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Mallardo D, Woodford R, Menzies AM, Zimmer L, Williamson A, Ramelyte E, Dimitriou F, Wicky A, Wallace R, Mallardo M, Cortellini A, Budillon A, Atkinson V, Sandhu S, Olivier M, Dummer R, Lorigan P, Schadendorf D, Long GV, Simeone E, Ascierto PA. The role of diabetes in metastatic melanoma patients treated with nivolumab plus relatlimab. J Transl Med 2023; 21:753. [PMID: 37880788 PMCID: PMC10601323 DOI: 10.1186/s12967-023-04607-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/08/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND The combination of nivolumab + relatlimab is superior to nivolumab alone in the treatment of naive patients and has activity in PD-1 refractory melanoma. We had previously observed a reduced expression of LAG3 in melanoma tissue from patients with type 2 diabetes. METHOD To evaluate the impact of diabetes on oncological outcomes of patients with advanced melanoma treated with nivolumab plus the LAG3 inhibitor relatlimab we performed a retrospective multicenter study. RESULTS Overall, 129 patients were included: 88 without diabetes before the treatment, 37 who were diagnosed with type 2 diabetes before the start of treatment, and 4 without diabetes before treatment who developed immune checkpoint inhibitor-induced diabetes (ICI-DM). PFS was 21.71 months (95% CI: 15.61-27.81) in patients without diabetes, 10.23 months (95% CI: 5.81-14.66) in patients with type 2 diabetes, and 50.85 months (95% CI: 23.04-78.65) in patients who developed ICI-DM. OS was 37.94 months (95% CI: 31.02-44.85) in patients without diabetes, 22.12 months (95% CI: 14.41-29.85) in those with type 2 diabetes and 57.64 months (95% CI: 42.29-72.99) in those who developed ICI-DM. Multivariate analysis showed that the presence of diabetes and LDH was correlated with OS and PFS. The mean OS was 64.63 months in subjects with low levels of glucose (< 137 mg/dl) and 36.27 months in those with high levels (hazard ratio 0.16, 95% CI: 0.04-0.58; p = 0.005). The patients whose glucose blood level increased after 3 months of treatment with nivolumab + relatinib compared to baseline (ratio of blood level at baseline/after 3 months > 1.5) had a worse prognosis than those whose glucose level had not increased. This result was observed also in subgroups treated either in first line or further lines. Patients who developed ICI-DM during the study period had better outcomes than the overall population and patients without diabetes. CONCLUSIONS LAG3 inhibition for treating metastatic or unresectable melanoma has a reduced efficacy in patients with type 2 diabetes, possibly due to a low expression of LAG3 in tumor tissue. Higher level evidence should be obtained.
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Affiliation(s)
- Domenico Mallardo
- Melanoma, Cancer Immunotherapy, and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Via Mariano Semmola, 53, 80131, Naples, Italy
| | - Rachel Woodford
- Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, NCT-West, German Cancer Consortium, Partner Site Essen and University Alliance Ruhr, Research Center One Health, Essen, Germany
| | - Andrew Williamson
- Christie NHS Foundation Trust and Division of Cancer Services, University of Manchester, Manchester, UK
| | - Egle Ramelyte
- Department of Dermatology, University of Zurich, Zurich, Switzerland
| | | | - Alexandre Wicky
- Department of Oncology, Precision Oncology Center, Lausanne University Hospital, Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | | | - Mario Mallardo
- Melanoma, Cancer Immunotherapy, and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Via Mariano Semmola, 53, 80131, Naples, Italy
| | - Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W120HS, UK
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Biomedico, Rome, Italy
| | - Alfredo Budillon
- Scientific Director, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Victoria Atkinson
- Greenslopes Private Hospital, University of Queensland QLD, Greenslopes, Australia
| | | | - Michielin Olivier
- Department of Oncology, Precision Oncology Center, Lausanne University Hospital, Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University of Zurich, Zurich, Switzerland
| | - Paul Lorigan
- Christie NHS Foundation Trust and Division of Cancer Services, University of Manchester, Manchester, UK
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, NCT-West, German Cancer Consortium, Partner Site Essen and University Alliance Ruhr, Research Center One Health, Essen, Germany
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Ester Simeone
- Melanoma, Cancer Immunotherapy, and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Via Mariano Semmola, 53, 80131, Naples, Italy
| | - Paolo A Ascierto
- Melanoma, Cancer Immunotherapy, and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Via Mariano Semmola, 53, 80131, Naples, Italy.
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Modestino L, Cristinziano L, Trocchia M, Ventrici A, Capone M, Madonna G, Loffredo S, Ferrara AL, Romanelli M, Simeone E, Varricchi G, Rossi FW, de Paulis A, Marone G, Ascierto PA, Galdiero MR. Melanoma-derived soluble mediators modulate neutrophil biological properties and the release of neutrophil extracellular traps. Cancer Immunol Immunother 2023; 72:3363-3376. [PMID: 37525065 PMCID: PMC10491523 DOI: 10.1007/s00262-023-03493-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/12/2023] [Accepted: 07/03/2023] [Indexed: 08/02/2023]
Abstract
Polymorphonuclear neutrophils (PMNs) are the main effector cells in the inflammatory response. The significance of PMN infiltration in the tumor microenvironment remains unclear. Metastatic melanoma is the most lethal skin cancer with an increasing incidence over the last few decades. This study aimed to investigate the role of PMNs and their related mediators in human melanoma. Highly purified human PMNs from healthy donors were stimulated in vitro with conditioned media (CM) derived from the melanoma cell lines SKMEL28 and A375 (melanoma CM), and primary melanocytes as controls. PMN biological properties (chemotaxis, survival, activation, cell tracking, morphology and NET release) were evaluated. We found that the A375 cell line produced soluble factors that promoted PMN chemotaxis, survival, activation and modification of morphological changes and kinetic properties. Furthermore, in both melanoma cell lines CM induced chemotaxis, activation and release of neutrophil extracellular traps (NETs) from PMNs. In contrast, the primary melanocyte CM did not modify the biological behavior of PMNs. In addition, serum levels of myeloperoxidase, matrix metalloprotease-9, CXCL8/IL-8, granulocyte and monocyte colony-stimulating factor and NETs were significantly increased in patients with advanced melanoma compared to healthy controls. Melanoma cell lines produce soluble factors able to "educate" PMNs toward an activated functional state. Patients with metastatic melanoma display increased circulating levels of neutrophil-related mediators and NETs. Further investigations are needed to better understand the role of these "tumor-educated neutrophils" in modifying melanoma cell behavior.
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Affiliation(s)
- Luca Modestino
- Department of Translational Medical Sciences (DiSMeT), University of Naples Federico II, 80131, Naples, Italy
- WAO Center of Excellence, University of Naples Federico II, 80131, Naples, Italy
| | - Leonardo Cristinziano
- Department of Translational Medical Sciences (DiSMeT), University of Naples Federico II, 80131, Naples, Italy
- WAO Center of Excellence, University of Naples Federico II, 80131, Naples, Italy
| | - Marialuisa Trocchia
- Department of Translational Medical Sciences (DiSMeT), University of Naples Federico II, 80131, Naples, Italy
- WAO Center of Excellence, University of Naples Federico II, 80131, Naples, Italy
| | - Annagioia Ventrici
- Department of Translational Medical Sciences (DiSMeT), University of Naples Federico II, 80131, Naples, Italy
- WAO Center of Excellence, University of Naples Federico II, 80131, Naples, Italy
| | - Mariaelena Capone
- Melanoma, Cancer Immunotherapy, and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", 80131, Naples, Italy
| | - Gabriele Madonna
- Melanoma, Cancer Immunotherapy, and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", 80131, Naples, Italy
| | - Stefania Loffredo
- Department of Translational Medical Sciences (DiSMeT), University of Naples Federico II, 80131, Naples, Italy
- WAO Center of Excellence, University of Naples Federico II, 80131, Naples, Italy
- Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131, Naples, Italy
- Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), 80131, Naples, Italy
| | - Anne Lise Ferrara
- Department of Translational Medical Sciences (DiSMeT), University of Naples Federico II, 80131, Naples, Italy
- WAO Center of Excellence, University of Naples Federico II, 80131, Naples, Italy
- Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), 80131, Naples, Italy
| | - Marilena Romanelli
- Melanoma, Cancer Immunotherapy, and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", 80131, Naples, Italy
| | - Ester Simeone
- Melanoma, Cancer Immunotherapy, and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", 80131, Naples, Italy
| | - Gilda Varricchi
- Department of Translational Medical Sciences (DiSMeT), University of Naples Federico II, 80131, Naples, Italy
- WAO Center of Excellence, University of Naples Federico II, 80131, Naples, Italy
- Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131, Naples, Italy
- Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), 80131, Naples, Italy
| | - Francesca Wanda Rossi
- Department of Translational Medical Sciences (DiSMeT), University of Naples Federico II, 80131, Naples, Italy
- WAO Center of Excellence, University of Naples Federico II, 80131, Naples, Italy
- Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131, Naples, Italy
| | - Amato de Paulis
- Department of Translational Medical Sciences (DiSMeT), University of Naples Federico II, 80131, Naples, Italy
- WAO Center of Excellence, University of Naples Federico II, 80131, Naples, Italy
- Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131, Naples, Italy
| | - Gianni Marone
- Department of Translational Medical Sciences (DiSMeT), University of Naples Federico II, 80131, Naples, Italy
- WAO Center of Excellence, University of Naples Federico II, 80131, Naples, Italy
- Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131, Naples, Italy
- Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), 80131, Naples, Italy
| | - Paolo Antonio Ascierto
- Melanoma, Cancer Immunotherapy, and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", 80131, Naples, Italy
| | - Maria Rosaria Galdiero
- Department of Translational Medical Sciences (DiSMeT), University of Naples Federico II, 80131, Naples, Italy.
- WAO Center of Excellence, University of Naples Federico II, 80131, Naples, Italy.
- Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131, Naples, Italy.
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Mallardo D, Fordellone M, White A, Ottaviano M, Sparano F, Bailey M, Facchini AB, Ong S, Maiolino P, Caracò C, Church S, Cavalcanti E, Warren S, Budillon A, Cesano A, Simeone E, Chiodini P, Ascierto PA. CD39 and LDHA affects the prognostic role of NLR in metastatic melanoma patients treated with immunotherapy. J Transl Med 2023; 21:610. [PMID: 37684649 PMCID: PMC10492378 DOI: 10.1186/s12967-023-04419-6] [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: 07/12/2023] [Accepted: 08/05/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Identifying response markers is highly needed to guide the treatment strategy in patients with metastatic melanoma. METHODS A retrospective study was carried out in patients with unresectable/metastatic melanoma (stage IIIb-IV), treated with anti-PD-1 in the first line setting, to better explore the role and the timing of neutrophil/lymphocyte ratio (NLR) as potential biomarker of response. The relationship of NLR with inflammation-immune mediators and the underlying negative effect of raising NLR during immunotherapy, have been investigated with transcriptomic gene analysis. RESULTS The results confirmed previous findings that a high baseline NLR is associated with a poorer prognosis and with higher serum level of lactate dehydrogenase (LDH), regardless of the presence of brain metastases. The transcriptomic analysis showed that high baseline NLR is associated with a characteristic gene signature CCNA1, LDHA and IL18R1, which correlates with inflammation and tumorigenesis. Conversely, low baseline NLR is associated with the signature CD3, SH2D1A, ZAP70 and CD45RA, linked to the immune-activation. The genes positively associated with NLR (CD39 (ENTPD1), PTEN, MYD88, MMP9 and LDH) are involved in processes of immunosuppression, inflammation and tumor-promoting activity. Increased expression of CD39 correlated with TGFβ2, a marker of the N2 neutrophils with immunosuppressive activity. CONCLUSIONS These results suggest that increasing NLR is associated with an increased neutrophil population, with polarization to the N2 phenotype, and this process may be the basis for the negatively prognostic role of NLR.
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Affiliation(s)
- Domenico Mallardo
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Mario Fordellone
- Universitiy of Campania "Luigi Vanvitelli", 81100, Naples, Italy
| | | | | | - Francesca Sparano
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | | | | | - Sufey Ong
- NanoString Technologies Inc, Seattle, WA, USA
| | - Piera Maiolino
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Corrado Caracò
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | | | | | | | - Alfredo Budillon
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | | | - Ester Simeone
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Paolo Chiodini
- Universitiy of Campania "Luigi Vanvitelli", 81100, Naples, Italy
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4
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Ascierto PA, Di Giacomo AM, Chiarion Sileni V, Queirolo P, Spagnolo F, De Galitiis F, Cognetti F, Mandalà M, Guidoboni M, Rinaldi G, Depenni R, Consoli F, Troiani T, Guida M, Marconcini R, Ferrucci PF, Strippoli S, Fava P, Merelli B, Simeone E, Di Guardo L, Giannarelli D, Maio M, Quaglino P, Del Vecchio M. Italian nivolumab Expanded Access Programme in melanoma adjuvant setting: patient outcomes and safety profile. Eur J Cancer 2023; 191:113246. [PMID: 37549531 DOI: 10.1016/j.ejca.2023.113246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/30/2023] [Accepted: 07/11/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION The CheckMate 238 randomised study demonstrated the relevant benefit in terms of recurrence-free survival (RFS) of nivolumab versus ipilimumab in resected stage IIIB-C or IV melanoma patients with a tolerable safety profile. MATERIALS AND METHODS From November 2018 to June 2019, 611 patients with stage III and IV resected melanoma were enroled to receive nivolumab as part of an Italian Expanded Access Programme (EAP). According to stages, 77% were stage III while 141 (23%) were stage IV with no evidence of disease (NED). Among stage III, 121 patients had IIIA (19.8%). RESULTS After a median follow-up of 23 months, the RFS in the Intention-to-Treat (ITT) population was 76.6% at 1 year and 59.6% at 2 years; 1- and 2-year distant metastasis-free survival were 83.7% and 71.2%, respectively. The overall survival rate in the ITT population was 93.8% at 1 year and 85.5% at 2 years. No significant differences in RFS were observed according to BRAF status. Treatment-related adverse events of grades 3-4 occurred in 11.5% of patients. CONCLUSION This paper reports the results of the Italian Nivolumab EAP in the adjuvant setting of stage III and IV NED melanoma patients. Our results confirm in a real-life setting the clinical activity and safety of nivolumab reported in the CheckMate238 registrative/pivotal. The enroled cohort of 611 patients highlights the relevant clinical need in this setting, also confirmed by the very short accrual time, representing one of the largest series reported as adjuvant EAP with the longest follow-up.
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Affiliation(s)
- Paolo A Ascierto
- Unit of Melanoma and Innovative Therapies, IRCCS Istituto Nazionale Tumori Fondazione G. Pascale, Napoli, Italy
| | - Anna M Di Giacomo
- University of Siena and Center for Immuno-Oncology, University Hospital Le Scotte, Siena, Italy
| | | | - Paola Queirolo
- Division of Melanoma Sarcoma and Rare Tumors, IRCCS European Institute of Oncology, Milano, Italy; IRCCS Ospedale Policlinico San Martino, Skin Cancer Unit, Genova, Italy; Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Università degli Studi di Genova, Genova, Italy
| | - Francesco Spagnolo
- IRCCS Ospedale Policlinico San Martino, Skin Cancer Unit, Genova, Italy; Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Università degli Studi di Genova, Genova, Italy
| | | | | | - Mario Mandalà
- University of Perugia, Perugia, Italy; Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Massimo Guidoboni
- Experimental and Clinical Oncology of Immunotherapy and Rare Cancers Unit, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori "Dino Amadori", Meldola, Italy
| | - Gaetana Rinaldi
- Department of Surgical, Oncological and Oral Sciences, Unità Operativa Complessa Medical Oncology, Policlinico Universitario Paolo Giaccone, Palermo, Italy
| | - Roberta Depenni
- Department of Oncology and Hematology, Università degli Studi di Modena e Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Francesca Consoli
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology Unit, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | | | - Michele Guida
- Rare Tumors and Melanoma Unit, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Riccardo Marconcini
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Pier F Ferrucci
- Biotherapy of Tumors Unit, Department of Experimental Oncology, European Institute of Oncology IRCCS, Milano, Italy
| | - Sabino Strippoli
- Rare Tumors and Melanoma Unit, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Paolo Fava
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Ester Simeone
- Unit of Melanoma and Innovative Therapies, IRCCS Istituto Nazionale Tumori Fondazione G. Pascale, Napoli, Italy
| | - Lorenza Di Guardo
- Unit of Melanoma Medical Oncology, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Diana Giannarelli
- Biostatistic, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Massimo Maio
- University of Siena and Center for Immuno-Oncology, University Hospital Le Scotte, Siena, Italy
| | - Pietro Quaglino
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Michele Del Vecchio
- Unit of Melanoma Medical Oncology, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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5
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Ferguson R, Chat V, Morales L, Simpson D, Monson KR, Cohen E, Zusin S, Madonna G, Capone M, Simeone E, Pavlick A, Luke JJ, Gajewski TF, Osman I, Ascierto P, Weber J, Kirchhoff T. Germline immunomodulatory expression quantitative trait loci (ieQTLs) associated with immune-related toxicity from checkpoint inhibition. Eur J Cancer 2023; 189:112923. [PMID: 37301715 PMCID: PMC11000635 DOI: 10.1016/j.ejca.2023.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/13/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Immune checkpoint inhibition (ICI) has improved clinical outcomes for metastatic melanoma patients; however, 65-80% of patients treated with ICI experience immune-related adverse events (irAEs). Given the plausible link of irAEs with underlying host immunity, we explored whether germline genetic variants controlling the expression of 42 immunomodulatory genes were associated with the risk of irAEs in melanoma patients treated with the single-agent anti-CTLA-4 antibody ipilimumab (IPI). METHODS We identified 42 immunomodulatory expression quantitative trait loci (ieQTLs) most significantly associated with the expression of 382 immune-related genes. These germline variants were genotyped in IPI-treated melanoma patients, collected as part of a multi-institutional collaboration. We tested the association of ieQTLs with irAEs in a discovery cohort of 95 patients, followed by validation in an additional 97 patients. RESULTS We found that the alternate allele of rs7036417, a variant linked to increased expression of SYK, was strongly associated with an increased risk of grade 3-4 toxicity [odds ratio (OR) = 7.46; 95% confidence interval (CI) = 2.65-21.03; p = 1.43E-04]. This variant was not associated with response (OR = 0.90; 95% CI = 0.37-2.21; p = 0.82). CONCLUSION We report that rs7036417 is associated with increased risk of severe irAEs, independent of IPI efficacy. SYK plays an important role in B-cell/T-cell expansion, and increased pSYK has been reported in patients with autoimmune disease. The association between rs7036417 and IPI irAEs in our data suggests a role of SYK overexpression in irAE development. These findings support the hypothesis that inherited variation in immune-related pathways modulates ICI toxicity and suggests SYK as a possible future target for therapies to reduce irAEs.
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Affiliation(s)
- Robert Ferguson
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY, USA; Departments of Population Health and Environmental Medicine, New York University-Grossman School of Medicine, New York, NY, USA; The Interdisciplinary Melanoma Cooperative Group, New York University-Grossman School of Medicine, New York, NY, USA
| | - Vylyny Chat
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY, USA; Departments of Population Health and Environmental Medicine, New York University-Grossman School of Medicine, New York, NY, USA; The Interdisciplinary Melanoma Cooperative Group, New York University-Grossman School of Medicine, New York, NY, USA
| | - Leah Morales
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY, USA; Departments of Population Health and Environmental Medicine, New York University-Grossman School of Medicine, New York, NY, USA; The Interdisciplinary Melanoma Cooperative Group, New York University-Grossman School of Medicine, New York, NY, USA
| | - Danny Simpson
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY, USA; Departments of Population Health and Environmental Medicine, New York University-Grossman School of Medicine, New York, NY, USA; The Interdisciplinary Melanoma Cooperative Group, New York University-Grossman School of Medicine, New York, NY, USA
| | - Kelsey R Monson
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY, USA; Departments of Population Health and Environmental Medicine, New York University-Grossman School of Medicine, New York, NY, USA; The Interdisciplinary Melanoma Cooperative Group, New York University-Grossman School of Medicine, New York, NY, USA
| | - Elisheva Cohen
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY, USA; Departments of Population Health and Environmental Medicine, New York University-Grossman School of Medicine, New York, NY, USA; The Interdisciplinary Melanoma Cooperative Group, New York University-Grossman School of Medicine, New York, NY, USA
| | - Sarah Zusin
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY, USA; Departments of Population Health and Environmental Medicine, New York University-Grossman School of Medicine, New York, NY, USA; The Interdisciplinary Melanoma Cooperative Group, New York University-Grossman School of Medicine, New York, NY, USA
| | - Gabriele Madonna
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Mariaelena Capone
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Ester Simeone
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Anna Pavlick
- Division of Hematology & Medical Oncology, the Cutaneous Oncology Program, Weill Cornell Medicine and New York-Presbyterian, New York, USA
| | - Jason J Luke
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA 15213, USA; UPMC Hillman Cancer Center, Pittsburgh, PA 15232, USA
| | - Thomas F Gajewski
- Department of Pathology, University of Chicago, Chicago, IL, USA; Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA; Ben May Department for Cancer Research, University of Chicago, Chicago, IL, USA
| | - Iman Osman
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY, USA; The Interdisciplinary Melanoma Cooperative Group, New York University-Grossman School of Medicine, New York, NY, USA; Department of Medicine, New York University-Grossman School of Medicine, New York, NY, USA; Ronald O. Perelman Department of Dermatology, New York University-Grossman School of Medicine, New York, NY, USA
| | - Paolo Ascierto
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Jeffrey Weber
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY, USA; The Interdisciplinary Melanoma Cooperative Group, New York University-Grossman School of Medicine, New York, NY, USA; Department of Medicine, New York University-Grossman School of Medicine, New York, NY, USA
| | - Tomas Kirchhoff
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY, USA; Departments of Population Health and Environmental Medicine, New York University-Grossman School of Medicine, New York, NY, USA; The Interdisciplinary Melanoma Cooperative Group, New York University-Grossman School of Medicine, New York, NY, USA.
