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Kluger HM, Tawbi H, Feltquate D, LaVallee T, Rizvi NA, Sharon E, Sosman J, Sullivan RJ. Society for Immunotherapy of Cancer (SITC) checkpoint inhibitor resistance definitions: efforts to harmonize terminology and accelerate immuno-oncology drug development. J Immunother Cancer 2023; 11:e007309. [PMID: 37487665 PMCID: PMC10373737 DOI: 10.1136/jitc-2023-007309] [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] [Accepted: 06/28/2023] [Indexed: 07/26/2023] Open
Abstract
The need for solid clinical definitions of resistance to programmed death 1 or its ligand (PD-(L)1) inhibitors for clinical trial design was identified as a priority by the Society for Immunotherapy of Cancer (SITC). Broad consensus efforts have provided definitions for primary and secondary resistance and resistance after stopping therapy for both single-agent PD-(L)1 inhibitors and associated combinations. Validation of SITC's definitions is critical and requires field-wide data sharing and collaboration. Here, in this commentary, we detail current utility and incorporation of SITC's definitions and discuss the next steps both the society and the field must take to further advance immuno-oncology drug development.
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Affiliation(s)
- Harriet M Kluger
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Hussein Tawbi
- Department of Melanoma Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | | | | | - Elad Sharon
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland, USA
| | - Jeffrey Sosman
- Jeff Sosman, Northwestern University, Chicago, Illinois, USA
- Department of Hematology and Oncology, Northwestern University, Evanston, Illinois, USA
| | - Ryan J Sullivan
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Maniar R, Wang PH, Washburn RS, Kratchmarov R, Coley SM, Saqi A, Pan SS, Hu J, Shu CA, Rizvi NA, Henick BS, Reiner SL. Self-Renewing CD8+ T-cell Abundance in Blood Associates with Response to Immunotherapy. Cancer Immunol Res 2023; 11:164-170. [PMID: 36512052 PMCID: PMC9898128 DOI: 10.1158/2326-6066.cir-22-0524] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 06/30/2022] [Revised: 11/04/2022] [Accepted: 12/12/2022] [Indexed: 12/14/2022]
Abstract
Treatment with immune checkpoint blockade (ICB) often fails to elicit durable antitumor immunity. Recent studies suggest that ICB does not restore potency to terminally dysfunctional T cells, but instead drives proliferation and differentiation of self-renewing progenitor T cells into fresh, effector-like T cells. Antitumor immunity catalyzed by ICB is characterized by mobilization of antitumor T cells in systemic circulation and tumor. To address whether abundance of self-renewing T cells in blood is associated with immunotherapy response, we used flow cytometry of peripheral blood from a cohort of patients with metastatic non-small cell lung cancer (NSCLC) treated with ICB. At baseline, expression of T-cell factor 1 (TCF1), a marker of self-renewing T cells, was detected at higher frequency in effector-memory (CCR7-) CD8+ T cells from patients who experienced durable clinical benefit compared to those with primary resistance to ICB. On-treatment blood samples from patients benefiting from ICB also exhibited a greater frequency of TCF1+CCR7-CD8+ T cells and higher proportions of TCF1 expression in treatment-expanded PD-1+CCR7-CD8+ T cells. The observed correlation of TCF1 frequency in CCR7-CD8+ T cells and response to ICB suggests that broader examination of self-renewing T-cell abundance in blood will determine its potential as a noninvasive, predictive biomarker of response and resistance to immunotherapy.
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Affiliation(s)
- Rohan Maniar
- Division of Hematology & Oncology, Columbia University Irving Medical Center; New York, NY, USA
| | - Peter H. Wang
- Department of Microbiology and Immunology, Columbia University Irving Medical Center; New York, NY, USA
| | - Robert S. Washburn
- Department of Microbiology and Immunology, Columbia University Irving Medical Center; New York, NY, USA
| | - Radomir Kratchmarov
- Department of Microbiology and Immunology, Columbia University Irving Medical Center; New York, NY, USA
| | - Shana M. Coley
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center; New York, NY; USA
| | - Anjali Saqi
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center; New York, NY; USA
| | - Samuel S. Pan
- Department of Biostatistics, Mailman School of Public Health, Columbia University; New York, NY; USA
| | - Jianhua Hu
- Department of Biostatistics, Mailman School of Public Health, Columbia University; New York, NY; USA
| | - Catherine A. Shu
- Division of Hematology & Oncology, Columbia University Irving Medical Center; New York, NY, USA
| | - Naiyer A. Rizvi
- Division of Hematology & Oncology, Columbia University Irving Medical Center; New York, NY, USA
| | - Brian S. Henick
- Division of Hematology & Oncology, Columbia University Irving Medical Center; New York, NY, USA
- Corresponding Authors: Brian S. Henick, 161 Fort Washington Avenue, Herbert Irving Pavilion 3 Floor, New York, NY 10032, Ph: 212-305-3997, ; Steven L. Reiner, 701 West 168 Street, HHSC Room 912, New York, NY 10032, Ph: 212-305-5177,
| | - Steven L. Reiner
- Department of Microbiology and Immunology, Columbia University Irving Medical Center; New York, NY, USA
- Department of Pediatrics, Vagelos College of Physicians and Surgeons; Columbia University Irving Medical Center New York, NY, USA
- Corresponding Authors: Brian S. Henick, 161 Fort Washington Avenue, Herbert Irving Pavilion 3 Floor, New York, NY 10032, Ph: 212-305-3997, ; Steven L. Reiner, 701 West 168 Street, HHSC Room 912, New York, NY 10032, Ph: 212-305-5177,
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Bukhari S, Henick BS, Winchester RJ, Lerrer S, Adam K, Gartshteyn Y, Maniar R, Lin Z, Khodadadi-Jamayran A, Tsirigos A, Salvatore MM, Lagos GG, Reiner SL, Dallos MC, Mathew M, Rizvi NA, Mor A. Single-cell RNA sequencing reveals distinct T cell populations in immune-related adverse events of checkpoint inhibitors. Cell Rep Med 2023; 4:100868. [PMID: 36513074 PMCID: PMC9873824 DOI: 10.1016/j.xcrm.2022.100868] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/13/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022]
Abstract
PD-1 is an inhibitory receptor in T cells, and antibodies that block its interaction with ligands augment anti-tumor immune responses. The clinical potential of these agents is limited by the fact that half of all patients develop immune-related adverse events (irAEs). To generate insights into the cellular changes that occur during anti-PD-1 treatment, we performed single-cell RNA sequencing of circulating T cells collected from patients with cancer. Using the K-nearest-neighbor-based network graph-drawing layout, we show the involvement of distinctive genes and subpopulations of T cells. We identify that at baseline, patients with arthritis have fewer CD8 TCM cells, patients with pneumonitis have more CD4 TH2 cells, and patients with thyroiditis have more CD4 TH17 cells when compared with patients who do not develop irAEs. These data support the hypothesis that different populations of T cells are associated with different irAEs and that characterization of these cells' pre-treatment has the potential to serve as a toxicity-specific predictive biomarker.
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Affiliation(s)
- Shoiab Bukhari
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY 10032, USA
| | - Brian S Henick
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY 10032, USA; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032, USA
| | - Robert J Winchester
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY 10032, USA; Division of Rheumatology, Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA
| | - Shalom Lerrer
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY 10032, USA
| | - Kieran Adam
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY 10032, USA
| | - Yevgeniya Gartshteyn
- Division of Rheumatology, Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA
| | - Rohan Maniar
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032, USA
| | - Ziyan Lin
- Applied Bioinformatics Laboratories and Genome Technology Center, Division of Advanced Research Technologies, NYU School of Medicine, New York, NY 10016, USA
| | - Alireza Khodadadi-Jamayran
- Applied Bioinformatics Laboratories and Genome Technology Center, Division of Advanced Research Technologies, NYU School of Medicine, New York, NY 10016, USA
| | - Aristotelis Tsirigos
- Applied Bioinformatics Laboratories and Genome Technology Center, Division of Advanced Research Technologies, NYU School of Medicine, New York, NY 10016, USA
| | - Mary M Salvatore
- Department of Radiology, Columbia University Medical Center, New York, NY 10032, USA
| | - Galina G Lagos
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032, USA
| | - Steven L Reiner
- Departments of Microbiology & Immunology and Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Matthew C Dallos
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032, USA
| | - Matthen Mathew
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032, USA
| | - Naiyer A Rizvi
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032, USA
| | - Adam Mor
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY 10032, USA; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032, USA; Division of Rheumatology, Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA.
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Dercle L, Fronheiser M, Rizvi NA, Hellmann MD, Maier S, Hayes W, Yang H, Guo P, Fojo T, Schwartz LH, Zhao B, Leung DK. Baseline Radiomic Signature to Estimate Overall Survival in Patients With NSCLC. J Thorac Oncol 2023; 18:587-598. [PMID: 36646209 DOI: 10.1016/j.jtho.2022.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 03/22/2022] [Revised: 11/22/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION We aimed to define a baseline radiomic signature associated with overall survival (OS) using baseline computed tomography (CT) images obtained from patients with NSCLC treated with nivolumab or chemotherapy. METHODS The radiomic signature was developed in patients with NSCLC treated with nivolumab in CheckMate-017, -026, and -063. Nivolumab-treated patients were pooled and randomized to training, calibration, or validation sets using a 2:1:1 ratio. From baseline CT images, volume of tumor lesions was semiautomatically segmented, and 38 radiomic variables depicting tumor phenotype were extracted. Association between the radiomic signature and OS was assessed in the nivolumab-treated (validation set) and chemotherapy-treated (test set) patients in these studies. RESULTS A baseline radiomic signature was identified using CT images obtained from 758 patients. The radiomic signature used a combination of imaging variables (spatial correlation, tumor volume in the liver, and tumor volume in the mediastinal lymph nodes) to output a continuous value, ranging from 0 to 1 (from most to least favorable estimated OS). Given a threshold of 0.55, the sensitivity and specificity of the radiomic signature for predicting 3-month OS were 86% and 77.8%, respectively. The signature was identified in the training set of patients treated with nivolumab and was significantly associated (p < 0.0001) with OS in patients treated with nivolumab or chemotherapy. CONCLUSIONS The radiomic signature provides an early readout of the anticipated OS in patients with NSCLC treated with nivolumab or chemotherapy. This could provide important prognostic information and may support risk stratification in clinical trials.
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Affiliation(s)
- Laurent Dercle
- Department of Radiology, Columbia University Medical Center, New York, New York.
| | | | - Naiyer A Rizvi
- Department of Radiology, Columbia University Medical Center, New York, New York
| | - Matthew D Hellmann
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Hao Yang
- Department of Radiology, Columbia University Medical Center, New York, New York
| | - Pingzhen Guo
- Department of Radiology, Columbia University Medical Center, New York, New York
| | - Tito Fojo
- Department of Radiology, Columbia University Medical Center, New York, New York
| | - Lawrence H Schwartz
- Department of Radiology, Columbia University Medical Center, New York, New York
| | - Binsheng Zhao
- Department of Radiology, Columbia University Medical Center, New York, New York
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de Castro G, Rizvi NA, Schmid P, Syrigos K, Martin C, Yamamoto N, Cheng Y, Moiseyenko V, Summers Y, Vynnychenko I, Lee SY, Bryl M, Zer A, Erman M, Timcheva C, Raja R, Naicker K, Scheuring U, Walker J, Mann H, Chand V, Mok T. NEPTUNE: Phase 3 Study of First-Line Durvalumab Plus Tremelimumab in Patients With Metastatic NSCLC. J Thorac Oncol 2023; 18:106-119. [PMID: 36240972 DOI: 10.1016/j.jtho.2022.09.223] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/29/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION NEPTUNE, a phase 3, open-label study, evaluated first-line durvalumab plus tremelimumab versus chemotherapy in metastatic NSCLC (mNSCLC). METHODS Eligible patients with EGFR and ALK wild-type mNSCLC were randomized (1:1) to first-line durvalumab (20 mg/kg every 4 weeks until progression) plus tremelimumab (1 mg/kg every 4 weeks for up to four doses) or standard chemotherapy. Randomization was stratified by tumor programmed death-ligand 1 expression (≥25% versus <25%), tumor histologic type, and smoking history. The amended primary end point was overall survival (OS) in patients with blood tumor mutational burden (bTMB) greater than or equal to 20 mutations per megabase (mut/Mb). Secondary end points included progression-free survival (PFS) in patients with bTMB greater than or equal to 20 mut/Mb and safety and tolerability in all treated patients. RESULTS As of June 24, 2019, 823 patients were randomized (intention-to-treat [ITT]); 512 (62%) were bTMB-evaluable, with 129 of 512 (25%) having bTMB greater than or equal to 20 mut/Mb (durvalumab plus tremelimumab [n = 69]; chemotherapy [n = 60]). Baseline characteristics were balanced in the intention-to-treat. Among patients with bTMB greater than or equal to 20 mut/Mb, OS improvement with durvalumab plus tremelimumab versus chemotherapy did not reach statistical significance (hazard ratio 0.71 [95% confidence interval: 0.49-1.05; p = 0.081]; median OS, 11.7 versus 9.1 months); the hazard ratio for PFS was 0.77 (95% confidence interval, 0.51-1.15; median PFS, 4.2 versus 5.1 months). In the overall safety population, incidence of grade 3 or 4 treatment-related adverse events was 20.7% (durvalumab plus tremelimumab) and 33.6% (chemotherapy). CONCLUSIONS NEPTUNE did not meet its primary end point of improved OS with durvalumab plus tremelimumab versus chemotherapy in patients with mNSCLC and bTMB greater than or equal to 20 mut/Mb. Despite the amended study design, with a resultant small primary analysis population, therapeutic activity was aligned with expectations based on mechanistic biology and previous studies.
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Affiliation(s)
| | | | - Peter Schmid
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Konstantinos Syrigos
- 3rd Department of Medicine, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | | | | | - Ying Cheng
- Cancer Hospital of Jilin Province, Changchun, People's Republic of China
| | | | - Yvonne Summers
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Ihor Vynnychenko
- Sumy State University, Sumy Regional Oncology Centre, Sumy, Ukraine
| | | | - Maciej Bryl
- E. J. Zeyland Wielkopolska Center of Pulmonology and Thoracic Surgery, Poznań, Poland
| | - Alona Zer
- Rabin Medical Center, Petah Tikva, Israel
| | - Mustafa Erman
- Hacettepe University Cancer Institute, Ankara, Turkey
| | | | | | | | | | | | | | | | - Tony Mok
- State Key Laboratory of South China, Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong, People's Republic of China
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Hamid O, Chiappori AA, Thompson JA, Doi T, Hu-Lieskovan S, Eskens FALM, Ros W, Diab A, Spano JP, Rizvi NA, Wasser JS, Angevin E, Ott PA, Forgie A, Yang W, Guo C, Chou J, El-Khoueiry AB. First-in-human study of an OX40 (ivuxolimab) and 4-1BB (utomilumab) agonistic antibody combination in patients with advanced solid tumors. J Immunother Cancer 2022; 10:jitc-2022-005471. [PMID: 36302562 PMCID: PMC9621185 DOI: 10.1136/jitc-2022-005471] [Citation(s) in RCA: 13] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Ivuxolimab (PF-04518600) and utomilumab (PF-05082566) are humanized agonistic IgG2 monoclonal antibodies against OX40 and 4-1BB, respectively. This first-in-human, multicenter, open-label, phase I, dose-escalation/dose-expansion study explored safety, tolerability, pharmacokinetics, pharmacodynamics, and antitumor activity of ivuxolimab+utomilumab in patients with advanced solid tumors. METHODS Dose-escalation: patients with advanced bladder, gastric, or cervical cancer, melanoma, head and neck squamous cell carcinoma, or non-small cell lung cancer (NSCLC) who were unresponsive to available therapies, had no standard therapy available or declined standard therapy were enrolled into five dose cohorts: ivuxolimab (0.1-3 mg/kg every 2 weeks (Q2W)) intravenously plus utomilumab (20 or 100 mg every 4 weeks (Q4W)) intravenously. Dose-expansion: patients with melanoma (n=10) and NSCLC (n=20) who progressed on prior anti-programmed death receptor 1/programmed death ligand-1 and/or anti-cytotoxic T-lymphocyte-associated antigen 4 (melanoma) received ivuxolimab 30 mg Q2W intravenously plus utomilumab 20 mg Q4W intravenously. Adverse events (AEs) were graded per National Cancer Institute Common Terminology Criteria for Adverse Events V.4.03 and efficacy was assessed using Response Evaluation Criteria in Solid Tumors (RECIST) V.1.1 and immune-related RECIST (irRECIST). Paired tumor biopsies and whole blood were collected to assess pharmacodynamic effects and immunophenotyping. Whole blood samples were collected longitudinally for immunophenotyping. RESULTS Dose-escalation: 57 patients were enrolled; 2 (3.5%) patients with melanoma (0.3 mg/kg+20 mg and 0.3 mg/kg+100 mg) achieved partial response (PR), 18 (31.6%) patients achieved stable disease (SD); the disease control rate (DCR) was 35.1% across all dose levels. Dose-expansion: 30 patients were enrolled; 1 patient with NSCLC achieved PR lasting >77 weeks. Seven of 10 patients with melanoma (70%) and 7 of 20 patients with NSCLC (35%) achieved SD: median (range) duration of SD was 18.9 (13.9-49.0) weeks for the melanoma cohort versus 24.1 (14.3-77.9+) weeks for the NSCLC cohort; DCR (NSCLC) was 40%. Grade 3-4 treatment-emergent AEs were reported in 28 (49.1%) patients versus 11 (36.7%) patients in dose-escalation and dose-expansion, respectively. There were no grade 5 AEs deemed attributable to treatment. Ivuxolimab area under the concentration-time curve increased in a dose-dependent manner at 0.3-3 mg/kg doses. CONCLUSIONS Ivuxolimab+utomilumab was found to be well tolerated and demonstrated preliminary antitumor activity in selected groups of patients. TRIAL REGISTRATION NUMBER NCT02315066.
