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Sorin M, Prosty C, Ghaleb L, Nie K, Katergi K, Shahzad MH, Dubé LR, Atallah A, Swaby A, Dankner M, Crump T, Walsh LA, Fiset PO, Sepesi B, Forde PM, Cascone T, Provencio M, Spicer JD. Neoadjuvant Chemoimmunotherapy for NSCLC: A Systematic Review and Meta-Analysis. JAMA Oncol 2024; 10:621-633. [PMID: 38512301 PMCID: PMC10958389 DOI: 10.1001/jamaoncol.2024.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/03/2023] [Indexed: 03/22/2024]
Abstract
Importance To date, no meta-analyses have comprehensively assessed the association of neoadjuvant chemoimmunotherapy with clinical outcomes in non-small cell lung cancer (NSCLC) in randomized and nonrandomized settings. In addition, there exists controversy concerning the efficacy of neoadjuvant chemoimmunotherapy for patients with NSCLC with programmed cell death 1 ligand 1 (PD-L1) levels less than 1%. Objective To compare neoadjuvant chemoimmunotherapy with chemotherapy by adverse events and surgical, pathological, and efficacy outcomes using recently published randomized clinical trials and nonrandomized trials. Data Sources MEDLINE and Embase were systematically searched from January 1, 2013, to October 25, 2023, for all clinical trials of neoadjuvant chemoimmunotherapy and chemotherapy that included at least 10 patients. Study Selection Observational studies and trials reporting the use of neoadjuvant radiotherapy, including chemoradiotherapy, molecular targeted therapy, or immunotherapy monotherapy, were excluded. Main Outcomes and Measures Surgical, pathological, and efficacy end points and adverse events were pooled using a random-effects meta-analysis. Results Among 43 eligible trials comprising 5431 patients (4020 males [74.0%]; median age range, 55-70 years), there were 8 randomized clinical trials with 3387 patients. For randomized clinical trials, pooled overall survival (hazard ratio, 0.65; 95% CI, 0.54-0.79; I2 = 0%), event-free survival (hazard ratio, 0.59; 95% CI, 0.52-0.67; I2 = 14.9%), major pathological response (risk ratio, 3.42; 95% CI, 2.83-4.15; I2 = 31.2%), and complete pathological response (risk ratio, 5.52; 95% CI, 4.25-7.15; I2 = 27.4%) favored neoadjuvant chemoimmunotherapy over neoadjuvant chemotherapy. For patients with baseline tumor PD-L1 levels less than 1%, there was a significant benefit in event-free survival for neoadjuvant chemoimmunotherapy compared with chemotherapy (hazard ratio, 0.74; 95% CI, 0.62-0.89; I2 = 0%). Conclusion and Relevance This study found that neoadjuvant chemoimmunotherapy was superior to neoadjuvant chemotherapy across surgical, pathological, and efficacy outcomes. These findings suggest that patients with resectable NSCLC with tumor PD-L1 levels less than 1% may have an event-free survival benefit with neoadjuvant chemoimmunotherapy.