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Galati D, Zanotta S, Capone M, Madonna G, Mallardo D, Romanelli M, Simeone E, Festino L, Sparano F, Azzaro R, De Filippi R, Pinto A, Paulos CM, Ascierto PA. Potential clinical implications of CD4 +CD26 high T cells for nivolumab treated melanoma patients. J Transl Med 2023; 21:318. [PMID: 37170241 PMCID: PMC10176780 DOI: 10.1186/s12967-023-04184-6] [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: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Nivolumab is an anti-PD1 antibody that has dramatically improved metastatic melanoma patients' outcomes. Nevertheless, many patients are resistant to PD-1 inhibition, occasionally experiencing severe off-target immune toxicity. In addition, no robust and reproducible biomarkers have yet been validated to identify the correct selection of patients who will benefit from anti-PD-1 treatment avoiding unwanted side effects. However, the strength of CD26 expression on CD4+ T lymphocytes permits the characterization of three subtypes with variable degrees of responsiveness to tumors, suggesting that the presence of CD26-expressing T cells in patients might be a marker of responsiveness to PD-1-based therapies. METHODS The frequency distribution of peripheral blood CD26-expressing cells was investigated employing multi-parametric flow cytometry in 69 metastatic melanoma patients along with clinical characteristics and blood count parameters at baseline (W0) and compared to 20 age- and sex-matched healthy controls. Percentages of baseline CD4+CD26high T cells were correlated with the outcome after nivolumab treatment. In addition, the frequency of CD4+CD26high T cells at W0 was compared with those obtained after 12 weeks (W1) of therapy in a sub-cohort of 33 patients. RESULTS Circulating CD4+CD26high T cells were significantly reduced in melanoma patients compared to healthy subjects (p = 0.001). In addition, a significant association was observed between a low baseline percentage of CD4+CD26high T cells (< 7.3%) and clinical outcomes, measured as overall survival (p = 0.010) and progression-free survival (p = 0.014). Moreover, patients with clinical benefit from nivolumab therapy had significantly higher frequencies of circulating CD4+CD26high T cells than patients with non-clinical benefit (p = 0.004) at 12 months. Also, a higher pre-treatment proportion of circulating CD4+CD26high T cells was correlated with Disease Control Rate (p = 0.014) and best Overall Response Rate (p = 0.009) at 12 months. Interestingly, after 12 weeks (W1) of nivolumab treatment, percentages of CD4+CD26high T cells were significantly higher in comparison with the frequencies measured at W0 (p < 0.0001), aligning the cell counts with the ranges seen in the blood of healthy subjects. CONCLUSIONS Our study firstly demonstrates that peripheral blood circulating CD4+CD26high T lymphocytes represent potential biomarkers whose perturbations are associated with reduced survival and worse clinical outcomes in melanoma patients.
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Affiliation(s)
- Domenico Galati
- Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
| | - Serena Zanotta
- Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
| | - Mariaelena Capone
- Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
| | - Gabriele Madonna
- Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
| | - Domenico Mallardo
- Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
| | - Marilena Romanelli
- Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
| | - Ester Simeone
- Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
| | - Lucia Festino
- Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
| | - Francesca Sparano
- Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
| | - Rosa Azzaro
- Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
| | - Rosaria De Filippi
- Dipartimento di Medicina Clinica e Chirurgia, Università Degli Studi Federico II, Naples, Italy
| | - Antonio Pinto
- Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
| | - Chrystal M. Paulos
- Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, GA USA
- Department of Microbiology and Immunology, Winship Cancer Institute, Emory University, Atlanta, GA USA
| | - Paolo A. Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
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7
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Mallardo D, Simeone E, Festino L, Tuffanelli M, Vanella V, Trojaniello C, Vitale MG, Ottaviano M, Capone M, Madonna G, Sparano F, Cioli E, Scarpato L, Palla M, Di Trolio R, Meinardi P, Caracò C, Ferrara G, Muto P, Cavalcanti E, Ascierto PA. IL-6 as new prognostic factor in patients with advanced cutaneous squamous cell carcinoma treated with cemiplimab. J Transl Med 2023; 21:140. [PMID: 36823670 PMCID: PMC9948392 DOI: 10.1186/s12967-023-03971-5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/05/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Prognostic factors for initial response of advanced cutaneous squamous cell carcinoma to cemiplimab treatment are lacking. Il-6 has been found to affect immune cell populations which impact tumor development. The aim was to investigate the prognostic significance of IL-6 serum levels before and during treatment. METHODS Serum levels of IL-6 were correlated with clinical outcomes in a retrospective study. RESULTS Overall, 39 patients were enrolled. High serum levels of IL-6 (> 5.6 pg/ml) were associated with poorer survival (45.1% vs 0 deaths; OS: 16.1 ± 1.5 vs 20.8 ± 0 months, 95% CI 13,046 to 19,184) and shorter PFS (10.3 ± 1.9 vs 18.9 ± 1.5 months; 95% CI 3433 to 10,133) in patients with advanced CSCC treated with cemiplimab. In addition, patients whose IL-6 level increased after treatment with cemiplimab, independently of the basal level, had a poorer response to treatment than patients whose level was reduced or stable after immunotherapy. CONCLUSIONS Serum levels of IL-6 at baseline and changes after cemiplimab immunotherapy may have a prognostic significance in patients with advanced cutaneous squamous cell carcinoma.
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Affiliation(s)
- Domenico Mallardo
- grid.508451.d0000 0004 1760 8805Istituto Nazionale Tumori – IRCCS – Fondazione “G. Pascale”, Naples, Italy
| | - Ester Simeone
- grid.508451.d0000 0004 1760 8805Istituto Nazionale Tumori – IRCCS – Fondazione “G. Pascale”, Naples, Italy
| | - Lucia Festino
- grid.508451.d0000 0004 1760 8805Istituto Nazionale Tumori – IRCCS – Fondazione “G. Pascale”, Naples, Italy
| | - Marilena Tuffanelli
- grid.508451.d0000 0004 1760 8805Istituto Nazionale Tumori – IRCCS – Fondazione “G. Pascale”, Naples, Italy
| | - Vito Vanella
- grid.508451.d0000 0004 1760 8805Istituto Nazionale Tumori – IRCCS – Fondazione “G. Pascale”, Naples, Italy
| | - Claudia Trojaniello
- grid.508451.d0000 0004 1760 8805Istituto Nazionale Tumori – IRCCS – Fondazione “G. Pascale”, Naples, Italy
| | - Maria Grazia Vitale
- grid.508451.d0000 0004 1760 8805Istituto Nazionale Tumori – IRCCS – Fondazione “G. Pascale”, Naples, Italy
| | - Margaret Ottaviano
- grid.508451.d0000 0004 1760 8805Istituto Nazionale Tumori – IRCCS – Fondazione “G. Pascale”, Naples, Italy
| | - Mariaelena Capone
- grid.508451.d0000 0004 1760 8805Istituto Nazionale Tumori – IRCCS – Fondazione “G. Pascale”, Naples, Italy
| | - Gabriele Madonna
- grid.508451.d0000 0004 1760 8805Istituto Nazionale Tumori – IRCCS – Fondazione “G. Pascale”, Naples, Italy
| | - Francesca Sparano
- grid.508451.d0000 0004 1760 8805Istituto Nazionale Tumori – IRCCS – Fondazione “G. Pascale”, Naples, Italy
| | - Eleonora Cioli
- grid.508451.d0000 0004 1760 8805Istituto Nazionale Tumori – IRCCS – Fondazione “G. Pascale”, Naples, Italy
| | - Luigi Scarpato
- grid.508451.d0000 0004 1760 8805Istituto Nazionale Tumori – IRCCS – Fondazione “G. Pascale”, Naples, Italy
| | - Marco Palla
- grid.508451.d0000 0004 1760 8805Istituto Nazionale Tumori – IRCCS – Fondazione “G. Pascale”, Naples, Italy
| | - Rossella Di Trolio
- grid.508451.d0000 0004 1760 8805Istituto Nazionale Tumori – IRCCS – Fondazione “G. Pascale”, Naples, Italy
| | - Paolo Meinardi
- grid.508451.d0000 0004 1760 8805Istituto Nazionale Tumori – IRCCS – Fondazione “G. Pascale”, Naples, Italy
| | - Corrado Caracò
- grid.508451.d0000 0004 1760 8805Istituto Nazionale Tumori – IRCCS – Fondazione “G. Pascale”, Naples, Italy
| | - Gerardo Ferrara
- grid.508451.d0000 0004 1760 8805Istituto Nazionale Tumori – IRCCS – Fondazione “G. Pascale”, Naples, Italy
| | - Paolo Muto
- grid.508451.d0000 0004 1760 8805Istituto Nazionale Tumori – IRCCS – Fondazione “G. Pascale”, Naples, Italy
| | - Ernesta Cavalcanti
- grid.508451.d0000 0004 1760 8805Istituto Nazionale Tumori – IRCCS – Fondazione “G. Pascale”, Naples, Italy
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Granata V, Fusco R, Setola SV, Simonetti I, Picone C, Simeone E, Festino L, Vanella V, Vitale MG, Montanino A, Morabito A, Izzo F, Ascierto PA, Petrillo A. Immunotherapy Assessment: A New Paradigm for Radiologists. Diagnostics (Basel) 2023; 13:diagnostics13020302. [PMID: 36673112 PMCID: PMC9857844 DOI: 10.3390/diagnostics13020302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/31/2022] [Accepted: 01/08/2023] [Indexed: 01/14/2023] Open
Abstract
Immunotherapy denotes an exemplar change in an oncological setting. Despite the effective application of these treatments across a broad range of tumors, only a minority of patients have beneficial effects. The efficacy of immunotherapy is affected by several factors, including human immunity, which is strongly correlated to genetic features, such as intra-tumor heterogeneity. Classic imaging assessment, based on computed tomography (CT) or magnetic resonance imaging (MRI), which is useful for conventional treatments, has a limited role in immunotherapy. The reason is due to different patterns of response and/or progression during this kind of treatment which differs from those seen during other treatments, such as the possibility to assess the wide spectrum of immunotherapy-correlated toxic effects (ir-AEs) as soon as possible. In addition, considering the unusual response patterns, the limits of conventional response criteria and the necessity of using related immune-response criteria are clear. Radiomics analysis is a recent field of great interest in a radiological setting and recently it has grown the idea that we could identify patients who will be fit for this treatment or who will develop ir-AEs.
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Affiliation(s)
- Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
- Correspondence:
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Sergio Venanzio Setola
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Igino Simonetti
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Carmine Picone
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Ester Simeone
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Lucia Festino
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Vito Vanella
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Maria Grazia Vitale
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Agnese Montanino
- Thoracic Medical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Alessandro Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Francesco Izzo
- Division of Epatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Paolo Antonio Ascierto
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Antonella Petrillo
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
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9
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Mallardo D, Simeone E, Vanella V, Vitale MG, Palla M, Scarpato L, Paone M, De Cristofaro T, Borzillo V, Cortellini A, Sparano F, Pignata S, Fiore F, Caracò C, Maiolino P, Petrillo A, Cavalcanti E, Lastoria S, Muto P, Budillon A, Warren S, Ascierto PA. Concomitant medication of cetirizine in advanced melanoma could enhance anti-PD-1 efficacy by promoting M1 macrophages polarization. J Transl Med 2022; 20:436. [PMID: 36180872 PMCID: PMC9523893 DOI: 10.1186/s12967-022-03643-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The clinical observation showed a potential additive effect of anti-PD-1 agents and cetirizine in patients with advanced melanoma. METHODS Clinical outcomes of concomitant cetirizine/anti-PD-1 treatment of patients with stage IIIb-IV melanoma were retrospectively collected, and a transcriptomic analysis was performed on blood samples obtained at baseline and after 3 months of treatment. RESULTS Patients treated with cetirizine concomitantly with an anti-PD-1 agent had significantly longer progression-free survival (PFS; mean PFS: 28 vs 15 months, HR 0.46, 95% CI: 0.28-0.76; p = 0.0023) and OS (mean OS was 36 vs 23 months, HR 0.48, 95% CI: 0.29-0.78; p = 0.0032) in comparison with those not receiving cetirizine. The concomitant treatment was significantly associated with ORR and DCR (p < 0.05). The expression of FCGR1A/CD64, a specific marker of macrophages, was increased after the treatment in comparison with baseline in blood samples from patients receiving cetirizine, but not in those receiving only the anti-PD1, and positively correlated with the expression of genes linked to the interferon pathway such as CCL8 (rho = 0.32; p = 0.0111), IFIT1 (rho = 0.29; p = 0.0229), IFIT3 (rho = 0.57; p < 0.0001), IFI27 (rho = 0.42; p = 0.008), MX1 (rho = 0.26; p = 0.0383) and RSAD2 (rho = 0.43; p = 0.0005). CONCLUSIONS This retrospective study suggests that M1 macrophage polarization may be induced by cetirizine through the interferon-gamma pathway. This effect may synergize with the immunotherapy of advanced melanoma with anti-PD-1 agents.
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Affiliation(s)
- Domenico Mallardo
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Ester Simeone
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Vito Vanella
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Maria Grazia Vitale
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Marco Palla
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Luigi Scarpato
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Miriam Paone
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Teresa De Cristofaro
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Valentina Borzillo
- Radiation Oncology Unit, Istituto Nazionale Tumori - IRCCS -Fondazione "G. Pascale", Naples, Italy
| | - Alessio Cortellini
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W120HS, UK
| | - Francesca Sparano
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori - IRCCS -Fondazione "G. Pascale", Naples, Italy
| | - Francesco Fiore
- Interventional Radiology Unit, Istituto Nazionale Tumori - IRCCS -Fondazione "G. Pascale", Naples, Italy
| | - Corrado Caracò
- Division of Surgery of Melanoma and Skin Cancer, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Piera Maiolino
- Hospital Pharmacy, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Antonella Petrillo
- Radiology Division, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Ernesta Cavalcanti
- Division of Laboratory Medicine, Istituto Nazionale Tumori - IRCCS -Fondazione "G. Pascale", Naples, Italy
| | - Secondo Lastoria
- Nuclear Medicine Unit, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Paolo Muto
- Radiation Oncology Unit, Istituto Nazionale Tumori - IRCCS -Fondazione "G. Pascale", Naples, Italy
| | - Alfredo Budillon
- Experimental Pharmacology Unit, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | | | - Paolo Antonio Ascierto
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy.
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10
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Dimitriou F, Hassel J, Orloff M, Hughes I, Kapiteijn E, Mehmi I, Montazeri K, Johnson D, Grover P, Gerard C, Simeone E, Gaudy Marqueste C, Cheng P, Long G, Carvajal R, Dummer R. 832P Treatment sequence with tebentafusp (tebe) and anti-PD1/ipilimumab (PD1+IPI) in HLA-A2*02:01 patients (pts) with metastatic uveal melanoma (mUM). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.958] [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: 11/25/2022] Open
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11
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Granata V, Simonetti I, Fusco R, Setola SV, Izzo F, Scarpato L, Vanella V, Festino L, Simeone E, Ascierto PA, Petrillo A. Management of cutaneous melanoma: radiologists challenging and risk assessment. Radiol Med 2022; 127:899-911. [PMID: 35834109 DOI: 10.1007/s11547-022-01522-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/27/2022] [Indexed: 02/07/2023]
Abstract
Melanoma patient remains a challenging for the radiologist, due to the difficulty related to the management of a patient more often in an advanced stage of the disease. It is necessary to determine a stratification of risk, optimizing the means, with diagnostic tools that should be optimized in relation to the type of patient, and improving knowledge. Staging and risk assessment procedures are determined by disease presentation at diagnosis. Melanoma staging is a critical tool to assist clinical decision-making and prognostic assessment. It is used for clinical trial design, eligibility, stratification, and analysis. The current standard for regional lymph nodes staging is represented by the sentinel lymph node excision biopsy procedure. For staging of distant metastases, PET-CT has the highest sensitivity and diagnostic odds ratio. Similar trend is observed during melanoma surveillance. The advent of immunotherapy, which has improved patient outcome, however, has determined new issues for radiologists, partly due to atypical response patterns, partly due to adverse reactions that must be identified as soon as possible for the correct management of the patient. The main objectives of the new ir-criteria are to standardize the assessment between different trials. However, these ir-criteria do not take into account all cases of atypical response patterns, as hyperprogression or dissociated responses. None of these criteria has actually been uniformly adopted in routine. The immune-related adverse events (irAEs) can involve various organs from head to toe. It is crucial for radiologists to know the imaging appearances of this condition, to exclude recurrent or progressive disease and for pneumonitis, since it could be potentially life-threatening toxicity, resulting in pneumonitis-related deaths in early phase trials, to allow a proper patient management.
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Affiliation(s)
- Vincenza Granata
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia", Via Mariano Semmola, Naples, Italy.
| | - Igino Simonetti
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia", Via Mariano Semmola, Naples, Italy
| | | | - Sergio Venanzio Setola
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia", Via Mariano Semmola, Naples, Italy
| | - Francesco Izzo
- Hepatobiliary Surgical Oncology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia",, Via Mariano Semmola, Naples, Italy
| | - Luigi Scarpato
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Vito Vanella
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Lucia Festino
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Ester Simeone
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Paolo Antonio Ascierto
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Antonella Petrillo
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia", Via Mariano Semmola, Naples, Italy
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12
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Pinto M, Marotta N, Caracò C, Simeone E, Ammendolia A, de Sire A. Quality of Life Predictors in Patients With Melanoma: A Machine Learning Approach. Front Oncol 2022; 12:843611. [PMID: 35402230 PMCID: PMC8990304 DOI: 10.3389/fonc.2022.843611] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/25/2022] [Indexed: 12/20/2022] Open
Abstract
Health related quality of life (HRQoL) is an important recognized health outcome for cancer treatments, but also disease course with slower recovery and increased morbidity. These issues are of implication in melanoma, which maintains a risk of disease progression for many years after diagnosis. This study aimed to explore and weigh factors in the perception of the quality of life and possible relationships with demographic–clinical characteristics in people with melanoma via a machine learning approach. In this observational study, patients with melanoma, without metastatic disease, were recruited from January 2020 to December 2021 with a follow-up of at least one year. Demographic variables and clinics were collected, and the 12-Item Short-Form Health Survey (SF-12) was adopted as the physical and mental aspects of the Health-Related Quality of Life (HRQoL) measure. All the variables were processed in a random forest model to weigh at each node of each tree of this machine learning regression model, their actual weight in SF-12 score. We included 203 melanoma patients, mean aged 59.25 ± 15.1 years: 56 (27%) affecting the upper limbs and 147 (73%) affecting the trunk. The model of 142 patients with no missing value, generating 92 trees (MSE = 0.45, R2 of 0.78), reported that the lesion site was the most influencing variable on HRQoL based on the decrease in Gini impurity in variable weighing at each node intersection in forest generation. In this scenario, we built two distinct models for lesion sites and demonstrated that the variable that most influenced the quality of life in upper limb melanoma was lymphedema, while BMI was in the trunk. Given these results, random forest regressions could play a crucial role in the clinical and rehabilitation approach. The machine-learning model for detecting the HRQoL predictor in melanoma patients indicates that the experienced lymphedema and BMI may influence the HRQoL perception. This study suggests that the prevention and treatment of lymphedema and bodyweight reduction might improve the quality of life in melanoma.
