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Chamseddine S, Mohamed YI, Lee SS, Yao JC, Hu ZI, Tran Cao HS, Xiao L, Sun R, Morris JS, Hatia RI, Hassan M, Duda DG, Diab M, Mohamed A, Nassar A, Datar S, Amin HM, Kaseb AO. Clinical and Prognostic Biomarker Value of Blood-Circulating Inflammatory Cytokines in Hepatocellular Carcinoma. Oncology 2023; 101:730-737. [PMID: 37467732 PMCID: PMC10614568 DOI: 10.1159/000531870] [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: 03/14/2023] [Accepted: 06/20/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Circulating inflammatory cytokines play critical roles in tumor-associated inflammation and immune responses. Recent data have suggested that several interleukins (ILs) mediate carcinogenesis in hepatocellular carcinoma (HCC). However, the predictive and prognostic value of circulating ILs is yet to be validated. Our study aimed to evaluate the association of the serum ILs with overall survival (OS) and clinicopathologic features in a large cohort of HCC patients. METHODS We prospectively collected data and serum samples from 767 HCC patients treated at the University of Texas MD Anderson Cancer Center between 2001 and 2014, with a median follow-up of 67.4 months (95% confidence interval [CI]: 52.5, 83.3). Biomarker association with OS was evaluated by the log-rank method. RESULTS The median OS in this cohort was 14.2 months (95% CI: 12, 16.1 months). Clinicopathologic features were more advanced, and OS was significantly inferior in patients with high circulating levels of IL1-R1, IL-6, IL-8, IL-10, IL-15, IL-16, and IL-18. CONCLUSION Our study shows that several serum IL levels are valid prognostic biomarker candidates and potential targets for therapy in HCC.
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Affiliation(s)
- Shadi Chamseddine
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA,
| | - Yehia I Mohamed
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sunyoung S Lee
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - James C Yao
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zishuo Ian Hu
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hop S Tran Cao
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lianchun Xiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ryan Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Morris
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rikita I Hatia
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Manal Hassan
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Dan G Duda
- Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Maria Diab
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Amr Mohamed
- Division of Hematology/Oncology, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ahmed Nassar
- Department of Surgery, Emory University, Atlanta, Georgia, USA
| | - Saumil Datar
- Department of Internal Medicine University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Hesham M Amin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ahmed Omar Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Nardo M, Yilmaz B, Nelson BE, Torres HA, Wang LS, Granwehr BP, Song J, Dalla Pria HRF, Trinh VA, Glitza Oliva IC, Patel SP, Tannir NM, Kaseb AO, Altan M, Lee SS, Miller E, Zhang H, Stephen BA, Naing A. Safety and Efficacy of Immune Checkpoint Inhibitors in Patients with Cancer and Viral Hepatitis: The MD Anderson Cancer Center Experience. Oncologist 2023; 28:714-721. [PMID: 36952233 PMCID: PMC10400154 DOI: 10.1093/oncolo/oyad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/24/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Despite the clinical benefit of immune checkpoint inhibitors (ICIs), patients with a viral hepatitis have been excluded from clinical trials because of safety concerns. The purpose of this study was to determine the incidence rate of adverse events (AEs) in patients with viral hepatitis who received ICIs for cancer treatment. MATERIALS AND METHODS We conducted a retrospective study in patients with cancer and concurrent hepatitis B or C, who had undergone treatment with ICI at MD Anderson Cancer Center from January 1, 2010 to December 31, 2019. RESULTS Of the 1076 patients screened, we identified 33 with concurrent hepatitis. All 10 patients with HBV underwent concomitant antiviral therapy during ICI treatment. Sixteen of the 23 patients with HCV received it before the initiation of ICI. The median follow-up time was 33 months (95% CI, 23-45) and the median duration of ICI therapy was 3 months (IQR, 1.9-6.6). Of the 33 patients, 12 (39%) experienced irAEs (immune-related adverse events) of any grade, with 2 (6%) having grade 3 or higher. None of the patients developed hepatitis toxicities. CONCLUSION ICIs may be a therapeutic option with an acceptable safety profile in patients with cancer and advanced liver disease.
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Affiliation(s)
- Mirella Nardo
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bulent Yilmaz
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Blessie Elizabeth Nelson
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Harrys A Torres
- Department of Infectious Diseases Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lan Sun Wang
- Department of Genitourinary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bruno Palma Granwehr
- Department of Infectious Diseases Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Juhee Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hanna R F Dalla Pria
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Van A Trinh
- Department of Melanoma Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Isabella C Glitza Oliva
- Department of Melanoma Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sapna P Patel
- Department of Melanoma Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nizar M Tannir
- Department of Genitourinary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ahmed Omar Kaseb
- Department of Genitourinary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mehmet Altan
- Department of Genitourinary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston TX, USA
| | - Sunyoung S Lee
- Department of Gastrointestinal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ethan Miller
- Department of Gastrointestinal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hao Zhang
- Department of Gastrointestinal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bettzy A Stephen
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aung Naing
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Chamseddine S, LaPelusa M, Kaseb AO. Systemic Neoadjuvant and Adjuvant Therapies in the Management of Hepatocellular Carcinoma-A Narrative Review. Cancers (Basel) 2023; 15:3508. [PMID: 37444618 DOI: 10.3390/cancers15133508] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
The burden of hepatocellular carcinoma (HCC) continues to pose a significant global health problem. Several systemic therapies have recently been shown to improve survival for patients with unresectable disease. However, evidence to support the use of neoadjuvant or adjuvant systemic therapies in patients with resectable disease is limited, despite the high risk of recurrence. Neoadjuvant and adjuvant systemic therapies are being investigated for their potential to reduce recurrence after resection and improve overall survival. Our review identified various early-phase clinical trials showing impressive preliminary signals of pathologic complete response in resectable disease, and others suggesting that neoadjuvant therapies-particularly when combined with adjuvant strategies-may convert unresectable disease to resectable disease and cause significant tumor necrosis, potentially decreasing recurrence rates. The role of adjuvant therapies alone may also play a part in the management of these patients, particularly in reducing recurrence rates. Heterogeneity in trial design, therapies used, patient selection, and a scarcity of randomized phase III trials necessitate the cautious implementation of these treatment strategies. Future research is required to identify predictive biomarkers, optimize the timing and type of therapeutic combinations, and minimize treatment-related adverse effects, thereby personalizing and enhancing treatment strategies for patients with resectable and borderline resectable HCC.
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Affiliation(s)
- Shadi Chamseddine
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Michael LaPelusa
- Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ahmed Omar Kaseb
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA
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Mohamed YI, Duda DG, Awiwi MO, Lee SS, Altameemi L, Xiao L, Morris JS, Wolff RA, Elsayes KM, Hatia RI, Qayyum A, Chamseddine SM, Rashid A, Yao JC, Mahvash A, Hassan MM, Amin HM, Kaseb AO. Plasma growth hormone is a potential biomarker of response to atezolizumab and bevacizumab in advanced hepatocellular carcinoma patients. Oncotarget 2022; 13:1314-1321. [PMID: 36473155 PMCID: PMC9726202 DOI: 10.18632/oncotarget.28322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) has limited systemic therapy options when discovered at an advanced stage. Thus, there is a need for accessible and minimally invasive biomarkers of response to guide the selection of patients for treatment. This study investigated the biomarker value of plasma growth hormone (GH) level as a potential biomarker to predict outcome in unresectable HCC patients treated with current standard therapy, atezolizumab plus bevacizumab (Atezo/Bev). MATERIALS AND METHODS Study included unresectable HCC patients scheduled to receive Atezo/Bev. Patients were followed to determine progression-free survival (PFS) and overall survival (OS). Plasma GH levels were measured by ELISA and used to stratify the HCC patients into GH-high and GH-low groups (the cutoff normal GH levels in women and men are ≤3.7 μg/L and ≤0.9 μg/L, respectively). Kaplan-Meier method was used to calculate median OS and PFS and Log rank test was used to compare survival outcomes between GH-high and -low groups. RESULTS Thirty-seven patients were included in this analysis, of whom 31 were males and 6 females, with a median age of 67 years (range: 37-80). At the time of the analysis, the one-year survival rate was 70% (95% CI: 0.51, 0.96) among GH low patients and 33% (95% CI: 0.16, 0.67) among GH high patients. OS was significantly superior in GH-low compared to GH-high patients (median OS: 18.9 vs. 9.3 months; p = 0.014). PFS showed a non-significant trend in favor of GH-low patients compared to the GH-high group (median PFS: 6.6 vs. 2.9 months; p = 0.053). DISCUSSION AND CONCLUSIONS Plasma GH is a biomarker candidate for predicting treatment outcomes in advanced HCC patients treated with Atezo/Bev. This finding should be further validated in larger randomized clinical trials in advanced HCC patients.
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Affiliation(s)
- Yehia I. Mohamed
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Dan G. Duda
- Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Muhammad O. Awiwi
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sunyoung S. Lee
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Lina Altameemi
- Hurley Medical Center, Michigan State University, East Lansing, MI 48824, USA
| | - Lianchun Xiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jeffrey S. Morris
- Department of Biostatistics, Epidemiology, and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Robert A. Wolff
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Khaled M. Elsayes
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Rikita I. Hatia
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Aliya Qayyum
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Shadi M. Chamseddine
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Asif Rashid
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - James C. Yao
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Armeen Mahvash
- Department of Interventional Radiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Manal M. Hassan
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Hesham M. Amin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ahmed Omar Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Lee HS, Kim K, Kang G, Jung KH, Kaseb AO, Lee SS. Quantitative analysis of spatial distribution of lymphocytes in hepatocellular carcinoma: A biomarker correlated with survival and gene expression in cancer immune system. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4119 Background: Tumor microenvironment (TME) is known to impact prognosis in hepatocellular carcinoma (HCC). Although digital pathology and artificial intelligence have been adopted in modern medicine and oncology, few quantitative biomarkers have been identified to predict the prognosis and guide treatment for HCC via an automated analysis of TME at the cellular level. Methods: Histopathological images and clinical data of 365 cases with HCC were obtained from TCGA (The Cancer Genome Atlas), and 60 of HCC pathology images and cancer lesion annotations were collected from PAIP2019 [1]. DenseNet-based HCC segmentation model (F1-score, 0.904) and Hover-Net-based cell detection model (F1-score, 0.914) were developed using PAIP2019 and MoNuSac datasets, respectively [2,3,4]. Each histopathology image of TME was segmented via the segmentation model into two areas: 1) non-tumoral regions that include the stroma; 2) tumoral regions where HCC cells are concentrated. The cell detection model recognized individual cells on images, specified lymphocytes, and calculated ratios of lymphocyte to total cell count (RLTCC) in segmented regions. RLTCC was then correlated with clinical survival outcomes, HCC primary risk factors, and RNA expression profiles. Results: RLTCC in tumoral regions was not significantly associated with prognosis. Patient groups with higher RLTCC in non-tumoral regions (RLTCC in NT) showed better overall survival (OS) than those with lower RLTCC in NT regardless of HCC risk factors (median OS 45.7 vs 18.6 months; log hazard ratio of -1.6 ± 1.1, p=0.006). These patients had significantly enriched expression of genes (p<0.05) related to cancer antigen presentation (higher gene expression by +33.7%), recognition of cancer cells by T-cell (+32.0%), T-cell priming and activation (+32.2%), immune cell localization to tumors (+31.9%), and killing of cancer cells (+24.7%). Those with HCC etiology of hepatitis B and C had more patients in the higher RLTCC in NT (17/21 patients, 81.0%; 23/29, 79.3%, respectively). In comparison, those with alcohol consumption showed equal distribution (26/53, 49.1%). The RLTCC in NT in hepatitis B/C groups was statistically higher than alcohol consumption group (p<0.05). Conclusions: A digital prognostic biomarker, RLTCC in NT of TME was identified as a significant prognostic indicator, and it was shown to correlate with RNA gene expression related to T-cell mediated cancer immunity. A retrospective analysis of clinical response from systemic therapy in relation to digital biomarkers is underway and will be reported. References: [1] Kim et al. Med. Image Anal. 67 (2021). [2] Riasatian, Abtin, et al. Med. Image Anal. 70 (2021). [3] Graham, Simon, et al. Med. Image Anal. 58 (2019). [4] Verma, Ruchika, et al. IEEE Trans Med Imaging 39.1380-1391 (2020).