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Affiliation(s)
- Omid Hamid
- Translational Research and Immunotherapy, The Angeles Clinic and Research Institute, A Cedars-Sinai Affiliate, Los Angeles, California, USA
| | | | | | - Toshihiko Doi
- Department of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan
| | - Siwen Hu-Lieskovan
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Ferry A L M Eskens
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Willeke Ros
- Department of Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Adi Diab
- Department of Melanoma Medical Oncology, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Jean-Philippe Spano
- Medical Oncology, APHP-Sorbonne University, IPLEs Inserm1136, Pitie-Salpetrière Hospital-Paris, Paris, France
| | - Naiyer A Rizvi
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Jeffrey S Wasser
- Neag Comprehensive Cancer Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Eric Angevin
- Drug Development Department, Institut Gustave Roussy, Villejuif, France
| | - Patrick A Ott
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Alison Forgie
- Translational Oncology, Pfizer Inc, San Francisco, California, USA
| | - Wenjing Yang
- Oncology Computational Biology, Pfizer Inc, San Diego, Calfornia, USA
| | - Cen Guo
- Clinical Pharmacology, Pfizer Inc, San Diego, California, USA
| | - Jeffrey Chou
- Early Oncology Development and Clinical Research, Pfizer Inc, San Francisco, California, USA
| | - Anthony B El-Khoueiry
- Department of Internal Medicine, Division of Medical Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California, USA
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Sanborn RE, Pishvaian MJ, Callahan MK, Weise A, Sikic BI, Rahma O, Cho DC, Rizvi NA, Sznol M, Lutzky J, Bauman JE, Bitting RL, Starodub A, Jimeno A, Reardon DA, Kaley T, Iwamoto F, Baehring JM, Subramaniam DS, Aragon-Ching JB, Hawthorne TR, Rawls T, Yellin M, Keler T. Safety, tolerability and efficacy of agonist anti-CD27 antibody (varlilumab) administered in combination with anti-PD-1 (nivolumab) in advanced solid tumors. J Immunother Cancer 2022; 10:jitc-2022-005147. [PMID: 35940825 PMCID: PMC9364417 DOI: 10.1136/jitc-2022-005147] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Phase 1/2 dose-escalation and expansion study evaluating varlilumab, a fully human agonist anti-CD27 mAb, with nivolumab in anti-PD-1/L1 naïve, refractory solid tumors. METHODS Phase 1 evaluated the safety of varlilumab (0.1-10 mg/kg) with nivolumab (3 mg/kg) administered once every 2 weeks. Phase 2 evaluated varlilumab regimens (3 mg/kg once every 2 weeks, 3 mg/kg once every 12 weeks, and 0.3 mg/kg once every 4 weeks) with nivolumab 240 mg once every 2 weeks in tumor-specific cohorts. Primary objective was safety; key clinical endpoints included objective response rate (ORR) and overall survival rate at 12 months (OS12) (glioblastoma (GBM) only). Exploratory objectives included determination of effects on peripheral blood and intratumoral immune signatures. RESULTS 175 patients were enrolled (36 in phase 1 and 139 in phase 2). Phase 1 dose-escalation proceeded to the highest varlilumab dose level without determining a maximum tolerated dose. In phase 2, ORR were ovarian 12.5%, squamous cell carcinoma of the head and neck 12.5%, colorectal cancer 5%, and renal cell carcinoma 0%; GBM OS12 was 40.9%. Increased tumor PD-L1 and intratumoral T cell infiltration were observed in ovarian cancer patients, with increases of ≥5% associated with better progression-free survival. The most common treatment related adverse events were fatigue (18%), pruritus (16%), and rash (15%). CONCLUSION Varlilumab and nivolumab were well tolerated, without significant toxicity beyond that expected for each agent alone. Clinical activity was observed in patients that are typically refractory to anti-PD-1 therapy, however, overall was not greater than expected for nivolumab monotherapy. Treatment was associated with proinflammatory changes in the tumor microenvironment, particularly in ovarian cancer where the changes were associated with better clinical outcomes. TRIAL REGISTRATION NUMBER NCT02335918.
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Affiliation(s)
- Rachel E Sanborn
- Providence Cancer Institute, Earle A. Chiles Research Institute, Portland, Oregon, USA
| | - Michael J Pishvaian
- Department of Oncology, Georgetown-Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - Margaret K Callahan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Amy Weise
- Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Branimir I Sikic
- Clinical and Translational Research Unit, Stanford Cancer Institute, Stanford, California, USA
| | - Osama Rahma
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Daniel C Cho
- Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York, USA
| | - Naiyer A Rizvi
- Division of Hematology/Oncology, Columbia University Medical Center, New York, New York, USA
| | - Mario Sznol
- Smilow Cancer Hospital, New Haven, Connecticut, USA
| | - Jose Lutzky
- Mount Sinai Comprehensive Cancer Center, Miami Beach, Florida, USA
| | - Julie E Bauman
- University of Arizona Cancer Center, Tuscon, Arizona, USA
| | | | | | - Antonio Jimeno
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - David A Reardon
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Thomas Kaley
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Fabio Iwamoto
- Department of Neurology, Columbia Presbyterian Medical Center, New York, New York, USA
| | - Joachim M Baehring
- Department of Neurosurgery, Yale New Haven Health Smilow Cancer Hospital, New Haven, Connecticut, USA
| | - Deepa S Subramaniam
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | | | | | - Tracey Rawls
- Celldex Therapeutics Inc, Hampton, New Jersey, USA
| | | | - Tibor Keler
- R & D, Celldex Therapeutics Inc, Hampton, New Jersey, USA
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Maniar R, Wang PH, Washburn RS, Rizvi NA, Reiner SL, Henick BS. Abstract 1240: Peripherally measured T cell self-renewal capacity associates with response to immune checkpoint blockade (ICB) in non-small cell lung cancer (NSCLC). Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-1240] [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
Recent studies have suggested that ICB does not primarily restore function to terminally exhausted T cells, but instead drives proliferation and differentiation of progenitor T cells into fresh effector cells. T cell factor 1 (TCF1) marks and maintains T cell self-renewal while repressing differentiation and has been associated with increased antitumor activity. These findings suggest ICB may depend on the continued availability of self-renewing TCF1+ progenitor T cells as the source of fresh effector cells. We hypothesized that characterizing the immunophenotype of T cells in the peripheral blood, with a focus on markers of self-renewal, might be predictive of ICB response. Utilizing an institution-wide biospecimen repository, we evaluated peripheral blood samples using multi-parametric flow cytometry from patients with metastatic NSCLC treated with single-agent ICB who experienced durable clinical benefit (DCB; >1 year of treatment and/or clinical response >1 year) or primary resistance (RES; <6 months of treatment with evidence of disease progression). Our analysis focused on a CCR7- T cell subset, which is characterized by lower proportions of TCF1+ cells but increase during active immune responses. We analyzed samples collected from a cohort of 22 patients, 11 of whom had DCB and 11 with RES. In the pre-treatment samples (n=22), we determined that the frequency of TCF1+CCR7- CD8+ T cells was significantly higher in patients with DCB compared to patients with RES (32.6% v. 19.0%; P = 0.0452). Importantly, the median progression free survival was 17.0 months in patients with TCF1+ frequency above the median compared to 3.0 months in patients with TCF1+ frequency below the median (HR 0.43; P = 0.0185). Among the on-treatment samples (n=19), there was an increased frequency of PD1+ expression within the CCR7- CD8+ T cell subset compared to the paired baseline samples. Examination of those therapy-expanded PD1+ T cells revealed differences in the composition of TCF1+ versus TCF1- fractions in relation to treatment outcome. The mean ratio of TCF1+ to TCF1- amongst PD1+CCR7- T cells on-treatment was found to be significantly higher in the DCB group (1.483 [DCB] v. 0.4791 [RES], P=<0.0001). In this analysis, we identified a pattern of pre-and on-treatment T cell populations that correlates with durable benefit from ICB in patients with NSCLC. We observed that the frequency of TCF1 expression in the more differentiated effector memory T cell subsets prior to treatment correlates with DCB. While on treatment, both groups experienced expansion of PD1+ CD8 T cells, but the presence of greater fractions of TCF1+ T cells in the PD1+ CD8 T cell population correlates with DCB. This finding suggests that persistence and mobilization of self-renewing progenitor T cells is associated with long-lived ICB-induced anti-tumor activity.
Citation Format: Rohan Maniar, Peter H. Wang, Robert S. Washburn, Naiyer A. Rizvi, Steven L. Reiner, Brian S. Henick. Peripherally measured T cell self-renewal capacity associates with response to immune checkpoint blockade (ICB) in non-small cell lung cancer (NSCLC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1240.
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Affiliation(s)
- Rohan Maniar
- 1Columbia University Irving Medical Center, New York, NY
| | - Peter H. Wang
- 1Columbia University Irving Medical Center, New York, NY
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Henick BS, Bukhari S, Winchester R, Lin Z, Khodadad-Jamayran A, Tsirigos A, Lerrer SS, Adam K, Salvatore MM, Lagos G, Pabani A, Maniar R, Reiner SL, Dallos M, Mathew M, Rizvi NA, Mor A. Baseline peripheral T-cell composition in relation to radiographic phenotypes of immune-related pneumonitis. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.2545] [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
2545 Background: Pneumonitis is one of the most morbid complications from immune checkpoint inhibitor (ICI) treatment, but pathogenic mechanisms are unclear and no biomarkers permit pre-treatment risk assessment. We sought to characterize peripheral T cell subsets of pneumonitis patients on the single cell level. Methods: Blood was collected before and during ICI treatment in 24 patients. Cells were processed for single cell RNA sequencing (scRNAseq) employing CITEseq methodology using multiplexed cell surface markers labelled with a cocktail of oligonucleotide-tagged Total-Seq anti-human antibodies against CD4, CD8, CD45RA and CD27 followed by Chromium 10X sequencing. Principal Component Analysis was performed with iCellR, K-nearest-neighbor-based Network graph drawing Layout, and PhenoGraph clustering to assign cell types. CT scans were performed per standard of care and were reviewed by an experienced thoracic radiologist. Results: Seven of 24 patients developed pneumonitis; 9 did not experience an immune-related adverse event, and the remainder experienced arthritis (4), thyroiditis (3), or neurotoxicity (1). Pneumonitis patients had expanded proportions of TH2 TCF7+ T cells at baseline as compared to the other patients. Radiographically, two patients’ pneumonitis manifested as Chronic Hypersensitivity Pneumonitis (CHP), and four had Organized Pneumonia (OP). At baseline, CHP patients had significantly lower levels of CD8+ TCM cells (CXCR3+), double-positive T cells, gamma-delta T cells, and higher levels of naïve-like CD4+ TN TCF7+LEF1+ and CD4+ TH1/2 CXCR3+GATA3+ cells compared to OP. Gene expression levels also distinguished between these radiographic phenotypes. Conclusions: The peripheral T cell composition of patients who developed pneumonitis was distinct from those who did not in our cohort and unique by radiographic manifestation, suggesting potential pathogenic mechanisms and a prelude to circulating predictive markers of ICI toxicity.
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Affiliation(s)
| | | | | | | | | | | | | | - Kieran Adam
- Columbia University Medical Center, New York, NY
| | - Mary M. Salvatore
- Department of Radiology, Columbia University Irving Medical Center, New York, NY
| | | | | | - Rohan Maniar
- Columbia University Medical Center, New York, NY
| | | | | | | | | | - Adam Mor
- Columbia University Medical Center, New York, NY
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Saqi A, Leslie KO, re L. Moreira MDP, Lantuejoul S, Shu CA, Rizvi NA, Sonett JR, Tajima K, Sun SW, Gitlitz BJ, Colby TV. Assessing Pathologic Response in Resected Lung Cancers: Current Standards, Proposal for a Novel Pathologic Response Calculator Tool, and Challenges in Practice. JTO Clin Res Rep 2022; 3:100310. [PMID: 35498382 PMCID: PMC9044000 DOI: 10.1016/j.jtocrr.2022.100310] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/15/2022] [Accepted: 03/06/2022] [Indexed: 11/04/2022] Open
Abstract
The efficacy of neoadjuvant treatment for NSCLC can be pathologically assessed in resected tissue. Major pathologic response (MPR) and pathologic complete response (pCR), defined as less than or equal to 10% and 0% viable tumor cells, respectively, are increasingly being used in NSCLC clinical trials to establish them as surrogate end points for efficacy to shorten time to outcome. Nevertheless, sampling and MPR calculation methods vary between studies. The International Association for the Study of Lung Cancer recently published detailed recommendations for pathologic assessment of NSCLC after neoadjuvant treatment, with methodology being critical. To increase methodological rigor further, we developed a novel MPR calculator tool (MPRCT) for standardized, comprehensive collection of percentages of viable tumor, necrosis, and stroma in the tumor bed. In addition, tumor width and length in the tumor bed are measured and unweighted and weighted MPR averages are calculated, the latter to account for the varying proportions of tumor beds on slides. We propose sampling the entire visible tumor bed for tumors having pCR regardless of size, 100% of tumors less than or equal to 3 cm in diameter, and at least 50% of tumors more than 3 cm. We describe the uses of this tool, including potential formal analyses of MPRCT data to determine the optimum sampling strategy that balances sensitivity against excessive use of resources. Solutions to challenging scenarios in pathologic assessment are proposed. This MPRCT will facilitate standardized, systematic, comprehensive collection of pathologic response data with a standardized methodology to validate studies designed to establish MPR and pCR as surrogate end points of neoadjuvant treatment efficacy.
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Kim DW, Kim SW, Camidge DR, Rizvi NA, Marrone KA, Le X, Blakely C, Park K, Chang GC, Patel SP, Cooper ZA, Kumar R, Samadani R, McCombs R, Pluta M, Wu KY, Ramalingam S. Abstract CT163: CD73 inhibitor oleclumab plus osimertinib for advanced EGFRm NSCLC: First report of a Phase 1b/2 study. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-ct163] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: Patients (pts) with EGFRm T790M-negative NSCLC with progressive disease (PD) on an EGFR TKI have limited therapy options. CD73 may promote immune evasion and is overexpressed in EGFRm NSCLC, suggesting the potential for combining CD73 blockers with EGFR TKIs. Oleclumab (MEDI9447) disrupts immune evasion by binding to CD73. This phase 1b/2, multicenter, dose escalation/expansion study (NCT03381274) evaluates the safety and efficacy of oleclumab plus osimertinib (osi) in locally advanced/metastatic EGFRm NSCLC. Methods: Pts had histologically or cytologically confirmed T790M-negative EGFRm NSCLC by local testing, a TKI-sensitive EGFR mutation (exon 19 del, L858R), ECOG PS 0-1, PD on a 1st or 2nd generation TKI, and no prior osi. Oleclumab 1500 mg (DL1) or 3000 mg (recommended Phase 2 dose, RP2D) IV Q2W + osi 80 mg PO QD were given until PD or intolerable AEs. Primary endpoints included AEs, SAEs and ORR by RECIST v1.1. DLTs were predefined and reviewed by a dose-escalation committee. Secondary endpoints included duration of response, disease control rate, PFS and OS. Results: As of November 9, 2020, 5 pts received DL1 and 21 pts received RP2D. Minimum follow-up was 44 wks. For the 5 pts receiving DL1, safety profile and response rate were generally similar to RP2D and no DLTs occurred. All of the 21 pts receiving RP2D had ≥1 treatment-emergent AE (TEAE), 38.1% had Grade 3/4 TEAEs and 23.8% had SAEs. Treatment-related AEs (TRAEs) occurred in 81.0% (19.0% Grade 3/4); none were SAEs or deaths. The most common TRAEs were rash (33.3%), stomatitis (28.6%), diarrhea (23.8%) and paronychia (23.8%). At data cutoff, 38.1% remained on treatment; 47.6% discontinued due to PD, with death, pt decision and AE (pneumonitis) as other causes. Response and survival for pts receiving RP2D are shown in Table 1. Conclusions: Oleclumab + osi was well tolerated at RP2D. Compared to T790M-negative EGFRm NSCLC pts in a prior study of osi monotherapy, ORR was similar (21% vs 19%) but mPFS was longer (2.8 vs 11.0 mos).
