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Raiser P, Schleiermacher G, Gambart M, Dumont B, Defachelles AS, Thebaud E, Tandonnet J, Pasqualini C, Proust S, Entz-Werle N, Aerts I, Ndounga-Diakou LA, Petit A, Puiseux C, Khanfar C, Rouger J, Mansuy L, Benadiba J, Millot F, Pluchart C, Laghouati S, Geoerger B, Vassal G, Valteau-Couanet D, Berlanga P. Chemo-immunotherapy with dinutuximab beta in patients with relapsed/progressive high-risk neuroblastoma: does chemotherapy backbone matter? Eur J Cancer 2024; 202:114001. [PMID: 38489858 DOI: 10.1016/j.ejca.2024.114001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Addition of anti-GD2 antibodies to temozolomide-based chemotherapy has demonstrated increased antitumor activity and progression-free survival in patients with relapsed/progressive high-risk neuroblastoma. However, chemo-immunotherapy is not yet approved for this indication. This study presents the chemo-immunotherapy experience in patients with relapsed/progressive high-risk neuroblastoma treated within the off-label use program of the Neuroblastoma Committee of the French Society of Pediatric Oncology (SFCE). METHODS Dinutuximab beta (dB) was administered alongside temozolomide-topotecan (TOTEM) or temozolomide-irinotecan (TEMIRI) at first disease relapse/progression or topotecan-cyclophosphamide (TopoCyclo) at further relapse/progression. Real-world data on demographics, treatment, antitumor activity and safety was collected from all patients after inclusion in SACHA-France (NCT04477681), a prospective national registry, which documents safety and efficacy data on innovative anticancer therapies prescribed to patients ≤ 25 years old as compassionate or off-label use. RESULTS Between February 2021 and July 2023, 39 patients with confirmed relapsed/progressive high-risk neuroblastoma (median age 6 years, range 1-24) were treated with dB+TopoCyclo (n = 24) or dB+TOTEM/TEMIRI (n = 15) across 17 centers. In total, 163 chemo-immunotherapy cycles were administered, main toxicities were mild or moderate, with higher incidence of hematological adverse drug reactions with dB+TopoCyclo than dB+TOTEM/TEMIRI. Objective response rate was 42% for dB+TopoCyclo (CI95% 22-63%) and 40% for dB+TOTEM/TEMIRI (CI95% 16-68%). CONCLUSION Similar objective response rates for dB+TopoCyclo and dB+TOTEM/TEMIRI in patients with relapsed/progressive high-risk neuroblastoma emphasize the importance of chemo-immunotherapy, irrespective of the chemotherapy backbone.
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Affiliation(s)
- Patricia Raiser
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, 94805 Villejuif, France
| | - Gudrun Schleiermacher
- RTOP (Recherche Translationelle en Oncologie Pediatrique), U830 INSERM, Institut Curie, PSL Research University, 75005 Paris, France; SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), U830 INSERM, Institut Curie, PSL Research University, 75005 Paris, France
| | - Marion Gambart
- Department of Pediatric Oncology, Toulouse University Hospital, 31300 Toulouse, France
| | - Benoit Dumont
- Department of Pediatric Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique/Centre Léon Bérard, 69008 Lyon, France
| | | | - Estelle Thebaud
- Pediatric Immuno-Hemato-Oncology Unit, CHU Nantes, 44000 Nantes, France
| | - Julie Tandonnet
- Pediatric Hematology-Oncology Department, Centre Hospitalier Universitaire (CHU), 33000 Bordeaux, France
| | - Claudia Pasqualini
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, 94805 Villejuif, France
| | - Stéphanie Proust
- Department of Pediatric Oncology, University Hospital, 49100 Angers, France
| | - Natacha Entz-Werle
- Pediatric Onco-Hematology Unit, University Hospital of Strasbourg, 67200 Strasbourg, France
| | - Isabelle Aerts
- RTOP (Recherche Translationelle en Oncologie Pediatrique), U830 INSERM, Institut Curie, PSL Research University, 75005 Paris, France; SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), U830 INSERM, Institut Curie, PSL Research University, 75005 Paris, France
| | - Lee A Ndounga-Diakou
- Pharmacovigilance Unit, Clinical Research Direction, Gustave Roussy Cancer Campus, Université Paris-Saclay, 94805 Villejuif, France
| | - Arnaud Petit
- Department of Pediatric Hematology and Oncology, Hôpital Armand Trousseau, 75012 Paris, France
| | - Chloe Puiseux
- Department of Pediatric Hemato-Oncology, University Hospital of Rennes, 35200 Rennes, France
| | - Camille Khanfar
- Department of Pediatric Oncology, CHU Amiens Picardie, 80054 Amiens, France
| | - Jeremie Rouger
- Department of Pediatric Hematology and Oncology, University Hospital of Caen, 14000 Caen, France
| | - Ludovic Mansuy
- Department of Pediatric Hematology-Oncology, Children's Hospital of Brabois, 54500 Vandoeuvre Les Nancy, France
| | - Joy Benadiba
- Department of Hemato-Oncology Pediatric, Nice University Hospital, 06000 Nice, France
| | - Frédéric Millot
- Department of Paediatric Haematology and Oncology, Centre Hospitalo-Universitaire de Poitiers, 86000 Poitiers, France
| | - Claire Pluchart
- Department of Paediatric Haematology and Oncology, Centre Hospitalo-Universitaire de Reims, 51100 Reims, France
| | - Salim Laghouati
- Pharmacovigilance Unit, Clinical Research Direction, Gustave Roussy Cancer Campus, Université Paris-Saclay, 94805 Villejuif, France
| | - Birgit Geoerger
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, 94805 Villejuif, France; INSERM U1015, Gustave Roussy Cancer Campus, Université Paris-Saclay, 94805 Villejuif, France
| | - Gilles Vassal
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, 94805 Villejuif, France
| | - Dominique Valteau-Couanet
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, 94805 Villejuif, France
| | - Pablo Berlanga
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, 94805 Villejuif, France.
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Hartl D, Godbert Y, Carrat X, Bardet S, Lasne-Cardon A, Vera P, Ilies E, Zerdoud S, Sarini J, Zalzali M, La Manna L, Schneegans O, Kelly A, Kaufmann P, Rodien P, Brunaud L, Grunenwald S, Housseau E, Laghouati S, Bouvet N, Lecerf E, Hadoux J, Lamartina L, Schlumberger M, Borget I. Correction: ESTIMation of the ABiLity of prophylactic central compartment neck dissection to modify outcomes in low-risk differentiated thyroid cancer: a prospective randomized trial. Trials 2023; 24:452. [PMID: 37434205 DOI: 10.1186/s13063-023-07467-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Affiliation(s)
- Dana Hartl
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France.
| | - Yann Godbert
- Institut Bergonié, 229 Cr de l'Argonne, 33076, Bordeaux Cedex, France
| | - Xavier Carrat
- Institut Bergonié, 229 Cr de l'Argonne, 33076, Bordeaux Cedex, France
| | - Stéphane Bardet
- Centre François Baclesse, 3 Av. du Général Harris, 14000, Caen, France
| | | | - Pierre Vera
- Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Elena Ilies
- Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Slimane Zerdoud
- Institut Universitaire du Cancer de Toulouse, 1 avenue Irène Joliot-Curie, 31059, Toulouse Cedex 9, France
| | - Jérôme Sarini
- Institut Universitaire du Cancer de Toulouse, 1 avenue Irène Joliot-Curie, 31059, Toulouse Cedex 9, France
| | - Mohamad Zalzali
- Institut Godinot, 1 Rue du Général Koenig, 51100, Reims, France
| | - Luigi La Manna
- Institut Godinot, 1 Rue du Général Koenig, 51100, Reims, France
| | - Olivier Schneegans
- ICANS Institut de Cancérologie Strasbourg Europe, 17 Rue Albert Calmette, 67200, Strasbourg, France
| | - Antony Kelly
- Centre Jean Perrin, 58, rue Montalembert, 63011, Clermont-Ferrand Cedex 01, France
| | - Philppe Kaufmann
- Centre Jean Perrin, 58, rue Montalembert, 63011, Clermont-Ferrand Cedex 01, France
| | - Patrice Rodien
- Centre Hospitalier Universitaire d'Angers, 4 Rue Larrey, 49100, Angers, France
| | - Laurent Brunaud
- Centre Hospitalier Régional et Universitaire de Nancy, Rue du Morvan, 54000, Nancy, France
| | - Solange Grunenwald
- Centre Hospitalier Universitaire de Toulouse, 2 Rue Charles Viguerie, 31300, Toulouse, France
| | - Elie Housseau
- Centre Hospitalier de Hagenau, 64 Av. du Professeur René Leriche, 67500, Haguenau, France
| | - Salim Laghouati
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Nathalie Bouvet
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Elodie Lecerf
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Julien Hadoux
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Livia Lamartina
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | | | - Isabelle Borget
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
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3
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Berlanga P, Ndounga-Diakou LA, Aerts I, Corradini N, Ducassou S, Strullu M, de Carli E, André N, Entz-Werle N, Raimbault S, Roumy M, Renouard M, Gueguen G, Plantaz D, Reguerre Y, Cleirec M, Petit A, Puiseux C, Andry L, Klein S, Bodet D, Kanold J, Briandet C, Halfon-Domenech C, Nelken B, Piguet C, Saumet L, Chastagner P, Benadiba J, Millot F, Pluchart C, Schneider P, Thouvenin S, Gambart M, Serre J, Abbou S, Leruste A, Cayzac H, Gandemer V, Laghouati S, Vassal G. Measuring Safety and Outcomes for the Use of Compassionate and Off-Label Therapies for Children, Adolescents, and Young Adults With Cancer in the SACHA-France Study. JAMA Netw Open 2023; 6:e2321568. [PMID: 37399010 DOI: 10.1001/jamanetworkopen.2023.21568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
Importance Innovative anticancer therapies for children, adolescents, and young adults are regularly prescribed outside their marketing authorization or through compassionate use programs. However, no clinical data of these prescriptions is systematically collected. Objectives To measure the feasibility of the collection of clinical safety and efficacy data of compassionate and off-label innovative anticancer therapies, with adequate pharmacovigilance declaration to inform further use and development of these medicines. Design, Setting, and Participants This cohort study included patients treated at French pediatric oncology centers from March 2020 to June 2022. Eligible patients were aged 25 years or younger with pediatric malignant neoplasms (solid tumors, brain tumors, or hematological malignant neoplasms) or related conditions who received compassionate use or off-label innovative anticancer therapies. Follow up was conducted through August 10, 2022. Exposures All patients treated in a French Society of Pediatric Oncology (SFCE) center. Main Outcomes and Measures Collection of adverse drug reactions and anticancer activity attributable to the treatment. Results A total of 366 patients were included, with a median age of 11.1 years (range, 0.2-24.6 years); 203 of 351 patients (58%) in the final analysis were male. Fifty-five different drugs were prescribed, half of patients (179 of 351 [51%]) were prescribed these drugs within a compassionate use program, mainly as single agents (74%) and based on a molecular alteration (65%). Main therapies were MEK/BRAF inhibitors followed by multi-targeted tyrosine kinase inhibitors. In 34% of patients at least a grade 2 clinical and/or grade 3 laboratory adverse drug reaction was reported, leading to delayed therapy and permanent discontinuation of the innovative therapy in 13% and 5% of patients, respectively. Objective responses were reported in 57 of 230 patients (25%) with solid tumors, brain tumors, and lymphomas. Early identification of exceptional responses supported the development of specific clinical trials for this population. Conclusions and Relevance This cohort study of the SACHA-France (Secured Access to Innovative Medicines for Children with Cancer) suggested the feasibility of prospective multicenter clinical safety and activity data collection for compassionate and off-label new anticancer medicines. This study allowed adequate pharmacovigilance reporting and early identification of exceptional responses allowing further pediatric drug development within clinical trials; based on this experience, this study will be enlarged to the international level.
