiliation(s)
- Claire F Friedman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Christine Spencer
- Parker Institute for Cancer Immunotherapy, San Francisco, California, USA
| | | | - Katherine S Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Daniel K Wells
- Parker Institute for Cancer Immunotherapy, San Francisco, California, USA
| | - Antoni Ribas
- Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Hussein Tawbi
- Department of Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Katy Tsai
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Michael Postow
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Alexander Shoushtari
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Paul Chapman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Joyson Karakunnel
- Parker Institute for Cancer Immunotherapy, San Francisco, California, USA
| | - Samantha Bucktrout
- Parker Institute for Cancer Immunotherapy, San Francisco, California, USA
| | - Pier Gherardini
- Parker Institute for Cancer Immunotherapy, San Francisco, California, USA
| | - Travis J Hollmann
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Margaret Callahan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Theresa LaVallee
- Parker Institute for Cancer Immunotherapy, San Francisco, California, USA
| | - Ramy Ibrahim
- Parker Institute for Cancer Immunotherapy, San Francisco, California, USA
| | - Jedd Wolchok
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
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10
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Katakura Y, Kimura T, Kusano T, Tatsumi F, Iwamoto Y, Sanada J, Fushimi Y, Shimoda M, Kohara K, Nakanishi S, Kaku K, Mune T, Kaneto H. Case Report: A Variety of Immune-Related Adverse Events Triggered by Immune Checkpoint Inhibitors in a Subject With Malignant Melanoma: Destructive Thyroiditis, Aseptic Meningitis and Isolated ACTH Deficiency. Front Endocrinol (Lausanne) 2021; 12:722586. [PMID: 34712202 PMCID: PMC8547604 DOI: 10.3389/fendo.2021.722586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/20/2021] [Indexed: 11/16/2022] Open
Abstract
Recently, immune checkpoint inhibitors have been drawing much attention as cancer immunotherapy, but it has been shown that various immune-related adverse events (irAEs) are induced by immune checkpoint inhibitors in various organs, which has become one of the serious issues at present. A 58-year-old Japanese male with malignant melanoma was treated with nivolumab and/or ipilimumab. During the period of treatment, he suffered from various irAEs. Firstly, about 1 month after starting nivolumab monotherapy, destructive thyroiditis was induced, and so we started replacement therapy with levothyroxine. Secondly, about 1 month after starting nivolumab and ipilimumab combination therapy, aseptic meningitis was induced. We stopped both drugs and started steroid therapy with prednisolone. Finally, about 9 months after restarting nivolumab, isolated adrenocorticotropic hormone (ACTH) deficiency was induced, and so we started replacement therapy with hydrocortisone. Taken together, we should bear in mind the possibility of a variety of irAEs when we use immune checkpoint inhibitors.
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Affiliation(s)
| | - Tomohiko Kimura
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
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Brastianos PK, Strickland MR, Lee EQ, Wang N, Cohen JV, Chukwueke U, Forst DA, Eichler A, Overmoyer B, Lin NU, Chen WY, Bardia A, Juric D, Dagogo-Jack I, White MD, Dietrich J, Nayyar N, Kim AE, Alvarez-Breckenridge C, Mahar M, Mora JL, Nahed BV, Jones PS, Shih HA, Gerstner ER, Giobbie-Hurder A, Carter SL, Oh K, Cahill DP, Sullivan RJ. Phase II study of ipilimumab and nivolumab in leptomeningeal carcinomatosis. Nat Commun 2021; 12:5954. [PMID: 34642329 PMCID: PMC8511104 DOI: 10.1038/s41467-021-25859-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 08/25/2021] [Indexed: 11/09/2022] Open
Abstract
Leptomeningeal disease (LMD) is a common complication from solid tumor malignancies with a poor prognosis and limited treatment options. We present a single arm Phase II study of 18 patients with LMD receiving combined ipilimumab and nivolumab until progression or unacceptable toxicity (NCT02939300). The primary end point is overall survival at 3 months (OS3). Secondary end points include toxicity, cumulative time-to-progression at 3 months, and progression-free survival. A Simon two-stage design is used to compare a null hypothesis OS3 of 18% against an alternative of 44%. Median follow up based on patients still alive is 8.0 months (range: 0.5 to 15.9 months). The study has met its primary endpoint as 8 of 18 (OS3 0.44; 90% CI: 0.24 to 0.66) patients are alive at three months. One third of patients have experienced one (or more) grade-3 or higher adverse events. Two patients have discontinued protocol treatment due to unacceptable toxicity (hepatitis and colitis, respectively). The most frequent adverse events include fatigue (N = 7), nausea (N = 6), fever (N = 6), anorexia (N = 6) and rash (N = 6). Combined ipilimumab and nivolumab has an acceptable safety profile and demonstrates promising activity in LMD patients. Larger, multicenter clinical trials are needed to validate these results.
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Affiliation(s)
| | - Matthew R Strickland
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Eudocia Quant Lee
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Nancy Wang
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Justine V Cohen
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Ugonma Chukwueke
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | | | - April Eichler
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Beth Overmoyer
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Nancy U Lin
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Wendy Y Chen
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Aditya Bardia
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Dejan Juric
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | | | - Michael D White
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Jorg Dietrich
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Naema Nayyar
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Albert E Kim
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | | | - Maura Mahar
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Joana L Mora
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Brian V Nahed
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Pamela S Jones
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Helen A Shih
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | | | | | - Scott L Carter
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Kevin Oh
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Daniel P Cahill
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Ryan J Sullivan
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
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12
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Klee G, Kurzhals J, Hagelstein V, Zillikens D, Recke A, Langan EA, Terheyden P. Low-dose ipilimumab combined with anti-PD-1 immunotherapy in patients with metastatic melanoma following anti-PD-1 treatment failure. Melanoma Res 2021; 31:464-471. [PMID: 34284462 DOI: 10.1097/cmr.0000000000000760] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Combined immunotherapy is associated with a significant risk of severe and potentially fatal immune-related adverse events (irAEs). Therefore, we retrospectively analyzed the side profile and efficacy of low-dose ipilimumab (1 mg/kg, IPI1) combined with anti-PD-1 immunotherapy in patients who progressed after anti-PD-1 monotherapy. Nine patients with unresectable stage III or IV melanoma treated with combined low-dose ipilimumab (1 mg/kg, IPI1) and anti-PD-1 immunotherapy, following progression after anti-PD-1 treatment, were identified. Treatment response and irAEs were recorded. Grade 3 irAEs occurred in one-third of patients. Interestingly, there were no grade 4 or 5 irAEs. In fact, four out of the nine patients experienced no irAEs at all. One patient discontinued combined immunotherapy due to immune-related colitis. The mean time to the onset of grade 3 irAEs was 14.3 weeks. The objective response rate was 33.3% and a disease control rate of 66.7% was achieved. Median progression-free survival (PFS) was 5.7 months and median overall survival (OS) was 21.6 months. The median PFS when IPI1 and anti-PD-1 treatment was administered in the second-line setting was not reached, but only 2.8 months when used in subsequent treatment settings. Combined IPI1 and anti-PD-1 immunotherapy was well tolerated. Its use in the third-line or above setting was associated with a significantly poorer prognosis than in the second-line setting. Larger, prospective studies are required to evaluate the safety and efficacy of this dosing regimen following anti-PD-1 treatment failure.
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Affiliation(s)
- Gina Klee
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - Jonas Kurzhals
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | | | - Detlef Zillikens
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - Andreas Recke
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - Ewan A Langan
- Department of Dermatology, University of Luebeck, Luebeck, Germany
- Department of Dermatological Sciences, University of Manchester, Manchester, UK
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13
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Schneider S, Alezra E, Yacoub M, Ducharme O, Gerard E, Dutriaux C, Prey S. Aseptic cystitis induced by nivolumab and ipilimumab combination for metastatic melanoma. Melanoma Res 2021; 31:487-489. [PMID: 34433197 DOI: 10.1097/cmr.0000000000000765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of advanced melanoma. Combination of ICI with ipilimumab cytotoxic T-lymphocyte antigen-4 and nivolumab [anti-programmed cell death-1 (PD-1)] improves tumoral response compared to anti-PD1 monotherapy in melanoma patients, but is associated with more severe and multiple immune-related adverse events. We report the first case of aseptic cystitis induced by ipilimumab and nivolumab combination in a 61-year-old melanoma patient. She described after two infusions, diarrhea, pollakiuria, intense bladder pain, urinary urgency, and nocturia. Repeated negative urine culture tests led to perform cystoscopy. Mucosal bladder biopsies showed lymphocytic T-cells infiltration in intraepithelial and in subepithelial connective tissue, which were consistent with the diagnosis of immune-related aseptic cystitis. Aseptic cystitis is a rare and poorly known side-effect related to ICI. Only four other cases with anti-PD1 monotherapy were found in literature, only in Japanese patients. It simulates bacterial cystitis with negative urinary tests, and is often associated with atypical symptoms like diarrhea, which may delay the diagnosis. Oral steroids appear to be the most efficient therapeutic options.
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Affiliation(s)
| | - Eric Alezra
- CHU de Bordeaux, Service de chirurgie urologique
| | | | | | | | - Caroline Dutriaux
- CHU de Bordeaux, Service de Dermatologie
- Univ. Bordeaux, Inserm U-1035, Bordeaux, France
| | - Sorilla Prey
- CHU de Bordeaux, Service de Dermatologie
- Univ. Bordeaux, Inserm U-1035, Bordeaux, France
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14
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Long GV, Robert C, Butler MO, Couture F, Carlino MS, O'Day S, Atkinson V, Cebon JS, Brown MP, Dalle S, Hill AG, Gibney GT, McCune S, Menzies AM, Niu C, Ibrahim N, Moreno BH, Diab A. Standard-Dose Pembrolizumab Plus Alternate-Dose Ipilimumab in Advanced Melanoma: KEYNOTE-029 Cohort 1C, a Phase 2 Randomized Study of Two Dosing Schedules. Clin Cancer Res 2021; 27:5280-5288. [PMID: 34210681 PMCID: PMC9401495 DOI: 10.1158/1078-0432.ccr-21-0793] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/16/2021] [Accepted: 06/25/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Standard-dose pembrolizumab plus alternative-dose ipilimumab (1 mg/kg Q3W for 4 doses) were tolerable and had robust antitumor activity in advanced melanoma in cohort B of the phase 1 KEYNOTE-029 study. Cohort C evaluated standard-dose pembrolizumab with two other alternative ipilimumab regimens. PATIENTS AND METHODS Patients with treatment-naive unresectable stage III/IV melanoma were randomly assigned 1:1 to pembrolizumab 200 mg Q3W for ≤24 months plus ipilimumab 50 mg Q6W for 4 doses (PEM200+IPI50), or the same pembrolizumab regimen plus ipilimumab 100 mg Q12W for 4 doses (PEM200+IPI100). Primary end points were incidence of grade 3-5 treatment-related adverse events (TRAE) and objective response rate (ORR) per RECIST v1.1 by independent central review. Per protocol-defined thresholds, grade 3-5 TRAE incidence ≤26% indicated meaningful toxicity reduction and ORR ≥48% indicated no decrease in efficacy versus data reported for other PD-1 inhibitor/ipilimumab combinations. RESULTS Median follow-up on February 18, 2019, was 16.3 months in PEM200+IPI50 (N = 51) and 16.4 months in PEM200+IPI100 (N = 51). Grade 3-5 TRAEs occurred in 12 (24%) patients in PEM200+IPI50 and 20 (39%) in PEM200+IPI100. One patient in PEM200+IPI50 died from treatment-related autoimmune myocarditis. Immune-mediated AEs or infusion reactions occurred in 21 (42%) patients in PEM200+IPI50 and 28 (55%) in PEM200+IPI100. ORR was 55% in PEM200+IPI50; 61% in PEM200+IPI100. CONCLUSIONS Pembrolizumab 200 mg Q3W plus ipilimumab 50 mg Q6W or 100 mg Q12W demonstrated antitumor activity above the predefined threshold; pembrolizumab plus ipilimumab 50 mg Q6W had lower incidence of grade 3-5 TRAEs than the predefined threshold, suggesting a reduction in toxicity. See related commentary by Jameson-Lee and Luke, p. 5153.
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Affiliation(s)
- Georgina V. Long
- Department of Medical Oncology and Translational Research, Melanoma Institute Australia, The University of Sydney, and Mater and Royal North Shore Hospitals, Sydney, New South Wales, Australia
| | - Caroline Robert
- Department of Medicine, Dermatology Service, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Marcus O. Butler
- Department of Medical Oncology, The Princess Margaret Cancer Center and University of Toronto, Toronto, Ontario, Canada
| | - Felix Couture
- Department of Hematology, CHU de Québec—Hôtel-Dieu de Québec, Québec City, Québec, Canada
| | - Matteo S. Carlino
- Department of Medicine, Westmead and Blacktown Hospitals, Melanoma Institute Australia, and The University of Sydney, Sydney, New South Wales, Australia
| | - Steven O'Day
- Department of Medical Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
| | - Victoria Atkinson
- University of Queensland, Division of Cancer Sciences, Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | - Jonathan S. Cebon
- Department of Hematology/Oncology, Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
| | - Michael P. Brown
- Cancer Clinical Trials Unit, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Stéphane Dalle
- University of Lyon, Hospices Civils de Lyon, Cancer Research Center of Lyon, Lyon, France
| | - Andrew G. Hill
- Department of Health, Tasman Oncology Research, Southport, Queensland, Australia
| | - Geoffrey T. Gibney
- Melanoma Disease Group, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
| | - Steven McCune
- Department of Clinical Research, Wellstar Health System, Marietta, Georgia
| | - Alexander M. Menzies
- Department of Medical Oncology and Translational Research, Melanoma Institute Australia, The University of Sydney, and Mater and Royal North Shore Hospitals, Sydney, New South Wales, Australia
| | - Cuizhen Niu
- Department of Clinical Oncology, MSD China, Beijing, China
| | - Nageatte Ibrahim
- Department of Clinical Oncology, Merck & Co., Inc., Kenilworth, New Jersey
| | | | - Adi Diab
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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15
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Gutierrez-Sainz L, Cruz-Castellanos P, Higuera O, de Castro-Carpeño J. Neoadjuvant Chemoimmunotherapy in Patients with Resectable Non-small Cell Lung Cancer. Curr Treat Options Oncol 2021; 22:91. [PMID: 34424417 DOI: 10.1007/s11864-021-00885-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Accepted: 05/18/2021] [Indexed: 12/25/2022]
Abstract
OPINION STATEMENT Worldwide, lung cancer is the most common cause of cancer morbidity and mortality. Despite a trend towards an escalating diagnosis of resectable non-small cell lung cancer (NSCLC), overall survival (OS) in patients with resectable NSCLC remains poor. The incorporation of chemotherapy into the neoadjuvant setting has improved disease-free survival (DFS), time to distant recurrence, and OS. Furthermore, the incorporation of immunotherapy and the combination of chemotherapy and immunotherapy have improved pathological responses, which seems to be associated with increased survival. Therefore, immunotherapy represents a paradigm shift in treating resectable NSCLC. However, validation in large randomized trials is mandatory and a longer postoperative follow-up period is required. Additionally, neoadjuvant therapy trials offer an exceptional environment for testing predictive biomarkers. PD-L1 expression and tumor mutational burden (TMB) are the most helpful tools for predicting the likelihood of response with immunotherapy in metastatic NSCLC. However, in the neoadjuvant setting, PD-L1 expression and TMB have had opposite results until now. Recently, the immune profiling and some immune-related genes also appear to be involved in the prognosis and response to immunotherapy in NSCLC. Further prospective studies are needed to derive definitive conclusions.