Table 1.Disease response and survivalOutcomeN=21Best overall response, n (%)CR0PR4 (19.0)SD13 (61.9)PD3 (14.3)Not evaluable1 (4.8)ORR, n (%)4 (19)Median duration of response, months (range)Not assessable (9.2-11.1)Disease control rate, n (%)17 (81.0)Median PFS (95% CI), months11 (3.7-not evaluable)6-month PFS rate (95% CI), %63.5 (38.3, 80.7)9-month PFS rate (95% CI), %52.9 (29.0, 72.1)Median OS (95% CI), monthsNot reached (11.7-not evaluable)6-month OS rate (95% CI), %100 (100, 100)9-month OS rate (95%CI), %90.0 (65.6, 97.4)
Citation Format: Dong-Wan Kim, Sang-We Kim, D. Ross Camidge, Naiyer A. Rizvi, Kristen A. Marrone, Xiuning Le, Collin Blakely, Keunchil Park, Gee-Chen Chang, Sandip Pravin Patel, Zachary A. Cooper, Rakesh Kumar, Ramin Samadani, Rebecca McCombs, Michael Pluta, Kevin Yufeng Wu, Suresh Ramalingam. CD73 inhibitor oleclumab plus osimertinib for advanced EGFRm NSCLC: First report of a Phase 1b/2 study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr CT163.
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Affiliation(s)
- Dong-Wan Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang-We Kim
- Asan Medical Center, Seoul, Republic of Korea
| | | | | | - Kristen A. Marrone
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, New York, NY
| | - Xiuning Le
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Collin Blakely
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | - Keunchil Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | | | | | | | | | | | | | | | - Suresh Ramalingam
- Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA
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Freemantle N, Xu Y, Wilson F, Guyot P, Chen CI, Keeping S, Konidaris G, Chan K, Kuznik A, Atsou K, Glowienka E, Stow L, Pouliot JF, Gullo G, Rietschel P, Rizvi NA. Network meta-analysis (NMA) of immuno-oncology (IO) monotherapy as first-line (1L) treatments (txs) for advanced non-small cell lung cancer (NSCLC) with PD-L1 expression ≥50%. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e21091] [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
e21091 Background: For advanced NSCLC patients (pts) with high (≥50%) PD-L1 expression, effective IO mono options with survival benefits are approved (pembrolizumab mono, current standard of care) and emerging (cemiplimab). In a recent Phase 3 trial, cemiplimab, a high-affinity, highly potent human PD-1 inhibitor approved for tx of advanced cutaneous squamous cell carcinoma, demonstrated significantly improved overall survival (OS) and progression-free survival (PFS) vs chemotherapy (CT) in advanced NSCLC pts with PD-L1 ≥50%. A systematic literature review and NMA were conducted to identify/compare the efficacy/safety from randomized controlled trials (RCTs) for cemiplimab vs pembrolizumab or other IO mono published 2010–19. Methods: Relevant RCTs were identified by searching Embase, MEDLINE, Cochrane, and conference proceedings with predefined search strategies according to ISPOR, NICE, and PRISMA guidelines. An NMA with time-varying hazard ratios (HRs) was performed for OS and PFS. Analyses were conducted for objective response rate (ORR), Grade (G) 3–5 all-cause adverse events (AE), G3–5 immune-mediated AE (IMAE) and discontinuation due to AEs (DAE). Fixed-effect models were used due to limited evidence. Results with standard constant HRs and various sensitivity analyses were conducted to account for differences in RCT designs and other txs. Results: The feasibility assessment determined that EMPOWER-Lung 1, KEYNOTE-024, and KEYNOTE-042 trials were eligible. IMpower110 was excluded since an incompatible PD-L1 assay (SP142) was used for pt selection. For 1L advanced NSCLC with PD-L1 ≥50%, cemiplimab was associated with significantly greater PFS and ORR, and comparable OS, G3–5 AEs, IMAEs, and all-cause DAEs vs pembrolizumab (Table). At 2 yrs, numerically more pts receiving cemiplimab vs pembrolizumab were alive (59% vs 49%) and significantly more were alive w/o progression (37% vs 18%). Conclusions: In advanced NSCLC pts with PD-L1 ≥50%, cemiplimab mono demonstrated significant improvements in PFS and ORR, and comparable OS, safety/tolerability vs pembrolizumab.[Table: see text]
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Affiliation(s)
- Nicholas Freemantle
- University College London, Institute of Clinical Trial and Methodology, London, United Kingdom
| | - Yingxin Xu
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
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Ozguroglu M, Sezer A, Kilickap S, Gumus M, Bondarenko I, Gogishvili M, Turk HM, Cicin I, Bentsion D, Gladkov O, Clingan PR, Sriuranpong V, Rizvi NA, McGinniss J, Pouliot JF, Lee S, Seebach FA, Lowy I, Gullo G, Rietschel P. Cemiplimab monotherapy as first-line (1L) treatment of patients with brain metastases from advanced non-small cell lung cancer (NSCLC) with programmed cell death-ligand 1 (PD-L1) ≥ 50%: EMPOWER-Lung 1 subgroup analysis. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9085 Background: In the Phase 3, EMPOWER-Lung 1 study, cemiplimab monotherapy provided significant survival benefit and an acceptable safety profile vs chemotherapy in patients with advanced NSCLC and PD-L1 ≥50%. EMPOWER-Lung 1 included patients with brain metastases at baseline who are typically underrepresented in clinical trials. Other published exploratory analyses in single-cohort studies suggest benefit from immunotherapy in this patient population. Here, we present subgroup analysis of patients with brain metastasis from EMPOWER-Lung 1. Methods: Patients were randomized 1:1 to cemiplimab 350 mg IV every 3 weeks or investigator’s choice of chemotherapy (NCT03088540). Patients with treated, clinically stable brain metastases (radiological stability not required) were eligible to enroll and are the focus of this subgroup analysis from the PD-L1 ≥50% population (n=563) of the EMPOWER-Lung 1 study. Results: A total of 68 of 563 (12.1%) cases had treated stable brain metastases at time of randomization. Patients were evenly distributed between cemiplimab (n=34) and chemotherapy (n=34), with similar median duration of follow-up (Table). Baseline characteristics were generally similar; median (range) age: 60.0 (45–76 ) vs 62.0 (48–77); male: 97.1% vs 85.3%; and non-squamous histology: 85.3% vs 76.5%; between cemiplimab vs chemotherapy, respectively. Per independent review committee, median overall survival (OS, 18.7 vs 11.7 months), median progression-free survival (PFS, 10.4 vs 5.3 months), and objective response rate (ORR, 41.2% vs 8.8%) were superior with cemiplimab vs chemotherapy (Table). After baseline, central nervous system (CNS) disease progression occurred in 2 (5.9%) patients with cemiplimab vs 4 (11.8%) patients with chemotherapy; extra-CNS disease progression occurred in 9 (26.5%) patients with cemiplimab vs 15 (44.1%) patients with chemotherapy. Conclusions: 1L cemiplimab monotherapy improved OS, PFS, and ORR vs chemotherapy, in patients with advanced NSCLC with PD-L1 ≥50%, and clinically stable brain metastases at baseline. Cemiplimab monotherapy represents a suitable option for this subgroup of patients. Clinical trial information: NCT03088540. [Table: see text]
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Affiliation(s)
- Mustafa Ozguroglu
- Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ahmet Sezer
- Department of Medical Oncology, Başkent University, Adana, Turkey
| | - Saadettin Kilickap
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Mahmut Gumus
- Department of Medical Oncology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Igor Bondarenko
- Department of Oncology and Medical Radiology; Dnipropetrovsk Medical Academy, Dnipro, Ukraine
| | | | - Haci M. Turk
- Department of Medical Oncology, Bezmialem Vakif University, Medical Faculty, Istanbul, Turkey
| | - Irfan Cicin
- Department of Medical Oncology, Trakya University, Edirne, Turkey
| | - Dmitry Bentsion
- Radiotherapy Department, Sverdlovsk Regional Oncology Centre, Sverdlovsk, Russian Federation
| | | | - Philip R. Clingan
- Southern Medical Day Care Centre and Illawarra Health and Medical Research Institute, University of Wollongong/Illawarra Cancer Centre, Wollongong Hospital, Wollongong, NSW, Australia
| | - Virote Sriuranpong
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Naiyer A. Rizvi
- Division of Hematology/Oncology, Columbia University Medical Center, New York, NY
| | | | | | - Sue Lee
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | | | - Israel Lowy
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
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Rizvi NA, Cho BC, Reinmuth N, Lee KH, Luft A, Ahn MJ, van den Heuvel MM, Cobo M, Vicente D, Smolin A, Moiseyenko V, Antonia SJ, Le Moulec S, Robinet G, Natale R, Schneider J, Shepherd FA, Geater SL, Garon EB, Kim ES, Goldberg SB, Nakagawa K, Raja R, Higgs BW, Boothman AM, Zhao L, Scheuring U, Stockman PK, Chand VK, Peters S. Durvalumab With or Without Tremelimumab vs Standard Chemotherapy in First-line Treatment of Metastatic Non-Small Cell Lung Cancer: The MYSTIC Phase 3 Randomized Clinical Trial. JAMA Oncol 2021; 6:661-674. [PMID: 32271377 PMCID: PMC7146551 DOI: 10.1001/jamaoncol.2020.0237] [Citation(s) in RCA: 391] [Impact Index Per Article: 130.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Question Does first-line durvalumab treatment with or without tremelimumab improve survival outcomes vs chemotherapy in patients with metastatic non–small cell lung cancer? Findings In this phase 3 randomized clinical trial including 1118 patients with non–small cell lung cancer, although the trial did not meet its primary end points, treatment with durvalumab resulted in a numerically reduced risk of death vs chemotherapy in patients with programmed cell death ligand 1 expression on at least 25% of tumor cells. In exploratory analyses, a blood tumor mutational burden threshold of at least 20 mutations per megabase was identified for optimal clinical benefit with durvalumab plus tremelimumab vs chemotherapy. Meaning These findings highlight the need for further investigation and prospective validation of blood tumor mutational burden as a predictive biomarker for immunotherapy. Importance Checkpoint inhibitors targeting programmed cell death 1 or its ligand (PD-L1) as monotherapies or in combination with anti–cytotoxic T-lymphocyte–associated antigen 4 have shown clinical activity in patients with metastatic non–small cell lung cancer. Objective To compare durvalumab, with or without tremelimumab, with chemotherapy as a first-line treatment for patients with metastatic non–small cell lung cancer. Design, Setting, and Participants This open-label, phase 3 randomized clinical trial (MYSTIC) was conducted at 203 cancer treatment centers in 17 countries. Patients with treatment-naive, metastatic non–small cell lung cancer who had no sensitizing EGFR or ALK genetic alterations were randomized to receive treatment with durvalumab, durvalumab plus tremelimumab, or chemotherapy. Data were collected from July 21, 2015, to October 30, 2018. Interventions Patients were randomized (1:1:1) to receive treatment with durvalumab (20 mg/kg every 4 weeks), durvalumab (20 mg/kg every 4 weeks) plus tremelimumab (1 mg/kg every 4 weeks, up to 4 doses), or platinum-based doublet chemotherapy. Main Outcomes and Measures The primary end points, assessed in patients with ≥25% of tumor cells expressing PD-L1, were overall survival (OS) for durvalumab vs chemotherapy, and OS and progression-free survival (PFS) for durvalumab plus tremelimumab vs chemotherapy. Analysis of blood tumor mutational burden (bTMB) was exploratory. Results Between July 21, 2015, and June 8, 2016, 1118 patients were randomized. Baseline demographic and disease characteristics were balanced between treatment groups. Among 488 patients with ≥25% of tumor cells expressing PD-L1, median OS was 16.3 months (95% CI, 12.2-20.8) with durvalumab vs 12.9 months (95% CI, 10.5-15.0) with chemotherapy (hazard ratio [HR], 0.76; 97.54% CI, 0.56-1.02; P = .04 [nonsignificant]). Median OS was 11.9 months (95% CI, 9.0-17.7) with durvalumab plus tremelimumab (HR vs chemotherapy, 0.85; 98.77% CI, 0.61-1.17; P = .20). Median PFS was 3.9 months (95% CI, 2.8-5.0) with durvalumab plus tremelimumab vs 5.4 months (95% CI, 4.6-5.8) with chemotherapy (HR, 1.05; 99.5% CI, 0.72-1.53; P = .71). Among 809 patients with evaluable bTMB, those with a bTMB ≥20 mutations per megabase showed improved OS for durvalumab plus tremelimumab vs chemotherapy (median OS, 21.9 months [95% CI, 11.4-32.8] vs 10.0 months [95% CI, 8.1-11.7]; HR, 0.49; 95% CI, 0.32-0.74). Treatment-related adverse events of grade 3 or higher occurred in 55 (14.9%) of 369 patients who received treatment with durvalumab, 85 (22.9%) of 371 patients who received treatment with durvalumab plus tremelimumab, and 119 (33.8%) of 352 patients who received treatment with chemotherapy. These adverse events led to death in 2 (0.5%), 6 (1.6%), and 3 (0.9%) patients, respectively. Conclusions and Relevance The phase 3 MYSTIC study did not meet its primary end points of improved OS with durvalumab vs chemotherapy or improved OS or PFS with durvalumab plus tremelimumab vs chemotherapy in patients with ≥25% of tumor cells expressing PD-L1. Exploratory analyses identified a bTMB threshold of ≥20 mutations per megabase for optimal OS benefit with durvalumab plus tremelimumab. Trial Registration ClinicalT rials.gov Identifier: NCT02453282
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Affiliation(s)
- Naiyer A Rizvi
- Division of Hematology/Oncology, Columbia University Medical Center, New York, New York
| | - Byoung Chul Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Ki Hyeong Lee
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Alexander Luft
- Department of Oncology No. 1 (Thoracic Surgery), Leningrad Regional Clinical Hospital, St Petersburg, Russia
| | - Myung-Ju Ahn
- Department of Hematology and Oncology, Samsung Medical Center, Seoul, South Korea
| | | | - Manuel Cobo
- Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - David Vicente
- Department of Medical Oncology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Alexey Smolin
- Department of Radiology, Burdenko Main Military Clinical Hospital, Moscow, Russia
| | | | - Scott J Antonia
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - Gilles Robinet
- Service de Pneumologie, Centre Hospitalier Régional Universitaire de Brest-Hôpital Morvan, Brest, France
| | - Ronald Natale
- Cedars-Sinai Comprehensive Cancer Center, Los Angeles, California
| | - Jeffrey Schneider
- Department of Hematology and Oncology, NYU Winthrop Hospital, Mineola, New York
| | - Frances A Shepherd
- Princess Margaret Cancer Centre and the Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Edward B Garon
- David Geffen School of Medicine, University of California/TRIO-US Network, Los Angeles
| | - Edward S Kim
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Sarah B Goldberg
- Yale School of Medicine and Yale Cancer Center, New Haven, Connecticut
| | - Kazuhiko Nakagawa
- Faculty of Medicine, Department of Medical Oncology, Kindai University, Osaka, Japan
| | | | | | | | | | | | | | | | - Solange Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
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Si H, Kuziora M, Quinn KJ, Helman E, Ye J, Liu F, Scheuring U, Peters S, Rizvi NA, Brohawn PZ, Ranade K, Higgs BW, Banks KC, Chand VK, Raja R. A Blood-based Assay for Assessment of Tumor Mutational Burden in First-line Metastatic NSCLC Treatment: Results from the MYSTIC Study. Clin Cancer Res 2020; 27:1631-1640. [PMID: 33355200 DOI: 10.1158/1078-0432.ccr-20-3771] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/07/2020] [Accepted: 12/17/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Tumor mutational burden (TMB) has been shown to be predictive of survival benefit in patients with non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors. Measuring TMB in the blood (bTMB) using circulating cell-free tumor DNA (ctDNA) offers practical advantages compared with TMB measurement in tissue (tTMB); however, there is a need for validated assays and identification of optimal cutoffs. We describe the analytic validation of a new bTMB algorithm and its clinical utility using data from the phase III MYSTIC trial. PATIENTS AND METHODS The dataset used for the clinical validation was from MYSTIC, which evaluated first-line durvalumab (anti-PD-L1 antibody) ± tremelimumab (anticytotoxic T-lymphocyte-associated antigen-4 antibody) or chemotherapy for metastatic NSCLC. bTMB and tTMB were evaluated using the GuardantOMNI and FoundationOne CDx assays, respectively. A Cox proportional hazards model and minimal P value cross-validation approach were used to identify the optimal bTMB cutoff. RESULTS In MYSTIC, somatic mutations could be detected in ctDNA extracted from plasma samples in a majority of patients, allowing subsequent calculation of bTMB. The success rate for obtaining valid TMB scores was higher for bTMB (809/1,001; 81%) than for tTMB (460/735; 63%). Minimal P value cross-validation analysis confirmed the selection of bTMB ≥20 mutations per megabase (mut/Mb) as the optimal cutoff for clinical benefit with durvalumab + tremelimumab. CONCLUSIONS Our study demonstrates the feasibility, accuracy, and reproducibility of the GuardantOMNI ctDNA platform for quantifying bTMB from plasma samples. Using the new bTMB algorithm and an optimal bTMB cutoff of ≥20 mut/Mb, high bTMB was predictive of clinical benefit with durvalumab + tremelimumab versus chemotherapy.
