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Brilli L, Danielli R, Campanile M, Secchi C, Ciuoli C, Calabrò L, Pilli T, Cartocci A, Pacini F, Di Giacomo AM, Castagna MG. Baseline serum TSH levels predict the absence of thyroid dysfunction in cancer patients treated with immunotherapy. J Endocrinol Invest 2021; 44:1719-1726. [PMID: 33367977 PMCID: PMC8285335 DOI: 10.1007/s40618-020-01480-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/27/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Immunotherapy against immune checkpoints has significantly improved survival both in metastatic and adjuvant setting in several types of cancers. Thyroid dysfunction is the most common endocrine adverse event reported. Patients who are at risk of developing thyroid dysfunction remain to be defined. We aimed to identify predictive factors for the development of thyroid dysfunction during immunotherapy. METHODS This is a retrospective study including a total of 68 patients who were treated with immune checkpoint inhibitors (ICIs) for metastatic or unresectable advanced cancers. The majority of patients were treated with anti-PD1 drugs in monotherapy or in combination with anti-CTLA4 inhibitors. Thyroid function and anti-thyroid antibodies, before starting immunotherapy and during treatment, were evaluated. Thyroid ultrasound was also performed in a subgroup of patients at the time of enrolment in the study. RESULTS Eleven out of 68 patients (16.1%) developed immune-related overt thyroid dysfunction. By ROC curve analysis, we found that a serum TSH cut-off of 1.72 mUI/l, at baseline, had a good diagnostic accuracy in identifying patients without overt thyroid dysfunction (NPV = 100%, p = 0.0029). At multivariate analysis, both TSH and positive anti-thyroid antibodies (ATAbs) levels, before ICIs treatment, were independently associated with the development of overt thyroid dysfunction during immunotherapy (p = 0.0001 and p = 0.009, respectively). CONCLUSIONS Pre-treatment serum TSH and ATAbs levels may help to identify patients at high risk for primary thyroid dysfunction. Our study suggests guidance for an appropriate timely screening and for a tailored management of thyroid dysfunctions in patients treated with ICIs.
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Affiliation(s)
- L Brilli
- Endocrinology Unit, Department of Medical, Surgical and Neurological Sciences, University Hospital of Siena, Siena, 53100, Italy
| | - R Danielli
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, 53100, Siena, Italy
| | - M Campanile
- Endocrinology Unit, Department of Medical, Surgical and Neurological Sciences, University Hospital of Siena, Siena, 53100, Italy
| | - C Secchi
- Endocrinology Unit, Department of Medical, Surgical and Neurological Sciences, University Hospital of Siena, Siena, 53100, Italy
| | - C Ciuoli
- Endocrinology Unit, Department of Medical, Surgical and Neurological Sciences, University Hospital of Siena, Siena, 53100, Italy
| | - L Calabrò
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, 53100, Siena, Italy
| | - T Pilli
- Endocrinology Unit, Department of Medical, Surgical and Neurological Sciences, University Hospital of Siena, Siena, 53100, Italy
| | - A Cartocci
- Department of Medical Biotechnologies, University of Siena, Siena, 53100, Italy
| | - F Pacini
- Department of Biomedical Sciences, Humanitas Clinical and Research Center, IRCCS, 20089, Rozzano, Milan, Italy
| | - A M Di Giacomo
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, 53100, Siena, Italy
| | - M G Castagna
- Endocrinology Unit, Department of Medical, Surgical and Neurological Sciences, University Hospital of Siena, Siena, 53100, Italy.
- Department of Medical Sciences, University of Siena, Policlinico Santa Maria Alle Scotte, Viale Bracci 16, 53100, Siena, Italy.
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Balar AV, Moreno V, Angevin E, Gan HK, Vieito M, Italiano A, Danielli R, Massarelli E, Opdam F, Chisamore MJ, Rogan D, Ji X, Henry C, Ellis CE, Ballas MS, Hoos A, Ricci F. Inducible T-cell co-stimulatory (ICOS) receptor agonist, feladilimab (fela), alone and in combination (combo) with pembrolizumab (P): Results from INDUCE-1 urothelial carcinoma (UC) expansion cohorts (ECs). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.4519] [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
4519 Background: INDUCE-1 is a first-in-human trial evaluating fela, an IgG4 ICOS agonist non-T-cell depleting mAb, as monotherapy (mono) and in combo with P. ECs include tumor types, such as UC, with high ICOS expression and immunotherapy-favorable features. Fela induced IFNγ, increased PD-1/L1 expression, and enhanced antitumor activity in combo with PD-1 blockade nonclinically. We report preliminary efficacy, safety, and biomarker data of fela ± P in INDUCE-1 UC ECs. Methods: Eligible patients (pts) had recurrent/metastatic (R/M) UC of the upper or lower urinary tract, ≤6 prior systemic therapy lines in the advanced setting, measurable disease, and no active autoimmune disease. Pts received 0.3 or 1 mg/kg fela (mono EC; anti-PD-1/L1–experienced [exp] pts) or 0.3 mg/kg fela + 200 mg P (combo EC; anti-PD-1/L1–naïve pts) every 3 wks, up to 35 cycles until disease progression or unacceptable toxicity. Disease was assessed every 9 wks through wk 54, then every 12 wks. Archival and/or fresh biopsy tumor tissue was collected for biomarker analyses and safety assessed. Results: By Nov 6 2020, 13 anti-PD-1/L1–exp and 32 anti-PD-1/L1–naïve pts were evaluable in the mono and combo ECs, respectively. In the mono EC, median age was 69 yrs (range: 47–82), 92% of pts were male, and 85% received ≥2 prior therapy lines in the metastatic setting. In the combo EC, median age was 70 yrs (range: 42–84), 75% of pts were male, and 72% received ≥1 prior therapy line in the metastatic setting. In the mono EC, median duration of follow-up (mDoF) was 10.6 mo (range: 1.1–22.8); overall response rate (ORR) was 8% (1 partial response [PR]; 95% CI: 0.2, 36.0) with a duration of response (DoR) of 6.1 mo; disease control rate (DCR [response or stable disease for ≥9 wks]) was 23% (95% CI: 5.0, 53.8), and median overall survival (mOS) was 14.5 mo (95% CI: 2.8, NR), with 74% of pts alive at 6 mo. In the combo EC, mDoF was 9.6 mo (range: 0.9–28.3); ORR was 22% (7 PRs; 95% CI: 9.3, 40.0) with a median DoR of 8.3 months (range: 3.5–23.3+); DCR was 63% (95% CI: 43.7, 78.9), and mOS was 10.7 mo (95% CI: 5.2, 18.1), with 64% of pts alive at 6 mo. Grade ≥3 treatment-related AEs were reported for 0% and 9% of pts in the mono (N = 16) and combo (N = 44) safety populations, respectively. PD-L1 expression and ICOS-specific biomarkers are being evaluated, with promising trends observed in enrichment of clinical activity in preliminary analyses. Conclusions: Fela is the first ICOS agonist with reported single-agent activity in anti-PD-1/L1–exp relapsed/refractory UC. Fela + P in combo shows promising clinical activity and manageable safety in PD-1/L1–naïve R/M UC. Further study is warranted. Updated data to be presented. Funding: Study 204691 (NCT02723955) funded by GlaxoSmithKline in collaboration with Merck Sharp & Dohme Corp, a subsidiary of Merck & Co, Inc, Kenilworth, NJ, USA. Clinical trial information: NCT02723955.
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Affiliation(s)
| | - Victor Moreno
- START Madrid-FJD, University Hospital “Fundacion Jimenez Diaz”, Madrid, Spain
| | - Eric Angevin
- Gustave Roussy Institut de Cancérologie, Villejuif, France
| | - Hui Kong Gan
- Department of Medical Oncology, Austin Hospital, Melbourne, VIC, Australia
| | - Maria Vieito
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital (HUVH), Barcelona, Spain
| | | | | | | | - Frans Opdam
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Debra Rogan
- GlaxoSmithKline, Research Triangle Park, Durham, NC
| | - Xiao Ji
- GlaxoSmithKline, Collegeville, PA
| | | | | | | | | | - Francesco Ricci
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris, France
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3
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Bersanelli M, Giannarelli D, Leonetti A, Buti S, Tiseo M, Nouvenne A, Ticinesi A, Meschi T, Procopio G, Danielli R. The right immune-modulation at the right time: thymosin α1 for prevention of severe COVID-19 in cancer patients. Future Oncol 2021; 17:1097-1104. [PMID: 33538178 PMCID: PMC7874885 DOI: 10.2217/fon-2020-0754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
We presented the rationale for the use of thymosin α1 as prophylaxis of severe COVID-19 in cancer patients undergoing active treatment, constituting the background for the PROTHYMOS study, a prospective, multicenter, open-label, Phase II randomized study, currently in its start-up phase (Eudract no. 2020-006020-13). We aim to offer new hope for this incurable disease, especially to frail patient population, such as patients with cancer. The hypothesis of an effective prophylactic approach to COVID-19 would have immediate clinical relevance, especially given the lack of curative approaches. Moreover, in the ‘COVID-19 vaccine race era’ both clinical and biological results coming from the PROTHYMOS trials could even support the rationale for future combinatorial approaches, trying to rise vaccine efficacy in frail individuals. We present scientific evidence in favor of using a drug (thymosin-α1) that modulates the immune system functions to try and prevent severe COVID-19 in cancer patients who are currently receiving anticancer treatment. Thymosin-α1 is produced normally by the body in the thymus, which is present in children but not in adults. Given the better outcomes of SARS-CoV-2 infections in children, we thought that thymosin-α1 could help to protect adults from severe infections as well. In this review, we explain some scientific evidence and the background of our clinical trial, PROTHYMOS, which is investigating this preventive treatment. Our aim is to offer a new hope to these at-risk cancer patients, particularly for the elderly who are at most risk of developing severe COVID-19. Given the lack of approaches that can provide cures to COVID-19, any possibility to prevent severe infection should be explored.
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Affiliation(s)
- Melissa Bersanelli
- Medical Oncology Unit, University Hospital of Parma, Via Gramsci 14, Parma, 43126, Italy.,Medicine & Surgery Department, University of Parma, Via Gramsci 14, Parma, 43126, Italy
| | - Diana Giannarelli
- Biostatistical Unit, Regina Elena National Cancer Institute, IRCCS, Via Elio Chianesi 53, Rome, 00144, Italy
| | - Alessandro Leonetti
- Medical Oncology Unit, University Hospital of Parma, Via Gramsci 14, Parma, 43126, Italy.,Medicine & Surgery Department, University of Parma, Via Gramsci 14, Parma, 43126, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Via Gramsci 14, Parma, 43126, Italy.,Medicine & Surgery Department, University of Parma, Via Gramsci 14, Parma, 43126, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Via Gramsci 14, Parma, 43126, Italy.,Medicine & Surgery Department, University of Parma, Via Gramsci 14, Parma, 43126, Italy
| | - Antonio Nouvenne
- Geriatric Rehabilitation Medical Department, University Hospital of Parma, Via Gramsci 14, Parma, 43126, Italy
| | - Andrea Ticinesi
- Medicine & Surgery Department, University of Parma, Via Gramsci 14, Parma, 43126, Italy.,Geriatric Rehabilitation Medical Department, University Hospital of Parma, Via Gramsci 14, Parma, 43126, Italy
| | - Tiziana Meschi
- Medicine & Surgery Department, University of Parma, Via Gramsci 14, Parma, 43126, Italy.,Geriatric Rehabilitation Medical Department, University Hospital of Parma, Via Gramsci 14, Parma, 43126, Italy
| | - Giuseppe Procopio
- Genito-Urinary Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori of Milan, Via Giacomo Venezian, 1, Milano, 20133, Italy
| | - Riccardo Danielli
- Immuno-Oncology Unit, University Hospital of Siena, Viale Mario Bracci 16, Siena, 53100, Italy
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4
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Fizazi K, Drake CG, Beer TM, Kwon ED, Scher HI, Gerritsen WR, Bossi A, den Eertwegh AJMV, Krainer M, Houede N, Santos R, Mahammedi H, Ng S, Danielli R, Franke FA, Sundar S, Agarwal N, Bergman AM, Ciuleanu TE, Korbenfeld E, Sengeløv L, Hansen S, McHenry MB, Chen A, Logothetis C. Final Analysis of the Ipilimumab Versus Placebo Following Radiotherapy Phase III Trial in Postdocetaxel Metastatic Castration-resistant Prostate Cancer Identifies an Excess of Long-term Survivors. Eur Urol 2020; 78:822-830. [PMID: 32811715 PMCID: PMC8428575 DOI: 10.1016/j.eururo.2020.07.032] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 07/27/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND The phase 3 trial CA184-043 evaluated radiotherapy to bone metastases followed by Ipilimumab or placebo in men with metastatic castrate-resistant prostate cancer (mCRPC) who had received docetaxel previously. In a prior analysis, the trial's primary endpoint (overall survival [OS]) was not improved significantly. OBJECTIVE To report the final analysis of OS. DESIGN, SETTING, AND PARTICIPANTS A total of 799 patients were randomized to receive a single dose of radiotherapy to one or more bone metastases followed by either Ipilimumab (n = 399) or placebo (n = 400). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS OS was analyzed in the intention-to-treat population. Prespecified and exploratory subset analyses based on Kaplan-Meier/Cox methodology were performed. RESULTS AND LIMITATIONS During an additional follow-up of approximately 2.4 yr since the primary analysis, 721/799 patients have died. Survival analysis showed crossing of the curves at 7-8 mo, followed by persistent separation of the curves beyond that point, favoring the ipilimumab arm. Given the lack of proportional hazards, a piecewise hazard model showed that the hazard ratio (HR) changed over time: the HR was 1.49 (95% confidence interval 1.12, 1.99) for 0-5 mo, 0.66 (0.51, 0.86) for 5-12 mo, and 0.66 (0.52, 0.84) beyond 12 mo. OS rates were higher in the ipilimumab versus placebo arms at 2 yr (25.2% vs 16.6%), 3 yr (15.3% vs 7.9%), 4 yr (10.1% vs 3.3%), and 5 yr (7.9% vs. 2.7%). Disease progression was the most frequent cause of death in both arms. In seven patients (1.8%) in the ipilimumab arm and one (0.3%) in the placebo arm, the primary cause of death was reported as study drug toxicity. No long-term safety signals were identified. CONCLUSIONS In this preplanned long-term analysis, OS favored ipilimumab plus radiotherapy versus placebo plus radiotherapy for patients with postdocetaxel mCRPC. OS rates at 3, 4, and 5 yr were approximately two to three times higher in the ipilimumab arm. PATIENT SUMMARY After longer follow-up, survival favored the group of men who received ipilimumab, with overall survival rates being two to three times higher at 3 yr and beyond.