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Affiliation(s)
| | | | | | | | - Ahmed Omar Kaseb
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sunyoung S. Lee
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Dharmapuri S, Ozbek U, Saeed A, Muzaffar M, Amara S, Personeni N, Pressiani T, Nishida N, Paul S, Bettinger D, Khan U, Fessas P, Huang YH, Kaseb AO, Pillai A, Rimassa L, Pinato DJJ, Ang C. Relationship between systemic inflammatory response markers and immune treatment related toxicity (IrAEs) in hepatocellular carcinoma (HCC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e16204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16204 Background: A well-recognized class effect of immune check point inhibitors (ICI) is IrAEs ranging from low grade toxicities to life-threatening end organ damage requiring permanent discontinuation of ICI. Treatment related deaths are reported in ̃5% of patients (pts) treated with ICI. There are, however, no reliable markers to predict the onset & severity of IrAEs. We tested the association between neutrophil-lymphocyte ratio (NLR) & platelet-lymphocyte ratio (PLR) at baseline with development of clinically significant IrAE (graded ≥2) in HCC pts treated with ICI. Methods: Data was extracted from a large international database from a consortium of 11 tertiary-care referral centers located in the USA, Europe & Asia. NLR=Absolute neutrophil count/ Absolute lymphocyte count (ALC) & PLR=Platelet count/ALC. A cutoff of 5 for was used NLR & 300 for PLR based on literature. We also tested the association between antibiotic & steroid exposure to IrAEs. Results: Clinical data was collected from 361 pts treated between 2016–2020 across the USA (66%), Asia (12%) & Europe (22%) in this multinational database. Most pts received Nivolumab monotherapy (n=318, 74%). 167 (46%) pts developed at least one IrAE, highest grade 1 in 80 (48%), grade ≥2 in 87(52%) pts. Baseline characteristics did not differ significantly between the groups (Table). In a univariable regression model to predict grade ≥2 IrAEs, a PLR >300 was associated with a lower incidence of clinically significant IrAEs (OR = 0.40; p=0.044). NLR >5 was associated with a trend toward lower incidence of clinically significant IrAEs (OR = 0.58; p=0.097). Multivariate analyses confirmed PLR as independent predictive marker of grade ≥2 IrAEs (OR = 0.24; p=0.007). Antibiotics use was not associated with IrAE incidence (OR = 1.02; p=0.954). Steroid use was associated with a >2-fold higher incidence of grade ≥2 IrAEs (OR = 2.74; p<0.001), though it may be noted that 37% of pts received steroids for treatment of IrAEs. Conclusions: Lower NLR & PLR may predict the appearance of IrAEs in HCC treated with ICI, although this conclusion warrants prospective validation. This finding is in keeping with several studies that showed improved survival in pts who develop of IrAEs & have a lower NLR & PLR.[Table: see text]
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Affiliation(s)
- Sirish Dharmapuri
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Umut Ozbek
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anwaar Saeed
- University of Kansas Cancer Center, Westwood, KS
| | | | | | | | | | | | - Sonal Paul
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - Dominik Bettinger
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Uqba Khan
- Weill Cornell Medical College, New York, NY
| | - Petros Fessas
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ahmed Omar Kaseb
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anjana Pillai
- Section of Gastroenterology, Hepatology & Nutrition, The University of Chicago Medicine, Chicago, IL
| | | | | | - Celina Ang
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital, New York, NY
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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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8
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Sigal D, Bhangoo MS, Frenette CT, Lee SS, Fark C, Gineste P, Vissian A, Teyton L, Pearce TE, Kaseb AO. A phase 1 study of ABX196 in combination with nivolumab in patients with previously treated hepatocellular carcinoma (HCC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
429 Background: ABX196, a synthetically modified α-galactosylceramide (α-GalCer), activates invariant NKT (iNKT) cells and produced anti-tumor activity in Hepa 106 xenograft HCC models. Pre-administration of anti-PD1 antibodies prevented α-GalCer-induced iNKT cell anergy and may also enhance iNKT cell-induced T cell response. We report on a phase 1 study evaluating the combination of ABX196 plus nivolumab (N) in HCC patients previously treated with at least 1 line of prior systemic therapy. Methods: In a 3+3 dose escalation design, intramuscular ABX196 was dosed at 0.1, 0.2, or 0.4 µg 120 mins after N infusion on day 1 of every other 28-day cycle. N (240mg) was administered intravenously on day 1 and 15 of each cycle. Key objectives were to assess safety, MTD, and signs of clinical benefit. Study endpoints included incidence and severity of AEs, laboratory parameters, DLTs, ORR, and PFS. Results: 10 patients (8 males, 2 females) were enrolled: median age, 66y (49-76y); median # of prior systemic therapies, 2 (1-3), including 9 patients with prior immune checkpoint inhibitor (ICI) therapy; median # of ABX196 doses, 2.5 (1-8). There were 76 AEs (95% G1/G2) and 1 non-treatment related SAE. Common non-serious AEs included diarrhea (6), malaise/fatigue (6), AST/ALT increase (6), and only 1 injection site reaction. Maximum administered dose was 0.4 μg; MTD not reached. Clinical benefit was observed in 5 patients (50%) including 1 patient with a PR (ORR 10%) and 4 patients with SD (40%). Of these 5 patients, 3 had viral hepatitis. Median PFS for all patients was 113.5 days (49-450 days), but for those with clinical benefit it was 276 days (172-450 days). Conclusions: ABX196 plus N was very well tolerated without any DLTs or treatment emergent SAEs. In this small but heavily pre-treated HCC population, ABX196 plus N demonstrated promising signals of clinical benefit, including in patients with previous ICI therapy. These results support further clinical development of ABX196 in the front-line HCC setting. Clinical trial information: NCT03897543. [Table: see text]
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Affiliation(s)
- Darren Sigal
- Department of Hematology and Oncology, Scripps Clinic and Scripps MD Anderson Cancer Center, San Diego, CA
| | | | | | - Sunyoung S. Lee
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christine Fark
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Ahmed Omar Kaseb
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
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9
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Kaseb AO, Kappadath SC, Lee SS, Raghav KP, Mohamed YI, Xiao L, Morris JS, Ohaji C, Avritscher R, Odisio BC, Kuban J, Abdelsalam ME, Chasen B, Elsayes KM, Elbanan M, Wolff RA, Yao JC, Mahvash A. A Prospective Phase II Study of Safety and Efficacy of Sorafenib Followed by 90Y Glass Microspheres for Patients with Advanced or Metastatic Hepatocellular Carcinoma. J Hepatocell Carcinoma 2021; 8:1129-1145. [PMID: 34527608 PMCID: PMC8437411 DOI: 10.2147/jhc.s318865] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/13/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose The most common cause of death in advanced/metastatic hepatocellular carcinoma (HCC) is liver failure due to tumor progression. While retrospective studies and meta-analyses of systemic therapy combined with liver-directed therapy have been performed, prospective studies of safety/efficacy of antiangiogenesis followed by intra-arterial therapies are lacking. We tested our hypothesis that sorafenib followed by yttrium 90 glass microspheres (90Y GMs) is safe and that survival outcomes may improve by controlling hepatic tumors. Methods We enrolled 38 Child–Pugh A patients with advanced/metastatic HCC. In sum, 34 received sorafenib, followed after 4 weeks by 90Y GMs. Analysis of safety and survival outcomes was performed to assess adverse events, median progression-free survival, and overall survival. Results A total of 34 patients were evaluable: 14 (41.2%) with chronic hepatitis, nine (26.5%) with vascular invasion, and eleven (32.4%) with extrahepatic diseases. Safety analysis revealed that the combination therapy was well tolerated. Grade III–IV adverse events comprised fatigue (n=3), diarrhea (n=2), nausea (n=1), vomiting (n=2), hypertension (n=4), thrombocytopenia (n=1), hyperbilirubinemia (n=1), proteinuria (n=1), hyponatremia (n=1), and elevated alanine or aspartate aminotransferase (n=5). Median progression-free and overall survival were 10.4 months (95% CI 5.8–14.4) and 13.2 months (95% CI 7.9–18.9), respectively. Twelve patients (35.3%) achieved partial responses and 16 (47.0%) stable disease. Median duration of sorafenib was 20 (3–90) weeks, and average dose was 622 (466–800) mg daily. Dosimetry showed similar mean doses between planned and delivered calculations to normal liver and tumor:normal liver uptake ratio, with no significant correlation with adverse events at 3 and 6 months post-90Y treatment. Conclusion This is the first prospective study to evaluate sorafenib followed by 90Y in patients with advanced HCC. The study validated our hypothesis of safety with encouraging efficacy signals of the sequencing treatment, and provides proof of concept for future combination modalities for patients with advanced or metastatic HCC. Clinical Trial Registration Number NCT01900002.
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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
| | - S Cheenu Kappadath
- Department of Imaging Physics, 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
| | - Kanwal Pratap Raghav
- 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
| | - Lianchun Xiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Morris
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chimela Ohaji
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rony Avritscher
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bruno C Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joshua Kuban
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mohamed E Abdelsalam
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Beth Chasen
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Khaled M Elsayes
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mohamed Elbanan
- Department of Diagnostic Imaging, 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 C Yao
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Armeen Mahvash
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Morris JS, Hassan MM, Zohner YE, Wang Z, Xiao L, Rashid A, Haque A, Abdel-Wahab R, Mohamed YI, Ballard KL, Wolff RA, George B, Li L, Allen G, Weylandt M, Li D, Wang W, Raghav K, Yao J, Amin HM, Kaseb AO. HepatoScore-14: Measures of Biological Heterogeneity Significantly Improve Prediction of Hepatocellular Carcinoma Risk. Hepatology 2021; 73:2278-2292. [PMID: 32931023 PMCID: PMC7956911 DOI: 10.1002/hep.31555] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 02/20/2020] [Revised: 06/02/2020] [Accepted: 07/02/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Therapeutic, clinical trial entry and stratification decisions for hepatocellular carcinoma (HCC) are made based on prognostic assessments, using clinical staging systems based on small numbers of empirically selected variables that insufficiently account for differences in biological characteristics of individual patients' disease. APPROACH AND RESULTS We propose an approach for constructing risk scores from circulating biomarkers that produce a global biological characterization of individual patient's disease. Plasma samples were collected prospectively from 767 patients with HCC and 200 controls, and 317 proteins were quantified in a Clinical Laboratory Improvement Amendments-certified biomarker testing laboratory. We constructed a circulating biomarker aberration score for each patient, a score between 0 and 1 that measures the degree of aberration of his or her biomarker panel relative to normal, which we call HepatoScore. We used log-rank tests to assess its ability to substratify patients within existing staging systems/prognostic factors. To enhance clinical application, we constructed a single-sample score, HepatoScore-14, which requires only a subset of 14 representative proteins encompassing the global biological effects. Patients with HCC were split into three distinct groups (low, medium, and high HepatoScore) with vastly different prognoses (medial overall survival 38.2/18.3/7.1 months; P < 0.0001). Furthermore, HepatoScore accurately substratified patients within levels of existing prognostic factors and staging systems (P < 0.0001 for nearly all), providing substantial and sometimes dramatic refinement of expected patient outcomes with strong therapeutic implications. These results were recapitulated by HepatoScore-14, rigorously validated in repeated training/test splits, concordant across Myriad RBM (Austin, TX) and enzyme-linked immunosorbent assay kits, and established as an independent prognostic factor. CONCLUSIONS HepatoScore-14 augments existing HCC staging systems, dramatically refining patient prognostic assessments and therapeutic decision making and enrollment in clinical trials. The underlying strategy provides a global biological characterization of disease, and can be applied broadly to other disease settings and biological media.
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Affiliation(s)
- Jeffrey S Morris
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Manal M Hassan
- Department of Epidemiology, the University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Zeya Wang
- Department of Statistics, Rice University, Houston, TX
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lianchun Xiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Asif Rashid
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Abedul Haque
- Department of Hematopathology, the University of Texas MD Anderson Cancer Center, Houston, TX
| | - Reham Abdel-Wahab
- Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yehia I Mohamed
- Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Robert A Wolff
- Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bhawana George
- Department of Hematopathology, the University of Texas MD Anderson Cancer Center, Houston, TX
| | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Genevera Allen
- Department of Statistics, Rice University, Houston, TX
- Department of Computer Science, Rice University, Houston and Jan and Dan Duncan Neurological Institute, Baylor College of Medicine, Houston, TX
| | | | - Donghui Li
- Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wenyi Wang
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kanwal Raghav
- Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX
| | - James Yao
- Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hesham M Amin
- Department of Hematopathology, the University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ahmed Omar Kaseb
- Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX
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Tsimberidou AM, de Achaval S, Alibhai I, Kaseb AO. First-in-man phase I clinical trial evaluating TTI-101, an orally bioavailable, small molecule inhibitor of STAT3, in patients with advanced solid tumors. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps3158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS3158 Background: Signal transducer and activator of transcription 3 (STAT3) is a transcription factor that is a key signaling node and a master regulator of the key hallmarks of cancer, including tumor angiogenesis, resistance to apoptosis, metastasis, and immune evasion. STAT3 activation is observed in ̃70% of all cancers and up to 95% of hepatocellular carcinomas (HCC). Thus, inhibition of STAT3 signaling is expected to have a therapeutic effect against a wide range of cancers. TTI-101 is a first-in-class, orally bioavailable, selective small molecule that binds STAT3 and prevents phosphorylation, homodimerization, nuclear translocation, and ultimately, STAT3-mediated transcriptional activity. TTI-101 has demonstrated anti-tumor activity across a broad range of preclinical cancer models, including a Hep Pten- (hepatocyte-specific deletion of Pten) murine model of liver cancer, which recapitulates the pathogenesis of HCC in non-alcoholic fatty liver disease (NAFLD) with chronic inflammation and liver fibrosis leading to cancer at 11 months. TTI-101 treatment starting at 11 months arrested tumor growth as well as reversed liver injury and fibrosis (1). Given these findings, a clinical trial is being conducted examining the effect of this novel, targeted therapeutic agent in patients with advanced solid malignancies. Methods: This single-site Phase I trial (NCT03195699) is evaluating TTI-101 as monotherapy in patients with advanced solid tumors who are refractory to prior therapies. The primary objectives of this dose-escalation study include establishing tolerability and safety at each dose level, pharmacokinetics (PK), and establishing the recommended phase 2 dose (RP2D). The secondary and exploratory objectives include assessing clinical outcomes of patients and pharmacodynamics (PD) of TTI-101 via timed, paired tumor biopsies. The initial dose-escalation study is stratified by disease type (HCC and non-HCC) with independent dose-escalation schemas and will be followed by dose expansion cohorts where safety, PK and PD will be evaluated. TTI-101 is administered orally, twice daily for a 28-day cycle. Key eligibility criteria include: 18 years of age or older, having metastatic or unresectable solid tumor refractory to standard therapies, and measurable disease as defined by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, an Eastern Cooperative Oncology Group (ECOG) score of 0-2, and normal organ function. Additional criteria are specified for patients with HCC including Child-Pugh class A. HCC cohorts 1-4 and non-HCC cohorts 1-3 have been completed without dose limiting toxicities (DLTs). Enrollment to the HCC dose expansion began in February 2021. 1. Jung KH, et al. Multifunctional Effects of a Small-Molecule STAT3 Inhibitor on NASH and Hepatocellular Carcinoma in Mice. Clin Cancer Res. 2017;23(18):5537-46. Clinical trial information: NCT03195699.
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Affiliation(s)
| | | | | | - Ahmed Omar Kaseb
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
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12
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Cortellini A, Marron TU, Mishra-Kalyani PS, Gong Y, Saeed A, Jun T, Dharmapuri S, Naqash AR, Khan U, Kaseb AO, Huang YH, Ang C, Schneider JA, Pillai A, Rimassa L, Pazdur R, Theoret MR, Lemery S, Pelosof LC, Pinato DJ. Treatment-related toxicity and improved outcomes with immune checkpoint inhibitors in patients with hepatocellular carcinoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.4085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4085 Background: The development of treatment-related adverse events (trAE) correlates favorably with clinical outcomes in multiple studies of patients receiving immune checkpoint inhibitors (ICI), however, this relationship is undefined in patients with hepatocellular carcinoma (HCC). This retrospective multi-center study aimed to examine whether trAEs are prognostic in HCC. Methods: We established an international consortium of 10 tertiary-care referral centers located in Europe (n = 67), United States (US, n = 248) and Asia (n = 42) to test whether the development of clinically significant trAE (i.e. graded >2, trAE2) predicted for improved overall (OS), progression-free survival (PFS), and overall response rates (ORR) following ICI, and subsequently validated this association in a separate cohort of 406 HCC patients receiving ICI therapy as part of international clinical trials submitted to the US Food and Drug Administration (FDA) in support of marketing applications. Results: In a multi-institutional cohort of 357 patients, 274 (77%) with Barcelona Clinic Liver Cancer (BCLC) stage C HCC mostly treated with ICI monotherapy (n = 304, 85%), trAE were reported in 146 patients (41%). Development of trAE2 were associated with longer OS (23.3 versus 12.2 months) and PFS (8.6 months versus 3.7 months). After adjusting for viral aetiology, gender, presence of cirrhosis, Child-Pugh class, BCLC stage, AFP levels, ECOG-PS, ICI regimen (mono/combination therapy) and receipt of corticosteroid therapy, trAE2 were confirmed predictors of improved OS (HR 0.55; 95%CI:0.34-0.88) and PFS (HR 0.51; 95%CI: 0.35-0.74). TrAE2 were associated with higher ORR (27% versus 16%) from ICI. The association between trAE2 and patients’ OS (HR 0.49; 95%CI:0.34-0.70) and PFS (HR 0.43; 95%CI:0.32-0.59) was also observed in the FDA dataset. After a 6-weeks landmark selection, trAE2 were confirmed to be associated with improved PFS (HR 0.59; 95%CI:0.39-0.87); the additional analysis adjusted for tumour response and duration of treatment within the FDA cohort further confirmed the association with longer PFS (HR 0.67; 95%CI: 0.47-0.94). Conclusions: Development of trAE2 may correlate with response and survival in patients with HCC receiving ICI, a clinical setting where the lack of biomarkers still represents an unmet need. Prospective studies aimed at understanding the underlying immunologic foundations of such relationship are warranted to identify predictive biomarkers of toxicity and response.