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Affiliation(s)
- Monica Pinto
- Rehabilitation Medicine Unit, Strategic Health Services Department, Istituto Nazionale Tumori-Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-Fondazione G. Pascale, Naples, Italy
| | - Nicola Marotta
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Corrado Caracò
- Melanoma and Skin Cancer Surgery Unit, Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori-Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-Fondazione G. Pascale, Naples, Italy
| | - Ester Simeone
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori-Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-Fondazione G. Pascale, Naples, Italy
| | - Antonio Ammendolia
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
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Turiello R, Capone M, Morretta E, Monti MC, Madonna G, Azzaro R, Del Gaudio P, Simeone E, Sorrentino A, Ascierto PA, Morello S. Exosomal CD73 from serum of patients with melanoma suppresses lymphocyte functions and is associated with therapy resistance to anti-PD-1 agents. J Immunother Cancer 2022; 10:jitc-2021-004043. [PMID: 35273100 PMCID: PMC8915288 DOI: 10.1136/jitc-2021-004043] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND CD73 is an ectonucleotidase producing the immunosuppressor mediator adenosine. Elevated levels of circulating CD73 in patients with cancer have been associated with disease progression and poor response to immunotherapy. Immunosuppressive pathways associated with exosomes can affect T-cell function and the therapeutic efficacy of anti-programmed cell-death protein 1 (anti-PD-1) therapy. Here, we conducted a retrospective pilot study to evaluate levels of exosomal CD73 before and early during treatment with anti-PD-1 agents in patients with melanoma and its potential contribution to affect T-cell functions and to influence the clinical outcomes of anti-PD-1 monotherapy. METHODS Exosomes were isolated by mini size exclusion chromatography from serum of patients with melanoma (n=41) receiving nivolumab or pembrolizumab monotherapy. Expression of CD73 and programmed death-ligand 1 (PD-L1) were evaluated on exosomes enriched for CD63 by on-bead flow cytometry. The CD73 AMPase activity was evaluated by mass spectrometry, also in the presence of selective inhibitors of CD73. Interferon (IFN)-γ production and granzyme B expression were measured in CD3/28 activated T cells incubated with exosomes in presence of the CD73 substrate AMP. Levels of CD73 and PD-L1 on exosomes were correlated with therapy response. Exosomes isolated from healthy subjects were used as control. RESULTS Isolated exosomes carried CD73 on their surface, which is enzymatically active in producing adenosine. Incubation of exosomes with CD3/28 activated T cells in the presence of AMP resulted in a significant reduction of IFN-γ release, which was reversed by the CD73 inhibitor APCP or by the selective A2A adenosine receptor antagonist ZM241385. Expression levels of exosomal CD73 from serum of patients with melanoma were not significantly different from those in healthy subjects. Early on-treatment, expression levels of both CD73 and PD-L1 on exosomes isolated from patients receiving pembrolizumab or nivolumab monotherapy were significantly increased compared with baseline. Early during therapy exosomal PD-L1 increased in responders, while exosomal CD73 resulted significantly increased in non-responders. CONCLUSIONS CD73 expressed on exosomes from serum of patients with melanoma produces adenosine and contributes to suppress T-cell functions. Early on-treatment, elevated expression levels of exosomal CD73 might affect the response to anti-PD-1 agents in patients with melanoma who failed to respond to therapy.
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Affiliation(s)
- Roberta Turiello
- Department of Pharmacy, University of Salerno, Fisciano, Italy.,PhD Program in Drug Discovery and Development, University of Salerno, Fisciano, Italy
| | | | - Elva Morretta
- Department of Pharmacy, University of Salerno, Fisciano, Italy
| | | | - Gabriele Madonna
- Istituto Nazionale Tumori IRCCS Fondazione G Pascale, Napoli, Italy
| | - Rosa Azzaro
- Istituto Nazionale Tumori IRCCS Fondazione G Pascale, Napoli, Italy
| | | | - Ester Simeone
- Istituto Nazionale Tumori IRCCS Fondazione G Pascale, Napoli, Italy
| | | | - Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione G Pascale, Napoli, Italy
| | - Silvana Morello
- Department of Pharmacy, University of Salerno, Fisciano, Italy
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Mallardo D, Cortellini A, Capone M, Madonna G, Pinato D, Warren S, Simeone E, Ascierto P. Concomitant type 2 diabetes mellitus (T2DM) in metastatic melanoma patients could be related to lower level of Lag-3: a transcriptomic analysis on retrospective cohort. Ann Oncol 2022; 33:445-447. [DOI: 10.1016/j.annonc.2022.01.007] [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] [Received: 11/19/2021] [Revised: 01/11/2022] [Accepted: 01/11/2022] [Indexed: 11/01/2022] Open
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Ruggiero CF, Fattore L, Terrenato I, Sperati F, Salvati V, Madonna G, Capone M, Valenti F, Di Martino S, Mandoj C, Liguoro D, Castaldo V, Cafaro G, Simeone E, Vanella V, Russillo M, Conti L, Cuda G, Giannarelli D, Ascierto PA, Mancini R, Ciliberto G. Identification of a miRNA-based non-invasive predictive biomarker of response to target therapy in BRAF-mutant melanoma. Am J Cancer Res 2022; 12:7420-7430. [DOI: 10.7150/thno.77761] [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] [Received: 08/04/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
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Mallardo D, Vitale MG, Giannarelli D, Trillò G, Esposito A, Capone M, Isgrò MA, Madonna G, D’Angelo G, Festino L, Vanella V, Trojaniello C, Manzoni A, White A, Bailey M, Simeone E, Caracò C, Maiolino P, Normanno N, Warren S, Cavalcanti E, Ascierto P. 24 Nivolumab serum concentration in metastatic melanoma patients could be related to anti-tumor activity gene and outcome. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundNivolumab (nivo) is a monoclonal antibody that targets programmed death-1 (PD-1) molecule and has been approved for the treatment of several solid tumors; in the treatment of adjuvant and metastatic melanoma had better efficacy compared with chemotherapy or ipilimumab (anti-CTLA4).1–4 The classical dosage of nivo tested in the phase III trials was 3 mg/kg every 2 weeks (Q2W). However, in order to make easier the administration, it was introduced the flat dosage at 240mg every 2 weeks (Q2W) or 480mg every 4 weeks (Q4W).5 6 The purpose of this study was to investigate retrospectively the relationships between the different nivo dosages and their serum concentration; in addition, we also investigated possible relationship with the expression of pro/antitumor activity genes.MethodsFrom July 2016 to December 2018 at INT IRCCS Pascale, Naples, we collected serum and RNA samples from 88 patients with metastatic melanoma at week 12 from the first administration of nivo. All patients have appropriately signed informed consent. The ORR among the 88 patients was 25% (patients baseline characteristics are listed in table 1). Commercial ELISA assay were performed in 96 well plates following the protocol procedures. Gene expression profiling was performed using NanoString® IO360 panels on 37 patients (CR: 4, PR: 10, SD: 11, PD: 12). Statistical analysis was performed through the Student’s t-test and via Spearman’s rho correlation coefficient. Gene profiling analysis was performed via Bonferroni correction.ResultsWe observed that patients with complete response (CR) have a higher nivo concentration (p=0.003) compared to other groups. No correlation was observed with the most important markers of renal and hepatic function: eGFR, creatinine, AUC, albumin, ALT, AST and gamma GT. Data from gene expression profile shown that patients with CR had a higher expression of anti-tumor and immune activation genes such as: TAPBP, CD47, HDC, IL12RB2 and HLA-DQA1 (P <0.05). Furthermore, genes with pro-tumor or immunosuppressive activity such as MMP9, GOR160, HK2 and LILRA5 (P <0.05) were found to be inversely related with drug concentration while CD1C, a T-cell surface glycoprotein involved in antigen-presenting, it is directly related (p=0.005).Abstract 24 Table 1Patients clinical parametersConclusionsIn this retrospective study we found that higher serum concentration of nivo was correlated with a better outcome and higher frequency of CR. Moreover, in patients with a CR there was an enhancing of the immune activation with an increase of HLA-DQA, TAPBP and IL12RB2. Further investigations are needed to get additional information.AcknowledgementsThe study was supported by the Institutional Project ‘Ricerca Corrente’ of Istituto Nazionale Tumori IRCCS Fondazione ‘G. Pascale’ of Napoli, Italy.ReferencesJames Larkin, Vanna Chiarion-Sileni, Rene Gonzalezet al. Combined nivolumab and ipilimumab or monotherapy in untreated melanoma. N Engl J Med 2015 Jul 2;373(1):23–34.Robert C, Long GV, Brady B et al. Nivolumab in previously untreated melanoma without BRAF mutation. N Engl J Med 2015 Jan 22;372(4):320–30.Weber JS, D’Angelo SP, Minor D et al. Nivolumab versus chemotherapy in patients with advanced melanoma who progressed after anti-CTLA-4 treatment (CheckMate 037): a randomised, controlled, open-label, phase 3 trial. Lancet Oncol 2015 Apr;16(4):375–8.Weber J, Mandala M, Del Vecchio M, Gogas HJ, Arance AM, Cowey CL, Dalle S,4. Schenker M, Chiarion-Sileni V, Marquez-Rodas I et al. CheckMate 238 Collaborators. Adjuvant nivolumab versus ipilimumab in resected stage III or IV melanoma. N Engl J Med 2017 Nov 9;377(19):1824–1835.Zhao X, Suryawanshi S, Hruska M et al. Assessment of nivolumab benefit-risk profile of a 240-mg flat dose relative to a 3-mg/kg dosing regimen in patients with advanced tumors. Ann Oncol 2017 Aug 1;28(8):2002–2008.Long GV, Tykodi SS, Schneider JG et al. Assessment of nivolumab exposure and clinical safety of 480?mg every 4 weeks flat-dosing schedule in patients with cancer. Ann Oncol 2018 Nov 1;29(11):2208–2213.Ethics ApprovalThe study was approved by the internal ethics board of the Istituto Nazionale Tumori IRCCS Fondazione ‘G. Pascale’ of Napoli Italy, approval number of registry 33/17 OSS.ConsentWritten informed consent was obtained from the patient for publication of this abstract and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.
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Mallardo D, Trojaniello C, Vitale MG, d’angelo G, White A, Capone M, Sorrentino A, Madonna G, Tuffanelli M, Vanella V, Festino L, Simeone E, Caracò C, Normanno N, Warren S, Ascierto P. 308 Transcriptomic analysis of melanoma patients in adjuvant setting treated with anti PD1 therapy: real life study. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundAdjuvant treatment of melanoma patients with immune-checkpoint inhibition (ICI) significantly improved relapse-free survival (RFS).1 In the phase 3 keynote-054 trial showed that pembrolizumab (anti-PD1) administration in adjuvant setting provided a longer RFS (59,8%) than the placebo group (41,4%) at a 3.5-year median follow-up.2 Moreover, 4 years RFS results from the phase 3 checkmate 238 trial, showed a superior efficacy of nivolumab versus ipilimumab in patients with resected AJCC-7 stage III or IV melanoma. RFS rate was of 58% in the nivolumab arm and 45% in the ipilimumab arm.3 Although treatment with ICIs has improved the RFS of melanoma patients in adjuvant setting, there is still a large proportion of patients who do not respond to the treatment and then relapse. The aim of this study was to investigate the molecular mechanisms underlying resistance to anti-PD1 treatment in the adjuvant setting.MethodsFrom December 2018 to July 2020, n. 121 melanoma patients in stage III or IV NED were treated with anti-PD1s as adjuvant (minimum follow up of 12 months, range 12–30 months). These patients received nivolumab (n=95) or pembrolizumab (n=26). Distant and local metastases was observed in 33 (27%) and 7 (6%) patients, respectively (patients baseline characteristics are listed in table1). Gene expression profiles, using NanoString IO 360 panel, were performed from peripheral blood mononuclear cell (PBMCs), collected retrospectively, from n.73 patients (of which n.26 had relapse). All patients have appropriately signed informed consent. Statistical analysis was performed via Bonferroni correction, P< 0.05 was considered statistically significant for median stratification.ResultsAt a minimum follow-up of 12 months, the 12-month rate of Relapse-free survival was 72%, confirming the data reported by checkmate 238 trial. In the transcriptomic analysis we observed that in patients with local-regional metastases there was a higher expression of ITGA2 (p<0.05), a gene that promotes malignant tumor aggression by up-regulating PD-L1 expression through STAT3 pathway and the downregulation of DUSP1 (p<0.05) that is linked in promotion of angiogenesis, invasion and metastasis. Moreover, in male group we found a higher expression of HLA-DQB1 and HLA-DQA1 which belonged to HLA class II beta chains.Abstract 308 Table 1ConclusionsIn this preliminary report we found that RFS 1-yr rate is similar to checkmate 238 study, and that patients with local metastasis have a higher expression of genes related to promote PDL1 levels. Further investigations are needed to get additional information.AcknowledgementsThe study was supported by the Institutional Project ”Ricerca Corrente” of Istituto Nazionale Tumori IRCCS Fondazione ”G. Pascale” of Napoli, Italy.ReferencesWeber J, Mandala M, Del Vecchio M, et al, CheckMate 238 Collaborators. Adjuvant nivolumab versus ipilimumab in resected stage III or IV melanoma. N Engl J Med 2017 November 9;377(19):1824–1835.Eggermont AMM, Blank CU, Mandalà M, et al. EORTC melanoma group. Adjuvant pembrolizumab versus placebo in resected stage III melanoma (EORTC 1325-MG/KEYNOTE-054): distant metastasis-free survival results from a double-blind, randomised, controlled, phase 3 trial. Lancet Oncol 2021 May;22(5):643–654.Ascierto PA, Del Vecchio M, Mandalá M, et al. Adjuvant nivolumab versus ipilimumab in resected stage IIIB-C and stage IV melanoma (CheckMate 238): 4-year results from a multicentre, double-blind, randomised, controlled, phase 3 trial. Lancet Oncol 2020 November;21(11):1465–1477.Ethics ApprovalThe study was approved by internal ethics board of the Istituto Nazionale Tumori IRCCS Fondazione ”G. Pascale” of Napoli Italy, approval number of registry 33/17 OSS.ConsentWritten informed consent was obtained from the patient for publication of this abstract and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.
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Mallardo D, Scognamiglio G, North K, Capone M, Bailey M, Scarpato L, Church S, Madonna G, Reeves J, Curvietto M, Tuffanelli M, d’angelo G, Simeone E, Festino L, Vanella V, Trojaniello C, Vitale MG, Tafuto S, Caracò C, Anniciello AM, Normanno N, Bonito MD, Warren S, Ascierto P. 934 Biological mechanisms in the different etiologies of Merkel cell carcinoma patients: polyomavirus or UV exposure. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BackgroundMerkel cell carcinoma (MCC) is a rare and aggressive skin cancer with neuroendocrine features, and it is associated with elevated mortality. The pathogenesis is associated with presence of clonally integrated Merkel cell polyomavirus (MCPyV) or ultraviolet light (UV) exposure.1 The MCPyV causes up to 80% of MCC tumors in North America and Europe.2–4 Recently immunotherapy is having good results,5 the phase 2 trial JAVELIN Merkel 200 indicated that treatment with Avelumab (PDL1 inhibitor) in patients with metastatic MCC pre-treated have a meaningful long-term survival outcomes respect chemotherapy. Moreover, ORRs were highest in patients with high TMB that were also MCPyV−, PD-L1+ or had a greater CD8+ T cell density at the invasive margin.6 In this study, we investigated the biological signatures in patients with MCPyV or not.MethodsFrom April 2011 to June 2018, we collected retrospectively 50 FFPE (Formalin-Fixed Paraffin-Embed) from 37 patients with metastatic MCC and 13 tissues from a secondary metastatic site. All patients have appropriately signed informed consent. We performed an immunohistochemistry assays (IHC) for MCPyV and PDL1. In addition, through the NanoString GeoMx DSP (Digital Spatial Profiling), we analysed 11 patients (6 MCPyV+; 5 MCPyV-) with cutaneous metastasis using a 44-plex antibody cocktail. For each slide we selected three different areas: Intratumoral, extratumoral and tumour border, in each area we selected CD4+ and CD8+ cells in 4 different ROIs (Region of Interest). Statistical analysis was performed via Bonferroni correction, P< 0.05 was considered statistically significant for median stratification.ResultsThe DSP analysis showed that the tumour border cells have an overexpression of IDO respect intratumoral area (adj. p<0.01). Instead, extratumoral area of MCPyV- patients have a higher expression of B7-H3 respect MCPyV+ as well as FOXP3 is higher in the tumour border of MCPyV+ patients and EpCAM in the intratumoral area (p<0.05). PDL1 is overexpressed in MCPyV+ CD4+ cells respect CD8+ (p<0.05). The IHC assay shown that viral status does not change in multiple metastases and PDL1 is elevated in the tumour border (p<0.05).ConclusionsIn this retrospective study, our preliminary data shown that tumour edge have an important role in the modulations of immune infiltrate and patients with Merkel cell polyomavirus could have a different pathway of immunosuppression compared to patients with non-virus related etiology. Further investigations are needed to get additional information.AcknowledgementsThe study was supported by the Institutional Project ”Ricerca Corrente” of Istituto Nazionale Tumori IRCCS Fondazione ”G. Pascale” of Napoli, Italy.ReferencesKaae J, Hansen AV, Biggar RJ, et al. Merkel cell carcinoma: incidence, mortality, and risk of other cancers. J Natl Cancer Inst 2010 June 2;102(11):793–801.Feng H, Shuda M, Chang Y, et al. Clonal integration of a polyomavirus in human Merkel cell carcinoma. Science 2008 February 22;319(5866):1096–100.Garneski KM, Warcola AH, Feng Q, et al. Merkel cell polyomavirus is more frequently present in North American than Australian Merkel cell carcinoma tumors. J Invest Dermatol 2009 January;129(1):246–8.Goh G, Walradt T, Markarov V, et al. Mutational landscape of MCPyV-positive and MCPyV-negative Merkel cell carcinomas with implications for immunotherapy. Oncotarget 2016 January 19;7(3):3403–15.Bichakjian CK, Olencki T, Aasi SZ, et al. Merkel cell carcinoma, version 1.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2018 June;16(6):742–774.D’Angelo SP, Bhatia S, Brohl AS, et al. Avelumab in patients with previously treated metastatic Merkel cell carcinoma: long-term data and biomarker analyses from the single-arm phase 2 JAVELIN Merkel 200 trial. J Immunother Cancer 2020 May;8(1):e000674.Ethics ApprovalThe study was approved by internal ethics board of the Istituto Nazionale Tumori IRCCS Fondazione ”G. Pascale” of Napoli Italy, approval number of registry 33/17 OSS.ConsentWritten informed consent was obtained from the patient for publication of this abstract and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.
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Madonna G, Masucci GV, Capone M, Mallardo D, Grimaldi AM, Simeone E, Vanella V, Festino L, Palla M, Scarpato L, Tuffanelli M, D’angelo G, Villabona L, Krakowski I, Eriksson H, Simao F, Lewensohn R, Ascierto PA. Clinical Categorization Algorithm (CLICAL) and Machine Learning Approach (SRF-CLICAL) to Predict Clinical Benefit to Immunotherapy in Metastatic Melanoma Patients: Real-World Evidence from the Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy. Cancers (Basel) 2021; 13:4164. [PMID: 34439318 PMCID: PMC8391717 DOI: 10.3390/cancers13164164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/31/2021] [Accepted: 08/16/2021] [Indexed: 12/18/2022] Open
Abstract
The real-life application of immune checkpoint inhibitors (ICIs) may yield different outcomes compared to the benefit presented in clinical trials. For this reason, there is a need to define the group of patients that may benefit from treatment. We retrospectively investigated 578 metastatic melanoma patients treated with ICIs at the Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale" of Napoli, Italy (INT-NA). To compare patients' clinical variables (i.e., age, lactate dehydrogenase (LDH), neutrophil-lymphocyte ratio (NLR), eosinophil, BRAF status, previous treatment) and their predictive and prognostic power in a comprehensive, non-hierarchical manner, a clinical categorization algorithm (CLICAL) was defined and validated by the application of a machine learning algorithm-survival random forest (SRF-CLICAL). The comprehensive analysis of the clinical parameters by log risk-based algorithms resulted in predictive signatures that could identify groups of patients with great benefit or not, regardless of the ICI received. From a real-life retrospective analysis of metastatic melanoma patients, we generated and validated an algorithm based on machine learning that could assist with the clinical decision of whether or not to apply ICI therapy by defining five signatures of predictability with 95% accuracy.
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Affiliation(s)
- Gabriele Madonna
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Napoli, Italy; (G.M.); (M.C.); (D.M.); (A.M.G.); (E.S.); (V.V.); (L.F.); (M.P.); (L.S.); (M.T.); (G.D.)
| | - Giuseppe V. Masucci
- Theme Cancer, Karolinska University Hospital, 171 76 Stockholm, Sweden; (G.V.M.); (L.V.); (H.E.); (R.L.)
- Department of Oncology and Pathology, Karolinska Institutet, 171 64 Stockholm, Sweden;
| | - Mariaelena Capone
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Napoli, Italy; (G.M.); (M.C.); (D.M.); (A.M.G.); (E.S.); (V.V.); (L.F.); (M.P.); (L.S.); (M.T.); (G.D.)
| | - Domenico Mallardo
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Napoli, Italy; (G.M.); (M.C.); (D.M.); (A.M.G.); (E.S.); (V.V.); (L.F.); (M.P.); (L.S.); (M.T.); (G.D.)
| | - Antonio Maria Grimaldi
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Napoli, Italy; (G.M.); (M.C.); (D.M.); (A.M.G.); (E.S.); (V.V.); (L.F.); (M.P.); (L.S.); (M.T.); (G.D.)
| | - Ester Simeone
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Napoli, Italy; (G.M.); (M.C.); (D.M.); (A.M.G.); (E.S.); (V.V.); (L.F.); (M.P.); (L.S.); (M.T.); (G.D.)
| | - Vito Vanella
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Napoli, Italy; (G.M.); (M.C.); (D.M.); (A.M.G.); (E.S.); (V.V.); (L.F.); (M.P.); (L.S.); (M.T.); (G.D.)
| | - Lucia Festino
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Napoli, Italy; (G.M.); (M.C.); (D.M.); (A.M.G.); (E.S.); (V.V.); (L.F.); (M.P.); (L.S.); (M.T.); (G.D.)
| | - Marco Palla
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Napoli, Italy; (G.M.); (M.C.); (D.M.); (A.M.G.); (E.S.); (V.V.); (L.F.); (M.P.); (L.S.); (M.T.); (G.D.)
| | - Luigi Scarpato
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Napoli, Italy; (G.M.); (M.C.); (D.M.); (A.M.G.); (E.S.); (V.V.); (L.F.); (M.P.); (L.S.); (M.T.); (G.D.)
| | - Marilena Tuffanelli
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Napoli, Italy; (G.M.); (M.C.); (D.M.); (A.M.G.); (E.S.); (V.V.); (L.F.); (M.P.); (L.S.); (M.T.); (G.D.)
| | - Grazia D’angelo
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Napoli, Italy; (G.M.); (M.C.); (D.M.); (A.M.G.); (E.S.); (V.V.); (L.F.); (M.P.); (L.S.); (M.T.); (G.D.)
| | - Lisa Villabona
- Theme Cancer, Karolinska University Hospital, 171 76 Stockholm, Sweden; (G.V.M.); (L.V.); (H.E.); (R.L.)
| | - Isabelle Krakowski
- Department of Oncology and Pathology, Karolinska Institutet, 171 64 Stockholm, Sweden;
- Theme Inflammation, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Hanna Eriksson
- Theme Cancer, Karolinska University Hospital, 171 76 Stockholm, Sweden; (G.V.M.); (L.V.); (H.E.); (R.L.)