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Affiliation(s)
- Karim Fizazi
- Gustave Roussy, University of Paris Sud, Villejuif, France.
| | - Charles G Drake
- Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Tomasz M Beer
- Oregon Health & Science University Knight Cancer Institute, Portland, OR, USA
| | | | - Howard I Scher
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Weill-Cornell Medical College, New York, NY, USA
| | | | | | | | | | - Nadine Houede
- CHU of Nimes, Nimes, France; Montpellier University, Montpellier, France
| | | | | | - Siobhan Ng
- St John Of God Hospital, Subiaco, Australia
| | | | | | | | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - André M Bergman
- The Netherlands Cancer Institute and Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | | | | | - Lisa Sengeløv
- Herlev Hospital, Region Hovedstadens Apotek, Herlev, Denmark
| | | | | | - Allen Chen
- Bristol-Myers Squibb Company, Wallingford, CT, USA
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5
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Di Giacomo AM, Calabrò L, Danielli R, Valente M, Gambale E, Coral S, Amato G, Keer H, Giannarelli D, Azab M, Anichini A, Covre A, Maio M. Abstract CT270: A randomized, multi-center, phase II study of nivolumab combined with ipilimumab and guadecitabine or nivolumab combined with ipilimumab in melanoma and NSCLC patients resistant to anti-PD-1/-PD-L1: The NIBIT-ML1 Study. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-ct270] [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: Therapeutic targeting of the PD-1/PDL-1 axis significantly increases the survival of melanoma (MM) and non-small cell lung cancer (NSCLC) patients. Despite this unprecedented efficacy, a sizeable proportion of MM and NSCLC patients fails to benefit from therapy due to primary or secondary resistance to treatment. In this scenario, deepening the knowledge on mechanism(s) underlying treatment failure allows to design novel, mechanism-based, therapeutic approaches to overcome resistance to anti-PD-1/PDL-1 therapy. Along this line, we have extensively characterized the immunomodulatory properties of DNA hypomethylating agents (DHA) in different human malignances. Exposure of neoplastic cells to DHA efficiently improved antigen-restricted and -unrestricted T cell recognition of cancer cells in vitro through the upregulation/induction of the expression of epigenetically regulated tumor associated antigens, HLA class I and/or accessory/co-stimulatory molecules by neoplastic cells. Supporting these ex vivo data, combining the systemic administration of DHA (ie, decitabine or guadecitabine) with antibodies to different immune checkpoints significantly reduced tumor growth of murine syngeneic grafts, compared to single-agent therapy. Supporting these pre-clinical findings, our phase Ib NIBIT-M4 study has been the first clinical trial demonstrating that systemic administration of guadecitabine followed by CTLA-4 blockade with ipilimumab is safe and tolerable in MM patients, shows a promising anti-tumor, and induces a significant modulation of immune related pathways in tumor samples (Di Giacomo AM, Clin Cancer Res 2019). Prompted by these results and to further explore the efficacy of DHA combined with immune-checkpoints blockade we have designed and activated the NIBIT-ML1 trial. This study aims at investigating the efficacy of guadecitabine combined with ipilimumab and nivolumab in reverting the resistance to PD-1/PDL-1 therapy of MM and NSCLC patients. Methods: The NIBIT-ML1 is a randomized, phase II study designed according to the two stages optimal design by Simon, in unresectable Stage III or Stage IV MM (Cohort A) or NSCLC (Cohort B) patients who failed therapy with anti-PD-1/PDL-1 as last treatment. Primary objective of the study is immune (i)-ORR according to iRECIST criteria. Secondary objectives include safety, DCR, PFS, median OS, and survival rate at 1 and 2-years. Extensive cellular and molecular immune correlates will also be explored. Following a safety run-in phase in 6 subjects per Cohort, eligible patients will be randomized to receive: guadecitabine plus ipilimumab and nivolumab (ARM A) or ipilimumab and nivolumab (ARM B). Sample size will range from 6 to 92 patients per Cohort. The first patient first visit is foreseen by March 2020 (NCT04250246)
Citation Format: Anna Maria Di Giacomo, Luana Calabrò, Riccardo Danielli, Monica Valente, Elisabetta Gambale, Sandra Coral, Giovanni Amato, Harold Keer, Diana Giannarelli, Mohammad Azab, Andrea Anichini, Alessia Covre, Michele Maio. A randomized, multi-center, phase II study of nivolumab combined with ipilimumab and guadecitabine or nivolumab combined with ipilimumab in melanoma and NSCLC patients resistant to anti-PD-1/-PD-L1: The NIBIT-ML1 Study [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 CT270.
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Affiliation(s)
| | - Luana Calabrò
- 1Center for Immuno-Oncology - University Hospital of Siena, Siena, Italy
| | - Riccardo Danielli
- 1Center for Immuno-Oncology - University Hospital of Siena, Siena, Italy
| | - Monica Valente
- 1Center for Immuno-Oncology - University Hospital of Siena, Siena, Italy
| | - Elisabetta Gambale
- 1Center for Immuno-Oncology - University Hospital of Siena, Siena, Italy
| | - Sandra Coral
- 1Center for Immuno-Oncology - University Hospital of Siena, Siena, Italy
| | - Giovanni Amato
- 1Center for Immuno-Oncology - University Hospital of Siena, Siena, Italy
| | | | | | | | - Andrea Anichini
- 4Human Tumur Immunobiology Unit- Dep of Research- Fondazione IRCCS Istututo Nazionale dei Tumori, Milan, Italy
| | - Alessia Covre
- 1Center for Immuno-Oncology - University Hospital of Siena, Siena, Italy
| | - Michele Maio
- 1Center for Immuno-Oncology - University Hospital of Siena, Siena, Italy
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6
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Chiarucci C, Cannito S, Daffinà MG, Amato G, Giacobini G, Cutaia O, Lofiego MF, Fazio C, Giannarelli D, Danielli R, Di Giacomo AM, Coral S, Calabrò L, Maio M, Covre A. Circulating Levels of PD-L1 in Mesothelioma Patients from the NIBIT-MESO-1 Study: Correlation with Survival. Cancers (Basel) 2020; 12:E361. [PMID: 32033266 PMCID: PMC7072596 DOI: 10.3390/cancers12020361] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/28/2020] [Accepted: 02/01/2020] [Indexed: 12/30/2022] Open
Abstract
Targeting of the programmed cell death protein (PD)-1/programmed death-ligand 1 (PD-L1) axis has shown a significant clinical impact in several tumor types. Accordingly, our phase II NIBIT-MESO-1 study demonstrated an improved clinical efficacy in mesothelioma patients treated with the anti-PD-L1 durvalumab combined with the anti-cytotoxic T-lymphocyte antigen (CTLA)-4 tremelimumab, as compared to tremelimumab alone. Due to the promising therapeutic activity of immune check-point inhibitors (ICIs) in mesothelioma patients, the identification of biomarkers predictive of response to treatment is of crucial relevance. The prognostic role of soluble PD-L1 (sPD-L1) proposed in cancer patients prompted us to investigate this protein in sera from mesothelioma patients (n = 40) enrolled in the NIBIT-MESO-1 study. A significant (p < 0.001) increase in sPD-L1 levels was detected in patients after the first cycle and during therapy vs. baseline. A longer overall survival (OS) was observed in patients with sPD-L1 concentrations below (at baseline, d1C2, d1C5 (p < 0.01)) or FC values above (p < 0.05 at d1C2, d1C3, d1C5) their statistically calculated optimal cut-offs. On the basis of these initial results, the specific role of CTLA-4-, PD-L1-, or PD-1-targeting on sPD-L1 release was then investigated in sera from 81 additional ICI-treated solid cancer patients. Results showed a significant (p < 0.001) increase of sPD-L1 levels during therapy compared to baseline only in anti-PD-L1-treated patients, supporting the specific involvement of PD-L1 targeting in the release of its soluble form. Our findings suggest that sPD-L1 represents a predictive biomarker of clinical response to anti-PD-L1 cancer immunotherapy.
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Affiliation(s)
- Carla Chiarucci
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, 53100 Siena, Italy; (C.C.); (S.C.); (M.G.D.); (G.A.); (G.G.); (O.C.); (M.F.L.); (C.F.); (R.D.); (A.M.D.G.); (S.C.); (L.C.); (M.M.)
| | - Sara Cannito
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, 53100 Siena, Italy; (C.C.); (S.C.); (M.G.D.); (G.A.); (G.G.); (O.C.); (M.F.L.); (C.F.); (R.D.); (A.M.D.G.); (S.C.); (L.C.); (M.M.)
| | - Maria Grazia Daffinà
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, 53100 Siena, Italy; (C.C.); (S.C.); (M.G.D.); (G.A.); (G.G.); (O.C.); (M.F.L.); (C.F.); (R.D.); (A.M.D.G.); (S.C.); (L.C.); (M.M.)
| | - Giovanni Amato
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, 53100 Siena, Italy; (C.C.); (S.C.); (M.G.D.); (G.A.); (G.G.); (O.C.); (M.F.L.); (C.F.); (R.D.); (A.M.D.G.); (S.C.); (L.C.); (M.M.)
| | - Gianluca Giacobini
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, 53100 Siena, Italy; (C.C.); (S.C.); (M.G.D.); (G.A.); (G.G.); (O.C.); (M.F.L.); (C.F.); (R.D.); (A.M.D.G.); (S.C.); (L.C.); (M.M.)
| | - Ornella Cutaia
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, 53100 Siena, Italy; (C.C.); (S.C.); (M.G.D.); (G.A.); (G.G.); (O.C.); (M.F.L.); (C.F.); (R.D.); (A.M.D.G.); (S.C.); (L.C.); (M.M.)
| | - Maria Fortunata Lofiego
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, 53100 Siena, Italy; (C.C.); (S.C.); (M.G.D.); (G.A.); (G.G.); (O.C.); (M.F.L.); (C.F.); (R.D.); (A.M.D.G.); (S.C.); (L.C.); (M.M.)
| | - Carolina Fazio
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, 53100 Siena, Italy; (C.C.); (S.C.); (M.G.D.); (G.A.); (G.G.); (O.C.); (M.F.L.); (C.F.); (R.D.); (A.M.D.G.); (S.C.); (L.C.); (M.M.)
| | - Diana Giannarelli
- Unit of statistics, Regina Elena National Cancer Institute IRCCS, 00144 Rome, Italy;
| | - Riccardo Danielli
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, 53100 Siena, Italy; (C.C.); (S.C.); (M.G.D.); (G.A.); (G.G.); (O.C.); (M.F.L.); (C.F.); (R.D.); (A.M.D.G.); (S.C.); (L.C.); (M.M.)
| | - Anna Maria Di Giacomo
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, 53100 Siena, Italy; (C.C.); (S.C.); (M.G.D.); (G.A.); (G.G.); (O.C.); (M.F.L.); (C.F.); (R.D.); (A.M.D.G.); (S.C.); (L.C.); (M.M.)
| | - Sandra Coral
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, 53100 Siena, Italy; (C.C.); (S.C.); (M.G.D.); (G.A.); (G.G.); (O.C.); (M.F.L.); (C.F.); (R.D.); (A.M.D.G.); (S.C.); (L.C.); (M.M.)
| | - Luana Calabrò
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, 53100 Siena, Italy; (C.C.); (S.C.); (M.G.D.); (G.A.); (G.G.); (O.C.); (M.F.L.); (C.F.); (R.D.); (A.M.D.G.); (S.C.); (L.C.); (M.M.)
| | - Michele Maio
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, 53100 Siena, Italy; (C.C.); (S.C.); (M.G.D.); (G.A.); (G.G.); (O.C.); (M.F.L.); (C.F.); (R.D.); (A.M.D.G.); (S.C.); (L.C.); (M.M.)
| | - Alessia Covre
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, 53100 Siena, Italy; (C.C.); (S.C.); (M.G.D.); (G.A.); (G.G.); (O.C.); (M.F.L.); (C.F.); (R.D.); (A.M.D.G.); (S.C.); (L.C.); (M.M.)
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7
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Di Giacomo AM, Covre A, Finotello F, Rieder D, Danielli R, Sigalotti L, Giannarelli D, Petitprez F, Lacroix L, Valente M, Cutaia O, Fazio C, Amato G, Lazzeri A, Monterisi S, Miracco C, Coral S, Anichini A, Bock C, Nemc A, Oganesian A, Lowder J, Azab M, Fridman WH, Sautès-Fridman C, Trajanoski Z, Maio M. Guadecitabine Plus Ipilimumab in Unresectable Melanoma: The NIBIT-M4 Clinical Trial. Clin Cancer Res 2019; 25:7351-7362. [PMID: 31530631 DOI: 10.1158/1078-0432.ccr-19-1335] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/23/2019] [Accepted: 09/13/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE The immunomodulatory activity of DNA hypomethylating agents (DHAs) suggests they may improve the effectiveness of cancer immunotherapies. The phase Ib NIBIT-M4 trial tested this hypothesis using the next-generation DHA guadecitabine combined with ipilimumab. PATIENTS AND METHODS Patients with unresectable stage III/IV melanoma received escalating doses of guadecitabine 30, 45, or 60 mg/m2/day subcutaneously on days 1 to 5 every 3 weeks, and ipilimumab 3 mg/kg intravenously on day 1 every 3 weeks, starting 1 week after guadecitabine, for four cycles. Primary endpoints were safety, tolerability, and MTD of treatment; secondary were immune-related (ir) disease control rate (DCR) and objective response rate (ORR); and exploratory were changes in methylome, transcriptome, and immune contextures in sequential tumor biopsies, and pharmacokinetics. RESULTS Nineteen patients were treated; 84% had grade 3/4 adverse events, and neither dose-limiting toxicities per protocol nor overlapping toxicities were observed. Ir-DCR and ir-ORR were 42% and 26%, respectively. Median CpG site methylation of tumor samples (n = 8) at week 4 (74.5%) and week 12 (75.5%) was significantly (P < 0.05) lower than at baseline (80.3%), with a median of 2,454 (week 4) and 4,131 (week 12) differentially expressed genes. Among the 136 pathways significantly (P < 0.05; Z score >2 or ←2) modulated by treatment, the most frequently activated were immune-related. Tumor immune contexture analysis (n = 11) demonstrated upregulation of HLA class I on melanoma cells, an increase in CD8+, PD-1+ T cells and in CD20+ B cells in posttreatment tumor cores. CONCLUSIONS Treatment of guadecitabine combined with ipilimumab is safe and tolerable in advanced melanoma and has promising immunomodulatory and antitumor activity.