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Affiliation(s)
- Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Thomas Urban Marron
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Yutao Gong
- U.S. Food and Drug Administration, Silver Spring, MD
| | - Anwaar Saeed
- Kansas University Cancer Center, Kansas City, KS
| | - Tomi Jun
- Tisch Cancer Institute, Mount Sinai Hospital, New York, NY
| | - Sirish Dharmapuri
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Abdul Rafeh Naqash
- Developmental Therapeutics Clinic/Early Clinical Trials Development Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Uqba Khan
- Weill Cornell Medical College, New York, NY
| | - Ahmed Omar Kaseb
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Celina Ang
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital, New York, NY
| | | | - Anjana Pillai
- Section of Gastroenterology, Hepatology & Nutrition, the University of Chicago Medicine, Chicago, IL
| | | | | | - Marc Robert Theoret
- National Cancer Institute at the National Institutes of Health, Bethesda, MD
| | - Steven Lemery
- U.S. Food and Drug Administration, Silver Spring, MD
| | | | - David James Pinato
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
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Park J, Kim K, Lee HS, Kang G, Jung KH, Kaseb AO, Lee SS. Impact of cell density in lymphocyte-rich areas in the tumor microenvironment on prognosis and gene expression landscape in hepatocellular carcinoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.4107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4107 Background: Cellular and non-cellular components in the tumor microenvironment (TME) impact prognosis and treatment in hepatocellular carcinoma (HCC). We previously reported a deep learning-based model of tissue segmentation in pathology images, showing an impact of stromal and malignant cell distribution with respect to gene expression on survival and molecular subtypes of cancer [1]. Methods: Clinical outcomes data, mRNA-seq, and histopathology images of 351 patients (pts) with HCC were obtained from TCGA. We established a combined algorithm of two deep learning models: ResNet-based model for tissue segmentation; YOLO-based model for cell detection, using published data sets [2, 3]. The tissue segmentation model defines six segments having following predominant components: malignant cells, lymphocytes, adipose, stromal, mucinous, and normal liver tissues. The cell detection model calculates density and mapping of cells in the TME. The immune landscape was analyzed via mRNA-seq of 770 genes enriched in TME. This comprehensive analysis defined parameters including the cell density per lymphocyte segmented area (CDpLA), representing the density of lymphocytes on a lymphocyte-rich area in TME. Results: Pts were clustered into two groups with high and low CDpLA (212 and 139 pts). High CDpLA was defined as lymphocyte density > 0.5 (13,618 cells/mm2 lymphocyte area). Pts with high CDpLA showed significantly better median overall survival (OS) than those with low CDpLA (82.9 vs 37.8 month, p < 0.005). The hazard ratio of CDpLA in OS was 0.36 (95% CI 0.18-0.72, p < 0.005). Among pts with available clinical data, 29 and 21 pts were with hepatitis C (HCV) and hepatitis B (HBV). Out of 29 HCV pts, 23 and 6 pts were with high and low CDpLA; out of 21 HBV pts, 17 and 4 pts were with high and low CDpLA. Fifty three were with alcoholic abuse, and 26 and 27 pts were with high and low CDpLA. Of note, pts with high CDpLA had significantly better OS in HCV pts (61.7 vs 19.9 months, p < 0.005). Genomic analysis with mRNA-seq shows that HCV pts with high CDpLA have lower expression of genes related to myeloid-derived suppressor cells (TRANK1, MEGF9, HS3ST2, GPNMB) and higher in genes related to immune activation (PLD4, IL3RA, TNFRSF4). Conclusions: A deep learning-assisted model of TME segmentation and cell detection showed an impact on survival from CDpLA, rather than the total number of lymphocytes in the TME. HCV pts are more likely to have higher CDpLA, and CDpLA was a strong prognostic indicator in HCV pts. Pts with high CDpLA are those with elevated expression of genes related to immune activation and decreased expression of immunosuppressive genes. Retrospective and prospective analysis of clinical response to immunotherapy and tyrosine kinase inhibitors is underway. [1] Kim et al. Cancer Res 2020 (80) (16 Supp) 2631 [2] Kather et al. PLoS Med 2019 16(1): e1002730 [3] Gamper et al. arXiv 2020:10778
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Affiliation(s)
| | | | | | | | | | - Ahmed Omar Kaseb
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
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14
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Finn RS, Qin S, Ikeda M, Galle PR, Ducreux M, Kim TY, Lim HY, Kudo M, Breder VV, Merle P, Kaseb AO, Li D, Verret W, Shao H, Liu J, Li L, Zhu AX, Cheng AL. IMbrave150: Updated overall survival (OS) data from a global, randomized, open-label phase III study of atezolizumab (atezo) + bevacizumab (bev) versus sorafenib (sor) in patients (pts) with unresectable hepatocellular carcinoma (HCC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.267] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
267 Background: Atezo + bev has been approved globally for pts with unresectable HCC who have not received prior systemic therapy, based on results from IMbrave150 (NCT03434379). At a median of 8.6 mo follow-up, both coprimary endpoints were met, with statistically significant and clinically meaningful improvements observed with atezo + bev vs sor for OS (HR, 0.58 [95% CI, 0.42, 0.79]; P<0.001) and independently-assessed progression-free survival (PFS; per RECIST 1.1; HR, 0.59 [95% CI, 0.47, 0.76]; P<0.001) (Finn, et al. N Engl J Med 2020). Here, we report an updated OS analysis for IMbrave150. Methods: The global, multicenter, randomized, open-label, Phase III study IMbrave150 enrolled 501 systemic treatment–naive pts with unresectable HCC, ≥1 measurable untreated lesion (RECIST 1.1), Child-Pugh class A liver function and ECOG PS 0/1. Pts were randomized 2:1 to receive either atezo 1200 mg IV q3w + bev 15 mg/kg IV q3w or sor 400 mg bid until unacceptable toxicity or loss of clinical benefit per investigator. This post hoc, descriptive OS analysis was conducted with 12 mo of additional follow up from the primary analysis. Results: 501 pts were enrolled, including 336 to atezo + bev and 165 to sor. At the clinical cut-off date of Aug 31, 2020, median follow-up was 15.6 mo and 280 OS events were observed. Median OS was 19.2 mo with atezo + bev vs 13.4 mo with sor (HR, 0.66 [95% CI, 0.52, 0.85]; P=0.0009). Survival at 18 mo was 52% with atezo + bev and 40% with sor. Survival benefit with atezo + bev over sor was generally consistent across subgroups and with the primary analysis. The updated objective response rate (ORR; 29.8% per RECIST 1.1) with atezo + bev was in line with the primary analysis, with more pts achieving complete response (CR; 7.7%) than previously reported. Additional response data are in Table. Safety was aligned with the primary analysis, with no new signals identified. Conclusions: IMbrave150 showed consistent clinically meaningful treatment benefit and safety with 12 mo of additional follow-up. The combination provides the longest survival seen in a front-line Phase III study in advanced HCC, confirming atezo + bev as a standard of care for previously untreated, unresectable HCC. Clinical trial information: NCT03434379. [Table: see text]
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Affiliation(s)
- Richard S. Finn
- Jonsson Comprehensive Cancer Center, Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Shukui Qin
- People’s Liberation Army Cancer Center, Nanjing, China
| | | | | | | | - Tae-You Kim
- Seoul National University College of Medicine, Seoul, South Korea
| | - Ho Yeong Lim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | | | | | - Daneng Li
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
| | | | - Hui Shao
- Roche Product Development, Shanghai, China
| | - Juan Liu
- Roche Product Development, Shanghai, China
| | - Lindong Li
- Roche Product Development, Shanghai, China
| | - Andrew X. Zhu
- Harvard Medical School, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Ann-Lii Cheng
- National Taiwan University Cancer Center and National Taiwan University Hospital, Taipei, Taiwan
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Kothari AN, Gaskill C, David Tzeng CW, Shin Chun Y, Omar Kaseb A, Anthony Aloia T, Nicolas Vauthey J, Sanderson Tran Cao H. Hospital Variation in Treatment Outcomes for High-Risk Hepatocellular Carcinoma: Where You Go Matters. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Ismail MS, Hassan M, Khaderi SA, Yousry WA, Kamal El-Din MM, Bahaa El-Din MM, El Sayed OA, Kaseb AO, Goss JA, Kanwal F, Jalal PK. Clinical efficacy of direct-acting antiviral therapy for recurrent hepatitis C virus infection after liver transplantation in patients with hepatocellular carcinoma. World J Hepatol 2020; 12:628-640. [PMID: 33033569 PMCID: PMC7522560 DOI: 10.4254/wjh.v12.i9.628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/03/2020] [Accepted: 08/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Recurrent hepatitis C virus (HCV) infection of transplanted liver allografts is universal in patients with detectable HCV viremia at the time of transplantation. Direct-acting antiviral (DAA) therapy has been adopted as the standard of care for recurrent HCV infection in the post-transplant setting. However, there are insufficient data regarding its efficacy in liver transplant (LT) recipients with a history of hepatocellular carcinoma (HCC), and the risk of HCC recurrence after DAA therapy is unknown.
AIM To demonstrate predictors of DAA treatment failure and HCC recurrence in LT recipients.
METHODS A total of 106 LT recipients given DAAs for recurrent HCV infection from 2015 to 2019 were identified (68 with and 38 without HCC). Descriptive statistics and logistic regression models were used to estimate the multivariate odds ratios and respective 95% confidence intervals for predictors of treatment failure and HCC recurrence.
RESULTS Six patients (6%) experienced DAA therapy failure post-LT and 100 (94%) had a sustained virologic response at follow-up week 12. A high alanine transaminase level > 35 U/L at treatment week 4 was a significant predictor of treatment failure. Relapse to pre-LT DAA therapy is a predictor of post-LT HCC recurrence, P = 0.04. DAA relapse post-LT was also associated with post-transplantation HCC recurrence, P = 0.05.
CONCLUSION DAAs are effective and safe in the treatment of recurrent HCV infection in LT recipients with history of HCC. Relapse to pre- and post-LT DAA therapy is associated with post-transplantation HCC recurrence.
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Affiliation(s)
- Mohamed Saleh Ismail
- Division of Gastroenterology, Baylor College of Medicine, Houston, TX 77030, United States
- Department of Internal medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
- Department of Surgery, Division of Abdominal Transplantation, Baylor College of Medicine, Houston, TX 77030, United States
| | - Manal Hassan
- Division of Gastroenterology, Baylor College of Medicine, Houston, TX 77030, United States
- Department of Epidemiology, the University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Saira Aijaz Khaderi
- Division of Gastroenterology, Baylor College of Medicine, Houston, TX 77030, United States
- Department of Surgery, Division of Abdominal Transplantation, Baylor College of Medicine, Houston, TX 77030, United States
| | - Wael Ahmed Yousry
- Department of Internal medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
| | - Maha Mohsen Kamal El-Din
- Department of Internal medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
| | | | - Osama Aboelfotoh El Sayed
- Department of Internal medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
| | - Ahmed Omar Kaseb
- Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - John Alan Goss
- Department of Surgery, Division of Abdominal Transplantation, Baylor College of Medicine, Houston, TX 77030, United States
| | - Fasiha Kanwal
- Division of Gastroenterology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Prasun Kumar Jalal
- Division of Gastroenterology, Baylor College of Medicine, Houston, TX 77030, United States
- Department of Surgery, Division of Abdominal Transplantation, Baylor College of Medicine, Houston, TX 77030, United States
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17
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Fessas P, Kaseb AO, Wang Y, Saeed A, Szafron D, Jun T, Dharmapuri S, Naqash AR, Khan U, Yu B, Paul SD, Nimkar NS, Bettinger D, Hildebrand H, Mohamed YI, Huang YH, Rimassa L, Ang C, Marron TU, Pinato DJ. Post-registration experience of nivolumab (nivo) therapy in patients with advanced hepatocellular carcinoma (HCC): An international study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16677 Background: Nivo is FDA-approved in sorafenib-experienced, advanced HCC. Post-registration data to portray treatment in a real-world setting is lacking. Methods: We describe safety and efficacy of nivo in patients (pts) from 8 centres (USA n = 181, Asia n = 47, Europe n = 5), documenting overall (OS), progression-free survival (PFS), overall response (ORR) and disease control rates (DCR) (RECIST). Results: We analysed 233 pts, mostly cirrhotic (n = 176, 75%) due to hepatitis C (n = 95, 54.0%) with Barcelona Clinic Stage (BCLC) C HCC (n = 178, 76.4%), Child-Pugh class (CP) A (n = 158, 67.8%) or B (n = 75, 32.2%), and AFP > 400 IU/mL (n = 132, 56.7%). Nivo was given as first (1L, n = 85, 36.5%), second line (2L, n = 130, 55.8%) or > 2L (n = 18, 7.7%), after local (n = 191, 82%) and systemic therapy (n = 148, 63.5%), mostly sorafenib (n = 142, 60.9%). Median duration of nivo was 6.0 months (mo, interquartile range [IQR] 2.6-11.9) and stopped due to progression (n = 109, 46.8%) or toxicity (n = 8, 3.4%). After median follow up of 7 mo (IQR 3.0-12.3), ORR was 22.4% and DCR was 52.1%. Best responses (n = 219, 94%) included complete and partial responses in 18 (7.7%) and 31 (13.3%) pts respectively, stable disease in 65 (27.9%) and progressive disease in 105 (45.1%), not dissimilar by CP (p = 0.26). Median OS was 12.2 mo (95%CI 8.4-16.0) and predicted by CP (CPA 16.3 mo 95%CI 11.7-20.8; CPB 7.3 mo 95%CI 4.2-10.4; hazard ratio [HR] 1.9, p = 0.01), nivo line (1L 16.3 mo 95%CI 8.0-24.5; > 1L 10.4 mo 95%CI 7.4-13.5; HR 0.68, p = 0.05), and PVT (PVT- 13.8 mo 95%CI 11.7-16.0; PVT+ 10.4 mo 95%CI 7.8-13.0; HR 1.8, p = 0.015) but not cirrhosis, AFP, BCLC or steroid use (p > 0.05). Median PFS was 10.1 mo (95%CI 6.1-14.2), predicted by BCLC (A-B 19.0 mo 95%CI 7.1-30.8; C 8.2 mo 95%CI 4.9-11.4; HR 2.8, p = 0.002) and line (1L 18.2 mo 95%CI 10.4-25.9; > 1L 8.2 mo 95% CI 6.2-10.2; HR 0.60, p = 0.021), but not cirrhosis, AFP, or steroid use (p > 0.05). 26 pts (11.2%) suffered > = Grade 2 toxicities, most commonly fatigue (n = 29, 24.7%). Conclusions: Real-world use of nivo in advanced HCC across line of therapy suggests reproducible clinical efficacy and safety compared to prospective trials.