- Department of Oncology and Pathology, Karolinska Institutet, 171 64 Stockholm, Sweden;
| | - Felipe Simao
- Genevia Technologies OY, 33100 Tampere, Finland;
| | - Rolf Lewensohn
- Theme Cancer, Karolinska University Hospital, 171 76 Stockholm, Sweden; (G.V.M.); (L.V.); (H.E.); (R.L.)
- Department of Oncology and Pathology, Karolinska Institutet, 171 64 Stockholm, Sweden;
| | - Paolo Antonio Ascierto
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Napoli, Italy; (G.M.); (M.C.); (D.M.); (A.M.G.); (E.S.); (V.V.); (L.F.); (M.P.); (L.S.); (M.T.); (G.D.)
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Borzillo V, Di Franco R, Giannarelli D, Cammarota F, Scipilliti E, D’Ippolito E, Petito A, Serra M, Falivene S, Grimaldi AM, Simeone E, Festino L, Vanella V, Trojaniello C, Vitale MG, Madonna G, Ascierto PA, Muto P. Ipilimumab and Stereotactic Radiosurgery with CyberKnife ® System in Melanoma Brain Metastases: A Retrospective Monoinstitutional Experience. Cancers (Basel) 2021; 13:cancers13081857. [PMID: 33924595 PMCID: PMC8068853 DOI: 10.3390/cancers13081857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/27/2021] [Accepted: 04/07/2021] [Indexed: 01/22/2023] Open
Abstract
Simple Summary Retrospective studies have shown a survival advantage in combining ipilimumab with radiotherapy in patients with melanoma brain metastases (MBMs). However, these studies did not clarify the correct timing between the two methods. The aims of our study were to demonstrate the efficacy and toxicity of stereotactic radiotherapy/radiosurgery on MBMs in combination with ipilimumab and estimate the correct timing of treatments to improve patients’ outcomes. Abstract The median overall survival (OS) and local control (LC) of patients with melanoma brain metastases (MBMs) are poor even with immune checkpoint inhibitors and/or radiotherapy (RT). The aims of the study were to evaluate the association and timing of stereotactic radiotherapy (SRT)/radiosurgery (SRS) performed with the CyberKnife® System and ipilimumab (IPI). A total of 63 MBMs patients were analyzed: 53 received RT+IPI and 10 RT alone. Therefore, the patients were divided into four groups: RT PRE-PI (>4 weeks before IPI) (18), RT CONC-IPI (4 weeks before/between first and last cycle/within 3 months of last cycle of IPI) (20), RT POST-IPI (>3 months after IPI) (15), and NO-IPI (10). A total of 127 lesions were treated: 75 with SRS (one fraction) and 24 with SRT (three to five fractions). The median follow-up was 10.6 months. The median OS was 10.6 months for all patients, 10.7 months for RT+IPI, and 3.3 months for NO-IPI (p = 0.96). One-year LC was 50% for all patients, 56% for RT+IPI, and 18% for NO-IPI (p = 0.08). The 1-year intracranial control was 45% for all patients, 44% for RT+IPI, and 51% for NO-IPI (p = 0.73). IPI with SRS/SRT in MBMs treatment could improve LC. However, the impact and timing of the two modalities on patients’ outcomes are still unclear.
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Affiliation(s)
- Valentina Borzillo
- Radiation Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (R.D.F.); (F.C.); (E.S.); (E.D.); (A.P.); (M.S.); (P.M.)
- Correspondence: ; Tel.: +39-08159031764; Fax: +39-0815903809
| | - Rossella Di Franco
- Radiation Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (R.D.F.); (F.C.); (E.S.); (E.D.); (A.P.); (M.S.); (P.M.)
| | - Diana Giannarelli
- Statistical Unit, Regina Elena National Cancer Institute-IRCCS, 00144 Rome, Italy;
| | - Fabrizio Cammarota
- Radiation Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (R.D.F.); (F.C.); (E.S.); (E.D.); (A.P.); (M.S.); (P.M.)
| | - Esmeralda Scipilliti
- Radiation Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (R.D.F.); (F.C.); (E.S.); (E.D.); (A.P.); (M.S.); (P.M.)
| | - Emma D’Ippolito
- Radiation Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (R.D.F.); (F.C.); (E.S.); (E.D.); (A.P.); (M.S.); (P.M.)
| | - Angela Petito
- Radiation Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (R.D.F.); (F.C.); (E.S.); (E.D.); (A.P.); (M.S.); (P.M.)
| | - Marcello Serra
- Radiation Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (R.D.F.); (F.C.); (E.S.); (E.D.); (A.P.); (M.S.); (P.M.)
| | - Sara Falivene
- Radiation Oncology Unit, Ospedale del Mare, Asl Napoli 1 Centro, 80147 Naples, Italy;
| | - Antonio M. Grimaldi
- Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (A.M.G.); (E.S.); (L.F.); (V.V.); (C.T.); (M.G.V.); (G.M.); (P.A.A.)
| | - Ester Simeone
- Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (A.M.G.); (E.S.); (L.F.); (V.V.); (C.T.); (M.G.V.); (G.M.); (P.A.A.)
| | - Lucia Festino
- Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (A.M.G.); (E.S.); (L.F.); (V.V.); (C.T.); (M.G.V.); (G.M.); (P.A.A.)
| | - Vito Vanella
- Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (A.M.G.); (E.S.); (L.F.); (V.V.); (C.T.); (M.G.V.); (G.M.); (P.A.A.)
| | - Claudia Trojaniello
- Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (A.M.G.); (E.S.); (L.F.); (V.V.); (C.T.); (M.G.V.); (G.M.); (P.A.A.)
| | - Maria Grazia Vitale
- Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (A.M.G.); (E.S.); (L.F.); (V.V.); (C.T.); (M.G.V.); (G.M.); (P.A.A.)
| | - Gabriele Madonna
- Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (A.M.G.); (E.S.); (L.F.); (V.V.); (C.T.); (M.G.V.); (G.M.); (P.A.A.)
| | - Paolo A. Ascierto
- Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (A.M.G.); (E.S.); (L.F.); (V.V.); (C.T.); (M.G.V.); (G.M.); (P.A.A.)
| | - Paolo Muto
- Radiation Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (R.D.F.); (F.C.); (E.S.); (E.D.); (A.P.); (M.S.); (P.M.)
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21
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Ottaviano M, Giunta EF, Tortora M, Curvietto M, Attademo L, Bosso D, Cardalesi C, Rosanova M, De Placido P, Pietroluongo E, Riccio V, Mucci B, Parola S, Vitale MG, Palmieri G, Daniele B, Simeone E. BRAF Gene and Melanoma: Back to the Future. Int J Mol Sci 2021; 22:ijms22073474. [PMID: 33801689 PMCID: PMC8037827 DOI: 10.3390/ijms22073474] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 12/13/2022] Open
Abstract
As widely acknowledged, 40-50% of all melanoma patients harbour an activating BRAF mutation (mostly BRAF V600E). The identification of the RAS-RAF-MEK-ERK (MAP kinase) signalling pathway and its targeting has represented a valuable milestone for the advanced and, more recently, for the completely resected stage III and IV melanoma therapy management. However, despite progress in BRAF-mutant melanoma treatment, the two different approaches approved so far for metastatic disease, immunotherapy and BRAF+MEK inhibitors, allow a 5-year survival of no more than 60%, and most patients relapse during treatment due to acquired mechanisms of resistance. Deep insight into BRAF gene biology is fundamental to describe the acquired resistance mechanisms (primary and secondary) and to understand the molecular pathways that are now being investigated in preclinical and clinical studies with the aim of improving outcomes in BRAF-mutant patients.
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Affiliation(s)
- Margaret Ottaviano
- Department of Clinical Medicine and Surgery, Università Degli Studi di Napoli “Federico II”, 80131 Naples, Italy; (P.D.P.); (E.P.); (V.R.); (B.M.); (S.P.)
- Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (L.A.); (D.B.); (C.C.); (M.R.); (B.D.)
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, 80131 Naples, Italy; (M.T.); (G.P.)
- Correspondence:
| | - Emilio Francesco Giunta
- Department of Precision Medicine, Università Degli Studi della Campania Luigi Vanvitelli, 80131 Naples, Italy;
| | - Marianna Tortora
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, 80131 Naples, Italy; (M.T.); (G.P.)
| | - Marcello Curvietto
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, 80131 Naples, Italy; (M.C.); (M.G.V.); (E.S.)
| | - Laura Attademo
- Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (L.A.); (D.B.); (C.C.); (M.R.); (B.D.)
| | - Davide Bosso
- Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (L.A.); (D.B.); (C.C.); (M.R.); (B.D.)
| | - Cinzia Cardalesi
- Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (L.A.); (D.B.); (C.C.); (M.R.); (B.D.)
| | - Mario Rosanova
- Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (L.A.); (D.B.); (C.C.); (M.R.); (B.D.)
| | - Pietro De Placido
- Department of Clinical Medicine and Surgery, Università Degli Studi di Napoli “Federico II”, 80131 Naples, Italy; (P.D.P.); (E.P.); (V.R.); (B.M.); (S.P.)
| | - Erica Pietroluongo
- Department of Clinical Medicine and Surgery, Università Degli Studi di Napoli “Federico II”, 80131 Naples, Italy; (P.D.P.); (E.P.); (V.R.); (B.M.); (S.P.)
| | - Vittorio Riccio
- Department of Clinical Medicine and Surgery, Università Degli Studi di Napoli “Federico II”, 80131 Naples, Italy; (P.D.P.); (E.P.); (V.R.); (B.M.); (S.P.)
| | - Brigitta Mucci
- Department of Clinical Medicine and Surgery, Università Degli Studi di Napoli “Federico II”, 80131 Naples, Italy; (P.D.P.); (E.P.); (V.R.); (B.M.); (S.P.)
| | - Sara Parola
- Department of Clinical Medicine and Surgery, Università Degli Studi di Napoli “Federico II”, 80131 Naples, Italy; (P.D.P.); (E.P.); (V.R.); (B.M.); (S.P.)
| | - Maria Grazia Vitale
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, 80131 Naples, Italy; (M.C.); (M.G.V.); (E.S.)
| | - Giovannella Palmieri
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, 80131 Naples, Italy; (M.T.); (G.P.)
| | - Bruno Daniele
- Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (L.A.); (D.B.); (C.C.); (M.R.); (B.D.)
| | - Ester Simeone
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, 80131 Naples, Italy; (M.C.); (M.G.V.); (E.S.)
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22
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Simeone E, Scognamiglio G, Capone M, Giannarelli D, Grimaldi AM, Mallardo D, Madonna G, Curvietto M, Esposito A, Sandomenico F, Sabbatino F, Bayless NL, Warren S, Ong S, Botti G, Flaherty KT, Ferrone S, Ascierto PA. A monocentric phase I study of vemurafenib plus cobimetinib plus PEG-interferon (VEMUPLINT) in advanced melanoma patients harboring the V600BRAF mutation. J Transl Med 2021; 19:17. [PMID: 33407577 PMCID: PMC7789377 DOI: 10.1186/s12967-020-02680-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/14/2020] [Indexed: 12/19/2022] Open
Abstract
Background Studies carried out in vitro and in a mouse model have shown that BRAF inhibitors enhance the effects of IFN-α on BRAFV600E melanoma cells through the inhibition of ERK. Therefore, the combination of vemurafenib and IFN-α in patients with BRAFV600E melanoma may provide therapeutic benefits; MEK inhibition may prevent the reactivation of the MAPK pathway induced by BRAF inhibitor resistance. Patients and methods In a phase I study, adult patients with advanced BRAFV600-mutated melanoma were treated with vemurafenib + PEG-IFN-α-2b or vemurafenib + cobimetinib + PEG-IFN-α-2b, to assess the safety of the combination and the upregulation of IFN-α/β receptor-1 (IFNAR1). Results Eight patients were treated; 59 adverse events with four serious ones (three related to study treatments) were reported. Patients with a pre-treatment IFNAR1 expression on ≤ 35% melanoma cells had a median progression-free survival of 12.0 months (range: 5.6–18.4 months) and a median overall survival of 31.0 months (range: 19.8–42.2 months), while patients with a pre-treatment IFNAR1 expression on > 35% of melanoma cells had a median progression-free survival of 4.0 months (range: 0–8.8; p = 0.03), and a median overall survival of 5 months (p = 0.02). Following treatment, responders had higher levels of growth-suppressor genes, including GAS1 and DUSP1, and genes involved in a metabolically robust immune response, including FAP. Conclusion Our study supports the overall safety of the vemurafenib + PEG-IFN-α-2b + cobimetinib combination. IFNAR1 expression levels correlated with response to treatment, including survival. Vemurafenib + PEG-IFN-α-2b + cobimetinib would have difficulty finding a niche in the current treatment scenario for advanced melanoma, but we speculate that our findings may contribute to identify subjects particularly responsive to treatment. Trial registration: The study was registered at clinicaltrials.gov (NCT01959633). Registered 10 October 2013, https://clinicaltrials.gov/ct2/show/NCT01959633
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Affiliation(s)
- Ester Simeone
- Istituto Nazionale Tumori-IRCCS-Fondazione G Pascale, Naples, Italy
| | | | | | | | | | | | - Gabriele Madonna
- Istituto Nazionale Tumori-IRCCS-Fondazione G Pascale, Naples, Italy
| | | | - Assunta Esposito
- Istituto Nazionale Tumori-IRCCS-Fondazione G Pascale, Naples, Italy
| | | | | | | | | | - SuFey Ong
- NanoString Technologies, Seattle, WA, USA
| | - Gerardo Botti
- Istituto Nazionale Tumori-IRCCS-Fondazione G Pascale, Naples, Italy
| | | | - Soldano Ferrone
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Paolo A Ascierto
- Istituto Nazionale Tumori-IRCCS-Fondazione G Pascale, Naples, Italy.
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23
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Ottaviano M, Curvietto M, Rescigno P, Tortora M, Palmieri G, Giannarelli D, Aieta M, Assalone P, Attademo L, Avallone A, Bloise F, Bosso D, Borzillo V, Buono G, Calderoni G, Caputo F, Cartenì G, Cavallero D, Cavo A, Ciardiello F, Conca R, Conteduca V, De Falco S, De Felice M, De Laurentiis M, De Placido P, De Placido S, De Santo I, De Stefano A, Della Corte CM, Di Franco R, Di Lauro V, Fabbrocini A, Federico P, Festino L, Giordano P, Giuliano M, Gridelli C, Grimaldi AM, Lia M, Marretta AL, Massa V, Mennitto A, Merler S, Merz V, Messina C, Messina M, Milano M, Minisini AM, Montesarchio V, Morabito A, Morgillo F, Mucci B, Nappi L, Napolitano F, Paciolla I, Pagliuca M, Palmieri G, Parola S, Pepe S, Petrillo A, Piantedosi F, Piccin L, Picozzi F, Pietroluongo E, Pignata S, Prati V, Riccio V, Rosanova M, Rossi A, Russo A, Salati M, Santabarbara G, Sbrana A, Simeone E, Silvestri A, Spada M, Tarantino P, Taveggia P, Tomei F, Vincenzo T, Trapani D, Trojanello C, Vanella V, Vari S, Ventriglia J, Vitale MG, Vitiello F, Vivaldi C, von Arx C, Zacchi F, Zampiva I, Zivi A, Daniele B, Ascierto PA. Impact of COVID-19 outbreak on cancer immunotherapy in Italy: a survey of young oncologists. J Immunother Cancer 2020; 8:jitc-2020-001154. [PMID: 33060148 PMCID: PMC7565202 DOI: 10.1136/jitc-2020-001154] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2020] [Indexed: 01/20/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has overwhelmed the health systems worldwide. Data regarding the impact of COVID-19 on cancer patients (CPs) undergoing or candidate for immune checkpoint inhibitors (ICIs) are lacking. We depicted the practice and adaptations in the management of patients with solid tumors eligible or receiving ICIs during the COVID-19 pandemic, with a special focus on Campania region. Methods This survey (25 questions), promoted by the young section of SCITO (Società Campana di ImmunoTerapia Oncologica) Group, was circulated among Italian young oncologists practicing in regions variously affected by the pandemic: high (group 1), medium (group 2) and low (group 3) prevalence of SARS-CoV-2–positive patients. For Campania region, the physician responders were split into those working in cancer centers (CC), university hospitals (UH) and general hospitals (GH). Percentages of agreement, among High (H) versus Medium (M) and versus Low (L) group for Italy and among CC, UH and GH for Campania region, were compared by using Fisher’s exact tests for dichotomous answers and χ2 test for trends relative to the questions with 3 or more options. Results This is the first Italian study to investigate the COVID-19 impact on cancer immunotherapy, unique in its type and very clear in the results. The COVID-19 pandemic seemed not to affect the standard practice in the prescription and delivery of ICIs in Italy. Telemedicine was widely used. There was high consensus to interrupt immunotherapy in SARS-CoV-2–positive patients and to adopt ICIs with longer schedule interval. The majority of the responders tended not to delay the start of ICIs; there were no changes in supportive treatments, but some of the physicians opted for delaying surgeries (if part of patients’ planned treatment approach). The results from responders in Campania did not differ significantly from the national ones. Conclusion Our study highlights the efforts of Italian oncologists to maintain high standards of care for CPs treated with ICIs, regardless the regional prevalence of COVID-19, suggesting the adoption of similar solutions. Research on patients treated with ICIs and experiencing COVID-19 will clarify the safety profile to continue the treatments, thus informing on the most appropriate clinical conducts.