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Affiliation(s)
| | - Alessia Covre
- Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - Francesca Finotello
- Biocenter, Division of Bioinformatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Rieder
- Biocenter, Division of Bioinformatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Riccardo Danielli
- Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - Luca Sigalotti
- Oncogenetics and Functional Oncogenomics Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | | | - Florent Petitprez
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Team Cancer, Immune Control and Escape, Paris, France
- University Paris Descartes Paris 5, Sorbonne Paris Cite, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
- Sorbonne University, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
- Programme Cartes d'Identitié des Tumeurs, Ligue Nationale Contre le Cancer, Paris, France
| | - Laetitia Lacroix
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Team Cancer, Immune Control and Escape, Paris, France
- University Paris Descartes Paris 5, Sorbonne Paris Cite, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
- Sorbonne University, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Monica Valente
- Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - Ornella Cutaia
- Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - Carolina Fazio
- Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - Giovanni Amato
- Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - Andrea Lazzeri
- Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - Santa Monterisi
- Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - Clelia Miracco
- Pathology Unit, Department of Medical, Surgical and Neurological Science, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - Sandra Coral
- Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - Andrea Anichini
- HumanTumors Immunobiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Christoph Bock
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
- Max Planck Institute for Informatics, Saarbrücken, Germany
| | - Amelie Nemc
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | | | - James Lowder
- Astex Pharmaceuticals Inc., Pleasanton, California
| | | | - Wolf H Fridman
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Team Cancer, Immune Control and Escape, Paris, France
- University Paris Descartes Paris 5, Sorbonne Paris Cite, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
- Sorbonne University, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Catherine Sautès-Fridman
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Team Cancer, Immune Control and Escape, Paris, France
- University Paris Descartes Paris 5, Sorbonne Paris Cite, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
- Sorbonne University, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Zlatko Trajanoski
- Biocenter, Division of Bioinformatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Michele Maio
- Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy.
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Weide B, Eigentler T, Catania C, Ascierto PA, Cascinu S, Becker JC, Hauschild A, Romanini A, Danielli R, Dummer R, Trefzer U, Elia G, Neri D, Garbe C. A phase II study of the L19IL2 immunocytokine in combination with dacarbazine in advanced metastatic melanoma patients. Cancer Immunol Immunother 2019; 68:1547-1559. [PMID: 31482307 DOI: 10.1007/s00262-019-02383-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/22/2019] [Indexed: 12/13/2022]
Abstract
Engineered cytokine products represent promising agents for the treatment of immunogenic tumors, such as malignant melanoma, in addition to immune checkpoint inhibitors. Here we describe the results of a controlled, randomized phase II clinical trial, aimed at assessing the therapeutic potential of L19IL2, a fully human fusion protein consisting of the L19 antibody specific to the alternatively spliced extra-domain B of fibronectin, fused to human interleukin-2 in advanced metastatic melanoma. In one arm, patients received dacarbazine (DTIC; 1000 mg/m2 of body surface on day 1 of 21-day cycles) as single agent, while in two other arms L19IL2 (22.5 million international units of IL2 equivalents) was added, based on two different schedules of administration. In total, 69 patients with stage IV melanoma were enrolled (24 in the dacarbazine arm, 23 and 22 in the other combination arms, respectively) and 67 received treatment. Analyses of efficacy results show a statistically significant benefit in terms of overall response rate and median progression-free survival for patients receiving L19IL2 in combination with DTIC, compared to DTIC as single agent. In light of these results, further clinical investigations with L19IL2 (alone or in combination with other agents) are warranted.
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Affiliation(s)
- Benjamin Weide
- Department of Dermatology, University Medical Center, Tübingen, Germany
| | - Thomas Eigentler
- Department of Dermatology, University Medical Center, Tübingen, Germany
| | - Chiara Catania
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Stefano Cascinu
- Ospedali Riuniti Ancona, Ancona, Italy
- Università di Modena e Reggio Emilia, Modena, Italy
| | - Jürgen C Becker
- Medical University of Graz, Graz, Austria
- Translational Skin Cancer Research, Deutsches Konsortium für Translationale Krebsforschung (DKTK) Partner Site Essen, Essen, Germany
- Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - Axel Hauschild
- University Hospital Schleswig-Holstein (UKSK), Campus Kiel, Kiel, Germany
| | | | | | - Reinhard Dummer
- University Hospital Zurich and University Zurich, Zurich, Switzerland
| | - Uwe Trefzer
- Charité, Berlin, Germany
- Dermatologikum Berlin, Berlin, Germany
| | - Giuliano Elia
- Philochem AG, Libernstrasse 3, 8112, Otelfingen, Switzerland.
| | - Dario Neri
- Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, ETH Zurich, Building HCI G396.4, Wolfgang-Pauli-Strasse 10, 8093, Zurich, Switzerland.
| | - Claus Garbe
- Department of Dermatology, University Medical Center, Tübingen, Germany.
- Sektion Dermatologische Onkologie, Universität Tübingen Hautklinik, Liebermeisterstraße 25, 72076, Tübingen, Germany.
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9
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Cinotti E, Fiorani D, Provvidenziale L, Miracco C, Calamai V, Danielli R, Rubegni P. Eruptive porokeratosis under nivolumab adjuvant treatment for melanoma. Int J Dermatol 2019; 58:e138-e140. [DOI: 10.1111/ijd.14415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/10/2019] [Accepted: 02/05/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Elisa Cinotti
- Dermatology Unit Department of Medical, Surgical and Neurological Science University of Siena S. Maria alle Scotte Hospital Siena Italy
| | - Diletta Fiorani
- Dermatology Unit Department of Medical, Surgical and Neurological Science University of Siena S. Maria alle Scotte Hospital Siena Italy
| | - Luca Provvidenziale
- Dermatology Unit Department of Medical, Surgical and Neurological Science University of Siena S. Maria alle Scotte Hospital Siena Italy
| | - Clelia Miracco
- Pathology Unit Department of Medical, Surgical and Neurological Science University of Siena S. Maria alle Scotte Hospital Siena Italy
| | - Vanessa Calamai
- Medical Oncology and Immunotherapy Unit Department of Medical, Surgical and Neurological Science University of Siena S. Maria alle Scotte Hospital Siena Italy
| | - Riccardo Danielli
- Medical Oncology and Immunotherapy Unit Department of Medical, Surgical and Neurological Science University of Siena S. Maria alle Scotte Hospital Siena Italy
| | - Pietro Rubegni
- Dermatology Unit Department of Medical, Surgical and Neurological Science University of Siena S. Maria alle Scotte Hospital Siena Italy
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Danielli R, Cisternino F, Giannarelli D, Calabrò L, Camerini R, Savelli V, Bova G, Dragonetti R, Di Giacomo AM, Altomonte M, Maio M. Long-term follow up of metastatic melanoma patients treated with Thymosin alpha-1: investigating immune checkpoints synergy. Expert Opin Biol Ther 2019; 18:77-83. [PMID: 30063847 DOI: 10.1080/14712598.2018.1494717] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Immune checkpoint blockade antibodies (imAbs), such as the anti Cytotoxic T Lymphocyte Antigen-4 (CTLA-4) ipilimumab (IPI) raised overall survival (OS) in metastatic melanoma (MM). Further, long-term OS is a crucial endpoint in MM. Thymosin alpha-1 (Tα1) with dacarbazine (DTIC) showed activity in a phase II trial and a compassionate use program (EAP). We report on long-term follow-up of patients treated with Tα1 to investigate the preconditioning role of Tα1 in imAbs-treated patients. METHODS Records of patients with melanoma treated with Tα1 within a phase II trial and EAP program were reviewed comparing median OS among patients that sequentially received anti-CTLA-4 imAb and Tα1. Further, the effect of Tα1 on IPI long-term survivor patients was investigated. RESULTS Among patients treated with Tα1, 21/61 patients received sequentially even anti CTLA-4 imAbs. Median OS at the data cut-off was 57.8 and 7.4 months in patients treated sequentially with anti-CTLA-4 imAbs or not, respectively. Moreover, pretreatment with Tα1 in all (95) IPI-evaluable patients confirmed a significant increase in long-term OS. CONCLUSION This is the first report on long-term follow-up of Tα1-treated patients. Moreover, an advantage in OS in patients sequentially treated with Tα1 and IPI was seen that suggests a synergistic effect.
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Affiliation(s)
- Riccardo Danielli
- a Medical Oncology and Immunotherapy, Center for Immuno-Oncology , University Hospital of Siena , Siena , Italy
| | - Filomena Cisternino
- a Medical Oncology and Immunotherapy, Center for Immuno-Oncology , University Hospital of Siena , Siena , Italy
| | - Diana Giannarelli
- b Biostatistical Unit , Regina Elena National Cancer Institute , Rome , Italy
| | - Luana Calabrò
- a Medical Oncology and Immunotherapy, Center for Immuno-Oncology , University Hospital of Siena , Siena , Italy
| | | | - Vinno Savelli
- d Department of Medicine, Surgery and Neurosciences , University of Siena , Siena , Italy
| | - Giovanni Bova
- e Emergency Medicine Department , University Hospital of Siena , Siena , Italy
| | | | - Anna Maria Di Giacomo
- a Medical Oncology and Immunotherapy, Center for Immuno-Oncology , University Hospital of Siena , Siena , Italy
| | - Maresa Altomonte
- a Medical Oncology and Immunotherapy, Center for Immuno-Oncology , University Hospital of Siena , Siena , Italy
| | - Michele Maio
- a Medical Oncology and Immunotherapy, Center for Immuno-Oncology , University Hospital of Siena , Siena , Italy
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11
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Calabrò L, Morra A, Giannarelli D, Amato G, D'Incecco A, Covre A, Lewis A, Rebelatto MC, Danielli R, Altomonte M, Di Giacomo AM, Maio M. Tremelimumab combined with durvalumab in patients with mesothelioma (NIBIT-MESO-1): an open-label, non-randomised, phase 2 study. The Lancet Respiratory Medicine 2018; 6:451-460. [DOI: 10.1016/s2213-2600(18)30151-6] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/05/2018] [Accepted: 04/05/2018] [Indexed: 02/07/2023]
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12
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Maio M, Lewis K, Demidov L, Mandalà M, Bondarenko I, Ascierto PA, Herbert C, Mackiewicz A, Rutkowski P, Guminski A, Goodman GR, Simmons B, Ye C, Yan Y, Schadendorf D, Cinat G, Fein LE, Brown M, Guminski A, Haydon A, Khattak A, McNeil C, Parente P, Power J, Roberts-Thomson R, Sandhu S, Underhill C, Varma S, Berger T, Awada A, Blockx N, Buyse V, Mebis J, Franke FA, Jobim de Azevedo S, Silva Lazaretti N, Jamal R, Mihalcioiu C, Petrella T, Savage K, Song X, Wong R, Dabelic N, Plestina S, Vojnovic Z, Arenberger P, Kocak I, Krajsova I, Kubala E, Melichar B, Vantuchova Y, Putnik K, Dreno B, Dutriaux C, Grob JJ, Joly P, Lacour JP, Meyer N, Mortier L, Thomas L, Fluck M, Gambichler T, Hassel J, Hauschild A, Schadendorf D, Donnellan P, McCaffrey J, Power D, Ariad S, Bar-Sela G, Hendler D, Ron I, Schachter J, Ascierto P, Berruti A, Bianchi L, Chiarion Sileni V, Cognetti F, Danielli R, Di Giacomo AM, Gianni L, Goldhirsch A, Guida M, Maio M, Mandalà M, Marchetti P, Queirolo P, Santoro A, Kapiteijn E, Mackiewicz A, Rutkowski P, Ferreira P, Demidov L, Gafton G, Makarova Y, Andric Z, Babovic N, Jovanovic D, Kandolf Sekulovic L, Cohen G, Dreosti L, Vorobiof D, Curiel Garcia MT, Diaz Beveridge R, Majem Tarruella M, Marquez Rodas I, Puliats Rodriguez JM, Rueda Dominguez A, Maroti M, Papworth K, Michielin O, Bondarenko I, Brown E, Corrie P, Harries M, Herbert C, Kumar S, Martin-Clavijo A, Middleton M, Patel P, Talbot T, Agarwala S, Chapman P, Conry R, Doolittle G, Gangadhar T, Hallmeyer S, Hamid O, Hernandez-Aya L, Johnson D, Kass F, Kolevska T, Lewis K, Lunin S, Salama A, Sikic B, Somer B, Spigel D, Whitman E. Adjuvant vemurafenib in resected, BRAF V600 mutation-positive melanoma (BRIM8): a randomised, double-blind, placebo-controlled, multicentre, phase 3 trial. Lancet Oncol 2018; 19:510-520. [DOI: 10.1016/s1470-2045(18)30106-2] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
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13
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Brilli L, Danielli R, Ciuoli C, Calabrò L, Di Giacomo AM, Cerase A, Paffetti P, Sestini F, Porcelli B, Maio M, Pacini F. Prevalence of hypophysitis in a cohort of patients with metastatic melanoma and prostate cancer treated with ipilimumab. Endocrine 2017; 58:535-541. [PMID: 28401443 DOI: 10.1007/s12020-017-1289-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/21/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Ipilimumab is a human monoclonal antibody directed against cytotoxic T-lymphocyte antigen-4, that has been shown to significantly improve survival in patients with metastatic melanoma. Blocking cytotoxic T-lymphocyte antigen-4 elicits T cell activation, proliferation and anti-tumor response, but can also trigger immune-related adverse events. Among immune-related endocrinopathies, hypophysitis represents the most frequent, with an incidence up to 17% in patients treated with ipilimumab. DESIGN AND METHODS We report nine cases of ipilimumab-induced hypophysitis in a cohort of 273 patients treated with ipilimumab between 2006 and 2015, as part of clinical trials or after its marketing. Thyroid function tests were scheduled at screening and during follow up (every 21 days) in all patients. Cortisol, adrenocorticotropic hormone, follicle-stimulating hormone, luteinizing hormone, and estradiol (for females) or testosterone (for males), prolactin, growth hormone, insulin-like growth factor 1 were measured only in case of clinical suspicion. RESULTS The incidence of hypophysitis was 3.3%. The most frequent pituitary failure was adrenocorticotropic hormone and thyroid stimulating hormone secretion with a complete recovery of thyroid stimulating hormone, but not of adrenocorticotropic hormone during follow up. All patients had negative pituitary antibodies. The main symptoms at diagnosis were fatigue and headache. CONCLUSION Clinicians should be aware about the risk of hypophysitis during treatment with immune check-point inhibitors and the necessity of investigating pituitary function during therapy. Pituitary magnetic resonance imaging does not seem pivotal for a definite diagnosis if not performed at the onset of disease.