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Affiliation(s)
- Pablo Berlanga
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Lee Aymar Ndounga-Diakou
- Pharmacovigilance Unit, Clinical Research Direction, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Isabelle Aerts
- SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, PSL Research University, Paris, France
| | - Nadège Corradini
- Paediatric Haematology-Oncology Institut, of Centre Léon Bérard, Lyon, France
| | - Stéphane Ducassou
- Paediatric Haematology-Oncology Department, Centre Hospitalier Universitaire (CHU), Bordeaux, France
| | - Marion Strullu
- Paediatric Immuno-Haematology Department, Hôpital Robert-Debré AP-HP, Paris, France
| | - Emilie de Carli
- Department of Pediatric Oncology, University Hospital, Angers, France
| | - Nicolas André
- Department of Pediatric Hematology & Oncology, Hôpital de La Timone, AP-HM, Marseille, France
| | - Natacha Entz-Werle
- Pediatric Onco-Hematology Unit, University Hospital of Strasbourg, Strasbourg, France
| | - Sandra Raimbault
- Department of Pediatric Oncology, Oscar Lambret Cancer Center, Lille, France
| | - Marianne Roumy
- Department of Pediatric Oncology, University Hospital, Angers, France
| | - Marjolaine Renouard
- SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, PSL Research University, Paris, France
| | - Gwenaelle Gueguen
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Dominique Plantaz
- Department of Pediatric Onco-Immuno-Hematology, Grenoble Alpes University Hospital, Grenoble, France
| | - Yves Reguerre
- Pediatric Oncology and Hematology Unit, CHU Saint Denis de la Réunion, Bellepierre, France
| | - Morgane Cleirec
- Pediatric Immuno-Hemato-Oncology Unit, CHU Nantes, Nantes, France
| | - Arnaud Petit
- Department of Pediatric Hematology and Oncology, Hôpital Armand Trousseau, Paris, France
| | - Chloe Puiseux
- Department of Pediatric Hemato-Oncology, University Hospital of Rennes, Rennes, France
| | - Leslie Andry
- Department of Pediatric Oncology, CHU Amiens Picardie, Amiens, France
| | - Sébastien Klein
- Pediatric Oncology and Hematology, CHU Jean-Minjoz, Besançon, France
| | - Damien Bodet
- Department of Pediatric Hematology and Oncology, University Hospital of Caen, Caen, France
| | - Justyna Kanold
- Department of Pediatric Hematology-Oncology, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | - Brigitte Nelken
- Department of Pediatric Hematology-Oncology, Jeanne de Flandre Hospital, CHRU, Lille, France
| | | | - Laure Saumet
- Department of Pediatric Hematology-Oncology, University Hospital of Montpellier, Montpellier, France
| | - Pascal Chastagner
- Department of Pediatric Hematology-Oncology, Children's Hospital of Brabois, Vandoeuvre Les Nancy, France
| | - Joy Benadiba
- Department of Hemato-Oncology Pediatric, Nice University Hospital, Nice, France
| | - Frédéric Millot
- Department of Paediatric Haematology and Oncology, Centre Hospitalo-Universitaire de Poitiers, Poitiers, France
| | - Claire Pluchart
- Department of Paediatric Haematology and Oncology, Centre Hospitalo-Universitaire de Reims, Reims, France
| | - Pascale Schneider
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Rouen, Rouen, France
| | - Sandrine Thouvenin
- Department of Pediatric Hematology-Oncology, University Hospital St Etienne, St Etienne, France
| | - Marion Gambart
- Department of Pediatric Oncology, Toulouse University Hospital, Toulouse, France
| | - Jill Serre
- Department of Pediatric Hematology-Oncology, CHRU de Tours, Tours, France
| | - Samuel Abbou
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Amaury Leruste
- SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, PSL Research University, Paris, France
| | - Hélena Cayzac
- Pharmacovigilance Unit, Clinical Research Direction, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Virginie Gandemer
- Department of Pediatric Hemato-Oncology, University Hospital of Rennes, Rennes, France
| | - Salim Laghouati
- Pharmacovigilance Unit, Clinical Research Direction, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Gilles Vassal
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
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Hartl D, Godbert Y, Carrat X, Bardet S, Lasne-Cardon A, Vera P, Ilies E, Zerdoud S, Sarini J, Zalzali M, La Manna L, Schneegans O, Kelly A, Kauffmann P, Rodien P, Brunaud L, Grunenwald S, Housseau E, Laghouati S, Bouvet N, Lecerf E, Hadoux J, Lamartina L, Schlumberger M, Borget I. ESTIMation of the ABiLity of prophylactic central compartment neck dissection to modify outcomes in low-risk differentiated thyroid cancer: a prospective randomized trial. Trials 2023; 24:298. [PMID: 37118818 PMCID: PMC10142499 DOI: 10.1186/s13063-023-07294-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/05/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Prophylactic central neck dissection in clinically low-risk cT1bT2N0 papillary thyroid carcinoma is controversial, due to a large number of conflicting retrospective studies, some showing an advantage in terms of locoregional recurrence, others showing no advantage. These previous studies all show high rates of excellent response. We aim to demonstrate the non-inferiority of thyroidectomy alone as compared to total thyroidectomy with prophylactic central neck dissection in conjunction with adjuvant RAI 30 mCi with rTSH stimulation in terms of excellent response at 1 year. TRIAL DESIGN AND METHODS Prospective randomized open multicenter phase III trial including patients with 11-40-mm papillary thyroid carcinoma (Bethesda VI) or suspicious cytology (Bethesda V) confirmed malignant on intra-operative frozen section analysis, with no suspicious lymph nodes on a specialized preoperative ultrasound examination. Patients will be randomized 1:1 into two groups: the reference group total thyroidectomy with bilateral prophylactic central neck dissection, and the comparator group total thyroidectomy alone. All patients will receive an ablative dose of 30mCi of radioactive iodine (RAI) within 4 months of surgery. The primary outcome is to compare the rate of excellent response at 1 year after surgery between the groups, as defined by an unstimulated serum thyroglobulin (Tg) level ≤ 0.2 ng/mL with no anti-Tg antibodies, an normal neck ultrasound and no ectopic uptake on the post-RAI scintiscan. Non-inferiority will be demonstrated if the rate of patients with excellent response at 1 year after randomization does not differ by more than 5%. Setting the significance level at 0.025 (one-sided) and a power of 80% requires a sample size of 598 patients (299 per group). Secondary outcomes are to compare Tg levels at 8 +/- 2 postoperative weeks, before RAI ablation, the rate of excellent response at 3 and 5 years, the rate of other responses at 1, 3, and 5 years (biochemical incomplete, indeterminate, and structurally incomplete responses), complications, quality of life, and cost-utility. DISCUSSION (POTENTIAL IMPLICATIONS) If non-inferiority is demonstrated with this high-level evidence, prophylactic neck dissection will have been shown to not be necessary in clinically low-risk papillary thyroid carcinoma. TRIAL REGISTRATION NCT03570021. June 26,2018.
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Affiliation(s)
- Dana Hartl
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France.
| | - Yann Godbert
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Xavier Carrat
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Stéphane Bardet
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | | | - Pierre Vera
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Elena Ilies
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Slimane Zerdoud
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Jérôme Sarini
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Mohamad Zalzali
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Luigi La Manna
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Olivier Schneegans
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Antony Kelly
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Philppe Kauffmann
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Patrice Rodien
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Laurent Brunaud
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Solange Grunenwald
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Elie Housseau
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Salim Laghouati
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Nathalie Bouvet
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Elodie Lecerf
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Julien Hadoux
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Livia Lamartina
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | | | - Isabelle Borget
- Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
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Danlos FX, Texier M, Job B, Mouraud S, Cassard L, Baldini C, Varga A, Yurchenko AA, Rabeau A, Champiat S, Letourneur D, Bredel D, Susini S, Blum Y, Parpaleix A, Parlavecchio C, Tselikas L, Fahrner JE, Goubet AG, Rouanne M, Rafie S, Abbassi A, Kasraoui I, Breckler M, Farhane S, Ammari S, Laghouati S, Gazzah A, Lacroix L, Besse B, Droin N, Deloger M, Cotteret S, Adam J, Zitvogel L, Nikolaev SI, Chaput N, Massard C, Soria JC, Gomez-Roca C, Zalcman G, Planchard D, Marabelle A. Genomic Instability and Pro-Tumoral Inflammation are associated with Primary Resistance to Anti-PD1 + Anti-Angiogenesis in Malignant Pleural Mesothelioma. Cancer Discov 2023; 13:858-879. [PMID: 36669143 PMCID: PMC10068454 DOI: 10.1158/2159-8290.cd-22-0886] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/25/2022] [Accepted: 01/18/2023] [Indexed: 01/21/2023]
Abstract
Cancer immunotherapy combinations have recently shown to improve the overall survival of advanced mesotheliomas especially for patients responding to those treatments. We aimed to characterize the biological correlates of malignant pleural mesotheliomas primary resistance to immunotherapy and anti-angiogenics by testing the combination of pembrolizumab, an anti-PD-1 antibody, and nintedanib, a pan anti-angiogenic tyrosine kinase inhibitor (TKI), in the multi-center PEMBIB trial (NCT02856425). Thirty patients with advanced malignant pleural mesothelioma were treated and explored. Unexpectedly, we found that refractory patients were actively recruiting CD3+CD8+ cytotoxic T-cells in their tumors through CXCL9 tumor release upon treatment. However, these patients displayed high levels of somatic copy number alterations in their tumors that correlated with high blood and tumor levels of IL-6 and CXCL8. Those pro-inflammatory cytokines resulted in higher tumor secretion of VEGF and tumor enrichment in regulatory T-cells. Advanced mesothelioma should further benefit from stratified combination therapies adapted to their tumor biology.