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Affiliation(s)
- Han Si
- AstraZeneca, Gaithersburg, Maryland
| | | | | | | | - Jiabu Ye
- AstraZeneca, Gaithersburg, Maryland
| | - Feng Liu
- AstraZeneca, Gaithersburg, Maryland
| | | | - Solange Peters
- Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
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Abstract
Despite the success of immune checkpoint blockade as a strategy for activating an antitumor immune response and promoting cancer regression, only a subset of patients have durable clinical benefit. Efforts are ongoing to identify robust biomarkers that can effectively predict treatment response to immune checkpoint inhibitors (ICIs). Although PD-L1 expression is useful for stratifying patients, it is an imperfect tool. Comprehensive next-generation sequencing platforms that are readily used in clinical practice to identify a tumor's potentially actionable genetic alterations also reveal tumor genomic features, including tumor mutation burden (TMB), that may impact the response to ICIs. High TMB enhances tumor immunogenicity through increased numbers of tumor neoantigens that may promote an immune response. Defective DNA repair, leading to microsatellite instability, is an endogenous mechanism for increased tumor TMB that augments response to anti-PD-1 blockade. Alternatively, DNA damage from exogenous factors is responsible for high TMB seen in melanoma, lung cancer, and urothelial carcinoma, among tumor subtypes with higher response rates to ICIs. In this review, we summarize data supporting the use of TMB as a biomarker as well as its known limitations. We also highlight specific tumor suppressor genes and oncogenes that are under investigation as biomarkers for ICI response and resistance. Efforts are ongoing to delineate which genomic tumor characteristics can eventually be utilized in clinical practice to ascertain the benefit of ICIs for an individual patient.
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Montesion M, Murugesan K, Jin DX, Sharaf R, Sanchez N, Guria A, Minker M, Li G, Fisher V, Sokol ES, Pavlick DC, Moore JA, Braly A, Singal G, Fabrizio D, Comment LA, Rizvi NA, Alexander BM, Frampton GM, Hegde PS, Albacker LA. Somatic HLA Class I Loss Is a Widespread Mechanism of Immune Evasion Which Refines the Use of Tumor Mutational Burden as a Biomarker of Checkpoint Inhibitor Response. Cancer Discov 2020; 11:282-292. [PMID: 33127846 DOI: 10.1158/2159-8290.cd-20-0672] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/14/2020] [Accepted: 10/27/2020] [Indexed: 11/16/2022]
Abstract
Neoantigen presentation arises as a result of tumor-specific mutations and is a critical component of immune surveillance that can be abrogated by somatic LOH of the human leukocyte antigen class I (HLA-I) locus. To understand the role of HLA-I LOH in oncogenesis and treatment, we utilized a pan-cancer genomic dataset of 83,644 patient samples, a small subset of which had treatment outcomes with immune checkpoint inhibitors (ICI). HLA-I LOH was common (17%) and unexpectedly had a nonlinear relationship with tumor mutational burden (TMB). HLA-I LOH was frequent at intermediate TMB, yet prevalence decreased above 30 mutations/megabase, suggesting highly mutated tumors require alternate immune evasion mechanisms. In ICI-treated patients with nonsquamous non-small cell lung cancer, HLA-I LOH was a significant negative predictor of overall survival. Survival prediction improved when combined with TMB, suggesting TMB with HLA-I LOH may better identify patients likely to benefit from ICIs. SIGNIFICANCE: This work shows the pan-cancer landscape of HLA-I LOH, revealing an unexpected "Goldilocks" relationship between HLA-I LOH and TMB, and demonstrates HLA-I LOH as a significant negative predictor of outcomes after ICI treatment. These data informed a combined predictor of outcomes after ICI and have implications for tumor vaccine development.This article is highlighted in the In This Issue feature, p. 211.
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Affiliation(s)
| | | | - Dexter X Jin
- Foundation Medicine, Inc., Cambridge, Massachusetts
| | - Radwa Sharaf
- Foundation Medicine, Inc., Cambridge, Massachusetts
| | - Nora Sanchez
- Foundation Medicine, Inc., Cambridge, Massachusetts
| | - Ameet Guria
- Foundation Medicine, Inc., Cambridge, Massachusetts
| | - Max Minker
- Foundation Medicine, Inc., Cambridge, Massachusetts
| | - Gerald Li
- Foundation Medicine, Inc., Cambridge, Massachusetts
| | | | | | | | - Jay A Moore
- Foundation Medicine, Inc., Cambridge, Massachusetts
| | - Alan Braly
- Foundation Medicine, Inc., Cambridge, Massachusetts
| | | | | | | | - Naiyer A Rizvi
- Columbia University Irving Medical Center, New York, New York
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Balmanoukian AS, Infante JR, Aljumaily R, Naing A, Chintakuntlawar AV, Rizvi NA, Ross HJ, Gordon M, Mallinder PR, Elgeioushi N, González-García I, Standifer N, Cann J, Durham N, Rahimian S, Kumar R, Denlinger CS. Safety and Clinical Activity of MEDI1873, a Novel GITR Agonist, in Advanced Solid Tumors. Clin Cancer Res 2020; 26:6196-6203. [PMID: 32887725 DOI: 10.1158/1078-0432.ccr-20-0452] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/07/2020] [Accepted: 09/01/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE The safety and preliminary efficacy of MEDI1873, an agonistic IgG1 fusion protein targeting glucocorticoid-induced TNF receptor-related protein (GITR), were evaluated in an open-label, first-in-human, phase I, dose escalation study in previously treated patients with advanced solid tumors. PATIENTS AND METHODS Two single-patient cohorts at 1.5 and 3 mg i.v. were followed by 3+3 dose escalation in six cohorts at 7.5, 25, 75, 250, 500, and 750 mg, all every 2 weeks, for up to 52 weeks. Primary endpoints were safety and tolerability, dose-limiting toxicities (DLT), and MTD. Secondary endpoints included antitumor activity, pharmacokinetics, immunogenicity, and pharmacodynamics. RESULTS Forty patients received MEDI1873. Three experienced DLTs: grade 3 worsening tumor pain (250 mg); grade 3 nausea, vomiting, and headache (500 mg); and grade 3 non-ST segment elevation myocardial infarction (750 mg). An MTD was not reached and treatment was well tolerated up to 500 mg. Most common treatment-related adverse events were headache (25%), infusion-related reaction (17.5%), and decreased appetite (17.5%). MEDI1873 exposure was dose proportional. Antidrug-antibody incidence was low. MEDI1873 increased peripheral CD4+ effector memory T-cell proliferation as well as cytokines associated with effector T-cell activation at dose levels ≥75 mg. The best response was stable disease (SD) in 17 patients (42.5%), including 1 unconfirmed partial response. Eight patients (20.0%) had SD ≥24 weeks. CONCLUSIONS MEDI1873 showed acceptable safety up to 500 mg i.v. every 2 weeks with pharmacodynamics activity, and prolonged SD in some patients. However, further development is not planned because of lack of demonstrated tumor response.
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Affiliation(s)
| | | | | | - Aung Naing
- MD Anderson Cancer Center, Houston, Texas
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Shire NJ, Klein AB, Golozar A, Collins JM, Fraeman KH, Nordstrom BL, McEwen R, Hembrough T, Rizvi NA. STK11 (LKB1) mutations in metastatic NSCLC: Prognostic value in the real world. PLoS One 2020; 15:e0238358. [PMID: 32881920 PMCID: PMC7470384 DOI: 10.1371/journal.pone.0238358] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/15/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Mutations in STK11 (STK11m) and frequently co-occurring KRAS mutations (KRASm/STK11m) are associated with poor survival in metastatic NSCLC (mNSCLC) immuno-oncology trials. There are limited data regarding the prognostic significance of these mutations in a real-world setting. METHODS This retrospective cohort study analyzed de-identified electronic medical records from the Flatiron Clinico-Genomic database to identify patients with mNSCLC who had initiated first-line immunotherapy (IO; alone or in combination) or chemotherapy under routine care between January 1, 2013 and June 30, 2017. The primary objectives were to assess the prevalence of STK11m and KRASm/STK11m and to determine associations of these mutations with overall and progression-free survival (OS, PFS). RESULTS Of 2407 patients with mNSCLC, STK11m and KRASm/STK11m were present in 13.6% and 6.5% of patients, respectively. Worse OS outcomes were observed in patients with STK11m versus STK11wt mNSCLC receiving IO (first-line, HR [95% CI], 1.4 [0.9-2.3; p = 0.1]; second-line [subset of first-line cohort], HR, 1.6 [1.3-2.0; p = 0.0002]) or chemotherapy (first-line, HR, 1.4 [1.2-1.6; p < 0.0001]); PFS outcomes showed similar trends. KRASm/STK11m double mutations were associated with worse OS and PFS outcomes versus KRASwt/STK11wt with IO and chemotherapy, similar to the single mutation (STK11m vs STK11wt) findings. CONCLUSIONS This large observational genomic study among patients receiving routine care highlights the negative prognostic impact of STK11m in patients with mNSCLC treated with IO or chemotherapy. These results complement previous clinical trial data and provide further evidence in the real world of a patient population that would benefit from new treatment options.
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Affiliation(s)
- Norah J. Shire
- AstraZeneca, Gaithersburg, MD, United States of America
- * E-mail:
| | | | - Asieh Golozar
- AstraZeneca, Gaithersburg, MD, United States of America
| | | | | | | | | | | | - Naiyer A. Rizvi
- Division of Hematology and Oncology, Columbia University Medical Center, New York, NY, United States of America
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MERINO DM, Yee LM, McShane LM, Williams PM, Vilimas T, Patidar R, Barrett JC, Chen SJ, Cheng JH, Conroy JM, Cyanam D, Eyring KR, Fabrizio DA, Funari V, Garcia EP, Glenn ST, Gocke CD, Gupta V, Haley LM, Hellmann MD, Keefer L, Keeler LR, Kennedy B, Lazar AJ, MacConaill LE, Meier KL, Papin A, Rizvi NA, Sokol E, Stafford P, Thompson JF, Tom W, Weigman VJ, Xie M, Zhao C, Stewart MD, Allen J. Abstract 5671: Alignment of TMB measured on clinical samples: Phase IIB of the Friends of Cancer Research TMB Harmonization Project. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-5671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction:
Tumor mutational burden (TMB) is the number of somatic mutations per megabase in a tumor's genome and has shown promise as a predictive biomarker of response to immune checkpoint inhibitors across several cancers. TMB is typically measured by whole exome sequencing (WES TMB) or by targeted next-generation sequencing gene panels (panel TMB). As more assays are developed to estimate TMB, harmonization is emerging as an unmet need and is a key goal of the Friends of Cancer Research (Friends) TMB Harmonization Project. Phase I of the Harmonization Project demonstrated correlation between panel TMB and WES TMB using TCGA data and defined theoretical sources of variability across panels. In phase IIA, sustainable TMB reference standard materials generated from human derived cell lines were used to characterize variability in TMB measurements across panels and assessed for utility in TMB alignment. Phase IIB aims to characterize variability in TMB measurements in clinical samples and to establish best practices for estimating and aligning TMB in order to improve consistency across panels.
Methods:
Fifteen laboratories (16 targeted gene panels) at different stages of development participated in phase IIB. Thirty formalin-fixed paraffin-embedded (FFPE) samples with >30% tumor content were acquired; tumor DNA was isolated by a single reference lab. TMB values were calculated for DNA extracted from lung (N=10), bladder (N=10), and gastric tumors (N=10) using WES and a uniform bioinformatics pipeline agreed upon by all Consortium members. DNA samples were also sent to all laboratories, and each used their own sequencing and bioinformatics pipelines to estimate TMB from the genes represented in their respective panels. For each tumor sample, a median across panel TMB estimates was calculated; individual panel TMB estimates were translated to fold-changes relative to the sample median to quantify variability. Association between WES TMB (reference) and panel TMB will be assessed by regression analysis; dependence of association on cancer type was investigated.
Results:
A subset of tumor samples (9 bladder, 7 lung, and 5 gastric) was analyzed using 11 panels at the time of abstract submission. Median panel TMB values ranged 0.60 - 40.26 across samples, with median of median values of 5.35. Fold-change from sample-level medians ranged 0x - 6.67x. Assessment of these clinical samples by WES and all 16 gene panels, as well as regression analysis results, are forthcoming.
Conclusions:
The Friends TMB Harmonization Project has made substantial progress in characterization of TMB measurement variability and association between WES TMB and panel TMB. These are important steps toward alignment of TMB estimates generated by different gene panels which may improve the interpretation of findings within clinical development programs and ultimately enhance the usefulness of this predictive biomarker in clinical decision making.
Citation Format: Diana M. MERINO, Laura M. Yee, Lisa M. McShane, P. Mickey Williams, Tomas Vilimas, Rajesh Patidar, J. Carl Barrett, Shu-Jen Chen, Jen-Hao Cheng, Jeffrey M. Conroy, Dinesh Cyanam, Kenneth R. Eyring, David A. Fabrizio, Vincent Funari, Elizabeth P. Garcia, Sean T. Glenn, Christopher D. Gocke, Vikas Gupta, Lisa M. Haley, Matthew D. Hellmann, Laurel Keefer, Lauryn R. Keeler, Brett Kennedy, Alexander J. Lazar, Laura E. MacConaill, Kristen L. Meier, Arnaud Papin, Naiyer A. Rizvi, Ethan Sokol, Phillip Stafford, John F. Thompson, Warren Tom, Victor J. Weigman, Mingchao Xie, Chen Zhao, Mark D. Stewart, Jeff Allen. Alignment of TMB measured on clinical samples: Phase IIB of the Friends of Cancer Research TMB Harmonization Project [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5671.
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Affiliation(s)
| | | | | | - P. Mickey Williams
- 3Molecular Characterization Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc, Frederick, MD
| | - Tomas Vilimas
- 3Molecular Characterization Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc, Frederick, MD
| | - Rajesh Patidar
- 3Molecular Characterization Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc, Frederick, MD
| | | | | | | | | | | | | | | | | | | | | | | | | | - Lisa M. Haley
- 12Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | - Brett Kennedy
- 8Intermountain Precision Genomics, Salt Lake City, UT
| | | | | | | | | | | | | | | | | | - Warren Tom
- 22Thermo Fisher Scientific, South San Francisco, CA
| | | | | | | | | | - Jeff Allen
- 1Friends of Cancer Research, Washington, DC
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Balli D, Wang X, Rizvi NA, Chan TA, Dowlati A, Doshi P, Chang H. Abstract 2047: Association of retinoblastoma function with response to immuno-oncology treatment in patients with small cell lung cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-2047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Anti–programmed death-1/programmed death ligand 1 inhibitors have been approved for the treatment of advanced small cell lung cancer (SCLC) as a single disease entity. However, efforts to detect and characterize biologically distinct subtypes of SCLC based on gene expression profiling (GEP) have identified multiple subtypes of SCLC, with potential therapeutic implications. These SCLC subtypes can be characterized as neuroendocrine (NE) or non-NE by GEP. Mutation in the retinoblastoma (Rb) transcriptional corepressor 1 (RB1) gene occurs in 65–85% of patients with SCLC, and RB1 mutation may be associated with improved survival with chemotherapy. In this retrospective, exploratory analysis, we investigated the association of genomic and transcriptional biomarkers, including RB1 mutation, with response to immuno-oncology (I-O) in patients with SCLC.
Methods: Biomarker evaluation was performed in baseline samples from patients with SCLC who received second-line or later nivolumab ± ipilimumab (NIVO±IPI) in CheckMate 032 (NCT01928394). RB1 wild type (RB1WT) or mutant (RB1MUT) status and tumor mutational burden (TMB) were determined by whole exome sequencing (WES). Gene expression signatures for SCLC transcriptional subtype (6 genes), Rb protein loss of function (LOF; 87 genes), and inflammation (4 genes) were determined using RNA sequencing.
Results: Of 460 total samples from patients with SCLC, WES and GEP data were available for 279 and 286 samples, respectively. 166 patients (59%) carried frameshift, in-frame insertions or deletions, truncations, or stop-gained mutations in RB1. No differences in RB1 mutation frequency were observed between treatment arms. Overall survival (OS) with NIVO was lower in RB1MUT patients compared with RB1WT (HR = 1.46 [1.02–2.1]). RB1 mutation status was not associated with OS in patients receiving NIVO+IPI. Similar trends were observed for objective response rates. Moreover, stratifying patients based on an Rb protein LOF gene expression signature showed an association between Rb protein loss and lower OS with NIVO (HR = 1.3 [1.05–1.65]) and NIVO+IPI (HR = 1.2 [0.95–1.49]). RB1 mutation status also associated with NE transcriptional subtype (P < 0.0001). Stratification of patients into NE/non-NE subtypes was not associated with OS. TMB and inflammation signatures did not differ between NE and non-NE SCLC subtype or RB1 mutation status.
Conclusion: This analysis of SCLC samples suggests that transcriptionally subtyping SCLC has limited clinical utility. Rb protein function, inflammatory gene signatures, and TMB may represent independent biomarkers of response to I-O in patients with SCLC, warranting further investigation to determine the predictive value of these biomarkers, alone and in combination.