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Affiliation(s)
- Lucia Brilli
- Section of Endocrinology, Department of Medical, Surgical and Neurological sciences, University of Siena, Siena, Italy
| | - Riccardo Danielli
- Medical Oncology and Immunotherapy Unit, Department of Oncology, Istituto Toscano Tumori, University of Siena, Siena, Italy
| | - Cristina Ciuoli
- Section of Endocrinology, Department of Medical, Surgical and Neurological sciences, University of Siena, Siena, Italy
| | - Luana Calabrò
- Medical Oncology and Immunotherapy Unit, Department of Oncology, Istituto Toscano Tumori, University of Siena, Siena, Italy
| | - Anna Maria Di Giacomo
- Medical Oncology and Immunotherapy Unit, Department of Oncology, Istituto Toscano Tumori, University of Siena, Siena, Italy
| | - Alfonso Cerase
- Unit of Neuroimaging and Neurointervention, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Patrizia Paffetti
- Section of Endocrinology, Department of Medical, Surgical and Neurological sciences, University of Siena, Siena, Italy
| | - Fausta Sestini
- Section of Endocrinology, Department of Medical, Surgical and Neurological sciences, University of Siena, Siena, Italy
| | - Brunetta Porcelli
- Department of Medical Biotechnologies, Biochemistry Division, University of Siena, UOC Laboratorio Patologia Clinica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Michele Maio
- Medical Oncology and Immunotherapy Unit, Department of Oncology, Istituto Toscano Tumori, University of Siena, Siena, Italy
| | - Furio Pacini
- Section of Endocrinology, Department of Medical, Surgical and Neurological sciences, University of Siena, Siena, Italy.
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Calabro L, Morra A, Giannarelli D, Amato G, Bertocci E, D'Incecco A, Danielli R, Brilli L, Giannini F, Altomonte M, Di Giacomo A, Maio M. MA 19.02 Tremelimumab plus Durvalumab in First- or Second-Line Mesothelioma Patients: Final Analysis of the NIBIT-MESO-1 Study. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Calabro L, Morra A, Giannarelli D, Amato G, Bertocci E, D'Incecco A, Danielli R, Brilli L, Giannini F, Altomonte M, Di Giacomo AM, Maio M. Tremelimumab in combination with durvalumab in first or second-line mesothelioma patients: Safety analysis from the phase II NIBIT-MESO-1 study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.8558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8558 Background: The anti-CTLA-4 tremelimumab at two different dose-schedules of administration showed promising activity in second-line malignant mesothelioma (MM) patients (Calabrò et al., Lancet Oncol, 2013; Calabrò et al., Lancet Respir Med, 2015). These initial results and the efficacy of targeting the PD-1/PD-L1 axis in different tumor types, prompted the NIBIT-MESO-1 study aimed at investigating the efficacy and safety of tremelimumab combined with the anti-PD-L1 durvalumab in mm patients. We report the safety analysis from the fully-enrolled NIBIT-MESO-1 study. Methods: The NIBIT-MESO-1 is a phase II, open-label, single Center study. Forty mm patients received tremelimumab at 1 mg/Kg i.v. every 4 weeks (Q4W) for 4 doses, and durvalumab at 20 mg/Kg i.v. Q4W for 13 doses. Primary objective is immune-related (ir)-objective response rate; secondary are safey, ir-disease control rate, ir-progression free survival, and overall survival. Tumor assessment per ir-modified RECIST or ir-RECIST 1.1 for pleural or peritoneal MM, respectively, was performed at baseline and q12 weeks. Adverse events (AEs) were recorded according to CTC v4.0. (ClinicalTrials.gov Id: NCT02588131). Results: From October 2015 to October 2016, 40 mm patients (38 pleural and 2 peritoneal), median age 64 years (range 41-80), ECOG performance status 0 (n = 19) or 1 (n = 21) were enrolled in the study. mm histology was epithelioid (n = 32), biphasic (n = 5), sarcomatoid (n = 2) or undefined (n = 1). As of January 2017, 12 first or 28 second-line mm patients received a median of 5.5 doses of therapy (range = 1-13). Twenty-four patients (60%) experienced any grade irAEs: 5 patients (12.5%) had grade 3-4 AEs, the most frequent being hepatotoxicity (7.5%). AEs were generally manageable and reversible per protocol guidelines. Three patients (7.5%) were discontinued due to treatment-related AEs (1 trombocytopenia, 1 limbic encephalitis, 1 liver toxicity). Conclusions: The combination of tremelimumab and durvalumab is safe and manageable in mm patients. Clinical trial information: NCT02588131.
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Affiliation(s)
- Luana Calabro
- Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - Aldo Morra
- Department of Radiology, Euganea Medica Diagnostic Center, Padua, Italy
| | | | - Giovanni Amato
- Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - Erica Bertocci
- Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - Armida D'Incecco
- Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - Riccardo Danielli
- Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - Lucia Brilli
- Section of Endocrinology, Department of Medical, Surgical and Neurological Sciences, University of Hospital of Siena, Siena, Italy
| | - Fabio Giannini
- Neurology and Clinical Neurophysiology Unit, University Hospital of Siena, Siena, Italy
| | - Maresa Altomonte
- Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | | | - Michele Maio
- Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
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16
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Maccalli C, Giannarelli D, Chiarucci C, Cutaia O, Giacobini G, Hendrickx W, Amato G, Annesi D, Bedognetti D, Altomonte M, Danielli R, Calabrò L, Di Giacomo AM, Marincola FM, Parmiani G, Maio M. Soluble NKG2D ligands are biomarkers associated with the clinical outcome to immune checkpoint blockade therapy of metastatic melanoma patients. Oncoimmunology 2017; 6:e1323618. [PMID: 28811958 DOI: 10.1080/2162402x.2017.1323618] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/20/2017] [Accepted: 04/21/2017] [Indexed: 12/23/2022] Open
Abstract
The introduction of immune checkpoint blockade into the clinical practice resulted in improvement of survival of a significant portion of melanoma patients. Consequently, predictive biomarkers of response are needed to optimize patient's stratification and the development of combination therapies. The aim of this study was to determine whether levels of soluble NKG2D ligands (MICA, MICB, ULBP1, 2 and 3; sNKG2DLs) in the serum of melanoma patients can serve as useful predictors of response to the treatment with immune checkpoint blockade. sNKG2DLs were measured by ELISA in baseline and post-treatment serum and these results were correlated with the clinical outcome of melanoma patients (N = 194). The same determinations were performed also in a cohort of patients (N = 65) treated with either chemotherapy, radiotherapy, or mutated BRAF inhibitors (BRAFi). Absence of soluble MICB and ULBP-1 in baseline serum correlated with improved survival (OS = 21.6 and 25.3 mo and p = 0.02 and 0.01, respectively) of patients treated with immunological therapies while detectable levels of these molecules were found in poor survivors (OS = 8.8 and 12.1 mo, respectively). Multivariate analysis showed that LDH (p <0.0001), sULBP-1 (p = 0.02), and sULBP-2 (p = 0.02) were independent predictors of clinical outcome for the cohort of melanoma patients treated with immune checkpoint blockade. Only LDH but not sNKG2DLs was significantly associated with the clinical outcome of patients treated with standard or BRAFi regimens. These findings highlight the relevance of sNKG2DLs in the serum of melanoma patients as biomarkers for patients' stratification and optimization of immune checkpoint inhibition regimens.
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Affiliation(s)
- Cristina Maccalli
- Research Branch, Division of Translational Medicine, Sidra Medical and Research Center, Doha, Qatar
| | - Diana Giannarelli
- Unit of Statistics, Regina Elena National Cancer Institute, Rome, Italy
| | - Carla Chiarucci
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy.,University of Siena, Siena, Italy
| | - Ornella Cutaia
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy.,University of Siena, Siena, Italy
| | - Gianluca Giacobini
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy.,University of Siena, Siena, Italy
| | - Wouter Hendrickx
- Research Branch, Division of Translational Medicine, Sidra Medical and Research Center, Doha, Qatar
| | - Giovanni Amato
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Diego Annesi
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Davide Bedognetti
- Research Branch, Division of Translational Medicine, Sidra Medical and Research Center, Doha, Qatar
| | - Maresa Altomonte
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Riccardo Danielli
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Luana Calabrò
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Anna Maria Di Giacomo
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Francesco M Marincola
- Office of the Chief Research Officer (CRO), Research Branch, Sidra Medical and Research Center, Doha, Qatar
| | - Giorgio Parmiani
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy.,Italian Network for Bio-therapy of Tumors-(NIBIT)-Laboratory, Siena, Italy
| | - Michele Maio
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
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17
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Calabrò L, Morra A, Giannarelli D, Annesi D, Bertocci E, Danielli R, Altomonte M, Di Giacomo AM, Maio M. Tremelimumab and durvalumab (MEDI4736) combination for first and second-line treatment of mesothelioma patients: The NIBIT-MESO-1 study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.tps8575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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)
- Luana Calabrò
- Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | - Aldo Morra
- Department of Radiology, Euganea Medica Diagnostic Center, Padua, Italy
| | | | - Diego Annesi
- Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | - Erica Bertocci
- Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | - Riccardo Danielli
- Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | - Maresa Altomonte
- Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | | | - Michele Maio
- Medical Oncology and Immunotherapy University Hospital of Siena, Siena, Italy
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18
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Calabrò L, Morra A, Fonsatti E, Giannarelli D, Annesi D, Bertocci E, Danielli R, Altomonte M, Di Giacomo A, Maio M. A phase II study combining tremelimumab and durvalumab (MEDI4736) immunomodulating antibodies in mesothelioma patients: The NIBIT-MESO-1 study. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv514.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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19
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Danielli R, Patuzzo R, Di Giacomo AM, Gallino G, Maurichi A, Di Florio A, Cutaia O, Lazzeri A, Fazio C, Miracco C, Giovannoni L, Elia G, Neri D, Maio M, Santinami M. Intralesional administration of L19-IL2/L19-TNF in stage III or stage IVM1a melanoma patients: results of a phase II study. Cancer Immunol Immunother 2015; 64:999-1009. [PMID: 25971540 PMCID: PMC11028725 DOI: 10.1007/s00262-015-1704-6] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [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: 11/15/2014] [Accepted: 04/23/2015] [Indexed: 11/26/2022]
Abstract
The intratumoral injection of cytokines, in particular IL2, has shown promise for cutaneous melanoma patients with unresectable disease or continuous recurrence despite surgery. We recently reported that the intralesional injection of L19-IL2, an immunocytokine combining IL2 and the human monoclonal antibody fragment L19, resulted in efficient regional control of disease progression, increased time to distant metastasis and evidence of effect on circulating immune cell populations. We have also shown in preclinical models of cancer a remarkable synergistic effect of the combination of L19-IL2 with L19-TNF, a second clinical-stage immunocytokine, based on the same L19 antibody fused to TNF. Here, we describe the results of a phase II clinical trial based on the intralesional administration of L19-IL2 and L19-TNF in patients with stage IIIC and IVM1a metastatic melanoma, who were not candidate to surgery. In 20 efficacy-evaluable patients, 32 melanoma lesions exhibited complete responses upon intralesional administration of the two products, with mild side effects mainly limited to injection site reactions. Importantly, we observed complete responses in 7/13 (53.8 %) non-injected lesions (4 cutaneous, 3 lymph nodes), indicating a systemic activity of the intralesional immunostimulatory treatment. The intralesional administration of L19-IL2 and L19-TNF represents a simple and effective method for the local control of inoperable melanoma lesions, with a potential to eradicate them or make them suitable for a facile surgical removal of the residual mass.
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Affiliation(s)
- Riccardo Danielli
- Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Siena, Italy
| | - Roberto Patuzzo
- Melanoma and Sarcoma Unit, Department of Surgery, National Tumor Institute, Via G. Venezian, 1, 20133 Milan, Italy
| | - Anna Maria Di Giacomo
- Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Siena, Italy
| | - Gianfranco Gallino
- Melanoma and Sarcoma Unit, Department of Surgery, National Tumor Institute, Via G. Venezian, 1, 20133 Milan, Italy
| | - Andrea Maurichi
- Melanoma and Sarcoma Unit, Department of Surgery, National Tumor Institute, Via G. Venezian, 1, 20133 Milan, Italy
| | - Annabella Di Florio
- Melanoma and Sarcoma Unit, Department of Surgery, National Tumor Institute, Via G. Venezian, 1, 20133 Milan, Italy
| | - Ornella Cutaia
- Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Siena, Italy
| | - Andrea Lazzeri
- Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Siena, Italy
| | - Carolina Fazio
- Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Siena, Italy
| | - Clelia Miracco
- Section of Pathological Anatomy, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | | | | | - Dario Neri
- Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Michele Maio
- Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Siena, Italy
| | - Mario Santinami
- Melanoma and Sarcoma Unit, Department of Surgery, National Tumor Institute, Via G. Venezian, 1, 20133 Milan, Italy
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20
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Di Giacomo AM, Annesi D, Ascierto PA, Calabrò L, Chiarion-Sileni V, Danielli R, Del Vecchio M, Ferraresi V, Ferrucci PF, Fonsatti E, Guida M, Giannarelli D, Guidoboni M, Mandalà M, Quaglino P, Queirolo P, Maccalli C, Parmiani G, Maio M. A randomized, phase III study of fotemustine versus the combination of fotemustine and ipilimumab or the combination of ipilimumab and nivolumab in patients with metastatic melanoma with brain metastasis: the NIBIT-M2 trial. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.tps9090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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)
| | | | | | - Luana Calabrò
- Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | | | | | | | | | | | - Ester Fonsatti
- Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | | | | | - Massimo Guidoboni
- Immunotherapy and Somatic Cell Therapy Lab, IRCCS-IRST, Meldola, Italy
| | | | - Pietro Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Torino, Torino, Italy, Torino, Italy
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21
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Di Giacomo A, Ascierto P, Queirolo P, Pilla L, Ridolfi R, Santinami M, Testori A, Simeone E, Guidoboni M, Maurichi A, Orgiano L, Spadola G, Del Vecchio M, Danielli R, Calabrò L, Annesi D, Giannarelli D, Maccalli C, Fonsatti E, Parmiani G, Maio M. Three-year follow-up of advanced melanoma patients who received ipilimumab plus fotemustine in the Italian Network for Tumor Biotherapy (NIBIT)-M1 phase II study. Ann Oncol 2015; 26:798-803. [DOI: 10.1093/annonc/mdu577] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Calabrò L, Morra A, Fonsatti E, Cutaia O, Fazio C, Annesi D, Lenoci M, Amato G, Danielli R, Altomonte M, Giannarelli D, Di Giacomo AM, Maio M. Efficacy and safety of an intensified schedule of tremelimumab for chemotherapy-resistant malignant mesothelioma: an open-label, single-arm, phase 2 study. Lancet Respir Med 2015; 3:301-9. [PMID: 25819643 DOI: 10.1016/s2213-2600(15)00092-2] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 02/28/2015] [Accepted: 03/02/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND CTLA4 blockade by tremelimumab 15 mg/kg every 90 days provided preliminary evidence of activity in patients with pretreated malignant mesothelioma; however, retrospective exposure-response analysis of data from patients with melanoma suggested that this schedule could result in underexposure to tremelimumab. We therefore investigated the efficacy and safety of an intensified schedule of tremelimumab in patients with advanced malignant mesothelioma. METHODS In this open-label, single-arm, phase 2 study, participants aged 18 years or older with unresectable, advanced malignant mesothelioma (measurable in accordance with the Response Evaluation Criteria in Solid Tumors [RECIST]), a life expectancy of 3 months or more, an Eastern Cooperative Oncology Group performance status of 2 or less, and who had failed a first-line platinum-based regimen were enrolled at the University Hospital of Siena, Siena, Italy. Participants received tremelimumab 10 mg/kg once every 4 weeks for six doses, then every 12 weeks until disease progression, unacceptable toxic effects, or refusal to continue treatment. The primary endpoint was the proportion of patients achieving an immune-related objective response (complete or partial), assessed in all patients who received at least one dose of the study drug. This study is registered with the European Union Clinical Trials Register, number 2012-002762-12, and ClinicalTrials.gov, number NCT01655888. FINDINGS Between July 30, 2012, and July 15, 2013, we enrolled 29 patients with a median age of 65 years (range 42-78), stage III (n=11) or IV (n=18) disease, and an Eastern Cooperative Oncology Group performance status of 0-1 (n=23) or 2 (n=6). Malignant mesothelioma histology was epithelioid (n=21, including one peritoneal), biphasic (n=6), sarcomatoid (n=1), or undefined (n=1). Patients received a median of six doses of tremelimumab (range 1-13). After a median follow-up of 21·3 months (IQR 18·7-25·9), four immune-related-partial responses were recorded, one at the first tumour assessment (after about 12 weeks) and three at the second tumour assessment (about 24 weeks), with two responses occurring after initial progressive disease and one response after initial stable disease. 15 (52%) of patients achieved disease control, with a median duration of 10·9 months (95% CI 8·2-13·6). According to modified RECIST, one patient (3%) achieved a partial response and 11 (38%) patients achieved disease control rate. Grade 1-2 treatment-related adverse events occurred in 26 (90%) patients and grade 3-4 adverse events in two (7%) patients. The most common treatment-related adverse events were gastrointestinal, dermatological, and fever. INTERPRETATION Our results suggest that the intensified schedule of tremelimumab investigated seems to have clinical and immunological activity in patients with advanced malignant mesothelioma, and a good safety profile. The same intensified schedule is now being investigated in an ongoing randomised, double-blind, placebo-controlled, phase 2b study. FUNDING Associazione Italiana per la Ricerca sul Cancro, Istituto Toscano Tumori, and MedImmune.