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Affiliation(s)
| | - Matthieu Texier
- Gustave Roussy, INSERM, Univ. Paris-Sud, Université Paris Saclay, Villejuif, France
| | | | | | | | | | - Andrea Varga
- Drug Development Department, Institut de Cancérologie Gustave Roussy, Villejuif, France
| | | | - Audrey Rabeau
- University Cancer Institute Toulouse Oncopole, France
| | | | | | | | | | - Yuna Blum
- Univ Rennes, CNRS, INSERM, IGDR (Institut de Génétique et Développement de Rennes) - UMR 6290, ERL U1305, Rennes, France
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Antoun S, Lanoy E, Ammari S, Farhane S, Martin L, Robert C, Planchard D, Routier E, Voisin AL, Messayke S, Champiat S, Michot JM, Laghouati S, Lambotte O, Marabelle A, Baracos V. Protective effect of obesity on survival in cancers treated with immunotherapy vanishes when controlling for type of cancer, weight loss and reduced skeletal muscle. Eur J Cancer 2023; 178:49-59. [PMID: 36403367 DOI: 10.1016/j.ejca.2022.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 08/01/2022] [Revised: 10/16/2022] [Accepted: 10/19/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Association of high body mass index (BMI) with longer survival has been reported in patients on immune checkpoint inhibitors (ICIs), but results are inconsistent. This 'obesity paradox' is potentially confounded by the effects of BMI change over time and of skeletal muscle depletion. METHODS We conducted a secondary analysis of a prospective cohort, including consecutive patients receiving ICI treatment for melanoma (n = 411) and non-small cell lung cancer (NSCLC) (n = 389) in routine care. RESULTS In the univariable analysis of the entire population, overweight/obesity (BMI ≥ 25 kg/m2) was associated with longer survival (p < 0.01); however, this effect was limited to NSCLC (p < 0.01) and was absent in melanoma. Weight loss (WL) and reduced skeletal muscle mass were observed in patients within all BMI categories. WL was associated with shorter survival in multivariable analysis in both tumour sites (p < 0.01), and for NSCLC, BMI lost significance when WL was included (p = 0.13). In models further adjusted for CT-defined skeletal muscle mass, WL retained significance for both tumour types (p < 0.01), and reduced skeletal muscle only for NSCLC (p = 0.02) was associated with shorter survival. WL retained significance when biomarkers (lactate dehydrogenase enzyme, albumin and derived neutrophil to lymphocyte ratio) were added to the multivariable model. CONCLUSIONS The so-called 'obesity paradox', counterintuitive association between high BMI and longer survival, vanished when controlling for confounders, such as type of cancer, and manifestations of depletion (WL and reduced skeletal muscle mass).
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Affiliation(s)
- Sami Antoun
- Département Interdisciplinaire d'Organisation Du Parcours Patient, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France.
| | - Emilie Lanoy
- Département Interdisciplinaire d'Organisation Du Parcours Patient, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France
| | - Samy Ammari
- Département d'Imagerie Médicale BIOMAPS, UMR1281 INSERM, CEA, CNRS, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France; ELSAN Département de Radiologie, Institut de Cancérologie Paris Nord, Sarcelles, France
| | - Siham Farhane
- Département des Innovations Thérapeutiques et Essais Précoces, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France
| | - Lisa Martin
- Department of Oncology, University of Alberta, Canada
| | - Caroline Robert
- Département d'Oncologie Medicale, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France
| | - David Planchard
- Département d'Oncologie Medicale, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France
| | - Emilie Routier
- Département d'Oncologie Medicale, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France
| | - Anne Laure Voisin
- Unité de Pharmacovigilance, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France
| | - Sabine Messayke
- Unité de Pharmacovigilance, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France
| | - Stephane Champiat
- Département des Innovations Thérapeutiques et Essais Précoces, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France
| | - Jean Marie Michot
- Département des Innovations Thérapeutiques et Essais Précoces, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France
| | - Salim Laghouati
- Unité de Pharmacovigilance, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France
| | - Olivier Lambotte
- Université Paris Saclay, UMR1184 CEA, Inserm, Le Kremlin-Bicêtre, France; Service de Médecine Interne et Immunologie Clinique, Hôpital Bicêtre, Université Paris Saclay, AP-HP, Le Kremlin-Bicêtre, France
| | - Aurélien Marabelle
- Département des Innovations Thérapeutiques et Essais Précoces, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France
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7
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Danlos FX, Baldini C, Texier M, Varga A, Mouraud S, Job B, Letourneur D, Cassard L, Bredel D, Laghouati S, Adam J, Droin N, Parpaleix A, Chaput-Gras N, Rabeau A, Massard C, Soria JC, Zalcman G, Planchard D, Marabelle A. 1661MO Genomic somatic copy number alterations drive adaptive tumor immune suppression and primary resistance to anti-PD1 + anti-angiogenics in pleural mesothelioma. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1741] [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] Open
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8
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Berger V, Jubé C, Forestier A, Mitonneau C, Humeau H, Limouzin S, Tiercin M, Morlière L, Geoffrois L, Cabart M, Bertholet M, Llambrich-Molines C, Breysse S, Laghouati S, Beaumont N. 1627TiP Impact of patient education on immune-related adverse events (irAEs) during immune checkpoint inhibitor (ICI). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1930] [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: 11/01/2022] Open
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9
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Kfoury M, Najean M, Lappara A, Voisin AL, Champiat S, Michot JM, Laghouati S, Robert C, Besse B, Soria JC, Lambotte O, Massard C, Marabelle A, Texier M. Analysis of the association between prospectively collected immune-related adverse events and survival in patients with solid tumor treated with immune-checkpoint blockers, taking into account immortal-time bias. Cancer Treat Rev 2022; 110:102452. [PMID: 35998515 DOI: 10.1016/j.ctrv.2022.102452] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Numerous retrospective studies and reviews have reported a positive association between immune-related adverse events (irAEs) and survival in non-small cell lung cancer (NSCLC) and melanoma patients treated with immune checkpoint blockers (ICBs). However, some results are controversial and the studies, whose results converge, should be interpreted cautiously because most of them do not deal appropriately with the immortal-time bias. Here, we report an observational real-life study of the association between prospectively collected irAEs and survival of patients treated with ICBs while dealing with the immortal-time bias. METHODS Data from patients treated at Gustave Roussy from June 2014 to October 2017 with anti-PD-(L)1 antibodies for a melanoma or NSCLC have been prospectively collected in the REISAMIC database, a pharmacovigilance registry dedicated to irAEs. Adverse events of grade 2 and higher were collected prospectively. To study the association between the occurrence of irAEs and survival, we used both a landmark analysis and a Cox regression model with time-dependent covariate. RESULTS 577 patients were treated with anti-PD-(L)1 antibodies for melanoma (60.3 %) or NSCLC (39.7 %). The occurrence of an irAE was significantly associated with improved overall survival (OS): HR 0.56, 95 % CI [0.41; 0.75], p = 0.0001 and progression-free survival (PFS): HR 0.63, 95 % CI [0.47; 0.83], p = 0.001 using a Cox regression model with time-dependent covariate. In a 12-week landmark analysis, median OS was 21.2 months (95 % CI, 12.2 to 35.7) and 16.4 months (95 % CI, 12.4 to 21.3) p = 0.26 and median PFS was 14.3 months (95 % CI, 9.5 to 24.6) and 13.4 months (95 % CI, 10.2 to 18.3) p = 0.66, for patients with and without irAEs, respectively. CONCLUSIONS In our real-life study of patients with melanoma and NSCLC treated with anti-PD-(L)1 antibodies, we confirm that irAEs are associated with improved survival using a time-varying Cox regression model. Analysis with a landmark method showed no difference in OS or PFS between patients who experienced irAE during the first 12 weeks of treatment and those who did not. Retrospective analysis and reviews including studies that do not deal with the immortal-time bias and studies insufficiently powered for a landmark analysis should be interpreted with caution.
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Affiliation(s)
- Maria Kfoury
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France; Département d'Oncologie Médicale, Gustave Roussy, Villejuif, France.
| | - Marie Najean
- Département d'Epidémiologie et de Biostatistiques, Gustave Roussy, Villejuif, France
| | - Ariane Lappara
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France; Département interdisciplinaire du parcours patient (DIOPP), Gustave Roussy, Villejuif, France
| | | | - Stéphane Champiat
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France
| | - Jean-Marie Michot
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France
| | - Salim Laghouati
- Unité de Pharmacovigilance, Gustave Roussy, Villejuif, France
| | - Caroline Robert
- Département d'Oncologie Médicale, Gustave Roussy, Villejuif, France; Université Paris Saclay, F-94276 Le Kremlin Bicêtre, France
| | - Benjamin Besse
- Département d'Oncologie Médicale, Gustave Roussy, Villejuif, France; Université Paris Saclay, F-94276 Le Kremlin Bicêtre, France
| | - Jean-Charles Soria
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France; Université Paris Saclay, F-94276 Le Kremlin Bicêtre, France
| | - Olivier Lambotte
- Département de Médecine Interne et Immunologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Bicêtre, F-94275 Le Kremlin Bicêtre, France; INSERM U1184, Immunologie des infections virales et maladies auto-immunes, F-94276 Le Kremlin Bicêtre, France; CEA, DSV/iMETI, IDMIT, F-92265 Fontenay-aux-Roses, France
| | - Christophe Massard
- Université Paris Saclay, F-94276 Le Kremlin Bicêtre, France; Département d'Oncologie Médicale, Centre Eugène Marquis, Rennes, France
| | - Aurélien Marabelle
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France; Département de Médecine Interne et Immunologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Bicêtre, F-94275 Le Kremlin Bicêtre, France; INSERM U1015 & CIC1428, Villejuif, France
| | - Matthieu Texier
- Département d'Epidémiologie et de Biostatistiques, Gustave Roussy, Villejuif, France
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10
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Baldini C, Danlos FX, Varga A, Texier M, Halse H, Mouraud S, Cassard L, Champiat S, Signolle N, Vuagnat P, Martin-Romano P, Michot JM, Bahleda R, Gazzah A, Boselli L, Bredel D, Grivel J, Mohamed-Djalim C, Escriou G, Grynszpan L, Bigorgne A, Rafie S, Abbassi A, Ribrag V, Postel-Vinay S, Hollebecque A, Susini S, Farhane S, Lacroix L, Parpaleix A, Laghouati S, Zitvogel L, Adam J, Chaput N, Soria JC, Massard C, Marabelle A. Safety, recommended dose, efficacy and immune correlates for nintedanib in combination with pembrolizumab in patients with advanced cancers. J Exp Clin Cancer Res 2022; 41:217. [PMID: 35794623 PMCID: PMC9260998 DOI: 10.1186/s13046-022-02423-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 06/17/2022] [Indexed: 12/15/2022]
Abstract
Background We aimed to determine the safety and efficacy of nintedanib, an oral anti-angiogenic tyrosine kinase inhibitor, in combination with pembrolizumab, an anti-PD1 immunotherapy, in patients with advanced solid tumors (PEMBIB trial; NCT02856425). Methods In this monocentric phase Ib dose escalation cohort, we evaluated escalating doses of nintedanib (Dose level 1 (DL1) = 150 mg bid [bis in die, as twice a day]; DL2 = 200 mg bid, oral delivery) in combination with pembrolizumab (200 mg Q3W, IV). Patients received a 1-week lead-in dose of nintedanib monotherapy prior starting pembrolizumab. The primary objective was to establish the maximum tolerated dose (MTD) of the combination based on dose limiting toxicity (DLT) occurrence during the first 4 weeks. Secondary objectives were to assess the anti-tumor efficacy and to identify the associated immune and angiogenic parameters in order to establish the recommended nintedanib dose for expansion cohorts. Flow cytometry (FC), Immuno-Histo-Chemistry (IHC) and electrochemiluminescence multi-arrays were prospectively performed on baseline & on-treatment tumor and blood samples to identify immune correlates of efficacy. Results A total of 12/13 patients enrolled were evaluable for DLT (1 patient withdrew consent prior receiving pembrolizumab). Three patients at 200 mg bid experienced a DLT (grade 3 liver enzymes increase). Four patients developed grade 1–2 immune related adverse events (irAE). Eight patients died because of cancer progression. Median follow-up was 23.7 months (95%CI: 5.55–40.5). Three patients developed a partial response (PR) (ORR = 25%) and five patients (42%) had durable clinical benefit (DCB), defined as PR or stable disease (SD) ≥ 6 months. At baseline, patients with DCB had higher plasma levels of Tie2, CXCL10, CCL22 and circulating CD4+ PD1+ OX40+ T cells than patients without DCB. Patients with DCB presented also with more DC-LAMP+ dendritic cells, CD3+ T cells and FOXP3+ Tregs in baseline tumor biopsies. For DCB patients, the nintedanib lead-in monotherapy resulted in higher blood CCL3, Tregs and CCR4+ CXCR3+ CXCR5− memory CD4 T cells. After the first pembrolizumab infusion, patients with DCB showed lower IL-6, IL-8, IL-27 plasma levels. Conclusion Nintedanib 150 mg bid is the recommended dose for combination with pembrolizumab and is currently investigated in multiple expansion cohorts. Early tumoral and circulating immune factors were associated with cancer outcome under nintedanib & pembrolizumab therapy. Trial registration ClinicalTrials.gov, NCT02856425. Registered August 4, 2016 — Prospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s13046-022-02423-0.