Citation Format: David Balli, Xuya Wang, Naiyer A. Rizvi, Timothy A. Chan, Afshin Dowlati, Parul Doshi, Han Chang. Association of retinoblastoma function with response to immuno-oncology treatment in patients with small cell lung cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2047.
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Affiliation(s)
| | - Xuya Wang
- 1Bristol-Myers Squibb, Princeton, NJ
| | | | | | - Afshin Dowlati
- 4University Hospitals, Seidman Cancer Center, and Case Western Reserve University of Cleveland, Cleveland, OH
| | | | - Han Chang
- 1Bristol-Myers Squibb, Princeton, NJ
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Glisson BS, Leidner RS, Ferris RL, Powderly J, Rizvi NA, Keam B, Schneider R, Goel S, Ohr JP, Burton J, Zheng Y, Eck S, Gribbin M, Streicher K, Townsley DM, Patel SP. Safety and Clinical Activity of MEDI0562, a Humanized OX40 Agonist Monoclonal Antibody, in Adult Patients with Advanced Solid Tumors. Clin Cancer Res 2020; 26:5358-5367. [PMID: 32816951 DOI: 10.1158/1078-0432.ccr-19-3070] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 03/06/2020] [Accepted: 07/30/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Immune checkpoint blockade has demonstrated clinical benefits across multiple solid tumor types; however, resistance and relapse often occur. New immunomodulatory targets, which are highly expressed in activated immune cells, are needed. MEDI0562, an agonistic humanized mAb, specifically binds to the costimulatory molecule OX40. This first-in-human study evaluated MEDI0562 in adults with advanced solid tumors. PATIENTS AND METHODS In this phase I, multicenter, open-label, single-arm, dose-escalation (3+3 design) study, patients received 0.03, 0.1, 0.3, 1.0, 3.0, or 10 mg/kg MEDI0562 through intravenous infusion every 2 weeks, until confirmed disease progression or unacceptable toxicity. The primary objective evaluated safety and tolerability. Secondary endpoints included antitumor activity, pharmacokinetics, immunogenicity, and pharmacodynamics. RESULTS In total, 55 patients received ≥1 dose of MEDI0562 and were included in the analysis. The most common tumor type was squamous cell carcinoma of the head and neck (47%). Median duration of treatment was 10 weeks (range, 2-48 weeks). Treatment-related adverse events (TRAEs) occurred in 67% of patients, most commonly fatigue (31%) and infusion-related reactions (14%). Grade 3 TRAEs occurred in 14% of patients with no apparent dose relationship; no TRAEs resulted in death. Two patients had immune-related partial responses per protocol and 44% had stable disease. MEDI0562 induced increased Ki67+ CD4+ and CD8+ memory T-cell proliferation in the periphery and decreased intratumoral OX40+ FOXP3+ cells. CONCLUSIONS MEDI0562 was safely administered at doses up to 10 mg/kg in heavily pretreated patients. On-target pharmacodynamic effects were suggested in this setting. Further evaluation with immune checkpoint inhibitors is ongoing.
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Affiliation(s)
- Bonnie S Glisson
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Rom S Leidner
- EACRI - Providence Cancer Center, Portland, Oregon, USA
| | | | - John Powderly
- Carolina BioOncology Institute, Huntersville, North Carolina, USA
| | - Naiyer A Rizvi
- Columbia University Medical Center, New York, New York, USA
| | - Bhumsuk Keam
- Seoul National University Hospital, Seoul, South Korea
| | - Reva Schneider
- Mary Crowley Cancer Research - Medical City Dallas, Dallas, Texas, USA
| | - Sanjay Goel
- Montefiore Einstein Cancer Center, Bronx, New York, USA
| | - James P Ohr
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | | | | | - Steven Eck
- AstraZeneca, Gaithersburg, Maryland, USA
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23
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Chen LN, Spivack J, Cao T, Saqi A, Benvenuto LJ, Bulman WA, Mathew M, Stoopler MB, Arcasoy SM, Stanifer BP, Rizvi NA, Shu CA. Characteristics and outcomes of lung cancer in solid organ transplant recipients. Lung Cancer 2020; 146:297-302. [PMID: 32619780 DOI: 10.1016/j.lungcan.2020.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Lung cancer is the third most common malignancy that develops in patients following solid organ transplantation and is the leading cause of cancer deaths in the general population. The aims of this study are to examine the characteristics of patients who developed lung cancer following solid organ transplantation at our institution and to compare their outcomes to those of lung cancer patients without a history of transplant. MATERIALS AND METHODS We performed a single-institution retrospective study of 44 solid organ transplant recipients who developed lung cancer and compared their characteristics to a cohort of 74 lung cancer patients without a history of transplant. We performed propensity score weighted analyses to compare outcomes between the two groups, including a cox proportional hazards model of overall survival. RESULTS 52 % of post-transplant patients who developed lung cancer were diagnosed with stage III or IV disease. In the propensity score weighted analysis that accounted for age at diagnosis, sex, lung cancer stage at diagnosis, Charlson comorbidity index score, and ECOG performance score, post-transplant patients were more likely to have squamous cell histology (p < 0.01) and had worse overall survival compared to the non-transplant cohort (HR = 1.88, 95 % CI 1.13-3.12, p = 0.02). The difference in survival remained significant after accounting for differences in lung cancer histology and treatment (HR = 2.40, 95 % CI 1.27-3.78, p < 0.01). CONCLUSIONS When compared to non-transplant patients with lung cancer, post-transplant patients have worse overall survival after accounting for differences in age, sex, lung cancer stage, comorbidities, and performance status. This survival difference is not solely attributable to differences in tumor histology and treatments received. This may suggest that post-transplant malignancies are more aggressive and difficult to treat.
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Affiliation(s)
- Lanyi Nora Chen
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Medicine, Columbia University Medical Center, United States.
| | - John Spivack
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, United States.
| | - Thu Cao
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Surgery, Columbia University Medical Center, United States.
| | - Anjali Saqi
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Pathology, Columbia University Medical Center, United States.
| | - Luke J Benvenuto
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Medicine, Columbia University Medical Center, United States.
| | - William A Bulman
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Medicine, Columbia University Medical Center, United States.
| | - Matthen Mathew
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Medicine, Columbia University Medical Center, United States.
| | - Mark B Stoopler
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Medicine, Columbia University Medical Center, United States.
| | - Selim M Arcasoy
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Medicine, Columbia University Medical Center, United States.
| | - Bryan P Stanifer
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Surgery, Columbia University Medical Center, United States.
| | - Naiyer A Rizvi
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Medicine, Columbia University Medical Center, United States.
| | - Catherine A Shu
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Medicine, Columbia University Medical Center, United States.
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Pagan CA, Shu CA, Crapanzano JP, Lagos GG, Stoopler MB, Rizvi NA, Heymann JJ, Sonett JR, Fernandes H, Saqi A. Synchronous Pulmonary Adenocarcinomas. Am J Clin Pathol 2020; 154:57-69. [PMID: 32146481 DOI: 10.1093/ajcp/aqaa023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To determine concordance/discordance between morphology and molecular testing (MT) among synchronous pulmonary carcinomas using targeted next generation sequencing (NGS), with and without comprehensive molecular review (CMR), vs analyses of multiple singe genes (non-NGS). METHODS Results of morphologic and MT assessment were classified as concordant, discordant, or indeterminate. For discordant cases, comprehensive histologic assessment (CHA) was performed. RESULTS Forty-seven cases with 108 synchronous tumors were identified and underwent MT (NGS, n = 23 and non-NGS, n = 24). Histology and MT were concordant, discordant, and indeterminate in 53% (25/47), 21% (10/47), and 26% (12/47) of cases, respectively. CHA of the 10 discordant cases revised results of three cases. CONCLUSIONS There is discordance between histology and MT in a subset of cases and MT provides an objective surrogate for staging synchronous tumors. A limited gene panel is sufficient for objectively assessing a relationship if the driver mutations are distinct. Relatedness of mutations require CMR with a larger NGS panel (eg, 50 genes).
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Affiliation(s)
- Carlos A Pagan
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY
| | - Catherine A Shu
- Department of Medical Oncology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY
| | - John P Crapanzano
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY
| | - Galina G Lagos
- Department of Medical Oncology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY
| | - Mark B Stoopler
- Department of Medical Oncology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY
| | - Naiyer A Rizvi
- Department of Medical Oncology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY
| | - Jonas J Heymann
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY
| | - Joshua R Sonett
- Department of Thoracic Surgery, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY
| | - Helen Fernandes
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY
| | - Anjali Saqi
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY
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25
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Skoulidis F, Neal JW, Akerley WL, Paik PK, Papagiannakopoulos T, Reckamp KL, Riess JW, Jenkins Y, Holland S, Parlati F, Shen Y, Whiting SH, Rizvi NA. A phase II randomized study of telaglenastat, a glutaminase (GLS) inhibitor, versus placebo, in combination with pembrolizumab (Pembro) and chemotherapy as first-line treatment for KEAP1/NRF2-mutated non-squamous metastatic non-small cell lung cancer (mNSCLC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.tps9627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS9627 Background: Mutational activation of the KEAP1/NRF2 pathway occurs in >20% of NSCLC patients (pts). KEAP1/NRF2 activation protects tumor cells from diverse forms of oxidative stress and promotes tumor growth and survival. In pts w/ advanced NSCLC, mutation of the KEAP1/NRF2 pathway is associated w/ dramatically reduced survival and poor outcomes following standard-of-care therapy. These tumors have increased dependence on GLS-mediated conversion of glutamine to glutamate due to upregulation of NRF2 target genes involved in glutamine metabolism. Telaglenastat (CB-839), an investigational, first-in-class, potent, oral GLS inhibitor, has demonstrated preclinical activity in KEAP1/NRF2-mutated NSCLC cell lines and xenograft models. This study will evaluate the safety and efficacy of telaglenastat + standard-of-care pembro and chemotherapy as 1L therapy for KEAP1/NRF2-mutated non-squamous mNSCLC (NCT04265534). Methods: This phase II, randomized, multicenter, double-blind study will enroll ~120 pts with histologically or cytologically documented stage IV non-squamous NSCLC w/ KEAP1 or NRF2 mutation, no prior systemic therapy for mNSCLC, measurable disease (RECIST v1.1), ECOG PS 0-1, and no EGFR, ALK, ROS, or other actionable mutation w/ available approved therapy in 1L setting. KEAP1 or NRF2 mutations will be determined by next generation sequencing (NGS), and study-provided liquid biopsy NGS will be available. Pts will be randomized 1:1 to receive telaglenastat (800 mg BID PO) or placebo, in combination with pembro, carboplatin, and pemetrexed at standard doses on day 1 of each 21-day cycle. Pts will be stratified by STK11/LKB1 mutational status and M stage of cancer (M1a-b vs M1c). The study will include an initial safety run-in period (n=12; 1 cycle). Co-primary endpoints are safety and investigator-assessed progression-free survival (RECIST v1.1). Secondary endpoints include overall response rate, duration of response, overall survival, and efficacy analysis in the subgroup of pts w/ biochemical confirmation of KEAP1/NRF2 pathway activation. Findings of this novel NGS biomarker-selected study will inform the efficacy and safety profile of telaglenastat + standard-of-care chemoimmunotherapy for 1L treatment of KEAP1/NRF2-mutated, non-squamous mNSCLC. Clinical trial information: NCT04265534 .
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Affiliation(s)
| | | | | | - Paul K. Paik
- Thoracic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | - Jonathan W. Riess
- University of California Davis Comprehensive Cancer Center, Sacramento, CA
| | | | - Sacha Holland
- Calithera Biosciences, Inc., South San Francisco, CA
| | | | - Yijing Shen
- Calithera Biosciences, Inc., South San Francisco, CA
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26
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Leighl NB, Redman MW, Rizvi NA, Hirsch FR, Mack PC, Schwartz LH, Wade JL, Irvin WJ, Reddy S, Crawford J, Bradley JD, Stinchcombe T, Ramalingam SS, Miao J, Minichiello K, Gandara DR, Herbst RS, Papadimitrakopoulou V, Kelly K. SWOG S1400F (NCT03373760): A phase II study of durvalumab plus tremelimumab for previously treated patients with acquired resistance to PD-1 checkpoint inhibitor therapy and stage IV squamous cell lung cancer (Lung-MAP Sub-study). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.9623] [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
9623 Background: The Lung Cancer Master Protocol (Lung-MAP) is designed to evaluate novel targeted therapies in patients with advanced squamous lung carcinoma. In the S1400F sub-study (non-match), we tested whether combined CTLA-4 and PD-1 inhibition with durvalumab plus tremelimumab (D+T) could overcome primary or acquired resistance to anti-PD-(L)1 therapy. Response, progression-free (PFS) and overall survival, and safety in the acquired resistance cohort are reported herein. Methods: Patients with previously treated squamous lung carcinoma, performance status (PS) 0-1, and adequate organ function that developed disease progression after ≥24 weeks of anti-PD-(L)1 monotherapy were eligible. Prior severe immune-related toxicities, intervening systemic therapy and combination chemo-immunotherapy were not permitted. Patients received D1500 mg + T75 mg IV q28 days for 4 cycles then D maintenance until disease progression. The primary endpoint was best objective response (RECIST 1.1). Interim analysis for futility was planned after 20 patients evaluable for response were enrolled. If no responses were observed, the cohort would stop enrolment. Results: 30 eligible patients were accrued to the acquired resistance cohort. Median age was 68 years, 60% of patients were male, 33% PS 0 and had received a median of 2 prior lines of therapy (maximum 4). Best response to prior anti-PD-(L)1 therapy was CR/PR/SD in 3/7/20 patients, with a median duration of anti-PD-(L)1 therapy of 8.6 months (5.2-30.4). No objective responses were seen with D+T; 47% had SD as best response. Median PFS was 2.0 months (95% CI 1.6-2.9) and survival 7.5 months (95% CI 5.3-8.7). Among the 14 patients with SD as best response, the median PFS calculated from first disease assessment is 2.8 months (95% CI: 1.4-3.9). Grade≥3 adverse events at least possibly related to protocol therapy were seen in 10/30 patients. These include 1 treatment-related death due to pneumonitis and 1 death not otherwise specified. Other adverse events include grade 3 confusion (1), dehydration (2), diarrhea (3), encephalopathy (1), weakness (1), hyperglycemia (1), hypoxia (1), lymphopenia (1), nausea, (1), neutropenia (1), thrombocytopenia (1), rash (1), vomiting (1), grade 4 dyspnea (1), leucopenia (1) and lymphopenia (1). Conclusions: D+T did not demonstrate activity in patients with acquired resistance to PD-1 checkpoint inhibitors and pretreated advanced squamous lung carcinoma. Clinical trial information: NCT03373760 .
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Affiliation(s)
| | - Mary Weber Redman
- SWOG Statistical Center; Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | | | | | | | | | | | - Jeffrey Crawford
- Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | | | | | | | - Jieling Miao
- SWOG Statistical and Data Management Center/Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - David R. Gandara
- University of California Davis Comprehensive Cancer Center, Sacramento, CA
| | | | | | - Karen Kelly
- University of California Davis Comprehensive Cancer Center, Sacramento, CA
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27
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Chowell D, Krishna C, Pierini F, Makarov V, Rizvi NA, Kuo F, Morris LGT, Riaz N, Lenz TL, Chan TA. Evolutionary divergence of HLA class I genotype impacts efficacy of cancer immunotherapy. Nat Med 2019; 25:1715-1720. [PMID: 31700181 DOI: 10.1038/s41591-019-0639-4] [Citation(s) in RCA: 156] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 10/03/2019] [Indexed: 12/22/2022]
Abstract
Functional diversity of the highly polymorphic human leukocyte antigen class I (HLA-I) genes underlies successful immunologic control of both infectious disease and cancer. The divergent allele advantage hypothesis dictates that an HLA-I genotype with two alleles with sequences that are more divergent enables presentation of more diverse immunopeptidomes1-3. However, the effect of sequence divergence between HLA-I alleles-a quantifiable measure of HLA-I evolution-on the efficacy of immune checkpoint inhibitor (ICI) treatment for cancer remains unknown. In the present study the germline HLA-I evolutionary divergence (HED) of patients with cancer treated with ICIs was determined by quantifying the physiochemical sequence divergence between HLA-I alleles of each patient's genotype. HED was a strong determinant of survival after treatment with ICIs. Even among patients fully heterozygous at HLA-I, patients with an HED in the upper quartile respond better to ICIs than patients with a low HED. Furthermore, HED strongly impacts the diversity of tumor, viral and self-immunopeptidomes and intratumoral T cell receptor clonality. Similar to tumor mutation burden, HED is a fundamental metric of diversity at the major histocompatibility complex-peptide complex, which dictates ICI efficacy. The data link divergent HLA allele advantage to immunotherapy efficacy and unveil how ICI response relies on the evolved efficiency of HLA-mediated immunity.
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Affiliation(s)
- Diego Chowell
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chirag Krishna
- Computational and Systems Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Federica Pierini
- Research Group for Evolutionary Immunogenomics, Max Planck Institute for Evolutionary Biology, Plön, Germany
| | - Vladimir Makarov
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Naiyer A Rizvi
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Fengshen Kuo
- Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Luc G T Morris
- Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nadeem Riaz
- Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tobias L Lenz
- Research Group for Evolutionary Immunogenomics, Max Planck Institute for Evolutionary Biology, Plön, Germany.
| | - Timothy A Chan
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Weill Cornell School of Medicine, New York, NY, USA.