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Affiliation(s)
- Luana Calabrò
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Aldo Morra
- Department of Radiology, Euganea Medica Diagnostic Center, Padua, Italy
| | - Ester Fonsatti
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Ornella Cutaia
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Carolina Fazio
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Diego Annesi
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Marica Lenoci
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Giovanni Amato
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Riccardo Danielli
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Maresa Altomonte
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | | | - Anna Maria Di Giacomo
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Michele Maio
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy.
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23
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Bracarda S, Altavilla A, Hamzaj A, Sisani M, Marrocolo F, Del Buono S, Danielli R. Immunologic checkpoints blockade in renal cell, prostate, and urothelial malignancies. Semin Oncol 2015; 42:495-505. [PMID: 25965369 DOI: 10.1053/j.seminoncol.2015.02.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Genitourinary (GU) tumors, and in particular renal cell and prostate cancer, represent one of the most dynamic areas in oncology from the scientific point of view. One of the most recent treatment approaches for GU tumors has focused on a series of molecules known as immune checkpoints and the possibility of manipulating immune responses against tumor cells by blocking these molecules with monoclonal antibodies (mAbs). Cytotoxic T lymphocyte antigen-4 (CTLA-4), and the immune checkpoint inhibitor mAbs ipilimumab and tremelimumab, represent the prototypes of this new growing class of agents called immunomodulating antibodies, while programmed death/ligand 1 (PD-1/PD-L1) also has garnered a significant interest as a new immune checkpoints to target in urothelial cancer, with the anti-PD-1/PD-L1 inhibitor mAbs nivolumab, MPDL-3280, and BMS-936559 as the first agents tested. Here we report the encouraging initial data observed in GU cancers with this new class of agents, which have reinforced the interest of investigating the therapeutic potential of the immune checkpoint modulators in large controlled trials.
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Affiliation(s)
- Sergio Bracarda
- Medical Oncology Unit, Department of Oncology, Ospedale San Donato, Istituto Toscano Tumori (ITT), Arezzo, Italy.
| | - Amelia Altavilla
- Medical Oncology Unit, Department of Oncology, Ospedale San Donato, Istituto Toscano Tumori (ITT), Arezzo, Italy
| | - Alketa Hamzaj
- Medical Oncology Unit, Department of Oncology, Ospedale San Donato, Istituto Toscano Tumori (ITT), Arezzo, Italy
| | - Michele Sisani
- Medical Oncology Unit, Department of Oncology, Ospedale San Donato, Istituto Toscano Tumori (ITT), Arezzo, Italy
| | - Francesca Marrocolo
- Medical Oncology Unit, Department of Oncology, Ospedale San Donato, Istituto Toscano Tumori (ITT), Arezzo, Italy
| | - Sabrina Del Buono
- Medical Oncology Unit, Department of Oncology, Ospedale San Donato, Istituto Toscano Tumori (ITT), Arezzo, Italy
| | - Riccardo Danielli
- Medical Oncology and Immunotherapy Unit, Azienda Ospedaliera Senese, University of Siena, Istituto Toscano Tumori (ITT), Siena, Italy
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Danielli R, Patuzzo R, Ruffini PA, Maurichi A, Giovannoni L, Elia G, Neri D, Santinami M. Armed antibodies for cancer treatment: a promising tool in a changing era. Cancer Immunol Immunother 2015; 64:113-21. [PMID: 25314912 PMCID: PMC11028442 DOI: 10.1007/s00262-014-1621-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 10/03/2014] [Indexed: 10/24/2022]
Abstract
Advances in the understanding of tumor immunology and molecular biology of melanoma cells have favored a larger application of immunotherapy and targeted therapies in the clinic. Several selective mutant gene inhibitors and immunomodulating antibodies have been reported to improve overall survival or progression-free survival in metastatic melanoma patients. However, despite impressive initial responses, patients treated with selective inhibitors relapse quickly, and toxicities associated to the use of immunomodulating antibodies are not easily manageable. In this sense, the concept of using antibodies as delivery vehicles for the preferential in vivo localization of the drug at the site of disease with reduction of side effects has raised particular interest. Antibody-cytokine fusion proteins (termed immunocytokines) represent a new simple and effective way to deliver the immunomodulatory payload at the tumor site, with the aim of inducing both local and systemic antitumoral immune responses and limiting systemic toxicities. Several clinical trials have been conducted and are actually ongoing with different immunocytokines, in several tumor histotypes. In metastatic melanoma patients, different drug delivery modalities such as systemic, loco-regional and intratumoral are under investigation. In this review, the rationale for the use of L19-IL2 and L19-TNF, two clinical stage immunocytokines produced by the Philogen group, as well as opportunities for their future development will be discussed.
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Affiliation(s)
- Riccardo Danielli
- Medical Oncology and Immunotherapy, Azienda Ospedaliera Universitaria Senese, Istituto Toscano Tumori, University Hospital of Siena, Strada delle Scotte, 53100, Siena, Italy,
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25
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Calabrò L, Morra A, Fonsatti E, Cutaia O, Fazio C, Danielli R, Giannarelli D, Altomonte M, Di Giacomo AM, Maio M. A phase 2 single-arm study with tremelimumab at an optimized dosing schedule in second-line mesothelioma patients. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.7531] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Luana Calabrò
- Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | - Aldo Morra
- Department of Radiology, Euganea Medica Diagnostic Center, Padua, Italy
| | - Ester Fonsatti
- Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | - Ornella Cutaia
- Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | - Carolina Fazio
- Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | - Riccardo Danielli
- Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | | | - Maresa Altomonte
- Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | | | - Michele Maio
- University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
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Danielli R, Patuzzo R, Di Giacomo AM, Gallino G, Di Florio A, Cutaia O, Lazzeri A, Fazio C, Giovannoni L, Ruffini PA, Elia G, Neri D, Santinami M, Maio M. A phase II study of intratumoral application of L19IL2/L19TNF in melanoma patients in clinical stage III or stage IV M1a with presence of injectable cutaneous and/or subcutaneous lesions. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.tps9103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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)
- Riccardo Danielli
- Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | - Roberto Patuzzo
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | | | - Ornella Cutaia
- Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | - Andrea Lazzeri
- Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | - Carolina Fazio
- Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | | | | | | | - Dario Neri
- Federal Institute of Technology, Zurich, Switzerland
| | - Mario Santinami
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Altomonte M, Di Giacomo AM, Queirolo P, Ascierto PA, Spagnolo F, Bajetta E, Calabrò L, Danielli R, de Rosa F, Maur M, Chiarion-Sileni V, Ferrucci PF, Giannarelli D, Testori A, Ridolfi R, Maio M. Clinical experience with ipilimumab 10 mg/kg in patients with melanoma treated at Italian centres as part of a European expanded access programme. J Exp Clin Cancer Res 2013; 32:82. [PMID: 24423086 PMCID: PMC4029467 DOI: 10.1186/1756-9966-32-82] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 10/16/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Patients with advanced melanoma are faced with a poor prognosis and, until recently, limited treatment options. Ipilimumab, a novel immunotherapy that blocks cytotoxic T-lymphocyte-associated antigen-4, was the first agent to improve survival of patients with advanced melanoma in a randomised, controlled phase 3 trial. We used data from an expanded access programme (EAP) at Italian centres to evaluate the clinical activity and safety profile of ipilimumab 10 mg/kg in patients with advanced melanoma in a setting more similar to that of daily practice. METHODS Data were collected from patients enrolled in an ipilimumab EAP across eight participating Italian centres. As per the EAP protocol, patients had life-threatening, unresectable stage III/IV melanoma, had failed or did not tolerate previous treatments and had no other therapeutic option available. Treatment comprised ipilimumab 10 mg/kg every 3 weeks for a total of four doses. If physicians believed patients would continue to derive benefit from ipilimumab treatment, maintenance therapy with ipilimumab 10 mg/kg was provided every 12 weeks. Tumour responses were assessed every 12 weeks using modified World Health Organization criteria and safety continuously monitored. RESULTS Seventy-four pretreated patients with advanced melanoma were treated with ipilimumab 10 mg/kg. Of these, 9 (13.0%) had an objective response, comprising 3 patients with a complete response and 6 with a partial response. Median overall survival was 7.0 months (95% confidence interval, 5.3-8.7) and 16.6% of patients were alive after 3 years. Forty-five patients (60.8%) reported treatment-related adverse events of any grade, which were most commonly low-grade pruritus, pain, fever and diarrhoea. Grade 3 or 4 treatment-related AEs were reported in 8 patients (10.8%). CONCLUSIONS The clinical activity and safety profile of ipilimumab 10 mg/kg in the EAP was similar to that seen in previous clinical trials of ipilimumab in pretreated patient populations.
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Affiliation(s)
| | | | - Paola Queirolo
- San Martino Hospital, National Institute for Cancer Research, Genoa, Italy
| | - Paolo Antonio Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapy, Istituto Nazionale Tumori Fondazione “G. Pascale”, Naples, Italy
| | - Francesco Spagnolo
- San Martino Hospital, National Institute for Cancer Research, Genoa, Italy
| | - Emilio Bajetta
- Istituto di Oncologia, Policlinico di Monza, Monza, Italy
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Maio M, Danielli R, Chiarion-Sileni V, Pigozzo J, Parmiani G, Ridolfi R, De Rosa F, Del Vecchio M, Di Guardo L, Queirolo P, Picasso V, Marchetti P, De Galitiis F, Mandalà M, Guida M, Simeone E, Ascierto PA. Efficacy and safety of ipilimumab in patients with pre-treated, uveal melanoma. Ann Oncol 2013; 24:2911-5. [PMID: 24067719 DOI: 10.1093/annonc/mdt376] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Patients with advanced uveal melanoma have a poor prognosis and limited treatment options. Ipilimumab is approved for pre-treated adult patients with advanced melanoma. However, because previous clinical trials with ipilimumab have excluded patients with uveal melanoma, data in this patient population are limited. PATIENTS AND METHODS Pre-treated patients with advanced uveal melanoma received ipilimumab 3 mg/kg through an expanded access programme, every 3 weeks for four doses. Tumour assessments were conducted at baseline and after completion of treatment and patients were monitored throughout for adverse events. RESULTS Among 82 assessable patients, 4 (5%) had an immune-related objective response and 24 (29%) had immune-related stable disease lasting ≥3 months for an immune-related disease control rate of 34%. With a median follow-up of 5.6 months, median overall survival (OS) was 6.0 months and median progression-free survival (PFS) was 3.6 months. The 1-year rates of OS and PFS were 31% and 11%, respectively. The safety profile of ipilimumab was similar to that in patients with cutaneous melanoma. CONCLUSIONS These data suggest ipilimumab 3 mg/kg is a feasible option in pre-treated patients with metastatic uveal melanoma. Evidence of disease control and a 1-year survival rate of 31% indicate the need for further investigation in randomised, controlled trials to determine the optimal timing and use of ipilimumab in this patient population.
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Affiliation(s)
- M Maio
- Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Tuscan Cancer Institute, Siena
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Calabrò L, Morra A, Fonsatti E, Cutaia O, Amato G, Giannarelli D, Di Giacomo AM, Danielli R, Altomonte M, Mutti L, Maio M. Tremelimumab for patients with chemotherapy-resistant advanced malignant mesothelioma: an open-label, single-arm, phase 2 trial. Lancet Oncol 2013; 14:1104-1111. [PMID: 24035405 DOI: 10.1016/s1470-2045(13)70381-4] [Citation(s) in RCA: 261] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Monoclonal antibodies to cytotoxic T-lymphocyte antigen 4 (CTLA4) have therapeutic activity in different tumour types. We aimed to investigate the efficacy, safety, and immunological activity of the anti-CTLA4 monoclonal antibody, tremelimumab, in advanced malignant mesothelioma. METHODS In our open-label, single-arm, phase 2 study, we enrolled patients aged 18 years or older with measurable, unresectable malignant mesothelioma and progressive disease after a first-line platinum-based regimen. Eligible patients had to have a life expectancy of 3 months or more, an Eastern Cooperative Oncology Group performance status of 2 or less, and no history of autoimmune disease. Patients received tremelimumab 15 mg/kg intravenously once every 90 days until progressive disease or severe toxicity. The primary endpoint was the proportion of patients who achieved an objective response (complete or partial response), with a target response rate of 17% according to the modified Response Evaluation Criteria in Solid Tumors (RECIST) for pleural malignant mesothelioma or standard RECIST 1.0 for peritoneal malignant mesothelioma. Analyses were done according to intention to treat. This trial is registered with EudraCT, number 2008-005171-95, and ClinicalTrials.gov, number NCT01649024. FINDINGS Between May 27, 2009, and Jan 10, 2012, we enrolled 29 patients. All patients received at least one dose of tremelimumab (median two doses, range one to nine). No patients had a complete response and two patients (7%) had a durable partial response (one lasting 6 months and one lasting 18 months); one partial response occurred after initial progressive disease. Thus, the study did not reach its primary endpoint. However, we noted disease control in nine (31%) patients and a median progression-free survival of 6·2 months (95% CI 1·3-11·1) and a median overall survival of 10·7 months (0·0-21·9). 27 patients (93%) had at least one grade 1-2 treatment-emergent adverse event (mainly cutaneous rash, pruritus, colitis, or diarrhoea), and four patients (14%) had at least one grade 3-4 treatment-emergent adverse event (two gastrointestinal, one neurological, two hepatic, and one pancreatic). INTERPRETATION Although the effect size was small in our phase 2 trial, tremelimumab seemed to have encouraging clinical activity and an acceptable safety and tolerability profile in previously treated patients with advanced malignant mesothelioma. FUNDING Associazione Italiana per la Ricerca sul Cancro, Istituto Toscano Tumori, Pfizer, and Fondazione Buzzi Unicem.