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Affiliation(s)
- Margaret Ottaviano
- Oncology Unit, Ospedale del Mare, Napoli, Campania, Italy.,Department of Clinical Medicine and Surgery, Università degli Studi di Napoli Federico II and CRCTR Coordinating Rare Tumors Reference Center of Campania Region, AOU Federico II, Napoli, Italy
| | - Marcello Curvietto
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Pasquale Rescigno
- Clinical Studies, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Marianna Tortora
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, AOU Federico II, Napoli, Campania, Italy
| | - Giovannella Palmieri
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, AOU Federico II, Napoli, Campania, Italy
| | - Diana Giannarelli
- Biostatistics Unit, IRCCS Regina Elena National Cancer Institute, Roma, Lazio, Italy
| | - Michele Aieta
- Medical Oncology Unit, Department of Onco-Hematology, IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Basilicata, Italy
| | - Pasquale Assalone
- Oncology Unit, Ospedale Ferdinando Veneziale, Isernia, Molise, Italy
| | - Laura Attademo
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Antonio Avallone
- Abdominal Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | | | | | - Valentina Borzillo
- Department of Radioterapia, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Giuseppe Buono
- Oncology Unit, San Rocco Hospital, Sessa Aurunca, Campania, Italy
| | | | - Francesca Caputo
- U.O.C. Oncologia, Azienda Ospedaliera dei Colli, Monaldi Hospital, Napoli, Campania, Italy
| | - Giacomo Cartenì
- Department of Medical Oncology, AORN "A. Cardarelli", Napoli, Campania, Italy
| | | | - Alessia Cavo
- Oncology Unit, Villa Scassi Hospital, Genova, Italy
| | - Fortunato Ciardiello
- Oncology, Department of Precision Medicine, Università della Campania "L. Vanvitelli", Napoli, Campania, Italy
| | - Raffaele Conca
- Medical Oncology Unit, Department of Onco-Hematology, IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Basilicata, Italy
| | - Vincenza Conteduca
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Emilia-Romagna, Italy
| | - Stefano De Falco
- Oncology Unit, Sant'Ottone Frangipane Hospital, Avellino, Campania, Italy
| | - Marco De Felice
- Oncology, Department of Precision Medicine, Università della Campania "L. Vanvitelli", Napoli, Campania, Italy.,Oncology Unit, Sant'Anna e San Sebastiano, Caserta, Campania, Italy
| | | | - Pietro De Placido
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Sabino De Placido
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, AOU Federico II, Napoli, Campania, Italy.,Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Irene De Santo
- Oncology Unit, Gemelli Molise s.p.a, Campobasso, Molise, Italy
| | - Alfonso De Stefano
- Abdominal Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Carminia Maria Della Corte
- Oncology, Department of Precision Medicine, Università della Campania "L. Vanvitelli", Napoli, Campania, Italy
| | - Rossella Di Franco
- Department of Radioterapia, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Vincenzo Di Lauro
- Breast Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy.,Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | | | | | - Lucia Festino
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | | | - Mario Giuliano
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, AOU Federico II, Napoli, Campania, Italy.,Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Cesare Gridelli
- Division of Medical Oncology, "San Giuseppe Moscati" Hospital, Avellino, Campania, Italy
| | - Antonio Maria Grimaldi
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Michela Lia
- Oncology Unit, SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Piemonte, Italy
| | - Antonella Lucia Marretta
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Valentina Massa
- Medical Oncology Unit, University of Pisa, Pisa, Toscana, Italy
| | - Alessia Mennitto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Sara Merler
- Department of Oncology, University of Verona, Verona, Veneto, Italy
| | - Valeria Merz
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Trentino Alto Adige, Italy
| | - Carlo Messina
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Trentino Alto Adige, Italy
| | - Marco Messina
- UOC Oncologia Medica, Ospedali Riuniti Villa Sofia Cervello, Palermo, Sicilia, Italy
| | - Monica Milano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Alessandro Marco Minisini
- Department of Oncology, Azienda Sanitaria Universitaria Integrata del Friuli Centrale, Udine, Friuli Venezia Giulia, Italy
| | - Vincenzo Montesarchio
- U.O.C. Oncologia, Azienda Ospedaliera dei Colli, Monaldi Hospital, Napoli, Campania, Italy
| | - Alessandro Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Floriana Morgillo
- Oncology, Department of Precision Medicine, Università della Campania "L. Vanvitelli", Napoli, Campania, Italy
| | - Brigitta Mucci
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Lucia Nappi
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada and British Columbia Cancer Agency-Vancouver Center-Department of Medicine, Division of Medical Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fabiana Napolitano
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Immacolata Paciolla
- Oncology Unit, Ospedale Sacro Cuore di Gesù Fatebenefratelli, Benevento, Campania, Italy
| | - Martina Pagliuca
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Giuseppe Palmieri
- Institute of Research on Genetics and Biomedicine (IRGB), National Research Council (CNR), Sassari, Sardegna, Italy
| | - Sara Parola
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Stefano Pepe
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Oncology Unit, University of Salerno, Baronissi, Campania, Italy
| | - Angelica Petrillo
- Oncology Unit, Ospedale del Mare, Napoli, Italy.,Oncology, Department of Precision Medicine, Università della Campania "L. Vanvitelli", Napoli, Campania, Italy
| | - Francovito Piantedosi
- U.O.C. Pneumologia Oncologica, Azienda Ospedaliera dei Colli, Monaldi Hospital, Naples, Campania, Italy
| | - Luisa Piccin
- Veneto Institute of Oncology IOV-IRCCS, Padova, Veneto, Italy
| | - Fernanda Picozzi
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Erica Pietroluongo
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | | | - Vittorio Riccio
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | | | - Alice Rossi
- Department of Oncology, University of Verona, Verona, Veneto, Italy
| | - Anna Russo
- Medical Oncology Unit, Fondazione IRCCS Giovanni Paolo II, Bari, Puglia, Italy
| | - Massimiliano Salati
- Medical Oncology Unit, University Hospital Modena, Modena, Emilia Romagna, Italy
| | - Giuseppe Santabarbara
- Division of Medical Oncology, "San Giuseppe Moscati" Hospital, Avellino, Campania, Italy
| | - Andrea Sbrana
- Medical Oncology Unit, University of Pisa, Pisa, Toscana, Italy
| | - Ester Simeone
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | | | - Massimiliano Spada
- Oncology Unit, Fondazione Istituto San Raffaele G Giglio di Cefalu, Cefalu, Sicilia, Italy
| | - Paolo Tarantino
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milano, Lombardia, Italy
| | | | - Federica Tomei
- Oncology Unit, Ospedale Ferdinando Veneziale, Isernia, Molise, Italy
| | - Tortora Vincenzo
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy.,Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Oncology Unit, University of Salerno, Baronissi, Campania, Italy
| | - Dario Trapani
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milano, Lombardia, Italy
| | - Claudia Trojanello
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Vito Vanella
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Sabrina Vari
- Medical Oncology 1 Unit, IRCCS Regina Elena National Cancer Institute, Rome, Lazio, Italy
| | - Jole Ventriglia
- Oncology Division, ASL San Felice a Cancello, Caserta, Campania, Italy
| | - Maria Grazia Vitale
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy.,Department of Oncology, Azienda Sanitaria Universitaria Integrata del Friuli Centrale, Udine, Friuli Venezia Giulia, Italy
| | - Fabiana Vitiello
- U.O.C. Pneumologia Oncologica, Azienda Ospedaliera dei Colli, Monaldi Hospital, Naples, Campania, Italy
| | | | - Claudia von Arx
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Francesca Zacchi
- Oncology Unit, Università degli Studi di Verona, sede Borgo Roma, Verona, Veneto, Italy
| | - Ilaria Zampiva
- Oncology Unit, Università degli Studi di Verona, sede Borgo Roma, Verona, Veneto, Italy
| | - Andrea Zivi
- Department of Surgery and Cancer, Imperial College, London, UK.,Medical Oncology Department, AOUI di Verona, Verona, Veneto, Italy
| | | | - Paolo Antonio Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
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Scarpato L, Simeone E, Trojaniello C, Palla M, Ascierto P. [Cutaneous squamous cell carcinoma: immunotherapy for locally advanced and metastatic disease]. Recenti Prog Med 2020; 111:21e-27e. [PMID: 33006588 DOI: 10.1701/3407.34316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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25
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Mallardo D, Grimaldi AM, Capone M, Bayless N, Madonna G, Festino L, Vitale MG, Trojaniello C, Vanella V, Curvietto M, Esposito A, Palla M, Scarpato L, Cavalcanti E, Caraco C, Ong S, Warren S, Cesano A, Ascierto PA, Simeone E. Identification of potential predictive biomarkers of rapid progression and rapid response to anti-PD1 treatment by gene profiling analysis in metastatic melanoma patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e22068] [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
e22068 Background: Anti-PD-1 agents represent a standard treatment for melanoma patients. However, most patients fail to respond, showing in some cases very rapid disease progression. At moment, there are no effective biomarkers that can predict patient's clinical benefit. The aim of this study is to retrospectively identify gene profiling biomarkers that could help to select melanoma patients who most likely respond to anti-PD-1 therapy. Methods: We defined as fast responder (FR) or fast progressor (FP) patients who got clinical response or clinical progression after two cycles of therapy. We collected data from 44 metastatic melanoma patients (21 FR and 23 FP) treated in first-line with anti-PD1 monotherapy (nivolumab or pembrolizumab) at National Cancer Institute of Naples, Italy. Gene expression profiling analysis was performed using NanoString IO 360 panels on PBMCs collected at baseline from 18 patients (10 FR and 8 FP). Patients with ECOG≥2 were excluded. They were all IV stage (5 M1a, 1 M1b, 12 M1c) of which 15 were B-RAF wild-type (83%) and 3 were B-RAF mutated (17%). Statistical associations between treatment response and gene score variables were estimated by Student’s T tests and correction for multiple comparisons by the Benjamini-Hochberg method. Results: Patterns of gene expression were assessed for correlation to response. We compared PBMCs nanostring analysis between FR and FP patients. We found a higher expression of KRas, CD39, IFI16, IL18, FCGR2A, IL1RN, MAP3K8, TLR5, TLR8, MyD88 and NF-kB in FP patients (all with p-value ≤0.005), most of them related to cell proliferation and immunosuppressive mechanism. Instead we found a higher expression of PRF1, PIK3R1, HLA-DPA1, HLA-DRB1, HLA-DOA, CD45RA, LDHB, KIR3DL2, CD2, CD28, CD7, CD27 in FR patients (all with p-value ≤0.01), most of them related to priming and cytolysis. Conclusions: These preliminary data obtained through gene profiling analysis on baseline PBMCs of melanoma patients suggest that a specific gene signature may discriminate FR or FP patients. Our study provides rationale for further investigating gene profiling signature as a potential association for response to immunotherapy.
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Affiliation(s)
- Domenico Mallardo
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Antonio M Grimaldi
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Mariaelena Capone
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
| | | | - Gabriele Madonna
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Lucia Festino
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Maria Grazia Vitale
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Claudia Trojaniello
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Vito Vanella
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Marcello Curvietto
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Assunta Esposito
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Marco Palla
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Luigi Scarpato
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Ernesta Cavalcanti
- Department of Diagnostic Pathology and Laboratory, National Cancer Institute "G.Pascale" Foundation, Naples, Italy, Naples, Italy
| | - Corrado Caraco
- Melanoma Surgery Unit. Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
| | - SuFey Ong
- NanoString Technologies, Inc., Seattle, WA
| | | | | | - Paolo Antonio Ascierto
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Ester Simeone
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
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Simeone E, Mallardo D, Giannarelli D, Festino L, Vanella V, Trojaniello C, Vitale MG, Palla M, Scarpato L, Capone M, Madonna G, Curvietto M, Esposito A, Hauber F, Sandomenico F, Cavalcanti E, Caraco C, Mainardi P, Grimaldi AM, Ascierto PA. Correlation of nivolumab 480 mg Q4W with better survival than other nivolumab monotherapy schedule in metastatic melanoma patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e22008] [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
e22008 Background: Nivolumab (nivo) 480 mg (Q4W) flat dose has already been assessed for safety compared to other drug dose regimens in clinical trials [1]. However, few data about melanoma patients treated in real life are available. The aim of our study was to evaluate safety and efficacy in metastatic melanoma pts treated with different schedules of nivo in clinical practice. Methods: We analyzed data from n.124 metastatic melanoma patients who were treated from Jun 2016 to Oct 2019 at NCI of Naples. 83/ 124 (67%) were treated with nivo 480 mg Q4W, and 41/124 (33%) with other schedules (n.26 [63%] with 3 mg/kg, and 15 [37%] with 240 mg Q2W). All patients were stage IV, and n.44/124 (35%) were B-RAF mutated. Nivo was administered as first line in n.95 patients (77%), n. 24 [19%] as second line, and 5 (4%) as third line. Among B-RAF mutated patients, n.23/44 [52%] received a first line with a target-based regimen. According to our previous work [2] we calculated Body Mass Index (BMI). In 93/124 pts the BMI was < 25 (75%), while in 31/124 (25%) BMI was ≥ 25. In the table are summarized other clinical characteristics. Hazard Ratios and their 95% confidence intervals (95% CI) were estimated with the Cox model. Association between factors was evaluated with the chi-square test. Results: Our data suggests that nivo 480 mg (Q4W) correlates with a better OS compared with other regimens (HR = 0.48; [95% CI: 0.24-0.96; p = 0.04]). Moreover, better OS trend was also observed in pts with BMI > 25 (HR = 0.48; [95% CI: 0.33-1.74]; p = 0.51) and with B-RAF mutation (HR = 0.53; [95% CI: 0.25-1.14); P = 0.10]). The incidence of any grade toxicities did not differ according the dosage. Conclusions: This retrospective analysis showed a trend of better outcome with nivo 480. This observation warrants further investigation in a larger cohort of pts. [Table: see text]
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Affiliation(s)
- Ester Simeone
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Domenico Mallardo
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori–Fondazione “G.Pascale”, Naples, Italy
| | | | - Lucia Festino
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Vito Vanella
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Claudia Trojaniello
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Maria Grazia Vitale
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Marco Palla
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Luigi Scarpato
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
| | | | - Gabriele Madonna
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapy, Istituto Nazionale Tumori Fondazione, Naples, Italy
| | - Marcello Curvietto
- Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Naples, Italy
| | - Assunta Esposito
- Unit of Medical Oncology and Innovative Therapy, Istituto Nazionale Tumori Fondazione Pascale, Naples, Italy
| | - Federica Hauber
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Fabio Sandomenico
- Department of Radiology National Cancer Institute of Naples, Naples, Italy
| | - Ernesta Cavalcanti
- Department of Laboratory Medicine, Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
| | - Corrado Caraco
- Melanoma Surgery Unit. Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
| | - Paolo Mainardi
- Melanoma Surgery Unit. Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
| | - Antonio Maria Grimaldi
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapy, Istituto Nazionale Tumori Fondazione, Naples, Italy
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Coutzac C, Jouniaux JM, Paci A, Schmidt J, Mallardo D, Seck A, Asvatourian V, Cassard L, Saulnier P, Lacroix L, Woerther PL, Vozy A, Naigeon M, Nebot-Bral L, Desbois M, Simeone E, Mateus C, Boselli L, Grivel J, Soularue E, Lepage P, Carbonnel F, Ascierto PA, Robert C, Chaput N. Systemic short chain fatty acids limit antitumor effect of CTLA-4 blockade in hosts with cancer. Nat Commun 2020; 11:2168. [PMID: 32358520 PMCID: PMC7195489 DOI: 10.1038/s41467-020-16079-x] [Citation(s) in RCA: 225] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 04/08/2020] [Indexed: 12/19/2022] Open
Abstract
Gut microbiota composition influences the clinical benefit of immune checkpoints in patients with advanced cancer but mechanisms underlying this relationship remain unclear. Molecular mechanism whereby gut microbiota influences immune responses is mainly assigned to gut microbial metabolites. Short-chain fatty acids (SCFA) are produced in large amounts in the colon through bacterial fermentation of dietary fiber. We evaluate in mice and in patients treated with anti-CTLA-4 blocking mAbs whether SCFA levels is related to clinical outcome. High blood butyrate and propionate levels are associated with resistance to CTLA-4 blockade and higher proportion of Treg cells. In mice, butyrate restrains anti-CTLA-4-induced up-regulation of CD80/CD86 on dendritic cells and ICOS on T cells, accumulation of tumor-specific T cells and memory T cells. In patients, high blood butyrate levels moderate ipilimumab-induced accumulation of memory and ICOS + CD4 + T cells and IL-2 impregnation. Altogether, these results suggest that SCFA limits anti-CTLA-4 activity. The gut microbiota has been reported to regulate the efficacy of cancer therapy. Here, the authors show that short-chain fatty acids, which are generated through bacterial fermentation, increases immune tolerance leading to resistance to anti-CTLA-4 immunotherapy in mice and patients with metastatic melanoma.
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Affiliation(s)
- Clélia Coutzac
- Université Paris-Saclay, Institut Gustave Roussy, Inserm, CNRS, Analyse moléculaire, modélisation et imagerie de la maladie cancéreuse, Laboratoire d'Immunomonitoring en Oncologie, F-94805, Villejuif, France.,Université Paris-Saclay, Faculté de Médicine, Le Kremlin Bicêtre, F-94276, France.,Université Paris-Descartes, Faculté de Médicine, F-75006, Paris, France.,Hôpital Européen Georges Pompidou, Département de Gastroentérologie et Oncologie Digestive, Assistance Publique-Hôpitaux de Paris, F-75015, Paris, France
| | - Jean-Mehdi Jouniaux
- Université Paris-Saclay, Institut Gustave Roussy, Inserm, CNRS, Analyse moléculaire, modélisation et imagerie de la maladie cancéreuse, Laboratoire d'Immunomonitoring en Oncologie, F-94805, Villejuif, France.,Université Paris-Saclay, Faculté de Médicine, Le Kremlin Bicêtre, F-94276, France
| | - Angelo Paci
- Université Paris-Saclay, Institut Gustave Roussy, CNRS, Vectorologie et thérapeutiques anticancéreuses, F-94805, Villejuif, France.,Institut Gustave Roussy, Pharmacology and Drug Analysis Department, Villejuif, F-94805, France.,Université Paris-Saclay, Faculté de Pharmacie, Chatenay-Malabry, F-92296, France
| | - Julien Schmidt
- Université Paris-Saclay, Institut Gustave Roussy, Inserm, CNRS, Analyse moléculaire, modélisation et imagerie de la maladie cancéreuse, Laboratoire d'Immunomonitoring en Oncologie, F-94805, Villejuif, France.,Université Paris-Saclay, Faculté de Médicine, Le Kremlin Bicêtre, F-94276, France
| | - Domenico Mallardo
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Instituto Nazionale Tumori- IRCCS -Fondazione G. Pascale, Napoli, Italia
| | - Atmane Seck
- Université Paris-Saclay, Institut Gustave Roussy, CNRS, Vectorologie et thérapeutiques anticancéreuses, F-94805, Villejuif, France.,Institut Gustave Roussy, Pharmacology and Drug Analysis Department, Villejuif, F-94805, France
| | - Vahe Asvatourian
- Institut Gustave Roussy, Biostatistics and Epidemiology Unit, Villejuif, F-94805, France.,Université Paris-Saclay, UVSQ, Inserm, CESP, 94807, Villejuif, France
| | - Lydie Cassard
- Université Paris-Saclay, Institut Gustave Roussy, Inserm, CNRS, Analyse moléculaire, modélisation et imagerie de la maladie cancéreuse, Laboratoire d'Immunomonitoring en Oncologie, F-94805, Villejuif, France
| | - Patrick Saulnier
- Université Paris-Saclay, Institut Gustave Roussy, Inserm, CNRS, Analyse moléculaire, modélisation et imagerie de la maladie cancéreuse, Genomic platform Molecular Biopathology unit and Biological Resource Center, F-94805, Villejuif, France
| | - Ludovic Lacroix
- Université Paris-Saclay, Institut Gustave Roussy, Inserm, CNRS, Analyse moléculaire, modélisation et imagerie de la maladie cancéreuse, Genomic platform Molecular Biopathology unit and Biological Resource Center, F-94805, Villejuif, France
| | - Paul-Louis Woerther
- Institut Gustave Roussy, Department of Medical Biology and Pathology, Microbiology unit, Villejuif, F-94805, France
| | - Aurore Vozy
- Université Paris-Saclay, Institut Gustave Roussy, Inserm, CNRS, Analyse moléculaire, modélisation et imagerie de la maladie cancéreuse, Laboratoire d'Immunomonitoring en Oncologie, F-94805, Villejuif, France
| | - Marie Naigeon
- Université Paris-Saclay, Institut Gustave Roussy, Inserm, CNRS, Analyse moléculaire, modélisation et imagerie de la maladie cancéreuse, Laboratoire d'Immunomonitoring en Oncologie, F-94805, Villejuif, France
| | - Laetitia Nebot-Bral
- Université Paris-Saclay, Faculté de Médicine, Le Kremlin Bicêtre, F-94276, France.,Université Paris-Saclay, Institut Gustave Roussy, CNRS, Stabilité génétique et oncogenèse, 94805, Villejuif, France
| | - Mélanie Desbois
- Université Paris-Saclay, Institut Gustave Roussy, Inserm, CNRS, Analyse moléculaire, modélisation et imagerie de la maladie cancéreuse, Laboratoire d'Immunomonitoring en Oncologie, F-94805, Villejuif, France
| | - Ester Simeone
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Instituto Nazionale Tumori- IRCCS -Fondazione G. Pascale, Napoli, Italia
| | - Christine Mateus
- Institut Gustave Roussy, Dermatology Unit, Department of Medicine, Villejuif, F-94805, France
| | - Lisa Boselli
- Université Paris-Saclay, Institut Gustave Roussy, Inserm, CNRS, Analyse moléculaire, modélisation et imagerie de la maladie cancéreuse, Laboratoire d'Immunomonitoring en Oncologie, F-94805, Villejuif, France
| | - Jonathan Grivel
- Université Paris-Saclay, Institut Gustave Roussy, Inserm, CNRS, Analyse moléculaire, modélisation et imagerie de la maladie cancéreuse, Laboratoire d'Immunomonitoring en Oncologie, F-94805, Villejuif, France
| | - Emilie Soularue
- Université Paris-Saclay, Institut Gustave Roussy, Inserm, CNRS, Analyse moléculaire, modélisation et imagerie de la maladie cancéreuse, Laboratoire d'Immunomonitoring en Oncologie, F-94805, Villejuif, France.,Université Paris-Saclay, Faculté de Médicine, Le Kremlin Bicêtre, F-94276, France.,Hôpital du Kremlin Bicêtre Department of Gastroenterology, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - Patricia Lepage
- Université Paris-Saclay, INRAE, AgroParisTech, Micalis Institute, 78350, Jouy-en-Josas, France
| | - Franck Carbonnel
- Université Paris-Saclay, Faculté de Médicine, Le Kremlin Bicêtre, F-94276, France.,Hôpital du Kremlin Bicêtre Department of Gastroenterology, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - Paolo Antonio Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Instituto Nazionale Tumori- IRCCS -Fondazione G. Pascale, Napoli, Italia
| | - Caroline Robert
- Université Paris-Saclay, Faculté de Médicine, Le Kremlin Bicêtre, F-94276, France.,Institut Gustave Roussy, Dermatology Unit, Department of Medicine, Villejuif, F-94805, France
| | - Nathalie Chaput
- Université Paris-Saclay, Institut Gustave Roussy, Inserm, CNRS, Analyse moléculaire, modélisation et imagerie de la maladie cancéreuse, Laboratoire d'Immunomonitoring en Oncologie, F-94805, Villejuif, France. .,Université Paris-Saclay, Faculté de Pharmacie, Chatenay-Malabry, F-92296, France. .,Université Paris-Saclay, Institut Gustave Roussy, CNRS, Stabilité génétique et oncogenèse, 94805, Villejuif, France.