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Affiliation(s)
- Petros Fessas
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Ahmed Omar Kaseb
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yinghong Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anwaar Saeed
- University of Kansas Medical Center, Kansas City, KS
| | | | - Tomi Jun
- Tisch Cancer Institute, Mount Sinai Hospital, New York, NY
| | - Sirish Dharmapuri
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Abdul Rafeh Naqash
- Division of Hematology/Oncology, East Carolina University, Greenville, NC
| | - Uqba Khan
- Weill Cornell Medical College, New York, NY
| | - Bo Yu
- Lincoln Medical Center, New York, NY
| | - Sonal D Paul
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | | | - Dominik Bettinger
- Department of Medicine II, Medical Center University of Freiburg, Freiburg, Germany
| | | | | | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | - Celina Ang
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital, New York, NY
| | - Thomas Urban Marron
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David James Pinato
- Department of Surgery and Cancer, Imperial College, London, London, United Kingdom
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18
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Lee SS, Mohamed YI, Lee SH, Baird A, Dolan J, furqan F, Kaseb AO. Risk score and prognostication modeling based on mRNA expressivity in the tumor microenvironment of hepatocellular carcinoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16658 Background: Stromal elements in the tumor microenvironment (TME) impact prognosis and response to therapy. Advances in mRNA-sequencing improved understanding of gene expressivity, but few models exist to model prognosis in association with mRNA expression. Methods: Clinical data and mRNA-seq of 256 patients (pts) with hepatocellular carcinoma (HCC) were obtained from TCGA. The expressivity of 191 genes enriched in cellular and structural components of the TME and clinical data were analyzed using machine learning, multivariable COX model, and Kaplan-Meier (KM) analysis to model risk score (RS) for prediction of prognosis. Results: Prognostication was modeled with higher risk score (RS) representing worse prognosis. Gene expression associated with poor (P) and good (G) in stage 1 and 2 HCC was identified (refer to presentation). RS (stage 1) = 5.997 - 0.589 × (Age at diagnosis−7.979E-06) - 4.818 × (P/G−0.009); RS (stage 2) = -5.704 - 0.780 × (Age at diagnosis−9.383E-06) + 7.228 × (P/G−0.004). Based on RS, pts were clustered into 2 groups in each stage - high and low RS groups, showing two KM curves with P < 0.05, HR = 3.213 (95% CI 2.212 – 4.347) in stage 1; HR = 2.733 (95% CI 2.131 – 3.426) in stage 2, confirming the validity of RS modeling. Analysis of immune profiles in high and low RS groups shows that expression of genes associated with immunosuppressive factors, desmoplastic reaction, neutrophils, and co-inhibitory factors of T-cells are higher in high RS group in both stages (p < 0.05). Conclusions: Machine learning-assisted mathematical modeling of RS and gene analysis identified TME-related genes and gene groups that are strongly associated with worse prognosis in stage 1 and 2 of HCC. RS could potentially prognosticate pts in the clinic with available genomic profiles.
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Affiliation(s)
- Sunyoung S. Lee
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Sung Hwan Lee
- CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | | | | | | | - Ahmed Omar Kaseb
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
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19
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Mohamed YI, Qayyum A, Hassan M, Xiao L, Duda DG, Hatia R, Lee SS, Wolff RA, Morris J, Altameemi L, Yao JC, Amin HM, Kaseb AO. IGF-Child-Turcotte-Pugh score as a predictor of treatment outcome in Child-Pugh A, advanced hepatocellular carcinoma patients undergoing sorafenib therapy. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16660 Background: Sorafenib is the first systemic therapy approved for advanced HCC treatment; with no accurate tool available to help predict survival and treatment outcome and to guide therapy decisions. Our novel blood-based insulin-like growth factor-1 (IGF)-Child-Turcotte-Pugh (CTP) score comprises levels of IGF-1, bilirubin, INR, and albumin. IGF-CP score significantly improved the prediction of HCC survival in our recently published studies. The current prospective study aimed to compare the overall survival (OS) and progression free survival (PFS) of 116 patients with CTP-A HCC treated with sorafenib whose score is reclassified as IGF-A (AA) to that of patients whose score is reclassified as IGF-B/C (AB/AC). Methods: After the approval of the institutional review boards and signing written informed consent, a total of 116 patients with HCC were prospectively enrolled and started on sorafenib and followed until progression or death. We calculated IGF-CTP scores, used Kaplan-Meier method and log rank test to estimate and compare time to event outcomes between subgroups of patients. Results: 116 patients were CTP class A, 87 of the patients with CTP class A were classified as IGF-CTP-A and had median OS of 13.16 ms (95% CI = 12.04 to 22.6 ms), and a median PFS of 5.82 months (ms) (95% CI = 4.34 to 9.14 ms), whereas 29 patients were reclassified as intermediate risk (IGF-CTP-B) and had had a higher risk of death with a shorter OS of 7.6 months (95% CI = 5.23 to 24.47 months) and shorter PFS of 3.49 months (95% CI = 2.53 to 5.26 months). There was higher overall rate of adverse events in the CTP-A patients reclassified as IGF-CTP B than IGF-CTP A especially in grade III-IV adverse events, upper GI Bleeding, lower GI Bleeding, nose bleeding, renal failure, liver failure, encephalopathy, fatigue, weight loss, anorexia, and vomiting. Conclusions: The results of this study support our biologically-driven hypothesis that among HCC patients with CTP-A class treated with sorafenib, those reclassified as IGF-CTP-B/C will have poorer prognosis in terms of shorter OS and PFS. Thus, our study provides an objective non-invasive strategy to better predict the outcome in HCC patients undergoing systemic therapy. Future validation of our IGF-1 score may lead to adopting it as a stratification tool in clinical trials as well as to predict HCC outcome and guide therapy decision in routine practice.
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Affiliation(s)
| | - Aliya Qayyum
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Manal Hassan
- The University of Texas-MD Anderson Cancer Center, Houston, TX
| | - Lianchun Xiao
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Rikita Hatia
- The University of Texas-MD Anderson Cancer Center, Houston, TX
| | | | - Robert A. Wolff
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey Morris
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lina Altameemi
- The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - James C. Yao
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hesham M. Amin
- The University of Texas-MD Anderson Cancer Center, Houston, TX
| | - Ahmed Omar Kaseb
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
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20
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Mohamed YI, Qayyum A, Hassan M, Xiao L, Duda DG, Hatia R, Lee SS, Wolff RA, Morris J, Altameemi L, Yao JC, Amin HM, Kaseb AO. Treatment outcome and prognostic indicators in 26 cases of fibrolamellar hepatocellular carcinoma under interferon based therapy. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16626 Background: Fibrolamellar hepatocellular carcinoma (FLHCC) is a variant of HCC that comprises ∼1%–9% of all HCCs, with about 200 annual cases reported globally, most often affects younger patients (10–35 years of age) with no underlying liver disease. There is no current standard of care therapy for unresectable FLHCC. We report an analysis of the treatment outcomes, and prognostic indicators of 26 cases. Methods: We retrospectively collected clinicopathologic and treatment outcome data from 26 FLHCC patients who received interferon alfa-2b (IFN) based therapy. Median overall survival (OS) and PFS were calculated using Kaplan-Meier curves, and survival rates were compared by the log-rank test. Results: 21 patient underwent treatment with continuous infusion (CI) 5-Fluorouracil (FU) at 200 mg/m2/day for 7 days on, 7 days off plus IFN at 4 million units/m2, subQ every other day for 7 days on, 7 days off, 1 patient FU+IFN+bevacizumab and 4 patients had PIAF (cisPlatin+IFN+Adriamycin+FU). Median age was 24 years (15-44), 13 males and 13 females, 8 of the 26 patients died, the median overall survival was 33.9 months (95% CI, 20.9, NA), estimated 3-year survival was 20.2% (95% CI: 4.1%, 98.5%), median follow up time was 13.4 months (95% CI: 9.79, NA) and median progression-free survival was 11.7 months (95% CI: 5.09, NA). The estimated 1-year survival was 47.9% (95% CI: 29.9%, 76.8%). Finally, FU+IFN combination was the most frequently used systemic therapy. 3/26 pts underwent surgical resection following neoadjuvant treatment with interferon based therapy; Interferon based therapy for the 26 patients had limited side effects, with only 3 of the 26 patients discontinued treatment due to grade 3-4 adverse event in the form of mucositis, severe fatigue and/or hematologic toxicity. Conclusions: Our analyses indicate that CI FU + IFN could be an effective treatment for FLHCC, and may have a neoadjuvant role in this disease with 3/26 were resectable following neoadjuvant treatment with interferon based therapy. This regimen can be well tolerated. Unfortunately, nonsurgical options for patients with FLC remain limited with no approved local or systemic therapies. Therefore, future research is needed to identify better multimodality therapies.
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Affiliation(s)
| | - Aliya Qayyum
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Manal Hassan
- The University of Texas-MD Anderson Cancer Center, Houston, TX
| | - Lianchun Xiao
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Rikita Hatia
- The University of Texas-MD Anderson Cancer Center, Houston, TX
| | | | - Robert A. Wolff
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey Morris
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lina Altameemi
- The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - James C. Yao
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hesham M. Amin
- The University of Texas-MD Anderson Cancer Center, Houston, TX
| | - Ahmed Omar Kaseb
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
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21
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Kaseb AO, Tran Cao HS, Mohamed YI, Qayyum A, Vence LM, Blando JM, Singh S, Lee SS, Raghav KPS, Altameemi L, Rashid A, Vauthey JN, Carter K, Tzeng CWD, Chun YS, Yao JC, Wolff RA, Allison JP, Sharma P. Final results of a randomized, open label, perioperative phase II study evaluating nivolumab alone or nivolumab plus ipilimumab in patients with resectable HCC. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4599] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4599 Background: In resectable hepatocellular carcinoma (HCC) surgical resection is associated with high recurrence rates. However, there is no approved neoadjuvant or adjuvant therapies yet. Neoadjuvant immunotherapy effect has never been reported in this setting in HCC. Methods: This is a randomized phase II trial of nivolumab (Arm A) or nivolumab + ipilimumab (Arm B) as peri-operative treatment for patients (pts) with HCC who are eligible for surgical resection. Pts in Arm A are given nivolumab 240 mg iv, every 2 weeks (wks) for a total of 3 doses followed by surgery on week 6. Pts in Arm B are treated with nivolumab per same schedule as arm A plus concurrent ipilimumab 1 mg/kg on day 1. Adjuvant part of study starts 4 weeks after surgery, with Nivolumab at 480 mg iv every 4 weeks for 2 years in arm A. Pts in Arm B are treated with nivolumab per same schedule as arm A plus concurrent ipilimumab 1 mg/kg every 6 weeks times 4 doses after resection. The primary objective was the safety/tolerability of nivolumab +/- ipilimumab. Secondary objectives include overall response rate, pathologic complete response (pCR) rate and time to progression. Exploratory objectives include evaluating the pre- and post-treatment immunological changes in tumor tissues and peripheral blood. Results: 30 patients were enrolled, 2 patients withdrew consent, one patient was not eligible at time of therapy, and 27 randomized (13 to Arm A and 14 to Arm B). 21 patients proceeded with resection as planned and surgery was aborted for 6 patients; 1 for frozen abdomen due to old surgery, 2 for small residual volume, and 3 for progressive disease. Pts age ranged between 32-83 yo, 75 % were males, 7 pts had HCV, 7 had HBV and 7 had no hepatitis. Pathologic complete response (pCR) was observed in 5/21 pts (24% pCR rate) – 2 in Arm A and 3 Arm B, and 3/21 pts (16%) – 1 in Arm A, 2 in Arm B, achieved major pathologic response (necrosis effect of 50-99%). 5 patients in Arm B and 1 in Arm A experienced grade 3 or higher toxicity prior to surgery. No grade 4 or higher toxicity were observed and surgery was not delayed or cancelled due to oxicity. Conclusions: Our study reached its primary endpoint of safety. Importantly, we report a 40% pathologic response rate = pCR rate of 24%, and major necrosis rate of 16% for resectable HCC after preoperative immunotherapy in a randomized phase II pilot trial. After future validation, these promising results may contribute to a paradigm shift in the perioperative treatment of resectable HCC. Clinical trial information: NCT03222076 .
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Affiliation(s)
- Ahmed Omar Kaseb
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Aliya Qayyum
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Luis M. Vence
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jorge M. Blando
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shalini Singh
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Lina Altameemi
- The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Asif Rashid
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Kristen Carter
- The University of Texas, Md Anderson Cancer Center, Houston, TX
| | | | - Yun Shin Chun
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James C. Yao
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert A. Wolff
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Padmanee Sharma
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Lee SS, Mohamed YI, Qayyum A, Hassan M, Xiao L, Duda DG, Hatia R, Wolff RA, Morris J, Altameemi L, Yao JC, Amin HM, Kaseb AO. The role of ALBI and IGF-CTP score in refining prognostication of HCC. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16659 Background: Child-Turcotte-Pugh (CTP) score is widely used in the assessment of prognosis of HCC and CTP-A is the standard criterion for active therapy and clinical trials entry. Recently, ALBI and insulin-like growth factor-1 (IGF)-CTP scores have been reported to improve survival prediction over CTP score. However, comparative studies to compare both scores and to integrate IGF into Albi score are lacking. Methods: After institutional board approval, data and samples were prospectively collected. 299 HCC patients who had data to generate both IGF-CPG and Albi index were used. The ALBI index, and IGF score were calculated, Cox proportional hazards models were fitted to evaluation the association between overall survival (OS) and CTP, IGF-CTP, Albi and IGF, albumin, bilirubin. Harrell’s Concordance index (C-index) was calculated to evaluate the ability of the three score system to predict overall survival. And the U-statistics was used to compare the performance of prediction of OS between the score system. Results: OS association with CTP, IGF-CTP and Albi was performed (Table). IGF-CTP B was associated with a higher risk of death than A (HR = 1.6087, 95% CI: 1.2039, 2.1497, p = 0.0013), ALBI grade 2 was also associated with a higher risk of death than 1 (HR = 2.2817, 95% CI: 1.7255, 3.0172, p < 0.0001). IGF-1(analyzed as categorical variable) was independently associated with OS after adjusting for the effects of ALBI grade. Which showed IGF-1 ≤26 was significantly associated with poor OS, P = 0.001. Conclusions: Although ALBI grade and IGF-CTP score in this analysis had similar prognostic values in most cases, their benefits might be heterogenous in some specific conditions. We looked into corporation of IGF-1 into ALBI grade, IGF score with cutoff ≤26 which clearly refined OS prediction and better OS stratification of ALBI-grade.