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Affiliation(s)
- Capucine Baldini
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France
| | - Francois-Xavier Danlos
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France.,INSERM U1015 & CIC1428, Gustave Roussy, Villejuif, France.,Faculté de Médecine, Université Paris Saclay, Le Kremlin-Bicetre, France
| | - Andreea Varga
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France
| | - Matthieu Texier
- Département de Biostatistiques, Gustave Roussy, Villejuif, France
| | | | | | - Lydie Cassard
- Laboratoire d'Immuno-Oncologie (LIO), CNRS-UMS 3655 and INSERM-US23, Gustave Roussy, Villejuif, France
| | - Stéphane Champiat
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France
| | - Nicolas Signolle
- INSERM U981, Department of Experimental Pathology, Gustave Roussy, Université Paris-Sud, Université Paris-Saclay, 94805, Villejuif, France
| | - Perrine Vuagnat
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France.,Département d'Oncologie Médicale, Institut Curie, Paris, France
| | - Patricia Martin-Romano
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France
| | - Jean-Marie Michot
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France
| | - Rastislav Bahleda
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France
| | - Anas Gazzah
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France
| | - Lisa Boselli
- Laboratoire d'Immuno-Oncologie (LIO), CNRS-UMS 3655 and INSERM-US23, Gustave Roussy, Villejuif, France
| | | | - Jonathan Grivel
- Laboratoire d'Immuno-Oncologie (LIO), CNRS-UMS 3655 and INSERM-US23, Gustave Roussy, Villejuif, France
| | | | | | - Laetitia Grynszpan
- INSERM UMR 1186, Integrative Tumor Immunology and Immunotherapy, Gustave Roussy, Faculté de Médecine, Université Paris-Sud, Université Paris-Saclay, 94805, Villejuif, France
| | | | - Saloomeh Rafie
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France
| | - Alae Abbassi
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France
| | - Vincent Ribrag
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France
| | - Sophie Postel-Vinay
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France.,INSERM U981, Gustave Roussy, Villejuif, France
| | - Antoine Hollebecque
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France
| | | | - Siham Farhane
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France
| | - Ludovic Lacroix
- Département de Biopathologie, AMMICA, INSERM US23/CNRS UMS3655, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Aurelien Parpaleix
- Service de Promotion des Etudes Cliniques, Gustave Roussy, Villejuif, France
| | | | - Laurence Zitvogel
- INSERM U1015 & CIC1428, Gustave Roussy, Villejuif, France.,Faculté de Médecine, Université Paris Saclay, Le Kremlin-Bicetre, France
| | - Julien Adam
- INSERM UMR 1186, Integrative Tumor Immunology and Immunotherapy, Gustave Roussy, Faculté de Médecine, Université Paris-Sud, Université Paris-Saclay, 94805, Villejuif, France.,Service d'Anatomo-Pathologie, Hôpital Paris Saint-Joseph, Paris, France
| | - Nathalie Chaput
- Laboratoire d'Immuno-Oncologie (LIO), CNRS-UMS 3655 and INSERM-US23, Gustave Roussy, Villejuif, France
| | | | - Christophe Massard
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France
| | - Aurelien Marabelle
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France. .,INSERM U1015 & CIC1428, Gustave Roussy, Villejuif, France. .,Faculté de Médecine, Université Paris Saclay, Le Kremlin-Bicetre, France.
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11
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Berlanga P, Ndounga-Diakou LA, Corradini N, Ducassou S, Strullu M, De Carli E, Andre N, Entz-Werle N, Defachelles AS, Roumy M, Valteau-Couanet D, Gandemer V, Laghouati S, Vassal G. Securing access to innovative anticancer therapies for children, adolescents, and young adults outside clinical trials: The SACHA study of the French Society of Pediatric Oncology (SFCE). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.10006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10006 Background: Access to innovative anticancer therapies for children, adolescents and young adults within clinical trials in France is steadily increasing in the last years. However, current clinical trials portfolios are still inadequate and thus pediatric hemato-oncologists regularly prescribe innovative medicines outside their marketing authorization, and/or experimental drugs through compassionate use. Methods: The Secured Access to innovative medicines for CHildren with cAncer (SACHA) is a French prospective observational study developed by the French Society of Pediatric Oncology (SFCE) with Gustave Roussy as the legal sponsor to prospectively collect real-world safety and activity data of innovative therapies administered to patients ≤ 25 years-old with pediatric malignancies (solid tumor or leukemia) or other related conditions, either on compassionate use of experimental drugs or off-label use of anti-cancer medicines that have been first approved in adults after 2007. Prior to SACHA inclusion, multicenter tumor board discussion defining best available therapeutic options for each patient with a relapsed malignancy is mandatory. Results: The SACHA study opened in March 2020 and by February 2022, 283 patients have been included from 29/31 SFCE recruiting centers; median age: 11.0 years (range: 0.3-24.4). Main cancer types were central nervous system (CNS) tumors (47%), followed by non-CNS tumors (40%) and leukemias (13%). Innovative therapies prescribed in > 10 patients with reported objective response rate (ORR) and related CTCAE v.5 grade ≥2 clinical and/or grade ≥3 biological adverse drug reactions (ADRs) are described in Table. Conclusions: SACHA confirms the feasibility of this type of prospective real word registry, with a high participation of French centers. Based on this French experience, the Innovative Therapies for Children with Cancer (ITCC) consortium is currently developing a “SACHA International Project” to be opened in ITCC and collaborating countries. [Table: see text]
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Affiliation(s)
| | | | - Nadege Corradini
- Department of Pediatric Oncology, Institut d'Hematologie et d'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - Stephane Ducassou
- Paediatric Haematology-Oncology Department, Centre Hospitalier Universitaire, Bordeaux, France
| | - Marion Strullu
- Paediatric Haematology-Oncology Department, Hôpital Robert-Debré Ap-Hp, Paris, France
| | | | | | | | | | - Marianne Roumy
- Department of Pediatric Oncology, University Hospital, Angers, France
| | | | | | - Salim Laghouati
- Pharmacovigilance Unit, Clinical Research Direction, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
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12
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Danlos FX, Baldini C, Texier M, Varga A, Mouraud S, Job B, Letourneur D, Cassard L, Bredel D, Laghouati S, Adam J, Droin N, Parpaleix A, Chaput-Gras N, Rabeau A, Zalcman G, Planchard D, Massard C, Soria JC, Marabelle A. 378 Efficacy, safety and ancillary analyses of pembrolizumab in combination with nintedanib for the treatment of patients with relapsed advanced mesothelioma. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundWe report the results from the advanced malignant mesothelioma (aMM) expansion cohort of the PEMBIB Phase Ib trial (NCT02856425) evaluating the safety, efficacy & biomarkers of an antiangiogenic tyrosine kinase inhibitor (nintedanib) with an anti-PD1 immunotherapy (pembrolizumab).MethodsPatients with aMM relapsing after at least one line of platinum doublet chemotherapy and not previously pre-exposed to IO were treated with a combination of oral nintedanib (150mg BID) & IV pembrolizumab (200mg Q3W) with a 7 days nintedanib lead-in preceding pembrolizumab initiation. Baseline and on-treatment (cycle D2, day 1 [C2D1]) fresh tumor & blood samples were prospectively phenotyped by flow cytometry (FC). RNAseq was run on tumor samples. Immune factors were titrated on tumor secretome and plasma.Results30 aMM patients were treated and 29 evaluable for response. Median age was 68 years old (38–85) and 86% of aMM were epithelioid. The most frequent adverse events (AE) (grades 1–3) related to the combination were liver enzymes increase, fatigue, nausea, and diarrhea. 4 (13.3%) patients developed grade 3–5 immune- related AE. Patients died of cancer progression (n=14, 46.7%), myocarditis with thrombo-embolic event (n=1, 3.3%) and COVID-19 (n=1, 3.3%). Median follow-up was 14.8 months (95%CI [9.70–18.2]). Best Overall Response Rates (BORR) per RECISTv1.1 were Partial Response (PR, n=7/29; 24.1%), Stable Disease (SD, n=17/29; 58.6%) and Progressive Disease (n=5/29; 17.2%). Disease Control Rate (DCR) (defined as PR + SD) was 46.6% at 6 months. Patients with DCR at 6 months had significantly higher percentage of PDL1 expression on tumor cells (by Immuno-Histo-Chemistry, antibody clone SP263) and higher CD8+ T cells infiltrate in tumor biopsies (by FC) at screening. Upon treatment, soluble plasma rate of CXCL9 and CXCL13 increased in all patients, as well as tumor immune infiltrates estimated by deconvolution of tumor biopsies RNA-seq. But deconvoluted estimates of NK cells, T cells and myeloid dendritic cells infiltrates on baseline tumors and C2D1 biopsies were higher in patients with DCR at 6 months. Pre & on-treatment IL6 and IL8 rates in tumor secretome & plasma were higher in patients without DCR. Gene Set Enrichment Analyses on RNA-seq from screening biopsies highlighted an enrichment in E2F, MYC and KRAS gene pathways and lower expression of type 1 interferon signature in patients without DCR than those with DCR at 6 months.ConclusionsWith a BORR of 24% and a DCR of 47% at 6 months, pembrolizumab and nintedanib combination provided valuable therapeutic benefits for patients with aMM.Trial RegistrationClinicalTrialsgov, NCT02856425. Registered August 4, 2016 — Prospectively registered,https://clinicaltrials.gov/ct2/show/NCT02856425?term=PEMBIB&draw=2&rank=1.Ethics ApprovalThe protocol was first approved by the Agence Nationale de Sécurité du Médicament (ANSM) on June 24th 2016 (Ref #160371A-12). The protocol was also approved by the Ethical Committee (Comité de Protection des Personnes Ile de France 1) on Jul 12th 2016 (Ref #2016-mai-14236ND).