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Affiliation(s)
- Laura Gutierrez-Sainz
- Oncology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | - Patricia Cruz-Castellanos
- Oncology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Oliver Higuera
- Oncology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Javier de Castro-Carpeño
- Oncology Department, Hospital Universitario La Paz, Cátedra UAM-AMGEN, CIBERONC, Paseo de la Castellana 261, 28046, Madrid, Spain
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16
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Wright K. FDA Approves Nivolumab Plus Ipilimumab for Previously Untreated Unresectable Malignant Pleural Mesothelioma. Oncology (Williston Park) 2021; 34:502-503. [PMID: 33206991 DOI: 10.46883/onc.2020.3411.0502] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The FDA approved nivolumab (Opdivo) in combination with ipilimumab (Yervoy) for the first-line treatment of adult patients with unresectable malignant pleural mesothelioma. The approval was based on efficacy results from a pre-specified interim analysis from the open-label, multi-center, randomized phase 3 CHECKMATE 743 (NCT02899299) trial, designed to evaluate nivolumab plus ipilimumab compared with chemotherapy (pemetrexed and cisplatin or carboplatin) in patients with histologically confirmed unresectable MPM and no prior systemic therapy or palliative radiotherapy within 14 days of initiation of therapy.
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17
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Haymaker C, Johnson DH, Murthy R, Bentebibel SE, Uemura MI, Hudgens CW, Safa H, James M, Andtbacka RHI, Johnson DB, Shaheen M, Davies MA, Rahimian S, Chunduru SK, Milton DR, Tetzlaff MT, Overwijk WW, Hwu P, Gabrail N, Agrawal S, Doolittle G, Puzanov I, Markowitz J, Bernatchez C, Diab A. Tilsotolimod with Ipilimumab Drives Tumor Responses in Anti-PD-1 Refractory Melanoma. Cancer Discov 2021; 11:1996-2013. [PMID: 33707233 PMCID: PMC8544022 DOI: 10.1158/2159-8290.cd-20-1546] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/08/2021] [Accepted: 03/09/2021] [Indexed: 11/16/2022]
Abstract
Many patients with advanced melanoma are resistant to immune checkpoint inhibition. In the ILLUMINATE-204 phase I/II trial, we assessed intratumoral tilsotolimod, an investigational Toll-like receptor 9 agonist, with systemic ipilimumab in patients with anti-PD-1- resistant advanced melanoma. In all patients, 48.4% experienced grade 3/4 treatment-emergent adverse events. The overall response rate at the recommended phase II dose of 8 mg was 22.4%, and an additional 49% of patients had stable disease. Responses in noninjected lesions and in patients expected to be resistant to ipilimumab monotherapy were observed. Rapid induction of a local IFNα gene signature, dendritic cell maturation and enhanced markers of antigen presentation, and T-cell clonal expansion correlated with clinical response. A phase III clinical trial with this combination (NCT03445533) is ongoing. SIGNIFICANCE: Despite recent developments in advanced melanoma therapies, most patients do not experience durable responses. Intratumoral tilsotolimod injection elicits a rapid, local type 1 IFN response and, in combination with ipilimumab, activates T cells to promote clinical activity, including in distant lesions and patients not expected to respond to ipilimumab alone.This article is highlighted in the In This Issue feature, p. 1861.
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Affiliation(s)
- Cara Haymaker
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniel H Johnson
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ravi Murthy
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Salah-Eddine Bentebibel
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marc I Uemura
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Courtney W Hudgens
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Houssein Safa
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marihella James
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert H I Andtbacka
- Surgical Oncology Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Douglas B Johnson
- Division of Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Montaser Shaheen
- Department of Medicine and Cancer Center, University of Arizona, Tucson, Arizona
| | - Michael A Davies
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Denái R Milton
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael T Tetzlaff
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Willem W Overwijk
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Patrick Hwu
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nashat Gabrail
- Department of Oncology, Gabrail Cancer Center, Canton, Ohio
| | - Sudhir Agrawal
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Gary Doolittle
- Department of Oncology, University of Kansas Medical Center, Kansas City, Kansas
| | - Igor Puzanov
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Joseph Markowitz
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Chantale Bernatchez
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Adi Diab
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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18
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Dart SJ, Cook AM, Millward MJ, McDonnell AM, Chin WL, Hakeem MU, Meniawy TM, Bowyer SE. Changes in expression of PD-L1 on peripheral T cells in patients with melanoma and lung cancer treated with PD-1 inhibitors. Sci Rep 2021; 11:15312. [PMID: 34321489 PMCID: PMC8319434 DOI: 10.1038/s41598-021-93479-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/17/2021] [Indexed: 12/26/2022] Open
Abstract
Advances in cancer immunology have increased the use of immune checkpoint inhibitors in clinical practice, however not all patients respond, and treatment can have severe side-effects. Blood-based immunological biomarkers are an attractive method for predicting which patients will respond to therapy, however, reliable biomarkers for immune checkpoint blockade are lacking. This study aimed to identify patients before or early in treatment who would best respond to PD-1 inhibitors. We hypothesised that higher baseline PD-L1 and/or PD-1 on peripheral blood T cells could predict radiological response to PD-1 inhibitors. This pilot prospective cohort study assessed 26 patients with melanoma or non-small cell lung cancer, treated with pembrolizumab, nivolumab, or nivolumab/ipilimumab combined. Response was assessed by RECIST 1.1. Peripheral blood lymphocytes collected at baseline, after one cycle, 10 weeks and at discontinuation of therapy were analysed by flow cytometry. Patients with a higher proportion of PD-L1+ T cells at baseline had improved objective response to PD-1 inhibitor therapy, and patients with a lower proportion of regulatory T cells at baseline experienced more immune-related adverse events. These findings may prove useful to assist in clinical decision making. Further studies with larger cohorts are required to validate these findings.
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MESH Headings
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/pharmacology
- Antibodies, Monoclonal, Humanized/therapeutic use
- B7-H1 Antigen/antagonists & inhibitors
- B7-H1 Antigen/biosynthesis
- B7-H1 Antigen/genetics
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/metabolism
- Female
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- Immune Checkpoint Inhibitors/adverse effects
- Immune Checkpoint Inhibitors/pharmacology
- Immune Checkpoint Inhibitors/therapeutic use
- Ipilimumab/administration & dosage
- Ipilimumab/adverse effects
- Ipilimumab/pharmacology
- Kaplan-Meier Estimate
- Lung Neoplasms/drug therapy
- Lung Neoplasms/metabolism
- Male
- Melanoma/drug therapy
- Melanoma/metabolism
- Molecular Targeted Therapy
- Neoplasm Proteins/antagonists & inhibitors
- Neoplasm Proteins/biosynthesis
- Neoplasm Proteins/genetics
- Nivolumab/administration & dosage
- Nivolumab/adverse effects
- Nivolumab/pharmacology
- Nivolumab/therapeutic use
- Pilot Projects
- Progression-Free Survival
- Prospective Studies
- T-Lymphocytes/drug effects
- T-Lymphocytes, Regulatory/drug effects
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Affiliation(s)
- Sarah J Dart
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- National Centre for Asbestos Related Diseases, Perth, WA, Australia
| | - Alistair M Cook
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- National Centre for Asbestos Related Diseases, Perth, WA, Australia
- Institute for Respiratory Health, Nedlands, WA, 6009, Australia
| | - Michael J Millward
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Alison M McDonnell
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- National Centre for Asbestos Related Diseases, Perth, WA, Australia
| | - Wee L Chin
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- National Centre for Asbestos Related Diseases, Perth, WA, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Institute for Respiratory Health, Nedlands, WA, 6009, Australia
| | - Muhammad U Hakeem
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Tarek M Meniawy
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Samantha E Bowyer
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia.
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia.
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19
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Lei M, Siemers NO, Pandya D, Chang H, Sanchez T, Harbison C, Szabo PM, Janjigian Y, Ott PA, Sharma P, Bendell J, Evans TRJ, de Braud F, Chau I, Boyd Z. Analyses of PD-L1 and Inflammatory Gene Expression Association with Efficacy of Nivolumab ± Ipilimumab in Gastric Cancer/Gastroesophageal Junction Cancer. Clin Cancer Res 2021; 27:3926-3935. [PMID: 33782030 DOI: 10.1158/1078-0432.ccr-20-2790] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/02/2020] [Accepted: 03/24/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE In advanced gastric cancer/gastroesophageal junction cancer (GC/GEJC), there is a need to identify biomarkers of response to therapies, such as immune checkpoint inhibitors. PATIENTS AND METHODS In post hoc exploratory analyses from CheckMate 032 (GC/GEJC cohort), we evaluated associations between nivolumab ± ipilimumab (NIVO ± IPI) efficacy and programmed death ligand 1 (PD-L1) expression, defined by tumor cells (% TC) or combined positive score (CPS; sum of PD-L1-staining TCs + immune cells, divided by total viable TCs, × 100) using the Dako PD-L1 IHC 28-8 pharmDx assay, or inflammatory gene expression. RESULTS There was a trend toward increased efficacy (objective response and overall survival) when PD-L1 expression was determined by CPS compared with % TC at higher cutoffs of ≥5 and ≥10 in the pooled analysis of all treatment regimens. In this analysis, 19% and 26% of patients with PD-L1-positive tumors at a CPS cutoff of ≥5 and ≥10, respectively, had an objective response compared with 8% and 9% of patients at the equivalent % TC cutoffs. Longer survival was demonstrated in patients with PD-L1-positive (defined by CPS cutoffs of ≥5 and ≥10) versus PD-L1-negative status. Similar results were observed in the NIVO 1 mg/kg + IPI 3 mg/kg subgroup. Multiple inflammatory gene signatures/transcripts, including a signature consisting of four genes (CD274, CD8A, LAG3, and STAT1), showed associations with response to NIVO ± IPI. CONCLUSIONS This study suggests a greater association of PD-L1 expression by CPS with NIVO ± IPI efficacy compared with % TC PD-L1 expression in patients with GC/GEJC. Inflammatory signatures were also associated with NIVO ± IPI response, warranting further investigation.See related commentary by Moutafi and Rimm, p. 3812.
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Affiliation(s)
- Ming Lei
- Bristol Myers Squibb, Princeton, New Jersey.
| | | | | | - Han Chang
- Bristol Myers Squibb, Princeton, New Jersey
| | | | | | | | - Yelena Janjigian
- Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Padmanee Sharma
- Genitourinary Medical Oncology and Immunology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Johanna Bendell
- Drug Development Unit, Sarah Cannon Research Institute at Tennessee Oncology, Nashville, Tennessee
| | - Thomas R Jeffry Evans
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom
| | - Filippo de Braud
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- University of Milan, Milan, Italy
| | - Ian Chau
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
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20
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Sanborn RE, Hamid O, de Vries EG, Ott PA, Garcia-Corbacho J, Boni V, Bendell J, Autio KA, Cho DC, Plummer R, Stroh M, Lu L, Thistlethwaite F. CX-072 (pacmilimab), a Probody PD-L1 inhibitor, in combination with ipilimumab in patients with advanced solid tumors (PROCLAIM-CX-072): a first-in-human, dose-finding study. J Immunother Cancer 2021; 9:e002446. [PMID: 34301808 PMCID: PMC8311331 DOI: 10.1136/jitc-2021-002446] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Probody® therapeutics are antibody prodrugs designed to be activated by tumor-associated proteases. This conditional activation restricts antibody binding to the tumor microenvironment, thereby minimizing 'off-tumor' toxicity. Here, we report the phase 1 data from the first-in-human study of CX-072 (pacmilimab), a Probody immune checkpoint inhibitor directed against programmed death-ligand 1 (PD-L1), in combination with the anti-cytotoxic T-lymphocyte-associated protein 4 (anti-CTLA-4) antibody ipilimumab. METHODS Adults (n=27) with advanced solid tumors (naive to PD-L1/programmed cell death protein 1 or CTLA-4 inhibitors) were enrolled in the phase 1 combination therapy dose-escalation portion of this multicenter, open-label, phase 1/2 study (NCT03013491). Dose-escalation pacmilimab/ipilimumab followed a standard 3+3 design and continued until the maximum tolerated dose (MTD) was determined. Pacmilimab+ipilimumab was administered intravenously every 3 weeks for four cycles, followed by pacmilimab administered every 2 weeks as monotherapy. The primary objective was identification of dose-limiting toxicities and determination of the MTD. Other endpoints included the rate of objective response (Response Evaluation Criteria In Solid Tumors v.1.1). RESULTS Twenty-seven patients were enrolled in pacmilimab (mg/kg)+ipilimumab (mg/kg) dose-escalation cohorts: 0.3+3 (n=6); 1+3 (n=3); 3+3 (n=3); 10+3 (n=8); 10+6 (n=6); and 10+10 (n=1). Dose-limiting toxicities occurred in three patients, one at the 0.3+3 dose level (grade 3 dyspnea/pneumonitis) and two at the 10+6 dose level (grade 3 colitis, grade 3 increased aspartate aminotransferase). The MTD and recommended phase 2 dose was pacmilimab 10 mg/kg+ipilimumab 3 mg/kg administered every 3 weeks. Pacmilimab-related grade 3-4 adverse events (AEs) and grade 3-4 immune-related AEs were reported in nine (33%) and six (22%) patients, respectively. Three patients (11%) discontinued treatment because of AEs. The overall response rate was 19% (95% CI 6.3 to 38.1), with one complete (anal squamous cell carcinoma) and four partial responses (cancer of unknown primary, leiomyosarcoma, mesothelioma, testicular cancer). Responses lasted for >12 months in four patients. CONCLUSIONS The MTD and recommended phase 2 dose of pacmilimab (10 mg/kg)+ipilimumab (3 mg/kg) every 3 weeks is active and has a favorable tolerability profile.
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Affiliation(s)
- Rachel E Sanborn
- Department of Medical Oncology, Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, Oregon, USA
| | - Omid Hamid
- Department of Medical Oncology, The Angeles Clinic and Research Institute, A Cedars-Sinai Affiliate, Los Angeles, California, USA
| | - Elisabeth Ge de Vries
- Department of Medical Oncology, Universitair Medisch Centrum Groningen, University of Groningen, Groningen, Netherlands
| | - Patrick A Ott
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Valentina Boni
- Department of Medical Oncology, START Madrid-CIOCC, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Johanna Bendell
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee, USA
| | - Karen A Autio
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Daniel C Cho
- Department of Medicine, Perlmutter Cancer Center at NYU Langone Medical Center, New York, New York, USA
| | - Ruth Plummer
- Department of Medical Oncology, Northern Centre for Cancer Care, Newcastle Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Mark Stroh
- CytomX Therapeutics Inc, South San Francisco, California, USA
| | - Lawrence Lu
- CytomX Therapeutics Inc, South San Francisco, California, USA
| | - Fiona Thistlethwaite
- Department of Medical Oncology, The Christie Hospital NHS Foundation Trust and University of Manchester, Manchester, UK
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21
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Penter L, Zhang Y, Savell A, Huang T, Cieri N, Thrash EM, Kim-Schulze S, Jhaveri A, Fu J, Ranasinghe S, Li S, Zhang W, Hathaway ES, Nazzaro M, Kim HT, Chen H, Thurin M, Rodig SJ, Severgnini M, Cibulskis C, Gabriel S, Livak KJ, Cutler C, Antin JH, Nikiforow S, Koreth J, Ho VT, Armand P, Ritz J, Streicher H, Neuberg D, Hodi FS, Gnjatic S, Soiffer RJ, Liu XS, Davids MS, Bachireddy P, Wu CJ. Molecular and cellular features of CTLA-4 blockade for relapsed myeloid malignancies after transplantation. Blood 2021; 137:3212-3217. [PMID: 33720354 PMCID: PMC8351891 DOI: 10.1182/blood.2021010867] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/23/2021] [Indexed: 02/07/2023] Open
Abstract
Relapsed myeloid disease after allogeneic stem cell transplantation (HSCT) remains largely incurable. We previously demonstrated the potent activity of immune checkpoint blockade in this clinical setting with ipilimumab or nivolumab. To define the molecular and cellular pathways by which CTLA-4 blockade with ipilimumab can reinvigorate an effective graft-versus-leukemia (GVL) response, we integrated transcriptomic analysis of leukemic biopsies with immunophenotypic profiling of matched peripheral blood samples collected from patients treated with ipilimumab following HSCT on the Experimental Therapeutics Clinical Trials Network 9204 trial. Response to ipilimumab was associated with transcriptomic evidence of increased local CD8+ T-cell infiltration and activation. Systemically, ipilimumab decreased naïve and increased memory T-cell populations and increased expression of markers of T-cell activation and costimulation such as PD-1, HLA-DR, and ICOS, irrespective of response. However, responding patients were characterized by higher turnover of T-cell receptor sequences in peripheral blood and showed increased expression of proinflammatory chemokines in plasma that was further amplified by ipilimumab. Altogether, these data highlight the compositional T-cell shifts and inflammatory pathways induced by ipilimumab both locally and systemically that associate with successful GVL outcomes. This trial was registered at www.clinicaltrials.gov as #NCT01822509.