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Affiliation(s)
- Luana Calabrò
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Aldo Morra
- Department of Radiology, Euganea Medica Diagnostic Center, Padua, Italy
| | - Ester Fonsatti
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Ornella Cutaia
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Giovanni Amato
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | | | - Anna Maria Di Giacomo
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Riccardo Danielli
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Maresa Altomonte
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Luciano Mutti
- Department of Medicine, Laboratory of Clinical Oncology, Hospital of Vercelli, Vercelli, Italy
| | - Michele Maio
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy.
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Di Giacomo AM, Calabrò L, Danielli R, Fonsatti E, Bertocci E, Pesce I, Fazio C, Cutaia O, Giannarelli D, Miracco C, Biagioli M, Altomonte M, Maio M. Long-term survival and immunological parameters in metastatic melanoma patients who responded to ipilimumab 10 mg/kg within an expanded access programme. Cancer Immunol Immunother 2013; 62:1021-8. [PMID: 23591982 PMCID: PMC11029072 DOI: 10.1007/s00262-013-1418-6] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 03/20/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Ipilimumab can result in durable clinical responses among patients with advanced melanoma. However, no predictive marker of clinical activity has yet been identified. We provide preliminary data describing the correlation between immunological parameters and response/survival among patients with advanced melanoma who received ipilimumab 10 mg/kg in an expanded access programme. METHODS Patients received ipilimumab 10 mg/kg every 3 weeks (Q3W) for four doses (induction) and Q12W from week 24 (W24) as maintenance therapy. Tumor assessments were conducted Q12W. Expression of inducible T cell costimulator (ICOS) on CD4(+) and CD8(+) T cells was assessed at baseline, W7, W12 and W24, and the ratio between absolute neutrophils (N) and lymphocytes (L) determined at baseline, W4, W7 and W10. RESULTS Median overall survival among 27 patients was 9.6 months (95 % CI 3.2-16.1), with 3- and 4-year survival rates of 20.4 %. Five patients survived >4 years. Patients with an increase in the number of circulating ICOS(+) T cells at W7 were more likely to experience disease control and have improved survival. An N/L ratio below the median at W7 and W10 was also associated with better survival compared with an N/L ratio above the median. CONCLUSIONS Ipilimumab can induce long-term survival benefits in heavily pretreated patients with metastatic melanoma. Changes in the number of circulating ICOS(+) T cells or N/L ratio during ipilimumab treatment may represent early markers of response. However, given the limited sample size, further investigation is required.
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Affiliation(s)
- Anna Maria Di Giacomo
- Division of Medical Oncology and Immunotherapy, Department of Oncology, Istituto Toscano Tumori, University Hospital of Siena, Strada delle Scotte 14, 53100 Siena, Italy
| | - Luana Calabrò
- Division of Medical Oncology and Immunotherapy, Department of Oncology, Istituto Toscano Tumori, University Hospital of Siena, Strada delle Scotte 14, 53100 Siena, Italy
| | - Riccardo Danielli
- Division of Medical Oncology and Immunotherapy, Department of Oncology, Istituto Toscano Tumori, University Hospital of Siena, Strada delle Scotte 14, 53100 Siena, Italy
| | - Ester Fonsatti
- Division of Medical Oncology and Immunotherapy, Department of Oncology, Istituto Toscano Tumori, University Hospital of Siena, Strada delle Scotte 14, 53100 Siena, Italy
| | - Erica Bertocci
- Division of Medical Oncology and Immunotherapy, Department of Oncology, Istituto Toscano Tumori, University Hospital of Siena, Strada delle Scotte 14, 53100 Siena, Italy
| | - Isabella Pesce
- Division of Medical Oncology and Immunotherapy, Department of Oncology, Istituto Toscano Tumori, University Hospital of Siena, Strada delle Scotte 14, 53100 Siena, Italy
| | - Carolina Fazio
- Division of Medical Oncology and Immunotherapy, Department of Oncology, Istituto Toscano Tumori, University Hospital of Siena, Strada delle Scotte 14, 53100 Siena, Italy
| | - Ornella Cutaia
- Division of Medical Oncology and Immunotherapy, Department of Oncology, Istituto Toscano Tumori, University Hospital of Siena, Strada delle Scotte 14, 53100 Siena, Italy
| | - Diana Giannarelli
- Statistical Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Clelia Miracco
- Department of Pathology, University Hospital of Siena, Siena, Italy
| | - Maurizio Biagioli
- Department of Dermatology, University Hospital of Siena, Siena, Italy
| | - Maresa Altomonte
- Division of Medical Oncology and Immunotherapy, Department of Oncology, Istituto Toscano Tumori, University Hospital of Siena, Strada delle Scotte 14, 53100 Siena, Italy
| | - Michele Maio
- Division of Medical Oncology and Immunotherapy, Department of Oncology, Istituto Toscano Tumori, University Hospital of Siena, Strada delle Scotte 14, 53100 Siena, Italy
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Chiarion-Sileni V, Pigozzo J, Ascierto PA, Maio M, Danielli R, Del Vecchio M, Ridolfi L, De Galitiis F, Testori A, Cocorocchio E, Cognetti F, Ferraresi V, Bernengo MG, Guida M, Antonuzzo A, Mandala M, Parmiani G, Vanella V, Aglietta M, Queirolo P. Efficacy and safety data from elderly patients with pretreated advanced melanoma in the Italian cohort of ipilimumab expanded access programme (EAP). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.9548] [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
9548 Background: Ipilimumab was the first agent approved for the treatment of unresectable or metastatic melanoma that showed an overall survival benefit in randomised phase III trials. Here we evaluate the safety and efficacy of ipilimumab treatment outside of clinical trials in elderly (>70 years old) patients (pts) enrolled in the EAP in Italy. Methods: Ipilimumab was available upon physician request for pts aged ≥16 years with unresectable stage III/IV melanoma who had either failed systemic therapy or were intolerant to ≥1 systemic treatment and for whom no other therapeutic option was available. Ipilimumab 3 mg/kg was administered intravenously every 3 weeks for 4 doses. Disease evaluation was performed at baseline and after completion of induction therapy using immune-related response criteria. Patients were monitored for adverse events (AEs), including immune-related AEs, using Common Terminology Criteria for Adverse Events v.3.0. Results: Out of 855 Italian pts participating in the EAP from June 2010 to January 2012 across 55 centres, 193 (22.6%) were over 70 years old (median 75; 70-88). Of these, 132 pts (68.4%) received all 4 doses of ipilimumab, 24 (12.4%) 3 doses, 17 (8.8%) 2 doses and 20 pts (10.4%) received 1 dose. With a median follow-up of 7.6 months (range 1-26), the disease control rate among 188 pts evaluable for response was 38.3%, including 4 pts (2.1%) with a complete response, 24 (12.8%) with a partial response and 44 (23.4%) with stable disease. As of December 2012, median progression-free survival and overall survival were 3.7 months and 8.9 months respectively, with 1-year survival rate of 38%. In total, 96 pts (49.7%) reported an AE of any grade, which were considered treatment-related in 69 pts (35.7%), with a safety profile comparable to the general population. Grade 3/4 AEs were reported by 19 pts (9.8%) and drug-related in 11 pts (5.7%). AEs were generally reversible with treatment as per protocol-specific guidelines with a median time to resolution of 2.0 weeks. Conclusions: Based on the data from EAP, ipilimumab is a feasible treatment in the elderly population; efficacy and safety results were similar to those observed in the general population.
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Affiliation(s)
- Vanna Chiarion-Sileni
- Department of Medical Oncology, Veneto Oncology Institute (IOV)-IRCCS, Padova, Italy
| | - Jacopo Pigozzo
- Medical Oncology Unit, Istituto Oncologico Veneto, IOV-IRCCS, Padova, Italy
| | | | - Michele Maio
- University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Riccardo Danielli
- Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | - Michele Del Vecchio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Ridolfi
- Immunotherapy and Somatic Cell Therapy Lab, IRCCS-IRST, Meldola, Italy
| | | | | | | | | | | | | | | | - Andrea Antonuzzo
- Polo Oncologico Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Mario Mandala
- Papa Giovanni XXIII, Division of Medical Oncology, Unit of Clinical and Translational Research, Department of Oncology and Hematology, Bergamo, Italy
| | - Giorgio Parmiani
- Molecular Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Vito Vanella
- "Paolo Giaccone" Polyclinic University Hospital, Palermo, Italy
| | - Massimo Aglietta
- Division of Medical Oncology - IRCC Istitute for Cancer Research and Treatment at Candiolo, Candiolo, Italy
| | - Paola Queirolo
- Department of Medical Oncology A, National Institute for Cancer Research, Genoa, Italy
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Coral S, Parisi G, Nicolay HJMG, Colizzi F, Danielli R, Fratta E, Covre A, Taverna P, Sigalotti L, Maio M. Immunomodulatory activity of SGI-110, a 5-aza-2'-deoxycytidine-containing demethylating dinucleotide. Cancer Immunol Immunother 2013; 62:605-14. [PMID: 23138873 PMCID: PMC11029398 DOI: 10.1007/s00262-012-1365-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 10/23/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Pharmacologic DNA hypomethylation holds strong promises in cancer immunotherapy due to its immunomodulatory activity on neoplastic cells. Searching for more efficient DNA hypomethylating agents to be utilized to design novel immunotherapeutic strategies in cancer, we investigated the immunomodulatory properties of the new DNA hypomethylating agent SGI-110, that is resistant to in vivo inactivation by cytidine deaminase. EXPERIMENTAL DESIGN Cutaneous melanoma, mesothelioma, renal cell carcinoma, and sarcoma cells were treated in vitro with SGI-110. RT-PCR, quantitative RT-PCR, quantitative methylation-specific PCR, and flow cytometric analyses were performed to investigate changes induced by SGI-110 in the constitutive immune profile of cancer cells. The recognition by gp100-specific CTL of gp100-positive melanoma cells, treated or not with SGI-110, was tested by LDH release assays. RESULTS SGI-110 induced/up-regulated the expression of investigated cancer/testis antigens (CTA) (i.e., MAGE-A1, MAGE-A2, MAGE-A3, MAGE-A4, MAGE-A10, GAGE 1-2, GAGE 1-6, NY-ESO-1, and SSX 1-5) in all cancer cell lines studied, both at mRNA and at protein levels. Quantitative methylation-specific PCR analyses identified a hypomethylation of MAGE-A1 and NY-ESO-1 promoters in SGI-110-treated neoplastic cells, demonstrating a direct role of pharmacologic DNA demethylation in CTA induction. SGI-110 also up-regulated the expression of HLA class I antigens and of ICAM-1, resulting in an improved recognition of cancer cells by gp100-specific CTL. CONCLUSIONS Our findings show that SGI-110 is a highly attractive therapeutic agent to comprehensively increase immunogenicity and immune recognition of neoplastic cells, and provide the scientific rationale for its clinical development to design novel chemo-immunotherapeutic approaches in cancer patients.
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Affiliation(s)
- Sandra Coral
- Cancer Bioimmunotherapy Unit, Centro di Riferimento Oncologico, Aviano, Italy
| | - Giulia Parisi
- Division of Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte 14, 53100 Siena, Italy
| | - Hugues J. M. G. Nicolay
- Division of Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte 14, 53100 Siena, Italy
| | - Francesca Colizzi
- Cancer Bioimmunotherapy Unit, Centro di Riferimento Oncologico, Aviano, Italy
| | - Riccardo Danielli
- Division of Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte 14, 53100 Siena, Italy
| | - Elisabetta Fratta
- Cancer Bioimmunotherapy Unit, Centro di Riferimento Oncologico, Aviano, Italy
| | - Alessia Covre
- Division of Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte 14, 53100 Siena, Italy
| | | | - Luca Sigalotti
- Cancer Bioimmunotherapy Unit, Centro di Riferimento Oncologico, Aviano, Italy
| | - Michele Maio
- Division of Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte 14, 53100 Siena, Italy
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Danielli R, Fonsatti E, Calabrò L, Di Giacomo AM, Maio M. Thymosin α1 in melanoma: from the clinical trial setting to the daily practice and beyond. Ann N Y Acad Sci 2013; 1270:8-12. [PMID: 23050811 DOI: 10.1111/j.1749-6632.2012.06757.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Thymosin α1 (Tα1) is an immunomodulatory peptide released by the thymus gland in mammals. It was first described in 1977 as a potential agent for the treatment of immune deficiencies and cancer. Among solid tumors, a number of clinical trials have investigated the activity of Tα1 in melanoma. In particular, a large randomized phase II trial that evaluated the safety and efficacy of combining Tα1 with dacarbazine and interferon alpha in metastatic melanoma patients provided the rationale for further clinical applications. The main findings emerging from clinical trials and that support the therapeutic use of Tα1 in human melanoma are summarized and discussed.