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Affiliation(s)
- Sunyoung S. Lee
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Aliya Qayyum
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Manal Hassan
- The University of Texas-MD Anderson Cancer Center, Houston, TX
| | - Lianchun Xiao
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Rikita Hatia
- The University of Texas-MD Anderson Cancer Center, Houston, TX
| | - Robert A. Wolff
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey Morris
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lina Altameemi
- The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - James C. Yao
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hesham M. Amin
- The University of Texas-MD Anderson Cancer Center, Houston, TX
| | - Ahmed Omar Kaseb
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
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23
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Finn RS, Qin S, Ikeda M, Galle PR, Ducreux M, Kim TY, Kudo M, Lim HY, Breder VV, Merle P, Kaseb AO, Li D, Feng YH, Verret W, Xu DZ, Hernandez S, Ding B, Zhu AX, Cheng AL. Complete responses (CR) in patients receiving atezolizumab (atezo) + bevacizumab (bev) versus sorafenib (sor) in IMbrave150: A phase III clinical trial for unresectable hepatocellular carcinoma (HCC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4596] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4596 Background: In the Phase III IMbrave150 trial, statistically significant and clinically meaningful improvements in OS and PFS were seen with atezo + bev vs sor in pts with unresectable HCC who had not received prior systemic therapy (Cheng, ESMO Asia, 2019). Historically, CR rates have been low in HCC clinical trials. Here we report the baseline characteristics for IMbrave150 pts with a CR. Methods: IMbrave150 enrolled systemic treatment-naive pts with unresectable HCC. Pts were randomized 2:1 to receive either atezo 1200 mg IV q3w + bev 15 mg/kg IV q3w or sor 400 mg BID until unacceptable toxicity or loss of clinical benefit per investigator. Co-primary endpoints were OS and PFS by independent review facility (IRF)–assessed RECIST 1.1. The key secondary endpoints IRF ORR per RECIST 1.1 and IRF ORR per HCC mRECIST were also part of the study statistical testing hierarchy. Results: The ITT population included 336 pts randomized to atezo + bev and 165 pts randomized to sor. With a median follow-up of 8.6 mo (data cutoff, Aug 29, 2019), OS HR was 0.58 (95% CI: 0.42, 0.79; P = 0.0006) and PFS HR was 0.59 (95% CI: 0.47, 0.76; P < 0.0001) with atezo + bev vs sor. ORR was 27% vs 12% ( P < 0.0001) per IRF RECIST 1.1 and 33% vs 13% ( P < 0.0001) per IRF HCC mRECIST with atezo + bev vs sor, respectively. For responders (per IRF RECIST 1.1), median time to response was 2.8 mo (range, 1.2-11.3) with atezo + bev and 3.3 mo (range, 1.2-7.2) with sor. CR per IRF-assessed RECIST 1.1 was achieved by 18 pts in the atezo + bev arm and 0 pts in the sor arm. The baseline characteristics for atezo + bev CR pts are shown in the table. Additional characteristics will be shown. Conclusions: IMbrave150 demonstrated statistically significant and clinically meaningful improvement in both OS and PFS with atezo + bev vs sor in pts with unresectable HCC who have not received prior systemic therapy. Pts achieved CRs regardless of poor prognostic factors or etiology. Atezo + bev may be a practice-changing treatment for pts with unresectable HCC. Clinical trial information: NCT03434379 . [Table: see text]
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Affiliation(s)
- Richard S. Finn
- Jonsson Comprehensive Cancer Center, Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Shukui Qin
- People's Liberation Army Cancer Center, Jinling Hospital, Nanjing, China
| | | | | | - Michel Ducreux
- Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - Tae-You Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Ho Yeong Lim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | - Ahmed Omar Kaseb
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Daneng Li
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA
| | - Yin-Hsun Feng
- Division of Hematology and Oncology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | | | | | | | | | - Andrew X. Zhu
- Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Ann-Lii Cheng
- National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Taiwan
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24
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Galle PR, Finn RS, Qin S, Ikeda M, Zhu AX, Kim TY, Kudo M, Breder VV, Merle P, Kaseb AO, Li D, Mulla S, Verret W, Xu DZ, Hernandez S, Liu J, Huang C, Lim HY, Cheng AL, Ducreux M. Patient-reported outcomes (PROs) from the Phase III IMbrave150 trial of atezolizumab (atezo) + bevacizumab (bev) vs sorafenib (sor) as first-line treatment (tx) for patients (pts) with unresectable hepatocellular carcinoma (HCC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.476] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
476 Background: Atezo + bev in pts with unresectable HCC who had not received prior systemic therapy has shown statistically significant and clinically meaningful improvement in OS and PFS per independent review facility-assessed RECIST 1.1 vs sor in the Phase III IMbrave150 study (Cheng ESMO Asia 2019). Here, we report PRO data from this trial to show pt perspectives on the overall clinical benefit of atezo + bev. Methods: Pts were randomized 2:1 to receive either atezo 1200 mg IV q3w + bev 15 mg/kg IV q3w or sor 400 mg PO BID until loss of clinical benefit or unacceptable toxicity. Pts completed the EORTC QLQ-C30 and EORTC QLQ-HCC18 questionnaires before tx, every 3 wk on tx, and every 3 mo after tx discontinuation or disease progression. A pre-specified secondary endpoint was time to deterioration (TTD; first ≥ 10-point decrease from baseline held for 2 consecutive assessments or 1 assessment followed by death within 3 wk) of pt-reported quality of life (QOL), physical functioning, and role functioning. Pre-specified exploratory analyses included TTD of and proportion of pts with a clinically meaningful change (≥ 10 points from baseline) in key pt-reported symptoms. Results: Questionnaire completion rates were ≥ 92% in both arms from baseline through most of the tx period. Compared with sor, atezo + bev delayed TTD of pt-reported QOL (median TTD, 11.2 vs 3.6 mo; HR, 0.63 [95% CI: 0.46, 0.85]), physical functioning (median TTD, 13.1 vs 4.9 mo; HR, 0.53 [95% CI: 0.39, 0.73]), and role functioning (median TTD, 9.1 vs 3.6 mo; HR, 0.62 [95% CI: 0.46, 0.84]). Atezo + bev also delayed TTD in pt-reported appetite loss, fatigue, pain, and diarrhea vs sor; a lower proportion of pts on atezo + bev experienced clinically meaningful deterioration in each of these symptoms vs sor. Conclusions: High-quality PRO results from IMbrave150 showed large and consistent benefits in key aspects of the pt experience with atezo + bev, further supporting its overall clinical benefit in pts with unresectable HCC who have not received prior systemic therapy. Clinical trial information: NCT03434379.
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Affiliation(s)
| | | | - Shukui Qin
- People's Liberation Army Cancer Center, Nanjing, China
| | | | | | - Tae-You Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | | | | | | | | | - Daneng Li
- City of Hope National Medical Center, Duarte, CA
| | | | | | | | | | - Juan Liu
- Roche Product Development, Shanghai, China
| | - Chen Huang
- Roche Product Development, Shanghai, China
| | - Ho Yeong Lim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Ann-Lii Cheng
- National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Taiwan
| | - Michel Ducreux
- Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
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25
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Kaseb AO, Duda DG, Tran Cao HS, Abugabal YI, Vence LM, Rashid A, Pestana R, Blando JM, Singh S, Vauthey JN, Hassan M, Amin HM, Qayyum A, Chun YS, Tzeng CWD, Sakamuri D, Wolff RA, Yao JC, Allison JP, Sharma P. Randomized, open-label, perioperative phase II study evaluating nivolumab alone or nivolumab plus ipilimumab in patients with resectable HCC. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
486 Background: In HCC, surgical resection is associated with high recurrence rates, and no effective neoadjuvant or adjuvant therapies currently exist. Immunotherapy using anti-PD-1 antibodies has shown promised but limited increase in survival in advanced disease. To maximize the benefit, we are studying the efficacy and safety of anti–PD-1 (nivolumab) and anti–CTLA-4 (ipilimumab) antibodies against HCC for resectable HCC. Methods: This is a randomized phase II trial of nivolumab (Arm A) or nivolumab + ipilimumab (Arm B) as pre-operative treatment for patients with HCC who are eligible for surgical resection. Pts are given nivolumab 240 mg every 2 weeks (wks) for a total of 6 wks. Pt in Arm B are treated concurrently with ipilimumab 1 mg/kg every 6 wks. Surgical resection occurs within 4 wks after last cycle of therapy. Pts continue adjuvant immunotherapy for up to 2 years after resection. The primary objective is the safety/tolerability of nivolumab +/- ipilimumab. Secondary objectives include overall response rate, complete response rate and time to progression. Exploratory objectives include evaluating the pre- and post-treatment immunological changes in tumor tissues and peripheral blood. Results: Twenty-six patients were enrolled at the time of this interim analysis, of which 20 have evaluable data. Most pts (55%) were between 60-70yo and male (75%). Four pts were HCV-positive, 6 had HBV and 10 had no hepatitis. 20 patients proceeded with resection as planned, surgery was aborted for 5 patients (1 for frozen abdomen and 2 development of contralateral liver nodule). Three are still receiving preoperative therapy. Pathologic complete response (pCR) was observed in 5/20 evaluable patients – 2 in Arm A and 3 Arm B (25% pCR rate). Five patients in Arm B and 1 in Arm A experienced grade 3 or higher toxicity prior to surgery. No grade 4 or higher toxicity were observed. Conclusions: We report a pCR rate of 25% for resectable HCC after preoperative immunotherapy in a randomized phase II pilot trial. Treatment was safe and surgical resection was not delayed. The study is ongoing. These promising results may contribute to a paradigm shift in the perioperative treatment of resectable HCC. Clinical trial information: NCT03510871.
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Affiliation(s)
| | | | | | | | - Luis M. Vence
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Asif Rashid
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Jorge M. Blando
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shalini Singh
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Manal Hassan
- The University of Texas-MD Anderson Cancer Center, Houston, TX
| | - Hesham M. Amin
- The University of Texas-MD Anderson Cancer Center, Houston, TX
| | - Aliya Qayyum
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yun Shin Chun
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Divya Sakamuri
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert A. Wolff
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James C. Yao
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Padmanee Sharma
- The University of Texas MD Anderson Cancer Center, Houston, TX
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26
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Qayyum A, Avritscher R, Aslam R, Ma J, Pagel MD, Sun J, Abugabal YI, Hassan M, Amin HM, Rashid A, Lee SS, Wolff RA, Yao JC, Ehman R, Duda DG, Kaseb AO. Immune checkpoint blockade (ICB) response evaluation with MRI/MR elastography (MRE) in surgical and nonsurgical patients with HCC. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
480 Background: Currently, there is a lack of imaging biomarkers of immunotherapy outcome in hepatocellular carcinoma (HCC). The study aim was to determine if HCC enhancement on MRI and stiffness change measured by magnetic resonance elastography (MRE) can predict immunotherapy response. Methods: This was a prospective, Institutional Review Board approved study of 38 patients with HCC treated with immune checkpoint blockade (ICB) therapy. All patients had liver MRI/MRE and HCC biopsy at baseline, and MRI/MRE with biopsy or resection after 6 weeks therapy. HCC stiffness (kPa) was measured on MRE elastograms (liver stiffness maps). HCC enhancement and change in stiffness were compared with treatment response to ICB in 1) non-surgical patients (pembrolizumab), and 2) surgical patients (nivolumab +/- ipilimumab). For non-surgical patients, treatment response was defined as overall survival >1 year. For surgical patients, treatment response was defined as <50% viable tumor at time of resection. Analysis was performed using descriptive statistics and Spearman correlation; p-value <0.05 was considered statistically significant. Results: Twenty-five patients were evaluable. Median age was 67 years (32, 78). Etiology of liver disease was NASH (n=8), HCV (n=8), HBV (n=2) and unknown (n=7). Treatment response occurred in 11/25 (44%) patients. Median HCC size and change in size were 4.7 cm (1.2, 14.0) and –0.32 cm, respectively. Median baseline HCC stiffness and change in stiffness were 5 kPa (2.2, 12.4) and –0.1 kPa (–2.2, 1.5), respectively. Median change in HCC size for responders and non-responders was –1.2 cm (–4.8, 0.4) and 0 cm (–1.5, 1.1), respectively (p = 0.02). Treatment response was associated with absence of portal venous phase capsular enhancement and increase in HCC stiffness, (p<0.001). Conclusions: Capsular enhancement and MRE stiffness change may be useful biomarkers of immune cell activated response to ICB therapy.
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Affiliation(s)
- Aliya Qayyum
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rony Avritscher
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rizwan Aslam
- The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Jingfei Ma
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Jia Sun
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Manal Hassan
- The University of Texas-MD Anderson Cancer Center, Houston, TX
| | - Hesham M. Amin
- The University of Texas-MD Anderson Cancer Center, Houston, TX
| | - Asif Rashid
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Robert A. Wolff
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James C. Yao
- The University of Texas MD Anderson Cancer Center, Houston, TX
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27
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Pinato DJ, Kaseb AO, Wang Y, Saeed A, Szafron D, Jun T, Naqash AR, Lee C, Khan U, Nimkar NS, Paul S, Bettinger D, Hildebrand H, Pressiani T, Abugabal YI, Personeni N, Huang YH, Rimassa L, Ang C, Marron TU. Impact of baseline and concomitant corticosteroid therapy on the outcomes of hepatocellular carcinoma treated with immune checkpoint inhibitor therapy. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
531 Background: The impact of corticosteroid treatment (CT) on the efficacy of immune checkpoint inhibitors (ICI) in hepatocellular carcinoma (HCC) is undefined. We evaluated whether CT administered at baseline (bCT) or concurrently to ICI (cCT) influences clinical outcomes of HCC patients treated with ICI. Methods: This retrospective, multi-center observational study was conducted across 9 tertiary academic referral centers collected 341 HCC patients who received ICI across 3 continents between January 1, 2016 and April 1, 2019. Outcome measures included overall (OS) and progression-free survival (PFS) calculated from time of ICI commencement and overall response rates (ORR) defined by Response Evaluation Criteria in Solid Tumors (v1.1) on 6-8 weekly periodic restaging. Results: Of 331 eligible patients, 254 (76%) had BCLC-C stage HCC and received mostly PD(L)-1 ICI monotherapy (n=250, 85%). Median OS was 12.1 months (95%CI 9.2-15.0 months) and median PFS was 8.1 months (95%CI 6.3-10 months). In total 81 patients (24%) received >10 mg prednisone equivalent daily either as bCT (n=15, 4%) or cCT (n=66, 20%). Indications for CT included procedure/prophylaxis (n=37, 45%), management of irAE (n=31, 37%), cancer-related symptoms (n=5, 2%) or comorbidities (n=8, 3%). Neither overall CT, bCT nor cCT predicted for worse OS, PFS nor ORR in uni- and multi-variable analyses (p>0.05). CT for cancer-related indications predicted for shorter PFS (2.4 vs. 11.3 months, p=0.01), OS (4.5 vs. 12.8 months, p=0.05) and reduced ORR (p=0.03) compared to cancer-unrelated indications. Conclusions: This is the first study to demonstrate that neither bCT nor cCT appear to influence response and OS following ICI in HCC. Worse survival and ORR in CT recipients for cancer-related indications appears driven by the poor prognosis associated with symptomatic HCC.