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28
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Phillips GS, Wu J, Hellmann MD, Postow MA, Rizvi NA, Freites-Martinez A, Chan D, Dusza S, Motzer RJ, Rosenberg JE, Callahan MK, Chapman PB, Geskin L, Lopez AT, Reed VA, Fabbrocini G, Annunziata MC, Kukoyi O, Pabani A, Yang CH, Chung WH, Markova A, Lacouture ME. Treatment Outcomes of Immune-Related Cutaneous Adverse Events. J Clin Oncol 2019; 37:2746-2758. [PMID: 31216228 PMCID: PMC7001790 DOI: 10.1200/jco.18.02141] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2019] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The aim of the current study was to report the efficacy of topical and systemic treatments for immune-related cutaneous adverse events (ircAEs) attributed to checkpoint inhibitors in an uncontrolled cohort of patients referred to oncodermatology clinics. METHODS A retrospective analysis of patients with ircAEs evaluated by dermatologists from January 1, 2014, to December 31, 2017, at three tertiary care hospitals and cancer centers were identified through electronic medical records. Clinicopathologic characteristics, dermatologic therapy outcome, and laboratory data were analyzed. RESULTS A total of 285 patients (median age, 65 years [range, 17 to 89 years]) with 427 ircAEs were included: pruritus (n = 138; 32%), maculopapular rash (n = 120; 28%), psoriasiform rash (n = 22; 5%), and others (n = 147; 34%). Immune checkpoint inhibitor class was associated with ircAE phenotype (P = .007), where maculopapular rash was predominant in patients who received combination therapy. Severity of ircAEs was significantly reduced (mean Common Terminology Criteria for Adverse Events grade: 1.74 v 0.71; P < .001) with dermatologic interventions, including topical corticosteroids, oral antipruritics, and systemic immunomodulators. A total of 88 ircAEs (20%) were managed with systemic immunomodulators. Of these, 22 (25%) of 88 persisted or worsened. In seven patients with corticosteroid-refractory ircAEs, improvement resulted from targeted biologic immunomodulatory therapies that included rituximab and dupilumab. Serum interleukin-6 (IL-6) was elevated in 34 (52%) of 65 patients; grade 3 or greater ircAEs were associated with increased absolute eosinophils (odds ratio, 4.1; 95% CI, 1.3 to 13.4) and IL-10 (odds ratio, 23.8; 95% CI, 2.1 to 262.5); mean immunoglobulin E serum levels were greater in higher-grade ircAEs: 1,093 kU/L (grade 3), 245 kU/L (grade 2), and 112 kU/L (grade 1; P = .043). CONCLUSION Most ircAEs responded to symptom- and phenotype-directed dermatologic therapies, whereas biologic therapies were effective in patients with corticosteroid-refractory disease. Increased eosinophils, IL-6, IL-10, and immunoglobulin E were associated with ircAEs, and they may represent actionable therapeutic targets for immune-related skin toxicities.
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Affiliation(s)
| | - Jennifer Wu
- Memorial Sloan Kettering Cancer Center, New York, NY
- Chang Gung Memorial Hospital, Taipei, Republic of China
- Chang Gung University, Taoyuan, Republic of China
| | - Matthew D. Hellmann
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Michael A. Postow
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | | | - Donald Chan
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephen Dusza
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert J. Motzer
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Jonathan E. Rosenberg
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Margaret K. Callahan
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Paul B. Chapman
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | | | | | | | | | | | | | - Chih-Hsun Yang
- Memorial Sloan Kettering Cancer Center, New York, NY
- Chang Gung Memorial Hospital, Taipei, Republic of China
- Chang Gung University, Taoyuan, Republic of China
| | - Wen-Hung Chung
- Memorial Sloan Kettering Cancer Center, New York, NY
- Chang Gung Memorial Hospital, Taipei, Republic of China
- Chang Gung University, Taoyuan, Republic of China
| | - Alina Markova
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Mario E. Lacouture
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
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29
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Garon EB, Hellmann MD, Rizvi NA, Carcereny E, Leighl NB, Ahn MJ, Eder JP, Balmanoukian AS, Aggarwal C, Horn L, Patnaik A, Gubens M, Ramalingam SS, Felip E, Goldman JW, Scalzo C, Jensen E, Kush DA, Hui R. Five-Year Overall Survival for Patients With Advanced Non‒Small-Cell Lung Cancer Treated With Pembrolizumab: Results From the Phase I KEYNOTE-001 Study. J Clin Oncol 2019; 37:2518-2527. [PMID: 31154919 PMCID: PMC6768611 DOI: 10.1200/jco.19.00934] [Citation(s) in RCA: 708] [Impact Index Per Article: 141.6] [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] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Pembrolizumab monotherapy has demonstrated durable antitumor activity in advanced programmed death ligand 1 (PD-L1)–expressing non‒small-cell lung cancer (NSCLC). We report 5-year outcomes from the phase Ib KEYNOTE-001 study. These data provide the longest efficacy and safety follow-up for patients with NSCLC treated with pembrolizumab monotherapy. PATIENTS AND METHODS Eligible patients had confirmed locally advanced/metastatic NSCLC and provided a contemporaneous tumor sample for PD-L1 evaluation by immunohistochemistry using the 22C3 antibody. Patients received intravenous pembrolizumab 2 mg/kg every 3 weeks or 10 mg/kg every 2 or 3 weeks. Investigators assessed response per immune-related response criteria. The primary efficacy end point was objective response rate. Overall survival (OS) and duration of response were secondary end points. RESULTS We enrolled 101 treatment-naive and 449 previously treated patients. Median follow-up was 60.6 months (range, 51.8 to 77.9 months). At data cutoff—November 5, 2018—450 patients (82%) had died. Median OS was 22.3 months (95% CI, 17.1 to 32.3 months) in treatment-naive patients and 10.5 months (95% CI, 8.6 to 13.2 months) in previously treated patients. Estimated 5-year OS was 23.2% for treatment-naive patients and 15.5% for previously treated patients. In patients with a PD-L1 tumor proportion score of 50% or greater, 5-year OS was 29.6% and 25.0% in treatment-naive and previously treated patients, respectively. Compared with analysis at 3 years, only three new-onset treatment-related grade 3 adverse events occurred (hypertension, glucose intolerance, and hypersensitivity reaction, all resolved). No late-onset grade 4 or 5 treatment-related adverse events occurred. CONCLUSION Pembrolizumab monotherapy provided durable antitumor activity and high 5-year OS rates in patients with treatment-naive or previously treated advanced NSCLC. Of note, the 5-year OS rate exceeded 25% among patients with a PD-L1 tumor proportion score of 50% or greater. Pembrolizumab had a tolerable long-term safety profile with little evidence of late-onset or new toxicity.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Leora Horn
- Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Amita Patnaik
- South Texas Accelerated Research Therapeutics, San Antonio, TX
| | - Matthew Gubens
- University of California, San Francisco, San Francisco, CA
| | | | - Enriqueta Felip
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | | | | | | | - Rina Hui
- Westmead Hospital, University of Sydney, Sydney, NSW, Australia
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30
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Rizvi NA, Cho BC, Reinmuth N, Lee KH, Luft A, Ahn MJ, van den Heuvel M, Dols MC, Vicente D, Smolin A, Moiseyenko V, Antonia SJ, Nakagawa K, Goldberg SB, Kim ES, Walker J, Raja R, Liu F, Scheuring UJ, Peters S. Blood tumor mutational burden (bTMB) and tumor PD-L1 as predictive biomarkers of survival in MYSTIC: First-line durvalumab (D) ± tremelimumab (T) versus chemotherapy (CT) in metastatic (m) NSCLC. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9016 Background: MYSTIC, an open-label, Ph3 trial of first-line D (anti-PD-L1) ± T (anti-CTLA-4) vs platinum-based CT, showed an improvement in OS with D vs CT in pts with tumor cell PD-L1 expression ≥25% (PD-L1 TC ≥25%; HR 0.76 [97.54% CI 0.56–1.02], p = 0.036). Exploratory analyses showed bTMB was a predictive biomarker for OS with D±T vs CT. We report further exploratory analyses of OS according to PD-L1 and bTMB. Methods: Immunotherapy/CT-naïve pts with mNSCLC were randomized (1:1:1) to D, D+T or CT. bTMB levels (mut/Mb) were evaluated with the GuardantOMNI platform (Guardant Health), and PD-L1 TC expression with the VENTANA PD-L1 (SP263) IHC assay. Results: D improved OS vs CT in pts with PD-L1 TC ≥25% across bTMB levels (PD-L1 TC ≥25%/bTMB≥20 HR 0.79 [95% CI 0.45, 1.39]; PD-L1 TC ≥25%/bTMB < 20 HR 0.64 [95% CI 0.45, 0.90]). In contrast, D+T improved OS vs CT in pts with bTMB≥20 across different PD-L1 TC expression levels (Table; PD-L1 TC ≥25%/bTMB≥20 HR 0.44 [95% CI 0.23, 0.84]; PD-L1 TC < 1%/bTMB≥20 HR 0.42 [95% CI 0.17, 0.97]). Additional cutoffs and outcomes in subgroups defined by both biomarkers will be presented. Conclusions: These exploratory analyses from MYSTIC support PD-L1 TC expression as an appropriate predictive biomarker for OS with D vs CT, while suggesting bTMB as a predictive biomarker for OS with D+T in mNSCLC. These biomarkers appear to be independent and both may be important for mNSCLC treatment decisions. Interpretation of these data may be limited by small sample sizes; further investigations are warranted. Clinical trial information: NCT02453282. [Table: see text]
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Affiliation(s)
| | - Byoung Chul Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Ki Hyeong Lee
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Alexander Luft
- Leningrad Regional Clinical Hospital, Oncology Department, Lunacharskogo Prospect, Russian Federation
| | | | - Michel van den Heuvel
- Department of Thoracic Oncology, Netherlands Cancer Institute (NKI), Amsterdam, Netherlands
| | - Manuel Cobo Dols
- Hospital Universitario Regional Málaga, Instituto de Investigaciones Biomédicas Málaga (IBIMA), Málaga, Spain
| | - David Vicente
- Hospital Universitario Virgen Macarena, Seville, Spain
| | | | | | | | | | | | | | | | | | | | | | - Solange Peters
- Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
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31
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Garon EB, Cho BC, Reinmuth N, Lee KH, Luft A, Ahn MJ, Robinet G, Le Moulec S, Natale R, Schneider JG, Shepherd FA, Garassino MC, Geater SL, Papai-Szekely Z, Van Ngoc T, Liu F, Scheuring UJ, Rydén A, Peters S, Rizvi NA. Patient-reported outcomes (PROs) with first-line durvalumab (D) ± tremelimumab (T) versus chemotherapy (CT) in metastatic NSCLC: Results from MYSTIC. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9048 Background: MYSTIC, an open-label, Phase 3 trial of first-line D (anti-PD-L1) ± T (anti-CTLA-4) vs platinum CT in mNSCLC, showed an improvement in overall survival (OS) with D vs CT in pts with tumor cell PD-L1 expression ≥25% (TC ≥25% [primary analysis population]; D vs CT, HR 0.76 [97.54% CI 0.56–1.02], p = 0.036; D+T vs CT, HR 0.85 [98.77% CI 0.61–1.17], p = 0.202). Here we summarize PROs from MYSTIC. Methods: Immunotherapy/CT-naïve mNSCLC pts were randomized (1:1:1) to D, D+T, or CT. Symptoms, function, and global health status/quality of life (QoL) were assessed using the EORTC QLQ-C30 v3 questionnaire and its lung cancer module, QLQ-LC13. A change in score from baseline ≥10 points was predefined as clinically meaningful (CM). Mean changes from baseline (over 12 mos) for prespecified symptoms were analyzed using a mixed model for repeated measures (MMRM). Time from randomization to the first CM deterioration (TTD) was analyzed. Results: Among pts with PD-L1 TC ≥25% (n = 488), there were no differences between arms in symptoms, function, or global health status/QoL at baseline. Compliance with completing the questionnaires was ≥60% to wk 120 in the D±T arms, and to wk 40 (C30) and wk 44 (LC13) in the CT arm. MMRM analysis showed significant between-arm differences in changes from baseline in favor of D for fatigue (difference vs CT −9.5) and appetite loss (−11.9; CM), and D+T for fatigue (−11.7; CM). Significantly longer TTD (median, mos) was seen with D and D+T vs CT for appetite loss (12.8 and 5.6 vs 4.5), constipation (14.6 and 9.0 vs 5.5), nausea/vomiting (16.7 and 9.7 vs 4.5), and dyspnea (10.6 and 7.4 vs 5.6); D vs CT for diarrhea (16.3 vs 9.0), insomnia (9.3 vs 6.2), and hemoptysis (not reached vs 10.3); and D+T vs CT for fatigue (5.6 vs 2.0). Significantly longer TTD (median, mos) was also seen with D and D+T vs CT for function (cognitive [9.1 and 6.6 vs 5.2], physical [9.0 and 7.4 vs 4.2], role [D vs CT only; 7.3 vs 3.7], social [12.9 and 5.4 vs 5.2]), and global health status/QoL (5.9 and 6.8 vs 5.5). Conclusions: Pts with PD-L1 TC ≥25% treated with D±T had a reduced symptom burden over time and longer TTD for symptoms, function, and global health status/QoL compared to pts receiving CT. Clinical trial information: NCT02453282.
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Affiliation(s)
- Edward B. Garon
- David Geffen School of Medicine, University of California/TRIO-US Network, Los Angeles, CA
| | - Byoung Chul Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Ki Hyeong Lee
- Chungbuk National University Hospital, Cheongju, South Korea
| | - Alexander Luft
- Leningrad Regional Clinical Hospital, Oncology Department, Lunacharskogo Prospect, Russian Federation
| | | | | | | | - Ronald Natale
- Cedars-Sinai Comprehensive Cancer Center, Los Angeles, CA
| | | | - Frances A. Shepherd
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | | | | | | | | | - Solange Peters
- Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
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Boothman AM, Scott M, Ratcliffe M, Whiteley J, Dennis PA, Wadsworth C, Sharpe A, Rizvi NA, Garassino MC, Walker J. Impact of Patient Characteristics, Prior Therapy, and Sample Type on Tumor Cell Programmed Cell Death Ligand 1 Expression in Patients with Advanced NSCLC Screened for the ATLANTIC Study. J Thorac Oncol 2019; 14:1390-1399. [PMID: 31063864 DOI: 10.1016/j.jtho.2019.04.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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: 02/15/2019] [Revised: 03/28/2019] [Accepted: 04/19/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION We evaluated the impact of patient characteristics, sample types, and prior non-immunotherapy treatment on tumor cell (TC) programmed cell death ligand 1 (PD-L1) expression using samples from patients with advanced NSCLC. METHODS Patients (N = 1590) screened for the ATLANTIC study submitted a recently acquired (≤3 months) or archival (>3 months to >3 years old) tumor sample for PD-L1 assessment using the VENTANA PD-L1 (SP263) Assay with a cutoff of ≥25% of TCs expressing PD-L1 (TC ≥25%). Samples were acquired either before or after the two or more treatment regimens required for study entry and sample age varied among patients. A subset of patients (n = 123) provided both recent and archival samples. RESULTS A total of 517 of 1590 (32.5%) patients had TC greater than or equal to 25%: prevalence was greater in smokers versus nonsmokers (p = 0.0005) and those with EGFR- versus EGFR+ tumors (p = 0.0002); these effects were independent. Prevalence of TC greater than or equal to 25% was increased in recent metastatic versus primary (p = 0.005) and recent versus archival (p = 0.039) samples. Chemotherapy or radiotherapy, but not tyrosine kinase inhibition, before sampling was associated with significantly increased PD-L1 prevalence. PD-L1 status (TC ≥25% cutoff) remained unchanged in 74.0% of patients with recent and archival samples; where PD-L1 status changed, it was more likely to increase than decrease over time or with intervening treatment. CONCLUSIONS Several factors potentially impact PD-L1 TC greater than or equal to 25% prevalence in advanced NSCLC; however, no characteristic can be considered a surrogate for PD-L1 expression. Fresh biopsy may provide more accurate assessment of current tumoral PD-L1 expression where a low/negative result is seen in an archival sample, especially if the patient has received intervening therapy.