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Affiliation(s)
- Riccardo Danielli
- Department of Oncology, Division of Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
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Filipazzi P, Pilla L, Mariani L, Patuzzo R, Castelli C, Camisaschi C, Maurichi A, Cova A, Rigamonti G, Giardino F, Di Florio A, Asioli M, Frati P, Sovena G, Squarcina P, Maio M, Danielli R, Chiarion-Sileni V, Villa A, Lombardo C, Tragni G, Santinami M, Parmiani G, Rivoltini L. Limited induction of tumor cross-reactive T cells without a measurable clinical benefit in early melanoma patients vaccinated with human leukocyte antigen class I-modified peptides. Clin Cancer Res 2012; 18:6485-96. [PMID: 23032742 DOI: 10.1158/1078-0432.ccr-12-1516] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The progressive immune dysfunctions that occur in patients with advanced melanoma make them unlikely to efficiently respond to cancer vaccines. A multicenter randomized phase II trial was conducted to test whether immunization with modified HLA class I tumor peptides in the context of adjuvant therapy results in better immunologic responses and improved clinical outcomes in patients with early melanoma (stages IIB/C-III). EXPERIMENTAL DESIGN Forty-three patients were enrolled to undergo vaccination (n = 22) or observation (n = 21). The vaccine included four HLA-A*0201-restricted modified peptides (Melan-A/MART-1([27L]), gp100([210M]), NY-ESO-1([165V]), and Survivin([97M])) emulsified in Montanide ISA51 and injected subcutaneously in combination with cyclophosphamide (300 mg/m(2)) and low-dose IL-2 (3 × 10(6) IU). The immune responses were monitored using ex vivo IFN-γ-ELISpot, HLA/multimer staining, and in vitro short-term peptide sensitization assays. RESULTS Vaccination induced a rapid and persistent increase in specific effector memory CD8(+) T cells in 75% of the patients. However, this immunization was not associated with any significant increase in disease-free or overall survival as compared with the observation group. An extensive immunologic analysis revealed a significantly reduced cross-recognition of the corresponding native peptides and, most importantly, a limited ability to react to melanoma cells. CONCLUSIONS Adjuvant setting is an appealing approach for testing cancer vaccines because specific CD8(+) T cells can be efficiently induced in most vaccinated patients. However, the marginal antitumor activity of the T cells induced by modified peptides in this study largely accounts for the observed lack of benefit of vaccination. These findings suggest reconsidering this immunization strategy, particularly in early disease.
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Affiliation(s)
- Paola Filipazzi
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Danielli R, Ridolfi R, Chiarion-Sileni V, Queirolo P, Testori A, Plummer R, Boitano M, Calabrò L, De Rossi C, Giacomo AMD, Ferrucci PF, Ridolfi L, Altomonte M, Miracco C, Balestrazzi A, Maio M. Ipilimumab in pretreated patients with metastatic uveal melanoma: safety and clinical efficacy. Cancer Immunol Immunother 2012; 61:41-8. [PMID: 21833591 PMCID: PMC11028946 DOI: 10.1007/s00262-011-1089-0] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 07/22/2011] [Indexed: 10/17/2022]
Abstract
Current systemic treatments for metastatic uveal melanoma (UM) have not improved overall survival (OS). The fully human anti-cytotoxic T-lymphocyte antigen-4 (CTLA-4) monoclonal antibody, ipilimumab, improved OS of patients with advanced cutaneous melanoma in a phase 3 trial; however, UM patients were excluded. The aim of this subanalysis, performed by the ipilimumab-ocular melanoma expanded access program (I-OMEAP) study group, was to assess the activity and safety of ipilimumab in patients with UM in a setting similar to daily clinical practice. Patients participating in a multicenter expanded access program (EAP) received induction treatment with ipilimumab 10 mg/kg. Maintenance doses were administered in patients who experienced clinical benefit or at physicians' discretion. Tumor assessment was evaluated per modified World Health Organization criteria at baseline, Week 12, Week 24, and Week 36. Adverse events (AEs) and immune-related AEs (irAEs) were collected according to Common Terminology Criteria for Adverse Events version 3.0. Thirteen pretreated patients with metastatic UM were treated at 6 European institutions. All patients received at least one dose of ipilimumab. Overall, no objective responses were observed; however, two patients had stable disease (SD), with a third patient achieving SD after initial progressive disease. Median OS as of July 1, 2011, was 36 weeks (range 2-172+ weeks). No grade 3/4 AEs of non-immune origin were reported. Three patients (23%) experienced grade 3 irAEs (1 thrombocytopenia, 1 diarrhea, and 1 alanine/aspartate aminotransferase elevation) that resolved with steroid therapy. The results indicate UM is a potential indication for ipilimumab treatment that should be further investigated in clinical trials.
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Affiliation(s)
- Riccardo Danielli
- Medical Oncology and Immunotherapy Unit, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte, 53100 Siena, Italy
| | - Ruggero Ridolfi
- Scientific Institute of Romagna for the Study and Treatment of Cancer (IRST), Meldola-Forlì, Italy
| | | | | | | | | | | | - Luana Calabrò
- Medical Oncology and Immunotherapy Unit, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte, 53100 Siena, Italy
| | | | - Anna Maria Di Giacomo
- Medical Oncology and Immunotherapy Unit, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte, 53100 Siena, Italy
| | | | - Laura Ridolfi
- Scientific Institute of Romagna for the Study and Treatment of Cancer (IRST), Meldola-Forlì, Italy
| | - Maresa Altomonte
- Medical Oncology and Immunotherapy Unit, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte, 53100 Siena, Italy
| | - Clelia Miracco
- Pathology, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte, 53100 Siena, Italy
| | - Angelo Balestrazzi
- Ophthalmology, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte, 53100 Siena, Italy
| | - Michele Maio
- Medical Oncology and Immunotherapy Unit, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte, 53100 Siena, Italy
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Calabrò L, Sigalotti L, Fonsatti E, Bertocci E, Di Giacomo AM, Danielli R, Cutaia O, Colizzi F, Covre A, Mutti L, Natali PG, Maio M. Expression and regulation of B7-H3 immunoregulatory receptor, in human mesothelial and mesothelioma cells: Immunotherapeutic implications. J Cell Physiol 2011; 226:2595-600. [DOI: 10.1002/jcp.22600] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Di Giacomo AM, Danielli R, Calabrò L, Bertocci E, Nannicini C, Giannarelli D, Balestrazzi A, Vigni F, Riversi V, Miracco C, Biagioli M, Altomonte M, Maio M. Ipilimumab experience in heavily pretreated patients with melanoma in an expanded access program at the University Hospital of Siena (Italy). Cancer Immunol Immunother 2011; 60:467-77. [PMID: 21170646 PMCID: PMC11029675 DOI: 10.1007/s00262-010-0958-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 12/06/2010] [Indexed: 01/31/2023]
Abstract
AIM OF STUDY To evaluate the feasibility of ipilimumab treatment for metastatic melanoma outside the boundaries of clinical trials, in a setting similar to that of daily practice. METHODS Ipilimumab was available upon physician request in the Expanded Access Programme for patients with life-threatening, unresectable stage III/IV melanoma who failed or did not tolerate previous treatments and for whom no therapeutic option was available. Induction treatment with ipilimumab 10 mg/kg was administered intravenously every 3 weeks, for a total of 4 doses, with maintenance doses every 12 weeks based on physicians' discretion and clinical judgment. Tumors were assessed at baseline, Week 12, and every 12 weeks thereafter per mWHO response criteria, and clinical response was scored as complete response (CR), partial response (PR), stable disease (SD), or progressive disease. Durable disease control (DC) was defined as SD at least 24 weeks from the first dose, CR, or PR. RESULTS Disease control rate at 24 and 60 weeks was 29.6% and 15%, respectively. Median overall survival at a median follow-up of 8.5 months was 9 months. The 1- and 2-year survival rates were 34.8% and 23.5%, respectively. Changes in lymphocyte count slope and absolute number during ipilimumab treatment appear to correlate with clinical response and survival, respectively. Adverse events were predominantly immune related, manageable, and generally reversible. One patient died from pancytopenia, considered possibly treatment related. CONCLUSION Ipilimumab was a feasible treatment for malignant melanoma in heavily pretreated, progressing patients. A sizeable proportion of patients experienced durable DC, including benefits to long-term survival.
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Affiliation(s)
- Anna Maria Di Giacomo
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte, 53100 Siena, Italy
| | - Riccardo Danielli
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte, 53100 Siena, Italy
| | - Luana Calabrò
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte, 53100 Siena, Italy
| | - Erica Bertocci
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte, 53100 Siena, Italy
| | - Chiara Nannicini
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte, 53100 Siena, Italy
| | | | - Angelo Balestrazzi
- Ophthalmology, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Francesco Vigni
- Radiology, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Valentina Riversi
- Radiology, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Clelia Miracco
- Pathology, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Maurizio Biagioli
- Dermatology, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Maresa Altomonte
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte, 53100 Siena, Italy
| | - Michele Maio
- Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Strada delle Scotte, 53100 Siena, Italy
- Cancer Bioimmunotherapy Unit, Centro di Riferimento Oncologico, Aviano, Italy
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Fratta E, Coral S, Covre A, Parisi G, Colizzi F, Danielli R, Nicolay HJM, Sigalotti L, Maio M. The biology of cancer testis antigens: putative function, regulation and therapeutic potential. Mol Oncol 2011; 5:164-82. [PMID: 21376678 DOI: 10.1016/j.molonc.2011.02.001] [Citation(s) in RCA: 241] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 01/31/2011] [Accepted: 02/03/2011] [Indexed: 12/14/2022] Open
Abstract
Cancer testis antigens (CTA) are a large family of tumor-associated antigens expressed in human tumors of different histological origin, but not in normal tissues except for testis and placenta. This tumor-restricted pattern of expression, together with their strong in vivo immunogenicity, identified CTA as ideal targets for tumor-specific immunotherapeutic approaches, and prompted the development of several clinical trials of CTA-based vaccine therapy. Driven by this practical clinical interest, a more detailed characterization of CTA biology has been recently undertaken. So far, at least 70 families of CTA, globally accounting for about 140 members, have been identified. Most of these CTA are expressed during spermatogenesis, but their function is still largely unknown. Epigenetic events, particularly DNA methylation, appear to be the primary mechanism regulating CTA expression in both normal and transformed cells, as well as in cancer stem cells. In view of the growing interest in CTA biology, the aim of this review is to provide the most recent information on their expression, regulation and function, together with a brief summary of the major clinical trials involving CTA as therapeutic agents. The pharmacologic modulation of CTA expression profiles on neoplastic cells by DNA hypomethylating drugs will also be discussed as a feasible approach to design new combination therapies potentially able to improve the clinical efficacy of currently adopted CTA-based immunotherapeutic regimens in cancer patients.
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Affiliation(s)
- Elisabetta Fratta
- Cancer Bioimmunotherapy Unit, Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico, Via Franco Gallini 2, 33081 Aviano, Italy
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Abstract
Available medical treatments have limited impact on the survival of patients with advanced cancer; therefore, new therapeutic strategies able to generate more effective host's immune responses against neoplastic cells are being actively pursued. Among these, a recent approach involves targeting of cytotoxic T-lymphocyte antigen-4 (CTLA-4), a key immune checkpoint molecule, by monoclonal antibodies (mAbs). Ipilimumab and tremelimumab represent the prototypes of this new class of immunomodulating mAb and have been extensively tested in metastatic melanoma with highly promising results. The clinical activity observed in melanoma has served as a model to exploit the therapeutic potential of CTLA-4 blockade in a variety of human malignancies. Along this line, early-phase trials with anti-CTLA-4 mAbs have been completed or are ongoing in tumors of different histotype. Results are demonstrating the feasibility, safety, and activity of these agents, thus suggesting a promising therapeutic role to be further investigated in phase II/III trials in a wide range of tumors. This review summarizes the main trials with ipilimumab and tremelimumab in tumors of different histotypes, excluding cutaneous melanoma, which is extensively described in other chapters of this issue of Seminars in Oncology.
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Affiliation(s)
- Luana Calabrò
- Division of Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy.
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Sigalotti L, Covre A, Fratta E, Parisi G, Colizzi F, Rizzo A, Danielli R, Nicolay HJM, Coral S, Maio M. Epigenetics of human cutaneous melanoma: setting the stage for new therapeutic strategies. J Transl Med 2010; 8:56. [PMID: 20540720 PMCID: PMC2901206 DOI: 10.1186/1479-5876-8-56] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [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] [Received: 02/16/2010] [Accepted: 06/11/2010] [Indexed: 12/15/2022] Open
Abstract
Cutaneous melanoma is a very aggressive neoplasia of melanocytic origin with constantly growing incidence and mortality rates world-wide. Epigenetic modifications (i.e., alterations of genomic DNA methylation patterns, of post-translational modifications of histones, and of microRNA profiles) have been recently identified as playing an important role in melanoma development and progression by affecting key cellular pathways such as cell cycle regulation, cell signalling, differentiation, DNA repair, apoptosis, invasion and immune recognition. In this scenario, pharmacologic inhibition of DNA methyltransferases and/or of histone deacetylases were demonstrated to efficiently restore the expression of aberrantly-silenced genes, thus re-establishing pathway functions. In light of the pleiotropic activities of epigenetic drugs, their use alone or in combination therapies is being strongly suggested, and a particular clinical benefit might be expected from their synergistic activities with chemo-, radio-, and immuno-therapeutic approaches in melanoma patients. On this path, an important improvement would possibly derive from the development of new generation epigenetic drugs characterized by much reduced systemic toxicities, higher bioavailability, and more specific epigenetic effects.
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Affiliation(s)
- Luca Sigalotti
- Cancer Bioimmunotherapy Unit, Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico, Via F, Gallini 2, Aviano, Italy.
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Fratta E, Sigalotti L, Colizzi F, Covre A, Nicolay HJMG, Danielli R, Fonsatti E, Altomonte M, Calabrò L, Coral S, Maio M. Epigenetically regulated clonal heritability of CTA expression profiles in human melanoma. J Cell Physiol 2010; 223:352-8. [PMID: 20127705 DOI: 10.1002/jcp.22040] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The intratumoral heterogeneity of cancer testis antigens (CTA) expression, which is driven by promoter methylation status, may hamper the effectiveness of CTA-directed vaccination of melanoma patients. Thus, we investigated whether the intratumoral heterogeneity of CTA expression is inherited at cellular level, or evolves throughout cellular replication, leading to a phenotypically unstable tumor cell population with reduced immunogenicity and/or able to escape immune control. Utilizing a previously characterized ex vivo clonal model of intratumoral heterogeneity of CTA expression in melanoma, Mel 313 MAGE-A3-low clone 5 (clone 5(M3-low)) and MAGE-A3-high clone 14 (clone 14(M3-high)) were sub-cloned and analyzed for CTA profile. Molecular assays demonstrated that levels of MAGE-A3 expression were highly conserved among generated sub-clones, as compared to parental clones. A similar behavior was identified for an extensive panel of other CTA investigated. Inherited levels of MAGE-A3 expression correlated with the extent of promoter methylation among clone 5(M3-low) and clone 14(M3-high) sub-clones analyzed. Treatment of clone 5(M3-low) with a DNA hypomethylating agent (DHA) resulted in an up-regulated expression of MAGE-A3, which was inherited at single cell level, being still detectable at day 60 in its sub-clones. Bisulfite sequencing demonstrated that also MAGE-A3 promoter methylation status was inherited among sub-clones generated from DHA-treated clone 5(M3-low) and strictly correlated with MAGE-A3 expression levels in investigated sub-clones. Similar results were obtained for additional CTA studied. Altogether our findings demonstrate that constitutive and DHA-modified CTA profiles of melanoma cells are clonally inherited throughout cellular replications, thus providing relevant insights to improve the effectiveness of CTA-based immunotherapy.