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Affiliation(s)
| | | | - Yinghong Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anwaar Saeed
- University of Kansas Medical Center, Kansas City, KS
| | | | - Tomi Jun
- Mount Sinai Hospital, New York, NY
| | | | - ChiehJu Lee
- Taipei Veterans General Hospital, Taiwan, Taiwan
| | - Uqba Khan
- Weill Cornell Medical College, New York, NY
| | | | - Sonal Paul
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | | | | | | | | | | | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Lorenza Rimassa
- Humanitas Clinical and Research Center-IRCCS, Humanitas University, Rozzano, Milan, Italy
| | - Celina Ang
- Memorial Sloan Kettering Cancer Center, New York, NY
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28
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Abugabal YI, Qayyum A, Hassan M, Xiao L, Duda DG, Hatia R, Lee SS, Wolff RA, Pestana R, Morris J, Yao JC, Amin HM, Kaseb AO. IGF-1 Child-Turcotte-Pugh score as a predictor of overall survival to therapy in CTP-A, BCLC stage C patients with advanced hepatocellular carcinoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
488 Background: Child-Turcotte-Pugh (CTP) A is the standard population for active HCC therapy. The IGF-CTP score, comprises levels of type 1 insulin-like growth factor (IGF-1), bilirubin, INR, and albumin, significantly improved the prediction of overall survival (OS) in recently published studies. Our current study aimed to investigate the accuracy of the IGF-CTP score in predicting OS in HCC Child-Pugh A patients (pts) treated with local and/or systemic therapies (tx). The overall hypothesis is that the IGF-CTP score can further distinguish CP-A pts in terms of overall survival, PFS. Methods: Between 2014 and 2018, a total of 274 pts with new advanced HCC BCLC stage who had available baseline plasma IGF-1 level were retrospectively enrolled. Clinicopathologic features and treatment history were collected. We calculated IGF-CTP scores, used Kaplan-Meier method and log rank test to estimate and compare time to event outcomes between subgroups of patients. Results: 198 pts were CTP Class A, 209 patient underwent systemic tx, 65 underwent local tx [see table]; 161 were re-classified as IGF-CTP-A with a median OS of 16.09 months (95% CI = 13.06 to 23.29 months) (p <0.0001), whereas 37 patients were reclassified as intermediate risk (IGF-CTP-B) and had significantly shorter OS of 10.66 months (95% CI = 5.49 to 26.51) (p <0.0001). Conclusions: The results of this study support our biologically-driven hypothesis that IGF-CTP score is predictive of overall survival to therapy in advanced HCC treated with local and/or systemic therapy. Among HCC pts with CTP-A class, some are reclassified as IGF-CP-B/C and were found to have significantly poorer prognosis in terms of shorter OS. Future validation of the predictive ability of our IGF-1 score may lead to adopting it as a stratification tool in clinical trials as well as to predict HCC outcome and guide therapy decision in routine practice. [Table: see text]
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Affiliation(s)
| | - Aliya Qayyum
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Manal Hassan
- The University of Texas-MD Anderson Cancer Center, Houston, TX
| | - Lianchun Xiao
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Rikita Hatia
- The University of Texas-MD Anderson Cancer Center, Houston, TX
| | | | - Robert A. Wolff
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Jeffrey Morris
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James C. Yao
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hesham M. Amin
- The University of Texas-MD Anderson Cancer Center, Houston, TX
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29
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Khalaf AM, Fuentes D, Morshid A, Kaseb AO, Hassan M, Hazle JD, Elsayes KM. Hepatocellular carcinoma response to transcatheter arterial chemoembolisation using automatically generated pre-therapeutic tumour volumes by a random forest-based segmentation protocol. Clin Radiol 2019; 74:974.e13-974.e20. [PMID: 31521326 DOI: 10.1016/j.crad.2019.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/31/2019] [Indexed: 01/03/2023]
Abstract
AIM To demonstrate the feasibility of correlating pre-therapeutic volumes and residual liver volume (RLV) with clinical outcomes: time to progression (TTP) and overall survival (OS) in hepatocellular carcinoma (HCC) treated with transcatheter arterial chemoembolisation (TACE). MATERIALS AND METHODS TTP was calculated from a database of 105 patients, receiving first-line treatment with TACE. TTP cut-off for stratifying patients into responders and non-responders was 28 weeks. Pre-treatment tumour and liver volumes were correlated with the TTP and OS following treatment. Univariate cox-regression model was used to assess whether these volumes could predict TTP and/or OS. Kaplan-Meier analysis with log-rank test was used to compare the TTP between high and low volume groups for viable, necrotic, and total tumour. Kaplan-Meier analysis was performed comparing the OS of 10 patients with the longest TTP (mean=122 weeks) in the responder group and 10 patients with the shortest TTP (mean=7 weeks) in the non-responder group. RESULTS HCC in high tumour volume groups had a shorter TTP than lesions in low tumour volume groups (p=0.05, p=0.04, p=0.02, for enhancing, non-enhancing, total tumour groups, respectively). A negative (correlation coefficient [CC] 0.3) linear correlation between TTP and tumour volumes, and a positive linear correlation between TTP and residual liver volumes were also demonstrated (CC 0.3). Patients with the longest TTP had a higher OS than with the shortest TTP (p=0.03). CONCLUSION This demonstrates the feasibility of predicting treatment response of HCC to TACE using volumetric measurements of pre-treatment lesion and the feasibility of correlating RLV with TACE outcome data in HCC patients.
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Affiliation(s)
- A M Khalaf
- Department of Imaging Physics, The University of Texas Anderson Cancer Center, Houston, TX 77030, USA
| | - D Fuentes
- Department of Imaging Physics, The University of Texas Anderson Cancer Center, Houston, TX 77030, USA
| | - A Morshid
- Department of Imaging Physics, The University of Texas Anderson Cancer Center, Houston, TX 77030, USA
| | - A O Kaseb
- Department of Gastrointestinal Oncology, The University of Texas Anderson Cancer Center, Houston, TX 77030, USA
| | - M Hassan
- Department of Gastrointestinal Oncology, The University of Texas Anderson Cancer Center, Houston, TX 77030, USA
| | - J D Hazle
- Department of Imaging Physics, The University of Texas Anderson Cancer Center, Houston, TX 77030, USA
| | - K M Elsayes
- Department of Diagnostic Radiology, The University of Texas Anderson Cancer Center, Houston, TX 77030, USA.
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30
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Kaseb AO, Vence L, Blando J, Yadav SS, Ikoma N, Pestana RC, Vauthey JN, Allison JP, Sharma P. Immunologic Correlates of Pathologic Complete Response to Preoperative Immunotherapy in Hepatocellular Carcinoma. Cancer Immunol Res 2019; 7:1390-1395. [PMID: 31289040 DOI: 10.1158/2326-6066.cir-18-0605] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/04/2019] [Accepted: 07/02/2019] [Indexed: 12/12/2022]
Abstract
In hepatocellular carcinoma (HCC), surgical resection is associated with high recurrence rate, and no effective adjuvant therapy currently exists. We initiated a pilot randomized trial of perioperative immunotherapy with nivolumab and ipilimumab for resectable HCC. Here, we provide an illustrative report of a case that achieved a complete response and report immunologic correlates of this complete pathologic response to perioperative immunotherapy. Clinical response was correlated with an increase in CD8+ T-cell infiltration, with an increase in two effector T-cell clusters. This study is ongoing, and the final results may contribute to a paradigm shift in the perioperative treatment of HCC, leading to the incorporation of immunotherapy in the curative setting.
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Affiliation(s)
- Ahmed Omar Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Luis Vence
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jorge Blando
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shalini S Yadav
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Naruhiko Ikoma
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Jean Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - James P Allison
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Padmanee Sharma
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Kaseb AO, Carmagnani Pestana R, Vence LM, Blando JM, Singh S, Ikoma N, Raghav KPS, Sakamuri D, Girard L, Tan D, Vauthey JN, Tzeng CWD, Aloia TA, Chun YS, Yao JC, Wolff RA, Allison JP, Sharma P. Randomized, open-label, perioperative phase II study evaluating nivolumab alone or nivolumab plus ipilimumab in patients with resectable HCC. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.4098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4098 Background: In HCC, surgical resection is associated with high recurrence rate, and no effective neoadjuvant or adjuvant therapies currently exist. On the basis of of previous reports on the efficacy and safety of anti–PD-1 (nivolumab) and anti–CTLA-4 (ipilimumab) antibodies against HCC, we initiated a randomized pilot trial of perioperative immunotherapy for resectable HCC. Methods: This is a randomized, phase II pilot trial of nivolumab (Arm A) or nivolumab + ipilimumab (Arm B) as pre-operative treatment for patients (pt) with HCC who are eligible for surgical resection. Pt are given nivolumab 240 mg every 2 weeks (wk) for a total of 6 wk. Pt in Arm B are treated concurrently with ipilimumab 1 mg/kg every 6 wk. Surgical resection occurs within 4 weeks after last cycle of therapy. Pt continue adjuvant immunotherapy for up to 2 years after resection. Primary objective is the safety and tolerability of nivolumab +/- ipilimumab. Secondary objectives include overall response rate, complete response rate and time to progression. Exploratory objectives include evaluating the pre- and post-treatment immunological changes in tumor tissues and peripheral blood. Results: 17 pt were enrolled at the time of interim analysis (8 in Arm A, 9 in Arm B) and 14 were evaluable. Most pt (53%) were 60-70yo, and males (70%). 6 pt were HCV-positive and 4 had chronic hepatitis B. 14 pt proceeded with resection as planned; surgery was aborted for 2 pt (1 for frozen abdomen and 1 for development of contralateral liver nodule). One is still receiving preoperative therapy. Pathologic complete response (pCR) was observed in 4/14 evaluable pt – 2 in Arm A and 2 Arm B (29% pCR rate). 4 pt in Arm B and 1 in Arm A experienced grade 3 or higher toxicity prior to surgery. Conclusions: We report a pCR rate of 29% in an interim analysis of a phase II pilot trial of perioperative immunotherapy for resectable HCC. Treatment was safe and surgical resection was not delayed. The study is ongoing and results may contribute to a paradigm shift in the perioperative treatment of HCC. Clinical trial information: NCT03222076.
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Affiliation(s)
| | | | - Luis M. Vence
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jorge M. Blando
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shalini Singh
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Naruhiko Ikoma
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kanwal Pratap Singh Raghav
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Divya Sakamuri
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lauren Girard
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dongfeng Tan
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Yun Shin Chun
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James C. Yao
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert A. Wolff
- Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Padmanee Sharma
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Abugabal YI, Kaseb AO, Rashid A, Pestana R, Abdel-Wahab R, Xiao L, Qayyum A, Girard L, Raghav KPS, Morris J, Wolff RA, Yao JC, Amin HM, Hassan M. Clinical and prognostic significance of serum levels of fatty acid binding proteins in hepatocellular carcinoma (HCC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.4099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4099 Background: Limited data are available about the prognostic effect of fatty acid binding proteins (FABP) in viral and non-viral-related hepatocellular carcinoma (HCC). Previous studies suggested that selected FABP could be a potential target markers for HCC chemotherapy response and may correlated with presence of cirrhosis and poor outcome. We aimed to test the association between plasma levels of Liver (L)-FABP, Heart (H)-FABP, and Adipose (A) FABP and HCC. Methods: we enrolled 767 HCC patients from MD Anderson Cancer Center. Under IRB approval, baseline patients’ characteristics were retrieved from medical records and blood samples were collected and tested form plasma levels of L-, A-, H-, FABPs. Descriptive statistics were performed and the median values of FABPs among 200 normal controls (NC) were used as cutoff values of FABPs. Overall survival (OS) was estimated by Kaplan Meier curve and log rank test. Results: FABPs were highly expressed in HCC cases than controls. Mean values (±SE) of AFABP, HFABP, and LFABP were significantly higher in cases [25.6 (.7), 10.8 (.5), and 47.8 (1.9)] than controls [19.1 (.8), 7.7 (2), 22. 9 (.5)], P < .001. All FABPs were significantly associated with cirrhosis, higher Child Pugh Score (CTP), advanced stage in Barcelona clinic liver cancer stage (BCLC), higher AFP levels, vascular invasion and thrombosis, and tumor nodularity. Median OS (months) (95%CI) were significantly short in patients with higher level of AFABP, HFABP, and LFABP [9.3 (6.8-11.9), 9.4 (6.8-11.9), and 11.1 (8.8-13.3)] as compared to patients with low levels [16.4 (13.8-18.9), 16.4 (14.2-18.6), and 17.9 (14.9-20.9) respectively (P < .01). The significance was observed in non-viral related HCC for LFABP and HFABP, but not AFBABP. Conclusions: To the best of our knowledge, we describe the largest study correlating FABPs levels with clinical and prognostic characteristics of HCC. Higher levels were associated with poor survival. These findings suggest that LFABP and HFABP may be used as potential prognostic biomarkers for non-viral-related HCC.
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Affiliation(s)
| | | | - Asif Rashid
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Lianchun Xiao
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Aliya Qayyum
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lauren Girard
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kanwal Pratap Singh Raghav
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey Morris
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert A. Wolff
- Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James C. Yao
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hesham M. Amin
- The University of Texas - MD Anderson Cancer Center, Houston, TX
| | - Manal Hassan
- The University of Texas - MD Anderson Cancer Center, Houston, TX
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Idris T, Barghash M, Kotrotsou A, Huang HJ, Subbiah V, Kaseb AO, Piha-Paul SA, Hong DS, Meric-Bernstam F, Javle MM, Janku F, Colen RR. CT-based radiogenomic signature to identify isocitrate dehydrogenase (IDH)1/2 mutations in advanced intrahepatic cholangiocarcinoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.4081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4081 Background: IDH1/2 mutations have a high prevalence (20%) in intrahepatic cholangiocarcinoma (iCCA) and can be associated with therapeutic benefit from IDH inhibitors. Radiomics, a developing field within imaging, has shown its ability to discriminate between tumors of distinct genomic profiles and mutational status. Methods: We developed a radiogenomic signature to robustly predict IDH1/2 mutation status (mutated versus wild-type [WT]) in 22 patients with iCCA using the pretreatment CT scans. The triphasic hepatic CT scan was used to segment the lesion. After semiautomatic segmentation of the tumor, the extracted volume of interest (VOI) was imported into our in-house radiomic pipeline and 610 radiomic features were extracted. The least absolute shrinkage and selection operator regression (LASSO) and minimum redundancy and maximum relevance (mRMR) were used for feature selection. Selected features were used to build a classification model for prediction of IDH1/2 mutation status (XGboost). The performance of the radiomics model was assessed using leave-one-out cross-validation (LOOCV). Results: Of 22 patients, 16 patients (male, 6; female, 10; average age, 55.5 years) had IDH1 (N = 14) or IDH2 (N = 2) mutations and 6 patients (male, 4; female, 2; average age = 55.5 years) had IDH1/2 WT.The CT-derived radiomic signature robustly predicted presence of IDH1/2 mutations versus WT with an area under the curve (AUC), sensitivity and specificity of 98.4%, 83.3% and 93.8%, respectively ( P = 0.037) and in a subgroup analysis presence of IDH1 mutation versus WT with an AUC, sensitivity and specificity of 98.2%, 83.3% and 92.8%, respectively ( P = 0.035). Conclusions: To our knowledge, this is the first study investigating the ability of radiogenomics as a potential method to predict the IDH1/2 mutation status in iCCA patients. Our data suggest that radiogenomic signature may correlate with IDH1/2 mutations and represent a promising non-invasive tool to stratify the patients based on molecular alterations.
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Affiliation(s)
- Tagwa Idris
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Maggie Barghash
- The University of Texas MD Anderson Cancer Center, Houson, TX
| | | | - Helen J Huang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vivek Subbiah
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - David S. Hong
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Filip Janku
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rivka R. Colen
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Gjyshi O, Kaseb AO, Ghia AJ. Spine stereotactic radiosurgery as a promising modality in patients with metastatic hepatocellular and cholangiocarcinoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e13551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13551 Background: While stereotactic body radiation therapy (SBRT), a form of high-dose rate radiation therapy, is often used in the local management of early-stage hepatocellular carcinoma (HCC), its role in managing metastatic hepatobiliary malignancies is currently unclear. Here, we investigate the role of spine stereotactic radiosurgery (SSRS), a form of SBRT that targets spinal metastases, in the management of late-stage HCC or cholangiocarcinoma. Methods: We retrospectively reviewed a total of 28 patients with 43 HCC or cholangiocarcinoma metastases treated with SSRS between 2004 and 2017 at our institution. We used Kaplan-Meier curves to estimate overall survival (OS) and local control (LC), and Cox regression analysis to identify potential predictive factors of the two. Results: The median patient age was 63 (range 28 to 78) years old. Four patients had a histology-proven diagnosis of metastatic cholangiocarcinoma, while 39 had hepatocellular carcinoma. Of the patients with HCC, 47% had predisposing viral hepatitis, while 53% had either non-alcoholic steatohepatitis (NASH) or no known predisposing factors. Twenty-nine cases were treated with 24Gy in 1 fraction, 11 with 27Gy in 3 fractions, 2 with 18Gy in 2 fractions, and 1 with 30Gy in 5 fractions. The 1-year actuarial OS and LC rates were 23% and 75%, respectively. The median OS was 6.3 months, while the median time to local failure was not reached. On univariate modeling, negative predictors of LC included history of prior RT to the site of metastasis (p < 0.005) and tumor volume > 60cc (p = 0.03), while biologic equivalent dose (BED) > 52Gy was the only positive predictive factor (p < 0.05). Presence of epidural disease, Bilsky grade, presence of viral hepatitis, or type histology were not predictors of LC (all p > 0.05). In patients who had pain or neurologic findings at presentation, 56% reported improvement in their symptoms on follow up. Three patients (11%) developed compression deformity and one patient (4%) developed radiation-induced neuritis. Conclusions: SSRS provides promising and durable local control in patients with metastatic hepatobiliary disease, and early intervention with high BED are necessary to ensure high level of local control, improvement in symptoms, and a low rate of long-term toxicity.