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Affiliation(s)
- Anne-Marie Boothman
- Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom.
| | - Marietta Scott
- Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
| | - Marianne Ratcliffe
- Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
| | - Jessica Whiteley
- Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
| | - Phillip A Dennis
- Global Medicines Development, AstraZeneca, Gaithersburg, Maryland
| | | | - Alan Sharpe
- Discovery Sciences, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
| | - Naiyer A Rizvi
- Division of Hematology and Oncology, Columbia University Medical Center, New York, New York
| | - Marina Chiara Garassino
- Thoracic Oncology Unit, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Jill Walker
- Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
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Hellmann MD, Callahan MK, Awad MM, Calvo E, Ascierto PA, Atmaca A, Rizvi NA, Hirsch FR, Selvaggi G, Szustakowski JD, Sasson A, Golhar R, Vitazka P, Chang H, Geese WJ, Antonia SJ. Tumor Mutational Burden and Efficacy of Nivolumab Monotherapy and in Combination with Ipilimumab in Small-Cell Lung Cancer. Cancer Cell 2019; 35:329. [PMID: 30753829 DOI: 10.1016/j.ccell.2019.01.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Samstein RM, Lee CH, Shoushtari AN, Hellmann MD, Shen R, Janjigian YY, Barron DA, Zehir A, Jordan EJ, Omuro A, Kaley TJ, Kendall SM, Motzer RJ, Hakimi AA, Voss MH, Russo P, Rosenberg J, Iyer G, Bochner BH, Bajorin DF, Al-Ahmadie HA, Chaft JE, Rudin CM, Riely GJ, Baxi S, Ho AL, Wong RJ, Pfister DG, Wolchok JD, Barker CA, Gutin PH, Brennan CW, Tabar V, Mellinghoff IK, DeAngelis LM, Ariyan CE, Lee N, Tap WD, Gounder MM, D'Angelo SP, Saltz L, Stadler ZK, Scher HI, Baselga J, Razavi P, Klebanoff CA, Yaeger R, Segal NH, Ku GY, DeMatteo RP, Ladanyi M, Rizvi NA, Berger MF, Riaz N, Solit DB, Chan TA, Morris LGT. Tumor mutational load predicts survival after immunotherapy across multiple cancer types. Nat Genet 2019; 51:202-206. [PMID: 30643254 PMCID: PMC6365097 DOI: 10.1038/s41588-018-0312-8] [Citation(s) in RCA: 2349] [Impact Index Per Article: 469.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/12/2018] [Indexed: 12/22/2022]
Abstract
Immune checkpoint inhibitor (ICI) treatments benefit some patients with metastatic cancers, but predictive biomarkers are needed. Findings in selected cancer types suggest that tumor mutational burden (TMB) may predict clinical response to ICI. To examine this association more broadly, we analyzed the clinical and genomic data of 1,662 advanced cancer patients treated with ICI, and 5,371 non-ICI-treated patients, whose tumors underwent targeted next-generation sequencing (MSK-IMPACT). Among all patients, higher somatic TMB (highest 20% in each histology) was associated with better overall survival. For most cancer histologies, an association between higher TMB and improved survival was observed. The TMB cutpoints associated with improved survival varied markedly between cancer types. These data indicate that TMB is associated with improved survival in patients receiving ICI across a wide variety of cancer types, but that there may not be one universal definition of high TMB.
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Affiliation(s)
- Robert M Samstein
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chung-Han Lee
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Alexander N Shoushtari
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Matthew D Hellmann
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Ronglai Shen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yelena Y Janjigian
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - David A Barron
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ahmet Zehir
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emmet J Jordan
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Antonio Omuro
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Thomas J Kaley
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sviatoslav M Kendall
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert J Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - A Ari Hakimi
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin H Voss
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Paul Russo
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan Rosenberg
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Gopa Iyer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Bernard H Bochner
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dean F Bajorin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Hikmat A Al-Ahmadie
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jamie E Chaft
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Charles M Rudin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Gregory J Riely
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Shrujal Baxi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Alan L Ho
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Richard J Wong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David G Pfister
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Jedd D Wolchok
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Philip H Gutin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cameron W Brennan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Viviane Tabar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ingo K Mellinghoff
- Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lisa M DeAngelis
- Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Charlotte E Ariyan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Mrinal M Gounder
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Sandra P D'Angelo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Leonard Saltz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Zsofia K Stadler
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Howard I Scher
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Jose Baselga
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Pedram Razavi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Christopher A Klebanoff
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Rona Yaeger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Neil H Segal
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Geoffrey Y Ku
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Ronald P DeMatteo
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc Ladanyi
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Naiyer A Rizvi
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Michael F Berger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David B Solit
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Timothy A Chan
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Luc G T Morris
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Bulik-Sullivan B, Busby J, Palmer CD, Davis MJ, Murphy T, Clark A, Busby M, Duke F, Yang A, Young L, Ojo NC, Caldwell K, Abhyankar J, Boucher T, Hart MG, Makarov V, Montpreville VTD, Mercier O, Chan TA, Scagliotti G, Bironzo P, Novello S, Karachaliou N, Rosell R, Anderson I, Gabrail N, Hrom J, Limvarapuss C, Choquette K, Spira A, Rousseau R, Voong C, Rizvi NA, Fadel E, Frattini M, Jooss K, Skoberne M, Francis J, Yelensky R. Deep learning using tumor HLA peptide mass spectrometry datasets improves neoantigen identification. Nat Biotechnol 2018; 37:nbt.4313. [PMID: 30556813 DOI: 10.1038/nbt.4313] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 11/06/2018] [Indexed: 12/30/2022]
Abstract
Neoantigens, which are expressed on tumor cells, are one of the main targets of an effective antitumor T-cell response. Cancer immunotherapies to target neoantigens are of growing interest and are in early human trials, but methods to identify neoantigens either require invasive or difficult-to-obtain clinical specimens, require the screening of hundreds to thousands of synthetic peptides or tandem minigenes, or are only relevant to specific human leukocyte antigen (HLA) alleles. We apply deep learning to a large (N = 74 patients) HLA peptide and genomic dataset from various human tumors to create a computational model of antigen presentation for neoantigen prediction. We show that our model, named EDGE, increases the positive predictive value of HLA antigen prediction by up to ninefold. We apply EDGE to enable identification of neoantigens and neoantigen-reactive T cells using routine clinical specimens and small numbers of synthetic peptides for most common HLA alleles. EDGE could enable an improved ability to develop neoantigen-targeted immunotherapies for cancer patients.
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Affiliation(s)
| | - Jennifer Busby
- Gritstone Oncology, Inc., Emeryville, California and Cambridge, Massachusetts, USA
| | - Christine D Palmer
- Gritstone Oncology, Inc., Emeryville, California and Cambridge, Massachusetts, USA
| | - Matthew J Davis
- Gritstone Oncology, Inc., Emeryville, California and Cambridge, Massachusetts, USA
| | - Tyler Murphy
- Gritstone Oncology, Inc., Emeryville, California and Cambridge, Massachusetts, USA
| | - Andrew Clark
- Gritstone Oncology, Inc., Emeryville, California and Cambridge, Massachusetts, USA
| | - Michele Busby
- Gritstone Oncology, Inc., Emeryville, California and Cambridge, Massachusetts, USA
| | - Fujiko Duke
- Gritstone Oncology, Inc., Emeryville, California and Cambridge, Massachusetts, USA
| | - Aaron Yang
- Gritstone Oncology, Inc., Emeryville, California and Cambridge, Massachusetts, USA
| | - Lauren Young
- Gritstone Oncology, Inc., Emeryville, California and Cambridge, Massachusetts, USA
| | - Noelle C Ojo
- Gritstone Oncology, Inc., Emeryville, California and Cambridge, Massachusetts, USA
| | - Kamilah Caldwell
- Gritstone Oncology, Inc., Emeryville, California and Cambridge, Massachusetts, USA
| | - Jesse Abhyankar
- Gritstone Oncology, Inc., Emeryville, California and Cambridge, Massachusetts, USA
| | - Thomas Boucher
- Gritstone Oncology, Inc., Emeryville, California and Cambridge, Massachusetts, USA
| | - Meghan G Hart
- Gritstone Oncology, Inc., Emeryville, California and Cambridge, Massachusetts, USA
| | | | | | - Olaf Mercier
- Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Timothy A Chan
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Giorgio Scagliotti
- University of Turin, Department of Oncology at San Luigi Hospital, Orbassano (Turin), Italy
| | - Paolo Bironzo
- University of Turin, Department of Oncology at San Luigi Hospital, Orbassano (Turin), Italy
| | - Silvia Novello
- University of Turin, Department of Oncology at San Luigi Hospital, Orbassano (Turin), Italy
| | - Niki Karachaliou
- Instituto Oncologico Dr. Rosell - Hospital Universitari Quiron Dexeus Location, Barcelona, Spain
| | | | - Ian Anderson
- St Joseph Heritage Healthcare, Santa Rosa, California, USA
| | | | - John Hrom
- Hattiesburg Clinic/Forrest General Cancer Center, Hattiesburg, Mississippi, USA
| | | | | | | | - Raphael Rousseau
- Gritstone Oncology, Inc., Emeryville, California and Cambridge, Massachusetts, USA
| | - Cynthia Voong
- Gritstone Oncology, Inc., Emeryville, California and Cambridge, Massachusetts, USA
| | - Naiyer A Rizvi
- New York Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Elie Fadel
- Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Mark Frattini
- New York Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Karin Jooss
- Gritstone Oncology, Inc., Emeryville, California and Cambridge, Massachusetts, USA
| | - Mojca Skoberne
- Gritstone Oncology, Inc., Emeryville, California and Cambridge, Massachusetts, USA
| | - Joshua Francis
- Gritstone Oncology, Inc., Emeryville, California and Cambridge, Massachusetts, USA
| | - Roman Yelensky
- Gritstone Oncology, Inc., Emeryville, California and Cambridge, Massachusetts, USA
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Brahmer JR, Govindan R, Anders RA, Antonia SJ, Sagorsky S, Davies MJ, Dubinett SM, Ferris A, Gandhi L, Garon EB, Hellmann MD, Hirsch FR, Malik S, Neal JW, Papadimitrakopoulou VA, Rimm DL, Schwartz LH, Sepesi B, Yeap BY, Rizvi NA, Herbst RS. The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of non-small cell lung cancer (NSCLC). J Immunother Cancer 2018; 6:75. [PMID: 30012210 PMCID: PMC6048854 DOI: 10.1186/s40425-018-0382-2] [Citation(s) in RCA: 161] [Impact Index Per Article: 26.8] [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: 03/22/2018] [Accepted: 06/27/2018] [Indexed: 12/19/2022] Open
Abstract
Lung cancer is the leading cause of cancer-related mortality worldwide, with non-small cell lung cancer (NSCLC) accounting for over 85% of all cases. Until recently, chemotherapy – characterized by some benefit but only rare durable responses – was the only treatment option for patients with NSCLC whose tumors lacked targetable mutations. By contrast, immune checkpoint inhibitors have demonstrated distinctly durable responses and represent the advent of a new treatment approach for patients with NSCLC. Three immune checkpoint inhibitors, pembrolizumab, nivolumab and atezolizumab, are now approved for use in first- and/or second-line settings for selected patients with advanced NSCLC, with promising benefit also seen in patients with stage III NSCLC. Additionally, durvalumab following chemoradiation has been approved for use in patients with locally advanced disease. Due to the distinct features of cancer immunotherapy, and rapid progress in the field, clinical guidance is needed on the use of these agents, including appropriate patient selection, sequencing of therapies, response monitoring, adverse event management, and biomarker testing. The Society for Immunotherapy of Cancer (SITC) convened an expert Task Force charged with developing consensus recommendations on these key issues. Following a systematic process as outlined by the National Academy of Medicine, a literature search and panel voting were used to rate the strength of evidence for each recommendation. This consensus statement provides evidence-based recommendations to help clinicians integrate immune checkpoint inhibitors into the treatment plan for patients with NSCLC. This guidance will be updated following relevant advances in the field.
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Affiliation(s)
- Julie R Brahmer
- Bloomberg Kimmel Immunotherapy Institute, Johns Hopkins Kimmel Cancer Center, Baltimore, MD, 21231, USA
| | | | | | - Scott J Antonia
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Sarah Sagorsky
- Johns Hopkins Kimmel Cancer Center, Baltimore, MD, 21231, USA
| | - Marianne J Davies
- Yale Comprehensive Cancer Center, Yale University School of Nursing, New Haven, CT, 06520, USA
| | - Steven M Dubinett
- University of California Los Angeles Lung Cancer Research Program, David Geffen School of Medicine, University of California, Los Angeles, CA, 90095, USA
| | | | - Leena Gandhi
- Department of Medicine, New York University, Perlmutter Cancer Center, NYU School of Medicine, New York, NY, 10016, USA
| | - Edward B Garon
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90404, USA
| | - Matthew D Hellmann
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Fred R Hirsch
- University of Colorado Denver School of Medicine, Denver, CO, 80011, USA
| | - Shakuntala Malik
- National Cancer Institute, Division of Cancer Treatment and Diagnosis, Cancer Therapy Evaluation Program, Rockville, USA
| | - Joel W Neal
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - David L Rimm
- Department of Pathology, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Lawrence H Schwartz
- Department of Radiology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York City, NY, 10032, USA
| | - Boris Sepesi
- Thoracic Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Beow Yong Yeap
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Naiyer A Rizvi
- Columbia University Medical Center, New York, NY, 10028, USA
| | - Roy S Herbst
- Yale Comprehensive Cancer Center, Yale School of Medicine, 333 Cedar Street, WWW221, New Haven, CT, 06520-8028, USA.
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38
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Garassino MC, Cho BC, Kim JH, Mazieres J, Gray JE, Wheatley-Price P, Park K, Soo RA, Huang Y, Wadsworth C, Dennis PA, Rizvi NA. Durvalumab in ≥ 3rd-line advanced NSCLC: Updated results from the phase 2 ATLANTIC study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.9058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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)
| | - Byoung Chul Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea, Republic of (South)
| | - Joo-Hang Kim
- CHA Bundang Medical Center, CHA University, Gyeonggi-Do, Republic of Korea
| | - Julien Mazieres
- Toulouse University Hospital, Université Paul Sabatier, Toulouse, France
| | | | - Paul Wheatley-Price
- The Ottawa Hospital Research Institute / University of Ottawa, Ottawa, ON, Canada
| | - Keunchil Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ross A. Soo
- National University Hospital / Cancer Science Institute, Singapore, Singapore
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Heymach J, Thomas M, Besse B, Forde PM, Awad MM, Goss GD, Park K, Rizvi NA, Lao-Sirieix SH, Patel SI, Mortimer PG, Ambrose H, Jewsbury PJ, Sachsenmeier K, Khoja L, Brugger W. An open-label, multidrug, biomarker-directed, multicentre phase II umbrella study in patients with non-small cell lung cancer, who progressed on an anti-PD-1/PD-L1 containing therapy (HUDSON). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps3120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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)
- John Heymach
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Thomas
- Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | | | - Patrick M. Forde
- Johns Hopkins Kimmel Comprehensive Cancer Center and Bloomberg-Kimmel Institute for Cancer Immunotherapy, Baltimore, MD
| | | | | | - Keunchil Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | | | - Sabina I Patel
- Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Melbourn, United Kingdom
| | | | | | | | | | - Leila Khoja
- Oncology IMED Biotech Unit, AstraZeneca, Melbourn, United Kingdom
| | - Wolfram Brugger
- Oncology IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
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Mathew M, Lagos GG, Rao N, Asmar RN, Liu X, Rizvi NA, Orjuela MA, Shu CA. Characteristics and outcomes of Latino patients with EGFR-mutant NSCLC. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Nisha Rao
- Columbia University Medical Center, New York, NY
| | | | - Xinhua Liu
- Columbia University Medical Center, New York, NY
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Wu J, Freites-Martinez A, Hellmann MD, Rosenberg JE, Motzer RJ, Chapman PB, Rizvi NA, Geskin LJ, Reed VA, Dusza SW, Markova A, Callahan MK, Chan D, Lopez A, Yang CH, Chung WH, Lacouture ME. Treatment outcomes of cutaneous adverse events to immune checkpoint inhibitors. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e22093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jennifer Wu
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Keelung, and Taipei, and Chang Gung University, Taipei, Taiwan
| | - Azael Freites-Martinez
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | | | | | - Alina Markova
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Donald Chan
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Wen-Hung Chung
- Chang Gung Memorial Hospital, Linkou, Keelung, and Taipei, Taipei, Taiwan
| | - Mario E. Lacouture
- Memorial Sloan Kettering Cancer Center, Department of Dermatology, New York, NY
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Johnson ML, Solomon BJ, Awad MM, Cho BC, Gainor JF, Goldberg SB, Keam B, Lee DH, Huang C, Helms HJ, Barak H, Fasso M, Bleul C, Cha E, Rizvi NA. MORPHEUS: A phase Ib/II multi-trial platform evaluating the safety and efficacy of cancer immunotherapy (CIT)-based combinations in patients (pts) with non-small cell lung cancer (NSCLC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps9105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Bhumsuk Keam
- Seoul National University Hospital - Cancer Research Institute (CRI), Seoul, Republic of Korea
| | - Dae Ho Lee
- Asan Medical Center, University of Ulsan College of Medicine Seoul, Seoul, Republic of Korea
| | - Chen Huang
- F. Hoffmann-La Roche Ltd., Shanghai, China
| | | | - Hila Barak
- Genentech, Inc., South San Francisco, CA
| | | | | | - Edward Cha
- Genentech, Inc., South San Francisco, CA
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Sanborn RE, Pishvaian MJ, Callahan MK, Weise AM, Sikic BI, Rahma OE, Cho DC, Rizvi NA, Bitting RL, Starodub A, Jimeno A, Yellin MJ, Rawls T, Vitale L, Halim A, Zhang H, Keler T. Anti-CD27 agonist antibody varlilumab (varli) with nivolumab (nivo) for colorectal (CRC) and ovarian (OVA) cancer: Phase (Ph) 1/2 clinical trial results. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.3001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rachel E. Sanborn
- Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR
| | | | | | | | | | | | - Daniel C. Cho
- New York University School of Medicine, New York, NY
| | | | - Rhonda L. Bitting
- Internal Medicine, Section on Hematology and Oncology, Winston Salem, NC
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Antonia SJ, Hellmann MD, Dennis PA, Melillo G, Abdullah SE, Lloyd A, Rizvi NA. A comparative safety analysis for durvalumab in patients with locally advanced, unresectable NSCLC: PACIFIC versus pooled durvalumab monotherapy studies. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.8556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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45
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Autio KA, Arkenau HT, O'Neil BH, Bendell JC, El-Khoueiry A, Strauss J, Weise A, Uboha NV, Rizvi NA, Zheng B, Desnoyers L, Stroh M, Carman L, Humphrey RW, Will M, Boni V, Spira AI, Naing A. Preliminary results of the first-in-human, dose-finding PROCLAIM-CX-072 trial of the PD-L1 Probody therapeutic CX-072 as monotherapy in patients (pts) with advanced solid tumors. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.3071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Bert H. O'Neil
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | | | | | - Amy Weise
- Barbara Ann Karmanos Cancer Institute, Detroit, MI
| | | | | | | | | | - Mark Stroh
- CytomX Therapeutics, South San Francisco, CA
| | - Lori Carman
- CytomX Therapeutics, South San Francisco, CA
| | | | | | - Valentina Boni
- START Madrid CIOCC, Hospital HM Universitario Sanchinarro, Madrid, Spain
| | | | - Aung Naing
- University of Texas, MD Anderson Cancer Center, Houston, TX
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46
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Shu CA, Grigg C, Chiuzan C, Garofano RF, Patel V, Hernandez S, Negri T, Sacher AG, Smith-Marrone S, Stoopler M, Gainor JF, Awad MM, D'Ovidio F, Sonett JR, Bacchetta M, Saqi A, Rizvi NA. Neoadjuvant atezolizumab + chemotherapy in resectable non-small cell lung cancer (NSCLC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.8532] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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)
| | - Claud Grigg
- Columbia University Medical Center, New York, NY
| | | | | | - Vijeta Patel
- Columbia University Medical Center, New York, NY
| | | | | | | | | | | | | | | | | | | | | | - Anjali Saqi
- Columbia University Medical Center, New York, NY
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47
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Hellmann MD, Callahan MK, Awad MM, Calvo E, Ascierto PA, Atmaca A, Rizvi NA, Hirsch FR, Selvaggi G, Szustakowski JD, Sasson A, Golhar R, Vitazka P, Chang H, Geese WJ, Antonia SJ. Tumor Mutational Burden and Efficacy of Nivolumab Monotherapy and in Combination with Ipilimumab in Small-Cell Lung Cancer. Cancer Cell 2018; 33:853-861.e4. [PMID: 29731394 PMCID: PMC6750707 DOI: 10.1016/j.ccell.2018.04.001] [Citation(s) in RCA: 594] [Impact Index Per Article: 99.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/12/2018] [Accepted: 04/02/2018] [Indexed: 12/13/2022]
Abstract
Durable responses and encouraging survival have been demonstrated with immune checkpoint inhibitors in small-cell lung cancer (SCLC), but predictive markers are unknown. We used whole exome sequencing to evaluate the impact of tumor mutational burden on efficacy of nivolumab monotherapy or combined with ipilimumab in patients with SCLC from the nonrandomized or randomized cohorts of CheckMate 032. Patients received nivolumab (3 mg/kg every 2 weeks) or nivolumab plus ipilimumab (1 mg/kg plus 3 mg/kg every 3 weeks for four cycles, followed by nivolumab 3 mg/kg every 2 weeks). Efficacy of nivolumab ± ipilimumab was enhanced in patients with high tumor mutational burden. Nivolumab plus ipilimumab appeared to provide a greater clinical benefit than nivolumab monotherapy in the high tumor mutational burden tertile.