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28
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Simeone E, Grimaldi AM, Festino L, Trojaniello C, Vitale MG, Vanella V, Palla M, Ascierto PA. Immunotherapy in metastatic melanoma: a novel scenario of new toxicities and their management. Melanoma Manag 2019; 6:MMT30. [PMID: 31871619 PMCID: PMC6920742 DOI: 10.2217/mmt-2019-0005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Checkpoint inhibitors can cause an imbalance in immune tolerance that may clinically manifest as immune-related adverse events (irAEs). These events may involve many organs and tissues, including the skin, gastrointestinal (GI) tract, liver, endocrine system, kidneys, central nervous system (CNS), eyes and lungs. The incidence of irAEs appears to be lower with anti-programmed death antigen-1/programmed death antigen-ligand-1 agents than with the anti-cytotoxic T-lymphocyte-associated protein-4 antibody ipilimumab. Combined immunotherapy does not appear to be associated with novel safety signals compared with monotherapy, but more organs may be involved. Increased experience and the use of algorithms for the most common irAEs have resulted in severe toxicity and related deaths being reduced. However, continuous vigilance, especially regarding less common events, is needed to better characterize the wide spectrum of clinical manifestations.
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Affiliation(s)
- Ester Simeone
- Unit of Melanoma, Cancer Immunotherapy & Innovative Therapies Unit - Istituto Nazionale Tumori Fondazione 'G. Pascale,' IRCCS, 80131, Napoli, Italy
| | - Antonio M Grimaldi
- Unit of Melanoma, Cancer Immunotherapy & Innovative Therapies Unit - Istituto Nazionale Tumori Fondazione 'G. Pascale,' IRCCS, 80131, Napoli, Italy
| | - Lucia Festino
- Unit of Melanoma, Cancer Immunotherapy & Innovative Therapies Unit - Istituto Nazionale Tumori Fondazione 'G. Pascale,' IRCCS, 80131, Napoli, Italy
| | - Claudia Trojaniello
- Unit of Melanoma, Cancer Immunotherapy & Innovative Therapies Unit - Istituto Nazionale Tumori Fondazione 'G. Pascale,' IRCCS, 80131, Napoli, Italy
| | - Maria G Vitale
- Unit of Melanoma, Cancer Immunotherapy & Innovative Therapies Unit - Istituto Nazionale Tumori Fondazione 'G. Pascale,' IRCCS, 80131, Napoli, Italy
| | - Vito Vanella
- Unit of Melanoma, Cancer Immunotherapy & Innovative Therapies Unit - Istituto Nazionale Tumori Fondazione 'G. Pascale,' IRCCS, 80131, Napoli, Italy
| | - Marco Palla
- Unit of Melanoma, Cancer Immunotherapy & Innovative Therapies Unit - Istituto Nazionale Tumori Fondazione 'G. Pascale,' IRCCS, 80131, Napoli, Italy
| | - Paolo A Ascierto
- Unit of Melanoma, Cancer Immunotherapy & Innovative Therapies Unit - Istituto Nazionale Tumori Fondazione 'G. Pascale,' IRCCS, 80131, Napoli, Italy
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Simeone E, Grimaldi AM, Festino L, Trojaniello C, Vitale MG, Vanella V, Curvietto M, Ascierto PA. Nivolumab for the treatment of small cell lung cancer. Expert Rev Respir Med 2019; 14:5-13. [PMID: 31622114 DOI: 10.1080/17476348.2020.1681977] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Treatment of extensive-stage SCLC is still a challenge but immunotherapy with checkpoint inhibitors is showing promising results. Nivolumab alone or in combination with ipilimumab has demonstrated a benefit in terms of response and survival in patients with pre-treated extensive-stage disease and has been approved as third-line therapy after failure of chemotherapy. However, data from two phase III trials with nivolumab are negative. In the first trial, nivolumab was administered as a single agent compared to second-line chemotherapy, while in the second it was given alone or in combination with ipilimumab as maintenance treatment after platinum-based chemotherapy.Areas covered: Our review focuses on the role of immunotherapy, and in particular nivolumab, in the treatment of SCLC, describing the results of the main trials and its future perspectives, with reference to clinical trials with other checkpoint inhibitors.Expert opinion: The future of nivolumab in the treatment of SCLC needs to be clarified with further clinical trials, in which improved patient selection and a more specific setting and/or timepoint of the disease may be identified.
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Affiliation(s)
- Ester Simeone
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Antonio Maria Grimaldi
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Lucia Festino
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Claudia Trojaniello
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Maria Grazia Vitale
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Vito Vanella
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Marcello Curvietto
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Paolo Antonio Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
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Ascierto PA, Capone M, Grimaldi AM, Mallardo D, Simeone E, Madonna G, Roder H, Meyer K, Asmellash S, Oliveira C, Roder J, Grigorieva J. Proteomic test for anti-PD-1 checkpoint blockade treatment of metastatic melanoma with and without BRAF mutations. J Immunother Cancer 2019; 7:91. [PMID: 30925943 PMCID: PMC6440152 DOI: 10.1186/s40425-019-0569-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 03/15/2019] [Indexed: 11/28/2022] Open
Abstract
The therapeutic landscape in metastatic melanoma has changed dramatically in the last decade, with the success of immune checkpoint inhibitors resulting in durable responses for a large number of patients. For patients with BRAF mutations, combinations of BRAF and MEK inhibitors demonstrated response rates and benefit comparable to those from immune checkpoint inhibitors, providing the rationale for sequential treatment with targeted and immunotherapies and raising the question of optimal treatment sequencing. Biomarkers for the selection of anti-PD-1 therapy in BRAF wild type (BRAF WT) and in BRAF mutated (BRAF MUT) patients help development of alternative treatments for patients unlikely to benefit, and might lead to better understanding of the interaction of checkpoint inhibition and targeted therapy. In this paper we evaluate the performance of a previously developed serum proteomic test, BDX008, in metastatic melanoma patients treated with anti-PD-1 agents and investigate the role of BRAF mutation status. BDX008, a pre-treatment proteomic test associated with acute phase reactants, wound healing and complement activation, stratifies patients into two groups, BDX008+ and BDX008-, with better and worse outcomes on immunotherapy. Serum samples were available from 71 patients treated with anti-PD1 inhibitors; 25 patients had BRAF mutations, 39 were wild type. Overall, BDX008+ patients had significantly better overall survival (OS) (HR = 0.50, P = 0.016) and a trend for better progression-free survival (PFS) (HR = 0.61, P = 0.060) than BDX008- patients. BDX008 classification was statistically significant in the analyses adjusted for mutation status, LDH, and line of treatment (P = 0.009 for OS and 0.031 for PFS). BRAF WT BDX008+ patients had markedly long median OS of 32.5 months and 53% landmark 2 years survival, with statistically significantly superior OS as compared to BDX008- patients (HR = 0.41, P = 0.032). The difference between BDX008+ and BDX008- in PFS in BRAF WT patients and in OS and PFS in BRAF MUT patients did not reach statistical significance, though numerically was consistent with overall results. The test demonstrated significant interaction with neutrophil-to-lymphocyte ratio (NLR) (PFS P = 0.041, OS P = 0.004). BDX008 as a biomarker selecting for benefit from immune checkpoint blockade, especially in patients with wild type BRAF and in subgroups with low NLR, warrants further evaluation.
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Affiliation(s)
- Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Mariaelena Capone
- Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | | | - Domenico Mallardo
- Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Ester Simeone
- Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Gabriele Madonna
- Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy.,Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131, Naples, Italy
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31
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Pistillo MP, Fontana V, Morabito A, Dozin B, Laurent S, Carosio R, Banelli B, Ferrero F, Spano L, Tanda E, Ferrucci PF, Martinoli C, Cocorocchio E, Guida M, Tommasi S, De Galitiis F, Pagani E, Antonini Cappellini GC, Marchetti P, Quaglino P, Fava P, Osella-Abate S, Ascierto PA, Capone M, Simeone E, Romani M, Spagnolo F, Queirolo P. Soluble CTLA-4 as a favorable predictive biomarker in metastatic melanoma patients treated with ipilimumab: an Italian melanoma intergroup study. Cancer Immunol Immunother 2019; 68:97-107. [PMID: 30311027 PMCID: PMC11028053 DOI: 10.1007/s00262-018-2258-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 10/04/2018] [Indexed: 12/11/2022]
Abstract
CTLA-4 blockade by means of ipilimumab (IPI) potentiates the immune response and improves overall survival (OS) in a minority of metastatic melanoma (MM) patients. We investigated the role of soluble CTLA-4 (sCTLA-4) as a possible biomarker for identifying this subset of patients. sCTLA-4 levels were analyzed at baseline in sera from 113 IPI-treated MM patients by ELISA, and the median value (200 pg/ml) was used to create two equally sized subgroups. Associations of sCTLA-4 with best overall response (BOR) to IPI and immune-related adverse events (irAEs) were evaluated through logistic regression. Kaplan-Meier and Cox regression methods were used to analyze OS. A remarkable association between sCTLA-4 levels and BOR was found. Specifically, the proportion of patients with sCTLA-4 > 200 pg/ml in irSD or irPD (immune-related stable or progressive disease) was, respectively, 80% (OR = 0.23; 95%CL = 0.03-1.88) and 89% (OR = 0.11; 95%CL = 0.02-0.71) and was lower than that observed among patients in irCR/irPR (immune-related complete/partial response). sCTLA-4 levels increased during IPI treatment, since the proportion of patients showing sCTLA > 200 pg/ml after 3 cycles was 4 times higher (OR = 4.41, 95%CL = 1.02-19.1) than that after 1 cycle. Moreover, a significantly lower death rate was estimated for patients with sCTLA-4 > 200 pg/ml (HR = 0.61, 95%CL = 0.39-0.98). Higher baseline sCTLA-4 levels were also associated with the onset of any irAE (p value = 0.029), in particular irAEs of the digestive tract (p value = 0.041). In conclusion, our results suggest that high sCTLA-4 serum levels might predict favorable clinical outcome and higher risk of irAEs in IPI-treated MM patients.
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Affiliation(s)
- Maria Pia Pistillo
- Unit of Tumor Epigenetics, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.
| | - Vincenzo Fontana
- Unit of Clinical Epidemiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Anna Morabito
- Unit of Tumor Epigenetics, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
| | - Beatrice Dozin
- Unit of Clinical Epidemiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stefania Laurent
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Roberta Carosio
- Unit of Tumor Epigenetics, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
| | - Barbara Banelli
- Unit of Tumor Epigenetics, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Francesca Ferrero
- Department of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Laura Spano
- Department of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Enrica Tanda
- Department of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Chiara Martinoli
- Oncology of Melanoma Unit, European Institute of Oncology, Milan, Italy
- iTeos Therapeutics, Gosselies, Belgium
| | | | - Michele Guida
- Department of Medical Oncology and Molecular Genetics Laboratory, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Stefania Tommasi
- Department of Medical Oncology and Molecular Genetics Laboratory, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | | | - Elena Pagani
- Istituto Dermopatico dell'Immacolata IDI-IRCCS, Rome, Italy
| | | | - Paolo Marchetti
- Istituto Dermopatico dell'Immacolata IDI-IRCCS, Rome, Italy
- Sapienza University of Rome, Rome, Italy
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - Paolo Fava
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - Simona Osella-Abate
- Department of Medical Sciences, Section of Surgical Pathology, University of Turin, Turin, Italy
| | - Paolo Antonio Ascierto
- Melanoma, Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione'G. Pascale', Naples, Italy
| | - Mariaelena Capone
- Melanoma, Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione'G. Pascale', Naples, Italy
| | - Ester Simeone
- Melanoma, Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione'G. Pascale', Naples, Italy
| | - Massimo Romani
- Unit of Tumor Epigenetics, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
| | - Francesco Spagnolo
- Department of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paola Queirolo
- Department of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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32
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Madonna G, Ballesteros-Merino C, Feng Z, Bifulco C, Capone M, Giannarelli D, Mallardo D, Simeone E, Grimaldi AM, Caracò C, Botti G, Fox BA, Ascierto PA. PD-L1 expression with immune-infiltrate evaluation and outcome prediction in melanoma patients treated with ipilimumab. Oncoimmunology 2018; 7:e1405206. [PMID: 30524879 DOI: 10.1080/2162402x.2017.1405206] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 10/16/2017] [Revised: 10/26/2017] [Accepted: 11/06/2017] [Indexed: 12/31/2022] Open
Abstract
Background: Tumor microenvironment may have a key role in providing immunological markers that can help predict clinical response to treatment with checkpoint inhibitors. We investigated whether the baseline expression of PD-L1 in advanced melanoma patients treated with ipilimumab may correlate with clinical outcome. Methods: PD-L1 expression was assessed in 114 patients with advanced melanoma treated with ipilimumab and, in a cohort of 77 patients, a comprehensive assessment using multispectral imaging to assess the presence and distribution of CD3+, CD8+, CD163+, FOXP3+ and PD-L1+ cells inside and at periphery of the tumor was performed. Results: PD-L1 status alone was not a predictive biomarker for response or survival. There was an association between clinical benefit from ipilimumab therapy with the coexistence of low densities of CD8+ and high densities of CD163+ PD-L1+ cells at the periphery of the tumor. Conclusions: To explain the association of this peculiar microenvironment with clinical benefit from ipilimumab, we proposed a model where baseline CD8 cells levels are low due to inhibitory effect of Tregs and to pro-tumor activity of TAM M2 (CD163+ PD-L1+ cells). Ipilimumab treatment causes a decrease of Treg cells, mediated by ADCC from macrophages, with a concomitant change in TAM polarization that switches from M2 to M1 with a subsequent attraction of CD8 cells and the increase of antitumor response.
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Affiliation(s)
- Gabriele Madonna
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione "G. Pascale", Naples, Italy
| | - Carmen Ballesteros-Merino
- Robert W. Franz Cancer Research Center, Earle A. Chiles Research Institute, Providence Cancer Center, Providence Portland Medical Center, Portland, OR, USA
| | - Zipei Feng
- Robert W. Franz Cancer Research Center, Earle A. Chiles Research Institute, Providence Cancer Center, Providence Portland Medical Center, Portland, OR, USA.,Department of Cancer Biology, Oregon Health & Science University, Portland, OR, USA
| | - Carlo Bifulco
- Robert W. Franz Cancer Research Center, Earle A. Chiles Research Institute, Providence Cancer Center, Providence Portland Medical Center, Portland, OR, USA.,Department of Pathology, Providence Portland Medical Center, Portland, OR, USA
| | - Mariaelena Capone
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione "G. Pascale", Naples, Italy
| | - Diana Giannarelli
- Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Domenico Mallardo
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione "G. Pascale", Naples, Italy
| | - Ester Simeone
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione "G. Pascale", Naples, Italy
| | - Antonio M Grimaldi
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione "G. Pascale", Naples, Italy
| | - Corrado Caracò
- Melanoma and Sarcoma Surgery Unit, Istituto Nazionale Tumori Fondazione "G. Pascale", Naples, Italy
| | - Gerardo Botti
- Unit of Pathology, IRCCS, Istituto Nazionale Tumori, Fondazione "G. Pascale", Naples, Italy
| | - Bernard A Fox
- Robert W. Franz Cancer Research Center, Earle A. Chiles Research Institute, Providence Cancer Center, Providence Portland Medical Center, Portland, OR, USA.,Department of Molecular Microbiology & Immunology, Oregon Health & Science University, Portland, OR, USA
| | - Paolo A Ascierto
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione "G. Pascale", Naples, Italy
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Capone M, Giannarelli D, Mallardo D, Madonna G, Festino L, Grimaldi AM, Vanella V, Simeone E, Paone M, Palmieri G, Cavalcanti E, Caracò C, Ascierto PA. Baseline neutrophil-to-lymphocyte ratio (NLR) and derived NLR could predict overall survival in patients with advanced melanoma treated with nivolumab. J Immunother Cancer 2018; 6:74. [PMID: 30012216 PMCID: PMC6048712 DOI: 10.1186/s40425-018-0383-1] [Citation(s) in RCA: 197] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/27/2018] [Indexed: 11/10/2022] Open
Abstract
Background Previous studies have suggested that elevated neutrophil-to-lymphocyte ratio (NLR) is prognostic for worse outcomes in patients with a variety of solid cancers, including those treated with immune checkpoint inhibitors. Methods This was a retrospective analysis of 97 consecutive patients with stage IV melanoma who were treated with nivolumab. Baseline NLR and derived (d) NLR were calculated and, along with other characteristics, correlated with progression-free survival (PFS) and overall survival (OS) in univariate and multivariate analyses. The best cutoff values for NLR and dNLR were derived using Cutoff Finder software based on an R routine which optimized the significance of the split between Kaplan-Meier survival curves. Results In univariate analysis, increasing absolute neutrophil count (ANC), NLR, dNLR and lactate dehydrogenase (LDH) (continuous variables) were all significantly associated with OS. Only NLR (hazard ratio [HR] = 2.85; 95% CI 1.60–5.08; p < 0.0001) and LDH (HR = 2.51; 95% CI 1.36–4.64; p < 0.0001) maintained a significant association with OS in multivariate analysis. Patients with baseline NLR ≥5 had significantly worse OS and PFS than patients with NLR < 5, as did patients with baseline dNLR ≥3 versus < 3. Optimal cut-off values were ≥ 4.7 for NLR and ≥ 3.8 for dNLR. Using this ≥4.7 cut-off for NLR, the values for OS and PFS were overlapping to the canonical cut-off for values, and dNLR< 3.8 was also associated with better OS and PFS. Conclusion Both Neutrophil-to-lymphocyte ratio (NLR) and derived (d) NLR were associated with improved survival when baseline levels were lower than cut-off values. NLR and dNLR are simple, inexpensive and readily available biomarkers that could be used to help predict response to immunotherapy in patients with advanced melanoma. Electronic supplementary material The online version of this article (10.1186/s40425-018-0383-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mariaelena Capone
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Via Mariano Semmola, 80131, Naples, Italy
| | - Diana Giannarelli
- Statistical Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Domenico Mallardo
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Via Mariano Semmola, 80131, Naples, Italy
| | - Gabriele Madonna
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Via Mariano Semmola, 80131, Naples, Italy
| | - Lucia Festino
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Via Mariano Semmola, 80131, Naples, Italy
| | - Antonio Maria Grimaldi
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Via Mariano Semmola, 80131, Naples, Italy
| | - Vito Vanella
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Via Mariano Semmola, 80131, Naples, Italy
| | - Ester Simeone
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Via Mariano Semmola, 80131, Naples, Italy
| | - Miriam Paone
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Via Mariano Semmola, 80131, Naples, Italy
| | - Giuseppe Palmieri
- Unit of Cancer Genetics, Institute of Biomolecular Chemistry, CNR, I-07100, Sassari, Italy
| | - Ernesta Cavalcanti
- Department of Diagnostic Pathology and Laboratory, Istituto Nazionale Tumori- IRCCS -Fondazione G. Pascale, Napoli, Italy
| | - Corrado Caracò
- Melanoma and Skin Cancers Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Napoli, Italy
| | - Paolo Antonio Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Via Mariano Semmola, 80131, Naples, Italy.
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Buonaguro L, Mayer-Mokler A, Accolla R, Ma YT, Heidenreich R, Avallone A, Simeone E, Koenigsrainer A, Loeffler M, Gouttefangeas C, Flohr C, Ludwig J, Rammensee HG, Iñarrairaegui M, Francque S, Chaumette T, Weinschenk T, Reinhardt C, Gnad-Vogt SU, Singh H. HepaVac-101 first-in-man therapeutic cancer vaccine phase I/II clinical trial for hepatocellular carcinoma patients. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps3135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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)
| | | | | | - Yuk Ting Ma
- University of Birmingham, Birmingham, United Kingdom
| | | | | | | | - Alfred Koenigsrainer
- Department of General, Visceral and Transplant Surgery, University Hospital, Tuebingen, Germany
| | | | - Cecile Gouttefangeas
- Institute of Cell Biology, Dept. of Immunology, University of Tuebingen, Tuebingen, Germany
| | | | - Joerg Ludwig
- Immatics Biotechnologies GmbH, Tuebingen, Germany
| | - Hans-Georg Rammensee
- Institute of Cell Biology, Dept. of Immunology, University of Tuebingen, Tuebingen, Germany
| | - Mercedes Iñarrairaegui
- Liver Unit and HPB Oncology Area, Clinica Universidad de Navarra, IDISNA and CIBEREHD, Pamplona, Spain
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35
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Queirolo P, Dozin B, Morabito A, Banelli B, Carosio R, Fontana V, Ferrucci PF, Martinoli C, Cocorocchio E, Ascierto PA, Madonna G, Simeone E, De Galitiis F, Antonini Cappellini GC, Marchetti P, Guida M, Tommasi S, Ghilardi L, Merelli B, Fava P, Osella-Abate S, Guidoboni M, Romani M, Ferone D, Spagnolo F, Pistillo MP. CTLA-4 gene variant -1661A>G may predict the onset of endocrine adverse events in metastatic melanoma patients treated with ipilimumab. Eur J Cancer 2018; 97:59-61. [PMID: 29743138 DOI: 10.1016/j.ejca.2018.04.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/05/2018] [Accepted: 04/05/2018] [Indexed: 01/18/2023]
Affiliation(s)
- Paola Queirolo
- Department of Medical Oncology, Ospedale Policlinico San Martino, Genova, Italy
| | - Beatrice Dozin
- Unit of Clinical Epidemiology, Ospedale Policlinico San Martino, Genova, Italy
| | - Anna Morabito
- Unit of Tumor Epigenetics, Ospedale Policlinico San Martino, Genova, Italy
| | - Barbara Banelli
- Unit of Tumor Epigenetics, Ospedale Policlinico San Martino, Genova, Italy; Department of Health Sciences, University of Genova, Italy
| | - Roberta Carosio
- Unit of Tumor Epigenetics, Ospedale Policlinico San Martino, Genova, Italy
| | - Vincenzo Fontana
- Unit of Clinical Epidemiology, Ospedale Policlinico San Martino, Genova, Italy
| | | | - Chiara Martinoli
- Oncology of Melanoma Unit, European Institute of Oncology, Milan, Italy
| | | | - Paolo A Ascierto
- Melanoma, Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy
| | - Gabriele Madonna
- Melanoma, Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy
| | - Ester Simeone
- Melanoma, Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy
| | | | | | - Paolo Marchetti
- Istituto Dermopatico dell'Immacolata IDI-IRCCS, Rome, Italy; Medical Oncology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Michele Guida
- Department of Medical Oncology and Molecular Genetics Laboratory, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Stefania Tommasi
- Department of Medical Oncology and Molecular Genetics Laboratory, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Laura Ghilardi
- Unit of Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Barbara Merelli
- Unit of Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Paolo Fava
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Simona Osella-Abate
- Section of Surgical Pathology, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Massimo Romani
- Unit of Tumor Epigenetics, Ospedale Policlinico San Martino, Genova, Italy
| | - Diego Ferone
- Endocrinology Unit, Department of Internal Medicine (DiMI), University of Genova, Italy
| | - Francesco Spagnolo
- Department of Medical Oncology, Ospedale Policlinico San Martino, Genova, Italy
| | - Maria Pia Pistillo
- Unit of Tumor Epigenetics, Ospedale Policlinico San Martino, Genova, Italy.