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Affiliation(s)
- Livius Penter
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA
- Harvard Medical School, Boston, MA
- Department of Hematology, Oncology, and Tumorimmunology, Campus Virchow Klinikum, Berlin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Yi Zhang
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Alexandra Savell
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Teddy Huang
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Translational Immunogenomics Laboratory and
| | - Nicoletta Cieri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA
- Harvard Medical School, Boston, MA
| | - Emily M Thrash
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Seunghee Kim-Schulze
- Human Immune Monitoring Center at the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Aashna Jhaveri
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | - Jingxin Fu
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | | | - Shuqiang Li
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA
- Translational Immunogenomics Laboratory and
| | - Wandi Zhang
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Emma S Hathaway
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Matthew Nazzaro
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Haesook T Kim
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | - Helen Chen
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; and
| | - Magdalena Thurin
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; and
| | | | | | - Carrie Cibulskis
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA
| | - Stacey Gabriel
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA
| | - Kenneth J Livak
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Translational Immunogenomics Laboratory and
| | - Corey Cutler
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Joseph H Antin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Sarah Nikiforow
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - John Koreth
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Vincent T Ho
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Philippe Armand
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Jerome Ritz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Howard Streicher
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; and
| | - Donna Neuberg
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | - F Stephen Hodi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Sacha Gnjatic
- Human Immune Monitoring Center at the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert J Soiffer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - X Shirley Liu
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Matthew S Davids
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Pavan Bachireddy
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA
- Harvard Medical School, Boston, MA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Catherine J Wu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA
- Harvard Medical School, Boston, MA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
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22
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Courtney PT, Yip AT, Cherry DR, Salans MA, Kumar A, Murphy JD. Cost-effectiveness of Nivolumab-Ipilimumab Combination Therapy for the Treatment of Advanced Non-Small Cell Lung Cancer. JAMA Netw Open 2021; 4:e218787. [PMID: 33938936 PMCID: PMC8094011 DOI: 10.1001/jamanetworkopen.2021.8787] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Treatment with nivolumab-ipilimumab combination therapy was found to improve overall survival compared with chemotherapy among patients with advanced non-small cell lung cancer (NSCLC) in the CheckMate 227 clinical trial. However, these drugs are substantially more expensive than chemotherapy and, given the high incidence of advanced NSCLC, the incorporation of dual immune checkpoint inhibitors into the standard of care could have substantial economic consequences. OBJECTIVE To assess whether nivolumab-ipilimumab combination therapy is a cost-effective first-line treatment for patients with advanced NSCLC. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation designed a Markov model to compare the cost-effectiveness of nivolumab-ipilimumab combination therapy with platinum-doublet chemotherapy as first-line treatment for patients with advanced NSCLC. The Markov model was created to simulate patients with advanced NSCLC who were receiving either nivolumab-ipilimumab combination therapy or platinum-doublet chemotherapy. Transition probabilities, including disease progression, survival, and treatment toxic effects, were derived using data from the CheckMate 227 clinical trial. Costs and health utilities were obtained from published literature. Data analyses were conducted from November 2019 to September 2020. EXPOSURES Nivolumab-ipilimumab combination therapy. MAIN OUTCOMES AND MEASURES The primary study outcomes were quality-adjusted life-years (QALYs) and cost in 2020 US dollars. Cost-effectiveness was measured using an incremental cost-effectiveness ratio (ICER), with an ICER less than $100 000 per QALY considered cost-effective. Model uncertainty was assessed with 1-way and probabilistic sensitivity analyses. RESULTS Treatment with nivolumab-ipilimumab combination therapy was associated with an increase in overall cost of $201 900 and improved effectiveness of 0.50 QALYs compared with chemotherapy, yielding an ICER of $401 700 per QALY. The study model was sensitive to the cost and duration of immunotherapy. Treatment with nivolumab-ipilimumab combination therapy became cost-effective when monthly treatment costs were reduced from $26 425 to $5058 (80.9% reduction) or when the maximum duration of immunotherapy was reduced from 24.0 months to 1.4 months. The model was not sensitive to assumptions about survival or programmed cell death 1 ligand 1 status. A probabilistic sensitivity analysis indicated that, at a willingness-to-pay threshold of $100 000 per QALY, nivolumab-ipilimumab combination therapy was less cost-effective than chemotherapy 99.9% of the time. CONCLUSIONS AND RELEVANCE In this study, first-line treatment with nivolumab-ipilimumab combination therapy was not found to be cost-effective at current prices despite clinical trial data indicating that this regimen increases overall survival among patients with advanced NSCLC.
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Affiliation(s)
- P. Travis Courtney
- University of California, San Diego School of Medicine, La Jolla
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
| | - Anthony T. Yip
- University of California, San Diego School of Medicine, La Jolla
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
| | - Daniel R. Cherry
- University of California, San Diego School of Medicine, La Jolla
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
| | - Mia A. Salans
- University of California, San Diego School of Medicine, La Jolla
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
| | - Abhishek Kumar
- University of California, San Diego School of Medicine, La Jolla
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
| | - James D. Murphy
- University of California, San Diego School of Medicine, La Jolla
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
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23
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Shenderov E, Boudadi K, Fu W, Wang H, Sullivan R, Jordan A, Dowling D, Harb R, Schonhoft J, Jendrisak A, Carducci MA, Eisenberger MA, Eshleman JR, Luo J, Drake CG, Pardoll DM, Antonarakis ES. Nivolumab plus ipilimumab, with or without enzalutamide, in AR-V7-expressing metastatic castration-resistant prostate cancer: A phase-2 nonrandomized clinical trial. Prostate 2021; 81:326-338. [PMID: 33636027 PMCID: PMC8018565 DOI: 10.1002/pros.24110] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/26/2021] [Accepted: 02/08/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND AR-V7-positive metastatic prostate cancer is a lethal phenotype with few treatment options and poor survival. METHODS The two-cohort nonrandomized Phase 2 study of combined immune checkpoint blockade for AR-V7-expressing metastatic castration-resistant prostate cancer (STARVE-PC) evaluated nivolumab (3 mg/kg) plus ipilimumab (1 mg/kg), without (Cohort 1) or with (Cohort 2) the anti-androgen enzalutamide. Co-primary endpoints were safety and prostate-specific antigen (PSA) response rate. Secondary endpoints included time-to-PSA-progression-free survival (PSA-PFS), time-to-clinical/radiographic-PFS, objective response rate (ORR), PFS lasting greater than 24 weeks, and overall survival (OS). RESULTS Thirty patients were treated with ipilimumab plus nivolumab (N = 15, Cohort 1, previously reported), or ipilimumab plus nivolumab and enzalutamide (N = 15, Cohort 2) in patients previously progressing on enzalutamide monotherapy. PSA response rate was 2/15 (13%) in cohort 1 and 0/15 in cohort 2, ORR was 2/8 (25%) in Cohort 1 and 0/9 in Cohort 2 in those with measureable disease, median PSA-PFS was 3.0 (95% confidence interval [CI]: 2.1-NR) in cohort 1 and 2.7 (95% CI: 2.1-5.9) months in cohort 2, and median PFS was 3.7 (95% CI: 2.8-7.5) in cohort 1 and 2.9 (95% CI: 1.3-5.8) months in cohort 2. Three of 15 patients in cohort 1 (20%, 95% CI: 7.1%-45.2%) and 4/15 patients (26.7%, 95% CI: 10.5%-52.4%) in cohort 2 achieved a durable PFS lasting greater than 24 weeks. Median OS was 8.2 (95% CI: 5.5-10.4) in cohort 1 and 14.2 (95% CI: 8.5-NA) months in cohort 2. Efficacy results were not statistically different between cohorts. Grade-3/4 adverse events occurred in 7/15 cohort 1 patients (46%) and 8/15 cohort 2 patients (53%). Combined cohort (N = 30) baseline alkaline phosphatase and cytokine analysis suggested improved OS for patients with lower alkaline phosphatase (hazards ratio [HR], 0.30; 95% CI: 0.11-0.82), lower circulating interleukin-7 (IL-7) (HR, 0.24; 95% Cl: 0.06-0.93) and IL-6 (HR, 0.13; 95% Cl: 0.03-0.52) levels, and higher circulating IL-17 (HR, 4.53; 95% CI: 1.47-13.93) levels. There was a trend towards improved outcomes in men with low sPD-L1 serum levels. CONCLUSION Nivolumab plus ipilimumab demonstrated only modest activity in patients with AR-V7-expressing prostate cancer, and was not sufficient to justify further exploration in unselected patients. Stratification by baseline alkaline phosphatase and cytokines (IL-6, -7, and -17) may be prognostic for outcomes to immunotherapy.
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Affiliation(s)
- Eugene Shenderov
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Karim Boudadi
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wei Fu
- Department of Oncology Biostatistics and Bioinformatics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Hao Wang
- Department of Oncology Biostatistics and Bioinformatics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Rana Sullivan
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alice Jordan
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Donna Dowling
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rana Harb
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Michael A. Carducci
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mario A. Eisenberger
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James R. Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jun Luo
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles G. Drake
- Department of Hematology/Oncology, Columbia University Medical Center, New York, NY, USA
| | - Drew M. Pardoll
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Emmanuel S. Antonarakis
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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24
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Laccetti AL, Garmezy B, Xiao L, Economides M, Venkatesan A, Gao J, Jonasch E, Corn P, Zurita‐Saavedra A, Brown LC, Kao C, Kinsey EN, Gupta RT, Harrison MR, Armstrong AJ, George DJ, Tannir N, Msaouel P, Shah A, Zhang T, Campbell MT. Combination antiangiogenic tyrosine kinase inhibition and anti-PD1 immunotherapy in metastatic renal cell carcinoma: A retrospective analysis of safety, tolerance, and clinical outcomes. Cancer Med 2021; 10:2341-2349. [PMID: 33650321 PMCID: PMC7982609 DOI: 10.1002/cam4.3812] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/29/2021] [Accepted: 02/08/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Two separate antiangiogenic tyrosine kinase inhibitors (TKIs) and immunotherapy (IO) combinations are FDA-approved as front-line treatment for metastatic renal cell carcinoma (mRCC). Little is known about off-protocol and post-front-line experience with combination TKI-IO approaches. METHODS We conducted a retrospective analysis of mRCC patients who received combination TKI-IO post-first-line therapy between November 2015 and January 2019 at MD Anderson Cancer Center and Duke Cancer Institute. Chart review detailed patient characteristics, treatments, toxicity, and survival. Independent radiologists, blinded to clinical data, assessed best radiographic response using RECIST v1.1. RESULTS We identified 48 mRCC patients for inclusion: median age 65 years, 75.0% clear cell histology, 68.8% IMDC intermediate risk, and median two prior systemic therapies. TKI-IO combinations included nivolumab-cabozantinib (N +C; 24 patients), nivolumab-pazopanib (N+P; 13), nivolumab-axitinib (6), nivolumab-lenvatinib (2), and nivolumab-ipilimumab-cabozantinib (3). The median progression-free survival was 11.6 months and the median overall survival was not reached. Response data were available in 45 patients: complete response (CR; n = 3, 6.7%), partial response (PR; 20, 44.4%), stable disease (SD; 19, 42.2%), and progressive disease (3, 6.7%). Overall response rate was 51% and disease control rate (CR+PR+SD) was 93%. Only one patient had a grade ≥3 adverse event. CONCLUSION To our knowledge, this is the first case series reporting off-label use of combination TKI-IO for mRCC. TKI-IO combinations, particularly N+P and N+C, are well tolerated and efficacious. Although further prospective research is essential, slow disease progression on IO or TKI monotherapy may be safely controlled with addition of either TKI or IO.
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Affiliation(s)
- Andrew L. Laccetti
- Genitourinary Oncology ServiceDepartment of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Benjamin Garmezy
- Department of Cancer MedicineUniversity of Texas M.D. Anderson Cancer CenterHoustonTXUSA
| | - Lianchun Xiao
- Department of Genitourinary Medical OncologyUniversity of Texas M.D. Anderson Cancer CenterHoustonTXUSA
| | - Minas Economides
- Department of Internal MedicineMcGovern Medical School at UTHealthHoustonTXUSA
| | - Aradhana Venkatesan
- Department of RadiologyUniversity of Texas M.D. Anderson Cancer CenterHoustonTXUSA
| | - Jianjun Gao
- Department of Genitourinary Medical OncologyUniversity of Texas M.D. Anderson Cancer CenterHoustonTXUSA
| | - Eric Jonasch
- Department of Genitourinary Medical OncologyUniversity of Texas M.D. Anderson Cancer CenterHoustonTXUSA
| | - Paul Corn
- Department of Cancer MedicineUniversity of Texas M.D. Anderson Cancer CenterHoustonTXUSA
| | - Amado Zurita‐Saavedra
- Department of Cancer MedicineUniversity of Texas M.D. Anderson Cancer CenterHoustonTXUSA
| | - Landon C. Brown
- Division of Medical OncologyDepartment of MedicineDuke UniversityDurhamNCUSA
| | - Chester Kao
- Division of Medical OncologyDepartment of MedicineDuke UniversityDurhamNCUSA
| | - Emily N. Kinsey
- Division of Medical OncologyDepartment of MedicineDuke UniversityDurhamNCUSA
| | - Rajan T. Gupta
- Duke Cancer Institute Center for Prostate and Urologic CancersDurhamNCUSA
- Department of RadiologyDuke UniversityDurhamNCUSA
| | - Michael R. Harrison
- Division of Medical OncologyDepartment of MedicineDuke UniversityDurhamNCUSA
- Duke Cancer Institute Center for Prostate and Urologic CancersDurhamNCUSA
| | - Andrew J. Armstrong
- Division of Medical OncologyDepartment of MedicineDuke UniversityDurhamNCUSA
- Duke Cancer Institute Center for Prostate and Urologic CancersDurhamNCUSA
| | - Daniel J. George
- Division of Medical OncologyDepartment of MedicineDuke UniversityDurhamNCUSA
- Duke Cancer Institute Center for Prostate and Urologic CancersDurhamNCUSA
| | - Nizar Tannir
- Department of Genitourinary Medical OncologyUniversity of Texas M.D. Anderson Cancer CenterHoustonTXUSA
| | - Pavlos Msaouel
- Department of Genitourinary Medical OncologyUniversity of Texas M.D. Anderson Cancer CenterHoustonTXUSA
| | - Amishi Shah
- Department of Genitourinary Medical OncologyUniversity of Texas M.D. Anderson Cancer CenterHoustonTXUSA
| | - Tian Zhang
- Division of Medical OncologyDepartment of MedicineDuke UniversityDurhamNCUSA
- Duke Cancer Institute Center for Prostate and Urologic CancersDurhamNCUSA
| | - Matthew T. Campbell
- Department of Genitourinary Medical OncologyUniversity of Texas M.D. Anderson Cancer CenterHoustonTXUSA
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25
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Chen Y, Liu X, Liu J, Liang D, Zhao M, Yu W, Chen P. Nivolumab plus ipilimumab versus nivolumab in individuals with treatment-naive programmed death-ligand 1 positive metastatic soft tissue sarcomas: a multicentre retrospective study. BMC Cancer 2021; 21:108. [PMID: 33530966 PMCID: PMC7856818 DOI: 10.1186/s12885-021-07843-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 01/26/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Currently, the choice of treatment for individuals with metastatic soft tissue sarcomas (MSTS) presents a significant challenge to clinicians. The aim of this retrospective study was to assess the efficacy and safety of nivolumab plus ipilimumab (NPI) versus nivolumab alone (NIV) in individuals with treatment-naive programmed death-ligand 1 (PD-L1) positive MSTS. METHODS Prospectively maintained databases were reviewed from 2013 to 2018 to assess individuals with treatment-naive PD-L1 MSTS who received NPI (nivolumab 3 mg/kg and ipilimumab 1 mg/kg every 3 weeks for 4 doses followed by nivolumab 3 mg/kg every 2 weeks) or NIV (3 mg/kg every 2 weeks) until disease progression, withdrawal, unendurable [AEs], or death. The co-primary endpoints were overall survival (OS) and progression-free survival (PFS). RESULTS The median follow-up was 16.0 months (IQR 14.4-18.5) after targeted intervention. The median OS was 12.2 months (95% confidence interval [CI], 6.1-13.7) and 9.2 months (95% CI, 4.2-11.5) for the NPI and NIV groups, respectively (hazard ratio [HR] 0.49, 95% CI, 0.33-0.73; p=0.0002); the median PFS was 4.1 months (95% CI, 3.2-4.5) and 2.2 months (95% CI, 1.1-3.4) for the NPI and NIV groups, respectively (HR 0.51, 95% CI, 0.36-0.71; p< 0.0001). Key grade 3-5 AEs occurred more frequently in the NPI group than in the NIV group (94 [72.9%] for NPI vs. 35 [27.1%], p< 0.001). CONCLUSIONS For treatment-naive PD-L1 positive MSTS, NPI seems to be less tolerated but has a greater survival advantage than NIV as the primary therapy.