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Ruste V, Goldschmidt V, Laparra A, Messayke S, Danlos FX, Romano-Martin P, Champiat S, Voisin AL, Baldini C, Massard C, Laghouati S, Marabelle A, Lambotte O, Michot JM. The determinants of very severe immune-related adverse events associated with immune checkpoint inhibitors: A prospective study of the French REISAMIC registry. Eur J Cancer 2021; 158:217-224. [PMID: 34627664 DOI: 10.1016/j.ejca.2021.08.048] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Immune-related adverse events (irAEs) remain generally unpredictable, and severe irAEs remain challenging to detect early and manage. Very severe (grade IV-V) irAEs have not been extensively characterised in prospective studies, and their predictive factors remain unknown. OBJECTIVE The objective of the study was to describe and identify predictive factors of very severe (grade IV-V) irAEs. DESIGN The French Registre des Effets Indésirables Sévères des Anticorps Monoclonaux Immunomodulateurs en Cancérologie (REISAMIC) registry has prospectively collected all clinically significant irAEs occurring in patients treated with immune checkpoint inhibitors at Gustave Roussy Institute since 2014. SETTING This was a single-centre prospective cohort study at the Gustave Roussy Institute cancer centre (Villejuif, France). PARTICIPANTS The participants were all adult patients with a solid or haematological cancer treated with an anti-programmed cell death 1 (PD-1) or an anti-programmed cell death-ligand 1 (PD-L1) and who presented a clinically significant irAE. MAIN OUTCOMES AND MEASURES The main outcomes included the clinical and laboratory characteristics of patients with very severe irAEs, including tumour type, affected organs, time to irAE occurrence, blood cell count and serum biochemistry parameters. RESULTS Of the 1187 patients prospectively followed in REISAMIC between December 2014 and January 2020, 380 (32.0%) had at least one irAE, and 34 (2.86%) presented with very severe irAEs (grades IV-V). Among the 380 patients with an irAE, the distribution of very severe irAEs (grades IV-V) was 8.95% and death (grade V) was 3.95%. Among the 34 patients with very severe irAEs, 33 were treated with monotherapy of PD-1 or PD-L1 inhibitors, and one patient was treated with a combination of PD-1 and cytotoxic T-lymphocyte-associated protein 4 inhibitors. The median time to occurrence was shorter for very severe irAEs (median [interquartile range]: 41 days [0-634] for grades IV-V; versus 91 days [0-1123] for grades I-III; p = 0.01680). On initiation of immunotherapy, the predictive factors for very severe irAEs were performance status ≥2, elevated neutrophil/lymphocyte ratio and treatment for lung cancer. CONCLUSIONS Very severe (grade IV-V) immunological toxicities occurred earlier than mild severe toxicities. On initiation of immunotherapy, patients with poor performance status, elevated neutrophil/lymphocyte ratio and lung cancer are identified at risk of developing these very severe toxicities. These results could help to develop risk scores to identify patients at risk of developing severe toxicities.
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Affiliation(s)
- Valentine Ruste
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, F-94800, Villejuif, France.
| | - Vincent Goldschmidt
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, F-94800, Villejuif, France.
| | - Ariane Laparra
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, F-94800, Villejuif, France.
| | - Sabine Messayke
- Gustave Roussy, Université Paris-Saclay, Unité de Pharmacovigilance, F-94800, Villejuif, France.
| | - Francois-Xavier Danlos
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, F-94800, Villejuif, France.
| | - Patricia Romano-Martin
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, F-94800, Villejuif, France.
| | - Stéphane Champiat
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, F-94800, Villejuif, France.
| | - Anne-Laure Voisin
- Gustave Roussy, Université Paris-Saclay, Unité de Pharmacovigilance, F-94800, Villejuif, France.
| | - Capucine Baldini
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, F-94800, Villejuif, France.
| | - Christophe Massard
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, F-94800, Villejuif, France.
| | - Salim Laghouati
- Gustave Roussy, Université Paris-Saclay, Unité de Pharmacovigilance, F-94800, Villejuif, France.
| | - Aurélien Marabelle
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, F-94800, Villejuif, France.
| | - Olivier Lambotte
- AP-HP Université Paris-Saclay, Hôpital Bicêtre, Clinical Immunology Department, F-94270, Le Kremlin Bicêtre, France; Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IDMIT/IMVA-HB), UMR1184, F-94270, Le Kremlin Bicêtre, France.
| | - Jean-Marie Michot
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, F-94800, Villejuif, France
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Danlos FX, Baldini C, Varga A, Mouraud S, Job B, Letourneur D, Cassard L, Bredel D, Laghouati S, Texier M, Adam J, Droin N, Parpaleix A, Chaput N, Rabeau A, Zalcman G, Planchard D, Massard C, Soria JC, Marabelle A. 1732MO Pembrolizumab and nintedanib for patients with advanced mesothelioma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1976] [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: 11/16/2022] Open
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Michot JM, Lappara A, Le Pavec J, Simonaggio A, Collins M, De Martin E, Danlos FX, Ammari S, Cauquil C, Ederhy S, Barreau E, Belkhir R, Berdelou A, Lazarovici J, Chanson P, Izzedine H, Seferian A, Le Pajolec C, Baldini C, Martin-Romano P, Mariette X, Robert C, Besse B, Hollebecque A, Varga A, Laghouati S, Mateus C, Voisin AL, Soria JC, Massard C, Marabelle A, Champiat S, Lambotte O. The 2016-2019 ImmunoTOX assessment board report of collaborative management of immune-related adverse events, an observational clinical study. Eur J Cancer 2020; 130:39-50. [PMID: 32172197 DOI: 10.1016/j.ejca.2020.02.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 02/11/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE We investigated the activities of an ImmunoTOX board, an academic, multidisciplinary group of oncologists and organ specialists that adopts a real-life, case-by-case approach in the management of patients with immune-related adverse events (irAEs). EXPERIMENTAL DESIGN The ImmunoTOX assessment board was set up in 2016 at Gustave Roussy in France. It meets every 2 weeks to discuss the case-by-case management of patients presenting with irAEs. Here, we describe the ImmunoTOX board's activities between 2016 and 2019. RESULTS Over study period, 398 requests (concerning 356 patients) were submitted to the ImmunoTOX board. Most of the requests concerned the putative causal link between immunotherapy and the irAE (n = 148, 37%), followed by possible retreatment after temporary withdrawal because of an adverse event (n = 109, 27%), the clinical management of complex situations (n = 100, 25%) and the initiation of immunotherapy in patients with pre-existing comorbidities (n = 41, 10%). The ImmunoTOX board discerned 273 irAEs. The five organ systems most frequently involved by irAEs were lung (n = 58, 21%), gastrointestinal tract (n = 36, 13%), liver or biliary tract (n = 33, 12%), musculoskeletal system (n = 27, 10%), and nervous system (n = 23, 8%). The time to occurrence was shorter for severe irAEs (grade III and VI) than for mild irAEs (grades I and II), with medians of 47 and 91 days, respectively (p = 0.0216). CONCLUSION The main medical needs in the management of irAEs involved the lung organ. Severe irAEs were expected to occur earlier than mild irAEs. This real-life study can help to better estimate medical needs and therefore help to assess the management of irAEs.
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Affiliation(s)
- Jean-Marie Michot
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, France.
| | - Ariane Lappara
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Service de Médecine Interne and Immunologie clinique, Le Kremlin-Bicêtre, France
| | - Jérôme Le Pavec
- Hôpital Marie-Lannelongue, Department of Thoracic and Cardiovascular, and Transplantation Cardio-Pulmonary, Le Plessis-Robinson, France
| | - Audrey Simonaggio
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, France
| | - Michael Collins
- Assistance Publique-Hôpitaux de Paris, Université Paris-Sud, Hôpitaux Universitaires Paris Sud, Gastroenterology Unit, Le Kremlin Bicêtre, France
| | - Eléonora De Martin
- Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
| | - François-Xavier Danlos
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, France
| | - Samy Ammari
- Gustave Roussy, Université Paris-Saclay, Department of Diagnostic Radiology, Villejuif, France
| | - Cécile Cauquil
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Division of Adult Neurology, Le Kremlin Bicêtre, France
| | - Stéphane Ederhy
- Assistance Publique-Hôpitaux de Paris, Saint-Antoine Hospital, Service de cardiologie, Unite de cardio-oncologie, Pierre et Marie Curie University, Paris, France
| | - Emmanuel Barreau
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Department of Ophthalmology, Le Kremlin Bicêtre, France
| | - Rakiba Belkhir
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Department of Rheumatology, Le Kremlin Bicêtre, France
| | - Amandine Berdelou
- Gustave Roussy, Université Paris-Saclay, Department of Cancer Medicine, Villejuif, France
| | - Julien Lazarovici
- Gustave Roussy, Université Paris-Saclay, Department of Hematology, Villejuif, France
| | - Philippe Chanson
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Unit of Endocrinology and Reproductive Health, Le Kremlin Bicêtre, France
| | - Hassan Izzedine
- Peupliers Private Hospital, Nephrology Department, Paris, France
| | - Andrei Seferian
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire, Le Kremlin Bicêtre, France
| | - Christine Le Pajolec
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Ear Nose and Throat Department, Le Kremlin Bicêtre, France
| | - Capucine Baldini
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, France
| | - Patricia Martin-Romano
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, France
| | - Xavier Mariette
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Department of Rheumatology, Le Kremlin Bicêtre, France
| | - Caroline Robert
- Gustave Roussy, Université Paris-Saclay, Department of Cancer Medicine, Villejuif, France
| | - Benjamin Besse
- Gustave Roussy, Université Paris-Saclay, Department of Cancer Medicine, Villejuif, France
| | - Antoine Hollebecque
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, France
| | - Andrea Varga
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, France
| | - Salim Laghouati
- Gustave Roussy, Université Paris-Saclay, Unité de Pharmacovigilance, Villejuif, France
| | - Christine Mateus
- Gustave Roussy, Université Paris-Saclay, Department of Cancer Medicine, Villejuif, France
| | - Anne-Laure Voisin
- Gustave Roussy, Université Paris-Saclay, Unité de Pharmacovigilance, Villejuif, France
| | - Jean-Charles Soria
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, France
| | - Christophe Massard
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, France
| | - Aurélien Marabelle
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, France
| | - Stéphane Champiat
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, France
| | - Olivier Lambotte
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Service de Médecine Interne and Immunologie clinique, Le Kremlin-Bicêtre, France; INSERM U1184, Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin Bicêtre, France; Université Paris Sud, UMR 1184, Le Kremlin Bicêtre, France; CEA, DSV/iMETI, IDMIT, Fontenay-aux-Roses, France
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Baldini C, Martin Romano P, Voisin AL, Danlos FX, Champiat S, Laghouati S, Kfoury M, Vincent H, Postel-Vinay S, Varga A, Vuagnat P, Ribrag V, Mezquita L, Besse B, Hollebecque A, Lambotte O, Michot JM, Soria JC, Massard C, Marabelle A. Impact of aging on immune-related adverse events generated by anti-programmed death (ligand)PD-(L)1 therapies. Eur J Cancer 2020; 129:71-79. [PMID: 32143106 DOI: 10.1016/j.ejca.2020.01.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/21/2020] [Accepted: 01/28/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Aging is an important risk factor for cancers and is associated with poor prognosis. Weakness of the immune system, also called immunosenescence may occur with older age. The impact of aging on efficacy and safety of immune checkpoint blockers, such as anti-programmed death (ligand) PD-(L)1, remains undetermined. This study aims to evaluate the incidence of immune-related adverse events (irAEs) in patients aged 70 years or older than their younger counterparts. METHODS Patients with advanced solid tumors treated at Gustave Roussy with an anti-PD-(L)1 monotherapy between June 2014 and October 2017 were prospectively included within the dedicated irAEs pharmacovigilance registry REISAMIC (Registre des Effets Indésirables Sévères des Anticorps Monoclonaux Immunomodulateurs en Cancérologie). The incidence of irAEs of grade ≥II was compared between patients aged ≥70 (old patients, OP) versus patients aged < 70 years (young patients, YP) using a chi-squared test. Survivals were estimated using the Kaplan-Meier method. RESULTS Among the 603 patients treated by anti-PD(L)1, 191 were ≥70 y.o (OP) and 424 < 70 y.o (YP). The median (range) age of OP and YP were respectively 77 (70-93) and 59 years old (17-69). A total of 165 irAEs occurred in these patients (103 grade II and 58 grade III-IV). The overall incidence of grade ≥II irAEs was higher in OP than in YP (33% versus 25%, p = 0.03). In addition, OP were more prone of having multiples irAEs compared with YP (p = 0.037). Skin toxicities were more frequent in OP than in YP (p = 0.007) but endocrine toxicities were less frequent in OP than in YP (p = 0.044). This higher level of irAEs seems to be responsible for a higher rate of treatment discontinuation in OP (p = 0.2). There was no statistical difference in median time to toxicity, exposure to steroids or survival between the two groups. CONCLUSION Although anti-PD-(L)1 immunotherapies remain an acceptable treatment option for older patients, prescribers should be aware that irAEs are more frequent in the elderly. Further translational studies are warranted to better understand the relationship between aging and irAEs.