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Queirolo P, Dozin B, Morabito A, Banelli B, Piccioli P, Fava C, Leo C, Carosio R, Laurent S, Fontana V, Ferrucci PF, Martinoli C, Cocorocchio E, Battaglia A, Ascierto PA, Capone M, Simeone E, De Galitiis F, Pagani E, Antonini Cappellini GC, Marchetti P, Guida M, Tommasi S, Mandalà M, Merelli B, Quaglino P, Fava P, Guidoboni M, Romani M, Spagnolo F, Pistillo MP. Corrigendum: Association of CTLA-4 Gene Variants with Response to Therapy and Long-term Survival in Metastatic Melanoma Patients Treated with Ipilimumab: An Italian Melanoma Intergroup Study. Front Immunol 2018. [PMID: 29531523 PMCID: PMC5840259 DOI: 10.3389/fimmu.2018.00403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article on p. 386 in vol. 8, PMID: 28446908.].
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Affiliation(s)
- Paola Queirolo
- Department of Medical Oncology, IRCCS AOU San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Beatrice Dozin
- Unit of Clinical Epidemiology, IRCCS AOU San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Anna Morabito
- Unit of Tumor Epigenetics, IRCCS AOU San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Barbara Banelli
- Unit of Tumor Epigenetics, IRCCS AOU San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.,Department of Health Sciences, University of Genova, Genova, Italy
| | - Patrizia Piccioli
- Unit of Cellular Biology, IRCCS AOU San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Cristiana Fava
- Department of Medical Oncology, IRCCS AOU San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Claudio Leo
- Department of Medical Oncology, IRCCS AOU San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Roberta Carosio
- Unit of Tumor Epigenetics, IRCCS AOU San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Stefania Laurent
- Intergruppo Melanoma Italiano (IMI) and Department of Internal Medicine, University of Genova, Genova, Italy
| | - Vincenzo Fontana
- Unit of Clinical Epidemiology, IRCCS AOU San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | | | - Chiara Martinoli
- Oncology of Melanoma Unit, European Institute of Oncology, Milan, Italy
| | | | - Angelo Battaglia
- Oncology of Melanoma Unit, European Institute of Oncology, Milan, Italy
| | - Paolo A Ascierto
- Melanoma, Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione 'G. Pascale', Naples, Italy
| | - Mariaelena Capone
- Melanoma, Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione 'G. Pascale', Naples, Italy
| | - Ester Simeone
- Melanoma, Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione 'G. Pascale', Naples, Italy
| | | | - Elena Pagani
- Istituto Dermopatico dell'Immacolata IDI-IRCCS, Rome, Italy
| | | | - Paolo Marchetti
- Istituto Dermopatico dell'Immacolata IDI-IRCCS, Rome, Italy.,Medical Oncology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Michele Guida
- Department of Medical Oncology, Molecular Genetics Laboratory, IRCCS Istituto Tumori "Giovanni Paolo II,"Bari, Italy
| | - Stefania Tommasi
- Department of Medical Oncology, Molecular Genetics Laboratory, IRCCS Istituto Tumori "Giovanni Paolo II,"Bari, Italy
| | - Mario Mandalà
- Unit of Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Barbara Merelli
- Unit of Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Pietro Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paolo Fava
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Massimo Romani
- Unit of Tumor Epigenetics, IRCCS AOU San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Francesco Spagnolo
- Department of Medical Oncology, IRCCS AOU San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Maria Pia Pistillo
- Unit of Tumor Epigenetics, IRCCS AOU San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
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Fratangelo F, Morello S, Madonna G, Capone M, Mallardo D, Falcone R, Grimaldi A, Simeone E, Vanella V, Giannarelli D, Sorrentino C, Pinto A, Ascierto P. Expression of CD73 on MDSCs and CD8+/PD-1+ cells as new possible biomarkers for advanced melanoma patients treated with nivolumab. Eur J Cancer 2018. [DOI: 10.1016/j.ejca.2018.01.060] [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: 10/17/2022]
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Ferrucci P, Ascierto P, Pigozzo J, Del Vecchio M, Maio M, Antonini Cappellini G, Guidoboni M, Queirolo P, Savoia P, Mandalà M, Simeone E, Valpione S, Altomonte M, Spagnolo F, Cocorocchio E, Gandini S, Giannarelli D, Martinoli C. Baseline neutrophils and derived neutrophil-to-lymphocyte ratio: prognostic relevance in metastatic melanoma patients receiving ipilimumab. Ann Oncol 2018; 29:524. [DOI: 10.1093/annonc/mdx059] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
- Ester Simeone
- Melanoma, Cancer Immunotherapy & Innovative Therapy Department at National Cancer Institute of Naples, Naples 80131, Italy
| | - Paolo A Ascierto
- Melanoma, Cancer Immunotherapy & Innovative Therapy Department at National Cancer Institute of Naples, Naples 80131, Italy
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Vanella V, Festino L, Strudel M, Simeone E, Grimaldi AM, Ascierto PA. PD-L1 inhibitors in the pipeline: Promise and progress. Oncoimmunology 2017; 7:e1365209. [PMID: 29296516 PMCID: PMC5739559 DOI: 10.1080/2162402x.2017.1365209] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 07/28/2017] [Accepted: 08/04/2017] [Indexed: 01/05/2023] Open
Abstract
Checkpoint inhibitors have improved survival for patients with melanoma, non-small-cell lung cancer (NSCLC), bladder, head and neck and other cancers. Antibodies against PD-L1, including atezolizumab, avelumab and durvalumab, are also being developed and have been approved for various cancers. Compared with anti-CTLA-4 drugs, studies with anti-PD-1/PD-L1 agents have suggested higher response rates and improved survival. Targeting PD-L1 rather than PD-1 may also theoretically offer further benefit, with the potential for improved efficacy and reduced toxicity, although this has not been clearly shown by clinical experience to date. Anti-PD-L1 agents have shown good efficacy and manageable toxicity in several tumor types.
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Affiliation(s)
- Vito Vanella
- Melanoma, Cancer Immunotherapy and Innovative Therapies Unit – Istituto Nazionale Tumori Fondazione “G. Pascale,” Napoli, Italy
| | - Lucia Festino
- Melanoma, Cancer Immunotherapy and Innovative Therapies Unit – Istituto Nazionale Tumori Fondazione “G. Pascale,” Napoli, Italy
| | - Martina Strudel
- Melanoma, Cancer Immunotherapy and Innovative Therapies Unit – Istituto Nazionale Tumori Fondazione “G. Pascale,” Napoli, Italy
| | - Ester Simeone
- Melanoma, Cancer Immunotherapy and Innovative Therapies Unit – Istituto Nazionale Tumori Fondazione “G. Pascale,” Napoli, Italy
| | - Antonio M. Grimaldi
- Melanoma, Cancer Immunotherapy and Innovative Therapies Unit – Istituto Nazionale Tumori Fondazione “G. Pascale,” Napoli, Italy
| | - Paolo A. Ascierto
- Melanoma, Cancer Immunotherapy and Innovative Therapies Unit – Istituto Nazionale Tumori Fondazione “G. Pascale,” Napoli, Italy
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Romano S, Simeone E, D'Angelillo A, D'Arrigo P, Russo M, Capasso M, Lasorsa VA, Zambrano N, Ascierto PA, Romano MF. FKBP51s signature in peripheral blood mononuclear cells of melanoma patients as a possible predictive factor for immunotherapy. Cancer Immunol Immunother 2017; 66:1143-1151. [PMID: 28434031 PMCID: PMC11028940 DOI: 10.1007/s00262-017-2004-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/16/2017] [Indexed: 12/22/2022]
Abstract
The inhibitory immune checkpoint PD-L1/PD1 promotes the alternative splicing of the FKBP5 gene, resulting in increased expression of its variant 4 in the peripheral blood mononuclear cells of melanoma patients. The variant 4 transcript is translated into the truncated FKBP51s protein. Given the importance of co-inhibitory signalling in tumour immune escape, here we tested the potential for using FKBP51s expression to predict immunotherapy outcomes. To do this, we immunophenotyped PBMCs from 118 melanoma patients and 77 age- and sex-matched healthy controls. Blood samples were collected before patients underwent ipilimumab treatment. In 64 of the 118 patients, FKBP51s expression was also assessed in regulatory T cells (Tregs). We found that each PBMC subset analysed contained an FKBP51spos fraction, and that this fraction was greater in the melanoma patients than healthy controls. In CD4 T lymphocytes, the FKBP51sneg fraction was significantly impaired. Tregs count was increased in melanoma patients, which is in line with previous studies. Also, by analyses of FKBP51s in Tregs, we identified a subgroup of ipilimumab nonresponder patients (p = 0.002). In conclusion, FKBP51s-based immunophenotyping of melanoma patients revealed several profiles related to a negative immune regulatory control and identified an unknown Treg subset. These findings are likely to be useful in the selection of the patients that are candidate for immunotherapy.
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Affiliation(s)
- Simona Romano
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Pansini, 5, 80131, Naples, Italy
| | - Ester Simeone
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione "G. Pascale", Via Mariano Semmola, 80131, Naples, Italy
| | - Anna D'Angelillo
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Pansini, 5, 80131, Naples, Italy
| | - Paolo D'Arrigo
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Pansini, 5, 80131, Naples, Italy
| | - Michele Russo
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Pansini, 5, 80131, Naples, Italy
| | - Mario Capasso
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Pansini, 5, 80131, Naples, Italy
- CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Vito Alessandro Lasorsa
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Pansini, 5, 80131, Naples, Italy
- CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Nicola Zambrano
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Pansini, 5, 80131, Naples, Italy
- CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Paolo A Ascierto
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione "G. Pascale", Via Mariano Semmola, 80131, Naples, Italy.
| | - Maria Fiammetta Romano
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Pansini, 5, 80131, Naples, Italy.
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Romano S, Simeone E, D'Angelillo A, D'Arrigo P, Capasso M, Lasorsa VA, Tufano M, Rea A, Russo M, Zambrano N, Ascierto PA, Romano MF. Abstract 2624: An FKBP5-based immunophenotype for assessment of the immunosuppression status and possible prediction of immunotherapy response in melanoma patients. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-2624] [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: 11/16/2022]
Abstract
Abstract
Background and aim: FKBP51 is an immunophilin encoded by FKBP5 gene on chromosome 6. It is a protein resident in lymphocytes and involved in immune response. Recently, our group demonstrated that the inhibitory checkpoint PD-L1/PD1 promoted the alternative splicing of FKBP5 gene, resulting in increased expression of its variant 4, in PBMC of melanoma patients. The aim of this study was to address whether such a molecular signature could help in identifying an immune profile associated with increased probability of immunotherapy response.
Experimental Design: The splicing FKBP51 isoform or FKBP51s was measured in peripheral blood T lymphocytes subsets (CD3/CD4, CD3/CD8, CD25 and PD-L1) and CD14 monocytes from a cohort of 118 patients and 77 age- and sex-matched healthy controls, by flow cytometry. Blood samples were collected before patients underwent ipilimumab treatment. Furthermore, in 64 out of 118 patients, expression of FKBP51s was also assessed in regulatory T cells.
Results: Physiologically, each PBMC subset analyzed contained a fraction of an FKBP51spos component, which resulted expanded in melanoma patients. We also measured an increase in CD3/CD8 and PD-L1 lymphocytes in patients. CD4 T lymphocytes showed the FKBP51sneg fraction significantly impaired, which might reflect the condition of impaired T cell help. Treg count was increased, in accordance with previous studies. The count of FKBP51sposTregs defined a subgroup of nonresponder patients to ipilimumab, by 92.6%. A 2D hierarchical partitioning of data from FKBP51s-immunophenotype (heatmap) revealed 3 main clusters: C1 (33 pts, 51,5%), C2 (14 pts, 22%) and C3 (17 pts, 26,5%). FKBP51spos Treg subset appeared globally increased in all clusters. In C1, values of effector T cells and monocytes were not different from normal donors. C2 showed a significant increase of FKBP51spos PD-L1 monocytes and a significant probability of not responding (Chi-square=5.46; p=0.019). This finding is consistent with the hypothesis that response to ipilimumab is prevented by accessory cells exerting a negative immune regulatory control. C3 showed a significant increase of FKBP51s in overall lymphocyte subsets analyzed. Patients in this cluster showed reduced overall survival. This finding suggests that a prevalence of activation (CD25) and co-inhibitory (PD-L1) markers together with the expansion of FKBP51spos effector T cells might reflect a condition of chronic lymphocyte stimulation in some advanced melanoma patients, contributing to T cell-exhaustion.
Conclusions: FKBP51s-based immunophenotype of melanoma patients revealed several profiles virtually related to a negative immune regulatory control and highlights an impairment of a Treg subset endowed with increased suppressive potential. Such FKBP51sTreg subset is likely to be associated with immunotherapy response (Chi-square=9.916, p=0.002) .
Citation Format: Simona Romano, Ester Simeone, Anna D'Angelillo, Paolo D'Arrigo, Mario Capasso, Vito Alessandro Lasorsa, Martina Tufano, Anna Rea, Michele Russo, Nicola Zambrano, Paolo Antonio Ascierto, Maria Fiammetta Romano. An FKBP5-based immunophenotype for assessment of the immunosuppression status and possible prediction of immunotherapy response in melanoma patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2624. doi:10.1158/1538-7445.AM2017-2624
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Affiliation(s)
| | - Ester Simeone
- 2National Cancer Institute "G Pascale", Napoli, Italy
| | | | | | | | | | | | - Anna Rea
- 1Univ. of Naples Federico II, Napoli, Italy
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Ascierto PA, Dummer R, Melero I, Palmieri G, Giannarelli D, Abrami E, Curvietto M, Simeone E, Grimaldi AM. SECOMBIT (sequential combo immuno and target therapy study): A three arms prospective, randomized phase II study to evaluate the best sequential approach with combo immunotherapy [ipilimumab (I) /nivolumab (N)] and combo target therapy [encorafenib (E)/binimetinib (B)] in patients with metastatic melanoma and BRAF mutation. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps9598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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
TPS9598 Background: Treatment of BRAF-mutated metastatic melanoma has dramatically changed with the introduction of targeted therapy (BRAF and MEK inhibitors) and immune-checkpoint blockade (anti-CTLA4, anti-PD-1, and anti-PD-L1). Target therapy has been associated with high response rates, but short-term responses. Conversely, treatment with immune checkpoint inhibitors was found to present with lower response rates, but long-term responses. Synergism has been demonstrated when targeted therapy is combined with immunotherapy. The risk of a high rate of toxicity limits the simultaneous combination of all the four compounds (target agents and immunomodulating monoclonal antibodies). Sequencing of these different combinations seems to be more feasible; finding the right treatment sequence represents an important issue to be addressed. Methods: Approximately, 230 patients with untreated, histologically-confirmed advanced melanoma (measurable disease by RECIST v1.1) and carrying the BRAFV600 mutation will be randomized to Arm A [E+B until disease progression (PD), followed by I+N], or Arm B (I+N until PD, followed by E+B) or Arm C (E+B for 8 weeks, followed by I+N until PD, followed by E+B until PD). Patients will receive the combo treatments with the following schedules: target therapy, E 450mg p.o. od + B 45mg p.o. bid; immunotherapy, I 3mg/kg + N 1mg/kg Q3w x 4 cycles, followed by N 3mg/kg Q2w. The OS (time from the date of randomization until death from any cause) is primary efficacy endpoint of the study. Secondary endpoints include total PFS (time from randomization until the second progression), survival at 2 and 3 years, best overall response rate, duration of response. About 90 patients will take part in the ancillary study for the evaluation of biomarkers on the biological samples available (biopsies + blood samples). 30 Sites in Europe will concur to enroll the patients in the trial. This study is open and currently enrolling patients. Clinical trial information: NCT02631447.
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Affiliation(s)
| | | | - Ignacio Melero
- CIMA, CUN, University Navarra, Centro de Investigación Biomédica en Red de Oncología (CIBERONC), Pamplona, Spain
| | | | | | | | - Marcello Curvietto
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapy, Istituto Nazionale Tumori Fondazione, Naples, Italy
| | - Ester Simeone
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapy, Istituto Nazionale Tumori Fondazione, Naples, Italy
| | - Antonio Maria Grimaldi
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapy, Istituto Nazionale Tumori Fondazione, Naples, Italy
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Di Monta G, Caracò C, Simeone E, Grimaldi AM, Marone U, Di Marzo M, Vanella V, Festino L, Palla M, Mori S, Mozzillo N, Ascierto PA. Electrochemotherapy efficacy evaluation for treatment of locally advanced stage III cutaneous squamous cell carcinoma: a 22-cases retrospective analysis. J Transl Med 2017; 15:82. [PMID: 28441954 PMCID: PMC5405498 DOI: 10.1186/s12967-017-1186-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extensive squamous cell carcinoma has few therapeutic options. In such cases, electrochemotherapy involving electroporation combined with antineoplastic drug appears to be a new potential option and may be considered as an alternative treatment. The aim of this retrospective single-center study was to evaluate electrochemotherapy efficacy in treatment of locally advanced stage III squamous cell carcinoma, in which surgical procedures would have entailed wide tissue sacrifice. METHODS Clinical features, treatment response, and adverse effects were evaluated in 22 patients treated with electrochemotherapy with intravenous injection of bleomycin for extensive stage III cutaneous squamous cell carcinoma. Treatment of cutaneous lesions were performed according to the European Standard Operating Procedures of Electrochemotherapy. RESULTS Overall response to electrochemotherapy treatment was observed in 18 (81.8%) patients. Clinical response with necrosis of tumor mass was observed from the first session and lasted for all follow up period that ranged between 5 and 48 months with a median of 34 months. Overall the treatment was well tolerated with a very low complication rate. CONCLUSIONS Electrochemotherapy represents a safe and effective therapeutic approach, associated with a good tolerability.