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Affiliation(s)
- Yaolin Chen
- Department of Orthopaedics, Henan Provincial People’s Hospital, Department of Orthopaedics of Central China Fuwai Hospital,Central China Fuwai Hospital of Zhengzhou University, No. 1, Fuwai Avenue, Zhengdong New District, Zhengzhou, 450003 China
| | - Xiangzhen Liu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080 China
| | - Jijun Liu
- Department of Orthopaedics, Henan Provincial People’s Hospital, Department of Orthopaedics of Central China Fuwai Hospital,Central China Fuwai Hospital of Zhengzhou University, No. 1, Fuwai Avenue, Zhengdong New District, Zhengzhou, 450003 China
| | - Donghua Liang
- Department of Orthopaedics, Henan Provincial People’s Hospital, Department of Orthopaedics of Central China Fuwai Hospital,Central China Fuwai Hospital of Zhengzhou University, No. 1, Fuwai Avenue, Zhengdong New District, Zhengzhou, 450003 China
| | - Mingdong Zhao
- Department of Orthopaedics, Jinshan Hospital, Fudan University, No. 1508, Longhang Road, Jinshan District, Shanghai, 201508 China
| | - Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080 China
| | - Pengfei Chen
- Department of Orthopaedics, Henan Provincial People’s Hospital, Department of Orthopaedics of Central China Fuwai Hospital,Central China Fuwai Hospital of Zhengzhou University, No. 1, Fuwai Avenue, Zhengdong New District, Zhengzhou, 450003 China
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26
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Bhave P, Pallan L, Long GV, Menzies AM, Atkinson V, Cohen JV, Sullivan RJ, Chiarion-Sileni V, Nyakas M, Kahler K, Hauschild A, Plummer R, Trojaniello C, Ascierto PA, Zimmer L, Schadendorf D, Allayous C, Lebbe C, Maurichi A, Santinami M, Roy S, Robert C, Lesimple T, Patel S, Versluis JM, Blank CU, Khattak A, Van der Westhuizen A, Carlino MS, Shackleton M, Haydon A. Melanoma recurrence patterns and management after adjuvant targeted therapy: a multicentre analysis. Br J Cancer 2021; 124:574-580. [PMID: 33087895 PMCID: PMC7851118 DOI: 10.1038/s41416-020-01121-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/07/2020] [Accepted: 10/02/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Adjuvant targeted therapy (TT) improves relapse free survival in patients with resected BRAF mutant stage III melanoma. The outcomes and optimal management of patients who relapse after adjuvant TT is unknown. METHODS Patients from twenty-one centres with recurrent melanoma after adjuvant TT were included. Disease characteristics, adjuvant therapy, recurrence, treatment at relapse and outcomes were examined. RESULTS Eighty-five patients developed recurrent melanoma; nineteen (22%) during adjuvant TT. Median time to first recurrence was 18 months and median follow-up from first recurrence was 31 months. Fifty-eight (68%) patients received immunotherapy (IT) or TT as 1st line systemic therapy at either first or subsequent recurrence and had disease that was assessable for response. Response to anti-PD-1 (±trial agent), combination ipilimumab-nivolumab, TT rechallenge and ipilimumab monotherapy was 63%, 62% 25% and 10% respectively. Twenty-eight (33%) patients had died at census, all from melanoma. Two-year OS was 84% for anti-PD-1 therapy (±trial agent), 92% for combination ipilimumab and nivolumab, 49% for TT and 45% for ipilimumab monotherapy (p = 0.028). CONCLUSIONS Patients who relapse after adjuvant TT respond well to subsequent anti-PD-1 based therapy and have outcomes similar to those seen when first line anti-PD-1 therapy is used in stage IV melanoma.
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Affiliation(s)
- Prachi Bhave
- Department of Medical Oncology, Alfred Hospital, Melbourne, VIC, Australia.
| | - Lalit Pallan
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Victoria Atkinson
- Department of Medical Oncology, Princess Alexandra Hospital, Greenslopes Private Hospital and University of Queensland, Brisbane, QLD, Australia
| | - Justine V Cohen
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Ryan J Sullivan
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Marta Nyakas
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Katharina Kahler
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ruth Plummer
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK
| | - Claudia Trojaniello
- Department of Melanoma and Cancer Immunotherapy, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Paolo A Ascierto
- Department of Melanoma and Cancer Immunotherapy, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, Essen & German Cancer Consortium, Heidelberg, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, Essen & German Cancer Consortium, Heidelberg, Germany
| | - Clara Allayous
- AP-HP Dermatology Department, Saint-Louis Hospital, Paris, France
| | - Celeste Lebbe
- AP-HP Dermatology Department, Saint-Louis Hospital, Paris, France
| | - Andrea Maurichi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Mario Santinami
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Severine Roy
- Department of Dermatology, Gustave Roussy and Paris-Saclay Institute, Villejuif, France
| | - Caroline Robert
- Department of Dermatology, Gustave Roussy and Paris-Saclay Institute, Villejuif, France
| | - Thierry Lesimple
- Department of Medical Oncology, Centre Eugène Marqui, Rennes, France
| | - Sapna Patel
- Department of Melanoma Medical Oncology, MD Anderson Cancer Centre, Houston, TX, USA
| | - Judith M Versluis
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Christian U Blank
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Adnan Khattak
- Department of Medical Oncology, Fiona Stanley Hospital, Perth, WA, Australia
| | | | - Matteo S Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Oncology, Westmead Hospital, Sydney, NSW, Australia
| | - Mark Shackleton
- Department of Medical Oncology, Alfred Hospital, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Andrew Haydon
- Department of Medical Oncology, Alfred Hospital, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
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27
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Baas P, Scherpereel A, Nowak AK, Fujimoto N, Peters S, Tsao AS, Mansfield AS, Popat S, Jahan T, Antonia S, Oulkhouir Y, Bautista Y, Cornelissen R, Greillier L, Grossi F, Kowalski D, Rodríguez-Cid J, Aanur P, Oukessou A, Baudelet C, Zalcman G. First-line nivolumab plus ipilimumab in unresectable malignant pleural mesothelioma (CheckMate 743): a multicentre, randomised, open-label, phase 3 trial. Lancet 2021; 397:375-386. [PMID: 33485464 DOI: 10.1016/s0140-6736(20)32714-8] [Citation(s) in RCA: 555] [Impact Index Per Article: 185.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Approved systemic treatments for malignant pleural mesothelioma (MPM) have been limited to chemotherapy regimens that have moderate survival benefit with poor outcomes. Nivolumab plus ipilimumab has shown clinical benefit in other tumour types, including first-line non-small-cell lung cancer. We hypothesised that this regimen would improve overall survival in MPM. METHODS This open-label, randomised, phase 3 study (CheckMate 743) was run at 103 hospitals across 21 countries. Eligible individuals were aged 18 years and older, with previously untreated, histologically confirmed unresectable MPM, and an Eastern Cooperative Oncology Group performance status of 0 or 1. Eligible participants were randomly assigned (1:1) to nivolumab (3 mg/kg intravenously once every 2 weeks) plus ipilimumab (1 mg/kg intravenously once every 6 weeks) for up to 2 years, or platinum plus pemetrexed chemotherapy (pemetrexed [500 mg/m2 intravenously] plus cisplatin [75 mg/m2 intravenously] or carboplatin [area under the concentration-time curve 5 mg/mL per min intravenously]) once every 3 weeks for up to six cycles. The primary endpoint was overall survival among all participants randomly assigned to treatment, and safety was assessed in all participants who received at least one dose of study treatment. This study is registered with ClinicalTrials.gov, NCT02899299, and is closed to accrual. FINDINGS Between Nov 29, 2016, and April 28, 2018, 713 patients were enrolled, of whom 605 were randomly assigned to either nivolumab plus ipilimumab (n=303) or chemotherapy (n=302). 467 (77%) of 605 participants were male and median age was 69 years (IQR 64-75). At the prespecified interim analysis (database lock April 3, 2020; median follow-up of 29·7 months [IQR 26·7-32·9]), nivolumab plus ipilimumab significantly extended overall survival versus chemotherapy (median overall survival 18·1 months [95% CI 16·8-21·4] vs 14·1 months [12·4-16·2]; hazard ratio 0·74 [96·6% CI 0·60-0·91]; p=0·0020). 2-year overall survival rates were 41% (95% CI 35·1-46·5) in the nivolumab plus ipilimumab group and 27% (21·9-32·4) in the chemotherapy group. Grade 3-4 treatment-related adverse events were reported in 91 (30%) of 300 patients treated with nivolumab plus ipilimumab and 91 (32%) of 284 treated with chemotherapy. Three (1%) treatment-related deaths occurred in the nivolumab plus ipilimumab group (pneumonitis, encephalitis, and heart failure) and one (<1%) in the chemotherapy group (myelosuppression). INTERPRETATION Nivolumab plus ipilimumab provided significant and clinically meaningful improvements in overall survival versus standard-of-care chemotherapy, supporting the use of this first-in-class regimen that has been approved in the USA as of October, 2020, for previously untreated unresectable MPM. FUNDING Bristol Myers Squibb.
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Affiliation(s)
- Paul Baas
- The Netherlands Cancer Institute and Leiden University Medical Center, Amsterdam, Netherlands.
| | - Arnaud Scherpereel
- Pulmonary and Thoracic Oncology, University of Lille, CHU Lille, INSERM U1189, OncoThAI, Lille, France
| | - Anna K Nowak
- Medical School, University of Western Australia Perth, WA, Australia; Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | | | | | | | | | - Sanjay Popat
- Royal Marsden Hospital, London, UK; Institute of Cancer Research, London, UK
| | - Thierry Jahan
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Scott Antonia
- H Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | | | | | | | - Laurent Greillier
- Aix Marseille University, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Multidisciplinary Oncology and Therapeutic Innovations Department, Marseille, France
| | - Francesco Grossi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dariusz Kowalski
- Department of Lung Cancer and Chest Tumours, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Jerónimo Rodríguez-Cid
- Centro Oncológico, Médica Sur-Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | | | | | | | - Gérard Zalcman
- Bichat-Claude Bernard University Hospital, AP-HP, Université de Paris, Paris, France
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Montfort A, Filleron T, Virazels M, Dufau C, Milhès J, Pagès C, Olivier P, Ayyoub M, Mounier M, Lusque A, Brayer S, Delord JP, Andrieu-Abadie N, Levade T, Colacios C, Ségui B, Meyer N. Combining Nivolumab and Ipilimumab with Infliximab or Certolizumab in Patients with Advanced Melanoma: First Results of a Phase Ib Clinical Trial. Clin Cancer Res 2020; 27:1037-1047. [PMID: 33272982 DOI: 10.1158/1078-0432.ccr-20-3449] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/27/2020] [Accepted: 11/30/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE TNF blockers can be used to manage gastrointestinal inflammatory side effects following nivolumab and/or ipilimumab treatment in patients with advanced melanoma. Our preclinical data showed that anti-TNF could promote the efficacy of immune checkpoint inhibitors. PATIENTS AND METHODS TICIMEL (NTC03293784) is an open-label, two-arm phase Ib clinical trial. Fourteen patients with advanced and/or metastatic melanoma (stage IIIc/IV) were enrolled. Patients were treated with nivolumab (1 mg/kg) and ipilimumab (3 mg/kg) combined to infliximab (5 mg/kg, N = 6) or certolizumab (400/200 mg, N = 8). The primary endpoint was safety and the secondary endpoint was antitumor activity. Adverse events (AEs) were graded according to the NCI Common Terminology Criteria for Adverse Events and response was assessed following RECIST 1.1. RESULTS Only one dose-limiting toxicity was observed in the infliximab cohort. The two different combinations were found to be safe. We observed lower treatment-related AEs with infliximab as compared with certolizumab. In the certolizumab cohort, one patient was not evaluable for response. In this cohort, four of eight patients exhibited hepatobiliary disorders and seven of seven evaluable patients achieved objective response including four complete responses (CRs) and three partial responses (PRs). In the infliximab cohort, we observed one CR, two PRs, and three progressive diseases. Signs of activation and maturation of systemic T-cell responses were seen in patients from both cohorts. CONCLUSIONS Our results show that both combinations are safe in human and provide clinical and biological activities. The high response rate in the certolizumab-treated patient cohort deserves further investigations.
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Affiliation(s)
- Anne Montfort
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
| | - Thomas Filleron
- Methodology, biostatistics and clinical operations, Institut Claudius Regaud, IUCT-O, Toulouse, France
- Institut Universitaire du Cancer (IUCT-O), Toulouse, France
| | - Mathieu Virazels
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
| | - Carine Dufau
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Jean Milhès
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
| | - Cécile Pagès
- Institut Universitaire du Cancer (IUCT-O), Toulouse, France
- Service d'Oncodermatologie, IUCT-O, CHU de Toulouse, Toulouse, France
| | - Pascale Olivier
- Service de Pharmacologie médicale et clinique, Centre Régional de Pharmacovigilance, de Pharmacoépidémiologie et d'information sur le médicament du CHU de Toulouse, Toulouse, France
| | - Maha Ayyoub
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Institut Universitaire du Cancer (IUCT-O), Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Muriel Mounier
- Methodology, biostatistics and clinical operations, Institut Claudius Regaud, IUCT-O, Toulouse, France
- Institut Universitaire du Cancer (IUCT-O), Toulouse, France
| | - Amélie Lusque
- Methodology, biostatistics and clinical operations, Institut Claudius Regaud, IUCT-O, Toulouse, France
- Institut Universitaire du Cancer (IUCT-O), Toulouse, France
| | - Stéphanie Brayer
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
- Service d'Oncodermatologie, IUCT-O, CHU de Toulouse, Toulouse, France
| | - Jean-Pierre Delord
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Institut Universitaire du Cancer (IUCT-O), Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Nathalie Andrieu-Abadie
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
| | - Thierry Levade
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
- Laboratoire de Biochimie, Institut Fédératif de Biologie, CHU Purpan, Toulouse, France
| | - Céline Colacios
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Bruno Ségui
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France.