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Affiliation(s)
- Capucine Baldini
- Gustave Roussy, Université Paris-Saclay, Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Villejuif, France.
| | - Patricia Martin Romano
- Gustave Roussy, Université Paris-Saclay, Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Villejuif, France
| | - Anne-Laure Voisin
- Gustave Roussy, Université Paris-Saclay, Unité de Pharmacovigilance, Villejuif, France
| | - François-Xavier Danlos
- Gustave Roussy, Université Paris-Saclay, Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Villejuif, France
| | - Stéphane Champiat
- Gustave Roussy, Université Paris-Saclay, Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Villejuif, France
| | - Salim Laghouati
- Gustave Roussy, Université Paris-Saclay, Unité de Pharmacovigilance, Villejuif, France
| | - Maria Kfoury
- Gustave Roussy, Université Paris-Saclay, Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Villejuif, France
| | - Hélène Vincent
- Gustave Roussy, Université Paris-Saclay, Département d'Oncologie Médicale, Villejuif, France
| | - Sophie Postel-Vinay
- Gustave Roussy, Université Paris-Saclay, Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Villejuif, France
| | - Andreea Varga
- Gustave Roussy, Université Paris-Saclay, Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Villejuif, France
| | - Perrine Vuagnat
- Gustave Roussy, Université Paris-Saclay, Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Villejuif, France
| | - Vincent Ribrag
- Gustave Roussy, Université Paris-Saclay, Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Villejuif, France
| | - Laura Mezquita
- Gustave Roussy, Université Paris-Saclay, Département d'Oncologie Médicale, Villejuif, France
| | - Benjamin Besse
- Gustave Roussy, Université Paris-Saclay, Département d'Oncologie Médicale, Villejuif, France
| | - Antoine Hollebecque
- Gustave Roussy, Université Paris-Saclay, Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Villejuif, France
| | - Olivier Lambotte
- Assistance Publique Hopitaux de Paris (AP-HP), Centre Hospitalier et Universitaire Kremlin Bicêtre, Médecine Interne, Kremlin Bicêtre, France; Université Paris Saclay, France; Université Paris-Sud, Orsay, France
| | - Jean-Marie Michot
- Gustave Roussy, Université Paris-Saclay, Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Villejuif, France
| | | | - Christophe Massard
- Gustave Roussy, Université Paris-Saclay, Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Villejuif, France
| | - Aurélien Marabelle
- Gustave Roussy, Université Paris-Saclay, Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Villejuif, France; INSERM U1015, Gustave Roussy, Villejuif, France
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Delanoy N, Michot JM, Comont T, Kramkimel N, Lazarovici J, Dupont R, Champiat S, Chahine C, Robert C, Herbaux C, Besse B, Guillemin A, Mateus C, Pautier P, Saïag P, Madonna E, Maerevoet M, Bout JC, Leduc C, Biscay P, Quere G, Nardin C, Ebbo M, Albigès L, Marret G, Levrat V, Dujon C, Vargaftig J, Laghouati S, Croisille L, Voisin AL, Godeau B, Massard C, Ribrag V, Marabelle A, Michel M, Lambotte O. Haematological immune-related adverse events induced by anti-PD-1 or anti-PD-L1 immunotherapy: a descriptive observational study. Lancet Haematol 2018; 6:e48-e57. [PMID: 30528137 DOI: 10.1016/s2352-3026(18)30175-3] [Citation(s) in RCA: 161] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/29/2018] [Accepted: 10/02/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anti-programmed cell death 1 (PD-1) and anti-programmed cell death ligand 1 (PD-L1) antibodies are novel immunotherapies for cancer that can induce immune-related adverse events (irAEs). These adverse events can involve all organs, including the haemopoietic system. Thus far, haematological irAEs (haem-irAEs) have not been extensively characterised. This study aims to provide a comprehensive report of the haem-irAEs induced by anti-PD-1 or anti-PD-L1. METHODS In this descriptive observational study, we included consecutive patients aged at least 18 years with grade 2 or worse haem-irAEs induced by anti-PD-1 or anti-PD-L1 immunotherapy registered in three French pharmacovigilance databases: the Registre des Effets Indésirables Sévères des Anticorps Monoclonaux Immunomodulateurs en Cancérologie (REISAMIC; a prospective registry of patients treated with anti-PD-1 or anti-PD-L1 at a single centre), the ImmunoTOX committee of Gustave Roussy (a national referral database of suspected irAEs in patients treated with immunotherapy), and the registry of the Centre de Référence des Cytopénies Auto-Immunes de l'Adulte (CeReCAI; a national database of autoimmune cytopenias). Cases were reviewed by a central committee; adverse events had to be classed as certainly or probably related to anti-PD-1 or anti-PD-L1 therapy, and their severity was assessed according to the Common Terminology Criteria for Adverse Events (version 4.03). The primary endpoint was clinical description of haem-irAEs, as reported in all databases, and their frequency, as reported in the prospective REISAMIC registry. FINDINGS We screened 948 patients registered in the three databases from June 27, 2014, to June 29, 2018 (745 from REISAMIC, 190 from the ImmunoTOX committee, and 13 from CeReCAI). 35 patients (21 men and 14 women) with haem-irAEs related to anti-PD-1 or anti-PD-L1 were included in the study. Of 745 patients in the REISAMIC registry treated with anti-PD-1 or anti-PD-L1, four had haem-irAEs, giving a frequency of 0·5%. Median age in the 35 patients was 65 years (IQR 51-75), and the most common tumour types were melanoma (15 [43%] patients), non-small-cell lung cancer (12 [34%] patients), and lymphoma (four [11%] patients). 20 (57%) patients received nivolumab, 14 (40%) received pembrolizumab, and one (3%) received atezolizumab. Among the 35 patients, neutropenia, autoimmune haemolytic anaemia, and immune thrombocytopenia were the most common types of haem-irAE (each in nine patients [26%]), followed by pancytopenia or aplastic anaemia (five patients [14%]), bicytopenia (one patients with thrombocytopenia plus anaemia and one patient with neutropenia plus anaemia [6%]), and pure red cell aplasia (one patient [3%]). The maximum grade of severity was grade 2 in three (9%) patients, grade 3 in five (14%) patients, and grade 4 in 25 (71%) patients; two (6%) patients died from febrile neutropenia during haem-irAE related to anti-PD-1. Haem-irAEs resolved in 21 (60%) of the 35 patients. INTERPRETATION Haem-irAEs induced by PD-1 or PD-L1 inhibitors are rare but potentially life-threatening events. The most common clinical presentations are neutropenia, autoimmune haemolytic anaemia, immune thrombocytopenia, and aplastic anaemia. Investigations into earlier detection and better management are warranted. FUNDING Gustave Roussy and Gustave Roussy Immunotherapy Program.
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Affiliation(s)
- Nicolas Delanoy
- Département des Innovations Thérapeutiques et Essais Précoces, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Jean-Marie Michot
- Département des Innovations Thérapeutiques et Essais Précoces, Gustave Roussy, Université Paris-Saclay, Villejuif, France; Service de Médecine Interne and Immunologie Clinique, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France.
| | - Thibault Comont
- Service de Médecine Interne et d'Immunopathologie, Institut Universitaire du Cancer, Toulouse, France
| | - Nora Kramkimel
- Service de Dermatologie et Vénérologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Julien Lazarovici
- Département d'Hématologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Romain Dupont
- Service de Médecine Interne et d'Immunopathologie, Institut Universitaire du Cancer, Toulouse, France
| | - Stéphane Champiat
- Département des Innovations Thérapeutiques et Essais Précoces, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Claude Chahine
- Département d'Hématologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Caroline Robert
- Département de Médecine Oncologique, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Charles Herbaux
- Service d'Hématologie, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Benjamin Besse
- Département de Médecine Oncologique, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Aude Guillemin
- Service d'Oncologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Christine Mateus
- Département de Médecine Oncologique, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Patricia Pautier
- Département de Médecine Oncologique, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Philippe Saïag
- Service des Cancers Cutanés, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France
| | - Emanuela Madonna
- Département d'Hématologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Marie Maerevoet
- Department of Haematology, Institute Jules Bordet, Brussels, Belgium
| | | | - Charlotte Leduc
- Service d'Oncologie Thoracique, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Pascal Biscay
- Service de Médecine Interne, Clinique Mutualiste de Pessac, Pessac, France
| | - Gilles Quere
- Service de Pneumologie, Hôpital Morvan Centre Hospitalier Régional Universitaire de Brest, Brest, France
| | - Charlée Nardin
- Service de Dermatologie, Centre Hospitalier Régional Universitaire Jean Minjoz, Besançon, France
| | - Mikael Ebbo
- Service de Médecine Interne, Hôpital de la Timone, Aix Marseille Université, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Laurence Albigès
- Département de Médecine Oncologique, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Grégoire Marret
- Service d'Oncologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Virginie Levrat
- Service de Pneumologie, Centre Hospitalier de La Rochelle, La Rochelle, France
| | - Cécile Dujon
- Service de Pneumologie, Hôpital André Mignot, Centre Hospitalier Universitaire de Versailles, Le Chesnay, France
| | - Jacques Vargaftig
- Service d'Hématologie, René Huguenin Hospital-Curie Institute, Saint-Cloud, France
| | - Salim Laghouati
- Unité de Pharmacovigilance, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Laure Croisille
- Laboratoire HLA-ILP, Etablissement Français du Sang, Créteil, France
| | - Anne-Laure Voisin
- Unité de Pharmacovigilance, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Bertrand Godeau
- Service de Médecine Interne, Centre de Référence des Cytopénies Auto-Immunes de l'Adulte, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Christophe Massard
- Département des Innovations Thérapeutiques et Essais Précoces, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Vincent Ribrag
- Département des Innovations Thérapeutiques et Essais Précoces, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Aurélien Marabelle
- Département des Innovations Thérapeutiques et Essais Précoces, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Marc Michel
- Service de Médecine Interne, Centre de Référence des Cytopénies Auto-Immunes de l'Adulte, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Olivier Lambotte
- Service de Médecine Interne and Immunologie Clinique, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France; Université Paris Sud, Centre de Recherche en Immunologie des Infections Virales et des Maladies Auto-Immunes, INSERM, Le Kremlin-Bicêtre, France; Division d'Immunovirologie, Commissariat à l'Energie Atomique et aux Energies Alternatives, Fontenay-aux-Roses, France