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Affiliation(s)
- Gianluca Di Monta
- Department of Surgery “Melanoma-Soft Tissues-Head & Neck-Skin Cancers”, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione G. Pascale”, Via Mariano Semmola, 80131 Naples, Italy
| | - Corrado Caracò
- Department of Surgery “Melanoma-Soft Tissues-Head & Neck-Skin Cancers”, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione G. Pascale”, Via Mariano Semmola, 80131 Naples, Italy
| | - Ester Simeone
- Unit of Medical Oncology and Innovative Therapy, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione G. Pascale”, Via Mariano Semmola, 80131 Naples, Italy
| | - Antonio Maria Grimaldi
- Unit of Medical Oncology and Innovative Therapy, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione G. Pascale”, Via Mariano Semmola, 80131 Naples, Italy
| | - Ugo Marone
- Department of Surgery “Melanoma-Soft Tissues-Head & Neck-Skin Cancers”, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione G. Pascale”, Via Mariano Semmola, 80131 Naples, Italy
| | - Massimiliano Di Marzo
- Department of Surgery “Melanoma-Soft Tissues-Head & Neck-Skin Cancers”, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione G. Pascale”, Via Mariano Semmola, 80131 Naples, Italy
| | - Vito Vanella
- Unit of Medical Oncology and Innovative Therapy, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione G. Pascale”, Via Mariano Semmola, 80131 Naples, Italy
| | - Lucia Festino
- Unit of Medical Oncology and Innovative Therapy, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione G. Pascale”, Via Mariano Semmola, 80131 Naples, Italy
| | - Marco Palla
- Unit of Medical Oncology and Innovative Therapy, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione G. Pascale”, Via Mariano Semmola, 80131 Naples, Italy
| | - Stefano Mori
- Department of Surgery “Melanoma-Soft Tissues-Head & Neck-Skin Cancers”, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione G. Pascale”, Via Mariano Semmola, 80131 Naples, Italy
| | - Nicola Mozzillo
- Department of Surgery “Melanoma-Soft Tissues-Head & Neck-Skin Cancers”, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione G. Pascale”, Via Mariano Semmola, 80131 Naples, Italy
| | - Paolo Antonio Ascierto
- Unit of Medical Oncology and Innovative Therapy, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione G. Pascale”, Via Mariano Semmola, 80131 Naples, Italy
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Queirolo P, Dozin B, Morabito A, Banelli B, Piccioli P, Fava C, Leo C, Carosio R, Laurent S, Fontana V, Ferrucci PF, Martinoli C, Cocorocchio E, Battaglia A, Ascierto PA, Capone M, Simeone E, De Galitiis F, Pagani E, Antonini Cappellini GC, Marchetti P, Guida M, Tommasi S, Mandalà M, Merelli B, Quaglino P, Fava P, Guidoboni M, Romani M, Spagnolo F, Pistillo MP. Association of CTLA-4 Gene Variants with Response to Therapy and Long-term Survival in Metastatic Melanoma Patients Treated with Ipilimumab: An Italian Melanoma Intergroup Study. Front Immunol 2017; 8:386. [PMID: 28446908 PMCID: PMC5388686 DOI: 10.3389/fimmu.2017.00386] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 12/01/2016] [Accepted: 03/20/2017] [Indexed: 01/14/2023] Open
Abstract
Ipilimumab (IPI) blocks CTLA-4 immune checkpoint resulting in T cell activation and enhanced antitumor immunity. IPI improves overall survival (OS) in 22% of patients with metastatic melanoma (MM). We investigated the association of CTLA-4 single nucleotide variants (SNVs) with best overall response (BOR) to IPI and OS in a cohort of 173 MM patients. Patients were genotyped for six CTLA-4 SNVs (−1661A>G, −1577G>A, −658C>T, −319C>T, +49A>G, and CT60G>A). We assessed the association between SNVs and BOR through multinomial logistic regression (MLR) and the prognostic effect of SNVs on OS through Kaplan–Meier method. Both −1577G>A and CT60G>A SNVs were found significantly associated with BOR. In particular, the proportion of responders was higher in G/G genotype while that of stable patients was higher in A/A genotype. The frequency of patients experiencing progression was similar in all genotypes. MLR evidenced a strong downward trend in the probability of responsiveness/progression, in comparison to disease stability, as a function of the allele A “dose” (0, 1, or 2) in both SNVs with reductions of about 70% (G/A vs G/G) and about 95% (A/A vs G/G). Moreover, −1577G/G and CT60G/G genotypes were associated with long-term OS, the surviving patients being at 3 years 29.8 and 30.8%, respectively, as compared to 12.9 and 14.4% of surviving patients carrying −1577G/A and CT60G/A, respectively. MM patients carrying −1577G/G or CT60G/G genotypes may benefit from IPI treatment in terms of BOR and long-term OS. These CTLA-4 SNVs may serve as potential biomarkers predictive of favorable outcome in this subset of patients.
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Affiliation(s)
- Paola Queirolo
- Department of Medical Oncology, IRCCS AOU San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Beatrice Dozin
- Unit of Clinical Epidemiology, IRCCS AOU San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Anna Morabito
- Unit of Tumor Epigenetics, IRCCS AOU San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Barbara Banelli
- Unit of Tumor Epigenetics, IRCCS AOU San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.,Department of Health Sciences, University of Genova, Genova, Italy
| | - Patrizia Piccioli
- Unit of Cellular Biology, IRCCS AOU San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Cristiana Fava
- Department of Medical Oncology, IRCCS AOU San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Claudio Leo
- Department of Medical Oncology, IRCCS AOU San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Roberta Carosio
- Unit of Tumor Epigenetics, IRCCS AOU San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Stefania Laurent
- Intergruppo Melanoma Italiano (IMI) and Department of Internal Medicine, University of Genova, Genova, Italy
| | - Vincenzo Fontana
- Unit of Clinical Epidemiology, IRCCS AOU San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | | | - Chiara Martinoli
- Oncology of Melanoma Unit, European Institute of Oncology, Milan, Italy
| | | | - Angelo Battaglia
- Oncology of Melanoma Unit, European Institute of Oncology, Milan, Italy
| | - Paolo A Ascierto
- Melanoma, Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione 'G. Pascale', Naples, Italy
| | - Mariaelena Capone
- Melanoma, Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione 'G. Pascale', Naples, Italy
| | - Ester Simeone
- Melanoma, Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione 'G. Pascale', Naples, Italy
| | - Federica De Galitiis
- Istituto Dermopatico dell'Immacolata IDI-IRCCS, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Elena Pagani
- Istituto Dermopatico dell'Immacolata IDI-IRCCS, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Paolo Marchetti
- Istituto Dermopatico dell'Immacolata IDI-IRCCS, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.,Medical Oncology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Michele Guida
- Department of Medical Oncology and Molecular Genetics Laboratory, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Stefania Tommasi
- Department of Medical Oncology and Molecular Genetics Laboratory, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Mario Mandalà
- Unit of Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Barbara Merelli
- Unit of Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Pietro Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paolo Fava
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Massimo Romani
- Unit of Tumor Epigenetics, IRCCS AOU San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Francesco Spagnolo
- Department of Medical Oncology, IRCCS AOU San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Maria Pia Pistillo
- Unit of Tumor Epigenetics, IRCCS AOU San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
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46
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Simeone E, Grimaldi AM, Festino L, Giannarelli D, Vanella V, Palla M, Curvietto M, Esposito A, Palmieri G, Mozzillo N, Ascierto PA. Correlation between previous treatment with BRAF inhibitors and clinical response to pembrolizumab in patients with advanced melanoma. Oncoimmunology 2017; 6:e1283462. [PMID: 28405510 PMCID: PMC5384373 DOI: 10.1080/2162402x.2017.1283462] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/10/2017] [Accepted: 01/12/2017] [Indexed: 10/20/2022] Open
Abstract
The optimal sequencing of targeted treatment and immunotherapy in the treatment of advanced melanoma is a key question and prospective studies to address this are ongoing. Previous observations suggest that treating first with targeted therapy may select for more aggressive disease, meaning that patients may not gain full benefit from subsequent immunotherapy. In a single-center retrospective analysis, we investigated whether response to pembrolizumab was affected by previous BRAF inhibitor therapy. A total of 42 patients with metastatic cutaneous or mucosal melanoma who had received previous treatment with ipilimumab were treated with pembrolizumab as part of the Italian expanded access program. Sixteen of these patients had BRAF-mutated melanoma and had also been previously treated with a BRAF inhibitor (vemurafenib or dabrafenib), while 26 had BRAF wild-type melanoma (no previous BRAF inhibitor). Patients with BRAF-mutant melanoma who were previously treated with BRAF inhibitors had a significantly lower median progression-free survival (3 [2.3-3.7] versus not reached [2-8+] mo; p = 0.001) and disease control rate (18.6% versus 65.4%; p = 0.005) than patients with BRAF wild-type, while there was also a trend toward a lower response rate (assessed using immune-related response criteria) although this was not significantly different between groups (12.5% versus 36.4%; p = 0.16). These data are consistent with previous reports that BRAF inhibitor therapy may affect subsequent response to immunotherapy.
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Affiliation(s)
- Ester Simeone
- Melanoma, Cancer Immunotherapy and Innovative Therapies O.U., Istituto Nazionale Tumori Fondazione “G. Pascale”, Napoli, Italy
| | - Antonio Maria Grimaldi
- Melanoma, Cancer Immunotherapy and Innovative Therapies O.U., Istituto Nazionale Tumori Fondazione “G. Pascale”, Napoli, Italy
| | - Lucia Festino
- Melanoma, Cancer Immunotherapy and Innovative Therapies O.U., Istituto Nazionale Tumori Fondazione “G. Pascale”, Napoli, Italy
| | | | - Vito Vanella
- Melanoma, Cancer Immunotherapy and Innovative Therapies O.U., Istituto Nazionale Tumori Fondazione “G. Pascale”, Napoli, Italy
| | - Marco Palla
- Melanoma, Cancer Immunotherapy and Innovative Therapies O.U., Istituto Nazionale Tumori Fondazione “G. Pascale”, Napoli, Italy
| | - Marcello Curvietto
- Melanoma, Cancer Immunotherapy and Innovative Therapies O.U., Istituto Nazionale Tumori Fondazione “G. Pascale”, Napoli, Italy
| | - Assunta Esposito
- Melanoma, Cancer Immunotherapy and Innovative Therapies O.U., Istituto Nazionale Tumori Fondazione “G. Pascale”, Napoli, Italy
| | - Giuseppe Palmieri
- Unit of Melanoma and Sarcoma Surgery, Istituto Nazionale Tumori Fondazione, Napoli, Italy
| | - Nicola Mozzillo
- Unit of Melanoma and Sarcoma Surgery, Istituto Nazionale Tumori Fondazione, Napoli, Italy
| | - Paolo Antonio Ascierto
- Melanoma, Cancer Immunotherapy and Innovative Therapies O.U., Istituto Nazionale Tumori Fondazione “G. Pascale”, Napoli, Italy
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47
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Tallerico R, Cristiani CM, Staaf E, Garofalo C, Sottile R, Capone M, Pico de Coaña Y, Madonna G, Palella E, Wolodarski M, Carannante V, Mallardo D, Simeone E, Grimaldi AM, Johansson S, Frumento P, Gulletta E, Anichini A, Colucci F, Ciliberto G, Kiessling R, Kärre K, Ascierto PA, Carbone E. IL-15, TIM-3 and NK cells subsets predict responsiveness to anti-CTLA-4 treatment in melanoma patients. Oncoimmunology 2016; 6:e1261242. [PMID: 28344869 DOI: 10.1080/2162402x.2016.1261242] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/09/2016] [Accepted: 11/09/2016] [Indexed: 12/31/2022] Open
Abstract
Despite the success of immune checkpoint blockade in melanoma, the majority of patients do not respond. We hypothesized that the T and NK cell subset frequencies and expression levels of their receptors may predict responses and clinical outcome of anti-CTLA-4 treatment. We thus characterized the NK and T cell phenotype, as well as serum levels of several cytokines in 67 melanoma patients recruited in Italy and Sweden, using samples drawn prior to and during treatment. Survival correlated with low expression of the inhibitory receptor TIM-3 on circulating T and NK cells prior to and during treatment and with the increased frequency of mature circulating NK cells (defined as CD3-CD56dim CD16+) during treatment. Survival also correlated with low levels of IL-15 in the serum. Functional experiments in vitro demonstrated that sustained exposure to IL-15 enhanced the expression of PD-1 and TIM-3 on both T and NK cells, indicating a causative link between high IL-15 levels and enhanced expression of TIM-3 on these cells. Receptor blockade of TIM-3 improved NK cell-mediated elimination of melanoma metastasis cell lines in vitro. These observations may lead to the development of novel biomarkers to predict patient response to checkpoint blockade treatment. They also suggest that induction of additional checkpoints is a possibility that needs to be considered when treating melanoma patients with IL-15.
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Affiliation(s)
- Rossana Tallerico
- Tumor Immunology and Immunopathology Laboratory, Department of Experimental and Clinical Medicine, University "Magna Græcia" of Catanzaro, Campus - Germaneto , Catanzaro, Italy
| | - Costanza M Cristiani
- Tumor Immunology and Immunopathology Laboratory, Department of Experimental and Clinical Medicine, University "Magna Græcia" of Catanzaro, Campus - Germaneto , Catanzaro, Italy
| | - Elina Staaf
- Department of Microbiology, Cell and Tumorbiology (MTC), Karolinska Institutet , Stockholm, Sweden
| | - Cinzia Garofalo
- Tumor Immunology and Immunopathology Laboratory, Department of Experimental and Clinical Medicine, University "Magna Græcia" of Catanzaro, Campus - Germaneto , Catanzaro, Italy
| | - Rosa Sottile
- Tumor Immunology and Immunopathology Laboratory, Department of Experimental and Clinical Medicine, University "Magna Græcia" of Catanzaro, Campus - Germaneto, Catanzaro, Italy; Department of Microbiology, Cell and Tumorbiology (MTC), Karolinska Institutet, Stockholm, Sweden
| | - Mariaelena Capone
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione "G. Pascale ," Napoli, Italy
| | - Yago Pico de Coaña
- Department of Oncology and Pathology, Karolinska Institutet , Stockholm, Sweden
| | - Gabriele Madonna
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione "G. Pascale ," Napoli, Italy
| | - Eleonora Palella
- Tumor Immunology and Immunopathology Laboratory, Department of Experimental and Clinical Medicine, University "Magna Græcia" of Catanzaro, Campus - Germaneto , Catanzaro, Italy
| | - Maria Wolodarski
- Department of Oncology and Pathology, Karolinska Institutet , Stockholm, Sweden
| | - Valentina Carannante
- Department of Microbiology, Cell and Tumorbiology (MTC), Karolinska Institutet , Stockholm, Sweden
| | - Domenico Mallardo
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione "G. Pascale ," Napoli, Italy
| | - Ester Simeone
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione "G. Pascale ," Napoli, Italy
| | - Antonio M Grimaldi
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione "G. Pascale ," Napoli, Italy
| | - Sofia Johansson
- Department of Microbiology, Cell and Tumorbiology (MTC), Karolinska Institutet , Stockholm, Sweden
| | - Paolo Frumento
- Karolinska Institutet Statistical Core Facility, Karolinska Institutet , Stockholm, Sweden
| | - Elio Gulletta
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Campus - Germaneto , Catanzaro, Italy
| | - Andrea Anichini
- Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Experimental Oncology and Molecular Medicine , Milan, Italy
| | - Francesco Colucci
- Department of Obstetrics and Gynecology, University of Cambridge Clinical School , Cambridge, UK
| | - Gennaro Ciliberto
- Scientific Directorate, IRCCS Istituto Nazionale Tumori Fondazione "G. Pascale ," Napoli, Italy
| | - Rolf Kiessling
- Department of Oncology and Pathology, Karolinska Institutet , Stockholm, Sweden
| | - Klas Kärre
- Department of Microbiology, Cell and Tumorbiology (MTC), Karolinska Institutet , Stockholm, Sweden
| | - Paolo A Ascierto
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione "G. Pascale ," Napoli, Italy
| | - Ennio Carbone
- Tumor Immunology and Immunopathology Laboratory, Department of Experimental and Clinical Medicine, University "Magna Græcia" of Catanzaro, Campus - Germaneto, Catanzaro, Italy; Department of Microbiology, Cell and Tumorbiology (MTC), Karolinska Institutet, Stockholm, Sweden
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48
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Cesarone MR, Belcaro G, Agus G, Georgiev M, Errichi BM, Marinucci R, Errichi S, Filippini A, Pellegrini L, Ledda A, Vinciguerra G, Ricci A, Cipollone G, Lania M, Gizzi G, Ippolito E, Bavera P, Fano F, Dugall M, Adovasio R, Gallione L, Del Boccio G, Cornelli U, Steigerwalt R, Acerbi G, Cacchio M, Di Renzo A, Hosoi M, Stuard S, Corsi M, Di Ciano L, Simeone E, Collevecchio G, Grossi MG, Di Giambattista F, Carestia F, Zukowski A. Management of Superficial Vein Thrombosis and Thrombophlebitis: Status and Expert Opinion Document. Angiology 2016; 58 Suppl 1:7S-14S; discussion 14S-15S. [PMID: 17478877 DOI: 10.1177/0003319706297643] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Superficial vein thrombosis is characterized by clotting of superficial veins (ie, following direct trauma) with minimal inflammatory components. Superficial thrombophlebitis is a minimally thrombotic process of superficial veins associated with inflammatory changes and/or infection. Treatments generally include analgesics, elastic compression, anti-inflammatory agents, exercise and ambulation, and, in some cases, local or systemic anticoagulants. It is better to avoid bed rest and reduced mobility. Topical analgesia with nonsteroidal, anti-inflammatory creams applied locally to the superficial vein thrombosis/superficial thrombophlebitis area controls symptoms. Hirudoid cream (heparinoid) shortens the duration of signs/symptoms. Locally acting anticoagulants/antithrombotics (Viatromb®, Lipohep ®, spray Na-heparin) have positive effects on pain and on the reduction in thrombus size. Intravenous catheters should be changed every 24 to 48 hours (depending on venous flow and clinical parameters) to prevent superficial vein thrombosis/superficial thrombophlebitis and removed in case of events. Low molecular weight heparin prophylaxis and nitroglycerin patches distal to peripheral lines may reduce the incidence of superficial vein thrombosis/superficial thrombophlebitis in patients with vein catheters. In case of superficial vein thrombosis/superficial thrombophlebitis, vein lines should be removed. In neoplastic diseases and hematological disorders, anticoagulants may be necessary. Exercise reduces pain and the possibility of deep vein thrombosis. Only in cases in which pain is very severe is bed rest necessary. Deep vein thrombosis prophylaxis should be established in patients with reduced mobility. Antibiotics usually do not have a place in superficial vein thrombosis/superficial thrombophlebitis unless there are documented infections. Prevention of superficial vein thrombosis should be considered on the basis of patient's history and clinical evaluation.
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Affiliation(s)
- M R Cesarone
- Vascular Lab, Department of Biomedical Science, G D'Annunzio University, Pescara; San Valentino Vascular Screening Project, Italy
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49
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Ascierto PA, Vanella V, Grimaldi AM, Lucia F, Palla M, Simeone E, Mozzillo N. Complete response to nivolumab monotherapy in a treatment-naive, BRAF wild-type patient with advanced mucosal melanoma and elevated lactate dehydrogenase: a case report from a phase III trial. Cancer Immunol Immunother 2016; 65:1395-1400. [PMID: 27604993 PMCID: PMC11028877 DOI: 10.1007/s00262-016-1898-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 04/07/2016] [Accepted: 08/30/2016] [Indexed: 02/03/2023]
Abstract
The anti-PD-1 agent, nivolumab, has been approved both as monotherapy and in combination with ipilimumab for the treatment of unresectable or metastatic melanoma in the USA and European Union. Here we present the case of a patient with treatment-naive, metastatic mucosal melanoma and baseline LDH approximately seven times the upper limit of normal. The patient was enrolled in a clinical trial (CheckMate 066) and achieved a partial response, followed by a durable complete response with nivolumab treatment. The patient's LDH levels were documented in each cycle and dropped markedly within 2 months, when partial response to treatment was already evident. LDH levels remained low for the rest of follow-up, consistent with the ongoing complete response to treatment. The patient experienced only mild immune-related adverse events (grade 1-2), which included vitiligo and rash. This exceptional response suggests that patients with high LDH levels at baseline should be considered for nivolumab treatment. LDH levels, however, should not serve as a predictive marker of response to nivolumab. Moreover, this case suggests the need to identify patients who will achieve the greatest benefit from nivolumab monotherapy.
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Affiliation(s)
- Paolo A Ascierto
- Istituto Nazionale Tumori Fondazione "G. Pascale", Via Mariano Semmola, 80131, Naples, Italy.
| | - Vito Vanella
- Istituto Nazionale Tumori Fondazione "G. Pascale", Via Mariano Semmola, 80131, Naples, Italy
| | - Antonio Maria Grimaldi
- Istituto Nazionale Tumori Fondazione "G. Pascale", Via Mariano Semmola, 80131, Naples, Italy
| | - Festino Lucia
- Istituto Nazionale Tumori Fondazione "G. Pascale", Via Mariano Semmola, 80131, Naples, Italy
| | - Marco Palla
- Istituto Nazionale Tumori Fondazione "G. Pascale", Via Mariano Semmola, 80131, Naples, Italy
| | - Ester Simeone
- Istituto Nazionale Tumori Fondazione "G. Pascale", Via Mariano Semmola, 80131, Naples, Italy
| | - Nicola Mozzillo
- Istituto Nazionale Tumori Fondazione "G. Pascale", Via Mariano Semmola, 80131, Naples, Italy
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50
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Morelli M, Masini A, Simeone E, Khazova M. Validation and in vivo assessment of an innovative satellite-based solar UV dosimeter for a mobile app dedicated to skin health. Photochem Photobiol Sci 2016; 15:1170-1175. [PMID: 27480452 DOI: 10.1039/c6pp00129g] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We present an innovative satellite-based solar UV (ultraviolet) radiation dosimeter with a mobile app interface that has been validated by exploiting both ground-based measurements and an in vivo assessment of the erythemal effects on some volunteers having controlled exposure to solar radiation. The app with this satellite-based UV dosimeter also includes other related functionalities such as the provision of safe sun exposure time updated in real-time and end exposure visual/sound alert. Both validations showed that the system has a good accuracy and reliability needed for health-related applications. This app will be launched on the market by siHealth Ltd in May 2016 under the name of "HappySun" and is available for both Android and iOS devices (more info on ). Extensive R&D activities are on-going for the further improvement of the satellite-based UV dosimeter's accuracy.
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Affiliation(s)
- M Morelli
- Flyby S.r.l., Via Puini 97, Livorno, Italy.
| | - A Masini
- Flyby S.r.l., Via Puini 97, Livorno, Italy.
| | - E Simeone
- siHealth Ltd, Atlas Building, Harwell Campus, Didcot, UK.
| | - M Khazova
- Public Health England, Chilton, Didcot, UK.
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