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Affiliation(s)
- Matthew D Hellmann
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, and Parker Center for Cancer Immunotherapy, 885 2nd Avenue, New York, NY 10017, USA.
| | - Margaret K Callahan
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, and Parker Center for Cancer Immunotherapy, 885 2nd Avenue, New York, NY 10017, USA
| | - Mark M Awad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Emiliano Calvo
- START Madrid, Centro Integral Oncológico Clara Campal, Medical Oncology Division, Hospital Universitario Madrid Norte Sanchinarro, Madrid 28050, Spain
| | - Paolo A Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapy, Istituto Nazionale Tumori Fondazione G. Pascale, Naples 80131, Italy
| | - Akin Atmaca
- Department of Hematology and Oncology, Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt am Main 60488, Germany
| | - Naiyer A Rizvi
- Division of Hematology and Oncology, Columbia University Medical Center, New York, NY 10032, USA
| | - Fred R Hirsch
- Department of Medicine, Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Giovanni Selvaggi
- Clinical Development, Bristol-Myers Squibb, Princeton, NJ 08648, USA
| | | | - Ariella Sasson
- Translational Medicine, Bristol-Myers Squibb, Princeton, NJ 08648, USA
| | - Ryan Golhar
- Translational Medicine, Bristol-Myers Squibb, Princeton, NJ 08648, USA
| | - Patrik Vitazka
- Translational Medicine, Bristol-Myers Squibb, Princeton, NJ 08648, USA
| | - Han Chang
- Translational Medicine, Bristol-Myers Squibb, Princeton, NJ 08648, USA
| | - William J Geese
- Translational Medicine, Bristol-Myers Squibb, Princeton, NJ 08648, USA
| | - Scott J Antonia
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
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48
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Brogden KA, Parashar D, Hallier AR, Braun T, Qian F, Rizvi NA, Bossler AD, Milhem MM, Chan TA, Abbasi T, Vali S. Correction to: Genomics of NSCLC patients both affirm PD-L1 expression and predict their clinical responses to anti-PD-1 immunotherapy. BMC Cancer 2018; 18:413. [PMID: 29649990 PMCID: PMC5898039 DOI: 10.1186/s12885-018-4200-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kim A Brogden
- Iowa Institute for Oral Health Research, College of Dentistry, The University of Iowa, 801 Newton Road, Iowa City, IA, 52242, USA.
| | - Deepak Parashar
- Cellworks Research India Ltd., Whitefield, Bangalore, 560066, India
| | - Andrea R Hallier
- Biomedical Engineering, The University of Iowa, 5318 SC, Iowa City, IA, 52242, USA
| | - Terry Braun
- Biomedical Engineering, The University of Iowa, 5318 SC, Iowa City, IA, 52242, USA
| | - Fang Qian
- Iowa Institute for Oral Health Research, College of Dentistry, The University of Iowa, 801 Newton Road, Iowa City, IA, 52242, USA.,Division of Biostatistics and Research Design, College of Dentistry, The University of Iowa, 801 Newton Road, Iowa City, IA, 52242, USA
| | - Naiyer A Rizvi
- Division of Hematology/Oncology, Columbia University Medical Center, 177 Fort Washington Avenue, New York, NY, 10032, USA
| | - Aaron D Bossler
- Molecular Pathology Laboratory, Department of Pathology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr., C606GH, Iowa City, IA, 52242, USA
| | - Mohammed M Milhem
- Clinical Services, Experimental Therapeutics, Melanoma and Sarcoma Program, Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, IA, 52242, USA
| | - Timothy A Chan
- Department of Radiation Oncology, Human Oncology and Pathogenesis Program, Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Taher Abbasi
- Cellworks Group, Inc., 2033 Gateway Place Suite 500, San Jose, CA, 95110, USA
| | - Shireen Vali
- Cellworks Group, Inc., 2033 Gateway Place Suite 500, San Jose, CA, 95110, USA
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Garassino MC, Cho BC, Kim JH, Mazières J, Vansteenkiste J, Lena H, Corral Jaime J, Gray JE, Powderly J, Chouaid C, Bidoli P, Wheatley-Price P, Park K, Soo RA, Huang Y, Wadsworth C, Dennis PA, Rizvi NA. Durvalumab as third-line or later treatment for advanced non-small-cell lung cancer (ATLANTIC): an open-label, single-arm, phase 2 study. Lancet Oncol 2018; 19:521-536. [PMID: 29545095 DOI: 10.1016/s1470-2045(18)30144-x] [Citation(s) in RCA: 417] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/23/2018] [Accepted: 01/25/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors are a new standard of care for patients with advanced non-small-cell lung cancer (NSCLC) without EGFR tyrosine kinase or anaplastic lymphoma kinase (ALK) genetic aberrations (EGFR-/ALK-), but clinical benefit in patients with EGFR mutations or ALK rearrangements (EGFR+/ALK+) has not been shown. We assessed the effect of durvalumab (anti-PD-L1) treatment in three cohorts of patients with NSCLC defined by EGFR/ALK status and tumour expression of PD-L1. METHODS ATLANTIC is a phase 2, open-label, single-arm trial at 139 study centres in Asia, Europe, and North America. Eligible patients had advanced NSCLC with disease progression following at least two previous systemic regimens, including platinum-based chemotherapy (and tyrosine kinase inhibitor therapy if indicated); were aged 18 years or older; had a WHO performance status score of 0 or 1; and measurable disease per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. Key exclusion criteria included mixed small-cell lung cancer and NSCLC histology; previous exposure to any anti-PD-1 or anti-PD-L1 antibody; and any previous grade 3 or worse immune-related adverse event while receiving any immunotherapy agent. Patients in cohort 1 had EGFR+/ALK+ NSCLC with at least 25%, or less than 25%, of tumour cells with PD-L1 expression. Patients in cohorts 2 and 3 had EGFR-/ALK- NSCLC; cohort 2 included patients with at least 25%, or less than 25%, of tumour cells with PD-L1 expression, and cohort 3 included patients with at least 90% of tumour cells with PD-L1 expression. Patients received durvalumab (10 mg/kg) every 2 weeks, via intravenous infusion, for up to 12 months. Retreatment was allowed for patients who benefited but then progressed after completing 12 months. The primary endpoint was the proportion of patients with increased tumour expression of PD-L1 (defined as ≥25% of tumour cells in cohorts 1 and 2, and ≥90% of tumour cells in cohort 3) who achieved an objective response, assessed in patients who were evaluable for response per independent central review according to RECIST version 1.1. Safety was assessed in all patients who received at least one dose of durvalumab and for whom any post-dose data were available. The trial is ongoing, but is no longer open to accrual, and is registered with ClinicalTrials.gov, number NCT02087423. FINDINGS Between Feb 25, 2014, and Dec 28, 2015, 444 patients were enrolled and received durvalumab: 111 in cohort 1, 265 in cohort 2, and 68 in cohort 3. Among patients with at least 25% of tumour cells expressing PD-L1 who were evaluable for objective response per independent central review, an objective response was achieved in 9 (12·2%, 95% CI 5·7-21·8) of 74 patients in cohort 1 and 24 (16·4%, 10·8-23·5) of 146 patients in cohort 2. In cohort 3, 21 (30·9%, 20·2-43·3) of 68 patients achieved an objective response. Grade 3 or 4 treatment-related adverse events occurred in 40 (9%) of 444 patients overall: six (5%) of 111 patients in cohort 1, 22 (8%) of 265 in cohort 2, and 12 (18%) of 68 in cohort 3. The most common treatment-related grade 3 or 4 adverse events were pneumonitis (four patients [1%]), elevated gamma-glutamyltransferase (four [1%]), diarrhoea (three [1%]), infusion-related reaction (three [1%]), elevated aspartate aminotransferase (two [<1%]), elevated transaminases (two [<1%]), vomiting (two [<1%]), and fatigue (two [<1%]). Treatment-related serious adverse events occurred in 27 (6%) of 444 patients overall: five (5%) of 111 patients in cohort 1, 14 (5%) of 265 in cohort 2, and eight (12%) of 68 in cohort 3. The most common serious adverse events overall were pneumonitis (five patients [1%]), fatigue (three [1%]), and infusion-related reaction (three [1%]). Immune-mediated events were manageable with standard treatment guidelines. INTERPRETATION In patients with advanced and heavily pretreated NSCLC, the clinical activity and safety profile of durvalumab was consistent with that of other anti-PD-1 and anti-PD-L1 agents. Responses were recorded in all cohorts; the proportion of patients with EGFR-/ALK- NSCLC (cohorts 2 and 3) achieving a response was higher than the proportion with EGFR+/ALK+ NSCLC (cohort 1) achieving a response. The clinical activity of durvalumab in patients with EGFR+ NSCLC with ≥25% of tumour cells expressing PD-L1 was encouraging, and further investigation of durvalumab in patients with EGFR+/ALK+ NSCLC is warranted. FUNDING AstraZeneca.
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Affiliation(s)
| | - Byoung-Chul Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Joo-Hang Kim
- CHA Bundang Medical Center, CHA University, Gyeonggi-do, South Korea
| | - Julien Mazières
- Toulouse University Hospital, Université Paul Sabatier, Toulouse, France
| | | | - Hervé Lena
- CHU Rennes-Hôpital Pontchaillou, Rennes University, Rennes, France
| | | | - Jhanelle E Gray
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - John Powderly
- Carolina BioOncology Institute, Huntersville, NC, USA
| | | | | | - Paul Wheatley-Price
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Keunchil Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ross A Soo
- National University Hospital and National University Cancer Institute, Singapore
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50
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Brogden KA, Parashar D, Hallier AR, Braun T, Qian F, Rizvi NA, Bossler AD, Milhem MM, Chan TA, Abbasi T, Vali S. Genomics of NSCLC patients both affirm PD-L1 expression and predict their clinical responses to anti-PD-1 immunotherapy. BMC Cancer 2018; 18:225. [PMID: 29486723 PMCID: PMC5897943 DOI: 10.1186/s12885-018-4134-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 02/15/2018] [Indexed: 12/21/2022] Open
Abstract
Background Programmed Death Ligand 1 (PD-L1) is a co-stimulatory and immune checkpoint protein. PD-L1 expression in non-small cell lung cancers (NSCLC) is a hallmark of adaptive resistance and its expression is often used to predict the outcome of Programmed Death 1 (PD-1) and PD-L1 immunotherapy treatments. However, clinical benefits do not occur in all patients and new approaches are needed to assist in selecting patients for PD-1 or PD-L1 immunotherapies. Here, we hypothesized that patient tumor cell genomics influenced cell signaling and expression of PD-L1, chemokines, and immunosuppressive molecules and these profiles could be used to predict patient clinical responses. Methods We used a recent dataset from NSCLC patients treated with pembrolizumab. Deleterious gene mutational profiles in patient exomes were identified and annotated into a cancer network to create NSCLC patient-specific predictive computational simulation models. Validation checks were performed on the cancer network, simulation model predictions, and PD-1 match rates between patient-specific predicted and clinical responses. Results Expression profiles of these 24 chemokines and immunosuppressive molecules were used to identify patients who would or would not respond to PD-1 immunotherapy. PD-L1 expression alone was not sufficient to predict which patients would or would not respond to PD-1 immunotherapy. Adding chemokine and immunosuppressive molecule expression profiles allowed patient models to achieve a greater than 85.0% predictive correlation among predicted and reported patient clinical responses. Conclusions Our results suggested that chemokine and immunosuppressive molecule expression profiles can be used to accurately predict clinical responses thus differentiating among patients who would and would not benefit from PD-1 or PD-L1 immunotherapies. Electronic supplementary material The online version of this article (10.1186/s12885-018-4134-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kim A Brogden
- Iowa Institute for Oral Health Research, College of Dentistry, The University of Iowa, 801 Newton Road, Iowa City, IA, 52242, USA.
| | - Deepak Parashar
- Cellworks Research India Ltd., Whitefield, Bangalore, 560066, India
| | - Andrea R Hallier
- Biomedical Engineering, The University of Iowa, 5318 SC, Iowa City, IA, 52242, USA
| | - Terry Braun
- Biomedical Engineering, The University of Iowa, 5318 SC, Iowa City, IA, 52242, USA
| | - Fang Qian
- Iowa Institute for Oral Health Research, College of Dentistry, The University of Iowa, 801 Newton Road, Iowa City, IA, 52242, USA.,Division of Biostatistics and Research Design, College of Dentistry, The University of Iowa, 801 Newton Road, Iowa City, IA, 52242, USA
| | - Naiyer A Rizvi
- Division of Hematology/Oncology, Columbia University Medical Center, 177 Fort Washington Avenue, New York, NY, 10032, USA
| | - Aaron D Bossler
- Molecular Pathology Laboratory, Department of Pathology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr., C606GH, Iowa City, IA, 52242, USA
| | - Mohammed M Milhem
- Clinical Services, Experimental Therapeutics, Melanoma and Sarcoma Program, Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, IA, 52242, USA
| | - Timothy A Chan
- Department of Radiation Oncology, Human Oncology and Pathogenesis Program, Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Taher Abbasi
- Cellworks Group, Inc., 2033 Gateway Place Suite 500, San Jose, CA, 95110, USA
| | - Shireen Vali
- Cellworks Group, Inc., 2033 Gateway Place Suite 500, San Jose, CA, 95110, USA
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