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Baldini C, Martin-Romano P, Voisin AL, Danlos F, Champiat S, Laghouati S, Kfouri M, Vincent H, Nagera C, Postel-Vinay S, Varga A, Ribrag V, Besse B, Hollebecque A, Lambotte O, Michot JM, Soria JC, Massard C, Marabelle A. Incidence of immune related adverse events in patients 70 years old treated with anti-PD-(L)1 therapy. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy288.079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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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Kfoury M, Voisin AL, Najean M, Champiat S, Laghouati S, Michot JM, Robert C, Mateus C, Albiges L, Besse B, Massard C, Texier M, Lambotte O, Marabelle A. Association between immune-related adverse events and efficacy in patients treated with anti-PD-(L)1. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy288.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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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De Martin E, Michot JM, Papouin B, Champiat S, Mateus C, Lambotte O, Roche B, Antonini TM, Coilly A, Laghouati S, Robert C, Marabelle A, Guettier C, Samuel D. Characterization of liver injury induced by cancer immunotherapy using immune checkpoint inhibitors. J Hepatol 2018; 68:1181-1190. [PMID: 29427729 DOI: 10.1016/j.jhep.2018.01.033] [Citation(s) in RCA: 323] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 01/12/2018] [Accepted: 01/26/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Immunotherapy for metastatic cancer can be complicated by the onset of hepatic immune-related adverse events (IRAEs). This study compared hepatic IRAEs associated with anti-programmed cell death protein 1 (PD-1)/PD ligand 1 (PD-L1) and anti-cytotoxic T lymphocyte antigen 4 (CTLA-4) monoclonal antibodies (mAbs). METHODS Among 536 patients treated with anti-PD-1/PD-L1 or CTLA-4 immunotherapies, 19 (3.5%) were referred to the liver unit for grade ≥3 hepatitis. Of these patients, nine had received anti-PD-1/PD-L1 and seven had received anti-CTLA-4 mAbs, in monotherapy or in combination with anti-PD-1. Liver investigations were undertaken in these 16 patients, including viral assays, autoimmune tests and liver biopsy, histological review, and immunostaining of liver specimens. RESULTS In the 16 patients included in this study, median age was 63 (range 33-84) years, and nine (56%) were female. Time between therapy initiation and hepatitis was five (range, 1-49) weeks and median number of immunotherapy injections was two (range, 1-36). No patients developed hepatic failure. Histology related to anti-CTLA-4 mAbs demonstrated granulomatous hepatitis including fibrin ring granulomas and central vein endotheliitis. Histology related to anti-PD-1/PD-L1 mAbs was characterised by lobular hepatitis. The management of hepatic IRAEs was tailored according to the severity of both the biology and histology of liver injury: six patients improved spontaneously; seven received oral corticosteroids at 0.5-1 mg/kg/day; two were maintained on 0.2 mg/kg/day corticosteroids; and one patient required pulses and 2.5 mg/kg/day of corticosteroids, and the addition of a second immunosuppressive drug. In three patients, immunotherapy was reintroduced without recurrence of liver dysfunction. CONCLUSIONS Acute hepatitis resulting from immunotherapy for metastatic cancer is rare (3.5%) and, in most cases, not severe. Histological assessment can distinguish between anti-PD-1/PD-L1 and anti-CTLA-4 mAb toxicity. The severity of liver injury is helpful for tailoring patient management, which does not require systematic corticosteroid administration. LAY SUMMARY Immunotherapy for metastatic cancer can be complicated by immune-related adverse events in the liver. In patients receiving immunotherapy for metastatic cancer who develop immune-mediated hepatitis, liver biopsy is helpful for the diagnosis and evaluation of the severity of liver injury. This study demonstrates the need for patient-oriented management, which could eventually avoid unnecessary systemic corticosteroid treatment.
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Affiliation(s)
- Eleonora De Martin
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire; Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay; Inserm, Unité 1193, Université Paris-Saclay; Hepatinov, Villejuif, F-94800, France
| | - Jean-Marie Michot
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Institut Gustave-Roussy, Université Paris-Saclay, Villejuif, France
| | - Barbara Papouin
- AP-HP Hôpital Bicêtre, Laboratoire Anatomie Pathologique, Le Kremlin Bicêtre, France, Université Paris Sud, UMR-S 1193, Université Paris-Saclay, France
| | - Stéphane Champiat
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Institut Gustave-Roussy, Université Paris-Saclay, Villejuif, France
| | - Christine Mateus
- Dermatology Unit, Department of Medical Oncology, Gustave-Roussy, Paris Sud University, Villejuif, France
| | - Olivier Lambotte
- APHP Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique, Université Paris Sud, CEA, DSV/iMETI, Division of Immunovirology, IDMIT, INSERM, U1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin Bicêtre, France
| | - Bruno Roche
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire; Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay; Inserm, Unité 1193, Université Paris-Saclay; Hepatinov, Villejuif, F-94800, France
| | - Teresa Maria Antonini
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire; Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay; Inserm, Unité 1193, Université Paris-Saclay; Hepatinov, Villejuif, F-94800, France
| | - Audrey Coilly
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire; Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay; Inserm, Unité 1193, Université Paris-Saclay; Hepatinov, Villejuif, F-94800, France
| | | | - Caroline Robert
- Dermatology Unit, Department of Medical Oncology, Gustave-Roussy, Paris Sud University, Villejuif, France
| | - Aurélien Marabelle
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Institut Gustave-Roussy, Université Paris-Saclay, Villejuif, France
| | - Catherine Guettier
- AP-HP Hôpital Bicêtre, Laboratoire Anatomie Pathologique, Le Kremlin Bicêtre, France, Université Paris Sud, UMR-S 1193, Université Paris-Saclay, France
| | - Didier Samuel
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire; Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay; Inserm, Unité 1193, Université Paris-Saclay; Hepatinov, Villejuif, F-94800, France.
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Danlos FX, Voisin AL, Dyevre V, Michot JM, Routier E, Taillade L, Champiat S, Aspeslagh S, Haroche J, Albiges L, Massard C, Girard N, Dalle S, Besse B, Laghouati S, Soria JC, Mateus C, Robert C, Lanoy E, Marabelle A, Lambotte O. Safety and efficacy of anti-programmed death 1 antibodies in patients with cancer and pre-existing autoimmune or inflammatory disease. Eur J Cancer 2018; 91:21-29. [PMID: 29331748 DOI: 10.1016/j.ejca.2017.12.008] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [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: 11/28/2017] [Accepted: 12/02/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Patients with autoimmune or inflammatory disease (AID) are susceptible to immune-related adverse events (irAEs) when treated with immune check-point inhibitors (ICIs). We decided to analyse the safety and effectiveness of anti-PD-1 antibodies in AID patients and look for an association between the presence of pre-existing AID and the clinical outcome. METHODS In a prospective study of the REISAMIC registry of grade ≥2 irAEs occurring in ICI-treated patients, we studied the associations between pre-existing AID on one hand and irAE-free survival, overall survival and best objective response rate on the other. RESULTS We identified 45 patients with 53 AIDs in REISAMIC. The cancer diagnoses included melanoma (n = 36), non-small-cell lung cancer (n = 6) and others (n = 3). The most frequent pre-existing AIDs were vitiligo (n = 17), psoriasis (n = 12), thyroiditis (n = 7), Sjögren syndrome (n = 4) and rheumatoid arthritis (n = 2). Twenty patients (44.4%) presented with at least one irAE: eleven of these were associated with a pre-existing AID ('AID flare'). Treatment with anti-PD-1 antibodies was maintained in 15 of the 20 patients with an irAE. The IrAE-free survival time was significantly shorter in AID patients (median: 5.4 months) than in AID-free patients (median: 13 months, p = 2.1 × 10-4). The AID and AID-free groups did not differ significantly with regard to the overall survival time and objective response rate (p = 0.38 and 0.098, respectively). CONCLUSION In patients treated with anti-PD-1 antibody, pre-existing AID was associated with a significantly increased risk of irAEs. Our results indicate that cancer treatments with anti-PD-1 antibodies are just as effective in AID patients as they are in AID-free patients.
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Affiliation(s)
- François-Xavier Danlos
- Gustave Roussy, Université Paris-Saclay, Département d'Innovation Thérapeutique et d'Essais Précoces, Villejuif, F-94805, France
| | - Anne-Laure Voisin
- Unité Fonctionnelle de Pharmacovigilance, Gustave Roussy, F-94800, Villejuif, France
| | - Valérie Dyevre
- Gustave Roussy, Université Paris-Saclay, Service de Biostatistique et d'Épidémiologie, F-94800, Villejuif, France
| | - Jean-Marie Michot
- Gustave Roussy, Université Paris-Saclay, Département d'Innovation Thérapeutique et d'Essais Précoces, Villejuif, F-94805, France
| | - Emilie Routier
- Gustave Roussy, Université Paris-Saclay, Département de dermatologie, F-94800, Villejuif, France
| | - Laurent Taillade
- Service d'oncologie médicale, Groupe Hospitalier Pitié Salpêtrière, Assistance Publique Hôpitaux de Paris, F-75013, Paris, France
| | - Stéphane Champiat
- Gustave Roussy, Université Paris-Saclay, Département d'Innovation Thérapeutique et d'Essais Précoces, Villejuif, F-94805, France
| | - Sandrine Aspeslagh
- Gustave Roussy, Université Paris-Saclay, Département d'Innovation Thérapeutique et d'Essais Précoces, Villejuif, F-94805, France; Clinical Trials Conduct Unit, Jules Bordet Instituut, B-1000, Brussels, Belgium
| | - Julien Haroche
- Service de médecine interne 2, Groupe Hospitalier Pitié Salpêtrière, Assistance Publique Hôpitaux de Paris, F-75013, Paris, France
| | - Laurence Albiges
- Gustave Roussy, Université Paris-Saclay, Département d'oncologie médicale, F-94800, Villejuif, France
| | - Christophe Massard
- Gustave Roussy, Université Paris-Saclay, Département d'Innovation Thérapeutique et d'Essais Précoces, Villejuif, F-94805, France
| | - Nicolas Girard
- Université de Lyon, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Stéphane Dalle
- Service de dermatologie, Université de Lyon, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, 69495, Pierre Bénite, France
| | - Benjamin Besse
- Service de médecine interne 2, Groupe Hospitalier Pitié Salpêtrière, Assistance Publique Hôpitaux de Paris, F-75013, Paris, France
| | - Salim Laghouati
- Unité Fonctionnelle de Pharmacovigilance, Gustave Roussy, F-94800, Villejuif, France
| | - Jean-Charles Soria
- Gustave Roussy, Université Paris-Saclay, Département d'Innovation Thérapeutique et d'Essais Précoces, Villejuif, F-94805, France
| | - Christine Mateus
- Gustave Roussy, Université Paris-Saclay, Département de dermatologie, F-94800, Villejuif, France
| | - Caroline Robert
- Gustave Roussy, Université Paris-Saclay, Département de dermatologie, F-94800, Villejuif, France
| | - Emilie Lanoy
- Gustave Roussy, Université Paris-Saclay, Service de Biostatistique et d'Épidémiologie, F-94800, Villejuif, France
| | - Aurélien Marabelle
- Gustave Roussy, Université Paris-Saclay, Département d'Innovation Thérapeutique et d'Essais Précoces, Villejuif, F-94805, France; INSERM U1015, Gustave Roussy, F-94800, Villejuif, France
| | - Olivier Lambotte
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique, F-94275, Le Kremlin-Bicêtre, France; INSERM U1184, Immunology of Viral Infections and Autoimmune Diseases, F-94276, Le Kremlin-Bicêtre, France; Université Paris Sud, UMR 1184, F-94276, Le Kremlin-Bicêtre, France; CEA, DSV/iMETI, IDMIT, F-92265, Fontenay-aux-Roses, France.