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Nicolas Meyer
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France.
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
- Institut Universitaire du Cancer (IUCT-O), Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
- Service d'Oncodermatologie, IUCT-O, CHU de Toulouse, Toulouse, France
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Mankor JM, Disselhorst MJ, Poncin M, Baas P, Aerts JGJV, Vroman H. Efficacy of nivolumab and ipilimumab in patients with malignant pleural mesothelioma is related to a subtype of effector memory cytotoxic T cells: Translational evidence from two clinical trials. EBioMedicine 2020; 62:103040. [PMID: 33166791 PMCID: PMC7658658 DOI: 10.1016/j.ebiom.2020.103040] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Combined immune checkpoint inhibitor (ICI) treatment targeting PD-1 and CTLA-4 was suggested to yield clinical benefit over chemotherapy in malignant pleural mesothelioma (MPM), whereas aPD-1 monotherapy failed to provide benefit in phase-III trials. Success of ICI depends on the presence and activation of tumor-specific T cells. Therefore, we investigated whether T-cell characteristics are underlying clinical efficacy of ICI treatment in MPM. METHODS Comprehensive immune cell profiling was performed on screening and on treatment peripheral blood samples of mesothelioma patients treated with nivolumab (aPD-1) monotherapy (NCT02497508), or a combination of nivolumab and ipilimumab (aCTLA-4) (NCT03048474). FINDINGS aPD-1/aCTLA-4 combination treatment induced a profound increase in proliferation and activation of T cells, which was not observed upon aPD-1 monotherapy. Moreover, patients that responded to combination treatment had low frequencies of naive CD8 T cells and high frequencies of effector memory CD8 T cells that re-expressed RA (TEMRA) at screening. The frequency of Granzyme-B and Interferon-γ producing TEMRAs was also higher in responding patients. INTERPRETATION High proportions of TEMRAs and cytokine production by TEMRAs before treatment, was associated with a better clinical outcome. TEMRAs, which likely comprise tumor-specific T cells, tend to require blockage of both aPD-1 and aCTLA-4 to be reactivated. In conclusion, peripheral blood TEMRAs can play a key role in explaining and predicting clinical benefit upon aPD-1/aCTLA-4 combination treatment. FUNDING Bristol-Myers Squibb sponsored NivoMes and INITIATE clinical trials and provided study drugs. No external funding was applicable for the flow cytometric analyses of peripheral blood samples described in this manuscript.
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Affiliation(s)
- Joanne M Mankor
- Department of Pulmonary Medicine, Erasmus Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.; Erasmus MC Cancer Institute, Erasmus Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | | | - Myrthe Poncin
- Department of Pulmonary Medicine, Erasmus Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Paul Baas
- Department of Thoracic Oncology, NKI-AVL, Amsterdam, the Netherlands
| | - Joachim G J V Aerts
- Department of Pulmonary Medicine, Erasmus Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.; Erasmus MC Cancer Institute, Erasmus Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands..
| | - Heleen Vroman
- Department of Pulmonary Medicine, Erasmus Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.; Erasmus MC Cancer Institute, Erasmus Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
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30
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Apolo AB, Nadal R, Girardi DM, Niglio SA, Ley L, Cordes LM, Steinberg SM, Sierra Ortiz O, Cadena J, Diaz C, Mallek M, Davarpanah NN, Costello R, Trepel JB, Lee MJ, Merino MJ, Bagheri MH, Monk P, Figg WD, Gulley JL, Agarwal PK, Valera V, Chalfin HJ, Jones J, Streicher H, Wright JJ, Ning YM, Parnes HL, Dahut WL, Bottaro DP, Lara PN, Saraiya B, Pal SK, Stein MN, Mortazavi A. Phase I Study of Cabozantinib and Nivolumab Alone or With Ipilimumab for Advanced or Metastatic Urothelial Carcinoma and Other Genitourinary Tumors. J Clin Oncol 2020; 38:3672-3684. [PMID: 32915679 PMCID: PMC7605393 DOI: 10.1200/jco.20.01652] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE We assessed the safety and efficacy of cabozantinib and nivolumab (CaboNivo) and CaboNivo plus ipilimumab (CaboNivoIpi) in patients with metastatic urothelial carcinoma (mUC) and other genitourinary (GU) malignances. PATIENTS AND METHODS Patients received escalating doses of CaboNivo or CaboNivoIpi. The primary objective was to establish a recommended phase II dose (RP2D). Secondary objectives included objective response rate (ORR), progression-free survival (PFS), duration of response (DoR), and overall survival (OS). RESULTS Fifty-four patients were enrolled at eight dose levels with a median follow-up time of 44.6 months; data cutoff was January 20, 2020. Grade 3 or 4 treatment-related adverse events (AEs) occurred in 75% and 87% of patients treated with CaboNivo and CaboNivoIpi, respectively, and included fatigue (17% and 10%, respectively), diarrhea (4% and 7%, respectively), and hypertension (21% and 10%, respectively); grade 3 or 4 immune-related AEs included hepatitis (0% and 13%, respectively) and colitis (0% and 7%, respectively). The RP2D was cabozantinib 40 mg/d plus nivolumab 3 mg/kg for CaboNivo and cabozantinib 40 mg/d, nivolumab 3 mg/kg, and ipilimumab 1 mg/kg for CaboNivoIpi. ORR was 30.6% (95% CI, 20.0% to 47.5%) for all patients and 38.5% (95% CI, 13.9% to 68.4%) for patients with mUC. Median DoR was 21.0 months (95% CI, 5.4 to 24.1 months) for all patients and not reached for patients with mUC. Median PFS was 5.1 months (95% CI, 3.5 to 6.9 months) for all patients and 12.8 months (95% CI, 1.8 to 24.1 months) for patients with mUC. Median OS was 12.6 months (95% CI, 6.9 to 18.8 months) for all patients and 25.4 months (95% CI, 5.7 to 41.6 months) for patients with mUC. CONCLUSION CaboNivo and CaboNivoIpi demonstrated manageable toxicities with durable responses and encouraging survival in patients with mUC and other GU tumors. Multiple phase II and III trials are ongoing for these combinations.
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Affiliation(s)
- Andrea B. Apolo
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Rosa Nadal
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Daniel M. Girardi
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Scot A. Niglio
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Lisa Ley
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Lisa M. Cordes
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Seth M. Steinberg
- Biostatistics and Data Management Section, Office of the Clinical Director, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Olena Sierra Ortiz
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jacqueline Cadena
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Carlos Diaz
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Marissa Mallek
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Nicole N. Davarpanah
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Rene Costello
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jane B. Trepel
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Min-Jung Lee
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Maria J. Merino
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Mohammad Hadi Bagheri
- Clinical Image Processing Service, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Paul Monk
- Division of Medical Oncology, Department of Internal Medicine, College of Medicine, The Ohio State University, and the Comprehensive Cancer Center, Columbus, OH
| | - William D. Figg
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - James L. Gulley
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Piyush K. Agarwal
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Vladimir Valera
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Heather J. Chalfin
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jennifer Jones
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Howard Streicher
- Investigational Drug Branch, Cancer Therapy Evaluation Program, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - John J. Wright
- Investigational Drug Branch, Cancer Therapy Evaluation Program, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Yangmin M. Ning
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Howard L. Parnes
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - William L. Dahut
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Donald P. Bottaro
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Primo N. Lara
- University of California Davis Comprehensive Cancer Center, Sacramento, CA
| | - Biren Saraiya
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Mark N. Stein
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Amir Mortazavi
- Division of Medical Oncology, Department of Internal Medicine, College of Medicine, The Ohio State University, and the Comprehensive Cancer Center, Columbus, OH
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Grasso CS, Tsoi J, Onyshchenko M, Abril-Rodriguez G, Ross-Macdonald P, Wind-Rotolo M, Champhekar A, Medina E, Torrejon DY, Shin DS, Tran P, Kim YJ, Puig-Saus C, Campbell K, Vega-Crespo A, Quist M, Martignier C, Luke JJ, Wolchok JD, Johnson DB, Chmielowski B, Hodi FS, Bhatia S, Sharfman W, Urba WJ, Slingluff CL, Diab A, Haanen JBAG, Algarra SM, Pardoll DM, Anagnostou V, Topalian SL, Velculescu VE, Speiser DE, Kalbasi A, Ribas A. Conserved Interferon-γ Signaling Drives Clinical Response to Immune Checkpoint Blockade Therapy in Melanoma. Cancer Cell 2020; 38:500-515.e3. [PMID: 32916126 PMCID: PMC7872287 DOI: 10.1016/j.ccell.2020.08.005] [Citation(s) in RCA: 167] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/17/2020] [Accepted: 08/10/2020] [Indexed: 12/21/2022]
Abstract
We analyze the transcriptome of baseline and on-therapy tumor biopsies from 101 patients with advanced melanoma treated with nivolumab (anti-PD-1) alone or combined with ipilimumab (anti-CTLA-4). We find that T cell infiltration and interferon-γ (IFN-γ) signaling signatures correspond most highly with clinical response to therapy, with a reciprocal decrease in cell-cycle and WNT signaling pathways in responding biopsies. We model the interaction in 58 human cell lines, where IFN-γ in vitro exposure leads to a conserved transcriptome response unless cells have IFN-γ receptor alterations. This conserved IFN-γ transcriptome response in melanoma cells serves to amplify the antitumor immune response. Therefore, the magnitude of the antitumor T cell response and the corresponding downstream IFN-γ signaling are the main drivers of clinical response or resistance to immune checkpoint blockade therapy.
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Affiliation(s)
- Catherine S Grasso
- Jonsson Comprehensive Cancer Center at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA; Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Jennifer Tsoi
- Jonsson Comprehensive Cancer Center at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Mykola Onyshchenko
- Jonsson Comprehensive Cancer Center at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Gabriel Abril-Rodriguez
- Jonsson Comprehensive Cancer Center at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | | | - Megan Wind-Rotolo
- Translational Bioinformatics, Bristol-Myers Squibb, Hopewell, NJ, USA
| | - Ameya Champhekar
- Jonsson Comprehensive Cancer Center at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Egmidio Medina
- Jonsson Comprehensive Cancer Center at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Davis Y Torrejon
- Jonsson Comprehensive Cancer Center at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Daniel Sanghoon Shin
- Jonsson Comprehensive Cancer Center at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Phuong Tran
- Jonsson Comprehensive Cancer Center at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Yeon Joo Kim
- Jonsson Comprehensive Cancer Center at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Cristina Puig-Saus
- Jonsson Comprehensive Cancer Center at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA; Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | - Katie Campbell
- Jonsson Comprehensive Cancer Center at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Agustin Vega-Crespo
- Jonsson Comprehensive Cancer Center at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Michael Quist
- Jonsson Comprehensive Cancer Center at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | | | | | - Jedd D Wolchok
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA; Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Bartosz Chmielowski
- Jonsson Comprehensive Cancer Center at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - F Stephen Hodi
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA; Dana Farber Cancer Institute, Boston, MA, USA
| | | | - William Sharfman
- Bloomberg-Kimmel Institute for Cancer Immunotherapy and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Walter J Urba
- Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR, USA
| | | | - Adi Diab
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Drew M Pardoll
- Bloomberg-Kimmel Institute for Cancer Immunotherapy and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Valsamo Anagnostou
- Bloomberg-Kimmel Institute for Cancer Immunotherapy and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Suzanne L Topalian
- Bloomberg-Kimmel Institute for Cancer Immunotherapy and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Victor E Velculescu
- Bloomberg-Kimmel Institute for Cancer Immunotherapy and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Anusha Kalbasi
- Jonsson Comprehensive Cancer Center at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Antoni Ribas
- Jonsson Comprehensive Cancer Center at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA; Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA.
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Sharma P, Pachynski RK, Narayan V, Fléchon A, Gravis G, Galsky MD, Mahammedi H, Patnaik A, Subudhi SK, Ciprotti M, Simsek B, Saci A, Hu Y, Han GC, Fizazi K. Nivolumab Plus Ipilimumab for Metastatic Castration-Resistant Prostate Cancer: Preliminary Analysis of Patients in the CheckMate 650 Trial. Cancer Cell 2020; 38:489-499.e3. [PMID: 32916128 DOI: 10.1016/j.ccell.2020.08.007] [Citation(s) in RCA: 187] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/14/2020] [Accepted: 08/13/2020] [Indexed: 12/13/2022]
Abstract
Metastatic castration-resistant prostate cancer (mCRPC) is immunologically "cold" and predominantly resistant to immune checkpoint therapy due to few tumor-infiltrating T cells. Ipilimumab (anti-CTLA-4) or anti-PD-1/PD-L1 monotherapy failed to show a significant benefit. Although the PD-1/PD-L1 pathway is minimally expressed in prostate tumors, we previously demonstrated that PD-1/PD-L1 expression increases as a compensatory inhibitory pathway in parallel with an ipilimumab-induced increase in tumor-infiltrating T cells. Here, we report the largest trial to date in mCRPC with anti-CTLA-4 plus anti-PD-1 (nivolumab 1 mg/kg plus ipilimumab 3 mg/kg; CheckMate 650, NCT02985957). With median follow-ups of 11.9 and 13.5 months in cohorts 1 (pre-chemotherapy; n = 45) and 2 (post-chemotherapy; n = 45), objective response rate was 25% and 10%, and median overall survival was 19.0 and 15.2 months, respectively. Four patients, two in each cohort, had complete responses. Exploratory studies identify potential biomarkers of response. Grade 3-4 treatment-related adverse events have occurred in ∼42%-53% of patients, with four treatment-related deaths. Therefore, dose/schedule modifications have been implemented.
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Affiliation(s)
- Padmanee Sharma
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, University of Texas, Unit 1374, 1155 Pressler Street, Houston, TX 77030, USA.
| | - Russell K Pachynski
- Division of Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Vivek Narayan
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Aude Fléchon
- Department of Medical Oncology, Centre Léon Bérard, 69008 Lyon, France
| | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes Aix-Marseille Université, 13009 Marseille, France
| | - Matthew D Galsky
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Hakim Mahammedi
- Department of Medical Oncology, Centre Jean Perrin, 63011 Clermont-Ferrand, France
| | - Akash Patnaik
- Department of Medical Oncology, The University of Chicago Medicine, Chicago, IL 60637, USA
| | - Sumit K Subudhi
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, University of Texas, Unit 1374, 1155 Pressler Street, Houston, TX 77030, USA
| | | | | | - Abdel Saci
- Bristol Myers Squibb, Princeton, NJ 08540, USA
| | - Yanhua Hu
- Bristol Myers Squibb, Princeton, NJ 08540, USA
| | | | - Karim Fizazi
- Department of Cancer Medicine, Gustave Roussy, University of Paris Saclay, 94800 Villejuif, France
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Kahl KL. Nivolumab/Ipilimumab Combo Yields Durable Efficacy in Advanced NSCLC. Oncology (Williston Park) 2020; 34:254. [PMID: 32674209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Frontline treatment with nivolumab (Opdivo) plus ipilimumab (Yervoy) induced durable and long-term efficacy, compared with chemotherapy, in patients with advanced non-small cell lung cancer (NSCLC) and tumor PD-L1 expression greater than 1% or less than 1%, according to updated results from part 1 of the phase 3 CheckMate 227 (NCT02477826)trial presented at the 2020 American Society of Clinical Oncology Virtual Scientific Program.