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Affiliation(s)
- Mark Sorin
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montréal, Quebec, Canada
- Department of Human Genetics, McGill University, Montréal, Quebec, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | - Connor Prosty
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | - Louis Ghaleb
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | - Kathy Nie
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | - Khaled Katergi
- Faculty of Medicine, University of Montreal, Montréal, Quebec, Canada
| | - Muhammad H. Shahzad
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | - Laurie-Rose Dubé
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | - Aline Atallah
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montréal, Quebec, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | - Anikka Swaby
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montréal, Quebec, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | - Matthew Dankner
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montréal, Quebec, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | - Trafford Crump
- Department of Surgery, McGill University, Montréal, Quebec, Canada
| | - Logan A. Walsh
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montréal, Quebec, Canada
- Department of Human Genetics, McGill University, Montréal, Quebec, Canada
| | - Pierre O. Fiset
- Department of Pathology, McGill University, Montréal, Quebec, Canada
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Patrick M. Forde
- Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University, Baltimore, Maryland
| | - Tina Cascone
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mariano Provencio
- Department of Medical Oncology, Puerta de Hierro University Hospital, Autonomous University, Madrid, Instituto de Investigacion Sanitaria Puerta de Hierro–Segovia de Arana, Spain
| | - Jonathan D. Spicer
- Rosalind and Morris Goodman Cancer Institute, McGill University, Montréal, Quebec, Canada
- Department of Surgery, McGill University, Montréal, Quebec, Canada
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Swaby A, Atallah A, Varol O, Cristea A, Quail DF. Lifestyle and host determinants of antitumor immunity and cancer health disparities. Trends Cancer 2023; 9:1019-1040. [PMID: 37718223 DOI: 10.1016/j.trecan.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023]
Abstract
Lifestyle factors exert profound effects on host physiology and immunology. Disparities in cancer outcomes persist as a complex and multifaceted challenge, necessitating a comprehensive understanding of the interplay between host environment and antitumor immune responses. Determinants of health - such as obesity, diet, exercise, stress, or sleep disruption - have the potential for modification, yet some exert long-lasting effects and may challenge the notion of complete reversibility. Herein we review intersectional considerations of lifestyle immunity and the impact on tumor immunology and disparities in cancer outcomes, with a focus on obesity.
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Affiliation(s)
- Anikka Swaby
- Goodman Cancer Research Institute, Montreal, QC, Canada; Department of Experimental Medicine, McGill University, Montreal, QC, Canada
| | - Aline Atallah
- Goodman Cancer Research Institute, Montreal, QC, Canada; Department of Experimental Medicine, McGill University, Montreal, QC, Canada
| | - Ozgun Varol
- Goodman Cancer Research Institute, Montreal, QC, Canada; Department of Experimental Medicine, McGill University, Montreal, QC, Canada
| | - Alyssa Cristea
- Goodman Cancer Research Institute, Montreal, QC, Canada; Department of Experimental Medicine, McGill University, Montreal, QC, Canada
| | - Daniela F Quail
- Goodman Cancer Research Institute, Montreal, QC, Canada; Department of Experimental Medicine, McGill University, Montreal, QC, Canada; Department of Physiology, McGill University, Montreal, QC, Canada.
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McDowell SA, Milette S, Doré S, Yu MW, Sorin M, Wilson L, Desharnais L, Cristea A, Varol O, Atallah A, Swaby A, Breton V, Arabzadeh A, Petrecca S, Loucif H, Bhagrath A, De Meo M, Lach KD, Issac MS, Fiset B, Rayes RF, Mandl JN, Fritz JH, Fiset PO, Holt PR, Dannenberg AJ, Spicer JD, Walsh LA, Quail DF. Obesity alters monocyte developmental trajectories to enhance metastasis. J Exp Med 2023; 220:e20220509. [PMID: 37166450 PMCID: PMC10182775 DOI: 10.1084/jem.20220509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 02/27/2023] [Accepted: 04/19/2023] [Indexed: 05/12/2023] Open
Abstract
Obesity is characterized by chronic systemic inflammation and enhances cancer metastasis and mortality. Obesity promotes breast cancer metastasis to lung in a neutrophil-dependent manner; however, the upstream regulatory mechanisms of this process remain unknown. Here, we show that obesity-induced monocytes underlie neutrophil activation and breast cancer lung metastasis. Using mass cytometry, obesity favors the expansion of myeloid lineages while restricting lymphoid cells within the peripheral blood. RNA sequencing and flow cytometry revealed that obesity-associated monocytes resemble professional antigen-presenting cells due to a shift in their development and exhibit enhanced MHCII expression and CXCL2 production. Monocyte induction of the CXCL2-CXCR2 axis underlies neutrophil activation and release of neutrophil extracellular traps to promote metastasis, and enhancement of this signaling axis is observed in lung metastases from obese cancer patients. Our findings provide mechanistic insight into the relationship between obesity and cancer by broadening our understanding of the interactive role that myeloid cells play in this process.