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Affiliation(s)
- Olsi Gjyshi
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Amol J. Ghia
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Carmagnani Pestana R, Abugabal YI, Xiao L, Hassan M, Hassan RAW, Girard L, Raghav KPS, Morris J, Rashid A, Qayyum A, Meric-Bernstam F, Wolff RA, Yao JC, Amin HM, Kaseb AO. Molecular profiling by circulating tumor DNA (ctDNA) and benefit from anti-PD-1 in HCC. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e15679] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15679 Background: Molecular profiling has defined actionable mutations in HCC, and has the potential to be used for selection of targeted therapies, as well as for the characterization of predictive biomarkers from approved treatments. Noninvasive strategies are critical to HCC given the challenge of obtaining liver biopsies. We investigated whether profiling by ctDNA could provide predictive and/or prognostic information for HCC patients (pt) treated with immune checkpoint inhibitors. Methods: We analyzed blood samples from 22 HCC pt who underwent treatment with anti-PD-1 using comprehensive genomic testing of ctDNA with a commercially-available platform (Guardant Health, CA). Demographic and treatment data were retrospectively collected with the goal of correlating treatment outcomes and drug response (by imaging and/or AFP) with molecular abnormalities. Results: 17/22 (77.3%) were men; median age was 66 years. 21 patients received nivolumab and 1 received pembrolizumab. 9 were HCV positive and 5 were HBV positive. 15/22 patients had > 1 alteration identified. The median number of alterations/pt was 3 (range, 1-8). TP53 was the common altered gene (n = 11) followed by CTNBB1 (n = 8) , TERT (n = 5) KRAS (n = 3) , GNAS (n = 2). Mutations were also seen (n = 1) in KIT, PIK3CA, PTEN, EGFR, NTRK, FGFR2 among others. 6 pt (27.3%) had AFP response and 8 (36.4%) achieved disease control > 12 weeks. Mutations involving KIT, PIK3CA and PTEN were associated with shorter progression-free (PFS) (p < .001 for all) and overall survival (OS) (p = .028 for all), whereas GNAS mutation was associated with shorter PFS (p = 0.019) but not OS. No differences in OS or PFS was observed for other alterations, including the presence of CTNNB1 mutation. There were no correlations between specific alterations and objective tumor response (either by imaging or AFP). 32% of pt were progression-free at 6 months. Median OS was not reached, and 62% were alive after 1 year. Conclusions: Identifying non-invasive predictive biomarkers of benefit to immunotherapy is a priority in HCC. Our data suggest that specific ctDNA alterations can provide predictive information for survival (OS and PFS) on immune checkpoint inhibitors. Further larger studies are warranted for confirmation.
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Affiliation(s)
| | | | - Lianchun Xiao
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Manal Hassan
- The University of Texas - MD Anderson Cancer Center, Houston, TX
| | | | - Lauren Girard
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Jeffrey Morris
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Asif Rashid
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Aliya Qayyum
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Robert A. Wolff
- Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James C. Yao
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hesham M. Amin
- The University of Texas - MD Anderson Cancer Center, Houston, TX
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Abugabal YI, Hassan M, Pestana R, Xiao L, Girard L, Raghav KPS, Morris J, Abdel-Wahab R, Wolff RA, Yao JC, Amin HM, Kaseb AO. IGF-Child-Pugh score as a predictor of treatment outcome in advanced hepatocellular carcinoma patients treated with sorafenib. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.4076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4076 Background: Our recent published studies concluded that Lower levels of Insulin like growth factors-I (IGF-I) is correlated with shorter overall survival (OS) in HCC, and IGF-CP scores assigned based on serum bilirubin, serum albumin level, prothrombin time, and plasma IGF-1 provides better prognostic stratification. Sorafenib is the first frontline drug approved for the treatment of CP class A patients with advanced HCC. CP class A is the standard criterion for active therapy and trials entry in HCC. In this study we aimed at evaluating the predictive ability of IGF-CP to sub-stratify old CP classes and better predict sorafenib outcomes. Methods: Total of101 patients were prospectively enrolled from MD Anderson Cancer Center (MDACC). Blood sample were collected and tested for IGF-I and IGF-CP was calculated into class A, B and C. Median OS and progression free survival (PFS) were analyzed, and log rank test was used to compare PFS and OS between subgroups of IGF-CTP score of patients. Results: Among CP class, patients who were reclassified as IGF-CP (B) (Old A/new B) had significantly shorter OS in months (m) was 7.6m (95% CI= 5.23-26.51m ) and PFS of 2.99m (95% CI=2.53-5.26m) with (P<0.001) in both, as compared to patients’ who classified as class A by both scoring systems (AA), who had OS of 15.43m (95% CI=12.3-31.18m) and PFS of 4.97m (95% CI=3.26-7.2m), (P<0.001) in both. Conclusions: IGF-CTP score sub-stratified CP A class, and provided better prognostic stratification and accuracy than CP score in predicting sorafenib survival outcomes in HCC. This approach may lead to a paradigm shift in predicting efficacy and toxicity of systemic HCC therapies and in stratifying patients for active therapy and selection in HCC clinical trials.
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Affiliation(s)
| | - Manal Hassan
- The University of Texas - MD Anderson Cancer Center, Houston, TX
| | | | - Lianchun Xiao
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lauren Girard
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kanwal Pratap Singh Raghav
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey Morris
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Robert A. Wolff
- Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James C. Yao
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hesham M. Amin
- The University of Texas - MD Anderson Cancer Center, Houston, TX
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Kaseb AO, Carmagnani Pestana R, Vence LM, Blando JM, Singh S, Ikoma N, Vauthey JN, Allison JP, Sharma P. Randomized, open-label, perioperative phase II study evaluating nivolumab alone versus nivolumab plus ipilimumab in patients with resectable HCC. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.8_suppl.52] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
52 Background: In HCC, surgical resection is associated with high recurrence rate, and no effective neoadjuvant or adjuvant therapies currently exist. On the basis of previous reports on the efficacy and safety of anti–PD-1 (nivolumab) and anti–CTLA-4 (ipilimumab) antibodies against HCC, we initiated a randomized pilot trial of perioperative immunotherapy for resectable HCC. Methods: This is a randomized, phase II pilot trial of nivolumab (Arm A) or nivolumab + ipilimumab (Arm B) as peri-operative treatment for patients (pt) with HCC who are eligible for surgical resection. Pt are given nivolumab 240 mg every 2 weeks (wk) for a total of 6 wk. Pt in Arm B are treated concurrently with ipilimumab 1 mg/kg every 6 wk. Surgical resection occurs within 4 weeks after last cycle of therapy. Pt continue adjuvant immunotherapy for up to 2 years after resection. Primary objective is the safety and tolerability of nivolumab +/- ipilimumab. Secondary objectives include overall response rate, complete response rate and time to progression. Exploratory objectives include evaluating the pre- and post-treatment immunological changes in tumor tissues and peripheral blood. Results: 9 pt were enrolled at the time of first interim analysis, and 8 pt were evaluable (5 in Arm A, 3 in Arm B). Most pt (78%) were 60-69 yo, and males (78%). 5 pt were HCV-positive and 1 had chronic hepatitis B infection. 7 pt proceeded with resection as planned; surgery was aborted for 1 pt due to frozen abdomen from previous surgery. Pathologic complete response (pCR) was observed in 3/8 pt – 2 in Arm A and 1 Arm B (37.5% pCR). 2 pt in Arm B and 1 in Arm A experienced grade 3 or higher toxicity. No grade 4 or higher toxicity were observed. Immune analysis of the first case with a pCR in Arm B demonstrated that clinical response correlated with an increase in CD8+ T cell infiltration, notably an increase in two effector T cell clusters. Conclusions: We report a pCR rate of 37.5% in the first interim analysis of a phase II pilot trial of perioperative immunotherapy for resectable HCC. Treatment was safe and surgical resection was not delayed. The study is ongoing and results may contribute to a paradigm shift in the perioperative treatment of HCC. Clinical trial information: NCT03222076.
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Affiliation(s)
| | | | - Luis M. Vence
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jorge M. Blando
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shalini Singh
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Naruhiko Ikoma
- University of Texas MD Anderson Cancer Center, Houston, TX
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Qayyum A, Avritscher R, Morani A, Sun J, Bhosale P, Hwang KP, Stafford J, Abugabal YI, Ma J, Kaseb AO. Immunotherapy response evaluation with MR elastography (MRE) in advanced HCC. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
230 Background: To determine changes in MRE HCC stiffness as predictor of immunotherapy response in patients with advanced HCC. Methods: This was a prospective, Institutional Review Board approved study of 15 patients with biopsy proven advanced HCC (not amenable to curative therapy), who were to be treated with Pembrolizumab. Eligible patients were > 18 years old with radiographic disease progression/intolerance to sorafenib. All patients had liver MRI with MR Elastography (MRE) and liver biopsy at baseline and at 9 weeks of therapy. HCC stiffness (kilopascals, kPa) was measured on liver MRE elastograms (stiffness maps). Change in HCC stiffness on MRE was compared with overall survival, time to disease progression, and total number of lymphocytes on targeted liver biopsy. Data cutoff date was September 1st 2018. Analysis was performed using descriptive statistics including Spearman correlation ( R), Cox regression, Wilcoxon rank sum test and Fisher’s exact test. Results: Of the initial 15 patients, 4 withdrew from therapy, 1 patient did not undergo MRE scan, and 1 patient had MRE failure. The final 9 patients included 6 men. Median age was 70 years (range, 54-78). Etiology of liver disease was HCV (n = 4) and NASH (n = 5). HCC was moderately differentiated in 8 of 9 patients and well-differentiated in 1 patient. Median overall survival and time to progression were 52 weeks (range, 16-112) and 18 weeks (range, 9-48), respectively. Average non-tumorous liver stiffness was 3.2 kPa (range, 2.1-4.3). No significant change in non-tumor liver stiffness was seen at 9 weeks (p = 0.12). Median baseline tumor stiffness was 4.5 kPa (range, 2.4-7.5). Increase in HCC stiffness at 9 weeks was seen in 5 patients, decrease in 3 patients and no change in 1. Change in HCC stiffness at 9 weeks correlated significantly with overall survival ( R = 0.83), and time to progression ( R = 0.96), (p < 0.05). Nine patients had liver biopsy at baseline and 7 had biopsy at 9 weeks. HCC T lymphocytes on biopsy (n/mm2) significantly correlated with HCC stiffness ( R = 0.79), (p < 0.01). Conclusions: Our pilot data suggests early change in tumor stiffness may help predict better immunotherapy response in patients with advanced HCC.
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Affiliation(s)
- Aliya Qayyum
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rony Avritscher
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Jia Sun
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Priya Bhosale
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ken-Pin Hwang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jason Stafford
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Jingfei Ma
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Carmagnani Pestana R, Hassan M, Abdel-Wahab R, Abugabal YI, Girard L, Hatia R, Nguyen V, Raghav KPS, Morris J, Rashid A, Wolff RA, Amin HM, Kaseb AO. Plasma GH as a diagnostic and prognostic biomarker in HCC without cirrhosis. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
227 Background: The association between the GH/IGF-1 axis and HCC was reported in patients (pt) with underlying cirrhosis. However, there is limited information among HCC pt without (w/o) cirrhosis. We herein investigated the role of GH as a circulating biomarker for HCC diagnosis and prognosis in pt w/o cirrhosis. Methods: Under IRB approval, we prospectively enrolled 1267 newly-diagnosed HCC pt in a case control study at the MD Anderson Cancer Center (2000-2015). Controls were healthy individuals (n = 1104). Plasma GH and AFP were measured 274 HCC pt w/o cirrhosis 200 healthy controls. IGF-1 was measured in 133 and 82 pt, respectively. We classified HCC pt into higher and lower GH values (cutoff for women, 3.7 µg/L; men, > 0.9 µg/L). Results: Most pt (74%) were male, with advanced BCLC staging (C-D, 74%) and 61% were older than 60y. Baseline GH was higher in HCC w/o cirrhosis (mean 3.3 µg/L) than controls (mean 0.4 µg/) (p < .001). ROC curve was plotted to assess diagnostic role. The AUC for AFP was 82.9 (p < .001); for GH 78.2 (p < .001). When only non-cirrhotic HCC pt with early stage (CLIP 0-2) and AFP < 20 ng/m were compared to controls, the GH/IGF-1 ratio had high prediction of early stage HCC - AUC 83 (95% CI 78-89%) (p < .0001). At a specificity of 90%, sensitivity of GH/IGF ratio was 67%. In addition, among HCC w/o cirrhosis, higher GH levels correlated with presence of vascular invasion (p < .001) and thrombosis (p = .004), tumor involvement of > 50% liver (p = .003), and more advanced BCLC (p < .001) and TNM staging (p < .001). Median overall survival (months) of HCC pt w/o cirrhosis with high GH levels was 13.1 (10.8-15.4) compared to 37.4 (19.8-55.1) of pt with lower plasma GH (p < .001). Multivariate cox-regression analysis identified high GH as an independent risk factor for mortality (HR = 1.8; 95% CI, 1.3-2.4; p < .001). Conclusions: Our study demonstrates the diagnostic and prognostic role of plasma GH in non-cirrhotic HCC and identifies the GH/IGF-1 ratio as a promising diagnostic marker for early stage HCC w/o cirrhosis and low AFP; this analysis excludes the confounding effect hepatocyte impaired function by presence of cirrhosis. Further studies are warranted to assess the causes of the observed differences.