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Kooshkaki O, Derakhshani A, Hosseinkhani N, Torabi M, Safaei S, Brunetti O, Racanelli V, Silvestris N, Baradaran B. Combination of Ipilimumab and Nivolumab in Cancers: From Clinical Practice to Ongoing Clinical Trials. Int J Mol Sci 2020; 21:ijms21124427. [PMID: 32580338 PMCID: PMC7352976 DOI: 10.3390/ijms21124427] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/15/2020] [Accepted: 06/18/2020] [Indexed: 12/13/2022] Open
Abstract
Cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death protein 1 (PD-1) are inhibitory checkpoints that are commonly seen on activated T cells and have been offered as promising targets for the treatment of cancers. Immune checkpoint inhibitors (ICIs)targeting PD-1, including pembrolizumab and nivolumab, and those targeting its ligand PD-L1, including avelumab, atezolizumab, and durvalumab, and two drugs targeting CTLA-4, including ipilimumab and tremelimumab have been approved for the treatment of several cancers and many others are under investigating in advanced trial phases. ICIs increased antitumor T cells’ responses and showed a key role in reducing the acquired immune system tolerance which is overexpressed by cancer and tumor microenvironment. However, 50% of patients could not benefit from ICIs monotherapy. To overcome this, a combination of ipilimumab and nivolumab is frequently investigated as an approach to improve oncological outcomes. Despite promising results for the combination of ipilimumab and nivolumab, safety concerns slowed down the development of such strategies. Herein, we review data concerning the clinical activity and the adverse events of ipilimumab and nivolumab combination therapy, assessing ongoing clinical trials to identify clinical outlines that may support combination therapy as an effective treatment. To the best of our knowledge, this paper is one of the first studies to evaluate the efficacy and safety of ipilimumab and nivolumab combination therapy in several cancers.
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Affiliation(s)
- Omid Kooshkaki
- Student research committee, Birjand University of Medical Sciences, Birjand 9717853577, Iran;
- Department of Immunology, Birjand University of Medical Sciences, Birjand 9717853577, Iran
| | - Afshin Derakhshani
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz 5165665811, Iran; (A.D.); (S.S.)
| | - Negar Hosseinkhani
- Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz 5166614766, Iran;
| | - Mitra Torabi
- Student research committee, Tabriz University of medical sciences, Tabriz 5165665811, Iran;
| | - Sahar Safaei
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz 5165665811, Iran; (A.D.); (S.S.)
| | - Oronzo Brunetti
- Medical Oncology Unit, IRCCS IstitutoTumori “Giovanni Paolo II” of Bari, 70124 Bari, Italy;
| | - Vito Racanelli
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Nicola Silvestris
- Medical Oncology Unit, IRCCS IstitutoTumori “Giovanni Paolo II” of Bari, 70124 Bari, Italy;
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy;
- Correspondence: (N.S.); (B.B.)
| | - Behzad Baradaran
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz 5165665811, Iran; (A.D.); (S.S.)
- Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz 5166614766, Iran;
- Correspondence: (N.S.); (B.B.)
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Wright KM. FDA Approves 2 Therapies for Treatment of Metastatic Non-Small Cell Lung Cancer. Oncology (Williston Park) 2020; 34:202. [PMID: 32609866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The FDA approved 2 new therapies, each with its own companion diagnostic, for the treatment of patients with metastatic non-small cell lung cancer.
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Tintelnot J, Goekkurt E, Binder M, Thuss-Patience P, Lorenzen S, Knorrenschild JR, Kretzschmar A, Ettrich T, Lindig U, Jacobasch L, Pink D, Al-Batran SE, Hinke A, Hegewisch-Becker S, Nilsson S, Bokemeyer C, Stein A. Ipilimumab or FOLFOX with Nivolumab and Trastuzumab in previously untreated HER2-positive locally advanced or metastatic EsophagoGastric Adenocarcinoma - the randomized phase 2 INTEGA trial (AIO STO 0217). BMC Cancer 2020; 20:503. [PMID: 32487035 PMCID: PMC7268753 DOI: 10.1186/s12885-020-06958-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 05/13/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Esophagogastric adenocarcinoma (EGA) currently represents a main cause of cancer related death. Despite an intensified treatment for locally advanced or metastatic EGA with a doublet chemotherapy consisting of a platinum compound and a fluoropyrimidine in combination with trastuzumab for HER2-positive disease or in selected cases with docetaxel, survival remains poor. Recently, immune-oncology based strategies relevantly improved the treatment of different solid tumors and showed some promise in late or later stage trials in EGA. Notably, the combination of immunotherapy with trastuzumab to enhance anti-tumor immunity through activation of innate and adaptive immunity was beneficial in preclinical studies or clinical studies in breast cancer. METHODS The INTEGA study is an open-label, randomized, multicenter, exploratory phase II trial designed to assess clinical performance, safety and tolerability of ipilimumab or 5-FU/folinic acid and oxaliplatin (FOLFOX) in combination with nivolumab and trastuzumab in patients with previously untreated HER2-positive, locally advanced or metastatic EGA. The primary objective is to determine the clinical performance of ipilimumab or FOLFOX in combination with nivolumab and trastuzumab in terms of overall survival. Secondary objectives are safety and tolerability, efficacy in terms of progression-free survival and objective response rate and blood-based signatures (e.g. immune response or suppression of anti-HER2 resistance) that may correlate with treatment response. DISCUSSION Recent evidence from the phase II NCT02954536 study (oxaliplatin, capecitabine, trastuzumab and pembrolizumab) suggests the clinical feasibility of combining chemotherapy, trastuzumab and checkpoint inhibition in EGA. However, evidence for a chemotherapy-free regimen is also mounting in HER2-positive disease (NCT02689284) i.e. margetuximab and Pembrolizumab. Both studies excelled with high overall response rates and manageable toxicities. The INTEGA study aims to comparatively assess these results and select a promising new 1st line regimen which then needs to be confirmed in a randomized phase III trial. Further, the translational part of the study might help to better stratify patients and tailor treatment of either arm. TRIAL REGISTRATION NCT03409848 24.01.2018.
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Affiliation(s)
- Joseph Tintelnot
- Department of Internal Medicine II (Oncology Center), University Medical Center Hamburg-Eppendorf, Hubertus Wald Tumorzentrum/UCCH, Martinistr. 52, 20246, Hamburg, Germany
| | - Eray Goekkurt
- Department of Internal Medicine II (Oncology Center), University Medical Center Hamburg-Eppendorf, Hubertus Wald Tumorzentrum/UCCH, Martinistr. 52, 20246, Hamburg, Germany
- Hematology-Oncology Practice Hamburg (HOPE), Hamburg, Germany
| | - Mascha Binder
- University Hospital Halle-Wittenberg, Halle, Germany
| | | | - Sylvie Lorenzen
- Rechts der Isar Hospital, Technical University of Munich, Munich, Germany
| | | | | | | | | | | | - Daniel Pink
- Helios Clinic Bad Saarow, Bad Saarow, Germany and University Medicine Greifswald, Greifswald, Germany
| | | | | | | | - Sven Nilsson
- Department of Internal Medicine II (Oncology Center), University Medical Center Hamburg-Eppendorf, Hubertus Wald Tumorzentrum/UCCH, Martinistr. 52, 20246, Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Internal Medicine II (Oncology Center), University Medical Center Hamburg-Eppendorf, Hubertus Wald Tumorzentrum/UCCH, Martinistr. 52, 20246, Hamburg, Germany
| | - Alexander Stein
- Department of Internal Medicine II (Oncology Center), University Medical Center Hamburg-Eppendorf, Hubertus Wald Tumorzentrum/UCCH, Martinistr. 52, 20246, Hamburg, Germany.
- Hematology-Oncology Practice Hamburg (HOPE), Hamburg, Germany.
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Najjar YG, Navrazhina K, Ding F, Bhatia R, Tsai K, Abbate K, Durden B, Eroglu Z, Bhatia S, Park S, Chowdhary A, Chandra S, Kennedy J, Puzanov I, Ernstoff M, Vachhani P, Drabick J, Singh A, Xu T, Yang J, Carvajal R, Manson D, Kirkwood JM, Cohen J, Sullivan R, Johnson D, Funchain P, Shoushtari A. Ipilimumab plus nivolumab for patients with metastatic uveal melanoma: a multicenter, retrospective study. J Immunother Cancer 2020; 8:e000331. [PMID: 32581057 PMCID: PMC7319717 DOI: 10.1136/jitc-2019-000331] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Uveal melanoma (UM) is the most common intraocular malignancy in adults. In contrast to cutaneous melanoma (CM), there is no standard therapy, and the efficacy and safety of dual checkpoint blockade with nivolumab and ipilimumab is not well defined. METHODS We conducted a retrospective analysis of patients with metastatic UM (mUM) who received treatment with ipilimumab plus nivolumab across 14 academic medical centers. Toxicity was graded using National Cancer Institute Common Terminology Criteria for Adverse Events V.5.0. Progression-free survival (PFS) and overall survival (OS) were calculated using Kaplan-Meier methodology. RESULTS 89 eligible patients were identified. 45% had received prior therapy, which included liver directed therapy (29%), immunotherapy (21%), targeted therapy (10%) and radiation (16%). Patients received a median 3 cycles of ipilimumab plus nivolumab. The median follow-up time was 9.2 months. Overall response rate was 11.6%. One patient achieved complete response (1%), 9 patients had partial response (10%), 21 patients had stable disease (24%) and 55 patients had progressive disease (62%). Median OS from treatment initiation was 15 months and median PFS was 2.7 months. Overall, 82 (92%) of patients discontinued treatment, 34 due to toxicity and 27 due to progressive disease. Common immune-related adverse events were colitis/diarrhea (32%), fatigue (23%), rash (21%) and transaminitis (21%). CONCLUSIONS Dual checkpoint inhibition yielded higher response rates than previous reports of single-agent immunotherapy in patients with mUM, but the efficacy is lower than in metastatic CM. The median OS of 15 months suggests that the rate of clinical benefit may be larger than the modest response rate.
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Affiliation(s)
- Yana G Najjar
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Kristina Navrazhina
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York, USA
| | - Fei Ding
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Roma Bhatia
- Beth Israel Medical Center, New York, New York, USA
| | - Katy Tsai
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | - Kelly Abbate
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Barbara Durden
- USF Health Morsani College of Medicine, Tampa, Florida, USA
| | | | | | - Song Park
- University of Washington, Seattle, Washington, USA
| | - Akansha Chowdhary
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sunandana Chandra
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Igor Puzanov
- Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Marc Ernstoff
- Roswell Park Cancer Institute, Buffalo, New York, USA
| | | | | | - Arun Singh
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Tan Xu
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jessica Yang
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Richard Carvajal
- Herbert Irving Comprehensive Cancer Center, New York, New York, USA
| | | | | | - Justine Cohen
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Ryan Sullivan
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Douglas Johnson
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Alexander Shoushtari
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York, USA
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Zimmer L, Livingstone E, Hassel JC, Fluck M, Eigentler T, Loquai C, Haferkamp S, Gutzmer R, Meier F, Mohr P, Hauschild A, Schilling B, Menzer C, Kieker F, Dippel E, Rösch A, Simon JC, Conrad B, Körner S, Windemuth-Kieselbach C, Schwarz L, Garbe C, Becker JC, Schadendorf D. Adjuvant nivolumab plus ipilimumab or nivolumab monotherapy versus placebo in patients with resected stage IV melanoma with no evidence of disease (IMMUNED): a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet 2020; 395:1558-1568. [PMID: 32416781 DOI: 10.1016/s0140-6736(20)30417-7] [Citation(s) in RCA: 184] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/07/2020] [Accepted: 02/12/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Nivolumab and ipilimumab, alone or in combination, are widely used immunotherapeutic treatment options for patients with advanced-ie, unresectable or metastatic-melanoma. This criterion, however, excludes patients with stage IV melanoma with no evidence of disease. We therefore aimed to evaluate the safety and efficacy of adjuvant nivolumab plus ipilimumab or nivolumab monotherapy versus a placebo in this patient population. METHODS We did a randomised, double-blind, placebo-controlled, phase 2 trial in 20 German academic medical centres. Eligible patients were aged 18-80 years with stage IV melanoma with no evidence of disease after surgery or radiotherapy. Key exclusion criteria included uveal or mucosal melanoma, previous therapy with checkpoint inhibitors, and any previous immunosuppressive therapy within the 30 days before study drug administration. Eligible patients were randomly assigned (1:1:1), using a central, interactive, online system, to the nivolumab plus ipilimumab group (1 mg/kg of intravenous nivolumab every 3 weeks plus 3 mg/kg of intravenous ipilimumab every 3 weeks for four doses, followed by 3 mg/kg of nivolumab every 2 weeks), nivolumab monotherapy group (3 mg/kg of intravenous nivolumab every 2 weeks plus ipilimumab-matching placebo during weeks 1-12), or double-matching placebo group. The primary endpoint was the recurrence-free survival in the intention-to-treat population. The results presented in this report reflect the prespecified interim analysis of recurrence-free survival after 90 events had been reported. This study is registered with ClinicalTrials.gov, NCT02523313, and is ongoing. FINDINGS Between Sept 2, 2015, and Nov 20, 2018, 167 patients were randomly assigned to receive nivolumab plus ipilimumab (n=56), nivolumab (n=59), or placebo (n=52). As of July 2, 2019, at a median follow-up of 28·4 months (IQR 17·7-36·8), median recurrence-free survival was not reached in the nivolumab plus ipilimumab group, whereas median recurrence-free survival was 12·4 months (95% CI 5·3-33·3) in the nivolumab group and 6·4 months (3·3-9·6) in the placebo group. The hazard ratio for recurrence for the nivolumab plus ipilimumab group versus placebo group was 0·23 (97·5% CI 0·12-0·45; p<0·0001), and for the nivolumab group versus placebo group was 0·56 (0·33-0·94; p=0·011). In the nivolumab plus ipilimumab group, recurrence-free survival at 1 year was 75% (95% CI 61·0-84·9) and at 2 years was 70% (55·1-81·0); in the nivolumab group, 1-year recurrence-free survival was 52% (38·1-63·9) and at 2 years was 42% (28·6-54·5); and in the placebo group, this rate was 32% (19·8-45·3) at 1 year and 14% (5·9-25·7) at 2 years. Treatment-related grade 3-4 adverse events were reported in 71% (95% CI 57-82) of patients in the nivolumab plus ipilimumab group and in 27% (16-40) of those in the nivolumab group. Treatment-related adverse events of any grade led to treatment discontinuation in 34 (62%) of 55 patients in the nivolumab plus ipilimumab group and seven (13%) of 56 in the nivolumab group. Three deaths from adverse events were reported but were considered unrelated to the study treatment. INTERPRETATION Adjuvant therapy with nivolumab alone or in combination with ipilimumab increased recurrence-free survival significantly compared with placebo in patients with stage IV melanoma with no evidence of disease. The rates of grade 3-4 treatment-related adverse events in both active treatment groups were higher than the rates reported in previous pivotal trials done in advanced melanoma with measurable disease. FUNDING Bristol-Myers Squibb.
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Affiliation(s)
- Lisa Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | | | - Jessica C Hassel
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Fluck
- Department of Oncology Hornheide, Fachklinik Hornheide, Münster, Germany
| | - Thomas Eigentler
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - Carmen Loquai
- Department of Dermatology, University Hospital Mainz, Mainz, Germany
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Ralf Gutzmer
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Friedegund Meier
- Department of Dermatology, University Hospital Dresden, Dresden, Germany
| | - Peter Mohr
- Department of Dermatology, Elbe-Kliniken, Buxtehude, Germany
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Bastian Schilling
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | - Christian Menzer
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Kieker
- Department of Dermatology, Charité Campus Mitte, Berlin, Germany
| | - Edgar Dippel
- Department of Dermatology, Ludwigshafen Medical Center, Ludwigshafen, Germany
| | - Alexander Rösch
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK), University of Duisburg-Essen, Essen, Germany
| | - Jan-Christoph Simon
- Department of Dermatology, Leipzig University Hospital Medical Center, Leipzig, Germany
| | - Beate Conrad
- Department of Oncology Hornheide, Fachklinik Hornheide, Münster, Germany
| | - Silvia Körner
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Claus Garbe
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - Jürgen C Becker
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; Translational Skin Cancer Research, German Cancer Consortium (DKTK), Partner Site Essen, Medical Faculty, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), University of Duisburg-Essen, Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK), University of Duisburg-Essen, Essen, Germany.