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Affiliation(s)
- Sheri A.C. McDowell
- Rosalind and Morris Goodman Cancer Institute, Montreal, Canada
- Department of Physiology, McGill University, Montreal, Canada
| | - Simon Milette
- Rosalind and Morris Goodman Cancer Institute, Montreal, Canada
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Canada
| | - Samuel Doré
- Rosalind and Morris Goodman Cancer Institute, Montreal, Canada
- Department of Human Genetics, McGill University, Montreal, Canada
| | - Miranda W. Yu
- Rosalind and Morris Goodman Cancer Institute, Montreal, Canada
- Department of Physiology, McGill University, Montreal, Canada
| | - Mark Sorin
- Rosalind and Morris Goodman Cancer Institute, Montreal, Canada
- Department of Human Genetics, McGill University, Montreal, Canada
| | - Liam Wilson
- Rosalind and Morris Goodman Cancer Institute, Montreal, Canada
- Department of Physiology, McGill University, Montreal, Canada
| | - Lysanne Desharnais
- Rosalind and Morris Goodman Cancer Institute, Montreal, Canada
- Department of Human Genetics, McGill University, Montreal, Canada
| | - Alyssa Cristea
- Rosalind and Morris Goodman Cancer Institute, Montreal, Canada
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Canada
| | - Ozgun Varol
- Rosalind and Morris Goodman Cancer Institute, Montreal, Canada
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Canada
| | - Aline Atallah
- Rosalind and Morris Goodman Cancer Institute, Montreal, Canada
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Canada
| | - Anikka Swaby
- Rosalind and Morris Goodman Cancer Institute, Montreal, Canada
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Canada
| | - Valérie Breton
- Rosalind and Morris Goodman Cancer Institute, Montreal, Canada
| | | | - Sarah Petrecca
- Rosalind and Morris Goodman Cancer Institute, Montreal, Canada
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Canada
| | - Hamza Loucif
- Department of Microbiology and Immunology, McGill University, Montreal, Canada
- McGill University Research Centre on Complex Traits, Montreal, Canada
| | - Aanya Bhagrath
- Department of Physiology, McGill University, Montreal, Canada
- McGill University Research Centre on Complex Traits, Montreal, Canada
| | - Meghan De Meo
- Department of Experimental Surgery, McGill University, Montreal, Canada
| | - Katherine D. Lach
- Department of Pathology, Faculty of Medicine, McGill University, Montreal, Canada
| | - Marianne S.M. Issac
- Department of Pathology, Faculty of Medicine, McGill University, Montreal, Canada
| | - Benoit Fiset
- Rosalind and Morris Goodman Cancer Institute, Montreal, Canada
| | - Roni F. Rayes
- Rosalind and Morris Goodman Cancer Institute, Montreal, Canada
| | - Judith N. Mandl
- Department of Physiology, McGill University, Montreal, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Canada
- McGill University Research Centre on Complex Traits, Montreal, Canada
| | - Jörg H. Fritz
- Department of Microbiology and Immunology, McGill University, Montreal, Canada
- McGill University Research Centre on Complex Traits, Montreal, Canada
| | - Pierre O. Fiset
- Department of Pathology, Faculty of Medicine, McGill University, Montreal, Canada
| | - Peter R. Holt
- Laboratory of Biochemical Genetics and Metabolism, Rockefeller University, New Nork, NY, USA
| | - Andrew J. Dannenberg
- Department of Medicine (retired), Weill Cornell Medical College, New York, NY, USA
| | - Jonathan D. Spicer
- Rosalind and Morris Goodman Cancer Institute, Montreal, Canada
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Canada
- Department of Surgery, McGill University Health Centre, Montreal, Canada
| | - Logan A. Walsh
- Rosalind and Morris Goodman Cancer Institute, Montreal, Canada
- Department of Human Genetics, McGill University, Montreal, Canada
| | - Daniela F. Quail
- Rosalind and Morris Goodman Cancer Institute, Montreal, Canada
- Department of Physiology, McGill University, Montreal, Canada
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Canada
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