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Affiliation(s)
- Elisabetta Fratta
- Cancer Bioimmunotherapy Unit, Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, PN, Italy
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Altomonte M, Queirolo P, Testori A, Ascierto P, Danielli R, Giacomo AD, Sileni VC, Del Vecchio M, Ridolfi R, Maio M. 9328 The Italian experience on the feasibility and safety of ipilimumab therapy in pretreated metastatic melanoma patients. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71972-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Danielli R, Queirolo P, Testori A, Plummer R, Razi E, Sileni VC, Calabrò L, Giacomo AD, Ridolfi R, Maio M. 9315 Ipilimumab in pretreated metastatic uveal melanoma patients: safety and clinical efficacy. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71959-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Di Giacomo AM, Danielli R, Guidoboni M, Calabrò L, Carlucci D, Miracco C, Volterrani L, Mazzei MA, Biagioli M, Altomonte M, Maio M. Therapeutic efficacy of ipilimumab, an anti-CTLA-4 monoclonal antibody, in patients with metastatic melanoma unresponsive to prior systemic treatments: clinical and immunological evidence from three patient cases. Cancer Immunol Immunother 2009; 58:1297-306. [PMID: 19139884 PMCID: PMC11030873 DOI: 10.1007/s00262-008-0642-y] [Citation(s) in RCA: 208] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Accepted: 12/08/2008] [Indexed: 12/11/2022]
Abstract
The management of unresectable metastatic melanoma is a major clinical challenge because of the lack of reliably effective systemic therapies. Blocking cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) has recently been proposed as a strategy to enhance cell-mediated immune responses to cancer, and clinical trials have demonstrated that anti-CTLA-4 therapy can produce durable outcomes with different response patterns than cytotoxic chemotherapy. We enrolled eight out of 155 patients with advanced melanoma in a multicentre phase II trial that evaluated the activity and tolerability of ipilimumab, a fully human, anti-CTLA-4 monoclonal antibody ( www.clinicaltrials.gov ; NCT00289627; CA184-008). Here we report our experience with three of these patients, who experienced progressive disease after a variety of previous therapies, including prior immunotherapies, and who achieved good outcomes with ipilimumab. One patient had a partial response ongoing at 17+ months on ipilimumab despite failure with four prior therapies, and the other two patients showed durable stable disease, both still ongoing at 17+ and 20+ months, respectively. The patient achieving a partial response experienced no side effects while receiving ipilimumab. The other two patients developed immune-related adverse events (irAEs) including rash (one case; grade 2) and diarrhoea (both cases; grades 1 and 2, respectively); the histopathology of colon biopsy samples from both was suggestive of colitis, with an abundant CD8+ T-cell infiltrate. Nausea, vomiting and acute pancreatitis were also observed in one patient. In addition, immunohistochemical findings of a dense CD8+, TIA1+ and granzyme B+ lymphoid infiltrate within a biopsied lesion provide indirect evidence of functional T-cell activation induced by treatment. These case reports highlight the potential for anti-CTLA-4-based therapy in previously treated patients with advanced melanoma. Moreover, because the patterns of response to ipilimumab differ from chemotherapy, we need to understand how and when patients may respond to treatment so that appropriate clinical decisions can be made.
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Affiliation(s)
- Anna Maria Di Giacomo
- Division of Medical Oncology and Immunotherapy, Istituto Toscano Tumori, University Hospital of Siena, Siena, Italy
| | - Riccardo Danielli
- Division of Medical Oncology and Immunotherapy, Istituto Toscano Tumori, University Hospital of Siena, Siena, Italy
| | - Massimo Guidoboni
- Division of Medical Oncology and Immunotherapy, Istituto Toscano Tumori, University Hospital of Siena, Siena, Italy
| | - Luana Calabrò
- Division of Medical Oncology and Immunotherapy, Istituto Toscano Tumori, University Hospital of Siena, Siena, Italy
| | - Dora Carlucci
- Division of Medical Oncology and Immunotherapy, Istituto Toscano Tumori, University Hospital of Siena, Siena, Italy
| | - Clelia Miracco
- Department of Pathology, Istituto Toscano Tumori, University Hospital of Siena, Siena, Italy
| | - Luca Volterrani
- Department of Radiology, Istituto Toscano Tumori, University Hospital of Siena, Siena, Italy
| | - Maria Antonietta Mazzei
- Department of Radiology, Istituto Toscano Tumori, University Hospital of Siena, Siena, Italy
| | - Maurizio Biagioli
- Division of Dermatology, Istitutto Toscano Tumori, University Hospital of Siena, Siena, Italy
| | - Maresa Altomonte
- Division of Medical Oncology and Immunotherapy, Istituto Toscano Tumori, University Hospital of Siena, Siena, Italy
| | - Michele Maio
- Division of Medical Oncology and Immunotherapy, Istituto Toscano Tumori, University Hospital of Siena, Siena, Italy
- Cancer Bioimmunotherapy Unit, Department of Medical Oncology, Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
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Di Giacomo A, Danielli R, Calabrò L, Guidoboni M, Miracco C, Biagioli M, Mazzei M, Altomonte M, Maio M. Ipilimumab in the common daily practice: Feasibility, safety, and efficacy in heavily pretreated metastatic melanoma patients. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
e20002 Background: Effective anti-tumor responses are being observed in metastatic melanoma (MM) patients (pts) with the anti-CTLA-4 antibody Ipilimumab (Ipi) in clinical trials; however no data support the feasibility and clinical effectiveness of Ipi use in the daily practice. We report a single Institution experience utilizing Ipi within a compassionate program for MM pts. Methods: 27 stage III (2) or IV (25) pts (14 males, 13 females), median age 55 (23–77) years, ECOG performance status 0- 1, with MM (23 cutaneous, 3 uveal, 1 mucosal) progressing to 3 median (1–5) systemic therapies for metastatic disease received Ipi. Eight pts had evidence (6) or history (2) of brain metastases and 11 elevated (>1x upper limit of normal [ULN]) LDH. In the induction phase (IF) pts received Ipi (10 mg/kg i.v.) q3 weeks (wks) x 4 cycles; after a 12 wks rest treatment was repeated q12 wks in the maintenance phase (MF). Tumor assessment (TA) per modified World Health Organization criteria was performed at baseline, week (wk) 12 (±2) and wk 24, then every 12 wks. Adverse Events (AE) and immune related AE (irAE) were collected according to Common Terminology Criteria for Adverse Events version 3.0. Results: All pts received at least one Ipi dose, and 18/27 completed the IF. Of the remaining 9 pts, 4 are completing the IF and 5 were withdrawn for AE severity (3 pts) or disease progression (2 pts). Eight pts entered the MF. TA at wk 12 showed partial response (PR) in 1/18 or stable disease (SD) in 5/18 pts. TA at wk 24 showed PR and SD in 3/8 and 5/8 pts, respectively, with an ongoing clinical benefit (SD + PR + CR) of 34% (8/23 pts); these pts are still on treatment. Slow, steady declines in tumor volume and appearance of new lesions with subsequent shrinking of total tumor burden has been observed. One patient had Grade 3 AE (myocardial infarction) and 2 pts had Grade 3 irAE (diarrhoea). Excluding pts who are in IF, to date median overall survival is 27 wks (19–39). Conclusions: Ipi treatment is feasible, safe and clinically effective also in the common daily practice and in heavily pretreated, progressing, MM pts. A sizable proportion of these pts experiences durable clinical benefit. No significant financial relationships to disclose.
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Affiliation(s)
- A. Di Giacomo
- University Hospital of Siena - ITT, Siena, Italy; University Hospital of Siena - ITT - CRO, Siena - Aviano, Italy
| | - R. Danielli
- University Hospital of Siena - ITT, Siena, Italy; University Hospital of Siena - ITT - CRO, Siena - Aviano, Italy
| | - L. Calabrò
- University Hospital of Siena - ITT, Siena, Italy; University Hospital of Siena - ITT - CRO, Siena - Aviano, Italy
| | - M. Guidoboni
- University Hospital of Siena - ITT, Siena, Italy; University Hospital of Siena - ITT - CRO, Siena - Aviano, Italy
| | - C. Miracco
- University Hospital of Siena - ITT, Siena, Italy; University Hospital of Siena - ITT - CRO, Siena - Aviano, Italy
| | - M. Biagioli
- University Hospital of Siena - ITT, Siena, Italy; University Hospital of Siena - ITT - CRO, Siena - Aviano, Italy
| | - M. Mazzei
- University Hospital of Siena - ITT, Siena, Italy; University Hospital of Siena - ITT - CRO, Siena - Aviano, Italy
| | - M. Altomonte
- University Hospital of Siena - ITT, Siena, Italy; University Hospital of Siena - ITT - CRO, Siena - Aviano, Italy
| | - M. Maio
- University Hospital of Siena - ITT, Siena, Italy; University Hospital of Siena - ITT - CRO, Siena - Aviano, Italy
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Di Giacomo AM, Danielli R, Guidoboni M, Calabrò L, Carlucci D, Miracco C, Volterrani L, Mazzei MA, Biagioli M, Altomonte M, Maio M. Therapeutic efficacy of ipilimumab, an anti-CTLA-4 monoclonal antibody, in patients with metastatic melanoma unresponsive to prior systemic treatments: clinical and immunological evidence from three patient cases. Cancer Immunol Immunother 2009. [PMID: 19139884 DOI: 10.1007/s00262?008?0642?y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The management of unresectable metastatic melanoma is a major clinical challenge because of the lack of reliably effective systemic therapies. Blocking cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) has recently been proposed as a strategy to enhance cell-mediated immune responses to cancer, and clinical trials have demonstrated that anti-CTLA-4 therapy can produce durable outcomes with different response patterns than cytotoxic chemotherapy. We enrolled eight out of 155 patients with advanced melanoma in a multicentre phase II trial that evaluated the activity and tolerability of ipilimumab, a fully human, anti-CTLA-4 monoclonal antibody ( www.clinicaltrials.gov ; NCT00289627; CA184-008). Here we report our experience with three of these patients, who experienced progressive disease after a variety of previous therapies, including prior immunotherapies, and who achieved good outcomes with ipilimumab. One patient had a partial response ongoing at 17+ months on ipilimumab despite failure with four prior therapies, and the other two patients showed durable stable disease, both still ongoing at 17+ and 20+ months, respectively. The patient achieving a partial response experienced no side effects while receiving ipilimumab. The other two patients developed immune-related adverse events (irAEs) including rash (one case; grade 2) and diarrhoea (both cases; grades 1 and 2, respectively); the histopathology of colon biopsy samples from both was suggestive of colitis, with an abundant CD8+ T-cell infiltrate. Nausea, vomiting and acute pancreatitis were also observed in one patient. In addition, immunohistochemical findings of a dense CD8+, TIA1+ and granzyme B+ lymphoid infiltrate within a biopsied lesion provide indirect evidence of functional T-cell activation induced by treatment. These case reports highlight the potential for anti-CTLA-4-based therapy in previously treated patients with advanced melanoma. Moreover, because the patterns of response to ipilimumab differ from chemotherapy, we need to understand how and when patients may respond to treatment so that appropriate clinical decisions can be made.
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Affiliation(s)
- Anna Maria Di Giacomo
- Division of Medical Oncology and Immunotherapy, Istituto Toscano Tumori, University Hospital of Siena, Siena, Italy
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Danielli R, Fratta E, Sigalotti L, Calabro L, Di Giacomo AM, Coral S, Colizzi F, Altomonte M, Maio M. OR.19. Can Epigenetics Have a Clinical Impact in the Treatment of Melanoma? Clin Immunol 2006. [DOI: 10.1016/j.clim.2006.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Emerging evidence demonstrates that epigenetic events associated with tumor development and progression may impair immunogenicity and immune recognition of cancer cells, possibly favoring their escape also from vaccination-induced antitumor immune responses. In fact, DNA hypermethylation and/or histone deacetylation plays a critical role in the downregulation and/or silencing of several genes involved in the recognition of neoplastic cells by the immune system, including human leukocyte antigens (HLAs), tumor-associated antigens, and accessory/costimulatory molecules. However, as opposed to genetic alterations, epigenetic events can be successfully handled through pharmacologic agents that induce DNA hypomethylation or inhibit histone deacetylation, resulting in a functionally "more efficient" immune profile of cancer cells. In light of the encouraging immunomodulatory results obtained with these "epigenetic drugs," they certainly will be used for the development of combined chemo-immunotherapeutic strategies for the treatment of patients with solid malignancies of different histology.
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Affiliation(s)
- Luca Sigalotti
- Cancer Bioimmunotherapy Unit, Department of Medical Oncology, Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
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Sigalotti L, Fratta E, Coral S, Tanzarella S, Danielli R, Colizzi F, Fonsatti E, Traversari C, Altomonte M, Maio M. Intratumor Heterogeneity of Cancer/Testis Antigens Expression in Human Cutaneous Melanoma Is Methylation-Regulated and Functionally Reverted by 5-Aza-2′-deoxycytidine. Cancer Res 2004; 64:9167-71. [PMID: 15604288 DOI: 10.1158/0008-5472.can-04-1442] [Citation(s) in RCA: 155] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cancer/testis antigens (CTA) are suitable targets for immunotherapy of human malignancies, and clinical trials are mainly focusing on MAGE-A3. However, the heterogeneous intratumor expression of CTA may hamper the effectiveness of CTA-directed vaccination through the emergence of CTA-negative neoplastic clones. We investigated the intratumor heterogeneity of CTA in human melanoma and the underlying molecular mechanism(s) at clonal level using 14 single cell clones generated from the melanoma lesion Mel 313. Reverse transcription-PCR revealed a highly heterogeneous expression of MAGE-A1, -A2, -A3, -A4, -A6, GAGE 1-6, SSX 1-5, and PRAME among melanoma clones. Only nine clones expressed MAGE-A3 and competitive reverse transcription-PCR identified relative differences in the number of mRNA molecules of up to 130-fold between clones 5 and 14. This clonal heterogeneity of MAGE-A3 expression correlated with the methylation status of specific CpG dinucleotides in MAGE-A3 promoter: i.e., hypomethylated CpG dinucleotides at positions -321, -151, -19, -16, -5, -2, +21, and +42 were found in clones expressing high but not low levels of MAGE-A3. Supporting the role of DNA methylation in generating the intratumor heterogeneity of CTA, the DNA hypomethylating agent 5-aza-2'-deoxycytidine (5-AZA-dCyd) invariably induced their expression in all CTA-negative clones. Furthermore, 5-AZA-dCyd-treatment reduced to 6 folds the differential expression of MAGE-A3 between clones 5 and 14, which became recognized to a similar extent by T cells specific for a MAGE-A-encoded peptide. These findings identify promoter methylation as directly responsible for the intratumoral heterogeneity of therapeutic CTA in melanoma and foresee the use of 5-AZA-dCyd to overcome the limitations set by their intratumor heterogeneous expression to CTA-based vaccine therapy.
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Affiliation(s)
- Luca Sigalotti
- Cancer Bioimmunotherapy Unit, Department of Medical Oncology, Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
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