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Remolina-Bonilla YA, Jimenez-Franco B, Lam ET, Bourlon MT. Immune-Related Adverse Events Involving Multiple Organ Sites in a Patient Treated With Nivolumab Plus Ipilimumab. Oncology (Williston Park) 2020; 34:171-174. [PMID: 32644176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 56-year-old white man with a 74 pack-year smoking history presented with macroscopic hematuria and a significant weight loss of 45 pounds in 6 months. His clinical laboratory tests indicated iron defi ciency anemia and a computed tomography (CT) scan showed a left kidney tumor, mediastinal lymph nodes, and multiple lung metastases. A percutaneous CT-guided kidney biopsy revealed grade 3 clear cell renal carcinoma based on World Health Organization/International Society of Urologic Pathology classifi cation. The patient started first line systemic treatment for intermediate-risk metastatic renal cell carcinoma (mRCC) with combination immunotherapy with nivolumab plus ipilimumab.1 After 10 days of the first cycle, he presented with a pruritic maculopapular rash covering 20% of his body surface.
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Affiliation(s)
- Yuly A Remolina-Bonilla
- Clinical Researcher, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Mexico City, Mexico
| | - Brenda Jimenez-Franco
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Mexico City, Mexico
| | - Elaine T Lam
- Department of Medicine, Division of Medical Oncology, University of Colorado Anschultz Medical Campus. Aurora, CO
| | - Maria T Bourlon
- Associate Professor, Hematology and Medical Oncology Department. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Mexico City, Mexico
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Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) can produce specific immune-related adverse events including pneumonitis. The impact of ICI therapy on the severity of acute coronavirus infection symptomatology warrants further exploration. CASE PRESENTATION We report a 65-year-old man diagnosed with stage IV melanoma who developed pulmonary and brain metastases and was treated with bilateral craniotomies followed by combined nivolumab and ipilimumab immunotherapy. He developed early-onset severe dyspnea associated with acute coronavirus HKU1 (non-COVID-19) infection, with diffuse pneumonitis evidenced by ground glass opacification on CT scan. He was treated with steroids leading to resolution of pneumonitis on repeat imaging, suggesting an exacerbated immune-mediated toxicity. CONCLUSION We report the first case of a patient with melanoma with severe and reversible diffuse pneumonitis in association with coronavirus HKU1 following combined nivolumab and ipilimumab immunotherapy. Although we do not have data on the impact of ICI therapy on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) symptomatology, a possible interaction should be considered when deciding on dosing in patients with possible SARS-CoV-2 exposure or when evaluating patients with presumed ICI-related pneumonitis during the COVID-19 pandemic.
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Affiliation(s)
- Michael T Serzan
- Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Princy N Kumar
- Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
| | - Michael B Atkins
- Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
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Ayoubi N, Haque A, Vera N, Ma S, Messina J, Khushalani N, Seminario-Vidal L. Ipilimumab/nivolumab-induced pseudolymphoma in a patient with malignant melanoma. J Cutan Pathol 2020; 47:390-393. [PMID: 31677178 DOI: 10.1111/cup.13604] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 10/05/2019] [Accepted: 10/27/2019] [Indexed: 12/31/2022]
Abstract
Combination therapy with ipilimumab and nivolumab is an adjuvant treatment approach for metastatic melanoma that boasts increased 3-year survival when compared with a single immunotherapy agent. Combination therapy, however, is associated with increased toxicities, especially cutaneous side-effects. Here we present a patient with metastatic melanoma and a sudden eruption of painful nodules on the face and arms 10 days after the administration of the fourth dose of combination ipilimumab/nivolumab. Biopsies demonstrated lymphoid hyperplasia, not clinically or pathologically consistent with an infectious, malignant or autoimmune etiology; a diagnosis of pseudolymphoma secondary to ipilimumab/nivolumab was made. After a steroid taper, the lesions resolved, and the patient was restarted on nivolumab monotherapy 2 weeks later without recurrence of symptoms or disease.
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Affiliation(s)
- Noura Ayoubi
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Adel Haque
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, Florida
| | - Nora Vera
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, Florida
| | - Sophia Ma
- Department of Dermatology, Pathology and Cell Biology, University of South Florida, Tampa, Florida
| | - Jane Messina
- Cutaneous Oncology Program, H. Lee Moffitt Cancer and Research Center, Tampa, Florida
| | - Nikhil Khushalani
- Cutaneous Oncology Program, H. Lee Moffitt Cancer and Research Center, Tampa, Florida
| | - Lucia Seminario-Vidal
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, Florida
- Cutaneous Oncology Program, H. Lee Moffitt Cancer and Research Center, Tampa, Florida
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Ohira J, Kawamoto M, Sugino Y, Kohara N. A case report of fulminant cytokine release syndrome complicated by dermatomyositis after the combination therapy with immune checkpoint inhibitors. Medicine (Baltimore) 2020; 99:e19741. [PMID: 32282733 PMCID: PMC7220092 DOI: 10.1097/md.0000000000019741] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Immune-related adverse events (ir-AEs) are increasingly becoming a concern, as immune checkpoint inhibitors (ICIs) are used more frequently. Herein, we present a case of fulminant cytokine release syndrome (CRS) complicated by dermatomyositis after the combination therapy with ICIs. PATIENT CONCERNS A 70-year-old male developed dermatomyositis during the course of treatment with two ICIs, nivolumab and ipilimumab. He was treated by steroid pulse therapy, but the effect was limited. Afterwards, he had acute-onset high fever, hypotension, respiratory failure, impaired consciousness, renal failure, and coagulation abnormality at the same time. C reactive protein (CRP), creatinine kinase (CK), D-dimer, and ferritin levels were considerably elevated: CRP, 24 mg/dL; CK, 40,500 U/L; D-dimer, 290 μg/mL; ferritin, 329,000 ng/mL. DIAGNOSIS CRS induced by ICI combination therapy. INTERVENTIONS Given that high fever and elevated CRP level indicated potential sepsis, an antibiotic was used until the confirmation of negative blood cultures. All the simultaneous acute symptoms were supposed to be CRS. He was admitted to the intensive care unit (ICU), and temporary intubation and hemodialysis were needed. Immunosuppressive therapy was reinforced by mycophenolate mofetil together with steroid, and plasma exchange was performed for the elimination of abnormal proteins. OUTCOMES The patient's clinical symptoms and laboratory parameters gradually improved and he was discharged from the ICU in a month. CONCLUSION Fulminant CRS can be induced by ICI combination therapy. As the initial symptoms of CRS resemble sepsis, it is important to consider CRS as a differential diagnosis and to initiate immunosuppressive therapy early when needed. In steroid-resistant cases, early introduction of other immunosuppressive therapy and plasma exchange can be effective.
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Affiliation(s)
- Junichiro Ohira
- Department of Neurology, Kobe City Medical Center General Hospital, 650-0047, 2-1-1 Minatojima-Minamimachi, Chuou-ku, Kobe, Hyogo
- Department of Neurology, Kyoto University Hospital, 606-8507, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto
| | - Michi Kawamoto
- Department of Neurology, Kobe City Medical Center General Hospital, 650-0047, 2-1-1 Minatojima-Minamimachi, Chuou-ku, Kobe, Hyogo
| | - Yoshio Sugino
- Department of Urology, Kobe City Medical Center General Hospital, 650-0047, 2-1-1 Minatojima-Minamimachi, Chuou-ku, Kobe, Hyogo, Japan
| | - Nobuo Kohara
- Department of Neurology, Kobe City Medical Center General Hospital, 650-0047, 2-1-1 Minatojima-Minamimachi, Chuou-ku, Kobe, Hyogo
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Brown NF, Ng SM, Brooks C, Coutts T, Holmes J, Roberts C, Elhussein L, Hoskin P, Maughan T, Blagden S, Mulholland P. A phase II open label, randomised study of ipilimumab with temozolomide versus temozolomide alone after surgery and chemoradiotherapy in patients with recently diagnosed glioblastoma: the Ipi-Glio trial protocol. BMC Cancer 2020; 20:198. [PMID: 32164579 PMCID: PMC7068928 DOI: 10.1186/s12885-020-6624-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/11/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Median survival for patients with glioblastoma is less than a year. Standard treatment consists of surgical debulking if feasible followed by temozolomide chemo-radiotherapy. The immune checkpoint inhibitor ipilimumab targets cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and has shown clinical efficacy in preclinical models of glioblastoma. The aim of this study is to explore the addition of ipilimumab to standard therapy in patients with glioblastoma. METHODS/DESIGN Ipi-Glio is a phase II, open label, randomised study of ipilimumab with temozolomide (Arm A) versus temozolomide alone (Arm B) after surgery and chemoradiotherapy in patients with recently diagnosed glioblastoma. Planned accrual is 120 patients (Arm A: 80, Arm B: 40). Endpoints include overall survival, 18-month survival, 5-year survival, and adverse events. The trial is currently recruiting in seven centres in the United Kingdom. TRIAL REGISTRATION ISRCTN84434175. Registered 12 November 2018.
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Affiliation(s)
- Nicholas F Brown
- Department of Oncology, University College London Hospitals, 250 Euston Road, London, NW1 2PQ, UK
| | - Stasya M Ng
- Oncology Clinical Trials Office (OCTO), Department of Oncology, The University of Oxford, Old Road Campus Research Building, Oxford, OX3 7DQ, UK
| | - Claire Brooks
- Oncology Clinical Trials Office (OCTO), Department of Oncology, The University of Oxford, Old Road Campus Research Building, Oxford, OX3 7DQ, UK
| | - Tim Coutts
- Oncology Clinical Trials Office (OCTO), Department of Oncology, The University of Oxford, Old Road Campus Research Building, Oxford, OX3 7DQ, UK
| | - Jane Holmes
- Centre for Statistics in Medicine (CSM), University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - Corran Roberts
- Centre for Statistics in Medicine (CSM), University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - Leena Elhussein
- Centre for Statistics in Medicine (CSM), University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, HA6 2RN, UK
| | - Tim Maughan
- Oxford Institute for Radiation Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford, OX3 7DQ, UK
| | - Sarah Blagden
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Oxford, OX3 7DQ, UK
| | - Paul Mulholland
- Department of Oncology, University College London Hospitals, 250 Euston Road, London, NW1 2PQ, UK.
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, HA6 2RN, UK.
- UCL Cancer Institute, 72 Huntley St, London, WC1E 6AG, UK.
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Tarhini AA, Lee SJ, Hodi FS, Rao UNM, Cohen GI, Hamid O, Hutchins LF, Sosman JA, Kluger HM, Eroglu Z, Koon HB, Lawrence DP, Kendra KL, Minor DR, Lee CB, Albertini MR, Flaherty LE, Petrella TM, Streicher H, Sondak VK, Kirkwood JM. Phase III Study of Adjuvant Ipilimumab (3 or 10 mg/kg) Versus High-Dose Interferon Alfa-2b for Resected High-Risk Melanoma: North American Intergroup E1609. J Clin Oncol 2020; 38:567-575. [PMID: 31880964 PMCID: PMC7030886 DOI: 10.1200/jco.19.01381] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2019] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Phase III adjuvant trials have reported significant benefits in both relapse-free survival (RFS) and overall survival (OS) for high-dose interferon alfa (HDI) and ipilimumab at 10 mg/kg (ipi10). E1609 evaluated the safety and efficacy of ipilimumab at 3 mg/kg (ipi3) and ipi10 versus HDI. PATIENTS AND METHODS E1609 was a phase III trial in patients with resected cutaneous melanoma (American Joint Committee on Cancer 7th edition stage IIIB, IIIC, M1a, or M1b). It had 2 coprimary end points: OS and RFS. A 2-step hierarchic approach first evaluated ipi3 versus HDI followed by ipi10 versus HDI. RESULTS Between May 2011 and August 2014, 1,670 adult patients were centrally randomly assigned (1:1:1) to ipi3 (n = 523), HDI (n = 636), or ipi10 (n = 511). Treatment-related adverse events grade ≥ 3 occurred in 37% of patients receiving ipi3, 79% receiving HDI, and 58% receiving ipi10, with adverse events leading to treatment discontinuation in 35%, 20%, and 54%, respectively. Comparison of ipi3 versus HDI used an intent-to-treat analysis of concurrently randomly assigned patient cases (n = 1,051) and showed significant OS difference in favor of ipi3 (hazard ratio [HR], 0.78; 95.6% repeated CI, 0.61 to 0.99; P = .044; RFS: HR, 0.85; 99.4% CI, 0.66 to 1.09; P = .065). In the second step, for ipi10 versus HDI (n = 989), trends in favor of ipi10 did not achieve statistical significance. Salvage patterns after melanoma relapse showed significantly higher rates of ipilimumab and ipilimumab/anti-programmed death 1 use in the HDI arm versus ipi3 and ipi10 (P ≤ .001). CONCLUSION Adjuvant therapy with ipi3 benefits survival versus HDI; for the first time to our knowledge in melanoma adjuvant therapy, E1609 has demonstrated a significant improvement in OS against an active control regimen. The currently approved adjuvant ipilimumab dose (ipi10) was more toxic and not superior in efficacy to HDI.
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Affiliation(s)
| | - Sandra J. Lee
- Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
| | | | - Uma N. M. Rao
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Omid Hamid
- Angeles Clinic & Research Institute, Santa Monica, CA
| | | | | | | | - Zeynep Eroglu
- H. Lee Moffitt Comprehensive Cancer Center, Tampa, FL
| | | | | | | | - David R. Minor
- Sutter-California Pacific Medical Center, San Francisco, CA
| | - Carrie B. Lee
- University of North Carolina at Chapel Hill, Chapel Hill, NC
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George G, Schmidt L, Tolat P, Riese M, Kilari D. Salvage ipilimumab associated with a significant response in sarcomatoid renal cell carcinoma. J Immunother Cancer 2020; 8:e000584. [PMID: 32114501 PMCID: PMC7057424 DOI: 10.1136/jitc-2020-000584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Metastatic sarcomatoid renal cell carcinoma (sRCC) is an aggressive variant of RCC with generally poor prognosis. Treatment with vascular endothelial growth factor inhibitors or chemotherapy generates only short-lived responses. Recent research has suggested a role for combination checkpoint inhibition as first line treatment for metastatic sRCC. This therapy consists of induction with cytotoxic T-lymphocyte-associated protein 4 inhibitor, ipilimumab, administered with programmed cell death protein 1 (PD-1) inhibitor, nivolumab. After completion of four cycles of combination therapy, single-agent maintenance nivolumab is recommended until progression. Patients who progress on maintenance nivolumab are switched to alternate therapy. Herein, we present a case of a patient with RCC who progressed on maintenance nivolumab who, on retreatment with ipilimumab, demonstrated a significant response In addition, we summarize important findings to support the role of salvage ipilimumab in patients with sRCC. CASE PRESENTATION A 46-year-old man presented with flank pain and hematuria, the work up of which noted a left kidney mass for which he underwent nephrectomy and was diagnosed with localized sRCC with 60% sarcomatoid differentiation. Within 3 months of nephrectomy, he presented with recurrent flank pain and was diagnosed with recurrence of disease. He was treated with ipilimumab 1 mg/kg and nivolumab 3 mg/kg for four doses and demonstrated a partial response. He was then transitioned to single agent nivolumab maintenance. After 3 months on maintenance therapy, he was noted to have progression of disease. Given prior response to immune check point combination, it was decided to rechallenge the patient with 1 mg/kg ipilimumab. After two doses of ipilimumab and nivolumab combination therapy, the patient was noted to have a partial response. He maintained a response for an additional 9 months and treatment was eventually discontinued due to grade 3 toxicity and progression. CONCLUSIONS This case report demonstrates the utility of retreatment with ipilimumab as a salvage option for patients progressing on maintenance PD-1 inhibitors in metastatic RCC. Further studies are needed to identify predictors of response and toxicity to this approach, as well as the optimal scheduling of ipilimumab with maintenance nivolumab.