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Affiliation(s)
| | - Manal Hassan
- The University of Texas - MD Anderson Cancer Center, Houston, TX
| | | | | | - Lauren Girard
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rikita Hatia
- The University of Texas - MD Anderson Cancer Center, Houston, TX
| | - Van Nguyen
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Jeffrey Morris
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Asif Rashid
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert A. Wolff
- Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hesham M. Amin
- The University of Texas - MD Anderson Cancer Center, Houston, TX
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Abugabal YI, Hassan M, Xiao L, Morris J, Carmagnani Pestana R, Abdel-Wahab R, Hatia R, Chang P, Girard L, Rashid A, Bhawana G, Raghav KPS, Abdelhakeem A, Wolff RA, Amin HM, Kaseb AO. IGF-Child-Pugh score as a predictor of treatment outcome in Child-Pugh A, advanced hepatocellular carcinoma patients undergoing sorafenib therapy. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
223 Background: Sorafenib is the first systemic therapy approved for advanced HCC treatment; with no accurate tool available to help predict survival and treatment outcome and to guide therapy decisions. Our novel blood-based IGF-Child-Pugh (CP) score comprises levels of IGF-1, bilirubin, INR, and albumin. IGF-CP score significantly improved the prediction of HCC survival in our recently published studies. The current prospective study aimed to compare the overall survival (OS) and progression free survival (PFS) of 101 patients with CP-A HCC treated with sorafenib whose score is reclassified as IGF-A (AA) to that of patients whose score is reclassified as IGF-B/C (AB/AC). Methods: Between 2014 and 2018, after the approval of the institutional review boards and signing written informed consent, a total of 101 patients with HCC, CP-A were prospectively enrolled and started on sorafenib and followed until progression or death. Results: Sixty-three patients were evaluable. Patients who were reclassified by the IGF-CTP scoring system were better stratified by their new risk groups. Forty-two of patients were classified as IGF-CTP-A and had median PFS of 4.87 months (95% CI=2.3 to 6.84), and median OS of 15.43 (95% CI = 12.04 to 31.18 months), whereas 21 patients were reclassified as intermediate risk (IGF-CTP-B) and had significantly shorter OS of 7.6 months (p-value<0.0001) and shorter PFS of 2.86 months (p-value=0.0021). Conclusions: The results of this study confirms our biologically driven hypothesis that: among HCC patients with “old CP-A” class treated with sorafenib, some will be reclassified as “new CP-B/C” will have poorer prognosis in terms of shorter OS and PFS. Thus, our study provides an objective non-invasive strategy to better predict the outcome in HCC patients undergoing systemic therapy. Future validation of our IGF score may lead to adopting it as a stratification tool in trials to predict HCC outcome and guide therapy decision in routine practice. [Table: see text]
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Affiliation(s)
| | - Manal Hassan
- The University of Texas - MD Anderson Cancer Center, Houston, TX
| | - Lianchun Xiao
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey Morris
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Rikita Hatia
- The University of Texas - MD Anderson Cancer Center, Houston, TX
| | - Ping Chang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lauren Girard
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Asif Rashid
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - George Bhawana
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Robert A. Wolff
- Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hesham M. Amin
- The University of Texas - MD Anderson Cancer Center, Houston, TX
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Abdelhakeem A, Kaseb AO, Hatia R, Abdel-Wahab R, Amin HM, Hassan M. Distribution of insulin growth factor-1 (IGF-1) binding proteins in hepatocellular carcinoma with and without cirrhosis. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.193] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
193 Background: Circulating insulin-like growth factor-1 (IGF-1) significantly declines in patients (pts) with cirrhosis and hepatocellular carcinoma (HCC), reflecting damaged hepatocytes. The bioavailability of IGF-1 is controlled by insulin-like growth factor binding proteins (IGFBPs), which bind IGF-1. IGFBPs transcription is cell specific, and are secreted mainly by the liver. Variations in circulating IGFBPs in HCC pts, especially those with non-cirrhotic HCC, has not been elucidated. We investigated the expression of these proteins in HCC with and without cirrhosis. Methods: Under Institutional Review Board approval, we measured plasma levels of seven IGFBPs in 489 cirrhotic HCC pts, 274 non-cirrhotic HCC pts, 75 pts with cirrhosis without HCC, and 200 healthy controls. Also, we assessed variations in IGFBPs plasma level between early and advanced stage HCC in the presence and absence of cirrhosis. Levels of circulating biomarkers were summarized by descriptive statistics, and both Chi-square and ANOVA tests were used to compare levels between groups. Results: IGFBPs levels varied significantly between groups (Table). Moreover, IGFBP-3 was lower in HCC pts than in healthy controls ( P ≤ 0.001), and IGFBP-1, -2, -4, and -7 were higher in HCC without cirrhosis than in healthy controls ( P = 0.001 for all). Additionally, in non-cirrhotic HCC pts, a similar pattern was observed in advanced Stage HCC compared with early stage HCC. Conclusions: Levels of circulating IGFBPs may be associated with risk of non-cirrhotic HCC and could be used as markers for underlying liver damage. [Table: see text]
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Affiliation(s)
| | | | - Rikita Hatia
- The University of Texas - MD Anderson Cancer Center, Houston, TX
| | | | - Hesham M. Amin
- The University of Texas - MD Anderson Cancer Center, Houston, TX
| | - Manal Hassan
- The University of Texas - MD Anderson Cancer Center, Houston, TX
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Kaseb AO, Carmagnani Pestana R, Vence LM, Blando JM, Singh S, Ikoma N, Vauthey JN, Allison JP, Sharma P. Randomized, open-label, perioperative phase II study evaluating nivolumab alone versus nivolumab plus ipilimumab in patients with resectable HCC. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.185] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
185 Background: In HCC, surgical resection is associated with high recurrence rate, and no effective neoadjuvant or adjuvant therapies currently exist. On the basis of previous reports on the efficacy and safety of anti–PD-1 and anti–CTLA-4 antibodies against HCC, we initiated a randomized pilot trial of perioperative immunotherapy for resectable HCC. Methods: This is a randomized, phase II trial of nivolumab (Arm A) or nivolumab + ipilimumab (Arm B) as peri-operative treatment for patients (pt) with HCC who are eligible for surgical resection. Pt are given nivolumab 240 mg every 2 weeks (wk) for a total of 6 wk. Pt in Arm B are treated concurrently with ipilimumab 1 mg/kg every 6 wk. Surgical resection occurs within 4 wkafter last cycle of therapy. Pt continue adjuvant immunotherapy for up to 2 years after resection. Primary objective is the safety and tolerability of nivolumab +/- ipilimumab. Secondary objectives include overall response rate, complete response rate and time to progression. Exploratory objectives include evaluating the pre- and post-treatment immunological changes in tumor tissues and peripheral blood. Results: 9 pt were enrolled at the time of first interim analysis, and 8 pt were evaluable (5 in Arm A, 3 in Arm B). Pt were 60-69 yo, and males (78%). 5 pt were HCV-positive and 1 had chronic hepatitis B infection. 8 pt proceeded with resection as planned; surgery was aborted for 1 pt due to frozen abdomen from previous surgery. Pathologic complete response (pCR) was observed in 3/8 pt – 2 in Arm A and 1 Arm B (37.5% pCR). 2 pt in Arm B and 1 in Arm A experienced grade 3 or higher toxicity which did not affect their resectability. No grade 4 or higher toxicity were observed. Immune analysis of the first case with a pCR in Arm B demonstrated that clinical response correlated with an increase in CD8+ T cell infiltration, notably an increase in two effector T cell clusters. Conclusions: We report a pCR rate of 37.5% in the first interim analysis of a phase II pilot trial of perioperative immunotherapy for resectable HCC. Treatment was deemed safe and surgical resection was not delayed. The study is ongoing and results may contribute to a paradigm shift in the perioperative treatment of HCC. Clinical trial information: NCT03222076.
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Affiliation(s)
| | | | - Luis M. Vence
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jorge M. Blando
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shalini Singh
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Naruhiko Ikoma
- University of Texas MD Anderson Cancer Center, Houston, TX
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Raghav KPS, Lee RT, Paluri RK, Mody K, Simpson B, Adams BJ, Theuer CP, Kaseb AO. An open-label phase Ib/2 trial of TRC105 plus sorafenib in patients with advanced/metastatic hepatocellular carcinoma (HCC) (NCT01806064). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
268 Background: TRC105, an endoglin antibody, potentiates the activity of sorafenib (S) in preclinical HCC models, and TRC105 + S demonstrated a 33% partial response rate (5/15 pts) by RECIST, at RP2D doses of TRC105 in HCC pts ( Clin Can Res 2017). Adverse events characteristic of each drug were not increased in frequency or severity when the two drugs were administered concurrently. Methods: P1: Compare wkly TRC105 dosing vs four wkly doses followed by every other wkly dosing + S 800 mg daily. P2: Four objective responses are required in 21 pts to reject the null hypothesis that the true response rate probability is < 5% with an alpha level of 0.1 and 80% power. Key inclusion criteria: disease not amendable to surgical or local therapies, ECOG ≤ 1; Child-Pugh A or B (7 points) classification. Results: Thirteen pts were enrolled in phase 1b at TRC105 10 mg/kg wkly for four doses and 15 mg/kg every other week thereafter + S. Mean serum levels of TRC105 exceeded the target conc. following 4 wkly doses of TRC105 at 10 mg/kg (mean = 34 µg/ml, range BLOQ-80). Mean trough conc. decreased following every other week dosing (mean = 13 µg/ml, range BLOQ-31), resulting in infusion reactions or a continued requirement for premedication. Therefore, wkly dosing of TRC105 at 10 mg/kg is the recommended Phase 2 dose. ADA were detected in 10 of 14 pts and correlated with lower than expected PK conc. Common TRC105 related AEs included ≤ G2 epistaxis, ≤ G2 fatigue and ≤ G2 headache. Common S related AEs included ≤ G3 fatigue, ≤ G3 hand foot syndrome and ≤G2 epistaxis. A total of 3 out of 14 evaluable patients (21%) enrolled in phase 1 and 2 achieved durable PR, 2 of these ongoing at week 45 and 17. Conclusions: TRC105 dosed at 10 mg/kg wkly was required to achieve target conc. due to higher clearance in HCC pts, which may have been influenced by a higher rate of ADA compared to studies of TRC105 in other tumor types. The combination of TRC105 + S demonstrated encouraging signs of activity, including durable PR in 2/9 evaluable pts in Phase 1b and 1/5 pts thus far in Phase 2. An additional 16 pts will be enrolled at the RP2D to assess the primary endpoint of ORR by RECIST. Clinical trial information: NCT01806064.
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Affiliation(s)
| | - Richard T. Lee
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Jain A, Borad MJ, Kelley RK, Wang Y, Abdel-Wahab R, Meric-Bernstam F, Baggerly KA, Kaseb AO, Al-shamsi HO, Ahn DH, DeLeon T, Bocobo AG, Bekaii-Saab T, Shroff RT, Javle M. Cholangiocarcinoma With FGFR Genetic Aberrations: A Unique Clinical Phenotype. JCO Precis Oncol 2018; 2:1-12. [DOI: 10.1200/po.17.00080] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose FGFR genetic aberrations (GAs) occur in an estimated 10% to 16% of intrahepatic cholangiocarcinomas (CCAs). The natural history of CCA with FGFR GAs, the prognostic role of coexisting GAs, and the outcome with FGFR-targeted inhibitors are unknown. Patients and Methods Patients with CCA with FGFR GAs were identified using next-generation sequencing or fluorescence in situ hybridization from four tertiary cancer centers and compared with FGFR wild-type counterparts. Data reviewed included demographic, treatment, overall survival (OS), and GA data. Fisher’s exact test, Kaplan-Meier plots, and log-rank tests were used for statistical analysis. Results Three hundred seventy-seven patients with CCA were identified, and 95 had FGFR GAs. FGFR2 GA was most common (n = 74, with 63 fusions) and seen in intrahepatic CCA. In patients with CCA, FGFR GAs occurred more frequently in younger patients (≤ 40 years; 20%) compared with older patients (> 40 years; 6.7%; P < .001), presented at an earlier stage (TNM stage I/II v III/IV: 35.8% v 22%, respectively; P = .001), and were associated with a longer OS compared with patients without FGFR GAs (37 v 20 months, respectively; P < .001). This difference remained significant after excluding 36 patients treated with FGFR inhibitors. There was no OS difference ( P = .60) between CCA with FGFR2 fusions (n = 63) versus other FGFR GAs (n = 29). Patients with FGFR GAs had a better OS with FGFR-targeted therapy compared with standard treatment ( P = .01). BAP1 mutation was the most common coexisting mutation without prognostic impact, whereas TP53 ( P = .04) and CDKN2A/B ( P = .04) were correlated with a shorter OS. Conclusion CCA with FGFR GAs represents a unique subtype occurring in younger patients with an indolent disease course. FGFR-targeted therapy may have a positive impact on OS in this subgroup.
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Affiliation(s)
- Apurva Jain
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Mitesh J. Borad
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Robin Kate Kelley
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Ying Wang
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Reham Abdel-Wahab
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Funda Meric-Bernstam
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Keith A. Baggerly
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Ahmed Omar Kaseb
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Humaid O. Al-shamsi
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Daniel H. Ahn
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Thomas DeLeon
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Andrea Grace Bocobo
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Tanios Bekaii-Saab
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Rachna T. Shroff
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
| | - Milind Javle
- Apurva Jain, Ying Wang, Reham Abdel-Wahab, Funda Meric-Bernstam, Keith A. Baggerly, Ahmed Omar Kaseb, Humaid O. Al-shamsi, Rachna T. Shroff, and Milind Javle, The University of Texas MD Anderson Cancer Center, Houston, TX; Mitesh J. Borad and Thomas DeLeon, Mayo Clinic, Scottsdale, AZ; Robin Kate Kelley and Andrea Grace Bocobo, University of California–San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Reham Abdel-Wahab, Assiut University Hospital, Assiut, Egypt; and Daniel
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Abugabal YI, Hassan M, Abdel-Wahab R, Lacin S, Carmagnani Pestana R, Wolff RA, Yao JC, Kaseb AO. Utility of Neuropilin-1 in predicting survival in patients with hepatocellular carcinoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Manal Hassan
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Sahin Lacin
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | | | - Robert A. Wolff
- Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James C. Yao
- University of Texas MD Anderson Cancer Center, Houston, TX
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Pairawan SS, Hess KR, Janku F, Sanchez NS, Eng C, Damodaran S, Javle MM, Kaseb AO, Hong DS, Subbiah V, Fu S, Fogelman DR, Raymond VM, Lanman RB, Meric-Bernstam F. Cell-free circulating tumor DNA somatic alteration burden and its impact on survival in metastatic cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.12022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Kenneth R. Hess
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Filip Janku
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nora Sylvia Sanchez
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy/ University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cathy Eng
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Senthil Damodaran
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - David S. Hong
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vivek Subbiah
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Siqing Fu
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - David R. Fogelman
- Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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47
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Hwang J, Torres HA, Lok A, Suarez-Almazor ME, Warneke CL, Miller E, Kaseb AO, Sturgis EM, Angelidakis G, Ahmed S, Ferrajoli A, McNeill LH, Samaniego F, Hawk E. Hepatitis c virus infection risk tool for patients with cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jessica Hwang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Anna Lok
- University of Michigan, Ann Arbor, MI
| | - Maria E. Suarez-Almazor
- Section of Rheumatology & Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Ethan Miller
- Department of Gastroenterology Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Sairah Ahmed
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Lorna H McNeill
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Ernest Hawk
- The University of Texas MD Anderson Cancer Center, Houston, TX
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48
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Carmagnani Pestana R, Hassan M, Abdel-Wahab R, Abugabal YI, Kaseb AO. Clinical and prognostic significance of serum levels of angiopoietin-1 (sAng-1) and angiopoietin-2 (sAng-2) in hepatocellular carcinoma (HCC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Manal Hassan
- University of Texas MD Anderson Cancer Center, Houston, TX
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49
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Kaseb AO, Abugabal YI, Abdel-Wahab R, Lacin S, Botrus G, Carmagnani Pestana R, Wolff RA, Yao JC, Hassan M. Prognostic significance of periostin in patients with hepatocellular carcinoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Sahin Lacin
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Gehan Botrus
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Robert A. Wolff
- Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James C. Yao
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Manal Hassan
- University of Texas MD Anderson Cancer Center, Houston, TX
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50
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Sanchez NS, Bailey AM, Wathoo C, Balaji K, Demirhan ME, Yang D, Kahle M, Kaseb AO, Javle MM, Eng C, Subbiah V, Janku F, Raymond VM, Lanman RB, Shaw KR, Meric-Bernstam F. Identification of actionable genomic alterations utilizing cfDNA. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.12110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nora Sylvia Sanchez
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy/ University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ann Marie Bailey
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chetna Wathoo
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Dong Yang
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Kahle
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Cathy Eng
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vivek Subbiah
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Filip Janku
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Kenna Rael Shaw
- University of Texas MD Anderson Cancer Center Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, Houston, TX
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