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Collins M, Michot JM, Danlos FX, Mussini C, Soularue E, Mateus C, Loirat D, Buisson A, Rosa I, Lambotte O, Laghouati S, Chaput N, Coutzac C, Voisin AL, Soria JC, Marabelle A, Champiat S, Robert C, Carbonnel F. Inflammatory gastrointestinal diseases associated with PD-1 blockade antibodies. Ann Oncol 2017; 28:2860-2865. [PMID: 29045560 DOI: 10.1093/annonc/mdx403] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [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] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Immune check-point blockade agents have shown clinical activity in cancer patients but are associated with immune-related adverse events that could limit their development. The aim of this study was to describe the gastrointestinal immune-related adverse events (GI-irAE) in patients with cancer treated with anti-PD-1. METHODS this is a retrospective study of consecutive adult patients who had a suspected GI-irAE due to anti-PD-1 antibodies between 2013 and 2016. Patients were recruited through a pharmacovigilance registry. Patients' data were reviewed by a multidisciplinary committee that included gastroenterologists, oncologists and a pathologist. Quantitative variables are described by median (range), qualitative variable by frequency (percentage). RESULTS Forty-four patients were addressed to a Gastroenterology unit for a suspected GI-IrAE. Twenty patients had a confirmed GI-irAE related to anti-PD-1, which occurred 4.2 months (0.2; 22.1) after the initiation of anti-PD-1. GI-IrAE incidence rate under anti-PD-1 treatment was estimated to be 1.5%. Among patients with GI-IrAE, main symptoms were diarrhoea (n = 16, 80%), abdominal pain (n = 13, 65%), nausea and vomiting (n = 11, 55%), intestinal obstruction (n = 1, 5%), and haematochezia (n = 2, 10%). No patient had colectomy. Four distinct categories of GI-irAE were observed: acute colitis (n = 8, 40%), microscopic colitis (n = 7, 35%), upper gastrointestinal tract inflammation (n = 4, 20%) and pseudo-obstruction (n = 1, 5%). Response rates to corticosteroids were 87.5% (7/8) in acute colitis, 57% (4/7) in microscopic colitis and 75% (3/4) in upper gastrointestinal tract inflammation. Median time to resolution was 36 days (6-172) in acute colitis, and 98 days (42-226) in microscopic colitis. CONCLUSION This study suggests that GI-irAE are different and less frequent with anti PD-1 than with anti CTLA-4.
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Affiliation(s)
- M Collins
- Department of Gastroenterology, Kremlin Bicêtre Hospital, Assistance Publique-Hopitaux de Paris, Le Kremlin Bicêtre;; Paris Sud University, Le Kremlin Bicêtre
| | - J M Michot
- Drug Development Department, Gustave Roussy, Villejuif
| | - F X Danlos
- Drug Development Department, Gustave Roussy, Villejuif
| | - C Mussini
- Paris Sud University, Le Kremlin Bicêtre;; Department of Pathology, Kremlin Bicêtre Hospital, Assistance Publique-Hopitaux de Paris, Le Kremlin Bicêtre
| | - E Soularue
- Department of Gastroenterology, Kremlin Bicêtre Hospital, Assistance Publique-Hopitaux de Paris, Le Kremlin Bicêtre;; Paris Sud University, Le Kremlin Bicêtre
| | - C Mateus
- Dermatology Unit, Department of Medical Oncology, Gustave Roussy, Villejuif
| | - D Loirat
- Department of Oncology, Curie Oncologic Institute, Paris
| | - A Buisson
- Department of Gastroenterology, CHU Estaing, Clermont-Ferrand
| | - I Rosa
- Department of Gastroenterology, Centre Hospitalier Intercommunal de Créteil, Créteil
| | - O Lambotte
- Paris Sud University, Le Kremlin Bicêtre;; Department of Internal Medicine, Kremlin Bicêtre Hospital, Assistance Publique-Hopitaux de Paris, Le Kremlin Bicêtre;; CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, Paris;; Inserm, U1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Paris
| | - S Laghouati
- Pharmacovigilance Unit, Gustave Roussy, Paris Sud University, Villejuif
| | - N Chaput
- Paris Sud University, Le Kremlin Bicêtre;; Laboratory of Immunomonitoring in Oncology, and CNRS-UMS 3655 and INSERM-US23, Gustave Roussy Cancer Campus, Villejuif, France
| | - C Coutzac
- Paris Sud University, Le Kremlin Bicêtre;; Laboratory of Immunomonitoring in Oncology, and CNRS-UMS 3655 and INSERM-US23, Gustave Roussy Cancer Campus, Villejuif, France
| | - A L Voisin
- Pharmacovigilance Unit, Gustave Roussy, Paris Sud University, Villejuif
| | - J C Soria
- Drug Development Department, Gustave Roussy, Villejuif
| | - A Marabelle
- Drug Development Department, Gustave Roussy, Villejuif
| | - S Champiat
- Drug Development Department, Gustave Roussy, Villejuif
| | - C Robert
- Dermatology Unit, Department of Medical Oncology, Gustave Roussy, Villejuif
| | - F Carbonnel
- Department of Gastroenterology, Kremlin Bicêtre Hospital, Assistance Publique-Hopitaux de Paris, Le Kremlin Bicêtre;; Paris Sud University, Le Kremlin Bicêtre;.
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Le Burel S, Champiat S, Mateus C, Marabelle A, Michot JM, Robert C, Belkhir R, Soria JC, Laghouati S, Voisin AL, Fain O, Mékinian A, Coutte L, Szwebel TA, Dunogeant L, Lioger B, Luxembourger C, Mariette X, Lambotte O. Prevalence of immune-related systemic adverse events in patients treated with anti-Programmed cell Death 1/anti-Programmed cell Death-Ligand 1 agents: A single-centre pharmacovigilance database analysis. Eur J Cancer 2017. [PMID: 28646772 DOI: 10.1016/j.ejca.2017.05.032] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [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: 12/12/2022]
Abstract
AIM The growing use of immune checkpoint inhibitors (ICIs) is associated with the occurrence of immune-related adverse events (irAEs). Few data are published on systemic, immunohaematological and rheumatic irAEs. In a pharmacovigilance database analysis, we screened for these irAEs and calculated their prevalence. PATIENTS AND METHODS Participants were recruited via Registre des Effets Indésirables Sévères des Anticorps Monoclonaux Immunomodulateurs en Cancérologie (REISAMIC)1 a French registry of grade ≥2 irAEs occurring in ICI-treated patients. The pathologies of interest were systemic autoimmune and inflammatory diseases, rheumatic diseases and immune cytopenia. RESULTS Out of 908 patients treated with anti-Programmed cell Death 1 (PD1)/anti-Programmed cell Death-Ligand 1 (PD-L1) agents (together with an anti-cytotoxic T-lymphocyte antigen-4 (CTLA-4) agent in 40 cases) between December 2012 and December 2016 at a single centre, 21 patients experienced systemic irAEs. The types and the prevalence of irAEs were as follows: immune thrombocytopenia (0.2%), Sjögren syndrome (0.3%), rheumatoid arthritis (0.2%), polymyalgia rheumatica (0.2%), psoriatic arthritis (0.2%), seronegative polyarthritis (0.7%) and sarcoidosis (0.2%). Patients with Sjögren syndrome or seronegative polyarthritis were more likely to have received combination therapy with ipilimumab (2.5% for both). We described these 21 cases, together with nine additional cases from five other centres. Most irAE were moderately severe (grade 2, 63%). The median time to onset was 57°days (interquartile range (IQR) 24-117). The ICI was withdrawn in 12 cases, 25 patients (83%) received corticosteroids, and five patients (17%) received immunosuppressant/immunomodulatory agents. The irAEs resolved fully or partially in 28 cases (93%). CONCLUSION Although systemic, immunohaematological and rheumatic diseases are rarely associated with ICI use, the prevalence is higher when two ICIs are combined. Corticosteroids are often effective and may enable the continued administration of ICIs. Studies designed to identify at-risk patients are warranted.
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Affiliation(s)
- Sébastien Le Burel
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique, F-94275 Le Kremlin-Bicêtre, France
| | - Stéphane Champiat
- Département D'Innovation Thérapeutique et des Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, F-94805 Villejuif, France; INSERM U981, F-94805 Villejuif, France
| | - Christine Mateus
- Département de Dermatologie, Institut Gustave Roussy, F-94805 Villejuif, France
| | - Aurélien Marabelle
- Département D'Innovation Thérapeutique et des Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, F-94805 Villejuif, France; INSERM U981, F-94805 Villejuif, France
| | - Jean-Marie Michot
- Département D'Innovation Thérapeutique et des Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, F-94805 Villejuif, France
| | - Caroline Robert
- Département de Dermatologie, Institut Gustave Roussy, F-94805 Villejuif, France
| | - Rakiba Belkhir
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Service de Rhumatologie, F-94275 Le Kremlin-Bicêtre, France
| | - Jean-Charles Soria
- Département D'Innovation Thérapeutique et des Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, F-94805 Villejuif, France; INSERM U981, F-94805 Villejuif, France
| | - Salim Laghouati
- Unité Fonctionnelle de Pharmacovigilance, Institut Gustave Roussy, F-94805 Villejuif, France
| | - Anne-Laure Voisin
- Unité Fonctionnelle de Pharmacovigilance, Institut Gustave Roussy, F-94805 Villejuif, France
| | - Olivier Fain
- Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Médecine Interne, DHU I2B, Université Paris 6, F-75012 Paris, France
| | - Arsène Mékinian
- Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Médecine Interne, DHU I2B, Université Paris 6, F-75012 Paris, France
| | - Laetitia Coutte
- Assistance Publique - Hôpitaux de Paris, Hôpital Cochin, Service de Médecine Interne, F-75014 Paris, France
| | - Tali-Anne Szwebel
- Assistance Publique - Hôpitaux de Paris, Hôpital Cochin, Service de Médecine Interne, F-75014 Paris, France
| | - Laetitia Dunogeant
- Center Hospitalier Du Pays D'Aix, Service de Rhumatologie et Médecine Interne, F-13616 Aix en Provence, France
| | - Bertrand Lioger
- CHRU de Tours, Hôpital Bretonneau, Service de Médecine Interne, F-37044 Tours, France
| | - Cécile Luxembourger
- CHU de Toulouse, Hôpital Pierre-Paul Ricquet, Center de Rhumatologie, F-31059 Toulouse, France
| | - Xavier Mariette
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Service de Rhumatologie, F-94275 Le Kremlin-Bicêtre, France; INSERM, U1184, Immunology of Viral Infections and Autoimmune Diseases, F-94276 Le Kremlin-Bicêtre, France; Université Paris Sud, UMR 1184, F-94276 Le Kremlin-Bicêtre, France
| | - Olivier Lambotte
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique, F-94275 Le Kremlin-Bicêtre, France; INSERM, U1184, Immunology of Viral Infections and Autoimmune Diseases, F-94276 Le Kremlin-Bicêtre, France; Université Paris Sud, UMR 1184, F-94276 Le Kremlin-Bicêtre, France; CEA, DSV/iMETI, IDMIT, F-92265 Fontenay-aux-Roses, France.
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