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Affiliation(s)
- Gemlyn George
- Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Laura Schmidt
- Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Parag Tolat
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Mathew Riese
- Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Blood Research Institute, Versiti Blood Center of Wisconsin, Milwaukee, WI 53213, USA
| | - Deepak Kilari
- Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Sanghavi K, Zhang J, Zhao X, Feng Y, Statkevich P, Sheng J, Roy A, Vezina HE. Population Pharmacokinetics of Ipilimumab in Combination With Nivolumab in Patients With Advanced Solid Tumors. CPT Pharmacometrics Syst Pharmacol 2020; 9:29-39. [PMID: 31709718 PMCID: PMC6966186 DOI: 10.1002/psp4.12477] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/11/2019] [Indexed: 12/13/2022] Open
Abstract
Ipilimumab is a fully human monoclonal antibody approved for the treatment of melanoma as monotherapy and for the treatment of melanoma, renal cell carcinoma, and colorectal cancer in combination with nivolumab. Ipilimumab time-varying clearance (CL) was assessed by a population pharmacokinetics (PPK) model developed using statistically significant covariates identified in a previous PPK analysis plus additional covariates. Data from 3,411 patients who received ipilimumab 0.3-10 mg/kg alone or in combination with nivolumab in 16 clinical trials were analyzed. Ipilimumab CL decreased over time; the change in CL was greater in patients treated with nivolumab combination than ipilimumab alone and in responders vs. nonresponders. Time-varying covariates including body weight, lactate dehydrogenase, albumin, and performance status were evaluated on change in ipilimumab CL. In addition, ipilimumab CL was similar across different tumor types, nivolumab dosing regimens, and lines of therapy. These data suggest an association of ipilimumab CL with disease severity.
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Affiliation(s)
| | | | | | - Yan Feng
- Bristol‐Myers SquibbPrincetonNew JerseyUSA
| | | | | | - Amit Roy
- Bristol‐Myers SquibbPrincetonNew JerseyUSA
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Zezza M, Kosinski C, Mekoguem C, Marino L, Chtioui H, Pitteloud N, Lamine F. Combined immune checkpoint inhibitor therapy with nivolumab and ipilimumab causing acute-onset type 1 diabetes mellitus following a single administration: two case reports. BMC Endocr Disord 2019; 19:144. [PMID: 31870373 PMCID: PMC6929418 DOI: 10.1186/s12902-019-0467-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/02/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The use of immune checkpoint inhibitor (ICI) therapy is becoming a standard of care for several cancers. Monoclonal antibodies targeting cytotoxic T-lymphocyte antigen-4 (CTLA-4) and programmed cell death protein 1 (PD-1) or its ligand (PD-L1) cause a broad spectrum of autoimmune adverse events. ICI-induced type 1 diabetes mellitus (T1DM) is extremely rare (< 1%) but potentially life-threatening. It appears to be more common with PD-1 blockade (or combination immunotherapy) than with anti-CTLA-4 therapy, often during the first three to six months of therapy. CASES PRESENTATION We report an acute onset T1DM with severe inaugural diabetic ketoacidosis (DKA) and remarkably elevated Glutamic Acid Decarboxylase antibody (GADA) titres following a single administration of combined ICI therapy with nivolumab (anti-PD-1) and ipilimumab (anti-CTLA-4) in two adult patients with advanced metastatic melanoma. In these cases, the time to diabetes onset was remarkably short (two and five weeks), and one presented with fulminous T1DM in a previous long-standing type 2 diabetes mellitus. CONCLUSIONS Oncological patients treated with combination therapy of anti-PD-1 and anti-CTLA-4 can develop a particular pattern of T1DM, with very rapid onset within a few weeks after starting ICI therapy, even in the presence of an existing type 2 diabetes. ICI-induced T1DM is a medical emergency in presence of severe inaugural DKA and requires a collaboration between specialists and primary care physicians, as well as patient education, for early diagnosis and supportive care.
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Affiliation(s)
- Marco Zezza
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital (CHUV), University of Lausanne, Av. de La Sallaz 8, 1011, Lausanne, Switzerland
| | - Christophe Kosinski
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital (CHUV), University of Lausanne, Av. de La Sallaz 8, 1011, Lausanne, Switzerland
| | - Carine Mekoguem
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital (CHUV), University of Lausanne, Av. de La Sallaz 8, 1011, Lausanne, Switzerland
| | - Laura Marino
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital (CHUV), University of Lausanne, Av. de La Sallaz 8, 1011, Lausanne, Switzerland
| | - Haithem Chtioui
- Service of Clinical Pharmacology, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Nelly Pitteloud
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital (CHUV), University of Lausanne, Av. de La Sallaz 8, 1011, Lausanne, Switzerland
| | - Faiza Lamine
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital (CHUV), University of Lausanne, Av. de La Sallaz 8, 1011, Lausanne, Switzerland.
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Zenati N, Charles J, Templier I, Blaise S. [Digital ischaemia with fingertip ulcers during ipilimumab therapy]. Ann Dermatol Venereol 2019; 147:212-216. [PMID: 31864764 DOI: 10.1016/j.annder.2019.09.606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/29/2019] [Revised: 04/17/2019] [Accepted: 09/05/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Anti-cancer drugs have many adverse effects including vascular side effects. Herein we present the case of a patient presenting digital ischaemia with high imputability of ipilimumab. OBSERVATION A 47-year-old male patient was treated for popliteal melanoma, initially stage IIIA but which subsequently became metastatic (stage IV), and for which ipilimumab was given after the failure of two lines of chemotherapy. During the 4th course of ipilimumab, the patient developed autoimmune hepatitis. Ipilimumab was suspended. Three months later, he developed a drug-like neuropathy followed one month later by ulceration of the right index finger. Causes of embolic, autoimmune and occupational origin (thrombotic microangiopathy, thrombosed aneurysm) were rapidly ruled out. Although a paraneoplastic origin could not be formally excluded, drug-induced immune disorder remained the most plausible origin. DISCUSSION This is the first reported case of digital ulceration under ipilimumab.
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Affiliation(s)
- N Zenati
- Department of Vascular Medicine, Grenoble University Hospital, 38000 Grenoble, France
| | - J Charles
- Department of dermatology, Grenoble University Hospital, 38000 Grenoble, France
| | - I Templier
- Department of dermatology, Grenoble University Hospital, 38000 Grenoble, France
| | - S Blaise
- Department of Vascular Medicine, Grenoble University Hospital, 38000 Grenoble, France; UMR 1042-HP2, Inserm, University of Grenoble-Alpes, 38000 Grenoble, France.
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Dudani S, Graham J, Wells JC, Bakouny Z, Pal SK, Dizman N, Donskov F, Porta C, de Velasco G, Hansen A, Iafolla M, Beuselinck B, Vaishampayan UN, Wood LA, Liow E, Yan F, Yuasa T, Bjarnason GA, Choueiri TK, Heng DYC. First-line Immuno-Oncology Combination Therapies in Metastatic Renal-cell Carcinoma: Results from the International Metastatic Renal-cell Carcinoma Database Consortium. Eur Urol 2019; 76:861-867. [PMID: 31445844 PMCID: PMC6858928 DOI: 10.1016/j.eururo.2019.07.048] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [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: 05/19/2019] [Accepted: 07/30/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND In metastatic renal-cell carcinoma (mRCC), recent data have shown efficacy of first-line ipilimumab and nivolumab (ipi-nivo) as well as immuno-oncology (IO)/vascular endothelial growth factor (VEGF) inhibitor combinations. Comparative data between these strategies are limited. OBJECTIVE To compare the efficacy of ipi-nivo versus IO-VEGF (IOVE) combinations in mRCC, and describe practice patterns and effectiveness of second-line therapies. DESIGN, SETTING, AND PARTICIPANTS Using the International Metastatic Renal-cell Carcinoma Database Consortium (IMDC) dataset, patients treated with any first-line IOVE combination were compared with those treated with ipi-nivo. INTERVENTION All patients received first-line IO combination therapies. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS First- and second-line response rates, time to treatment failure (TTF), time to next treatment (TNT), and overall survival (OS) were analysed. Hazard ratios were adjusted for IMDC risk factors. RESULTS AND LIMITATIONS In total, 113 patients received IOVE combinations and 75 received ipi-nivo. For IOVE combinations versus ipi-nivo, first-line response rates were 33% versus 40% (between-group difference 7%, 95% confidence interval [CI] -8% to 22%, p = 0.4), TTF was 14.3 versus 10.2 mo (p = 0.2), TNT was 19.7 versus 17.9 mo (p = 0.4), and median OS was immature but not statistically different (p = 0.17). Adjusted hazard ratios for TTF, TNT, and OS were 0.71 (95% CI 0.46-1.12, p = 0.14), 0.65 (95% CI 0.38-1.11, p = 0.11), and 1.74 (95% CI 0.82-3.68, p = 0.14), respectively. Sixty-four (34%) patients received second-line treatment. In patients receiving subsequent VEGF-based therapy, second-line response rates were lower in the IOVE cohort than in the ipi-nivo cohort (15% vs 45%; between-group difference 30%, 95% CI 3-57%, p = 0.04; n = 40), though second-line TTF was not significantly different (3.7 vs 5.4 mo; p = 0.4; n = 55). Limitations include the study's retrospective design and sample size. CONCLUSIONS There were no significant differences in first-line outcomes between IOVE combinations and ipi-nivo. Most patients received VEGF-based therapy in the second line. In this group, second-line response rate was greater in patients who received ipi-nivo initially. PATIENT SUMMARY There were no significant differences in key first-line outcomes for patients with metastatic renal-cell carcinoma receiving immuno-oncology/vascular endothelial growth factor inhibitor combinations versus ipilimumab and nivolumab.
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Affiliation(s)
- Shaan Dudani
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | | | - J Connor Wells
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Ziad Bakouny
- Dana-Farber Cancer Institute/Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Nazli Dizman
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | - Camillo Porta
- Department of Internal Medicine, University of Pavia and Division of Translational Oncology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | | | - Aaron Hansen
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Marco Iafolla
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Benoit Beuselinck
- University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | | | - Lori A Wood
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | | | - Flora Yan
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Takeshi Yuasa
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | - Toni K Choueiri
- Dana-Farber Cancer Institute/Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Daniel Y C Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada.
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Hellmann MD, Paz-Ares L, Bernabe Caro R, Zurawski B, Kim SW, Carcereny Costa E, Park K, Alexandru A, Lupinacci L, de la Mora Jimenez E, Sakai H, Albert I, Vergnenegre A, Peters S, Syrigos K, Barlesi F, Reck M, Borghaei H, Brahmer JR, O'Byrne KJ, Geese WJ, Bhagavatheeswaran P, Rabindran SK, Kasinathan RS, Nathan FE, Ramalingam SS. Nivolumab plus Ipilimumab in Advanced Non-Small-Cell Lung Cancer. N Engl J Med 2019; 381:2020-2031. [PMID: 31562796 DOI: 10.1056/nejmoa1910231] [Citation(s) in RCA: 1583] [Impact Index Per Article: 316.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND In an early-phase study involving patients with advanced non-small-cell lung cancer (NSCLC), the response rate was better with nivolumab plus ipilimumab than with nivolumab monotherapy, particularly among patients with tumors that expressed programmed death ligand 1 (PD-L1). Data are needed to assess the long-term benefit of nivolumab plus ipilimumab in patients with NSCLC. METHODS In this open-label, phase 3 trial, we randomly assigned patients with stage IV or recurrent NSCLC and a PD-L1 expression level of 1% or more in a 1:1:1 ratio to receive nivolumab plus ipilimumab, nivolumab alone, or chemotherapy. The patients who had a PD-L1 expression level of less than 1% were randomly assigned in a 1:1:1 ratio to receive nivolumab plus ipilimumab, nivolumab plus chemotherapy, or chemotherapy alone. All the patients had received no previous chemotherapy. The primary end point reported here was overall survival with nivolumab plus ipilimumab as compared with chemotherapy in patients with a PD-L1 expression level of 1% or more. RESULTS Among the patients with a PD-L1 expression level of 1% or more, the median duration of overall survival was 17.1 months (95% confidence interval [CI], 15.0 to 20.1) with nivolumab plus ipilimumab and 14.9 months (95% CI, 12.7 to 16.7) with chemotherapy (P = 0.007), with 2-year overall survival rates of 40.0% and 32.8%, respectively. The median duration of response was 23.2 months with nivolumab plus ipilimumab and 6.2 months with chemotherapy. The overall survival benefit was also observed in patients with a PD-L1 expression level of less than 1%, with a median duration of 17.2 months (95% CI, 12.8 to 22.0) with nivolumab plus ipilimumab and 12.2 months (95% CI, 9.2 to 14.3) with chemotherapy. Among all the patients in the trial, the median duration of overall survival was 17.1 months (95% CI, 15.2 to 19.9) with nivolumab plus ipilimumab and 13.9 months (95% CI, 12.2 to 15.1) with chemotherapy. The percentage of patients with grade 3 or 4 treatment-related adverse events in the overall population was 32.8% with nivolumab plus ipilimumab and 36.0% with chemotherapy. CONCLUSIONS First-line treatment with nivolumab plus ipilimumab resulted in a longer duration of overall survival than did chemotherapy in patients with NSCLC, independent of the PD-L1 expression level. No new safety concerns emerged with longer follow-up. (Funded by Bristol-Myers Squibb and Ono Pharmaceutical; CheckMate 227 ClinicalTrials.gov number, NCT02477826.).
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Affiliation(s)
- Matthew D Hellmann
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - Luis Paz-Ares
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - Reyes Bernabe Caro
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - Bogdan Zurawski
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - Sang-We Kim
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - Enric Carcereny Costa
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - Keunchil Park
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - Aurelia Alexandru
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - Lorena Lupinacci
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - Emmanuel de la Mora Jimenez
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - Hiroshi Sakai
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - Istvan Albert
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - Alain Vergnenegre
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - Solange Peters
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - Konstantinos Syrigos
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - Fabrice Barlesi
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - Martin Reck
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - Hossein Borghaei
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - Julie R Brahmer
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - Kenneth J O'Byrne
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - William J Geese
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - Prabhu Bhagavatheeswaran
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - Sridhar K Rabindran
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - Ravi S Kasinathan
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - Faith E Nathan
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
| | - Suresh S Ramalingam
- From the Memorial Sloan Kettering Cancer Center, New York (M.D.H.); Hospital Universitario Doce de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and Centro de Investigación Biomédica en Red de Cáncer, Madrid (L.P.-A.), Hospital Universitario Virgen Del Rocio, Seville (R.B.C.), and the Catalan Institute of Oncology-Germans Trias i Pujol Hospital, Badalona (E.C.C.) - all in Spain; Ambulatorium Chemioterapii, Bydgoszcz, Poland (B.Z.); the Asan Medical Center (S.-W.K.) and the Samsung Medical Center at Sungkyunkwan University School of Medicine (K.P.) - both in Seoul, South Korea; the Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania (A.A.); the Hospital Italiano de Buenos Aires, Buenos Aires (L.L.); Instituto Jalisciense de Cancerologia, Guadalajara, Mexico (E.M.J.); the Saitama Cancer Center, Saitama, Japan (H.S.); Matrai Gyogyintezet, Matrahaza, Hungary (I.A.); Limoges University Hospital, Limoges (A.V.), and Aix-Marseille University, National Center for Scientific Research, INSERM, Centre de Recherche en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille (F.B.) - all in France; Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland (S.P.); Sotiria General Hospital, National and Kapodistrian University of Athens, Athens (K.S.); Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany (M.R.); Fox Chase Cancer Center, Philadelphia (H.B.); Johns Hopkins Kimmel Cancer Center, Baltimore (J.R.B.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., P.B., S.K.R., R.S.K., F.E.N.); and Winship Cancer Institute, Emory University, Atlanta (S.S.R.)
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